Excellent analysis. I knew there's a glitch in the law because all these hospitals are spending a lot of money on new urgent cares out by us. It is good for the construction business but not for health care.
One hospital by us shut down their baby delivery but it was due to a bad reputation. Even medicaid patients would find rides 15 miles away to deliver their babies.
Finally Milton Friedman said Regulations are to keep new competitors out rather than protect consumers. This us a prime example.
It is such a terrible Rube Goldberg mess! We need immensely more thinking and posting like this. With the right incentives there could be so much creative destruction in medicine leading to so much more efficient, sensible, effective, prudent and gratifying care. We’ve got to find ways to unleash it!
And new physicians coming out of training with hundreds of thousands of dollars in debt are reluctant to take on more debt and the uncertain and likely lower reimbursement of a private practice. The rather attractive guaranteed salary, benefits, pensions and incentives sure are helpful when those loan repayments come due. Not to mention the relief that comes with having actual paid time off and not having to worry about the complexities of running a business and managing operations in this highly regulated environment with constantly changing payment structures, variables and risk.
I’ve been on both sides and would never go back to private practice. Plus my patients genuinely appreciate the integration of their care and the access to specialists and higher levels of care is better for them than for patients of our local concierge and direct primary care practices.
I do not understand the title of this essay. What bluff is being called?
The core question is whether access to healthcare resources is a right or a privilege. In the US it has become an assumed right in the last 6 decades, as federal programs ( Medicare and Medicaid est. 1965) were created. The inevitable consequence is the emergence of a single federal payment scheme, as private investment, rational price signals, and actual free market transactions are now irrelevant.
The economics of the current healthcare market are the death throes of a remnant of previous local markets. It is fighting over the last scraps of private funding.
Federal funding, initially generous, was the bait to lure an entire sector of the US economy into government control.
The cost of doing business is out of control. Just like because of property taxes, one never really pay off the house, you never pay off your exam tables or waiting room chairs. Tax this, tax that. And you still have not paid for license and DEA fees, paid employee salaries and those taxes, building and contents and malpractice insurance and utilities. The list goes on. And, the regulations even dictate what kind of trash can and eye wash station has to be used. The whole process is taxing….
I try to explain how the healthcare payment system works, though I might be oversimplifying it, by using this example: go to Walmart and the 72” flat screen tv that they charge $2500, you offer them $1800 but due to contractual terms, only pay them $1400. Try to walk out with it. Can you ? Easier to go through the buffet line of employment than eat what you kill. The system is anti-entrepreneurial. Some fail to understand that INCOME is what’s left after EXPENSES. Then, one can’t be given a pen or pad with a drug name because it will impact your prescribing practices…. Do they really think that goes into our decision making process when treating a patient? Wow, wow, wow.
Our whole health care model needs a revamp but there are too many forces against making health care both affordable and available. It's not just hospital lobbies, but insurance lobbies, and pharmaceutical lobbies as well. Mind you, I am not advocating a single-payer system - that would likely be even worse.
I am saddened and frustrated with the state of health care in this country. We could and should be doing better than the greed and money-driven systems that have taken over.
In addition, the Hospital Administrator makes millions, the practitioner is now the new Doc at a lower cost, the Doc gets to assume the liability of the hospital by signing for the practitioner, metrics for pay, CON, non-competes, I can keep going ……….. Medicine is whacked.
Our value system is to blame too. The one that can kick a ball between two posts from 50 yds out makes lots more than the one that can make a positive impact on your quality of life and life expectancy. The 60 yr old doctor in his 35 ft boat is making too much money but the athlete that arrived at the dock in his million dollar car to board the mega yacht, surrounded by the in crowd of the day is not. What does a CEO bring to the table to support his “ earnings “ ? Just a thought.
“…hospitals (or health systems) should be barred, or heavily restricted, from buying up independent medical practices and vertically integrating their services.” Sorry, too late as most independent physicians have had their practices bought up after Obama Care also called ironically The Affordable Care Act. “Indeed, since 2024, hospitals and corporate entities have owned nearly 60% of all medical practices, and over 80% of physicians were employed by them, up from 14% and 26% respectively since 2012.” Those statistics are in this report.
Excellent analysis. I knew there's a glitch in the law because all these hospitals are spending a lot of money on new urgent cares out by us. It is good for the construction business but not for health care.
One hospital by us shut down their baby delivery but it was due to a bad reputation. Even medicaid patients would find rides 15 miles away to deliver their babies.
Finally Milton Friedman said Regulations are to keep new competitors out rather than protect consumers. This us a prime example.
It is such a terrible Rube Goldberg mess! We need immensely more thinking and posting like this. With the right incentives there could be so much creative destruction in medicine leading to so much more efficient, sensible, effective, prudent and gratifying care. We’ve got to find ways to unleash it!
And new physicians coming out of training with hundreds of thousands of dollars in debt are reluctant to take on more debt and the uncertain and likely lower reimbursement of a private practice. The rather attractive guaranteed salary, benefits, pensions and incentives sure are helpful when those loan repayments come due. Not to mention the relief that comes with having actual paid time off and not having to worry about the complexities of running a business and managing operations in this highly regulated environment with constantly changing payment structures, variables and risk.
I’ve been on both sides and would never go back to private practice. Plus my patients genuinely appreciate the integration of their care and the access to specialists and higher levels of care is better for them than for patients of our local concierge and direct primary care practices.
Like the other post above -
PS I still love what I do
I do not understand the title of this essay. What bluff is being called?
The core question is whether access to healthcare resources is a right or a privilege. In the US it has become an assumed right in the last 6 decades, as federal programs ( Medicare and Medicaid est. 1965) were created. The inevitable consequence is the emergence of a single federal payment scheme, as private investment, rational price signals, and actual free market transactions are now irrelevant.
The economics of the current healthcare market are the death throes of a remnant of previous local markets. It is fighting over the last scraps of private funding.
Federal funding, initially generous, was the bait to lure an entire sector of the US economy into government control.
The cost of doing business is out of control. Just like because of property taxes, one never really pay off the house, you never pay off your exam tables or waiting room chairs. Tax this, tax that. And you still have not paid for license and DEA fees, paid employee salaries and those taxes, building and contents and malpractice insurance and utilities. The list goes on. And, the regulations even dictate what kind of trash can and eye wash station has to be used. The whole process is taxing….
I try to explain how the healthcare payment system works, though I might be oversimplifying it, by using this example: go to Walmart and the 72” flat screen tv that they charge $2500, you offer them $1800 but due to contractual terms, only pay them $1400. Try to walk out with it. Can you ? Easier to go through the buffet line of employment than eat what you kill. The system is anti-entrepreneurial. Some fail to understand that INCOME is what’s left after EXPENSES. Then, one can’t be given a pen or pad with a drug name because it will impact your prescribing practices…. Do they really think that goes into our decision making process when treating a patient? Wow, wow, wow.
The last one out turn the lights off.
P.S: I still love what I do.
Our whole health care model needs a revamp but there are too many forces against making health care both affordable and available. It's not just hospital lobbies, but insurance lobbies, and pharmaceutical lobbies as well. Mind you, I am not advocating a single-payer system - that would likely be even worse.
I am saddened and frustrated with the state of health care in this country. We could and should be doing better than the greed and money-driven systems that have taken over.
In addition, the Hospital Administrator makes millions, the practitioner is now the new Doc at a lower cost, the Doc gets to assume the liability of the hospital by signing for the practitioner, metrics for pay, CON, non-competes, I can keep going ……….. Medicine is whacked.
Our value system is to blame too. The one that can kick a ball between two posts from 50 yds out makes lots more than the one that can make a positive impact on your quality of life and life expectancy. The 60 yr old doctor in his 35 ft boat is making too much money but the athlete that arrived at the dock in his million dollar car to board the mega yacht, surrounded by the in crowd of the day is not. What does a CEO bring to the table to support his “ earnings “ ? Just a thought.
“…hospitals (or health systems) should be barred, or heavily restricted, from buying up independent medical practices and vertically integrating their services.” Sorry, too late as most independent physicians have had their practices bought up after Obama Care also called ironically The Affordable Care Act. “Indeed, since 2024, hospitals and corporate entities have owned nearly 60% of all medical practices, and over 80% of physicians were employed by them, up from 14% and 26% respectively since 2012.” Those statistics are in this report.