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Comment by valleyer | Hacker News Reader

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.)

Unfortunately, some doctors are willing to take advantage of this.

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> The more treatments a doctor gives, the more they get paid

You could say this 30 years ago, but it's not really the case today. The majority of physicians are now salaried, not independent. And even for many of the ones in independent private practice, the amount they make is not necessarily tied anymore to the services they provide, due to the rise of capitation and other forms of bundled service agreements.

Nowadays, it's actually statistically more likely that you receive care from a doctor who has an explicit incentive to undertreat, because they receive a fixed amount of money per patient per year, and the costs of treatment come out of pocket directly with no additional reimbursement.

This is the basis of all Medicare Advantage Plans, where the physician or their employer gets X$ a month per MAP patient and must pay for most of the cost of care. The insurance company gets to keep most of its share of what Medicare pays. Nice profit ensues for the insurance company.

Insurance companies that sell Medicare Advantage plans end up keeping only a tiny fraction of what they're paid, hardly "most". This is a low-margin, high-volume business. You can find the details in their published financial reports.

I would love to see some data on this, if anyone knows of any. I'll just provide anecdata that of the doctors among my friends and family, more of them get paid by "wRVU" [0], which is basically a derivative of "how much treatment you give", than by salary.

(I only happen to know this because they complain nearly incessantly about the wRVU system! I make no claim to be an expert on the topic.)

[0] https://www.physiciansthrive.com/physician-compensation/wrvu...

It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.

I always preferred "The cure is worse than the disease." for a metaphor describing US healthcare billing.

Nobody actually wants to control costs. From doctors to hospitals to insurance companies, everyone but consumers benefit from high prices.

Employers and other group buyers want to control costs.

They are consumers

Employers are customers, not consumers. That word has a specific meaning in the industry and you are using it incorrectly.

Corporate entities consume administrative hours, paperwork, procedures, etc... of the healthcare system, which have many interested parties that benefit from that, they are consumers in a broader sense.

You're really missing the point. The word "consumer" has a specific meaning in the health insurance industry, which is what this article covers. What you're describing is irrelevant and off topic.

How is that 'off-topic'? That is the point of the parent, that many, including employers, corporate entities, etc., benefit from increasing consumption of the healthcare system.

Those are not consumers.

Did you misread my comment? Corporate entities certainly consume non-zero amounts of resources. They are definitely consumers in an economic sense. That applies for all sectors of the economy, not just healthcare.

Actually if you think about it insurance is forced investment in a fund where the amount they make is driven as much by the amount they can get you to pay in as much as efficiency. It is only beneficial not to be so obviously egregious that nobody will touch you in an environment full of people who are tacitly collaborating to increase prices so that the pie gets bigger for everyone.

Everyone is actually collaborating against you which is why in the US we only provide free health care for a small fraction of the populace but still manage to pay for THOSE folks as much as some other developed nations pay to cover their entire population.

And why this has not been prosecuted as giant racketeering operation is beyond me.

This has gradually changed with the emergence of "value-based healthcare", which is what we should be solving for (and building the right incentive structures for)

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