The same perverse incentives have permeated into healthcare, which is no longer about owning the patient's health journey, vs administrators handling contracts, billing , benefits, claims, and shifting responsibility elsewhere
What was first - barriers to entry, or administrative inertia?
Im not sure whos right, but im sure between thw two of them, they are making entire industries extremely inefficient.
In fact, we go the opposite direction, telling literally every student in high school that they will be throwing their life away if they choose to work after graduation, and that vocational training is for an underclass. Only university will do, we say.
Which is why you have graduates who majored in art because they like manga, or in ethnic/gender studies because identity politics sounds exciting to a teenager. All this is actually fine if you are doing it with an understanding that it’s about becoming more cultured and learned, and that it has nothing to do with career training. But people seem to think there are white-collar jobs waiting for them because of these degrees they’re borrowing to pay for, and then they’re very shocked and have no other plan to support themselves. The millennial generation, I think, is the first to be tricked into this fate en masse, and gen-z even more so.
It’s like 2 whole generations were lied to that the full implications of the decline of manufacturing and professional retail jobs that happened 1970-1990 are “only white-collar careers will exist” rather than the more correct “skilled trades and professional services are better bets than simply looking for a factory or clerk job at 18 and working your way up.”
Talk about zagging when everyone is zigging.
The problem is your share of health dollars going to administrators, which is bundled with the barriers to entry into healthcare and into insurance.
Its very hard to be a doctor that doesnt take insurance, so administrators come to rule the roost. If there was truly a free market, yiud see a material share of doctors working outside the insurance system. Yet no such niche really exists.
I would guess that most of their patients are quite well off, given that they have the cash available to pay out of pocket. That probably eliminates quite a lot of issues for the practice, as that would tend to select for reasonably educated and high-functioning patients. They also don't have to deal with insurance companies or collections.
I do see this to a huge extent in the area of mental health in the wealthy area that I live in.
Many of the best doctors have no need for insurance- rich people will gladly pay $300 an hour or more for a good therapist so why bother with the insulting $60 reimbursement that a doctor will get after doing a lot of paperwork with an insurance company.
I am not sure that this means anything whatsoever about a free market or not - and not all kinds of doctors are doing this, but it’s happening. And it really sucks to be paying the huge insurance premiums I’m paying, and still have the best doctors all out of reach unless I’m willing to shell out MORE money out of pocket.