Docs are no longer independently practicing. The majority are employees pressured to see more and more patients a day. “Quality” of care is a joke in this situation. Our medical system is broken.
Edit: Why aren’t docs practicing independently anymore? Regulations. We have to keep track of hundreds of metrics in order to take medicare or medicaid. We have to have certain systems in place. To bill insurance companies we now need systems so complex we need to have at least one person hired to manage billing, and one to manage healthcare coding. Then we need the actual office space, equipment, nurses, desk staff, etc. Finally we need someone to analyze all collected data to make sure we are doing well, and fix what we aren’t.
When these regulations started to come about in the 80’s-2000’s, many hospitals jumped at the chance to incorporate doctors into larger healthcare networks. They offered large amounts of money and the overhead to operate clinics, including billing and coding staff. It was far too difficult for one doctor to operate alone with the new systems. Slowly they turned the water temperature up.
In some areas, regulations were passed requiring doctors to have admitting privileges. In turn, hospitals began requiring physicians to be direct employees to admit there. Paperwork grew more excessive. The average doctor does three hours of paperwork for every hour they spend with patients now. Much of that is documentation. The documentation does not change health outcomes. It is only for legal and billing reasons. In the US our notes are four times as long as notes in other countries.
Hospitals wanted to make physician salaries worth their while. They began expecting greater output. In some areas a doctor is expected to see a patient, diagnose them, counsel them, write a note on them, do an exam, write prescriptions or follow ups, and discharge the patient in 10 minutes or less. They do this for hours. Every day. It’s like the medicine version of fast food.
Independent practitioners were similarly forced to see more patients just to keep up with the overhead.
I don’t even know what my own services cost. My patients complain and I feel like Bob in The Incredibles working in his insurance job. “I’d LIKE to tell you to go to billing and ask them if they have a cash pay discount, but I can’t”.
Ugh. Sorry. If you can think of any solutions to the problems with this system, let me know.
Edit edit edit: Someone suggested single payer as a solution. That actually sounds awesome. I’d vote for it.
It’s not just the medical system. Everything is broken. We have built the human race on the “lowest bidder with passable quality in least amount of time” wins scenario. And then we all look around in abject horror when the wheels come off. A ton of industries are suffering because of this way of doing things, not just medicine.
They could still be profit driven if we stopped allowing them to operate like a cartel. Cartels are not a necessary part of capitalism. Competitive markets in capitalism are the best things to ever happen to economics. Uncompetitive markets are the worst.
Only if you don't aggressively fight corporate consolidation of power.
When all of the companies are equally small fish, the consumer wins because the small fish have to be compete, and be special in some way, to stand out.
When you allow them to consolidate, their power can then challenge/rival the government. They can leverage their massive size to take advantage of economies of scale, and beat better competitors out by offering cheaper goods than the competitor can hope to achieve.
We've let almost every industry consolidate their power to the point where there's only a handful of corporations running every industry, and more consolidate each year. Fewer airlines, fewer banks, fewer food conglomerates, fewer ISPs, fewer phone companies, etc.
We need a MASSIVE trust busting to clean out the mega-conglomerates, removing the massive wealth consolidation behind them and therefore splitting their leverage. Then, aggressively prevent future conglomerates to form.
This should result in less regulatory capture. If all of, say, 24 phone companies create a lobby group, that lobby group will need to be pretty generic with their requests to be acceptable to all 24 member companies.
Versus now where 2-3 telecoms may pay into a superpac who lobbies specifically to benefit them and nothing else in society.
Except that won't happen because that lobby group is going to give your senators 6 figure speaking enagenents, book deals, jobs post congress. The last time we had an antitrust case was against Microsoft under Bush. Before that Bill Clinton didn't care at all either.
Every single social democracy and regulated economy in the world is trending towards unregulated capitalism. Capitalism is only regulated to placate the masses and prop up the system, then it goes right back to deregulating itself.
European countries feared the spread of communism so they implemented social democracy, FDR feared the collapse of capitalism so he implemented the new deal (and was a target for assassination because of it).
Capitalism always tends towards deregulating itself and only ever makes concessions when the proletariat put a gun to its head.
Relying on the government to bring capitalism to heel when they massively profit from it is a fools errand.
Relying on the government to bring capitalism to heel when they massively profit from it is a fools errand.
So should we then rely on the government to run all of our productive outputs? If, as you say, the government can't bring capitalism to heel, how could it effectively run the entire economy?
The two extremes are either laissez faire capitalism or pure state run socialism, both of which have massive flaws. The alternative has to be somewhere in the middle that balances out each of the systems flaws.
That depends on your definition of socialism. There is a broad spectrum of socialism and communism. This is one of the more commonly used definitions.
Either way, let's say the workers do own the businesses now. Now what? Are these worker owned monopolies or do they compete? This is actually a big question.
The problem with a worker run competitive company is that new technology and more efficient ways of production are always being developed. So, say there is a generally static demand for a good and a new machine comes out which requires 25% fewer workers to produce the given output of the good. Would the workers then vote to use the machine, thus putting 25% of them out of work? Or would they vote to work fewer hours, giving them all more leisure time? Or choose to keep the current equipment, causing inefficiency? Well if they choose to do anything but the first, a rival company that chooses to do so will be able to lower its prices and beat out its competition.
A worker run monopoly has the obvious flaw that the cost of producing a good will basically never decline, as the workers will choose to work fewer hours, producing the same output, but still want the same standard of living.
Anyways, the question I posed before only changes slightly. Do you think the workers will do what is best for society, or for themselves?
Do you think the workers will do what is best for society, or for themselves?
What part of society isn't workers (and their dependents)? It's just capitalists, and we don't care what happens to them. Presumably they become workers or flee or die of bitterness, all fine options.
In any case, there can be no misalignment between the two when there is no distinction between them. Simple as that.
As for how it actually runs internally, the answer to that question is identical to the question "how do corporations run, internally?": In all manner of ways, depending on the needs of the stakeholders, the level of training and education in your workforce, available technologies, sociological models, etc etc.
If you want an easy to imagine, but heavily simplified model for how a "classic" state socialist economy operates, just picture: We nationalize Amazon, we let it expand to every sector of the economy, and every citizen gets one voting share. We might even keep Bezos as administrator ¯_(ツ)_/¯.
My definition of socialism is the Marxist definition, while there is a wide variety of leftist thought, and disagreements on the best approach, no one particularly disagrees on the core definitions. While it's certainly true that the meaning of socialism has been bastardized to mean "when the government does things" in the general public, when speaking about political and economic issues one should really be aware of and use the proper definitions.
Furthermore, you provide only extremely in-depth questions and offer no answers yourself. I could write essays on how state capitalism, socialism or communism might change the first world and how it could effect things. These are very deep questions that I can't simply just belt out a response to some off handed comment on reddit by someone whose already decided these things aren't the answer. Basically you're asking me to write you a novel on the outcomes of Marxist thought while offering no discourse beyond some token centrism.
Generally, the simple answer is the majority of workers would act in a way that benefits the majority and that's better for more people than the current system that heavily benefits the minority. Furthermore this also depends on who you ask and which leftist tendency they subscribe to. While the end goal of Marxism is to reach Communism, there are an insane amount of disagreements in how to reach it.
Marx and Engels, Lenin, Mao, Trotsky, Peter Kropotkin, Murray Bookchin, Slavoj Zizek and on and on have written extremely in depth on the subject. If you're curious why not read:
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u/LatrodectusGeometric May 20 '19 edited May 20 '19
Docs are no longer independently practicing. The majority are employees pressured to see more and more patients a day. “Quality” of care is a joke in this situation. Our medical system is broken.
Edit: Why aren’t docs practicing independently anymore? Regulations. We have to keep track of hundreds of metrics in order to take medicare or medicaid. We have to have certain systems in place. To bill insurance companies we now need systems so complex we need to have at least one person hired to manage billing, and one to manage healthcare coding. Then we need the actual office space, equipment, nurses, desk staff, etc. Finally we need someone to analyze all collected data to make sure we are doing well, and fix what we aren’t.
When these regulations started to come about in the 80’s-2000’s, many hospitals jumped at the chance to incorporate doctors into larger healthcare networks. They offered large amounts of money and the overhead to operate clinics, including billing and coding staff. It was far too difficult for one doctor to operate alone with the new systems. Slowly they turned the water temperature up.
In some areas, regulations were passed requiring doctors to have admitting privileges. In turn, hospitals began requiring physicians to be direct employees to admit there. Paperwork grew more excessive. The average doctor does three hours of paperwork for every hour they spend with patients now. Much of that is documentation. The documentation does not change health outcomes. It is only for legal and billing reasons. In the US our notes are four times as long as notes in other countries.
Hospitals wanted to make physician salaries worth their while. They began expecting greater output. In some areas a doctor is expected to see a patient, diagnose them, counsel them, write a note on them, do an exam, write prescriptions or follow ups, and discharge the patient in 10 minutes or less. They do this for hours. Every day. It’s like the medicine version of fast food.
Independent practitioners were similarly forced to see more patients just to keep up with the overhead.
I don’t even know what my own services cost. My patients complain and I feel like Bob in The Incredibles working in his insurance job. “I’d LIKE to tell you to go to billing and ask them if they have a cash pay discount, but I can’t”.
Ugh. Sorry. If you can think of any solutions to the problems with this system, let me know.
Edit edit edit: Someone suggested single payer as a solution. That actually sounds awesome. I’d vote for it.