The AMA is a tax-exempt hedge fund and licensing corporation

https://www.epsilontheory.com/ama-bitfd/

by erentz • 6 years ago

277 115 6 years ago

epsilontheory.com

erentz• 6 years ago

Note original title “AMA? BITFD!” is vague so chose another line from the article that better describes it.

wbenhunt2• 6 years ago

Thank you!

yostrovs• 6 years ago

Author forgot to note that the AMA is also a political advocacy organization that seems to speak on behalf of some insider committee of the AMA, rather than the supposed members of the organization. It seems to have strong political opinions that arise out of ether.

JumpCrisscross3• 6 years ago

author forgot to note that the AMA is also a political advocacy organization that seems to speak on behalf of some insider committee of the AMA

That would make the post look like infighting.

By focussing on dereliction of fiduciary duty, possibly to an unlawful extent, the argument is rendered sharper.

wbenhunt2• 6 years ago

YES

hpoe• 6 years ago

To me this seems to highlight the worry about "fake news" and "credible sources". To me it seems less like the quality of journalism and reporting has gone down hill and more like because we have so many new independent sources of news and information we are starting to realize that the originally "trusted" organizations were not as objective and honest as we originally thought.

Ultimately the problem is that it isn't that we have illegitimate news flooding the market of information it's that we are finally starting to realize almost all of our information was biased to one degree or another and we are slow to adjust the way we consume information.

JumpCrisscross3• 6 years ago

the originally "trusted" organizations were not as objective and honest as we originally thought

Has AMA been plumped up by mainstream journalists? I can’t recall them being quoted as an authority.

ponker• 6 years ago

The AMA decides who gets to call themselves a doctor. Can’t imagine a more pivotal arbiter of trust.

TuringNYC• 6 years ago

Conveniently ignoring -- for decades -- major questions about national healthcare (e.g., who creates the artificial scarcity in medical specialists) is essentially fostering the status quo.

I'm happy with the AMA being the authority on medical news, but that does not mean their business practices should be beyond scrutiny.

eightysixfour• 6 years ago

Ultimately the problem is that it isn't that we have illegitimate news flooding the market of information it's that we are finally starting to realize almost all of our information was biased to one degree or another and we are slow to adjust the way we consume information.

Why not both...?

isn't that we have illegitimate news flooding the market of information

This is absolutely a problem. Old media seems to be pretty content with narrative framing for the most part, this new brand of illegitimate media just makes shit up. They have no intent to engage in the public discourse, their only purpose is to reinforce alternate realities and to shift the Overton window.

pessimizer2• 6 years ago

Old media also sometimes just makes things up, but usually they uncritically pass on things that anonymous administration officials and intelligence agencies just make up. The real way to distinguish mainstream news outlets from less mainstream news outlets is that mainstream outlets have cultivated relationships with administration and intelligence officials, relationships that are maintained by those outlets' willingness to publish whatever those officials want to publicize.

It's almost the only criterion. "Mainstream" outlets will have a lot of inside information that will later turn out to be true, but will also constantly publish completely false stories on the behalf of government officials "leaking" as part of their jobs, and conceal their origin.

JumpCrisscross3• 6 years ago

If you are an Illinois-based AMA member, consider calling your Attorney General’s Charitable Trust Bureau to make a complaint citing this article [1].

AMA is registered in Illinois; your voice will be louder. As a paying member, you have standing to show harm.

[1] https://ag.state.il.us/charities/rules_statutes.html

vmception2• 6 years ago

As someone forming a private foundation, this is very inspirational, thank you!

Albeit under 501(c)3 and not 501(c)6 like this organization.

ghaff3• 6 years ago

The two categories are pretty different. A 501(c)6 exists for the benefit of its members. That doesn't mean it's bad or can't have a positive mission but it's a trade association at the end of the day. A 501(c)3, as you know, at least ostensibly has some sort of charitable/educational/etc. mission.

vmception2• 6 years ago

I'm aware, and I take issue with the "this is bad because I have an uncomfortable relationship with money" approach that the article took.

The point of the author's digital sleuthing was not for inspiration, it was to find fault to reinforce a conclusion they had already made. I doubt there was any transparent and accurate reporting that would have satisfied their idea of acceptable.

The primary difference with the 501(c)3 is that 5% of the assets has to be granted per year. It would for the most part have the exact same flexibility as this organization.

gen220• 6 years ago

The AMA was the first group to lobby against publicly-funded healthcare (1930s-40s).

See here [1] for some examples of cartoons they commissioned, playing to base emotions to sink the healthcare components of Truman's Fair Deal.

There's not a lot of content on wikipedia about the details of the opposition, but here's the summary of the context of the pre-WWII years [2].

Then after WWII, Truman proposed revisiting this problem. There's a really good account of what followed here [3].

Essentially, the AMA engaged in a mass-marketing scheme to paint universal healthcare as part of a communist agenda and therefore un-American.

This advertising, coupled with the ironically-government-induced rise of employer-subsidized insurance, decimated what had been broad public support for universal healthcare.

So, yeah. There's a pretty proximate alternate history where we've had universal healthcare since 1947. It'd be interesting to see what that world looks like today.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935669/

[2] https://en.wikipedia.org/wiki/History_of_health_care_reform_...

[3] https://www.pbs.org/newshour/health/november-19-1945-harry-t...

tgbugs• 6 years ago

Don't forget that CPT is also a massive money maker and completely proprietary. Want to do open research to improve patient care and health and use CPT codes? Probably not going to happen [1].

1. https://www.ama-assn.org/practice-management/cpt/ama-cpt-lic...

ericd• 6 years ago

Yeah, this was a big stumbling block for a project we wanted to work on. So completely bizarre that you essentially need to pay a toll to them to do public projects with medical billing data that uses standard codes. One of the more egregious examples of rent seeking I’ve seen recently.

tehlike• 6 years ago

Another one is cusips in a similar fashion. Cusips are unique identifiers that identify a security. They are also proprietary with fairly expensive pricing for startups.

maxwell• 6 years ago

The AMA killed the single payer option in the ACA under Obama, and they'll do their damndest to keep it dead under Biden:

https://www.nytimes.com/2009/06/11/us/politics/11health.html

https://www.modernhealthcare.com/physicians/ama-maintains-it...

lumost• 6 years ago

Single payer makes US healthcare a monopsony, a market with only one buyer. All sellers/providers inherently hate that as the single buyer can check each companies margin, and dictate a lower price in the future.

baryphonic2• 6 years ago

The problem with monopsony in theory is that it reduces the actual wage below the market-clearing wage, which results in a lower quantity of labor supplied. A better arrangement in such cases is usually a bilateral monopoly (think of how sports leagues negotiate with players' unions), which results in wages and labor supplied much closer to market clearing amounts (again, in theory).

In many ways, the US already has a soft form of monopsony, given the total dominance of CMMS in determining everything from reimbursements to billing codes to proper medical procedures. We shouldn't be surprised by the already significant shortages within US medical professions given this situation. CMMS regulation has also resulted in large hospital groups absorbing private practices such that most physicians now work for some large hospital group, and most of the rest work for larger companies focused on one or a few specialities.

mindslight2• 6 years ago

Anecdotally my ophthalmologist has told me that they would actually prefer single payer, as it would make their finances more predictable for investing in new equipment. My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me.

lekanwang2• 6 years ago

The AMA chooses who can be a doctor, who can train doctors, who can practice any kind of medicine, has extremely strong pricing power over the entire healthcare system via the RUC (https://en.wikipedia.org/wiki/Specialty_Society_Relative_Val...), advocates on behalf of doctors whether or not you agree, and much more, all under a guise of "non-profit advocacy for public health." They are a racket -- we would do well to have a rogue upstart competing licensing body.

goatinaboat3• 6 years ago

They are a racket -- we would do well to have a rogue upstart competing licensing body.

And programmers think that they are too intelligent and have too much variation in productivity to form any sort of professional organisation, or “union”, you could call it.

Doctors don’t worry about ageism or offshoring or being stabbed in the back by their peers or managers.

H8crilA3• 6 years ago

Unions work, there's no question in my mind about that. Just look at macroeconomic stats from the 40s to 70s. All that inflation took pretty much all the wealth from capital owners and handed it over to workers.

However, most software people are clearly in the capital owners category (despite still having salaries), so maybe it is justified to keep the status quo.

ketzo• 6 years ago

Offshoring maybe, but I think pretty much anyone in a corporatized career worries about those others. I know for certain that doctors have no shortage of office politics.

chimeracoder2• 6 years ago

The AMA chooses who can be a doctor, who can train doctors, who can practice any kind of medicine

The majority of doctors are not AMA members. The oft-cited claim that they choose who can be a doctor or how many people get to be doctors is also a myth.

There are a lot of criticisms of the AMA, but these two are not really factual in basis.

pc867• 6 years ago

You're correct that they do not choose who can be a doctor.

You're incorrect in that they are the primary force and loudest voice restricting the number of residency slots in the US. You cannot practice medicine without matching into a residency program, whether you have an MD/DO or not.

orthopodvt• 6 years ago

Most of what is stated is simply not true. I am a physician, not a member of the AMA. They have absolutely no role in the selection of medical students, training of physicians, or their licensing. I have no particular love for the AMA. But lets keep the criticisms accurate.

EvanAnderson2• 6 years ago

The AMA lobbied in the 90s to limit federally funded residency slots. This served to restrict supply of doctors because medical schools base acceptance on available residency slots. The AMA has pushed for more funding of residency slots in more recent times, but their lobbying behavior in the 90s clearly shows they have an interest in controlling the supply of doctors.

devenson• 6 years ago

I believe the AMA is responsible for accreditation of medical schools. Without accreditation, they can't make doctors, thus the AMA controls the supply of doctors.

Shivetya• 6 years ago

The ABA pretty much does the same for their profession and I would not double many of such organizations is the same. Why dock just one, we need to get them all.

GavinMcG• 6 years ago

The ABA does not do anywhere near as good a job of protecting their market. There are far more law school slots each year, and that's reflected in salaries for lawyers, a huge portion of which are well under $100k/year.

AtlasBarfed• 6 years ago

There are four pigs at the trough of US healthcare:

1) drug/device companies 2) insurance companies 3) trial lawyers 4) doctors

When asked what's wrong, they point at one of the other three.

The AMA is guild that makes sure doctors stay rich, valued, and semi-scarce.

terr-dav• 6 years ago

What about for profit hospitals?

It’s the marketization of health care that incentivizes suffering and death, not any particular group.

triceratops• 6 years ago

Ok so 5 pigs at the trough.

kgwgk• 6 years ago

For-profit hospitals are not that important (~20% of the hospital system). Edit: But if lawyers can make it to that list hospitals can as well (including not-for-profit hospitals paying huge salaries, just because they are not “for profit” it doesn’t mean they are not profit-driven).

pessimizer2• 6 years ago

Non-profit hospitals are responsible for the bulk of health care costs, they just extract the profits in salaries.

BurningFrog• 6 years ago

    "The American Medical Association is perhaps the strongest trade union in the United States."

        --- Milton Friedman

From https://www.fff.org/explore-freedom/article/freedom-daily-cl...

JMTQp8lwXL• 6 years ago

You'd think Hospitals would want to strip the AMA of its power in order to lower worker wages. Health care wages are unusually high in America, though that's true of other fields as well. Compared to technology, however, the regulatory environment is mostly the same: yet SWE's in America are paid a premium (even without a group formalizing 'who' can be a SWE).

nickff• 6 years ago

Industry-wide unions like the AMA, UAW, and Longshoremen help to maintain a tacit price-fixing (as everyone is subject to the same price floor on their major expense), which can be very convenient for large, established players.

Areibman• 6 years ago

When we ask ourselves why healthcare is so expensive in the US, we never seem to point out that it's the health care that's so expensive. As many others have already said, the AMA puts an artificial cap on the number of medical school graduates each year at around 20,000.

Anecdotally, I know several bright minds who either pursued a DO or dropped out of medicine entirely because they couldn't pass the med schools' opaque admissions procedures. I'm cynical, but there's something disturbing about the fact that GPs and family doctors have to invest so much time and undertake so much debt just to become professional symptom Googlers.

I'm glad this article has the chutzpah to call the AMA what it really is-- a protectionist guild. These doctors make me sick.

hhs• 6 years ago

According to the AAMC, it seems like residency slots have also been an issue: https://www.aamc.org/news-insights/medical-school-enrollment...

mimikatz• 6 years ago

Do all doctors need residency or is it another barrier to having enough cheap doctors?

eej71• 6 years ago

Is it the AMA that puts that cap on? I was always under the impression that was really a consequence of the 1997 Balanced Budget Act (?).

EvanAnderson2• 6 years ago

The AMA lobbied for that cap.

https://usatoday30.usatoday.com/news/health/2005-03-02-docto...

wutbrodo12• 6 years ago

I have a lot of doctors in my family, and while it's not surprising that they've fully swallowed the bizarre fetishization of doctors we have in this country[0], it's really shocking to me the degree to which almost _everyone_ I know has, including those with no ties to the medical field whatsoever.

To be extremely clear, I don't think there's anything wrong with appreciating doctors for the hard work they do, nor the special feelings that people have historically always had towards healers[1]. If someone said they respected a person more for choosing medicine as a career, I can't say I'd disagree. But for some reason, most people seem to model doctors as incorruptible angels, incapable of making decisions that are suboptimal for others or for society. This makes it uniquely difficult to have a conversation about the problems of the devilishly complex healthcare system, since it's impossible to talk about one of the most important groups of stakeholders and their role in healthcare economics.

I remember talking to my sister shortly after her med school graduation about a topic that involved influences , and she said with a straight face "doctors don't do things that aren't in the patient's best interest". My (Ivy-League educated, MD-holding) sister isn't the sharpest tool in the shed, but even for her, the idea that an entire industry full of people are immune to incentives is an especially pants-on-head stupid model of the world. She's since unlearned much of the creepy indoctrination that med school drilled into her (and that her much-smarter doctor husband was never fully taken by), but the same messages have trickled down to many of the friends and family I have that are unconnected with the medical field, without any of the ego-protective incentives that my doctor acquaintances have.

[0] And most countries; if anything, it's way worse in the other countries I'm familiar with, as the US tends to be (on average) more dynamic and less worshiping of formal credentials than the average country

[1] Though I do think it's irrational; I distinctly remember my mom trying to communicate this feeling to me when trying to get me to be a doctor, and my high-decoupling teenage self telling her that she should also be appreciating the engineers whose work powers the hospital and the economists whose work was critical to building the hospital and paying doctor's salaries.

bsanr2• 6 years ago

Ask marginalized people - generally a subset of, but not limited to, people subject to generational poverty, people with prominent genetic ancestry in the Global South, LGBT/queer folk (especially the T), and those with visible, chronic physical (weight, height, mobility, etc.) or mental (developmental disorders, mental illness, etc.) "deviances" - and you'll learn just how effective and esteemed doctors really are. (Of course, people generally don't ask us, so...)

While I imagine that some people have already had a certain particular rage switch thrown in their brain wrt the preceding list, stay with me here. We're not just talking about intersectional pile-ups; go ask your fat friend about his last check-up.

nostrademons2• 6 years ago

the idea that an entire industry full of people are immune to incentives is an especially pants-on-head stupid model of the world

This is true of nearly every industry, though. Our real estate agent (who was otherwise pretty good) insisted that he was a fiduciary to us and would seek the best financial deal for us, but his advice on our bid was "I don't think that'll be enough to get the job done", and then we were the high bid. I'm a Google engineer, and from my perception, my job is to give people free services that they want, despite HN's perception of my employer. Investors will say that they "get paid for allocating capital and making the economy more efficient", lawyers are here to "help people enforce the rights granted to them by law", salesmen "make people aware of products that they really want to buy anyway", etc.

Of possible interest:

https://slatestarcodex.com/2017/10/02/different-worlds/

People's perceptions really do differ, and people see through their values and emotions. When people hold a self-perception of what they do that is wildly at odds with what you think they do, it's often because folks who actively believe they are doing bad for the world are often so bitter that nobody wants to be around them.

programmertote• 6 years ago

Thanks for sharing this! I went to med school for two years in my home country, married to a doctor who is in her residency training in the US and couldn't agree more.

If you look at my HN comment history, you'll see that I've tried to mention that part of the problem of exorbitant healthcare expenses in the US is the artificial scarcity of doctors. It starts with this inflated/unnecessary requirement to have a bachelor's degree before going to med school. Other nations in the world (e.g., India) do fine with training their doctors for five years (even that, I think is too much; the first year of med school training in my country is pretty much an extended high school curriculum not essential to medicine).

An internal medicine (generalist) doctor in the US can earn $250K right after finishing the residency. Elsewhere in the world (e.g., in the UK), the doctors earn about $90-150K.

I also have to agree with you that contrary to the popular belief in the US, doctors can be fairly un-intellectual. The main requirement to do well in their career is to rely on rote memorization (go check out on YouTube how Anki is so important/popular among med school people).

anonymouse008• 6 years ago

"Physicians are just human mechanics" - a disgruntled PhD

jbob2000• 6 years ago

This reminds me of a debate I had in high school, where the topic was (and I quote verbatim) "A country that does not provide universal healthcare to its residents is evil".

I was assigned the side that argued that it's not evil. The problem our opponents had was that they could not could not argue for a definition of evil that was strict enough to capture universal healthcare but not so strict that a doctor who makes a mistake and kills someone is also evil.

tobmlt• 6 years ago

Well said. If anyone would care to read further on the history from a similar point of view:

https://mises.org/library/100-years-medical-robbery

phaedrus4414• 6 years ago

The biggest issue isn't domestic medical school slots, it's a lack of residency training slots (for which federal funding was capped in 1996). If more residency slots were available with adequate funding, these positions could easily be filled with foreign medical graduates that have passed the US's medical boards (USMLE steps 1 & 2, with 3 taken during or after intern year).

killjoywashere2• 6 years ago

There were more US residency spots (23,339) than US allopathic medical school graduates (17,789) in 2016. https://pubmed.ncbi.nlm.nih.gov/28919221/

pc867• 6 years ago

I know several bright minds who either pursued a DO or dropped out of medicine entirely because they couldn't pass the med schools' opaque admissions procedures.

I... what? A DO is a doctor, full stop. Aside from there being different organizations, there is no difference between what an MD can do and a DO. In fact, a DO is trained in OMM while an MD is not. DOs have more training than MDs, not less. A lot (I think most, but I'm not 100% sure) of residency programs are combined and will accept either credentials. Many are still DO-only.

Med schools conferring a DO degree have identical admissions processes to those conferring MDs. It may be unintentional but the wording of the quoted phrase makes it seem like if you can't get into an MD program you will either go "down" and apply to a DO program, or not go into medicine.

there's something disturbing about the fact that GPs and family doctors have to invest so much time and undertake so much debt just to become professional symptom Googlers

I'm not defending the ludicrous price of medical school (which is due in large part to the AMA's physician cap that you mentioned), but even mediocre GPs are much more than "professional symptom Googlers."

jjav2• 6 years ago

it's the health care that's so expensive

Doctors earn well but not particularly different from FAANG-style software salaries.

I don't know how good these numbers are but here's some: https://blog.nomadhealth.com/complete-list-of-average-doctor...

For example emergency medicine doctor is listed at 366K average (~$162/hr). So when I've had to go to the emergency room and end up seeing the doctor for about 20 minutes, that's about $54 worth of doctor-time (as an order-of-magnitude approximation, ignoring fully-loaded employee costs since I don't have that number).

And yet the bill that arrives is on the order of ~$6000. Sure there's also nurse salary to pay for my visit and other legitimate overhead that's part of the actual "care".

So from that bill I got, over $5000 are inefficiencies and non-care-providing rentiers inflating the cost. Nearly all the bill goes to entities other than the actual medical care providers! So no, it's the the actual doctor+nurse salaries that makes the USA health care so exceptionally expensive.

nn3• 6 years ago

For the emergency room bills most of it is paying for other people who didn't pay. It's kind of socialized medicine.

MagnumOpus• 6 years ago

Doctors earn well but not particularly different from FAANG-style software salaries.

Yes, but ALL doctors earn that much ALL the time, whereas the FAANG salaries you read are the lucky/skilled top 5% of the industry and only during a once-in-a-generation share price boom where stock grants exceed salaries.

And yes, doctor/nurse salaries are a big part of US healthcare excess cost (as is over-prescription, obesity,insurance profits, insurance admin overhead)

ixacto• 6 years ago

It is more a billing negotiation tactic between your health insurance company and the medical facility that you are seeing.

The insurance company negotiates the bill to a rate of $x for in network $y for out of network. So no they are not expecting you to pay that $6000.

I got a bill from my therapist for $430 for a 30min appointment, insurance paid $186 with zero copay, it just had to go through the magical cost-reducing power of an insurance company.

This system is wierd.

vernie• 6 years ago

Don't forget this gem: https://en.wikipedia.org/wiki/Ronald_Reagan_Speaks_Out_Again...

analogwzrd• 6 years ago

Russ Roberts did a good interview on EconTalk with Christy Ford Chapin, who wrote a book about the history of health insurance in the US and pointed several fingers at the AMA for preventing any progress or innovation in the healthcare industry.

https://www.econtalk.org/christy-ford-chapin-on-the-evolutio...

tropdrop• 6 years ago

The AMA has a Chief Strategy Officer who was paid $1,130,000 in 2018.
The AMA has a Chief Operating Officer who was paid $1,350,000 in 2018.
The AMA has a Chief Financial Officer who was paid … huh? … only $730,000 in 2018. Wow, that’s weird. I mean, she’s the only woman in the C-suite, but I’m sure that has nothing to do with it. I think we all know that being a CFO is nowhere near as rigorous or demanding a job as being a ((checks notes)) Chief Strategy Officer...
That’s Jim Madara... telling us that the core challenge for the medical profession in general and the AMA in particular will be finding ways to address health inequity – the disparate healthcare outcomes for Americans stemming from food and housing insecurity, limited access to transportation, and above all, income inequality.

A great demonstration of what "diversity," "the triple bottom line," "social responsibility" and "addressing income inequality" really looks like at the corporate level.

duffpkg• 6 years ago

... I wrote Hacking Healthcare, created ClearHealth & HealthCloud, many other credentials...

I have negotiated with the AMA in several arenas. If they had anymore lawyers in a single place it would create a black hole.

Everything in healthcare anything (procedure, test, sponge, scalpel, etc) that gets billed or reported to the federal government, that is roughly ~2.7 Trillion worth of transactions a year, roughly 160 billion line items, requires a CPT code (current procedure terminology). The federal government legally requires this. CPT is owned and licensed by the AMA, they spend incredible lobbying dollars to maintain that the CPT codes are used and required by the federal government. It is legally impossible to create an alternative. It is complete regulatory capture. That CPT revenue was 160 million a year as of 2018. A pure tax on healthcare, sadly one among many. Also a reason truly fully open source systems are impossible in healthcare.

jl27182• 6 years ago

You need to pay somebody to use a lookup table? I just realized I forgot to pay my language license to Webster’s. If they haven’t licensed the human anatomical nomenclature and all known DNA sequences yet, they are missing out.

haltingproblem• 6 years ago

Similarly the American Heart Association is a licensing and fundraising organization which rakes in around $750 million in revenues and gave out $150 in grants. The rest of the program spend of $595 million which was $445 million (!!) goes on salaries and fund raising. The AHA has around 4,000 employees. They have an endowment of $1.2B. [1]

Amongst the most dubious of AHA recommendations are dietary sodium around 1.5-2.5g/day [2] which flouts established research which shows all-cause mortality doubling from 4-6 g/day to 1.5-2.5g/day to those who do not have salt specific hypertension. But they dgaf as their primary focus is not the heart and cardiovascular health of Americans but licensing the "Good Heart" license to cereal companies so they can use it to sell more obesity causing products like Honey Nut Cheerios.

[1] https://paddockpost.com/2016/02/09/where-does-1-to-the-ameri...

[2] https://www.heart.org/en/health-topics/high-blood-pressure/c...

[3] https://www.nejm.org/doi/full/10.1056/nejmoa1311889

javajosh• 6 years ago

One thing they could fund with all that money is an independent, regularly televised frank discussion between patients, doctors, and administrators about their issues with the healthcare system, and each other, from a moral and ethical perspective. It seems to me that if you want to represent some sort of "halo of authority" then you better earn it by hosting some frank and real dialectic!

jl27182• 6 years ago

The doctor-centric medical system is rapidly becoming technologically obsolete. It’s now cheaper to get an MRI with radiology report than a primary care office visit. Lab tests for most common ailments are less than gas to get to the hospital (GSA schedule pricing). Doctors don’t have any more information than the diagnostics tell them. Office visits are a functionally useless exercise. Innovations in private elective procedures have dramatically reduced costs and increased safety compared to procedures controlled by hospitals and paid by insurance. The government pays for drug development and then the FDA grants monopolies charging several orders of magnitude markups and giving kickbacks for prescriptions. Although there is little technological need for most doctors, the administrative demand is greater than any other industry, but don’t expect many H1Bs granted for physicians. Limiting access to the profession through high standards is actually great for innovation, if innovation is allowed, but protecting obsolete functions is probably bad for everybody.

I’d like to do some angel funding of new concepts in private consumer healthcare that go around the system. Medical hacker stuff. For instance, you can buy an imaging ultrasound system from China for roughly the cost of a single ultrasound appointment. I think micro-MRI is achievable under $10k, mostly a problem of data analysis. X-rays of course could be very cheap if people could be trusted not to abuse them. DIY blood and urine testing could be nearly free. I don’t want to sound like Elizabeth Holmes here; I’m mostly talking about known existing simple procedures with huge unnecessary overheads, replaced by DIY, community, or AI business models that are aligned with users.

derbOac• 6 years ago

The worst problem with the AMA is that it's worked to completely distort our expectations about what is possible in a healthcare system. A lot of the comments here are focused on artificial restrictions in supply of physicians and so forth, which are important issues, but the more insidious problem is the way in which licensing and practice laws distort alternative structurings of healthcare delivery.

As you point out, healthcare should be more consumer-driven, with providers acting more as consultants, akin to how tax accountants and lawyers work. The problem isn't necessarily that we need more physicians, it's that we need consumers to get more of their healthcare directly, and/or through alternate providers like pharmacists, psychologists, dentists, optometrists, or some other classes of providers we haven't even dreamed up yet because the healthcare system is so centralized and rigid.

The discussion of healthcare in the US has focused so much on who pays, with such little attention to how the care is structured, when it seems to me that's a much bigger problem. To me the payment issue is almost an entirely different issue.

I have lots of family in healthcare, including physicians in administration, and they're terrified of single-payer not because they don't want universal care, but because they already see the healthcare system overburdened by regulation and red tape, and don't really see how having single payer (as opposed to something like the ACA) will really help a lot. In their minds the only thing worse than what existed 10 years ago, is what existed 10 years ago plus a monolithic government agency controlling payment as well.

I see an important role for physicians, but there needs to be a lot more flexibility and deregulation in healthcare. There's so much that could be written about this it's absurd.

wutbrodo12• 6 years ago

I’d like to do some angel funding of new concepts in private consumer healthcare that go around the system. Medical hacker stuff. For instance, you can buy an imaging ultrasound system from China for roughly the cost of a single ultrasound appointment. I think micro-MRI is achievable under $10k, mostly a problem of data analysis. X-rays of course could be very cheap if people could be trusted not to abuse them. DIY blood and urine testing could be nearly free.

The challenge here isn't technological. As you point out, there are a lot of things you could do, but I'm not confident that the relevant lobbying groups won't just pay off the government to ban whatever it is you want to do.

Corruption is more or less open the minute it gets too complex for the average person to understand, and healthcare regulation falls squarely into this bucket. Name some protectionist, anti-patient, cost-increasing move the "Patient Protection Act" and half the idiot voters out there will support it. Specifically, the half of the country reflexively inclined to support any positive-sounding regulation instead of those reflexively inclined to oppose it (most voters' brains consist almost entirely of these "reflexes")

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