Wednesday, February 10, 2010

Medical Monopolists

I had no idea that hospitals, i.e. Big Medicine, had codified into law their monopoly position.

Read John Stossel on the ridiculous CON law.

Wall Street may indeed be full of scumbag crooks, BUT, there are at least plenty of fringe voices there calling out for more competition, more transparency, and less plunder.

However, the next time I hear a doctor say *healthcare needs more competition*, well....that'll be the first!


Anonymous said...

medicine and financial services are two fields that allows you to let your greed run amok without any guilt.

doctor reasons every additional test he prescribes with perfect "just to be on safe side" reason.

a banker reasons all the work he does as "doing gods work" , without him it would'nt be possible for poor people to get credit ?

I guess in financial services some people quickly realize they were fraud. In medicine, there is perfect explanation(excuse?) for every fraud. "we are serving humans" yeah right.

CaptiousNut said...

Plus, doctors are imbued with the sense that they are the brightest people on earth. They got straight A's and the system has them *certified* as authorities.

Medical schools are closed shops as well. They hide their protectionist monopoly behind *standards* - and they get tax-payer subsidies to boot!

Anonymous said...

straight As? if you have $10,000 dollars you can complete entire 5 year medical degree (after high school) in Russia or Nepal or even India(has more internal competition) - even if you have worst grades.

All of them in english and the degree is recognized here in the US to boot. You just directly join Residency in US (you do need to complete USMLE requirements - just like american med grads).

a doc is a doc (does @ivy-league or not), though work experience/reputation does matter.

neil said...

C-nut, found the brightest people in the world line ironic based on the title of your blog and its tone ;)

You're notion that more competition will lower costs is based on the false presumption that the way hospitals and physicians are paid is based on a rational system. There is no encouragement for providing better care at a lower cost. The fee for service model that Medicare and most of the private insurers use to pay for medical services encourage more tests, procedures, etc. This can be seen in what happened in Mcallen, TX ( . So more hospitals just mean more places that would be encouraged to order more tests and procedures-based on fee for service.

Patients have no concept what anything in healthcare costs, except for their co-pay. If you surveyed patients at my hospital they would have no idea that their insurance is paying a lower amount at my hospital than they would be if the patient was at the one on the other side of town. They also wouldn't that our measures of quality of care are similar to that hospital.

As for Anon's contempt towards unneeded tests-I share it. Esp to those who benefit from it. I do my best to only order tests that my patients need, based on their history, and practice guidelines(and as an internist I don't financially benefit from additional tests). Those who do tests and procedures strictly for their own financial gain instead of patient need deserve our anger and spite. That person is putting their own need ahead of their patient's-I'm pretty sure that wasn't the point of the Hippocratic Oath

CaptiousNut said...


Well, I'm obviously against the *system* even more so than I am against the *CON law*. I hope that is clear - if not in this post, but throughout my blog.

I fully understand that restricting the number of hospitals out there is hardly THE PROBLEM with today's cost/availability issues.

I just highlighted it because it's a flagrantly anti-competitive law, and because I'd never before heard of it.

Anon 7:46,

Russia, India, and Nepal???

I'm not talking about cab driver school!

Mark said...

I second Neil's thoughts... right on
However there is a real concern for defensive medicine.... tests that are ordered looking for the 1 in 10k or 100k rare event
It pains me when I have to order expensive tests to "rule out" the rare event
It's a waste of resources
Because if they have it, I'm screwed medicolegally
I cannot agree with anon #1 comment
I do think the vast majority of docs are not looking to pad their pockets...
true some are but they are very clearly the exception
Anon #2 Nepal and Russia med grads in the US originally from the US? Come on, where are these "bought" medical training. We do have foreign medical grads picking up training slots... the vast majority in primary care where low reimbursements and respect have discouraged US grads from going into..
but that's another topic for another day

CaptiousNut said...

In defense of Anon 7:46,

I do recall some 15 years ago a guy I knew who, after being rejected from all the med schools....

He was trying to get into one in Guatemala that he asserted would be *accepted* here.

Though that never happened. He ended up a quack podiatrist!