Health care consolidation definitely has some non-regulation-driven advantages, both for providers and patients. I say this as a longtime member of Kaiser Permanente, perhaps the most consolidated private health care organization in the US. I originally got it because my then-employer offered a financial incentive to choose it rather than a more traditional PPO/HMO; I am now an individual customer.
Some nice things about Kaiser:
-- Well integrated electronic medical records easily accessible to patients.
-- Ease of getting *someone* knowledgeable to help address your health concerns, anytime, anywhere, especially by phone or video visit.
-- Consistency in quality of care. You're not going to get superstardom, but there is a solid minimum level of competence you can rely on.
-- Providers can work normal-person hours and take vacations, because there is always a deep bench of substitutes. This seems to make them pretty happy.
I have tried a couple of concierge wellness providers who purport to offer advanced insights into what I can do to increase my healthspan, and they haven't given me anything significantly beyond what I can get through Kaiser.
On the downside, there is sometimes frustrating impersonality and bureaucratic hoop-jumping, and you get handed off to substitutes more often than you would elsewhere. And people who have more unusual or "exotic" health needs sometimes say Kaiser is not great for those because it is optimized for the relatively easy cases (though fwiw, the one time my family had an issue beyond their capabilities, they referred us out to a reasonably good contracted specialist). But it's a well-designed system overall and there is comfort in that good design.
My dad, a retired doctor, whose economic views are rather to the left of mine, likes to say that Kaiser ought to be the basis for a single-payer US health care system. I would say instead that the ability of such an organization to thrive in the private market undermines the case for single-payer.
> No country we know of switched to a fiat standard following an open public discussion of its benefits and costs. p. 194
This is a straw man, isn't it? Has any country that anyone knows of switched to any currency standard following an open public discussion of its benefits and costs? That's not how any currency standards are established.
>Homework: use this model to explain the emergence of movements to deal with climate apocalypse or AI apocalypse.
Last one emerges as a result of the internet allowing a very niche type of nerdy autodidact to form a community. Since rationalists pride themselves in their rationality, techieness, high IQ, lack of traditional credentials and ability to identify long-run risks, fighting AI gives them a chance to both show off their strengths and protect themselves from a being they fear could replace them.
Ya but it's always good to read where people are coming from. Diversity of ideas thoughts, whether you agree or not, is ALL GOOD! Free speach must set president over stupid speach. No censorship please.
That sounds mostly right except I'd argue there are also many who aren't techie-nerdy who have similar fears. And maybe some fear others will be replaced. It would seem there is a strain of pessimism not unlike climate activist. Then there are people like Musk who don't seem at all described by either of us. Maybe the main driver is something else. (Do I get a FIT point for pointing out the weakness in my position?)
“But some of it comes indirectly from insurance companies, which were strengthened by the government in the misguided belief that more powerful insurance companies would drive down health care prices.”
Nobody responsible for giving insurance companies more power actually believed they would drive down healthcare prices. Many in the population were perhaps gullible enough to believe competitors seeking profits helps drive prices down, for even inelastic goods, like medicine. However, no one pushing it thought that, just like Reagan’s handlers knew trickle down economics was a scam. Every business student learns about inelastic demand curves in first year economics.
"If consolidation were purely efficiently-promoting, one would expect the ratio of administrators to physicians to decrease rather than increase."
I think your primary point still stands but it is worth noting that if "doctors" included people who are doing tasks that used to be more often done by doctors, that number would have grown far more than double. I would bet there are more nurses per doctor today and WAY more medical assistants and techs who do various tasks such as vitals and tests that can be easily viewed later by the doctor. And of course the relative and absolute numbers of NPs and PAs has exploded.
It also seems likely that most of these people not directly caring for patients have salaries much lower than doctors.
" I am not sure that the ladder works for me. I still prefer the FITs categories, which mostly involve addressing the strong points of an opposing view and acknowledging the weaknesses of one’s own position."
I am baffled by this comment. Corcoran roughly describes four types of people. FIT gives points for acts within one of those categories and more or less ignores behavior more likely in the other categories.
Kevin Corcoran vastly overestimates everyone but the zealots.
Ya...kinda over the top and very laughably simplistic. Was it satire I was reading?
Health care consolidation definitely has some non-regulation-driven advantages, both for providers and patients. I say this as a longtime member of Kaiser Permanente, perhaps the most consolidated private health care organization in the US. I originally got it because my then-employer offered a financial incentive to choose it rather than a more traditional PPO/HMO; I am now an individual customer.
Some nice things about Kaiser:
-- Well integrated electronic medical records easily accessible to patients.
-- Ease of getting *someone* knowledgeable to help address your health concerns, anytime, anywhere, especially by phone or video visit.
-- Consistency in quality of care. You're not going to get superstardom, but there is a solid minimum level of competence you can rely on.
-- Providers can work normal-person hours and take vacations, because there is always a deep bench of substitutes. This seems to make them pretty happy.
I have tried a couple of concierge wellness providers who purport to offer advanced insights into what I can do to increase my healthspan, and they haven't given me anything significantly beyond what I can get through Kaiser.
On the downside, there is sometimes frustrating impersonality and bureaucratic hoop-jumping, and you get handed off to substitutes more often than you would elsewhere. And people who have more unusual or "exotic" health needs sometimes say Kaiser is not great for those because it is optimized for the relatively easy cases (though fwiw, the one time my family had an issue beyond their capabilities, they referred us out to a reasonably good contracted specialist). But it's a well-designed system overall and there is comfort in that good design.
My dad, a retired doctor, whose economic views are rather to the left of mine, likes to say that Kaiser ought to be the basis for a single-payer US health care system. I would say instead that the ability of such an organization to thrive in the private market undermines the case for single-payer.
> No country we know of switched to a fiat standard following an open public discussion of its benefits and costs. p. 194
This is a straw man, isn't it? Has any country that anyone knows of switched to any currency standard following an open public discussion of its benefits and costs? That's not how any currency standards are established.
What are the FITs categories Kling is referencing?
See https://www.arnoldkling.com/blog/reflections-on-fits-so-far/
Thank you!
>Homework: use this model to explain the emergence of movements to deal with climate apocalypse or AI apocalypse.
Last one emerges as a result of the internet allowing a very niche type of nerdy autodidact to form a community. Since rationalists pride themselves in their rationality, techieness, high IQ, lack of traditional credentials and ability to identify long-run risks, fighting AI gives them a chance to both show off their strengths and protect themselves from a being they fear could replace them.
Ya but it's always good to read where people are coming from. Diversity of ideas thoughts, whether you agree or not, is ALL GOOD! Free speach must set president over stupid speach. No censorship please.
That sounds mostly right except I'd argue there are also many who aren't techie-nerdy who have similar fears. And maybe some fear others will be replaced. It would seem there is a strain of pessimism not unlike climate activist. Then there are people like Musk who don't seem at all described by either of us. Maybe the main driver is something else. (Do I get a FIT point for pointing out the weakness in my position?)
White: Presumably if a public open and informed discussion could have been held the government would have issued fiat currency in the first place. :)
“But some of it comes indirectly from insurance companies, which were strengthened by the government in the misguided belief that more powerful insurance companies would drive down health care prices.”
Nobody responsible for giving insurance companies more power actually believed they would drive down healthcare prices. Many in the population were perhaps gullible enough to believe competitors seeking profits helps drive prices down, for even inelastic goods, like medicine. However, no one pushing it thought that, just like Reagan’s handlers knew trickle down economics was a scam. Every business student learns about inelastic demand curves in first year economics.
"If consolidation were purely efficiently-promoting, one would expect the ratio of administrators to physicians to decrease rather than increase."
I think your primary point still stands but it is worth noting that if "doctors" included people who are doing tasks that used to be more often done by doctors, that number would have grown far more than double. I would bet there are more nurses per doctor today and WAY more medical assistants and techs who do various tasks such as vitals and tests that can be easily viewed later by the doctor. And of course the relative and absolute numbers of NPs and PAs has exploded.
It also seems likely that most of these people not directly caring for patients have salaries much lower than doctors.
" I am not sure that the ladder works for me. I still prefer the FITs categories, which mostly involve addressing the strong points of an opposing view and acknowledging the weaknesses of one’s own position."
I am baffled by this comment. Corcoran roughly describes four types of people. FIT gives points for acts within one of those categories and more or less ignores behavior more likely in the other categories.