Medicine as Business

I have previously voiced my support for a Medicare for All national single payer system. I have many reasons for this but one is the slowing and perhaps even the reversal of the transition of the practice of medicine to the business of medicine. There are implications and costs to the privatization and conversion of healthcare to income producing equity.

While Medicare is still overpaying for many services and being defrauded or exploited by many providers, the centralized nature of the beast has enabled it to turn some of the screws to reverse those growing trends. The actual practice of medicine is generally limited to physicians, and other trained providers, but they are increasingly in the employ of for-profit entities.
A simple search for statistics on cost versus outcomes shows there is little correlation in many areas. This is not surprising given the sophistication of the local vendors of care in terms of their ability to focus on profit over outcome. For example, Medicare expenditures per person in the Fort Myers area are about half as those in the Miami area. In Minneapolis, they are a third of what they are in Miami.
That Florida regulations and enforcement are lax, and that it is heavily endowed with Medicare beneficiaries, is no secret. So it should not be surprising that Florida is a haven for exploitation of the system ranging from outright fraud and abuse, to “well run” (from a business perspective) medical practice and supporting industry. High cost comes in two flavors, Old school “medicine as business” was independent doctors doing unneeded procedures and small timers overcharging or submitting fraudulent claims. Bad medicine, bad practice. New school high costs are seen in those areas that have “evolved” in the “medicine as business” model, and it comes in many varieties. But the bottom line is current medical business models have learned how to extract megadollars from the system in many niche area. Sometimes “legally” and sometimes not. This is good business, bad medicine and patient outcomes are not even in the formula. Make no mistake. their methods will continue to spread, because the profits can be enormous. If you are in the business, there is likely already a conference telling you how to cash in for more bucks in your chosen niche. If you already have something working, a larger entity might be interested in acquiring it for their equity partners and leveraging it even further.
The ACA makes a few changes trying to realign incentives toward rewarded better patient outcomes, instead of provider income. Medicare for all would give them further power and leverage but we have a long way to go to change the culture.

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