Doctors without competition

When you take away the profit motive, you don't get altruism, you get non-monetary self-interested incentives.  Unfortunately, there's no reason to suppose that the alternative incentives lead to improvement in performance.  The point isn't profit or non-profit, it's whether customers have choices.

From a doctor's OpEd in the WSJ today:
In my experience, the best thing that a patient in the VA system could hope for was that the services he needed were unavailable.  When that is the case, the VA outsources their care to doctors in the community, where their problems are promptly addressed.  But these patients still need to return to the VA system for other services and get back on a long waiting list.


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4 comments:

  1. DL Sly12:53 PM

    That's very true. MH has been able to go out of system for many things here due to our remote location, but my father would have to drive 2 hrs or more to get to his VA appt's in Portland. As it is, it still takes weeks just to get in to see his regular doc for anything, but my Pop would not be able to get appointments for months at the much larger Portland VA facility.
    We finally had to go out of system for a stomach aneurism because the VA was waiting for it get "get bigger" before it could be deemed necessary to treat. His aneurism grew from less than 2 cm to over 5 in a span of two months. At 6 cm they usually burst - which would have caused incredible pain in his back for about two minutes before he bled out internally and died. But the VA was determined to wait until it reached 6 then they'd get him back in. See above for schedule times for him.
    I could go on and on and on and on....

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  2. douglas11:37 PM

    " The point isn't profit or non-profit, it's whether customers have choices."

    Yes- this is the key issue in the discussions of the virtues of the free market that you and Grim have been having around here- The market allows for two parties to engage in negotiation with both having leverage in that negotiation- power is shared (or at least the opportunity to share it exists- if opportunity was good enough for our founders...). Unlike other systems which always end up in a hierarchical arrangement where one is dependent on another with no real recourse should goodwill not be forthcoming, and situations like that, human nature being what it is, always devolve into corruption.

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  3. Texan991:23 AM

    "Key issue" is a nice way of saying "Tex99's consuming preoccupation." It's really at the center of how I look at the civilized compact. Lately I find it hard to talk about much else.

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  4. douglas4:09 AM

    I've noticed...

    ;)

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