You can argue that hospitals and ERs in particular are not a good place for checkups, but discouraging them is likely to be more costly (in $ and human lives) than not.

It makes so much sense: If your father had to decide between a beer and you getting that wound checked, kids would die.

(For clarification, I'm all in for universal free healthcare, but comparisons need to be fair, and comparing the US to the nordics, is not fair)

What I DO know from working in insurance is that lifetime medical costs are concentrated in the last 2 years of life (I worked on credit card insurance and life insurance).

That's where you could make huge costs savings (but is an ethical landmine, not to mention economic interests)

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017....

https://www.nihcm.org/categories/publications/the-concentrat...

I presume you really mean 'residency slots' when you say doctors. In this case, the relevant administrative body is the ACGME... who sets the limits based on appropriations from Congress.

The trope of doctors restricting entry to enrich themselves does not explain reported physician shortages.

http://articles.baltimoresun.com/1994-06-14/news/1994165047_...

Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments occurred, also with work performed by licensed physicians.

Just that the bureaucracy has resulted in an industry that fails patients. Heart surgeons refuse difficult surgeries to juke the stats. Good for their mortality ratings (not that anybody could blame individuals doctors)[1], not so great for patients.

Even just the notion of specialties hurts the patient - it makes perfect sense that the deep knowledge involved means that an orthopedic doctor can't (and shouldn't!) treat issues that should be seen by a podiatrist. But at the end of the day, the patient is in chronic pain, and has such a low quality of life, that to them, the risks of street heroin are acceptable. This isn't a moral failing by the patient's, nor is it a lack of intelligence, this life being too much to bear otherwise, and if you've never considered suicide as an option, be grateful.

Dr. David Casarett's talk[2] takes a closer look at an alternate, but accepted medical practice, and gives some thoughts about how our medical bureaucrats have resulted in worse patient care.

[1] https://www.telegraph.co.uk/science/2016/06/03/one-in-three-... [2] https://www.ted.com/talks/david_casarett_a_doctor_s_case_for...

> Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments

The AMA has no role in licensing physicians, a task which is left to the states.

> Heart surgeons refuse difficult surgeries to juke[sic] the stats.

This is far more complicated than it seems. For example, consider that the sickest/most difficult patients are the most likely to die, irrespective of an intervention. At a certain point, the harm inherent to surgery outweighs any potential for benefit that the surgery might yield.

As a patient in that system (the NHS) I would prefer my surgeons not to make decisions based on trying to game the statistics. If I need heart surgery, I want whoever is competent and available. So if these stats block that, I'd rather we don't have the stats.

Frankly it's weird anyway because surgery is a team activity, not solo. Nothing serious is done by one bloke in a surgical gown, there's a team. I had a relatively minor operation and the named surgeon will have spent most of that operation _talking_ not operating. All the sewing and some of the cutting will be the nice younger doctors I met, a woman who'd been doing this a few years and was well on her way to being an actual surgeon, and a new bloke who seemed like he'd probably graduated just a couple of years ago. The old bloke with the paperwork saying he's allowed to cut people open is mostly there to watch over them both and step in if things go to shit. The woman is doing most of the work, showing the noob what she's doing and maybe overseeing while he stitches me back up at the end. There's some Eastern European doctor lady making sure I neither die nor wake up, and two or three nurses making sure everybody has what they need, and counting things to make sure nothing is left inside me that shouldn't be there. But if I'd died (very unlikely for minor surgery) it would count against my named surgeon and not the rest of the team.

The AMA even explains this process: https://www.ama-assn.org/education/obtaining-medical-license

For example, this guy was prescribing powerful meds with severe side effects.

http://www.chicagotribune.com/suburbs/daily-southtown/crime/...

But more to the point, almost everyone suffers harm because of the way our medical system is set up.

Maybe some ailments don't need 8 year degrees to cure. Just throwing out ideas here.

But anyhow, more transparency is almost always good. Particularly in the morass that is the American medical system. I keep wondering how ever let something so important get like this.

The knock-on effect of there being fewer machines built keeps the price high. The first photocopier (the Xerox 914) cost the equivalent of $220,000 in 1965, yet there are very few businesses without a copier today because the price is so reasonable (5% of the 914's cost), and they do much much more.

In healthcare you'd not only like to even out expenses over time, you'd also like to spread expenses over a group, else people with chronic conditions are still screwed.

https://www.kff.org/health-reform/fact-sheet/preventive-serv...

What you propose would work fine if humans were fully rational and not living paycheck to paycheck. Unfortunately that's not reality.

The law that got the nickname “Obamacare” is not the Accountable Care Act, it is the Patient Protection and Affordable Care Act.

That is, for any one particular patient who's found to have a disease down the road - say, cancer - it would have been cheaper for him if that problem had been found very early, so for his individual case the checkups and tests would have been a big savings.

But when you account for all the people that do not turn out to have the problem at all, and the cost of checkups and tests, and then especially the costs of the followups due to false positives that are a risk in every test, the overall cost of test and prevention is actually worse.

Firstly putting a bullet in the head of anyone with non trivial cancer would probably be a financial savings for the insurer but the real equation is the human/societal benefit of treatment vs costs to best make use of a finite resource.

A simple cost of treatment analysis even misses out on the income that a person would have earned had they not died and the money that could have been paid in taxes and used to fund more treatment.

Drilling down into just the cost of treatment your statement isn't even wrong its a category error like saying that adding 2 integers always yields a number greater than 42.

For any given test and set of circumstances under which it is administered there can be a cost benefit analysis.

Example if you spend a thousand dollars on each false positive result and save 10k for each and have a 1% false positive rate and test a million people with a 1 in a million true positive rate. You will find one true positive saving 10k unfortunately you will also find 10k false positives and waste 10 million dollars.

In actuality you wouldn't do this you would test people whose symptoms or circumstances suggest they are likely to have it.

It seems fantastic to suggest that preventative medicine is always financially negative when people who actually study health care say otherwise.

Mr. Gruber [yes, it's THAT Jonathan Gruber] found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care — in the form of doctors visits and drugs. ... As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.” [1]

You go on to state that the additional productivity of the person we saved also nets us additional savings. But the same article contradicts this notion as well:

The actual savings are also not as large as might at first seem. Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.

You go on to suggest that medical professionals would not be wasting money on doing too many tests: "For any given test and set of circumstances under which it is administered there can be a cost benefit analysis."

That seems logical, but it's not how the real world works. People get emotional about the potential risks, and demand the tests even when there's not a clear indication. You might remember the hubbub a couple of years ago when it was suggested, based on historical evidence, that regular mammograms should be delayed a few years later than was currently the practice. But women's health advocacy groups raised such a hue and cry that the actual medical guidelines were not changed to follow the evidence.

[1] https://www.nytimes.com/2007/08/08/business/08leonhardt.html

This may be true in terms of outcomes, but it turns out not to be true in terms of aggregate costs.

(If you encourage smoking and discourage screenings and preventive care, you'll probably do a lot to reduce aggregate health costs, but at the expense of outcomes; the efficiencies you really want are ones that reduce cost while preserving outocomes, or improve outcomes without increasing costs. When outcomes and costs are in tension, though, desirability can be more ambiguous.)

More importantly it leads to less people dying of preventable matters. What you seem to be implying is that its a net negative to which I say citation needed.

Doing that could also drive up the price of oil changes such that they're no longer affordable without the use of insurance. If you could get an oil change for $50, then most people could afford it by paying for it outright. If that oil change now costs $500, then most people would have to go through insurance, and get the "discounted" price of $100 (which either has to be paid if the deductible has not been met, or you end up paying 10 to 30% of it).

It also catches things that require long expensive treatment early enough for them to be treated, rather than treatment be pointless, and, even if attempted, of shorter duration (on average) than if the conditions were found earlier, which is why preventive care doesn't seem to reduce aggregate costs.

The best way to reduce aggregate healthcare costs, if you have no other priorities, is to just make people less likely to seek care. No care = no costs.

Goods and services are allocated by price or by time. Take out the price component and assume that people will go to doctor more often, obtaining an appointment will take longer. How do time and hassle required to see a doctor disincentivize well visits?