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Why mandate a single price? Don’t we want prices to be competitive? As a young doctor I may want to bill at a 10% discount?


Medicine is very much standardized, so you want to bill the same per procedure, but for complicated cases you want to allow upcharges.


So a fresh out of residency eye surgeon should get paid the same as a 20 year old doctor who has done 1,000s of the procedures?


The patient should pay the same, no matter who does it. Compensation of healthcare staff is an internal matter and frankly not relevant to the patient.

That's how it works in Germany.


So should every healthcare provider organization throughout the country be required to charge the same price for a given procedure? Many US doctors still run solo practices, so there is no real difference between the company and the "staff". It seems reasonable that doctors with more experience and better skills should charge higher fees.


It seems reasonable that doctors with more experience and better skills should charge higher fees.

That's entirely your opinion. A more experienced doctor shouldn't have problems finding cases that require advanced expertise.


I don't understand, are you being sarcastic? Which is preferable?


The preference would be a higher quality, by virtue of more experience, gets paid more.

Why would I be sarcastic?


To read your sarcasm I'd have to know whether you have in fact gotten surgery by a more experienced doctor. It just depends on so many things. First, you can't be a surgeon for that long, you start losing your "pulso" like stillness of hand at around 50. Then there's the vibe the old doctor and the young doctor give you.

You must use your judgment to interpret it, but let me tell you a trope: the old doctor, sure, he's done this thousands of times, so it's no big deal for him. But he might be complacent, and plus he's been a surgeon for decades, these guys get worshipped by the rest of the hospital, it typically gets to their head. He might have long ago lost sight of needing to help people who lost sight, if he's not a virtuous guy he'll hustle you, 100%. And if he fucks up? 1 divided by 2000 is what percentage error rate, .05%? Assuming it's never happened before.

Whereas the young doctor is probably hungry for his first paycheck after a decade of getting into debt and memorizing stuff, his big chance to stop getting hazed, this won't be his first time really, he'll want to do an amazing job. He has no track record so if he screws up, it won't be automatic to get a second chance, it's high stakes, and he'll have that error hanging over him. He might be nervous though, so you have to keep that in mind. But much better hands, and he'll actually perform the surgery according to the original definition of "perfection" : he'll carry it out all the way through. Won't skip steps to save himself a couple of minutes at the expense of weeks of pain. He doesn't yet know what parts of the surgery he can get away with not doing, he just does the whole thing.

On the other hand, if the old doctor is humble and the young doctor is arrogant, it could be the other way around. You need to judge the vibe.


So the choice would be between glaucoma surgery according to the standard of care - or glaucoma surgery according to the standard of care.

Now we are getting somewhere! What if all this "choice" did nothing to improve patient outcomes or public health but entirely served to get more money out of your pocket?


Are you saying outcomes aren’t influenced by the skill of the doctor?

Are the outcomes of CS folks impacted by their skill?




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