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Culture War Roundup for the week of December 9, 2024

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-Okay how much of healthcare spending is doctor’s salaries?

About 8%. If you cut physician salaries by half you get 4% savings. That’s not a little but it is also not a lot.

This seems like a super-important number. I'd like to see the rest of healthcare broken out this way. Who, ultimately, are the people getting paid? Health insurance has a profit margin of 3.4%. So, stylizing a little, if I put $1 into the healthcare system, I have:

  • $0.08 goes to doctors via salary and benefits
  • $0.03 goes to teachers, engineers, and other retail investors via dividends
  • Remaining $0.89 goes to [???]

All the breakdowns I see look at institutions; but institutions are just placeholders. When we say "Drug Companies" got paid $1M, is that $800k in researcher salaries, $100k in admin, and $100k in marketer salaries? Or is that $500k in corporate dividends, $100k in researcher salaries, and $400k in marketer salaries?

The difference matters a lot, since - like you're saying - cutting healthcare means that someone is going to stop getting paid for work they're currently doing. And who it is / how much they're getting paid now matters a lot.

I've never seen it broken out in a way that granular but I expect a bunch of it would be line items like "secretary to assistant infection control nurse" and you'd be like "who the fuck is that and what do they do" to which my response would be "well I don't know who that person is, but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault) because the government doesn't like when we have those.

The sheer number of admin and regulatory compliance people who don't really do anything has massively ballooned.

It's very much like universities.

"well I don't know who that person is, but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault)

"this is the person who goes around committing what amounts to fraud because we don't want to get caught having caused an infection" (which is totally our fault, they got it while they were in our care). What do you think this sort of a thing sounds like to other people?

I mean it's nuts and physicians hate it.

They do generally have paper thin justifications to avoid it being outright fraud but it is stupid and everyone outside of administration acknowledges that.

It's also a classic "juke the stats" type government/regulation outcome.

but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault) because the government doesn't like when we have those.

First thought: How is this a thing?

Second thought: Oh yeah, economics. Of course this is a thing.

Third thought: Can we shoot these people instead?

Fourth thought: It totally was somebody’s fault. I realize that meticulous clinical hygiene is hard. People will still die if you screw it up.

OH LET ME TELL YOU ABOUT WELLNESS MODULES.

Problem: Our resident physicians keep killing themselves.

Solution: Make them come in at 6am on their day off to spend 2 hours filling out un-skippable e-learning trainings reminding them that they should sleep. The person who worked a 24 hour shift over night and is being prevented from going home starts screaming incoherently. Then the hospital hires a "chief wellness officer" at executive pay scale who comes up with more wellness modules. If you are lucky they throw the residents a pizza party while they are working and the nurses eat their pizza.

Sorry one of the other comments made me think about wellness modules.