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Scientific Encounters
Between the government and private insurers, medical office personnel spend an inordinate amount of time processing bills. What is reimbursable, what is not? What type of documentation is required? What billing code should we use? How much can we charge? And that is one big reason the US spends so much on healthcare administration. Time is money.
Doctors typically get a cut of the profits and that provides incentives for expensive care and/or high premiums (in the case of HMOs). Add in the relative ease of gaming the billing system, and you've got a recipe for out-of-control healthcare spending. It doesn't matter if the medical bills are paid by Medicare or private insurers. If the system of payment can be gamed, it will be gamed.
Last post was about outpatient services, specifically how reimbursement rates and physician profit-sharing arrangements contribute to the cost of outpatient care in the US. This post will address the cost of pharmaceuticals…A recent JAMA study ( Papanicolas et al, 2018) found that annual per capita spending on pharmaceuticals in the US was $1443, compared to an average of $680 for ten other developed countries.
…Thus, if you want to understand why these procedures cost so much, follow the reimbursement rates. For instance, in 1997 Medicare raised reimbursement rates in certain parts of the country. On average, areas with a 2 percent increase in payment rates experienced a 3 percent increase in care provision. Physicians charge what they can, and then some.
Given that old people consume way more healthcare than anyone else, why do other rich countries spend so much less on healthcare than the US, when the US has comparatively fewer oldsters? Something is very wrong with this picture. What is all that money going? … A lot is paying for outpatient care and administration, which alone account for half of US healthcare expenditures
In other words, rats make choices based on what they want and what they consider possible. They imagine the future, weigh the relative merit of different actions, seek additional information if needed, choose what to do, and then act. They are agents with desires and goals.
There's something about psychologizing that's invalidating. As if psychology was the science of human error. But does it have to be so? Humans are pretty good at tracking reality, thanks to biases and heuristics that work well most of the time. Error can be an ally in the search for truth.
Point is, no one has an emotional reaction to inequality without a sense of what it speaks to. Inequality is a concept for God's sake. It's not at the same level of concreteness as, say, a snake slithering in the grass.
The above game is an example of what I call an "Act of God" study design, in which researchers (playing God) randomly dole out good and bad fortune to study participants, typically in the form of monetary payments.
Prone to anxiety? The machinery will tilt towards the threat potential in its representations, systematically reviewing the possibilities. Confident and optimistic? The machinery will tilt towards images of success and triumph, but not dwell on them because no preparation is required for what may come. We already know we can handle whatever is thrown our way, and it will be good.
On second thought, all research is desire-driven. Because behavior is necessarily goal-driven and you don't have goals without wanting something to happen and wanting is desire and doing science is a behavior. But some desires are more conducive to scientific progress than others. Like the desire for reality not to make fools of us.
That just about all personality traits show significant and substantial genetic influence is the stuff of college textbooks, e,g, Behavioral Genetics, now in its 7th edition.
...they describe cleaning chemicals as "unnecessary" and propose that microfiber cloths and water are "enough for most purposes". The lead author, Oistein Svanes, summed up the take-home message of the study: "in the long run cleaning chemicals very likely cause rather substantial damage to your lungs".
Of course, we must remain vigilant! But measured optimism is not the enemy.
It's not all that hard or time-consuming to check the actual study behind a headline. If the article doesn't provide a link to the academic paper being cited, judge the publication (shame on them!) and then Google Scholar the paper...
Tell subjects they scored in the bottom 20% on some performance measure and they'll feel rotten. Expose women to a 15-minute video of gorgeous models and their self-esteem will take a beating. So, sure, you can make experimental subjects feel bad by exposing them to certain conditions in a lab, but do those conditions prevail in everyday life?
Beliefs serve decision-making under conditions of uncertainty. Without uncertainty, we just act. I don't "believe" the ground will stop my foot when I walk....That's just the neural prediction and reward-seeking machinery running smoothly. It's when the machinery gets stuck that the brain shifts into belief mode to help break the logjam.
Jumping the groove from dopamine to self-efficacy: here we go!
But science is a way of thinking, not a body of knowledge. Science is a way to acquire knowledge. Science is about being ruthless with oneself and the evidence; proposing and testing hypotheses, over and over; being careful, tentative, incremental and alert to alternative explanations.
Want to convince someone the situation is urgent and immediate action is imperative? Well, you're not going to get very far by laying it on with a sledgehammer. This approach usually backfires by triggering resistance and motivating counterarguments.