American Medicine’s Meagerness Paradox

American Medicine’s Meagerness Paradox – The Health Care Blog

Beautifully written piece by Mark-David Munk about the contradiction between the vast amounts of money that enters the healthcare system and the day to day, on the ground, reality of patient care in important settings.

Here, regulatory agencies have made themselves both expensive and indispensable. The American Board of Internal Medicine brought in $90 million in fees in 2023 (and there are 23 other specialty boards). The Joint Commission pulled in $208 million last year. Press Ganey, which owns a large part of the mandatory patient survey business, reportedly had revenues in the hundreds of millions of dollars (before they stopped reporting revenue figures after being bought by private equity). The medical journal business is especially galling: doctors write, edit, and review articles for free, yet those journals are locked behind paywalls. Elsevier’s parent company, with over 2,500 journals, generated £3.06 billion in revenue in 2023 with a 38% profit margin.

Good luck saying no to all this. We’re stuck. Doctors have no choice but to be board certified. Hospitals must be surveyed. Expensive licenses and permits are non-negotiable. We pay what they ask, with increases year after year. On these cocooned organizations, we impose few demands, few hard bargains and few consequences for poor value. In my early years in medicine it felt like there was at least a veneer of plentitude. These days, I look at our worn clinic and our patients who respond with dignity as I explain that their insurer has rejected their fifteen-dollar pain medication prescription, again.