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Culture War Roundup for the week of May 15, 2023

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The defense in the article is

“There’s just more and more layers of stuff that hospitals and physicians’ offices—anyone in healthcare—is being asked to do. Documenting and meeting regulatory requirements—all of these have added to the demand,” Selberg told Healthline. “Has that demand actually gone into creating better outcomes…in less time and with lower costs? I think, as the blog described, the answer is no.”

It's hard to know whether this is accurate or not without finding a trustworthy expert. But if "administrative bloat" is where all the money is going, and if there is no good reason for it, this seems more like a symptom of the lack of competition, which is driven by a ton of factors (failures of governments to prevent monopolization, lack of transparent pricing, etc.).

I know you were explicitly asked "where is the money going", but I think it's worth being clear that "where the money is going" is not necessarily the area where Solutions need to be directed. Blaming "administrative bloat" is like blaming "corporate greed" when the paper mill dumps too much pollution in your river. One of the government's core jobs is keeping people's incentives aligned with being pro-social. Forcing hospitals to downsize or pay administrators less (or whatever) is treating a symptom of the overall screwed-upped-ness of legislation of the medical system.

No disageement with the administrative bloat vs corporate greed comparison, but he does outline an upstream policy driver pushing the bloat: an increasing regulatory load that needs more staff to push papers. No clue if that's right either.

Separately, one of the panelists did recommend strengthening hospital price transparency, but I kind of wonder if it would even be a problem if hospitals weren't de facto monopolies. It's not like we need to legislate normal businesses into telling you their services cost.