Cost Disease In Medicine: The Practical Perspective

A short, concrete practical follow-up to the famous Cost Disease essay. Scott imagines 'Cheap-O Psychiatry': no office (Skype), no receptionist (Google Calendar), no billing (PayPal/crypto), brutally efficient 15-minute appointments plus a self-help resource library. The math: $200K salary at 6,000 appointments/year ≈ $35/appointment, vs. the $150 going rate. Then asks why nobody does this, speculating: doctor-entrepreneurs chase ultra-premium clinics; insurance squats the mid-market (copays undercut cash); insurance rules demand armies of administrators. Notes the Surgery Center of Oklahoma already does exactly this at ~1/5 the cost.

Quality 70 · Strong. Strong, mid-upper. A sharp, concrete, memorable illustration of how a free market could undercut medical cost disease (the Cheap-O thought experiment) plus a good structural 'why doesn't this exist' analysis, prescient re the direct-primary-care movement. Held mid-Strong as a brief and admittedly speculative follow-up ('I've never run a business'), well below the canonical Cost Disease essay.

Claude’s paradigm shift 48 · Moderate. Moderate (48). A vivid concrete model rather than a new idea — direct-pay/cash practices already existed (he cites the Surgery Center of Oklahoma); the freshness is the illustration and the cost-disease framing.

Real-world impact 2 · Minor. Minor (2). Connects to the real (and growing) direct-primary-care/cash-practice movement and is cited in cost-disease/healthcare discourse, but the movement isn't due to this post; within-discourse reach.