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Why Medical Bills Are Killing Us (2013) [pdf]

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Re: Why Medical Bills Are Killing Us (2013) [pdf]

#81
post #68

I came across this last night and stayed up too late reading it. It's a fascinating exposé of where at least a good part of the money is going -- the extra money that we Americans spend on health care that doesn't bring us any better outcomes. I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy ad…

A great book on this is Healing America by T.R. Reid, who saw doctors in eight countries about his bum shoulder and wrote about their healthcare systems. Interestingly, single-payer isn't the only good option, or even necessarily the best. Canada was the only country with single-payer like we talk about in the U.S. The U.K. is single-payer but also single-provider, the doctors work for the government-run healthcare s…

I've never been to a doctor in Germany that doesn't have office staff (though I suspect that it would be possible). You still need someone to deal with incoming calls, organizing the file cabinet and looking through the insurance rule changes of the week. Usually this is done by people who do limited medical work on patients as well (think nurse). Having one employee per doctor is not uncommon.

Doctors only send their bills once every three months and payment takes a while after that - a week would be a dream. Insurance can deny payment if they determine it wasn't medically necessary (and they do checks if they find a trend) but that comes out of the doctor's pocket. And for expensive things (like psychotherapy or dental) it needs to be preapproved by the insurance but they are are very limited in what they can deny.

And good digital health records? I don't think I will live long enough to see that in Germany. The only thing that leaves your doctor's office digitally (within they are free to work with paper or computer or whatever they wish) are the procedure and a short code for the diagnosis. If you need to see a specialist, paper still gets send around.

Edit: I just read the Germany chapter of that book. While it contains some (not really significant) errors and is a bit outdated (now six years old) I would still recommend that book based on this chapter.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#83

Earlier quoted context omitted.

Can you get a private MRI without a doctor's requisition in Australia? I know in Canada they try to burn you at the stake if you do that.

Why would one get a private MRI without doctor's orders?

Because you don't have claustrophobia and you're interested in what the MRI might show.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#85

Earlier quoted context omitted.

Single payer works well in many places other than the US. People on private insurance plans in the US die or suffer while waiting for care their plans allegedly offer, while executives of those private insurance companies get "lavish bonuses".

The US is the wrong level of government for a healthcare system. If a place like California wanted to offer free healthcare to its residents, that's fine, but the federal government should only be responsible for war, negotiating trade deals, handling immigration, and other external issues. Keep in mind that "many other places" are smaller than a single US state.

Consider that Californian's pay about $290 Billion to the Feds and the state collects about $70 billion. Do other small countries pay most of their taxes to a larger central organization? Much of that Federal money gets shunted to other states.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#86
post #68

I came across this last night and stayed up too late reading it. It's a fascinating exposé of where at least a good part of the money is going -- the extra money that we Americans spend on health care that doesn't bring us any better outcomes. I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy ad…

A great book on this is Healing America by T.R. Reid, who saw doctors in eight countries about his bum shoulder and wrote about their healthcare systems. Interestingly, single-payer isn't the only good option, or even necessarily the best. Canada was the only country with single-payer like we talk about in the U.S. The U.K. is single-payer but also single-provider, the doctors work for the government-run healthcare s…

> Japan implements their mandate in an interesting way: you're free to not pay, but if you go to the doctor and you want it covered, you have to pay your back premiums.

That's a brilliant solution!

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#87
post #85

Earlier quoted context omitted.

The US is the wrong level of government for a healthcare system. If a place like California wanted to offer free healthcare to its residents, that's fine, but the federal government should only be responsible for war, negotiating trade deals, handling immigration, and other external issues. Keep in mind that "many other places" are smaller than a single US state.

Consider that Californian's pay about $290 Billion to the Feds and the state collects about $70 billion. Do other small countries pay most of their taxes to a larger central organization? Much of that Federal money gets shunted to other states.

For consistency, I also support repealing the 16th amendment and removing the interstate commerce clause. Then California would have more direct control over its citizens' tax money.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#88

Earlier quoted context omitted.

Why would one get a private MRI without doctor's orders?

Because you don't have claustrophobia and you're interested in what the MRI might show.

Why should curiosity be covered? A similar scenario involving car insurance, and curiosity of "what's inside", would surely be considered fraud.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#89
post #88

Earlier quoted context omitted.

Because you don't have claustrophobia and you're interested in what the MRI might show.

Why should curiosity be covered? A similar scenario involving car insurance, and curiosity of "what's inside", would surely be considered fraud.

It doesn't need to be covered just don't try to restrict me from diagnosing my own health when doctors have shown their shit at diagnostics

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#90

Earlier quoted context omitted.

Relevant quote from the article re: what an effective solution needs to achieve: >The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Con…

How about capping the salaries of doctors at, say, 100,000 and nurses at 60,000? US salaries in health care are incredibly high. Administration and the like could be capped at the nurse level. Only a very small minority could realistically get higher paying jobs outside the US anyway. If your main motivation is to make a lot of money, choose a different career. Also, cap profits to almost zero while moving to a compl…

Capping admin salaries makes a lot of sense. Maybe not at nurse level, but at doctor level for sure.

Capping doctor's salaries at $100,000 is probably a bad idea. Some cap might make sense, but definitely not $100,000.

$100,000 may sound like a lot, but keep in mind that US doctors take on a lot of debt -- both actual and in terms of opportunity cost. And they also take on a lot of personal risk up until the point where they become doctors. And sometimes even after thatn.

So you're not really saying that should make "around what a software dev makes". You're actually saying that doctors should make significantly less than your average software developer.

Driving smart and driven people away from medicine doesn't seem like a great idea.

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