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Why Did My Patient Leave Me?

cancer.nautil.us

191–200 of 257 posts

Re: Why Did My Patient Leave Me?

#191

Earlier quoted context omitted.

Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

You wrote: > most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures. They typically can't pay for a new washing machine if their current one breaks down.

This is why I liked the health care system in Belgium, where my wife and I lived for almost eight years.

In Belgium, you are charged based on your income, and they don't ask you how much you can pay when you get admitted.

As US ex-pats, we made enough money that we were in the top payment bracket.

Yet, for a significant surgery that kept my wife in the hospital in a private room for two weeks, we still paid less for the whole surgery plus hospital room WITHOUT insurance, than we would have paid in the US but with insurance.

That kind of social medicine does actually work, and work pretty well.

Re: Why Did My Patient Leave Me?

#192
post #35

Earlier quoted context omitted.

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer…

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

In other industries you would call health care billing practices fraud. They just make up charges and when you complain they disappear. They just try what they can get away with.

Re: Why Did My Patient Leave Me?

#193

Earlier quoted context omitted.

I guess. Medicaid and Medicare are more than a third of spending and don't necessarily cover the total costs of the care provided under the programs (any unmet costs are a hidden tax). The VA is not nearly as expansive as those programs but is another couple whole percentage points of US health spending. And you've also got Tri Care and some BIA stuff, and state expenditures that are outside of Medicaid.

Not sure we are discussion the same thing. My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money. A system like the american overall can make money, it's it's goal to profit. That's the difference between whether it's a market driven market or not IMO.

For me, to be "market driven", you have to have easy entry on the supply side and not have huge amounts of mandated care on the demand side.

The US has all sorts of constraints on the supply side and a lot of the demand side is treated under various mandates.

Without easy entry on the supply side, there can't really be a market response to changes in demand, hence not really market driven.

When care is provided to comply with government mandates and incentives rather than because it can be priced above cost, not a market driven transaction.

Re: Why Did My Patient Leave Me?

#194
post #189

Earlier quoted context omitted.

Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it. The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlep…

"cost still is bigger than the money you can afford to put into it." - so spending even more would be super sustainable, so long as it enriches the wealthy shareholders? "you can never spend enough money on it" - i say again, 'enough' is defined differently, a 'socialist enough' is enough to please the people; where a 'capitalist enough' is the smallest number that can sustain profit. these 'enough's are radically di…

Spending even more is whats unsustainable you can't keep spending more and more money in a single payer system as it will either affect other areas or you will have to tax the citizens even more. There is a limit to that.

If you get more and more treatments available and what people consider being part of healthcare and you are running a cost center then your system gets more and more expensive.

No enough here is meant as there will always be things you can spend to make your system better than it is. It's not a matter of opinion it's a matter of what kind of treatments are available compared to how many you can offer.

The single payer system is also denying treatment exactly because it can't pay if everyone used it. It's just another way to say some people don't matter enough.

In the UK system is also deciding which drugs it will prioritize and which it wont.

You are mixing two things together. Yes there are plenty of issues with the US system but the single payer system have issues too and they are not the same.

Re: Why Did My Patient Leave Me?

#195
post #154

Earlier quoted context omitted.

> and fortunately the only people at risk are those that have not been vaccinated yet No, vaccines are not 100% effective. For example, the H3N3 vaccine was 90% effective[1]. So the only people at risk are those not yet vaccinated...and an additional 10% of the people who did get the vaccine. Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading th…

> and an additional 10% of the people who did get the vaccine. That's hardly the fault of the people who didn't get vaccinated. > Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading the disease around. True > You can't vaccinate a newborn, for example. Also true, I'm painfully aware of that one. > There's a lot of value in bodily autonomy, and it…

> if you want science rather than regular imprecise human reasoning to take over at all levels of society you will end up with a society where freedom of religion and all kinds of other goodies that we have come to agree are good for all of us are going to be thrown out.

> Science is a good thing, let's not make it seem as though it is perfect

Uh....I want our decisions to be based on evidence. Science is not a moral theory, and I'm not pretending it is, but it our most reliable source of empirical data. Science never says "you should do X", so you don't have to worry about that. It only says "Best data available says that doing X will result in in Y with probability P".

> But if you start to push back you are only making it bigger, better to respect their right to make the wrong decisions than to force them creating even more resentment and ill-will.

I'm all for a pragmatic, effective approach to getting people to vaccinate, and I want one that balances people's rights. I also agreed that turning the issue into a culture war is counter-productive.

At the same time, I want to get people to vaccinate, and while I won't hold them down and jab a needle in their arm to do it, I am in favor of doing what we can to effectively get them to vaccinate.

Anecdote: I have a friend who got sick during the Ebola scare, and had recently been in [an Ebola-free country in] Africa, so the police came by and forced her to go to the hospital where they determined she didn't have Ebola and sent her a bill. Which she had to pay.

I'd argue that forcing her to go to the hospital was reasonable (or would have been if it hadn't been predicated on the idea that "Africa" is one homogenous place full of Ebola), but that charging her for it was not. I think we as a society have the right to demand people with serious contagious diseases be quarantined and receive treatment, and that we as a society should pay for that.

I assume that at least if she had Ebola, you'd agree with overriding her bodily autonomy for a forced quarantine. That's further on the freedom end of the "bodily autonomy vs. societal well-being" scale than I'm on, but still one that recognizes the trade-offs and makes a thoughtful, pragmatic balance rather than holding one goal, bodily-autonomy, as completely outweighing the other.

I don't actually know if you'd agree with the forced quarantine, but I'm making the assumption that, like most everybody, you agree that the trade-off is sometimes worthwhile.

With vaccines you absolutely reasonably take the stance that requiring them is the wrong balance, but you seem to be arguing as if even evaluating the cost-benefit is wrong--at least judging by your initial post. "But your body is yours and yours alone and that's a good thing even if there are negative consequences for society."

It's hard to draw a line about where the balance lies, and it feels more principled to say "value X always outweighs value Y", but very, very few people are willing to take the hard stance. Instead they take the hard stance where they've drawn the line, and pretend that's the non-arbitrary line, dismissing the reductio as "well, yes, in that example it's obvious".

Are you willing to actually go with "bodily autonomy trumps societal consequences in every situation"? Or are you striking a balance? Because if you're striking a balance, the debate has to be about where the balance lies, not just "bodily autonomy uber alles". And that requires--in addition to moral beliefs--using empirical data ("science") about what the costs and benefits are.

Re: Why Did My Patient Leave Me?

#196

Earlier quoted context omitted.

You wrote: > most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures. They typically can't pay for a new washing machine if their current one breaks down.

This is why I liked the health care system in Belgium, where my wife and I lived for almost eight years. In Belgium, you are charged based on your income, and they don't ask you how much you can pay when you get admitted. As US ex-pats, we made enough money that we were in the top payment bracket. Yet, for a significant surgery that kept my wife in the hospital in a private room for two weeks, we still paid less for…

Belgium is pretty fair. NL requires you to pay between 100 and 150 euros per month or so (kids are free) and that covers everything, the rest is paid from the tax base so you already pay the income dependent part. The only bit that's nasty about it is the deductible, they really screw the poor people on that because of course only the cheap plans have high deductibles so those that can afford the least will end up with the highest costs when something does go wrong.

Re: Why Did My Patient Leave Me?

#197

Earlier quoted context omitted.

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way,…

That's not a hierarchy thing. Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do. My buddies are in latter years of residency and no one works that's despite running around like their hair is on fire. I assure…

Why are there so few doctors in the USA that they need a whole system around them to ensure they spend < 5 min in front of each patient?

Re: Why Did My Patient Leave Me?

#198

Earlier quoted context omitted.

Not sure we are discussion the same thing. My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money. A system like the american overall can make money, it's it's goal to profit. That's the difference between whether it's a market driven market or not IMO.

For me, to be "market driven", you have to have easy entry on the supply side and not have huge amounts of mandated care on the demand side. The US has all sorts of constraints on the supply side and a lot of the demand side is treated under various mandates. Without easy entry on the supply side, there can't really be a market response to changes in demand, hence not really market driven. When care is provided to co…

We were talking relative to ex. europe. Not some ideological defintion. Then the US isn't a market driven economy.

Thats not a useful way to look at things.

Re: Why Did My Patient Leave Me?

#199
post #195

Earlier quoted context omitted.

> and an additional 10% of the people who did get the vaccine. That's hardly the fault of the people who didn't get vaccinated. > Also, as noted in another reply, many, many people can't get vaccinated and rely on those of us who can to not be spreading the disease around. True > You can't vaccinate a newborn, for example. Also true, I'm painfully aware of that one. > There's a lot of value in bodily autonomy, and it…

> if you want science rather than regular imprecise human reasoning to take over at all levels of society you will end up with a society where freedom of religion and all kinds of other goodies that we have come to agree are good for all of us are going to be thrown out. > Science is a good thing, let's not make it seem as though it is perfect Uh....I want our decisions to be based on evidence. Science is not a moral…

> Uh....I want our decisions to be based on evidence.

But we don't live in societies ruled by scientists, as much as we would like. And it's not as if scientists are perfect either, they have their own shortcomings, both individually and as a group.

> Science is not a moral theory, and I'm not pretending it is, but it our most reliable source of empirical data.

Yes, so consider it a failure of communication that not everybody sees it that way. And it's up to the scientists to figure out better ways of communication. It's a sales job.

> Science never says "you should do X", so you don't have to worry about that. It only says "Best data available says that doing X will result in in Y with probability P".

Yes, but by the first press release that will already have been changed into 'you should do X or terrible thing Y will happen'.

And that's not even getting into those scientists who let themselves be harnessed into doing active wrong.

So scientists are not above doubt and would do well to remember that the vote of an anti-vaxxer counts for just as much as the vote of an MIT graduate and that the latter are likely in the minority. So you have to at least try to figure out a way to bridge the gap if you want the problem to be solved.

> I'm all for a pragmatic, effective approach to getting people to vaccinate, and I want one that balances people's rights. I also agreed that turning the issue into a culture war is counter-productive.

> At the same time, I want to get people to vaccinate, and while I won't hold them down and jab a needle in their arm to do it, I am in favor of doing what we can to effectively get them to vaccinate.

So, what would you do other than what we do today?

> Anecdote: I have a friend who got sick during the Ebola scare, and had recently been in [an Ebola-free country in] Africa, so the police came by and forced her to go to the hospital where they determined she didn't have Ebola and sent her a bill. Which she had to pay.

> I'd argue that forcing her to go to the hospital was reasonable (or would have been if it hadn't been predicated on the idea that "Africa" is one homogenous place full of Ebola), but that charging her for it was not.

Agreed on all counts.

> I think we as a society have the right to demand people with serious contagious diseases be quarantined and receive treatment, and that we as a society should pay for that.

Yes.

But vaccination against diseases that are endemic and that have far lower incidence rates, mortality and so on are a different thing than ebola, which has a quality all its own. Also, visiting a country with an elevated risk was a decision made of free will whereas being born is not.

> I assume that at least if she had Ebola, you'd agree with overriding her bodily autonomy for a forced quarantine.

I do.

> That's further on the freedom end of the "bodily autonomy vs. societal well-being" scale than I'm on, but still one that recognizes the trade-offs and makes a thoughtful, pragmatic balance rather than holding one goal, bodily-autonomy, as completely outweighing the other.

Yes. And it is also roughly where society is at these days.

> I don't actually know if you'd agree with the forced quarantine, but I'm making the assumption that, like most everybody, you agree that the trade-off is sometimes worthwhile.

I do.

> With vaccines you absolutely reasonably take the stance that requiring them is the wrong balance, but you seem to be arguing as if even evaluating the cost-benefit is wrong--at least judging by your initial post. "But your body is yours and yours alone and that's a good thing even if there are negative consequences for society."

In principle yes, I think that is a very high bar to cross and there should be an extremely carefully laid out argument if you want to cross that line. And we do have mechanisms for that if it is so required up to and including placing children in foster care if their parents do not take proper care of them.

But such a maneuver should always carry the signature of a judge.

> It's hard to draw a line about where the balance lies, and it feels more principled to say "value X always outweighs value Y", but very, very few people are willing to take the hard stance. Instead they take the hard stance where they've drawn the line, and pretend that's the non-arbitrary line, dismissing the reductio as "well, yes, in that example it's obvious".

It's never simple. But I'm comfortable with hard lines being drawn and judges being allowed to cross those lines at their discretion. That's enough of a safeguard for me.

> Are you willing to actually go with "bodily autonomy trumps societal consequences in every situation"?

Yes, unless a judge overrules that.

> Or are you striking a balance?

I think that's balanced enough because it allows evaluation on a case-by-case basis whilst erring on the side of caution and giving maximum power to the individual as long as they are capable of taking the responsibility for that power. Just like we are able to commit people to mental institutions against their will and without their consent but only after a very thorough look at the case.

> Because if you're striking a balance, the debate has to be about where the balance lies, not just "bodily autonomy uber alles".

No, but it's a good default.

> And that requires--in addition to moral beliefs--using empirical data ("science") about what the costs and benefits are.

Obviously, and the empirical data so far does not warrant a de-facto 'vaccinate or be relieved of your parental duties' regime. It may come to that but for now we don't have it and there are all kinds of options that should be maxed out first before we'd let it get that far.

It's funny, I wonder how the debate would go if the choice were a life ending injection because of the cost to society instead of a life-saving injection at the beginning to statistically expand your life-span.

I'm pretty sure a lot of the people arguing for vaccination would switch sides to 'bodily integrity' in an eye-blink.

Re: Why Did My Patient Leave Me?

#200
post #63

Earlier quoted context omitted.

My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they g…

The problem is that people then tend to forgo preventive care & routine checkups if they don't have to (especially poor people), and in the long term end up costing a lot more when they do get treatment once their situation is far worse.

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