Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

npr.org

Post reply on HN
Print view View original

41–50 of 121 posts

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#41

Post by dagw »

fennecfoxen wrote: post #28
timthelion wrote: post #26

Earlier quoted context omitted.

When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?

1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage…

1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues?

If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around.

If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#42

Post by DBNO »

distances wrote: post #33
dr_ wrote: post #27

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient populatio…

Being from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US? As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?

For me, I use my annual checkup to get data (i.e. lipid and comp panels, etc, hearing test, electrocardiogram, urinalysis) on myself so I have a baseline of what the data looks like when I'm healthy. Everyone has slightly different baselines, so it's nice to have a better picture/time-series of mine.

Edit: I pay for the additional blood panels

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#43

Post by zxcmx »

brightball wrote: post #37
baldfat wrote: post #34

Earlier quoted context omitted.

It eventually is exploitation no matter how you slice it. Doctor's salaries and the money that is made in medical just because it is medical is insane. How much money does a doctor need to make? Why is $400,000+ a year okay when it is bankrupting thousands of people's lives? > which happened from union demands Explain????

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. And with all tha…

I find it really interesting that we don't have, for example, a cheaper way of doing front-line health care than teaching people to diagnose every possible ailment.

Similarly that that the mechanics of surgery aren't considered a manual skill practicable in a largely assembly line fashion.

Apparently, everyone gets artisanal health care, regardless of the level of complication (or not) of their condition.

Nothing wrong with doctors at all, but curious that this field above all others is so resistant to the methods of industry which have worked so well to reduce costs in every other field.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#44

Post by [deleted] »

timthelion wrote: post #26
bluecalm wrote: post #18

Earlier quoted context omitted.

People are willing to pay anything for food or clothes as well. Still, free (well, at least way more free than in case of healthcare) market works decently, at least when it comes to providing cheap and decent food options. The problem with healthcare is the opposite: there is no free market and it's impossible to compete without huge investment and even then it's sometimes still impossible (patents, long approval pe…

When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?

[deleted]

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#45

Post by crusso »

fennecfoxen wrote: post #28
timthelion wrote: post #26

Earlier quoted context omitted.

When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?

1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage…

If outrageous healthcare costs were only kicking in for life-or-death emergencies then you might have a point.

Healthcare costs across the board - except in unregulated, uninsured spheres like plastic surgery, lasik, etc. - are extraordinarily high.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#46

Post by duncan_bayne »

kalleboo wrote: post #22
duncan_bayne wrote: post #20

Earlier quoted context omitted.

> The free market is a poor model for providing healthcare. No; a free market has been _proved_ to be good at providing healthcare in the US. What you folks have now is an utterly corrupt cartel.

I feel like I'm walking into a trap now, but when was that proven?

"Friendly societies", back in the day. My understanding is the AMA was formed more or less as a counter to the negotiating power of those societies around pay and conditions.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#47

Post by NoGravitas »

fennecfoxen wrote: post #28
timthelion wrote: post #26

Earlier quoted context omitted.

When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?

1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage…

Even for non-emergency care, it's not feasible to shop around in the US healthcare market.

Doctors don't know prices. Typically, front-office staff won't know prices until they've talked to your insurance company. It's probably not possible to get prices from your insurance company except in the context of a very specific claim, which can only come from the doctor's office or hospital's office staff. A small difference in coding for the same issue/procedure can result in huge cost differences.

It might be possible to shop around for prices on particular surgical procedures (eg), but only after you've paid an unpredictable amount for diagnosis. And you may have to pay twice for diagnosis to make this possible.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#48

Post by fao_ »

crusso wrote: post #38
oldandtired wrote: post #9

A former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry. After six months or so, he returned to his former job of head of R&D at the advertising agency. When quizzed by the staff at the advertising agency as to why he came back to such a corrupt industry. His comment was that advertising were little children in term…

factor of 10 over what they would sell the same product for to non-health care areas That's a key statement. So these same people charge less for the same product in other fields. Why? The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.

> The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.

Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it.

I don't see why regulations, and laws "designed to destroy innovation" (i.e. keep people safe from bogus drugs) are a bad thing. (Of course lack of transparency and middlemen are bad). Almost all of the regulations in the medical industry are for ensuring people are safe, and do not succumb to drugs that are no more effective than a placebo.

I think one of the main reasons why the price is artificially inflated is because of the patent laws in this area. Capitalism itself has various safeguards to ensure that the cost does not get too high for people to buy it, and to ensure that monopolies do not grow, but it seems that we have actually created laws (patent laws, mainly) that circumvent these safeguards.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#49

Post by afpx »

oldandtired wrote: post #9

A former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry. After six months or so, he returned to his former job of head of R&D at the advertising agency. When quizzed by the staff at the advertising agency as to why he came back to such a corrupt industry. His comment was that advertising were little children in term…

For all the big talk that US republicans do on 'regulations' I'll only take them seriously if and only if they deregulate the health care market. The regulations only enable a demand-heavy, supply limited market which jacks prices to crazy levels (ever try to buy CPAP equipment?).

On the flip side, without some sort of oversight, reporting, and rational tort-enforcement, I'm sure the slimiest of vendors would overtake the market.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#50

Post by ada1981 »

You may want to screen / sort customers based on Attachment style.. it's been found folks with anxious attachment visit the doctor more often and use more resources - but they visit for things that are non-issues, basically they are going for the relationship.
Post reply on HN