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

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

#71

Post by baldfat »

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…

Not Unions' fault. I don't understand the animosity towards Unions specifically to this revisionist history of Health Care.

> The Birth of Employer-Provided Health Insurance

During World War II, the federal government was wary of post-war inflation. The administration saw the terrible devastation hyperinflation wreaked on post-World War I Germany and they were determined to hold it at bay through wage and price controls which they instituted during the war. In reaction to the wage controls, many labor groups planned to go on strike en masse. In order to avert the strike, in a concession to the labor groups, the War Labor Board exempted employer-paid health benefits from wage controls and income tax. https://www.zanebenefits.com/blog/part-1-the-history-of-u.s....

> Company provided health care became a standard thing from union demands years ago.

I have heard that for years and I can't see anything that wasn't really the Federal Government's plan to stop all wage increases. Yes the Unions got mad and were going to strike but that was because the federal government was going to freeze all wages. Hardly a Union fault.

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

#72

Post by ekidd »

baldfat wrote: post #34
brightball wrote: post #29

Earlier quoted context omitted.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

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????

> How much money does a doctor need to make?

If patients are looking for open heart surgery, brain surgery, or something else that's life-and-death? It's amazing how quickly people start looking for "one of the best surgeons in our state." And I don't blame them! If somebody is going to saw open your skull and stick a scalpel in your brain, you want the medical equivalent of a respected senior Google engineer, and not a fly-by-night outsourced IT subcontractor.

Similar issues apply with rare or weird medical conditions. In these cases, front-line doctors might see a condition once in their career. But there's a specialist somewhere that deals with those conditions all day long. If you ask your regular physician to try to diagnose something weird, you may wind up getting expensive tests like an MRI, whereas a specialist might instantly recognize that an MRI is useless.

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

#73

Post by crusso »

dragonwriter wrote: post #58
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…

> The problem with healthcare is the opposite: there is no free market No, it's not; this is evident from all the other countries without free markets in healthcare that provide universal access and equal or better overall outcomes and far less cost (per capita, and even as a share of GDP) than the US, without anything more of a “free market”.

I'd say that it's more that we're caught in the middle. We can't get the advantages of a free market because there's too much regulation and a competition-hostile legal framework. We can't get the advantages of socialized medicine because we lack the regulatory and legal framework.

We're just kind of stuck in a local maximum in a poor area of the search space. In order to see a much better maximum, we'd have to move to an entirely different area of the search space.

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

#74

Post by Spooky23 »

fao_ wrote: post #48
crusso wrote: post #38

Earlier quoted context omitted.

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 i…

He's not talking about medicine here. Medical facilities pay more for stuff like toilet paper and chairs.

There's a culture of bureaucracy and incompetence in the medical industry that is unbeaten even by government.

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

#75

Post by brightball »

baldfat wrote: post #71
brightball wrote: post #37

Earlier quoted context omitted.

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…

Not Unions' fault. I don't understand the animosity towards Unions specifically to this revisionist history of Health Care. > The Birth of Employer-Provided Health Insurance During World War II, the federal government was wary of post-war inflation. The administration saw the terrible devastation hyperinflation wreaked on post-World War I Germany and they were determined to hold it at bay through wage and price contr…

Still, that concession created the imbalance that got us where we are today.

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

#77

Post by ghaff »

maxerickson wrote: post #57
zxcmx wrote: post #43

Earlier quoted context omitted.

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 wro…

Generic OTC drugs are healthcare. They often cost ~$3-5 a month. Pretty cheap, available to treat a wide variety of issues. And increasingly, first contact will not be with an MD or DO (there's several paths, nurse practitioners, physicians assistants, etc).

And in fact, lots of common prescription drugs that people may take daily don't even hit $15 copay levels for a month's supply.

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

#78

Post by maxerickson »

afpx wrote: post #49
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 overtak…

The focus on discussing regulations in terms of "more" and "less" is a big problem.

Things like whether a regulation is well targeted, whether the costs it imposes are reasonably related to the benefit it provides and so on are much more interesting.

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

#79

Post by maxerickson »

ghaff wrote: post #77
maxerickson wrote: post #57

Earlier quoted context omitted.

Generic OTC drugs are healthcare. They often cost ~$3-5 a month. Pretty cheap, available to treat a wide variety of issues. And increasingly, first contact will not be with an MD or DO (there's several paths, nurse practitioners, physicians assistants, etc).

And in fact, lots of common prescription drugs that people may take daily don't even hit $15 copay levels for a month's supply.

You do have to go through a relatively expensive gatekeeper for those though. And they won't lightly pass on the opportunity to monitor things.

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

#80

Post by germanier »

vxNsr wrote: post #70
timthelion wrote: post #25

Meanwhile in the Czech Republic, for caa 50$ a month (for a person making minimum wage, it's double that for median wage workers) there is no copay on anything and the insurance covers everything including sex change surgery (but not facelifts and dental)...

I always chuckle when I see people compare what amount to 3rd world countries with the US system, my mother was trained and worked in Moscow's largest hospital. The shenanigans that went on there, the level of training and expected knowledge of staff, the baseline expected standard of care all don't even hold a candle to what she had to reach to be considered competent in the US. On top of that I don't know if this a…

Then take a look at other countries: The German system was introduced 130 years ago[0], survived multiple forms of government, two world wars, the incorporation of a former socialist country, multiple waves of immigration, and still provides excellent care. It just works.

(And modern medicine is not yet at a level where ethnicity is a relevant factor when deciding treatment options.)

[0]: By highly conservatives by the way, to fight the rising social democrats

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