A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics • Hacker News Board

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

#91

Post by tim333 » Wed, Jun 21, 2017, 2:30 PM UTC

douche wrote: post #30

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…

There's also a lot of stupid shit that you need to have a prescription for that you ought to just be able to go out and buy. Case in point, my dad has a CPAP machine for sleep apnea, and it stopped working a few months ago. You'd think something that is conceptually similar to a vacuum cleaner operating in reverse with a mask on the end would be something that you could just go find on Amazon and have shipped to you…

You can get them on Amazon.co.uk. Different regs I guess. https://www.amazon.co.uk/Carejoy-Quality-Screen-Portable-Mac...

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

#92

Post by firebird84 » Wed, Jun 21, 2017, 2:33 PM UTC

baldfat wrote: post #67

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…

Robots have been in the operating room for several years now. People are just not aware they certainly aren't there to reduce cost as much as reduce risk from human error. http://fortune.com/2016/07/11/robots-medical-surgeons/

The two concerns are intertwined, as reduced risk from human error means fewer malpractice claims, and slower premium increase (assuming a well functioning malpractice insurance market).

Also, improved outcomes (due to fewer errors) also improve costs, as patients won't have to come back due to complications as often.

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

#93

Post by tzs » Wed, Jun 21, 2017, 2:47 PM UTC

AdmiralAsshat wrote: post #82

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…

It doesn't surprise me. I did several weeks of physical therapy for back pain. The PT suggested that I get a TENS Unit for pain. She said, "It costs about $800, but don't worry, your insurance will cover it with no copay to you." Additionally, the pad refills were free and paid by insurance (they stop being adhesive after so many uses). And so for several months I had sales rep calling me once every few weeks, asking…

Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol.

Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon.

I was also paying a $20 copay for a 120x50mcg bottle of fluticasone propionate nasal spray. I have since found out that I can buy a 5 bottle pack for $35 from Amazon, with no involvement from insurance.

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

#94

Post by scarhill » Wed, Jun 21, 2017, 2:47 PM UTC

brightball wrote: post #29

kingkawn wrote: post #12

Earlier quoted context omitted.

Straight up exploitation of people during their most vulnerable moments.

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…

The story of why the US has such a bizarre system of paying for healthcare is more complicated and interesting than just union demands and WW II price controls. Here's a great podcast discussing it: http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...

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

#95

Post by ghaff » Wed, Jun 21, 2017, 3:08 PM UTC

tzs wrote: post #93

AdmiralAsshat wrote: post #82

Earlier quoted context omitted.

It doesn't surprise me. I did several weeks of physical therapy for back pain. The PT suggested that I get a TENS Unit for pain. She said, "It costs about $800, but don't worry, your insurance will cover it with no copay to you." Additionally, the pad refills were free and paid by insurance (they stop being adhesive after so many uses). And so for several months I had sales rep calling me once every few weeks, asking…

Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol. Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon. I was also paying a $20 copay for a 120x50mcg bottle of f…

I don't know about your pharmacy but at my (major chain) pharmacy, if a drug price is less than the co-pay, I just pay the price. (Which is I assume the same situation as with Walmart.)

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

#96

Post by gehwartzen » Wed, Jun 21, 2017, 3:09 PM UTC

tzs wrote: post #93

AdmiralAsshat wrote: post #82

Earlier quoted context omitted.

It doesn't surprise me. I did several weeks of physical therapy for back pain. The PT suggested that I get a TENS Unit for pain. She said, "It costs about $800, but don't worry, your insurance will cover it with no copay to you." Additionally, the pad refills were free and paid by insurance (they stop being adhesive after so many uses). And so for several months I had sales rep calling me once every few weeks, asking…

Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol. Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon. I was also paying a $20 copay for a 120x50mcg bottle of f…

One of the perverse ramifications of a lot of heathcare plans is that the Deductible and Max-Out of Pocket limit disincentivises the consumer to buy the cheaper retail product. I could save my insurance money by buying a drug or medical device cheaper but would be screwing myself because non of that would count towards my out of pocket limit.

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

#97

Post by BeetleB » Wed, Jun 21, 2017, 3:10 PM UTC

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…

>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.

The "number of years" argument doesn't explain it. For most doctors, it is comparable to someone doing a PhD - maybe a year or two longer on average. PhD's don't get paid anywhere near the amount doctors do.

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

#98

Post by [deleted] » Wed, Jun 21, 2017, 3:10 PM UTC

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…

[deleted]

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

#99

Post by BeetleB » Wed, Jun 21, 2017, 3:12 PM UTC

tertius wrote: post #59

bryanlarsen wrote: post #53

Earlier quoted context omitted.

"The problem with healthcare is the opposite: there is no free market" Every other developed nation has less of a free market in health care than the United States, and every other developed nation seems to do better on this front than the United States does. It could well be that you're right, but the examples of other nations make this an extraordinary claim requiring extraordinary evidence. Or we could just stop e…

> Every other developed nation has less of a free market in health care than the United States Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm. I can agree that this like infant mortality is much better in a lot of countries. But this doesn't change the the U.S. pretends to have a "market" f…

>Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm.

Nope. It's not government run in a number of those countries. Although I do not mean to include them in my comment, but even Canada's health care industry is not government run.

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

#100

Post by Avshalom » Wed, Jun 21, 2017, 3:26 PM UTC

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? What percentage of health care spending overall are these issues?

100%, in theory at least.

See I'm vaguely poor--18421 before taxes last year, currently about 5000 before taxes this year--which means I can't afford to go see a doctor because "I'm not sure but I think this is more than a sprain", "that's weird this lymph node has just swollen to thrice it's normal size over night" or "hmm this is definitely infected"[1]. In fact anything that isn't 0-copay, which isn't much because I can't afford swanky insurance, is basically out of reach. ALSO because I'm 31 and spent my adult life insurance-less I have almost literally no idea how to even get myself care if I could afford it (I mean what do you just throw a dart at a phone book? walk into a hospital and keep asking nurses questions?)

As a result any[2] health care I receive is going to be a result of some one else calling an ambulance for me. Which will leave me in exactly no state to be comparison shopping.

[1]true stories

[2]well I did manage to get on some anti depressents and counseling last year by crying at the good people at my student health center for an hour or so, only after some one pointed out that generics for chronic conditions are covered by my insurance (a fact which does not actually appear in the policy packet but is only mentioned in small print on a PDF comparing the different plans) and the first month of counseling being covered by my student activity fees.