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

#101

Post by distances » Wed, Jun 21, 2017, 3:51 PM UTC

ams6110 wrote: post #87

distances wrote: post #33

Earlier quoted context omitted.

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?

I haven't been to a doctor for a "check-up" since I was a kid. Probably been nearly four decades now. I think for growing kids it's probably a good thing -- if nothing else to be sure you're on schedule for various vaccines. As an adult, I have regular dental care but I do not see an MD unless I am sick or injured. And "sick" does not include colds/sore throat -- there are good OTC meds for that. For most people, if…

Just to expand on this, Europeans do get doctor's visits every now and then even if there's nothing clearly wrong, as sick leaves extending a couple of days usually requires a medical certificate. This doesn't obviously usually include blood analysis or other such tests though.

Disclaimer: I'm extrapolating from personal experience of a handful of countries, this of course doesn't necessarily apply to all of Europe.

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

#102

Post by refurb » Wed, Jun 21, 2017, 3:51 PM UTC

alkonaut wrote: post #24

> "some health care analysts are questioning whether the approach to medical care is valid and viable." Perhaps just stop trying to figure this out from scratch, look at any of N countries where healthcare is just a solved background issue? Yes there are issues with people overusing services that don't have an associated cost for usage, and many similar issues. But every damn country in the world has been adjusting t…

I come from Canada and I would say healthcare is not "solved" by any means. There are constant struggles with wait times, growing budgets and allocation of limited resources.

There is no magic solution. I do agree that the US should look to other countries for ideas though.

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

#103

Post by fao_ » Wed, Jun 21, 2017, 5:02 PM UTC

crusso wrote: post #69

fao_ wrote: post #48

Earlier quoted context omitted.

> 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…

their life literally depends on it. That would only explain emergency procedure costs. Everyday healthcare costs that are not life-or-death are also extremely high. Almost all of the regulations in the medical industry are for ensuring people are safe Are tax laws that benefit employers and lock employees into healthcare plans there to keep people safe? How about laws that prevent companies from selling insurance acr…

> That would only explain emergency procedure costs.

No. It also includes maintenance medicine.

If I stop taking my asthma medicine, my quality of life would rapidly deteriorate and I would sooner or later have to be admitted to A&E for an asthma attack. So my life depends on those medicines. The same for people with Depression, Chronic Pain, Severe Vitamin Deficiencies, etc.

> How about laws that prevent companies from selling insurance across state lines?

That seems extremely logical given how much variation in local law exists in North America.

> but they have the negative effect of stifling innovation that could bring down costs and make people safer in the long run

could. Given the sheer amount of bad science in medicine at the moment (e.g. refusing to publish negative studies), it is not likely. Medicine is difficult, and where we have rushed drugs through we have an extremely poor track record (Such as, a type of SRIs being prescribed, that later was discovered to raise the incidence of suicide among adolescents. In this specific instance this was known before it went on market, but the papers were not published).

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

#104

Post by alkonaut » Wed, Jun 21, 2017, 5:05 PM UTC

refurb wrote: post #102

alkonaut wrote: post #24

> "some health care analysts are questioning whether the approach to medical care is valid and viable." Perhaps just stop trying to figure this out from scratch, look at any of N countries where healthcare is just a solved background issue? Yes there are issues with people overusing services that don't have an associated cost for usage, and many similar issues. But every damn country in the world has been adjusting t…

I come from Canada and I would say healthcare is not "solved" by any means. There are constant struggles with wait times, growing budgets and allocation of limited resources. There is no magic solution. I do agree that the US should look to other countries for ideas though.

Well it depends on the definition of "solved". Having a system where people have access to decent healthcare and it doesn't ruin public finances I mean.

I keep twisting the thermostat a bit but I consider building heating to work in the "solved problem" sense

Public healthcare will never be perfect.

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

#105

Post by duckingtest » Wed, Jun 21, 2017, 5:24 PM UTC

fredley wrote: post #13

kingkawn wrote: post #12

Earlier quoted context omitted.

Straight up exploitation of people during their most vulnerable moments.

The free market is a poor model for providing healthcare. In an ideal free market, market forces work to find the optimum price for a product, depending on how much it costs to create the product, and how much people are willing to pay for it. In healthcare, though, how much people are willing to pay for a product is anything , if it's the one thing they need to stay alive, or to reduce chronic pain, etc.

There's no free market in healthcare. Healthcare in the US is a guild with state-enforced monopoly. Reasonable prices would defeat the whole point of this.

Naturally, it's sold to the public as 'safety' or other BS.

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

#106

Post by 1812Overture » Wed, Jun 21, 2017, 5:41 PM UTC

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.

It has nothing to do with that. It's because the person making the purchase decision isn't the person paying. Usually the doctor and the patient will have no idea how much money is actually changing hands behind the scenes.

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

#107

Post by com2kid » Wed, Jun 21, 2017, 5:54 PM UTC

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?

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

Any elective procedure. If I want to get laser eye surgery done, the price has dropped to 1/10th of what it was when the procedure first debuted. Likewise for common plastic surgeries.

Dental care is also interesting, there is actual competition for many cosmetic procedures, although there is of course a price floor, Dentists compete based on reputation and presentations of previous quality work to justify higher prices.

Same thing for eye glasses. Eye glasses range from $50 to $500, insurance distorts this a little bit, but the market is generally quite competitive. If you want hand made frames from a local artists, they are as available as $50 mass produced frames. Likewise many lens materials exist, from $20 plastic lens all the way up to $300+ fancy coated materials with some really cool properties (oleophobic lens coatings!).

There is also an interesting market for customer requested lab work. If I want to get basic blood work done, I can walk into clinics that specialize in it and request blood work for a fraction of the price my doctor can order it at!

Finally DNA testing is another example where an incredibly complex technological process can now be, quite literally, ordered off of Amazon, and mailed off to a processing center.

Meanwhile if I break a toe, I get a giant rubber flat sandal from the doctor that is billed at $200, that same boot can be ordered online for under $30!

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

#108

Post by tertius » Wed, Jun 21, 2017, 6:08 PM UTC

mattkrause wrote: post #63

tertius wrote: post #60

Earlier quoted context omitted.

The point he's making is that it's only unfeasible to negotiate when you need treatment this minute. Therefore a free market system is feasible for everything else. Not that it's what we currently have as you point out.

Even there though.... Do you think (or the average person) knows enough to shop around? This stuff is complicated! I'm not sure I could make a rational decision between treatments that have different prices, but also different likelihoods of success, side effect profiles, and all that. This is even more complicated when you're paying for a diagnosis too, rather than just a treatment. Lasik and plastic surgery are int…

> Do you think (or the average person) knows enough to shop around?

Do I think that education surrounding general health has diminished. I feel very strongly about this. There should not be as large of a chasm between my knowledge or ability to diagnose (i.e. is something serious enough to go to the doctor for) and the knowledge of a doctor/PA etc.

But yes, the average person deals with market economics every day and they're certainly smart enough to make decisions there.

> Lasik and plastic surgery

So are office visits, annuals, screenings, minor procedures (think stitches to Tonsillectomy). I.e. the bulk of medical service.

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

#109

Post by tertius » Wed, Jun 21, 2017, 6:11 PM UTC

BeetleB wrote: post #99

tertius wrote: post #59

Earlier quoted context omitted.

> 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.

Hence the "generally."

And Canada does on a large scale what Medicare does in the U.S. it is a single point of negotiation. This may be good or bad depending on how well medicare is run.

Many are saying that medicare should just be expanded to cover all people, prices should go down.

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

#110

Post by tertius » Wed, Jun 21, 2017, 6:13 PM UTC

crusso wrote: post #65

tertius wrote: post #52

Earlier quoted context omitted.

Why? Because the market will bear it. Simple.

The "market" bears it because the regulatory structure of the market allows for no alternatives.

And the market is struggling to push back against those. So we keep it low enough to be affordable (i.e. people are still paying) and not high enough for revolt to ensue.

I was mainly replying to conflation of extra middle men etc. for increasing costs. That's nonsense.