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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#61

Post by mindslight »

kbenson wrote: post #10
araes wrote: post #6

Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

The problem isn't really the 20 minutes it takes to get up to speed, but that each patient visit is only allocated to get 15.

Re: Doctors, Revolt

#62

Post by tensor_rank_0 »

craftyguy wrote: post #60
RA_Fisher wrote: post #57

Earlier quoted context omitted.

Yep and the common thread in both is the government.

Specifically, the government's mostly laissez-faire approach to handling both and, for education at least, its inability to prioritize it above other priorities like declaring war on vague concepts (drugs, crime, terrorism, etc)

> Health care and education

> government's mostly laissez-faire approach to handling both

actually those are among the most heavily regulated and subsidized industries in the us.

Re: Doctors, Revolt

#63

Post by erentz »

bsder wrote: post #50
whatthesmack wrote: post #35

Earlier quoted context omitted.

> HOWEVER, that is going to cost money. Quite a lot of money. And, really, nobody is actually interested in doing that in the US. This seems to imply that the US doesn’t spend enough money on education, even though it is (one of?) the highest spender(s) on education in the world (just from a quick Google search). I believe the real change needed is better management of how the existing money is spent.

You are regurgitating a "misused funds" talking point that Republicans always fall back on when facts don't support their position. The US isn't that out of line with spending: US is $15,171 per student while Switzerland is $14,922 per student. US is 7.3% of GDP while Denmark is 8% of GDP. Source: https://www.cbsnews.com/news/us-education-spending-tops-glob... There is not some magic bank of "misused" money waiting t…

Not trying to be antagonistic, but aren’t you kind of proving the point? You've shown the US funding for education is good, it’s comparable with other countries that have good education systems, but the results seem to be poorer. (I guess that’s what people are saying but I haven’t verified that myself.) Thus there seems to be inefficiency in how that funding is allocated/used compared to other countries. So increasing funding doesn’t seem necessary. But improving the system that uses that funding through the measures you’ve rightly identified seems... well obvious at this point. (And those points you've identified IMO are key to improving a lot of the broken systems we talk about.)

As anecdata about this misallocation in US education funding: I come from another part of the world (a first world country), and something that I have not, for the life of me, been able to reconcile with the funding arguments is the stupendous sports facilities that most schools have. High schools in the US have sports stadiums bigger than many cities where I come from. If there were a real funding problem in an education system, sports should be the first thing to downsize in order to protect the core mission. But the priorities are just not aligned right for education.

Re: Doctors, Revolt

#64

Post by andmarios »

kbenson wrote: post #10
araes wrote: post #6

Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

Is there really a need for 24 hour doctor visits most of the time?

No. Doctors can have mostly normal 8-hour workdays, 5 times per week. Nurses administer drugs and monitor the patients. If a problem arise, they can call the doctor in charge of the patient or bring the doctor doing the night —or weekend— shift.

Re: Doctors, Revolt

#65

Post by fbdjskajxb »

RA_Fisher wrote: post #57
araes wrote: post #6

Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…

Yep and the common thread in both is the government.

The government is also involved in lots of other things without exploding costs. I’d say the common thread is the combination of these factors: 1) the service is considered essential by consumers and 2) payments are deferred (by insurance or student loans). So consumers never say no due to rising prices.

Re: Doctors, Revolt

#66

Post by snomad »

bsder wrote: post #50
whatthesmack wrote: post #35

Earlier quoted context omitted.

> HOWEVER, that is going to cost money. Quite a lot of money. And, really, nobody is actually interested in doing that in the US. This seems to imply that the US doesn’t spend enough money on education, even though it is (one of?) the highest spender(s) on education in the world (just from a quick Google search). I believe the real change needed is better management of how the existing money is spent.

You are regurgitating a "misused funds" talking point that Republicans always fall back on when facts don't support their position. The US isn't that out of line with spending: US is $15,171 per student while Switzerland is $14,922 per student. US is 7.3% of GDP while Denmark is 8% of GDP. Source: https://www.cbsnews.com/news/us-education-spending-tops-glob... There is not some magic bank of "misused" money waiting t…

I just worked 10 years at a public state University. The inefficiency, cronyism, and often blatant corruption is staggering. At least with respect to universities, there is some magic bank of "misused" money waiting to be tapped. But it is in no one's interests - not the high paid administrators, not the powerful local real estate developers and other businesses, and not the state and national politicians who generally work out a way to personally benefit from those big expensive projects.

Fun example of inefficiency, - 2 units at university using same enterprise software package - I propose consolidating to one license, 1 server, both departments split cost. - Both department heads agree, both IT depts agree, campus IT agrees - cancelled last minute - that was 7 years ago, by now both departments combined (not each) would have saved $250k

Re: Doctors, Revolt

#67

Post by bawana »

Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services. The surgeon has to see the patient,make the diagnosis, provide the treatment, provide the aftercare and be the 'face'. The hospital-insurance complex has managed to create this fantasy world with complicated rules and somehow have sequestered themselves from the free market. They set their own prices and by virtue of being of local monopolies thwart the ability of the individual to choose. Hospitals have become like cable companies.

Re: Doctors, Revolt

#68

Post by dkarl »

candiodari wrote: post #49
dkarl wrote: post #40

Earlier quoted context omitted.

They treat the customers like replaceable widgets This sounds like first world problems. You have a doctor you trust to go off script? You trust that when your kids' teachers treat them differently they aren't just stereotyping and limiting them? Lucky you. While you work to unshackle your providers from the mediocrity of "best practices" (and I say that as someone for whom "best practices" is a bane in my own work)…

The problem is MBA administrators looking at their little accounting tables and deciding that not letting patients actually see a doctor is their purpose in life, just so they can pay everyone at a hospital as little as possible. This of course leads to global cost blowups and worse care. Of course, by now there is no turning back, and the government has decided that actually training doctors must be prevented at all…

I'm talking about teachers with master's degrees and MD doctors, which means many years of education. We've made it standard to have access to these people (unless you have a scratch???) but it's not a panacea. Just got word that my father is seeing the same doctor that has fucked up his care multiple times, not out of creativity or being too smart but because of not guessing the simplest and most common explanation of common symptoms. I'm very angry, but can't convince my father to move out of the home & town I grew up in so he doesn't have to deal with this incompetence.

If you live in a town where smart and educated people like to live, you get the cream of the crop of doctors. It's very different from living in a backwater where ambitious young people aspire not to live. And most of the world lives in backwaters, with unexceptional doctors who make simple but deadly mistakes when they go off script.

Re: Doctors, Revolt

#69

Post by geomark »

bawana wrote: post #67

Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services. The surgeon has to see the patient,make the diagnosis, provide the treatment, provide the aftercare and be the 'face'. The hospital-insurance complex has managed to create this fantasy world with complicated rules and somehow have sequestered themselves from t…

Where I live that is the case. Prices are not only made available, they are often advertised on websites and even on TV. Just one example of how it is done here https://www.bumrungrad.com/en/womens-center-obgyn-thailand/p...

Re: Doctors, Revolt

#70

Post by danans »

whatthesmack wrote: post #35
bsder wrote: post #30

Earlier quoted context omitted.

> Doctors / teachers often don't seem to communicate / care. You really don't have much contact with teachers if you believe this. The education system runs in spite of its systemic horribleness precisely because there are enough teachers who do care and fight/ignore the system when necessary. If you want to actually fix the educational system, we have models for doing so in several different countries. However, they…

> HOWEVER, that is going to cost money. Quite a lot of money. And, really, nobody is actually interested in doing that in the US. This seems to imply that the US doesn’t spend enough money on education, even though it is (one of?) the highest spender(s) on education in the world (just from a quick Google search). I believe the real change needed is better management of how the existing money is spent.

The US spends double the OECD average on tertiary education (university, etc), but we're just somewhat above average in spending on primary and secondary education [1].

In the US at least, you can't read too much into the averages, because there are so many additional factors that vary by state and between cities. Some states spend far more per pupil than others, although different states can have very different cost-of-living, so comparing absolute numbers in that case doesn't make much sense.

Even within a state, different areas have very different cost of living, and very different hyper-local conditions like concentrations wealth or poverty, that have a big affect on how far each dollar spent goes.

[1] http://www.oecd.org/education/EAG2014-Indicator%20B1%20(eng)...

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