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

Doctors, Revolt

nytimes.com

Post reply on HN
Print view View original

71–80 of 178 posts

Re: Doctors, Revolt

#71

Post by [deleted] »

candiodari wrote: post #41
OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

This. Every healthcare system in the world needs to choose. We simply cannot have healthcare for everything, including rare, expensive and/or hopeless diseases (or all 3 at the same time). As long as that's what we demand, healthcare will go wrong. And let's please just stop pretending that this is somehow an America-only problem, caused by whatever (democrats: by not being public conservatives: by public largesse. A…

[deleted]

Re: Doctors, Revolt

#72

Post by pishpash »

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 alternative? How about not artificially restricting the number of doctors in the system so the ones in it don't play musical chairs and ones aspiring to don't do 28-hour shifts?

Re: Doctors, Revolt

#73

Post by curun1r »

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.

To be more specific, the US government. Other governments seem to figure this stuff out, from time to time, but there's something about the FPTP, federal/state split or other such details that's sabotaged efforts here.

We should realize that it isn't a fundamental property of government, just the one we have and we have mechanisms for making changes that we haven't yet tried.

Re: Doctors, Revolt

#74

Post by neffy »

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…

Consider who and how benefits. The incentive in for-profit medicine in the US is to spend as much time and treatment as possible per patient. If each Doctor has to order the same tests as the patient is passed around - that is efficient from the perspective of maximising profit.

Re: Doctors, Revolt

#75

Post by pishpash »

OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

> ... gets an extraordinary result from a collection of ordinary people

Of course doctors are ordinary people. The ones that become doctors these days aren't even the brightest in school -- those go into STEM or, god forbid, finance.

But if they are ordinary people why are they paid like the superhuman healers that they aren't and still hold themselves as such?

Re: Doctors, Revolt

#76

Post by jdminhbg »

wyager wrote: post #32
lkrubner wrote: post #17

Earlier quoted context omitted.

" everything in America is a business " If by "business" you mean a public/private hybrid in which profits are privatized while losses are socialized, then you are correct, in so far as health care goes. And that seems to be the model that is now being adopted in more and more areas of economic activity.

I don’t like that wording because it implies that hospitals somehow benefit from government involvement; in reality, it just sucks for everyone. In general, I agree - very few medical institutions in the US actually get to be private. I will say that truly private medicine is, in my reasonably broad experience, excellent. I use a private subscription-only medical service in the US which is excellent (and procedures a…

> it implies that hospitals somehow benefit from government involvement

But they very clearly do. A huge proportion of their income comes from government sources (Medicare/Medicaid/VA), they are subsidized by tax exemption for health spending, and government grants them the power to deny competitive entrants into their markets via "certificates of need."

Re: Doctors, Revolt

#77

Post by jackcosgrove »

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…

The underlying problems in these industries are because they are labor intensive. Partly this is due to the difficulty of automating those jobs, and partly it is due to political arrangements that protect incumbents.

Technological innovations that reduce costs will be the most lasting ways to reform these sectors.

Re: Doctors, Revolt

#78

Post by fucking_tragedy »

dkarl wrote: post #68
candiodari wrote: post #49

Earlier quoted context omitted.

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…

To add to this anecdote, I lived in the suburbs of a major city for quite some time. My primary care doctor's practice was in the city at a prestigious hospital.

The care I received at that hospital was a night and day difference compared to what I received in the suburbs.

My favorite experience was the time I was very sick, went to a doctor in the suburbs and was told I was absolutely fine, despite the coughing, difficulty breathing, looking like I was dying, chest pain and X-ray results. I was sent on my way without even a script for antibiotics.

The next day, I went to see my PCP who demanded the names of the doctors responsible for letting a patient with severe pneumonia leave their care without proper treatment. Said if I waited another day, I'd have to be hospitalized.

Re: Doctors, Revolt

#79

Post by toomuchtodo »

jackcosgrove wrote: post #77
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…

The underlying problems in these industries are because they are labor intensive. Partly this is due to the difficulty of automating those jobs, and partly it is due to political arrangements that protect incumbents. Technological innovations that reduce costs will be the most lasting ways to reform these sectors.

Other first world countries don’t require technological innovations to deliver affordable, quality healthcare. They just break the profit motive.

Re: Doctors, Revolt

#80

Post by adventured »

curun1r wrote: post #73
RA_Fisher wrote: post #57

Earlier quoted context omitted.

Yep and the common thread in both is the government.

To be more specific, the US government. Other governments seem to figure this stuff out, from time to time, but there's something about the FPTP, federal/state split or other such details that's sabotaged efforts here. We should realize that it isn't a fundamental property of government, just the one we have and we have mechanisms for making changes that we haven't yet tried.

The problem in the present US system, is that it's a bad mixture of private and government involvement. We have the negatives from both acting simultaneously.

5% of patients are half of all costs in the US healthcare system; 1% of patients are 22% of the cost. People over the age of 65 are a greater share of cost in the US system than in universal healthcare systems, because the US doesn't have a big lever for rationing care.

The healthiest half, is 3% of the cost in the system.

A market healthcare system, which is widely considered immoral, will drop many of the most expensive and poorest patients from the system. That's how you can dramatically lower costs in the US system, if you want to go the market route. A market system would particularly focus on the 50% that are only 3% of cost, with costs being far higher for everyone else (resulting in lack of access to expensive treatment for many, and many millions of people would get denied healthcare coverage due to pre-existing conditions).

A universal healthcare system smashes costs by rationing care, and tightly controlling everything from drug prices to healthcare worker salaries.

The US today has neither of those approaches widely implemented. We have a lot of government and private healthcare without enough of the tight cost checks. The obvious outcome, is a perpetual cost spiral until it can't spiral anymore (which is about where we're at now).

Post reply on HN