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Unnecessary medical care is harming patients physically and financially (2015)

newyorker.com

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Re: Unnecessary medical care is harming patients physically and financially (2015)

#41

Post by joncrane »

LeifCarrotson wrote: post #27
vonmoltke wrote: post #16

Earlier quoted context omitted.

> I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member "Intake appointment"? "Official member"? What kind of system is this?

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

Exactly. You have to be an established patient to get some of the benefits, the most important being (IMO) being able to see a doctor within a day or two if you're really sick. (But not emergency room sick)

Re: Unnecessary medical care is harming patients physically and financially (2015)

#42

Post by whb07 »

phil21 wrote: post #33
0xcde4c3db wrote: post #23

Earlier quoted context omitted.

I'm not sure it would. Given the information asymmetries involved, how does it avoid the "market for lemons" problem?

I think HN could do with some older folks on it. Heck, I remember growing up and using insurance was rare. You paid cash for your doctor visits, and typically only used insurance for major hospital stays as that's more or less all it covered. Doctor visits just 30 year ago did not cost what they do today. You could get a clean break in your arm, go into your GP, have it fully fixed and be out the door for less than a…

So much this! I broke my leg a decade ago and asked my doctor how much did it cost to get X done if I wanted to pay in cash. He didn’t know and looked dumbfounded by such a simple question.

In what other profession can a professional perform a task not knowing what he’s charging for the services being rendered?

Re: Unnecessary medical care is harming patients physically and financially (2015)

#43

Post by maxerickson »

learnstats2 wrote: post #29

The article pins part of its argument on the claim that advances in diagnostics have not changed the death rate for (e.g.) breast cancer during the past quarter century, but a superficial search immediately suggests this to be grossly false. "Death rates from female breast cancer dropped 39% from 1989 to 2015." - all other things being equal, it ought to have increased: age is a risk factor for cancers, and we have a…

How do the survival rates speak to the impact of advances in diagnostics?

For improvements in diagnostics to be particularly important to survival rates, you'd need to show things like cancer being found much more often now or that finding it sooner (than was typical in 1985) greatly improves survival rates.

Really what has happened is that treatments have gotten a lot better.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#44

Post by [deleted] »

tr0ut wrote: post #11
mtgx wrote: post #4

It sounds like in the "free market healthcare" system hospitals are incentivized to get the patient to spend as much as possible. That's aside from other bad incentives of such a system such as hospitals not wanting to be transparent with their prices, insurance companies not wanting to take patients with pre-existing conditions, also wanting to cover as few conditions as possible, Big Pharma being incentivized to as…

You have the wrong idea. A better example of what you're calling "free market" would be dentistry or something like Lasik surgery. You can shop around and figure out the prices because they are very much apparent since you pay out of pocket for the majority of the former and completely for the later. Would Medicaid/Medicare be "free market"? Why bother shopping around when someone else picks up the tab? Insurance com…

[deleted]

Re: Unnecessary medical care is harming patients physically and financially (2015)

#45

Post by kreco »

For the physical harming, Nassim N. Taleb wrote a book called "Anti-Fragile" desribing the concept of iatrogenic illness.

https://en.wiktionary.org/wiki/iatrogenic

An alarming fact was less dying patients when an hospital workers were in a strike action (during 2 weeks).

Re: Unnecessary medical care is harming patients physically and financially (2015)

#46

Post by maxerickson »

tinokid wrote: post #14
marze wrote: post #6

This article makes it sound like medical costs in the US could be halved if everyone understood this problem, and did their own research on proposed procedures.

Nice idea, but how realistic is it? Most patients are not scientifically-literate, some are flat out incapacitated. For all the stories about heartless insurance companies denying to pay for things, perhaps they should actually be more strict. As in, refuse to pay for anything unless there is 1) rock-solid (i.e. double-blind, placebo-controlled) evidence that it helps 2) for a specific, objectively verifiable indicat…

In the US system you agree to pay any bills the insurance will not cover prior to receiving treatment.

Which is an obvious opportunity for improvement. When a giant hospital and a giant insurance company get in a knife fight over whether a procedure is covered, the patient shouldn't be the loser.

(Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim)

Re: Unnecessary medical care is harming patients physically and financially (2015)

#47

Post by tyu100 »

joncrane wrote: post #5

Sounds like another one of those "this is what happens when money (as opposed to patient wellbeing) becomes a driving factor in health care." I remember I tried to find a PCP once and I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member unless I had two intake visits. They were gaming the insurance system.

Did you read the article? It was a very nuanced look at how to provide medical care and the reasons caregivers and people either under-treat or over-treat and the high levels of uncertainty about the efficacy of any given medical procedure. Certainly financial issues are a large part of the equation but certainly not the only one.

Really an excellent read overall.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#48

Post by Retric »

phil21 wrote: post #33
0xcde4c3db wrote: post #23

Earlier quoted context omitted.

I'm not sure it would. Given the information asymmetries involved, how does it avoid the "market for lemons" problem?

I think HN could do with some older folks on it. Heck, I remember growing up and using insurance was rare. You paid cash for your doctor visits, and typically only used insurance for major hospital stays as that's more or less all it covered. Doctor visits just 30 year ago did not cost what they do today. You could get a clean break in your arm, go into your GP, have it fully fixed and be out the door for less than a…

Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. However, this improvement takes a lot of effort and really does mean higher prices.

So, all you are proposing is rationing care aka if people can't get care then cost is not a problem.

I would suggest a public option that excluded any patented medication or extensive intervention could be really cheap if you also removed most paper work and the ability to sue. But, nobody would accept a significantly lower standard of care.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#49

Post by heimidal »

joncrane wrote: post #41
LeifCarrotson wrote: post #27

Earlier quoted context omitted.

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

Exactly. You have to be an established patient to get some of the benefits, the most important being (IMO) being able to see a doctor within a day or two if you're really sick. (But not emergency room sick)

Even as an existing patient, I’ve been quoted wait times of more than three weeks to see my PCP.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#50

Post by blattimwind »

jessaustin wrote: post #17
Broken_Hippo wrote: post #9

Earlier quoted context omitted.

I'll take the socialist healthcare over the shit I got in the states, thank you. Sure, every system has its own problems and it isn't perfect. But I can get care. My yearly out-of-pocket is less than some folks pay per month for premiums, and definitely less than the average deductible. No more fears of losing a job and therefore losing medical coverage or going broke because of something out of my control. Have you…

See irony.

I even threw in "free [as in choice not cost] healthcare", but I guess that's Poe's law for you.
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