Unnecessary medical care is harming patients physically and financially (2015) • Hacker News Board

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

#241

Post by HarryHirsch » Fri, Mar 02, 2018, 10:57 PM UTC

tinokid wrote: post #115

phil21 wrote: post #33

Earlier quoted context omitted.

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…

"People cared" maybe plays a bigger role than you realize here. There were stronger social norms back then about the role of medical care in society. Most hospitals were community or religious owned, physicians were content with merely above average professional salaries, and you never saw any kind of advertisement that ended with "ask your doctor about X". I think it's naive to assume the 16.5%-of-GDP octopus we've…

You also wonder how much consolidation has had to do with the erosion of social norms. An owner of a community practice might feel constrained in a different way than an employee at a healthcare company.

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

#242

Post by tinokid » Fri, Mar 02, 2018, 11:22 PM UTC

skadamou wrote: post #136

tinokid wrote: post #14

Earlier quoted context omitted.

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…

> "3) when provided by a doctor whose track record is demonstrably non-inferior to that of other practitioners" This is interesting. I think there will always be a somewhat normal distribution of medical skill among doctors so how do we decide whose track record is good enough to preform which procedures? We probably don't need top preforming doctors to implement every procedure but then how do we decide which proced…

Right, it's not easy and there are adverse selection issues when you start incentivizing doctors to avoid complex cases that are more likely to involve complications. And the scientific basis for a given procedure is likely more important than minor variations in doctors' technical competence levels.

That said, insurers have better insight into this than almost anyone else. If they see a young person with almost no medical claims go in for an elective foot surgery with Doctor Lexus, and then all of a sudden that person is attending physical therapy and filling opioid prescriptions every month, that's a bad sign. If it happens more than once, insurers should feel empowered to go ahead and shut the good doctor down. But this does not happen.

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

#243

Post by Omnus » Sat, Mar 03, 2018, 12:21 AM UTC

jartelt wrote: post #96

s3nnyy wrote: post #85

Earlier quoted context omitted.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

MRIs should be safe. It's the unnecessary CT scans you want to avoid. Those blast you with x-rays and increase your risk of cancer by a non-negligible amount.

Not really. The absolute worst estimates for CT scans increasing your risk of fatal cancer is around 1 in every 2,000 scans. That statistic almost certainly isn't true, since we'd see skyrocketing cancer rates since the development of CT scans, which we haven't. But even assuming it was true, that's pretty close to a "negligible" risk. 1 in 5 people will die from cancer. That's 400 out of 2000. Getting a CT scan makes your risk 401 out of 2000 in the worst possible scenario. If anything, that's an argument for more CT scans (as long as they're necessary or preventative), especially if you're at risk for certain types of cancer and could detect it early with preventative scans. MRIs would be better in that case, but you aren't going to die from a CT.

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

#244

Post by goblin89 » Sat, Mar 03, 2018, 1:34 AM UTC

hestipod wrote: post #218

thebladerunner wrote: post #216

Earlier quoted context omitted.

Please do share your story! We need to understand your situation first. I'd suggest a separate post but also link it here.

I thought linking to other self posts was against the rules...is it allowed? I was also advised by several people to post early in the week and morning for best traffic. Friday evening seems the worst time to start new and this post will be dead by tomorrow. I've been agonizing over how and when to post for a while now as it's my hail mary and it is just such an all encompassing misery. Facing actually laying my soul…

> I am also panicking over edits and fearing missing the mark

Maybe you’re already doing this, but if not—having somebody read a draft of your post ahead of publication might help. Sorry about what you had to go through.

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

#245

Post by _emacsomancer_ » Sat, Mar 03, 2018, 3:41 AM UTC

pjc50 wrote: post #170

TallGuyShort wrote: post #142

Earlier quoted context omitted.

>> vague forms hurridly shoved in front of me as I was being prepped and legally he as allowed to One of the many problems when the legal system has just become "formalities" that only get used by the powerful against everybody else. Last time we had a baby the hospital was so prepared they were able to bill us for the entire pregnancy when we arrived for our first prenatal check-up. But somehow they couldn't show my…

> somehow they couldn't show my wife the forms that waived her right to sue the hospital, her agreement to pay whatever they billed her regardless of correctness of timeliness This really ought to be illegal. It's continually amazing how the US has seemingly no effective consumer rights organisations.

That would erode rugged individualism though, right?

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

#246

Post by saagarjha » Sat, Mar 03, 2018, 4:34 AM UTC

39d3493I93 wrote: post #225

hliyan wrote: post #37

I live in a 3rd world country (Sri Lanka). Healthcare is not as advanced as it is in the US, but it is decent for all except the most complicated cases. The vast majority of people use the free services at state hospitals. If you want slightly better care, you can go to a private hospital and still come out with most of your wealth intact. I recently had a minor surgery to remove a conjunctival granuloma from my left…

You bring up a couple of interesting points even if you don't realize it. There are a couple of things that impact your experience that are externalizations. For example, your "cheap" healthcare is largely due to massive amounts of subsidies and NGO work that goes into helping third wold countries provide such "cheap" medical services. In many ways, due to rather authoritarian types in control in government in the we…

Wait, so you’re saying that we’re subsidizing Sri Lankan healthcare? US’s aid to Sri Lanka is in the tens of millions of dollars; this wouldn’t even put a dent in their total medical expenses.

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

#247

Post by nazgulnarsil » Sat, Mar 03, 2018, 5:14 AM UTC

hestipod wrote: post #117

I was preparing to make a long post asking for ideas/help (been saying that for weeks but it's ready and I was waiting to Monday since weekends are slower) This sort of thing ruined my life, cost me everything, and has finally brought me to the precipice. I was convinced 15 years ago to have surgery to "prevent later disability" and it ironically left me disabled and in severe pain. I later found out abroad from seve…

This won't help with the physical problems, but do check out Shinzen Young's material on pain relief. He describes practices that have helped many many people (known as 'sensory splitting' in the western medical world). I personally went from suicidal from chronic pain to being able to enjoy life due to these practices. https://www.shinzen.org/wp-content/uploads/2016/12/art_synop...

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

#248

Post by gnarbarian » Sat, Mar 03, 2018, 6:58 AM UTC

saagarjha wrote: post #246

39d3493I93 wrote: post #225

Earlier quoted context omitted.

You bring up a couple of interesting points even if you don't realize it. There are a couple of things that impact your experience that are externalizations. For example, your "cheap" healthcare is largely due to massive amounts of subsidies and NGO work that goes into helping third wold countries provide such "cheap" medical services. In many ways, due to rather authoritarian types in control in government in the we…

Wait, so you’re saying that we’re subsidizing Sri Lankan healthcare? US’s aid to Sri Lanka is in the tens of millions of dollars; this wouldn’t even put a dent in their total medical expenses.

In a way the U.S. does subsidize healthcare in the rest of the world by performing most of the research. It's part of the reason drugs cost so much in the U.S.

"Of almost 3,000 articles published in biomedical research in 2009, 1,169, or 40%, came from the United States."

https://www.forbes.com/sites/matthewherper/2011/03/23/the-mo...

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

#249

Post by hliyan » Sat, Mar 03, 2018, 9:03 AM UTC

saagarjha wrote: post #246

39d3493I93 wrote: post #225

Earlier quoted context omitted.

You bring up a couple of interesting points even if you don't realize it. There are a couple of things that impact your experience that are externalizations. For example, your "cheap" healthcare is largely due to massive amounts of subsidies and NGO work that goes into helping third wold countries provide such "cheap" medical services. In many ways, due to rather authoritarian types in control in government in the we…

Wait, so you’re saying that we’re subsidizing Sri Lankan healthcare? US’s aid to Sri Lanka is in the tens of millions of dollars; this wouldn’t even put a dent in their total medical expenses.

This is correct. As far as I know, there's no significant foreign funding coming into the Sri Lankan health sector. Most of the foreign aid that did arrive, went into post-war reconstruction efforts.

Also worth noting: higher education (including Medical College) in Sri Lanka is free.

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

#250

Post by arkades » Sat, Mar 03, 2018, 2:58 PM UTC

mortenjorck wrote: post #239

arkades wrote: post #134

I worked in health insurance, and had a graduate degree in health policy, before I second-careered into medicine. I helped implement some of the programs that Guwande promotes in this article; I was and am a true believer in some of these programs, and have built my medical career around implementing them properly. I say all that to provide an important caveat: Guwande's a Harvard-associated surgeon largely insulated…

> iatrogenesis compensation fund built at the national level An FDIC for malpractice suits is an interesting idea. Is there anything comparable to this in universal healthcare systems like the NHS?

Yes, France has this as the national scale, and we have something similar for certain federally-qualified facilities aimed at low-income communities. In our case, they need to maintain an ongoing, federally audited QA/QI program, but as long as they meet those requirements any malpractice suits get redirected to a federal malpractice policy.