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America’s Looming Primary-Care Crisis

newyorker.com

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Re: America’s Looming Primary-Care Crisis

#11

Post by maxerickson »

AdrianB1 wrote: post #4
paulcole wrote: post #2

Well well well, if it isn’t the consequences of 50+ years of terrible policy making. Who could’ve seen this coming except every other country on the planet?

No idea what you want to say, but in my country the situation is worse for about 100 years. Yes, we have free lack of health care: no resources shared to almost everyone, so we are equal in getting nothing.

The US centrally plans the healthcare supply and then doesn't control prices (sort of).

We can and should have lots more doctors (and other primary care providers), but we've long restricted that because people have wacky ideas about things like economics and intelligence.

Re: America’s Looming Primary-Care Crisis

#12

Post by coronadisaster »

dimensi0nal wrote: post #9
runawaybottle wrote: post #3

Earlier quoted context omitted.

You really think 5 months of a pandemic is going to expose this? New York is returning back to normal. The new surges will pass in the same time frame (5 months). The looming primary care crisis will show itself on a much longer time frame. It’s a snake that’s wrapping around, slow acting venom, and we’ll finally see it when it’s not just the ailing boomers that will need continuous care for ubiquitous things like Di…

Should health insurance, private or public, really pay to deal with people's self-induced health problems from eating too much, smoking, etc?

Maybe the health insurance companies should sue tobacco and fast food companies amoung others?

Re: America’s Looming Primary-Care Crisis

#13

Post by wwweston »

runawaybottle wrote: post #3
paulcole wrote: post #2

Well well well, if it isn’t the consequences of 50+ years of terrible policy making. Who could’ve seen this coming except every other country on the planet?

You really think 5 months of a pandemic is going to expose this? New York is returning back to normal. The new surges will pass in the same time frame (5 months). The looming primary care crisis will show itself on a much longer time frame. It’s a snake that’s wrapping around, slow acting venom, and we’ll finally see it when it’s not just the ailing boomers that will need continuous care for ubiquitous things like Di…

Your last sentence is logically equivalent to saying that no society can afford to give medical care to everyone, the only choice is who to ration it for, since Medicare-for-all is characteristically no different from any other comprehensive risk pool bridged over an entire population. And under conditions you're describing where the population truly is uniformly ill, every sub-population will look similar to the population at large, so no private insurance pool will do better by excluding some of the population.

Sounds like a problem.

Re: America’s Looming Primary-Care Crisis

#14

Post by refurb »

paulcole wrote: post #2

Well well well, if it isn’t the consequences of 50+ years of terrible policy making. Who could’ve seen this coming except every other country on the planet?

Canada is having a huge shortage of primary care doctors. So much many people don’t have one and have to rely on urgent care.[1]

This isn’t a US only issue.

[1] https://www.ctvnews.ca/health/despite-more-doctors-many-cana...

Re: America’s Looming Primary-Care Crisis

#15

Post by fennecfoxen »

maxerickson wrote: post #11
AdrianB1 wrote: post #4

Earlier quoted context omitted.

No idea what you want to say, but in my country the situation is worse for about 100 years. Yes, we have free lack of health care: no resources shared to almost everyone, so we are equal in getting nothing.

The US centrally plans the healthcare supply and then doesn't control prices (sort of). We can and should have lots more doctors (and other primary care providers), but we've long restricted that because people have wacky ideas about things like economics and intelligence.

> people have wacky ideas about things like economics and intelligence.

Boy howdy.

There are three major parts of the economy which are extensively regulated to achieve political goals: health care and higher education (on the national level with some state involvement) and housing (city-level zoning, with occasional other mandates particularly in places like California).

Notice then the three areas where prices have become radically more expensive over the past several decades, fomenting a crisis that threatens our prosperity as a nation: housing prices, higher education prices, health care prices...

Re: America’s Looming Primary-Care Crisis

#16

Post by disabled »

> Payers routinely reimburse health-care providers for specialized procedures at high rates, but primary-care visits—which might include chronic-disease management, routine vaccinations, or smoking and diet counselling—generate lower revenues. This imbalance is due, in large part, to the Relative Value Update Committee (R.U.C.), an extraordinarily powerful group of doctors that advises the federal government on reimbursement rates for physicians. The R.U.C. consists of thirty-one doctors convened by the American Medical Association; it’s structured such that each specialty has an equal say. On the R.U.C., urology, thoracic surgery, and head-and-neck surgery have, individually, about the same representation as all of pediatrics. The Centers for Medicare and Medicaid Services (C.M.S.), which has final authority to set payment rates for Medicare, has in many years accepted the R.U.C.’s recommendations nearly ninety per cent of the time.

This is more deadly than it appears on the surface.

For example, this article on life expectancy is a good read. One should pay close attention to the case of South Korea and how they are focusing on the health of the younger generation, which has the best payoff (By the way, I am both a citizen of the US and Croatia. The biggest difference: Croatia is going the right way, the US is not): https://www.washingtonpost.com/news/to-your-health/wp/2017/0...

Archived version of link: http://archive.is/3EpBi

Re: America’s Looming Primary-Care Crisis

#17

Post by maxerickson »

dimensi0nal wrote: post #9
runawaybottle wrote: post #3

Earlier quoted context omitted.

You really think 5 months of a pandemic is going to expose this? New York is returning back to normal. The new surges will pass in the same time frame (5 months). The looming primary care crisis will show itself on a much longer time frame. It’s a snake that’s wrapping around, slow acting venom, and we’ll finally see it when it’s not just the ailing boomers that will need continuous care for ubiquitous things like Di…

Should health insurance, private or public, really pay to deal with people's self-induced health problems from eating too much, smoking, etc?

A healthcare system should strive to make the care people need affordable.

Your framing is boring, we need to figure out how to make the care as widely available as possible regardless of the payment model.

Re: America’s Looming Primary-Care Crisis

#18

Post by kcb »

fennecfoxen wrote: post #15
maxerickson wrote: post #11

Earlier quoted context omitted.

The US centrally plans the healthcare supply and then doesn't control prices (sort of). We can and should have lots more doctors (and other primary care providers), but we've long restricted that because people have wacky ideas about things like economics and intelligence.

> people have wacky ideas about things like economics and intelligence. Boy howdy. There are three major parts of the economy which are extensively regulated to achieve political goals: health care and higher education (on the national level with some state involvement) and housing (city-level zoning, with occasional other mandates particularly in places like California). Notice then the three areas where prices have…

You really think that those are the only three things regulated to achieve political goals?

Re: America’s Looming Primary-Care Crisis

#19

Post by wwweston »

dimensi0nal wrote: post #9
runawaybottle wrote: post #3

Earlier quoted context omitted.

You really think 5 months of a pandemic is going to expose this? New York is returning back to normal. The new surges will pass in the same time frame (5 months). The looming primary care crisis will show itself on a much longer time frame. It’s a snake that’s wrapping around, slow acting venom, and we’ll finally see it when it’s not just the ailing boomers that will need continuous care for ubiquitous things like Di…

Should health insurance, private or public, really pay to deal with people's self-induced health problems from eating too much, smoking, etc?

Certainly an issue insurers have been thinking about for a while.

Funding certain kinds of care with heavy taxes on things like smoking makes a lot sense.

Other things like unhealthy eating (or sitting, HN participants, lookin' at you) are so much harder to draw easy lines dividing contributing activity from everyday liberties that it makes less sense. You can work at the margins with something like soda taxes or maybe even incentives around bloodwork but the tradeoffs are less clear along with the dividing lines.

Re: America’s Looming Primary-Care Crisis

#20

Post by hippich »

Anecdotal data point about primary care:

About a year or so ago I subscribed to "direct/concierge primary care practice". I pay $80/month and in exchange getting an access to a primary doctor who takes care of keeping an eye on me, my blood pressure, all my prescriptions (some of which used to require monthly visits to specialists). I am also getting access to really cheap prices on labs, typically 30 min visits same or next day if I wanted (unlimited visits per months), EKG when I wanted to put my mind at peace right there in the office ($25 one time fee), etc. Doctor is available over the phone, text or email. Does not dismiss me when I mention "I've read on internet..." something and actually explains things. Basically, I think it will take care of the most of my health care needs, as well as puts my mind at ease thanks to easy access to the doctor.

The doctor also refers me to specialists who's cash-prices were often below my co-pays.

For major accidents I still have a traditional health insurance with high out-of-pocket limit bought at the marketplace (self-employed).

This practice existed for quite some time and thanks to the subscription-based fees (not episodic described in the article), I expect it to be a long-term sustainable business. It is also owned by the doctor as far as I am aware. They explicitly do not deal with private or public insurances. (Although by recent law changes I can charge monthly fee to HSA account).

There are a few practices like that in the area. Can't say if others are similar in experience, but fees - are. So it looks like it is possible to build sustainable business around primary care. But it takes a different approach.

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