America’s Looming Primary-Care Crisis • Hacker News Board

Re: America’s Looming Primary-Care Crisis

#51

Post by dialamac » Sun, Jul 26, 2020, 2:55 AM UTC

NicoJuicy wrote: post #38

briandear wrote: post #27

Earlier quoted context omitted.

> it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Want ice cream after a hard running workout? Pay a tax. Don’t exercise enough? Pay another tax. Allo…

> Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual. You probably have better genes than my family. Lookup endomorph body type or reasons of reduced metabolism. Evolution has inversed survival of the fattest, so it seems ;)

That’s pseudoscience.

Regardless of any minor variability in metabolism, you literally cannot get fat from things you don’t put in. This is like high school or middle school physics. This is by far the biggest factor in obesity (consumption).. such that everything else is essentially irrelevant. People with actual metabolism disorders either die or require replacement of enzymes, whether that’s type 1 diabetes or the rarer metabolism disorders.

If you eat high volume foods with calories at or below what you’re expending, you will not get fat, full stop. Starving people aren’t fat.

There are of course behavioral differences that dictate consumption, some of which are genetically influenced, but metabolism has not much to do with it.

Re: America’s Looming Primary-Care Crisis

#52

Post by HarryHirsch » Sun, Jul 26, 2020, 2:59 AM UTC

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 think that other countries don't have housing, education and healthcare policies?

Re: America’s Looming Primary-Care Crisis

#53

Post by mandelbrotwurst » Sun, Jul 26, 2020, 3:04 AM UTC

gruez wrote: post #45

briandear wrote: post #27

Earlier quoted context omitted.

> it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Want ice cream after a hard running workout? Pay a tax. Don’t exercise enough? Pay another tax. Allo…

>It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Okay I'll bite. Why shouldn't we do that? If you're going to 28x your death risk[1] by participating in a purely non-essential activity, why should you be able to externalize the costs to others? >Perhaps instead of taxing food, we instead ta…

Who is going to decide which activities are "non-essential" ? How will they go about determining whether there are more benefits or costs associated with a particular activity?

Rock climbers can fall - they also build physical and mental fitness as well as learn to work together with and trust others in a high pressure environment.

Motorcyclists can crash, but they're choosing a form of transport that is far more efficient than a single passenger vehicle in many ways (fuel consumption, parking requirements, traffic impact).

People are already incentivized by nature to sort out on their own what sorts of activities will allow them and their communities to flourish. Let them. We will all be better for it.

Re: America’s Looming Primary-Care Crisis

#54

Post by baix777 » Sun, Jul 26, 2020, 3:04 AM UTC

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…

The issue with health care is it is a superior good. This means if someones incomes increases by 10%, people spend 12-13% more on health care.

Canada has more regulated health care than the US, and yet the health care has better outcomes and is delivered at a lower price. It isn't perfect, but having seen both systems, the Canadian one is overall better.

One of the reasons, although not the only one, for higher education prices is less subsidies for education at the state level.

I agree that city zoning, and the lack of quick public transit, explains much of the increased price of housing. But some of this increase in cost is due to increased population, and the amount of land in and close to cities being fixed. Higher density would help, but higher density housing to also more expensive to create than lower density housing. A lack of regulation also leads to outcomes like houses in Houston being build on flood plains.

There is a role for government and regulation, and a role for free enterprise, but to understand the balance one need to look a other countries it see if they have a better balance and what works well.

Re: America’s Looming Primary-Care Crisis

#55

Post by roenxi » Sun, Jul 26, 2020, 3:05 AM UTC

cortesoft wrote: post #26

pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

Adding to this; there is also no evidence that the US's politicians care about financial incentives as applied to the US government.

If it affects them personally then they'd jump like a cat on a stove; but if it only affects the budget they aren't going to respond to any incentive.

If the US was being influenced by financial incentives it wouldn't be doing many of the things it does. Like tax cuts or spending more money.

Re: America’s Looming Primary-Care Crisis

#56

Post by Coldgamr » Sun, Jul 26, 2020, 3:07 AM UTC

tristor wrote: post #32

hippich wrote: post #20

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…

I’d be interested in enrolling in a similar service. How do you find out about these services in your area?

DPC Frontier has a mapper with many, many practices on it along with prices, open date, and if it’s a “pure DPC” (i.e. no insurance) or hybrid (i.e. they also accept insurance for Medicare or other reasons). https://mapper.dpcfrontier.com/

Disclosure: I am the founder of Akute Health which makes software for DPC practices. https://www.akutehealth.com

Re: America’s Looming Primary-Care Crisis

#57

Post by baix777 » Sun, Jul 26, 2020, 3:10 AM UTC

runawaybottle wrote: post #8

1996 wrote: post #6

Earlier quoted context omitted.

Ban, ban, ban, then force people to work for the government? I'm not sure I want to live in the country you are suggesting we make. What about drugs are legalized instead, and the medical sector is deregulated for example by removing residency requirements? If a rating system can let anyone become the equivalent of a cab, we certainly can do the same with doctors educated abroad while also educating more at home.

You guys are missing the point. I’m saying the general public is too unhealthy for this not to be extremely costly going forward, whether it’s for profit or non profit. The only thing we solved is making sure you can live with the ailment. We didn’t solve the cost of continuous care. Whoever is born today, will enter the demographic of questionable health in just 40 years. That means in our lifetime we’ll have almost…

If you look at this from a socioeconomic standpoint, the poor are more obese and exercise less than the better off. Being poor is hard, so the wealth gap of the US looks to be partial cause of this, but the whole cause and effect is hard to determine here.

Re: America’s Looming Primary-Care Crisis

#58

Post by [deleted] » Sun, Jul 26, 2020, 3:10 AM UTC

evan_ wrote: post #29

pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

What if the money collected for the theoretical tax on sugar-containing products went directly to subsidize the sugar producers? Then again just ditching the subsidies would get the same thing done with less paperwork...

[deleted]

Re: America’s Looming Primary-Care Crisis

#59

Post by Coldgamr » Sun, Jul 26, 2020, 3:12 AM UTC

hippich wrote: post #20

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…

Thank you for sharing this anecdote. I don’t think enough people understand the value of direct primary care. Of note, concierge primary care is more associated with something like one medical where you pay a membership in addition to your regular insurance co-pays. Direct primary care, or DPC, is full stop no insurance, only membership. And the doctor will limit their patient panel (the patients they see) to about 600 or even less to ensure they can provide amazing service to those patients. Generally, primary care doctors see 3000 or more patients.

Disclosure: I am the founder of a DPC software company. I absolutely love this model for so many reasons. I’d love to answer questions people have.

Re: America’s Looming Primary-Care Crisis

#60

Post by bluedino » Sun, Jul 26, 2020, 3:15 AM UTC

baix777 wrote: post #48

pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

Canada is similar to the US in terms of food consumption, and yet Canada has much better health care outcomes and lower health care expenditures. I'm not saying food isn't a factor, I'm just wondering how big a factor it is compared to universal access to health care.

It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage.

Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.