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America’s Looming Primary-Care Crisis

newyorker.com

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Re: America’s Looming Primary-Care Crisis

#91

Post by frank2 »

pm90 wrote: post #90
frank2 wrote: post #89

Earlier quoted context omitted.

True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.

It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.

Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food.

I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of the group collectively deciding to continue the subsidies probably know or strongly suspect that.

In my experience, the elected representatives and other influencers arguing for the subsidies don't even use food security as an argument. (Again, like others in the thread, I am restricting myself to US food policy.) Instead, they argue that the family farm is a producer of particularly virtuous individuals, and it would be a shame if all the family farms were to be driven out of business by large corporations.

The US Midwest has the largest tract of arable land in the world and twice as large as the second largest. If the people of the world were redistributed among the countries so as to equalize the probability of famine among the countries, the US would probably end up with a population over a billion.

Re: America’s Looming Primary-Care Crisis

#92

Post by curryst »

spaetzleesser wrote: post #65

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets…

A big part of it is that nurses have been granted authority to do more procedures/prescriptions, and are now overlapping with doctors. For healthy people, a nurse practitioner could probably fulfill all of your standard medical needs.

You can see the effects of this in the clinics popping up inside a lot of grocery stores in the US. They have nurses on staff who can do standard procedures like flu shots, strep tests, common cold treatment etc. And to me, it seems, the outcomes are effectively the same. You get your tests, if it comes back as something known, they prescribe you meds. If not, they advise you to go to the hospital or a specialist.

Re: America’s Looming Primary-Care Crisis

#93

Post by spaetzleesser »

Nasrudith wrote: post #81
spaetzleesser wrote: post #65

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets…

The assumptions are incorrect. Medical associations may influence supplies to some degree but they don't set the price. Supply, demand, and what the market may bear do. There are also really several different healthcare systems. The government can set say VA rates and medicare to some degree. The sort of balancing done is encouraging more family doctors. Radiology and anesthesiology are also two "cash cows" of proced…

I was thinking about this: https://en.wikipedia.org/wiki/Specialty_Society_Relative_Val...

"Supply, demand, and what the market may bear do."

I agree about "what the market may bear". Normal supply and demand market ideas really don't apply to a lot of medical areas.

Re: America’s Looming Primary-Care Crisis

#94

Post by hippich »

ackbar03 wrote: post #70
Coldgamr wrote: post #59

Earlier quoted context omitted.

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 6…

How does this work with the insurance dynamics though? You say no insurance full stop, does that make the cost prohibitively high for some? I feel like insurance in a way is similar to a membership model for the patient in terms of cash flow although definitely not the same for the doctors. I'm not in the US so I don't really understand how medicaid works over there

Everything my doctor can do in the office, is part of the monthly fee. Everything on top of it - either cash or insurance. Labs are very cheap when ordering through my doctor (I am talking about $4-$8 for typical stuff). Prescription drugs - i fill through the insurance (fixed co-pay in my case) and if something major will happen, like accident or such, my regular insurance will kick in (after paying several thousands out of pocket)

The thing is - the most expenses I had throughout the years I lived in the USA were on primary doctor and labs. Only in one year out of 10 I had an accident where without a regular insurance I would be screwed.

So high-deductible plan + direct care is the most optimal setup for me right now.

Re: America’s Looming Primary-Care Crisis

#95

Post by NicoJuicy »

mlavin wrote: post #46
NicoJuicy wrote: post #38

Earlier quoted context omitted.

> 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 ;)

>endomorph body type Somatypes are an ancient pseudoscience, while caloric intake relative to TDEE doesn't lie.

Completely ignoring some persons that can eat everything they want and don't gain weight.

I lost 25 kg. In 6 months, with counting calories and all. But the amount of effort I had to deliver for a normal weight is almost exponentially more

1 hour strength training per day

1 hour cardio in the morning

No alcohol

6 * eating small portions

8 hours of sleep

1 cheat meal per week

Every day, no exceptions.

Re: America’s Looming Primary-Care Crisis

#96

Post by knubie »

nolangerner wrote: post #67
bluedino wrote: post #60

Earlier quoted context omitted.

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.

Where are you getting your numbers? Canada is at ~29% and the US is at ~36%. Sources: https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r... https://ourworldindata.org/obesity https://worldpopulationreview.com/country-rankings/obesity-r...

That's interesting, the CDC lists 42.4% for the US. https://www.cdc.gov/obesity/data/adult.html

Re: America’s Looming Primary-Care Crisis

#97

Post by PhantomGremlin »

naveen99 wrote: post #83
spaetzleesser wrote: post #65

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets…

Medicare had been cutting radiology reimbursements for a while, to the point radiology had almost a 100 unfilled residency spots in the us a few years ago. Radiologists are being paid the bottom of market clearing rates. You pay them much less than what they make now, and you will have a severe shortage quickly.

It makes utterly no sense to become a radiologist in the USA.

Of all the specialties, it's one of the easiest to "offshore". Just send the data to Elbonia and have someone there examine it.

There was a company hyped on Wall Street doing this a number of years ago, but my Google skills are lacking and I can't seem to find it any more. IIRC they were sending the data to civilized countries such as New Zealand (great for time shifting if for nothing else). So maybe they just weren't competitive with Elbonia.

Here's a similar comment someone made on HN a few days ago: https://news.ycombinator.com/item?id=23882138

Here's the first Google hit on "remote radiology": https://argusrad.com/8-remote-radiology-benefits/

   8 Benefits of Remote Radiology
includes:

   REDUCES COST
   NO SHORTAGE OF RADIOLIGISTS
Why waste years specializing when some "scab" can undercut you?

Welcome to the global race to the bottom!

Re: America’s Looming Primary-Care Crisis

#98

Post by jjk166 »

frank2 wrote: post #91
pm90 wrote: post #90

Earlier quoted context omitted.

It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.

Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food. I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of th…

The farm subsidies started after the great depression when food shortage was a serious possibility and national security was forefront. While the rhetoric has shifted, the real purpose has not. Yes, the US has the geography to produce vast quantities of food, but that's all useless if no one is farming it. Even with subsidies agriculture is neither lucrative nor appealing for the vast majority of individuals. If the few remaining farmers go off and get better jobs, a huge amount of implicit knowledge will be lost and a lot of infrastructure would be left derelict. This might not be a problem in the short term, America is wealthy enough to import food, but should its suppliers ever try to leverage that position then America would not be able to instantly resume producing the food it needs. Every major power heavily subsidizes domestic agriculture for the same reason.

Re: America’s Looming Primary-Care Crisis

#99

Post by JoeAltmaier »

frank2 wrote: post #91
pm90 wrote: post #90

Earlier quoted context omitted.

It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.

Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food. I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of th…

I've heard it said the US could feed the entire world!

Re: America’s Looming Primary-Care Crisis

#100

Post by fomine3 »

dialamac wrote: post #51
NicoJuicy wrote: post #38

Earlier quoted context omitted.

> 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…

Yes, What people eat is most important but Is metabolism not influenced from genes?
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