The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician • Hacker News Board

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#41

Post by gretch » Thu, Jan 12, 2023, 3:50 AM UTC

wrp wrote: post #30

CynicalMD wrote: post #2

Continued: Why did you end up in the ER in the first place? If you’re lucky enough to have a primary care doctor, they probably couldn’t see you for at least a week or two because they’re too busy. By busy, I mean filling out prior authorization forms - the bureaucratic stranglehold of the health insurance companies is immense. If you had abdominal pain the primary care doctor could easily order labwork and a CT scan…

> Patients yell, they are demanding, they are untrustworthy. This gets a lot of comment, but it's half the story. I get most of my medical care abroad, but have escorted family through through local medical visits. I've noticed a marked decline in empathy among medical staff the past few years, even in the secretaries at the front desk. This seems to be a general social trend, not just a problem of bad patients.

It’s probably a runaway positive feedback loop. Someone is an asshole to you, you’re less likely to treat the next patient as well, leading to them treating the next nurse a bit worse.

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#42

Post by no_wizard » Thu, Jan 12, 2023, 3:51 AM UTC

jeanlucneptune wrote: post #39

Veteran doc and health services executive here. Three recommendations to improve your overall healthcare experience as a patient. Number one recommendation: spend $$$ on a concierge primary care doc. Depending on your market can be anywhere from $1,500 to $15,000 per year. Why? Concierge doc will help you triage your problems, give you great access, keep you out of the hospital/ER, and help you cut through red tape i…

I have to say, at least if you're tied to employer healthcare plans, there are bad Aetna and United contracts out there. I've had better runs (on the west coast at least) with Anthem Blue Cross, in terms of engaging with the system. I've been lucky enough in my life to have high quality plans that the employer subsidies (100% paid for me, 80% for my partner) with very low deductibles, and they're PPO to boot (no HMO hoops), which helps when you want to completely by pass getting a recommendation to see a specific doctor (useful when you know what you're doing)

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#43

Post by bruce511 » Thu, Jan 12, 2023, 3:51 AM UTC

lotsofpulp wrote: post #19

AnimalMuppet wrote: post #11

Earlier quoted context omitted.

I could see a single payer system having the same problems. All it would take is a system with some incentive to save money, and a bureaucracy. I could easily see Congress designing a single payer system that had both of those. Would it be as bad? Hard to say. In one way it would be worse: There would be no alternative. You couldn't switch insurance providers to get something better. And, in fact, just today I saw st…

>I could see a single payer system having the same problems. You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system. I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in orde…

To be fair, the current govt is preciding over a (self inflicted) economic collapse in all areas, not just the NHS.

And ultimately voters have no-one to blame but themselves. (or half of them anyway.) leaving the EU is epically dumb on a truly impressive scale.

So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces.

Japan might be a better place to look if you want examples.

In truth the US has plenty of money in the pot to implement effecient health care. But for-profit companies will not go quietly into the night.

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#44

Post by [deleted] » Thu, Jan 12, 2023, 3:51 AM UTC

jeanlucneptune wrote: post #39

Veteran doc and health services executive here. Three recommendations to improve your overall healthcare experience as a patient. Number one recommendation: spend $$$ on a concierge primary care doc. Depending on your market can be anywhere from $1,500 to $15,000 per year. Why? Concierge doc will help you triage your problems, give you great access, keep you out of the hospital/ER, and help you cut through red tape i…

[deleted]

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#45

Post by spicyusername » Thu, Jan 12, 2023, 3:52 AM UTC

blueridge wrote: post #10

This seems like a good spot to repost a few passages from Limits to Medicine, Medical Nemesis: The Expropriation of Health by Ivan Illich, 1974: "A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes, on a healthy diet, in an environment equally fit for birth, growth, work, healing, and dying; they are sust…

Great quote, thanks for sharing.

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#46

Post by netdoll » Thu, Jan 12, 2023, 3:52 AM UTC

runnerup wrote: post #34

ars wrote: post #26

Everyone knew Obamacare would cause this (or make it worse), but no one could do anything about it because there was no alternative plan acceptable to a large enough majority. Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What should have happened is politicians should have worked on costs , not on payments. The…

> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. I don't understand this. Are you saying everyone just lets the bills for the deductible go to debt collections?

I've heard it often remarked in my circles (wryly and bitterly) that "bankruptcy and gofundme are the American health care plans of choice". So yes, it would seem that for a lot of stuff the plan is just to let it go to collections and then default for as long as you can get away with it.

(n.b. I have some relatively significant physical health issues, so if I can't afford medical tourism and/or get on an absurdly good plan before I'm 26, I may end up being forced into a strategy like this)

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#47

Post by anon291 » Thu, Jan 12, 2023, 3:52 AM UTC

Apreche wrote: post #27

I have a question, which you may not know the answer to, but I'm just asking it to everybody these days. Let's say hypothetically that all the medical providers suddenly all decide to stop being evil. They increase staffing to safe ratios. They even have extra staff so people can take vacations and have days off without it being a problem. They give everyone very good compensation and the big time administrators stop…

The deeper problem is the demographic pyramid. We have lots of old people and the younger generation is smaller. Of course there's not enough caretakers, which is why the US systematically imports them from other countries, leaving those countries with the same problems.

Ultimately, there is no escaping the market. No amount of public-funding, socialism, or outright communism can escape the simple facts of supply and demand. Right now, medicine is expensive because demand exceeds supply. Do insurance companies and bad administrations exacerbate that? Yes, of course they do. But they are only exacerbating an existing problem.

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#48

Post by noobermin » Thu, Jan 12, 2023, 3:53 AM UTC

blueridge wrote: post #10

This seems like a good spot to repost a few passages from Limits to Medicine, Medical Nemesis: The Expropriation of Health by Ivan Illich, 1974: "A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes, on a healthy diet, in an environment equally fit for birth, growth, work, healing, and dying; they are sust…

The alternative you ask for then, is for people to merely die and suffer in pain while doing so. In the past, that's what we did, because there just was no option for such people.

I looked up Ivan Illich, and this essay critiques modern medicine as creating "lifelong patients." That indeed is what has happened, but the alternative is for people to just die. The reality really is I don't really believe anyone ever took death "peacefully" as he puts it here, they too raged and cried and felt all the painful emotions people feel today, they just would actually die and so those emotions would eventually cease. The argument then should be about values: do we actually value human beings as sacred, important things, and their lives are worth preserving just because they are human? The only way you can accept his argument is your answer to this is no.

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#49

Post by noobermin » Thu, Jan 12, 2023, 3:55 AM UTC

a-user-you-like wrote: post #20

orbz wrote: post #3

I’ve been working in the health tech space for awhile now and it’s sad how you’re not alone in noticing this. It’s the dirty secret of the entire industry, and there’s too many things disincentivizing any fixes. The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men an…

We already have a ridiculously regulated, stifling environment. More stifling is not the answer, just look at the wait times and patients being denied basic care in Canada and the UK. We need to end the ridiculous grip the AMA has on the # of doctors; get rid of the hospital certificates of need, and encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other a…

https://en.wikipedia.org/wiki/Jim_(horse)

Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician

#50

Post by dr_ » Thu, Jan 12, 2023, 3:55 AM UTC

Wasn’t this bound to happen? The US population is aging rapidly, their need for healthcare services continues to grow, yet there are limited resources. I’ve had an elderly parent go thru COVID, fall and get badly bruised (but nothing broken), develop a gastroenteritis - and my goal was to manage them at home and avoid a hospitalization. Fortunately it worked out, but I know it won’t always. The only way to manage this onslaught to the system is to be able to better monitor and manage patients as outpatients - so that the heart attack, stroke etc can be avoided. The system is not quite there yet, but it is heading in that direction.