Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

news.ycombinator.com

Post reply on HN
Print view View original

51–60 of 228 posts

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

#51

Post by mikeyouse »

dcolkitt wrote: post #22
mikeyouse wrote: post #18

Earlier quoted context omitted.

There is no limit by rule -- just by funding. We've had really nice increases in medical school graduates since the ACA, but predictably, one of the two major parties is staunchly against spending more dollars on residency slots so they torpedo the legislation every time when it's proposed (the vast majority of residency funding is provided via Medicare). The most recent bill: https://www.congress.gov/bill/117th-cong…

The issue isn't a shortage of residency slots, it's that we don't allow doctors with foreign residencies to practice in the United States. The physicians in Spain and South Korea and Costa Rica are really good. Arguably better than American doctors based on health outcomes. Many would jump at the chance to earn high American wages. There's no reason a South Korean doctor with ten years of experience in the world lead…

I mean, that's one solution to a similar problem - but we also have a fixed number of residency slots and an increasing number of med school graduates, including overseas ones who could come to the US and complete their training in US Residency programs.

https://www.aamc.org/news-insights/medical-school-enrollment...

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

#52

Post by jeanlucneptune »

no_wizard wrote: post #42
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…

Agreed. If your employer is trying to skimp on cost you can end up with some really poor options. Lesson there is to find an employer that offers generous benefits. Easier said than done, I know.

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

#53

Post by vladvasiliu »

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…

> 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 and bureaucrats blocking this change.

By "single payer" do you mean the European model of "socialized" healthcare? That may be necessary (I don't know) but it's clearly not enough.

I'm in France, and I hear the exact same complaints from physicians here [0], and the hospitals seem to be in terrible shape. People quitting or being on leave, hence understaffing, so more people quitting because of burnout, etc.

[0] Basically, the gist is that for some time, hospitals have been run "like an enterprise", seeking (cash) efficiency above all. There was absolutely no slack in the system, so when COVID hit, medical professionals ended up in a terrible situation. This situation has not subsided even after the epidemic became less of an issue.

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

#54

Post by ShredKazoo »

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…

>Number three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system.

Why would the size of the deductible/copay affect the amount of paperwork? My naive assumption would be that the amount of paperwork would be O(1) with respect to the amount of money changing hands -- same way you will always be asked if you want a receipt in a store, regardless of how much stuff you bought.

Also, how do I know if an insurer is "high quality"? Neither Aetna nor United is available in my state.

(Thanks in advance for any replies -- I still have about 3 days during which I can switch my insurance for 2023; was thinking of switching to a high-deductible plan since I don't anticipate using my plan much in 2023)

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

#55

Post by bruce511 »

acdha wrote: post #32
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…

Given how many news stories there have been about people leaving the field due to the working conditions, low pay, and insurance red tape, it seems like getting rid of that enormous layer of inefficiency would do double duty both in terms of freeing up money for productive uses and not pushing experienced workers out.

You use the words "red-tape" and "inefficiency" there in a very patient-centric way.

Whereas from a profit point of view fewer doctors is good, more insurance red tape is good, effeciently increasing bills and billing customers is good.

The health system is set up to maximise profits. And it is doing so most effeciently. If you want a different outcome then you need a different system.

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

#56

Post by toomuchtodo »

runnerup wrote: post #31
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…

> But if the deeper problem is there, is there any short term solution? No. > Sure we can start training people and make lots of incentives for people to enter the field, but that will take years. Yes. But it should be done. Also, there shouldn't be shortages of saline IV solution and bacteriostatic water -- but no one's rebuilding the factories destroyed by hurricanes in Puerto Rico because there's not "enough" of a…

Some things should not be ruthlessly efficient; what appears to be waste is tail risk premium. Alas, that “efficiency savings” becomes someone’s bonus or profit, and a loss for the rest of us.

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

#58

Post by maerF0x0 »

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…

Unfortunately we seem to be stuck in a local maxima, where we do not yet know how to do permanent regeneration to keep someone well in the healthy zone, but also know how to keep people into what can best be describe as "Not yet dead" (but certainly not "healthy" either).

Groups focused on longevity and removing age related diseases, in theory, should eventually get us to a point where the best parts of youth (including learning and plasticity) should make it unnecessary to have children any more, save for replacement of those who die from other causes (and maybe populating other planets etc).

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

#59

Post by ars »

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?

> just lets the bills for the deductible go to debt collections?

Yes. Nothing happens as a result. They mail letters, and try to call, and that's about it. It doesn't even hurt credit scores, since they exclude medical debt.

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

#60

Post by jeanlucneptune »

ShredKazoo wrote: post #54
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…

>Number three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system. Why would the size of the deductible/copay affect the amount of paperwork? My naive assumption would be that the amount of paperwo…

If you have a zero copay plan and your provider is in-network, for example, you're not going to be getting a bill in the mail later saying you owe XYZ dollars.

If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare.

In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).

Post reply on HN