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

61–70 of 228 posts

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

#61

Post by [deleted] »

noobermin wrote: post #48
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 too…

[deleted]

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

#62

Post by derbOac »

bu7w41t wrote: post #29
a-user-you-like wrote: post #20

Earlier quoted context omitted.

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…

“… encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other areas.” Sounds stifling. What’s the problem with holistic training? Except some admin does not want to pay for it? Extreme division of labor will just create backups for some specialists and time to twiddle thumbs for others. The opposite across society seems necessary; people need to become more se…

I don't know. In my opinion there's nothing wrong with holistic training but I think there's also nothing wrong with different training paths. Better to let them all flourish and find their way in the system.

It all needs to happen in my opinion though: let the current provider models stay, but let in lots of other educational models, and empower people to take more care of themselves by giving them access to what they need. Everything is far too overregulated in medicine, or at least is regulated in the wrong way.

Even within the physician model it's broken and overregulated. Board certification is ridiculous and insane in some specialties.

I think medicine is just an amplified version of a lot of problems in the US, but it also has significant consequences for life and wellbeing.

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

#63

Post by ars »

lotsofpulp wrote: post #36
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. What does this mean? The Affordable Care Act did not directly increase deductibles. It even provided huge subsidies from the young and healthy to the poor and old via age rating factors, restricting of pricing criteria (removal of pre existing conditions exclusions…

> The Affordable Care Act did not directly increase deductibles.

My deductible before the ACA was around $500 before, and around $4000 after. In one year it changed that much. Other people I've spoken with had the same experience.

> It even provided huge subsidies from the young and healthy to the poor

Only to people not in employee health care plans, which always have high deductibles.

> about their premiums going up due to being in the same risk pool as poorer and sicker people.

I'm not seeing the connection. People can buy whatever plan they want, receiving the money in cash doesn't force people into any particular risk pool. Not to mention the ACA majorly combined pools, and in fact did cause premiums to go up for this exact reason.

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

#64

Post by giardia »

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…

>concierge doc

Can you please elaborate? I need something like this and I'm willing and able to pay for it.

How would I get started finding one?

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

#65

Post by mikeyouse »

runnerup wrote: post #33
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…

Do hospitals lose money on medical residents without federal funding? I'd figure residents provide a lot of labor for the hospitals.

Yeah, residency programs are extremely expensive to run -- most of the work they do is duplicative, especially for 1st & 2nd year students. You're essentially paying multiple doctors a little money to follow doctors who make a lot of money around. They do cover overnight shifts, but they still need to be supervised by 'real' physicians so there aren't really any savings. Vox did a good summary of the whole situation last year;

https://www.vox.com/22989930/residency-match-physician-docto...

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

#66

Post by RhodesianHunter »

dr_ wrote: post #50

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 thi…

No it was not bound to happen. Greed and deregulation made it happen.

Don't give people inflation adjusted raises for a decade, remove all nurse to patient ratios, run them through hell, and then you're right it's inevitable

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

#67

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…

A high deductible plan can save you money on the front end, but if you start using that plan you should prepare for rain - a deluge of bills from providers who have no idea what the insurance owes and what you owe.

And God-forbid you use a narrow network plan like an EPO because it's hard to figure out ahead of time what services are covered by the network and what's not. I went to see a doc who was in-network and only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.

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

#68

Post by dmitrygr »

bruce511 wrote: post #37
wrp wrote: post #25

Earlier quoted context omitted.

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally com…

> are not a grassroots movement, people in the street demanding insurance-based healthcare.

> No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies.

I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.

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

#69

Post by jeanlucneptune »

giardia wrote: post #64
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…

>concierge doc Can you please elaborate? I need something like this and I'm willing and able to pay for it. How would I get started finding one?

Basically, like a doctor with a membership club. Generally doesn't take your insurance, although some services might covered by your insurance.

Good example is MDVIP - https://www.mdvip.com/. I have no relation to the company other than being a customer. I pay $1,600 a year for my Mom to be a member and it's the best money I've ever spent.

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

#70

Post by RhodesianHunter »

anon291 wrote: post #47
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…

What you're saying maybe true in the long run but it's not true right now. There are more nurses holding nursing degrees that are not in bedside care than nurses performing bedside care right now in the United States.

These people could easily be brought back into bedside care but the pay and conditions are absolutely abysmal.

Post reply on HN