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

If I were king:

1) Free time-saver perks for all hospital staff. I'm talking cleaners to the houses, pre-cooked take-home family meals, the whole nine yards.

2) Temporarily lower the threshold for trained medical professionals. There are many students and immigrants with plenty of education and skills. Get them in hospitals until we reach the point where it becomes a space issue rather than a staffing one. Give more experienced staff priority pick on working hours. Stem the bleeding and stop the work exhaustion/burnout.

3) Start longer term efforts to ramp up training of medical professionals. It's only gonna get worse with the baby boomers retiring and needing their own care.

4) Tell "big insurance" and "big healthcare" to put up or shut up. Slap on metrics and quotas focused on efficiency and net outcomes. Tweak the metrics until they get the picture. Set the bars high enough that the majority of issues are solved if the bar is met. If they can't meet the bar, hit their pocket books until they go bankrupt, nationalize them, then convert to single payer.

> 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.

I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there.

I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Same issues with the health system. A few months ago we were rationing paracetamol. Now we're back to not allowing sales of it online because of shortages.

I'm not saying Brexit helped, but I doubt it was the main cause, seeing how the same exact effect happened elsewhere, at the same time, while staying in the EU.

It would seem to me that, for whatever reason, many countries chose efficiency of the healthcare system above all else. Meaning closure of hospital beds, reduction of medical staff, etc.

This may be great for producing cheap Toyotas. No one cares if theirs is one week late because something unforeseen came up. It doesn't work as well for medical emergencies.

> 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.

I meant the deductible increase was not a statutory part of ACA, but an inevitable part due to the drastic increase in benefits (all preventative care, all medicines assuming there was efficacy data, out of pocket maximum instead of benefit maximum).

Before ACA, insurance could deny you healthcare easily. After ACA, they had to provide the benefit, even if the medicine cost $1M per month, and the insurance company could not choose to drop you as an insured.

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

As far as I know, this applies to all ACA compliant health plans, even ones that employers subsidize:

https://www.healthcare.gov/how-plans-set-your-premiums

> 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.

Being part of an employer subsidized insurance plan’s risk pool can result in you being in a better risk pool than the public ones on healthcare.gov. For example, white collar businesses with lots of young, healthy employees like law firms and tech companies.

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCould open source EMR, built and operated ~90 acute care management services organizations (MSO) (the "things" that operate the non-medical aspects of many acute care systems).

Healthcare is highly dysfuctional but I want to dampen the notion a little bit that it is in some unique and new kind of collapse today. Everything you are stating is nearly verbatim what was being said in the 1980s at the dawn of HMO legislation which was somehow supposed to fix things.

There has been a lot of pushing the food around the plate since then. My view is that there are three legs to the tripod of the healthcare system, providers, patients and insurers. For fourty years those three legs have been fighting each other on many fronts and no leg is willing to give substantial ground. If I had a magic wand I would bring into existence a being of profound integrity and leadership that could negotiate meaningful compromises between those three groups but I think practically speaking, that is a pipe dream. The current status quo will continue, more or less, how it is for several decades yet.

I will agree with the other comentator that if you are sick a direct access primary care doctor or concierge doctor can really help. In many cases they can end up saving money versus deductibles and by helping you find specialists and facilities in your budget and timeframe. They vary but can be found in most markets for $1500 - $3000 per year. That's not cheap by any means but something that can pay for itself quickly.

I would also say to OP, seriously consider becoming a direct access provider. Feel free to reach out to me and I can put you in touch with some folks who you can talk to. You are not alone in your sentiment and in large part those sentiments are what led to the creation of direct primary care.

du@50km.com