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

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

#121

Post by HereIGoAgain »

Rury wrote: post #114
noobermin wrote: post #48

Earlier quoted context omitted.

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…

I disagree. Look at your body. It's multicellular, not one living thing. Your very cells both compete and cooperate with one another for resources to survive (just as we humans do amongst ourselves). For the greater good of the organism (you), individual cells are programmed to die when they are in poor health or old age or in too much stress, to allow younger healthier cells to take their place for the greater good…

Holy shit, GTFO of here with that shit. You first!

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

#122

Post by vgatherps »

vgatherps wrote: post #84
wrp wrote: post #30

Earlier quoted context omitted.

> 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.

Reminds me of a friend who passed away from what was essentially doctor apathy. While recovering from a major surgery started getting terrible abdomen pains. Doctors could hardly even be bothered to tell her to deal with it, completely dismissed her. about a week later a new resident comes in, pokes and prods her a bit (no doctor prior could even be bothered to do that), looks horrified and orders some scans. Her sto…

In case anybody is wondering whether there’s a game of telephone happening from mad family members, I was literally there watching this happen. I regret not speaking up.

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

#123

Post by DangitBobby »

RhodesianHunter wrote: post #78

The New York times recently had an excellent piece on how exorbitant greed, even in the non-profit side of healthcare, has decimated its quality over the last decades. https://www.nytimes.com/2022/12/15/business/hospital-staffin...

Wondering why this for profit organization isn't on the hook for tax fraud

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

#124

Post by vladvasiliu »

bruce511 wrote: post #115
vladvasiliu wrote: post #105

Earlier quoted context omitted.

Sure, every situation has its shortcomings, possibly even big sucking chest wounds which don't help. But my point was that if multiple systems, some of which seem different (US vs EU), all with different apparent wounds, appear to fail in the same way at the same time, maybe there's something that's common among them which is the actual cause. Perhaps it's just a coincidence. But which is more likely?

I would argue they're not failing in the same way though. The US system is "failing" in the sense that health services are not available/affordable to all. The NHS has issues with funding and staffing. France has issues with supply chains. Any system will have flaws, but just because no system is perfect it does not mean that all are imperfect in the same way.

France absolutely has staff and funding shortages, on top of the supply chain issues for medicine [0].

For the US, there sure is the affordability issue, but I don't think that's anything new. However, OP's point is that there had already been staff shortages for a while before COVID, but now the proverbial camel's back has been broken:

> Ultra lean staffing prior to covid led to the sh*tshow during the pandemic and, now that everyone is quitting, things are now in total collapse. [...] There are 30 rooms in the ER, but 3 nurses overnight…

This is the exact situation in France. The hospitals are physically still there, but there's not enough staff.

---

[0] French only, but the title reads "Health ministry admits to emergency services being closed" https://www.lefigaro.fr/conjoncture/urgences-le-ministre-de-...

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

#125

Post by unity1001 »

vladvasiliu wrote: post #53
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 e…

> By "single payer" do you mean the European model of "socialized" healthcare?

Its socialized healthcare. You dont have to put in quotes. It was first advocated by socialists in the First Socialist International at the end of 19th century. It constitutes part of the social democratic program.

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

#126

Post by mledu »

It took the ER 4 hours to give me pain meds for my kidney stone. They sent me to imaging where the tech asked “did they give you any pain meds?” and I said no, and she sighed. The PA knew within two minutes I had a stone but it took them hours to give me anything for it while I lay in a gurney in on the open floor while Covid patients coughed all around me during the height of the pandemic.

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

#127

Post by mledu »

bruce511 wrote: post #97
dmitrygr wrote: post #85

Earlier quoted context omitted.

It is simple, calculating, and heartless. When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y. When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO) Since I can afford to buy a lot more than X / Y of healthcare for me…

I appreciate your honesty. I completely agree that the current system is excellent for those who can afford it, and queuing-based-on-worth certainly appeals to those with worth. In the US this worth translates into money, which translates into lobbying. You are not marching in the streets because you don't need to. Your money speaks for you. I say this not to patronise you, since you clearly understand this is the ca…

I will also add that many problems in the US and other countries stem from the perversion of incentives and benefits of the few over the many. What I mean is that keeping this broken system in place as it greatly benefits the insurance companies, of which there are a few. It’s so valuable that they have the money and resources to buy the politicians, pay for the media campaigns and lobby the propaganda outlets to mitigate any power the populace has to address the issue. This allows industries to control pretty much all policy in the US. It’s a sad state of affairs.

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

#128

Post by ShredKazoo »

duffpkg wrote: post #111
ShredKazoo wrote: post #83

Earlier quoted context omitted.

Is direct primary care something to do instead of insurance, or in addition to insurance? I know someone who gets direct primary care and has no insurance, but I was telling him he should get insurance anyway in case of disaster -- was my advice incorrect?

Typically it is something you do in addition to insurance, though there is not a one size fits all model to it. Different providers and systems offer different levels and types of it. Atlas MD in kansas is an interesting one which is aimed at average income people and offers some pharmacy and labs at heavily discounted prices. From a cost savings standpoint things like x-rays, ultrasounds, ECG/EKG, stitches, cast rem…

Thanks for the info everyone!

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

#129

Post by twelve40 »

illirik wrote: post #109
footlose_3815 wrote: post #101

Earlier quoted context omitted.

>Number one recommendation: spend $$$ on a concierge primary care doc. Fuck the country I was born in if this is the solution I need to keep myself healthy in a place I pay more than my fair share of taxes and rent to scumbag landlords just to live. Fuck this world.

Exactly this - life in the USA has felt like an unfamiliar board game, run by a rules lawyer who has a grudge against you (personally), my entire life. No wonder we have a shorter life expectancy than _Cuba_!

Cuba is definitely an outlier specifically for that among developing countries and therefore not a great comparison.

I hate the US healthcare experience and try to avoid it, but somehow after all the craziness you hear about half the country uninsured and $500k medical bills, the life expectancy numbers are actually not that terrible. I'm not sure why.

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

#130

Post by vladvasiliu »

unity1001 wrote: post #125
vladvasiliu wrote: post #53

Earlier quoted context omitted.

> 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 e…

> By "single payer" do you mean the European model of "socialized" healthcare? Its socialized healthcare. You dont have to put in quotes. It was first advocated by socialists in the First Socialist International at the end of 19th century. It constitutes part of the social democratic program.

The reason I put it in quotes is that at least in France, healthcare is not completely free, and somewhat resembles the US model. Sure, everyone has to pay and gets "free" healthcare, but that's the basic level, barely above "none".

If you need dental work, glasses, etc, you better have either cash or a "mutuelle", which is usually tied to your employer (though you can purchase your own above that if you like). Lower-level jobs don't always have one (or it doesn't cover much).

However, procedure prices might be lower than in the US, though (I don't actually know) which is a big part of the issue with access to healthcare.

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