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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

#161

Post by nine_zeros »

America used to be a country that understood production. Today, America has become a has-been country mired in divisive politics and systematic enrichment of vested interests.

The solution is simple guys.

1. Produce unlimited number of doctors, nurses, insurance companies, drugs. Flood the market with healthcare practitioners.

2. Remove all unnecessary paperwork and regulations. Let doctors start private practices like a startup. Let them charge a fee without insurance. Let insurance compete with prices on the street.

Another way to think about this is, use the dentist model for doctors.

I know 50% of the population will comment about "fraud" and "eligibility". But guess where we are with all the "fraud protection" today.

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

#162

Post by cudgy »

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…

Ah. The good ol’ “steal the good workers from the poor countries to serve my wealthy country that doesn’t want to invest in training its own workers” argument. What happens when those workers are tapped and/or the cost/benefit for them is not attractive? Back to square one.

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

#163

Post by cudgy »

nine_zeros wrote: post #161

America used to be a country that understood production. Today, America has become a has-been country mired in divisive politics and systematic enrichment of vested interests. The solution is simple guys. 1. Produce unlimited number of doctors, nurses, insurance companies, drugs. Flood the market with healthcare practitioners. 2. Remove all unnecessary paperwork and regulations. Let doctors start private practices li…

I like point 1, but point 2 sounds like a nightmare.

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

#164

Post by nine_zeros »

cudgy wrote: post #163
nine_zeros wrote: post #161

America used to be a country that understood production. Today, America has become a has-been country mired in divisive politics and systematic enrichment of vested interests. The solution is simple guys. 1. Produce unlimited number of doctors, nurses, insurance companies, drugs. Flood the market with healthcare practitioners. 2. Remove all unnecessary paperwork and regulations. Let doctors start private practices li…

I like point 1, but point 2 sounds like a nightmare.

Point 2 is very important. All the prior authorization paperwork, forms, sequence of tests are not necessary. Those are imposed by regulations and insurance on the providers. Outcomes are not any better due to that.

You don't need to go much further than Asian countries to see how less paperwork makes things move fast.

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

#165

Post by cudgy »

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…

> Sure we can start training people and make lots of incentives for people to enter the field, but that will take years.

Ok then. Get started on it now! This has been a known issue for decades, so I’m not expecting much action until it gets so bad that a revolt occurs.

The private insurance model is still a horribly broken concept that needs to be addressed as well. Single payer seems to be the only reasonable alternative to prevent the broken feedback loop (insurance companies are driven by higher premiums which are driven by higher costs so there is no accountability) of the current system.

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

#166

Post by cudgy »

nine_zeros wrote: post #164
cudgy wrote: post #163

Earlier quoted context omitted.

I like point 1, but point 2 sounds like a nightmare.

Point 2 is very important. All the prior authorization paperwork, forms, sequence of tests are not necessary. Those are imposed by regulations and insurance on the providers. Outcomes are not any better due to that. You don't need to go much further than Asian countries to see how less paperwork makes things move fast.

Removing unnecessary paperwork and the private insurance model altogether is great. Removing regulations and reasonable standards of care for doctors is the nightmare.

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

#167

Post by caeril »

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…

> keep you out of the hospital/ER

You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list the number one correct recommendation:

If you are overweight, lose the weight.

~80% of healthcare costs in this country are attributable to chronic conditions, and ~80% of chronic conditions are caused by obesity or lifestyle directly connected to obesity.

You improve your own health outcomes, and reduce the burden on the healthcare system as a whole, by ~64% if you're not fat.

And your response, as a doctor, mirrors the most infuriating thing about your profession:

  Hi, you're 260lbs and pre-diabetic. I'm going to put you on Metformin. 
  Hi, you're 280lbs and your LDL/HDL is WAY too high. Here's a prescription for statins.
  Hi, you're 190lbs at 5'1 and your infertility is caused by LH/FSH imbalances. Take this Clomid.
When the hell are the "professionals" in your line of work going to stop medicating away the consequences of this absolutely absurd epidemic and actually address it? The only time I've ever heard of a physician actually advising an obese person to lose weight is for conditions where pharmaceutical interventions don't exist, such as non-alcoholic fatty liver disease. The rest of the time? Take these drugs so you have a couple more years to enjoy your triple bacon cheeseburgers and large fries.

It's absolutely maddening.

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

#168

Post by dcolkitt »

cudgy wrote: post #162
dcolkitt wrote: post #22

Earlier quoted context omitted.

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…

Ah. The good ol’ “steal the good workers from the poor countries to serve my wealthy country that doesn’t want to invest in training its own workers” argument. What happens when those workers are tapped and/or the cost/benefit for them is not attractive? Back to square one.

There's 1.1 million physicians in the US, and about 12.8 million worldwide. Almost all of whom are making substantially lower salaries than their American counterparts. Many more than 50% lower. Even if 10% were willing to immigrate for a huge wage boost we could replace every doctor in America multiple times over.

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

#170

Post by nine_zeros »

cudgy wrote: post #166
nine_zeros wrote: post #164

Earlier quoted context omitted.

Point 2 is very important. All the prior authorization paperwork, forms, sequence of tests are not necessary. Those are imposed by regulations and insurance on the providers. Outcomes are not any better due to that. You don't need to go much further than Asian countries to see how less paperwork makes things move fast.

Removing unnecessary paperwork and the private insurance model altogether is great. Removing regulations and reasonable standards of care for doctors is the nightmare.

Yes, there are two types of bureaucracy. It is not too hard to figure out which of them is unnecessary garbage.

Reasonable standards need to exist. But asking patients to drive an hour to sign a document for a treatment 4 months later is not acceptable.

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