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Diagnosis: Insufficient Outrage

nytimes.com

31–40 of 98 posts

Re: Diagnosis: Insufficient Outrage

#31
post #9

Earlier quoted context omitted.

Oh, but you can order your own blood tests. I've done it before. Google "order own blood tests." I've used Health One before to run a test that I wanted done. I had insurance, but I didn't want to go through the awkwardness of convincing my doctor that it was worth doing, and I think it was only $40.

Thanks very much for dropping that name. I had looked once before but somehow missed Health One. I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.

I think you guys are on to something.

I choose to fix my own car when it has small issues, I choose to fix my own computer when things go haywire (whether it's a hardware or software problem), I choose to install/fix issues relating to the washing machine & dryer, furniture, faucets, etc. etc.

To get to the point where I could fix these things I had to learn various things from others, from reading up, and so on.

I can do that quite easily when it comes to my own body too. Only in the most extraordinary of circumstances will I seek medical healthcare.

To relate this to HN: make systems that facilitate acquisition of knowledge, conducting tests, studying those tests, etc. Maybe hook the other end of the system to a database of vetted doctors in India and China who could study the test results and suggest future options?

By golly does this industry need some disruption. Please make it happen guys.

Re: Diagnosis: Insufficient Outrage

#32
Yes, if prices are skyrocketing it must be a "Crime" caused by all the dirty capitalists enriching themselves. There could be no possible explanation for it. Unless, of course, you want to consider:

1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporations 2) The necessity to offset insanely low negotiated and subsidized Medicare/Medicaid rates with bills on the uninsured, thus bifurcating healthcare recipients into "pays too little" and "pays too much" categories with no in-between 3) The employer-provided insurance scheme--another government-subsidized program--which hides prices from consumers and incentivizes providers to hike up prices 4) Let's not forget about the inability for insurance companies to hedge risk and lower costs by selling insurance across state lines 5) Obamacare destroying any potentially new avenues for innovation by forcing the uninsured to buy into a broken system

What would happen if a doctor or hospital today started practicing medicine at affordable prices, competitively? What's stopping that from happening? If you look for what isn't there instead of what is there, you'd see how we've completely eviscerated any hope of competition, innovation or lower prices in our system.

The "moral outrage" we should have as Americans is not toward the doctors who--as even this article grudgingly acknowledges--are good people working in a bad system. The outrage we should have is toward the captured healthcare-industrial complex that has a stranglehold on our Congress and President, using its influence to send more profits its own way at the expense of patients.

High prices are not a crime. Bad policy is.

Re: Diagnosis: Insufficient Outrage

#33

Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable. If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.

Doctors and medical facilities would need to make a lot less money. That is the source of most of the cost difference. The vehicle of payment is maybe a secondary cause. It might be good to change it, but if it's not directly responsible for the majority of the difference in what doctors are getting paid, it's not going to fix the problem.

My Uncle is a doctor, went the full 9 years at Tulane and everything. He had to close his own practice because Medicare paid dirt, insurers would delay payments for years, and malpractice insurance was thousands a month. He was running around a 2,000 a month deficit when he had to fire his secretary and close down. He now works in a general hospital as a surgeon, and is actually happier not having to try to haggle getting paid or getting people to pay more.

Some doctors may be profiting off this, but the principle beneficiary is private insurance companies, at least from my experiences. Doctors spend an eighth of their life learning some of the hardest science and discipline of any profession and you do want to compensate the good ones well. We need more people entering medicine, not fewer.

Re: Diagnosis: Insufficient Outrage

#34

How much does the Affordable Care Act addresses this? I know insurance can't be denied to people with pre-existing conditions and there can't be any life-time expense caps. But is there any measure to address the high cost of health care in US?

Effective next year up to 400% of the poverty line is eligible for some fraction of their expenses covered under Medicaid. If you are beyond that threshold is the infamous "uninsured tax". Note that 400% of the poverty line is around $50k a year.

Re: Diagnosis: Insufficient Outrage

#35

Prescription: Free Market Competition

There is no such thing as the free market when it comes to healthcare. Not only is the consumer not in a position to shop around when dealing with health issues, partly because you're often not in a position of even knowing what treatment you need until you've decided on a provider and undergone expensive consultations, but also, providers are put in positions of not being allowed to refuse service based on ability to pay.

Not to mention, the "free market" solution doesn't actually involve consumers "voting with their wallets" and choosing the healthcare they want, but rather choosing from a very limited set of insurance options where they have no real choice or power. And the choices they are offered basically amount to a small array of socialized healthcare options: you have no control over your benefits and extremely little ability to choose a different one, but everyone pays into a large pool and costs are shared by the group as a whole so outlier costs are not overly burdensome to individuals. It is wholly baffling to me that anyone can support this system but be against socialized healthcare. Our model is socialized healthcare, but instead of being socialized across the nation as a whole, it's socialized across a particular employer or purchasing group. Does this actually give us choice? No. Go analyze your health plan "options" offered by your employer and tell me you're participating in the free market and I will laugh in your face.

Re: Diagnosis: Insufficient Outrage

#36
post #3

This rings so true. When I had graduated college I was in a 3 week lull between graduation and a job around January when I was struck with a kidney stone. No health insurance. I took a trip to the ER around 10pm one evening in agonizing pain and was treated like a drug addict. I wasn't even triaged for over 2 hours (peak flu season) and everyone acted like I was just trying to score pain meds. Finally, after 3.5 hour…

Oh, but you can order your own blood tests. I've done it before. Google "order own blood tests." I've used Health One before to run a test that I wanted done. I had insurance, but I didn't want to go through the awkwardness of convincing my doctor that it was worth doing, and I think it was only $40.

The ability to shop around is great and all, but hardly something I could reasonably expect of somebody currently suffering from kidney stones, or worse (if you can even imagine a worse state).

Re: Diagnosis: Insufficient Outrage

#37

Earlier quoted context omitted.

People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated. A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.

Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub…

$2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.

Re: Diagnosis: Insufficient Outrage

#38
post #26

Prescription: Free Market Competition

Why don't you elaborate instead of just yelling "free market!" and waving your hands? How might we encourage competition effectively?

Eliminate drug patents, remove the annual cap on medical students in doctoral programs, remove that requirement entirely from a medical license and let anyone practice medicine that wants to (albeit with some regulation requiring a practitioner explicitly state their qualifications, and you would have to prosecute impostors).

That would probably lead to what we have today - people only trust literal doctorates from top medical schools - but you could open new medical schools to placate demand, and hopefully reduce the workload required to obtain a medical license (the current 8+ years of schooling is excessive for any profession) or provide some kind of doctoral certification program outside the bounds of academia, though I have no intimate knowledge to know how you would do it.

It does become buyer beware, but it also means you would have treatment at most pay grades. Also, if it wasn't illegal to produce chemical compounds (really, that is dumb, and all the arguments of how they produce progress because of profit motive is pointless if nobody can afford the result, and the investment funds in big pharma would find other avenues to stimulate growth and research). The costs of care would fall absurdly fast if there weren't a dozen golden gates on the road to being a medical professional or medical facility, I wouldn't even mind if they just reduced the barriers, but they are too high and too plentiful right now.

Re: Diagnosis: Insufficient Outrage

#39
post #26

Prescription: Free Market Competition

Why don't you elaborate instead of just yelling "free market!" and waving your hands? How might we encourage competition effectively?

No one can open a new, competing hospital without the permission of the lousy overpriced hospitals that its intended to compete with.

Yes, you need your competitor's permission to enter the market. Its the law.

http://en.wikipedia.org/wiki/Certificate_of_need

Re: Diagnosis: Insufficient Outrage

#40

Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable. If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.

The EU is not a country. The EU has no single healthcare system.

Every country has it's own system, which range from anything between 100% government provided to mostly privatized. No system is the same. And it's not just the EU, it's the entire Western civilization outside the US.

This is extremely important, because the healthcare debate in the US is falsely framed as a choice for or against "socialized medicine", were in reality socialized medicine is a rarity amongst the various healthcare systems.

Whether or not to make quality healthcare accessible to everyone is not an ideological choice, the problem can be solved within the framework of any political ideology.

It's strictly a choice between decent healthcare for everyone or bigger profits for the healthcare industry.

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