Why doctors are sick of their profession • Hacker News Board

Re: Why doctors are sick of their profession

#191

Post by gyardley » Sun, Aug 31, 2014, 2:44 PM UTC

amirmc wrote: post #187

jval wrote: post #164

Earlier quoted context omitted.

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

> "It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest." Really? Please can you elaborate on this as it makes no sense to me.

He's arguing that the United States has had a stable political system for a long period of time because the federal government has relatively few powers, allowing the people in its widespread, culturally-different regions to craft state and local governments to their liking. I suspect he believes an activist, centralized government, imposed on all Americans, would eventually result in the division of the United States.

There's plenty of stuff in there to debate (the US did have a rather bloody civil war, so it's not like it's been perfectly stable), but his argument is plausible enough - I'm not sure why it makes no sense to you. Personally, traveling around the United States has convinced me that there's ten countries worth of distinct cultures in it - one-size-fits-all government isn't going to work well.

Re: Why doctors are sick of their profession

#192

Post by tomjen3 » Sun, Aug 31, 2014, 2:46 PM UTC

jjoonathan wrote: post #31

jprince wrote: post #26

I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.

It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it…

I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games.

However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.

Re: Why doctors are sick of their profession

#193

Post by specialist » Sun, Aug 31, 2014, 2:48 PM UTC

jasonisalive wrote: post #162

toasted wrote: post #159

Earlier quoted context omitted.

NZ

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.…

Single payer accounting is greatly simplified, so is easier to audit, so has less fraud. Comparatively. In the real world.

http://www.amazon.com/Healthcare-Fraud-Auditing-Detection-Gu...

Also, you misspelled "corporatist oligarchy" as "free market". Easy mistake.

Re: Why doctors are sick of their profession

#194

Post by Spooky23 » Sun, Aug 31, 2014, 2:53 PM UTC

jval wrote: post #164

toasted wrote: post #38

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

The Feds pretty much mastered the "how do I make 50 states do stuff" problem -- they give the states money and threaten to take it away.

We've had Medicare and Medicaid for almost 50 years now, and it works reasonably well, despite significant differences in administrative practices between states. So it absolutely can be done.

We've figured out how to build a national road system, healthcare for old people, healthcare for destitute people, a national tax collection system, and 1,000 other examples. It's a solvable problem.

Re: Why doctors are sick of their profession

#195

Post by specialist » Sun, Aug 31, 2014, 2:54 PM UTC

jasonisalive wrote: post #165

Bootvis wrote: post #163

Earlier quoted context omitted.

That's unfortunate but the bottom line for patients is that the NZ works excellently. Sure, it sucks that someone committed fraud and got rich in a dishonest manner but preventing that is not the goal. In the end, this fraud doesn't really affect the healthcare given.

NZ works excellently. That is a pretty big claim... Have you ever actually lived in NZ and experienced the realities of paying for this system via taxes and claiming its services? Have you monitored the incessant demands for more services at better quality, the incessant complaints about being over-worked and underfunded, the endless criticisms and debates about inefficiency, long wait times, burdensome bureaucracy,…

You're confusing ideology (dogma) with market design and (lack of) incentives.

Markets are good for determining price. Not finding efficient solutions. You've heard of "rent seeking"?

Single payer systems enable the capitation model of care services. Because wellness is incentivized, vs the treatment of disease.

Re: Why doctors are sick of their profession

#196

Post by Spooky23 » Sun, Aug 31, 2014, 2:57 PM UTC

jasonisalive wrote: post #162

toasted wrote: post #159

Earlier quoted context omitted.

NZ

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.…

Yes. Bad actors are present everywhere, and fraud happens everywhere. There's always a kink in the system.

There was a dentist a few years ago who was treating 2,000 patients a day, and stole several million dollars from several insurance companies.

I worked at a midsize company in a highly competitive market... one of the call center manager embezzled something like $75k over a period of 3 years by fraudulently purchasing telephone headsets. He paid for $$$$ plantronics, and delivered $ no-name brand.

Re: Why doctors are sick of their profession

#197

Post by hvidgaard » Sun, Aug 31, 2014, 3:06 PM UTC

jval wrote: post #167

hvidgaard wrote: post #166

Earlier quoted context omitted.

I can understand the political barriers to socialized healthcare in the US, for starters it would require a federal tax. However, I am not buying the scale argument. What exactly makes it hard to scale? The only argument I've heard is that managing all doctors and hospitals, but that is trying to control everything, something that never works when you try to scale out, and isn't necessary either. If anything the scal…

Politics is all about the money. Obviously administration is worse at scale too, but it comes down to political will in having the money to do it. The way you keep a political union together without having it break apart is by limiting the amount of things the members of the union have to share. If you start taxing rich states and funnelling the money over to poor states, you give people a reason to want to break out…

New Yorkers aren't going to "pay for Idaho". NY may be paying more in tax for the entire state, but their budget would also be much larger. For obvious reasons NY can be more efficient, but that doesn't mean that they'll be paying a significant amount of the budget in Idaho.

Re: Why doctors are sick of their profession

#198

Post by jjoonathan » Sun, Aug 31, 2014, 3:17 PM UTC

tomjen3 wrote: post #192

jjoonathan wrote: post #31

Earlier quoted context omitted.

It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it…

I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games. However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.

Demand is too low, supply is too high... potato potahto.

We won't run out of work across all sectors. EEs still have work. Chemists and Biologists still have work. Aerospace engineers still have work. And lots of it! But the supply/demand balance has shifted enough in their respective sectors to have a very concrete impact on their compensation.

Re: Why doctors are sick of their profession

#199

Post by dlp211 » Sun, Aug 31, 2014, 3:35 PM UTC

anon13434 wrote: post #58

venomsnake wrote: post #44

Earlier quoted context omitted.

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

The VA is not a good example of a working system though, it has been heavily in the news for denying timely treatment, see http://en.wikipedia.org/wiki/Veterans_Health_Administration_...

Bad press about a few VA clinics does not mean that the entire system is garbage. In fact, as recently as last year, veterans rated their satisfaction with VA care higher than the general public rates private care[1]. Also according the the Inspector General, while no one denies that delays in care happen at the VA (it should be noted that delays happen in the private sector as well), that the deaths at those hospitals can not be directly linked to the delay in care[2].

Finally, my anecdotal evidence: I am highly satisfied with the care that I receive at the VA. I have 20% disability due to a significant loss of peripheral vision in my right eye. I am scheduled yearly for an annual physical including urine and blood work, a field scan with my eyes to test regressions, and two general appointments with an optometrist. I also have free access to nutritionists and weight support groups since weight management can be an issue for veterans. Is it perfect, no, but I have never felt that I didn't get the care that I needed in a reasonable amount of time.

[1] http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537

[2] http://online.wsj.com/articles/no-deaths-caused-by-delays-at...

edit: formatting

Re: Why doctors are sick of their profession

#200

Post by aianus » Sun, Aug 31, 2014, 3:54 PM UTC

mikeleeorg wrote: post #66

Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days. Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborh…

> As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"

Because I can't write my own prescriptions. Doctors like to abuse this privilege to charge ridiculous 'consultation fees' for giving me what I already know I need. One recent example I had to deal with: travel vaccines. $50 + $10/shot in addition to the cost of the vaccines so the guy could go "uh-huh you do need those vaccines; here you are".