Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why doctors are sick of their profession

online.wsj.com

Post reply on HN
Print view View original

201–210 of 249 posts

Re: Why doctors are sick of their profession

#201

Post by Retric »

ThomPete wrote: post #168
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…

I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead. If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy a…

Insurance is a competing market and companies can discriminate by age so the young don't subsidize the older though the insurance system.

You could argue that the healthy subsidize the sick but that's the point of insurance. It's like saying the living subsidize the life insurance payouts of the dead.

Re: Why doctors are sick of their profession

#202

Post by aianus »

danieltillett wrote: post #94
im3w1l wrote: post #77

Earlier quoted context omitted.

I wonder if in the future, doctors will become more like bearucracts. You go to the internet, find out what you have. Then you fill out the appropriate form, go to a doctor who stamps the decision with a red mark of approval, granting you access to medication / surgery.

This is exactly how I interact with the medical monopoly. I don't think I have been to the doctor for the last 10 years without knowing my diagnosis and treatment in advance. My job has then been to guide the doctor to the correct diagnosis in a way that keeps their ego intact.

I couldn't have said it better myself.

Re: Why doctors are sick of their profession

#203

Post by dmfdmf »

zAy0LfpBZLC8mAC wrote: post #155
dmfdmf wrote: post #148

Earlier quoted context omitted.

>...than a doctor weighing in on your position... As smart as they are, the doctors are most clueless regarding the moral issues involved. There is another MD in this thread claiming the essence of medicine is service to others but I think 5 minutes of thought can dismiss that non-sense, even from a doctor. > It'd seem that you suffer from all-or-nothing, black-and-white thinking -- I don't consider this a flaw in my…

As you have invited personal criticism: You are naive and your thinking is simplistic. You have managed to get away from complete naivete, you think using abstract concepts, which allows you to look through the superficial appearance of things, and thus cut through a lot of bullshit. But you haven't noticed yet that your abstractions are way too abstract to give a reliable representation of the real world by themselv…

This a wordy and intellectually sounding repudiation of reason, nothing more.

Re: Why doctors are sick of their profession

#204

Post by dmfdmf »

secabeen wrote: post #153
dmfdmf wrote: post #148

Earlier quoted context omitted.

>...than a doctor weighing in on your position... As smart as they are, the doctors are most clueless regarding the moral issues involved. There is another MD in this thread claiming the essence of medicine is service to others but I think 5 minutes of thought can dismiss that non-sense, even from a doctor. > It'd seem that you suffer from all-or-nothing, black-and-white thinking -- I don't consider this a flaw in my…

In most western civilizations government food assistance and other nutritional aid are available for those who would otherwise starve to death. Given that the only estimate I found of actual starvation deaths in the United States was 140 in 2004, I think we can say that people in the United States have a right to basic amounts of food.

Is food a right or is charity for the poor humane? These are completely different world views.

Re: Why doctors are sick of their profession

#205

Post by ThomPete »

Retric wrote: post #201
ThomPete wrote: post #168

Earlier quoted context omitted.

I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead. If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy a…

Insurance is a competing market and companies can discriminate by age so the young don't subsidize the older though the insurance system. You could argue that the healthy subsidize the sick but that's the point of insurance. It's like saying the living subsidize the life insurance payouts of the dead.

They discriminate in so many other ways. Thats all fine and good they are privately owned companies and can do what they want, but it's not a good setup for healthcare.

Re: Why doctors are sick of their profession

#206

Post by ThomPete »

gyardley wrote: post #191
amirmc wrote: post #187

Earlier quoted context omitted.

> "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 State…

The size of the country have a much higher impact on the fact that there haven't been more conflicts IMHO.

Re: Why doctors are sick of their profession

#207

Post by mcguire »

hvidgaard wrote: post #197
jval wrote: post #167

Earlier quoted context omitted.

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.

Well, actually, they would, for the same reasons that the postal service will make money in populated areas and lose money in less populated areas.

Say you need a trauma center within 1 hour of anywhere in the country. A trauma center in Manhattan is going to see a lot of traffic, while one in Clayton, NM, isn't. But the centers have the same basic cost in staff and gizmos.

Re: Why doctors are sick of their profession

#208

Post by mikeleeorg »

aianus wrote: post #200
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 additi…

That's a legitimate reason. I believe people that come in simply seeking drugs make it tough on you. Enough people abuse this privilege that many (but certainly not all) doctors have become vary of writing prescriptions. I honestly don't know if this translates into high consultation fees though.

Re: Why doctors are sick of their profession

#209

Post by mikeleeorg »

a3n wrote: post #85
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…

> A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article. Does this mean a lack of general respect, the type that all people deserve? Or is this some kind of extra respect and dererence due to their education or profession, which no one deserves? Because I am constantly disrespected by the medical profession. I am sent email a day or two before each appointment, remindi…

Just a general level of respect, from what I can gather. This is all second-hand info of course. But the stories they've told me seem to indicate this.

I should have added that my friends are specialists, not general practitioners. I've heard lots of complaints about general practitioners too, in terms of late and canceled appointments, little to no interaction, being rushed out the door, etc.

Re: Why doctors are sick of their profession

#210

Post by Symmetry »

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 issue is more complicated than just socialized vs. non-socialized. There are many countries with privately run healthcare system that are perfectly good, such as France or Switzerland. And there are countries that combine both public and private provision of healthcare and have it work perfectly well, such as Sweden or Singapore[1]. The US actually does run some hospitals directly, the VA, and I doubt this made the news outside of the US but there was a huge scandal a while ago concerning them.

The current US health situation is the end result of a long process of complicated schemes to provide more healthcare to Americans without any clearly visible costs in ways complicated enough that there are no obvious deficiencies. For instance Nixon's scheme[2] to lower costs by preventing competitions between hospitals[3] is still on the books all these years later. Given all the government interventions in the healthcare market combined with an unwillingness to bite the bullet pay for or subsidize most people's insurance directly has left the US with a healthcare system that is neither government run nor free market, but something far inferior to both.

[1] Singapore has a really weird combination of forced savings, mostly private payment, and mostly public provision which is really weird compared to everyone else but somehow gives them really good health outcomes really cheaply. I don't think the US could make that system work, though.

[2] Is there something Nixon didn't screw up? Well, besides repairing our relationship with China.

[3] Back in the day everybody knew that the USSR had a far more efficient economy than the US did (the Soviet statistics said so!), and one way people explained this was that the Soviets weren't wasting resources on competition but instead just figured out the best way to do something and put all their effort behind that.

Post reply on HN