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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

#101

Post by footlose_3815 »

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…

>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.

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

#102

Post by Der_Einzige »

wrp wrote: post #25
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…

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

It will also massively hurt global drug and medical research.

We are the leader in it partly because we pay these exhortation prices when the rest of the developed world simply won't play that kind of game.

I'm okay with biting that bullet, and taking a global reduction of health research by some double digit percent for awhile, but that's a serious unintended consequence of single payer.

I'm a Bernie voter who supports single payer, but it's not sunshine and roses everywhere, and crooked capitalism really does do some "not bad" things for us.

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

#103

Post by Der_Einzige »

derbOac wrote: post #80
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…

I personally think the way your question is framed is kind of an example of how insidious the influence of the current system is. It's not a matter of "are there enough humans who have sufficient training in medicine who are willing and able to fill all those positions?" It's are there enough humans with sufficient training in whatever positions there could be to meet the health needs that exist? Just for example: it…

Except that's the status quo. These days, all but the most intense of medical procedures is being done by increasingly less qualified people.

Nurse too expensive? Get a CPA!

Most of the time I go for checkups I see a CPA for the majority of the time, a nurse for less, and almost no time with a doctor. Excepts are usually for surgery or other intense operations.

This idea of "just let less holistically trained people do the work" honestly sucks. Dentists are better on average at teeth cleaning than dental cleaning specialists. MDs are better on average at putting IV needles in, etc

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

#104

Post by jay3ss »

no_wizard wrote: post #42
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…

I have to say, at least if you're tied to employer healthcare plans, there are bad Aetna and United contracts out there. I've had better runs (on the west coast at least) with Anthem Blue Cross, in terms of engaging with the system. I've been lucky enough in my life to have high quality plans that the employer subsidies (100% paid for me, 80% for my partner) with very low deductibles, and they're PPO to boot (no HMO…

Have had both employer provided Kaiser and Aetna. Aetna was awful while Kaiser was great. Aetna made us jump through all kinds of hoops to get a simple prescription (not pain meds) while it was only a quick phone call with Kaiser. In fact, while in great pain we had to wait for over 8 hours with Aetna to even talk with someone before we gave up and went to GoodRx and got the help we needed nearly instantly. I don't really know where I'm going with this, but I have to say there's a wide discrepancy between employer provided health insurance. I had ACA and it was actually really good! No or low copay (less than $10) and was always able to get ahold of someone when I needed it.

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

#105

Post by vladvasiliu »

bruce511 wrote: post #88
vladvasiliu wrote: post #73

Earlier quoted context omitted.

> So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there. I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Sam…

Its pretty easy to find shortages and flaws in any system. And yes, national health is always tempting for budget cuts because its a huge number, and trimming it 5% gives real returns. Shortages of drugs and equipment are often tied to supply-chain issues more than budget, and again that's a barrel of worms best left for another thread. Clearly single-payer can work, but it does need the single-payer to, well, pay. B…

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?

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

#106

Post by jakeinspace »

toomuchtodo wrote: post #56
runnerup wrote: post #31

Earlier quoted context omitted.

> But if the deeper problem is there, is there any short term solution? No. > Sure we can start training people and make lots of incentives for people to enter the field, but that will take years. Yes. But it should be done. Also, there shouldn't be shortages of saline IV solution and bacteriostatic water -- but no one's rebuilding the factories destroyed by hurricanes in Puerto Rico because there's not "enough" of a…

Some things should not be ruthlessly efficient; what appears to be waste is tail risk premium. Alas, that “efficiency savings” becomes someone’s bonus or profit, and a loss for the rest of us.

Allow CEOs to keep their performance-based bonuses. However, add a stick to balance out that carrot, like capital punishment if your hospital falls below a certain level of patient outcome on the year.

Seriously though, if the people responsible for hospital cutbacks had to rely on the same level of care the average American gets, we would never have gotten to this state.

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

#107

Post by ankaAr »

My fiance works as therapist in USA. I was born and raised in Argentina.

Sometimes when I see the healthcare system in USA I cannot believe how the country could be like that, how people cannot think for a moment about other people in needing, I really cannot believe why there is people that cannot want universal healthcare. It is beyond my worst imagination.

It is an human right, it is someone suffering. I know that is expensive, I know that there is a lot of things to do, but people is dying, because they are poor, because they cannot pay an insurance, because the insurance is for profit and is not hiring more doctors, etc.

Healthcare system and education system is something that I cannot believe how bad it is in usa. And is sad af.

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

#108

Post by ramin_hal9001 »

dmitrygr wrote: post #94
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…

> Surely capitalism [...] problem Spoken like someone who's never lived NOT under capitalism. It amazes me how young people today say things like this, as if they are self evident. I used to think that I'd not wish that life on anyone, but really y'all could use some, to see the contrast.

> lived NOT under capitalism

What, for example, is "NOT capitalism?" You mean like communist countries? You seem to be making the old mistake of thinking communism and capitalism are opposites of one another.

What is more, the problems with the communist countries was massive cryptic bureaucratic systems preventing practical problems being solved. If you hadn't noticed (or just ignore OP entirely) we have this exact problem right now with the health care/insurance system under the capitalist US system.

This is what I mean by capitalism and communism aren't opposites. Capitalism is turning our society into something like what was seen under more oppressive communist governments. And simply voting as if "things are better here, now, than it was under communism" won't solve the very real, pressing problems that OP was talking about.

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

#109

Post by illirik »

footlose_3815 wrote: post #101
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…

>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_!

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

#110

Post by pzone »

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…

Healthcare in this country is so broken. This industry should be made as simple efficient and affordable as visiting Walgreens. The regulations, the cartel-like barriers to competition, the behemoth corporate powers. The only way to get adequate care is to become so rich you can escape the whole thing.
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