A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics • Hacker News Board

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#111

Post by rincebrain » Wed, Jun 21, 2017, 9:49 PM UTC

distances wrote: post #33

dr_ wrote: post #27

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient populatio…

Being from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US? As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?

It seems to vary between two extremes - people who do it and people who will only reluctantly visit a doctor when at death's door.

I think the former stems from annual checkups in childhood.

Some insurance providers/employers, I suspect for preventative reasons against the latter category above, have started incentivizing annual physicals, so this may shift, but the whole US healthcare system is in such flux I wouldn't put money down on any outcome.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#112

Post by timthelion » Wed, Jun 21, 2017, 9:53 PM UTC

germanier wrote: post #80

vxNsr wrote: post #70

Earlier quoted context omitted.

I always chuckle when I see people compare what amount to 3rd world countries with the US system, my mother was trained and worked in Moscow's largest hospital. The shenanigans that went on there, the level of training and expected knowledge of staff, the baseline expected standard of care all don't even hold a candle to what she had to reach to be considered competent in the US. On top of that I don't know if this a…

Then take a look at other countries: The German system was introduced 130 years ago[0], survived multiple forms of government, two world wars, the incorporation of a former socialist country, multiple waves of immigration, and still provides excellent care. It just works. (And modern medicine is not yet at a level where ethnicity is a relevant factor when deciding treatment options.) [0]: By highly conservatives by t…

> (And modern medicine is not yet at a level where ethnicity is a relevant factor when deciding treatment options.)

Perhaps OP was refering to the fact that the decendets of slaves in America are MUCH less healthy than the rest of the population.[1]

[1] http://archive.independentmail.com/features/columnists/what-...

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#113

Post by otherme1 » Wed, Jun 21, 2017, 10:05 PM UTC

fao_ wrote: post #48

crusso wrote: post #38

Earlier quoted context omitted.

factor of 10 over what they would sell the same product for to non-health care areas That's a key statement. So these same people charge less for the same product in other fields. Why? The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.

> The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes. Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it. I don't see why regulations, and laws "designed to destroy i…

Food and clothes are more needed than health products. You'll literally die in less than one week without any of them, yet they're cheap and plenty.

And make no mistake: when the state intervened those markets people died like flies from starvation. Just look at Venezuela, that was a rich country 20 years ago.

If you want to learn something about state protection in the drug market, see "Dallas buyers club" movie.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#114

Post by baldfat » Wed, Jun 21, 2017, 10:21 PM UTC

brightball wrote: post #75

baldfat wrote: post #71

Earlier quoted context omitted.

Not Unions' fault. I don't understand the animosity towards Unions specifically to this revisionist history of Health Care. > The Birth of Employer-Provided Health Insurance During World War II, the federal government was wary of post-war inflation. The administration saw the terrible devastation hyperinflation wreaked on post-World War I Germany and they were determined to hold it at bay through wage and price contr…

Still, that concession created the imbalance that got us where we are today.

But it is not the Unions' fault.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#115

Post by jghn » Thu, Jun 22, 2017, 9:57 AM UTC

brightball wrote: post #37

baldfat wrote: post #34

Earlier quoted context omitted.

It eventually is exploitation no matter how you slice it. Doctor's salaries and the money that is made in medical just because it is medical is insane. How much money does a doctor need to make? Why is $400,000+ a year okay when it is bankrupting thousands of people's lives? > which happened from union demands Explain????

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. And with all tha…

There is also somewhat of a correlation between the years spent in training and their pay. Not all doctors are making 400k, not by a long shot.

However, your statement about the doctor shortage. For some cases, like PCPs it is due precisely because they dot get paid nearly as Wells's you intimate. OTOH in general the supply of doctors across the board is carefully metered my the medical community. We could easily turn that dial up if we wished. They don't like that for various reasons, including watering down their pay.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#116

Post by ChrisLomont » Thu, Jun 22, 2017, 11:52 AM UTC

baldfat wrote: post #71

brightball wrote: post #37

Earlier quoted context omitted.

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. And with all tha…

Not Unions' fault. I don't understand the animosity towards Unions specifically to this revisionist history of Health Care. > The Birth of Employer-Provided Health Insurance During World War II, the federal government was wary of post-war inflation. The administration saw the terrible devastation hyperinflation wreaked on post-World War I Germany and they were determined to hold it at bay through wage and price contr…

> In order to avert the strike, in a concession to the labor groups, the War Labor Board exempted employer-paid health benefits from wage controls and income tax

How is this interpreted?

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#117

Post by ChrisLomont » Thu, Jun 22, 2017, 11:55 AM UTC

BeetleB wrote: post #97

brightball wrote: post #37

Earlier quoted context omitted.

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. And with all tha…

>Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. The "number of…

There's less demand for most PhDs. Clearly different fields for PhDs average quite different salaries, so there's plenty of evidence some are worth more to the market than others.

Having a shortage of doctors is most consistent with insufficient reward to attract more entrants.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#118

Post by kingkawn » Thu, Jun 22, 2017, 3:25 PM UTC

BeetleB wrote: post #97

brightball wrote: post #37

Earlier quoted context omitted.

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. And with all tha…

>Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. The "number of…

It's because being a doctor is uniquely stressful and the training and work takes an emotional toll to a degree that is hard to explain. I think the reasoning behind their pay is that you want those people to have essentially no other stressors in their lives in order to facilitate the quality of their work. In our society material support is how that is achieved. Public respect and deference used to play a larger role, today people are more comfortable questioning doctors. Normally I wouldn't make excuses for wildly exorbitant compensation, but for so many doctors it is what holds their world in place.

Granted there are specialities like dermatology that derive their compensation more from severely limiting the size of the specialty training programs, and the work itself is not as stressful as I'm claiming doctors in general have to bear.

All this said, yes of course they're all overpaid. But the way we got here makes perfect sense, and if we're going to change it there must be a new way to aid them that is just as impactful.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#119

Post by cookiecaper » Thu, Jun 22, 2017, 5:18 PM UTC

ghaff wrote: post #95

tzs wrote: post #93

Earlier quoted context omitted.

Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol. Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon. I was also paying a $20 copay for a 120x50mcg bottle of f…

I don't know about your pharmacy but at my (major chain) pharmacy, if a drug price is less than the co-pay, I just pay the price. (Which is I assume the same situation as with Walmart.)

Without an external mandate to keep the price low, this should only happen rarely, because the chain will realize that they're underpricing the drug. If your copay is $10 and they sell it retail for $5, they'll make some kind of differentiation in the labeling to effect price segmentation and maximize the profit from each group of potential shoppers. That way, they'll be able to bill your insurance co $30, you'll pay your $10 copay, and they won't legally be allowed to sell you the cheaper $5 version since it will no longer fit the doctor's Rx.

They may keep a few things underpriced so that they can have pharmacists offer the cheaper version and create the impulse/illusion that the chain is looking out for their best interest.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#120

Post by BeetleB » Thu, Jun 22, 2017, 5:23 PM UTC

kingkawn wrote: post #118

BeetleB wrote: post #97

Earlier quoted context omitted.

>Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours. The "number of…

It's because being a doctor is uniquely stressful and the training and work takes an emotional toll to a degree that is hard to explain. I think the reasoning behind their pay is that you want those people to have essentially no other stressors in their lives in order to facilitate the quality of their work. In our society material support is how that is achieved. Public respect and deference used to play a larger ro…

>It's because being a doctor is uniquely stressful and the training and work takes an emotional toll to a degree that is hard to explain.

Knowing several doctors, it is not that hard to explain.

And frankly, most of your answer is merely a reflection of the status quo, but not why that status quo exists.

Look at most developed countries and I wager you'll see less stress in becoming a doctor. Are they providing lower quality of service than US doctors?

And not all doctors work highly stressful jobs. All the PCP's I've had had a comparatively relaxed lifestyle compared to people like surgeons. Sure, they get paid less, but still get paid a lot. In my company I know plenty of engineers who work longer hours with greater stress (roughly 10-12 hour days and then being on call on top of that - PCP's are usually not on call). Their pay is a lot lower than that of a PCP.

I'm not saying they don't deserve to get paid a lot. Just that the "number of years of training" is not a good justification for it.