‘Out here, it’s just me’: one doctor for 11,000 square miles • Hacker News Board

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#111

Post by EliRivers » Tue, Oct 01, 2019, 7:01 AM UTC

jandrewrogers wrote: post #45

EliRivers wrote: post #17

Earlier quoted context omitted.

I understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?

In most cases, people live there because that is where their lives and family are, not because they are poor per se or "trapped". In fact, many of them are not poor by any constructive definition. These populations, while shrinking and aging, have productive lives often related to resource extraction industries such as farming and mining which are not going away. People are simply choosing to remain in the areas wher…

Didn't a lot of mining jobs already, to a significant extent, go away?

Here's coal mining in the US, over the last 35 years: https://fred.stlouisfed.org/series/CES1021210001

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#112

Post by EliRivers » Tue, Oct 01, 2019, 7:03 AM UTC

pdub123 wrote: post #56

EliRivers wrote: post #17

Earlier quoted context omitted.

I understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?

Eh, I think you exaggerate. Sure, some people are so disabled they can't travel. For those who are not disabled but are simply poor, here's what they need-- and it doesn't cost much. - A greyhound bus ticket - Camping gear: A tent, sleeping bag, inflatable camping mattress - Clothes I used to live in a tent. Sure, it's uncomfortable, but it is fully survivable. While living in a tent in some woods, I pulled myself up…

Good for you. Many people cannot do it. Are not capable of bootstrapping. They will live and die in misery because you and others like you put your ideology ahead of reality and people.

Just look at how well you wrote your words. You are functionally literate and comfortable with technology.

When you moved and lived in a tent, did your spouse and children live there too? Who looked after the children while you were job hunting, given that your social support network was back where you used to live? Where did you get your medication during that time? I guess you had a health advantage. You were also lucky nobody came looking for the money you owed them.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#113

Post by trianglem » Tue, Oct 01, 2019, 7:20 AM UTC

segmondy wrote: post #80

belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

Have you ever thought about the fact that the issuing of green card to immigrant doctors is really hurting other countries? Other countries need doctors as much as America, there's a huge brain drain when green card is issued for immigrant doctors. BTW, I'm not saying that I'm for it or against it. I also want to point that that giving a migrant doctor green card is not guarantee that they can practice in the US. Pas…

That's not America's concern. We're looking for the best and the brightest.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#114

Post by Bombthecat » Tue, Oct 01, 2019, 7:32 AM UTC

belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

Is the green card attached with the rule, that you need to work umin rural area? Otherwise those people would just do what everyone would do. Work in a big city / hospital etc..

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#115

Post by SamReidHughes » Tue, Oct 01, 2019, 10:53 AM UTC

hanniabu wrote: post #55

kgermino wrote: post #38

Earlier quoted context omitted.

I absolutely would. One of the best things we can do for poor people - and for the economy as a whole - is getting them physical access to better jobs. If people are trapped in an economically dead area the few grand it would take to support them moving to a more vibrant area is a pittance, especially compared to the cost of bringing jobs and services to rural areas. I'm absolutely opposed to forcing people to move,…

If you instead move a doctor to a rural area it's a much more cost effective solution because that one doctor could treat everyone in the area rather than needing to move everyone in that area out of the rural area. A new doctor in the rural area would also create jobs as they would need at least a receptionist.

That act of "creating a job" is just a money transfer from some people in the area to another. The only real thing to celebrate is the actual work being done.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#116

Post by vo2maxer » Tue, Oct 01, 2019, 11:44 AM UTC

saghm wrote: post #109

vo2maxer wrote: post #95

Earlier quoted context omitted.

I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which…

> I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, whi…

You’re right. I appreciate your comment. I allowed my own frustration with the obvious problems around me to cloud my comments. Here, hoping to clarify my original argument: Adding healthcare services by producing more physicians, costly in training and by their later contribution through a perverse incentive system, does not appear to be the simple answer. In addition, is there a physician shortage [1] or not [2]? I recommended more midlevel providers, who are capable of handling a vast majority of medical problems. To suggest that only professionals with years of training and paid an exorbitant rate can do this, is not to understand what physicians do or midlevel providers’ capability. It is another way of buying into the self-serving mantra promulgated by medical boards and organizations: Only a doctor knows and, furthermore, needs to be board certified.

Depending on the state, multiple nurse practitioners and physician assistants can be supervised remotely by one physician. Add telemedicine and other online tools to this partnership and you’ve got a pretty robust team able to care for a much larger population than one physician could. A zillion other tweaks to the system, and all of a sudden efficiency starts to make an impact. But some artificial barriers must be broken in the process (e.g., coordinated information dissemination between health professionals).

[1] https://www.aamc.org/news-insights/press-releases/new-findin...

[2] https://www.ncbi.nlm.nih.gov/pubmed/26177529

Edit: For now and the near future, there are procedures that only physicians can perform (e.g., surgery mostly). This is not true in most general medical care and even in specialized care.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#117

Post by pjc50 » Tue, Oct 01, 2019, 11:50 AM UTC

pdub123 wrote: post #56

EliRivers wrote: post #17

Earlier quoted context omitted.

I understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?

Eh, I think you exaggerate. Sure, some people are so disabled they can't travel. For those who are not disabled but are simply poor, here's what they need-- and it doesn't cost much. - A greyhound bus ticket - Camping gear: A tent, sleeping bag, inflatable camping mattress - Clothes I used to live in a tent. Sure, it's uncomfortable, but it is fully survivable. While living in a tent in some woods, I pulled myself up…

Note that there are plenty of US cities where this is illegal and the police will confiscate and destroy your tent.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#118

Post by HeadsUpHigh » Tue, Oct 01, 2019, 1:12 PM UTC

bradleyjg wrote: post #105

jandrewrogers wrote: post #45

Earlier quoted context omitted.

In most cases, people live there because that is where their lives and family are, not because they are poor per se or "trapped". In fact, many of them are not poor by any constructive definition. These populations, while shrinking and aging, have productive lives often related to resource extraction industries such as farming and mining which are not going away. People are simply choosing to remain in the areas wher…

So what’s the problem then? If they have the money to pay the extra costs needed to attract labor to provide the services they want where they choose to live then the system is working perfectly fine, no? If they don’t have the money they should move, possibly with assistance. I don’t see any case for subsidizing services in places where it really expensive to provide those services. Why that’d be like government gra…

I'm not sure what you mean by that but there's a limit to how many more people you are going to attract with more money. Quality of the job in rural areas for doctors is pretty low as you don't get a lot of other specialties to help you and you don't have the same tools available either.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#119

Post by HeadsUpHigh » Tue, Oct 01, 2019, 1:13 PM UTC

haimez wrote: post #74

rayiner wrote: post #71

Earlier quoted context omitted.

The story flips if you use the Supplemental Poverty Measure, which adjusts for cost of living: https://www.irp.wisc.edu/wp/wp-content/uploads/2019/01/Focus... . Rural poverty has consistently been similar to urban poverty, and was measurably lower during the great recession. Rural areas also have lower long-term poverty (where a family was poor for two successive measurement years). About 4% in 2016 for rural areas,…

Sure, but during a recession no one is moving into those areas and a LOT of unemployed are moving AWAY from them. The metrics look good because they misrepresent what’s actually happening.

That's objectively and measurably false.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#120

Post by flyingfences » Tue, Oct 01, 2019, 1:53 PM UTC

yourbandsucks wrote: post #85

chimi wrote: post #79

Earlier quoted context omitted.

He stays quite true to his brand in the video when he chastises them with a list of the many things they have done to destroy the free market in healthcare.

What a fragile free market. You're telling me that the free market requires willing selflessness of players to function? That sounds more like the ghost of Christmas than the invisible hand to me..

No, a free market expects selfish players to function. The adjective "free", however, means an absence of a government that can be lobbied to restrict the market.