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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

#111

Post by duffpkg »

ShredKazoo wrote: post #83
duffpkg wrote: post #79

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCould open source EMR, built and operated ~90 acute care management services organizations (MSO) (the "things" that operate the non-medical aspects of many acute care systems). Healthcare is highly dysfuctional but I want to dampen the notion a little bit that it is in some unique and new kind of collapse today. Everything you are stating is nearly verb…

Is direct primary care something to do instead of insurance, or in addition to insurance? I know someone who gets direct primary care and has no insurance, but I was telling him he should get insurance anyway in case of disaster -- was my advice incorrect?

Typically it is something you do in addition to insurance, though there is not a one size fits all model to it. Different providers and systems offer different levels and types of it. Atlas MD in kansas is an interesting one which is aimed at average income people and offers some pharmacy and labs at heavily discounted prices. From a cost savings standpoint things like x-rays, ultrasounds, ECG/EKG, stitches, cast removal, minor in office procedures, etc, are often done at no additional cost beyond the annual price. An ECG/EKG might be as much as $400 or more against your deductible, which instead could go toward direct primary care where it would be included.

In particular if you have say a chronic condition which remains unresolved after several interactions with the general purpose health system a direct primary care doctor has the time to put towards your case on an individual basis to potentially get to the bottom of it. My experience has been that they also do a much better job at management of chronic conditions but I would really like to see some more studies done in that area.

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

#112

Post by weakfortress »

lotsofpulp wrote: post #36
ars wrote: post #26

Everyone knew Obamacare would cause this (or make it worse), but no one could do anything about it because there was no alternative plan acceptable to a large enough majority. Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What should have happened is politicians should have worked on costs , not on payments. The…

> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What does this mean? The Affordable Care Act did not directly increase deductibles. It even provided huge subsidies from the young and healthy to the poor and old via age rating factors, restricting of pricing criteria (removal of pre existing conditions exclusions…

[dead]

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

#113

Post by illirik »

ankaAr wrote: post #107

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…

It's not the people in general - many people, including every family member and friend of anyone who has ever been seriously ill while not being seriously wealthy, understands just how bad things are. However, when things are this bad, (and this is actually _the best things have ever been_ [1]), it's so easy to spread fear and anxiety that the situation could get worse, when you represent the people who profit from this situation. This effectively paralyzes public opinion. At this point, over half a million Americans work for health insurance companies _alone_, and health care spending overall is now over 17% of GDP [2]! Unfortunately, this rot is now structural.

[1] Before the Obama administration, your health insurance could be denied or cut off based on arbitrary reasons ("pre-existing conditions"), and if you did not have a job that provided health insurance, you had to pay this cost entirely yourself - unless you qualified for Medicaid through absolute destitution. The Affordable Care Act ("Obamacare"), despite being a massive compromise from universal health care, allowed the sick and poor to get subsidized insurance, shielding tens of millions of people from the worst outcomes of the system.

[2] https://www.healthaffairs.org/do/10.1377/hpb20220506.381195/

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

#114

Post by Rury »

noobermin wrote: post #48
blueridge wrote: post #10

This seems like a good spot to repost a few passages from Limits to Medicine, Medical Nemesis: The Expropriation of Health by Ivan Illich, 1974: "A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes, on a healthy diet, in an environment equally fit for birth, growth, work, healing, and dying; they are sust…

The alternative you ask for then, is for people to merely die and suffer in pain while doing so. In the past, that's what we did, because there just was no option for such people. I looked up Ivan Illich, and this essay critiques modern medicine as creating "lifelong patients." That indeed is what has happened, but the alternative is for people to just die. The reality really is I don't really believe anyone ever too…

I disagree.

Look at your body. It's multicellular, not one living thing. Your very cells both compete and cooperate with one another for resources to survive (just as we humans do amongst ourselves). For the greater good of the organism (you), individual cells are programmed to die when they are in poor health or old age or in too much stress, to allow younger healthier cells to take their place for the greater good of the organism as a whole. When this process is averted, or goes awry, old/unhealthy cells remain and the organism suffers, as it has to support these old/unhealthy cells which don't contribute their fair share to the organism. It has to divert resources which could otherwise go to new younger healthier productive cells. Worse, is cancer, which is literally when cells rebel their original programming, and become selfishly greedy. Obviously, as we all know, these things can lead to the organism becoming dysfunctional and even dying.

This reality applies to cells, and to organizations like companies, governments, and even species.

So to answer: are lives worth preserving? Yes. But reality is, there can come times when the preserving the lives of the old, is directly at odds with the lives of the young, and choosing to preserve old lives over young lives, is harmful to lives as a whole.

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

#115

Post by bruce511 »

vladvasiliu wrote: post #105
bruce511 wrote: post #88

Earlier quoted context omitted.

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?

I would argue they're not failing in the same way though.

The US system is "failing" in the sense that health services are not available/affordable to all.

The NHS has issues with funding and staffing.

France has issues with supply chains.

Any system will have flaws, but just because no system is perfect it does not mean that all are imperfect in the same way.

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

#116

Post by spfzero »

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.

If you're in the category of paying more than your fair share of taxes you probably can afford to buy instead of rent. But if you want to keep renting, find a non-scumbag landlord. They exist, I've rented from them.

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

#117

Post by spfzero »

a-user-you-like wrote: post #20
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…

We already have a ridiculously regulated, stifling environment. More stifling is not the answer, just look at the wait times and patients being denied basic care in Canada and the UK. We need to end the ridiculous grip the AMA has on the # of doctors; get rid of the hospital certificates of need, and encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other a…

Canada and the UK illustrate the downside of single provider, but the US has embraced all of the bad about single provider, but with multiple providers. Anyone can get into the game, but no one tries to make the product better. The patient is not the customer in either the US or Canada or the UK. They are the same in that respect and that is what matters.

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

#119

Post by HereIGoAgain »

Um don't know where you're working but that isn't how any of the hospitals or ERs here are running. I was into an ER room being treated within 20 minutes only a week ago... and they said they were pretty busy that day.

This all reads like complete and utter FUD

EDIT: Never mind engagement, I see this is nothing but a SP propaganda thread.

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

#120

Post by DoreenMichele »

giardia wrote: post #64
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…

>concierge doc Can you please elaborate? I need something like this and I'm willing and able to pay for it. How would I get started finding one?

Another term for this is direct primary care.

https://www.forbes.com/health/healthy-aging/concierge-medici...

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