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The Amish health care system

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Re: The Amish health care system

#121

Post by mundo »

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

There's a parallel here, between the medical field requiring 8+ years of schooling to put in stitches, and the days (not so distant) when most software companies wouldn't hire you to write an online mortgage interest calculator unless you had passed classes in compiler design and calculus.

edit: that said though, your opening question is kind of odd - doesn't pretty much everyone view the medical field as a racket?

Re: The Amish health care system

#122

Post by amiga_500 »

anon09809809 wrote: post #103
amiga_500 wrote: post #98

Earlier quoted context omitted.

Other countries have fully trained doctors yet they don't have this problem. Therefore fully trained doctors setting bones is not the problem. It's another problem or set of problems that occurs in the USA.

The 250k+/year US salary of the fully trained doctor setting bones could be a problem. Many doctors are paid significantly less in many of those other countries.

Go back a step further. Why do they need a big income? Because they took on lots of education debt. Why did they take on so much? Why is it so expensive? Because the usurers extend that much credit.

The free market in shampoo is okay, sort of. For a lot of other stuff "free market" + fiat looks like a mess.

Re: The Amish health care system

#123

Post by amiga_500 »

throwawayjava wrote: post #102
amiga_500 wrote: post #98

Earlier quoted context omitted.

Other countries have fully trained doctors yet they don't have this problem. Therefore fully trained doctors setting bones is not the problem. It's another problem or set of problems that occurs in the USA.

In other countries banks don't make five+ figures on every doctor's education, and their doctors certainly don't make enough to service six figures in education debt. Finance capitalists keep the vicious cycle going. Doctors' unions scratch and claw for high comp because without it their new entrants are screwed.

100% on the (fiat) money.

Re: The Amish health care system

#124

Post by wahern »

new_time wrote: post #108
amiga_500 wrote: post #98

Earlier quoted context omitted.

Other countries have fully trained doctors yet they don't have this problem. Therefore fully trained doctors setting bones is not the problem. It's another problem or set of problems that occurs in the USA.

In the 19th and early 20th centuries there was in the US a proliferation of medical schools - many unaffiliated with Universities - with very few entrance requirements, extremely uneven quality of education and little standardization in curriculum. In fact many people became doctors through apprenticeship right up through the turn of the 20th century. Many states had extremely lax or nonexistent licensing requirement…

The number of physicians per capita in the U.S. is greater than Canada or Japan, both of which have cheaper healthcare. Yes, apparently most European countries have a significantly higher ratio. But, interestingly, all the Anglo countries (UK/GB, US, AU, IE) seem to cluster together.

The issue seems more complex than something simple like number of physicians. A high ratio is unnecessary for cheaper, quality healthcare (e.g. Canada, Japan), and whatever dynamics control the ratio in the U.S. (schooling, licensing) probably also exist in other countries with similar legal systems, but with different outcomes.

Data: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?location...

EDIT: Looking at the ratio of GP to specialists for Canada (~1:1) and California (~1:2), it's more likely that the problem (such as it relates to numbers of physicians) is that we have too many specialists in the U.S. See https://www.cma.ca/sites/default/files/pdf/Physician%20Data/... and https://www.chcf.org/wp-content/uploads/2018/06/CAPhysicianS... And that probably has to do with 1) how we consume healthcare in this country and 2) the career expectations of medical students. And arguably this is a typical pattern of American culture more generally and in all our industries. Everybody wants to push the envelope and everybody expects the products and services they consume to be bleeding edge, both as a cultural expectation and in pursuit of higher profits--as consumers we tend to assume more costly services are more advanced.

Re: The Amish health care system

#125

Post by Ididntdothis »

a2tech wrote: post #22
floren wrote: post #18

I'm surely hopelessly naive and ill-informed for even asking, but is there a reason a hospital or clinic couldn't operate 100% without dealing with insurance? Do such places exist in the US? We always hear how the hospital sends a bill for $40,000, then the insurance company argues that down to $2000, but woe unto you if you DON'T have insurance because you'll have a hard time getting that same deal yourself. Couldn'…

In practice what you describe in the tail end of your post is how it works. Except the hospital can’t blackball you for emergency care even if you have a history of failure to pay. The hospital will work with you and put you on a payment plan if you don’t just disappear. If you stop communicating they’ll sell your debt to a debt collector which is a bad deal for both you and the hospital. They’d rather have you payin…

That's not how it always works. Sometimes they reduce the price and sometimes they play hardball. You are completely at the mercy of the hospital who charges whatever they feel like. And if you, the insurance or the hospital make a mistake they are happy to send you a 300k bill that you will have the responsibility to clear up over the next few years by constantly calling insurance and dozens of doctors who all somehow got put on your bill.

Re: The Amish health care system

#126

Post by stormdennis »

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

A sibling of mine is a very highly paid medical specialist. She studied, worked and studied more doing exams into her early thirties. Combined with having to travel a lot to get experience meant she wasn't able to settle till her mid thirties. Prior to that she earned good money but worked insane hours not including study time. I know because I stayed with her sometimes. I work in a pretty stressful job but I couldn't handle the stress her job entails on a daily basis where she sees extremely ill people in theatre and whose lives are literally in her hands both there and later in the ICU. She's well into her fifties now but still one week a month had to be available to work in the middle of the night if called on a rota. She earns a good multiple of what I do but I think she earns every penny.

Re: The Amish health care system

#127

Post by itsrajju »

_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

Something like this happens in Indian Railways too. Lower class tickets are dirt cheap -- around 20 cents for a 100km journey. Whereas an air-conditioned first class ticket costs about 10 dollars.

Re: The Amish health care system

#128

Post by stormdennis »

abakker wrote: post #112
motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

My sister is a veterinarian. Honestly, I think I’d rather have her give me stitches than most doctors. She’s had to give so many more than most doctors.

Most doctors aren't surgeons though.

Re: The Amish health care system

#129

Post by WaylonKenning »

hateMyIdeas wrote: post #116
grecy wrote: post #96

Earlier quoted context omitted.

Please look around you a little more. My buddy separated his shoulder snowboarding in Tahoe. He had a full time (40 hours a week) job at the time, but it didn't provide healthcare. He couldn't afford to go to hospital, so never did. I was visiting from Australia at the time and was utterly horrified, having no idea the US worked like that. Now years later his shoulder is still screwed. Of course people in the US avoi…

Person doesn't have insurance and injured themselves doing a risky activity, and can't afford treatment. If it's really bad, why not use bankruptcy, I can't imagine this person has anything valuable given the history you described. Or use physical therapy, it's cheap.

What is insurance for? To cover risk of something bad happening. The bigger the pool paying for it, the less impact to any one person to cover all the risk.

Now imagine that was scaled up to a whole country. That's New Zealand. Check out the Accident Compensation Corporation. All medical costs related to accidents are automatically covered!

But who pays the costs! Everyone, via levies. How much? $2000 on a $150K IT income.

But how do you control costs? Who is entitled? Who is at fault? Surprise! It's a no-fault accident insurance system that covers all accidents.

In exchange for that, we gave up our right to sue in accidents for medical damages. Why pay a lawyer when they're not required?

Re: The Amish health care system

#130

Post by peter_d_sherman »

In general, the healthcare profession could do the same double-blind studies they do on drugs -- but on substances that are not patentable, such as vitamins, minerals, fruits, vegetables, natural herbs and plants, etc.

They could even do double-blind studies on things that are not ingestable, like sunlight, doing enough exercise, getting enough rest, etc., etc.

But will they, ever?

No they will not.

That's because they will not make any money if these studies are successful.

Quite the opposite.

If there is any successful study in one or more of these areas, it could very well have negative and damaging economic impact to the medical community.

I like Doctors, and believe that most of them are good, honest, decent, hard-working (especially now, during CoronaVirus!) people.

They are not the enemy, quite the opposite!

But we really need to think about double-blind studies on non-patentable things that could potentially cure people, or at least alleviate their condition in some small way.

That, and the FDA needs to allow those things as treatments that Doctors may legally prescribe, if the double-blind studies prove successful...

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