[dead]
The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
141–150 of 228 posts
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#142There was an interesting article published recently about ICUs, the medical wonders that happen there and the problems with them. It goes much deeper on this very topic and is very interesting:
https://thebaffler.com/salvos/the-power-and-peril-of-the-icu...
It tracks the problem to the emergence of ICU wards being profit centers for hospitals, a development that began decades ago. Every hospital suddenly built an ICU ward and off to the races they all went.
Also predictably, as jeanlucneptune touched on above, this lead to affluent neighborhoods having better care than non-affluent ones.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#143Earlier quoted context omitted.
> By "single payer" do you mean the European model of "socialized" healthcare? Its socialized healthcare. You dont have to put in quotes. It was first advocated by socialists in the First Socialist International at the end of 19th century. It constitutes part of the social democratic program.
The reason I put it in quotes is that at least in France, healthcare is not completely free, and somewhat resembles the US model. Sure, everyone has to pay and gets "free" healthcare, but that's the basic level, barely above "none". If you need dental work, glasses, etc, you better have either cash or a "mutuelle", which is usually tied to your employer (though you can purchase your own above that if you like). Lower…
> in France, healthcare is not completely free, and somewhat resembles the US model
That's the result of the privatization that has been pushed by the Anglosaxon business lobbies to Europe and everywhere else since Reagan/Thatcher period. They forced privatization of whatever they could get away with. Its still a socialized system with some forced privatization being pushed through. France is not the only country - all US satellites have been pushed to do some degree of privatization.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#144Earlier quoted context omitted.
Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22...
It is simple, calculating, and heartless. When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y. When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO) Since I can afford to buy a lot more than X / Y of healthcare for me…
private care exists in the UK.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#145"Up in the ICU hopeless 95 year olds will sit on ventilators and other life support machines for weeks because doctors don’t have any discretion in stopping futile care. You can be a 30 year old pregnant woman, and you will die waiting for your ICU bed in the emergency room." I recently went through a situation where my family member was the 95 year old. The immediate family had no basis to judge whether the care bei…
This is an open debate in the medical community. I’m told there have been pilot programs for “end of life counseling” where folks at a certain age are given advice about quality of life expectations once this situation is reached. They often responded by talking to their families and creating plans for ending care before things are bad, solving the weird pressures that families feel in that situation. I’ve not yet go…
I mean, hospice knows roughly when someone is near death because when you remove care, the patient basically starves, and that generally follows a pretty clear progression.
It seems like the hard part is making sure people have had the conversation. If I'm over 80 years old and can't communicate or feed myself, I'm not expecting much of a recovery. I think a lot of people would acknowledge that if they were asked to think about it.
(of course there are lots of situations where a good recovery is pretty likely, but hopefully the doctors aren't waffling about what to do in those situations)
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#146Veteran 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’ve been on paperwork side of health a small bit.
1) cash pay / direct / concierge
Agreed - especially if employer plan not great. Some of these folks do house calls. I did this for a while
2) high income area
Sadly agreed. Even in a city if a hospital is more accessible etc that can be tough. I did a walk in to sf general once a long while back - took me 20 minutes to walk out. Great hospital, but waiting room was nuts. Had a finger burned being an idiot and got seen very quickly at a different sf hospital - night and day difference in waiting room
3) mixed view on this. Kaiser brings some peace of mind - grandfathered hsa plans w 2k deductible and some free base car not a bad experience - key for me is not coordinating/ dealing w multiple bills. Their issue resolution team is terrible though on billing
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#147Earlier quoted context omitted.
> are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.
Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22...
The article says $2 trillion over 10 years, that's $200 billion a year.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#148Earlier quoted context omitted.
Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22...
It is simple, calculating, and heartless. When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y. When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO) Since I can afford to buy a lot more than X / Y of healthcare for me…
X isn't fixed though.
New technology, new knowledge and training all increase X. It's relatively fixed at a given moment in time (where your point is very true), but society shouldn't be making a major structural decision one moment at a time.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#149Earlier quoted context omitted.
Do hospitals lose money on medical residents without federal funding? I'd figure residents provide a lot of labor for the hospitals.
Yeah, residency programs are extremely expensive to run -- most of the work they do is duplicative, especially for 1st & 2nd year students. You're essentially paying multiple doctors a little money to follow doctors who make a lot of money around. They do cover overnight shifts, but they still need to be supervised by 'real' physicians so there aren't really any savings. Vox did a good summary of the whole situation…
I would say it's not so clear, and it's open for debate until hospitals open up their books.
Yes residents need to be supervised, but one doctor can supervise many residents seeing many more patients than they could alone. If hospitals didn't have residents they would have to hire more doctors.
Also consider that a resident costs less to employ than a nurse and that the hospital bills for all the work residents do.
Finally, doctors in teaching hospitals tend to be payed less than doctors in non-teaching hospitals.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#150Earlier quoted context omitted.
>I could see a single payer system having the same problems. You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system. I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in orde…
This seems like a problem that would right itself if the conservatives allowed for more immigration
It would not be a new idea:
https://time.com/6051754/history-filipino-nurses-us/
The difference this time is “extra” young Filipinos may not be as numerous:
https://www.macrotrends.net/countries/PHL/philippines/fertil...
And they might have more preferable work options such as work in IT fields.