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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

#151

Post by lotsofpulp »

jay3ss wrote: post #104
no_wizard wrote: post #42

Earlier quoted context omitted.

I have to say, at least if you're tied to employer healthcare plans, there are bad Aetna and United contracts out there. I've had better runs (on the west coast at least) with Anthem Blue Cross, in terms of engaging with the system. I've been lucky enough in my life to have high quality plans that the employer subsidies (100% paid for me, 80% for my partner) with very low deductibles, and they're PPO to boot (no HMO…

Have had both employer provided Kaiser and Aetna. Aetna was awful while Kaiser was great. Aetna made us jump through all kinds of hoops to get a simple prescription (not pain meds) while it was only a quick phone call with Kaiser. In fact, while in great pain we had to wait for over 8 hours with Aetna to even talk with someone before we gave up and went to GoodRx and got the help we needed nearly instantly. I don't r…

Aetna is known to be low quality, especially after CVS bought them. CVS has a ton of debt and I do not see CVS management to have a culture of investing in employees. They are known for their retail business, where it is typical to ride employees to the limit until they burnout.

I like sticking to BCBS insurers, such as Elevance, Regence, Independence, Horizon, etc.

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

#152

Post by lotsofpulp »

kashunstva wrote: post #135
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…

Undoubtedly all of this is true and an effective set of strategies for people of means to navigate the system. But this is precisely why healthcare reform will never take root in the U.S. There is no vision for public health. As an academic discipline, public health is robust in the U.S.; but there is no traction in the practical realm because the ghosts of Puritanism still inhabit the the sociopolitical structures.…

For leaders, this is the beauty of health insurance companies (better called managed care organizations, MCOs).

For places like UK and Canada, leaders have to answer to everyone for why access and quality of healthcare is declining. In the US, using the MCOs, leaders can more easily direct sufficient healthcare to who they want it to go to without being able to be identified as the cause.

For example, leaders can tell MCOs to reimburse healthcare providers less for Medicaid (poor people), and more for Tricare (military) and Medicare (old people who vote), and even more for federal government employee health plans (for themselves). Or they can tell MCOs to require more “prior authorization” (PA) for Medicaid so people give up more quickly at getting medicine, whereas federal government employee plans can require fewer PAs.

Add employer specific risk pools/deductibles/copays/out of pocket maximum limits into the mix, and there are multitude of levers that can be pulled to ensure people are getting the quantity and quality of healthcare corresponding to their socioeconomic level.

Rich people always had concierge medical care. But with the use of MCOs, you can drill it down to income/wealth/political quintiles or even deciles.

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

#153

Post by nubinetwork »

Not to discredit what you're saying, but everyone seems to forget all the other employees at hospitals.

I've been in Canadian healthcare IT for 20 years, and for the past 5-10 we've been overworked, understaffed, denied vacations and sick days...

The past year alone half our department walked out because we just couldn't deal with it anymore.

The users (doctors, nurses, janitors, shipping/receivers, maintenance staff, etc) aren't happy, we're not happy, yet upper management gets a round of promotions.

I feel for you, but the whole system is broken and won't change until someone steps in and overhauls everything. (Or they'll just outsource everything and everyone loses.)

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

#154

Post by lotsofpulp »

ShredKazoo wrote: post #54
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 three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system. Why would the size of the deductible/copay affect the amount of paperwork? My naive assumption would be that the amount of paperwo…

>I still have about 3 days during which I can switch my insurance for 2023; was thinking of switching to a high-deductible plan since I don't anticipate using my plan much in 2023)

If you have sufficient cash flow and savings to afford out of pocket maximum (usually $10k or so for a family), and you can max out contributions to an HSA, it is always advantageous to opt for an HSA eligible plan (which are legally defined as High Deductible Health Plans, but they will say “HSA” in the name of the plan).

This is due to the triple tax advantages of an HSA, which surpass any other type of investment vehicle.

You can put pre tax money in an HSA, all investment earnings are tax free, and withdraw all of that free of tax to reimburse yourself for healthcare expenses you incur at any time during your life.

So you keep a spreadsheet of all your healthcare expenses, pdfs of receipts, and do not touch it until you absolutely need to. Use a free Fidelity HSA to have access to all investment options (you can continuously transfer from any HSA your employer uses to fidelity HSA).

In the absolute worst (best?) case that you simply do not have healthcare expenses, the HSA functions as an IRA, and you pay regular income tax when you withdraw after age 65.

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

#155

Post by [deleted] »

gretch wrote: post #41
wrp wrote: post #30

Earlier quoted context omitted.

> Patients yell, they are demanding, they are untrustworthy. This gets a lot of comment, but it's half the story. I get most of my medical care abroad, but have escorted family through through local medical visits. I've noticed a marked decline in empathy among medical staff the past few years, even in the secretaries at the front desk. This seems to be a general social trend, not just a problem of bad patients.

It’s probably a runaway positive feedback loop. Someone is an asshole to you, you’re less likely to treat the next patient as well, leading to them treating the next nurse a bit worse.

[deleted]

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

#156

Post by cudgy »

Anecdote alert. Recent visits to hospitals for myself and others did not exhibit these terrible conditions. There are so many new hospitals in my area that some are practically empty. Staff were amazing and no chance someone is pooping in their bed … you can barely get any sleep with all the staff checking in on you.

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

#157

Post by endisneigh »

oaktrout wrote: post #149
mikeyouse wrote: post #65

Earlier quoted context omitted.

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. F…

Right, exactly - I'd skeptical of the claim that residents cause hospitals to lose money.

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

#158

Post by cudgy »

wrp wrote: post #25
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…

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

Not sure I agree with this. Lower cost of care via single-payer would seem to create more jobs not less. Would be nice to find out though.

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

#159

Post by cudgy »

Der_Einzige wrote: post #102
wrp wrote: post #25

Earlier quoted context omitted.

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

It will also massively hurt global drug and medical research. We are the leader in it partly because we pay these exhortation prices when the rest of the developed world simply won't play that kind of game. I'm okay with biting that bullet, and taking a global reduction of health research by some double digit percent for awhile, but that's a serious unintended consequence of single payer. I'm a Bernie voter who suppo…

> It will also massively hurt global drug and medical research.

This may not be the case, since much research is subsidized by the government and educational funding providing labs that train the scientists the pharmaceutical companies utilize. Single-payer may result in lower costs and therefore more money for support of research and laboratories. Also, pharmaceutical companies would not need to spend vast amounts for marketing their drugs direct to consumers.

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

#160

Post by cafard »

pzone wrote: post #110
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…

Healthcare in this country is so broken. This industry should be made as simple efficient and affordable as visiting Walgreens. The regulations, the cartel-like barriers to competition, the behemoth corporate powers. The only way to get adequate care is to become so rich you can escape the whole thing.

I've received COVID vaccinations at Walgreens, but nothing else you'd call health care. I would imagine that if the industry limited itself to filling prescriptions (though prescribed by whom?) and selling aspirin etc., it could be very simple, efficient, and affordable.
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