Was in the ER recently for an undiagnosed clam allergy. I'll echo everything the OP is saying. Healthcare in my area is going to be luck to survive all the kids going back to school this week and passing around all the germs from Xmas visits.
The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
171–180 of 228 posts
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#172Earlier quoted context omitted.
Ah. The good ol’ “steal the good workers from the poor countries to serve my wealthy country that doesn’t want to invest in training its own workers” argument. What happens when those workers are tapped and/or the cost/benefit for them is not attractive? Back to square one.
There's 1.1 million physicians in the US, and about 12.8 million worldwide. Almost all of whom are making substantially lower salaries than their American counterparts. Many more than 50% lower. Even if 10% were willing to immigrate for a huge wage boost we could replace every doctor in America multiple times over.
Huge wage boost erased by increased supply and much higher living costs. Also, I am not convinced quality is the same and language barrier results in poor communication with patients. Let other countries have their doctors and train doctors in your own country is the proper and moral solution.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#173Veteran 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…
Health insurers (payers) don't deliver different levels of service based on a plan’s deductible or copay. That's literally just a field in the database. All of your claims and prior authorization requests still flow through the same systems.
In general high deductible health plans can be good option for consumers who are in good health and have the financial means to absorb an occasional large medical bill. There are also tax incentives for such plans.
https://www.healthcare.gov/glossary/high-deductible-health-p...
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#174Don't forget all the nurses and doctors fired for not getting the COVID vaccine as well. Probably wasn't the wisest decision.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#175I’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.
Pull up a list of the Fortune 500. Look how many US healthcare companies are in the top 100. Many in the top 20.
That, plus the loosening of donation rules aka "corporations are people", is all you need to know about the state of American healthcare.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#176Veteran 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.…
"The poor apparently deserve their poor health access." Exactly what a large percentage of Americans believe. I disagree with them, but hard to make an argument for a better system when many believe that the poor shouldn't have quality healthcare.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#177Veteran 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…
> keep you out of the hospital/ER You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list the number one correct recommendation: If you are overweight, lose the weight. ~80% of healthcare costs in this country are attributable to chronic conditions, and ~80% of chronic conditions are caused by obesity or lifestyle directly connected to obesity. You i…
You're not wrong about the root cause of chronic medical conditions. Depending on how you count, something like 1/7 of all healthcare spending now goes to type-2 diabetes and related conditions, and nearly 100% of those cases are caused by lifestyle issues.
But it's unfair to blame doctors. In a typical office visit they only have a few minutes with the patient which isn't enough time for useful lifestyle counseling. And it isn't even really their job anyway; diet counseling should be provided by Registered Dieticians who are specifically trained in that field. Any real improvements will require major national political policy changes to better align incentives and shift resources away from treatment and towards prevention.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#178Earlier 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…
Kaiser is legendarily great healthcare, so I hear you.
Not familiar with Kaiser being in NYC, but I can say that Aetna is probably the best insurer here (again, depending on your plan).
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#179Veteran 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…
#3 - Kaiser is great, no question. Just not familiar with them since they don't have a presence in NYC. Honestly, if we had to emulate one model in the country it would definitely be the Kaiser model.
Re: The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician
#180Earlier quoted context omitted.
>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.
Exactly this - life in the USA has felt like an unfamiliar board game, run by a rules lawyer who has a grudge against you (personally), my entire life. No wonder we have a shorter life expectancy than _Cuba_!
I suspect Cuba is an outlier because they have a reasonably functional healthcare system, but at the same time most people are too poor to overeat or indulge in substance abuse. They literally can't afford to sit around and get fat.