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Post-apocalyptic life in American health care

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Re: Post-apocalyptic life in American health care

#171

Post by Projectiboga »

spondylosaurus wrote: post #147
andutu wrote: post #19

My boyfriend woke up one day to find out they couldn't pee. After a few ER visits and an MRI, they determined he had Stage 2 bladder cancer. However, because they had the audacity to seek immediate medical treatment for a life threatening health issue, they have now been saddled with thousands of dollars in medical debt. I had to personally dip into my earnings from my Big Tech internship to help pay some of it off.…

> The vast majority of doctors genuinely want to help people and are more I interested in practicing the skills they've honed for decades rather than deal with faceless automata at health insurance companies who deny claims upon a mere glance. Not only that, but doctors also have to fight tooth and nail to get reimbursed by insurance companies (some worse than others... I have doctors who won't even take UHC anymore…

Single payer would lower costs by greatly reducing liability insurance both for the doctors themselves but also for car insurance and business liability coverage. All those would still exist but not for the actual medical treatments. The estimates are it would start to save money nationally the first year, and once the medical industry reorganized around delivering care that plus savings from preventive care and less lags getting scans. It isn't just the insurance providers against single payer, all the big pharma and medical technology providers don't want that. The saving would come from having most every health care outcome in one place along with every treatment and medicine. We would start to really see what works and is worth the money. Second even the most affluent would benefit from less crowded emergency rooms that puts us all at risk.

Re: Post-apocalyptic life in American health care

#172

Post by Wytwwww »

BeefDinnerPurge wrote: post #169
Wytwwww wrote: post #158

Earlier quoted context omitted.

> The chief problem is here is asserting healthcare must be either entirely Medicare For All or the current inadequate privately funded system when the two can coexist I'm certainly not asserting that. However, first of all, 'Medicare For All' only makes sense if it's mandatory, which means additional taxes. Yes, considering the social, political, and economic reality, the likeliest outcome would be a two-tier system…

>Would passing an extended ACA II with way fewer compromises and more effective regulation than the Obamacare version be really harder than instituting Medicare for All (so either a significant increase in federal income tax or a new tax altogether)? My marginal rate in California is 53+%. That IMO is ludicrous given the horrendous condition of California and its budgetary planning. But... I don't think the marginal…

> higher than most of the world* including most European

I'm not sure that's true in general. e.g. at around 300k the effective income tax rate in CA is ~34% (26% + 8.0% state) +5% (SS etc.) = 39%. That's quite low by European standards, if you go down to 150k the total is just 35%.

In Germany for instance you'd already be paying ~42% on 100k

Anyway, that wasn't my point at all, I'm just unsure how politically feasible it would be to accomplish this on the federal level.

> European Socialist Democracies

There is not a single country in Europe left which would describe itself as a "socialist" democracy (thankfully most of them collapsed around ~1990).

Re: Post-apocalyptic life in American health care

#173

Post by spondylosaurus »

2-718-281-828 wrote: post #88
whutsurnaym wrote: post #78

Earlier quoted context omitted.

Looks like they used both "he" and "they". My guess was that the boyfriend might use either set of pronouns.

I understand they as a pronoun if the person identifies as neither male nor female. But if boyfriend is considered appropriate then why not also he? he: boyfriend / they: s/o, partner, friend, hckrfriend ...

Commented this earlier up the thread, in case you didn't see it: https://news.ycombinator.com/item?id=38765243

And it's a fair question; I'd guess you were met with downvotes because so much Pronoun Discussion is made in bad faith, but I don't get the sense you were. So I wish more people would use these moments as an opportunity to explain their points of view!

Part of what I mentioned in that other comment is the sparse availability of good gender-neutral words in English ("spouse" is a good one I should have mentioned—great on its own but sadly not applicable to the unmarried!), and something I didn't mention but should have is that it's not uncommon for people to use they/them pronouns while still identifying as male or female to some extent, whether by choice or upbringing or simply to make things convenient when signing paperwork.

You may have heard of the Kinsey scale for sexual preference; there's no widely accepted equivalent for gender identity, but in some cases it offers a similarly useful mental model. One person smack in the middle of "equally (or neither) male nor female" might swear off words like boyfriend and wife entirely, but another person who falls slightly off to the side into the "somewhat but not entirely /exclusively male" camp might use a mix of masculine and neutral terms, but probably not many feminine terms, if any. And then someone who falls into the "entirely and exclusively male" side of the chart would almost certainly object to being called someone's wife, lol.

Re: Post-apocalyptic life in American health care

#174

Post by RoyalHenOil »

specialist wrote: post #136
ufocia wrote: post #128

Earlier quoted context omitted.

Not an ad hominem attack or a microaggression, but hopefully constructive criticism. Your use of the "them" pronoun makes the post confusing. Does it refer to "they," presumably the doctors, the employer (job), the insurance, UT Southwestern, or to the gendered "boyfriend." Since you already decided to use a gendered noun, perhaps use it instead of the "they/them" or use a matching gendered pronoun "he/him" to distin…

https://en.wikipedia.org/wiki/Singular_they

People know what the singular "they" is. It has been a common feature of English for centuries.

It's just difficult to parse a writing where the same pronoun is used throughout for multiple different entities. This exact same issue commonly crops up with "he", "she", and "it" as well.

The solution in these instances is to limit usage of the pronoun altogether and just use the noun directly wherever there may be any ambiguity.

For example, don't say, "Julia wrecked Sarah's car; she was pissed!" The "she" here should just be replaced with "Sarah" or "Julia", even if it sounds a little odd to use the same noun twice in short succession.

Re: Post-apocalyptic life in American health care

#175

Post by secabeen »

badpun wrote: post #108
ars wrote: post #70

Earlier quoted context omitted.

> but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+. That's the goal!! Very high doctor pay is the number 1 cause of skyrocketing medical expenses. The model should be coupled with them opening a lower cost university and training 10 times as many medical people as we do today. Along with better supply lowering prices, it also means a Doctor could have normal working hours, s…

> That's the goal!! Very high doctor pay is the number 1 cause of skyrocketing medical expenses. Exactly! I can't think of any other country where doctors routinely make 15-20x minimum wage, and people become doctors predominantly to make a lot of money. In most countries, doctors make very good money, but not 15-20x minimum wage good. In Western Europe, for example, it's more of 5-8x minimum wage.

This is why every attempt to reform healthcare that gets the approval and endorsement of the American Medical Association is doomed to failure. The AMA was vehemently against medicare, and they will be similarly against any reform that actually makes a meaningful downward impact on Physician compensation.

Re: Post-apocalyptic life in American health care

#176

Post by thallium205 »

nradov wrote: post #117
thallium205 wrote: post #21

“Standardizing an interface between health care providers and insurance companies would be a huge win.” There is a government mandated interface and it’s found at http://www.x12.org in the form of the 837, 835, 276/277, and 271/272 among some others. There are also paper equivalents in the CMS1500 and CMS1450. These are truly one of the main culprits of the problem because of how old, woefully inadequate, and rigid t…

The HL7 Da Vinci Project has defined modern FHIR based standards for many interactions between payers and providers. Some of these standards are now incorporated into CMS/ONC interoperability rules. https://www.hl7.org/about/davinci/

Vaporware.

Re: Post-apocalyptic life in American health care

#177

Post by aragilar »

ianburrell wrote: post #135
addicted wrote: post #106

Earlier quoted context omitted.

> They pay little, but there was an instance where one of their physicians had to appeal to insurance to get a scan done (thankfully the insurance acquiesced). It doesn't make sense and all this debate around single payer healthcare is just obfuscation and distraction from investigating actual solutions. Single payer is literally a complete solution to the problem you’re mentioning before. So why is it obfuscation an…

Single payer is actually pretty rare in developed countries. Canada and UK are the main ones. Hybrid public/private models are more common. Universal healthcare, where everyone has coverage, is what people usually want.

Australia? New Zealand?

Re: Post-apocalyptic life in American health care

#178

Post by persolb »

RoyalHenOil wrote: post #174
specialist wrote: post #136

Earlier quoted context omitted.

https://en.wikipedia.org/wiki/Singular_they

People know what the singular "they" is. It has been a common feature of English for centuries. It's just difficult to parse a writing where the same pronoun is used throughout for multiple different entities. This exact same issue commonly crops up with "he", "she", and "it" as well. The solution in these instances is to limit usage of the pronoun altogether and just use the noun directly wherever there may be any a…

This is a good example of where they is extra confusing too. It would be better if English had separate singular/plural versions of they.

If Sarah goes by ‘they’, “They was pissed” sounds wrong and most people would actually speak “they were pissed”… but now it is a three way ambiguity: Julia pissed, Sarah pissed, both pissed.

This feels like an example of a bigger failure mode, but I can’t nail it down. Something like ‘groups are resistant to short term change even if it is a clear Pareto improvement’

Re: Post-apocalyptic life in American health care

#179

Post by nradov »

thallium205 wrote: post #176
nradov wrote: post #117

Earlier quoted context omitted.

The HL7 Da Vinci Project has defined modern FHIR based standards for many interactions between payers and providers. Some of these standards are now incorporated into CMS/ONC interoperability rules. https://www.hl7.org/about/davinci/

Vaporware.

Multiple vendors have literally shipped products which implement those standards. They are being used to production today.

Re: Post-apocalyptic life in American health care

#180

Post by wh0knows »

Wytwwww wrote: post #161
wh0knows wrote: post #154

Earlier quoted context omitted.

Profit can be manipulated. Creating a giant bureaucracy of overpaid administrators and middlemen can siphon off any amount of money while declaring no profit.

> Profit can be manipulated You mean costs can be inflated? Yes, the American healthcare system is extremely inefficient but that doesn't help the shareholders of those insurance companies at all.

Yes, I mean the amount that the cost is inflated by is much greater than 4%.
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