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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

#181

Post by jeanlucneptune »

caeril wrote: post #167
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…

> 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…

Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.

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

#182

Post by jeanlucneptune »

nradov wrote: post #177
caeril wrote: post #167

Earlier quoted context omitted.

> 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.…

Thank you for your sane reply.

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

#183

Post by nradov »

twelve40 wrote: post #129
illirik wrote: post #109

Earlier quoted context omitted.

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_!

Cuba is definitely an outlier specifically for that among developing countries and therefore not a great comparison. I hate the US healthcare experience and try to avoid it, but somehow after all the craziness you hear about half the country uninsured and $500k medical bills, the life expectancy numbers are actually not that terrible. I'm not sure why.

Anyone who has medical insurance regulated under the Affordable Care Act (Obamacare) will not receive a $500k bill. The individual out-of-pocket maximum is only $9k.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

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

#184

Post by comte7092 »

cudgy wrote: post #162
dcolkitt wrote: post #22

Earlier quoted context omitted.

The issue isn't a shortage of residency slots, it's that we don't allow doctors with foreign residencies to practice in the United States. The physicians in Spain and South Korea and Costa Rica are really good. Arguably better than American doctors based on health outcomes. Many would jump at the chance to earn high American wages. There's no reason a South Korean doctor with ten years of experience in the world lead…

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 are numerous physicians who have immigrated to the US already and are stuck working menial jobs instead of providing people with care when they are fully qualified to do so. There’s absolutely no good reason for this.

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

#185

Post by mzgaljic »

caeril wrote: post #167
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…

> 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…

serious question - you think overweight people do not know they are overweight? And they don’t know it’s bad for them? They are probably overweight because they physically have trouble losing the weight (disability, hormonal issues, etc), or they have no self-control, or they are poor and don’t have the means or time to focus on their health.

if you are already fat and prediabetic, you have a lifestyle problem, not a medical problem a doctor can fix.

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

#186

Post by CogitoCogito »

dmitrygr wrote: post #68
bruce511 wrote: post #37

Earlier quoted context omitted.

In the USA its all about the money. Those "political forces" 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. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally com…

> 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.

The US could have medicare for all and additional private insurance simultaneously.

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

#187

Post by RedditKon »

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…

Why do you define United as a cadillac plan? I've only had awful experiences with them thus far.

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

#188

Post by nradov »

cudgy wrote: post #159
Der_Einzige wrote: post #102

Earlier quoted context omitted.

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 f…

The government subsidizes much of the basic research needed to identify candidate drugs. However, private companies usually pay for the human trials necessary to bring new drugs to market. A stage-3 clinical trial can cost >$1B with no guarantee of success. It's a huge financial risk.

In theory we could nationalize the whole industry, and let government bureaucrats decide which clinical trials to fund. I'm skeptical whether that would produce better results. Government employees with no skin in the game have a poor record of picking winners.

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

#189

Post by freedomben »

Gibbon1 wrote: post #140
dmitrygr wrote: post #68

Earlier 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.

Lobbyists have been successful convincing you of something in their paymasters interest and not at all in yours.

I despise the current system, but arguments like this do a lot of damage to the reform cause.

Aside from the incredible arrogance of assuming that GP is just so much stupider and more manipulable than you, it's also factually wrong in enough cases that it instantly discredits you. For example, many people who are upper-middle-class and above are better off in the current system.

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

#190

Post by erik_seaberg »

toomuchtodo wrote: post #56
runnerup wrote: post #31

Earlier quoted context omitted.

> But if the deeper problem is there, is there any short term solution? No. > Sure we can start training people and make lots of incentives for people to enter the field, but that will take years. Yes. But it should be done. Also, there shouldn't be shortages of saline IV solution and bacteriostatic water -- but no one's rebuilding the factories destroyed by hurricanes in Puerto Rico because there's not "enough" of a…

Some things should not be ruthlessly efficient; what appears to be waste is tail risk premium. Alas, that “efficiency savings” becomes someone’s bonus or profit, and a loss for the rest of us.

We have to compensate the supply chain for accepting the burden of being prepared for these risks. Today we pass “anti-gouging” laws declaring that we refuse to value it at all.
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