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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

#191

Post by EVa5I7bHFq9mnYK »

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…

I don't know, many of the major drugs, like penicillin, insulin, thorazine, birth control etc were developed without those hurdles, and not in the USA. But US gave us Viagra)

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

#192

Post by nradov »

a-user-you-like wrote: post #20
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…

We already have a ridiculously regulated, stifling environment. More stifling is not the answer, just look at the wait times and patients being denied basic care in Canada and the UK. We need to end the ridiculous grip the AMA has on the # of doctors; get rid of the hospital certificates of need, and encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other a…

The American Medical Association does not control the number of doctors. The primary bottleneck in producing new doctors is limited federal (Medicare) funding for residency programs. The AMA has been actively lobbying Congress to increase the number of doctors.

https://savegme.org/

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

#193

Post by caeril »

jeanlucneptune wrote: post #181
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…

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.

No, all the problems wouldn't go away. But a healthy-weight population would cost roughly 64% less to treat, which implies a 64% reduced hospital congestion and workload. This could get offset somewhat as people die later in life of "old age" rather than chronic conditions or CVD events, but those costs would be much lower. So let's say a 50% reduction over the long run.

Yes, I am a former fatty who has kept it off for well over a decade now. It's really quite trivial to do.

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

#194

Post by caeril »

mzgaljic wrote: post #185
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…

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…

My point is that the medical industry prioritizes treatment of expedient consequences over treatment of root causes, and then they bitch that they're so overworked and overwhelmed.

If they were truly interested in un-clogging their hospitals and clearing their dockets, they'd be actively engaged in treating root causes. Sure, maybe alongside the pharmaceutical interventions, but the focus ought to be on the cause.

To your points:

- Most moderately overweight people do not, in fact, know they are. Humans operate on the basis of visual comparison, not medically significant measurements like BMI or visceral fat measurements. If you look approximately like your other overweight coworkers, friends, etc, then you'll assume you're fine (in the genpop case, HN denizens and other data-driven folks likely excluded).

- Many of those who are morbidly obese to the point it's obvious they're much larger than their peers, are likely blind to the actual health consequences of their behavior. The general population is vaguely aware that being fat is not super healthy, but they have no idea of HOW devastatingly unhealthy the actual medical literature indicates. On top of this, you have HAES/fat-acceptance nutcases convincing huge swathes of the obese population that they are perfectly healthy.

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

#195

Post by ThePowerOfFuet »

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…

Or do what I did and get on an A320 with a one-way ticket.

I haven't set foot anywhere in North America in almost ten years, and frankly I don't miss it.

The food is better, the transport is far better, the weather is better, and my health care costs are literally a rounding error.

Where do I live, you ask?

Not in the US.

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

#196

Post by no_wizard »

jeanlucneptune wrote: post #178
jay3ss wrote: post #104

Earlier quoted context omitted.

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).

Having had Kaiser, it really, really really depends on what care you seek.

Broken arm? great. Straightforward / well known ailment? Check check check. Psychiatric care? Hit or miss, but was not good in our experience (I can attest to some close friends and family who did receive quality care). Need an uncommon specialist or research doctor? Horrible.

My partner has a relatively rare thoracic spinal herniation issues, and Kaiser just wanted to put her on drugs and tell her "too bad, its all we can do". No physical therapist specializations, only 1 standard MRI and was looked at by a doctor who was not a specialist in thoracic spinal issues. When we balked at that, they then tried to turn around say it was "all in her head". We had to go out of pocket to see a physical therapist who specialized in this sort of thing to get any real help, and we have as of yet to meet a doctor who's willing to take on her case and advocate for specialized care, who then recommended us a chronic pain psychiatric specialist who's job is, to tl;dr, to help train the mind to lessen the daily chronic pain. That combined with a pretty strict diet & regiment of physical activities are the only thing giving her quality of life. Kaiser blew it. I can only imagine how much worse off we'd be had I not have a good job to cover the costs out of pocket.

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

#197

Post by jay3ss »

jeanlucneptune wrote: post #178
jay3ss wrote: post #104

Earlier quoted context omitted.

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).

Aetna seems to be hit or miss here in California. My brother had it and it was great for him. For me, it doesn't compare to Kaiser

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

#198

Post by jackieomk »

bruce511 wrote: post #37
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.

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…

[flagged]

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

#199

Post by jackieomk »

bruce511 wrote: post #37
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.

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…

[flagged]

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

#200

Post by buffington »

mzgaljic wrote: post #185
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…

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…

I used to work with a brilliant software engineer who weighed at least 400lbs when we worked together. Incredibly smart, kind, and thoughtful, and funny. But there was this one puzzling thing about her.

She was vocally critical of the mere concept of "fat" and would find any excuse to pick fights about it. During a company-wide meeting of about 1200 people it was announced that we'd be inviting employees and their families to a theme park for the day, all to ourselves. She stood up during the Q&A portion and asked if the company would be, in her words "giving people who didn't fit on the rides a sum of money equal to the cost of admission, travel expenses, and meals." The HR rep asked for clarification, to which she said "those of us who were born too big to go on rides shouldn't be denied benefits other people get because they fit. That's discriminatory."

She would also frequently and passionately argue about how the idea of "overweight" or "underweight" is an invention of capitalism - a tool to get people to spend money on books, gyms, diet programs. No amount of rational debate would alter her stance. She'd cite supposed medical journals from memory disputing the concept of obesity if anyone asked "aren't there health risks?"

Denial is a crazy, sometimes heart breaking, thing. There are people who don't believe that being fat is unhealthy.

She was one of them. I say "was" because she died of cardiac arrest at the age of 27 while at work, 20 feet away from where I was sitting. Even now, I still have a hard to reconciling who she was (smart, rational, kind) with what she believed and how she died. Utterly tragic.

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