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

This will be a large investment (if doubling the training budget produced double the graduates that would not be enough), and will NOT bear fruit until those people actually graduate, which is 6 years minimum, and mostly 10 years away. So for 10 years, it means paying through taxes while getting minimum to no improvements in return. Furthermore, such a large increase is not possible at short notice, even if the money is available, so it will take more than 10 years time.

For research one might take profit margins of large pharma as an indicator: a fully nationalized, but equally capable, pharma research system would cost some 15% less, assuming nationalizing introduces zero inefficiencies. BUT that money would have to come from taxpayers directly through the government budget.

And nobody is looking for 15% reduction in drugs costs. That just won't move the needle enough. So in reality the government would have to increase the drug research budget to make drugs cheap.

Failing to do this will mean medicine becomes less accessible to people, regardless of whether we switch to a single payer system or not.

So let's get real here: we will fail to do this, and it will get worse.

So some aspect of the coverage might be a 20% coinsurance, where you pay the full cost up to the deductible and then pay 20% of the cost after that until you have reached the out of pocket maximum.

Most of the fees you pay count against both of them, so like if you pay $35 to visit your primary care doctor, you are $35 closer to meeting your deductible, and then also $35 closer to reaching your out of pocket maximum. Lots of frequently used services are covered as a fee based co-pay rather than as coinsurance.

If you have a major expense for something that is covered as 20% coinsurance, the amount up to the deductible would be 100% out of your pocket, and then the coverage would kick in and pay for 80% of the rest (until your 20% exceeds the out of pocket maximum).

I kind of wonder if disallowing insurance companies to negotiate deals with providers would actually end up improving things a lot (because it would create pressure to normalize prices vs fucking around to save a little bit).

A massive number of calls are simply untreated low-grade fevers where the patient was unaware of the fever. I am OBLIGATED and MANDATED to send them to the ED if they request transport. Furthermore, I am LEGALLY bound to offer transport to the ED. I have ZERO authority to tell them to take a fever reducer and call back if that doesn't fix their medical concern.

We are taught to use differential diagnosis in paramedicine. However, we are not allowed to diagnose per medical guidelines from the medical director. Working with this dichotomy has made the entire pre-hospital care system complete bullshit. Based on what I see in the ER, the entire system is on the precipice of complete failure. This collapse is unique and new due to the absurd volume of patients and bullshit policy that has not changed.

Let poorer countries pay to train nurses and doctors, and then wealthier countries take the best because they can pay more for them due to economic dominance.

We do it in New Zealand by importing a lot of doctors (Chinese and Indian seem common), and nurses . The reason we need to import doctors is because we export a lot of doctors and nurses to wealthier countries such as the USA.

In New Zealand, we get people from poorer countries because we can pay more, and we also get people from first world countries because people want to move here for the lifestyle or for their children.