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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

#211

Post by bradknowles »

lotsofpulp wrote: post #151
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…

Aetna is known to be low quality, especially after CVS bought them. CVS has a ton of debt and I do not see CVS management to have a culture of investing in employees. They are known for their retail business, where it is typical to ride employees to the limit until they burnout. I like sticking to BCBS insurers, such as Elevance, Regence, Independence, Horizon, etc.

Aetna used to be good here in Texas. That was a few years back. I had them when I worked at Whole Foods, and that was probably what you'd call a "Cadillac Plan".

Now, as bad as BCBS Premera is, it's still better than Aetna. Maybe it's because CVS bought Aetna, or some other reason, but they've definitely taken a major nosedive here in the last few years.

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

#212

Post by claytongulick »

tzs wrote: post #131
HereIGoAgain wrote: post #119

Um don't know where you're working but that isn't how any of the hospitals or ERs here are running. I was into an ER room being treated within 20 minutes only a week ago... and they said they were pretty busy that day. This all reads like complete and utter FUD EDIT: Never mind engagement, I see this is nothing but a SP propaganda thread.

SP?

Single payer

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

#213

Post by amf12 »

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…

> It will also massively hurt global drug and medical research.

I doubt it would. Private drug companies would still exist and charge the same money regardless of whether the insurance is paying for it or "the single payer system".

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

#214

Post by danny_codes »

DangitBobby wrote: post #123
RhodesianHunter wrote: post #78

The New York times recently had an excellent piece on how exorbitant greed, even in the non-profit side of healthcare, has decimated its quality over the last decades. https://www.nytimes.com/2022/12/15/business/hospital-staffin...

Wondering why this for profit organization isn't on the hook for tax fraud

They are well connected, I'd guess.

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

#215

Post by danny_codes »

nine_zeros wrote: post #161

America used to be a country that understood production. Today, America has become a has-been country mired in divisive politics and systematic enrichment of vested interests. The solution is simple guys. 1. Produce unlimited number of doctors, nurses, insurance companies, drugs. Flood the market with healthcare practitioners. 2. Remove all unnecessary paperwork and regulations. Let doctors start private practices li…

Or we can copy just implement universal healthcare like everyone else.

Seriously literally every other developed country has single-payer. The only reason the US doesn't is we got unlucky with how Healthcare originated in the US. For us it started as workers comp, as opposed to other countries where it started as Healthcare.

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

#216

Post by rnk »

nradov wrote: post #183
twelve40 wrote: post #129

Earlier quoted context omitted.

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...

what about the dodge where when you to an emergency room, there are multiple providers who bill separately (doc x was not on the emergency room bill, he's some other provider).

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

#217

Post by int_19h »

unity1001 wrote: post #125
vladvasiliu wrote: post #53

Earlier quoted context omitted.

> 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 and bureaucrats blocking this change. By "single payer" do you mean the European model of "socialized" healthcare? That may be necessary (I don't know) but it's clearly not enough. I'm in France, and I hear the e…

> By "single payer" do you mean the European model of "socialized" healthcare? Its socialized healthcare. You dont have to put in quotes. It was first advocated by socialists in the First Socialist International at the end of 19th century. It constitutes part of the social democratic program.

Single payer is certainly socialized public healthcare, but not all socialized public healthcare is single payer. I think Americans are predisposed to treat it as an either-or because Canada, which is used most often for comparisons by virtue of being the country with which relatively more Americans are familiar, is single payer. However, many European countries aren't, and there's no discernible pattern for countries with single payer being better than other forms of public healthcare.

I think pushing for single payer specifically is one of the biggest mistakes of the American left, because it's that much harder to sell in US due to more restrictions - and that's inherent in the model. If we took something like the German model instead, I think we'd be way ahead by now.

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

#218

Post by int_19h »

dmitrygr wrote: post #94
Apreche wrote: post #27

I have a question, which you may not know the answer to, but I'm just asking it to everybody these days. Let's say hypothetically that all the medical providers suddenly all decide to stop being evil. They increase staffing to safe ratios. They even have extra staff so people can take vacations and have days off without it being a problem. They give everyone very good compensation and the big time administrators stop…

> Surely capitalism [...] problem Spoken like someone who's never lived NOT under capitalism. It amazes me how young people today say things like this, as if they are self evident. I used to think that I'd not wish that life on anyone, but really y'all could use some, to see the contrast.

I lived "not under capitalism", and while I have many problems with that system, one of the few things that it actually could legitimately boast of was healthcare that was available to everyone, no matter how poor. I don't see any reason why the much richer capitalist societies can't afford the same thing, if they wanted to.

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

#219

Post by [deleted] »

int_19h wrote: post #218
dmitrygr wrote: post #94

Earlier quoted context omitted.

> Surely capitalism [...] problem Spoken like someone who's never lived NOT under capitalism. It amazes me how young people today say things like this, as if they are self evident. I used to think that I'd not wish that life on anyone, but really y'all could use some, to see the contrast.

I lived "not under capitalism", and while I have many problems with that system, one of the few things that it actually could legitimately boast of was healthcare that was available to everyone , no matter how poor. I don't see any reason why the much richer capitalist societies can't afford the same thing, if they wanted to.

[deleted]

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

#220

Post by Traubenfuchs »

pfraze wrote: post #16
DrWorldwide wrote: post #12

"Up in the ICU hopeless 95 year olds will sit on ventilators and other life support machines for weeks because doctors don’t have any discretion in stopping futile care. You can be a 30 year old pregnant woman, and you will die waiting for your ICU bed in the emergency room." I recently went through a situation where my family member was the 95 year old. The immediate family had no basis to judge whether the care bei…

This is an open debate in the medical community. I’m told there have been pilot programs for “end of life counseling” where folks at a certain age are given advice about quality of life expectations once this situation is reached. They often responded by talking to their families and creating plans for ending care before things are bad, solving the weird pressures that families feel in that situation. I’ve not yet go…

Talking about impending death and especially anything even close to "euthanasia" is absolutely verboten in many places, contexts, cultures and countries.
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