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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

#221

Post by horns4lyfe »

footlose_3815 wrote: post #101
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…

>Number one recommendation: spend $$$ on a concierge primary care doc. Fuck the country I was born in if this is the solution I need to keep myself healthy in a place I pay more than my fair share of taxes and rent to scumbag landlords just to live. Fuck this world.

That’s not what you need to keep yourself healthy. Statistically, you need to not overeat, exercise, walk a lot, and not do too much risky shit (i.e., ride a motorcycle). Obviously there are exceptions, but in a system where people are actually taking care of themselves the resources are there for it. The sooner people realize they alone are responsible for most of their health, the better off we’ll be.

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

#222

Post by jeffdn »

robocat wrote: post #208
kelseyfrog wrote: post #28

Earlier quoted context omitted.

End of life counseling became a political third rail when it was rebranded as "death panels" by Sarah Palin in order to delegitimate the ACA. Since then, it has been avoided as a topic of public discourse by the media. Discourse around death in general makes people queasy. We tend to avoid the cognitive dissonance between the idea that supplying less end of life care would dramatically reduce medical expenses and the…

> supplying less end of life care would dramatically reduce medical expenses This is a myth. [Those] with a high chance of dying accounted for only 5 percent of total Medicare spending, and among them about half survived in any case total spending on end-of-life care is only 9 percent of the total cost of health care.

9% of $4.3 trillion is $387 billion. That’s a pretty dramatic reduction.

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

#223

Post by jeffdn »

derekp7 wrote: post #99
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…

I'd like to see a different take on single payer. First, allow anyone to buy into medicare for their insurance provider (at a market reasonable price for younger people, subsidized like it is now for seniors). This could act as a nation-wide insurer without any "funny business" such as getting charged thousands because an assistant that wasn't in-network showed up the day of your surgery. Second, if an employee isn't…

This is essentially what the “public option” in the original Obamacare proposal was — an opt-in publicly owned insurance company, which would compete with all the other insurers, but not have the overhead of their business models. Unfortunately, it was axed alone with much of the other important aspects of that bill.

The great irony is that the initial Obamacare proposal was a Republican policy — originally proposed in the mid-‘90s as an alternative to the proposal from the Clinton White House, and implemented in Massachusetts by Mitt Romney when he was the governor. The Republican congress and conservative media machine were so invested in seeing Obama fail that they instead branded it socialism and fought it tooth and nail. It would’ve been a fantastic opportunity for a resurgence in bipartisanship in government, and could potentially have averted the subsequent 14 years of animosity and bitter obstructionism. Ah well, so it goes.

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

#224

Post by pav345678 »

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…

Hi, I apologize if my comment is not relevant to the conversation, but this specific comment seems very useful to my personal situation and I desperately need some further insight on the matter.

I am an US expat living in a country with free universal healthcare. It is also affected by a war that started a year ago. I could not leave then because I had a life threatening health emergency and had to spend 2 month in a hospital. Luckily, it was finally resolved, but i need to stay on heavy meds to remain in remission.

And they just discovered that I have a tumor in my kidney that requires major surgery. To have surgery here is almost certain death from complications/infections/neglect (i've seen it happen)

So I have to go back to US.

My plan is to move back, buy a "cadillac" health plan on ACA market place. I understand that one can enroll after enrollment period if moving from overseas. Then try to get a treatment.

What is the best approach to get the treatment as fast as possible? Is concierge thing only way to go? I checked major cancer centers in an area where I plan to settle, they are all accepting new patients. Does it mean I can go directly to them and expect them to treat me right away?

Most important question. What if I denied insurance or it is delayed and I end up uninsured? Is there a way to get a treatment first and pay later/negotiate price, payment plan, etc

Any advice is appreciated

Thank you

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

#225

Post by Jochim »

lotsofpulp wrote: post #19
AnimalMuppet wrote: post #11

Earlier quoted context omitted.

I could see a single payer system having the same problems. All it would take is a system with some incentive to save money, and a bureaucracy. I could easily see Congress designing a single payer system that had both of those. Would it be as bad? Hard to say. In one way it would be worse: There would be no alternative. You couldn't switch insurance providers to get something better. And, in fact, just today I saw st…

>I could see a single payer system having the same problems. You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system. I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in orde…

The problem in the UK is that conservatives and neo-liberals have been actively dismantling the service over the last 20 years.

At a time when there were already staffing difficulties conservatives dis-incentivised people from becoming nurses by removing training bursaries.

Parts of the system have already been stealthily privatised with the associated drop in quality and additional costs. In many cases employees of the NHS are simultaneously being paid private rates using public money through schemes like "right to choose".

At a time when staff nurses are being told they don't deserve higher pay, private agencies are being paid >3 times the staff rate in order to fill gaps in staffing caused by lack of pay and overwork. The result is artificially inflated staffing costs and an incentive for the remaining staff to move over to the agency for what is often double what they'd be earning.

The correct course of action is to bring costs back into line by expunging the parasitic private healthcare system. Every agency position eliminated pays for 2 staff nurses with a healthy pay rise. The improvement to staffing ratios would further improve the nature of the job.

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

#226

Post by mharig »

pav345678 wrote: post #224
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…

Hi, I apologize if my comment is not relevant to the conversation, but this specific comment seems very useful to my personal situation and I desperately need some further insight on the matter. I am an US expat living in a country with free universal healthcare. It is also affected by a war that started a year ago. I could not leave then because I had a life threatening health emergency and had to spend 2 month in a…

Go to Slovakia. Relative cheap and relative good health care. At least some years ago. Language may be a problem.

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

#227

Post by pav345678 »

mharig wrote: post #226
pav345678 wrote: post #224

Earlier quoted context omitted.

Hi, I apologize if my comment is not relevant to the conversation, but this specific comment seems very useful to my personal situation and I desperately need some further insight on the matter. I am an US expat living in a country with free universal healthcare. It is also affected by a war that started a year ago. I could not leave then because I had a life threatening health emergency and had to spend 2 month in a…

Go to Slovakia. Relative cheap and relative good health care. At least some years ago. Language may be a problem.

May be some years ago. Now Slovakia is also affected by a nearby war and packed with refugees from Ukraine.

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

#228

Post by robocat »

jeffdn wrote: post #222
robocat wrote: post #208

Earlier quoted context omitted.

> supplying less end of life care would dramatically reduce medical expenses This is a myth. [Those] with a high chance of dying accounted for only 5 percent of total Medicare spending, and among them about half survived in any case total spending on end-of-life care is only 9 percent of the total cost of health care.

9% of $4.3 trillion is $387 billion. That’s a pretty dramatic reduction.

Unfortunately that figure contains selection bias - it is measured for those who die, but the figure for those who survive is missing.

That reduction is simply not achievable unless you can accurately predict who is going to die, which turns out to be very difficult to do.

The most significant health costs are for chronic conditions, and their ongoing consequent costs.

Your point is as non-sensical as saying we could save millions of dollars by killing 10% of the population at random.

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