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Post-apocalyptic life in American health care

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Re: Post-apocalyptic life in American health care

#81

Post by mr_overalls »

nradov wrote: post #63
lovich wrote: post #59

Earlier quoted context omitted.

It sounds like the answer would be to standardize everything so that it wasn't 90% edge cases but there is no incentive for many of the players to do so

Standardize what? With a complex medical condition like that every patient is different so it's tough to apply evidence-based medicine practices. The technology for sharing patient records is gradually being standardized. But that won't help if the doctors don't actually take time for a detailed review of the patient's records.

ICD 10 is a medical classification system by the World Health Organization. It contains thousands of extremely detailed codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. It is used by all parties in the healthcare system.

https://en.wikipedia.org/wiki/ICD-10

Re: Post-apocalyptic life in American health care

#82

Post by maxxxxx »

ferongr wrote: post #54
trowawee wrote: post #38

Earlier quoted context omitted.

Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-…

I live in a "first world nation" and 10 years ago (before the global financial crisis even) public vs private healthcare meant the difference between leg amputation and implantation. The public system is only good for routine diagnosis and minor surgery. For everything else, care quality goes down the toilet. Not to mention on the effectively complete lack of dental care.

What country is this?

Re: Post-apocalyptic life in American health care

#83

Post by conanbatt »

frgtpsswrdlame wrote: post #75
conanbatt wrote: post #70

Earlier quoted context omitted.

> Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me I didn't argue that regulations are good because there was a purpose to them nor its opposite. So it doesnt really apply to my stance so far. > Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated. I disagree with that…

>I didn't argue that regulations are good because there was a purpose to them nor its opposite. So it doesnt really apply to my stance so far. I mean 'the road to hell is paved' is just an argument against trying to do anything good, it's not exactly relevant. >I disagree with that statement, and I am sure that you will find examples of private markets that are more efficient than public markets, of the which you onl…

> Well no, because I'm speaking in general. But I'd love to know your example.

Instead of wasting time with examples that dont go for the core of your stance, can you share what would change your mind in the general?

Mine is that lightly regulated free healthcare markets will be efficient (though might not be equitable).

Re: Post-apocalyptic life in American health care

#84

Post by aeorgnoieang »

testplzignore wrote: post #30

In the software world, we would fork or rewrite, and deprecate the old version. I think we should do the same for healthcare. The existing system is unmaintainable spaghetti code that needs to be deleted. Create a new single payer healthcare system that is completely separate from anything existing now. Don't attempt to incorporate any existing insurance, regulations, medical records, etc. Allow the new system to ign…

> In the software world, we would fork or rewrite, and deprecate the old version.

Yes and no. Can you name even one specific example of this being done with software on a scale within even an order of magnitude of "healthcare"?

Certainly people fork and rewrite software all the time. But almost all of those projects fail to replace the 'old version'.

And even large software projects that are rewritten are often (heroically) written so as to be (maximally) compatible with the ecosystem of users.

> The only obstacles are political and legal, which can be overcome in one or two election cycles.

This is both wildly optimistic and pessimistic. Vermont voters passed a single-payer referendum (but the government decided to cancel the plans because of the estimated cost). I'm not sure that there's much of anything stopping a single city from doing so (besides things like free-healthcare tourism).

Re: Post-apocalyptic life in American health care

#85

Post by conanbatt »

shrike wrote: post #25

About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago. I can second the experience of the author. All in I had contact with over 40…

> It's broken and I am sure it's killing people. I also don't see a technology fix. Anything that requires more than two or three providers is an edge case, this space is 90% edge cases.

Vertical integration is the biggest hope. With vertical integration, there is no billing.

Re: Post-apocalyptic life in American health care

#86

Post by ashark »

EliRivers wrote: post #67

It appears that 73% of the labor cost of a health care organization is spent on trying to communicate with other health care organizations that have no defined interface. So if it worked properly, US healthcare would cost one quarter if what it does. Less, once the people engaged in trying to talk to each other are no longer required. That's quite a statement.

Considering that (IIRC) other OECD states typically sit between 40% and 60% of US spending on healthcare per-capita, and they presumably haven't actually eliminated these sorts of inefficiencies (so some percentage even of that 40% is still communication overhead) I'd say 73%'s at least plausible (could still be wrong, of course).

Re: Post-apocalyptic life in American health care

#87

Post by maxxxxx »

u801e wrote: post #60
maxxxxx wrote: post #3

"There is, in fact, no system. There are systems, but mostly they don’t talk to each other. I have to do that." That's something I have noticed too. My girlfriend had to visit several doctors for a problem. One was confused about the notes of the other doctor so I proposed to call and figure it out together. The doctor seemed really perplexed about this suggestion and instead ordered the same series of tests again.

Shouldn't the results of the previous tests be part of the medical record? If so, then the other doctor should have been able to view the results.

I don't know. It should but something wasn't clear. The point is that for some reason they didn't make a quick call to clarify and seemed genuinely confused about this suggestion. Instead they ran the tests again.

Re: Post-apocalyptic life in American health care

#88

Post by aeorgnoieang »

mattchew wrote: post #65

Best article I've read this year. (Haha, but it's very good, if a little burdened with weird terminology.) I have been through some similar experiences myself. Not as bad, but enough to find OP's story not-really-remarkable. This is what we've got for healthcare in the USA. I wish it was fixable, but I do not believe it is. Powerful interests will resist or subvert any substantive change. (I do expect new "reforms" t…

> weird terminology

That's due to several factors but one of them is that some of the terms are specific 'concepts' described elsewhere on the same site, which is itself a 'book'.

Re: Post-apocalyptic life in American health care

#89

Post by JimboOmega »

baobrain wrote: post #73
JimboOmega wrote: post #66

Earlier quoted context omitted.

Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. Consider the example the OP gives is a patient who they're paying thousands of dollars a day for, rather than hundreds. They're paying several people to work for days just to figure out how the rules work. It's only marginally working for them. And let's not forget that they are also fighting profi…

> Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. There is something like this for the wealthy [0]. Obviously, concierge medical services are very expensive, and morally questionable imo. [0] https://www.nytimes.com/2017/06/03/business/economy/high-end...

Let's not forget that most people get insurance through their employers, which really limits the choices.

Paying up front for medical services - especially in today's "Chargemaster" world where nobody has a clue what anything really costs - requires you to be REALLY rich. A straightforward appendectomy for me required an overnight hospital stay which was billed at a $17K (the surgery, etc, was more).

Funny thing about that link. It has a chart of "The average number of days to get a non-emergency doctor’s appointment". Los Angeles is pretty flat around 23 days. Guess what time limits the state of California places on that legally? (hint, it's less: http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCare...)

Re: Post-apocalyptic life in American health care

#90

Post by borvo »

nathanaldensr wrote: post #11

I love this article. I feel like it gets down to the real root of the problems with the complexity of Western culture. I feel like this perspective applies to a lot more than healthcare. It matches my own thoughts that technological complexity is getting so high that eventually it will be beyond our own understanding, both individually or in a group of any size. We as a species simply won't be able to make use of our…

Most Western societies are able to operate healthcare systems that don't have this problem - and this "solution" is often advocated as a panacea for the coordination issues they face due to centralization.
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