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America’s Looming Primary-Care Crisis

newyorker.com

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81–90 of 103 posts

Re: America’s Looming Primary-Care Crisis

#81

Post by Nasrudith »

spaetzleesser wrote: post #65

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets…

The assumptions are incorrect. Medical associations may influence supplies to some degree but they don't set the price. Supply, demand, and what the market may bear do. There are also really several different healthcare systems. The government can set say VA rates and medicare to some degree. The sort of balancing done is encouraging more family doctors.

Radiology and anesthesiology are also two "cash cows" of procedures. All of internal medicine wants radiology for tests and needs anesthesiologists if surgical remedies are required.

Primary care pays less because it requires less additional training than the specialties. Although some specialties aren't higher - Children's Oncology for instance.

Re: America’s Looming Primary-Care Crisis

#82

Post by AdrianB1 »

HarryHirsch wrote: post #52
fennecfoxen wrote: post #15

Earlier quoted context omitted.

> people have wacky ideas about things like economics and intelligence. Boy howdy. There are three major parts of the economy which are extensively regulated to achieve political goals: health care and higher education (on the national level with some state involvement) and housing (city-level zoning, with occasional other mandates particularly in places like California). Notice then the three areas where prices have…

You think that other countries don't have housing, education and healthcare policies?

By comparison we have a very relaxes housing regulation and it works a lot better. Same for education.

Re: America’s Looming Primary-Care Crisis

#83

Post by naveen99 »

spaetzleesser wrote: post #65

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets…

Medicare had been cutting radiology reimbursements for a while, to the point radiology had almost a 100 unfilled residency spots in the us a few years ago. Radiologists are being paid the bottom of market clearing rates. You pay them much less than what they make now, and you will have a severe shortage quickly.

Re: America’s Looming Primary-Care Crisis

#84

Post by mensetmanusman »

katbyte wrote: post #61
briandear wrote: post #27

Earlier quoted context omitted.

> it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Want ice cream after a hard running workout? Pay a tax. Don’t exercise enough? Pay another tax. Allo…

> And “liquid sugar” isn’t a problem. People choosing to consume too much of it is. I am perfectly healthy, normal weight, plenty of exercise and I like to drink Coke. Should I have to pay a tax or higher prices because some fat-ass makes the choice to drink it like water? yes. we tax darts and alcohol - the medical cost of sugar probably well exceeds all risky outdoor activities by orders of magnitude. ~200 climbing…

‘Should I have to pay for other people’s unhealthy behavior’ is the main debate about healthcare...

Re: America’s Looming Primary-Care Crisis

#85

Post by mensetmanusman »

pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

It doesn’t matter what you eat if you don’t move your body.

People have to realize that the wealth America gained post WW2 was poured into making life comfortable and easy (institutionally and economically).

This had the unintended consequence of making Americans (on average) some of the unhealthiest humans in the world.

Re: America’s Looming Primary-Care Crisis

#86

Post by shados »

kevin_thibedeau wrote: post #77
bluedino wrote: post #60

Earlier quoted context omitted.

It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage. Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.

Or it's not the food and people have just adopted a lifestyle where all energy expenditure is minimized. That is self evident in social behavior. Your theory is just an easily trotted out bogeyman.

Anecdotally, it's at least partially the food. I was a little overweight when I moved to the US, and now I'm full blown fat. My lifestyle (aside for food), didn't change.

The main difference is availability and price, especially the latter. A decent lunch near my office in my home country was 20-30 bucks (converted in USD), and I made X/year. Now I make 3-4+ times X, and you can get more food than I can eat at shit like Panda Express for 6-8 bucks. So vs my income, it's almost 10 times cheaper.

If it wasn't for health concerns, it no longer made sense for me to cook. So I just had delivery/takeout almost every day after I moved (switching country is stressful, so I was happy to get all the time back I could get). Then the health issues cropped up. Now I'm trying to dial it back, but its tough.

I know a _lot_ of people who had similar things happened to them after they moved here, and anecdotally again, one of them moved back and started losing weight super fast, without really trying.

Re: America’s Looming Primary-Care Crisis

#87

Post by u801e »

qserasera wrote: post #74
DoreenMichele wrote: post #41

Earlier quoted context omitted.

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. That's only one factor. Another is car dependence and lack of pedestrian-friendly built environments. There is a lot of research on just how much harm it does us to sit all day, every day. We sit in a car to make a long commute to work. We sit our desks. We sit in the car again. And hitting the gym occasionally d…

Our metabolism increase from walking 5-15 minutes every day is significant. With individual car transportation there is little want or little ability to do so. Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car. Every day US citizens waste hours life with transportation. I do believe in cars but I also believe we need to reshape how we live. If the US…

> Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car.

You can get that 60 minutes of exercise/physical activity if the transportation to various destinations is changed into a form of exercise for all or some part of it. In the case of a bicycle, it does require that destinations are less than 10 miles (16 kilometers) away, otherwise it would take too much time.

Re: America’s Looming Primary-Care Crisis

#88

Post by cortesoft »

reducesuffering wrote: post #79
cortesoft wrote: post #26

Earlier quoted context omitted.

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

Food subsidies poll extremely well and the US votes for them. They are one of the least controversial public policies and not because of "powerful donors." Almost all countries subsidize food production and there are strong reasons why this is so. Primarily, countries want a robust domestic food surplus for social stability. High food prices or lack of food leading to famine are one of the highest causes of social un…

Ok, even if you are right, they still aren’t concerned with the fiscal impact of the policy.

Re: America’s Looming Primary-Care Crisis

#89

Post by frank2 »

pm90 wrote: post #44
pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

Growing food and subsidizing farmers that produce food is more for the National Security angle: without enough food, there will be rapid social instability and riots and a complete breakdown of society. It’s absolutely essential to produce much more food than can be possibly required by the populace.

True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.

Re: America’s Looming Primary-Care Crisis

#90

Post by pm90 »

frank2 wrote: post #89
pm90 wrote: post #44

Earlier quoted context omitted.

Growing food and subsidizing farmers that produce food is more for the National Security angle: without enough food, there will be rapid social instability and riots and a complete breakdown of society. It’s absolutely essential to produce much more food than can be possibly required by the populace.

True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.

It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.
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