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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

#81

Post by asdff »

dmitrygr wrote: post #68
bruce511 wrote: post #37

Earlier quoted context omitted.

In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally com…

> are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.

Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least

https://thehill.com/blogs/congress-blog/healthcare/484301-22...

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

#82

Post by asdff »

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…

This seems like a problem that would right itself if the conservatives allowed for more immigration

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

#83

Post by ShredKazoo »

duffpkg wrote: post #79

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCould open source EMR, built and operated ~90 acute care management services organizations (MSO) (the "things" that operate the non-medical aspects of many acute care systems). Healthcare is highly dysfuctional but I want to dampen the notion a little bit that it is in some unique and new kind of collapse today. Everything you are stating is nearly verb…

Is direct primary care something to do instead of insurance, or in addition to insurance? I know someone who gets direct primary care and has no insurance, but I was telling him he should get insurance anyway in case of disaster -- was my advice incorrect?

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

#84

Post by vgatherps »

wrp wrote: post #30
CynicalMD wrote: post #2

Continued: Why did you end up in the ER in the first place? If you’re lucky enough to have a primary care doctor, they probably couldn’t see you for at least a week or two because they’re too busy. By busy, I mean filling out prior authorization forms - the bureaucratic stranglehold of the health insurance companies is immense. If you had abdominal pain the primary care doctor could easily order labwork and a CT scan…

> Patients yell, they are demanding, they are untrustworthy. This gets a lot of comment, but it's half the story. I get most of my medical care abroad, but have escorted family through through local medical visits. I've noticed a marked decline in empathy among medical staff the past few years, even in the secretaries at the front desk. This seems to be a general social trend, not just a problem of bad patients.

Reminds me of a friend who passed away from what was essentially doctor apathy.

While recovering from a major surgery started getting terrible abdomen pains. Doctors could hardly even be bothered to tell her to deal with it, completely dismissed her.

about a week later a new resident comes in, pokes and prods her a bit (no doctor prior could even be bothered to do that), looks horrified and orders some scans.

Her stomach had burst and was leaking into abdominal cavity the whole time, she later passed from the complications.

I gained a ton of sympathy for folks for fight and push back against doctors after that.

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

#85

Post by dmitrygr »

asdff wrote: post #81
dmitrygr wrote: post #68

Earlier quoted context omitted.

> are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.

Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22...

It is simple, calculating, and heartless.

When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y.

When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO)

Since I can afford to buy a lot more than X / Y of healthcare for me and my family, should it be needed, the outcome for that limited and, to be honest, complete set of people whose well-being i care about is better in the current system.

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

#86

Post by ShredKazoo »

jeanlucneptune wrote: post #69
giardia wrote: post #64

Earlier quoted context omitted.

>concierge doc Can you please elaborate? I need something like this and I'm willing and able to pay for it. How would I get started finding one?

Basically, like a doctor with a membership club. Generally doesn't take your insurance, although some services might covered by your insurance. Good example is MDVIP - https://www.mdvip.com/ . I have no relation to the company other than being a customer. I pay $1,600 a year for my Mom to be a member and it's the best money I've ever spent.

Would it still be good to have insurance in addition to this, in case of disaster?

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

#87

Post by noobermin »

CynicalMD wrote: post #2

Continued: Why did you end up in the ER in the first place? If you’re lucky enough to have a primary care doctor, they probably couldn’t see you for at least a week or two because they’re too busy. By busy, I mean filling out prior authorization forms - the bureaucratic stranglehold of the health insurance companies is immense. If you had abdominal pain the primary care doctor could easily order labwork and a CT scan…

The last sentence is chilling. What can or will replace it? And how?

tbf, it sounds like you're just saying the US will collapse because while the health care system is a big part of it, the whole US is facing issues as you pointed out.

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

#88

Post by bruce511 »

vladvasiliu wrote: post #73
bruce511 wrote: post #43

Earlier quoted context omitted.

To be fair, the current govt is preciding over a (self inflicted) economic collapse in all areas, not just the NHS. And ultimately voters have no-one to blame but themselves. (or half of them anyway.) leaving the EU is epically dumb on a truly impressive scale. So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform…

> So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there. I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Sam…

Its pretty easy to find shortages and flaws in any system.

And yes, national health is always tempting for budget cuts because its a huge number, and trimming it 5% gives real returns.

Shortages of drugs and equipment are often tied to supply-chain issues more than budget, and again that's a barrel of worms best left for another thread.

Clearly single-payer can work, but it does need the single-payer to, well, pay.

Brexit is a large factor because the UK was a net-importer of aid from Europe. And Europe was the biggest trading partner. Predictably leaving has decreased the economy such that tax revenues are down, which in turn means less to spend on social services.

Then we can talk about freedom of movement, and the number of Europeans who staffed the NHS and who no longer do so, and cannot be replaced by other Europeans.

So sure, the global economy is taking strain at the moment. Brexit is not the only cause. But its a pretty big sucking chest wound.

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

#89

Post by ShredKazoo »

jeanlucneptune wrote: post #67
ShredKazoo wrote: post #54

Earlier quoted context omitted.

>Number three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system. Why would the size of the deductible/copay affect the amount of paperwork? My naive assumption would be that the amount of paperwo…

A high deductible plan can save you money on the front end, but if you start using that plan you should prepare for rain - a deluge of bills from providers who have no idea what the insurance owes and what you owe. And God-forbid you use a narrow network plan like an EPO because it's hard to figure out ahead of time what services are covered by the network and what's not. I went to see a doc who was in-network and on…

>a deluge of bills from providers who have no idea what the insurance owes and what you owe.

But if the provider can't communicate with the insurance in order to figure that out, why would a different deductible/coinsurance change that?

I was actually told that I met my deductible in 2022, and then I got another big bill in the mail. So that made me think deductibles are a scam and I should just pick the plan with the lowest premium.

(Thanks a lot for answering my questions by the way!)

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

#90

Post by noobermin »

vgatherps wrote: post #84
wrp wrote: post #30

Earlier quoted context omitted.

> Patients yell, they are demanding, they are untrustworthy. This gets a lot of comment, but it's half the story. I get most of my medical care abroad, but have escorted family through through local medical visits. I've noticed a marked decline in empathy among medical staff the past few years, even in the secretaries at the front desk. This seems to be a general social trend, not just a problem of bad patients.

Reminds me of a friend who passed away from what was essentially doctor apathy. While recovering from a major surgery started getting terrible abdomen pains. Doctors could hardly even be bothered to tell her to deal with it, completely dismissed her. about a week later a new resident comes in, pokes and prods her a bit (no doctor prior could even be bothered to do that), looks horrified and orders some scans. Her sto…

You hear both sides, likely the "doctors could hardly be bothered" might be in fact due to some doctors being overworked.

I was in the A&E (what is the ER in singapore and the UK I think) and I had severe chest pain due to chest infection. There were like 40 of us in there and like 5 nurses that one nurse just blew me off when I asked for pain killers because she didn't read my record properly and thought I took acetaminophen that morning. It took the pain getting worse to the point I was rocking and screaming for them to give me tramadol. that said, I sympathize with the situation, given they were running around and hardly able to fill out the paper work and do their normal tasks AND be attentive to the sick.

That said, hey I hear you. That doctor fucked up and it was on them yes, it does not absolve them. That said, things sure are getting worse in total across the system in the US, and bad attitudes doesn't explain nationwide scales. For that, you must look at systemic solutions, especially if you don't want more people to die in such situations again.

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