5 ms·

I think there are usually two reasons. 1 - A significant portion of our economy is healthcare middlemen. With single payer or nationalized care, all of our Bl

I think there are usually two reasons. 1 - A significant portion of our economy is healthcare middlemen. With single payer or nationalized care, all of our Blue Crosses and Cignas (and the jobs associated) would evaporate overnight. I'm not arguing that we need trillions of dollars of our GDP locked up in middlemen, but it's very hard for a man to understand something when his salary depends on his not understanding it. 2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions. People in the United States with high-quality private insurance* can usually be seen by a specialist within a few weeks regardless of how severe or immediate their problem is. The truth is that unless that person has some kind of advanced or rapidly progressing disease, they could wait for months without any problems. But that would be a major change to the way we think. It would mean allocating care based on need, not based on ability to pay. *High-quality private insurance is usually one of the perks of working for a great company. I would argue that only a small minority of Americans have truly high-quality coverage. But all of the people who don't have high-quality coverage envy the others and vote with them, a la "temporarily embarrassed millionaire."

SolaceQuantum 7y ago
"2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions." Are you sure? I have to schedule several days if not a week in advance just to go to my PCP, much less a specialist. I also live in an area with no shortage of medical services.
- slumdev 7y ago
  Is this sarcasm?
  - SolaceQuantum 7y ago
    No, not really. I've lived in Toronto and USA, and the times aren't really different IME.
    - slumdev 7y ago
      Just making sure. Waiting a few days to see a GP isn't that weird. If it's emergent (like a severe allergic reaction), there's the ER. If it isn't emergent but needs resolving sooner (like an ear infection), there are Urgent Care clinics everywhere. I've also had the experience that my GPs' assistants can find time in their schedules if my problem is one that (1) they can resolve and (2) does need a quicker resolution.
      - SolaceQuantum 7y ago
        So how can we say we expect near-immediate responses when waiting days for basic checkups is normal?
programmertote 7y ago
You are absolutely right about the middlemen/women. But don't forget to mention the doctors, nurses and PAs as well (more on doctors). They have skin in the game and most of the US doctors that I've talked to aren't that keen on single-payer system. The only excuse they have is that it'll flood the system with a lot more patients (I'm sure it can be solved the same way it is solved in Canada et al.) and that the quality of care will be reduced (can't see that rationale). About the long wait time - I waited from 11pm until 8:30am (discharge) in the morning in ER of Strong Memorial hospital one day for falling and bleeding from my nose (I thought I broke my nose, but luckily, I didn't). I should have answered my pain level was 10 instead of being truthful about it and responding 3. This is not to mention that I got charged $250 from deductibles despite having the insurance. My sister, who lives in Rochester, NY, is waiting until May 2020 to get an appointment for yearly physical checkup. There's a significant shortage of doctors in rural areas (Rochester isn't even that rural to be honest). And yet, AMA is happily restricting the supply of new doctors by putting up multiple hurdles including exam fees (not to mention the amount of money they charge for each USMLE exam is ridiculous) and requirement to go through 8 years of education when that could have been easily reduced to just 4 for any IM (internal medicine) physician.
- slumdev 7y ago
  > About the long wait time - I waited from 11pm until 8:30am (discharge) in the morning in ER of Strong Memorial hospital one day for falling and bleeding from my nose (I thought I broke my nose, but luckily, I didn't). This is how the system is supposed to work. Even if you had broken your nose, unless it's some gaping open fracture or the bleeding can't be controlled, it's probably not a higher priority than most of the cases they see. > My sister, who lives in Rochester, NY, is waiting until May 2020 to get an appointment for yearly physical checkup. There's a significant shortage of doctors in rural areas (Rochester isn't even that rural to be honest). And yet, AMA is happily restricting the supply of new doctors by putting up multiple hurdles including exam fees (not to mention the amount of money they charge for each USMLE exam is ridiculous) and requirement to go through 8 years of education when that could have been easily reduced to just 4 for any IM (internal medicine) physician. This is a complicated problem. Our current system incents people to become specialists. Why would I want to go to school for 8 years (taking on $200-300k in student loans if I'm lucky) and then do 1-3 years of 100-hour weeks making $50k to come out making less than a twentysomething software engineer?
Zarath 7y ago
Yep, I laughed the other day when I saw an article in WSJ that was talking about a billion dollar business responsible for putting drug ads in doctors offices. That billion dollars is coming from somewhere and I think I have a good idea of where.

SolaceQuantum 7y ago

"2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions." Are you sure? I have to schedule several days if not a week in advance just to go to my PCP, much less a specialist. I also live in an area with no shortage of medical services.

slumdev 7y ago
Is this sarcasm?
- SolaceQuantum 7y ago
  No, not really. I've lived in Toronto and USA, and the times aren't really different IME.
  - slumdev 7y ago
    Just making sure. Waiting a few days to see a GP isn't that weird. If it's emergent (like a severe allergic reaction), there's the ER. If it isn't emergent but needs resolving sooner (like an ear infection), there are Urgent Care clinics everywhere. I've also had the experience that my GPs' assistants can find time in their schedules if my problem is one that (1) they can resolve and (2) does need a quicker resolution.
    - SolaceQuantum 7y ago
      So how can we say we expect near-immediate responses when waiting days for basic checkups is normal?

programmertote 7y ago

You are absolutely right about the middlemen/women. But don't forget to mention the doctors, nurses and PAs as well (more on doctors). They have skin in the game and most of the US doctors that I've talked to aren't that keen on single-payer system. The only excuse they have is that it'll flood the system with a lot more patients (I'm sure it can be solved the same way it is solved in Canada et al.) and that the quality of care will be reduced (can't see that rationale). About the long wait time - I waited from 11pm until 8:30am (discharge) in the morning in ER of Strong Memorial hospital one day for falling and bleeding from my nose (I thought I broke my nose, but luckily, I didn't). I should have answered my pain level was 10 instead of being truthful about it and responding 3. This is not to mention that I got charged $250 from deductibles despite having the insurance. My sister, who lives in Rochester, NY, is waiting until May 2020 to get an appointment for yearly physical checkup. There's a significant shortage of doctors in rural areas (Rochester isn't even that rural to be honest). And yet, AMA is happily restricting the supply of new doctors by putting up multiple hurdles including exam fees (not to mention the amount of money they charge for each USMLE exam is ridiculous) and requirement to go through 8 years of education when that could have been easily reduced to just 4 for any IM (internal medicine) physician.

slumdev 7y ago
> About the long wait time - I waited from 11pm until 8:30am (discharge) in the morning in ER of Strong Memorial hospital one day for falling and bleeding from my nose (I thought I broke my nose, but luckily, I didn't). This is how the system is supposed to work. Even if you had broken your nose, unless it's some gaping open fracture or the bleeding can't be controlled, it's probably not a higher priority than most of the cases they see. > My sister, who lives in Rochester, NY, is waiting until May 2020 to get an appointment for yearly physical checkup. There's a significant shortage of doctors in rural areas (Rochester isn't even that rural to be honest). And yet, AMA is happily restricting the supply of new doctors by putting up multiple hurdles including exam fees (not to mention the amount of money they charge for each USMLE exam is ridiculous) and requirement to go through 8 years of education when that could have been easily reduced to just 4 for any IM (internal medicine) physician. This is a complicated problem. Our current system incents people to become specialists. Why would I want to go to school for 8 years (taking on $200-300k in student loans if I'm lucky) and then do 1-3 years of 100-hour weeks making $50k to come out making less than a twentysomething software engineer?

Zarath 7y ago

Yep, I laughed the other day when I saw an article in WSJ that was talking about a billion dollar business responsible for putting drug ads in doctors offices. That billion dollars is coming from somewhere and I think I have a good idea of where.