6 ms·

Veteran doc and health services executive here. Three recommendations to improve your overall healthcare experience as a patient. Number one recommendation: s

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 if you need to engage the system. Number two recommendation: seek care in facilities in high-income communities with relatively small general hospitals (i.e. Greenwich Hospital in CT) UNLESS you need tertiary/quarternary care. Why? Much better staffing. Much less riff-raff common people stuff (i.e. like homelessness) and much higher patient expectations about quality of care. 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. Yes, I understand that I'm saying "be rich", but if you can afford any of the three recommendations above your healthcare experience will be MUCH better.

no_wizard 4y ago
I have to say, at least if you're tied to employer healthcare plans, there are bad Aetna and United contracts out there. I've had better runs (on the west coast at least) with Anthem Blue Cross, in terms of engaging with the system. I've been lucky enough in my life to have high quality plans that the employer subsidies (100% paid for me, 80% for my partner) with very low deductibles, and they're PPO to boot (no HMO hoops), which helps when you want to completely by pass getting a recommendation to see a specific doctor (useful when you know what you're doing)
- jeanlucneptune 4y ago
  Agreed. If your employer is trying to skimp on cost you can end up with some really poor options. Lesson there is to find an employer that offers generous benefits. Easier said than done, I know.
- jay3ss 4y ago
  Have had both employer provided Kaiser and Aetna. Aetna was awful while Kaiser was great. Aetna made us jump through all kinds of hoops to get a simple prescription (not pain meds) while it was only a quick phone call with Kaiser. In fact, while in great pain we had to wait for over 8 hours with Aetna to even talk with someone before we gave up and went to GoodRx and got the help we needed nearly instantly. I don't really know where I'm going with this, but I have to say there's a wide discrepancy between employer provided health insurance. I had ACA and it was actually really good! No or low copay (less than $10) and was always able to get ahold of someone when I needed it.
  - lotsofpulp 4y ago
    Aetna is known to be low quality, especially after CVS bought them. CVS has a ton of debt and I do not see CVS management to have a culture of investing in employees. They are known for their retail business, where it is typical to ride employees to the limit until they burnout. I like sticking to BCBS insurers, such as Elevance, Regence, Independence, Horizon, etc.
    - bradknowles 4y ago
      Except BCBS Premera here in Texas. They're having a bitch fight with Ascension/Seton healthcare, which includes Dell Children's Center and the majority of the good hospitals and ERs in the area, as well as many doctors practices. But Open Season ended in November, so now people can't switch insurance companies so that they can actually go to their healthcare provider of choice. And BCBS desperately wants to force you to use only their approved pharmacies, but as of late last year there is a new law here in Texas that makes that illegal. So, what BCBS does is make their preferred pharmacy "optional", but what is not optional is that you can't get any drugs from any other pharmacy until you call up their preferred pharmacy on the phone and speak to a human being to get them to opt you out of the "optional" preferred pharmacy. And imagine how hard that process is these days. Fuck BCBS.
    - bradknowles 4y ago
      Aetna used to be good here in Texas. That was a few years back. I had them when I worked at Whole Foods, and that was probably what you'd call a "Cadillac Plan". Now, as bad as BCBS Premera is, it's still better than Aetna. Maybe it's because CVS bought Aetna, or some other reason, but they've definitely taken a major nosedive here in the last few years.
deleted 4y ago
[deleted]
ShredKazoo 4y ago
>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 paperwork would be O(1) with respect to the amount of money changing hands -- same way you will always be asked if you want a receipt in a store, regardless of how much stuff you bought. Also, how do I know if an insurer is "high quality"? Neither Aetna nor United is available in my state. (Thanks in advance for any replies -- I still have about 3 days during which I can switch my insurance for 2023; was thinking of switching to a high-deductible plan since I don't anticipate using my plan much in 2023)
- jeanlucneptune 4y ago
  If you have a zero copay plan and your provider is in-network, for example, you're not going to be getting a bill in the mail later saying you owe XYZ dollars. If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare. In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).
- jeanlucneptune 4y ago
  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 only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.
  - ShredKazoo 4y ago
giardia 4y ago
>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?
- jeanlucneptune 4y ago
  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/ 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.
  - giardia 4y ago
    Thank you. My local practioners are terrible and border on being unethical.
  - ShredKazoo 4y ago
    Would it still be good to have insurance in addition to this, in case of disaster?
    - jeanlucneptune 4y ago
      Yes, you definitely should have a health insurance plan of some type. Your concierge doc fee will not pay for a visit to the ER, which can bankrupt the average person who doesn't have coverage.
- DoreenMichele 4y ago
  Another term for this is direct primary care. https://www.forbes.com/health/healthy-aging/concierge-medicine/ https://www.forbes.com/health/healthy-aging/concierge-medici...
footlose_3815 4y ago
>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.
- illirik 4y ago
  Exactly this - life in the USA has felt like an unfamiliar board game, run by a rules lawyer who has a grudge against you (personally), my entire life. No wonder we have a shorter life expectancy than _Cuba_!
  - twelve40 4y ago
    Cuba is definitely an outlier specifically for that among developing countries and therefore not a great comparison. I hate the US healthcare experience and try to avoid it, but somehow after all the craziness you hear about half the country uninsured and $500k medical bills, the life expectancy numbers are actually not that terrible. I'm not sure why.
    - nradov 4y ago
      Anyone who has medical insurance regulated under the Affordable Care Act (Obamacare) will not receive a $500k bill. The individual out-of-pocket maximum is only $9k. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
      - rnk 4y ago
        what about the dodge where when you to an emergency room, there are multiple providers who bill separately (doc x was not on the emergency room bill, he's some other provider).
  - nradov 4y ago
    I suspect Cuba is an outlier because they have a reasonably functional healthcare system, but at the same time most people are too poor to overeat or indulge in substance abuse. They literally can't afford to sit around and get fat.
pzone 4y ago
Healthcare in this country is so broken. This industry should be made as simple efficient and affordable as visiting Walgreens. The regulations, the cartel-like barriers to competition, the behemoth corporate powers. The only way to get adequate care is to become so rich you can escape the whole thing.
- cafard 4y ago
  I've received COVID vaccinations at Walgreens, but nothing else you'd call health care. I would imagine that if the industry limited itself to filling prescriptions (though prescribed by whom?) and selling aspirin etc., it could be very simple, efficient, and affordable.
kashunstva 4y ago
Undoubtedly all of this is true and an effective set of strategies for people of means to navigate the system. But this is precisely why healthcare reform will never take root in the U.S. There is no vision for public health. As an academic discipline, public health is robust in the U.S.; but there is no traction in the practical realm because the ghosts of Puritanism still inhabit the the sociopolitical structures. The poor apparently deserve their poor health access.
- lotsofpulp 4y ago
  For leaders, this is the beauty of health insurance companies (better called managed care organizations, MCOs). For places like UK and Canada, leaders have to answer to everyone for why access and quality of healthcare is declining. In the US, using the MCOs, leaders can more easily direct sufficient healthcare to who they want it to go to without being able to be identified as the cause. For example, leaders can tell MCOs to reimburse healthcare providers less for Medicaid (poor people), and more for Tricare (military) and Medicare (old people who vote), and even more for federal government employee health plans (for themselves). Or they can tell MCOs to require more “prior authorization” (PA) for Medicaid so people give up more quickly at getting medicine, whereas federal government employee plans can require fewer PAs. Add employer specific risk pools/deductibles/copays/out of pocket maximum limits into the mix, and there are multitude of levers that can be pulled to ensure people are getting the quantity and quality of healthcare corresponding to their socioeconomic level. Rich people always had concierge medical care. But with the use of MCOs, you can drill it down to income/wealth/political quintiles or even deciles.
- jeanlucneptune 4y ago
  "The poor apparently deserve their poor health access." Exactly what a large percentage of Americans believe. I disagree with them, but hard to make an argument for a better system when many believe that the poor shouldn't have quality healthcare.
onphonenow 4y ago
I’ve been on paperwork side of health a small bit. 1) cash pay / direct / concierge Agreed - especially if employer plan not great. Some of these folks do house calls. I did this for a while 2) high income area Sadly agreed. Even in a city if a hospital is more accessible etc that can be tough. I did a walk in to sf general once a long while back - took me 20 minutes to walk out. Great hospital, but waiting room was nuts. Had a finger burned being an idiot and got seen very quickly at a different sf hospital - night and day difference in waiting room 3) mixed view on this. Kaiser brings some peace of mind - grandfathered hsa plans w 2k deductible and some free base car not a bad experience - key for me is not coordinating/ dealing w multiple bills. Their issue resolution team is terrible though on billing
- jeanlucneptune 4y ago
  #3 - Kaiser is great, no question. Just not familiar with them since they don't have a presence in NYC. Honestly, if we had to emulate one model in the country it would definitely be the Kaiser model.
caeril 4y ago
> keep you out of the hospital/ER You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list the number one correct recommendation: If you are overweight, lose the weight. ~80% of healthcare costs in this country are attributable to chronic conditions, and ~80% of chronic conditions are caused by obesity or lifestyle directly connected to obesity. You improve your own health outcomes, and reduce the burden on the healthcare system as a whole, by ~64% if you're not fat. And your response, as a doctor, mirrors the most infuriating thing about your profession: Hi, you're 260lbs and pre-diabetic. I'm going to put you on Metformin. Hi, you're 280lbs and your LDL/HDL is WAY too high. Here's a prescription for statins. Hi, you're 190lbs at 5'1 and your infertility is caused by LH/FSH imbalances. Take this Clomid. When the hell are the "professionals" in your line of work going to stop medicating away the consequences of this absolutely absurd epidemic and actually address it? The only time I've ever heard of a physician actually advising an obese person to lose weight is for conditions where pharmaceutical interventions don't exist, such as non-alcoholic fatty liver disease. The rest of the time? Take these drugs so you have a couple more years to enjoy your triple bacon cheeseburgers and large fries. It's absolutely maddening.
- jeanlucneptune 4y ago
  Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.
  - caeril 4y ago
    No, all the problems wouldn't go away. But a healthy-weight population would cost roughly 64% less to treat, which implies a 64% reduced hospital congestion and workload. This could get offset somewhat as people die later in life of "old age" rather than chronic conditions or CVD events, but those costs would be much lower. So let's say a 50% reduction over the long run. Yes, I am a former fatty who has kept it off for well over a decade now. It's really quite trivial to do.
- nradov 4y ago
nradov 4y ago
Health insurers (payers) don't deliver different levels of service based on a plan’s deductible or copay. That's literally just a field in the database. All of your claims and prior authorization requests still flow through the same systems. In general high deductible health plans can be good option for consumers who are in good health and have the financial means to absorb an occasional large medical bill. There are also tax incentives for such plans. https://www.healthcare.gov/glossary/high-deductible-health-plan https://www.healthcare.gov/glossary/high-deductible-health-p...
RedditKon 4y ago
Why do you define United as a cadillac plan? I've only had awful experiences with them thus far.
ThePowerOfFuet 4y ago
Or do what I did and get on an A320 with a one-way ticket. I haven't set foot anywhere in North America in almost ten years, and frankly I don't miss it. The food is better, the transport is far better, the weather is better, and my health care costs are literally a rounding error. Where do I live, you ask? Not in the US.
pav345678 4y ago
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
- mharig 4y ago
  Go to Slovakia. Relative cheap and relative good health care. At least some years ago. Language may be a problem.
  - pav345678 4y ago
    May be some years ago. Now Slovakia is also affected by a nearby war and packed with refugees from Ukraine.

no_wizard 4y ago

I have to say, at least if you're tied to employer healthcare plans, there are bad Aetna and United contracts out there. I've had better runs (on the west coast at least) with Anthem Blue Cross, in terms of engaging with the system. I've been lucky enough in my life to have high quality plans that the employer subsidies (100% paid for me, 80% for my partner) with very low deductibles, and they're PPO to boot (no HMO hoops), which helps when you want to completely by pass getting a recommendation to see a specific doctor (useful when you know what you're doing)

jeanlucneptune 4y ago
Agreed. If your employer is trying to skimp on cost you can end up with some really poor options. Lesson there is to find an employer that offers generous benefits. Easier said than done, I know.
jay3ss 4y ago
Have had both employer provided Kaiser and Aetna. Aetna was awful while Kaiser was great. Aetna made us jump through all kinds of hoops to get a simple prescription (not pain meds) while it was only a quick phone call with Kaiser. In fact, while in great pain we had to wait for over 8 hours with Aetna to even talk with someone before we gave up and went to GoodRx and got the help we needed nearly instantly. I don't really know where I'm going with this, but I have to say there's a wide discrepancy between employer provided health insurance. I had ACA and it was actually really good! No or low copay (less than $10) and was always able to get ahold of someone when I needed it.
- lotsofpulp 4y ago
  Aetna is known to be low quality, especially after CVS bought them. CVS has a ton of debt and I do not see CVS management to have a culture of investing in employees. They are known for their retail business, where it is typical to ride employees to the limit until they burnout. I like sticking to BCBS insurers, such as Elevance, Regence, Independence, Horizon, etc.
  - bradknowles 4y ago
    Except BCBS Premera here in Texas. They're having a bitch fight with Ascension/Seton healthcare, which includes Dell Children's Center and the majority of the good hospitals and ERs in the area, as well as many doctors practices. But Open Season ended in November, so now people can't switch insurance companies so that they can actually go to their healthcare provider of choice. And BCBS desperately wants to force you to use only their approved pharmacies, but as of late last year there is a new law here in Texas that makes that illegal. So, what BCBS does is make their preferred pharmacy "optional", but what is not optional is that you can't get any drugs from any other pharmacy until you call up their preferred pharmacy on the phone and speak to a human being to get them to opt you out of the "optional" preferred pharmacy. And imagine how hard that process is these days. Fuck BCBS.
  - bradknowles 4y ago
    Aetna used to be good here in Texas. That was a few years back. I had them when I worked at Whole Foods, and that was probably what you'd call a "Cadillac Plan". Now, as bad as BCBS Premera is, it's still better than Aetna. Maybe it's because CVS bought Aetna, or some other reason, but they've definitely taken a major nosedive here in the last few years.

deleted 4y ago

[deleted]

ShredKazoo 4y ago

>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 paperwork would be O(1) with respect to the amount of money changing hands -- same way you will always be asked if you want a receipt in a store, regardless of how much stuff you bought. Also, how do I know if an insurer is "high quality"? Neither Aetna nor United is available in my state. (Thanks in advance for any replies -- I still have about 3 days during which I can switch my insurance for 2023; was thinking of switching to a high-deductible plan since I don't anticipate using my plan much in 2023)

jeanlucneptune 4y ago
If you have a zero copay plan and your provider is in-network, for example, you're not going to be getting a bill in the mail later saying you owe XYZ dollars. If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare. In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).
jeanlucneptune 4y ago
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 only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.
- ShredKazoo 4y ago

giardia 4y ago

>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?

jeanlucneptune 4y ago
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/ 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.
- giardia 4y ago
  Thank you. My local practioners are terrible and border on being unethical.
- ShredKazoo 4y ago
  Would it still be good to have insurance in addition to this, in case of disaster?
  - jeanlucneptune 4y ago
    Yes, you definitely should have a health insurance plan of some type. Your concierge doc fee will not pay for a visit to the ER, which can bankrupt the average person who doesn't have coverage.
DoreenMichele 4y ago
Another term for this is direct primary care. https://www.forbes.com/health/healthy-aging/concierge-medicine/ https://www.forbes.com/health/healthy-aging/concierge-medici...

footlose_3815 4y ago

>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.

illirik 4y ago
Exactly this - life in the USA has felt like an unfamiliar board game, run by a rules lawyer who has a grudge against you (personally), my entire life. No wonder we have a shorter life expectancy than _Cuba_!
- twelve40 4y ago
  Cuba is definitely an outlier specifically for that among developing countries and therefore not a great comparison. I hate the US healthcare experience and try to avoid it, but somehow after all the craziness you hear about half the country uninsured and $500k medical bills, the life expectancy numbers are actually not that terrible. I'm not sure why.
  - nradov 4y ago
    Anyone who has medical insurance regulated under the Affordable Care Act (Obamacare) will not receive a $500k bill. The individual out-of-pocket maximum is only $9k. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
    - rnk 4y ago
      what about the dodge where when you to an emergency room, there are multiple providers who bill separately (doc x was not on the emergency room bill, he's some other provider).
- nradov 4y ago
  I suspect Cuba is an outlier because they have a reasonably functional healthcare system, but at the same time most people are too poor to overeat or indulge in substance abuse. They literally can't afford to sit around and get fat.

pzone 4y ago

Healthcare in this country is so broken. This industry should be made as simple efficient and affordable as visiting Walgreens. The regulations, the cartel-like barriers to competition, the behemoth corporate powers. The only way to get adequate care is to become so rich you can escape the whole thing.

cafard 4y ago
I've received COVID vaccinations at Walgreens, but nothing else you'd call health care. I would imagine that if the industry limited itself to filling prescriptions (though prescribed by whom?) and selling aspirin etc., it could be very simple, efficient, and affordable.

kashunstva 4y ago

Undoubtedly all of this is true and an effective set of strategies for people of means to navigate the system. But this is precisely why healthcare reform will never take root in the U.S. There is no vision for public health. As an academic discipline, public health is robust in the U.S.; but there is no traction in the practical realm because the ghosts of Puritanism still inhabit the the sociopolitical structures. The poor apparently deserve their poor health access.

lotsofpulp 4y ago
For leaders, this is the beauty of health insurance companies (better called managed care organizations, MCOs). For places like UK and Canada, leaders have to answer to everyone for why access and quality of healthcare is declining. In the US, using the MCOs, leaders can more easily direct sufficient healthcare to who they want it to go to without being able to be identified as the cause. For example, leaders can tell MCOs to reimburse healthcare providers less for Medicaid (poor people), and more for Tricare (military) and Medicare (old people who vote), and even more for federal government employee health plans (for themselves). Or they can tell MCOs to require more “prior authorization” (PA) for Medicaid so people give up more quickly at getting medicine, whereas federal government employee plans can require fewer PAs. Add employer specific risk pools/deductibles/copays/out of pocket maximum limits into the mix, and there are multitude of levers that can be pulled to ensure people are getting the quantity and quality of healthcare corresponding to their socioeconomic level. Rich people always had concierge medical care. But with the use of MCOs, you can drill it down to income/wealth/political quintiles or even deciles.
jeanlucneptune 4y ago
"The poor apparently deserve their poor health access." Exactly what a large percentage of Americans believe. I disagree with them, but hard to make an argument for a better system when many believe that the poor shouldn't have quality healthcare.

onphonenow 4y ago

I’ve been on paperwork side of health a small bit. 1) cash pay / direct / concierge Agreed - especially if employer plan not great. Some of these folks do house calls. I did this for a while 2) high income area Sadly agreed. Even in a city if a hospital is more accessible etc that can be tough. I did a walk in to sf general once a long while back - took me 20 minutes to walk out. Great hospital, but waiting room was nuts. Had a finger burned being an idiot and got seen very quickly at a different sf hospital - night and day difference in waiting room 3) mixed view on this. Kaiser brings some peace of mind - grandfathered hsa plans w 2k deductible and some free base car not a bad experience - key for me is not coordinating/ dealing w multiple bills. Their issue resolution team is terrible though on billing

jeanlucneptune 4y ago
#3 - Kaiser is great, no question. Just not familiar with them since they don't have a presence in NYC. Honestly, if we had to emulate one model in the country it would definitely be the Kaiser model.

caeril 4y ago

> keep you out of the hospital/ER You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list the number one correct recommendation: If you are overweight, lose the weight. ~80% of healthcare costs in this country are attributable to chronic conditions, and ~80% of chronic conditions are caused by obesity or lifestyle directly connected to obesity. You improve your own health outcomes, and reduce the burden on the healthcare system as a whole, by ~64% if you're not fat. And your response, as a doctor, mirrors the most infuriating thing about your profession: Hi, you're 260lbs and pre-diabetic. I'm going to put you on Metformin. Hi, you're 280lbs and your LDL/HDL is WAY too high. Here's a prescription for statins. Hi, you're 190lbs at 5'1 and your infertility is caused by LH/FSH imbalances. Take this Clomid. When the hell are the "professionals" in your line of work going to stop medicating away the consequences of this absolutely absurd epidemic and actually address it? The only time I've ever heard of a physician actually advising an obese person to lose weight is for conditions where pharmaceutical interventions don't exist, such as non-alcoholic fatty liver disease. The rest of the time? Take these drugs so you have a couple more years to enjoy your triple bacon cheeseburgers and large fries. It's absolutely maddening.

jeanlucneptune 4y ago
Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.
- caeril 4y ago
  No, all the problems wouldn't go away. But a healthy-weight population would cost roughly 64% less to treat, which implies a 64% reduced hospital congestion and workload. This could get offset somewhat as people die later in life of "old age" rather than chronic conditions or CVD events, but those costs would be much lower. So let's say a 50% reduction over the long run. Yes, I am a former fatty who has kept it off for well over a decade now. It's really quite trivial to do.
nradov 4y ago

nradov 4y ago

Health insurers (payers) don't deliver different levels of service based on a plan’s deductible or copay. That's literally just a field in the database. All of your claims and prior authorization requests still flow through the same systems. In general high deductible health plans can be good option for consumers who are in good health and have the financial means to absorb an occasional large medical bill. There are also tax incentives for such plans. https://www.healthcare.gov/glossary/high-deductible-health-plan https://www.healthcare.gov/glossary/high-deductible-health-p...

RedditKon 4y ago

Why do you define United as a cadillac plan? I've only had awful experiences with them thus far.

ThePowerOfFuet 4y ago

Or do what I did and get on an A320 with a one-way ticket. I haven't set foot anywhere in North America in almost ten years, and frankly I don't miss it. The food is better, the transport is far better, the weather is better, and my health care costs are literally a rounding error. Where do I live, you ask? Not in the US.

pav345678 4y ago

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

mharig 4y ago
Go to Slovakia. Relative cheap and relative good health care. At least some years ago. Language may be a problem.
- pav345678 4y ago
  May be some years ago. Now Slovakia is also affected by a nearby war and packed with refugees from Ukraine.