9 ms·

US Physician Blasts 'Lucrative System of For-Profit Medicine'

90 points by gardenfelder 4y ago

wwweston 4y ago
This is the part that gets me every time this topic comes up: > "the U.S.... spends far more on healthcare than comparable nations both on a per-person basis and as a share of gross domestic product. And it's not just "on a per-person basis." We spend more public funds per person; there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. And we don't have better outcomes. There are some ways I'm glad medicine is a way for people to build wealth. It seems more reasonable to reward good physicians and health-related product creators than, say, pro athletes and maybe even SaaS providers. But on the other hand, if financial incentives were all it took to build an exceptional healthcare system, we'd have one.
- lokar 4y ago
  But at least we don’t have death panels!
  - johnea 4y ago
    Instead we have the idiot herd... Did you not read the part about 10,000+ unnecessary deaths per year due to financial inaccessability?
    - lokar 4y ago
      You won’t get very far in the Ayn Rand club with that redistributive attitude.
    - kevviiinn 4y ago
      People in the US tend to ignore systemic issues while hyper focusing on individual cases. Talk about missing the forest for the trees
    - lostlogin 4y ago
      I read the comment you’re replying to as intensely sarcastic.
    - amluto 4y ago
      And there are even what are, effectively, “death panels”! Doctor prescribes potentially lifesaving (or life extending, or quality of life improving) medicine. Drug maker sets outrageous price. Patient and doctor argue with the insurer (the death panel!) over whether the patient actually gets to buy the medicine. Meanwhile, the drug seller engages in the utterly corrupt practice of offering a kickback (sorry, I mean coupon) to help give the patient an incentive to win the argument with the insurer.
- s1artibartfast 4y ago
  The problem is that there are no incentives to optimize benefit versus price. Socialized systems, the state looks at each new drug and decides if the benefit is worth the additional cost. They will either agree to Buy it, not buy it, or negotiate the price. When private individuals purchase Healthcare out of pocket, they do the same. It is only in an insurance Market with mandatory treatment coverage where drugs and Medicine get purchased no matter what the cost is. If you asked a private individual or socialized system to pay 500K to extend someone's life 2 months, both would refuse. Someone with insurance that they've been paying for has no reason to put the brakes on
  - rayiner 4y ago
    > Someone with insurance that they've been paying for has no reason to put the brakes on Especially when the insurance company itself can just pass the costs along in the form of higher premiums because people are legally required to buy insurance.
    - lotsofpulp 4y ago
      The 2017 TCJA repealed all federal penalties for not having health insurance, making the individual mandate to have health insurance moot since 2019. https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factors https://www.commonwealthfund.org/publications/fund-reports/2...
      - toomuchtodo 4y ago
        These people still get indirectly subsidized when they receive healthcare they can’t pay for and providers have to collectively eat the cost. Removing the penalty simply enables inefficient freeloading on the system (as these folks are likely to be stuck with medical debt or have to declare bankruptcy from medical bills they will never be able to repay).
        sanp 4y ago
- rayiner 4y ago
  Most countries with universal healthcare don't have "socialized medicine." The UK has a socialized system, with public insurance and public healthcare providers. But only a third of hospitals are publicly owned/managed, and even there most doctors are private practitioners. And in the Netherlands and Switzerland, both the insurance and hospitals are private. Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures. [1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.
  - dumpsterlid 4y ago
    [dead]
  - tptacek 4y ago
    The US is moving towards requiring a bachelors degree to maintain an RN license, and the majority of US nurses have one already.
    - rayiner 4y ago
      More of elite America’s war on the working class.
      - tptacek 4y ago
        In the main I agree with this sentiment, but you're being reflexive here, which gets you into trouble. The movement towards BSN degrees follows a significant amount of research showing that BSN degrees correlate with superior patient outcomes. You wouldn't call a degree credentialing requirement for an MD "an elite war on the working class", nor would you visit a doctor without a degree. You're happy to throw a little culture war barb at nursing credentials because: you don't respect the profession. It is much, much harder than it looks. Its biggest problem is that it has a stupid name; they should be called "associate physicians". You can reasonably disagree with state statutes requiring BSNs for RN licensure! But you can't pretend that the notion is risible, the way you have here. It is not.
- savanaly 4y ago
  >And we don't have better outcomes. It's apples and oranges though, yeah? Do we have worse health outcomes after controlling for the health-related demographics of our population? That's like saying I live a ten minute walk from my job in Manhattan's financial district and you live a ten minute walk from your job in New Jersey; I pay more in rent but have the same commuting outcome! Therefore it's the fault of the overpriced sidewalks in Manhattan??
  - dumpsterlid 4y ago
    [dead]
  - lostlogin 4y ago
    If you ignore those pesky poor people and those that died, the stats look amazing. You realise that comparing countries and the amount they paid is as good as it gets? It’s a direct comparison.
  - kashunstva 4y ago
    > Do we have worse health outcomes after controlling for the health-related demographics of our population? Health outcomes in the U.S. do track socioeconomic and regional factors. But should the system not meet the needs of whomever walks through the clinic door? I mean, some of the difference is not just the direct effects of poverty or social disadvantage on physiologic parameters but also on access to healthcare itself. We can control for socioeconomic factors and make the data look better but it doesn’t entirely exculpate the system which makes it incredibly difficult to get state-of-the-art care if you haven’t got ample resources to gain access.
  - wwweston 4y ago
    We're talking about other industrialized mixed market democratic nation states. At that level, demographics fade into the background, to the point where it's not even clear that we're talking Granny Smith vs Red Delicious, it's more like Fuji vs Pink Lady. If there's citrus in the basket of fruit under examination, it's policy.
- refuse 4y ago
  Also of interest is that R&D costs are often used to justify exorbitant drug costs, but it's been pretty widely reported that pharma spends much more on marketing drugs than developing them. Don't forget that these drugs are funded in large part by tax dollars. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
- cscurmudgeon 4y ago
  US does have an exceptional health care system if you are moderately rich or moderately powerful. There is a reason an Indian communist leader that hates the US came to the US flying halfway around the world on tax payer money for medical treatment. https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minister-pinarayi-vijayan-to-visit-us-again-this-time-for-health-check-up https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minis...
  - gorbachev 4y ago
    I just read this article earlier today about NYU Langone ER prioritizing treatment of VIP patients (politicians, celebrities, donors, trustees of the hospital): https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...
    - metadat 4y ago
      JS-free archive link: https://archive.today/eds69 https://archive.today/eds69
    - cscurmudgeon 4y ago
      That is plainly disgusting.
  - speakfreely 4y ago
    Doctors are typically very status-hungry creatures, thus when someone quantitatively more influential than them comes along, they are extra impressed and pay more attention to them. But simply having an 8 digit net worth won't do much for you, except to allow you to buy expensive concierge medicine services that can use their medical community connections to pull strings for you.
- phkahler 4y ago
  >> there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. To tie some things together, don't forget the doctors have to earn very high pay to cover the (insane) cost of medical school and insurance.
  - lotsofpulp 4y ago
    >have to earn very high pay to cover the (insane) cost of medical school and insurance. Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients. Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.
- rcme 4y ago
  The medical systems of other countries definitely deliver better results on average. It's plainly obvious if you look at a top-level metric like life expectancy. However, from personal experience in the U.K., Germany, and the U.S., the U.S. system unquestionably delivers better outcomes to wealthy people with health insurance. It's not surprising that the U.S. policy remains in place: it benefits the elites. Also, healthcare makes up something insane like 20% of GDP. The amount of people employed by the healthcare sector is staggering. Spending less means putting people out of work. It's going to be hard to sell that idea.
- Eddy_Viscosity2 4y ago
  One is there is a supply problem. There are lots of people who would like to be doctors, that are capable of being doctors, that won't become doctors because there are only so many seats available at medical schools. So fixed supply of new grads every year. Next is there is no market pressure on prices, even though theoretically that's what should happen. People NEED medical care so there isn't much to haggle about. Insurance companies don't care about prices so much, they just raise their rates if prices go up and take a bigger cut. In countries with socialized medicine, the government is THE buyer and can negotiate prices for things. But here, a drug company just raises the prices by 10^3 percent and everyone just pays it.
- deleted 4y ago
  [deleted]
johnea 4y ago
Why link to the common dreams review of the article, instead of the NYT article? https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html https://www.nytimes.com/2023/02/05/opinion/doctors-universal...
arrrghthrowaywa 4y ago
IMHO this is necessary reading about one of the largest hospital systems in the country-- https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html https://www.nytimes.com/2023/02/05/opinion/doctors-universal...
syzarian 4y ago
In every healthcare system rationing has to occur since there aren’t enough resources to 100% cover everything. The U.S. rations its care in one of the most unethical ways amongst the industrialized nations. The whole system needs a reboot. Anyone who says, “The reason that it is bad is because…”, is delusional. The system is so complex that there are multiple causes and many things need to be changed. Simplistic analysis leads to tweaks that end up contributing to the mess. A full reboot is needed but won’t happen until things get unbearably bad.
- 908B64B197 4y ago
  What would be a more ethical way? Death panels of government appointed employees "ethicists" deciding who lives and who dies?
  - syzarian 4y ago
    Other countries provide universal care and access to the system is not determined by how generous your employer is or how much money you have. A lot of people in the U.S. put off care due to upfront costs at the point of usage. This is particularly true for people on high deductible plans. Every other country has a more ethical way of providing care as far as I can tell.
  - CogitoCogito 4y ago
    Personally I think a "death panel" made up of government employee "ethicists" is more likely to make ethical choices than a death panel made up of private company employees trying to optimize their profits. The government employees are, after all, at least making an attempt at being ethical.
  - speakfreely 4y ago
    Government-run death panels would be anti-American. We privatized them and delegate our death panel decisions to for-profit insurance companies.
readthenotes1 4y ago
Iirc, nearly half of the people in the US are receiving medical cost insurance through government sources (Medicare, Medicaid, Tricare, CHIPs, various Indian/indigenous organizations, etc). It's a sad joke ...
vsskanth 4y ago
Sometimes I wonder what the end game is for US healthcare. Costs for private (even employer subsidized) insurance keeps going up every year, and then you have Medicare, Medicaid and ACA on the other hand for a separate set of individuals who have their own spiralling costs. My own prediction is that we all end up with very high deductible HSA plans, basically catastrophic insurance, paying out of pocket for everything else. Probably will need to work till 65 just to avoid healthcare costs bankrupting you.
- azinman2 4y ago
  I would say that about capitalism, AI, etc. The way it’s going it feels like there will be only 1 company after all M&A, and then eventually only 1 person running it.
  - kelseyfrog 4y ago
    We will finally have the thing we've been wanting for, the King of America.
- dsfyu404ed 4y ago
  >My own prediction is that we all end up with very high deductible HSA plans, basically catastrophic insurance, paying out of pocket for everything else. How is this a bad thing? The insurance model breaks down when you try and use it for routine stuff because it creates perverse incentives since the person services are being rendered to isn't paying. On some level every average person's lifetime cost has to be paid for by them if populations are stable? Why should we pay a 3rd party to administrate that stuff.
fwungy 4y ago
[flagged]
- rstat1 4y ago
  and c) don't get vilified by psuedoscientists or celebrity mouth pieces looking for something to falsely blame their kid's ailments on
  - fwungy 4y ago
    Vaccines might not have the same reputation problems if people weren't blackmailed into taking them and doctors didn't push them like carnival barkers. Sensitivities and allergies are recognized for the most mundane and innocuous of things and yet the suggestion that some people may have real problems with some vaccines that endanger their lives is treated in the same way as Holocaust denial (i.e.insane and evil - I am strongly opposed to Holocaust denial myself and always confront people who attempt to deny it.)
  - blue039 4y ago
    Aren't you forgetting something? The "believe the science" shills that just so happen to be the same people that write "study says" type articles? People are right to be suspect of medicine. Especially when things like vaccinations are shrouded in FAITH and not SCIENCE. You wouldn't trust a faith healer, yet here we are accosting people for criticizing medicine literally promoted as "believe the science or you're an anti-vax idiot". I'd take a lay-on-hands over injecting myself with any substance promoted by such people. Especially when people like Pfizer stand to profit from it. You're welcome to your 5-8 helpings of covid vaccine boosters (more boosters than any disease requires on the planet, btw). If you're still hungry (and alive) after that, you can take mine for me too. For-profit medicine whether for an alleged "global good" (covid) or not is sinister and should be suspect. When the people writing the studies are on the payroll, or produced through the revolving door, of the creators of said thing you should probably begin running the other direction. It wasn't more than 60 years ago smoking was proven by SCIENCE to be optimal for weight loss. Phillip-Morris even funded the studies. You wouldn't doubt that science, would you, shill?
mindslight 4y ago
My immediate question for this physician: when discussing care with patients, is he able to readily answer questions about how much various services he provides/recommends will cost? Or if he is like every doctor I've asked, equivocating and generally acting like the financial damage shouldn't be important - effectively forcing people further into the arms of the same "insurance" protection racket hellhole that he's bemoaning. Because ultimately the only way we've found to orchestrate large scale distributed behavior is through price signals, no matter who is paying. The main reason that healthcare has become so screwed up is the utter destruction of price signals through cartel behavior by "insurance" companies and healthcare providers. So it's a bit disingenuous to focus on one type of miscreant in the industry while sidestepping your own part in the symbiosis. Having said that, I'm not against single payer because it will at least put some of the garbage into a bag and tie it off, rather than the current system continuing to dump it into everyone's lives. But it's important to keep it in context - single payer is nowhere near a full solution to the real problems of the healthcare industry. If you've ever been party to someone needing significant healthcare, it's quite apparent that affordability is merely the tip of the iceberg.
yread 4y ago
It's not just the healthcare system, also the pharma. Trials for more precise targeting of cancer medicines don't get sponsorship from the maker of the medicine because if it succeeds they would sell less. Trials for new uses of medicines don't go through if the medicine is close to patent expiry. It makes sense as they are for profit corps but it sucks
secabeen 4y ago
The biggest challenge of changing the health system now is the entrenched interests. If we reduced our spending health care just to the average of the OECD nations, it would remove $1 Trillion of annual revenue from the US Health Care system. Even if you assume that the average health care worker makes $100k, and that labor makes up less than 50% of the cost of health care, that's still over 5 million people no longer employed in the industry. Those people, and the organizations that employ them, are understandably going to fight tooth and nail to keep their jobs and their livelihoods.
- japhib 4y ago
  I think you underestimate how much money is absorbed by insurance companies, and the bureaucracies hospitals/doctors offices need to maintain to deal with all the different insurance companies.
  - secabeen 4y ago
    I don't think so, I'm including those people in the 5 million that would lose their jobs or see pay cuts. They are exactly the ones who will fight to keep the system as it is. We absolutely should get rid of those expenses, it will take quite a while, or be a significant disruption.
Dr_throwawayMD 4y ago
IMO This is a deep-seated cultural problem. Specifically the overtly litigious corporate culture that exists in the US creates systems that are inherently flawed and tend to be abused. The idea that every misfortune is subject to multi-million dollar lawsuit settlements led to such modern 'innovations' as the 700$ epinephrine auto-injector. There is also a rash of arrogant cretins impersonating doctors across the US. Midlevels (NP, PA, DO) are a serious danger to patient safety in the US healthcare system. This is basically McDonald's medicine and relegates the MD to a manager of nitwits. Essentially, going to an ER with an emergent problem today is rolling the dice. Imagine going to a hospital or clinic, only to never be seen by a doctor. Many times the patient will not know they are seeing a midlevel because they use vague terms like 'provider' to refer to themselves. Few procedures in medicine are both diagnostic and therapeutic. Endoscopy is one such procedure. A GI surgeon will have all the knowledge to deal with any implication or complication should it arise. Today, in many places, mid-levels are allowed to perform endoscopic biopsies (without treatment) resulting in repeat surgeries($$$) to the patient. https://www.midlevel.wtf/ https://www.midlevel.wtf/ This site is made by dissident American physicians

90 points by gardenfelder 4y ago

This is the part that gets me every time this topic comes up: > "the U.S.... spends far more on healthcare than comparable nations both on a per-person basis and as a share of gross domestic product. And it's not just "on a per-person basis." We spend more public funds per person; there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. And we don't have better outcomes. There are some ways I'm glad medicine is a way for people to build wealth. It seems more reasonable to reward good physicians and health-related product creators than, say, pro athletes and maybe even SaaS providers. But on the other hand, if financial incentives were all it took to build an exceptional healthcare system, we'd have one.

lokar 4y ago
But at least we don’t have death panels!
- johnea 4y ago
  Instead we have the idiot herd... Did you not read the part about 10,000+ unnecessary deaths per year due to financial inaccessability?
  - lokar 4y ago
    You won’t get very far in the Ayn Rand club with that redistributive attitude.
  - kevviiinn 4y ago
    People in the US tend to ignore systemic issues while hyper focusing on individual cases. Talk about missing the forest for the trees
  - lostlogin 4y ago
    I read the comment you’re replying to as intensely sarcastic.
  - amluto 4y ago
    And there are even what are, effectively, “death panels”! Doctor prescribes potentially lifesaving (or life extending, or quality of life improving) medicine. Drug maker sets outrageous price. Patient and doctor argue with the insurer (the death panel!) over whether the patient actually gets to buy the medicine. Meanwhile, the drug seller engages in the utterly corrupt practice of offering a kickback (sorry, I mean coupon) to help give the patient an incentive to win the argument with the insurer.
s1artibartfast 4y ago
The problem is that there are no incentives to optimize benefit versus price. Socialized systems, the state looks at each new drug and decides if the benefit is worth the additional cost. They will either agree to Buy it, not buy it, or negotiate the price. When private individuals purchase Healthcare out of pocket, they do the same. It is only in an insurance Market with mandatory treatment coverage where drugs and Medicine get purchased no matter what the cost is. If you asked a private individual or socialized system to pay 500K to extend someone's life 2 months, both would refuse. Someone with insurance that they've been paying for has no reason to put the brakes on
- rayiner 4y ago
  > Someone with insurance that they've been paying for has no reason to put the brakes on Especially when the insurance company itself can just pass the costs along in the form of higher premiums because people are legally required to buy insurance.
  - lotsofpulp 4y ago
    The 2017 TCJA repealed all federal penalties for not having health insurance, making the individual mandate to have health insurance moot since 2019. https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factors https://www.commonwealthfund.org/publications/fund-reports/2...
    - toomuchtodo 4y ago
      These people still get indirectly subsidized when they receive healthcare they can’t pay for and providers have to collectively eat the cost. Removing the penalty simply enables inefficient freeloading on the system (as these folks are likely to be stuck with medical debt or have to declare bankruptcy from medical bills they will never be able to repay).
      - sanp 4y ago
rayiner 4y ago
Most countries with universal healthcare don't have "socialized medicine." The UK has a socialized system, with public insurance and public healthcare providers. But only a third of hospitals are publicly owned/managed, and even there most doctors are private practitioners. And in the Netherlands and Switzerland, both the insurance and hospitals are private. Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures. [1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.
- dumpsterlid 4y ago
  [dead]
- tptacek 4y ago
  The US is moving towards requiring a bachelors degree to maintain an RN license, and the majority of US nurses have one already.
  - rayiner 4y ago
    More of elite America’s war on the working class.
    - tptacek 4y ago
      In the main I agree with this sentiment, but you're being reflexive here, which gets you into trouble. The movement towards BSN degrees follows a significant amount of research showing that BSN degrees correlate with superior patient outcomes. You wouldn't call a degree credentialing requirement for an MD "an elite war on the working class", nor would you visit a doctor without a degree. You're happy to throw a little culture war barb at nursing credentials because: you don't respect the profession. It is much, much harder than it looks. Its biggest problem is that it has a stupid name; they should be called "associate physicians". You can reasonably disagree with state statutes requiring BSNs for RN licensure! But you can't pretend that the notion is risible, the way you have here. It is not.
savanaly 4y ago
>And we don't have better outcomes. It's apples and oranges though, yeah? Do we have worse health outcomes after controlling for the health-related demographics of our population? That's like saying I live a ten minute walk from my job in Manhattan's financial district and you live a ten minute walk from your job in New Jersey; I pay more in rent but have the same commuting outcome! Therefore it's the fault of the overpriced sidewalks in Manhattan??
- dumpsterlid 4y ago
  [dead]
- lostlogin 4y ago
  If you ignore those pesky poor people and those that died, the stats look amazing. You realise that comparing countries and the amount they paid is as good as it gets? It’s a direct comparison.
- kashunstva 4y ago
  > Do we have worse health outcomes after controlling for the health-related demographics of our population? Health outcomes in the U.S. do track socioeconomic and regional factors. But should the system not meet the needs of whomever walks through the clinic door? I mean, some of the difference is not just the direct effects of poverty or social disadvantage on physiologic parameters but also on access to healthcare itself. We can control for socioeconomic factors and make the data look better but it doesn’t entirely exculpate the system which makes it incredibly difficult to get state-of-the-art care if you haven’t got ample resources to gain access.
- wwweston 4y ago
  We're talking about other industrialized mixed market democratic nation states. At that level, demographics fade into the background, to the point where it's not even clear that we're talking Granny Smith vs Red Delicious, it's more like Fuji vs Pink Lady. If there's citrus in the basket of fruit under examination, it's policy.
refuse 4y ago
Also of interest is that R&D costs are often used to justify exorbitant drug costs, but it's been pretty widely reported that pharma spends much more on marketing drugs than developing them. Don't forget that these drugs are funded in large part by tax dollars. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
cscurmudgeon 4y ago
US does have an exceptional health care system if you are moderately rich or moderately powerful. There is a reason an Indian communist leader that hates the US came to the US flying halfway around the world on tax payer money for medical treatment. https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minister-pinarayi-vijayan-to-visit-us-again-this-time-for-health-check-up https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minis...
- gorbachev 4y ago
  I just read this article earlier today about NYU Langone ER prioritizing treatment of VIP patients (politicians, celebrities, donors, trustees of the hospital): https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...
  - metadat 4y ago
    JS-free archive link: https://archive.today/eds69 https://archive.today/eds69
  - cscurmudgeon 4y ago
    That is plainly disgusting.
- speakfreely 4y ago
  Doctors are typically very status-hungry creatures, thus when someone quantitatively more influential than them comes along, they are extra impressed and pay more attention to them. But simply having an 8 digit net worth won't do much for you, except to allow you to buy expensive concierge medicine services that can use their medical community connections to pull strings for you.
phkahler 4y ago
>> there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. To tie some things together, don't forget the doctors have to earn very high pay to cover the (insane) cost of medical school and insurance.
- lotsofpulp 4y ago
  >have to earn very high pay to cover the (insane) cost of medical school and insurance. Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients. Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.
rcme 4y ago
The medical systems of other countries definitely deliver better results on average. It's plainly obvious if you look at a top-level metric like life expectancy. However, from personal experience in the U.K., Germany, and the U.S., the U.S. system unquestionably delivers better outcomes to wealthy people with health insurance. It's not surprising that the U.S. policy remains in place: it benefits the elites. Also, healthcare makes up something insane like 20% of GDP. The amount of people employed by the healthcare sector is staggering. Spending less means putting people out of work. It's going to be hard to sell that idea.
Eddy_Viscosity2 4y ago
One is there is a supply problem. There are lots of people who would like to be doctors, that are capable of being doctors, that won't become doctors because there are only so many seats available at medical schools. So fixed supply of new grads every year. Next is there is no market pressure on prices, even though theoretically that's what should happen. People NEED medical care so there isn't much to haggle about. Insurance companies don't care about prices so much, they just raise their rates if prices go up and take a bigger cut. In countries with socialized medicine, the government is THE buyer and can negotiate prices for things. But here, a drug company just raises the prices by 10^3 percent and everyone just pays it.
deleted 4y ago
[deleted]

johnea 4y ago

Why link to the common dreams review of the article, instead of the NYT article? https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html https://www.nytimes.com/2023/02/05/opinion/doctors-universal...

arrrghthrowaywa 4y ago

IMHO this is necessary reading about one of the largest hospital systems in the country-- https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html https://www.nytimes.com/2023/02/05/opinion/doctors-universal...

syzarian 4y ago

In every healthcare system rationing has to occur since there aren’t enough resources to 100% cover everything. The U.S. rations its care in one of the most unethical ways amongst the industrialized nations. The whole system needs a reboot. Anyone who says, “The reason that it is bad is because…”, is delusional. The system is so complex that there are multiple causes and many things need to be changed. Simplistic analysis leads to tweaks that end up contributing to the mess. A full reboot is needed but won’t happen until things get unbearably bad.

908B64B197 4y ago
What would be a more ethical way? Death panels of government appointed employees "ethicists" deciding who lives and who dies?
- syzarian 4y ago
  Other countries provide universal care and access to the system is not determined by how generous your employer is or how much money you have. A lot of people in the U.S. put off care due to upfront costs at the point of usage. This is particularly true for people on high deductible plans. Every other country has a more ethical way of providing care as far as I can tell.
- CogitoCogito 4y ago
  Personally I think a "death panel" made up of government employee "ethicists" is more likely to make ethical choices than a death panel made up of private company employees trying to optimize their profits. The government employees are, after all, at least making an attempt at being ethical.
- speakfreely 4y ago
  Government-run death panels would be anti-American. We privatized them and delegate our death panel decisions to for-profit insurance companies.

readthenotes1 4y ago

Iirc, nearly half of the people in the US are receiving medical cost insurance through government sources (Medicare, Medicaid, Tricare, CHIPs, various Indian/indigenous organizations, etc). It's a sad joke ...

vsskanth 4y ago

Sometimes I wonder what the end game is for US healthcare. Costs for private (even employer subsidized) insurance keeps going up every year, and then you have Medicare, Medicaid and ACA on the other hand for a separate set of individuals who have their own spiralling costs. My own prediction is that we all end up with very high deductible HSA plans, basically catastrophic insurance, paying out of pocket for everything else. Probably will need to work till 65 just to avoid healthcare costs bankrupting you.

azinman2 4y ago
I would say that about capitalism, AI, etc. The way it’s going it feels like there will be only 1 company after all M&A, and then eventually only 1 person running it.
- kelseyfrog 4y ago
  We will finally have the thing we've been wanting for, the King of America.
dsfyu404ed 4y ago
>My own prediction is that we all end up with very high deductible HSA plans, basically catastrophic insurance, paying out of pocket for everything else. How is this a bad thing? The insurance model breaks down when you try and use it for routine stuff because it creates perverse incentives since the person services are being rendered to isn't paying. On some level every average person's lifetime cost has to be paid for by them if populations are stable? Why should we pay a 3rd party to administrate that stuff.

fwungy 4y ago

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rstat1 4y ago
and c) don't get vilified by psuedoscientists or celebrity mouth pieces looking for something to falsely blame their kid's ailments on
- fwungy 4y ago
  Vaccines might not have the same reputation problems if people weren't blackmailed into taking them and doctors didn't push them like carnival barkers. Sensitivities and allergies are recognized for the most mundane and innocuous of things and yet the suggestion that some people may have real problems with some vaccines that endanger their lives is treated in the same way as Holocaust denial (i.e.insane and evil - I am strongly opposed to Holocaust denial myself and always confront people who attempt to deny it.)
- blue039 4y ago
  Aren't you forgetting something? The "believe the science" shills that just so happen to be the same people that write "study says" type articles? People are right to be suspect of medicine. Especially when things like vaccinations are shrouded in FAITH and not SCIENCE. You wouldn't trust a faith healer, yet here we are accosting people for criticizing medicine literally promoted as "believe the science or you're an anti-vax idiot". I'd take a lay-on-hands over injecting myself with any substance promoted by such people. Especially when people like Pfizer stand to profit from it. You're welcome to your 5-8 helpings of covid vaccine boosters (more boosters than any disease requires on the planet, btw). If you're still hungry (and alive) after that, you can take mine for me too. For-profit medicine whether for an alleged "global good" (covid) or not is sinister and should be suspect. When the people writing the studies are on the payroll, or produced through the revolving door, of the creators of said thing you should probably begin running the other direction. It wasn't more than 60 years ago smoking was proven by SCIENCE to be optimal for weight loss. Phillip-Morris even funded the studies. You wouldn't doubt that science, would you, shill?

mindslight 4y ago

My immediate question for this physician: when discussing care with patients, is he able to readily answer questions about how much various services he provides/recommends will cost? Or if he is like every doctor I've asked, equivocating and generally acting like the financial damage shouldn't be important - effectively forcing people further into the arms of the same "insurance" protection racket hellhole that he's bemoaning. Because ultimately the only way we've found to orchestrate large scale distributed behavior is through price signals, no matter who is paying. The main reason that healthcare has become so screwed up is the utter destruction of price signals through cartel behavior by "insurance" companies and healthcare providers. So it's a bit disingenuous to focus on one type of miscreant in the industry while sidestepping your own part in the symbiosis. Having said that, I'm not against single payer because it will at least put some of the garbage into a bag and tie it off, rather than the current system continuing to dump it into everyone's lives. But it's important to keep it in context - single payer is nowhere near a full solution to the real problems of the healthcare industry. If you've ever been party to someone needing significant healthcare, it's quite apparent that affordability is merely the tip of the iceberg.

yread 4y ago

It's not just the healthcare system, also the pharma. Trials for more precise targeting of cancer medicines don't get sponsorship from the maker of the medicine because if it succeeds they would sell less. Trials for new uses of medicines don't go through if the medicine is close to patent expiry. It makes sense as they are for profit corps but it sucks

secabeen 4y ago

The biggest challenge of changing the health system now is the entrenched interests. If we reduced our spending health care just to the average of the OECD nations, it would remove $1 Trillion of annual revenue from the US Health Care system. Even if you assume that the average health care worker makes $100k, and that labor makes up less than 50% of the cost of health care, that's still over 5 million people no longer employed in the industry. Those people, and the organizations that employ them, are understandably going to fight tooth and nail to keep their jobs and their livelihoods.

japhib 4y ago
I think you underestimate how much money is absorbed by insurance companies, and the bureaucracies hospitals/doctors offices need to maintain to deal with all the different insurance companies.
- secabeen 4y ago
  I don't think so, I'm including those people in the 5 million that would lose their jobs or see pay cuts. They are exactly the ones who will fight to keep the system as it is. We absolutely should get rid of those expenses, it will take quite a while, or be a significant disruption.

Dr_throwawayMD 4y ago

IMO This is a deep-seated cultural problem. Specifically the overtly litigious corporate culture that exists in the US creates systems that are inherently flawed and tend to be abused. The idea that every misfortune is subject to multi-million dollar lawsuit settlements led to such modern 'innovations' as the 700$ epinephrine auto-injector. There is also a rash of arrogant cretins impersonating doctors across the US. Midlevels (NP, PA, DO) are a serious danger to patient safety in the US healthcare system. This is basically McDonald's medicine and relegates the MD to a manager of nitwits. Essentially, going to an ER with an emergent problem today is rolling the dice. Imagine going to a hospital or clinic, only to never be seen by a doctor. Many times the patient will not know they are seeing a midlevel because they use vague terms like 'provider' to refer to themselves. Few procedures in medicine are both diagnostic and therapeutic. Endoscopy is one such procedure. A GI surgeon will have all the knowledge to deal with any implication or complication should it arise. Today, in many places, mid-levels are allowed to perform endoscopic biopsies (without treatment) resulting in repeat surgeries($$$) to the patient. https://www.midlevel.wtf/ https://www.midlevel.wtf/ This site is made by dissident American physicians