5 ms·

> Until we stop this madness How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money.

> Until we stop this madness How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money. How do you opt out? I live in a country with a better (though still troubled) system. I can’t see how you fix the US system, even in hand waving terms.

chrischen 3y ago
Medical tourism. Give the money to the airline industry instead, who have a more competitive market in terms of price.
- lostlogin 3y ago
  That’s actually crazy. Who can manage an international trip each time they need medical help? Not everyone can afford the delay, the time, the money or the inconvenience. If you paid me and made it immediately available I still wouldn’t want to travel internationally for medical care.
  - klooney 3y ago
    Driving to Mexico isn't so bad from lots of the country- and in the North you could drive to Canada.
    - barry-cotter 3y ago
      Private medical care is in most circumstances illegal in Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care. Medical tourism to Canada is a non-starter for Yanks. > “Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA). … > He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights. > In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge. > However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.” https://globalnews.ca/news/9099696/canada-private-health-care-options/ https://globalnews.ca/news/9099696/canada-private-health-car...
      - kelnos 3y ago
        What is the reason for the wait times, though? If it's availability of doctors, I don't see how paying for private insurance magically makes doctors less busy and able to see you. And if that does work, then it just means that the mostly-unavailable doctors are prioritizing people who can pay them more, which isn't exactly a great outcome either. Or am I missing something?
        otherme123 3y ago
        This is how it happens in Spain: public doctors work from 8:00 to 15:00, with long queues. The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero. There are some doctors that works exclusively public or private.
        lostlogin 3y ago
        > The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero. If there is a queue, the price is too low. Surely a good business optimises price such that there is no queue and maximum revenue?
        brigandish 3y ago
        It may be that the service provider (in this case, a doctor) realises that to price too many people out would be an optimisation that ignores that not all kinds of suffering are equal e.g. yes, optimise the pricing of Playstations and flight tickets and some people will miss out and feel bad, but the suffering of those priced out of a medical procedure is worse. On the other hand, if we allowed a freer market in medicine (anywhere, no particular target country in mind), seeing doctors make more money treating something should spur on new trainees, thus more doctors in that specialism, and hence price drops and improvements in waiting times and possibly techniques, but that would require that freer market that so many seem against.
        lostlogin 3y ago
  - toast0 3y ago
    > Who can manage an international trip each time they need medical help? > Not everyone can afford the delay, the time, the money or the inconvenience. If you have no symptoms and it's follow up for a routine screening test, you can probably afford the delay. The time is certainly an issue, although if you can get any needed subsequent tests and care immediately internationally, it might be less time overall. The money could work out in favor of international travel, depending on the details; almost certainly less all things included, but not necessarily less if you're only counting money that comes directly out of your pocket. The real question is when does it become legal for insurers to send you overseas for care, and when does it become legal for medicare and medicaid to do it.
- naet 3y ago
  If our (US) medical system is so broken that your best option is to travel thousands of miles to a different medical system for care, that's a sign that things need serious change. Medical tourism is the equivalent of treating a symptom but leaving the root cause untreated.
bozhark 3y ago
remove pharmaceutical companies ability to set their own price. remove the insurance ability to negotiate prices. Ensure American's right to Healthcare.
- lostlogin 3y ago
  These are all correct, but as an individual you’re pretty much limited to writing to your representative. You can’t opt out in any immediate sense.
  - the_real_sparky 3y ago
    See my nearby comment on Direct Primary Care. It is possible to partially opt out of the system, and fortunately it is the part of the system that you touch most often (or should be anyway).
- deepsun 3y ago
  [flagged]
  - bmoe 3y ago
    Lol. You'll get better results if you stop smelling with your ears
  - rgbgraph 3y ago
    [flagged]
- shjake 3y ago
  > pharmaceutical companies But it’s hospitals/labs which are as bad or much worse in this regard. “Greedy” pharmaceutical companies are just a boogeyman, insurance companies, hospital admin and doctors are just fine with charging “random”/arbitrary fees based on clients perceived ability to pay and not in anyway related to actual costs.
  - hellotomyrars 3y ago
andreareina 3y ago
Your test is consistent with condition A. Its prevalence in the general population is B/1000 people. We can do a follow-up test that involves B, C, D, will cost $E and in cases like yours confirm condition A in F% of cases. Or we can wait and see; we'll redo the test in G time out if you present with other signs and symptoms H, I, J. Other possible causes for the test result are K, L, M. How could you like to proceed?
- mattkrause 3y ago
  I have a PhD in this stuff and I'm not sure I'd want to be making those sorts of decisions, especially for myself or a loved one. In your example, suppose I do have A (or K, L, or M). If I wait, how will that affect the costs and prognosis? Or if I go ahead with the test, what are the possible side effects (e.g., for a biopsy) and what would managing them cost? Even if you're confident that you have—and understand—all the relevant information, you're also often making these decisions in an emotionally-charged situation.
akvadrako 3y ago
Price transparency is the obvious start. Before agreeing to non-emergency care, you should be told what it'll cost. At least a range.
siliconc0w 3y ago
I can think of a few ideas: * you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care). * a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices. * anti-trust break up of healthcare cartels * some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.

chrischen 3y ago

Medical tourism. Give the money to the airline industry instead, who have a more competitive market in terms of price.

lostlogin 3y ago
That’s actually crazy. Who can manage an international trip each time they need medical help? Not everyone can afford the delay, the time, the money or the inconvenience. If you paid me and made it immediately available I still wouldn’t want to travel internationally for medical care.
- klooney 3y ago
  Driving to Mexico isn't so bad from lots of the country- and in the North you could drive to Canada.
  - barry-cotter 3y ago
    Private medical care is in most circumstances illegal in Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care. Medical tourism to Canada is a non-starter for Yanks. > “Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA). … > He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights. > In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge. > However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.” https://globalnews.ca/news/9099696/canada-private-health-care-options/ https://globalnews.ca/news/9099696/canada-private-health-car...
    - kelnos 3y ago
      What is the reason for the wait times, though? If it's availability of doctors, I don't see how paying for private insurance magically makes doctors less busy and able to see you. And if that does work, then it just means that the mostly-unavailable doctors are prioritizing people who can pay them more, which isn't exactly a great outcome either. Or am I missing something?
      - otherme123 3y ago
        This is how it happens in Spain: public doctors work from 8:00 to 15:00, with long queues. The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero. There are some doctors that works exclusively public or private.
        lostlogin 3y ago
        > The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero. If there is a queue, the price is too low. Surely a good business optimises price such that there is no queue and maximum revenue?
        brigandish 3y ago
        It may be that the service provider (in this case, a doctor) realises that to price too many people out would be an optimisation that ignores that not all kinds of suffering are equal e.g. yes, optimise the pricing of Playstations and flight tickets and some people will miss out and feel bad, but the suffering of those priced out of a medical procedure is worse. On the other hand, if we allowed a freer market in medicine (anywhere, no particular target country in mind), seeing doctors make more money treating something should spur on new trainees, thus more doctors in that specialism, and hence price drops and improvements in waiting times and possibly techniques, but that would require that freer market that so many seem against.
        lostlogin 3y ago
- toast0 3y ago
  > Who can manage an international trip each time they need medical help? > Not everyone can afford the delay, the time, the money or the inconvenience. If you have no symptoms and it's follow up for a routine screening test, you can probably afford the delay. The time is certainly an issue, although if you can get any needed subsequent tests and care immediately internationally, it might be less time overall. The money could work out in favor of international travel, depending on the details; almost certainly less all things included, but not necessarily less if you're only counting money that comes directly out of your pocket. The real question is when does it become legal for insurers to send you overseas for care, and when does it become legal for medicare and medicaid to do it.
naet 3y ago
If our (US) medical system is so broken that your best option is to travel thousands of miles to a different medical system for care, that's a sign that things need serious change. Medical tourism is the equivalent of treating a symptom but leaving the root cause untreated.

bozhark 3y ago

remove pharmaceutical companies ability to set their own price. remove the insurance ability to negotiate prices. Ensure American's right to Healthcare.

lostlogin 3y ago
These are all correct, but as an individual you’re pretty much limited to writing to your representative. You can’t opt out in any immediate sense.
- the_real_sparky 3y ago
  See my nearby comment on Direct Primary Care. It is possible to partially opt out of the system, and fortunately it is the part of the system that you touch most often (or should be anyway).
deepsun 3y ago
[flagged]
- bmoe 3y ago
  Lol. You'll get better results if you stop smelling with your ears
- rgbgraph 3y ago
  [flagged]
shjake 3y ago
> pharmaceutical companies But it’s hospitals/labs which are as bad or much worse in this regard. “Greedy” pharmaceutical companies are just a boogeyman, insurance companies, hospital admin and doctors are just fine with charging “random”/arbitrary fees based on clients perceived ability to pay and not in anyway related to actual costs.
- hellotomyrars 3y ago

andreareina 3y ago

Your test is consistent with condition A. Its prevalence in the general population is B/1000 people. We can do a follow-up test that involves B, C, D, will cost $E and in cases like yours confirm condition A in F% of cases. Or we can wait and see; we'll redo the test in G time out if you present with other signs and symptoms H, I, J. Other possible causes for the test result are K, L, M. How could you like to proceed?

mattkrause 3y ago
I have a PhD in this stuff and I'm not sure I'd want to be making those sorts of decisions, especially for myself or a loved one. In your example, suppose I do have A (or K, L, or M). If I wait, how will that affect the costs and prognosis? Or if I go ahead with the test, what are the possible side effects (e.g., for a biopsy) and what would managing them cost? Even if you're confident that you have—and understand—all the relevant information, you're also often making these decisions in an emotionally-charged situation.

akvadrako 3y ago

Price transparency is the obvious start. Before agreeing to non-emergency care, you should be told what it'll cost. At least a range.

siliconc0w 3y ago

I can think of a few ideas: * you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care). * a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices. * anti-trust break up of healthcare cartels * some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.