11 ms·

Americans Are Skipping Doctor Visits Due to Costs

46 points by marifi 3y ago

mynameisnoone 3y ago
I de facto require semaglutide due to the side-effects of the only anti-depressant I'm able to tolerate (I've titrated up and down on 17+). Unfortunately, I currently don't have health insurance and hovering at 35% excess weight. There's no point in my going to a doctor when all of their recommendations are "window shopping". The only way this shit stops is not Medicare for all, which is a red herring with third-class coverage, surprise costs, and still run by for-profit corporations. The ultimate solution is universal healthcare for all and making for-profit health insurance illegal. This can only happen when (low-information) voters stop shouting FUD like "Communism", "rationing", "waiting lists", "big gubberment reg-u-lation", and "death panels". Every other free country in the world has better outcomes, healthier citizens, and lower costs. The root cause is unregulated profiteering that cannot be changed at present because of regulatory capture, corrupt politicians, and the lack of people organized and protesting about it.
- hippich 3y ago
  While it is not the answer to the problem you stated, just in case, there are companies selling "research only" peptides including semaglutide. And depending on you risk tolerance, are viable alternative.
  - mynameisnoone 3y ago
    I'm not going to go to some crack dealer to get a medication that requires refrigeration. This is a systemic problem. Also, semaglutide will be soon available in pill form. Semaglutide and metformin are the most revolutionary medications to prevent the most common and expensive diseases and improve life quality. One issue is that there is also a lack of longitudinal, evidence-based prophylaxis policy even in Medicare (the budget, third-rate health insurance for disabled and poor people) that waits until someone has suffered irreparable harm to then intervene with expensive care reactively. America is all about waiting until people are in the ER to do anything, and then drive them into bankruptcy while they're dying. I wonder how many people outside of Americans have met people with terminal cancer in the midst of bankruptcy proceedings with the hospitals pounding at the door to take everything they have while they're dying.
- SnorkelTan 3y ago
  Gastric bypass? Has the benefit of being a onetime payment instead of in perpetuity.
  - frumper 3y ago
    I’m sure some people have, but of the half dozen people I know to have gotten a gastric bypass, all of them were about where they started no more than 5 years later.
    - jonex 3y ago
      Weight gain does often happen a few years post treatment. Even then it's beneficial compared to no intervention, which would most likely have them be even worse off five years later. Long term health outcomes are better for those who get treatment than those who don't.
    - SnorkelTan 3y ago
      Are you sure they got gastric bypass and not lap band? All the people I know that got the bypass has lost significant quantities of weight. The bypass surgery essentially greatly reduces/removes the stomach from the digestion equation and greatly reduces the efficiency of digestion. The lap band is a rubber band around the stomach which makes it harder to consume large quantities of food, but has a higher chance of being ineffective. I’m overweight myself but it’s not medication related. I’ve been using behavior modification using cbt paired with diet and exercise. The cbt was a recent addition since I’ve regressed several times with just diet and exercise alone.
  - mynameisnoone 3y ago
    Fuck no. You first.
- kube-system 3y ago
  > The ultimate solution is [...] making for-profit health insurance illegal. > Every other free country in the world has [...] ... and most also have private health insurance too. Some have a higher percentage of people with private health insurance than even the US does, often in a supplementary role.
  - wharvle 3y ago
    Yep. The single thing they all seem to do that the US doesn’t isn’t eliminate private health insurance, but institute price controls—one way or another. Some with literal price sheets (Japan), others by creating a government-controlled monopsony of some sort (Canada), others by taking over healthcare providers themselves so the government can set prices (er, well… compensation) directly (the UK). Well, and I’m not sure any others have a problem like we do with the AMA.
  - dmos62 3y ago
    Private or public doesn't really matter as long as the prices are sensible. I recently learned that you can pay as much as 1k dollars a month (not a typo) for regular health insurance in US, whereas I pay ~55 euros a month for mine. Median salary here is around 1k euros a month. I pay around 15-25% taxes.
  - nielsbot 3y ago
    (Not sure if you're arguing for or against a privatized health insurance system) I guess that countries that provide public health insurance don't have people skipping doctor visits because of costs, even if the majority of residence also have private insurance.
    - kube-system 3y ago
      I’m not arguing for either. I’m just pointing out that the “other countries” the parent commenter is referring to as a benchmark didn’t eliminate private health insurance.
  - otikik 3y ago
    Well we do know how much we are going to get charged by private hospitals, at least.
- s3p 3y ago
  100% agree. Also, just wanted to say that having used semaglutide myself I really empathize with your situation. I had struggled with an eating disorder to varying degrees of success for about 5 years before I found semaglutide. Suddenly my mental fixation on food was gone and I finally felt what it’s like to have a normal relationship with food. The medical landscape in the US is fucked and I hope it changes. Drugs like these would be much better if they weren’t governed by profit seeking companies.
- freddie_mercury 3y ago
  Wait, do you think every other free country in the world has made private health insurance illegal?
  - mynameisnoone 3y ago
    Don't be silly. The smart ones have for good reason.
- rolisz 3y ago
  FYI, you might be out of luck in other countries: in Romania (where I live) semaglutide is made available for free only for diabetics. If you want it for off label usage, you'll pay for it. In Hungary, it's illegal for doctors to prescribe it to non diabetics, so good luck getting it off label.
- ars 3y ago
  Absolutely none of the insults you wrote have any connection with healthcare issues. The actual issue is way way simpler: Doctors and other healthcare works make too much money for it to be affordable for everyone. That's it, it's as simple as that. Compare Dr salaries to other countries. Doctors in the US make 2 to 10 times as much as other counties. (Google it if you don't believe me.) And they make so much because there is not enough supply. And colleges take advantage of that and charge insane tuition. Want to actually change things? Start educating way way way more Doctors, and encourage people to go to low cost universities (which do exist - but everyone wants "the best"). See: https://www.advisory.com/daily-briefing/2022/02/16/physician-shortage https://www.advisory.com/daily-briefing/2022/02/16/physician...
  - genocidicbunny 3y ago
    > Compare Dr salaries to other countries. Doctors in the US make 2 to 10 times as much as other counties. This is slightly unfair if you don't consider the cost and time of becoming a doctor. That is not to say that the AMA doesn't purposely enforce a shortage as an attempt to drive up wages, but many doctors spend the better part of a decade (or more) before they're really earning any reasonable amount, and they have large debts from paying for school. > Start educating way way way more Doctors Yes. But that will hurt those who are already doctors somewhat, so there's a strong incentive to limit the pool. > encourage people to go to low cost universities (which do exist - but everyone wants "the best"). These don't really exist in any reasonable amounts. You also have to consider how much of a doctor's education is outside of a university. And it does make a difference which hospitals you have your rotations and residency at. If you want to be doing EM, you're not going to want to end up in some sleepy town in the midwest where the most that happens is some drunk dude needing his stomach pumped. If you want to end up being in a specific field, your choices tend to be relatively limited in where you can actually get the education and experience you need for that specialty. Anyways, all that is mostly to say that the healthcare 'system' in the US is a clusterfuck for many interconnected (and entangled) reasons and there is no one simple issue to address.
- slipandafall 3y ago
  I think it's the over regulation of the industry that's causing the issues. A medical degree AND at least 1 year of residency are required to be licensed to practice, which is fine. But congress capped the amount of residency slots in 1997 due to fears of having to many doctors and hasn't raised it pretty much since. So yes, "big government regulation" and central planning aka communism has caused this issue. Those companies and individuals that are profiteering off of this situation are also to blame, but not nearly as much blame as the whole of congress.
  - mynameisnoone 3y ago
    This is a really sophomoric, conspiratorial, uninformed take. Doctors aren't the problem. It's the for-profit engines of corporate hospitals, insurance, and big pharma.
    - slipandafall 3y ago
      I never said doctors were the problem, I said congress was the major cause of the problem by limiting the amount of residency slots based on incorrect predictions. Those for-profit engines do have an effect but they're just playing by the rules established by congress. Not sure where you got conspiratorial or uninformed, here's the study that guided the decision making [1]. I will take sophomoric since I don't know a damn thing about this industry, but both left and right are recognizing the problem and trying to get something done about it which is what we need more of[2]. [1] - https://eric.ed.gov/?id=ED210990 https://eric.ed.gov/?id=ED210990 [2] - https://www.ualrpublicradio.org/local-regional-news/2023-05-03/u-s-sen-john-boozman-introduces-bill-aiming-to-address-physician-shortage https://www.ualrpublicradio.org/local-regional-news/2023-05-...
flibbityflob 3y ago
Water gets wetter.
- mcbishop 3y ago
  What that means?
  - metabagel 3y ago
    It means that this is a worsening of an existing phenomenon in the U.S.
  - dylan604 3y ago
    This isn't new information. It's about as obvious as the nose on your face. Some people are just now openly recognizing it. Compare the number of people skipping visits with the number of uninsured. Even with insurance, doctor's visits can still be expensive depending on the plan. After the doctor's visit, there's still paying for any prescriptions. Without insurance, some medicines are pretty much impossible to afford.
barrenko 3y ago
(EU) Doctors are skipping visits with me.
solardev 3y ago
We can't even get people to pay $14/mo for YouTube without ads, and you expect them to pay for healthcare?!
- nielsbot 3y ago
  I don't understand this comment--what do you mean?
  - solardev 3y ago
    I just mean that people will be cheap and complain endlessly about small trivial things that they use all the time (like YouTube, or Netflix, or an IDE) rather than paying for it. And those things are like $20/mo and have an immediately visible benefit. Meanwhile, a doctor's visit can cost anywhere from $50/visit (with good insurance and a copay) to hundreds of dollars, more for special procedures, and more for prescriptions, etc. Much of the time you walk away with the problem not really solved, requiring multiple referrals and specialist visits. It's really easy to want to put it off till later, especially when money's tight. Yes, the situation gets worse over time, but it's one of the easiest things to procrastinate on. It's part of the reason I hate for-profit healthcare... it discourages routine preventative care that could help a lot of people and prevent more expensive treatments later, instead of just making them put it off until an ER visit is needed. Making people pay for their healthcare like this just means few people are going to use it routinely, instead waiting for their condition to worsen and fester. Especially teeth, yeesh, where even good insurance doesn't get you much.
carbocation 3y ago
As a patient, post-2020 I find even basics like appointment scheduling to be hard. (I'm also an MD, which makes all of this easier for me, and yet it's still a morass of scheduling hell, too many phone calls, too many logins/reauthentications, etc.)
- solardev 3y ago
  What happened in 2020?
  - str3wer 3y ago
    a global pandemic?
    - solardev 3y ago
      Ohhhh yeah, lol. I always forget that really took off in 2020 (since it's called COVID-19). What even is time anymore =/ Anecdotally, though, it seemed like a lot of healthcare providers at the time moved to having better online appointment systems and remote visits, which made scheduling a lot easier for me. Probably a heavily YMMV situation though.
- modeless 3y ago
  Appointment scheduling is beyond awful these days. We're getting specialist appointments scheduled literally a year out, or just outright rejected because they're too full. It's de facto rationing.
  - wrp 3y ago
    Experiencing that, too. Are these long waits due to anything other than a shortage of specialists? If not, why is there a shortage? I thought more doctors wanted to be specialists because of better hours and pay.
    - modeless 3y ago
jimbob45 3y ago
On the bright side, virtual doctor visits have led me to obtain medications that I would have gone without in the past. I have to imagine US healthcare outcomes would dramatically improve if insurance companies weren't charging $80+ per virtual visit. Oh well, the revolution can come in a decade rather than this year.
c_o_n_v_e_x 3y ago
My parents (both in late 60s) live in the US and I'm alarmed by what they tell me. Their old GP retired and sold his clinic to a "concierge" system/network (I don't know the terminology, been overseas for over 10 years so I'm not familiar with any of this.) You have to pay upfront a few thousand per year to get into the system. The US system sounds totally broken compared to my experiences within the Singapore and Australian health care systems.
- frumper 3y ago
  They should just find a new office. If theirs retired anyway, they’re getting a new doctor. They’d be on Medicare and the participation rate for doctors with Medicare is in the high 90s.
- danans 3y ago
  > Their old GP retired and sold his clinic to a "concierge" system/network Concierge medicine is a luxury service where you pay an annual out of pocket membership fee to have a doctor always on call, including home visits. Its popular among the very wealthy, but not affordable for most people.
  - wrp 3y ago
    I've read comments that concierge medicine is cost effective if you require frequent visits, as with many older patients. Would like to know if this is true.
    - nth_degree 3y ago
      My in-laws, who are not wealthy, absolutely love the concierge set-up they have with their doctor. They do utilize it often, which makes it worth it.
      - danans 3y ago
        We're falling into a trap of using subjective definitions the term "wealthy". $2000-$3000/person/year [1] on top of regular insurance is a more than most people can afford, especially in a country where a large percentage of the population has little in terms of savings [2], and 60% live paycheck-to-paycheck [3]. But you certainly don't have to be a billionaire or even a deca-millionaire to afford it. You just need to be in the higher percentiles of your local income/wealth distribution. 1. https://www.partnermd.com/blog/concierge-medicine-costs-factors-considerations https://www.partnermd.com/blog/concierge-medicine-costs-fact... 2. https://www.bankrate.com/banking/savings/emergency-savings-report/#no-emergency-savings https://www.bankrate.com/banking/savings/emergency-savings-r... 3. https://www.cnbc.com/2023/09/27/60percent-of-americans-are-still-living-paycheck-to-paycheck.html https://www.cnbc.com/2023/09/27/60percent-of-americans-are-s...
tppiotrowski 3y ago
I had a virtual care plan from Kaiser Permanente. What I liked: - you can email a photo to the dermatologist and get a diagnosis for free. I used this for moles and rashes. Saved me a visit and $$ - you can email the doctor for free and chat with a nurse for free and if they refer you for labs or vaccines you just go directly to the lab and get your results online. No time with doctor required. I am young and have no major health issues. I found this a drastic improvement over going to see a doctor in person, being told to take Tylenol + rest then getting a $700 bill for that advice.
halfjoking 3y ago
I believe modern medicine is fraudulent. So I didn’t just not get the Covid vaccine, but I canceled my health insurance during Covid. I will never go back to paying for insurance or even going to a doctor in the US unless there is an overwhelming consensus acknowledging the harms of this study: https://pubmed.ncbi.nlm.nih.gov/36055877/ https://pubmed.ncbi.nlm.nih.gov/36055877/ [1] This system ends only when enough people refuse it. I know I won’t ever give this healthcare system a cent or an ounce of recognition they are an “authority” on anything. I’ll fly to f-ing Cuba for surgery if I have to… I’d rather die than go to an American hospital. After doctors went along promoting such an unsafe “vaccine” and have continued to ignore the overwhelming evidence of harm, they deserve absolutely nothing. [1] Since it’s important I’m going to quote what Dr. Aseem Malhotra says about this reanalysis of Pfizer and Moderna studies… "In my whole career, looking at all of the drugs and knowing about many different prescribed medications, I've never seen something that when you look at the data has such poor effectiveness and unprecedented harms. In the summer of last year, in the journal Vaccine, the highest-impact medical journal for vaccines, they published a reanalysis of Pfizer and Moderna's original double-blinded randomized controlled trial. This is the highest quality of scientific evidence. Joseph Fraiman is an ER doctor and clinical data scientist from Louisiana. Associate editor of the BMJ, Dr. Peter Doshi. Dr. Robert Kaplan from Stanford. Some real eminence of integrity published this reanalysis, and what they found was this. In the trials that led to the approval of regulators worldwide, you were more likely to suffer a severe adverse event from taking the vaccine, hospitalization, disability, or life-changing event than you were to be hospitalized with COVID. This mRNA vaccine should likely have never been approved for a single human in the first place, and that rate of serious adverse events is at least 1 in 800... 1 in 800 is a very, very high figure. We've pulled other vaccines for much less. The 1976 Swine Flu vaccine was pulled because it was found to cause a debilitating neurological condition called Guillan-Barre syndrome in about 1 in 100,000 people. The Rotavirus vaccine was suspended in 1999 because it was found to cause a form of bowel obstruction in kids in 1 of 10,000. This is at least 1 in 800. It's a no-brainer. So the question is, why have we not paused it?"
- glimshe 3y ago
  To all other people on HN: don't follow this person's advice if you live in the US. They are likely relatively healthy and has never experienced the crushing financial burden of long term, or serious health issues. The financial risk of living with insurance is high enough as it is, but living without insurance is madness if you have any sort of asset that can be taken away by creditors - assuming, obviously, that you can afford insurance (which most people, even if not as many as we'd want, can through work or Obamacare). FYI, my family had a "bad luck" year with 2 surgeries that added up to over 130K this year alone, but insurance covered it all (after deductible). We are in good health now.
SpaceNoodled 3y ago
We already were, but we still are, too.
drdaeman 3y ago
Hah. If it'd be only about the costs - I have a good insurance and decent income, but but I find the overall system very confusing. Five years and I can't say I've figured out how to use it. Dentists and ophthalmologists - super easy. I pick a place I like (based on location and reviews), I fill a form online (or give them a call if this doesn't work), I tell what I need or want, I make a visit and get full information on what should I do next. Simple as anywhere else in the world. But the other medical stuff is confusing to me, or makes me have reservations about it. - The majority of places seem to be affiliated with religious megacorps - they just bought out nearly every other hospital in my area. I'm not a woman, but I'm no fond of contributing to companies who then lobby for medical restrictions based on their religious beliefs. - Then, there's also a lot of alternative medicine, way more than in any other country I've seen. Holistic, osteopathic, chiropractic, you name it. Yes, I've read that DO in the US isn't exactly a quack who's gonna suggest a manipulation that has a chance of getting a person quadriplegic, but a cheaper way to get a medical degree than an MD (and the osteopathic junk tends to just gets thrown out of the window after graduating), but still - weird. Just something that scratches at the back of my mind. - Finding a GP is something I still haven't figured out in five years. They always seem to have appointment times in no less than half a year (!) so I'm really not sure how to find one I would like. And I'm still not sure what they do exactly, because I can go to the specialized doctor (like a dermatologist or otolaryngologist) directly anyway - and somehow it's a matter of weeks, not months. I've had a GP which I visited exactly once - should've went for urgent care, but I wasn't aware that's what I needed - then they stopped working at that hospital and I haven't explicitly asked for a new one so the whole relationship just lapsed somehow. In other countries, I went to GPs either for a quick dispatch to a specialist (next-day appointment for "hey doc, I've got $symptoms, can you send me off to $specialist and/or $lab") or for managing (simplifying) routine checkups (them organizing it instead of me running on my own to different labs and specialists). I should figure out the routine stuff, but still haven't - must be that the whole system operates on some unspoken rules, and I'm just unaware about it because I grew up elsewhere. At least the urgent care works in a way I understand.
Eddy_Viscosity2 3y ago
Another source of doctor supply-side issues is the number of doctors graduating each year not increasing with the population. Medical schools are highly regulated and love that exclusivity, limiting seats in schools means scarcity and higher prices.
beej71 3y ago
Even if you go in for your free checkup, all the clinics know the tricks for turning it billable. Years ago a study came out that most Americans couldn't afford an emergency $400 medical bill. (For non-Americans, $400 for an emergency is nothing.) I doubt the situation has improved.
- floor2 3y ago
  That often quoted (or misquoted?) study was wildly misleading and became complete misinformation through the retelling. People who said they'd pay using a credit card got reported in the media as being "unable to afford" the expense. The original study might have been an interesting finding on the transition to a cashless society, but for millions of Americans, paying using a credit card is the default rather than carrying cash and dealing with change, and not actually indicative of lacking funds to pay for something.
nhance 3y ago
In my mind, one of the most likely consumers of our data is insurance companies. It really exposes to me how messed up the idea of health insurance really is. As an insurance company, you are incentivized to de-risk your pool as much as possible, and by spending a few dollars you're able to get to the earliest possible signals of who might be needing services very easily. Things like complaining about a sore throat on social media to friends, or even within private messages, are all things you might be interested in. Other signals, purchase history, location history, contact tracing, all of these provide potential ways to spot early risk and increase rates/push out the undesirable members of the pool. Of all of the potential customers of our data, I keep coming back to insurance companies as having the most interest in these signals. When you can identify risks correctly, you can trim out or adjust rates to make things as safe as possible for your income stream. This has a reactionary component to it that hurts us all. With most of our communication being digital now, I find myself thinking twice about putting out anything that could be taken as a signal to an insurance company. As an avid runner with most of our events organized online, this presents a social cost because I just won't engage in some conversations for fear of how companies will use whatever I might engage with against me. Where does this type of behavior lead when practiced at scale?

46 points by marifi 3y ago

I de facto require semaglutide due to the side-effects of the only anti-depressant I'm able to tolerate (I've titrated up and down on 17+). Unfortunately, I currently don't have health insurance and hovering at 35% excess weight. There's no point in my going to a doctor when all of their recommendations are "window shopping". The only way this shit stops is not Medicare for all, which is a red herring with third-class coverage, surprise costs, and still run by for-profit corporations. The ultimate solution is universal healthcare for all and making for-profit health insurance illegal. This can only happen when (low-information) voters stop shouting FUD like "Communism", "rationing", "waiting lists", "big gubberment reg-u-lation", and "death panels". Every other free country in the world has better outcomes, healthier citizens, and lower costs. The root cause is unregulated profiteering that cannot be changed at present because of regulatory capture, corrupt politicians, and the lack of people organized and protesting about it.

hippich 3y ago
While it is not the answer to the problem you stated, just in case, there are companies selling "research only" peptides including semaglutide. And depending on you risk tolerance, are viable alternative.
- mynameisnoone 3y ago
  I'm not going to go to some crack dealer to get a medication that requires refrigeration. This is a systemic problem. Also, semaglutide will be soon available in pill form. Semaglutide and metformin are the most revolutionary medications to prevent the most common and expensive diseases and improve life quality. One issue is that there is also a lack of longitudinal, evidence-based prophylaxis policy even in Medicare (the budget, third-rate health insurance for disabled and poor people) that waits until someone has suffered irreparable harm to then intervene with expensive care reactively. America is all about waiting until people are in the ER to do anything, and then drive them into bankruptcy while they're dying. I wonder how many people outside of Americans have met people with terminal cancer in the midst of bankruptcy proceedings with the hospitals pounding at the door to take everything they have while they're dying.
SnorkelTan 3y ago
Gastric bypass? Has the benefit of being a onetime payment instead of in perpetuity.
- frumper 3y ago
  I’m sure some people have, but of the half dozen people I know to have gotten a gastric bypass, all of them were about where they started no more than 5 years later.
  - jonex 3y ago
    Weight gain does often happen a few years post treatment. Even then it's beneficial compared to no intervention, which would most likely have them be even worse off five years later. Long term health outcomes are better for those who get treatment than those who don't.
  - SnorkelTan 3y ago
    Are you sure they got gastric bypass and not lap band? All the people I know that got the bypass has lost significant quantities of weight. The bypass surgery essentially greatly reduces/removes the stomach from the digestion equation and greatly reduces the efficiency of digestion. The lap band is a rubber band around the stomach which makes it harder to consume large quantities of food, but has a higher chance of being ineffective. I’m overweight myself but it’s not medication related. I’ve been using behavior modification using cbt paired with diet and exercise. The cbt was a recent addition since I’ve regressed several times with just diet and exercise alone.
- mynameisnoone 3y ago
  Fuck no. You first.
kube-system 3y ago
> The ultimate solution is [...] making for-profit health insurance illegal. > Every other free country in the world has [...] ... and most also have private health insurance too. Some have a higher percentage of people with private health insurance than even the US does, often in a supplementary role.
- wharvle 3y ago
  Yep. The single thing they all seem to do that the US doesn’t isn’t eliminate private health insurance, but institute price controls—one way or another. Some with literal price sheets (Japan), others by creating a government-controlled monopsony of some sort (Canada), others by taking over healthcare providers themselves so the government can set prices (er, well… compensation) directly (the UK). Well, and I’m not sure any others have a problem like we do with the AMA.
- dmos62 3y ago
  Private or public doesn't really matter as long as the prices are sensible. I recently learned that you can pay as much as 1k dollars a month (not a typo) for regular health insurance in US, whereas I pay ~55 euros a month for mine. Median salary here is around 1k euros a month. I pay around 15-25% taxes.
- nielsbot 3y ago
  (Not sure if you're arguing for or against a privatized health insurance system) I guess that countries that provide public health insurance don't have people skipping doctor visits because of costs, even if the majority of residence also have private insurance.
  - kube-system 3y ago
    I’m not arguing for either. I’m just pointing out that the “other countries” the parent commenter is referring to as a benchmark didn’t eliminate private health insurance.
- otikik 3y ago
  Well we do know how much we are going to get charged by private hospitals, at least.
s3p 3y ago
100% agree. Also, just wanted to say that having used semaglutide myself I really empathize with your situation. I had struggled with an eating disorder to varying degrees of success for about 5 years before I found semaglutide. Suddenly my mental fixation on food was gone and I finally felt what it’s like to have a normal relationship with food. The medical landscape in the US is fucked and I hope it changes. Drugs like these would be much better if they weren’t governed by profit seeking companies.
freddie_mercury 3y ago
Wait, do you think every other free country in the world has made private health insurance illegal?
- mynameisnoone 3y ago
  Don't be silly. The smart ones have for good reason.
rolisz 3y ago
FYI, you might be out of luck in other countries: in Romania (where I live) semaglutide is made available for free only for diabetics. If you want it for off label usage, you'll pay for it. In Hungary, it's illegal for doctors to prescribe it to non diabetics, so good luck getting it off label.
ars 3y ago
Absolutely none of the insults you wrote have any connection with healthcare issues. The actual issue is way way simpler: Doctors and other healthcare works make too much money for it to be affordable for everyone. That's it, it's as simple as that. Compare Dr salaries to other countries. Doctors in the US make 2 to 10 times as much as other counties. (Google it if you don't believe me.) And they make so much because there is not enough supply. And colleges take advantage of that and charge insane tuition. Want to actually change things? Start educating way way way more Doctors, and encourage people to go to low cost universities (which do exist - but everyone wants "the best"). See: https://www.advisory.com/daily-briefing/2022/02/16/physician-shortage https://www.advisory.com/daily-briefing/2022/02/16/physician...
- genocidicbunny 3y ago
  > Compare Dr salaries to other countries. Doctors in the US make 2 to 10 times as much as other counties. This is slightly unfair if you don't consider the cost and time of becoming a doctor. That is not to say that the AMA doesn't purposely enforce a shortage as an attempt to drive up wages, but many doctors spend the better part of a decade (or more) before they're really earning any reasonable amount, and they have large debts from paying for school. > Start educating way way way more Doctors Yes. But that will hurt those who are already doctors somewhat, so there's a strong incentive to limit the pool. > encourage people to go to low cost universities (which do exist - but everyone wants "the best"). These don't really exist in any reasonable amounts. You also have to consider how much of a doctor's education is outside of a university. And it does make a difference which hospitals you have your rotations and residency at. If you want to be doing EM, you're not going to want to end up in some sleepy town in the midwest where the most that happens is some drunk dude needing his stomach pumped. If you want to end up being in a specific field, your choices tend to be relatively limited in where you can actually get the education and experience you need for that specialty. Anyways, all that is mostly to say that the healthcare 'system' in the US is a clusterfuck for many interconnected (and entangled) reasons and there is no one simple issue to address.
slipandafall 3y ago
I think it's the over regulation of the industry that's causing the issues. A medical degree AND at least 1 year of residency are required to be licensed to practice, which is fine. But congress capped the amount of residency slots in 1997 due to fears of having to many doctors and hasn't raised it pretty much since. So yes, "big government regulation" and central planning aka communism has caused this issue. Those companies and individuals that are profiteering off of this situation are also to blame, but not nearly as much blame as the whole of congress.
- mynameisnoone 3y ago
  This is a really sophomoric, conspiratorial, uninformed take. Doctors aren't the problem. It's the for-profit engines of corporate hospitals, insurance, and big pharma.
  - slipandafall 3y ago
    I never said doctors were the problem, I said congress was the major cause of the problem by limiting the amount of residency slots based on incorrect predictions. Those for-profit engines do have an effect but they're just playing by the rules established by congress. Not sure where you got conspiratorial or uninformed, here's the study that guided the decision making [1]. I will take sophomoric since I don't know a damn thing about this industry, but both left and right are recognizing the problem and trying to get something done about it which is what we need more of[2]. [1] - https://eric.ed.gov/?id=ED210990 https://eric.ed.gov/?id=ED210990 [2] - https://www.ualrpublicradio.org/local-regional-news/2023-05-03/u-s-sen-john-boozman-introduces-bill-aiming-to-address-physician-shortage https://www.ualrpublicradio.org/local-regional-news/2023-05-...

flibbityflob 3y ago

Water gets wetter.

mcbishop 3y ago
What that means?
- metabagel 3y ago
  It means that this is a worsening of an existing phenomenon in the U.S.
- dylan604 3y ago
  This isn't new information. It's about as obvious as the nose on your face. Some people are just now openly recognizing it. Compare the number of people skipping visits with the number of uninsured. Even with insurance, doctor's visits can still be expensive depending on the plan. After the doctor's visit, there's still paying for any prescriptions. Without insurance, some medicines are pretty much impossible to afford.

barrenko 3y ago

(EU) Doctors are skipping visits with me.

solardev 3y ago

We can't even get people to pay $14/mo for YouTube without ads, and you expect them to pay for healthcare?!

nielsbot 3y ago
I don't understand this comment--what do you mean?
- solardev 3y ago
  I just mean that people will be cheap and complain endlessly about small trivial things that they use all the time (like YouTube, or Netflix, or an IDE) rather than paying for it. And those things are like $20/mo and have an immediately visible benefit. Meanwhile, a doctor's visit can cost anywhere from $50/visit (with good insurance and a copay) to hundreds of dollars, more for special procedures, and more for prescriptions, etc. Much of the time you walk away with the problem not really solved, requiring multiple referrals and specialist visits. It's really easy to want to put it off till later, especially when money's tight. Yes, the situation gets worse over time, but it's one of the easiest things to procrastinate on. It's part of the reason I hate for-profit healthcare... it discourages routine preventative care that could help a lot of people and prevent more expensive treatments later, instead of just making them put it off until an ER visit is needed. Making people pay for their healthcare like this just means few people are going to use it routinely, instead waiting for their condition to worsen and fester. Especially teeth, yeesh, where even good insurance doesn't get you much.

carbocation 3y ago

As a patient, post-2020 I find even basics like appointment scheduling to be hard. (I'm also an MD, which makes all of this easier for me, and yet it's still a morass of scheduling hell, too many phone calls, too many logins/reauthentications, etc.)

solardev 3y ago
What happened in 2020?
- str3wer 3y ago
  a global pandemic?
  - solardev 3y ago
    Ohhhh yeah, lol. I always forget that really took off in 2020 (since it's called COVID-19). What even is time anymore =/ Anecdotally, though, it seemed like a lot of healthcare providers at the time moved to having better online appointment systems and remote visits, which made scheduling a lot easier for me. Probably a heavily YMMV situation though.
modeless 3y ago
Appointment scheduling is beyond awful these days. We're getting specialist appointments scheduled literally a year out, or just outright rejected because they're too full. It's de facto rationing.
- wrp 3y ago
  Experiencing that, too. Are these long waits due to anything other than a shortage of specialists? If not, why is there a shortage? I thought more doctors wanted to be specialists because of better hours and pay.
  - modeless 3y ago

jimbob45 3y ago

On the bright side, virtual doctor visits have led me to obtain medications that I would have gone without in the past. I have to imagine US healthcare outcomes would dramatically improve if insurance companies weren't charging $80+ per virtual visit. Oh well, the revolution can come in a decade rather than this year.

c_o_n_v_e_x 3y ago

My parents (both in late 60s) live in the US and I'm alarmed by what they tell me. Their old GP retired and sold his clinic to a "concierge" system/network (I don't know the terminology, been overseas for over 10 years so I'm not familiar with any of this.) You have to pay upfront a few thousand per year to get into the system. The US system sounds totally broken compared to my experiences within the Singapore and Australian health care systems.

frumper 3y ago
They should just find a new office. If theirs retired anyway, they’re getting a new doctor. They’d be on Medicare and the participation rate for doctors with Medicare is in the high 90s.
danans 3y ago
> Their old GP retired and sold his clinic to a "concierge" system/network Concierge medicine is a luxury service where you pay an annual out of pocket membership fee to have a doctor always on call, including home visits. Its popular among the very wealthy, but not affordable for most people.
- wrp 3y ago
  I've read comments that concierge medicine is cost effective if you require frequent visits, as with many older patients. Would like to know if this is true.
  - nth_degree 3y ago
    My in-laws, who are not wealthy, absolutely love the concierge set-up they have with their doctor. They do utilize it often, which makes it worth it.
    - danans 3y ago
      We're falling into a trap of using subjective definitions the term "wealthy". $2000-$3000/person/year [1] on top of regular insurance is a more than most people can afford, especially in a country where a large percentage of the population has little in terms of savings [2], and 60% live paycheck-to-paycheck [3]. But you certainly don't have to be a billionaire or even a deca-millionaire to afford it. You just need to be in the higher percentiles of your local income/wealth distribution. 1. https://www.partnermd.com/blog/concierge-medicine-costs-factors-considerations https://www.partnermd.com/blog/concierge-medicine-costs-fact... 2. https://www.bankrate.com/banking/savings/emergency-savings-report/#no-emergency-savings https://www.bankrate.com/banking/savings/emergency-savings-r... 3. https://www.cnbc.com/2023/09/27/60percent-of-americans-are-still-living-paycheck-to-paycheck.html https://www.cnbc.com/2023/09/27/60percent-of-americans-are-s...

tppiotrowski 3y ago

I had a virtual care plan from Kaiser Permanente. What I liked: - you can email a photo to the dermatologist and get a diagnosis for free. I used this for moles and rashes. Saved me a visit and $$ - you can email the doctor for free and chat with a nurse for free and if they refer you for labs or vaccines you just go directly to the lab and get your results online. No time with doctor required. I am young and have no major health issues. I found this a drastic improvement over going to see a doctor in person, being told to take Tylenol + rest then getting a $700 bill for that advice.

halfjoking 3y ago

I believe modern medicine is fraudulent. So I didn’t just not get the Covid vaccine, but I canceled my health insurance during Covid. I will never go back to paying for insurance or even going to a doctor in the US unless there is an overwhelming consensus acknowledging the harms of this study: https://pubmed.ncbi.nlm.nih.gov/36055877/ https://pubmed.ncbi.nlm.nih.gov/36055877/ [1] This system ends only when enough people refuse it. I know I won’t ever give this healthcare system a cent or an ounce of recognition they are an “authority” on anything. I’ll fly to f-ing Cuba for surgery if I have to… I’d rather die than go to an American hospital. After doctors went along promoting such an unsafe “vaccine” and have continued to ignore the overwhelming evidence of harm, they deserve absolutely nothing. [1] Since it’s important I’m going to quote what Dr. Aseem Malhotra says about this reanalysis of Pfizer and Moderna studies… "In my whole career, looking at all of the drugs and knowing about many different prescribed medications, I've never seen something that when you look at the data has such poor effectiveness and unprecedented harms. In the summer of last year, in the journal Vaccine, the highest-impact medical journal for vaccines, they published a reanalysis of Pfizer and Moderna's original double-blinded randomized controlled trial. This is the highest quality of scientific evidence. Joseph Fraiman is an ER doctor and clinical data scientist from Louisiana. Associate editor of the BMJ, Dr. Peter Doshi. Dr. Robert Kaplan from Stanford. Some real eminence of integrity published this reanalysis, and what they found was this. In the trials that led to the approval of regulators worldwide, you were more likely to suffer a severe adverse event from taking the vaccine, hospitalization, disability, or life-changing event than you were to be hospitalized with COVID. This mRNA vaccine should likely have never been approved for a single human in the first place, and that rate of serious adverse events is at least 1 in 800... 1 in 800 is a very, very high figure. We've pulled other vaccines for much less. The 1976 Swine Flu vaccine was pulled because it was found to cause a debilitating neurological condition called Guillan-Barre syndrome in about 1 in 100,000 people. The Rotavirus vaccine was suspended in 1999 because it was found to cause a form of bowel obstruction in kids in 1 of 10,000. This is at least 1 in 800. It's a no-brainer. So the question is, why have we not paused it?"

glimshe 3y ago
To all other people on HN: don't follow this person's advice if you live in the US. They are likely relatively healthy and has never experienced the crushing financial burden of long term, or serious health issues. The financial risk of living with insurance is high enough as it is, but living without insurance is madness if you have any sort of asset that can be taken away by creditors - assuming, obviously, that you can afford insurance (which most people, even if not as many as we'd want, can through work or Obamacare). FYI, my family had a "bad luck" year with 2 surgeries that added up to over 130K this year alone, but insurance covered it all (after deductible). We are in good health now.

SpaceNoodled 3y ago

We already were, but we still are, too.

drdaeman 3y ago

Hah. If it'd be only about the costs - I have a good insurance and decent income, but but I find the overall system very confusing. Five years and I can't say I've figured out how to use it. Dentists and ophthalmologists - super easy. I pick a place I like (based on location and reviews), I fill a form online (or give them a call if this doesn't work), I tell what I need or want, I make a visit and get full information on what should I do next. Simple as anywhere else in the world. But the other medical stuff is confusing to me, or makes me have reservations about it. - The majority of places seem to be affiliated with religious megacorps - they just bought out nearly every other hospital in my area. I'm not a woman, but I'm no fond of contributing to companies who then lobby for medical restrictions based on their religious beliefs. - Then, there's also a lot of alternative medicine, way more than in any other country I've seen. Holistic, osteopathic, chiropractic, you name it. Yes, I've read that DO in the US isn't exactly a quack who's gonna suggest a manipulation that has a chance of getting a person quadriplegic, but a cheaper way to get a medical degree than an MD (and the osteopathic junk tends to just gets thrown out of the window after graduating), but still - weird. Just something that scratches at the back of my mind. - Finding a GP is something I still haven't figured out in five years. They always seem to have appointment times in no less than half a year (!) so I'm really not sure how to find one I would like. And I'm still not sure what they do exactly, because I can go to the specialized doctor (like a dermatologist or otolaryngologist) directly anyway - and somehow it's a matter of weeks, not months. I've had a GP which I visited exactly once - should've went for urgent care, but I wasn't aware that's what I needed - then they stopped working at that hospital and I haven't explicitly asked for a new one so the whole relationship just lapsed somehow. In other countries, I went to GPs either for a quick dispatch to a specialist (next-day appointment for "hey doc, I've got $symptoms, can you send me off to $specialist and/or $lab") or for managing (simplifying) routine checkups (them organizing it instead of me running on my own to different labs and specialists). I should figure out the routine stuff, but still haven't - must be that the whole system operates on some unspoken rules, and I'm just unaware about it because I grew up elsewhere. At least the urgent care works in a way I understand.

Eddy_Viscosity2 3y ago

Another source of doctor supply-side issues is the number of doctors graduating each year not increasing with the population. Medical schools are highly regulated and love that exclusivity, limiting seats in schools means scarcity and higher prices.

beej71 3y ago

Even if you go in for your free checkup, all the clinics know the tricks for turning it billable. Years ago a study came out that most Americans couldn't afford an emergency $400 medical bill. (For non-Americans, $400 for an emergency is nothing.) I doubt the situation has improved.

floor2 3y ago
That often quoted (or misquoted?) study was wildly misleading and became complete misinformation through the retelling. People who said they'd pay using a credit card got reported in the media as being "unable to afford" the expense. The original study might have been an interesting finding on the transition to a cashless society, but for millions of Americans, paying using a credit card is the default rather than carrying cash and dealing with change, and not actually indicative of lacking funds to pay for something.

nhance 3y ago

In my mind, one of the most likely consumers of our data is insurance companies. It really exposes to me how messed up the idea of health insurance really is. As an insurance company, you are incentivized to de-risk your pool as much as possible, and by spending a few dollars you're able to get to the earliest possible signals of who might be needing services very easily. Things like complaining about a sore throat on social media to friends, or even within private messages, are all things you might be interested in. Other signals, purchase history, location history, contact tracing, all of these provide potential ways to spot early risk and increase rates/push out the undesirable members of the pool. Of all of the potential customers of our data, I keep coming back to insurance companies as having the most interest in these signals. When you can identify risks correctly, you can trim out or adjust rates to make things as safe as possible for your income stream. This has a reactionary component to it that hurts us all. With most of our communication being digital now, I find myself thinking twice about putting out anything that could be taken as a signal to an insurance company. As an avid runner with most of our events organized online, this presents a social cost because I just won't engage in some conversations for fear of how companies will use whatever I might engage with against me. Where does this type of behavior lead when practiced at scale?