3 ms·

I support M4A for other reasons, but as of today the US governments(s) spend more on health care per citizen than many/most European countries with universal he

I support M4A for other reasons, but as of today the US governments(s) spend more on health care per citizen than many/most European countries with universal health care. A little more than a third of Americans are on Medicaid and/or Medicare. The scale is already there and the costs are already out of control. I think the GP is right that the inefficiencies are baked in at every possible level. M4A makes people's lives easier, but it won't solve the cost problem. We're at a point where we need massive reform of the entire system, not just nationalization (or privatization, if you want to go that way), and there would be a lot of people unemployed (or suddenly asked to do a lot more work[1]) and a lot of pain re-aligning people's expectations around medical care. [1] One example of this is the degree of specialization and division of labor that is just wasteful. A friend has a medical job where he is on-call to monitor a machine. He does nothing else. He rarely works more than a few hours a week. Another example: a family member needed an ultrasound. The doctor's office had an ultrasound. The doctor wanted an ultrasound. It was urgent. The ultrasound tech had recently quit. He ordered an ultrasound from an imaging center with a two-month wait time instead of simply doing a very easy ultrasound himself, which he would be the one required to interpret anyway. He wasn't busy either; he chatted about golf for almost a half-hour. In his mind, it was simply not his job. (Perhaps insurance also won't compensate doctors for performing ultrasounds, only techs. Who knows.)

alistairSH 2y ago
To your example... Would the physician in your example really do the reading of the ultrasound? Every time I've had imaging done, a radiologist has done the initial read of the scan - the ordering physician has only worked on the treatment plan. Maybe my experience really is just another example of what you're saying - I don't know how capable a typical GP is at reading ultrasounds or MRIs or whatever else. Possible counter-example... my wife broke her pelvis a few years ago in a bicycle crash - the attending physician at the ER totally missed the break and sent us on our way (with instructions to follow up with a specialist later). Maybe a radiologist would have caught the break up front and saved us some pain+suffering. To your point about Medicaid/Medicare spending... one of my (perhaps naive) thoughts is simplifying the system would help cost cutting debates because we'd all be trying to solve the same problems. Right now, we're all spread across different programs/systems, so it's almost impossible to even talk to individuals about cost savings.
- Amezarak 2y ago
  > Would the physician in your example really do the reading of the ultrasound? Every time I've had imaging done, a radiologist has done the initial read of the scan - the ordering physician has only worked on the treatment plan. My last ER visit involved being dismissed by the ER doctor with a diagnosis I knew was wrong. I played Dr. Google when I got home, went to a nurse practitioner, told her what I thought it was and requested an ultrasound to confirm. The tech came in and did it, and we all three saw exactly what it was and she ordered a referral to the surgeon on the spot. I'm sure there is some complex of rules regarding radiologists, but I don't know what they are. They also don't send one in for most prenatal ultrasounds; it's just the doctor and the tech, or sometimes only the doctor. I would expect a radiologist is only needed in certain complex cases, or for certain types of scans. > the attending physician at the ER totally missed the break and sent us on our way (with instructions to follow up with a specialist later). Maybe a radiologist would have caught the break up front and saved us some pain+suffering. Maybe. A lot of doctors are just not great at their jobs. I have many, many stories about this. If I were once again to play Dr. Google, I'd hope that the reason he missed it is because it was a comparatively small and non-obvious break, for which there isn't really treatment besides rest anyway. Since you mentioned averting pain and suffering...maybe not.

alistairSH 2y ago

To your example... Would the physician in your example really do the reading of the ultrasound? Every time I've had imaging done, a radiologist has done the initial read of the scan - the ordering physician has only worked on the treatment plan. Maybe my experience really is just another example of what you're saying - I don't know how capable a typical GP is at reading ultrasounds or MRIs or whatever else. Possible counter-example... my wife broke her pelvis a few years ago in a bicycle crash - the attending physician at the ER totally missed the break and sent us on our way (with instructions to follow up with a specialist later). Maybe a radiologist would have caught the break up front and saved us some pain+suffering. To your point about Medicaid/Medicare spending... one of my (perhaps naive) thoughts is simplifying the system would help cost cutting debates because we'd all be trying to solve the same problems. Right now, we're all spread across different programs/systems, so it's almost impossible to even talk to individuals about cost savings.

Amezarak 2y ago
> Would the physician in your example really do the reading of the ultrasound? Every time I've had imaging done, a radiologist has done the initial read of the scan - the ordering physician has only worked on the treatment plan. My last ER visit involved being dismissed by the ER doctor with a diagnosis I knew was wrong. I played Dr. Google when I got home, went to a nurse practitioner, told her what I thought it was and requested an ultrasound to confirm. The tech came in and did it, and we all three saw exactly what it was and she ordered a referral to the surgeon on the spot. I'm sure there is some complex of rules regarding radiologists, but I don't know what they are. They also don't send one in for most prenatal ultrasounds; it's just the doctor and the tech, or sometimes only the doctor. I would expect a radiologist is only needed in certain complex cases, or for certain types of scans. > the attending physician at the ER totally missed the break and sent us on our way (with instructions to follow up with a specialist later). Maybe a radiologist would have caught the break up front and saved us some pain+suffering. Maybe. A lot of doctors are just not great at their jobs. I have many, many stories about this. If I were once again to play Dr. Google, I'd hope that the reason he missed it is because it was a comparatively small and non-obvious break, for which there isn't really treatment besides rest anyway. Since you mentioned averting pain and suffering...maybe not.