5 ms·

Tangentially related, but it is increasingly obvious that there's an ever-growing chasm between these two aspects of medicine in the U.S.: - What's possible fo

Tangentially related, but it is increasingly obvious that there's an ever-growing chasm between these two aspects of medicine in the U.S.: - What's possible for medical professionals to do for certain conditions, in large part due to the amazing levels of investment into research and implementation. - How difficult it is for ordinary people to receive care. Primarily due to private insurance companies intentionally making it more difficult to get care. Like the fact we're giving stem cell therapy to fetuses successfully is amazing, yet any time I go to a doctor's office or bloodwork company I hear an elderly person explain to the front desk person that they've been on the same insurance for decades and only recently started receiving bills they can't afford, or listening to the front desk person explain that now medicare no longer covers them for a routine thing. Ideally, we could have both great research _and_ great general care in this country. I just don't know if I will ever see that day.

ecshafer 7mo ago
I think the largest issue with health care right now is that the US is artificially shrinking the supply of Doctors. This is due to: 1. Size of medical school classes not increasing with population 2. US has an artificially small amount of residency slots. These are largely due to AMA lobbying afaik and bad bills. But if we allowed every qualified medical student to enroll, and gave a residency slot to every graduate. In a decade we would have really shrunk the gap.
- iamtheworstdev 7mo ago
  the largest issue in American health care is private equity and middle men raising the cost of everything. edit if doctor scarcity were the issue then doctors would have a lot more leverage in salary negotiations than they do, which is to say they don't have much. because the hiring practices are limited by what they can bill, which they have no power over.
  - doomslayer999 7mo ago
    Private Equity is the effect not the cause. We need them to create efficiency because of the shenanigans that the AMA guild did in limiting doctor supply. Just allow people to take an exam to get credentialed, we'd have foreign doctors flown in by the hundreds of thousands and care would be as cheap as it is in India.
    - lazyasciiart 7mo ago
      That doesn’t make sense - private equity has done the same thing in completely orthogonal industries, like manufacturing.
    - watwut 7mo ago
      Private Equity does not create efficiency and we do not need them. What they do is to take debt to buy healthy companies, transfer debt onto them and then kill them. None of that is efficiency in any reasonable sense.
    - iamtheworstdev 7mo ago
      private equity doesn't create efficiencies. The real world is not some MicroEcon 101 class. > “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures. Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals. And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on. Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.” https://www.grassley.senate.gov/news/news-releases/private-equity-in-health-care-shown-to-harm-patients-degrade-care-and-drive-hospital-closures https://www.grassley.senate.gov/news/news-releases/private-e...
  - pembrook 7mo ago
    Ugh I wish this braindead populist 'private equity boogieman' meme that's taken ahold of reddit-types would die. No, private equity is not the reason healthcare costs in the US are out of control, you can even ask chatgpt. PE is a 3rd tier mild symptom in certain niche health markets that sits downstream of all the structural root issues created due to the twisted public/private incentive misalignment nightmare of US healthcare.
    - Eisenstein 7mo ago
      People would have an opportunity to change their stance if you explain why they should hold a different one with evidence and persuasion. Berating them and then saying they are wrong without explaining why is not going to change anyone's mind.
      - pembrook 7mo ago
        I used to do that when HN was a more rational, thinking-man's place years ago. It's been poisoned by the hysterical climate of US politics like everything else on the internet, so there are no thinking men left. It's a lost cause. If I were to explain the situation rationally I would get downvoted for not cheering on the shooting of CEOs. Upvote communities are all dead and dying. There are no more interesting conversations happening in them anymore.
- exhilaration 7mo ago
  Does that matter though? My impression is that most people don't see doctors anymore. Every urgent care visit I've had in the past few years has been with a physicians assistant or nurse. Same for our pediatrician, I can't remember the last time we saw her instead of one of the nurses. I actually have a routine visit with a specialist at one of the top hospital systems in the country in 2 days, and I see in the portal I'm seeing a "CRNP, MSN", not a doctor.
  - ecshafer 7mo ago
    This affect is because of the doctor shortage though. I am in the process of trying to find a primary care provider, and I cant find anyone accepting new patients. Bigger places you basically see the doctor for 2 minutes when you actually need one. I went to a ortho surgeon and they had a dozen patients “seeing them” at the same time. As he just went between rooms and nurses prepped everything.
    - fleshdaddy 7mo ago
      I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.
      - renewiltord 7mo ago
        The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
        stalfie 7mo ago
        As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
- deleted 7mo ago
  [deleted]
- watwut 7mo ago
  AMA was lobbying for more residencies for years. And residencies are the bottleneck.
holoduke 7mo ago
The US is a country of cowboys. There is literally nothing that can be considered fair. The only thing what is left is the kindness of it's people. If that detoriates, well...
throwawayORAJ 7mo ago
[dead]
slibhb 7mo ago
Does that really happen "any time you go to a doctor's office"? That aside, what if novel therapies like this are linked to the fact that US healthcare is expensive? If you make it cheap -- as in other countries -- there's less incentive for companies to invest and you get less research and fewer breakthroughs. Also fewer doctors, hospital beds, and more rationing. In an ideal world, everyone would have exactly the right amount of healthcare. But our world isn't ideal, it runs on incentives, and it's not clear to me that all the hand-wringing over US healthcare will lead to positive changes.
- willio58 7mo ago
  > Does that really happen "any time you go to a doctor's office"? Yes. I recently made a resolution to get established with all the medical professionals I don’t have set up. So a primary care, dermatologist, etc. over the past 2 months I’ve visited and had to go back a couple of times. I’ve literally overheard insurance-related issues in all cases. Whether it was the person in line before me or just overhearing people complaining while I’m in the waiting room. Just last week I was waiting to get my blood drawn and the woman at the front desk, after continued prodding by an elderly man frustrated with lack of coverage, out loud said “Well, that’s insurance in America for you. Go ahead and call the number on the back of your insurance card because we can’t do anything for you.” Just deeply disheartening stuff to watch a late 80s man not realize after 15 minutes of being tossed between automated insurance phone responses that he simply won’t get the help he needs.
  - slibhb 7mo ago
    Well I just had an MRI and didn't see one elderly person complaining about bills. Guess that cancels our anecdotes out
- doctorpangloss 7mo ago
  > That aside, what if novel therapies like this are linked to the fact that US healthcare is expensive? you don't have to wonder, people have been writing about this as a major factor of costs for nearly 50 years
- 7mo ago
Cthulhu_ 7mo ago
What may be necessary is for other countries to be better. These treatments / studies don't just affect USAmericans but everyone everywhere, and if there's enough signals of "this treatment saves kids abroad but we can't afford them in the US because of policy", MAYBE said policy will change. Maybe. Not likely because the corporations have control over the government, and the US government system is stuck in laws drafted up in the 1700s.

ecshafer 7mo ago

I think the largest issue with health care right now is that the US is artificially shrinking the supply of Doctors. This is due to: 1. Size of medical school classes not increasing with population 2. US has an artificially small amount of residency slots. These are largely due to AMA lobbying afaik and bad bills. But if we allowed every qualified medical student to enroll, and gave a residency slot to every graduate. In a decade we would have really shrunk the gap.

iamtheworstdev 7mo ago
the largest issue in American health care is private equity and middle men raising the cost of everything. edit if doctor scarcity were the issue then doctors would have a lot more leverage in salary negotiations than they do, which is to say they don't have much. because the hiring practices are limited by what they can bill, which they have no power over.
- doomslayer999 7mo ago
  Private Equity is the effect not the cause. We need them to create efficiency because of the shenanigans that the AMA guild did in limiting doctor supply. Just allow people to take an exam to get credentialed, we'd have foreign doctors flown in by the hundreds of thousands and care would be as cheap as it is in India.
  - lazyasciiart 7mo ago
    That doesn’t make sense - private equity has done the same thing in completely orthogonal industries, like manufacturing.
  - watwut 7mo ago
    Private Equity does not create efficiency and we do not need them. What they do is to take debt to buy healthy companies, transfer debt onto them and then kill them. None of that is efficiency in any reasonable sense.
  - iamtheworstdev 7mo ago
    private equity doesn't create efficiencies. The real world is not some MicroEcon 101 class. > “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures. Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals. And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on. Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.” https://www.grassley.senate.gov/news/news-releases/private-equity-in-health-care-shown-to-harm-patients-degrade-care-and-drive-hospital-closures https://www.grassley.senate.gov/news/news-releases/private-e...
- pembrook 7mo ago
  Ugh I wish this braindead populist 'private equity boogieman' meme that's taken ahold of reddit-types would die. No, private equity is not the reason healthcare costs in the US are out of control, you can even ask chatgpt. PE is a 3rd tier mild symptom in certain niche health markets that sits downstream of all the structural root issues created due to the twisted public/private incentive misalignment nightmare of US healthcare.
  - Eisenstein 7mo ago
    People would have an opportunity to change their stance if you explain why they should hold a different one with evidence and persuasion. Berating them and then saying they are wrong without explaining why is not going to change anyone's mind.
    - pembrook 7mo ago
      I used to do that when HN was a more rational, thinking-man's place years ago. It's been poisoned by the hysterical climate of US politics like everything else on the internet, so there are no thinking men left. It's a lost cause. If I were to explain the situation rationally I would get downvoted for not cheering on the shooting of CEOs. Upvote communities are all dead and dying. There are no more interesting conversations happening in them anymore.
exhilaration 7mo ago
Does that matter though? My impression is that most people don't see doctors anymore. Every urgent care visit I've had in the past few years has been with a physicians assistant or nurse. Same for our pediatrician, I can't remember the last time we saw her instead of one of the nurses. I actually have a routine visit with a specialist at one of the top hospital systems in the country in 2 days, and I see in the portal I'm seeing a "CRNP, MSN", not a doctor.
- ecshafer 7mo ago
  This affect is because of the doctor shortage though. I am in the process of trying to find a primary care provider, and I cant find anyone accepting new patients. Bigger places you basically see the doctor for 2 minutes when you actually need one. I went to a ortho surgeon and they had a dozen patients “seeing them” at the same time. As he just went between rooms and nurses prepped everything.
  - fleshdaddy 7mo ago
    I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.
    - renewiltord 7mo ago
      The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
      - stalfie 7mo ago
        As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
deleted 7mo ago
[deleted]
watwut 7mo ago
AMA was lobbying for more residencies for years. And residencies are the bottleneck.

holoduke 7mo ago

The US is a country of cowboys. There is literally nothing that can be considered fair. The only thing what is left is the kindness of it's people. If that detoriates, well...

throwawayORAJ 7mo ago

[dead]

slibhb 7mo ago

Does that really happen "any time you go to a doctor's office"? That aside, what if novel therapies like this are linked to the fact that US healthcare is expensive? If you make it cheap -- as in other countries -- there's less incentive for companies to invest and you get less research and fewer breakthroughs. Also fewer doctors, hospital beds, and more rationing. In an ideal world, everyone would have exactly the right amount of healthcare. But our world isn't ideal, it runs on incentives, and it's not clear to me that all the hand-wringing over US healthcare will lead to positive changes.

willio58 7mo ago
> Does that really happen "any time you go to a doctor's office"? Yes. I recently made a resolution to get established with all the medical professionals I don’t have set up. So a primary care, dermatologist, etc. over the past 2 months I’ve visited and had to go back a couple of times. I’ve literally overheard insurance-related issues in all cases. Whether it was the person in line before me or just overhearing people complaining while I’m in the waiting room. Just last week I was waiting to get my blood drawn and the woman at the front desk, after continued prodding by an elderly man frustrated with lack of coverage, out loud said “Well, that’s insurance in America for you. Go ahead and call the number on the back of your insurance card because we can’t do anything for you.” Just deeply disheartening stuff to watch a late 80s man not realize after 15 minutes of being tossed between automated insurance phone responses that he simply won’t get the help he needs.
- slibhb 7mo ago
  Well I just had an MRI and didn't see one elderly person complaining about bills. Guess that cancels our anecdotes out
doctorpangloss 7mo ago
> That aside, what if novel therapies like this are linked to the fact that US healthcare is expensive? you don't have to wonder, people have been writing about this as a major factor of costs for nearly 50 years
7mo ago

Cthulhu_ 7mo ago

What may be necessary is for other countries to be better. These treatments / studies don't just affect USAmericans but everyone everywhere, and if there's enough signals of "this treatment saves kids abroad but we can't afford them in the US because of policy", MAYBE said policy will change. Maybe. Not likely because the corporations have control over the government, and the US government system is stuck in laws drafted up in the 1700s.