7 ms·

As a 26 year old American, my experiences with the US hospital system have been so abysmal that I would consider not even seeking treatment for many serious con

by javert 14y ago

As a 26 year old American, my experiences with the US hospital system have been so abysmal that I would consider not even seeking treatment for many serious conditions unless I knew the solution would be straightforward. Abysmal in terms of having good medical outcomes, and being treated respectfully by hospital staff (who tend to be extremely overworked). Plus, it's degrading to have no control over how much you will be charged, and whether insurance will cover it. I personally have had one relatively minor medical issue, so the above comes more from experiences with family members in the hospital.

danielweber 14y ago
As Americans, we seem unable to realize that in many cases the best thing to do is nothing, or just keep an eye on it. We love the thought of "fighting cancer." You can't just fix this problem at one level; it's pretty endemic. To start with, I'd love to be able to opt-out of unlikely-to-improve-my-outcome procedures, but even with those wishes doctors are likely to still act because of other pressures.
- robbiep 14y ago
  You can make your wishes explicitly known, it's called 'advanced directives' however most people either don't know about this or don't want to have to think about it because it involves facing their own mortality. IF you really don't want CPR, or heroic measures to be taken on you, then get a DO NOT RECUSSITATE' or DNR tattoo on your chest or side, where the defib pads go (just in case) and carry around a copy of your advanced directives in your wallet. For everything else, you will be conscious and thus have the ability to tell someone 'no'
  - nialo 14y ago
    The previous HN thread claimed that it's better to have a bracelet or necklace or similar than a tattoo, and in particular that tattoos may not actually be followed as consistently as bracelets etc. I'm not interested in the debate as to why this is, just trying to inform people.
    - Someone 14y ago
      For those wondering: https://news.ycombinator.com/item?id=3313928 https://news.ycombinator.com/item?id=3313928? Main reasons are: - a tattoo may be a strong indication that, some time ago, you had an opinion, but it isn't any kind of indication that you still are of that opinion (including a timestamp in your tattoo is an option, but impractical). A signed statement in a bracelet, on the other hand, can be updated regularly, and even if it is not updated, the fact that you still are wearing it can be seen as confirmation that your opinion hasn't changed. - regulations.
purplelobster 14y ago
I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just too much. I don't want to have to think about it. Americans seem to value choice and being able to shop around much more highly than I do. "Being a good consumer". I can intellectually understand why, but making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of.
- philwelch 14y ago
  What happens in Sweden? Does the state assign a doctor to you? What happens if you don't like that doctor and want a different one? I wouldn't want to do away with the freedom of choice, convenient as it may be to have a default. Besides, once you've chosen all those things you can just stick with them for years on end.
  - goodcanadian 14y ago
    I can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.
    - philwelch 14y ago
      That depends on your insurance company, too. In my city it's not a big problem.
  - purplelobster 14y ago
    I'm sure you can choose if you really really want to, but there are sensible default options. The way it should be in my opinion: 1. Go to nearest hospital, no need to worry about insurance or whether it's a "preferred" hospital for your insurance company. 2. Get assigned doctor(s) based on your needs. 3. Get treatment. No need to check what treatments are covered and if your doctor is trying to screw you over with unnecessary expensive tests. 3. Relax. No paperwork because there is a unified information system. No insurance paperwork because it's all covered. I think it's difficult to imagine how much easier it can be, when you're used to dealing with heavy bureaucracy and insurance companies. I can't explain how much less stressed I was in that system. Then again, I'm even stressed about owning a car with all that entails in terms of check-ups, oil changes, repairs, insurance, expiring licenses, parking etc. Perhaps other people are better at dealing with this crap than I am.
drcube 14y ago
I agree, and it's not just end of life treatment. I often tell people, half joking but half serious, that I would rather die than go to the hospital. Even the simplest visit is an excruciatingly long, bureaucratic, kafkaesque nightmare where your bank account is drained, and the patient has little if any input or control over how they're treated. Hospitals just suck.
- javert 14y ago
  A "kafkaesque nightmare" perfectly describes my thinking.
benched 14y ago
Strongly agree. Last year, I had the misfortune of being sent to the ER for lightheadedness and confusion while hiking. All different doctors ran a battery of very expensive tests, none of which I was in any condition to consent to. They discovered nothing. Most of the time I spent on a bed in the hallway under piercing lights, being ignored, surrounded by such chaos that I had PTSD from it for months. Nobody was able to provide any form of tangible help. I got better on my own just resting for a few days. That was only the beginning. I received dozens of singleton bills for the co-pay amounts for dozens of separate procedures and tests, which each arrived in my mailbox over a period of seven months. Seven months of surprise bills for various different things they did in a period of a couple of hours. The charges totalled in the thousands. And of course, for each separate charge, I got mail from both the insurance company and the hospital. The net effect being that I received nothing except doctors saying "we see nothing wrong" and being sent home. But I had to endure finding surprise bills in the mail, and doing the paperwork to pay and file them, randomly for the next seven months. Every one a reminder of how a system took advantage of me while I was down and couldn't answer for myself. I felt betrayed, like could not one person have the sensitivity and take the time to let me rest somewhere and feed me food and gatorade or something? And no matter how much I wanted to move on from it and get on with my life, I still had to face the bills streaming in like randomized salt rubbed into the wound. Lesson: Take outstanding care of yourself at all times without fail. Don't have medical problems. If you do, have amazing health insurance.
- davidtanner 14y ago
  Well buddy you'd be singing a different tune if the doctors discovered a medical issue and prevented you from dying. If you were so lightheaded and confused that you were unable to be your own advocate and get yourself some fluids and food then you probably should have gone to the hospital. If you just let doctors talk you into it and you didn't think it was warranted then you have a problem with your assertion skills.
  - geden 14y ago
    You're ignoring the very lucid point he's making. Why is that? As a UK citizen I've never had to endure such nonsense around health. I don't know what's weirder, that such a crazy system was allowed to evolve or that people defend it.

by javert 14y ago

danielweber 14y ago

As Americans, we seem unable to realize that in many cases the best thing to do is nothing, or just keep an eye on it. We love the thought of "fighting cancer." You can't just fix this problem at one level; it's pretty endemic. To start with, I'd love to be able to opt-out of unlikely-to-improve-my-outcome procedures, but even with those wishes doctors are likely to still act because of other pressures.

robbiep 14y ago
You can make your wishes explicitly known, it's called 'advanced directives' however most people either don't know about this or don't want to have to think about it because it involves facing their own mortality. IF you really don't want CPR, or heroic measures to be taken on you, then get a DO NOT RECUSSITATE' or DNR tattoo on your chest or side, where the defib pads go (just in case) and carry around a copy of your advanced directives in your wallet. For everything else, you will be conscious and thus have the ability to tell someone 'no'
- nialo 14y ago
  The previous HN thread claimed that it's better to have a bracelet or necklace or similar than a tattoo, and in particular that tattoos may not actually be followed as consistently as bracelets etc. I'm not interested in the debate as to why this is, just trying to inform people.
  - Someone 14y ago
    For those wondering: https://news.ycombinator.com/item?id=3313928 https://news.ycombinator.com/item?id=3313928? Main reasons are: - a tattoo may be a strong indication that, some time ago, you had an opinion, but it isn't any kind of indication that you still are of that opinion (including a timestamp in your tattoo is an option, but impractical). A signed statement in a bracelet, on the other hand, can be updated regularly, and even if it is not updated, the fact that you still are wearing it can be seen as confirmation that your opinion hasn't changed. - regulations.

purplelobster 14y ago

I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just too much. I don't want to have to think about it. Americans seem to value choice and being able to shop around much more highly than I do. "Being a good consumer". I can intellectually understand why, but making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of.

philwelch 14y ago
What happens in Sweden? Does the state assign a doctor to you? What happens if you don't like that doctor and want a different one? I wouldn't want to do away with the freedom of choice, convenient as it may be to have a default. Besides, once you've chosen all those things you can just stick with them for years on end.
- goodcanadian 14y ago
  I can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.
  - philwelch 14y ago
    That depends on your insurance company, too. In my city it's not a big problem.
- purplelobster 14y ago
  I'm sure you can choose if you really really want to, but there are sensible default options. The way it should be in my opinion: 1. Go to nearest hospital, no need to worry about insurance or whether it's a "preferred" hospital for your insurance company. 2. Get assigned doctor(s) based on your needs. 3. Get treatment. No need to check what treatments are covered and if your doctor is trying to screw you over with unnecessary expensive tests. 3. Relax. No paperwork because there is a unified information system. No insurance paperwork because it's all covered. I think it's difficult to imagine how much easier it can be, when you're used to dealing with heavy bureaucracy and insurance companies. I can't explain how much less stressed I was in that system. Then again, I'm even stressed about owning a car with all that entails in terms of check-ups, oil changes, repairs, insurance, expiring licenses, parking etc. Perhaps other people are better at dealing with this crap than I am.

drcube 14y ago

I agree, and it's not just end of life treatment. I often tell people, half joking but half serious, that I would rather die than go to the hospital. Even the simplest visit is an excruciatingly long, bureaucratic, kafkaesque nightmare where your bank account is drained, and the patient has little if any input or control over how they're treated. Hospitals just suck.

javert 14y ago
A "kafkaesque nightmare" perfectly describes my thinking.

benched 14y ago

Strongly agree. Last year, I had the misfortune of being sent to the ER for lightheadedness and confusion while hiking. All different doctors ran a battery of very expensive tests, none of which I was in any condition to consent to. They discovered nothing. Most of the time I spent on a bed in the hallway under piercing lights, being ignored, surrounded by such chaos that I had PTSD from it for months. Nobody was able to provide any form of tangible help. I got better on my own just resting for a few days. That was only the beginning. I received dozens of singleton bills for the co-pay amounts for dozens of separate procedures and tests, which each arrived in my mailbox over a period of seven months. Seven months of surprise bills for various different things they did in a period of a couple of hours. The charges totalled in the thousands. And of course, for each separate charge, I got mail from both the insurance company and the hospital. The net effect being that I received nothing except doctors saying "we see nothing wrong" and being sent home. But I had to endure finding surprise bills in the mail, and doing the paperwork to pay and file them, randomly for the next seven months. Every one a reminder of how a system took advantage of me while I was down and couldn't answer for myself. I felt betrayed, like could not one person have the sensitivity and take the time to let me rest somewhere and feed me food and gatorade or something? And no matter how much I wanted to move on from it and get on with my life, I still had to face the bills streaming in like randomized salt rubbed into the wound. Lesson: Take outstanding care of yourself at all times without fail. Don't have medical problems. If you do, have amazing health insurance.

davidtanner 14y ago
Well buddy you'd be singing a different tune if the doctors discovered a medical issue and prevented you from dying. If you were so lightheaded and confused that you were unable to be your own advocate and get yourself some fluids and food then you probably should have gone to the hospital. If you just let doctors talk you into it and you didn't think it was warranted then you have a problem with your assertion skills.
- geden 14y ago
  You're ignoring the very lucid point he's making. Why is that? As a UK citizen I've never had to endure such nonsense around health. I don't know what's weirder, that such a crazy system was allowed to evolve or that people defend it.