5 ms·

It never occurred to me that carrying high-level heath insurance would mark me as a candidate for unnecessary surgery. Perhaps this is exactly why health care

by fnid 17y ago

It never occurred to me that carrying high-level heath insurance would mark me as a candidate for unnecessary surgery. Perhaps this is exactly why health care costs have gone up so dramatically. We have insurance, so the doctors take advantage of it -- needlessly. We very well could be spending a lot less money for the same amount of health care. I think the solution to the health care problem is for someone to start saying NO, like in that other article on the front page now. No to more test, no to unnecessary treatments and surgeries and non-generic drugs. Say no!

gruseom 17y ago
We very well could be spending a lot less money for the same amount of health care. ... not to mention greater actual health. When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more. It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").
- windsurfer 17y ago
  Hey, as a Canadian, if you feel you don't want as much health care, just use it less. The system is designed so that people take as much as they need, but not more.
  - DougBTX 17y ago
    Rational appraisal of risks, especially about your own healthcare and as a non-expert, is difficult.
  - pyre 17y ago
    One of the problems in Canada (at least Ontario -- because healthcare is run by the province not the federal government) is people using the emergency room as a doctor's office. This is because regular practice doctor's are regulated on the number of patients they can see (this is an attempt to prevent doctors from seriously overbooking themselves with patients in an attempt act like a 'health factory' where patients are just pushed down an assembly-line) so people have a hard time getting an actual physician. There are a couple of solutions to this, but no one really talks about them. (1) There are plenty of people that are qualified to be doctors, but because they did their medical school in India or China before immigrating to Canada, they aren't allowed to be certified as doctors. (2) Lots of doctors 'jump ship' to more profitable countries like the USA because they can just charge insurance and they aren't regulated from creating a 'factory practice' where no patient ever gets more than 5 minutes of the doctor's time.
    - joe_the_user 17y ago
      Uh, In the US, a large number of people use the emergency room as a doctor's office because they have no other choice. So, Canada: problematic. US: fail But if Canada keeps using US logic, it might wind-up in our boat. Good luck to you...
      - pyre 17y ago
        > In the US, a large number of people use the emergency room as a doctor's office because they have no other choice. How do you mean though? I'm saying that people with flu/colds/UTI/etc just go to the emergency room instead of a doctor's office (or even walk-in clinics at times) in Canada. I've been without healthcare, but I spent most of my life on a good healthcare plan through my parents. I don't have much experience with people that are off of the healthcare system (the only time I've had friends that were 'poor'[1] was in Canada where they were still covered for healthcare and social assistance). [1] By poor I mean, barely making any money and living off of welfare and/or living in subsidized housing. I don't mean starving/homeless, though I was a couple of 'degrees' away from people that were homeless. > But if Canada keeps using US logic, it might wind-up in our boat. How do you mean? > Good luck to you... I'm currently living in the US, but I was living in Ontario for a time. It just irks me when people start talking about the 'problems with the Canadian system' when it's not a unified system as I understand it. The same when people start talking about 'socialized medicine,' since every country that has such a system has a different take on it.
kmavm 17y ago
This is essentially the thesis of Arnold Kling's "Crisis of Abundance": http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Care/dp/1930865899 http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car... Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.
- Retric 17y ago
  The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years. Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath. PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
  - btilly 17y ago
    Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
cwan 17y ago
The remedy isn't about saying no, the remedy is sunlight and transparency. There should be consequences to overbilling, unnecessary treatments. There are after all a great deal of medical treatments and tests that are necessary and should be done but because of third party payers, it creates perverse incentives and discourages competition and accountability which is what we really need.
markerdmann 17y ago
This article in the New Yorker is excellent: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_... Atul Gawande argues that the problem with healthcare in the US is overutilization. The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder. Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.
- sireat 17y ago
  My wife had the exact same problem: first time gallstone pain, and the hospital wanted to operate immediately. Instead, we got second opinions from various sources and decided to wait. I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.
JimmyL 17y ago
As much as I think "tort reform" is a right-wing dog-whistle term, medical malpractice law has a lot to do with cases like this. Put simply, if you're insured and there's an incredibly remote chance that a test could show something, most doctors will issue it - it doesn't cost them anything, it doesn't cost you anything, and it protects them if something happens to you in the long run, at which point they can say "well, we tested for it and it was negative, so it's not our fault". From the doctor's point of view, ordering the additional test (or surgical procedure, etc.) has very little downsides and either marginal or significant upsides, depending on what ends up happening. If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer. Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).
po 17y ago
Another good article which I don't think is getting as much press as the New Yorker article: http://www.theatlantic.com/doc/200909/health-care http://www.theatlantic.com/doc/200909/health-care
- shykes 17y ago
  This is a fascinating read. It's long but worth it.
- mhb 17y ago
  http://news.ycombinator.com/item?id=760477 http://news.ycombinator.com/item?id=760477
- ryanwaggoner 17y ago
  Fantastic article, but it was on the front page about a month ago: http://news.ycombinator.com/item?id=760477 http://news.ycombinator.com/item?id=760477
SarahCortes 17y ago
I agree, and I said, No! Less was way more, for me.
catch23 17y ago
A friend of mine who works for Qualcomm in san diego says this happened to him as well. He went to the dentist to have all 4 wisdom teeth removed. They asked him to schedule it over 4 separate days rather than doing it all at once, just so that they could charge the maximum allowable amount per day to the insurance company -- they actually explained that to him!

by fnid 17y ago

gruseom 17y ago

We very well could be spending a lot less money for the same amount of health care. ... not to mention greater actual health. When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more. It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").

windsurfer 17y ago
Hey, as a Canadian, if you feel you don't want as much health care, just use it less. The system is designed so that people take as much as they need, but not more.
- DougBTX 17y ago
  Rational appraisal of risks, especially about your own healthcare and as a non-expert, is difficult.
- pyre 17y ago
  One of the problems in Canada (at least Ontario -- because healthcare is run by the province not the federal government) is people using the emergency room as a doctor's office. This is because regular practice doctor's are regulated on the number of patients they can see (this is an attempt to prevent doctors from seriously overbooking themselves with patients in an attempt act like a 'health factory' where patients are just pushed down an assembly-line) so people have a hard time getting an actual physician. There are a couple of solutions to this, but no one really talks about them. (1) There are plenty of people that are qualified to be doctors, but because they did their medical school in India or China before immigrating to Canada, they aren't allowed to be certified as doctors. (2) Lots of doctors 'jump ship' to more profitable countries like the USA because they can just charge insurance and they aren't regulated from creating a 'factory practice' where no patient ever gets more than 5 minutes of the doctor's time.
  - joe_the_user 17y ago
    Uh, In the US, a large number of people use the emergency room as a doctor's office because they have no other choice. So, Canada: problematic. US: fail But if Canada keeps using US logic, it might wind-up in our boat. Good luck to you...
    - pyre 17y ago
      > In the US, a large number of people use the emergency room as a doctor's office because they have no other choice. How do you mean though? I'm saying that people with flu/colds/UTI/etc just go to the emergency room instead of a doctor's office (or even walk-in clinics at times) in Canada. I've been without healthcare, but I spent most of my life on a good healthcare plan through my parents. I don't have much experience with people that are off of the healthcare system (the only time I've had friends that were 'poor'[1] was in Canada where they were still covered for healthcare and social assistance). [1] By poor I mean, barely making any money and living off of welfare and/or living in subsidized housing. I don't mean starving/homeless, though I was a couple of 'degrees' away from people that were homeless. > But if Canada keeps using US logic, it might wind-up in our boat. How do you mean? > Good luck to you... I'm currently living in the US, but I was living in Ontario for a time. It just irks me when people start talking about the 'problems with the Canadian system' when it's not a unified system as I understand it. The same when people start talking about 'socialized medicine,' since every country that has such a system has a different take on it.

kmavm 17y ago

This is essentially the thesis of Arnold Kling's "Crisis of Abundance": http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Care/dp/1930865899 http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car... Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.

Retric 17y ago
The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years. Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath. PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
- btilly 17y ago
  Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.

cwan 17y ago

The remedy isn't about saying no, the remedy is sunlight and transparency. There should be consequences to overbilling, unnecessary treatments. There are after all a great deal of medical treatments and tests that are necessary and should be done but because of third party payers, it creates perverse incentives and discourages competition and accountability which is what we really need.

markerdmann 17y ago

This article in the New Yorker is excellent: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_... Atul Gawande argues that the problem with healthcare in the US is overutilization. The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder. Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

sireat 17y ago
My wife had the exact same problem: first time gallstone pain, and the hospital wanted to operate immediately. Instead, we got second opinions from various sources and decided to wait. I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.

JimmyL 17y ago

As much as I think "tort reform" is a right-wing dog-whistle term, medical malpractice law has a lot to do with cases like this. Put simply, if you're insured and there's an incredibly remote chance that a test could show something, most doctors will issue it - it doesn't cost them anything, it doesn't cost you anything, and it protects them if something happens to you in the long run, at which point they can say "well, we tested for it and it was negative, so it's not our fault". From the doctor's point of view, ordering the additional test (or surgical procedure, etc.) has very little downsides and either marginal or significant upsides, depending on what ends up happening. If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer. Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).

po 17y ago

Another good article which I don't think is getting as much press as the New Yorker article: http://www.theatlantic.com/doc/200909/health-care http://www.theatlantic.com/doc/200909/health-care

shykes 17y ago
This is a fascinating read. It's long but worth it.
mhb 17y ago
http://news.ycombinator.com/item?id=760477 http://news.ycombinator.com/item?id=760477
ryanwaggoner 17y ago
Fantastic article, but it was on the front page about a month ago: http://news.ycombinator.com/item?id=760477 http://news.ycombinator.com/item?id=760477

SarahCortes 17y ago

I agree, and I said, No! Less was way more, for me.

catch23 17y ago

A friend of mine who works for Qualcomm in san diego says this happened to him as well. He went to the dentist to have all 4 wisdom teeth removed. They asked him to schedule it over 4 separate days rather than doing it all at once, just so that they could charge the maximum allowable amount per day to the insurance company -- they actually explained that to him!