4 ms·

"Narrow" doesn't mean "inadequate". It just means that instead of having access to 75% of doctors in your area, you only have access to 25%. But you still have

by exelius 11y ago

"Narrow" doesn't mean "inadequate". It just means that instead of having access to 75% of doctors in your area, you only have access to 25%. But you still have multiple specialists in each area, and you still have hospitals you can go to. Most people don't even scroll past the first page of results in a doctor search anyway, so would having access to 200 dermatologists provide much difference versus having access to 50? Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood. There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.

mtVessel 11y ago
I live 20 minutes outside of New York City. I put up with an extremely high cost of living for easy access to the incredible resources of a great city. In my new, "narrow" plan, I can only see doctors in my home county. Outside of ER visits, I cannot see a single doctor within the confines of NYC. I've never had to make such a choice before. For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance. Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
- ghufran_syed 11y ago
  Couldn't you just buy your own private health insurance that does cover that doctor or hospital? I'm guessing it might be for the same reason your insurance company (or your employer) doesn't want to: it's too expensive for what you get. I like having options too, I'd really like the option of driving a new mercedes instead of 14 year-old toyota, for the same amount of money, but I don't think it's my employer or anyone else's responsibility to make it happen.
  - merpnderp 11y ago
    Except under our current law, premiums have gone up by 50% in order to pay for subsidized insurance. So for the average person, they got hit with a huge price increase at the same time they saw a large decrease in value (access to specialists). http://www.forbes.com/sites/theapothecary/2014/06/18/3137-county-analysis-obamacare-increased-2014-individual-market-premiums-by-average-of-49/ http://www.forbes.com/sites/theapothecary/2014/06/18/3137-co... In my case, a family member went to a local oncologist who prescribed a series of treatments. She went for a second opinion to MD Anderson in Houston (a few states away) and was told by their team this treatment was ludicrous and they prescribed an entirely different series of treatments. My family member is now just fine, but if they had stayed with the local specialist who knows. But if I get sick I want access to places with the best long term survival rates, not whichever doctor happened to move next door.
    - exelius 11y ago
      The new laws had nothing to do with the price increases; rapidly increasing premiums coupled with reduced benefits are a trend that stretches back to the mid-90s. Obamacare actually caused a temporary slowdown in premium hikes, though they have since picked back up to the previous pace. I don't have the data in front of me right now, but I've looked it up in the past enough times. And yes, Obamacare did increase costs for young, healthy people. But one day, those young, healthy people are not going to be so young or healthy; and the system will need new young, healthy people to help subsidize the cost of health care for the old and sick. Or to put it another way: if we as a society don't want to deny life-saving health care based on a person's ability to pay, we have to make everyone pay all the time. And honestly, it's cheaper overall if people have less hesitation to go to the doctor and get their medical issues treated before they become serious and life-threatening, so we should pay to treat the non life-threatening conditions as well because it's a better use of money.
- exelius 11y ago
  But here's the thing: while a broken ankle may not be routine for you, it is routine for pretty much any orthopedist. It's simply not sustainable to have every person in the NY metro area all want to go to the same hospital when they break their ankle. But if you want to understand the real problem, ask yourself by what criteria is the "foremost orthopedic hospital" considered better? I know this will sound insane, but most medical quality metrics for hospitals and doctors don't take patient outcomes into account. Due to a combination of HIPAA rules and the way follow-up care is often performed by practitioners from multiple hospitals/private practices/therapists, it's nearly impossible to track patient outcomes even if you wanted to. So if the quality of a hospital isn't determined by patient outcomes, what is it determined by? The government uses a combination of patient volume, malpractice claims, accident rate, rate of hospital acquired infections, cost efficiency, scheduling availability and survey data (they're more concerned about cost effectiveness as it relates to Medicare than anything else). For any other source, the hospital probably just paid a bunch of money to be listed in the top spot on a "top orthopedic hospitals" list.

by exelius 11y ago

mtVessel 11y ago

I live 20 minutes outside of New York City. I put up with an extremely high cost of living for easy access to the incredible resources of a great city. In my new, "narrow" plan, I can only see doctors in my home county. Outside of ER visits, I cannot see a single doctor within the confines of NYC. I've never had to make such a choice before. For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance. Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.

ghufran_syed 11y ago
Couldn't you just buy your own private health insurance that does cover that doctor or hospital? I'm guessing it might be for the same reason your insurance company (or your employer) doesn't want to: it's too expensive for what you get. I like having options too, I'd really like the option of driving a new mercedes instead of 14 year-old toyota, for the same amount of money, but I don't think it's my employer or anyone else's responsibility to make it happen.
- merpnderp 11y ago
  Except under our current law, premiums have gone up by 50% in order to pay for subsidized insurance. So for the average person, they got hit with a huge price increase at the same time they saw a large decrease in value (access to specialists). http://www.forbes.com/sites/theapothecary/2014/06/18/3137-county-analysis-obamacare-increased-2014-individual-market-premiums-by-average-of-49/ http://www.forbes.com/sites/theapothecary/2014/06/18/3137-co... In my case, a family member went to a local oncologist who prescribed a series of treatments. She went for a second opinion to MD Anderson in Houston (a few states away) and was told by their team this treatment was ludicrous and they prescribed an entirely different series of treatments. My family member is now just fine, but if they had stayed with the local specialist who knows. But if I get sick I want access to places with the best long term survival rates, not whichever doctor happened to move next door.
  - exelius 11y ago
    The new laws had nothing to do with the price increases; rapidly increasing premiums coupled with reduced benefits are a trend that stretches back to the mid-90s. Obamacare actually caused a temporary slowdown in premium hikes, though they have since picked back up to the previous pace. I don't have the data in front of me right now, but I've looked it up in the past enough times. And yes, Obamacare did increase costs for young, healthy people. But one day, those young, healthy people are not going to be so young or healthy; and the system will need new young, healthy people to help subsidize the cost of health care for the old and sick. Or to put it another way: if we as a society don't want to deny life-saving health care based on a person's ability to pay, we have to make everyone pay all the time. And honestly, it's cheaper overall if people have less hesitation to go to the doctor and get their medical issues treated before they become serious and life-threatening, so we should pay to treat the non life-threatening conditions as well because it's a better use of money.
exelius 11y ago
But here's the thing: while a broken ankle may not be routine for you, it is routine for pretty much any orthopedist. It's simply not sustainable to have every person in the NY metro area all want to go to the same hospital when they break their ankle. But if you want to understand the real problem, ask yourself by what criteria is the "foremost orthopedic hospital" considered better? I know this will sound insane, but most medical quality metrics for hospitals and doctors don't take patient outcomes into account. Due to a combination of HIPAA rules and the way follow-up care is often performed by practitioners from multiple hospitals/private practices/therapists, it's nearly impossible to track patient outcomes even if you wanted to. So if the quality of a hospital isn't determined by patient outcomes, what is it determined by? The government uses a combination of patient volume, malpractice claims, accident rate, rate of hospital acquired infections, cost efficiency, scheduling availability and survey data (they're more concerned about cost effectiveness as it relates to Medicare than anything else). For any other source, the hospital probably just paid a bunch of money to be listed in the top spot on a "top orthopedic hospitals" list.