Comment by willio58
5 hours ago
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.
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.
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.
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.
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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.
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.
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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.
> 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.
Well I just had an MRI and didn't see one elderly person complaining about bills. Guess that cancels our anecdotes out
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...
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