Happy New Year!
Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
This is your opportunity to ask questions. No question too simple or too silly.
Culture war topics are accepted, and proposals for a better intro post are appreciated.
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Notes -
You can see my responses below if you are interested in more details but I fundamentally don’t feel any moral obligation to a system where you have in network hospitals with out of network doctors.
Also it’s sort of stunning that americas credit bureaus appear to agree that the system is so exploitative that they simply ignore small
Amounts of medical debt when considering my probability of repaying other debt.
Do you believe health systems should be forced to provide care for someone who has no willingness and/or ability to pay? (They are - if you walk into an emergency room and say I will not pay for any care you provide me they are legally required to give you the same shit as anyone else).
If your response is "you know what I don't want any medical care" then my complaint is withdrawn, but otherwise it sounds like you want to "steal" because you don't like how the process works and don't have a lot of information about healthcare economics.*
*From your other post it sounds like you've been on the receiving end of a practice called surprise billing, which is controversial and legislated against in some jurisdictions but exists for a complicated and justifiable reason but is still annoying, as is usual the problem is health insurance companies being pretty much straight up evil and then blaming everyone else.
As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care. I can understand you're frustrated but these things exist for a reason.
They lobbied to make it illegal for anyone outside their club to provide medical care and then they charge an arm and a leg for it. If they didn't require 10 years of school to fix a nosebleed then it wouldn't be this bad.
I'm going to be a bit fiery here because this comment is top to bottom incorrect. It will never cease to amaze me how strong opinions on healthcare are with no experience, knowledge, or accuracy.
The minimum amount (with room for a lot a lot more) of training for a physician to practice independently in the U.S. is 11 years (4+4+3), there are some exceptions but they are very rare.
The person caring for OP who they are complaining about is a provider (a PA), not a doctor, and has a minimum (and essentially maximum) amount of training of 7 (4+3) years.
Physician lobbying groups have spent the last 15-20 years heavily lobbying for people outside their "club" to able to provide healthcare (providers), because they could charge for it in a supervisory capacity. Now it's biting them in the ass because those providers are lobbying for independent care, providing inferior and infuriating care (often while identifying themselves as doctors) and increasing costs (PA/NP care costs more but it's in stuff that the hospital/ownership group gets to take a bite out of instead of professional fees, for example unnecessary lab testing).
Fixing a nosebleed is harder than you think it is. A lot harder. A school nurse or a person at home can shove a tissue up your nose but that doesn't mean they are thinking about coagulopathy, and considering the risk of TSS, other infection, necrosis, know when to call ENT or to do a further work up and so on. Nasal packing for epistaxis is something requires a surprising amount of considering and critical thought, but you don't know that, the nurse doesn't know that, the PA probably doesn't know it, and an annoyingly large number of EM doctors don't know it. Ask a pediatrician.
Physician professional fees are a small portion of the cost of healthcare.
You're incorrectly imagining that competition to the medical industry would take the form of a smaller less trained private healthcare industry that otherwise operates entirely the same as the current dysfunctional system. In reality it could be something like going into a clinic staffed by a couple of people with bachelors degrees who go through a digital flow chart and either refer you to a full hospital if the flow chart says it's beyond their capabilities, with an estimate of how much the hospital will charge so that you can be an informed consumer, or solve issue using a step by step guide that comes up immediately from the flow chart. This whole process could cost nearly nothing compared to going into a hospital and paying hundreds of dollars to waste an MD's time and be perfectly transparent.
And yes, the idea that you need over a decade of training to do the majority of what people are paying for in the healthcare industry is absurd and broken.
Just so so wrong. Even in other countries with faster tracking the thing that gets cut down is undergrad (which is fair but hard to do in America, has its own significant problems, and is logistically unfeasible without completely uprooting our system in a way that isn't happening, and only shaves off two years anyway). We have some good evidence for this in the highly limited care given by providers - the NP lobbying groups best data says that NPs outcomes in simple cases is about equal with physicians outcomes in complicated cases (of course they jazz it up but that's what their data says, never mind the MD studies). Keep in mind that doctors are also the only ones getting that much training, everyone else is considerably less....and it shows. Ask any psychiatrist off the record about how the NPs and PAs are doing and they'll be able to convince you to never send a loved one to either.
As for your other point, flow chart care just doesn't work, no matter how much the MBA types may want it to. Decision support tools are miles off, for some godforsaken reason you can replace artists with an "AI" but the EKG autoread (which is one of the most computationally simple tasks imaginable) would get people killed if put in charge.
In addition to the always underestimated medical complexity, you have the human element - patient entitlement these days is sky high (as exhibited in this thread), people are always demanding things that are not indicated or are outright bad for them (ex: antibiotics for viruses) and your flowchart clinic would be immediately going off the chart or burned down.
That's not taking into the account the unacceptability of failure and legal environment, as soon as someone dies because of an edge case (which happens all the time) flowchart clinic would get sued into oblivion.
If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome and 1% of people are going to die unnecessarily you'd be able to do as you say, but nobody is signing up for that. We (rightly so) value human life too much for that.
Really? What are the numbers under the status quo?
The unnecessarily is doing work for me but I can't construct any real numbers without a lot more clarification and information, for instance you could do OP's flowchart suggestion if you were cautious and dumped people to a real level of care at a drop of a hat (this is basically how urgent care works, anything that shouldn't actually be managed by a primary care gets sent to the ED and billed by the ED and the urgent care).
The idea that medicine is somehow not complicated is a common one but is indicative of near absent epistemic humility. I'm a doctor and probably in greater than 90th percentile knowledge of other specialties and I can't use the other disciplines algorithms at a standard of care level. The field is big, technical, but also fuzzy (thus the "Art and Science of Healthcare").
We can see this in revealed preferences in innumerable ways (ex: calling consults even when we are 95% sure what is going on because we don't want to make a mistake or get sued).
I sympathize but this struck me as the argument against self-driving cars: it's a difficult problem, there are fuzzy situations, as such it's basically impossible for the cars to drive perfectly, and therefore it's not a viable technology. But this is of course ridiculous: self-driving cars don't need to drive perfectly to be viable, they only need to drive better than the current humans on the road, who are as a group atrocious.
So the real question is, what number of people are dying "unnecessarily" or having "unnecessarily bad outcomes" under the status quo where care may be high quality but expensive and illegible to the end user, as compared to a scenario where care might be less cautious but more accessible. First, you seem to be implying that the base rate of unnecessary bad outcomes or death under current practices is much less than 10%/1%, but we know that medical errors are not uncommon. Is it less than those figures? How much less? Recent figures put the annual number of deaths in the U.S. due to medical error at about 250,000 annually. Is your position that this is substantially less than 1%, or that these are necessary errors?
Second, how many people don't go to the doctor because they are afraid of predatory billing or just because it's too much hassle? How many people experience complications from tests and procedures that had a low probability of being useful? How many people consume ER resources just because it's easier to ignore the bill than with a normal office visit? It's not fair to compare a potentially reformed system as a whole against a subset of outcomes under the status quo.
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