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If your response is "you know what I don't want any medical care" then my complaint is withdrawn, but otherwise it sounds like you want to "steal" because you don't like how the process works and don't have a lot of information about healthcare economics.*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.
I'm married to one, she disagrees. Most of her beefs have been with the embarrassingly dysfunctional nature of the hospitals she's been in that would never stand if there was real competition. EDs that either have no way of checking how many bed the psych department has open or for some reason refuses to believe either those tools or the doctors who tell them they have no beds. Spending countless hours on hold with pharma companies because for some reason totally inconceivable to me you need multiple doctorates to navigate call trees. The pure waste of it all has had me furious more than a few times.
If by "unnecessarily bad outcomes" you mean their nose bleed takes longer to figure out then sure I think people would be more than happy to deal with that and save hundreds of dollars.
No way this is accurate.
Why yes, we're discussing the legal framework your lobbying group has been enmeshed in creating. "We'll crush your upstarts like the pathetic little bugs they are if they dare" is precisely the thing I'm arguing should be abolished.
I refuse to believe she doesn't see a reduction in quality of care provided by mid-levels.
Ask her: "insert pet name here do you see any differences in quality of formulation and medication management (including things like benzo use) between NPs and MD/DOs?"
The rest of her relayed complaints are def real and accurate enough to make me believe you (and won't get any complaints from me, although as always theirs hidden complexity responsible for why those things are the way they are, especially the ED stuff).
Your nosebleed is not meant to be managed by an ED, your PCP should have same day sick slots. It's meant to be managed by a cost effective and cheap entity instead of the TRIGGER THE FULL IS THIS PERSON DYING APPARATUS (which they can't not trigger because liability). If they don't it's because PCPs are underpaid and overworked and most don't want to be one....
The AMA is the villain meme pisses me off so much because it's a "the sky is green" level take. At one point it might have been accurate but at this point the AMA has been lobbying against physician interests for decades and one of those things is deliberately increasing the amount of competition for physicians. Those idiots are on your "side."
And that's not getting into some of the shop talk level stuff here, you can't snap your fingers and make more surgeons for instance. If you gave every hospital a million dollars for every extra surgeon they trained (at the same quality as current) they just couldn't do it. For example currently we are talking about increasing the length of surgery residency (already 4+4+5+(0-3+)) because we can't train them adequately as is (because of the increase in robotic surgery and increasing specialization and IR and blah blah blah).
I don't necessarily have a problem with physicians themselves so much as this attitude that seems to be shared by so many of my partner's colleagues that nothing can possibly be done to fix these systems and instead all the complaints are about individual doctors or features of the system. I've spoken to developers of Epic or one of the Epic competitors briefly and they also noted Doctors are generally hesitant to streamline processes(and working in a heavily regulated industry myself I understand the people aren't the only source of change resistance). But when you have someone who received a decade or more of education personally spending most of their time doing tasks a bright high school student could accomplish it's time to seriously consider burning the whole thing down and restarting.
Maybe you've been burned by incremental changes not panning out in the past but you need to understand that from the outside looking in the whole system is insane and every anecdote I hear only further cements this view. Maybe people in the medical field are just so used to dollar amounts not meaning anything that they truly believe it is reasonable for packing a nose bleed to cost $500 but that's a rate for like, world's greatest expert to fly in and consult in any other field. I'm willing to believe you that there is some important art involved here but if that's how much it's worth to do that service there should be vocational classes for it and someone without an advanced degree should be doing it. The average hourly wage in the united states is something like $30/hour if we call the bandages a hundred bucks that is 13 hours of average wage to pack a nose, someone could make the average American hourly wage and do this procedure 3 times a week to be working full time. Obviously none of this is that simple but do you not see how this doesn't pass the smell test(no pun intended)?
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