Many of the patients here are dealing with serious illnesses as a result of not being able to get access to basic preventive care. This is part of why it matters to make healthcare accessible: It's more expensive to not make it accessible.
Ye olde "the horse was lost because the horseshoe was lost because a nail was lost" principle. It's not just that someone has an advanced illness, if they die and now their kid needs additional resources from the welfare system, the rest of us are paying for it.
According to this piece, under EMTALA -- he Emergency Medical Treatment & Labor Act passed in the 1980s -- it's not illegal to treat undocumented immigrants.
I was under the impression that USA healthcare has out of control costs due chronic diseases[1] . None of which have any 'preventative care' that you get at an hospital( cancer maybe an exception) . What can a hospital do about 'physical inactivity' ?
We can blame this or that but mind boggling half the population in USA is obese. What can any healthcare system possibly do about that.
When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc).
So a hospital can actually do a lot for fatties. Being able to talk to a nutritionist, set up a plan, gain access to any applicable medication, addressing out underlying inflammation/hormone/disordered eating...
> When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc).
This is such a stupid, self-defeating policy for an insurer. Until your problem costs us a lot, don't you dare try to mitigate it on our dime!
After Obama Care, insurance companies profits are now capped at 8% (think that is the number) of revenue (ie premiums) in the US. So one way to grow revenue is to have higher costs per policy, pay out more, and charge higher premiums. If you are at 8% profit and you reduce your payouts as you are describing with preventative care, then you don't get to keep that money. You have to pay it back to the insurance buyers. Very perverse incentive.
The goal of the insurance companies is to make sure that all medical costs go up 10% every year so that their profits can increase and shareholders benefit. They are NOT negotiating lower pricing from medical providers, because why would they? Medical providers (and even individual care givers) have similar incentive structures to raise rates since they are paid only by insurance.
The last local obstetricians were pushed into hospitals and large groups by insurance companies paying them 20-40% of prevailing fees. They now make more per procedure and don't have to pay for facilities or do billing. Why would the insurance company pay so much less? Because once the cartel is created their profit (and pricing) will double.
That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.
>>>>>That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.
Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995.
Yes, they have not raised rates...despite inflation
That's true profit healthcare.
What we have is a monster hybrid between government healthcare and subsidized, monopoly care
Unfortunately no one is lobbying for a truly free market in healthcare. For instance, at all the supply-side restrictions on new physicians and hospitals. Limited residency spots, certificates of need whatever.
Ideally the party in opposition to government-funded healthcare would do this.
>Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995.
This portion of the linked article seems to contradict your claim of "has not raised the rates for any of their services since 1995"
>Had the pathology fees that apply to the examination of breast masses not increased, our price would be the same now as it was in 1997, but alas it is now $2,365. Only three other fees have increased since we began quoting them over the phone in 1997.
That said, I'll admit that the claim is broadly true.
That is not really how the modern medical insurance business works. Most group buyers such as employers are now self insured. The medical "insurance" companies no longer bear much risk, they merely administer claims and manage provider networks. This business is intensely competitive with low profit margins. Insurance companies have to negotiate lower costs in order to sell to their customers, which are primarily employers that buy plans on behalf of their employees.
Costs have continued to rise because provider organizations have been merging in order to gain more market negotiating power. Expensive patented drugs and medical devices also play a major role in driving up costs.
In the US with healthcare tied to either employment or medicare, by the time these costs come around you're likely to either transfer out of this insurance or to the medicare option. Either way, it's someone else's problem (from the perspective of the current insurer).
> This is such a stupid, self-defeating policy for an insurer.
Quick, rank speculation:
100% of obese people don't go on to suffer from 100% of the potential risks of obesity.
Given the actual percentages, it may be cheaper for the insurance company to pay for (and, at least in part, deny!) actual treatment for those potential risks than to cover the vast majority of preventative doctor visits and labs.
Additional rank speculation-- I wonder if that problem gets worse as obesity numbers rise. E.g., symptom A necessitates a test for condition X, but symptom A plus obesity necessitates tests for condition X, Y, and Z...
I'd be willing to bet that GP had a high deductible health plan. They leave you on the hook for 100% of your healthcare costs until you reach your deductible, unless your care is on a narrow list of things that they consider "preventable care." By insurer logic obesity is almost certainly an existing condition, even though treating it can prevent future healthcare complications. HDHP's are pretty perverse IMO.
Bariatric procedures can be included as a sort of "rider". This is typically written into self funded plans. Bariatric is not an essential coverage therefore ACA qualified plans do not typically include them - unless medically necessary.
I don’t know, looking at the percentages… I’m not sure preventative care for obese people is sustainable at this point.
Not that I shed tears for insurance companies, but I think this would be a lot of money. Now… the problem should have been addressed twenty years ago before it went critical.
> Until your problem costs us a lot, don't you dare try to mitigate it on our dime!
I assume gp meant bariatric surgeries by 'weight loss procedure'. These are not just cost considerations , they come with significant risks and long term side effects. They aren't get out jail free card to be handed out like candy and isn't a 'preventive care' for obesity related diseases.
No. I was literally charged full price just for consulting with my family doctor about my weight. The doctor at the time referred me to a nutritionist; the nutritionist coverage was further denied because I had no qualifying health conditions. There was another option for weight loss medication, not the kind that affects hormones but makes the stomach feel full. These were also denied because I was just fat, not diabetic, heart problem, etc.
yea you might be one of those 'overweight but metabolically healthy' people. Despite the common misconception, you can infact live a healthy life even you are overweight if you are metabolically healthy ( ie. no insulin resistance)
Metabolic health is not the only type of issue overweight people face.
I suspect the real issue is that there are no universally proven ways to reduce weight that have high success rates of adherence - for example, this is why CPAP and insurance is really tricky... too many people wear them for a bit then stop using them, wasting thousands of dollars (between the sleep study and the equipment itself).
Perhaps they are, perhaps they aren't. But it seems to me that the way to figure out whether they are or are not is by taking the very reasonable step that they took: a visit to their GP (and including following the doctor's referral to a nutritionist).
The number one problem is that a visit with a discussion costs $250 which is absolutely ridiculous, obscenely expensive.
Healthcare insists on the very best, most expensive in gauzes and then when they can’t afford them they let people die, instead of using cheaper gauzes which are just fine and have been used for years.
Doesn't matter. I asked how significantly overweight I had to be to have access and the insurance company told me there's no weight-- it's purely obesity related health condition only. Theoretically also I could be 10 lbs overweight and diabetic and get a fast track to ozempic, lol.
At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.
The most serious health effects tend to come not from absolute weight per se, but from excessive body fat percentage. And particularly from visceral (intra-abdominal) fat, which is far more dangerous than subcutaneous fat in terms of risk for conditions like type-2 diabetes, arteriosclerosis, and COVID-19.
The excess adipose tissue causes subtle, progressive damage which won't necessarily be obvious in the regular preventative screening exams that most younger patients receive. But as some point after age 50 or so the systems decompensate and the patient's overall health deteriorates rapidly.
No, that's not the case for many insurance companies. My insurance company only qualified surgery if you had a qualifying health condition. If you were just obese you didn't qualify.
I am obese, I have been fighting my weight nearly my entire life. At one point I did manage to get down to a "normal" weight and body fat percentage, but it took more than 7 years of concerted disciplined effort to do so, and it disappeared in less than 6 months by no longer eating as a significant calorie deficit, despite a massive increase in physical activity. For many obese people, for reasons we don't fully understand, our metabolism does not work the same as for people who are not obese.
The first time we've had any sort of medical intervention that seems to actually address this is the invention of GLP1 agonists and similar medications. Most insurance providers REFUSE to provide coverage for these medications, even though they are a net positive for the patient and society. Taking a GLP1 agonist while obese can straight-out /prevent/ the development of Type 2 Diabetes, even while you are still obese, and can cure some people of Type 2 Diabetes while they are ungoing further treatment.
I am very lucky in that my insurance does cover this treatment. The insurance of several of my friends (who are on ostensibly "better" plans because their premiums are more heavily covered by their employers) does not cover this. If I could make one legal change to the healthcare system in the US, it would be to require insurance providers to cover preventative treatments for obesity. Obesity is the primary cause of chronic health problems in the US, and it's nearly entirely preventable with proper care, but it's almost impossible to get that care /even as a tech worker with employer-provided insurance/.
It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. It isn't currently. Lacking this, means that obesity will continue to be a social disease that drives up healthcare costs and drives down productivity, quality of life, and total life outcomes in the US.
> I thought it was only approved for diabetes not obesity.
Ozempic and Wegovy are the same substance from the same company, Ozempic is approved for diabetes, Wegovy is approved for obesity. Similar situations apply to other competing GLP1 agonists.
oh yea i think i have some family on wegovy ( or maybe mounjaro now ), hadn't realized that it was approved for obesity.
What i don't understand is that you are saying these are "preventative treatments for obesity" . aren't preventative treatements given before the condition even comes into picture, these drugs are after you get obese so not sure how they are preventative.
Doesn't weight just come back instantly once you stop these drugs. Hard time accepting that solution is putting 200million americans on this drug for rest of their lives.
"Cardiometabolic improvements seen from week 0 to week 68 with semaglutide reverted towards baseline at week 120 for most variables."
I didn't say it prevents obesity, I said it prevents Type 2 Diabetes, which is a chronic disease caused by obesity. And it does. It's nearly a miracle drug.
Yes, if you stop taking the drugs, after a short time you return exactly how you were prior. You must take these drugs for life, unless something else comes out that improves the situation.
Ah I understand now what you meant. I remember looking into while ago( i have like half my extended family on these drugs now lol) but couldn't really find evidence to support this claim.
"There is only limited-quality evidence that at-risk patients taking GLP-1 receptor agonists are less likely to progress to diabetes (number needed to treat [NNT] = 23). Serious adverse events were more likely in patients taking GLP-1 receptor agonists than in patients taking placebo (number needed to harm [NNH] = 42). There is insufficient evidence to evaluate the effect of DPP-4 inhibitors on at-risk patients. There is no evidence that either medication class affects the development of diabetes-associated complications.1"
Hey mate, as a fellow obese (soon to only be overweight) person, I found something that makes a lot of sense to me: the carbohydrate-insulin model of obesity.
The thermodynamic model of calories-in-calories-out doesn't work because we are not a thermodynamic system; it doesn't take into account the hormonal and metabolic changes that occur when calories are chronically restricted.
Have you done a resting metabolic rate test to establish a baseline for total daily energy expenditure?
The GLP-1 drugs can be a net benefit for some patients but they come with serious side effects. In particular most patients lose significant amounts of lean muscle tissue, which is a risk factor for metabolic diseases and sarcopenia.
It's not clear to me that the risk to lean muscle tissue is unique to GLP-1 drugs. The counter point is that the risk exists in practically any severely calorie restricted plan. In other words, the reason why most treatments work is by reducing calories and if you reduce them too fast, any of those treatments will put lean body mass at risk.
When a patient loses weight, some fraction of that will always be lean muscle mass. The issue with GLP-1 drugs is that fraction tends to be higher than with other approaches to weight loss. See the link I posted above for details which should make the risk clear to you.
There are circumstances when those drugs are medically indicated. However, it seems they are being over prescribed without proper consideration of the harmful side effects.
Basically yes, but there are nuances too complex to summarize in a brief comment here. If anyone is considering taking one of those drugs then I highly recommend subscribing to watch the entire video and read the show notes (including the linked scientific papers). There is a subscription fee but the it's a fraction of the price of the drugs and the information is top notch.
Can you link those articles directly? I have access to a lot of journals but it’s more out of curiosity than being a candidate for the drugs.
Edit: from what I could read from Attia’s other posts were studies where the control was a reduced calorie placebo group. However, they weren’t controlled to reduce calories to the same extent as the semaglutide group. This still leaves the question open as to whether the side effects are due mainly to the extent of calorie reduction (which could occur through other treatments) or due to some other mechanism unique to the drug.
This a purely anecdotal opinion but most people overestimate their required calorie intake, and according to my long experience in the fitness world you need to keep your desired weight stable for at least 2 years to reach homeostasis and avoid “rebound”. Increased physical activity has a lot of benefits but it has a mild impact in weight loss. Again, this is solely based in my 20+ years of experience.
> most people overestimate their required calorie intake
It's not something so mechanical as this. For obese people, our /bodies metabolic system/ overestimates our required calorie intake and causes us to feel the pangs of hunger far past when we've consumed a sufficient amount of calories. It's not a conscious choice to overeat, nor is it something that takes effort to do. I ate like a normal person while traveling around the world, walking 10 to 15 miles per day, and going to the gym 3 times a week for an hour, and I still gained back 40 pounds over the course of 18 months (nearly 20 of it in the first 6 months) after going off a monitored, strict calorie restrictive diet.
My actual daily caloric intake need was around 1200 kcals, exceeding this isn't hard to do, and keeping to it was a daily struggle that wasn't possible to maintain while traveling when I could no longer strictly control all the food I ate or even know how many calories it was or what its ingredients were. If I was to guestimate, I'd say I was consuming between 2500-3000 kcals daily while traveling, and this was sufficient to gain almost all of the weight I lost over 7 years back in a matter of months.
This is the reality of being obese. It's not like you choose to be fat, or you choose to over eat, or even that you're over eating to the point of gluttony, it's merely that your metabolism needs far less calories than it believes it needs, so if you simply eat a normal amount when you are hungry, you will be fat, guaranteed.
The reason GLP1 agonists work so well is that they actually change how your body's metabolism reacts, and make it so you no longer feel hungry constantly. In fact, you have to force yourself to eat sometimes or you'll end up having the effects on not eating often enough. While taking a GLP1 agonist, reducing or maintaining weight is not the same struggle as it is without medical intervention.
I counted calories and religiously recorded all of my physical activity and food and water intakes using very technological means tied into MyFitnessPal for almost a decade. It was not for lack of effort, dedication, or knowledge that I gained back weight or realized that I was not going to succeed for a lifetime without medical intervention. It's simply not possible to rationally fight your base biological impulses when they are fall into your body's basic survival mechanisms. I effectively "tortured" myself psychologically for almost a decade, and the net result was the moment I stopped I gained all the weight back. GLP1 agonists are basically miraculous.
If we are at "swapping anecdotes and wild speculation", getting the right medical diagnosis and improving my nutritional status caused me to unintentionally drop multiple dress sizes.
My hypothesis: Obese people are unknowingly malnourished and keep eating because they still need nutrients they aren't getting.
Maybe not just crazy talk given how nutritional value of produce has gone down in recent decades.
This is true and not really relevant to the point that people who can't afford healthcare get very sick before they go to a doctor and then their care is more expensive and has worse outcomes.
One hospital was having so many resources consumed by a relatively small number of very ill homeless people and concluded that housing them would be cheaper and more effective, so it did.
Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions.
> Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions.
Exactly.
Whole hospital floors are completely dedicated to patients with completely preventable diseases with proper lifestyle choices (uncontrolled type-II diabetes, most cardiac and vascular surgeries...). What these people needed a decade or two ago was someone to coach them/engage in a long term discussion about their labs and deteriorating health with them.
I can't help to think that defining healthcare exclusively as medical care is an attempt at further gatekeeping from a profession already known for these practices... I mean, what brings in more dollars for the provider, a series of hospitalizations and vascular surgeries or a few hours of consulting and coaching?
> I was under the impression that USA healthcare has out of control costs due chronic diseases.
It's an incorrect impression. All health care systems have to deal with chronic diseases. Americans are fat, through they aren't twice as fat as other people, and the UK and Greece are nearly as fat in Europe. US health care costs are out of control because the system is kleptocratic.
> What can any healthcare system possibly do about that.
Its damned job. The healthcare system doesn't get to complain about the existence of sick people, even if people eugenically think that some illness are less deserving than others.
For me, my ability to stick to a diet was predicated on my ADHD being properly medicated. I never reached the "obese" category, mostly because ADHD seemingly doesn't prevent me from sticking to an exercise plan, but I was in the "overweight" for most of my 20s because I wasn't able to focus consistently enough to effectively count calories.
Many people can't stick to a diet or exercise plan because they haven't been treated for a related problem. For example, many people can't effectively exercise due to joint pain which could be alleviated by physical therapy which is frequently denied by health insurance.
Additionally, the "healthcare system" includes stuff like nutritional and exercise education, public gyms, etc., all of which are woefully underfunded in the US. Worse, the programs which do exist have been heavily influenced by lobbyists (lobbyist influence on the Food Pyramid, for example, is well-documented). The corporate right to lie in advertising also means that much education is undermined by straight up lies in ads.
People who do vigorous sport can turn into complete couch potatoes once they are too old to practice that sport. Difficult concept for you to get, perhaps? Hint: being “healthy” wasn’t the point; it was the excitement, the adrenaline… etc.
"Federally qualified health centers" (FQHC) are required to treat people regardless of ability to pay, and are able to provide preventive care to non-citizens. A list of such health centers is available here, and there are quite a number in Houston (where the subject of the article is based):
Whether would-be patients are sufficiently informed of this opportunity is another question, but resources for preventive care are not completely unavailable to these folks.
> Like only counting dollars is a bad way to run a society.
Absolutely. But one measure everyone understands is money, and you can convert a lot of situations into money.
Poor health = missed work, missed rent payments, drugs needed etc.
It’s not a nice measure, but it works.
I think one of the points of this entire thread has been to make it clear that "it works" only applies to people who have money, which means of course that it doesn't work.
I live in New Zealand, and we have a healthcare system that’s free to use (YMMV). It’s creaking, but the situation in the US really doesn’t seem to suit anyone, nor even the rich.
New Zealand is incredibly beautiful, I just wish I could go back. The US healthcare system suits the rich quite well. The companies that the rich people work for tend to offer significantly better plans that cover a lot of what you hear a bunch of people complain about. High earners and C-suite execs typically get offered a different plan then the rest of the proletariat do. They can cover the out of pocket costs just fine, and cover the elective procedures themselves. They generally have access to better doctors as well just based on location, flexibility with working hours, plans that will pay for them, and/or it being easier to handle the out of pocket costs.
Universal healthcare actually means a downgrade in the experience for these people, which is one of the reasons why they don't want it. Yea, they might want to make sure that people don't get sent to the poor house just because they came down with some random disease, but god forbid they have to wait their turn behind some plebe in the doctors office.
> Universal healthcare actually means a downgrade in the experience for these people
But it also means a much higher cost. I know these people are wealthy, but they are getting fleeced. Many (all?) socialised systems also have a private system along side, so the wealthy can avoid the great unwashed.
It is because it’s not a cost of the policy, it’s a benefit. You can reframe any benefit of a policy as the “cost” of not doing the policy. In practice it’s just a right-brain advocacy-speak way to double count the benefit in the equation: “people will be healthier, and it will reduce costs.” That’s not a good way for intelligent people to communicate.
I suppose if I had written a longer comment I might have gone on about how lots of times advocates choose bad positions (so like here, the trope is trying to argue that preventative care reduces medical costs when there's a better position arguing that the benefits of preventative care outweigh the costs).
It's not really very interesting to discuss the bad position at any length, except maybe as a launching point into some more interesting adjacent discussion.
If you watch what you eat, avoid obesity and some of the practices that lead to heart disease, and if you can moderately exercise you can avoid expensive health procedures. I don't even think that's debatable...
None of what you just described is preventative care from a doctor. Everyone knows about exercise and junk food that doesn’t mean someone will chose to do or not to do those things.
This is simply not true, to a significant degree, as people age into and past middle age. (And even that is ignoring that accidents happen to healthy people of all ages. Eating well and exercising don't eliminate the need for expensive medical care after being in a serious car accident.)
Insurance companies (in the US) prefer rising costs, because they get a flat 8% (or whatever) of what costs are. If they reduce consumer costs, they also have to reduce their revenue and profit.
I'm not convinced that the way insurance works in the US explains rising costs here, because costs in most of the rest of the first world such as the EU and Japan have been rising about as fast as costs in the US for at least at least the last 50ish years.
We pay a lot more per capita than any of those other places, but the ratio of what we pay per capita to what a given other first world country pays per capita has been pretty steady long term.
From what I have read preventative medicine has been tried as a cost saving measure and it only seems to reduce costs in dentistry, immunization, and a few other fairly narrow areas.
“Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.” https://pubmed.ncbi.nlm.nih.gov/22052182/
Yes, this is the absurd part of the fat-hate movement, "you're wasting my insurance/tax dollars!" actually no fat people tend to die early, and US healthcare spending is absurdly weighted towards end-of-life care for terminal patients, something like 50-70% of your total life spending comes in the last 18 months of your life. Someone quietly dying at 50 of heart disease is really cheap compared to the person spending 10 years fighting lung cancer at 70.
Not that it should really matter, if the goal is to "get them healthy", right? But it's not, it's about having someone to hate and look down on. Black Mirror nailed this vibe perfectly in Ten Million Merits.
Anyway this is a specific problem with the US healthcare system though - we spend way too much on patients who are circling the drain and everyone else gets screwed. Broken bones and bad dentistry and missed immunizations are what produces the single largest improvement in health outcomes - Cuba really only has something like a 7-year reduced lifespan vs the US iirc, because they do well at delivering that basic care even if you're not going there for proton radiotherapy or other ultra-high-end treatments. And the US does the latter but sucks at the former.
I don't think there's a fat-hate "movement" tbh. I think it's always been popular to make fun of fat people. Harry Potter and the Philosopher's Stone had a fat child be described as neglected, spoiled, and a bully, and therefore it was justified to magically force the child to grow pig parts that had to be surgically moved. Published 1997.
I guess somewhat more recently we have people like Lizzo trying to push back on things like this, but the CDC has recently pushed a recommendation for bariatric surgery on children as young as 14 so. Shrug, I guess.
Growing up elsewhere, the stereotype of fat people was that they are nice and kind. The level of hate was quite surprising to me when I first encountered it.
Your point seems muddled. If the majority of costs come from the last 18 months of care why does it matter if those last months occur at age 50 with heart disease or 70 with cancer? 18 months is 18 months.
Your point seems to rather be that some diseases are cheaper to treat than others, or that the total area under the cost-life curve is driving the cost, not just the last few months.
A. I spoke of other expenses, not merely health care, such as costs, both financial and non financial, of a minor child losing a parent.
B. I have trouble believing this analysis is really looking at the whole picture.
One of the costs of illness that is frequently cited is lost productivity. You are going to tell me that when people live longer, all of them are merely running up more medical bills without also working additional years to help cover those costs?
It is possible, in the current environment, that people’s labor, on average, is not valuable enough relative to the healthcare they might receive.
For example, how many people get coronary heart disease, and how many years of their work would be needed to pay for a bypass or stent or even open heart surgery? I assume these surgeries cost hundreds of thousands of dollars. Plus the ongoing costs after that. Same with effects of diabetes and hypertension, which might as well effect everyone.
Of course, there is liability, patents, licensing costs, etc that can be changed.
If you live long enough, you are practically guaranteed to end up with cancer (say, past age 80).
On the other hand, if you drink and drive while young and healthy, you can helpfully donate your organs to someone with a terrible condition and they can run up potentially a few million dollars in health care.
It doesn't have to be that expensive. Hospitals in India manage to do coronary bypass surgery for only $4,300 with good outcomes. I understand that costs and salaries are higher in the US, but still there is a huge amount of waste, fraud, and abuse that could be cut out.
An extremely simplistic analysis would say assuming that conversion factor holds true for all costs, you are “spending” $100,000 dollars of US value when you spend $4300 USD in India.
I hear you, but reducing the incidence of someone's limbs dying because they were not allowed to get follow-up care from emergency surgery, or reducing the incidence of a 40 year old woman with advanced dementia because she didn't get basic treatment for her diabetes - that's worth it.
These folks could be doing other, more productive things with their lives, rather than wasting away in the shadows while we debate the national merit of saving them.
Treatment for diabetes is one of those narrow areas. We know this because private health insurance companies will pay for measures that improve compliance.
A few years back I was hospitalised because of a bite on my arm from one of our cats (long story) and was given heavy doses of multiple antibiotics.
If that hadn't been treated so promptly I might have required surgery or might even have lost my arm (a nurse told me about someone who lost a leg to a cat bite!).
Edit: When I went to the hospital I had no idea how serious it was and turned up to the "Minor Injury Unit" - they had me in A&E and X-rayed within about 10 minutes!
Edit: Of course, having been in the hospital for 3 days rather than the expected hour or so I was fretting about car parking charges - turns out they are free at the point of parking....
Preventative medicine is that which is done before significant symptoms. The basic issue, people tend to heal from most things. So the worst case of losing an arm to a cat bite is extremely unlikely. Meanwhile your hospital trip had an cost.
Suppose the odds work out to 1:100,000 lost arm vs 300$ hospital treatment. Now a lost arm is expensive but it’s not 30 million dollars expensive.
Those numbers aren’t based on anything but that’s the kinds of calculations involved. And as I mentioned the winners seem to be extremely cheap options like vacations.
Civilization has multiple goals. That may be one valid use for it but it is not the only one. For example, I might say that money is for feeding hungry children
I'll be honest, I'm really struggling to understand what you're trying to say here.
It sounds like you're saying these are Universal truths, but I certainly don't think they are.
I don't think the goal of civilization is to fight entropy or Foster evolution, or prolong lifespan. I also don't think most people would agree with that.
I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?
Well, my original point was just that increased longevity and caring for our sick and elderly are, anthropologically speaking, what separated us from the primates and hominids, eh?
In re: the (sole, underlying) purpose of civilization, well, do you believe in evolution? I don't mean that in a snarky or combative way. I do, and as a corollary to that it seems clear to me that, whatever else is going on, successfully getting into the future, aka "defeating entropy", is as close to a "Universal truth" as you're likely to get, outside of physics. Evolution may have changed form when the human brain, uh, evolved, but the fundamental structure of the situation didn't change: we're still evolving, still trying to find the best way to ensure the future contains humans for the foreseeable, uh, future. Remember, all the other hominid species have gone extinct! We are not guaranteed to succeed, eh?
There's a discussion we could have around around whether caring for the elderly is really the optimum strategy, but I don't think that's really very interesting? I'm spending a significant amount of my person time and resources caring for my elderly mother who has dementia. I could put her in a home, and use the extra time to work more hours, and I would make more money even after paying for her care. I may yet have to do that if she becomes more difficult to care for, so far we have been lucky. Our neighbor's father got dementia and would sometimes try to fight them. Like throw punches and such! Mom's a cheerful sweetheart. I'm very grateful for that.
Anyway, if someone wants to tell me that I'm wasting my time caring for my mom, well, I'd question their sanity.
- - - -
> I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?
Now I'm struggling to understand you. :) The thought experiment is so simple that it doesn't make sense. Do I really sound like someone who would choose the latter option? Can you imagine anyone who would choose the latter option?
Exactly. More people are making more money which is way more important than providing healthcare to those with not-enough-money. Not saying that it should be like this, but it is.
> "My cap is 15 patients in one day," Nuila says. "That's compared to some of my colleagues in the private world, who I've heard admit up to 24 patients in one night, or don't carry a cap."
Learning from my spouse who is a current medical resident -- some attendings admit and discharge more patients than the capacity because their bonuses are tied to that. That is a twisted incentive and it is in conflict with ACGME's guidelines of not letting residents handle more than 10 patients at a time. The attending/hospitalist at my wife's hospital makes $420K/year + bonus (it's near Miami, FL). They work 8-hours shift for 7 days and then rest 7 days. If one chooses to, s/he can moonlight at another place (a senior friend of my wife works for a hospital in Palmdale, CA and another one nearby for 7 days each; she easily bags $600K/year; she is raking in money when she can work this much while buying houses, and she plans to work half as much in a few years).
I also wonder if hospitals like "The People's Hospital" make patients sign waiver to not sue them. At my wife's hospital, some of the patients (and/or their families) are obviously angling for lawsuit and are always looking for excuses to do that. That legal/liability burden (among may other things like doctor's salaries; bloated administration; etc.) is part of the reasons why hospital bills are exorbitant.
That's actually a little bit surprising to me. I have some family friends who are doctors (one's a dermatologist, the other an internist). They each pay somewhere around $50k per year in malpractice insurance premiums. Now sure, in the grand scheme of things, the 50k extra your doctor demands is likely not transformative for health care costs, but I also wouldn't imagine it is nothing.
In a transparent market, the theory of 'reduce costs' -> 'cheaper healthcare' might hold, but the healthcare market is anything but transparent. If my doctor can save money on something, he's not going to pass in on to me in the form of lower costs. Why would he? I don't pay my doctor! Three months after I visit him, I get a bill from my insurer for some co-pay that's a tiny fraction of what the doctor billed them.
I'm assuming the savings were happily eaten by doctors' wages/hospital shareholders/admins/insurers. Meanwhile, the patients got to deal with gems like this[1] doctor.
Healthcare seems to be much like rent in a supply-constrained environment, in that it is doing its best to siphon up all surplus funds sloshing around the economy.
[1] https://www.propublica.org/article/dr-death-christopher-dunt... - the hospitals didn't care that he was butchering his patients, because they get money per surgery performed, not per successful surgery performed. The patients had no recourse, thanks to tort reform. The doctor himself didn't care. He shuffled around from hospital to hospital (who welcomed a rainmaker that brings more business in with open arms), maiming people, until his negligence reached criminal levels.
Did training doctors get any cheaper? If not, then a doctor will try their hardest to get out of debt as soon as possible. Just think, their friends who aren't doctors already have a house by the time they graduate with a few hundred thousand in debt and no house to show for it.
You want cheaper healthcare? Make becoming a doctor cheaper.
One interesting point it emphasises is just how important insurance coverage is for survival. And that government insurance processes can be rather arbitrary or even injust.
I hope this book is successful and that it makes a change towards more equitable healthcare in the United States.
We don't need them to. 62% of hospitals in the US are non-profit, and an additional 20% are run by the government. Only 18% are for-profit. In some states, like New York and Minnesota, there are no for-profit hospitals.
The funding for my entire Canadian province for all healthcare; two main hospitals, two small hospitals, a dozen clinics, a few nursing homes for one year is $850 million. So that single US hospital takes in over 7X more than we get per year to run it all.
Because we don't want them to be bureaucracies that grow and grow without providing increasingly good service.
If you can solve the problem of state agencies becoming insanely inefficient (mostly due to lack of incentive to be efficient, I suppose), you'll make everyone happy.
Super interesting idea. I can't seem to find out how they actually operate though. It seems like this would be prone to general abuse with if an individual electing little/no/catastrophic coverage while also using this resource...or do they ask for W2s to verify eligibility?
This is not how it works in any country on the planet. You do not walk through the door and get unlimited care of all types and for all diseases.
Different countries have different methods for deciding who gets what care, and when they are cut off. You can argue which are better than others, but nowhere is it an all you can consume Buffet
I think what you're trying to say is that there are always limits to what care is available, and that the best possible care is not always provided due to resource constraints.
There are of course always methods for determining who gets care, but at least as far as the UK goes, anyone who is legally resident in the UK can walk into a hospital and get largely the same healthcare as anyone else.
If you're not legally resident in the UK (i.e., you're a visitor or undocumented), you will receive emergency care and primary care without charge, and you will only be charged if you're admitted to hospital. Many countries (including the EU) have arrangements so that their citizens/residents won't be charged even in those circumstances.
Almost every developed country on the planet other than the US has universal healthcare. The notion that you will be cut off because you can't pay is the exception not the rule.
>anyone who is legally resident in the UK can walk into a hospital and get largely the same healthcare as anyone else
This is true in the US too. Hospitals don't just refuse care unless they consider you "well enough" which unfortunately happens sometimes but its not per policy. Same thing in the UK though...
I know a guy who's next door neighbor's dad died because he couldn't get an ambulance or basically any "urgent care."
Didn't have a car and they refused to send an ambulance for some reason. They called the police to try to get them to help but they were too late. I don't know the details but he was fuming mad about it.
> There are of course always methods for determining who gets care, but at least as far as the UK goes, anyone who is legally resident in the UK can walk into a hospital and get largely the same healthcare as anyone else.
They are allowed the privilege of a multi-year waiting list for basic procedures (unless they happen to be high enough socially to rub elbows with doctors.)
My point was that the differences are more nuanced than presented.
Most developed countries on the planet including the UK also have private insurance, which serves to give you different Healthcare options then what is covered by their socialized medicine systems.
Anyone in the United States can walk into an emergency room and will not be denied treatment based on their lack of insurance.
I'm not trying to argue that the US system is better, but point out that it is often compared to an idealized and imaginary European system that does not exist.
Some people loudly Proclaim that citizens are entitled to any Healthcare they might need or want like in Europe.
I guess that's why Canadian to US medical tourism is skyrocketing and growing at more than 50% a year, because as you say non-US free healthcare systems provide care on demand.
The question is, why is the Canadian system crumbling so badly that patients flee to the US if it's so perfect?
There's two big problems with the Canadian system. The first is brain drain; doctors can make way more money in the US. The other is politics. Slashing taxes is a short-term political win, even if it has disastrous long-term consequences.
The Canadian system is far from perfect. But nobody can match the waste in the US system.
If the US system was so bad, you would not be seeing rising amounts of medical tourism to the country. Generally, when systems are bad, people flee it by any means necessary.
Canadians come to the US because Canadian healthcare quality is garbage, or simply non-existent. Yeah, it's free, but have a rare or advanced cancer and you're on your own. The US has probably the best cancer treatment options in the entire world. It's not free, it's not perfect, but it's available.
Canadian, European and other countries love to dunk on US healthcare by posting misleading information and pictures (omg look a $100,000 bill! [insurance pays it all]). Meanwhile, Canadian and Europe have death panels, 24 month waiting lists, no right to try experimental treatment, predatory euthanasia (18 year old has depression? sign here for suicide) and other atrocities.
And a third, also giving #1 to Canada, and excluding the US from the top sixteen. Or, on clicking through to the full report, any of the 46-listed nations. <https://www.medicaltourism.com/mti/home>
Leadership in the US should be deeply ashamed that such things even exist. Unfortunately there is nothing in sight that would change this anytime soon. Obamacare was screwed up, Medicare For All seems a no-go (Biden should be ashamed for not embracing it), and Congress probably will be busy in the next few years investigating and impeaching each other while not doing anything productive.
And Biden lost me when the train people were on strike. The whole concept of limited sick leave is already ridiculous but their situation was just crazy.
The COVID response not including Medicare4All is the “Sandy Hook” of healthcare for me: if we didn’t do it with a Democratic Congress and President during a national pandemic, it’s not happening any time soon (like meaningful gun control post-Sandy Hook).
It's important to remember who is represented in the US political system. It is a federation of states, whose legislative districts have been heavily gerrymandered.
As POTUS he can choose to not suspend the ability of rail workers to strike and let the workers and rail companies sort it out. That whole capitalism thing?
Instead he has used his powers to prevent a rail strike since it would increase the cost of groceries and lead to (short term) grocery shortages.
This comment is strange since you seem to live in the EU [1] where healthcare is, reluctantly and depending on each member state's policy, extended to everyone. The EU faces both demographic and labour force problems which can be remediated by immigration. In that respect, investing in a healthy work force seems preferable to the purge you seem to be proposing.
Not only that but you have to validate the ID too. You know these illegal immigrants use Fake IDs, so you better be sure. If they can't procure an ID, it's better to let a fellow citizen die than take the risk of rescuing an illegal immigrant.
You remind me of a comedian I saw years ago say something like "All those illegal immigrants here to take our jobs. I always wanted to be an underpaid farmhand but, no, the illegal immigrants took all those jobs."
Since Brexit (and compounded by the pandemic), here in the UK a lot of industries turned to shit because it turns out that 1) the Brits don't actually want those low-paid jobs and 2) immigrants (whether outright illegal or "legal" under EU rules) were critical to a lot of those industries' proper functioning.
I'm talking about hospitality, transportation (Uber/etc), basically anything that relies on unskilled labor.
Most people do not understand that raising the prices of these "basic" workers will make these jobs higher paid (for sure) but will also reduce the opportunity (or the size) of the market. If you had 4.000 Uber eats bikers with illegals, then you'd only have 400 without. On the other hand, the 90% of the population (that used the remaining 3.600 bikers) no longer can afford the "Uber Eats" and will no longer have that luxury.
Now imagine that for almost everything, and there you have inflation for basic goods.
Fascism in this century is a very real and growing problem. We all have some measure of responsibility to actively reject it and those who advocate for it. Remember: tolerance is a peace treaty, not a moral precept. Treaties only protect parties who abide by their terms.
By that logic people who attempt to maliciously deprive other human beings of life-saving treatment deserve no better than the same conditions they would have others suffer through.
A free alternative can only drag the prices down of the privatized sector. I wonder if they will go down kicking and screaming, and that this freer alternative will be allowed to thrive.
No, the SV model would be to treat you for free until you have some chronic condition that locks you in, at which point, they pull the "free" rug, and take you for every spare penny (and sometimes more).
This is the worst of both worlds - those who could pay would just go to a private hospital (and pay for the best they can get). This just leaves those who can't pay at the public hospital, incurring the cost and the burden onto the few existing payers.
I think people completely miss the point that this further enables a caste system in the US. You have an entire class of people who have almost no rights who live and work in this country. Any politician that makes it easier for illegal immigrants to survive in this country is NOT doing it out of the goodness of their heart. It's a calculated move to further abuse a class of people who can be completely abused without recourse.
Does no one stop to wonder why the government is actively hindering border states from enforcing their international borders after 20+ years of a war on terrorism? Why are these people coming to the US in such high numbers now full-well knowing they will be abused here? Look up the School of the Americas and who their list of graduates include.
Ye olde "the horse was lost because the horseshoe was lost because a nail was lost" principle. It's not just that someone has an advanced illness, if they die and now their kid needs additional resources from the welfare system, the rest of us are paying for it.
According to this piece, under EMTALA -- he Emergency Medical Treatment & Labor Act passed in the 1980s -- it's not illegal to treat undocumented immigrants.