Hi Veeky Forums please tell me about the American medical system

Fuzzy_Logic
Fuzzy_Logic

Hi Veeky Forums please tell me about the American medical system. Why is it so ineffectual and expensive? What could be theoretically done to mend this?
References, resources, and politically-charged discussion welcome.

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https://www.youtube.com/watch?v=lOKbMW2uqs8
https://www.youtube.com/watch?v=bQnYY7_iF_o
Nude_Bikergirl
Nude_Bikergirl

@Fuzzy_Logic

https://www.youtube.com/watch?v=lOKbMW2uqs8

Lord_Tryzalot
Lord_Tryzalot

@Fuzzy_Logic
ineffectual
nice fuckin made up word faggot, did you go to harvard?

Boy_vs_Girl
Boy_vs_Girl

Hospital administrators are turbojews

girlDog
girlDog

@Lord_Tryzalot
Maybe not, but you certainly dropped out of public school

Playboyize
Playboyize

@Fuzzy_Logic
ineffectual

They have the best hospitals in the world.

expensive

They have a weird insurance payment schemes where hospitals inflate costs then discount them by some insane %.

Methshot
Methshot

@Playboyize
So they give a discount to the insurance company and up charge the patient?

Emberburn
Emberburn

@Methshot

No, not at all.

A good insurance plan will cover almost all costs, patients don't usually pay very much at all.

The US expensive healthcare meme is so tired, people only get fucked over if they have a terrible plan or if they don't have insurance at all.

TurtleCat
TurtleCat

@Emberburn
So then the inflated prices could be thought of as incentives to have insurance, leading to a sort of socialized healthcare system?
What about the whole medication industry? That's what I was referring to as ineffectual.
Don't medications get produced and marketed on the sole basis that they'll produce more in profit then what's lost through lawsuits when they kill people? Isn't that unethical?

StonedTime
StonedTime

@Fuzzy_Logic

cyborg enhancements ain't cheap.

DeathDog
DeathDog

@TurtleCat

Hospitals make a shitton of money by overcharging insurance companies, patients *very* rarely end up footing major costs if they have a good insurance plan.

Don't medications get produced and marketed on the sole basis that they'll produce more in profit then what's lost through lawsuits when they kill people?

No.

PurpleCharger
PurpleCharger

@StonedTime
He fell for the cyborg meme
@DeathDog
Then what's the deal with new medications coming out so often, then getting recalled? What's the deal with all the side-effects?

StrangeWizard
StrangeWizard

@PurpleCharger

new medication comes out
supposed to be more effective, more cost-efficient, more competitive, etc
unforeseen complications happen
it gets recalled

Pharma companies spend TONS of money on R&D for new medication, they wouldn't purposefully put out something harmful if they could just put out something effective that wouldn't be recalled and make them much more money in the long run.

whereismyname
whereismyname

I took a Medical Sociology class and a big chunk of my family works in medicine. I'll try to explain both sides.

The Sociology text was largely in favor of top down management of capital expenditures. They were saying that doctors have a monopoly over patient spending. If left to their own devices, individual doctors do not have the bargaining power over big pharma, and in canada and UK the price setting is done by some state purchasing board. and drops the price due to bulk purchases.

Author also claimed Capital Mismanagement. The story was all 3 hospitals in the area buys an MRI machine at full price, so they can all claim they have most modern care. But these MRI's only serve 1/3 the population they were designed. In order to pay for the machines the hospitals all charge that extra 66%. Where as a properly managed network would only have one MRI that all the other hospitals sent the patients to.

Family has been in medicine for multiple generations. So they've got a few stories. The guy that sold the practice to my family, would tell stories of the little old lady whose clothes were basically rotting off her, and the doc took pity, and would say for the 2k procedure. Ethel $500 the procedure aint cheap, but you'll get the best care. and to Cousin Clarence who was well off and asking for a deal, he'd say normally the procedure is $4k but you're friends and family discount makes it $3500 you're getting a stupendous deal. And that was the way Doctors made ends meet.

Quality of care was a rampant issue however and Insurance with its Actuarial Science took over. They created cost plans and have really added a great deal of analysis to the system. They hired the "best" doctors to pick and choose the most effective medications and create the demand for those meds, via payout rules. The whole Generic works just as good argument, price as placebo, and general ignorance.
Look at the corrupt system in china and you'll see this with doc bribing.

kizzmybutt
kizzmybutt

@whereismyname
Okay so part of the problem is that hospitals can't work together to get patients from hospital(1) to use the equipment at hospital(2) that was put there for hospital(1,2,&3)?
And on the low-level, doctors set prices based on bargaining? wow
They hired the "best" doctors to pick and choose the most effective medications
How should medications be selected?
@StrangeWizard
Shouldn't the overall increased cost of keeping an individual healthy be factored into the equation of whether or not a medication should go to market, based on its potential long-term side effects? I had a teacher, who worked in the industry, who said medications go to market based on whether they'll churn more profit from the cost of lawsuits. So that aligns with what you said.
Pharma companies spend TONS of money on R&D for new medication
They know they're going to spend that money if their medication screws too many people up, so they're still producing potentially harmful medication based on projected profit minus the projected lawsuit cost.
Do you think it should be this way, or should the potential overall increased healthcare cost of fixing the issues those medications will likely cause be factored into the decision to produce a given medication?

BlogWobbles
BlogWobbles

@whereismyname
Chinese Patients walk out with bags of the most expensive pills that wouldn't kill them and doctors walk away with little red envelopes of cash.
Its an example of an insurance system that doesn't adequately pay the real costs.

The US is a little different. We still barely cover administrative overhead. The insurance companies have combated payouts with bureaucracy there is not a whole new job called the medical Coder. whose job is to tick the boxes on the insurance paperwork for everything that could be construed legally as a payout, Without an expensive legal paperwork battle. So a person comes in with the symptom. Hospital bureaucracy have been playing the actuary game right back at the insurance companies and they take statistics on what the companies payout for and there is a constant pissing match between the two over who covers what and when its needed.

There is loss in the system because of patients who simply cannot pay. in years prior, they would simply owe the doctors for life and pay a little every month.
However with a 3 party system all parties have to account for the loss and they pass the buck between each other at growing rates. Insurance overcharges patients, Docs overbill insurance b/c they don't pay, and Patients often can't pay for modern medicine b/c of shit wages.
This system has gone full batshit insane and The Obama stepped in to sort it out.
The Now the Governments Lawyers and accountants, Battle it out with the Lawyers and Accountants of Big Mutual, and the Lawyers and accountants of doctors and hospitals to sort them out. Everybody getting their hands greased at 10% of the bill along the way.

It was a bad business made worse with increased overhead.
Today we have doctors who have more accountants than they have nurses.
Nurses are getting a raw deal btw.

The system that was once fairly flat now has increasing tiers with diversified risk among the tiers. Their salaries are being cut to pay for the overhead

BinaryMan
BinaryMan

@BlogWobbles
Holy sh*t that's a mess. Is the Chinese system better then?
Also, did "obamacare" just skyrocket admin costs? or did it reduce admin costs by putting govt in charge?

viagrandad
viagrandad

@BlogWobbles
The jobs that once belong to nurses now belong to PAs and RNs and a host of other slightly more qualified individuals.
So instead of one king with many pawns, you have a full back line and one pawn or many pawns who took a pay cut.

I have met a few Doctors and Nurses who simply can't get paid b/c they overspecialized and insurance priced them right out b/c of rare conditions. One pediatric brain surgeon told me he had a 60k year and said fuck it and started a construction company and only works enough to keep his certs up. Bunch of nurses too, had just had enough. There is only so much human excretion you can deal with for 60-80k per year on top of 12-36 hour shifts depending on specialties.
They're trying to cut pay to 40-50k per year while increasing responsibilities in most places.
Many are simply walking b/c there are significantly easier jobs for that money.

Increasing Litigation is also a thing. Its a growing saying in Medicine, its not an if you'll get sued its a when. With the increasing tiers and mixing of responsibility and Growing Bunching together of Doctors to form Groups, to better fight the system. You'll have a patient who can sue the insurance, of the nurse, PA, Doctor, the other doctors in the Group, The group itself, and possibly the referring hospital. Creating fat checks for lawyers, who can fight a legal battle for years unrelentingly in hopes of a legal costs payout. Its a great investment for them, for the price of stamps, letterhead and certified mail you get a check for an hourly rate of $300.

So the Malpractice Insurance companies have to charge ridiculous rates, which either goes to the patients or the Doctor's bottom line, protip, Its not the Doctor's who know their numbers.

You're seeing more and more Doctor's practicing Concierge medicine, or straight up moving to different countries to avoid the headache altogether. They take cash and let you deal with the insurance companies.

happy_sad
happy_sad

@Fuzzy_Logic
https://www.youtube.com/watch?v=bQnYY7_iF_o

Inmate
Inmate

@happy_sad
you won't make it in this country if you have morals
Nope. If everybody works together to maintain a morally sound system, there's greater overall benefit because of reduced admin and legal.
@viagrandad
Really makes you think what the future of medicine will be when the doctors are leaving and all that's left is lawyers and accountants. Even the patients are going to different countries to get proper treatment. What would fix this? Do we need a hard reset?

kizzmybutt
kizzmybutt

@Fuzzy_Logic
It's expensive because it's for profit and a necessity.

In social systems it's not for profit thus much of the cost is purely break-even, for example a night in a hospital room might cost the government $500 whereas for some reason USA charges $25,000 for the same uncomfortable bed and community college educated nurses.

There is absolutely no reason other than profit of the highest magnitude.

Sharpcharm
Sharpcharm

@kizzmybutt
On to your questions
Okay so part of the problem is that hospitals can't work together to get patients from hospital(1) to use the equipment at hospital(2) that was put there for hospital(1,2,&3)?
Yes and No. Its a question of Competing Needs and Time. You're a Hospital Overseer. You're tasked with 1 saving patients, which requires you to attract the best doctors, and the best patients. Do you want to get cucked and send all your patients to the Hospital with the Gear, thus gaining a reputation as a shitty hospital losing you both good doctors and good patients. b/c if you've got 20 minutes to live who are you gonna choose, hospital 2, which has the gear or H1 which is gonna send you to hospital 2 any way. As a Doctor do you want to work in the Hospital where you're forced to kill people b/c Nancy in the Local Ways and Means Committee says you can't have your life saving machine b/c you only serve 2 Million people and the usage and collection rates don't justify its purchase. BTW Nancy has 0 medical experience whatsoever and is so overburdened with requests that frankly she'll just shred half a pile of paperwork and make you resubmit it b/c if it was really a need you'd be on her ass about it.

And on the low-level, doctors set prices based on bargaining? wow
It used to be that way, today its mostly set by actuarial tables, and accountants, the doctors take away whatever they feel their time away from their families is worth.

@kizzmybutt
medications
This is a clusterfuck. Medical Education is getting shittier and Shittier, and more and more evidence is coming out that says doctors prescribe based on fads and marketing, or whatever pharma rep let him stick it in last. The student loans are not insignificant that a few 1000 extras a month really helps pay those fuckers down. Often trial results are private and behind paywalls.
cost
there are a lot of unknowns. that need to be tested for. but simply will not be tested.

Firespawn
Firespawn

@Sharpcharm
thanks for answering those. This is a lot to think about.

TurtleCat
TurtleCat

@Fuzzy_Logic

Inneffective.

It isn't. All memes aside, the best care, specialists and advances are all in the USA.

expensive
The problems are:
1) insanely greedy insurance companies
2) insanely greedy medical management groups
3) greedy pharma companies
4) The American way of life, American psychology of excess, American belief that medicine can cure any problem caused by lifestyle
5) Collusion between the United States government and the first three groups I mentioned to artificially keep prices high and maintain systems that keep Americans dependent on the healthcare system

And that my friends, is why we have a problem.

JunkTop
JunkTop

@Fuzzy_Logic

One more thing it's critical to take note of:

2/3 of all medical costs within the United States are due to lifestyle. i.e: overeating, no exercise, tobacco and excessive alcohol.

Literally 2/3 of the whole pie is fatties and idiots who smoke 2 packs a day.

I for one don't want to pay for these people. They dug their grave.

girlDog
girlDog

@Sharpcharm
@kizzmybutt
cont.
These pills are going to market with a lot of complete mysteries to their workings. Some pills today we know have minimal side effects but we have no idea how they work, and likely will not for another 100 years.
Human testing has ludicrous hurdles in front of it. I think most pills require 20 years to be said to be fully studied, however. There is huge waste in this system as well. The gov't gives research grants to folks, but the clever ones have figured out how to game the system by the end of their first trial. "Results Inconclusive. Further Study Required" All you have to do is publish one real finding in a journal at the end of 2 years to get re-upped by the govt. So say a researcher mentally notes 20 things that a particular treatment does. He's got 40 years of paychecks lined up and all the lab equipment and hot young researchers he can hire, or two if he says the truth. Which would you pick?
So the very best medications are incentivized to be kept from the market.
Simultaneously,
You have say a mediocre treatment laden with risks. Researchers are paid, based on whether or not the findings come out and the Pharma's can manufacture the infrastructure and demand for these pills. However, these pills malignant effects can be hidden in the numbers and noise, the pill pushed out to consumers rapidly b/c they've got to make a profit before the knowledge becomes widespread.

Administration does hamper progress in many ways, but bad administration is worse and gov't is usually dis-incentivized to doing good work.
Anomalies and whistleblowing are literally ruined by the government bureaucracy. It was usually the dropouts and the rejects who had to go government work in the first place.
It is a failure to think the government is infallible and worthwhile. Especially in something as complex as medical care.
You have talented people trying to convince idiots that they're right. I don't know if you've ever tried this, Its hard.

TalkBomber
TalkBomber

@girlDog
It seems like most people at every level are striving to siphon as much money as they can from the system. How can one discourage this? How does one incentive the greater good? It seems that if everybody at every level were to suddenly start doing their jobs, would the system would rapidly correct itself?

FastChef
FastChef

@girlDog
but we have no idea how they work, and likely will not for another 100 years.
I think that's a vast overestimate. The moment we are able to see exactly what electrons are doing, we'll know how they interact within a molecule. Once we know this, we'll be able to rapidly compute how any given molecule will interact in the human body, thus greatly reducing the research needed for any given medicine.
Labs lagging results for more funding
So in conjunction of this and the above point, I think it's fair to say we may already have technology that can be used to detail electron/chemical interaction, but it hasn't been used because the current system provides more profit and/or the system has military uses which cause it to be a government secret.
Administration does hamper progress in many ways
Advancement in AI may greatly reduce administrative costs, and hopefully curb bureaucracy costs too, soon.
It is a failure to think the government is infallible and worthwhile
Of course it is, but what is the alternative?

Illusionz
Illusionz

MD/PhD here. We're not the ones fucking you, it's the HMOs and Insurance companies working together to basically force you to bet against your own health or risk bankruptcy because you got sick.

Nude_Bikergirl
Nude_Bikergirl

@BinaryMan
China
Its effectively more capitalistic, but when compensation is direct to the doctor. You get a lot of snake oil being bought and sold, and bad shit happening. non-critical rich patient gets bumped ahead of poor critical patient. If the triage system is broken people fucking die. end of story. You can get more what you need, with money as doctors have more leeway. but they also will tell you what you want to hear to get a quick buck. In Eastern Culture, the Fair deal, as a concept doesn't really exist and if you are dumb enough to get conned, than you deserved it.

obamacare
Its a Joke. We won't know the true impact, but most of the important stuff hits this year. So far its not good. Theres a good infographic floating around about the real impact to the american taxpayer. But it wasn't pretty then and it's only going to get worse.
At the practitioner level, I have yet to meet anyone happy about it. The only ones are a few patients who thought they couldn't get insurance before and now they can, on further discussion they just never explored the possibility in the first place and just assumed they were un-insurable and can't quote me rates from before. In the few people who I've talked to b/c its pretty private stuff, People are either equal or worse off.
A good sign that its bullshit, is that practically overnight, in the poor parts of the city, you've got we do Obamacare paperwork offices in half the mini-malls.

@happy_sad
As a rule I don't listen to people who can't do basic math. This guy got every number wrong in his personal quotes. Second, Get a Patreon and move to NYC one of the most expensive cities in the world. Poor people logic.
3rd didn't look up the facts on Skhrelli. Took me 5 minutes. guy raised the price on a rare medication to market price to price in research for better meds, gives it at a discount to most people, and free to anyone with hardship.
4th full entitlement mindset, shooting themselves in the foot.

Booteefool
Booteefool

@TurtleCat
the best care, specialists and advances are all in the USA.
Citation needed

Sir_Gallonhead
Sir_Gallonhead

@Emberburn
people only get fucked over if they have a terrible plan

This is my problem with it. I wouldn't have a problem with the system if people all had decent insurance, but that's not the case. Even people who can afford great insurance sometimes get shit insurance because they're stupid and can get away with it.

I have great insurance, but a lot of people don't.

Inmate
Inmate

@Illusionz
Math student here. I'm not blaming you. I know it's a systematic issue with many people invested in maintaining status quo. The reality is that these issues are killing a lot of people, and hampering the quality of life for many more.
@Nude_Bikergirl
I never bothered to try to understand obamacare. I'm not sure if anybody knows what it actually requires.

DeathDog
DeathDog

@Fuzzy_Logic
I'm not exactly sure why this is the case, but if I had to guess I'd say it's because America hates poor people.

New_Cliche
New_Cliche

@FastChef
agreed. computing is going to make a lot of shit much easier. but medicine is further behind the curb than construction as far as adoption, and ahead of the education gap.

on government, the alternative is more liberty, which comes with the cost of more death and accidents. A flatter system is the only way to really reduce burden like this. You suggest that it will effectively become flatter by speeding up bureaucracy through AI. It may be the case. I believe that frankly if its as you say and we can in-vivo track a prognosis down to the elements, doctors will pretty much be redundant.

Do you have a source for electron tagging tech? I'd like to see that.

@TalkBomber
greed is part and parcel for the world, the other name for it is desire. People will always do things they don't like to exchange them for what they do like. its the economy. Frankly less moving parts always helps reduce the amount of grease in a system. A flatter system would help but at the same time we have more people doing more and more things. The human is far more complex than most things. Most Doctors are already incentivized to save your life. They can't help but help people in need. Large systems have drag, You need to create a very robust and adaptable system. Ultimately, medicine will be fully commoditized. And you'll have a system like 99 designs for doctors where they will compete for a patients commission and most blood tests will be literal pennies and done in every home by the morning home health center appliance.
But fix it today, I'm far from qualified to get the details right. I can broadstroke it, and point out fucked up relationships and situations. I'd need much more data to come close to building an optimal system.

iluvmen
iluvmen

OP creates thread asking a question
So he can give his Bernie tier answer for it
While ignoring everyone telling him he's wrong
None of which has anything to do with Veeky Forums

You are a fag OP.

Inmate
Inmate

@New_Cliche
source for electron tagging tech
It's a personal theory of how we could use "scalar wave" technology or something similar to "remote view" what electrons are doing.
Remote viewing
Ingo Swann came up with a method to cultivate psychic phenomena to view and record details of any place in any point in time.
Scalar technology
Tesla found a waveform that traveled without interacting with matter. When two waves intersect, they make or take energy. I've read that this technology has been engineered to view similar to remote viewing. The "only" problem is that this technology also makes some awesome weapons and missile defense systems, so using it for research outside of some compartmentalized section of the NSA is probably not possible.
So theoretically one could use scalar technology to remote view the inner workings of atoms and molecules. Plug that information into the supercomputers and apply results.

Deadlyinx
Deadlyinx

@iluvmen
No I'm just gathering information.
So he can give his Bernie tier answer for it
I'm priming. I think I know what the general answer has to be, but I'm trying to gauge the situation better as to why things are the way they are...

Supergrass
Supergrass

@Illusionz

TLDR: The best doctors, pharma, devices and advances are all in the USA, but poor people can't afford it because our insurance system and government regs are still fucked.

Sir_Gallonhead
Sir_Gallonhead

@iluvmen
this

Don't like it OP? Move.

Evil_kitten
Evil_kitten

@Supergrass
tldr this for me too

5mileys
5mileys

be me
make this thread
first Veeky Forums thread where I actually have to think deeply
chat with some sky-high IQ anons
I regret nothing

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