The U.S. Health Care System Isn’t Built for Primary Care
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Healthcare in the US is completely broken. Primary doctors do not have an incentive to produce good results. They are being squeezed by the corporate overlords and insurance companies to do bare minimum with patients. Each hospital network has their own medical records software. The care is extremely fragmented.
Records need to be centralized. Primary care physicians should be required to spend more time with patients and not be punished for it. If issue is difficult they should be allowed time for research, but that doesn't make money....seeing patients does.
In the end, get rid of the middle man, the insurance companies. Quit paying specialty doctors $600k, and offer free education. I would love to go into medicine to help people, but I'm not going to go into debt, grind for free doing insane hours and hope to get a decent job in the end. If I could get a free medical degree and a salary of around $150k I would do it in a heartbeat. Current healthcare is so commercialized it is disgusting.
I have a family member with a terrible back who has had multiple neuro-spinal surgeries.
There's about ~250 doctors in the entire country trained on that family member's procedure and generally speaking, they're earning well over that arbitrary $600k that you have picked. There's no reason that they shouldn't.
Quite a lot of the neurosurgeons etc. I interact with make well above that and they should. It's 4 years of medical school, plus sometimes over a decade of residency and fellowships to get to their level of expertise.
> Primary care physicians should be required to spend more time with patients and not be punished for it. If issue is difficult they should be allowed time for research, but that doesn't make money....seeing patients does.
Healthcare in the US is not perfect but I often wonder about comments like yours.
I'm an expat and have had to use the medical systems in a number of countries and the idea that Americans are being short-changed in terms of doctor time is curious to me.
Instead of giving you some horrible examples of truly broken healthcare systems, let's take the country I'm currently a resident of, Taiwan. It has a single payer system that's well-regarded. As a resident, I am a part of this system and have had to use it more in the past year than I would have liked.
The system is very cheap compared to the US and efficient. It's structured in a way that gives patients a lot of choice. I can see a doctor at a clinic (for a few bucks) or I can go to a hospital and see a physician of my choice (even a specialist) for no more than around $20 USD.
But primary care doctors here see way more patients on a daily basis than doctors in the US do. Go to a hospital during peak hours and it's not uncommon to find the halls packed with people waiting to be seen. Doctors can easily see upwards of 50 patients in a half-day rotation.
I've never had a basic internal medicine appointment here last more than 5 minutes. Even with a specialist, I've never had an appointment here go beyond 10 minutes. From what I've seen among friends, quick prescription writing is common with a lot of head scratchers, namely antibiotics for suspected viral (cold and flu) infections.
In the US, my primary care appointments are rarely shorter than 10 minutes, and I've had appointments with specialists last upwards of 30-45 minutes. Additionally, many health systems in the US let you email your doctor, which provides the opportunity for correspondence and research, something that I've never seen available in Taiwan. I've also never been prescribed antibiotics in the US for cold or flu symptoms.
I didn't look at Taiwan but looked at European nations. US outcomes were poorer and the care was more expensive.
I don't know any other first world nation, where managing medical bills can take this much time. After we had a child, I spend 40 hours on a phone trying to untangle insurance mix up made by the hospital.
I have an EU citizenship and did use healthcare in Poland. While imperfect my parents were never worried about cost. People in US do not seek care to avoid spending money, which drives the cost even higher.
I could go on and on, and maybe I can dig up the paper. Make some updates and make a post about it.
But that's very different from the statement than "healthcare in the US is completely broken" and the suggestion that patients in the US are being short-changed when it comes to time with primary care physicians.
Even if European nations have better outcomes at lower cost wouldn't inherently mean that US healthcare is "completely broken."
> I don't know any other first world nation, where managing medical bills can take this much time.
When I was in the US, I was a member of one of the largest HMOs. I never had any issues with medical bills. Of course, HMOs are very different than PPOs, but that too makes me question the "healthcare in the US is completely broken" sentiment.
I think a less hyperbolic and more accurate statement would be "healthcare in the US is big and complex and one's experience and outcomes can vary greatly based on a wide range of factors."
We could accept doctors from other parts of the world to do residencies here but imo Che fear would then be that doctors get paid less, and the system is against that and wants to keep it broken. We could also make healthcare education free to the student, but only pay in the 150-250 range much lower than current 600-1.2MM range.
This is one thing that most democrats and republicans don’t want to fix. Biden has explicitly came out against single payer universal healthcare as that would go way against what the corporations want.
So why do people keep voting democrat?
It isn't the parties that are the issue. It is the money in politics. You could go back 100 years and find both parties passing laws and marketing them as beneficial...but in reality they benefited big business. Corporate overlords expect return on their investment.
What’s the alternative in your mind?
Hence my skepticism of people complaining about people just voting for democrats. It seems like you don’t appreciate the gap between your preferences and the current structures.
I've thought a bit about this, and really, I don't see any reason why it has to be a physician that does these things. Why can't we change the law to allow an RN or some other qualified but cheaper medical practitioner to write adderall scripts? Why do we need someone who went to 8 years of higher ed and several years of residency to do that?
It reminds me of eyeglasses in the UK. Prior to 1984, you had to get them through a licensed ophthalmologist. As a result, it was quite a process and expensive to get a pair of them. Then in 1984, it was deregulated and now you can go to SpecSavers and get a pair of eyeglasses for cheap. There was no reason that a licensed and well paid ophthalmologist had to gatekeep it.