Hacker News Reader

Specialty doctors making a lot of money isn't the issue here.

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.

It is absolutely insane and drives the cost up.

It's all relative. Many people think what developers get paid is insane. After all, it's just typing things into a computer. And you don't even need 10 years of schooling to do it. Some didn't even finish high school.

> Healthcare in the US is completely broken.

> 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 actually wrote a paper on the US healthcare some time ago.

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.

> I didn't look at Taiwan but looked at European nations. US outcomes were poorer and the care was more expensive.

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."

Agreed. But there is also a Medicare funded residency bottleneck that we also have to take care of.

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?

Why do people keep voting republican?

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.

> So why do people keep voting democrat?

What’s the alternative in your mind?

Third party like Yang is doing or abandon this broken system altogether and form a new government as the founders had suggested. But there are way too many political and business interests that want to keep the status quo.

Both of those are fairly gargantuan lifts. I can see where you’re going, but I don’t think it’s realistically a choice between “vote Democrat” or “form a new party/government”. Most of the work for the latter has nothing to do with voting per se, rather it would require a significant amount of infrastructure to be built up. Voting is more of a final act after a series of significant movements.

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.