Comment by jonhohle | Hacker News Reader

Comment by jonhohle | Hacker News Reader

I’m going through this right now and it feels like everything Americans have complained about socialized healthcare is now true in the US as well: long wait times to see providers, providers that churn through patients like their doing oil changes, providers that just push you along to the next step in a playbook without considering individual needs.

I’ve been dealing with fatigue for about two years and had to preempt a yearly physical to be able to talk to my GP about it in December. That gave me the referral I needed to get a sleep study, which identified moderate apnea. It’s the middle of April and I would have just been getting a provider prescribed auto PAP had it not been for a friend who had an unused one.

Like the author, CPAP is doing nothing for me, so next month the specialist will probably recommend another sleep study, followed by several more months of waiting for appointments and DME providers.

Meanwhile, my wife found that one of the medicines I had been taking had recent studies indicating effects on sleep. I went from 10-20mins of REM a night to 2-2.5 hours by cutting it out prior to any PAP therapy. It should have been done under Dr. supervision, but I can’t ever see my Dr., so I said screw it, found a typical tapering protocol and did it myself.

For shorter term things - sick visits, etc., it is impossible for my wife or me to see anyone at the network of our GP (one of the largest in the state) and have to go to urgent care. The last time my wife wanted an appointment she asked if she could go to another location to get in sooner. They denied the request because of continuity of care. So she went to a minute clinic that is completely unrelated to the network - how does that provide continuity?

It's been like that in the US like forever. Once you actually have medical problems. The main difference is the whole going bankrupt thing.

I'm a US expat living in London for 1.5y. I find the opposite is true.

US healthcare moves much faster and turnaround to getting a new appointment with a specialist is a fraction of the time in the UK (NHS only).

My SO had a personal health issue that she attempted to get help for in the UK. She had to wait months for a GP appointment with the NHS, only to be told "let's monitor the issue" instead of actually doing anything. We went home to the US (making an appointment <2w in advance) and we saw a doctor who immediately found the underlying issue and had it fixed.

I could go on about the health system in the UK...

edit: Ha even the article talks about this! "I am in the system for NHS treatment, but things are so bad that I have not even received an inital letter with a date for a test. It would likely take up to year for the NHS to treat me."

As far as I can follow, the NHS has been severely and intentionally undermined of resources by the ruling party. They are in the cusp of doctors going on strike.

They're trying to get things privatized like they did with rail. You can see how well that turned out

> The main difference is the whole going bankrupt thing.

US healthcare really does seem to want to bankrupt people. As an example, most insurance doesn't cover dental care, which is (in)famously one of the parts of the body that needs the most maintenance.

My insurance doesn't cover my ADHD meds because I have to take more than 1 pill a day. $80/mo for the rest of my life if I want to treat a disorder. (My case is pretty bad, too.)

I (hopefully?!) have decades of life left, and $80/mo is almost $1,000/year. Not super cheap. I actually can't afford this on my own income and have to rely on a family member to help.

Most work plans include a separate dental plan, for which I am thankful. However, near worst-case scenarios for dental issues are comparatively affordable ordeals. My routine dental care is covered for me, but it's affordable either way. I had to have a root canal and crown, which would have been annoying to pay for, but certainly not something that would bankrupt me. If I remember correctly, it was in the ballpark of $2k in the DC metro area. It's still possible to set money aside for possible dental issues and self-insure.

Because dental costs are more reasonable, insurance premiums don't tend to be very high and can be purchased outside of your main health plan. If primary medical costs were more on par with dental costs (as it probably did once upon a time, when the offerings were much more primitive), insurance wouldn't be such a big issue.

> everything Americans have complained about socialized healthcare is now true in the US as well

With the added bonus of paying completely insane amounts.

Totally agreed about the problem of long latencies due to bufferbloat in our medical system. I ran into it last year and I believe it significantly raised my risk of death.

A suggestion in case it's unfamiliar: there are doctors who don't take insurance. I can always see mine within a few days, for $80/month. (I set this up after the above experience.) It's absurd that I have to do this and also pay for insurance separately (paying much more than I did before the Affordable Care Act made insurance plans for catastrophic medical costs illegal) -- but that's where we are.

> everything Americans have complained about socialized healthcare

> long wait times to see providers, providers that churn through patients like their doing oil changes, providers that just push you along to the next step in a playbook without considering individual needs

I don't have any idea what that has to do with "socialized care." If anything, most of those factors resemble the way businesses scale up.

I disagree- socialized care is like insurance. The incentive is to pay out as little as possible. This is true whether it's a government health care program or actual health insurance.

An actual "market" system encourages consumption and competes on price and quality.

Health insurance (public or private) makes sense for catastrophic events (major illnesses) but for regular ongoing things like GP visits and common prescriptions, it's just a middleman that drives up prices and discourages prevention and primary healthcare.

I don't have any experience with US healthcare, but presumably having insurance and whatever conditions they enforce is basically a form of socialized healthcare, no?

If one wanted to, couldn't they find a provider they could pay to deal with whatever issue immediately?

There are three main types of insurance in the US: HMO, PPO, and EPO.

HMO works a lot like my understanding of the UK system (except the government doesn't pay for it); if you want to see a specialist, you need to get permission from the insurance provider, either directly, or (more typically) by having your GP (a.k.a "primary care provider) write you a referral.

PPO and EPO do not require referrals. A PPO typically has high deductibles for doctors that are not contracted with the PPO, and an EPO does not provide any coverage for doctors that aare not contracted with it (the P vs E is "preferred" vs "exclusive").

PPOs tend to have the highest premiums. Anecdotally, HMOs used to be a pretty good deal. From my earliest memories of how health-care worked HMOs didn't add too large of a delay. However, more recently it has been harder to get a referral, and once I get the referral, there are so few local places that accept the HMO (perhaps because of below-market rates paid out?) that a 6+ month wait list to see a specialist is not uncommon (some things like physical therapy having such a long wait-list that it's hardly worth it; I was quoted an 8 month wait list for PT for a shoulder injury, at which point I just googled for exercises I could do).

Also twice now I have been hit by the HMO refusing to pay for emergency care because even though the ER I took my kid to was "in-network" one of the doctors who saw the kid at the ER was an independent contractor which isn't covered by the HMO. Over $1k out-of-pocket each time.

This is a good summary. What's interesting to me to observe here is your PT story is the system working as designed. This intention is not hidden. If one could just google the solution to their problem instead of using scarce resources, as the common phrase goes, that's a good thing actually.

We do an awful lot of rationing in these sorts of ways. It's maddening to me that I pay the astronomical premiums I pay and yet, end up having to play mini-doctor by asking the internet for answers. I do not have any illusions that I'm able to provide sound medical advice to myself or others, but just due to these sorts of issues and also doctors visits that are practically conducted via drive-through, Google MD is often my doctor / PT person / etc of first resort.

If you substitute "google the problem" for "get a printout from my doctor that isn't from a possibly sketchy internet source" I would be a lot happier.

> If one wanted to, couldn't they find a provider they could pay to deal with whatever issue immediately?

If you live in or near a large town, yes, but the price will likely be 4-8x what your insurance company would pay for the same services, and you can't get a quote in advance.

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