Americans Are Skipping Doctor Visits Due to Costs
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The US system sounds totally broken compared to my experiences within the Singapore and Australian health care systems.
Concierge medicine is a luxury service where you pay an annual out of pocket membership fee to have a doctor always on call, including home visits. Its popular among the very wealthy, but not affordable for most people.
The doctors I know of who practice it have very wealthy clientele for whom convenience and access is the important factor, not the cost.
$2000-$3000/person/year [1] on top of regular insurance is a more than most people can afford, especially in a country where a large percentage of the population has little in terms of savings [2], and 60% live paycheck-to-paycheck [3].
But you certainly don't have to be a billionaire or even a deca-millionaire to afford it. You just need to be in the higher percentiles of your local income/wealth distribution.
1. https://www.partnermd.com/blog/concierge-medicine-costs-fact...
2. https://www.bankrate.com/banking/savings/emergency-savings-r...
3. https://www.cnbc.com/2023/09/27/60percent-of-americans-are-s...
Even things like my yearly checkups which technically doesn’t need an MD, have gone poorly. One of the NPs strongly wanted me on statins of slightly elevated cholesterol meanwhile the MD that I eventually took a second opinion from, suggested that for my age and physical condition, I most definitely don’t need to be on them.
Same with mental health care. Tried to find a therapist, literally everyone booked out 18 months, many just said no, not taking new patients.
But at least we don't have death panels amirite?
I actually ended up finding a new PCP in the next state over. It's a 10hr drive one way to see them, but when adding up the time, travel costs and other expenses, it's still cheaper than most of the concierge health services in my area.
(I was also younger, so had fewer things to talk to my doctors about...)
Anecdotally, though, it seemed like a lot of healthcare providers at the time moved to having better online appointment systems and remote visits, which made scheduling a lot easier for me. Probably a heavily YMMV situation though.
Dentists and ophthalmologists - super easy. I pick a place I like (based on location and reviews), I fill a form online (or give them a call if this doesn't work), I tell what I need or want, I make a visit and get full information on what should I do next. Simple as anywhere else in the world.
But the other medical stuff is confusing to me, or makes me have reservations about it.
- The majority of places seem to be affiliated with religious megacorps - they just bought out nearly every other hospital in my area. I'm not a woman, but I'm no fond of contributing to companies who then lobby for medical restrictions based on their religious beliefs.
- Then, there's also a lot of alternative medicine, way more than in any other country I've seen. Holistic, osteopathic, chiropractic, you name it. Yes, I've read that DO in the US isn't exactly a quack who's gonna suggest a manipulation that has a chance of getting a person quadriplegic, but a cheaper way to get a medical degree than an MD (and the osteopathic junk tends to just gets thrown out of the window after graduating), but still - weird. Just something that scratches at the back of my mind.
- Finding a GP is something I still haven't figured out in five years. They always seem to have appointment times in no less than half a year (!) so I'm really not sure how to find one I would like. And I'm still not sure what they do exactly, because I can go to the specialized doctor (like a dermatologist or otolaryngologist) directly anyway - and somehow it's a matter of weeks, not months. I've had a GP which I visited exactly once - should've went for urgent care, but I wasn't aware that's what I needed - then they stopped working at that hospital and I haven't explicitly asked for a new one so the whole relationship just lapsed somehow. In other countries, I went to GPs either for a quick dispatch to a specialist (next-day appointment for "hey doc, I've got $symptoms, can you send me off to $specialist and/or $lab") or for managing (simplifying) routine checkups (them organizing it instead of me running on my own to different labs and specialists). I should figure out the routine stuff, but still haven't - must be that the whole system operates on some unspoken rules, and I'm just unaware about it because I grew up elsewhere.
At least the urgent care works in a way I understand.
As an insurance company, you are incentivized to de-risk your pool as much as possible, and by spending a few dollars you're able to get to the earliest possible signals of who might be needing services very easily. Things like complaining about a sore throat on social media to friends, or even within private messages, are all things you might be interested in. Other signals, purchase history, location history, contact tracing, all of these provide potential ways to spot early risk and increase rates/push out the undesirable members of the pool.
Of all of the potential customers of our data, I keep coming back to insurance companies as having the most interest in these signals. When you can identify risks correctly, you can trim out or adjust rates to make things as safe as possible for your income stream.
This has a reactionary component to it that hurts us all. With most of our communication being digital now, I find myself thinking twice about putting out anything that could be taken as a signal to an insurance company. As an avid runner with most of our events organized online, this presents a social cost because I just won't engage in some conversations for fear of how companies will use whatever I might engage with against me.
Where does this type of behavior lead when practiced at scale?
Years ago a study came out that most Americans couldn't afford an emergency $400 medical bill. (For non-Americans, $400 for an emergency is nothing.) I doubt the situation has improved.
People who said they'd pay using a credit card got reported in the media as being "unable to afford" the expense. The original study might have been an interesting finding on the transition to a cashless society, but for millions of Americans, paying using a credit card is the default rather than carrying cash and dealing with change, and not actually indicative of lacking funds to pay for something.
Compare the number of people skipping visits with the number of uninsured. Even with insurance, doctor's visits can still be expensive depending on the plan. After the doctor's visit, there's still paying for any prescriptions. Without insurance, some medicines are pretty much impossible to afford.
- you can email a photo to the dermatologist and get a diagnosis for free. I used this for moles and rashes. Saved me a visit and $$
- you can email the doctor for free and chat with a nurse for free and if they refer you for labs or vaccines you just go directly to the lab and get your results online. No time with doctor required.
I am young and have no major health issues. I found this a drastic improvement over going to see a doctor in person, being told to take Tylenol + rest then getting a $700 bill for that advice.
So I didn’t just not get the Covid vaccine, but I canceled my health insurance during Covid. I will never go back to paying for insurance or even going to a doctor in the US unless there is an overwhelming consensus acknowledging the harms of this study:
https://pubmed.ncbi.nlm.nih.gov/36055877/ [1]
This system ends only when enough people refuse it. I know I won’t ever give this healthcare system a cent or an ounce of recognition they are an “authority” on anything. I’ll fly to f-ing Cuba for surgery if I have to… I’d rather die than go to an American hospital. After doctors went along promoting such an unsafe “vaccine” and have continued to ignore the overwhelming evidence of harm, they deserve absolutely nothing.
[1] Since it’s important I’m going to quote what Dr. Aseem Malhotra says about this reanalysis of Pfizer and Moderna studies…
"In my whole career, looking at all of the drugs and knowing about many different prescribed medications, I've never seen something that when you look at the data has such poor effectiveness and unprecedented harms. In the summer of last year, in the journal Vaccine, the highest-impact medical journal for vaccines, they published a reanalysis of Pfizer and Moderna's original double-blinded randomized controlled trial.
This is the highest quality of scientific evidence. Joseph Fraiman is an ER doctor and clinical data scientist from Louisiana. Associate editor of the BMJ, Dr. Peter Doshi. Dr. Robert Kaplan from Stanford. Some real eminence of integrity published this reanalysis, and what they found was this. In the trials that led to the approval of regulators worldwide, you were more likely to suffer a severe adverse event from taking the vaccine, hospitalization, disability, or life-changing event than you were to be hospitalized with COVID.
This mRNA vaccine should likely have never been approved for a single human in the first place, and that rate of serious adverse events is at least 1 in 800... 1 in 800 is a very, very high figure. We've pulled other vaccines for much less. The 1976 Swine Flu vaccine was pulled because it was found to cause a debilitating neurological condition called Guillan-Barre syndrome in about 1 in 100,000 people. The Rotavirus vaccine was suspended in 1999 because it was found to cause a form of bowel obstruction in kids in 1 of 10,000. This is at least 1 in 800. It's a no-brainer. So the question is, why have we not paused it?"
More likely it ends when enough people vote in politicians that regulate it.
Living without insurance in the US is great if you have no assets or if you're fantastically wealthy and can afford million dollar healthcare bills.
If you don't fit into one of those groups, get insurance.
Edit: I do absolutely agree that this system is broken at a fundamental level.
[1] https://news.stanford.edu/2018/02/26/americans-dont-think-ea...
FYI, my family had a "bad luck" year with 2 surgeries that added up to over 130K this year alone, but insurance covered it all (after deductible). We are in good health now.
If you have to go through a procedure of any complexity in a hospital, you may discover after the fact one or more of the doctors that were brought in were out-of-network despite the hospital being in-network, and suddenly, you're stuck with a giant bill insurance won't cover.
There's a reason some people have secondary, tertiary, and even quaternary insurance nowadays to cover things each previous providers don't.
We truly need to burn down the current system and reset to something sane.
Unfortunately, I currently don't have health insurance and hovering at 35% excess weight. There's no point in my going to a doctor when all of their recommendations are "window shopping".
The only way this shit stops is not Medicare for all, which is a red herring with third-class coverage, surprise costs, and still run by for-profit corporations. The ultimate solution is universal healthcare for all and making for-profit health insurance illegal. This can only happen when (low-information) voters stop shouting FUD like "Communism", "rationing", "waiting lists", "big gubberment reg-u-lation", and "death panels". Every other free country in the world has better outcomes, healthier citizens, and lower costs. The root cause is unregulated profiteering that cannot be changed at present because of regulatory capture, corrupt politicians, and the lack of people organized and protesting about it.
> Every other free country in the world has [...]
... and most also have private health insurance too. Some have a higher percentage of people with private health insurance than even the US does, often in a supplementary role.
Well, and I’m not sure any others have a problem like we do with the AMA.
I guess that countries that provide public health insurance don't have people skipping doctor visits because of costs, even if the majority of residence also have private insurance.
Also, semaglutide will be soon available in pill form. Semaglutide and metformin are the most revolutionary medications to prevent the most common and expensive diseases and improve life quality. One issue is that there is also a lack of longitudinal, evidence-based prophylaxis policy even in Medicare (the budget, third-rate health insurance for disabled and poor people) that waits until someone has suffered irreparable harm to then intervene with expensive care reactively. America is all about waiting until people are in the ER to do anything, and then drive them into bankruptcy while they're dying. I wonder how many people outside of Americans have met people with terminal cancer in the midst of bankruptcy proceedings with the hospitals pounding at the door to take everything they have while they're dying.
The medical landscape in the US is fucked and I hope it changes. Drugs like these would be much better if they weren’t governed by profit seeking companies.
The actual issue is way way simpler: Doctors and other healthcare works make too much money for it to be affordable for everyone. That's it, it's as simple as that.
Compare Dr salaries to other countries. Doctors in the US make 2 to 10 times as much as other counties. (Google it if you don't believe me.)
And they make so much because there is not enough supply. And colleges take advantage of that and charge insane tuition.
Want to actually change things? Start educating way way way more Doctors, and encourage people to go to low cost universities (which do exist - but everyone wants "the best").
See: https://www.advisory.com/daily-briefing/2022/02/16/physician...
This is slightly unfair if you don't consider the cost and time of becoming a doctor. That is not to say that the AMA doesn't purposely enforce a shortage as an attempt to drive up wages, but many doctors spend the better part of a decade (or more) before they're really earning any reasonable amount, and they have large debts from paying for school.
> Start educating way way way more Doctors
Yes. But that will hurt those who are already doctors somewhat, so there's a strong incentive to limit the pool.
> encourage people to go to low cost universities (which do exist - but everyone wants "the best").
These don't really exist in any reasonable amounts. You also have to consider how much of a doctor's education is outside of a university. And it does make a difference which hospitals you have your rotations and residency at. If you want to be doing EM, you're not going to want to end up in some sleepy town in the midwest where the most that happens is some drunk dude needing his stomach pumped. If you want to end up being in a specific field, your choices tend to be relatively limited in where you can actually get the education and experience you need for that specialty.
Anyways, all that is mostly to say that the healthcare 'system' in the US is a clusterfuck for many interconnected (and entangled) reasons and there is no one simple issue to address.
I’m overweight myself but it’s not medication related. I’ve been using behavior modification using cbt paired with diet and exercise. The cbt was a recent addition since I’ve regressed several times with just diet and exercise alone.
It's the for-profit engines of corporate hospitals, insurance, and big pharma.
Not sure where you got conspiratorial or uninformed, here's the study that guided the decision making [1]. I will take sophomoric since I don't know a damn thing about this industry, but both left and right are recognizing the problem and trying to get something done about it which is what we need more of[2].
[1] - https://eric.ed.gov/?id=ED210990 [2] - https://www.ualrpublicradio.org/local-regional-news/2023-05-...
Meanwhile, a doctor's visit can cost anywhere from $50/visit (with good insurance and a copay) to hundreds of dollars, more for special procedures, and more for prescriptions, etc. Much of the time you walk away with the problem not really solved, requiring multiple referrals and specialist visits. It's really easy to want to put it off till later, especially when money's tight. Yes, the situation gets worse over time, but it's one of the easiest things to procrastinate on.
It's part of the reason I hate for-profit healthcare... it discourages routine preventative care that could help a lot of people and prevent more expensive treatments later, instead of just making them put it off until an ER visit is needed.
Making people pay for their healthcare like this just means few people are going to use it routinely, instead waiting for their condition to worsen and fester. Especially teeth, yeesh, where even good insurance doesn't get you much.