Hacker News Reader

Comment by goethes_kind | Hacker News Reader

DISCLAIMER: If you have back/spine problems and you delay surgery because you hope the problem would go away on its own, with healthy living, you might end up with damaged/dead nerves which is irreparable damage, which even a delayed surgery cannot fix.

With regards to for-profit medicine, this is why I hate all market based health insurance systems. Even if you are rich and get treated like a king, you still have to question whether your doctor/surgeon is trying to sell you a procedure. The only system that does not suffer from this issue is the NHS (e.g. UK) where the incentive is lacking. The debate about health care systems tends to focus on availability and coverage, but this for-profit perverse incentive is orthogonal to all that.

View on HN

This is not really true unless there's something _really_ wrong with your back. For run of the mill disk hernia the patient satisfaction scores at 1 year for surgery and conservative treatment are pretty much the same [0][1].

[0] - https://bmjopen.bmj.com/content/6/12/e012938.short

[1] - https://link.springer.com/article/10.1007/s00586-010-1603-7

I've dealt with lower back issues for a long time. The worst of it was long behind me and I've been diligent enough to not have crippling events. My lower back hasn't felt as good and pain free as of today.I don't know if it was all the walking I've been doing (vacation) and the bag on my back (weird right). The biggest change was the level of stress after vacation. I haven't been on one for over 7 years.

I feel much more relaxed these days but I can also tell that everyday this "stress bucket" is slowly getting filled by daily life and I have to dump it all out by doing something other than the ordinary. I'm not a super healthy eater but I'm conscientious about it. I'm not a gym goer or even home exerciser. Once in a while, I'd use my weights and do somebody weight exercises.I don't eat fruits and vegetables as much as one should. I also know that there is great variability in humans.

I'm also much more aware of my body and what it needs as far as physical therapy exercises. I've a lot of time watching videos on physical therapy and back pain. I spend the most of my time at home walking on a treadmill while watching something on the TV.

> The only system that does not suffer from this issue is the NHS (e.g. UK

Is that a joke? With NHS you have to wait to get GP appointments, wait several weeks for examination by specialists, more waiting in waiting list for surgery... The backlog for everything is huge!

In NHS you can literally wait years for non life threatening surgeries.

you also have to deal with every person at every step of the way trying to gatekeep healthcare from you instead of trying to help you.

Parent comments is still correct, NHS is free from the Financial Incentive problem. I don't think anyone claims the system is good, just this one aspect is correct.

They maybe have a bit of the opposite problem of avoiding treatments to save resources. That said it mostly works kind of ok.

Very incorrect. NHS is still an health insurance company that is trying to save money by using their own doctors.

There is a long history (20 years) of people who gave up, did their surgeries in France, and sued NHS for reimbursement. More recent stories are from EU, when NHS was part of unified health system (they should pay for medical procedures done in other EU countries to UK citizens).

Dealing with NHS if you need surgery, is basically full time job. You have to navigate Kafka like administrative labyrinth. Sometimes you have to drive 10 hours, to other side of country, because the only specialist who takes new patients is in Scotland.

NHS is doing everything it can, not to pay! If you have any problems and can do so, save your mental health, and just do medical tourism to Turkey, Malaysia or Thailand!

In the US, I am waiting 6 months for an eval appointment to redo an eval to see if a brain problem has progressed enough to put in a shunt.

how is this different from NHS?

It is not different, that is the point. Theme of this thread is that NHS is somehow better because it "does not have financial incentives"!

whereas here, if I paid more, I would get faster service, which means there is a financial incentive to provide slow service, pushing people to a higher-priced but not necessarily better-quality service.

I have that gold plated US insurance that you pay a lot for. Just last week, I was rushed to the hospital due to my heart. We don't yet know what tried (or is actively trying) to kill me. The cardiologist ordered an emergency MRI.

Three weeks. I am told to wait three weeks. The doc wants it last week. We are having to call around and mess with coverage questions. Similar for my dad and a specialist. Waiting a month while having breathing issues.

People wait already for emergency medical situations, but we pay a premium. And I am still not sure what my 20% shared cost is gonna be for the ambulance and hospital stay. And yes, that factored into my decision to even be treated, which, had I stayed home, may have killed me.

Fuck our system. Medical should not be for profit. It should cost money to run because it should be a service.

How long did you wait in hospital, before you actually talked to doctor? Did you actually had MRI the same day?

In UK we had to wait 10 hours in ER before talking to doctors. Only passing out would get us some attention! Getting MRI was impossible in system. We had to pay privately for MRI, as part of building up case to get surgery approved.

And we also pay good money to NHS.

I went at night and there was no line, so I saw a general doctor immediately. I've gone in the past and had to wait hours for less critical issues. I was shipped to a larger hospital with a cardiac unit. I was seen for catheter placement the following day.

I still need an MRI. Haven't had one. It has been over a week and I am still waiting on a back up option to open up next week. Meanwhile, nobody knows what my heart is doing aside from EKGs that a nurse can run that say something aint right yet.

My mother waited for 3 months for imaging on her heart. 4 ER trips in that time, she spent much of it afraid she could die at any minute. We tried to comfort ourselves with the idea that her GP and the cardiologist knew what she was experiencing, surely if it were as critical as it felt to her something would be escalated right? But when they finally got a lock at her heart they all but handcuffed her to the hospital bed, and scheduled emergency surgery for the morning. 4 valves repaired and I don't recall what all else. She is doing well now, but our conversations during those months where she was simultaneously trying not to scare me, but also make sure her affairs were in order will undoubtedly be with me for the rest of my life.

Our system is broken.

It might help if congress allowed more doctors and hospitals to keep the ratio per capita the same it was a century ago.

> Is that a joke? With NHS you have to wait to get GP appointments, wait several weeks for examination by specialists, more waiting in waiting list for surgery... The backlog for everything is huge!

My experience of healthcare in capitalist America is exactly the same in that regard. I have a mole I want examined, and one of the dermatology practices I called (part of a major local health system) was taking appointments for March 2025! I usually have to wait 3 or 4 weeks to see my primary care doctor (though I suppose I could settle for a rando doctor with an opening or a nurse practitioner and be seen sooner, but whenever I've done that there have been other issues).

When I moved a few years ago and had to look for a new doctor, new patient appointments were all at least 8-9 month waits. We regularly have to wait 1-2 months even as established patients. Due to these extreme waits, we end up going to Urgent Care clinics for routine things that we used to just go to our family doctor for. This is in the USA.

I don't know about NHS, but I do know about Michael Jackson. He was a rich person and got treated like a king; and how did the for-profit health care system treat him? (It killed him.)

A bed side and what appears to be an unethical doctor overdosed his meal ticket with a heavy duty medication to induce sleep. I don't think there is much to argue either way on for-profit medicine in that case.

Ok, and the NHS let Jimmy Saville molest possibly hundreds of children.

https://www.bbc.co.uk/news/uk-28021488.amp

> The only system that does not suffer from this issue is the NHS (e.g. UK) where the incentive is lacking.

Why not mentionning France? It's pretty awesome in that regard

Classic anglophonic world view. Seems like people forget that literally all of Europe has universal healthcare, with many working far better than the NHS.

Reply on news.ycombinator.com