SAD state of Healthcare

[disneysteve]

I recall Steve always mentioning a Healthcare fund he has had for a long time that has consistently outperformed the S&P (if I'm recalling properly).

VGHCX has an average annual return since inception (5/23/84) of 16.05%.

I've personally been in that fund for probably 25+ years. I'd have to pull my records to check exactly when I first invested.

[disneysteve]

I understand this point through the concept of "medical necessity." You are correct that health insurers have really clamped down on procedures and treatment they deem unnecessary for either health outcomes or cost containment because it just isn't necessary. If a patient demands a test but there's no medical indication for it, no, the insurer (paying the bill) isn't going to pay for it.

This is really the key here. EBM focuses on exactly that. There are things that doctors have done for decades that have turned out to simply not be effective even though they were standard of care for a long time. When studies were actually done to evaluate them, the practices didn't turn out to make a difference, and sometimes even made things worse. The hard part is convincing patients - and even doctors - of that fact. "This is the way we've always done it" is a powerful force. Doctors are creatures of habit and it's hard to change those long-standing treatment patterns. It's even harder to convince patients who don't have the medical knowledge.

[LivingAlmostLarge]

But that is an inherent problem right? Is healthcare a right or a something we afford? If it's a right then people do lean to more socialized system I think. You believe there is a minimum level of care. If you don't then you are all for you get what you pay for. And therein lies the rub. The US is the only westernized and 1st world country with paid healthcare. You get what you pay for. Everywhere else has found it more beneficial to treat healthcare as a right.

Americans complain more and struggle more than everywhere else with healthcare. I wonder if that's because we don't move to a fully free market healthcare and see how the market would bring prices down? That the unfettered competition would make it cheaper? It would make people shop around? It would make individuals have more skin in the game? That you can only pay to live if you can afford it. Sounds scary? It should. That's how free market healthcare would work if we decided to decouple insurance. People would be fully responsible for their own bodies, choices, decisions. We would not have it linked and we'd have to shop insurance. And depending on your health and wealth, well the rich will do okay.

[Smallsteps]

That's BS, pure and simple. For a health insurance provider to actually put that in their printed materials is criminal. No way would I do business with a company like that.
I can understand and agree with second opinion on surgery or pricey treatment event.

In this presentation ( salesperson) said they would want you to consult on MOST of your visits not just major ones. The fact they did use printed material is one of the reasons my husband spoke up.

Under what circumstances? Before surgery? Only for specific conditions? Requiring a second opinion before elective surgery might not be an awful idea, or perhaps before beginning cancer treatment. But the times when a 2nd opinion should be required should be pretty limited.

They said other then just basic items to call in for consult on any NEW condition or diagnosis. they want to review all drugs suggested as well.

You do need to be licensed in the state in which you are practicing telehealth. Telehealth was already around but Covid probably advanced the field by a good 5 years or more when nearly all doctors were forced to start doing it since they had to close their offices to most or all in-person visits.

I thought they should be in state providers ........but as there are more and more ads for this................ I have not seen ( looking for in small disclaimers on screen) Something that says that. Some states have eased licensing things to get more providers that could work (COVID prep) does that apply?
GOOD RX is a national company offering $20 virtual visits ........ with one phone # and website perhaps the company then directs specific request back to the state you are calling in from again nothing that clearly shows that.

My urgent care started doing telehealth. I haven't done it yet myself but we have several providers doing it. When you call in, you're getting the very same people you would get if you walked in the door for an in-person visit. They aren't lesser providers in any way. If they feel your condition can safely be handled by phone, they do. If they think an in-person exam is warranted, they refer you to one of the physical urgent care sites, or the ER if appropriate.

I am sure like anything else there is good and bad examples i just question the one on one interaction...... if video link this persons color mean bad camera angle of lighting or perhaps they are super pale or jaundice ....... many items you may pick up on in a in person visit......
if an established patient with history might be better communication then a person you have never seen or treated. I am sure doctors like yourself pick up on body language in person to narrow down if they are telling you the whole story etc.


Unfortunately, many people have been delaying necessary medical care because of fear of Covid. I think it's important to let people know that that isn't a good idea. Healthcare facilities are taking every precaution they can to keep people safe. It's not perfect but you're a lot less likely to catch Covid at your doctor's office or the hospital than you are going out to dinner or visiting your family for Christmas.

i agree some conditions should not be put off etc these seem to be IMO more directed at making up for lost demand. I have zero problem for medical places advertising to keep up with your treatments / visits......... ADS sponsored by specific drug makers for certain conditions it does not come off as concern for much more then their market share.

I see in some ads saying you can TEXT a doctor........... then they can call in your prescription or send to your house...... that does not seem serious........ you have zero idea who is texting you. I mean you have the phone # but that is no guarantee that is who is texting ..... maybe you input insurance if taken perhaps they have you submit a ID like you would at most urgent care type places ..... I don't know i have not seen requirements listed.

I might not have an issue with a visit like this with a regular provider just do not see this as a first time meeting with a doctor.

Seems like wholesale Price transparency would be the answer ........much like the dealer posts on new cars .....
it is not possible for them to sell for a drug $10-20 through Good Rx/ Singlecare etc.......... but it is $200 through insurance.

[Snicks]

Surely there is some truth to this, but on the other hand it also ties in to what I said earlier about evidence based medicine. For example, the reason that people get discharged right after surgery rather than spending a couple of days in the hospital "recovering" like they did years ago is that we've found that outcomes are better with earlier discharge. Post-op infection rates are lower. Getting people up and moving around faster is better than having them sitting in that hospital bed. I'm not familiar with pre-op data but I wouldn't be surprised to learn that the same is true there. Spending a day in the hospital before surgery probably raises your risk of catching some infection that you wouldn't have been exposed to at home.

Come on. YOU of all people know how easy it is to manipulate stats. Do you want me to show that versed is cheaper as a sedative today? Sure. Do you want me to show that Propofol is cheaper tomorrow, sure. Much of medicine is manipulated when you KNOW in your heart of hearts that there are patients who are not getting what they really need.

[amarowsky]

I'm very glad that there is so much participation in this thread.

This means we're all scratching on something that is unsettling to a lot of us. I think this is as good an idea (improve our healthcare system) that American's could unite around as any....

I wish there was a more sound, articulated, plan/idea that made the most sense to everyone, and had enough momentum to go up against our gov't for change.


As good as a free market would be for health care. It would be exhausting having to search around forever..... And continually outwit the greedy boards that want to maximize profits.... Imagine cable companies as hospitals. All either is concerned w/ is capacity on their network. I'd still take free market over our current "semi-subsidizedprofits-kinda life", But i'd rather just pay it through taxes, not have to directly part w/ the money or deal w/ transactions, and be done w/ it. (ala - the majority of the developed world). But the Swedish, or German systems would be fine. The German one's at least non-profit (makes the most since, let them fight for their paychecks, not their bonuses and stock prices) or the sweed one (not sure if for-profit). Nvm, upon closer research, Sweden's is non-profit also. But you can have some transactions (not all gov't paid). FWIW in sweden 13% of people hold private supplementary insurances for additional access to specialists and their treatments.

FYI = Sweden is Tiny, and more homogenous than USA (population is 10 mil, roughly pop of NYC). Germany is MUCH larger, pop = 1/4 usa, but again, much more homogenous. Humanities flaws & greatnesses are exacerbated in america (probably because of our amazingly wonderful diversity). I think this is our largest obstacle... getting good coverage to a group of entitled, fiercely independent, and historically rebellious, melting pot of Americans.

I have heard interesting speculation, as to why America has never developed a national healthcare. More reverse engineering/evolution explanation, that made sense to me. In the last hundred or so years, we're like one of the only, major, developed nations that never had been invaded by a foreign power. All across Europe, Asia (south/east especially) , Mid-east, Africa, basically everywhere that was "in the zone of fire" during the 1900's , has been bombed, invaded, sacked, conquered, split up, or other. They've constantly had to feel the sharp edge of collateral damage, both from their conflicts or from neighboring countries. because of all of this loss of life, it made the most since to turn healthcare into a right. Not enough care would be administered, if you had to spend time identifying which insurance, in which country, which which plan. <----- This was the speculation. I think I read about this in the book, "the price we pay" by Dr. Marty Makary. I mentioned it before, but it was really helpful to organize and align some of the arguments, from a very well respected & high authority jons hopkins doc.

Our fortune of peace in the states, basically since the civil war, has made us cavalier to the risk we hold. This has brought our weakness into global focus, that we have net completely capable of taking care of everyone it's made for, but we choose to contort this net, to optimize profits, and wield it like a toy, instead of a tool for survival.

The kinda crazy thing is.... there is like no way to explain how a "For Profit" healthcare system would work, in a Generally healthy society. You'll have to suspend some disbelief , to let this argument take hold. But if you were generally, much much healthier, and had to go to the doctor less, and ideally only VERY RARELY have to take medicine or an Rx on any frequency. My hypothesis..... If the supply for medical services plummeted, these massive, and costly hospitals and staff would not be able to carry on. Let alone, expensive development on new technology. It would seem hard to keep a place only open to serve injuries that are accidental in nature. (assuming all emergencies related to - Long, Poor health maintenance, are dramatically reduced by a more -Health conscious population). <----- IN this type of dream world, I can't see a (decent) for profit system surviving.... Unless the cost of an accidental emergency was like winning the reverse lottery, and you have to give all your assets to save your life (as it should be worth it to you). You can't make the same argument in reverse.... If we all had to pay a tax, the healthier we got, and less we needed more hospitals/staff/research, we would just toggle down our taxation as needed. But you would always have the lights on somewhere. I'd love healthcare to be about as much of a decision as "calling the police" or "calling the fire dept" and you just know, You're in the hands of professionals, who no reason to be interested in your money, or insurance, but merely what is the problem they're designed to fix (health).

[amarowsky]

I guess the real hoop to get past is Establishment Media (cable news, broad facing social media, anything you see w/ commericals) . They're SUPER SUPER SUPER PRO : BIG Insurance, Big Pharma (non-stop line of dick pills on every freggin channel) , and huge on lawyers.

But we (American's who agree, there is room for improvement on our healthcare system) can get behind A idea (or bundle or like ideas), and support it as an american community, would be able to get some headway. Good luck doing that though.... When #1 priority on cable news is to tribalize their viewership into (2) teams, when we are all on the same team.

[thewings]

thanks for sharing information
I am still not sure how all these virtual visits work as far as if a doctor is licensed in the your state