[HN Gopher] 'The People's Hospital' treats uninsured and undocum...
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'The People's Hospital' treats uninsured and undocumented
Author : lxm
Score : 127 points
Date : 2023-03-16 00:57 UTC (1 days ago)
(HTM) web link (www.npr.org)
(TXT) w3m dump (www.npr.org)
| interactivecode wrote:
| Again why do we need hospitals to make money? Aren't national
| expenses like healthcare a good place to use taxes for?
| luckylion wrote:
| Because we don't want them to be bureaucracies that grow and
| grow without providing increasingly good service.
|
| If you can solve the problem of state agencies becoming
| insanely inefficient (mostly due to lack of incentive to be
| efficient, I suppose), you'll make everyone happy.
| dbtc wrote:
| The real money is in insurance. From what I can tell, this is
| the cancer in our system, and the hospitals take more than
| their share of the blame.
|
| https://en.wikipedia.org/wiki/UnitedHealth_Group
| dghughes wrote:
| I'm not in the US and it is staggering to see how much one
| hospital take in just one single hospital.
|
| Tisch Hospital New York NY Net patient revenue 2022
| $6,273,707,636
| lief79 wrote:
| Without the number of patients, this number is fairly
| meaningless. The hospitals can be and often are huge.
| jonas21 wrote:
| We don't need them to. 62% of hospitals in the US are non-
| profit, and an additional 20% are run by the government. Only
| 18% are for-profit. In some states, like New York and
| Minnesota, there are no for-profit hospitals.
| burkaman wrote:
| Non-profit doesn't mean you don't make a profit, and doesn't
| mean you behave more ethically than for-profit hospitals.
|
| Example: https://www.propublica.org/article/methodist-le-
| bonheur-heal...
| verall wrote:
| Tons of people getting rich as fuck at those non-profit
| hospitals though.
| itamarst wrote:
| In normal sufficently-rich countries they call this a "hospital".
| rqtwteye wrote:
| Leadership in the US should be deeply ashamed that such things
| even exist. Unfortunately there is nothing in sight that would
| change this anytime soon. Obamacare was screwed up, Medicare For
| All seems a no-go (Biden should be ashamed for not embracing it),
| and Congress probably will be busy in the next few years
| investigating and impeaching each other while not doing anything
| productive.
| giraffe_lady wrote:
| We didn't even get paid sick leave out of covid we're extremely
| dedicated to not ever improving this at all.
| rqtwteye wrote:
| And Biden lost me when the train people were on strike. The
| whole concept of limited sick leave is already ridiculous but
| their situation was just crazy.
| pkaye wrote:
| Not enough Republicans senators would agree (need 60) for a
| bill to mandate paid sick leave for the train workers.
| vkou wrote:
| Then parade them as the boogieman, fire your friendly
| press machine on all cylinders, don't just roll over and
| take the L.
|
| ... Or, more likely, the bill went exactly the way he and
| his backers wanted.
| anovikov wrote:
| [flagged]
| kwhitefoot wrote:
| That has to be the most bonkers comment I have ever seen on HN.
|
| You must be great fun to know. /s
| wongarsu wrote:
| Why would it be illegal? If it is where's the line? If I find
| myself in a first aid situation, do I have to ask for valid ID
| before initiating CPR?
| csomar wrote:
| Not only that but you have to validate the ID too. You know
| these illegal immigrants use Fake IDs, so you better be sure.
| If they can't procure an ID, it's better to let a fellow
| citizen die than take the risk of rescuing an illegal
| immigrant.
|
| s/ of course.
| DoreenMichele wrote:
| You remind me of a comedian I saw years ago say something
| like "All those illegal immigrants here to take our jobs. I
| always wanted to be an underpaid farmhand but, no, the
| illegal immigrants took all those jobs."
| Nextgrid wrote:
| The "taking our jobs argument" is stupid.
|
| Since Brexit (and compounded by the pandemic), here in
| the UK a lot of industries turned to shit because it
| turns out that 1) the Brits don't actually want those
| low-paid jobs and 2) immigrants (whether outright illegal
| or "legal" under EU rules) were critical to a lot of
| those industries' proper functioning.
|
| I'm talking about hospitality, transportation (Uber/etc),
| basically anything that relies on unskilled labor.
| csomar wrote:
| Most people do not understand that raising the prices of
| these "basic" workers will make these jobs higher paid
| (for sure) but will also reduce the opportunity (or the
| size) of the market. If you had 4.000 Uber eats bikers
| with illegals, then you'd only have 400 without. On the
| other hand, the 90% of the population (that used the
| remaining 3.600 bikers) no longer can afford the "Uber
| Eats" and will no longer have that luxury.
|
| Now imagine that for almost everything, and there you
| have inflation for basic goods.
| ggeorgovassilis wrote:
| This comment is strange since you seem to live in the EU [1]
| where healthcare is, reluctantly and depending on each member
| state's policy, extended to everyone. The EU faces both
| demographic and labour force problems which can be remediated
| by immigration. In that respect, investing in a healthy work
| force seems preferable to the purge you seem to be proposing.
|
| [1] https://news.ycombinator.com/item?id=35155097
| ashwagary wrote:
| >ground should literally be burning under the illegals;
| wherever they go they
|
| I would hope we can all live in a society compassionate enough
| to care about human life/health before borders.
| yummypaint wrote:
| Fascism in this century is a very real and growing problem.
| We all have some measure of responsibility to actively reject
| it and those who advocate for it. Remember: tolerance is a
| peace treaty, not a moral precept. Treaties only protect
| parties who abide by their terms.
|
| By that logic people who attempt to maliciously deprive other
| human beings of life-saving treatment deserve no better than
| the same conditions they would have others suffer through.
| localplume wrote:
| [dead]
| esalman wrote:
| Outside of the US this is pretty much how most hospitals operate.
| You get through the door, you get care.
| s1artibartfast wrote:
| This is not how it works in any country on the planet. You do
| not walk through the door and get unlimited care of all types
| and for all diseases.
|
| Different countries have different methods for deciding who
| gets what care, and when they are cut off. You can argue which
| are better than others, but nowhere is it an all you can
| consume Buffet
| noodlesUK wrote:
| I think what you're trying to say is that there are always
| limits to what care is available, and that the best possible
| care is not always provided due to resource constraints.
|
| There are of course always methods for determining who gets
| care, but at least as far as the UK goes, anyone who is
| legally resident in the UK can walk into a hospital and get
| largely the same healthcare as anyone else.
|
| If you're not legally resident in the UK (i.e., you're a
| visitor or undocumented), you will receive emergency care and
| primary care without charge, and you will only be charged if
| you're admitted to hospital. Many countries (including the
| EU) have arrangements so that their citizens/residents won't
| be charged even in those circumstances.
|
| Almost every developed country on the planet other than the
| US has universal healthcare. The notion that you will be cut
| off because you can't pay is the exception not the rule.
| 908B64B197 wrote:
| > There are of course always methods for determining who
| gets care, but at least as far as the UK goes, anyone who
| is legally resident in the UK can walk into a hospital and
| get largely the same healthcare as anyone else.
|
| They are allowed the privilege of a multi-year waiting list
| for basic procedures (unless they happen to be high enough
| socially to rub elbows with doctors.)
| dundarious wrote:
| The waiting lists time increase over the last decade or
| so is unnecessary and scandalous, and the government
| should be held accountable.
| s1artibartfast wrote:
| My point was that the differences are more nuanced than
| presented.
|
| Most developed countries on the planet including the UK
| also have private insurance, which serves to give you
| different Healthcare options then what is covered by their
| socialized medicine systems.
|
| Anyone in the United States can walk into an emergency room
| and will not be denied treatment based on their lack of
| insurance.
|
| I'm not trying to argue that the US system is better, but
| point out that it is often compared to an idealized and
| imaginary European system that does not exist.
|
| Some people loudly Proclaim that citizens are entitled to
| any Healthcare they might need or want _like in Europe_.
|
| There is a lot more to it than that
| robswc wrote:
| >anyone who is legally resident in the UK can walk into a
| hospital and get largely the same healthcare as anyone else
|
| This is true in the US too. Hospitals don't just refuse
| care unless they consider you "well enough" which
| unfortunately happens sometimes but its not per policy.
| Same thing in the UK though...
|
| I know a guy who's next door neighbor's dad died because he
| couldn't get an ambulance or basically any "urgent care."
|
| Didn't have a car and they refused to send an ambulance for
| some reason. They called the police to try to get them to
| help but they were too late. I don't know the details but
| he was fuming mad about it.
| 0xy wrote:
| I guess that's why Canadian to US medical tourism is
| skyrocketing and growing at more than 50% a year, because as
| you say non-US free healthcare systems provide care on demand.
|
| The question is, why is the Canadian system crumbling so badly
| that patients flee to the US if it's so perfect?
| shanty wrote:
| Super interesting idea. I can't seem to find out how they
| actually operate though. It seems like this would be prone to
| general abuse with if an individual electing
| little/no/catastrophic coverage while also using this
| resource...or do they ask for W2s to verify eligibility?
| renewiltord wrote:
| Take doctors out of the loop and let me prescribe with the
| Internet as my guide and I will save more lives in America than I
| will harm.
|
| Access is everything.
| programmertote wrote:
| > "My cap is 15 patients in one day," Nuila says. "That's
| compared to some of my colleagues in the private world, who I've
| heard admit up to 24 patients in one night, or don't carry a
| cap."
|
| Learning from my spouse who is a current medical resident -- some
| attendings admit and discharge more patients than the capacity
| because their bonuses are tied to that. That is a twisted
| incentive and it is in conflict with ACGME's guidelines of not
| letting residents handle more than 10 patients at a time. The
| attending/hospitalist at my wife's hospital makes $420K/year +
| bonus (it's near Miami, FL). They work 8-hours shift for 7 days
| and then rest 7 days. If one chooses to, s/he can moonlight at
| another place (a senior friend of my wife works for a hospital in
| Palmdale, CA and another one nearby for 7 days each; she easily
| bags $600K/year; she is raking in money when she can work this
| much while buying houses, and she plans to work half as much in a
| few years).
|
| I also wonder if hospitals like "The People's Hospital" make
| patients sign waiver to not sue them. At my wife's hospital, some
| of the patients (and/or their families) are obviously angling for
| lawsuit and are always looking for excuses to do that. That
| legal/liability burden (among may other things like doctor's
| salaries; bloated administration; etc.) is part of the reasons
| why hospital bills are exorbitant.
| vkou wrote:
| Texas did tort reform, severely capping doctor liability and
| damages, and to the surprise of nobody, healthcare didn't get
| any cheaper there.
| givemeethekeys wrote:
| Did training doctors get any cheaper? If not, then a doctor
| will try their hardest to get out of debt as soon as
| possible. Just think, their friends who aren't doctors
| already have a house by the time they graduate with a few
| hundred thousand in debt and no house to show for it.
|
| You want cheaper healthcare? Make becoming a doctor cheaper.
| aftbit wrote:
| That's actually a little bit surprising to me. I have some
| family friends who are doctors (one's a dermatologist, the
| other an internist). They each pay somewhere around $50k per
| year in malpractice insurance premiums. Now sure, in the
| grand scheme of things, the 50k extra your doctor demands is
| likely not transformative for health care costs, but I also
| wouldn't imagine it is nothing.
| vkou wrote:
| In a transparent market, the theory of 'reduce costs' ->
| 'cheaper healthcare' might hold, but the healthcare market
| is anything but transparent. If my doctor can save money on
| something, he's not going to pass in on to me in the form
| of lower costs. Why would he? I don't pay my doctor! Three
| months after I visit him, I get a bill from my insurer for
| some co-pay that's a tiny fraction of what the doctor
| billed them.
|
| I'm assuming the savings were happily eaten by doctors'
| wages/hospital shareholders/admins/insurers. Meanwhile, the
| patients got to deal with gems like this[1] doctor.
|
| Healthcare seems to be much like rent in a supply-
| constrained environment, in that it is doing its best to
| siphon up all surplus funds sloshing around the economy.
|
| [1] https://www.propublica.org/article/dr-death-
| christopher-dunt... - the hospitals didn't care that he was
| butchering his patients, because they get money per surgery
| performed, not per _successful_ surgery performed. The
| patients had no recourse, thanks to tort reform. The doctor
| himself didn 't care. He shuffled around from hospital to
| hospital (who welcomed a rainmaker that brings more
| business in with open arms), maiming people, until his
| negligence reached criminal levels.
| whoisthemachine wrote:
| This is a hard article to read, as you say, this man's a
| butcher.
| saul_goodman wrote:
| I think people completely miss the point that this further
| enables a caste system in the US. You have an entire class of
| people who have almost no rights who live and work in this
| country. Any politician that makes it easier for illegal
| immigrants to survive in this country is NOT doing it out of the
| goodness of their heart. It's a calculated move to further abuse
| a class of people who can be completely abused without recourse.
|
| Does no one stop to wonder why the government is actively
| hindering border states from enforcing their international
| borders after 20+ years of a war on terrorism? Why are these
| people coming to the US in such high numbers now full-well
| knowing they will be abused here? Look up the School of the
| Americas and who their list of graduates include.
|
| https://wikispooks.com/wiki/School_of_the_Americas
| hammon wrote:
| [dead]
| tetris11 wrote:
| A free alternative can only drag the prices down of the
| privatized sector. I wonder if they will go down kicking and
| screaming, and that this freer alternative will be allowed to
| thrive.
| maxerickson wrote:
| It's not a free hospital, it's a public hospital that treats
| people regardless of their ability to pay while still charging
| people that can pay.
| quickthrower2 wrote:
| The same model as silicon valley!
| p0pcult wrote:
| No, the SV model would be to treat you for free until you
| have some chronic condition that locks you in, at which
| point, they pull the "free" rug, and take you for every
| spare penny (and sometimes more).
| maxwell wrote:
| Zuck got the idea from some "books on finance and banking"
| he read in 2012:
|
| "The whole banking industry is based on charging people
| different rates."
|
| https://theguardian.com/technology/2018/dec/05/facebook-
| emai...
| [deleted]
| lostlogin wrote:
| No, a pure SV healthcare model would sell your healthcare
| records to advertisers.
| DoreenMichele wrote:
| Many of the patients here _are dealing with serious illnesses as
| a result of not being able to get access to basic preventive
| care._ This is part of why it matters to make healthcare
| accessible: It 's more expensive to not make it accessible.
|
| Ye olde "the horse was lost because the horseshoe was lost
| because a nail was lost" principle. It's not just that someone
| has an advanced illness, if they die and now their kid needs
| additional resources from the welfare system, the rest of us are
| paying for it.
|
| According to this piece, under EMTALA -- he Emergency Medical
| Treatment & Labor Act passed in the 1980s -- it's not illegal to
| treat undocumented immigrants.
| dangwhy wrote:
| > It's more expensive to not make it accessible.
|
| I was under the impression that USA healthcare has out of
| control costs due chronic diseases[1] . None of which have any
| 'preventative care' that you get at an hospital( cancer _maybe_
| an exception) . What can a hospital do about 'physical
| inactivity' ?
|
| We can blame this or that but mind boggling half the population
| in USA is obese. What can any healthcare system possibly do
| about that.
|
| https://www.cdc.gov/chronicdisease/about/costs/index.htm
| avgcorrection wrote:
| - Let's go mountain biking!
|
| - I'm uninsured. Too risky.
|
| You could do something about that.
| dangwhy wrote:
| lack of insurance is stopping people from taking a walk
| around the block. It _has_ to be a extreme sport.
| tristor wrote:
| I am obese, I have been fighting my weight nearly my entire
| life. At one point I did manage to get down to a "normal"
| weight and body fat percentage, but it took more than 7 years
| of concerted disciplined effort to do so, and it disappeared
| in less than 6 months by no longer eating as a significant
| calorie deficit, despite a massive increase in physical
| activity. For many obese people, for reasons we don't fully
| understand, our metabolism does not work the same as for
| people who are not obese.
|
| The first time we've had any sort of medical intervention
| that seems to actually address this is the invention of GLP1
| agonists and similar medications. Most insurance providers
| REFUSE to provide coverage for these medications, even though
| they are a net positive for the patient and society. Taking a
| GLP1 agonist while obese can straight-out /prevent/ the
| development of Type 2 Diabetes, even while you are still
| obese, and can cure some people of Type 2 Diabetes while they
| are ungoing further treatment.
|
| I am very lucky in that my insurance does cover this
| treatment. The insurance of several of my friends (who are on
| ostensibly "better" plans because their premiums are more
| heavily covered by their employers) does not cover this. If I
| could make one legal change to the healthcare system in the
| US, it would be to require insurance providers to cover
| preventative treatments for obesity. Obesity is the primary
| cause of chronic health problems in the US, and it's nearly
| entirely preventable with proper care, but it's almost
| impossible to get that care /even as a tech worker with
| employer-provided insurance/.
|
| It should be affordable and accessible for nearly anyone in
| the US to get access to GLP1 agonists and a dietitian. It
| isn't currently. Lacking this, means that obesity will
| continue to be a social disease that drives up healthcare
| costs and drives down productivity, quality of life, and
| total life outcomes in the US.
| neuralRiot wrote:
| This a purely anecdotal opinion but most people
| overestimate their required calorie intake, and according
| to my long experience in the fitness world you need to keep
| your desired weight stable for at least 2 years to reach
| homeostasis and avoid "rebound". Increased physical
| activity has a lot of benefits but it has a mild impact in
| weight loss. Again, this is solely based in my 20+ years of
| experience.
| tristor wrote:
| > most people overestimate their required calorie intake
|
| It's not something so mechanical as this. For obese
| people, our /bodies metabolic system/ overestimates our
| required calorie intake and causes us to feel the pangs
| of hunger far past when we've consumed a sufficient
| amount of calories. It's not a conscious choice to
| overeat, nor is it something that takes effort to do. I
| ate like a normal person while traveling around the
| world, walking 10 to 15 miles per day, and going to the
| gym 3 times a week for an hour, and I still gained back
| 40 pounds over the course of 18 months (nearly 20 of it
| in the first 6 months) after going off a monitored,
| strict calorie restrictive diet.
|
| My actual daily caloric intake need was around 1200
| kcals, exceeding this isn't hard to do, and keeping to it
| was a daily struggle that wasn't possible to maintain
| while traveling when I could no longer strictly control
| all the food I ate or even know how many calories it was
| or what its ingredients were. If I was to guestimate, I'd
| say I was consuming between 2500-3000 kcals daily while
| traveling, and this was sufficient to gain almost all of
| the weight I lost over 7 years back in a matter of
| months.
|
| This is the reality of being obese. It's not like you
| choose to be fat, or you choose to over eat, or even that
| you're over eating to the point of gluttony, it's merely
| that your metabolism needs far less calories than it
| believes it needs, so if you simply eat a normal amount
| when you are hungry, you will be fat, guaranteed.
|
| The reason GLP1 agonists work so well is that they
| actually change how your body's metabolism reacts, and
| make it so you no longer feel hungry constantly. In fact,
| you have to force yourself to eat sometimes or you'll end
| up having the effects on not eating often enough. While
| taking a GLP1 agonist, reducing or maintaining weight is
| not the same struggle as it is without medical
| intervention.
|
| I counted calories and religiously recorded all of my
| physical activity and food and water intakes using very
| technological means tied into MyFitnessPal for almost a
| decade. It was not for lack of effort, dedication, or
| knowledge that I gained back weight or realized that I
| was not going to succeed for a lifetime without medical
| intervention. It's simply not possible to rationally
| fight your base biological impulses when they are fall
| into your body's basic survival mechanisms. I effectively
| "tortured" myself psychologically for almost a decade,
| and the net result was the moment I stopped I gained all
| the weight back. GLP1 agonists are basically miraculous.
| nradov wrote:
| Have you done a resting metabolic rate test to establish a
| baseline for total daily energy expenditure?
|
| The GLP-1 drugs can be a net benefit for some patients but
| they come with serious side effects. In particular most
| patients lose significant amounts of lean muscle tissue,
| which is a risk factor for metabolic diseases and
| sarcopenia.
|
| https://peterattiamd.com/ama45/
| bumby wrote:
| It's not clear to me that the risk to lean muscle tissue
| is unique to GLP-1 drugs. The counter point is that the
| risk exists in practically any severely calorie
| restricted plan. In other words, the reason why most
| treatments work is by reducing calories and if you reduce
| them too fast, any of those treatments will put lean body
| mass at risk.
| nradov wrote:
| When a patient loses weight, some fraction of that will
| always be lean muscle mass. The issue with GLP-1 drugs is
| that fraction tends to be higher than with other
| approaches to weight loss. See the link I posted above
| for details which should make the risk clear to you.
|
| There are circumstances when those drugs are medically
| indicated. However, it seems they are being over
| prescribed without proper consideration of the harmful
| side effects.
| bumby wrote:
| The link doesn't actually cover all the material listed,
| only the first 27 minutes. It looks like the relevant
| stuff came later.
|
| Was that higher fraction compared to equally drastic
| calorie reduction in other methods in a RCT?
| dangwhy wrote:
| > For many obese people, for reasons we don't fully
| understand, our metabolism does not work the same as for
| people who are not obese.
|
| My impression was that obese people first get less insulin
| sensitive over the years and then become obese as a result.
|
| They usually measure insulin sensitivity as a proxy to
| 'metabolism'.
|
| > It should be affordable and accessible for nearly anyone
| in the US to get access to GLP1 agonists and a dietitian.
|
| I thought it was only approved for diabetes not obesity.
| tristor wrote:
| > I thought it was only approved for diabetes not
| obesity.
|
| Ozempic and Wegovy are the same substance from the same
| company, Ozempic is approved for diabetes, Wegovy is
| approved for obesity. Similar situations apply to other
| competing GLP1 agonists.
| dangwhy wrote:
| oh yea i think i have some family on wegovy ( or maybe
| mounjaro now ), hadn't realized that it was approved for
| obesity.
|
| What i don't understand is that you are saying these are
| "preventative treatments for obesity" . aren't
| preventative treatements given before the condition even
| comes into picture, these drugs are after you get obese
| so not sure how they are preventative.
|
| Doesn't weight just come back instantly once you stop
| these drugs. Hard time accepting that solution is putting
| 200million americans on this drug for rest of their
| lives.
|
| "Cardiometabolic improvements seen from week 0 to week 68
| with semaglutide reverted towards baseline at week 120
| for most variables."
|
| https://dom-
| pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
| tristor wrote:
| I didn't say it prevents obesity, I said it prevents Type
| 2 Diabetes, which is a chronic disease caused by obesity.
| And it does. It's nearly a miracle drug.
|
| Yes, if you stop taking the drugs, after a short time you
| return exactly how you were prior. You must take these
| drugs for life, unless something else comes out that
| improves the situation.
| DoreenMichele wrote:
| This is true and not really relevant to the point that people
| who can't afford healthcare get very sick before they go to a
| doctor and then their care is more expensive and has worse
| outcomes.
|
| One hospital was having so many resources consumed by a
| relatively small number of very ill homeless people and
| concluded that housing them would be cheaper and more
| effective, so it did.
|
| Health care really shouldn't be used to mean _medical care_
| per se. And that 's one of the things that complicates such
| discussions.
|
| https://news.ycombinator.com/item?id=34397790
| 908B64B197 wrote:
| > Health care really shouldn't be used to mean medical care
| per se. And that's one of the things that complicates such
| discussions.
|
| Exactly.
|
| Whole hospital floors are completely dedicated to patients
| with completely preventable diseases with proper lifestyle
| choices (uncontrolled type-II diabetes, most cardiac and
| vascular surgeries...). What these people needed a decade
| or two ago was someone to coach them/engage in a long term
| discussion about their labs and deteriorating health with
| them.
|
| I can't help to think that defining healthcare exclusively
| as medical care is an attempt at further gatekeeping from a
| profession already known for these practices... I mean,
| what brings in more dollars for the provider, a series of
| hospitalizations and vascular surgeries or a few hours of
| consulting and coaching?
| PuppyTailWags wrote:
| When I was fat, my insurance wouldn't cover any weight loss
| procedure (including just visiting my primary physician to
| discuss my options for weight loss-- a lovely $250 surprise)
| because I had no obesity-related health problems (heart
| disease, diabetes, joint issues, etc).
|
| So a hospital can actually do a lot for fatties. Being able
| to talk to a nutritionist, set up a plan, gain access to any
| applicable medication, addressing out underlying
| inflammation/hormone/disordered eating...
| hn92726819 wrote:
| How many pounds over a healthy weight were you? 20? 50?
| 150?
|
| Just curious
| PuppyTailWags wrote:
| Doesn't matter. I asked how significantly overweight I
| had to be to have access and the insurance company told
| me there's no weight-- it's purely obesity related health
| condition only. Theoretically also I could be 10 lbs
| overweight and diabetic and get a fast track to ozempic,
| lol.
|
| At one point my family medicine guy suggested he could
| write down something arguable just to get me to a
| nutritionist (think making me do some wicked pose while
| measuring my blood pressure and then writing it down as
| "high blood pressure") and I told him just don't bother.
| We did however in future meetings ensure I always had
| something else to talk about besides my weight progress
| so I'd never get billed again.
| dangwhy wrote:
| They usually consider you for surgery if your bmi is over
| 40 and you've tried ( and failed) conservative approaches
| to weightloss.
| PuppyTailWags wrote:
| No, that's not the case for many insurance companies. My
| insurance company only qualified surgery if you had a
| qualifying health condition. If you were just obese you
| didn't qualify.
| [deleted]
| nradov wrote:
| The most serious health effects tend to come not from
| absolute weight per se, but from excessive body fat
| percentage. And particularly from _visceral_ (intra-
| abdominal) fat, which is far more dangerous than
| subcutaneous fat in terms of risk for conditions like
| type-2 diabetes, arteriosclerosis, and COVID-19.
|
| The excess adipose tissue causes subtle, progressive
| damage which won't necessarily be obvious in the regular
| preventative screening exams that most younger patients
| receive. But as some point after age 50 or so the systems
| decompensate and the patient's overall health
| deteriorates rapidly.
| kspacewalk2 wrote:
| > When I was fat, my insurance wouldn't cover any weight
| loss procedure (including just visiting my primary
| physician to discuss my options for weight loss-- a lovely
| $250 surprise) because I had no obesity-related health
| problems (heart disease, diabetes, joint issues, etc).
|
| This is such a stupid, self-defeating policy for an
| insurer. Until your problem costs us a lot, don't you
| _dare_ try to mitigate it on our dime!
| ecommerceguy wrote:
| >> self-defeating policy for an insurer.
|
| Bariatric procedures can be included as a sort of
| "rider". This is typically written into self funded
| plans. Bariatric is not an essential coverage therefore
| ACA qualified plans do not typically include them -
| unless medically necessary.
| njarboe wrote:
| After Obama Care, insurance companies profits are now
| capped at 8% (think that is the number) of revenue (ie
| premiums) in the US. So one way to grow revenue is to
| have higher costs per policy, pay out more, and charge
| higher premiums. If you are at 8% profit and you reduce
| your payouts as you are describing with preventative
| care, then you don't get to keep that money. You have to
| pay it back to the insurance buyers. Very perverse
| incentive.
| kurthr wrote:
| The goal of the insurance companies is to make sure that
| all medical costs go up 10% every year so that their
| profits can increase and shareholders benefit. They are
| NOT negotiating lower pricing from medical providers,
| because why would they? Medical providers (and even
| individual care givers) have similar incentive structures
| to raise rates since they are paid only by insurance.
|
| The last local obstetricians were pushed into hospitals
| and large groups by insurance companies paying them
| 20-40% of prevailing fees. They now make more per
| procedure and don't have to pay for facilities or do
| billing. Why would the insurance company pay so much
| less? Because once the cartel is created their profit
| (and pricing) will double.
|
| That is for profit healthcare for you. Costs guaranteed
| to grow at DJI rates.
| nradov wrote:
| That is not really how the modern medical insurance
| business works. Most group buyers such as employers are
| now self insured. The medical "insurance" companies no
| longer bear much risk, they merely administer claims and
| manage provider networks. This business is intensely
| competitive with low profit margins. Insurance companies
| have to negotiate lower costs in order to sell to their
| customers, which are primarily employers that buy plans
| on behalf of their employees.
|
| Costs have continued to rise because provider
| organizations have been merging in order to gain more
| market negotiating power. Expensive patented drugs and
| medical devices also play a major role in driving up
| costs.
| peyton wrote:
| Ya insurers are price takers. They're fine being the bad
| guy though--your employer picks them, not you.
|
| It's unpopular to point fingers at provider orgs.
| IG_Semmelweiss wrote:
| >>>>>That is for profit healthcare for you. Costs
| guaranteed to grow at DJI rates.
|
| Not true. The Surgical Center of Oklahoma, a purely for
| profit clinic that does not take insurance, has not
| raised the rates for any of their services since 1995.
|
| Yes, they have not raised rates...despite inflation
|
| That's true profit healthcare.
|
| What we have is a monster hybrid between government
| healthcare and subsidized, monopoly care
| triceratops wrote:
| Unfortunately no one is lobbying for a truly free market
| in healthcare. For instance, at all the supply-side
| restrictions on new physicians and hospitals. Limited
| residency spots, certificates of need whatever.
|
| Ideally the party in opposition to government-funded
| healthcare would do this.
| gruez wrote:
| >Not true. The Surgical Center of Oklahoma, a purely for
| profit clinic that does not take insurance, has not
| raised the rates for any of their services since 1995.
|
| Source?
| dangwhy wrote:
| > Until your problem costs us a lot, don't you dare try
| to mitigate it on our dime!
|
| I assume gp meant bariatric surgeries by 'weight loss
| procedure'. These are not just cost considerations , they
| come with significant risks and long term side effects.
| They aren't get out jail free card to be handed out like
| candy and isn't a 'preventive care' for obesity related
| diseases.
| PuppyTailWags wrote:
| No. I was literally charged full price just for
| consulting with my family doctor about my weight. The
| doctor at the time referred me to a nutritionist; the
| nutritionist coverage was further denied because I had no
| qualifying health conditions. There was another option
| for weight loss medication, not the kind that affects
| hormones but makes the stomach feel full. These were also
| denied because I was just fat, not diabetic, heart
| problem, etc.
| dangwhy wrote:
| yea you might be one of those 'overweight but
| metabolically healthy' people. Despite the common
| misconception, you _can_ infact live a healthy life even
| you are overweight if you are metabolically healthy ( ie.
| no insulin resistance)
| deathanatos wrote:
| Perhaps they are, perhaps they aren't. But it seems to me
| that the way to figure out whether they are or are not is
| by taking the very reasonable step that they took: a
| visit to their GP (and including following the doctor's
| referral to a nutritionist).
| zdragnar wrote:
| Metabolic health is not the only type of issue overweight
| people face.
|
| I suspect the real issue is that there are no universally
| proven ways to reduce weight that have high success rates
| of adherence - for example, this is why CPAP and
| insurance is really tricky... too many people wear them
| for a bit then stop using them, wasting thousands of
| dollars (between the sleep study and the equipment
| itself).
| SV_BubbleTime wrote:
| I don't know, looking at the percentages... I'm not sure
| preventative care for obese people is sustainable at this
| point.
|
| Not that I shed tears for insurance companies, but I
| think this would be a lot of money. Now... the problem
| should have been addressed twenty years ago before it
| went critical.
| jancsika wrote:
| > This is such a stupid, self-defeating policy for an
| insurer.
|
| Quick, rank speculation:
|
| 100% of obese people don't go on to suffer from 100% of
| the potential risks of obesity.
|
| Given the actual percentages, it may be cheaper for the
| insurance company to pay for (and, at least in part,
| deny!) actual treatment for those potential risks than to
| cover the vast majority of preventative doctor visits and
| labs.
|
| Additional rank speculation-- I wonder if that problem
| gets worse as obesity numbers rise. E.g., symptom A
| necessitates a test for condition X, but symptom A plus
| obesity necessitates tests for condition X, Y, and Z...
| aqme28 wrote:
| In the US with healthcare tied to either employment or
| medicare, by the time these costs come around you're
| likely to either transfer out of this insurance or to the
| medicare option. Either way, it's someone else's problem
| (from the perspective of the current insurer).
| pessimizer wrote:
| > I was under the impression that USA healthcare has out of
| control costs due chronic diseases.
|
| It's an incorrect impression. All health care systems have to
| deal with chronic diseases. Americans are fat, through they
| aren't _twice_ as fat as other people, and the UK and Greece
| are nearly as fat in Europe. US health care costs are out of
| control because the system is kleptocratic.
|
| > What can any healthcare system possibly do about that.
|
| Its damned job. The healthcare system doesn't get to complain
| about the existence of sick people, even if people
| eugenically think that some illness are less deserving than
| others.
| dangwhy wrote:
| > through they aren't twice as fat as other people
|
| Did a quick google search.
|
| "The Health Survey for England 2021 estimates that 25.9% of
| adults in England are obese and a further 37.9% are
| overweight but not obese." 1
|
| "Approximately 70% of American adults have obesity or
| overweight. " 2
|
| 1. https://commonslibrary.parliament.uk/research-
| briefings/sn03...
|
| 2. https://www.fda.gov/news-events/press-announcements/fda-
| appr...
| [deleted]
| [deleted]
| logifail wrote:
| > Americans are fat, through they aren't twice as fat as
| other people
|
| They are, almost:
|
| "US obesity prevalence was 41.9% in 2017 - March 2020"[0]
|
| "25.9% of adults in England are obese"[1]
|
| [0] https://www.cdc.gov/obesity/data/adult.html [1]
| https://commonslibrary.parliament.uk/research-
| briefings/sn03...
| JohnFen wrote:
| > I was under the impression that USA healthcare has out of
| control costs due chronic diseases
|
| That certainly doesn't explain a great deal of it.
| rayiner wrote:
| I'm a supporter of universal healthcare but that trope about
| preventative care reducing cost isn't true:
| https://www.nytimes.com/2018/01/29/upshot/preventive-health-...
| lostlogin wrote:
| The article ends with 'good things cost money', which is a
| pretty good summary.
| standardUser wrote:
| Insurance companies sure do seem to push preventive care a
| lot these days, which would be bizarre if they didn't think
| it would reduce their costs.
| Eumenes wrote:
| See: Canada
| weberer wrote:
| I have no idea what's happening in Canada. What do you
| mean?
| [deleted]
| pookha wrote:
| If you watch what you eat, avoid obesity and some of the
| practices that lead to heart disease, and if you can
| moderately exercise you can avoid expensive health
| procedures. I don't even think that's debatable...
| wil421 wrote:
| None of what you just described is preventative care from a
| doctor. Everyone knows about exercise and junk food that
| doesn't mean someone will chose to do or not to do those
| things.
| runako wrote:
| This is simply not true, to a significant degree, as people
| age into and past middle age. (And even that is ignoring
| that accidents happen to healthy people of all ages. Eating
| well and exercising don't eliminate the need for expensive
| medical care after being in a serious car accident.)
| s1artibartfast wrote:
| I don't think the point is that eliminates every single
| cost, but offset some very major costs. Hope you see and
| obesity derived illness are real.
| maxerickson wrote:
| At a societal level, it isn't that ridiculous to look at
| worse outcomes as a cost.
|
| Like only counting dollars is a bad way to run a society.
| lostlogin wrote:
| > Like only counting dollars is a bad way to run a society.
|
| Absolutely. But one measure everyone understands is money,
| and you can convert a lot of situations into money. Poor
| health = missed work, missed rent payments, drugs needed
| etc. It's not a nice measure, but it works.
| uoaei wrote:
| I think one of the points of this entire thread has been
| to make it clear that "it works" only applies to people
| who have money, which means of course that it doesn't
| work.
| lostlogin wrote:
| I live in New Zealand, and we have a healthcare system
| that's free to use (YMMV). It's creaking, but the
| situation in the US really doesn't seem to suit anyone,
| nor even the rich.
| polygotdomain wrote:
| New Zealand is incredibly beautiful, I just wish I could
| go back. The US healthcare system suits the rich quite
| well. The companies that the rich people work for tend to
| offer significantly better plans that cover a lot of what
| you hear a bunch of people complain about. High earners
| and C-suite execs typically get offered a different plan
| then the rest of the proletariat do. They can cover the
| out of pocket costs just fine, and cover the elective
| procedures themselves. They generally have access to
| better doctors as well just based on location,
| flexibility with working hours, plans that will pay for
| them, and/or it being easier to handle the out of pocket
| costs.
|
| Universal healthcare actually means a downgrade in the
| experience for these people, which is one of the reasons
| why they don't want it. Yea, they might want to make sure
| that people don't get sent to the poor house just because
| they came down with some random disease, but god forbid
| they have to wait their turn behind some plebe in the
| doctors office.
| lostlogin wrote:
| > Universal healthcare actually means a downgrade in the
| experience for these people
|
| But it also means a much higher cost. I know these people
| are wealthy, but they are getting fleeced. Many (all?)
| socialised systems also have a private system along side,
| so the wealthy can avoid the great unwashed.
| tptacek wrote:
| That's as may be, but you can't just change the common
| definitions of terms to win the argument.
| maxerickson wrote:
| I suppose if I had written a longer comment I might have
| gone on about how lots of times advocates choose bad
| positions (so like here, the trope is trying to argue
| that preventative care reduces medical costs when there's
| a better position arguing that the benefits of
| preventative care outweigh the costs).
|
| It's not really very interesting to discuss the bad
| position at any length, except maybe as a launching point
| into some more interesting adjacent discussion.
| rayiner wrote:
| It is because it's not a cost of the policy, it's a
| benefit. You can reframe any benefit of a policy as the
| "cost" of not doing the policy. In practice it's just a
| right-brain advocacy-speak way to double count the benefit
| in the equation: "people will be healthier, and it will
| reduce costs." That's not a good way for intelligent people
| to communicate.
| carapace wrote:
| I dunno, it sounds to me a little bit like the concept of
| "opportunity costs"?
| gruez wrote:
| That's a real thing, but counting the benefits and the
| opportunity cost of not doing it is still double counting
| s1artibartfast wrote:
| It is like saying you will have the savings of being
| healthy plus avoid the costs of being sick.
|
| How would you show that on your balance sheet?
| [deleted]
| Retric wrote:
| From what I have read preventative medicine has been tried as a
| cost saving measure and it only seems to reduce costs in
| dentistry, immunization, and a few other fairly narrow areas.
|
| "Prevention can reduce the incidence of disease, but savings
| may be partially offset by health care costs associated with
| increased longevity." https://pubmed.ncbi.nlm.nih.gov/22052182/
| arethuza wrote:
| What counts as preventative medicine?
|
| A few years back I was hospitalised because of a bite on my
| arm from one of our cats (long story) and was given heavy
| doses of multiple antibiotics.
|
| If that hadn't been treated so promptly I might have required
| surgery or might even have lost my arm (a nurse told me about
| someone who lost a leg to a cat bite!).
|
| Edit: When I went to the hospital I had no idea how serious
| it was and turned up to the "Minor Injury Unit" - they had me
| in A&E and X-rayed within about 10 minutes!
|
| Edit: Of course, having been in the hospital for 3 days
| rather than the expected hour or so I was fretting about car
| parking charges - turns out they are free at the point of
| parking....
| yamtaddle wrote:
| > A few years back I was hospitalised because of a bite on
| my arm from one of our cats (long story) and was given
| heavy doses of multiple antibiotics.
|
| And of course there's an XKCD for that:
|
| https://xkcd.com/1775/
| Retric wrote:
| Preventative medicine is that which is done before
| significant symptoms. The basic issue, people tend to heal
| from most things. So the worst case of losing an arm to a
| cat bite is extremely unlikely. Meanwhile your hospital
| trip had an cost.
|
| Suppose the odds work out to 1:100,000 lost arm vs 300$
| hospital treatment. Now a lost arm is expensive but it's
| not 30 million dollars expensive.
|
| Those numbers aren't based on anything but that's the kinds
| of calculations involved. And as I mentioned the winners
| seem to be extremely cheap options like vacations.
| arethuza wrote:
| Vaccinations? :-)
| pclmulqdq wrote:
| That was one of the examples OP cited already as a place
| where preventative medicine works.
| i80and wrote:
| I believe they are referring to a
| s/vaccinations/vacations typo
| lostlogin wrote:
| The poor poster is likely getting hit by triggered HN
| users.
|
| On a brighter note, no one is anti-vacation.
| interactivecode wrote:
| If people don't get healthcare but still have costs of
| managing their symptoms. Or when people die at home,
| those costs aren't in the hospital books.
| Retric wrote:
| But they are largely on insurance companies/public
| healthcare systems books.
|
| This is why vaccines are generally free out of pocket,
| the ROI is very positive for the insurance company.
| bigbillheck wrote:
| The second half of that quoted sentence is really doing some
| work, isn't it.
| carapace wrote:
| > savings may be partially offset by health care costs
| associated with increased longevity
|
| This is the thinking of an insane person.
|
| Taking care of the elderly is what money is _for_ , yes?
|
| I mean, "increased longevity" and caring for our sick and
| elderly is kind of the point of civilization?
| s1artibartfast wrote:
| Civilization has multiple goals. That may be one valid use
| for it but it is not the only one. For example, I might say
| that money is for feeding hungry children
| carapace wrote:
| > Civilization has multiple goals.
|
| No. There is only one goal: defeat entropy.
| ("Evolution".)
|
| > money is for feeding hungry children
|
| Who then (ideally) grow up and become (eventually) old,
| eh?
| s1artibartfast wrote:
| I'll be honest, I'm really struggling to understand what
| you're trying to say here.
|
| It sounds like you're saying these are Universal truths,
| but I certainly don't think they are.
|
| I don't think the goal of civilization is to fight
| entropy or Foster evolution, or prolong lifespan. I also
| don't think most people would agree with that.
|
| I also don't think longevity is a singular goal on an
| individual or civilization level. As a simple thought
| experiment would you rather live to 50 and absolute
| happiness and pleasure, or live to 100 in complete
| misery?
| paulmd wrote:
| Yes, this is the absurd part of the fat-hate movement,
| "you're wasting my insurance/tax dollars!" actually no fat
| people tend to die early, and US healthcare spending is
| absurdly weighted towards end-of-life care for terminal
| patients, something like 50-70% of your total life spending
| comes in the last 18 months of your life. Someone quietly
| dying at 50 of heart disease is really cheap compared to the
| person spending 10 years fighting lung cancer at 70.
|
| Not that it should really matter, if the goal is to "get them
| healthy", right? But it's not, it's about having someone to
| hate and look down on. Black Mirror nailed this vibe
| perfectly in Ten Million Merits.
|
| Anyway this is a specific problem with the US healthcare
| system though - we spend way too much on patients who are
| circling the drain and everyone else gets screwed. Broken
| bones and bad dentistry and missed immunizations are what
| produces the single largest improvement in health outcomes -
| Cuba really only has something like a 7-year reduced lifespan
| vs the US iirc, because they do well at delivering that basic
| care even if you're not going there for proton radiotherapy
| or other ultra-high-end treatments. And the US does the
| latter but sucks at the former.
| bumby wrote:
| Your point seems muddled. If the majority of costs come
| from the last 18 months of care why does it matter if those
| last months occur at age 50 with heart disease or 70 with
| cancer? 18 months is 18 months.
|
| Your point seems to rather be that some diseases are
| cheaper to treat than others, or that the total area under
| the cost-life curve is driving the cost, not just the last
| few months.
| masfuerte wrote:
| Cuba and the USA have roughly the same life expectancy,
| with Cuba slightly ahead. https://en.m.wikipedia.org/wiki/L
| ist_of_countries_by_life_ex...
| [deleted]
| PuppyTailWags wrote:
| I don't think there's a fat-hate "movement" tbh. I think
| it's always been popular to make fun of fat people. Harry
| Potter and the Philosopher's Stone had a fat child be
| described as neglected, spoiled, and a bully, and therefore
| it was justified to magically force the child to grow pig
| parts that had to be surgically moved. Published 1997.
|
| I guess somewhat more recently we have people like Lizzo
| trying to push back on things like this, but the CDC has
| recently pushed a recommendation for bariatric surgery on
| children as young as 14 so. Shrug, I guess.
| jvanderbot wrote:
| I hear you, but reducing the incidence of someone's limbs
| dying because they were not allowed to get follow-up care
| from emergency surgery, or reducing the incidence of a 40
| year old woman with advanced dementia because she didn't get
| basic treatment for her diabetes - that's _worth it_.
|
| These folks could be doing other, more productive things with
| their lives, rather than wasting away in the shadows while we
| debate the national merit of saving them.
|
| (These are examples from TFA)
| coredog64 wrote:
| Treatment for diabetes is one of those narrow areas. We
| know this because private health insurance companies will
| pay for measures that improve compliance.
| DoreenMichele wrote:
| A. I spoke of other expenses, not merely health care, such as
| costs, both financial and non financial, of a minor child
| losing a parent.
|
| B. I have trouble believing this analysis is really looking
| at the whole picture.
|
| One of the _costs_ of illness that is frequently cited is
| _lost productivity._ You are going to tell me that when
| people live longer, all of them are merely running up more
| medical bills without also working additional years to help
| cover those costs?
| lotsofpulp wrote:
| It is possible, in the current environment, that people's
| labor, on average, is not valuable enough relative to the
| healthcare they might receive.
|
| For example, how many people get coronary heart disease,
| and how many years of their work would be needed to pay for
| a bypass or stent or even open heart surgery? I assume
| these surgeries cost hundreds of thousands of dollars. Plus
| the ongoing costs after that. Same with effects of diabetes
| and hypertension, which might as well effect everyone.
|
| Of course, there is liability, patents, licensing costs,
| etc that can be changed.
| nradov wrote:
| It doesn't have to be that expensive. Hospitals in India
| manage to do coronary bypass surgery for only $4,300 with
| good outcomes. I understand that costs and salaries are
| higher in the US, but still there is a huge amount of
| waste, fraud, and abuse that could be cut out.
|
| https://www.annfammed.org/content/12/5/470
| DoreenMichele wrote:
| If you live long enough, you are practically guaranteed
| to end up with cancer (say, past age 80).
|
| On the other hand, if you drink and drive while young and
| healthy, you can helpfully donate your organs to someone
| with a terrible condition and they can run up potentially
| a few million dollars in health care.
| mhardcastle wrote:
| "Federally qualified health centers" (FQHC) are required to
| treat people regardless of ability to pay, and are able to
| provide preventive care to non-citizens. A list of such health
| centers is available here, and there are quite a number in
| Houston (where the subject of the article is based):
|
| https://www.findahealthcenter.hrsa.gov/
|
| Whether would-be patients are sufficiently informed of this
| opportunity is another question, but resources for preventive
| care are not completely unavailable to these folks.
| abujazar wrote:
| That's how all hospitals work in developed countries.
| Mariehane wrote:
| I read an absolutely heart-wrenching excerpt from this book (The
| People's Hospital) recently in the new yorker. See:
| https://www.newyorker.com/science/annals-of-medicine/the-ass...
|
| One interesting point it emphasises is just how important
| insurance coverage is for survival. And that government insurance
| processes can be rather arbitrary or even injust.
|
| I hope this book is successful and that it makes a change towards
| more equitable healthcare in the United States.
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