Is the US health system collapsing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Average annual salary of a US pediatrician is $183,000. At 50hrs/wk with 2wk/yr vacation, that's about $73 an hour. Average debt from training is $264,000, but of course it accrues interest until paid off.

For family doctors, it's an average salary of
$220,000, of about $88/hr, with an average of $192,000 school debt.

I don't think they are going to Europe multiple times a year. You probably want to aim that arrow, PP.

https://www.forbes.com/sites/andrewdepietro/2020/02/27/pediatrician-salary-state/

https://www.aap.org/en/career-resources/planning-your-career/managing-medical-student-debt/

I don’t think it’s accurate. DC has a friend group where almost all kids are doctors’ kids and they are all millionaires.

Do you think a surgeon makes the same as a pediatrician? A cosmetic dermatologist makes the same as a family doctor, and works the same ours?

Look up "proceduralist." You need information.

[Anonymous]

^^"hours," not "ours"

[Anonymous]

Anonymous wrote:

Anonymous wrote:Average annual salary of a US pediatrician is $183,000. At 50hrs/wk with 2wk/yr vacation, that's about $73 an hour. Average debt from training is $264,000, but of course it accrues interest until paid off.

For family doctors, it's an average salary of
$220,000, of about $88/hr, with an average of $192,000 school debt.

I don't think they are going to Europe multiple times a year. You probably want to aim that arrow, PP.

https://www.forbes.com/sites/andrewdepietro/2020/02/27/pediatrician-salary-state/

https://www.aap.org/en/career-resources/planning-your-career/managing-medical-student-debt/

I don’t think it’s accurate. DC has a friend group where almost all kids are doctors’ kids and they are all millionaires.

Levels.fyi

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Lots of people go overseas for cheaper care, and that includes Americans.

https://www.magazine.medicaltourism.com/article/top-10-medical-tourism-destinations-world

Canada and the UK are on the list of countries people go to for medical care. Non residents would pay out of pocket, of course, so they don't use the national care service.

US is not on the list. Most people in the world cannot afford American medical prices.

https://www.insidermonkey.com/blog/top-5-medical-tourism-destinations-in-the-world-1176780/5/

This one lists in order from the first link (Medical tourism link)
1. Canada
2. Singapore
3. Japan
4. Spain
5. UK

Example of hip replacement surgery in different countries (hint: US is the most expensive; UK is less than half the cost of the US, and India is the cheapest):

https://www.medicaltourismco.com/hip-replacement-surgery-abroad/

How do you get follow up care if you have a hip replacement or other procedure abroad? I'm part of the "if anything can go wrong it will go wrong" category of patients.

Typically, medical tourists recover and stay in that country a bit longer until they are fully recovered.

Harder to do in the more expensive countries like Canada and UK.

I think if you go to cheaper countries, there are medical care packages you can buy. It covers the cost of the medical treatment, stay at a place where you can recover and you get care.

*If* something happens months later, I guess you have to go back or try to find a US doctor who will deal with it (most probably won't due to malpractice).

But, when you don't have the money for medical care, you are going to take that small risk of something happening to get that care that you can afford.

When complications arise when patients return to the US, they appear in ERs and doctors are not happy about being faced with someone else's mess. Probably more with people who go to Mexico since part of the idea is likely not have to spend money on boht travel and extended stay in another country.

This is the typical scare tactic to dissuade people from traveling abroad for much cheaper medical care, how is that any different than in the U.S.? If I get a hip replacement done by a crappy surgeon in California, move to Virginia, and then need to go to the EE because of the crappy surgery, the ER doc in VA is still going to be dealing with crappy work left behind by a doctor far away.


American doctors think they’re the best in the world and that the rest of the world is incapable of training just as good physicians. What a farce. Typical dumb scare tactics used to convince Americans they should keep paying 10-1000x more for the same procedures that are done elsewhere in the world at just as good if not better standards than what you get here.

This. The difference in cost isn't because our doctors or equipment are better, it's due to many factors.

1) Doctors have to make enough to compensate for huge student debt and many years of not earning enough to pay it off. Otherwise nobody will be going into medical profession
2) Insurance companies are not non-profits and will be looking out to maximize returns.
3) Big Pharma and medical equipment industry will lobby hard to get their products pushed to general public and incentivize medical professionals to give them to patients. This may not often be in patient's interests due to high prices or drugs/equipment later proven to be unsafe.
4) Malpractice insurance is very costly here and doesn't exist overseas. If someone screws up your surgery overseas, can you sue?
5) Not every hospital can turn away uninsured, some have to take in patients who are expensive to treat and will never pay. This cost is prorated to the paying customers in the form of exorbitant and irrational fees for the same procedures/meds provided in other clinics and urgent care centers for a fraction of the cost.
6) Big hospital systems have huge admin overheads and dont' care to compete on prices with smaller clinics or radiology centers.
7) hospital rooms cost more than 5 star hotels and this doesn't include care

These are standard insurance industry talking points. PP, are you affiliated with an insurance company of payer.

Nope. Not at all. I would never advocate for insurance industry and our entire healthcare clusterf**k. I Had stated this in point (2) .
This doesn't negate issues with Hospital systems and Big Pharma I observe directly as a consumer.

I've had private health insurance and high deductible corporate plans. I've had to fight multiple claims and a couple of these lasted for years to avoid paying many thousands hospitals/insurance said I owed when they change things around with their network contracts. I am not a fan.

Can we talk about the bolded? I also have good insurance, but the last couple of years I have defn seen an increase in me being told I was responsible for things that are clearly covered in my plan. The biggest reason I get is "well we did cover that, but the medical office coded this other thing and that thing isn't covered." Like I'm supposed to discuss coding on check out. Last was I went in for an annual well woman aka gyn check. The visit was covered, but the Dr's office "coded" an extra charge for the pelvic exam. I was absolutely incredulous.....like how can you do an annual gyn exam without a pelvic? Back and forth, back and forth until I finally figured that right appeal mechanism and got it removed. It was also "only" for $50 so I'm sure a lot folks wouldn't even fight it. But this type of thing is happening more and more in my experience. And I'm sure it all has to do with players in the system trying to maximize profits. Not healthcare.

[Anonymous]

U.S. Health system is awesome for those of us who have good health insurance. It is far from collapsing. In fact, your posting this makes me think you have no idea what a bad health system looks like.

This is from 2022.
https://www.ctvnews.ca/health/i-thought-i-might-die-at-home-canada-s-health-care-system-is-crumbling-experts-say-1.6036628#:~:text=Across%20the%20country%2C%20Canadians%20have%20been%20struggling%20with,needs%20to%20be%20taken%20to%20aid%20health-care%20workers.

[Anonymous]

Anonymous wrote:My family mostly uses providers who don't accept insurance at all. We have BC/BC HMO so that we get good rates on blood work and are covered for emergencies. Our insurance is bought from the "exchange" and runs $2k a month with a $5k deductible. So $24k+ for useless insurance and thousands of dollars for providers who don't have waits and give us good service. This is insane. But the care we've received from providers in the system has mostly sucked.

I think we are headed toward private pay for the rich, and endless waits and poor care for everyone else.

Truly insane. If this — which is fairly typical—isn’t proof that the system is broken, I don’t know what is.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The other thing that's stunning is the cost of medication in the USA. I know people who go on trips abroad just to stock up on their regular medicines that are 1/20 of the price in other countries.

If the cost of medication was the same globally only the us could afford it

Snort. Pfizer's CEO gets paid $35 million/year, 2nd among all corporate CEOs. Yes, it is expensive to develop new drugs, but that doesn't explain why low cost generics aren't more widely available in the USA

Watch the “farm bill.” It is a massive piece of legislation that flies under the radar. Look at that bill, and you will see how big pharma funds R&D. Tax credits. Huge amounts of corporate welfare.

[Anonymous]

Anonymous wrote:Today I saw a Facebook story posted by a family of doctors that we know where they are flying overseas with 4 of their children (6 total) all in the first class. This is their fourth or fifth European vacation in the past year. All 4 kids go to a private school. They have multiple million dollar homes.

Meanwhile, people can’t afford to have medical conditions treated. Meanwhile, people have to ration insulin injections.

Meanwhile, in the country I came from a doctor often has to work 2-3 hobs to make ends meet.

US healthcare system is definitely a disaster.

These people are exception and not rule when it comes to doctors. What kind of doctor is this friend? Surgeons and specialists can make money especially if they own surgery centers. But regular primary care doctors are not wealthy unless they have family money to start with.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It isn’t collapsing. It has collapsed.

100%

When someone goes to the ER with chest pains & is waiting in the waiting room for 9 hrs instead of immediately being taken to triage, it's a broken system.

When an elderly person is diagnosed with having had a stroke in the ER & discharged with orders to follow up with a neurologist within 7 days, but the earliest appointment you can get them is 8 months out, the system is broken. My sibling and I sat calling with our mom to try to get my dad an appointment & this was the result. We have him on a dozen different waitlists but we're still 4 months away from his appt. Terrifying.

A friend went through something similar in finding a Derm. Her Derm couldn't get her in until FEBRUARY 2025 and she had a worrisome spot appear that was rapidly changing. After finding none that could get her in, she went the concierge Derm route. Luckily she had the funds to do so, but what about those who can't go that route? We're going to get to the point where those without the funds to seek alternate treatments get sicker or die while waiting.

Is this small town USA?

Not PP. After a sleep study revealed severe obstructive, sleep apnea, the earliest available appointment I could get with the sleep doctor was eight months out. They told me that during that time while I was waiting my heart enlarged because I was untreated. Very dangerous.

This was Medstar Georgetown. Not “small town USA.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Lots of people go overseas for cheaper care, and that includes Americans.

https://www.magazine.medicaltourism.com/article/top-10-medical-tourism-destinations-world

Canada and the UK are on the list of countries people go to for medical care. Non residents would pay out of pocket, of course, so they don't use the national care service.

US is not on the list. Most people in the world cannot afford American medical prices.

https://www.insidermonkey.com/blog/top-5-medical-tourism-destinations-in-the-world-1176780/5/

This one lists in order from the first link (Medical tourism link)
1. Canada
2. Singapore
3. Japan
4. Spain
5. UK

Example of hip replacement surgery in different countries (hint: US is the most expensive; UK is less than half the cost of the US, and India is the cheapest):

https://www.medicaltourismco.com/hip-replacement-surgery-abroad/

How do you get follow up care if you have a hip replacement or other procedure abroad? I'm part of the "if anything can go wrong it will go wrong" category of patients.

Typically, medical tourists recover and stay in that country a bit longer until they are fully recovered.

Harder to do in the more expensive countries like Canada and UK.

I think if you go to cheaper countries, there are medical care packages you can buy. It covers the cost of the medical treatment, stay at a place where you can recover and you get care.

*If* something happens months later, I guess you have to go back or try to find a US doctor who will deal with it (most probably won't due to malpractice).

But, when you don't have the money for medical care, you are going to take that small risk of something happening to get that care that you can afford.

When complications arise when patients return to the US, they appear in ERs and doctors are not happy about being faced with someone else's mess. Probably more with people who go to Mexico since part of the idea is likely not have to spend money on boht travel and extended stay in another country.

This is the typical scare tactic to dissuade people from traveling abroad for much cheaper medical care, how is that any different than in the U.S.? If I get a hip replacement done by a crappy surgeon in California, move to Virginia, and then need to go to the EE because of the crappy surgery, the ER doc in VA is still going to be dealing with crappy work left behind by a doctor far away.


American doctors think they’re the best in the world and that the rest of the world is incapable of training just as good physicians. What a farce. Typical dumb scare tactics used to convince Americans they should keep paying 10-1000x more for the same procedures that are done elsewhere in the world at just as good if not better standards than what you get here.

This. The difference in cost isn't because our doctors or equipment are better, it's due to many factors.

1) Doctors have to make enough to compensate for huge student debt and many years of not earning enough to pay it off. Otherwise nobody will be going into medical profession
2) Insurance companies are not non-profits and will be looking out to maximize returns.
3) Big Pharma and medical equipment industry will lobby hard to get their products pushed to general public and incentivize medical professionals to give them to patients. This may not often be in patient's interests due to high prices or drugs/equipment later proven to be unsafe.
4) Malpractice insurance is very costly here and doesn't exist overseas. If someone screws up your surgery overseas, can you sue?
5) Not every hospital can turn away uninsured, some have to take in patients who are expensive to treat and will never pay. This cost is prorated to the paying customers in the form of exorbitant and irrational fees for the same procedures/meds provided in other clinics and urgent care centers for a fraction of the cost.
6) Big hospital systems have huge admin overheads and dont' care to compete on prices with smaller clinics or radiology centers.
7) hospital rooms cost more than 5 star hotels and this doesn't include care

These are standard insurance industry talking points. PP, are you affiliated with an insurance company of payer.

Nope. Not at all. I would never advocate for insurance industry and our entire healthcare clusterf**k. I Had stated this in point (2) .
This doesn't negate issues with Hospital systems and Big Pharma I observe directly as a consumer.

I've had private health insurance and high deductible corporate plans. I've had to fight multiple claims and a couple of these lasted for years to avoid paying many thousands hospitals/insurance said I owed when they change things around with their network contracts. I am not a fan.

Can we talk about the bolded? I also have good insurance, but the last couple of years I have defn seen an increase in me being told I was responsible for things that are clearly covered in my plan. The biggest reason I get is "well we did cover that, but the medical office coded this other thing and that thing isn't covered." Like I'm supposed to discuss coding on check out. Last was I went in for an annual well woman aka gyn check. The visit was covered, but the Dr's office "coded" an extra charge for the pelvic exam. I was absolutely incredulous.....like how can you do an annual gyn exam without a pelvic? Back and forth, back and forth until I finally figured that right appeal mechanism and got it removed. It was also "only" for $50 so I'm sure a lot folks wouldn't even fight it. But this type of thing is happening more and more in my experience. And I'm sure it all has to do with players in the system trying to maximize profits. Not healthcare.

They are literally scamming us. Right out in the open.

[Anonymous]

Private equity is a massive and scary problem that is not getting enough attention

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Lots of people go overseas for cheaper care, and that includes Americans.

https://www.magazine.medicaltourism.com/article/top-10-medical-tourism-destinations-world

Canada and the UK are on the list of countries people go to for medical care. Non residents would pay out of pocket, of course, so they don't use the national care service.

US is not on the list. Most people in the world cannot afford American medical prices.

https://www.insidermonkey.com/blog/top-5-medical-tourism-destinations-in-the-world-1176780/5/

This one lists in order from the first link (Medical tourism link)
1. Canada
2. Singapore
3. Japan
4. Spain
5. UK

Example of hip replacement surgery in different countries (hint: US is the most expensive; UK is less than half the cost of the US, and India is the cheapest):

https://www.medicaltourismco.com/hip-replacement-surgery-abroad/

How do you get follow up care if you have a hip replacement or other procedure abroad? I'm part of the "if anything can go wrong it will go wrong" category of patients.

Typically, medical tourists recover and stay in that country a bit longer until they are fully recovered.

Harder to do in the more expensive countries like Canada and UK.

I think if you go to cheaper countries, there are medical care packages you can buy. It covers the cost of the medical treatment, stay at a place where you can recover and you get care.

*If* something happens months later, I guess you have to go back or try to find a US doctor who will deal with it (most probably won't due to malpractice).

But, when you don't have the money for medical care, you are going to take that small risk of something happening to get that care that you can afford.

When complications arise when patients return to the US, they appear in ERs and doctors are not happy about being faced with someone else's mess. Probably more with people who go to Mexico since part of the idea is likely not have to spend money on boht travel and extended stay in another country.

This is the typical scare tactic to dissuade people from traveling abroad for much cheaper medical care, how is that any different than in the U.S.? If I get a hip replacement done by a crappy surgeon in California, move to Virginia, and then need to go to the EE because of the crappy surgery, the ER doc in VA is still going to be dealing with crappy work left behind by a doctor far away.


American doctors think they’re the best in the world and that the rest of the world is incapable of training just as good physicians. What a farce. Typical dumb scare tactics used to convince Americans they should keep paying 10-1000x more for the same procedures that are done elsewhere in the world at just as good if not better standards than what you get here.

This. The difference in cost isn't because our doctors or equipment are better, it's due to many factors.

1) Doctors have to make enough to compensate for huge student debt and many years of not earning enough to pay it off. Otherwise nobody will be going into medical profession
2) Insurance companies are not non-profits and will be looking out to maximize returns.
3) Big Pharma and medical equipment industry will lobby hard to get their products pushed to general public and incentivize medical professionals to give them to patients. This may not often be in patient's interests due to high prices or drugs/equipment later proven to be unsafe.
4) Malpractice insurance is very costly here and doesn't exist overseas. If someone screws up your surgery overseas, can you sue?
5) Not every hospital can turn away uninsured, some have to take in patients who are expensive to treat and will never pay. This cost is prorated to the paying customers in the form of exorbitant and irrational fees for the same procedures/meds provided in other clinics and urgent care centers for a fraction of the cost.
6) Big hospital systems have huge admin overheads and dont' care to compete on prices with smaller clinics or radiology centers.
7) hospital rooms cost more than 5 star hotels and this doesn't include care

These are standard insurance industry talking points. PP, are you affiliated with an insurance company of payer.

Nope. Not at all. I would never advocate for insurance industry and our entire healthcare clusterf**k. I Had stated this in point (2) .
This doesn't negate issues with Hospital systems and Big Pharma I observe directly as a consumer.

I've had private health insurance and high deductible corporate plans. I've had to fight multiple claims and a couple of these lasted for years to avoid paying many thousands hospitals/insurance said I owed when they change things around with their network contracts. I am not a fan.

Can we talk about the bolded? I also have good insurance, but the last couple of years I have defn seen an increase in me being told I was responsible for things that are clearly covered in my plan. The biggest reason I get is "well we did cover that, but the medical office coded this other thing and that thing isn't covered." Like I'm supposed to discuss coding on check out. Last was I went in for an annual well woman aka gyn check. The visit was covered, but the Dr's office "coded" an extra charge for the pelvic exam. I was absolutely incredulous.....like how can you do an annual gyn exam without a pelvic? Back and forth, back and forth until I finally figured that right appeal mechanism and got it removed. It was also "only" for $50 so I'm sure a lot folks wouldn't even fight it. But this type of thing is happening more and more in my experience. And I'm sure it all has to do with players in the system trying to maximize profits. Not healthcare.

Same here - it's insane. And the insurer, who you are paying for their service, almost gleefully tells you, oh, it was coded wrong. And my GYN billed me for my annual because the GYN asked me about pelvic floor function (a covered part of a well-woman exam) and then made a referral. I was like, I am not paying that. The office staff was clueless. It was finally resolved in my favor but seriously!?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Average annual salary of a US pediatrician is $183,000. At 50hrs/wk with 2wk/yr vacation, that's about $73 an hour. Average debt from training is $264,000, but of course it accrues interest until paid off.

For family doctors, it's an average salary of
$220,000, of about $88/hr, with an average of $192,000 school debt.

I don't think they are going to Europe multiple times a year. You probably want to aim that arrow, PP.

https://www.forbes.com/sites/andrewdepietro/2020/02/27/pediatrician-salary-state/

https://www.aap.org/en/career-resources/planning-your-career/managing-medical-student-debt/

I don’t think it’s accurate. DC has a friend group where almost all kids are doctors’ kids and they are all millionaires.

Doctor here. If your kids’ friends’ parents are millionaire doctors then they sure as heck don’t work for Johns Hopkins. I earn 450K (20+ years of experience, division director at an academic hospital, very high cost of living city, subspecialty that is moderately well paid), and Hopkins contacted me asking me to consider a division director position at their main hospital for 215K.

Almost certainly the reason that these people appear to be millionaires is family money. Lots of family money in medicine. It’s expensive just applying to med school.

And yes, the medical system in the US is crashing and burning. My colleagues and I work 60 hours a week; it is exhausting. So many people are retiring because they can’t take it. Last night several people in my group and an attending from another hospital were all shooting emails to each other about a new patient from 10-midnight because the person on call was already swamped and the fellows can’t take call anymore (work hours regulations). We just work all the time. I think we do it because is very very rewarding - we literally save people’s lives, the patients are complex and interesting, and my colleagues are brilliant and funny, so it can be really fun to work - it’s almost addicting to get the opportunity put your brain into hyperdrive daily!

But the administrative burden is crushing, we haven’t had a raise since 2019, and I saw - this is not a joke - 47% more patients per year in 2023 than in 2019. And hospital leadership took away my admin, so now I get to do things like fix the (shared) printer, fax documents, and order office supplies.

It not a great way to live when you are in your 50s, and it enrages your family when you work on vacation, on weekends, and immediately start up your computer the minute you get home from work at 9:30 PM. And we make an order of magnitude less than the tech guys in our city who work 30 hours a week from home.

[Anonymous]

Anonymous wrote:Private equity is a massive and scary problem that is not getting enough attention

This! Why is this allowed? Private equity companies are focusing on short-term profits over the long-term health of patients.

The worst is the majority of nursing homes have been taken over by for profit firms.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Private equity is a massive and scary problem that is not getting enough attention

This! Why is this allowed? Private equity companies are focusing on short-term profits over the long-term health of patients.

The worst is the majority of nursing homes have been taken over by for profit firms.

Yep, this. There is a huge conflict of interest in health care being for profit. I’m an American physician and have done temporary jobs in two countries with very well functioning public health systems (New Zealand and Israel) - until I did that, I don’t think I understood how disgusting it is that such a massive chunk of health care spending goes to corporate profit along with the many thousands of middlemen involved in billing, collections, etc. It is directly being taken away from patient care and out of the pockets of the sick. It’s clear why we spend so much more on health care than other countries with often-worse outcomes. If Medicare had extended to all from the start as had been originally considered, it wouldn’t have stifled innovation - Israel is full of high quality health care research and startups despite their socialized system. But because of our country’s bizarrely permissive lobbying rules, it will never happen.