“So that’s how I lost 30 years of my medical records.”
That sucks. Always, ALWAYS insist on having hard copies of your medical records/lab results etc mailed to you. If you have a patient portal, print out everything from there. Especially if there are a lot of records. It may be the difference between life and death. Take the records with you to every appointment just in case their computer system is down.
Take this advice form an insider.
Yes, says the libertarian, but they’re serfs to private enterprise, not the big bad government, so everything is just ginger peachy.
“There is an entire ecosystem of dueling administrators…”
And also there are primary care physicians or specialist outside the hospital who would not accept Medicare patients. They reject not only new patients but if you went to your family doctor for thirty years he tells you you’ll have to find someone else when you retire and have Medicare.
True story, I have the names of these dr’s.
In a functioning market, you would get that one line, unsigned pathology report and say “fuck that, I’m not paying for a useless piece of paper”. But in the laughable system we deal with, not paying for something like that (even though it is useless) will ruin your credit.
If we truly had a free-market healthcare system, I’d be able to call or go online and actually get costs in advance - not be told (as I have been) “we’ll do the procedure and then submit it through insurance and see what it comes out to”.
Sigh…
Some of this is due to international standards. Ever heard of ICD-10? https://en.wikipedia.org/wiki/ICD-10
Being international didn’t make it better or worse. It does mean that this source of confusion is standardized across countries.
And it’s not really that bad a standard. It’s just ginormous. Couple that together with a huge number of providers in the US (https://en.wikipedia.org/wiki/National_Provider_Identifier), none of which provide more than a fraction of the services in ICD-10, you’re going to have confusion.
Which makes the comparison to overnight delivery a bit off. That’s a couple services versus >70,000.
Single payer won’t magically fix it (but does give one entity power to dictate uniformity for good or bad). And at some level, you always need some way to bypass the system because no system is ever perfect.
That is a great meme.
It’s great because it is funny to the stupid for one reason, and funny to the smart for an opposite reason.
I like the particular observation that he notes at the start of the article.
“Communal-mode interpersonal skills may become increasingly important to life success—not less, as techies hope.”
This is an important thing that I had to come to understand since I’ve always had issues socializing with others. When I was in my 20s I really got into the free market capitalism and Objectivist ideologies because of the promise of not having to deal with people regardless of how good or bad they were. I wrongly believed that any complex economic or social system could be automated and thus remove the human element. The fact that many in the healthcare startup world think this way is clearly a deficiency that’s going to rob many of them an advantage to succeed (let alone actually benefit society). It’s frightening to me now how much effort is being spent on removing people from the equation when it comes to healthcare or any other sector of the economy on the flawed assumption that people are the problem rather than the system which people have to operate within.
Brother you said mouth full.
"I like the particular observation that he notes at the start of the article.
“Communal-mode interpersonal skills may become increasingly important to life success—not less, as techies hope.” "
Those always were, always will be no matter how automatized/depersonalized a system is.
In the old times this was one of the things your parents told you about.
Just human nature. It always comes down to who you know and how much influence they have. In every aspect of life.
the main issue is that internally the system doesnt work either
This is a liberal critique. Please permit me to offer a radical structural alternative: The health care system works as intended by its architects. If we shift our frame from how can we cover the most people with the best quality of care? to how can we maximize the wealth and income of private insurance company owners, private hospital owners, pharmaceutical company owners, and the requisite physicians and executive management? the health care system will be understood to be operating quite efficiently.
The health care system is akin to being shot into a giant pinball machine.
One of the things I have noticed more and more is hospitals using contract doctors from an outside source and techs rather than real residents or employees so you never see the same person twice and the one who ran the test last week might not be there this week.
This has got to play hell with continuity of care and, while I do not always agree with the bleak assessment of our health system (Do some digging to find out how many people from those “utopian” countries with government paid health care come here on medical visas to get things done . I think the numbers will astound you.) the never see the same doctor twice issue has got to cause problems.
That’s because Medicare does not pay them enough.
“That’s because Medicare does not pay them enough.”
They get more than enough from non-medicare patients. Also, Medicare payments are not as bad as people made to believe. Let me not pull out my hankies just now for the greedy moneygrabbing individuals. I know plenty of drs who are satisfied with their income and do not deny healthcare for those who are on Medicare. And I work for one.
In that case, no problem.
I know and have known quite a few relatives who went on medicare over the past 5 years… and none of them have ever complained about being unable to find or get appointments with doctors and every one of them goes to the doctor fairly regularly, uses specialists, and a few of them have had some serious issues this year.
I once read that while medicare does typically pay somewhat less than private insurance doctors also find it a lot cheaper to deal with. Medicare billing isn’t simple, but it is consistent and it predictable. Private insurance billing is chaotic and far more likely to start a lengthy argument over a bill and finally cough up the money months later. Doctors offices in the US have something like 3x the support staff vs other countries because it takes that much time to deal with billing here.
Viewing from within a medical system far from the US, there are very similar elements. Let’s forget about how you pay for treatment, because the US is seriously screwed for various reasons. Other than that, the medical system I am a part of is not much different.
GP/Specialist relationships have always worked this way, and it is not a bad system. It only becomes bad when something non-medical. like health insurers, are inserted into the chain. Fortunately, Australia is still in a situation where they can be easily bypassed. For instance, I, as a clinician, can decide at my hospital that a particular patient bill generated by my activity will not be passed to a collection agency, but will be written off. I also have a personal relationship with various (most) specialists in my town that allow me to have an actual direct conversation about a patient, rather than have that conversation though an administrative gatekeeper.
A relationship with a patient is much more like a village bartering system, or a small corner business. And that’s the way it needs to stay.
This is kind of the point of the rest of Meaningness - how to deal with that fact. Personally I think reading that site should be a prerequisite for anyone who wants to propose any kind of reform of anything more complicated than a hamburger.
Actually there are good reasons for having a paging system! Don’t get me wrong the pagers are a piece of crap. BUT not relying on main mobile networks is a great idea as it means that medical communication stays up even during busy patches for communication (like following a major disaster or or NYE)
Faxes piss me off to no end, but emails are basically harder to secure for the purposes of sending patient information.
The whole electronic medical records thing is a bit of a funny one.
It’s a great idea in theory. Except that you can buy all the medical records systems you like but you still need to -
We recently moved over to an electronic prescribing system. On a good day it’s very convenient, helps reduce errors. On a bad day with a poor connection it can take me, a computer-savvy millennial, 45mins to write a script that I could handwrite in 3.
Yes, but professional government technocrats, all of them with lots of academic credentials, made up the EHR and meaningful use regulations, so they must be a good idea.
