dagblog - Comments for "Where did our raises go? To health care."

the Amazon Buffett

artappraiser — Mon, 03 Sep 2018 18:14:47 +0000

In reply to 1) what you're describing is

the Amazon Buffett experimental health care thing is intriguing to me precisely because I, along with a gazillion other customers, have been impressed with Amazon.com huge majorly yuge automation and yuge number of "providers" and getting them to lower prices while at the same time somehow still assuring a relative level of satisfaction. And most importantly when something goes wrong there is always a human to reach on the phone with the power to change things. Not just the review and rating system alone. The underlined is the most important part. Ebay's process of letting the communal market sort out problems of using an automated system on their own didn't work so well.

What Amazon has done may have had all kinds of unexpected bad effects on our economy and livelihoods etc. But contrarily, some of what it has done might be exactly what the health care system needs.

They have hired Dr. Atul Gawande as CEO, did you see!? He is like the best, the major domo, at figuring out what is wrong with the health care system(s.) Their gain, our loss in that he is no longer going to be writing about what he has discovered and what he knows.

And then deny them coverage

PeraclesPlease — Mon, 03 Sep 2018 17:28:43 +0000

In reply to another example one kind

And then deny them coverage when they have a reaction, cause they missed a dose. Too clever by far.

1) what you're describing is

PeraclesPlease — Mon, 03 Sep 2018 17:26:56 +0000

In reply to I'm seriousy accessing the

1) what you're describing is non-automation, even if you think you're describing automation. There should be *0* reson to wait on hold - they have either your number or whatsapp or web link to follow you back, for example. Your message can include requests, notes, or doctor's forms, x-rays, etc as ling as you have your own records. Think of booking Uber or AirBnB - no one wiuld stand for this shit.

2) I left the US 15 years ago largely because of this dismal health care situation and my inability to get theough or understand the care system. Seems like I made a good decision - the problems are still there. And I was in above average position.

another example one kind

artappraiser — Mon, 03 Sep 2018 17:25:07 +0000

In reply to I'm seriousy accessing the

another example one kind doctor revealed to me. I asked him if he could do something about me getting more than a month of my prescription at a time, so that I didn't have to worry about not having enough to take an out of town trip and also so i do not have to arrange to be in line at the pharmacy at a certain time each month. This is something I have taken for a decade. He said oh I know why they do that! With a sort of anger in his voice. He said they do it intentionally hoping that people will skip a few days of their medication inbetween renewals. That it is especially common with Medicare, that with the huge pool of people on fixed income who might no have co-pay available at a certain time, it can make them a nice profit if a lot of people are skipping their meds for a few days each month. Very perverse incentives being built in by not that smart "algorithms" or AI or whatever.

I'm seriousy accessing the

artappraiser — Mon, 03 Sep 2018 17:10:06 +0000

In reply to Yeah, I'm still wondering

I'm seriousy accessing the last year or so and I think the automation is part of the problem. The practice of medicine is an art not a science so one-size cookie cutter screws everything up for provider and patient both but makes things efficient and profitable for the behemoth corps.

Illness does not always fit a code. I would venture it rarely does and in actuality anyone getting health care that way is not really getting decent medicine to maximize quality of health and life. They are just getting lots of prescriptions and tests that don't really fit what's wrong with them.

Example: a couple of years ago if an insurer denied a brand name prescription, and said you must take generic first. The doctor or patient could call up a human at the insurer and argue the patient tried generic years ago with another doc and it makes them sicker but the new brand might help or even get pharmacist to intervene. There is no longer the human there for patient nor doctor nor pharmacist, just diagnostic codes and huge Kafka like CVS pharmacy system and huge Kafka like Optum RX corp. denying or approving on behalf of huge United Insurance corp according to protocols set for that diagnostic code.

It's very profitable to just have the patient suffer a long-lasting cookie cutter bunch of medicines and treatment protocol which are no longer being arranged by a stupid aggravating human nurse at some desk in Nebraska but rather now it has been pre-arranged at a price that is sure to be profitable for both CVS and generic drug co. maker X.

This is the same with like a provider, like if you have undiagnosed nerve pain, the human neurologist to be profitable has 15 minutes with the patient, he better figure out what code to put in so the patient can get all the right drugs. The patient is not given a phone number to talk to the doctor nor an assistant nor anyone really, the patient is then on his own with the automated system of treatment for a a few months accessing stuff that is profitable for the big cos. but not helping him and is not cured but comes back in a few months for another appt. to rinse and repeat and everyone gets a profit while the patient is still ill. What in the old days could have been a quickly resolved acute problem with human attention becomes a chronic problem for the patient and a profit machine of people being kept ill and/or made ill for the big providers

It affects the whole system. One can see how even providers like physical therapists have become machines that prolong illness and increase number of short billable visits where the patient is told to practice the wrongly prescribed exercise at home and then after that doesn't work another and and another. Where they used to individualize treatment for each individual human as they observed with their own eyes.

Really truly has gotten more Kafka like in the last few years with big automation. And both human providers and patients are ready to crack. If the want to get well, patients have do a lot more of the labor now that used to be done by the doctors and their offices, the profit makers have shifted the labor to the party, the patient, who does not extract any payment, just gives free time suffering.

Check out what medical practitioning is most popular these days to go into and you'll see that it's dentistry because it is not covered by health insurance nor by automation of care.

There's all kinds of odd results. It''s very clear once a patient starts accessing that specialist doctors if that take insurance are rarely reachable by phone nor by email once you are their patient. Instead if lucky you talk to some idiot phone line person who is trained not to bother the doctor or any provider if at all possible. Often a one-size-fits all robot phone doctor or P.A. If you have a question or bad reaction, he/she types it into the system and it gets ignored. What the system really wants is for you to come in for another short appt which is billable and profitable. Meanwhile you suffer. Not to mention labor hrs. has been shifted to you who does not charge for your time. While with doctors that don't who have stopped taking insurance and go out-of-pocket fees, they are the ones who will give you their cell phone # and email, what they are selling: access and care through diagnosis and treatment. Partly because it's efficient and partly because they get to practice medicine like they were trained to and hoped to.

Edit to add: on the drug thing, I've had CVS pharmacist tell me about a denial (after I have waited 30 min. in line to talk to one, naturally-and a reminder, my time is not billed): we have to call the same phone number you do! Meaning: they have few humans to interact with when the system is not working, either. Basically it's: you get what the system says you get, whether it's helping you or not. An illusion of efficiency of care when actually it's like an assembly line to make money off of illness, a lot of of it iatrogenic, caused by the wrong treatments themselves. So much so that I will not be surprised to read someday that like, the "epidemic" of diabetes was being caused by everyone being on the wrong blood pressure medications. (Oh isn't this sorta like how the opoid epidemic happened? Really?)

Yeah, I'm still wondering

PeraclesPlease — Mon, 03 Sep 2018 10:28:40 +0000

In reply to Where did our raises go? To health care.

Yeah, I'm still wondering about Obamacare, as in "was this the best we could do?" (not that GOP doesn't have much worse ideas) with its seeming abandonment of cost reduction/containment as equal to extent of coverage.
Which considering that with IT & digital sequencers & better scanners and probes, et al - they can automate things much better, cut down on personnel, catch problems faster, speed up sharing of info - and yet it all costs exponentially more. Even the insurance part should have pared back costs tremendously. Instead, everyone just charges more, and without much pushback, we just eat the cost.Yum.