I have a medical condition with no cure, yet I still have to pay a doctor every 6 months to keep my prescription with no changes. Total racket.

Having a doctor verify that you're not having any issues with your prescription medication is pretty normal.

Maybe you can find someone that'll do telehealth.

If I'm having issues I'll call the doctor. I don't need a babysitter.

There are definitely doctors who will space it out if you’re stable or do a phone refill

I think some tech health platforms like Capsule will even have a pharmacist call your doctor for a refill for you.

It means you need to pay your doctor and this company.

Some people do though. Imagine someone who just lets this stuff lapse and they are still being regularly prescribed stuff that should have been cancelled 8 years ago.

Just like how we require people to check in with their accountant every 6 months to make sure their finances are doing well, check in with a teacher and take a test every year to make sure our education is still up to date, and we have the cops investigate us biannually to catch any signs of legal trouble early.

We don't and we shouldn't require everyone to be nannied just because some people might benefit - they can seek those services on their own if they wish. Requiring someone else's permission to maintain your personal health would be considered just as absurd if it weren't the status quo.

Please, sign a notarized document saying you, your family or the DA won't sue because you were (a) lost to follow-up, (b) developed a medical condition as you grew older, (c) got a side effect because of long term medical use. Then, don't waste ER time if you have a stroke or heart attack because government can't tell me not to eat trans fats.

And, by the way, if you have an accountant, you should check in more than once a year. It's not fair to them to dump stuff only during tax time. Also, I do have to do regular tests to make sure my medical knowledge is up to date.

If we could sue hospitals into paying out because we developed medical conditions as we aged, there wouldn't be any hospitals.

You have to qualify your statement with "if you have an accountant" because I don't have to have an accountant, it is an optional service I can seek if I want. In my case, I do my own taxes, and if I don't get as big a tax return as I could've back, it hurts nobody but me.

The requirement for you to do regular tasks for the privilege of practicing your profession is forced upon you because the the consequences of any lapse in your knowledge are borne by others, not you. I too have professional requirements, but I can choose a different profession and be absolved of all of them.

A chronic condition is not a choice. Dealing with your pain is not a privilege, it is a right. The idea that people should be forced to forego their right based on the idea that some others will benefit (a dubious claim for which I can find no evidence supporting) is absurd.

Thanks for your response. I think I was unfairly attacking you after a rough day. I'll just say that preventative care is very important and you have a right to receive the proper medication.

People already die quietly alone all the time. How far do we need to go to have everyone have a babysitter, especially at their own expense?

I think the idea is that the doctor is actively intervening in your medical treatment, so they have a responsibility to make sure they're getting it right. This person is free to stop taking their meds and die alone whenever they like.

Visits to the doctor should be cheaper and more efficient, but people shouldn't stop going to the doctor.

I find it fascinating that the HN crowd complains about doctors being too expensive. I mean what is the comparative value that software developers add to society compared to doctors that justify their salaries (which are often on the same level or higher)?

False equivalence. Software developers "charge" companies (that are very much able to pay) for their services. Doctors charge everyone, from the rich to the poor, for their services. The poor (and even not-so-poor) get screwed by this, more often than not. I haven't heard of a bunch of software developers bankrupting people in exchange for their health...

Why is it always "doctors" and not "administrators" in these threads on HN? They don't set the price of the drug. They don't set the price of an ER visit. If their hourly rate seems high, have you seen the hourly rate of a plumber who absolutely did not go to school for ten years?

Most people in IT related fields aren't at doctor level pay.

I suspect the sentiment is from commonly interacting with absolutely useless doctors. There are a lot of them.

I've seen 200k+ salaries as standard here. Look up salaries of primary care physicians. Then add on the 50k+/year MD debt, and any undergrad debt.

That's not a normal range for most of the country doing SWE. If you know where to get that type of job let me know. I've done blind, sent out tons of applications, whatever. Hurts to know I'm potentially screwing myself out of tens of thousands of dollars, but nobody is contacting me back.

My professional contacts have told me I'm doing senior level work but nobody will respond even for positions below that.

Haha greener grass and all I guess. I've seen those numbers on glassdoor and a couple threads here.

Edit: sorry it was site https://www.levels.fyi/company/Google/salaries/Software-Engi.... No idea how real it is.

Yeah, I've seen it. Not many companies seem to pay well. An issue (on the employer side) is my lack of degree, but as stated I'm doing senior level work and have plenty of experience.

Doctors are the third leading cause of death, after only heart disease and cancer.

By many measure: if you see a doctor, cross the street.

I’m in the same position my dr is kind enough to let me email in for refills.

So? Some people need exercise, does that mean the government should force everyone to exercise?

I personally prefer a proactive doctor. Life gets busy and I don't always find time to get checkups and such. A small nudge from the doctor's office to get a checkup pays dividends. People with chronic conditions do need monitoring. It shouldn't be absurdly expensive.

I take a medication for a rest-of-your-life condition I've had since childhood. The simple blood test used to calibrate dosing is about $10 in saner countries. In order to get the blood drawn and tested it costs me >$100 out of pocket and I also have to see a doctor for a half hour ($250) before they'll update my prescription, regardless of if there is any change. This is with insurance, and must happen every 2 years or so. Medication cost is $10/mo or so.

This is completely ridiculous, and yet my situation is downright reasonable compared to what a lot of people have to deal with.

I shouldn't have to take permission from anyone to be able to buy the medicines I need. This is a cartel-type situation where your pharmacist won't sell you meds unless you pay a doctor.

When a prescription becomes your baseline you should stop having to mother may I except for changes to it.

Have you considered stocking up at the Mexican border? So many things are available over the counter in Mexico its awesome.

Is that legal?

Been there done that but from a different continent flying in. Nobody cares in general unless you're importing scheduled substances. You need to do your research but it's a way to beat the racket.

Drive up to the border and walk across on a day trip to the pharmacy. I believe the first few miles into the country are a NAFTA special economic zone with very relaxed paperwork requirements.

You can personally import up to 3 months worth of medications if you have doctors prescription.

https://www.fda.gov/industry/import-basics/personal-importat...

You can buy prescription drugs online from India without a prescription for super cheap. They arrive in your mail.

This is probably illegal, but not enforced.

I’m insured so it’d actually be cheaper for me personally to go in to the doctor and ask for a prescription. But I got tired of taking time out of my day for this - these are just beta blockers for fuck’s sake.

> You can buy prescription drugs online from India without a prescription for super cheap. They arrive in your mail.

And what guarantee do you have of their contents?

Gas chromatography-mass spectrometry (GC/MS [1]) by an independent third-party lab [2]. For unscheduled substances they'll even email you the mass plot.

Nearly all of our (US) pharmaceuticals already come from India anyways. Manufactured there from Chinese bulk precursors.

I trust a third-party GC/MS plot way more than any brand slapped on a package.

[1] https://en.m.wikipedia.org/wiki/Gas_chromatography–mass_spec...

[2] https://energycontrol-international.org/

I'm confused. Are you saying that every time you receive a package of medications from India, you send a sample off to for spectrometry?

That seems extremely arduous.

The point is that you don't trust this specific supply chain/manufacturer, which is part of the approval process.

"India/China" is not some monolithic entity that is either good or bad, there are some manufacturers that you can trust, and some you cannot.

Quality control in drug manufacturing is what ensures that every single pill has the correct dose, and not some random batch accidentally having 100x the active drug you need - or 0.01%.

the good pharmacies in India have started asking for prescriptions.. so, one is left to go the sketchy/tinier ones, where quality can be expected to be lower as well.

… kind of. There are certain personal use exceptions, but definitely something you want to speak with a lawyer about.

Don't need to speak to a lawyer. Millions of folks do this every year to save money. Doesn't mean they'll have unique drugs in stock however.

My contact lens prescription is similar.

Contact lens prescriptions change though, and bad contacts can do subtle damage to the wearer’s eye. I have permanent scarring in my eyes because I over-wore my 2 week contacts, my fault I know, but without an eye doctor appointment I would have done even more damage.

Wow, no kidding? I used to wear mine for months, maybe even close to a year. Anytime I had my eyes examined I asked how my eyes looked due to the constant wear and the optometrist told me they looked great but frowned at me doing so. I figured the disposable contact thing was mostly a racket, but I had some doubts. I wear glasses now.

These were the 2 week variety that were on sale between 2008 and 2012, after which I changed to 1 month lenses. It’s possible that newer lenses are better when worn outside the recommended range.

I’ve had the same script for 20 years.

I should add that the same thing applies to glasses.

Sorry to say but you'll have to find a better doctor if all you're getting is refills without being seen. It's a sad state of medicine but primary care is being rapidly replaced by NP/PAs who do a good job but are very regimented in their thinking.

I don't see most physicians being an issue. Many of them are fed up with the insurance, pharma, and regulations. Most are forced to work for large providers instead of being independent just due to the overhead of dealing with digital record systems, legal, insurance billing, etc.

I've heard they're fed up w/ insurance, billing...but the few times I've asked "hey what if I pay cash, not through insurance, is it cheaper?" (I knew I wont meet deductible...)

It was actually more expensive. I've stopped asking and feel it's a urban myth.

The list price will nearly always be a multiple of your cost with insurance. The issue here is that insurers have provisions in their network contracts that prevent providers from publically advertising lower prices than what's charged to the insurer, which mandates discounting. In many other industries, these most favored nation arrangements are considered anti-competitive and, thus, illegal.

Large hospital systems totally separate business and care, so it can be difficult to negotiate a discount. Smaller and independent providers are often more accommodating. However, you need to ask for a discount, you can't simply offer to pay cash (i.e. "If I pay cash, can I get 40% off"). The providers can counter your offer, but can't discount you off the bat or else they invite legal action from insurers.

Good to know! Dang 40% is a lot but I believe it hah!

When they spent $400,000,000 on favorable monopolistic legislation it helps to aim the spotlight on anyone else.

What organization and legislation was that?

American Medical Association, aka physicians

And what was the legislation? How was it monopolistic in favor of physicians?

The AMA does not really represent physicians. Less than 1/4 of doctors belong to the AMA. Many of them do not feel the AMA represents them. The AMA also accepts substantial donations from other sources, including corporate donors and foundations.

https://www.physiciansweekly.com/is-the-ama-really-the-voice...

The lobbying to:

A. Limit medical care to being provided by these people

B. Limit number of residencies

"Limit medical care to being provided by these people"

Who else would provide this care? This licensure is similar to other professions, like lawyers, and really doesn't take very much lobbying since the majority of the public want oversight of these sorts of professionals.

Residencies simply haven't kept pace with medical student numbers. They have gone up though. The main question is "where does the funding come from for residency training?". Medicare provides most of that funding, but that is a constrained resource. I find it hard to believe that the AMA lobbied for this provision.

>>the majority of the public want oversight of these sorts of professionals.

The majority of the public wants whatever they are lobbied to believe they need. The majority also supports the War on Drugs and criminalizing the sex trade, and for the same reason: fear tactics used to convince them that the mere option of doing an ostensibly harmful activity, is to the detriment of themselves and society at large, even though the activity would harm no one but the party engaged in it.

Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public. There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them.

"The majority of the public wants whatever they are lobbied to believe they need."

Ok, can you show me the lobbying that swayed their opinion on this topic then? If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?

"Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public."

This is not banned at all. Physician assistants and nurse practitioners exist and can perform some medical procedures/tasks. Even pharmacists. Granted I've personally had some negative experiences with some PAs and try to choose actually physicians for most things.

"There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them."

That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others? Usually things like insurance and bonding are requirements to cover any issues for people in this and other licensed fields.

>>Ok, can you show me the lobbying that swayed their opinion on this topic then?

I only deduce it happens.

I mean the lobbying happens in ordinary conversations like these, where people with a vested interest in gatekeeping argue it's in the public interest. I'm deducing it happens based simply on the incentives that exist for concentrated interests, in the form of insiders, to engage in it.

It also manifests as major political representatives legitimizing said licensure, and rationalizing the principle behind it to the public, in exchange for support from insiders within the regulated industry.

>>If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?

Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life.

>>That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others?

I don't see how the absence of licensure would prevert courts from issuing restrictions on individuals found guilty of criminal misconduct.

The government requiring a conviction in court before restricting someone's right to free association is how it should be. That is what the principles of a free society demand.

"I don't see how the absence of licensure would prevent courts from issuing restrictions on individuals found guilty of criminal misconduct."

That might cover fraud, but that doesn't cover incompetence or other harm.

"The government requiring a conviction in court before restricting someone's right to free association is how it should be."

That is one way to look at it, yet is is not how the legal system works today. The courts have determined that licensure is a lawful restriction on association.

"Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life."

It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice. The important part is "their level of knowledge". Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional. Most people accept it as truth and do not care to do any research on credible sites like PubMed.

>>That might cover fraud, but that doesn't cover incompetence or other harm.

If someone acts non-fradulently, and honestly conveys their lack of experience, their lack of competency in carrying out the service is no one's fault than the consumer.

>>The courts have determined that licensure is a lawful restriction on association.

I'm arguing this legal framework, not saying that's how it currently is.

>>It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice.

Only 8% of healthcare spending is on emergency services, which can and should have government involvement to avoid abuse of geography-based monopoly by service providers.

But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options.

>>Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional.

Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market.

"If someone acts non-fradulently, and honestly conveys their lack of experience, their lack of competency in carrying out the service is no one's fault than the consumer."

You're ignoring the part where it cannot be conveyed, like when people are mentally ill, incapacitated, etc.

"But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options."

Just because it's non-emergency does not mean the person is capable if choosing. You have people who are mentally ill and incapacitated who are treated in settings other than the ER. The highest spending happens at the end of life stage.

"I'm arguing this legal framework, not saying that's how it currently is."

Do you actually have more details for how that framework would work? So far all I'm hearing is that we should nor have licenses for medical professionals. How does that work with medical professionals powers to suspend drivers licenses, commit people, help in emergencies (good samaritan laws), etc. How does this affect malpractice insurance and torts, especially if you're saying that any incompetence can simply be stated by the provider to avoid court intervention? How would this system work in relation to controlled substances and expensive equiptment maintenance/procurement? How are the safety programs legally enforceable or logically possible without training? We already see that VEARS has terrible quality data. There are many adverse events that go unreported, especially by the lower trained PAs/NPs (my experiences).

"Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market."

You keep calling this a monopoly, but it is not a monopoly. There are numerous providers competing with each other. There's simply a training/licensure requirement. How are reputable experts foing to be any different than the current system? My guess is that they will create their own license system and force people through that too. Insurances, which cover the vast majority, will still require licenses to ensure that people aren't getting care that will be ineffective and cost them even more. This includes stuff like Medicare and Medicaid that the government controls.

Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work', how that will affect the numerous aspects of the system as well as it's integration with other systems, and what research there is to support it.

>>You're ignoring the part where it cannot be conveyed, like when people are mentally ill, incapacitated, etc.

We already have provisions for when someone cannot make decisions for themselves, like guardianship. We do not need to subject the entire population to guardianship-like subordination.

>>You keep calling this a monopoly, but it is not a monopoly.

It is a monopoly: the licensure rules have a monopoly over all providers. Your argument seems to be that people cannot choose for themselves, so it's better we impose this monopoly on them.

But if they can't choose an effective delegate in the marketplace, who says they can choose an effective politician to vote for in an election, who will then appoint the regulator that vets their market options? It's better to go with a decentralized approach, where each individual is free to choose their own delegate, rather than a centralized one where the entire population votes every four years for one delegate that gets the power to vote for every one, whether they consent or not.

>>Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work',

I think the burden of proof is on those who advocate for continuing to limit people's right to freely contract and purchase the goods/services they want.

You find it hard to believe a thing that the AMA made an overt aim of. Fascinating. Well, I’m out of this conversation.

Then show me a source.

I showed you a source earlier in the thread and you didn't respond. It is the website of AMA, where they celebrate their success in lobbying against any bill that would allow other professionals expanded capabilities.

"For over 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by opposing nurse practitioner (NP) and other nonphysician professional attempts to inappropriately expand their scope of practice."

Here it is again: https://www.ama-assn.org/practice-management/scope-practice/...

Ah, that prior comment is dead.

So this is a source just saying they oppose inappropriate expansion. That they want PAs and NPs to practice as part of a team that includes a physician. I don't really see this as an issue. I also see PAs, NPs, and nurses as falling into the medical profession and subject to licensing, etc. So I see them as being on the inside of the system, not one of the "other people".

What I was specifically looking for was a source about the second part of this thread - the restriction of residency by the AMA.

When asked on the street people always say "yes I want healthcare to be safe" but if you actually see who is lobbying for certification requirements it is always incumbents.

If people wanted and needed licensure for health, hair cutting, whatever, you'd expect that they would be at the state house. But they're not.

You have that backwards. The AMA is actively lobbying to increase the number of residencies.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

Haha this is exactly why point source information is so damaging. The AMA spent years keeping this tightened down by spending money and then they started issuing press releases asking for the opposite (but this time, conspicuously leaving off the money spending).

This naïveté is typical of HN. You’d read a press release from ISIS and conclude they’ve built a paradise. You need more knowledge than you can Google up. You need to be aware of what they did and do over the last 30 years.

But it’s okay, you can believe falsehoods. No skin off my back.

Sources?

I hate this line that's repeated all the time because its simply wrong. Osteopathy has its own residencies and the DO is legally equivalent to an MD

I say this as an MD: AMA can suck it. I don't pay them and I don't think they represent me or the profession.

Seen the same

Are you kidding?

https://www.rand.org/news/press/2021/01/28.html

> Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries

So are the nannies and the landscapers. Are these also a racket?

It is just amazing to watch people in the US defend the price gouging in healthcare in the US.

The medicine prices are MUCH lower in other parts of the world - including in places where the cost of living is much higher than in the US such as Norway and Switzerland.

The cost of Insulin is 8x higher in the US than in comparable countries around the world.

https://pharmanewsintel.com/news/insulin-prices-8x-higher-in...

Services from nannies and landscapers are nontradeable goods. See https://en.wikipedia.org/wiki/Tradability

Drugs are almost non-tradable goods because of all the regulations and differences in drug standards between countries.

So they're artificially non-tradeable, not innately non-tradeable like the other examples.

We're talking western countries, not places where you would expect it to be less like Mexico, India, Brazil. Basic domestic services are going to be about the same across various western countries. Drugs and health services in general are 2-4x what other western countries pay AT A MINIMUM. Most have free health care.

Maybe I'm weird but I don't have a nanny or landscaper and neither does anyone I know or any of their relatives that I'm aware of. But I pay a flat €5 for most prescription drugs (the rest are free) and my public health insurance costs are capped at about €700 per month (and I get to keep it for free if I become unemployed).

Are you that out of touch to not realize those services are luxuries and not life saving health treatments?

You never been to Switzerland I guess. Cheap meds and WAY MORE expensive manual labor.

They're part of the same mafia, Pharmaceutical Research & Manufacturers of America spent $8664000 in 2021 only on lobbying.

https://www.opensecrets.org/federal-lobbying/top-spenders

That looks like a big number, but it is $8.6M ? Is that a lot?

No it's not. Lobbying in that reported sense is also a very small slice of persuading politicians and regulators and bureaucrats.

PHRMA plays big in politics, 501c4 space etc.

They also are known for the revolving door which is hard to quantify, but surely it makes a big difference on regs. Look at the Purdue, they got the regulator responsible for approving the label to actually sit in a hotel room and help write their oxy label together...

Here's an article shows "in the US from 1999 to 2018, found that the pharmaceutical and health product industry spent $4.7 billion, an average of $233 million per year, on lobbying the US federal government; $414 million on contributions to presidential and congressional electoral candidates, national party committees, and outside spending groups; and $877 million on contributions to state candidates and committees."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054854/

I double checked -- another source[0] mentions amounts that are a bit higher:

"The Chamber [of Commerce] spent nearly $82 million on lobbying in 2020"

But generally in line with the list posted by the GP:

"Facebook and Amazon were the only companies in the top 10 spending list and spent nearly $19.7 million and more than $18.7 million on lobbying in 2020, respectively"

I too, am surprised as how little this is for these gigantic companies ($20M for FB? 1/1000th of their quarterly revenue?) and more generally, how little money this is... in comparison with the entire US government budget?

Sorry, this is probably all obvious? Just a bit.. sad?

[0] https://thehill.com/business-a-lobbying/536082-us-chamber-nu...

How much do you think lobbyists should earn instead?

Really. Who doesn't get how cheap our politicians come? Old joke about Spiro Agnew (Nixon's VP who had to resign because he took around $30,000 in bribes while Governor of Maryland years before): When Armstrong set foot on the Moon he would have been set for life if his first words had just been "Coca Cola!" Of course if it had been Agnew he probably would have said something like, "Fred's Tailor Shop, Baltimore!" Point is, US politicians really do come cheap. Political favors are a wholesale business, they make out on volume.

It was purposefully written to mislead, hence the lack of commas or the M suffix. So yeah, it is definitely not a lot. For comparison, Facebook alone spent $17M on lobbying in 2019.

Its certainly more than I paid in taxes

Do you think this is a big number? $8mm across a huge industry is barely enough to get a legal team out of bed. This is really pocket change.

What about $8664000.00? I made it slightly longer. I can add some more zeroes.

So much evil in 1 list.

Sutter Health is one of those hospital cartels. They've made it so that giving birth in Sacramento is now one of the most expensive cities in America. It's all a racket.

Source: https://www.kqed.org/stateofhealth/205822/northern-californi...

"Well paid nurse"... Now thats a funny one.

Capital loves to blame labor, capital owns the media and we're inclined to believe their stories.

I think pretty much all players in the US health system are a problem. They all benefit to some degree from this corruption. If I had to pick the worst I would name hospitals. But everybody else profits handsomely too.

Everyone except for the people who are actually providing direct patient care like the nurses and the technicians.

I would think tech is now at the point to undermine micro-exploiters who extract punitive payments from people who feel that there is no viable alternative provider (e.g. a specialist who requires completely unnecessary monthly visits, gives a cursory glance, keeps treatment unchanged and charges hundreds in the process).

What do you think? - Is this something tech CAN do today, with an open source application and publicly available data?