Not true at all, in countries with dual systems(public healthcare and private one) the private care usually acts as a shortcut to get things done quickly.

Often it's useful to get things going in private care and if you are not rich you can continue on the public system. The idea is that once you know which specialist you need to see, the waiting lists are shorter and you will be triaged depending on you situation. If that specialist happens to have long waitlist, you can choose to get private care and maybe get the actually expensive surgery in public hospital.

Is it really?

I come from a country with universal healthcare, and while public healthcare suffers from the same wait times we see in the US, private healthcare is on an entirely different league. For instance, with a good private health insurance plan, on a whim, without a referral, one could get an appointment at a decent specialist, and possibly the specialist of their choice within the week. My experience in the US is that you wait 3 months to see any specialist at all.

Not really been my experience in a midsized US town. Don’t think I’ve ever waited more than a month or so… and generally same week if it’s something urgent. I do have Blue Cross though, which is I guess pretty good as us insurance goes.

Right now I live in Cambridge, MA. The wait time to see a dermatologist was 3 months when I needed one. My health plan is also Blue Cross, hired through MIT Medical.

Isn't Cambridge part of Boston?

By mid sized I mean approx 100k people, and it's an hour+ drive to anywhere bigger.

The US equivalent would be concierge medicine, which performs as well as you're saying private medicine does in your country.

What was the last time that you tried to get an appointment at a decent specialist at your home country?

To give you some context, my home country is Brazil. Last time I used my private health insurance was in July 2021 and the wait time to see a top specialist was one week. However, I have been there again (without health insurance) and was able to get a same week appointment at the end of March this year, which cost $200.

With a good private insurance (a PPO plan), I had a similar experience in the US. Well, in NYC which is not representative of the US, of course. Many things in the US basically repeat the population density map.

I just scheduled my first appointment with a new primary care doctor. It's on January 7, 2025. NOT a typo.

Some problems solve themselves. If you're already deceased by the time the service date comes up, they don't have to do anything.

That's fucked up.

Modern problems require modern solutions

The "free market" is so good at problem solving! I hope the entrepreneur who thought of this made a tremendous profit!

Imagine thinking the US health care system is anywhere near a "free market"

My dad used to say he had three piles of papers on his desk: "urgent", "very urgent" and "no longer urgent".

While it's mostly not quite as bad here in Norway, it's getting there.

Lots of GP's here are quitting because they've been overloaded by paperwork. Government wants more documentation on everything. Can't just trust "some random doctor" who's known the patient for decades to sign a few days of sick leave, nope, we need paper trail!

My SO's GP almost started crying during one of her checkups since he was so overworked. He'd have a normal day seeing people during normal working hours, then there would be at least 5-6 hours of paperwork to do. He quit half a year later.

The newly trained doctors have caught on and don't apply for open GP positions. The result is that we have a massive deficit of GPs which keeps getting worse day by day.

Death by paperwork is the symptoms of late-stage bureaucracy. In the early days of something, it's all fly-by-pants and everything is so good compared to the previous alternative that nobody cares, but as it gets more and more "finalized" the paperwork mounts more and more to "prevent" issues, because the issues the overload of paperwork causes aren't accounted for.

Ten patients die because there was no doctor to see them? Nothing important.

One patient sued because a doctor made a mistake that didn't even kill them? Hugely important, ten more pages of paperwork will have to be added; the paperwork won't prevent it happening again, but now it'll clearly be the doctor that is liable, not the practice/hospital/insurance company.

You must be psychic. I'll be 75 on June 8 of this year, and it occurred to me that scheduling old people for appointments a year and a half way is a frictionless way of keeping a full schedule that will only get lighter as geezers like me drop dead before we can be seen. Oh well...

Not psychic at all, unfortunately! I just upvote you a lot and keep and eye out for your (nearly always thought provoking) posts. IIRC, you said in the past you're a retired M.D., is that right?

If you live around the bay area, I'd love to buy you lunch sometime. You are indisputably a super interesting person, @bookofjoe! Email in profile, promise I'm pretty cool as far as humans go :p

Thanks for your kind words. Yes, I'm a retired neurosurgical anesthesiologist (38 years: 1977-2015).

I lived in LA from 1966-1983, when I moved to Charlottesville, Virginia, where I've remained.

I'm easy to connect with: [email protected]

When I'm not acting out on HN, I do so in these arenas:

https://www.bookofjoe.com/ (since August 2004) https://www.youtube.com/user/bookofjoe (since March 2006) https://twitter.com/bookofjoe (since November 2006)

Reminds me of this little-known Seuss book: https://www.youtube.com/watch?v=WHyrVyCqKwo

If it's not a scheduled appointment, but a "next available time" one, ask to be put on a cancellation notification if you're near the doctor's office; they get a cancellation, call you, you're there in 10 minutes kind of thing.

You must also be psychic! The day after I got my "see you in the future" 2025 appointment, I woke up and saw there was a text from the doctor's office offering an earlier appointment: it said to go to the scheduling portal and follow the instructions.

I thought, "huh." That was around 6 am. I mulled it over: did I even want an earlier appointment? I'm not a big fan of doctors (full disclosure: I am one). So I went about my day and finally around 1 p.m. decided it wouldn't hurt to have a look; after all, I could ignore or decline the offered new slot.

No worries: when I logged on around 1 p.m., the portal said the new slot was no longer available.

I wasn't sad.

Whenever that happens I just to the ER and greatly exaggerate my symptoms.

anecdata - E/Rs in my locale are 6 to 8 hour waits with total time spent with triage/nurse/physician totalling maybe 15 minutes (20 if they decide you need an x-ray). Since the queue seems to vary very little it just seems weird.

Due to this wait, I've been conditioned to treat it as a last resort. Perhaps that is the desired effect.

You wanna be careful with that...

Was that due to a lack of supply or too much demand?

Which city/system?

General practitioners (who you need for primary care doctors) are unfortunately in extreme undersupply in the US.

This is a combination of things:

1) Being a specialist is much more lucrative

2) The AMA has been resisting calls to increase the pipeline of doctors

3) The absolutely shitty treatment of medical interns.

4) Many of them left due to Covid (the primary care physician is on the front line dealing with the Covidiots)

Is a doctor really necessary for GP type stuff though? I've found physicians assistants to be just as effective and more readily available.

Yes and no. The buck needs to stop with somebody and that responsibility is on the GP. So, you need at least ONE visit to the main GP before you can access their assistants.

I agree that most of what GPs do is be a "router" than sends your packet to various specialists. But somebody actually has to do it.

NPs can practice independently in ~1/2 of states, they aren't relegated to being 'assistants':

https://www.aanp.org/advocacy/state/state-practice-environme...

Of course they will escalate some care to other providers.

Is this doctor special or in high demand or something? this sounds like a machine err.

Kaiser's web portal showed no PCP doctors available, but when I called I was able to get assigned.

No, just an ordinary family doctor. Coincidentally, my neighbor across the street, a 70-year-old woman, had her longtime family doctor retire. She was given a list of names recommended by her doctor. She called the first one to make an appointment and — believe it or not — received one for January 2025 (not the same doctor as me). I told her we should go as a couple to both appointments for moral support.

Woah. Where in the United States is this? Have you tried looking around at different providers or is there a extreme shortage?

Might as well drive or fly to another area for healthcare.

Charlottesville, Virginia

Wow, I'm in the Nova/DC area. Thats really somewhat surprising to hear. Does Charlottesville have a medical network like One Medical that exist there?

That's ... insane. We can get an appointment same-day sometimes, and never more than a week out.

Maybe it's a very popular doctor?

Only 2-3 months would be heaven sent. And don't forget we're paying twice as much for the care that we do receive.

But I was always assured the US has the greatest healthcare system in the universe because it's privately profited from!

Any system predicated on the assumption that all humans are good-willed and eager to sacrifice for others is doomed.

ie. there must be some other incentive for a system, operated by humans, to succeed.

Capitalism is predicated on profit. I don't know what system you're talking about.

Just because you're a bad person doesn't mean everyone else is

Which proves my point, doesn't it?

If I'm not a good person, your system fails. It literally only takes one...

The US is the greatest healthcare system, because it's the most profitable (for insurance companies).

Patient outcomes and public health are irrelevant and unimportant; only profit matters.

Yes it is my experience in the US -- but not across the world.

Last year, I was in visiting in Korea and needed to see a doctor. I randomly picked a name out of the phone book and asked my Korean-speaking friend to call and make an appointment. They said no appointment needed, just walk in. So I did.

The doctor saw me within 5 minutes of arrival. He did a physical exam, listened to my lungs, did a simple blood test and gave me a prescription. He then asked if I had insurance, to which I said No.

So he said: "I'm sorry I wlll have to charge you." I went out to the front desk and got the bill. It was the equivalent of $12. In the US it would be $300 before insurance, and $50 after -- not counting the lab cost, which would be separately billed. And all this would take weeks or months to schedule.

I went to a Korean pharmacy with a prescription for 30 days supply of multiple medicines, which in the US costs me $200 with insurance. In Korea, the cost was $50 without any insurance. I had a similar experience in Portugal years back.

People in the US don't realize how screwed up the healthcare system is here. And seem powerless to change things.