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Back and shoulder surgery is often worse than useless

127 points · 144 comments · burntcaramel

  1. tptacek · · focus · HN ↗
    This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.

    I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.

    1. FlyingAvatar · · focus · HN ↗
      I would posit this is more of a function of Canada having too few machines, with a median wait of 10 weeks for an MRI. [1]

      To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.

      [1] [<a href="https:&#x2F;&#x2F;getmrifast.ca&#x2F;mri-wait-times" rel="nofollow">https:&#x2F;&#x2F;getmrifast.ca&#x2F;mri-wait-times]

      1. OsrsNeedsf2P · · focus · HN ↗
        One of the reasons I left Canada was it took me 6 months to get an MRI after a severe head injury in 2017. I have since gladly paid nearly 500k in taxes to other countries. Fuck Canada.
        1. skylurk · · focus · HN ↗
          Clearly you had the means... was it not possible to pay for private healthcare?
          1. brink · · focus · HN ↗
            What does that have to do with the conversation here?
            1. readthenotes1 · · focus · HN ↗
              Some countries have a dual insurance system that might allow wealthier people to get better access.

              Think of Steve Jobs jumping to the head of the line for a liver transplant

              1. jjtheblunt · · focus · HN ↗
                he was already at the head of the line where he got the liver.

                the article below is interesting, as it goes into the hearsay you repeated and the facts of how the system works.

                <a href="https:&#x2F;&#x2F;www.nytimes.com&#x2F;2009&#x2F;06&#x2F;23&#x2F;business&#x2F;23liver.html" rel="nofollow">https:&#x2F;&#x2F;www.nytimes.com&#x2F;2009&#x2F;06&#x2F;23&#x2F;business&#x2F;23liver.html

                1. readthenotes1 · · focus · HN ↗
                  Thanks! It was Paywalled, but I found this

                  <a href="https:&#x2F;&#x2F;globalbioethics.org&#x2F;2013&#x2F;12&#x2F;11&#x2F;did-steve-jobs-cut-the-line-in-order-to-obtain-a-liver-transplant&#x2F;" rel="nofollow">https:&#x2F;&#x2F;globalbioethics.org&#x2F;2013&#x2F;12&#x2F;11&#x2F;did-steve-jobs-cut-th...

                  To restate my now better informed opinion, Jobs money allowed him to increase his chances dramatically of getting a liver transplant.

                  1. jjtheblunt · · focus · HN ↗
                    yeah it seems that there are multiple regions of donor registries, perhaps predating the idea that a recipient could fly within expiration date?
          2. excannuk · · focus · HN ↗
            No, that&#x27;s illegal. Thats what single payer means, only one payer is allowed [1].

            Is meant to encourage rich people to support the health system since everyone&#x27;s in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.

            It&#x27;s also not lost on public policy experts that MAID has the potential of &quot;solving&quot; a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.

            [1] with some exceptions largely grandfathered in

            1. bigDinosaur · · focus · HN ↗
              That&#x27;s not what single payer actually means, since Australia has both a single payer public system and a separate private system. The part that allows these to both exist is that the public system has vast resources (i.e. an entire national&#x2F;set of state governments) that can act as one for immense negotiating power. This does not preclude a private system from existing.
              1. b112 · · focus · HN ↗
                Legal definitions vary from legal jurisdiction to jurisdiction, and in Canada?

                That&#x27;s what it means. In Australia it can mean something different.

              2. excannuk · · focus · HN ↗

                [dead]

            2. pfannkuchen · · focus · HN ↗
              &gt; But in reality the very wealthy go to Buffalo

              This has to be a brand new sentence (post 1950s anyway).

              1. excannuk · · focus · HN ↗

                [dead]

            3. gremlinunderway · · focus · HN ↗
              It&#x27;s not meant to &quot;encourage the rich to support&quot; the health system, it&#x27;s meant to avoid completely gutting the public health system by creating a parallel pay-for-play system where only the richest pay and subsequently suck up all of the already finite resources and talent.

              Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.

              There&#x27;s no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.

              1. glenra · · focus · HN ↗
                In most other contexts, rich people being able to spend money for some good or service would simply induce more supply ultimately making the product cheaper and better for the masses as well. The rich get to be &quot;early adopters&quot; buying a product when it&#x27;s expensive and not very good; the poor as &quot;late adopters&quot; get to buy a product that is cheaper and works better once the bugs have been worked out. So...why exactly are resources and talent considered &quot;finite&quot; when it comes to health care and shouldn&#x27;t we maybe look at FIXING that rather than take it for granted?

                Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se &quot;suck up all the resources&quot; needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald&#x27;s by making it harder to find burger-flippers? And does McDonalds in turn &quot;suck up all the resources&quot; thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?

                1. M95D · · focus · HN ↗
                  Not comparable.

                  If there were a limited number of licensed cooks like there are doctors, it would be far different.

              2. excannuk · · focus · HN ↗

                [dead]

            4. scratcheee · · focus · HN ↗
              Not how it works in the UK, everyone pays into public single-payer healthcare, but you’re free to buy your own private healthcare on top if you like.
              1. excannuk · · focus · HN ↗

                [dead]

            5. Cpoll · · focus · HN ↗
              There are private clinics like Medcan, which you can pay for checkups, referrals, etc., so it&#x27;s not all single payer. You usually end up in the same queue for MRIs though, so it doesn&#x27;t help there.
            6. monocasa · · focus · HN ↗
              Medical imaging and diagnostic testing is one of services allowed by private healthcare in Canada.

              &gt; Diagnostic Testing: Private labs and clinics provide quicker access to diagnostic tests such as MRI scans, blood tests, and X-rays, which can expedite treatment plans.

              <a href="https:&#x2F;&#x2F;schwartzcohenlaw.com&#x2F;does-canada-offer-private-healthcare-options&#x2F;" rel="nofollow">https:&#x2F;&#x2F;schwartzcohenlaw.com&#x2F;does-canada-offer-private-healt...

          3. Scoundreller · · focus · HN ↗
            For ~90% of the population, it’s right there under 200km away.
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