I imagine I will very much regret commenting here.<p>When the pandemic began, I left a few comments with home healthcare tips, like how to do lung clearance. People attacked me and accused me of practicing medicine without a license.<p>At some point, I went looking for an officially recommended list of OTC drugs for covid. I couldn't find any such thing online.<p>Healthcare shouldn't really be used to mean <i>medical care.</i> I think it's a mistake to treat those as synonyms.<p>Diet, exercise and lifestyle choices are all part of caring for your health. We could include grocery stores, restaurants and gyms as part of the "Healthcare Industry" though they certainly aren't part of the <i>medical</i> industry.<p>I think it was a huge missed opportunity that no official health organizations, like the CDC, put together tips of a sort I naively tried to share as someone with a serious condition who therefore has no choice but to do a lot of medical-like healthcare things at home. I was shocked at how hostile people were to that.<p>Because of that, I've mostly opted to say little about this topic. People are scared, etc and I didn't want to become a target.<p>But the mistake we made here was relying too heavily on the medical industry and not leveraging the internet as the perfect first line of defense for sharing good info without sharing germs.
I think the global problem is that medicine has improved so much that, unlike a hundred years ago, it's impossible to provide the full extent of modern medicine (which is huge!) to everyone, so some form of rationing/filtering is inevitable and necessary.<p>You can do the rationing through market forces, where people who can't afford it get less care; you can do the rationing through some other allocation system (e.g. priority systems, or long queues, or lottery, or committee allocation) which in effect still mean that not all people get everything.<p>If you want to say "In our society, everyone gets healthcare" then you have do define "healthcare" narrowly, which includes some services but not everything technically possible - I mean, if we have services that take more than a man-month of labor for each month of prolonged life (and there are some) then that's not possible to provide for everyone always even from a purely mathematical standpoint.<p>On the other hand, if you want to attempt to provide (nearly) everything to (nearly) everyone and avoid planned rationing of the available healthcare resources (which still comes up to more care for more people than it was 50 or 100 years ago) then the overload catches up to you as described in this article, and you get a collapse of the system.
A few years ago we were visiting friends in northern Netherlands. Our friend's father in law was feeling unwell and asked to be taken to the hospital. Apparently in the Netherlands you can't just go to the hospital (unless it's an emergency I guess), so you need to call them first. You'll be interviewed by a doctor, who'll schedule an appointment. The doctor told the father in law to continue taking his medication and come to the hospital the next morning. I got to accompany him to the hospital and go with him through the whole process. It was like nothing I've ever seen - the hospital was quiet, very few people, the guy for a while room for himself, and the treatment was efficient and <i>on schedule</i>. I thought the whole pre-screening on the phone thing was brilliant.
I think regulatory thinking has failed to keep up with health issues. We need to treat excess sugar consumption like we do smoking. Its amazing to me how you can walk into a supermarket and be consistently advertised things that are bad for you, a 'sharing' pack of M&Ms 2-for-1. Want to buy a single ice cream? Too bad its actually cheaper to buy a pack of 4, and most singles are out of stock ....<p>Another issue not widely discussed is that 20% of patents are responsible for 80% of the cost. If you look at said 20% more often than not you'll find consistent failure to intervene early enough while the illness is easy to treat.
Related post from a very harsh doctor who really has lost hope in American healthcare. In the comments he mentions essentially collapse as the only way out he sees.<p><a href="https://news.ycombinator.com/item?id=34347962" rel="nofollow">https://news.ycombinator.com/item?id=34347962</a>
> The problems facing health-care systems are not therefore caused by a lack of cash. Much of the increased spending has gone on programmes to combat covid<p>Maybe in your country, but not in mine... Our government is sitting on a surplus and won't spend it, and what little we do get goes to executives and all the laptops we had to give out so they could work from home, while all the serfs toil and burnout.
Calling the situation a collapse is a bit alarmist. However, the cold realities of demographics make continued service level declines inevitable. Demand is accelerating because populations are sicker on average, due to both aging and chronic diseases caused by overeating and sedentary lifestyles. We can't really afford to spend higher percentages of GDP on healthcare and there don't appear to be any revolutionary productivity improvements on the horizon, so unfortunately those who lack the means to pay out of pocket for high-quality care can expect to wait in longer queues.
This is partly a UK view. The UK is in serious trouble. GDP is down 10% since Brexit. The combination of Brexit, COVID, and several incompetent government in a row has just been too much.
Public healthcare in Austria has declined shockingly fast over the covid times. Many doctors and nurses from hospitals filed official Gefährdungsanzeigen ("endangerment reports") because their overwork and lack of personnel has been starting to endanger human life. Politicians do NOTHING. The only thing we hear from our minister of health is blips about Covid.<p>Waiting for appointments with publicly funded doctors can now take several months, some doctors refuse adding further people to their wait lists. Many publicly funded positions for doctors stay vacant. Doctors are fleeing into private practices, where they earn significantly more money, have a more pleasant set of patients and less regulations.<p>I had to wait 2 months for a heart MR at the only institute that does heart MRs in Vienna. Paying privately, I would have gotten it at the day and time of my choice.<p>We are still getting our brain, heart and lung surgery or organ transplants for free as in 0€, but anything not absolutely necessary is declining, slowing down or starting to cost real money.
Economist articles are usually well-founded and fairly objective, but not this one. With cherry-picked quotes from several reports but no citations, this read like it was written to serve some agenda/narrative.<p>E.g. a study "found only one example where there were more covid patients than intensive-care beds". For real? Was it perhaps because of the triage process used during covid? What about the non-covid patients that were left without an IC bed because of IC bed segregation?<p>It is also reprehensible that everything is pinned down to "productivity" of health workers. Are those the same people hailed as "heroes" a year or so ago?
Summary of causes per the article: treatments delayed due to covid coming back to haunt, out-of-practice immune systems, provider burnout, all of which should normalize in time.<p>The tone of the article doesn't match that of the title.
We are at ~300 comments. If these same set of 300 comments had been posted in 2020, over 50% would have been greyed out, users shadowbanned, and within an hour the entire discussion would be flagged and demoted from the front page. And all for what ? Because you can’t use the C word.<p>So in that sense, we’ve come a long way.<p>But realize that we are the same people we were 3 years ago. We haven’t changed. So what has ?
Over the last 50 years or so, the west has become much more individualistic and less social. This has lead to all sorts of problems (good things too, I am sure). And it just so happens that medicine is where people turn to fix many of those issues. We don't properly regulate food, and people are free to get obese and malnourished, then after a few decades of that their body starts to fail and they need complex, expensive, flawed medical intervention for instance. The same applies to exercise and stress. We've also become hyper-competitive, busy and isolated, and that's leading to an epidemic of mental health issues. No one wants to make the decision to let people with serious neurological conditions like dementure die. So again, we spend enormous sums and cause great suffering because no one wants to make a hard decision.<p>So spending has ballooned and it's done it in the most inefficient and ineffective areas.<p>This is the price of "freedom".
40 years of slow and creeping privatization of healthcare, and this is what happens. The worst impacted were the countries that privatized their healthcare totally and maximized profits instead of any concern for the society. Now that a pandemic hit, its not surprising that they don't have the personnel, medical facility capacity and enough beds to handle the impact. Not to mention that in these countries, the entire vaccination process has been one that was run to suck out the maximum money from the healthcare system as much as possible while delivering the minimum possible. Classic profit maximization.
The most exciting thing about ChatGPT is the potential for an AI which can perform same functions as a General Practitioner. Its such a good use case for AI and feels so close. The biggest road block will be lawyers dumbing down its capabilities.
I think a lot of this has to do with older, more experienced staff retiring as soon as they can. That was brought forward by COVID. So of course productivity drops off a cliff. As more boomers retire we will continue to see this compound many issues, including healthcare.
While I am aware of the extent of the morale and exhaustion problems in health care, and largely sympathetic, I must push back against the overuse of the word "collapse" for everything these days. I must have seen hundreds of headlines since the beginning of the pandemic about how this country's health care system is collapsing or that country's health care system.<p>Here's what an actual collapse of a health care system would look like to me:<p>- 95% of a country's health care personnel disappearing<p>- Hospitals have to close because they no longer have <i>any</i> health personnel. All hospitals, not just rural hospitals. And the closures must be permanent.<p>Since HN's crowd heavily tilts toward the US West Coast and the Bay Area in particular, I googled a list of all hospitals in San Francisco.[1]<p>- California Pacific Medical Center
- Davies Medical Center
- Kaiser San Francisco Medical Center
- Friends of Laguna Honda Hospital
- Langley Porter Psychiatric Institute
- Letterman Army Hospital
- Pacific Dispensary for Women and Children
- Public Health Service Hospital (San Francisco)
- Saint Francis Memorial Hospital
- St. Joseph's Hospital (San Francisco)
- St. Luke's Hospital (San Francisco, California)
- St. Mary's Medical Center (San Francisco)
- San Francisco Chinese Hospital
- San Francisco General Hospital
- San Francisco VA Medical Center
- And the UCSF system<p>A proper collapse of the Bay Area's health care system, to me, would entail the permanent closure of every one of the above. All of them. A "every man for himself" scenario. A scenario where there are <i>no</i> more nurses; <i>no</i> more doctors; <i>no</i> more surgeons. A scenario where health care requiring any kind of advanced equipment is no longer possible, where MRIs become impossible, where cancer treatments become impossible, for rich and poor people alike. A scenario where pregnant women have no choice but to give birth at home. A scenario where no one but the wealthiest billionaires can access any kind of health care that's not a Tylenol or an Advil. <i>That's</i> a collapse.<p>25% of nurses leaving within a year (and being replaced), or anecdotes of personnel calling out sick, while deeply concerning (as I wrote above, I am very sympathetic), just aren't bad enough to warrant the use of the word "collapse".<p>[1] <a href="https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Francisco" rel="nofollow">https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Fran...</a>
Perhaps the institution of hospitals is outdated. With concierge medicine, a doctor can make house calls with a nurse and solve most medical issues. The ideal should be like Star Trek (hyperbolic, I know). A tricorder should be able to scan me and care should be in the form of a hypo spray.<p>Hospitals are a single point of failure as an institution and we should be moving away from centralized medical care in the 21st century. As an aside, I’ve noticed a lot of people are in hospital waiting rooms whereas they could be served with a doctor making a house call. Just my 2c