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Medical Anarchy

45 pointsby protabout 11 years ago

12 comments

chimeracoderabout 11 years ago
&gt; The AMA, which is little more than a union for doctors, doesn’t allow any policy changes that threaten to increase competition and reduce their monopoly profits<p>That&#x27;s like saying that Comcast&#x2F;Time Warner are a &quot;union for Internet users&quot;.<p>If the AMA were &quot;little more than a union for doctors&quot;, doctors would have a lot more respect for it, instead of the great contempt that they currently do.<p>If anything, you could argue that, because power follows the money, the AMA is an advocate for the insurance companies that the doctors are beholden to (essentially every doctor in the country must pay their fees to the AMA in order to process billing, because the AMA has a monpoly on that[0]). One of the big disadvantages of dissociating with the AMA (yes, a provider <i>can</i> do this) is losing the ability to use these insurance codes.<p>I don&#x27;t think that that characterization is quite fair either, but it&#x27;s a lot more correct than saying that the AMA is a union for doctors.<p>If you want to know more about CPT codes and billing, my startup[1] works with hospitals and outpatient providers to handle the billing process - I am happy to tell you far more about CPT codes than you ever wanted to know. :)<p>[0] The AMA owns and controls the CPT codes - the billing codes that payers use. The providers don&#x27;t always pay them <i>directly</i> (especially if they&#x27;re not independent practitioners), but they do end up paying them in the end.<p>[1] <a href="https://www.boardrounds.com/" rel="nofollow">https:&#x2F;&#x2F;www.boardrounds.com&#x2F;</a> (plugging shamelessly because it&#x27;s relevant).
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steveklabnikabout 11 years ago
I&#x27;m quite torn about this. In some ways, it seems massively irresponsible, but framed another way, it makes some sense.<p>I think it&#x27;s important to distinguish here between &quot;screw experts they don&#x27;t know anything&quot; and &quot;I&#x27;ve taken your professional opinion into account, and will be making my decision.&quot; The second has a long, long history in anarchist thought:<p><pre><code> &gt; Does it follow that I reject all authority? Far from me such a thought. In &gt; the matter of boots, I refer to the authority of the bootmaker; concerning &gt; houses, canals, or railroads, I consult that of the architect or the &gt; engineer. For such or such special knowledge I apply to such or such a &gt; savant. But I allow neither the bootmaker nor the architect nor the savant to &gt; impose his authority upon me. I listen to them freely and with all the &gt; respect merited by their intelligence, their character, their knowledge, &gt; reserving always my incontestable right of criticism and censure. I do not &gt; content myself with consulting a single authority in any special branch; I &gt; consult several; I compare their opinions, and choose that which seems to me &gt; the soundest. But I recognise no infallible authority, even in special &gt; questions; consequently, whatever respect I may have for the honesty and the &gt; sincerity of such or such an individual, I have no absolute faith in any &gt; person. Such a faith would be fatal to my reason, to my liberty, and even to &gt; the success of my undertakings; it would immediately transform me into a &gt; stupid slave, an instrument of the will and interests of others. &gt; &gt; - Bakunin, &quot;What is Authority&quot; http:&#x2F;&#x2F;www.panarchy.org&#x2F;bakunin&#x2F;authority.1871.html</code></pre>
vezzy-fnordabout 11 years ago
Time for a reality check.<p>Okay, so I like the idea of CoinMD. It&#x27;s a nice way for people with medical knowledge to get paid for their tips, but so far that&#x27;s really about it. It&#x27;s just yet another forum for medical advice, but with a gimmick. It&#x27;s not even an original gimmick. The whole &quot;integrate Bitcoin into everything&quot; appears to be motivated by more of a cargo cult to appear modern and countercultural than anything rational.<p>However, it does offer an alternative payment system and in this case it works, so I won&#x27;t complain about that.<p>But can we please let go of these childish fantasies that Bitcoin will overthrow all government and usher us into an anarchist utopia of voluntaryism and global human liberation? Those kinds of libertarian&#x2F;anarchist pipe dreams were excusable during the very beginning of Bitcoin, when the protocol was still being sharpened and everyone was enthusiastic about this new idea.<p>I don&#x27;t know what kind of world the author lives in where he thinks people posting textual descriptions of their conditions on the Internet, backed by a digital currency, will revamp the healthcare system into an anarcho-capitalist institution and turn government irrelevant? What bullshit. Do I seriously need to explain that writing about your condition isn&#x27;t enough to get diagnosed with <i>anything</i> beyond the most rudimentary of advice (&quot;This might be that, but I&#x27;m not sure. Go see a doctor and try this herb in the meantime to see if it stops.&quot;)?<p>Bitcoin will not render government irrelevant. You see, the thing is that even if the concept of Bitcoin theoretically can allow financial independence from the state, it&#x27;s completely meaningless when your ecosystem is a mess. The Bitcoin ecosystem, as we have witnessed so many times, is absolute chaotic mayhem that can ironically only be controlled through state regulation, which many hardcore Bitcoiners are advocating for.<p>Homeschooling is opting out of the state? Uh, last I checked, homeschooling requires one to be registered with the state, as well as offer vigorous and regular checks with it to ensure you&#x27;re in line.<p>The Silk Road isn&#x27;t any different from your standard drug dealing market, only it&#x27;s online and just as volatile and unreliable as the physical thing.<p>Look, Bitcoin is certainly capable of great things, but these here are just naive pipe dreams.
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pakabout 11 years ago
Disclosure: I&#x27;m currently attending medical school in New York.<p>It seems incredibly irresponsible for a doctor to prescribe things based on an internet conversation without a physical exam. You can&#x27;t auscultate (listen to with a stethoscope), visually inspect, run labs, do basic imaging, etc. over an anonymous internet forum, which are basic facilities that anybody should expect a doctor in the US to utilize. It is plainly evident, once you become involved in clinical encounters, that you discover things on exam that the patient didn&#x27;t know about, forgot to tell you, or wouldn&#x27;t be able to find themselves. These findings are often critical for diagnosis. Telling the patient to take a certain drug without that data is dangerous and irresponsible.<p>You could certainly offer general &quot;advice&quot;, but this will never be a substitute for seeing a doctor. Perhaps interfaces with video and sound are able to up the bandwidth of internet medicine but currently there is still too wide of a gap between that and actually laying hands on the patient.<p>I was not surprised to find that this is exactly what the linked document of related policies by state medical boards states for New York (<a href="http://www.fsmb.org/pdf/InternetPrescribing-law&amp;policylanguage.pdf" rel="nofollow">http:&#x2F;&#x2F;www.fsmb.org&#x2F;pdf&#x2F;InternetPrescribing-law&amp;policylangua...</a>):<p><i>Section 80.63 of the controlled substance regulations requires a practitioner to physically examine a patient prior to initially prescribing a controlled substance. Issuing a prescription for a controlled substance solely on the basis of a questionnaire or other medical history submitted to a practitioner over the Internet does not meet the requirement of a physical examination or establish a legitimate practitioner-patient relationship and is not a valid prescription.</i><p>I cannot find anything controversial about that. I am all for forums linking doctors to talk to more patients, even for payment, but keep the &quot;MD&quot; out of the name because this is not a true substitute for seeing a doctor.
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01Michael10about 11 years ago
This article is for real? Am I missing something? Sure, people want a diagnosis and other services from an unregulated, anonymous doctor with a reputation built by what? Amazon-like reviews? Come on!
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psaintlaabout 11 years ago
So they are hoping people will make medical decisions based on advice from an anonymous doctor whose credentials you cannot verify and who does not have prescribing ability? Is this serious?
baddoxabout 11 years ago
I think an even better example of potential crypto-anarchist success is legal advice. It could work largely the same as the medical service this article describes, but legal advice fits better than medical advice.
hershelabout 11 years ago
Another interesting thing to do is having a high quality medical expert system(Watson), running outside the u.s.(say africa[1]) with people who we&#x27;re taught how to use it(even doctors), with access to video communication with the patient, with access to his test results - administer advice to him.<p>Assuming good , mostly automated process and a good expert system - this could be a way to offer highly accurate second opinion.<p>And it would be a perfectly legal service from the provider side.<p>[1]This could be used locally in the country, which is a nice way to augment&#x2F;start a country medical system
kevingaddabout 11 years ago
I&#x27;m bothered that this article seems to believe that the rise in homeschooling (in large part by unqualified parents using low-quality textbooks and ill-considered strategies) is another example of people &#x27;opting out&#x27; of some particular brand of oppression by the State, and that doing so will increase supply, or something?<p>As far as I&#x27;m concerned, students have a right to a high quality education because without one their future will be a trainwreck. Just because they&#x27;re largely minors doesn&#x27;t, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the &#x27;rights&#x27; of parents, but I don&#x27;t think parents have the right to treat children like property in the first place.<p>And yes, there are some parents who do a great job homeschooling; I&#x27;m sure of it. I&#x27;ve just never met them, and I was extensively involved in local homeschooling programs back in my home town, so I interacted with dozens of homeschooling families, hundreds of homeschooled kids, and visited some of the organized conventions and programs that involved thousands more. Too many of these people simply aren&#x27;t qualified to teach a child from the beginning up to college age, even if they may have the legal freedom to do it.<p>As it relates to the article&#x27;s premise: I also think individuals have a right to reasonable health because it is integral to their future. A nation full of sick people is going to be a nation with low productivity and a high tax burden from running things like emergency rooms. It is in our best interest to offer everyone affordable access to some basic minimum level of health care, and to do so in the cheapest possible manner. The author seems to believe that a comparison shopping website for doctors will deliver affordable health care to everyone, but I think he ignores a few essential issues that could make it impossible for such a website to deliver good results:<p>a) Even now, many people who need health care do not have regular access to the internet. This is in part due to the huge stretches of rural America, but it is also due to the fact that we have a huge homeless population and a huge low-income population, both of whom may not even be able to afford the equipment necessary to get on the internet. You certainly aren&#x27;t going to propose giving them free equipment and internet access so they can go buy health care on a website.<p>b) It is arguably impossible to comparison shop for essential health care. You don&#x27;t have the time to waste on it and you are emotionally&#x2F;mentally compromised by the stress of your impending doom. To a degree, this is correct - you should be prioritizing your own well-being. It should be the responsibility of everyone else in the system to try and keep costs for this essential care to a minimum; instead, a profit-driven health system tries to maximize profit off this essential care, and deny claims to as many dying people as possible. Introducing more profit motive into this system does not seem like it will fix anything.<p>c) Medical practice over the internet without licenses is simply a recipe for disaster. I am willing to accept that a licensed doctor could perhaps perform a subset of their duties over the internet; I occasionally email my doctor instead of visiting them in person when I need minor adjustments to medicine doses, and that is fine - both sides are fully informed and no corners are being cut. However, if you&#x27;re not even going to license them to verify that they meet the basest standards of medical competence, you&#x27;d be mad to also let them practice without ever seeing a patient in person. It&#x27;s just a bad idea. We have enough issues with malpractice and patients being sold treatments they don&#x27;t need as things are; removing licensing and medical standards will make this worse as both of those problems can be increased by a profit motive.<p>d) Comparison shopping for long-term health care seems nearly impossible since in many cases, if you discover the care you are getting is suboptimal, it is too late to switch - whether because of pre-existing conditions, or because the care is ongoing and transferring to another provider would put you at risk. You can&#x27;t trivially ask to have your dying father moved to an intensive care unit across town just to save a couple thousand dollars, even if you CAN do it.
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chiphabout 11 years ago
You&#x27;d want that your physician has more training than just having read some WebMD articles. How can you be sure?<p>What about liability in case they&#x27;re wrong? A coworker lost a relative last year because the doctor missed an obvious case of septic infection. How do you take an anonymous physician to court for a mistake like this? Hard to pay restitution when the injured party dies.
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mwnzabout 11 years ago
I stopped reading when the author implied that the U.S healthcare systems woes were due to supply and demand. This is a shallow view of a completely broken system. The supply and demand ratio is comparable to that of other wealthy nations, yet almost every other wealthy nation has kept their health care industry in check.
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etanazirabout 11 years ago
MD = Monopoly on Drugs