[motoko]

I know the primary care outpatient business, and I support "Walmart medical care." (We call them "counter clinics.")

People who don't want expert medical advice go to the counter clinic, we don't have to serve resentful patients, and we can spend our time thinking about medicine with patients who appreciate our service.

Further, patients sometimes visit a counter clinic, but they have issues beyond what the counter clinic can handle. So, the counter clinic will refer the patient to us ---the medical doctors. One of our most regular patient referrals is corner CVS because the local medical doctors introduced themselves respectfully to the CVS clinic staff.

However, don't be fooled by the "cost cutting" nonsense. My estimation is that counter clinics increase total medical spending in the same way that shopping at Wal-Mart increases total consumer spending. Yes, each individual purchase of "health care" is moderately cheaper. However, given the lower prices, omnipresent availability, and cross-marketing of other products in the store, people do not simply buy the same things at a lower cost, they impulsively buy many smaller purchases of dubious value.

So, rather than visit an outpatient medical doctor for an hour for $500 (that is what we bill, though we usually only collect about $300 of that from insurance), one visits the Wal-Mart counter clinic for $70. That's a savings of $430, right? Maybe. Assume the counter clinic treated your sore throat, but you also had another issue, and later visited the medical doctor. Both issues could have been treated by the medical doctor for $500 now rather than $570 over several weeks. Oh, and you also bought "health supplements." Add another $30 recurring cost. Well, actually, you don't go to the doctor at all because you only have $500 for health care, and the doctor costs $500, but you only have $400 because you've already spend $100 on the counter clinic and supplements ---oops, actually, that $400 is already spent by your employer for health insurance.

So, you still pay, but you never visit a doctor, chronic heath conditions continue to exasperate, and in addition to suffering from chronic health problems, you eventually get very sick, progressively lose your ability to function, and are hospitalized sooner at a much higher cost.

Even a single day of missed work at $5 minimum wage due to illness not addressed by a counter clinic is quantitatively worth more than the $37 best case savings at the counter clinic. Primary and preventative care alternatives are almost never "cost savings" unless you know precisely otherwise.

By the way: there is some ludicrous cultural myth that exasperated health problems can be "fixed," or if you can just avoid "having a a serious problem" and "keep natural," you will be OK ---or at least, you can "fix" health "issues" "later."

No, you don't. You die.

Also, jeez, you spend so much time and money making your face and buying clothes, but when you have a disease, you're thinking about saving a few dozen dollars? Bleh.

[catzaa]

The problem is that doctors charge ridiculous amounts even for simple treatments. If I have Bronchitis I know exactly what I need and the doctor knows it too. Yet he will charge a shitload for a 10 minute appointment.

The same with medical tests – the doctors draw blood and send it to a pathologist. They then charge you a 400% mark-up on that and make pure profit. Then it is the unnecessary x-rays (if the doctor happens to have a digital x-ray machine that he is itching to use).

If a doctor prescribes anything he will prescribe the most expensive antibiotics ever – even though a much cheaper run of the mill one will work as well (I don’t know why they do that).

Why do they want routine appointments (once a month) for chronic medicines?

No offence, but I think modern day doctors focus on ripping off medical schemes because there is no apparent victim.

[motoko]

> The problem is that doctors charge ridiculous amounts even for simple treatments.

Assuming you are a programmer, why should I pay to use your software? I would prefer to pay nothing because it doesn't "cost anything" to copy it. Oh, well, ok, I'll pay for my 10 minute share of your time at $40 / hour. You have to eat, too.

> If I have Bronchitis I know exactly what I need and the doctor knows it too.

Great. Go visit a counter clinic and get exactly what you need ---though I'm sure you know that you have acute viral bronchitis and you only needs some over-the-counter drugs to treat symptoms. Then, you can go reinvest your "shitload" in something more intelligent like car insurance or a new graphics card. Like, your lungs are fine. I'm pretty sure all lungs have been fine forever for everybody, and if not, well, you can buy a new lung from the lung store and swap it in for all those shitloads you saved in ten minutes years ago. It will probably even be a better lung than your old obsolete one.

"The same with medical tests – the doctors draw blood and send it to a pathologist. They then charge you a 400% mark-up on that and make pure profit."

You're right. Health care should be like sex. Free only, illegal otherwise, immoral regardless. There should be laws to enforce this.

"Then it is the unnecessary x-rays (if the doctor happens to have a digital x-ray machine that he is itching to use)."

Say no.

"If a doctor prescribes anything he will prescribe the most expensive antibiotics ever – even though a much cheaper run of the mill one will work as well (I don’t know why they do that)."

Did you ask?

Also, doctors prescribe generally prescribe what will be most likely to work the fastest because ---if you remember from a century ago--- bacterial infections kill you and then spread to your friends and family to kill them. They don't care that you can save $30 with some similar drug they don't know much about.

"Why do they want routine appointments (once a month) for chronic medicines?"

Because

"No offence, but I think modern day doctors focus on ripping off medical schemes because there is no apparent victim."

If you know some rip off scheme perpetuated by licensed medical doctors, write it down and submit it to a medical journal. I think modern day people focus on engorging distractions while they mindlessly spawn and decay because there is no apparent victim. No offense.

[catzaa]

> Go visit a counter clinic and get exactly what you need ---though I'm sure you know that you have acute viral bronchitis and you only needs some over-the-counter drugs to treat symptoms. Then, you can go reinvest your "shitload" in something more intelligent like car insurance or a new graphics card.

The problem is that in my country you cannot get a prescription without a doctor’s appointment. What happens (at least with me) is that I wait to see if I get better by myself.

> You're right. Health care should be like sex. Free only, illegal otherwise, immoral regardless. There should be laws to enforce this.

Nowhere did I claim that. What I meant was that doctors have a conflict of interest. On the one hand they should care for your health and on the other hand they should make as much money as possible. That causes a lot of doctors to prescribe unnecessary tests and perform unnecessary x-rays. In my country there was a law that allowed doctors to sell medicine (usually a pharmacy had to be owned by a pharmacist). This caused a lot of doctors to give out overly expensive medicine that people do not need.

> Say no.

And the doctor will tell you that it is really necessary. Since most people do not know the field they will believe the doctor with blind trust.

> Also, doctors prescribe generally prescribe what will be most likely to work the fastest because ---if you remember from a century ago--- bacterial infections kill you and then spread to your friends and family to kill them.

They actually do that to make money (see above).

> They don't care that you can save $30 with some similar drug they don't know much about.

Those “similar drugs” are run of the mill anti-biotics that have been on the market for 20+ years.

[motoko]

"The problem is that in my country you cannot get a prescription without a doctor’s appointment."

Acute viral bronchitis: http://www.amazon.com/s/ref=nb_ss_0_9?url=search-alias%3Dhpc...

"They actually do that to make money (see above)."

In the USA, doctors do not make money from drugs directly, though they may indirectly benefit from pharmaceutical "good-will." However, that's more common for new drugs that patients would take chronically, like psych drugs, not antibiotics to treat common, acute issues.

"And the doctor will tell you that it is really necessary. Since most people do not know the field they will believe the doctor with blind trust."

Well, do you really know the field enough to know that it's _not_ necessary? And if so, then why would this be relevant to you?

"Those “similar drugs” are run of the mill anti-biotics that have been on the market for 20+ years."

The standard of care evolves ---as do the "biotics."

[billswift]

I had shingles in 2000. I had to go to a hospital emergency room to get a prescription for painkillers, since the extortionists (aka medical professionals) require permission before we serfs are allowed to buy many drugs. It cost me over $300 for what should have been about $1 worth of oxycodon.

[motoko]

You are paying for $299 worth of emergency room, not $1 of oxycodon.

However, I do agree that distribution of drugs in the USA has become a franchised back office sales game of all rent and no responsibility. I don't like that.