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Rite Aid Drug Stores Offer Virtual Doc Visits

Soulskill posted about 3 years ago | from the please-state-the-nature-of-the-medical-emergency dept.

Communications 138

Lucas123 writes "Rite Aid today announced it is offering virtual face-to-face physician consultations through an in-store kiosk. The virtual consultation services are currently being tested in the Detroit area, but the company expects they will do well and the virtual consults will expand to other regions. The service costs $45 for a 10-minute physician consultation. Consultations with nurses are free."

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healthcare's a rip-off (4, Insightful)

Hazel Bergeron (2015538) | about 3 years ago | (#37523992)

Why is healthcare such a rip-off? In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high.

We can see from countries like Cuba that doctors aren't the result of educating a rare genius. But for some reason in the Western world we feel the need to artificially constrain their supply, take them through a hazing ritual to make them cynical about their patients, then treat them like gods.

Let's return medicine to what it started as in Greece: a calling to care for the sick. Let it be a thoroughly secure vocation for permanent healthcare workers, where there is an understanding of difficulties on both sides - not one solved by high price doctors, lawyers, insurance, third party agencies and miscellaneous bureaucracy (public or private).

Re:healthcare's a rip-off (1)

TooMuchToDo (882796) | about 3 years ago | (#37523998)

You know its only a matter of time before IBM's Watson replaces a substantial amount of doctor consultations (being an expert system that never sleeps and all). This is not a bad thing. Just as the cost of manufacturing and some services have plummeted, so will healthcare with technological progress.

Re:healthcare's a rip-off (1)

shawn443 (882648) | about 3 years ago | (#37524070)

This free consultation is brought to you by Company Name. Company Name, for all your medical and well being needs. Company Name is dedicated to you. Please choose from the following options. Are you feeling sad? ... ...

Re:healthcare's a rip-off (1)

adolf (21054) | about 3 years ago | (#37524126)

Have you watched the movie THX-1138?

I have, and I'm not so sure that I'm interested in having Watson be in charge of my health.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524314)

It's likely you won't have a choice. I can envision a future where you get to see a physician only when Watson (or whatever it will be called) refers you. Oh well, at least it's not a death panel.

Re:healthcare's a rip-off (1)

TooMuchToDo (882796) | about 3 years ago | (#37528362)

As if its significantly better to have someone making 5x the median income in the US and who can accept kickbacks from pharmaceutical companies is any better.

I'll take Watson thanks.

Re:healthcare's a rip-off (1)

elrous0 (869638) | about 3 years ago | (#37525790)

Just remember to put the blue one in your mouth and the green one up your butt.

Or was that the other way around?

Re:healthcare's a rip-off (1, Insightful)

BlackSabbath (118110) | about 3 years ago | (#37524076)

> Why is healthcare such a rip-off?

Because you are American.

Before anybody jumps up and yells at me that other health systems have their own problems and/or their success/efficacy is greatly inflated, let me agree with you that all those other health systems are generally crappy too.

It's just that your health system is so fucked that it makes everyone else's crappy to mediocre systems look luxurious* by comparison.

* in the Monty Python sense.

Re:healthcare's a rip-off (0)

slydder (549704) | about 3 years ago | (#37524152)

I am forced to agree with you on this one.

I was born and raised in the U.S. and know how crappy the health care system is. A lot of people I knew went into the military because that was a major factor in the decision process (that and educational opportunities were very important).

I have been in Germany for, approximately, 20 years now and I must say the health care system here is also screwed up but better than the system in the U.S. By several magnitudes of better. O.K. I have to pay 10 € every 3 months if I want/need to visit my Doctor, but hey that isn't soooo bad. At least I'm not going to be treated by an impersonal online virtual Doctor any time soon.

Re:healthcare's a rip-off (2)

MrL0G1C (867445) | about 3 years ago | (#37524662)

I'm in the UK and I'd like to point out that the National Health Service is fucking awesome, there's nothing like being able to walk into any A+E and get treated without having to worry about proving who you are or what bills there are going to be because there are any. Doctor visits, check-ups, tests etc are all 100% free.

Why anyone would want to have the stress of worrying about health care costs is something I don't understand. Only the super-rich could have reason for wanting private health-care.

Re:healthcare's a rip-off (2)

sub67 (979309) | about 3 years ago | (#37524992)

Only the super-rich could have reason for wanting private health-care.

We all like to pretend we're super-rich here in the US.

The Wrath of the Millionaire Wannabe's (1)

Paul Fernhout (109597) | about 3 years ago | (#37525128) []
"The right likes to think that every Leftist "hates" the "rich". I suppose there are those on the Left who hate the rich, but if they do, their anger is misplaced. It's the "wannabe's" you have to watch out for. ..."

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37527340)

We all like to pretend we're super-rich here in the US.

Like 'Joe the (unlicensed) Plumber', who gained fame by lying telling a lie to a presidential candidate.

Re:healthcare's a rip-off (1)

jellomizer (103300) | about 3 years ago | (#37525262)

If you do have a serious problem, then you need to pay out of the pocket to get treatment in the United States, or wait years to get treatment.

Re:healthcare's a rip-off (1)

skegg (666571) | about 3 years ago | (#37525344)

Doctor visits, check-ups, tests etc are all 100% free

Wow ... sounds too good to be true. Does that include CT scans, MRI's, ultra-sounds?

Re:healthcare's a rip-off (1)

MrL0G1C (867445) | about 3 years ago | (#37525690)

Yes to all of those, with a referral from the doctor (free) who would obviously want good reason to do so (illness, pregnancy etc). Prescriptions aren't free unless you're unemployed etc, even then they are cheap (fixed cost).

Re:healthcare's a rip-off (1)

c6gunner (950153) | about 3 years ago | (#37526824)

Why anyone would want to have the stress of worrying about health care costs is something I don't understand. Only the super-rich could have reason for wanting private health-care.

Good point. I don't want to have to worry about a mortgage, either - let's just have the government provide communal housing for free! Only the super-rich could have reason for wanting private housing.

Re:healthcare's a rip-off (1)

Hazel Bergeron (2015538) | about 3 years ago | (#37527868)

A social democracy looks after the vulnerable.

A man who is homeless and unable to support himself through disability (other vulnerable categories are also eligible) is provided with housing under a legal duty of care assigned to local authorities in the UK. If he has wealth then he may be required to contribute once stable arrangements have been made.

A man who is homeless but who has health but not wealth is not as vulnerable, so has access to free advice and a limited allowance toward his own housing arrangements. But he is not given housing outright because he can look after himself to some extent.

A man who is homeless but who has health and wealth is eligible for advice but, because of his health and wealth, will not be provided housing or an allowance toward housing. He can choose to live in a house, in a hotel, in a tent, etc.

Sick and disabled people are vulnerable, so the NHS provides healthcare to all sick and disabled people. A sick human is a sick human, and his treatment needs apply regardless of health or wealth.

tl;dr Accommodation arrangements are the subject of choice - everyone wants to live in a different way and many different arrangements remain healthy and productive. Health is not the subject of choice - the only option is to be as healthy as possible and the only question is whether the resources are available to monitor and/or treat you.

If you don't like society, you're welcome to live outside of it and hope that - if you try to impose your will in any way beyond living in the hills as a hermit - your mob isn't overrun by the majority. History suggests that it would be, however.

Re:healthcare's a rip-off (1)

c6gunner (950153) | about 3 years ago | (#37528012)

Health is not the subject of choice - the only option is to be as healthy as possible and the only question is whether the resources are available to monitor and/or treat you.

Nonsense. Health is absolutely a choice. A person who smokes, drinks, and injects himself with heroin obviously places a lower value on health than does a vegan Buddhist tai-chi practitioner. A person who decides to spend $500,000 to get the absolute best doctor in the world obviously care more about his odds of survival than does a guy who will only spent $50. Life is ALL about choices, and death is a natural consequence of life. I don't need a government dictating how I live or how I'll die.

You're not explaining a logical divide - you're rationalizing a choice which you've already made. You can rationalize ANY position in a similar manner, and it would be equally useless.

If you don't like society, you're welcome to live outside of it

Ditto. You don't like the way I organize my society? Go away. Move to China. The workers paradise will take great care of all your needs.

Re:healthcare's a rip-off (1)

MrL0G1C (867445) | about 3 years ago | (#37528420)

UK used to have a lot of council housing - Govt. supplied housing, not free but far more reasonable prices that what the private landlords charge. Personally I don't think a system where people work hard and then buy other people houses (rent->mortgage) is fair - that's what we have now.

Re:healthcare's a rip-off (2)

BJ_Covert_Action (1499847) | about 3 years ago | (#37527732)

A lot of my friends and family are staunchly conservative (their words, not mine). They walk along the Republican party lines and watch a lot of Fox News, and all that kind of crap. When the discussion about healthcare comes up, I will ask questions about how they would address certain fringe cases, how they would cover certain social costs of not having socialized medicine, etc. etc. I ask these questions sincerely and earnestly because I want to hear what the self-proclaimed conservative philosophy is on this subject.

After dozens of conversations with otherwise decent folk, the discussion always comes down to this: my friends and family would typically prefer to watch another human being die, and still have an extra $200 in their pockets at the end of the year, than to simply reach out and help the folks who need it.

And that is the mindset, so far as I can tell, of the modern American conservative: "My money is more important and valuable to me than another man's life."

Some folks don't seem to see anything morally bankrupt about this stance. At the end of the day, it is just a game of, "me first, my shit's more important, always." But it really is a heart-breaking eye-opener when you notice that the folks you have respected and loved all your life would rather be rich and on top than be charitable and do with a little less.

So stands modern America, as far as I can tell.

Re:healthcare's a rip-off (2)

MrL0G1C (867445) | about 3 years ago | (#37528572)

The irony is that our health care system treats more and costs half as much. The European treaties that have been signed by UK traitor politicians unfortunately demand that everything possible be privatised :-(

Re:healthcare's a rip-off (1)

SuricouRaven (1897204) | about 3 years ago | (#37524094)

1. It takes a vast amount of training. An encyclopedic knowledge of all common illnesses and most of the rare ones too. That's why the education process is so demanding.
2. Because when they make mistakes, people die. That makes medicine a legal minefield, and drives very high standards.

Re:healthcare's a rip-off (1)

Hazel Bergeron (2015538) | about 3 years ago | (#37524148)

(1) I admit that I had a fairly privileged upbringing, but I have a few schoolfriends who went into medicine. It really doesn't require "an encyclopedic knowledge of all common illnesses and most of the rare ones" - it requires a good knowledge of all common illnesses and some of the rarer ones, with the latter learnt about for exams/practical testing then mostly forgotten about just as in any other field.

The demanding bit is the hazing which occurs at the start of the practical hospital training. You are made to work very long hours and any mistakes you make may retard your career a little but will hurt the patient a lot. The experience reflects one small, occasional part of the responsibilities of the doctor, but those who perform complex procedures and who advance the state of the art in medicine are those who can sit down and thnk, not those who are capable of running around with little sleep. Nurses often have to work in similar conditions, but in their case it's because they're "just nurses" and it's expected of them.

(2) Yes, as with many healthcare workers. I don't know how high it drives standards, though - all doctors make mistakes which reduce the quality of life of their patients, all experienced surgeons have killed patients, etc. The legal minefield problem is evident, but insurance for practitioners is expensive because so much money is paid out, and if so much money is paid out then either (i) doctors are making mistakes all the time or (ii) patients are able to make successful claims with no basis.

(But the people who really get to decide quality of life on a large scale - civil servants and CEOs - are comparatively unqualified and immune!)

Re:healthcare's a rip-off (1)

swb (14022) | about 3 years ago | (#37528688)

My neighbor's daughter became a nurse and I'm always amazed when I see her Facebook postings "Whew -- just finished 3 16s and a 24, ready to enjoy 14 days off."

I'm surprised that staffing works like that. One, is it really helpful to have a nurse be awake and on the job for 16 hours? I get punchy doing IT work after about 12 hours. 24 hours? That seems crazy.

How does it work that she can work 3-4 days and then have like two weeks off? This seems to happen a lot, and while not all shifts are as crazy long as above, it seems like she's constantly off work for runs of 4-5 days, even when she appears to only have clocked 50 hours in 4-5 days.

I may be misinformed, but it strikes me that this kind of staffing would be extremely expensive compared to more uniform staffing levels and shift lengths.

Re:healthcare's a rip-off (2)

sjames (1099) | about 3 years ago | (#37524154)

Those points are constants in medical practice, but it's not so crazy expensive in other countries. I don't mean it is crazy expensive but it comes out of your taxes, I mean all expenditures taken together are lower in practically every other country in the world including those whose healthcare ranks better than the U.S.

Re:healthcare's a rip-off (1)

antifoidulus (807088) | about 3 years ago | (#37524390)

It's not just "lower", it's about half(in terms of % of GDP) in most other OECD countries. Now certainly part of this can be attributed to the general state of health in the US(it's not good), and of course people will scream trial lawyers, which do take a toll on the system, but not nearly as much as the private health insurance system does.

I personally like the Japanese system, you pay a certain amount every year based on your salary(it's not expensive at all), and then for every covered medical expense you pay 30% and the state pays 70%. This gives people a financial incentive NOT to go to the doctor for very common maladies, but gives them a huge financial incentive to seek out preventative care as well as take care of themselves. Furthermore it gives the state motivation to keep costs down, as people know how much they, as well as the state, are paying for medical services. As a result, medical services are pretty much the only thing that is considerably cheaper in Japan than it is in the US.

Re:healthcare's a rip-off (1)

dotancohen (1015143) | about 3 years ago | (#37525672)

2. Because when they make mistakes, people die. That makes medicine a legal minefield, and drives very high standards.

No, when a doctor makes a mistake a _person_ dies. When an engineer makes a mistake hundreds of people die.

Who is more stressed?

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37526730)

The engineer never has to tell the next of kin that their loved one died because he forgot to carry the 1.

A surgeon who's hand slips may very well have to look the patients next of kin in the eye and say "they died from complications".

The latter is considerably more stressful (to non sociopaths) even if it is technically a smaller loss of life.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37526756)

The doctor. The engineer is not personally responsible; the corporation is.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524134)

"Why is healthcare such a rip-off?"

Because human illness is complicated.

Re:healthcare's a rip-off (1)

Great Big Bird (1751616) | about 3 years ago | (#37524142)

Not all doctors get paid insanely high. []

Re:healthcare's a rip-off (1)

sjames (1099) | about 3 years ago | (#37524228)

That article's own numbers don't support it's conclusion. It claims auto workers make more money, but then cites $75k as compared to the doctor's $99k. It wants us to be upset that it is possible for a skilled tradesman putting in a great deal of overtime can earn nearly as much as a doctor working a normal work week.

I'm not saying doctor's are being paid lavishly, but they're nowhere near sitting on sidewalk with a "will diagnose for food" sign. Of course, they don't tend to get laid off, and they don't go home every night feeling (and occasionally looking) like they just lost a prize fight.

That said, doctors do sometimes end up as the scape goat for the high healthcare costs when they're not really the problem. Those overhead costs are a huge contributor. That would be liability insurance, crazy cost of medication and disposable supplies, etc.

Re:healthcare's a rip-off (1)

Errol backfiring (1280012) | about 3 years ago | (#37524232)

I agree wholeheartedly. And, like in the ancient Greek medicine, treat the elementary particle "person" as a human being again. The ancient Greek medicine is not a fight of symptoms, it is a whole healthcare. The basis was a balance, like in so many other medicine systems in other cultures. So the personal situation, mental environment, domestic environment etc. were all investigated when you visited the doctor. But off course the doctor knew you. He was a member of your own community. Not some unknown call-centre doctor routing his voice packets from the other side of the world.

The article also says that the VOIP thing was investigated as being good, as there was less time needed for administrative work and therefore more time for the patient. So I think it is the healthcare system itself that should visit an ancient Greek doctor. Its mental situation is very unhealthy, as is its domestic situation. And no, a Greek doctor would not necessarily subscribe pills. Often it was a diet, exercise or even telling the patient to play music.

Re:healthcare's a rip-off (1)

c6gunner (950153) | about 3 years ago | (#37527168)

The basis was bullshit, like in so many other "medicine systems" in other cultures.


Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524366)

In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high.

This isn't always true. It depends on where you're talking about. Not all systems are created equal, and they all have their failings.

Though I agree that our HC is ridiculously expensive, overall.

Re:healthcare's a rip-off (0)

lakeland (218447) | about 3 years ago | (#37524412)

Er, not really

Name one nationalised healthcare system in which the doctors get paid insanely high.

I guess it depends what you consider insane. Where I live the average doctor is paid approximately four times the average wage. is that insanely high? Doctors are smarter than the average punter and harder working. I would've said that most people with enough intelligence and diligence to go into med that decide to go elsewhere end up getting only slightly lower salaries - perhaps 20%.

I don't know, I never felt any real desire to go into med at school. Twenty years later it looks more attractive, with doctors having much more flexibility on where and when they work but that's probably just be a standard 'grass is greener' reaction.

As for restricting their supply... yeah, that's a tricky one. One counter argument is that many universities have shown the higher you place your entry bar, the higher standard of graduate you get. i.e. it doesn't work long term to put a high bar on graduation and rely on failing most people. So those tight funnels are a good way of ensuring every doctor is pretty good.

Re:healthcare's a rip-off (1)

sjames (1099) | about 3 years ago | (#37524670)

4 times the average wage is certainly nothing to sneeze at.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524496)

I live in a nationalised healtcare system and a visit to the doctor costs me €30 tops, off which I get €20 back. Is that a rip off ?

Re:healthcare's a rip-off (1)

JustOK (667959) | about 3 years ago | (#37524558)

someone's getting ripped off at those prices.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524510)

"Why is healthcare such a rip-off? In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high... But for some reason in the Western world ...."

It's not the "western world". It's the USA. I live in another country of the "western world" where I get cheap good health care and doctors are not paid insanely high. Indeed many countries face issue with the health care system, but it's especially problematic in the USA.

The main reason,obviously, that in the USA "quality of life" is not the top priority of the state, otherwise you would have, for example, a national all encompassing health care insurance for all.

45USD for 10 minutes of VIRTUAL doctor is truly unbelievable...

Re:healthcare's a rip-off (1)

buybuydandavis (644487) | about 3 years ago | (#37524672)

Why is healthcare such a rip-off?

...But for some reason in the Western world we feel the need to artificially constrain their supply, take them through a hazing ritual to make them cynical about their patients, then treat them like gods.

Health care is a ripoff because while information is cheap, regulation is expensive.

"We" don't feel the need to constrain supply, the government cartel granted a monopoly on legally providing health care services and controlling access to medication and medical equipment feels the need because they need yachts and summer homes in the Hamptons.

Health care is cheap; health care regulation is expensive crony capitalism.

Re:healthcare's a rip-off (2)

PSandusky (740962) | about 3 years ago | (#37526994)


Health care is cheap; health care regulation is expensive crony capitalism.

Um... no. At least, not necessarily.

I worked for a blood bank for several years, and because blood banks by definition supply both pharmacologics (plasma fractions, IIRC) and biologics (practically everything else), they are subject to FDA regulation as defined in the CFR for those types of agents. My particular blood bank was under a consent decree with FDA for failing to follow those regulations in whole and/or in part, and that failure to follow can have real consequences for the patient -- accidental infections with things like CMV become a whole lot easier when your controls over CMV status labeling are lax, for example. In that case, an otherwise healthy adult might just get flu symptoms. In someone who is ill (or someone who is not yet an adult, or even an adolescent), which a recipient would generally be, the consequences can be significantly more dire.

Why does that matter?

It's truly amazing just how many corners blood banks like mine were willing to cut in the name of building product numbers, because ultimately, they're really just manufacturers pushing a product for maximum profit -- sure, any time we'd send letters to anyone we'd play up the non-profit jag and ask them to use their own stamps on the SAE we'd send them for their reply, but all management really ever cared about was pumping up profits. If the regulations weren't in place to cover things like labeling, it's a fair bet the manufacturers wouldn't bother to enact those policies on their own. If they're not held to a given standard, they won't expend the money to maintain that standard. Labelers, training, equipment, testing supplies, testing contracts, and other related recurring expenses are exactly the type of expenses management doesn't want to incur. Patient health really only matters if it could bring legal ramifications, and if there's no law being violated or regulatory standard in place, it's actually fairly easy for the manufacturers to get off scot-free -- even in a civil trial. Regulatory infractions come up in civil trials all the time.

Blood banks in particular demonstrated this fairly clearly in the early 1980's, when HIV started to show up on the scene. HIV itself wasn't immediately apparent, but a tremendous uptick in Hepatitis B cases was -- and at the time, the technology did indeed exist to test for that virus. Blood banks advised that testing for Hepatitis B was not acceptable... because of cost. Bayesian false positives didn't come into it. Faults with the general theory of testing didn't come into it. Fears of HIV infection didn't come into it (at least, at the testing phase). The reason blood banks didn't want to test for HepB was the cost to institute a testing program, and it was FDA's mandate that ultimately got them to start testing and getting the bad blood out of the supply. (It was also FDA's regulation that pegged Abbott Laboratories, I think, with bad HepB testing supplies... here again, without regulation, nothing would've been done, because nothing would've been illegal.)

The expense of regulation isn't a 100% honest deal, because there are always going to be corrupt regulators. At the same time, I would much rather have legitimate regulators working from a pool that includes a few corrupt ones, and dealing with that, than to have the corporate health care industries strictly regulate themselves, because as has been proven numerous times (blood banks, contaminated food cases, contaminated drug cases, improperly tested drug cases, I could go on...), they will do no such thing with that inherent conflict of interest.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37524708)

Sadly, I have no mod points. Brilliant summation of the American Health "care" system.

Re:healthcare's a rip-off (1)

damn_registrars (1103043) | about 3 years ago | (#37524898)

In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high.

There are a lot of people who make a lot more money than doctors who have jobs of far less importance. Say what you will about the practice of medicine in this country (or others) but really the salary isn't out of line for what they do.

then treat them like gods.

I do agree we could do without that part.

Re:healthcare's a rip-off (0)

Anonymous Coward | about 3 years ago | (#37525476)

Say what you will about the practice of medicine in this country (or others) but really the salary isn't out of line for what they do.

Yes, there are superstars who deserve all they get... but just like in IT, 90% of the profession is... well... filler. Those are the folks who don't become surgeons and are happy to tax your insurance every few months for a checkup of some sort or another. And in most cases, the ONLY reason to go see them is to get a prescription for something YOU already know you need.

Try paying cash for your next visit. You'll come out of the office feeling ``heck, I paid $370 for *this*???''

Re:healthcare's a rip-off (3, Informative)

jellomizer (103300) | about 3 years ago | (#37525242)

Doctors pay is only the small part of the cost. Don't blame the Professional doing the work.

Where does your money go...
1. Malpractice insurance - Because the Doctor makes a mistake people feel they should sue them for a ton of money, although he is just trying to help.
2. Unpaid Health Care - Health care has a high rate of treatment to people who cannot afford to be treated. So that is factored into the cost
3. Insurances and Medicare/Medicaid - Their goal is to find a way not to pay the doctor unless they go threw a bunch of loops requiring more staff or cutting into his business time. Heck just dealing with the IT Staff alone you run into the biggest IT Idiots in the world. Here is how a typical integration project works....
ME: My claim has been rejected why is that.
INSURANCE COMPANY (IC): We changed our format around.
ME: When was I notified about this
IC: We posted the notification change on our webpage in
ME: I am looking at the page right now I don't see a path to get there.
IC: You should have this link bookmarked.
ME: When did you tell people about this page.
IC: We had the link up for one day on December 25th 2 years ago.
ME: Can I have YOUR 837 specifications....
IC: We follow the 837 standard you should know it.
ME: I want a copy of your version of the specifications.
IC: It is just like what we require on the paper form.
ME: Please can I have the specs to be sure I am doing it your way.
IC: OK... (Gives you a generic 837 standard spec)
ME: (Follows the specs as giving, runs the test and gets rejections back, a week later) What is wrong why isn't this working.
IC: Well we don't follow those areas of the specs. We put those values in this filed
ME: (Follows the specs as giving, runs the test and gets rejections back, a week later) What is wrong why isn't this working.
IC: Well we don't follow those areas of the specs. We put those values in this filed ... (this will be about 25 iterations sometimes in those iterations we again beg for the full specs to follow for them)
ME: Ok it seems to process why is it rejecting.
IC: Well the claim is too old so we wont pay it.
4. Staff, front desk, practice managers, billers, nurses....
5. Building upkeep
6. Medical Equipment ...
The doctor while getting paid well isn't really everything you are paying for.

Re:healthcare's a rip-off (1)

dciman (106457) | about 3 years ago | (#37526184)

Because the poor overworked doctor that you are seeing has to be able to pay back the $300K in debt they owe to the government. Until we fundamentally change the way doctors are trained and, more importantly, who funds the bill, nothing is going to change.

Re:healthcare's a rip-off (1)

Kjella (173770) | about 3 years ago | (#37526716)

Why is healthcare such a rip-off? In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high.

I guess that depends on your definition of "insanely high". Here in Norway an average doctor makes around 750000 NOK/year ($130k) and the average full time employee 450000 NOK/year ($80k) so about 2/3rds more. You have to study for 6 years so your study costs are among the highest short of PhDs and with progressive tax earning more in fewer years gives you a higher tax burden. They are admittedly one of the highest earning groups but it is by no means insane. Perhaps you were thinking of the US?

Re:healthcare's a rip-off (1)

tlhIngan (30335) | about 3 years ago | (#37526988)

Why is healthcare such a rip-off? In nationalised healthcare systems, the doctors get paid insanely high; in private healthcare systems, the doctors get paid insanely high.

You have to remember, that a M.D. has a doctorate degree. And before they can basically earn any money, they have to get their doctorate. So at med school, they get their bachelor's, then do their masters, internships, residencies, then their doctorate. At which point then they can go and make money. But it's still a multi-year process and by the time they're done at the earliest they're in their late 20's or early 30's, and saddled with large debts (imagine having to student loan your way through your doctorate).

So you have a doctor who basically has to start paying off his huge debt and has anywhere from a 5 to 10 year delay before earning the "big bucks".

Then add in the fact that if the doctor is in private practice, they have to pay for an office, staff and equipment (even a doctor billing out $200K a year doesn't make that much after shelling out for an office and a receptionist/nurse). That's why they're often partner practices. Oh yeah, and in private healthcare, dealing with insurance and other payers can easily cost another $30-40k in paperwork alone per year. (It's much less in a single payer system - around $5k ish).

In places like Cuba, because the state pays for the education (it IS a Communist country), said doctor is no longer saddled with huge debts from education, the office and staff are likely provided for (by the state), so a doctor really only needs to earn enough to live on.

Oh yeah, the lawyers and malpractice costs are pretty high. I'm sure in Cuba that stuff is handled much quicker, mostly because of Communism means everyone is provided for, so there's no breadwinner to die and leave their family homeless because the remaining spouse can only get a minimum wage job.

Doing some math here (1)

boulat (216724) | about 3 years ago | (#37523996)

So this virtual 'doctor' earns about $561,600 salary a year for consulting services? There is no liability, no physical exam, no prescription services. This is a great business model!

Re:Doing some math here (1)

atari2600a (1892574) | about 3 years ago | (#37524072)

Great job taking into account the cost of the infrastructure & greater company profit. I still say the service is a bit pricy. I'd feel more comfortable for $25/10m or $50/30m, perhaps that's what will happen if the service is successful.

Re:Doing some math here (1)

TouchAndGo (1799300) | about 3 years ago | (#37524334)

Pretty sure if the service is successful it'll just illustrate that $45/10m is the cost that people are willing to bear, and it won't change.

Re:Doing some math here (1)

atari2600a (1892574) | about 3 years ago | (#37524562)

if it barely just projects to turn a profit they'll drop the price to increase potential clients, maybe, kinda...

US health care system (4, Informative)

Anonymous Coward | about 3 years ago | (#37524100)

Has the US health care system really come to this?

Please enlighten me, do Americans consider $45 for a 10 minute virtual doctor visit an attractive price?

In Australia seeing a real physician (GP) in the flesh within a few hours for any reasonable length of time typically costs between $35-$60, of which the public health system pays $35. So net cost to me is $FREE-$25.

I recently dropped a weight on my foot which fractured my toes, I went to my local bulk billing GP without an appointment, was seen within 30 minutes, was referred to get an X-ray across the road without an appointment (wait time - 10 minutes, X-ray time, 10 minutes, result with professional summary time - 40 minutes), then returned to the original GP, wait time - 5 minutes.

Total net cost to me for all of the above - $0 (no private health insurance involved here).

Re:US health care system (0)

Anonymous Coward | about 3 years ago | (#37525010)

Yes, the US health care system really is this bad. To answer your question, at first glance this actually does seem like an ok idea compared to the alternatives.

I'm an Aussie that now lives in the US. I've been here about 8 years so it's possible that some things have changed since I've been gone, but they would have to change a LOT before the Aussie health care system could be anything remotely close to being described as 'bad' when compared to the US one.

Here's a few examples of some of the absurdities.

1) If you don't have a 'regular' doctor when you call a GP the first thing you have to ask is "Are you taking new patients?". It's possible they're not, so you'd have to go elsewhere. If they are, they'll reply with something like "Yes, we're taking new patient appointments for some date 6 months into the future". I don't know who gets sick and then is ok waiting 6 months for an appointment, but apparently some people are.
You can absolutely forget about getting an appointment for the same day, or just walking into a doctors office like you can in AU. If you want to do that you have to go to an 'urgent care clinic' which in my experience is code for 'skeevy shady doctors that couldn't work at a regular practise'. You'll pay extra and out of pocket for it

2) Everything above is even worse for a specialist. If you develop some bizarre rash covering half your body and want to see a dermatologist? Hope you're ready to wait a few months

Basically care provision separates into emergency room at the hospital if it's life threatening ($$$$$$$$$), urgent care if its well urgent ($$$) or longass wait to see your regular doctor ($$)

If you're a foreigner here or someone without insurance, you're pretty much F'ed (unless you're really poor). Most places wont even talk to you if you don't have insurance. Travel insurance wont do either. In fact, any time you want to see how F'ed up the US health care system is just get some quotes on travel insurance. The US portion will likely cost 10X the cost of the rest of the world combined.

Argh. I feel a rant coming on. Have to stop....

Re:US health care system (2)

elrous0 (869638) | about 3 years ago | (#37525974)

I went to my local bulk billing GP without an appointment, was seen within 30 minutes, was referred to get an X-ray across the road without an appointment (wait time - 10 minutes, X-ray time, 10 minutes, result with professional summary time - 40 minutes), then returned to the original GP, wait time - 5 minutes.

In the U.S., you're going to spend more time than that dealing with the paperwork. And god help you if you don't have insurance. That means an emergency room visit. And one of those is going to basically bankrupt you (that's not an exaggeration, an ER visit for even a simple thing here can end up costing well into the ten-of-thousands of dollars). About your only hope in the U.S. if you're uninsured is getting on Medicare or Medicaid. And if you're under 65 or employed at all, good luck with *that*.

It must be so nice to live in Canada or the UK and not have to worry about that stuff. One medical emergency in the U.S. can bankrupt an entire family. There was a 17-year-old kid nearby here who got shot by a mugger recently. His family didn't have insurance and now they owe over $100,000 in medical bills. They caught the mugger, but of course he's some piece-of-shit crackhead with no money. So now this kid and his family are basically fucked. After a public outcry, they held a fundraiser for him which raised a whopping $8,000. So much for private charity.

Re:US health care system (1)

jmottram08 (1886654) | about 3 years ago | (#37526936)

Please. Go to a general practitioner, get an xray for your foot, maybe a cast. It will cost about 100-200 bucks with no insurance help at all. I recently did this exact thing when i dislocated my shoulder.

Want to rack up HUGE medical bills? Go to an ER for a fractured toe.

Re:US health care system (1)

Cruciform (42896) | about 3 years ago | (#37528552)

Maybe Ron Paul would chip in the rest, since that was his go-to platform on healthcare.

We just had a serious accident in the family, which resulted in that family member being kept in Nuerosciences, under constant supervision, for days. It's been just over a week now. The costs associated with this is the US would have destroyed any financial future my family had left.

In Canada it comes out as a manageable chunk of my taxes, and if the same disaster befalls someone else they'll be protected too.

Sure, our health care system is fucked, but it's partly because we sit beside this massive for-profit clusterfuck that is sucking up all the talent because they can get rich bankrupting the sick and desperate.

Re:US health care system (1)

fhage (596871) | about 3 years ago | (#37526912)

Yes. This is a great deal for about 100 million people in the US.

Here's why. Many people in the US, like myself, have no health insurance or what is made available to us has a very high annual deductible. ($6000/yr in the case of my insurance). After paying 28 years of premiums as a young healthy adult, as I turn 50, the rules all change and I'm effectively left to my own devices to find health care services. To Illustrate; let's say I've come down with a sinus infection (4th time in my life. - I recognize the symptoms) and I need to get a prescription for an antibiotic. This is a trivial medical problem, that in other countries might involve $10 and 30 minutes. In the US, we have very limited options and the terms and conditions to access specific health services often change annually. First task is to find someone who will treat you given your insurance plan. You may have to travel to the next city to find a doctor who will take your insurance. If you do not have insurance and no cash on hand for one of the for-profit private urgent care clinics, you may only get seen if your life is in immediate danger at an Emergency Clinic. In the case of my insurance plan, which very few providers accept, success is when it only takes 1-3 weeks to get a 20 minute appointment with a doctor you've never seen before in the middle of a work day. Before receiving any treatment for anything, at each new clinic one has to fill out a lengthy health questionnaire (entire life's health history from memory including dates, medications and dosages). The entire last page of the health form is a release that you must initial and sign, allowing all US insurance companies and the US government access to these records. Doctors will not treat you if you do not sign. I've tried. We all know this information can and will be used in the future to deny insurance claims as most individual health insurance plans in the US exclude coverage for "pre-existing conditions". Additionally, failing to document a treatment received 20+ years earlier, for example; acne, on any form may allow the insurance company to deny all coverage when your bills come due because you 'falsified' your application forms. You don't own any of your medical records (seems like "work for hire" to me) and you often can't get them from previous providers without another doctor requesting them. No one in the US really knows if the insurance they pay for actually covers them until the bills hit. "Medical bankruptcy" is common in the US.

Conversely, I'll be able to go down to Rite-Aid, talk for 5 minutes for free to the gate keeper nurse, she determines that you have a simple problem that a prescription can solve and that you can pay for it. The doctor gets on-line, asks you if you are allergic to any medication then she writes a prescription for a nicely profitable brand-name antibiotic and sends it right to the store, ready for pick up in 15 minutes. This visit will likely take no phone calls, one car trip, cost less than $100 out-of-pocket without a loss of a half day at work and treatment beings within the hour. This is how "the best health care system in the world" currently operates.

Re:US health care system (1)

Xacid (560407) | about 3 years ago | (#37526968)

The value added here is probably time & convenience. It's kind of a pain to schedule appointments, then have to wait sometimes up to an hour to be seen, and then be herded in and out once you finally are seen.

It's kind of like the difference between getting a hooker vs. getting married. ;)

Re:US health care system (1)

Pionar (620916) | about 3 years ago | (#37527622)

Not really, if you have insurance. I pay $25 for a GP visit under my insurance plan, same if it's a specialist (though, with most insurance, it's more), and $200 for an emergency room visit.

Although, I do pay $180 per month for the insurance.

Re:US health care system (1)

sherriw (794536) | about 3 years ago | (#37527676)

I'm a Canadian and had to go to a clinic in Florida when on vacation. I saw the doctor for about 10mins to explain my sore throat. Came out of there with a $235 bill for the visit and a written prescription note, and $50 for the strep-throat test. The antibiotics were a deal at $25 at the drug store across the street. Luckily my travel insurance back home reimbursed me for all of it.

So yeah, $45 is a bargain...

Us Canadians need to take out travel insurance mainly to cover us in case we have to use the US healthcare system.

Re:US health care system (1)

poofmeisterp (650750) | about 3 years ago | (#37527702)

Oh, you are *SO* in the lucky seat compared to the U.S. system.

Let me put it this way.... When I was working for a company that had excellent health insurance, my pay architecture was like this:

Regular Doc's Visit: $20
Emergency: $60
EVERY single medication: $10
Total cost per month for the meds I take: $30 flat.
The pay was ~$610/mo. The contracting company I was working for covered this 100%.

I had to have brain surgery to fix the epilepsy issue that was a result of scar tissue surrounding (and part of) the hippocampus on my left side. It was a birth injury, unfortunately. The surgery removed the scar tissue and solved the issue (hopefully permanently; it's going on three years now with no seizures).

With all of the medications, doctors visits, scans, EEG testing, more scans, more this, more that, surgical preparation monitoring, in-skull brain surface EEG monitoring, more preparation, and finally the full brain surgery cost me (over a 2 year period) roughly under $100. The final cost for the $62,000 pre-surgery testing, surgery, and hospital stays cost me $0.00! It amazed me! I loved that employer and insurance carrier.

Since I have moral and ethical values, I had to weigh and balance something. Do I sue my employer for saying that they "had no work" once I was cleared by doctors for work again? Mind you, I actively communicated with three coworkers and one employee of the client company, and they all stated clearly to me that there were people being brought in to fill new openings in the exact role (call it former position) that I had. OR, do I appreciate the fact that they kept me "employed" and covered by their insurance for over a year, and then let me keep my insurance under COBRA [] until the max duration was reached?

I'm not sue-happy, sue-crazy, a suit-monger, legal extortionist, whatever you want to call it.... I opted to just let it go and part ways without any incident.

NOW, I have a new employer. It's actually a former employer that I ended up back with under an interesting coincidence, so call it luck. This is a non-contract job with much lower pay (proportionally, not ethically). Since the company is not profit-crazy and is pretty fair, it makes enough to get by but not enough to have a lot of money for things that would sometimes be nice like, oh I dunno, good insurance for employees... Let's just say that. It's absolute SHIT insurance compared to my AWESOME insurance I had in the past. Not many people talk about insurance with me so I'd appreciate any comments to indicate whether or not this is good or bad, but here's the layout of the new one:

Meds depend on the "class" the medication is in (my former insurance didn't classify) so here it is...
Doctor: $50
ER: $150 flat just to go, you'll know about the other costs when you get the bill in the mail; no joke. They're BIG, BIG bills.
Meds: $10, $40, $65, or 25% (% is for 'not approved by the insurance company' ones; that is newly-created ones etc).

I end up paying, just for the meds, $115/mo now. I pay for each doctor's visit the flat $50 right out of pocket. There is ALWAYS a bill that comes in the mail from each visit for stuff that the insurance company doesn't want to cover (and the numbers are random; they differ each time for the same exact thing). I'm not joking; I have analyzed this to the hilt, trust me.

I'm seeing docs for severe sinusitis with swelling to the point I can't breathe and still on the anti-seizure meds (required, not a complaint).

Nasal surgery (which has improved my breathing significantly) with meds tried cost over $5000 (none of the meds worked, btw). Good thing I had 5 grand in my savings account or that would be a ruin.
My averaged monthly costs are now ~$300/mo. including doc visits with add-on billing and meds. I still have ~$1000 to pay on a monthly basis at $100, so the grand total monthly is ~$400/mo.


Epileptic dude pays with past insurance out of pocket:
Total: $30/mo.
Bills (TOTAL) paid in a two-year period excluding the $30/mo meds: ~$100
Grand total: $820 over TWO years!

Dude with good health (sans sinusitis which is fixed now) pays with current insurance out of pocket:
$50/doc visit, random amounts attached to each visit, and, $115/mo
Total: $115/mo.
Bills (TOTAL) for a one-year period excluding the $115/mo meds: ~$3000 (not paid in full)
Grand total: ~$4500 over ONE year.

The Virtual Doctor always recommends RiteAid Drugs (1)

PolygamousRanchKid (1290638) | about 3 years ago | (#37524210)

Gee, who would expect an unbiased, independent recommendation from a doctor who works for a store, that sells drugs?

"Hi, I'm your Virtual Pfizer/Novartis/Merck Doc . . . I'm sure that your illness will fall into a category that fits our product offerings."

"I don't want to gossip, but I would stay away from Dr. Wallgreens . . . his stuff uses powder made from DNA replication from the ground up remains of old Sam Walton's bones. He is considered a bit of a quack in the Virtual Doctor Community."

Re:The Virtual Doctor always recommends RiteAid Dr (0)

Anonymous Coward | about 3 years ago | (#37524576)

"Gee, who would expect an unbiased, independent recommendation from a doctor who works for a store, that sells drugs? "

When you go to a 'real' doctor, a part of your waiting time is because Pfizer/Novartis/Merck representants are before you in the doctor's office, promising him free computers/travel/money returns if he prescribes lots of Pfizer/Novartis/Merck medicines.

Re:The Virtual Doctor always recommends RiteAid Dr (1)

jmottram08 (1886654) | about 3 years ago | (#37526948)

Except that this is illegal. Welcome to 5 years ago.

Re:The Virtual Doctor always recommends RiteAid Dr (1)

c6gunner (950153) | about 3 years ago | (#37527284)

Gee, who would expect an unbiased, independent recommendation from a doctor who works for a store, that sells drugs?

I dunno ... how about the hundreds of millions of people who go to homeopaths, naturopaths, nutritionists, etc? They seem to have no problem with conflicts of interest, so why would they have an issue with this?

Re:The Virtual Doctor always recommends RiteAid Dr (1)

drosboro (1046516) | about 3 years ago | (#37527750)

Perhaps even more likely:

"I am not a robot. I am a unicorn."

CAum (-1)

Anonymous Coward | about 3 years ago | (#37524304)

are aatending a

Is this really sufficient for most illnesses? (1)

TouchAndGo (1799300) | about 3 years ago | (#37524340)

Generally speaking, I'd like some sort of diagnostic tests beyond a conversation and a limited visual inspection via streaming with questionable resolution.

Re:Is this really sufficient for most illnesses? (1)

TouchAndGo (1799300) | about 3 years ago | (#37524362)

Also, what happens if their advice is just "You'll need to go to the doctor's office/emergency room"? Does the $45 get refunded?

Color me unimpressed. (1)

flimflammer (956759) | about 3 years ago | (#37524376)

So I could pay $45 to have a doctor talk to me, unable to examine me, unable to do anything other than make generic suggestions based on my conditions, or I could pay around a hundred and actually find out what's wrong with me?

Think I might pick the latter so I don't end up paying for both when the first run of suggestions doesn't pan out.

Re:Color me unimpressed. (1)

darekgla (2447906) | about 3 years ago | (#37524468)

Partially, you are right, however please do not be under a delusion that most doctors know what they are doing if they can just get hold of you and have a time for the medical examination.Modern medicine is far from perfect and still very unwise.I am not that sure if the future generations will laugh our therapies like we do the ones used in the middle age. With exemption of dentists and surgeons, most fields may offer you a temporary relief but on the other hand for e.g. shorten your life or 'sell' you diabetes. Have you ever taken antibiotics ? Did you know which of the antibiotics would work for you the best at that time? ...Do not worry your doctor did not know that either unless you had an antibiogram done (which I doubt) :) .What's worse, even that, would not guarantee that was the right therapy (problem : in vivo vs in vitro) . Medicine and pharmaceuticals nowadays become too large businesses to remain honest ...

Re:Color me unimpressed. (1)

oh-dark-thirty (1648133) | about 3 years ago | (#37525226)

With a few exceptions, unless it's a common ailment with clearly defined symptoms and/or easily detectable with diagnostic tests, many doctors are simply making a best-guess estimate of what you have. In addition, they are so busy (read over-booked) they rarely have the time to devote to really digging into hard cases. I've known a few people with difficult diagnoses, and they bounced around to several physicians before they found one willing to take the time and go further than prescribing a few pills.

Re:Color me unimpressed. (0)

Anonymous Coward | about 3 years ago | (#37525710)

It will be terrible for diagnosis, but pretty ok for medical advice. If a mom needs to call about what dose of apap to give her infant, it would save time and money. A lot of conditions can be diagnosed by history alone. In my area I'm seeing a few grocery stores have small clinics attached to their pharmacy. From a pharmacist's perspective it could be really helpful. We are drug experts, doctors in fact, but our hands are tied a lot of times in recommendations for therapy, even for OTC drugs. We generally can't do anything that isn't in writing or from the MD's mouth, which is why we always 'have to ask'. Not because we are stupid. With an attached clinic or teleconference we can quickly get in touch with a doc instead of waiting 5 hours for him to get back to us by fax, and do collaborative practice agreements.

the wild west (-1)

Anonymous Coward | about 3 years ago | (#37524472)

This is one of the reasons you cannot really classify USA as a "civilized" nation yet, developed yes, civilized towards fellow man ? not quite, maybe in 100 years or so

Re:the wild west (-1, Flamebait)

WindBourne (631190) | about 3 years ago | (#37524494)

Nope. THis is not the wild west. The wild west cared more about his fellow man. Not anymore. USA will not exist in 100 years.

I will bet that it is outsourced. (0)

Anonymous Coward | about 3 years ago | (#37524486)

I seriously doubt that this is a virtual doc. I am guessing that it is an avatar for an offshored group of ppl

$270/hr? (0)

Anonymous Coward | about 3 years ago | (#37524566)

Why should I pay RiteAid $270/hr for a Skype chat with a doctor in India, China, or the Czech Republic when I can go see my regular doctor for as long as I need for $70 ($20 if I use my insurance)?

Sounds like an offshoring insurance bilking scam to me.

Re:$270/hr? (1)

DrgnDancer (137700) | about 3 years ago | (#37525300)

I can think of two reasons:

1) You don't have insurance or a "regular doctor". There are a remarkable (and growing) number of people in this country who might be able to afford $50 on a quick talk with a doc in kiosk, but can't afford regular and sustained health care. Many of those people might consider this options "better than nothing".

2) You have a quick easy to diagnose problem and you want a simple pharmaceutical fix. I know what a sinus infection looks and feels like. I know what the treatment is. I can't prescribe myself antibiotics. If there's a Rite-Aide on the corner and the Doc-in-the-box can give me a quick script for them; then for $45 I might do so in a pinch (especially if my insurance pays a part of that cost).

In general though you are correct. Assuming I have insurance and a regular doctor, I would not use this service for any but the most trivial cases.

HIPAA Compliance (0)

Anonymous Coward | about 3 years ago | (#37524700)

After going to the American Well web site to research the tech used for this network, I was not really surprised that I found no mention of how they maintain a secure system and adhere to HIPAA regulations. This whole concept, which is the coming future of medicine like it or not, has strict security measures in place for the protection of patient medical records. However I do not see this in action on American Well's website, all they put forth is "firewalls" shown in a diagram of the network design. Big whoop. They need to be a little more forth coming about their security practices and measures, if it was easy (and cheap) then every hospital in the nation would already be set up. So far a "fail" on not mentioning protocols used for the network, nor any mention of encryption of signal.

They gotta do this on "House" (1)

RevWaldo (1186281) | about 3 years ago | (#37524854)

House gets out of prison and "virtual doctor" is the only gig he can get. Abrasive bedside manner! Pissed off executives! An interesting life-threatening case stumbled upon out of the blue! The episode writes itself.


They also offer ... (1)

damn_registrars (1103043) | about 3 years ago | (#37524860)

virtual customer service. Use your imagination, and you can be served virtually. Then when you're done you can go somewhere else to interact with someone who cares.

Unregulated administrators (0)

Anonymous Coward | about 3 years ago | (#37525044)

Google was fined HOW MANY HUNDREDS OF MILLIONS OF US DOLLARS for allowing Canadian drug ads? Clearly there are strong and invisible forces driving the cost of healthcare up. Physicians and nurses are the cannon fodder. Whereas their salaries and numbers are set by the govt, their administrators are invisible and unregulated. There are 19 hospital administrators in Boston whose salaries exceed $1 million. And they havent saved a single life. Many of them serve on other corporate boards as well - get get paid handsomely for that >100k per slot. Some are still practicing physicians. Are there enough hours in a day to justify their income? This is money being paid to people who work in non profit institutions. Most of the money hospitals make comes from Medicare - money that comes from the taxpayer.

New pacemaker with 50 million free beats! (1)

Okian Warrior (537106) | about 3 years ago | (#37525064)

Your new pacemaker comes with 50 million free beats!

You can buy additional beats at

(Close to home) []

Finally. (0)

Anonymous Coward | about 3 years ago | (#37525074)

I'm a US primary care doctor. I've worked in Australia and New Zealand. Both systems have their benefits and flaws, but I can assure you that US patients aren't ready for rational health care spending:

"I can't get my bypass surgery on demand, even though I'm still smoking?"
"You mean that we aren't gonna put my 85 year old relative on a ventilator in the ICU?"
"You mean my baby with multiple congenital defects is not a candidate for a multimillion dollar surgery + 2 years in neonatal ICU?"

On the other hand, in New Zealand and Australia, you can have a nurse come to your house to help you with your insulin, the government uses it's purchasing power to drive a hard bargain with pharmaceutical companies and getting an appointment with a primary care doctor is not as hard as it is in the US. That seems like a pretty good trade.

The United States has, far and away, the best care ONCE YOU GET SICK. But if you don't want to get sick? Get your care overseas. The outcome is the same. it just costs ten times more to do it the US way.

As far as the cost? Right now, I clear about $75/hr on $170 gross/hr. I need to see 30 patients per day to make that work. (On another front, having to purchase an Electronic Health Record is going to put me out of business.) If I could do three 10 minute consults per hour and take home $75 (because I assume that Rite-Aid takes home the rest), I'm in.

I don't really know what other doctors make but I think that I'm just about average. I don't think that what I make is wildly different than what computer consultants make.

Re:Finally. (1)

nedlohs (1335013) | about 3 years ago | (#37525610)

The United States has, far and away, the best care ONCE YOU GET SICK

If you don't mind accepting bankruptcy with your health.

"I can't get my bypass surgery on demand, even though I'm still smoking?"
"You mean that we aren't gonna put my 85 year old relative on a ventilator in the ICU?"
"You mean my baby with multiple congenital defects is not a candidate for a multimillion dollar surgery + 2 years in neonatal ICU?"

And an inunsured American smoker will get bypass surgery on demand? And their baby will get that multimillion dollar surgery? Those who want such ridiculous allocation of limited resources in countries like Australia can pay to get such things in the private sector so how is it different?

Cash before health (1)

Dunbal (464142) | about 3 years ago | (#37525104)

Pharmacies should be banned from hiring physicians due to the conflict of interest inherent in this situation: the physician is probably under a lot of pressure to sell drugs stocked by the pharmacy. If pharmacies really cared about patient health they would recognize that the physical exam component of a medical visit is an integral part of effective medical practice. I just wonder what is going to happen when (not if) someone with a life threatening condition is misdiagnosed and dies because of their "business model".

Re:Cash before health (1)

Binkleyz (175773) | about 3 years ago | (#37525290)

So, need to reply to just a few things here, not just your point, so hope you don't mind me hijacking your post.

Little story:

About 2 years ago, I was having coughing fits severe and long enough that I was on the verge of blacking out (from lack of oxygen) several times. I called my primary care doctor, but even with the description I gave, their only advice was to either come in the following day or go to the ER.

So, being a reasonable sort of person, I decided to take the middle path. I went to one of those "Doc in a box" clinics, and within 45 minutes, I'd been seen, x-rayed, given a lung capacity test (one of those plastic things with the little red ball inside), advised of my diganosis, handed some prescription cough syrup and some STRONG antibiotics (turned out I was developing pneumonia) and sent on my way.

Cost.. $20, same as an office visit (since they're not open 24/7, they don't count as an ER).

I can find no fault with the entire experience. Now, if I thought that I'd developed meningitis or Parkisons or whatever, sure, I'd get an appointment with a "real" doctors office. But for probably 95% (total guess on that percentage, but seems reasonable to me) of what people go into their GP for, this was a perfect solution.

The clinic was staffed with 5 or so Physician Assistants and 2 Nurse Practitioners, with only one "real" doctor, but at no point was I concerned about the level of care or knowledge-base of those non-doctor staff people.

In short, I got quality care, in virtually no time at all, for the cost of an office visit. I simply cannot find anything to complain about in the entire experience.

Re:Cash before health (4, Informative)

Dunbal (464142) | about 3 years ago | (#37525574)

Hey no problem. Communication is what it's all about. I'm glad you had a positive experience.

My point of view is that of a physician, because I am one myself. It's absolutely true that any pre-schooler can follow an algorithm and "cure" disease with a high degree of success. After all that is why, in your country, you let nurses and "physician assistants" screen patients and do the grunt-work. Medicine is not hard. However I will argue that in the US medicine has become all about the technology and the tests, and not at all about the patient. I don't practice in the US, but one hears stories of regular CT scans for migraines, abdominal ultrasounds for appendicitis, etc. Mixed in with these stories is a healthy dose of "defensive medicine" (I will do these tests exclusively to lessen my likelyhood of being sued for negligence because there is a faint possibility of a misdiagnosis).

At the end of the day when you add it all up, you end up with a very expensive health system. Yeah ok you paid $20 for the consultation. Now how much did the X-ray cost? How much did the spirometry (blowing in the tube) cost? Even if you didn't pay up front, someone somewhere paid for the equipment, the film, and the little disposable cardboard toilet-paper roll thing you blow in (you would not believe how much those cost!). Now compare that with visiting someone like me, who probably would have prescribed you the same antibiotic and the same cough syrup after a couple minutes of listening to your lungs through your back, and tapping you on the ribs with my finger. No x-ray. No spirometry. Which is more efficient?

A doctor is not supposed to order tests just to order tests. They only do that on medical shows. Well no, they are doing that regularly in the US. But you are supposed to know the results of the test before you get it. The test exists to prove your hypothesis (the diagnostic impression), not to "brute-force" a diagnosis. Now admittedly there are cases where a diagnosis is not clear - older patients with several chronic diseases, unconscious patients, pediatric patients, patients with very slight symptoms. These are harder to diagnose and more testing might be required. But in the example you gave me - a patient with a severe cough - the possibilities are very limited. Yes there are many many possibilities - pulmonary fibrosis, sarcoidosis, lung cancer, TB, asthma, etc etc etc. However you consider the age of the patient, how long you've had the symptoms, how severe the symptoms are, obstructive versus restrictive problem (through a physical exam, no spirometry required), and it's a pretty safe bet we're up against pneumonitis (viral most likely) or pneumonia (bacterial). Despite everything the CDC and infectologists say about overprescription of antibiotics, I would probably send you home with antibiotics (viral infections do sometimes turn into bacterial ones due to all that inflammation) and a note to come back in a few days if you are not recovered. If you don't recover, THEN we start looking at x-rays, etc.

What they are doing is all the testing up front. That's great when you want to sell tests. It's great when you have patients who are more trusting of a machine than the human doctor sitting in front of them. But it's not really good "medicine". My $0.02.

Re:Cash before health (1)

Binkleyz (175773) | about 3 years ago | (#37526092)

Undoubtedly you are correct.

The X-Ray they did was apparently to confirm their thoughts on the pneumonia, but the rest of the diagnosis seemed (to my admittedly untrained eye) to be good deduction and experience.

I can speak to the "Physician Assistant" thing personally, as an ex-girlfriend was one.. The law varies from state to state, but at least in Pennsylvania, becoming a PA requires several years of graduate-school education and a sort of mini-internship/residency period. They can pretty much do anything a doctor can do, short of surgery, with the supervision of a LOCAL (meaning in the building, within no more than a minute or two distance).

Re:Cash before health (1)

Binkleyz (175773) | about 3 years ago | (#37526226)

forgot to add the word "physician" at the end there.... ;)

Re:Cash before health (1)

PSandusky (740962) | about 3 years ago | (#37527126)

I wouldn't call PA school "graduate-school education." I'd call it a post-bac program, but let's not call it graduate school. I hear that from enough starry-eyed undergrads that think all programs (PA, MD, MS, PhD) programs are the same, so they should be able to bide their time in one (MS, PhD) while they wait for an acceptance from another (MD, PA).

Does not work (1)

Hentes (2461350) | about 3 years ago | (#37525228)

There are lot of things that can be done on the phone, but visiting a doctor is not one of them. Diagnosis requires physical presence, a doctor can't examine a patient that is not there.

Excellent idea to start in Detroit (1)

BigSes (1623417) | about 3 years ago | (#37525694)

They can save plenty of man-hours because the diagnosis will be simple for 90% of patients - gunshot or stab wound.

Google Docs (1)

Sqr(twg) (2126054) | about 3 years ago | (#37525976)

A competing service has been around for some time. You get a word processor were you write down your symptoms, and ads for the appropriate medicines appear on any website that you visit subsequently.

They're called the "Google Docs".

Next Step (1)

Fieryphoenix (1161565) | about 3 years ago | (#37526382)

Local independent Urgent Care clinics in my community have prescription medication vending machines inside. If this is the route we're gonna take, we might as well just have drive through shacks where you stop first at the doctor vending machine and then the drug machine next to it.

Exams from Nurses are free? (1)

sgt scrub (869860) | about 3 years ago | (#37526560)

I'm hesitant to read TFA.

Detroit? (0)

Anonymous Coward | about 3 years ago | (#37526790)

That's odd, I didn't see any of those in the L.I.M.B. clinic in Detroit...

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