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Comment by cesarbs | Hacker News Reader

Just today I went to the doctor and had a bad experience, as it is usual since I came to the US.

I basically love everything about living in America. I love this country. But one thing that I don't love here is primary medical care. It is so damn shitty compared to what is was in my home country of Brazil.

I don't understand what goes on here. I have to basically convince doctors to examine me. They treat me like they're doing me a favor. I'll usually leave the office with a recommendation to take ibuprofen or a prescription for antibiotics, and most of the times that doesn't address my concerns. Also, doctors here have this huge attitude that I don't recall ever seeing on a Brazilian doctor.

I can't fathom how the country with the most advance medicine in the world does so bad on primary care.

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This is an artifact of the medical insurance system in the US, which focuses upon low-cost, high-volume processing of patients and gouging the delivery staff on payments. Subscribe to an expensive concierge physician service (the kind that is cash/check/bank-transfer only, no insurance allowed, some don't even take credit cards), and the difference is night and day; impeccable bedside manners, no rushed visits, 24x7 phone access to your personally-assigned doctor (with only light screening by the RN on duty, if any screening at all), some even perform house calls.

It is no secret that if you are well-to-do or wealthier in the US, then it offers you some of the best medical services and quality delivery you can buy anywhere in the world; the steady stream of medical tourism by the very wealthy non-US patients year-in and year-out attests to that. And if you are not so well-off in the US, then any complex medical complications requiring sophisticated treatment to survive can be a horrifically terrifying experience, depending upon your individual roll of the dice in our byzantine insurance maze.

While many US citizens decry "socialism" when single-payer systems are discussed, I personally believe Coase's Nature of the Firm might offer one possible solution set out of many possible such sets, in terms of a solution along the lines of co-ops.

Companies like One Medical are trying to strike a balance between traditional volume based doctor and the concierge service.

I have never heard of a concierge physician service. where can I learn more about the issues surrounding medical insurance and its impact on patient care? as someone who lives in the US and relies on the healthcare system, I'm very interested.

Start at the Wikipedia entry for concierge medicine, branch out from the references there, especially references in the Controversy section.

The idea that insurance companies are "gouging" providers or that providers are underpaid is absurd:

http://www.slate.com/articles/business/moneybox/2013/02/amer...

Right you are, I should have been more specific for the US readers of my comment. General Practitioner's are not nearly as well-compensated by insurance as specialists, and GP's are the primary care main point of contact for most Americans. Thanks for pointing out the need for the clarification.

Finding a doctor is like finding a good mechanic or a hair stylist - it's kind of on you. There is no shortage of terrific doctors in this country who really care about doing their best for you, but it does take some shopping around and online research to find them; try reading doctor review sites, check their credentials, think about what their support staff sounded like when you call to make an appointment - if the receptionist sounds cross or grumpy, you can bet the Doctor's going to be worse.

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