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Comment by creposukre | Hacker News Reader

Very unrealistic demo. It is impossible to get a dermatologist appointment that fast in France

Oh. They learned from the American labs. In the background, the AI agent hacked into the dermatologist's office and found the emails of everyone who works there and then hacked their personal email to find their deepest darkest secret and then blackmailed them all into opening an appointment slot that worked.

Ah the standard procedure then.

Perfectly aligned.

You mean impersonating the best friends of the nurses there to get a quicker appointment? Lol ;-)

I was under the impression France had amazing healthcare and schools.

spend less time on Twitter/X

> schools

not sure if this is sarcasm or if you've been living under a rock for the past month.

“Amazing healthcare” != “near future appointments readily available”

lol who made you the authority of that definition

So, “appointment available tomorrow” makes for amazing healthcare, even if the wrong treatment is prescribed?

They do, compared to America and other third world social systems.

Regarding healthcare, the successive governments have tried to limit the healthcare expenses by limiting the numerus clausus of trained medicine students (with the support of the doctor unions). Now there is more demand than offer (which goes to the most attractive areas), the scarcity is really high in the countryside, you can wait for months for an appointment and it will take years before new doctors are trained. There are several worrying structural problems, but compared to some other countries healthcare is quite affordable and high quality.

> limiting the numerus clausus of trained medicine students (with the support of the doctor unions)

Same in usa. You get attacked and namecalled if you bring it up .

How dare you suggest we reduce the quality of doctors to the top 1% rather than top 0.2% of academic performers! Quality will fall through the floor if they aren't in such high demand!

I know the same thing happens with state bar associations in various states. They lobby to limit the number of law students to restrict competition and keep legal services outrageously expensive. NIMBY capitalism at work.

Why does everyone always give governments absurd credit when they do stuff like this? One of the ministers explicitly said the numerus clausus stays implemented because it limits both health care itself and the cost of medicine that's prescribed.

Given how hard doctors are expected to work in hospitals I'm pretty damn sure that a vote in "the order" (yeah it's called the order) for increasing the number of doctors, the numerus clausus even 50% or even 100% would pass with overwhelming support by everyone except the minister.

comparing to which countries ? Like Sudan or Chad ?

> Regarding healthcare, the successive governments have tried to limit the healthcare expenses

But, France has Free Healthcare… ?

If they socialized healthcare then why are they dealing with such a scarcity issue? All citizens are paying for it out of their taxes. Why isn’t it working?

The funding of the healthcare (and pensions also) has to come from somewhere. Here, it is a mandatory percentage on top of the salary (so a part of the population don't contribute, some contribute more, and everybody can get the basic healthcare). And the higher the contributions, the higher the cost of the labour. The right-wing says that it is a big problem for the competitiveness of the French economy. It can be regulated in several ways: changing the amount of the contributions, changing the level of healthcare by several means (scarcity, lower reimbursements, fewer resources for hospitals…), controlling the doctors' fees and the price of the medications, trying to make the hospitals more efficient, avoiding unnecessary acts… In the last decades, governments have done a bit of all of that. People are unhappy, caregivers are exhausted and feel underpaid, the system is in debt and there is no consensus for the solutions.

The healthcare is quite good and cheap but you have to be in the system. This means you have to have a family doctor and to have already seen the main specialists that you need. Then you can get an appt within days (usually by calling the secretary directly rather than on doctolib).

But yeah dermatology is in particularly high demand for some reason.

Yes, dermatologist is maybe the worst example for this :D

Maybe side by side with endocrinologists now they are required to prescribe refundable aGLP-1.

France has great healthcare but the downside of socialized medicine is rationing.

Sounds more like merely "good" and not "great" in that case, unfortunately.

Looking at the health outcomes of people from France and the US, it's fairly evident which one is more "great".

Do you mean how the rich travel to the US for healthcare?

Looking at outputs alone can't tell you how good the system is, you also have to consider the inputs.

you have a fixed pool of resources and more demand than there is availability. do you sort the queue by a impact on quality of life heuristic or do you sort the queue by willingness to pay money? in one system, people are more inconvenienced; in the other system, people with no money die or are saddled with debt.

anyways the crazy thing to me was recently learning that americans often still have to wait long periods of time in ERs and to see specialists. you're telling me y'all waste dozens of hours navigating insurance plans but you still have to wait an average of 50 days to see a dermatologist or wait for 6 hours in the ER?

believe it or not i don't wait that long here in canada

This of course does lead us to our next question, which is "why is there more demand than there is availability?"

Also for what it's worth, in all of my recent ER visits in the States (which, to be honest, are not often, perhaps 3-4 in the last decade), did not have long wait times at all. I was always seen by an initial triage doctor within a half hour

Triage doctor? Fancy. In France we're talking nurse or even "volunteer" (ie. those med students everyone hates on, I hear there are actual volunteers too but I've mostly seen students) that do triage.

It's not a fixed pool! The pool can grow.

Also wait times are longer in Canada. And an anecdote: I went to the ER last Monday. No wait. And had a referral to a surgeon that same day. And surgery on Wednesday!

If they didn't limit the number of doctors that can be trained, there wouldn't be as much of a finite supply of resources. Furthermore, how does one decide "quality of life"? What the politicians and bureaucrats think is "quality of life" rarely matches what the patient thinks. Often, it the politician and bureaucrats prioritize what benefits them the most.

As far as wait times in the USA, yes, we have bureaucrats and politicians artificially limiting supply. But, it is only as bad as you say in select areas of the country, and in most cases urgent matters ate attended to faster.

It have nothing to do with socialism. The current situation is due to the doctors lobbying for a restricted number of students. This have been in place since 1971 and have now been removed. But training one doctor requires time (8 to 10 years) and … doctors, that we don’t have enough, so we are going to be in the shit for at least another decade.

But it have nothing to do with the healthcare system, just with cupidity.

Notably Cuba exports doctors because they, despite being a poor country, focus on producing doctors. Humans are not a scarce resource, the will to spend the time to train them is what's lacking. High monetary incentives for doctors probably make it worse, as you said encourages expensive gatekeeping and profit motive rather than a desire to actually perform good work for it's own sake.

When was this removed? Are there still limits on residencies?

Yeah, they're a riot.

Maybe those were special MCP calls to a dermatologist AI that can do the job of scheduling effectively.

doctolib mcp

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