There are many ways to be disposable. In Canada, wait times have increased 173% in the past 27 years. Median wait times for a specialist go from 21 weeks to 39 weeks. Median waits for ortho are 39 weeks. Prince Edward Island is a minimum 20 weeks wait.

I know the US healthcare system isnt perfect, but I know enough that prolonging care that long has negative impacts as well.



https://www.fraserinstitute.org/...-care-in-canada-2019

You wanna look at big bucks, look in to the profits of some of this country's largest insurers. I believe United Healthcare did well to the tune of $26 billion last year. At the same time, my company, your company, and almost every other company are seeing huge increases in our out of pocket expenses and monthly payments. For my practice alone, with 200 employees, our health insurance costs were expected to go up nearly 20% for 2020.....and yet, our insurance was going to pay less for almost everything.

To keep costs down for my patients, I tried using drugs off the $4 WalMart formulary. That didn't last long before I had patients coming in telling me their eye drops (that had been $4) were now $60+. Its a constant battle to find affordable drops for my patients. A drop may cost $10 at one pharmacy, and $100 at another one. Yeah, Big Pharma is making some big money but, if you really wanna know who is getting the money look up Pharmacy Benefit Managers.

No, there's not any competition for our care, but would you want it much differently. You either get a well regulated system to protect people or you get a system of OTC treatments where those protections are not present. Antibiotics are a perfect example. Almost everyone who walks in to an ER, or primary care doc's office, with a sniffle or sore throat, or cough wants antibiotics. For almost all of us, these are self limiting diseases, and many times caused by a virus. We have an ever growing problem with antibiotic resistance. I've read that by 2050, some experts predict drug resistant bacteria will be one of the leading causes of death in our country. Its bad enough that docs, and Nurse practitioners, give antibiotics away willy nilly but make it OTC and you are looking at true disaster potential.

Healthcare is complicated. I don't know the answers but I do believe things are going to get a whole lot worse before they will ever get better.

I've had too many relatives left to die in Canada to buy this. Sure they had care, it was just going to take longer then the disease took to kill them to see the doctor.

Just a couple weeks ago I went to an orthopedic guy to see why my knee was hurting to the point where I could no longer run.

They took some X-rays. The doc came in and said I had some mild arthritis that is endemic in runners for the most part. He looked at an MRI I had done 12 years ago on that knee. He did some manipulations to figure out if I had anything broken/damaged (vs just inflamed). I walked out with instructions to do more strength training to hopefully correct a muscle imbalance that is typical of runners, and to take naproxen to help keep the inflammation down. With orders to come back if it gets any worse...

Bill was $200 (started at $275 before the insurance-negotiated discount). Paid out of my HSA.

I can't say that wasn't a terrible use of $200.

Except thats terrible info and advice. NSAIDs are one of the worst things for runners. It destroys the liver. And arthritis doesnt plague runners. Running doesnt result in more degeneration than other weight bearing activity. That advice, to me, is endemic to the orthopedic community. Poorly educated.

That being said, not a bad price for good info. We charge far less than that for our 60 min sessions.

So I am no doctor... And now this concerns me. If I wasted $200 and an hour of my Tuesday, that bothers me. If I was given incorrect, and possibly dangerous advice, that really bothers me. I had no way to know that was bad advice. Maybe asking for advice on the internet would be better? My knee still bothers me... nothing has changed.

I thought it seemed cheap too. I had hip xrays at the Hospital for Special Surgery on the Upper East Side of NYC and they alone were about $700. When I went back 18 months later and was going to have an MRI, they wanted to do the xrays again too, and I said no. My deductible is $7k, so basically I pay for everything.

Having lived and worked in the UK, I can comfortably say the healthcare system in the US is very broken. In the UK, my employer gave me free BUPA (private healthcare), but if I ever needed to I could also use the public hospitals and doctors (though I always used BUPA). So I had no monthly insurance expenses, and zero expenses when I got treatment. Note, I never used public healthcare, so I was not a drain on their resources. This is true of most middle class people in the UK, with lower income groups the ones primarily using public health services.

Here in the US, even while working for a large financial institution, I pay about $300pm for my family's coverage, and have a $7k deductible and an $18k max out-of-pocket. And here they want to run every possible test they can think of and treat you as aggressively as possible, presumably to rack up the charges and out of fear of being sued. And of course the pharma companies, the hospitals and the insurance companies all have significant influence in Washington...

A few things......I don't believe you were given bad advice but it could've been explained better. Orthopedic surgeons love to bang on running.

Not sure how old you are but the mild arthritis changes are probably more age related than any running you do. My wife and I are a good example of this. She has terrible knees with quite a bit of arthritic changes. (with cartilage loss at the end of her "knee" bones). My knees show no evidence of arthritic changes yet I am quite a bit larger than her and run A LOT more than she does (or ever has). Her mom also had bad arthritic changes at an early age so I feel like a lot of it has to do with genetics. She was told it would be a good idea to not run anymore. But, the advice to cut back on running, or stop, would be relevant to a person with arthritic changes. Not so much for someone without.

Tylenol is bad for the liver. Its amazing how little of an overdose of Tylenol can lead to liver damage.......even to the point of needing a liver transplant.

NSAIDS are, like any other drug, ok to use as long as you follow the directions and be careful when you use them. For us athletes, the NO NO time for NSAID use is during a long endurance event (or really anytime when you may become badly dehydrated). You could develop renal failure.

The piece of advice you were given, about strength training, is probably the best thing the doc told ya. Unless a structural problem was found, muscle imbalances are a very common cause of knee issues in runners. I've had Runner's Knee so bad that it had me limping badly. A week or two of PT, and it disappears quickly. If I was you, I'd go see a good physical therapist and have them assess you, and then give advice about improvements to be made.

OK this sounds way better. And better explained. I am 39. At risk of being told to go to the other forum, I have been through 12 IMs over the past 7 years. More on the way. Numerous BQs and Boston races. Etc... So yea I run a lot.

Anyway the doc told me to specifically use naproxen as it's the least damaging, and to ensure I was well hydrated whenever I used it. And not to go overboard with it. And yes, he isn't wrong that I should do more strength training.

The MRI I had done was 12 years ago when I was experiencing the common symptoms of a torn meniscus (this was before I even got into endurance sports). Crunching when I walked. Pain that felt "inside" the knee. Etc. Anyway the MRI showed not a tear but a "contusion" and the surgeon I saw basically said he can't fix it surgically. And it wouldn't really ever heal. And his suggestion was to start riding a bike to strengthen around it. Well that's what started me on the tri thing. (I started running after my knee felt better).

That is pretty good coin. Fee for service docs in my province now get about 40 Cdn dollars for a visit. American docs have much higher overhead though. My friend in Kentucky says it is common for each doc to have one full time person chasing down billings and approvals for stuff with insurance companies. An malpractice is more too I guess. My annual cost is 5000 dollars and the gov't pays another 5000 on my behalf. How long did the actual visit take?

---

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Ok, that'll be $200 please ;)

Great post. I was between patients and should have expanded on the info better. But you nailed it. I hate NSAID prescription for non-inflammatory acute RRIs (running related injuries). The risk/reward is not in favor of endurance athletes. We specialize in runners and I see it all too often.

Im loving reading your posts, especially bridging the gap from the medical community to the rest.