The Great American Eye Exam Scam(theatlantic.com) |
The Great American Eye Exam Scam(theatlantic.com) |
Should you get an exam? Yes. Should you need to if your vision hasn’t changed? Nope. This whole “gotta have a two-year current prescription” nonsense has got to go.
All that said, a number of folks were told to simply get some readers by their doctor - because they only needed the glasses for such things. And honestly, if this is what you need, more power to you. I'm of the subgroup that finds readers absolutely useless: I am nearsighted. Glasses help me greatly with night vision, driving, watching TV, and other such things but I take them off to read.
I do agree that folks shouldn't need to update their prescription every year or two, mostly because it is silly. If we want medical checkups for the eyes, then we need to cover the exam as a medical exam through regular health insurance... even if we don't cover the glasses. Of course, I think dentistry should be covered similarly as well.
Machines will likely be able to do this if they can’t already, but my main point was around the exam being a barrier to a purchase, not that you should NEVER get an eye exam.
Especially advice not to get qualified advice.
Also, LASIK isn't that expensive compared to other surgical operations. Here's a price list from the Surgery Center of Oklahoma, which specializes in low-cost, out-of-pocket surgical procedures with transparent pricing: https://surgerycenterok.com/pricing/
And here's the pricing from the LASIK specialist I went to: https://sharpe-vision.com/pricing/
Notice how LASIK is pretty cheap compared to other surgeries--and this is from a cash surgical center in Oklahoma as opposed to the higher-cost locations Sharpe Vision operates from. I mean, there are cheaper surgeries out there, but probably because they're simpler and require less expensive equipment. For example, a local urologist in my area, "Dr. Snip", charges $1000 for a vasectomy: https://www.drsnip.com/getting-started/#billing
That’s my main argument against getting the procedure done: my work benefits cover my lenses/contacts, so the $thousands doesn’t yield any out-of-pocket savings.
If it saves me several hundred a year, it would be a good ROI.
But I also stock up when chickpeas are 20 cents off/can.
I do always think about going overseas though.
Normally I would be annoyed by this, but LASIK has a small but significant rate of severely bad outcomes, and a larger rate of poor outcomes (e.g. extreme light sensitivity), and the cost reduces the number of bad outcomes.
We go to the local eye hospital in Saigon which looks on the outside like it hasn't changed much since 1974. Kind of scary for a third world country.
Turns out that the doctor speaks perfect english, they have all the very latest equipment and offer many different procedures depend on your eyes, they do literally tens of thousands of procedures a year.
My friends operation cost $1600 and they were completely healed up within 24 hours. Mine cost $7500 and took 6 months. We are both happy with the results though.
Of course mine was more complicated, I needed PRK which is more invasive... but still. The hospital here has the newer laser version of PRK (SMILE), which my 'best' doctor in SF didn't offer.
Any way, I'm surprised medical tourism isn't more of a thing. I know that Thailand is starting to crack down on it because people are stiffing the hospitals with the bill. But this experience definitely opened my eyes (ha ha) to being more open about finding alternatives.
Why is that the government's problem? Hospitals can just require payment in advance or the use of some kind of escrow service.
https://www.vox.com/the-goods/2019/3/6/18253555/eyeglasses-c...
[..] Essilor is a French optical company that’s been around since the 1800s but has spent the past 20 years acquiring some 250 companies. In 2017, Essilor bought Luxottica for about $24 billion. Although it got approval by regulators in the US and the EU, and even passed an antitrust investigation by the Federal Trade Commission, business experts have called the merged EssilorLuxottica a monopoly.[..]
Also: how does one be ‘in charge’ of their own exams. Walking around and operating with impaired vision is a danger to public safety. Is this a joke article?
The same thing happens with people with glaucoma, or macular degeneration, or...
Being able to see is a really big deal. Catching stuff that can make you blind rather abruptly is a big deal. On the other hand, as you say, being able to afford to get a prescription and glasses that fit them is also a big deal.
It’s absurd to see a doctor before procuring a corrective pair of lens? The ability to see right changes with age, life style, genetics and disease. It absolutely does require a diagnosis. Some random guessing is not sufficient to determine which number you would choose for eye glasses. Especially in a country that is dependent on cars and we still need proper vision for driving.
There would have been some point to this rambler of an article if the author had bothered to explain why it’s a hardship. It’s the expense, of course. Which directly ties to the cartel like system of Essilor Luxxotica frames company. It’s really cheap to produce but it’s sold at super high mark ups. This is a problem.
The last part of the article was pure dumbass’ery. Appalling!
> Walking around and operating with impaired vision is a danger to public safety.
Surely this is an argument for making it easier to get glasses? Better a slightly wonky/old prescription for glasses than none at all.
Eye exams ought to be cheaper, but that doesn’t mean that it shouldn’t be mandatory to get an eye exam before filling a new order.
Isn’t it a business liability to hand out glasses that’s supposed to make someone see better but without necessary preliminary testing? Imagine if they did it with pharmaceuticals.
https://asia.nikkei.com/Spotlight/Asia-Insight/Tourism-prove...
Also interestingly enough while searching for the above article, it seems Chinese medical tourism in Thailand is also on the rise.
But the solution should be eye exams every 12-24 months; for everyone earning above a tax threshold, the Govt takes $50/year whether you have an exam or not (okay, with an exception for those without eyes/sight). When you go to get lenses you can get an exam without any extra cost. If you want to get lenses with an old prescription you can.
For the record, in the Czech Republic, I have entered strength, cylinder, axis and PD into a website, paid $18 and picked up the glasses a few days later, and I haven't noticed any problems with quality despite the rather high strength (-4D). We also have over-the-counter contact lenses widely available, though I have never used contact lenses.
($18 is a suspiciously cheap online service with basic lenses, glasses with lenses with higher refractive index and some oleophobic and anti-reflex coating usually cost around $150 here, but they will also make them for you without prescription, you just tell them the numbers)
Now a decade later without complication, I hope they've lost a customer for life.
Perhaps this is because I purchase my eyeglasses online, e.g. Zenni. I could pull out my prescription from last year or five years ago and they'd take it at face value along with my credit card.
The last time I needed contacts I tried to save money by going to the one in Walmart but I think it still cost about a hundred dollars for the exam.
I mean if there are five million people who would participate then that's only $5 each.
Seems like there should be a startup for this. Buycongress.org.com or something. Lol.
But when I need a new pair of glasses, I go to an optometrist. They don't do pachymetry or fundoscopy, their job is to match a perfect set of lens. This kind of arrangement makes perfect sense to me.
The fact that it's easy in Japan is the whole point of the article. It's easy in most countries outside the USA!
(Costco, at least, charges a membership fee, so that can hardly be called a cheap option. And 99$ is also hardly cheap considering that glasses cost less than 5$ to make: https://www.vox.com/the-goods/2019/3/6/18253555/eyeglasses-c...)
The test always show I need to replace my glasses because prescription changes, I found that after 2 months of wearing new glasses I see the same way as before replacing glasses, so it's like a yearly upgrade that you dont need.
- Exam: ~80 BRL = 20 USD - Glasses without the lenses: ~100 BRL (of course there are all sorts of prices above this, but this is a very reasonable model) = 25 USD - Lenses: ~100 BRL = 20 USD
Ironically, we can just buy from USA online! Cheaper and almost as fast.
https://www.ftc.gov/tips-advice/business-center/guidance/com...
The PD is measured by the optician later as part of the glasses fitting process.
Alcon and Coopervision are the only manufacturers with high quality contact lenses, and they charge a ton for it. 6 pairs of Biofinity's is ~26USD ($2USD per lens), totally absurd.
Such a living contradiction
You need transparent pricing to enable competition. Right now that’s hardly the case, and eye care is hardly a big issue compared to most other medical procedures.
This problem under discussion is not caused by capitalism but by regulatory capture.
> The Great American Eye-Exam Scam
Subtitle:
> Why is it so difficult to get a new pair of glasses or contacts in this country? It’s easier pretty much everywhere else.
First line:
> On a beautiful summer day a few months ago, I walked down to the part of the Connecticut River that separates Vermont from New Hampshire, and rented a kayak. I pushed myself off the dock—and the next thing I remember is being underwater. Somehow, the kayak had capsized as it entered the river.
I'd much rather read a concise, 3 paragraphs outlining what is actually wrong with the system than this author's personal life story. If this trend continues the rise of summary generation add-ons/sites is inevitable and I for one will gladly give them my money when they ask, super tired of click bait titles that lead to winding narratives.
I tire of country comparisons with Scandinavia or australia or India or China or Japan..or Mars.
We are who we are..we can only work within the parameters we have and strive to be the best within it.
I don’t even know who your incumbents are ..what qualifies you to speak of Sanders or Trump or Warren or our politicians. You are not here.
Instead of demanding free everything, it would make more sense to incentivize health.
ETA: I have often wondered why people want ‘free’ stuff? What is it that they offer for ‘free’ just like they receive for ‘free’?
Do they work without pay? Create things for free? Code for free? Every free act of labour or service is charity or volunteerism.
Even at subsidized level, this is true. An economy doesn’t work that way. A society doesn’t work that way. It would cause greater imbalances. Imbalances are entirely different and more difficult to remedy than inequalities.
If anything ‘free’ will come disguised as a perk. From corporations than governments. Example: buy our video game and get free eye exams for three years.
Amazon Prime does that. Become a prime member and get prime videos free or amazon music for free. And you have an opp to buy more when you are in..shipping isn’t free, but it’s kinda free, no?...one still pays for amazon prime.
I would rather have a for profit corporation make a deal with me for services(goods are over consumed with our increasing global population leading to resource crunch and unsustainability) and get freebies than feed Big Gov to become a giant nanny state. That would be the beginning of the end, IMO.
Labour should be compensated fairly but it should be subsidized from demand side by boosting purchasing power rather than supply side subsidies. This is of course more true for food/Ag than healthcare...but I feel it can be applicable to healthcare industry too.
What’s the marginal cost on the machine’s procedure anyway?
Just like how I have to pay for paper maps, but electronic ones are free and better. Making them electronic cost a lot, but once that cost is paid for, the ongoing costs are less than any paper map to provide.
Currently, LASIK can be cost-competitive with soft contacts, but not when your benefits cover soft contacts and not LASIK.
Electronic map services also make money. Either through phones or apps or siphoning your personal data.
And that’s not how business economics run. The purpose of a business is to make a profit. That’s why they exist. First you absorb the cost of equipment and operation ..and then you take the profit from the margin. If there are no profits, there is no reason for a business to exist.
https://people.com/health/former-fda-adviser-who-voted-to-ap... :
https://www.healthline.com/health-news/should-lasik-eye-surg...
http://lasiksuicides.com/evidence/the-mdrs
Apparently it leads to suicidal thoughts and depression.
I don’t know what to make of it. Thoughts?
Can this machine run 24/7? Sure! I can show up for an appointment at 3:15AM.
I asked my optometrist once why a prescription was necessary to buy glasses or contacts, and why prescriptions expire so quickly, and she gave me the reason offered in the article: that it forces people to be screened early for treatable eye diseases. But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want. It's hard to see it as anything other than a cynical ploy to extract money from people.
Ha!! Many woman feel this way about birth control! It's held hostage until you get a pap smear. Yearly pap smear, mind you, evidence and recommendations to the contrary be damned. This is despite the fact that cervical cancer screenings have zero to do with safety of birth control.
Just to be clear, cervical cancer screenings are very good! Especially so when done at evidence based intervals. But birth control can be safely prescribed without it, yet many health care providers require a pap test before they prescribe birth control.
edit: Here is a link to the recommendation https://www.uspreventiveservicestaskforce.org/Page/Document/...
Happens to women too for birth control.
I asked what about all the rest of the bones in my body?
I skipped it.
Luckily there is a loophole when you donate blood.
Or you can do your own lab, but I wouldn’t recommend it.
All that being said, I always ask for a copy of my prescription so that I have it in my wallet just in case. I've been abroad when my glasses broke and having that on-hand made getting an emergency pair of glasses very simple.
edit I get my glasses at Costco, probably $120 all-in.
I’ve been using the same prescription for about 6 years, it may be about time to see an optometrist and get my eyes checked out...
I had to really hunt to find a doctor who would give me a prescription without an annual checkup.
The result is I often run out at inopportune times so I try to hoard / ration medication to avoid that situation.
(I'm providing another example, but I agree they shouldnt withhold care.)
In the US, lab results are nearly always sent to the doctor who prescribed the tests, not to the patient. (And most tests cannot be requested without a doctor's order.) Some doctors are good about sharing the detailed results with their patients while others are not.
You can ask your doctor to send the results to another doctor (more often you just tell the new doctor to request them from the original doc). By law you are entitled to a copy of your medical record yourself but with many doctors it is surprisingly difficult to get them to do this. I have heard of cases where it took many weeks and the threat of a lawsuit.
Ostensibly, the reason for this state of affairs is so a patient can have a professional help explain and interpret the results.
Certain medications require regular testing (example I'm familiar with is Orkambi for Cystic Fibrosis, and regular liver screens are required due to potential side effects), and the prescribing doctor won't renew those prescriptions otherwise.
Often they will say "it's for your own good".
In reality, it's just a cartel, extremely protected by government regulation.
For some reason, people think that the rules of economics don't apply when it comes to healthcare.
In general, degrading quality of vision is most likely a symptom of something. Needing reading glasses when you age is the only exception, that is just normal.
If you mean 'come with a written expiration date,' then mine never have and I would find this practice abhorrent.
If you mean 'really is no good in six months,' then your eyes are actually changing.
Meanwhile everyone else is like:
#pass in left_power and right_power directly if you know them.
def get_glasses(powers=None):
if not powers:
powers = eye_exam()
(left_power, right_power) = powers
return add_frame(make_lenses(left_power,right_power)) #make_lenses takes optional args for rarer eye conditionsOf course, MIT patented it, and SV made it into low-order-hundred dollar devices, with mandatory annual per-person subscriptions, but oh well. Looks like there's a current indiegogo, fwiw.[2] Amazon reviews are mixed. At least it's apparently no longer necessary in the US to pretend it's not used to get glasses - yay progress.
An optical trial lens set is another option.[3]
[1] https://www.eyeque.com/pvt/ [2] https://www.indiegogo.com/projects/smartphone-vision-tests-o... [3] https://www.amazon.com/s?k=optical+trial+lens+set
The dangers associated with not being able properly come to mind.
It has always seemed rather scummy. That's why I've been buying glasses online for several years, tweaking it a bit based on actual all-day wearing experience each time because a measurement taken at any one time of day is sure to be wrong at another. So it's better as well as cheaper. Just need to find a site that doesn't play the optometrists'game, because some do and some don't.
I do think it makes sense to get a checkup every few years, but the 1 or two year prescriptions optometrists want are absurd.
In the US, much of the healthcare regulation like this has been to ensure widespread access to care. In this case, by an optometrist not an optician. Remember, historically and maybe even today, we’re a pretty rural and sparsely populated country and the government is giving doctors a reason to open stores in every tiny town. Not saying I agree, just that is what is at play. If reverse this, access will be reduced significantly and US regulators have track record of not liking actions that reduce access.
Anyways, my "vision insurance" actually covers a certain $ amount yearly towards contacts, so I send them the receipt (in pounds) and they actually cut me a check. Same contacts brand and model I'd get in the USA.
I calculated it and using the insurance does indeed cost me less overall than buying the contacts straight. It's essentially just a discount program that hopes people will forget to use it.
eyebuydirect.com
zennioptical.com
visionpros.com
I don't think this is true of the UK. I couldn't buy contact lenses without a contact lens prescription. That might be because i'm astigmatic and wanted toric lenses, but i didn't think so. I can buy glasses online, and there's a note that says i must have a current prescription to do that; i doubt they check, but the principle is there.
Oh, and eye tests aren't usually free. They are cheap, though, around £25. There are free eye tests for children, people over 60, diabetics, people with various chronic eye disorders, and prisoners on parole (!). Also, if you buy glasses from the optician who gave you the test, they will usually credit the cost of the test towards the price of the glasses, so it sort of works out free (except you have to buy overpriced high street glasses rather than cheap internet ones).
This doesn't seem like a bad rule, to be honest. Glasses and contact lenses are medical devices. They're important to their wearer, and to the safety of people around them if they drive a car etc. Eye tests are cheap and easily available. The article's take earns a "this ain't it, chief" from me.
But he is right about it in Italy - no prescription required.
- One free eye exam each year covered by Medicare (to obtain your latest prescription, and check for all eye disease).
- Ability to go into an optical store and buy contact lenses/glasses if you tell them your prescription.
Only if you're over 65! Otherwise its one exam every three years for a standard exam. [1]
It's been a while since my last check, but last time I went they did try upselling to some more advanced scan that wasn't covered by medicare.
Either way, still think we're doing something right in Australia but having this base coverage for everyone.
[1] https://www.humanservices.gov.au/individuals/subjects/whats-...
(And for non-poor people we can cut out the middle-men: just let them pay for their eye check out of pocket. Instead of having them pay a levy, have some layers of bureaucracy, and then give it back to them in the form of eye checks.
(Note: this is not an argument against medical insurance as insurance against unforeseeable, big events. It's only an argument against indirecting payments for small-ish, routine and predictable items.))
A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.
There's no good reason for healthcare that everybody needs to be locked behind a prohibitive money gate.
Also, that prescription is only good for 1 year, many times I’ve wanted to get a new pair of sunglasses, but have been prohibited since my prescription was out of date.
I've picked up frames and new lenses, both online and in local stores, without having anyone point out that my prescription was at least a decade out of date.
The frames that I generally go for are pretty pricey anyway, and maybe that's a factor, but I've never been prohibited from buying an new pair. I've also had older lenses re-cut to fit newer frames, all without issue.
What wasn't addressed in the article is the accuracy of the typical eye exam. A 19th century idea: a single specified distance, no movement, perfect black vs white contrast, well-lit room, etc. Does it really measure "real-world" scenarios like driving at night, playing sports, or staring at a computer for 10 hours? I've received (mandatory, due to the U. S. laws described) prescriptions that were way off, that missed my astigmatism, or which switched the eye with the stronger correction. This is why being able to diagnose one's self, to an extent (buying glasses which vary 0.25 or 0.5 from the exact prescription) should be allowed, at the very least.
Separately I went to see the professor/specialist who trains them all. He used a newer, one-click device which works with pre-literate children, pressed two buttons and reproduced my script in 20 seconds without the flim-flam.
I did ask him, and he did smile. There's what you can do and there is what the industry is built around and they aren't the same thing.
Btw the check for intra-ocular pressure, posterior vitreous detatchment, glaucoma, signs of cateracts are all highly valuable. Don't ditch the baby with the bath-water.
I agree 100% with what the author but the combined $3.2 million does not seem like much compared to how much Google, Amazon, Facebook, Microsoft and Apple spent on lobbying:- $63 million.
Source:- https://www.bloomberg.com/news/articles/2019-01-22/google-se...
After the exam ends its somtimes "Let me hand you over to <person> who will take you through the options" and the next thing you know they are trying to make you look at £350 frames, suggesting exotic coatings to the lenses etc.
You're legally entitled to the results of your exam - you are not obliged to buy from them. The exam itself however is usually free so I guess the psychology of it is you feel like you need to get glasses from them since you got the free eye exam from them.
Personally I usually just say "I am in a bit of a rush - I'll come back at the weekend with my partner to help my choose". We both know I'll never do that :-)
There are places where you can order your glasses + lenses online though. Enter prescription and so long as it looks "normal" (i.e. did you enter it right) there are no questions asked. I've had pairs of glasses that have lasted for several years of use that cost £6.99 (no typo: six ninety-nine) including delivery. (from goggles4u if you are wondering - no connection, just a satisfied customer)
https://www.aarp.org/health/conditions-treatments/info-2019/...
A few years ago, as due diligence, my GP referred me to an audiologist. She found moderate high-frequency hearing loss in one ear. Which isn't surprising, given my love for screaming guitars.
But no way am I spending thousands of dollars on a hearing aid. I'm the sort of guy who'd always be turning it off.
And her office just wouldn't give up. They sent periodic reminders for at least two years.
I remember once i'd bought cheap glasses online, then a year or so later went for an eye test; my prescription hadn't changed, but they measured the glasses, and found that they weren't quite right for the prescription, so i got a new pair. An effective sales technique, and assuming that they weren't lying to me, a useful service for me.
Here people are talking about actual prescriptions, which expire? And hundreds of dollars for glasses? Bizarre.
If there is a more persisting issue, you may see a doctor, but for buying contacts, its a non issue.
Edit: updated details
You can just give the numbers you want for your lenses, though if buying from a brick and mortar store the sight examination in included for free.
Voila a cheap (~$40US) spare pair of glasses.
A former optometrist of mine once gave me a 5 minute lecture on how I must buy my glasses from him because he makes no money from doing exams.
Cry me a river... guess ya should have gone into dentistry.
Never had anyone trying to convince me to leave it uncorrected.
Indeed, ZenniOptical sunglasses simply don't come in m prescription. It flat out tells me to select their regular frames and pay for the tinting. Between my astigmatism and my prism in each eye I'm fairly limited.
Or it just gets expensive. Last Friday I was curious about the new Oculus but hate how VR headsets like my friend's Vive shove my glasses into my face or just simply don't fit and looked at inserts for it, the cheapest I could find from the companies that manufacturer the lenses were 98$ per eye.
I have it, recently got glasses and it annoys me that in my peripheral vision and while moving things get a little distorted. Glasses without astigmatism correction seem like a valid choice.
The prescription I got at America's Choice, got the cheapest possible (maybe $50), but for $70 got two pairs of glasses (total cost with the prescription), but the quality was nowhere near that of the glasses from China.
And note: you can get even cheaper at AliExpress (under $20 lenses and frames). I just opted for a best seller that was slightly more to play it safe.
They aren't the greatest frames in the world but they're definitely punching above their weight.
The lenses are fine, I'm nearsighted with minor correction and an astigmatism and I have no complaints.
I like that when I need new glasses, I can order two pairs and sunglasses for less than $100 shipped.
The Ronsir Zyl, Freeway, or Sidewinder frames all appeal to me. Shuron makes quality, practical frames and allows you to choose temple length, width, and other frame dimensions, and they have stellar customer service.
And I'm now thinking about what I'm not searching for because I think it's not available to me. Hmmm.
Overall, very happy. Shipped quickly, frames are pretty good, lenses are just right.
I've personally bought from eyebuydirect several times, and vision pros once.
Vision pros was $200 for a pair of glasses. I found EyeBuyDirect later and I think the glasses I ordered were closer to $40 a pair.
My mom came over last christmas. In my home county, glasses are very expensive and getting an opticians appointment can take months. She walked into Specsavers on a Monday, and by Thursday she had two new pairs of glasses, all for under 300 pounds. Just the appointment would have cost that much back home. After she talked about the experience with our family, I've been getting a steady stream of relatives coming over for a visit, just to buy glasses.
Went to my usual optometrist when I was back home in Malaysia 6 months later and surprise, surprise my prescription has not changed for the past 2 years!
Why does the DMV suck so bad in the US?
In Canada it was much better because there were private retail locations.
Private retail locations (there are some in the US too -- in California, at least, you can go to the AAA if you pay their membership fee) can charge the right amount needed to pay a sufficient number of skilled employees, or they go under. The government-run DMVs have to scrape by with whatever the state affords them.
What i don't understand is why people have to visit this DMV. There isn't even an equivalent in the UK; licensing is done by the DVLA, but they don't have local offices, it's just a civil service office block in Swansea. If you want to do licensing stuff, you do it by post, or online, or via a local post office.
What is it that people are going to the DMV for?
We have multiple markets like this in the US which have occured as the result of consolidation and lobbying and we're just...not doing anything about it. While they exercise rent-seeking behaviors in order to gouge customers.
Unabated would imply that such regulations are not enforced or in place, and you're starting to see that with online retailers that will sell you anything eye-wear related with a little warning that you're agreeing you do have a valid prescription, which noone believes anyone will get in trouble for lying about. (I.e. zenni)
The same is starting to be true for cpap machines and other things as well.
You can blame certain companies, you can blame certain politicians and bureaucrats, but you cant blame all companies or that companies are running "unabated". It is disingenuous, facile and simply incorrect.
Fun fact - most doctors in the UK do not have any kind of doctoral degree! Just bachelors degrees (they're sort of treated like masters degrees though.)
Medical doctors in the UK and other commonwealth countries have traditionally been MBBS.
In Australia, the adoption of the Australian Qualifications Framework and pressure from the US, where people seem to expect 'MD's has lead to most universities shifting to MD programs from MBBS (an AQF level 7 -> AQF level 9).
The bottom line on this is substantively nothing, except a bit less ink being used on business cards, millions of dollars spent on website rebranding by medical schools and endless posturing by faculty for students.
So basically, whether you are a 'Doctor' by post-nominals or a 'Doctor' by recognition of your MBBS, your education has been effectively the same, and the distinction is actually meaningless.
But what I'm more interested in - is it common to _call_ an optometrist a doctor in the US? As opposed to an opthalmologist? Or is this just a weirdness in this article?
I don't believe everything they say. But when my back feels twisted, I trust them enough to straighten it out. They even did a good job straightening out my whiplash.
This must be merely what "increased access to eye exams and eye doctors" means in the USA.
Zenni lets you punch in your own numbers and takes your money and gives you glasses. These are a bit strong (my eyes have to adjust) but they are satisfactory.
I am reasonably sure this is not true, at least for most people's definition of "few".
When i wanted contact lenses, i asked about leaving it uncorrected, so i didn't need toric lenses, which come in fewer variations (i don't think there were daily disposable torics at the time, for example). They weren't having any of that.
> Thankfully, I knew that two laws, one passed in 1997 and the other in 2003—which had, incidentally, been loudly opposed by the AOA—gave me the right to demand a copy of my prescription.
They don't even tell you the numbers, unless you insist. On they used to not tell you the numbers at all even after insisting..
And in the past I did not go to the doctor because it was very often a piss poor experience, with piss poor results.
The added burden may also dissuade people from getting either thing in the first place.
Yeah, that takes a while, even with someone explaining it to you
theoretically they should rotate to match the axis if they're slightly out of position, but if it's way out of position it won't.
Not to mention manufacturers have different ways of indicating this (with different degrees of weirdness)
Not because they are horribly run.
Most things have moved online. I needed to get a replacement license about a year ago and the online process was easy as could be.
Some of them are even allowed to prescribe medicine and perform surgical procedures. And just about all of this “naturopathic medicine” is entirely without evidence.
People, at least here in Indy, don't (generally) say "I'm going to the optometrist" we say "I'm going to the eye doctor" because they are doctors (they've obtained a Doctor of Optometry degree).
Another English dialectical difference I wasn't aware of.
Of course more complex things such as antireflective coatings add a sputtering step to the process which might be a bit much to expect a shop to do in-house.
This is reminiscent of the principle that marginal improvements become exponentially more expensive as we seek ever more improvement.
Sure I could get a decent pair of glasses in China for $40, but to get a truly great pair of glasses, the increase in cost that comes with that quality will be disproportionate to the quality itself.
That same Optometrist who taught me that also taught me about diopters (the inverse of the focal length in meters squared) and optics of my negative prescription.
An "optometrist" has a Doctorate in Optometry, which is several years of post-college education and internship. They can write some prescriptions, too, and diagnose, etc.
An "optician" is a person certified to give eye exams. They do not have a graduate degree.
Those are DOs.
You may come across a lot of >40 year old pharmacists that have a Bachelors in the US.
In Australia this is a closed shop, in that the College of Ophthalmology has a very entrance hard exam and effectively regulates the number of new Fellows to maintain scarcity/standards.
Could you back that up? Are you talking about a specific country, or all manners of private healthcare?
As far as I can tell, the least regulated bits of healthcare systems that people pay out of pocket for tend to have done the best in terms of cost control.
Eg few if any insurances around the world pays for laser eye surgery. And it's one of the few common healthcare procedures whose costs have dropped massively in recent decades.
> A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.
That seems like a good argument in favour of taxing the well-to-do to give the poor money. That's a fine decision for a democracy to make.
But I don't see the argument of forcing the poor to spend that money on healthcare instead of letting them decide what's best for themselves. Do you know what they need better than them?
I don't know that an elective procedure is the best example, but it's still an example. One counter is prescription drugs. My insurance would only allow a small number of tablets for my migraine medication because the cost for them was so artificially high. When I called the insurance company to ask why they wouldn't pay for the number of tablets that I needed, I was told that my doctor should do a better job of controlling the number of migraines that I get. Where do I get this medication now that I don't have insurance? From countries that have socialized medicine, and the cost is substantially less. Unreasonably high costs for prescription meds in the US is not unusual. I recently had to take doxycycline for Lyme disease. Back in 2012, this cost 6 cents per dose. That price increased by over 6,000 in one year, just as Lyme cases were also skyrocketing.
In any case, the socialized health care probably doesn't cover the drugs that get to exported to foreigners like you?
> Unreasonably high costs for prescription meds in the US is not unusual.
Yes, that's a separate problem.
Enabling (re-) imports is an important safety valve. Medical tourism is another.
Ideally, the US would fix their healthcare system. But I wouldn't hold my breath.
In terms of letting the poor spend it on what they like, I disagree. You aren't giving them money. You're giving them healthcare. In my opinion, people are not entitled to money. But I do think they are entitled to good health if it can be at all given to them.
I'd say that if as a society we want to help (poor) people, we should do whatever provides the most bang for the buck; ie the highest quality of life improvement at the lowest burden to the rest of society and the smallest disincentive effects.
But yes, if you explicitly want to restrict what poor people can do, then your position is a consistent one.
They also quantify the degree to which private providers can "recover" costs for pre-existing conditions. E.g. mandatory wait-out periods and relatively minor penalties, and then they have to provide full cover.
But beyond some of those items, they pretty much let the private providers run it as a business. You can decent cover for as low as $60, but if you want additional benefits and ad-hoc medical spending-money, you pay more obviously. Some of them even have packages that are reduced based on they person's salary to make it more affordable for low-income families.
Mind you it's covered by my dental insurance so it's fine.
Large doses of xrays aren't without risk. Apparently the comprehensive xray uses 4-6x the exposure of a normal xray.
But there was no point. The only Dr I could afford became terrified of prescribing opioids (thanks DEA. yes it was the DEA). No matter that I had, for years and years, taken opioids responsibly.
However it's no longer a problem. That only Dr - that countless thousands of us could afford to visit - just closed up shop.
Am I willing? Sure. Able, no. Not in any way.
Even so, the need to get your vision tested is often not related to the need to replace your glasses because they broke or you lost them.
So what's the argument that suggests poor people need to be given healthcare, but not bread?
I suggest to just give them money, and then they can buy the bread and healthcare they need.
(And that's a general principle.
However giving goods and services directly does make sense for non-excludable public goods. Eg don't give poor people money to procure national defense. Just provide national defense directly with tax payer money.)
You (deliberately?) misread the parent's comments. It was not very long, and it centered on the word "both".
> I suggest to just give them money, and then they can buy the bread and healthcare they need.
Elsewhere you wrote that "unforeseeable, big events" should still be covered by insurance, but I don't think you understand that if people don't have enough money, even getting regular checkups and medication can be pretty "big" from the affected person's perspective. If two people are scraping by on a universal basic income that is enough for basic shelter and food, and one of those people regularly needs checkups or medication for some chronic condition, then you are screwing over one of those people.
This isn't about the freedom to choose not to be chronically ill, because there is no such freedom. Neither is it about the freedom to choose not to be treated for chronic medical conditions. There is no such freedom, the word for that "choice" is "torture".
To be more clear: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.
Is that better?
About the latter part of your comment:
Yes, that is a real problem. There are (at least) two reasonable approaches that leave insurance as insurance:
First, you can just give the chronically ill or disabled person more welfare money.
Or, second, if you are a purist for equality: enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.
BUT: I do gladly concede that for serious enough conditions just handing out medical services might be a reasonable choice. I don't know. But that doesn't say much about routine check-ups for healthy people.
I believe you mean "bread OR healthcare".
To quote myself: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.
It’ll say “When A occurs, try replacing X” and they’ll do that, even though my notes stated that I switched all the Xs around and the problem didn’t move with them.
The crucial thing is that there are alternative providers where I can get exactly what I say I want, and get it.
It's just a fancier version of having a friend or family member push on your back until it pops whatever was out of place.
A fortune-teller could probably give great advice about family relationships, but I'd recommend a counselor or therapist instead. And I'd probably treat the fortune-teller as a scam artist. In the same vein, a chiropractor might relax my back, but that doesn't make them credible.
Fun fact: the inventor of chiropractic was also big believer in the healing power of magnets, and was murdered by his son.
For example, muscle cramps often feel better after a stretch. However, eating a banana is more likely to help by dealing with a common underlying cause.
We weren't going to let that truck leave our shop w/o getting fixed, none of us wanted dead kids on our conscience. We extended credit to the customer & cut our rate so the owner could afford it. Point being, in this case we definitely knew better than the customer, somehow they didn't realize a wheel falling off at highway speed is dangerous. P
However, that was a very rare situation. If a customer insisted they wanted work done that we didn't feel was necessary, we would tell them so but still do the work if they wanted it.
That line of thought can be used to justify a huge amount of intrusion into people’s lives.
Giving them a specific good is equivalent to giving them money, but forcing them to only spend it on something you approve of.
Some amount of "paternalism" is good for society. Someone likened health to car maintenance, but I can tell you that of the drivers I know, zero of them would get their car the yearly technical check unless it was explicitly illegal to drive that car otherwise. I'm starting to believe we should have something similar in places with public healthcare - there should be a set of free, mandatory, noninvasive checkups to screen for diseases that don't have symptoms noticeable by patients, and there should be a way to compel everyone to take those tests. It would be better for everyone's well-being, would save public healthcare a lot of money, and the doctors could stop attaching unrelated tests to getting prescriptions for glasses or birth control.
With cars, there are greater third-party effects (i.e. your car failing and crashing into someone else), so it makes sense to require a certificate before one is allowed to use public roads.
Of course, in practice the government would probably come up with silly layers and restrictions on how to use the money etc.
The idea of giving cash is, frankly, asinine. The objective is not to increase the recipients spending power, but to reduce health problems population wide, reducing expensive medical interventions and productivity-draining disability.
And you'll find politicians lack that resolve.
However, this ain't an all or nothing game:
You can move some in-kind services to money payment without moving all. Eg it should be possible for politicians to refrain from handing out annual eye exams.
> enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.
I guess this is a complicated way of saying the same thing as I did, except that "your parents" are "the law"?
Your parents are your parents. They have skin in the game.
People with heritable diseases would presumably pay more for that kind of pre-insurance. (That's pretty similar to how the church in Cyprus apparently asks couples to get tested for Thalassemia genes before marrying them: if both parents have a single copy of the recessive allele, the children run the risk of sickle cell anemia.)
> Where I live (Austria), everybody (modulo a few exceptions and quirks that shouldn't exist) has state-mandated health insurance. If we go to the doctor, of course the doctor gets paid, but not directly out of our pockets. The system is simple, and it works. I don't understand why you discount this possibility. It's the best model.
I grew up in Germany with a similar model. The various European models look good compared to the American mess we hear so much about. The Singaporean system is superior, even if not perfect.
They didn't have the Praxisgebühr for fun in Germany. (https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr)
Maybe I'm misunderstanding, but large markets (socialised healthcare systems) can negotiate a fair market price for medications. This is something that the US system prevents.
Have a look at mebendazole. It's on the WHO list of essential medication. It's old so available as generic.
In the UK this costs a few pounds per tablet. https://bnf.nice.org.uk/medicinal-forms/mebendazole.html
In the US it currently costs $440 (about £340) per tablet.
There are many similar examples: Americans pay huge amounts for medications that should be cheap.
There's probably a legal reason why someone can't just set up a company to buy mebendazole in bulk in the UK and ship it to the US and sell it for eg $200 per tablet?
Almost all developed countries have socialized healthcare. What countries do you have in mind?
Singapore has some of the best healthcare outcomes in the world, and costs about half as much as a share of GDP per capita as the British NHS.
Where the American system seems to combine the worst of public and private healthcare, Singapore combines the best.
In the Singaporean system individuals use a health savings account to pay for small, routine health care costs. The insurance part of the system only kicks in for larger, costlier, uncertain items.
There's plenty of subsidies for poor people, too.
See eg https://www.nytimes.com/2019/04/22/upshot/singapore-health-s... for an American perspective. There's also plenty of easy to find material on the web.
I especially like that doctors usually have a list with price ranges for their most common items hanging out prominently. Very transparent.
If there is a major haemorrhage the patient will receive the universal donor (O-) while the test for definitive blood type is performed.
Is that not the case?
Had they asked, I would have given the wrong answer. My blood was typed when I was born. 25 years later when I started donating blood, I was typed again -- and told a different type.
My physicians and phlebotomists assure me blood type cannot change, and old blood tests were simply not very accurate. I don't know any lab or clinic that trusts what someone else claims about blood type.
A quick Google search returns this, for example: https://questdirect.questdiagnostics.com/products/blood-type...
It's not like your bloodtype changes over time...
The aspect of the system that I wanted to highlight is that routine care is paid for out of the health savings account (Medisave), and not out of the insurance portion.
Another interesting aspect is that the bill you get for treatments always mentions the total cost and any subsidies you are getting. All very transparent.
There's also always a co-pay as a matter of principle, even if it's just a few dollars.
And btw there is a good reason to know. Look up for example Rh sensitivity, for pregnancy reasons. A woman who had a miscarriage and was Rh negative may be sensitized and won’t be able to have children with someone that has Rh positive blood. At least - it isn’t advisable!