Health Care Rant

[ulthar]

I am so sick of the US health care system.  Sometimes I wonder if less availability would be better - maybe the SYSTEM as a unit would function better.

Before getting to my most recent 'episode,' here's some historical anecdote just to set the stage.  Several years ago, while at work, I got lightheaded, felt faint and very pale.  With a history of heart issues from when I was younger, I figgered it best to get checked out.  So, I went to my primary care doctor, who ran an EKG.  He saw something there that warranted sending me over to a cardiologist ASAP.  They ran some tests and found nothing of immediate consequence.

Insurance did not cover it since I did not go to the emergency room.  W-T-F??

Two weeks ago, I went to the ER for something.  But, I learned that the Co-Pay for an ER visit is like 9x a regular office visit.  This is to discourage unwarranted visits to the ER. I"ve never been to the ER for anything that was not a genuine emergency, but I am 'punished' alongside those that do.  Yet a couple of years ago, my insurance did not even cover a couple thousand in tests because I did not go to the ER.

Again.  W-T-F??

So, now I am scheduled for outpatient surgery for next week in regard to the thing I went to the ER.  Now, the hospital tells me that I have to pay a deposit, to cover anything my insurance does not cover.  WHAT????  I told them I was not paying a deposit, and they said "okay, that's fine, too."  What???  Do they need it, or don't they?  Jeez.

Why even bother having insurance?  I hate the insurance system and the mindset it creates.  To me, it is similar to the withholding system on taxes.  If you make people pay AT THE TIME a service is rendered, they will know the cost.  Otherwise, it creates too much hidden opportunity for what I feel compelled to call corruption.

Thanks for the rant.  Back to Bad Movies....

[Mr_Vindictive]

The health care system in this country is a joke.  It's not there to help people, just there for the insurance companies to make a boatload of cash. 

That's all I'm going to say on that subject.  If I were to say more, then I'm sure it would spawn some sort of argument with those that feel the companies should get rich while not helping those that are genuinely sick.

Ulthar, best of luck on the surgery.  We'll be thinking of you.

[RapscallionJones]

Boy, this thread sure is going to get ugly the first time someone speaks in favor or socialized healthcare. 

So f**k it.

A European-style socialized healthcare system would fix everything.  EVERYTHING.  Right now, the healthcare industry exists as a business model to make money.  They have a bottom line to consider and while I ordinarily can't fault a business for considering profits and investors, this time around they're making money on the backs of people who desperately need healthcare and are paying out the nose for it if they can afford it at all.

One of the main arguments against social medicine is that it's more government, more beuracracy and longer waits since there's a standardized system in place and a priority queue but if you had to wait a little longer to get the help that you're guaranteed wouldn't it be worth it?

Everyone benefits.  We pay a little more in taxes, everyone gets the help that they need despite their social class and the quality of life in the United States rises.  There's a positive social impact there that extends beyond doctors offices and hospitals.

Am I dreaming?  In spite of healtcare being a hot button issue in the current presidential race, I think I am but I can dream.

So bring on the criticism.

[Mr_Vindictive]

Boy, this thread sure is going to get ugly the first time someone speaks in favor or socialized healthcare. 

So f**k it.

A European-style socialized healthcare system would fix everything.  EVERYTHING.  Right now, the healthcare industry exists as a business model to make money.  They have a bottom line to consider and while I ordinarily can't fault a business for considering profits and investors, this time around they're making money on the backs of people who desperately need healthcare and are paying out the nose for it if they can afford it at all.

One of the main arguments against social medicine is that it's more government, more beuracracy and longer waits since there's a standardized system in place and a priority queue but if you had to wait a little longer to get the help that you're guaranteed wouldn't it be worth it?

Everyone benefits.  We pay a little more in taxes, everyone gets the help that they need despite their social class and the quality of life in the United States rises.  There's a positive social impact there that extends beyond doctors offices and hospitals.

Am I dreaming?  In spite of healtcare being a hot button issue in the current presidential race, I think I am but I can dream.

So bring on the criticism.

That just seems to be such a stupid idea.  Who would want to pay a slight amount in taxes and get free healthcare?  I can't begin to imagine what kind of idiot would be for such a thing.

Karma.

[trekgeezer]

I remember at the start of my career in computers (this was 1979), the company I worked for had great insurance. If you were single you paid no premium and they covered 100% or everything. The only time you really had to pay anything out of pocket was when your treatment for something reached $10,000, you had to pay the next thousand and after that it was unlimited. They also had a stipulation about if a service cost above what was reasonable and customary, you would have pay the difference.

They gave us these big envelopes with a form on the flap. You tore the form off, filled it out, threw in your receipts (including drugs), mailed it and then got a check in couple of  weeks.

When I got married in 1981 I had to start paying $4.80 a week to cover my dependents, no matter how many there were. Everything was paid in full for our two kids being born. 

Things changed in the late 80's when HMOs and PPOs started to appear.  Basically what this did was transfer the money from the doctors and hospitals into the pockets of the insurance companies.  There in lies the problem, the insurance lobby.

Nothing is going to change as long as interests with deep pockets control our elected officials.  Take the medicare drug program, this wasn't written to help people on Medicare, it was put in to effect to keep the drug companies from having to negotiate drug prices with the Federal Government.


We seriously need to address this whole issue, but it's not likely to happen with politics the way they are in this country.

[CheezeFlixz]

We put government is charge of our schools now we are falling behind most of the western world in education and continuing to fall. If you put them in charge of health care what do you think will happen?

Just wondering ...

[Zapranoth]

I believe (as a doctor who works in a non-profit HMO) that our system will inevitably take on the characteristics of socialized medicine, whether we call it that or not at the time.

And that is a good thing.  But it won't happen yet...   the shields are only down to 25%, and we don't as a rule fix things until collapse is imminent, and we aren't there yet.

[nshumate]

Before anyone swallows the Sicko claims hook, line, and sinker... Ever asked a Canadian what they think of their healthcare system?

'T'ain't the promised land.

I've seen private insurance in action.  I've seen the government in action.  And if you think that private for-profit bureaucracies operating in a competitive marketplace are bad, just imagine what mandated and entitled government bureaus would be like.  It's be like getting your healthcare from the IRS.  Or the DMV.

For the federal government to be able to administer a healthcare system even as efficiently as our hobbled private-insurer morass, there would need to be a reinvention of government structure and culture that would dwarf the switchover to a public healthcare system.

[Newt]

I'm Canadian.  My Dad was a doctor.  Socialized medicine is not all you seem to think it is.  The grass may look greener, but you really should be checking it for spraypaint before you buy.

The wait times are killing people, for one thing.  The rest...well, what  you 'need' and what the system defines as a 'need' may not be the same thing.  My relatives in England have said it has been even worse over there for a long long time.

Bottom line: it still runs on a 'business' model.   Has to.  Every part of it is subject to drastic cuts and redefinitions in order to make it look good to the 'shareholders' - on paper.  As a result, many of us do not have the same access to care and facilities. In my community, the ambulance service covers such a large area that it cannot possibly respond to such things as heart attacks within the optimum time.  Not good with an ageing population.  And our ER (we DO have a hospital - of sorts; just barely) shunts just about everything to the city 45 minutes away (where the waits are regularly over six hours, often eight or twelve - been there with a sick child myself).  We have too few doctors - cannot pay them decently - so many people do not have a family doctor at all - my own family went without one for several years, and we have kids.

It does cover most essentials; if you can live with your condition and/or survive the wait for tests, diagnosis and treatment, I suppose that it 'works'.

[Zapranoth]

Oy.  This kind of debate is too much to type (done it before) -- I guess the short form of it is that I don't wish for the US to take on a Canadian system or a British system.     I do think, though, that the current system is too all-or-nothing, and that something more in the middle is in the aggregate going to be better for most people.

I'll see if I can give an example.  Okay.  This is one facet of a small thing, but the principle is the thing.  Where I work, like in many systems, there is a formulary (a list of preferred meds).  There are financial penalties for not using meds on the formulary -- costs more to buy if it isn't on the formulary.      Our formulary is made up by a committee of docs, pharmacists, and some members of the cooperative, and each med on the list is weighed, based upon the evidence that it actually leads to better outcomes for patients, how safe it is, and yes how much it costs. 

So when someone comes to me with depression and she says that her friend does so well on Cymbalta, and she wants to take it too, we talk about what she has tried.  Turns out she hasn't taken anything for depression -- so for her, there's economic incentive to start her on Prozac or Celexa or perhaps sertraline (generic Zoloft) -- actually, generics of all three.  The randomized, placebo-controlled trials show similar efficacy between all these meds for the typical depressed person, so why spend 77 times more money per dose on brand-name Zoloft?  It's unnecessary, and wasteful.           If the patient tries several meds and fails them, yes, we might eventually move up to Effexor or a med like that (more expensive) but that isn't first-line.     If it takes several courses of medication, yeah, that's inconveniencing and has its own problems... but in the aggregate, I get to effectively treat a lot more depressed people as a consequence, and most people do better.       These decisions, as I said, are based on safety, efficacy and cost.

What about at a random clinic here in town?  That same patient might come in, and the doctor there has taken in some drug rep propaganda recently (no drug reps allowed in our clinic, by the way -- haven't seen one in three years, except at conferences, when I walk past them without pausing) and the patient ends up with some sample boxes of Cymbalta.  She does well on it, and wants to continue it.  Doc writes a prescription,  and the med is either   A)  not covered, and she shells out hundreds a month to pay for her med, when probably $10 of generic fluoxetine would have done as well, or B) it's covered, and EVERYONE pays more than necessary for the treatment of her uncomplicated depression.  (or C:  Doesn't take anything, gets sicker, loses relationships, starts drinking or using drugs, loses job, attempts suicide, is hospitalized... ... ...)

That's one facet of a greater philosophical approach to the problems of cost and risk/benefit analysis in healthcare decisions.  The cooperative I work in is  and has been on the leading edge of doing the right thing, for years.  I'm proud to work here.   If I could force every practice in town to make decisions the way we do, would I?   Yes, because we are trying to do the best evidence-based medicine for patients, with the lowest costs we can manage.    When I said that I hope our system (in the US) becomes more socialized-like, I was meaning more specifically, more like how some (non-profit) managed care works.  I apologize for speaking unclearly and in sound-bites.

Rebecca, I'm sorry to hear that you didn't have a family doctor for a while.   I hope that you've got better healthcare now -- there are quite a few people in the US who don't have doctors, either, nor any hope of being able to afford insurance (when the rates go up in double digit percentages each year, for several years in a row!)   If you could command the Canadian system to change, which changes would you make to improve it?

[ulthar]

Basically what this did was transfer the money from the doctors and hospitals into the pockets of the insurance companies.  There in lies the problem, the insurance lobby.

100% agree.  Therein lies the problem - the INSURANCE system.

I remember the pre-HMO days.  I also remember how HMO's were 'forced' on everybody as The One True, Right Way (tm).

The insurance industry operates on second derivative growth. The growth must grow.  I personally do NOT think any form of socialized medicine as the solution.    Like Newt said, you just trading one ill informed power for another.

Zap, the decision of which med to use for a given patient should be YOURS as her doctor.  You should not have to base that on some list a COMMITTEE decided was statistically best.  Humans are not averages.  Now, you can certainly use such a list as a guideline, but that should be as far as it goes.

My wife (also a doc) complains about these lists all the time.  You see, her problem is that in peds, virtually NOTHING is 'approved' for use on children because the clinical trials cannot be done because people don't want to use THEIR child in a trial.  So, the FDA says "no, it's not approved."  That does not mean it is not a good med, it simply means no one had paid for, and received FDA approval.  She fights this all the time, and now with the OTC cold meds, it's becoming a big deal.

Bottom line is that WAY WAY too much power is in the hands of the insurance companies.  And they do not have your interest or mine in mind.

[Mortal Envelope]

I don't really have a good opinion on what to do about our s**tty health care system but I can say that I sure am having problems getting the insurance to cover the most basic things for my child, even when she has both parents with supposedly good health insurance.  This is all a pretty new experience for me because I haven't been to a doctor in about 20 years and don't even have a personal family doctor of my own -never needed one.

All I know is that I don't really want nationalized health care but it really p**ses me off when local hospitals over charge (like in the case of an 8$ q-tip).  They need to police themselves before god-forbid the government steps in.  I guess there just needs to be some kinda balance/something to keep things in check.

But at the same time, I don't think a child's health should be a factor in what's profitable and what's not.  Bah I don't know what I'm talkin about.  Damn ideals anyway.  I guess there's just no silver bullet on the mess we call health care.

[Zapranoth]

Ulthar,

I am not forced to prescribe, or not to prescribe, anything.  But in terms of what it costs, there are direct and real implications in the choice.  In our formulary, the choices are based on what works best and safest, and often the new "me too" drugs (ie new twists on old molecules) are not better, just more expensive (and on-patent).  Their willy-nilly use ought to be discouraged in the absence of clear evidence of benefit for their cost.

I would never work for anyone who tried to tell me what I can and can't prescribe. 

If a patient has tried four antidepressants, for example, and hasn't done well on any of them, I could order venlafaxine (an expensive but effective antidepressant) and have it covered as a formulary med.     But if the patient has never tried anything and insists on venlafaxine, I can still order it -- I can prescribe anything I want -- but what the patient's insurance will and won't cover is and remains a separate issue.

In our system, though, we try to align what the insurance will and won't cover with what makes sense to cover first, or not.

Also, let me inject this into the thread:  not all HMOs are the same, and not all HMOs deserve their connotation.   I have worked inside and outside of HMOs, and have some experiential basis for this opinion.

I agree that the insurance lobby, and Big Pharma, are real and present dangers to all our health.

[Torgo]

I've got Southern Health HMO through my employer.

I haven't had too many issues with them.  I looked at my card and I have to pay 150 dollars for an emergency room visit but I don't have to pay extra to go to my doctor after hours or on the weekends which is nice.

Urgent care is only a 250 dollar co-pay for no matter how long the stay is according to my paperwork.

But we all know how they can "change their mind" about stuff despite what's in print.

[CheezeFlixz]

I have CheezeFlixz HMO I have coverage for really major stuff like a brain transplant, but the day to day sniffles and boo-boo I just pay it.

Regular coverage for me would be as a self employed person nearly $800 a month ($9600 a year), and I haven't spent $800 on health care in the last 20 years.