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Health Care in the U.S.A.
Posted Tuesday, August 19, 2008, at 9:20 PM<< Previous | Read comments | Respond | Email link | Next >>
I'm starting this blog due to considerable interest in it based on other blogs where this has been discussed. I've yet to see a blog devoted to this topic and, whether you like it or not, it directly affects everyone...eventually.
Below are some comments where this was brought up in a different blog of mine. I figured this would be a good place to start: Interesting, I have been away for amost a week and no one is still able to answer my one question. How do you make the decision for who is worthy of receiving healthcare? Yes, I am very opinionated on this subject, being highly involved on both the giving and receiving end. I with Thom though and would like thoughtful consideration given to the subject (any subject), even personal insight, but not the same old political rhetoric. -- Posted by Sharon22 on Tue, Aug 19, 2008, at 12:01 AM How do you make the decision for who is worthy of receiving healthcare? -- Posted by Sharon22 on Tue, Aug 19, 2008, at 12:01 AM Why don't you ask this question to the multi-million dollar insurance companies, you know those people who deny health coverage to at least 50,000,000 Americans. I mean really. -- Posted by darrick_04 on Tue, Aug 19, 2008, at 2:07 PM
The health insurance companies are in the business of MAKING money, not losing it, just like any other business. It seems to me all the liberals seem to have all the answers, so again, WHO is WORTHY of receiving healthcare, and is it a right or a responsibility? -- Posted by Sharon22 on Tue, Aug 19, 2008, at 3:02 PM Oh, so not covering 50,000,000 people makes more sense than losing money. Hmm, very Christian of you to place dollar signs on people's lives. With trash talk like "all the liberals seem to have all the answers" nothing gets accomplished. You've been to Mexico plenty of times, giving health care to needy, homeless people... Now, all of a sudden you ask who is worthy of health care and who isn't? Weren't those people JUST AS ABLE to go get health care as the 50,000,000 Americans who can't...? It is a responsibility, of each person to get health care.. but when jobs are being taken away and corporations are offering "temp-to-hire" positions rather than offering their employees benefits and health coverage, WHO is supposed to do that? I am not advocating free health care for any adult who doesn't work, even though they are highly capable, it is for the millions of children who have no choice, and millions of hard working Americans who have pre-existing conditions, have been dropped (even though they have paid for insurance for decades), or denied for other red tape reasons. The question is not up to you and me of who is or isn't worthy, but if all you have to offer to the conversation is terms like "liberal" then you'll never get your head far enough out of the sand to actually THINK, like a liberal. -- Posted by darrick_04 on Tue, Aug 19, 2008, at 7:02 PM Darrick - Ok, first of all I have to ask where you're getting your fifty million figure from? If it's from the 2005 Census then there are some other numbers that you may not be aware of. I'm not arguing that there are a great number of Americans without health care, I'm just debating the reasons for those individuals being without health care. According to the same Census there are 8.3 million uninsured people that make between $50k and $75k (sounds like they could probably afford health coverage to me). You can also subtract the 8.74 million that make over $75,000 a year. Oh, and the Census Bureau report "Income, Poverty, and Health Insurance Coverage in the United States: 2005" reports that 9.487 million of the original number (46.577 million) are non-Americans. Again, I'm not arguing that more people should have health insurance (the more people that have it, the cheaper it is for me to go to the doc if I have to), I'm disputing this "50,000,000" number that you keep throwing out. So please, enlighten me as to where this number comes from. -- Posted by Thom on Tue, Aug 19, 2008, at 8:29 PM Who are the uninsured? * Nearly 47 million Americans, or 16 percent of the population, were without health insurance in 2005, the latest government data available.1 * The number of uninsured rose 2.2 million between 2005 and 2006 and has increased by almost 9 million people since 2000.1 * The large majority of the uninsured (80 percent) are native or naturalized citizens.2 * The increase in the number of uninsured in 2006 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 19.7 percent in 2005 to 20.2 percent in 2006.1 Nearly 1.3 million full-time workers lost their health insurance in 2006. * Nearly 90 million people - about one-third of the population below the age of 65 spent a portion of either 2006 or 2007 without health coverage.3 * Over 8 in 10 uninsured people come from working families - almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers.2 * The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006. This is the lowest level of employment-based insurance coverage in more than a decade.4, 5 * In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member.6 * In 2006, 37.7 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is at their fingertips.1 * The number of uninsured children in 2006 was 8.7 million - or 11.7 percent of all children in the U.S.1 The number of children who are uninsured increased by nearly 610,000 in 2006, the second year that the number of uninsured children increased. * Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2005 - 29.3 percent of this group did not have health insurance.1 * The percentage and the number of uninsured Hispanics increased to 34.1 percent and 15.3 million in 2006.1 * Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more.1 A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers. http://www.nchc.org/facts/coverage.shtml The only reason I say 50,000,000 is because if you average in the annual increase of people who continue to lose health insurance, along with those who simply can't get it, or are on a waiting list because of a "pre-existing" condition... then the number I use, is probably far less than the actual number. For instance, my 4 best friends work hard, over 40+ hours a week, none of them have private health insurance... two of their employers don't offer it, one can't afford it (because they only make $8 an hour supporting a child), and the last one just graduated college in May, so they are no longer on their parents coverage... I myself, have NEVER been without health insurance, and I will graduate MTSU in December, therefore I will have to begin looking into something affordable in cost, but not cheap in coverage. With the dramatic increase in the cost of energy, food, and life itself, this is but one more burden... -- Posted by darrick_04 on Tue, Aug 19, 2008, at 8:48 PM Comments Showing comments in chronological order [Show most recent comments first] |
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Ah ha...
GREAT BLOG! LOL ;)
It has become a vicious cycle.
The doctors offices gouge the insurance companies so much they have to pass along their "loss" to us the policy holder. I know at my doctors office she charges $50.00 for a routine office call if you have no insurance but for the same office call if you have insurance it is $75. Why is the same office call $25 more if I have insurance?
My insurance premiums go up every year, I have Blue Cross Blue Shield HMO. Which means I am paying $249.00 a month for my HMO coverage. Then I go to the doctor I pay another $30 co-pay, by all rights my insurance should not have to pay but $20 but because I have insurance they are paying $45 almost as much as someone without any coverage pays plus my $30 co-pay is $75.00.
M prescription care is a joke..My co-pay for generic drugs is $15, heck I can go to Wal-mart and get generic for $4.00 without insurance. My non-generic drug co-pay is $40.
As long as there is no guide lines for doctors and hospital or drug companies charges, insurance companies will continue to increase premiums and co-pays. Making it even harder for the average American to carry coverage.
Then there is the aspect of having insurance that will not pay! Many of us have such insurance. It should NOT be at the behest of the insurance company for a procedure or treatment to be performed. This has happened to me and members of my family.
The most pitiful part is that some people who have been government employees, some no more than societal leeches, have GREAT insurance while working folks have insurance that will not pay for needed treatment. You can bet your bottom dollar that our Legislators are never refused treatment. But that isn't so for lowly school teachers.
So you ask who is "worthy" of coverage? Well I ask, who is worthy of having their health care paid for by the companies taking premiums? Why should illegal aliens have better health care than insured citizens, or uninsured citizens for that matter?
What about my child's first hand experience. She and her husband have insurance (privately). They recently had a baby and afterward discovered that it had actually cost them over five thousand dollars more than to have paid out of pocket for the entire procedure. That's right. The insurance company danced through so many loopholes and refused to pay so many portions of their "normal birth" bills that it actually cost them more to have insurance. Their lawyer says it is unlikely they will recover any of their loss. When the premiums paid are factored in their loss is over twenty thousand dollars.
Anyone who asks, "who is worthy" is either some sort of heartless elitist snob or someone who has not thought this thing out very deeply. I personally can't see any other way. Perhaps there are other avenues of thought, enlighten me.
Thom, thanks for bringing this up.
Derrick,
WHY might I ask have you never been without health insurance? Might be because your parent/s
were responsible enough to make sure you have always had coverage and a roof over your head with food available.
If you would go back and read my entire previous entry, I have had family members dropped from health insurance coverage, only because they were not pregnant or did not have children. That would be the point of who is worthy and who should make that decision. That person dropped has a life long pre-existing condition and was amazingly enough dropped by TennCare during it's first purge of the rolls.
Most folks make choices in their lives and their are still quite a few jobs out there that offer health insurance. I have several co-workers, one in particular that is young and has a young child, yet provides for the health needs of her child through her choice of jobs and has never depended on the government. I know that some people feel like they are "stuck" with the job they have, but what have they done to improve their status in life. Have they taken classes, gone back to school, taken any online courses? Last I looked we still live in America, land of opportunity for those wanting it.
You bring up me going to Mexico serving homeless people. Have you been? How do you know if they were homeless? The people I have served in Mexico have all had homes and none were homeless, they might live in a shack, but were not homeless. They also were able to communicate what healthcare needs they had, i.e. high blood pressure or blood sugar and were at least able to tell us what medications they were on more than a lot of folks here can do when coming into the ER or the hospital. The prevalant anwere here is "I take a white or pink pill for my blood pressure."
I'm not quite sure what you mean by the statement of it's not very Christian to place dollar signs on peoples lives. I think I was the first one to bring up the question of How do you decide who is worthy, so please explain that comment.
I have said before and will say again, I am very, very opinionated on this subject, esp. being on both the giving and the recieving end and trying to assist in meeting the need of elderly parents.
I will agree that their are folks out there with out healthcare insurance, but even locally organizations are available to meet the needs of even the working poor. The health department is there to meet the needs of those without jobs and on a sliding scale basis (I would have to confirm that). Community Clinic of Shelbyville provides needs to the working poor, even assisting with medications. The Dispensary of Hope was started in Murfresboro by a local MD to provide medications for those falling through the cracks. These are the ways that health care needs should be met and the church should be at the forefront of assisting with those needs. Parishing nursing is one way churches could provide health care needs to those within their own congregations and communities and do in many areas of the country.
Now, what are your fixes to the current healthcare crisis? I am also interested in what other options are out there and ways that those of us that have either available time or resources could assist.
I guess I am liberal enough to say that if someone is worthy, then everyone is worthy. I am also conservative enough to know that opening up the medical profession to true market forces will be the only way to salvage it, if what you want to see is decent healthcare for the masses.
darrick_04, have you seen Bushs ideas (long since dead) for privatizing medicine? I think you would like them. :O
According to the Henry J. Kaiser Family Foundation (one of the sources quoted by the NCHC in their "facts" that was quoted by Darrick) there were 46.1 million non-elderly people without coverage in 2005. Of these, it's estimated that approximately 80% (36.9 million) of these were eligible for public health insurance coverage or live in families with income below 300% of the federal poverty level (FPL). The FPL is figured on a sliding scale based on the number of persons in your household. In 2005 these were the numbers:
2005 HHS Poverty Guidelines
Persons in ______Poverty
Family Unit____level income:
1----------------$9,570
2----------------12,830
3----------------16,090
4----------------19,350
5----------------22,610
6----------------25,870
7----------------29,130
8----------------32,390
So we'll go with a family of four (two parents and two children). That means that 300% of the FPL was (in 2005) $58050 per year.
Of the uninsured, 25% (11.5 million) are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) and 56% (25.8 million) are not eligible for public programs but need assistance to make coverage affordable. The remaining 19% (8.8 million) live in families with incomes above 300% of the FPL where coverage is more likely to be affordable.
I've heard so many people talk about all of the children that do not have health coverage, well according to the Kaiser Family Foundation (2004 numbers), 74% of the 8 million uninsured children are eligible for Medicaid or SCHIP and another 15% were not eligible because their family made over 300% of the FPL.
So, I ask again, where is the huge disconnect? The vast majority of people that do not have health insurance do so by personal choice, not because it's not available to them. I understand that there are many people that feel that they can't afford it, but do these people have cable, or internet access, or cellular phones, or any of the other "luxuries" that we tend to take for granted? If they do, then they have chosen those "luxuries" over health care for their families.
When I grew up in West Tennessee, we were below the poverty level and didn't have any of those things (ok, two of those three things didn't exist then), but we still managed without a lot of things that my friends all had. It didn't really bother me at all because we managed to make due with my single mother's income.
I am glad you can understand that the health of American citizens is not a blue or red, liberal or conservative, Democrat or Republican issue.. It is simply an imperative duty in which we should ALL work together to reform.
Not going to say any names, but there are a few politicians who agree that each and every American who works hard and still can't afford health insurance should get the same world class health care as Congress.
By the way, it isn't socialized health care, if private corporations are still covering you, but at much cheaper rates, and without loopholes which cause so many to go without coverage.
darrick_04, have you seen Bushs ideas (long since dead) for privatizing medicine? I think you would like them. :O
-- Posted by memyselfi on Tue, Aug 19, 2008, at 10:39 PM
Bush had an idea? Where have I been... HAHA...
DMCG,
I have been through this, that why I ask the worthy question. I sure don't think of myself as thoughtless and have taken care of many of folks in my years in healthcare that don't have insurance. I provide the same care no matter where the payment source is from. Insurance companies have been dancing through loop holes for years, sometimes it easier to get procedures done if you don't have insurance than if you do.
What I find interesting in MD' office visits is how many folks it takes to run an office anymore. I still remember my pediatricians office from when I was a child had an MD, couple of nurses and a receptionist. I'm not sure how many are in my PCP's office not to mention some of the specialist my parents see.
I don't believe illegals should be provided ANY benefits here, they are after all here illegally. The last time I looked that meant they were breaking the law.
I fully understand the insurance issues, try explaining what medicare will and will not pay to your elderly parents.
Private corporations should not be in the picture at all. It is largely the insurance companies fault healthcare is in the position it is. People should be paying cash for their needs. When people refuse to pay $150.00 for office visits that consistently run behind schedule, when people decide not to be paying $5.00 out of their pocket for a single aspirin, when everyone being served in a hospital realizes exactly what they are paying to have the questionable service provided, we will see changes. The power of choice is amazing and forceful. The same people you are referring to that cannot afford 1000.00 monthly premiums could afford $40.00 office visits and reasonably priced hospital stays. Let the market bear it out. It would effectively lower the prices and increase the quality.
I think when you look at the history of insurance and factor in medicare, we can see where the "market" part of healthcare went awry. My Dad use to say my mom's synthroid medication was cheeper prior to his healthcare paying for the meds than after. I totally agree that the power of choice is amazing and very forceful, but I'm not sure how to totally get the healthcare companies out of the picture, they have been around quite a long time.
I was not exactly referring to healthcare companies in general, just the ones that do nothing. The ones that make a profit calculating the odds of your health and lack of it. I like the companies that provide the care; they are the ones that will be competing against one another if the public ever decides that a doctor is much like a plumber or mechanic with a super inflated ego. (stereotypical and unfair-I know)
People seem to put doctors and healthcare in general into a different category than any other business in existence and that is a mistake in my opinion. A doctors office and hospital are businesses that make repairs on peoples bodies. I do think the profession should be somewhat altruistic, but there are a lot of people in the field that made the decision to go into medicine with other intentions. I understand it is a lot of work to become a doctor, but the same can be said of any PHD. I believe anyone with that degree of education deserves a comfortable lifestyle, but to accumulate large amounts of wealth at the expense of driving up the cost of care so high that many are left out is shameful. That goes for the individual doctors, hospital directors and stockholders, insurance companies and their stockholders and even to the self propagating government run provider agencies. With all the waste greed and corruption, I am surprised anyone can afford premiums.
I once heard a hospital director state he understood living from paycheck to paycheck and his college age kids needs. I know he made at least a 6 figure salary, so how can he understand he lower wage earning employees living paycheck to paycheck? I think most young folks go into the medical field to "help people", some want to be "rich MD's" but like me when I entered my chosen part of the medical profession did not understand the paperwork part of it. I still don't like the paperwork part, I'd rather be taking care of the patient.
I think that's what I like about my foreign mission trips, no paperwork, I just get to take care of the people we see each day, even local volunteer work requires paperwork.
I think the profession in general can rob the caregivers of why they wanted their career to begin with. It is not an easy one. The hours are sometimes long, the pressure is sometimes high and sadly they cannot fix everything, even when expected to have the ability. I am however more skeptical than you regarding the number of younger doctors that were ever really focused on helping. The last good doctor I had any experience with was local man, several years retired that was exactly what a doctor should be in my opinion. His name was Barnes and unfortunately, he was retiring before I even knew the importance of a good doctor.
I wonder how much paperwork is required by licensure and what percentage is required by payment providers both private and governmental. Do you have an estimate?
I not sure of percentages. I know very little of my documentation is required for my licensure and most is JACHO and government. A good deal of medical documentation was brought on by the medical field itself (my opinion) not providing follow-up. The most recent push in healthcare being pain control and safety. I would love to see better electronic access across the board that would improve individual healthcare and possibly prevent doctor hopping and other abuses that occur. This would need to happen without a "Big Brother" government oversight.
The good old county doctors are going into extinction is what you are trying to say. I think that goes back to healthcare being run by insurance companies and the government and not letting the market take over. I know of several docs that are still practicing "old fashioned" bedside care, just had one taking care of me recently, but they are far and few between.
I almost hate to jump into this, but.... here I go.
I believe that most medical professionals get into the business because they want to help. By the time you reach the doctor stage, the pay appears to be fantastic, but I believe all the insurance payments that they have to PAY, record keeping and liability issues they face will eat a lot of that money away.
By the nature of what they are doing, it is natural to expect them to be altruistic by giving their services but reality keeps getting in the way. I would love to help people all day long and not charge them. It has been a problem of mine for many years though, that I have bills and a life to live of my own.
My father-in-law used to own several grocery stores and kept allowing people to charge their food. He also ended up living on social security with no savings in the bank.
The insurance companies as noted are a business and if they do not make a profit, they can not help ANYONE! Now, I have my complaints about insurance companies dodging payments. While I have insurance, I have stopped going to the doctors and have chosen to tough it out rather than put my family into deep debt.
I believe the problem to our spiraling medical expenses and costs goes back to us as individuals and the legal system. How many ads do you see now about how well someone is living because XYZ Law firm represented them and won millions? How many ads for class action lawsuits that say if you or your loved ones were ever exposed to bla bla bla, please contact us because we want to make millions for you and us at the same time?
And the crazy courts GIVE IT TO THEM. They award huge compensation for spilling hot coffee or breaking a tooth from some food, or walking in front of a car even though you saw it coming?
I understand wanting to punish careless or reckless physicians, but as individuals many of us can't seem to resist wanting to make a windfall on honest mistakes or just bad luck. Lawyers who take this to an extreme are not high on my list either. And judges!?
To account for all this craziness and greed, the medical field inflates bills to account for the insurance company that which deducts and dis-alloys claims. They dodge everything they can to make up for the frivolous and extravagant rewards given others.
So who really pays for that million dollar award? We all do.
I work in the medical field and I see firsthand how our healthcare system is broken. It is abused by patients, healthcare providers and insurance companies. I am not sure it could ever be fixed. I recently saw a show about the documentary "Sicko" by Michael Moore that was very interesting, I have not seen the complete documentary but I intend to. When he was interviewed he said something very powerful that has stuck in my mind. He asked how we, as a country, had the right to attach a dollar sign to someones life and that is exactly what we do in the USA, money buys medical treatment. This documentary shows that insurance companies will deny treatment even if it cost someone their life and sometimes they deny treatment when they should pay but they hope it will never be questioned. The part I saw was very scary and gave me something to think about.
Steve,
You bring up another very important reason for the increased cost of healthcare.
While I certainly understand that healthcare needs reform from the bottom up, it is undebatable that some responsibility lies with the individual.
How many people in our society have lifestyle habits that are directly contributing to their increased health care costs. The person who smokes, the person who eats too much junk, the person who refuses to exercise, the person who over imbibes on the bottle, and the person with other types of drug addictions, are living lives that will more than likely make them dependent on a doctor's care or a pharmaceutical's pill. I also that those who meticulously make the right choices get ill as well, but I know we would see a reduced incidence of some cancers, hypertension, hyperlipidemia, diabetes, cardiovascular disorders, and muskuloskeletal disorders. I also know that many have congenital or genetic factors that manifest completely independently from lifestyle.
I also think it is ridiculous the sums of money patients are given for an adverse drug reaction. Everyone should be aware that there are always risks,side effects, and even unknowns with ALL drugs. By agreeing to ingest these little pills, the patient should assume the risk to his own body and even more so with new, less tested drugs. It is a well known fact that many older drugs may work just as well ( and are time tested) than the barrage of new meds on the market. Just a travesty to hear 'just ask your doctor is XXX is right for you'
OK I just couldn't stay outta this one :)
This problem is multifaceted but there is a root cause. When the government became a major player in reimbursement issues in the 60's, they became the standard bearer for level of payment. All 3rd party payers now take their cue from CMS (Center for Medicare and Medicaid Service). With that you have all the political pressures from special interest groups to obtain payments for their particular groups. So over the last 40 years, there has been an ongoing battle each budget cycle. Every year when CMS issues payment schedules the other private 3rd party payers adjust accordingly. Long and the short, every policy decision that CMS makes is amplified throughout the entire system.
Folks who talk about having universal access tend to forget about the effect the political process has on healthcare. Just think about all the healthcare promises you've heard on the stump this year. Think that any of these can be paid for as you go? Nope, that cost would be shifted to your children and grandchildren. But that's ok with the politicians making the promises since they'll be long gone.
The most logical solution is getting government out of the health care business. It does it poorly. If you did, you'd see true competition in the health care arena which WILL drive down prices. As long as government is there to help prop up prices, this is what you'll get.
Amen and well said. I've said for many years that the Federal government needs to get out of the healthcare business and you just listed the reasons why.
The federal government has no business being that involved in ANY business aside from the defense of our nation. If the individual states wish to have their own version of universal healthcare, that's entirely up to them.
Now the 94 million, billion, trillion dollar question. What can I do to correct it? What can WE do to correct it?
I would love to go out of this world knowing that I was a part of something that corrected the problem.
I am not asking this in any way other than dead serious. What can we do? Is there a movement already started? To make a big impact, it needs to be a big movement and then the original purpose seems to get lost in the "bigness". (not sure that is a word but it seemed to fit and the spellchecker did not choke on it)
Is there a first step?
One topic discuss at my workplace regularly is how tenncare does not require its recipients to pay a copay. If the majority of people had to pay some type of copay every time they saw a doctor it would do several things. It would reduce the amount their insurance would have to pay putting money back into the system. Most would think twice before running to the dr for everything if they had to pay a copay.It is amazing what people will come to the dr for when it is free. These same people stand outside smoking and talking on their cell phone while waiting to be seen.It does not bother me to care for hispanics because they are always grateful and respectful but they bring their children to the dr for everthing. They need to be educated when they are given tenncare to help them decide when their child needs medical care and when to give them some tylenol and wait.
I would LOVE to contribute to this! As I see it:
The problem with health care today can be summed up with one concept: A system designed for altruistic ends but governed by economic forces is doomed to failure. Every one agrees that, in El Dorado, everyone is healthy and everyone becomes so for free. Working backwards, what happens if someone in El Dorado decides to charge for a service, say some novel treatment. Immediately that service ceases to be a right and becomes a privilege.
Name any other provided service, governmental or otherwise, that is a fundamental right for us as human beings. Cars? Electricity? Housing? Money? We can, and have, survived without all of these. Deny a child healthcare, you are a criminal. Deny someone a house, you are doing business.
Remember, insurance companies do NOT deny people healthcare...they deny PAYMENT for healthcare. Consider this: When was the last time you saw an altruistic doctor (providing good healthcare for all without regard to ability to pay) who was also "rich"? As long as profit, market forces, and economics govern healthcare, there will be inequities in access and quality.
DISCLAIMER: I am a "for profit" doctor, but I never deny anyone my services because they cannot pay, I provide them services with the EXPECTATION that THEY be responsible in addressing the debt. I instill my practice with as much altruism as I believe possible with this system of ours, and I think most of my patients are happy with that.
Well said. The bottom line requires us to decide if healthcare is a right or a service.
It is a service, regardless.. I think you meant, is it a right or a privilege?
For all hard working, legal citizens who aren't offered health care through their jobs, or are dropped or denied for whatever reason, it IS right, but unfortunately not a privilege.
For all those who are advocates of the current health care situation, explain why the richest and most prosperous nation on earth is ranked below 35 other countries in patient satisfaction, and overall health..
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America <<-- GO U.S.A.
nmonajjem, While I appreciate your venturing out into this topic, I would like your input on whether or not you (as a doctor) would support a move to remove the third party payer system we currently have or do you prefer it to remain as it is? I didnt catch that in your comment.
I think one of those reasons showed up in an article on MSN tonight. Many insurance companies are charging extra for certain health risk, and some industries are following. I would say that most of those countries eat a much healthier diet that the USA, not that better healthcare is provided.
Here's the link to the article on MSN:
http://www.msnbc.msn.com/id/26337794
If the link does not work - the article is about the State of Alabama charging $25.00 per month for any obese that does not attempt to loose weight or adopt a healthier life style.
Those rankings didn't have a thing to do with what the people eat. Yet again, diet along with health care are two of the MANY areas the U.S. lags behind less prosperous countries.
But glad to see you just pass off that list as having more to do with diet, than health care, when in fact what it measured was health care satisfaction, wait times, success of procedures and affordability.
A quick look at the list will tell you that folks in those countries EAT a much healthier diet than most folks in the USA.
A co-worker of mine was on a girl scout trip to one of those countries when one of the mom's fell and broke her arm. Care provided: she had to pay for a Taxi trip to the local clinic which essentially provided no care, not even pain medication. Care provided here: met at the airport by an ambulance with a ride to the closest ER and her arm surgically repaired and able to return home to TN.
I also know that insurance companies are paying for people to go to other countries for certain surgeries because cost is cheeper.
I am not downing other countries healthcare systems, some have great hospitals and great MD's. I still see more docs coming to the USA to practice medicine than the other way around. I wonder why, sure would love to have that one explained.
A co-worker of mine was on a girl scout trip to one of those countries when one of the mom's fell and broke her arm. Care provided: she had to pay for a Taxi trip to the local clinic which essentially provided no care, not even pain medication. Care provided here: met at the airport by an ambulance with a ride to the closest ER and her arm surgically repaired and able to return home to TN.
Posted by Sharon22 on Thu, Aug 21, 2008, at 9:44 PM
Oh ok, so a $5 taxi ride as opposed to what.. a $600 ambulance ride? How is that a bad thing? Yeah, your version seems dandy, but you forget to include the cost of an ambulance ride, when one isn't even necessary!
I am not downing other countries healthcare systems, some have great hospitals and great MD's. I still see more docs coming to the USA to practice medicine than the other way around. I wonder why, sure would love to have that one explained.
-- Posted by Sharon22 on Thu, Aug 21, 2008, at 9:44 PM
Because in THIS country, doctors make millions while their nurses, physicians assistants, etc do the busy work, in those countries, they actually have to earn their income. And perhaps the only reason you see more doctors from other nations here, than U.S. doctor's in other countries, is because you don't live in those other 36 countries to see it with your own eyes.
Because in THIS country, doctors make millions while their nurses, physicians assistants, etc do the busy work, in those countries, they actually have to earn their income. And perhaps the only reason you see more doctors from other nations here, than U.S. doctor's in other countries, is because you don't live in those other 36 countries to see it with your own eyes.
-- Posted by nascarfanatic on Thu, Aug 21, 2008, at 9:51 PM
Have you actually been to any of those countries to see any of their healthcare with your own eyes? I can find facts and figures to prove amost anything I want - depending on what I was trying to prove.
I also don't know many doctors making millions of dollars without having to earn it. I know many that make very good incomes, but the ones I know that do earn it. Are you working in a profession where you can be called 24/7 and still try to have a family and personal life? I work nights and see MD's present in the hospital late at night, often the middle of the night and early in the morning, I'd love for you to tell them that they are not earning their income.
Perhaps our blogging MD - Dr. Monajjem could have some input on how many hours he puts in. I bet he's had a few late night calls.
I'm with many of the other commenters on here. We know we have a system that needs fixing, but I have not seen any suggestions as of yet.
My co-worker by the way was for socialized medicine until she experienced it first hand.
Call it what you want, be it "socialized medicine" or whatever. You have seen suggestions you made, but when you turn a blind eye to them, don't expect people to repeat it. So you missed the ENTIRE point, a 600 DOLLAR AMBULANCE RIDE, as opposed to a FIVE DOLLAR TAXI FARE in a NON-EMERGENCY situation. THAT is what is wrong with health care in America. When people are trying to "save your life" and charging you hundreds and thousands of dollars... for what.
Btw, since this is near to your heart, why don't YOU tell us what needs to be fixed and what YOU think we should replace it with. Also, in MANY of those countries that rank higher than the U.S. they do not have physicians assistants, fill in's, and an office full of secretaries. With the amount of people working in one U.S. doctor's office, why must we wait an hour or two longer than our appointment just to get called back? That is ridiculous.
Lastly, why do I need to visit 36 countries to know their health care is better than ours, when you live in this country, and can't even understand it.
nmonajjem,
Interesting comments :)
There is a fairly civil and informative debate going on. Awesome...
Oh by the way everyone, how many homes do you own? LOL...
Good question Darrick, I own one that I will making payments on for several years yet, by my choice, and it's not a new home either, it's many decades old. I love old farmhouses, they have some "character" to them.
Nascar,
I did not say that situation was an emergency situation at the onset, but by the time she arrived in the states it had evolved into one because it was not set properly to start with and required emergency surgery to fix, hence the emergency here.
If you were actually interested in fixing the situation, I did list some up earlier also. I still believe personal responsibility should top the list. I also stated that improving communication between hospitals and MD's could help with not dupicating tests, procedures, and yes, doctor, pharmacy and hospital hopping. I firmly believe that those receiving Govt. benefits, i.e. TennCare should have a co-pay and yes possibly even drug tested to see if they are using illegal drugs. I also believe like a few others on here that the FEDERAL govenment should not be involved in healhcare, Tim Baker gave a very good history of medicare and how CMS sets payment rates. The MD's are not the root cause of the problem, abuse of the system is.
Darrick: I live in one home, but the bank "owns" it. :)
memyselfi: There is no easy solution because "root causes" are legion. I believe, in the future, a single payor system will prevail. Jumping into one now would be folly. I envision a "Star Trek" future: eradication of wealth as a social standard, every one contributing, according to their capabilities, to the well-being of all. Sounds like Communism? I think the spirit of Comminism has validity, but the means to that end was flawed. Maldistribution of wealth in the world today is incredible. Imagine what could be accomplished if those that have that wealth did not value it, working hard in the spirit of service rather than excess. Also imagine what could be achieved if all that were capable of contributing, but choose not to because they get free money, also rose up and worked in the spirit of service to the whole. There is enough "wealth" in this world to provide everyone with everything, including healthcare, if this ideal could be realized.
Sharon22: I don't count my hours. I can tell you this...I consider medicine a profession, meaning I work when I am needed and continue until it is done. Surgical disease does not keep time!
Dr. Monajjem,
Mine point exactly. The majority of the docs I know feel the same way, that it is a profession. I love your last line that surgical disease does not keep time, but possibly you could tell nascarfanatic that if he developed acute appendicitis or cholecystis at 3:00am he would have to see one of your PA's or NP's first (do you even have any?) in the office while waiting 2-3 hours. I know you would never respond to a person in need that way, I just get tired of certain people blaming all our healthcare problems on supposedly "rich MD's".
No PAs, no NPs, no voicemail, no answering service, no beepers, one cell phone (mine) that takes all after hours calls. One great nurse and one great office manager who hold it all together. I think we do pretty well! :)
BTW: PAs and NPs, also known as physician extenders, fill a very important role in healthcare, especially in underserved areas and very large practices.
BTW#2: This notion of rich MDs did not arise in a vacuum. As I have alluded to in a previous blog, the practice of medicine used to be a "cash cow".
Yes, you do an awesome job here in Shelbyville and we are lucky to have a surgeon of your caliber and kindness here.
NPs and PAs do fill a much needed role in healthcare, some would have no healthcare if not for them. NPs are even uping the anty by getting doctorate degrees, not MD, but a doctorate. It would be neat if we had a NP around here we could call Phd!
Too bad we can't go back to barter.
I remember when schoolchildren would debate their individual worth by relating that one's birth had been paid for by a hand-stitched quilt and a jar of chow chow while the other had been paid for by four days of putting up hay and a mess of clean catfish.
Shots,stitches and blood pressure checks could be traded for fresh produce or mowed lawns while a few quail,half a hog or deer,peach preserves,some curtains,a repaired transmission,etc. could pay for a coronary,a bout with influenza or a broken bone.
We didn't have many cases of people running to the doctor over nothing or making frivolous suits nor did we have a lot of people neglecting their health because the couldn't afford the treatment or co-pay or having to wait forever to be seen by a stranger in another city.
Since we seem to know what should be done and how it can be done,maybe we should work on combining the two more than arguing over who to blame for current imperfections?
It would be neat to go back to the old barter system. I just might have to put up a chicken coop outback, or buy a herd of goats. I'd have to first learn how to care for those types of critters, for some reason I don't think they eat cat or dog food, maybe table scraps.
Darrick: 6 less than McCain :) And the bank would disagree with that.
Dr. M: Very Star Trekian vision but you and I will be long gone before that ever occurs. It is not human nature to have a service first focus. We MAY be around for a single payor system but I still see that as a long way off. All it takes is a look at the federal balance sheet to know that THIS government cannot function as the single payor and still carry out it's other constitutionally required work. The last line though is so true. We don't think of it as time, just folks. Although those 48 hour stretches in residency had me looking at my watch :)
Why do we spend all this money on discovering new cures & treatments for conditions & diseases that no one can afford to receive unless they are filthy rich? In my opinion, hospitals, pharmaceutical companies, and doctors charge way too much money for their service/product rendered. Have you ever called around to the different hospitals to find their charges for instance if you were to be admitted for a gall bladder surgery? They all have different prices...Why? I am not really for social government insurance because citizens & loved ones would not receive quality service like private insurance companies provide. It is sad that when you have a loved one who truly needs medical attention...you get what you pay for...your treatment is given according to what you can afford. If you have insurance that is willing to pay the best...you get the best...if you don't & you want the best quality treatment then you better let the doctor know that you have a BIG PURSE full of money & you can afford to pay the difference. Insurance companies are the only entity in America I know of that can legally discriminate. In my opinion, greed & denial are the root of our healthcare problems in America.
Here's an easy way to compare prices and also quality of care that hospital provide. It is from the United States Dept. of Health & Human Services; it is based on Medicare payments, but most other third party payors tend to follow Medicare.
Here's the link: http://www.hospitalcompare.hhs.gov/Hospi...
Although I will admit I haven't researched this topic thoroughly - I wanted to comment about the difference in rates a doctor charges when paying on your own vs insurance. When you pay on your own the transaction is simple and helps to keep a doctors overhead low. When you use insurance, there is paperwork and processing involved - so a greater expense to the doctor. This comment really surprised me because from the little I have read on this subject it is my understanding that a doctor doesn't really get to set his/her rates carte blanche - but rather the insurance company pretty much dictates what they will pay for services - which I feel contributes to doctors having less time to spend per patient and can result in not always getting the care your doctor might like for you to have. On the whole I think doctors are taken for granted. Sure they make a lot of money but look at the debt they start off their working life with - even with scholarships - med school isn't cheap and neither is setting up a practice. Having said that however - I also think consumers are not really all that savy in picking their doctor. Most doctors will offer a free get acquainted vist. Anytime I've had to choose a new doctor, I've taken advantage of that and have always interviewed 5 at minimum before choosing. As a result - my doctor is worth every penny he asked. I was unemployed for awile a few years ago and came down with Pneumonia...and my doctor worked with me to make sure I got the medicine I needed without making me go to the hospitial which he knew I couldn't afford. Yes he charged me less and I was grateful.
That's AWESOME GeeWoman!! I am glad you have a true, dedicated, & caring doctor. You are exactly right not ALL doctors are greedy. I did not mean to stereotype, but there are some that unfortunately are. I am proud to say that I know several doctors in this community who are true to their oaths. Haven't you ever been warned before that a particular surgeon for instance had developed a reputation & nickname called "a butcher" or as "knife happy"? Some patients have had unnecessary surgeries to help pay back those college loans or pay for that new mercedes. I overheard a team of doctors one time at a hospital in a heated discussion about how they were limiting a man's surgery according to what his insurance would pay...then one looked up and noticed me standing there & then they all took notice, lowered their heads and silently walked away.
The insurance companies do dictate what they will pay for services &/or treatments, but a doctor sets their own rates usually in the same ball park as all the other doctors in the same field in the area they are practicing. That is why doctors are even selective about which insurance they will accept. Some insurances pay better & faster than others. Haven't you ever noticed that is why the first question asked to you is if you have insurance & who is the subscriber? Then when you fill out your paper work you sign that you understand that you are responsible for paying the remaining balance and if the insurance declines payment. I have even been to some that made me pay up front and file my own insurance for a refund. Have you ever noticed how for instance eye doctors charge different rates? That is why most folks without insurance go to places like Walmart & Lens Crafters. Some insurances pay better & faster than others. Haven't you ever received an EOB (explanation of benefits) showing the doctor's charge...the amount the insurance covered, the amount you owe the provider, and then a column with charges that most doctors write off or some will try to bill you the extra amount. I called my insurance company & they advised me that for the field & area the doctor was in that those charges were an overcharge & I nor the insurance company was responsible for paying it. There are a lot of things that are swept under the rug that we do not know about. Unfortunately, the incident that happened with Dennis Quaid's twins have helped expose to the public how medical mistakes most often are swept under the rug unnoticed.
"Star Trek" future: eradication of wealth as a social standard, every one contributing, according to their capabilities, to the well-being of all.
Under these circumstances I think you would find "the capable" carrying the weight of "the incapaple" until they were crushed. I have read the post back comments in the newspapers of countries where universal health care is a reality and it isn't the wonderful solution it is touted to be.
Oustanding doctors simply stop taking insurance and only those who can afford to pay for their services have access to their care.
For those who don't want government guidelines dictating when or "if" they are going to get treatment - they are forced into paying for private health insurance policies on top of the government taxes taken from them to provide universal health care - so they are paying "twice" for their healthcare.
Do you honestly think the biggest proponet of universal healthcare (Hillary Clinton) will be put on a waiting list and sitting in a clinic to take advantage of the wonderful services she has worked so hard to create? No - she will be seeing her own priviate M.D. in his private office - getting the best of private care and we will still be paying for it - while the young couple that lives up the street from you just had a premature baby that won't be getting treatment because the government guidlines say her apgar test was/is 1 point too low.
Public education should serve as an example to all those who want government sponsored universal healthcare.
No THANK YOU!!!!
Great research & info...thanks GeeWoman & Sharon22
I think I just figured out what would fix our healthcare system, (thanks to gottago)... a standardized dress! But wait, I already do that, it called scrubs. Sorry all, I couldn't resist after the comparision to public education.
Back to a little more serious side of the issue.
Thanks to GeeWoman she got my curiosity up about checking foreign newspapers. I did a quick search on our northern neighbors up in Canada since their healthcare system is universal healthcare to see if I could find any opinions. The first article I came across was an editorial about universal healthcare by Paul Rutherford of the London Free Press. It seems the new incoming president of the Canadian Medical Association, Dr. Robert Ouellet made the following statement to the press "We could say if the public system was working properly, there wouldn't be any private system. But the problem is, it's not working," he told Sun Media this week. "I am raising a taboo subject I know. . . . We need to pull our heads out of the sand." The editorial also seems to imply that the federal government in Canada is ignoring the citizens input into the current healthcare issues they are facing. Here's the link to this article: http://lfpress.ca/newsstand/Opinion/Edit...
I also checked into the Canadian Medical Associations web site to see what information it offered on universal healthcare. What I found was an on-line survey done by Ipsos-Reid, in 2006, sponsored by the CMA on Canadians opinions on healthcare reform. Two-thirds of Canadians are looking for more than the status quo. For a look at the full survey here's the link: http://www.cma.ca/multimedia/CMA/Content....
I will continue to see what other information is available esp. on the European countries.
Most folks that have commented have stated that we have too many loops to jump through with our private insurance and it's too costly for some to afford. I highly agree with that. I suspect we might be beginning to see some changes with healthcare, esp. pharmacuticals, with Walgreen's, Target, and Walmart competing for the generic drug business. Another area, which we have not seen much of in this area is the walk in clinics located at pharmacies. I have seen both positive and negative responses to these types of clinics. I know we as consumers of healthcare do need to keep involved and informed of changes as they occur.
Thank you everyone - I feel like I've just gotten a proverbial pat on the back! I applaud your efforts to research. I think one of the big changes we are going to see in the future of Insurance will be a concentrated effort on wellness programs, getting/staying healthy rather than coping with being ill. I recall reading a article about an insurance company in Indianapolis who started a new program for their employees this year. The employees were required to get a health assessment. Any issues they were diagnosed with...like diabetes, high colesterol, high blood pressure, overweight, etc If they failed to make progress/improvements...like bringing down their blood sugar levels, lowering their colesterol, losing weight...etc, they would be charged higher premiums. In my place of work this year - they changed our coverage to pay more for preventitve care rather than being ill. We now have huge deductables (mine is $1200 a year). Like this last week (I have Asthma) I had to go to the doctor for a new inhaler. I had to pay for the office visit and prescriptions. But - on the flip side - if go in for a yearly check-up and my doc orders a mammogram as a preventative screening - my insurance pays 100% of the cost - including the doctors visit. I think these types of programs will empower Insurance companies to answer "who is worthy" by refusing treatment to those who fail to get/stay healthy.
Why would we want the government involved in our healthcare? They are wholly incapable of doing anything right on time or under budget. Why would we want to trust our very health to a government who cant even educate our kids (unless they are dressed properly, lol)?