Because it keeps getting brought up in other threads, I wanted a thread to discuss medical insurance and other issues. I am very interested in hearing your opinions about the title question: is medical care a right or a commodity.

Some background: when I was a kid, I fell off my bike, and a caring passerby took me to the ER. I didn't know you had to pay, I thought it was like a public service, a room for emergencies. I honestly don't know how the payment was resolved.

I wonder how many people think that is how it works still.

We are obligated by federal law to evaluate, stabilize, and treat anyone who comes into the ER regardless of their ability to pay. We have to assess them before we even inquire about their ability to pay, or their insurance status. NO OTHER BUSINESS has this requirement, to my knowledge. Part of the reason our medical insurance is so high is this federal requirement.

So question #1 is should we provide medical care for free, and if so, should it be the same LEVEL of medical care; that is, should indigent patients expect CT scans, subspecialty consultation, and expensive medications, or should there be a "lower level" of care?
Should they be able to sue us if they have a bad outcome, if they did not pay for our service?

Which brings me to question #2 - would you be willing to accept a lower level of medical care for lower insurance premiums? Part of the reason for high premiums is #1 above, but also the malpractice environment. Almost everyone who presents to the ER with chest pain is admitted for other expensive tests and labwork, and almost everyone with a headache gets a CT scan and sometimes a spinal tap. Now we can tell 95% of the time who REALLY needs these tests and admissions, but sometimes we are wrong, and harm comes to people. So if your initial tests are OK, and I send you home and you die, will your family not sue me? Not likely. Number two is a rhetorical question.

I've got a lot more to say about these issues, but this will get us started.

Coming from a land (Australia) where basic medical insurance is provided by the federal government (funded by a 1.5% levy on taxable income), and private health insurance is only necessary if you want things like a private room or elective surgery, I have to say that the medical insurance and pharmaceutical industries in this country strike me as evil incarnate.

I agree with eccles. I saw a $500 a year raise on my property taxes to pay for school funding. I know this is necessary even though my wife and I don't have children. I am willing to do the same thing with medical care. It is a right. We all deserve to be healthy and not have to worry about basic care. Breast implants on the other hand now that is a joke.

Medical insurance only pays for breast implants if they are after mastectomy/breast cancer, etc. They do not pay for elective augmentation.

Another tidbit you may not know...

We have to give discounted rates to insurance companies to attract their business. Medicare discounts their rates too. If you don't have insurance, you get charged much more than people with insurance.

Name another business that can't set their own rates. If I am better at what I do than anyone else, you would think that I could charge more. Nope.

Is healthcare a right? No. We are no more "entitled" to healthcare than we are to a new car every year or a nice cabin on a lake. Want a new car? Earn the money to buy it. Healthcare is a service, like any other.

That said, I believe that it is in our collective best interest to ensure that all persons have access to at least adquate healthcare. As we never know where the next Salk, Einstein or Edison will come from, having a healthy population provides everyone with the opportunity to contribute to society to the best of their ability. Having significant portions of society held back by medical problems that are fully treatable ultimately deprives society of their potential.

Now, does that mean I support national healthcare? Absolutely not! I formery worked for a medical device manufacturer and spent quite a bit of time in Europe on company business. Guess what the number 1 fringe benefit is for management and professional staff over there? PRIVATE HEALTH INSURANCE! In every country on the continent, and in the UK, anyone with the means to acquire private health insurance does so. Effectively, these countries all have two tier health systems: the public system for the masses and private insurance for those who can afford it.

The number one problem I observed in all of these government run health care systems is the focus on cost control instead of optimum patient outcomes. For example, in Canada, the official phrase used to describe the goal of the health care system is to ensure a "sufficient outcome" for all citizens. Yes, sufficient. This means, in practice, that the oldest, cheapest technology is used to the greatest extent possible. New, state of the art technology is generally not used because it is expensive. Sometimes, the difference in outcomes is not significant. Other times people die who would have lived had they been treated in the US. People of means in Canada routinely come to the US for critical treatment because either it is not available in Canada or it is of inferior quality to what they can get in the States.

We already have nationalized healthcare, socialized medicine, to some degree, but only for the elderly (Medicare) and extremely poor (Medicaid). The middle class gets screwed, once again.

Many doctors do not take patients with Medicaid, because they don't pay enough to cover expenses. A few years ago, some docs stopped taking Medicare patients (some still don't) because they kept cutting rates as well. Problem was, the insurance companies used Medicare rates to set their rates, then Medicare patients started looking better.

We cannot charge a Medicare patient more or less than what Medicare pays for a given procedure/visit. Their rate is the law. You can "opt out" of the Medicare system, foregoing all paments by them, and charge whatever you want, but few could afford it.

These rates are very procedure-oriented, and often do not make sense. For instance, if you come in with chest pain and high blood pressure (and might die), I charge an "evaluation and management code" that pays a fixed rate from Medicare or your insurance company. If you have an ingrown toenail, and I remove the ingrown part, I bill for a procedure code that pays twice as much as the chest pain visit. Cognitive skills are not considered to be as important as procedural skills. Ever had stitches? We charge by the centimeter, not the number of stitches. And don't blame me for the cost, I do not set the cost, it is ridiculous.

So there are benefits to nationalized healthcare, but problems as well. If I were setting the rates, pneumonia or heart attack would cost more than stitches or an ingrown toenail. But what do I know?

If doctors spent less time on the rx8club.com, maybe the Americans would have better health care.:p

There is something terribly wrong with health care in the USA on many levels. Patients without insurance can incur bills that will put them in debt for life, physicians have to accept less and less from medical insurance payments while paying more and more in malpractice premiums, and there is definitely a tiered system already in place -- I can get access to my doctor a lot quicker than a Medical (California's plan for indigents) patient can. Emergency trauma centers in LA are being shut down because they hemorrhage money as much as blood; hospitals can't afford to keep them open because so many people treated there have no ability to pay.

I look at a nationalized system like Australia's or Canada's and I think we ought to have something like that in place here as a minimum baseline standard of care.

Ahh, but doc... what is an Australian or Canadian physician's income compared to yours? Do physicians practicing there have the opportunity to earn the equivalent of multiple hundreds of thousands of dollars per year, especially in the more lucrative specialties?

Many of the students in my classes plan careers in medicine, but what lures them isn't necessarily the altruistic desire to help people... it's the income and prestige of being a doctor.

It seems to me that we have the very best medical care available in the world right here in the USA -- if you can afford it. You get what you pay for... unless you're a set of conjoined twins born to a dirt poor family in a third world country. THEN it's free.

I'm certainly not complaining about my income. I don't know what docs make elsewhere, but it is a comfortable living here.

My complaints are with health insurance premiums and the malpractice climate.

A typical family health insurance plan can run anywhere from what, 7 to 10 thousand dollars a year? If you have a group rate at work (lucky you) it is maybe $5-6,000? What do y'all pay for health insurance?

Just doesn't seem feasible for most people, no wonder there are so many uninsured. I don't know what the answer is, but I'd like to hear your thoughts. I think we are destined for expansion of our national health insurance to include everyone.

I pay about $3,000 a year for insurance. But I'm also single, and have a huge deductible of $2,500. Fortunately, I'm also tough as nails. :p I just keep the insurance in case something drastic happens to me. Oh and my company pays for it. :p

I guess first off, how difficult is it to undertake a significant reevaluation in the way medicare prices medical care?

Secondly, are medical techniques such as CT scans priced according to demand or just by cost of operation? Also, can individual treaments or procedures be subject to a rigorous cost-benefit analysis?

I don't know how to change Medicare, but doesn't seem like an easy thing.

After the CT scanner is paid for, the cost of hiring a tech to run it and do do the scans is not that much. The radiologist who reads the scan (takes less than a minute) makes several hundred dollars of course, which is as much or more than the physician who is caring for the patient over the course of an hour or longer (often several hours). The patient will get charged $1000 or so for the scan in addition to the "professional fee" by the radiologist, in addition to the hospital fee and the ER physician fee, and the consultants fee (if one is called in). If you get a spinal tap, there is a fee for that, plus the laboratory fees, plus the medications, IV fluids, IV tubing, etc. Then if you go home, you have to buy your prescriptions.

So if you come into the ER for a headache, it had better be a really bad headache, because when you get the bill, you will definitely have a worse one.

Point is, can we skip all that? Can you just see your doctor and get a shot, skip the scan and the ER visit, and go home? Are you willing to accept the 1/100 chance that you have an intracranial hemorrhage or meningitis and might die? What about 1/1000?

At what point can we limit the workup and expense and take some risk?

Right now, it doesn't matter what the odds are. I have been sued for a 1/1,000,000 occurrence that I recognized and treated appropriately, admitted the patient to ICU where he died the next day. He had no blood pressure on arrival to the ER, and was going to die anyway, but I settled the case for $30,000 because it was "less than the cost of defense" and took away the possibility of a big verdict. This is the medicolegal climate in America, and it is not right.

being a W-2 consultant i get no paid benefits(Sick, vacation, medical, dental, etc)i pay $10,000 OOP for medical insurance for a family of 5. the plan is terrible with $15 co-pay and the list of practitioners that use the plan are small compared to say US Healthcare which i used to have with a $5 co-pay. as of march 12th i will be unemployed with no medical insurance. my next job will be a permanent, full time job. i have had enough of consulting jobs.

I was waiting for this kind of thread to pop up...and I should have known Speed-ER-doc would have initiated another heated debate..

Coming from a medical family whom everyone BUT ME is in the medical field there is a HUGE problem that not only effects patients but its providers...My dad for instance every year has malpractice premiums increase because of stupid ass people that will sue for anything...MALPRACTICE INSURANCE is one of the leading if not THE leading cause to doctors increasing their pricing, but then again that's regulated to some extent due to the insurance companies and HMO's saying what will be paid based on what THEY think the pricing should be...it's all a bunch of $HIT....that's why I chose to stay out because even though everyone sits comfortably in my family financially it's still unbelievable how much is being ripped off from doctors everywhere...IF YOU THINK DOCTORS MAKE TO MUCH MONEY ANYWAY ...go cry somewhere else and go to school...everyone of the doctors in my family, except the ones in my generation which were fortunate enough their parents had the money to help out with Med School, were from POOR families and had to work and attend school or have their siblings help pay for college and med school...people crap on doctors all the time for them making the money they make and it just irks me to no end ...they busted their ass and had the dedication to go through all the schooling and they put up with all the long hours and at times not being able to spend quality time with family members and are shunned by whiny cry babies and politicians because of the amount of money THEY have to spend for health care when they don't understand the half of where the money has to go in the first place.

HELL no health care is not a RIGHT...it;s a GD PRIVELEDGE...I'll be DAMNED if i'm gonna pay more TAX so some LAZY ass person who rather sit at home, smoke crack, have more kids, drink all day, not care about furthering themselves in society can par-take in something that most of us have a significant chunk taken out of our paychecks to provide for us and our family.

I was a Wilderness EMT for a while in NC(kinda like what they did on CliffHanger without the hollywood BS) and the same applied there...no matter who it was, healthcare or none, we HAD to give medical attention. It bugged the hell outta me in clinicals when we had to ride around in the ambulance's and rescue drunks and shootings, i'm sorry i have no remorse for idiots that place others lifes in danger and those that either take their own life or someone elses but get "popped" themselves in the process...

Your right someone needs to stand up for healthcare but this time be on the PROVIDERS side ...not the damn HMO and INSURANCE political side.....

whew..i'm done...

Originally posted by XeRo
I was waiting for this kind of thread to pop up...and I should have known Speed-ER-doc would have initiated another heated debate..

Coming from a medical family whom everyone BUT ME is in the medical field there is a HUGE problem that not only effects patients but its providers...My dad for instance every year has malpractice premiums increase because of stupid ass people that will sue for anything...MALPRACTICE INSURANCE is one of the leading if not THE leading cause to doctors increasing their pricing, but then again that's regulated to some extent due to the insurance companies and HMO's saying what will be paid based on what THEY think the pricing should be...it's all a bunch of $HIT....that's why I chose to stay out because even though everyone sits comfortably in my family financially it's still unbelievable how much is being ripped off from doctors everywhere...IF YOU THINK DOCTORS MAKE TO MUCH MONEY ANYWAY ...go cry somewhere else and go to school...everyone of the doctors in my family, except the ones in my generation which were fortunate enough their parents had the money to help out with Med School, were from POOR families and had to work and attend school or have their siblings help pay for college and med school...people crap on doctors all the time for them making the money they make and it just irks me to no end ...they busted their ass and had the dedication to go through all the schooling and they put up with all the long hours and at times not being able to spend quality time with family members and are shunned by whiny cry babies and politicians because of the amount of money THEY have to spend for health care when they don't understand the half of where the money has to go in the first place.

HELL no health care is not a RIGHT...it;s a GD PRIVELEDGE...I'll be DAMNED if i'm gonna pay more TAX so some LAZY ass person who rather sit at home, smoke crack, have more kids, drink all day, not care about furthering themselves in society can par-take in something that most of us have a significant chunk taken out of our paychecks to provide for us and our family.

I was a Wilderness EMT for a while in NC(kinda like what they did on CliffHanger without the hollywood BS) and the same applied there...no matter who it was, healthcare or none, we HAD to give medical attention. It bugged the hell outta me in clinicals when we had to ride around in the ambulance's and rescue drunks and shootings, i'm sorry i have no remorse for idiots that place others lifes in danger and those that either take their own life or someone elses but get "popped" themselves in the process...

Your right someone needs to stand up for healthcare but this time be on the PROVIDERS side ...not the damn HMO and INSURANCE political side.....

whew..i'm done...

To be brutally honest with you, I don't think you exhibit the necessary intelligence required to become a doctor. Blaming all the problems with healthcare on lazy, crack-smoking, poor drunks with a bunch of kids sure makes life simpler, doesn't it? No offense.

I didn't blame it all on them..you obviously can't read...and I was accepted to med school at UAB..if necessary I can send you a copy of my acceptance letter back in 98 if you would like...I think you need to check yourself before flaming someone you haven't a clue who your talking about...I've done more things, been more places, academically and occupationally in a 15 year time span than you could possibly fathom in your total measily existence here...so back off and go flame someone else...

I do believe a system of "Loser Pays" should be instituted for malpractice lawsuits. Wherein the plaintiff bringing the lawsuit loses should be made to pay the defendants legal fees. I just don’t under stand how you can sue doctors, who in most cases have the best intentions to help and heal someone. More and more in the past 20 years in the US people feel they are entitled to a lawsuit settlement because their loved one could not be saved - not due to negligence from the MD.
My .02 ¢

You obviously can't write.

Your right someone needs to stand up for healthcare

Use "You're" instead of "Your".

Coming from a medical family whom everyone BUT ME is in the medical field there is a HUGE problem that not only effects patients but its providers

Use "affects" instead of "effects".

It bugged the hell outta me in clinicals when we had to ride around in the ambulance's and rescue

Plural form of the word "ambulance" will work here.

Anyways, I'm being a grammar nazi to illustrate my point.

HELL no health care is not a RIGHT...it;s a GD PRIVELEDGE...I'll be DAMNED if i'm gonna pay more TAX so some LAZY ass person who rather sit at home, smoke crack, have more kids, drink all day, not care about furthering themselves in society can par-take in something that most of us have a significant chunk taken out of our paychecks to provide for us and our family.

My sisters and I grew up on medicaid, but I'll be damned if my father was anything of what you said. Of course, "lazy crack-smoking, poor drunks" probably do exist, and maybe some of them even use medicaid, but not everyone fits the description. I'm sure I'm not the only "successful" medicaid case (maybe on this forum, but not in the country).

And nice work with the with this statement:

"I've done more things, been more places, academically and occupationally in a 15 year time span than you could possibly fathom in your total measily existence here...so back off and go flame someone else..."

Just goes to show you what being born in a rich family can do for you! Yea, that was probably uncalled for. But hey, you probably went to a nice college and paid for it all by yourself, right? It's too bad you didn't learn much in the way of grammar while you were there!

I'll stop with the flames, it's childish and we're straying off topic.

Originally posted by Knerk
I do believe a system of "Loser Pays" should be instituted for malpractice lawsuits. Wherein the plaintiff bringing the lawsuit loses should be made to pay the defendants legal fees.I totally agree. When the plaintiff stands to lose nothing, and doesn't even have to pay his own legal fees if he loses, in exchange for a share of the booty if he wins, the system is all too enticing to folks looking for a quick buck.

good....because this is an internet forum and i'm not writing dissertations, functional specification documents or SLA's...i don't care about my "grammar" here..and yes I was born into a privedged childhood, but I also was taught responsibilty and things do not come for free..I attended an "ok" college (Auburn University) and YES I PAID for the majority of it myself..my parents were on the kick that I would perform better if it was my own money that was paying for schooling...

Speed-ER doc...sorry for the temporary tangent ...people seem to like to flame those they do not know alot here...and for some reason, I guess I virtually have a red target on me...oh well sorry..

Originally posted by Knerk
I do believe a system of "Loser Pays" should be instituted for malpractice lawsuits. Wherein the plaintiff bringing the lawsuit loses should be made to pay the defendants legal fees. I just don’t under stand how you can sue doctors, who in most cases have the best intentions to help and heal someone. More and more in the past 20 years in the US people feel they are entitled to a lawsuit settlement because their loved one could not be saved - not due to negligence from the MD.
My .02 ¢

I somewhat agree with you. But I think if we implemented what you suggest, it alienates the poor and defeats the purpose of providing medical care, regardless of the patient's ability to pay. Not all doctors are in it to save lives, some are in it for the money and prestige, as Aratinga pointed out. Xero also brought up good points about how his family worked their butts off to go through medical school. Does the government provide any kind of aid to students in medical schools? If not, wouldn't providing aid help the situation? Might not be a bad investment for the government. Provide aid now, and then med student spends the rest of his life paying it back in the form of taxes. Doctors typically pay more taxes, right? Those that pursued a career in medicine would do so knowing that malpractice lawsuits come with the territory. Not the most eloquent solution, but....

Originally posted by Winning_BlueRX8
I pay about $3,000 a year for insurance. But I'm also single, and have a huge deductible of $2,500. Fortunately, I'm also tough as nails. :p I just keep the insurance in case something drastic happens to me. Oh and my company pays for it. :p
Doesn't that seem like a lot for a healthy 26 year old? When I was 26, it would have. When you add a family, it goes up quite a bit, too. And it only seems to be getting worse, especially the last 2 years.

Originally posted by Speed-ER doc
A typical family health insurance plan can run anywhere from what, 7 to 10 thousand dollars a year? If you have a group rate at work (lucky you) it is maybe $5-6,000?By comparison, top level private hospital cover with dental, vision, physio, etc, costs around AU$3000-3500 for a family down under. That's about $2500 USD. Add in the 1.5% medicare levy on the average Australian wage of approximately AU$50,000, and you're looking at a total of around AU$4000 (US$3000) per year for "the works."

(Quotes from http://www.medibank.com.au/, if anyone's interested.)

Originally posted by XeRo
...people seem to like to flame those they do not know alot here...and for some reason, I guess I virtually have a red target on me...oh well sorry..

I didn't start off with a flame. If you're going to use poor wording to illustrate a point, so am I. I'm not referring to your grammar, I'm referring to this:

"HELL no health care is not a RIGHT...it;s a GD PRIVELEDGE...I'll be DAMNED if i'm gonna pay more TAX so some LAZY ass person who rather sit at home, smoke crack, have more kids, drink all day, not care about furthering themselves in society can par-take in something that most of us have a significant chunk taken out of our paychecks to provide for us and our family."

Not the most sensitive way to approach the subject, is it? It didn't strike me as something a potential doctor would say, so I commented on it.

Originally posted by Speed-ER doc
Doesn't that seem like a lot for a healthy 26 year old? When I was 26, it would have. When you add a family, it goes up quite a bit, too. And it only seems to be getting worse, especially the last 2 years.

I'm actually 22 (I'm a privacy freak, and I hate spam, so I lie in all my Internet profiles). I really don't know if that's high or not, I've never really had health insurance before. But like I said, my company pays for most of it. We get "benefit dollars", so I end up paying about $8 a week for medical, dental, and vision coverage, and the company pays the rest. Tommorow will be the first time I use the insurance.

Winning_BlueRX8

I know it can’t be as cut & dry as I said, but I think a variation of "Loser Pays" would discourage the more frivols suits that logjams the courts and costs society of as a whole. If a doctor was obviously negligent then a lawsuit should be brought up against them. As you said some doctors are in it for money & prestige, but I think to obtain those they will have to save lives and heal people. Not a bad byproduct from someone with that much drive and ambition, even though they might be doing it for selfish reasons.


Hey Doc question, I have heard the argument that the USA has the best medical care and advancements because of current system. That’s why people from countries with state sponsored health care come here for treatment. Do you agree with that?

I too work in the medical industry and deal with insurance billing on a day to day basis. The primary problem I see with the system is that Insurance companies not only decide "medical necessity" but also have the authority to tell the provider of medical service that they CANNOT BILL THE PATIENT if they "decide" that something is not medically necessary.

I give a $1,400 knee brace to someone who has just had reconstructinve surgery and has a PRESCRIPTION from their DR. We bill in good faith with the insurance company who after waiting 45 days, and asking for medical records from birth to present, decides that the brace is not necessary. Then what happens next is criminal. The insurance company sends an explanation of benefits to us and to the patient describing how the $1,400 brace was denied for medical necessity. AND guess what? I even had the brace PRE-CERTIFIED. Not only are they not going to cover the brace, but they tell me that the patient does not have to pay for it either. What other business is like this? That's equivalent to me going in to Best Buy picking out a HDTV and walking out with it never to pay a penny. How could Best Buy stay in business like this? Insurance companies should not be able to determine necessity.

Ok...I've vented....I feel better.....well.......not really :mad:

I could discuss insurance all day

THE GOOD: I pay nothing out of pocket for my medical insurance for just li'l ol' single me, and the plan's a pretty good one -- Blue Shield PPO, $250 annual deductible, 90% coverage on all prescriptions (no formulary), and vision and dental coverage as well. One of the benefits of a teaching career is, in fact, the benefits.

THE BAD: I'm a teacher. I'll never come close to making a six-figure income, even with a Ph.D. and 20 years on the job.

THE UGLY: My days of paying nothing for my coverage are numbered. Medical insurance rates are increasing nearly as fast as California real estate prices (20% per year or more) and our school district is talking making us start paying more for less coverage. I'm looking at having to cough up a premium (yet to be determined) for a plan that now has double the deductible and limited formulary of drugs that will be covered.

We're all paying the price for a health care system that has gone horribly out of whack. Doctors are paying obscene premiums for malpractice insurance, and patients are paying more and more for their medical insurance.

Gee. The word in common to both is insurance. Maybe we should make all insurance companies NON-PROFIT corporations and see what happens....

Originally posted by Knerk
Winning_BlueRX8

I know it can’t be as cut & dry as I said, but I think thank a variation of "Loser Pays" would discourage the more frivols suits that logjams the courts and costs society of as a whole. If a doctor was obviously negligent then a lawsuit should be brought up against them. As you said some are Doctors are in it for money & prestige, but I think to obtain those they will have to save lives and heal people. Not a bad byproduct from someone with that much drive and ambition, even though they might be doing it for selfish reasons.

Not a bad byproduct at all. But what I meant by that, was a selfish doctor might not provide the best of care to someone who could not afford to pay if he was released of all liability. And like you said, it isn't cut and dry, so who determines whether or not the doctor was negligent? It's usually the courts, and unfortunately, the doctor foots the bill. What I was suggesting was that the government provide more assistance to med students (a wise investment in my book), and med students acknolwedge the fact that they are going into a field where malpractice lawsuits are common. Or we can approach it differently by providing some kind of relief in court costs for doctors. Basically, what I'm saying is the malpractice lawsuits keep doctors in check. It's kind of a shoddy setup, but it's also the lesser of evils.

being someone who's live in many countries and visit other frequently for business (i'm a wine maker) I'd say the state of healthcare in this country is horrible. With the money going to private healthcare industries, if those funds were channeled to a public healthcare system, there shouldn't be any reason why Americans can't enjoy the same level of healthcare as Europe, Canada, etc etc. but the healthcare industry has a strangle hold on american politics so I doubt public healthcare is going to happen anytime soon in this country. some americans are even brainwashed into thinking that public healthcare is somehow socialist :P
hopefully soon, there will be that big overhall of the healthcare system as was promised back since the founding of this otherwise beautiful country.

P. J. O'Rourke said it best:

"If you think health care is expensive now, wait until you see what it costs when it's free."

I agree malpractice lawsuits keep them in check. My point is there is very little that keeping the lawsuits in check. Back a 100 years ago some of the most important a profound medical discoveries were made, and many patients died at the medical communities intellectually benefited and from there society as a whole. Such quantum leaps we made in such a short time because of the lack of restrictions. But with today’s current mess the malpractice sword hanging over their proverbial head is hamstringing the doctors making new innovations. And because of this it will also cause doctors who are selfish not to help someone not because of the patient being unable pay, but due to the fact if something goes wrong he may loose all he/she has worked for, if any thing it encourages sub-par treatment. I believe it’s the reason that that some professionals are so guarded about helping. I would be to if over eight years of education went down the can just because there no sure things on this planet.

I never did answer your questions, doc! Sorry.

Should we provide medical care for free, and if so, should it be the same LEVEL of medical care; that is, should indigent patients expect CT scans, subspecialty consultation, and expensive medications, or should there be a "lower level" of care?

Ideally, basic medical care should be available at no charge to all citizens, legal residents, and legal visitors. The only way you can justify offering a lower level of care to indigent patients (defined: uninsured or otherwise unable to pay) is if you're willing to admit that an indigent person's life is potentially less valuable than the life of a person who has the means to pay. Where do you draw the line as to which procedures would and would not be available to the indigent? Would more expensive tests, surgeries, etc. be reserved only for those who can pay for them, even if they can be justified in the treatment of the illness/injury?

Would you send an uninsured construction worker with a spiral fracture of the femur out of the ER with a cast and crutches and tylenol when an elderly retired man with good insurance and the same injury gets orthopedic surgery?

What about preventive care? This, at the very least, should be free to everyone. But where do we draw the line here? Do all poor women over 40 get annual mammograms, or just breast palpation? Does everyone over fifty get regular colonoscopy, or flex sig, or just an occult blood test?

Hillary, where are you? We need you!! ;)

question #2 - would you be willing to accept a lower level of medical care for lower insurance premiums?

No. Risking my health isn't worth saving a few bucks. I want access to the best care available.

Originally posted by Knerk
I agree malpractice lawsuits keep them in check. My point is there is very little that keeping the lawsuits in check. Back a 100 years ago some of the most important a profound medical discoveries were made, and many patients died at the medical communities intellectually benefited and from there society as a whole. Such quantum leaps we made in such a short time because of the lack of restrictions. But with today’s current mess the malpractice sword hanging over their proverbial head is hamstringing the doctors making new innovations. And because of this it will also cause doctors who are selfish not to help someone not because of the patient being unable pay, but due to the fact if something goes wrong he may loose all he/she has worked for, if any thing it encourages sub-par treatment. I believe it’s the reason that that some professionals are so guarded about helping. I would be to if over eight years of education went down the can just because there no sure things on this planet.

I don't know how you can keep the malpractice lawsuits in check, which is why I said "lesser of two evils". Only thing that comes to mind is to limit the award amounts of medical malpractice lawsuits, but then we're faced with only limited liability. And then how do we put a price tag on life, or "mental anguish", etc. It's all whacked out, and I don't know if a healthcare system where everyone is happy will ever exist. The system has to work in someone's favor, and right now it seems to be a toss up between insurance companies, and the poor man.

Originally posted by Winning_BlueRX8
I don't know how you can keep the malpractice lawsuits in check, which is why I said "lesser of two evils". Only thing that comes to mind is to limit the award amounts of medical malpractice lawsuits, but then we're faced with only limited liability. And then how do we put a price tag on life, or "mental anguish", etc. It's all whacked out, and I don't know if a healthcare system where everyone is happy will ever exist. The system has to work in someone's favor, and right now it seems to be a toss up between insurance companies, and the poor man.



What if the there were still no limits on settlments but a person suing received 30% of the settlement while while the other 70% was given to a court sanctioned charity of their choice? That way many people benifit instead of one.

Folks would claim the 70% as a deductable donation on their tax return. :p

Yea really! :) - Im sure that there would have to be a provision against it for any thing like that to work. Im sure any lawyers involved would try to take their cut before any settlement was broken up.

Religion has the answer to the malpractice debate!

Let him who is without sin among you cast the first stone. -- Jesus of Nazareth

Make all potential plaintiffs in malpractice suits prove that they, unlike all other human beings including doctors, have never made an honest mistake.

Of course, the attorneys know that they can still extract settlements from doctors (or more precisely, the doctors' insurance companies) by threatening to sue over issues that aren't even remotely the doctor's fault. When paying off a groundless claim is cheaper and less painful than defending oneself, something is wrong.

The loser of the suit should absolutely be obligated to pay the legal costs for ALL parties involved.

Originally posted by Aratinga
Religion has the answer to the malpractice debate!

Let him who is without sin among you cast the first stone. -- Jesus of Nazareth

Make all potential plaintiffs in malpractice suits prove that they, unlike all other human beings including doctors, have never made an honest mistake.

Of course, the attorneys know that they can still extract settlements from doctors (or more precisely, the doctors' insurance companies) by threatening to sue over issues that aren't even remotely the doctor's fault. When paying off a groundless claim is cheaper and less painful than defending oneself, something is wrong.

The loser of the suit should absolutely be obligated to pay the legal costs for ALL parties involved.

Playing Devil's Advocate....

Does the prosecutor pay before, or after? If it is before, this works against the poor man, and middle class for that matter. If it is after, it actually hurts the situation by driving up the award amounts. If you're going to sue, you want to come out ahead, so you seek awards that will cover the court costs, and then some. It may discourage middle class workers from suing, but I don't think it would discourage the poor man. After all, if you're broke, you're broke. "Just put it on my tab, Your Honor".

I stayed out of this as long as I could, but I guess it is time to give you the lawyers position

1) loser pays does not work, because it puts all the power in the hands of the insurance co. They really do not care what they have to pay, their profits are in the billions! meanwhile, a poor person with a good cliam may well balk at the chance of being put in more debt...lets face it if a doc screwed up thier treatment they are no doubt in bad shape. under the normal contingency fee, the lawyer bears all the risk, often tens of thousands of dollers in costs alone!

2) A six week study by USATODAY found that most physicians are minimally affected, with premiums rising at the same rate as other health care costs.

3) Caps do not work, why? because pain and suffering awards are not going up, it is the cost of economic damages, like future medical bills and lost wages that have jumped 15%-20% per year.....because the insurance industry keeps jerking rates up!

Remeber that a plan to cap damages is a sop to the insurance industrie, increasingly generous financial backers of the republican party....

Anyone who wants can find out much more in the march 5, 2003 issue of USA TODAY..including the average pctg of revenue various medical specialties pay for mal insurance..for example..the national average income of a cardiologist in the US is $362,209. They pay about 1.5% of that in insurance...

Bottom line..DO NOT BE SNOWED BY THE INSURANCE COMPANYS!

Originally posted by Knerk
Hey Doc question, I have heard the argument that the USA has the most best medical care and advancements because of current system. That’s why people from countries with state sponsored health care come here for treatment. Do you agree with that?
We have the best training, the best equipment, the best facilities, and the best doctors in the world. Physicians from other countries dream about coming here for additional training, because when they go back home (if they do) they are superstars. Wealthy people from many countries (Middle East, South America, Mexico) come here for treatment. They pay cash, and stay in the poshest rooms in the hospital. Nurses on these floors are allowed to accept tips from their patients (don't want to offend their culture).

Insurance companies generally are awful about paying their bills. Even if the bill is approved, they often take months to pay, with no interest.

Lawyers generally get 30% or more of the settlement off the top.

We already have a tiered medical system to some degree, with the "county" hospitals which subsidize medical care for indigent patients, even covering many of their prescriptions (if they go to one of the designated hospitals). If they go to a private hospital, they still have to be seen, and the patient cannot be transferred to a county hospital just because they cannot pay.
Indigent preventive and primary care is also provided by the county. The middle class is on their own. Even the state prison inmates get better care than the middle class, although it by no means is perfect.

The problem with "low level" care is that it usually takes much longer than it should. Inmates and county patients for example usually wait longer just to be seen, and wait longer for surgeries.
It would take a big investment to beef up the system for more people to get this type of care, and many would be unsatisfied.

More about malpractice reform later.

Klegg
Do you think the system is fine the way it is?

I agree with you klegg. "Loser pays" is not fair, and caps do not help much.

Physicians are affected by malpractice premiums less than patients. For example, there aren't many Obstetricians in the valley (South Texas) who will deliver babies because of the high rate of lawsuits down there, and the high malpractice premiums. Mississippi has the same problem, and I think West Virginia and Florida too. Neurosurgeons are hard to find in those areas as well.

Patients lose, and so we all do. The lack of prenatal care means more complications, and more clogging of the ERs.

Originally posted by klegg
the national average income of a cardiologist in the US is $362,209. They pay about 1.5% of that in insurance...
I think you mean 15%, but some of them pay closer to 30%.

Originally posted by Knerk
Klegg
Do you think the system is fine the way it is?

No, it needs some work, and it should began with isnsurance company profits CAPPED at no more then 5% a year..

not understanding all the interworkings of the American system, i still can comment on statistical data that i've seen (it was less than a year old, when i saw it a year ago) comparing both the Canadian national healthcare system, and the American system.

in Canada, we have more hospital beds per person, stays in hospital (which can be equated to amount of care) are longer, and number of doctors visits per person are also higher (as you'd expect from a system such as ours).

on the other hand, our waiting lists are longer, doctor and nurse pay is "slightly" lower (it's still a damned good living), and our equipment is... next-to the best (new machines are less frequently purchased, and special machinery is usually purchased from American hospitals used), although we do not have a shortage of it.

the biggest difference (which i'll direct at Maniac's comment) is cost. people here are not stupid, nor abusive, nor ignorant to the fact that we do actually pay for this "free" healthcare through taxation. it is actually cheaper, per visit, or per hour of hospital stay, or however else you'd like to determine rate of care, because of one huge advantage a consolidated, national system has: low beaurocracy. we don't have forms to fill out in triplicate, we have a "CareCard", which has all of our personal information on it. whereever we are in Canada, with that card, we have universal coverage of "basic" medical care (meaning, health services... things like medication or devices for use outside the care environment are not "basic"). this eliminates an unbelievable amount of work dealing with insurance and payment, is is the largest advantage our system has over yours.

for everyone who thinks that nothing but the absolute greatest amount of care you can get is the minimum, i'll just have to smile and say "i sincerely think you're a little confused on the issue", and leave it at that.

for my personal convictions, i really do believe that in a society, as a civilized nation of rational individuals, we ought to be able to see the benefit in working together (ie, covering each other's asses) for necessary things, like health.

Originally posted by klegg
No, it needs some work, and it should began with isnsurance company profits CAPPED at no more then 5% a year..

won't work. insurance companies are not evil, and in a competitive environment are always trying to produce as close to actuarily fair coverage as possible (of course, adjusters like all other people make mistakes, and statistics aren't very good at predicting the future in an exact way).

the other thing is that you can in no way try to cap a company's profits artificially like that (you can't track accurately how much money they "make"... book cooking doesn't need a cook book, just a dishonest and very clever auditing firm). the only way to do it is to institute a taxation system (oh no!! progressive economics!! run!! in terror!! :eek: ) which would make it beneficial for these companies to invest in efforts to reduce risk (thus reducing premiums, costs, and increasing profits) in the areas they're insuring.

don't ask me how, i'm a drop-out :p but it doens't take a genius to see that you cannot artificially affix a ceiling to profits in a competitive environment and expect the market to work.

Originally posted by wakeech
won't work. insurance companies are not evil, .

You are wrong, they are....you have got to see what my clients go through, and the fights I have to get past thier mantra" we collect money, we DON'T pay cliams.."

of course people have to prove to them that their claim is legitimate: do you know how much fraud costs not just these companies, but the economy in general (because of the lost capital)??

of course i don't have a specific figure for you, but it's huge... hundreds of millions. edit: i was thinking in Canada-sized economics... wouldn't surprise me if it was billions upon billions

btw, why would you complain if insurance companies want lawyers to twist their arms to pay out?? ;)

Originally posted by Speed-ER doc
I think you mean 15%, but some of them pay closer to 30%.

No he's right, the survey by Medical Economics found that on average, OB-GYN's paid the largest percentage of their revenue for malpractice insurance - 6.7% - and cardiologists the smallest percentage - 1.5%.
Such statistics, however, are extraordinarily misleading, and I have to doubt their accuracy. This needs to be looked at on a state by state basis. In certain states, such as Florida, Pennsylvania, and New Jersey, there is a crisis and the rates are extraordinarily higher than in other states. As an indicator of how different it is state to state, many physicians are leaving Pennsylvania to practice in Florida, while Florida physicians are fleeing Florida for states like California. Florida malpractice rates increased 400% from 2000 to 2002. Annual rates for OB-GYN's are routinely $50,000 a year, and for neurosurgeons $100,000 a year. This is not about doctors no longer getting rich - it's about doctors being able to survive in their careers.
This is a complicated issue, where health insurance rates, malpractice rulings, trial lawyers, and the stock market are all entangled, among other things.

Originally posted by noahprtlnd
rates for OB-GYN's are routinely $50,000 a year, and for neurosurgeons $100,000 a year. This is not about doctors no longer getting rich - it's about doctors being able to survive in their careers.
This is a complicated issue, where health insurance rates, malpractice rulings, trial lawyers, and the stock market are all entangled, among other things.

Yea, I think misleading is an understatement. I don't know of any obstitricians pulling $746,268 a year. And neurosurgeons paying $100,000 a year? Salary.com says the national average for neurosurgeons is about $250,000 a year. And if they're paying 40% for malpractice insurance, and about 20-30% to taxes, that leaves them with take home pay of about $75,500. BS.

Originally posted by Winning_BlueRX8
Yea, I think misleading is an understatement. I don't know of any obstitricians pulling $746,268 a year. And neurosurgeons paying $100,000 a year? Salary.com says the national average for neurosurgeons is about $250,000 a year. And if they're paying 40% for malpractice insurance, and about 20-30% to taxes, that leaves them with take home pay of about $75,500. BS.

Absolutely, I have no idea where those figures in the USA Today article came from. It says Medical Economics but those cannot be correct. Regardless, that whole article is heavily skewed towards one side of the argument. (Siding with the lawyers)

Medical Economics is a joke, throwaway journal.

Some OB-Gyns in Florida are paying 200K for insurance, and the average is close to 100K. Most of us in "risky" specialties pay at least 15% for malpractice insurance. 35% of my collections go to malpractice and "overhead" (collections, administration, etc).

Here are Harris County rates (Houston):

http://www.tdi.state.tx.us/general/pdf/jua_harris.pdf

Here is a fantastic article addressing the problem:

http://www.policyalmanac.org/health/archive/medical_malpractice.shtml

Excerpt:
... the only hospital in a rural county in Pennsylvania no longer has full orthopedic on-call surgery coverage in its emergency room (ER) because three of its five orthopedic surgeons left in the spring of 2002, largely in response to the high cost of malpractice insurance. Similarly, pregnant women in rural central Mississippi must now travel about 65 miles to the nearest hospital obstetrics ward to deliver because family practitioners at the local hospital, faced with rising malpractice insurance premiums, stopped providing obstetrics services.

Easy on the specialists-particulary the cardiologists.

4 years of college, 4 years of medical school, 3 years of general internal medicine training(brutal), and 3-4 more years of cardiology subspecialty training. Add to the long hours of training $ 200,000 + in student loans accumulated over the years.

Not complaining about my chosen career or income potential(2 more years of training left), but the reality is physicians make tremendous personal, family(2 young children I haven't seen much in the past 5 years) and financial sacrifices during the prime years of their lives. Most other professions reward hard work/dedication/specialized knowledge with increased levels of compensation, should medicine be treated that differently?

Hmmmm way to drunk now and busy at work to get into this.. But you'll hear my opinion when I'm sober! By Cracky!!

RotaryStalker

Medical service should be provided to anyone who needs it, free of charge. It's the humanity of it. And, everyone should get excellent care, nomatter who they are. After all, now that it's free, why not? Inalienable rights given to all the people, who are born with an equal amount of "brain damage" (Bill Cosby).

Of course, this is so pie-in-the-sky... well, you asked... who knows if / when that may happen.

But, like you said when you were a kid, why should somebody have to pay to fix an ouchie? Man, that's double bad! No fair!

I only jump into this mostly-American debate to add my voice to the chorus of “aliens” who live in societies that long ago settled the debate on the merits of universal health care. It is as strange for us to hear the question posed as it is to hear the debates on gay-marriage or capital punishment currently going on in the US. I do not resent nor complain about my 50%+ marginal income tax rate as it is the price of living in a country that aspires to be a “just society”. It was a former prime minister, Pierre Trudeau who said over thirty years ago:

"To seek the Just Society must be amongst the highest of human purposes. Because we are mortal and imperfect, it is a task we will never finish; no government or society ever will. But from our honest and ceaseless effort, we will draw strength and inspiration; we will discover new and better values. On the never-ending road to perfect justice we will, in other words, succeed in creating the most humane and compassionate society possible."

For Canadians at least, this principle is mostly shared and guides what must appear from south of the border as policies and practices that are perilously close those of communism.

Note that I am not stating that our system is better. It comes from a different set of guiding principals

This is one of my favorite topics.

Medical care is one of those services that just doesn't respond to normal supply and demand economics, but we Americans are so enamored with our system of capitalism that we seem hell-bent on making it fit. I think it's more like military service. Left to the individual none of us would buy enough military service to protect the country, so it's an area where the Federal government has to step in.

Here are some specific areas where Adam Smith fails us in medical economics:

Emergency care: Nobody with serious and urgent medical needs negotiates and researches the best prices and the best care. You go wherever the ambulance takes you and you worry about the bill later. That actually happened to me in Northern California and they took me to that notorious Tenet Healthcare hospital in Redding. They have a culture of bill padding there that is beyond belief. Since my insurance had no contract with these guys there was no market-driven incentive to provide reasonably priced services. I still churn over the $680 plastic donut that Savons sells for $28 (Aetna paid, no questions asked).

Insurance availability: So a guy works for a good chunk of his life, gets middle aged, a few body parts starts to fail, and then he hits a rough patch on the job market. After Cobra runs out, GOOD LUCK in finding health insurance. If you do find it, whatever ails you already ain't covered, yet that's where your insurance needs are the greatest. Insurance companies can offer the lowest insurance prices to statistically healthy people by systematically weeding out those that are problematic. I don't blame them, that's just the system. The only way to make sure that everybody has insurance access is to require everybody to belong to the same basic system to eliminate the cherry-picking. You can still pay extra for a premium service if you want.

Economy of scale: Along with losing access to medical insurance, an uninsured patient with a few dollars left pays the highest rates for medical care. He has no negotiating power. He will be stuck with more $680 donuts than anybody else with an insurance company with negotiated rates. A guy on his own needs the government because there is no way else for him to get negotiating clout.

Medicines: The incentive to buy affordable medicines from Canada instead of the US is a glaring consequence of a failed system. No other country on earth allows individual or relatively small groups to negotiate medicine prices with the pharmaceutical companies. The reason why Canadian, or English, or French, or German medicines are cheaper is because they negotiate with the clout of the whole nation behind them. The country of Canada has more clout than I do, therefore they pay less. I get to pay for all this R&D that makes all these wonderful new medicines, while the rest of the world gets to pay just the manufacturing costs. Such a sweet deal. This is where Washington needs to come in, to make sure I have access to the same deal the rest of the world does. Gee, does that make me a socialist? Nah, just a guy who's tired of being a chump.

Managed health care: Much is made of the fact that there are long waits for services in countries with socialized medicine, that it's run by uncaring bureaucrats who couldn’t care less if you live or die. Well, I think that’s better than a system that is financially incented IF YOU DO DIE!!!! Think about it: A lady with breast cancer costs an insurance company less over her life time if she dies quickly and gets it over with, than if she receives expensive care, gets cured once, is treated for chronic side-effects, has a recurrence 3 years later, fights it for a couple of years, and dies an ugly death. Sorry for being graphic, but I’ve seen this. Doing battle with HMOs to get quality care at a time when you are least emotionally and physically equipped to do battle is an outrage. I have seen enough of these stories among my friends and relations to know that it’s not isolated, it happens all the time. The stonewalling, the bureaucracy, the obfuscation, it’s all built into the system in spades. I don’t need CEOs with 8 digit compensation packages figuring out new and more clever ways to deny me care to improve his stock option value. Government bureaucrats are bargains in comparison, and aren’t actively out to kill us.

Originally posted by wakeech
for everyone who thinks that nothing but the absolute greatest amount of care you can get is the minimum, i'll just have to smile and say "i sincerely think you're a little confused on the issue", and leave it at that.
Nice post, I was hoping for some Canadian input. It will take a monumental shift in ideology for Americans to settle for less than perfection. If something bad happens to a person here, it is always someone else's fault. If your kid is obese, sue McDonald's. If your kid is a slow learner, sue the Obstetrician, it must have been a problem with the delivery. If you smoke 2 packs a day for 50 years and get lung cancer, sue Phillip Morris, or the doctor who finds your cancer (he must not have found it soon enough).

Until that attitude changes, health care costs will continue to be unreasonable no matter what system we have. I think the idea of providing basic health care for everyone, supported by taxation somehow (yes, I said that) is inevitable. However, a change in priorities is also likely. Is everyone entitled to the most expensive treatments available, like various organ transplants, dialysis or heart bypass surgery for 80 year olds, aggressive treatment of ultra-premature infants? These are hard questions that must be answered.

edit: Bernie, you made some good points too, I'm glad we finally agree on something! :)

Originally posted by bernieunger
Managed health care: Much is made of the fact that there are long waits for services in countries with socialized medicine, that it's run by uncaring bureaucrats who couldn’t care less if you live or die. Well, I think that’s better than a system that is financially incented IF YOU DO DIE!!!! .... Government bureaucrats are bargains in comparison, and aren’t actively out to kill us.
Yeah, I was just thinking about this...the ONLY system that does not feature a financial incentive for you to die early rather than utilize a lot of resources is cash accrual, self-pay. If anyone else is footing any of the bill, you are costing them money.

The difference is, who is getting the incentive. In a capitated HMO, either the primary care physician or the executives in the company have the incentive to limit care. If someone is potentially getting a bonus because they saved the company money, they are less likely to approve controversial or expensive treatments, or drag out the approval process so you can die first. In a national system, there MIGHT be less incentive to limit care, although I probably am being naive again.

This is the ultimate manifestation of tiered care - you get what you pay for.

Here's the question. Are insurance companies getting value for money, or do the hospitals see health insurance patients as nothing more than a nice little earner?

Normally, if you are suddenly taken ill and have to be admitted to hospital, which hospital is not as important as the quality of treatment you'll receive. But with so many people now covered by private health insurance, choosing where to be treated is assuming far more importance.

This has resulted in several hospitals opting to promote themselves and their range of medical and surgical services, the type of equipment used and the qualifications of their staff, in the same way as many day to day commodities.

Every private hospital of note has its own promotions or public relations executive - several employ professional advertising agencies to promote their facilities - and all are quick to point out which health insurance policies they accept, leading to suspicions of connivance between individual hospitals and insurance companies.

It's fortunate that the situation in this part of the world has not reached the level of the United States, where on many occasions, medical treatment has been refused because the patient does not carry medical insurance. However, the danger signs are starting to show in Dubai.

There are recorded cases of a patient being admitted to a hospital as an emergency case, and later being transferred to another private hospital by ambulance - still in a serious condition - because the first hospital doesn't have an agreement with the patient's insurance company.

Insurance companies are as much to blame as the hospitals for the current situation. A number of policies actually state which hospitals are prepared to accept a patient insured by the company, adding the proviso that if the insured is treated elsewhere, the terms of the policy could be void.

In other parts of the world, insurance companies have gone even further and built their own hospitals!

The type of medical treatment available at different private hospitals is not very different. Most have the same equipment; treat patients within similar areas of speciality and staff have identical qualifications.

The main differences are in the experience of the hospital staff, or more correctly, where that experience has been gained. It's often believed that surgeons, specialists, doctors and nurses who've been trained and gained experience in European or North American hospitals and clinics, provide a superior treatment than those with the same qualifications who've previously been employed in hospitals in the sub Continent.

Nothing could be further from the truth. Any medical specialist with up-to-date qualifications, using the same state-of-the-art medical technology, can perform the same treatment, irrespective of where experience has been gained.

The difference is that the hospital employing Western experienced staff normally charges more than one in which staff previously worked in the sub-Continent, Asia or Eastern Europe.

As local private hospitals continue to vie with each other for patients, it's interesting to compare how two different hospitals (which shall remain nameless) promote themselves.
The brochure of one begins by proudly stating how many "spacious and luxurious private rooms" it contains. Many would probably prefer to be treated in another, which starts by listing the extent of its operating rooms - four, "extensively equipped."

The promotion goes further, with one boasting that many of its senior medical staff have come from some of the largest hospitals in the US and all staff members are familiar with American standards of healthcare. The other tells prospective patients that the hospital is managed by a handpicked team of internationally qualified and experienced healthcare professionals.

When it comes down to the cost of treatment, private hospitals appear to have everything worked out, down to the cost for the last bandage. The charges for various treatments are listed in a similar way to a supermarket's checkout list.

At one, for example, a cardiac test would involve X-ray, ECG and other electronic investigations, various complex laboratory tests, discussions with a consultant and a final written report of the examination findings. The price for this (the hospital describes it as a "package"), is 2,500 dirhams. A check for diabetes costs 1,500 dirhams, while charges for having a baby are also listed. There's an "antenatal package" for 3,500 dirhams, while the "delivery package" can add another 9,750 dirhams, depending on the type of delivery. In addition, patients are warned, "prices are subject to change without prior notice."

Are we really talking about caring for people in hospital, perhaps even saving their life, or a commercial commodity?

Because of continuing advances in medical technology, illnesses that were considered incurable a decade ago are now being successfully treated, prolonging life and improving the quality of life for thousands of people. But new treatments require the use of new technology. Many of the life-saving medical machines now available cost hundreds of thousands of dollars, plus the price involved in training staff in the use of the technology. Because of this, the cost of health care continues to rise, often at a frightening pace.

This is one of the main reasons for the upsurge in private hospitals - because insurance companies, earning revenue from policyholders, are the only organisations able to meet the cost of treatment. To expect an individual to pay what could sometimes amount to tens of thousands of dirhams would be unrealistic.

The current annual budget for health care in the UAE is 1.3 billion dirhams, but the government is aware that to ensure that public health services continue to improve, new equipment has to be purchased which will mean that budget has to be increased.

According to Abdul Ameri, the Director of Hospitals and the Ministry of Health, total healthcare spending has increased by 12% over the past seven years. In order to keep any increase in the future to a reasonable level, he believes there should be more cooperation between government medical facilities and private sector hospitals and medical centres.

the United States as an example of the significance of health care in a nation's economy. There, expenditure on health care is 14% of GNP, or more than one trillion dollars.

As well as increased cooperation between government and private medical institutions, the role played by insurance companies needs to be examined.

Do they provide sufficient cover for policyholders? Are the premium levels set at the right level? Do the premiums accurately reflect the type and quality of treatment given and, perhaps most importantly of all, are patients receiving the best possible care in private hospitals here, considering the amount paid to the insurance companies by way of annual premiums?

The quality and effectiveness of its education and medical systems often measure a country's worth.

Originally posted by Aratinga
There is something terribly wrong with health care in the USA on many levels. Patients without insurance can incur bills that will put them in debt for life, physicians have to accept less and less from medical insurance payments while paying more and more in malpractice premiums, and there is definitely a tiered system already in place -- I can get access to my doctor a lot quicker than a Medical (California's plan for indigents) patient can. Emergency trauma centers in LA are being shut down because they hemorrhage money as much as blood; hospitals can't afford to keep them open because so many people treated there have no ability to pay.

I look at a nationalized system like Australia's or Canada's and I think we ought to have something like that in place here as a minimum baseline standard of care.

Ahh, but doc... what is an Australian or Canadian physician's income compared to yours? Do physicians practicing there have the opportunity to earn the equivalent of multiple hundreds of thousands of dollars per year, especially in the more lucrative specialties?

Many of the students in my classes plan careers in medicine, but what lures them isn't necessarily the altruistic desire to help people... it's the income and prestige of being a doctor.

It seems to me that we have the very best medical care available in the world right here in the USA -- if you can afford it. You get what you pay for... unless you're a set of conjoined twins born to a dirt poor family in a third world country. THEN it's free.

Socialized medicine is the bugaboo conservatives love to dredge up whenever anyone makes a healthcare proposal not written by the insurance industry. "Long lines!" they cry. "Bureaucrats! You'll die waiting for heart surgery!" More often than not, it works. Hilary Clinton's proposals to reform healthcare went nowhere in 1993. Modest attempts to ensure quality medical care for all citizens are drowned out by conservatives hailing them as the second coming of communism.

Conservatives insist that healthcare is a commodity. It should not be overregulated, they say, and competition will ensure it is distributed fairly. They point out that the government doesn't buy its citizens cars (a favorite analogy when we liberals suggests the government should provide any service for the needy) and should treat healthcare similarly.

But that analogy is absurd, and more than a little cruel. No, the government should not buy its citizens cars. It shouldn't by them boats, TVs, fine china, cruises, designer jeans, or jewelry. But when a single mother can't take her child to the doctor because her job doesn't provide health insurance and she can't afford the visit on her own, then yes, the government should do something about that. Such is the raison d'etre of government.

There are millions of people in this country who currently don't have health insurance. Anyone on the edge of poverty can easily be thrown into destitution by an unexpected medical problem. Inadequate care--preventative and otherwise--plagues poor and lower-middle class families. People are not getting the medical attention they need, and it's a crisis with an obvious cause: profiteering by the insurance industry.

By convincing people that healthcare is just one more consumer good that shouldn't be subject to too much regulation, insurers have wormed their way in between people and their doctors to the point where it is now considered un-American to question whether or not they deserve to rake in millions of dollars from people's suffering. Consumer choice is supposed to be the ultimate goal of our profit-focused society, and conservatives insist it would disappear under universal healthcare. Of course, these arguments usually come from politicians who both have access to quality healthcare and access to the generous checkbooks of insurance-industry political donors.

Of course, these arguments avoid the obvious point: any doctor is better than no doctor at all, and millions have no doctor. What's the conservative solution to this conundrum? Tax breaks. You might recall that one of Steve Forbes's most common assertions during GOP presidential debates this year was that the "Daley family"--self-employed New Hampshire fishermen making $50,000 per year if I remember correctly--would save enough money with his flat tax to afford health insurance. But tax breaks only help the wealthy and the middle class. What about the people who don't earn enough to pay taxes in the first place? How will tax breaks help them when they get sick, break a leg, or need to take their children to a doctor for preventive checkups?

Conservatives want to have it both ways. While acknowledging that there is a problem--there are Americans with inadequate healthcare--they look to shirk that responsibility by claiming that any solution involving the government would lower healthcare quality. This doesn't matter to those who have no healthcare! But it matters plenty to insurance companies, who get rich providing second-rate service to the middle class. (The wealthy, of course, don't need insurance, and would be able to pay as much as they like for higher-quality services no matter what the government offered.)

The only way to ensure that all Americans have access to healthcare is a single-payer system. This means that one institution, a public insurance agency, would be responsible for all healthcare costs for people who need the help. There would still be private options for those who can afford it, of course, but there would never, ever be a case where someone had to go without necessary care.

Who loses out in this picture? Not patients. No one would ever have to go without crucial medical care again, and those who want to pay for the most elite doctors and services would be able to. Not taxpayers. With universal access to preventative care, the government could save billions in disastrous medical care costs. Not doctors. Some claim they'd flee to friendlier countries, lowering the quality of care, but it's unlikely that any area of the world would be able to support a mass influx, especially since many of the industrial democracies of the world have already implemented single-payer systems. Besides, the American Medical Association supports universal medical coverage.

No, the only loser is the big insurance companies. And by spending millions on lobbying efforts and campaign contributions to keep legislators friendly to their interests, they easily keep single-payer at bay. It's their profits that keep the poor from getting the care they need. It's their disproportionate political power that keeps kids from getting the checkups that will keep them healthy.

It's a simple choice: medical care for the people who can't afford it or profits for the wealthy. It may be un-American of me, but the former seems more important.

Here is the EMTALA statute (Emergency Medical Treatment and Active Labor Act):

http://www.medlaw.com/regs.htm

Here is a paragraph from your post that I disagree with:

It's often believed that surgeons, specialists, doctors and nurses who've been trained and gained experience in European or North American hospitals and clinics, provide a superior treatment than those with the same qualifications who've previously been employed in hospitals in the sub Continent. Nothing could be further from the truth. Any medical specialist with up-to-date qualifications, using the same state-of-the-art medical technology, can perform the same treatment, irrespective of where experience has been gained.
Do you really believe this? While I agree with many of the statements in the above posts, this is rather bold, and laughably incorrect to those who know better. While every country has the potential to produce great physicians, American training programs and medical care are considered the best. For one thing, the "other countries" simply don't have the technology we have, and their teaching materials are often out of date or incomplete. You don't see wealthy Americans going elsewhere for treatment, but I see plenty of wealthy foreigners coming here for their heart bypasses and cancer therapy. A statement like this jeopardizes the credibility of your entire post.

Originally posted by Speed-ER doc
Here is the EMTALA statute (Emergency Medical Treatment and Active Labor Act):

http://www.medlaw.com/regs.htm

Here is a paragraph from your post that I disagree with:


Do you really believe this? While I agree with many of the statements in the above posts, this is rather bold, and laughably incorrect to those who know better. While every country has the potential to produce great physicians, American training programs and medical care are considered the best. For one thing, the "other countries" simply don't have the technology we have, and their teaching materials are often out of date or incomplete. You don't see wealthy Americans going elsewhere for treatment, but I see plenty of wealthy foreigners coming here for their heart bypasses and cancer therapy. A statement like this jeopardizes the credibility of your entire post.



I stand corrected!

The Baller

I work in an economically depressed area. The local Emergency Departments are overwhelmed with patients. A very high percentage of them are Medicaid for the disabled or Masshealth for the poor.

One of the problems I see with the "free care" system here is the lack of monetary consequence for an ED visit. Co-payments are often waived as well. This poses a distinct problem with high volume, low priority patients.

The Emergency Departments here are utilized as walk in clinics due to the large amount of patients with non life threatening illness or injury. The EMS system is saturated with patients as well that dont require immediate medical care, never mind an Ambulance to get them there. Since there is no or very little money to pay for care in the emergency setting using Masshealth or medicaid, it continues to be utilized in this manner.

The ED can not outright refuse to see a patient regardless of low priorty nature.

Ambulance services can not refuse transport to anyone. Regardless of low priority nature. This poses a direct threat to city residents with ACTUAL life threatening illness or injury. They will wait longer due to someone demanding transport to the hospital by ambulance with an complaint of "flu-like symptoms" for example. It happens ALL the time.

The same threat can be posed as Emergency Departments go on "divert". This means they close their doors to ambulance traffic due to over saturation with patients. How many of those patients really need to be in an Emergency Department? Regardless.....the patient with a life threating problem will need to go farther away to a hospital for care. Precious golden hour minutes lost. The hospital they end up in may not have the proper resources to deal with the specific problem. Who wins here?

There are walk in clinics around town well equipped for routine visits as well as urgent care (not Emergency however). These patients may wait longer, and the operating hours are limited to 12 hour days. This is more than appropriate for MANY of the patients seen at the hospital's ED. The resourses for a legitimately sick person will be greatly increased if the system was utilized properly.

Its not just lack of monetary consequence causing this. Its many layers of reasons. A patient on a stretcher will (most of the time) go ahead of the patients in the waiting room. This is known by the offenders I talk about here. Many people figure they will go to the ED and leave the 6 family members at home, all with cars in the driveway. This affects all of us. Not only are our taxes paying for it, our assumption as a reasonable resident in a communtity that an Ambulance will arrive timely and an ED will be accepting for a real emergency may often times be incorrect.

Medicaid patients don't have to pay anything, no copay, and some of them definitely DO abuse the system. They also get three prescriptions per month paid for, which is nice, and often prevents more expensive complications later. Most of them do not seek inappropriate care, and they are grateful for the care they receive.

The ER triage system can usually identify who needs to be seen and who can wait. It doesn't matter how you arrive: bus, car, walking, or EMS - we will stick you in the hall for hours if you come in for a toothache or a dressing change (which people do all the time!). If sicker patients than you keep coming in, you potentially will NEVER make it to the front of the line, and (hopefully) you will eventually leave. Yet you will complain the loudest.

It's an old but often true adage that in triage, you don't worry about the jerks that are yelling and carrying on, threatening to "call the supervisors," you worry about the quiet guy in the corner who is suffering in silence, because HE is more likely the one who needs the attention, and might die without it. People with heart attacks NEVER yell, scream, or cry. They just wince.

I have a different comment; I work in the correctional field. The inmates that come into the Department of Corrections receive all of their medical care and medicine for near nothing. One example is if the are ill and come to the clinic and get a prescription it costs them a whole 4.00 dollars. That is 2 dollars for the medical care and 2 dollars for each prescription. Now keep in mind these are not the folks that are there for singing to high in the choir, they are the rapist, murderers etc so as soon as they hit the gate they start yelling how sick they are. I work in the clinics and argue daily with them about the 2 and 4 dollar charges. Don't get me wrong, some of my family has been in prison and I have seen the other side too but I would much rather be providing the cheap medical care to senior citizens of families with little or no medical insurance that are law abiding citizens. I do agree everyone should receive adequate medical care but the states need to look at availability of healthcare to our law abiding citizens vs convicted criminals.

Done a bit of Correctional Medicine myself (TDC). Yeah, they get meds free, but often not good pain relievers (too much risk of diversion). They also can wait a week to get fractures splinted, and longer for surgical referrals.

They all want to be written "bottom bunk passes" and "shower slippers" and hand lotion (must get awfully dry skin working in the fields). :)

I never wanted to look and see what they had done, because I was usually sorry I had. Most of them really do deserve to be there.

Why don't we at least frame the question correctly . . . clearly medical care is not a right . . . from where would such a right come from? Do people have an obligation from some source to provide medical care to others? In a large part of the world medical care isn't even generally available . . . who is obligated to provide it under those circumstances?

The question is more accurately asked "Should medical care be a right and, if so, to what level and at who is obligated to provide it?"

It is so easy to demagogue this and other issues and decide someone or something is "evil incarnate" as one poster put it when one has no real notion of how the world works or any idea of how to implement or what the consequences of their emotional responses would be.

I don't have an answer to this question or most others but at least I don't pretend to. If as many people with so little information "opined" on issues related to the automotive issues on the board they would be ignored or flamed because it would be obvious they knew nothing about the item they chose to express an opinion on. I alway thought people had opinions about too many things they know nothing about . . . and those are the ones that have the strongest opinions. It seems the less one knows about the a subject the more certain they seem to be.

quote:
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Originally posted by Winning_BlueRX8
But $155 for a 30 minute visit? He basically told me to use the duct tape treatment in combination with salyclic acid
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You have no sympathy here. I suggested you go to the family doc for your simple wart. That was echoed by a real family doc who gave you a key piece of info you may not have had before - that the family doc deals with warts all the time. You could have gotten quick and competent treatment for a $10 copay (or whatever your insurance deal is). Instead, you went ahead and jumped the ladder for premium, out of plan service. Then you have the audacity to whine about it.

bernieunger



This is part of the tiered medical care we currently enjoy in the US:

Medicaid patients can go to any ER for quick care without cost to them. Uninsured patients are the same but they get a huge bill, which they may or may not pay. They may get charged less at "county" hospitals if they don't mind the wait. Many docs don't take Medicaid or uninsured patients. The ER is legally required to. HMO-insured patients go through their primary doc, but often have a few days (or weeks) wait to be seen. Specialist referrals take longer, and choices are limited. PPO-insured patients choose any doctor they want, can often get in quicker, and pay considerably more. Anyone can go the the ER 24 hours a day if they cannot get in to see their chosen doctor soon enough. Of course we charge more. But we are the safety net.

The only real problem with the current system is the number of uninsured. Everything else works pretty well. I can even prescribe cheap meds for you; of course if you want less side effects, once a day dosing, and possibly more effectiveness, you can always buy the more expensive meds. I'll prescribe whichever you wish. If we expand the amount of governmental assistance to provide a basic level of healthcare for more people, they still will have the option of paying for more care. So health care would then be both a right and a commodity.

Originally posted by wakeech


new machines are less frequently purchased, and special machinery is usually purchased from American hospitals used.



This works fine for Canada but where would the US purcase it's good used equipment from if the US enacted a similar system? In fact who would be developing new equipment?

The same can be said for prescription drugs. Canadians pay less for the same drugs because they don't carry the cost associated with R&D on new drugs. If US buyers were paying the same as Canadians where would the money for the development of new drugs come from? On this issue I blame the pharmicutical companies, they should be charging everyone the same for their product, if you purchase in volume.

In short I think Canada's system works fine for them, but you should recoginize that it only works because someone else (the US) is footing the bill for medical advancement. If the US institiuted the same system, medical advances would significantly slow down since there would be no money or incentive for them.

Economically being one step behind the "leading edge" (or "bleeding edge" as we engineers term it, refering to money not actual blood) makes the most sense. This true for any item computers, cars, cameras, washing machines and medical care. Having the "latest and greatest" is expensive, therefore there has to be some incentive to drive the development, and introduction into common use, of new technologies and procedures. If the US were to adopt a system such as Canada's I fear the medical advancement would pretty much stop. Is everyone happy with the present state of medical technology? Actually, I should say are you happy with the state of medical technology 5 to 10 years ago since the "state of the art" stuff is the most expensive and wouldn't be available?

This is not intended as a statement that there is no room for improvement in US medical care, or as a slam of Canada's medical care system. My intention is to point out that in spite of the problems with the US healthcare system much of the advancement of medical science comes from the US and the the reason for this is that the money and incentive to do that research is available. Any major healthcare reform needs to address how medical research and advancement will be funded (and I don't think letting the goverment fund or do all the reseach is the answer). Unless. of course, you're all happy with where things are at.

In answer to doc's question #1, should we provide a basic level of medical care for free, I believe that we should.

To the second part of the question, should the care be the same for everyone or should there be a "lower level" of care for those that can't pay, I feel that everyone is not "entitled" to the same level of care, therefore there should be a multi-tiered system. Asserting that everyone should get the same level of care assumes that everyones "value" to society is the same. It may not be PC but I don't agree with that, in my book a crack addict living in the gutter does not have the same "value" as a doctor or even a bus driver. Arguing for a multi-tiered system of course begs the question of how to determine who get's what level of care, how do you determine a persons "value"? I believe that we should let the marketplace decide "value", beyond basic care you should be "entitled" to that level of medical care that you can pay for.

Originally posted by Speed-ER doc
This is part of the tiered medical care we currently enjoy in the US:

Medicaid patients can go to any ER for quick care without cost to them. Uninsured patients are the same but they get a huge bill, which they may or may not pay. They may get charged less at "county" hospitals if they don't mind the wait. Many docs don't take Medicaid or uninsured patients. The ER is legally required to.

Good reasons for a basic, universal health plan. We actually have a universal health plan now but it's chaos, with the true cost of each individual treatment far from being transparent. For once I'd like to see a hospital that itemizes the costs of the patient care, and adds the cost of Mrs. Gonzales healthy baby delivery and Crackerjack William's knife wound, which was also paid for.

Originally posted by Speed-ER doc
HMO-insured patients go through their primary doc, but often have a few days (or weeks) wait to be seen.

I don't know about Houston, but over here most HMO setups have urgent care facilities. From 7 am to 9 pm you can see a family physician no appointment required. Even if that's not available, a good family doc will have a mechanism for squeezing in patients who really need to be seen quickly. You are encouraged to go to the ER afterhours- but don't forget the $50 copay. I guess some statistician figured out the break-even for keeping Urgent Care open as opposed to sending patients to ER. I'm not a fan of HMOs, but they do work great for colds and flues and minor boo-boos and plantar warts.

Originally posted by Speed-ER doc
The only real problem with the current system is the number of uninsured. Everything else works pretty well.

You've trivialized a lot in that statement. Everything else does not work well. Consider HMOs that are incented to withhold services while those of us who are not in medicine have to do independent research and go to war in order to get appropriate treatment. People who would like to be self-insured, but can't get the price breaks that come with economy of scale. Bad doctors who are shielded from discipline by the system. Inability to find doctor ratings so that I can make an intelligent choice which doctor to choose, which doctor to pay up for. Overblown malpractice awards in some states. Overblown malpractice award limits in others. I better stop here because a list of my pet medical peeves would go on for quite a while.

I didn't say it worked perfectly well, it works pretty well. I agree with the need for universal coverage.

We have urgent care centers here too, and they are great, but it is not the same as seeing your own doctor, and it DOES cost more (same copay as ER, but usually less wait). Yes HMOs delay services, that is the "weeks for appointments" I mentioned, such as to see a Gastroenterologist or Surgeon or Neurologist. We (physicians) can usually push that up a bit by calling and talking with the specialist directly IF NECESSARY. Usually people are not harmed by waiting, it is just part of the system, maybe it keeps cost down. They just don't want to wait, and that is fine. Keeps me in business.

If you want faster care, pay more. HMOs are for healthy people. If you want cheaper care, stop filing so many damn lawsuits, lobby for tort reform, and settle for the occasional worse outcome if we don't order every possible test to cover our asses.

I'm not trivializing the problems. It's the middle class that has the problems. But they still have ACCESS to the greatest healthcare in the world. I would like to see their access made easier, but I think my earlier statement is appropriate: it works pretty well.

Edit: and who are these "bad doctors" who are "shielded from discipline" by the system? What system? Bad doctors get disciplined all the time. Here's a link:

http://www.tsbme.state.tx.us/press/2003/pr2003.htm

You can also get licensure information on all physicians along with their disciplinary record. Word of mouth is still the best way to find out who is good, though.

Originally posted by Speed-ER doc
I didn't say it worked perfectly
We have urgent care centers here too, and they are great, but it is not the same as seeing your own doctor, and it DOES cost more (same copay as ER, but usually less wait).

We're talking about two different urgent care concepts. The one that I'm talking about are set up by the HMO in the building where the family doctors practice, and are usually manned by the same doctors on a rotation. The copay is the same as visiting your family doctor. In my case $10 vs $50 for ER. You don't go there if you're experiencing chest pains.

I'm done with long posts today - gotta go drive the 8 somewhere. Anywhere.

Two great ideas! (the urgent care you describe and driving the 8)

it's raining here.....

The first step in fixing the whole managed care dilema in this country is to cap the malpractice payouts. There are too many malicious payouts by malpractice that crank the premiums for Doc's and Practioners sky high. With these huge premiums for malpractice the insurance companies have the Doc's hands tied because they have capped rates. The Dr. is paying out the wazoo for protection for himself and can't catch up when it's time to bill for services. Unfortuneatly, Insurance companies consider what I do as a specialty and is near impossible to get a honest reinbursement. But I'm still mandated to carry a 1 billion dollar malpractice insurance policy. Need to stop these people who are looking to win the lotto at someone's else expense!!!!

It is neither a right nor a commodity. It is a service. It is provided for a fee. It is offered without disclosure of the fee in advance and without payment in advance of the service.
Procedures are valued more highly than so-called "cognitive" services because both services are rendered, the cognitive then the procedural and then the care afterward is included in the payment for the procedure.
I advocate letting the consumer know the fee beforehand and let them choose. When this happens they can have or not have as much or as little service as they desire and live or die with the consequences. If legal torts are removed from the equation it becomes easier to offer only that which is needed to diagnose and treat a given problem.
The problem remains how to disincentivise providers from doing things not needed just to pad the bill. More informed, smarter, more aware consumers would help but most people are not knowledgable about such matters. And really could care less as long as you make them well.

Originally posted by Baller
. But when a single mother can't take her child to the doctor because her job doesn't provide health insurance and she can't afford the visit on her own, then yes, the government should do something about that. Such is the raison d'etre of government.

It's a simple choice: medical care for the people who can't afford it or profits for the wealthy. It may be un-American of me, but the former seems more important.

Au contrair mon frair
Or something like that.
I remember that our goverment was establised by the people, for the people to provide for the common defense and insure domestic tranquility and to safe guard our rights....those being life, liberty and the persuit of happiness. Not to provide the poor with healthcare.
What I hear is the liberal mindset that urges us towards socialism. You said communism in your post, pointing to the fear of conservative, but the political idiology you speak is socialism. Conservatives, as far as I can tell, do not treat medical care as a commodity. It cannot be bought or sold in lots and there will not be futures traded. Orange juice is a commodity. Health care is a service provided by one person for another for a fee.
Those who cannot afford it must rely on the charity of others to provide it for them or do without. That some will die prematurely for want of medical care is a given in all societies, even ours in the US. It happens in Canada, Australia, UK and all over the globe. There is a time to live and a time to die.
Our country's founding fathers knew of poverty. Poor people existed back then. They could not afford food to eat and begged for a meal. They did not institute the goverment to provide food for people. Only for a framework whereby an effective society could care for their own.
That being said.....look to our past and ask yourself what happened to people before goverment entitlements and social welfare programs. For the most part poor people survived and relied on the charity of others. So what is wrong about that?
I disagree that a one payer system is the cure for the nation's healthcare system's ills. I am not smart enough to envision a solution beyond having people pay for what they get, and if they cannot afford it and noone will give it to them as charity they must do without. And I realize to do without may bring death sooner than they want, but we all must die. :( I do not want to live in a socialist society, if I did I would move to China.

the problem with health care is health insurance. when i was a kid we didn't have insurance. but we got our checkups every year and when we were sick we went to the doctor. my parents scrimped and saved so that we could do so. i keep seeing the arguement(not here specifically)that X amount of the population doesnt have insurance. who frigggin cares. the real question is can they get medical care and treatment when they need it. and if they can then who will pay for it.

for instance i was in a local fast foods resturant the other day. i heard one manager ask another "is so and so comign back" the reply was "no because then she cant afford medical insurance" the 1st person said "what does that have to do with getting a paycheck" and the 2nd replied " well if she works here she wont make enough to cover her normal bills and get on the insurance, and she will be making too much to get on the Oregon Health Plan. but if she has no job she can get on the OHP" That is the problem in a nutshell. Why doesn't she take the job and then pay for medical out of her pocket? people think they need the insurance to get care. So the cost of Insurance keeps people from getting medical care. i dont have a solution yet. but there has to be a better way. paying for all the beuracracy and lawsuits is where the money goes, not to the health care.

no feed-back from doc?

Looks like there's a new doc in (our internet) town! :) It's nice to have a fresh perspective, welcome.

I don't know if it's these West Coast liberals on rx8club.com brainwashing me, or that the the federal requirement for me to see everyone has made me think it is right, but I think everyone in America should have some form of basic coverage, including at least vaccinations and emergency care. Details can be left to the pencil-pushers. If we're going to give coverage to the bottem 5% (or whatever) of income, why not come up with some sort of plan that will cover everyone at least to some degree?

I like to think I would see and treat people anyway whether the EMTALA law was there or not, at least if they are polite and respectful. Sure would be nice to be able to kick the drunk abusive jerks out to the street. (That's one reason why I am still sort of anonymous on here, I like being able to write things like that :D )

The ability of many ER's to provide emergency care is being limited by the overcrowding and lack of reimbursement caused by by the huge numbers of uninsured. Currently medical care is too expensive for most to pay for "out of pocket," at least emergency care. How much does a laparoscopic cholecystectomy cost? I wouldn't want to pay for that myself, and I'm pretty well off! Imagine if it was 6-12 months salary.

As I wrote earlier, we are the safety net, but without reinforcement at either the local, state, or national level, the holes in the net are endangering many. We can still provide a service to people and charge a fee to the government, like we are doing already with Medicaid and Medicare.

Sorry, gotta go to work now, more later.

if we are going to cover the bottom 5% wouldn't it be a good idea to not cover the top 5-10%?

Originally posted by zoom44
if we are going to cover the bottom 5% wouldn't it be a good idea to not cover the top 5-10%?

I don't agree. I want everybody, and I mean everybody to be in this system of very basic coverage, no chance to opt out. We need that statistical coverage so that people who have some hard luck in their lives aren't screwed out of healthcare. That doesn't mean that somebody who can afford a premium medical service won't be able to get it. It does mean that young healthy people without too much money won't be tempted to take a chance without insurance. It means that somebody unemployed won't be tempted to opt out of the system just until things get better. It means that people with preexisting conditions can still get coverage.

Fitting healthcare to a 100% market system just doesn't work. It's an experiment gone bad in our country and only the well-heeled and the healthy/young are too proud to see the dangers.

If this was posted before in some kind, I apologize, after a while my eyes glaze over from reading so many posts...

I believe medical care should be an inherent human right. Many doctors, at least ones that have graduated from most Catholic/Christian medical schools, take courses in ethics and are required to learn and uphold the Hippocratic Oath: http://www.csun.edu/~hcfll004/hippocr.html

The oath is an understanding that you are in the profession to help humanity, not because it will line your pockets. I do not mean this to infer that Physicians are overpaid, nor that the insurance, pharmaceutical costs, and malpractice debates are not out of control and impractical. I won't touch any of them as they are not germane to my subject.

Americans, as a majority, have historically been vocal about not paying for the general welfare of others. And we often hear quotes such as, "it's my money, I earned it, and I'll be damned if I'm gonna pay for somebody else."

The problem with such arguments, are how we identify the individual within society. Because X makes more than 100K a year and Y makes minimum wage, does that automatically entitle X to better healthcare? Does X's income make him more important, valuable, to society than Y? If the answer was “yes,” than I ask you to take away your income and imagine that you are the one that cannot pay for healthcare. Is your answer still the same? Perhaps it is…

What if it’s your child? Of course you want the best for him/her, but if you are not insured for adequate care, is that fair? Is X’s child more entitled to healthcare than Y’s? After all, the children don’t make the income, so why should they potentially be at a disadvantage?

I could probably take the time to lay out a much better argument than this, but I'll leave it here, for now...

I doubt it. Your argument is fatally flawed. You start with the idea that healthcare is a right (or should be). All else that comes after that does not really matter. It is socialist thought anyway.
Our tax code is set up in a Robin Hood manner. Take from the rich and give to the poor.
Well some of us give hundreds of tousands of dollars away each year to the poor to help care for them. Does this make me a better person? Because I am able to give such sums away. What if I were poor and gave away all that I have to care for the poor? Am I a better person? What if I give nothing away to the poor and let the goverment continue to distribute it, am I a better person?
You see no matter if I am rich or poor ( I have been both , once poor and now rich) my worth as a human being rests not in what I give away or keep, rather it is intrinsic in my exisistance as a human being created in the image of God. We are all equally valuable. However we will not all be able to work or earn or have the same things. Some will die young and some old. Some will have more and some less. The function of our democratically elected goverment is not to socialize any service. It is a mess that FDR got us into as a result of the public programs established after the depression. Capitalism works better than socialism and communism, If goverment function is limited to what was intended by the framers of our constitution.
I am glad for many of the changes and amendments to the constitution, but I am a supporter of the private sector taking care of those who live in their own back yard and not abrogating that responsibility to the goverment.

sounds like something Ben Franklin would agree with. "but I am a supporter of the private sector taking care of those who live in their own back yard and not abrogating that responsibility to the goverment."

Fatally flawed? It doesn’t matter because it’s, “socialist thought anyway.”

I'm not sure that I follow your argument of the rich giving to the poor and how that takes away from my aforementioned position. In that case, I believe we are in agreement that intrinsic value determines an individuals worth. Or as you say, "image of God." aka Imago Dei - a common rationale for Christian Medical Ethics. Meaning that we are all created in the image and likeness of God, therefore we should be treated and should treat others with reverence and sanctity. This works very well with the Hippocratic Oath.

Not everyone will earn or have the same things in life. But what you refer to are material, “work or earn or have the same things.” The right to life, from an ethical standpoint, is not a material matter. Healthcare cannot be viewed as a capitalistic function, unless capitalism can provide equality to everyone. And at the moment, it clearly does not.

Capitalism has proved more successful than Marxism; however, true Marxism has never occurred in any country throughout the world. I don’t believe it ever will work either and am firmly against any such form of total government. But there is nothing wrong with using some of its better points for society’s problems as long as it doesn’t interfere with free enterprise. Healthcare should not be the large money making machine that it has become in America.

alright, i finally have an afternoon where i'm bored and do really have nothing better to do. *cracks knuckles* oh yes, i'm back.

first is the issue of insurance. i really wonder if everyone here has an idea of what insurance is really all about, so i'll go to define that.

it's a system of communal risk reduction. i'll illustrate a very simple situation.
say, for instance, we have a community of 10 people. in this community, they do lots of manual labour, farming and keeping animals. the risk of serious injury is omni-present in their daily lives. there is a hospital not too far away, so if someone broke their leg they would be able to recieve treatment. for the sake of simple math, the cost of treating a broken leg is $2000. each year, there is a 1/20 chance that someone will break their leg. so, each year, each contributes $100 to the insurance fund (which is never depleated other than to pay for health costs) to cover themselves for a broken leg. this means that it's lower cost for the individual, and there is zero risk of being in a situation where you cannot afford to recieve treatment. suppose one person in the group is a real dunderhead, and breaks his leg twice as often as the statistical norm. he'd necessarily have to pay twice as much into the insurance. say another of the members was still young, and dealt mostly with collecting eggs: their risk is significantly lower, and would pay a smaller fraction into the fund. very complex mathematical models are built to assess the risk people are at of whatever it is they're insuring against, to thus determine actuarially fair pricing.

health, itself, is actually a commodity. it is a capital good, the product of money (in the form of "care", and other goods (meaning healthcare too is a good, crump) which are conducive to increasing health) and time, balanced against how utile you find both your "spare time" (aggregate of time not working or in this case improving your health) and health itself, which is where you can find your optimal level of health, which is seldom at its maximum... hence my comment before). i could go into further detail, but it's not of much consequence. my point to Speed ER doc wasn't that Canadian healthcare is somehow inferior, or we enjoy less care, but simply that people who say "i want the absolute maximum" have the wrong idea in their heads and are usually talking about their percieved optimum.

anyhoo, back to the topic at hand: why American healthcare kinda suc... oops, i mean, why American healthcare has shortcomings.

the concept of insurance is critical to healthcare, as none of us can predict the future. we all want safety, and minimzing risk is the principal aspect of this. in the american system, the government allows open market commodification of healthcare, in the hopes that competition between the insurance companies will ensure the lowest possible costs, with the highest possible returns (investing the money collected from the insured).

the problem here is that the insurance structure, with so many huge companies, and the complicated network of coverage (some will work with some hospitals and not others) has created a beaurocratic structure which far exceeds any "wasteful" arragement the government could do on its own.

our medicare system, a universal insurance arrangement, again offers total coverage to any citizen of our country. the unbelievably low-cost arrangement, by comparison, offers no disadvantage to your system other than its comparably more expensive to get special treatment over the unwashed masses, if you want to afford it. the quality of care is no less, our facilities are not appreciably lacking in any way, although it is always strained to its maximum (which would be true no matter how enormous the institution became) it does still provide more than adequate care for everyone. the difference is that your contribution to the universal insurance coverage is based more strongly on your level of income than your statistically associated demographic risk. of course, conservatives get hopping mad over the idea that people think they should pay more because they have more (no, not propotionately equal, but more is more) for the same level of coverage, but i'm trying to leave ideological reasoning out of the discussion. what can be said though, is that its certainly not unbelievably more expensive for the better off to get coverage here than it is down south, unless you happen to be obscenely wealthy (at which point you ought to have nothing to bitch about, financially).

Originally posted by Zoom2X
This works fine for Canada but where would the US purcase it's good used equipment from if the US enacted a similar system? In fact who would be developing new equipment?

In short I think Canada's system works fine for them, but you should recoginize that it only works because someone else (the US) is footing the bill for medical advancement. If the US institiuted the same system, medical advances would significantly slow down since there would be no money or incentive for them.

Economically being one step behind the "leading edge" (or "bleeding edge" as we engineers term it, refering to money not actual blood) makes the most sense. If the US were to adopt a system such as Canada's I fear the medical advancement would pretty much stop. Actually, I should say are you happy with the state of medical technology 5 to 10 years ago since the "state of the art" stuff is the most expensive and wouldn't be available?

My intention is to point out that in spite of the problems with the US healthcare system much of the advancement of medical science comes from the US and the the reason for this is that the money and incentive to do that research is available.

this is not exactly it. firstly, Canada is no where near 5 to 10 years behind "medical technology" you have in the states. we are on that very same bleeding edge, and make our own contributions to further western medical science. my inference was that our level of demand for health care, our GDP, and current budget for the system are such that we do not afford ourselves all new machines all the time, and use older machines for longer, sometimes buying used machines from the states which are too expensive to buy new (for their benefit in application up here).

anyhoo, medical advancement would not stop if you adopted a system similar to Canada, as we do not simply ride your coat-tails.

Free Basic Health Care.
Who is to define this and how would it read?

1) Annual check up and immunizations and treatment of childhood illnesses and injuries?
2) Evaluation and treatment for acute life threatening condition to the point it is no longer life threatening or it is determined that recovery is not probable?
3) Evaluation and treatment to negate or limit suffering? (we would then have to define 'suffering' and measure this subjective term)
4) Treatment to allow return to baseline activity?

I can agree with #1 for children. Call it Pediacaid. #2 for all. Then if more or greater services were wanted, they would fall out of the term Basic and must be paid for, just as you pay for that extra slice of cheese at Wendy's.

Our forefathers did not address this issue in the constitution as health care was provided to those who went to the doctor (when one was available) and PAID for their visit weather with money, services, or even chickens. The point is that they (the patient) knew the payment was an inherent part of the treatment proceedings. If the patient did not pay, then the physician would subsequently either treat or deny services in the future at the physicians discretion just as the owner of the local coop or general store would decide to extend a line of credit to a customer who did or did not pay their previous months balance.

As a child, my parents of little financial means would seek medical care for me if I ran fever >102 for 2 or more days that would not respond to St.Josephs Children's Aspirin as it would appear that antibiotic intervention was necessary and would then 'do without' or 'cut back' on our daily expenses if the cost ran more than they had 'set aside'. The items set in quotes are terms I don't hear much of these days. Lacerations were cleaned and taped. Vomiting was something that everyone experiences from time to time and this too shall pass. When I was hit by a car, I was taken to the hospital and treated. Who paid? Not the guy who hit me. We 'did without' for quite awhile after that one. Were my parents naive? Probably. But they did set a ground work in me that not only do you get what you pay for, but also, you pay for what you get.

As a safety net for the nation, ED's have a huge responsibility to the community and if they were allowed to operate as ED's and not be abused by being treated as walk-in clinics, they would be far more effective and cost efficient. So much of this precious resource is squandered with the individuals who don't plan ahead and make an appointment with a local physician in his office, people suffering the consequences of life long self destructive behaviors, narcotic seekers trying to beat the system, and individuals with unrealistic expectations (like 'my belly has been hurting for 6 months and I want it fixed NOW!' and 'I threw up once 15min. ago. FIX IT!' and 'I have low abdominal cramping with my period and I did not try any OTC meds.' and 'I ate the 3 alarm chili and washed it down with 1/2 a bottle of tequila and now I have a bellyache, why aren't you seeing me immediately?') that the laboratory is swamped with specimens to run that the blood work to see if Grandma is having a heartattack is delayed. The guy on the backboard from the 3 car pile up waits longer to have his C-spine cleared before he goes to CT because X-Ray is trying to get little Johnny to cooperate with his exam for the ankle he twisted 4 days ago. The little old lady in 7 who can't ambulate ends up crapping herself because all the aid's were tied up holding down the combative drunk who may have ODed. Your child has to wait for pain meds. for her broken arm because her nurse is tied up trying to placate the obnoxious, demanding 'lawyer' who 'knows his rights' and doesn't know yet that there are orders for pain meds yet.

What's the right answer? I don't know. I do know that this behavior is now allowed to occur because of lawsuits that should have never been filed, not to mention won. We should be able to tell non-urgent cases during triage that their visit to the ED is inappropriate and another venue should be sought weather it is to treat at home or see a doctor in office or outpatient clinic, but that's another whole can of worms!

to make matters worse, a quote of a 20 year old New Yorker about why she doesn't watch regular network news in an AP article today about lots of people under 30 tuning in to the Daily Show for news:

"I'm not really interested," said Michelle Cohen, a 20-year-old New Yorker. " A lot of those shows focus on topics that have aboslutely nothing to do with me, like old people's health care."

Originally posted by zoom44
"I'm not really interested," said Michelle Cohen, a 20-year-old New Yorker. " A lot of those shows focus on topics that have aboslutely nothing to do with me, like old people's health care."


Yikes. Bet she doesn't care about Social Security either. If she keeps it up, that will have nothing to do with her either. Ever.

One of the problems with medical care that I see is that patients' first point of contact is not a medical professional at all; it's the Dreaded Receptionist, or DR.

The DR is oblivious. Got a hangnail? The doctor can see you in 3 weeks. Hives? 3 weeks. Numbness and paralysis? 3 weeks. A tumor the size of a golfball in your neck? 3 weeks. Or, "you can see our PA on Friday" - the PA is the person who will try to irrigate your infected ear despite the fact that you tell them you have a perforated eardrum.

Yeah, it's up to the patient to see after their own care, but you know, some people just aren't equipped or predisposed to be insistent enough to get past the DR. Emergency rooms get the patients who come in because they can't endure 3 weeks to deal with a sore throat (which unbeknownst to them is strep).

So don't tell me we have the best healthcare in the world. We may have some of the best doctors, medicines and diagnostic equipment. But access is via the DR.

Great comments. Lest you think that Dr. maxwell72764 is embellishing the situation, the scenarios he describes take place every day. I have to keep myself from laughing when someone comes to the ER for diarrhea AT ALL, but then when I ask them how many times they went to the bathroom, they say "two." Give me a break. Or the person with headache or back pain that hasn't tried any meds at home before coming. We have to wade through all those pretenders to pick up the one person out of 100 with "indigestion" who is actually having a heart attack.

I can't be too hard on them though, because I realize the layman does not always know what to do for every medical situation. My last medical visit was in college, when I didn't realize that my itchy eyes were from allergies, or that Benadryl would help. So I do cut people some slack, and teach them so that next time they might be able to avoid a visit.

The thing I don't understand is this: how can the federal government require ERs and hospitals to evaluate nonpaying patients (and to provide definitive care if an emergent condition DOES exist) but not reimburse us for the time, expense, and risk we undertake in doing so? The government is in effect saying that emergency healthcare is a right, but is not interested in backing that position up with financial assistance. The hospital, ER, and their staffs are just supposed to "write off" that care. Universal coverage of emergency care would at least be consistent with the government's mandate that it is important.

Otherwise get rid of EMTALA. Why doesn't this act apply to dentists, hamburger joints, and clothing manufacturers? Do you know where the guy with a bad toothache but no money goes? To the ER. Do you know where the homeless person who is hungry and cold goes when the shelters are closed? You got it. To the ER. We are the safety net.

I agree with Dr. Crump that in a perfect world, we would be able to care for our neighbors and work things out ourselves in the private sector. But a perfect world doesn't have laws which take away judgment about who to serve and who not to serve. In the private self-financed scenario he describes, if the same patient kept coming back over and over for the same things and not paying, you would eventually cut him off. Or if he were rude to the staff, or sprayed diarrhea on the wall ON PURPOSE, or cursed loudly frightening the paying patients, your "working things out" would last about as long as it took to show him the door. In the ER, we can't do that. EMTALA - fund it or lose it.

edit: here's the EMTALA act again -

http://www.medlaw.com/regs.htm

Originally posted by zoom44
"I'm not really interested," said Michelle Cohen, a 20-year-old New Yorker. " A lot of those shows focus on topics that have aboslutely nothing to do with me, like old people's health care." She's either an orphan, or doesn't give a rat's ass about her family. You decide.