Can the Healthcare Crisis be Resolved?
Beginning to Define the Problems and Solutions
We first need to understand what the crisis is. We have a million articles out there telling us what the crisis is and showing example upon example of the crisis, but few have the cojones to force a solution or even propose one.Over the past year, looking at the mainstream media and its reporting of the healthcare crisis in America and I have learned (or been told) many things. Let's blog these and see if we can, as a community, decide which the major issues are and what the reasonable solutions are.
PRESUMED HEALTHCARE CRISIS ISSUE #1: There are too many people without health insurance.
This is true. It is also true that if someone arrived at a solution the people will rise and anoint them The Emperor/Empress of America immediately.
Let's look at some analyses and solutions on this issue of the uninsured.
"The Uninsured Healthcare Crisis in America (7/6/05)
By Steve Sellery, health analyst
From The Ultimate Field Guide to the U.S. Economy
The United States spends far more on healthcare per person than any other country in the world - 47% more than Switzerland, the next largest spender on healthcare. We spend over $1.5 trillion on healthcare, and still, we have over 45 million people who are uninsured.For the sole issue of the problem of the uninsured this link really summarizes it well: . It also offers the beginning of a solution that I will reproduce below:
Conclusion:All these articles, unfortunately, compare us to countries like Sweden or Switzerland. That is brain dead. In Sweden all that exists are Swedes. Beautiful, mainly blonde, healthy people. While I have no problem if they exist when I roll to the left or right in bed, they are not the gold standard to which to compare for the average healthcare concerns of Americans.
There is a serious crisis in the healthcare system as more businesses and individuals find health insurance unaffordable. The pressure for change is growing. According to a Washington Post/ABC news survey in 2003, 62% of Americans support a "universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers" (see Note 5). The popular support exists for universal healthcare – let the will of the people prevail"
We need to stop making comparisons to countries that have no urban or rural problems. We don't need comparisons. The problem is so obvious it needs no comparison.
The first issue you may think that we need to solve is that there are millions of Americans who are uninsured. That is only part of problem number one. It may be better understood that there are millions of Americans who don't have access to quality healthcare. What is the difference? If you are given a universal health plan but no doctor with a brain and good hands will accept that health plan then you might as well be considered uninsured.
There appears to be a contradiction here. If we have everyone on Universal Health Insurance that will solve our problem, BUT if we have Universal Health Insurance and the solution that brings me health is not part of that plan then Universal Health Insurance did not solve the problem.
Here is a quote that can help us is looking to refine the number one problem in healthcare in America:
Contradictions do not exist. Whenever you think you are facing a contradiction, check your premises. You will find that one of them is wrong." ---Ayn RandBased on this, our premise that simply having a universal payor will solve a universal problem is incorrect. This is because problem NUMBER ONE in healthcare is not the uninsured in America. Here is problem number one:
MAD ABOUT MEDICINE HEALTHCARE CRISIS ISSUE #1: There are millions of Americans who due to a variety of reasons (lack of insurance, failure of their insurance company to appropriately pay, lack of qualified doctors in their region, lack of knowledge as to how to seek out qualified health solutions) fail to have access to solutions to make them healthier.
MAD ABOUT MEDICINE CHALLENGE:
As a blog community lets first define the nature of this problem. Post example after example that demonstrates the existence of how the current healthcare system has left you less healthy and possibly sicker, and your ideas for how to turn that around.
Dr. K.
Related Topics:
Technorati Tags: health insurance, healthcare, policy reform
11 Comments:
First, the idea of the government or anyone besides a doctor being in charge of my healthcare is too chilling to even think about.
I don’t begin to understand why healthcare costs continue to increase. Is it because of evil insurance companies, lawsuits, technology costs, research, people not paying their bills? Why does it have to be so unaffordable? When I look at my insurance payments online I notice that my insurance company pays only about half of what my doctors charge for their services. I assume that this is a write-off for the doctors and that payments are negotiated ahead of time. Are my doctors overcharging because insurance companies don’t pay up and/or because patients don’t pay? Why can’t an uninsured patient negotiate the same price as the insurance companies?
One thing that I find disturbing is the number of people that think healthcare should be provided for them by the government. People just don’t want to pay for the things they need, they only want to pay for the things they want. We have a friend that often won’t go to a doctor because he says he can’t afford to go. But he can spend $1000 on a canoe that rarely gets used and has a wife that spends $200 a month getting hair and toenails done for her and their 4 year-old daughter. It’s not that he can’t afford the doctor, he just doesn’t want to spend the money. I believe this is the case for many people. They want their $100 pair of shoes, to hell with paying for a check-up. I think people need to change their mindsets and put medical care at the top of their priority list.
I don’t know how to lower healthcare costs but if we could get people to change their priorities perhaps we could make health insurance work the same way as home or car insurance. We could have higher deductibles and pay for routine healthcare out of our pockets the same way we pay for home improvements and car maintenance. Insurance could then be used for major expenses. Pre-tax flexible spending accounts can cover the routine stuff. Even if the poorest people paid 5-10 dollars a month towards their medical bills it could help a great deal.
Lawsuits would have to go. I believe places like England have a “loser pays” system. If you file a lawsuit and lose you pay all the court expenses for both sides. This could eliminate the frivolous lawsuits.
A civilized society can’t leave people dying in the streets but where do we draw the line? Should we have to pay medical expenses for people who spend a couple hundred dollars a month on booze and cigarettes but contribute nothing to their own healthcare when they get sick because of it? Should people have to pay for a middle-aged woman like me who gets injured after flying over the handlebars of her mountain bike? It would be great if we all took better care of ourselves but I’d be lying if I said I’d taken great care of my body all my life. If we have some kind of national healthcare should we demand that people take better care of themselves? If so, how long will it be before Big Brother and the Healthcare Police starts monitoring everything we put in our bodies and bans some of the activities that we enjoy? Smoking bans are an indication that this sort of thing has already started happening. How long before McDonald’s cheeseburgers are banned?
I can’t say that the current healthcare system has ever left me less healthy except when I had an HMO. My primary care doctor failed to see a fracture in my ankle and as a result I ended up walking around on a pretty serious injury. Had I not had an HMO I would have gone straight to an orthopedic doctor but my primary doctor did not think it was necessary. While part of that HMO my husband was denied a $200 contraption that would have helped with herniated disks in his neck because the insurance company was afraid he would use the thing for “recreational purposes”. Say what? He was later denied further physical therapy because he had “exhausted the benefit on that body part”. Oddly enough, the insurance company paid out thousands of dollars for major surgery on that same body part. If we end up with a national healthcare plan that is anything like an HMO then God help us.
I agree with many points made by swank - excellent post! There is always a trade off in healthcare (as with anything else). Not everyone has health insurance and they therefore can't afford to see a physician when they are sick or injured. What do they do? They go to the emergency room because they cannot be turned away. This is a major catalyst for the current health insurance crisis. Why, you ask?
When you fracture your femur, tear your ACL, or break an arm, you can expect to wait several hours in an emergency room because they are so backlogged (and you can possibly contract an illness from another waiting patient who could be treated by a general practitioner). Many of those without health insurance simply go to the emergency room instead of a doctor's office because they must be treated and then don't pay the bill. This is compounded by the hospital raising costs to stay out of the red - therefore raising insurance costs, which means even less people can afford insurance, resulting in even more people using the emergency rooms as their primary healthcare. As a result, plan on waiting in the ER whether or nor you are insured.
An example of these repurcussions is explained with my recent knee surgery; I saw that the hospital charged $119 for "physical therapy" which entailed a "physical therapist" handing me a pair of crutches. How about $45 for an ace bandage? Is this the hospitals fault? Is it the insurance companies fault?
My insurance is excellent - out of an operation that should cost $15,000 when all is said and done, I paid a $35 copay.....but I also pay a great deal in premiums. I still would have been charged the outrageous prices if I was uninsured which is not fair; my insurance company has negotiated prices, why shouldn't the uninsured be able to negotiate prices? On the other hand, if the hospital was operating in the red, they might not be able to have administered the excellent care which I received (or they might not be able to exist at all).
There is also the issue of money itself. Many feel that Doctors make too much money; I do not. Try grueling through 12+ years of schooling (undergraduate, medical school, internships, residencies, fellowships, and then establishing a practice - while paying off medical school bills). On top of that, trying finding a spouse at the age of 34 (because you were way too busy in medical school) while working many hours trying to establish your name as a doctor). Doctors deserve to get paid - especially good doctors. Visionary physicians, such as Dr. K, offer to open their office 24/7 for a non-life threatening orthopedic emergency. This means that if I was to break my arm tonight, I could simply look up Dr. K's cell phone number WHICH HE GIVES YOU or contact the answering service and I will be treated in his office by either him or one of his professional counterparts. That is one area in healthcare that is rarely addressed - a person being both a good surgeon and a good doctor (yes there is a difference). Dr. K is an excellent surgeon because he approaches an orthopedic medical problem with science, skill, knowledge, and a good set of hands. On the other hand, he is a also good doctor, because he not only treats the condition but also treats the patient with compassion and understanding. He deserves much more than my insurance company pays him; yet he treats me and my condition to the best of his ability. In a previous post, Dr. K mentioned that the average salary for a pediatrician is $120,000. That is crap considering many pharmaceutical sales reps without a college degree can easily make $200,000+. Don't get me wrong, I believe that pharmaceutical companies also deserve to earn their money because they invest a great deal to develop the drugs which are necessary to treat medical conditions. I they were not making money, what would their incentive be? There are so many great drugs out there because pharmas have invested the time and money to develop them - they should be reimbursed adequately (they just shouldn't be too greedy such as offering drug in combinations to maximize profit).
On the other hand, insurance companies also shouldn't be greedy. When an insurance company has a good fiscal year, it means that they took in more premiums than they paid out in claims. Maybe they should be forced to refund a percentage of premiums when they have a good year; the problem is that that open the door for government involvement, which brings be to the national healthcare topic.
National healthcare doesn't sit right with me. The reason I say this is becuase THE MONEY HAS TO COME FROM SOMEWHERE!!!! It will not magically appear. Let say that I pay $160 per month for my healthcare premiums (for my family of four). If there was a national healthcare system in place, I would pay much more than that in my tax increases only to receive less care than I do now. Why should I pay more money for less than I receive now? Am I wrong for feeling this way? Take Canada, for example, where the average wait for an ACL reconstruction surgery can be as long as 12-18 months. By then, you have probably torn your medial meniscus as a result and will new be at a 60% higher risk for developing osteo-arthritis. If the Doctor you first see decides that you don't need surgery, you are screwed because you can't just change doctors at your whim (similar to some of the crap HMO's out there). Now what do you do? You go to the Unted States and have your surgery by some of the leading doctors in the world (where there is currently no national healthcare system). I have seen this with my own eyes while in college in Upstate NY, where Canadians routinely come to the ER's in NY with every intention on throwing out the hospital bill and going right back to Canada because there is better care and they can get away without paying. Yes, this system is flawed and people deserve healtcare, but should I have to pay for it? Should you? I pay enough in taxes which fund many other failed social programs. Why should I take more clothes off my children's back to pay for someone else? Where do you draw the line?
First off, lets cut the space program back a bit. Sorry, I don't give rats ass what type a fossilized bacteria was located by the Mars rover, or what new major storm syrge is brewing on Jupiter - put that money into healthcare. Before we worry about foam (yes, foam) falling off a billion dollar hunk of flying crap called the Endeavor, instead ENDEAVOR to find a cure for Child Leukemia. Priorities. Let's worry about taking care of our own county before worrying about some other sewer that stands out with a demanding open hand and then stabs us in the back the minute we turn around. I think that would raise a few dollors to take care of our own - at least to set some on the right track. Maybe we could also developed an uninsured bargaining unit to negotiate hospital prices for the uninsured to ease the burden. The disease and the cure are both capitalism. Capitalistic greed fuels the pharma and insurance company price index, yet, at same time, it fuels the desire to create new drugs, research and procedures that eases pain and saves lives - the infamous double edged sword. It is easy to say that we simply need a national healtcare system, but my feeling is that it will demote doctors to being civil servants. Nothing against civil servants, I am one myself, but how do you convince a person to go through medical school for as long as they do, and deal with all they do, and in the end, they are could make the same money putting half of the time into a fraction of the work for a normal 9-5 job. You can't; the best and brightest would choose other careers - I want the best doctors possible.
my son who is a full time college student living at home and working a well known ---mart, partime,and is offered no health insurance there, was always on my husbands insurance, but when he turned 25 he was KICK-OFF of our insurance just because of his age, even though he was a full time college student still. because he has asthma and somewhat high blood pressure, we can't find or afford any outside insurance for him. shortly after he was without insurance, he had a severe asthma attack, i got him through it, but he still had a URI that needed treated, he went to 2 of our local free clinics and was turned away because he still lived at home with a working parent. i am on perm. disability myself and we can barely make ends meet with my medical bills. so even though at that time he was unemployed and an adult he had no where to turn. So even free clinics don't work in our society.
I agree that many minor illness and injuries are being treated in the ER instead of the family dr. but, i fell several weeks back and new that i had probably broken my arm. i called my family dr. and the soonest that they could get me in was 3 days from the day i called. they told me that i had to go to the ER. i they did there was xray me and splint me. the same my family dr. could have done. so many times you have no choice but to go to the ER, because even your family dr. is too busy to see you without an advance appt.
(I wrote the original post regarding the ER) and yes, most of the time you have to go to the ER, except in the case when you have an exceptional Orthopedic surgeon (such as Dr. K). I spent MANY times in the ER as a kid with torn up knee, broken fingers, etc. My point was simply that when you go to the ER for a non-life threatening broken bone (which does need to be treated right away), you wind up waiting anywhere between 2 and 12 hours in some part due to those who use the ER as a "clinic" - such as the have a bad chest cold, the flu, etc - all that could be treated in a regular Physicians office. This over-stresses the ER and places improper burdens on different areas of the medical field. As a result, you can wait for a LONG time in the ER with a emergency such as a broken bone (which needs prompt attention, but is not life threatening). In the process, you might contract what the person next to you has. Most Ortho surgeons are not exceptional - it is great to find one that will keep you out of the ER when appropriate. The only trade off is that you may wait during normal office visits because the OS may be backlogged for these "emergency" calls. A small price to pay. I would rather wait in a crowded Os office with people who have knee problems than wait in an ER next to someone with whooping cough that might get passed to my kids.
There are so many opinions out there and one can talk themself in circles in a basic discussion on the problem. Some like to blame the hospitals and drug companies and most like to blame the doctors.
You asked where the system has let me down. I don't know that this is an example, but it infuriates me.
My monthly insurance premium for a well known and mostly accepted HMO is $670.00. Because I work in a small office we do not have a group plan, but my employer pays my premium.
Every year the insurance company raises my premium 20 to 25%. WHY?? They aren't paying my doctors 25% more, they aren't paying more for my medications which haven't changed in years (other than the occasional antibiotic for a UTI or sinus infection). I've seen the EOB's (explanation of benefits) and half the time they deny most of the doctors charges. Sometimes my co-pay is about the only thing the doc gets for his services.
I called the insurance company and they say it is because there was an increase in claims in my geographic area.
In the meantime, insurance companies have raked in RECORD profits in the dozens of BILLIONS of dollars per company. I read a report that said one health insurance companie alone had netted over 16 billion in the first two quarters of this year (not including investment profits), while paying out less in claims than previous years. I believe another report said they collectively had a net profit of 127 billion last year or the year before.
This is insane. They raise premiums, seemingly cart blanche, to a point where employers are forced to pass the increase along to the workers who already barely get by. At the same time the public is freaking because a company that makes a mere (in comparison) ten billion in profit a year doesn't absorb more of their employees insurance costs. I'm not usually in favor of regulation but when we've gotten to a point where we feel the need to demand universal healthcare I think it's time to take a look at the biggest beast of them all.....the insurance company.
And now, my other point. (there could be more to follow)
I was born and raised in a rural area of the country. I don't just mean that I didn't live in town, I mean that I lived in a town of 1200 people (which has now lost its hospital) and the next largest town is 90 miles away. The next largest town with medical specialists is 230 miles away.
The doctors in these small communities are typically fantastic. They handle everything from ear aches to heart attacks. In general medicine you couldn't ask for a better physician. But for the bigger issues they have to refer patients out to specialists.
Where people fall through the cracks is when it comes to these specialists. Living in New York I see that the primary care doctors pass nearly everyone on to a specialist. Some of the specialists pass patients to a sub-specialist.
The needs of rural healthcare: Case in point. My best friend's mother, Carol, lives in that town of 1200 and is a diabetic. Because of varying blood sugar control over a number of years she is mostly blind. The reason is access to the PROPER care.
The big city offers patients access to diabetic specialists, endocrinologists, the latest in medications and equipment. Diabetics see a retinal specialist the second they begin to have vision problems. In the rural community the nearest retinal specialist could be hundreds of miles away. How does a patient with failing eyesight and no driver's license get to that doctor? Even if they have the transportation resources it is a major challenge. Often, the need is overlooked or underestimated.
Another case: A dear friend of mine was diagnosed with breast cancer. She had to drive 230 miles to have a mastectomy. When she healed up enough for chemo she traveled 230 miles each way for that. After the chemo was over she then had to live 230 miles from home for several months in order to have radiation three days a week.
The personal resources required for this kind of care take a huge toll. Not only is there the added expense of major health care in a time of crisis but there is time lost from work due to the illness. Time lost from work by her husband who drove her for treatments. And then the 460 miles of round trip expenses. Some patients are broken both financially and spiritually by the exacting toll.......and I'm talking about people WITH health insurance.
Having universal healthcare would fix none of this.
These are all remarkable posts. I am printing them and putting them up in my office!
Swank: You are wonderful. Insurance costs probably rise because the insurance companies and investors want to make more money. Healthcare does not cost money. It is MAKING money for wall street supported companies. This nonsense about us spending too much on healthcare is a ridiculous notion. The profits from for profit companies are wild. This is the American way I guess but in healthcare the consequences are more serious.
Dr. K.
OK. We know there is a health crisis, and we know that it is multi-faceted. Multi-faceted problems require multi-faceted solutions.
1. With exception to the "truely" mentally/physically handicapped "U.S. citizens", lets start by terminating those living on public "assistance" as their sole/primary means of income. Public assistance is great as a stop-gap measure, but not to be used as a multi-generational sole/primary source income. To those that are not U.S. citizens, no free health care-no exceptions. The U.S. healthcare system has been abused too long by too many and the average U.S.tax payer can't afford it anynore.
2. As for those H.M.O.'s-get rid of them-looks like they are exploiting the "insured" with co-pays, deductables, maximum benefits... The insurance companies make too much of a profit on the illness' of the Americans. With all of the limits and restrictions that are placed on the benefits, one has to wonder what the value of the managed care insurance really is.
Reasonable profit is good. That is what keeps the economy chugging along.
Sound like a good start?
Hi Doc,
Remember the story about the Emperors New Clothes? It seemed some con artists convinced a government official that they could create clothes so fine that the clothing would be invisible to fools. Cutting to the chase-naturally, a child who didn't know any better loudly proclaimed the official's nakedness.
Highly intellectual people today would not be so foolish right? Ever heard of political correctness? How bout we call political correctness what it is-Social Cowardess.
In my opinion, lifestyle in many cases has acquired minority status. It is no longer politically correct to criticize or evaluate unhealthy lifestyles.
As a result, health promotion/disease prevention is handicapped. With this handicap in place, medical care instead of being prevention oriented now becomes a delayed sin tax.
Society now demands to have their cake and wear it too. We don't dare criticize their lifestyle-yet we become responsible for the results of their lifestyle. Unlimited demand chasing a limited supply of health care. Bit*h ain't it?
Is healthcare subject to capitalist mechanisms? maybe anonymous' "double sword" mentioned above is accurate. But as an industry, operating in a capitalistic environment, healthcare cannot afford to make us healthy. They would put themselves out of business: spending a few dollars on preventative procedures today would deny them big bucks a few years down the line.
I do agree that during one's lifetime the question is not "will I ever get sick?" Rather the question is "when will I get sick and how bad will it be?" In my personal opinion the healthcare market is regulated in such a way that the regulatory environment is pushing the industry towards treating the symptoms, syndromes and managing conditions. What business owner in his right mind would turn down repeat customers? What if the customer would entrust you, the business, to decide whether it will turn you into a repeat customer or not?
Maybe I am wrong, and the market movement in the healthcare industry is governed by people randomly entering and exiting the "sick state." And thus, those that get 100% cured by healthcare are different from the newly sick?
Please tell me which hypothesis you think is correct.
Your thoughts please and thank you!
Post a Comment