Health Care: What Single Thing Would You Change?
From the vantage point of this Blog, the state of our health care system ranges from the totally remarkable (advances in body imaging and cancer therapies) to more evil than the drug-lord tactics of nearly every insurance company and pharmaceutical company that make the Columbian Cartel look like the Vienna Boys Choir.
What do you do when nearly every aspect appears to require a major overhauling? Do you scrap the system? Do you make small changes? Do you have a philosophy of building or do you overlay a regulatory estate on the system -- sort of like "Big Brother meets your local doctor or hospital"?
As with many things in our daily lives that seem too complex to take on there are times when the adoption of a single event places us on the road to recovery. On a personal level it can be leaving that dead-end job you had and starting over. Maybe it's something as simple as cleaning off your desk. Whatever it is, the road to success starts not with a single step, but with an index moment. What is an index moment? It is a behavior or event that as time marches on you look back to the index of your life and see that event as a critical juncture where significant change began.
What Will be Our Index Event for Health Care?
Here is the challenge. There are a lot of smart people out there. Actually there are too many smart people out there. There are too few people with common sense. But a helluva lot of freaking smart people. The smart people outline, in article after article, ALL the problems with our health care system. The problem is that they are right. Every one of those articles has important points for us to ponder.
It really doesn't matter since we all have so much time to ponder health care anyway - the wait to get precertification for 4 extra physical therapy visits from our insurance company can take weeks, approval for surgery from the Worker's Compensation Board takes months, and doctor office waits, maybe longer.
Boy, do we have a lot of time to ponder these questions. That is why doctors' offices have so many magazines - to feed into our need to ponder these great dilemmas. The reason we need to ponder these is because since no one has the courage to DO a single thing to effect change (writing is not doing by the way) we are left with pondering. Let's ease off on pounding the pondering and figure out what we can do.
Is it Just One Thing? Maybe...
I think we all believe in the following statement:
If this one thing just changed in health care then we would be significantly better and on the road to recovery.
What is that "one thing"?
I asked a colleague this question recently. She was trained as a radiologist and ranks as one of the smartest doctors I ever met. She felt that if she had to change just one thing in medicine she would improve the environment for medical students coming out of medical school so that it would be more attractive to want to be a doctor. She feels that many of the best and brightest of our college graduates are not going into medicine because of the problems in the system and that any solution to health care must make sure that it is an attractive enough field to bring those people back in.
I agree with her, although the definition of "attractive" can be complex. Does this mean more money? More jobs offers? Tort reform (the changing of the medical malpractice system)? Either way, her point is that the destruction of the health care system will really be felt in twenty years when the current group of doctors will have some voids of talented people who went to other endeavors.
Recently I read a few articles by Atul Gawande, the respected health writer and author of the recent book Better. Since the end of April, Dr. Gawande, who is also a surgeon who practices in what appears to be an academic-based practice through a hospital system, wrote fourteen columns or reviews in the New York Times alone. All of them excellent and insightful. Dr. Gawande writes in other venues as well, so in a year he produces for us an encyclopedia of the issues that are presented to us in health care today. Read what he writes. You may or may not agree but it will clearly bring you up to speed on the major issues in front of us.
If reading Dr. Gawande's work was enough then we can stop there. No way, Jose. It is not that simple. The range of Dr. Gawande's work is massive, covering topics from access to HIV drugs to problems in the elderly related to nursing homes to hand-washing in hospitals; almost like a medical Wikipedia in action.
Unfortunately, like the movie said "there are a thousand stories in the Naked City...this is one of them..." applies to the American health care system. We are a complex melting pot of needs, special needs and special interests. We are a country with a deep attachment to civil liberties and the needs of the individual. That is not necessarily the case around the world.
In a recent NY Times article Dr Gawande makes reference to an important study performed by The Commonwealth Fund that showed our health care system is the most expensive but our life expectancy is the same as Australia, Canada, New Zealand, Germany, and Britain. While we don't appear to fare well against these countries in some areas, we excel in others. The take-home lesson is that what is important to Americans may not be as important to citizens of these other countries or to the authors of these studies.
That leaves us here, on this blog with one goal.
If you can do JUST ONE THING to change health care, what would it be? Just one thing. Not two, not three, not 28 million. One thing.
Here are a couple of ideas (not necessarily mine but ones that have floated through this Blog over the past year) but there are obviously more:
Post away, baby....
Dr. K.
Related Topics: Technorati Tags: healthcare reform, health and wellness
What do you do when nearly every aspect appears to require a major overhauling? Do you scrap the system? Do you make small changes? Do you have a philosophy of building or do you overlay a regulatory estate on the system -- sort of like "Big Brother meets your local doctor or hospital"?
As with many things in our daily lives that seem too complex to take on there are times when the adoption of a single event places us on the road to recovery. On a personal level it can be leaving that dead-end job you had and starting over. Maybe it's something as simple as cleaning off your desk. Whatever it is, the road to success starts not with a single step, but with an index moment. What is an index moment? It is a behavior or event that as time marches on you look back to the index of your life and see that event as a critical juncture where significant change began.
What Will be Our Index Event for Health Care?
Here is the challenge. There are a lot of smart people out there. Actually there are too many smart people out there. There are too few people with common sense. But a helluva lot of freaking smart people. The smart people outline, in article after article, ALL the problems with our health care system. The problem is that they are right. Every one of those articles has important points for us to ponder.
It really doesn't matter since we all have so much time to ponder health care anyway - the wait to get precertification for 4 extra physical therapy visits from our insurance company can take weeks, approval for surgery from the Worker's Compensation Board takes months, and doctor office waits, maybe longer.
Boy, do we have a lot of time to ponder these questions. That is why doctors' offices have so many magazines - to feed into our need to ponder these great dilemmas. The reason we need to ponder these is because since no one has the courage to DO a single thing to effect change (writing is not doing by the way) we are left with pondering. Let's ease off on pounding the pondering and figure out what we can do.
Is it Just One Thing? Maybe...
I think we all believe in the following statement:
If this one thing just changed in health care then we would be significantly better and on the road to recovery.
What is that "one thing"?
I asked a colleague this question recently. She was trained as a radiologist and ranks as one of the smartest doctors I ever met. She felt that if she had to change just one thing in medicine she would improve the environment for medical students coming out of medical school so that it would be more attractive to want to be a doctor. She feels that many of the best and brightest of our college graduates are not going into medicine because of the problems in the system and that any solution to health care must make sure that it is an attractive enough field to bring those people back in.
I agree with her, although the definition of "attractive" can be complex. Does this mean more money? More jobs offers? Tort reform (the changing of the medical malpractice system)? Either way, her point is that the destruction of the health care system will really be felt in twenty years when the current group of doctors will have some voids of talented people who went to other endeavors.
Recently I read a few articles by Atul Gawande, the respected health writer and author of the recent book Better. Since the end of April, Dr. Gawande, who is also a surgeon who practices in what appears to be an academic-based practice through a hospital system, wrote fourteen columns or reviews in the New York Times alone. All of them excellent and insightful. Dr. Gawande writes in other venues as well, so in a year he produces for us an encyclopedia of the issues that are presented to us in health care today. Read what he writes. You may or may not agree but it will clearly bring you up to speed on the major issues in front of us.
If reading Dr. Gawande's work was enough then we can stop there. No way, Jose. It is not that simple. The range of Dr. Gawande's work is massive, covering topics from access to HIV drugs to problems in the elderly related to nursing homes to hand-washing in hospitals; almost like a medical Wikipedia in action.
Unfortunately, like the movie said "there are a thousand stories in the Naked City...this is one of them..." applies to the American health care system. We are a complex melting pot of needs, special needs and special interests. We are a country with a deep attachment to civil liberties and the needs of the individual. That is not necessarily the case around the world.
In a recent NY Times article Dr Gawande makes reference to an important study performed by The Commonwealth Fund that showed our health care system is the most expensive but our life expectancy is the same as Australia, Canada, New Zealand, Germany, and Britain. While we don't appear to fare well against these countries in some areas, we excel in others. The take-home lesson is that what is important to Americans may not be as important to citizens of these other countries or to the authors of these studies.
That leaves us here, on this blog with one goal.
If you can do JUST ONE THING to change health care, what would it be? Just one thing. Not two, not three, not 28 million. One thing.
Here are a couple of ideas (not necessarily mine but ones that have floated through this Blog over the past year) but there are obviously more:
- Universal health care insurance supplied by the government
- Complete restructuring of medical malpractice
- Nationalize the drug companies (treat pharmaceuticals like natural resources such as oil from the Alaska pipeline)
Post away, baby....
Dr. K.
Related Topics: Technorati Tags: healthcare reform, health and wellness
60 Comments:
After having a stapeling procedure done on my hemorrhoids 12/28/06 I have had nothing but problems and have had 4 doctors tell me there is nothing I can do it could take years to heal. They tell me I have Post PPH Syndrome and I cannot live a normal life and dont know what to do. I would change the way they discuss problems that might occur afterwards. Had I known this might happen I would never had done this.Now I dont know what to do.
Thank you Shel:
Your "One Thing" is:
The way we train doctors.
Thanks.
Doctor K
Geez, only one thing?
Alrighty then, get rid of the suits making decisions in the insurance companies and let doctors run the show. They'd save millions of dollars by not having to pay those huge salaries.
For some reason my insurance company requires a two day waiting period from the time they approve a request for an MRI until I can actually have the MRI. And they always approve them so it makes no sense whatsoever. I wonder how many hands have to touch that request and how much time it takes. Since my doctor's group owns their own MRI I wonder how much money would be saved if I could just have an MRI right then and there like an x-ray.
It's kind of sad when our pets get faster, better and cheaper healthcare because the vet makes all the decisions.
There have been a lot of cross posts to this original posting on Denise's blog at Blogher:
http://blogher.org/node/20184
See the comments there.
Doctor K.
Lyndon Johnson had his heart in the right place when he created Meidcare but not his head. He increased the demand for medical care but not the supply and this has caused the prices to be bid up for both the government system and for everyone else. Doctors, like everyone else in a capitalist system, are out to maximize their personal gains. SO...
Fund more medical education and encourage qualified immigrants to study and practice here. When the gouging is reduced, even the insurance companies will back off.
I would like to find some way to set up my doctor visits so that I can make it clear that I will gladly pay extra out-of-pocket over what my HMO will pay to have the doctor not feel pressed to move on to the next patient before my issues have been fully addressed. I would like to know how to do this without offending the doctor by implying that he/she is not giving me the attention that I need.
As a nurse, one thing that I think would make a great difference is better staffed hospitals. The way things are now, nurses do not have time to give patients the patient care that they want to give and were trained to give. This leads to post op infections due to lack of adequate handwashing, medication errors that could be fatal, unacceptable patient education on meds and disease process. All of these could
cause longer hospitalization and readmission. There are not enough hours in a shift to get done what a nurse has to do. Some stay overtime, but this is frowned on by hospital administration. I hate to say, but some just do the best they can and leave when their shift is over...leaving things not done. All of these things contribute to longer hospital stays amd readmissions.
Nurse burnout is a serious problem. Also(I know you said just 1), but lack of essential equipment needed to care for patients is a HUGE problem that delays care which can result in setbacks in recovery. Man....I could go on and on!!! From a patient's perspective, I will not tolerate a physician that is backing out of the room while I am trying to ask important questions about my treatment. Wow, this is just a drop in the bucket!
Great writeup--but your three Things--will not do it.
Please read WSJ of May 30th,2007--front page:
HOW 10 People Reshaped Massachusetts Health Care.
1)That is the way to approach Health Care for people without insurance.
2) MalPractice--so long you have Lawyers/Lobbyist--major changes are not likely--perhaps only small changes at best.
3) Nationalize Drug Co.--All the advancements that has happened in the last 30 years is due to these Co.
Instead of your three points--Here are mine:
1) Provide Health Care for all like MASSACHUSETTS.
2)Insurance Co. and Clinics bosses have reduced Doctors to technicians--subordinates to them--Doctors are being told "what to do" to help their profits so they can make billions .
Seek Doctors who are independent of these Clinics and make the decisions--Best For Patients.
3)Get to know your doctor--do not select a doctor haphazardly.Make sure that your doctor is up to date on NEW ADVANCEMENTS.
Sorry, but there's way too much wrong with the US health care "system". Changing one thing would not have much impact in the face of the US's dismal infant mortality, longevity and other health statistics, ranking us near the level of Guam. 47 million US citizens have NO health insurance, and this number is growing daily, as more employers refuse to provide employee health insurance benefits. (And many of those with health insurance are under-insured, as well). Then there is the greedy pharmaceutical industry with its' price-gouging and incentives to physicians to prescribe their shamefully overpriced, over-hyped products. A single-payer national health insurer (Medicare for ALL citizens, for example) would take care of these problems--and would be the only insurer with the clout to control the ever-rising costs of healthcare in this country. It's past time we woke up and joined the rest of the civilized world in admitting that health care, as a "business," is morally inappropriate, and should instead be provided by the government to its citizens as the "right" that it is.
I could not disagree with you more about there being too much wrong. Too much wrong should never immobilize us to start.
“A Journey of a Thousand Miles Begins with One Step”
There are massive problems everywhere in the world- from what your perceive as the US Healthcare Crisis to Darfur. We can start with one thing. We need to start with one thing because we NEED to string together real successes and not the rhetoric of politicians who have yet to get things done.
A single payer appears to be your suggestions and well-noted. This may be the answer but there are a number of issues in that as well but thank you for this contribution.
Just one thing.
It’s a start.
Dr. K.
I'm going to have to disagree with the anonymous person that said healthcare in this country is a "right". It is NOT a right. There is nothing written about it in the Constitution. Nor is it the responsibility of employers to provide it.
I know this is a radical concept but what about personal responsibility? People are more interested in iPods, $200 shoes, cell phones and various other toys than they are about their own personal health. How about taking care of ourselves and paying for our own insurance? Nobody expects the government to provide homeowners or auto insurance, why should they provide health insurance? It is a proven disaster in other countries. I pay out the wazoo for my insurance and my husband's. I've had to sacrifice other things because of it but my health is my top priority. Hell, I've even had to sacrifice beer and that extra satellite TV package in order to pay for healthcare. What a travesty.
Do you know where the government gets their money? From people like me that have worked our butts off. I surely do not want to pay healthcare costs for someone that eats every meal at McDonald's and spends $200 a month on beer and/or drugs.
If Dr. K would give me one more thing I would say "personal responsibilty".
Sorry, Swank, but half of the bankruptcies in the US are due to the cost of a family member's chronic or catastrophic illness. And many of those bankrupted already had health insurance--but the benefits were inadequate to protect them from medical bankruptcy. Also, you seem to think "everyone" can get health insurance, even when employers don't provide it! (And even if everyone had the funds to pay for it, which they do not). Ever heard of "pre-existing condition" exclusions? Ever heard of anyone being turned down for private health insurance due to poor health? Your "personal responsibility" argument just doesn't cut it in the face of reality. (And, BTW, organized health care did not exist at the time the Constitution was written, but the Constitution gave Congress the right to legislate "for the welfare and benefit" of US citizens. That would include health care. Read it, you'll be amazed).
Yes, a single-payer health system is the "one change" we need.
But here's the thing. Health care doesn't cost that much. Greedy insurance companies and malpractice lawyers are part of the reason health care is so expensive. People that refuse to pay anything are another part of the problem. Ever read an itemized bill from a surgery? I can guarantee you it didn't cost $19,000 for the titanium in my knee, or $6 for a pencil. Bypass all the rot and let patients deal directly with doctors and costs will go down and we won't even need insurance. But people would also be expected to pay their share. Unfortunately, not many are willing to do that because they somehow got the idea it was owed to them. They've also somehow gotten the idea that they can't get medical care at all without insurance. When I was a poor college student I didn't have medical insurance but I managed to pay $10 a month for my medical bills. It took several years but I did pay in full. If people would just do that instead of paying $3 for a cup of coffee at Starbucks imagine the dent it would make.
People have more money than they think. But we live in a society that wants only to pay for what they want and not what they need.
Not all of us spend extra money on coffee, beer and cigarettes. I happen to be disabled and my husband works 3 jobs and we have a teenage daughter. We barely make it. Some weeks we can barely afford groceries. We don't have a savings account, or an IRA or any of those things. We do have 2 cars, a used one (1993) and a 2006 for me as I can't walk very well and my husband wants me to have a car that is reliable. My husband works in a neighboring town (40 miles away) 7 days a week. I use my car for doctor appointments and taking my daughter places. We bought our own house last year as we were living in a downstairs apartment and I could no longer walk up the stairs very well. So, we got one with no steps. I am on Medicare and on my husbands work insurance. I could not get private insurance. I have so much arthritis it isn't funny, plus I am obese and I have heart problems from the diet drugs, and there is a family history of cancer. Would you insure me? Not likely. My husband is of average weight, 6'2" and has a back defect he was born with. He also has a bad knee. Would you insure him? His premium would be rather high with back problems and we already pay over $120.00 a month just for his insurance. I will have 4 surgeries this year alone, and my daughter has to have her tonsils out tomorrow. Since 2000, I have had about 14 surgeries, mostly due to arthritis. Do you really think any insurance company would think that I am a good risk? Then you would be fooling yourself.
Swank, even if health care weren't a moral "right" which government in all wealthy civilized countries provides to its citizens, your "self-pay" scenario would only work for those who are wealthy or healthy in the first place. This country now has the worst personal savings rate of all time, yet you suggest people should just save up for or make monthly payments on their cancer treatment or heart attack care....get real! That worked well 100 years ago, but not now when care is much more sophisticated and expensive. ERs and hospitals would be going out of business even faster than they already are.
I agree with you that the insurance companies are greedy and pay their CEOs exhorbitant amounts. At this point, it will require a single-payer system to reign them in, IMO. However, your assumption that health care costs would decrease if we all self-paid instead of relying on insurance has no evidence to back it up, even if we could somehow afford this. (This assumption reminds me of the one about malpractice insurance rates declining dramatically when damage awards were capped. Didn't happen).
As for malpractice suits, they have never been a big factor in healthcare costs, and are definitely not now, after many, or even most, states have legislated caps on malpractice damage awards. (In fact, far fewer attorneys will even take a malpractice case now due to the low damage award caps).
One last thought--do you think it's fair for convicted criminals in prison to receive health care at taxpayer expense while many decent citizens go without? Single payer national health insurance is the only remedy for this injustice.
In answer to this question:
"I have so much arthritis it isn't funny, plus I am obese and I have heart problems from the diet drugs, and there is a family history of cancer. Would you insure me?"
Hell no!! But any kind of national health care system will force me to do just that. And I will have no choice in the matter. Why should I have to pay for your problems when I have enough of my own? And oh, by the way, I'm not anywhere close to being rich.
If I'm forced to pay for your health care should I be able to force you to eat healthy and exercise?
Swank, I'm not the same "Anonymous" that posted with the health issues, but, 2 things here: You, she, all of us, ARE already paying for her health insurance in the form of Medicare. But since you object so much to paying for others' health insurance, will you be turning your Medicare down when you qualify for it?? Of course not, even though others will be paying for YOUR benefits then, same as you are paying for hers now.
And what makes you so sure she caused her own problems, rather than the health problems limiting her ability to exercise, for example?
"Personal responsibility" is a good thing for us all to practice, but it's mean-spirited, judgmental and unfair to assume that's "the" answer to anyone's health problems.
Well, we're off topic so this is all I'm going to say about this. Yeah, I'll be collecting my Medicare, after all, I've been paying into it all my life. But I was born at the end of the Baby Boom Generation. By the time we're done we will have sucked Medicare and Social Security dry. Since today's generation has not been taught to take responsibility for their actions, expects the government to pay for everything and doesn't want to work, there will be nobody paying into any healthcare system. God help them.
MUCH BETTER INSURANCE COVERAGE FOR SENIOR CITIZENS PHARMACY NEEDS FROM MEDS TO MOBILITY AIDS
Yes, there are MANY things that need changed, but if you had to limit it to just one....i'd say managed care----remove it! When you have to wait a month or more to get approval for a proceedure, when your insurance company decides that your doctors are wrong and you don't need a medicine you've been taking for years, or when you get out of the hospital and are sent to rehab and the insurance says that the company gets $600 to take care of you and the rehab facility says that that amount will cover 1.5 days of drugs and treatments so you must leave after that, there's definately a problem. Our Doctors, hospitals and Rehabilitation facilities do not run or dictate our care any more, the insurance company does. And mostly the decisions are left to tables and huidelines read by a less educated person than myself and then signed off on by a Dr. who probably didn't even read the entire case, afterall his caseload is humungous!
Dear Anonymous, anonymous, and other anonymous:
First- could you at least make up a name so we can follow the thread of who said what. Anonymous is OK I guess when you are so wrong in disagreeing with Swank. I would be anonymous too if I actually thought that healthcare supplied by government or healthcare paid by others was a “right.” It is not a right. It may be law one day. It may be the right thing to offer but in no way it is a right currently. If Congress (a lot of sorry lawyers and other clods) gets their heads out of the rears of special interest groups long enough to make meaningful legislation it may be a legal right in this country. It could then be taken away by another law.
Let me give you an idea of a right:
Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
That is the first Amendment of the Constitution.
How about we peaceably assemble and petition our government for a redress of grievances concerning the disaster our healthcare system is in because they can’t make ANY law that helps the average citizen.
Dr. K.
OK, Dr. K, I'll adopt a name besides "anonymous" and participate if you promise to refrain from showing your perceived self-interest in keeping the present failing and dysfunctional health care system alive. So please, no more tacky name-calling about other professions, other's ideas or suggestions, etc. Not necessary.
You are correct, health care is not a legal right (except for Medicare) in the US, though it is in all other developed democracies. However, these countries recognize that basic health care is a MORAL right, which is why they have made it a legal one. And we ourselves recognize it as a legal right for our senior citizens, by providing them with Medicare. (Yes, it's still a right, though one provided through legislation and not the constitution. Constitutional rights are not necessarily the same as legal rights, though all constitutional rights are legal ones. Sheesh!)
My "baby step" suggestion is that we in the US should also recognize that it's a moral right not only for senior citizens, but for everyone. Why is it a moral right? Because it is inappropriate for it to be a commodity, as it is in the US now, since it is unlike other commodities (shoes or gasoline, for example) that people can do without if they had to. It is simply too basic to the population's welfare and life itself for it to NOT be considered a moral right instead of a commodity.
And then too, without a national health care system, think of the possibilities for the spread of infection, such as we have now. Other developed countries would never risk having such an inadequate public health system to deal with the next pandemic, or whatever catastrophe might happen. (Only the US, in its infinite wisdom).
So, yes, there really are a few functions that the government provides better than the private sector, and health care is one of them! BTW, there's no need for us to re-invent the wheel here--we only need to JOIN THE REST OF THE DEVELOPED WORLD. We should be studying their nationalized health care systems, learning from them, and tailoring them appropriately to our needs.
Doctors in America earn too much. There. I've said it. Also -- drugs and care are too expensive. It's cheaper and in many ways safer for Americans to get their care in Thailand or in other Third World countries. We need universal care and a drastic decoupling of Big Pharma.
Oh good God. Do you have any idea how much the average doctor makes? Nope, didn't think so. I'm sure Dr. K will correct me but I think orthopedic surgeons with fellowships are in school for something 14-15 years. After all that they deserve to make a lot of money. Feel free to go to Thailand though. My friend's son lived over there. He can tell you about medical care. On the upside, you can buy many drugs over-the-counter there without a prescription. Of course you don't really know what you're getting.
To wakeupfolks and warthog:
Point 1: Join the rest of the developed nations. I do not want t joint these countries- France, England, Germany, Sweden, Canada. Why- There healthcare systems have hosts of problems that are unacceptable to me and most Americans. First- In England you need to wait 6-12 months to get a joint replacement. In France- try to get healthcare if you are an immigrant with a job. The list can go on. What Americans want is perfect, error-free medicine- Cheap costs, immediate access, and highest quality. Try getting that in a clinic in Canada.
Point 2: The average total compensation (salary plus benefits) of doctors in America is:
Family Practice $148,000
Internal Medicine $160,000
Pediatrics $149,000
Reference (http://www.physicianssearch.com/physician/salary2.html)
If you think that is overpaying someone with that level of responsibility and job importance- let alone the average work week of 65 hours a week that you are truly either currently on hallucinogenic drugs or have your brain cells burned out from a life on these drugs.
Point 3: The question is not whether or not healthcare is a MORAL right but rather what do you mean by the word “healthcare?” Do you mean free healthcare, do you mean access to the best surgeon in American, and do you mean all drugs free. If would be nest to define which aspects of healthcare are a moral right and which would be a reasonable expectation.
Dr. K.
As a person suffering from a dibilitating illness, I only have one suggesstion. Do not allow hospitals to turn away patients. I'm not talking about insurance matters(I do have insurance). Recently a prominent hospital in Florida(I bet you can guess who) refused to see me after they told me the day before I had been approved. They gave no reason only stated that I could go elsewhere. Where's the justice?
Doctoring for almost a year with a GI specialist - tells me that I have had too many abdominal surgeries (TAH/BSO and laparoscopic exploratory) and this is causing adhesions to shut down my colon. I was devistated, pain and inability to eat escalated, lost 20 pounds. Finally have gallbladder taken out by another surgeon - there are no adhesions - I am pain free and eating again. I am upset and unsure how to address the GI doctor for such a bad call and months of pain, suffering, trauma, anxiety, medical bills, lost work??
Dr. K,
In response to your comments about not wanting to join the rest of the developed world, I must ask why not? All available evidence shows that these countries manage to deliver better quality of care, and deliver it to ALL of their citizens, for HALF the total cost of what we spend in the US to deliver it to SOME of our citizens. Hmmm.... And while elective surgeries in these countries do tend to have the waiting periods you mentioned, non-elective surgery and all other access to basic care is much quicker and easier, according to the citizens themselves. (And many mention that they are, for the most part, grateful for a health care system that does not put them at the mercy of insurers, who may or may not decide to insure them based on their health conditions! Imagine that!)
Another bonus--there's much less administrative cost in these countries, as well. (Administrative costs in the US eat up 30% of each health care dollar! Well, with the exception of Medicare, which costs much less to administer). Also holding down costs in these countries is the fact that they have no bloated Big Pharma and Big Insurance industries dictating prices, because a national single-payer system reins in Big Pharma with bargaining clout, and makes private health insurance optional, though necessary for non-basic services. (By basic care, I'm referring to the same level of care and medication cost-sharing provided by, for example, US Medicare).
Oh, and you'll like this--medical malpractice suits are much less common and less allowed in these countries, as any current or future medical or custodial care needed by a potential victim is provided by the government, at no personal cost to the victim, REGARDLESS of cause. (Not so in the US, of course--hence, one valid need for med mal suits here, alas!)
BTW, if you check the statistics for an NHS physician's salary, I believe you'll find they make an average that is comparable to family physicians, internists, and pediatricians in the US. The difference is that they don't pay certain other specialties what they are paid here--anesthesiologists, certain types of surgeons, etc., are way overpaid in the US, but not in these other countries.
NO system is or can be perfect, but ours is less perfect and way more unfair than it needs to be. (In fact, it's difficult to argue that we actually have a "system" at all! We should all be living in fear of the next pandemic/catastrophe, since we have no adequate means of dealing with such a disaster, unlike those countries with a national health care system. But I digress).
There's simply no evidence or rationale for arguing that a system where everyone is entitled to BASIC health care (i.e., what's necessary, not cosmetic, not unproven, appropriate at least cost, etc.) and which delivers better health and quality of life at HALF the cost, has more problems than ours! And it's a shame, because we are all the losers. If these other nations can provide such a system for their citizens, we certainly can, too.
Swank,
Actually, as the hordes of US uninsured/underinsured grow, and as more US insurers catch on that prices in foreign countries for medical procedures can be both safe as well as up to ten or twenty TIMES less expensive, medical tourism will just keep growing. Elective surgeries in countries such as India, Thailand, and other medical tourism destinations are excellent values, and generally no less safe there than here, if done in one of the many for-profit "state of the art" facilities meant to be utilized by foreigners. (And many of the doctors/surgeons were trained in the US or Europe). Of course, you do need to research both the hospital and surgeon, but that's the same here, IMO.
This is a relatively new phenomenon, but the only way many of the US uninsured can obtain the necessary surgery. These places will continue to enjoy great success at the expense of our private for-profit health care system, because those with no insurance can come up with/borrow the total of $12,000 or so necessary to cover the operation/hospitalization/rehab,plus airfare for two, including many extra amenities not provided in the US. Both the physicians and the facilities are generally top-notch, so US insurers are now getting into the act as well, offering a "no co-pay" deal to those of their insured who will agree to have their surgery done in these places.
Disadvantages? You'll likely be unable to sue if anything goes wrong, BUT, if you choose your hospital carefully, results have so far been overwhelmingly good. After all, these medical tourism facilities exist in order to, as they advertise, "be the world's health care provider", and many are fully accredited by the international hospital accrediting entity. Without national health care here, they will continue to make big inroads...in fact, I wouldn't be at all surprised if this was the face of elective health care in the US.
(Perhaps we should consider investing!?)
I am a disabled adult in KY, and have been greately dissatisfied with the health care in this state. Despite being disabled, I don't yet qualify for medicaid and according to the SSI/Medicaid guidlines for my state make $36 dollars too much a month to qualify for medicaid. Don't believe that I have plenty of money leftover to buy private health insurance on my own: after my rent is paid I have $152.00 a month to spend on gas, soap, my phone bill, car and renter's insurance, prescriptions, and non-charity healthcare. I take care of myself as best as I can - my lungs don't let me exercise; I recently had to cancel my gym membership because the last time I went, I caused a 2 month asthma exacerbation. My car has 3X as much damage to it as it's bluebook value; I don't have cable or any other luxry except a computer which I need to try to look for an employer that would be willing to hire me. Personal responsibility working to get me healthcare where I'm not in the red by $300+ every month is a dream.
After I graduated college and went back home to live with my parents to have surgery and then look for a job for a year and a half, I found the health care in NY to be great. During the six months I was covered by my father's insurance things were expensive but manageable. After that, his health insurance cut me off, and I had to get medicaid. It wasn't as if I didn't want to work, I couldn't find a job and I was looking hard every day. Because of my asthma I needed healthcare, and I needed medication coverage in order to properly look for a job. My ADHD meds cost $450.00 every three months alone - except for the medicaid. Medicaid paid for nearly everything and I qualified for that level of coverage because my income and assets were nonexistant. My family wouldn't have been able to pay for my healthcare otherwise. And there are different levels of medicaid in NY - you pay a premium/copay based on your income, assets and ability to pay. I believe this type of system should be everywhere with one addition - have the equivalent also for Rx coverage because some people work and have health insurance but their prescription copays put them in a hole every month; and since they have coverage, they are ineligible for prescription assistance programs. This type of a system may involve alot of administrative costs to determine eligibility, and if eligible, the copays for various things - but will ensure sufficient coverage to keep people healthy, so they can work, or at least if disabled, contribute to the household in chores or the community through volunteering. Also, by ensuring that doctors and hospitals get a reasonable minimum compensation for their services, it can allow some to stay in business and be adequately staffed, including having enough nurses, and enough residents to cover the hospitals around the clock so they don't work 100 hours a week, can therefore properly learn and avoid mistakes caused by fatigue. In KY, I've had bills written off because I couldn't pay them, which only leaves the hospital in the red for their services provided to me.
I believe this is the best solution for now simply because it allows privatization of healthcare while still ensuring adequate coverage for all and proper compensation to the hospitals/doctors/pharmacies for services, which will help keep costs down.
Also, has anyone wondered why it costs so darn much in this country to develop and test drugs before they can go to market and yet there are still holes in that testing process that don't exist in other countries where the cost of drug development is a fraction of what it is here.
ONE THING??? Is "all of the above" an option? LOL
Now I know how George W.Bush must have felt at his SAT's...
This one's going to require more thought than I'm capable of after reading about someone's stapled hemorrhoids.
Shel, my heart goes out to you, but that's more information than most people outside of the medical profession may have wanted to hear about. If you've seen four doctors but are still not in agreement with their opinion, seek and listen to the professional advice of a fifth one.
As far as not being able to live a "normal life", I wouldn't suggest letting anyone determine what you can or cannot do. Only you can set those parameters.
To All:
Thanks for the great comments so far. What have we learned?
There is really no concensus on one thing but it appears that people , in general, have had it with insurance companies making decisions for them and lack of access to qualified medical care.
As to the comparisons to all the lame studies about the health of developing nations- they have no vale in application here. The trial attorney lobby is too strong and developing nations do little to protect immigrants. Additionally the wait for surgery in unethical- a 6-9 month wait for a total hip replacement is the norm and tha is an operation that relieves intolerable pain- you can call it elective but it is in another category.
Dr. K.
Boy...to say this is interesting reading would be an understatement...
There are so many problems with healthcare that it is extremely hard to pick just one..
I guess my 1st pick would be to stop the insurance companies from making decisions that only the docs that see us should be making..
The insurance companies need to stay out of what patients and docs decide are medically necessary treatments..
My husband and I are self employed and have been for 25 yrs..
We make ok money but we work alot of hours and seldom take a vacation, we pay more taxes than most and having to buy private insurance is as much as a mortgage payment to most..
I have rheumatoid arthritis so we have to stay with the company we have because no other insurance company will insure me..We had to raise our deductible and we still pay more than $1000. per month and that doesn't give us coverage for eye or dental..My presciption benefits have lowered and we have to pay more out of pocket now than ever..
The middle class small business owner gets hit hard especially if you by chance have a disease that has to be treated..
I don't believe that docs are overpayed, they put in alot of hours and are at risk daily by the sue happy people out there and the liability coverage they pay to protect themselves is thru the roof...
Just an average, hard working citizen trying to make ends meet..
Cindy
Why does the public (and physicians, who should know better) continue to profess the belief that medical malpractice cases are a big cost driver of US health care? They never amounted to more than 1-2% of the cost, ever, (as per ABA statistics) and now, with LEGISLATED DAMAGE AWARD CAPS), one only has to do the math to understand that few medical malpractice suits are profitable anymore for attorneys to take--so few will take them unless the malpractice is blatant and pretty obvious!
Perhaps few people understand that medical malpractice cases are taken on a CONTINGENCY FEE basis, unlike physician fees. That means, if the attorney loses the case, he/she gets $0, along with the client. If he/she wins, attorney's fees can be no more than 50% in most states, regardless of how much time was spent on the case. So, in a state with a $250,000 med mal damage award cap, that means, EVEN IF they win, they'll be winning only HALF or less of a total MAXIMUM of $250,000 for what could be months of work. Do the math, folks, and you should be able to "get" why these lawsuits wouldn't be a big factor in driving up health care costs--though they continue to be a popular scapegoat.
Physician's MALPRACTICE INSURANCE PREMIUM RATES, on the other hand, continue to be high, because doctors "bought" the idea that premiums would go down when legislative caps were put on malpractice damage awards. (Should we be surprised that this did not happen, when these awards were not a big factor in determining malpractice premium rates in the first place?) Then Big Insurance laughed all the way to the bank...and now you know "the rest" of the story, as they say.
Dr. K,
If I had only one choice it would be to return the 'medical necessity control' to the practitioner. Too often patients' suffering is prolonged because their insurance carriers expect the practitioners to carry out the 'least costly alternative'. In in the long run, the insurance ends up paying for more tests or procedures because the 'least costly' sometimes doesn't work. The insurance companies claim this helps to deter fraudulent charges. Bull! They do that now by conducting random audits. Most, if not all the physicians who've been involved in my care plan have always chosen the LEAST INVASIVE treatment, unless the situation called for more aggressive measures (I've been truly blessed with fantastic doctors). But, I can only imagine their fights for reimbursement. However, I'm sure there are practitioners who don't fight the insurance companies because it can be an enormous hassle with no positive results no matter what is documented. So, hopefully, in the near future, practitioners will regain more control.
To "wakeupfolks":
You are correct in the general assumption that medical malpractice does not drive up health costs. Insurance company profits, pharmaceutical profits, and very sick patients drive the cost of medicine.
Do not fool yourself into thinking that medical malpractice has not diminished the quality of medical care. Many doctors in many states retired early and there are some fields that are in dangerous short supply.
It is almost comical to read your comment that "contingency fees" has some moral basis. Nice try. Lawyers and morality- pleeeeease! Contingency fees mean the lawyers have nothing to lose to sue whomever they want. How about this for tort reform: If in a a malpractice case, the plaintiff loses then the platintiff's attorney pays all the defense legal fees.
If there is a universal insurance then the universal insurer NEEDS to pick up the medical malpractice premium. Seems that they are tied together.
BTW- I don't agree with your comments but do appreciate the difference of opinion.
Dr. K.
Make "RECORD OF VISIT" mandatory:
The "single thing" would be to focus on EMPOWERING THE HEALTHCARE CONSUMER. For starters, make it mandatory that a provider (a physician, therapist or any other healthcare provider) provide the consumer with a "RECORD OF VISIT" UPON DEPARTURE OF VISIT OR SESSION--a receipt which summarizes the visit. Each discipline (whether it is related to medical or dental or any other therapy) can have their own standard "visit" form which is completed and given to the consumer/patient at the time of visit. This note (or record) should begin with the consumers' notation of their complaints or concerns on the form. This form should then be filled out by the provider to document their observations, assessments, and plan. The form could be in check-off format or simple fill-ins since many providers have illegible handwriting, or they can use a computer to record the visit. This action provides a sense of legitimacy of the visit and offers a clear record of what transpired. It reinforces to the physician the patient's concerns and provides the patients with instructions in writing. Such a document would also be helpful in obtaining second opinions. Overall it would empower the consumer.
It is sad to say that I receive better documentation (for my records) when I bring my auto in for service. My receipt lists my complaints and notes the mechanic's findings and services performed; it also notes the plan (to return for service after 3 months/30,000 miles for example). I also am made aware of the estimated costs up front. When I walk into a physician's office, I verbally discuss my complaints or concerns and many times walk out without having these concerns addressed. I usually have to ask the assistant for the blood pressure and heart rate results. There is nothing more important than one's health, in my opinion, so I think it is inappropriate that an individual who walks into a doctor's office, for example, is expected to remember all that was discussed--especially when the patient is not feeling well. Amazing!...sadly.
adejet,
I'm a little confused by your post. My doctors always give me a copy of my bill before I leave which has checkmarks for the reason for the visit and any procedures that were performed. You can just ask for it on the way out. But if they had to write a report after every patient they would spend most of their day doing that instead of actually seeing patients. Nobody is going to want to wait in the waiting room for that. Most doctors nowadays dictate a record of the visit into a recorder which is later transcribed. You're already legally entitled to that record. All you have to do is ask for it. Any time I have a test or surgery done I get a copy of the report. I take them and scan them into my computer so I can access them at any time.
As for bp and heart rate readings what's the big deal? Just ask whoever is taking the readings what the results are right then and there. Any time I have blood taken the results are dictated into a lab results database. All I do is call the number, enter my code and I get my results.
If your concerns are not being addressed before you leave the doctor's office then that's more than likely your fault. Most doctors ask if you have any more questions. If you don't answer then they can't help you. They're not mind readers and many people clam up when they're talking to a doctor. If you're one of those people write down your concerns before you go so you don't forget.
The first time I saw my current orthopedic surgeon he started leaving the room before I was finished asking questions. I told him I wasn't done with him yet. He laughed, sat down, and told me to fire away. Now, two years later we have a great relationship and he asks permission before he leaves the room.
Good doctors are going to try and help you. But you have to help them by making all your concerns known. You are in charge of empowering yourself, not the government.
Come on!! Do you really want our Government in charge of your health care?! We provide the elderly with Medicare, so what do they want next? Pay for our drugs!!
I agree with Swank. People spend all of their lives throwing their money on the latest conveinence, than whine when something goes wrong!! WE ARE ALREADY TAXED TO DEATH!!! Of coarse, all of you whiney butt liberals wouldn't know about paying taxes, now would you?
One change? No more freebies to Doctors from the drug companys!! Recommend the right drug for me, not the one your drug company rep gave you all of the freebies to recommend.
Dr. K,
I'm not sure what you've been smoking, but I said nothing about "morality" having anything to do with contingency fees, cases, lawsuits, etc. However, I noticed that one driver of health care costs you conveniently omitted is "physician's fees". (They are too high, in many cases).
Oh--and I'm sure you'll agree that turnabout is fair play, so if you expect losing plaintiffs to pay for the physician's legal fees, why, it's only fair that physicians agree not to charge patients for treatment if their treatment doesn't help the patient. (Now there's a sensible and fair swap--perhaps the "baby step" that we all, as US consumers, can finally agree upon!)
Yes, I think that's it:
Because health care in the US is a commodity just like any other, inferior/unhelpful service should not be paid for. The maltreated/unimproved patient deserves a refund from the physician, just as he/she is due a refund from the auto dealership when ending up with a "lemon" there. And if this change were instituted, I'm certain physicians would have fewer--even less than now-- malpractice suits to complain about, as well!
If I could change one thing I would change the way we all think about getting medical attention. I have never heard anyone EVER ask how much something costs, but we are quick to sue for millions when something doesn't work. A universal system like Canada would never work in the States. As Americans when we want medical attention when we want it now. Imagine having to tell your mother that she can't have chemo for 8 months because she's not first in line. The same thing will happen here, all the best doctors will leave and the patients who can afford private insurance will buy it.
Gee, Anonymous,
If all those "bad things" happened in Canada (or in any of the other developed democracies--all of who have a national health care system) then HOW COME the World Health Organization, the Commonwealth Fund, etc. rates all those other countries above the US in health, longevity, infant mortality, you name it! And how come their doctors didn't leave?
Yes, we will proudly soldier on, with our sadly broken health care "system" until all the ERs and hospitals go under (we are almost there) and the majority of our citizens are obtaining their health care in India and Thailand (see above posts.) Hmm....seems like that might put our US doctors out of business, too. But oh, well....health care is but a commodity on the "free market", and we all have the freedom to get it where we can afford it. (Which is increasingly in other countries!)
BTW, I hope you never have to rely on getting any crucial emergency medical assistance in a US ER--many are now so overcrowded that ambulances are routinely diverted to other ERs, which proves fatal to many, as they cannot be treated as quickly or adequately as their condition requires. But, OH WELL, at least we don't have the horror of "national health care" like all those other (bad=foreign!) countries do!
If that gives you comfort, then, good luck!
To the above comments:
Since when did the World Health Organization and the COmmonweath Fund become the final judge oof healh care. They are important organizations that do serious work but they only add to the solution and there work needs to be read in its original form and not used a sound bite quotes.
Healthcare is so much more than mortality and longevity rates. It includes acces to care in a complex environment as well as the expectations of the population.
I suspect that many of these studies in developed countries like in Europe did not canvas the many illegal immigrants in that country or legal aliens who work there- especially in France.
The problems in healthcare begin with our broken insurance industry that is removing dollars from the care and placing them into for profit shareholders. ER's are in trouble because hospitals are in financial trouble. While the CEO of an insurance company has a private jet, hospitals are desparately looking for donors to help with finances.
Medicare has severely cut back paymetns to docotrs and hospitals (total hip replacement for Medicare- $1400) but insurance companies are the robber barons.
Doctor K.
Can't Believe I missed this one.
I really enjoyed wakeupfolks comments on contingency fees. I think it is a great idea! As hip replacement comes with it a 98% patient satisfaction rate (far better than any trial lawyer's success BTW) I would defintely do surgery on contingency- The current Medicare reimbursement for a hip replacement is $1400 (wakeupfolks seemns to think this is overcharging). As this operation totally transforms a person's life allowing them to walk and work again and live pain-free what is that worth- $2000? $20,000? or on contingency is it a permanent percentage of the money the patient gets by being able to return to work.
Bring on contingency fees and lets have Medicare pay the lawyers!
Doctor K.
So what's wrong with endorsing and investing in a product that you know works 98% of the time? Wouldn't you want those odds if you were getting a new hip? Sounds like good financial planning for the future to me. It also says he's a consultant for the manufacturer. Who better to be a consultant than an expert that uses the product? I think you can rest assured he's not going to put a crap product in your hip solely for financial gain. If Dr. K lived closer to me he would have been the one to replace my knee. That's if he could stand having me hold him hostage until all my questions were answered to my satisfaction.
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Thank you.
Why don't people realize that they need to take responsibility for their own health? The starting place is: (1)Proper amount of restorative sleep(2)Good Nutrition based on unprocessed foods and elimination of sugar(3)Exercise...people need to get off their lazy butts and move. (4) Minimize Stress by dealing with life as it is instead of being weak and turning to drugs/alcohol.
If people made the above (no cost-low cost)lifestyle changes, they'd have less need for medical care. The reason health care is the way it is in this country is because people won't take personal responsibility for their own health, and have bought into the fear that those who stand to profit have created.
ONLY GOD & NATURE HEAL
We the People can make things happen...step up to the plate!
LZ
Take Michael Moore off the organ donors list..........
Take care of yoursel and yourself will take care of you and teach this to the children. And the health of the nation will improve.
I am Canadian but have also lived in the States. My one thing would be to definitly have a one payer systrm such as Canada. Sure it has its problems but nothing like the American system where you pay and pay or else arn't able to get any health care.
Summary:
I took the time to review the many posts to date and here is a list of the “Just One Thing You Would Change in Healthcare.” I tried to prioritize the list based on the number of times something was mentioned with a somewhat subjective view of how passionate the blogger made their point. In the coming year I will try to have my own blog entries expand on each of these individually.
Insurance companies- their interference with decision making
Insurance Companies- regulation on their financial responsibilities to pay
Change the “For Profit” structure of American Healthcare
Develop a national single payer insurance system
Develop a Medicare/Medicaid/National system that takes into account a person’s ability to pay- lower incomes pay less, wealthy do not ever qualify for Medicare
Outlaw Managed Care Insurance
Concentrate more on a patient’s rights in the healthcare process
Insure the Uninsured
Do not allow hospitals to turn away any patient
Regulate the greed of the Pharmaceutical companies
Doctor payments should be less
Patients taking personal responsibility for their health
Drug Health benefits
The way doctors are trained
Medical Malpractice Reform
Improvement of Hospitals- Better Staffing
Managing the costs of catastrophic illnesses
Dr. K.
When a doctor treats a Medicare patient, he/she loses money because of the very low government reimbursement rate paid to doctors compared to the actual costs involved. So think twice if you believe a universal government health care plan is the answer. Who pays for this "free" insurance? You and me, the taxpayers. The brightest and best doctors will be no more because they will attract to other professions where they will get paid what their intellect is worth!
The above comment if correct in that a forced single payer system effectively is communism in the land of capitalism. Absolute nonsense to have a forced single payer system. This will have long-lasting effects on all aspects of healthcare that we are not ready to absorb.
On the other hand, if there was a single payer system where all doctors can opt out with no repercussions and the patient will still get reinbursed the single payer rate on an our-of-network event then the market will correct itself.
More on this is an upcoming blog entry.
Dr. K.
Take all the profit that health insurance companies make and distribute it evenly and fairly among the unfortunate sick and in promoting preventive and wellness medicine. For this American Ingenuity can come up with a system modeled after the UK's NHS. After watching "Sicko" I starting wishing I had never left the UK and wish my family obligations did not prevent me from moving back. I have two children who have chosen medicine as a career, I am encouraging them to seek life career opportunities in the UK or lobby our politicians to promise us Universal Health Care, American Brand: USuniverssal Health: USUHCare: GoogleHealth, YahooHealth, USGoodHealth, HealthyUSA.
Doc,
I would expect better of someone of your education (and someone who seems so adamantly anti-insurance company) than to perpetuate these ridiculous myths about "trial attorneys driving up health care costs."
HMO profit margins, and those of the insurance industry overall, continue to grow, and grow, and grow. Trial attorneys aren't putting anyone out of business. You don't seem to reject that argument, you just mention offhandedly that lawsuits are forcing doctors into retirement.
If you, your wife, your children, or anyone close to you were the victim of medical malpractice, would you just "take one for the team?" I seriously doubt it. You'd do the same that anyone else would do in case of mistaken amputation or any other grievous mistake committed by a professional with the degree of training that American doctors are required to have; you'd sue. If there are honestly doctors that are retiring because they've been malpracticing SO MUCH that they can't make a living, then maybe they *should* retire.
Your analysis of contingency fees is shortsighted and flat wrong. It's not a free ride for a trial attorney to take any case on a contingency fee, and particularly not a medical malpractice case. What a contingency fee agreement means to an attorney is: hundreds of hours of potentially unpaid work, and hundreds of thousands of dollars worth of litigation costs. The plaintiffs aren't paying these costs. Attorneys eat the costs up front and don't get paid unless the case is won. (For the record, physicians get paid quite well for the time they put in, regardless of success.) If it's not a really, REALLY good case - in other words, if there's some chance that a doctor did not malpractice - then very few attorneys would take the case, and those attorneys would likely be counter-sued and subject to discipline by their respective state bars.
Furthermore, you surely know that the ONLY POSSIBLE WAY an attorney can win one of those cases is to get another doctor - an expert - to testify against the malpracticing physician.
One other thing you might want to consider: if doctors were government employees, they'd likely have governmental immunity from suit. I don't expect that to change your mind, given your adamant insistence that a system of socialized medicine - despite being the norm for every other industrialized nation in the world - simply won't work in this country . It's funny that you suggest a reform to the legal system (i.e., that the plaintiff bear the costs of litigation if s/he loses) that is the norm in the UK, but refuse to believe that a system that has worked for 60 years in Britain is somehow unmanageable in the U.S.
The assertion that trial lawyers are driving up health care costs is a specious, facile analysis. After all, attorneys are the straw men of society. Everyone hates a lawyer until you actually need one. Attorneys are the only means by which normal, middle-class folks can receive any compensation for someone else's negligence. Seriously - how many doctors do you know who would commit a serious error, one that cripples a patient for life, let's say, and then freely admit culpability? "Oh, sorry about that Mr. Johnson. Let me pick up your future medical bills, and your lost wages for the 6 extra months of work you'll have to miss because of my screw up." Doesn't happen.
Of course, in a socialized system, you wouldn't have to worry about any of that...
Harveybirdman,
The actual cases where a doctor does something like cut off the wrong limb are pretty rare. In every case where I’ve had surgery on a limb they write a big “NO” on the limb I’m not having surgery on and the doctor comes in and signs the one that’s having surgery. That’s probably a one in a million occurrence nowadays. Most of the time people are filing frivolous lawsuits simply because they can. I’ve read message boards on WebMD for years and there are countless posts from people that want to sue their doctors for various things. Often because surgery didn’t come out exactly as planned, or they got an infection or any number of things. All known complications of surgery. A coworker’s friend wanted to sue his doctor because his back was screwed up after surgery. Never mind that he didn’t do a thing the doctor told him to do, didn’t go to physical therapy and started working on cars a week later. In his mind it was the doctor’s fault. People want to sue if they have an allergic reaction to medication that they have never taken before. Somehow they expect the doctor to know this sort of thing will happen ahead of time. And it’s not just doctors, this is a sue happy society and people will sue for anything they can. Why? Because they get away with it. Whether a doctor did anything wrong or not they (or their insurance company) are still going to have to pay to take a case to court. They often settle just because it’s cheaper than fighting. Of course this encourages more lawsuits. Auto insurance companies do this sort of thing all the time. Ever watch daytime TV? Every other commercial is a lawyer encouraging you to sue for an accident, or because you’ve taken some drug, whatever. This sort of thing doesn’t happen in the UK because they have a “loser pays” system. This means if you file a lawsuit and lose, you pay court costs for both parties. Unless you have a really good case, no lawyer is going to take your case. We need that here.
A national healthcare system like they have in the UK will never work here. People in the USA are used to getting things done quickly. From reading a message board based in the UK and having friends there, I’ve learned a few things. If for instance, you injure your knee, you could wait weeks to get in to see a GP. It’s up to him to decide if you need to see a specialist. If you get that far expect weeks or months before you can see a specialist. And oh, by the way, you don’t get to choose your own doctor. You get who you get. If an MRI is ordered expect to wait several more months. And then expect weeks or months for someone to actually read the MRI. In some cases the MRI actually gets sent out of the country so it can be read faster. Then of course, you have to wait again to see the specialist. If you need surgery expect to wait months. And you’ll have to wait around for a phone call or letter that gives you your surgery date. Whenever I’ve needed surgery it gets scheduled right then and there. More often than not, you can expect your surgery date to get changed. For an added bonus, when you finally make it to your surgery date, there’s no guarantee that the surgeon you get will be the one that you have been seeing. Do you really want this kind of healthcare system? Not me. Anytime I’ve needed surgery I’ve gotten it scheduled within a month unless it was my choice to schedule it later. I can call my doctor and be in his office within a day, get an MRI scheduled within a week, have a follow-up appointment and be in surgery in less than a month. You can schedule when it’s convenient for you and plan accordingly. I’ve been seeing the same family doctor for eight years. We know each other well. Forget about that in the UK.
When my friend in the UK discovered he needed double bypass heart surgery he had to wait two months for surgery. My mother waited one day. One thing you don’t hear about much here is the number of people from Canada that come into the US for various medical procedures. It happens all the time but those in favor of national healthcare don’t want you to know about it. Any national healthcare system that doesn’t allow doctors and patients to opt out will be a national disaster.
Response to harverybirdman:
I don't think that anyone reasonable puts forth the argument that medical malpractice directly drives up costs. Many things drive up costs. Medical malpractive is one of them.
I did enjoy Mr. Bidman's views:
His statement:
"Everyone hates a lawyer until you actually need one."
No, Mr. Birdman- everyone even hates their own lawyer. They actually do.
Here is another one:
"(For the record, physicians get paid quite well for the time they put in, regardless of success.)"
Actually, for the record a hip replacement reimburses approximately $1400.00. This includes the operating room, every day in the hospital, and 90 days postoperative care.
While I do believe that medical malpractice is not "the one thing" to change in healthcare it is clearly one of the many broken things whether you or any other trial attorneys want to admit otherwise.
Doctor K.
UNIVERSAL HEALTH CARE PROVIDED BY THE GOVERNMENT. PERIOD.
Here is one thing:
Completely eliminate third party payments.
Doctors are happier, they have more time, they earn more and therefore care more and study more.
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