Health Care

That is a horrible story, and I hope several licenses are lost and criminal charges levied if justified. However, don't act like that is the normal way poor/minotrities are dealt with in the medical community here. It's not even close.

blatantninja said:

That is a horrible story, and I hope several licenses are lost and criminal charges levied if justified. However, don't act like that is the normal way poor/minotrities are dealt with in the medical community here. It's not even close.

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Yes, I thought you and/or dte would call me on that one. I won't even go there with you. And I really don't know the woman is poor--that's an assumption--an assumption based on the fact that if she could afford better care, she would have been somewhere else. Maybe we can agree that's she's black, and she's dead?

bn--I don't want to be offensive, but please don't tell me how to "act." I'm not "acting"--I have strong feelings about how the disadvantaged are treated and I also have personal experience of it. Yes, this is an extreme example, but it also points to a larger issue, which of course, you can choose to avoid and ignore if you so desire by saying "most health care is better than this." Things like this should NEVER happen to anyone, and that they can and do says more than I ever will be able to.

magerette said:

Yes, I thought you and/or dte would call me on that one. I won't even go there with you. And I really don't know the woman is poor--that's an assumption--an assumption based on the fact that if she could afford better care, she would have been somewhere else. Maybe we can agree that's she's black, and she's dead?

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She probably is poor. Sadly, many people that are mentally handicapped end up that way.

bn--I don't want to be offensive, but please don't tell me how to "act." I'm not "acting"--I have strong feelings about how the disadvantaged are treated and I also have personal experience of it. Yes, this is an extreme example, but it also points to a larger issue, which of course, you can choose to avoid and ignore if you so desire by saying "most health care is better than this." Things like this should NEVER happen to anyone, and that they can and do says more than I ever will be able to.

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I don't avoid it, I understand the reality of it. And yes, while this should never happen to anyone, it is still sensationalistic to showcase it as a prime example of what is wrong with our healthcare system. There are far less sensationalistic things that are still very widespread and very disturbing.

Clearly not a representative sample, but clearly reprehensible. Looks like the legal system is gearing up, which is appropriate in this case.

You're highlighting a single datapoint to support your position, which is problematic, as you've already noted.

Now, the interesting question here is whether a "beyond the pale" situation like this is more likely in a market-driven system like ours (designed to give only such care as money will buy) or a public-driven system like Europe's (well documented for ridiculous waits for often sub-standard care). Obviously, this situation happened on our watch, but I'm wondering what the broader picture truly is.

bn wrote:

I don't avoid it, I understand the reality of it. And yes, while this should never happen to anyone, it is still sensationalistic to showcase it as a prime example of what is wrong with our healthcare system. There are far less sensationalistic things that are still very widespread and very disturbing.

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I'll agree to being "sensationalistic"--even though all I said was that this case "points out how bad it is to be poor/minority and needing health care in America." But then you have to agree to being defensive and jumping all over the point to imply it's not valid. I don't see how "more widespread and disturbing things" being out there in any way makes this example less heinous, or less indicative of the flaws in our healthcare system.

I agree, though, I do tend to be melodramatic and emotional in my assessments, which tends to make for a less even playing field when talking with those who don't look at issues from the emotional end of the spectrum. If you're reacting to my over-emotional approach and trying to tone it down a bit, I understand that. But don't overlook what's really happening here. No fines or criminal charges are going to bring back this woman's life, which was lost because it had no value to the system designated to preserve it. Why exactly do you think that was?

magerette said:

which tends to make for a less even playing field when talking with those who don't look at issues from the emotional end of the spectrum.

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I think I just got called a cold-hearted bastard...

( )

Naah--just a guy. The republican part is just icing on the cake, though.

magerette said:

I'll agree to being "sensationalistic"--even though all I said was that this case "points out how bad it is to be poor/minority and needing health care in America." But then you have to agree to being defensive and jumping all over the point to imply it's not valid.

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I'm as guilty of being emotional on these issues as well. I'm in the )maybe upper) middle class that is feeling squeezed as it is and then people want to suck even more money out to pay for things like universal healthcare. I get very defensive about my taxes going up!

No fines or criminal charges are going to bring back this woman's life, which was lost because it had no value to the system designated to preserve it. Why exactly do you think that was?

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It was because someone failed in their job. This is what bothers me about argument for universal healthcare. This woman (and I am making assumptions here) most likely already qualified for medicaid. Maybe she was taking advantage of it, maybe not (unfortunately in the case of the mentally ill, it is usually the latter), but she had access to a government plan. I'm not going to pretend that medicaid buys the best care out there, it doesn't. But she had access.

The problem was the staff were she was behaved in at best a negligent and at worst a criminal manner. And the other patients, that could have at least tried to call another doctor (since the one that showed up didn't seem to care), did nothing either. How is universal healthcare going to fix that? Especially if we end up with a hybrid system? If I understand them correctly, in a hybrid system, doctors can still choose whether or not to accept universal plan members, so the best are still going to be in a private practice, and we're going to be left with the lower end of the medical profession handling the masses. How is that any different or better?

blatantninja said:

I'm as guilty of being emotional on these issues as well. I'm in the )maybe upper) middle class that is feeling squeezed as it is and then people want to suck even more money out to pay for things like universal healthcare. I get very defensive about my taxes going up!

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You know what they say about death and taxes. I'm willing to guarantee that your/my taxes will go up regardless of whether universal health care comes to pass, or who is elected the next president. At least if they went up in the interests of health care you might be able to afford to get sick, whereas paying for more military bases in Iraq won't be much help to anyone but the military contractors.

It was because someone failed in their job. *snip*

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Agreed, but it is also because the system sets that person up to fail--it's overloaded, underfunded, and poorly managed. In a word, broken. That was really all I was intending to point out with my OP.

How is universal healthcare going to fix that?...How is that any different or better?

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Obviously it *may* not be any better. Can you agree with me that it also *might* not be any worse? I understand, and have even argued, that with our government's track record government regulated healthcare seems doomed to be boondoggled in a quagmire of bureaucracy. Nonetheless, like the energy crisis, something has got to be done. I don't know if universal healthcare is the last best answer, but it seems to be working well in other countries when it's done right--why shouldn't it be possible to have it work here, to overhaul and fix the system we have now so that it works for everyone paying into it?-(and most people receiving medicaid pay into it at some point in their lives.)

The problem is that most people have lost all expectations of our government actually doing its job. We just sit back and complain, and expect that nothing will ever change for the better.

In short, I'd like to believe that it's possible for our government to be competent, and to run efficiently if the citizens pay attention and demand that it do so instead of expecting that any change will be for the worse.

magerette said:

The problem is that most people have lost all expectations of our government actually doing its job. We just sit back and complain, and expect that nothing will ever change for the better.

In short, I'd like to believe that it's possible for our government to be competent, and to run efficiently if the citizens pay attention and demand that it do so instead of expecting that any change will be for the worse.

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Tru dat!

The problem is that, given the breadth of opinions among our citizenry, no organization is capable of meeting even a majority of the requirements, particularly given that those requirements will constantly change on the chaotic waves of self-interest.

And that's assuming that said organization actually attempted to focus on the citizenry rather than its own perpetuation... (it just wouldn't be the same if I didn't throw in a pinch of cynicism)

dteowner said:

And that's assuming that said organization actually attempted to focus on the citizenry rather than its own perpetuation... (it just wouldn't be the same if I didn't throw in a pinch of cynicism)

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The two aren't necessarily at odds, you know.

I really don't know how I'd fix American healthcare, but I can identify a few big, structural inefficiencies that need solving:

(1) Insurance companies spend enormous amounts of resources finding ways *not* to pay for healthcare, by carefully vetting applicants, wording contracts, and disputing them. If these resources were spent on treating people, they would buy a quite a lot of it.

(2) Medical professionals spend enormous amounts of money on malpractice insurance. If these resources were spent on treating people, they would buy a quite a lot of that too.

(3) Limited medical coverage, which a great many of you guys have, will generally pay for treatment of existing medical conditions, but not of preventative care. So, for example, if a diabetic's toe goes gangrenous, insurance will cover the cost of the amputation. However, most insurance *won't* cover the much, much lower cost of physical therapy that would have stopped the toe from going gangrenous in the first place. This is much more expensive *and* much harder on the patient; it's also a drag on the national economy as someone recovering from an amputation won't be able to work, whereas someone getting physical therapy once a week is. "An ounce of prevention is worth a pound of cure" and all that.

(4) Conversely, people with (virtually) unlimited medical coverage get prescribed a lot of completely unnecessary and often expensive tests and treatments. Under this system, the doctor has the incentive to prescribe everything possible, "just in case," since that's where the money comes from, and the patient has no incentive to refuse them, since he isn't paying for them. Again, massive resources get used with no tangible result.

IOW, your current system has perverse incentives, which lead to enormous waste of resources at all levels -- insurance companies working hard not to pay or not to insure those people who most need the insurance, patients ending up in expensive treatments because they put off cheap preventative care because their insurance wouldn't cover it, doctors prescribing expensive but unnecessary tests and treatments to patients who don't need them and don't pay for them, and *everybody* employing an army of lawyers to sort out the mess when something goes wrong, or to prevent it from going wrong (in the legal sense).

Now, I'm not saying that a universal health care system, or single-payer medical insurance with identical conditions for all, would be the *only* solution to these structural problems, but it is certainly *a* solution to them (other than the malpractice stuff, which would require changes to tort law). If you can figure out a way to solve these problems some other way, while keeping the things that do work well in your system, more power to you. I'll be watching with keen interest.

Prime Junta said:

(1) Insurance companies spend enormous amounts of resources finding ways *not* to pay for healthcare, by carefully vetting applicants, wording contracts, and disputing them. If these resources were spent on treating people, they would buy a quite a lot of it.

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This is certainly true to some extent. I'm not sure just opening the floodgates would fix it, but I think it could be streamlined to a much better extent. A great example is the over-charged bill--> insurance kicks it back at a lower cost --> then you get billed for the deductible scheme, which is primarily caused by Medicare's reimbursement policies. Lots of waste there.

(2) Medical professionals spend enormous amounts of money on malpractice insurance. If these resources were spent on treating people, they would buy a quite a lot of that too.

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They passed tort reform in Texas a few years back, and it's a mixed bag of returns. On the one hand, as malpractice insurance rates have declined, the number of doctors moving to Texas has increased significantly, giving us a better pool. On the other hand, when you legislate something like tort reform, you end up with some cases that actually DO deserve larger amounts in a settlement getting artificially capped. Personally, I blame the legal community. They simply don't police themselves and are far too interested in getting the biggest judgment and not the right judgment. Also, you get doctors that may have really high rates elsewhere because they make a lot of mistakes now coming to Texas.

(3) Limited medical coverage, which a great many of you guys have, will generally pay for treatment of existing medical conditions, but not of preventative care. So, for example, if a diabetic's toe goes gangrenous, insurance will cover the cost of the amputation. However, most insurance *won't* cover the much, much lower cost of physical therapy that would have stopped the toe from going gangrenous in the first place. This is much more expensive *and* much harder on the patient; it's also a drag on the national economy as someone recovering from an amputation won't be able to work, whereas someone getting physical therapy once a week is. "An ounce of prevention is worth a pound of cure" and all that.

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I have no idea what the statistics are on limited medical coverage, but my impression has been that it isn't that high. Every employer I've worked for has had full coverage, and even when I was unemployed I had a full coverage individual package (which interestingly, at least in Texas, if you have been covered by a group plan for at least 3 yrs prior to getting an individual plan, the individual plan can't exclude anything for pre-existing conditions).

But yes, I think we really need to push preventative medicine. In fact, that is one of the problems with the uninsured. If they have something that finally gets bad enough that they HAVE to see a doctor, it's more expensive to treat since it wasn't caught early and they will likely go to the emergency room, which is the most expensive place to treat something.

(4) Conversely, people with (virtually) unlimited medical coverage get prescribed a lot of completely unnecessary and often expensive tests and treatments. Under this system, the doctor has the incentive to prescribe everything possible, "just in case," since that's where the money comes from, and the patient has no incentive to refuse them, since he isn't paying for them. Again, massive resources get used with no tangible result.

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They've tried various ways to control this (the HMO being the most notable), but it never seems to work. I'm not sure how much doctors benefit from extra tests (just don't know how much, if anything, they get paid for these things since the doctor prescribing usually isn't the one doing them). Regardless, I haven't yet seen an effective way to eliminate unnecessary tests and treatments. If you have too many approval levels (like an HMO), you waste as much in bureaucracy.

How do they do it in a universal plan? Does the doctor have to get the procedure's approved at a higher level? Or since I assume they are just paid a salary, the thought is they have less incentive to order extra tests (assuming they benefit from them)?

blatantninja said:

How do they do it in a universal plan? Does the doctor have to get the procedure's approved at a higher level? Or since I assume they are just paid a salary, the thought is they have less incentive to order extra tests (assuming they benefit from them)?

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There isn't any single way of doing it, just like there isn't any single model for a universal plan. At least in Finland, individual physicians have a great deal of discretion over what they prescribe. A patient will have to go through the system "bottom up" -- first talk to a nurse, who will make an appointment with a GP; the GP will then authorize tests or refer the patient to a specialist. Emergency rooms work much as they do in your neck of the woods, of course. In this system, there are no financial incentives for physicians to prescribe unnecessary tests or procedures "just in case," so generally speaking they don't.

(The Finnish system isn't terrible, but it's far from the best out there either, except in pediatrics where it really is rather good; if you want an example of a really well-run public health care system, you should look at France.)

This BBC news article surprised the heck out of me. No dentistry, spectacles, not even a GP consultation for the poor? Amazing for the richest country in the world.

Excellent article, Dyne, and rather ironic that a charity originated to help third world countries is doing 60% of it's work here in America. Yes, many insurance programs have separate plans for vision and dental, but if you have no employer-based insurance, then you have no plan except buying private policies(expensive) or state aid, which is spotty. As a little girl, my single mom took us to the U. of Chicago dental school for free dental care from the students. I still have the hole where one of them pulled my permanent molar thinking it was a baby tooth.

magerette said:

This is one of the most disgusting stories I've ever seen--and points out how bad it is to be poor/minority and needing health care in America:
Mental Patient Dies in Waiting Room while Staff Does Nothing

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It's in the press today, even here !

It's horrible. "Disgusting" is still an understatement for me.

Plus it's said to be the second case of that that comes to public attention - although in the article someone is cited who says that it occurs much more often without being noticed.