<p>I guess from what little I know and have seen, the Obamacare paradigm will not survive the tumultuous years ahead in its current form. It tries to do too much with too little. The new bureaucracy will cause a great deal of headaches in the meantime and almost every practicing (non-academic) doctor I’ve spoken has confirmed this. </p>
<p>Now, more than ever, it will be important to have a doctor or two in the family who knows the in and outs of the system methinks.</p>
<p>Most folks who claim that the U.S. has the best health care in the world have never had any experience of health care abroad. They haven’t seen that the standard of care in France is for physicians to come to your home. They haven’t seen world class diabetes clinics in Chennai, or had state-of-art heart surgery in Delhi, or had integrated allopathic/naturopathic care for Parkinsons in British Columbia.</p>
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<p>This is so true, romani. Fifty million of our fellow citizens have no insurance at all. But there’s another class of Americans, a class which includes my family – the under-insured. We pay astronomical premiums for terrible coverage; as a result, we pay through the nose for the medical care we get, and have at times opted not to get treatments and tests because our deductible is so high that we might as well not have insurance at all.</p>
<p>As mentioned above, medical bills are the most common reason for personal bankruptcies. But here’s the part that really scares me: Most of those people had health insurance. Something is very, very wrong.</p>
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<p>Fear of the unknown replacement (especially among Medicare socialized insurance users who fear that their Medicare socialized insurance will be reduced in any change).
Vested interest lobbying (insurance, hospitals, doctors, lawyers, drug companies, AARP, etc.).
No consensus on what to replace it with.
Partisan politics and the frequent use of Senate filibusters to cause failure rather than try to create success.</p>
<p>^^ I think the single biggest hurdle to change is that the insurance industry has managed to implant in the collective brain the canard that universal health insurance is “socialized medicine” and “government-run healthcare”, when in fact, no such thing has ever been proposed. And they’ve been wildly successful at confusing health CARE and health INSURANCE in the public mind.</p>
<p>Strange that when people turn 65, they and their lobbying organization suddenly become staunch defenders of socialized medical insurance for themselves (but not for everyone else).</p>
<p>Was speaking with a paramedic this evening about healthcare on Guam, which is a US territory. Not so long ago, the MD husband of one of the nurses with us flew there fairly reguarlyl to provide medical care. She said he stopped going there some time back after being “stiffed too many times.” He & his hospital system would provide care for which they would bill–including him flying there. More often than not, they would NOT be paid. The paramedic saw this a part of the corruption on Guam which does not see fit to pay the bills due and owing.</p>
<p>The paramedic said the same thing happened with the company who employs him, which is why they no longer provide care, getting the often VERY ill/injured patients from the airport to the hospitals.</p>
<p>When we go out into the communities, we meet many people who are getting healthcare I find very upsetting. Today, we met a man who said he had a bad infection and now only one of his lungs works properly and the other only seems to work partially. The docs (including a specialist) have been unable to offer ANY explanation, treatment or medication and he’s feeling breathless and is pretty upset. We encouraged him to continue to press for answers and some treatment.</p>
<p>We have also met many smokers who have NEVER before had any medical professional recommend that they quit smoking or offer them ANY help in quitting. I find that very troubling. We also find many people with significant low lung function (often close to 1/2 or less of what is predicted for a “normal” individual of the same height, age and gender) who have never been tested, even though some have complained of symptoms, some are current or former smokers. Many report having insurance!</p>
<p>I been fortunate to have access to medical care, as we have good insurance coverage. I have struggled to find healthcare providers who will work and communicate with me. Along the way (mostly about twelve to ten years ago), I have had to fire 6 pulmonologists, 4 allergists, a surgeon, a pediatrician, several counselors and 2 gastroenterologists!</p>
<p>My older brother who thinks outside the box (sometimes successfully, sometimes disastrously) recently went to Costa Rica for a medical procedure. Oh my. We heard so much from him about how stupid healthcare is in the US, how cheap is in Costa Rica and how wonderful, blah, blah. Well, let’s put it this way. He’s back in USA and had to have another corrective surgery and is on quite a regimen of antibiotics.</p>
<p>If it looks really cheap and great then it’s usually neither. Just like most stuff.</p>
<p>And as for all those Indian docs coming over here. They come here rather than stay home because they make a better living here. Is this a win for India?</p>
<p>Economics and especially healthcare economics is a very gnarly subject. Healthcare is very much driven by technology and highly skilled practitioners. But no one likes to be sick and everyone hates to pay money to feel better. They’d rather pay money for a car or a vacation or a house. </p>
<p>Take a look at David Culter’s “Your Money or Your Life”.</p>
<p>LasMa is correct. Many discussions completely confuse the two subjects: our medical care system (excellent doctors, facilities, ancillary professionals) and our PAYMENT system. </p>
<p>If we have inefficiencies in our medical care system, we are certainly not assisted in trying to improve them by having hundreds of continually morphing insurance companies writing conflicting rules about what will and won’t be paid for.</p>
<p>The people on this thread who persist in saying that the uninsured and underinsured prefer to throw money away on unneeded luxuries really tick me off. I’m willing to bet that NOT ONE OF YOU has any recent experience being uninsured and low income, or paying through the nose for a catastrophic policy that leaves one essentially uninsured and unable to pay for routine care that all of you take for granted. </p>
<p>When I was under and un-uninsured, these are the things I did not have for over a decade: an Iphone (or any cell phone at all), cable tv (and in fact our only tv was a hand-me-down portable thing), vacations, $100 shoes (except for some that are 15+ years old), daily–or even monthly–lattes. I also did not have dental care (including no cleanings) pap smears, mammograms, a “routine” colonoscopy, a physical (much less an annual physical),and so forth. When I needed to have a D&C due to uncontrolled bleeding that left me weak and fainting with anemia (hematocrit 24), I had it in the ER with a local anesthetic, instead of in the OR with real anesthesia (now the standard of care, they informed me, because “the women kept screaming”). Why? Because I had a $15K deductible and setting foot in the OR would cost $3K.</p>
<p>LasMa, ITA with your posts. Universal single payer: bring it on. Let’s join the civilized world.</p>
<p>Consolation – we are a consumer society, obviously. But American consumers don’t see medical care as a consumer product. They see it as a right. That is the dilemma.</p>
<p>My post was more about what we are willing to pay for healthcare as a society, not really about what we should be paying individually. We seem to think healthcare should be a relatively small part of our national budget. All this worry over getting the costs down. </p>
<p>If you think about it, what is more important? Our health is really the most important thing. Yet the tendency is to think that it should be cheap.</p>
<p>Yes, I see basic healthcare as a right.</p>
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<p>Yes, this is a huge problem in the US. Both of my children had minimum wage jobs last summer. They received information on health insurance options for year round employees. I glanced at it. The health insurance that is offered to employees in my opinion is awful. There are such severe limitations. I feel that it basically paid for some medical treatment for very minor illnesses, but was not going to cover to the extent a patient would need coverage in the event of serious illness.</p>
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<p>That is horrible. </p>
<p>I am the OP and I can tell you that although I did not have incorrect treatment (I have not had any treatment) the NP had me mistaken for another patient who had multiple procedures and cancer treatmtents! I don’t have cancer, and I did not have those procedures! She kept talking as though she knew my medical history and I had to interrupt to correct her! That is what prompted my initial post! Do not think that poor care cannot happen here! I was simply shocked that such a mistake happened to me. It really opened my eyes!</p>
<p>northeastmom, without going into much about what I think about this subject (which is a lot) - I just want to comment on Nurse Practitioners. I have seem two in place of the specialist and they both made errors that I caught. Now I will only see a PA who assists my Internist for something like a tetanus shot. NP’s and PA’s just don’t have the training and liability of MD’s. If a Dr. won’t see me ( all have if I insist) I go elsewhere.</p>
<p>I think a bigger problem is the proliferation of MA’s in Drs. offices, that have replaced RNS.</p>
<p>I always ask them about their training, which is minimal. This is only a cost cutting devise for the medical practice.</p>
<p>My initial experiences (nearly 30 years ago) with NPs were great!</p>
<p>Last week’s experience was shocking. One does not have to be a rocket scientist to read a chart and know which patient they are speaking with. It was just very sloppy medical practice which could lead to a horrible medical outcome, in my opinion. Yes, it is cost cutting, and that is also what prompted the post. BTW, I do think that this NP is doing much of what a MD might do and because she might be paid more than a RN there is only one NP when they may need several nurses (perhaps with different skill levels, I don’t know). This is a very large practice.</p>
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<p>A friend of mine who has health insurance has been fighting leukemia, which was diagnosed less than a year ago. He has had a lot of complications, hundreds of blood and platelet transfusions, spent months in the hospital, received a bone marrow transplant, etc. He recently got an EOB that shows his medical expenses to date are 1.8 millions dollars. YIKES!</p>
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As one who opposes any expansion to healthcare, I agree with your statement with the caveat that we nail down what “basic” means. Does a 93-year old with a dozen serious conditions who would be allowed to sign out in comfort in the European universal-coverage countries have a right to a million dollar treatment egged on by AARP, Big Pharma, lawyers, suppliers, hospitals and AMA, or will you draw lines in the sand beyond which coverage is on the patient’s dime? What I’m saying is that if we do indeed proceed towards expanded healthcare, nobody will have the courage to draw these lines and you’ll just have $3 of unreasonable spending for every dollar that goes to a worthwhile treatment, and any expansion of healthcare must be done rigidly tied to contraction in treatment “rights” (“rationing” to me is not a bad word - it’s essential). </p>
<p>The big picture is similar to the animal shelters that DD2 volunteers at, which do have external financial constraints - you have the option of a no-kill shelter where they don’t accept every unfortunate kitty that needs help, or the kill-shelter where the pooch that doesn’t get adopted ultimately gets euthanized.</p>
<p>Healthcare unfortunately doesn’t lend itself to parallels like food, clothing, or shelter where a right of someone not to starve can be satisfied without extending it to a right to $1,000 dinners.</p>
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<p>And that is part of why the system is broken and will remain broken – the AARP and other powerful lobbying groups with interests in the current level and direction of medical care spending will resist any attempt to reallocate medical care spending away from where it currently goes (remember the oxymoronic “government hands off my Medicare”?).</p>
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the question is if we accept this reality (which I personally do), is it worth large scale escalation of services and costs? Focusing only getting more money, even if it is from the “unworthy” who shouldn’t have all the money they have, misses this bigger systemic problem.</p>
<p>It has never been a “right” in this country. Why is it suppose to be a right at this point in our history?</p>
<p>I’m not saying I’m against it being a guaranteed right but I’m asking why now? </p>
<p>I think there is something going on here that is at a deep infrastructure level of our social ethos. If it becomes a right then it will become essentially free and the quality will deteriorate and we will essentially get what we pay for.</p>
<p>We see a proliferation of NPs and MAs right now because we are demanding it should be cheap. They are much cheaper than MDs. </p>
<p>What are we suppose to spend our money on if not healthcare? What is more important than our health?</p>
<p>I’m questioning the assumption that we need cheap healthcare. So we can save our money to spend on what?</p>