Sicko (the movie)

Parent Cafe
101

<p>“Mini, how could that be that it is taking your daughter nine months to see a specialist. Who is your insurance carrier? An ER wouldn’t make somebody in respiratory distress wait 5 hours, especially a child, if the parent is in their face. You can demand a test be given your child.”</p>

<p>The problem in the first case was referral to the wrong, incompetent, unqualified specialist (listed as their sports medicine injury specialist, but knew nothing about sports); broken MRI machines; two botched surgeries; wrong diagnosis; refusal of insurance to refer to the sports medicine expert actually listed in their own referral system as being among their specialists; and a much longer list. Once we changed insurance, on Monday morning January 3rd at 5:30 a.m. she had the right surgery, and was back in the gym, without any complications, in two weeks. Nine months of unnecessary pain. The HMO was Group Health, considered one of the best HMOs in the country. You would have loved my very detailed 8-page letter to their director, after they had taken several hundred thousand dollars in premiums from us (and my employer) over a 15-year period.</p>

<p>re: emergency room. We were not only in their face - we had two extra adults in their face. Nothing doing. We would have had no idea about vaccine resistance in our community - we found out about the public health advisory later (this happened, by the way, nationwide, as the CDC didn’t want to scare people off getting vaccinated next year). Five hours (and other folks have told us we were lucky.) This was no “inner city” hospital filled with poor people, or people who didn’t speak English, or people who use the ER for primary care, or shooting victims. This is a so-called “Center for Excellence” in ER health care delivery (top 5% in the nation). </p>

<p>The problem in the system is that it is built on profit. It means that people WITH insurance get substandard care, as do people without it. It is NOT the best system in the world - I get consistently better care when I am in South India. Disconnect health care from profit. I’m in favor of any reform that takes profit out of the system, and I don’t particularly care whether it is single-payer/multiple-payer, government or non-government. It is the pursuit of profit in dealing with people’s health that has bent the entire system out of shape.</p>

102

<p>“In February, my younger d. went to the emergency room for an asthma-related condition. This is a town of mostly middle-income folks, very, very few undocumented immigrants, few language difficulties, etc. She waited for 5 hours. They didn’t test for influenza (figuring that since she had been vaccinated, it couldn’t be that.) She was back in the emergency room the next night, a slightly shorter wait, and this time they bothered to test her. Sure enough.”</p>

<p>Where was your primary care doctor on all of this? And is this the hospital that you have been touting as the ideal place, which is subsidized by fruit-growers for the illegal immigrants? I looked up the hospital you mentioned and it was was fully staffed, took Medicaid and all insurances, and you said that it is a great hospital. Did you go there?</p>

<p>“As noted, we had to wait almost nine months to see the right specialist here. Anecdotal of course, but lowering wait time to see less than qualified specialists (which happened to us because of insurance company practice) is hardly a response worth having. We would have been extremely grateful for a 17.9 week wait for the result finally achieved after fighting with, and ultimately leaving, a very highly ranked HMO.”</p>

<p>What type of specialist was that? I cannot think of a Pediatric specialist with a 9 month back-up. Why was her asthma so diificult to treat? Usually it is fairly routine, and this can be done often by a primary care doctor. Did she really wait 5 hours just to have treatment initiated in an ER in a middle-class area? How many doctors were there? What type of treatment did she get the 2nd night?</p>

103

<p>jamie:</p>

<p>I did not mean to say that any Vets are being denied care. What I said, or meant to say, was that Vets under the VA system were being denied access new drugs bcos of the VA’s drug formulary. Ask your friend about it, or check out the VA benefits, or any number of Congressional reports on the VA’s formulary for drugs. </p>

<p>It’s just another way of rationing in a single-payer plan.</p>

104

<p>“Where was your primary care doctor on all of this? And is this the hospital that you have been touting as the ideal place, which is subsidized by fruit-growers for the illegal immigrants? I looked up the hospital you mentioned and it was was fully staffed, took Medicaid and all insurances, and you said that it is a great hospital. Did you go there?”</p>

<p>Primary care doctor visited earlier in the day. I live in Western Washington (in my town, there are very few undocumented workers); Wenatchee Valley Rural Health Centers is in Eastern Washington.</p>

105

<p>“The problem in the first case was referral to the wrong, incompetent, unqualified specialist (listed as their sports medicine injury specialist, but knew nothing about sports); broken MRI machines; two botched surgeries; wrong diagnosis; refusal of insurance to refer to the sports medicine expert actually listed in their own referral system as being among their specialists; and a much longer list. Once we changed insurance, on Monday morning January 3rd at 5:30 a.m. she had the right surgery, and was back in the gym, without any complications, in two weeks. Nine months of unnecessary pain. The HMO was Group Health, considered one of the best HMOs in the country. You would have loved my very detailed 8-page letter to their director, after they had taken several hundred thousand dollars in premiums from us (and my employer) over a 15-year period.”</p>

<p>What were the botched surgeries? Were all of these doctors Orthopedic doctors? How many MRIs are there in your town that could all break? This story sounds so unusual for a child to have so many surgeries.</p>

106

<p>“Primary care doctor visited earlier in the day. I live in Western Washington (in my town, there are very few undocumented workers); Wenatchee Valley Rural Health Centers is in Eastern Washington.”</p>

<p>I thought you have always maintained that you live in a fruit growing/picking area w/ lots of illegal immigrants, which is why you understand the situation so well.</p>

107

<p>It sounds unusual to us, too. All doctors were Orthopedic. HMO was Group Health, with its own MRI. Instead of repairing it, they got one in a mobile van which they parked in the parking lot. Sent daughter to it. Waited outside in the cold…in the same place as all the smokers! (she’s asthmatic, duh!)</p>

<p>“I thought you have always maintained that you live in a fruit growing/picking area w/ lots of illegal immigrants, which is why you understand the situation so well.”</p>

<p>I have never maintained any such thing. What I DID maintain (and still do) is that I worked for a decade for the State Board of Health, that holds regulatory power over all temporary (read: agricultural) worker housing, and advisory powers over community and migrant health center health care delivery. It was my job to visit the labor camps, the housing establishments, and the health care establishments, and to set up hearings for the Board in those communities. I put 20,000 miles a year on my car. I know (or knew) dozens of growers personally, the folks that run each of the health centers, the worker advocates, the union folks, the docs, and the builders.</p>

<p>The cherry harvest, by the way, is about over, with (it is estimated) roughly 85,000 pounds of cherries left on the trees, even at $20/hour. Your kids, obviously, didn’t show up. We’ll have plenty of jobs next year as well, though, so keep it in mind.</p>

108

<p>I have a couple things I’d like to say, but I’m going to skip them for now (and one would require me drawing a graph, and CC isn’t at that level of technology yet!). </p>

<p>I do want to share a quick anecdote, since that’s what everyone else seems to be doing (even Mini :eek:). </p>

<p>When I was a few days old, I developed a fever of 105 degrees. Infants are protected by their mothers’ immune systems, of course, so they really shouldn’t be getting high fevers. I was rushed to the emergency room, and a doctor was called in for me specifically. I was seen right away, as I’m sure I would be in Canada or any other reasonably good hospital. I was sent home a week later with a diagnosis. My pediatrician did not think that was the only thing wrong with me, so a little while later I saw specialists at one of the best children’s hospitals in the world. I was diagnosed with a condition that, left untreated, could lead to extensive damage and life-long health problems. If I were in another country, I don’t think I would have been able to be seen so quickly by such a high-up specialist. There was a good explanation for my illness by my local hospital, and after taking antibiotics I seemed very healthy. The fact is, the antibiotics were hiding the fact that I had a much more serious condition that, if untreated, could result in extensive damage and life-long health problems. Since I was able to be diagnosed early, the effects of my condition are minimal. If it was not diagnosed very early–and I do not believe it would be in most UHC systems–I would likely have some organ damage today. </p>

<p>As I said already, yesterday I went to the doctor’s office. I left knowing that in the next few weeks I will have blood work done, get two minimally invasive surgical procedures done for diagnostic purposes, see a neurologist, see a hematologist/oncologist, see another specialist (I can’t spell the name :)), and later in the summer get any further tests/treatments those doctors require and get my wisdom teeth pulled (an elective procedure). I’d be able to get a fraction of this done during my summer home in a UHC country, I’d imagine.</p>

<p>EDIT: One of the things I wanted to say I am actually going to touch on briefly. I do not want profit taken out of the system. I want physicians to be among the highest paid professionals. I want the smartest college graduates to choose medicine if they’re deciding between that and some other, higher-paid profession (such as law) because I want the smartest graduates to choose medicine instead of passing it up for another profession they like just as much but comes with a higher paycheck.</p>

109

<p>When I was in college, I spent a summer studying in Denmark and living outside Copenhagan with a host family. At some point during my stay, I became very ill during the middle of the night. My host parents called their family doctor, who came out to the house at 3:30 AM (mind you, we lived in a rural farming area well outside the city), examined me, gave me an injection, antibiotics and something to help me sleep, and took only a bottle of wine (reluctantly) from my host father as a thank you for the house call. The doctor called the next day to see how I was doing. Although I had student health insurance, the Danish government paid the entire tab. Now THERE’s a government that knows how to run a national healthcare plan. I’ve stayed in touch with my friends in Denmark and little has changed – cradle to grave social safety net, including national healthcare, for all. The Danes pay a much larger percentage of their income in taxes than we do, but they sure get a lot more for their money.</p>

110

<p>As to the Swedes and the Norwegians. Health care, maternity leave (or parental leave), geriatric care, free higher education…it’s amazing, isn’t it?</p>

<p>$15-20 for a plain Jane sandwich is a bit hard to bear though. ;)</p>

111

<p>Allmusic, I am terribly sorry those experiences happened to you. I know they do happen - I have been to the ER several times and really had to ***** and moan and rant and rave to get service. </p>

<p>The thing about this stuff that is so aggravating (and it is not just health care - it is any service provided today) is that it is so time consuming to take care of every little incident that occurs. All the extra charges on bills, the totally phony charges, the idiots companies hire to deal with complaints. That is what bothers me the most. The delaying tactics we have to put up with that are such time wasters.</p>

<p>For instance, the title to this post. I warned the NYT’s I was going to start posting on blogs and bulletin boards if they didn’t deal with an issue I have with them. They have some type of database error that prohibits me from getting into Time Select, for which I have paid. For several weeks we have been emailing, and I have spent at least an hour of my cell phone minutes attempting to clear this up. Who has time for this? Who wants to deal with this negativity constantly? And, they keep sending me emails telling me it is fixed, and it isn’t.</p>

<p>I agree. It is outrageous!!!</p>

112

<p>We have had mostly good ER experiences. We did have one horrible visit. My S tore a tendon. I only saw a deep wound that I knew required stitches. I requested a plastic surgeon. The ER doctor argued that since it was not a wound to his face that my son did not require a plastic surgeon. I told the ER doctor that I have self referred plan and that I am requesting an opinion from a plastic surgeon. The ER doctor did not know that my son tore a tendon and that it was hanging on by a thread (in other words over 90% torn). She wanted to just sew up my kid. She did end up calling a plastic surgeon. The plastic surgeon told me that this is not a simple case of stitches. My son first needed to have his tendon reattached! Unbelievable, but it was a good thing that I stood my ground with that ER doctor!</p>

113

<p>couple of opinions in today’s LA Times: the first demonstrates the absolute worst in a govt-run operation…the second discusses health care politics of today, i.e., 2008.</p>

<p><a href=“Why King-Harbor must die”>Why King-Harbor must die;

<p><a href=“The plague or the cure?”>The plague or the cure?;

<p>Jamie: yes, and EVERY drug your father received was on the VA’s approved formulary. By limiting choice of drugs for certain medical conditions the VA buys in bulk and obtains the drugs cheaply. For example, compazine, a very inexpensive drug, is a standard anti-nausea drug given to chemo patients, and it works for many of them – but not all patients. Those patients will respond to newer drugs that cost $50-100 per tab, however, but are frequently excluded from drug formularies so the patients suffer (dunno about the VA in this instance).</p>

<p>I’m not sure that folks will stand for such a limitation. Heck, even some the anectodes given on this thread relate to managed care, and the problems inherent in it.</p>

114

<p>After Sicko, my husband commented that he thought it was odd Moore didn’t highlight any of the Scandinavian countries, which have excellent health care. I thought France, Canada and Cuba were strange comparisons. His other movies I have liked much more. He could have taken his crew that went to Cuba to any prison in the country and seen the same health care.</p>

<p>Did anyone catch what the French were paying in taxes? I heard him mention it, then when he was interviewing the family, he didn’t ask.</p>

<p>He said Americans, on average, pay $7000/person for care. </p>

<p>Bluebayou, my father had zillions of medications filled by the VA for 3 years before he died a couple years ago - WW2 veteran. He also had lots of private insurance and medicare, but the VA was totally free and never refused his medications. That seems to contradict what I thought you said about the subject.</p>

115

<p>corranged,
is there any proof that your condition wouldn’t be timely diagnosed and treated in a UHC country? “I’d imagine” doesn’t count. :slight_smile: Also I’d rather people went into medicine for the love of profession and not for the love of money.</p>

116

<p>Nope. No proof. Everyone else was sharing anecdotes and “I’d imagine”'s, so I shared one. Given the statistics about specialists that were shared on this thread previously and that I had a perfectly fine and fitting (though incomplete) diagnosis, though, I can’t see me making the top of the list. </p>

<p>People who go into medicine, with the 7+ year training after college, are going to want to be doctors. My issue is with the smartest people who are deciding between being doctors or something else but would choose that something else if the income is significantly higher.</p>

117

<p>Corranged, you’re right: Smart people go where the money is. So if we want smart people to go into medicine, it needs to be a well-paid profession.</p>

<p>That still doesn’t mean we can’t have a single-payer system, and it still doesn’t mean we can cover all our citizens. What it does mean, IMO, is that we shouldn’t pay doctors based on the number of complicated procedures they do, but maybe on something as mundane as how many hours they work or how many patients they see or how healthy they keep those patients.</p>

118

<p>

I agree with this. I have no idea how doctors should be paid, but I want good doctors to be paid top salaries. I was responding specifically to Mini’s comments and the general thinking that with UHC physicians’ salaries would and should be leveled out.</p>

<p>My currect objection to UHC–and it is current; I’m very welcome to change my opinion–has a number of additional reasons. :)</p>

119

<p>"Opie: If you re-read my posts, I never said that having the government be the single payer was the solution; I just said we need a single payer. I don’t know who should manage the single payer health care plan. "</p>

<p>That is a part of the ongoing problem. Ever since the Clinton’s floated that boat, It’s been the big fish swallowing the little fish. That plan had four to five regional players and that’s why we have United healthcare and some of these other monsters out there. There isn’t price competition anymore because there are only a few players outside of the blues. And the blues are being bought up too. Not good for consumers. It was much better in the 90’s to show a dozen different carriers for medical than it is to show 5 now. </p>

<p>“That said, I do believe it’s the responsibility of the government to make sure its citizens have decent health care,”</p>

<p>The problem becomes defining decent health care… I sat in on our state’s attempt in 93 (probably was there with mini) and listened to tesitmony from groups that wanted chiropractic included, another group wanted accupuncture and still another (and I kidd you not) wanted pryamid healing covered. I would love to see a basic level of care decided on with the ability to purchase supplemental coverage (like medicare supps) to fill in what the consumer wants extra. As with current medicare supps an insured can choose the level of coverage they want above and beyone medicare. </p>

<p>We would just have to come up with ‘Basic’. So far that’s been pretty impossible. </p>

<p>“That’s why we have public schools, and laws requiring children to attend school” </p>

<p>And we have private where people can pay extra for what they preceive as better. So far with NHC people have to sue the government to get supplements. As far as laws to be healthy… good luck.</p>

<p>“And Yes, my company is self-insured; and Yes, we do have stoploss insurance. I’m not sure how that’s relevant, but you did ask.”</p>

<p>I was just curious that’s all. Being self insured your able to opt out of state mandates which in many cases make insurance quite a bit higher. Your company may choose to include them (hair restoration, aroma theraphy, etc…) but unlike the little fish, you don’t have to, if you do provide these coverages, it’s because you choose to. Self insured plans aren’t suffering in the same way fully insured small group is. One of the biggest drivers of cost is mandates, it takes choice away from business and sets the price pretty high in some cases. It’s a different world than dealing with a stop loss carrier and a TPA handling claims. Have you noticed a reduction in stop loss carriers over the last 15 years? I know the market is shrinking.</p>

120

<p>I agree with the basic premise of the Moore film and Mini’s view that the profit has to be taken out of the health care payment system. (That doesn’t mean that doctors can’t be highly paid – it means that profit motive needs to be removed from the system that does the payment – the UK physician that Moore interviewed mentioned getting bonuses and increased payment based on quality of patient care, with a high focus on preventative care. )</p>

<p>However I did note that the US horror stories focused on by Moore seemed to be primarily HMO’s, where there is a huge problem getting approval for procedures or treatment at “out of network” hospitals. I know that this was an issue for my son – he had a job locally with health insurance - Blue Cross HMO – but moved about 50 miles away for a work assignment, and did not know that he had to notify the HMO and pick a new primary care provider. So when he got sick with an ear infection, there was no doctor or clinic he could go to – he had to come to his primary care provider 50 miles away, and at the time he didn’t own a car. Finally I insisted that he just go to an emergency room – he didn’t want to because the HMO would charge $100, so I told him to send me the bill when he got it … and of course I paid.</p>

<p>I have a PPO and like the flexibility it affords. I can go anywhere I want, and just about every doctor is on the “preferred provider” network (Blue Shield). However, cost has been a problem – the rates go up & up, and right now both my son and I have plans with $4000 annual deductibles, and I put my daughter on $5000 deductible plan when she started college. I figure the higher deductible makes sense for a student, since they can use their college clinics for routine stuff – and in the case of a serious accident or illness requiring hospitalization, that $4-$5K deductible is going to be passed in the blink of an eye. My plan actually pays 100% once the deductible is met, so I’m happy with that. </p>

<p>But the point is – I can afford to take that risk – I would be able to come up with $4k to pay a bill --it wouldn’t be easy, but I woudn’t go bankrupt or lose my home. Many other people can’t. The downside for me is that I find myself avoiding routine preventative care because I don’t want to pay for it. A few years ago I sprained my ankle quite badly, and I treated myself with ice packs and an ace bandage because of the cost of treatment. It swelled up terribly and I hobbled around for a month-- and when it comes down to it, I am not sure what a doctor would have been able to do for me other than to order up x-rays to prove what I could figure out on my own (no broken bone) and to prescribe more powerful pain killers … but the point is, if I didn’t have that huge deductible, I would have seen a doctor. So it does tend to deter me from getting reasonable care for non-life threatening conditions. </p>

<p>I think that I really favor a combined system – a government-paid system that will cover necessary care for everyone, together with the option of private insurance to pay for elective procedures or premium services for those who want it. That way the people who aren’t satisfied with wait times or the drugs offered by the government formulary do have the option of getting what they want, if they can afford it. I don’t see this as much different than our current system of K-12 education – I had a free public education and even a choice of several schools open to me for both my kids, but that didn’t stop anyone from opting for an even greater selection of options for private schools.</p>