Health Care Reform; The Summation
- June 27, 2009
- Category: Daily Diary
- (8) Comments
I’d like to thank each one of you who participated in the discussion on health care reform. I appreciate your stories, your thoughts and links for further reading. I am honored to have readers who will discuss both pros and cons with such civility. It is only through discourse that we can begin to bridge the gap between differing points of view.
Today, I’m going to publish all your comments because they are insightful and informative and I want everyone dropping by my blog to have the benefit of seeing them but before I do so, I’d like to address more of my story.
Mountain Man said I erred in his out of pocket costs after insurance. They were $20,000.00 not $10,000.00 as I had written.
Many of you know my late husband was a physician. He went to medical school on a military scholarship and when he finished he owed several years of active duty service to the U.S. Navy. Not very much time at all considering they footed the $100,000.00 bill (back in those days). My husband loved military medicine so much he stayed for almost 30 years. One of the things he loved about the Navy was the fact the government allowed him to give exemplary care to his patients. He could spend the necessary amount of time required with each patient. If one of them needed a test, he was free to order it. Outside consultation at a civilian hospital with better equipped facilities than a base clinic? No problem. Whatever it took to provide the best care for their members; that about summed up Navy medicine. Sure, we in the military didn’t get paid as much as people in the civilian sector but our free medical care was factored into our salary and we never had to worry about medical costs.
My husband went into private practice after he retired and those last 3 years of his life were probably the hardest. He was no longer free to spend time with his patients. Instead, he had a set appointment time limit. If he ran over that time, other patients were kept waiting and then became irate. No longer could he pick up the phone and order a test. He had to obtain prior approval from insurance companies, each with differing policies. Hospitalization needed for longer than the insurance company thought necessary? That situation required even more intensive intervention as he would spend hours fighting to ensure a patient received necessary days of in-patient care. These insurance company personnel were not trained medical professionals. They were following a formula that says for such and such an illness, x number of days in the hospital is usual and customary.
I saw far less of him after he entered private practice. He felt he owed a standard of care to his patients and if that meant working far into the night coping with unreasonable, burdensome insurance company demands and then providing his patients with his time and attention, that’s what he would do. Time and time again he would express his frustration to me. He lived for the weekends in the Navy Reserves when he was allowed to just practice medicine again. Over and over, he’d say “I want to be a doctor, not a bureaucrat.” As a physician, he was and is not alone. There are many fine doctors who just want to take care of patients but are not allowed to do so by a system that leaves them overburdened as quasi-administrators and gate keepers of cost control because the bottom line is profit and cost containment. Then, as Tim and Lin wrote, there are the ever escalating malpractice insurance premiums brought about by frivolous lawsuits. Have you ever wondered why many doctors are moving to other careers? Perhaps these days doctors do run unnecessary tests to cover themselves but I don’t believe doctors are the main problem.
Have you considered all the ads for prescription drugs on television? How much money is being spent on those ads? How is the cost of advertising factored into the price of drugs?
One of the comments that really struck me was made by Windroot and one I hope you will think about, “How can we as Americans feel that we have the greatest health care system in the world when families have to run bake sales and put out jars to collect money at the local restaurant to pay for their kids’ kidney transplant or chemotherapy?”
The wealthy will always have options. That’s the way it has been and will be for time immemorial. But what about us, the middle class and the working poor? We own our homes, we’ve struggled for years to amass a small retirement fund, to care for our children, we pay our insurance premiums each month. What happens to us when a serious illness occurs? Will your insurance company cover it all? If so, you are fortunate. Most say “allowable” charges. Do you understand the impact to your share of cost of the words “allowable” and phrases such as “reasonable and customary?” Are you certain your doctor, the hospital, the radiologists, the physical therapists, and all the other ancillary personnel will accept your insurance as payment in full and write off the balance? Most health insurance has a lifetime maximum cap. Do you know if yours does or what that amount is? Do you have an extra $10,000.00 or more in case of a serious illness? Do you have the ability to borrow that money or the means to pay it back? What happens when you lose your home, your nest egg, your savings for your children’s future? I realize there are those of you who have full coverage through your employers but what happens if you get laid off? Can you afford your company’s premiums on COBRA? As we confront this issue, honest financial self assessment is a must.
I do not think insurance companies are the answer. Their bottom line is profit. What is “reasonable profit” when we are speaking of human lives?
There has been much discussion as to our “right” to health care. It’s not a right in my opinion but how can we call ourselves a civilized society if those in need of care don’t receive it? Could we walk by a person on the street suffering and not offer aid? Isn’t our government meant to be a reflection of We the People? And, if we pay our insurance premiums in good faith and take all the other necessary steps to protect ourselves, should we be required to lose everything for which we’ve worked because of an illness?
I’m a believer in the private sector, in free enterprise and I admire and applaud those people who have made their dreams a reality. The United States stands as a shining beacon in the world to those who want to achieve their dreams.
But hasn’t the private sector had their chance to rectify this situation? Hasn’t the problem become more acute as medical tests and procedures become more sophisticated, equipment more expensive? The progress made within the medical establishment has and will continue to have a profound impact on our health but has our ability to pay for these increasingly refined procedures kept up with the expense? Somewhere, somehow the bridge must be gapped. Yes, there is government waste, special interests, lobbyists and more but isn’t the same thing true of the private sector? We are all aware of the companies who have run themselves into financial ruin and are seeking the government’s (we, the taxpayers) assistance. Did they do a better job of handling their responsibilities to us as consumers?
It is my opinion we are already paying for the uninsured through escalating premiums. The cost gets passed on to us who are self insured or business owners who are struggling to keep their employees covered. We bear the burden of a broken system and while it is true we have some of the finest medical care in the world, we don’t always have access to it. We have registries, waiting lists, referral lists where are physical problems are categorized and ranked as to need.
People fear the government will have access to their records but in fact they already do. There is no privacy any more. Not with the internet and the unprecedented access to information.
As you reflect on this matter, I urge you to read the stories posted on President Obama’s page by clicking here. These stories could be told by you or me, our parents or our children. These are the voices of our fellow Americans.
This is not a political blog and I rarely venture into controversial waters and I’m leaving my soapbox now. On Monday, this blog will return to the usual topics. The farm awaits, Mountain Man is hard at work and we are both blessed to be in good health and surrounded by the beauty of a Vermont summer. But every now and then, when I am passionate about an issue, I have to step outside my comfort zone even though I know I risk offending my dear readers. If I have accomplished anything by these past two posts, it is to have us reflect on an issue that concerns each and every one of us and our children as well.
As much as I may long for simpler days, I do know is the world is changing and the status quo on many fronts is being undone. I may be dragged into the future kicking and screaming and wish I had been born in another era altogether but I have to face reality. This is the moment in time in which we live.
The future is waiting to be written and it is incumbent upon us to be proactive. As President Obama said today in his radio address speaking about the climate change bill, “We cannot be afraid of the future. And we must not be prisoners of the past.”
I envision a future where we focus on wellness and healthful living; where we don’t live in fear that if the unexpected should arise, we make the choice between life and losing everything for which we have worked. No, not free health care but predictable costs.
Whatever side of this issue you find yourself on, I urge you to contact your elected representatives and express your point of view.
One of the wonderful reasons I love our country is because we are free to debate and disagree and it is this exchange and free flowing of ideas that has made us stronger throughout time. I’ll leave you now with the comments from my wonderful readers as we struggle with this difficult and, yes, personal, issue.
Comment:
don’t get me started!!!! Being half French and having lived and worked there where everything is covered, and having a daughter in college in Canada, where she’s covered, to here this week I’ve got to pay the deductible for my daughter’s MRI (she’s got short term ins while at home) and the dentist for my broken molar (my insurance doesn’t include dental…) and my 20 yr old in uninsured…Socialized medicine is the way to go.
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Have you heard the horros stories about Medicare when you reach 62. One of my friends is going thru a nightmare right now and she had health insurance from Verizon. Medicare only pays 80% of what THEY THINK THE BILL SHOULD BE. Verizon is her secondary and may not pay anything so she is stuck with the balance. She gets Orencia once a month injection $5000.00 a pop. Medicare will only pay what they want not the whole 80% of 5000.00 She says she won’t get them anymore, this is for rheumatoid arthritis. She could afford to get them with just her Verizon insurance. Let’s not even talk about prescriptions when on Medicare. Why do so many Canadians and others come here for healthcare when they have universal? One friend told of a 6 month wait for a procedure in Canada and came to U.S. and had it immediatley but paid for it. He woyuld ghave died in Canada. Same with England. Something has to be done, I agree.
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Hi MW, I’m kinda on the ‘other’ side of this also. I do agree that our healthcare needs to be fixed. BUT–having the government (who cannot run anything accurately–such as Post Office, Social Security, etc.) in charge scares me to death. I don’t want us to end up with healthcare like they have in Canada. Everyone there talks about bad it is…
AND–as Tim says (above), we cannot bankrupt our country. All Obama seems to do is just keep spending money… We could be in MUCH worse shape in the future with all of our economy problems.
YES—-healthcare is broken–but let’s not take away the private sector’s ability to work on it and get it fixed. I want Capitalism and not Socialism. I for one do not want my Government to take care of me. I’ve worked hard for my money–and don’t want to be ‘made’ (through taxes) to pay for others who can’t or won’t do what they need to do to take care of themselves. There are cases where help is needed—but “I” want to choose whom I want to help, not the Govt.
WELL—I’ll get off my soapbox. I’m sure I’m in the minority on this one. AND–I’m sorry for what you and hubby have been through. YES—there need to be changes for sure. I’ll agree with that.
Thanks for listening.
Hugs,
Betsy -
I have a friend in Canada and he says their income is taxed for the health care, so it’s not free.Same in England where my cousin lives, it’s taxed on their income.
Our health insurance cost went up so high, that on our retirement salary, we couldn’t afford it,hence, it was dropped. My husband has many medical problems and he sees the VA drs. for his treatments,but we pay and small fee for his treatments and meds.I on the other hand,don’t have insurance. I pay out of pocket for my yearly allergy test and my medicine for the weekly shots. I didn’t go to the drs much when I had insurance, because it didn’t cover my expenses, always fees that insurance didn’t cover.So I no longer get my mammagrams, or my female visits. I ONLY will go if absolutely have to. I had to pay to have 2 of my molars pulled because they were broken and needed a root canal. I couldn’t afford the canal, so I had to have them pulled.I cried for 3 days. -
I must say that I agree with Tim on this one.
AND…
NOTHING is really free…you just haven’t gotten the bill yet.
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As someone who was born in the States and has lived in England I could spend hours discussing this topic but I’ll try to be brief. Not only have I been fortunate enough to be a beneficiary of the NHS in England but I also worked for them at one time. In ’94 I was having “woman” problems and my doctor (in England) sent me to the hospital for a laparoscopy, basically just to look inside to find out what the issue was. I was only in the hospital for the day but it didn’t cost me a penny. Yes there are always going to be flaws in Universal or Socialized health care but I’d personally rather have those flaws then to be in a position where I have no coverage at all or cover that someone else may decide they don’t want to pay which is often what happens with the Insurance Companies. I have to say that I’m not sure who Betsy has spoken to because everyone I have from Canada couldn’t be happier with their system. We have a friend who had cancer and he was flown to a major Canadian city for more treatment and this was all covered.
It seems most of the people who opposed to Universal Health Care are the ones who are alright but I’m sure if their situation changed or if a family member was affected by lack of coverage and funds to pay huge medical bills, they would certainly change their minds.
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Luckily I have not incurred massive medical bills in my lifetime but can see where people are going crazy!! What annoys me the most is when I as a provider (doctor) if they are in contract with my health insurance, they say yes, then i get a bill reflecting that they are NOT in the network. I think they are fraudulent in their actions since usually i would choose a different doctor based on what my coverage would be. This has happened at least three times to me. It’s like you can not trust the office to tell you the truth in regard to billing questions.
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I don’t know what the answer is but I do have a question: How can we as Americans feel that we have the greatest health care system in the world when families have to run bake sales and put out jars to collect money at the local restaurant to pay for their kids’ kidney transplant or chemotherapy? My feeling is that the old “women and children” first thing still applies to health care. If some form of public health insurance is the answer then so be it.
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My wife and I have both dedicated our careers to medical science, she as an advanced practice Nurse Practitioner, myself as a research faculty member at a medical school. For several years recently, neither of us had medical insurance. During that time, I ran my hand through a table saw. The ER bill was outlandish, and I still needed surgery to regain some function in my fingers. The only hospital in our area, “Ministry” health care would not schedule my surgery unless we agreed to sell our farm. I did not have the surgery and live with limited function in my left hand. This is outrageous to me. Contrary to what the US health and insurance industries would have you believe, the World Health Organization has ranked the US health system performance as 72nd in the world, and the Canadian health system as 35th (http://www.photius.com/rankings/world_health_performance_ranks.html)
My biggest objection with the Obama approach is that, while a step in the right direction, it does not go nearly far enough. We need and deserve a single payer system. Study the evolution of the health care system in the US since World War II, and you will soon see the guilty parties. Doctors, lawyers, and insurance companies were not always wealthy. I would recommend the writings of Atul Gawande on health care (Google for his website). Most of it is spot on. -
Even the American Medical Association is in the minority among physicians in its opposition to health care reform. This just came out this morning: http://www.nytimes.com/2009/06/25/opinion/25kristof.ready.html?_r=1&em=&pagewanted=print
Lin said…
I’m agreeing with Betsy–government taking over healthcare is NOT the answer. And this healthcare bill is loaded with payoffs to special interest groups to get it to pass. We need crackdowns on frivolous and ridiculous lawsuits so that doctors can practice. Doctors need to stop running expensive unnecessary tests to save costs and government needs to stay out. They have destroyed the schools with this No Child Left Behind act–I’d hate to see healthcare after they stick their finger in it. I’m not sure Canada’s system is as lovely as some would like us to believe. This is huge–not a lot of room to debate this issue.
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I’m agreeing with Betsy–government taking over healthcare is NOT the answer. And this healthcare bill is loaded with payoffs to special interest groups to get it to pass. We need crackdowns on frivolous and ridiculous lawsuits so that doctors can practice. Doctors need to stop running expensive unnecessary tests to save costs and government needs to stay out. They have destroyed the schools with this No Child Left Behind act–I’d hate to see healthcare after they stick their finger in it. I’m not sure Canada’s system is as lovely as some would like us to believe. This is huge–not a lot of room to debate this issue.
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Ratty said… -
The insurance companies are bad, and I don’t think our system is working well. More government intervention would make things even worse. I’ve known people from Canada who have come here for health care so they don’t have to deal with all of the red tape. I don’t know of a solution, but it’s not what we have now or national health care.
- Mary said…
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I’ve had company provided insurance since I left my parents home. My husband did also. When he was sick it didn’t cost us a cent, so we must have both had very good insurance. Once he was in ICU for a month on a respirator, the bill was over $200,000. I was scared we would lose everything, but I would have paid it. As a retiree, I got to keep my insurance, but as time goes on the deductibles and co-pays keep increasing. I fully expect to have it taken away in the future.
I don’t have an answer, but I do know we don’t need more government. I agree that they haven’t done an even mediocre job of managing anything.
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The Old Gray Egg said… -
This is a wonderfully open discussion, and one that I am passionate about.
The tone of many anti-socialized medicine voices is that the government will only screw it up.
Correction: Certain administrations will only screw it up. A financial system with all meaningful regulations removed caused our current financial crisis. No regulation of our “free market” medical-pharmaceutical-industrial/medico-legal complex has gotten us where we are today.
We already have socialized medicine in the VA system. I am old enough to have many friends that are Vietnam vets that can get medical treatment in that system whenever they need it. True, it could be improved, but I’ll guarantee that it beats my situation and that of way too many others where there is no place to go if you have no or few liquid assets. This is especially true of farmers with a little land, some vital equipment, but little cash.
As I travel this country, some of the most beautiful, long lasting attractions to me are the old WPA projects. The government sure didn’t screw that one up. Were it not for the government we wouldn’t have an interstate highway system.
We just need to see payback for our tax dollars. Imagine what it would be like if the tax dollars entirely freed you of all medical-related financial worries.
I highly recommend that you read an American’s experience with the Dutch system: http://www.nytimes.com/2009/05/03/magazine/03european-t.html?_r=1&sq=netherlands%20health%20care&st=cse&scp=5&pagewanted=print
I am hoping the president can come up with a plan that will work for everyone. I know many people, myself included who had ‘excellent’ insurance coverage, but when something unexpected happened ended up owing thousands of dollars. And our rates (and everyone elses at work) then went up at renewal time.
As you know, right now I am unemployed and have no insurance. When we applied for MediCal we were awarded a share of cost program. So if we need medical care we are covered AFTER the first $1,000 every month. Yes, they expect us to have $1,000 to spare every month. It is scary. Unemployment is $1800 per month and I am supposed to be able to pay $1000 of that towards medical expenses. Leaving $800 per month to pay my $900 mortgage, utilities and food for three people. Insanity. Both Mike and I have chronic medical conditions which require costly medications every month. I wish I could choose not to take mine, but with diabetes I risk permanent damage or death; and I want to stick around for my kids and grandkids. I have found a program that is helping us with prescriptions, thank heavens. But if they can do that, why can’t the help with other stuff?
I just don’t know all the answers, but I know that the status quo doesn’t work for so many working families. I hope we can find a way to help all receive the medical care they need.
I think that a healthcare plan should be universal and run much like the assigned risk auto plan. Basically, everyone would be covered for the basics including preventative care and those who wish to have the extras can find private insurance. To me it’s a simple solution.
Being a business owner and suppling heatlh care for my team we have seen a tremendous cost in premiums over the last several years. With that being said, in no way do I want the government involved in it. When you said mountain man needed surgery in a hurry, you could forget about that. We have the best health care in the world and that comes at a cost. We need to get all the bogus law suits stopped that in part raise the cost of health care, stop paying for illegal aliens and get all the dead beats out of the system as well. If we bankrupt the country, which is where we are headed, it want make a difference anyway.
Tim
My blog is on Facebook and I get comments there as well. Here is what I’ve received so far:
Comment:
Have you ever seen Sicko by Michael Moore? That would probably make you really mad just as it made me.
We all know that American healthcare system sucks. The question is how to fix it. My tip is to move up north to Canada where everything is covered ;o)
Comment:
Sounds familiar. I wish that insurance companies were not such a racket. My heart attack cost me $10, 000 out of pocket and that was only for the immediate care the day f the heart attack…the rest of the treatment costs was frightening.
I can see where people could end up with no medical care…pity that in the US that people are dying from lack of medical treatment.
Comment:
I had the same exact situation w/a stone almost 22 years ago, thankfully though we had insurance then.
Comment:
I wish I had an answer. All I have is another story. My sister was uninsured. She developed a kidney stone. Emergency MRIs and medical treatment, then surgery to remove the stone (it was too large for her to pass or to break up using lasers and ultrasounds) left her with bills of more than $40,000. If she had had insurance, the hospital/doctors would have written off the difference of what the insurance thought was more than “usual and customary charges.” Potentially, as much as half of the fees. But without insurance, neither the hospital nor doctors were willing to write anything off. She applied to the hospital for their “financial assistance” program, but because they owned their home (instead of renting), they didn’t qualify for it. Never mind the mortgage on the house, the fact that it is 60 years old and in poor condition, or that it is only 900 square feet and houses a family of 6. They filed bankruptcy. No other option. And still no insurance.