July 16, 2009

• WHAT? The point of this post is...? Yes, sometimes things go terribly terribly wrong--even with the BEST doctors, the highest quality health care, people can have severe complications, even die. Look at how many misdiagnoses there are every day. It's because doctors--and medicine--aren't perfect. Getting a correct diagnosis sometimes doesn't happen the first time. Medicine is an art as well as a science. One disease mimics another--it can be a crap shoot trying to wade through things like Lyme disease or Celiac problems. Lupis, early MS, neurological disorders, PCOS--require the patient be extremely proactive in seeking care because they're often tough to pin down. Ever take your kid in for a rash? By the time they do skin scrapes, the dang things gone. Sometimes just making the appointment does it. The woman in the story wound up with compromised health (apparently) resulting from a voluntary surgery. She seems to blame all the subsequent problems on the military, but why didn't she see a civilian doctor somewhere in that time line? Yes, she'd be out of pocket, but we're talking about her health. If she's a military wife, she can afford it, unlike other people without any insurance working a low-paying job. Believe me, if I felt I needed to see another doctor that wasn't on my preferred provider list, I'd do it. Second opinion, you betcha. You're citing the story of one military wife with major problems and extrapolating from that, assuming that all universal health care will be terrible care. I live in a military town, and was a military wife for a short time. I can cite at least a hundred stories of optimal care for dependents, including some of my own. Talk to the wife of an airman that can afford to take her kids in to the doctor on a regular basis FOR THE FIRST TIME because they've not been able to afford it before. She's ecstatic about military health care. Why is it everyone is so focused on crying about universal health care not being as good as it ought to be? What we have now is NOTHING. Anything is better than that. Will we wind up with good universal health care? I doubt it. Primarily because what they're talking about in Washington isn't CARE, it's INSURANCE. There's a difference. What they're figuring now is how to cut the pie and who's going to get rich on the changes. The red herring is starting to stink up your post. The issue isn't what if universal health care is as bad as some woman with a blog thinks military health care is. The issue is why can't we have a decent system in place to care for people who have NO options.
• Quoting from the FAQ for new users: So what's the point? The point is to hang out and have fun. Like Metafilter, we basically aim to find interesting, bizarre or just plain random links on the web, bring them here to show off, discuss them. But regardless, I didn't get that she was dissing military care, which is very good. She went through so much though, and seemed so lovable I was struck by her convoluted tale... (Hope this brings her graphic service some business for her troubles.) Yet even with commercial insurance much unnecessary work gets done *because it can be done* Secondary point: what kind of triage should be in place for Universal Health Care to work without imploding? *Somebody take these boxer shorts out of here to air out this post!* Then too, there are unnecessary and expensive tests that get done. Like when my real GranMa, dying
• ...
• Well, to continue the ellipsis (after checking to make sure about HIPAA rules), what happened is they cut into her, saw the metastasized ovarian cancer, stitched her back together, and THEN ordered an expensive MRI scan!
• ...which is the kind of thing that happens ALL THE TIME to patients under the currently convoluted rules of Private Insurance (my ex-wife had a somewhat similar but far less extreme experience). Was your grandmother under Medicare or a Privately Managed Medicare Plan? Sounds like the latter. Universal Health Care might be the BEST opportunity to do away with such abuses by changing priorities.
• Here in soviet Canuckistan where we have a form of what you call Universal Health Care ( I prefer to call it Socilaized Health Care, just to get the wingnuts all worked up). We do have significant wait times for certain elective surgeries and tests but if you need immediate care, you get it. Some cosmetic procedures are not (and I don't think they should be) fully funded. The standard of care, while not perfect, is generally high but the costs to the government are also high. As the population ages, costs will only increase. There is pressure here, mainly from the insurance companies and medical corporations, for a two-tiered system under which basic care would be provided for those who need it but, for those who can pay, better and quicker care will be available. A slippery slope. What we don't have (yet) is the predatory overhead of the HMOs, insurance companies, private hospital corporations, lobbyists and other vultures who are only looking to make a buck and who syphon off so many of the available health care dollars before any care actually reaches the patients. I see our system, while imperfect, as both more compassionate and more efficient than the US one but, as is true everywhere, if you have the money, you can always buy better care.
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• Sorry Dan. I shouldn't have assumed your agenda was to argue against any kind of health care. I'm pretty testy about the whole subject. Even steps the press is lauding as positive seem to be side steps away from health care. They're talking insurance, which is not care. What would happen if Universal Health Care was as *good* as that for which military wives can elect? Sounds like you're arguing that UHC would be as *bad* as military care = ANOTHER reason to shoot UHC down. Since you've clarified, I realize that wasn't your intention. Your point re: unnecessary testing. I agree that there maybe be some tests that are "unnecessary", but much of the testing, I believe, is driven by two factors. The first factor I mentioned in my previous post--getting a correct diagnosis the first time isn't always possible. Many serious problems present with relatively innocuous symptoms at first, and no doctor likes to miss something that, in retrospect, should have been "obvious". Well, duh! My hindsight is always 20/20, too! Missing something that could have been caught with a simple blood test or non-invasive procedure such as an ultrasound or x-ray shouldn't have to happen. Someone can always say the test was "unnecessary" if everything's normal. But ruling things out can sometimes be as important as a positive finding. Another issue that plays into this is that doctors can be sued for missing the obvious or failing to perform procedures that look obvious in hindsight.... Litigation drives up the price of health care an exorbitant amount. Yes, there is some malfeasance. But most problems are caused by the errors in the system. Surgical checklists are a no brainer, no cost, way to assure quality care. Why aren't checklists like this mandatory for all hospitals? We KNOW errors are made by rushed or sleep-deprived doctors. Why is the system set up to guarantee that they won't get enough time or sleep? We need to separate REAL health care from "designer" health care. Pay out of pocket for your Botox, your Viagra, your teeth whitening and cosmetic caps, your hair implants, your breast augmentation and tummy tucks. Don't ask the rest of us to subsidize your in vitro fertilization procedures. Yes, these are all 'concerns', but they don't impact the basic health of the individual and the nation. ...what kind of triage should be in place... The problem is that all health care shouldn't HAVE to be about triage. We need prophylactic care--in both senses of the word. Birth control should be FREE for life to anyone who wants it, female (or male) above the age of 21--but I digress. I'll stick to the main definition of prophylactic health. Physical Care: Pre-natal care and well-baby checkups, as well as yearly health and dental checkups, should be FREE for all Americans. This is basic stuff. This is where issues are caught when they're minor. The cost of this would be offset greatly by the savings in preventable illnesses. Why is the US so high in infant mortality? Hey! At least we're up from 37th since 2002. /sarcasm. This is a damning indictment of our health care system.
• Then we need primary emergency care. I'm talking serious stuff--major accidents, broken bones, stroke, severe bleeding, breath stoppage. This can still take place at major hospitals. Secondary immediate care, sprained ankles, small lacerations with sutures, high fevers, etc. should be seen elsewhere, as needed, in a 24 hour walk-in. Finally, things that should be seen by appointment, long-term care, can occur on a 9-5 daily schedule. Free hospice care should be available when needed. Mental Health Care: We desperately need mental health care. Everything from long-term treatment facilities to half-way houses. Medications for bi-polar and other significant disorders should be free. Part of health is provision of basic needs. People need enough (good) food to eat, a place to sleep, and provisions for hygiene. How are we going to take care of all this and keep it functioning? We need to educate. And keep educating. Sign everyone age 18 and up for mandatory 120 hours of health education (with homework!) before they use their health services. Educate for health. Educate for life. If you have a health condition--overweight, smoker, alcoholism--once a year you have a required 12 hour health course to attend. It’s not punishment. Doesn't mean you won't get treated. We'd just like to remind you how you're impacting your health, what new procedures are in place and are there for you, and what you can do about it. It's about education. It's about care. We need GPs desperately. Make med school free to any student willing to practice as a GP for ten years. Then, if they want to specialize, let them go back on an interest-free loan. How are we going to pay for this? Let's start by taking just ONE billion of the isn't much in the scheme of things, but it's a start. Then we can tax the hell out of companies that impact American's health in a negative way. The tobacco industry. The alcohol industry. Coal companies that don't care about their workers black lung. Nuclear facilities that deny links to cancer. Chemical companies that have less than adequate safety procedures. Oh, sure, they comply with toothless OSHA requirements. But they're negatively impacting America's health. Their CEOs get rich at the expense of their workers and the country. Even a preschooler can understand fairness. This is not an issue of someone getting MORE than you're getting. It's an issue of everybody getting something they need. Grow up, America. (GramMa's stompin' her hooves and got her ears pinned today)
• And Dan, sorry to hear about your grandmother. Islander, if you weren't such a bunch of socialist four-flushers, we USians might start by patterning health care after your system, then tweek it to fit. But you folks are aboot as loony as a US two-dollar bill, and you all eat cheesy poutine, eh? Right? So we'd rather re-invent the wheel.
• Wendell, my GranMa was a medicare recipient, but private insurance may be even more Byzantine. I do like BlueHorse's thoughts about supporting more prophylactic care and education. I'm getting more hopeful from all this discussion.
• I forgot about the lawyers. Historically we haven't been as litigious as our noisy neighbours to the south but I fear that the trend toward more frivolous lawsuits and absurd settlements will increase the cost of medical care here as well. It is very heartening to see that our American friends are making concerted efforts towards health care reform and I think that under the current administration you have a much greater chance of success than you've had for some time. Also sorry to hear about your Grandmother, Dan. As I butt out my smoke and head to the fridge for another beer, I fully concur with your comments, GramMa, about preventative medicine and efforts to dissuade people from unhealthy habits too. We don't say "aboot", we say "abowt", poutine except in very rare instances, quickly reveals itself to be artery and bowel clogging crap, best eaten while drunk, and I'm quite fond of the loon on our ONE dollar coin. And we spell it "Socilaized" to distinguish it from "Commieunistic". *sigh*
• I have to say, t'other day I noticed this AskMe question and just reeled at the thought of having to pay for a colonoscopy, and pay $1500 or more, too! Great fook in the marnin', folks! That's scary stuff.
• Dreadnought and I just moved back to Canada and the US - and we're so relieved to be back in the land of universal health care. Not everything is universal - Ontario has stopped paying for eye exams (I suspect it's because the optomitrists started doing more expensive exams to bill more). But we don't have to try to figure out how we can put 1/8 of our not quite adequate income to health care - and that was with an excellent employer based plan. Our half alone was the equivalent of 3 months rent. I can't imagine what we would have done had we been on the private market. All systems can improve, though there must be a careful balance between costs and actual effectiveness - but Blue Horse said it right: What many people in the US have is "NOTHING. Anything is better than that."
• No one can be turned away from the Emergency Room by law. Even for trivial complaints. If a patient doesn't have insurance, that's their main recourse. Hospitals eat the cost if the patient can't pay for that, and this raises the price of health care anyway. Doesn't it? A universal system would at least not be a shell game. Yet now there is said to be growing opposition to what I had thought to be a done deal! Where was this outcry when the bankers got bailed? Why now, when honesty should be policy?
• Spot on, Dan. Yes, no one can be turned away, but using the ER as the only medical recourse is not conducive to overall individual patient health and is a waste of resources. Hospitals bill insurance the low-ball figure. The high-ball figure is what they charge someone without insurance. In addition, if you're what they used to call middle class, 25-50K, which is way down below the actual middle, an emergency room visit can wipe out all your savings or devastate you financially. If you don't pay, or can hang on and try to make payments, hospitals can still sell the bill to the collection agencies, who tack on usurious credit charges and make your life hell from then on. Non-trivial issues usually require follow-up care, which the patient may or may not (usually may not) receive. Here's what the American College of Emergency Physicians says about it. Amazing that American's feel comfortable bailing out the banks, making the rich richer through their own little welfare system, and seeing absolutely NO return. We're willing to throw more money at the system even if we're getting nothing out of it. The system is obviously broke. Yet if you ask someone to pay a bit more in taxes, pennies to the dollars helping out the banks, and help provide health care for people without it, something that would have visible returns, the screeching cries of 'socialism' welfare, lazy freeloaders, NOT ON MY DIME, rise to the sky. We're idiots.
• Uninsured Travel from Across US for Free Healthcare from Relief Group Remote Area Medical
• We ought to fund a congressional junket to let 'em see what life is like in the other half of the US. Instead of $300/night hotels, they could stay in moldy canvas tents. Werks fer me.
• The 10 Dumbest Arguments Against Health-Care Reform
• And 7 out of ten (the dumbest)Americans will agree with those arguments.