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#1
09-09-1999, 07:15 AM
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Is health care an inalienable right, or a service to be purchased? If my kidneys failed, why can I go into a hospital and receive dialysis to save my life when I have no way to pay the bill? The hospital and the taxpayers eat the cost to save my life. I also need water to survive, but if I don't pay my water bill the city will shut off my utilities.
Imagine going into a grocery store and filling your cart with food. You explain to the checkout clerk that you can't pay for it, but she needs to give you the food anyway because you're starving and you'll die without the food. You explain that you don't qualify for food stamps. Will she let you walk out with the food? Why is access to health care any different than buying food, paying your water bill, or hiring someone to fix the brakes on your car? 
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#2
09-09-1999, 07:21 AM
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Or, looked at from the opposite perspective, why are we willing to use the public dime to provide armies to protect the lives of our citizens, but unwilling to use the public dime to provide doctors to treat the health of our citizens?
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#3
09-09-1999, 07:43 AM
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Our government and hospitals do pay for healthcare. My hospital is allotted several million dollars each year from the government to the defray the cost of indigent care, but the hospital still has to pony up a lot of cash to cover the excess. Sometimes the patients are not even citizens; my hospital pays millions each year to provide treatment for illegal aliens. Two cases that come to mind are a woman who needs long-term dialysis; she receives dialysis free of charge at my hospital. The Mexican government will not pay for her dialysis in her own country. Another case is a young man, also a Mexican citizen, who was critically injured in a car accident and spent several months in our ICU at a cost of almost several thousand dollars, free of charge.
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#5
09-09-1999, 08:07 AM
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Could it be that the health services in the USA are sooooooo expensive that the government isn't capable of covering all of it? Hundreds of thousands of dollars? What kind of accident was that? What were the injuries?
In México, the Social Security services are not the best in the world, I know. But even if you are unemployed, you have the right to be treated in a State facility, it's the law. Maybe this lady goes to your hospital because of the better services she can get over there, but I don't know how can she get them for free. I have been in the need for health care while in the USA and I've always been charged.
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#6
09-09-1999, 08:41 AM
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The car accident guy had a massive head injury. As with most really bad trauma cases, the course of his illness was complicated by sepsis, musti-system organ failure, etc. Shoot, the device we use to monitor intracranial pressure costs six hundred dollars per day. Include cost of one-on-one nursing care, respiratory therapy and ventilator, several surgeries, physical therapy, various supplies and devices, and medications (including the nutrition that had to be given intravenously for a few months since his digestive system wasn't working- that stuff costs $1,000 per bag) and it adds up right quick.
The hospital at one point refused to treat the dialysis lady but a public outcry ensued. "How could the hospital just send this woman away and let her die?" seemed to be the majority opinion. Reluctantly, the hospital agreed to continue treating her. How available is dialysis in Mexico? Maybe the reason she couldn't receive dialysis there is because it's not as widely available. Here, the hospital can't turn you away due to inability to pay. Sure, they'll send you a bill, but you can simply not pay and continue to receive services. Part of the reason health care is so expensive in the US is because people feel entitled to receive unlimited, high quality care without necessarily having to pay for it. Those who do pay, and the taxpayers, have to cover that cost.
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#7
09-09-1999, 09:39 AM
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Quote:
 ). Since we are already paying to support charity cases, perhaps we may as well go to a government-run health care system, although I am by no means certain if that would be the most effective/efficient system.------------------ "Eppur, si muove!" - Galileo Galilei
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#8
09-09-1999, 09:51 AM
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Not only is the equipment and medicine of health care expensive (as some here have already mentioned), doctors training is both time-consuming and expensive. In many cases, if potential doctors don't see the profit potential in medicine (and if the government is paying for it, there's likely to be fixed pay scales), then they might not go through the considerable trouble necessary to acquire proficiency in that craft.
------------------ Chaim Mattis Keller ckeller@schicktech.com "Sherlock Holmes once said that once you have eliminated the impossible, whatever remains, however improbable, must be the answer. I, however, do not like to eliminate the impossible. The impossible often has a kind of integrity to it that the merely improbable lacks." -- Douglas Adams's Dirk Gently, Holistic Detective
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#9
09-09-1999, 10:28 AM
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I agree with Dex that medicine must be profitable in order to attract capable people to the profession. I also think the the cost of health care is so high for a couple of other reasons. First, the drug companies need to recoup their R&D expenses, so patents on medicines keep the prices high. Equipment is also costly, and especially so when you consider that a company is not mass marketing whatever piece of equipment they make. The latest and greatest machine would be sold to (WAG) a few thousand hospitals? The only way to make a decent profit is to up the cost in that case
Another problem (IMHO) is doctor's fear of being sued. Most times, one could get by with fewer tests and less costly treatment, but if you turn out to be the 1 in 10,000 for whom that extra test revealed some major problem and your doctor didn't do the test, you could (and many do) sue him/her for malpractice. To avoid this, doctors order many tests which they are pretty sure aren't necessary just to cover their asses. Naturally, this is expensive. On the other side of that coin is the patients. Patients are quite willing to have any test the doctor recommends and sometimes even demand additional tests and/or treatment, regardless of the doctor's opinion. They have no qualms about doing this because they do not have to pay the bill. Their insurance carrier pays. How does this relate to the OP, you ask? My opinion is this: The United States is better equipped than any other nation in the world to develop new medicines, treatments, surgical techniques, etc. We have, therefor, an obligation to do so (my opinion, remember). This means treatment here will be costly (and the best). The truth is that no-one, save for the very very rich, can afford medical care in America. We can only afford it through insurance. So what is the difference between 'us' and the poor? Because our companies pay for our medical care? It is hypocritical to pat oneself on the back for being able to pay one's own medical bills and look down on the poor when the truth is, you are not paying your own medical bills and could not afford to if you had to. Jobs that provide insurance are most often good jobs which require some skills. Especailly of late, when fewer companies are offering insurance because they can't afford it. So what that leaves, IMHO, is an elietist system wherein only the rich and well educated can afford medical care (and the truth is that they can't really afford it either--it just means they can pay their premiums). I can understand the argument that it is too much of a drain on the system to treat illegal aliens for free, but I don't think we can turn our backs on our own people and deny them a service which the rest of us are able to use only by the grace of our employers. If it were left up to me, all hospital fees would be on a sliding scale. ------------------ "I think it would be a great idea" Mohandas Ghandi's answer when asked what he thought of Western civilization
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#11
09-09-1999, 10:42 AM
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I agree people are so quick to sue. I mean 20 years ago when my mother died people were pressing me to sue. What for? She was 60 she had a heart attack. Maybe the doctors didn't due ALL they could. But you know people will die. A million dollars isn't bringing her back.
Still, healthcare is so screwed it is unbelievable. My current policy says only 5 reassons are acceptable to go to the emergency room without calling a doctor first 1) If your unconcious[sp?] 2) If you have a severed limb 3) If you have completely stopped breathing on your own 4) If you have chest pains with radiating pains for over an hour 5) If your fever is over 104 Everything else must be called in first. Granted the ER is abused way too much but still....
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#12
09-09-1999, 10:54 AM
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I think one reason emergency rooms are overused are most doctor's can't get people in within 2-3weeks of the date you call. Depending on why you need to see a doctor, either it will run it's course in that time (in that case why call anyway) or it's more serious and you can't wait 3 weeks.
Many of the "quick care" clinics I have seen and been to in times of need have made me almost ready to go to the emergency rtoom, many of these places are understaffed and with poor doctors when there are any doctors at all. Most times they are staffed with PA's who say, "take this antibiotic and call your doctor". I believe part of the high cost of health care is to subsidise those without insurance who cannot pay their bills. Hospitals need to charge more for a service because they had to write it off on the last 3 patients. ------------------ To deal with men by force is as impractical as to deal with nature by persuasion.
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#13
09-09-1999, 11:31 AM
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Lucky made some good points about technology and equipment. Technology allows us to save people who would have been left for dead in the recent past. Two classic examples of this are patients with severe head injuries or strokes, and premature infants. Through aggressive (and unbelievably expensive) treatment, these lives can be salvaged, though the quality of life afterward is often miserable. The idea is "we CAN save this person, therefore we MUST, no matter what the cost".
Only a few years ago, CT scans and MRI's were new, not widely available, and thus infrequently used. Now every hospital has a scanner and an MRI and our critical care patients receive these tests regularly. Truely, this helps to save lives in many cases. These tests improve the quality of care, but they still cost a fortune. The same is true of dialysis; many of our patients receive dialysis and not only renal patients- those with multisystem failure need to be dialyzed, too. We even have a new technology that allows us to do dialysis continuously, 24 hours a day, for those patients who need dialysis but are too sick to tolerate the traditional treatment. I can't even imagine what this machine costs, but every nurse has to receive special training to operate it and the patient is automatically a one-to-one, so the nursing cost is tripled.
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#15
09-13-1999, 01:21 PM
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Quote:
The object of single-payer health care is to take the 25% of your insurance premium that the insurance company keeps and use the bulk of it to pay for the uninsured. Most countries with a single-payer plan spend 2-3% on overhead. If done right, it would cost more for very few people. (My main concern is the ability of the government to do it right.) Quote:
Dr. J PS: In the interest of full disclosure, the above analogy was for demonstration purposes only. While my neighborhood is safe, my house is 70 years old and a tinder box waiting to happen. Doesn't change my point.
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#16
09-13-1999, 01:36 PM
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I think the problem is a little of everything that everyone has said so far: Insurance companies cut down on covered services in order to preserve profits; not enough people have access to decent insurance, sticking the hospitals with the bills; hospitals charge outrageous prices for nearly every service to cover services for indigent patients -- it's a vicious cycle. All of them need to be reduced or none of them will.
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#17
09-13-1999, 01:42 PM
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Doc, that all depends on where you live.
In many states the fire and police funding comes from the regional taxes, for example in city a you're only paying for city a and not cities b, c, and d. I still don't equate paying taxes for your police and fire service to paying your money for someone elses health care. ------------------ Don't let the loveless ones sell you a world wrapped in grey.
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#18
09-13-1999, 09:19 PM
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BurnMeUp writes: "Yes I think all people deserve quality health care, but do I want to have to pay for the people who don't use birth control and have 15 kids? Do I want to pay for the high risk people getting expensive treatments when I am perfectly healthy?"
If you pay premiums, you're paying for it. BurnMeUp also writes: "Look at it like this, What if we had community car insurance, you had to pay for all those uninsured high risk drivers (like habitual DUI-ers and the others who are uninsurable), would that be fair?" Again, you are paying for that in your premium. As I stated before, the bigger the pool, the lower the cost per individual. The smaller the pool, the higher the cost per individual. Therealbubba
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#19
09-13-1999, 10:27 PM
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[rant]
There are multiple contributors to the high cost of health care. To some extent, it's you get what you pay for. 50 years ago, someone had a bad stroke, the family took them home, did what they could, but the stroke victim usually died in a month or so. Now, most are admitted to ICUs, get several MRIs, maybe arteriograms, or even surgery to improve blood flow. If they stop breathing (because their brain stopped working) unless there's a pre-existing living will directing otherwise, life-support (ventilator, etc. to keep the body alive) is at least offered to the family. If the patient does better than that, extensive rehabilitation in special rehab hospitals & then home therapists all help stroke victims recover as fully as possible. Miracles, both small & large, do occur & many people are helped tremendously by all this and most of us count this as money well-spent, but still the cost of treating those who are not helped is staggering. All the fantastic research that promises the world on our nightly news is expensive, even (especially) that which never makes it into a single human patient. The commission (JCAHO) that makes sure all hospitals meet certain "minimum" standards started off as a great idea. Now it is an out-of control bureaucracy. They survey your hospital & 2 other local hospitals. All of you are striving to meet all of the requirements. Sometimes to make sure you don't get "dinged" you interpret a standard more stringently than the inspectors do. The inspectors are so impressed that - voila - it's next year's "minimum" standard. The number of full-time staff who never come in contact with a live patient, but only to help the hospital pass it's inspections is mind-boggling. That's all overhead that gets tacked onto the cost of every aspirin and bandaid given out. How to pay for medical care for the poor is a major struggle. Do we pay for their mdicines for high blood pressure & diabetes, or wait to pay for their bypass surgery after the heart attack that leaves them completely unable to be independent again. Or do we just let them die because they weren't able to hold a job with full benefits, or the expenses of running the farm kept them from being able to buy insurance? Million dollar claims for pain & suffering contribute to the total cost, as do unneeded tests designed to prevent suits. But a major cause of rising costs is patient expectations. There's not a doc out there that doesn't know that viruses can't be killed with antibiotics. But their HMOs are much more concerned with a) getting patients in & out of an appointment on time & b) keeping patient satisfaction high. Ever try to get a history, examine someone & explain to someone convinced his sore throat needs antibiotics that its just a virus, and send him away empty-handed and feeling like he got good quality care from you? In 10 minutes? 6 minutes, really, because you're trying to catch up from the 80 year old who took 5 minutes just to get on the exam table, and the mom who wants you to look in her other 2 kids ears in the one appointment for Jimmy. And don't even get me started on the disgusting multi-million dollar bonuses that HMO CEOs award themselves for paying people less to do more, while charging people slightly less to get a whole lot less. [/rant] ------------------ Sue from El Paso members.aol.com/majormd/index.html
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#20
09-14-1999, 12:17 AM
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BurnMeUp writes:
--------------------------------------------- I believe part of the high cost of health care is to subsidise those without insurance who cannot pay their bills. Hospitals need to charge more for a service because they had to write it off on the last 3 patients --------------------------------------------- Very good point. If you have health insurance, you pay for the uninsured. Hospitals do cover the costs of indigent care by cost shifting the costs to your insurance company. If everyone had insurance, everyone would pay significantly lower health care costs. The more spread out the risk is (more people in the pool), the lower the risk per consumer. This will never happen, conservatives hate the idea of poor people having equal access to quality health care. Also, insurance company's would really lose out if there were a single payer system of health care, our politicians get a significant amount of campaign financing through their friends in the insurance industry. So, is health care a right? It should be. Therealbubba
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#21
09-14-1999, 12:26 AM
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Therealbubba wrote:
<Blockquote>conservatives hate the idea of poor people having equal access to quality health care.</blockquote> I don't know if it's so much they hate the idea, what they hate is the idea that they have to pay for it. Yes I think all people deserve quality health care, but do I want to have to pay for the people who don't use birth control and have 15 kids? Do I want to pay for the high risk people getting expensive treatments when I am perfectly healthy? Look at it like this, What if we had community car insurance, you had to pay for all those uninsured high risk drivers (like habitual DUI-ers and the others who are uninsurable), would that be fair? True, health care is not a priveledge like driving, but expensive treatments and exploratory operations and other non necessities shouldn't be payed for by the general public. Most hospitals have a certain number of cases they are allowed to write off if you prove you cannot pay. These people who end up using ER's and even OR's when they have no money can contact the billing offices and the hospitals write them off and get a tax write off for taking a loss. ------------------ Don't let the loveless ones sell you a world wrapped in grey.
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#22
09-14-1999, 11:01 AM
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If car insurance were optional ( I think all states require it), the next thing the insurance companies would do after changing their underwear, would be to double their premiums. They'd have to to offset the number of consumers that would drop or reduce their coverage.
Well, medical insurance is optional. That's one of the reasons why it's expensive. That and greed by the industry. If there was a law making medical insuranc mandatory, like single payer coverage, you could watch the cost to consumers literally halved overnight. Therealbubba
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#24
09-14-1999, 11:54 AM
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Therealbubba;
You said: Quote:
------------------ "I think it would be a great idea" Mohandas Ghandi's answer when asked what he thought of Western civilization
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#25
09-14-1999, 01:43 PM
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Like any other market, if you lower the cost of health care, you increase the demand. And when you do that, you run into other limits. You'll find out that there just aren't enough doctors and hospitals around to serve the demand. So you wind up with waiting lists, which can be more detrimental to public health than the current system.
Countries that have socialized medicine routinely have this problem. In Canada and the U.K. waiting lists for serious surgery can be months long. The head of the Canadian Chamber of Commerce died of a brain tumor while waiting for months for a CT scan. If he'd gotten the scan right away, his life may have been saved. And, our lists are not nearly as long as they could be because we have a big safety valve - the U.S. People who get put on long lists here often go to the U.S., and the wealthy here will also often go to the U.S. for treatment because at the highest levels it's better than in Canada. The Premier of Ontario went to the U.S. for his cancer treatments. Thus, the most difficult and time-consuming cases get offloaded from our overworked system. If you guys socialize your medicine, you won't have that escape valve (although it wouldn't surprise me to see 'medical havens' with top-flight doctors spring up in small countries in the Caribbean and such) Medical care can never be a 'right', because it requires someone to provide it. The only way you can make it a right is to make doctors slaves. In a free society, you can't do that. What you CAN do is force them out of their profession, or force them to leave the country. And that is what has happened in almost every country that dabbles in socialized medicine - they suffer a 'brain drain', where the very best doctors leave and go elsewhere (usually the U.S.). Health care is very expensive, and maybe too expensive for society to get all they want. You can't just pass a law and make it so. It seems to me that the U.S. has a pretty workable compromise right now. The indigent are cared for, the middle class typically has insurance available for reasonable prices, the rich get all they want, and doctors have lots of choices. It's not perfect, but it never will be.
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#26
09-14-1999, 11:43 PM
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I wish that were true dhanson, but there's a fourth group here called the working poor. Income too high to qualify for Medicaid, too low to afford individual policies (which cost about 2-3x what groups/employers pay). I'm not talking that they don't want to pay; I'm talking it would cost them 20% or more of their take-home pay. Food & shelter are higher priorities.
If their part-time, low-paying job doesn't have full bennies, they're left out in the cold right now. ------------------ Sue from El Paso members.aol.com/majormd/index.html
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#27
09-15-1999, 12:40 AM
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I agree that the working poor are the biggest problem, but that is counteracted somewhat by hospital charity and subsidies. Hospitals write off a lot of debt every year, usually from this category of people. And the federal government subsidizes hospitals to the tune of 130 billions dollars a year partially because of this problem.
I DID say that the system wasn't perfect. The problem is that it isn't perfect simply because it's very expensive. There also a 'problem' in the U.S. that everyone can't have a yacht. No amount of tinkering with the laws will get everyone a yacht. Health care may fall into the same category. You can have an imperfect system with holes, or you can have massive waiting lists and a decrease in the number of people who become doctors in a market already facing shortages of skilled help. Pick one.
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#29
09-15-1999, 05:43 AM
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Quote:
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#30
09-15-1999, 07:34 AM
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Walk into your local hospital and tell them that you're the working poor and they can just "write off" your bill because Uncle Sam gives them a subsidy. Our largest hospital in town, a 700 bed medical center, gets 3 million a year for indigent care. That covers about a weeks worth of operating costs, if they're lucky. They'll still treat you, and they are going to shift the cost of it to the HMO and PPOs that they have contracts with. And who's paying for that?
So, the bottom line is that you do pay for indigent care, through taxes and cost shifting to your insurance carrier. Imagine being able to make a career decision and not have to base it on whether or not your new job has health benefits. Ever feel tied to a job you hate because you need their benefits? What about welfare? How many of the folks on welfare would get off of it tomorrow if they were assure that they wouldn't lose their medicaid? Decreaseing costs increases demand? I doubt it. The same patients are coming in the door no matter the cost. By that logic, we can eliminate disease by lowering costs. In the end, it comes down to a handful of greedy people that will do whatever it takes to keep the status quo and the little man down. Therealbubba
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#31
09-15-1999, 08:01 AM
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Kudos to pldennison and therealbubba for brilliant posts. I find nothing to disagree with on either. "Gee, the hospitals are cutting their charges; guess I'll get sick. Can't miss out on a special!!" (Although come to think of it, I know a few bargain shoppers who might just think that way!)
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#32
09-15-1999, 01:37 PM
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I wasn't trying to equate health care with yachts. I guess I should have picked a different example. I was attempting to show that health care may be so expensive that the U.S. simply can't afford all that it wants. If that's the case, then you can't change it by juggling the books. And it certainly does look like that's the case. The U.S. already spends a huge chunk of its GDP on health care, as does every other modern nation. And yet they all want more. Here in Canada we read headlines about the 'health care crisis' every other week.
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