Health care and poverty in the US: the system is crazy.

[eleanorigby]

Couple of things.

First, AMA stands for “against medical advice”–not, in this case, the American Medical Ass’n.

I AGREE with you that they system is crazy–our ER’s are overcrowded and functioning as clinics for those (rising) number of people who have no insurance/cannot afford to pay for care. Hospitals take in everyone-we are not allowed to turn folks away without a place for them to go. Frankly, most of my pts are the un-insured and the poor–so much is done outpatient now, that you ahve to be really, really, sick to be admitted. And those who do not receive preventative care, tend to get sicker and sicker more frequently than those who can utilize other options.

It sucks that you couldn’t get basic, preventative care–I’m with you there.
But IMO, you should have stayed hospitalized longer so that follow up labs could have been drawn.

As a pt, you have every right to refuse treatment, once informed of your options.
You were well within those rights to leave when you did.

I am just puzzled. How could a phone call to an employer, made by you or a case manager at the hospital, lose you your job? And even if it did so-fast food jobs are not hard to come by(around here, anyway). If I were an employer, I would like to know that my workers valued their health enough to get a very serious condition treated. It’s not a cold or the Monday flu!

I wish you well, and I don’t see much help for the American system anytime soon.

Oh-and we have MRSA here, too. And if visitors would wash their hands, not insist on antibiotics for viral infections, use the isolation techniques that are presented to them etc–it would make a dent in the rise of “superbugs”.

It, and it’s buddies, VRE etc are here to stay. It is a huge problem–but having socialized medicine is NOT the cause of MRSA and its ilk.

[rfgdxm]

@treis

I can find plenty of articles about the WHO survey but I can’t seem to find a direct link to the survey or complete rankings. This is the best I could find. I swear I think they did this study and then hid it from everyone but news reporters. It appears that the UK is 18th according to the BBC . Looking at the GDP numbers as ** Wesley Clark ** has pointed out the UK spends about half of what the US and France does. To compare France is the number one ranked and the US is the 37th ranked. It seems on the face of it that socialized medicine provides more bang for your buck but not suprisingly if you do not fund it it is not as good.

If you were a not so well to do resident of the U.S. you would not be able to afford any essential care or doctors visits. You would only recieve emergency care for immediately life threatening ailments. When you consider that this is the situation that 1/5 of the country is in it is not hard to see why the U.S. ranks 37th.

To me the health care situation in the U.S. is ass-backwards. You wouldn’t dream of driving your car without changing the oil or having fairly regular checkups. Thats becuase its more cost effective to pay 20 bucks for an oil change every so often than to pay $3,000 to replace an engine. Unforunately we do it the other way in the U.S. by only paying to replace engines and not to change the oil.

That is a shocking statistic. The US is by far the tops in health care spending per GDP, yet has only the 37th best health care in the world. The big problem is that in the US the spending is mostly on health care for the financially well to do. The rich stay health, while the poor suffer and die.

[rfgdxm]

It sucks that you couldn’t get basic, preventative care–I’m with you there.
But IMO, you should have stayed hospitalized longer so that follow up labs could have been drawn.

I wish I could have. Although since I haven’t keeled over yet, in the short term I’m probably OK. At this point the onus is on me to follow up applying for possible financial aid assistance. If I get that, then I should hopefully be able to be treated as an outpatient. And of course from now on I should take good care of myself physically.

I am just puzzled. How could a phone call to an employer, made by you or a case manager at the hospital, lose you your job? And even if it did so-fast food jobs are not hard to come by(around here, anyway). If I were an employer, I would like to know that my workers valued their health enough to get a very serious condition treated. It’s not a cold or the Monday flu!

You don’t know my employer. To the top boss, employees are expendable items. She also tends to discriminate against anyone who is older, particularly if they show any signs of intelligence and maturity. And she wonders why recently a corporate secret shopper totally slammed the place for slow service by obnoxious employees. (Oh, and they said the food sucked too.) She thinks hiring clueless kids dirt cheap who have no idea about customer service is the best way to run a business. Little wonder that the store I work in is dead last in the region in terms of customer service, and sales are declining.

You do have a point that trying to find a better job makes sense.

[whiterabbit]

I have been on disability for some years now, and have never had to pay a penny for any doctor’s appointments they sent me to for determination – which happens ever few years when I get reassessed. This has happened in three different states. What should happen is that you apply, then they send you to their own doctors (in my experience, they suck big time) who report back to them.

[Cheesesteak]

@UncleBeer

Lemme get this straight. Your complaint is that medical care isn’t available to you until a crisis has been reached. But when that point has been reached, you can’t be bothered to follow the course recommended by your doctors. Why then, should we believe you’d follow any regimen recommended by a doctor you might see for your regular checkups were insurance and a doctor available to you?

Hear hear! I’m expected to believe that you would have taken a half day off of work to go down to the free, national healthcare clinic for what you thought was a minor virus? You were griping about having to take a couple of days off for ARF and a heart attack.

I agree that we would all be better off if basic care was more widely available, stitch in time and all that. I don’t think it would have made a bit of difference in your case, though.

[DSeid]

Maybe he would’ve gotten care earlier maybe not. But the anecdote is illustrative of our bass ackwards system.

We all pay for the care of the uninsured.

Pay for it out in doc’s offices and before it is critical; or pay for it when they show up in the ED with ARF and an MI, but the cost is passed on to all of us no matter what. we are choosing to pay for it in a very expensive, inefficient, and poor quality way.

If Mr. rfgdxm lives to recieve the bills, he will be charged full retail rates. The insurance companies all have hefty negotiated discounts. Only those who cannot afford it are charged full retail. He won’t pay most of it and will eventually declare bankruptcy. If he was insurable (which he currently aint) he’d pay the full retail for a product that mega-corp gets a discount for. Few can afford that.

Our model is perverse.

And the only choices are not this or socialized. For example one three-pronged approach (among others):

[ol]
[li]Make basic healthcare coverage mandatory.[/li][li]Require that insurance companies offer the same product for the same cost to all comers. No cherry-picking except on the basis of controllable risk factors such as smoking. No volume discounts. Thus no motivation to have employer-based coverage.[/li][li]Sliding scale tax credits to aid affordability from none to full coverage for the truely indigent.[/li][/ol]

Everyone but the very poor buys insurance. Insurance companies happy. Providers happy. The poor get a government safety net.

Competition on all sides. Providers happy not to have one single payor on the other side with all the power.

Insurance has full portability. No inefficiency of changing with jobs.

Insurance companies all compete on an even playing field. Save on the cost of trying to out cherry-pick the other guy. Compete instead on quality, package, and cost.

Everybody’s happy.

[rfgdxm]

@DSeid

Maybe he would’ve gotten care earlier maybe not. But the anecdote is illustrative of our bass ackwards system.

We all pay for the care of the uninsured.

Correct. My medical bills for this will be paid somehow, someway by somebody. If not through higher doctor or hospital bills, then it will be through taxes. And it is also possible because of the fact I could not get any medical care before I had to go to the ER that someone who did have insurance, or could pay out of their pocket, was delayed in getting ER services (possibly for something life threatening) because the doctors, nurses etc were at the moment taking care of me rather than someone who unavoidably would have had to be treated in the ER, such as an accident or sudden heart attack. As a Great Debate issue, I say this is a crazy system.

[Zoe]

Not only do we pay for the care of the uninsured, but we are also paying for the insurance of other workers anyway. Who pays the insurance for someone who works for Ford? Anyone who buys a Ford does. Each car costs between $1,000 - $1,500 addition to cover insurance for employees.

I had rather pay less for the car, real estate, clothes and food that I buy and pay more in taxes and not have to worry about medical expenses. I have good coverage, but it is terrible to see people suffer and go without decent care in such a prosperous country. I haven’t seen it this bad since I was a child.

rfgdxm, some of the best hospitals in the world are teaching hospitals. I’ve never had a doctor yet who was impatient about my paying a bill as long as I made some monthly payment.

In fact, a nurse at a major medical hospital said that some monthly payment is all that is required. I cannot vouch for that, but it seems reasonable. When the alternative is death, I think I would rather be heavily in debt, but in good health. Don’t play around with this.

[Muffin]

@treis

I can find plenty of articles about the WHO survey but I can’t seem to find a direct link to the survey or complete rankings.

Here is the WHO study: WHO | World health report 2002 statistical annex

A comparision of health care in Cananda and the USA using the the above stats indicates that the American system costs more while Americans have poorer health: http://boards.straightdope.com/sdmb/showpost.php?p=6113420&postcount=6

[Muffin]

Make that “costs more per capita”. Sorry.

[rfgdxm]

@Zoe

rfgdxm, some of the best hospitals in the world are teaching hospitals. I’ve never had a doctor yet who was impatient about my paying a bill as long as I made some monthly payment.

In fact, a nurse at a major medical hospital said that some monthly payment is all that is required. I cannot vouch for that, but it seems reasonable. When the alternative is death, I think I would rather be heavily in debt, but in good health. Don’t play around with this.

The state of my financial health is that just about any payment would be impossible. However, it does look like I may have an option. That hospital’s “Community Financial Aid Policy” says people with incomes less than 140% of the Federal poverty guidelines “are eligible for free care”. My income is (uncomfortably) lower than that. My guess is they are getting some sort of government block grant that is covering much of this cost. Plus as a teaching hospital they do need patients from somewhere. The obvious pool is those who currently have no access to medical care. (To qualify, you must be ineligible for Medicaid.)

And the “problem” I had with this teaching hospital is that in some ways they were too good. Not only did they want me to stay around longer (even though they knew I couldn’t pay) to stabilize my ARF, after that they wanted me to stay so they could do an angiogram, and even possibly an angioplasty. Huh? I wasn’t even complaining about cardiac symptoms. I was already in shock after being told ARF wasn’t something they could just give me some pills for an go home that day, and that if I just checked out right then the odds of me soon being dead were “very high”. After being informed by them it looked like I also had a heart attack (which of course was their job to tell me), I was absolutely horrified. I’m afraid if I am approved for this “Community Financial Aid Policy” what they will find if I go in for a physical? First thing I know they will do is a battery of cardiac tests. If these show that I will be a goner in the next year, I’m not sure I’d really like to know that. Although as I am already at the point I figure my health is declining fast and I’ll cash in my chips soon. I’m not sure that anything they could tell me would be worse than I already have assumed.

At least they didn’t say they thought I had cancer of an internal organ or such.

[Sarah_Woodruff]

@griffen2

I am a resident of the UK, and a far from well-to-do resident at that. Consequently I have to rely on the National Health Service (a socialized medical system funded through taxation) for any treatment I require. The conditions of the wards in which I have been treated have been uniformally abysmal. We wait months for essential treatment and, when we finally get it, we run a higher than average risk of contracting MRSA because our hospitals are understaffed. Doctors waiting rooms are typically jam packed 24/7 so doctors typically get to spend only a couple of minutes with each patient, many of whom are clogging his schedule with trivial ailments because the service is “free”.

I find it difficult to believe that US Private health care could be significantly worse that the British socialized system.

The difference being, as has been said, that you are able to see a doctor for free when you need to. You also get to see the dentist when you need to. In Australia we also have this “two-tiered” health system. There are people from the US on these boards who have lost several teeth because they haven’t got the necessary insurance coverage that would allow them to get the dental treatment they require because they aren’t affluent enough to pay for it.
Surely adequate healthcare is a fundamental right that all citizens of a Developed country should possess. I think this is in no way the fault of the doctors and nurses, but perhaps down to politics and money money money.
Best wishes, rfgdxm. I hope you recover quickly.

[Guinastasia]

@rfgdxm

You don’t know my employer. To the top boss, employees are expendable items. She also tends to discriminate against anyone who is older, particularly if they show any signs of intelligence and maturity. And she wonders why recently a corporate secret shopper totally slammed the place for slow service by obnoxious employees. (Oh, and they said the food sucked too.) She thinks hiring clueless kids dirt cheap who have no idea about customer service is the best way to run a business. Little wonder that the store I work in is dead last in the region in terms of customer service, and sales are declining.

You do have a point that trying to find a better job makes sense.

Depending on where you live, this could be illegal. Certainly, I believe, regardless of “at will” states, it’s illegal to discriminate on the basis of age.