For the past three weeks, each issue of The New England Journal of Medicine has featured viewpoints on the pressing health-care policy issues facing the next administration. These topics (in case you haven’t heard) include health insurance and rising health-care costs, and how to balance them economically, ethically, and politically.
I see the insanity of the current “system” pretty much every day.
For instance: the patient crippled by diabetes at age 60, unable to hold a job, and therefore out of luck when it comes to health insurance—too young for Medicare, slightly too wealthy for Medicaid. The older man with lengthy illnesses who’s “used up” his eligibility for rehabilitation and is forced to pay out of pocket. The transplant patient trying to figure out how to pay for the medications that keep the transplant working. Medicare would pay tens of thousands of dollars for dialysis, should her kidney fail—but it won’t cough up the hundreds of dollars to cover medications that will prevent that from happening in the first place.
These people face unfathomable financial stress in the midst of significant illness.
I’ve asked patients to come to the emergency room because of disturbing symptoms or lab-test results, only to have them tell me that they fear a denial letter and the ensuing insurance fight, should the ER evaluation reveal that nothing is wrong.
I also see patients like those highlighted in this week’s New York Times health section—people deciding not to take some or all of their medications because of the cost. Sure, some of those people will do OK. There are well-documented problems with polypharmacy (when too many medications actually create health problems), particularly in older adults. And not every person at risk for a disease (heart disease and stroke, for instance) will actually get it without being treated.
But many who skimp on their meds to save money will pay the price later, when uncontrolled high blood pressure leads to a stroke, or undertreated diabetes leads to vision loss or heart disease.
It used to be said disparagingly of Britain’s national health system that it ought to be called the “national sickness system.” Well, that’s what we’ve got here in the United States: a sick system. Without extending coverage beyond the employed, the impoverished, and those at the extremes of age, there will be no cure. Massachusetts has made a tremendous step in this direction. The rest of the nation should watch and learn.
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Comments (16)
Great post, great blog. I blog on health care issues and how they effect small biz each monday. I’m adding your blog to my feeds and linking to you and this article on Monday.
It horrifies me to read story after story about this kind of thing in the American health care system. I live in Canada, where our health care needs are mostly covered by our taxes, meaning that everyone is given the treatment they need regardless of how much money they make, so the idea of an individual being forced to go without much-needed treatment is completely foreign to me. My heart breaks for every person who has been let down by the American health care system — these people deserve better than this. Should a human being’s right to good health, or even to live, be measured by their income? Should mothers be forced to bury their children because their family slipped through the cracks?
I wouldn’t necessarily go so far as to say that the US should make the switch to entirely public health care, at least in the near future, but the American government needs to do something to help their citizens. How can anyone dismiss this kind of suffering on the grounds that they “should have earned their health care”? Who could be so selfish to claim that another person should suffer or die just so you can save a few dollars in taxes? This isn’t just politics — it’s people’s lives.
I wish more doctors would speak up about this kind of thing. Maybe then people will start paying more attention to the human element of the situation, instead of worrying about money.
As a self employed individual that is not eligible for Medicare, Medicaid, or in any type of HMO group health insurance is just out of the question. It would cost more than our mortgage to pay for coverage for 3 people. There are months that it is a struggle to pay our mortgage – how on earth could we swing health care. We have no family doctor and would need to be on our deathbed to go to an emergency room. I know many people in the same situation – we pray for health!
1. Unfortunately, there are more people spending their money on cigarettes, alcohol, drugs, etc.
2. Medical conts are artificially high due to lack of competition and the insurance industry.
3. The ER is the worse place to go if sick – you’ll die waiting or leave broke. Todays’ ER’s have become CT Triage Centers.
How about when a “plan” doctor calls an ambulence to his office and sends you to the emergency room because you are showing life-threatening symptoms and need treatment NOW…and when all is said and done, your employer-selected medical plan disallows most of the treatment? That’s what happened when I presented symptoms of a heart attack: my doctor took an EKG at his office, which includes an urgent-care practice, saw my heart rhythms, and pulled the panic switch. He sent me to the hospital via cardiac-care ambulance. The plan administrator said “your doctor sent you to the wrong place” and as a consequence I have to pay 55% of a 60K hospital bill. That’s AFTER major-medical coverage is “exhausted”.
So much for “insurance”. I’ve experienced the same problem with subsequent emergency-room visits with two different health plans. (I was laid off from my first job, in part because of the health claim — yes, I know that’s illegal, but it happened.) It’s especially galling when I just sit there, and the condition that sent me to the emergency room reverts itself while I wait…and there is another $1,000 that gets added to my debt. So now, I don’t go to the emergency room. Period.
Physicians order more expensive test than are needed. Risk Management at its finest. Thank your friendly lawyers for this trend.
Shakespeare has the answer to fixing healthcare.
First, we kill all the lawyers.
Healthcare needs to be fixed. It is very stressful to all involved and will boil over. You know the kooks who shoot up schools, churches, and the post office. Hospitals will be next.
Doctors and hospitals are a major part of the problem. There are simple fixes they themselves can undertake to relieve healthcare costs instead of just bemoaning the present situation. Here are some examples:
1. Publish all fees for all services by CPT code. It’s the fault of the healthcare industry that people don’t know what a CPT code is except for the insurance industry, Medicare and Medicaid. I had to file an open-records request to get the list here in Texas.
2. Require that all invoices to the uninsured be accompanied by the CPT codes and a statement as to what the fee would be if charged to Medicare.
3. Give all patients MFN status, meaning that the patient is not charged more for any treatment than Medicare, Medicaid or an insurance company would be charged.
4. Encourage some physicians and hospitals to refuse to deal with insurance, Medicare and Medicaid altogether, so that the self-insured can be spared the 40% markup in the bill that covers the front office insurance and medicare filings.
If US physicians and nurses don’t institute some of these reforms, they deserve to become Obama government employees and treated like the Canadians and Brits treat their healthcare workers, only the US docs and nurses won’t be able to improve their situation by crossing the border, as the Canadians do.
I hate the idea that I’m paying $$ for health insurance but the corporation providing the insurance is (essentially) obligated to do everything in their power to deny me care when I need it.
And politicians act like giving everyone the privilege of paying for Health Insurance will solve everything. It won’t. It might spread the costs but we really need to fix what happens once people get sick and ask the insurance companies for money.
Some people get mad, all I can do is sing about it:
http://www.fandalism.com/index.cfm?songid=216577
http://www.fandalism.com/index.cfm?songid=216499
http://www.fandalism.com/index.cfm?songid=216498
The failure to identify corruption as the road block to a functional health care system is the central issue.
All other examples are only secondary effects of that central key.
I have health insurance and I am reluctant to go to the doctors because of the ensuing paper trail it triggers. The thought of dealing with the paper trail and numerous phone calls to Insurance companies, doctors makes me sicker than the physical sickness.
It’s complete insanity. I was in the hospital couple of years ago for a about a week. The paper trail continued for a year along with numerous phone calls for clarification and I have a box full of paper work from that one incident of hospitalization.
I agree with the premise of your post. The health care system in the US is broken.
I also agree with Pranab because I went to the emergency room for an abnormal heart beat, and got bills that my insurance was supposed to pay. So I had to call the insurance and send them the bills, and then I got more bills from other doctors who did one of the many tests I had done. If I hadn’t known better, I would have paid these bills. The hospitals and insurance companies have no incentive to get it right and bill correctly. The hospital gets paid either way, and if you pay it, the insurance company gets off the hook. I bet hundreds of millions are collected from unknowing individuals every year.
Personally, I think we need to go to a system that does not have any managed care. HMOs have driven costs to ridiculously high levels because they do not care if they get the best value for their dollar. If you and I were paying, we would question bills and fight for the lowest cost. Insurance companies, drug companies, etc, have no incentive to lower or control costs.
Our health care is run by lawyers, accountants and bureaucrats. We need it to be run by patients and doctors. Until we get big business and managed care out of the way, we will continue to have a system that is the laughing stock of the civilized world.
Re: the sixty year old man disabled by diabetes. His age is not a factor in the Medicare issue. There is something wrong there, he should be eligible for medicare if he is disabled. A good lawyer or even someone with some common sense should be able to help him fill out the Social Security paperwork and his doctors should furnish certification so he can collect both SSI and Medicare. (Personal experience, my coverage started at 55) As for the other problems you mention, these should be fixed with intelligent regulation and severe penalties for the people who exploit sick people for profit. Denying life saving treatment should be criminalized.
Everyone has a story. Everyone has a comment. Not many are prepared to pay . Not many can afford it.
Is there a price for health care? Yes !!! Death and a slow one at that.
While I agree that the health care system is horrendous, I don’t think that simply extending it to more people is the answer. I have health care provided by my employer and I’m still facing claims denials. I have a chronic knee injury that requires physical therapy for rehabilitation. My plan with United HealthCare provides me with 60 physical therapy sessions per calendar year. I’ve been through 25 so far, yet United HealthCare is now denying my treatment because, since my knee isn’t miraculously healing, I’m not progressing enough to warrant treatment. Though my doctor and physical therapist agree that stopping treatment will in the long run hurt my knee, the insurance company stands by their decision to cut my benefits.
Universal health care will do nothing but afford more people the opportunity to deal with the frustration I’ve felt while battling for my rightful benefits.
Here in SE WI, we have some of the highest healthcare costs in the country because of the “non-profit” game the big healthcare providers and hospitals play. All of their profits are shovelled into capital improvements, so they have to build new clinics and hospitals to avoid having profits. The new clinics are underused, so the fees have to go up to maintain them. It’s ridiculous!
If all clinics and hospitals and doctors were required to post their fees, satisfaction ratings or provide estimates like a mechanic, which they couldn’t go over without approval or putting their own money on the line, we could be empowered consumers of healthcare rather than sitting ducks for the bloodsucking “non-profits” around here.
well I was put on disability at the age of 28 and it was only SSI along with medicaid. Let me tell you a few things about that. I have a lot of medical problems that I have to go to the doctor for, such as chronic asthma,bronchitis,seizures,migraines,etc, and medicaid limits you to 24 visits a year.I did not know this until I had went over my 24 vists with him and I owed him a lot of money. My family doctor sent medicaid a override form and they denied it because they said my illness wasn’t life threatening.. I tried to pay as much as I could on the bill but is wasn’t enough so I lost my family doctor. I still have a neurologist for my seizures because I was refered to him by family doctor before he refused to see me any more. Now if I get sick or have a seizure or one of my bad migraines I have to go to the ER and sat all day and night just to be labled a obese drug seeker because I have to go to the ER at least once a week for my migraines because again medicaid will only pay for a certain amount of medicine for this to. I think our health care system is off somewhere. My son has medicaid for now but at the end of this month 3/09 he will no longer have it because he will be 19. And he has no health coverage and he needs his medication and doctor for his allergies and bi-polar but medicaid said that we make to much money to keep him on medicaid. For a family of four you can only make a little over $550 a month. Now tell me our system ain’t screwed up somewhere when they are giving all these banks and stuff millions in bailout money.