U.S. CitiesCity-Data Forum Index
Go Back   City-Data Forum > General Forums > Great Debates
 [Register]
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
View detailed profile (Advanced) or search
site with Google Custom Search

Search Forums  (Advanced)
Reply Start New Thread
 
Old 08-15-2009, 12:06 PM
 
Location: Not where you ever lived
11,544 posts, read 25,113,118 times
Reputation: 6189

Advertisements

This GREAT DEBATE is NOT about POLITICS, TROLLS, BAITING, SPAM, OR SNARKY REMARKS! ALL WILL BE REMOVED BY ME. DON'T LIKE MY RULES? DON'T BOTHER. We have already heard from the politicians, the pollsters, the pundits, the Right and the Left, the Red and the Blue, and we've heard the commercials.

Now it is time for an honest discussion of what is *wrong* with healthcare in America?

It is time to hear from the rest of America. The people who live it every day. The people who work in the system, the caregivers, home health nursing, the homemaker services, the homebound, the folks that deliver meals, hospice, seniors, patients who use home health equipment and the folks I did not name.

In 1950 a doctor would make a house call.
In 1962 the cost to have a baby and three days of hospital care was $500.
In 1982 the average cost of a office call for a doctor was $25.
In 1999 the average cost of gasoline was $1.00.
In 2000 the generic equivalent of an old drug called Medrol was $9.
In 2002 the average cost of a office call for a doctor was $187.
In 2004 Medicare Part B cost about $50 per person.
in 2008 Medicare Park B cost about $100 per person.
In 2008 the Medrol cost $55.00
In 2009 Seniors did not get a COL; Part B did not increase.

Are insurance companies to blame? From my experience there is plenty of blame to go around from the pharmaceutical companies that pay doctors to write prescriptions, to hospital owned HMO's that not only hire poorly trained doctors, the hospital board set the rules on how much care a patient can have.

A hospital took office space away from a very good, well trained doctor, because he refused to order expensive tests for patients that were not needed. He bucked the system and lost. Except another hospital in another town was delighted to have him. Another doctor in the same town went independent. He takes no insurance, no Medicare, does not make hospital rounds or rotate into the ER on weekends. His office call is $25 and most of his medical supplies are donated by pharmaceutical companies. As a former ER doc in one of the busiest hospitals in the United States, he gives terrific care.

In my way of thinking, sanitation in hospitals is the number two source of problems. The number one problem is lousy doctors. No patient should leave a hospital with MRSA, but it happened in my family. It took seven months and seeing every doctor in town, ER, WoundCare and a surgeon - who did nothing- before we found a doctor who did a Culture on the wound. The ER which was the first stop, should have been the last stop - except the doctor did not have the good sense to Culture. He did not and he is still practicing.

All of this happened in rural America.

I firmly believe four things, [1] We need a national health standard that is enforced in every county in every state. [2]All graduating doctors should be required to serve in rural America for two years. Boredom and lack of the bright city lights will not kill anyone.[3] Pharmacists should be banned from giving 'gifts' of any kind to any doctor, and [4] no hospital board should be allowed to dictate how a doctor treats his patients.

Good rural doctors either quit, go to another field, or they go to bigger cities due to the $250,000 policy they have to carry. It is absurd. Insurance companies are killing independent doctor practices.

I've been actively involved in eldercare for 20 years. The games pharmaceutical companies play is dangerous. It is one thing that should be stopped now.

What say you???

Last edited by linicx; 08-15-2009 at 01:03 PM..
Reply With Quote Quick reply to this message

 
Old 08-15-2009, 02:08 PM
 
8,324 posts, read 8,602,376 times
Reputation: 25996
1. National health standards exist and are enforced. These standards tend to be established by bodies like Joint Commission on Accreditation of Hospitals (JCAH). Virtually every medical doctor is board certified and to maintain board certification he/she must follow national standards annunciated by boards such as the American Academy of Family Practice (AAFP) or the American Academy of Obstetricians and Gynecologists (ACOG)

2. Making doctors agree to serve for two years in a rural area might sound good, but it is not practical. It might reduce medical school applications and lead to less qualified people entering the medical profession. You must consider the fact that unlike many occupations, doctors often begin their career over $100,000 in debt because of the cost of medical school tuition and student loans. There are also issues about forcing people to do things they don't want to do. Most military men would not want our army to return to the draft. There were too many issues with discipline because of men who did not want to be there.

3. I think what you mean when you talk about "pharmacists giving gifts to doctors" what you are referring too are pharmaceutical companies giving giving freebies to docs in exchange for prescribing their medications. Actually, some of the issues are much larger than this. Pharmaceutical companies spends billions every year on direct-to-consumer (DTC) marketing. Twenty years ago this was unheard of. DTC is a problem and causes too many physicians to prescribe brand name products to patients. Insurance picks up this bill and passes it on to all of us.

4. Hospitals maintain internal rules and policies which dictate standards of care to all physicians who have privileges with that hospital. Its a form of quality control that typically results in better (not worse) care for patients.

I think that all of us both in and out of the medical profession recognize reform must occur. Perhaps a few whackos challenge the need for any reform, but that's about it. The dilemma we have is over the direction and the speed of reform. My problem is that I don't have alot of confidence in either the free market or the government to fix things. Some combination of both is what is needed. Also, there is the cost issue. I can't see how any meaningful change can occur without some infusion of money. Yet, our country is currently in debt up to its ears. We have to do something, but it better be done as economically as possible.

Big problem, healthcare reform. I wish we had started the process years ago.
Reply With Quote Quick reply to this message
 
Old 08-15-2009, 02:13 PM
 
Location: Victoria TX
42,668 posts, read 71,653,762 times
Reputation: 35885
In my view, the problem is not who pays the bill (it will all come out of our national wealth), but what the medical and health expectations are.

People now believe that they have, as a birthright, nearly 100 years of good, painfree health. That is an unrealistic expectation. There isn't enough money in our treasury to pay the practitioners what it will cost to keep on giving everybody long and comfortable life. Everybody needs to accept the fact that the end will come, and throwing a few million at it for some added months or even years is not a luxury that can be afforded to all.

I would propose a multi-tiered healh system. A universal plan, paid from general tax revenues, that is capped at some lifetime figure, say $200K for starters. The cap wil give people an incentive to not squander health care privileges on trivial matters, and encourage them to live a healthy lifestyle. The rich may, at their option, purchase a more comprehensive plan from the private sector, to cover all their organ transplants and intensive care villas and tummy-tucks and everything. Rich people can afford lush greens and first-class legroom and a slip at the yacht harbor. If they can afford a long life and good health, they can pay for that too.

For the rest of us, we would be guaranteed all the simple basics---procedures to keep us going against the usual knocks that life delivers. If you have organ failure or live to be 99, you do what people have been doing for millennia---you die. But until then, you have access to repairs and remedies for the nagging things that are debilitating, but not life-threatening. And lower the minimum standards. The poor cannot afford health care, because they are forced to pay the cost of immaculate standards. Give people the option of a slightly higher risk at a greatly reduced price. Medical care today is like forcing every passenger to fly first class. In third world countries, a patient sleeps in a bed in a ward, where a nurse periodically takes vital signs. A member of the family sleeps in a chair next to the bed, brings you your meals, does the practical nursing duties, and tells the staff when the IV runs out. Ten bucks a night. But the doctor is real and competent, lab, x-ray and MRI up to date.. Why shouldn't poor Americans have a budget option?

I would also propose a two-tiered doctor system. You call in sick and go and see, not a doctor, but a trained sub-doctor, who has the expertise to prescribe antibiotics or order the usual tests for commonplace ailments, or refer you up the ladder to a specialist for more difficult diagnoses. One of the problems for the uninsured is having to pop for two-days pay to get a doctor to write a prescription for an everyday product that the pharmacist already knows you need. Every community and neighborhood should have a free, government paid outpaient clinic staffed by such sub-doctors, to take the intense pressure off the people who are trained and capable of dealing with the urgent and catastrophic medical needs.

Most important of all, our medical dollars have to stop pating for things unrelated to medical services. Universal medical care can be delivered for less than one tenth of the bureaucratic paperwork that presently attends the health care field. Medical advertising has to stop. It's all paid for by the sick, who have higher priorities, and seeking medical care will occur to them on their own. And who do you think pays the rent on those palatial office suites in the Medical Arts Plaza?

Last edited by jtur88; 08-15-2009 at 02:29 PM..
Reply With Quote Quick reply to this message
 
Old 08-15-2009, 02:47 PM
 
Location: North Beach, MD on the Chesapeake
32,177 posts, read 39,280,307 times
Reputation: 40671
The system changed when insurance changed from covering "catastrophic" events (hospitalization, surgery, etc.) to covering everything including simple office visits. I remember the first insurance I had (dad was an insurance agent among other things) was a private policy and he filed the paperwork after paying the provider. The same thing with the first work provided coverage I had, I paid then was reimbursed by the insurance company. Dr. offices now have staffs to process insurance paperwork that are larger than the medical staff.
Reply With Quote Quick reply to this message
 
Old 08-15-2009, 04:29 PM
 
Location: Not where you ever lived
11,544 posts, read 25,113,118 times
Reputation: 6189
I favor the idea of a sliding scale, income based, $0 -$25 clinics staffed with EMT's. Those with no income pay nothing. Otherwise the rest of us pay something. I do not advocate caps because someone, somewhere, always *falls through the crack*. Natural disaster and catastrophic illness cannot be capped. It it was, my daughter would have died a horrible painful death. without medical care, long ago. Call me a sucker, but I am not sure a cap is the best method.

My spouse had a quad-bypass that failed within 50 days. We were going to a clinic staffed by the herft doctors. There were four doctors that rotated. No two could agree on one drug. AT the end of six months I'd wasted $4-5k with the pharmacy games and almost killed my spouse because they kept playing with the rat poison aka blood thinner. I fired them, the family doc took over, and the PT tests have been stable for 12 years.

I disagree on another point. I can show you four states where the state health department fails miserably because counties are not allocated enough money to hire the staff to do inspections of restaurants, motels, hospitals, nursing homes, retirement homes and every other place the public eats in a timely manner. A yearly inspection is woefully inadequate. It is not necessary - any more that it is necessary to remove children from foster homes where guns are present. That was another state legislature bright idea until the natural son killed the foster child with daddy's shotgun that was not secured. The parents and the kid are in jail; the 12 year old was tried as an adult; he may be a lifer. HIs siblings were moved to foster homes and will not be released until their are majority age. The point being state legislatures are not terribly bright when it comes to common sense and practical issues. The NRA and Insurance companies lobby against good practices.

There is no hope of righting a sailboat as long as friendly PACs are in the room. JCAH does not work in rural hospitals where they are understaffed, overworked and no one cares. These people will CYA long before they ever CBC. As long as hospitals send out skewed surveys that return positive results the administrator pats himself on the back when he ought to be fired. The good old boys on the hospital board play golf with the admin while his executive secretary bowls with their wives. It keeps the dirty little secrets close - like the RN in ER that did not know what a PT test is - to the vest. Doctors who go to rural America should have a home provided and receive comparable wages to any large hospital. They should also have the option of staying permanently.
Rural hospitals should not go begging for basic services like heart and lung doctors. I should not have to drive my spouse 100 miles to see a specialist.
Reply With Quote Quick reply to this message
 
Old 08-15-2009, 07:00 PM
 
Location: Orlando, Florida
43,858 posts, read 43,597,332 times
Reputation: 58603
Quote:
Originally Posted by linicx View Post
I favor the idea of a sliding scale, income based, $0 -$25 clinics staffed with EMT's. Those with no income pay nothing. Otherwise the rest of us pay something.
This has been my opinion for many years. It makes so much sense....until it seems politicians can't comprehend the simplicity of it all. At the end of the day MOST people can easily afford $25 for an office visit. It is coming up with $200 or more they can't deal with. If the minimum was even $25 for everyone other than those with no income, the majority of the people could afford their own regular checkups and minor illness needs.
Reply With Quote Quick reply to this message
 
Old 08-15-2009, 11:49 PM
 
8,324 posts, read 8,602,376 times
Reputation: 25996
This has been my opinion for many years. It makes so much sense....until it seems politicians can't comprehend the simplicity of it all. At the end of the day MOST people can easily afford $25 for an office visit. It is coming up with $200 or more they can't deal with. If the minimum was even $25 for everyone other than those with no income, the majority of the people could afford their own regular checkups and minor illness needs.
.................................................. .............................................

The concept of a deductible for all but the most urgent care is a good one. It makes people think about whether the visit is worthwhile or not.

However, the notion that you could create clinics and staff them entirely with EMT's is a fallacious one. EMT's have no legal right to prescribe medication. Everyone coming in with everything from a strep throat to high blood pressure would be unable to get medication prescribed.

The lowest level person you could staff such a clinic with is a nurse-practitioner. They have privileges to prescribe non-narcotic medications. Physician Assistants could also be hired, I suppose. However, they work under the supervision of a physician, so there would have to be a doctor somewhere, someplace supervising them.

These are all ideas worth exploring, but state laws prohibit EMT's from prescribing medication and its for a reason. They are generally trained to deal with urgent care situations under direction from a physician. They are not trained to render primary care to patients coming in for routine medical problems.
Reply With Quote Quick reply to this message
 
Old 08-16-2009, 09:58 AM
 
Location: Victoria TX
42,668 posts, read 71,653,762 times
Reputation: 35885
Quote:
Originally Posted by markg91359 View Post

However, the notion that you could create clinics and staff them entirely with EMT's is a fallacious one. EMT's have no legal right to prescribe medication. Everyone coming in with everything from a strep throat to high blood pressure would be unable to get medication prescribed. .
Therefore, the idea is a useless one not worth thinking about? Simple solution. Give EMTs the legal right to prescribe medication (and the training). Then the notion stops being a fallacious one. It is very short-sighted to reject out of hand any idea that depends on simply amending a statute.

We're not talking about EMTs anyway. What about PAs (physician's assistants) who can and do write prescriptions and order tests and make diagnoses, with a doctor sitting in the next room, to make it legal?
Reply With Quote Quick reply to this message
 
Old 08-16-2009, 10:03 AM
 
Location: Victoria TX
42,668 posts, read 71,653,762 times
Reputation: 35885
Quote:
Originally Posted by markg91359 View Post

However, the notion that you could create clinics and staff them entirely with EMT's is a fallacious one. EMT's have no legal right to prescribe medication. Everyone coming in with everything from a strep throat to high blood pressure would be unable to get medication prescribed. .
Therefore, the idea is a useless one not worth thinking about? Simple solution. Give someone the legal right to prescribe medication (and the training). It is very short-sighted to reject out of hand any idea that depends on simply amending a statute. Can't you think any more creatively than that? It can't ever be done, absolutely impossible, forget about it, because it's against the present law today and there is no current statute allowing for it, so we're stuck forever and ever with what we've got?

We're not talking about EMTs anyway. What about PAs (physician's assistants) who can and do write prescriptions and order tests and make diagnoses, with a doctor sitting in the next room, to make it legal?
Reply With Quote Quick reply to this message
 
Old 08-16-2009, 10:28 AM
 
Location: In a house
5,230 posts, read 7,327,596 times
Reputation: 2558
I think the wastefullness of our current system is obvious. There are huge corporations (ins companies) who's only income is whats left over after our medical bills are paid. Huge corporations with complexes all over the country, complete with CEO's & other bigshots getting million dollar bonuses. All because we pay more than we have to, even with overinflated Dr & hospital rates. Then they in turn give more money to insurance companies.

If only our country wasn't run by politicians, lawyers & crooks this would be easy to get right & make reasonable for people to just pay for most services & use ins for emergencies.
Reply With Quote Quick reply to this message
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.

Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.


Reply
Please update this thread with any new information or opinions. This open thread is still read by thousands of people, so we encourage all additional points of view.

Quick Reply
Message:

Over $104,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Great Debates
Similar Threads
Follow City-Data.com founder on our Forum or

All times are GMT -6.

2005-2018, Advameg, Inc.

City-Data.com - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 - Top