Observations of a Dr in an emergency room. (biased, money, states)
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According to the most recent figures I could find (2006) the Veteran's Administration costs per patient was a little over $5000. The cost of for-profit healthcare was about $8000, in most cases.
Don't say publicly funded healthcare can't be done because the VA does it every day.
Of course, there are some caveats to that. In the first place, the VA is self-contained and is not a part of the for-profit healthcare system. In the second, their mission is patient care and ONLY patient care. Profit does not enter into the equation for the VA. Consequently, unlike for-profit medicine, they are free to do whatever they think is best for the patient without answering to the corporate bean counters and without considering how much money they can extract from a patient.
No, the VA is isn't perfect and, yes, there is always room for improvement, but if you want to model publicly funded healthcare, use the VA instead of Medicare/Medicaid.
When the President and Congress embarked on a universal healthcare plan, I wish they'd used the VA as a template.
Have you ever used the VA? Obviously not. I needed a brain scan.. My doctor ordered it.. It took a year... Thankfully there was no malignacy or any other issues that they suspected but a year? I needed a hearing aid.. that took a year and a half. When I need to see the podiatrist, the wait is 6 months.. The prescriptions I truly need, are not on the VA formullary so I don't get them. The only way I can is to see a physician outside of the VA. I can't make appointments that work into my schedule for work, instead I have to take off and lose money. I could go on for hours about what is wrong with the VA. Don't get me wrong, the doctors and staff at the VA treat me very well and they do all that they can for me, but the system restricts them to the point that people die waiting for services they need. It is a ridiculous suggestion that anyone use the VA as a template for healthcare. There is too much beauracracy and what is available through the VA is extremely limited. The VA also has trouble retaining good doctors and nurses. When you get a good one, they are not there long. They head to greener pastures. This is particularly true of specialists. This is what you want to model US healthcare after?
Last edited by freightshaker; 04-21-2012 at 06:52 PM..
Have you ever used the VA? Obviously not. I needed a brain scan.. My doctor ordered it.. It took a year... Thankfully there was no malignacy or any other issues that they suspected but a year? I needed a hearing aid.. that took a year and a half. When I need to see the podiatrist, the wait is 6 months.. The prescriptions I truly need, are not on the VA formullary so I don't get them. The only way I can is to see a physician outside of the VA. I can't make appointments that work into my schedule for work, instead I have to take off and lose money. I could go on for hours about what is wrong with the VA. Don't get me wrong, the doctors and staff at the VA treat me very well and they do all that they can for me, but the system restricts them to the point that people die waiting for services they need. It is a ridiculous suggestion that anyone use the VA as a template for healthcare. There is too much beauracracy and what is available through the VA is extremely limited. The VA also has trouble retaining good doctors and nurses. When you get a good one, they are not there long. They head to greener pastures. This is particularly true of specialists. This is what you want to model US healthcare after?
I am a private practice physician, yet work at the VA one day a week. I agree and disagree with a few things you have said (thanks for your service, by the way)
1. The waits at the VA are long
2. the formularly is generally limited to generic drugs, but a "non formularly request" can be made for drugs not on the formulary.
3. It used to be that less talented docs staffed the VA. Now, given economic pressures in the private sector, our VA is staffed by many docs who were very successful in private practice, but just tired of the BS. I see the staff at our VA as being comparable to that in private practice.
4. While the formulary is limited, one has access to a greater range of services through the VA. Non conventional medicine, such as chiropractic and accupuncture, is covered in many VISNs. Further, "cutting edge" technology, considered "experimental" in private practice is covered in the VA.
5. The VA is CHEAP for patients
6. Most providers really respect the vets ((I certainly do and choose to work there one day a week for essentially nothing).
7. Prescriptions are DIRT CHEAP
8. Psychiatric and social counseling is available which is not available outside the VA.
9. Litigation is different in the VA system, therefore there is not as great of a burden by medical malpractice and litigation costs. Further, decisions are not driven by medico-legal concerns as a result.
The VA has positives and negatives, but overall I feel it is a good system (from the VA I have seen and worked in).
Have you ever used the VA? Obviously not. I needed a brain scan.. My doctor ordered it.. It took a year... Thankfully there was no malignacy or any other issues that they suspected but a year? I needed a hearing aid.. that took a year and a half. When I need to see the podiatrist, the wait is 6 months.. The prescriptions I truly need, are not on the VA formullary so I don't get them. The only way I can is to see a physician outside of the VA. I can't make appointments that work into my schedule for work, instead I have to take off and lose money. I could go on for hours about what is wrong with the VA. Don't get me wrong, the doctors and staff at the VA treat me very well and they do all that they can for me, but the system restricts them to the point that people die waiting for services they need. It is a ridiculous suggestion that anyone use the VA as a template for healthcare. There is too much beauracracy and what is available through the VA is extremely limited. The VA also has trouble retaining good doctors and nurses. When you get a good one, they are not there long. They head to greener pastures. This is particularly true of specialists. This is what you want to model US healthcare after?
Yes, I use the VA exclusively. It's the only healthcare I get and I'm more than happy with it.
And, yes, there are problems of availability for certain services, but that's a funding issue, not a systemic problem. Take your brain scan, for instance. It's not that the VA didn't want to do it, it's just that because of budgetary restrictions, they simply don't have enough equipment to meet the demand and access to that equipment is prioritized. I don't know what your VA priority number is, but it makes a difference. Personally, being a 100% disabled Vet, I'm a priority 1, which means I would get that brain scan before anyone else with a lower priority number.
The reason for that is found in the VA's mission. It is not a general healthcare organization freely available to every Veteran. It was specifically designed to serve the needs of people with service connected problems. The greater the problem (as determined by the percentage of disability rating), the greater the access to care. At some point in the past, Veteran's without a service connected problem were allowed to use the system too, but they are prioritized at the bottom. In terms of scheduling access to limited services, that means the guy or gal rated at 100% service connected disability gets first access, followed by those with less than 100% in descending order and, lastly, those with no disability issues at all (Priorities 7 and 8).
Most patrons of the VA haven't really taken the time to understand the system, how it works or how much control they have over their own healthcare via the Patient Reps and that's the source of much of the horror stories you hear about the VA. I'm not saying that's the case in your instance, but it is very common. It's been my experience that the loudest complainers are the ones who expect to be treated first, no matter what, but who don't know why the priority system is there and how it applies to them.
When I said the VA would have been a great template for a national healthcare system, it was that prioritizing of need in the scheduling of services that I had in mind. In for-profit healthcare, anybody can schedule any test or procedure any time they like, so long as they can pay for it. The system, motivated by profit, will provide the equipment needed. The prioritizing of access to that equipment, though, is done by the ability to pay, not medical necessity and that's where insurance bean-counters enter the process. They often operate as exactly like those "death panels" we hear so much about because they determine whether or not it's a justified expense for their company based upon corporate profits, rather than your needs. If they don't want to pay for it, you won't get it unless you can pay for it out of your own pocket and that's just tough for you.
Naturally, using the VA as a model would also require the setting up of some sort of prioritizing system based upon patient need, but what that would look like and what it would be based upon, would be a part of the negotiating process for the whole idea.
All it really proves is that doctors can be bigoted too.
Every time I read the moronic assault you made on someone's life experience, I become more bigoted.
You obviously have no clue how the 'bigoted' and 'racist' accusations drive people into the very thing you rail about. When the lower IQ population accuses me of being something I'm not, I'm not gonna like that person. And I'm certainly not going to waste my time proving you wrong. And so it goes. Congratulations!
I find you biased. I see tons of people who make little to no money and live clean lifestyles also on medicaid.
If we claim to be a Christian nation we should acknowledge that God would have spared Sodom for 10 good people. Perhaps we should take that as an example.
Just 2 days ago I saw a 3 year old that I am worried may have cancer with parents on medicaid. If you and the Republicans have their way that kid will be dead soon.
Keep that in mind before you whine about the minority of people that you end up seeing because of a flaw in the system.
Perhaps those patients which annoy you so much would take better care of themselves if they had a primary care provider who gave a crap instead of having to see you.
I find you biased. I see tons of people who make little to no money and live clean lifestyles also on medicaid.
If we claim to be a Christian nation we should acknowledge that God would have spared Sodom for 10 good people. Perhaps we should take that as an example.
Just 2 days ago I saw a 3 year old that I am worried may have cancer with parents on medicaid. If you and the Republicans have their way that kid will be dead soon.
Keep that in mind before you whine about the minority of people that you end up seeing because of a flaw in the system.
Perhaps those patients which annoy you so much would take better care of themselves if they had a primary care provider who gave a crap instead of having to see you.
Every time I read the moronic assault you made on someone's life experience, I become more bigoted.
You obviously have no clue how the 'bigoted' and 'racist' accusations drive people into the very thing you rail about. When the lower IQ population accuses me of being something I'm not, I'm not gonna like that person. And I'm certainly not going to waste my time proving you wrong. And so it goes. Congratulations!
What assault did I make on someones life experience? You do realize, I hope, that it wasn't me who wrote that original piece?
What I said is that the doctor who wrote it is a bigot. A bigot is someone who practices bigotry, which is defined as: :a person who is obstinately or intolerantly devoted to his or her own opinions and prejudices; especially : one who regards or treats the members of a group (as a racial or ethnic group) with hatred and intolerance.
He used his position as a doctor to criticize and belittle a group of people: his poor patients. He deigned to sit in judgment of them based upon his observations. If that's not bigotry, what is?
I find you biased. I see tons of people who make little to no money and live clean lifestyles also on medicaid.
If we claim to be a Christian nation we should acknowledge that God would have spared Sodom for 10 good people. Perhaps we should take that as an example.
Just 2 days ago I saw a 3 year old that I am worried may have cancer with parents on medicaid. If you and the Republicans have their way that kid will be dead soon.
Keep that in mind before you whine about the minority of people that you end up seeing because of a flaw in the system.
Perhaps those patients which annoy you so much would take better care of themselves if they had a primary care provider who gave a crap instead of having to see you.
Sincerely
A primary care provider
How do you figure that Republicans would rather that child dead? I have seen entire counties come together as well as churches, etc in massive fundraising efforts to help families like this.
That was a horrible thing to say and a terrible generalization. You are lumping all republicans in one group the same as the "observation" that started this thread. Do all doctors do this? If so, while I will admire their dedication to their profession, I will certainly look down on them as a very closed minded bunch of people.
All I can say is WOW.
What's the solution? Deny them care and let them die right there in the floor?
Start billing their countries. A lot of the expense is not necessarily born from emergency care but from what comes after they are stabilized. We have patients we can't discharge home or some other long term care facility because no one will take them because of their status. So they move them to a wing of a hospital sucking up valuable resources that could be used for another patient.
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