State of US Health Care on ABC This Week

[Rgirl]

From today, Monday 10-20, until Friday 10-24, on every ABC news show, including Good Morning America, ABC Nightly News, Nightline, and ABC news magazines such as Prime Time and 20/20 will devote some or all of the program to the state of US health care and health insurance. In 1982, when I first got involved in working in health care and insurance, people in the industry felt the country was already in crisis. In 1992, most Americans felt health care was the most important issue in the presedential election. Now it's 2003 and if it's not affecting you or your family now, it will within the decade. I'm not shilling for ABC; just hope people will take the opportunity to become informed, though granted the information is coming from ABC.
Rgirl

 

[BronzeisGolden]

Sounds interesting, will have to check that out. A local hospice here is having a convention that's main theme is centered around disparities in health care. I find that to be a fascinating topic and one I never really thought much about. People with the same terminal diseases will experience different levels of pain all due to their health plans/coverage. It's sad and truly frightening to think about.

 

[Rgirl]

I think most people rarely or never think about health insurance issues until they or a close loved one experiences the inequities involved. It seems to be a natural human trait that as long as you feel well you expect you will always feel well. One interesting statistic cited was that in 1992, only 27% of people in a national poll supported some kind of federal health insurance. But in a recent poll, 64% supported it. One thing that it seems people are more willing to consider is a Canadian style system where the government covers the costs (ie, is the insurer) but is not part of the healthcare delivery system. In Great Britain, the government is in charge of both. In fact part of our healthcare system is already based on the Canadian model: Medicare. It's not without its problems, as I'm sure the Canadian members of GS can attest to. But fewer and fewer employers are able to provide health insurance for their employees and those that can have had to raise premiums, deductibles, and copays.

Don't want to get into a healthcare debate (there's too much important skating going on!) but I hope peoople will take the opportunity to watch some of the coverage. Having worked in healthcare, you see first hand how anything and everything can happen to anyone, anytime, anywhere.
Rgirl

 

[tharrtell]

Thanks for the heads up. Huge topic - clearly problems with the system, but there are so many problems it almost seems overwhelming. Where to start?

When I decided to go back to school, I took a part time position with an organization. No benefits. So, I'm paying for my health insurance myself. I originally had one carrier - paid a little for nothing more than catastrophe insurance. I'd never even used them when they jacked my premium up 46%. While I had my non-existant coverage, I tried to get some assistance through Planned Parenthood, but I apparently made too much. Of course, I'm not making much considering I live in the San Francisco - breaking even, if that and extrememly careful about spending - apparently it's still too much. After the rate hike, I changed carriers. I pay significantly more, but can actually see a doctor which is actually a sense of relief. Thank goodness I'm under 30 otherwise I'd be paying a heck of a lot more.

I never really thought about health insurance before this. I had a good deal with my past two employers. Before that, I was on my parents' plan. Obtaining medical coverage shouldn't break anyone. Things have got to change.

 

[Rgirl]

Tharrtell,
I so wish more people your age had your awareness of this problem. Problems with health insurance are one of those things people tend not to appreciate until it's too late. ABC hasn't covered things in depth, but I think their intention was to raise awareness and not scare viewers away with "It's such a huge problem, I can't even think about it." True, it is a huge problem, but like anything else, if you break it down it's not so intimidating. Sorry if I sound like Carry Healthcare, I've just been in the biz for many years. It's hard to watch and experience things getting worse. As much as I think private enterprise works best for most things, I believe health care, like the police, fire departments, and other institutions where the public's well-being is concerned needs the financial support of the government. When you're sick or have been in an accident, you can't shop around for the best deal. Ironically, with health insurance as it is, companies only want you as a "customer" if you don't get sick. And if you do go through a major illness, such as cancer, and recover, you have to hope that you can stay with your same job and insurance carrier because once you've had any significant illness or accident, no other company will cover you. Even the company you have will drop you in those states where it's legal. End of tonight's speech
Rgirl
Rgirl

 

[tharrtell]

And if you do go through a major illness, such as cancer, and recover, you have to hope that you can stay with your same job and insurance carrier because once you've had any significant illness or accident, no other company will cover you. Even the company you have will drop you in those states where it's legal.

My friend's dad had a heart transplant. He's self employeed. His wife (my friend's mom) is working at a job she hates but cannot leave because they simply can't lose her benefits. A pretty unfortunate situation.

The rules are so messed up. There needs to be some serious house-cleaning. Get the insurance companys/HMOs out of there. Maybe handing it over to the government is the way to go. Although, I've always heard, and please anyone correct me if I'm wrong, but one of the reasons that Canada's health care system works is because they are close to the US and if anyone needs anything quickly, they come here?

 

[Grgranny]

I do wish some of the Canadians would give us their side of the health care situation up there.

 

[Rgirl]

Tharrtell,
It is true that Canadians who can afford it come to the US for certain specialized treatments or if they're on a waiting list for elective surgery and don't want to or feel they cannot wait. (A surgery can be "elective" but the condition still very severe and painful.) But the key phrase is "who can afford it." As I've said before, the Canadian system has its problems and I don't think an exact copy of the Canadian system would work in the US. A lot of systems that work well in other countries would not work in the US just because the US is so large. The thing is, the main argument against having the government getting involved in health insurance is that the US would then have a two-tiered healthcare system, one for the rich and one for everybody else. But that's what we've had for years. Many hundreds of thousands of people cannot change jobs simply because of the health insurance situation for themselves, their spouse, or one of their children, and if they get laid off, forget it.

Doctors are already rationing care. Some refuse to take Medicare and/or Medicaid patients. Some limit all their patients to 15 minutes or less per visit no matter how complex the problem is. I think a lot of the problem is that the costs of the technology that have made procedures such as heart transplants viable for most people have also made everything a lot more expensive. Plus physicians are held to much higher standards of care re malpractice, especially in certain specialties, so the amount of "CYA" (cover you a$$) medicine that goes on also drives up the costs. Then there's the fact that the very bureaucracy of medicine has grown so enormous. In the 1960s and '70s, the number of billing people relative to physicians was about 1:3. Now it's the reverse. And those are just three examples of problems in health care.

I think a big psychological hurdle is that most of us grew up in a time when health insurance was a given benefit with any job and dealing with physicians still had a feeling of personal service to it. Those of us in our 40s or older no doubt remember going to the family doctor in our pajamas. Anything a doctor could do for you then s/he would do for you. Today that is no longer the case and I think it's difficult when you can remember how things used to be to allow yourself to take the mental leap of overhauling the system when the "good old days" don't seems very long ago. In fact they aren't that long ago. Things in health care have changed rapidly and I think the rapidity of change is part of the problem as well.

Anyway, I wasn't all that impressed by ABC's coverage. For example, 20/20 last night focused on Princess Diana's butler when there was no prime time 60-minute slot dedicated to the healthcare issue on ABC at all this week. OTOH, it's a start. Unfortunately, IMO in order to have anything close to universal coverage for US citizens the government is going to have to be involved in the payment end and at least since 1980, government involvement is the last thing many people want. The other difficulty, as I've mentioned before, people just naturally tend to not think about serious illness or injury unless or until it happens to them. It's just human nature. But for most people, however bad they think the health insurance/health care situation is in the US, in reality it's 100 times worse.
Rgirl

 

[heyang]

I got my open enrollment paperwork yesterday. My share of the premium is going up and copays are going up, too. Also, well-adult exams are limited to once very 3 years under age 40, once every 2 years age 40 - 50 and 50 + once per year. I kinda find this anti SOP since most women are encouraged to have at least a PAP smear every 2 years starting at age 30. I'm not overly concerned since the doctor's will usually make up an 'excuse' to try to cover costs. Also, it's always been thought that prevention is important - thus the need for more frequent exams to catch illnesses in their earlier stages.

Anyway, I'm fortunate to be healthy , except for being allergic to NJ.

 

[Rgirl]

I'm not overly concerned since the doctor's will usually make up an 'excuse' to try to cover costs.

Things are probably worse in urban areas, especially New York and California, than others, but I wouldn't continue to count on doctors being able to find ways to make up for insurance limits and low reimbursement rates. I know I'm the unyielding voice of doom and basically keep telling people, "Be overly concerned. Be very overly concerned." I know it's hard when you feel there's nothing you can do and to a certain extent that's true. But people can become informed about the situation and which political candidates on the local, state, and federal level have a record of doing something on this issue. And now I promise I'll shut up, lol.
Rgirl

 

[Mathman]

Don't shut up. Shout it from the rooftops. The health care crisis is going to be a huge ethical and political issue very soon. I am afraid that politics will win. There is only one way to beat it. Don't get sick and don't get old.

Under the policies of the current administration we have taken a nice federal butget surplus, careful crafted over the whole decade of the 1990s, and turned it into one of the worst deficits and most burdensome debts in our history. We are committed to spending hundreds of billions of dollars to clean up the mess we made in Iraq. Syria and Iran appear to be next. In the mean time, medical costs are threatening to put adaquate health care out of the reach of most average Americans.

Mathman

 

[Grgranny]

Rgirl, for goodness sakes don't shut up. You have so much knowledge about things we need to know.
I know I am very fortunate in that above medicare, my insurance pays approx 80 % of medical and also 80% of prescriptions.
Another thing that has come up recently. My rheumatologist gave out information saying he would only see patients once a year instead of twice and a nurse would see us the other times. The reason was given that there is a shortage of Rheumatologists in the Wichita area. I wonder if that is true elsewhere? I am definitely thinking of changing Drs.

 

[Rgirl]

Thanks for your contributions, Mathman and Grgranny--actually everybody. I just didn't want to "cry wolf" so much that people stopped listening. I also didn't want to get too political about this administrations policies, though let's just say I don't disagree with Mathman. It's just that health is one of those things people tend not to appreciate until it's gone and there is not a person alive who can say they don't have the gene for some genetic disease waiting to "switch on" in their system, or that some accident won't take them to the brink, or that some environmental process where they live or work isn't affecting them. Sometimes I think the "medical miracle" stories such as successful surgical separation of conjoined twins sends the wrong message, at least relative to what really goes on in health care. For example, one very large study found that when you account for all the misdiagnoses and lab errors, the chances that you will be accurately diagnosed by the first doctor you see when you have an injury or illness is zero. In other words, on average, the chances that you will be accurately diagnosed by the first physician you see when you are complaining of symptoms that ultimately will turn out to be due to cancer are none. Of course some people will be accurately diagnosed on the first go-round and somewhere down the line people will usually find a physician who will correctly diagnose the problem, but it could take one more physician or it could take 100. And we're not even talking yet about treatment.

There are a whole host of reasons why this happens, but the bottom line is you want to have health insurance that will allow you to get multiple opinions. Because we're living longer--and not due to medicine actually but to things such as cleaner water, sanitation, and better nutrition (people may not have the best diets in the US but it's better than chronic salmonella and starvation)--chronic illnesses such as arthritis and continued care for cancer and heart patients, to name just a few problems, are what are eating up a lot of health care dollars. I know it seems inconceivable that a physician would knowingly let a patient suffer just for a "few bucks" when they make so much. But doctors have rationalization skills just like anybody else and in many specialties today, doctors no longer make that much. Between costs of medical school and malpractice insurance, a lot of doctors are no longer taking hospital patients because of (a) the malpractice rates and (b) the relatively low reimbursement rates for the amount of time they have to spend seeing hospital patients (and that's their standard five-minute "Howareyougood" visit). There's not a serious nursing shortage for nothing.

So I guess I'll just rant every so often, but I hope others will contribute. The severity of the situation only starts to seem real when a lot of people share their experiences or the experiences of friends or loved ones, though of course I'm not asking that anyone go beyond the bounds of their privacy. Health insurance and health care are just incredibly important issues and the only group that isn't organized are the patients. In fact, the group that has the best health insurance in the US right now are retirees because of Medicare and the reason politicians won't touch Medicare is because senior citizens are organized in groups such as AARP and they VOTE.

Thank you for listening to today's segment of "Inside Health Care, Yeah, Even on a Figure Skating Board."
Rgirl

 

[Piel]

What a timely thread. Government in health care...hmmm. Here in WV we are having a major crisis with our worker's comp system which is totally run by the state and the cry now is for privatization. I will share with you what has been the insurance hell that I have been going through for the past eleven days. The condensed version. I was injured in 1981, a simple fall on a wet floor at work resulting in a crushed kneecap that had to be removed followed by a ruptured patellar tendon, deepvein thrombosis and a blood clot to the lung. Two more attempts at reconstructing the knee joint resulted in a severe bone infection , gangrene, multiple skin grafts, two more blood clots to the lung, clotting off of the superior vena cava, a juglar vein, and septicemia from I.V. devices in the chest. And finally an autoimmune reaction triggered by the trauma to the veins resulting in autoimmune vasculitis which is (simplified) my body now sees my blood vessels as foreign objects and is rejecting them. Up until now I have been very lucky as my employeer has never protested my injury nor have I ever been denied any medical care. A week ago Friday I recieved a letter from comp saying that in an attempt to contain costs they had asked one of their new doctors to review my case when my doctor had asked for authorization to do another skin graft. The new doctor has decided that my complications in his opinion should not be compensible and that they will no longer pay for any of my medical care which totals over $2000,00/month normally (not including hospitalizations). I have 30 days to protest......and now the interesting part. By law in WV a worker's comp claiment who is awarded permanent total lifetime disability which includes lifetime medical for their injury and it's complications may only be charged in legal fees what is equal to 208 weeks of their benefits. This my attorney ireceived in the late 80's when I was awarded my PTD. My attorney is now a federal judge and no longer practices law. No other attorney is by law allowed to charge me legal fees so therefore no other attorney can represent me to protest this decision if it comes to having to go to court.

The main problem is supposedly unfunded liability. The state, if it had to pay off all claims at once would be millions of dollars short. Our state due to the coal mining industry has a large amount of WC claims. What happens is a for years coal companies would not pay their premiums, rename their company, start with a fresh slate so to speak while continuing to be a major drain on the system with lots of work related injuries and of course black lung. This makes for an "unfriendly" business climate
in the state. New business won't locate here because of the large WC premiums. For a long time the way companies were rated and charged their WC premiums wasn't really based on the number of injuries they had, again basically giving the big coal companies (owned by the big politicians) huge breaks.

Now in an attempt to fix the system, reduce the unfunded liability, and make the state more attractive to new businesses we have Worker's Comp Reform. Apparently I have just been reformed!



"i'm mad as hell and not going to take it!"
Piel

P.S. Where is spellcheck now?

 

[Grgranny]

I could have all kinds of workers comp experiences from family that could curl your toes. I won't go into detail but so far none of them have been winners.
You're not going to like this one. I had one of my husbands nurses tell me that they have cures for cancer but the Doctors, hospitals, etc. are making so much money they are keeping it hidden. I keep hearing it from other sources as well.
Personally, I have come to be really suspicious of the medical community altogether. Very depressing.

 

[Yazmeen]

Grgranny:

Geez, its nice to know that while I am at work today caring for patients, taking care of my committee work, running the physician education program for my hospital and chairing it at the State level plus other work I take on as a physician, there's a know-it-all nurse out there telling the world that I'm a charlatan who's keeping life saving techniques hidden from the world while I count my gold. Forgive me if I sound insulted, but I am. If that's her attitude, she has no business being in the profession she's in.

I can tell you as a doc that we have no cures for cancer, heart disease or any other magic potions that we are hiding from you. What we are is overloaded, burned out and still trying to do our best for all patients in an atmosphere where many of us can't get insured, have to take on idiotic workloads to pay our care costs and genuinely wish we had more time for all of our patients.

I work at a hospital where I am a salaried employee because the hospital has a charitable basis and still has a dispensation to not balance bill--we take insurance only--not that the dear Federal Gov't. hasn't tried to end that. We are 90% plus reliant on medicare outlier payments for survival, and those will drop sharply this year thanks to gov't. cuts. Yet, we will still keep going even though we have to cutback on everything from salaries to benefits. In fact, I'm lucky in one respect that because of our charitable foundation, my malpractice insurance is paid for me. My own gynecologist just gave up her practice after her insurance rate TRIPLED--and she hasn't delivered babies in over a year and has a great track record!!! She has had to join a group practice to survive.

Meanwhile, every day I have patient's complaining because they can't get all their tests done in one day and can't have everything right away. And this doesn't just affect doctors--it affects nurses, technologists and all health care employees. I'm in diagnostic imaging, and we can't find Techs for our open positions because there's a huge shortage and we get turned down constantly by good candidates because our workloads are heavy here and they can make more money and do far less work outside the hospital setting. The problems in health care are not all the fault of just doctors, or nurses, or lawyers or insurance companies. Its an out of control system in a country where demand is "give me everything, and give it to me now" but who is going to pay for it all and who's going to give it? I hate hearing the "if you can see these many patient's in this much time the financials will be better" argument because no-one can tell me exactly how much time I need with each individual patient or study until I see them/it. I can tell you what we DON'T need, though, crap like that nurse is peddling. The situation is bad enough as it is without outright lies and rumors like this.

Pardon the rant, but that really touched a nerve.

 

[Piel]

Oh Granny, I know what you mean. What gets me is that since I was injured in 1981 have seen gosh I don't know how many doctors and none have ever questioned my complications relation to the broken knee. Deep vein thrombosis is very common after this type of injury (Tara is a spokesperson for this I think). My boss was right beside me when I fell so I didn't have to deal with my employer contesting the injury. A lot of people do have to so I'm lucky there. A friend of mine who works at comp told me that the new doctor was "a prostitute" whoever he works for he will report whatever they want . My biggest help is going to come from my doctor who has to convince the appeal board that the complications are related to the originali njury. English is not his first language and although he is an excellent doctor his world is the O.R.. He hates dealing with the paperwork and all that IS practicing medicine now and communicates poorly. So I am more than a little anxious about the outcome of this. Of course stressmakes my vasculitis worse. No stress here LOL.

Piel

 

[Grgranny]

Ok Yazmeen, this is what I was hoping to get. An answer like yours. Sometimes it takes a "nasty" comment to get to the truth. I apologize and hope now you know why I printed this. I do know that Drs have their problems too. I wish I knew how to get a Dr. that would diagnose problems correctly. Although I am sure you know that there are a lot of people in the medical field that aren't all that great. Show me a profession where ther aren't. I started going to a place called Wichita Clinic. You never have to wait very long if at all. Of course when you get in there you are alotted the 20 minutes and if you need any more than that forget it. It is huge. I do have problems with a lot that goes on but I also know that there are so many of you who are truly caring people. I wish the Internal Med. Dr. I had the last couple of years hadn't moved away. I've seen the new one twice now and have mixed feelings. It doesn't seem to me that living with very little sleep could be healthy.
Actually this nurse was/is a really good nurse and was their home health "bandage specialist".
I hope you're not quite as angry with me now.
Still, you can't convince me that insurance companies are all that great.

 

[Yazmeen]

Grgranny: First of all, a big hug from me to you, and I sympathize on the clinic you described. And don't get me started on insurance companies, either the ones for malpractice or for health insurance. I just love it when some paper pushing numbers cruncher tells me how I should practice...

I still think the US could benefit from a system more like Canada's, but there's one major problem here: No-one in this country likes to wait for anything. I've had patients who pitch fits because certain of our tests are "all day marathons" and there's nothing I can do about that--to quote the immortal Mr. Scott, "I canna change the laws of physics!!!!" Oh, and don't even mention anything more than a one day weight for a study, you're likely to get your head bitten off. I sit on our customer service committee (only physician on it) and I'm the official curmudgeon because I'm constantly harping on them that we are fostering a unrealistic expectation of "I want what I want and I want it now!!!" with our patients, and they throw fits if they have to wait any period of time for a test. Heck, I have to wait more than month to get my yearly mammogram after calling for the appointment and you don't hear me complaining or demanding special treatment!

A funny story. A few years ago, several patients in our waiting room were grumbling over being stuck in the department for several hours because of the nature of the testing and they had a major gripe session going. One finally opined that "they probably keep us here longer so they can charge more." My poor receptionist at the time had to restrain herself from leaping up and screaming "But we're X-hospital--WE DON'T BILL YOU!!!" (Not to mention that your insurance company pays us a fixed rate) We still chuckle over that one.

 

[Grgranny]

I'm sure all doctors and nurses have many funny experiences. I remember one time many years ago everyone was still laughing when I went into the room to be checked out. A woman had never had a pelvic exam or a urine culture before. Before her exam she was told to take her panties off and get on the table. She said well she couldn't take them off as she didn't have them on. When she went to get her specimen she dropped them in the stool and they were wet. The Dr. was laughing so hard he was leaning over the sink with his back to her so she couldn't see him. (This Dr. just died Saturday). No one could ever understand why she had them over the stool in the first place.