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Free-Market Medicine: A Personal Account
When I recently went to Alta Bates hospital for surgery, I discovered that legal procedures take precedence over medical ones. I had to sign intimidating statements about financial counseling, indemnity, patient responsibilities, consent to treatment, use of electronic technologies, and the like.
One of these documents committed me to the following: “The hospital pathologist is hereby authorized to use his/her discretion in disposing of any member, organ, or other tissue removed from my person during the procedure.” Any member? Any organ?
The next day I returned for the actual operation. While playing Frank Sinatra recordings, the surgeon went to work cutting open several layers of my abdomen in order to secure my intestines with a permanent mesh implant. Afterward I spent two hours in the recovery room. “I feel like I’ve been in a knife fight,” I told one nurse. “It’s called surgery,” she explained.
Then, while still pumped up with anesthetics and medications, I was rolled out into the street. The street? Yes, some few hours after surgery they send you home. In countries that have socialized medicine (there I said it), a van might be waiting with trained personnel to help you to your abode.
Not so in free-market America. Your presurgery agreement specifies in boldface that you must have “a responsible adult acquaintance” (as opposed to an irresponsible teenage stranger) take you home in a private vehicle. I kept thinking, what happens to those unfortunates who have no one to bundle them away? Do they languish endlessly in the hospital driveway until the nasty weather finishes them off?
You are not allowed to call a taxi. Were a taxi driver to cause you any harm, you could hold the hospital legally responsible. Again it’s a matter of liability and lawyers, not health and doctors.
One of the two friends who helped me up the steps to my house then went off to Walgreen’s to buy the powerful antibiotics I had to take every four hours for two days. I dislike how antibiotics destroy the “good bacteria” that our bodies produce, and how they help create dangerous strains of super-resistant bacteria. I kept thinking of a recent finding: excessive reliance on medical drugs kills more Americans than all illegal narcotics combined.
So why did I have to take antibiotics? Because, as everyone kept telling me, hospitals are seriously unsafe places overrun with Staph infections and other super bugs. It’s a matter of self-protection.
Two days after surgery I noticed a dark red discoloration on my lower abdomen indicating internal bleeding. I was supposed to get a follow-up call from a nurse who would check on how I was doing. But the call might never come because the staff was planning a walkout. “We have no contract,” one of them had told me when I was in the recovery room. So now the nurses are on strike---and I’m left on my own to divine what my internal bleeding is all about. What fun.
Fortunately, it didn’t turn out that way. A nurse did call me despite the walkout. Yes, she said, it was internal bleeding, but it was to be expected. My surgeon called later in the day to confirm this opinion. Death was not yet knocking.
A few days later, there were massive nurses strikes on both coasts. Among other things, the nurses were complaining about “being disrespected by a corporate hospital culture that demands sacrifices from patients and those who provide their care, but pays executives millions of dollars.” (New York Times, 16 December 2011). One cold-blooded management negotiator was quoted as saying, “We have the money. We just don’t have the will to give it to you” (ibid.).
As for the doctors, both my surgeon and my general practitioner (GP) are among the victims, not the perpetrators, of today’s corporate medical system. My GP explained that it is an endless fight to get insurance companies to pay for services they supposedly cover. Feeling less like a doctor and more like a bill collector, my GP found he could no longer engage in endless telephone struggles with insurance companies.
There are 1,500 medical insurance companies in America, all madly dedicated to maximizing profits by increasing premiums and withholding payments. The medical industry in toto is the nation’s largest and most profitable business, with an annual health bill of about $1 trillion.
Along with the giant insurance and giant pharmaceutical companies, the greatest profiteers are the Health Maintenance Organizations (HMOs), notorious for charging steep monthly payments while underpaying their staffs and requiring their doctors to spend less time with each patient, sometimes even withholding necessary treatment.
I am without private insurance. And my Medicare goes just so far. Like many other doctors, my GP no longer accepts Medicare. For a number of years now, Medicare payments to physicians have remained relatively unchanged while costs of running a practice (staff, office space, insurance) have steadily increased. So now my GP’s patients have to pay in full upon every visit—which is not always easy to do.
Our health system mirrors our class system. At the base of the pyramid are the very poor. Many of them suffer through long hours in emergency rooms only to be turned away with a useless or harmful prescription. No wonder “the United States has the worst record among industrialized nations in treating preventable deaths” (Healthcare-NOW! 1 December 2011).
Too often the very poor get no care at all. They simply die of whatever illness assails them because they cannot afford treatment. An acquaintance of mine told me how her mother died of AIDS because she could not afford the medications that might have kept her alive.
In Houston I once got talking with a limousine driver, a young African-American man, who remarked that both his parents had died of cancer without ever receiving any treatment. “They just died,” he said with a pain in his voice that I can still hear.
Living just above the poor in the class pyramid are the embattled middle class. They watch medical coverage disappear while paying out costly amounts to the profit-driven insurance companies. I was able to get surgery at Alta Bates only because I am old enough to have Medicare and have enough disposable income to meet the co-payment.
For my out-patient operation, the hospital charged Medicare $19,466. Of this, Medicare paid $2,527. And I was billed $644. The hospital then writes off the unpaid balance thus saving considerable sums in taxes (amounting to an indirect subsidy from the rest of us taxpayers). Had I no Medicare coverage, I would have had to pay the entire $19,466.
I was informed by the hospital that the $19,466 charge covers only hospital costs for equipment, technicians, supplies, and room. So besides the $644, I will have to pay for any pathologists, surgical assistants, and anesthesiologists who performed additional services. I am waiting for the other shoe to drop.
How much does my surgeon earn? Not much at all. He gets about $400 to $500 for everything, including my pre-op and post-op visits and the surgery itself, an exacting undertaking that requires skills of the highest sort. He also has to maintain insurance, an office, an assistant, and an increasing load of paperwork.
My surgeon pointed out to me, “If you ask people how much I make on an operation like yours, they will say $4000 to $5000, and be wrong by a factor of ten.” He noted that in a recent speech President Obama criticized a surgeon for charging $30,000 to replace a knee cap. “The surgeon gets a minute fraction of that amount,” my doctor pointed out.
To make matters worse, there is talk about cutting Medicare payments to physicians by 27 percent. If this happens, it is going to be increasingly difficult to find a surgeon who will take Medicare. Still worse, the private insurance companies will join in squeezing the physicians for still more profits.
I was able to meet my payment ($644) not only because my operation was heavily subsidized by Medicare but because it was a one-day “ambulatory surgery.” I don’t know how I would fare if I had to undergo prolonged and extremely costly treatment.
So much for life in the middle class. At the very top of the class pyramid are the 1%, those who don’t have to worry about any of this, the super rich who have money enough for all kinds of state-of-the-art treatments at the very finest therapeutic centers around the world, complete with luxury suites with gourmet menus.
Among the medically privileged are members of Congress and the U.S. president. They pay nothing. They are treated at top-grade facilities. They enjoy, how shall we put it, socialized medicine. No conservative lawmakers have held fast to their free-market principles by refusing to accept this publicly funded, medical treatment.
John Mackey, CEO of Whole Foods, cheerfully announced that medical care is not a human right; it should be “market determined just like food and shelter.” Nobody has a higher opinion of John Mackey than I, and I think he is a greed-driven, union-busting bloodsucker. Nevertheless I will give him credit for candidly admitting his dedication to a dehumanized profit pathology.
The U.S. medical system costs many times more than what is spent in socialized systems, but it delivers much less in the way of quality care and cure. That’s the way it is intended to be. The goal of any free-market service---be it utilities, housing, transportation, education, or health care---is not to maximize performance but to maximize profits often at the expense of performance.
If profits are high, then the system is working just fine---for the 1%. But for us 99%, the profit lust is itself the heart of the problem.
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81 Comments so far
Show AllHere in Canada, sometimes we have to wait for high-end medical procedures. That's it. That's the complaint. That's what is wrong with "socialized medicine". Nothing else I can think of.
Have a nice day, USA.
Americans should be told that there is technology to help the Canadian patient in waiting. The province of Ontario, for example, has a website where procedures and location availability are posted. If you live near Ottawa - where for some reasons waitings are commonly longer - you can BOOK surgery in some other ONTARIO city that has a spot available. Yes, the cost of transportation is added, but that's all.
In my 30 years experience with health care in Canada, it is not perfect - but no system is. The Canadian system is run by =normal people = not by psychopaths. System monitors find psychopaths pretty quickly - and deal with them. With a few clicks in SQL, a graph can be created for use of Cesarian Section by obstetricians. Practitioners falling more than one standard deviation above the discipline's mean can be put on a list for undercover investigation. I, personally, succeeded in pulling the medical license of an alcoholic surgeon in eastern Ontario. The damage he had done was an atrocity. So was the silence of hospital colleagues who let him get away with it.
Trylon
And in many cases you can also go to nearby Buffalo or Detroit for procedures, and the province will still pay for it, right? Canadian-paid medicine is probably a big economic boost to the poor rust-belt cities to your south.
You forgot to mention also that you wait only for procedures for elective or non-serious conditions. No one waits for treatment for urgent or serious conditions - "high-end" or not. This is why there are wait times. It is called "efficient allocation of resources" using traige. Funny, I thought that only "free markets" could allocate resources efficiently.
We do the same sort of healthcare rationing her in the US, but it is based on income. The well-off get an MRI, on a knee they strained on the golf course, the next day, the poor get no MRI at all, even for a possible malignant tumor.
But the Canadian wait times for MRI's (once again, only for non-life threatening DD's like bad backs, knees, etc.) could certainly be improved. A bad back disc might not kill you, but sure is painful. But this easily fixed with a bit more funding, and per-capita healthcare expeditures in Canada would still be less than half the USA.
That's because Canadians have health care. Americans have health insurance (if they're lucky). There is a difference.
"the profit lust is itself the heart of the problem."
didn't we used to hear that health contributes more toward the "good life" than money? so very, very glad you're doing well in spite of the system, mr. parenti!
michael is an internationally renown writer, thinker political commentator and intellectual
and that's the treatment he gets
most of us get what the limo driver's parent's got - death without treatment
do people have any realization how sick it is - on every level - to provide medical care on the basis of the "free market" which aint free and aint a market either
i guess we are not far from getting referred to videos on youtube for self-surgery - cut yourself open and pray you don't have any bandwidth or streaming issues
it also says a lot about how beaten down the sheeple are when you think that most folks wouldn't allow their dogs to be treated like this...
"That’s why our health care law relies on a reformed private market, not a Government program." - Barack Obama
A private market can do no other than seek to maximise profit. That is the very definition of the private market in this predatory society we are saddled with. The notion of reforming it is just so much hopey-changey bullshit rhetoric. But, I guess if Nobel Peace laureate presides over the greatest purvayor of violence in the world, we shouldn't be surprised that we are truly Through the Looking Glass.
Ah, competition. One winner, many losers. Why did humanity ever decide that is the organizing principle of all reality?
So true. When you take a deep breath, and start to question some of these basic assumptions:
1. brutal competetion without rules is good;
2. people competing to sell their body, muscles and sweat to another man for the lowest possible price in order to survive, is good.
3. Endless, ever increasing resource consumption to infinity (which, dear Malthusian cranks, has nothing to do with population, by the way - capitalism would be compelled to grow forever even if the earths population were stable at 50 persons) is good..
It was the winners who decided. It has nothing to do with humanity.
The system works just fine for a POS like Mitt "I like to fire people" Romney.
Perfect analysis of what's wrong with our current health system.
Was it an inguinal or umbilical hernia repair? Parenti makes it sound so serious.
But yes, of all the annoyances that hospitals impose, this iron rule that you must have a "responsible adult with a private car" take you home after any procedure that requires sedation or anesthesia - colonoscopies, endoscopies, minor surgery of any sort - is the most annoying. They allow no other arrangements - no taxis, not ACCESS vans, no walking - even when you live a block from the hospital like I did - and definitely not the bus. Where I live, it isn't too unusual for people and their friends not to have cars - what do they do?
Once I had a stomach endoscopy without sedation just to avoid this stupid rule. You gag and retch some, but it isn't too bad. Wouldn't want to go through a colonoscopy without it, though.
It's absolutely astonishing that in the "great" United States -- the most precious posssession -- one's health -- is subject to the vagaries of the "free market". The philosophy is increasingly clear -- make sure that the "insurance" companies (Orwellianly referred to as "the payers"), pharmaceuticals and large hospital systems are able to run a disgustingly profitable business -- then after that maybe there'll be some health care dispensed -- if you're lucky (like Mr. Parenti).
And Obama's proposed changes to deepen the involvement of "the payers" (among other corporate-directed "reforms") is a good example of doing nothing being a better option than doing something. This will become clear by perhaps 2015-2016 or later by which time few commentators will care to recall recent history, no-one will be accountable, and Obama and company will have left Dodge City.
And so it goes. Obama, the master of illusion, will have helped the "health care" industry to weather another few election cycles unscathed. How long will it be before the US populace demands a decent comprehensive system (yes -- like they have in CANADA!!). God help you if you become seriously ill in the meantime. Who was it who said "You can always depend on the Americans to do the right thing -- after they have tried everything else" ? Health care is surely a supreme example, but we are surely running out of knots to tie ourselves in to avoid the obvious -- a National US Health Care System -- and funded by the military dollars that are currently used to foment war, death and destruction thousands of miles away in the name of "national security".
I am sorry - and this doesn't go for GPs or even some specialists - but surgeons do make a lot of money (I'm thinking of a few that I know with salaries over $500,000/year, with some making over $1,000,000/year) and there are some specialists who make starting salaries that easily exceed $200,000/year. The excuse is that they are "the best and brightest" (which isn't true, by my experience) and that they work long hours (not any longer than anyone else I know who works as a scientist - not any longer than most of the janitors I know, too, who often work 2-3 jobs just to make ends meet and who can't afford to send their kids to private schools). Why not increase the number of surgeons and decrease the number of hours worked for each one, for the same money? No, I'm not a physician or a nurse, but I have worked in a hospital, and I have physician colleagues with whom I collaborate on research projects, so I've seen a good bit of the medical system (although, I can't comment on private practice). Yes, the CEOs and administrators can make big salaries, and the insurance companies are awful - I agree that we need socialized healthcare - but the argument that physician salary is dictated by "scarcity" and "intelligence" when we have so many more bright students we could be training to become physicians (but who get turned away from med schools) or physicians from foreign countries that we could be hiring is ridiculous.
There's a "healthy" number of physicians in the top 1% (and far less of the 1% are scientists): http://economix.blogs.nytimes.com/2011/10/17/the-top-1-executives-doctors-and-bankers/ . There are many physicians who are Republican, too.
Only the one percent can afford to go to school for that many years, many really talented brilliant kids cannot afford med school, predator school loans from the same banks that the working class bailed out are screwing our young people out of their education. I'm sure voting republican will help, maybe Willard Mitt Romney, he's so in touch with normal people, until Paul Ryan runs anyhow, or till the Republican tea party Koch brothers buy America, OH, they already have. Never mind.
Exactly! We could also do something about education reform at the same time! It's ridiculous! In fact, I've seen med school admissions applications (I helped a friend out with some things, once): they ask your family's (parents') average household income and whether or not you have family members who are physicians. Now, the first question may help to recruit kids from lower socioeconomic backgrounds, but I personally know the Dean of a prominent med school who told me that they prefer kids who are used to a "certain lifestyle." What that breeds are physicians who can be quite out of touch with the realities of their patients' lives. I've overheard obnoxious conversations/comments about indigent patients coming from the lips of medical fellows. Yes, med students may have done "volunteer" work with indigent folks to get into med schools (to show that they "genuinely care" about people), but that's just so they can get into the schools. Same thing with fellows who do research - most of them don't get trained to think critically in med school, and it is literally like working with an undergrad. So, how then can they be expected to think critically about the medications they prescribe? It shouldn't all be memorization and regurgitation.
My daughter graduated from the U of O two years ago after over six years of school, my wife and I both helped as much as possible but she was still subject to the predator lending from US Bank. She's a marine biologist and is an observer on fishing ships, she makes pretty good money which means her school debt might be paid in 10 to 15 years, till then she will be working out at sea in Alaska instead of working locally for our state fish and wildlife where she is safe. I can't imagine the debt after ten years of school.
Sorry to hear about that! From my observation, debt for medical students can accrue for different reasons. Some of the MDs I know incurred debt because they went to expensive schools and didn't get any financial help. Some of the MDs I know went to state schools and graduated with less debt. Some of the MDs I know did joint PhDs and got out of schools a few years later, but with no debt (and had a living stipend during school, to boot). And, many of them had Mommy and Daddy pay for at least part of the cost/living expenses.
On the other hand, if one chooses to get a PhD in a medical field in which graduate students are awarded [extremely modest] living stipends ($18,000-25,000), one may still graduate with a lot of debt. Although the purpose of the graduate student stipend is essentially to give the student enough money to scrape by, this is extremely difficult if the academic institution is in a high cost-of-living area or if the student has a family to support. Often, the workload required for such degrees/programs is heavy (I know some grad students who work 60-80 hour weeks in labs), and getting a second job isn't an option (and may not even be allowed by the institution). Tuition for those programs is typically paid for by the institution/department, usually through federal funding. But, for PhD's, the training time is the same as for MDs: combined: 4-6 years in grad school + 5 years average postdoc, with much less salary (and benefits), just as long hours, and much less job stability to look forward to, plus the added burden of student loans to pay back from college years past. This is why I have so little pity for "poor physicians."
Sometimes I wonder what would happen if we did maximize the number of working physicians in this country, socialize medicine, and limit physician hours to 40 h/week and pay to a comfortable but not outrageous, salary, with the guarantee that med school tuition was free for everyone. Would the time spent on each patient in the doctor's office change? Would we recruit more physicians who were more humane? Would more physicians have more time to devote to reading up on various studies published on drug efficacy or on studies relevant to their field of work?
My nephew is a Certified Nurse Anesthiologist. He make really good money. The Drs are pissed because he makes as much as they do w/o having to go to med school
I remember when my doc 1st told me about the HMO. Thing. I couldn't believe it could happen.
And Obama throwing it in our faces with his snide remark.
" I will veto any bill that does not have the PO in it". Meanwhile working behind the scene to make sure it didn't happen.
Doesn't matter how we say it, educating our young people is the most important way to keep America livable.
Yeah, I heard that Nurse Anesthetists get pretty good pay. I also hear Physician Assistants make pretty good pay for having less lengthy training than MDs. Pharmacists make nice salaries for the 4 years of school they put in after undergrad. People can make good money working for Big Pharma, too. I remember once how, totally out of the blue (because I'd never work for Big Pharma, and I hadn't even been looking for a job at the time), I was called on my cell phone a few years ago by a head hunter for a HUGE Pharma company who offered me a 6-figure starting salary, a car, a blackberry, and a computer if I would go around giving talks about certain drugs that were "in the pipeline" to local physicians (in my area). That's just being a sales rep! Not good job security, but it would have paid well. He was shocked when I told him I wasn't interested. I guess not many people turn them down? My friends think I'm crazy for not taking the job. I don't - I would have hated myself for it. It's kinda degrading - having a degree you worked hard for, only to whore drugs for a company to physicians who don't know any better.
Going by my own experience, there is a lot of "waste" in the health care field created by such things as prescription laws and unnecessary "preventive care". This takes up a lot of physician time that could be better spent actually helping people who need help. The medical conditions I have at the age of 73 are all "chronic". That is, they are not "curable", but can be treated with medication. However there is no good reason for visits to the doctor 4 times a year except to put money in his pocket. Without prescription laws I might see this doctor maybe once every three or four years. My wife's chronic conditions are pretty much the same. Add this up for the entire country and you start seeing why US health care is so incredibly expensive.
". However there is no good reason for visits to the doctor 4 times a year except to put money in his pocket. "
There IS a good reason: age 73. Once you reach that age, even an initially minor problem can rapidly degenerate and become fatal. Seeing a doctor once every few years is fine for someone in his / her 20s, 30s, 40s, who does not have any existing chronic conditions.
"Add this up for the entire country and you start seeing why US health care is so incredibly expensive."
Other countries also have prescriptions laws, and doctors in other countries also engage in "unnecessary" preventive care, simply because that preventive care is necessary.
I agree.
Oh, and I also know a lot of postdocs who work 60-80 hours per week, too, only to make annual salaries of $38,000-50,000 (it's actually worse for some foreign postdocs who get positions here in the U.S.; some make even less - at my institution, some of the foreign postdocs get salaries as low as $20,000/year - because they're not eligible for some U.S. government funding and some institutions don't have postdoc pay scales that go by U.S. government standards). Like grad students, postdocs don't get paid overtime - it's a fixed amount per year, regardless of hours worked - nor do they get benefits like staff or faculty, except for health insurance (although, I've heard that some grad students and postdocs at my institution *have* to supplement their basic health insurance from their own pockets). BUT, postdocs are motivated to work long hours because they are pressured to keep generating data for their "mentors" (bosses), who may use that data for [their mentors'] publications or grants. Keep in mind that postdocs usually have families to support and old school loans to pay off. Postdoctoral "training" in medical sciences usually ranges from 3-5 years, with 5 years becoming the norm, with no guarantee of a faculty position or a stable job at the end. Yet, those are the highly skilled people who are the main driving force for the basic science and medical research that saves lives.
500000 to 1 mil may sound like a lot but it is peanuts compared to the insurance CEOs who bring in several hundred mil without anywhere near the education. I would much rather our health care dollars were going to health care providers rather than the health care vampires. The vampires add nothing to health care and never well. They do nothing but drain. Providers add to the system. That is we're our Heath care dollars should be going.
I agree with you, except that I think it doesn't have to be a choice. What I'm getting at is that MOST of healthcare in this country is overpriced, in general, and it leads to a really inefficient system that focuses more on palliative than preventive medicine. We need more physicians (there are some who are wonderful people, yes) who genuinely care about patients and who have the time to care about patients, too. Anyway, apparently having an annual salary of $500k qualifies one for membership in the 1%.
Where the hell is all of that best health care in the world that the republicans kept talking about during the health care debate? America does not have health care we have a medical for sale system, huge profits for insurance and big pharma or die. ONLY the wealthy has health care, back to the one percent, and they wonder why people are pissed. Medicare for all, screw the insurance and pharmaceutical companies. We pay more than twice as much for far less than countries with single payer systems. This countries greedy bastards really suck!
Odd is it not, that the Republicans think so poorly of their troops they force them into using a Socialized health Care system and not the "Best health care system in the world".
Were they true to their convictions they would be calling for an end to the VA and insisting that their veterans deserve ONLY the very best in the World and force them to use the "free market" that those troops sacrificed so much for defending.
(yes tongue in cheek)
I have a relative who is a Vietnam Vet. He thinks the VA is great. He's been getting treatment for years for exposure to Agent Orange (which damaged his lungs). He is also getting treatment for diabetes and other things at very little cost to himself. The VA is a very close parallel to the British National Health Service. Doctors on salary, hospitals owned by the government. The power to negotiate drug prices with the manufacturers. If we extended the VA system to everyone, it would give us all health care services for about half of what we're paying now. Pretty much on a par with Canada, Europe, Japan, "down under". Maybe we'd even get the "American Dream" back... That died with Ronald Reagan's move into the White House in 1981. Came briefly back for a few year in Bill Clinton's second term. Hasn't been seen since...
You have to be almost a member of the 1% to get the "best health care in the world". The rest of us get the "#37th best health care in the world" and pay a lot for it.
Below is a story I wrote that proposes where our sociopathic healthcare system could end up someday. When you have a heartless industry, ANYTHING could be possible.
"Annie hurt all over. She had never felt pain like that before. It even hurt when she tried to open her eyes, so she laid there motionless. Where was she? What had happened? Her curiosity finally overcame her pain and she slowly opened her eyes. "Quick, turn on the camera and lights, she's coming around!" she heard a woman yell. Her opening eyes were met with a blinding video camera light. "Congratulations you won!" she heard the woman say. "What did I win?" Annie mumbled. Barely able to contain her excitement the unknown woman said, "You won treatment for your injuries, in the Great American Health Care Lottery!"
In mid 21st century America there were no longer any social programs. They were all done away with in 2023 under the "Freedom for Americans Act". This act did away with Social Security, Medicare, Medicaid, Food Stamps, and Unemployment insurance. President Paul Ryan said signing that Bill into law was the highlight of his administration."
You can read the rest of the story here:
http://what-could-posibly-go-wrong.blogspot.com/2011/12/lotteries-of-lives.html
NC-Tom: I introduced the analogy of health care as lotto system over a year ago in this forum. I don't recall anyone commenting, but I see the idea took SEED and grew in your imagination. And I used the reference at least one other time, here, too.
Very interesting, I had missed those posts of yours. There are just too many articles and too many posts to read them all, but it is interesting that more than one person could envision our current health care system evolving that way.
It's an example of synchronicity. Happens all the time. I'll write something - or maybe just think it - and a short time later, others are coming out with similar ideas. Who knows, I may have picked up the idea from something I heard or read, not remembering who said it or exactly what it was. A joke around our house is when I yell out to my wife, "hey, it's happened again, someone has stolen my idea!"
Back to the lotto: The state lotteries and even the casinos that are situated in some of the poorest communities have a tendency to suck in the poorest among us. It's like relying on Oprah Winfrey to give away a car to every person in the audience. Keeps hope alive when, in reality, your life is going down the drain.
Michael, thanks for the article and I hope you are recovering and are no longer in need of anything more from such a system at this time.
I live in a place that has the vestiges of a public health system, remainders from colonial days when the powers that be couldn't quite manage to set up something that was the same as the National Health Service for the natives and expats. But they did set up something. Recently I fell and injured my shoulder on the evening of a public holiday. I managed to gather myself together enough to go out and get a taxi to the emergency room of the nearest public hospital. Could the standard of care been higher? Could more hygiene protocols have been followed? Could there have been a more in depth examination, more privacy and better 'bedside manner?" Yes to all that but what I did get was a brief wait, some x-rays taken, saw a doctor, got a prescription and a referral for physiotherapy. I got all this without becoming destitute or facing a choice between not getting treatment or filing for bankruptcy. The total for everything, excluding the taxi, was $100, local currency, and that includes the prescription being filled; it totals about $15 US.
It is an outrage that the US continues to treat us, its citizens in need of health care, as disposable commodities to be squeezed of every dime and then discarded. And that there are people who speak in praise of this system leaves me without adequate words to convey my astonishment and disgust.
I went to a town hall meeting two years ago held by a democrat senator, I couldn't believe how many local republicans showed up with signs that said keep the government out of our health care, or Obama wants death panels, etc. When I got home I went to a republican website and found instructions on what to put on your sign, where to stand in the hall and what to ask. People like Huckabee are fighting health care in the name of GOD, may the greedy bastards rot in hell! They are fucking murderers.
This article only confirms that there really is no truly free market in the USA. This article is NOT a personal account but a totally accurate analysis of "health care" in the USA and very sad proof that health care in the USA should have been made a human right at the time of the writing of the US Constitution. I would also add to this article by pointing out that alternative practitioners are economically treated as "nobodies" only because they offer natural alternatives rather than bother with Big Pharma.
I hope you understand that a "truly free market" would never be a good thing at all, of course.
To be clear, by free market, we mean a market completley free of externally imposed favors or impediments, but for which all of the theoretical caveats for a market to function still apply - perfect information held by all buyers and sellers, number of buyers and sellers equal and approaching infinity, perfectly rational self interest among all actors, all externalities accounted for in the settled price.
Outside of the Arab bazaars of the Casbah of Hollywood movies, even coming the least bit close to complying with these caveats is a preposterous proposition for ANY market. And to think a market could function in even a highly flawed way in the case of hospitals and doctors is manifestly absurd!
Forget looking to Canada for a model to save us, we are too far gone for that. I think the model to save us from the ongoing, soon to be complete market failure in medical care is for a complete government takeover of both payer and payee, in the manner of the highly successful British NHS.
Yes, a better term would have been fair market. I was referring to the lack of choices cited in the article.
A true free market would be better than what we have. In a true free market there would be no prescription laws, no drug laws, you'd be free to purchase medicine for any condition from anywhere on Earth. There would be various grade of "medicals" able to assist you at various levels of skill and fees. Hospitals that would run the range from glorified skilled nursing homes to the Mayo Brother's level. Obviously under such a system health care would be considerably less expensive than it is today. Government "regulation" here in the USA has made things worse instead of better. When my mother went into the hospital in 1947 for three weeks, her whole bill was $300. Today the same experience would cost you perhaps thirty to forty times as much. Why? Partly because of government regulation and partly because they can charge such fees and get paid for them. A good portion of the hospital room rate is going towards equipment only a few people use. Then malpractice "encourages" the doctors and the hospitals to use this expensive hi-tech equipment not out of medical necessarity, but because your insurance will pay for it and its "covers their butt" in case there is ever a lawsuit. The rest of the developed world has put curbs upon the activities of lawyers, refuses to pay for expensive equipment that is seldom really needed in the medical sense. Plus what the doctor gets paid is determined by the government, and drug prices are "negotiated" by the government instead of being set by the drug companies on a basis of "all the traffic will bear". This is why the rest of the developed world has medical costs 1/2 of those of the US. Here in the US the government is on the side of the big corporations, the lobbyists, and every public official is a bribe taking criminal who deserves serving the next decade in prison!
Thank you for your comment. We not only do not have a free market but we have a monopoly that is enforced by the government.
Your comments about what a free market would be like missed the points Jennifer was making about alternative healing systems. THAT is where the competition would be for allopathic medicine and costs would plummet.
I do not believe that there should be no laws whatsoever. Regulation up to a point should be in place to prevent out of control price spikes.
My health has been generally good. I had used our medical services once in my 20s for a broken ankle and then more recently in my 50s when i underwent a series of tests for what turned out to be a minor problem. This included a CAT scan, mri, and a few heart tests so I will speak to the latter and how it went.
Have an issue and drop in at a medical Clinic. They take a quick look and suggest I make an appointment with my family Doctor. I did not have one as this the first issue I had had with my health in years. They gave me a list of Doctors accepting new Patients in North Vancouver and I picked one.
NOthing to sign . No bill to pay. All I showed them was my health card.
I picked a Doctor off the list and he set an appointment two days later. After questions etc he set me up for a battery of tests the first which was two days later with a specialist.
I did not have to sign any papers. All I showed was a health card.
The specialist sets me up for the cat scan. It was again two days later. Negative. They also had me do a series of heart tests this about a week later. negative.
They then set up an mri which would be a monday of the next week. I asked if it could be delayed as I headed on holidays. No probelm. I came back two weeks later and had the tests negative.
Back to the family doctor who discussed all my tests and suggested what my problem might have been and what to do to monitor it.
The end. No bills at all. I did not sign a single form. It did not even cost me 10 bucks.
All i received in the mail was a letter from the Hospital asking that I rate their performance. I do have private supplementary insurance with my company but all this gives me is insurance if I am out of the country and things like a private hospital room if I had an extended stay.
All the rest was covered under Canadas' Universal system.
British Columbia DOES charge a monthly premium for its Health Care system. It akin to a surtax off ones pay and is 49 dollars a month. This does not preclude one from getting treatment if not paying that premium. As in this premium subsidized for low income families and waived for those with no income.
Man, does that make me jealous. On the other hand, I hope that Stephen Harper and his band of goons don't succeed in gutting Canada's current system of single payer health care. By the way, I don't know if you're aware of this but insurance companies in the US can retroactively deny a claim and they'll make up bs on "adjustments". They'll give you one letter saying that you owe nothing but 3-6 months later go retroactive. Their weapon for doing this? Trying to link current cases to former ones as pre-existing. The doctors are usually understanding but not the insurance companies. Also beware that more medications are getting misclassified as "enhancements" and "cosmetic" so that the customer pays the full costs.
Is vision, dental, or physical therapy covered in BC?
My brother and his partner Tim are in Toronto. They became Canadian citizens last week after reciting (not singing?) "Oh Canada" - both English and Quebec French lyrics - as part of the test.
Anyway, he has a shoulder injury which requires physical therapy - but Ontario's healthcare does not cover it, so he, like most Ontarians, must have supplemental insurance (through employer) for dental, PT and other stuff. This is similar to the supplemental insurance needed for US old-age-only Medicare. And when he needed an MRI for a bad lower back, I recall that he had to wait 6 months. But then again, he was just happy to have access to medical care for the first time in many years.
As far as I know, it is not fully covered in BC, however, I may be wrong since I have not needed any physio here. I do know that the physio treatments I received when I lived in ON were covered through my employer's extended care benefits as were dentist visits and glasses.
Vision tests are covered minus a small percentage, especially if you are at risk of cataracts or glaucoma and need more than once every two year check-ups, but have to pay for glasses unless you have extended care benefits through work. If you are in a low income situation, you should be covered. In Canada, percentages are linked to income and ability to pay.
Congrats to your brother and his partner on attaining their citizenship in Canada!
I do believe if the physio is requested by a Doctor it is covered. I am not certain on that.
i think the way the vision part is worked is you pay a fee every two years (60 dollars I think it is) and those cover as many followup tests as the optometrist deems necessary.
Again all these extra fees are waived for folk with low incomes though I do not know what level that is.
I have never needed prescription drugs but the way it works is Seniros and the poor are covered and then the rest pay the first 800 dollars per year. After 800 dollars the Governmnet pays 70 percent up to 2000$$ and after 2000$$ they pay 100 percent.
Thus unless you poor or a senior you would not pay over 1160$$ a year.
Dental care is not covered in BC. There have been a number of inititaives to try and get Dental care cobered under the Universl program but for naught, It was never a part of the original program.