Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Sunday, January 24, 2010

American Health Care; Vew from Afar

I received the following email from an expat friend of mine from college who now lives in Israel:
I thought of you when I read this, and would be interested to hear your take on it. (I'm one of those pessimistic types that think that America's health care problems will only begin to be cured when a majority of the public realize that their "insurers" are truly robber barons. Guillotining comes to mind as an option. But that's just me.) Trying to sound rational I usually say that it's high time the US took a look around at countries that have dealt successfully with providing health care (Denmark springs to mind) -- but I doubt the American political system or the American voter are ready for that.
My response:

Yeah, don't get me started on all that "Patient Centered Medical Home" shit. Basically, it's a way to get large impersonal multispecialty practices to work like me, from the patient's perspective (ie, everything they say they want to accomplish is precisely what I'm already doing).

As for systems in other countries, forget it. You know what the main problem is with American health care? Americans. If you could magically impose any other country's health care system on the US, I guarantee it would crash and burn in 6 months. Mostly because of the unparalleled litigiousness found here, but also because of patients' generally unreasonable expectations of medical care, coupled with an appalling refusal to take responsibility for modifiable lifestyle factors.

So yeah, if everyone recognized that the "insurance companies" are basically robber barons, and made rational decisions in their own financial best interests (which would involve paying cash for quite inexpensive primary care, true insurance for catastrophic illness, and programmed savings for end-of-life care (a la retirement)) then sure, we'd be fine. Just remember that this is a country of Limbaugh dittoheads who think Sarah Palin has more than two functional neurons in addition to a hyperfunctional uterus [edited to add] and left-wing nanny-staters who think it's their civic duty to wipe everyone's ass from cradle to grave. Believe me, there are times when guillotining sounds downright sensible to me too.


At Sun Jan 24, 11:33:00 AM, Anonymous Anonymous said...

Don't blame only the right wingers. The left has fostered the idea of medical care as a "right" that should be freely available in a way they would never expect of their plumber, electrician or grocer.

At Sun Jan 24, 11:45:00 AM, Anonymous Anonymous said...

This is also a country of Olbermann slurpers who get their "news" from an ex-SNL cast member who broadcasts on a comedy station, think Obama is qualified to run a country and believe that "free = more."

Still ready to bring on that guillotine?

Plenty of blame to go around, so let's not disingenuously claim it's all about the right-wing.

At Sun Jan 24, 11:56:00 AM, Blogger Andrew C said...

I would LOVE to get catastrophic health insurance only, and pay cash for my regular health care. Unfortunately, I attend a government-operated university that mandates full-coverage health insurance! The government already makes it hard to make wise decisions about health insurance - I dread what it will be like if the "healthcare reform" bill passes.

At Sun Jan 24, 12:03:00 PM, Anonymous Anonymous said...

Riiight. Why pay attention to a silly thing like our Constitution? Get a grip, Dino.

At Sun Jan 24, 12:09:00 PM, Blogger #1 Dinosaur said...

Edited to expand the political spectrum.

Why is everyone focusing on only my last sentence? Americans of ALL political persuasions appear to be either incapable or unwilling to get a grip and do what needs to be done (ie, stop smoking, get off their arses, and stop demanding immediate appointments with the dermatologist for every hangnail).

At Sun Jan 24, 12:14:00 PM, Blogger Amy said...

To me, the fundamental problem is that pricing is invisible to consumers, thus free-market dynamics do not take place. I have two kids on a "Cadillac" insurance plan through my ex-husband's employer, and I myself am on a relatively crappy private insurance plan with co-pays and a high deductible.

The way I handle medical care for myself is different from how I handle it for the kids. For the kids, it's cost no object. Whatever medicine the doctor prescribes is fine, even if it's brand new and very expensive. We'll go to the doctor for any problem, no matter how minor, do any tests, whatever. We don't think about costs because from my perspective there are none; the insurance covers everything.

For my own medical care, I think about price all the time. If my doctor prescribes an expensive new medication, I ask if we can get the same results from a generic. (The answer is usually yes. I am on all generics now. I pay only $10 for a generic, but non-generics are very expensive for me.) I very rarely go to specialists. Sometimes I turn down recommended tests and therapies because I can't afford them. An orthopedist recommended physical therapy to strengthen a particular muscle. I'd had physical therapy for that issue before and already knew all the stretches the therapists would teach me; I opted to strengthen the muscle myself at the gym. (It worked.) I delay going to the doctor for some issues and wait to see if the problem will resolve itself.

Some of these may not be very good strategies--as in they might be dangerous--but that's the reality of a limited budget and crappy insurance. On the other hand, there's no question that my medical spending on my kids, which is invisible to me, is quite wasteful.

At Sun Jan 24, 01:21:00 PM, Anonymous Anonymous said...

Back in the day people only had catastrophic insurance and paid cash for everything else. Because we were paying for everything ourselves, competition kept prices in check.

Nowadays "competition" and "free market" are evil words. Now that someone else is footing the bill [via high taxes], the sky is the limit.

It's a twisted world where Americans are forced to pay for someone else's medical care.

At Sun Jan 24, 04:32:00 PM, Anonymous Anonymous said...

Why is everyone focusing on only my last sentence?

Because pre-edit, it was one-sided sop?

The edit greatly improved your point.

At Sun Jan 24, 08:42:00 PM, Anonymous Anonymous said...

Ain't it funny how tort reform isn't included in any of the "reform" packages (yeah, sure they include money to 'study' it, like that's going to do anything). Tort reform is a low priority for politicians, anyway--recall that the Republicans ran on that, had 8 years in the White House and control of the legislature (for a while) and accomplished exactly squat. Don't have any great expectations from the party currently in power, either.

At Mon Jan 25, 08:14:00 AM, Anonymous Anonymous said...

Sarah Palin has 2 neurons? And they function?!?!?!?! Actually the non-medical scary part is that my kid's teacher told him that Obama's health care "reform" was putting us on the road to "Cuba-ism".

I don't claim to know exactly what the best way to do it is, but considering the layoffs I am seeing across all industries, and all the newly uninsured families,I think there has to be a way for people who cannot afford it to get some sort of health care.

At Mon Jan 25, 09:55:00 AM, Anonymous BD said...


>>...which would involve paying cash for quite inexpensive primary care, true insurance for catastrophic illness, and programmed savings for end-of-life care>>

Amen! I've been saying this for years! This is smart and fair. That's why it will never work.

As for tort reform... the fact is, the current system serves no one well. Cases without merit are frequently settled, angering physicians. Meanwhile, small cases with merit are ignored by attorneys (no profit there!), leaving legitimately damaged patients frustrated and angry.

At Fri Jan 29, 09:12:00 AM, Anonymous Griffin3 said...

Turn so-called "health insurance" back into real insurance (what is currently billed as 'catastrophic health insurance') and most of these problems just, simply go away.

You pay for car insurance. You hopefully have a decent deductible, to keep your premiums down.

- Do you clamor for an appointment with your body shop for every door ding? Do you insist on only the most expensive repair possible to your car, knowing what will happen to your premiums?

- Do you shop around for car insurance? Do you weigh the coverage against the price?

- Do you needlessly drive down gravel roads behind semi trucks, just because you know the insurance will fix it?

- Do you buy every engine additive that anyone recommends, because it just might possibly make you car look faster/ shinier/ with less late-night anxiety?

And even that isn't a real analogy, what with the way car insurance is distorted by all the medical and liability requirements, hurricane recovery fees, all the state and local nonsense that's added in. Make health insurance like car collision insurance (sure, with a no-fault rider), and you'll see a lot of people making more sensible choices, shopping around, and taking better care of their bodies.

And the rest, can ride the bus, paid for by the government. Which is not as nice an option, doesn't come to your door, but gets you where you need to be. As long as you at least bother yourself to get to the bus stop on time.

At Tue Feb 02, 10:35:00 AM, Anonymous Anonymous said...

The one thing that is also at issue is AMERICAN doctors, who are paid substantially more than their colleagues worldwide, and are probably the highest paid professionals in the world on average. Try subjecting other systems to that pay scale, and you'll soon find everything else going up to pay for it.


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