Thursday, January 22, 2009

An apple a day just ain't gonna cut it

I heard something the other day that really bothered me, and when I told Ken about it, it bothered him, too.

A young person was discussing health care, and the attitude I got was basically that if you don't work or contribute to society, you don't deserve benefits such as health care. That if people really want health care, they'll figure out a way to get it, and it's not the government's job to provide motivation.

They went on to say that if someone really needs health care, they can get it by walking into a hospital, that the hospital has to treat them.

When asked what happens with disabled people or those with long-term problems, the answer was "privately funded health care."

I guess I can forgive this young person their ignorance, because they're obviously too young to understand the full implications of what they are saying. (And obviously not paying for their own health care!)

I found a graphic about health care. While specific to New York state, the amounts spent on various categories is interesting, and I would say fairly consistent with nationwide trends. Over half of the health care costs for New York are spent on nursing homes, mental health/mental retardation, family health, managed care, and home care. We're talking about the elderly, children, mentally handicapped, and people who need care in their homes. In other words, people who can't work. What are they going to do about health insurance and health care? This cannot be a pay for play scenario.

As far as I know, there is no regulation stating that a hospital must treat a patient who walks in. Most hospitals treat a certain number of indigents, and that is part of their operating costs. However, that is one of the very things that is broken in our health care system. Emergency room visits are terribly expensive (I'm sure most of you have experienced the costs of an ER visit.) and are one of the things that hike up the costs of health care in general. When a patient can't afford reasonable health insurance that will pay for doctor's visits and preventive care, they end up in the ER and are unable to pay those higher costs, which are then absorbed into the operating costs of the hospital...which are then passed on to the rest of us.

I was aghast over forcing the disabled and those with long-term problems to pay for their own health care. I guess this young person has never experienced being denied insurance due to a pre-existing condition or forced to pay exorbitant prices, and they've never been denied a treatment that will ease their suffering--or a loved one's--because the insurance company has deemed the treatment unnecessary, or beyond reasonable and customary charges.

I was fortunate to work in health care, because I always had great (and inexpensive) insurance. Ken's company provides good insurance, as well. There are many companies that don't, and it's a huge concern for retirees to figure out how they're going to pay for their health care costs, especially when faced with a serious or even catastrophic illness. We've seen loved ones forced into bankruptcy because of illness, and that is a burden on the economy that we need to address.

I'm not in favor of nationalized health; I'd rather not see the government have their hand in every aspect of our health care. But I believe we do need to find a way to insure each of our citizens and give them access to health care. Part of that will entail working smarter, finding inefficiencies, and eliminating them. For example, we don't live in a large city, but we have two large hospitals in our area, and those hospitals compete with each other and duplicate extremely expensive procedures. Let's rethink how we do things, and let hospitals divide up some of these larger services such as MRI's, or let them concentrate on different areas of expertise. One hospital can concentrate on vascular surgeries while the other concentrates on orthopedic surgeries, just as an example. I believe that if we adjust our thinking to making things work better and more efficiently, we can absolutely provide health care for all.

We also need to change our mindset and focus on preventive medicine rather than only on curative. As Barney Fife would say, "Nip it in the bud!" Stop problems before they start. This involves education from grade school up; programs to help people stop unhealthy behaviors, whether it's smoking or unprotected sex; changing the menus to healthier ones in all schools, not just a few; and responsibility on the parts of both producers and consumers. You may say that I'm a dreamer, but I'm not the only one. [grin] This is something we can and should do. We can make it better, and we can care for all of our citizens. Employee incentive programs can and do work, and can save thousands in costs down the road, and employers can motivate their employees and save future costs by offering such programs.

As for the young person who I heard this from, as I said, I suppose I can forgive this person's lack of knowledge, because it's something that they just haven't had to worry about. When they start working and get out on their own, I suspect it will be quite an eye opener for them, and their tune might change. In the meantime, I find it disturbing and terrible that their parents aren't teaching them more compassion for those less fortunate, and trying to instill an understanding for those who have been raised in different circumstances, or those who suffer from chronic illness. Shame on them.

I believe we have a moral obligation to care for those who cannot care for themselves, and I believe we can find a way to do it so that good behavior is rewarded, all receive needed care, and the system is not abused.

I'll enjoy hearing all of your comments, and I know there are a few of you in health care. Jimi? Claudia? Melissa? I look forward to hearing your take on this.


  1. Once again your entry is timely for me. Our group plan renews March 1...I was just informed last Friday our renewal rate is 66% higher. Wow!!! We only charge our employee $100 a month for excellent coverage - what to do now that we've got this kind of increase? It puts us in quite a bind right now.

    Something HAS to be done, there is no way around it and it is getting critical. Now that so many have lost their jobs they may have to pick up the premiums themselves under COBRA or if the group is small they won't even be offered the benefits. I don't want to see the govt take over healthcare either but I don't foresee the health care providers or drug companies lowering their outrageous costs anytime soon in order to help out.

    As you said, the young person you speak of has quite alot to learn.

  2. medical bills force many working Americans into bankruptcy.
    many people go without care because they can not afford the doctors visit (copay) and the meds and go into work sick and infect others
    often, a working American will not treat a critical condition because they have to chose between food and paying utilities and gas money OR the medical bills.
    the health care in America is not fair and not working.

  3. Hi Beth,
    It's sad to say, but maybe the failing economy will give this "young person" some new ideas, soften-up his or her callous attitude. Our healthcare system is in a shambles. Just this week I had to take a colleague of mine from Europe to the Emergency Room for some urgent care. In his own country, healthcare is "nationalized," it's all taken care of. In ours, since he doesn't have a U.S. insurance plan, I warned him to expect thousands of dollars in bills just so he could be prescribed antibiotics, get a bandage for a cut and a flu test. I guess the only good news is that by the time he gets all these bills, he'll be back home in Europe, so even if he faints or has a heart attack after seeing the charges, he can be rushed to a hospital in his own country.

  4. Interesting post, Miss Beth!
    The unfortunate situation seems to be that hospitals have become "big business", and like automakers and banks, have become poorly managed and fail to self-regulate. Your 2 hospital scenario is a great example of what WON'T happen with our current system. From your example, either vascular surgery or orthapedic surgery will prove to be more lucrative, and therefore both "businessmen" will make the decision to go after that business, leaving the other, less profitable one, underspaced, underfunded, underdeveloped, and overpriced.
    One other interesting thing I learned from a benefits administrator at work. We employ huge numbers of legal immigrants who grew up in other cultures. Where they come from, when you get sick, you go to the hospital. So that's what they do here. For a headcold, hangnail, or whatever else. They really just don't understand or trust our private clinic system. All those (espensive) ER visits drive up the cost of health care for all of us.
    I'm afraid that what will happen is our healthcare system will begin to fail, the way of automakers and banks. The government will have no choice but to bail them out, and then we end up with exactly what we are all saying we don't want: government funded health care! I'd rather see us get in there and get it organized up front, since we're ultimately going ot have to pay for it anyway!

  5. We have universal health care in Canada that is very fair and it works very well. Everyone is covered for very little money or paid for through work benefits. If we need medical help, we go to our doctor and get it at no cost to us. If we need to go to the hospital or have surgery, there is no cost to us. It is very civilized, sane, fair for everyone and we are a healthier country because of it. There is nothing to fear.

  6. Very interesting post Beth. I agree with all you are saying here. Helen

  7. Hi Beth, well you know how horrified I am with the lack of health care you have in what we are always being told is the wealthiest country and the most advanced country in the world (when was that ? !!)
    I have the most horrendous personal experience of the US system and because of it I fear returning to your beautiful country which is so sad.
    Yes we may have it bad here in the UK at the moment but our health care is first class usually...There are always exceptions !!

    Love Sybil xx

  8. I'm thinking...and thinking and trying to figure out what to say. There are many Americans who have been forced out of their full time jobs w/benefits to working a part time job(s) just to pay the bills because full time jobs w/ benefits are more and more rare. Unless you have a college education the likelihood that you will find a substantial enough full time job w/ benefits is greatly reduced. That leaves low income clinics etc. to cover a growing number of people that need care. The economy is causing the govt. to close more and more state run and govt. run facilities (i.e. mental institution etc.) and having to let the "less compromised" patients out on the street with no way of supporting themselves and becoming homeless but with the same problems they were admitted into said institution in the first place. Thing is the institutions "less compromised" consists of what conditions?
    Also, something I've noticed since moving to the South/Southwestern United States (TX, NM, AZ) there are VAST distances where there are hospitals only every few hundred miles from each other for emergency care. Said hospitals are shutting down at a frightening rate because their inability to maintain operating costs. Illegal Immigrants make quite a blatant use of this system, (no I'm not bashing I'm making a statement) use the system and the costs aren't covered because the one's that do use the ER's like this are afraid to bring further attention to themselves & be sent back to where they came. I bring this up because for the people that live in these remote areas if something major happens and they require immediate care, their source of healthcare shuts down they have to drive double the distance in order to receive that care! Does that make sense? Something needs to be done either by the government itself or by some kind of CONTROL being excerted over the Pharmaceutical Co's, the Hospitals, Insurance Co's or there is going to be a huge mess to clean you said, it's the banks etc. now..what will happen when healthcare joins the ranks?
    Blessings, Teresa

  9. I absolutely agree, although having also worked in healthcare my whole life, I have stopped discussing it with (some) people because many are quite narrow-minded once they hear me say(as you just did) that I am not in favor of nationalized health care. They don't wait long enough to hear what I AM in favor of. I've had deluded ego maniacs rant at me about this in a way that is more painful than a Brazilian bikini wax. You put it all very well, and I thank you.

    Funny that I had a doctors appt yesterday with a doc from Canada, who left her country because of her problems with nationalized, and seeing how long it took to get someone a simple ultrasound; but she wants all people to have health care.

  10. Deep post. I don't think I have a big enough 'arm' to make that pass, but here goes.

    The collective mindset against socialized health care here is part of the problem. Should health care be a part of the same kind of thinking that commands capitalism? Or is it that there is so much waste and inefficiency in health care that cost will be lowered by eliminating duplication and unnecessary paperwork?

    A lot of health issues can be minimized thru preventative measures ... but what is the financial motivation for that? There isn't enough emphasis placed on what you do before something goes wrong ... and there is a conspiratorial feel between what food we eat, and the habits we have developed and cultured for us, at least to me.

    You make things 'affordable', then what makes being a doctor or surgeon a lucrative profession? That is something else that rightly or wrongly, factors into the health care equation. Soon, you will have not the best and brightest entering medicine, but the same kind of folks that work at the DMV's around the country.

    See, someone smarter than me will need to figure this out. I think that there is something against the preventative part of health care, that keeps real change from occuring in the system.

  11. My grandaughter had to take her 2 kids to the ER. The baby had DOUBLE EAR INFECTION and was wheezing badly and the other bou has a upper respritory infection, Gortunatly she was still on medicaid because the nebulizer med was 500.00 and the antibiotics for both boys was over 300.00 and the nebulizer machine was outrageous. This is in Tx. I have a friend in Canada and she explained their system to me and I will take her care over ours any daY. nATIONALIZED OR SOCIALIZED MED REQUIRES WAITING UNLKESS IT IS AN EMERGENCY, in thAT CASE SHE GETS IN IMMEDIATLY. Her father had a heart attack at work and his co-workers got him help and kept him alive tioll someone was able to get him in which was fast. He was not breathing but he is back at work today. What is best?? I don't know but I think it is outrageous what the US health care costs us and meds aRE OUT OF SIGHT. lUCY

  12. Ignorance is bliss for only so long. Hoping someday the young will understand what was being said. Take care and enjoy your weekend,

  13. Hello Beth. OOh what a subject. I have recently lost my medical insurance and I had to get private insurance for my daughter. I am now trying to get insurance for me and my husband. To continue with COBRA it would have cost us $1000.00 a month. I can not affford that!
    As far as I know any state owned hospital ER can not turn patients away. I worked in a state owned hospital ER and we could not turn anyone away. This was over 12 years ago and I remember the patients who were homeless and drunk would come in by ambulance, which costs us $150.00 per ride. And then when they sobered up we sent them to a homeless shelter by ambulance on our dime. And for the patients on state medicaid, the state paid for them to come by ambulance and to go home w/there grey state card. NICE a ride to the ER and to home. Alot of the times they were seen for minor problems that could be done in the clinic, but they did not like going to the clinic.
    I am seeing first hand how hard it is not having insurance. I list mine and currently am on some medication, that I pay for now. Any doctor visit I pay in full for. I had an injury to my elbow and would like an xray but I cant afford that. The elderly folk of America should be covered in full as far as I am concerned. They worked all there lives in this country (many of them immigrants as some of my family came here from Italy) and many served our country (like my Grandfather and Dad) and they should have medical coverage and Rx coverage at a very resonable rate and I mean AFFORDABLE. A lot of elderly folks can not afford there medications so they skip them or they cut the pill in half or the take it every other day. It makes me sad.
    Take care Lynne

  14. Very thoughtful post and I am totally with you on everything except I do support nationalized health care. A nationalized system does not necessarily eliminate private health care. It means that there is health care available for all at reasonable rates and if I have the funds or want something different, than I can seek out private health care at a higher rate. To some extent, we have elements of a nationalized system. I work for the state, the largest employer in any state is state government. Because of the huge base of members, state employees typically have access to health care at much better rates than people employed in the priivate sector. In my state, enrollment of the employeeonly is available at no cost to the employee. There is additonal cost to add a spouse and children, but it still is well below what the costs are for people employeed in the private sector. To my way of thinking, state employees receive subsidized health care. Federal employees also receive helath care at much lower rates than the private sector. We have a quasi nationalized health care program for state and federal employees.

    I have a list of health issues-atrial fibrillation, a leaky heart valve, and diabetes to name a few. A couple of years ago when I was considering going into private practice, I checked into insuring myself. I was told that I was clasified as "uninsurable" and offered a basic policy by the same group that insures state employees. It had a $7500 deductible and a price of $3,200 per month. I decided that I couldn't afford to hang out my shingle.

    I am very fortuante to be employed by the state and I will stay until I retire. You see, if I retire from the state, I get to stay on my current health insurance plan after I retire. Great for me, but what about all those other people with the same health issues, the uninsurables, how do they get care and afford medications? Even with good insurance from Blue Cross, I still spend $250 per month in co-pays for my medications.

    We are in a health care crisis for millions of people; it's truly a crying shame.

    Sorry for the soap box but this health care issue really pushes all of my buttons.

  15. Good post. Luckily I have health insurance thru work with a co-payment both from my check and when I go. Some people don't have that option and suffer. Nursing home costs are outrageous. I work in one and we don't get paid adequately from Medicaid. We are a non for profit and have not been in the black in a few years. Lots of cut backs.

  16. I just skimmed the entry, as Smiley is trying hard to get my attention, but in Wisconsin ER's are required to treat anyone who walks in the door. Of course, that means nearly everyone without healthcare walks into the ER for every earache and sore throat.

  17. Wow Beth I have just read the blog. Health care in the USA is a mess. We have some of the best health care in the world, but it is so expensive. I work in health care and to buy it for my husband and I cost me about $450/month. My daughter does not have health care because she worked part time. I am paying for hers, it is a bare bones policy, which cover 4 doctor visit/year. No prescriptions, it is essentially for emergencies, accidents.....she is healthy and does not take Rx. We went to the Urgicare she needed a nebulizer treatment (not covered) and the nurse practicioned gave us a script for generic antibiotics, and a coupon for a free albuterol inhaler. The antibiotics cost $4 at Target because it was on their list.

    To Cobra the policy will cost about $450/month each. I can not buy a policy because Chuck had cardiac stents....

    ER's do have to have a MD evaluate each patient and they have to treat them if it is an emergency. They can be evaluated and sent elsewhere, but they need to be treated if warranted. This is in PA. A person without insurance will be billed at the premium price, with most agreements the company bills at some reduced rate, those without get the highest bill.
    Socialized health care would work and I think it is coming. But we will not have the same access or services that people expect now. They will probably triage and ration care. No more total hips for those ove say, 80. And all the life sustaining care at the end of life will probably not exist. It will be the care for those who will benefit the most.

  18. Hi Beth,
    I'm sad that you don't believe in a National Healthcare System. I would just like to tell you my story.
    I am a sixty year old man, who voluntarily retired ( Read:quit ) last year, due to the fact that caring for my elderly Mom made too many demands on my job. They basically said it's us or your mom. I chose Mom! I finally had health insurance, after six years of a job that provided none. I checked out COBRA only to find out that my premium would be over $500 a month. Since I am now living off of savings ( prior to supplementing it with Social Security in two years ) that would have put quite a dent in my monthly expenses. I was only in a "service" industry.

    I finally got to realizing that a catastrophic illness, could clean out my savings completely. Leaving me with nothing to live on. So I sought out private insurance. I am paying $180 a month, on a policy that has a $7,500 deductible. I am in relatively good health and take no medications. Today I had to go to the doc for a minor ear infection. Well the bill amounted to $130 for an approximate ten minute visit. Am I wrong to think this is outrageous. Had I had blood tests or x rays, I could be looking at a bill of over $500.
    I have considered attempting to move to Germany, because of a better and cheaper standard of living. ( trust me I have stayed there before ) I checked into private insurance there. It would cost me $90 a month, and would cover EVERYTHING! I have no idea what my plan actually covers. I have a 49 page booklet, that simply explains all the reasons they might not pay for certain things.

    I really think this country needs to adapt a Socialized form of Medical Care. This "For Profit" stuff is ridiculous!


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