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I haven't been writing much around here lately. It's not because I don't have anything to say as much as it's because I have a lot going on. I have to recertify my skills this year and it's taking a bit of work. While I'm on this odyssey of getting enough CEU's to keep my alphabet soup after my name, I've run across every meme you can think of concerning the state of the U.S. health care system.

I shouldn't be astounded that the people I have to take courses from to keep my certifications are grossly ignorant of just how substandard U.S. health care is; but I've been trapped in classrooms listening to crap. I'm a little concerned about voicing my opinion; because if I do, it could seriously impact my career in a negative way. What I'm coming to realize is that I can't do much about the U.S. health care system from working on the inside of it. It's a shameless, greed based system and I dare not complain too much. It's been stressful.

So, I've been doodling and writing some outlines of diaries, while trapped in conference rooms and I'll be rolling them out as I finish them.

Right now; I really need to blow off some steam.

But How Do We Pay For It?

“It” being health care.  The discussion was about health care reform. Oh, the usual facts were cited.
    "It’s the best health care in the world."
    We spent about $2.6 trillion on health care in 2010.
    52% of Americans went without some aspect of health care within the last 12 months.
    49 million people are uninsured.
    The average premium for a family of 4 is about $1,300 per month.
    The average deductible is over $1,000 per year.

Grim, I tell you, the discussion was grim. Grimmer still was what came next.

We have the best health care in the world (and he must of seen me roll my eyes because he vectored off to) U.S. healthcare is very effective, but also very expensive. We have to do something about health care. We know we have to do something about health care…. (and in the next breath) We’ll never have socialized medicine in the United States. We won’t stand for it. We can’t have the government make our health decisions for us. We don’t want death panels… We’ll get some sort of Universal Health Care, but we won’t ever have a socialized system.. (and you’ve heard these memes before.)
It was absurd. It was political pablum. It was the same ole drivel. No depth of thought. Unfortunately, I could see that there was no way to move him or the rest of the room from this view point. The memes took root. They have become reality for this speaker and most of the room nodded like bobbleheads in agreement with him.

This wasn’t a group of ignorant people. Some have worked in health care for over 30 years. The average for the room was 12 years experience in health care in all venues (a doctor, risk managers, health care lawyers, hospice, nurses, office, hospital, administrators and educators). The others in the room were so entrenched in the status quo that they can’t conceive a solution. They have too many sacred cows. They are beholden to too many stakeholders. Their paralysis is real. They can’t see a solution. They aren’t alone.

Most people can’t see a solution that doesn’t kill at least one sacred cow.

Maybe the real problem with health care in America is that we focus on what we can’t do instead of what we can do.

“Can’t” and “Won’t” never did anything, never accomplished anything. And, “never” is a long time. It wasn’t so long ago that people said black men and women of any color would “never” have the right to vote. It was said that LGBT’s would “never” have the right to live in peace or serve in the military; let alone marry.  These “nevers” (despite some false starts) have fallen or are currently falling by the wayside. Maybe it’s time we drop the health care “nevers” too.

I once read that typically when 30% of a population has trouble accessing health care, then, we’ll have a chance at possibly getting Single Payer or at the least, Universal Health Care. That time is here, but the meme BS is still in the way.

What the people in this room would admit is that they saw suffering people every day who had limited access to health care. They saw people who couldn’t get adequate health care, but they wouldn’t acknowledge their own complicity in the crime. They refused to look at the other side of the story.

1.    It’s the best health care in the world.

But, that is small comfort if you don’t have the means to access the “best health care in the world”

2.    We spent about $2.6 trillion on health care in 2010.

But, $800 billion of it is estimated to be wasteful, fraudulent and abuse – in short unnecessary expenses.

3.    52% of Americans went without some aspect of health care within the last 12 months.    
     (Click Chartpack, page 16) …that we know of, but that was too bad, so sad for
     this group of people.

4.    49 million people are uninsured.

Our system effectively excludes 1/6th of the U.S. population, but since this group doesn’t see the uninsured, no harm, no foul.

5.    The average premium payment for a family of 4 is about $1,300 per month.

Forcing more and more families to go bare – see above.

6.    The average deductible is over $1,000 per year (Click Chartpack, slide 4) .

Which encourages more people to self-ration their care – see above, again.

7.    We won’t tolerate the government making decisions about our health care
       Yet we allow private insurers who have a fiduciary duty to maximize their profits to make
       those decisions with impunity. We won't stand for "socialized medicine", but we will die
       waiting for Medicare. (Click Chartpack, read it and weep)

8.    It’s the best health care in the world.

     My ass

Originally posted to JDWolverton on Mon May 21, 2012 at 04:56 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

    •  thanks for writing (12+ / 0-)

      it's horrible and sad how backwards we are.

      here's a potential tool: in 2008, I produced a short series about national healthcare in Japan: it might be useful for the persuadable amongst your fellow health practitioners:

      National Healthcare Mythbusters

    •  Where is this being taught? (2+ / 0-)
      Recommended by:
      Wee Mama, mrkvica

      A deluge of complaints from the great interwebs might be able to help remove the politics from the training - once you're done with your certification, of course.

      •  Oh, just a few places here and there (8+ / 0-)

        I can't too angry at the local Universities and Colleges where the courses are being held, because these classes must conform to standards set out by:

        Florida AHCA - Florida Agency for Health Care Administration
        AHIMA - American Health Information Management Association
        AAPC - American Academy of Professional Coders
        JCAHO - Joint Commission for the Accreditation of Health Care Organizations

        These groups specify the credentials of the people giving the training and these trainers and instructors (in South Florida anyway) tend to be a very conservative lot.

        Corporate influences also come into play and we could possibly get some traction here. Some of these trainings are sponsored by text book firms like McGraw-Hill, Cengage. I haven't attended one sponored by El Sevier, but since they are a major coding text book seller, I'm sure they do too.

        It's just a little nauseating to hear this stuff, but what is really daunting is that so many of the people I work with are afraid of health care reform eliminating their jobs. That concept alone makes them anti-reform.

        If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

        by JDWolverton on Tue May 22, 2012 at 07:26:11 AM PDT

        [ Parent ]

        •  Here in Iowa the health care providers have (5+ / 0-)

          been talking about moving to a capitation model instead of fee for service for I believe over a decade (a little foggy - trying to remember my husband's comment from a meeting with the High and Mighty). But then this is Iowa and we have high coverage rates, including a state based system for kids.

          Some of us here are thinking of pulling a Vermont and pushing for single payer - there is enough similarity between the two states that it is at least conceivable.

          If memory serves that is how Canada got its federal system - provincial systems were set up and then spread.

          Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

          by Wee Mama on Tue May 22, 2012 at 09:05:36 AM PDT

          [ Parent ]

    •  Physician 'poverty' will be tipping point. (18+ / 0-)

      Bear with me on this; I know when you see that thoracic surgeon tooling around in his Jaguar, this is hard to imagine. But primary care doctors have seen their income slide substantially over the last decade, enough so that it's now very hard to pay off med school loans. Which explains why the percentage of U.S. medical grads going into primary care has crater'd.

      So far medicine is still dominated by procedural subspecialists who think the current 'system' is just hunky-dory; we family docs are the Appalachian poor relations no one wants to talk to. We have about as much influence as that homeless guy on the bus station bench.

      But after a few more revolutions of the great hamster wheel of economic 'progress', the orthopedists and gastroenterologists are going to see their incomes crimped too. And pretty soon after that you'll see a critical mass of doctors suddenly realizing they have more in common with their patients than with GE Medical Imaging or Pfizer. And then things will start to change from the inside.

      •  Kudos to you for doing family practice - (6+ / 0-)

        my FP doc saved me two C sections.

        Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

        by Wee Mama on Tue May 22, 2012 at 09:06:31 AM PDT

        [ Parent ]

      •  Friend of mine (1+ / 0-)
        Recommended by:

        realized that at the end of the day, after paying all the practice bills, that she made more money as a professional artist living in the rural west than she did as a doctor living in the rural west.

        So now she's a professional artist with an MD.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Tue May 22, 2012 at 01:24:14 PM PDT

        [ Parent ]

        •  I do have a wee problem with that. (1+ / 0-)
          Recommended by:

          Don't get me wrong; I totally understand the frustrations and disappointments of dealing with the insurance cartels, running a very complex small business, being up all night on call and, you know, actually caring for people. It makes painting (or whatever) a very appealing alternative.

          But a medical school slot is a very precious commodity. Medical education even today is heavily subsidized by the taxpayers. We already have a critical shortage of primary care physicians nationwide, and significant shortfalls in some other specialties like child psychiatry. So when a practicing clinician throws in the towel to do something else, he/she is also throwing away a substantial taxpayer investment in his/her training.

          •  I agree (2+ / 0-)
            Recommended by:
            splashy, JDWolverton

            And honestly, I think she felt the same - she after all still had student loans to pay, even after ten years practicing post-residency. But she felt she had no viable future and she didn't feel like she made a positive difference for her patients. Perhaps she lacked a good mentor as much as she lacked remuneration.

            Her story is not unique.

            This person wrote a memoir about it:

            She ended up quitting medicine because it made more sense financially to teach at the private school her daughters attended, and because she felt sucked dry by the insurance system.

            Fry, don't be a hero! It's not covered by our health plan!

            by elfling on Tue May 22, 2012 at 03:14:13 PM PDT

            [ Parent ]

            •  Totally agree on the mentor thing. (1+ / 0-)
              Recommended by:

              I had a terrific mentor in medical school who steadied me when I experienced some doubts about ever knowing enough to practice primary care. He explained how he had managed it, and provided the little spark of encouragement that got me over that hump.

              As opposed to the bitter, angry burned out surgical chief resident I scrubbed for surgery with one morning as an eager 3rd year med student. I asked him, "when did you know you wanted to be a doctor?" He never looked at me, but said "I regret the day I ever started medical school. Medicine has ruined my life". And then he walked through the door into the operating room. Yikes! To this day, 30 years later, I still don't get that. People are willing to entrust their lives, and their childrens', to my care. The satisfaction and gratitude I routinely get from my patients are still humbling. I honestly look forward to work every day.

              I did skim Maggie Kozol's book, and was very disappointed by it. The culture of Pediatrics is a bit unique in medicine; it's overwhelmingly female, particularly among younger docs, and there is a very powerful expectation of 'reasonable' work hours. In my experience many young pediatricians, especially women, are shocked to discover how many hours they have to work to have a financially viable practice. Absolutely true story: the head of our local rural pediatrics group has been trying to recruit a new partner to replace one who is leaving. But she's having a very hard time finding new residency grads willing to take any night call at all. The last candidate she interviewed asked, "What if it's 5 o'clock and there are still patients to see? I can still leave for home, right?" Needless to say, this candidate was shown the door. But that attitude is distressingly common among younger docs, in particular those from very affluent backgrounds. Which in turn is why ruinous education costs are so problematic: folks from working class backgrounds who understand that working hard is expected can't afford college & med school. But the affluent & entitled kids who can afford it don't want to work that hard.

              Just my two cents; feel free to disagree.

    •  please blow a gasket (1+ / 0-)
      Recommended by:

      more of need to blow gaskets more frequently. This is unacceptable and yet I am accepting it. Thanks for writing this diary!! Thanks for thinking critically, and questioning!!

      To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

      by kareylou on Tue May 22, 2012 at 11:45:06 AM PDT

      [ Parent ]

  •  Great diary. Nothing makes me angrier than this. (23+ / 0-)

    We all know someone who has no (or inadequate) access to health care.  I have friends who need multi-thousand dollar surgeries to return to full health, but yet cannot afford to even consider it without insurance.  

    The "safety net" has too many rips to be effective.

    "I like paying taxes. With them I buy civilization." - United States Supreme Court Associate Justice Oliver Wendell Holmes (Republican) -8.12, -5.18

    by ncarolinagirl on Mon May 21, 2012 at 05:43:49 PM PDT

    •  Indeed. Even with insurance, I cannot afford (18+ / 0-)

      anything other than a basic office visit. My insurance used to be good. Not so much anymore thanks to the increases in my costs and decreases in coverage that my insurance company has been allowed to make so that they can continue to be obscenely profitable. I have begun to ration my care because I cannot afford to incur the costs.

      •  I'm doing the same thing (7+ / 0-)

        on Medicare disability and with my secondary insurance.  They are now charging patients like me the full amount of the office visit even after Medicare and my secondary pay whatever is left from the charge I'm billed.  It is against Medicare law, but screw it, at this point I just do what I have to, I had to many fights and runarounds with insurance companies when I got slapped with a pre-existing that cause astronomical medical bills prior to getting on disability.

        Health-care is necessary in any population, it keeps down disease and major epidemics.  But at the rate we are going most people can't afford the doctor even if insured.  Some major epidemic would spread like wildfire in our country because too many people couldn't afford to get the help they would need and/or the hospital costs to contain it.  We are playing with fire in this country.

        "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

        by zaka1 on Mon May 21, 2012 at 11:42:22 PM PDT

        [ Parent ]

      •  That is what really sends it home for me (6+ / 0-)

        I have basically the same plan that I've always had, through my employer, but little by little the benefits have eroded away. Co-pays have gone up, prescriptions that used to cost me $5 now cost at least $22 (and that's generic!) and my "pre-payment" for labor and delivery of my baby is $812! And that's just doctor's costs, not even the hospital stay! What is really sick is that what I've got still passes for "Good" health insurance-- when 10 years ago I would have pitched a blue fit if someone told me what I'd be putting up with now.

        "You must love the art in yourself, not yourself in the art." -- Konstantin Stanislavski

        by emilymac on Tue May 22, 2012 at 08:26:37 AM PDT

        [ Parent ]

  •  Thank you for posting (24+ / 0-)

      The U.S. wealth care system gets me crazy angry in seconds
        In France the health care costs half, on a per capita basis then U.S. care
        And the French are far healthier.
        And over and over "they" say best health care in the world.  If you're are a millionaire heart surgeon maybe.

    •  You are pointing at the wrong widget (8+ / 0-)

      There are millionaire surgeons in the US, no doubt about that, but most heath care providers, like myself, are straining to repay our graduate school debt with stagnant wages, kind of like other nonmedical professionals in the US.

      There are some physicians who own radiology facilities or same-day surgical centers who are wealthy but most health care providers are not in those categories.

      Who is profiting from our health care system? Insurance company executives, hospital executives, electronic medical records executives, for profit health care shareholders and lobbyists.


      "And tell me how does god choose whose prayers does he refuse?" Tom Waits

      by madaprn on Tue May 22, 2012 at 06:17:36 AM PDT

      [ Parent ]

  •  I'm a health care lawyer (26+ / 0-)

    going on 20 years in the field and lots of deals, regulatory issues, affiliations, etc.  

    My opinion of what we need specifically in the health care field is:

    1.  Single payer funded with new taxes to support those who can't afford it.  Lots of preventative care and chronic disease management options, which often pay for themselves several times over.

    2.  Payments to health care providers that are based at least in part on achieving wellness instead of just treating sickness.

    3.  Payments to health care providers that are based at least in part on the quality of care provided.

    4.  Less non-functional regulation, especially around billing.  These days billing/admin expense uses around 25% of every health care dollar.  Some regulations are useful, most are not.

    5.  Government investment in developing more primary care docs (internal medicine, family medicine, peds, OB/GYN).  There's a shortage now and it will get much worse without intervention.  In my mind it would be worth the government creating a large new medical school where students could attend for free if they agreed to go into primary care and not a specialty.

    The other area is finding ways to incentivize and educate people to avoid doing things that are unhealthy.  Especially smoking.

    •  Number 3 (5+ / 0-)

      I'd love to know more of your thoughts on quality of care.

      Not to be cynical, but I'm sure it'll sound like it: How is it measured?

      In fact, what is quality when it comes to healthcare? Is it outcomes? Is it perceived satisfaction? Something else?

      And more importantly, on the other side of the payment-for-quality, is the question of how it's supposed to be used by people like you and me. Or isn't it?

      If one doctor only treats people who are relatively healthy to begin with, won't his "quality" be better than another doctor who happens to treat more unhealthy people?

      How do we compare one doctor who is 100 percent successful performing a knee replacement, for example, on a healthy person against another doctor who can only claim partial success on another person's knee replacement when the patient is 100 lbs overweight? Is the former better? Are they the same quality?

      And more specifically, how is the quality measurement (if that's what it is), represented to lay people like myself? How do I, as a purchaser of medical services, assess the measurement that's given to me? And more so, if I have "quality measurements" of 2 or 3 or 4 doctors, how do I compare those measurements if I have no clue what any of them mean and no clue for their basis?

      So what exactly is quality medical service, who defines it, and how are we supposed to use it (or not)?

      Very curious because I'm not an insider.

      Chaos. It's not just a theory.

      by PBnJ on Mon May 21, 2012 at 09:16:48 PM PDT

      [ Parent ]

      •  Answers! (7+ / 0-)

        Pay-for-quality is just getting off the ground, so right now it's mostly easy-to-understand requirements, that are easy to measure.  For example, anyone who comes in to an emergency room with symptoms of stroke needs an MRI or CAT scan.  The quality measure asks "Did everyone who came in to the hospital with syptoms of stroke get an MRI or CAT scan that was interpreted within 45 minutes?"    Hospitals get measured and try to shoot for higher percentages.

        There's a couple of hundred of these types of measures in a bunch of areas.  Things like the number of people who get antibiotics when they have surgery (should be high), etc.  Most don't change depending on the status of each specific patients.

        There are some quality measures that measure outcome (how health a patient is), and there will be more in coming years.  Generally speaking, differences in how sick people are are equalized by looking at the "case mix" score of each patient.  There are diagnosis codes for everything that can go wrong with you.  So one person may have a single code indicating stroke, while another more sick person has three codes indicating stroke, heart disease and cancer.  The outcomes of the more sick person are counted with greater weight than the healthy person.

        Most quality measures are meant to be translated into information average people can understand.  A good example is Medicare's Nursing Home Compare which takes the quality-related information reported by nursing homes, and then summarizes it in a simple system for regular people (between one and five stars).

        •  your MRI-CAT-stroke example points to several... (7+ / 0-)


          It's actually a quality of diagnosis issue, and it's not as quite as simple as devising some over-arching measures and then applying them.

          This link explains some of the issues in layman's terms. There's really far too many excellent points made in the article to excerpt it here...

          I'd also point out that quality of care measures and systems have a fair bit o' history going back decades, whether it's referred to as QC, TQM, or pay-for-quality.

          Meant collegially.


        •  One really straightforward one (7+ / 0-)

          How many ER visits were required for asthma in the treatment population, and is it lower than the median and dropping?

          The reason for this is as a helpful measure:

          Most cases of asthma can be controlled with proper medication and appropriate education. Patients who are properly educated on how and when to use their medications, and on how to avoid triggers are more likely to keep severe attacks at bay. Patients who are just prescribed an inhaler, given no instruction, and not prescribed a spacer are less likely to succeed at keeping severe attacks at bay.

          Similar measures are possible for diabetes, cholesterol levels, obesity, etc. There are ways to measure quality in health care. On the larger societal meta level, longevity and infant mortality are good measures (we're piss-poor at both of those).

          •  And yet the insurance company (2+ / 0-)
            Recommended by:
            JDWolverton, PBnJ

            gets upset if I try to refill my daughter's asthma meds at the 20 day instead of the 25 day mark.

            I would hope that would be a demerit for them instead of for her pediatrician.

            Fry, don't be a hero! It's not covered by our health plan!

            by elfling on Tue May 22, 2012 at 03:16:15 PM PDT

            [ Parent ]

        •  About that Medicaid "quality" rating for nursing (5+ / 0-)
          Recommended by:
          JDWolverton, mrkvica, ladybug53, Dave925, PBnJ

          homes ...

          Oh, it's completely "understandable" ...  one to five stars in a half dozen important care quality headings -- and one overall rating.   So simple.  So very very simple.

          But I had occasion in the past two years to look for nursing home placements for a my mother and my girlfriend.

          Now, when I saw a combination of "under thee stars" AND locations in deep poverty pockets -- I didn't visit those.  Of the ones I did visit ... similar ratings didn't indicate similar facilities --  as it turned out, one of the worst-rated turned out to be the best for physical rehab ... and one of the best rated turned out to be a clean and cheerful place to sit in a wheelchair and wait for death.  None would place hand over heart and swear that pain medication would be administered "on schedule" give or take an hour.

          The point however is that if each of these facilities were paid a sliding scale depending on the "quality" of their care ... they would all be paid the same, anyway ...

          But the shocking fact is, the County Facility ...  known locally as a hellhole of a warehouse for insolvent patients and those without "advocates"  -- that place got full 5 star ratings in every category and overall.

          And when I asked the private facilities " why is it that your facility has only a three stars for staffing levels, and four for sanitation -- but the county home has five across the board"  -- the answer was  "we don't really know -- but my guess is that the County doesn't deserve its five."

          The good news, I suppose, is that a pay for quality program that (for example) penalizes "re-admits" might be useful, unless some bean-counter calculates the risk-reward ratio of the cost of keeping all patients the "extra" day or three against the fines or hold-backs for patients released "too early" who then come back with complications.

    •  I think you just described- (7+ / 0-)

      the whole section in Michael Moore's Sicko when he visited England and observed their system - everything from preventative care being emphasized to no need for a massive billing department in their hospitals - just a cashier somewhere deep in the heart of the hospital that actually reimbursed for parking - imagine a hospital where the only billing type of office actually gave out money to patients as they left?  

      "Selfishness must always be forgiven, you know, because there is no hope of a cure." Emma 1816 Check out my blog

      by ArtemisBSG on Tue May 22, 2012 at 12:02:14 AM PDT

      [ Parent ]

      •  And yet my English cousins are always griping (3+ / 0-)
        Recommended by:
        ladybug53, davewill, Dave925

        about the inconvenience and impersonality of care ... the long waits for non-emergency appointments ... the long waits in-clinic on the day of the appointment ... the recycling of medical hardware such as hearing aids and implanted pacemakers ...

        Yet they admit that for "maternity and casualty" the system works very well.  But for routine care "if you can afford 'Harley Street' -- you go to Harley Street.

        I'm pretty sure that the BBC-produced "Doc Martin" is not supposed to be a documentary, or a satirical look at how offhand and dismissive care under the National Health plan might be in an outlying district -- but on  the other hand, since the offhand and dismissive doctor is the protagonist -- my guess is that the slipshod treatment of routine cases isn't slanderously inaccurate in the minds of average British healthcare consumers and providers.

    •  About #2 ... (2+ / 0-)
      Recommended by:
      mrkvica, JDWolverton

      I am a behavioral scientist myself, not a physician. I work on a research campus. I am absolutely disgusted that our med school is still, in 2012, teaching doctors to disdain holistic wellness approaches and behavioral change techniques.

      That said ... with every trick in my arsenal, I cannot outright control the behavior of another human being. The ultimate decision of whether to comply with meds, alter one's diet and exercise, or stop smoking lies with the individual. And these kinds of changes are what we require to achieve wellness rather than just absence of illness or injury.

      So I do not find it justified to automatically blame doctors, and fine them, when patients don't hop right on board the wellness train. Some doctors do stress prevention, use motivational techniques, and refer for intensive intervention when warranted.  But they still cannot force compliance or guarantee outcomes.

      I am the last person in the room to throw up my hands and say "people gonna do what they wanna do."  But there does come a point at which people have to accept responsibility for their choices.

      Just because you're not a drummer doesn't mean that you don't have to keep time. -- T. Monk

      by susanala on Tue May 22, 2012 at 09:25:55 AM PDT

      [ Parent ]

  •  When you can't stand it any more (10+ / 0-)

    you might try asking some, um, 'innocent' questions.

    A great one might be: "What percentage of your office's budget is spent on clerical staff?"


    "How much of your time is spent talking with insurance companies or understanding health plan variations?"


    "What do you do when you have a patient that needs X and the insurance won't pay?" How often does that happen?


    "What do you do when a patient changes insurance in the middle of the treatment and suddenly isn't covered?"

    Don't ask them sarcastically; ask them honestly, and listen to the answers. Perhaps in followup you might prompt them if there might be a different way, or not; you have to judge. But often questions like this get people thinking... and in a way that won't label you as a troublemaker.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Mon May 21, 2012 at 09:34:52 PM PDT

    •  These classes surround these insurance and paper (4+ / 0-)
      Recommended by:
      emilymac, mrkvica, ladybug53, Dave925

      work issues, but I see your point.

      To that end, we are all focused on the variances of insurance products and clerical oriented budgeting. These classes are all about efficient paper pushing, billing and coding regulations and risk management. We are all painfully aware of just how thick the morass of bureaucratic health care paperwork BS is. That's not the problem, it's the mind set that predicates both the instructors and many of my fellow student's approach to health care. It's mind boggling. In fact if you look at my earlier posts, say from around 2006, I was one of them!

      I have to say it was dkos that jolted me out of holding onto the memes.

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Tue May 22, 2012 at 07:36:47 AM PDT

      [ Parent ]

  •  Fee for service (7+ / 0-)

    is a huge problem.  Health care providers are incentivized financially to order unnecessary proceeders and tests.  

    A patient's perception becomes "My Doctor is awesome, I've had every test to rule out every illness!  We have the best health care in the world!"

    Also, I can kill you with my brain.

    by Puffin on Mon May 21, 2012 at 10:14:00 PM PDT

  •  Great diary, (8+ / 0-)

    but it is more than just the access to healthcare, it is also still the cost even if insured and the out of pocket.  I was just reading on Huffpo about how hospitals are trying to get people to pay while still in the hospital or in the ER.  There are hundreds of comments about people being charged thousands of dollars out of pocket.  

    And there were the other comments, I've gone to school for seven to twelve years and have $250,000.00 in school debt, etc., etc.  One of the best responses I saw as a reply was you have $250,000.00 in school debt, yet your driving a 100K car, how does that work?  I keep thinking we have a one trillion dollar student loan debt and it can be all doctor's debt, so why do they think they are the only ones with debt problems.

    The healthcare system, and I worked in it for years, has so many problems from health insurance companies to the costs for doctor visits, to malpractice insurance being far too expensive (which I think doctors should protest themselves instead of whining to their patients) etc., etc.

    But, this is an economic problem in our country, period.  Most people are being crushed by the healthcare system and it is TOO EXPENSIVE!  

    I was a social worker, they have dismantled the whole mental health system, and this weekend big article talking about how family don't have access to mental health services.  Health-care is going to go the same way and as far as I'm concerned I rather die than rack up big bills.  I've already been there done that, and will never do it again.  Out of pocket costs were all of my retirement money I had saved, while being fully insured, and now they want to take SS.  This country is scary, really scary.  

    Let's stop calling it healthcare it is so passe and rename it "your money or your life for profit health fix if you can afford it center."

    "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

    by zaka1 on Mon May 21, 2012 at 11:29:51 PM PDT

  •  Everyone in health care (4+ / 0-)

    from insurance to providers are vested in the pay for service system, and that is the majority of the problem.  That 2.6 trillion dollars represents millions of jobs, and a great deal of wealth.  It's not just insurance companies, but doctors as well who have historically fought the transition to single payer.  

    The main problem is that we don't understand how the majority of us pay for health care.  Most of an insurance premium is paid for by employers which is then subsidized to an incredible amount by the tax code.  Government money is what drives health care for the majority of the American people.  I would estimate that upwards of 70% of all U.S. healthcare dollars are actually government programs or subsidies in one form or another.  But this central fact is missing from the debate.

    We're closer than we think to socialized risk/private profit.  Without that understanding, it's difficult to have a rational discussion about health care.  Once we can admit to how enmeshed government is in health care, the debate can then deal with the underlying objectivist argument: that proponents of private health care systems are nothing more than social engineers tinkering with malthusian daydreams.  "We cannot feed every mouth, therefore we must kill the weakest and the hungriest."  

    The history of the social darwinist movement is a consistent arc that matches the growth of private health care.  If we want universal health care, if we want egalitarian (rational) public health policy, we'll have to provide a transition for all those jobs, and people that are propped up in a sick system that nonetheless serves their needs even though it does not serve anyone else's.  True government based health care with the government spending and local and national jobs and budgets that ultimately means.  The good news is that our government is already spending the money.

    If we allow profit to be a motive that even breathes in the direction of health care we will always have the same underlying problem: the Stephen Hawkings of tomorrow that failed to thrive because someone, somewhere, made a decision that did not allow them to survive.  

    What a man can be, he must be. -- Abraham Maslow

    by Mr Jones on Tue May 22, 2012 at 12:28:46 AM PDT

  •  how many times can I rec this diary? (5+ / 0-)


    I wish more people would see this righteous rant!

    How interesting that you came to all this from inside your classroom taking required courses for your credentials.  How much of these courses are to update your skills, and how much is to make sure that you are up-to-date on the latest "memes" as you put it.  Make sure your indoctrination is up-to-date?  

    Very well done.

    •  Have you thought about how much (4+ / 0-)
      Recommended by:
      JDWolverton, mrkvica, ladybug53, Dave925

      the current reality benefits insurance companies?  It seems more and more, the issue is not just "the one percent" (the richest of the rich), but more especially the insurance companies.  What role do the various kinds of insurance companies play in pushing for policies that create and sustain the security state we are living under.  I think there are lots of avenues true investigative reporters could explore.  Have you considered writing an op-ed for the New York Times--you seem to have an important angle on this.

  •  I'm one of those people you don't see. (5+ / 0-)

    I even have insurance.  Also two jobs, because it takes two to earn a subsistence wage.  I am alone - no family, community or friends who could or would help if I couldn't work around the clock.  No savings either - don't make enough. (Did I mention I finished an undergraduate program with honors. Yeah. Big deal.) The moment I stop being able to work two jobs I lose everything - apartment, car, dog.  I'm actually even looking for a third job, because it is hard to get by on what I make from just two.

    I have scary lumps in all sorts of spooky places.  Been there for a while and growing. I figure I've got cancer and have had it for a while.

    Sometime soon I will find time to start going to a shooting range so someone knowledgeable can show me the proper use of the revolver I have that used to belong to my dad.  

    Then I will go online and find out where to shoot myself so that it really kills me instead of just maiming me.  I read that women try suicide more often than men, but often fail because we are less knowledgeable about such things.  Fortunately I can probably use the internet to work around that problem.

    So, I get to live, laugh and love until ... well until the cancer decides I can't.  Then I get the dog adopted, have the cat put down, burn my journals, donate my good books to a good bookstore - and then take myself out.  Hopefully with as little fuss and bother for others as possible.

    Thanks for noticing that people like me are out here.

    It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

    by treesrock on Tue May 22, 2012 at 07:53:50 AM PDT

    •  {{treerock}} (5+ / 0-)

      this post makes me cry.  You sound so alone.  We should all have a village to fall back on.  What part of the country do you live in?  

      •  Atlanta (0+ / 0-)

        It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

        by treesrock on Wed May 23, 2012 at 04:25:08 AM PDT

        [ Parent ]

        •  Is there a local (0+ / 0-)

          Atlanta Kos meetup group ??    If so please consider joining so you have an active support group.  

          I live in DC area.  

          •  I went (2+ / 0-)
            Recommended by:
            JDWolverton, ScienceMom

            and felt unwelcome.  I'm an older, single female.  Somehow that didn't quite click.  

            The local bookseller who sponsored the last visit from Kos told me earlier this month that "Nobody cares what you think. Nobody cares what you say."

            Especially in the South, true middle class people who have property and good jobs as professionals and managers - are consistently, politely and firmly indifferent to the working poor.  

            It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

            by treesrock on Wed May 23, 2012 at 06:45:58 AM PDT

            [ Parent ]

            •  I am sorry (0+ / 0-)

              you had a bad experience.  It is terrible that anyone would be indifferent to the working poor.  I wish you could find and cobble together a collection of people to make your own support/family.  

              My family sucks, they are a bunch of authoritarian uber conservative republicans.  That said...I could always rely on them for support.  

    •  oh my (4+ / 0-)

      I can't form words to respond to this.  Please--share some details.  There are people who care, there are ways to get the medical attention you need.  

      There is no snooze button on a cat who wants breakfast.

      by puzzled on Tue May 22, 2012 at 12:20:07 PM PDT

      [ Parent ]

      •  If you look at the big picture, I'm lucky. (1+ / 0-)
        Recommended by:

        I've lived a long and happy life.  I am already decades older than some poor impoverished soul in Asia or South America.  Friends who travel in Mexico tell me that in rural areas there children die of measles because there are no antibiotics or medical care of any sort available to them.  My own grandmother married at sixteen, had two children that survived and three that died before they were born.  Then she died in her late 50s because the sweat shop she had to work in destroyed her lungs.

        If you take the large view, I've no reason to complain.

        It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

        by treesrock on Wed May 23, 2012 at 04:30:09 AM PDT

        [ Parent ]

    •  You are not alone. (1+ / 0-)
      Recommended by:

      I have met and talked with many who tell similar stories.

      What I want you to know is that most health care systems make some arrangements for life or death treatment.  At worst, at the end of treatment, and after your insurance has paid what it will, you could declare bankruptcy on the rest.  Or sometimes health providers will write it off when they see your income situation.  Or develop a $25/mo repayment plan.  Or allow them to place a judgement against you.  They cannot get blood out of a turnip, ya know?  

      And if the situation is so serious that you are not able to work, you would likely be eligible for disability - which would open up a replacement source of income as well as apartments with subsidies for disabled or low income folks...

      You have obviously put much thought and effort into planning this, and I hope you will put equal thought and effort into carefully considering options for life.  The world needs your voice.


      "I like paying taxes. With them I buy civilization." - United States Supreme Court Associate Justice Oliver Wendell Holmes (Republican) -8.12, -5.18

      by ncarolinagirl on Tue May 22, 2012 at 02:20:21 PM PDT

      [ Parent ]

      •  Good ideas. (1+ / 0-)
        Recommended by:

        It wouldn't hurt to call a couple of local hospitals and ask about the sort of things you suggest.

        Even the best of those outcomes would probably involve losing the dog, but I guess if it's the dog or my life, it might be necessary.

        It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

        by treesrock on Wed May 23, 2012 at 04:43:52 AM PDT

        [ Parent ]

        •  There are many (1+ / 0-)
          Recommended by:

          dog rescue groups that will help you find a temporary foster home for you dog if you are sick.  Please call around.  We fostered a dog once for six months until the owner was able to car for him again.  

          I am sure there are Atlanta Kossaks who would foster if you put the word out.  

          •  good point (2+ / 0-)
            Recommended by:
            ncarolinagirl, ScienceMom

            I actually even know people that might be perfect.

            Time to make a visit to those folks a priority.

            It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

            by treesrock on Wed May 23, 2012 at 06:47:41 AM PDT

            [ Parent ]

    •  treesrock, please see if the American (0+ / 0-)

      Cancer Society can set you up for some screening. I know komen is a dirty word these days, but they also have screening affiliates as does Planned Parenthood. Also, you might try your local health department too.

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Tue May 22, 2012 at 04:45:28 PM PDT

      [ Parent ]

      •  I have insurance (2+ / 0-)
        Recommended by:
        ScienceMom, JDWolverton

        so I could afford screening later this year probably.

        I keep hesitating to actually get a diagnosis because then I have a pre-existing condition.  I know they can't deny me insurance for that anymore, but they can still jack the price of it through the roof, which amounts to denial for a poor person.

        It is the highest impertinence ... in kings and ministers, to pretend to watch over the economy of private people, ... They are themselves always, and without any exception, the greatest spendthrifts in the society. - Adam Smith

        by treesrock on Wed May 23, 2012 at 04:50:30 AM PDT

        [ Parent ]

  •  just yesterday I met a casualty of the system (6+ / 0-)

    I walked into the living room/waiting room of a hands-on faith healer, having just had an appointment with her. I am very scientific minded, but I see this woman in addition to traditional doctors because she is actually very healing and soothing.
    A middle-aged woman and her daughter were waiting there. The woman, who I will call Laura, had noticed a lump in her breast some months ago, but she was uninsured and almost homeless, and just wanted to get her daughter through college.
    This previous weekend she drove up from Florida to Virginia to attend her daughter's college graduation. She was in a lot of pain and kept having to pull over. Part way here, her arm started swelling. When she arrived she went immediately to Sibley Memorial Hospital who diagnosed her with breast cancer with extensive metastases. They are treating her as a charity case and wanted to start chemo immediately. They did let her delay one day to go to her daughter's graduation first.
    So instead of being excited about her daughter's new life, mother and daughter were in tears in a waiting room of a psychic surgeon in a last-ditch effort to save her life.
    If Laura had felt free to get her lump checked out, if our society didn't have the attitude that preventive care is for rich people, what would the outcome have been? Where would Laura and her daughter have been yesterday? Celebrating perhaps? We will never know. What an indictment of our system.  

    To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

    by kareylou on Tue May 22, 2012 at 11:40:39 AM PDT

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