Response to Cele's Talk Thursday: I Mind

http://ohjoyitsme.blogspot.com/2011/01/talk-thursday-i-mind-i-dont-mind-yes-i.html

I started to post a comment to this on her bog, but it became ridiculously long so I just decided to put my comments here.

I hesitate to stand behind anyone's healthcare bill. The big picture is GIGANTIC, and to attempt to fix it a little at a time will result in failure. They really have to start at the bottom and create a completely different system.


First, sorry Jen... the lawyers won't like this.. First we have to cap malpractice. Malpractice insurance is outrageously expensive and people are getting rich for very stupid reasons. If I go to McDonald's and ask for no mustard, but get mustard.. I don't really have a lawsuit. Don't get me wrong, if I'm allergic, I might... But not just because the sight and smell of mustard horrifically offends me.

Next, we need to give physicians the freedom to say NO. In the emergency room we see patients who come in (even by ambulance) for the most ridiculous things; toothaches, blisters, migraines, ingrown toenails. The physician HAS to see them. Once he sees them, he can technically say "You don't have a medical emergency, I'm releasing you," but, if the patient has any sort of medical emergency in the next week or so, he's setting himself up for a lawsuit. If the patient says they have pain, we have to treat them for pain. I've seen people completely snowed on painkillers wake from their stupor claiming 10 out of 10 pain. We have to give doctors the freedom to say no. For that matter, we need to give paramedics that freedom as well. If a patient says I want to go to the hospital, they have to load them up and give them the ride. Sometimes they walk from the ambulance into the ER. Sometimes they flat out tell the medics "Thank you for the ride" and leave the ER all together.

Because physicians can't say no, we have terms like fibromyalgia and abdominal migraines, both of which can't be medically proven or disproven and are born from a need to label the patient's "condition". We have 20 year old pain med junkies who suffer from "chronic back pain". ER's are besieged by pain control contracted patients who take enough meds to put a horse into a coma. The medical community, and the authorities that govern them, have created a society that refuses to feel even the slightest discomfort of pain.


Next, something HAS to be done about the pharmaceutical companies. They budget more of their money for advertising their product than producing or researching those products. There's something incredibly wrong with that. What happened to physician's prescribing meds, now I have network television telling me what meds I need to ask my doctor for. In the medical industry, we call that "med seeking behavior", and you're not going to get what you ask for. Don't get me wrong, you'll get something.. just not whatever it is you're asking for.

Next, reduce medical waste. This might not actually save money, but find a way to make it so. Why is it less expensive to throw away hemostats after one use than it is to sterilize them and reuse? We "throw them away" which means that nurses gather them and donate them to Doctors Without Borders because they're greatly valued in places like Sudan, Belize, and Nepal. Yay for them, but why is it not good enough for us?

Also, in that line of thought, medical supplies need to be reasonably priced. Suppliers and medical facilities shouldn't be allowed to jack up the prices, which just results in jacked up medical bills. And... if the government can cap what Medicare and Medicaid patients can be billed, why not make it uniform and say "this" is what is reasonable to pay for this procedure, "this" is all you're allowed to charge ANYONE! It's insane to charge an out-or-pocket patient 3 or 4 times what is paid for an insured patient. Where's the reality in that?  We had a trauma patient who had extensive surgery and a long stay in the hospital, her total bill was something like $60,000... she was double covered.. one of those insurances being Medicare. The combined total reimbursement for her care was less than $15,000.  In Oregon, if you have a baby on Medicaid, the total bill is around $10,000 (which the patient never sees because it is illegal to send them a bill or explanation of benefits) Medicaid pays out roughly 10%, so the hospital only sees about $1000 of that and is barred from attempting to collect further from the patient. At the facility I work at, I would say that atleast 50% of our patients are Medicare or Medicaid insured. (I know that people claim that as Medicare or Medicaid they don't receive the same care as other patients, but our facility strives to make that impossible. EMTALA law states that you can not base the kind of care or speed of care on a patients ability to pay or method of payment. To protect ourselves from people who might claim we treated them with prejudice, we don't get people's billing information until the end of their visit.)

Lastly, while the concept of centralized medicine of some sort sounds fabulous, we have to fund the program. We fund everything from taxes. Right now, our unemployment rate is astronomical. Very few people have taxes taken out of their unemployment. So how do we fund a program with no funds? I have seen the result of this during my stay in Canada. At the time that I was there, their unemployment rate was fairly high. The biggest problem I saw was that doctors can't earn the kind of income that they can in the States, so they leave Canada and go to the US. They had a lack of specialized physicians, specialized diagnostics, and specialized procedure. I saw people assigned to ER's as their primary physician. They have to send some patients out of country for specialized treatments.
 
I don't see an easy answer. I don't see a feasible difficult answer. Free market has kind of kicked our asses here, but do we solve it by giving government total and complete control of the health care market? That seems the only way to regulated it from the ground up, but American's are a bit anti-Communism...