Interesting review of Sicko

[Dr JPH]

---

Members do not see this ad.

Your view of the world is shockingly black and white, and somewhat cold and indifferent to some degree. Both my wife and I have Masters level education, she is working on her doctorate and I will be returning to medical school...so were aren't slouches. However, despite our education and income, money is an issue and I can understand/empathize with those who don't have the opportunities that we were fortunate enough to have received (life is hard). Things happen, and people who have a finite income have to make choices every month. Health Ins v. food may be one of those choices, and what percentage of the people you lament (the uneducated, pregnant, abusers of the system) actually account for the money spent in the system? I'd be interested in knowing your background to shed some light on where you're coming from.

What would you like to know ?

 

[the1doc]

Having lived in a country with socialized medicine for 4 years - a country that WHO ranks above the US - I can tell you that socialized medicine is NOT the answer. You think the number of people who "slip through the cracks" is bad here in the US? Go spend a couple of years in a country with one of these ridiculously "ideal" systems of providing health care. People waiting two months to see their primary care doc...and when they are finally seen the quality of care they receive is often so poor that they receive the wrong treatment.

I shadowed several physicians while living in this socialized bliss. One of them made the comment to me, while rushing to get through ONE HUNDRED patients for the day, "I just hope to get 50% of my diagnoses right." Wow...talk about setting the standards high. The country is recruiting docs from overseas...continually lowering their standards for medical education. But they don't have a choice. The country gutted the health care system when they took the incentive out of becoming a doc. Patients end up paying just as much, albeit in the form of taxes, and their money feeds the bureaucracy. In THEORY the bureaucracy wasn't supposed to take so much away from the system...but that is ALWAYS the theory with socialized programs...a theory that is rarely realized.

 

[hilseb]

I dont understand how there can be such a call for socialized medicine in this country. I fully support trying to make changes to provide healthcare to more citizens even if its costs us more in taxes. However, the two programs we have right now that are closest to socialized medicine are the military and medicare/medicaid. I really dont know anyone who would possibly say that that is the type of care they would like to receive. It justs completely implausible to me that socialized medicine in America would be anything less than a complete disaster.

Look OUTSIDE of our country. Every Westernized country that has socialized medicine has a medical system that is rated higher than ours and costs less money (including taxes) per capita. Check out Japan and England. As for the anecdotal story about the overworked doctors there, I hear about people dying in emergency room waiting rooms here. Every system has its drawbacks. At least the patients were being seen.

As for doctors making less income in those countries, (mentioned much earlier in the thread) I wonder how much student loan debt they have? I would trade my student loan debt, out of pocket insurance expenses and child care expenses for a good socialized medical system any day.

As for JP H., how do you put someone on ignore? I try to stay away from these threads when you are polluting them, but other people want to have a conversation sometimes. I hate it when people take aim at the poorest and weakest of our country and begrudge them the pennies they get out of our barely existent social net. I am so sorry the single working mothers seem to be squeezing a whole 2 cents out of your taxes for basic health coverage for their kids. We spend more on tax breaks for the rich and non compete contracts for Halliburton.

 

[Animus]

Look OUTSIDE of our country. Every Westernized country that has socialized medicine has a medical system that is rated higher than ours and costs less money (including taxes) per capita. Check out Japan and England. As for the anecdotal story about the overworked doctors there, I hear about people dying in emergency room waiting rooms here. Every system has its drawbacks. At least the patients were being seen.

As for doctors making less income in those countries, (mentioned much earlier in the thread) I wonder how much student loan debt they have? I would trade my student loan debt, out of pocket insurance expenses and child care expenses for a good socialized medical system any day.

As for JP H., how do you put someone on ignore? I try to stay away from these threads when you are polluting them, but other people want to have a conversation sometimes. I hate it when people take aim at the poorest and weakest of our country and begrudge them the pennies they get out of our barely existent social net. I am so sorry the single working mothers seem to be squeezing a whole 2 cents out of your taxes for basic health coverage for their kids. We spend more on tax breaks for the rich and non compete contracts for Halliburton.

Lol I would love to see the numbers on the cost of socialized medicine vs our country. And not the cost per patient numbers because those do not reflect how much they actually cost people. Then what is included in cost? Is pharm money included? How about the fact that we do the R&D for the entire world because of the money we put into pharm? I mean sure socialized medicine is a nice system because everyone is included and gets care but at the cost of FAR less R&D I would say no thank you.

Hmm dont think JP is talking about the hard working single mom's, he is probably talking about the poor ones feeding off this country through social programs and costing us money we could put elsewhere.

 

[JonnyG]

Lol I would love to see the numbers on the cost of socialized medicine vs our country. And not the cost per patient numbers because those do not reflect how much they actually cost people. Then what is included in cost? Is pharm money included? How about the fact that we do the R&D for the entire world because of the money we put into pharm? I mean sure socialized medicine is a nice system because everyone is included and gets care but at the cost of FAR less R&D I would say no thank you.

Hmm dont think JP is talking about the hard working single mom's, he is probably talking about the poor ones feeding off this country through social programs and costing us money we could put elsewhere.

I would also like to see the stats on the amount of money spent in the last month of life. If i recall we spend and insane amount of money in that last month compared ot other countries. Why because we don't give up and fight to the end. Other cultures its perfectly acceptable to say i have had a good run. Socialized medicine is a pipe dream that could never work on the schale that it would need to in the US.

 

[Sartre79]

So if the current US is broken....and Socialized medicine in not the answer....What is the solution? Instead of focusing on the negative, what can we do or where can we steer the system? We will all be knee-deep sooner or later as physicians, so what can we do?

 

[JayneCobb]

So if the current US is broken....and Socialized medicine in not the answer....What is the solution? Instead of focusing on the negative, what can we do or where can we steer the system? We will all be knee-deep sooner or later as physicians, so what can we do?

The first thing I'd say is to help promote an atmosphere of fiscal responsibility in the hospital. I've seen and am sick of the mentality "oh i don't get paid for managing every thing wrong with the pt, so I'll give the subspecalists a slice of the pie." There is no reason a good doctor needs to consult surgery for every abd pain, cardio for everyone with heard problems, or nephro for every elevated BUN, (or my personal pet peeve of the month) ID for "leuckocytosis"

 

[Dr JPH]

There is no reason a good doctor needs to consult surgery for every abd pain, cardio for everyone with heard problems, or nephro for every elevated BUN, (or my personal pet peeve of the month) ID for "leuckocytosis"

Sure there is. Why? Because a lawyer would expect that you do so.

And Animus is correct. Im not saying that the hardworking, socially responsible people of our society dont deserve healthcare. Come to Philadelphia and see what patient population you encounter, but more importantly what their attitude towards healthcare and medical services is like. Its not the same as in Kirksville.

In Philadelphia you can spend $10,000 working up a patient and then get sued because the patient doesnt feel you did a good job.

Dont try to tell me that my views are skewed or wrong, Im relaying information from scenarios that I have seen over the last 3 years.

Its nice to sit back and dream and hope that things arent this way, but that would be foolish.

When you get out into the real world and start seeing patients rather than just reading Netter then you may see what Im talking about. Come to Philly. I have a few clinics I think you should work in.

You can ignore me if you wish, but Im not saying anything but the honest truth based on what I have encountered.

Im sorry the truth makes you sad.

 

[group_theory]

Sure there is. Why? Because a lawyer would expect that you do so.

And Animus is correct. Im not saying that the hardworking, socially responsible people of our society dont deserve healthcare. Come to Philadelphia and see what patient population you encounter, but more importantly what their attitude towards healthcare and medical services is like. Its not the same as in Kirksville.

In Philadelphia you can spend $10,000 working up a patient and then get sued because the patient doesnt feel you did a good job.

Dont try to tell me that my views are skewed or wrong, Im relaying information from scenarios that I have seen over the last 3 years.

Its nice to sit back and dream and hope that things arent this way, but that would be foolish.

When you get out into the real world and start seeing patients rather than just reading Netter then you may see what Im talking about. Come to Philly. I have a few clinics I think you should work in.

You can ignore me if you wish, but Im not saying anything but the honest truth based on what I have encountered.

Im sorry the truth makes you sad.

The public has a "perception" of what an ideal doctor should be, should act, should behave. A pre-med has a little better understanding of the outside forces involved, but still has an idealistic view of medicine. A pre-clinical med student is still fasinated by medicine, has lost some of the idealism of medicine but is still eager, still willing, and still ready to make his or her mark on the world of medicine.

A new 3rd year is scared ****less and just wants to not piss off anyone, not accidentally pull the plug on someone, and worries about the proper way to write a H&P, pre-op note, post-op note, progress note, discharge instructions, and oral presentation to the attending ... to worry about idealism.

Somewhere along the line, being exposed to "society" strips away the idealism ... maybe somewhere between the 3am pages for tylenol, the 5am ER visit for "my kid had a nose bleed for 5 minutes", the ER drive-through for narcs, missing out on weekends/holidays/family events while at the same time you see your attendings deal with insurance companies denying payment, a patient in the hallway wanting to sue because he is not getting his oxycontin, and getting served a lawsuit from a lawyer representing a former patient who did not get a colonoscopy that the attending recommended and now has colon cancer and is going through the "blame" stage of grief and wants to blame his PCP for not forcing him to go get a colonoscopy (anyone can sue ... they might not win, but anyone can file a suit ... and you still have to talk to your malpractice carrier, get a defense lawyer, turn over copies of records, go to deposition ... and sleepless nights and worries later, win BUT end up with higher insurance premiums cuz lawyers are not cheap)

It gets to you after a while ... and hence the reason why you see attendings so cynical (telling premeds to get out of medicine), while premeds and med students are idealistic.

I doubt there is any skeletons (beside the bones of AT Still) in JP's closet ... he probably wasn't dropped as a child, abandoned as a child, teased as a kid, outcasted as a teenager, the target of an attending's pimping session, etc. It is probably due to repeated exposure to a certain subset of patient. But that's my $0.02 (not inflation adjusted, dependant on proper ICD-9 code and proper supporting documentation, subject to CMS audit, dictation number 2451232).

 

[Dr JPH]

The public has a "perception" of what an ideal doctor should be, should act, should behave. A pre-med has a little better understanding of the outside forces involved, but still has an idealistic view of medicine. A pre-clinical med student is still fasinated by medicine, has lost some of the idealism of medicine but is still eager, still willing, and still ready to make his or her mark on the world of medicine.

A new 3rd year is scared ****less and just wants to not piss off anyone, not accidentally pull the plug on someone, and worries about the proper way to write a H&P, pre-op note, post-op note, progress note, discharge instructions, and oral presentation to the attending ... to worry about idealism.

Somewhere along the line, being exposed to "society" strips away the idealism ... maybe somewhere between the 3am pages for tylenol, the 5am ER visit for "my kid had a nose bleed for 5 minutes", the ER drive-through for narcs, missing out on weekends/holidays/family events while at the same time you see your attendings deal with insurance companies denying payment, a patient in the hallway wanting to sue because he is not getting his oxycontin, and getting served a lawsuit from a lawyer representing a former patient who did not get a colonoscopy that the attending recommended and now has colon cancer and is going through the "blame" stage of grief and wants to blame his PCP for not forcing him to go get a colonoscopy (anyone can sue ... they might not win, but anyone can file a suit ... and you still have to talk to your malpractice carrier, get a defense lawyer, turn over copies of records, go to deposition ... and sleepless nights and worries later, win BUT end up with higher insurance premiums cuz lawyers are not cheap)

It gets to you after a while ... and hence the reason why you see attendings so cynical (telling premeds to get out of medicine), while premeds and med students are idealistic.

I doubt there is any skeletons (beside the bones of AT Still) in JP's closet ... he probably wasn't dropped as a child, abandoned as a child, teased as a kid, outcasted as a teenager, the target of an attending's pimping session, etc. It is probably due to repeated exposure to a certain subset of patient. But that's my $0.02 (not inflation adjusted, dependant on proper ICD-9 code and proper supporting documentation, subject to CMS audit, dictation number 2451232).

👍

You have seen the light as well.

Things arent as bright as they seemed first year of medical school.

 

[Sartre79]

So we've pointed out everything that currently sucks about the system and how disgruntled we soon will be. Nice bitch session. Now what?

I wasn't alluding to some horrible incident that may have happened to or shaped JP, but someone who grew up in certain segments of society probably views things differently. For instance, my cousins have silver spoons in their mouths, and I've been working since I was in 8th grade. We see things differently.

 

[Animus]

So we've pointed out everything that currently sucks about the system and how disgruntled we soon will be. Nice bitch session. Now what?

I wasn't alluding to some horrible incident that may have happened to or shaped JP, but someone who grew up in certain segments of society probably views things differently. For instance, my cousins have silver spoons in their mouths, and I've been working since I was in 8th grade. We see things differently.

I agree with you, anyone can point out the negative parts of anything and claim themselves a genius (cough Michael Moore). The true geniuses of society though come up with answers and solutions. If I were further into healthcare I would try and provide some answers unfortunately I am just begining this journey and do not have the info to help much.

Some things I have read about and have even been said in this thread is the way the insurance companies and drug companies spend money. Just like any big business they spend mass amounts of unnecessary money on perks, advertising, and limiting their customers availability to lesser pricing.

I was watching the Rep. Debate and I think it was Ron Paul who said he would open insurance across state borders. Currently insurance companies cannot sell insurance across state lines meaning in certain states they jack up the prices. It seemed like a good idea so they would all have to lower their prices to meet some sort of nation wide standard.

 

[Doc2007]

Let's say that hospitals across America started providing health insurance. Our population size is 300 million and lets say that average cost for insurance per person is $100 per month. If everyone started purchasing insurance through hospital, hospitals across America will get around $30 billion dollars per month. That is $360 billion dollars per year. Isn't that lot of money to cover health care cost across America?

 

[EM2BE]

I haven't read this whole thread, but I would like to say that health insurance can save patients. My sister has had 4 surgeries involving her brain. Over time, we still won't pay as much on her health insurance as the total cost of all the surgeries. In this case, the insurance company lost big time. Just a thought to consider: with some people, they will earn money, and with others they lose. Granted they still end up profiting plenty, but it worked in our case. If we had socialized medicine, I don't know if she would have gotten the surgeries. Just my 2 cents.

 

[group_theory]

Let's say that hospitals across America started providing health insurance. Our population size is 300 million and lets say that average cost for insurance per person is $100 per month. If everyone started purchasing insurance through hospital, hospitals across America will get around $30 billion dollars per month. That is $360 billion dollars per year. Isn't that lot of money to cover health care cost across America?

In 2005, health care spending in the United States reached $2 trillion, and is projected to reach $2.9 trillion in 2009. Health care spending is projected to reach $4 trillion by 2015. Good idea, but you are short roughly $2000 billion ($2 trillion).

If you want to make up the shortfall, you will have to increase the monthly fee to $555.56 per person per month to BREAK EVEN at 2005 spending level (assuming population of 300 million and everyone pays an equal share monthly)



Sources:

National Coalition on Health Care - http://www.nchc.org/facts/cost.shtml

Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005." Health Affairs 26:1 (2006): 142-153.

Borger, C., et al., "Health Spending Projections Through 2015: Changes on the Horizon," Health Affairs Web Exclusive W61: 22 February 2006.

 

[pguin]

In 2005, health care spending in the United States reached $2 trillion, and is projected to reach $2.9 trillion in 2009. Health care spending is projected to reach $4 trillion by 2015. Good idea, but you are short roughly $2000 billion ($2 trillion).

If you want to make up the shortfall, you will have to increase the monthly fee to $555.56 per person per month to BREAK EVEN at 2005 spending level (assuming population of 300 million and everyone pays an equal share monthly)



Sources:

National Coalition on Health Care - http://www.nchc.org/facts/cost.shtml

Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005." Health Affairs 26:1 (2006): 142-153.

Borger, C., et al., "Health Spending Projections Through 2015: Changes on the Horizon," Health Affairs Web Exclusive W61: 22 February 2006.

I've been having a lot of trouble trying to find any figures on the estimated tax raise to cover health costs. If anyone has any sites where this is talked about plz post them.

However, I've tried a very very very unscientific measurement by using the previous statement that we spend 2 trillion dollars on healthcare and another previous statement that the governement already currently covers 50% of all healthcare costs. This would mean that the government would have to pick up an extra 1 trillion dollars to cover the costs. With 300 million people in the US that comes out to 3,333 per person just to receive the same coverage as we are currently getting, and this doesnt include the extra costs for people who arent currently covered by insurance. This seems like a lot of money especially since my current insurance is only about 2,000 per year.

Obviously this is a very rough estimate with very little reason behind it...but its better than anything ive been able to find

 

[group_theory]

I've been having a lot of trouble trying to find any figures on the estimated tax raise to cover health costs. If anyone has any sites where this is talked about plz post them.

However, I've tried a very very very unscientific measurement by using the previous statement that we spend 2 trillion dollars on healthcare and another previous statement that the governement already currently covers 50% of all healthcare costs. This would mean that the government would have to pick up an extra 1 trillion dollars to cover the costs. With 300 million people in the US that comes out to 3,333 per person just to receive the same coverage as we are currently getting, and this doesnt include the extra costs for people who arent currently covered by insurance. This seems like a lot of money especially since my current insurance is only about 2,000 per year.

Obviously this is a very rough estimate with very little reason behind it...but its better than anything ive been able to find

Instead of using exact figures, you can go by GDP. The 2005 figures represent roughly 16% of the country's GDP, with projection of it going up to 20% of the GDP in the next 10 years.

You also have to factor in the spending habits and mentality of the american public. At current rate, the public want MORE, not less healthcare services.

Also, if you remove the "cost" of healthcare away from those utilizing healthcare, there is no incentives to "save" money or consequences (on an indivudal level) of excessive or unwarranted spending.

Countries such as Canada, England, France, Germany, etc. are facing this situation ... where increasing healthcare expenditure is forcing the government (the payor) to find ways to restrict growth and curtail spending.

 

[Sartre79]

Instead of using exact figures, you can go by GDP. The 2005 figures represent roughly 16% of the country's GDP, with projection of it going up to 20% of the GDP in the next 10 years.

You also have to factor in the spending habits and mentality of the american public. At current rate, the public want MORE, not less healthcare services.

Also, if you remove the "cost" of healthcare away from those utilizing healthcare, there is no incentives to "save" money or consequences (on an indivudal level) of excessive or unwarranted spending.

Countries such as Canada, England, France, Germany, etc. are facing this situation ... where increasing healthcare expenditure is forcing the government (the payor) to find ways to restrict growth and curtail spending.

Do you find these trends to be problematic? In other words, should we be concerned that 1/5 of GDP is for healthcare?

You seem to have a very good bead on the industry as a whole, where do you see it heading? Do we need reform? If so, how?

 

[SexPistol]

Would you like an easy solution to the cost of health care as a whole. Do something with ventilated patients in nursing homes. these patients come in with more decubiti than you can count and their sacral decubitus is larger than my head. how is this living? and i dont have any real numbers but i bet you these patients cost over 500,000 a year to "live" if that is what you want to call it. and we all pay for this because most of these cases have of used up all of their private insurance years ago

 

[Sartre79]

Would you like an easy solution to the cost of health care as a whole. Do something with ventilated patients in nursing homes. these patients come in with more decubiti than you can count and their sacral decubitus is larger than my head. how is this living? and i dont have any real numbers but i bet you these patients cost over 500,000 a year to "live" if that is what you want to call it. and we all pay for this because most of these cases have of used up all of their private insurance years ago

Pretty sure this wouldn't fly in the public eye. You would have to get past the "right to life" people and then there's that whole "do no harm" oathe. I appreciate what you are getting at though. Quality v. Quantity of life.

 

[Lshapley]

👍

You have seen the light as well.

Things arent as bright as they seemed first year of medical school.

Not to mention the Philly is the #1 most litigious patient population according to a recent cnn/time article on emergency room care. That might affect JPH's views a wee bit.

 

[Kappy1]

I mentioned this suggestion on the second page of the thread and no one really discussed it. Would it be possible to have some sort of base line coverage to the general public. What that base line should be would be up for debate. Feel free to discuss. Any coverage after that point would require HMO or the system that we have currently in place. I think that would solve the issue of people being turned away from a hospital initially and everyone would receive some sort of care. Just an idea. What do you guys think?

 

[Sartre79]

I mentioned this suggestion on the second page of the thread and no one really discussed it. Would it be possible to have some sort of base line coverage to the general public. What that base line should be would be up for debate. Feel free to discuss. Any coverage after that point would require HMO or the system that we have currently in place. I think that would solve the issue of people being turned away from a hospital initially and everyone would receive some sort of care. Just an idea. What do you guys think?

A physician I shadowed mentioned changing medical education, so that physician's are prequired to work one year after residency training for free clinics at a substanially reduced salary (govt funded) as opposed to if they went into private practice. A physician could have the option of buying their way out if they wanted to go straight into private practice, etc.. This way at least we could offer baseline health care (albeit inexperienced) to those without insurance while gaining more experience in our fields before heading out into the real world. Kind of a two-tiered variation.

 

[pguin]

I mentioned this suggestion on the second page of the thread and no one really discussed it. Would it be possible to have some sort of base line coverage to the general public. What that base line should be would be up for debate. Feel free to discuss. Any coverage after that point would require HMO or the system that we have currently in place. I think that would solve the issue of people being turned away from a hospital initially and everyone would receive some sort of care. Just an idea. What do you guys think?

Then comes the problem of defining what baseline coverage is. If you're talking about access to primary care that may help some people but the majority of people who see a primary care provider that have a potentially fatal disease need to be referred to specialists and have costly procedures to be able to help them. If you spend the money to diagnose someone but then tell them they cant afford the treatment it does no good to have diagnosed them in the first place. Additionally, all hospitals in the US now provide emergency care no matter what the financial situation is. Also baseline coverage would still have the problem of overcrowding the already low supply of primary care physicians with many trivial conditions that would usually not warrant medical treatment.

I like the idea overall but there are just so many potential problems with the system that would all need to be worked out.

 

[Sartre79]

Then comes the problem of defining what baseline coverage is. If you're talking about access to primary care that may help some people but the majority of people who see a primary care provider that have a potentially fatal disease need to be referred to specialists and have costly procedures to be able to help them. If you spend the money to diagnose someone but then tell them they cant afford the treatment it does no good to have diagnosed them in the first place. Additionally, all hospitals in the US now provide emergency care no matter what the financial situation is. Also baseline coverage would still have the problem of overcrowding the already low supply of primary care physicians with many trivial conditions that would usually not warrant medical treatment.

I like the idea overall but there are just so many potential problems with the system that would all need to be worked out.

Actually, I mistyped and didn't mean to misrepresent her idea. It would be full service, since all specialties coming out of their residency would participate to gain increased exposure.

Another thing to point out is that no system would be perfect/run without flaw. But if something could be developed that would achieve the main objectives...why not?

 

[JonnyG]

People shouldnt have insurance for basic things. You should have insurance for catastrophic things like cancer or a car accident. Things would be better if you just paid cash to your PCP and not force them to hire staff to fill out endless forms because you had a cold or needed your blood pressure checked.

 

[Dr JPH]

We already have a system for basic emergency coverage, its called the ER.

There are free clinics in all major cities but patients dont utilize the services.

There are shelters, outreach programs, free healthcheck days, traveling RVs staffed with doctors and nurses, discount prescription programs and free education courses.

I remember trying to recruit patients in one clinic to come to a FREE diabetes education seminar. There was going to be information about diabetes, prevention, diet and cooking, medication usage and other things. We were going to give everyone who attended free vouchers for a certain medication (who was sponsoring the program). I even went so far as to arrange for free food.

I got 3 people to show up, 2 ate and left and only one person stayed the entire time.

You cant tell me people arent reaching out to the poor people in our communities.

But the same people that want things now, their way and if they dont get it they will sue you are the SAME people who dont take advantage of what is available.

As I said above...do some time in an inner city clinic. Work in an inner city ER. You tell me after a few weeks what sort of patients are coming to see you and how many of them are 'emergencies'.

ERs are dumping grounds for nursing homes and uncaring families and they have become the free PCP for almost all of low income america.

And they dont even have to tspend money on a bus to get there. They can just call 9-1-1

 

[Sartre79]

We already have a system for basic emergency coverage, its called the ER.

There are free clinics in all major cities but patients dont utilize the services.

There are shelters, outreach programs, free healthcheck days, traveling RVs staffed with doctors and nurses, discount prescription programs and free education courses.

I remember trying to recruit patients in one clinic to come to a FREE diabetes education seminar. There was going to be information about diabetes, prevention, diet and cooking, medication usage and other things. We were going to give everyone who attended free vouchers for a certain medication (who was sponsoring the program). I even went so far as to arrange for free food.

I got 3 people to show up, 2 ate and left and only one person stayed the entire time.

You cant tell me people arent reaching out to the poor people in our communities.

But the same people that want things now, their way and if they dont get it they will sue you are the SAME people who dont take advantage of what is available.

As I said above...do some time in an inner city clinic. Work in an inner city ER. You tell me after a few weeks what sort of patients are coming to see you and how many of them are 'emergencies'.

ERs are dumping grounds for nursing homes and uncaring families and they have become the free PCP for almost all of low income america.

And they dont even have to tspend money on a bus to get there. They can just call 9-1-1

It would be more like and extra year of residency, and would probably treat more than just the scourge of the earth that you lament.

 

[sexyman]

JP for President!

 

[Dr JPH]

It would be more like and extra year of residency, and would probably treat more than just the scourge of the earth that you lament.

When youre ready to see the medical world as it truly is then I will be able to have a conversation with you.

Until then keep thining about puppy dogs and ice cream. 👍

 

[SexPistol]

And they dont even have to tspend money on a bus to get there. They can just call 9-1-1
You are so right about that. 911 is like a free taxi if you have medicare, and if you dont pay any bills who cares how much the ambulance rides cost. Also if you call 911 you dont have to wait in the waiting room, you get a bed right away why wouldnt you call it if you vomitted twice in an hour

 

[Sartre79]

When youre ready to see the medical world as it truly is then I will be able to have a conversation with you.

Until then keep thining about puppy dogs and ice cream. 👍

Ok...so just dismiss me and go back to pissing and moaning about the way things are while sitting on your thumb. You're like one of those people the bitches about the gov't but doesn't vote. Have you considered investment banking?

 

[Dr JPH]

Ok...so just dismiss me and go back to pissing and moaning about the way things are while sitting on your thumb. You're like one of those people the bitches about the gov't but doesn't vote. Have you considered investment banking?

Oh come on, dont turn this into a personal attack. Simply man up (or woman up) and admit that our views differ. So what? Theres no reason to start making this personal.

Just because Im not on here throwing around irrational solutions to a problem doesnt mean Im sitting back and not taking notice.

All you know of me is what you read here, and moreso all you know of me is your interpretation of what you read here.

I chose to be part of the solution by taking a realistic hard lined approach to the problem. I dont want to sit back and dream of a socialized medical system that will never, ever come to fruition in the United States.

In fact, wasting time proposing socialist medicine and universal healthcare is a TRUE waste of time and thats all you have done over the past 2 pages of this post.

Perhaps your insights are narrowed by where you are in your medical training. If I remember correctly I think your just about starting your first year of medical school.

I dont think a premed in Minnesota has the same outlook as an intern in Philadelphia.

When you see more perhaps you will know more and have a more global and realistic view. I cant fault your opinions completely about the state of things as a physician...at least not for a few more years.

So Im going to just leave it at that. I cant convince a street thug that prison is a scary place. You'll get your sneak peek soon enough.

 

[white_n_nerdy]

Ok...so just dismiss me and go back to pissing and moaning about the way things are while sitting on your thumb. You're like one of those people the bitches about the gov't but doesn't vote. Have you considered investment banking?

Hey,
I appreciate your passion for the problem. And it is a problem. Bottom line, like it or not, JP is right. I spent the majority of my life in one of the most depressed neighborhoods in America. JP is not being sarcastic or brash. He is trying to convey the realty of living and working in the inner city. Now back to the subject, socialism does not work. End of story. Our system has major problems but, socialism is not the answer. If you want socialism, move to Europe or Canada but, leave this country alone.

 

[Sartre79]

Oh come on, dont turn this into a personal attack. Simply man up (or woman up) and admit that our views differ. So what? Theres no reason to start making this personal.

Just because Im not on here throwing around irrational solutions to a problem doesnt mean Im sitting back and not taking notice.

The person whom I spoke of previously went to the University of Chicago. I hear it's hard to get into [sarcasm]. Did her residency in ER at Northwestern, and worked at Cook County Hospital in Chicago.

All you know of me is what you read here, and moreso all you know of me is your interpretation of what you read here.

I chose to be part of the solution by taking a realistic hard lined approach to the problem. I dont want to sit back and dream of a socialized medical system that will never, ever come to fruition in the United States.

Your approach isn't hard-line in as much as you just shoot down every idea or opinion, in stead of contributing or thinking of ways to change the system. In the last 3 pages of this thread...you pretty much have only pointed out how crappy everything is, and how nothing else will work.

In fact, wasting time proposing socialist medicine and universal healthcare is a TRUE waste of time and thats all you have done over the past 2 pages of this post.

If you read back, I noted that I was NOT advocating socialistic medicine.

Perhaps your insights are narrowed by where you are in your medical training. If I remember correctly I think your just about starting your first year of medical school.

I dont think a premed in Minnesota has the same outlook as an intern in Philadelphia.

You chose to live there, and practice medicine there.

When you see more perhaps you will know more and have a more global and realistic view. I cant fault your opinions completely about the state of things as a physician...at least not for a few more years.

So Im going to just leave it at that. I cant convince a street thug that prison is a scary place. You'll get your sneak peek soon enough.

It's all about attitude.

 

[Sartre79]

Hey,
I appreciate your passion for the problem. And it is a problem. Bottom line, like it or not, JP is right. I spent the majority of my life in one of the most depressed neighborhoods in America. JP is not being sarcastic or brash. He is trying to convey the realty of living and working in the inner city. Now back to the subject, socialism does not work. End of story. Our system has major problems but, socialism is not the answer. If you want socialism, move to Europe or Canada but, leave this country alone.

1. Why do you think it will not work (looking for an honest analysis, not just a blanket statement).

2. I hate that "you don't like it, then move" crap. If anything, that opposes "American ideaology". Read up on John Adams if you don't get what I'm alluding to.

 

[group_theory]

1. Why do you think it will not work (looking for an honest analysis, not just a blanket statement).

2. I hate that "you don't like it, then move" crap. If anything, that opposes "American ideaology". Read up on John Adams if you don't get what I'm alluding to.

I would like to remind everyone to try to focus the conversation on the topics at hand and refrain from personal attacks.


Back to the topic at hand

Why do I think your proposal (or at least the proposal that you put out here on SDN from what you have heard) won't work? Simple - It does not address the issues at all.

The proposal simply is to punish all physicians and squeeze more cheap or free labor out of young physicians who are already debt ridden and have put off having a fun rewarding life into their late 20s/early 30s (or later). That extra year will have little or no educational value, with salary being grossly inappropriate for a residency-trained physician. As it stands right now, you can only defer your government loans for 3 years max, and afterwards you can forbear only at the discretion of your lender (that 6-figure loans now have its interests compounded on a regular basis now). From an economical standpoint, that extra year is quite expensive for the young physician, with a lost opportunity cost of at least $120k for a primary care bound physician, and $200-$500k for a specialty bound physician. From a long-term perspective, why would someone want to be a primary care physician if they can simply become a PA/NP and end up working earlier, with fewer debt (both in terms of school loans and lost opportunity cost). The market as it is right now is highly selective against primary care physicians despite a huge demand for PCP. Making the economic environment more unfavorable won't help the issue at all.

AND yet it doesn't address any of the other factors involved. Let's say we get all the physicians to work for free. Who will pay for imaging services (x-ray, CT, MRI, ultrasound)? Who will pay for lab services (pregnancy test, CBC, Chem 7, Blood culture, etc). Who will pay for pharmaceutical services (antibiotics, pain drugs, etc)? Who will support the increase need for pharmacists resulting from more prescription? Who will pay for the dramatic increase in infrastructure. Who will pay for the secretaries to process all the paperwork? There is a nursing shortages right now - yet we need more nurses to take care of the influx of patients. Who will pay for the nurses (and will nurses be forced to work for below-market wages too?). Right now a lot of hospitals are operating at near critical-capacity - who will provide more beds or build more hospitals should the influx of admission come?


With your plan, healthcare expenditure will actually increase. Yes, you will have a pool of cheap labor from physicians, but physician salary only make up a small percentage of healthcare expenditure. With increase access to physicians, expect more tests, more admissions, more prescriptions, more followup care, etc. So all the other factors that contribute to our healthcare expenditure (roughly 80-85%) will have an dramatic increase in the rate of growth. So while physician access will be free, the cost per capita will be greater than what the current rate is. And the big question overall is: who will pay for this?


If you look at other countries with physician salary already below that of the US, utilization of imaging services WAY below that of the US, drug prices below that of the US, and the legal environment which is more physician friendly than the US ... their tax rate is already much higher than what is acceptable to the American public. Yet healthcare expenditure is already a major issue with various national governments trying to restrict spending by various means (denial of service, long waiting time for "elective" procedures, etc).

 

[medhacker]

1. Why do you think it will not work (looking for an honest analysis, not just a blanket statement).

2. I hate that "you don't like it, then move" crap. If anything, that opposes "American ideaology". Read up on John Adams if you don't get what I'm alluding to.

Sartre79

It could work, who knows. At SDN, we all like to be geniuses (whether we admit it or not) throwing around our apparent mastering of the topics, when in reality, we are probably just rationalizing our way out of our fears and misconceptions.

</psychoanalysis>

Universal healthcare has its issues, some major ones and some minor ones. None of these, however, in my opinion, could not be resolved in a way, just enough, for most people in the country.


P.S. good to see someone passionate about finding a solution 👍

 

[Sartre79]

I would like to remind everyone to try to focus the conversation on the topics at hand and refrain from personal attacks.


Back to the topic at hand

Why do I think your proposal (or at least the proposal that you put out here on SDN from what you have heard) won't work? Simple - It does not address the issues at all.

The proposal simply is to punish all physicians and squeeze more cheap or free labor out of young physicians who are already debt ridden and have put off having a fun rewarding life into their late 20s/early 30s (or later). That extra year will have little or no educational value, with salary being grossly inappropriate for a residency-trained physician. As it stands right now, you can only defer your government loans for 3 years max, and afterwards you can forbear only at the discretion of your lender (that 6-figure loans now have its interests compounded on a regular basis now). From an economical standpoint, that extra year is quite expensive for the young physician, with a lost opportunity cost of at least $120k for a primary care bound physician, and $200-$500k for a specialty bound physician. From a long-term perspective, why would someone want to be a primary care physician if they can simply become a PA/NP and end up working earlier, with fewer debt (both in terms of school loans and lost opportunity cost). The market as it is right now is highly selective against primary care physicians despite a huge demand for PCP. Making the economic environment more unfavorable won't help the issue at all.

AND yet it doesn't address any of the other factors involved. Let's say we get all the physicians to work for free. Who will pay for imaging services (x-ray, CT, MRI, ultrasound)? Who will pay for lab services (pregnancy test, CBC, Chem 7, Blood culture, etc). Who will pay for pharmaceutical services (antibiotics, pain drugs, etc)? Who will support the increase need for pharmacists resulting from more prescription? Who will pay for the dramatic increase in infrastructure. Who will pay for the secretaries to process all the paperwork? There is a nursing shortages right now - yet we need more nurses to take care of the influx of patients. Who will pay for the nurses (and will nurses be forced to work for below-market wages too?). Right now a lot of hospitals are operating at near critical-capacity - who will provide more beds or build more hospitals should the influx of admission come?


With your plan, healthcare expenditure will actually increase. Yes, you will have a pool of cheap labor from physicians, but physician salary only make up a small percentage of healthcare expenditure. With increase access to physicians, expect more tests, more admissions, more prescriptions, more followup care, etc. So all the other factors that contribute to our healthcare expenditure (roughly 80-85%) will have an dramatic increase in the rate of growth. So while physician access will be free, the cost per capita will be greater than what the current rate is. And the big question overall is: who will pay for this?


If you look at other countries with physician salary already below that of the US, utilization of imaging services WAY below that of the US, drug prices below that of the US, and the legal environment which is more physician friendly than the US ... their tax rate is already much higher than what is acceptable to the American public. Yet healthcare expenditure is already a major issue with various national governments trying to restrict spending by various means (denial of service, long waiting time for "elective" procedures, etc).

Great insight. What do you think would work? Or, is change needed at all? If so, how?

 

[white_n_nerdy]

1. Why do you think it will not work (looking for an honest analysis, not just a blanket statement).

2. I hate that "you don't like it, then move" crap. If anything, that opposes "American ideaology". Read up on John Adams if you don't get what I'm alluding to.

There have been enough failed experiments with socialism in this world that someone can make a blanket statement about its effectiveness. It does not work. Second, socialism controls and erodes certain rights of the participants. It has to, in order to function. And if the country adopts a socialist medical system, everyone has to participate. You have no choice. That in itself is an infringement on our rights. I really do not think that our Founding Fathers would have been keen on restricting person choice while advocating a large governmental medical bureaucracy.

 

[medhacker]

BlueCross Secret Memo Re: 'Sicko' ... "You would have to be dead to be unaffected by Moore's movie..."

July 6th, 2007

Friends,

An employee who works at Capital BlueCross has sent us a confidential memo written and circulated by its Vice President of Corporate Communications, Barclay Fitzpatrick. His job, it seems, was to go and watch "Sicko," observe the audience's reaction, and then suggest a plan of action for how to deal with the movie.

The memo, which I am releasing publicly in this email, is a fascinating look at how one health care company views "Sicko" -- and what it fears its larger impact will be on the public. The industry's only hope, the memo seems to indicate, is if the movie "flops."

Mr. Fitzpatrick writes: "In typical Moore fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich."

No. You don't say! That can't be!

BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just saw. "You would have to be dead to be unaffected by Moore's movie," he writes. "Sicko" leaves audiences feeling "ashamed to be...a capitalist, and part of a 'me' society instead of a 'we' society."

He walks out of the theater only to witness an unusual sight: people -- strangers -- mingling and talking to each other. "'I didn't know they (the insurers) did that!' was a common exclamation followed by a discussion of the example," according to Fitzpatrick.

He then assesses the film's impact: "[T]he impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of Moore's films ... If popular, the movie will have a negative impact on our image in this community."

The BlueCross memo then suggests a strategy in dealing with "Sicko" and offers the BCBS "talking points" to be used in discounting the film.

My heartfelt thanks to the employee who sent this to me.

And now a word from me to Capital BlueCross:

How 'bout a debate? No more secret memos and hand wringing about the millions seeing "Sicko." Just me and your CEO openly debating the merits of a system that kills thousands of innocent Americans every year.

In the meantime, I hope you don't mind me sharing your thoughts and impressions in your well-written memo. And if the rest of your executive team hasn't seen "Sicko," it opens in an additional 100 cities tonight for a total of over 700 screens across North America. Attendance went up a whopping 56% on the 4th of July, higher than any other film in the theaters right now. But don't be scared, and certainly don't be ashamed to be a capitalist. Greed is good! Especially good for you. There's nothing like having the pre-existing condition of being rich, should you ever get sick and need help.

Yours,

Michael Moore
[email protected]
www.michaelmoore.com

P.S. Join me at noon EST, today, when I'll be chatting with U.S. Steelworkers, the California Nurses Association, and whoever stops by to talk about "Sicko" and the industry's attempt to stop this movement. Check my website for details.

[The following memo was written by Barclay Fitzpatrick, VP of Corporate Communications for Capital BlueCross]

I was able to see Sicko last night in Lancaster. There were about 30 other viewers in the theatre covering all age groups. I have attached the well-written memo from one of our partners, which describes cases used in the movie, to the end of my memo. Also attached are the latest talking points from BCBSA. I will focus on impact to our brands, issues, and suggested strategies in this memo.

The Movie
You would have to be dead to be unaffected by Moore's movie, he is an effective storyteller. In Sicko Moore presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit. Denial for treatments that are considered "experimental" is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit.

While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market. Here are some examples:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad treatment of members.
* BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection.
* BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature.
* BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding inaccuracies in applications to enable post-treatment payment denials.
* A BCBSA card is shown while the narrator describes how they (insurers) got wealthy.

In typical Moore fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich. Nixon Oval Office tapes are used to show how the initial idea of a 'less care = profit' enterprise was supported by the administration and became the HMO paradigm. Legislators are presented as bought stooges for the political agendas of insurers and big Pharma. Insurers are middlemen in the Medicare Modernization Act - which is presented as a trick to charge seniors more for their prescription drugs.

Doctors are barely touched - only in the course of discussing the AMA's work to sink early efforts in the 40's and 50's to start universal health care. He takes efforts to show that doctors live well in other countries despite the existence of universal health care. In follow-up interviews, Moore has stated that he has spoken to and knows many doctors, and "doctors aren't the problem".

In the second half of the movie, Moore walks us through individual stories of the Canadian, British, French, and Cuban health care systems where everything is free and - he reminds us repeatedly - no one is ever denied service because they can't pay. In addition to health care, the government provides free day care, college, and someone to do your laundry. Everybody gets along and takes care of each other and life is beautiful because there is universal health care. As a viewer, you are made to feel ashamed to be an American, a capitalist, and part of a 'me' society instead of a 'we' society - and the lack of universal health care is held up in support of that condemnation.

The Impact
Moore's movies are intentionally intense and his objective in Sicko seems to be to revive the earlier Clinton efforts - not to achieve universal coverage with this movie, but to push the topic to the top of the agenda. He will be just as successful whether proponents mount momentum or discussion entails key stakeholders defending why it won't work.

As a health care industry educated viewer it is easy to pick out where Moore is cultivating misperceptions to further a political agenda, but you will also recognize that 80%+ of the audience will have their perceptions substantially affected. In demonstration of its impact, an informal discussion group ensued outside the theatre after the movie. While some people recognized how one-sided the presentation was, most were incredulous and "I didn't know they (the insurers) did that!" was a common exclamation followed by a discussion of the example.

The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as Moore's efforts in the movie and surrounding PR activity are seen by more of the community. The impact on industry savvy Sales' contacts should be minimal, while the impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of Moore's films nor the way this one appears to be headed. If popular, the movie will have a negative impact on our image in this community.

There should be no doubt that many of our employees will be asked what they think of the movie by friends, family, and neighbors. We should anticipate that our customer service people will be asked about particular cases from the movie and if we follow similar policies. Word and phrases we have routinely used to date in policy change communications or denial letters, such as "Investigational", will be seen as affirming the film's contentions. The national BCBSA response - while coming out against the film's divisiveness and focusing on the positive work of the Blues - steers media inquiries about policies and denials back to the plans themselves.

There are 4 key areas of misperception cultivated by the movie that we should consider in any messaging strategy:

1. That the industry is all about HMO's. Moore cultivates this further in his interviews. The reality is that HMO's are a minority product and have been for some time.
2. The movie attacks insurers for a profit motive, but makes no distinction among for-profit and non-profit insurers, and in its execution places the Blue Plans together with the for-profit insurers.
3. All plans and employees - from leaders to service representatives - are painted as motivated by profit to deny claims, and only those with crisis of conscience have come forward to confess their sins.
4. Perhaps most damaging of all, Moore completely fails to address the most significant driver of health care costs - our own lifestyle choices - and seeks to focus attention and efforts on the alluring 'quick-fix' of universal health care. It has taken a generation of poor nutrition and exercise to get obesity and related health issues - and subsequent costs - to their current levels, and Moore's movie fails to acknowledge the causal relationship or need to change (he briefly touches the subject in a non-memorable way). Contrast this to the recent Health Care Symposium held in Harrisburg - where a panel of representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers agreed on one thing - that there was no quick fix and that Health and Wellness was the critical area of focus.

Suggestions
I believe the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve (aligns with BCBSA strategy), and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness. We will convene a team to consider other approaches and work on potential messages for media inquiries, customer service, and employees.

Confidential Memo (from partner)

SiCKO - viewed on 6/26/2007

Takeaways

* The main theme of the movie is that American society needs to focus on the "we" and not the "me" in healthcare.

o This broad message is an overlay for the specific criticisms of the healthcare industry - the movie asks where the morality of the American public lies and contrasts America's approach to health care unfavorably with other nations.

* SiCKO does not go into any depth about how health insurers operate how the health insurance business works - instead it fixates on what it characterizes as the profit incentive to deny care to patients (e.g. examples of barriers to getting health insurance if you are not healthy; examples of people being denied expensive tests or procedures; examples of efforts to deny reimbursement after care has been received.)

* The film draws no distinction between not-for-profit and for-profit insurers - in fact the Blue Cross/Blue Shield brand is intermixed with the for - profit brands as background reference points. o One scene shows a Blue Cross / Blue Shield logo as Michael Moore's voice over begins, "While the healthcare companies get wealthy..."

* The health insurers that get the most airtime are:

o Kaiser Permanente
o Humana
o CIGNA
o Blue Cross of California
o Aetna

* No Pharma companies are mentioned - but SiCKO suggests in multiple instances that prescription drugs are overpriced

o At a pharmacy in London, prescription drugs are £6.65, no matter how large the dose
o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100

Further Notes

* Some of the examples of denial of care highlighted in the film:

o A woman with Kaiser Permanente takes her 18-month daughter to the hospital in an ambulance, only to be told to go to an in-network hospital. By the time they reach the second hospital, her daughter has stopped breathing and dies 30 minutes later in ER.

o A woman with Blue Shield of California has a tumor but is denied requests to get an MRI, or to see a specialist. While on vacation in Japan she is given an MRI, and eventually returns to the U.S. to demand treatment from her insurer.

* In the ensuing court case, a doctor admits to denying her request without having reviewed it.

o Blue Cross of California approves one woman's $7,500 treatment, but the approval is later denied for her failure to report a previous medical incident - a yeast infection.

* "They're just looking for a way out," she says

* Other examples of how health insurers avoid paying for treatment:

o One graph (from Humana) shows that doctors with the highest % of denials get a bonus.

o Michael Moore interviews a former health insurance employee who specialized in denying care to patients retroactively - by finding inconsistencies in their medical records.

o A 5-minute piece in the beginning of the movie .

* The film also focuses on the politicians and the funds they raise from Pharma and other player in the health care industry and alleges that the system has been heavily influenced by lobbyists and contributions.

Barclay Fitzpatrick
Vice President
Corporate Communications
Capital BlueCross
(w) 717-541-7752
(c) 717-329-3648
[email protected]

MichaelMooreTalkingPoints61807.doc

Blue Cross and Blue Shield Association
Talking Points in Response to Michael Moore's "Sicko"
June 2007

1) The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer.

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by Michael Moore and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government.

3) The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States.

4) The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information. In addition:

o The Blues recently created Blue Health Intelligence a data resource that will shine light on emerging medical trends and treatment options in an unprecedented way. To further the use of evidenced-based medicine, BCBSA has called upon Congress to establish an independent, payer-funded institute that will study the comparative effectiveness of new and existing medical treatments and procedures.

o Blue Cross and Blue Shield companies are at the forefront of healthcare transparency by providing their members with online access to real-time information related to provider quality and the cost of common healthcare services. In addition, the Blues have committed to making personal health records available to their members by 2008.

o We are working to ensure that Medicare is funded appropriately and that seniors continue to have access to comprehensive benefits.

5) The Blues are proud of these efforts and we will continue to work with consumers, providers, employers and the government to provide Americans with the healthcare services and information they need to lead full, healthy lives.

 

[the1doc]

Look OUTSIDE of our country. Every Westernized country that has socialized medicine has a medical system that is rated higher than ours and costs less money (including taxes) per capita. Check out Japan and England. As for the anecdotal story about the overworked doctors there, I hear about people dying in emergency room waiting rooms here. Every system has its drawbacks. At least the patients were being seen.

As for doctors making less income in those countries, (mentioned much earlier in the thread) I wonder how much student loan debt they have? I would trade my student loan debt, out of pocket insurance expenses and child care expenses for a good socialized medical system any day.

As for JP H., how do you put someone on ignore? I try to stay away from these threads when you are polluting them, but other people want to have a conversation sometimes. I hate it when people take aim at the poorest and weakest of our country and begrudge them the pennies they get out of our barely existent social net. I am so sorry the single working mothers seem to be squeezing a whole 2 cents out of your taxes for basic health coverage for their kids. We spend more on tax breaks for the rich and non compete contracts for Halliburton.

LOL...break my bleeding heart.

The "anecdotal" story about the overworked docs has appeared repeatedly in the major newspapers of the country I speak of the - Australia - the country that WHO ranks higher than the US - the country where people are waiting 2 months in major cities just to see their primary care doc. Let's talk about anecdotal...like WHO's ridiculous list. WHO's ranking (which you have chosen to embrace) means nothing....it's no more accurate than VH1's list of the 100 hottest Hollywood couples...because everyone knows that Brangelina is not REALLY the hottest Hollywood couple....If you like overrated actors and bulemic actresses, you'll probably like VH1's criteria and agree that Brangelina is Hollywood's hottest couple....if you don't care for those qualities, you'll probably disagree...

If you like the idea of socialized medicine, you'll probably like WHO's criteria for ranking the world's health systems....if you think socialized medicine sucks, you'll probably rank the system in the US a little higher than #37.

Michael Moore's attack on the US system is nothing more than his typical political nonsense...he's tried to dig up the most ridiculous and radical stories out there and portray it as the typical standard of care...which it's not. Those who see Michael Moore as a fat guy in desperate need of some good medication will see the attack as nothing more than a fat guy's rants...those who like Moore will agree...and on and on...it's all about your perspective.

 

[pguin]

LOL...break my bleeding heart.

The "anecdotal" story about the overworked docs has appeared repeatedly in the major newspapers of the country I speak of the - Australia - the country that WHO ranks higher than the US - the country where people are waiting 2 months in major cities just to see their primary care doc. Let's talk about anecdotal...like WHO's ridiculous list. WHO's ranking (which you have chosen to embrace) means nothing....it's no more accurate than VH1's list of the 100 hottest Hollywood couples...because everyone knows that Brangelina is not REALLY the hottest Hollywood couple....If you like overrated actors and bulemic actresses, you'll probably like VH1's criteria and agree that Brangelina is Hollywood's hottest couple....if you don't care for those qualities, you'll probably disagree...

If you like the idea of socialized medicine, you'll probably like WHO's criteria for ranking the world's health systems....if you think socialized medicine sucks, you'll probably rank the system in the US a little higher than #37.

Michael Moore's attack on the US system is nothing more than his typical political nonsense...he's tried to dig up the most ridiculous and radical stories out there and portray it as the typical standard of care...which it's not. Those who see Michael Moore as a fat guy in desperate need of some good medication will see the attack as nothing more than a fat guy's rants...those who like Moore will agree...and on and on...it's all about your perspective.

Thats all bull!@#$....everyone knows that VH1's list was spot on. Get your facts straight!

 

[Dr JPH]

I just had a drug seeking patient today who came in and ordered his own narcotics. Then when no one is looking he sneaks off to the bathroom to masturbate. Then he likes to shake the doctors hand. Apparently he does this a few times per month.

Then theres the 30 year old woman with 3 kids who is in "excrutiating back pain". In fact, she said it was a 12 out of 10. Wow. She was in so much pain that the only thing that would help her was us allowing her to go outside to smoke. Oh...and the percocet. But what really made her feel better was the note that she needed to stay out of work until Monday. She wanted us to make sure the note was a good one because she just started that job last week and didnt want to lose it. 🙄

These 2 patients were preceded by the young intoxicated postictal gentleman who decided to crap his pants because he liked the idea of a nurse wiping his ass. He also thought it would be funny to vomit on the floor next to the bed so you stepped in it if you werent paying attention.

And 3 three patients were just from 2pm to 7pm tonight.

I dont think its about attitude.

I think I treat these people just the way they deserve to be treated. I probably treat them too good in fact. But I dont treat them as well as our government already does, despite no universal healthcare.

Oh, and by the way, just wanted to inform all of you that the 3 above mentioned patients are truly appreciative for your tax dollars.

3 patients in 5 hours at a small community hospital in Philadelphia.

Its an epidemic. And now some of you people want to give them MORE access to healthcare. Good idea. 🙄

Dont tell me Im wrong about my observations. As said above, Im just being realistic about our world.

Bring your bleeding heart to this ER and take a look around. Just dont step in the vomit.

 

[JayneCobb]

Sure there is. Why? Because a lawyer would expect that you do so.

I'm a physician, training to be an interest and I know how to handle an elevated white count, I can pick out an antibiotic, I know the proper management of the most common heart ailments and I know how to renal dose medicines. And I also know when I have a pt who needs more help than I can provide. And if you don't think that I as an internist can't figure out when I have an adynamic ileus on my hands and not something that needs surgery, then you'd be mistaken.

When you get out into the real world and start seeing patients rather than just reading Netter then you may see what Im talking about. Come to Philly. I have a few clinics I think you should work in.

You can ignore me if you wish, but Im not saying anything but the honest truth based on what I have encountered.

Im sorry the truth makes you sad.

That's JayneCobb D.O, I'm not some pre-med ***** who has no clue. and I'm not sure why half of this rant was seemingly directed at me.

 

[mitawa]

I just had a drug seeking patient today who came in and ordered his own narcotics. Then when no one is looking he sneaks off to the bathroom to masturbate. Then he likes to shake the doctors hand. Apparently he does this a few times per month.

Then theres the 30 year old woman with 3 kids who is in "excrutiating back pain". In fact, she said it was a 12 out of 10. Wow. She was in so much pain that the only thing that would help her was us allowing her to go outside to smoke. Oh...and the percocet. But what really made her feel better was the note that she needed to stay out of work until Monday. She wanted us to make sure the note was a good one because she just started that job last week and didnt want to lose it. 🙄

These 2 patients were preceded by the young intoxicated postictal gentleman who decided to crap his pants because he liked the idea of a nurse wiping his ass. He also thought it would be funny to vomit on the floor next to the bed so you stepped in it if you werent paying attention.

And 3 three patients were just from 2pm to 7pm tonight.

I dont think its about attitude.

I think I treat these people just the way they deserve to be treated. I probably treat them too good in fact. But I dont treat them as well as our government already does, despite no universal healthcare.

Oh, and by the way, just wanted to inform all of you that the 3 above mentioned patients are truly appreciative for your tax dollars.

3 patients in 5 hours at a small community hospital in Philadelphia.

Its an epidemic. And now some of you people want to give them MORE access to healthcare. Good idea. 🙄

Dont tell me Im wrong about my observations. As said above, Im just being realistic about our world.

Bring your bleeding heart to this ER and take a look around. Just dont step in the vomit.

However, I think that those who are advocatind for more access are not doing so for those who frequent health care centers looking to abuse their resources. They are looking to help those who don't frequent or in some cases even avoid healthcare services b/c they cannot afford the necessary insurance despite working full-time (and are ineligible for government sponsered benefits). Despite what some may think there are many people out there with this problem. They have families to support and are not mooching off the government. Insurance premiums cost money as you have pointed out, and the costs vary and coverage is not guaranteed. You can be denied at the insurer's discretion.

I guess that's why it's is so disgusting to have to sit and watch others abuse benefits that others are desparate to have.

 

[sasevan]

Look OUTSIDE of our country. Every Westernized country that has socialized medicine has a medical system that is rated higher than ours and costs less money (including taxes) per capita. Check out Japan and England. As for the anecdotal story about the overworked doctors there, I hear about people dying in emergency room waiting rooms here. Every system has its drawbacks. At least the patients were being seen.

As for doctors making less income in those countries, (mentioned much earlier in the thread) I wonder how much student loan debt they have? I would trade my student loan debt, out of pocket insurance expenses and child care expenses for a good socialized medical system any day.

I hate it when people take aim at the poorest and weakest of our country and begrudge them the pennies they get out of our barely existent social net. I am so sorry the single working mothers seem to be squeezing a whole 2 cents out of your taxes for basic health coverage for their kids. We spend more on tax breaks for the rich and non compete contracts for Halliburton.

To: Hilseb,
WOW!!! I'm so glad we're going to be in the same school and in the same class.
One of the things that I want to do in my medical career is to become an advocate for socialized/universal healthcare as well as to practice with underserved inner city populations.
BTW, I have 4 years experience working at one of the largest public hospitals in the country and 2 years volunteering at a homeless clinic; so I'm not naive about scams, but in my experience the overwhelming majority of patients in those places are in need not undeserving.
Anyway, keep the faith...we already have socialized/universal education and I believe we will have socialized/universal healthcare.
Perhaps there's much that can be done to improve on other nations' universal healthcare models but I belive that our own country's greatness is best measured not by the exceptional care that it provides to the wealthy few but rather by the efficient and ethical care it will hopefully provide to all, poor, middle class, and rich alike.

To: Everyone,
I think Jesus said it best: "Those who are well do not need a physician, but the sick do. Go and learn the meaning of the words, I desire mercy..." Matthew 9:11-13.
Justice is giving to the other what they deserve but mercy is giving to the other what they need.
The poor and working class have a need for healthcare. 45 million of our fellow Americans can't afford to have medical insurance; people are becoming sick, dissabled, homeless, and dying because of this.
I hope and believe that we can be a nation not only of MEs but also of WEs.
Please, go see "Sicko".
I don't agree with everything in it but it is starting a dialogue that our society needs to have; the status quo is no longer acceptable.
Namaste. 🙂

 

[sasevan]

I mentioned this suggestion on the second page of the thread and no one really discussed it. Would it be possible to have some sort of base line coverage to the general public. What that base line should be would be up for debate. Feel free to discuss. Any coverage after that point would require HMO or the system that we have currently in place. I think that would solve the issue of people being turned away from a hospital initially and everyone would receive some sort of care. Just an idea. What do you guys think?

👍

Kappy1,
I think that what you're proposing is what is in place in most socialized/universal healthcare models: basic coverage for all while those that can afford superior service can opt for private insurance. Kind of like basic education for all while those that can afford superior schooling can opt for private education.
Obviously, the devil is in the details but we can continue to make progress by having a public dialogue that starts by affirming that the goal is for every American to have accessible and adequate healthcare. If we have this goal and the will to achieve it then we will find a way.
Namaste. 🙂

 

[sasevan]

However, I think that those who are advocatind for more access are not doing so for those who frequent health care centers looking to abuse their resources. They are looking to help those who don't frequent or in some cases even avoid healthcare services b/c they cannot afford the necessary insurance despite working full-time (and are ineligible for government sponsered benefits). Despite what some may think there are many people out there with this problem. They have families to support and are not mooching off the government. Insurance premiums cost money as you have pointed out, and the costs vary and coverage is not guaranteed. You can be denied at the insurer's discretion.

I guess that's why it's is so disgusting to have to sit and watch others abuse benefits that others are desparate to have.

mitawa,

excellent point.

 

[Xoynx]

Bottom line,
Socialism looks good in theory but, in reality it does not work.

My rule of thumb: socialism works great, but only insofar as every member of its society knows each other by name or is otherwise homogeneous.