What do YOU think are three major issues affecting healthcare today?

[shnuffles]

Just seeing if there is any sort of consensus

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[Decicco]

1. Access
2. Cost
3. Socialism

 

[lol.psych]

Access.
Time (for physician/patient interaction).
Cost.

 

[Chemist0157]

1. Time
2. Cost
3. Lack of Responsibility

 

[mfrizzo3]

1. Access
2. Cost
3. Fat People

 

[SDN2013]

Neurotic premeds
Higher-ups not knowing how to fix healthcare
Not enough primary care docs

 

[umean2tellme]

1. Access
2. Disparity in pay between primary care docs and specialists
3. Legal issues that doctors face

I think that law suits are too common in this socieity today. I am a nurse and I have seen some people sue a nursing facility and a doctor with no real reason only to get a least a small settlement. For example, I heard from a colleague that a 90 year old woman sued a hospital because her 90 year old husband fell. But he didn't hurt himself, she sued because the fall made him impotent. They settled out of court of 10,000. Last time I checked most 90 year old men were impotent. Hell, most 60+ year old men have either prostate problems or some kind of erectile dysfunction, which is why Cialis and viagara exist. There should be more accountability for people who try and sue doctors without any understanding of science/medicine. Doctors work hard and are underpaid but the moment an undesirable result happens they're quick to sue them and ruin their lives.

 

[Aladdin]

THE biggest problem: see thread 1/2 of all primary care docs would consider quitting

That is the biggest threat to healthcare in the United States.

 

[Greonis]

(In no particular order...)

*Access
*Cost
*Medicine and the law (end-of-life care issues, defensive medicine, etc...)

 

[shnuffles]

HAHA! I like Gloryfield's "neurotic premeds"

 

[majahops]

1) The obvious one - lack of reliable access to health care services for far too many.

2) Discontinuity ("gaps") between temporal sectors of health care: preventative, primary, in-patient, post-op, rehabilitation and hospice.

3) Fragmentation of electronic medical records. We need a nationalized, uniform system of electronic medical records. All clinicians with a good reason for access should have it, from the rural clinic to the metropolitan trauma center. My patient has a full medical history, let's get it recorded in one central database so I can use it as a reliable tool!

 

[BlackDr2b]

Access, Education, Lack of Trust

 

[gujuDoc]

1. Access
2. Cost
3. Fat People

I'd agree with this, but rephrase and expand on number 3 some.

Lack of ability to afford good healthy foods for the poorer people, and lack of the wealthier and middle class people eating such healthier foods. Too much eating of poor fatty foods i.e. fast food, overly oily unhealthy restaurant food, etc. in favor to healthy things like steamed and baked foods and things like carbs and fats instead of more fruits and veggies.

With relation to number 3, the other problem is poor people who live in such dangerous areas that kids are not really getting outside and getting exercise needed or parents are poor so they can't afford to put them in afterschool sports type of activities. And again with the rich, its just laziness to exercise and sedentary behavior.

The combo of all of the above leads to obesity, chronic health problems, and so forth.

So probably a better short phrase of the third point above is APATHETIC LAZY IRRESPONSIBLE PEOPLE
and the poor people part does more with lack of access. I think lack of access is not just a matter of lack of access to doctors but lack of affording to take those other preventative measures which I described earlier.

 

[EpiPEN]

Access
Cost
Quality

the golden triangle of healthcare

 

[Kaya12]

1) Flexnor Report 1910

Template for change in medical eduation, paid for by Rockefeller foundation... AAMC makes curriculum, leads to demise of most schools that many making the report graduated from... graduated physicians #'s decline from 1910-1950 (a guilded society, gee how lovely for them!)

2) Committe of 430... principals... (love them!)
1. The health of the ppl is a direct concern of the gov't!
2. National health policy should be formulated and organized!
3. Attacked by the AMA..... of course what else do they have to do!

3) After WWII, there is a economic upturn and research exapansion... NIH is formed (annnd.... research is less politically invasive than anything else,... so the heck w/ it, lets fund everything!)

1940's... As Canada and UK make nat'l/univeral coverage, U.S. otps for voluntary employment-related health insurance and publicly encourages it's development (invarable tax treatment)

-beause emplyee based insurence isn't taxed, unions want it and it becomes norm!

4) 1960's... AMA thwarts Truman's attempt to establish a system of national health insurance (truman wants comprehensive gov't plan, AMA doesnt)

5) 8 yr battle over medicare ends.... AMA presented "eldercare" doesnt pass... Lyndon B. Johnson & his demo's pass medicare instead (plan A and B to come....) I'm sooooo happy that I get to pay for all these old ppl to have fantasmic health care when i didn't have any growing up... but not to worry... SCHIP came about in '97... I was already in 8th grade, but whatev! good news!.

6) 1973- HMO's come out of prepaid group practice (PGPS) w/ goal of controlling utilization of services. Operate in an umbrella in which hospitals/docs must be part of HMO.. attempted to stress preventative medicine but lead to "denial of care".... btwn 1960-1980 41 new allopathic medical schools...)

7) 1980's... GROWTH but little consideration for the balance and residtruibution of resources

institutions guided by self interest...

Hospitals as a business sometimes call for a reassessment of the Hospitals sense of "mission"....

8) George L Engel of Univ of Rochester "biopshychosocial teaching of medicine" includes interdisciplin teaching of basic schiences, vertical integration of clinical exp and psych classes...

9) Harvard "new pathway" ooohhhh hahvahhd

10) Computers change physcal setting of teaching

11) Most patient unhappiness comes from sytem problems involving organization & financing issues, not doc training..

12) 1990's.... Academic physicians devote energies to professional matters including research..... Fee for service may generate "overdoctoring" in some peoples perspective.... However, salary and capitalized agreement could lead to "underdoctoring" in other perspectives....

13) Managed Care becomes a force.... Though delivery system rapidly changes, there is little initial opposition voiced by physicians....
ex. 1985: 3/4 of ppl in managed care plans are in not for profit plans
1999: 2/3 are in for-profit plans
HMO's appeal to employers based on economis preformance and cost containment

14) Prz clinton wants changes in 1992.... aka hillary is in charge.... changes in organization and structure of the health care delivery system.... less prepared to change the financial arrangements and funding patterns... does no one else remember this??>? geez I feel OLD! I WAS THERE!

15) 99-2000 30% pop obese, 64% overweight.... if obesity epidemic continues by 2020, 1/5 of all HC $ will be spent on ppl age 50-69 and obesity related medical problems (tell this to my 94 yr old grandma, who is from look out mtn, TN).... lard is a food grp.... aside)....

16) 2004 Standardized simulated patients introduced to improve evaluation of student clinica performance... yay we love standardized patients!

17) We are optimistic in our increase in the science base! BUT... by no means does this imply that we have the strategies or political consensus in place to make them available to the population


18) RAMBLE.... nonetheless.... do your research... obama seems to want to establish NHC (national health care) in the old fashioned (aka "politically easy way") of leaving all of the private/employer based health care policies in place... umm.... how bout you look at what happened to Truman's similar plan, or Clinton in '92-93...... just a suggestion Obama... I love you anyways... But history is a good teacher

 

[majahops]

With all due respect, if Obama used history as a teacher, he wouldn't be where he is today.

It is time for the people of this nation to stand up and crush all barriers to goodness.

 

[Kaya12]

With all due respect, if Obama used history as a teacher, he wouldn't be where he is today.

It is time for the people of this nation to stand up and crush all barriers to goodness.

I didnt mean that he should be limited by history by all due respect my friend I love Obama.... I mean that he should be informed by history and branch out from such a perspective/.....

 

[majahops]

I didn't mean to argue with your statement or your contributions to this thread - very valuable indeed.

However, a thoughtful attempt at instituting (not "proposing") national health care has never been made in this country. Clinton never got her plan off the ground. Today is a new day. To be honest, I don't think Obama's plan goes far ENOUGH toward national health care. I sincerely believe that everyone should have access to top of the line health care in this wealthy nation of ours. More importantly, I sincerely believe that everyone CAN have access to top of the line health care in this wealthy nation of ours.

How? Increase our taxes. Start with mine.

... It's the right thing to do.

I didnt mean that he should be limited by history by all due respect my friend I love Obama.... I mean that he should be informed by history and branch out from such a perspective/.....

 

[Decicco]

It is time for the people of this nation to stand up and crush all barriers to goodness.

[youtube]http://www.youtube.com/watch?v=p3MiD_U4CHQ[/youtube]

 

[Kaya12]

I didn't mean to argue with your statement or your contributions to this thread - very valuable indeed.

However, a thoughtful attempt at instituting (not "proposing") national health care has never been made in this country. Clinton never got her plan off the ground. Today is a new day. To be honest, I don't think Obama's plan goes far ENOUGH toward national health care. I sincerely believe that everyone should have access to top of the line health care in this wealthy nation of ours. More importantly, I sincerely believe that everyone CAN have access to top of the line health care in this wealthy nation of ours.

How? Increase our taxes. Start with mine.

... It's the right thing to do.

Word

 

[majahops]

Dude I'm laughing so hard right now. Though it makes it immediately obvious how ideologically different you and I must be, you got me good. Nice one.

[youtube]http://www.youtube.com/watch?v=p3MiD_U4CHQ[/youtube]

 

[LadyWolverine]

I'd agree with this, but rephrase and expand on number 3 some.

Lack of ability to afford good healthy foods for the poorer people, and lack of the wealthier and middle class people eating such healthier foods. Too much eating of poor fatty foods i.e. fast food, overly oily unhealthy restaurant food, etc. in favor to healthy things like steamed and baked foods and things like carbs and fats instead of more fruits and veggies.

...and the poor people part does more with lack of access. I think lack of access is not just a matter of lack of access to doctors but lack of affording to take those other preventative measures which I described earlier.

This is such complete BS. Today at wal-mart (since that's all I can seem to afford on med student loans) I bought a big bag of frozen broccoli ($1 and change), a box of dehydrated mashed potatoes (another $2 for a huge box), some bell peppers (50 cents a piece), a whole bag of chicken breasts ($6) and a half-gallon of milk ($1.50). What I bought was enough to feed an entire family of 4 + leftovers. A relatively healthy dinner (chicken breasts seasoned with spices and no salt, plus grilled bell peppers served with broccoli and potatoes with milk for a beverage), all for less than the cost of a 12-piece bucket of chicken, or burgers, fries, and drinks for 4 at a local fast-food drive-thru.

I wish people would stop bitching about "access" to healthy foods for the poor. The problem isn't access, it's education re: healthy choices for familes.

 

[majahops]

It's so not-at-all BS... I'm too tired to argue why it's not... but it is VERY true... there are social, commercial, structural, psychological and financial blockades between a large portion of the underclass (particularly minority) population in this country and healthy eating, which don't exist for the "rest of us." If you don't see it, you probably don't want to. In the off chance that you do want to, can somebody here please argue the point to LadyWolverine? I'm pooped.

This is such complete BS. Today at wal-mart (since that's all I can seem to afford on med student loans) I bought a big bag of frozen broccoli ($1 and change), a box of dehydrated mashed potatoes (another $2 for a huge box), some bell peppers (50 cents a piece), a whole bag of chicken breasts ($6) and a half-gallon of milk ($1.50). What I bought was enough to feed an entire family of 4 + leftovers. A relatively healthy dinner (chicken breasts seasoned with spices and no salt, plus grilled bell peppers served with broccoli and potatoes with milk for a beverage), all for less than the cost of a 12-piece bucket of chicken, or burgers, fries, and drinks for 4 at a local fast-food drive-thru.

I wish people would stop bitching about "access" to healthy foods for the poor. The problem isn't access, it's education re: healthy choices for familes.

 

[Decicco]

I sincerely believe that everyone should have access to top of the line health care in this wealthy nation of ours. More importantly, I sincerely believe that everyone CANhave access to top of the line health care in this wealthy nation of ours.

How? Increase our taxes. Start with mine.

... It's the right thing to do.

Have you been to http://finance.yahoo.com lately? Make sure to bring your scrubs, its a bloodbath.

I wish people would stop bitching about "access" to healthy foods for the poor. The problem isn't access, it's education re: healthy choices for familes.

I heart WalMart. Even fast food is healthy if you buy the right things. People complain about "big bad business" for everything, forgetting the jobs they provide, the low prices they provide, etc. When NYC banned trans fat, McDonalds adapted easily. The places that went out of business were the mom-and-pop Mexican resturaunts that liberals shed so many tears over. Board rooms are not responsible for your mistakes.

 

[LadyWolverine]

maja: It's too bad you're too tired to argue. Technically, I should be too tired to argue, seeing as I'm actually in medical school and currently on day 10 of a neverending week of inpatient internal medicine, but I'm not. Comments as ignorant as yours get me fired up. Please, don't pretend to know the first thing about what I "see" from day to day. I shop at the same places as the "underclass" of this city, something your NorCal-turned-Georgetown mind might not be able to wrap itself around. Please, spare me the condescending spiel about psychological and financial blockades and how I need to be educated on the subject. I have been behind plenty of folks in the shopping line here in good ol' Balmer to realize where your so-called "blockade" lies, and all I seem to have going for me is common sense. Why don't you spend a couple of years in a city like Baltimore, outside of your comfortable Cali/Georgetown bubble, before you start running your mouth about schooling the old hands around SDN?

 

[majahops]

Then I am wrong. Accept my apologies. You are right, there are no barriers to healthy eating for the lower class (particularly minorities).

I apologize for being oh so very blind to the reality.

maja: It's too bad you're too tired to argue. Technically, I should be too tired to argue, seeing as I'm actually in medical school and currently on day 10 of a neverending week of inpatient internal medicine, but I'm not. Comments as ignorant as yours get me fired up. Please, don't pretend to know the first thing about what I "see" from day to day. I shop at the same places as the "underclass" of this city, something your NorCal-turned-Georgetown mind might not be able to wrap itself around. Please, spare me the spiel about psychological and financial blockades. I have been behind plenty of folks in the shopping line here in good ol' Balmer to realize where your so-called "blockade" lies. Why don't you spend a couple of years in a city like Baltimore, outside of your comfortable Cali/Georgetown bubble, before you start running your mouth?

 

[Kaya12]

oooh mylanta

 

[NTF]

1. Cost
2. Access/Coverage
3. Fragmentation of care.

 

[ANF1986]

1. Over-regulation (HMO Act, ERISA)
2. Medicare/Medicaid
3. Democrats

 

[ANF1986]

I didn't mean to argue with your statement or your contributions to this thread - very valuable indeed.

However, a thoughtful attempt at instituting (not "proposing") national health care has never been made in this country. Clinton never got her plan off the ground. Today is a new day. To be honest, I don't think Obama's plan goes far ENOUGH toward national health care. I sincerely believe that everyone should have access to top of the line health care in this wealthy nation of ours. More importantly, I sincerely believe that everyone CAN have access to top of the line health care in this wealthy nation of ours.

How? Increase our taxes. Start with mine.

... It's the right thing to do.

Man, liberals just can never have enough. It's not enough that they say everyone should have healthcare, NOW its top of the line healthcare! Where do you expect to get the funding for this massive entitlement program? There is 100 trillion dollars in unfunded entitlements between Medicare&Social Security over the next 30 years. That is a present day figure with the expected amount of people retiring over the next 30 years. They have no idea where they can get the money to pay for this. But YOU think we can afford to insure every man, woman, and child in this country, and not only to insure them and guarantee them care, but TOP OF THE LINE CARE!

That is the problem with liberalism, funding social programs with money from Santa Claus. Saying we want top of the line healthcare for everyone, gives people nice warm fuzzy feelings inside, makes everyone feel good. And then reality hits and those of us living in the real world, know that the only way to provide these things is to massively raise taxes. Sorry bud, you might want to take a pay cut, but I dont. It's easy to sit up on a high horse right now and talk about being ok with making less, and how I'm going to be a bad doctor because I actually give a flying **** about how much money I'm going to make. You'll be singing a different tune if those policies get implemented, and you are struggling to pay student loans, a mortgage, 2 car payments, water, electric, property taxes, retirement savings, braces, and college funds for your kids.

It's ok to be mildly self-interested, it doesn't make you a bad person. You can still be a good liberal even if you actually want to get paid what you are worth for the amount of schooling and debt you've had to acquire to become a doctor.

 

[Gut Shot]

But YOU think we can afford to insure every man, woman, and child in this country, and not only to insure them and guarantee them care, but TOP OF THE LINE CARE!

If you look at how much we already spend, and the gross inefficiencies of how we spend it, yes, it's absolutely possible. There are other nations that provide high quality health care to their entire populations for a fraction of what we spend. You should pull your head out of Ayn Rand's colon and have a look.

It's easy to sit up on a high horse right now and talk about being ok with making less, and how I'm going to be a bad doctor because I actually give a flying **** about how much money I'm going to make.

I also give a flying **** about my future income, and trust me, I'm a helluva lot closer to the payoff than you are. However, if my tax bill goes up (by a rather modest sum, as far as I can tell), I choose not to look at it as some punishment to fund social programs. Rather, I look at it as helping to ensure the long term fiscal solvency of the country by paying off the debt that Reagan and the two Bushes ran up. They're the ones who have necessitated this course of action. Being upset at the Democrats over this is akin to being pissed off at the medicine rather than the disease.

BTW, I'm sure you remember that both Reagan and Bush 41 raised taxes during their terms.

 

[airmax]

1. Access to quality care
2. Abuse from patients and doctors (just because you have insurance coverage, does not mean you need all forms of treatment)
3. Societal belief in this country (relates to #2. americans believe that the best most expensive treatment equates to quality care which is simply not true.)

when it comes to people thinking about health insurance and payment, i like to think of this little comparison.

people never like to pay for anything when it comes to health care. this is unique to health insurance within insurance. think of it this way. if you were backing up your car and bumped into another car, leaving a small ding, most people would most likely offer to pay for the damage out of pocket because you wouldn't want your insurance to go up. THIS NEVER HAPPENS IN HEALTH CARE. no one ever offers to pay for a vaccination out of pocket, a physical, or any other medical procedure.

 

[Szent]

1) Expectations (health care is not free, nor instant, nor perfect)
2) The burden of health should be placed on the individual, not the industry (if you repeatedly do stupid things, ie: not taking your BP medications, you should deal with the ramifications)
3) Access

 

[umean2tellme]

1) Expectations (health care is not free, nor instant, nor perfect)
2) The burden of health should be placed on the individual, not the industry (if you repeatedly do stupid things, ie: not taking your BP medications, you should deal with the ramifications)
3) Access

to #2. I'm a doctor, not a magician. If you want to lose weight, why not exercise. Trouble breathing? Try putting down those cigarettes.

 

[disorder]

people

 

[Cardiac]

If you take the partisan bickering out of this discussion, it becomes a simple problem. This liberal vs. conservative crap just wastes time.

The simple fact is that top-of-the-line universal healthcare is impossible. I urge you to name one example any time in history where a country has successfully provided top-of-the-line healthcare to everybody. Any measure to nationalize healthcare, or even to have it function on government subsidies is only going to reduce the quality of care. There is an inherent tradeoff between the quality of our doctors and patients' access to healthcare, and this tradeoff is driven by money. If the government were to intervene, by increasing the number of doctors/nurses and paying the difference or some similar measure, this will only breed a greater number of bad doctors who are doing the minimum to get their government-mandated check. Reducing the incentivisation of excellence by taking the subsequent compensation out of healthcare will only breed inefficiency and sub-par care.

If either Gunshot or majahops has some theory for how a top-of-the-line universal healthcare system might work, I'd love to hear it. Otherwise, I urge you to think through the ramifications of government-mandated healthcare before you try to argue on its behalf. Yes, statements of the need for universal health make you feel good inside and might make a good admissions essay, but they're functionally impossible. Don't get me wrong - I love Obama as much as the next person, I'm just hoping he can't do anything towards universal health. If you're interested, you can look at my other posts to see a market-based solution that increases access while keeping the quality of our doctors.

As an aside, making money is never a bad thing. It's an all-too-common sentiment that getting paid makes you a bad doctor when, in fact, having good compensation makes our doctors better.

 

[majahops]

We funded/are funding a war which might as well be AGAINST Santa Claus, funded BY Santa Claus. What are YOU talking about?

Man, liberals just can never have enough. It's not enough that they say everyone should have healthcare, NOW its top of the line healthcare! Where do you expect to get the funding for this massive entitlement program? There is 100 trillion dollars in unfunded entitlements between Medicare&Social Security over the next 30 years. That is a present day figure with the expected amount of people retiring over the next 30 years. They have no idea where they can get the money to pay for this. But YOU think we can afford to insure every man, woman, and child in this country, and not only to insure them and guarantee them care, but TOP OF THE LINE CARE!

That is the problem with liberalism, funding social programs with money from Santa Claus. Saying we want top of the line healthcare for everyone, gives people nice warm fuzzy feelings inside, makes everyone feel good. And then reality hits and those of us living in the real world, know that the only way to provide these things is to massively raise taxes. Sorry bud, you might want to take a pay cut, but I dont. It's easy to sit up on a high horse right now and talk about being ok with making less, and how I'm going to be a bad doctor because I actually give a flying **** about how much money I'm going to make. You'll be singing a different tune if those policies get implemented, and you are struggling to pay student loans, a mortgage, 2 car payments, water, electric, property taxes, retirement savings, braces, and college funds for your kids.

It's ok to be mildly self-interested, it doesn't make you a bad person. You can still be a good liberal even if you actually want to get paid what you are worth for the amount of schooling and debt you've had to acquire to become a doctor.

 

[Gut Shot]

I urge you to name one example any time in history where a country has successfully provided top-of-the-line healthcare to everybody.

How about four? Switzerland, France, Germany and Japan all provide extremely good care to their entire populations.

Oh but no, America has the best healthcare system in the world! Jesus, if you want to see a problem, try this one:

 

[PlacesToFish]

maja: It's too bad you're too tired to argue. Technically, I should be too tired to argue, seeing as I'm actually in medical school and currently on day 10 of a neverending week of inpatient internal medicine, but I'm not. Comments as ignorant as yours get me fired up. Please, don't pretend to know the first thing about what I "see" from day to day. I shop at the same places as the "underclass" of this city, something your NorCal-turned-Georgetown mind might not be able to wrap itself around. Please, spare me the condescending spiel about psychological and financial blockades and how I need to be educated on the subject. I have been behind plenty of folks in the shopping line here in good ol' Balmer to realize where your so-called "blockade" lies, and all I seem to have going for me is common sense. Why don't you spend a couple of years in a city like Baltimore, outside of your comfortable Cali/Georgetown bubble, before you start running your mouth about schooling the old hands around SDN?

LadyWolverine,

I agree that healthy foods can be purchased cheaply at Wal-Mart. Furthermore, I am sure that living in Baltimore truly has provided you with the opportunity to witness poverty firsthand.

However, you make some assumptions that I would like to draw your attention to. First of all, many poor people do not have adequate knowledge about nutrition to make informed choices. People in these communities sometimes grow up calling Kool-Aid "juice" and thinking that french fries are a vegetable. To them, a salad is a plate of iceberg lettuce with ranch and maybe some carrots. I have had strange conversations with some of my neighbors who didn't even know what a cantaloupe was! Do you really expect them to pick out fruits and vegetables that they have never heard of (or never tried, anyway) with the little money that they have? Or to know that they should choose romaine over iceberg, or tomatoes over cucumbers?

Furthermore, why do you assume that everyone has access to healthy foods just because these foods are cheap at Wal-Mart? Do you honestly think that every impoverished person lives near a Wal-Mart (or another discount grocery store)? Living on the reservation, all we had were convenience stores attached to gas stations 20 miles apart. Sometimes you'd see some mealy apples or brown bananas (fresh produce was a rarity), but again... who's going to buy that when they look gross? For most families, going into town to go to Wal-Mart was something that you saved up for (it took several hours to get there and gas is expensive). To me, your healthy meal of chicken, milk and frozen broccoli is kind of a joke. By the time I'd get home, the broccoli would have thawed out and the rest of it would be spoiled. Thanks for the menu-planning advice, but I'd rather not get Salmonella.

The most insidious assumption that you make is that your experience with poverty is all-encompassing. Poverty is not a shared experience; it affects different people in different ways.

 

[Decicco]

First of all, many poor people do not have adequate knowledge about nutrition to make informed choices. People in these communities sometimes grow up calling Kool-Aid "juice" and thinking that french fries are a vegetable. To them, a salad is a plate of iceberg lettuce with ranch and maybe some carrots.

If only poor people could have knowledge as "adequate" as the rest of us. Like you said, these people have probably been dumb their whole lives. If we could only get the government to create a vegetable czar, this would all go away. I really don't understand why right-wingers always call us liberals elitist.

 

[Gut Shot]

If only poor people could have knowledge as "adequate" as the rest of us. Like you said, these people have probably been dumb their whole lives. If we could only get the government to create a vegetable czar, this would all go away. I really don't understand why right-wingers always call us liberals elitist.

Straw man, much?

 

[RoyBasch]

You should pull your head out of Ayn Rand's colon and have a look.

Gut Shot, you have my vote.

-Roy

 

[umean2tellme]

Well there are poorer countries with better healthcare, so I would imagine the U.S. could do something to make things better.

 

[gujuDoc]

LadyWolverine,

I agree that healthy foods can be purchased cheaply at Wal-Mart. Furthermore, I am sure that living in Baltimore truly has provided you with the opportunity to witness poverty firsthand.

However, you make some assumptions that I would like to draw your attention to. First of all, many poor people do not have adequate knowledge about nutrition to make informed choices. People in these communities sometimes grow up calling Kool-Aid "juice" and thinking that french fries are a vegetable. To them, a salad is a plate of iceberg lettuce with ranch and maybe some carrots. I have had strange conversations with some of my neighbors who didn't even know what a cantaloupe was! Do you really expect them to pick out fruits and vegetables that they have never heard of (or never tried, anyway) with the little money that they have? Or to know that they should choose romaine over iceberg, or tomatoes over cucumbers?

Furthermore, why do you assume that everyone has access to healthy foods just because these foods are cheap at Wal-Mart? Do you honestly think that every impoverished person lives near a Wal-Mart (or another discount grocery store)? Living on the reservation, all we had were convenience stores attached to gas stations 20 miles apart. Sometimes you'd see some mealy apples or brown bananas (fresh produce was a rarity), but again... who's going to buy that when they look gross? For most families, going into town to go to Wal-Mart was something that you saved up for (it took several hours to get there and gas is expensive). To me, your healthy meal of chicken, milk and frozen broccoli is kind of a joke. By the time I'd get home, the broccoli would have thawed out and the rest of it would be spoiled. Thanks for the menu-planning advice, but I'd rather not get Salmonella.

The most insidious assumption that you make is that your experience with poverty is all-encompassing. Poverty is not a shared experience; it affects different people in different ways.

I agree with this post. People might be working 2-3 jobs. Not everyone has access to personal transportation. I know that Walmart in Tampa is wayy out far in and the only way to get there from where I used to live in Tampa was via car or bus. There were a ton of poor people around the area where I lived and half the time I saw that they had to walk or take the bus to get to the grocery stores. the quality of the grocery stores in our immediate area did not have good quality fresh veggies that were not spoiled. Publix was also a drive away and far more expensive although it had better quality stuff. People need to take into account that they don't know everyone's individual personal story. I still stand by my original statement tat changes need to come at the bottom not when the problem is beyond no return.

 

[messenger634]

I'll try to be a little more specific -

1. Low emphasis (or lack of reimbursement) on preventative medicine.
2. Downsides of managed care that need addressing
3. "Awareness"

I say awareness because I work in an ER, and I'm not sure how many people know what their opportunities are as citizens, re healthcare. I have joked - seriousely - with co-workers about having some type of health awareness program - going door to door to meet with people and review their personal rights and options for their health problems. I think that might be an effective way to improve access in general. ex-the benefits and uses of going to a local pharmacy instead of the ER, or actually showing people how to find a pcp and how to use one. Sometimes its just amazing how lazy people are - including me!

 

[LadyWolverine]

For chrissakes people, the wal-mart story was just an EXAMPLE. I realize that "don't know everyone's individual personal story" and that I can't necessarily extrapolate my experiences to the entire population of the planet. Obviously. Oh, how I tire of that same silly, pedantic argument that seems to pop up in every single SDN thread. Nowhere did I ever assert that my particular experience here in Baltimore could be extrapolated to include the rural poor or cities with more urban sprawl. I never assumed that everyone in the entire country lives next door to a wal-mart. My "healthy meal" example may be a joke to you, but I assure you, I see the checkout belts loaded up with high-fat ground beef, 2L bottles of soda, boxes of packaged snack cakes, ice cream, and the like, which ends up costing twice as much as what I buy. Spend an afternoon shopping at the (Un)Safeway on S. Carey street, which is on Baltimore's west side. It is with in walking distance of many, many residences that house the extremely impoverished. They actually have a pretty decent produce selection (sometimes the broccoli looks a little tired, but a varied selection of fruits and vegetables), and, here's the kicker - the produce is almost ALWAYS on sale for ridiculous prices. As is the yogurt. As is the wheat bread. Then, stand in the checkout line, and see what the patrons actually buy. I used to get funny looks from the checkout clerks because I would arrive with a cart filled with fruits, vegetables, skim milk, yogurt, and wheat bread. Because that's apparently an oddity around here. And the reason for it must have very little to do with financing, because, as I've stated again and again, my grocery bills end up costing a comparable amount, or even less, for a comparable amount of food (maybe just not a comparable amount of empty calories or fat grams).

And, as to your first point, if you'd read my original post, you'd realize that my original argument CLEARLY states that the problem, at least here in Baltimore, is much less one of access and more of educational deficit regarding healthy food choices. But it's OK, I understand. You just wanted someone to jump all over.

I know what I see, day in and day out, when I'm walking down the street, when I'm shopping for groceries, when I'm in a convenience store. True, maybe the lady in front of me with the 3 hyperactive kids at Safeway who loaded up the grocery store belt with 8 x 2L bottles of soda, a few boxes of hostess ho-hos or some similar snack cake, 6 pounds of full-fat ground beef, countless packages of bacon, a sack of onions (this was the only identifiable vegetable in the entire order), 2 containers of sour cream, a box of butter sticks, and a couple of boxes of sugary kid's cereal and then paid for all of it with food stamps had some special situation for which she was purchasing these specific items and foregoing healthier choices. But it becomes very difficult to give everyone the benefit of the doubt when you keep seeing the same thing over and over again.

Look, my main point was that there is obviously something grossly wrong with either 1) basic healthy food education or 2) priorties. I guess you missed that part. I've already demonstrated that it is possible to make AFFORDABLE healthy food choices here in this city, without having to stray too far from home or spend half a day commuting.

 

[Japika]

Three Major Issues

1) Lack of respect for physicians by the average person.
2) The belief that physicians are money hungry slackers by the average person based on skewed average salaries listed on the internet.
3) Dirt bad lawyers suing doctors for everything they do.

Solutions....
1) Create hierarchies in which doctors, who spend more time in school than any other professional, more time studying, more time helping people at the top of it. This should lead more physicians into the top positions in the country like presidency, majority of congress, and let lawyers deal with the criminals in the judicial system.
2) Educate people on how hard you guys have to work to become a physician, then express that in comparison to how much a physician really makes.
3) Grant immunity to physicians from lawyers. How heads of boards pay closer attention to what each physician is doing.
*Suing every doctor won't help the country. This individualistic approach isn't the solution. If a doctor does something wrong, have somebody report it to the board, and the board will do it. That will keep prices down.

 

[majahops]

Look, my main point was that there is obviously something grossly wrong with either 1) basic healthy food education or 2) priorties.

In my feeble, simple little premed mind, this statement illustrates perfectly what separates even the most compassionate conservative from any liberal.

The compassionate conservative is able to recognize [and many times even care] that there is in fact a given problem among the poor (this statement relates particularly to poor minorities). However, this is typically where their concern for such matters deadends - at the recognition stage.

The liberal (compassionate or not) is able not only to recognize that a given problem exists, but is able to see structural societal factors that contribute to the problem.

This is not to shift your mind to the thought that liberals are out to attack big business or "the man," although that's a typical conservative retort... It is to emphasize that liberals, for whatever reason, are able to sympathize and somehow even empathize with groups of people who's cultural and material lives are radically different from their own.

... This is why the privileged white kid from "Cali/Georgetown", which you refer to, might find himself intent on seeing to it that his nation provides the same type of health care he receives to a random, black, impoverished family in say - South Carolina. So intent that he would ask to have his own taxes raised to see it done...

... This is why he may be concerned with the REASONS why this particular demographic is - at the end of the day - eating substantially worse than he and his friends and family.

But alas, the reason I said I was too tired to provide more substance to my argument last night was because the matter of true importance here is actually not one of details or statistics. To be honest, what I am referring to here is not at all a matter of the mind, but of the heart... and my own heart has grown tired of trying to point the less overt societal injustices out to conservatives who simple haven't the heart's-eye to see them with.

And you can call me naive, or a hippie, or say I'm a babbling ***** who contemplates matters on a level intellectually inferior to yours. And, hey, there's a good chance you're more intelligent, thoughtful, better read and learned than I... But that doesn't change the fact that, however feebly stated, what I've said here is true - and many people know it.

 

[cheshir3]

In no particular order:

-Lack of universal medical coverage.
-Decrease in insurance reimbursements, which result sin more doctors taking on more patients, which snowballs into less time per patient and possibly worse care. and the rising costs of insurance versus coverage.
-Lack of primary care doctors.

 

[Cardiac]

How about four? Switzerland, France, Germany and Japan all provide extremely good care to their entire populations.

Great graphs, they have conclusively proven that US health insurance (Read: Medicaid) has thrown our healthcare system into the financial crapper. Unfortunately, they don't come close to proving your point.

Yes, it is possible to have universal healtcare with top-of-the-line care, but this will only persist for a short time. Look at countries where this has been implemented and you will see a diminishing quality of care. As the incentivization of excellence inherently decreases, so does the level of talent of the doctors. There is no denying the quality of physicians in the US compared to the rest of the world, and this is due to a mix of incentivization and a culture of excellence. Universal healthcare can only diminish this.