Why our medical system sucks - a small rant

[matt819]

Preface - I have no health insurance.

Reality - I have a situation (doesn't really matter what) that requires medication. It's a judgment call, perhaps, but I think my doctor and I are agreed that medication is better than no medication.

Situation - I call my doctor to renew prescription. I get two -- not one, but two -- calls back from "gatekeepers" at the doctor's office. One says it's been some time since I came in and that I should make an appointment to come in for a consultation and get the Rx renewed. Another calls to remind me that I should have done this a few months ago.

Reaction - So, I'm supposed to spend $80 (of my own money - no insurance, remember) to waste my doctor's time to renew a RX that is going to be renewed anyway. At the same time, two non-MD gatekeepers with less education than I have tell me how to take care of myself.

Repeat this scenario millions of times a year and you can see why the system is broken. It has no respect for intelligent medical consumers. It has too many non-professional personnel wasting their time, and mine, trying to get me to spend more money than I have to. They seem to have forgotten that I am the consumer. I am not a child, and I am not an idiot. It's my money, my health - and, frankly, I don't need gatekeepers running interference with my doctor.

I am disgusted.

[yellowdogintexas]

1. remind them you have no insurance, therefore no gatekeepers

re: coverage,

and that it costs you a lot to see the doc.

Now, it may be that the physician actually has instructed the staff to get you in for an appointment to review systems, etc and make sure this med is still the best one for you to take.

[brainshrub]

2. But at least you get to choose your doctor!

:eyes:

BTW: Any conservative that tells you that you can't chose your doctor under a single-payer plan is a liar. In most cases you can, unless you are in a rural area.

Besides which, when you are sick it's more important to have access to medical care than choice. In the current system we have neither.

[Warpy]

3. I'm an RN, and I run into some of that garbage from time to time,

but I've been uninsured for 18 long years and I know how to deal with sweet young things who went through six month med tech programs and know it all. No, I'm not particularly rude, but I am quite assertive.

The problem is that most of the people they see ARE morons. Maybe they're tops in their fields, whatever they may be, but when it comes to how their bodies work, they're morons.

So take a very deep breath and explain that you and your doctor have decided upon a schedule for your visits (mine are every 6 months) and if she doesn't like it, to take it up with the doc, now refill the damn pills.

The docs have been great, though, and generally stick it to the HMO they're listed with by charging me the least amount of money they can.

[wurzel]

4. We don't have systems. We have rackets.

Legal, political, educational, and medical rackets.

[stellanoir]

5. yeah the system is horrifically broken

I generally don't ascribe to western medicine for myself but my kid has health insurance through his father. My child ingeniously collided into another child on the hockey court and split his upper right eyelid. Nothing major really, but the school nurse thought that he'd need stitches. Well 4 hours later, hanging out at the emergency room, a Doctor spent far less than five minutes with him and applied a adhesive that I later learned was chemically exactly similar to crazy glue to his eyelid.

The bill was for $956.00. 'Scuse me for a couple of minutes and a dollop of krazy glue. . .? No wonder people go broke. Oh but I forgot. . .with the bancruptcy bill. . .that's no longer an option.

We're so screwed without total reform.

[Hand]

7. If anyone tries to tell you that the Canadian system doesn't work...

Just recount this same story to them. If you'd been in a Canadian ER... well, you'd still have to wait and you'd probably have pretty much the same time and treatment.

Only difference would be the $956.00... subtract that from the equation. (Mind you, taxes are higher here--the big secret about how you finance universal health care is that everybody pays for it. On the other hand, everybody gets it, too.)

Also, no claim forms to fill out; you show them your card, pretty much as Clinton envisioned it.

Now, if you were in Cuba...

[Warpy]

10. Well, it's not exactly like Crazy Glue

or we'd have been using it for decades.

It's relatively new. There are a lot of new things out there now that we fantasized about 30 years ago.

There's a liquid bandage that's wonderful for cuts on the fingers. No more bandaids! It's great!

As for that bill, have a nurse friend look it over very, very carefully. I got a bill like that once, caught them in blatant fraud and bill padding, complained to the state Attorney General, got it reduced to a hundred bucks.

If he wasn't taken in for an examination of his corneas (a slit lamp exam using flourescene dye that would have colored his lower eyelid yellow), that bill is outrageous. You need to complain.

However, if they did do that exam in the emergency room, you may be stuck. You can try to get the bill reduced, and sometimes it works.

[shrike]

12. There are Indonesian tribes who use a vegetable paste as adhesive

Or at least they used to. I've read accounts of western visitors being doctored by the natives, who've used the paste to bind up wounds. Heals fast, leaves no scar. Have no idea what materials they use.

[Tux]

6. Sucks

I have no insurance at all. Many employers in my town refuse to provide it ("God heals all" fundies, I swear, I hate them). My gf goes to the local free clinic and gets decent help with her blood pressure problem. When I had a job, I went to a physician and I'll be damned if I wasn't charged $80: waited 30 minutes (only patient at time), had blood pressure checked, Dr. told me to relax, and gave me a sample of pills to see if they worked. She wanted to do MRI, EKG, and some other thing that would cost thousands of dollars. Our healthcare system needs medication for insanity.

[Sgent]

8. That's the doctor's fault

not the LPN's/medtech's.

In all the facilities we were in we had standing order's for refills of medication based on when you were last seen. On top of that, the doctor always tried to write enough of it to start with.

End result, 99% of the time if we said to come in, it was becasue the doctor wants to do something... bloodwork, followup on condition, etc.

One final note, you should look for a community health center at www.bphc.hrsa.gov. If they have one near you, you can get primary care, dental care, and drugs on a sliding fee.

[HuckleB]

9. This is painful.

However, I do have to offer something from "the other side," so to speak. Obviously, I don't know the medication or condition in question, however, as a psychiatric nurse practitioner, I cannot, in good conscience renew prescriptions on an ongoing basis without seeing the patient at some level of frequency. Even patients on maintenance doses, in remission, so to speak, face a medical issue that warrants some level of regular check in. To fail to do so would be malpractice, IMHO. Changes occur too frequently, sometimes slowly over time, sometimes quickly. But the reality is that dangerous crises often derive from psychiatrists and general practitioners who prescribe without regular check-ins, making the practice incredibly dangerous and irresponsible medicine. And that's only one part of the why for regular check-ins, nevermind that the practitioner who doesn't see his or her patients puts him or herself in a very dangerous position in terms of lawsuits if something goes awry. And there's a very good reason for that. The practitioner should be seeing his or her patients regularly. Medication is one tool of health care, but it is not the be all, end all in any condition. It acts within a complex biochemical and environmental framework that can change quite quickly, leading to diminished efficacy and/or serious side effects.

Now, that said, the lack of insurance can be blamed for this situation, more than anything. And that is THE number one problem when it comes to providing the level of care that people should be getting in this country.

OK. I'm sure this isn't a popular opinion. However, there are other pieces to stories such as this, IMHO.

Salud.

[Sgent]

11. I may not have made myself clear

I agree with you.

In our facility the doctor would decide that someone with controlled diabetes needed to be seen every three months, so she would write two refills on every script. We had standing orders to 1 ) authorize a refill if she forgot to write it on the script, but for no longer than the next appointment. If they called in and were out, we could only give 10 days of meds. Unfortunately this would work for pdocs in our area as they have 2-3 month waits to see one (PNP's? too)

[HuckleB]

15. Actually...

I was responding to the original post. But no matter. As you noted, I think we generally agree.

Yes, the wait for pediatric np services is just as long as for pediatric services in our area. And the wait for pediatric psych is longer still.

Salud.

[matt819]

17. And that's fine. . .

As long as everyone understands that this is the regime.

In this case, however, that was never the case. In fact, at one point I decided to stop taking the RX and was told that this was not a particularly good idea. In short, stay on the medication. End of story. If I wanted to see the doctor, I have enough sense to know how to do this. If the doctor wanted to see me, he has the capacity to let me know that this is his decision, not that of a gatekeeper.

And I have to come back to the cost issue. I mean, think about this. I know I seem like the proverbial skipping CD (okay, broken record), but if 100,000 Americans per day were required to see their doctors about matters that could otherwise be dealt with by phone, that's a daily additional cost of health care of $8 million per day (at $80 for that office visit). Is 100,000 a good number? Is $80 a reasonable assumption? I don't know. I'm not a statistician. But that 100,000 comes to 2,000 in every state, a minuscule percentage of most states' population. Multiply that $8 million out to $40 per week, and then out to more than $200 million per year. And let's add to that the time factor. Let's say every one of those 100,000 people works and has to take off two hours from work for a 30-minute appointment, and let's say they are being paid $10 per hour. So that's an additional cost of $2 million per day of lost production. So that "routine" visit is now costing $10 million per day. And, finally, let's take those 30-minute visits, and you have 50,000 hours daily spent by doctors, who are taken away from patients who might in fact need the personal service that I am taking away.

Is this simplistic? Sure it is. But it's one man's example of what is wrong. And, yes, it is rant, because I am pissed. End of rant, for the time being.

[Sgent]

20. Ahh....

Now we come back to another issue... The fact that phone calls are a cost center for doctors -- not a profit center.

Any doctor who talks a lot on the phone, espcially with patients, is financially foolish, since with a very few exceptions, no one will pay for that. The insurance companies would rather pay for a $50 office visit than a $20 phone call.

[HuckleB]

22. There is another piece to that equation, however.

That is the cost of issues not discovered because said transaction occurred over the phone, where communication is minimal by comparison to a face-to-face encounter. Further, this comes back to the insurance issue. How many insurance companies are going to pay for phone consults? Etc...

I'm only pointing out that what's perceived to be wrong at one point in time by one person is usually only a very small part of the story.

Salud.

[Sugarbleus]

13. GREAT RANT ...interesting replies too..

It does my heart good to see that people are talking about these issues.

Frankly, I'm pretty freaked out about the future of healthcare in this country. Something definately has to be done, no question.

Too many people uninsured, too many people WITH insurance being gouged and "handled", too many misguided docs, too few places to find relief and adequate care. Even the poor with state medicaid or medicare are being cheated out of full service.It's unconsionable.

I use medicare/medicaid as a disabled/aging person. I have suffered with a periodontal disease for 1,800 hours--75 days! The dentist wanted to do one thing, I wanted something else. They refused to see me until today--clinic is over-crowded and the only one in the county!

I need an extraction (oral surgery) and then partial dentures in the back so I can chew for heaven's sake. They say my healthcare coverage won't pay for that??!!(but medicaid will pay for full sets of dentures):eyes: It's a long story but suffice it to say, they simply don't listen to the patient, don't really KNOW the patient or their real needs and you can bet the store that when I scrap up some cash for those dentures (I will have to pay for them $KACHING$), they are going to cost so much more than would be charged if they were covered by a common insurance carrier.

I was without health insurance for some 20 years before this. There were a couple instances where extra cash was available to us. I used it for docs office visits and the meds only...no tests. The doc I was seeing would NOT allow me to come in every three or so months. He insisted I pony up the cash and go see him every single month in order to get my meds refilled. Other docs I knew of would allow a patient to let a couple months go by before they called them back in for a check up.

Eventually, with the extra cash supply dried up, my spouse offered to go into his doc on his SSI/medicaid insurance and lie to them that he needed this certain med....he did it for me. He risked his own situation to help me.

Whadda country! :(

[Sgent]

14. Medicare

pays for nothing dental. Medicaid is notiously bad when it comes to any coverage, but dental especially.

In my area of 100,000+ ppl spread out over the north quarter of my state, there is 1 dentist that will see medicaid patients unless they are in the hospital (jaw surgery, etc). That dentist is with a CHC, thus recieves a LOT more money from Medicaid, plus federal and state grants, and wouldn't see Medicaid patients except for that.

[Sugarbleus]

16. You are so right.... and your area sounds as desperate as mine is

for real dental care. Let's not forget vision as well; but thats another thread. ;)

Medicare, in it's present form, does little for real medical issues. Doesn't pay for drugs, dental or vision. It will pay for some "equipment", and yet doctors constantly ask hubby and other's why they aren't on Medicare. Medicare, Medicare, Medicare, NO Medicaid. I don't get it.

As for my current dental emergency and medicaid (I have both=Medi-Medi), my adult daughter had to step up for me and find an oral surgeon that would take me sooner than the "clinic" that refered me. I called the referal surgeon that the dental clinic suggested; they told me they were booked up and couldn't see me until JULY!!!!!!!!!!!!!!!!!!!!!!! Holy crap! I've been suffering with intense periodontal disease w/pain since the end of MARCH!! I had to go to my primary doc to give me pain killers! The dentist wouldn't. Unbelievable.

By the time this is over, I'll be an addict!!

These programs were intentionally ruined (instead of improved). And no one in power will move off the dime to do one damn thing about it. They roll over for the powers that be then come up with some lame excuse for health care coverage. Pisses me off to no end :grr:

There needs to be either a single payer plan w/access for those who are too poor to buy shoes OR universal health care for everyone. The uber rich can buy their own if they wish. I don't have a problem waiting for my turn on a normal doc office visit. Emergencies are different...they should be taken first.

End of rant.... And Many best wishes to those who live in Sgent's community.

[matt819]

18. Oh, good, a dental rant. . .

Is this problem representative of the problem with our system? I think so, but what do I know.

My child had a chipped tooth. We called the dentist to make an appointment to get it fixed. We explained as best we could what the problem was, hoping we could get this sorted out in one visit. Hah!

There was only one visit, and here's how it went. My child goes in, and the dental assistant looks at the chipped tooth and says, yep, that tooth is chipped. The dentist looks at it for 8 seconds, grunts uh huh, and tells us to schedule a visit for the repair. She was in there for 30 seconds. Cost? $42.

If this crook can pull this off regularly, he's pulling in some $5,000 per hour. I filed a complaint with the state's dental board of examiners. That was a crock. What a shock. They found he did nothing wrong. I thought about the LTTE route or filing a complaint with all the dental insurance providers in the state, but just got fed up.

This system is so seriously broke, I'm not sure it can be fixed.

[Sgent]

19. I don't really know enough

about dental billing/costs to comment, except to say did you talk to the dentist about the charge, and the fact you believed it should have been included in the surgery?

[Sugarbleus]

21. Dontcha just love it....

I went into my particular dental questionaire/rant some weeks ago. I got thee best feedback from DUers. To my dismay, dental malfeasance is rampant. I got some good info on what one can do IF they live in certain areas.

Anyway, my adventure in dental hell started with a toothache-March 31st. I went to my former "private" dentist to have him take care of it and start on a proper dental repair regimen as the "clinic" didn't do any cosmetic or preventative dental work. He took x-rays of the area and then said he COULDN'T FIND ANYTHING WRONG (??????) He said my back teeth were loose for sure, but he couldn't do anything about any of it; he didn't know what the problem was that was causing my pain. I told him I clench my teeth lately so he FILED my teeth down. Charge=$88. I'm wondering: is this a dentist or a tea leaf reader!?

I was in complete disbelief. I looked at the receptionist whom I know and said wha?? They whispered that I should come back if the pain didn't cease. SAY WHAT? My daughter said I shouldn't have paid the bill.

I went back to the medicaid clinic on an emergency appt. (still had to wait in writhing pain for two hours). That dentist DID find that there was decay under my crown and that the other loose teeth were from periodontal disease. He wanted me to go for a root canal. I called back and said NO, I want them out and I want partial dentures in the back. That was just the beginning and here I still sit....IN MINDNUMBING PAIN.

Unfreakingbelieveable.

I'm very sorry about your child. This clinic I have access to DOES care for the children much better than for the adults. They did a great job on my grandson with ongoing appointments and finished him up in good time. That, I can say is a good thing (for the kids). The rest of us have to "grin and bare it" I guess..

Maybe I should have gone to a veterinarian!! :think: Much more compassionate.

[bobbieinok]

23. medicare and medi-gap

medicare pays for no annual physical...except for one in the first 5 months.......my dr said 'don't even get me started on what medicare does and doesn't pay for'

talking to the people I went with on medi-gap.....they said what medicare pays for and the 10 different medi-gap plans pay for is based on the state of medicine and costs when the programs started....eg, medi-gap plans that pay for preventive medicine pay only up to ca $120

he didn't say, but I sure thought: 'it would be nice to bring the provisions and payment into the 21st century BUT not with this adm; they'd just wipe it all out.....pay for nothing'

[Sgent]

24. Not quite true

Medicare will pay for an annual or biannual gyn exam, as well as an annual mammogram, prostate exam, and digital rectal exam.

What it won't pay for is a "physical";, so for the 1/50 ppl over age 65 w/o a chronic health condition, you'll have to pay 50-150 (less for females, more for males) for an annual physical. Many medigap policies will pick up the difference however.

Also, it will pay for a colonoscopy every 10 years (preventative) or more often if indicated (previous polyps).

[oscar111]

25. RX's used to run forever. i remember when i first ran into this new idea

of having to go in to the doc to renew a RX. "gee what a huge hassle, and so unnecessary".

Same reaction as i had when i first ran into the new idea that checks to me can go "stale" in say one year, and need to get a re-issue on them... if one can wrangle it. At one time all checks were eternally good. As far as i know.

Both cases happen now because we dont have a progressive government putting a stop to these outrages.

Another case: tiny print and faint ink is used all over , to help trick us all, but especially to trick the elderly with their poor eyes. Disgraceful, to trick the oldsters. No progressive government would allow tiny print or faint ink or stale checks or stale RX's , at any time anywhere.

[oscar111]

26. Limit dr incomes to US average 5O K

that is the only fix which will work to fix our system.

it will drive greedheads out fast, and nothing else will.
Or perhaps you have an idea that will drive them out? The Frist types.

true caring healer types will stay in the field, since fifty K is enough to live on.
the entire average middle class does it.
============================
Current greedheads in the field will go away, and open up storefront Payday Loan shops to make an easy fortune that way.

now just watch, dear reader, as the doctor worshippers flame me. LOL.

[oscar111]

27. 25 nations outlive us: system is 37th: health of our populatn is 72nd

no typo, thirty seventh and seventy secondth.
37-- quality of our health delivery system

72 -- health status of our population.
both from ---
WORLD HEALTH REPORT 2OOO from the UN.

we pay the most per capita, BTW.
===========================
i forget the source on being twentyfifth, but google and you will surely find it.

interns are kept working 48 hours , no sleep.
isnt that a great, safe idea for patients? sure. I wouldnt want even my cab driver to work forty eight hours . Insane idea. Obviously insane to any observer.

[HuckleB]

29. Umm. It's not the doctors who are greedy.

Not compared to the administrative greed of hospital administration and the insurance companies, that's for sure.

Further, you damn well better pay for their education and give them the same salary while their putting in their 12-14 years so they can do their jobs.

Sheesh.

[bemildred]

28. One cannot simultaneously pursue quality and profit.

There is an inherent conflict. Every dollar of unearned profit is better care of the patient forgone.