Wrapping up med school in June, some thoughts on healthcare

[NNguyenMD]

I've always wondered since even before coming to medical school, does it really cost so much to take care of someone in the hospital? Yes under our current healthcare economy is absolutely does. The amount of money that it takes to train eveyboday responsible for you in the hospital and I'm not just talking about the doctors, its the ICU nurses, ward nurses, nurse aids, respiratory therapists, Occupational and Physical therapists, phlebotomist, radiology technicians, social workers, all the way to the people who work in billing is just astronomical. Especially when it comes to the people who physically take care of you like the nurses and technicians, its costs them alot of money and years of schooling to learn how to make sure you get out of that hospital bed alive and well. The hospital equipment is really expensive, and the work it takes to keep it running correctly is also quite expensive.

Under our current system, we CANNOT afford healthcare. In my view at its current rate its damn near unsustainable for anyone insured or not. Even working in a major county hospital, people still lose their houses and property for the mere fact that they are sick.

I think for easy problems to take care of, heart attack, cellulitis, broken arms, cough and cold a nationalized system would save everyone an astronomical amount of money. I think that access would be in everyones reach, and most all people will live longer healthier lives without losing their house. For the problems that aren't so easy, hemorrhagic stroke, paralysis, end stage liver and kidney failure, we cannot give the same services that we continue to give today if we're going to make an affordable NHS system work. There has got to be a time for society to say "No, that money needs to be allocated to others who we are able to save." Healthcare to some degree will need to be rationed out, and for many people this will be very uncomfortable.

Rationing of healthcare is already happening, in my experience just as a student I've only seen it occur when the resources become scarce and providers are pushed to decided who gets a treatment and who doesn't.

And I'm not arguing yay or nay on an NHS system, I'm saying that its inevitable. Healthcare costs has already crippled the poor and working class, its begun to wither away at the life savings of the middle class and up. The costs will become so suffocating that society will have to nationalize the system, its just a matter of when and how many lives it will take for it to occur.

[The_Casual_Observer]

1. May you be blessed to never have hemorrhagic stroke, paralysis

end stage liver and kidney failure that those other inconvenient pests get. Medical costs have spiraled in the same way that housing prices have. The "medical industry" won't be satisfied until the last dollar has been wrung out of the hands of the customer.

[NNguyenMD]

20. between making more money from treating a dying end stage liver patient

and letting them die with dignity at home. Trust me I'd rather not "wring out that last dollar" for the healthcare industry. I think most healthcare workers would agree with me on that.

[Horse with no Name]

29. I'll stand beside you as a critical care nurse

and say...that most don't want to wring out someone's last dollar.
Now the guys in the big office, I can't speak for them...

[eShirl]

30. end stage kidney disease alive & going strong 9 years later

and he will be around for a long time to come. I suggest the cuts come from the profit-taking end before you start deciding who you are going to let die.

I hope you are not going to be practicing in my state.

[NNguyenMD]

36. I didn't mean that we shouldn't treat these people, but it does get more

complicated with these patients.

I'm happy to hear that your friend is doing well, and I hope that he lives a long time on hemo or peritoneal dialysis. He sounds like he takes very good care of himself, and would be the model patient who benefits from current technologies. But I'm afraid that the other end of the spectrum is much bleaker.

With a large segment of patients on chronic dialysis for end stage renal failure you have an enormous plate of complications, and its usually with the ones who aren't compliant with treatment. These patients typically have a history of multiple admissions for infected catheters, quite often needing admission into the ICU for sepsis. If they're luck they won't pick up one of the many hosptial acquired complications they're at VERY high risk for such as pulmonary embolisms, and pneumonias. Many of these patients are also unfortunately bedridden because quite a few of them have multiple amputations, and are at higher risk of developing sacral decubitus ulcers which also can make them septic.

This costs money, if society if willing to pay for it, which it does currently btw all dialysis patients are fully covered under medicare and medicaid, then they have to accept that its naturally expensive to treat these patients. This is not like taking an aspirin a day, this is very complicated highly expensive medical care. Think of it like living in a place like Florida. Its expensive to live there and there are a lot of hurricanes, and every hurricane season you're always at risk of a big financial loss, your home. But you pay the high prices to live there anyways, and when a hurricane does strike, you pay even more to rebuild.

If you want my own personal opinion, I'm happy to treat any patient so long as they prove to me that they want to live. That means if you're a liver patient you don't drink alcohol, you don't shoot up drugs. If you're a renal patient, you stop smoking, you come to dialysis like you're suppose to and keep your catheter clean. Guess what? Most of the really sick people we get in the hospital ICU, the ones who get all the complications that I explained earlier, they're the liver patients who continue to drink alcohol, kidney patients who keep smoking and doing drugs, and murmur patients who shoot up. You decide how far you want your healthcare dollars to go for them, because there are a lot of families out there with no healthcare that could use them.

[eShirl]

49. Guess what? I know what having someone on dialysis is like.

You really don't need to educate me about that, thanks.

[Stardust]

60. My sister has liver disease but no one's calling it end-stage outright

but at the same time, urging her to get the transplant,I'd love to hear some perspective on what to expect down the road. It's like trying to see down a long, dark corridor. No answers, only mysteries.

[NNguyenMD]

84. I can try, but remember I'm not even done with schooling yet...take this

with a grain of salt. Depending on what kind of liver disease she has, Hepatitis related, alcohol related, some of the more rarer ones like hemochromatosis or Wilsons, its hard to say what there is to expect.

The end stage of liver failure that I have seen has all been alcohol related and from Hep C. When you are in liver failure, several major things happen you are not able to process toxins in your body and thus accumulate high levels of ammonia in your blood. This makes people display dementia like symptoms, which is reversable but with chronic use of a very potent laxative called Lactulose that they take 4x a day. They also develop what called portal hypertension, which basically means that the blood in their venous system gets backed up in their liver and their veins dilate throughout their body namely in their stomach and esophagus which causes varicies. This can present with bloody vomit. And then they have cirrhosis, which is fluid accumulation in the belly. There are ways to deal with this, one is to drain is out with a needle by bedside, the other is a surgical procedure where they reroute your blood vessels so that you pee out toxins instead of running ti through a nonfunctioning liver.

Liver transplantation is always the best option, but not everyone is a candidate for it. I'm not familiar with the scoring system used by the United Network of Organ Sharing (UNOS). Its better to refer to their site for more info. www.unos.org

Goodluck to your sister, I hope that she does well. And thanks for sharing your story on this post.

[Stardust]

94. Thank you and good luck to you, too.

[Warpy]

2. That's certainly one area of reform

Another is the system, itself. Right now, all those expensively trained professionals and paraprofessionals have gotten that education on their own dime, and many are working to pay of crushing debt burdens. Many leave direct patient care and go into bureaucracies because they simply can't afford to pay their debts and have a reasonable income over and above them on what hospitals are willing to pay.

Another problem you may be aware of now, and you will be aware of when you start your internship, is working conditions. Hours are long, the work is back breaking, and management can require extra shifts at its own discretion.

There wouldn't be a nursing shortage in this country if they did something about the JOB. Fully half of trained RNs have left the profession because of poor working conditions.

The patchwork, piecemeal, brutally run and brutally rationed health care system we have now is simply unsustainable. It serves no one except insurance company upper management.

You're correct. It's broken beyond the point we can repair the system we have. We will need a new system, and my guess is that it will happen sooner rather than later.

[NNguyenMD]

3. good nurses are what make for great hospital care

nursing way up there with teaching and then some, is the most underpaid underappreciated job out there. Godbless the ones who are still working in the profession now.

Its an extraordinary profression with extraordinary pressures. I've gained a whole new respect for nurses since I've begun working alongside them.

[ikojo]

32. Both daughters of my boss's boss are nurses

They are hardly poor. They make around $40/hour and work three nights a week.

Not saying they have it easy but they work Friday, Saturday and Sunday night...not too shabby. I'd work 12 hours a day if I could have four days per week free.

[NNguyenMD]

37. believe me depending where they work, especially at a county hospital

they earn every penny for what they do and then some. Its just about the most demanding, unglamorous work you can imagine.

[greenman3610]

51. You need every minute of that time off to recover

that's if you work somewhere that doesn't
have mandatory overtime.

I once left my phone off the hook because I was too
exhausted to come in. They sent the cops to my house
to get me out of bed.
no shit.

and that 40 bucks an hour is far from the rule.
Most will start at 20 to 25 if lucky,
and get to 30 after 5 to 10.

[likesmountains 52]

81. I am an RN, I work 12 hour shifts..and I have "eaten dinner" while

sitting on toilet because it was the only time I sat down the entire shift...and even after 30 years I am not making $40/hour...there are plenty of things wrong with the health care system but overpaid nurses is not one of them!

[NC_Nurse]

4. I hear you.

I appreciate the acknowledgment of nurses role in actually making sure the patient LIVES. I also agree that here in the U.S. we are in some serious denial about death and the fact that sometimes it's better for everyone - not just from the money perspective - to STOP treating someone. Noone wants to talk about that little problem. Most sane cultures respect death and the dying - we torture people WAY past reasonable probability of recovery sometimes, for what I wonder?
I am one of many nurses I know who will be leaving the profession in the next decade. Some are retiring, some are just tired. I wonder who will be around when I am old and needing a good nurse...

[NNguyenMD]

19. I have enormous respect for you and your profession, godbless you for the

years you've given to your patients. I understand your reason for leaving. No one can do that job without being extremely physically and emotionally drained.

[NC_Nurse]

96. I'm not out yet...

Still working and will be for quite some time. :-)
Thanks for the props for nurses. You are right, it's a very demanding job. Most of us are middle age and up
and it becomes hard to do the more physical stuff.
You're gonna be a great doc! Best wishes to you! :hi:

[Coyote_Bandit]

5. Healthcare

What's that?

Haven't seen a doctor for nearly 8 years. And if I do happen to darken your door it will only be because there really is something seriously wrong with me - and if it happens to be terminal then I will probably refuse treatment.

Last real doctor I knew died a few years ago. He had been forced to leave his practice and retire a few years before that because he lost his vision. When he practiced he made housecalls. After he retired he would go an sit in the hospital with former patients who were dying. He cared about people. Only real doctors do that.

[NNguyenMD]

18. don't drink, don't smoke, wear a seatbelt, and exercise 5 x a week

that'll take care of like 95% of the things likely to kill you.

And you'll never need to see me

oh yeah if you ride a bike then wear a helmet.

[Coyote_Bandit]

42. Thanks, Doc

I've worn a seatbelt religiously since I was in an accident about 20 years ago and hit the windshield in a vehicle going less than 20 MPH. Nothing serious fortunately, just some nasty scrapes.

I walk at least 3 miles a day 4 to 6 days a week.

I have allergies to environmental and chemical pollutants - as do several other folks in my family. I don't smoke. Never have. Would love to be able to move out of the city and get away from the pollution.

I do drink but not much - maybe a couple glasses of wine once or twice a week.

Recently I've adopted a semi-vegetarian diet. I rarely eat beef or pork - though I do eat lean ham from time to time. I do eat chicken and turkey and fish - but no more than 3 or 4 times a week at most. Lots of whole grains, legumes, veggies, fruits and protein smoothies. No artificial sweeteners. I rarely drink soda pop. I can't remember the last time I ate fast food. And it is unusual for me to dine out more than once or twice a week. I feel a lot better since I have changed my diet - something which I acomplished gradually over a period of time.

I do what I can.

[druidity33]

65. hey doc...

I thought one drink a night was healthy?

What happened to moderation?

[NNguyenMD]

79. not a doc quite yet, but moderation is fine but overall alcohol is a #1

cause of death in the number of gun related fatalities and motor vehicle fatalities. When it is used at levels of chronic abuse, it is also the number one cause of liver cirrhosis, and a major cause of heart failure. But the car/gun with alcohol is more likely to cause death.

[truedelphi]

76. Years ago Your program would ensure your health BUT

Today we live in a country where the major chemical manufactureres are
convincing everyone that it is in their best interests to "purify" and deoderize,perfume and sanitize the air.

Places where this is now happening the most? Hospitals and nursing homes. I'm sure you'vve seen Lysol bottles in the hospital where you work.

Want to know what is in those products? Benzene, phenols, phenyls, zylene, ethylene, and various other substances. (This according to World Health Organization) Were these chems sitting around in a warehouse, the chemical companies would need to put them in special containers at great cost and dump at a super fund sote, also at great cost.

So instead they have put them into "personal care" products advertise and sell them... Pesticides are regulated as to the chems in them. Not so personal care products.

Wonder why there is this sudden epidemic of young women (thiry to forty age group) getting lung cancer? Chris Reeves' wife Marla recently died of lung cancer. Never smoked a day in her life, but she was in and out of hospitals with Chris and I am sure the health care workers employed at her home used these things. Constantly.

Pure breathable air is a rquirement for health. It virtually does not exist in a health care setting any more. And studies have proven that what you breath affects your health just as much as what you eat.

So continue your health program. But no matter how healthy your diet, and your exercise, don't be surprised if you or colleagues around you are stricken by lung cancer, skin cancer or pulmonary fibrosis.

[NNguyenMD]

82. I think the health report of the 9/11 rescue workers is a great example of

what you just discussed. But overall, heart disease is the number one cause of death in the united states. And the biggest risk factors are smoking and family history. You can always not smoke, and as far as family history, you can minimize your risk of having a heart attack by keeping vigilant watch of your cholesterol via your provider.

Over half of motor vehicle deaths had alcohol involved in some manner or form. Now that doesn't always mean that you were drinking alcohol, the other driver might have been too, which in that case you are SOL. But it is also prevalent in gun related fatalities as well. So in my opinion, I'd obstain from it completely.

Those are the big things that will kill you, cancer is a mix of family history and environmental exposures. I'm afraid that there is less you can do for that one, other than be vigilant of your surroundings. If the water near your home glows maybe its time to look for a new place to live.

[Phx_Dem]

90. and having your Dr check the C-reactive protein is good idea

according to my GP.

[NNguyenMD]

95. LDH isn't a bad one either, though it could almost mean anything

[KT2000]

87. bullcrap

the entire medical community is missing a huge source of chronic illness and birth defects.

100,000 commercial chemicals have been dumped into our air, water, food and just about every consumer product you can mention in the last 50 years. We are just now learning how these chemicals interfere with proper development; affect the immune systems of the young; affect fertility and sexuality; affect the proper functioning of the heart; affect the proper functioning of the brain, and on and on. The current research does NOT make it to the medical journals, in fact most of it is rejected for "lack of interest."
My guess is that you have been taught to respond with skepticism when chemical issues come before you.

Sorry, but there is a big hole in your education and a big hole in your practice if you do not make the extra effort to learn about the effects of these chemicals. They are ubiquitous and are the 800 lb gorilla in the room. Unfortunately their effects are and will be the burden of the medical system. For all the admonitions to stay healthy - we still have increasing rates of cancer for children and an epidemic of neurological disorders in children. What role do you think chemicals play in these issues, what role do chemicals play in the epidemic of auto-immune illnesses, heart disease and neuro-degenerative diseases. If you track the research - a lot!

Congrats on finishing your education and I wish you well.
But along with the admonitions about "personal behavior" please realize that your Parkinson's patient could very well be living next to a backyard chemist (yard nut with chemicals); the child you are treating for asthma could be going to a school that has a monthly pesticide application contract; the child with behavior problems could be continually exposed to neurotoxic chemicals in the home; the fatigued housewife could be spending her days in a brand new home off-gassing high levels of formaldehyde and could be exposed to a highly toxic chemical (BCME) when she adds clorox to her wash and cleaning regimen.

Best of luck to you!

[NNguyenMD]

91. heart attacks still kill more people annually

those are preventable if you don't smoke, and helps more if you don't drink. If there is a family history of diabetes, then you definitely need to be vigilant about your own nutrition. Yes there are a lot of environmental carcinogens, but for anyone those are preventive measures that go a long way to maintaining health.

Alcohol is the number #1 risk factors in trauma related deaths for all young people.

I'm not arguing against you, the previous poster stated that he didn't go to a physician, I was reminding him of some basic tips to stay healthy.

I was not making light of the effects of carcinogens on public health.

[KT2000]

97. That was good advice BUT

the personal responsibility crusade, while good advice, is also being used to steer attention away from the environmental exposures over which people usually do not have a choice and make huge profits for huge international corporations.

Carinogenesis is the least of the worries from these exposures. Did you know that heart rate can be affected by exposure to Roundup? Do you have any idea how many people's life-long arrhythmia has been initiated by over-exposure to herbicides (products such as weed & feed)? This is just a bit - So much has been learned.

My personal doctor was told before he graduated that diabetes was a rare illness. Now it is epidemic. Of course you know that fat soluble chemicals often find their way to be stored in human fat - to be released into the blood when there is weight loss and stress. Dioxin and PCBs (among others) can be found there. Dioxin and PCBs have been implicated in causing diabetes.

All I am saying is that if you dig for it, you will find that chemical exposures play a role in our leading causes of death and illness. To relegate these powerful influences on health to obscurity, as has been done in the medical mainstream, is absurd.

I am not really getting on your case, but rather I wish for you a career that is satisfying and is constantly challenged by new knowledge and the truth that comes from that. The choice that society has made to ignore the influence powerful chemicals are having on us all is economic not health based. When you avail yourself of that information you will be a much better and more satisfied physician - I promise you that. The alternative is frustration and anger with your patients.

:hi:

[truedelphi]

78. Isn't it true that about half the money spent on health care

in the USA is money we spend propping up the insurance companies?

Have to allow those CEO's to make hundreds of millions ya know. It's the American way

A research study published this summer indicates that our northern neighbors in Canada are not just universally insured - they are across the board happier and healthier. This is done for far less money per capita than here.
(Can you say single payer health plan?)

[KT2000]

92. One third

goes to "administration"

[truedelphi]

118. Thanks KT

[HiFructosePronSyrup]

6. Hmm. No it doesn't.

It costs that much because all those people plus more want to make a huge profit off of it.

Look at pharmaceutical companies, for instance. Check out their income in the United States compared to their percentage of sales in the United States. They rip us off here because they're allowed to rip us off here. Same goes for insurance companies and other things.

If we nationalized our healthcare the prices would drop. And there's the rub. They'd make less money if we nationalized our healthcare, so that's why they lobby so much against it.

[NNguyenMD]

15. my friend, running a hospital is not like running a Walmart

believe me it costs a fortune hiring even the barebone staff you need to running a healthcare facility. Ever worked in medicine before? Ask any DU nurse or doctor what is involved in their daily job. How much do you want to be paid to be responsible for someone hanging to life on a thread, and taking care of ALL of their bodily fluids? How much do you think you should get paid for handling dozens of needles and injections on patients who potientially have HIV or Hep C? I think people who are in that work damn well deserve to make a decent living for what they do.

As for drugs, I'm with you there. Outpatient drugs are a disgrace. I'm a newbie to the healthcare profession and the "latest" drugs for hypertension and cholesterol that have been shoved into my face by pharm reps are either combinations of or mild variations of whats been out there for like 10 years. And they still charge an arm and a leg.

Congress could have mandated that they dictate the price they will pay for drugs with the new medicare drug plan, but we all know how that went.

[druidity33]

66. well...

having worked in upper Manhattan for awhile cleaning up the parks (Fort Tryon, Highbridge, + other Wash Heights neighborhood areas) i and my coworkers were constantly picking up needles and condoms. We dredged portions of the Harlem River, fer chrissakes... talk about a mess! But hey, guess what? Most of us were volunteers or working off a "stipend" ( for me $800 a month to live in the city). I lived in a group home (ok, it was a commune) in Staten Island and commuted every day 2 and 1/2 hours in each direction. My coworkers and i found a severed hand, beaten prostitutes, the worst kind of human shit, angry dealers, voodoo ritual remnants (bucket full of blood, goat's head, MANY dismembered chickens, other unidentifiable things), etc.

If there ever was a scale of jobs that deserved good pay, that one should be near the top. And yet, no one made more than around $5 an hour ( a stipend is not a wage). We were the highest paid Americorps crew in the country.

Doctors and nurses are necessary, but i tell ya , the whole lot of them seem to suffer from some kind of self-importance syndrome... don't let that happen to you. BE REAL.

[lapislzi]

67. Of course it is expensive to run a hospital and treat people, BUT

...the trend among hospitals is that they have become "for profit" corporations. They're run by large hospital corporations who are in business to MAKE MONEY. That's not even factoring in the pharma and medical supply/equipment cartels. That is the cold hard fact of it and you must know it too, being a doctor. Then there's the insurance companies--also FOR PROFIT entities--who can only turn a profit by NOT paying claims. You've got a basic conflict right there. Profits are the problem. Take the parasitic insurance companies out of the equation and you've solved part of your problem right there.

[truedelphi]

80. Also the health insurance industry would seee a huge drop

Probably 60% or so in policies written

[borlis]

7. This is very interesting

Thanks for sharing. I remember Hillary Clinton getting laughed at when she suggested National Health care years ago. Realistically though, something's got to give. Prices are way out of control in this country compared to others. My hubby was hospitalized a week ago for pneumonia. They admitted him through the emergency room in the middle of the night and he stayed for 2 nights after that. We have BCBS insurance, so I think the bills will be paid at 90%. Yesterday we were guessing at what the bills would be when they start coming in. I am thinking somewhere around 30K. I hope I am high considering he didn't have any surgery. But even then we will owe 3K to the hospital. Which I plan to pay over time. It's really easy to see how someone could be bankrupted by a medical problem. Every year my hubby gets a raise at work (not a great one, but something) and sure enough six months later the insurance will go up and take away half of the little pay increase there was. There has to be someone out there willing to tackle this problem.

[lumberjack_jeff]

8. We currently ration based upon profitability..

... or based on ability to pay, however you want to look at it.

A wealthy or well-insured patient with end-stage liver failure is a more profitable customer than a poorly-insured customer with manageable diabetes.

[NNguyenMD]

10. I'm not sure if there is a huge difference, The poorly insured will always

have access to drugs, but he/she may end up losing their property in the process. A hospital social worker will connect you into medicaid if you are unable to pay for healthcare services, but you cannot own any property at the time that you do this. That is a crime if you ask me. You can save the patient with diabetes.

The liver patient will be a financial sink hole for anyone, especially if they're not a transplant candidate.

[Cleita]

13. This is not a solution. Impoverishing a whole family for a generation

because one member needed extraordinary health care is not a solution and it isn't necessary. All the money poured into healthcare and doled out by insurance companies and managed care could cover everyone if most of the money goes to health care, not administrative costs and corporate profits.

[NNguyenMD]

17. I agree, I was just stating what happens in that situation

no one should lose everything for being sick

[zanne]

63. Lord, prevent me from becoming a "financial sinkhole"

Let the doctors practice medicine and leave the rest to the accountants. It used to be that way, but now doctors are much more concerned about the bottom line. If you don't go into medicine with the goal of caring compassion, why bother?

[NNguyenMD]

77. I'm sorry, that was a careless statement. What I should have said was that

in the end stages of liver failure, you can sustain someone artificially for quite some time. They need near dailt transfusions of Fresh Frozen Plasma, which we harvest from donated blood, Albumin and Vitamin K. Many of them also begin developing loss of cognitive function from the effects of the high levels of ammonia in their body, and the prognosis becomes really bad at that point. We can spend the hundreds of thousands of dollars it will take to sustain them, if that is society's will.

The point I was trying to make that, in those cases where the quality of life is poor and there is little benefit from added therapy, at what point do you stop treatment and use those resources to help other patients. Do you think that there isn't a huge crowd of the sick waiting at the doors of the hospitals for a free bed to open up? Do you think that we as healthcare workers don't take into consideration that while we have this terminal patient in our hands, there is an Emergency Room downstairs that is FILLED with bleeding sick people waiting to get through the doors?

Is there no compassion when thinking about the other people whom we can save?

[zanne]

88. That's the question with no answer.

I used to think that, if someone was terminally ill and no longer able to function (or even think), that they would be better off dead. Then my mother was diagnosed with Alzheimer's. I took care of her for ten years (the last two years she was bedridden, incontinent and could no longer speak). But she could still smile and laugh and that made it impossible for me not to force fluids when she had an infection, then rush her to the hospital when she became dehydrated. I don't know if there's an answer to that question; I used to be so sure there was. I guess there's more than one point of view when it comes to deciding whose life is valuable and whose life is not.

[Gregorian]

9. Yes, but we have money for other things.

I used to be a cardiac cath lab tech. I've seen it all. I'm also an engineer, and know what is going on behind the scenes. And given the cost to live in this society (ie. real estate), it's pretty well fixed. Yes, those radiologists and cardiologists making a half million a year are sucking up a bit. But here's where I see the real problem.

We have the money. It's just going to the wrong people. Who needs cluster bombs being manufactured. And that stuff is all MIL-SPEC. That means it's all extremely expensive. No hand grenade is to go off until it's meant to go off. And then some. How many millions for the newest fighter jets? How much for a B-2 bomber? A trillion dollars lost at the pentagon?

Our military is killing us. It's a chronic systemic disease. It is rationalized through fear. And we are forced to pay up or face the IRS and all of it's teeth.

I hear what you are saying, but I think we can do what is important. For the people of this country. Not for it's corporations. Darn it, there's an FDR quote floating around lately, and it's to that effect. We did it then, and we will do it again. Or be an unhealthy country.

As far as I'm concerned, access to medicine is part of America's infrastructure.

PS- I hope you do well in your profession.

[NNguyenMD]

12. thanks!

[Jcrowley]

45. That's pretty much it

Social services for life are being sucked away by the machinery of death. Slashing the military budget by a half would open up many corridors and still leave enough firepower for the most trigger happy interventionists.

[Cleita]

11. That group of Harvard doctors over at Physcians

for a National Health Plan, have crunched the numbers and have come to the conclusion that we can deliver quality health care to everyone if we stop the waste that comes from our corporate, for profit health care system. Also, it isn't even a theory anymore. Other countries have proved it can be done and that this quality health care can be delivered for half the cost of our system in place today.

[eShirl]

35. thank you for posting that

[Turbineguy]

14. We should start viewing health

as a valuable asset to society instead of illness as a way to make money.

The health system is the leading edge of a bizarre economic model based on consumption in total imbalance with production. In a consumption driven economy, the benefit of having sick people is that they consume and on a vast scale. Our health system makes even the poorest able to compete with the rich in consumption of health services.

[NC_Nurse]

16. No kidding!

If we promoted health and wellness programs and paid for them...wow....

[Ron Green]

25. And to promote a sustainable and health-affirming culture . . .

rather than the toxic culture that our consumer culture demands. Plus, critical thinking and media literacy to combat the addictions that have become the hallmark of our "society:" tobacco, sugar, instant gratification, big cars, brand names, celebrities, shopping. . . the list is long.

Think how much we could change our country just by demanding time on TV for PSA's equal to that of commercials!

[CanSocDem]

34. The best posts of the thread.

If only the push was to lessen the number of health consumers instead of expanding the list.

[haydukelives]

21. Wrapping up nursing school in May

Looking forward to improving the health care system with you

[NNguyenMD]

24. feeling's mutual =)

[applegrove]

22. All Universal Health Care systems ration out some very expensive treatment

They all do. There is a pill or treatment out there that costs 20 Million. And when the health care system cannot treat you.. you have the right to go out and buy it yourself if you have the money.

By putting everyone under the universal tent..those rarer diseases are taken care of via shared risk. Shared risk over generations and shared risk over the population. That makes it shared risk squared.

No longer will business go bankrupt if they have one or two very sick employees. Because the risk of that is shared across the board.

Right now.. pharmaceutical companies decide on what pills they will investigate. And it isn't always pretty. Though many of the drugs they investigate will be life-savers. Keep in mind that in the future..the pills they do invent will make some of what you say ..so expensive.. but then treatments will come down in price. In Canada..corporations have offer you a drug plan as a teaser for signing on. Normally people pay for their own prescriptions.. or have a private insurance plan to cover that. Or they pay out of pocket. Or the well-fare system pays.

So the mix you are sorta talking about already exists in the Canadian model. The French too are at about 70 per cent public/private. So universal health care is pretty much just talking about covering the things that make sense over the shared risk of illness, chronic illness - except the drugs. (don't know if drugs are covered in France).

Why not extend your system to cover people across the board. Right now the cost per Canadian for health care is about $2000 or less. Per American..it is up wards of $6000 dollars. And that includes all the people who don't get treatment because they don't have a plan. So they die or live chronically ill or get sicker. A certain portion of the population are not seeing doctors, getting treatment but still your prices are so high.

When looking to a plan..look around the West and pick and choose the parts of universal health care that will work best for the USA. By all means. But you ignore the shared risk squared when you say that more serious issues should not be covered. There is room for that. Especially if you put a value added tax on luxuries and home decor items, fashion, hair cuts, dye jobs... and all the other frivolous stuff we spend our money on when we don't need to. Mall business may scream bloody murder but prices for goods are already coming down due to China & outsourcing. So it isn't like they are hurting. They are just competing with each other and the same tax on all of them will not change how they compete.

What will hurt them more is a health care system that bankrupts..well half of your bankruptcies are health care related. That hurts retail a great deal if a family has to start from scratch and don't shop for a decade or longer. McJobs will hurt retail more than anything.

Add it all up. And shared risk health care..across generation and across the population is the cheapest and most effective way to deliver health care to any population.

What will be rationed..will be drugs (depending on whether you have a plan or not) and plastic surgery. And million dollar treatments..until they come down in price. And such.

I don't know all the details...but it is pretty interesting stuff when you think that universal health care is both more equitable and efficient that your private system.

[NNguyenMD]

23. there is a great FRONTLINE program on drug costs on PBS and...

it says that the governments of Europe and Canada dictate how much pharmaceutical companies will charge for their drugs. In fact, every country except the United States has cost control when it comes to pricing pharmaceuticals.

[applegrove]

28. Under Nafta we actually added to the time until a patent runs out.

New drugs very expensive.

[bobbolink]

39. Other countries don't ALLOW patents on medications!

I was shocked when I first learned this years ago.

It makes it clear just how bass akwards this nation truly is.

Think of what a difference that would make in the availability of meds!!

[applegrove]

46. Um..yes they do. Pharmaceuticals have patents so somebody will

bother to research and make the drugs that are needed. The issue is how long should the patent (monopoly) last? What is fair.

Some countries like India ignore worldwide patents when it comes to emergency epidemics like AIDS.

I'm not sure exactly how long the patents are in Canada. But they certainly exist.

[bobbolink]

83. umm, no, you are mistaken on that

I first heard this from someone from the Czech Republic (who was a doctor, by the way), and then found later than most countries are like that.

They don't believe in making huge profits from health issues.

You are also mistaken about the "research" issue. That is a PHARMA talking point which is simply not true. Most drugs are researched with government grants.

We must first face the truth. We, as murkins, CHOOSE to allow companies to make huge profits from our health miseries. Those PHARMA CEOs make millions and millions, and that is OBSCENE!

[applegrove]

89. You and I will have to disagree. We need drugs and private corporations.

They just need to be monitored if they are not doing a good job. And patents need to be based on the need for the drug (is the issue solved already by other drugs... you get a short patent). How I see it anyway.

[bobbolink]

99. Yes, I saw from your other replies that you are on the side of

the corporations.

Maybe some day you'll understand what that is doing to this once-great nation.

Other countries are doing it much better without the corporations, so I don't buy that it "HAS" to be corporate owned.

I guess the deaths coming from this don't matter.

:grr:

[applegrove]

102. I'm all for a better more universal health care system. And for shorter

patents. And longer ones only for really desperately needed drugs.

Really - it isn't as black and white as you paint it. And I think the drug companies do not quite get how they are hurting Americans with their support of manipulation of the market.

But really - the guy who invented the light bulb got a patent. What is so different about encouraging innovation and research. A mix is the way to go. A mix of public and private. Why every country in the West is in fact a "mixed market economy". Cause that is how it works. You let business to stuff they willingly do..and you use government to step in and fund areas where corporations drop the ball.

People are living longer. I agree that pharmaceuticals have behaved terribly in the USA. Especially when it comes to drug laws and smear campaign against Canadian generic drug makers. So too the Bush health care plan is crap.

No need to push me out of the middle and into the gang of sickos just because I do not agree exactly with you. Shades of grey. There is a middle you know.

[bobbolink]

117. Dying from lack of medication IS black and white

Again, since you seem to want to bypass this, OTHER COUNTRIES don't patent medications. They care more about their citizens than they do about exhorbitant profits.

NOBODY NEEDS PAYCHECKS ADDING UP TO MILLIONS AND MILLIONS EVERY YEAR!! Especially while our citizens go without needed medications. That is just plain crazy, and anyone who cares to actually look at that, can see it for what it is.

Thank you for IGNORING what I said about R&D. That's a RW meme, btw. It completely sidesteps the reality, and the truth. It's EXHORBITANT AND OBSCENE PROFITS!! Check the profit margin of these PHARMCOs! You can be mad all you want because I'm not buying your excuses for these sick corporations, but that's just too bad. I care more about people than corporations.

And, yes, we all know that the "middle" has been pushed far to the right. So, if you're content to be in that "middle", and ignore those who are hurting so badly because of this policy, then that's your choice.

OTHER COUNTRIES DON"T DO THIS! People are living longer in other countries, also.

[Cleita]

41. Myself, I think we should outlaw big PHARMA.

There is no reason why drugs can't be developed in our university hospital system, with government grants, and the patents contracted to the best manufacturers of course after bids have been made. Those drugs that aren't that attractive could be manufactured as non-profit by the government.

Today big PHARMA supports the most corrupt of our representatives in Congress. The profits are as big as the oil industry and most of it comes at the expense of the taxpayer and the patient.

[applegrove]

48. Pharmaceuticals save lives. And make life pleasant for billions of

people. They deserve a patent..just not something that is unreasonable. As always..good to have a mix of government and industry. Pharma is no different.

I don't understand why Pharma is so pro-Bush. Seems to me if Americans had universal health care.. Pharma would do very well. People would be healthy enough to benefit from long term meds. Which would make more money for them (even if patents were a little shorter).

[Cleita]

68. They get the patent only because they develop the drugs.

This invites a ton of abuse by the PHARMA industry. For one thing they don't develop needed drugs that are unprofitable and could benefit those with rare diseases. They also keep developing drugs to get patents to replace perfectly good drugs that have gone to generic. It's a corrupt system.

Drugs should be developed and tested in universities under government grants where there is no temptation for profit. Then they could bring in the private sector to manufacture them. This would make the drug industry compete to manufacture the drugs and would keep the price down.

For those unprofitable drugs the government could give the industry an incentive to produce them. But the business of profiting from sick and elderly people the way it is today sucks.

I assume the reason big PHARMA doesn't want universal health care is that it's more profitable for them to keep the corrupt system in place.

[applegrove]

71. Universities would be overwhelmed. For sure they develop some stuff.

But they are also there to teach students. If there was no patent.. there would be no drugs. And many drugs developed by drug companies are life-savers.

Don't throw the baby out with the bathwater. Patents are in ingenious way to reward private research and trust me.. other countries have them too. It is the only way to get a myriad of research done.

I belief that universities should be given extended patents if they fix a problem and find a drug that the pharmaceuticals ignore.

[Cleita]

72. The development of a drug shouldn't be a for profit enterprise.

That's why I suggested universities, but it could be done in other venues through government grants. However, there are many universities throughout the country, even the world. I can't imagine that they would be that overwhelmed and probably would welcome the cash to expand their various departments through research. The University of California system does it all the time as long as there is grant money, something that started to disappear in the Reagan years.

On edit, I forgot to add that universities hire researchers, who already have their Phds. to work with the profs and students relieving them of most of the burden.

[applegrove]

103. Canada does alot of that type of research too. But you do need a mix.

We are all mixed market economies. No point in pretending that we haven't had a mix of corporate and public investment in innovation for the last 50 years. And it made for a huge middle class for once.

The issue today is how corporations are regulated. And indeed that the corporation do not end up owning governance. That isn't the way it is supposed to be.

[Cleita]

104. Although I'm pretty much a social democrat, I don't go as far

left to advocate communism. I believe we need capitalism to thrive as well. However, health care and other basic needs should not be thrown on the free marketplace as a commodity. Even though a certain amount of entrepreneurship and profit making can be mixed into these industries, that should never be the reason for their existence and they need to be heavily regulated to make sure no one is denied what they need to survive and thrive.

[applegrove]

106. I agree with that. Though even public health care rations medicine. They

don't often go for the $100 million dollar treatment of a rare disease (usually childhood diseases..cause folk are children for only a little bit of their lives). That being said..I'm all for regulation. Especially aggressive drug companies who cross the line.

[applegrove]

107. Here is another August article by Malcolm Gladwell on the Risk Pool - FYI

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=103&topic_id=233362&mesg_id=233362

[Cleita]

108. Thanks! Interesting article. I always felt that pensions

as well as health care should go into a centralized fund so that workers could take it with them. I lost so many pension benefits because when I changed jobs or the company went bankrupt the pension benefits ended, not to mention health care benefits that often didn't kick in for six months at a new job.

I wonder why companies are so short sighted that they can't see that such a system would benefit them. If they are afraid of workers changing jobs then they could put their money into more attractive salaries and working conditions to keep workers. It would seem the would welcome not having health insurance and pensions worries.

[applegrove]

109. Yes. Perhaps offering a drug plan could replace health benefits. Don't

know if it is maybe more expensive. But that is because Patents are really long in the USA.

Many automotive companies settle in Canada or open plants here because we have the free health care.

[Cleita]

110. Yes, some guest Al Franken had on said that this morning.

He was actually ragging on Wal-Mart but he mentioned that the Canadians could produce cars much more cheaply because the company didn't have to shell out for health care. It would seem the obviousness of this win-win situation hasn't sunk into the miniscule brains of our corporate leaders here stateside. I don't even know if they are just being mean and don't want the hoi polloi to have the same benefits they do.

[cynatnite]

26. Good preventative care could go a way in helping...

Even with insurance rates are so high that people won't get care until they are too ill to work. If free medical care was widely available to all we would see more getting mammograms, colonoscopies, and the old fashion physical. Illnesses could be caught before they became problematic which would save untold amounts of money for when they became more serious.

[Cobalt Violet]

33. And treat liver disease before it becomes end stage?

:wow: That's an idea.

[Lydia Leftcoast]

52. That is my biggest complaint about the current system

Either you pay premiums that are so high that you can't afford preventive care and diagnostics at any price, or you have such a high deductible that you end up paying full fare for all the tests and diagnostics (about $300 each), so that's another disincentive.

It would be more cost effective to make sure that everyone had all the standard tests and immunizations and health counseling free or at a nominal cost, and then we wouldn't have so many late-stage cancers and diabetic comas and pneumonias and heart attacks and strokes to pay for.

Kaiser-Permanente sort of knows this, although they're not as good as they used to be. Their philosophy on immunizations is that it's cheaper to give a thousand people flu shots at no additional charge than to treat one person who is in danger of dying from pneumonia.

My current insurer here in Minneapolis charges me for flu shots because I'm an individual subscriber, not a member of an employee group, as if my premiums go into a separate drawer earmarked just for me. :grr:

[Canadiana]

27. Here in Canada

as you know, our health care is free. The system is not perfect...but it works. I need an operation? FREE. Need to see a doctor? I have my little health card, so if my GP isn't working, I simply walk in to a clinic, show it and I'm in. FREE. Its all free free free, and though there are going to be some problems because of that, its still an absolute comfort.

[Monk06]

47. Not quite true but close.............

All Canadians pay healthcare premiums which
vary in rate and coverage from province to
province.

In BC premiums are subsidized 100% under
$20,000 per year. And reduced to zero
subsidy over $28,000. This rate is for
individuals or combined individual net
income.

Subsidized premium rates prorated by income
as of 2005 are as follows. Family rates over
$28,000 differ according to total family income.

The current adjusted net income thresholds are:
$20,000 - 100 percent subsidy
$22,000 - 80 percent subsidy
$24,000 - 60 percent subsidy
$26,000 - 40 percent subsidy
$28,000 - 20 percent subsidy

Note Adusted Net Income is Net Taxable income
according to the previous years income tax filing.

[ikojo]

31. An executive of one of the hospitals here in St Louis

gets paid approx a MILLION bucks a year. What does HE do to provide healthcare?

[bobbolink]

38. First of all, congratulations on your accomplishment!

That is no small task!

Second, have you joined PNHP? www.pnhp.org (for some reason it's not coming up right now, but there is a very good website there) They have lots of good information, and I would think it would be good networking for you.

When you are talking about costs, one of the things you don't mention is the cost of schooling. By that I mean, you talk about the debt, but don't mention that it's NOT NECESSARY for every individual doctor to have such a huge debt burden. Other countries don't. If we also subsidized our educational system, that would also ease much of the problem.

Speaking of which... are you aware that people from poor areas can receive free medical schooling in Cuba, if they are willing to then practice in poor areas? The rational is they get free schooling, graduate with no debt, so they can practice medicine among people who need their services for a much lower fee.

Isn't that great?

See what this country could do if we really put our minds to it?

sigh....

Best of luck to you! :toast:

[NNguyenMD]

40. Lots of thanks =). There is actually a National Health Service Corp that

offers full government paid scholarship of tuition and fees to students willing to commit one year of service for every year of scholarship that they give you. Wouldn't it be wonderful if everyone joined? Unfortunately they can only take so many, but usually they are the ones truly dedicated to providing primary services to underserved areas of the nation.

http://nhsc.bhpr.hrsa.gov/join_us/scholarships.asp

Its a great option when compared to the alternative scholarship...joining the US military. More people at my school did that instead, and will proceed to work at military facilities for every year of scholarship they accepted from the Army, Navy, or Air Force. And its a great scholarship in peace time, not so great today.

And its not just doctors who incur lots of debt, going to college for nursing, physical and respiratory therapy is very expensive as well. There are some programs in my area, Syracuse NY, where nursing students can get tuition paid in full if they agree to commit a certain number of years working at the hospital they train at for school.

[bobbolink]

85. I didn't know about the bhpr. That is encouraging, but of course

it serves very few, if I'm reading your correctly.

At any rate, my point was that in other countries, where education is valued, doctors don't start out with a huge debt hanging over their heads.

One more factor in our health care mess that needs to be changed.

[qwertyMike]

43. Move to Canada

We need you

I cound tell you my long, long story, but it was about $145,000
I didn't pay a penny - it all went to (you)

Plus 3 babies

Mike

[leesa]

44. I agree. National shared risk is the only way to have coverage.

Private insurance doesn't offer a whole hell of a lot anymore anyway. You will always be able to buy it if you really want to.

[lisainmilo]

50. Healthcare is a commodity!

We are the ONLY industrialized country without NHS. I believe healthcare should be a right for all citizens. They way it stands now, it is a commodity run by insurance corportations and pharmaceutical corporations. Perhaps the cost would be different if it didn't need to go into the pockets of CEO's, etc.
I was going to do a study on pharmaceutical corporations ( and I may still...just need time ) because of all the TV ads I have been bombarded with lately. There is no way for a physician to know about all these new meds, they have to depend on the manufacter to give them the info on it. So why are we being bombarded all of a sudden. I looked up the generic name for Lunesta - eszopiclone, and came across this. http://phx.corporate-ir.net/phoenix.zhtml?c=90106&p=irol-newsArticle&ID=804572&highlight= Now this tells me this is a commodity for investors. Not only that but if you go to Lunesta at http://www.lunesta.com/ you can get 4 free tablets with your next prescription....How nice! So all those commercials ...Ask your Doctor?? Has taken people away from their healthcare providers and is now run by pharmaceutical corporations. People may feel more in control, by asking their doctor, but really the doctor should make the diagnosis based on symptoms, labs, studies, etc. However, this is not what is being presented on T.V. ads. The ads are giving the person the symptoms, then telling them to ask their doctor about the med.

Now medicaid, it's a mess. For example, say Joe American 70 years old is on Tagament. Say its been a good medicine for him for quite a few years now. Now Joe American, lost his home due to his declining health and he had to admitted into LTC and he is now on medicaid. One day, as a nurse, you get a phone call from the pharmacy, Medicaid is no longer paying for Tagament ( or what have you ) Now the facility doesn't want to buy it, they are already strapped, since most of their residents are medicaid. So what happens? You have to call the Doc and change medicines, now what if it doesn't work and Joe American begins to suffer from terrible indigestion? Say he sleeps flat. Say he has uncontrollable reflux and he aspirates. Now he has aspiration pneumonia. Now what is the cost? I could go on and on with this scenerio. This is what is happening.

Medicare.....lots of documentation, by the staff...or the facility wont get paid.

[Lydia Leftcoast]

53. My brother the doctor stopped taking Medicare because of their

regulations. He hates insurance companies, but he said that Medicare is so paranoid about cheaters and so burdened with minute regulations that they send threatening letters for innocent mistakes.

I'd support Medicare for all, as Kucinich proposed, but the rules would have to be streamlined.

[earth mom]

54. Do doctors really need to make as much money as they do?

Does big pharma need to rip all of us off? Do the insurance companies need to screw us all over the way they do? HELL NO!

Sorry, but take the GREED out of the healthcare system and then we can have a serious discussion about it. :grr:

[hunter]

56. Fewer Doctors make "good money" than they used to.

Now most of them are wage slaves like everyone else.

Welcome to the new USA. If the AMA hadn't been dominated by old farts living in the last century they could have made one kick-ass union. But now they are nothing, mere water carriers for big pharm.

[sir_captain]

105. Doctoring is a pretty piss poor way to get rich

Perhaps you don't realize it, but most American medical students exit school with *hundreds of thousands of dollars of debt*

I myself will have around $300,000, and that does not include the interest that I will be paying to the feds.

After leaving school, docs have the pleasure of working hundred hour weeks for somewhere around minimum wage. The average salary for a medical resident last year was in the mid-$30,000s. We're talking highly, highly skilled labor here, for 80-100 hours a week.

Once that finishes, they have to pay somewhere in the neighborhood of $30,000-$50,000 a year back to the feds in order to have any chance of getting their student debt paid off within 10 years.

I have no love of insurance companies or pharmaceutical companies, but the idea that young men and women are becoming medical students and eventually doctors out of greed is really a boring canard.

[leftofthedial]

55. why could we afford it a generation ago?

is all the technology driving costs?

[carpetbagger]

57. Not just technology, but lucrative stuff by itself.

Currently, the high-end procedures are the ones making the money. Those are the docs making the money, those are the hospital services, etc. When I say "high end", I'm talking more about what adults with private insurance are willing to pay good money on. Liver procedures can be just as high-tech, but it's the coronary patient, not the cirrhotic patient, that the system makes money from. The more things you do on people who can pay, the more money you make.

Other big money-makers are, of course, drugs and administrative costs. Streamlining costs has evolved from the 1990s managed care model to the 2000s profit maximization model. That's not good, since it gives a positive incentive for BC/BS to spend $90 to deny a $100 claim, thus doubling the cost to the system.

[leftofthedial]

58. It is the insurance companies (banks)

cutting themselves in on every transaction (and clogging the industry with so much paper that there are three clerks for every care provider).

and the pharmaceutical companies.

[Prisoner_Number_Six]

59. Two words.

House calls.

(...as the newly graduated med student runs screaming from the room...)

[JCMach1]

61. 100% Wrong- Having lived for several years in a non-national

system that actually works (UAE)... It is possible to get good health care.

Prices have to be under control probably through direct government intervention. That means hospitals, doctors,drug companies, insurance companies and consumers are going to have to lower their expectations. Sorry, but all of those folks are going to have to accept less $$$

Rationing is also BS. There is too much healthcare available in the US, it's just being allocated in a inefficient manner. Take Emergency rooms as a prime example (people using them for primary care).

[bmbmd]

69. UAE frequently runs ads in JAMA et al.

for American-trained physicians to work in their hospitals. They pay top dollar, plus expenses, and much of that income is tax-free. Perhaps UAE has good healthcare not because they restrict costs, but because they are made of money???

[JCMach1]

112. Not true, those jobs are for high-end specialist jobs

in private hospitals...

[midnight]

62. Congratulations. You just achieved an amazing degree of

education. Some thoughts on my experience as an end user. It is absolutely non user friendly. Way to expensive-Maybe your awareness will aid in the recovery of big pharmaceuticals, and insurance ceo's making off with big bonuses that could be better used to keep pricing down in hospitals. Also give those nurses respect when they page you. It is for your patients care that they call you.

[REP]

64. I Have Idiopathic FSGS - Am I SOL Under Your System?

In case your speciality isn't nephrology, idiopathic FSGS isn't caused by anything except perhaps havig te wrong genetics (I'm a young, hypOtensive white woman; the usual FSGS patient is an older black man with hypERtension). It responds poorly to treatment pre-dialysis and transplanted organs have been known to become show symptoms of FSGS (proteinuria) during the transplant surgery. It's a disease with a grim prognosis, and it's grimmer in patients like me, who also have extensive renal scarring from a chronic renal infection and stone formation as well as two other kidney diseases. I am an exemplary patient, extremely compliant with the treatment (such as it is) and didn't do something stupid, like get pregnant* ... but that doesn't change the fact that FSGS is a hard disease to treat and has a poor prognosis. Do I deserve treatment, dialysis and a transplant?


*Pregnancy is contraindicated in FSGS patients; yet if I wanted children, I would no doubt be praised as "courageous" for risking my life to do so. Billions of dollars in medical resources are thrown at the reproductive industry and the often premature and gravely-ill results; merely placing limits on how many embryoes could be implanted per IVF cycle would save quite a bit of money - and suffering.

[NNguyenMD]

74. I think you absolutely deserve treatment, and your story is a good example

of the dilemma we would face with a system that has to ration out its services. From what you've just shared with us, I doubt that anyone will question your need for treatment. But what about the patients who aren't so exemplary, the ones with multiple admissions for the mere fact that that they refuse to take care of themselves. Their use and reuse of the healthcare system drains out of the same pool of resources that you depend on for your own survival. Are we able to say "no" at any point?

[REP]

116. I Have an Above Average Understanding of My Disease

This is not say I'm wonderful; just that I had some advantages and can read and understand medical literature. Because of this, I have an edge in managing my disease without running to the doctor every five minutes (although, being nephrotic, I get sick so easily it sometimes seems like I am). For those without college educations, even understanding the patient handouts may be a challenge, and recognizing what symptoms need urgent care and which ones can wait is something not even HMO call center nurses can do well. I'm not excusing the patients with cirrhosis who continue to drink or the women in early stage renal failure who insist on pregnancy (and then demand a directed donation of a new kidney because "I'm a mother!"), but there's a lot of people who just don't know enough about their disease or how to manage it on their own, and lack the ability to get that information. Again, I agree there's plenty of patients who should know better, but I can't help but think there's almost as many who'd do better if they knew better.

[Festivito]

70. Already is rationed. Can't get bone marrow if over 65. ? is: Who choses?

Democracy, fascism, or democracy's fascism?

For half the price per capita, Canada rations by saying if someone wants it, everyone gets it. Cuba manages, we don't look at how well. (They're not rich by the way.)

We are rich. And we cannot afford what you would want, even though you have no figures to present, no links to back up your statements. I know family members with that last name and I expect better.

I certainly wish you well in your practice.

[Cleita]

73. Well, there is another reason for that besides the fact that

system favors doling out scarce organs and tissues to younger people. A very big reason that no one talks about outside of the medical community is that most doctors don't want to do this kind of risky surgery on the elderly because it increases the chances they will be sued for malpractice, which is another big problem plaguing our medical system.

[NNguyenMD]

75. no figures or links, just hospital experience. and it is expensive

I think anyone who has been hospitalized will tell you how expensive it is to go to the hospital. I'm not exactly sure what statements you're asking me to back up, I think you would agree that healthcare is expensive wouldn't you? I was saying that the current system is broken, and just walking through the halls of a county hospital you can tell that its ready to implode.

And I'm not sure what you mean when you say you "expect" better? Is it because I said that an effective NHS system in the US would have to impose limits on those with poor prognosis or refuse to be compliant?

I'm sorry that I sound cruel, but when you work with really sick patients with little or no chance of recovery, then you wonder whether its more cruel to prolong their lives only for them to live just alittle longer in reaching the horrific end point of their disease. Thats not what I call living. Maybe others might, but I see no quality of life in having your entire body sustained artificially with the only end point being death.

I appreciate your good wishes, I'm sorry if I've dissapointed you.

[Festivito]

111. But, so expensive we cannot afford good care for all?

One statistic that came earlier was that if all the people hired to deny insurance payments and all the people hired to obtain those insurance payments were dismissed, the money they were paid would give everyone currently without insurance, full insurance. In other words, we spend more on denying people insurance than we would spend just giving them insurance. So, the idea that we cannot give the level of care we already try to give seems incorrect. There is the added benefit that with everyone insured, there is no need to charge higher prices to account for costs of the uninsured from payments made by payers.

Saying we must ration seems to deter us from having national health care. It is something that should save us money, increase our good health, and even, possibly, enhance the service we receive.

[NNguyenMD]

86. the other question is, will a BM transplant over age 65 hurt this patient?

If you are refering to someone you know or perhaps even yourself. I'm not sure you just stated "Can't get bone marrow if over 65?"

Anyone healthcare professional would be crazy to go through the process of a bone marrow transplantation if they didn't think that the patient could survive the process. If its a healthy 65 year old with otherwise no contraindications to transplant, then they ought to get it. If it could kill them or cause them serious permanent injury than they shouldn't touch it at all.

[Vinca]

93. Here's real life.

I'm not old enough for Medicare, but old enough so private insurance is priced foolishly high and out of my reach. I have come to the conclusion that if I should become ill - let's say treatable breast cancer - I'm going to ignore it, live my life and die at home rather than send my family into bankruptcy and a cardboard house that used to contain a refrigerator. Fortunately, I'm pretty healthy at the moment, but I think this is a very sad statement in what is supposed to be the greatest nation on earth. You make some good points, Doctor.

[cmd]

98. I understand what you are saying

My Dad is eighty-six. Last September he had surgery for colon cancer and has been on chemo since that time. In June he was diagnosed with Type II diabetes. He is mentally alert, but can no longer stand by himself. He has bouts of vertigo that make him miserable. His doctors are going to extraordinary measures to keep him alive. I dearly love my Dad. I believe that at this stage of his life he should be allowed to die in peace. Let him eat the foods he likes when he is able to eat. Stop the chemo. It's not just about money, but also about quality of life.

edit: Congratulations and Best of Luck to you.

[NNguyenMD]

100. I hope your dad gets better. It must be heartbreaking to be where you are

right now. I don't know what the answer is. When you work in a place like critical care, where everyday you wonder what some of these patients have to look forward to when you send them home with lines, and trachs and peg tubes, you really wonder if you did them any good at all. Maybe one day, soon hopefully, we can have a health care system that works so well for everyone, not nearly as many people will end up this way. And for the ones who do, we will have plenty of resources set aside to take care of them as dignified and long as they want to.

I really do hope that thanks get better for the both of you. Thank you for the congrats, I hope not to let anyone here on DU down.

[Amesh]

101. Healthcare costs

Healthcare costs have spiraled out of control for one chief reason--government intervention--and the only solution is to remove the government from healthcare.

To illustrate my point, it is necessary to briefly recap how the healthcare system got where it is today. During the WWII, the government instituted wage/price freezes which prohibited employers from using higher wages to attract (or keep) employees. In place of money, employers began to use healthcare benefits (which were tax-deductible only to employers) as perks to work for them. Although this is commonplace today (and many people argue for more health benefits from employers) this marked the 1st time a 3rd party (the employer) was picking up the tab for healthcare. In effect, this shielded healthcare consumers from the costs of the services they were receiving. Coupled with President Johnson's Medicare and Medicaid programs, virtually everyone was having their healthcare paid for by a 3rd party (the government via taxation, or their employer).

These situations provided no dis-incentive for healthcare consumers to abuse the system and demand the best treatments irrespective of cost or supply. Also, physicians were able to charge prices that may have been above market value because they really were immune from market forces. As the costs started to mount, employers reconfigured the way they provided healthcare switching to an HMO model. HMOs had been around but had not made much ground until President Nixon signed The HMO Act allowing federal funding for some HMOs and giving them many government-bestowed advantages over traditional insurance. HMO's main purpose was to "manage care", i.e. ration care. They achieved this goal by restricting access to sub-specialists, treatments, and requiring pre-authorization for emergency department visits (amongst other things).

In sum, market distortions introduced by the government caused a boom in healthcare spending followed by an attempt to contain those costs via rationing.

The administrative costs inherent in such a system—forms, paperwork, bureaucrats—drive the cost even higher.

Onerous FDA regulations that make the cost of bringing drugs to market range in the hundreds of millions of dollars with only a few years to recoup R&D expenses before patent expiry, drive the high cost of pharmaceuticals.

Increasing rates of litigation with the subsequent rise in malpractice premiums have made the cost of doing business high for hospitals and physicians. Additionally, these concerns sway many physicians to order unnecessary tests or medications (defensive medicine) in the off chance that their initial diagnosis is wrong. The accumulation of these costs adds a lot to the burden of healthcare costs.

People would automatically reject, out of hand, a plan by the government to take over and police any other industry to the degree it does healthcare. Healthcare people view differently. If we are to avert a socialized, ration-prone medical system it is the idea that healthcare is a right that must be fought. Healthcare should be viewed as a very precious commodity, too precious for government to intrude upon and only the free-market can rescue it. To this end, health care savings accounts (HSAs), full tax-deductibility for health insurance premiums and tort reform should be championed as early steps toward solutions.

Amesh Adalja, MD

[moondust]

113. This must be why

virtually all the other western democracies have universal health care systems I believe run primarily by their relatively competent, honest, and representative governments acting in the best interests of their people and not their supergreedy corporate masters.

[Mayberry Machiavelli]

114. NN, what specialty are you matching? Internal Med/subspecialty? What

program, do you know yet? Do you know what part of the country you intend to go to afterwards? Academic or private?

I like what you have to say in your post and agree with most of it. I would be curious to converse with you either on this thread or via PM. I can perhaps offer you the perspective of someone who's spent many years in the public sector/teaching setting and now private practice for several years, even if not in your specialty.

I agree with the bottom line assessment that the current situation is just not sustainable, the question is how many years until the end. 5? 10? 2?

When you get to the point where such a large portion of the population is uninsured, and subject to financial ruin from even shorter term illnesses that they might otherwise bounce back fine from, how can this be politically tenable? It's amazing to me even now, and possibly would be the single most powerful political issue in America over the next several years, even more so than any Iraq or war on terra. Because it DIRECTLY affects almost everyone, and in a huge way. It seems plain as day to me and I'm not even seeing it in a county hospital setting. I can only imagine.

And it will happen regardless of who is in power. It's just not possible to sustain the current system.

All I can say is, those docs who are still making big dough in medicine better not spend it all in one place. I can't see that the buffet line will be open forever.

[NNguyenMD]

115. those are very kind words MM, I'm applying as we speak in fact and...

you're right on the money, I'm going into Internal Medicine. I'm looking into possibly Nephrology or Pulmonary/Critical Care in the future. I'd like to stay in the educational aspect in medicine, so I'm listing larger academic centers now like LAC+USC and LAC Harbour UCLA in California. On the east end, where I'm finishing up school I'm applying to New York Methodist, Maimonides, Kings County Hospital hehe I know, Strong Memorial in Rochester, and so on.

Are you an internist as well? Its such as great pleasure to hear from you, and I welcome any advice or perspective you have to offer me. Where did you teach?

Most of the opinions I stated earlier is largely from the rotations I spent in critical care sectors, like MICU and SICU. It seemed like so some patients, the was no end point to their care. The worst scenarios were patients who rolled in in very bad shape, and lasted for weeks before eventuall succumbing to their fate. This was at LAC+USC, where the ERs in the Los Angeles area are notoriously known to be jack full of patients lying in the hall ways waiting for a free bed. That ICU and step up unit was full 95% of the time trust me.

Anyway, I look forward to hearing some more of your thoughts on what to expect after the post-grad years, namely how you decided where to go after residency and what convince you to go into the private sector. I've got a hell of a lot to learn still.

[Mayberry Machiavelli]

119. I'll PM you or reply on this thread, possibly by the weekend.

Worked a lot recently and just need to crash and get some sleep.