Health Care: Good Reading

[drscott]

Hat tip Greg Minkow's blog: long but rewarding Atlantic article on health care reform. They killed his father, and the bill was $636,687.75.

Comments

[txkink.livejournal.com]

A great reply both here and to my comment above. What happened to both you and this woman's husband is inexcusable. The doctor who ignored your warning about the MAOI should have been fired.

I cannot agree with you more on the subject of insured vs uninsured getting different care. I'm not told what a patient's funding status is until we're discussing disposition. It has absolutely no bearing on what I order in their care. In the ER especially, there's absolutely no distinction made between the two. The law states we have to treat all comers regardless of their funding. In fact in Dallas (as elsewhere) it was the doctors who refused to go along with asking patients if they were here legally or not. The hospital administrators floated that idea with us but ethically we were all opposed.

Many of the accounts I hear of horrible care seem to come from hospitals with trainees. This is not an excuse but is perhaps an explanation. Despite many rules about supervision, numbers of hours worked, etc. there are still problems with poor care - some of it due to poor supervision while others are from trainees who do not follow standard of care.

I am one of many doctors who desperately wants this system reformed. Our fear is that it will sink deeper into the mire of bureaucracy which will not improve care. Money is not and never was my motive for medicine. Even 14 years after residency my salary is $20K per year less than new graduates starting in private practice groups. My hope is that all those who have no coverage can have some consistent and reliable resource instead of the designation "self pay" which means they will ultimately get a huge bill.

[audrabaudra.livejournal.com]

Curtis, I know. I know it's desperately unfair to tar the whole country with one brush based on the anecdotal evidence about my husband's injury. Now that the emotion has worn off from my recounting, I will agree that American medical research drives the world, and our practitioners are fantastic here, too. I agree that a person might get treated poorly in Canada or the UK. I had an IUD inserted as birth control in the UK, and my US doc was appalled when I came over here, which goes to show.

Yet I think that if you go to an ER in the US and 1) you have a funny accent, and 2) you say you have "travel insurance" when the doctor (Yes, the doctor) asks if you have any coverage, then 3) the likelihood of being treated like cattle at the abattoir is significantly higher than it might be in a country where healthcare is more freely doled out.

I know it's hard to believe that the doc never told us to put ice on the injury, but he didn't. I'm extraordinarily detail-oriented in these situations, plus I still have a copy of his written orders, kept for our NZ insurance. He wrote instructions about 800mg of ibuprofen, but nothing else. When we got home and got Ross to bed, I Googled and saw that the primary treatment is ice. Couldn't believe that the doctor hadn't said a word about something so basic. Perhaps he thought the hospital would have to supply a cold pack if he did.

More, anecdotally speaking. NZ: I was in orthopaedic trauma in a bed across from a Swiss woman who'd fallen whilst penguin-watching in Antarctica and come to Christchurch as first port of call for treatment off the Russian boat (international!). She spoke French, and we chatted, but her English was quite poor. She was going home to Switzerland to recuperate, so her insurance sent a nurse to travel with her. The nurse was fluent, and she set about making the discharge arrangements. I was a witness to what happened next: a man from Christchurch Hospital came to Giselle's bed and explained to both women that Giselle would have to pay NZ$30,000 in cash before she could go.

It's only half the amount in Euros--15,000 or thereabouts--so it wasn't a huge burden. Still, the NZ hospital wasn't accepting the travel insurance's promises.

Limitations, then, on travel insurance wherever one goes...but Giselle wasn't sent back to her hotel room with advice to see a specialist "whenever," either.