Thursday, May 29, 2008

Good doctor, bad doctor?

The other day I was reading an article in the Washington Post about a kid who had a heart attack and was saved due to very expensive medical treatment that doctors tried despite not knowing whether it would work. And it got me thinking about the much maligned U.S. health care system, and my own experiences with it this year, and how it compares to the rest of the world.

Let me put a disclaimer right here: I am not at all educated about health care and the way it works. I know a bit about the U.S. based on my own experience. I also know a bit about health care in France, England, Germany, and Senegal, based on my experience and experiences that Torsten has had. I haven't even seen that Michael Moore movie about this. Seriously, everything I know is based on personal experience and not on any objective, researched literature.

But here's what I think about health care in the U.S.: The system sucks. But the quality of the health care itself does not suck. But I could be wrong.

The system of health care sucks for many reasons, first and foremost being that not everyone is included, and the people who aren't included are the same people who tend to be marginalized and excluded from most societal benefits. Other reasons why it sucks include that it's overburdened, that it's expensive, that insurance is complicated and confusing, that you only really get insurance if you have a traditional full-time job, that the main onus of paying for health care is placed on employers, and that there isn't much of an emphasis on preventive care, which means that more people develop serious medical conditions.

But for people who do have insurance, and do receive treatment for medical issues, the health care itself is good. At least most of the time. Sure, there are bad doctors and people sometimes have bad experiences, and that's true everywhere in the world. But we have a lot of great doctors here. We have a lot of really impressive medical technology. We have state-of-the-art hospitals. We have excellent and varied treatment.

Yes, the systems are overburdened and doctors are often rushed and on call for 36 hours (or more) straight. But compare this to Britain's NHS, which provides a basic--very basic--level of care for free to everyone. Nurses are often rude, hospitals are overflowing, people are sent home or shunted aside when they have serious conditions that need to be dealt with, waiting times are outrageous, and the overall level of care is deplorable. The NHS is infamous for this kind of service, or lack thereof.

But then I hear horror stories from people here in the U.S.--but they never come from primary sources. It's always a friend of a friend whose doctor diagnosed her in two minutes, incorrectly, and almost killed her with a mistaken prescription. I have never personally experienced anything like that. Yes, doctors run late and waiting rooms are full, but when I finally see the doctor, he treats my problem, and he treats it well. And if I don't like a doctor, I can find another doctor and get a second opinion.

I firmly believe that everyone in the U.S. should have access to this level of health care, regardless of ability to pay. I believe that the system is flawed and it needs to be fixed. But I've never witnessed poor quality of health care itself. It seems to me that the 6/7 of U.S. residents who do have insurance have it pretty good. But like I said, I really don't know much about it beyond my own experience.

So my question is, have I just been incredibly lucky with the doctors I've encountered and the insurance plans that I've had? Have you had terrible experiences in medical settings, in the U.S. or otherwise? How do you think the health care itself--not the health care system--in the U.S. measures up to that of other countries?


  1. I've had shitty experiences with both doctors and insurance (not paying claims that were clearly valid, not paying claims resulting in my bills being sent to collection, doctors ignoring real problems, misdiagnosing, being rude). I'm not exactly ready to jump on the socialized medicine bandwagon, but I do think people need to get medical care in some capacity free of charge. Interesting to hear that about NHS because it is painted as damn near idyllic in Sicko.

  2. I DESPAIR over health care, and especially how I will afford it as I grow old, and I am a Healthy Person! This is one reason why exercise is important to me. It freaks me out to think of being old and sick and not having help.

    I have no frame of reference for the quality of healthcare here. I GUESS it's good? I think it swings wildly, depending on where you get it.

    In my small, rural, hometown, I did't get the quality (although they are NICE and FRIENDLY) that I get in an affluent suburb of a major US city now.

  3. It's interesting, because my mom was making a similar point a while ago. She is the company nurse for a company that does some testing work in Canada, even though they are based in Minnesota. One of the employees was seriously injured and had to be treated in a Canadian hospital, and she pointed out to me that the good thing about US health care is that it is still a consumer-based product. We can go to whatever doctor we want (generally), and doctors only get paid when we choose to use them. In countries that have national health care (including Canada), it's not consumer-based, and so you don't get luxuries like private rooms and a specific doctor. You get whatever they can give you.

    Of course this too is based only on anecdotal experience and not on any research. It is possible that some countries with universal health care have great treatment (including Canada - this was just one instance). I just don't know.

  4. I completely agree with you.

    Part of the fuck up of this "system" is the insurance companies and the idea that if money can't be made off it, there is no use in putting it on the market.
    Examples?: Two I personally know of are a new AIDS drug that is so effective it almost is like AIDS is in remission for some and this drug is not very available, also herbal treatments such as Hemp Oil on cancers and tumors (very effective!) but not used as it can't patten it! so no money made.

    medical care should not be a money maker, its a basic human right.

  5. I don't know much about health care in other countries, but from my experience and my family's experience, I'm happy with it. The one problem ever with insurance that I've had is when the insurance company did not want to cover my 3rd MRI during the tests that led to my MS diagnosis. The doctor felt strongly that it needed to be done. I told him I would not have it done if it wasn't covered (a couple thousand dollars). He said if they could not convince the insurance company to pay, I would not have to pay. They felt it was that important to get done, and felt they were in the right. As it turned out, that was the test that finally diagnosed me and the insurance company did reverse their decision.

  6. I agree with you: in my experience, the care is good, but the system sucks. If only we could have it both ways.

    Also, you should go ahead and watch that Michael Moore movie you mentioned. It is depressing beyond belief, but important anyway.

  7. In my experience, problems have ALWAYS ALWAYS been with the insurance companies. I really wish it wasn't all about the goddamn dollar. And I really hate it when insurance companies won't pay for preventive measures (say, Jason's TMJ mouthguard, which will cost us $1,100) but will cover the jaw surgery at $6,000. It sickens me that they'd rather save money than improve people's health.

  8. I had an expierence with a doctor once that left me realizing that some doctors are all about the money. I didn't have insurance coverage for this particular kind of doctor at the time and the doctor wouldn't see me unless I paid him $1300 up front to even speak to me. This was recently, too. April of 2006. I had been seeing this doctor for almost 7 years and because I didn't have the money he wouldn't even talk to me. I call that poor medical care.

  9. I've had some experiences with doctors over here where I feel like they just don't care about you. You wait for hours, and they are in and out of your room in 5 minutes. They are too busy rushing off to the next person to sit around and ask you questions about your health/lifestyle.

    My sister broke her arm in Germany one summer and had to get taken care of at a German hospital. They took x-rays, set her arm and gave her meds, and she only had to pay around $90. She got back to the US and went to her regular doctor, and they charged her insurance hundreds of dollars for the office visit and x-rays. And they didn't even re-set her arm since the German doctors did such a good job. It's all about making money over here.

    Both of my jobs have been with smaller companies, so my insurance plans have never been stellar since there are so few employees. I have to pay $50 for office visits, $40 for some generic perscriptions, and it sucks. The focus needs to be taken off making money and be put on trying to help/save people.

  10. THere are some doctors I've seen, where I've just not liked their attitude, but they were still good dr's and gave me proper prescriptions. I have also have times where my dr visits were super short. Once because it wasn't their fault because they were needed for a birth and squeezed me in to begin with and the second time was this last time- I was literally in there no more than 10mins. However, there wasn't much she could do and I got the meds I wanted (and had before). As I've recently written on my site, I don't have health insurance. Mostly because I got dropped from my mom's plan after college and I didn't bother getting it thru my own job because I figured I wouldn't be there as long as I have been since school. So I've had to pay for a few things sans insurance. It sucks, but I've also learned that there should be a basic care plan that is cheaper for those who don't have insurance. It's taught me why some people don't go to the dr because of no insurance as well. It's expensive! I thank god I am in the position of still being able to (somewhat) afford going and paying out of pocket.

  11. I am completely in the same camp as you in terms of experiencing mostly great health care (personally) and believing everyone should have access to the same level of care.

    There is a downside to that ideal world, which I think both you and I would be willing to tolerate. And that is, an increase in the number of patients without an increase in the number of doctors means wait times will go up, time spent with your doctor will go down. And that's speaking very broadly with lots of room for interpretation.

    Point being, we all pay one way or another in both situations. And I'd much rather see everyone provided with equal care and the added administrative hassles that come along with it.

  12. You're right, the system sucks. Working in the schools here gave me a first hand look at how the system is failing those who cannot afford full coverage.

    This is a hot issue for me and I'll stop now lest I end up in a major rant.

    I've had pretty good luck with doctors (as opposed to insurance companies) but the corporation that runs the clinic I visit shut down the one closest to my house. This did not please me one bit.

  13. I once had to see an Italian doctor. The hospital was like a big communist barracks and I had to wait forever. And then the doctor told me over and over that maybe things aren't as NICE in his hospital, not everything is NEW like in America, but at least everyone has access to him. He seemed nervous I might give his hospital a bad rap when I went home. I was all, "Whatever dude, just give me the drugs."

    I know a few people who had babies in Italian hospitals and I thank God I got to give birth in the USA. But, like you said, all personal experience!

  14. I think people often confuse NEW with GOOD. Uhm, sure our hospitals are clean and sure our doctors are educated but is it phenomenally better than anything else? No. Our doctors are quick to write a prescription for anything, avoid telling people that they need to lose weight and generally don't do as good a job as they can.

    I have nothing but nice things to say about doctors I've seen here in the US but I wouldn't say that we have exactly cornered the market on anything.

  15. Brava!

    I actually had one close call in a hospital once. I was to be admitted after haveing some sever abdominal pains. So I had to recite my medical history. Well one doctor and one nurse decided to give me a particular drug and just as they were to do it one of the asked if I had a certain condition. I said yes.

    She proceeded to get rude with me about how I should have told her. I told her that I did to another nurse and that it is in my chart. So she huffs off and looks at my chart and lo and behold it is there. She never even read my chart.

    I could have been in serious danger if they gave me that drug.

  16. I am a well-educated person who lives in the suburbs, so I am guessing that my anecdotal "evidence" about the quality of health care in our country would be very different than the anecdotal evidence of someone with less money who lives in a rural or urban area. My guess is that there are awesome doctors who work at free clinics and in rural areas because that is what they want to do, and that there are sucky doctors who work at free clinics and in rural areas because they couldn't get other jobs. Just like I'm sure there are nurses in the UK who are mean because they can be, and there are other nurses who are great because they love their jobs.

  17. No, I agree with you: the care itself is good; the cost and the difficulty in getting coverage, those are the problems.

    I think doctors can make mistakes just like anyone can, but that since their mistakes can be SO SERIOUS, those stories get spread. People think doctors should be PERFECT and PSYCHIC, so whenever they're NOT we all hear about it as if it's a Major National Crisis.

    I have a Norwegian friend who gets free national health care, but when she had her baby she shared a room with FIVE other women. FIVE! And she says it's nice to have it free and stuff, but that it's really hard to get to USE it---like, hard to get an appointment, hard to wait for hours to see the doctor she has an appointment with, hard to get ACCESS to the benefits she supposedly has for free. Whereas I was alone in my maternity ward room (and that was standard in both hospitals I've delivered in), and I can get doctor appointments easily (well, except with specialists, as you've found too).

  18. Oh, but INSURANCE COMPANIES, that's another issue. They suck.

  19. I wrote a post about my horrendous experiences in February. It is here:

    I'm still disgruntled.

  20. I think it's a valid point, the quality of health care is better in many aspects. Or maybe just the access to technology, I don't know.

    But there are other gaps, like HMOs overbooking their doctors which leads to lack of time spent with patients (thus errors produced), and insurance companies denying the use of some techniques.

    So not great, over all, I still say.

  21. that's been my experience, too: doctors seem fine (exceptions, sure, blah blah) but it's the insurance companies / health system - which is run like a business - that poses so many problems.

    another added problem is that whenever a doctor DOES screw up, people sue the doctor, their practice, the insurance company, and the nurse's dog walker for eleventy frillion dollars... which just ups premiums overall as well.

  22. I am quite the conspiracy theorist and I think the doctors, insurance companies, and pharmaceutical companies are all in cahoots together! I've actually had a doctor tell me he was asked to push a certain medication. Are you kidding!

  23. So. The obvious thing to open my comment with is a disclaimer that I a) already work in healthcare and b) want to go to medical school and become a doctor.

    I think that the medical training in the US is superior. I won't say that the 100% of the world's best doctors come from the U.S., but I will say that most do.

    I think that the system is totally broken. I hate that people don't have, or have limited, access to care without insurance. I hate that, even with insurance, things are so expensive.

    To me, that problem comes down to several things: the first being that it is SO EXPENSIVE to practice medicine in the U.S. First, there's the tuition problem. At the state med school in Oregon, that'll run you $40,000 per year, in state. Most people who aren't rich (myself being one of those not rich people) will have to pay for that with loans. Scholarships are few, and uber competitive. Then you add to that the fact that you can't work during med school, so you have to take out loans to cover the cost of living. In Oregon, that's another $30,000 a year or so. For four years of school, that means you're taking out upwards of $225,000 in loans.

    Then you graduate. And you start residency training. Where you make, on average, something in the neighborhood of $40,000-$45,000. Which is not a bad salary, if you, oh, WEREN'T ALREADY A QUARTER OF A MILLION DOLLARS IN DEBT, and having to start repaying those loans.

    When you're done with residency, if you start practicing without doing fellowship training in a specialty, then you can start making full physician salary. If you're a neurosurgeon (which means your residency was 7 years long), then you know, you can pay those loans back pretty quickly. If you're a pediatrician, then you make on average $80,000, and that loan repayment takes a long time.

    Especially once you then factor in that you have to pay malpractice insurance, to protect yourself from devastating lawsuits (that's not to say that I think that all lawsuits are unjustified, some are very warranted, and I think there has to be checks and balances to the system, with legal recourse being the main way to accomplish that), which as often as not, are the result of doctors merely being human and not always being perfect. And I think everyone would do well to keep in mind that the human body is not as cut and dried as a math problem, sometimes the solutions are not clear and the pathway to getting there is ambiguous - medicine is a lot of science, but there's still some art to it. Anyway, add to malpractice insurance, the overhead of an office, including supporting medical staff, administrative staff that have to wrangle with insurance companies and etc, and today's average doctor is not becoming rich off his or her practice. Living comfortably, yes. Affording new cars and some vacations, totally. Raking in the dough and living the high life? Most aren't.

    So where are we? Oh yes, what's wrong with the system. Insurance companies. I HATE INSURANCE. It should not be up to someone at a company, totally removed from the practice of providing care and seeing patients, to decide what should be covered by a policy, and what shouldn't. And it is equally wrong for so many people to just simply not be able to afford insurance, and by extension, not get care.

    I work at a medical school/its associated hospital. In most cities that have them, academic hospitals like ours take the lion's share of underinsured or uninsured patients, bill them an collect what they can, and figure out how to deal with the giant portion that goes unpaid. Sometimes, states help with that. In my state, they don't.

    But then, the Federal government comes in and tells doctors and hospitals that they legally can't charge anyone less than what they charge the medicaid/medicare patients. It's illegal, and it makes sense if you look at it as a way to avoid defrauding the government (charging them more just because you know that they will pay it, that would be a neat trick). But in practice, what it means, is that our hospital can no longer take patients and that can't pay. Because if we know they can't pay, (i.e. they are uninsured and can't pay for the services up front), and we see them at our hospital, then we are essentially charging them less than the medicaid/medicare patients - because we won't be asking them to pay anything.

    So many departments, have had to make the decision not to take any uninsured patients, or risk lawsuits from the federal government. I mean, who can afford a $10,000 orthopedic spine surgery, if not insured (or wealthy enough to have access to care regardless)? My department, fortunately, has some private donors that help fund some of the under/un-insured patients, so we still get to see a certain number. I merely point this out because it's a confusing, and not widely known, facet of the US system. There are doctors out there willing to see patients pro bono (I work with them!) who aren't allowed to.

    I also believe that not every doctor is a good match for every person. I often use this example, which I tell to my patients as well - think about all the many people who have cut our hair. Some, I have liked. Some I have not liked. Do I go back to the ones I don't like? No. I try a new one, until I find the hairstylist that gets what I'm asking for, that can understand my descriptions and bring them to life. One that makes me feel comfortable, and that I click with. When I moved to my new city, it took me a year's worth of haircuts with new stylists to find one that I was happy to stick with. How did I do it? Research. I asked people who's hair I liked, I read the online reviews, I inquired about the reputations of salons.

    I believe that should be a similar approach that we take to finding a doctor. If I spend that much time deciding who cuts my hair, WHY WOULDN'T I do the same for my doctors? Each one has a different bedside manner, each one a different philosophy of care, each one a style of practicing medicine. Some will click more with me than others - either through their belief in preventative care, through treating the whole person instead of just one symptom, through prescribing practices, etc. It just takes finding the one that you feel comfortable with his or her style.

    So that's my rant. There are excellent doctors in the US, working through a frustrating system (trust me, many of them are frustrated by it, too), and my excellent doctor may not be your excellent doctor, depending on what we're each looking for. I think taking a proactive stance, if we are lucky enough to be able to do so, in our health care is key.

    And with our broken system - we have to be the ones that change it. I'm a total idealist, but I think it can get better. It will take people advocating and being willing to change, and being open to the idea of change, though...gah, I need to shut up already.

  24. I have had "meh" experience with my health care over the year. My insurance company has always paid everything... in the end... but on more than one occasion in the five years that I've been independently insured (not on my parents'), I've had to haggle over three bills for routine expenses, with three different doctors and insurance companies.

    (Most recently--my insurance didn't pay for my annual pap smear. I mean... how more basic can you get?)

    There has to be some way to streamline the system a little so that the obvious stuff doesn't fall through the cracks!

  25. One big factor that determine the level of health care you the patient! Patients have to advocate for themselves, come prepared, not settle for status quo, etc. That makes a huge difference. And who are more likely to be able to do that? The educated and middle/upper classes. It is all related.

  26. Okay, nobody get guns out and shoot me, but I am going to play the part of the devil's advocate here (and try to do that without taking up so much space) - I have worked in the insurance industry for over 20 years selling (gasp) health insurance. I totally agree that our health care system needs some serious help, and I consider myself a democrat and think we need some sort of universal health care. However the crisis is not and should not fall on the shoulders of the insurance companies.

    It is true that insurance companies are in business to MAKE money, aren't we all? And the whole jest of an insurance company is to take monthly premiums and invest that money so they make money off the premiums paid so that when someone gets sick they have money to pay the claims. The problems with most consumers are that they want to pay little to no money for health insuance but they expect it to pay for everything, all those expensive tests, MRI's that cost $2500, etc. But if you think about it for just a minute, if you are paying $200 per month for your insurance, which is $2400 a year, and you have an MRI that cost $2500, who made money? The hospital that got paid the $2500, but the insurance company at that moment is now losing money on you for paying that huge claim. But we as consumers bitch and complain that the insurance company is screwing us. The insurance company doesn't set the medical prices at the hospitals or doctors office, they just pay the bills. And yes they will argue with or refuse to pay for services that are not necessary or that are overpriced. You should also argue and negotiate with the hospital and doctor because they are screwing you!

    The real problem is that there are too many Americans that REFUSE to pay for health insurance because they just don't want to. It is available to them and they have car insurance on their car and homeowners insurance on their house yet they refuse to pay for insurance for their most important asset, themself, often using the excuse that they are healthy. Then when they get sick and have to have $100,000 worth of treatment and then don't have the money to pay, guess who pays? You and Me, the consumer with health insurance because our premiums go up because the hospitals and doctors charge more to make up the difference of all the services given to people that don't pay them because they don't have insurance.

    Yes we have shitty doctors and hospitals in this country and I too have had my share of them, but I also have the freedom to go to another doctor if I don't like the one I'm using. Other countries that have free healthcare don't allow the people the freedom to do that. They have no choices at all.

    So while all of it sucks, the high insurance costs, the high medical costs and the crappy care we recieve is not the responsibility of the government to take care of. It is OUR responsibility as consumers to fight for changes and be more proactive in our own health care.

  27. An example of bad care? Okay. :) A couple of years ago I had a really bad flu with a really bad cough and ended up coughing so hard that I tore some muscles in my shoulder and back. Of course, I didn't know this--all I knew was that I was having these weird pains in my left side and behind my heart, I figured it couldn't be that serious because Hi, still walking and breathing and everything, just every once in a while a really sharp "OW" sensation . When the "OW"s started happening more frequently I decided to see a doctor. I started calling through the doctors that my insurance would cover and each one said "you're having chest pains? You need to go to urgent care. We don't have space in our schedule today for a new patient." So I walked over to urgent care and when I checked in with a nurse and showed her where the pain was located, I kid you not, she bugged her eyes out, pointed at the door and said "That's your heart! You need to go to the emergency room! Get out! Get out! Your heart is in trouble!" I looked at her and said "Can't I please just see a doctor here first? If it is my heart I'm pretty sure I shouldn't be walking across town to the emergency room." And she flat out refused to let me see a doctor, even when I told her that I don't drive (hello, if someone is having heart problems that are that serious, shouldn't you call for an ambulance or something?) and that going to the emergency room would mean an hour and a half walk across town. And when I asked "won't walking an hour and a half across the park make my heart problem worse?" she yelled (YELLED) "Get out of here! Your heart is in danger! You need to go to the emergency room! No doctor here is going to treat you if you're having problems with your heart! Get out!"

    So I walked (walked with an apprently dangerous heart condidtion) the hour and a half across town to the emergency room, waited a while to see the emergency room doctor who, in all of fifteen minutes discovered that "your heart isn't in trouble, you just have a few torn muscles. Go home, take some advil and keep still for a few days."

    Oh and the emergency room that I went to was notorious for terrible care. The slogan for the hospital in that town was "drive an hour, save your life," because the doctors and nurses were so terrible at their jobs that you were better off driving an hour to the next town and seeing a doctor there. I don't mean that they were terrible because people were dissatisfied with wait times, I mean the number of people who had malpractice lawsuits against the doctors at this particular hospital was abnormally high. You couldn't say the name of the hospital in the grocery store without having five people turn around and tell you about the lawsuits they had either for themselves or for wrongful deaths of loved ones.

    (And I had to pay the full emergency room bill because I didn't actually need emergency treatment!)

    Crap, that took way longer than I meant it to! [/rant] :)

    PS: We don't live in that town anymore, thank god.

  28. My super quick answer to this is that I pretty much agree with you. Based on my own experience and that of friends & relatives in other countries (primarily the UK and Canada) I would say that our health care overall is above average. I actually have had the experience of having a doctor give me a prescription that nearly killed me. More than once, actually! Twice I discovered I was allergic to something I've never had before and had severe reactions to it both times. Once I saw the physician's assistant when my doctor was booked and she gave me a medicine she shouldn't have given me because of what I'm allergic to. Despite the fact that the allergies are prominently listed in my chart AND I reminded her of them. She assured me that it shouldn't be a problem and she was wrong. The next day I saw my own doctor who was surprised that she prescribed the drug for me. I seriously get the feeling that she thinks I either exaggerate or am I hypochondriac.

    I've also had my share of crappy experiences dealing with insurance agencies, nurses, etc. But I've also had plenty of positive experiences as well.

    Hmm, I guess this is turning out to be not such a super quick answer after all!

  29. My (Canadian) perspective is that the US system is very profit-oriented (insurance companies) which may compromise the overall purpose of a healthcare system.

    Here, we pay a lot more taxes for the benefit of universal healthcare, but I have no complaints about our system. I love my family doctor and she is part of a network of doctors that ensures access to someone 24/7. I may have to wait a few weeks for a regular check-up appointment, but immediate concerns are addressed within hours. My aging parents are given excellent care for their various maladies. If the English system is similar to ours, more than just basic care is covered. Here, you only pay for elective medical services, like plastic surgery. Prescription drugs are extra, but most employers have a drug and dental plan and low income people and senior citizens are covered by the govenment.

    I think my experience (living in close proximity to a university hospital) is probably vastly different than someone in the far north, but those issues are addressed with scholarships and grants for med students who agree to work in those areas. I imagine this would be the case in the US as well.

    Where we do suffer a little is in access to things like MRI machines, especially in smaller areas. You hear of people having to travel 6+ hours to a hospital that has such a machine.

    I would think that medical training in the western world (US, Great Britain, western Europe, Canada) is all first rate.

  30. Health insurance was one of THE worst things about moving to America; it is just SO confusing! Six years later, I still don't understand it.

    The quality of health care can be pretty good depending on where you are. I will say it's very helpful having a husband who works in health care. It's easier to get the inside scoop on which doctors, etc. to avoid.

    Have you seen "Manufacturing Dissent"? I'll never see another Michael Moore movie, ever...the big jerk!

  31. Great post topic, Jess!

    I live in a town of 28,000 people. Small, but not tiny. Though I complain about the wind, it is a great community with a fantastic school system and the dollar buys a fair amount of house around here. It shouldn't be hard to attract doctors and keep them.



    Let me say that again: There are no physicians taking new patients.

    My and A.'s only option is the nurse practicioner (who is FANTASTIC, thank goodness) or the emergency room.

    I am sure you can guess how I feel about the current system.

  32. I think the most shining flaw in our health care system is everyone is not included. Those that are not included often have health problems (like diabetes) that, left untreated, go on to prevent them from ever getting jobs that can provide health insurance thus getting proper treatment. I also think it's outrageous that even if one does have health insurance, the cost of care "not approved" or "not covered" can be just as detrimental as if the person didn't have insurance to begin with, but its a bigger fight because the insurance company then has to approve you getting care outside of what they recommend even though they are not covering the cost.

    Example, I was in a car accident in 2000 that was my fault. Due to state law (NV) my health insurance (not car insurance/PIP) was responsible for paying claims. Because I had serious nerve damage, 4 months after the accident they deemed the cheaper option to be amputation of my leg. I fought this with the help of an attorney and while I did receive care that resulted in being able to keep my leg, my cost of that care was over $50,000. It has taken SEVEN years to pay that debt off and in the meantime my credit/ability to acquire credit has been seriously compromised. I did not declare bankruptcy as many suggested, knowing this route would further compromise my credit for 10 additional years.

    I consider myself a success story in that, most importantly, I got to keep my leg. I was able to repay the medical debt and can now rebuild my credit and continue moving forward and it gave me great perspective on a varied assortment of life's unfortunate realities.

  33. I'm with you on not understanding much about the whole thing. I used to hear how you NEVER wanted an HMO because blah, blah, blah. But in reality, I've never had a problem with any of our doctors or the various insurance policies we've had over the years, and most were an HMO plan offered. We've had several things happen, the most major of which was this, and have never had the insurance company refuse to pay for anything or gotten less than stellar medical care. Granted, it's CHOP, so better care really doesn't EXIST, so maybe much of the quality of care is determined by location, location, location. When I received that bill, it was about $60,000. We paid $35.

    I have two "consult" visits coming up with my kids' pediatrician. One is for a bedwetting problem (the 7-year-old) and one is for behavioral issues (the 5-year-old). The doctor told me to make them consult visits because they were longer appointments, so she could spend plenty of time with us (not that she's EVER rushed us through a regular appointment) and if the insurance didn't cover the visits, they would not charge me.

    So I've had good doctors and good insurance; I really can't complain about my own personal experience.

  34. Such an interesting topic! I have really good doctors that I like, and my big beef with the insurance companies is the unevenness of it all. Kat was mentioning how they don't always make money, and I suppose that's true. I wouldn't have a complaint if my insurance was $200 per month like her example. But mine is NINE HUNDRED a month. Unless it's a year I have a baby, they're raking in plenty of money off my family.

    And why is it $900? just because that's what the company decided? Or my husband's company won't kick in? I don't really know. But even though it sucks, I'm not willing to gamble and go without it. And yes, I do bitch when I think about that extra $10,800 per year that I'm not seeing, that I could use to pay off the rest of my medical bills I had to put on my Visa because the damn insurance still only covers 80% of everything...

  35. Healthcare can be a bitch, but I get your differentiation... the science and the actual healthcare is fabulous. It's just that no one wants to pay for it. The price is too high.

  36. Here in Iceland we have socialized health care and it is the bomb! We have a small co-pay with the state (like around 10 dollars)and you have a gp (general practitioner) at local healthcare offices. They do all the pre and post natal care (Which is free) and will see you anytime. Specialists you can just call yourself and get appointments, plus we have a world class teaching hospital.
    I mean, sure you can bump into really annoying doctors ... and sometimes you wait for callbacks. But for the most part you get help quickly and competently.

    Pretty much you get exactly what you'd get in the states, just without anyone ever asking you about health insurance.
    P.s. oh and they also pay for healthcare in Europe.... Outside of Europe you need to buy special healthcare- but these days travellers healthcare is covered by Visa- as long as you have a creditcard you're covered. Sweet.

  37. It's insane. Insurance companies are for-profit organizations so they actually benefit from denying claims. It's an extremely difficult system to navigate as someone who is well educated and has really good insurance. I can't comprehend how others who are not in my position are able to navigate the system. There does need to be some sort of universal coverage, but I don't know how that switch can be made from our current system effectively.

  38. I lived in Holland for two years. During this time I had galbladder disease, depression, and numerous lady problems. For the galbladder i was diagnosed with "seasickness." WTF?! Depression, given a random drug and the WRONG INSTRUCTIONS ON HOW TO TAKE IT!! WTF?!!! And lady problems? My obgyn of ONE time asked me to strip down in front of him so that I could pee in a cup for a bladder infection. What the ever living F?! Seriously. I ended up flying back to the US EVERY time i had a problem. I have had some bad experiences here too, but in most instances can find a replacement doctor in minutes. I'm all about firing doctors who sucketh. Overall, our quality is the bomb. But hells bells if it isn't expensive and complicated. Something needs to be done, but the thought of putting the government up to the task scares the living bajeezers out of me. What to do.

  39. I was on Medicaid for a few years, and the quality of healthcare available to those on the bottom of the totem pole isn't all that great... You go to clinics in hospitals and get examined by med students who then have to go find an attending to verify that they haven't screwed up the diagnosis, but it's better than nothing.

    I lived in the UK for a year and while the NHS may be flawed, I was floored that there is FREE BIRTH CONTROL FOR EVERYONE!! 'Nuff said.

    On my good insurance plan at my last job, one of my coworkers went to a gynecologist who spent 2 minutes with her, left the room, came back, told her she had some disease and would never be able to have kids, but he didn't have time to talk about it right now, come back another day, and left her. Turns out he was WRONG, as well as rude and insensitive. Thank goodness for second opinions.

    I also have some horror stories from my uninsured days of going to Planned Parenthood for gyno visits, but I'll spare you the details :)

    I guess what this goes to show is... um, I don't know. But I agree that our healthcare system is wildly flawed and needs some *serious* revamping.