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May 25, 2005

National Health Care "Insurance" « Social Issues »

One of the things that bugs me about national health care is that those who use it the least (take the best care of themselves to need less care, as well as not going to the doctor for minor problems) are the ones who pay the most (as it, getting the least value for the amount of money they pay).

There are certainly medical conditions in which it would be difficult, if not impossible, for an individual to afford decent care, and I guess I don't mind so much that we spread the cost around to the entire society for such situations. But I do object to the people who go to emergency rooms with a cold because they didn't call early enough for a same-day appointment during normal hours. I do object to the people who go in for viral infections (which can be recovered from through time and rest only). I do object to the people who show no interest in being involved in their own treatment and conditions, and so waste doctors' time and raise costs for the rest of us.

A yearly check-up is a good idea, especially as you advance in age. But unless you seriously injure yourself, most people really shouldn't need to see a doctor that often. For most minor illnesses, time is the best medicine.

Posted by Nathan at 10:21 AM | Comments (9)

You should see the beautiful medical center across the street where I work. Stainless steel & glass walls, perfectly manicured lawns, a state of the art workout facility, lighting that would make a Starbuck's interior designer weep with joy, and 60" plasma tv's in the waiting rooms (I go there because they have a Nature's Table restaraunt).

Most of the patients are the elderly (as this is an outpatient type center) so probably paying using all that money from Medicare/Medicaid.

While I have no qualms about the elderly receiving medical attention, I have a hard time accepting the fact that a large percentage of that care money goes into paying for extravegant luxuries such as flat panel TV's and solid burled walnut desks.

Posted by: Sharp as a Marble at May 25, 2005 11:17 AM

There *are* diseases that one doesn't bring upon oneself, you know. ;)

I object to nationalized health care simply because I think the government already takes enough of my money and enough of an interest in my personal life, thankyouverymuch. Not that I have an opinion or anything...

Of course, this is a huge problem already because gov't is paying, what, 47 percent now? Ugh.

Posted by: Deb at May 25, 2005 07:35 PM

Of course there are some diseases that just happen.

That's what health care is for, yes. But people can't be bothered to tell the difference. Our societal emphasis on sensationalism probably doesn't help much, either, encouraging people to go see doctor's for every minor sniffle on the off chance it's the onset of AIDS or something.

I just think our health insurance should be geared more to catastrophic coverage than making the people who don't use doctors pay for those who use 'em too much.

Posted by: Nathan at May 25, 2005 08:22 PM

Yeah, I've been doing some reading about it and I think the only thing that gets us back anywhere close to a functioning market is going to be a shift toward cash-pay for the little stuff and catastrophic coverage for the big stuff. It's so screwy because the heavy layers of regulation are killing the thing, but without them most people would be uninsurable. Without a major change in the structure of the thing, any move to make it more expensive for the less-perfectly-healthy would make it impossible for me to carry insurance at all, so I worry about that. A nationalized system isn't the answer, but it's where we're headed anyway, I think. People seem to want it. I do not think it means what they think it means, though.

Posted by: Deb at May 26, 2005 09:24 AM

Another way to resolve the problem, perhaps, is to make it so difficult/painful/troublesome to get basic care at emergency rooms and such that people stop doing it.
Since that probably wasn't stated very elegantly, let me put it another way: Part of the high cost of health care is the waste from people using it because it's there, getting meds they don't need because insurance pays for it and the drug companies have created a desire for their product, along with kickbacks to the doctors. So if we can make it more difficult for people to abuse the system without raising the costs of the system, it could save money.
One simple step, from what I understand, would be simply to have an INS team in every emergency room checking IDs.
While it might seem barbaric, it would provide a disincentive for someone to be in the US illegally. If someone is in bad shape, sure, give them care...but when they recover, they'll find themselves back in Mexico. Making the choice of coming here in the first place at least a little more worth consideration.

This is too big a problem for one simple idea to resolve though. I really hate that there's enough people who object to any specific change that it makes it impossible to make any progress on the issue. We are being incrementalized to death in our health care system.

Posted by: Nathan at May 26, 2005 09:48 AM

The problem with emergency rooms is that in some cases it's the only choice on a weekend or holiday, when doctor's offices are closed and your two-year-old is screaming from a painful ear infection, or your wife can't hold anything down because of her three-day migraine. Only recently has my health-plan allowed access to urgent-care centers open at odd hours. Until people are given an alternative to the emergency room for non-emergency problems, ER problems are going to persist.

Unfortunately nobody in the government seems to be willing to tackle the healthcare crisis, if anyone cares at all. The nation's healthcare system needs serious attention NOW. SOMETHING needs to be done, even if it doesn't make everyone happy.

When FDR took office during the Great Depression, he didn't just sit there and let Congress bicker back and forth about how to fix things. He actually TRIED something, even if some of it was only partially successful (the New Deal). If one program didn't have desired results, something else was tried. The point is, something HAD to be done and something was, and the net result was that America was able to pull itself out of a black hole (though painfully). Too bad our current politicians won't take that attitude.

Posted by: diamond dave at May 26, 2005 02:09 PM

So can't the govt set up some rules/laws that would make it more profitable for doctors to establish private 24-hour clinics?

A painful ear infection isn't actually an emergency, and could probably be treated by an experienced nurse. Same thing for the 3-day migraine.

I've been guilty of taking my son to an emergency room unnecessarily, just because my wife was accusing me of wanting to let him die...
He had a fever of 101 degrees and was coughing.
No where near death. After three such visits, I pointed out that the hassle and stress of being at the emergency room was making him more tired than if we'd just stayed at home and given him a cool bath, and that's what we did from then on. Once, when he had an obvious ear infection and we went to a normal appt, I had a long talk with then nurse and she blessed me for making that policy change for our family.

I wish more people would get that: unless you think death, scarring, or crippling is imminent unless you see the doctor right away, they don't belong in an emergency room.

Education of the populace of basic health issues would probably be a good start. But we can't even get correct climate information to people, so I guess personal health care is too much to ask.

Posted by: Nathan at May 26, 2005 03:13 PM

I read somewhere recently (on one of the medblogs, God knows which one) a post suggesting that there be parallel systems...emergency rooms for real emergencies and 24/7 urgent care centers for the other. Might be an idea.

My insurance company discourages ER visits by making them a large copay if they decide the visit was necessary and refusing to pay at all if they decide it wasn't. This I'm quite happy with, since I'm not the type to go anywhere near an ER unless living with it until Monday is just impossible...think major bleeding, broken bones, that sort of thing.

Jay and I were talking about the insurance thing the other day and he said something that I think explains a lot of it...that people think of health insurance not as insurance but as pre-payment for unlimited medical care. That attitude is only going to get worse if we nationalize the thing, which is one of the big dangers of doing so, I think.

Posted by: Deb at May 26, 2005 03:58 PM

Well said, and exactly the point I was hoping/trying to make.

There is no incentive for people to be smart about their own treatment, and so it drives up costs beyond the average person.

But more govt control and aid is no solution, because that not only drives up costs higher and gives further reason for people to not take responsibility for their own health, but also doesn't actually address the problem: too much time, money, and effort is wasted just supporting the process, rather than the actual health care.

One of my sisters was an ER nurse, and she said it caused no end of frustration how many people would come in at 10pm on a Wednesday, and the nurse would ask about their wrist injury:
"When did you hurt it?"
"Is it hurting worse?"
"Why did you come in now, then?"
I dunno.

And $10 gets added to your insurance bill for each syllable of his answers.
It's gotta stop.

Posted by: Nathan at May 26, 2005 04:24 PM
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