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"What is the difference between a realist and a dreamer? The realist thinks that someday a UFO will come down and hover over the UN building, and that the aliens will come out of the UFO and offer to share their technology and solve all our world's problems.

The dreamer thinks maybe we can get our act together and do it ourselves."

Russian joke [It's a joke?] cited in William K. Hartmann, A Traveler's Guide to Mars.

11 April 2005

Shoot Me Now: "Health Care" in the new millenium

Please see my current blog (at molvray.com/acid-test) for this post. It's filed under the same name and date in the Archives.

The material here is being stolen by a cheesy marketer as filler for a linkfarm.

21 Comments:

Anonymous Anonymous said...

Wow. It's only April and there's already a Blogpost of the Year.

4/27/2005 1:27 PM  
Anonymous Anonymous said...

I retired from nursing after 34 yrs. It became too dangerous from short staffing,sicker people and too many new meds that hurt more than helped. and I couldn't give good care. Always have someone with you in hospital to be your advocate. My daughter is now a RN(never could do anything with her stubborness). She catches at least two errors a day. The doctors treat her without respect. 12 hr shifts increase the danger. Healthcare, just like teaching and politics, are so caught up with money rather than performing good services. I'm glad you survived what sounds like hell. It is happening all the time.

4/27/2005 6:54 PM  
Anonymous Anonymous said...

Blogpost of the year - absolutely.

I know exactly what you mean when you wonder what other patients do, the ones who don't know their ABCs so well, the ones who don't have much experience with bureaucracy, the ones who are in so much pain they can't formulate the questions. I'm taking several expensive medications. There's no way on earth that I could afford them. Even if I had prescription coverage, the co-pay alone would be beyond my reach.

But I know stuff, and I have internet access, and I've heard that most pharmaceutical companies have public assistance plans. They keep those plans pretty covert, but if you know they exist, and you can get online and have some basic research skills...and if you are very patient and know enough to object when they decline your application...then you can get real lucky, like I have. I get one medication at no cost, in three-month supplies. I have to provide income information and the drugs are sent to my physician. The other two medications cost me $15 per month on the companies' "We Care A Whole Bunch" plan...and $15 a month is just a fraction of what the regular price would be.

And this works only because I'm literate and obnoxious. As you've noted, lots of other people simply suffer or die.

Thank you for your meticulous account of this awful experience. It's really important.

Larkspur

4/27/2005 10:09 PM  
Blogger That Girl said...

I once went into the hospital with a spike through my hand. I sat for hours as the pain got steadily worse. All of a sudden, doctors swarmed around me, they Iv'd me, poked me, prodded me, finally removed the spike, checked my hand function. It was a whirlwind of activity. I was astounded. Then the doctor said "Are you satisfied with your care?" when i nodded he looked very relieved. He said "Call your mom and tell her please. I dont want her to call here again."
Apparently, my mom (a former RN)had called and read them the riot act about my wait and care.
I know what people without an advocate do - suffer.

Brilliant post - did they ever find out what was wrong?

4/28/2005 6:44 AM  
Blogger quixote said...

Folks- thanks for the kind words!

I want to say again that most of the health professionals I dealt with, from doctors to towel-providers, functioned astonishingly well under really difficult circumstances. I *know* I wouldn't do anywhere near as well. We don't need to lower the pay of doctors or nurses. We just need to let them do their jobs without all this insane and useless profit pressure.

As to what was wrong, no, they never did find out. The problem never recurred, either. I have my pet theory, but I know the specialist didn't think much of it. I'd been weeding my garden before all that happened, and we'd get poison ivy seedlings (planted by the birds...). I think I handled poison ivy, rubbed my eye, and managed to spread the allergic reaction through the entire orbit of that eye. Mom says: don't rub your eyes!

4/28/2005 3:41 PM  
Anonymous Anonymous said...

I know this is probably a really obvious thing to say, but why didn't your doctor ask some questions and try giving you piriton (antihistamine) as a first step? Just curious.

4/29/2005 2:17 AM  
Blogger quixote said...

Antihistamines suppress the immune response, so when the doctors were mainly worried about a bacterial infection, that was the last thing they wanted to give me. The doctors did actually ask me what brought it on, but when I gave them my poison ivy theory, they didn't feel that fit the symptoms.

4/30/2005 1:16 PM  
Blogger Dreaming again said...

It is frustrating.

I hate to say it, but my first thought in reading the beginning of your blog was "is she in rural Oklahoma?"

I about spit my water out when you said you had to go to OKC!

I live in Tulsa, sitting in waiting rooms here, the stories you hear about ER's in rural hospitals (like ENT's being called in for eyes) is amazing!

5/02/2005 8:54 PM  
Blogger Carrie said...

Good Lord!

I'm glad you're ok, home safe and sound and healing up well. I live in Canada. You've likely heard all about our healthcare system. I can say that the entire situation is similar to what we endure EXCEPT no financial hardship to deal with at the end of it.

Like you, I avoid the hospitals and hope to never need one again (foot surgery experience in 93 very similar in many ways to your experience). But I have a chronic illness now, similar to lupus, so chances of that are slim. Still, I feel as you do, I think I'd rather die than endure the nightmare again.

This was truly a great post.

5/03/2005 12:07 AM  
Anonymous Anonymous said...

It's not capitalism that doesn't mix with midical care, it's the semi-socialist system we have currently. And it's better here than in any of the "single payer" (viz., the taxpayer) systems that are used in other countries.

By way of example, take a look at Lasic eye surgery. It's typically not covered by insurance, so patients have to pay for it out of pocket. Patients therefore look at costs and effectiveness rates, and doctors compete with each other to attract more customers. Costs have gone from thousands of dollers per eye to hunders per eye, while effectiveness and safety have improved.

With insurance companies mandating what doctor you can see, and how much (s)he'll be paid, and with the bulk of the cost invisible to the patient, there's no market incentives anywhere in the entire system....

5/03/2005 9:05 AM  
Anonymous Arnold Kling said...

Interesting post. Other countries have a much lower ratio of specialists to interns. This really helps to hold down costs, and it might have done so in your case. Frankly, I could not tell from reading the post whether or not you benefited from having the specialists see you. It seems to me that any internist could have treated you empirically with an antibiotic and prednisone.

I think that all of us as patients are prone to going onto childish rants about "the system." Not that those rants are without justification. But there are all sorts of imperfect human beings and flawed processes in the world.

The processes will gradually improve, if there is enough flexibility and accountability in the system. However, once government takes over as a single payer, you will see at best a one-time gain in efficiency. From then on, the system will ossify into a stagnant state, frozen by the political process.

5/03/2005 10:11 AM  
Blogger Roderic said...

I like the description of your hospital stay and your illness, and I'm glad to hear that you got over it.

Sad to say there's nothing really unusual about your experience.

Americans want the best care. They want to be seen right away when they go to the ER, to have a specialist available, to have plenty of people on staff when they are hospitalized so that they get good personal attention, and to sue for millions if anyone makes a mistake. They want the insurance to cost less but to cover the costs for all this, but they don't want doctors or themselves to have to deal with the insurance companies or all the little restrictions the companies impose on coverage to keep costs down.

I'm convinced that basic care for everyone will do people more good than first class care for some. But to get the former people will have to agree to give up ready access to the latter.

Best of luck getting Americans to accept the trade off.

And having an advocate in the hospital is fine, but remember that there's a point where whipping a horse harder will not make it go any faster.

5/03/2005 11:05 AM  
Blogger Joan said...

I don't think I can say I "enjoyed" you post, that would just be cruel -- but I do appreciate it, all the more since I am a semi-professional patient lately.

I have to say you kind of went off-track for a bit there, especially in your quoting of the US's infant mortality statistical rating in decrying the quality of our health care. Live births are accounted for differently here than elsewhere, and that does a lot to explain the low ranking.

5/03/2005 5:52 PM  
Blogger quixote said...

There's been quite a lot of expert blogging on the whole insurance issue, and on where the US stands in the world. I've appended the links below.

"Semi-socialist" is right: We've socialized the risk, and privatized the profit. This is Not a Good Thing....

To Joan: best of luck becoming an amateur patient again! (I hope that's a possibility!)

Kash at AngryBear A very thorough look at the economics and statistics of the whole sorry business, in several posts, by a professional economist.

Kevin Drum's posts are scattered, mainly through the April archive, and have links to several other sources of information:

Health care in France
Health care in America
Health care around the world
Health care in America [not a duplicate of above]
Health care in France, part 2
Health Care Top Ten
Health care. ("I've long thought that the spectre of "socialized medicine" is the greatest con ever perpetrated on the American public." 'Nuff said.)
Health care woes

5/03/2005 7:21 PM  
Anonymous jcp said...

Excellent post, and I am glad to hear you made it out OK.
My only direct encounter with the medical industry was a similar eye problem that turned out to be an infection. My case, Im sorry to say, stretched on for three months and resulted in minor loss of vision. This encounter combined with numerous indirect encounters through friends and family lead me to agree with your generalization that the medical industry is broke.
I have to strongly disagree as to the cause of the inefficiency and misdirected priorities you experienced and I see no support for the conclusion that eliminating the profit motive will improve quality or efficiency. I am also skeptical regarding the comparisons between US and other health care systems. It has become “common knowledge” that the US consumer pays more for less, but I doubt you would have received the same level of care anywhere else in the world.
-jcp-

5/10/2005 10:26 PM  
Blogger The Comic Project said...

This was a great read, but makes me wonder, whatever happened to trusting your doctor. I dread the situation when doctors here start functioning like doctors in the west due to fear of litigation, . I can see myself running to an emergency room because my eyes dont stop watering and treated with antibiotics, when all that happened would be a speck of dust flying into my eyes and lodging itself in the upper corner under the eyelids. eeeeeeeeeeeek!!!

Well, here in india, I trust my doctor not to screw up, do my bit of praying to god :-) and everything works out fine. Don't have the best healthcare in this country, but the best doctors, not much health insurance, but treatment is neither too expensive nor inexpensive. Given a similar situation like yours, I would have gone to my "family doctor" and come back with a eye-drop, and resumed normal life and vision in a couple of days. But things are changing, sadly.

5/10/2005 10:31 PM  
Blogger quixote said...

jcp- sorry to hear about the outcome for you. I lived in Holland, England, and Germany for a number of years. I was never hospitalized there, but care in terms of doctors' visits was the same, and friends who were hospitalized either had similar experiences to what we have here, or better. I have to disagree that it's merely "common knowledge" that we pay more for less. I'm afraid it's a matter of financial fact. Some of the links I have in an earlier comment take you to detailed articles on that.

Comic Project-
A friend of mine from India had a complicated problem with the small bones in her ear that needed surgery. She had to make the decision whether to have it done in India for about $10,000, or US for about $80,000. She went to India. (Everything worked out fine.) I've heard of many people in the US who go on medical "vacations" to Mexico for the same reason.

Most of the doctors and nurses seem to be good everywhere. It's all the other stuff that needs work....

5/11/2005 9:38 AM  
Anonymous Anonymous said...

I have dealt with health care in 10 nations over a period of 30 years. This experience includes both socialized medical nations, 3rd world nations, the US, and others with a mix of systems.

Medical errors and mistakes happen everywhere. The doctors in Germany are no better or worse than the doctors in america.

The difference is the LEVEL OF EXPECTATION of american patients vs other patients around the world.

In the US, if a doctor misses a "zebra" (i.e. a rare cause of illness) then the doc faces a very high risk of lawsuit. In other nations with socialized med systems, they dont expend resources to hunt out zebras. If you came in with your eye infection, they wouldnt run all those fancy tests to rule out zebras, they'd limit their discovery to the 1 or 2 most common causes and forget about the other stuff.

Socialized med nations are much better at providing BASIC lower cost care to everyone because there is a tradeoff involved. Its understood that with socialized medicine we are not going to spend resources chasing zebras. If your illness isnt caused by what statistics dictates as the 2 most likely causes, then we arent going to explore it any further and thats that.

The problem with implementing that in america is that in america the individual, not the community is of primary importance. Too many americans would put up resistance against the tradeoff of not catching the zebras. They want "better" healthcare than what exists in Germany, or France, or Canada.

America epitomizes the Burger King mentality. They want it "your way, right away" whereas other nations make a conscious tradeoff. Americans arent interested in tradeoffs, so although the current healthcare system is troubled, they refuse to switch because they want to believe in the illusion of the current system.

6/04/2005 8:42 AM  
Blogger Jack said...

This might be of interest:
http://www.nytimes.com/2006/02/22/business/22leonhardt.html?incamp=article_popular

2/22/2006 3:16 PM  
Blogger quixote said...

Jack, that's a great link. (Just to make it live:
Why Doctors So Often Get It Wrong. Requires free registration on the NYTimes site. If you don't like that, use Bugmenot which is an extension for Firefox.)

The money paragraphs for me were:
"
With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.
"

Wow.

I have to say I disagree totally with the idea in the article of tying doctors' jobs to outcomes. There are just too many things involved besides the skill of the doctors for that to be a smart thing to do. Every doctor who could get away with it would have to start treating nothing but colds in healthy teenagers. (Actual malpractice, of course, is a different matter.)

(BTW, I love your blog. Go read, folks: Blue Collar Politics Blog. I just found it a couple of weeks ago. I think I don't get around enough....)

2/23/2006 6:53 PM  
Anonymous Anonymous said...

This is why I'm writing a book on wellness and longevity age of mediocrity.

4/14/2006 12:11 PM  

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