This is why socialist health care doesn't scare me at all

[cameraeye]

Another interesting aspect of the cost of healthcare to all of us that doesn't get much press:

http://www.nytimes.com/2009/07/08/business/economy/08leonhardt.html?_r=1

[Seeker]

One of my patients sent me this link:
Debunking Canadian health care myths - The Denver Post
The title is "Debunking Canadian health care myths."

I admit, I don't know too much about Canadian healthcare, so I found it interesting.

Thank you for posting that. Yes, it's a very interesting comparison.

[Seeker]

Another interesting aspect of the cost of healthcare to all of us that doesn't get much press:

http://www.nytimes.com/2009/07/08/bu...ardt.html?_r=1

This too is interesting.

When my Dad was diagnosed with this cancer, they told us that he will die of something else long before the cancer became an issue for him. They've watched and pretty much there's minimal growth of the cancer.... they give him some hormone from time to time.. to slow down the growth. He is 82 years old now; Aunts and Uncles have passed... but nobody will live forever.

But I believe that if a doctor thinks whatever procedure will prolong life and the patient too wants to live that life, then who are the Insurance Company people to come along and say "No, we will not pay?" It should be between Doctor and patient, nobody else should have any right to intrude.

[maat55]

I don't know Maat.... more excessive than already exists?

Insurance companies are a MAJOR portion of the problem here. 47 million people not insured. How many people who are insured, are denied coverage on a specific treatment? How many people are tied to working someplace for paying for medical things that that cannot currently live without? How many people wrongfully denied coverage for pre-existing conditions or having missed a line on paperwork.

And finally, what about the previously working and under any type of medical coverage, but now unemployed and having to do without?

Is medical failing entirely because of people themselves? Or because big business (Insurance campanies) greed and politics?

Canada was not a system that Obama really considered for America. Canada has some sort of priority system where the really sick, can get help without too much wait -- and the people waiting for elective surgery may end up waiting a bit longer. Yes, taxes are higher... but people can get care.

I watched an documentary recently where a women with a back problem could not get an MRI for a year. She had to pay out of pocket at a new non- government facility.

I think we all know that with either system, not everyone will get serviced. I would rather not be serviced based on my merits than on those of the government.

Pre-existing problems are something that has to be dealt with, but I do not accept that the government will be a viable solution in this country due to its past record of poorly managing its current entitlements.

We can have the best army in the world, but that doesn't mean we did it efficiently. Our deficit is growing fast, our obligation to future entitlements is massive, I can't help but believe that NHC will do nothing but compound these problems.

[disneysteve]

I watched an documentary recently where a women with a back problem could not get an MRI for a year. She had to pay out of pocket at a new non- government facility.

This really isn't the best point to argue. The vast majority of spine MRIs done in this country are unnecessary. They don't alter treatment regimens one bit. If a patient presents with a history of low back pain radiating down one leg, especially with a history of trauma , a physically demanding job or in an obese patient, I don't need an MRI to assume they have a herniated disc. Without the MRI results, I would order anti-inflammatory medicine and physical therapy. If I get the MRI and confirm the diagnosis, I would order anti-inflammatory medicine and physical therapy but would have blown $1,000 on an MRI.

That's part of the problem in this country. Patients have come to expect a million dollar workup for every ache and pain, and doctors have become far too dependent on technology over taking a good history and doing a thorough physical exam, partly due to fears of litigation. If you speak with many older physicians, you'll hear that before all the high-tech testing was around, patients were treated just as well and at a much lower cost, and doctors had much better honed diagnostic skills.

[LivingAlmostLarge]

Let me add, that because we're tied to our jobs because of health insurance, I am hesitant to find a job because I don't want to change insurance while pregnant!

This is something not dealt with using socialized system. Why? Because it's not a preexisting condition I have to worry about.

[pikey412]

I don't like the idea of my wife having to wait 4-6 months to see a doctor if she's detected a lump in her breast.

[markusk]

I don't like the idea of my wife having to wait 4-6 months to see a doctor if she's detected a lump in her breast.

I my view, a major problem with US healthcare is how physicans and hospitals get paid, namely "fee for service." In the above example, a primary care physician can spend time examining the patient and ordering mamograms at the appropriate age and time intervals. The primary care physician does not get much income from this routine visit. Now a surgeon may need to remove this lump in her breast and this proceedure will generate significantly more income for the physician.

In otherwords, physicians currently get paid much more to do stuff to patients, ie, proceedures, than to interview/examine/prevent disease/figure out what is wrong with the patient -- which takes time but which pays little. As a financially savy physician in this "fee for service" pay structure, what you want to do is have some other physician do the interview/exam/come up with a diagnosis, then have them send you the patient for a simple (but financially rewarding) proceedure.

[disneysteve]

I my view, a major problem with US healthcare is how physicans and hospitals get paid, namely "fee for service." In the above example, a primary care physician can spend time examining the patient and ordering mamograms at the appropriate age and time intervals. The primary care physician does not get much income from this routine visit. Now a surgeon may need to remove this lump in her breast and this proceedure will generate significantly more income for the physician.

In otherwords, physicians currently get paid much more to do stuff to patients, ie, proceedures, than to interview/examine/prevent disease/figure out what is wrong with the patient -- which takes time but which pays little. As a financially savy physician in this "fee for service" pay structure, what you want to do is have some other physician do the interview/exam/come up with a diagnosis, then have them send you the patient for a simple (but financially rewarding) proceedure.

And this is exactly why family practice is suffering. We don't do many (if any) procedures that generate income. We're left with increasing volume of patient visits to keep our income up. That means seeing 5 or 6 patients per hour in order to generate enough income to cover overhead, pay the staff and take home a decent salary for ourselves. Of course, that means we don't have time during a 10 minute visit to address a bunch of preventative measures. We have just enough time to treat the presenting problem and move on. That results in patients not getting the counseling and support they need to lead healthier lives and it burns out the doctor who feels like he's on a treadmill all day long.

[maat55]

This really isn't the best point to argue. The vast majority of spine MRIs done in this country are unnecessary. They don't alter treatment regimens one bit. If a patient presents with a history of low back pain radiating down one leg, especially with a history of trauma , a physically demanding job or in an obese patient, I don't need an MRI to assume they have a herniated disc. Without the MRI results, I would order anti-inflammatory medicine and physical therapy. If I get the MRI and confirm the diagnosis, I would order anti-inflammatory medicine and physical therapy but would have blown $1,000 on an MRI.

That's part of the problem in this country. Patients have come to expect a million dollar workup for every ache and pain, and doctors have become far too dependent on technology over taking a good history and doing a thorough physical exam, partly due to fears of litigation. If you speak with many older physicians, you'll hear that before all the high-tech testing was around, patients were treated just as well and at a much lower cost, and doctors had much better honed diagnostic skills.

Typically, I just go to a 30.00 dollar Chiropractor. But, what if the women needed an surgery? Would not waiting a year make the problem worse? How do they decide if she is need of surgery if they do not take the MRI or some other test? How many deferred treatments will get worse without faster service?

[markusk]

And this is exactly why family practice is suffering. We don't do many (if any) procedures that generate income. We're left with increasing volume of patient visits to keep our income up. That means seeing 5 or 6 patients per hour in order to generate enough income to cover overhead, pay the staff and take home a decent salary for ourselves. Of course, that means we don't have time during a 10 minute visit to address a bunch of preventative measures. We have just enough time to treat the presenting problem and move on. That results in patients not getting the counseling and support they need to lead healthier lives and it burns out the doctor who feels like he's on a treadmill all day long.

I totally agree. The "fee for service" payment structure does not reimburse primary care docs enough, and that is why we have a shortage of primary care physicians (family med, internal med, peds).

Talk about lack of reimbursements for routine office visits. When I was a resident not so long ago, I specifically remember being told not to dictate office visit notes on patients who have a certain type of insurance, but to hand-type our own office visit notes for those visits. Normally, we made type written notes in a patients chart that was dictated over the phone -- this recording is in turn transcribed/converted to text via someone in a 3rd world country which is then sent via secure email to us the next day. We then make corrections, print it out and place the note in the patient's chart. It turned out this one insurance company only paid $15 for a routine 20 minute follow up visit. The cost of a two page dicated note was $12, for a net profit of $3. But there was really no profit if you count office staff costs, etc. That was when I decided primary care was not for me.

[markusk]

Typically, I just go to a 30.00 dollar Chiropractor. But, what if the women needed an surgery? Would not waiting a year make the problem worse? How do they decide if she is need of surgery if they do not take the MRI or some other test? How many deferred treatments will get worse without faster service?

Back pain is a very common problem, the vast majority of which can be taken care of by conservative treatment: rest/exercise/NSAIDS, but it all depends. A physician should spend time getting the history: How/when did it occur? Where is the pain? How bad is the pain? Contant/intermittant? What makes the pain better/worse? Any associated symptoms like numbness/weakness? Then there should be a good musculoskeletal exam, followed by a discussion with the patient concerning imaging studies, if appropriate, the most likely diagnosis and treatment plan. Surgery is the last option, but an option that should be available if needed.

Now a financially savy physician, because he/she knows it does not pay to to spend alot of time with each and every patient (who sometimes demand an MRI or a referal to a specialist right away), will spend very little time listening/examing the patient, but will order alot of tests including an MRI, and if he/she still cant figure it out what the problems is, will send a referal to a major university for more tests, etc. Now magnify this 10,000 times or more per day --> runaway health care costs.

Most physicians with any self respect will take the time needed to do the proper work up. But my point is, the system is set up to reward the lazy way and financially penalize the correct way. And remember, the problem is not who pays (a government entity vs private health insurance), but how physicians/hospitals get paid.

[maat55]

Back pain is a very common problem, the vast majority of which can be taken care of by conservative treatment: rest/exercise/NSAIDS, but it all depends. A physician should spend time getting the history: How/when did it occur? Where is the pain? How bad is the pain? Contant/intermittant? What makes the pain better/worse? Any associated symptoms like numbness/weakness? Then there should be a good musculoskeletal exam, followed by a discussion with the patient concerning imaging studies, if appropriate, the most likely diagnosis and treatment plan. Surgery is the last option, but an option that should be available if needed.

Now a financially savy physician, because he/she knows it does not pay to to spend alot of time with each and every patient (who sometimes demand an MRI or a referal to a specialist right away), will spend very little time listening/examing the patient, but will order alot of tests including an MRI, and if he/she still cant figure it out what the problems is, will send a referal to a major university for more tests, etc. Now magnify this 10,000 times or more per day --> runaway health care costs.

Most physicians with any self respect will take the time needed to do the proper work up. But my point is, the system is set up to reward the lazy way and financially penalize the correct way. And remember, the problem is not who pays (a government entity vs private health insurance), but how physicians/hospitals get paid.

I'm trying to figure out the final outcome of a person who needs back surgery in Canada as apposed to the US. Here, you could get the MRI quickly and have the surgery. What would happen in Canada?

I agree the system is a mess either way you pay. I am an advocate of eliminating insurance companies and excessive government involvement, while achieveing reasonable tort reform. I like the idea of flat-fee agreements with the doctor and hospital, bypassing the middleman.

[southerndoc]

Now a financially savy physician, because he/she knows it does not pay to to spend alot of time with each and every patient (who sometimes demand an MRI or a referal to a specialist right away), will spend very little time listening/examing the patient, but will order alot of tests including an MRI, and if he/she still cant figure it out what the problems is, will send a referal to a major university for more tests, etc. Now magnify this 10,000 times or more per day --> runaway health care costs.

Are you kidding me? Patients WANT diagnostic testing. They want MRI's. I have to argue with them why MRI's aren't needed or why I shouldn't order it from the ER and why they should see a primary physician.

We are a society that we want every diagnostic test known to man done to determine what we have, and we don't want to take responsibility for our healthcare. "No, it's bad luck that I had a heart attack. It's not because I'm 150 pounds overweight, sit on my butt all day long, eat double cheeseburgers five days/week, and smoke two packs of cigarettes/day."

It's going to be interesting in 10 years when we get to say "I told you so" when we start spending on healthcare like other countries, but our outcomes drastically get worse because we don't adopt healthy lifestyles, still have 30+% obesity rates, and have months long waits.

[disneysteve]

Typically, I just go to a 30.00 dollar Chiropractor. But, what if the women needed an surgery? Would not waiting a year make the problem worse? How do they decide if she is need of surgery if they do not take the MRI or some other test?

I'm not a neurosurgeon, but I'd venture to say that very few surgeries are done because of MRI findings. They are done because of intractable pain or symptoms indicative of neurologic compromise (weakness of legs, loss of bowel or bladder control, etc.). Yes, an MRI will be done as part of the work-up to make sure that the problem is a herniated disc and not a big spinal cord tumor, but it is generally already decided that the patient is heading for surgery. The MRI just gives the surgeon a good idea of what to expect when he gets inside.