Long long ago, in the 1920s our modern health care system began to take shape. Plans were formed linking multiple hospitals together. "Modern Medicine" was the wave of the future and it would save us all. Well, not everyone (Uncle Walter would have had another Aunt if "Modern Medicine" hadn't give Grandma so many pain killers in the 1930s that the baby was stillborn). Time marched on and around 1939 we had HMOs. The health care insurance system evolved, we gained a bit of Medicare, which was, GOD FORBID, government run health care, yep Socialism! How horrible, except for all the good it did for the people without insurance, but I am not going to debate medicare, today.
So our health care system evolved like a giant creature. More and more people got insurance so they could go to the doctor. Then more and more drug companies made better and better drugs, mostly for people's benefit. Then the unthinkable happened. People lived longer. Strange as it is when people get check-ups and go to the doctor for simple things like cancer, they tend to live longer. Combined with the baby boom there were more and more people in the health care system. So doctors had more and more patients, so segmentation by specialty became more and more prominent. The family doc will take care of you if you have the flu, but if you need to have blood drawn there is a flabotomist. Yes, I misspelled it, I can't figure that one out. (phlebotomist -- edited to add by The Wife. Sorry UW, couldn't let that one go).
Anyway there are docs for everything. From simple to complex. More and more people made sure that there would be mistakes. Then you have big lawsuits, then big insurance to insure the doctors, who have to be protected from the insured, fueled by lawyers with lawsuits. In turn the insurance companies, which keep in mind are for profit organizations, wanted to have less and less sick people. Makes sense, less sick people, less to pay. So, some plans say you can't go to a doctor outside of your plan or without talking to the on-call nurse to get pre-approval. I kid you not, I know someone who had to get pre-approval for an emergency room visit and ended up waiting six hours for the on-call nurse to call back and authorize the visit for a real emergency.
Then you get to the absurdity of the plans themselves. PacificCare is a good example. They don't insure high risk professions, like policeman, or firefighter, or air traffic controller. OK, I don't get the last one. After that you have the fact that you may be declined for taking certain medications like Zyrtec. I hope my allergies don't come back under that plan! And of course the all mighty pre-existing condition! God forbid you have AIDS, Cancer, Appendicitis (un-operated) - Good thing I didn't have their plan, obesity, acne, and more. You can even be declined for being an expectant father. You can read for yourself here: http://www.consumerwatchdog.org/resources/PacifiCareUnderwriting.pdf.
The whole thing gets crazy and the prices go up while the coverage levels go down. The insurance companies are at great risk of losing money, hospitals are going broke, general doctors become specialists so they can make more and we have a shortage of generalists. Not to mention that it costs a bloody fortune to become a doc, and for that you only have to barely pass your classes. I don't know my doctor's GPA, do you?
So, what the h*ll can we do? Well, before we revise, change and alter the existing system, we need to know the history and realize the fact that the current system is a result of the natural growth of an economic entity reacting to the environment. Next we look at the real question, does it work? Yes, but not all that well. So now what do we do to fix it? Damned if I know. I just complain about this stuff. Lets hope the politicians are better at fixing this than I am.
-Uncle Walter
Well, first, I must say that I like Maryland's laws against descrimination based on pre-existing conditions. They're not perfect, but they keep someone like me from losing my health-care coverage.
Secondly, as we discussed this evening, most of the problems that people have with their doctors stems from the patient themselves being uneducated about their own health care. Another problem is when the patient is too afraid to either stand up to their doctor or to fire them. As you know, the last doctor I fired has been removed as an approved provider.
Ultimately, doctors are no better or worse than anyone else. As I've said before, a person who graduates last in their class from med school is still called Dr. We have to be proactive for our health care, but also for our health insurance.
Mostly, though, we desperately need tort reform. We MUST stop all of these unnecessary lawsuits that hurt ALL of us by making the insurance companies recoup their losses through jacked up prices.
But that's another topic, for another post.
Posted by: The Wife | October 06, 2009 at 12:12 AM
I agree, MD's pre-existing rules make a huge difference and keep people from being excluded from insurance. You are right about patient's responsibility. People are too quick to say OK to the doctor who is overworked, or doesn't care, and may have missed something. Too often people do not listen to their bodies and major ailments are missed. As for tort reform, you are correct, there are too many lawsuits which makes doctors too afraid to do their job well. Especially with diagnostics. A patient who has something simple may be subjected to a huge battery of tests, just in case, there is something else wrong. The bills go up, but if something was missed then the doctor, hospital, and everyone gets sued.
Posted by: Uncle Walter | October 06, 2009 at 08:06 AM
It's a double edged sword. Doctors are afraid of missing something they should have found, so they run tons of tests -- but then they miss big things because they don't do basic steps that would have caught the problem. YOU know all about that. And *I* know that making sure your care was appropriate is why I was at the hospital with you for 4 days straight.
Posted by: The Wife | October 06, 2009 at 07:14 PM