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Originally Posted by SteveZ
Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.
The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.
Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.
Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.
If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/...irectory.html# ) |
Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.
The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured
conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.
As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.
It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.
As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.