Posted by Benjamin on: 05.26.2007 /
Eliza made some useful observations and asked a great question in the conversation in another thread. Thankyou Eliza!
Interesting discussion. Thanks to all of you for going into, and staying in or trying to stay in, helping professions.
In health care, for me as a physician, “the system” is a (the) major idealism-sucking factor. There are soooo many people who really, really need health care, but who can’t access it because of health care is a commodity in this country, & it’s the “haves” who have access. (Even the “have-nots” who have coverage with Medicaid, which in this state is a pretty limited proportion of those in need, find it hard to access health care.)
It’s so discouraging to work with someone who wants alot of health care dollars spent on them for minimal health benefit, because they have coverage, like an expensive oral antifungal medication because they don’t like how their toenails look & they’ve seen the TV ads for Lamisil.
Then 30 minutes later you work with someone whose health is actively deteriorating because they can’t afford the most basic of medications or tests, and you’re trying hard to find some way to help them get it, in a patchwork, half-assed, suboptimal kind of way. That’s what I find really discouraging.
Anyone else find “the system” in which they work to be part of the problem?
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Comment by: Benjamin
1 05/26/07 6:39 PM | Comment Link |Eliza,
Megan and I were riding home with some friend the other day and one of us said “Somehow we two end up deconstructing every institution in which we ever find ourselves”, after which we, both rather liking that idea, did our little ritual high five that we like to do at connectivish moments. So yes, I’m totally with you in the idea of the system being the problem. The problem I’m finding as I get older is that this POV isn’t really helping me accomplish anything, since it seems that all the really big *good* stuff is accomplished by groups of people using a system, and on my own, outside of systems to the best of my ability, I can’t really be all that helpful in the world. Maybe the idea is to build better systems?
Specific to the medical system in this country, I’ve been on the wrong end of this broken system, and it sucks. I’d love to hear from our UK/Australian/Canadian friends on how their medical systems work better or worse, and why they might think that is.
Comment by: Sharon
2 05/26/07 8:12 PM | Comment Link |Not UK/Australian/Canadian but kiwi!
We theoretically have a socialised system of medicine here in New Zealand- we have huge problems but I think it is a whole heap better than what you have in the US.
As a Primary Health Nurse in a busy city health centre we spend a lot of time working to get funding from various government agencies and even more battling the hospital system and other health providers for specialised treatment for our patients. My own husband suffers from frequent, severe headaches (the result of a head injury) and has been waiting for months to get an appointment with a neurologist. He was denied an MRI recently because the request came from his GP (family physician) rather than a specialist. Because government agencies are involved in the allocation of scarce resources, and demand is fast outstripping supply, sub-optimal care and lengthy waiting lists are unfortunately a reality we have to live with.
That said, my faith in the system was somewhat restored this weekend. Yesterday my father had severe chest pain while working on his car at home. We called an ambulance (free) which took him to the Emergency Dept at the public hospital (free) where he was assessed and eventually admitted to the Cardiac Care Unit (free). The biggest problem (other than the chest pain obviously) was that the lab workers are all on strike this weekend! However the staff coped admirably, have done as much as they can and I am confident that he is getting the best care available here. It is good to know that in an emergency, we don’t have to worry about insurance or how we are going to pay. For this reason I remain a strong advocate of the public health system and socialised medicine in general. Although it can be difficult to get the care needed at times, at least prioritisation is generally done on the basis of need rather than ability to pay.
Comment by: Sharon
3 05/26/07 8:15 PM | Comment Link |Benjamin- I hear you. My husband and I have often been accused by those around us of being cynical and critical. “Deconstructing every institution in which we ever find ourselves” is a great way to put it. Yes, we do that. You should hear our analysis of Mercy Ships. Or maybe not.
Comment by: Benjamin
4 05/27/07 12:05 AM | Comment Link |sharon,
I’m sorry to hear about your dad! I hope he’s okay. My own dad has heart disease and has had bypass surgery. I get really upset at my parents (and those who agree with them) because the U.S. government is totally paying for all my dad’s healthcare (which is totally awesome IMO), but it’s because he’s retired military. And my parents think that makes sense that they should get free health care paid for by the citizens because my dad worked for the U.S. military (which is, let’s face it, a machine designed for mainly one purpose–but I digress), but everyone else should have to face the fear of how to pay for it, which is just the last thing people need when they are already suffering and frightened over some nasty horrible medical problem.
yeah, I’m thinking if you and hubby are ever up in seattle, you shall have to stay with or at least visit Megs and me, and we can all exchange horror stories about missionary ships =).
Comment by: Rachel
5 05/27/07 10:21 AM | Comment Link |Welcome, Sharon! I’m so glad to hear that your dad received the care he needed.
Comment by: Doreen
6 05/27/07 4:16 PM | Comment Link |Benjamin,
I’m like you when it comes to many institutions - insurers, banks, institutions of higher education, the government, the post office. Like you, I’m not sure I get anywhere except more frustrated.
I’ve got a lot of horrific “institituion” stories, most having to do with medical care. Among the worst, while waiting in my OB/GYN’s office, I heard someone on the phone with what was obviously an insurance co. A patient was lying in the ER next door and was bleeding to death. The dr. needed to do an emergency hysterectomy. The ins. co. was insisting the dr. do a D&C first! I couldn’t believe it. Finally I heard my dr. on the phone and she quickly ran out to go over to the hospital. I often wonder if the patient died while everyone tried to agree on what she needed….
Comment by: Heart Attacks and Health Systems « A Cup of Coffee
7 05/29/07 1:54 AM | Comment Link |[...] did however strike some inspiration at a post about health systems on Justice and Compassion. Given my very recent experience I thought it appropriate to comment, and with my current lack of [...]
Comment by: Eliza
8 05/29/07 7:40 PM | Comment Link |Sharon, I hope your dad is doing well - glad he got such prompt & appropriate (& free) care!
Benj, I share your frustration that some groups get coverage that’s free or very low cost, just because of their employer, esp. when it is/was the government. It seems very easy for people w/ good coverage to feel entitled to it, & see no reason to fight for coverage for others (esp. if it seems it might jeopardize their own coverage). I find it so interesting that the VA system covers medical conditions depending on the percentage which they are deemed “service-related”. One problem with that is, there’s a disincentive for people to get better - they might lose their coverage if their main “service-related” problem improves too much!
Doreen, phone conversations (or, these days, dueling faxes) like the one you overheard are not unusual. In my practice, the situation is usually not such an emergency. It’s been my pleasure to use the “no holds barred” approach with the insurance companies when advocating for something a patient really needs - I try to relay a “DUH, this is medically necessary & if you don’t agree here’s what the consequences could be, more $$ in claims for you to pay” message - without actually saying the DUH part. (I actually am sympathetic that the insurance companies have to stay afloat, & have to figure out some way to contain medical expenses to do that, but throwing up a bureaucratic barrier is such an unimaginative way to do that!)
Minor example recently - an insurance company faxed me a note that they were granting authorization for insulin syringes for one of my patients with diabetes…for one month. Well, duh, insulin-dependent diabetes is a chronic condition that doesn’t resolve without a pancreas transplant. I called them & said, “Let’s not do this every month. I can PROMISE you that she needs these and if she doesn’t get her insulin, because she doesn’t get syringes because she’s waiting for you to give the OK next month or the month after, she would need to be admitted to the intensive care unit for treatment of diabetic ketoacidosis.” It worked, as best as I could hope for within the insurance world…she’s been approved for insulin syringes for 1 year…but what a waste of time!
Comment by: Elaine
9 05/29/07 9:42 PM | Comment Link |For all your patients, I want to say thank you Eliza. Great job!
Health insurance is a pain. My husband and I are now both self-employed. Try to find health insurance when you are over 55 (we are now 59). We were able to get a policy through AARP - but it costs us $820/month & we have a combined deductible of $5700.
With paying that much money each year, I would have to get really sick to begin to collect. Ugh! And, I don’t really want get sick enough to collect.
I am glad that the military has health insurance provided. Although from a report I heard on NPR and what Eliza said, once they are out of the military, it can be daunting to get approved.
In short, our health care system is seriously broke. Isn’t calling it a “health care” system an oxymoron (or at least a contradiction in terms)? It rarely feels like the insurance company cares about maintaining our health.
Comment by: Benjamin
10 05/29/07 10:34 PM | Comment Link |Eliza,
You rock! the U should give you a big raise =)
Elaine–you rock. I think are out in the tails of the distribution in being 59 years old and being a blogger. I hope I stay that connected when I’m 59. You remind me of Jim.
My god, I can’t imagine forking out $820/month for health insurance. Yeah, it feels more like insurance bottom line care than health care–you nailed it.
today we were talking in abnormal psych class about the VT shooter, and his previous health care, or lack thereof. An intersting and difficult discussion, when do we involuntairly commite people? Who’s responsible? Etc. touches on this thread a little.
Comment by: Doreen
11 06/2/07 3:27 PM | Comment Link |Eliza,
That’s scary about an ins. co. only authorizing insulin syringes for a month! A few years ago Medi* (don’t remember which one) stopped paying for them altogether, leaving my mother to wonder if they expected her to DRINK from the vials of insulin!
d.
Comment by: Sharon
12 06/2/07 7:52 PM | Comment Link |Thanks all for your kind comments. Dad want home last week, then was readmitted the next day with more pain and is still in hospital. It is worrying and stressful but I can be thankful that he is getting the best care available here, and free. However I am concerned as my parents don’t have any health insurance and while he can get such good care acutely, should he need surgery there is a long waiting list for the public system. Unfortunately there is a bit of a 2-tier system and with insurance you can book in to a private hospital and have the surgery done immediately. Hopefully we won’t have to go through that stress though.
Benjamin-if we ever make it back to Seattle we’d love to take you up on that invitation. Same goes for you and your family if you ever are in NZ! Our little girl always likes new playmates.
Comment by: Elaine
13 06/11/07 3:42 PM | Comment Link |Benjamin - Thanks - I think(?). “59 is out in the tails of distribution” - not sure what that means.
As far as reminding you of Jim, I can’t speak for Jim - although I would be happy to….The older I get, the more I am becoming myself. Ha!
59 is the new 35 :) at least mentally. I’m not sure my body would agree. Which brings us back to health care. Ugh!
Sharon - I am sorry to hear your father is back in the hospital. When my parents became ill, it was a real education for me about healthcare AND the importance of having an advocate. When you are sick, you just don’t have the energy to disagree with the professionals.
Comment by: Rachel
14 06/11/07 5:44 PM | Comment Link |I feel the same way, Elaine!
Comment by: benjamin ady
15 06/12/07 4:41 PM | Comment Link |Elaine. Sorry. I just finished the 2 quarter psychology statistics course, and it’s very much centered around the idea of a normal distribution–you’ve seen it, no doubt–it’s shaped like a bell curve, with most people falling in the middle somewhere. “Out in the tails” just means people who are way over on the left or right ends of that normal curve–people who are more unique. So according to one study I looked at, only 3.5% of bloggers are over age 50. So I just thought it was really kewl to have you here!
Comment by: Elaine
16 06/13/07 3:49 PM | Comment Link |Benjamin - nothing to apologize for - no offense taken - I hadn’t realized I was an anamoly :) Thanks for the stats.
Although, I have frequently been the the odd woman out - so to speak. It is probably why Jim and I get along so well.
It is even funnier to me as I am a native Cincinnatian - and as Mark Twain said - if the world is coming to an end tomorrow - go to Cincinnati - it will be another 10 years before it catches on there. (not exact quote) - but you may get my point anyway. Ha!