I want universal health care. But I'd like to hear Ro's insights on whether it would work -- because in my exposure to Veterans Affairs, government hasn't been able to take care of even its retired fighting men and women. It's my understanding that the VA is hemorrhaging quite shamefully.
Medicare overhead isaround 3% right now, and private insurance overhead isaround 25%. The "evil Canadian system" generates abouta fifth of the overhead the American system does. All the evidence is pointing to government being able to solve this problem better than private industry.
I'm talking in generalities on this. But it does raise the question of has my long held believe that big government sucks become obsolete. With modern relational databases and powerful computers, can government do things efficiently?
However, if the damage is self-inflicted than I'm not for covering it.
If you need medical care you can go to an ER and wait (cheap, quality, slow). If your insurance plan will not cover some form of care you can buy it (expensive, quality, fast). If we go to a system like GB or Canada we lose the second option just as they have. Why do I say this? Because the people in those countries that do not want to wait 6 months for care go to the USA and pay for care.
As to ERs being slow, they really aren't. You may have to wait several hours to be seen if you do not have an immediate life threatening issue, but I have never heard of anyone waiting days to be seen at an ER. Also ERs are not "cheap" by any means. Mere admittance can be hundreds of dollars, an ambulance ride is hundreds more, and care for even routine issues can equal thousands of dollars. While people do have to wait in other countries for less immediate needs, we also have to wait in the U.S. for non-immediate needs. I know that when I had insurance, I had to wait months for appointments for check ups or minor concerns. Personally, I would rather wait six months for a less urgent medical procedure than not have access at all because of lack of insurance and funds.
As to your statement on self-inflicted illnesses, where do we draw the line? Someone that has gone without health insurance, has little money, comes from a family that never educated them on health issues or emphasised the necessity of paying attention at school, and is now 18 and morbidly obese, too poor to join a gym, ignorant of cheap and healthy foods, and already has weight related diabetes should not be covered? Now this is an extreme example, but not exactly a rare example. Personally, if I can help someone get healthier and learn how to live a healthier existence, then I will happily pay that cost.
Also, if prevention is our goal, then universal health care from infancy on and free access to public gyms and health education for the impoverished (of any age) is a great way to prevent future illnesses.
I want universal health care. But I'd like to hear Ro's insights on whether it would work -- because in my exposure to Veterans Affairs, government hasn't been able to take care of even its retired fighting men and women. It's my understanding that the VA is hemorrhaging quite shamefully.
Are there certain questions you have? I mostly know things on the financial side, and a few on the actual health care side.
Mrs. Macross.. you have commited a terrible crime.
And yes, I am from the "fucking moon". It is a 24/7 orgy, baby! Want to join in? ^_~
How could you miss out on the joke: "No, I'm from fucking Uranus."
Because I don't do butts. ^_~
I'm sure Adam is thoroughly relieved about that. :P
What I would really like to see is an elimination of all current social medical programs (Medicare, Medicaid, etc.) and just replace it with cradle-to-grave health insurance for all.
I want universal health care. But I'd like to hear Ro's insights on whether it would work -- because in my exposure to Veterans Affairs, government hasn't been able to take care of even its retired fighting men and women. It's my understanding that the VA is hemorrhaging quite shamefully.
Are there certain questions you have? I mostly know things on the financial side, and a few on the actual health care side.
The VA is shameful, but it is also shamefully underfunded and poorly organized. I hate that bureaucracies are so static. We need liquid bureaucracy that is ready and willing to make changes when and where necessary. Unfortunately, those already in positions want to keep their positions and think that that equates to keeping the system as is. It is truly sad. The best asset an organization can have is alacrity and adaptability.
What I would really like to see is an elimination of all current social medical programs (Medicare, Medicaid, etc.) and just replace it with cradle-to-grave health insurance for all.
The VA is shameful, but it is also shamefully underfunded and poorly organized. I hate that bureaucracies are so static. We need liquid bureaucracy that is ready and willing to make changes when and where necessary. Unfortunately, those already in positions want to keep their positions and think that that equates to keeping the system as is. It is truly sad. The best asset an organization can have is alacrity and adaptability.
I can agree with this. There are so many things that can be easily streamlined to make work processes more cost efficient and effective, but we don't do it because people who have been here for a long time don't want to change or adapt to improve things.
It gets really discouraging at times because you know there are people who are here that really want to improve things for Veterans but whenever they try to change things to improve the quality of care, they get shot down.
I can agree with this. There are so many things that can be easily streamlined to make work processes more cost efficient and effective, but we don't do it because people who have been here for a long time don't want to change or adapt to improve things.
It gets really discouraging at times because you know there are people who are here that really want to improve things for Veterans but whenever they try to change things to improve the quality of care, they get shot down.
Government really needs to be able to fire people more liberally. I work in IT in the private sector. When we make a massive system change we train people on the new way of business. If they are unwilling to make changes in their work habits, then we are no longer willing to employ them. It's just that simple. Government could do with more of this way of thinking.
I guess, Ro, that the most specific I can get is: What could be done differently to make UHC work where the VA has failed, and is it plausible given the bureaucratic tendency to compromise goals for political reasons?
I have never, in my life, been seen in an ER inside of four hours. More than once, I've walked out on my own and self-treated. Other times, I've been misdiagnosed. ("You may have a brain tumor: it's clearly not Lyme disease, despite you having all of the symptoms of Lyme disease and a propensity to spend time in the tall grass"). And this is with the best insurance money can buy.
I had immediate medical needs that required immediate attention. I have a scar and a large, permanently numb spot on my left pinky finger that would trivially have been avoided had the ER simply provided the simple suture/stitches that I required (and could not perform safely myself). After waiting almost five hours, I walked out, went home, sutured it shut with superglue, and went to a day-clinic for some antibiotics the following morning. The doctor there was aghast, and basically told me that the damage was permanent, and could have been avoided had I been treated within a couple of hours.
I would have understood if there were life-threatening calamities taking up the ER's time, but it was basically empty. No amount of money or prevention (beyond not cutting myself, I suppose) could have afforded me better care, and I've generally resolved to self-treat all but the most serious injuries in the future.
Also ERs are not "cheap" by any means. Mere admittance can be hundreds of dollars, an ambulance ride is hundreds more, and care for even routine issues can equal thousands of dollars.
With good insurance or total indigence, it's all free, and the level of care is the same. The only people who have to pay for the ER are the middle/lower-middle class people with average insurance. So, they get screwed care-wise AND money-wise, while the ultra rich and ultra poor are screwed only care-wise.
If we provide basic care to all, then triage in the ER can be made much more efficient, making things better for everyone. Instead of keeping the hundreds of uninsured there taking up beds, chairs, and resources for their non-serious problems, the triage nurse can schedule them appointments later. We need 24/7 triage, and we need 24/7 critical/time sensitive care: we do not need 24/7 routine care. But, with the current system, we're basically paying for that last one at the expense of the others. If we're going to treat them anyway, we can at least do it outside of the ER.
Government really needs to be able to fire people more liberally. I work in IT in the private sector. When we make a massive system change we train people on the new way of business. If they are unwilling to make changes in their work habits, then we are no longer willing to employ them. It's just that simple. Government could do with more of this way of thinking.
QFT. I think one of the reasons why this doesn't happen is because the VA wants to be known to have Veterans working to take care of Veterans, even if they aren't totally qualified. I find it extremely frustrating when we hire people with little or no computer knowledge or skills.
Rym, did you go during the day or in the middle of the night when nothing else was open?
If you have good insurance, there is very little reason to go to the ER for minor injuries unless nothing else is open. If you can, go to an URGENT CARE facility. You will get seen faster than at the ER, the care is cheaper, and the doctors are less overworked and generally more competent at dealing with minor things.
In the ER, you rarely get seen by an actual doctor if you have a minor injury. It's a good idea to check for Urgent Care facilities in your area should you ever need one.
QFT. I think one of the reasons why this doesn't happen is because the VA wants to be known to have Veterans working to take care of Veterans, even if they aren't totally qualified. I find it extremely frustrating when we hire people with little or no computer knowledge or skills.
It's been said before, computer skills are becoming like literary skills used to be. If you don't have them, society has little need for you.
Rym,
I think your experiences are the result of the ER's you went to more than ER's in general. But ERs are really only for emergencies. If you're dying right now then go to the ER. If you're dying at only a slightly faster rate than the rest of us then there are better options for that.
If we were to branch off from health insurance reform and talk a little about health care reform, this should be a point. There needs to be a massive public education campaign to teach people about how the health care system works and what options you should use when.
There needs to be a massive public education campaign to teach people about how the health care system works and what options you should use when.
Public health education in this country is woefully inadequate. This is why we have people who don't understand why homeopathic remedies and other such quackery don't work, or why we have people who think that "organic" food is better for you. Whenever I get to grad school, it's going to be for an MPH in Public Health Education and Administration. The greatest medical science we have is useless if the public doesn't understand how to use it.
If you're dying at only a slightly faster rate than the rest of us then there are better options for that.
Not at night. It was actually hard to find an open ER in the area, and there were zero 24/7 clinics.
I think your experiences are the result of the ER's you went to more than ER's in general.
In Detroit, in Sterling Heights, in Rochester, in Beacon, in New York: it's always been the same. I've never in my life been seen in any reasonable amount of time.
But ERs are really only for emergencies.
They are indeed. They are triage and response for immediate medical concerns that cannot wait to be treated, or which appear to require immediate professional care.
There needs to be a massive public education campaign to teach people about how the health care system works and what options you should use when.
There were two options: go to an ER, or superglue it shut and accept permanent damage. It's not like anything else within a reasonable drive was open, and I'd previously been effectively denied care (for another issue) at the only other hospital in the area.
An Urgent Care facility just opened up near us and we have resolved to go to it if the need arises. (I hope the need doesn't, but one can never be too careful.) Rym cut himself at around 8:00 at night, and was bleeding profusely into a towel. He obviously needed stitches, and I would assume that this is the sort of thing the emergency room is for. You don't call you PCP and say, I'd like an appointment for stitches next week! There were no doctors in Beacon to help us at that time, so we went to the Newburgh emergency room, where Rym continued to bleed by himself in a corner until we finally went home, untreated, in the middle of the night. Needless to say, this was a horrible experience, but pretty typical of emergency rooms.
Yes, ER care is generally inefficient. You really need something like a compound fracture or bullet wounds to be seen immediately. The truth is, with a cut on the finger, you most likely won't bleed to death, so they let you sit there bleeding and deal with you when they can. Yes, it sucks. That's why we need more urgent care facilities.
What could be done differently to make UHC work where the VA has failed
Short answer: Hire people that are capable and qualified in the position they are hired for on both the Administrative and Clinical side. Also never compromise on the main goal at hand: Quality health care for the patient.
is it plausible given the bureaucratic tendency to compromise goals for political reasons?
As long as the funding is there to complete the goal, it is possible, but they have to put make Health Care a priority over politics, which is very hard to do and rarely seen. Not many people have the courage to stick their necks out for what needs to be done. From my own observation that health care ends up being neglected because of lack of funds certain processes where changed on a short term basis to make the higher ups look good when the goal was completed or achieved, but in the long run created new problems for the lower tiered workers to fix.
I'm sorry I can't provide better answers. I can one good thing about the VA is that in regards to patient out of pocket expenses is very minimal, and the VA does try to help as much as possible to help with the cost of care if there is a burden on the Veteran.
Not at night. It was actually hard to find an open ER in the area, and there were zero 24/7 clinics.
Fail.
In Detroit, in Sterling Heights, in Rochester, in Beacon, in New York: it's always been the same. I've never in my life been seen in any reasonable amount of time.
Well that sucks that your personal experiences have been so bad. The one time I went to the ER I was seen relatively quickly. Admittedly they had no freaking idea what to do with me after that, but it was nerve problems and that's way outside what your typical ER doctor is ready to diagnose. If I had needed simple stitches I think they could have handled it in a relatively reasonable amount of time.
There were two options: go to an ER, or superglue it shut and accept permanent damage. It's not like anything else within a reasonable drive was open, and I'd previously been effectively denied care (for another issue) at the only other hospital in the area.
I'm not saying you did anything wrong. Seriously, if things were as poorly handled as you say, you should complain to the state board of health or something. There are channels to get these issues resolved and if they can't be resolved they can close the hospital.
I've been to multiple ERs. For less urgent issues I've had to wait from 1 hour to 6 hours and for urgent matters I was seen between 10 minutes and 3 hours. Personally, if it isn't an "I'm about to die!" situation, I consider being seen within 12 hours (particularly if I arrive any time after 5:00 p.m.) a win. After hours clinics and urgent care facilities are often denied by insurance providers and the centers can only deal with limited and relatively minor issues. If you have anything that requires more than simple tests or medication, then they ship you to the ER and bill your insurance (or you if you have no insurance) anyway.
Actually, according to soil and water surveys I have seen, it IS better for you, but not in the way that you'd think.
The nutritional content is identical, and the bacterial contamination rates are the same if not higher. The only possible difference may be in pesticide residue levels, but non-organic produce isn't exactly loaded down with pesticides either. Also, you wash your produce. It has less of an impact on the environment in which it's grown, but it's also less efficient to farm.
But last month on "20/20" producer Miguel Sancho and I reported on Medicare’s $34 trillion in unfunded liabilities, on how Medicare is a prime example of government promising MUCH more -- that it is prepared to deliver. But the Obama administration has succeeded in promoting the fiction that Medicare is a shining example of government working well. Statists suggests that because Medicare only spends two or three percent of its budget on overhead, that means it's a smoothly running machine. Bevan cites recent columns by Jonathan Alter and Paul Krugman, and “West Wing” fans will remember Jimmy Smits’ Matt Santos making the same argument in the famous “live debate” episode.
Bevan argues persuasively that Medicare’s low overhead is the product of government accounting sleight-of-hand. But there’s a bigger point – the connection between “low” administrative costs and staggeringly HIGH levels of fraud and waste. As Michael Cannon at the Cato Institute and Regina Herzlinger at Harvard Business School have pointed out, much of the 10 to 20 percent of private insurance administrative costs goes to preventing fraud. Private insurers, you see, care about whether or not they lose money. Medicare, with its unlimited claim on the public purse, does not. It's only taxpayer money, after all.
Do a search online for the "Medicare overhead myth" and you will find a wealth of information on the subject.
Actually, according to soil and water surveys I have seen, it IS better for you, but not in the way that you'd think.
The nutritional content is identical, and the bacterial contamination rates are the same if not higher. The only possible difference may be in pesticide residue levels, but non-organic produce isn't exactly loaded down with pesticides either. Also, you wash your produce. It has less of an impact on the environment in which it's grown, but it's also less efficient to farm.
In fact, the largest research into the nutritional value of organic vs. traditional methods says there is no significant difference.
The nutritional content is identical, and the bacterial contamination rates are the same if not higher. The only possible difference may be in pesticide residue levels, but non-organic produce isn't exactly loaded down with pesticides either. Also, you wash your produce. It has less of an impact on the environment in which it's grown, but it's also less efficient to farm.
I never argued that. They are the same vegetables, with the same vitamins and mineral content. I'm just saying too many agricultural chemicals do weird stuff to the creeks and water supply.
Let me put it this way: Don't worry about the apple you are washing, worry about the water you are washing it with.
I never argued that. They are the same vegetables, with the same vitamins and mineral content. I'm just saying too many agricultural chemicals do weird stuff to the creeks and water supply.
Are foods labeled "organic" more effective in lowering cancer risk?
The term organic is popularly used to designate plant foods grown without pesticides and genetic modifications. At this time, no research exists to demonstrate whether such foods are more effective in reducing cancer risk than are similar foods produced by other farming methods.
Do pesticides in foods cause cancer?
Pesticides and herbicides can be toxic when used improperly in industrial, agricultural, or other occupational settings. Although vegetables and fruits sometimes contain low levels of these chemicals, overwhelming scientific evidence supports the overall health benefits and cancer-protective effects of eating vegetables and fruits. At present there is no evidence that residues of pesticides and herbicides at the low doses found in foods increase the risk of cancer, but fruits and vegetables should be washed thoroughly before eating.
WHAT MAKES PRODUCE "ORGANIC"? Contrary to what most people believe, "organic" does not automatically mean "pesticide-free" or "chemical-free". In fact, under the laws of most states, organic farmers are allowed to use a wide variety of chemical sprays and powders on their crops.
So what does organic mean? It means that these pesticides, if used, must be derived from natural sources, not synthetically manufactured. Also, these pesticides must be applied using equipment that has not been used to apply any synthetic materials for the past three years, and the land being planted cannot have been treated with synthetic materials for that period either.
Most organic farmers (and even some conventional farmers, too) employ mechanical and cultural tools to help control pests. These include insect traps, careful crop selection (there are a growing number of disease-resistant varieties), and biological controls (such as predator insects and beneficial microorganisms).
ORGANIC PRODUCE AND PERSONAL HEALTH When you test synthetic chemicals for their ability to cause cancer, you find that about half of them are carcinogenic.
Until recently, nobody bothered to look at natural chemicals (such as organic pesticides), because it was assumed that they posed little risk. But when the studies were done, the results were somewhat shocking: you find that about half of the natural chemicals studied are carcinogenic as well.
This is a case where everyone (consumers, farmers, researchers) made the same, dangerous mistake. We assumed that "natural" chemicals were automatically better and safer than synthetic materials, and we were wrong. It's important that we be more prudent in our acceptance of "natural" as being innocuous and harmless.
ORGANIC PESTICIDES VERSUS SYNTHETIC PESTICIDES Clearly, the less we impact our environment, the better off we all are. Organic farming practices have greatly advanced the use of non-chemical means to control pests, as mentioned earlier.
Unfortunately, these non-chemical methods do not always provide enough protection, and it's necessary to use chemical pesticides. How do organic pesticides compare with conventional pesticides?
A recent study compared the effectiveness of a rotenone-pyrethrin mixture versus a synthetic pesticide, imidan. Rotenone and pyrethrin are two common organic pesticides; imidan is considered a "soft" synthetic pesticide (i.e., designed to have a brief lifetime after application, and other traits that minimize unwanted effects). It was found that up to 7 applications of the rotenone- pyrethrin mixture were required to obtain the level of protection provided by 2 applications of imidan.
It seems unlikely that 7 applications of rotenone and pyrethrin are really better for the environment than 2 applications of imidan, especially when rotenone is extremely toxic to fish and other aquatic life.
It should be noted, however, that we don't know for certain which system is more harmful. This is because we do not look at organic pesticides the same way that we look at conventional pesticides. We don't know how long these organic pesticides persist in the environment, or the full extent of their effects.
When you look at lists of pesticides allowed in organic agriculture, you find warnings such as, "Use with caution. The toxicological effects of [organic pesticide X] are largely unknown," or "Its persistence in the soil is unknown." Again, researchers haven't bothered to study the effects of organic pesticides because it is assumed that "natural" chemicals are automatically safe.
Comments
As to your statement on self-inflicted illnesses, where do we draw the line? Someone that has gone without health insurance, has little money, comes from a family that never educated them on health issues or emphasised the necessity of paying attention at school, and is now 18 and morbidly obese, too poor to join a gym, ignorant of cheap and healthy foods, and already has weight related diabetes should not be covered? Now this is an extreme example, but not exactly a rare example. Personally, if I can help someone get healthier and learn how to live a healthier existence, then I will happily pay that cost.
Also, if prevention is our goal, then universal health care from infancy on and free access to public gyms and health education for the impoverished (of any age) is a great way to prevent future illnesses.
What I would really like to see is an elimination of all current social medical programs (Medicare, Medicaid, etc.) and just replace it with cradle-to-grave health insurance for all.
It gets really discouraging at times because you know there are people who are here that really want to improve things for Veterans but whenever they try to change things to improve the quality of care, they get shot down.
I had immediate medical needs that required immediate attention. I have a scar and a large, permanently numb spot on my left pinky finger that would trivially have been avoided had the ER simply provided the simple suture/stitches that I required (and could not perform safely myself). After waiting almost five hours, I walked out, went home, sutured it shut with superglue, and went to a day-clinic for some antibiotics the following morning. The doctor there was aghast, and basically told me that the damage was permanent, and could have been avoided had I been treated within a couple of hours.
I would have understood if there were life-threatening calamities taking up the ER's time, but it was basically empty. No amount of money or prevention (beyond not cutting myself, I suppose) could have afforded me better care, and I've generally resolved to self-treat all but the most serious injuries in the future. With good insurance or total indigence, it's all free, and the level of care is the same. The only people who have to pay for the ER are the middle/lower-middle class people with average insurance. So, they get screwed care-wise AND money-wise, while the ultra rich and ultra poor are screwed only care-wise.
If we provide basic care to all, then triage in the ER can be made much more efficient, making things better for everyone. Instead of keeping the hundreds of uninsured there taking up beds, chairs, and resources for their non-serious problems, the triage nurse can schedule them appointments later. We need 24/7 triage, and we need 24/7 critical/time sensitive care: we do not need 24/7 routine care. But, with the current system, we're basically paying for that last one at the expense of the others. If we're going to treat them anyway, we can at least do it outside of the ER.
If you have good insurance, there is very little reason to go to the ER for minor injuries unless nothing else is open. If you can, go to an URGENT CARE facility. You will get seen faster than at the ER, the care is cheaper, and the doctors are less overworked and generally more competent at dealing with minor things.
In the ER, you rarely get seen by an actual doctor if you have a minor injury. It's a good idea to check for Urgent Care facilities in your area should you ever need one.
Rym,
I think your experiences are the result of the ER's you went to more than ER's in general. But ERs are really only for emergencies. If you're dying right now then go to the ER. If you're dying at only a slightly faster rate than the rest of us then there are better options for that.
If we were to branch off from health insurance reform and talk a little about health care reform, this should be a point. There needs to be a massive public education campaign to teach people about how the health care system works and what options you should use when.
Rym cut himself at around 8:00 at night, and was bleeding profusely into a towel. He obviously needed stitches, and I would assume that this is the sort of thing the emergency room is for. You don't call you PCP and say, I'd like an appointment for stitches next week!
There were no doctors in Beacon to help us at that time, so we went to the Newburgh emergency room, where Rym continued to bleed by himself in a corner until we finally went home, untreated, in the middle of the night. Needless to say, this was a horrible experience, but pretty typical of emergency rooms.
I'm sorry I can't provide better answers. I can one good thing about the VA is that in regards to patient out of pocket expenses is very minimal, and the VA does try to help as much as possible to help with the cost of care if there is a burden on the Veteran.
After hours clinics and urgent care facilities are often denied by insurance providers and the centers can only deal with limited and relatively minor issues. If you have anything that requires more than simple tests or medication, then they ship you to the ER and bill your insurance (or you if you have no insurance) anyway.
Do a search online for the "Medicare overhead myth" and you will find a wealth of information on the subject.
Let me put it this way: Don't worry about the apple you are washing, worry about the water you are washing it with.