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jmj11

I'm Sorry To Say This . . . But

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I recently traveled to Croatia and Bosnia and discussed their "universal healthcare" with a couple of the drivers we used. Unanimously they despised the government provided care because a) it wasn't really free. Their employers were required to pay x amount to the gov for each employee to receive HC coverage. The workers felt like this money could have been provided as salary instead. B) The care came with ridiculous waiting times e.g. 6 month wait for abd CT to rule out appy. and C) the government was so corrupt that they felt that the money wasn't being put back into HC facilities. Furthermore, Physicians there were paid a standard rate whether they saw 1 or 20 patients a day which led to ridiculous wait times for appointments. It's interesting to me that these systems have failed so miserably that the rich pay cash to private MDs and skip out on gov subsidized HC all together and there are private insurance firms popping up underground. 

 

 

so then it is so sad that they still did BETTER in the 2000 WHO rankings for  PERFORMANCE ON LEVEL OF HEALTH

 

YUP 

 

We were 72

 

Bosnia was 70!!!

 

 

Croatia was actually a little bit better

 

 

 

Now lets actually have some valid comparisons between first world countries with established countries (that did not just gain independence)- and mature health care delivery systems....

 

yup we are pretty much DEAD LAST against those countries.... 

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There are always these annoying, hyperbolized stories about socialized healthcare around the world. Most of the time they just aren't true, or we're ignorant of the fact these problems exist in any healthcare delivery system. Heck, I live in the Midwest and both my dermatologist and ENT have wait times of about one month right now. 

 

And then there's this drivel about doctors being woefully underpaid in socialized medicine... http://www.renalandurologynews.com/commentary/nephrologists-woefully-underpaid-in-us-vs-canada/article/331739/

 

Perhaps it's different for primary care, but here's a case study in nephrology (since that's something I'm interested in):

 

Many Canadians had a good chuckle during the debates on Obamacare, when the word “socialist” was bandied about to describe underpaid doctors and long waiting lists for surgeries. Maybe there are such health care debacles in Canada, but definitely there is no long waiting period if you need to start dialysis treatment and to find a dedicated nephrologist.

 

Nephrologists in Canada can expect to make over $700,000 in collections. Even better... they are allowed to incorporate themselves so they pay a 16% tax as opposed to a 45% personal income tax. But the real kicker... most Canadian physicians avoid nephrology because the other specialties have even higher collection rates. 

 

Nephrologists in Canada can expect to collect about $7,000 per patient, while US physicians can expect to only collect $3,000. 

 

I just got back from Germany as well.... I think (as a foreigner) my visit to the doctor should I need to see one would only be about 35 euros. Now I know doctors over there do make less (around $70,000-$120,000 USD or so), but they're in school for about as long as we are (they do 6 years with no undergrad). In that comparison, we're right on par. Not to mention, they have the added benefit of having the right to have their credential respected in over 25+ countries should they choose to practice someplace else (as any physician in the EU has the right to). Combine that with no student loans and a government that pays for your books and living stipend... not the worst deal in the world. 

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Amazing topic! I have worked in an ER in an underserved area and on Park Ave Concierge practice as well. Clearly there are those who need to be helped by the system. There are many in the middle class being crushed by the Obamacare monthly fees and reduction in benefits. A universal medicare or medicaid for all will raise taxes (relax---most PAs can afford to pay more) but will also cause the upper and middle to return to the cash practices of the 1960s to 1980s for the services/attention they need.  No right answer!

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Our son is adopted from the state and therefore qualifies for Medicaid which we used until we could add him to our health insurance at work.  The difference between a Medicaid office and one that does not accept Medicaid are vastly different.  Not only are the patients different but so are the staff.  Not sure which comes first, the irate patient or the short-tempered employee, I imagine the former.  I've met plenty a medical provider go into these practices bright eyed and bushy tailed and not make it a year.  It's tough working with the Medicaid population.  I don't view them as victims nor any other such nonsense.  They may not have college degrees however they have smart phones and access to the internet.  It doesn't take much to read up on issues and the like.  Heck just show up to your appointment!  When I worked for Social Security people applying for SSI were notorious for not showing up or showing up an hour late and with an attitude.  It was always fascinating to me that those people who worked for decades and were filing to retire were always on time but those who had never worked but were now claiming to be disabled could never show up on time if at all.  Don't even get me started on the foreigners who would drive from the airport to our office to apply for benefits...

While Medicaid is paid by tax dollars the standard of care our son received was no doubt subpar, it just was.  Medicaid providers begin to...resemble their patients and look and act as "Medicaid doctors."  It's unfortunate but very true.  Our son needed surgery and his surgeon takes one Medicaid pediatric patient every month.  When we visited his office it was the type of service my wife and I receive.  Pleasant staff, nice office, and a pleasant exam with the physician.  YET after the surgery at the follow-up visit it was literally, "well this has been fun but I doubt I'll ever see you guys again in this part of town.  Have a great life!" as he escorted us out of the office, it was surreal. 

It's like all this talk about a physician shortage in psychiatry, there isn't one.  There is a shortage of community health psychiatrists.  It's the difference in seeing healthcare as a right or a service, I opine the latter as does the free market.  We're all people and people go where the money is and that goes for the Medicaid population.  When I volunteered at the free clinic so many couldn't wait to get Medicaid because then they "could tell the doctors what to do."

There is a stigma working with the Medicaid population as well as being part of the Medicaid population but it's not a case of a few are ruining it for the many.  It's more like our society has created a sense of entitlement about everything.  Heck people are now entitled to their opinion and entitled not to hear yours and even call it hate speech because they are offended that you disagree with them....

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so then it is so sad that they still did BETTER in the 2000 WHO rankings for  PERFORMANCE ON LEVEL OF HEALTH

 

YUP 

 

We were 72

 

Bosnia was 70!!!

 

 

Croatia was actually a little bit better

 

 

 

Now lets actually have some valid comparisons between first world countries with established countries (that did not just gain independence)- and mature health care delivery systems....

 

yup we are pretty much DEAD LAST against those countries.... 

Doesn't shock me, compare the diets of the USA and others...We are providers are fixing the problems and the US government could care less about preventing disease... If the food/diet doesn't change then we will never get ahead of this. 

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Amazing topic! I have worked in an ER in an underserved area and on Park Ave Concierge practice as well. Clearly there are those who need to be helped by the system. There are many in the middle class being crushed by the Obamacare monthly fees and reduction in benefits. A universal medicare or medicaid for all will raise taxes (relax---most PAs can afford to pay more) but will also cause the upper and middle to return to the cash practices of the 1960s to 1980s for the services/attention they need.  No right answer!

unsure where you get your data

 

ACA did not INCREASE fees or DECREASE coverage

 

in fact there is pretty good info saying it did EXACTLY the opposite...  hence why insurance companies are pulling out of the exchanges.... more coverage for less money means less profit...

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unsure where you get your data

 

ACA did not INCREASE fees or DECREASE coverage

 

in fact there is pretty good info saying it did EXACTLY the opposite...  hence why insurance companies are pulling out of the exchanges.... more coverage for less money means less profit...

 

 

https://www.forbes.com/sites/nickclements/2016/10/25/obamacare-premiums-increase-25-is-the-death-spiral-here/#253926296429

 

from 2016 "The Obama administration confirmed this week that marketplace premiums will increase and consumers will have fewer choices."

 

http://www.pbs.org/newshour/rundown/obama-administration-announces-double-digit-premium-hikes-affo/

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Fee's don not equal premiums

 

It was stated insurance coverage would get worse, but in fact it has gotten better 

 

 

now if we talk premiums - yes indeed they have gone up, but when you buy a yugo and get a yugo you can't complain when the next caryou buy is a Ford and costs more......

 

 

Overall I agree that premiums are going up, but that has most to do with insurance companies and their crappy practices, the drug companies, and lastly large hospital systems that just bilk the insurance companies.....

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Fee's don not equal premiums

 

It was stated insurance coverage would get worse, but in fact it has gotten better 

 

 

now if we talk premiums - yes indeed they have gone up, but when you buy a yugo and get a yugo you can't complain when the next caryou buy is a Ford and costs more......

 

 

Overall I agree that premiums are going up, but that has most to do with insurance companies and their crappy practices, the drug companies, and lastly large hospital systems that just bilk the insurance companies.....

oh got it, instead of a turd sandwich its turd soup. I'm sure people really care whether they're paying more in fees or premiums. "It's not a tax, it's a penalty." With the semantics aside, the main point stands that the ACA = people paying more with fewer choices. Yay!

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Soylent Green is getting closer and closer. Just saw statement on ABC World News that 40% of US kids are on Medicaid. Really? 40%? Someone please explain...never mind, I think I've got it figured out.

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I’m not gonna lie there’s truth to this. 

While I was pregnant in school and broke Medicaid saved me and my child. Still thankful I got health care for him. And the quality of doctors ... terrible. The quality of people in those offices... terrible. Low tier everything. But, it comes with the territory. 

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Interesting topic. In our private ortho trauma practice, we have a large portion of Medicare and Medicaid, about 60% of the practice. And compared to the experiences above, the vast majority are compliant and show up. We'll get a few bad apples periodically, but most are actually very respectful. And oftentimes the no-showers are actually the elderly SNF patients with dementia, not the Medicaid patients. Although we work harder for our money since we collect so little, it's very rewarding to have patients who are grateful for our service. But I suppose it does help that we have a nice office space that we rent and not a typical "Medicaid-like" office filled with "Medicaid-like" staff.

There's a saying that "trauma is a disease" and the saying is true for the most part. It happens to a particular kind of person who happens to also typically be un- or underinsured. But someone's gotta do it. Maybe it's because patients can't imagine not using their limb and fixing broken bones is viewed as healthcare as a previous poster suggested. But I always try to impress personal responsibility, general health care, healthy eating, alcohol moderation, risk reduction, and smoking cessation on all in hopes they'll take that to heart. 

In our field, there's no way we could ever get rid of our patients who have government-supported insurance because we'd have almost no patients and with call contracts and EMTALA, we can't refuse service. So it's a necessary "evil" we've learned to work with and take care of. 

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This is such a sad post. This sort of healthcare is there for those that need it. It is not for the provider to judge why they may have it or to pick and choose the "easy" patient. I would hope we chose this profession to help those in need and to educate and care for all. This is just another example of prejudice in our country and it saddens me that our profession could foster this type of behavior. 

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I've seen both sides of this coin, in and out of medicine. I have a great deal of experience as an instructor during my previous non-medical life as well. From a psychological standpoint, the attitude of patients is likely directly related to their experience in the clinic and attitude of the staff and provider(s).

I'll give a couple examples to illustrate, but basically it all boils down to "people act like they are treated." As an instructor, if I assumed my students were stupid and treated them like that, they acted the part; if I treated them like they were competent and intelligent, they "rose to the occasion." See the "Stanford Prison Experiment" about psychological mirroring of one's environment.

I too have volunteered at a free clinic that was only open to those who did not qualify for any insurance at all, including medicare and VA benefits. We had zero problem patients, but we also went to great lengths to provide the very best care possible.

One the one hand I know a few folks dependent on the VA who appreciate everyone who works there, even if they don't receive great service, because the providers and nurses take their time, treat them with respect, and try to offer the best care possible, despite their limited means. I also know VA patients who hate the VA, and one who told me their attending told them "you get what you pay for." It isn't likely a difference in level of care, but in facility attitude.

I myself even became a "bad patient" when in my early 20's had a bout of "gastroenteritis" that left me doubled over on the floor, couldn't walk, was expelling fluid at impressive velocity from both ends, and was barely cognizant of my surroundings. It started with the LEO who responded to my girlfriend's 911 call telling me I probably had kidney stones and asking if I drank a lot of soda, because he had kidney stones once and his doctor told him to stop drinking soda. It escalated with EMTs arriving and interrogating me as to why I waited until midnight to call 911 and suggesting my GF drive me to the hospital (I couldn't walk...). I only remember seeing the EMT's shoes given my physical state, but I'll never forget "If you need to throw up on the way, just have her pull over and open the door." Things didn't get any better when the whole ER staff (except for the check-in nurse) treated me like a drug addict. Only when my urine came back clean and I destroyed the ER bathroom and vomited in every trash can between my room and the bathroom for an hour did they finally say, "huh, maybe he is actually sick." Needless to say, I wasn't very kind in my choice of verbage while interacting with the ER staff.

Lesson learned, a few years later, same thing. Told the check-in nurse, "it's probably gastroenteritis, I've had it before, give me a drug screen so we can get that out of the way, I probably just need saline and IV Zofran." I repeated that with everyone else I encountered, no one was keen on a 20 something year old telling them what to do but after a urine and stool screening, that is exactly what I got. Clearing the drug seeking bias/assumption made a huge difference IMHO. Same patient, same problem, very very different experience.

Edited by Anachronist
grammar
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