ndab Ah Yes, Medical School: Shande

Thursday, November 09, 2006

Shande

Somewhere between Einstein and Gene Simmons in the list of Jewish contributions to mankind, Yiddish, a mutt language that is sadly fading away with each generation, is arguably one of the most fascinating and lasting because of its richness and knack for having just the right dour expression for any situation. I thought of Yiddish today, motoring around a packed county emergency room, because I cannot stop thinking about one expression in its repertoire: shande fur de goyim. Literally, this means “shame for the gentiles”. It is an expression used by Jews to describe a person or event that brings a collective shame to the Jews, something that makes us think the gentiles (that’s you people) will think less of us and, as was often the case not too long ago, proceed with a pogrom or other form of mass extermination to display their displeasure with our actions. For instance, Jack Abramoff is a shande fur de goyim. It is a sense of communal embarrassment, collective shame, for someone or something that makes us shake our heads with a combination of disgust, fear, and sadness.

I couldn’t stop thinking about that phrase recently, not so much as it relates to Jews, but as it relates to the health of our country. You see, I am about halfway through my emergency room rotation at an extremely busy county hospital in a very urban (i.e. poor) area, and I feel like I keep seeing the same thing over and over again. The typical patient encounter goes something like this:

Hi Doc, I’m here because I have chest pain. It started this morning, and it feels like an elephant is on my chest. What’s that? No, I don’t have a regular doctor. I don’t have insurance. What’s that? No, well, I had some medications given to me the last time I felt like this and came here, the doc said it was important I take it every day. But I ran out and each time I come to get a refill the wait is more than 12 hours here, and I can’t stop working for that long because I have to support my family, so I just kept putting it off. I mean I work 14 or 15 hours a day just to get by, I can’t afford to pay for the drugs. I have to put food on the table, doc. You understand, right? No, I don’t have a regular doctor, I can never get an appointment, and I can’t afford an outside one.


The story ends one of three ways:
1) The patient ends up being fine, gets a refill of his medications, and maybe fills the prescription before walking out the door.
2) The patient is having symptoms of a heart attack, gets seen early enough, has a corrective procedure done, and has a protracted hospital stay at an exorbitant cost to the taxpayer.
3) The patient has a massive heart attack and dies either in the ER or soon thereafter in the intensive care unit, also at an exorbitant cost to the taxpayer.

I bring this story up not just because it keeps happening over and over again, but more because I was thinking about it today in the context of how embarrassed it made me feel, how each day I come home and take a moment to myself to simply shake my head in disgust. Not for myself, or for the doctors, nurses, and other ancillary staff at the hospital. But for my country. See, just like all of you, I was brought up to believe that America is the greatest country in the history of civilization, the land of opportunity, of equality and freedom and on and on. While there is clearly a fair amount of jingoism going on with this sentiment, I genuinely believed in this concept in a general sense, especially after being lucky enough to travel around much of the world over the last 4 years and seeing what other “first world” countries have to offer in terms of basic transportation, amenities, and other basic societal services. (One need only compare the ease in finding a street sign at a random corner in a random city in the U.S. versus just about any other country to see the difference.)

This sentiment even extended into medicine. Much of my medical career has been spent seeing the cutting edge of medical technology (i.e. the most expensive new stuff out there), provided at both county and private hospitals. I presumed and initially observed that even the county system, with all its flaws, worked well enough to provide basic medical care for everyone at minimal cost to them and independent of the patient’s insurance or citizenship status. A noble effort, indeed, despite the obvious disparities between care provided to insured and non-insured patients, as all were treated adequately by competent physicians even if the hospital surroundings differed dramatically. Sure, things didn’t run as smoothly at a public hospital, but all patients were still given the care the needed when they needed it, or so I observed on various inpatient rotations, such as neurology or general surgery.

However, it has taken only about two weeks working in a county emergency room, at the front lines of medical care, for me to realize how ridiculously wrong I was, and I am astounded at myself that I didn’t fully appreciate this earlier. The one aspect of medical care I was not able to compare up until this time was the emergency room, and I was unaware of the magnitude with which people depend on the ER for the entire spectrum of medical care that they need. People go to the ER for everything from medication refills to heart attacks to the most obscure disease you could conjure up, the ER serving in place of having regular doctors. Regular doctors who would follow these patients and do their part to contribute to preventative medicine by providing them with cheaper earlier interventions that are easier on the patient and the system as a whole. But our system does not provide for such basic services at levels necessary to cover even a remote number of the people who need such services. As a result, people show up to the ER sicker, require more involved (and, therefore, more expensive) care, and have worse prognoses, all a drain on the patient, the hospital, and society at large.

Put simply, the American health care system is broken. But I don’t mean that the way people throw that type of phrase around, as it has been used for some time now and as I have joked about in the past. Not “broken” in the “we should probably maybe do something about it but it sort of works so it’s ok for now as long as you’re insured” way. It’s embarrassingly broken. Shamefully broken. Broken to the point where thousands of people are dying solely because as a society, the presumed greatest society, we can’t institute a system to provide basic simple preventative medical care for everyone. We’re not talking invasive neurosurgery here; we’re talking cheap blood pressure pills, quick clinic visits, simple follow-ups. It’s broken to the point where, for the first time in my life, I came home from a shift a few days ago feeling embarrassed. Not just for myself, or for the medical community, or for the vast amount of people waiting for ages in the emergency rooms across the country that haven’t been closed down yet begging for medical care…but for the entire country, for America, that we can’t do better than this. I know about the statistics, pointed out in a similar rant by Bill Maher on his cable show two weeks ago, how we rank somewhere in the 30s or 40s among all nations in terms of things like quality of care or infant mortality, but I never really believed it. I never saw this played out before my eyes this frequently to this level of magnitude before, and it is simply shameful.

Now before I get barraged with hate mail calling me un-American or a communist or whatever else you have in store, keep in mind a few things. First, make sure you have any clue what you are talking about before you start screaming at me, because I defy anyone who’s actually worked in this system to tell me it works. Frankly, it’s a miracle it works at all, and this is only because a few good doctors, nurses, and ancillary staff take significant pay cuts to work with the poorer segments of society in these crowded and understaffed public hospital environments. Second, know that it is actually painful for me to write in print that I’m embarrassed for my country, because despite all the crap our country has been involved with of late, I have never taken pleasure in it, never found any sort of joy in what I’m seeing, and never felt embarrassed enough to actually say something about it.

But most importantly, remember this: without enough people from all segments of society screaming about this, complaining, being ashamed, it is not going to change, because as this most recent election has demonstrated, things only changed when people get so dramatically upset about a unifying issue they find so repulsive that they decide to clean slate and elect new leadership that will presumably change things. I don’t know what would be better, whether we need a national health care system, whether we need more incentives for businesses to provide adequate insurance plans, or what, but it is painfully clear that something needs to change, because the system as it currently exists is a disaster.

So if we want to parade around the world telling everyone how amazing we are, how genuinely attractive a society we have built, how we are the greatest country in the world, we damn well better start acting like it. And one way to do so would be to not let this shande persist, because the whole world is watching, and they’re probably having a laugh at our sickly expense. Shame on you. Shame on me. Shame on all of us.

236 Comments:

Blogger Lesley said...

And the saddest thing is that leaders in the rest of the world look on the US as a role model and would really quite like to duplicate your dysfunctional health care system.

12:09 AM  
Blogger Sheila said...

Sometimes I think you're too smart to be a doctor. ;)

12:30 AM  
Blogger Darwin said...

Call me naiive as I don't know much about these things but can't America come up with something like the NHS over on this side of the pond? I mean sure, the waiting list is long for some simple proceedures but from what I've heard (and experienced from living in England for four years and America for one year), it's a heck of a lot better that what's going on over there?

1:08 AM  
Blogger Motherkitty said...

You have illustrated this national shame for us all in a most eloquent manner.

The last time any politico talked about healthcare insurance and medical issues was the Clintons way back when. The Republicans didn't give a damn if the uninsured or underinsured got healthcare or not, as long as they got theirs.

I don't know what the answer is, but we are the laughingstock of the world in this arena. We are actually second in the world with the number of infant deaths per thousand, second only to some tiny obscure nation in Africa. How's that for modern innovative science.

5:52 AM  
Anonymous Anonymous said...

Amen

6:05 AM  
Anonymous Anonymous said...

Hi!
I'm a spanish medicine student and I love your blog! There are things which I won't understand very well because of the differences between your country and mine (i.e. we have a national health care system, and I can't imagine what life would be like without it), but you've helped me so much with your experiences and your shared emotions! It just feels good to know there are people out there who have the same problems and thought that I have.
Please, keep writing!

Videogirl_cris

6:12 AM  
Anonymous Melle said...

I'm Canadian, and reading that, was thinking repeatedly: "That's not us... But it could be..."

As you noted, the big problems in the US, like healthcare, are not so much fodder for mockery (by those more fortunate or living elsewhere), but require grave concern and fear and pity for those very real people the the big problems are affecting. Or worse, killing.

6:24 AM  
Anonymous Anonymous said...

Coming from France I have always known what you just described. I believe that it is a product of capitalism...people who have money make it, people who don't have money don't...it is pretty sad indeed.

7:11 AM  
Blogger gabbiana said...

I know, man, I know. I just feel pissed off and powerless. I don't know how to fix it; I don't even know whom to complain to (except equally powerless and pissed-off MDs). I'm beginning to think socialized medicine is the answer, but it's a pipe dream; the insurance companies donate to the right governmental officials and nothing will change. We live in a country that places so little value on preventative care that we think denying health care to Americans just because they're the children of illegal immigrants is a good way to cut costs. Yeah, god forbid we should offer primary care and cheap meds to everyone so we *didn't* have to hospitalize that diabetic with failing kidneys in ten years. WTF?

7:40 AM  
Blogger Rebecca said...

I'm currently living in Italy, and it's amazing how some Italians talk about the US medical system as better than their own, until I explain how the US medical system actually works: that if you have money and insurance, you're fine (unless you actually get sick, in which case your insurance may stop covering you), but if you don't have money and insurance, you're completely out of luck. Yes, we have cutting edge equipment, but it's only available to the wealthy.

Here in Italy, even the fairly poor Peruvian housekeeper who lives with us has complete gynocological care for her pregnancy, and should anything happen to her, she would have complete care for whatever it happened to be as well.

I've also lived in Ecuador, where doctor visits cost $5 (the quality wasn't the best, but at least I could see a doctor), medication was inexpensive, and malaria medication, which I needed, was free for everyone. Had I been in the US, I wouldn't have been able to afford the doctors' visits and the medication that I needed.

No country has a perfect medication system, but it's a sad day when a US citizen prefer's the medical system of a third world country over that of the US.

7:49 AM  
Anonymous Anonymous said...

It's amazing I never realized how inadequate our health care system really is until I read this posting. I lived in Italy for a year, and it is brought back to my my memory that the one time out of the entire year that I unexpectedly had to visit a doctor - I was able to walk in and see a physician without waiting, and had only had to pay a small fee for the medication prescriibed. I had no insurance, was not an Italian citizen - and it was that easy. I didn't realize the difference between the Italian system and our own until today. This is unbelievably sad.

8:07 AM  
Blogger Jenn said...

very well written.

8:38 AM  
Blogger missbhavens said...

It is truly, truly shamesfull, indeed. Pathetic, actually And it traces waaayyyyy back to when Medicine became a for-profit industry. I'm not sure there is anything we can do about it now--it's too big, too out of control, with the pharmacutical lobby being what it is. It's alllll about money. ER docs in public hospitals these days are actually more like the "family doctors" of yesteryear. So much time spent on cases that should be seen in a clinic setting. So many patients showing up far sicker than they need to be. So much money flushed. I work in a city hospital and it freaks me out daily. Somehow, as a country, we have to get a handle on this. Unfortunately, the only way to establish some level of naational health care would be to raise taxes through the roof. I'd be happy to pay them.

8:59 AM  
Blogger The MSILF said...

What's even worse is that the US spends way more proportionally on healthcare relative to the budget than countries with systems that do work. (Most countries with a socialized system spend around 8%, and the US around 14-16% I believe.) So not providing basic care, and letting things deteriorate doesn't even end up being economical. That's what really gets me every time.

9:49 AM  
Anonymous Anonymous said...

Horrible isn't it?

Even those with health insurance have trouble getting appropriate affordable health care. You have a heart attack and have to pay 20% of the bill, you're still owing the hospital thousands of dollars. At least in those cases the hospital gets reimbursed for some of the care it supplies.

Sadly enough it seems like we are just to far gone for a solution.

12:13 PM  
Anonymous Anonymous said...

hmm...sounds alot like northern manitoba. All of our doctors up here service multiple communitites, many of them fly in, those communities the rest of the time only have nursing stations, and get this...the doctors all have terminal diseases. They only have a few months to live, but no one will work here. Few people get the treatment they need, teh prescriptions are exorbitant (we have to pay for healthcare somehow) and if you need anything other than stitches, a simple cast, or a prescription, you have travel anywhere from 4-13 hours on a bus over a gravel road for any modicum of "modern" health care.

But at least its free right...

12:14 PM  
Anonymous Anonymous said...

beautifully said. i work in los angeles' largest county hospital--a place that is staffed with brilliant, experienced specialists, residents and nurses who work their butts off...and not enough resources to provide patient care as quickly as we would like. be it inpatient, outpatient or emergency....whether we are trying to get a CT scan or blood drawn or simply a translator so we can GET ON WITH IT...there simply isn't enough. it is not only terrifying as a resident (have you ever spent hours arguing with a guy in CT to get a scan when you think your patient is about to crash? i've aged 20 years in just over 1), it is draining to go through all the effort, because every step DOES take an incredible amount of effort. and those that are there to help??...they burn out. or get lazy. it is a soul-sucking system on all fronts.

half the battle of providing decent health care in this system is to get access (within the system) to the care the patient needs in the appropriate amount of time. the rest of it is getting it done in a manner that is convenient and accessible to the patient--so they'll actually DO whatever it is you're asking them to do. this is immeasurably more difficult in the County...and doing a great disservice to those who need help the most.

the system is not breaking, it is not getting overloaded...it is fully broken and the people who are paying the ultimate price are the very people we are trying to help. ask anyone on the front lines...most would agree. the answer is certainly not "more money"--we spend enough as it is. the system needs to be razed, re-designed, and resurrected.

12:43 PM  
Anonymous Aspen said...

Excellent post. i was discussing this with my fiance just the other day, as I came home. It's really terrible.

1:44 PM  
Blogger DrivingMissMolly said...

Fake Doctor, methinks you are becoming a real one, and a real man to boot.

Lily

1:56 PM  
Blogger ABBEY said...

its funny you put this up now...i'm nigerian and i was just reading up all the american health care policy stuff for some interviews, and finally grasping the concept of HMOs and such along with realizing how many people fell between the cracks, and how some doctor's are rewarded for saving the HMOs money(which means doing the least possible for patients).

At that point I began to realize that America really wasn't all it was cut out to be. Well I have been realizing this for a while now. Yes the US has electricity for most of the day, unlike Nigeria and yes millions of people aren't plagued with AIDS like Africa...

But I have never been more afraid of going to the doctor in my life before as since I got here. Most of college I couldn't afford insurance, and even when i did, it didn't cover much, which meant at the slightest hint of a fever, I started doing some serious praying that things didn't get worse. At least back home we could self-medicate(never mind the chance of buying fake drugs) but here you needed prescripitons for many drugs, and you also needed a doctor for such prescriptions. I had heard enough bad stories from my friends who had been bold enough to get themselves checked out by the doctor so I spent the whole of college practicing some serious preventive and alternative medicine. So much for them telling us mice that there were no cats in america, and the streets were paved with cheese!

2:05 PM  
Anonymous Anonymous said...

Sadly, I think a big part of it requires a huge paradigm shift that would undermine a huge part of what it means to "be American". Individual rights trump all in the US but to have a functioning health care system the society has to value collective wellbeing over that of the individual. Collective wellbeing is not just the rights of the majority, but a desire to set up a system that benefits all.

You don't have it, we in Canada have it less and less everyday (private care that's available to only those that can afford it).

Somehow we have to ditch the words "socialism" and "welfare state" and come up with some other terms... "we're-all-in-it-together-ism"?

2:27 PM  
Blogger skinnyminny8 said...

Hmm.. as a uk med student, we have the NHS, free healthcare for all, taken as a right. So that is great. Except the NHS is this massive black hole with loads of money going in, and it still not getting better as treatments get more expensive and more can be done to treat people. It's a difficult situation, however, I'd definitely rather get ill in England than the USA.

I think ppl take their health system for granted more in the Uk though, we just go to our family doctor (GP) and expect pills/ cures. We pay a minimal amount for prescriptions, but not if you are on benefits.

3:09 PM  
Anonymous Anonymous said...

The US system isn't great but it is better than Canada's system and many others. I have many friends who are docs in Canada. You know how much they get paid for a kid coming in with CP, brain shunts, ear infection, and a list a page long? $26. Yep, that's right. Considering your overhead is a couple hundred dollars, it is not that great. Those docs are wishing they had our system. The patients waiting 3 weeks for a visit are probably wishing they had our system. Medicare and Medicaid pay for everything, if you are poor enough you will get it. Our system is not perfect but it is better than the alternative. Practice a few years and your tone may change. Better yet, try out another country for some real world experience.

3:45 PM  
Blogger The Angry Medic said...

Darwin & SkinnyMinny8: WELL. I dunno about whether the NHS is actually better than the US system...each system has its pros and cons, and that's a huge debate that I'm not touching with a ten-foot pole. But I agree that generally first-world medicine is going to hell. I'm glad that Americans woke up enough to knock the current administration up so they can get some changes made. Maybe now people here in Britain will do the same, or in a few years the NHS WILL be the American system.

5:50 PM  
Blogger Susan said...

I lived in Mexico for 15 years, and they have a socialized system as well (private care is optional if you can afford it).
Now, let me make clear that while the socialized system might not be the best system of all when it comes to care, at least people of low resources can get SOME care.

Even the guy who makes $50 dollars a week can get care for him and his entire family. That would never happen in the US.

I've been in the US for 5 years now, and I've only had health insurance for the last 3 months because I couldn't afford it before then.

Before having insurance, I was scared as hell to get sick or break a bone. Now that I have insurance, I'm still scared as hell. Why? Because the insurance company seems to have 1000 ways of getting out of paying for my office visits.

Last month I went to an ENT, he saw me for 2 minutes, said it was nothing, and the next week I get a bill in the mail for $200 dollars. Now I have to deal with insurance bureaucracy to see IF they pay for their 80% share of the cost. I don't want to think how much it would have been if I had had ANY sort of procedure/test done on me (I used to work at a clinic and patients are charged for everything used during a consult, syringes, band-aids, strep tests, blood sugar strips, EVERYTHING, so I would know).

I am not kidding, and I know many of you can probably relate.

Sorry if this is so long, I wanted to vent.

GREAT POST.

9:01 PM  
Anonymous Anonymous said...

well said doctor, my heart goes out to what you said. is there anything non-medical people can do to help the situation in those places such as volunteer, run errands, campaign etc? - snoopy girl.

incidentally, have you read the new york times article? Oct 25, 2006 "Hospitals Try Free Basic Care for Uninsured " its exactly what you're talking about - lemme email you the article

10:28 PM  
Anonymous canclinclerk4 said...

anonymous at 345pm...i'm a canadian and i don't wish for america's system, i know plenty of doctors who don't wish to work in america or wish for an "american-style system" (unless you equate 'better' by being paid more, which may be good for doctor,HMO,etc..but not so good for the paying patient) 45 million people in America don't have health insurance...that's alot and I (personally) think that's 45 million too many for a first world country that boasts the latest technology, and the best facilities in the world. The means are there, the will is not.

10:55 PM  
Anonymous hadi said...

Greetings from a medical student in Ireland.

12:52 AM  
Anonymous Anonymous said...

Health care is a privilege not a right.

8:15 AM  
Anonymous Anonymous said...

I am a Canadian med student and I have my eyes open to the sorry state of the American health system (if you can even call it that), but more importantly to the scary trends in Canada.

What drives me bonkers is that Canadian physicians seem to have blinders on. On one hand, they say they want to help people and improve Canadian's health, but then they go and vote to expand the role of private practice. The two do NOT go hand in hand, no matter what anyone says. The minute someone is trying to make a profit off of a healthcare, they have a very different motive. Sure, as a physician, you might make more money under the private system, but looking to the U.S., there are many cons (high insurance, dealing with insurance/HMOs, not actually being able to help those who need help). I am very afraid of what medicine will be like when I graduate. Sure I want to make a decent salary and support my family, but not at the cost of society losing access to healthcare.

I don't know what the solution is. I feel bad for Americans. Plus so many people lack the understanding and knowledge, and thus fail to do anything about it.

8:19 AM  
Blogger riverie said...

This comment has been removed by a blog administrator.

8:36 AM  
Blogger riverie said...

The current state of (healthcare) affairs in our country is really sad, but true. Check out http://www.pnhp.org/ for a proposed solution by physicians and ways to get involved in activism around the issue.

I'm a med student in Texas, which has the worst uninsured rate (25%) in the country. Thousands more are underinsured. Most of these people are employed (and are citizens no less,) yet either make too much to qualify for Medicaid, or have an employer who can't afford to provide insurance.

I'm involved in HCFAT -- http://www.healthcareforalltexas.org/ We're the local chapter of PNHP. Basically the solution we're proposing is the single-payer system. You can read more about it on either website. It proposes to have public payment and private delivery of healthcare. It's not a perfect system, but it would provide universal coverage and be more efficient and cost-saving than our current system. Right now, we spend millions of dollars of taxpayer money on inefficient healthcare; much of the money goes to the drug and insurance companies to pad their pockets.

However, changes to the current system face immense resistance by powerful lobbyists comprised of drug companies, insurance companies and people who mistakenly associate universal healthcare with socialism, communism and government control.

If enough awareness is raised about the issue, maybe we can raise a stink about it from the grassroots level and someday, somehow, a long long time away from now, elicit some change. For our collective health and wellbeing. Hopefully.

9:00 AM  
Anonymous anon 227 said...

Anon @ 3.45: It's one thing for docs in canada to be against fee for service and another for them to be against socialized care for all. You are right that family and internal docs here aren't paid enough in a way that allows them to give holistic care. The answer though as pointed out by canclinclerk isn't private care and very few people here (maybe just your friends...)of any profession would choose the american system.

Even people here who favour privatised medicine (politicians, the current president of the Cdn medical assn, Joe Oilrich of Backwater, Alberta, etc) ALWAYS back up their statements with something along the lines of "avoiding the problems seen in the US". If a private system develops here it would likely be a system similar to Britain(and Mexico as I've learned here--Thanks!)

Snoopy girl: There's nothing like writing a good old hand written letter to a politician stating your opinion. See my website. Things in the US may be a bit different, but generally hand written letters from constituents are thought to be worth much more than mass generated emails from interest groups. Many emails go unread by anyone in a political office.

J.

10:00 AM  
Blogger genderist said...

Exactly. I think you hit the nail on the head, my dear. I see this kind of thing EVERY DAY with the status quo system.

And you're absolutely right: until *everybody* starts complaining to Washington, until someone declares a WAR ON HEALTHCARE or a WAR ON CANCER, monies will be spent on the other wars and things that Americans want done... but first they have to admit, like you did, that America has dropped the ball along the way.

12:23 PM  
Anonymous Jeff said...

Rebecca-
You really can't say that third world countries have better systems than the US because you can take your 5 American dollars and see a doctor there. Many citizens of places like Ecuador make the equivalent of a dollar a day, which has to be used for food, shelter, etc. To save up 5 dollars to see a doctor is nearly impossible. To adequately compare healthcare systems, you have to look at how well the country is able to care for its own population.

1:51 PM  
Anonymous Anonymous said...

If you are poor enough in the US you will get Medicaid. If you are not poor enough for medicaid, budget and put money in a health savings account. And like someone else said, healthcare is a privilege not a right. I don't show up at McDonald's and demand free food because I need to eat.

6:06 PM  
Anonymous Anonymous said...

The US also gives food stamps and a big fat monthly check in the form of welfare to the poor.

6:08 PM  
Blogger Random "Frequent Flyer" Dent said...

Maybe being Canadian has something to do with this, but...

how is going to teh emergency room because you broke something a privilege.

If it were...I mean, my family is too poor to "budget" (the reason me and my mom work two jobs and my brother has his and my stepdad has his) And too "rich" to get on welfare.

SO therefore wouldn't I have been screwed when I fell figure skating and fractured my collarbone.

Imagine how bad it might've been had I been in teh U.S. as a citizen, and with something like an open fracture tibia or something screwed up like that?

8:36 PM  
Blogger Mimi said...

Now, how many trillions are we spending to slaughter people in Iraq? How far would that go for universal health care?

2:20 AM  
Blogger Milk & Two Sugars said...

The thing that's always bugged me the most when I looked at how health care is portrayed in America is the idealism of it all. I watched G W Bush give his keynote speech on healthcare prior to the last election (2 years ago, right?) - he said nothing of substance. For 25 minutes. I was disappointed for all Americans then.

3:05 AM  
Anonymous Nicole said...

Fantastic post. You ought to turn it into an article and try to get a magazine to publish it. . .

I've never really understood why I am considered unamerican for thinking that everyone deserves healthcare, education, and shoes. . .

3:05 AM  
Blogger B said...

Hi! I live in a country with Bismarck's model of health insurance. Plus that, over 90% of people are additionally insured for the insurance companies to cover the participation fees. From the end-user's point of view, we live in a place next to heaven. Everything is free (or better: it costs you less than a car monthly). If one gets sick, everything is there. To take and do. But the system as a whole is reaching breaking point faster than you can say... Actually, faster than you can breathe in to say anything. Because of many things. I do not want to blame the victim here, but the insured somehow do not care for their health as much as they should. The insured want to excercise every right they have when they are sick. That's their right, right? The waiting periods for some procedures are already longer than they should be. Doctors are underpaid and overworked. The equipment is growing old. There is lack of managerial skills (it is all public, remember?). I guess all systems have advantages and disadvantages but still it is easier on everybody if there is a safety net. Our country is always reforming something though. I wonder what will happen to the net...

6:38 AM  
Anonymous Anon 227 said...

Anon @ 606: Brush up on your current events: just this past month Bush denied Medicaid to an entire cohort of US CITIZENS: infants born in the US to non-citizens. Nice.

I'm sure you'll tell us how infants are supposed to budget for their own health. Please also tell us how this will improve the shocking US infant morbidity and mortality rates.

J

see here for links and excerpts:

http://www.wmtc.ca/2006/11/babies.html#comments

9:49 AM  
Anonymous Anonymous said...

Canadian Flyer,
If you broke your leg in the US, you would go to the Emergency Room and get it fixed. You don't pay and the hospital writes it off and passes it on to those that can pay. The non-payers increase the price for the rest of us and in turn more people cannot afford it making us pay more. It is a cycle, just like welfare, medicaid, the rich (or those who can budget) pay while those who can't don't. There is a reason millions come to the US every year. Freedom and Freebies.

12:51 PM  
Blogger The Screaming Nutcase said...

If you're worried about the US healthcare system, do read NHS Blog Doctor, and see that it's not quite as rosy on the other side of the pond as you'd think.

Also, before you blame our healthcare system for poorer outcomes than countries with socialized medicine, I should refer you to JAMA 2006 May 3;295(17):2037-45, which showed health discrepancies between US and UK citizens persisted at all income levels, i.e. even those Americans wealthy enough to afford care don't necessarily have better outcomes.

And finally...do you really want American politicians having that much control over health care? Look at all the other "successes" our government has had lately, in Iraq, Katrina, etc.

2:46 PM  
Anonymous red rabbit said...

Looks like you struck a nerve, and not the one you thought you were going to hit.

Like one of your other commentors I am Canadian and truly worried that our health care system is heading the way of yours, that is, down the shitter. I didn't write the USMLE because the idea of not treating someone properly because the insurance company didn't fund it boggles my mind. I hope your heart holds out.

And as for third world heathcare and being un-American, you should look up the Brazialian health system and decide for yourself which one you would rather work in.

5:58 PM  
Blogger Ex Utero said...

Nice Post. Probably one of your best.

6:12 PM  
Blogger Ex Utero said...

Nice Post. Probably one of your best.

6:12 PM  
Anonymous Anonymous said...

Why do all these Canuks and foreigners want to practice in the US if our health care system sucks so bad? Even if you aren't poor enough to get medicaid you can still get a medicaid deductable. I don;t get all this Anti-crap most people on this board have. The grass isn't always greener.

8:59 PM  
Blogger riverie said...

To anon 8:15 and 6:06 who claim healthcare is a privilege not a right, do you then believe that falling sick is a privilege and that only those who can afford it should do it?

Healthcare should not be treated as a commodity, because no one can control when or how sick they fall, nor can they freely choose what medical services they need since most lack the expertise.

People should be entitled to a basic level of preventative healthcare, just as they should be entitled to basic human rights such as food, shelter and education. Anything more than that level of coverage they can choose to pay for out of their "privileged" pocket.

9:26 PM  
Blogger Vol Abroad said...

I've lived in the US and I currently live in the UK. It's a fallacy to think that either of these are the best choice for healthcare. They are opposite ends of the economic spectrum and both lead to the worst health outcomes in the developed world. Of course, the UK beats the US in health outcomes because basic care is covered - and most other care, too though you may have to wait for it. (And the UK is cheaper to boot!)

BUT there are MIXED models which incorporate elements of personal payment and payment for discretionary care, but also universal coverage for basic health care. But alas, we don't find these in the models in the English speaking world. Scandic countries, France, Germany, have far better systems.

3:21 AM  
Blogger FUNKYBROWNCHICK said...

To the anonymous person who said that creating a national / socialized healthcare system would require "a huge paradigm shift that would undermine a huge part of what it means to 'be American'" ... AMEN! I couldn't agree with you more. It *is* truly shameful that we don't have a better healthcare system. :( While other countries were busy establishing nationalized healthcare systems, we were busy basking in the aftermath of McCarthy. The thinking goes: "Socialized healthcare" sounds too much like "socialism". And, isn't socialism like Communism-lite? What could be more "unAmerican" than Communism? It's a terrible (and shameful) side of America.

And, now, to the anonymous person who said that "[h]ealth care is a privilege not a right" ....

Fuck you. :)

5:13 AM  
Blogger Susan said...

I love how at the first mention of the word "socialized" people jump out and yell 'UNAMERICAN!!', 'COMMUNIST!!', IF YOU DON'T LIKE AMERICA, THEN LEAVE!!'

Unfortunately, things are more complicated than that.

10:09 AM  
Anonymous Anonymous said...

What I really despise about the socialized system that is going to be forced on me isn't the increased taxes, or decreased physician autonomy, or decreased salary. What really gets me is that my family members and I will face WORSE healthcare. My mom will have to wait months for her hip replacement (because a new hip is "elective"), my aunt won't get herceptin (because it's not "cost efficient"). I work 88 hours a week, every week, and yes, a consequence of that is that I have access to first class health care which is not rationed. Quite frankly the majority of cases I saw on my ED rotation left me with less, not more sympathy for the uninsured. Truly poor people ARE ALL INSURED BY MEDICAID, END OF STORY. Most of the time people just put health insurance as a very low priority, below things like new Nikes and HBO. Which is perfectly fine, but I'll be damned if I'm going to pay more for worse health care just to finance people's preference for the Sopranos.

11:20 AM  
Anonymous Anonymous said...

Anon @1120,
Exactly. You don't know how many times people say they can't afford insurance and then I see them drive off in their new car with new bling around their neck. People only want health care as a priority if someone else is paying for it. The US system is great, as long as you use that thing on top of your shoulders. Poor people get free care. People making money get insurance. People in between choose new shoes, cars, lap dances over getting health care.

11:40 AM  
Blogger Susan said...

And hasn't it occured to you greate minds (both comments above me), that a socialized system for the low/middle classes can be merged with private care for those who want it?? That is how it works in other places, and it seems like it is fair. Unfortunately in our country, POOR people are insured by Medicaid, but MIDDLE CLASS people get screwed, because they don't qualify for it, yet they can't pay for it out of their own pockets. That's the way it is.

12:43 PM  
Anonymous Anonymous said...

Incredibly well said.

As with most things, it's a mixed picture. I think the U.S. health system is very good at high-tech, expensive intervention. Maybe the cheaper stuff has become denigrated too much - look at all the scorn that's heaped on primary care docs. The system has become sick in more ways than one, and there are so many special-interest groups clamoring to get theirs, I don't see a solution anywhere on the horizon.

I have to say it's not quite true that someone who's uninsured can walk out of an ED and not pay a dime. I can guarantee you that if I showed up at the local emergency room with a broken leg and said I was uninsured, they would try to collect at least some of the money, possibly even turning my account over to a collection agency.

To whoever advised the uninsured to open a health savings account and budget money for it each month: Dream on. By the time the working poor have finished paying for the rent and groceries and gas, there's almost nothing left. You have to have money in the first place before you can put it into an account. And no, the poor do *not* all drive fancy cars and own expensive jewelry and plasma TVs. This boring stereotype is so lame, so trite, that it makes me want to vomit every time I hear it.

Fake Doctor, you rock.

1:52 PM  
Anonymous Anonymous said...

What ever happened to going out and making a decent buck? Everyone now wants free everything. Free money for every baby you have. Free money from your baby daddy. Free food stamps because you can't work because you got fat watching Jerry Springer while watching your 10 kids. Free health care because the geniuses on this blog think everything should be free.

Give me a break people. Go out, make money and earn something for once. My single mom of 3 kids went back to school to get a job so she could provide for our family. I should have told her that everything would be free one day. The brains on this blog are going to pick up the tab for everyone.

3:05 PM  
Anonymous misha said...

I am insured and have experienced very large ongoing medical bills spanning 10 years due to a child with chronic health issues. Over the years I have met many families like ours as we meander through health care and I know this. Those of us who are middle income, working, 2 parent home owners have the most difficult circumstances. It makes me sick as I watch us lose our jobs, lose our homes, lose our credit ratings and so on. We have to pay for our medications, those on title 19 do not. We pay to stay at the hotels/ronald mcdonald houses, the unisured/unemployed do not. We have to transport ourselves. We pay our co pays until it hurts. WE would have been better off to quit jobs and go on assistance. It is a sin.

5:35 PM  
Blogger Susan said...

Making a decent buck?? Why, I had never thought of that before!! (there's some sarcasm for you).

My parents have been uninsured for a while now. Both of them work full-time, sometimes over time. We do not have a fancy house, they only have 1 small car that doesn't eat up a lot of gas, they have no credit cards, and certainly no "bling."

For a family of 4, paying for a good health insurance would be too expensive. It would be either that or paying the bills and eating, and I guess staying alive takes and having a roof over our heads somehow takes priority over a health insurance premium. My parents usually have nothing at all left for savings at the end of the month.

And no, we are not poor enough to qualify for assistance. Maybe if my parents quit their job and claimed disability we would...and that is wrong in so many levels.

Go figure.

6:46 PM  
Anonymous Anon 227 said...

Anon 305: Imagine for a moment that your mum had Misha's situation on child #3... Somehow, I think you'd be singing a different tune if that were the case. I'm sorry, but it is impossible to "save for a rainy day" if the costs of a sudden illness is at minimum in the tens of thousands of dollars. It's not like the severity of your illness or injury is on a sliding scale. Cancer in an upper middle class uninsured family would be as devestating as an MI (shorter stay, single event) to an uninsured low class family. Now imagine the tables turned: Cancer to a low class family would be catastrophic.

To everyone calling socialized medicine "free": It's simply not. We pay in taxes (gladly, our system is consistently what Cdns cite as "most valuable" in polls). Taxes ARE set on a sliding scale (to varying degrees of fairness). The thing is that by paying through your taxes, you are "saving for a rainy day". So, thanks to all those saying "set aside cash", I do--every April.

J.

7:13 AM  
Blogger Susan said...

I just found out I got accepted into medical school. My first acceptance!! (And on my first try too...lol)

I spend so much time reading this blog it only seemed appropiate to share with you all.

Hopefully Fake Doctor will not be too disappointed that I decided not to listen to his advice and go to med school anyway.

4:42 PM  
Anonymous Anonymous said...

I agree with the things you're saying in this post 100%. Anyway you have it there will be serious drawbacks to healthcare. I live in Canada and we have a relatively good health care system - no one is without readily available healthcare services primary/special/elective. But, given the current structure of our system the drawbacks affect everyone who needs critical care services - and our only option is to go to the US [or another country] to receive critical services [no full service private healthcare up here]. Although I think the Canadian system needs to revamp the way medical services are provided, I'm of the mindset that you guys in the US are far worse off. We even get patients that come from the US with no coverage and take care of them - when the hospital administration attempts to recoupe the costs of care from the US government, the bills are essentially ignored and the Canadian taxpayers absorb the costs [I've only been privy to one case like this personally]. So yeah, I felt bad for that gentleman - I felt that his own country basically abondoned him over a few [thousand] dollars. Maybe we should try the system Cuba has in place - docs get paid when pts are healthy as opposed to getting paid for treating sick pts - don't see that happening anytime soon.

7:21 PM  
Anonymous Anonymous said...

Medicine in Australia is difficult trying to balance the cost/supply of the medics and the demands of the community.

Our drugs subsidy program (PBS) is actually the biggest component and in the last US-Aust free trade agreement it was so controversial because the US drug company lobby wanted Australians to free up the supply-demand and not bargain as a whole nation.

Our meds are cheap as a result but hospital beds are in massive shortage.

There is no easy solution but i loved your post's insight.

9:58 PM  
Blogger L.Bo Marie said...

some fantastic responses!
I do wish people wouldn't hide behind the Anon titles though.

As a small town Canadian girl, I am so thankful that our town is large enough to support a hospital, and some family doctors. But I also see that we have no family doctors. Someone mentioned about the lower wages that some CND Doc get, but here in small town, we are offering "incentives" (read: bribes) to Docs who will consider moving here. A board goes out and tracks down doctors.... Free home for two years, moving costs covered, set up a practice for you.... the list goes on, we just don't have enough docs to support the town, our ER is getting crowded from the hundreds of towns pepole how don't have docs of their own....
hey... come to "small town" if you get too frustrated, there are hundreds of them in Ontario alone!

7:01 AM  
Blogger Nikki said...

And for some ridiculous reason the current Canadian government keeps pushing for more privatization and a two-tier healthcare system. Our public system is also far from perfect, but it is a little more equitable.

Yes, the pay for physicians is better in the U.S., but I'll be sticking with the Canadian system when I finally graduate.

5:44 PM  
Anonymous Anonymous said...

My humble opinion, please grain of salt it as you will. My experience in the busy metro county system has been a bit different and frankly different than the American system I see described by the folks making comments here. I see homeless, insuranceless, and penniless people come into the emergency room. These people are not turned away. If it is part of the chief complaint they will get a workup that is incredibly expensive. They will get all the benefits of cutting edge technology. I have had upper middle class people with their families in the cardiac recovery rooms right next to the homeless man- this is not uncommon. I hear it often said by those outside of the American system that it is wonderful for the capitalist with resources, but I challenge you to find another system that goes to such extent for those without capital or any connections.
I agree with the statement that our medical system is broken. Medicine, no matter how much we'd like it to be something different, is a business. It is a business whether it would be run by our central government or by the private companies that own the hospitals. The system is broken because our values are not fundamentally united on the purpose of health care. Is it to prolong life, prolong quality of life, decrease pain, or provide a functional productive work force to increase general capital? I argue that the later is the world's view of our system and grossly inaccurate. The former things are our principles as physicians; they are our commitments to our patients. Those in elected office or those managing hospitals do not share these sentiments. Medicine is a broken business because it offers services to all, requiring payment from some at rates to make up the difference. We do this because we do not turn people away, and doing it basically screws the possibility of the average person without insurance and a job to afford their primary care.
People wait forever in the emergency room because (consciously or not) they do not see the bill coming in the mail after care. Most people with jobs view the emergency room as some kind of last-ditch clinic. Free if I’m willing to wait or if I’m in a trauma and need immediate care. If they knew before hand the relative cost, I think people with jobs and no insurance would see the value of paying for established primary care. One thing about American capitalists, they tend not to want to pay more for the same thing.
People often never expect illness; they are even shocked by the manifestations of their own prediagnosed illnesses. They have no plan in their lives for dealing with it or the costs that it can demand. People are also not okay with the idea that yes, they too will someday die. To fix our system I think people should decide how important it is for us as a nation to offer care to everyone. If it is, lets make our national deficit generated by paying for care for all. If it is not, then lets make a system where all the resources are not squandered on the last few years of life (unless of course you care to float the bill yourself).

10:01 AM  
Blogger sadielady said...

should we have a national health care system that provides low-cost or no-cost health care to everyone? should we all then pay higher taxes to pay for it? would that help to reach out and encompass more people who couldn't otherwise afford health care? would it result in a diminishment of the quality of heatlh care that our nation's physicians provide, if it changes the way/amount they are paid for their services?

I have no idea what the best options are, but I applaud you for raising the issue for discussion - - because I do not think the system as it is today is fair, and I think it's awful how many people are not able to get/afford the medical treatment they need.

3:48 PM  
Anonymous Anonymous said...

anon @ 0815

your an idiot!

6:39 PM  
Blogger Erik said...

It's stuff like this that makes me want me be a doctor. Just knowing that they're guys like you that want to change this shit. Keep on, brother.

1:57 PM  
Anonymous Meghan said...

Healthcare is a privilege!?! Are you f*ing kidding me? Even people who take wonderful care of themselves can become trauma cases through no fault of their own! Anyone who can possibly think that has never worked in healthcare. Anyone who has worked in healthcare knows this: preventative and primary care is cheaper for all, and just plain better business than trying to treat a person who has become very ill. Simply put, if through primary care, a person is prevented from ever becoming diabetic, they (or society) will never have to pay for that amputation of the gangrenous foot, etc and so on. As an ER nurse, I could probably bitch about this for 2 days straight, but you all have covered it pretty well.

12:10 PM  
Anonymous Anonymous said...

this is why i'm studying and plan to practice medicine in Canada - ah the land of publicly funded healthcare. Perhaps we won't be paid as well as our American counterparts, and there's waitlists, etc...but we won't feel like crap at the end of the day turning away patients because they don't have insurance.

5:26 PM  
Blogger MsBehavn said...

Long time reader, first time commentor here. As shameful as it is, your health care system still beats the pants off anything we will ever have here in South Africa. *sigh*

4:52 AM  
Blogger Char said...

Well, health care is a right according to article 25 of the Universal Declaration of Human Rights, which the US has ratified.

As a Scandinavian who lived in the US for some time I couldn't believe the rip-off prices on medication. Even without government subsidies medication in the US is 2 to 3 times as expensive as here, because apparently the US is the only industrialized country where the state does not limit what medical companies are allowed to charge. Together with parallel imports allowed in the whole EU, you can actually afford to refill a prescription here.

3:16 PM  
Anonymous Selkie said...

I lived in America for about seven years. I then moved to England. I came down with a bout of flu that knocked me on my rear for a week.

Locals: Why didn't you go to the doctor?
Me: Well, it was only flu.
Locals: But you could have gotten it checked out, some medicine to ease it.
Me: It passed so quickly, I'd have had to wait for an appoint...
Locals: Oh, I'm sure you could have gotten a walk-in appointment. Curse them for not doing home visits anymore.
Me: ?? ...oh. Well, I can't really affor... oh yeah, NHS. Er, what I mean is... um, I guess I'm not in the habit of going to the doctor for anything?

The locals then complain about the state of the NHS while I sit there trying to wrap my head around the difference...

10:10 PM  
Anonymous Anonymous said...

oh yea the burning Scrubs question - are surgeons superstitious? the show said they're the most superstitious bunch - and are they allowed to choose the bandanas they wear like say pirate bandanas for good luck? (on the operating table)

1:51 PM  
Blogger Melissa said...

I so know what you mean. I am a nurse on a telemetry unit. I would say that 65% of our patients are such frequent flyers that their mail should be delivered to our unit. Usually the same thing over and over, malignant hypertension, CHF and uncontrolled A-Fib. They spend time with us, we get them straightened out somewhat and semd them home with scripts. A couple of weeks at the most go by and they are right back with us again because they can't afford their medicine. Heartbreaking to watch and soooo frustrating.

8:52 PM  
Anonymous Dana said...

I lived in Korea for 11 years...I married a Korean man. I returned to the states a year ago with my five year old son. People here are very surprised when I tell them that I will probably return to Korea. The health care system is much better and my children are safer...

9:36 PM  
Anonymous Anonymous said...

I've never considered my lack of health insurance a problem, because I've never been sick. Now it's come down to pay the rent or get the medication needed. I need a place for my family and me to live, so I ignore the "needed" meds and do my best trying to eat better, exercise, etc. Still, my b.p.'s thru the roof and I often wonder if I'll even make it to 50 years old. All this time I have blamed myself for being self-employed and not wealthy enough to afford basic medical insurance. I guess I should now blame my country. I know you're fed up and embarrassed.But, seriously, I don't blame my country. In my case, I didn't do what I needed to stay healthy enough. I know others have different situations, but I take responsibility for my own fat and inactivity. I'll tell you, though, my blood pressure would be a helluva lot lower and I'd have less stress if it didn't cost so much for basic living in this country.

3:51 AM  
Anonymous Anonymous said...

your post actually moved me to tears. This type of dispartiy is detestable and disgusting. I believe in a solution, and I am dedicating my life to bridging that gap.

3:40 PM  
Anonymous p said...

Hey,
I just came to your blog, and I think it's fantastic. As a med/peds physician working in those front lines you've described, I can tell you exactly what we do to help. I work in a community health center which provides a significant discount for health services based on income. For example, a regular follow-up visit costs $10, and a 3 month prescription for most meds is $6. I see the stories you are describing daily. I enjoy my job and the majority of my patients. However, despite what your commentators are saying, I don't think socialized medicine is the answer. Part of the reason I am able to get meds to my patients is that the drug companies can afford to discount them (or give them free when we ask). If one of my patients truly needs a surgery or consult, I have methods of getting them these things for free b'c the doctor is willing (and can afford)to give a certain amount of time per month to these patients. In many countries w/ socialized medicine, the doctors do not make enough money to compensate for the hours and shit we put up with. Australia, New Zealand, Canada, to name a few, are willing to pay American doctors well to practice temporarily in their countries b/c they don't have enough doctors to take care of all their population. Also, no matter what enyone else says, American medicine is easily the best in the world. Why else would kings and presidents from other countries preferentially come to the Mayo Clinic, Harvard, etc, for their medical care?
I agree the system is not a good one, but I truly feel it is better than anywhere else in the world.

7:11 PM  
Blogger Chips Whitesugar said...

An alternative, that I don't believe has been tried recently, would be to ban insurance entirely. Any treatment would be paid for in full by the treated. While this would initially be very painful, the cost of medicine would be driven down fairly quickly to
the level that the average person could afford. Draconian perhaps, but is it any worse than the current situation?

3:09 AM  
Blogger medstudentitis said...

I'm Canadian and planning on going into family med when i graduate in 2 years and I wouldn't trade our system for the American system in a heartbeat. One of the things about our system is that you have to know how to make it work for you, and fee per service isn't it. The new stuctured health care groups like FINs and FITs and all those other ones are the way to go.

Our main problem is that we don't have enough primary care docs and going to private isn't going to help that. You can't squeeze blood from a stone. People are constantly saying to me that private care will stop Canadian docs from going to the states, but that's not the origin or the major cause of our shortage. Our shortage is being caused by insufficient training opportunities for med students and lack of flow of residents/docs back into this country who are from here and had to go do their training somewhere else. Private healthcare is NOT the way to go.

5:45 AM  
Anonymous USAmedicalstudent said...

If Canada can't even get enough docs to provide for their patients then how is the Canadian system better? You canucks are always decades behind the US.

8:13 PM  
Blogger Housewife said...

Amen.

I'm glad you'll be in practice.

5:49 PM  
Anonymous Anonymous said...

Hey p,

The problem is that the VAST majority of people are not kings and presidents and so do not get their care at Harvard or Mayo....I don't see much royalty going to a county hospital.

I don't understand why there cannot be properly integrated public and private systems in the US and Canada. Most students/doctors are not going into the careers to make bajillions (just ask them during their med interviews!), so they should be held to this! Allow private systems to open in parallel--they will initially only cherry pick the easy operations like knee/hip replacements, cataract repair--but tax their profits heavily, with the revenue directed toward the public system. This should ensure the public system gets continued support and will not degrade.

Plus, since so many surgeons complain that they don't get enough operating time in their hospitals, there should be an organization system that allows these surgeons to maximize the number of operations they can do at their home hospital and then free them up to make some extra bucks at one of the private surgical centres. BUT, make it a condition to maintain their license that they must never drop below the number of service hours they are able and required to put into the public hospitals from said organization system.

9:00 AM  
Anonymous Anonymous said...

As a medical coder for ER physicians I see, on a daily basis, what you described. But, I also see many situations of abuse by patients. It seems the definition of an 'emergency' has radically changed. The ER is used for everything from socio-economic issues and sore throats to the rare true emergency situation. I do not disagree with you in any way. Something must be done. But, those that abuse the current system drain it for people that truly need the assistance. Recognizing and holding the abusers accountable for the cost of their care will, sadly, never be a wide-spread reality. Individual responsibility is a dying moral in this country that is rapidly being replaced by the 'don't blame me syndrome'.
I'm also a single mother and sole supporter of my 2 children. While one might think that working in the healthcare industry would provide better than average insurance coverage, it does not. I do have insurance, but it is costly and the coverage is not as good as that which can be found at many other non-healthcare related jobs in my community. But it's a choice that requires no thought. Insurance is a MUST. If you're breathing, you must have some form of coverage. For those Americans that do not see it this way and fall into the previously referenced 'middle class', you might need to assess your priorities and perhaps find that you can do away with the cell phone and cable bills and more easily afford insurance premiums. As an added bonus, since the number of accidents related to drivers distracted by their phone conversations is on the rise, getting rid of the cell might also prevent an accident that could lead to a rather costly ER visit. (No, I won't apologize for the reality sarcasm.)

8:55 PM  
Anonymous Anonymous said...

It really is easy to get discouraged at the state of healthcare in America, especially when you see the same types of cases over and over.

In your particular example of the 16 hour-a-day working stiff, the guy had a lot of (legitimate) excuses for not taking care of himself.

There are programs out there that will pay for your medications, but you do need a prescription and the proper paperwork filled out.

This particular guy "can't" take time out of his busy schedule to set an appointment to get his refills and can't afford an outside doctor.

I argue that a guy working 16 hour days has to have some serious vacation time saved up. Why can't he take one day, or even a half of a day, off to keep that appointment? Guy argues that he can't miss work. Truth is, he can't take care of his family if he doesn't take care of himself first.

Socialized medicine isn't the answer. Sometimes doing whatever you can to take care of yourself (and as a result your loved ones) results in more appropriate action than blaming America for it's sorry state of it's peoples health.

12:29 AM  
Blogger Panda Bear said...

And yet, the patient described in the original article probably smokes, drinks, has cable TV, a cell phone, and many other luxury items but will not pay a red cent for his inexpensive beta-blocker and diuretic.

America is not a country of freeloaders although many struggle mightily to make it one.

9:29 AM  
Blogger PK said...

i read your this post accidentlly !!,as title didnt give any indication of what the post was all about.i am Ob/Gyn consultant in India and Visit US to meet my son and other relatives.i pray that I should not have any Medical Emergency while I am in US because I cant get Insurance for Pre Existing condition and cant afford pvt Medical care. i will end up in ER in Emergency and hope that I survive.Its difficult to find solution to this problem.You can well imagine conditions in India.But surprisingly we can deal with this as its presumed that majority of patients will end up in Public Hospital ER ( Casualty or daily OPD-out Patient Dept.)But in Rural areas there is no Medical facility.--PK

7:38 AM  
Blogger workingmemory said...

this doesn't really have much to do with the substance of your post, but you can take yiddish at UCLA. i am!

12:28 AM  
Anonymous Anonymous said...

I agree with your shame and I plan to work at the Health Department for a few years after graduation, but I don't think NHS is the answer - a socialist system of medicine will result in apathy - it's sad that some physicians are so wealthy when so many people can't afford their meds (I can't even afford mine while I'm in school!) but if a crappy doctor gets paid the same and works the same hours, etc. as a fantastic doctor, the good ones are going to quit or just stop being motivated to excel.
I think the most frustrating thing for me is how people don't take responsibility for their own health. Don't expect me to do something to "fix" your problems when you're not willing to stop eating fast food and go for a walk every evening! I know in lower socioeconomic classes a lot of the lifestyle choices result from lack of education, so we need to do more public health education BUT if you know better and you continue to poison your body, you're GOING TO GET SICK - you're going to get HTN, you're going to have a heart attack, you're going to get diabetes - TAKE RESPONSIBILITY!

2:05 PM  
Blogger necrosisoftheheart said...

A + +, my friend. Very well done.

7:54 PM  
Anonymous Stan Woodring said...

If you want to know how to get help for people wo can't afford their medicine because they have no prescription coverage, call me at 1-800-875-7027. I work with a company called MedWise. You also can visit their website at www.medwisehealthcareinc.com. We CAN help!

Stan Woodring

6:34 PM  
Anonymous Anonymous said...

http://www.curebraintumors.info/
http://www.curemycancer.info/

5:18 AM  
Anonymous Anonymous said...

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A fact that i want to shed light on-closer to home. Ther is a guy who works around where i live and he has 4 children and here Polio is still a problem that has to be prevented by Pulse poilio drops that every child is given after they are born- all his children took these drops-but two of them still got polio! what are the odds? there are things like this, small teensy wincy things that make people loose trust in a system that does relatively well. But i Suppose"if we keep trusting in the ???? and according to his word, we will understand it better by and by!"
Also-you've got my respect for putting down facts of america and for writtign incredibly!

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