Health Care in America

[john57classic]

After dealing the failing health of our parents and various “challenges” with obtaining care. One of my sisters blurted out in frustration
“We don’t have a healthcare system in this country, we have a health insurance system”
Though I am thankful that Medicare (and other insurance earlier in life) is available to us I very much agree with my sister!

[6L6]

As bad as things can be in the USA, we're on "easy street" compared to the situation in the UK.

Huge shortage of doctors in the UK and guess what a new doctor gets paid after getting certified? How about MINIMUM WAGE! You read that right. And they wonder why young folks aren't going into medicine for a career.

I feel very fortunate to have excellent medical care where I live, but I pay a lot of money to have it. Eat healthy and hope for the best.

[foxo]

Originally Posted by 6L6

As bad as things can be in the USA, we're on "easy street" compared to the situation in the UK.

Huge shortage of doctors in the UK and guess what a new doctor gets paid after getting certified? How about MINIMUM WAGE! You read that right. And they wonder why young folks aren't going into medicine for a career.

I feel very fortunate to have excellent medical care where I live, but I pay a lot of money to have it. Eat healthy and hope for the best.

Doctors aren’t being paid minimum wage in the UK. NHS salary bands are transparent and available for public viewing.

As I said previously the standard of healthcare I have received has been good.

[6L6]

Glad to hear you're being treated well, Foxo. My friends in England have not been so fortunate.

[catndahats]

No one should have to jump through all those hoops and obstacles, and common sense would think Medicare would be thrilled for you to fix the chair yourself to save money and deliver quick relief for your wife, but have seen similar things happen to family members as well. At some levels we've experienced it at our home.

my thoughts are with you and your wife.

Originally Posted by redcrow

First, a little background. My wife is afflicted with Hereditary Spastic Paraplegia. It's a progressive degenerative neuromuscular disease that gradually causes the victim to loose control of first their legs, then their upper body due to uncontrollable spasms which are painful. It is every bit as nasty as it sounds. Judy was diagnosed in 1984. All 5 of her siblings are also affected. By 2009, she became 100% disabled. In 2013, she could not stand or walk without a walker. Next, her arms weakened to the point that her walker was of no use to her, and by 2017 she was wheelchair bound requiring a power chair because of her diminishing arm strength.

When things got to that point, she went through a lengthy evaluation by a license physical therapist, a neurologist, and an orthopedic surgeon, all required by Medicare. Then came a paper chase between Medicare, the wheelchair vendor, and her PCP that took almost 3 months. There just aren't words for the frustration while these 3 entities passed paperwork back and forth. Never was there any medical question of her need for this equipment, but the Vogons in Medicare fought tooth and nail to put roadblocks in her way. By the time her chair was finally delivered, she'd been admitted to the hospital twice for injuries sustain in falls. Falls she'd never have taken if she had been in possession of the equipment she needed.

Fast forward to the present. The joystick controller on Judy's chair failed completely 2 weeks ago rendering the chair completely inoperative. The vendor sent out a technician who confirmed the failure and put in an order for a replacement controller. Well, guess what? Medicare won't approve the repair until we go through the same evaluation/approval process for the whole chair ALL OVER AGAIN!! Oh, BTW, if and when they do approve replacing the controller, our out-of-pocket is going to be over $1K.

This part you really won't believe. I found a brand new controller of Ebay for $350. Just pay for it and it gets delivered in about a week. So I called the vendor and Medicare, and told them to stop the whole bloody process because I found the replacement part myself for a third the price. And the vendor tells me doing so would void their warranty even though the Ebay unit is an OEM from original manufacturer), and they would not supply any further service going forward. Medicare says if I attach "after market components", without their approval, the chair becomes my property(?) and they'll want to be reimbursed for their contribution to the original purchase price. Welcome to American healthcare.

[rllink]

Originally Posted by 6L6

As bad as things can be in the USA, we're on "easy street" compared to the situation in the UK.

Huge shortage of doctors in the UK and guess what a new doctor gets paid after getting certified? How about MINIMUM WAGE! You read that right. And they wonder why young folks aren't going into medicine for a career.

I feel very fortunate to have excellent medical care where I live, but I pay a lot of money to have it. Eat healthy and hope for the best.

There's a shortage of Doctors in the US. Mine is retiring and I am having a heck of a time finding a doctor who is taking new patients. Word to the wise, find a doctor young enough that he won't retire when you get old enough to really need one.

[TheGITM]

This is not meant to minimize the impact of service obstacles to those needing Medicare services, but the other side of the equation that has contributed a great deal to those 'obstacles'... is Medicare fraud. There are estimates as high as $100 billion in fraud annually, so Medicare/Medicaid have had to implement more detailed reviews of claims, particularly in certain higher risk areas.

I don't know any of the details, so I'm not trying to excuse anything. I'm simply pointing out that while it's easy to think that people should just get what they need more easily, the easier you make it the more opportunity you create for fraudulent billing to occur. It's a balancing act, and right not is sounds like pendulum has swung more toward making it harder to get claims processed.

I would add that it's typically not that the people working for Medicare don't care about the individuals needing services. It's just a mammoth, unwieldy system that is difficult to manage, and likely impossible to 'manage well'.

What I would ask is, what's the alternative?

[redcrow]

Originally Posted by Gitfiddlemann

I understand your frustration with these ongoing battles, but before condemning the entire system, have you considered other options for your wife?
Even though you may be covered by Medicare, Medicare may not be the best way to go with anything related to long term care and disabilities. Have you considered going the Medicaid route for her care? Medicaid might be better suited for her particular situation. It's worth looking into.
Talk to an elder care lawyer. There might be alternative and legal ways to get your wife the care and equipment she needs under Medicaid without taking these battles on yourself on her behalf.
Apologies if you've already gone that route, but if not, it's worth looking into.

Here's the reality of Medicaid in Oregon. Any household netting more than $27,186.00 per year. is not eligible for Medicaid. The average cost of living in this state is around $48, 000. Would you want to try living on half that? Are you aware of Medicaid's very restrictive requirements for DME? For instance, you can't get supplemental O2, for instance, unless your arterial oxygen levels at rest are < 85% AND you can't get to the bathroom and back under your own power AND you can't speak more that 4 words without becoming short of breath. I was a respiratory therapist for 27 years. I've seen plenty of people in that state. It is not a life I'd wish on anyone. My wife would need to be a C5 quad to qualify for a power chair of any sort under Medicaid.

In a nutshell, Medicaid is useful for people without much to loose and is pretty hard on those people as well.

I stand by my previous assessment of health care in this country. It is a for profit industry with medical professionals, lawyers, insurance companies, hospital administrations and government agencies all trying to squeeze as much money out of it as they can. Providing services and equipment seems to be pretty low on their list of priorities.

I'm not a health care administrator. I have no MBA or any other credentials that might qualify me to suggest a more viable system. However, many other technically advanced nations seem to be able to keep their populations healthy without bankrupting them.

We pay nearly twice what the average Swiss, German, Belgian, Australian, Japanese or Italian pays for health care. For that we get a system with one of the highest infant mortality rates, maternal fatality rates, hospital acquired infection rates and lowest life expectancy. I suspect those nations might offer some salient suggestions.

[blackie51]

I stand by my previous assessment of health care in this country. It is a for profit industry with medical professionals, lawyers, insurance companies, hospital administrations and government agencies all trying to squeeze as much money out of it as they can. Providing services and equipment seems to be pretty low on their list of priorities.

And don't forget private equity/investment ownership of health care providers, pharmaceutical businesses, hospital systems, nursing homes, doctor practices etc.

Tom

[redcrow]

Originally Posted by TheGITM

This is not meant to minimize the impact of service obstacles to those needing Medicare services, but the other side of the equation that has contributed a great deal to those 'obstacles'... is Medicare fraud. There are estimates as high as $100 billion in fraud annually, so Medicare/Medicaid have had to implement more detailed reviews of claims, particularly in certain higher risk areas.

I don't know any of the details, so I'm not trying to excuse anything. I'm simply pointing out that while it's easy to think that people should just get what they need more easily, the easier you make it the more opportunity you create for fraudulent billing to occur. It's a balancing act, and right not is sounds like pendulum has swung more toward making it harder to get claims processed.

I would add that it's typically not that the people working for Medicare don't care about the individuals needing services. It's just a mammoth, unwieldy system that is difficult to manage, and likely impossible to 'manage well'.

What I would ask is, what's the alternative?

You are aware that the vast majority of that fraud is committed by the very people and facilities that are supposed to be rendering services(?) Do you have any idea how many physicians have a significant financial interests in the very service providers they send patients to or the pharmaceutical companies providing the meds they prescribe? According to research by Mt Sinai, unnecessary tests and questionable prescriptions cost the American people about $6.7 billion a year?

Yes, fraud is a factor in the cost of health care, but it's largely a case of leaving foxes to guard the hen house.

What's the alternative? Well most other technically advanced nations seem to have found at least a better delivery system if not a complete solution.

[TheGITM]

Originally Posted by redcrow

What's the alternative? Well most other technically advanced nations seem to have found at least a better delivery system if not a complete solution.

I believe that you have a rose-colored view of healthcare in other countries. While other systems may be more affordable overall, the services are frequently less available, and often come with fewer options/alternatives.

I'm not evaluating what's 'better or worse' - I'm simply saying that there are areas that are not easily comparable. I have had conversations about healthcare with people living in other countries. One example is about a friend from my running community who suffers from lower back pain. Here in the US, I can get in to see a physician fairly quickly/easily and will get a referral to see a specialist fairly quickly/easily. The specialist will order a battery of scans/tests to diagnose the issue and plan for treatment. This all costs a lot of money, but it's built into our healthcare system. Not so for my Canadian friend. Those with 'non-life threatening' issues get put into a queue to even see a physician. The prescribed treatments are often simply to address the symptoms and provide relief, and not necessarily to find and treat the underlying ailment. There is disincentive in their healthcare system to run a lot of tests. This is largely why so many needing specialized treatment will cross the border and come here. In their system, they will also make judgements on whether or not a given individual warrants treatment... i.e., if you are suffering from something that would be costly to treat but would greatly improve your quality of life, and you're 76 years old with diabetes, they can/will simply deny the treatment. Another example of the type of thing that will send someone across the border to get treatment from our healthcare system.

It's easy to gripe about things. I totally understand the frustrations. But get the real story from people in those other systems before you flush this one down the drain... I don't think those systems work as well for the average Joe as you might believe.

We have forum members here from the UK/Canada and elsewhere that can chime in and correct me if I am misstating anything. I am happy to be corrected.

[MikeB1]

Redcrow,
First and foremost, I am very sorry that you have to go through this.

I am an epidemiologist and now work in research, but I have worked in various fields of health for 40 years. In addition, I was a caretaker for both of my parents for 17 years when they experienced health problems, Now, this past Monday, I have just completed my first round of chemotherapy. So I have experienced the healthcare system from different contexts: as a healthcare professional, a caretaker of loved ones, and a patient.

I have experienced both the strengths and the weaknesses of the healthcare system. While inconsistencies may be more easily tolerated in less critical fields, they can be extremely difficult in healthcare because we are dealing with human suffering and life and death issues.

I'm sorry that I don't have any suggestions for you. I can only offer an empathetic voice to you today.

[Mr. Jelly]

If a person looks at the data concerning health care from different places around the world you quickly understand that America is not among the best. I assume the system will have to totally fall apart before real change will ever happen. It appears that politicizing things only makes them worse.

[TheGITM]

Originally Posted by Mr. Jelly

If a person looks at the data concerning health care from different places around the world you quickly understand that America is not among the best. I assume the system will have to totally fall apart before real change will ever happen. It appears that politicizing things only makes them worse.

True. Very true.

The other piece of the healthcare puzzle in the US involves the general health across the population before you even factor in the effects our healthcare system. The obesity rate in the US is insane compared to other developed countries. On the whole, it feels like we are starting from a worse point as far as general health of the population, and then we add in the healthcare system challenges on top of that.

Obesity, diabetes, heart and arterial issues, blood pressure...

We are simply less healthy to start with, which just adds to the worsening outcomes.

Personally, I try to stay reasonably healthy by paying attention to what I eat and staying active. That's about all I can control...

[rllink]

Originally Posted by john57classic

After dealing the failing health of our parents and various “challenges” with obtaining care. One of my sisters blurted out in frustration
“We don’t have a healthcare system in this country, we have a health insurance system”
Though I am thankful that Medicare (and other insurance earlier in life) is available to us I very much agree with my sister!

One of my friends talks about the ability to pick your own doctors, go to any doctor you please and control your own healthcare as the advantage over socialized medicine, but he doesn't seem to understand that the here in the US insurance companies are controlling which doctors you can see, what procedures you can have.

For a long time I didn't have dental insurance and my dentist would give me a break because he didn't have to deal with the insurance companies, which evidently is costly. He got a letter from one of the major healthcare insurance companies that if he didn't quit that practice, they would remove him from their preferred list. That would be the death of his practice, so he complied. It is not a free market, it is highly controlled to maximize profits.