The Death of Decent Medical Care in America.

[Raven]

I posted a thread about this a few weeks ago and there was very little response. I am going to try once again. As far as I am concerned, if this government wants to get rid of us, here is the way to do it and we are all asleep at the switch.

In Boston, certain doctors and hospitals are now offering "concierge medical care" for people who can afford to pay a hefty fee for it. This is over and above medical care covered by insurance. This is the way it works: I pay a fee, say $2000.00 and I get more time with the doc and more advice about my health and preventing illness. I get a longer visit with the doc and a special waiting room that is less crowded and quieter.

I wonder what I get in surgery, or if I need emergency care.

This, my friends, is the beginning of the end. It now sets a standard of medical care that essentially says to docs not "do no harm" but do only the very least for people who won't or can't pay a premium for it.

All of us should be raising hell about this...with our doctors, legislators, hospitals. It is the beginning of the end of principled medical care as we know it and it will happen fast!

[liberalnurse]

1. It's inappropriate, grounded in greed.

At this early stage, such an approach should not alter your quality of care yet this greed driven bedside manor will be the downfall of medical credibility. So much for the Hypocratic Oath.

[Raven]

5. I don't think this is an "early stage"

since it seems to me that it doesn't take very long for these things to become the norm. At this point we should be asking our docs... "if I don't pay the fee, what is it that you will neglect to tell me about my health or how to prevent illness. After all, aren't you supposed to be doing this very thing without a fee?"

It's bad enough in this country that people who can't afford insurance are afforded shoddy medical treatment or no treatment at all...now the bar has been raised and inusrance is not enough. Where do the docs stand on this?

[Heddi]

14. There was recently an article on DU

(i'll try to find it) where Doctors ADMITTED to withholding vital medical information from patients if the patient's insurance wouldn't cover the procedure, medication, treatment, etc......

Of course, by NOT giving patients the information b/c of insurance troubles, they're automatically assuming that the patient wouldn't WANT the procedure, medication, or treatment, even if they had to pay for it out of pocket, which is just bunk.

Right now I'm a nursing student. The reason I'm becoming a nurse is because I want to help people.

I'm also becoming a nurse because for the majority of my life, I've had either NO insurance, or rag-tag "doesn't cover anything more severe than a headache" kind of insurance. I know what it's like to "allow" yourself to become as sick as possible before you make the first call to the Dr, or in most cases, before you make that trip to the emergency room.

Last Year, luckily I had insurance. I say luckily, because Last year I suffered a herniated disk that pressed upon my sciatic nerve and totally deadened all senses in my right leg...well, deadened all senses except for constant 24 hour pain for nearly a year.

It took me over 8 months before they would give me an MRI, which is also the amount of time it took them to Rx any pain meds for me---I was up to 24+ advil a day before they finally took my pain seriously. I guess getting less than 2 hours sleep a night for 6+ months because of the pain is just "whining" in this day and age.

So I got an MRI, foudn out that YES, I did have a herniated disk, and YES I needed surgery.

Happily, I got the surgery and only had to pay a $20 co-pay. I was able to get a 'bill' for the procedure, just to see what it cost.

Over $10,000 for this surgery. It was an outpatient surgery--went in at 6am and was home by noon. The surgery itself took less than 2 hours, yet it cost $10,000 to do.

I cringe when I think what would have happened had I *NOT* had insurance. There was no way I could go without the surgery---by the time I had it, I was crying every night and unable to sleep. I couldn't walk, stand, sit, lay---I couldn't do anything. I was crabby and in constant, total, unrelenting pain that was getting worse by the day (if that's possible).

While I couldnt' have gone without the surgery, I certainly couldn't have afforded it out of pocket. Even at a community hospital, I would have been billed (if they did the surgery at all) which would have then gone to creditors and eventually gone on my credit report.

I find it sickening that your level of care is DIRECTLY tied to how much $$ you make.

Go into any local non-private emergency room.

See all those people sitting there?

Wonder why it took you or your friend over 5 hours to be seen?

It's because at least 80% of the people are there because they have no insurance, and cannot be seen in anything but an emergency setting. It's because they've been sick for a long time, but cannot afford Preventive Medical Treatment.

They can't get an antibiotic when they first get sick. So they get sicker and sicker and sicker until they HAVE to go to an Emergency Room....which means HIGHER cost of procedures, MORE time spent on something that would have been corrected in a single office visit a month earlier.

We are reaching (have reached?) Crisis level with regards to medical care in this country. It is OBSCENE that people cannot afford basic--BASIC--treatment for themselves and their family.

It's sickening....that's why i'm getting into the field---to be able to help people directly.

It's sickening that medicine is seen as a profit-making business, instead of a life-saving business....

[realFedUp]

15. Boutique medicine

just heard something said about it on the radio, so
it's getting out there...
Good to keep talking about it.

[FlaGranny]

11. My friend's doctor did that 2 years ago.

He tried to talk her and her husband into it. She told him, in so many words, "are you crazy, I can't afford that." Anyway, he did it, and they dropped him. The $2000 (or however much they charge) is a yearly fee and it doesn't cover anything except the privilege of being seen, I believe. You still need insurance and PPO's and HMO's are a no-no. You must have private "standard" insurance" or pay cash. That kind of insurance is running close to $1000 a month for a family now (last time I checked). There must be a market for it. It's a sickening development.

[bicentennial_baby]

2. I agree

This is disturbing. to say the least. We do need to bring this up, often and loudly.

[sandnsea]

3. Siphon the rich off... might be good

They're the ones who promote the 'choice' idea. 'Oh my gosh, I'd have to go to the same doctors as everybody else, gads no!!!

Get them the hell out of the system so they'll shut up and the rest of us can have health care we can count on.

I actually support a two-tiered system. Single Payer Healthcare for everyone and then if somebody wants to pay $2,000 for a designer doctor, let them. I can guarantee you it isn't a doctor I want to see in the first place.

[Raven]

6. You really miss the point!

There should be no such thing as a "designer doctor" to be paid for. I have docs on both sides of my family (grandfathers and grandfathers-in law) and their care was the same, whether someone could pay or not. My grandfather took homemade wine from the barber because that was what he could pay and I'll guarantee that the guy and his family got the same care as my granddad's paying patients. Look at what has been lost here...even you are willing to settle for less!

[sandnsea]

20. I understand

I don't think the amount of money you pay a doctor has all that much to do with the quality of the doctor. In the town where I used to live, one of the doctors still treated people whether they could pay or not. Our family doctor knew each of us and we could call on a Sunday, get a call back in 5 minutes, quick question answered because he knew us. No charge. So I do know about quality health care and I believe those kinds of doctors aren't going to become designer doctors anyway.

Let the dingbats who are fighting against national health care because they want their 'choice' go off into glitzville if it will mean everybody can have the opportunity to see a doctor in the first place. A caring doctor, like your granddads were.

[DemoTex]

4. "Concierge medical care"

This is catching on with wealthy Texans, too. I see it as the rich buying what should be the public health care system in this country. They are fighting national health care tooth-and-nail. Privatize the gains or best working elements of a system, and leave the losses, wrecks, and marginally functional elements of a system for the public to pick up. It's the GOP way.

Work until you die, and die quietly; that's what they want. They really don't care about you and me.

Yes, we should be raising hell about this. This is a major thrust in the assault to totally destroy the middle class.

[Raven]

7. What can be done about this?

What I don't want is what I call a "bitch thread", one where everyone agrees, vents and then goes on to something else. What, specifically can we do about this? That question assumes folks think we have a problem.

[FlaGranny]

12. The only thing that could be

done is to pass a law against it, but the law would be declared unconstitiutional. It is capitalism at its finest. The doctors are selling their services, at prices they determine, to people who can afford them. The doctors are doing this because they no longer want to deal with insurance companies, HMO's, and PPO's, who give them a hard time about what treatments they are allowed to supply their patients at cut rate prices. The solution is simple. Universal health care for all.

[CMT]

8. This is totally wrong

I'm getting to feel more and more (especially since I work in a hospital and see some of this) that healthcare in this country should be a basic right for everyone--whether they can afford it or not. People should be treated the same whether they have money or not.

[Clete]

9. Doctors like this because they can lower their patient

load and increase their income. This is why we need universal health care so that the people who need health care, the sick, can get it. Fee schedules can be worked out with physicians like they are in Canada so that everyone benefits.

[Skittles]

10. why don't they just add

black and white waiting rooms too and be done with it. This is disgusting.

[Raven]

13. I am going to mark this day.

12 posts. One time soon I'm going to be forced to say "I told you so"!

[fishnfla]

16. I think its a damn good idea

The docs are telling the HMO's and insurance companies to get bent. HMOs are really the problem. Its hardly the rage anyway, there is only one Dr around here that is doing it. Most of his patients got sick of dealing with HMOs too.

[FlaGranny]

19. Everyone is sick of dealing with HMOs

but only a select few can afford anything else. I'd like some of that "private" care too. I'll bet you, so would just about everyone else, but how can it be good when the people 3 blocks away from me can afford this care, but I cannot? A doctor has dumped the 80% of his patients who cannot afford his care onto other doctors, already overworked, and who now have more patients in HMO's to deal with, thereby increasing the disparity in health care.

[samsingh]

17. i think this happened long ago

in all the States

[Mandate My Ass]

18. AFAIC managed care is intrinsically unethical.

They provide doctors with incentives to deny patients proper medical care. They penalize doctors who refer patients for specialists' visits and testing. They impose gag clauses that prevent doctors from even informing patients about non-covered treatments that might benefit them because disclosing this information would reflect badly on the insurance company or lead to patients filing grievances.

These companies lobbied politicians to relax regulations under the guise of containing spiralling medical costs but *they* are the vultures. Doctors are constrained in treatments they provide by HMOs whose only priority is to make a profit. Capitation, loss of patient confidentiality, gatekeeping, rationing treatment are all detrimental to patient care becaue profit demands the least amount of service possible be offered. Profit-making is directly antithetical to the practice of medicine which demands providing needed medical treatment no matter the cost.

Bring back fee-for-service plans, they're not necessarily wasteful as these HMO companies claim, and they are ethical. I have no problem compensating someone who is an expert for providing quality service but I do have a problem with insurance CEOs being compensated for keeping patients sick and in the dark about what is available to heal them.

Concierge medical service is a way to keep the rich healthy, keep doctors from rebelling too much against capitation, and foist substandard care on the rest of us.

[tom_paine]

21. Raven, the problem is "Trotsky's Perpetual Revolution"

which the Busheviks have "borrowed" (these thugs will steal ANUTHING from ANYONE).

Basically, we are being deluged with daily miniature absurdities and atrocies like this one, on all levels. Sure it would be easier if they cut to the chase because people would notice but that's exactly why they won't do that.

And so, amidst the sea of monstrous tides the Busheviks have set up in their Imperial Bathtub, this is but one piece of flotsam.

Yes, I agree completely that it is a bad thing, but it makes perfect sense in an Empire that has given up on "the mob" and is now dedicated exclusvely to the flourishment of every Aristocrat in the Empire.

It makes perfect sense. It is a logical outgrowth, not just of the Busheviks, but of the entire Empire as it charts it's course downward to the Ash-Heap of History (perhaps to drag the entire species down with it).

[Jax]

22. "Special fees" happening here in the Northwest too

This article was news to me. So for 25 bucks a month over your premiums you get the care from your doctor you should be getting without that fee.

link: http://www.komotv.com/healthwatch/story.asp?ID=26602

snip...
"A monthly $25 access fee on top of her insurance premiums buys her extra perks.

"Longer appointments, more timely appointments, providing emergency care on site when needed and in the emergency room," said Dr. Brad Harris."

Not the thousands being paid above and beyond in Boston, but for me, no way I could come up with the extra $300 bucks a year on top of premiums to get the coverage I 'used' to get with my doctor. Once upon a time.

I will be watching to see how the insurance commission here views these "special fees".

Good post Raven. Important. Thanks.

Jax