Is this indicative of the state of health care in the United States?

I have insurance and still feel second class…

Been to Mexico lately? :P

Weird, he didn’t even check your glands?

I don’t know, I have some complaints, with insurance – but that’s a different story.

Are you talking about one of those 3-minute clinics? The real quick ones? If so, I have many complaints about those! I took my daughter to one on a Sunday afternoon, I thought from the looks of her throat and her symptoms she might have strep. After a strep (rapid) test came up negative, we were told basically the same thing. I don’t remember if her glands were checked. What got me was the nurse practitioner that was there, basically told me I wasted my time and her time…it was just a virus. There was this attitude that I couldn’t stand. Next day, my daughter was worse and I took her to the doctor (regular doc) they did the rapid, and of course, this time, it was positive. I know strep can move fast, so I can’t say whether or not the other person did something wrong, but the exam itself, sucked.

I do wonder, because I went without insurance, if they do cut corners when you don’t have insurance. I’ve had the “quickie” exams and had a doctor stand in front of me and mention blood work and eye the chart again, (no insurance) and back off of the idea, until I assured him I had the means to pay for the blood work. (charge it!) I know some are trying to be cost conscious for the patient, but at what cost?

The health care system in America, in the state it is now – sucks. It’s craziness that people in America have to make some of the decisions they are forced to make to be treated, medically. It’s also crazy that health care isn’t accessible to everyone. (unless you just use the ER as your regular doctor)

I take your point, but I went to the doctor recently and was treated much the same way. And I have insurance. In either case, it is a sad statement about health care.

My sense is that they are so overloaded with patients, they have no time to spare being thorough.

our bumper sticker America’s Health Care Plan: Don’t Get Sick.

Same exact thing happened to me last weekend. The sore throat got so bad I had to go in a second time. That time they gave me some pain meds. Now I’ve never been prescribed pain meds before so don’t think I was looking for them, lol. Here’s to hoping yours recovers quickly

Here’s another indication of the health care policy in the U.S. I have a surgery all the doctors agree is needed but not life or death. I can’t get it because I don’t have health care. I finally found myself a job that offers health care and now I have to wait for it to “kick in”. And hope they don’t make me wait longer because it’s a “pre-existing” condition. They tell us that if you need health care you can’t be denied. Well I can tell you that is false.

That is pretty much the way it goes even with insurance. I took my daughter in for something similar not too long ago and was told the same thing. One thing I will say about her pediatrician is they always take a negative rapid strep and do the 24 hour culture as back up. I’m guess that may be because it is more common in kids, though.

I’ve never had any real problem with doctors (other than wait times at least) .... Mostly my qualms are with the cost…. To have what you just described done, but with much more bed side manor and care… cost ME 50 bucks. let alone the insurance company.

I mean come on, how serious was it to tell me I’ve got the flu or something? I just needed a doctors note, I could’ve told you what I had.

I’d have a bigger problem if he’d prescribed antibiotics as a way to make you feel better. Some docs still do that just because some patients want something, anything, to feel like it was worth the trip.

Furthermore, I don’t understand the difference you’d expect from having insurance pay. So… you want more of his valuable time and possibly more expensive tests just to confirm something he already knows the answer to???

You do understand that insurance ain’t free, right?. Excessive healthcare burdens the system… and my payments. I’d hope he’d treat you the exact same however you pay.

BTW… he probably makes more money off of you as private pay… since the insurance companies only pay out at a bulk, discount rate.

—

All in all, this is a pathetic whine. I’m sorry you’re not feeling well. And I hope you get better soon so you can put your efforts into something more productive.

@robmandu . . .don’t beat around the bush man. tell me how you really feel.

I got nothin’ but love for ya, man. =)

More likely you were rushed through because you were the 34th person that day with the exact same symptoms.

There is no doubt that our health care system is broken in many ways. That makes it even more important to know how to negotiate your way through the system.
When one has relatively few medical needs, one does not learn the fine art of getting what you need out of the health care maze.
I have have many years of experience with health care as I had preemies when I was younger and my husband has been disabled for twenty years.
I come armed with current xrays/ultrasounds and any other current test results. I have my husband’s MRIs in the trunk of the car so they are always with us.
For those of you who are healthy and need to see the doc for regular stuff, you don’t need to go to that extreme. But, adjusting your body language, tone of voice and educating yourself enough to ask the right questions and know your rights are all good strategies.

I had a concussion. I was dizzy, I couldn’t keep my balance, and I had blinding headaches for 3 days. When I finally went in, they tucked me in a room and ignored me for 2 hours, sent me for an MRI, and made me sit for another hour and a half. Then the doctor came in, repeated everything the nurse had already said to me earlier, told me that the MRI looked normal, and made me do a squat, said I was fine, and sent me home.

The entire experience they made me feel like I was wasting their time, making shit up, and imagining things. I got checked full force during a hockey game and my head bounced off the ice! I blacked out, and I had to replace my helmet! I wasn’t fucking imagining things!

It took about 2–3 weeks before I felt like “myself” again. To this day, even mild hits to the head (have not been in hockey, but dumb things like bonking my head on a cupboard) make me disoriented and confused.

Actually, I don’t jave insurance and I have seen the amount my old insurance paid out, and I see the bills I pay out of pockey. They are getting hundreds, if not thousands more from insurance companies.

@blondesjon I know exactly what you mean. I feel like the quality of care has dropped significantly. It’s sad. I don’t have health insurance, but still see the same doctors I had when I had insurance. My PCP does all he can so I can save money, but still treats me as he did pre me turning into one of the many statistics of the noninsured. We need more doctors like him.

Do you pay up front, or pay the bill later?

Health practitioners are required to treat everyone who shows up, whether they can pay or not. So, if you don’t have insurance, and can’t pay, the health practitioners make up for that by charging insured patients more. It’s called the cost shift.

Anyway, it is always a dicey business about whether self-payers will pay, and if you have too many of them, you can’t make up for it by charging insured folks more, and you go out of business. So there is an incentive to get rid of self-pay folks fast, so you can have more time for folks who do have insurance.

This is why it is so important that everyone in the US be insured. It will reduce the cost-shift. It won’t eliminate it, since different insurers will pay different rates, and Medicaid pays below the cost of treatment, and so practitioners have to charge people with better insurance more in order to make up the difference.

Another way providers make more money is by referring you for more tests, even tests you probably don’t need. This is fine for insured people, since insurance will pay. It’s not so good for self-pay people, because of how often they don’t pay. So there’s little incentive to refer in-house, since it will only increase your losses.

Now, you may pay all your bills, but the health providers don’t know that up front. On the other hand, they might just be really harried, have a waiting room full of patients, and they were really hoping to get home and be able to go out and see a movie with the spouse. Or just see their kids before they are asleep.

Health practitioners are required to treat everyone who shows up, whether they can pay or not.

They have to see you but they don’t have to offer all treatment necessary. They won’t offer me my surgery even though they agree it is necessary.

Another way providers make more money is by referring you for more tests, even tests you probably don’t need.

Prime example. I went in for a sore throat and they tried to give me an X-Ray. I declined.

BTW the cost shift information was enlightening.

@daloon – I don’t know what you are talking about, but no…not all health practitioners have to treat you if you show up in their office. At the ER, yes, they have to treat what they deem is necessary. They cannot turn you away at the ER, if you cannot pay; however, they only treat what is absolutely necessary.

Sitting in the waiting room at my oncology office, I saw people that could not pay for chemotherapy, and were turned away. They needed the treatment, but were not treated there, because they were already treating a full load of “free” or “reduced” cost patients, for the year. That was in the early months of the year.

Those patients get referred to a state’s clinic system. Hopefully, they can still take the patient.

Patients get denied service, all the time.

The type of clinic @Blondesjon is talking about is a full pay service. You must pay for all of it up front. It’s like an Urgent Care Clinic.

@cak That must be devastating to watch and think about when fighting such an illness. Not to mention what it must be like to need chemo and not be able to get it. I don’t know how someone could cope with that type of devastation.

I’ve also seen people turned away and been turned away myself. Scary business. I’m a big advocate for health care reform.

@RedPowerLady – Yes, it is. I still deal with a huge amount of guilt for being able to afford my care. My husband and I donate money to my dr’s fund to help treat patients. His practice takes on more than any other private practice in town – he does what he can, but it’s so expensive. The first time I saw it happen, I was so physically ill – just from the emotions, I went home without my treatment.

I now participate in a program that helps find treatment for uninsured patients. There has to be something better we can do for our fellow citizens.

It’s true that there are lots of ways of getting around the requirement to treat everyone. Hospitals want to stay afloat, too. Where I live, every hospital that can is closing its emergency room so they don’t have to treat a bunch of “self-pay” patients. Things are much slower if you don’t have insurance. People are afraid to go get care if they don’t know how to pay for it. It’s problem after problem, and it affects us all, by driving up the cost of care, as cost-shifting gets more and more complicated.

Obama’s plan won’t help much, either. As long as you let the private insurers play, and they don’t have any competition from, say, a government insurance product, they’ll continue to steal us blind. They are very, very clever about how to generate as much money as they can, ripping off both patients and doctors.

Without single-payer, there won’t be any change, but single-payer is deemed politically infeasible. As they say, Americans will try everything that doesn’t work before they finally try what does work.

@cak That is so fantastic you help out in the ways you can personally. We should all do as much. I am so sorry you had to be a part of any of that, what an awful experience.

First – congratulations for seeing a doctor, even though you had to self pay.
Second – If you believe your weren’t properly treated, go back and tell them to correct it at no additional charge. They most likely will comply.

I’ve had health insurance my entire life, but less than a year ago I paid a visit to the emergency room, and was treated promptly and politely despite lacking all kinds of proof of insurance.
I haven’t seen a single hospital in this country (which isn’t saying much, I’ve been in 10 at most for various reasons) that hasn’t had a sign near every entrance assuring visitors that they have a right to be treated if they feel they should be, whether or not they have insurance. I doubt that they rushed you through because they didn’t want to treat you, so much as possibly because they didn’t want you to suffer financially just because you wanted to remain healthy. The emergency rooms I’ve seen have also often featured a sign basically advising people not to use their services unless necessary, because of the expense. I get the feeling that many ER doctors are quite aware of how expensive a visit can be, and may feel guilty about putting a financial burden on someone who doesn’t have insurance.

Yarnlady
I don’t know any doctor who will see a dissatified patient a second time without charging them. And, I know a whole lotta doctors.

I also don’t have insurance. I had a regular checkup (seriously she just listened to me breathe and took my blood pressure, took all of 6 minutes) and charged me $80 for the office visit. Then two weeks later I got a bill for another $120 bucks.
Same thing when I took my daughter to the pediatrician. She needed shots, the doctor herself said she was going to arrange it so I didn’t have to pay full price. I paid $44 and I specifically asked if I would get another bill, they said no. Yesterday I got a bill for another $130. Of course the bill has a phone number on it that doesn’t reach the regular doctors office, and if you try to call the regular office they say to call the billing office. I’m so sick of trying to come up with hundreds and hundreds of dollars just to get three minutes of a doctors time.

@elijah Oh ya I’ve been through that one too. I’ve learned whenever the doctor says anything about the bill, absolutely, I mean absolutely, do not believe it.

I went to a meeting today about improvements in patient care at two local free clinics and how to take on more patients. Understand that all services there are volunteered, down to answering the phone. Completely non-profit.

I gotta say that I was appalled when one of the newer doctors started laughing and joked that we should regulate it like the biggest local health care provider does…15 minutes, max per patient. Only exception is a medical emergency, or one that may require further tests…then, if they are in the doctor’s office, they should be transported to a hospital, via ambulance (you have to waive it to not be transported). In fact, if a doctor shows that they are minimizing the mandated 15 minutes or less, and moving more patients in a day, they receive a bonus. They also encourage triple booking appointments. You wait, that’s fine. You are late, and you are charged. He went on to brag that he’s averaged 6 minute a patient, on some days.

To rush a patient is very dangerous. Things can be missed. Now, with that said, I am perfectly aware a doctor cannot take all day with one patient and expect to maintain a practice. However, I am a person that was rushed and rushed through visits. Not until one doctor said enough is enough, let’s figure out what is going on with you – that is when it was discovered that I had CLL – a form of leukemia. I had a rare presentation where the blood tests didn’t reflect it right away – I think it was call small CLL or small cell CLL. Something like that. It took one doctor that flipped off the system and took more than 15 minutes with me.

I don’t think that Blondesjon is off base in his complaint, but I understand the importance of doctors treating other patients. When a patient feels that they haven’t received quality care, there is something wrong. We can complain about a bad meal, we can complain about a ding on furniture. We can complain about poor service in the medical community.

@basp I thought he was talking about a local clinic, where you pay to get in, and then are seen by any doctor on duty. They will allow you to come back at no charge for a follow up visit, if your problem is still the same one.

Yarnlady
Maybe it is different where you live, but I don’t know any doctor at any clinic or any other place that would not charge again.

The neighborhood clinic where I have taken both my son and my grandson for different problems allows follow up’s at no charge, I guess we are just lucky.

Sonny went in for an outbreak on his back, which was treated with a salve, and the doctor had him come back in two weeks to make sure it was gone. Grandson went in for a very bad splinter which they removed, and when it got infected, he went back the following week, they looked at it and prescribed an antibiotic. Neither of the follow-up visits cost anything.

@YARNLADY That’s rare. I had to take my daughter for multiple follow-ups for one issues, each time…the bill came (to the house) for no less than $180.

All this griping about bills is a bit much. I’ve just had an oven repair man come to my house to fix the stove. He was here less than 20 minutes. Charges $80 for the diagnostic visit, $120 for the labor (20 minutes) and $80 for one part (grand total $280 for 20 minutes). I’m sure people have gone to a mechanic or had other repairs and had it cost way more and also take (what appears to be) minimal time and effort. Paying a doctor a fair wage for an office visit is appropriate. This is health care, not cosmetology. Doctors go to school for years, have enormous loans to pay off, malpractice insurance to pay, offices to rent, nurses and administrator salaries to pay, etc. To pay a reasonable amount for a visit is fair. How many people go to SuperCuts for a haircut and expect the same experience as at a high priced salon? The same is true here. If you go to a clinic inside a mall staffed by nurses, don’t expect to get a one hour history and physical from a Harvard trained doctor, all for $10.

With respect to the issue of unnecessary tests, it isn’t as simple as doctors trying to drive up expenses. Many of those tests are also ordered because doctors practice defensive medicine. Too many frivolous lawsuits have ingrained a style of medicine that says, do as much as possible (even it is expensive and likely meaningless) to protect yourself from a big lawsuit in case you miss something. So, someone who has a fever and sore throat gets a chest x-ray to “rule out pneumonia”, just in case. Health care reform is important, but so is reform of malpractice litigation.

Now, @Blondesjon, I understand things still aren’t right with you. If you are up to it, feel free to send me a PM and we can discuss further.

The issue of malpractice and malpractice insurance is a complex one. It’s like the issue of insuring any perceived risky activity (like diving boards at swimming pools). Sometimes the fear of a lawsuit is so much larger than the facts warrant. That’s because of the few lawsuits that are won by plaintiffs and they get what seem to be unmerited rewards. Perhaps they are unmerited. It’s hard to understand how juries think.

I think most people who are not medical professionals probably don’t appreciate the difficulties of trying to bring people back to expected health. So when a practitioner does make a mistake, and that mistake is a negligent one, or appears to be a negligent one to them, they want to slam the doctor in order to discourage other doctors from making the same mistake.

Yet, in some regions, medical practices keep people just as healthy, but spend a lot less than others. I don’t believe their malpractice insurance rates are any higher than in the areas that practice defensive medicine. That would be an interesting study, come to think of it.

One study found that tort reform has no effect on medical practice or on reduction of health care costs. Another study found that cost and quality of care are unrelated. Other studies appear to show both the same and the opposite. So this is inconclusive.

This doctor argues that defensive medicine actually reduces quality of care. This study also says that defensive medicine has negative consequences sometimes, as does this one.

So, medical malpractice costs are associated with increased defensive medicine and the cost of care, but not with an increase the quality of care.

Overall quality of care, positive or negative, then perhaps does not impact the cost of malpractice insurance premiums.

Malpractice premium reduction does not impact medical care cost in a noticeable way. Caps on awards do seem to reduce premiums, but malpractice attorneys are finding ways around that.

Doctors seem to practice defensive medicine more out of a fear of lawsuits than out of any real likelihood of law suits. Places with lower cost but high quality care may not have reduced malpractice premiums. Thus, we could reduce the cost of health care, by educating doctors that defensive medicine does nothing for their patients, and may even hurt them (leading to greater likelihood of a lawsuit), and it also hurt society overall.

If defensive medicine does not reduce likelihood of suits, nor malpractice premiums, then it is a waste on all fronts and docs shouldn’t do it. Reduction in malpractice premiums therefore won’t necessarily reduce indirect costs, unless it reduces defensive medicine practices. It may reduce defensive medicine, but it may not be the only way to reduce defensive medicine. The other way around: it seems likely that defensive medicine does not reduce malpractice insurance costs.

We can, perhaps, reduce defensive medicine with physician education. Reducing defensive medicine will reduce costs, but not malpractice insurance costs. So, in a way, they are separate issues, yet linked issues.

On a policy basis, we want to eliminate defensive medicine as much as possible. We also want to insure, as best we can, the physicians are not negligent. Physicians want to reduce insurance costs.

There are several ways to go on this, but it seems like we can address society’s issue without necessarily addressing the physicians’ issue.

I’m sorry if this is unclear. I had to work a lot of stuff through, and, as I said, it is complex.

@shilolo Only a person in privilege (or in the medical field) could say that what is being charged for health care is reasonable or fair. What about the, what is it?, 60% of America who can’t afford health care?? We aren’t allowed to gripe and complain and demand change?

@RedPowerLady Sure, throw about random numbers. Feel free. It makes your arguments so tangible. What I am alluding to are the complaints about an $80 office visit when people spend more at the salon, or for the plumber. That, in a nutshell, isn’t fair.

@shilolo While it is quite a bit crappy of me to throw-out numbers without looking them up you still get the drift of my point.

I think we all pretty much understand that our health care system right now is not adequate and it is leaving countless amounts of people in debt over what should be a right and not a privilege. I think the people who complain about 80.00 fees are more incensed about the state of health care and not that particular fee. It seems more of the icing to top the cake, so to speak.

Of course there are some families who can’t even afford that 80$ fee and they have a reasonable reason for complaining because getting adequate health care shouldn’t mean having less money to put food in your kid’s mouths. Less money to go party or buy that new boat maybe but if people are already living below the poverty line then that money is coming directly from a necessary expense.

Anyhow that is a long way of saying that people complain because this is a real and pressing problem. Even if every complaint isn’t quite reasonable it does come from a reasonable foundation.

As for the people who spend more money at the salon or for the plumber you have to look at the difference there. Healthcare should be easily accessible and a right. So spending money for that right is outrageous for many. It isn’t comparable to spending money for other things because those things are not all rights.

@RedPowerLady I’m all for a national health care plan, but what I don’t get is where it says health care is a right? And, if I am reading your message correctly, you think health care should be free, but people can be at liberty to spend whatever they want on other things? Really?

In many ways, you could argue that a plumber is even more of a right. Running, clean water is absolutely essential in every conceivable way.

And yet, we must pay the water bill. I think I’ll start a movement.

Seriously, look at what happens when you bring access to water to people who don’t have it. If you’re looking for a new “right” to trumpet, this should be the very first one.

@shilolo I think people should be able to pay for an affordable health care plan. I wouldn’t complain if it were free. But I do not have an issue with the cost being taken from our taxes for example. However those who fall below the poverty line should get free or considerably lower-cost health care (ex: those who don’t have paychecks for it to be taken out of taxes).

I absolutely fundamentally do believe that health care is a right .
And I do not believe in a police-state. Just because someone has the right to affordable health-care does not mean that we have the right to examine their other expenses to see if everything they buy is reasonable. So are you saying that people should only get affordable health care if the rest of their expenses are reasonable? And how would you draw those lines? If someone goes to the salon they should be charged more for health care? Or not be allowed to opt in to a national health plan??

@robmandu Hey I think that having clean water is a right as well. But it doesn’t have to be in the form of plumbing. Well-Water for example could qualify. Or being able to go to a clean local river and get water. For those of us who live in America, Canada, Europe, Australia I do not believe this is much of an issue. Even if we do not have running water in our homes we can get it, without cost, in public facilities. The water bill is paying to have water running to your home. This is quite different from health care. You can’t just go somewhere and get health care (as you can get clean running water). You can’t get it at a reasonable price (as most people can get running water in their home). And they help available for reasonable health care is quite hard to obtain (while, in my town at least, there are tons of programs and quite a bit of money available to help people pay their water bills if they cannot afford it). The reality is that most people in our country do not go without clean water. However many many people do go without adequate health care. It’s a good argument but it isn’t applicable to our current circumstances.

I also think that there are plenty of people going without basic rights. And I am a strong advocate for people without such rights. But that does not mean I do not have the right to argue for affordable health care. It is quite silly to say that because someone is suffering from hunger (for example) we can’t argue for appropriate health care?? This isn’t about fixing one issue at a time. We are talking about health care here. We can work on providing clean water to other nations while we work on our own health care system.

@RedPowerLady I see, let the guys who graduate from a technical high school charge what they want, when they want, how they want. But, make the people who go to college, medical school, residency, fellowship, etc. and amass hundreds of thousands of dollars of debt along the way give their services away at minimum cost? How is that fair? Your sense of entitlement is a bit much. There should be no “police state” dictating where people spend their escess money, but there should be a “police state” that makes doctors charge a precise amount or give their services away for free?

@shilolo, I think you just summed up why the AMA is not in support of the current administration’s health care plans.

@shilolo I think there is a big difference between consumer rights and a right to health care. Of course people should be charged fair prices for other services but that is consumer rights. Health care is essential for life, it isn’t comparable to consumer rights. I also believe in education as a right if that gets this conversation anywhere. The fact that doctors have to go into debt to become a doctor is certainly unfair. The reimbursement to doctors should be coming from a health care system that does not cause them to be in debt. But it does not make it okay to charge rates that leave an insanely high amount of our nation without adequate health care.

To compare. I went to college and graduated. I have insane amounts of school loans I owe (not nearly what a dr. would but I do feel the pain from it). So because I have that kind of loan debt I should be able to charge whatever I feel appropriate to get me personally out of of debt and leave those who can’t afford my costs without my services? This is quite individualistic and is not benefiting society.

Having said that I agree it is unfair, as stated previously, that Dr.s should have to incur such debt in the first place. That is why the entire system needs changed. We can argue for affordable health care and adequate reimbursement or debt forgivness for Dr.s at the same time. They do not have to be separate arguments.

My sense of entitlement is a bit much?? I disagree. Everyone is entitled to adequate health care. Arguing for that is never a bit much. How could it be so?

Great Discussion, people. My lurve doesn’t count anymore, but thanks for the fine work.