April 6, 2010

The problems of our current healthcare system

That we are in the process of trying to fix, I understand, but the problems still abound. One of SOF's favorite bloggers has a great post on the subject, and from someone with some inside knowledge of the healthcare system.
Case in point, was the patient I saw this week, who was employed and who fell off his porch back in 2004, sustaining a fracture of his left tibia and fibula of the lower leg. He had surgery to correct it, but in the interim, he lost his job due to being unable to work, and thus, his benefits. Back in the fall, he re-injured the leg and now needs to have hardware removed and the bones fused. He is in horrible chronic pain, and no orthopedic surgeon will touch him. He has no coverage. He can't pay for the surgery or an expensive hospital stay. So, what does he do? He takes numerous trips to the ER when the pain becomes too unbearable, and receives a prescription for maybe 10 pain pills. Why doesn't he see his PCP? He has no PCP, as he's still in the "process" of applying for Medicaid, and thus can't afford to see a primary care physician. Oh, did I mention he has hypertension too which is untreated? What happens if this man has a stroke? I'll tell you what happens. He gets taken by EMS to a hospital, is admitted and given the very same care as an insured patient, but there is no one to pay the bill. Who pays? You do. You and I do. And the bills keep getting higher and higher and higher to somehow compensate for those with no way to pay.

As I noted on her blog, this is my frustration with the discussion about healthcare. We already provide a "public option" but it is the least efficient possible, and one that certainly discourages people like this patient to get the care they need. The FB conversation I had with the woman convinced that anyone who criticizes tax cuts is, in fact, a "liberal," included the kinds of suggestions that people would be better off negotiating directly with doctors for their care. All fine and good for the head cold and even a simple break (I imagine) but unmanageable for chronic and expensive care.

One other thing here, btw, is the specter of "moral hazard" thought coming into play. One of the conservatives I speak with is very concerned that this new healthcare subsidize people who don't "try." That FB woman said something similar, that this new ACA would lower the incentive for people to work hard to get their own care.

8 comments:

Smitty said...

ACA would lower the incentive for people to work hard to get their own care.

Interesting paradox the FB user expresses. How is it that handing out tax breaks and cash incentives to businesses somehow incentivizes them to grow and flourish, but handing out health care to people who will eventually become sick or broken will actually keep them from getting their own?

Corporate welfare: help business grow and is good for economy!

Poor people welfare: keeps them from getting jobs of their own and they feed off the government teat their whole life.

Smitty said...

I was trying for "more restrained and subtle" on that post...

Smitty said...

About fucking time.

It felt really unnatural. I don't think I'll go back to that "subtle" well anymore.

steves said...

The FB conversation I had with the woman convinced that anyone who criticizes tax cuts is, in fact, a "liberal," included the kinds of suggestions that people would be better off negotiating directly with doctors for their care.

Like you said, that would work great for very minor things, but would be useless for a catastrophic injury. What are you going to do, have the ambulance drive you all around town looking for the best rate.

That FB woman said something similar, that this new ACA would lower the incentive for people to work hard to get their own care.

Then this person is a damn moron. Has she ever had Medicaid? If she did, then she would know that it is difficult to qualify for and many doctors do not accept Medicaid patients. You should direct this person to one of many Medicaid information sites where they can find out that you CAN'T get Medicaid if you are and able bodied adult. I suppose you could try and develop a disability like terminal cancer, blindness, or amputate several of you limbs, but otherwise you won't get Medicaid.

Cold In Laramie said...

Streak, I think it is interesting that way in which some people reify the Protestant Work Ethic. As I see the argument, some people do not deserve health care because they are "unwilling" to work for, essentially, the right to pay for health insurance. Now, since I am a labor historian of dubious qualifications, it strikes me that this misses the point. For one, the idea of what "work" means is a cultural construct. No everyone conceives of the meaning of work in the same way. Second, and more importantly to this discussion, is that one can blame workers for not getting health care, when there are countless stories of companies hiring people for 38 hours a week (or something to that effect) in order not to provide benefits. Once again, corporations and businesses are exculpated in these discussions.

Streak said...

CIL, I would really like to hear more about different cultural concepts of work. Can you say a little more about that?

Your second point is right on target, of course.

Steve, I am not sure if she is a moron. But her approach sounds more like right wing talking points than thoughtful conservative. That "moral hazard" thing is straight out of that playbook, and might have legitimacy in some areas. But almost everyone says that it doesn't apply to healthcare in the same way. But, like I said, I have run into that argument elsewhere. One of my friends is concerned that healthcare will go to people who don't try.

As Smitty points to, the moral hazard idea is often not applied to corporate interests.

steves said...

Moron may not have been fair. Ignorant may have been a better choice. My frustration mostly stems from the fact that critics of "welfare" seldom know very much about how it actually works and who is able to get services.

If I compare my private health care coverage that I get now (through my wife's union job) to what I had when I was fresh out of grad school in an entry level counseling job, I would say that it has gotten worse. I think most people's health care is going to get worse as more employers cut benefits or make employees pay their own premiums.

Streak said...

No, moron might be right on. It certainly frustrates the hell out of me.

One of the things I was convinced of during the recent healthcare debate was that many of those with insurance were oblivious to how more expensive it was than 10 years ago, and were completely over-impressed with its quality. They often framed this reform as only dealing with the uninsured, and some of us on the supporting side did this too, but the reform was as much (if not more) about those with insurance that isn't as good as they think.