American Healthcare System

Still ... I've always said that if I have a real emergency I'd dash over to the UCD vet hospital and throw myself on their mercy.  Hey ... if they're good enough to deliver Lassie's pups.  I just wanted to jump in here and explain that my eternal grumpiness about Kaiser has to do with the way something was handled - and that's most likely the fault of a particular doctor and not hospital policy.  I've never had a problem with the quality of care.

Joyce

ottoluv

 

Yes but BC, you don't have a pharmD making sure your medications don't interact with the anesthesia and other mediations you are given when you are at home or a nurse administering it to you, making sure you don't have a reaction.  You are looking at it the wrong way, it's not the med that's 35 dollars, it's the med plus everything else.  You also in general cannot take your own meds at the hospital because I don't know for sure what you are taking and I will not allow myself to be liable for your mistakes.  Some charges are trumped up, but some are not.  I agree you should look at your bill, but don't make assumptions about the "games" that are played.  Hospitals get only a few cents on the dollar for what they charge, so you need to understand that too.  Hospitals are just trying to break even, or make up for losses in other areas.  The only two areas in the hospital that make money in general are the OR and NICU.  Money from there goes to cover huge losses elsewhere like emergency departments. 

Policy may be different at your particular hospital, but I was able to bring my own meds, both RXs written prior to surgery by my doctor and OTC ibuprofen as long as it came in sealed and the nurse confirmed that fact.  I brought my own pads and pajamas.  I had to wear hospital PJs into the OR and REFUSED the bottoms because I knew they would charge for each piece and just kept the sheet over my bottom half.  The nurses HATED me because not only did I insist on having everything written in the chart, I also insisted on viewing it at every entry to confirm everything was clearly documented and insisted on a photocopy when I checked out.  Even with all of that, the billing dept. tried to charge me the standard charges for everything and in the end removed ~$1500 from my bill for things that I provided myself.

The hospitals are not barely breaking even, just check their stock prices.  In a plummeting economy, them, the insurance companies and the drug companies are the few that continue to rise, along with those good ole' oil companies who also enjoy sticking it to us.  I have no problems with the individual providers who do great work, but the systems within which they operate are designed for one thing and one thing only -- MAXIMIZING PROFIT.

I now make a practice of only patronizing faith based health care providers for a number of reasons (and I'm athiest/agnostic!).  One - they don't report to collection agencies (at least the one here that I go to doesn't), they bend over backwards to make payment arrangements, and they don't overcharge and rape their customers for services.  They also don't slam the door in your face if you don't have insurance or your card on you at the precise moment you present for services.  When my son broke his back, HCA charged $4500 for his MRI, Bon Secours $700, that's profiteering, plain and simple and I refuse to patronize an organization that engages in it. 

ottoluv

Many of the expense of human medicine is due to the history of malpractice suits which influences all the rules we follow, and it will only likely get worse unless there is more legislation to protect hospitals and physicians from frivilous lawsuits.  Some of these changes are good and add to patient safety, but many are worthless and only add to patient expense.  Something like 90% of medical malpractice suits are thrown out, but they still cost money.  It's like comparing a CIA operative to a security guard at walmart IMO.  (not anything against vet medicine, they just don't have the money to use as we do so they don't do/use many of the things we do).
 

And that's what happens when you live in the most litigious country in the world. Maybe the problem with the HealthCare system is the Legal system.  

denise m

ottoluv

Many of the expense of human medicine is due to the history of malpractice suits which influences all the rules we follow, and it will only likely get worse unless there is more legislation to protect hospitals and physicians from frivilous lawsuits.  Some of these changes are good and add to patient safety, but many are worthless and only add to patient expense.  Something like 90% of medical malpractice suits are thrown out, but they still cost money.  It's like comparing a CIA operative to a security guard at walmart IMO.  (not anything against vet medicine, they just don't have the money to use as we do so they don't do/use many of the things we do).
 

 

And that's what happens when you live in the most litigious country in the world. Maybe the problem with the HealthCare system is the Legal system.  

I don't think it's the system itself, but the people that abuse it. 

 If a system allows abuse, then the system needs to be changed. JMHO

denise m

 If a system allows abuse, then the system needs to be changed. JMHO

It does not allow it, but just being taken to court can be devastating for someone and their practice, even if no judgment is made against them or they settle.  However, there needs to be room for true criminal or civil cases.

 Maybe I should have stated : If a system is being abused, it needs to be changed.  Ottoluv stated that the high cost of Health Care was due (in part) to the high malpractice and the cost of liability insurance. There are 2 reasons why those costs would be so high. Either there are a lot of Dr.s who are malpracting (is that a word?) or the legal system is being abused.

denise m

 Maybe I should have stated : If a system is being abused, it needs to be changed.  Ottoluv stated that the high cost of Health Care was due (in part) to the high malpractice and the cost of liability insurance. There are 2 reasons why those costs would be so high. Either there are a lot of Dr.s who are malpracting (is that a word?) or the legal system is being abused.

Or, too many people are filing suit/threatening to file suit.  Sometimes, it is cheaper to settle, even if there is no malpractice or liability on the part of the Dr.  An unhappy person and their accusations can be more damaging than a large chunk of change.  I think often our culture has unreasonably high expectations. 

It's kind of like when I did gymnastics.  It's an expensive sport.  The insurance costs and liability are insane.  Our entire school district dropped the sport b/c no one could afford the insurance.  You cannot do it for free, or even very cheaply like you can join a peewee soccer league at the local park for $25/season or whatever.

BCMixs

The hospitals are not barely breaking even, just check their stock prices.  In a plummeting economy, them, the insurance companies and the drug companies are the few that continue to rise, along with those good ole' oil companies who also enjoy sticking it to us.  I have no problems with the individual providers who do great work, but the systems within which they operate are designed for one thing and one thing only -- MAXIMIZING PROFIT.

No, the hospitals here aren't breaking even at all. They're losing money big time. My sister is a nurse at a hospital in New Jersey, which will be going bankrupt shortly. She isn't allowed to work overtime anymore, and bonuses were scaled back, because the hospital just can't afford to pay it. The hospital loses major money because like it has been said, they have to treat patients regardless of their ability to pay. There are lots of people in that hospital, and lots that are on the floor she works on, who are never going to pay their bills. Some will never have that much money, others will voluntarily, or perhaps involuntarily, return to their home countries after treatment, others won't live long enough to pay the bills.

Ottoluv has the right of it and I am sorrry I can't pick a specific line or two to qoute.  In our family we have a wide variety of medical care.  From Government to private.  My scripts cost anywhere from $1.-$3.00 if I had to pay for them it would be nearly a grand a month. Bob has worker's comp for 3/4s of his care the rest he pays about 300.00 a month for and again no script cost for 98% of his meds. One daughter has zero coverage, when things get bad she goes to an er and then racks up yet another bill she can't pay. The grandkids are on AllKids and Medicaid without that Bob and I would be in the poor house.  The 4 year old has a dental appointment coming up everything is paid for EXCEPT the sedation , she will have to be knocked out since her mother neglected her teeth and she will need a really tough appointment so that 200.00 came from the Stimulus check that we just got.  Our Nation has issues and problems but after traveling the world I would rather live here than anywhere else.

Bonita of Bwana

griffinej5

BCMixs

The hospitals are not barely breaking even, just check their stock prices.  In a plummeting economy, them, the insurance companies and the drug companies are the few that continue to rise, along with those good ole' oil companies who also enjoy sticking it to us.  I have no problems with the individual providers who do great work, but the systems within which they operate are designed for one thing and one thing only -- MAXIMIZING PROFIT.

 

No, the hospitals here aren't breaking even at all. They're losing money big time. My sister is a nurse at a hospital in New Jersey, which will be going bankrupt shortly. She isn't allowed to work overtime anymore, and bonuses were scaled back, because the hospital just can't afford to pay it. The hospital loses major money because like it has been said, they have to treat patients regardless of their ability to pay. There are lots of people in that hospital, and lots that are on the floor she works on, who are never going to pay their bills. Some will never have that much money, others will voluntarily, or perhaps involuntarily, return to their home countries after treatment, others won't live long enough to pay the bills.

Very True Griffin, BC, I'm sorry, but you have an extremely inacurate view of medicine and healthcare.  I'm acutally quite shocked.  Hospitals all over the country are in absolute crisis right now and many that are needed most (those in the inner cities) are on the verge of closing all together which will be one of the biggest public health nightbmares in history.  ER's in particular run in the red by millions upon millions at every major institution in the united states.  Doctors are in huge shortage in fields such as general surgery or rural medicine because the pay/reimbursment is so rediculously low that no one in their right mind would go through this much training and do it.  It actually was the cover story in TIME magazine the day prior to 9/11 so obviously it didn't get press as it should.  The cost of care at hospitals has nothing to do with what faith it claims, that is just nonsense.  I have worked at multiple in the past ten years and most charge much, much, much more then any surrounding university or county hospital.  For example a Stat/Trauma CT of the abdomen/pelvis at my ED is 8000-10000, and it is faith based.  Denise, I agree with you that lawyers are what have caused this problem for the most part.  There were irresponsible people of course in the healthcare field as well, but it's the legal system that has really put medicine on a crunch.  One of the biggest problems is that people expect there to be NO complications and any complication is malpractice.  That just couldn't be further from the truth.  FYI, many hospitals are not for profit, mine included.  How do you explain the high prices at cedars??? 

Ottoluv, 

 My "extremely inaccurate view" is based on my personal experience and those of my friends and family.  Experiences, I might add, that plummeted my family into bankruptcy because two family members actually had a need for the services we paid insurance premiums for.  While it might not be the experience for every American citizen, or even every member of this board, it was my experience and as such, shaped my very jaded view of the "system" and as I said more than once, NOT THE PROVIDERS.  With the exception of one physician who told me my endometriosis was in my head, despite documented PHOTOS of the condition from a laprascopy, the providers have been great.  But when you have to scream LAWSUIT to get an HMO to approve a surgery that is medically necessary, and when you have two identical MRIs performed and one is charged at $4500 and the other at $700, and when you're charged $100 for pajamas that remain in the hospital in a dirty laundry bin, you get a wee bit jaded.

I believe the OPs question was regarding our OPINIONS of the system.  Those were mine, they were NOT a personal attack on your or your chosen profession, as you seem to have taken them.  Sorry your hospital isn't making $$$, maybe you should come work for HCA in VA, they're positively rolling in it. 

I'm sure we both understand that Southern California is dealing with demographic issues that are swamping every public system in their area, not every place in the US is forced to provide the quantity of unreimbursed services that those in CA are.  Here in VA it is very easy to move that demographic along to city ERs and to refuse service, and they do.  You only have the right to be stabilized, and most who walk in are stable.  Even the faith-based, not for profit wouldn't see me in their emergency room because my insurance was screwed and showed inactive.  It took a phone call from my physician insisting that my condition was life-threatening to get me into a CT scan.  I got stuck with an ER copay as well as the CT scan copay because my insurance company's computers don't sync for 15 to 21 days after my COBRA payment posts.  Don't tell me the system works, it only works for those who don't use it or only have to use it for things like well woman visits and ear infections.  If you've got serious health issues, you're the bubonic plague to the insurance companies and the doctors who are leaving practice in droves because of them can only shrug their shoulders at you because they're getting it stuck to them in the same place you are by the same schmucks who are calling all the shots -- the insurance companies.  They manage cost, they manage care and they're killing the system. 

ETA: Yeah, they're really hurting, profits up, adding physicians. Cry me a river. 

LOL, I'm sorry I just had to laugh at that article. It's hardly can be used as an example of the "american healthcare system".  It says that they are "looking" to increase their profits, not that they had.  In fact, if you read the last line, two of the three companies actually lost money. 

 "LifePoint shares fell 89 cents, or 2.7 percent, to close at $31.91, while Health Management shares rose 7 cents to $7.62. Shares of Community Health fell $1.08, or 3 percent, to $35.68. 
"

They added physicians because their admissions increased and they needed manpower, not added physians in some diabolical scheme to steal money from people.  I know you are looking for proof that hospitals are making billions, but you won't find it.  If you think virginia is different you are wrong as well.  Just google some of the hospitals there.  MCV looses over 30 million from the ED alone every year.  I'm sorry for what you have gone through, but it doesn't make your experience proof of the whole.  Are insurance companies a major problem? of course.  Lawsuits are as well.  Every major hospital in the country is struggeling and there are lots in virginia or the vicinity (UVA, Shock trauma, Hopkins, GW, Georgetown, ........). 

ottoluv

 I'm sorry for what you have gone through, but it doesn't make your experience proof of the whole.

Hmm, I do believe that's what I said, if YOU'D read what I wrote:

BCMixs

While it might not be the experience for every American citizen, or even every member of this board, it was my experience and as such, shaped my very jaded view of the "system" and as I said more than once, NOT THE PROVIDERS.

You also are incorrect about the "being stabalized" thing.  I, and every other practitioner, am obligated by law to take care of someone in need of acute hospital care until they don't need hospital care when they present to me.  Most of these people walk in actually. 

Read up on EMTALA.  You can theoretically transfer someone from hospital to hospital after they are deemed "stable", but you cannot refuse treatment to someone who needs emergency medical care.  You cannot transfer a patient against their will if they do not wish to go to another hospital though.  If their insurance does not cover that hospital, you provide them with the information and billing so they know that if they refuse, they will not be covered.  In addition, you cannot refuse to examine someone who comes to you and requests so and believes they have an emergency medical need.  You cannot turn people away in the ED. 

Everyone's favorite WIKI!!!

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act