Most Americans remain opposed to this plan, and they should be. It's a plan that will not work. It also doesn't make sense. The proposed legislation will help a relatively small percentage of the population while bringing down the quality, speed and efficiency of care for the majority. As I've mentioned, this has been tried in other countries (and in Massachusetts) and has failed time and time again.
In nearly every socialized healthcare system, primary care physicians (family medicine, internal medicine, pediatrics & obstetrics/gynecology) are the backbone of the system. They act as the gatekeepers, seeing patients before they are allowed to see a specialist. In the U.S., there is a shortage of primary care physicians (PCPs), especially in rural areas. Currently, PCPs account for one third of the physican workforce, but medical students are not nearly as interested in these fields as they used to be. "The percentages of U.S. medical students entering residencies in family medicine and internal medicine has declined substantially" in the last 10 years (NEJM 6/25/09).
The shortage of primary care physicians compounds this plan's many pitfalls. If enacted, such a plan would put further strain on an area of the system that is already burdened. This would lead to longer waiting times to see a PCP and possibly even waiting lists to be assigned a PCP. This is what I mean by hurting the majority while helping a few. These issues are a sad reality in socialized healthcare systems. Let's look at some examples:
In Canada, an estimated 4.7 million people over the age of 15 don't have a family doctor. In many cities and towns, a lottery is held when there is an opening to see a family doctor. The average wait time to see a specialist is over 4 weeks, but over 40% of people wait 1-3 months, and over 10% wait more than 3 months. Receiving diagnostic testing is also a major issue. The average wait time for tests such as MRI and CAT scans is 2 weeks, but more than 30% wait longer than a month, and over 10% wait more than 3 months. Likewise, in 2007, the average patient waited more than 18 weeks (4.5 months!) between seeing their family doctor and receiving the surgery they required. In Masschusetts, where socialized healthcare is imploding, the average wait time to see a specialist is 50 days, while the U.S. average in other states is 20 days.
Of course, these issues result in major delays in the diagnosis and treatment of disease, and increase death and disability. Can you imagine delaying the diagnosis and treatment for such diseases as breast cancer, prostate cancer, or heart disease for 4 weeks, let alone 3 months? What happens if we delay the diagnosis of disease and therefore the treatment? More people die. In Canada, the mortality rates for colon, breast, and prostate cancer, as well as heart attack are significantly higher compared to the U.S. And in England, mortality rates for these diseases are even higher than Canada. The bottom line is that delaying treatment can be deadly. In 4 weeks, breast cancer can metastasize to bones, brain, the lungs or liver.
When I was in college, my mom was diagnosed with breast cancer. She had a biopsy on a Thursday, with pathology confirming the diagnosis on Friday. She then had a mastectomy and lymph node dissection on Monday. Within 5 days she went from diagnosis to treatment. She also needed chemotherapy and radiation for weeks afterward. Given the example above, do you think this would ever happen with such rapidity in a socialized healthcare system?
The proposed change in our healthcare system is bad for us as Americans and as patients. We shouldn't stand by while politicians, who don't have our best interests at heart, move toward such a drastic decision. Over the next few weeks, all over the country, House members and senators will be holding town hall meetings to hear feedback from the American people on this plan. It's our duty to attend these meetings and let our voice be heard, that this plan is not acceptable. Stay tuned for future posts, where I'll discuss what's missing from the current legislation and other important details.
as a case in point for the big bad, evil insurance companies.
ReplyDeletein 1999 my 29 yr old brother in his 4th year of medical school was diagnosed with T-cell, Non Hodgkins Lymphoma. It was one of the more rare forms as his doctor (who created and chaired the department of bone marrow transplant at Sloane Kettering beforte moving to KC and St. Luke's) couldnt even give odds as the longest lived a person from diagnosis to death was 4 months at that point.
Long story short, 7 months later (setting a record only through amazing medicine) and two bone transplanets from me to him, sick chemo and full body radiation treatment he lost his battle and died.
His total expenses for that 7 months of care was $2.1 million. He had standard Blue Cross and Blue Shield PPO plan through my parents business. His wife's TOTAL out of pocket expense was $2500.
So the big evil companies that are portrayed as murdering patients daily simply because they may dispute a cost or procedure paid nearly every penny of the bill without even so much as a dispute. They even agreed to pay for experimental treatment that his doctor gained permission from thre FDA to use out of study on a 5 day course that ran $150,000 alone.
So while everyone gripes and whines about our system being expensive, etc. Remember the line "you get what you pay for" and in the US you get the best medicine your money can buy. Elsewhere under free plans...well you get equal treatment of waiting and praying you dont die.
Dr. Dan,
ReplyDeleteCan you perhaps explain in your own words why we pay twice as much as a country for health care and don't have demonstrably better health outcomes when compared to other industrialized countries? Also, can you explain why we should waste so much time and effort with insurance companies as middlemen who suck up medical care dollars as profits and salaries and create a whole layer of non-standardized paperwork for health-care providers to deal while providing no material benefits to patients or doctors?
As far as the cancer anecdote above goes, I had cancer too. I was diagnosed one week before I graduated from college. I was covered on my dad's health insurance plan. If I had been diagnosed one week after I graduated college, I would have been denied coverage because I was no longer a dependent. And then I wouldn't have gotten any coverage at all because I would have had cancer as a pre-existing condition. That would not happen in any other industrialized country.
Employment dependent health insurance is a crappy system. Losing your health care when you lose your job or get divorced or change jobs or start a new business sucks. And I work at a small business and our health care costs are the number one thing driving up our prices. Each year we increase premiums and/or lower coverage because it costs too much and makes us less competitive on price when bidding for work. In five years we've gone from complete coverage for everyone at no cost to the employees to having premiums for dependents, higher co-pays, and higher deductibles. Health care is already a burden on small businesses.
Mike McCarthy
So what you are illustrating in your example and the example in the first comment, is that if one is poor, uninsured, or both, they'll be dead or bankrupt. According to you, healthcare is only for the wealthy, and someone is just SOL if they can't afford it. I guess the first thing we have to sort out is whether we believe health care is a basic human right.
ReplyDeleteHealth care is not a right, it is a privilege. Regardless, have you never heard of EMTALA? Or of the countless programs already available to the uninsured and underinsured? Let the states run health care programs.
ReplyDeleteMike,
ReplyDeleteAre you saying that if you were diagnosed without insurance you would not receive proper health care? Or is that you would have to arrange a payment plan? Which is it?
The current system is simply not affordable. We need change and we need it now! All other industrialized nations provide healthcare at a lower cost to their citizens. Further - when comparing populations as a whole, life expectancy, standard of care, etc. are not worse but in many cases the systems work better (Germany for instance). Examples of individual people and their experiences with one or the other system are more or less irrelevant - examples of good and bad care exist in both systems to more or less the same degree and therefore cancel each other out. There is an obvious gap in the current US system and as a country we should be able to do much better than what we have at the moment. The current proposals get us part of the way there.
ReplyDeleteScribed by Sebastian Fischer
"Dr. Dan", I too am a physician. Although you are certainly allowed to say whatever you want, you offer no solutions, only rhetoric. It is my experience that most physicians (much less the general public) have no idea what is being proposed. Using your position as a doctor makes you no more or less knowledgable about what is best for the public in health care, and yet you seem to stand behind it as if you have better insight than anyone else. We already have spokesmen in our field to represent us that clearly have a better understanding than you do. Please stop discrediting our field and let those in the AMA who follow these things more closely than what they hear on Rush or what political party they are affiliated with influence them, speak for us, as I assure you they do so in our and patients best interests. Thank you.
ReplyDeleteI beg to differ. As a physician, I am in a unique position to offer my viewpoint on this subject. I became a physician to help people. When a bill is being proposed that many claim would help our citizens and this isn't true, I think I have a duty to speak out against it. You're clearly disconnected from what most physicians believe and understand from this bill. The AMA does not speak for me or the majority of physicians. A recent poll on Sermo.com showed that over 95% of physicians did not believe the AMA spoke for them and did not agree with the AMA's support of the bill. As far as solutions, I have plenty of ideas on how things can be fixed and they don't include throwing out the entire system (most of which is good) or over a thousand pages of bureacratic madness. You'll see my solutions in an upcoming post. If you don't like what I say, don't read it.
ReplyDelete