The State of Medicine in the U.S.

Which is pretty sorry.  Let me tell you a story.  Last Thursday afternoon, I went to the pharmacy for a refill on one of the two medications I take for hypertension, and found out the prescription had expired.  I asked for a small supply to get through the next few days until I could get the prescription refilled, and they said they couldn’t do that, because it’s a “controlled substance”.  What?

It used to be you could call your doctor and ask for a refill, but now they (at least the clinic where I go) requires the pharmacy to do that.  Which the pharmacy does by sending a fax.

On Friday, I went to the pharmacy, but the prescription had not been filled yet.  They hadn’t heard from the doctor.  My clinic is closed on weekends, but I hoped they had called it in late Friday.  So I called the pharmacy.  No luck.

I waited until Monday, which was Christmas Eve, and called the clinic.  They were closed.  I got a recording which said, “If this is an emergency, please hang up and call 911 or go to the Emergency Room”.  Well no.  I’m not going to the Emergency Room (an $800 minimum charge) for a $10 generic prescription. So I called one of their sister clinics–there are seven in the area–and they said, “We can’t help you. We don’t have access to your records. But if is this is an emergency…”

One of the initiatives of the President’s health care plan is moving toward electronic records, so that any caregiver has access to your history.  I confess I was somewhat leery of that, but now I get it.

The thing is, while I wouldn’t go to the ER, it was becoming something of an emergency.  Saturday, after missing a day and a half of the medication, I had a massive headache, which I knew meant my blood pressure was up.  I chose to try to be very quiet and still and wait.  And hope I didn’t have a stroke in the meantime.  The headache never went away, and plus, I felt sick.  The kind of “sick” that you are when your blood pressure is high is not easily described.

It was no use calling either the clinic or the pharmacy on Tuesday.  It was Christmas Day, and both were closed.  On Wednesday, I called the pharmacy.  Still no prescription.  I called the clinic.  They said, “Yes, we do have the fax from the pharmacy, but the thing is, it’s still on the doctor’s desk. She’s been the only doctor here today and has had to see all the patients”.

On Thursday I called the pharmacy back.  Still no prescription.  On Friday I called again.  They had it, and it was ready.  By this time, I’m very, very sick, and was having trouble contemplating the idea of moving from the couch.

So here are a few things that are wrong:  no electronic record.  Not enough doctors.  The fact that doctors in the U.S. expect to be rich.  Which is understandable, since the cost of medical school is astronomical.  Assuming you ever make it out of that debt in your lifetime, then you’re faced with malpractice insurance, which is equally astronomical. The cost of going to the Emergency Room–which is the primary source of medical care for those without health insurance. So if you do have it, then you are paying for all those who don’t.  (Thus the $800 minimum.) So wouldn’t it be better if everyone had it?

Having said all that, I’d say that in order to have a good medical professional, you also have to be a good patient.  For instance, don’t fail to notice that a critical prescription is expiring just before the Christmas holidays.

Getting Old(er)

I am not going gently into that good night.  Getting older just pisses me off.  So mostly, I just ignore it.I know there is no turning back.  That is a foolish fantasy, but I’m having trouble “accepting” what it really means.

Case in point:  Exactly a month ago, I sprained my left knee.  It still hurts.  Once I’m up and either sitting or standing, it starts to swell, and so does my ankle.  Lesson One:  you don’t heal as well or as fast.

I should go back to the doctor, but what for?  It will mean an MRI or CT scan that I can’t afford (even though I have insurance which will pay for most of either.)  So then you start to do that weighing thing:  on one hand…and on the other hand…So, do I want to do this (no) or do I want to have trouble walking forever (no).  Great choice. No versus no.

I don’t want to take any more medications.  I take two for high blood pressure already (take the pills, or have a stroke).  Okay…that was easy.  I take one, once a week, for osteoporosis, and that REALLY pisses me off.  Why do I have osteoporosis?  For one thing, I am the queen of dairy, not to be confused with the restaurant of the same name.  I drink milk with every meal.  I eat ice cream and cheese like it was going out of style.  But…that’s only since I was 17, when it was probably too late.  And I seem to have some problem absorbing Vitamin D, which is critical to your ability to absorb calcium.  Plus, I had radiation therapy, which leaches calcium.

So what are you gonna do?  Answer:  take the drug.

What I would like is the magical nystery pill.  Not one that promises to make me younger, but one that makes me happier about getting older.  Or smaller or larger.

The Health Care “Debate”

As I commented today on Nick’s blog, I haven’t seen any debate.  To be exact, I said I haven’t seen any goddamn debate.  All I’ve seen is a bunch of hysterical people, like the woman weeping her ugly eyes out saying “I want my America back!”  As Helen, of the immensely popular Margaret and Helen blog said, the America she wants back must be the one where a black man does not grow up to be President. All I’ve seen is debate being shouted down.   I’ve seen people openly carrying guns to an event where the President is scheduled to speak.  When did we start allowing that?  What I hear is, it’s legal.  I also saw a comment that said those people probably had snipers trained on their ignorant persons from the nanosecond they showed up.  I have no doubt that’s true.  Remind me to tell you sometime about when I lived in New Orleans and personally had the occasion to witness said snipers in place.  So let’s acknowledge that it’s legal.  But at the very, very least, it’s rude. 

Now that I’ve gotten that out of my system, let’s talk about the villains in the story.  You get to take your pick, but the rules are that you have to prioritize.  Your choices are:  doctors, insurance companies, the pharmaceutical companies, and the government.  Hint:  you don’t get to pick the government.  The government is what we rely on to protect us.  And you don’t get to pick who you want the government to protect you from.  You don’t get to say that Osama Bin Laden is fair game, but Bernie Madoff and his ilk isn’t. 

Of our three remaining choices, I’d say that doctors have the least blame.  Which is not to say”no blame”.  The second least blamable is the pharmaceutical industry.  Granted, they are raking in millions, but this isn’t about castigating capitalism.  Profit is not a four-letter word.  The pharmaceutical industry has come up with life-saving drugs, and research is expensive (after all, they have to pay doctors to do it).  That leaves us with the insurance companies, which bingo, you guessed, is my prime suspect.  Doctors agree with me.  But all three of these villains are trapped in a system which none of them can bail out of on their own. 

So here is Fakename’s prescription for “fixing” healthcare.  Make all insurance companies and pharmaceutical companies non-profit.  (Like that would ever happen lol. Especially since it might play havoc with your investments.) Pay for doctors to go to medical school–anyone who wants to go into that field should not be discouraged.  Too many idealistic people are changed for the worse by the reality that they will be 50 years old before they get out from under their student loans.  In fact, if you did just that one thing, pay for medical school education, it would make a huge difference.  Then doctors might retain some of their idealism, instead of bowing to the need to make as much money as possible.  In the U.S., doctors are rich (well, after age 50).  In other countries, not so much.  In other words, they don’t do it for the money. 

It sort of comes down to what you value.  Doctors are not miracle workers, they are craftsmen (and women).  They hold no more value to me to me than Jeff the Mechanic.  In fact, increasingly I find that I have to do most of the work for my own health care, and thankfully the Internet is my Second Opinion.  Now that I think about it, Jeff the Mechanic is worth more, since the Internet will never tell me what I need to know to replace a head gasket. 

My point, in case you were wondering, is that I am terminally angry with these people who are sabotaging reform, in the name of protecting their “individual freedom”.  They don’t even have a clue what they’re talking about.  I can deal with people disagreeing with me in a thoughtful way.  But I am done dealing with stupid, and the apologists for stupid.

The Good Doctor–Part 1

Yesterday when posting about how to fix health care, I pointed a finger at the insurance industry.  The other three major players are doctors, hospitals, and the pharmaceutical industry.  While I’m not through pointing fingers, I’ll only be pointing a very small weak finger at doctors. 

Sure, you can expect doctors, as represented by the AMA, to vigorously fight anything they perceive as being “socialized medicine”.  They’ll say it’s because they fear that patients will suffer.  And I reply:  what do you think is happening now?  The insurance industry is now dictating what treatments you can provide, what medications you can give, how long your patient can stay in the hospital.  You aren’t in charge.  The insurance industry is making the decisions based solely on money.  I’m all for returning the decision-making to doctors.

But there is a hidden agenda here too.  Doctors get freaked out about the term “socialized medicine”.  The meaning of the term itself has been lost in the hysteria, like the term “gay marriage”.  If you ask any doctor, Do you think every person should have access to health care?, I can’t imagine any of them saying no.   Okay, then.  What would you call “socialized medicine”?  The hidden agenda is that doctors are afraid they’re all going to be put on a salary that will be far beneath what they hope to earn.  That “socialized medicine” will turn them into worker bees no better than Joe the Plumber. 

I used to not like or trust doctors.  That was grounded in real-life experience.  I worked my way through college working part-time in a hospital as a “ward clerk”–what in other hospitals was called a unit secretary.  The job included greeting visitors, entering admission information into the nurse’s station computer, transcribing doctor’s orders–meaning that you sent requests to various departments for tests and actually ordered medications from the pharmacy as well (this all had to be signed off on by a nurse), and running errands for the nurses, which sometimes included taking specimens to the lab or picking up reports, things of that nature. 

But at that time (I graduated from college in 1973) there was a strict attitude of  reverence for doctors that I thought was unearned.  I understood that then, as today, there are laws that govern who has to have the final say, and that is the doctor.  But doctors are human too, and some of them took that responsibility to mean that they were gods.  So there were those who had all the personality and social skills of  Tasmanian Devils.  One of the things they did not teach in medical school was the concept of drawing more flies with honey.   So here is my favorite anecdote from that time: 

I was working on the Neuro floor, and one of the neurosurgeons came breezing in with an entourage of interns or residents (neurosurgeons were the worst with the god-complex thing).  He handed me his suit jacket and ordered me to hang it up for him, then breezed down the hall with his flock. 

I folded his jacket in half, and laid it over the back of a chair.  When he returned to the nurse’s station and saw his jacket, he said WHAT IS THIS!!!  Don’t you know how to hang a jacket?  You must not know anything about a man!  (Note:  I was pretty cute in those days.  I now recognize this as a totally nerd version of flirting.) He proceeded to take his jacket, unfold it and drape it over the chair.  THIS, he said, is how you hang a jacket!  During that whole demonstration you could hear a pin drop.  When he was done, I said, “Well, since I apparently can’t do it right, next time I think you need to hang your jacket yourself.”  As soon as I said it, I was like, I am so fired.  You could actually hear the gasps from the nurses.  And then he started laughing.    Somewhere in there, behind the arrogant exterior, was a guy who had a sense of humor; a guy, I think, who had a facade to keep up like the Wizard of Oz. 

At the time though, that incident (news of which spread around the hospital like wildfire–I was a hero!) did not change my view of doctors.  Two things happened to cause that, which will be part of The Good Doctor–Part 2.

I can say though, that that arrogance is mostly a thing of the past.

How to Fix Health Care…Part 1

From December 15th through the 31st, Barack Obama is asking Americans to come up with ideas on how to fix the health care system.  Here’s the report about that from the Washington Post.  http://www.washingtonpost.com/wp-dyn/content/article/2008/12/05/AR2008120503322.html?hpid=topnews

Here’s what’s astonishing about that.  They’re not starting out with a question, such as “Do we have a problem?”  They’re starting out with a statement.  “We have a problem, what do we do?”

Here’s what’s even more astonishing:  our President-elect is giving us homework!  He’s suggesting that during the holidays, as people get together and have more time to think, that maybe this could be a topic to discuss.  This seems to me to be no less than an attempt to engage people in their own government.  After decades of top-down government, culminating in the 8-year long monarchy we’ve just endured, this is practically a revolution.  Sign me up. 

So I’m wading in.  And it won’t take long.  What’s wrong with the health care system is the profit motive.  I’m not opposed to profit.  I’m employed in the business world.  What we do is sell stuff, and charge as much for as we can without shooting ourselves in the feet.  In other words, you can price yourself out of business.  But health care is not a commodity like computers or shoes or cell phones. 

The whole health care system should be not-for-profit.  The argument is, if you make the system non-profit, then no one will do it any more and then where would we be?  Not true.  Not-for-profit doesn’t mean you can’t make any money at it. 

The big players in the health care system are doctors, hospitals, pharmaceutical companies, and insurance companies.  If you don’t pay the people in those fields well, then it would probably be true that fewer would go into those fields.  Plus, all of them have to have a way to have some sort of reserve, whether it’s just for the occasional rainy day or to do research or to pay for catastrophic occurrences.

But when you make huge profits and split them up amongst yourselves, rather than putting it into research or treatment, that’s thievery.  There is a lot of finger-pointing amongst the groups I named above, and let me jump in there too.  The villain, in more ways than you can count, is the insurance industry.  All you have to do to verify that is this:  pay health insurance premiums your whole life, then make a claim. 

Actually I’m simplifying, because that has not been my exact experience.  But for the most part, once you need them, the insurance company’s job is to try to find a way not to pay you.  Because that’s how they make money.  Denying your claims, making it difficult, and hoping you’ll die before they have to pay.     

The solution is simple:  take profit out of the equation.  And how to do that?  No need to reinvent the wheel.  Countries throughout the world are operating workable and compassionate health care systems.  Use their model.