TSara & eKayak: Knocked Up!!! :^D

[Alelou]

That's cuz people in socialist countries aren't allowed to see our stinkin' avatars.

Just kidding.

I can't say I was overly impressed with British medical care when I spent a year there, but then I was a foreigner and so were many of the other students who needed to take advantage of it. I had a dorm mate from Trinidad who needed her appendix out and was treated fairly brutally. But then I guess we exchange students were essentially free-loading on the system. I also know my cousin the doctor in Edinburgh would locum in Canada every chance he got because there he could make much better money.

Very few politicians in this country are talking about truly nationalized health care. (Maybe Ralph Nader.) I think we all suspect we'd screw THAT up.

[Escriba]

That's cuz people in socialist countries aren't allowed to see our stinkin' avatars.

French people come to Spanish hospitals for free checkups and operations. And I'm not kidding, I know some of them. Don't ask me why, because I don't know it. Maybe, because the zone where I live is small, our wait times are shorter or something.

[blacknblue]

The primary difference is that it is not evenly distributed. Truly broken people in the US (people who have nothing at all) are supposed to get completely free care. But sometimes they don't. You see, the governmental system tries to save money by avoiding payment whenever possible. Therefore, if a poor person comes in for help and , for example, they have no home of their own but their relatives have taken pityon them and given them a place to live, then they are credited with having a home. And the total household income of their relative's home is included in their income. However, if they leave their (cousin-brother-sister-uncle) home and go live on the street they can't get help because they have no permanent address.

When my ticker blew up my total hospital bill came to somewhere in the neighborhood of $50,000US. I paid a couple thousand in co-payments and deductables, and the rest was covered by insurance. However, I did steal a coffee cup when I packed up to go home. I still have the coffee cup. In fact, i am drinking from it as I type this. My $50,000 coffee cup is my pride and joy.

If you are rich enough to afford the best coverage, and can afford to pay the difference out of pocket, then US health care is unmatched. Otherwise, you are up shit creek. If you go to the emergency room, the hospital administrators are no longer allowed to shove you back outside to die in the parking lot because you can't pay. They actually used to do that, which is why the federal law was passed in the first place forbidding the practice. Now, federal law requires the hospital to permit the doctors to do the minimum necessary to save your life, even if you are poor. But that's all you can count on.

IF you are persistent and, IF you are adept at working the system and, IF you are lucky enough to be in the right circumstances to qualify for a medical card then you can get free medical coverage.

In my case, I have medicare. Which covers 80% of an office visit. I have to pay the other 20%. If I can. Since I draw social security disability and nothing else, it is not always easy. I do however qualify for free medicine, since I am under the income level. Which helps. If I had to pay cash for the medication that I am prescribed, the total would come to approximately 47% more per month than I draw from from disability check.

[Distracted]

As a doctor I really can see both sides of the issue. I would personnally not think it was fair to be paid about as much as the average taxi driver per year, which is what doctors in the Soviet bloc made before its dissolution, after all the time, effort, and money I spent to go to med school.

Yes. In the US, med school costs big bucks. Most docs are over 100,000 dollars in debt at graduation. If the money was borrowed through governmental grants, partial debt forgiveness is possible with public service like working for the Indian Health Service for a couple of years, but young doctors usually require a decade or more to pay off student loans, not to mention the practice start-up costs. Now, granted, their income level after that is usually in the top 10% of the nation, but medical school, residency, and private practice are physically, intellectually, and emotionally demanding. Doctors have both a very high divorce rate and a very high suicide rate. For the most part, we work damn hard for the money.

The bad guys here are the insurance companies, IMO. If a doc could just hang a shingle, charge reasonable fees for office care, take care of his or her poorest patients at a discount or through barter (eggs and chickens anyone?) and not get a third party involved, we'd be much better off, but medical care is too complex now for a country doctor, and when large conglomerates get involved, like multispecialty hospitals who've got to make huge profits for their investors and greedy insurance companies who refuse to reimburse the physicians for their services, prices get hiked up and things get out of control.

Some people think that universal health coverage run by the government is the answer, but the idea scares me. Have you EVER seen how much a government contractor bills for the toilet seats on government aircraft? Graft and corruption are political realities, and we'd just be replacing rich insurance companies with rich politicians. Not only that, but the paperwork gives me nightmares. That's why I'm not in private practice anymore.

I'm a government employee. I make about as much as the average nurse practitioner but with twice the education and ten times the malpractice risk. Nobody sues nurses. But it's a choice I chose to make. Between my husband and I, we make an excellent living. If I were the sole breadwinner trying to support a family and pay off practice starter debt and student loans, though, I'd be in serious financial trouble. The government reimbursement at present isn't enough for me to live on and do all that.

In the US, a serious revamping of society would have to take place before a single payor insurance system like the one in Spain would be feasible. We'd have to first convince people that medicine is a vocation rather than a profession. It would have to be something similar to a religious calling to convince people to go through the hell of medical school and residency when they could make twice as much money after a 4 year business degree. Then we'd have to make medical school free and get rid of the strict entry requirements. After all, why would the brightest and the best deliberately choose a profession which is so devalued and gives them such a high stress lifestyle? Then, maybe we'd get enough takers willing to devote their lives to the health of others for what the government is willing to pay. By this time, of course, there will be drastically fewer doctors, and fewer resources to go around since utilization goes up when everything is covered and everything is "free". So the lines will be much longer and the wait times for office visits would be drastically longer as well.

So... who wants to convince the executive who makes ten million dollars a year that he's got to wait in a waiting room for two hours with Joe the ditch digger for his annual physical?

[CX]

Your taxes are higher - you're still paying for it, they just gouge it from your paycheck before you can even get your hands on it. "Free" medical care is an illusion.

Except if you're an English (to say a country) tourist that accidentally has to be operated and you casually are in Spain and, of course, the doctors here operates you and then, it's free for you .

It's just the idea of paying the doctor which surprises me. I mean, do you pay him with a check, in cash, or you receive a bill days later?

All of the above. Well, not so much the cash.

It's not free anywhere, that is true. But there's a big difference between places where everybody is covered and what we have, and the actual costs are actually lower in the former. We pay more and get less.

Actually we can get more out of our health care system if we're willing to pay more for it, and you can get it right away, whereas in place that have so-called "free" health care, you are put on a waiting list and you get whatever is in the budget basically. Classic example of a government-run health care system - the VA Hospital, and the military health care system in general. MIlitary health care is not superior to normal civilian health care.

[Alelou]

Distracted, I do think you'd find that in countries with nationalized health care, higher education is also covered by the government.

I wonder if medical residency and so forth are as brutal in Europe as they are here? It's mind-boggling what young doctors have to go through.

[Distracted]

It's not just young doctors. My husband's been in practice nearly 20 years. How'd you like to get up two to three times a week at 4 am to deliver babies and spend every other weekend working too, only to have a malpractice insurance company take a tenth of your annual income while the medical insurace companies decide that they'll only pay 70 percent or less of what you charge for your services? My husband's income has dropped in the past several years while his work load is increasing, all because HMO's and Medicaid have forced him to take on more patients to pay his overhead. He gets a full night's sleep maybe twice a week. Would you do that voluntarily unless you were paid more than the average office executive?

[blacknblue]

There is a real shortage of doctors in many parts of the rural US now. Malpractice insurance is literally impossible to obtain. Even when it can be obtained, it is impossible to pay for, especially for baby doctors like Distracted's husband. An obstetrician is going to get sued sometimes, no matter what he/she does. Even if the doctor does everything right, and the hospital does everything right, sometimes babies die. Or are born with birth defects. It might be because the mother drank during pregnancy. It could be because of genetic defects. It might be due to environmental factors like a nearby factory. It could be because she didn't get to the hospital in time and and the baby choked on the umbilical cord. It could be a host of things that had nothing to do with the doctor. But I can guarantee you that if the baby or the mother dies, the doctor is going to get sued. You can count on it.

In rural areas, where incomes are low and populations are not large enough to make up the income difference in volume, small town hospitals simply can't afford to compete. The US government WILL NOT subsidize rural health care effectively. So if you live in the country in the USA, you could easily live as much as 3-5 hours away from a doctor. Or more. And even then you could still be several days travel away from a specialist if you need one. This is a BIG country.

[JadziaKathryn]

You know what I like about the future humans in Star Trek?

They aren't lawsuit happy. (Medical care must be cheaper because malpractice insurance wouldn't be so darned expensive.)

Half the people in America today, if in Trip's shoes, would get a lawyer to sue Terra Prime for emotional distress.

I'm just saying.

[Escriba]

Classic example of a government-run health care system - the VA Hospital, and the military health care system in general. MIlitary health care is not superior to normal civilian health care.

That's unfair. Military health care should be at least as good as the good civil one, with proficient specialists in injury treatment and post-rehabilitation (not just physical, but psychological too.) Yes, I know, I'm too naïve sometimes.

Distracted, I do think you'd find that in countries with nationalized health care, higher education is also covered by the government.

Well, at least in a great deal. I remember I had a scholarship. I feel relieved for not having to give a kidney to pay the University

There is a real shortage of doctors in many parts of the rural US now. Malpractice insurance is literally impossible to obtain. Even when it can be obtained, it is impossible to pay for, especially for baby doctors like Distracted's husband. An obstetrician is going to get sued sometimes, no matter what he/she does.

When my cousing's baby died one day after being born nobody thought about sueing the hospital (which would mean the Public Service because the hospital wasn't private) or the doctor. We assumed everything was done right. I don't know why some people is so eager to sue, really.

[Alelou]

Well, that brings us back to Shakespeare: "First, kill all the lawyers." Our legal system is out of control and it affects the cost of everything, from running your local town and school district to medicine to business ... everything. Just this week the library board I am on was threatened that everybody on it was going to be sued. We're talking about a volunteer library board, for God's sake. (Not that I'm worried in this particular case.) And there are people in this country who make a living going from town to town pretending to have tripped on a sidewalk or whatever and then suing the town, knowing a lot of towns will take the short-term cheaper legal path and settle.

Obstetrics is hell, I know. In the metropolitan areas where I've lived it seems like all the older doctors get the hell out of it and it's the younger partners or associates in their practices who get stuck with it. In rural areas without enough doctors to begin with, it's a disaster.

[JadziaKathryn]

When my cousing's baby died one day after being born nobody thought about sueing the hospital (which would mean the Public Service because the hospital wasn't private) or the doctor. We assumed everything was done right. I don't know why some people is so eager to sue, really.

How very civilized. Unless there's something obvious, like the doctor showing up drunk, I think American culture has a ridiculous obsession with trying to squeeze money from misfortune through lawsuits. (When I heard about the burglar who won a settlement because he got hurt while breaking into a couple's house, I thought, "What was the jury thinking? This is a sad sad day for America.")

Now I have a question for ek: is Aureilia looking forward to being a big sister?

[Escriba]

Well, that brings us back to Shakespeare: "First, kill all the lawyers."

Aheam... I'm a Lawyer. Or, more specifically, I have a BA Degree in Laws, but I'm preparing the Competitive Exams (I hope it's how they're called) for the Public Service.

[CX]

Let's put it this way, the lawyers responsible for all this litigous attitude in the US are the ambulance chaser types. You can see them in ads all the time on TV here.

Classic example of a government-run health care system - the VA Hospital, and the military health care system in general. MIlitary health care is not superior to normal civilian health care.

That's unfair. Military health care should be at least as good as the good civil one, with proficient specialists in injury treatment and post-rehabilitation (not just physical, but psychological too.) Yes, I know, I'm too naïve sometimes.

I used to think it would be superior, then I joined AFROTC and had my first experiance with the military medical system. Let's just say that it wasn't very positive. But for some other examples, there are all kidns of people getting screwed out of benefits by being purposely misdiagnosed, the motivator for which (not to obsolve the people doing the misdiagnoses) is that the system is constantly underfunded.

There are also civil examples of bad medical care where there is no competition, I need only look as far as Minot, North Dakota, where Trinity Medical Center has become Trinity Medical Group. It is supposedly a non-profit hospital, which makes them tax exempt, but they have a horrendous record when it comes to medical care, particuliarly when it comes to surgury. The thing is, people in that area really don't have much choice if they don't want to drive over a hundred miles, because Trinity bought out the only other hospital in Minot, and promptly fired all of their experianced doctors and nurses, because it's obviously cheaper to pay for someone fresh out of school than to pay for someone who's experianced.

With no competition, prices go up and service goes down, because there is nothing to drive a monopoly to do any better than the bare minimum that the law requires. People who are yelling about universal heath care apparently don't understand this fundamental thing, despite what was seen in places like Soviet Russia. But really the fact of the matter is that the cause of all the problems in our medical system is that there isn't enough competition between hospitals. Instead, what we have are a bunch of conglomerates that take over an area and monopolize. If anything, the government should give grants to help out small hospitals so they can stand half a chance against these hige corporate medical companies.

[Alelou]

I don't really have anything against lawyers just for being lawyers. I have friends who are wonderful lawyers and fight long and hard for what's right, and in this state at least you have to really have to feel a calling to want to be a public defender or even a judge (they haven't had a raise in ten years). But for every one of them there are plenty of ambulance chasers and main chancers raking in big bucks suing everybody's pants off.