Daily Reads

Thursday, July 02, 2009

Response to a responses to post at Cranky Prof's place.

Here is the original post and comments.

Most hospitals and doctors in this country are more than happy to work with folks with no insurance. Especially the non-profit hospitals, such as the one I work at. We have foundations and other programs specifically to help people in your position. I know of no-one who has been denied lifesaving treatments solely because of lack of insurance or another way to pay. If you get your insurance through your employer, especially if it's a larger employer, the plan they offer HAS to take you, though some do deny payments on pre-existing conditions for up to 12 months. After that period, you ARE covered. And I know a lot of doctors who would rather do so-called charity work, than see medicaid or medicare patients, because at least with the charity case, their office doesn't have to spend hours trying to get the gov't to cough up the insurance payment, which is always less than the cost of the billing office's time, never mind the doctor's. And they legally DO have to bill the gov't, they can't just write it off.

I am a medical librarian, so I get to read a lot of the British medical literature - we subscribe to both Lancet and BMJ as well as some of the specialty journals. When patients have to wait over 6 months between cardiac imaging studies and the stenting those studies show is required, patients die. When studies show that of patients considered curable at the time they go on the list to recieve chemo or radiation treatment for cancer at least 10% have their disease advance to the uncurable stage before they can even begin treatment, it is obvious to most that that system is far more broken than the one in the US.

Remember, that if your insurance denies you, you have options which include legal, such as suing the bastards, changing your insurance, and if the bill is small enough, paying for it yourself. In a lot of nationalized systems, you aren't allowed to pay for procedures the gov't plan won't cover. For that matter, if the gov't plan won't cover it, the doctor probably can't even offer the procedure. If there is only one plan nationally, and it only covers certain drugs within a class, the other drugs cease to be available, as they are no longer financially viable for the manufacturer. I can't use albuterol sulfate for nebulizer treatments, since it makes me throw up for the first few doses, and then attacks my guts, which take years to recover (if ever). If the gov't plan becomes the only one, and they decide that they're only going to cover generic albuterol, and not Zopenex, I'm in deep s**t the next time I get bronchitis or pneumonia, because the xopenex will no longer be there at all, no matter how it's paid for.

I lived in Ireland for 8 years and because of my age I was on the national health system, and the waiting for anything other than my GP was months, and a lot of the stuff that had to be done at clinics was stuff my GPs here in the States have always been able to do in their offices. I've had to deal with only one drug in a given class being allowed, and that was one I had vile reactions to, so my options was to pay myself (very expensive) or do without. I was told I had a 6 to 12 month waits to have a "wart" removed at the clinic, when it wasn't even a wart, and if my GP hadn't been willing to inject a local and attack it with a scalpel, I'd have waited the 9 months or so for ineffective treatment, and then another God-knows-how-long for another appointment for them to try to figure out what it was (a dermatofibroma) and then who knows how much longer after that for an appointment to have it removed. In the US I made one appointment with a dermatologist, who looked at it (it had grown back due to not being completely excised in Ireland) and removed it that visit. And yes, my insurance covered it, but I bet it cost them a lot less than the three visits would have cost the Irish NHS.

Our system is hardly perfect, but instituting a gov't plan which due to it's subsidy by the gov't will put all the private insurers out of business it not the way to go. When patients are insulated from the actual costs of their treatments, a lot of unnecessary stuff is done (e.g. it is quite possible to diagnose appendicitis without a $2K CT scan, which also exposes the patient to LOTS of unnecessary radiation). And when there is only one plan and it's run by the gov't there will be no recourse when they tell you you're too old for a kidney transplant or a hip replacement, or not sick enough for the drugs which may not cure the problem but which will allow you to have a decent quality of life.

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