Health care is a basic human right, not a privilege. For some reason, we’ve allowed ourselves as Americans to be fooled into accepting that one must be blessed with “means” to actuate appropriate health care. As a nation we have failed to realize that our health care system is a barometer of our society’s value for human life.

-Me

Friday, December 21, 2007

In Response

Christine-Megan had a great comment on my last post, so great that I had to dedicate an entire post to respond to it.

I agree that healthcare isn't nearly what it should be here and a lot of people get screwed, but I'm not sure what the solution is.
Healthcare as it is in the UK or Canada scares the crap out of me.
It's HARD to get a pump in the UK, and I like my pump.
I know people in Canada that bought their's out of pocket.


Why does it scare the crap out of you? Maybe it is news, but it can be fairly hard to get a pump in the United States as well. First of all, you must meet at least one of the following criteria in order to get a pump in the US: Be well-to-do or have pretty damn good insurance. If you are well-to-do then you can afford the co-pays & deductibles of your insurance to not only initiate pump therapy but also continue it. You also have the option of paying for a pump out of your own pocket if you are well-to-do and your insurance doesn’t feel that it is a medical necessity. If you aren’t well to do, then you can pay your percentages, co-pays and deductibles, and hope it doesn’t bankrupt you with your current insurance policy to continue pump therapy.

So who in the US doesn’t get the option at all? The un-insured and the under-insured. They can’t get a pump at all. The un-insured can’t afford to buy a pump out-of-pocket nor can they afford the supplies needed to maintain therapy. The under-insured, even if their insurance approves the purchase of a pump and covers part of the cost, still can’t afford their portion.

So I guess that it is easy to get a pump in the US if you meet certain class criteria (see above). If you don’t, sorry man, you are out of luck.

When I needed a neurology consult, I got one in 2 days here. I can often get into the doctor's office the next day if I need to. When I needed a CT scan, I got one that day.
My family in the UK has connections and they wait a LONG time to see a specialist.
When I was observing in the ICU there was a patient there who's family was paying out of pocket for him to be in the ICU here, because the one in Canada was full.
That scares me.


I find this interesting because the US of A has fewer doctors, fewer nurses, and fewer hospital beds per capita than the average country in the Organization for Economic Co-operation and Development.

(I stole the above reference from “Your Pharmacist May Hate You”. Hop on over and take a look at his blog.)

As they say- access, quality, affordability- pick any 2.

And the uninsured and underinsured of America have which of these? That’s right, none.

I’d love to share with you a personal story about a man I know, a man I know and love, who just so happens to be uninsured.

This man is a small business owner (we’re talking one man crew), and at the tender age of 35 he discovered (quite painfully) that he has a congenital defect of his urethra which over the course of his life caused his urethra to completely close.

In significant (excruciating) amounts of pain, this man went to visit the Emergency Room. Upon finding out that he had no insurance, they performed a uroscopy on this man under local anesthesia to widen and open his urethra. So basically, what they did (in laymen’s terms) is they put a long camera up his urethra (penis) while he was fully awake and somewhat anesthesized (thanks to fentanyl) and used rods to widen his urethra so it was no longer closed. Typically this type of procedure is done in an OR under general anesthesia, but why waste the time and money on someone who probably can’t pay for the expense in the first place?

This man wore a catheter for two weeks, and after this period followed up with a clinic in the hospital, where they informed him that if he had insurance (or once he had insurance) they would schedule surgery to correct the problem with his urethra. In the mean time, he would have to self-catheterize himself daily (with the same catheter no less) for at least two weeks to help assure that his urethra would stay open longer. They prescribed him some empiric antibiotics (levaquin) to help fight off certain infection for a period of two months and sent him off on his way.

Oh, and his bill? Over $10,000. He was billed over $10,000 for sub-par care that did not take into account his pain level (in the hospital nor at home) nor his capabilities to perform the tasks requested of him, tasks that are typically reserved for a home-health nurses. The care also did not correct his problem, and this problem is likely to (will) happen again when their temporary solution runs its course. And then? Another $10,000 bill this man cannot pay.

To this day approximately one year later, this man still has not had the surgery to repair his urethra, and fortunately, has not yet had another problem.

Is this the type of care we want for our loved ones (or ourselves?) should they not have health insurance? This is just one story, I’d love to hear more.

6 comments:

Christine-Megan said...

Good response. Your Pharmacist May Hate You is actually one of the blogs I read regularly, and I read that entry (and your comment on it).

I can't deny that there are gaps in coverage with the current system- like I said, it's far from perfect, and I fear the day I ever lose insurance.

I'm just not sure what the answer is, and I'm not convinced I want health care as it is in Canada or the UK.

I actually thought I did until I looked more into it and before I got into nursing school and started seeing things, such as the ICU man I previously mentioned.

Another blog I encourage you to check out is kevinmd.com. He has a lot of interesting points.

Christine-Megan said...

Regarding the CGMS, I still use it once in awhile, but haven't had great luck with it. I hope you have better luck.

nightengalesknd said...

I am fortunate. I have insurance. My insurance didn't qualify me for an insulin pump because I hadn't been diagnosed for 6 months yet. Only they didn't tell the pump company this and the pump compnay didn't ask when they called for authoization, so I found out 6 months after I had been sent and started on the pump.

I am fortunate. I have insurance. My insurance only covered my physical therapy at one location, even though that location made me worse. It only covers one brand of glucometer, one where the test strips cost 5$ less per hundred but I waste 2-3 strips per day for not enough blood, so the total cost is higher. The total cost to the company is higher, I mean, not to mention the total cost to my fingers. My insurance would cover 80% of a psychiatry visit if I were prescribed meds but only 50% if the same psychiatrist did not prescribe me meds. It does not cover my allergy medication because claritin is over the counter now. Never mind claritin doesn't work nearly as well.

My patients are fortunate. Low-income children in our state are all elegable for insurance. More than half my patients are on the state Medicaid. Sometimes they can get better care than those patients who have private insurance. Also, many of my patients on state Medicaid, their parent's don't have insurance.

I have cared for adult patients who have no insurance. Some are homeless with multiple medical and mental health problems. Some are self-employeed workers or part-time workers.

I have a friend who can get health insurance through her medical school, but her insurance will not cover genetic conditions. 98% of her health needs are related to a genetic condition, including a wheelchair, doctors visits and sometimes surgery. She also had the choice of paying $$$$ for Cobra to stay ono her parents insurance.

Socialized health care in the Canada and UK models may not be the answer. But non-socialized health care in the US model we have now is chaos. As a patient and a provider, I firmly believe that as a bare minimum, we need basic and catestrophic coverage for all, and it would truly be in the best interest of the US to have a more socialized system for all.

The Sick Chick said...

I know that probably no one will see this as it's an old post, but I just wanted to comment that as an American living in the UK, I *love* the NHS and will not move back to the US until they get their head out of their *** regarding health insurance for pre-existing conditions. Oh and living in London I have access to the best specialists in the country (among the top ten in the world and better than what the US has to offer) for my two top/most rare diseases all right in my city. In the US I'd have to visit at least 4 states in different parts of the country. Yes, you do have to wait to see specialists, but my parents who are *double insured* which the best health care they can find (they can afford anything) have to wait nearly as long and that's if they have a specialist in their network that treats whatever the problem is at the moment. My dad has prostate cancer and is jerked around all the time with not being able to get the best people...

So yeah, I'll stick with my UK heathcare ANY day over the US. Because if I am dissatisfied with the waiting lists I can always pay to get seen sooner and STILL not spend as much on healthcare costs as well-insured people in the US!!!!

Nurse K said...

Feel free to buy better insurance if it makes better financial sense for you. Many if not most plans cover diabetic testing supplies and pump equipment better than other medications and such. I can't say that I've ever paid a co-pay on either, even in my string of crap-jobs in college and whatnot.

If you are in a govt plan, you are at the mercy of the govt and their whims, not the free market which offers many choices rather than one-size-fits-all.

MileMasterSarah said...

haha, seriously nurse k...Obviously you haven't attempted to obtain private pay health insurance as an individual with type 1 diabetes (for more than 16 years), degenerative disc disease, and a colorful medical history.

Haha. Feel free! Funny!

I'd be spending my entire salary on health insurance!

Unfortunately, I'm bound to the insurance my employer offers. And, that being said, it isn't terrible insurance, but insurance for individuals with any sort of chronic oondition in our "free market" system (cough cough: elitist) just isn't designed to be affordable for any but the wealthy.

Many if not most plans cover diabetic testing supplies and pump equipment better than other medications and such. I can't say that I've ever paid a co-pay on either, even in my string of crap-jobs in college and whatnot.

Congrats to you and you are blessed with your luck. Unfortunately, this just isn't the norm.