Should healthcare be a right or a priviledge?

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ecCA1

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Knowing that people will spend $$$ for utterly useless stuff, should medicine not become more of a priviledge, too? It's hard to justify people going to school for years on end, with all the attendent debts, only to hope that they actually get paid once the billing company can round up the checks. I for one have a hard time dealing with the idea that people can abuse their bodies for years, but expect us to be there, ready to help at all hours of the day or night, unwavered by the prospect of being stiffed.
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why should it be a right? why would that position be justified? Health is the patients' responsibility -- nothing we can do is better than the things that they can do -- not smoke, watch their blood sugar, lower cholesterol, compliance with medications... as simple as wash their hands more often to reduce risk of the common cold, etc. medicine can do amazing things but 90% of it comes down to what the patients themselves do. our country has removed too many of the responsibilities of peoples actions already...
 
Clearly a priviledge. Unfortunately, when the baby boomers start benefiting from all of our modern technologies, they'll also be spending more of their disposable income on said care. Then, they'll legislate to cut those costs, and we're in for it.

I hate to be so pessimistic, but that generation is a very sophisticated, relatively wealthy, and very numerous constituency. And they'll be voting based on their interests. We'll have to see, but it's imperative that we start being more active politically, in order to best protect our interests.
 
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medicare/medicaide and the County Hospital should be a right.

PPO and self pay is a privelage.

The standard HMO falls somewhere inbetween. The patient ends up getting screwed more often than not. One certainly is a number in these institutions. Much more so than a PPO type patient.

The more cash one has the better insurance they can afford the better care they are going to have. Same old story the whole world around. Don't think its any different in places which have socialized medicine. Even if those countries lack the care which the patient perceives they deserve they can always fly to the US and fork out the cash to get it.
 
So Venty is it not unreasonable to look for a job that is mainly caring for the insured patients versus those on some form of gov-sponsored aid? I ask this not to pick a fight but to see who it is who is agreeing with me on the issue.
 
VentdependenT said:
The more cash one has the better insurance they can afford the better care they are going to have. Same old story the whole world around. Don't think its any different in places which have socialized medicine. Even if those countries lack the care which the patient perceives they deserve they can always fly to the US and fork out the cash to get it.
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Working on the Border I have taken care of many patients who came across to get their free medical care. Last week we got a patient whose south of the border doctor was nice enough to diagnose her cholecystitis and drew her a map of the bus routes to get to our hospital to get her free cholecystectomy. Down her we got three types of insurance. Self-pay (i.e. no pay), medicaid, and medicare. Anyone with real insurance or money flies north to the big city for their care.
 
souter said:
Working on the Border I have taken care of many patients who came across to get their free medical care. Last we got a patient whose south of the border doctor was nice enough to diagnose her cholecystitis and drew her a map of the bus routes to get to our hospital to get her free cholecystectomy. Down her we got three types of insurance. Self-pay (i.e. no pay), medicaid, and medicare. Anyone with real insurance or money flies north to the big city for their care.
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where on the border are you? If you don't mind.
 
militarymd said:
where on the border are you? If you don't mind.
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AZ.

You coming to work for me? I give you up to 50% of what you bill for after I take all my expenses out, until you make partner in seven year? Down here you can buy a nice house for 50K. So you can live real well on less. The border patrol far out numbers the cops down here.
 
souter said:
AZ.

You coming to work for me? I give you up to 50% of what you bill for after I take all my expenses out, until you make partner in seven year? Down here you can buy a nice house for 50K. So you can live real well on less. The border patrol far out numbers the cops down here.
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Man...that deal sucks.

I interviewed with a group in AZ that was doing really well and only 1 year to full partner status.....I didn't go because my wife didn't like brown....although it was my first choice..

What city you in?
 
You all are being such cry babies...comeon, its unquestionable that some level of health care is an absolute right. And its simple fact that grossly inequitable healthcare (and other social services) for the haves and have-nots create significant social strife and unrest...so if you want your family to receive the best healthcare technology has to offer you either have to provide reasonable access to those who are "burdens on society," or they will organize, riot, smash up you brand new BMW and burn down your 6 bedroom house. So lets just continue to squeeze the middle class and ensure there plenty of money to pay for this all, so when we're all making bank we can have nicely groomed country clubs to play golf at.
 
militarymd said:
Man...that deal sucks.

I interviewed with a group in AZ that was doing really well and only 1 year to full partner status.....I didn't go because my wife didn't like brown....although it was my first choice..

What city you in?
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You figured that one out; unfortunately too many people get suckered into crap like that down here. You can’t make a very good living on no pay, medicaid and medicare only. You need the hospital to kick in something, other wise it is a revolving door down here. People come for the sign on bonus and leave before the year is up.

The absence of green is hard to take for a Virginia boy like my self but 110 degrees in the shade in the summer is tough to adjust to as well.

Douglas
 
Goooood morning Vietnam!!!

thats all i have to say really because its sunday morning and I'm in Vietnam! hahahaha! actually i do have something. the people that ive met in thrid world countries have nothing compared to our bare bones county hospitals and medicare/medicaid programs have to offer. only the tiniest percentage of the world's population have access to top notch medical care. back to my noodles.

SF
 
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All I want to know is if health care is a right, why isn't dental care a right too. Cause those dentist dudes get paid in cash, don't take **** from anyone, and no one seems to mind.
 
blocks,
stop whining. Dentistis are a rare breed that is protected from HMOs and insurance companies. You know, its kinda like protected marshlands and wetlands. We have to preserve some semblance of our golden age of medicine, might as well be dentistry. Because dentists are real doctors and they deserve the utmost respect and compensation for years of hard work that we "slackers" could never accomplish.
 
Lonestar said:
blocks,
stop whining. Dentistis are a rare breed that is protected from HMOs and insurance companies. You know, its kinda like protected marshlands and wetlands. We have to preserve some semblance of our golden age of medicine, might as well be dentistry. Because dentists are real doctors and they deserve the utmost respect and compensation for years of hard work that we "slackers" could never accomplish.
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How did dentists manage to keep everyone away from messing with their reimbursements?
 
blocks said:
All I want to know is if health care is a right, why isn't dental care a right too. Cause those dentist dudes get paid in cash, don't take **** from anyone, and no one seems to mind.
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The public perceives dentistry as optional like elective plastic surgery and while some employers offer dental insurance many do not. Those with no money just ignore their teeth and they go away. We call them summer teeth, some are there, and some are not.

Even in dentistry the orthodontists who do what the public see to be purely elective work are some of the best paid medical specialist. I do not think the public is willing to accept that medicine is optional like they perceive dentistry. If you get mouth cancer or something worse than a mouth of rotting teeth it is a medical issues and ENT or oral surgery takes care of it paid by medical insurance.
 
souter is mostly correct. you cannot just leave an open checkbook for people to write checks for their own healthcare on someone's else's hard earned dollars. This is unAmerican. Accountability and responsibility go hand in hand. Just visit your neighborhood ER and you will see what I am talking about. Another major expense is the ICU. Some families are just unwilling to let go of family members despite their doctor's urging. They will continue to do so unless there are measures taken to address these issues. Hey, its not their money so might as well spend it. NOT ALL OF HEALTHCARE IS A RIGHT!!!!!! I guess some of my tax dollars are going towards some old geezer having a hard-on. Part of all of this mess is our own fault. We as physicians have named many conditions as "medical conditions". And, once something becomes a condition it never goes away. Bye.
 
everyone has a right to healthcare...by exercising their freedom to purchase health insurance.

I liked the post about the cost of ICU care. Almost half of healthcare costs are spent in the last 6 months of life.

What about a system where as soon as the physicians determine that further efforts are futile, the patient's account is transferred into a "pay-as-you-go" account that would be prepaid by the family or patient. I think this would decrease families disagreements with intensivists.

Bottom line is that people are willing to pay their plumber or air conditioning technician more than their physicians. As employers shift costs to consumers the drive to lower healthcare costs is only going to increase.
 
Stimulate said:
everyone has a right to healthcare...by exercising their freedom to purchase health insurance.

I liked the post about the cost of ICU care. Almost half of healthcare costs are spent in the last 6 months of life.

What about a system where as soon as the physicians determine that further efforts are futile, the patient's account is transferred into a "pay-as-you-go" account that would be prepaid by the family or patient. I think this would decrease families disagreements with intensivists.

Bottom line is that people are willing to pay their plumber or air conditioning technician more than their physicians. As employers shift costs to consumers the drive to lower healthcare costs is only going to increase.
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I know. It's a funny thing. When I hear people complain that it's so "unfair" that they must pay so much for their monthly medications, I want to say to them, "Well, what value do you place on your life??" The fact is that we all know the going rate for a car or a gallon of gas. We know what rate is fair to pay an accountant, or contractor. But, the problem is the intangibility of health.

I'm not minimizing the very real costs that many elderly must pay to manage their conditions. But, what's the alternative? How do you value staying alive? It seems we need to have a national debate on these issues, especially as healthcare costs continue to rise (mostly due to new technologies and advancements that save lives).

It's gonna be a fact that more and more of peoples' "disposable" income will need to go to healthcare related expenditures. This is increasingly true as the babyboomers' needs are increasing. Although, in reality, I'm concerned that this generation will do what they've always done, which is to screw (in many ways) the next generation, through their organized constituency (i.e. AARP). Historically, they've been a very prosperous and arguably spoiled generation. Obviously this is a generality, but there's some truth to it.
 
This is exactly why we'd better gear up as physicians for a battle---because the people will not hesitate to exploit your work and turn you into a slave for free health care. The same long hours, the same sacrifice to become a physician, the same time away for your family and friends, for a salary of 80-120 K. Coming soon to a theatre near you. And while you are slaving away in med school and residency during the prime of your life, the "middle class" is buying their house, starting their family, buying their nice car they can barely afford, maybe a plasma TV and high def cable, a video game system for the kids, nice weekends off and vacations, etc. I see it in my own neighborhood, the new BMers, Mercedes and Lexus, it's unbelievable. Then they will complain to their politicians about the cost of their healthcare, and the politicians will continue to squeeze us. 5-14% cuts is only the beginning, people want their cake and to eat it too, they want the best health care in the world, and they want it on the cheap.

And even though our salaries make up a small fraction of health care costs, its easy to cut our salaries, becaue there is nothing we have historically done about it, except drop trou to ankles and take it. Our professional organizaions should be supported because they're the only one's we have, but they have done nothing to stop this, the bottom line is we have to fight for ourselves. Any other employee in the hospital would be on the warpath if you mentioned cutting 5-14% of their income, from the nurses to the parking attendants to the executives. Attending physicians have to be the same way, or they are just slave labor that they were back in residency. Health care may or may not be a right, but I know our life, liberty and the pursuit of hapiness is, and that includes the right to stand up for ourselves and demontrate the value of our services.
 
I totally agree with your post. I support organized medicine in the form of membership in AMA/AOA and my professional society (ASA) and the PACs of both my national/state professional societies. The participation of organized medicine in the PAC system is terrible and we should all be ashamed of ourselves. Physicians have a sense of entitlement that makes us feel like we don't need to contribute. The trial lawyers kick our butts in this regard.

Also, we need to speak with our feet in terms of not accepting patients who won't reimburse adequately. For example, many physicians are dropping medicaid and worker's compensation patients for financial reasons and for the burden of paperwork that comes with accepting these patients. When I start my practice I plan on not accepting patients who have "bad" insurance. I would rather sit around and take a longer lunch break than seeing patients who are only a "break-even" enterprise.

There are general public and even other physicians who will read this and say what about idealism and taking care of patients. And I say to them that why is that physicians who want to be fairly compensated are seen as selfish and evil, but nobody calls the United Auto Workers and airline mechanics evil when they go on strike for fair wages? There is this double-standard that physicians can't push for higher pay and lower malpractice rates.

I do have a problem with the fact that we are the richest country in the world and we haven't figured out how to insure everybody. Problem is that we will never move to a single-payor system because it completely violates the principles of capitalism. If healthcare moves to a single-payor system, then we should move accountants, dentists, CEOs, attorneys, engineers, etc. all to a single payor system as well.

We can buy legal insurance, dental insurance, plumbing insurance, all at a super-low cost. The advantage of this system would be that we could totally wipe out the existence of a majority of the upper class. Wouldn't that be great? (sarcasm)
 
I am truly shocked. I was pretty sure when i opened this thread that people would at least mostly be saying healthcare is a right. To my disappointment it appears that most of my colleagues (if this serves as a representative sample) feel that only the "privileged" should be entitled to healthcare. To me it's an absolute no-brainer. . .healthcare is a basic RIGHT that every human being is entitled to. It shouldn't matter whether they've neglected their health, whether they have no money to pay off our loans, etc. When you applied to med school did you guys not realize that your job was going to be treating sick people? The poor and those who neglect their health tend to be sicker, after all. . .

Reimbursements, etc. . .that's a separate issue. Take that up with the insurance companies. You shouldn't fault the people you are treating and every patient deserves good health care, equally, whether or not they actually comply. Besides, we should stop whining about our own paychecks. Medicine isn't a field for making money.
 
This is exactly why we'd better gear up as physicians for a battle---because the people will not hesitate to exploit your work and turn you into a slave for free health care. The same long hours, the same sacrifice to become a physician, the same time away for your family and friends, for a salary of 80-120 K. Coming soon to a theatre near you. And while you are slaving away in med school and residency during the prime of your life, the "middle class" is buying their house, starting their family, buying their nice car they can barely afford, maybe a plasma TV and high def cable, a video game system for the kids, nice weekends off and vacations, etc. I see it in my own neighborhood, the new BMers, Mercedes and Lexus, it's unbelievable.
Any other employee in the hospital would be on the warpath if you mentioned cutting 5-14% of their income, from the nurses to the parking attendants to the executives. Attending physicians have to be the same way, or they are just slave labor that they were back in residency.
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I believe it's been common wisdom for many decades that if you want to be rich, don't go to med school. You have chosen a service profession....you are supposed to serve, altruism and all that stuff.While you were being used as "slave labor" during your residency did you like those wages? Well, that's what those "middle class" are making. As far as cutting 5-14% and being on the warpath....I assume you can do basic math so 5-14% of 40K has a much larger affect on basic living than does a 5-14% cut on 400K. Shame on you spoiled little rich boys.
 
I think BASIC healthcare (well visits, screening, basic meds) is a right, not excessive interventions, diagnostics, expensive treatment modalities, ESPECIALLY in those pts who repeatedly demonstrate their lack of compliance with meds, etoh abstinence, HD, etc.

Medical care in our country IS too expensive to pay out "perfect" standard of care healthcare such as hemodialysis in those who do not even try on their end.

Life is a meritocracy...
 
Chicamedica started a thread wherein she asks a question for which she has already determined the answer. Why not just start a thread with a statement of fact/opinion and then write a dissertation defending your position...

Both chicamedica and johnnywad have yet to face the reality that medicine is a career about helping people but also about earning a living. Medicine is in fact a business because without successful medical businesses/practices/ hospitals there will be NOBODY around to take of the sick people we all love so much.

In real life (where the rest of us live) altruism isn't always possible. For example, why do we compensate felony-committing professional athletes more than we do teachers? Both are service industries right?

Also, to johnnywad, physicians go through an immense amount of training and sacrifice. Your insinuation that I am a "spoiled little rich boy" only reflects your own stupidity, immaturity, and ignorance. I have earned every aspect of success in my life so why do you pretend to know anything about me? I suspect that your comments stem from an intense feeling of jealousy, originating from your own personal lack of acheivement.

The majority of people who go into medicine do so because of the opportunity to help people. Many of us will have student loans in excess of $100,000, and face huge medico-legal liability risks with every patient we treat. Not to mention the personal sacrifices we make in waiting 12 years to begin earning a living. Because of our expertise, delay of entry into the workplace, high overhead costs ($100,000 a year for OBs to buy malpractice insurance) and student loan debt, we have been traditionally paid at a reasonable rate. The desire to have financial security is nothing to be ashamed of. I don't believe in this double-standard that doctors have to pretend to enjoy paycuts while our overhead expenses rise.

I know that I can only see a certain number of patients in a day. So assuming my services are in demand and patients are plentiful (they are), why would I choose to accept patients who are under/un-insured? I have the same medico-legal liability issues and overhead expenses with the "poor" patients as I do with the "wealthy" patients. Do I want to keep my practice open or do I want to treat only the "poor" patients until I file for bankruptcy and lay off my office staff?

When laymen (like chicamedica and johnnywad) talk about reducing healthcare costs they point to doctors as the culprits for high medical costs. What they fail to realize is that physician fees account for only 2% of healthcare costs. Prescription drugs (roughly 45%) and insurance company profit/administration (22% of premiums....CEO of United Healthcare makes over 100 million/year) comprise a far greater portion. The drug companies, American Hospital Association, and the insurance industry support huge lobbying efforts to deflect payment cuts. What is wrong with physicians supporting our organizations to ensure that medicine continues to attract the best and brightest individuals?
 
I'm not sure which thread you're referring to here. I started this one, and Chica, God bless her, showed up with her opinion. I don't agree with her, however, and like you, I think that she probably has an unrealistic view of what medicine and society in general are all about.

It's not fair to say that doctors, by being in the "service field" must expect to earn less than business and law professionals. They're also in the "service field" and really should not be expected to play by different rules. Robust ethics and fair play should be demanded from all members of society, not just those who are in the health care field.
 
ecCA1 said:
I'm not sure which thread you're referring to here. I started this one, and Chica, God bless her, showed up with her opinion. I don't agree with her, however, and like you, I think that she probably has an unrealistic view of what medicine and society in general are all about.

It's not fair to say that doctors, by being in the "service field" must expect to earn less than business and law professionals. They're also in the "service field" and really should not be expected to play by different rules. Robust ethics and fair play should be demanded from all members of society, not just those who are in the health care field.
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Well said! Nice to hear a voice of reason.
 
As it is regarding this debate, so it is with life in general: the number of people who are willing to screw other people to get what they want far exceeds the number of people who are willing to do what's fair and just to everyone involved, even if it means giving up some of their own comfort and convenience. For people in the former group, it's not a question of fairness, but of what they can get away with.

And for whatever reason, the people in the former group seem to be far more willing and able to unify and organize their efforts. It is a reflection of human nature that a common cause of greed and self-interest has far more power to unite people than the cause for fairness and equity.

As long as it is possible for the general population to organise--either by joining an HMO, or the AARP, or just signing on with Medicare, etc.--and force doctors to work for ever-diminishing salaries, they will do so. Because it serves their own self-interest, and because they can get away with it. It will never change.

I've thought about this dilemma long and hard -- the only solution I can come up with is to pay down my student loans as soon as I can, and the leave medicine. Maybe I'll go to law school and set up a medico-legal practice. Big money, I hear.
 
EuroMutt said:
As it is regarding this debate, so it is with life in general: the number of people who are willing to screw other people to get what they want far exceeds the number of people who are willing to do what's fair and just to everyone involved, even if it means giving up some of their own comfort and convenience. For people in the former group, it's not a question of fairness, but of what they can get away with.

And for whatever reason, the people in the former group seem to be far more willing and able to unify and organize their efforts. It is a reflection of human nature that a common cause of greed and self-interest has far more power to unite people than the cause for fairness and equity.

As long as it is possible for the general population to organise--either by joining an HMO, or the AARP, or just signing on with Medicare, etc.--and force doctors to work for ever-diminishing salaries, they will do so. Because it serves their own self-interest, and because they can get away with it. It will never change.

I've thought about this dilemma long and hard -- the only solution I can come up with is to pay down my student loans as soon as I can, and the leave medicine. Maybe I'll go to law school and set up a medico-legal practice. Big money, I hear.
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Sounds like a great plan. You can sue the pants off the rest of us and then run for president!
 
DrDre' said:
I think BASIC healthcare (well visits, screening, basic meds) is a right, not excessive interventions, diagnostics, expensive treatment modalities, ESPECIALLY in those pts who repeatedly demonstrate their lack of compliance with meds, etoh abstinence, HD, etc.

Medical care in our country IS too expensive to pay out "perfect" standard of care healthcare such as hemodialysis in those who do not even try on their end.

Life is a meritocracy...
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this doesnt too much sense. you screen for free and find the disease but no means for the person to afford the cure.
 
historically speaking...physicians haven't been the economical elite that they are in this country. lawyers and landowners have always been. docs lived in the community of their patients and didnt get paid all that much. this changed in the 40s and 50s when docs made some fantastic changes in medicine regarding PCN, treatment of war trauma/shock and operating on the heart etc. suddenly docs were treated and paid like gods.

the other major problem is that since the invention of medicare in the 60s (i think) people have been trying to make money off medicine they same way it is made in non medical fields. the problem is patients cant really choose treatments the same way they choose TVs at circuit city. also physicians put themselves in positions of making medical decisions with a potential monetary self benefit and causes us to sell out our fiduciaryresponsibilities to our patients.

that all being said, someone needs to make the cost of getting educated cheaper, and we need to bring back the respect of our patients.

eventhough i am like everyone else and want to make a buck and the freedom money can give you if you use it right, but sometimes i wish i could let go of all this money stuff and just enjoy my job for its intrinsic rewards.

patients are responsible too for this costly healthcare crisis by being greedy themselves when looking for monetary compensation through lawyers for medical blunders. i wish there was a good semaritan law for helping patients like there is for helping a stranger on the street.

sorry for being long winded.
 
Stimulate said:
Chicamedica started a thread wherein she asks a question for which she has already determined the answer. Why not just start a thread with a statement of fact/opinion and then write a dissertation defending your position...

Both chicamedica and johnnywad have yet to face the reality that medicine is a career about helping people but also about earning a living. Medicine is in fact a business because without successful medical businesses/practices/ hospitals there will be NOBODY around to take of the sick people we all love so much.

In real life (where the rest of us live) altruism isn't always possible. For example, why do we compensate felony-committing professional athletes more than we do teachers? Both are service industries right?

Also, to johnnywad, physicians go through an immense amount of training and sacrifice. Your insinuation that I am a "spoiled little rich boy" only reflects your own stupidity, immaturity, and ignorance. I have earned every aspect of success in my life so why do you pretend to know anything about me? I suspect that your comments stem from an intense feeling of jealousy, originating from your own personal lack of acheivement.

The majority of people who go into medicine do so because of the opportunity to help people. Many of us will have student loans in excess of $100,000, and face huge medico-legal liability risks with every patient we treat. Not to mention the personal sacrifices we make in waiting 12 years to begin earning a living. Because of our expertise, delay of entry into the workplace, high overhead costs ($100,000 a year for OBs to buy malpractice insurance) and student loan debt, we have been traditionally paid at a reasonable rate. The desire to have financial security is nothing to be ashamed of. I don't believe in this double-standard that doctors have to pretend to enjoy paycuts while our overhead expenses rise.

I know that I can only see a certain number of patients in a day. So assuming my services are in demand and patients are plentiful (they are), why would I choose to accept patients who are under/un-insured? I have the same medico-legal liability issues and overhead expenses with the "poor" patients as I do with the "wealthy" patients. Do I want to keep my practice open or do I want to treat only the "poor" patients until I file for bankruptcy and lay off my office staff?

When laymen (like chicamedica and johnnywad) talk about reducing healthcare costs they point to doctors as the culprits for high medical costs. What they fail to realize is that physician fees account for only 2% of healthcare costs. Prescription drugs (roughly 45%) and insurance company profit/administration (22% of premiums....CEO of United Healthcare makes over 100 million/year) comprise a far greater portion. The drug companies, American Hospital Association, and the insurance industry support huge lobbying efforts to deflect payment cuts. What is wrong with physicians supporting our organizations to ensure that medicine continues to attract the best and brightest individuals?
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First of all, i didn't start this thread, it was someone called eCCA. By "opening the thread" i meant clicking on the link. Secondly I am not a layperson (and i doubt johnnywad is), I will be starting anesthesiology residency in a few months (ok maybe that makes me a relative layperson). I am not, however blaming doctors for the rises in healthcare costs (when the hell did i say that?). You, on the contrary, are blaming our nation's poor for this, which i think is not only an inaccurate statement, but unethical.

Our differences of opinion just goes to show that people often have different goals/motivations for pursuing medicine. My primary motivation is not to become wealthy, but to serve and to help those who suffer. Anesthesiology, to me, was a field where i felt i could more directly be involved in fixing health problems that can be fixed (short of being a surgeon--not too keen on cutting and also want to have time for family eventually). even a salary of $80-90k/yr is a lot of money (a lot of highly educated software engineers dont make more than this). All this griping about how an extra CT-scan or heart cath (when indicated) on a patient who has suboptimal health insurance is going to lower our salaries from $300K/yr to $200K/yr is completely ridiculous to me and is very discouraging that my colleagues are full of greed at the expense of the people we should be trying to help.

I agree that prescription coverage should be more optimized than it is, as should HMOs, but blaming the patients and saying complete healthcare is not everyone's human right is the wrong way to solve this problem.
 
let me bottom-line it...

access to preventive healthcare should be a right. carte blanche access to the best medical care money can provide with no intent of ever paying for it should not.

the majority of americans do not understand the importance of good health until they get sick... really sick. and, by the time they show up to the hospital, they have extensive problems that are not easily fixed. furthermore, they have had essentially zero planning financially, educationally, and habit-wise in how to deal with that problem after they're fixed. result? they show right back up again... and the cycle repeats itself.

now, multiply that by about 30-40 million current 25-45 year-olds who's BMI>30 coupled with the aging baby-boomer population, many of whom are already in debt up to their eyeballs, and it doesn't take a rocket scientist to figure out what's going to happen in about 15-20 years.

as a very wise pulmonologist once told me, "it takes a long time to go from good to bad, but very little to go from bad to worse." until we can prevent people from getting bad, or do a better job of educating them on how to save and prepare, then we're going to continue to have this problem.

until then, one of my immediate solutions: $20 tax on each pack of cigarettes.
 
How about a BMI tax.....your tax rate = to your BMI.
 
VolatileAgent said:
the majority of americans do not understand the importance of good health until they get sick... really sick. and, by the time they show up to the hospital, they have extensive problems that are not easily fixed. furthermore, they have had essentially zero planning financially, educationally, and habit-wise in how to deal with that problem after they're fixed. result? they show right back up again... and the cycle repeats itself.
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i've had more thought on this...

i think we need to do a better job as physicians of discussing the financial ramifications of disease with our patients. we need to tell them that that MRI scanner costs the hospital hundreds of thousands of dollars to lease and maintain every year, and what an actual scan costs their insurance company. we need to tell them that there are thousands of employees at the hospital that make things work, from the doctors and nurses who take care of them, to the food service workers and the housekeepers who makes sure they get fed and their blood gets scrubbed off the floor. i just don't think a lot of people think about these things when they walk into the hospital... and, in spite of their illness, they should.

coupled with that discussion, we should be directing them to information which shows how much smoking is really costing them in terms of actual dollars per year. for example, a 2-pack/day habit will will cost someone about $3,000 per year to maintain. staggering. most people don't realize or think about this on a daily basis.

another example... a 30-year-old male who is 5'8" and weighs 70kg has a BMR of 1700kcal per day. we know that bad diets are cheaper and that they are not as satisfying so people eat more. therefore, it is very easy for that 30-y.o. male to overeat, and a fast-food lunch at mickie-d's of, let's say, a big mac, large fries, and a 32oz regular coke will provide him a whopping 1,440 kcal - which is 84.7% of his total daily caloric needs! and, i assure you that he won't feel very satiated for very long after that meal.

we need to make the cost of bad habits part of our daily discussion with patients whenever we get the chance, even as anesthesiologists. when you frame it for people - and you repeat it over and over again - they start to get the picture. and, we simply have got to stop enabling and rewarding people's bad habits. it may take a decade or more of painful adjustment, but eventually people will get the message. the truth of the matter is that we just can't continue down the path that we are now on, or we will destroy the healthcare system in this country. and, when that happens, we ALL lose. it will punish all of us.
 
militarymd said:
How about a BMI tax.....your tax rate = to your BMI.
Click to expand...

I wish the airlines would charge based on weight...jet fuel ain't cheap, and it sucks to be the 160-pounder underwriting the excess gas for Senors Fatty to my left and right when I'm stuck in the middle seat on a 5-hour flight.
 
militarymd said:
How about a BMI tax.....your tax rate = to your BMI.
Click to expand...


LMAO

Everyone would be bone thin. Mcdonald's and other food chains would file bankruptcy. Hospitals would go out of business. Every american would suddenly open a savings account.
 
Wish I could find the link, but there was a news story a year or so ago about a hotel in Germany that was basing it's nightly rate on the customer's mass. Something about wear and tear on the mattress...
 
VolatileAgent said:
i've had more thought on this...

i think we need to do a better job as physicians of discussing the financial ramifications of disease with our patients. we need to tell them that that MRI scanner costs the hospital hundreds of thousands of dollars to lease and maintain every year, and what an actual scan costs their insurance company. we need to tell them that there are thousands of employees at the hospital that make things work, from the doctors and nurses who take care of them, to the food service workers and the housekeepers who makes sure they get fed and their blood gets scrubbed off the floor. i just don't think a lot of people think about these things when they walk into the hospital... and, in spite of their illness, they should.

coupled with that discussion, we should be directing them to information which shows how much smoking is really costing them in terms of actual dollars per year. for example, a 2-pack/day habit will will cost someone about $3,000 per year to maintain. staggering. most people don't realize or think about this on a daily basis.

another example... a 30-year-old male who is 5'8" and weighs 70kg has a BMR of 1700kcal per day. we know that bad diets are cheaper and that they are not as satisfying so people eat more. therefore, it is very easy for that 30-y.o. male to overeat, and a fast-food lunch at mickie-d's of, let's say, a big mac, large fries, and a 32oz regular coke will provide him a whopping 1,440 kcal - which is 84.7% of his total daily caloric needs! and, i assure you that he won't feel very satiated for very long after that meal.

we need to make the cost of bad habits part of our daily discussion with patients whenever we get the chance, even as anesthesiologists. when you frame it for people - and you repeat it over and over again - they start to get the picture. and, we simply have got to stop enabling and rewarding people's bad habits. it may take a decade or more of painful adjustment, but eventually people will get the message. the truth of the matter is that we just can't continue down the path that we are now on, or we will destroy the healthcare system in this country. and, when that happens, we ALL lose. it will punish all of us.
Click to expand...


Somewhat off post, but w/r/t the bolded, my buddy recently had a little trip to the ED. He was in the wrong place at the wrong time and got punched in the face. It was a pretty bad cut just under the eye and a very minor cut (albeit in a precarious area) on his eyelid itself (plastics handled that one so as to prevent my poor pal from the possibility of partial ptosis).

Neurologically, the ER doc could have done a pretty thorough workup "manually". Instead, he covered his ass and ordered a CT scan. Granted, I'm not sure if a traditional neurological exam would elucidate something like a cerebral hemmorhage or something. Eventually, perhaps, but who wants to wait.

The point is that whenever costs of malpractice suits are considered, it seems rare that these CYA costs are considered. Admittedly, they're hard to measure or determine, since they can be subjective. But, it just struck me how a pretty minor ED visit turned into this big fiasco to include a CT scan, which couldn't have been cheap.

I'm glad my buddy had the CT frankly. But, there's always a risk/benefit ratio (for overall societal costs) that needs to be considered. Had the doctor NOT ordered the CT and my buddy ended up with some kind of cerebral/subarachnoid hemmorhage, you can just imagine the field day the lawyers would have with that.

Granted, I'm a first year med student. So, I clearly am ignorant on most medical issues at this point. It just occured to me how costly this seemingly minor ED visit turned out to be, all in the name of trying to avoid being held liable by some attorney that wakes up each day thinking about how he can expoloit the system and take 30% of some settlement. It's sick.
 
cfdavid said:
Granted, I'm a first year med student. So, I clearly am ignorant on most medical issues at this point. It just occured to me how costly this seemingly minor ED visit turned out to be, all in the name of trying to avoid being held liable by some attorney that wakes up each day thinking about how he can expoloit the system and take 30% of some settlement. It's sick.
Click to expand...

you may be a 1st year, but this is a very astute post. and, you're right. we practice defensive medicine, especially in the ED as you'll learn, for the exact reasons you describe. i think, until we have a legitimate and reasonable tort reform in this country, this will continue.

but, as you'll also learn, hospitals should function to take care of guy's like your buddy with the highest level of care. this is where resources should be spent. where they should not go is to the 37th admission for hyperglycemia in the 58-year-old morbidly obese non-compliant diabetic with no healthcare insurance... and now buys an intermediate-care stay while getting the million-dollar work-up. this is a person who has no investment in their own health. why should we continue to tune them up, send them out, and have them bounce back a couple of weeks later?

we learn about the concept of "futility" in treating certain patients. i'd argue that this is a different kind of futility, and we shouldn't be forced to take care of these people. kind of a "three strikes" mentality. sure, it sounds harsh. but, medicine-types have got to get over this mamby-pamby, paternilistic notion that their job is to put the disease first and take care of everyone. believe it or not, a lot of people who end up in the system don't really want our help to get better... they want our help to stay sick and get all the secondary gain that comes with being "disabled".

it's high time we stop playing their game.
 
VolatileAgent said:
you may be a 1st year, but this is a very astute post. and, you're right. we practice defensive medicine, especially in the ED as you'll learn, for the exact reasons you describe. i think, until we have a legitimate and reasonable tort reform in this country, this will continue.

but, as you'll also learn, hospitals should function to take care of guy's like your buddy with the highest level of care. this is where resources should be spent. where they should not go is to the 37th admission for hyperglycemia in the 58-year-old morbidly obese non-compliant diabetic with no healthcare insurance... and now buys an intermediate-care stay while getting the million-dollar work-up. this is a person who has no investment in their own health. why should we continue to tune them up, send them out, and have them bounce back a couple of weeks later?

we learn about the concept of "futility" in treating certain patients. i'd argue that this is a different kind of futility, and we shouldn't be forced to take care of these people. kind of a "three strikes" mentality. sure, it sounds harsh. but, medicine-types have got to get over this mamby-pamby, paternilistic notion that their job is to put the disease first and take care of everyone. believe it or not, a lot of people who end up in the system don't really want our help to get better... they want our help to stay sick and get all the secondary gain that comes with being "disabled".

it's high time we stop playing their game.[/QUOTE]

That's why I'm a Republican. Democrats don't, in general, seem to have what it takes to make those kinds of decisions. Or, even to think on such terms in the first place. It would be too "harsh"..... Heaven forbid we put the onus of responsibility on the individual!
Click to expand...
 
cfdavid said:
That's why I'm a Republican. Democrats don't, in general, seem to have what it takes to make those kinds of decisions. Or, even to think on such terms in the first place. It would be too "harsh"..... Heaven forbid we put the onus of responsibility on the individual!
Click to expand...

this pretty much says it all right here...

Direct medical and indirect expenditures attributable to diabetes in 2002 were estimated at $132 billion.
Click to expand...

http://care.diabetesjournals.org/cgi/content/full/26/3/917

and, remember, that was for one year. and, who's paying for all this?
 
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