Friday, June 29, 2012

Health Care Response

While I was sitting in the sun I guess some pretty monumental stuff was happening in the high courts.

Isn't that just like the proverbial doctors wife? Sitting in the lap of luxury, sipping water from plastic bottles she will throw away carelessly, watching her offspring dance in the surf in designer swim wear, ignoring Rome as it burns (I am not saying Rome is burning) or issuing the order to "let them eat cake". Who cares about the little people when I am having fun?! 

I do have a heart, but this issue is completely overwhelming. Not overwhelming because I am not smart enough to handle the arguments. Overwhelming because it pulls me in so many directions. I don't want people to suffer. I don't want people to go broke from illness. I don't want sick people dying needlessly. I don't want people not seeking medical treatment because they can't afford it. I don't want people to lose their jobs. I don't want doctors to have to consult anyone other than their patients for decision making. I don't want doctors refusing treatment based on ability to pay. And I do care about clean air and clean water for my children and yours.

I love politics, but hate all the political dancing. So much of what happens in our government seems like a complicated waltz, meant to dazzle and convince us that we could never move like they do or that we aren't brilliant enough to understand why they changed directions and paused just so with that little head tilt. In reality a two step could get the job done and everyone could figure it out in one lesson.

The problem I have had with healthcare (since I became a part of the system in a small way by marrying it) is that patients and doctors don't have a vested interest in working toward true health.

When it comes down to it I am not convinced that we (collectively) care about health that much. What we care about is having someone treat symptoms with as little inconvenience to the ill as possible. Wait times, co-pays, unacceptable  - we want on demand medical care. If the cable company can do it why can't health care follow that model?

You could give every American free membership to a local gym, including free babysitting and fancy aluminum water bottles engraved with their name and still the number of people who actually go to the gym wouldn't change much. No one is just that interested in prevention.

We know what we should do to optimize our health but how many people really do it? Stop smoking, eat more fruits and vegetables, lay off the potato chips at 2 am, eat less, exercise more, drink more water  and less soda, whole grains, lean meats. It would be difficult to find one American who couldn't name at least 3 things that would immediately improve their health.

We know it, we don't do it. Why? Because it doesn't really matter. Why doesn't it matter? Because no matter what we do to our bodies the miracle that is modern medicine can take care of it. There is a pill/procedure for that!

You can give free screenings, free contraceptives, free prescriptions all day long and still not everyone who needs them will get them. You can give away fruits and vegetables, but they won't get eaten. It is just the way we are.

How can a group of people with different beliefs, and motivations be moved to change the way they think about their own health? That is the key. Not everyone will respond in the same way to whatever carrot is dangled in front of them. Penalties? Taxes? Liens? Public humiliation? Cash rewards? TV's? Gas cards? Movie tickets?

My husband operates on obese patients all day long with back problems. Guess what is causing the back problems? All that excess weight!!!! If they would lose the weight they would solve the back problems (in most cases). Guess what is easier than losing weight for back pain? That's right, it is easier to operate (i.e. faster, less inconvenient, no lifestyle change, and very cheap if insured) and if it does not work you can always blame your doctor!

The part that really gets me is that there always has to be a bad guy. Why does it always have to be the doctor? Probably because he is an easy target. Overworked, tired, having been slowly "managed" out of reimbursements, regulations driving up overhead costs, and always promised that it will get fixed this time. It's not getting fixed.

When did we go from honoring and respecting the people who care for our health to demonizing them? This would never happen to a firefighter! It shouldn't happen to anyone. Every contribution to our economy/community should be respected. 

Some where the doctor has become the poster child for all that is wrong with healthcare. As if it is their own greed and self-preservation that is causing the problems. Right now we have people deciding what our healthcare system should be, how it should be delivered, who should pay for it, how much providers should get paid, etc who have absolutely no medical experience.

It doesn't give me warm fuzzies thinking that politicians, law makers, and judges are making decisions about healthcare, an area where they have very limited experience and are so very easily swayed by interests that often compete against what is truly best for all the people they claim to serve.

Would you let a mechanic represent you in a court of law. NO! 

The ideal panel of participants in a true reform bill: doctors, patients (insured/uninsured), insurance providers, hospital administrators. Put them in a room for a week, I am sure something useable would come out of it. Let's add a doctors wife to the mix just to make sure it all gets done and no one gets hurt.


Because the Supreme Court decision basically held that this was a taxation issue I thought I would include my two cents here. Who really pays taxes? I have given my complete tax history here in previous posts. Bottom line, I haven't paid federal income taxes in the last 7 years (state taxes is another story). In fact, they keep giving me my money and some back. Maybe some of it was your money... sorry.

So who is going to foot the bill? If it isn't me (and probably isn't you), who?

Well, it will be us (as in me for sure) in 2013. Have you looked at the tax brackets that we are going to be in? Above $218,450 taxable income 36% to 39.6%. That is some serious cash and that is only the federal income tax. Talk about eye opening.

Salaries sound really good, but after taxes..... oh my. The people providing the care will also be the ones paying for it.  There are a whole host of other taxes that we will pay, not to mention the expenses that come with practicing medicine. I am thinking of malpractice insurance to the tune of $50-100K per year (or let's just say another 10%), and then employees/facilities..... how will a doctor be able to afford to provide care when everything they have is taxed or spent in the pursuit of practicing medicine? 

And here is where I have to pause and go hmmmmm. Is it fair that some people will pay 39.6% and others will pay absolutely nothing? And this isn't a question I ask just because I am going from the zero tax payer to the crazy tax payer in the near future. I have always wanted to pay something, but that's just me. 

I belong to the school of "everyone should have skin in the game". Those who have more should pay more, those with less should pay less, but everyone should pay something (unless you really have nothing). For me it is a matter of principle. There never was a free lunch and there never will be, someone always pays.


  1. You lost me when you stated providing preventative care is a's not. Nobody has attacked doctors or their salaries. The insurance companies are the criminals in this scenario. Getting bogged down in the "taxation" issue is a smokescreen. There is so much to say. Just don't want you to think you've lost your readers. Work inner city for a few years or a decade and your opinions might change. That's not an assault--it's just hard to understand what it is like for the poor in this country without having it in your face. Better yet, don't worry about the poor or the rich. They are taken care of. Just focus on the middle class. They are the ones being screwed and they are the ones falling for the tricks. Lastly... this will benefit YOUR husband because you will see ( I am 3rd generation doctor family) your benefits as an attending absolutely suck. The fact that you can buy into an affordable insurance plan will now increase your salary. This mandate is the beginning of a lot more changes including tort reform for liability, litigation, etc. The issue is complex. Google Cuba's preventative healthcare. That country is poor as dirt but they are healthier than us. Preventative care just have to get over handing out condoms, promoting birth control, teaching elementary kids about drugs, sex and rock and roll and allow the separation of church and state to run its course. Your husband deserves all of his salary and then some, as does my husband. Be strong and don't give into the hysteria that anyone is attacking your husband...last I checked the gov't, courts, patients and doctors were disgruntled with the insurance companies and nobody else. Thanks for sharing your thoughts.

    1. I don't think preventative care is a waste, I think it is the only answer to achieving real health. Everything else that we talk about is symptomatic, when the question we should be asking is how can "we" get more people to care about their health in meaningful ways. I am skeptical by nature.

  2. And one more thing...the middle class are ALREADY footing the bill. A hospital in MN wrote off $40billion dollars in debt last year. If everyone who walked through their ER had some form of insurance (you know, the free kind or the kind where they've got some skin in it) the middle class wouldn't go bankrupt covering those poor folks and the rich wouldn't need to donate so much to their charities bc they would just be paying their fair share in their every day life. But now I'm getting too political. And by the rich I mean folks making over 1$million a year, not the middle of the road doctors who average $250K-$650K.

    1. I agree! The middle class has been squeezed from the very beginning, but this isn't the only reason. The people in the middle that I know aren't talking about healthcare (recent events excluded) they are talking about lost savings, investments, cost of housing, food, gas. Money doesn't buy what it used to. Not to mention the debt burdens families carry. It is not all from healthcare.

  3. I'm failing to see where doctors look like the bad guys? Can you please explain? (Seriously. I'm not being sarcastic.) I was under the impression that people see insurance companies as the bad guys?

    1. I suppose it depends on who you are talking to or reading. It was a generalization. Not everyone sees the doctors as the bad guys, just like not everyone sees the insurance company as the bad guys (I am giving them the benefit of the doubt). Some people are looking for a bad guy, and when you look for one you usually find one (it just might not be the right one). Because patients typically have zero interaction with their insurance company, and see the doctor face to face, he (or she) becomes the face that gets attached to their complaints.

      I have seen too many posts recently complaining about having to make a co-pay for a well visit. Don't get mad at your doctor. Or posts about having to sit in a waiting room for 30 minutes. Don't get mad at your doctor (unless he is out playing golf when he should be in the office - I don't think that happens much) he is taking care of someone just like you/me. Complaints about certain things not being covered. Don't get mad at your doctor, he is the messenger. He would gladly provide whatever care you require. When he sends a bill, he is just trying to pay his bills.

      For certain groups, the only context in which they have to judge their healthcare is through the relationship they have with their doctor and an insurance plan that was picked out for them through their employer. The issue is bigger than that, but it is their only context.

    2. Thanks. That makes sense.

  4. I understand what you're saying about doctors being the bad guys. I think that most people unless they have personally lived the sacrifice of the training it takes to be a physician they don't understand how long of a road it is. I think a lot of people think that doctors make too much money, not realizing that the drs are the ones that are shouldering a huge amount of responsibility & liability for their patients, but yet even with rising healthcare costs the reimbursements are going down so therefore drs are making less money for the same treatments than they used to make, but yet have much higher expenses. The news only portrays the positives of Obamacare which things such as not discriminating against pre-existing conditions etc is stuff that most people are for. What I have a problem with is the govt wanting to control healthcare & run it like social security since we can see how great that is working out! It is not in the best interest of patients to have socialized medicine & if we continue down this path that's where we'll be & people will be waiting months to have a test only to find out if they'd have the lump removed 6 months ago they would have had a chance. Reform is needed but obamacare is not the best plan.

  5. I think some of you are getting caught up in your own world. Not once on the news, on facebook, in person or amongst doctor communities have I ever heard of anyone thinking the doctors are the jerks. Doctors who overbook their patients and have poor bedside manner are a completely different issue than insurance companies who REFUSE TO PAY for services rendered to hospital/ doctors and/or insurance companies who deny coverage to patients for certain issues. This is where insurance companies dictate the relationship between doctors and patients. I don't understand how you can give a "free pass" to the insurance companies or give them any benefit of the doubt when they never apologize for screwing over docs/patients/hospitals and the gov't just tries to patch things up by giving grant money they don't have to pay for all these uninsured folks. If you don't like a large gov't then go live in a small country where you have to pay for your own security, garbage, healthcare, prison, education, etc. You can't ride two horses with one ass, for lack of a better term. You have to take the good with the bad. This BS of having lumps removed and dying of cancer is nothing but fear mongering BS. Obamacare is NOT socialized medicine. It's preventative medicine with the INSURANCE that every doctor/hospital will receive SOME FORM OF reimbursement. I can't imagine why any doctor or doctor wife would be so upset about this? YOUR HUSBAND CURRENTLY WORKS FOR FREE!!! He will finally make some $ for each uninsured idiot who decides to ride a bike without a helmet or addicts who spend months in the ICU without insurance. How can you be upset about being compensated? Also, I don't understand why any doctor or his/her spouse would be upset that now THEY TOO can buy into affordable healthcare. You have so much to learn about the attending lifestyle... Do your research before you get huffy and puffy. Nobody thinks docs are jerks for needing compensation. They think insurance companies are jerks for demanding co-pays and then covering next to nothing of services. Two very different issues.

    1. Huffy and Puffy? I think I can summarize my post in two simple points.

      1. People should care about their health and do something about it (prevention).
      2. Everyone should contribute something.

      And the benefit of the doubt comment was: "Not everyone sees the doctors as the bad guys, just like not everyone sees the insurance company as the bad guys (I am giving them the benefit of the doubt)." Meaning I am sure people exist who think that the insurance companies are the heros in the story. I just don't know any, and don't want to rule out the possibility that they exist.

      The relationship between doctors, insurance companies, and patients is tainted and needs to be restructured. I hope whatever reform finally takes place solves that.

      We can agree to disagree on how it all gets done.

  6. Sorry my comments came off so intense. As I'm re-reading I realize what an a-hole I sound like! I agree with you about both of your points. I went nuts hearing anything positive about health insurance companies. I see your point. Not everyone views them as the problem. When those companies can "afford" to reward their CEO's with tens of millions of $ in bonuses but deny payment to docs/hospitals it makes me nuts. Thats' one nice thing about this new legislation... there are caps on those bonuses. I don't have all the answers nor do I want that pressure. I'm just glad there is something set in motion to change the current system. Maybe by the time my husband is done with residency some things will be figured out and we will have good options for insuring our own growing family (without paying an arm and a leg for crummy coverage). Here's hoping.....

    1. I am glad we are friends. It would be nice to have "talk" about reform over and for reform to arrive. Here is to hope!


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