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Why our current health care system doesn't work

2009 August 21
tags: , ,
by Terri Schmitt

O.K. I am totally cheating and stealing from an e-mail conversation I had with my wonderful and brilliant sister who has been a Labor and Delivery nurse for 19 years. I know I am belaboring this, and I promise this is the last post, but seriously… American health care is broken and here are just a few reasons why.

She pointed to the need for tax breaks for small businesses to provide health care! I agree!!!!!
“Excellent point about tax breaks. however, businesses do get tax breaks, individuals who have to insure themselves don’t though (that is unfair).”
I have about 30% of my practice w/o insurance and most of them are self employed (farmers, truck drivers) and they can’t afford personal insurance (many with 1000$/month premiums)… I have one truck driver who has back pain and now weakness on his left leg, but he can’t afford a much needed MRI let alone surgery and soon suffers the risk of paralysis. He will never ever get insurance now because he has a pre-existing condition, even if he could afford it. I hate it for these people.

Insurance rates are climbing for businesses astronomically. Case in point, friend owns a business and feels it is his duty to insure his people, he has done this for 4 years… second year insurance company raised the business rates 30%, third year 40%, fourth year 40%, now they are going to drop it because they can’t afford it. Insurance is a problem. The employer I work for, just had United health care raise their rates 40% this year, so they are now have a different carrier, which was still a 20% increase. United is in trouble over how it pays CEO’s and possible fraud. Blue cross blue shield has other troubles. etc…

Drug and test costs are outrageous and the health care systems are to blame. There is no way a PET scan should cost $15,000 dollars (yes, you read that correctly) but it does. People should not be charged 200$ for a simple CBC when I know for a fact that a CBC costs to our clinic are $11 from the lab (and yes the lab is still making money and paying its employees). Health care providers should not be doing stupid crap and ordering stupid tests to prevent us from being sued (when they are not needed). Also, we should not be doing things that are not clinically proven to work. For example, the best research on laproscopic knee surgery for knee pain is as effective as placebo, yet it is usually the number 1 procedure done by health systems because it is billable.

Meds cost too much… capitalism works. I guarantee if all insurance, medicaid, medicare QUIT paying for medications that the prices would drop like a rock because pharm companies would want to continue to sell their medications. There is NO way lipitor should cost 200$ per month, it has been a round for 15 years, or that wellbutrin should cost this much (this one a generic and cheap to produce) but because insurance will pay for it… they do.

Patients are penalized for paying cash! Look, a check up with my old pediatrician, which we were paying out of pocket to see when our insurance changed was $135 per child (no vaccines, no blood work, no tests)… my past insurance paid $70 for the same exam. Yet, if I paid cash (which I did and which saved the office lots of time and money in billing) I was not allowed a cash discount at all because it would be “insurance fraud” the old health system we went to. WHAT???? Give me a break.

Laws governing nurses and preventing the church from stepping up are RIDICULOUS…. look, you and I both know that you as a nurse could do prenatal education or get the social worker or decide to give a patient TYLENOL without needing a physician. I could do asthma education, diabetes education, diabetic foot care, wound clinic, etc… and run businesses with access for all (because nurses are trained in these things) if it weren’t for stupid governmental oversight, fear of malpractice suits…. Also, the CHURCH who fixed the last health care crisis in America (remember when NUNs and nurses built hospitals for the right reasons)… is too scared of these things, too busy trying to fill their own pews and keep people out… to care whether the woman down the street will get a mammogram this year. Jesus own ministry was healing.

We already have socialized medicine. Medicare, medicaid are both socialized programs. Honestly, the medicare system works pretty good but costs a lot because we have lots of baby boomers (wait… hold the press…. it is not the Baby boomers yet… just outrageous medical costs… see below comments so well put!). Most brits get pretty good coverage with their system, seriously… there are always cases where this doesn’t happen, but I have tons of cases where I have patients who have no access to proper care, right here in America. We do not have the best system in the world.

The system is too focused on medical model/ after the fact treatment instead of prevention. Look, if my patients could get their gym membership and dietary counseling paid for many of them wouldn’t have diabetes. We spend millions of dollars providing chemotherapy to 85 year old people, keeping people with no chance of survival alive… instead of providing dental care (which is a huge factor in overall cardiac and physical health), letting young working people get physicals and blood work, or paying for mammograms before the age of 50. For example, I have a strong family history of heart disease (mom with MI and open heart surgery at 41), but my insurance will not pay for cholesterol screenings but once every 5 years and only after age 40… all this time we could be monitoring and preventing.

Bottom line – the entire system is broken, but it is a very complex issue and just having insurance won’t solve it.

There will always be those among us who cannot provide for themselves, I am not talking about those who can and choose not to because they are lazy… they will always be around too… Jesus did say “what every you do for the least of these you do for me”… this is why I am a nurse. I see every patient through the same lens regardless of insurance status. Nursing is such a noble art because of this.

from → health care reform, NP, nurse, Nurse Practitioner, Nursing

  • JTapp

    I like your thoughts. I think we need a robust debate. The Washington Post printed a ‘health care cheat sheet’ that broke down the current debate pretty simply, you might like it.

    I would attach a couple caveats. The fear of lawsuits is based on some pretty real verdicts over the years, so I think medical malpractice tort reform is a reasonable idea (Obama disagrees). Some of the ridiculous mark-ups are to cover those losses, as well as the risk of not being paid by indigents. A colleague of mine was recently a few hundred dollars from meeting his deductible and he had a scheduled treatment. The doctor’s office demanded he pay 75% of the amount two weeks in advance of his visit. Fraud and delinquency are real problems for providers.

    The Congressional Budget Office (CBO) studies say that preventative care wouldn’t actually bring down costs because in order to prevent you have to provide the prevention care to everyone. So, to prevent the one person from getting the expensive diabetes you have to spend as much money in the long run on preventative care for everyone.

    CBO also says demographics (lots of baby boomers) aren’t the cost driver for medicare, rather it’s all the increase in new available treatments/technologies. Demographics become more important further out, say 10 years, but even then it’s not the primary driver of cost.

    Employers do get tax breaks for providing health care and employees are getting a tax-free benefit but that’s part of the problem. It’s a system that is regressive, it benefits those who can already afford insurance more than those who cannot. There are a lot of economists who think that the taxing of health care benefits is a good idea (like the McCain plan where individuals then get a tax credit to buy insurance).

    I agree meds are expensive. Big Pharma twisted Bush’s arm on Medicare Part B and now Obama’s arm on new reform not to give the government the power to negotiate for lower costs. Rather they say they’re voluntarily (magically!) going to cut costs by a large amount instead, and that we should just trust them. The power of the government, being the largest customer of meds, to negotiate prices is obviously important. That we’re voluntarily tying government’s hand to do that now is really sad.

    I saw a study last week that about 10% of patients in Britain have waited an obscene amount of time for treatments. But the good part is they get quality care and the overall cost of health care treatment is much less than here. But doctors get paid less in real terms….Benefits and costs.

    I think the only people who think the U.S. system is “the best in the world” have never traveled outside the U.S. I personally prefer a public/private partnership like an Australia or Switzerland… where some hospitals are state-owned and others are private. If you’re on the public option, you go to public hospitals. If you can afford private insurance then you go to private hospital. The public sector gets lower costs due to its economies of scale (like a Britain or France) while the private sector works to keeps costs low due to competition. Makes sense to me.

    I favor reform and I’m not completely opposed to a “public option” but it has to be structured right (like being able to negotiate with drug companies). Those views alone make me somewhat “liberal” but that’s okay. As you pointed out, much of our health care is already “socialized,” and it’s the part that’s not that isn’t functioning very well.

    I currently can’t afford to put my wife on my employer’s plan and we can’t afford maternity insurance at all so she has private insurance and is underinsured. We did the math and figured out that with our AGI if we have an “accident” we’d still qualify for state help. So, we have a moral hazard problem here…the state is our backstop. Since the state is the backstop of so many it makes no sense to me at all to hear people say “don’t socialize our health care.”

    Sorry for the rambling..

  • JTapp

    Oh, and I totally forgot to write that I 100% agree on the role of the church here. It’s that way with so many things. I think it’s something most Christians and churches haven’t thought of, over the years they’ve just gotten used to the government being the caretaker for the poor and social services being the educator of the huddled masses. That’s a shame.

    • http://www.nursestory.com Terri Schmitt

      Excellent points. Thanks for commenting. THere is so much more that can be fixed, we can each do our part… what is holding us back? maybe beurocracies of government, businesses/insurance, and hospitals. I have hope that we can fix it though!!!!!

    • http://www.nursestory.com Terri Schmitt

      Oh and thanks for the link. The cheat sheet was excellent. I am going to forward the link to others. You did not ramble. Your points are very well taken. Thanks for being a voice!

    • http://fnp2011.wordpress.com FNP Student

      But the churches would have to be under the same onerous regulations as the other hospitals, which drives up costs!
      I feel every test, treatment etc. should have a fixed cost, whether insurance pays or individuals. More fair that way!

      • http://www.nursestory.com Terri Schmitt

        Great point FNP student! (by the way congratulations on being an FNP student :) )… yes so the law stands in the way? Or if it was primary care (like health departments and clinics do) would the law be different (no JCHO, etc.)? It could be done. I agree… one flat price or even a discount for cash (after all those who pay cash save us billing, mailing, paper, time, etc…).
        Thanks for your comments! I love conversation.
        P.S. have you checked out the great podcasts from the December RWJF Future of Nursing conference? It may be on their website… but dealt with the ideas of nursing helping to solve the health care crisis.