MaryAnne - HMO & Health Care

Hi MaryAnne,

In your reply to Verger on surgery and anesthesia you say "Now in Canada your surgery would be done high risk or not if it is determined you need the surgery. You see, we don't have HMO's that dictate whether you can have the surgery or not."

I wish to respond to that statement of as to me that may imply that in the USA the HMO helps the doctor make the decision on the level of care for a patient. We do not have HMO's that dictate the level of treatment for a patient, be it surgical or not. We do have HMO's, as everyone knows, but their only role in the making of a decision on a patients' care is to decide how much they will or will not pay toward the cost of that care. The same goes for any procedure or medication a doctors deems necessary. The final decision is in the hands of the doctor and the patient. To me, the prudent thing is to leave the decision in the hands of the surgeon as that is the person best qualified to make the decision.

I frequently hear people in other countries criticizing our health care system, and while it may not the best in the world, it is not the disaster so often described. Any of us can purchase any level of medical care insurance we wish to purchase, the same as with any product available in the USA. And until we have a socialized medicine, as some countries do have, it will always be that way.

Personally, I prefer our free enterprise health care system. While I am a member of an HMO, I can select the specific doctor I need to see, regardless of their specialty, if that is what I need. And I can continue to see that same doctor so long as their services are needed without fear of being told by some paper shuffler I must see Dr. So-In-So next time.

As a side note, I've been with the same HMO for nine years. During that time my ONLY costs for medical care has been the cost of my health care premiums (about $300/mo.) plus about 10% of my prescription costs as co-payments. To me, I get excellent care at a very reasonable cost.

Best regards,

Smitty

8 Comments

Health care system

by Cycledoc - 2008-08-12 01:08:49

It's fascinating to follow the health care controversies. Our non system in the U.S. is technologically advanced and offers access at a price to the newest approaches to care. While we spend almost twice as much other industrialized countries on health our health care outcomes (morbidity and mortality) are mediocre in comparison with others. We ration care by economic status--if you have money and/or can obtain quality insurance you are OK. If not you are like 50 million of our citizens out of luck.

In my specialty of oncology drug companies aggressively market new medications that extend the lives of patients with cancer by a few months (there are one or two exceptions that do better). These are interesting medications and do offer incremental improvements in care. They are, however, expensive--up to $100,000/year and more. This cost exceeds the average and median incomes in our country. It may cost up to $300,000-$400,000 for an additional year of life among the drug's recipients. This is not cost-effective and unaffordable for the system and most individuals.

That's why I'm looking forward to the elections and listening carefully to candidate's approaches to changes in our expensive inefficient mediocre health care non-system.

I occasionally blog on health care at www.medicynic.com

To help clarify......

by Bionic Beat - 2008-08-12 06:08:39

Yes, the Canadian system has waiting lists but if your illness is urgent or emergent, you are seen very quickly, if not immediately.
Cardiac and respiratory issues are dealt with very quickly.

If you need hip/knee replacements, you'll be waiting awhile....but it's not life-threatening, just painful and debilitating.

Once I got to the EP Guy, he assessed me as Urgent, it was put into the computer and spit out a date 6 weeks later.

If it was not Urgent, it could have taken 3 or 4 months.

I never mind waiting in the ER, as I have gone in with terrible heart problems and been taken first, right away.

Even in England, on vacation, I was taken first with an arrythmia. No cost whatsoever to our family.

We are taxed to the teeth and there are abuses that need clearing up but it's a good system overall.

Bionic Beat

I Agree

by scadnama - 2008-08-12 07:08:15

Smitty,

You are absolutely right! Health care in the US is a very touchy subject. I for one am scared to death to have universal health care. I have a great dr., and I am worried that I will no longer be able to see her if this new system is implemented.
When I had my car accident last month, I was taken to a hospital that was not private and that cares for anyone regardless of insurance or ability to pay, because it is the only hospital in the area that has a trauma center. I was admitted, and while I was there, I had a roommate who was an illegal immigrant from Mexico. She was having chest pains, and instead of going to a hospital Mexico, she had someone drive her 150 miles to this hospital, because she knew that they would take her in even though she was not legal. She ended up needing a cardiac catherterization and no telling what else, so you can imagine the hospital bill. I know that she didn't pay a dime, but my stay was over $18,000!
How fair is that?

Amanda

Healyj Care

by SMITTY - 2008-08-12 07:08:23

These comments are very interesting. While I may have implied that only the people with money or insurance can get health care, I did not mean too. No matter your financial situation, if you present yourself at a health care facility needing help you will get cared for regardless of whether you can pay or not. There are very heavy penalties to refuse, or base quality of care, on the person's ability to pay.

Those that think the heath care programs being proposed by some of our candidates for president are so great, I suggest that they go to an ER, especially on a weekend, and take a look. People that go there are seen on a first come first served basis, except in case of a dire emergency. If you don't like what you see, you are looking at what we will probably have in the USA if some of the proposed programs are implemented.

I have first hand experience because on a Saturday in 2000 wife hauled me to the ER at our local hospital. A heart attacked was suspected and I was seen in a few minutes and was not put ahead of anyone. There simply were very few people in that ER in 2000. Then in 2007 we had a repeat of the 2000 episode and this time that ER had at least 100 people waiting. My needs were greater than some of the others and I was pushed ahead of some, and my wait was only four hours until I was assigned a room. The major difference in those seven years is that the majority of those people in the ER in 2007 were non English-speaking immigrants, both legal and illegal, while there were none that could not speak English in 2000.

So to any of you that are wishing for a government sponsored and operated health care system in the USA, I suggest that you think twice about that for which you are wishing. Our government has proven time and time again that it is a total failure when it comes to running anything that must emulate private business. Any operation the size of a universal health care system in the USA would be a disaster waiting to happen if it is run by our government.

A perfect example is our Medicare program and a universal heath care system would be many times bigger. Another example of government failure at helping people is the chaos experienced by the people needing help as a result of Hurricane Katrina.

Smitty

yes - the freedom to die

by winesap - 2008-08-12 08:08:19

Smitty - the difference you saw in the ER was because of the lack of access to general health care not because of a solid single payer system (socialized medicine using your term). If everyone in the USA had access to regular health care, use of emergency rooms would drop dramatically.

Amanda - don't believe the myths of universal health care you apparently have encountered. In Sweden, I had my regular Dr and my regular cardiologist (I chose them both). They shared a common computerized medical record about my health - and in fact when I went to emergency for treatment of bicycle crash injuries - the Drs there also had the computerized record of my health problems. A superior system to the insurance industry dominated multiple payer system we have in the USA.

It makes no sense to operate a health care industry based on a for profit model. We have the freedom to die or the freedom to become bankrupt because of health care costs. I don't want a health care system that emulates private business. I want a health care system that provides health care to all. I know we have members of our little group in the USA who are in dire financial straits and cannot obtain private insurance - simply because we are being kept alive with the computer we all have in our chest. Some of us have good insurance - we are simply lucky. Imagine if you didn't ...

sick children

by jessie - 2008-08-12 10:08:34

the thing is if a baby is sick here regardless of social status of parents that child is seen and treated. it may not be the best in the world but it does relieve anxiety for some people who are not of any means. everyone gets the same care. like any one else when they age they better hope their partner lives on too. it is this helping each other which keeps us relatively healthy or contributes to our health. it is not true anyone can purchase health care if you don't have the means you go without.noone is told here in canada who to see. we pay yearly premiums for heathcare out of our pensions and every canadian out of their pay.so we don't get off scott free here. we too get excellent care here. i had a temp pacemaker put in by a cardiologist in our little town of 11,000. for the permanent one 2 days later i went to london's university hospital in an ambulance with a registered nurse and there was absolutely no cost . so yes we are proud of our healthcare system.my husbandw aited one week for bi-pass surgery. just to clear up a few facts jess

Bottom line...

by dward - 2008-08-12 11:08:02

I'm just thankful we have Doctors and I hope that both Canada AND the U.S. health care models can sustain in the long haul.

I live in Canada right now, but am moving to Michigan soon.

I know the waiting lists in Canada can be a bit of a pain (pardon the pun) and smaller towns (at least in BC) are having a difficult time recruiting MDs.

To Smitty, you have to appreciate that other country's view on U.S. health care took a blow for Mike Moore's movie (Hmmmn, he's from Michigan...!)

hey dward

by jessie - 2008-08-12 12:08:12

michigan good for you, you can visit us . in ontario. we live 5 min from the ferry. we have our doctors 45 minutes away but we are in a different county now so we have access here as well to the hospital. it is a bit crazy but our hospital in sarnia is blackballed by the ontario nurses association for 10 years. it is part of why i got out early. the administaration is toxic. i get treated well tho if i go there because i nursed there. here the waiting lists are very much improved. jess

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