Sunday, October 2, 2011

American Healthcare Systems Needs Overhaul To Focus on Fair Access and Healthy Futures

The world will read this blog post, and probably correctly call their own health care system superior to the American model, despite any improvements that may have already been enacted here.

Doctors in America work in a system in which they routinely and unwisely lose interest in their patients and get away with it. Medical doctors in America refer their patients around other doctor's offices without caring about outcomes just because they don't have to, and get paid for it.

They do not automatically, and only rarely, request a follow up return visit. They just seek payment for referrals of patients to other doctors and forget who matters. I have had doctors at all levels do that, and it makes me angry at their irresponsibility. They don't get paid for caring. They get paid more for other so-called services, like ripping people apart in surgeries, whether or not they have had their medical education in the United States.

They are in it for the money, and they are not supposed to be and should care more for their patients. They do not know if patients have followed up on their ailments and they don't care if  patients don't follow the recommendations -- sometimes because patients can't afford to. If patients don't get treatment, doctors wouldn't know or care. I know because I have been treated that way, too, and I supposedly have good insurance that covers catastrophic incidents.

American medicine is a joke for most Americans, even me, a vacuous hollow of the good health care system the country could have if it ever got its act together. It is an extremely poor, inefficient system, as it has been for at least thirty years since I have lived, fortunately healthily, for the last thirty years in this country.

Here's a good example of a gross inefficiency of the medical system overall...Someone who has insurance in one state has to pay the bills for health services rendered in another state.

That's exactly what happened to a good, old friend of mine, my former cleaning lady, who lives in Florida and pays health insurance there. When she visited her daughter on holiday, she had emergency gall-bladder surgery in New Jersey. A couple of months later, she has been billed for more money than she makes in a year in Florida.

A little background: she was visiting her daughters in New Jersey  when she was admitted. They looked after her when she was discharged from the hospital. She lives alone in Florida, so it was actually better for her to have the operation in New Jersey and stay afterward with her daughter's family. She also knew and trusted some of the doctors who performed the operation because she used to work cleaning the hospital for thirty years and felt familiar with it. Another of her daughters works at the hospital...

Which brings us back to the paperwork and the expenses  she submitted from  her New Jersey hospital that are now being rejected by her Florida insurer. Does this make sense to charge her to pay more for a required procedure than she can  make in one year? In her sixties, she labors in a job requiring a lot of physical effort. She might have spent a few more expensive days in the hospital in Florida had she done the procedure in that state. She would certainly had a lot more personal trouble since she hadn't anyone to help her post-discharge. She is understandably disputing her bills.

In an even more extreme case, an article called "Stuck in Bed for 19 Months, at Hospital's Expense" in the New York Times today tracks a case in an extravagantly inefficient American health care system that lacks accountability for long-term patients without insurance. The profiled patient had previously made $400 in cash each week, and been abandoned by his wife and children who could not afford his care, although he ultimately returned home.

"For the $1.4 million in services that [the hospital] had provided, total reimbursement to the hospital from Medicaid was $114,000...

If he had been insured or immediately eligible for Medicaid or Medicare, he might have gone to a nursing home after a week or two, where the average daily cost in New York is about $350 — and where he might have had steady companionship. Or he might have received a home health aide in his apartment, which could have cost even less, depending on the required hours. 

For hospitals---that treat many illegal immigrants, the health care plan enacted last year does nothing to solve this liability...During debates about reform, lawmakers insisted that the plan’s benefits not extend to the nation’s 11 million illegal immigrants...Nor is this likely to change."

Hospitals keep patients and can't efficiently care for them; they don't automatically transfer them to less expensive  locations. This inefficiency is another example that hospitals fail to address. Even if hospitals say they don't have the money, by not improving this practice they have, in fact, consciously condoned it. They  actually allow patients  like him to stay at a place that normally charged over USD$2,000 a day instead of  forcing them to transfer to another  less-expensive alternative at $350 a day.  Why are the 'powers that be' not ashamed of this administrative malpractice. Why are they not held accountable for their inefficiency?

Either expense will appear nonsensical and outrageous to my international audience.  Yet, America lacks the business and political will to improve health care. Meetings between hospital, long-term care facilities, and the government should have taken place to care for this patient instead of making me, a taxpayer, help pay for his excessive bill and their mistakes. Let's face it, many mistakes have been made that have not been corrected yet. There should be financial incentives to reward results in the best interests of the long-term health and longevity of the patient. Successful diagnoses  obviously need to be followed through with intelligent treatments. Treatments and results matter to patients. America has a system where doctors are better rewarded for referrals and invasive surgery than long-term results, and have the wherewithal to sway politicians with graft.

If you are an international visitor, or on business, in the United States, and happen to land in the hospital, these extremely high bills will have to be paid.

What about patients who are airlifted to safety only to have to pay more than they can afford? They have no choice but to pay, unless covered by the appropriate insurance.

Instead of being an intelligent, broadly inclusive health care system, the bureaucratic rules are unintelligible at times, disconnected, and open to inconsistency and misinterpretation on an individual level. 

It should have made taxpayers in America revolt by now. Oddly, that has not happened. Businesses could not change the health care system; the inefficient American health care system has led giant car companies to bankruptcy.

Sensible rules to reward follow ups and make records of results need to be formed by the government,  as the British and Canadian governments did after the Second World War, or else all that is left is inefficiency and chaos. The rich might or might not pay for high end treatments, but every taxpayer loses overall in the American health care system. And that's not being caring, charitable, or compassionate to patients. For this reason, the American government must rule where businesses do not for the greater good of all patients. I just hope I don't get sick; the risks of getting sick are too horrific and expensive for me to imagine.

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