A Second Opinion on US healthcare

  1. http://www.nytimes.com/2004/06/28/opinion/28HERB.html

    Published on Monday, June 28, 2004
    A Second Opinion
    by Bob Herbert

    In an article a few years ago in The Journal of the American Medical Association, Dr. Barbara Starfield of the Johns Hopkins School of Medicine took a look at the overall health of the American people, and compared conditions here to those in other industrialized countries.
    What she found was disturbing.

    "The fact is that the U.S. population does not have anywhere near the best health in the world," she wrote. "Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators."

    She said the U.S. came in 13th, dead last, in terms of low birth weight percentages; 13th for neonatal mortality and infant mortality over all; 13th for years of potential life lost (excluding external causes); 11th for life expectancy at the age of 1 for females and 12th for males; and 10th for life expectancy at the age of 15 for females and 12th for males.

    She noted in the article that more than 40 million Americans lacked health insurance (the figure is about 43 million now) and she described the state of Americans' health as "relatively poor."

    "U.S. children are particularly disadvantaged," she said, adding, "But even the relatively advantaged position of elderly persons in the United States is slipping. The U.S. relative position for life expectancy in the oldest age group was better in the 1980's than in the 1990's."

    The article was published in the summer of 2000. At the time Japan ranked highest among developed countries in terms of health, and the United States ranked among the lowest.

    Last week I talked with Dr. Starfield, an internationally respected physician, professor and researcher, and asked whether the situation had improved over the last four years.
    "It's getting worse," she said, noting, "We've done a lot more studies in terms of the international comparisons. We've done them a million different ways. The findings are so robust that I think they're probably incontrovertible."

    The U.S. has the most expensive health care system on the planet, but millions of Americans without access to care die from illnesses that could have been successfully treated if diagnosed in time. Poor people line up at emergency rooms for care that should be provided in a doctor's office or clinic. Each year tens of thousands of men, women and children die from medical errors and many more are maimed.

    But when you look for leadership on these issues, you find yourself staring into the void. If you want to get physicians' representatives excited, ask them about tort reform, not patient care. Elected officials give lip service to health care issues, but at the end of the campaign day their allegiance goes to the highest bidders, and they are never the people who put patients first.
    To get a sense of just how backward we're becoming on these matters, consider that in places like Texas, Florida and Mississippi the politicians are dreaming up new ways to remove the protective cloak of health coverage from children, the elderly and the poor. Texas and Florida have been pulling the plug on coverage for low-income kids. And Mississippi recently approved the deepest cut in Medicaid eligibility for senior citizens and the disabled that has ever been approved anywhere in the U.S.

    Even the affluent are finding it more difficult to obtain access to care. For patients with insurance the route to treatment is often a confusing maze of gatekeepers and maddening regulations. The costs of insurance are shifting from employers to employees, and important health decisions are increasingly being made by bureaucrats and pitchmen interested solely in profits.
    In the maddening din that passes for a national conversation in this country, distinguished voices like Dr. Starfield's are not easily heard.

    Echoing so many other patient advocates, she continues to call for movement on two crucial needs: coverage for the many millions who currently do not have access to care, and the development of a first-rate primary care system, which would bring a sense of coherence to a health care environment that is both chaotic and wildly expensive.

    "We don't have any national health policy at all in this country," said Dr. Starfield.
    And there is no sign of that changing anytime soon.
    Copyright 2004 The New York Times Company
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  2. 22 Comments

  3. by   Dixiedi
    And it will continue to get worse because our system focuses on hand outs.
    Our medicaide recipients are allowed to walk into the ER for a runny nose. Insurance companies keep raising rates because, unfortunately, insurance companies are not in the business to provide affordable healthcare, they are in business to make a huge profit.
    I would be very interested in pioneering a project that facilitated a group of uninsured working families to create an insurance co-op. It would have to work as any other HMOs to prevent abuse (maybe a NP to see them for referral to specialist or somethhing of that nature)
    Our HMO could buy group catastophic illness coverage from BCBS, hire our own docs (general practice, pedi, OB, allergy) have a few specialist on retainer, etc.
    I believe an insurance company in business to provide health care at reasonable prices would do far better for far less than Anthem, BCBS, etc that are in business to make money.
  4. by   fergus51
    I thought it was interesting you mentionned the need for a referal before getting an appointment with a specialist Dixiedi. In most Canadian provinces you need to see a GP before being a specialist and people complain about it a lot. I think it's a necessary thing too, but that's just me.
    Last edit by fergus51 on Jul 4, '04
  5. by   Dixiedi
    Quote from fergus51
    I thought it was interesting you mentionned the need for a referal before getting an appointment with a specialist Dixiedi. In most Canadian provinces you need to see a GP before being a specialist and people complain about it a lot. I think it's a necessary thing too, but that's just me.
    The HMOs that require it here also get a lot of complaints. However, it is a very good idea from a pt safety standpoint as well as cost savings.
    There's no reason for a person with known seasonal allergies to run off to the allergist just because spring has sprung. A GP can prescribe a regime at much less cost. If that doesn't work, then a referral to the allergist would be called for. The pt could then come in to see the NP (why see the doc again - NP could have prescribed the regime to start with - anyway...) the NP could then make the referral to the allergist and the pts medical history would go with them! Folks just going to see a specialist all up on their own will not usually be able to provide an adequate Hx. We all know the problems that very often creates for the pt.
    Managed health care. "Our" insurance company would manage the members health care to provide the best care possible at the lowest price possible. That's really gotten lost these days.
    Walk-ins for colds, flus, sprains, etc can be seen by a NP. They'd be in and out a lot quicker for less money. The NP would send them on to the doc if needed, but I'd say most walk-ins don't really need to see a doc. Hell, most of them don't need to see a NP, they need to go to Walgreens and pick up some DayQuil, DeBrox, Mylanta, Tylenol or other! lol
  6. by   fergus51
    We are DEFINITELY in sync there!!! I would love more common sense in healthcare, and I mean that for both Canada and the US.
  7. by   Dixiedi
    Canada has socialized medicine, right?
    How is it as messed up as ours if it is?
    Oh gees, what a mess!
  8. by   fergus51
    Not socialized really (It's government funded, but not government run). There are problems, but they are different problems. The most common complaint in Canada is the waitlists for certain tests and procedures (though a lot of the people doing the complaining seem to forget that they wouldn't get it done at all in the US since they couldn't cough up the money for it). Dollar for dollar we get a lot more than the US, but we spend fewer dollars. Personally speaking, I would rather be in Canada if I get sick, but choose to work as an RN in the US right now. I don't like how things here are all about money, but I do like the wage.
    Last edit by fergus51 on Jul 4, '04
  9. by   KarafromPhilly
    BCBS is a nonprofit, actually. Several years ago many of their people went on strike b/c--get this--their employer tried to cut their health care benefits. How sad is that???
  10. by   RN4NICU
    Quote from KarafromPhilly
    BCBS is a nonprofit, actually. Several years ago many of their people went on strike b/c--get this--their employer tried to cut their health care benefits. How sad is that???
    Almost as sad as health care providers having some cheapo, doesn't cover crap policy from an insurance company that is affiliated with the hospital system...and a punitive sick call policy to add insult to injury.
  11. by   Dixiedi
    Quote from KarafromPhilly
    BCBS is a nonprofit, actually. Several years ago many of their people went on strike b/c--get this--their employer tried to cut their health care benefits. How sad is that???
    I did not know BCBS is nonprofit, explains why their offerings far exceed other options I've come across over the years. Anthem is one of those that just crack me up!
    Working in home care, I see the insurance side of the business (probably) more often than the average staff nurse. I have never seen a pt with Anthem that did not have to also have supplimental medicaid becasue Anthem doesn't pay for this, that or anyting else!
  12. by   catcolalex
    I would rather be in Canada if I get sick, but choose to work as an RN in the US right now. I don't like how things here are all about money, but I do like the wage.
    just another example of people badmouthing the US yet "choosing" to live here and benefit from our system. Also, how two-faced is this statement?
    I don't like how things here are all about money, but I do like the wage
  13. by   fergus51
    Quote from catcolalex
    just another example of people badmouthing the US yet "choosing" to live here and benefit from our system. Also, how two-faced is this statement?
    Your system is mine too. I'm an American citizen so I still have the right to "choose" to live anywhere I want. And yes, I choose to benefit from the system where I live and I also contribute to it, same as everybody else. Where did I badmouth the US exactly? I am honest about the problems with the American healthcare system, just like I am with the Canadian healthcare system. What's the problem with that? Should I pretend the US system is perfect? Why the defensive reaction?

    As far as the second statement you don't like, I'll explain. I don't believe people should be denied care because of money and I don't like having to constantly be thinking about it at work (seeing the treatment of the medicaid vs private pay, seeing the hospital lay off workers because they have been stiffed on too many bills, etc). It isn't something you see in Canada. I like my wages here in American dollars because putting my American dollar paychecks on my Canadian debt is helpful thanks to the exchange rate. It's simply an honest discussion of the pros and cons of living in each country. I maintain the US has more opportunities for nurses, but it isn't where I would want to get sick. Life is always about tradeoffs and that's the one I have made for now. I will most likely choose to live in Canada again in the future where my career opportunities are not as good, but the benefits are better. If you can point me in the direction of a perfect country, I'll happily leave and stop annoying you.
    Last edit by fergus51 on Jul 5, '04
  14. by   Dixiedi
    Loved your answer to catcolalex Fegus. Too true! The US has lots of problems but it's still the best game available. Some things better elsewhere, but they are few in number.

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