Thursday, January 7, 2010

Rush(ed) to the Hospital and Why Health Care Ain't Broke

(note:  If you're going to comment, make it relevant.   I will be particularly quick to delete long tirades about Rush in general, just as I am about off-topic Obama rants.  And the fact I'm disclaimering should indicate how tired I'm getting over deleting shit.)

The idea for this post began as I basked in the glow that Rush Limbaugh, after missing the first two days of his show (leaving us to listen to the intelligent but boring-as-shit Mark Steyn), returned to do his first show.  Naturally, the beginning topic of discussion was his emergency room visit to the hospital [full transcript].  Unfortunately, while it was a great story, I lacked answers.  So, to clarify what might have actually led to the chest pain, I consulted the nurse. 

Unfortunately, since I don't have a conservative nurse that I know of to look at it and speculate, I ended up on the other end of the political spectrum.  So here's Satyavati's post detailing the problems with the story of Rush's treatment (and professing her everlasting love with every inch of Rush's greatness).  For those of you who will whine and refuse to click the link, I'll give you the summation:
So my conclusion is that it's inconclusive. I don't know what, if any, intervention was given for the two-day gap between evaluation and procedure. I don't know how someone can walk out of a procedure and onto a golf course. I'm just seeing a mix of things I know are true and things that appear to be highly irregular. It's just what I'm seeing. There's problems with the story; it's not complete.
 This was the sense that I got that forced me to seek out professional assessment of the story.  It continues me along the lines of asking questions, specifically concerning the fact he is (as far as we know) a recovering addict.  And it serves as a disclaimer for citing Rush as the source of the rest of the post.

The relevant part of the story (to this post) is twofold.  First, there was the level of treatment that Rush received from the onset of the chest pain.  And second, the issue of payment.

Health Care Ain't Broke

Rush has stated in the past, and specifically on Wednesday that, "There's nothing wrong with the American health care system." Well, yes and no.   We'll deal with the 'no' part first.

With the obvious exceptions, most nurses and many doctors don't see their work as just a job, or even just a career, but as a calling.  They got into their profession to help people.  Combine that with the technology that has flourished in a free society, where innovation pays, and we have an excellent system for administering care.

In the Limbaugh case, hotel security helped him until the EMTs got there.  They stabilized and transported him to the hospital, where doctors ran their tests.  This is what would happen to anyone on the receiving end of emergency service. 

The simple fact is, that when our doctors and nurses set out to fix problems and heal people, they generally do a damned good job.  And it's when the only people making decisions are the doctors (or nurse practitioners) and patients, the system works best.

It's like tech support (something I know a little about), except with lives. If I can fix it, I'll do my damnedest.  If not, I do my best to get them the help they need.  So it is with the medical community.  At least until we come to....

Paying for Health Care is a Clusterfuck

Rush trumpeted what happened when he paid cash for his stay instead of having to go through an insurance path of some kind.  And according to him, he got a discount for paying cash, rather than forcing the hospital to have to submit paperwork to an insurance company, then have it denied, then resubmit with some more documentation, then wait for a couple more months before a check for half the asked amount shows up, then they have to submit something else to get more cash, and so on and so forth (yes that was a runon sentence, but that's the point).  And while it wouldn't be practical for most of us (I don't have a documented figure, but it was about $12k) or possible for some of us, the key to fixing health insurance and the price disaster is found in this example.

Because it's something I've been saying for a while now.  The biggest problem with access to health care is the price of health care (because the doctors are there) and the biggest cause of the overpricing of health care is that we don't pay for health care ourselves.

There are a few things that counter this trend.  The concept of a nurse-in-a-box:  a basic health clinic set up in a chain pharmacy or a Wal-Mart that does some basic medical checkups and such, referring anything serious to an actual doctor (because not everybody needs to see a doctor).  Web sites that allow you to shop around for procedures or services (still hazy but growing).  And more knowledge in general thanks to sites like WebMD (although most of the answers seem to be "go see a doctor").  And the concept of actually getting market forces back into the offering of health care (because health care is mostly an oligopoly).

But most of the things being thrown up (as vomit is) to "solve" the health care "crisis" are simply continuing the trend toward taking what should be simple and personal and direct and making it into a ghastly beastly all-encompassing irrational rationed hell care system.

It began simply enough.  We began on the road to the Imperial federal  government being the controller and gateway for medical care for all of America with the establishment of Medicare (with the noble "goal" of taking care of our elderly) and Medicaid (doing the poor the same way).  (disclaimer:  I am currently in the Medicaid system, mainly because I have my children to worry about.)  Meanwhile, in the private market, it became part of the compensation package from employers.  It seemed sensible at the time:  Paying a small amount now as part of your pay to cover expenses down the road.  However, when we don't feel the pinch at the time we use something, it's easier to spend it (also how we get into trouble with credit cards, by the way).  In addition, large insurance companies, who enticed individual doctors to sign on with them, had more power to bargain for better prices, then be able to control the prices.  In the end, both private insurance (continually subjected to more mandates to cover an increasing list of shit (some good, some stupid)) and the government-run monstrosities found that with more people using more services, costs had to be controlled further.  To compensate, the prices began going up.  Fast.  Furthermore, as the states laid more mandates as to what coverage had to be, they also limited what companies were able to even offer insurance, and any semblance of the free market became a joke.

Now, we live in an era where government continues a relentless march to control the purse strings of every individual by demanding either insurance coverage or money.  And for those who can afford to go without insurance and pay the penalty, the insurance goes out the door.  Add to that the next mandate, covering people who will cost more money than they will pay in, and also mandate that you can't charge for that, and the prices will continue to rise, until no one can reasonably afford it.  And as mandates pile on employers to provide or pay, they'll take the less expensive hit and drop coverage.  Then there's the taxation of health insurance, especially those policies that are too "extravagant" by government standards (hint, the really rich, like Rush, just pay cash) which means soaking the source of all real tax revenue, the middle class.

In the end, because the system is too controlled, prices spin out of control.  This means our Imperial Federal Government gets to ride in to "save" people "and "fix" the mess caused by "private insurers" and the "free market" and the EEEVIL rich, who still have more money than the proletariat.

I've advocated solutions, as have many people.  Solutions that don't require the government to mandate what I have to eat to stay healthy, what tests I have to take to keep costs low, what medical care I deserve, or to hold my dick while I piss, because I might turn the stream on them.  But in the hellbent rush to "do something" the political class of Washington continues to find their solutions by adding to the pile of laws that caused the problems in the first place.  And rather than targeting the actual problems (the 30 million uninsured, for example), it's a mad rush to pile on page after page and bill after bill.  And except for devotees to the idea of universal government health (no) care (ask the VA), anyone knows that continuing down the path we've been going since FDR is a continuation of every mistake we've made so far.

In the end, there will be some nice islands in small countries where people like Rush and Obama will go for the best health care in the world.


Bee said...
This comment has been removed by a blog administrator.
Toad734 said...

If our health care system wasn't broken my brother wouldn't be an addict right now.

And no, the health care system isn't broke for rich people. The problem is that only 3% of this country is rich.

I have had an arm injury for 2 years now, after about $1000 in medical bills I am afraid to invest any more into it. If money weren't an issue, I am sure it would be fixed by now.

Patrick M said...

Bee: I think there was fair question in that mass of blather. Doesn't stop me from moderating it out of existence.

Where were the policies that made this situation unsustainable?

While the Democrats can certainly own the majority of things that created the health insurance mess we now have, the GOP did their fair share of damage. A perfect example from the Bush era is the Mediscare prescription drug debt. There are few heroes here

Toad: If our health care system wasn't broken my brother wouldn't be an addict right now.

I'm not sure how, but bu that rationale, neither would Rush.

As for the arm, of course money is an issue. If money weren't an issue, I'd have a perfect mouth of teeth. Money will always be an issue in everything. But trying to take it out of the system out of some misbegotten notion that we have a "right" to other people's time and money means that instead of having to make the decision on how fixed you want to be based on your finances, you get a bureaucrat (insurance company or government) deciding if your arm is good enough instead.

A Pissed off American said...

The sickness of your readers (commenters) is over whelming.
I ahve been reading where so many of them had wished that Rush had died.
And they call republicans mean and call themselves compassionate.
The things that drip form their ugle mouths is such bull-shit

Satyavati devi dasi said...

The sickness of your readers (commenters) is over whelming.
I ahve been reading where so many of them had wished that Rush had died.

I sure would love to know where you read this.

One of the things that I hear a lot from the conservative side is about charity, how we're such a charitable nation, how we take care of those who can't take care of themselves, and we should leave the health care business alone, because we can take care of everyone with charity.

If this were true, we wouldn't even be talking about reforming healthcare, because everyone who had no health insurance would be taken care of through the generosity of their neighbours, communities, churches and so forth.

I can assure you that in the real world, this doesn't happen. Fund raiser fish fries and stew sales might get you $500, if you're lucky. Your church might possibly, once a year or so, give you $100. Meanwhile, your baby averages a week-long hospital admission every month for something that isn't his, or your, fault. That week-long admission in intensive care costs upwards of $20K. Every month. You put in as many hours as you can at your $10/hr job, because you never know when the baby will be in the hospital, and you take care of your other two kids on your own, because the deadbeat daddy is sitting in jail for all the child support he hasn't paid. You live in a dump because it's all you can afford, but you try like hell to do the best you can for your babies.

The baby alone racks up close to a quarter of a million dollars in medical bills every month.

Do you think the neighbours, church, and community will support you? How about all the other people just like you in your area? Think they've got a quarter of a million between them sum toto? Think they're all ever so willing to help you out?

If charity was enough, we wouldn't need to reform healthcare, would we?

Satyavati devi dasi said...

The baby alone racks up close to a quarter of a million dollars in medical bills every month.

Sorry... meant 'every year'.

Satyavati devi dasi said...

If our health care system wasn't broken my brother wouldn't be an addict right now.

Toad: I say this with all the love in the world and I mean it. Your brother, regardless of what kind of health care system we have, will be an addict til the day he dies. Whether he uses is a choice he has to make every day. That's something he has to own... no one ties you down and forces you to make these decisions. Equally, no one wakes up one day and thinks 'hey, wouldn't it be cool to be a junkie'. I'm just saying. Addiction is a disease. What we do with it, and how we manage it, is a completely individual thing, and dependent on no one but that person.

Pamela D. Hart said...

Toad: I'm with Satyavati. The Health Care System didn't fail your brother or any other addict.

My sister is a "recovering" heroine/cocaine addict and Rush is a "recovering" oxycodone addict. The ONLY difference between the two is that Rush paid CASH for his recovery program and our Government (our taxes) paid for my sister's.

Addictions are extemely difficult to kick, but it can be done. In my book, however, they fall under the "personal responsibility" category".

One of the things that I hear a lot from the conservative side is about charity, how we're such a charitable nation, how we take care of those who can't take care of themselves, and we should leave the health care business alone, because we can take care of everyone with charity.

Satyavati: There was a time, long ago, when communities and churches were able to do this, but not anymore.

I am a Conservative that does believe we need true Health Care reform, however, the current bills running through the House and the Senate aren't TRUE reform. They're catering to big business, Pharma, lobbyists and Politicians. There's not a whole lot in there for "the people". Highere taxes, Medicare cuts, mandates and more govt. jobs, and neither bill is going to cover ALL Americans, plus the Senate bill won't go into effect for 4 years! It's really shameful.

Satyavati devi dasi said...

Speaking from within the healthcare industry, as it were, I don't necessarily believe it's possible to enact all the reform that's really required at one time. The problems are too far-reaching and actually extend into cultural and societal mores in this country; too many people who are adamantly, staunchly, passionately against anything 'socialized' really don't know what they're talking about. (Like the folks who hold up signs telling the government to get out of Medicare, and yes, Patrick, I know that not *everyone* believes this).

I have been active in supporting the socialisation of medicine in this country since 1985, before I was old enough to vote. The absolute necessity to me for all Americans to have access to quality healthcare (and not having insurance DOES in many cases equal lack of access for practical purposes; I myself put off intervention for a broken ankle/96% ligament tear for 3 months until my insurance kicked in with devastating consequences) was a major player in shaping my future political orientations. But I am neither naive enough nor revolutionary enough to think that it's possible to entirely dismantle the system in one shot.

However, we have to start somewhere. The system is untenable as it is. Where disagreements come is in where to start and how to do it. This creates its own problem; we can stand around and have pissing contests over it for virtually ever, and meanwhile, people are still dying. At some point you just have to jump in and get started. It's all a mess no matter where you begin, so just pick up a shovel and get to it.

To completely reform healthcare in this country is going to take years, and more bills than one. It's going to take addressing entire parts of the industry. It involves streamlining the delivery system (ie, hospitals, etc, the places healthcare actually is given) from information systems to medical professional education. It involves insurance, the FDA, international pharmaceutical corporations.. it involves the dissemination of truthful knowledge to the public.

We have to begin somewhere. All change is hard and when industries stand to lose money they are not above putting out information that miseducates the public into supporting them (the beef, dairy, egg, tobacco councils have done this for decades). People who were raised in the shadow of McCarthyism may not know anything about socialism, but they sure know it's the incarnation of evil, and by God, get out of my Medicare.

All I'm saying is that it's unreasonable to expect that one piece of legislation is going to fix the system, but that we have to dig in and get started, because as melodramatic as it sounds, days can be counted in lives for the number of people who go without healthcare in this nation.