Honestly -

[kyburg]

March 5 (Bloomberg) -- The shortcomings in outpatient treatment that were exposed at Walter Reed Medical Center in Washington exist throughout the military health-care system, Representative John Tierney said today during a hearing at the center.

Shame on me for quoting Bloomberg. But honestly.

What was your first clue?

What makes you think care under the VA system - which is a 'benefit', not insurance and they'll be very quick to tell you that at the door - would be much better than the care anyone gets walking into a facility today?

You've been the ER lately - within two years or less. Everyone does - tell me.

How long did you have to wait? Six hours? Longer?

Left AMA before you got care? Sure you did. You probably went home, treated it yourself and scheduled an office visit. You could. Faster.

Get hit with a huge bill, even if you did get seen? Sure you did. Particularly if you did not have insurance, and were you referred out perhaps at the same time to the county facility? Oh, and if you think the VA is short on funds and staff, you ought to try the tax-paid-for facilities that are there to act as the safety net.

We're back to the days before hospitals were considered the place one went by choice to get well.

MRSA? Ever heard of it? No? Go google it. Scared now? Entirely facility born, bred and maintained.

Talk about your elephant in the living room.

Hey. Remember all those wonderful trauma centers? Know where your nearest one is? Or if you even HAVE one? (You in Florida? No. You don't have one. Anywhere. Disney World and everything, and not ONE trauma center in the whole state.)

You get hit on the I15 on the California side of the border between Nevada and California, on your way to Las Vegas. You'll be airlifted to Loma Linda...that's just South and East of San Bernardino.

Hope the helicopter don't crash. Of course, that's after a unit finds you, which could be up to two hours.

Pro-life, my butt.

You know, I think all of this brougha is very nice, but you know something? This isn't symptomatic of the military insofar as our whole healthcare system has been underfunded to the point of failure for decades.

I doubt Walter Reed has to meet JCAHO requirements, being a military facility - that whole 'benefit' thing again, they don't bill Medicare.

This isn't even as easy as taking candy from babies. You're sick and disabled? You're invisible. Oh, until someone makes a news story over it - everyone clucks a bit, people get fired and maybe...maybe someone gets their wrists slapped.

When...WHEN...are we going to ever ACKNOWLEDGE THIS IS A PROBLEM? Change? Oh, that's what you need for the soda machine downstairs.

rrrrr.

Comments

[mactavish.livejournal.com]

We are very lucky that we have a good PPO insurance, can afford (though it's not always easy) to pay our deductibles and copay, and live a couple of miles from what is not only a trauma center, but good enough that it's the official trauma center for the president when he's in the region. When someone got shot across the street from Washington Hospital in Fremont (which has an ER, and perfectly good, oh, maternity and joint replacement), he was helicoptered from there to our hospital.

I haven't always had that. I'm lucky, now.

I like the Australian system, or at least, what it was like last time I investigated it in the early nineties. They have -- had? -- a basic public health system like England's or Sweden's, with issues now and then with doctor choice or having to wait for non-urgent but important surgery. But they also have (again, had? I'm not sure) a relatively cheap private insurance. In '91, my family there paid $28/month for insurance that paid for private hospitals, doctor choice, acupuncture, prescriptions, dental, midwives, just about everything medical one would need outside of the public system. I'm sure that cost has gone up, but still, when they were paying that, I was paying about $100/month for Kaiser.

I know they still have the extra insurance for private care option, I'm not sure how much it costs these days.

[kyburg.livejournal.com]

What I took away from the visit we made a year and a half ago was the enormous amount of liability we were expected to carry for some of the most routine things (they wanted a $1,000 cash deposit upon check in. The rental car had a $2,500 deductible for any damage, and there wasn't an insurance policy we could buy that would cover it. Things like that.) and that health care providers were rather individual in nature and specific. (Plenty of skin cancer clinics, but I don't recall seeing a district hospital or any other facility one would call "central.")

We need to ask deense - she's the Canadian who lives in Australia.

[mactavish.livejournal.com]

Where I lived, district hospitals were all they had, but there were towns of 300 or so, scattered 10-15 miles apart. If I had RA there, I'd have to go to Adelaide for care. That said, I know people in California who travel 200 miles for rheumatology.

[kyburg.livejournal.com]

*raises hand* Lived in Ontario, went to West LA for care. 60 miles each way, an hour solid in the worst traffic LA has to offer.

This is the biggest metropolitan area on the West Coast. Would do it again in a heartbeat.

And I thought it was nuts then, still do annnnnnd stuff.

[feyandstrange.livejournal.com]

And the sad thing is that in some ways, VA care is a lot better than what I get via Medicare and Medicaid. Walter Reed and the combat-vet dumping grounds are hellholes, but the VA did manage to computerize all their records not too long ago; when NOLA was evacuated, the only people who could get immediate care in other states were VA patients, because their records were in the national computer database.

Good thing I live in CA; our state system is so much better than most others.

Although I think people are starting to notice; recent headlines/surveys said that health care was #1 voter priority this election season, and that a majority support a socialized medicine system AND are willing to pay more in taxes for it.

[kyburg.livejournal.com]

California is also the state that takes the federal funds for Medicaid and in turn, provides Medi-Cal and bills us residents for what Medicaid doesn't come across for.

More babies born in CA are born with Medi-Cal insurance than any other provider, including private pay.

Surely someone notices, right?

[feyandstrange.livejournal.com]

Well, I noticed, but I'm still trying to figure out why being fifty bucks over the monthly income limit - my whopping disability check - means I am supposed to be able to pay four hundred every month towards my medical expenses.

And come on, it's not like poor and uninsured people vote. Half of them are illegals anyways, and you don't think we let cripples vote here, do you?

[kyburg.livejournal.com]

I'm sure it's been suggested to you, but if not, let me pass this bit of advice on to you.

Go spend the fifty bucks on health insurance of some kind. Dental. Long-term care. Prescription discount cards. Whatever will bring you under - just under, mind.

What a racket.

[feyandstrange.livejournal.com]

Yeah, that's what I did for last year, but then they tried to run every single claim through my "other insurance" (vision only) first, and things got hairy. ALso, my social worker is out recovering from surgery, Medicaid lady #1 quit, and as of Jan 15 they still couldn't give me the new Medicaid numbers for this year over the phone, because Plan D confused everyone.

But hey, they gave me the wheelchair at last.

[poetpaladin.livejournal.com]

A year ago, I had a really bad fever. Had to go to the ER at night because there was no Urgent Care.

Waited about two hours - this was in Fountain Valley, which typically doesn't have a lot of real emergencies like a city in L.A. would, as the harder cases to go other nearby hospitals.

Charged about $500 after copay. This included a $250 consultation by a doctor that lasted maybe... 4 minutes.

[kyburg.livejournal.com]

You also paid for the tech who checked you in, the housekeeping staff who cleaned the room, the linens on the beds, all the disposable stuff used in your care, the property taxes on the facility, the utilities...all the techs who took samples, the lab who processed them...oh, don't forget the nurses....

It adds up quick.

Oh, and add in the bankruptcy loans the facility has outstanding, and all the patients with underpaying policies that the hospital has to hire collection agencies (and give them a piece of the money they recover) to get the balances from - sense a pattern?

[turandot.livejournal.com]

It adds up quick.

*nods*

I'd like to add that they really try put the screw to you if you have no choice but to undergo hospitalization for surgery. My dad's been through it, I've been through it, and both times there was an exorbitantly ridiculous charge on the final bill.

I had surgery first, where nearly $3,000 out of a $9,000 bill for when I was in the hospital overnight after a surgery: it was basically two administrations of a painkiller by a nurse. I had to laugh maddeningly at that one. I was uninsured at the time, and unemployed, but hell if the hospital did not refuse to discount a single dime on the bill using the argument that since I had been living with my boyfriend for 4 months, I was technically his common law wife*, so he could shoulder my medical expenses.

My parents on the other hand had Humana coverage, and their PPO pretty much argued them tooth and nail over all the charges, also notifying my parents not to pay a dime until the hospital sent a revised bill (because partial payment would equal acceptance). They got the bill reduced by half.

At that point I realized that in my case the hospital knew that not having health insurance meant I essentially had no one on my side who could argue that they were making me pay for my own procedure, and then some. Welcome to fully privatized health systems!


*Found out since that under the laws of most states, including Texas, common law marriage designation requires that a couple has to have lived together, i.e., shared assets, for six months or more. So that was a filthy lie right there (and no, the knowledge that the person on the other end of the phone was under pressure to collect as much as she could from her accounts does not make me any less bitter).

[foogod.livejournal.com]

You know, I think part of the reason that nothing is ever done about this is that every so often I see somebody or other talking about how horrible the health-care situation has gotten in this country and how it was so much better back in the old days, but I've never (ever) heard anybody attempt to figure out how it got so much worse.

What's the reason we're in this fix now? Why is it so much more unaffordable now? I'm asking this seriously, because I don't know the answer either.

Yes, there have been cutbacks in public funding for a lot of facilities, but that doesn't account for anywhere near the amount of issues that have been developing in recent years. Somewhere in there the costs of medicine have also been skyrocketing, and nobody's explained to me why that is.

We can't fix the problem until somebody starts figuring out what the cause is.

Oh, and to be honest, I'm having a hard time seeing the connection between the health care issues in the US and MRSA.. MRSA and things like it are a pretty much inevitable result of our current limits of medical science which people have known were coming for a long time. The quality of health care really had nothing to do with its emergence, as far as I know (well, unless you're arguing for getting rid of all health care entirely, which admittedly would have staved off MRSA, but isn't a great trade-off, in my opinion).

[kyburg.livejournal.com]

This shows my age. That, and my mother's - to be honest.

I can recall her talking about Medicare cutbacks - in 1971. Yeah, the 'trimming the fat' has been going on that long.

There are hospitals who went out of business when Medicare stopped paying so well. At that point, Medicare paid enough for services that facilities didn't have to go elsewhere to cover the cost of providing them (loans, higher fees for other services, etc.) and they got enough funding for indigent care (Halliburton used to provide them, strangely enough - at least in CA, it was one of the terms of receiving state funded loans to build facilities) that so many instances of care went unfunded. Today, you can basically expect (and most do) that if you don't have insurance or can pay on the spot, you won't pay. Ever.

Back in St. Louis, there's a huge hospital standing derelict in Jim's old neighborhood. It must have been close to 1,000 beds back in the day. It went bankrupt - and nobody has taken any interest of trying to revive it. That's the kind of scope we're talking about. Whole facilities were able to run on what Medicare paid - what we're seeing right now, IMHO, is decades of bankruptcies, unpaid services and underpaying insurance policies. Add to that, this is the one industry still seeing growth in the US. And very labor-intensive.

Something has given. It's the consumer.

[feyandstrange.livejournal.com]

Health Maintenance Organization Act of 1973, the switch to HMOs, and cuts to Medicare and Medicaid (which were hardly full-coverage to start with) since, well, their inception.

Antibiotic-resistant diseases were indeed probably inevitable, and I won't argue that they are a very small contribution to rising health care costs. However, better treatment in the first place - and less costly treatment - probably would have slowed the rise of drug-resistant TB in the poor, to take one example. Cost cuts mean doctors and nurses spend less time with the patients telling them to take their antibiotics, the patient can't afford the drugs anyway and so skimps on treatment - voila, drug-resistant TB. And it's possible that overworked staff cutting corners on cleanliness, as well as patients skimping on care, contributed to drug-resistant wound staph.

sputtering at some length...

[nagasvoice.livejournal.com]

My sister (more details in another comment below) stayed in one hospital locally where the cleaning staff complained bitterly to the patients about cutbacks in *how much soap* they were allowed to use on their mops for the floors and for cleaning toilets. They told *me* that the amount they used to use for one floor now had to do four floors. Why? Cost cutbacks by the administration.
I kid you not.
It was not a sanitary place, and to blame it on the cleaning staff is absurd. They tried very hard to do the job anyway, they *knew* what a difference it made, long before resistant staph had been diagnosed anywhere.
Similarly, a cousin's wife back east picked up resistant staph infection in the bones of her spine in a nursing home where the toilets weren't cleaned for the entire three weeks she was there. The infection (by then in another facility) eventually killed her.
My aunt worked for a health care system in the Midwest where the officers of the corporation ransacked the pension fund and all the other assets they could lay hands on in about 18 months, abandoned the company, and took off. (The head pharmacist was running his own fiddles where he had underlings substitute placebos for major drugs like Taxol, goodness only knows where he found to resell the pilfered goods by the truckload, and he left with the rest of the crooks.) Employees found out, a little late, this was the fourth major hospital chain these robbers had bankrupted by buying the company, gutting its assets, and vanishing. There seemed to be no enforcement and no oversight to stop them doing it again in another state, and nobody much interested in preventing it. The pension fund was gone, nobody is ever going to reimburse anybody on the loss. When multimillion dollar companies are run the way Enron was (and worse) then a petty matter of lawsuits over failing to use soap on the floors is of little or no concern.
When nursing home inspectors hit any given facility out here maybe once every ten years, if that, you can be sure the really greedy owners are not paying out for more nurses and janitors to keep the residents in good shape.
That's entirely aside from legitimate companies whose medical malpractice liability insurance is skyrocketing and those county-run facilities groaning under state and federal funding cutbacks of draconian proportions while serving a growing population of sicker local people who are getting priced out of any housing they can afford on minimum wages.
This system has feedback loops of enormous proportions.

[nagasvoice.livejournal.com]

My sister and her partner both have chronic conditions that flare up from time to time. MY sister is on SSDI for her major condition, and her partner is mostly occupied iwth taking care of her, and just now getting back to going to school, has no $ of her own. Recent gallbladder surgery on her partner ended up being courtesy of the county, emergency funds for indigents, because there was *no* other recourse.
Average wait in a county ER when you have medicare (or less) runs about 12 - 16 hours here. That's *before* you see the dr. If you've only got a broken limb without blood running out in gouts and if your fever is *only* 103 degrees.

[riverheart.livejournal.com]

You're sick and disabled? You're invisible.

Sick OR disabled, either one. You're invisible. The system does not exist to take care of you, or (better yet) to help you take care of yourself. It exists to extract money from healthy people while pretending to help those who are not healthy back into health.

Don't let me get started on our "health care" system. There are good reasons why people speak badly of things like HMOs, referring to, for example, our local one, "Group Health", as "Group Death". The PPO system isn't much better. Ask me sometime about all the rigmarole that my doctor and I had to go through to get me seen by the UW kidney clinic. Now that I'm in the system, I'm good, and they'll give me good care (I've gone through major procedures there before, too, so I can speak well of their care). But to get in? Man.

[kyburg.livejournal.com]

Dude, you have my history.

An hour solid each way. And I'd do it again in a heartbeat. Oh, and I was able to find insurance - but what a patchwork mess it was. There's no doubt in my mind Cliff's quality of life would be ten times worse today than when he died in 1998 - it was bad then. Now? *shudders*

[riverheart.livejournal.com]

BTW, you want good, fast care in the ER? Go to the emergency vet. That's the only place you're going to find it. Bonehead got better care, faster, than I did when I was dehydrated.

[kyburg.livejournal.com]

You know, as I think of it? I know there are at least four vet facilities to each urgent care on my way to work every morning. *sighs* That's so true it hurts.