The Folly of Managed Care
A few days ago my wife was rear-ended while sitting at a red light. While she and my son were unhurt (for the most part) a few days later she was complaining of pain in her jaw, neck and shoulder. This wasn’t surprising to me as it is usually about 24 hours before such aches and pains show up. The problem is that the pain in her jaw isn’t going away. So she called our HMO to try and get into see a doctor. The problem is nothing is available for up to 10 days and if she is really in discomfort her only only options are to:
- Go to family practice and wait for a doctor to have a few spare minutes to see her or
- Go the the emergency room.
Seriously, that is what they tell her on the phone.
The spiffy thing about this, from a cost containment perspective is that option 1 discourages my wife from going to see a doctor at all, even though she might have an actual problem. Option 2 on the other hand is just stupid and costly. This isn’t an emergency room issue and she should see a doctor in family practice.
Fortunately, she as an appointment with our dentist much sooner than what is available with our HMO.
And people think that managed care, with the government doing the managing, is the answer. Pardon me while I fall down laughing.
I’d characterize your experience as definitely no better, and probably quite worse, than you’d be likely to experience under single-payer, even with the worst socialized systems. It’s amazing that you somehow use this as fuel for _your_ position. The market did a bad job of providing you a doctors’ appointment, so somehow socialized medicine is to blame?
Wow, because your private HMO is doing such a bang up job?
Your ideology is overwhelming rationality.
So one instance of a crappy HMO is enough for you to disavow all Gov’t care options, eh?
I spent 30 minutes waiting at the Columbus Health Department (a sparkling new and spankingly clean facility) and received excellent care and instruction along with a battery of tests, saw a doctor and received medication, all for a $25 donation. Visit their web site if you need further review. Maybe you and your wife should move here. Or Canada. Or England. Or any other of a dozen nations that know how to manage care better than for-profit HMO’s.
But Steve, realize that even socialized medicine managers can improve by gaining new insights.
For example on the failure of the Canadian system to provide for child delivery.
“It’s a big number and bigger than the previous capacity of the system to deal with it,” said Adrian Dix, a British Columbia legislator, told FOXNews.com. “So when that happens, you can’t have a waiting list for a mother having the baby. She just has the baby.”
…
“The Canadian healthcare system has used the United States as a safety net for years,” said Michael Turner of the Cato Institute. “In fact, overall about one out of every seven Canadian physicians sends someone to the United States every year for treatment.”
So with Hillary care, your wife might have been given the third option to go to a country without nationalized health care to actually receive health care.
If you love how congress is taking care of the problems facing the country, then vote to put them in charge of tacking care of your health problems.
Three things. First, this is a good argument for immediate care clinics and/or intermediate care facilities who can handle non-emergency yet necessary needs. Your options were limited so how can we increase options?
Second, I’m glad everyone’s okay.
Three, I see your point. Bureaucracies can be a huge problem so why create and even bigger one with no incentives to treat people right.
For every Columbus Health Department there is a King/Drew Medical Center, you can ask someone about their King/Drew visit..but there is a good chance they are dead.
It isn’t about blaming socialized medicine for an HMOs failing, its realzing that socialized medicine controls costs through the same means.
One other interesting I found when I was in Austria recently was that while they have the socialized medicine the costs are split 70/30 between the government and the patient, so its not as “free” as one would think.
Yea, I’d just have to echo the above thoughts. Managed care is creation of the private sector and glommed on by the right wing as a “fix” for the problem with government paid health care.
The fact that your private sector insurance can’t figure out how to solve this problem doesn’t mean that there aren’t ways of solving it.
Never thought of you as an apocalyptic, but the picture is becoming more and more clear.
This simply does not follow. The current system contains incentives to not treat people. HMOs make money by withholding care.
France is an excellent counter example to the absurdity of the two-tiered American system of a long wait or an emergency room. They have a system of on-call physicians who will come to your home at any time of day or night for a very reasonable fee. This system reduces overall costs by limiting expensive ER visits, and improves overall health by actually treating people quickly.
Such a program by itself isn’t profit making, but it makes economic sense as a component of a universal managed care system. Private HMOs don’t have the incentives or scale to develop such a program.
Truly we need a libertarian solution: a bottle of bourbon and Bob’s your uncle.
Libertarian? I don’t see any mention of pot, guns, or gambling.
When your wife turns age 65 her worries will be over. She will qualify for the fee for service Medicare and could then make an appointment with any doctor she wanted to as soon as they could see her.
If she lives long enough she will never have this problem again.
Or alternately we could just provide Medicare to everyone right now. Problem solved.
It does become increasingly difficult to imagine what Steve would consider evidence *against* his position. Hope Mrs. V. has a speedy recovery.
Steve’s position is quite simple:
It’s not just managed care, Steve. Here in Chicago it’s the same for plain old fee for services care. The problem is that there is no excess capacity. Lack of excess capacity is the fundamental flaw in the economic model for universal coverage.
As should be obvious from what I’ve been harping on around here, I’m in favor of much, much greater capacity.
It will be awesome when Wal-Mart gets in to the health care racket–24/7 access, part time doctors imported from China, and an examination room in as much disarray as the typical clothing department in WalMart.
Your insurance doesn’t cover urgent care clinics? That is usually the option between the ER and your regular physician.
I think they already are. I know that many grocery chains are beginning to include clinics in their stores that offer an RN who can do a basic exam and prescribe medications, which you can then fill at the store’s pharmacy, and they usually charge the same as your regular physician’s office but keep the same hours as the grocery store. This is the only movement I’ve seen so far at improving the supply side of the equation, while also lowering the barrier to entry (RN instead of a full MD).
An example from my neck of the woods: http://www.thelittleclinic.com/default.asp
I know of no states where RNs may prescribe medications. Advanced-degree nurses (Nurse Practitioners) can (my wife is one), but not RNs. And having seen the students in RN courses (my wife taught nursing at Penn State/Hershey for a time), this is a very good thing.
Steve,
First of all, jaw pain 3 days after being rear-ended? LOL! That’s just BS. I am sure that since you are a liberal you will be suing someone soon, and are posting to gather evidence for the suit. Maybe you even coached her about the “pain”?
In any event, move to Canada. I’m sure you will like it much better there. Oh wait-she will still have to wait, and even longer. Their lawsuit situation isn’t nearly as jackpot as the US. And you wuld have to actually live in Canada. All bad options, huh?
Ok, I am corrected, I am pretty ignorant about the requirements and abilities associated with the different nursing titles. The website I liked to does specify that they are staffed my nurse practitioners.
France? Isn’t that the country where 10K people died because it was hot?
United States? Isn’t that the country where 18,000 people die each year because of the lack of health insurance?
Oh, and heat waves aren’t caused by socialism.
Geebus.
Hal, I think JohnG was merely pointing out how wonderful it is that Al Gore won the Nobel peace prize for addressing such an important issue.
<hehe>
Hal,
Why don’t you go live in Canada? Please.
And if you are so concerned about people getting killed from lack of health insurance, then I hope you are donating most of your income and assets to their needs. No fair having fun while people are being offed by evil republicans!
Christopher – Were you trying hard to be a jackass just then or did it kind of happen all by itself?
It’s amazing the socialists who want everyone to be the same no matter if they sit on their butts or work their butts off because God forbid people achieve anything who want to socialize medicine are doing this during Breast cancer month.
Because every socialized medicine company has a higher death rate from breast cancer and other diseases where early detection is key.
When you hear about illegals crossing the border to steal identities from Mexico there is another border situation.
Cities near the Canadian border have patients all the time who have to wait in Canada for life saving treatment.
It makes it even more have and have nots. When you have to pay out of your own pocket for any kind of decent service instead of waiting for the government.
ANd under socialized medicine don’t dare get sick after age 60. They like to kill those people. And dare have a child that has problems. Forced abortions.
There’s a reason the Nazis were the NATIONAL SOCIALIST PARTY.
meant every socialized medicine country not company.
Of course where would all the people coming here for healthcare go if the socialists get their way?
Hal a member of the NATIONAL SOCIALIST PARTY what about all those people dying of diseases where early detection is key in other countries?
The pro Communism anti America people who hate WalMart because of all the lies that have been told in the Hate America first love Bin Laden media don’t have a clue.
I haven’t gone to Walmart but I did go to a local Walgreens about a rash a few weeks ago. Got it looked at, some topical ointment applied and I was good to go. Cleared up in a couple of days. This was on a Sunday and hardly was worth an emergency room trip but I itched horribly and it looked weird.
Or they can advise you to go to the ER.
I was given a topical ointment and told what to watch for and to call my physician if it wasn’t gone in 3 days.
And a nice write up of the findings to take to my doctor for my file.
If you believe that, then you must also believe that North Korea is a democracy, in which case I have some ocean-front property in Tennessee I’d like to sell you.
Steph, I’ve owned my own successful business, have you? I’ve actually had employees and had to pay for health care and benefits? Have you?
Hal a member of the NATIONAL SOCIALIST PARTY
I love it when the wingers get fired up about socialism. Hey, how about that 40 hour work week? Going to give that back because it was a SOCIALIST, UNION won thing?
Didn’t think so.
Steph, fantastic spoofery. The rambling, incoherent four post shotgun blast of wingnuttery is truly excellent! The “Nazis = socialist” is a good start, but old hat to anyone spoofing a winger. But you really took it to the next level with the completely nonsensical, yet clearly anti-immigrant, “illegals crossing the border to steal identities from Mexico.”
Beautiful.
Let’s not overlook this gem:
Jeebus.
Since you socialists hate this country so much LEAVE! Every socialist hates this country so they are free to leave.
Andy of course the pro stolen identity pro rape and murder (as everyone pro illegals is since they think crime is okay) accuses me of being anti immigrant. NO WORTHLESS SLIMEBALL I am anti illegal.
AS far as the Nazis being socialist they were.
The unions were once good but now they are not worth anything.
GET RID OF THE SOCIALISTS THEY HATE AMERICA.
Sorry I want to be awarded for my hard work and want it to matter whether I sit on my butt my life or work hard to achieve things.
And the worthless business owner here who wants the government to pay for healthcare for his workers.
PRobably rapes and beats employees daily.
Bravo, Steph, bravo!
I am going to nominate your last post for craziest wingnuttery EVAR!!!one!1!!1 (spoof category) in the next webbie awards.
Andy,
No Andy, it is that bureaucracies tend to muck things up, and health care has lots of bureaucracy. Adding the government to the mix doesn’t strike me as the right strategy to simplifying/reducing bureaucratic involvement.
Also see this response by Mr. Biggs,
Having a person sit at home in pain and being miserable isn’t perceived as a cost by government run systems like in England, Canada, etc. Nor is it seen as a cost by those advocating such systems.
Well, now we know you aren’t that well informed. France has a two tier system with public and private insurance. And guess what, the French government actually indicated that it should consider more market based reforms to their system. Of course, that lead to protests, but hey don’t let stuff like this get in the way of your views.
Hal,
Sorry “managed care” is what you’ll get with a government program and more-so. For example, in England you have mandatory waiting times before you can see a doctor. Basically a super-charged version of “wait in the waiting room for 3 hours”, but with the slight benefit that you can wait at home…possibly in pain, reduced mobility, etc.
Ken,
Let me see. Medicare is facing a huge projected shortfall in the the trillions of dollars. So your solution is to expand Medicare. Brilliant.
Michael,
When you go to urgent care oddly enough you find yourself in the same waiting room, seeing the same doctors, etc. as when you go to family care.
Christopher,
Actually, my wife was already suffering from TMJ, a problem related to grinding one’s teeth during sleep. It affects, AFAIK, the jaw and how it works. According to the doctor, a collision from the rear can exacerbate the problem.
Oh, and we aren’t planning on suing anyone.
Hal,
Of course not, but the fact that their health systems couldn’t deal with the situation is problematic. My understanding was that a part of the problem was that many doctors were on vacation during the heat wave.
Overall, this problem is going to get worse as we find ourselves with fewer doctors. Soon the baby boomers will be retiring, and when that happens lots of currently practicing doctors will retire as well. And since the number of doctors isn’t determined by the market system, but instead by government there will likely be a problem. And since people are reluctant to allocate medical resources via price, they’ll use other mechanisms…like increasing waiting times. You’ll either give up and go home and live with the problem, you’ll die if it is serious enough, and some will get treated.
But Medicare has many fewer layers of profit taking and administration.
You have to be able to show that having private insurers is so much more efficient than Medicare, that even with their profits and extra layers of administration, their price-performance is as good as Medicare. All real world evidence is to the contrary.
Yea, what’s a few million kids going without health insurance compared to your inconvenience. And let’s forget about those 18,000 deaths every year due to inadequate health insurance.
I’m sure each and every one said a silent prayer of thanks each day that they weren’t in such a country with such shitty health care. I mean, much better to die or grow up without proper nutrition and care than have Steve wait at home for health care.
Death and permanent assignment to the underclass because you didn’t have the right vitamins during the crucial first five years of life is nothing compared to that.
Of course not, but the fact that their health systems couldn’t deal with the situation is problematic. My understanding was that a part of the problem was that many doctors were on vacation during the heat wave.
My GOD! Imagine that! On vacation. During August! In the EU! Who would have thought? Just the entire fricking continent goes on vacation during that month. And the implication is? What? Socialism leads to vacations which leads to? It was a completely and totally unpredicted event that overwhelmed their systems.
I doubt we in the USA would have done any better. And I’m sure that our response to Katrina would support this. Oh wait! That’s the government, and as we all know, anarcho capitalists believe the government can’t do anything and so Katrina disaster was just what one would expect.
Except there is no anarcho capitalist mechanism for dealing with large scale disasters other than “let ’em die, god will sort them out”, which will inevitably decrease the population to the size where Grover Norquist can strangle them all in the bathtub – and then there’ll be no more problem.
Man, I thought I’d seen you scrape the bottom of the barrel with the previous issue wrt “waiting” vs. people in this country dying. But this is somehow even more sleezy, using a natural disaster which overwelms a system as proof that their health care system is worse than ours…
I’ll just reiterate it so you’ll get the point:
Every year, 18,000 people die in the US because of inadequate health insurance. That’s 8K more than died in France in this incident, and unlike the incident in France, it happens EVERY YEAR.
But, hey, we’re better because Steve doesn’t have to wait as long.
Geebus.
Still no answers as to how to do this?
Health care in the West will have layers of bureaucracy whether government is directly involved or not. It is simply too large an undertaking not to.
I have seen no evidence that adding more government provided care to the mix will appreciably increase the bureaucracy involved for any individual in the system. I seriously doubt that it would. Do you have any real evidence that per capita health care bureaucracy will increase with increased government involvement? (Gammon’s hypothesis does not count as real evidence.)
Again, nothing behind the etc but the implication that this is standard and that wait times in the UK are standard for universal systems. You must know that this is misleading.
Canada’s wait list issues are generally limited to a few specific procedures and are more problematic in rural areas. The US has considerable issues in medically serving its rural areas as well.
Do you think it would be a legitimate for a Frenchman to point to the fact that the US is considering more government involvement in health care as an argument counter to market based changes to their health care system?
As far as the looming health care crisis in France is concerned, their projected health care costs in 2010 (with the 29B shortfall) are still about 2/3s of our per capita costs in 2006. Their financing problem is simply nowhere near as large as ours and their growth in costs is less.
Again with the UK canard?
Waiting times are not administratively reported in the US so there is no real basis for comparison, but anecdotally wait times in the US are similar to those in Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland. Though they are slightly less than in Denmark, Netherlands, Norway, and Spain. (and considerably less than in the UK or Finland)
That Medicare is underfunded is not a real argument about its efficiency or efficacy.
BTW Bush proposed to cut funding this year. How do you think that effects the projected shortfall?
PS Steve, hope your wife is doing better.
According to his post he has to wait as long or longer than in a typical universal care system.
Dave’s experiences in Chi indicate the same.
The wait list argument is a canard.
The wait list argument is a canard.
Well, sure. It’s Steve favorite argument form. But my point is even if there are wait lists lasting years and people writhe in horrible pain waiting for doctors to come see them, it would still be a step up from people who die because they never even have that chance. Worse, there’s children – children! – who basically miss out on the crucial first 5 years of – if nothing else – brain development because they don’t get adequate nutrition and care. Something that severely impacts them negatively for the rest of their life.
But, in Steve’s World ™, there’s a hierarchy of need which seems much different from the way my mother taught me.
Commie that she is. (actually, she’s a hard core christian conservative, but that’s another story)
Melanie Philiips has an article about nursing care in hospitals in Southern England. If someone can show me how to link to here site from her I will do so. Meanwhile the article is reproduced below:
October 15, 2007
Ther de-moralisation of health care
Daily Mail, 15 October 2007
How in God’s name have we come to this? In three hospitals in Kent, at least 90 patients have died from a superbug infection caused by filthy conditions with unwashed bedpans, staff ‘too busy’ to clean their hands and — most appalling of all — nurses telling patients with diarrhoea to ‘go in their beds’.
This unspeakable situation reveals not just callousness towards suffering and indifference to human dignity but a breakdown of some of our most basic civilised values.
Nor is this an isolated scandal. Last October, an internal memo warned the Government that virtually every NHS trust was reporting superbug infection. The health service, in other words, is institutionally polluted.
The Government’s response? To ignore this crisis, and then belatedly to bring forth Gordon Brown’s pathetic commitment to a sporadic hospital ‘deep clean’.
What has happened to the duty of care in our flagship public service? What has happened, indeed, to our sense of common humanity?
Two things have combined to cause this awful situation. The first is the Government’s Stalinist control of the NHS which directly conflicts with patient care. The Kent hospitals focused on meeting waiting time targets to the exclusion of just about everything else; and the NHS management’s byzantine structure ensures an almost total absence of accountability.
But that is far from the full explanation. Much more important is what has happened to the nursing profession, where there has simply been a collapse of that ethic of caring first promulgated by the inventor of modern nursing, Florence Nightingale.
Of course, it must be said that there are still many dedicated and caring nurses of whom Nightingale would be proud. But in general, her ethic has been all but destroyed.
Nursing is not a job but a vocation. That means it is governed by a sense of moral duty to the patient rather than by the self-interest of the nurse.
That sense of vocation lay at the heart of Nightingale’s vision. It was no accident that in her seminal Notes On Nursing, published in 1860, she wrote that ‘the greater part of nursing consists in preserving cleanliness’.
It was not just that cleanliness was essential for recovery and health. Keeping both hospital and patients clean meant the nurse needed to have the most elevated of motives to put the care and dignity of her patients first.
Accordingly, lowly functions such as washing, dressing and administering bedpans — where dignity was most fragile — were the functions that in nursing were invested with the highest possible significance. Simply, these were moral acts.
Accordingly, wrote Nightingale, if a nurse declined to do these kinds of things for her patient because she was so concerned about her own status, nursing was not her calling. ‘Women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them.’
Florence Nightingale belongs in the first rank of pioneering Victorian feminists. But the tragedy is that modern feminism has all but destroyed what she stood for.
In the 1980s, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that nurses were treated like skivvies by doctors, who were mostly men. To achieve equality for women, therefore, nursing had to gain equal status with medicine. So nurse training was taken away from the hospitals and turned into an academic subject taught in universities.
This directly contradicted an explicit warning given by Florence Nightingale herself, that her ’sisters’ should steer clear of the ‘jargon’ about the ‘rights’ of women, ‘which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do.’
That, however, was exactly what the nursing establishment proceeded to do. Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse, to deliver equality with the male-dominated medical profession.
In her book The Project 2000 Nurse, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training. Student nurses now studied courses such as sociology, gender studies, politics, psychology, microbiology and management. They were assessed for their communication, management, problem- solving and analytical skills. ‘Specific clinical nursing skills were not mentioned,’ she wrote.
In short, nursing ditched its core vocation to care.
I wouldn’t have believed this possible had I not been forced to witness how my own mother was treated in a London teaching hospital a few years ago. She suffered under a wretched double burden of multiple sclerosis and Parkinson’s disease. In that pitiable condition, which meant she could barely walk, she broke her hip and was admitted for surgery to a fracture ward.
If I hadn’t been on hand every day, she would have starved. After surgery, she was unable to move at all in her bed. Yet the nurses made no attempt to help her to eat; nor did they even deign to move her pillow to make her more comfortable. Yet when I protested, I was told by the senior nurse on duty the bare-faced lie that an hour previously my mother had been ’skipping round the ward’.
It was then that I realised that all the excuses about NHS failure being caused by lack of money were a lie. It was then that I understood that there was, instead, a lack of something infinitely more profound — conscience, kindness, a sense of duty to others — and that the image of the NHS as the embodiment of altruism was a grotesque illusion. If you were old and incapable, it was an encounter to be feared.
The memory of my mother’s terrible experience still makes me cry; and I weep also for all those poor souls who have died at the hands of the NHS in Kent, and all those other frail and powerless patients who are being treated so abominably in hospitals up and down the country.
What’s happened in our hospitals surely reflects a still wider social breakdown. Our society seems to have turned into a Darwinian nightmare in which the fittest prosper mightily while the old and weak are tossed aside as of no value.
That’s why we starve and dehydrate some elderly people to death. That’s why we turn a blind eye to the dreadful conditions in so many old people’s homes. And that’s why nurses become managers, and preen themselves as expert professionals in meetings and seminars and conferences and away- days while patients in their hospitals are left to die in their own filth.
And what about the Labour Party, for which the NHS is the ultimate symbol of its own superior social conscience? Are Labour MPs agitating about the filth in our hospitals and the deaths it is causing?
Dream on. Labour MPs are currently wholly occupied with inspecting their own navel and analysing who is up or down in the Gordon Brown/David Cameron circus. And as for the Health Secretary, while patients are dying as the direct result of the system over which he presides, he appears to think that the biggest threat to the future of the very planet is that people are too fat.
Our NHS is now the symbol of a society that has lost its moral compass along with its heart and soul.
http://www.melaniephillips.com/articles-new/?p=542
You already did. If you put the URL into the text it automatically makes it a link or you can use the link button the same way you use the bquote button.
The NHS in the UK is a train wreck. Fortunately it is the exception rather than the rule for universal care systems.
Grewgills:
The exception?
Davod,
Yes the exception.
There are all of the rest of the Western industrialized nations in the world and Japan to pull examples from, yet virtually all of the examples of failures come from the UK. Why do you think that is? Is it because it is so representative that one need not look for examples elsewhere?