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Sunday, February 6, 2011

Hopelessly Flawed Health Care System and Decision Making

I have had way to much contact with our health care system since last summer. First i had urological surgery and then a severe pressure sore I am still dealing with. In the last few months all those I have met that work in the health industrial complex agree the American health care system is deeply flawed. The words I have heard the most to describe our health care system are grossly dysfunctional. Few agree with me that we need to somehow move toward a single government run system. Even fewer like what Obama has proposed. When I state my endorsement of a single payer system the reaction is often one of silence or polite indifference. A few will venture a negative comment about socialized medicine while others point out that the government also runs the department of motor vehicles and query "how is that working out for you". I usually reply that I trust the government more than I trust health insurance companies and policies that are designed not be utilized. This exchange is pointless as nothing is accomplished. I do not pretend to have the answer to our current health care crisis--and there is no doubt the word crisis applies. I do know something has to change. I feel very strongly about this because I am virtually uninsurable. Insurance companies have the right to make money but we Americans I believe have the right to be able to afford adequate health insurance. Our government has utterly failed to protect half the population and people like me that are locked out of insurance industry. There is no question to me that health care is a basic human right. From an economic point of view I understand health insurance companies are designed to make money--this is why such corporations exist. But the health care industry must be regulated in a way that all Americans can access the system equally. Too many I know fear getting ill. People fear illness because they worry about the costs involved. This is just wrong.

What we need is a massive cultural change when it comes to how we perceive the health industrial complex. We need health care professionals to become human again. I think it is just too easy for us to complain and not demand social change. When I was ready to be discharged from the hospital in the Fall my choices were stark--go to a nursing home or get a clinitron bed and have family care for me. This was not really a choice. The surgeon following my care said simply "that's the way it is, there is nothing I can do". The discharge planner did nothing--explained what was and was not covered and told me "that's all I can do". Sorry but that is not acceptable. We Americans value personal autonomy almost as much as we value life itself. This throwing up of hands and saying "that's the way it is"is not acceptable and must change. There is much debate within bioethics about the degree to which doctors advise their patients. Doctors now routinely lay out the options as though we are playing the old TV game show Let's Make a Deal. This is done under the belief that patients are the best person equipped to decide what is best for them. In theory this is correct--in theory. But how many people understand the nuances, meaning, and ramifications of those decisions. In the end we end up feeling very much alone and isolated. Most of us die in a hospital, unaware and medicated into oblivion. For the vast majority unfamiliar with hospitals they are unable to know what is the "right thing to do". I am not suggesting we put such decision making back into the hands of doctors and the health care industry. What I am suggesting is that we need to have health care professionals empower people to navigate a complex cultural system that is not only vastly different but scary. In my estimation few doctors are capable of doing this. They are in many instances oblivious to the needs of those they are charged with healing. Patient care representatives are no better--they are adept what deciphering what one is and is not covered for by a given insurance company. They do nothing more and nothing less. Their job is to get a person out the door without any fuss. What happens when they leave the front door is of no concern.

I am naive? You bet. But I am also hopeful that if enough people get fed up and refuse to be abused by health care industrial complex change will be forced upon corporations that simply do not care one iota. I know this because I am spending much of my time fighting my health insurance company and the wound vacuum company KCI. If I have learned one thing it is that these companies do not care one iota. They are nothing short of evil. They want one thing and one thing only--payment. KCI has earned my particular wrath as they are stunning in their disregard for the humans that use their products. Those that I have spoken to at KCI have no heart--no soul. The corporate mentality has infected the people that work for KCI to the extent they have no empathy. None. To me this is a symptom of a much larger grossly dysfunctional health care industrial complex. This complex can be changed. We must demand it. How we do this I do not know. I do know we as are all cultural systems capable of such change. Look at the newspapers and read about what is transpiring in Egypt. I for one never thought such change was possible. A friend of mine has written about the situation in Egypt and noted we have had American Pharaoh in place for decades. If Egyptian citizens can rail against the government and force such a cataclysmic change i posit the question--why can we Americans not demand comparable change in our health care industrial complex?

8 comments:

Becs said...

I haven't had health insurance for about a year. I went to the dentist twice and what I paid was as much as I would have paid, had I insurance. I went for one check-up and was give a handful of referrals for tests. The referrals ended up in the trash and I didn't go.

If I had gone, if the tests had shown something amiss, I don't have the financial wherewithal to pay for treatment.

In the words of Jane Eyre, "I must keep in good health and not die." Or keep in good health and die very quickly. Nothing in-between will do.

Assiya said...

Thank you for this. It really is time to rethink the health care system. One of my biggest fears is what to do if I lose my insurance and can't afford to pay for my health care. The best doctors I have had have tried to help teach me my options. They have even stretched the bounds of insurance to make sure that I can get the health care I need. But there is still so much to do. And I still worry about it every day.

ginger said...

So what are you all going to do about it? Keep on typing and crying?
The case of Sakineh Mohammadi Ashtiani who was lashed 99 times, then sentenced to be stoned to death several months ago is still alive thanks to internet publicity.
If it works for a woman in Iran, then it will work for the disabled.
Try reading her case history and the means that have been and are being used to keep her alive and hopefully free her.

Eric said...

First of all, good to see you back in form William.
Second, this reads almost like a conspiracy plot from a science fiction movie and I mean that in a good way.
Third, as a denizen of the middle east don't be so easily fooled by the appearance of change.
Lastly, as a Dutch born individual who actually made an arduous preparation to return to live in Holland for the single and sole purpose of finding benefit for my son in the super-socialistic and humanistic health care system there, let me tell you that it works with the qualification of a lot of if's and's and but's. For severely mentally and physically compromised children I am certain there is no better place to be but for adults the wait and quality of care is at best described as 'apathetic'. A so called socialist health care system is cultural dependent as you know just as well as I. To transfer this to the US, a megalith of complexity, seems to me an impossibility.
Health care providers, as I have recently reaffirmed in a lengthy stay in hospital for my son, are "institutionalized" and everything is about cutting costs. I had to fight my way to recognition in dealing with my son's serious condition, one of many hospital stays and constant care that he requires, but lost many of the battles due to my own fatigue and technical difficulties in updating relevant medical knowledge on the spot. The result was a longer stay, more danger and the three-shifts-a-day struggle of education with every nurse and physician until the 8 day mark when we had come to an understanding. He could have died in the mean time.
I thought What you wanted is two things- a social revolution and an organizational reassesment but it is really only one thing, the acknowledgement that modern society has not brought with it a change for the better in social values.

william Peace said...

Becs, Goodness who can afford a dentist today. The only people i know who go regularly have outstanding insurance. I cringe every time my son needs to see the dentist and turn down 90% of what he suggests. Health care to me excludes dentistry--we are on our own. I have no illusions this will change. As for diagnostic testing, that too is for the well insured only. I cannot even afford basic blood work.
Assiya, Thanks for the kind words. Health insurance is essentially insurance against bankruptcy. I fear getting ill as much as I fear the economic consequences.
Ginger. What am I doing? I write, complain to elected officials, rail against the wrongs. I also fight daily with health insurance, appeal and appeal and appeal. What more do you expect?
Eric, I realize the single payer system is not the ideal solution. I know that there is a significant downside and an all out effort at cost containment. I saw this first hand long ago when I lived in the UK. I was impressed and turned off by the British health care. BUT the system we now have in the USA desperately needs to be overhauled. The leading cause of bankruptcy in the US is the result of paying medical bills. We need to change the way we perceive medical care and who is and is not allowed to access it. Any change will be gradual as half the population, those with insurance, do not want ot see any change. It is a divisive issue and polarizing in the extreme. As for the social unrest in Egypt, I do not believe a single word reported in the American media. These would be the same people that whipped up a frenzy about weapons of mass destruction that did not exist. Our media is contemptible.

ginger said...

William,
A large advantage being used against the disabled is the fact that travel and sitting at meetings is extremely difficult and often impossible.
As I had stated previously, organization is the key. There are many organizations for the disabled, such as the MS Foundation.
Contacting these types of organizations is a plus for support.
Constant complaining can write a person off as a chronic complainer.
Here is an example of a productive method of accomplishing the necessary changes.
First, a letter of "needs" that are most likely covered under the ADA is composed. The letter is precise, polite, yet formal in setting forth the demands.
Second, signed emails by individuals and those representing proper agencies and organizations is sent on a monthly basis to each Senator. 50 States, 100 Senators. 100 emails is not considered spam.
Third,
One or two people are in charge of updating the people and agencies that will sign the email. The response from Governors is then kept track of.
Fourth,
A check of legalities of publishing these responses from Governors is done. If permissible newspapers etc are informed until they publish and national attention is achieved.
The issue of the economy and National Debt is ignored 100%.

Buckford said...

Hi, William. I'm a C-6 quad from Stamford. I pay $1,479 a month for UnitedHealthcare coverage with a $1,500 deductible. Fortunately, I will be eligible for Medicare in about a year. I'm self-employed as a writer/reporter.

Carl said...

Great informative post William.