On Healthcare

When it comes to Healthcare, I’ve a little experiment to suggest. You can take the combined brain mass of the intellectuals around the world, and defy them to come up with a mess. I’ll bet the feather on my hat that they could not come up with a solution that matches the large scale bungling that capitalism has produced.

There are certain things that Doctors have to do to survive, and there are certain things that Insurance companies have to do to survive. What’s the wrong with that? Nothing *shrugs shoulders* Everyone could sing and admire sunrises, but for the minor blemish on the horizon: The things that Insurance companies and Doctors have to do to be healthy financially don’t always intersect with the fact that the patient has to healthy.

Let’s consider a chest congestion. If the same ailment were to befall me in my hometown in India a few years ago, I would walk up to the clinic across the street. Not in the mood for a clinic? No problem, I’ll settle for the pharmacy and refer lovingly to the “brother” who runs the store as “Anna”, and say I have a cough. If I could cough for him grossly, with the ringing sound of phlegm, he would prescribe me an anti-biotic in a jiffy. Two days later, I can breeze along the streets of Broadway and perform as the lead singer at the Italian Opera without anybody being any the wiser.

Not so here – uh uh! Nope! I have to get a minimum for 3 appointments before the anti-biotic, charging my insurance company I know not how much, and charging me my “co-pay” each time. Let’s say, the co-pay is $20. $60 and 10 days later, I am still no closer to getting a cure than a baboon coughing up phelgm without any access to health care in the Congo basin.(I don’t know whether baboons cough, but let’s assume they do) Then, it is prudent to have a meltdown in the Doctor office, at which point a nurse would stir in your direction, and touch you with her sympathy. By the time, the anti-biotics come along, the lung that’s been wheezing along fine thus far looks pneumonic, and a chest x-ray is in order, the bronchial tract that was hitherto clear has constricted making you whistle everytime you breathe. In short, you can forget the opera, and the coughing baboon in Congo is better off, because it did not lose $60.

I am not saying that walking to a pharmacy and having an anti-biotic prescribed has merits. But you must accept, it has ease and works for 80% of the minor ailments that befall a middle aged person.

Now, we come to Pricing. You can get the medications from an approved pharmacy for $160, whereas the same thing in Walmart costs something the common man can afford(like $10). It has happened to me, I got something for $4 in Walmart, while the same medication cost $100 in Walgreens after the co-pay of $20!

What is frightening is, where does this rip off stop?

Does it make older people feign health as long as they can possibly help it rather than get entangled in the quagmire of health care?

As if, the medical healthcare industry has not caused enough heart-ache, they are now becoming creative. Case in point: this lady’s depression treatment was denied because she put up photographs of herself in a bar on her birthday on Facebook!

http://tech.yahoo.com/news/ap/20091123/ap_on_hi_te/cn_canada_facebook_insurance

(which incidentally lends credence to my previous post on Facebook)

Where does this long road lead?

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8 thoughts on “On Healthcare”

  1. Saumya, the cost of the ease of having a pharmacist prescribe anti-biotics is not whether it is applicable to 80% of the ailments or not. The real danger which is anyway becoming more and more common is drug resistant bacteria. So next time- you have to have a more potent anti-biotic…until at some point the bacterial strain is almost immune to antibiotics. Btw, this is now not uncommon in India- Many of my sister’s friend’s children have had to be treated with extremely potent doses of anti-biotics which now leave them extremely weak.

    1. Though I agree with your point Manu, I have personally undergone the experience where I or someone I knew clearly required anti-biotic the second time. I agree the first time – let us see if the infection goes away by itself. But the second time, when the signs are clearly not going away – in fact worsening, I don’t see the justification.

      In fact, one time, I remember 4 children I know going through the same problem and then being treated with a strong anti-biotic that left them weak anyway.

      All I am saying is – I find it difficult to justify when the second and sometimes the third visit still yeilds nothing and then the fourth visit suddenly requires pneumonia tests, oxygen levels dipping in blood etc.

  2. Doesn’t that mean you need a second opinion or third opinion. Rather than loose availability of potent drugs.
    Doc’s make mistakes too. This is actually one of the main reason I have ppo. Just my 2c.

    1. I actually meant 2nd or 3rd visit to the same doc. This has nothing to do with the doctor’s abilities, simply the fact that insurance companies get to determine treatment.

      I am not saying that giving anti-biotics in the first shot is good – in fact, I said it does not have merits. But, I have problems when some strains that are clearly bacterial are not given the treatment they deserve after a week of not subsiding.

      If you look at how much is being paid for premiums, the companies dictating terms is not at all warranted for, YEt, that is what is happening.

  3. I would agree with both u and Mano. Yes, the health care industry is a big rip off, but as Mano says, antibiotic is not the cure for most. I guess once we develop a rapport with the doctors here, things change and we might be able to avoid the unnecessary costs.
    That said, I have had nightmarish experiences in the hospitals here because of insurance as you know. I guess everything has its pros and cons.

  4. Mano@ If the problem is systematic, going multiple doctors is nto going to help much.

    Having heard from 2-3 people and facing it first hand, I think, there is some basic issue in the health care system here.
    IMO, one size fits all approach is used in these cases. You don’t have to give Anti-biotic on the day one. But on day 5, if you see secondary infection is developing, you have to use your medical judgement instead of waiting for X-ray results 3 days from then.

    Not putting too much medicine to one’s body is a good logic. But that option can be given to the individual instead of forcing on them.

    All:

    Increasing the number of doctors who can handle minor issues like fever,broken bones etc. will offload the system to work on serious issues. (which the system is good at handling)
    They can create a two tier system, with doctors brought in from other countries (with trusted medical degree) to work on minor issues etc.

    But doctor’s union/association blocks any such moves.

    Health-industry’s wealth is big part of the problem.

    1. That is an interesting point. It is rather hard for doctors educated elsewhere to join the mainstream. They have to come here and do another specialization. Like in the case of software, it can be opened up, so talented doctors make it here. You can still have the specialist surgeries etc elite.

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