MEDBAG

With new healthcare legislation, I feel I must re-publish an entry of mine from almost 2 years ago. Though written for the democratic convention to choose the candidate for the upcoming presidential election, it seems as relevant now as it did then.

ONE:

It was 6 months after my unceremonious slide out of a pre-medical degree, and my 3rd clinical service job in 7 years. My previous experience made me overqualified for this new position, but I’d never worked in long-term care before and needed to see what it was like. I was still under the impression that I’d be returning to my degree someday, and any clinical-service experience would make my med-school application that much more impressive. The possibility that I might be stationed in their state-of -the-art Alzheimer’s unit was too tempting. I wanted to see that research in action, and that was common in this large nursing-home in rural Chardon, Ohio.

Did I get stationed there? No. It was the Medicare wing for me. They needed a strong back to act as an orderly, and I fit the bill. Now, I’ve heard stories from other nurses, doctors, and aids about medicare-based care provided by facilities like this, so I was a little anxious about going. Arriving didn’t change my mind.

The sheep in room 109 was a thin old man who was completely unable to communicate, and usually unconscious for most of the day. The time he did spend awake, he filled by uttering a high warbling moan. It lasted for hours until he passed out again. The familiar sound of the moans apparently had won him the moniker of ‘the sheep’ with the staff. Don’t be offended. Medical humor is common and necessary throughout the industry to keep workers from going insane. While caring for him, I found strange bilateral protuberances just below his navel, and they seemed to get larger for 3 days in a row. They appeared to be an unusual hernia, but no one seemed to know. As a matter of fact, the more I inquired, the less interest there seemed to be. It was as if he was already considered dead. What was left was not really a patient; simply a plumbing problem room 109 that needed to be occasionally tended to.

The next couple of days, I got the privilege of watching patients bathing, shitting, and throwing-up in the same basin. We would rinse it out between uses, and place it next to the patient’s bed when done. Only one cheap plastic basin was allotted per patient, so one must be frugal. If the administration could have figured out how to get away with feeding them with that basin as well, they would have.

I left after a week.

I have always been amazed how well that we, as a species, can adapt to almost any condition. Whether it is our own suffering, or the suffering of others; either can become tolerable. You won’t hear the stories of how our medical system tortures people to death through technology. You won’t hear stories of neglect or warehousing. The only people who know this are the ones who make a living at it. Any poor, permanently disabled patient, with no friends or family to advocate for them, can die a terrible prolonged death in this type of hell; a hell of indifference and bureaucracy for profit. The only improvements that happen are hat the behest of outsiders who get to see their loved ones treated like meat. An extra pillow, a timely response to a call light, a basin; sometimes the smallest things make the most difference. Is medicare bad? No. It’s anemic funding and humorously low payment limits are. Are providers bad? They’re neutral; they will do as any business will expectedly do- make a profit.

TWO:

There is a quality-range of healthcare in America. The disparity in treatment between private-insurance, PPO, and medicare-holders is stark. This doesn’t include the uninsured, who are simply denied services through a multitude of bureaucratic methods.

The plethora of MMO/PPO insurance types and providers has elicited a dizzying array of levels of care. Each insurance company has a better or worse track-record of payment for billed procedures. Hospitals and providers know this, and will prescribe accordingly. Mix in the different insurance types of each insurer, and things get very technical. People are routinely denied proper care due to insurance requirements. Some are offered sub-standard care as an ‘approved’ alternative. Even some medically unnecessary procedures are ordered due to legal requirements of the insurer. Hospitals know how to game the system as well. To make up losses from other uncovered procedures, hospitals will ‘upgrade’ certain procedures to more expensive ones if covered by loop-holes in your insurance (like ordering a CAT-scan when a cheaper x-ray would have been sufficient). Rarely, there will be stories of expensive diagnostic procedures for illness with little evidence in the patient, or expensive treatments for non-existing disorders. Usually, insurance-fraud is not so blatant. Modern medicine and medical insurance has more than enough grey-area between fraud and compliance to make profit for everyone. Knowing what can be done for each patient is a delicate balance between doctors, hospital administrators, and insurers.

Private insurance holders receive the best treatment. They have little worry for lack of facilities, and their care reflects it. This is also why this form of insurance is exceedingly rare.

Medicare’s places unbelievably strict limits on procedures and payment for procedures, regularly leaving both patients and doctors wanting. many doctor’s wont’ even accept medicare-only patients due to payment limits that are below the cost of the procedure to the DOCTOR. With the unmanageable college debt most physicians carry, working at a LOSS is not an option. From what few reports I’ve heard, not even Medicaid is as stringent, though that makes no sense to me at all. Oddly, Medicare (for all it’s problems), is one workable model for socialized health care. As I mentioned above, it’s evils stem from funding, or lack thereof. And those evils are great.

THREE:

I used to laugh at pundits and politicians re-using the rhetoric of traditional commie-hatred when discussing socialized medicine. The problem is, it’s not funny anymore. They level the same accusations against a socialized system that already exist in out “open-market” system. I’ve seen the place that “for-profit” medicine leads, and it’s not pretty. Keep in mind, ‘Cash-for-care’ already exists in this world. This is the gold-standard of capitalism, free-markets, and profitability in medicine. In the Philippines, for one example, there is no government-sponsored system and actual health insurance is a rarity. Another system exists to keep emergency facilities functioning.

In western hospitals, security guards are used to maintain peace and remove any violent individuals. In the cash-for-care system, hospital security exists to keep the patient in the hospital until payment is rendered. You didn’t read that wrong. Security exists to keep you in, not keep bad people out.

If you come to a hospital, you provide payment before receiving service. If you arrive unconscious or in dire need, you are still given attention. Once better, you are provided a phone in your room. It is your responsibility to contact friends, family, whatever, to arrange for some cash to be brought to your room. Once payment is received, you allowed to leave. This system, though seemingly illegal to western eyes, works well in the Philippines. Because few people have a fixed address (not for lack of homes, but because most homes don’t have a recognizable mailing addresses), a provider can’t actually send a bill. False imprisonment is really the best alternative for them. And, unlike the U.S., no one is ever alone in the Philippines, anyway. There exists a much tighter, more interdependent social structure, allowing for a type of networking that can raise funds quickly. Also, the bills aren’t padded into stratospheric amounts, as in the U.S. Asian prices are based on the actual service provided- not a corporate profit target. Oddly, when trying to explain to an Asian how an unpaid bill from a simple illness can cause someone to have their home, car, and belongings taken away from them by men with guns, they don’t believe me (and they actually have more guns around them). Our government justifies these actions with words like, “universal default”, “repossession”, and such, but normal Filipino’s think that we must be insane to allow this.

NEW AMERICA:

We already have institutionalized corporate greed. Imaging adding was is essentially a modern debtors prison to the mix. Is this what we want for America? We don’t want what we have now! Why would any leader insist we should have more of the same? Why would we let them get away with it? Being wealthy and secure under the congressional health plan must warp the mind in some horrific way; maybe as badly as living a life in poverty and lies, with no way to see how the rest of the world lives. Americans devote more of their GNP to healthcare than any other country. Any Other Country. Imagine what a socialized system could do with that kind of funding. Imagine what it could do with just half that. Every other industrialized country has solved the healthcare problem. Yes, details change from country to country, and these systems have problems of their own. But these problems pale next to the defective care Americans receive. We are a 1st-world nation with 2nd-world healthcare (3rd-world, in some areas). For-profit health care is corporate-backed 19th-century thinking, and it’s time we grew-up. Here’s the issue: What are our candidates planning to move America’s healthcare system into the 21st-century?


Now it’s our legislature’s turn to take up the healthcare cause our candidates stood upon in the election. As the bill slowly works its way though our representatives’ hands, it’s good to remember the pitfalls of medical care we’ve witnessed in our own country, as well as around the world.