Why we have expensive and not very good healthcare

[Warren Stupidity]

Here is a fine example of why we pay the most per capita in the world and get fair-to-poor results in exchange.

My knee hurts. Eventually I decided to go see the orthopedic doctor for some help. Fortunately I didn't first have to go see my 'primary care physician', as my employer's insurance company finally figured out that was an incredible waste of resources, and besides my primary care physician is an idiot who I avoid whenever I can. So the bone doctor has merged into a spiffy new clinic that is huge and has all the help running around with laptops to keep them all linked up and online and into their computerized system, impressive but sort of costly but not the point (and they could trade in those $1500 hefty clunkers for $350 netbooks, but I digress.)

The whole point of this knee thing is to get an MRI. For knees, this is essential as it takes ALL of the guess work out of diagnosis. I know this, the clinic knows this, the insurance company knows this. The clinic has an on-site MRI (seems a bit of overkill to me but there it is) but guess what? Of course we cannot use it. No no no no. Physical exam, x-ray, blah blah blah. I waste the time of at least four people, my time is wasted for a morning, and an x-ray that will soon be filed and forgotten yields not enough information to proceed. But we all knew that. My appearance and the kerfluffle at the clinic were all the pre-requisites for putting in with the insurance company for the MRI that we all know I need. We will then repeat the whole process in a week or two. Another half day of my time and three or four people at the clinic's time will be consumed. The total bill will probably be at least several hundred dollars over that required to get me in for the MRI and the MRI consult that was actually needed. All of the padding being required to 'save costs'.

Stupidest health care system on the planet. At least we are world class at something.

[Warpy]

1. I might be alive right now because I don't have insurance

An infection turned ugly on July 3, and I went from low grade temperature and weeping skin lesion to septic shock within 4 hours. I knew I was in real trouble and called an ambulance, got fast and appropriate treatment. Septic shock is 50% fatal, usually dependent on how fast treatment is initiated.

I didn't spend an hour on the phone telling a disinterested bean counter why his/her hemming and hawing over approving an ambulance ride and an ER visit was dangerous and they needed to be approved NOW. That hour could easily have been the difference between life and death in my case.

Insurance companies endanger people's lives every hour of every day, either by withholding coverage, withholding care, or simply denying care every step of the way.

I'm alive right now because they didn't stand between me and the emergency care I desperately needed.

Now all I have to do is pay for the five days in intensive care.

[Lars39]

4. Glad you're on the mend, Warpy.

:hug:

[Oregone]

2. You need referrals in a lot of systems

Canada included. I need an orthopedic surgery myself so I went to a clinic for a referral. The doctor suggested getting the diagnostics done first before the referral (because specialists are limited). So they sent me down same-day for an x-ray and scheduled a cat scan before they decide where to send me. If they referred me, I still wouldn't have any tests done. So basically, Ill probably walk into the specialist with all the needed tests done, for the most part. Might save some time in the long run.

This is for a painful injury I lived with for 3 years in the states because I couldn't afford diagnostic tests, much less the surgeries.

[panader0]

3. My buddy had a bad hernia

He had to quit work to qualify for AHCESS, the Arizona health care for the poor. With no insurance the operation would have been way too expensive, and you need to be dirt poor to qualify. Once he did qualify, he was bounced back and forth fron doctor to doctor, each recommending another test from one of their collegues. Once the doctors know you are on AHCESS or Medicare or have good insurance, they keep you in the system and bleed you dry. It's alot like the mechanics who tell you that you need a new throzzle rod in your car. When it was all said and done, his expenses would have been well over $100,000.00. Geez!

[Kansas Wyatt]

5. It's amazing in the difference of treatment you get from a doctor...

When you have insurance compared to when you are paying cash for services.

With insurance, they just have to as many tests as possible, desperately searching for a problem, and in some cases inventing a problem, so they can treat it and keep you coming back for follow-ups.

Without insurance, they treat a person based on their best interests, first medically with financial situation in mind. They don't invent crap to treat and they don't run a bunch of tests, just because they can.

[OHdem10]

6. Our Health Care System is a for Profit System. Every quarter

Wall Street demands earnings and profits. If an Insurance Company
does not meet Wall Street demands, they are punished by the Ratings
Companies. Insurance and other Health Care entities will do anything
to avoid the ratings punishment. Increase costs whereever you can.

Too bad we cannot change from the For Profit system, this is the
only way to lower costs. The CBO Report on the Congressional Health
Plan just may have proven that.

We cannot change because we would dismantle the Insurance Companies
and no one in Leadership has that kind of courage. They would
see this as harming the economy.

Are we simply trying to do Health Care at the worst time.
Economic Crisis.

[Catshrink]

7. I have a similar story...

I also hurt my knee. I was at my doc's to review blood tests and I mentioned that it had been bothering me and didn't seem to be getting any better. She moved it around, etc., and said we'll get an X-ray and send you to physical therapy and reevaluate.... I have the X-ray (that shows nothing) and PT twice a week for a month($30 co-pay each time)and no improvement at all, even with me faithfully doing the exercises. The therapist told me the first visit that it sounded like a classic torn meniscus. But... nevertheless, we had to go through the PT thing. I went back to my doc after a month, then she ordered the MRI and sent me to an ortho (took three tries to find one that took my insurance). Finally, finally.... I saw the ortho for 5 minutes -- he looked at the MRI and said "torn meniscus. Here are your options: nothing, PT, or surgery." He didn't even touch my knee, just looked at the MRI.

Since nothing and PT hadn't worked, I had the surgery - got there at 7am and was home by 11am. Quick, done. I was sore the first day and it lessened each day after. I'm nearly pain free a month post-op.

So, instead of get ordering the MRI first, or at least after the physical therapist checked it out, I could have had the surgery a month earlier and not the wasted money (and time)on the PT, both for me and the insurance company.

The good part is that I am almost back to normal. Best system in the world my ass.

[SOS]

8. An idea: nationalize the MRI

The government buys the MRI machine. The price of an MRI machine has come down from $2 million to $500K.
Government then limits fee for MRI to $100.
This is how MRIs are done and paid for in Japan.
This would save $35-$50 billion a year.

At $100, you could pay out-of-pocket.

[enlightenment]

9. It's amazing that anyone ever resolved orthopedic issues

before the MRI . . .

[Warren Stupidity]

11. They frequently found out exactly what was wrong after they started surgery.

I am old enough to have experienced pre-MRI pre-orthoscopy knee medicine and have a huge scar on my other knee to show for it. That operation turned out fine, but I know lots of people from my

Yes of course you can diagnose a menuscus tear fairly accurately from a history and physical exam, but with an MRI you can see everything about the knee - bone wear and tear, ligament damage, and cartilage issues - before you stick anything into anyone.

[enlightenment]

14. I'm also old enough to recall it - and I can't have MRI's so

I still have to rely on that primitive medicine. ;)

Born with crappy knees, so I can probably diagnose the issue better than the orthopods at this point . . .

[timeforpeace]

10. It will be better when everyone will be able to order their own MRI like you tried to do.

[Warren Stupidity]

12. I think you misunderstand.

I didn't want to order anything. The clinic wanted to do an MRI. They had an MRI machine right there. An MRI was the correct diagnostic procedure. Instead we all had to waste each others time going through the motions in order to satisfy an entirely bogus mandated process and then reschedule another appointment pending insurance approval. Everyone's time was wasted. Resources were spent for no good reason. Nothing was saved. I am not really any closer to getting effective treatment as there has been no definitive diagnosis. NO HEALTH CARE WAS DELIVERED. Cost for no service? Hundreds of dollars not including my time. This goes on every day repeated thousands of times.

[Wednesdays]

13. K&R

:kick: