Health Care Summit discussion

[PrincessFiona]

Re: Health Care Summit discussion

Ok Sandy,

I think that's fair criticism. I will hereby put myself over my own knee.

As to ability to pay and inferior care. I guess it depends on where you are. Here, you receive the same care regardless if ability to pay andvtge catholic hospital tends to comp much of the cost based on income.

I know of places where this is not the case though.


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[PrincessFiona]

4 is more reasonable than the 1 they had when we were there. Is it adequate? I have no way assessing need and wait times ( or over/under use). Red headed stepchild is true. Care there was simply inferior and in some ways scary. But everyone had equal access to it. Are the uninsured here the red headed step children of our system? In a way.

Of course, if you have money in the UK you can enjoy the benefits of a two-class system too. Maybe we aren't as far apart then culturally when you get down to it. Scholarly evaluations are always interesting but my experience is that for the most part we have more in common than we like to believe.


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[PrincessFiona]

Re: Health Care Summit discussion

PS. I clearly need to face the mound of laundry and am procrastinating.


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[Sheherezade]

Admitting to my lack of knowledge, here. I have been reading details about the Senate and House bills all morning and it seems that a large part of each bill is a slate of pilot programs designed to cut costs from both the practitioner side (hospitals, doctors) and from the insurance side. It includes things like the 30 day payment for care for a single event we've discussed here before and things like a comprehensive single form insurance billing mechanism to reduce paperwork/billing costs. I was unaware that all these programs (which together amount to 1000 pages of the 2000 page document) are individual pilots that will be tested in small markets. The results will be returned to a government commission. After evaluation, they will make recommendations to Congress which can be BLOCKED at that time by a vote.

Somehow, this makes me feel better. They acknowledge that no one knows what will actually cut costs and have written a plan for study in to the bill....with the ability to press ahead on a plan immediately if Congress does not reject it.

Was this common knowledge to everyone else? I didn't realize that so many of the things I'd heard mentioned were at this point small pilots in competition with other health care reform ideas that will be tested simultaneously.

[poky]

I guess it depends on where you are. Here, you receive the same care regardless if ability to pay andvtge catholic hospital tends to comp much of the cost based on income.

Only places I'm aware of in the places I've lived that do "ability to pay" scaling are government-run (generally county) clinics that are *very* limited in what kinds of things they can do. It's better primary care than an ER, for sure, but nothing like what you can get if you have money.

Quit procrastinating and do your laundry!

[PrincessFiona]

Angie, I had no idea about that. It is a relief to know that some of these ideas are going to be tested first. I still wonder about paying for it all and issues of quality of care and rationing of care, but it appears that's an unpopular topic everywhere...I'll have to troll another board to have that conversation, I guess! I consider myself to be a person who generally speaking WANTS some form of universal coverage. I have always stood for that, as you know. At the same time, I have my pain threshold when it comes to taxes, and it is especially hard this time of year when many people I know are rejoicing about getting the money they paid in back (which means for a lot of them that they aren't paying taxes) when we owe despite paying in the max and not claiming dependents. I can imagine that if we have to pay more money, that it won't be worth it to continue on this career path. I want coverage for every American in some form...fair, affordable, quality coverage....and I'm willing to chip in my fair share. But everyone doesn't have this mentality. Too many people don't want to have to pay in and want everything possible. We already pay more in taxes/social security than we would if Thomas worked in Germay. At least if we lived in Europe, our children would benefit from that money (as would we). This is another issue for a debate with McPants if he is still following. In Europe, physicians earn less, but it all works out because they don't have to pay for college for their children, etc. Neither does anyone else, btw...but everyone who pays in gets these benefits. Physicians in Europe aren't concerned with paying back student debts of over 150,000$ or more. They finish training quite young, relatively debt free, have been better paid during training and don't have the same worries about sending their own children to college, etc.

I struggle to see how physicians coming out of training in coming years can take the salary pay cut that is certainly coming down the pike and still pay off the enormous student loan debt. I feel strongly that this is an important issue too. People want the best and the brightest to become doctors and for the honor, people must take on a huge amount of debt. At the end of the day, that money has to be paid off with interest and represents a substantial amount.

Sandy, Thomas' hospital is an NFP that is a catholic facility. Patients aren't turned away everbecause of inability to pay and bills are greatly reduced/comped quite regularly. I know about this only because my husband goes in and sees patients even in the middle of the night...regardless of ability to pay. The hospital comps this for the docs as well by paying them for rvu billed and not by rvu collected. That may change though as money gets tighter due to medicare rule changes.

Kris

[Sheherezade]

I can vouch for you Kris: In the past, you've been a HUGE advocate of healthcare for all. I think that regardless how it is done, the generation of physicians that experience the change will be pinched. I know we are in that position. It is kind of like (but worse) being the last generation of residents to go through the no 80 hour work week training. You feel like you had it harder but you get absolutely no advantage for it. We may be saddled with large debt and smaller income. That sucks. Still, if change is going to happen that will have to happen at some point. I look at our entire deficit issue this way. It will SUCK to pay more taxes, get cut out of Medicare, SS and pensions that may have been promised -- but if the country it to right itself it will have to increase revenue and break promises made. I think I'd rather struggle and feel cheated than have my kids struggle and feel cheated when they are the 30 somethings on the block. I'm not looking forward to it - but if that's the route we need to go, lets get it over with and get on with life.

The article I read about the pilot programs was a December issue, Atul Gawande, New Yorker thing. It is online. I found it through an Ezra Klein column in the Washington paper.

I heard yesterday that a bill to extend the unemployment benefits that expire Sunday was held by the Senator from Kentucky because he will no longer allow anything to pass that is not paid for in full. They mentioned in passing that the bill also included a fix for the Medicare cuts. I'm not sure which Medicare cuts they are referencing because I've heard that there are some significant cuts to Medicare payments due to begin on Monday. Are these the same consultant fee cuts or across the board cuts? Not sure. *sigh* Either way, the bill is being held. I'm all for deficit reduction and I understand that that won't happen just by cutting programs *I* don't like -- but I'd at least like to understand what's going on. So, if anyone knows more....could you fill me in?

Thanks.

[Sheherezade]

Found the article this morning. Near the end is the mention of the Medicare cuts. It says "21% cut". Starts Monday with a two week grace period. I think this is the recurring Medicare "fix" they pass each year. It's pending. Probably will eventually pass because of the weight of the unemployment benefits issue. We should watch it. I agree that we should pay for this stuff though. Which means a cut somewhere OR a new tax.

http://www.cnn.com/2010/POLITICS/02/...ntent=My+Yahoo

[McPants]

We already pay more in taxes/social security than we would if Thomas worked in Germay. At least if we lived in Europe, our children would benefit from that money (as would we). This is another issue for a debate with McPants if he is still following. In Europe, physicians earn less, but it all works out because they don't have to pay for college for their children, etc. Neither does anyone else, btw...but everyone who pays in gets these benefits. Physicians in Europe aren't concerned with paying back student debts of over 150,000$ or more. They finish training quite young, relatively debt free, have been better paid during training and don't have the same worries about sending their own children to college, etc.

Hmm, I'm not sure what we're supposed to debate with McPants here. I agree with your assessment of the differences in general although I should perhaps point out that it is getting to be more common for European universities to charge tuition these days. It is of course still nowhere near what your husbands pay, however. Here in the UK I think the gf pays something like £3000 per year or so and there are bursaries readily available for students that come from less affluent backgrounds.

[PrincessFiona]

Re: Health Care Summit discussion

Discuss?

I think that most Americans want coverage for their neighbors.

The problem isn't with an American culture of selfishness or putting the individual before the group. We are divided on how to get there because our systems are so different.

My experience in Europe was that everyone pitched in tax wise for heallthcare and took great pride in it. Here, many want coverage but at no cost to them. Some people truly villify doctors.

Talks here include things like lifting the social security fee income cap (which is also capped in Europe), drastically increasing payments for many people and then also discussing not making them eligible to receive any benefits from that money. It's sort of insane. If you disagree with that you are greedy and selfish.

As it is, my husband and I pay as much in taxes as we would in Europe. We do not reap the benefits if that money and although we are more than happy to contribute for the well-being of society, shouldn't we also be elegible for the benefits our tax dollars support? In Europe most people pay at least some taxes. Here roughly 50% get that money back and feel that it is their right.

It is hard to make changes. Either we ask those already overburdened by taxes to pay more or those who pay little to nothing to pony up.


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[JaneDoe]

So, I have a question and I'm not trying to be rude either. I'm just curious. Why do some European-trained physicians, like your Dh Kris, choose to practice in the States? Is it the pay? Is it something else? If the benefits are better in Europe; i.e., more affordable health care, college tuition for your kids, etc., then why come to the US? It's a lot of work and effort for an IMG to become a licensed phsyician in the US, but something attracts them here. Really, I'm just curious.

[PrincessFiona]

That's not rude. It's a totally valid question.

Thomas decided to practice in the US for a couple of reasons (and they are reasons that stick in our throats when we talk about changes in the health care system here.)

Residency training in Germany is set up very differently. You are an AIP for 18 months (it may be less now)...this is equivalent to being an intern. You then become an AssistenzArzt...which is kind of...a resident.

Here's the kicker....you could end up practicing in a hospital as an AssistenzArzt for the rest of your career (at least as it was established when we were there and had been for years.) The old political machine that is the German medical society created a Niederlassungssperre which in essence prevents physicians from going into private practice to compete with other practices. Only x number of practices are available and unless someone dies or retires, well...you were/are out of luck.

There is also a very old-fashioned heirarchy. The chief of the department of medicine, for example, might be a gastroenterologist. Like many appointments, a lot of politics goes into it. Whether you are a cardiologist, ID doc, oncologist or whatever, he is your boss... For example, the chief of the dept. of surgery when Thomas' dad became critically ill with sepsis and then died from that was an anesthesiologist. Thomas spoke with him on the phone and begged for a consult from internal medicine (there is no ID to speak of in germany, though that is slowly changing). The anesthesiologist was "beleidigt" (insulted) that Thomas would question his competence as an anesthesiologist to treat sepsis....and once he found out Thomas was an ID doc he refused to take any and all calls from him. Thomas flew home, said his good-byes, and his father died. It's a rather horrific irony that his father died of a sepsis that his own son might have been able to treat to extend his life by months or more.... It really is.

Thomas resented this heirarchy from day 1. He thought it was ridiculous that the system churned out doctors who (though the education is solid...Thomas has an excellent background in the basic/clinical sciences and pharmacology) were unwilling to turn to a colleague for advice or help.

For him, the clincher was that he wanted to do Infecious Disease and that is not a specialty area in Germany. There is medical microbiology, but it isn't the same.

We came to the US thinking we would go back to Germany (Thomas really wanted to spear-head an ID effort in his own country).

Once he started working in the US, he was very happy with the nursing care (which in Germany is a joke in comparison). He finds the nurses here to be well-educated and qualified and has a great deal of respect for them because he has seen the nursing profession in his country. The hospitals are well-staffed, there is 1:1 nursing care, there are collegial relationships. He likes that. He feels that he has a stronger foundation in the sciences than some, but that in America physicians tend to offer more compassionate care. He also thinks that patients here have nicer treatment in general...with semi-private or private rooms, tv's in their rooms, etc. Seriously, I gave birth to Andrew at Frauenklinik Berg, a good hospital in Stuttgart. Less than 12 hours after my c-section they ripped me out of a dead sleep and made me walk sobbing across the room to wash myself. Then they asked me for a towel. I didn't have one with me (who would think of THAT) and the nurse said "this is not a hotel" and proceeded to hand me a wad of wet paper towels to bathe myself with. There is no standard of care there in terms of treatments for certain things and this hospital insisted that because I had had a c-section, I was only allowed to drink broth for days. I was not allowed to drink juice or certain teas but I was allowed water and camomille tea. Then I was to take a super-power laxative...then I was permitted to eat. When I refused the laxative, it was given to me against my knowledge in a cup of tea. I was so sick you have no idea.

It's very different. Buckle up for the ride.

As far as money is concerned...the pay here is better than there in some areas, but that has only been true for us for the last few years. How does that translate though when you aren't having to put back a lot of money for your child's college or health care costs or aren't having to pay back your own expensive loans? Thomas' best friend from medical school is an internist who did manage to get into a practice situation. He earns pretty much what an internist does here...and pays about the same in taxes.

[JaneDoe]

Interesting, thanks for sharing.

[PrincessFiona]

It's really interesting to see the response to the health care summit now that it's past. I think Obama showed a lot of wisdom as a leader for bringing both sides to the table. I also believe he handled it all very well.

He is offering to bring republican ideas into the bill, etc and the republican response is kind of "well, well....sure you're offering to meet us half way, but we don't want that. We want you to scrap it all and start over."

I don't remember a republican president ever being this willing to sit all parties down at the table publicly and have this kind of a discourse/be willing to make these kinds of compromises.

Kris

[Rapunzel]

Outside of the healthcare issue this summit had another apparently interesting (and negative) outcome: The president repeatedly referred to senators and representatives by their first names.

http://www.realclearpolitics.com/art...nt_104601.html

What would happen if a senator addressed the president as "Barrack" or even "Barry"?

Will he start referring to heads of state by their first names? (He could call the queen of England "Liz"!)

Was this lack of respect a strategy (as outlined in the article above) or was it just very, very poor etiquette?