We can’t have healthcare anyway, why debate?

I wish I was a writer.  Sadly, I’m not.  I pretend with this blog, but I write this blog in the same way I have always done my homework throughout all my years of school:  I think and ponder and put off until the very-last-minute then I purge my system of my cluttered thoughts, let it sit for an hour, reread, and then publish.  Not the best way for making good, well researched arguments, I’ll definitely concede.

But anyway.

We bailed out the banks.  We are funding a war on three fronts now:  Afganistan, Pakistan, and Iraq.  We are bailing out the car companies.  We have sent all our manufacturing overseas.  Our infrastructure is crumbling.

We can’t afford healthcare now.  If indeed we ever could, as it is defined presently.

I made a post on Automatic Earth yesterday in response to someone who claims to be an anesthesiologist in the Dallas area…quite interesting to see the responses.  People really do have a faith in the medical profession’s abilities and skills that appears to border on the mystical.  And most scary, several people who claim to also be in the medical field ALSO appear to have a faith in their own abilities and skills that appears to border on the mystical.


To me, although I’m not a Christian, I do think that the sacred books of the world contain much good sense.   For me, the line ‘to whom much is given, much is expected’ resonates as though it was written 2000 years ago especially knowing I would end up being born and needing to read it, to understand it, and to live each day knowing I will be held accountable in some karmic way to that statement.  I was born in a family where intelligence is the norm, and being a complete screwball is also the norm…as is not living up to one’s potential.  I am still, to this day, a disappointment to my family in that I did not finish becoming a doctor (I started on that path several times and each time I ended up saying ‘whoa, this is a lot of work for a slacker like me’)

Another line that really resonates with me is this:  ‘he who would be master of all, would be servant of all’  Now I have misplaced pride just like the next person, but I really think this is true of my profession like perhaps no other.  I really have to be of service to humanity.  It’s part of my ‘lot’ in life.  I’m in a helping profession.

Where the problem comes is that my profession, like the medical industry generally, is just that:  an industry.  We are glorified factory workers with a never ending conveyor belt in front of us, trying our best to slap bandaids on broken human beings as they move down the line.  When did this happen?  How did it happen?  How can we fix it?  I wake up at night more nights than not with those questions hanging like a sword over my head.  I don’t know the answers and it bugs me that the only solutions I can think of aren’t palatable options at all.

Several people have posited that the true solution to our problems lies in simply going back to plain ole’ fee for service, direct pay.  I simply don’t know how that can possibly work.  Physicians have worked very hard since the Puritan days to achieve that mystical status and prestige.  When someone lays claim to an exclusive status and is able to enforce that legally, it automatically becomes only the province of those who can afford it.  I don’t think we want that to continue.  I don’t think it’s in anyone’s best interests.  Including the physicians.

As part of that, some think that negotiating with the hospitals will mean you will get a better deal.  Not so, at least in my experience.  My youngest son was hospitalized with pneumonia when he was 15, on a monitored floor, for several days.  Not only would they not negotiate price with me, they also insisted on $500/month payments or they would (and did) turn me over to a collection agency.  I tried repeatedly to explain to them that if I could afford $500 a month I would have had insurance for him in the first place, as that is what my employer sponsored insurance wanted for me to get the family plan.  They didn’t care, so I have this hospital bill on my credit rating, and probably will for the rest of my life.  I pay them anywhere from $25 to $50 per month, and I still owe well over $5500 on a nearly $10,000 bill.  I can’t for the life of me understand why they were willing to sell the debt to a company for pennies on the dollar but they weren’t willing to negotiate a payment plan we both could live with directly with me.

If we are to accept a direct pay plan, it will mean the costs must come down drastically and immediately, which I don’t see happening.  I can’t afford it.  I incurred tens of thousands of dollars of student loan debt that I must pay off, as well as a mortgage and a car. If the price is to come down, my pay scale must also come down.  The only way I can afford that is if the government forgives my debt ($500 a month to those alone).  Now, I’m willing for that to happen, but I’m not sure my colleagues would be as willing.  For me, it would mean dropping to a lower tax bracket to take a $500 per month hit — which would add up to less taxes overall at the present rates.  Some of my colleagues have contracted with our employer in return for employment commitments to pay their student loan debt…I’m simply not willing to bind myself to any company for that amount of time in order to have someone peruse my every bank statement under the guise of making sure I’ve paid my loans myself (for purposes of reimbursement, of course — also taxable as income).

So, so far, in order to get a more affordable health care system, we must take away prestige, reduce wages, and remove it from industry status.  I really don’t know how that will ever happen except that we are going to get very very poor in the waiting time.  It will happen, I just don’t think it will happen in my lifetime.  What I do think will happen is that it will become the province of those who can afford to pay cash, as much of our elective stuff (like plastic surgery and dental care) is now.  Not a palatable thought.  But one that keeps me up at night none the less.

One of my friends suggested that Mr. Tin Foil and I begin learning ‘forbidden’ skills to our certification/license levels, as we could end up being the community ‘go to’ resource for under the table medical care.  That frightens me on a level you can have no understanding of.  I have done many hours of research into the demonization and marginalization of midwives for example; I don’t want to go to jail, nor do I want to be hung, nor do I want my land and home taken from me as punishment for serving my neighbors with something that others view as their rightful province.  Is that what it will come to?  Not a palatable thought either.  One that also keeps me up at night.  Especially when I know how much I DON’T know and probably never will.

How much we owe to the simple existence of antibiotics is incalculable.  And you can’t stockpile those.  Will there be a black market trade in those and other medicines for those who can afford them?

Oy.  I think too much.  I wish I could think of solutions as much as the causes and the problems.  Well, I can, but I don’t like the answers.  I really think that provision of preventative care, and some access to affordable illness care when necessary, is absolutely the responsibility of us all in civilized society.  The problem is that we are becoming less and less civilized, and more and more unwilling/unable to even listen to each other.  Or to work together.

5 responses

  1. Well, Susan, I think this is one of the best pieces on healthcare that I’ve read. Sadly, we are caught in a cycle and I also have trouble seeing a way to make it work. I began my schooling as a nurse, quit, went back a few years as a biology student at a “pre-med biology” school and heard many students talking about the reason they wanted to be Dr’s. Pay was a big one. I don’t recall ever hearing any of them say “helping people” as a reason. Now the vet students, they knew their debt load for school would be greater than their salary (for the most part) and cited ‘I love animals” over and over for their reason for going into that professional. When I take my dog to the vet, the bill for a vaccination or antibiotic is still reasonable. I can get a c-section for a bull dog for a few thousand (I used to work in an emergency animal clinic), my own c-sections were well into the 10’s of thousands with 3-4 K as my cost after insurance (which I pay $300 a paycheck, or $600 a month, $7200 a year).

    i don’t know what the answer is either, but your points are so clear. Why do they not negoitiate, but send bills off to third party debt buyers (and they don’t waste any time selling them off)? Why is dental care not an important part of ‘healthcare’ (I mean it is the beginning of our digestive system and was one of the major contributors to the death of the Incas)? The questions are just endless!

    I’ve been brewing on a post of my own on this topic after receiving an $8100 quote when I went to the dentist because one of my teeth hurt. I never received any comfort or help for the pain (or the tooth), but was told my wisdom teeth (not the one in pain) needed to come out (they came in beautifully and have never been a problem to me). I had to sign all these papers saying if I treated the bad tooth, I was obligated to received all the ‘recommended treatments’ as well which included crowns on all my old fillings, the wisdom teeth extraction, the hurting tooth (which turned out to be a mandible fracture) extraction and a bridge. I just wanted the ONE tooth removed or fixed. I had also printed off a coupon off of their website for first time customers (I had to switch dentists because of my insurance network-who says we don’t have a form of socialized-type healthcare???) and was told when I presented it I could not use it because I have insurance. WTF? My husband called it “bait & switch”. When I left (without any sort of treatment and $129 in debt to the place for the exam and full mouth xrays for my one hurting tooth), I noted the dentist drove a BMW. Just a note, but for $8100 for ONE tooth it was no surprise.

    It’s really dismal no matter which side of the fence one leans on…

    • Gina, that’s crazy!

      A nurse I work with had to switch dentists also because our health insurance quit covering the one she had been going to for years. She received a written quote from the dentist for something (I can’t remember what) and then found out she had to switch. When she got to the new dentist’s office and got a price for the same thing, it was literally four times what the first dentist had quoted, and that’s taking into account the insurance payment! She went out to her car, got the paperwork, and showed it to the new dentist. He took it to his office staff, who at first tried to say IT WAS A FORGERY. When she got angry and told them to call the office they realized she was serious and suddenly, they were able to meet the first dentist’s price. By that time she was so angry and offended that she left…but they too still made her pay the fee for the new patient visit and consult.

      She did end up getting whatever work she needed done, at the price the first dentist gave her — from a dentist in the same building as her old one who took the new insurance.

  2. I thought about taking their quote back to my old dentist too and letting him know DentistII said the work he did last year was bad (not in those words, but more-or-less).

    i would have been so mad to hear a dentist accuse me of forgery!

  3. Hi Gina,

    I found your blog from Gene Logsdon’s website – great post! Cost of medical services is indeed a too-often overlooked aspect of the healthcare debate, even though insurance companies deserve every punch they take. My son was born with av canal (hole in the heart) and the bill for the heart surgery (2 hours) and recovery (2 weeks) was ~$150,000 – billed to my insurance company though I can only assume not paid in full. If I may throw a few points in:

    • Hospitals and doctors charge as much as they do in part because insurance companies negotiate and pay less, and public insurance pays less by statute (which is why many private physicians won’t accept medicaid patients – a violation of their Hippocratic oath). If they’re going to charge Aetna $10k for your C-section, that’s what they have to charge you, despite the fact Aetna will cut the payment in half through their bargaining power.

    • Medical education costs too much, and medical colleges in the US are dominated by private interests like the Rockefeller Foundation. This ensures a steady supply of doctors who are only in it for the money, who need to make a lot to pay back their debt, and who will enter the real world with an extremely narrow view of medicine based on the interests of big pharma and medical cartels.

    • The fact that medical costs are 1/6 of GDP is not only an indication that medicine and insurance are too expensive – but that we’re not generating enough earned income. If most people were comfortably employed in productive work, the increase in earned income would eventually be reflected in better education, better health and more dispensable income.

    All of the above is an indication that we live in a fascist country – where private interests own the government and steer policy in a direction directs income toward non-productive expenses like debt and chemotherapy. One of my big concerns is that more people like you who realize the system is broken would rather go it alone and let government wither on the vine than fight for a real government that builds and protects the general welfare rather than “the business community” (Wall Street). In the spirit of the Abraham Lincoln, this country has the ability to decrease the cost of living by increasing the productivity of labor and protecting the unorganized people against organized private interests – rather than falling apart into the “free market” and hoping we’ll end up with doctors willing to do a C-section for $1,500.

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