That self-same doctor was interviewed by MSNBC for an article about "House" published today. People with real health problems are searching the world for a "real Dr. House", someone who can solve their puzzle and tell them what they have sometime faster than the average of 7 years it takes for a definitive diagnosis for a rare disease.
The article ends with a criticism against the TV doctor that the TV show itself has already addressed. From the article: "In med school, doctors-to-be learn the opposite, summed up by the adage, 'If you hear hoofbeats, think horses, not zebras.'" From the show: "Are you in first year medical school? If she had [a common, 'horse' of a disease] the kindly family doctor in Trenton would have made the diagnosis. It'd never get anywhere near this office." Dr. House isn't a fictional version of your family doctor. He's a fictional version of a job that doesn't exist -- the authority that doctors refer you to as an admission that they can't solve your problem. If a regular doctor is your county judge, Dr. House is the Supreme Court. When he has to deal with patients directly in the clinic, he tells them exactly what your doctor will tell you when you talk to them: it's a cold. It's the flu. It's a horse, not a zebra. It's only once the horses are ruled out that Dr. House even comes into play.
One particular story of a too-long-awaited diagnosis struck a nerve.
It took five months — and visits to 21 doctors — before one finally correctly diagnosed her with Lyme disease, a bacterial infection often spread by deer ticks.Did you get chills, too? If not, let me spell it out: No one was able to solve her medical problem until she got to the doctor that doesn't accept health insurance. That's not from House, the fictional TV show. No one would write anything so crazily unbelievable. No, no, that's the real-world true story. The elitist, overpaid doctor could afford the time to properly consider and finally solve the puzzle. That's exactly the kind of thing the big Obama Health Bill currently being debated in the legislature is designed to stall. In all our worries about health care costs, we forget one thing: you get what you pay for.
That final doctor, she says, did something that all those before her hadn't. “She listened to me,” said Risley, who opted to see a physician who was generous with her time, and got paid well for it, accepting only out-of-pocket payments.
For a further example of the political angle of it, look at Medicare. The principle behind Medicare is that government pays for the health care of the needy. In practice, though, Medicare rarely covers the full price of the service. Doctors have to cut costs, raise prices, and rush through as many patients per day as possible in order to make ends meet when accepting Medicare patients. In short, government health insurance makes health care worse. The White House has been promoting Obama's health care plan with the very words "Medicare for everyone." This spells doom.
You want better medical care? Look to your pocket book. Unlike government programs, it might help.
Huh? Why would the existence of a public health care option affect the medical care received by someone who can afford to pay for it out of pocket (or to have private insurance)?
ReplyDeleteMaybe I'm reading you wrong, but it sounds like you're saying the equivalent of, "If we open thrift stores, people will have to wear secondhand clothes!" The thrift stores are for the people who can't or won't buy new clothes, not the ones who already do. And for them, it's necessarily an improvement.
The biggest problem of a medicare for everyone system is that doctors are bound by law to provide the same care to medicare patients as to paying patients, and to charge the medicare patients less. To remain solvent, doctors respond in two ways: either they refuse to honor medicare, or they lower the amount of care they give per dollar. The latter includes cutting costs (which, on average, lowers quality of care) or raising prices (on paying customers only).
ReplyDeleteOn a national scale, some doctors will pick each and both effects will permeate the market. Thus, a patient faces a choice between 1) rushed, low-quality care under medicare, 2) rushed, low-quality, expensive care with doctors who also accept medicare patients, or 3) good, expensive care with doctors who refuse public option patients.
That's all medicare. That has already happened. A national public option based on the principle of "medicare for everyone" simply multiplies this same effect.
That kind of public option doesn't put good health care within reach of the poor. Rather, it removes good care from the reach of those barely able to afford it now. At best, it's hurting some for the benefit of others. At worst, it also lowers the mean average care across the country.
Teaching and charitable hospitals often accept patients regardless of their ability to pay. That's a far better way of offering good care to those who can't afford it. That way, no one is robbed of quality of care to pay for it.
It never ceases to amaze me how/why the U.S. continues to see itself as apart, separate and unique from other western / stable countries it has a lot in common with (ie. Canada, most of the EU, etc.). You see it in gun culture/control, and now you're seeing it in healthcare reform.
ReplyDeleteCanada, UK, France, Germany... in fact most of Europe have some portion of state-run healthcare, and are doing fine, thank you very much. No vast dilution of quality exists. And yet the U.S. continues to see even the tiniest bit of government healthcare as an *option* as the first step towards totalitarianism.
Medicare for everyone is not, in my view, the first step in that direction, nor is it that direction necessarily toward totalitarianism.
ReplyDeleteFirst, it is by definition an extension of medicare. Medicare is a previous step. Thus, it is not the first step. Easy.
Second, other state-run health care systems have exactly the same problem I'm describing: government-paid basic care of reasonable quality and greater coverage at much greater expense for the privately insured or independently wealthy. Those who are financially just short of the better group lose out in just the same way as I am describing. This results in a health care system that is better than the USA at general care and worse at specialist care.
Check the stats. Americans who cross the border into Canada are typically looking for cheaper general care, but Canadians who cross the border into the USA are looking for better quality specialist care. Both happen frequently. Those habits bear out my theory.
In your amazement at US habits, have you considered the European/Canadian tendencies to assume it's the right thing to do just because other similar countries are doing it? I'm more of a pluralist and a non-conformist than that: it's better that many nations use many different approaches to the same problems, and my nation's unique approach offends me in no way.
You could've mentioned Brazil and Japan as national medical care countries, too. Especially Brazil; as the only national health insurance system for a nation of roughly comparable population size to the USA, it deserves mention.
Your response answered my questions, but I felt like the point you made in it was so necessary that I'm not sure why it wasn't in the original post.
ReplyDeleteDo you have an idea of how the government could help provide medical care for people who don't have it without causing the side effect you describe?
I'm so used to talking to conservatives who already know about medicaid underpaying doctors (and love to complain about it) that I assumed that it and it's repercussions were already known. That's a problem with partisan segregation in politics: different views don't talk with each other enough to know what the other side doesn't know.
ReplyDeleteIf government necessarily must be involved in medical care they could donate money to teaching and charitable hospitals. Such hospitals accept patients regardless of ability to pay, so government would be helping to pay for medical care without the overhead costs and political controversy of determining which individuals are deserving. Further, the bulk of the cost would be covered by the very rich in exactly the same proportions as tax revenue already does, eliminating the poor-for-middle-class trade off.
I'd prefer government leave all the authority and money with taxpayers, though. I trust individuals to know which hospitals and medical charities deserve their donations better than governments. Everyone is more thoughtful with their own money than with other peoples'. Also, many charitable hospitals have connections to religions, so letting individuals handle it side-steps the church and state controversy.