Wednesday, November 22, 2006

Outsourcing Compassion in Health Care?

I went yesterday to my regular check-up with my cardiologist and spent most of the session talking with him about socialized medicine and its repercussions. You know it's a sign your health is improving when your doctor talks more about what is going on in the wider world then your bum ticker. That is fine by me.

My cardiologist works in a large practice at one the local hospitals here in Knoxville. They have outreach care for heart patients in many of the small counties in this part of the state with physicians who are willing to drive many miles to see patients who cannot or will not come into Knoxville. Some of the cardiologists in my doctor's practice donate their time to the Interfaith clinic here in Knoxville that provides medical services to those who fall through the cracks:

In January, 1990 a twelve member committee worked together to create a place where people without insurance could receive affordable health care. On March 6, 1991 the InterFaith Health Clinic opened its doors to serve those earning too much to qualify for government subsidized insurance and too little to afford private insurance. Since opening, the clinic has served over 50,000 patients.


"What the general public does not realize," my cardiologist said, "is how much free work we doctors give away. We had a patient in here yesterday without insurance, nothing, and he was in the heart cath lab yesterday afternoon."

What will happen to this same patient of my doctor's if the United States had Universal Health Care? Would he have been put on a waiting list for the heart cath lab or for other necessary tests like so many in Canada? What will socialized medicine do to the compassion and/or working habits of doctors? Will taking away the free market in medicine start a new generation of doctors who see no incentive or reason to take on more patients when they draw a salary regardless of how many patients are seen? Have you ever dealt with HMO's who tried that approach? By paying doctors a fixed sum for so many patients, the incentive is to ration care, not provide more. In addition, if doctors are working for the government, they may see that as fullfilling their obligation already to the underprivileged etc., so they may not feel such a strong need to help out in extra ways.

Once the government is in charge, will doctors view their loss of autonomy over their practices as reason to turn compassion over the government? I think so. It is human nature to work for an incentive of some kind and to feel that one has some kind of autonomy over one's work--that is why capitalism is the only system that works, it allows people to reap the rewards of their own work and rewards those who are better than the competition. To completely take the market out of healthcare allows mediocrity to flourish. Can we really afford to do that with people's lives?

Shouldn't we be asking ourselves these questions before demanding that the government take charge of health care? Because asking them after the fact may be too little for many and too late for some.

50 Comments:

Anonymous Anonymous said...

Something tells me they wouldn't give away so much as to have to say, move in with their relatives or give up their financial independence. It's funny how some people like to act generous with other people's money.

11:14 AM, November 22, 2006  
Blogger Out of Step in Kfar Saba said...

Having lived with socialized medicine for 10 years now the least you will give up is the personal attention of having "your" doctor treat you. That is not the case with socialized medicine. Even in a system like Israel's (which is much better that the UK's or Canada's) where the specialty care is good - the general family care is adequate at best.
That is not to say that many doctors remain compassionate in spite of the system.
The US system is clearly the best. What Europeans and American Euro-wannabe's don't understand is that solutions and compassion are best given by people who are not also bureaucrats.

11:30 AM, November 22, 2006  
Blogger Helen said...

Anonymous 11:14:

I am not sure what you mean by "act generous with other people's money." Exactly how are doctors who are giving their time free to patients doing so on other people's money?

11:40 AM, November 22, 2006  
Anonymous Anon824 said...

Due to my family hx, elevated cholesterol and high blood pressure, my internist sent me for a cardiac CT scan last Friday. Because it showed a very high level of plaque buildup in 1 coronary artery, I will have a radionuclide stress test on Monday.

Hopefully, nothing dangerous will be revealed. I'm just glad that I wont have to wait 2 or 3 months to find out.

11:41 AM, November 22, 2006  
Blogger Helen said...

anon824:

I am so glad they are following up with you quickly and hopefully all is well. However, do not worry as heart care has never been better. I am so amazed at the technology they have now for heart problems.

11:48 AM, November 22, 2006  
Anonymous Anonymous said...

mediocracy?

(sorry.)

5:46 PM, November 22, 2006  
Blogger Grumpy Old Man said...

There was a story recently that said conservatives donate much more to charity than liberals. The latter figure the gummint will take care of people.

The demand for health care is much more elastic than some think. Where it doesn't cost extra, people will seek treatment for conditions that usually go away by themselves, like sprains and upper respiratory infections. If it's "free" (to the individual at the time of delivery), demand will go up.

One way or another, health care must be rationed.

6:28 PM, November 22, 2006  
Blogger Joe Baby said...

We often hear the role of the military is to kill people and break stuff.

I'm fairly certain that socializing health care would do the same.

6:28 PM, November 22, 2006  
Anonymous Anonymous said...

Actually, a lot of doctors do subsidize more than just free care because they want to work in a particular setting, say an academic medical center. I would make twice as much in the private sector as I do in my non-profit teaching hospital position (which is still a good salary overall, but if it was much less, it wouldn't be worth the stress and time away from family and fear of lawsuits to me, so I wouldn't do it. Yes, I expect some fair level of compensation, greedy doc that I am). Granted, I want to be here so I can teach residents, but people like me do subsidize the system with our hard work. I generate hundreds of thousands of dollars for a non-profit hospital, none of which ever makes it into my pocket. It goes into the overall budget and running of this place, which provides a heck of a lot of free care. So, I benefit, the hospital benefits, the patient benefits.

As a physician and a patient with multiple sclerosis, I think the problem with the medical system in the US is the feeling, from patients and doctors both, that there is no choice. It may be more choice than in other systems, but the rigidity chafes....at least that's how I feel as both a deliverer and a ,er, consumer, of medical care. I am so locked in to the system. Any changes or improvements I'd like to make in my position are out of my hands and dealt with by middle-managers or I-only-care-about-the-next-line-on-my CV academic types. Hence, 'youngsters' like me typically last a few years in this sort of hospital and move on to private practice. Not so much for the money, as for the perceived *freedom* of it. Laugh, but that's how it feels.....

6:30 PM, November 22, 2006  
Blogger Helen said...

anonymous 5:46:

Thanks for the spell check.

6:51 PM, November 22, 2006  
Anonymous A VA Pathologist said...

We already have doctors who get their salaries from the federal government: full-time physician employees of the Veterans Health Administration. I have worked at a VA hospital and in other enviroments, and I believe that VA physicians display as much compassion towards their patients as independent physicians. At VA facilities, charity care cannot be provided to non-VA patients, but I know of some VA physicians who also work at free clinics.

Of course, we are voluntary employees of the federal government. Going to a national healthcare system and essentially forcing all doctors to participate might generate resentment, anger, and frustration that would result in some doctors being less compassionate. (It's hard to be compassionate when you are angry and frustrated.)

6:56 PM, November 22, 2006  
Blogger Billy Beck said...

Speaking only for myself: I can't afford "compassion" in any case, anymore.

This government priced me out of the market a long time ago.

7:06 PM, November 22, 2006  
Anonymous Fritz said...

Living in Canada one of the biggest problems is a shortage of doctors.

Because education of doctors is also controlled exclusively by the government not enough doctors are trained due to the high cost. The hoped for solution is to pilfer doctors from third world countries. (I think most of South Africa's white doctors now work in Canada.)

Most countries with socialized health care offer a private alternative if you want to pay for it. Canada is one of 3 countries in the world where private alternatives are illegal. Hence those who can afford it go across the border to the USA.

A few years back the Prime Minister of Canada (Jean Chretien)privately sent his son for drug and alcholic treatment to the US because the waiting lists were too long in Canada. Yet derided others who did the same thing. Of course the pro-socialized medicine media refused to cover this story citing privacy considerations.

The only reason Canada's health care system has not completly imploded is because the US acts as a safety valve - 80% of Canadians live within 100 miles of the US border.

The hypocrisy and horror stories are endless.

No one is impressed with the job Homeland Security or any other major government agency is doing in running its affairs. Do you really think putting all of your health care in the hands of government bureaucrats will make things better?

7:27 PM, November 22, 2006  
Anonymous Anonymous said...

Do you want a health care system that runs just like the socialized eduation system you have now?

I am a Canadian expatriate. Let me tell you how the Canadian system works:

One friend I have, developed an anemic condition due to a series of heavy periods. However, her GP had retired, and she couldn't find a new one; GP's are in short supply outside the major cities, and none in her town were taking new patients. As GP's are the gatekeepers of the system -- you must get referrals from one to see a specialist -- it took her about seven months to find a way in. By that time, however, she was already recovered; she's a retired RN, and was able to medicate herself.

Were she not an RN, the few months of lethargy she endured because of the system would have gone on for more than twice as long.


Next story: A 70-year old man ends up in the hospital after a heart attack, his third. Amidst 1950's era equipment, interspersed with a few modern bits here and there -- invariably inscribed with a plaque thanking some private donor -- his doctors are horrified to discover that he's been on Inderal for years, despite it's having been obsoleted by better drugs for some time. But since his GP had retired, nobody had bothered to follow up. How many years off his life, lost down that crack in the system? Your guess is a good as mine. Seeing as this man was my father, I don't want to know... we buried him five years ago. He was lucky to have a whole year between his third and final heart attack, all four seasons one more time... I like to call that his "victory lap".


Next story: another friend of mine had a young daughter with a suspected condition that required a test to verify it. The condition was such that delay in the diagnosis was potentially dangerous. The waiting list fot the TEST (not the treatment) was several months long. She is an RN, so she pulled levers within the system "jump the queue" and get the test earlier.

God knows where she and her daughter would be, if she were just one of us instead of an insider.

Would you call her choice immoral? I would call the system that put her in that position immoral. The system, and its advocates.

The system does this *because it is socialized*. You can't make it or any half-breed of it (like the current system here in the US) "work". If Tenncare wasn't enough to show you where that road leads, perhaps the Canadian experience will.. if you look past the guff from socialized health care's advocates and try reading Canadian news directly. Let your northern neighbor's experience be your guide.

You can thank us later.

7:44 PM, November 22, 2006  
Anonymous F. Galton said...

If socialized medicine had been implemented in the 1920's it would have been heralded as a testement to the efficacy of eugenics.

8:19 PM, November 22, 2006  
Anonymous Anonymous said...

I too am a Canadian. I am also a lawyer. The system here works reasonably well if you have an emergency situation and it is easily diagnosable. My late girlfriend was diagnosed with cancer, was started on treatment immediately and that continued for 3 years until she died. The system breaks down with elective care - you get on a waiting list and you are vulnerable to strikes, etc (you lose your spot on the list). Of course, queue jumping seems to be relatively easy here if you know a doctor - being a professional, I understand that I am already half way there to being able to qeue jump at will.

Do yourselves a favour, do not emulate our system.

8:45 PM, November 22, 2006  
Anonymous Anonymous said...

The last anonymous poster (845) raises an interesting point. In Canada, it's largely about your nominal standing in society, who you know, and how agressive and effective an advocate you have working on your behalf.

Lawyers do quite well -- reasonable social standing, most know doctors, and typically very articulate.

His view of the system working relatively well if you have a diagnosable emergency situation is at best half true. If you're relatively young (say under 55), then it's certainly possible to get good care if you have a very effective advocate or know someone.

If you're older, forget it.

My father (64 and generally in excellent health) was diagnosed with prostate cancer; it was stage 3 (fair-sized tumour; hadn't yet spread) which is reasonably serious. He had to wait the better part of a year for surgery.

While he was waiting, the Federal Minister of Health, the "Honourable" Alan Rock was also diagnosed with the disease. Earlier stage. He was seen to within approximately a week.

Somehow, Health Minister Rock was able to jump a year-long queue. That's certainly very nice for him and his family, but I wonder why other Canadians had to wait behind him, wondering over the course of a year if their cancer was spreading and if they'd die.

To have Rock preen on TV and speak about how excellent Canada's health care system was, and how no choice was needed... well, let's just say he turned me from being a Conservative into a 'broken-glass' Conservative voter.

After my father's surgery, he wound up contracting sepsis. It was extremely serious, and not helped by his doctor telling him (over the phone) that he shouldn't worry, it was probably just the flu, that he'd see him the following week. I phoned his doctor, was told the same thing. Phoned a friend who's a physician in another province, described the symptoms, and was told to get my father to an ER, and that he'd try and have a friend of his see my Dad on an expedited basis.

My Dad came within 6-12 hours of organ failure. If I hadn't been there, I think the odds are fair that he would have languished long enough in the ER (or not gone in at all) that he'd have died.

No, this isn't a good system even for those with diagnosable emergency conditions.

As with most hard-line socialist schemes, the Canadian system is good for the incredibly poor, stupid, and unlucky. It's also good for the fantastically well connected. Everyone else?

Would you want to wait a year at stage 3 for surgery? Come that close to dying of sepsis? And see the Health Minister on TV prattling on about how wonderful things were?

Any American who proposes something even close to the Canadian system is either stupid, evil, or crazy.

10:19 PM, November 22, 2006  
Anonymous Anonymous said...

"Any American who proposes something even close to the Canadian system is either stupid, evil, or crazy." The prominent American who has just threatened the return of her single-payer health care system is none other than Mrs. Rotham-Clinton.

1:27 AM, November 23, 2006  
Blogger Rowena Hullfire said...

Seeking private care outside the system is illegal under HillaryCare. Canadians won't be able to come here any more to get care outside their queue; doctors won't see them. See, under HillaryCare, the patient AND the doctor can go to jail.

However, Americans with resources will engage in medical tourism to other countries if they need to. This is already happening more and more just as a cost management system even in private plans. India has very good doctors and low expenses.

In England and Canada, there are ongoing discussions about how the poor and minorities are on waiting lists longer than wealthier white people. It's not like a government bureaucrat keeps rearranging the list out of crass classism and racism, it's what you describe--people going elsewhere, private, or negotiating faster treatment.

But yes, people get disabled and die on waiting lists.

In the US, public health departments, clinics, and hospitals will treat everyone regardless of ability to pay, and there are massive charity programs. I live in a small town, with county population of 70k, and our hospital provides something like $60m of charity care annually.

Several of my English cousins, and outside NHS they have private practices and make good money treating the wealthy.

There are a lot of Canadian doctors in the USA who fled Canada when socialized medicine started there.

I can easily imagine government bureaucrats managing costs by downgrading granny's care, or even pulling the plug on really sick and/or comatose people. In the UK, if you are over 65, anyone younger automatically moves ahead of you on the list.

In commentboxes on the topic, with some English and European folks, we all compared what we paid for medical...and yes, you pay for government medical care, it's not getting something for nothing! Even with copays and uncovered services, plus premiums, I paid LESS than anyone on government care in England/Europe. They pay!!!

I am totally against socialized medicine. I am against government interference with/control of our lives. It will be a colossal failure. It makes me afraid; I have had cancer twice and received world class care. I still have cancercritters in my bloodstream but only need occasional screening to make sure they're not setting up camp anywhere. I hate to think of being stuck in a situation like the prostate cancer situation mentioned above...where a non-life threatening cancer is made life-threatening because of being stuck on a waiting list.

If we go to socialized medicine, I might even change careers so as to be able to queue-jump--in health care probably, or government (yuck). I love my career and don't want to change careers, but I will if I feel it would benefit me and my family.

8:19 AM, November 23, 2006  
Blogger Pogo said...

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* Long waits and reduced quality. In Canada, the average wait between a general practitioner referral and a specialty consultation has been over 17 weeks. Beyond queuing for care or services, single-payer sys­tems are often characterized by strict drug for­mularies, limited treatment options, and discrimination by age in the provision of care.
* New inequalities. Beyond favoritism in the provision of care for the politically well-con­nected, single-payer health care systems often restrain costs by limiting surgeries for the eld­erly, restricting dialysis, withholding care from very premature infants, reducing the number of intensive care beds, limiting MRI availability, and restricting access to specialists.
* Labor strikes and personnel shortages. In 2004, in British Columbia, Canada, a health worker strike resulted in the cancellation of 5,300 surgeries and numerous MRI examinations, CT scans, and lab tests.
* Outdated facilities and medical equipment. An esti­mated 60 percent of radiological equipment in Canada is technically outdated.
* Politicization and lost liberty. Patient auton­omy is curtailed in favor of the judgment of an elite few, who dictate what health care needs and desires ought to be while imposing social controls over activities deemed undesirable or at odds with an expanding definition of “public health.”

9:13 AM, November 23, 2006  
Anonymous Len said...

Most people think that capitalistic rewards refer only to money, but that's not true. Here is a beautiful quote (from whom I do not know - I did not record his name):

“Each human can (and should) seek his own well being, including of course the well being that comes only from the trust and high regard of his fellow humans, and including the pleasure he derives as benefactor from acts of uncompensated charity; and therefore he will arrange his affairs to please others while enhancing his own position and enjoyment of life. That's a rational ethic, and a reflection of it can be seen in every honest business transaction in history.”

9:59 AM, November 23, 2006  
Anonymous Len said...

Just found where the quote came from (what I quoted in the last "len said"). It came from Jim Davies frome the blog site called "Anarchist."

Just a reminder - the quote is:
\
“Each human can (and should) seek his own well being, including of course the well being that comes only from the trust and high regard of his fellow humans, and including the pleasure he derives as benefactor from acts of uncompensated charity; and therefore he will arrange his affairs to please others while enhancing his own position and enjoyment of life. That's a rational ethic, and a reflection of it can be seen in every honest business transaction in history.”

10:17 AM, November 23, 2006  
Anonymous Len said...

One more observation about Jim Davies great comment. Here is his comment (again):

“Each human can (and should) seek his own well being, including of course the well being that comes only from the trust and high regard of his fellow humans, and including the pleasure he derives as benefactor from acts of uncompensated charity; and therefore he will arrange his affairs to please others while enhancing his own position and enjoyment of life. That's a rational ethic, and a reflection of it can be seen in every honest business transaction in history.

And here is my observation. He says in two sentences what it has taken others whole books (Ayn Rand, for instance).

10:45 AM, November 23, 2006  
Anonymous Anonymous said...

"Will taking away the free market in medicine start a new generation of doctors who see no incentive or reason to take on more patients when they draw a salary regardless of how many patients are seen?"

What incentives do doctors have now to treat patients for free?

The quote above is nice, but I reckon there are lots of "irrational" doctors, lawyers and business people in the world. And their numbers are rising every minute. Hell, even paying folks can't get polite, competent customer service any more.

11:13 AM, November 23, 2006  
Anonymous tyree said...

In the not to distant past, banking regulations allowed only one income to be used for a home mortgage. The reasoning was that in tough times, both husband and wife would be able to make up the shortfall and still keep their house. In deference to the feminist lobby and higher profits, the regulations were changed so that two or more incomes could be used. Soon, due to market pressures, two or more incomes were required to buy a home.
Modifying the lending laws did not make homes more affordable for families with stay at home moms. Socialized medicine will create new problems even as it tries to address the old.
All earth shattering changes to our legal system, such as implementing socialized medicine, should be tried out in four states for five years before they are implemented in the entire country. The data collected could be used to inform the electorate so better choices can be made.

11:27 AM, November 23, 2006  
Anonymous Anonymous said...

rowena said:

"However, Americans with resources will engage in medical tourism to other countries if they need to. This is already happening more and more just as a cost management system even in private plans. India has very good doctors and low expenses."

Your criticims of socialized medicine may be spot on. However, your above comment reflects that you are aware of serious problems in our system as it is. What do you propose?

9:55 AM, November 24, 2006  
Anonymous Andrew Zalotocky said...

Britain's experience with the NHS (National Health Service) should be a warning of how badly a centralised government-run health system actually works. The mere fact that it is run by government ensures that every decision becomes political, leading to ever-tighter central control, ever more bureaucracy and ever more waste. People suffer because of shortages, serious hygiene problems
and long waiting lists for treatment while the government spends a fortune on management consultants.

For an inside view of the system, see NHS Blog Doctor (Warning - some posts contain graphic images but only when necessary to make a point).

Whatever you do, don't replicate this disastrous system in your country!

1:40 PM, November 24, 2006  
Anonymous Anonymous said...

Does the VA count as government controlled medicine? I'm quite happy with the VA, by the way. I've been in the system since 2005. It's not perfect, but it's hardly endangered my health with long waits or shortages.

10:58 PM, November 24, 2006  
Anonymous libounari said...

Great Medical Books: http://www.onlybooks.us/categories/medicine.html

6:32 AM, November 25, 2006  
Blogger Helen said...

Anonymous 10:58:

My guess is you are a fairly healthy person who does not have a chronic illness that is life threatening. The VA killed 700 people alone in less than two years:

http://www.asdv.org/pnol/pnolhealth.cfm?AutoNum=20

My experience in working with patients who have been in the VA is that civilian care is better and more thorough. Others may have a different experience.

7:47 AM, November 25, 2006  
Anonymous Anonymous said...

From helen's link:

"McManus and other health care experts said they believed that the prevalence of errors at veterans hospitals was similar to that at other hospitals. "I don't think it's any different from the private sector." McManus said."

and:

"The comprehensive self-examination by the VA believed to be the first of its kind by any health care system in the nation, shows what could be expected if all hospitals had to report their errors as recommended recently by the National Academy of Sciences."

So, I'd say you rather misrepresented the article. Particularly with hyperbole like, "The VA killed 700 people..."

11:51 AM, November 25, 2006  
Blogger Helen said...

Anonymour 11:51:

Okay, if it makes you feel better--I will quote directly from the headline of the article:

"VA Medical mistakes: 700 dead in 2 years Report documents 2,927 errors at veterans hospitals around the nation"

4:06 PM, November 25, 2006  
Anonymous Anonymous said...

The idea that inpatient care in the VA is routinely of the same quality as that available in the best private hospitals is beyond ludicrous. I'm sorry to tell this to the many veterans who have served their country and deserve better, but most physicians I know would move mountains *not* to work in the VA. Yes, there are plenty of committed, altruistic docs who have self-sacrificingly chosen to work there, and many more trainees who are required to, but the majority of physicians desperately want to avoid working in an environment filled with outdated equipment, sclerotic bureaucracy, and overwhelmed ancillary staff. How many deaths, or errors, this actually translates into is open to argument - much of it manifests more as long waiting times than anything else - but find me a physician who would voluntarily send a family member to a VA hospital and I'll show you someone who has never worked in one.

5:07 PM, November 25, 2006  
Anonymous Anonymous said...

"but find me a physician who would voluntarily send a family member to a VA hospital and I'll show you someone who has never worked in one."

Regardless, VA hospitals have to meet accreditation standards. Besides, the comparison should be between VA care, and uninsured or underinsured private care. (Also, I believe the health care crisis among the top 5% of income earners in the U.S. is relatively solved -- or at least as much as it’s going to be)

I might add, I know of no movement among veterans (despite complaints) to do anything but increase funding and other positive trends, *not* get rid of the VA system. That would seem to be more of an endorsement, than not.

2:22 AM, November 27, 2006  
Blogger a psychiatrist who learned from veterans said...

If memory serves, medicine in Rome was performed by Greek slaves. Your doctor is probably not angling for the role. The narcissistic satisfaction on the patient's part would probably not translate into motivated medical care. We might socialize the wait staff at restaurants first and see how that works out.

12:03 AM, November 28, 2006  
Blogger quadrupole said...

Trust me, you will like it even less when things like Quebec's Bill 114 start coming down the line...

In Quebec they have a shortage of emergency room physicians. So their solution was to pass a law allowing the state to *compel* doctors with emergency room experience to report to and work at understaffed emergency rooms. Now maybe I'm just a little old fashion, but that sounds a lot like slavery to me...

Oh, and they definitely mean it... I've seen articles about law enforcement sent to collect non-responsive physicians...

1:03 AM, November 28, 2006  
Anonymous cass said...

Well, back to Helen's post...my town has a similar outfit that does a stellar job providing medical services to any and all comers.

Yet the local liberalocracy goes on and on about lack of health care for the poor...so what are the local pro bono providers--chopped liver?

Let's face it, the libs HATE anything smacking of charity. They think it undignified. But I always thought dignity was something you gained for yourself, not something conferred on you by government.

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