Comments on: Welcome To The Waiting Room

By: KL7212

KL7212 — Fri, 12 Jun 2009 14:10:26 +0000

"To have coverage without care is to have no care at all. "

This is silly. Nobody who falls and breaks his leg or has a heart attack is going to wait for treatment by a primary physician; He's going to the ER.

The "waiting time" argument against the Obama plan is a canard, especially since we already have extended waits for primary and emergency care are largely due in no small part to the huge number of uninsured patients clogging the system.

I think a "two-tier" system might work. Those who need just basic coverage will get it, free of charge or at low cost through a publicly funded plan. Those who wish to purchase a higher level of care can do so through their employers or out of their own pockets.

Most everybody agrees the current system is badly in need of reform. It is hideously expensive and inefficient. It combines the worst aspects of capitalism (profiteering, cost cutting) and socialism (rampant bureaucracy, rationing). It is geared more towards catastrophic care rather than preventative care. Worse still, the outcome yielded by this health care monstrosity--life expectancy--is no better and, in many cases worse, than that of public health care systems offered in other affluent nations.

By: GoramFirefly

GoramFirefly — Thu, 11 Jun 2009 18:22:02 +0000

Sinz,

Thank you for your detailed account. Yes, it helped very much.

I live out here in California, and the only thing I heard about the Massachusetts system was that "it mandates everyone to buy insurance" and that was it. Needless to say, that didn't sit well with me. Your account puts it in a totally different light.

Thank you.

By: Jeb Golinkin

Jeb Golinkin — Thu, 11 Jun 2009 16:34:13 +0000

So you think that someone with the flu would rather go untreated than deal with the hassle that is the ER? When the options are (a) ER (b)wait two months (by which time you will be over whatever you've got) or (c) do nothing, I think its a pretty safe assumption that not everyone is going to take the "tough it out approach." You mention that you can blow an entire day in the waiting room of an ER, well if you have the flu and you don't get treatment you will be out of commission even longer....most people will take that day if the other option is to go untreated (and again, with something like the flu....a 50 day wait= not getting treated)

I'm all for extending coverage but you'd sure as hell better encourage the growth of the convenient care industry so that doctors and ER patients can spend their time seeing patients with serious illnesses. It makes no sense to have a doctor take an appointment with someone with the common cold when a nurse practitioner will identify the same basic symptoms and proscribe the same medication to treat those symptoms that a Dr. will. If the symptoms are less clear, then the nurse practitioner sends the patient to see a Dr. with more extensive training to diagnose the more complex illness. There are actually machines that, if you type in your symptoms, can diagnose basic illnesses.

My point is not "don't expand coverage." It is rather that expanding coverage in and of itself will not result in decreased costs. We have to address coverage to make more care available otherwise health care reform will fail.

By: sinz54

sinz54 — Thu, 11 Jun 2009 16:09:52 +0000

JebG:
Are you kidding???

When you go to an Emergency Room for routine care or even urgent care, you sit and wait--and wait--and wait. These days, every Emergency Room has a "Triage Coordinator" who first takes a look at you and your problem, and decides if it should be "fast-tracked" or not. And only those with life-threatening conditions like bleeding or asthma attacks are fast-tracked. Otherwise you go back out to the Waiting Room--and wait some more. You can waste most of a day waiting there (so much for your job productivity).

As for rising costs: Romney and the Mass legislature had made a deliberate decision to *defer* strong cost controls until after health care reform went into effect. If they had put cost controls up front, it would have scared stakeholders like hospitals and insurers, and made it much harder to enact the plan. Now that residents have gotten used to health care reform, Governor Patrick and the legislature can gradually start imposing cost containment--little by little, giving everyone time to adjust and to bring in such innovations as computerized networked databases to lower costs. It is also hoped that better preventive screening, now available to the uninsured through the public CommonHealth Care plans, will help lower health care costs eventually.

That last is kind of iffy. Because you may prevent one illness, but eventually you'll get another. The Grim Reaper can't be put off forever, no matter how much someone focuses on wellness.

As Sanford once said in the TV comedy "Sanford & Son": "What's he gonna do when he's an old man, lying in a hospital bed, dyin' of nothin'?"

By: sinz54

sinz54 — Thu, 11 Jun 2009 15:52:22 +0000

ottovbs:
In Massachusetts, health care reform had a long and complex history.

http://tinyurl.com/kkq8tr

The Massachusetts legislature first announced they wanted to to cover more of the state's uninsured. Then Romney proposed his own outline of a plan that would insure virtually all of the uninsured.

http://tinyurl.com/kkc4gq

The Massachusetts legislature came up with a plan that differed from Romney's plan in some areas, which Romney tried to veto but failed.

http://tinyurl.com/lqdwnf

But in the end, he signed it into law as is.

By: ottovbvs

ottovbvs — Thu, 11 Jun 2009 12:00:41 +0000

JebG
wrote 15 minutes ago
"the wait times are problematic because it will drive routine patients who ARE unwilling to wait to the emergency room."

.....Except that as others have pointed out that has not been the effect in Mass. Essentially your case boiled down to the fact that a shortage of primary care physicians was going to create inconvenience for those with health insurance who would have to wait longer for appointments and this was sufficient reason to derail the push for reform.....Doesn't really stack up does it.

By: ottovbvs

ottovbvs — Thu, 11 Jun 2009 11:55:10 +0000

sinz54 wrote 48 minutes ago”The irony of RomneyCare, is that here’s a *Republican* governor, who successfully implemented the kind of health care reforms that Hillary failed at, and that during the 2008 campaign Obama could only make vague promises about. He got nearly everybody in the state covered, and created a nifty public plan for the needy, without driving the private insurers out.”…….Actually as you well know Sinz if you live in the state the bill was largely written by the legislature. Romney certainly was not the architect of this scheme although he wasn’t massively obstructive and worked in a constructive way with the house/senate. The real irony is that he essentially denied having anything to with the plan when he ran for president. Did the cock crow three times I wonder? When he was on the campaign trail Obama didn’ have to provide all the detail just a committment that he would introduce it. Obviously the bill would ultimately be written by congress.

By: Jeb Golinkin

Jeb Golinkin — Thu, 11 Jun 2009 11:39:58 +0000

You folks are right. “Catastrophe” was certainly poor word choice. The point I was attempting to convey was that Romney Care has not reduced health care costs, as many of its proponents claimed it would….I have changed the wording….your objections on that point were well founded.To address another point, the wait times are not problematic because I am upset that I will have to wait a little longer to get care, the wait times are problematic because it will drive routine patients who ARE unwilling to wait to the emergency room. If we extend coverage without also increasing care options, we have no chance of controlling costs. Of course we need to extend coverage….but we need to do so while increasing care options.

By: sinz54

sinz54 — Thu, 11 Jun 2009 10:58:48 +0000

The irony of RomneyCare, is that here's a *Republican* governor, who successfully implemented the kind of health care reforms that Hillary failed at, and that during the 2008 campaign Obama could only make vague promises about. He got nearly everybody in the state covered, and created a nifty public plan for the needy, without driving the private insurers out.

But the GOP base believes that any government initiative in this area is "socialized medicine." So as candidate for President, instead of running on his achievement, Romney was forced to run away from it. It ended up adding to his image as a flip-flopper, which is a big reason he failed to get the GOP nomination.

By: sinz54

sinz54 — Thu, 11 Jun 2009 10:54:33 +0000

GoramFirefly:
With Massachusetts RomneyCare: If you lose your job, and have little income from other sources, then you may quality for the state plan, CommonwealthCare. It covers everything, including prescriptions. It has the "look and feel" of any private plan, including a 24x7 phone help line--not like a Government bureaucracy at all.

By Massachusetts state law, no resident is penalized for having a pre-existing condition. Neither with CommonwealthCare or private plans. In my case, I switched to BlueCross some time ago after RomneyCare went into effect. Their Massachusetts online application form didn't even *ask* me if I had a pre-existing condition (which I did), or any questions about my current state of health. Neither did their phone representatives. The issue just didn't come up.

For CommonwealthCare, the public plan, premiums are on a sliding scale based on income--but even such things as Social Security disability payments are counted as "income." If your income is below $10,000, your monthly premium is ZERO. If your income is up to $32,000, your monthly premium is about $140. If your income is over $32,000 (say from interest on a big bank account), then you don't qualify for this plan.

So this plan is really for the truly needy. And so it can't drive the private insurers out of the market for middle class and upper class citizens.

You don't have to be without *assets* to qualify for this plan, so you're not going to lose your home or car. But you do have to have less than $32,000 of total *income*--so if you have income-producing property producing more than $32,000 of income, you don't qualify.

For the uninsured who wish to purchase private insurance on their own, these reforms have actually *lowered* premiums:

http://en.wikipedia.org/wiki/File:HealthReform.jpg

Hope this helps.