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Government Health Services - to draw posts from other thread

Ernest Bywater

Another thread is drifting very heavily into a discussion on government provided health service to such an extent I think it needs a thread of its own, so here it is.

I'll start the ball rolling about how stupid bureaucracy can warp a health care system.

Here in Australia the majority of health care funds come from the Commonwealth Government (read Federal for those in the USA), but the majority of services are delivered by the states (sound familiar to anyone), when there is a dispute about health care each level of government blames the other (what a surprise). Anyway, we have two major levels of bureaucrats creating laws, rules, and regulations for the politicians to approve and pass to run the health care system; in many cases there's a third regional bureaucracy involved as well.

One oddity about the whole thing is certain types of services are paid by the Commonwealth Government through the Medicare system, while the main health care services are paid by the state government health department through the hospitals. One way the state government bureaucrats save money is to have the minimum number of doctors on permanent staff at the hospitals they think they can get away with. Often this means small hospitals in rural areas have no doctors while most have less than they really need. This is because employed as full-time or part-time the doctor's wages come from the state budget, but if the doctor is employed and utilised as an on call professional who goes to the hospital when called in they send their bill to the Commonwealth Government for payment by Medicare as an external professional. You can guess what this means in regards to doctor response times to emergencies at the hospital: ambulance brings patient in, nurse checks patient, nurse calls doctor, and doctor has to drive over from their office, surgery, or where they are. In most cases it's fifteen minutes or more between when a patient arrives and a doctor can get there to see them. Does not bode well for real emergency situations. I know of cases where ambulances have taken patients to another hospital in another town that was further away because it was quicker to get the doctor to the patient there than at the closer hospital.

graybyrd
Updated:

I'm almost sorry I ever broached this subject back in that "unfinished stories" thread! It would be like trying to drain the ocean with a teaspoon.

I'm not at all familiar with OZ & public health, whether it's a private pay or public access or whatever.

The US has always been a 'fee for service' system. My first recollection was our family being chased across the US by aggressive bill collectors. My step-dad was a construction worker and a gambling alcoholic, so high wages in 1945 became scrabbling for meals on the table every week after he lost his paycheck to drinking and card games. Mom had horrible miscarriage in Virginia; lost the child and was permanently damaged. We were suddenly several thousands of dollars in debt. That began the constant threats and hounding from debt collectors.

Then in 1949 we were living in a motel room in Pocatello, ID while step-dad worked on a Snake River dam. I was playing on an asphalt pile left behind by a road crew, behind the motel. I fell and tore my pants over my knee, and embedded some tar-covered gravel under the skin. We left that week, step-dad "drug up" as he said, taking his pay and packing us up. We were driving to the next job on the west coast. We reached Oregon; I was feverish and unable to stay awake. Mom had a sister who lived in a rural area who worked at a local shoe factory. We made an emergency stop there. In short, I had developed "blood poisoning" with red streaks down my leg. Hospitalization was out of the question. We had no money and bill collectors still hot on our trail. "Auntie" called a local doctor who came, looked, and scared hell out of Mom. The kid might well lose that leg, or die. Keep him in bed, and make him drink three tall water glasses of hot sauerkraut juice three times a day. It's a natural blood purifier. And keep the dressing changed, the knee infection drained, and pray.

We were there for a month. I still have that leg, and for years carried angry circular scars from that infected, tar-crusted gravel. Try a tall glass of hot sauerkraut juice for kicks. I never did see the inside of a hospital in the US until I was a prisoner of Navy malpractice.

Next, I was just 12 and foolishly got bucked off the back of my colt. There was no hospital or clinic in our mountain valley. The nearest was 45 miles down to the river mouth. There was no program to support rural health care in the US.

Mom took me to the local rural doctor, who administered ether via the wire face mask with a cloth draped over it, to set my arm. That became my "near death" experience. No white tunnel; just a vivid experience in celestial surroundings. When I was pulled back, Mom complained I'd been swearing like a sailor. And we were another thousand dollars in debt.

I went to Kansas City, MO to a private radio technical college. Our family had bad teeth; we couldn't afford dental care. My mouth was hurting; I went to a KC dentist. He examined me, and asked where I worked. I explained I was a local technical student. He demanded that I leave his office. He wanted cash payment up front. My savings from summer jobs were too meager to do more than make monthly payments. He wouldn't accept that.

I joined the US Navy. As part of the induction process, they pulled half of my teeth and discarded them. There was no attempt to save them. Later, another tooth impacted while I was in Electronics School on Treasure Island, SF. It was a Friday afternoon. The Navy dentist started a root canal. The yeoman stuck her head in the door and reminded the Lieutenant that he had a golf date with the base commander. He dipped a wad of cotton in alcohol, stuffed in my open tooth, and sent me back to the barracks.

Monday afternoon I went back to finish the root canal. My lymph nodes under my chin and on both sides of my neck were swollen from infection caused by the open tooth. The Lieutenant looked, called another officer, and they both said, "Mumps!" That led to a mandatory involuntary "incarceration" at Oak Knoll Naval Hospital in Oakland. I never had the mumps. The infection cleared up and I was the victim of a malpractice cover-up.

Later, following my discharge, I paid considerable money to have the damage repaired. I told what happened, and as the dentist looked at the mangled, still open front tooth, he shook his head but couldn't openly condemn a fellow professional.

Years later, I bought a country newspaper. My wife was pregnant with our daughter. The community, a county seat town of a county the size of the state of Connecticut, used to have a small 'hospital' that served as area clinic and doctor's office. The state and federal government had forced it to close a few years earlier, because it was not able to meet increasing standards. The government, in its typical wisdom, decided that several thousand rural residents, isolated from any other health services by 60 miles in any direction, was best served by access to nothing, rather than something 'substandard.' That was our situation for several more years, until the volunteer EMT program came along, and then a rash of well-trained paramedics from the Vietnam debacle.

Our daughter was born 60 miles south after a midnight ride to a small area hospital in the next county.

Our county was 97-percent federal lands; a hugely popular recreation area in National Forest and National Recreation Area campgrounds. We had one nurse-practitioner in a tiny community clinic upriver in the neighboring valley, still in our county. During the summer season, she had to deal with an estimated transient population of 20,000 people! That was six times our county population. There was no federal program or money, no state money, and no assistance. Even law enforcement came under pressure; we received a small stipend from the federal government to subsidize one sheriff's deputy in the area.

My wife became an Advanced EMT via a state training program several years later; I was a volunteer ambulance driver for five years. Our entire community was volunteer. There were no professionals, other than a private dentist, in our area.

It is now safe to say that when we had a tragic ranch accident, or highway accident with severe injuries, our local pharmacy owner would volunteer to administer morphine to the victims as needed, so our volunteer, locally-obtained ambulance could transport the victims 60 miles downriver to the closest emergency treatment.

In brief, that was my life's experience with the American health care system. You got what you paid for, and if you couldn't pay, you got sick, suffered, then got well or died. Nobody much cared.

Today, they still don't much care. I know a number of people and families today who just gained access to health care which they couldn't possibly afford before, thanks to so-called "Obamacare." If current political threats to dismantle the program are successful, all those people will be cut off.

I guess we'll see. Since we live right on the edge of the Canadian border, I get to see the truth of the matter. The friends I have there feel sorry for us down here, but not too much. They consider our problems to be self-inflicted.

Replies:   Ernest Bywater
Ernest Bywater

@graybyrd

Here, in Australia, we used to have a system where those who were unemployed or on the pension or on a very low income could go to the hospital emergency and be looked at on the Federal Government tab quick smart, but those who worked or weren't citizens or permanent legal residents had to pay the bill at the going rate set by the AMA, most people who worked had health insurance which was very cheap and went to private doctors. The the health system got socialised, de-socialised in the 1970s, and resocialised on a permanent basis in the 1980s. Within a few years health insurance became way to expensive for any but the rich to have, the government who socialised the health system added a new tax levy to pay for it all. They also provided the free health care to everyone, regardless of their legal status. Since then the health care costs have gone up much faster than the inflation rate, the number of bureaucrats in the health system quintupled within a few years (and has kept growing since) and in the last few decades the actual services provided by the socialised health care has been reduced by the same political party that introduced it. Wait times at hospitals have gone out of sight, as well. Plus the overall level of care allowed by the rules has dropped.

In the 1980s the state government also stole billions of dollars of local community health facilities by using the Medicare legislation to justify taking full ownership and control of the facilities built by locals out of local funds. Naturally, as soon as the government took over each facility needed more bureaucrats to run it and that meant less front-line staff to pay the wages for the clerical workers pushing useless papers around.

The services provided pre-medicare were faster and better quality, regardless of your status.

Replies:   graybyrd
graybyrd

@Ernest Bywater

I understand that cycle all too well. "Obamacare" has a fatal flaw: it works through the existing health insurance corporations, who have already begun to increase premiums or cancel offerings. The federal government, by legislation, is forbidden to negotiate drug costs. The medical industry enjoys carte blanche pricing structures, which had always been easy to pass along under former employer-provided health insurance. It's hard to reverse that practice.

As desperately as the nation needs universal health care, the current model will probably prove unaffordable. There's simply nothing to rein in the costs.

I do believe if we were to achieve sensible universal health care, it would immediately follow the Australian experience: bureaucracy on federal and state levels would explode exponentially, and it would be worse than before.

So it's not really that different than it was in 1940 when I was born. Pray to stay healthy; if sick, stay home in bed for family nursing; and if you had to go to the hospital, pray it wasn't the situation where all the friends had to take up a collection from friends and neighbors: "Little Jimmy needs an operation, or he'll die!"

Wife & I have Medicare, and pay about US$550 a month for supplemental insurance. Sometimes I feel guilty that we have it, and so many don't. But that's our system, and nothing else for it.

richardshagrin
Updated:

You can move to another country and have different problems. If the standard of living is sufficiently low, say the Philippines, medical care may be more affordable, and at least English is an official language.

The problem with "free" health care is that there is an infinite demand for a free good. Somebody is always so poor that charging anything is difficult to pay. Very few have resources to pay for a quad heart bypass or some other extremely expensive procedures. Medical research and drug research keep coming up with more things almost no one can afford. Certainly even just existing in a standard (low level) American nursing home will evaporate all your assets fairly quickly.

Decide you are going to die of something, treat what is reasonably curable and die of what isn't. All the insurance in the world isn't going to cure old age.

Dominions Son

@richardshagrin

Certainly even just existing in a standard (low level) American nursing home will evaporate all your assets fairly quickly.


Average cost for a private room in a nursing home in the US is $229/day.

For comparison the average hotel rate is $137/night, but that doesn't include meals and nursing care.

Crumbly Writer

@richardshagrin

The problem with "free" health care is that there is an infinite demand for a free good. Somebody is always so poor that charging anything is difficult to pay. Very few have resources to pay for a quad heart bypass or some other extremely expensive procedures. Medical research and drug research keep coming up with more things almost no one can afford. Certainly even just existing in a standard (low level) American nursing home will evaporate all your assets fairly quickly.

I never meant for this to explode, I was just trying to say that this isn't a "Free Health Care" issue, but rather what can happen when you turn over health care to a large group of largely unregulated private companies, especially when they sell a 'set quality of goods' with widely divergent requirements (ex: the requirements for advanced Alzheimers care is vastly different than caring for fully-functional elderly citizens. When a vast majority of relatives are comfortable with 'parking relatives' there, can't monitor the care, and you have a recipe for disaster.

Replies:   docholladay
docholladay

@Crumbly Writer

When a vast majority of relatives are comfortable with 'parking relatives'


For a long time State run Mental Hospitals were used for a dumping ground for unwanted relatives. That practice continued in at least one state until around 1970 when a major change was made in the state law, at the same time repealing all the previous laws.

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