Third-World Healthcare Comes to the U.S.
My mother is elderly and in poor health. She is like many older folks in that much of her daily life centers on doctors’ offices with occasional side trips to the ER, and periodic hospital admittance. I worry about her, but have assuaged that worry over the years with the sure knowledge that she has some of the best healthcare available. In addition to extensive basic care through her former employer, she pays for (and uses) various supplemental health plans that are expensive, but I have considered money well spent.
She recently had fairly major surgery, which went well, but she complained of substandard post-operative care in the hospital. My mom’s doctor had ordered a procedure that was clearly not working and (according to mom) the nurses failed to monitor the process adequately. From her point of view, she would have died if a friend had not come by for a visit and alerted an unaware nursing staff that she was in serious trouble.
In all honesty, I largely discounted this story as the angry and scared recollections of a woman who is not as mentally quick as she once was, especially under stressful conditions. How could the nursing staff be THAT out of touch with an on-going medical procedure under their supervision?
My mom is now on her way back to the same hospital for a standard follow-up surgical procedure. She’s scared. She is, quite simply, afraid she will be overlooked and die. Who pays attention to sick old women? Again, I was reluctant to believe that things were that bad. This is a big regional hospital with a solid reputation.
Here’s where I get shocked and need to apologize to my mom. Apparently, I’m one of those people who don’t pay attention to sick old women. In a recent pre-operative office visit, her surgeon suggested that she hire a nurse to stay with her in the hospital for at least the first two days post surgery. The job of this private nurse would be to make sure that my mother gets the care and attention she needs while in the hospital. Let me be as clear as I can about this. My mom’s SURGEON suggested that the only way to ensure quality care while in a large, fully staffed U.S. hospital under normal operating conditions, was to hire her own private nurse. His reasoning was simply that under current conditions at many U.S. hospitals, even the best nurses do not have the time and other resources necessary to care for patients adequately.
OK, grasping at straws and STILL not wanting to believe, I did a net search on this and found that the straws likely don’t exist. This NY Times article from 2005 lays out the issues pretty clearly. Despite paying more for healthcare than most other humans on the planet, Americans may not get adequate hospital care without the additional expense of a private nurse/aide. And this isn’t cheap. In my mom’s case, she’s looking at about $2,000. Let’s not even ask about the large numbers of people who a) don’t have healthcare to begin with and b) certainly cannot afford this additional expense.
In the U.S. we hear horror stories about people needing to bring their own drugs and medical supplies to hospitals in other countries because healthcare in those countries simply doesn’t work. Well, it seems we’re a whole lot closer to that than I realized. I’m both scared by this and profoundly angry. This is simply not acceptable. How did we get to this point and how do we find our way back?
April 30th, 2007 10:18
I have no suggestions for ways to fix this problem. I can only commiserate with you Grant, because my own elderly mom has had on-going problems with her doctor and hospital visits. In her case, I am furious that the doctors just throw a prescription at her to take care of whatever is going on, rather than taking the time to ascertain and then fully treat the causes of her symptoms. She’s on a dozen medications (that is not an exaggeration) and recently discovered that some of the worst symptoms she’d been suffering from were side effects from two of those medications. After months and months of pain, her doctor finally said, “Ahhhhhhhhhh, wait a minute, perhaps it’s the (insert generic medication here) that’s giving you the problem.”
The doctors are owned by the pharmaceutical companies and the insurance companies. Insurance companies dictate what procedures and medications the patient is “allowed” to have (by virtue of denying payment), and the pharm companies are here to convince us that popping pills is the only way to being healthy. They market themselves aggressively to doctors as well as patients. I’d be interested to learn more about the ropes that bind doctors and pharm companies.
April 30th, 2007 11:34
Hi Grant-
Interesting and scary post. One of the problems, I believe, is that many people do not think of themselves as consumers when they deal with health issues…they become patients. People in the medical field have a great deal of specialized skills that the rest of us lack. I also know nothing about construction, but if I had a contractor doing some major work on my house, I’d surely stay on top of things and be consulted in what was going on. Health and medicine can be frightening and intimidating. I noticed this a couple years ago when my mom became seriously ill, but her generation did not question doctors or seek much information. Luckily, she had my brother for an advocate, and he did ask and follow up.
I never thought about consumerism until I was pregnant and taking birthing classes. The instructor was very insistent that this was our birth and that we had the right to make requests (and sometimes demands) of the hospitals, doctors, nurses, midwives, etc. It had never occurred to me before not to just “go along” with what I was told. That was a real eye-opening experience, and just in time, too, as I deal with my daughter’s (normally) good health. I can question prospective pediatricians to find one that matches our family’s needs and perspective.
This is just a very small part of a much larger problem, but it is something where individuals (or, if necessary, their advocates) can immediately become involved.
Susan
April 30th, 2007 20:54
Hi Grant,
Wow! what a shock and how discouraging when you think you’ve got it covered.
I know your words Let’s not even ask about the large numbers of people who a) don’t have healthcare to begin with and b) certainly cannot afford this additional expense. were mostly rhetorical, but what happens when you really DO DWELL on the kind of health care the US offers its disadvantaged citizens? Have they been getting Third World care all along?
Probably not - US blacks have an infant mortality rate of 17 per 1,000 - three times higher than US whites. But still not Third World. In Tanzania, 20% of children die before the age of 5 years - that’s 200 in 1,000.
So, in the broader context of all US citizens, your mum is getting good care, and in the context of world citizens, she’s getting great care. It’s just that it costs a lot of money.
I’m glad she’s got you to watch over her. The old and frail are very vulnerable, whatever the circumstances.
April 30th, 2007 23:00
The simple fact is you cannot take 30 or 40 percent of the dollars spent for health care and give it to insurance companies…. if you do that, you will get the type of care that is happening now.
I had a friend who had surgery in Ka—-r, An old man next to him lost his pain medication tube in the night. Moaned and begged for help… friend buzzed nurse… guess what? no one on night staff spoke English. Old man did not get his pain medication tube put back in until English speaking Doctor showed up in the morning.
Old people do not count… unless they are rich old people and have family to look out for them. Grant’s Mom had him and an honest surgeon… hope Grant coughed up the 2K to see her through the night. If people truly see what is going on, they will sit down and write out what they want and do not want done, AHEAD of time.
I have decided no brain surgery, heart surgery, chemo, amputations, feeding tubes, respirators EVER. Why… the odds of coming out with your brain intact are terrible… then you get warehoused in some hell hole where they will keep you just alive enough to collect with the least amount of care…. read bedsores, urine soaked sheets, fillth, cruelty.
I have seen Asian aids (imported for their cheap wages) literally jerking old people down the street and shoving them around. Believe me, medicine is fine up to a point and then you should post a notice on your mirror and read it daily….
The difference between God and a Doctor is, God never thought he was a Doctor… Being dead is one thing, being tortured to death by the medical community for profit is quite another.
May 1st, 2007 11:48
Hello all,
Elena, your mom’s experience sounds like part and parcel of the current problems, and is another verse in the same song in my mom’s life as well.
I don’t know what to do either. I’m honestly not sure where the money is going. Are the HMO’s all run by evil people? I can’t imagine it’s that simple. But where IS the money going? Bon, welcome to the site. I agree that the problems you talk about are real, and the HMO’s get a good deal of money, but are those problems the norm, and if we kill the HMO’s can we replace them with something better? Universal healthcare sounds like a great idea in the abstract, but we need only look as far as the Department of Homeland Security to see the problems of creating huge new government agencies to deal with real problems.
I do know that the fact U.S. citizens do not have guaranteed health care is a travesty of the worst kind, but how do we address this problem? In the U.S. we hear horror stories of socialized medicine in which people wait months for substandard care. If this is true it is no solution, but what systems out there DO work? Gillian, you seem to like the Australian system-Could you discuss its broad strengths and weaknesses in you experience?
Susan, I am also aware of the importance of being a good healthcare consumer, but am worried that healthcare has become so much of an adversarial system-see Bon’s comments. It simply should not be this way.
My only suggestion, based on the VERY limited knowledge I have this topic, is that the U.S. must disconnect healthcare and employment. Private companies should not be in the healthcare business for their employees, AND humans should not have to have the “right” job in order to get healthcare. Now, what we replace this with, I have no idea.
May 1st, 2007 18:36
Hi Grant,
The Australian system is two-tier — free care for important things, plus the option of private care for access to better-appointed hospitals, doctor of choice, and shorter queues for elective procedures. There are financial incentives encouraging people to take out private hospital cover to supplement the basic Medicare.
Everyone has a Medicare card that gives them access to free care for necessary procedures. For important and urgent matters there is no waiting - when my 85 year old mother-in-law fell and broke an arm and a leg, she had weeks of care in a major teaching hospital, followed by a couple of months in a small rehab hospital till she was ready to go home. No charge.
For less urgent matters (aka ‘elective’ procedures like knee replacement) public patients go on a waiting list that may take months, private patients will have shorter waits. The same orthopedic surgeon will see both private and public patients. Fees for public patients are agreed with the govt via medical associations, whereas fees for private patients are whatever the medical association (or doctor) wants to charge.
The system works really well in cities and large towns, but health care resources get quite ‘thin on the ground’ in rural towns. Most small towns in Aust are a couple of hours apart, and too small to justify a full range of all specialties - so people often find they travel for some hours to access services beyond what a small hospital and GP (doc) can provide.
One of the best parts of the Austn health system is that all prescription pharmaceuticals on a govt list are available to patients for a set fee of a few dollars. Even cancer drugs that cost $40,000 pa in other countries are available here for a few dollars. There is a cap of $2,000 pa on what individuals have to pay for all medicines for all their conditions (e.g. your mother’s dozen pills). This system means that drugs that are not on the list are simply not prescribed, and so, in effect, all necessary drugs are on the list (cos the medical profession makes a big stink if they aren’t). To make the system effective, the govt buys all the drugs on the list. This means that drug companies who want to sell in Aust, have only one buyer to negotiate with. This gives power to the buyer, and as a result the Aust govt gets drugs very cheaply. The drug companies sell to the govt at the price offered, or they don’t sell at all. I have read that Aust gets the cheapest drugs in the world because of this system. So that is one way that a govt run system can be MORE efficient rather than less efficient.
There is constant public discussion here about the quality of health care, shortage of resources and waiting lists. But it is never suggested that Aust should scrap Medicare, or that the system is a bad one. Discussion is about putting more resources into areas of need (e.g. mental health, or reducing waiting lists for elective surgery, or rural areas) or mismanagement of a particular facility, or fine tuning some things.
The system could be better, but the govt accepts the social responsibility of providing health care for everyone, especially the poor and vulnerable. Our system allows for a mix of public and private services. The Medicare system is about funding the system efficiently, not about delivering the actual services.
You’re absolutely right about disconnecting healthcare and employment. Here, the employer has nothing to do with it. The Govt provides universal health care directly to citizens regardless of their employer, or employment status.
So, the US could look at Australia and see, yes, they have a universal health care system that works overall and is fair and reasonably efficient. I suspect that there are lots of examples around the world. So, this is not the reason why the US does not have a universal health care system. I think that in the US UHC would have to be implemented State by State, wouldn’t it? Some States already have something like UHC don’t they?
May 3rd, 2007 08:04
@Grant
Coincidentally, the day this entry posted, an Ohio AM NPR station (from the town we lived in) had a talk show episode on this very topic (I subscribe to the podcast, which is how I got it in NY). It was an interview with Jonathan Cohn who wrote the book SICK: THE UNTOLD STORY OF AMERICA’S HEALTH CARE CRISIS–AND THE PEOPLE WHO PAY THE PRICE.
Here’s the mp3 link.