Monday, July 23, 2007

Jane Bryant Quinn gets it mostly right

in Yes, We Can All Be Insured. Nice to see some MSM writers for the masses telling it like it is. Finally.

One thing I'd like to see: on those waiting times that we're so much better at than everybody else, is anybody figuring in those of us, the uninsured, who are just going to have to wait forever?

That's what I thought.

Interesting article in that same issue on Express-Lane Medicine.

Some doctors are complaining that walk-in clinics at grocery stores -- I [heart] HEB -- will, among other evils, fragment health care. Ha!

And the free-marketeers are going to go batshit happy over the fact that market forces are solving a pressing problem here [they are]. What those people aren't going tell you [or themselves] is that dispensing antibiotics for sinus infections is easy, quick, and cheap, but this model isn't going to be expadable to the big stuff, cancer, heart transplants, the like, unless everyone has upfront all the dollars they'll need before they walk in. The only way to do that of course is some version of Medicare-for-All.


Bryan said...

What they want is for you to visit an emergency room to get a prescription for a course of antibiotics, even when you know what the problem is, because they don't want to work more than 40 hours per week or offer off-hours coverage.

Hours waiting, hundreds of dollars in cost, for a $50 prescription. It just jacks up the cost of health care.

Keifus said...

Y'know there are problems (I suspect overprescribing antibiotics as one potential, and yeah, medical record clusterfucks, which feelings may be mixed, depending), but it seems like a fine band-aid for a small part of the problem. Fragment health care? Huh?

fmlkowm: female cow mommas

hipparchia said...

antibiotics aren't over-prescribed now? dude, if your kids see an actual doctor every time they get an ear infection, you're probably in the minority. and whether or not they see a doctor or physician assistant or nurse practitioner, parents all too often press until whoever is doing the prescribing relents and gives out antibiotocs against their better judgment, just to get rid of this whining patient and move on to the next.

hipparchia said...

bryan, i've got a friend who actually likes being a doc-in-the-box. i think it's possible that enough people, including doctors, would like the more flexible hours.

the insurance companies are going to lose one of their revenue sources if it becomes cheap enough, easy enough, and fast enough for ordinary folks to get very basic health care on their own. this isn't a perfect model, but it's inching back towards what we used to have, which is that you could call up the doctor, get seen that day if it was bad enough, and go home with the needed drugs.

and it's not quite as good as house calls, but it's a huge improvement over waiting 12 hours in the emergency room on a saturday night.

Steve Bates said...

Time before last that I went to a doc-in-the-box, I was in severe pain. I didn't even make it through the line to get seen before I left to seek quicker attention at a conventional clinic I had been to years before. That proved a bad decision on my part, on several counts.

The last time I went to a doc-in-the-box, seeking a diagnosis on what proved eventually to be a skin tag, the doc promptly referred me to a specialist, talked nonsense at me for 10 minutes and charged me well north of $50 for the referral. (I presume the nonsense was free.)

Will I go to a DitB again? Possibly. After Stella's recent experience in a local ER, where she and I waited over six hours for her to be diagnosed for possible injuries after a major auto accident, I am disinclined to go to a hospital ER again.

Consistently good health care requires a system. Band-aids are great if your problem is a minor cut. Otherwise...

[ofkygnr - oh, from Kentucky? get no rest.]

hipparchia said...

we had a really good doc in the box here many years ago, and a good many of them too. they're all gone now, victims of the large hospital chains going around buying up or otherwise eliminating the small independents [probably also the insurance hassles made things worse].

the few walk-in clinics we have now all belong to the 3 big hospital corps in town, they're not really walk-in, they're not especially well located, they do refer you to the emergency room anyway all too often, and their hours don't extend very much beyond regular doctors office hours.

i've had the same wonderful doctor for years now, but before i found this one, i got excellent care at the ditb's i went to.

i'm not sure how wonderful this new model is going to prove to be. from what i read, the new storefront medicine can't even sew up a small wound. the two medical not-quite-emergencies my brother and i inflicted most often on our parents when we were kids were chronic ear infections and gaping [though non-life-threatening] wounds.

i'm not sure what the rules are nowadays, but back when i had insurance, if you got treated for something anything [like a sinus infection at the grocery store] and didn't report it to your insurance company, they could refuse to ever cover anything that later cropped up as a result [ie further sinus infections]. also, all doctors were at one time required to report to the insurance companies [or some central clearinghouse or something] all treatments they prescribed, so eventually your insurance provider would find out about it anyway if you went to a ditb, and they could still deny you further coverage for whatever it was you got treated, just because you didn't report it and/or get it approved.

in recent years, i've waited in emergency rooms, just from check-in to triage [does not include waiting for actual treatment after being triaged]: 4 hours, 6 hours, and 14 hours [not a typo].

the system is broken. anything that [1] moves us away from for-profit insurance and [2] has even the remotest possibility of reducing visits to the emergency room is worth looking at.