[quote name='dopa345']I would agree with you. After all, I went into medicine to take care of patients, not to be a pencil pusher rationing care for the "greater good." However, doctors and hospitals are second guessed on every turn and get stiffed if our care somehow doesn't meet some arbitrary guidelines and thus in the opinion of some bureaucrat, the same care could have been administered more cheaply (usually by not admitting the patient to the hospital).
I'll give two real-life examples which I recently had to write written appeals (BW both are Medicare patients). One was a guy with a history of hydrocephalus (lifelong build up of fluid around the brain) which periodically leads to excruciating headaches. Also if the pressure is too high for too long, that could lead to coma and death so it requires urgent evaluation. The guy comes into the ER with "10/10" headaches, absolutely miserable. We work him up and do rule out any imminent danger. However, the guy still has horrible headaches, not responding to anything. I admit him for 2 days of IV pain medications and finally get him on an oral regimen that finally reduces his pain to tolerable levels. Now three months later, we get a claims rejection letter from Medicare. According to them, once I had excluded any imminent worsening of his clinical condition in the ED, I should have discharged him and not admitted him for pain control "which could have be done in an office follow-up visit."
that, if the guy is in too much pain to walk, how the hell am I going to kick him out of the ER? Unfortunately, we'll probably not win this one since he wasn't technically at risk and I should of just been a heartless bastard and kick him to the curb.
Second example, the patient is a woman that was visiting her doctor when she suddenly couldn't talk and was immediately sent to the ED due to concerns she was having a stroke. Her symptoms resolved in the ED about an hour after it started. It is standard of care to admit patients with transient stroke symptoms even if fully resolved because risk of permanent stroke if untreated is up to 20% in 90 days and 50% of these patients get the stroke in the first 2 days. We admit her, work her up expeditiously and get her out the door on treatment for stroke prevention the next day. Again three months later, it gets denied because according to Medicare, since her symptoms resolved, she was stable enough to go home, completely ignoring what the standard of care is in this clinical situation; though perhaps from the standpoint of Medicare, it is worth gambling her 20% risk of stroke in the next 90 days in order to cut costs.
This is why, I'm very skeptical of government run health care. When the decisions for care are taken out of the hands of the doctor who is with the patient and instead given to bureaucrats with no medical training only concerned about the bottom line, we should all be very concerned. It's extremely unfair to have our hands tied when making treatment decisions yet we bear all the medicolegal risk for adverse outcomes.
Sorry for the long rant, but this hit a nerve because of these stupid rejections letters I got the other day since nothing pisses me off more than getting second guessed by someone who wasn't there and had no
ing clue about what's going on.[/QUOTE]
I think you make a number of fair points.
However they are anecdotal. I could respond with cases where the government effected positive change - such as the case where a government official supplanted hospital visits with a community-based outreach for a guy who was suicidal.
Also I don't think a transition to individual mandates (and a soft form of socialized healthcare) would be easy, or that mistakes wouldn't be made, but we can learn, we can lobby for fixes, we can do better.
I'm trying to be real here - so let me ask you a question. What would have happened if Medicare didn't exist. What would have happened to the 10/10 guy?