Since our country has been discussing health care options, the problems we face, this was something that I came across. What do you think about it?
The gist of it is that those, with sufficient money to pay a 'physician membership' fee each year (this is on top of any insurance they might opt to buy), then receive premium access to their doctor, guaranteeing not having to see a changing array of doctors or a physician's assistant.
For those with the money, paying a yearly fee offers security, quicker access to an appointment, more time with their doctors once there. The doctor limits how many patients he/she will accept under this concierge arrangement.
Are we more and on so many levels becoming a nation of have and have not? Is this where our medical system is heading with or without health care reform?
With a shortage of doctors, which doesn't seem to be letting up, more treatment is being provided by Physician Assistants. If you are not familiar with their requirements, it generally is a Bachelor's degree, possibly with prior medical experience, say as a nurse, then two years of graduate level training to get the equivalent of a master's degree. Wikipedia on Physician Assistants. Each state can have different requirements as can each clinic or doctor as the PA works under the supervision indirectly, of a physician. For those who would like to see what we have considered to be a traditional doctor, it sounds like it might be getting more costly.
We have two new calves. One night, with all the storms we have had, the cold air that is bringing snow to the highest hills around us, just as we were getting ready for bed, one of the new mothers decided she had lost her new baby. Misplaced it? Someone stole it. It wandered off. What a mournful sound she made as she ran around the pasture.
Finally it became impossible for Farm Boss to ignore her wailing-- just in case. So out he went with the spotlight to find a pile of calves in the corner of the barn on the straw he had put out for this exact purpose. The mama could not be convinced that her calf was one of those inside and safe. Although he moved her down to the barn, she ran back out determined to find her calf where it had been born. He left the calf where it was as an upset mother is better (if not quieter) than a calf out in the heavy rain and wind.
Next morning all was well and no apologies to the neighborhood from the cow.
Photos are of a two day old calf and one born several days earlier as they get acquainted with their world. By now they are already leaping in the air and running.
I wonder what the doctors of 100 years ago would think of the profit motive in medicine now? Only in movies of that era do we hear of doctors making house calls.
ReplyDeleteFarm Boss is a good caretaker by getting out of a warm bed to go help a distraught mama. Kudos to him.
Maybe I should have made that last comment 200 years ago. ;-)
ReplyDeleteUniversal/Single Payer Healthcare has spread all over the civilized world except for the USA. Americans should put aside capitalistic desires and embrace the collective good. Talk of socialism shouldn't be cause for a Red Menace alert. For-profit healthcare leaves some *without*. I personally don't know what it's like to be *without* but empathy delivers the pain of it.
ReplyDeleteI want the U.S. Congress to enact Universal/Single Payer Healthcare reform. Raise my tax and raise the tax on the über-rich even more. Progressive tax is the way to a healthy citizenry and lasting prosperity.
Strange that cow couldn't recognize her calf amongst the others, but maybe she had herself worked up into such an emotional state she simply wasn't thinking clearly -- just like people sometimes.
ReplyDeleteI think we've been on the road for awhile of trying to become a third world country with basically two classes -- the rich and the poor. Of course, even in those countries with a universal health care system, there are still services those willing to pay extra out-of-pocket get and can get more quickly that others don't, but at least the others all have health care.
I'm more than a little leery of physician's assistants just as I have reservations about the "assistant class" that has been created in all the rehab therapies. IF they have received excellent training, IF they receive the proper supervision, IF they recognize their limits and when to refer to the Dr., IF they don't allow themselves to be exploited by their employer in order to keep their job, or don't become greedy themselves, they can offer some quality beneficial service, but then we could say the same about the actual Drs./Rehab Therapists such as myself and all medical professionals.
I have encountered Nurse Practioners on two occasions who have performed an excellent service, the first was years ago with my young daughter when I knew in advance we wouldn't be seeing a Dr. The care was excellent. The second, I expected to see an OBGYN and ended up with the Nurse who was fine, as far as I know, but I felt short-changed at not getting to talk with the Dr. I had never seen this Dr. before, and think I was lucky he saw me. I had phoned a few others first and quickly discerned that once they learned I was Medicare, though I had good supplemental ins., they had some excuse to not be able to see me. This Dr. saw me only because my GP's nurse was his patient and I mentioned to the receptionist that nurse had told me to call. My former Dr., who died, would have personally called a Dr. requesting him to see me and would have brought pressure to bear had the Dr. been reluctant. Medicine has changed even for those of us who professionally move in that world if we don't personally know some of those we must contact for our own care. I would caution that there still are Drs. who practice much as we have long been accustomed but they cope with an increasing variety of pressures.
I had a brief but shockingly bitter taste of what happens with some doctors if they think you don't have insurance when my son broke his wrist over twenty years ago. Dr. did a complete reversal in offered care when I set him straight that we did have ins. He was one of the most professionally highly respected Orthopedists in our area and this was in my local hospital. The irony was that our family members were patients in his practice, but with one of his partners so we had never seen him.
I've believed for some years that the delivery of medical services as we have know them to be is going to change considerably whether or not we pass any health care reform. The only question is how these changes will evolve, how they will effect each of us and how much we'll have to pay for the services we need and want. Many will have to change their thinking, approach to using health care and how they care for their own bodies and health. People are going to have to think about dying and death realistically and probably not with an expectation to staying alive at whatever the cost, for as long as possible without considering quality of life issues. Obviously, I'm no authority, this is just my opinion based on my own philosophy, personal and professional experiences.
We are screaming and complaining about the fact that we have fewer and fewer doctors. Why aren’t we screaming and complaining about the cause? And that is the fact that the government run Medicare system is not fully paying them for the services rendered and continues to cut those payments every year. That just isn’t right. And this new healthcare legislation proposes that over half its costs are to be paid by cuts in Medicare to the tune of $500 billion. So if anyone thinks things are bad now…..well just hang on to your bloomers folks
ReplyDeleteI have been a proponent of this new healthcare legislation from the beginning but I am slowly but surely beginning to see a little further down the tunnel and the light I’m seeing with, well it is coming from the rear, not from the opening on the other end of the tunnel.
In Rain’s previous post I went to some lengths giving Sarah Palin hell. But 5-years from now when few doctors are accepting Medicare patients and there is a landslide of hospitals beginning to follow suite, I may just have to bite my lip and apologize to Mrs. Palin because indirectly, but in a very real way, them there death panels will be alive and functioning well in the form of little to no care available to seniors who depend on Medicare.
Folks, I can’t tell you how bad I want to be wrong with my current line of thinking, but I just don’t see how.
By the way Rain, here is another link to an article regarding a Mayo Clinic in Arizona who is shutting down their Medicare services with regard to their doctors and going to a new system, primarily due to Medicare reimbursement….
http://www.azcentral.com/community/surprise/articles/2009/11/19/20091119gl-nwvmedicare1120.html
I agree, Alan but we have them now with insurance companies. An insurance agent commented in another blog about how it works when you need say chemotherapy. They ask you to prove you can pay the 20% (your share) and without it, you cannot get the treatment. It happens all the time to people with no insurance who can get ER treatment but that's not going to be a permanent solution to most major health problems. I also have had concern about them cutting Medicare payments because in Oregon many doctors won't take a patient with just Medicare. As long as medicine remains a major profit making business, this is how it will be.
ReplyDeleteWhen Farm Boss and I decided to give up a policy that guarantees a limit on out of pocket expenses because the premium would amount to more than we could afford, we also decided that if we had a major problem that would require huge expenses to treat, we would not do it. I suspect a lot of elders reach the point of deciding the same thing with yet more doing the same thing as they face total financial ruin for their spouse if they do not. Our system today is a cruel one and looks to be getting crueler.
Thanks to everyone for the added insights to this serious issue that impacts the old but also the young. I am not sure Congress has much chance of making it better and blame not just Republicans but also Democrats who care more about contributions to their campaigns than the people they claim to represent.
On health care reform, the average citizen is not very well informed. Try reading the health care bill and you will see it's almost impossible to be informed with the complexities and confusing language. Heck, just try signing up for Medicare and a supplement and you can feel you are on a short road to madness.
Universal, single payer is the way to go but it will always have ways for the rich to get more and better care and it sounds like the PA program is going to be one of them. I am sure such health aides can be good but when they are the only one you see and their training is way less than a physician's, it won't be the same level of diagnostic ability. How could it unless you believe doctors receive too much training now?
I was born not so long ago as a hundred years ago. And in my shorter life I have had two doctors who made house calls. The last house call was in in 1961. These doctors were also somewhat behind on givng tests prefering to say time and bed rest will heal all my problems.
ReplyDeleteI had a great experience with government versus private for profit care. County health services were half the price in a governmental run health agency.
Rain . . . I'm curious.
ReplyDelete(1) What motivator do you think could replace "greed" either in our capitalistic/free market/free trade economy or any other economic system?
(2) Or do you think any social/ethnic/geographic group etc. needs a motivator to encourage labor, progress and innovation?
(3) Animal mothers do (rarely) get their mothering instincts mixed up a bit. I doubt this will be much of a problem for mom or calf.
Dixon
I don't think you need greed to want to succeed. Greed is wanting more than you can use, more than you need, and it has no end for how much that would be. So you pay your employees less than they are worth because you can and you don't care how they live.
ReplyDeleteMy thought is a lot of this is taught in the home. If you teach your children that there is never enough money to make you happy, that only things you can buy are worth any thing, they probably learn that as a way they behave unless they come across someone they admire who sees it otherwise.
Wanting to have good things, to be successful, to run businesses, to create new products, none of that requires greed to happen. Ambition doesn't require greed either.
You know when I was a girl it seemed to me we admired different things than we do today. Those who were ostentatious in what they had, who constantly promoted themselves as being superior to others, they were not the ones admired. Then it shifted and it seems we do admire greedy people. The shift does not appear to have made our economy stronger.
What I think government needs to do is make sure products are safe that are out there (because we can't each test say our own meat) and protect us from one company taking over everything and forcing everyone to pay whatever price they decree (monopolies). Government can make sure people have a chance to get an education that will enable them to get good jobs. It used to be a college education was possible for working class people's kids. That day is disappearing because government sees no responsibility for educating the people. A good section of the right wing would jettison public schools period if they could.
I do not have anything against capitalism but you know as well as I that we do not have a true capitalistic society. There'd be no lobbyists if that was the case. And you cannot possibly believe that Republicans are more inclined to free enterprise than Democrats. Try doing something about farm subsidies and see who is on your team.
People like Sarah Palin talk one way right now to get votes but if you look at her record in Alaska, you see something very different.
We have had a few cows that rejected their calves but it's rare. Usually it happens when they have had a very hard delivery and aren't emotionally able to recognize they had a baby. It happens most in the young ones and they do fine the next time.
Altruism could be a good motivator, don't you think? If people saw it as a virtue... You can't give unless you are successful enough to give; so it gives you motivation to succeed to be able to share it.
ReplyDeleteWhat concerns me is that a serious illness could be missed.
ReplyDeleteHappy Thanksgiving!!!!
True, Medicare may not be paying doctors the rate they're charging, but maybe some of the rates are just a little high. Maybe we'd have more doctors if so many didn't become specialists.
ReplyDeleteI've written elsewhere before that I receive approx. 1/3 of what Medicare pays for my services and all the rest is siphoned off to those in the middle between me and my patient -- for profit insurers are in that group -- paying lobbists, buying advertising, etc. Let's free up some of those doctors and nurses to serve patients directly instead of primarily doing paperwork, finding ways to deny claims -- if that's not rationing, I don't know what is.
All the tactics to scare people about Medicare cuts are a little off the track. The big cut that is really beneficial to cut out of Medicare is that Part D give away to private insurers. (Read Saul's post at TGB 11/28/09 for the true facts on "D.")
Medicare is already being cut yearly here and there, little by little, so what's new? That's the reality of the current health care state and we all know that's not getting better.
Yes, the hospital's are hurting, too, and have been. Maybe we should just let the whole health care system collapse, experience a little chaos, then build a new system from the bottom up -- single payer incorporated into Medicare.
As for altruism, I was once challenged that no act is ever altruistic -- there is no such thing -- that there is always some motivating factor for people to do what they do, even if they are not consciously aware of it, or think they're doing it for other reasons. Interesting to examine various acts under that microscope.
If we are looking for a motive besides greed, then altruism might be the one. Of course, it can have a reward attached (of feeling good). It would be rather foolish for us to do things that we believe had nothing good for us in them; but if the reward is feeling we improve other people's lives or help someone else then that becomes a healthier one than amassing wealth that we cannot possibly use and may hurt others and even ourselves. Altruism can be taught as well as greed can.
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