T Nation

Let's Talk About Health Care!

As a health care professional for over 15 years, frankly i am more than a little tired of hearing various politicians, pundits, and frankly, people on this site who have no idea what is really going on today. instead of posting a long winded rant that would be far to long for anyone to read, i have started this thread as a question and answer type forum, in which i welcome any other members with experience in the health care field or insurance side of things to create a place to voice concerns or ask questions.

What troubles me as a practicing nurse in a very busy ED/regional trauma center is the increasing gap between what the public expects from the current health care system and the what it can deliver with the ever dwindling resources available.

I am not about to marginalize myself or this discussion to the simple prospect of socialized medicine vs private insurance, too many would take their sides and it would be a pissing match back and fourth drawn upon partisan/ideological lines that would produce the typical arguments and cliches.

Suffice it to say, the systems as it exists, is collapsing, and cannot continue much longer. take it from and "insider", all of us are about to have to face some very hard choices and get a serious reality check in the very near future. 


Well, let's get this started -- What are the primary problems facing you today?


He already said that public expectation vs what is realistic and can be delivered with limited resources available = strain on the system. HT do you get paid for all and any extra hours worked? Do you ever pull double shifts?


When you talk about dwindling resources, do you mean cash, or manpower.

I suspect it's mostly cash, as I've often wondered how a system could sustain a number of pieces of expensive diagnostic equipment, expensive drugs, and to top it off, wages for very highly trained staff.


Good luck with that on this forum or anywhere else.

As for a real question, how do you feel that the for profit aspect of health care is bringing the system down? I've heard many people--including the president--comment that we need to make health care more efficient in order to make it affordable and sustainable for us as a society.

I though have also heard from some critics that we will never reach the level of efficiency needed if we continue to allow our health care system to be for profit.

Basically the argument goes that for profit health care not only drives up costs in obvious ways by having middle-man investors take their cut, but also by driving up incentives to provide unnecessary treatment just for more profit. Ultimately the argument goes that our health care institutions need to be nonprofit and that all health care workers need to work for hourly wages, not piecemeal.

Of course how you actually implement such changes could vary, and who ultimately pays for the system depends too. I'm not really a fan of the idea that health care should be government run, but nonprofit health care institutions need not mean government run health care institutions.

Anyway, since I know little about the system I thought I'd throw that out there to you. Do you think the level of efficiency required so that, for example, patients wants don't outstrip the system's capabilities requires going nonprofit?


If you thought Emergency Rooms were busy now, it's going to get worse I bet.


as stated above, people are expecting more and we have less to give. I am astounded at what people think we should know and able to do. on one side of the spectrum, TV has romanticized the role of doctors and hospitals.

people come in with vague complaints and think a team eager scientist/doctors are going to ascend upon them and work 24-7 on their problem. its not like "House" folks. most doctors are skilled tradesmen, who look for textbook answers to textbook symptoms. not much on the way of imagination.

on the other end, there is a presumption that we have some sort of socialized system in which we will take care of all there needs, free of charge.

many come in by ambulance for trivial complaints (like vomiting ONE TIME) and expect to be admitted, given free drugs prescriptions handed to them free right there in the ED, AND transportation back to wherever also free of charge. no i am not kidding.

i would say 1/3 to 1/2 of my patients leave either unsatisfied or angry due to this gap in expectations vs resources. people, we have a broke health care system and we are in an unbelievable amount of debt.


yes, and yes. i get paid well for my job. but i am asked to do more and more each day, not an exaggeration. EDs are seeing more patients than ever, wait times are going up, and they are asking us to go faster and faster, but at the same time, each day new rules, regulations (read bureaucracy and paperwork) come down form the state(CA) that add busy-work and inefficiency to my job.

i am astounded that a legislature that cant pass a budget can agree enough to make new regulations on a weekly basis for us(health care workers).


problem is, in our system we get paid to treat diseases. without a diagnosed disease, we have no treatment(procedure/surgery/drugs) to prescribe, and then no reimbursement. so we test, test, test.

a 90 year old with a 3 pack a day smoking history for last 70 years comes in with a bad cough. a chest x-ray ($50) shows a spot. that leads to a CAT scan($1500), THAT LEADS TO AN mri($3000), AND possibly a PET scan($5000?). then chemo and or surgery and lengthy complicated hospital stay($$$$$$$$$$$$) all to provide 6 months to a couple of years of shitty quality of life to a very sick old person.

there is no way to test and prescribe quality of life or prevention, so no reimbursement, so no way. but under our system, we go ALL OUT on everybody, but we wait until a big disease is found and then its too late and too expensive.

here is a stat for you, did you know, that over 90% of the total money spent on your healthcare will be spent in the last few weeks of your life??? think about that one.


thats just it, the system is horrifically inefficient, by necessity. SOOOOOO much of what i do is to protect myself and the hospital against lawsuits. one bad outcome in a 10000, results in a mountain of rules, paperwork, double and triple charting, bureaucracy, that it is oppressive.

i do have a problem with health insurance. so often i see them deny crucial care at the last minute to save money. i dont believe corporations should be profiting from misery. take out the middle man, i am all for it. but the insurance companies are getting bilked at the same time on the other end.

ex, typical nor cal LOSER (unemployed, frequent visitor, medi-cal, on drugs, ect) comes into mY ED. basic visit, tests, out the door with some vicodin to placate him/her so they dont throw a fit and cause a scene and hold us up anylonger preventing us from seeing actual sick patients by taking up a bed. we will bill medical 600-700$.

now, change that to a guy with private insurance, the same workup will be billed for thousands of dollars. the insured are paying for the uninsured. we in a way already have a socialized system.


Look at Europe and Canada. They tell the story on socialized medicine. In canada There is a doctor shortage because of this, and in Europe well there is over a million people on a waiting list.

If the government wants to fix something they can regulate the cost any other option would fuck us over.


Price fixing!


What could possibly go wrong?


just in the last 3 years, I have seen a DRAMATIC increase in ED traffic. due to dwindling reimbursements(read money) for healthcare means fewer hospitals, fewer private doctors, which means the hospitals that are still open are more busy.

not just sick people, but EDs are a dumping ground for law enforcement, mental health agencies and nursing homes who dont have the resources to deal with people with medical, or social or psychological issues.

jails used to have drunk tanks, medical facilities with a small staff, now if you are arrested, and get the hiccups, you end up in the ED cause the jails dont want the liability. not much of an exaggeration.

i could tell you how fucking easy it is to avoid going to jail in this state, and get a "free" trip to the ED. just say the magic words: "chest pain" or "i feel like i am a danger to self or others" boom, handcuffs off, your in the Emergency room.

at any given time in our 35 bed department, we have people waiting 12-48 hours taking up a valuable room needed for really sick patient waiting for mental health placement. now these often are NOT foaming at the mouth lunatics, but somebody who got drunk or high, made an ass of themselves in public or at home, and some good Samaritan or family member calls 911,

they say they are depressed, made a couple of superficial scratches to their wrists that dont even need a bandaid, and BOOM! all night stay in ED while mental health tries to place them in THEIR underfunded overburdened system. it is INSANE.


if you find yourself waiting 6 hours in an ed, it is meant to be that way. as reimbursements are down, means less hospitals, less doctors, and said hospitals and doctors need to see more and more patients just to break even, much less make a profit.

hospitals HAVE to stat jam-packed to stay in the black. so next time you find yourself waiting forever in the ED, remember, it is all part of the plan.


That's great 6 hours really isn't that long at all. People are waiting months in socialized places to get in. I come from a family where my dad was a doctor and my mom is a nurse I know many doctors so I know the health care system pretty well.


i for one feel that we are a country of paradoxes as i cant place the name of the author who wrote: America, a paradox or something along those lines,
but i feel we always demand more from our government which would mean we need to put more into the govt.

aka more taxes, but we would never agree to that, some countries such as the netherlands have a highest tax rate of almost 50% for the rich, but all of the money goes back to the people, they get paid vacations from the govt.

when they have children they are given monthly chewcks to cover that. We are afraid of thing labeled as socialism or communism ideals because of their names. We claim that they take away individualism.

Buy can you define yourself through what you make and your possessions? of course you can, and thats limited in these govts, but they do not limit who you are which people always seem to forget. I for one think that if we really want to push for better and nation healthcare we need to raise taxes or create some sort of revenue to expand the business


Not exactly price fixing but when there are obvious gouging taking place they can regulate that. There are plenty of examples of doctors popping in and saying a few things when a couple is having a baby delivered then charging them an ass ton of money. You can regulate that. But as far as saying something like you can only charge $20 for an x-ray then that is not right.


what exactly do you mean by non-profit? I'm inclined to disagree on the very simple grounds that making doctors and other health care professionals work on an hourly wage in a non-profit setting is a great way to lose talent. High powered docs don't want to go into a lower paying job. Hell, med school students often choose to go into medicine with the expectation of some great money.

I'm not a fan of the insurance companies getting their pound of flesh in the same way they do now. Costs are waaay too inflated. There are MANY problems with our system.

And honestly, I don't know how to fix it, but I feel I know some ways to avoid making it worse---and I think killing profits is a great way to do that because the profit motive is probably the biggest drive to innovation, advancement, and improvement there is. There is a reason Canadian docs migrate here, and docs from Britain try to get out of there---its the lack of monetary incentive in their home countries.

There's one rule in business....you get talent by paying for the best talent. If you don't pay whats expected, people don't want to work for you when they can go elsewhere, be it another state or another country.

You know as well as I do that one of the reasons socialism doesn't work economically is that it kills the desire to excel by guaranteeing a wage--but a much lower wage than one might get--and making it difficult or impossible to move up from the set wage.

If for example I'm guaranteed 30,000 a year for just showing up to my job, but making it to 50,000 a year is prohibitively difficult, I'm going to be a bum on 30,000 because I don't need to do shit to make that money. I just have to show my face.


But if you have one than you will get the other.

There is simply too much money too be made to not expect this to be a highly politicized area.Naturally there will be waste and corruption like in any other government run area.

It seems to me that a lot of people ask the wrong question. Instead of asking "Why does the market not work in health services" they ask "Given that the market does not work in health services what can government do to help?".

It seems to me that getting the market to work in this area should be the main concern but yet it is not.

And that is bad.

Because if I ever should have cancer I want the Samsung 8th generation OLED treatment and not the government provided black and white POS.


And I personally agree if I ever get sick I want the best technology and I will pay for it. But please understand that I in fact do not want the government messing with anything when it comes to health care I am simply saying that what I suggested would be the only non disastrous way for them to get involved.