A couple of random questions about US healthcare from a Canadian...

[Lucy Goosey]

A couple of random questions about US healthcare from a Canadian...
(If these are stupid questions, forgive me - my mind has been warped by a lifetime of receiving quality medical care on demand without having to worry about the cost of any procedure, or about whether my insurance company will drop me for once having had a hangnail. ;))

1 - Many Americans are uninsured because they are too "rich" for Medicaid and too poor for insurance, right? So does that create a situation where there are people who would be better off not working, and getting welfare and medicaid? I remember a single Mom in my province a couple of years ago who quit her job as a waitress to go on welfare - she issued press releases and was interviewed because she was doing it to prove a point about it being impossible to pay for childcare on minimum wage. Does that kind of thing happen in the US?

2 - US hospitals are mostly for profit, right? So does that restrict the ability of doctors from one hospital to consult with specialists at a "competing" hospital? I ask because my Dad had a scary medical episode a couple of months ago, which presented like meningitis, but tested negative for everything his neurologist thought it could possibly be. He then passed Dad's information around to neurologists all accross the province for additional suggestions, and it occurred to me that if these hospitals were all competing for cash, they might not have been able to do that.

[T Wolf]

1. It is a fallacy that living on welfare (and Medicaid) is wonderful. The monthly budget barely

is enough for survival.

That being said, in a few specific circumstances for a very few individuals, it might be better in the short term to get medical coverage. This usually does not work out however, because the delay caused by excessive paperwork and human procrastination will cause serious delays in obtaining the actual medical care.

So, NO to #1.

As for #2, individual physicians can consult across corporate lines, but sometimes it does cause problems if those controlling the systems get wind of it. The actual cooperation between separate and competitive corporate units can also be problematic, at an institutional level. Sharing records may be allowed, but certainly there is competition for the bodies (pardon the expression) that show up in the hospital beds.

[ejpoeta]

2. these are not stupid questions.

I can't answer as to the second one... I have no idea how that stuff works. I know that going to the same doctor seems like no one pays attention to your chart because they ask you the same questions every time.... as far as different doctors.... no idea.

as far as the 1st one, there are a LOT of folks who make too much to qualify for medicaid but don't make enough for insurance. That is assuming they are even able to get it through their job. Many places like to play a game where they give you just enough hours so they don't have to offer you insurance and then of course there are the insurance policies that are junk.... cost a lot and don't cover anything. That is where a lot of people are. Then there are those who THINK they have decent insurance but it is just because they haven't had to use it. Even if they actually have the good insurance, and there are those that do... there is no guarantee that it will be there in a couple months or next year.... costs keep going up and employers end up having to pass htat on to their employees. in the form of deductibles and large copays.

I think it's worse for the ones caught in the middle... the ones who make too much to qualify for anything but not enough to be able to afford anything. I know we are just under the threshold for paying $9/mo for each of our kids on the state child health plus program. This helped us when we switched from our insurance we had and went with CIGNA which has deductibles and higher copays... but the kids still get decent coverage. Bit us in the ass though as I found out I was pregnant in the middle of January... So I have been very worried about how much of this pregnancy and birth is going to cost us out of pocket. But at least we aren't straddled between two years, because then it would be even more.

I wish people would get their heads out of their asses about this. THis is something that affects everyone, whether they have insurance or not. ANd I don't understand why they don't get it that we already pay for eveyrone and we pay twice as much as everyone else, so the argument about how we would pay for universal healthcare is bullshit. WE ALREADY ARE!!! we would save ourselves money by switching to a medicare for all type system and then maybe we wouldn't spend half of our lives worrying about how we are going to afford to pay for our healthcare when it goes up again in january or what to do if we get sick.

[damntexdem]

3. Some partial answers:

1) There have always been perverse incentives in American social programs, as in other programs, and or course in programs elsewhere. However, in the case you cite, the incentives are actually not to quit, particularly since 1996, when welfare for the non-aged/non-disabled was ended. The old Aid for Families of Dependent Children did give automatic eligibility for Medicaid. Since its end, there is only temporary welfare assistance, with strong pressures to find work.
2) Actually, most American hospitals, and by far most of the larger ones, are non-profit. For-profit hospitals tend to be smaller, and sometimes specialized (although there are major exceptions). However, in the Reagan Era of the 1980s, non-profits were encouraged to act more like for-profits, and their behavior did tend to change, coming to look and act more like for-profit hospitals. That said, there is considerable cooperation in terms of information and even staffing. However, health insurance tends to create barriers in terms of definitions of what is "in-network" versus "out-of-network," so the major barriers derive from coverage rather than from competing providers.

[Critters2]

4. Most US hospitals are private, some for-profit, but probably most

are technically "not for profit", which mostly means they're tax exempt and are supposed to offer "charity care". Some non-profit hospitals have lost their status in recent years for either not offer adequate charity care, or for using aggressive collection practices. Not many, though.

Doctors have privileges to practice in certain hospitals, but most belong to professional associations which require them to consult with other doctors when it aids a patient. They may not be able to practice in a given hospital, but can be in communication with doctors who do. From what I've seen among parishioners, doctors are pretty good about helping one another in this way.

I have a parishioner with a rare myelin-related disease, and she has a whole team of docs who consult with one another, including local physicians, and specialists at Northwestern Hospital in Chicago, Mayo Clinics in both Minnesota and Arizona, and the Cleveland Clinic in Ohio. They seem to cooperate pretty well.

[Altoid_Cyclist]

5. I'll always have the deepest gratitude for the Cleveland Clinic.

They were able to save my wife when her local Cardiologist said she was dying and it was no big deal to him so why should it bother her.

We were lucky enough to get Dr. Delos Cosgrove to do her surgery. As far as I know, he's now the CEO of the CCF.

Every Doctor that we've dealt with there has been outstanding in their treatments and their demeanor. They pretty much insist that the patient always comes first and they don't let egos get in the way of helping a patient.

Around here, Doctors' egos almost always come first when treating a patient.

[Critters2]

6. It was at Cleveland Clinic that she was finally diagnosed,

after her condition had baffled doctors here. Northwestern realized it was a myelin-deteriorating condition, but couldn't name it for sure. The Cleveland Clinic diagnosed her, and then referred her to the top expert on her condition, at Mayo. Now, a doctor at Cleveland and the guy at Mayo and another specialist at Mayo consult to design her treatment plans, which are then sent to her primary care physician here, who oversees treatment and therapy. I've been impressed with how well they all work together.

[Altoid_Cyclist]

8. It's never good to have a serious illness, but finding the right people to treat you gives you

a lot better chance to beat the illness. If all hospitals in the US would admit that sometimes another facility can provide better care, then other countries would have one less reason to make fun of our health care system and more people would have a better outcome.

Here's hoping that your fellow parishioner does well.

[madmom]

7. My daughter is among the un-insured. She is a 25 year old college student. She

is too old to be on our insurance(through employer) too young to be on medicare and to responsible to be on medicaid (no kids, went back to school)She can not get medicaid because she is single with no kids. Shes one of the ones who goes to the ER when she gets sick because that's her only option.