1. When I think about the "federal government" and "healthcare" in the same sentence my first thought goes to the VA hospital. I had the fortunate and humbling experience to volunteer at one in 2001. For me, it was a great experience. For the patients, doctors, nurses, and staff...not so much. So much waiting (for treatment, for procedures, for medications)....too much red tape (paperwork, paperwork, and more paperwork) to accomplish anything. I always wondered why it was so difficult and the answer by all those I worked with always contained some form of "because we work for the government".
Years later, I worked for an Ob/gyn who slowly started to stop taking Medicare patients for the simple reason of reimbursement. Any other insurance provider would compensate the doctor within 30 days of his electronic bill. Medicare would take 90 days. And, if anytime within the year, the government felt they paid too much, they would just take it back. No questions asked. It would take months, sometimes up to a year to garner any explanation. It became too time consuming with all of the phone calls and paperwork. Time that was taking the doctor away from seeing patients. So, no more medicare. Which in the end, only hurts the patients.
What do these two examples above represent? The fact that the government already has control over some if not many aspects of medicine and already they fail miserably. They have not proven that they can manage any aspect of medical care appropriately and yet, we the people want to hand over all medical care to our government. Every big name program they have their hands in (Medicare, Medicaid, Social Security, the US Postal service) are all FAILING!! I just don't see how they will manage everyone's medical care with a track record like that!
2. For too many years, reimbursements were higher for "procedures" like surgery and less for "preventive care" like seeing your doctor regularly for check-ups (we can blame the government for this one as well). So now, we have a system where new medical graduates gravitate towards surgical fields where the money is and less towards the primary care specialties (family medicine and pediatrics). The federal government wants to shift the system where more money goes to preventive medicine which is FANTASTIC!! And I totally applaud that idea. However, our system is not in the position to accept that change quickly. There are not enough primary care doctors to take on new patients. In addition, residency spots (all of which are partly paid for by Medicare dollars) for family medicine and pediatrics have remained stagnant over the last 10 years. If you cannot graduate enough residents to fill the need, you will have a severe shortage of doctors. Which means what?? Which means they will show up in the Emergency Department looking for care.
Now you may be asking yourself why I, an emergency resident, am upset about that. It's more money for us right?? WRONG! Because the government compensates the ED very, very poorly. Plus, we are not trained to be primary care doctors. We are an entirely different specialty with a different mindset. I don't treat long term. I treat short term. I look at each of my patients and think "what could potentially kill you today?" and then I search out those things with my plethora of testing. If I rule out my potential fatal list, you go home to follow up with your primary care doctor. If I find something, you now are admitted for further work-up. I do not counsel, or spend hours convincing you to eat properly, or exercise, or take your medications as prescribed. I just don't have the time because while I am dealing with you, I have someone in respiratory distress who needs a tube in their throat!
What this all means is that we routinely see primary care problems in the ED and many repeat offenders who cannot get appointments with their doctor. This puts pressure on us (the ED) to be something we are not, and also impacts patients who truly have a medical emergency and need immediate care. I love my my primary care friends and colleagues! I just don't see the government giving them the resources they need (more residency spots, more incentive to go into primary care, better money) to tackle this entire situation.
3. By far the biggest problem I have with the healthcare bills is the individual mandate, that all must participate or be fined/jailed. To give the federal government that much control is beyond unconstitutional. If the government can tell you what to buy in terms of healthcare insurance because they deem it a "national problem", then what prevents them from telling you:
- What to eat? From now on, all must purchase tomatoes, or bananas, or broccoli everytime you are at the store because obesity is overrunning America and these things are healthy
- What to drive? All Americans must purchase an electric car, because pollution...and costs of oil are increasing....and because we believe America will be better.
- Where to live? All Americans must move away from natural disaster areas that include tornados, hurricanes, floods, earthquakes, etc because it is just too costly to continue to re-build. Where would be all live?? Montana....Idaho...North or South Dakota.
I could continue on with my list, but I will spare you my continued rant. I do, however, want to point out one final thing. Prior to 1973, healthcare was between you and your doctor. It was supply and demand....there was no middle man....you negotiated amounts to be paid and for most people, medicine was affordable. Then the Federal government stepped in and mandated with the HMO Act of 1973 that employers give their employees health care...and they gave tax incentives to employers, not employees or the individual. And HMO's were born. And so began the illogical coupling of employment with health care and the exponential increase in health care costs over the last 40 years. Today, your congressman are so quick to denounce HMO's and the costs associated with them. But, our government made those rules!!! They imposed by federal law the above ideas and look where it got us. And now, they want to make more laws?? To "benefit" all? Be careful America.....be very careful.
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