There’s Enough Blame to Go Around in the Health Care System

by francine Hardaway on September 11, 2009

Now that Obama has given his speech about health care, people are actively talking about their horrible experiences with Medicare and wondering if the "public option" will produce care for everybody that's as bad as what they've seen their own aging relatives  receive. These examples, however, show me there's a profound misunderstanding about what Medicare (or any public program does).

Here it is in simple terms: Medicare writes the checks. It doesn't operate on the wrong leg, over-radiate a cancer patient, miss a cancer, or give people too many prescriptions.

That's the job of the provider, who is hamstrung by a larger problem, which is lack of continuity of care. And there's also a shortage of doctors.

Here's what Medicare is designed to do: provide a safety net for catastrophic illness. That's all. It covers mainly hospitalization, although you can buy a supplement that takes care of co-pays, tests and doctor visits, and another supplement that covers prescription drugs. I have fancy Medicare and supplements by AARP; everything is covered, For this I pay $132 a month. I pay a premium for Medicare part D, the drug plan, of $47.74 a month.

I can go to any doctor I want. At age 65, I had a hip replacement, no waiting, for which the bills totaled nearly $50,000. I paid only for the special physical therapy I wanted that was beyond what I really needed (I wanted to go back to athletics and yoga).

I have no complaints about Medicare. It covers a lot more than the insurance I had just one year previously, when in the same good health I paid $600 a month with a $1000 deductible. And I have chosen my providers with care. I get good treatment from people who treat me well. But that's because I've taken the time to learn the system, evaluate doctors, and look up information.

You see, folks, there are three players in any health care transaction–the payer, the provider, and the patient. All three have a responsibility. As the patient, your responsibility is to take care of yourself and to be informed and to be realistic.

Waiting? That's the provider. How busy is he/she? Family practice, internists and pediatricians are very busy because there aren't enough of them.  And there aren't enough of them because they don't make enough money to pay off their medical school debts by going into primary care.

Negligence? That's the provider, too. Medicare doesn't mark the wrong leg for surgery or fail to diagnose an illness. That's between the patient and the provider.

Kicked out of the hospital before you think you are well? Private insurance kicks people out of the hospital just as quickly as Medicare does, and often more quickly.

So when you have a beef with the health care system, which we all do, at least lay the blame in the right place. It doesn't matter who pays the bill. It's who does the job. When the government pays the bill, the entire "business" side of the issue gets taken care of more efficiently with less waste and expense.


Payer: establishes coverage guidelines
Juggles available funds to decide how much money is spent per patient per life
Decides if it is a hospital treatment (Medicare) or an outpatient treatment that's paid for
Gives money to provider for the treatment
[Medicare pays more over the life of a patient and includes more
treatments than almost anything else because it doesn't have to be profitable]

Provider: Doctor or nurse or hospital or outpatient facility. That's who makes you wait, doesn't have automated records, makes you fill out forms over and over, and sometimes mis-diagnoses things because he/she is only a human being

Patient: The person who receives the treatment and should know all this, but often doesn't. The person who likes to blame others for lifestyle choices that have to be corrected by the health care system at great cost to society

Posted via email from Not Really Stealthmode

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