Medicare/Medicaid Horror File

[Darrell Hougen]

I was reading the comments following Paul Hsieh's editorial on pajamasmedia.com:

http://pajamasmedia.com/blog/health-care-r...al-health-care/

and thought it might be a good idea to start a "horror file" of government health care gone astray. This is a comment from that list. The poster didn't list his/her name, so I'm assuming he/she doesn't mind me lifting the comment.

Here is the comment:

I am a pediatric physical therapist. I routinely treat children with private insurance, Medicaid, and private pay. Medicaid coverage is so poor that my decision making process is markedly different for children on government health care, as I know they will receive a fraction of the services needed to best deal with their conditions. Children with severe neurological conditions(traumatic brain injury, cerebral palsy, spinal cord injury) are routinely denied treatment that any other insurance provider would deem necessary. Private health care companies pay for these treatments as they recognize the connection between improved health/ mobility/ independence and reduced lifetime health costs. Medicaid does not. Wisconsin Medicaid is particularly nonsensical. Everyone, including young children, have 35 lifetime physical therapy visits. Once they are gone, you can apply for more sessions, but in nearly all cases treatment is denied. Examples of recent denials I have received:

A 19 year old one year status post traumatic brain injury had gained the ability to hold her head upright and turn her head to track conversations and people in the room. (A HUGE DEAL- imagine not being able to control where you are looking!). She also gained improved ability to consistently bear weight through her legs when transferring out of her wheelchair. (Another big deal- her mother had been lifting her. Imagine lifting your teenager any time she needed to be moved). Denied- “No functional progress.”

A seven year old with cerebral palsy had frequent respiratory infections. In PT she gained the trunk control to sit independently and gained sufficient respiratory control to cough and to swallow her own saliva without choking. (The respiratory component is huge- when a child with limited motor control dies, it is generally due to pneumonia). Denied- “No functional progress.”

The hardest part of my job is talking with parents who know their child’s independence, health, and ability to safely get through the day will be compromised due to Medicaid restrictions. Increased government control over health care will wreak havoc among the countries most vulnerable populations, as having health insurance is not the same as getting appropriate health care.

[Christopher]

Scary. People come to the U.S. to receive world-class medical services from countries such as France and Canada where social medical systems exist. Shouldn't that tell us something.

Anyway guys, this is a really disheartening subject. The government is rolling socialized medical care into effect, and I don't have the confidence that it can be stopped. It's sort of like talking about the unfairness of a terminally-ill friend... it only hurts and you feel no hope.

Chris

[Darrell Hougen]

The situation is disheartening, but I don't think it's a done deal. Many middle-of-the-roaders can be swayed by the right arguments. Most people don't want rationing or low quality care and we have to tell them that that's coming if nothing is done to stop this juggernaut. If everyone on the right (on this issue) were to contact a few people on the left or middle, we might be able to stop this or at least get it watered down.

Here is a link to a great discussion of the issue:

http://liberty.pacificresearch.org/publica...-citizens-guide

You can buy the book or download the pdf and read it for free. Pass it on to people you know who may be sitting on the fence.

One little fact from that book (which is sort of long): If you discount car accidents and homicides (neither of which have anything to do with the health care system) the United States has a longer life expectancy than any Western European country. If that fact alone became widely known, I think we could derail this thing.

Darrell

[Alfonso Jones]

I think that there is much reason for optimism. The medical community (mostly) has the good sense to be strongly opposed to national health care.

The American public has never been fond of such ideas. There is broad resentment of the current restrictions on medical practice. And I think there is a bgeneral awareness of the extent to which those from other countries come to the USA for health care (and Americans don't go abroad for health care!).

Dramatic illustration: Insurance policies for expats will, in many cases, not cover non-emergency procedures done in the USA. The insurance companies know that many of those they cover would prefer to go to the USA for many procedures, even with the substantial additional personal travel cost - and don't want it to happen. If I go see a doctor in the USA, the only way my insurance covers it is if I can document that it was clearly an emergency situation which could not have reasonably waited. (The same doesn't apply for most other countries I could be visiting...)

So, I am optimistic. Hopefully doctors will aggressively inform their patients, and we will all speak to our elected "representatives." This could be one of those litmus test type issues on which many people decide their votes.

Bill P

[tjohnson]

I think the biggest problem with our (Canada's) healthcare system is the emphasis on treating illness instead of promoting health. I have heard that in the UK a government employed doctor is given a certain number of patients and is paid a salary to look after them. So if he can keep them healthy he won't have to see them often and he can go golfing. Here the doctors get paid x dollars per visit and so it is in their best interest to see as many patients per day as possible which has lead to a system where doctors are mainly drug pushers for the pharmaceutical companies.

[Brant Gaede]

I think the biggest problem with our (Canada's) healthcare system is the emphasis on treating illness instead of promoting health. I have heard that in the UK a government employed doctor is given a certain number of patients and is paid a salary to look after them. So if he can keep them healthy he won't have to see them often and he can go golfing. Here the doctors get paid x dollars per visit and so it is in their best interest to see as many patients per day as possible which has lead to a system where doctors are mainly drug pushers for the pharmaceutical companies.

The biggest problem with your system is that it exists.

The second biggest problem is the absence of a private sector, which is somewhat tolerable by having the United States just to the south.

--Brant

Edited May 14, 2009 by Brant Gaede

[Selene]

Brant:

We should be sending Canada a huge invoice for the defensive shield that we provide and Canadians did not have to pay their "fair share" for. Therefore, in the spirit of fairness, empathy and justice, we will either take one province in payment or lots of gold.

Adam

[tjohnson]

The second biggest problem is the absence of a private sector, which is somewhat tolerable by having the United States just to the south.

Hah, you wouldn't catch me going to the US for anything! You guys are crazy.

[BPW]

I am curious !

I don’t follow your line of reasoning here. What you are saying is US medical care for those who are not insured is appalling and reminiscent of a 3rd world country. Or am I missing something. There is also a very worrisome implication, and that is the USA is biasing health care to the ‘old and relatively wealthy’ against the interests of the ‘young and poor’. Is that a policy that sits well with Americans religious beliefs?

I was reading the comments following Paul Hsieh's editorial on pajamasmedia.com:

http://pajamasmedia.com/blog/health-care-r...al-health-care/

and thought it might be a good idea to start a "horror file" of government health care gone astray. This is a comment from that list. The poster didn't list his/her name, so I'm assuming he/she doesn't mind me lifting the comment.

Here is the comment:

I am a pediatric physical therapist. I routinely treat children with private insurance, Medicaid, and private pay. Medicaid coverage is so poor that my decision making process is markedly different for children on government health care, as I know they will receive a fraction of the services needed to best deal with their conditions. Children with severe neurological conditions(traumatic brain injury, cerebral palsy, spinal cord injury) are routinely denied treatment that any other insurance provider would deem necessary. Private health care companies pay for these treatments as they recognize the connection between improved health/ mobility/ independence and reduced lifetime health costs. Medicaid does not. Wisconsin Medicaid is particularly nonsensical. Everyone, including young children, have 35 lifetime physical therapy visits. Once they are gone, you can apply for more sessions, but in nearly all cases treatment is denied. Examples of recent denials I have received:

A 19 year old one year status post traumatic brain injury had gained the ability to hold her head upright and turn her head to track conversations and people in the room. (A HUGE DEAL- imagine not being able to control where you are looking!). She also gained improved ability to consistently bear weight through her legs when transferring out of her wheelchair. (Another big deal- her mother had been lifting her. Imagine lifting your teenager any time she needed to be moved). Denied- “No functional progress.”

A seven year old with cerebral palsy had frequent respiratory infections. In PT she gained the trunk control to sit independently and gained sufficient respiratory control to cough and to swallow her own saliva without choking. (The respiratory component is huge- when a child with limited motor control dies, it is generally due to pneumonia). Denied- “No functional progress.”

The hardest part of my job is talking with parents who know their child’s independence, health, and ability to safely get through the day will be compromised due to Medicaid restrictions. Increased government control over health care will wreak havoc among the countries most vulnerable populations, as having health insurance is not the same as getting appropriate health care.

[Selene]

BPW:

Welcome to OL.

I am not sure which line of reasoning in this thread you are referring to as we have at least two different positions in this thread.

Again welcome.

Are you a student, economic slave to the state or just a willing participant in the global recession?

Adam

[Reidy]

A good way to stay au courant on stories like these is to follow Critical Condition at the NRO website. See, for example the NHS Links entries today and last Friday, the 28th. What's remarkable is that they all come from British news outlets.

[BaalChatzaf]

The second biggest problem is the absence of a private sector, which is somewhat tolerable by having the United States just to the south.

Hah, you wouldn't catch me going to the US for anything! You guys are crazy.

But you don't have to wait six months for an MRI or a PET scan. Also our heart surgery is superior to that of the Canadian medical system. Most of the advanced heart repair techniques were invented in the United States.

The U.S. is not the best place to be for health maintainance. The U.S. system is oriented toward treating illness rather than maintaining wellness.

Ba'al Chatzaf

[Brant Gaede]

Have to agree with Ba'al: if you need your pet scanned come to the US.

--Brant

nothing too good for Fido

Email me for the address of my nearest clinic

humans add 20%

[BaalChatzaf]

Have to agree with Ba'al: if you need your pet scanned come to the US.

--Brant

nothing too good for Fido

Email me for the address of my nearest clinic

humans add 20%

PET scan = Positron Emission Tomography scan.

Ba'al Chatzaf

[DavidMcK]

Does anyone know why drugs are so much more expensive in the US than Canada or Mexico? I'm thinking the existence of numerous FDA regulations are involved; can anyone confirm this?

[merjet]

Does anyone know why drugs are so much more expensive in the US than Canada or Mexico? I'm thinking the existence of numerous FDA regulations are involved; can anyone confirm this?

The cost of drugs still under patent in the U.S. is higher than in Canada and elsewhere, because it is U.S. customers that bear the R&D costs of bringing a new drug to market. Once a drug is developed and marketable drug companies can sell it outside the U.S. and still make a profit if only "marginal cost" is included rather than that plus a share of the R&D costs.

Generic drugs are another story. They are more expensive in Canada than in the U.S.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=17757