No cost for preventive care????

[Acklander]

Insurance companies are finally starting to realize that better care is actually cheaper care, so profit isn't such an evil thing. Many insurers are starting to team up with doctors and hospitals to improve quality of care, improve outcomes and, in the process, reduce costs. The one thing that neither the doctors nor the insurers can fix, however, is the malpractice system. There needs to be reform there so that doctors stop being forced to practice defensive medicine, racking up billions of dollars in unnecessary tests and procedures in the process.

Yes, on reducing unnecessary tests, but with malpractice reform also doctors need to stop covering for bad doctors.

 

[angwill]

One thing that many patients don't realize that greatly complicates this whole discussion is that if the doctor finds and treats anything during the visit or if the patient complains about anything during the visit, it ceases to be a well-visit. For example, if you come for an "annual physical" and your blood pressure is high or during the exam, you ask the doctor to take a look at a spot on your back, that is no longer just a "well-visit" and you probably need to pay your co-pay.

Another problem is that many of these types of rules and policies make it much harder on the doctors' offices. Many offices collect co-pays upon arrival, not at the end of the visit. If certain types of visits don't have a co-pay, collecting first is a problem. However, collecting after the fact is a bigger problem because only then will patients mention that they forgot their wallet or checkbook and ask to be billed for the service you've already provided. It leaves the doctors on the hook for a lot of free care.

That is a simple fix then the doctor just does like ours does and when you go in for something and ask about something else he will tell you he is sorry but he can only see you for one thing per visit and you will have to schedule another visit for the other reason. Oh and the visits have to be on different days as well so next week my son has a doctors appointment both Thursday and Friday one being his sport physical. Sometimes if it is just a question he will give advise about the other issue but if it takes any time other than a minute or two explaination it needs a seperate visit.

 

[EmpressBubbles]

I don't understand why everyone thinks they will now start having to pay for uninsured people's healthcare costs. You ALREADY ARE! Every time an uninsured person walks into an ER and is seen and can't pay, that hospital writes that bill off on their taxes as charity/non-collected. If City Hospital isn't paying $X in taxes that they would have paid, who do you think makes up that amount to Uncle Sam???? WE DO!!!!

So...you have been paying for all the healthcare of everyone else all along. It's just going to start coming out of your left pocket now instead of your right. What's the difference?

I see better access and better care for everyone. How can we call ourselves a civilized country when every Tom, Dick and Harry on the block DEMANDS a Zpak from their doctor every time they sneeze, yet Sally, Jerry and Richard can't see a physician when they have a fever or chest pain? Is that moral? Is that ETHICAL? It's certainly not American!

 

[angwill]

Of course it's about profits. That's how insurance works. Insurance reform was sold as "healthcare" but it isn't. That would be like calling car insurance "car care" and making Progressive pay for my oil changes. Two different businesses.
That wouldn't have anything but a negative impact on auto insurance costs.

This doesn't make a whole lot of sense because if you don't take care of your car by getting oil changes and it dies the insurance company isn't responsible for getting you a new car or paying for the damage.

On the other hand health insurance companies do have to pay for the damage people do to their bodies when they don't get their well visits and in turn cause damage to their bodies. They then have to pay the bills to fix the damage you caused until you die.

 

[disneysteve]

That is a simple fix then the doctor just does like ours does and when you go in for something and ask about something else he will tell you he is sorry but he can only see you for one thing per visit and you will have to schedule another visit for the other reason. Oh and the visits have to be on different days as well so next week my son has a doctors appointment both Thursday and Friday one being his sport physical. Sometimes if it is just a question he will give advise about the other issue but if it takes any time other than a minute or two explaination it needs a seperate visit.

That would never work in my patient population. Actually, it probably doesn't work all that well in any patient population and probably does little more than piss off patients. Let's say a patient has scheduled a well visit with me. Chances are they made that appointment 3-4 weeks ago. They arranged their work schedule to be off at that time. If they come in that day and raise an issue that needs attention, I can't tell them to come back tomorrow or the net day. First, tomorrow and the next day are already booked up. Second, they can't take another day off of work on short notice. Either I take care of it right then or risk it getting ignored for weeks or months which wouldn't be good for the patient and wouldn't represent good care on my part.

 

[deegack]

I don't understand why everyone thinks they will now start having to pay for uninsured people's healthcare costs. You ALREADY ARE! Every time an uninsured person walks into an ER and is seen and can't pay, that hospital writes that bill off on their taxes as charity/non-collected. If City Hospital isn't paying $X in taxes that they would have paid, who do you think makes up that amount to Uncle Sam???? WE DO!!!!

So...you have been paying for all the healthcare of everyone else all along. It's just going to start coming out of your left pocket now instead of your right. What's the difference?

I see better access and better care for everyone. How can we call ourselves a civilized country when every Tom, Dick and Harry on the block DEMANDS a Zpak from their doctor every time they sneeze, yet Sally, Jerry and Richard can't see a physician when they have a fever or chest pain? Is that moral? Is that ETHICAL? It's certainly not American!

I was staying out of this but I do have to agree with the first part here. Dd#1 was a bit premature. Her hospital bill for six days in the nicu was $120,000. While there a met a woman whose son had been in the nicu four weeks. Somehow insurance came up and I mentioned how glad I was we had good insurance. She said she had none but the social worker and the hospital told her not to worry about it. That there are programs for uninsured and if not they could write off the rest. I don't think my dd care actually cost over 100k but when combined with te care of this child and others like him I see why my insurance company was billed that much. Hospitals have to pay their bills so they are going to get the money from somewhere.

 

[disneysteve]

On the other hand health insurance companies do have to pay for the damage people do to their bodies when they don't get their well visits and in turn cause damage to their bodies. They then have to pay the bills to fix the damage you caused until you die.

This raises an extremely important point that almost never gets mentioned in the healthcare debate. The blame gets placed on the insurance companies and the doctors and the government but you hardly ever hear the blame getting placed on the patients. I guess it isn't politically correct to do so.

A huge percentage of healthcare expenses goes to treat self-induced disease. Smoking is an obvious example of this. Obesity is another. As our population gets increasingly obese, the cost of healthcare rises dramatically. That isn't the fault of the insurance companies or doctors or government but they're the ones stuck trying to figure out what to do about it and they're the ones getting blamed for rising costs that they really have no control over in this regard.

 

[angwill]

This raises an extremely important point that almost never gets mentioned in the healthcare debate. The blame gets placed on the insurance companies and the doctors and the government but you hardly ever hear the blame getting placed on the patients. I guess it isn't politically correct to do so.

A huge percentage of healthcare expenses goes to treat self-induced disease. Smoking is an obvious example of this. Obesity is another. As our population gets increasingly obese, the cost of healthcare rises dramatically. That isn't the fault of the insurance companies or doctors or government but they're the ones stuck trying to figure out what to do about it and they're the ones getting blamed for rising costs that they really have no control over in this regard.

Well it is a national problem that includes the government, insurance, doctors, lawyers, patients and everyone because it is effecting everyone of those people and practices. If everyone doesn't work together to fix the problems it will never get fixed and prices will just keep going up.

You can not just blame smokers and obese people either just because those two vices can be seen so they are easy targets. I would think a majority of healthcare expense goes to people not doing what they need to do to keep up their health like not having the money for a well care visit because costs are so high. How about a thin person who doesn't exercise or eat right like the guy on fastfood nation who eats big macs and fries every day? Anyway it is everyones fault including all I mentioned above from insurance companies trying to make profits so their CEO's etc can get bonuses, lawyers who have their commercials on TV soliciting people to sue doctors and hospital etc. It will take everyone to fix the problem and the only one powerful enough for that is the government. That's the way I see it anyway.

 

[angwill]

That would never work in my patient population. Actually, it probably doesn't work all that well in any patient population and probably does little more than piss off patients. Let's say a patient has scheduled a well visit with me. Chances are they made that appointment 3-4 weeks ago. They arranged their work schedule to be off at that time. If they come in that day and raise an issue that needs attention, I can't tell them to come back tomorrow or the net day. First, tomorrow and the next day are already booked up. Second, they can't take another day off of work on short notice. Either I take care of it right then or risk it getting ignored for weeks or months which wouldn't be good for the patient and wouldn't represent good care on my part.

It works here and as a patient how can I be mad about that. If I told the receptionist that I needed two things done that would take some time I would be told they can not be done at the same time and would have to make 2 appointments for when I could get them taken care of. I learned by going in for one thing and something else coming up in the mean time and he simply explained the policy and why and I had to pick one thing for him to do that visit and make an appointment for the other. Unless it is something quick and simple that we can discuss while doing the original thing I completely understand. If it is something important that would be at risk of being ignored then deal with that problem instead of the original and have them make another appointment for the first. It works where I live and it is their policy. I guess I could look for another doctor that might work for another hospital with different rules but I like the one I have so I will abide by his rules.

 

[ilovemk76]

This raises an extremely important point that almost never gets mentioned in the healthcare debate. The blame gets placed on the insurance companies and the doctors and the government but you hardly ever hear the blame getting placed on the patients. I guess it isn't politically correct to do so.

A huge percentage of healthcare expenses goes to treat self-induced disease. Smoking is an obvious example of this. Obesity is another. As our population gets increasingly obese, the cost of healthcare rises dramatically. That isn't the fault of the insurance companies or doctors or government but they're the ones stuck trying to figure out what to do about it and they're the ones getting blamed for rising costs that they really have no control over in this regard.

What about all the ...
people who get knee surgeries from sports injuries?
people not completing their antibiotic meds?
people not using proper protection when using power tools?
people not properly cleaning a wound?
people who noticed a problem but refused to see the Dr. and it turned into stage 4 cancer when they could have caught it in stage 1?
and on and on....

Most medical treatment is a result of something the person did or did not do rather than something that just happened.

Smokers and the obese are just the ones who are acceptable to pick on right now.

 

[angwill]

What about all the ...
people who get knee surgeries from sports injuries?
people not completing their antibiotic meds?
people not using proper protection when using power tools?
people not properly cleaning a wound?
people who noticed a problem but refused to see the Dr. and it turned into stage 4 cancer when they could have caught it in stage 1?
and on and on....

Most medical treatment is a result of something the person did or did not do rather than something that just happened.

Smokers and the obese are just the ones who are acceptable to pick on right now.

I agree with this completely.

 

[fakereadhed]

This doesn't make a whole lot of sense because if you don't take care of your car by getting oil changes and it dies the insurance company isn't responsible for getting you a new car or paying for the damage.

On the other hand health insurance companies do have to pay for the damage people do to their bodies when they don't get their well visits and in turn cause damage to their bodies. They then have to pay the bills to fix the damage you caused until you die.

I guess I see well visits like car maintenance. I don't understand why people would not set money aside for yearly visits, even without insurance. It's not a large yearly cost per person or an unpredictable expense.

The people who don't take care of their health maintenance by making it a priority already might show up for a "free" visit but will they follow thru with the advice given? Or will they go because it's free and feel like they did something good for their health. I'm not sure.

I don't really think lack of insurance was the problem because as others have pointed out there was already "free" care to those who couldn't pay and payment plans for those that could but were just scraping by. I think insurance reform won't fix the lack of people viewing their health as important.

 

[disneysteve]

What about all the ...
people who get knee surgeries from sports injuries?
people not completing their antibiotic meds?
people not using proper protection when using power tools?
people not properly cleaning a wound?
people who noticed a problem but refused to see the Dr. and it turned into stage 4 cancer when they could have caught it in stage 1?
and on and on....

Most medical treatment is a result of something the person did or did not do rather than something that just happened.

All true. I wasn't trying to "pick on" smoking and obesity. I was just using those as common examples of lifestyle choices that have a significant impact on the cost of healthcare in this country.

 

[disneysteve]

The people who don't take care of their health maintenance by making it a priority already might show up for a "free" visit but will they follow thru with the advice given? Or will they go because it's free and feel like they did something good for their health. I'm not sure.

Good question. I don't know the answer either. Certainly, especially once you reach a certain age, preventative care involves a lot more than just a visit to your doctor. It may involve bloodwork, mammogram, eye exam, colonoscopy, gyn exam, etc. There needs to be a certain level of committment to taking care of yourself.

 

[angwill]

I guess I see well visits like car maintenance. I don't understand why people would not set money aside for yearly visits, even without insurance. It's not a large yearly cost per person or an unpredictable expense.

The people who don't take care of their health maintenance by making it a priority already might show up for a "free" visit but will they follow thru with the advice given? Or will they go because it's free and feel like they did something good for their health. I'm not sure.

I don't really think lack of insurance was the problem because as others have pointed out there was already "free" care to those who couldn't pay and payment plans for those that could but were just scraping by. I think insurance reform won't fix the lack of people viewing their health as important.

There are people who don't have money to set aside for yearly visits. It is all relevent to how much it costs to live in different areas and how much a person gets paid. I am sure there are people out there with the money that choose to spend it on something other than health care as well. Maybe they are afraid to find out what is wrong because they know they can pay for that well care visit but they know they do not have money for what is necessary to fix the issue. Maybe the last thing they want to do is to leave a spouse and children with tons of debt for their health care only to die in the end anyway. Maybe they don't have health care and are afraid of being diagnosed with something that will be considered a pre exhisting condition when they do get coverage. Personally, I do understand and respect those decisions even if I would not do the same.

I can tell you from trying to help people in need find health care at a reasonable cost that in some areas there is no such thing as a free clinic or payments. In our area and within a two hour drive there is no such thing as a free clinic and everyone doctor or dentist expects payment when services are rendered. I could find no one willing to take payments but some do push a care credit card with high interest rates and if someone doesn't have good credit they are not getting that credit card. So unless they have the cash they are not getting the help. I did find one low cost clinic about an hour away but that was very expensive when you add in lab fees that are not at a lower cost. For the one person I tried to help they made a little over minimum wage at $8 and hour and worked both full and part time. No medical benefits offered at either job. The minimum cost of a visit at the low cost clinic was $45 which is just under 6 hours of work for her before taxes. Then the labs she needed that were not discounted were another $150 which is almost another 19 hours of work before taxes. No payment plan allowed either and she was barely making it so $200 would have been a windfall for her. She had no family to help out either.

Another lady saved for her gyn appointment each year and one year she found out she had uterine cancer. There was not one doctor willing to give her treatment without her paying for their services up front. The hospital was willing to work with her but without the cash up front for the surgeon, anesthetist, and her gynecologist she had no choice but to live knowing she had the cancer and beg everyone she knew while trying to set aside what little she could.

These are the working poor making too much for medicare and too little to pay the inflated health care costs. These were people who are willing to take their health care seriously.

I think we tend to look at how things are around our area and don't take into account that things are different in different places. There is no one size fits all answer to what is going on with healthcare and how it effects the people of America.

 

[disneysteve]

There are people who don't have money to set aside for yearly visits.

Maybe they are afraid to find out what is wrong because they know they can pay for that well care visit but they know they do not have money for what is necessary to fix the issue.

Maybe they don't have health care and are afraid of being diagnosed with something that will be considered a pre exhisting condition when they do get coverage.

there is no such thing as a free clinic or payments.
So unless they have the cash they are not getting the help.

Another lady saved for her gyn appointment each year and one year she found out she had uterine cancer. There was not one doctor willing to give her treatment without her paying for their services up front.

These are the working poor making too much for medicare and too little to pay the inflated health care costs.

Great post angwill! You hit on a number of issues that many people never think about or don't realize exist. I work in a very poor area and I see all of the things you mentioned and more on a daily basis.

The uninsured have little to no access to care. Even if I'm willing to discount my fee, or waive it entirely, that doesn't help a whole lot if the patient needs additional testing, medication or specialist care. Yes, they can visit the ER for acute care, but that still leaves them with no follow up or more advanced treatments.

Many of my patients don't have cars so transportation is a big issue. If I refer them to someplace the next town over, I might as well be sending them across the country. They can't get there.

Many of the working poor have jobs with lousy working conditions. No vacation time. No sick days. If they miss work, they don't get paid and they risk being fired for not showing up. So they keep working to pay their bills and feed their families while their medical condition goes untreated and gets worse and worse.

Having insurance isn't a panacea either as transportation, copays and time off work are still issues. If a husband and wife each have some medical issues and each take 4 or 5 different meds, even a $10 copay becomes $100/month just for medicines.

 

[Marnm02]

We need congress's insurance plan.

In 2014 we will. Or at least we will have the option of having the same plan members of Congress do.

http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011g.html

 

[angwill]

Great post angwill! You hit on a number of issues that many people never think about or don't realize exist. I work in a very poor area and I see all of the things you mentioned and more on a daily basis.

The uninsured have little to no access to care. Even if I'm willing to discount my fee, or waive it entirely, that doesn't help a whole lot if the patient needs additional testing, medication or specialist care. Yes, they can visit the ER for acute care, but that still leaves them with no follow up or more advanced treatments.

Many of my patients don't have cars so transportation is a big issue. If I refer them to someplace the next town over, I might as well be sending them across the country. They can't get there.

Many of the working poor have jobs with lousy working conditions. No vacation time. No sick days. If they miss work, they don't get paid and they risk being fired for not showing up. So they keep working to pay their bills and feed their families while their medical condition goes untreated and gets worse and worse.

Having insurance isn't a panacea either as transportation, copays and time off work are still issues. If a husband and wife each have some medical issues and each take 4 or 5 different meds, even a $10 copay becomes $100/month just for medicines.

It is sad when you hear stories from different areas and different circumstances. I think a lot of people assume those without health insurance are just not working hard enough. Some areas don't have many businesses that even offer health insurance which is what our area is like. If they have pre exhisting conditions they can not get private insurance even if they could afford it to top it all off. Oh and in our state we can cross state lines to find health insurance but that doesn't make the cost any lower than instate insurance prices.

Your talking of transportion issues and having no paid time off in your area now makes more sense when you talked of how treating one issue per visit will not work in your practice. That is not something I thought of.

 

[dawnball]

It works here and as a patient how can I be mad about that. If I told the receptionist that I needed two things done that would take some time I would be told they can not be done at the same time and would have to make 2 appointments for when I could get them taken care of. I learned by going in for one thing and something else coming up in the mean time and he simply explained the policy and why and I had to pick one thing for him to do that visit and make an appointment for the other. Unless it is something quick and simple that we can discuss while doing the original thing I completely understand. If it is something important that would be at risk of being ignored then deal with that problem instead of the original and have them make another appointment for the first. It works where I live and it is their policy. I guess I could look for another doctor that might work for another hospital with different rules but I like the one I have so I will abide by his rules.

Can the receptionist not find you two appointments that connect? I'm fairly sure that my doctor has a similar policy, but wouldn't ever put it so bluntly, and would waive it if the situation called for it.

My first appointment was for an annual physical, because new patients are always physicals. But I'd called in the first place because I'd pulled a muscle in my back and wanted a PT referral, but didn't have a local doctor. Once the doctor knew what the situation was, we shelved the physical, she evaluated my back, and sent me on my way with a referral.

On the other hand, when I had an appointment for abdominal pain, and said "Oh, in the last week I started having issues with irregular heartbeats and very low blood pressure" - we took care of both, and I didn't feel rushed at all.

How I feel about that kind of policy is very dependent on how they explain it, and how many exceptions they make. Just like my doctor will work me in same-day for something if it's important, I expect them to extend an appointment if it's called for, and to set limits so my appointments happen in a timely fashion.

 

[angwill]

Can the receptionist not find you two appointments that connect? I'm fairly sure that my doctor has a similar policy, but wouldn't ever put it so bluntly, and would waive it if the situation called for it.

My first appointment was for an annual physical, because new patients are always physicals. But I'd called in the first place because I'd pulled a muscle in my back and wanted a PT referral, but didn't have a local doctor. Once the doctor knew what the situation was, we shelved the physical, she evaluated my back, and sent me on my way with a referral.

On the other hand, when I had an appointment for abdominal pain, and said "Oh, in the last week I started having issues with irregular heartbeats and very low blood pressure" - we took care of both, and I didn't feel rushed at all.

How I feel about that kind of policy is very dependent on how they explain it, and how many exceptions they make. Just like my doctor will work me in same-day for something if it's important, I expect them to extend an appointment if it's called for, and to set limits so my appointments happen in a timely fashion.

I asked about two appointments one after the other and was told each procedure had to be on two seperate days. I just talked to the doctor about it last week when having to take my son in both Thursday and then Friday for two different things and he said he hates it. He wishes he could just address everything at one appointment but with the regulations from the state coming down on him it was not his choice. He blamed it on all the changes to healthcare. I almost wonder if it is might be a choice from the hospital he works under just because I have not heard of anyone else having to do the same but I could be wrong.

I would think like in your case with the physical and needing a back referral that he would have done the same and gave the referral in the one appointment but I don't really know. I do know that when I go in for my thyroid to get my blood TSH checked I have to make an appointment with the doctor despite not really needing one just need that blood checked. The nurse checks my weight and blood pressure and the doctor comes in to hear me tell her what I am there for and that is it. I pay for that appointment for nothing too but those are regulations. I wish I could pay a smaller fee to wave seeing the doctor.