* * Anonymous Doc

Monday, November 14, 2011

Helped someone on the street yesterday. Can't escape the job even on vacation. Saw someone on the ground, struggling to get up, first instinct to walk past without stopping but saw that he was really struggling. Went over to him, someone else stopped too, we tried to help him up, asked what had happened. He said he was weak, couldn't get up. He was outside a medical office, so I asked if he had just come from the doctor. He said he hadn't. Someone went into the medical office and called for help. The guy said no, no, he didn't want help from the medical office.

"Why not?"

"I don't have insurance."

"But you can't even stand up by yourself."

"But I don't have insurance."

"You need help."

"But I don't have insurance. Just leave me here."

We got him to a bench, asked where he lived. He said he only lived a few blocks away, and said he just needed to catch his breath and call his wife.

"Are you sure you don't want us to call an ambulance, or get a doctor?"

"No, no doctors. I don't have insurance."

"You sure you're going to be okay?"

"I'll be fine. I don't have insurance."

Clearly, there is something wrong with our health care system.
(I don't have any answers.)

29 comments:

  1. Meanwhile in Brazil, we'd have called an ambulance, he'd be taken to an E.R., got tested and treated for anything they found and sent back home without spending a single dime!

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  2. I've gone to three funerals in the last eight years for people who had diagnosed but untreated diseases. In two cases the dead had to file bankruptcy due to medical costs just to find out what was wrong. In all cases they were not able to afford the treatment prescribed. One was fully insured until he lost his job due to multiple absences for medical treatment.

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  3. I have insurance. It's horrible insurance, because I work for myself, but it's the best I could afford and I need something for catastrophes. I don't use it at all for two reasons: the company likes to deny charges and it takes months to figure out exactly how much I'm actually going to be in the hole; and I refuse to enrich the pocketbooks of physicians who run up the bill without thinking, figuring that the insurance company will pay the bill, and if not, it's my problem.

    I've received care in both Canada and Chile. In both countries, where I was NOT insured, I received excellent care and reasonable bills for that care, which I paid gladly.

    There is something very very wrong with the U.S. system.

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  4. I'm happy the guy was too proud to beg. Seems to me a lot of doctors will happily give people tens of thousands of dollars' worth of health care to save their lives without worrying about whose money is going to pay for it. That's not right.

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  5. Beg? Really? Having lived in the US and Canada and experience the health care systems in both countries, I can say that I received equally good care in both -- the difference being that no one in Canada has had to "beg" for life-saving treatments.

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  6. Canada has a system where you don't have to beg, you're entitled to healthcare and there's a system for paying for it. I'm fine with that. But here, we don't. It's the difference between being invited to a pot luck and having the guy at the hot dog stand just giving you some for free because he thinks you look hungry.

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  7. Thanks for replying Noumenon.

    Pardon my ignorance but a great deal of the taxes I paid while working in the US went to cover the health insurance of those who couldn't afford regular health insurance. Between the taxes and what we paid for our "private" health insurance in the US we paid at least 50% of our taxes here now in Canada -- with no discernible difference (to us) in care. To my mind using your analogy, everyone has contributed to the potluck but some people have slipped the organizers a few thousand so they can get to the front of the line -- even though they're not hungry. (To note; the organizers of the potluck have set it up so that they get rich off of the entire party)

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  8. @ Noumenon. So you're saying it's not right that doctors prioritize saving someone's life over money? I think that's entirely right. I hope I never have a doctor who thinks it's more important to focus on whether they get paid than whether I live or die.

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  9. I thought the only taxes that went for health insurance was Medicare, Medicaid and the VA. But I can definitely imagine myself getting jealous of the potluckers as well, maybe I just don't like sick people.

    Anonymous 2, the doctor gets paid either way. What I don't want is a doctor who decides other people should pay for you to live or die. Ordering up procedures to save someone who can't afford them is basically like stealing from people to send the money to Ethiopia. It feels kind but is not cool.

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  10. >>the doctor gets paid either way

    Not if I don't see physicians.

    >>What I don't want is a doctor who decides other people should pay for you to live or die.>>

    That's the current U.S. system, actually.

    >>Ordering up procedures to save someone who can't afford them is basically like stealing from people to send the money to Ethiopia. It feels kind but is not cool>>

    As I said, I have insurance, really $#!()& insurance, because that's what you're forced to purchase when you're self-employed. There's little choice. I know from experience that my insurance company regularly denies charges for needed tests and procedures, because it can. Appeals are a waste of time, because it's the individual vs. the insurance company. Physicians have no incentive to check if a patient's insurance covers charges, or to code appropriately, and why should they when, if the insurance company denies the charge, the patient will then be on the hook for the full charge, NOT the lower charge negotiated by the insurance company? Physicians are complicit in this system, and that's been true since the onset of its gradual evolution, dating back to the 1960s. At the moment, everyone is trying to sock away as much money as possible, to "get theirs" before the party is over. There's no incentive for anyone to care, other than the patient, who is at the bottom of the food chain.

    I opt out of the system by staying away from physicians. Will it shorten my life? Well, I'm basically healthy, and my family tends to live into its 90s. Since I definitely don't want to undergo the torture I've seen physicians inflict on my family members, for no discernable reason other than profit, I made the decision I'd risk dying well before then. Why do I have health insurance? If I'm ever brought to an emergency room, unconscious after a car wreck or some other major calamity, at least I probably won't lose my house. It's no guarantee, but at least my loved ones have some protection from financial ruin.

    It's obvious you, Noumenon, have never experienced a serious accident or chronic illness. When this finally happens to you or one of your loved ones, enjoy.

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  11. Noumenon, you're a horrible, self absorbed person who lacks empathy for your fellow human beings. I hope I never know anyone like you.

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  13. I am SO happy that I live in a country where EVERYBODY has insurance and NO ONE has to woryy about going bankrupt and losing their house if they go to the hospital / see a doctor.

    Also, speaking as someone who works in the medical field: doctors have to deal with enough bureaucratic hassle already. If they had to worry about the patients' insurance status / financial means to pay for procedures, they wouldn't get ANYTHTHING done anymore. Worrying about insurance issues ISN'T and SHOULDN'T be a doctors' job.

    A doctor's job is to treat illness and promote his patients' health. Asking them to deal with the insurance bits too is like asking a cook to build the table on which the food will be served. Cooks are NOT carpenters...and doctors are NOT insurance people.

    To see to the welfare of a people as a whole is the governments's job....and the US, so far, is doing a sub-standard job of it.

    (BTW, NOT having insurance for everbody is a serious drain on the US economy as a whole. E.g. Capable and competent workers going bankrupt because of health-issues means that theses peoples' much needed work-force and input is no longer available to the economy. Instead, they and their families become a drain on the welfare system. Way to shoot yourself in the knee, dear US!)

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  14. Isn't it kind of insane from a public health and safety point of view to have people walking around with treatable-but-untreated illness as the default option?

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  15. @FuguSushi, I think empathy is harmful from people who don't understand the value of money. The flip side of me not wanting other people's money spent on empathy is that I've sent $10,000 of my own money to WaterAid more than once.

    @Anonymous, auto mechanics don't seem to have a problem with not providing repairs that aren't paid for. It doesn't make them "insurance agents," they just don't replace engines for people who don't have the money.

    @Knot Telling, that is the default option. Your basic condition is untreated suffering and death, when there is not enough money to prevent that. We're lucky to have enough money now to prevent a lot of diseases, diarrhea, fix broken bones and teeth, but serious surgery and prescription drugs are still too expensive to provide them to everyone. It's reality, not lack of empathy, that denies health to people with no ability to pay.

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  16. @Noumenon: I'm not sure if you've noticed this, but cars are inanimate objects, and when auto mechanics refuse to work on them, they don't suffer. Would you like for a hospital to treat your mother like a car? Think about that for a minute.

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  17. >>Worrying about insurance issues ISN'T and SHOULDN'T be a doctors' job.>>

    I disagree, given that this is the system in which U.S. physicians presently work, and, as I mentioned earlier, absolutely are complicit. Look into the history of Medicare/Medicaid reimbursement if you don't believe me. Dentists and veterinarians seem to have no problem quoting prices, preparing estimates, and investigating insurance - why should physicians receive a pass here? Sure, it might impact income, but keep in mind that physicians, even those in the lower-paid specialties, are in the top 6% of wage earners in the U.S. Cry me a river.

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  18. Just a random comment regarding the "really &*&#! insurance" a previous commenter said was what self-employed people are "forced to buy." My father, a type I diabetic, was unemployed (save the occasional consulting job) pretty much from 1995-2003 and my mom has always been self-employed. They of course had to purchase their own insurance once dad lost his benefits when he lost his job. Their insurance was definitely not "*$#&%" insurance! It was perfectly good insurance. Expensive, but fine.

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  19. @Noumenon - Do you realize that sending money to Ethiopia is exactly what the US does? According to state.gov, "Total U.S. Government assistance, including food aid, between 2000 and 2010 was $5.056 billion. In FY 2010, the U.S. Government provided $932.6 million in assistance, including more than $451 in food aid."

    Now, granted, I don't see this as stealing precisely because I don't think taxes and stealing are alike. However, that money is coming from the pockets of American tax payers.

    Are Ethiopians to be condemned as you seem to believe poor people are who would care to live?

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  20. To be consistent with my other posts, I would be criticizing the government for giving Ethiopians unaffordable care with other people's money, not the Ethiopians themselves. I'm not quite as hard on the government as I am on the doctor because the government is transparent about who they're taking money from and why. If AIDS drugs still cost $6000/yr I would deem that kind of wasteful, yes.

    I'm just relieved not to be eaten alive after seeing four comments here. I did type about five different paragraphs comparing my mother to a restored automobile, but I think I'd be better off not digging any deeper.

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  21. Noumenon, did you ever inhabit IRC back in the day? That is a very unusual nickname -- I've only seen it once before.

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  22. I was using "Noumenon" twelve years ago, but I only inhabited IRC for about two days, so it probably wasn't me. "Noumenon" is not super common, but I've never been able to get it as an e-mail address, Livejournal, or Reddit handle.

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  23. Hmm. Well, thanks.

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  24. webhill: Some states offer a good selection of individual insurance plans for the self-employed, but that's not where I live. In my state, the self-employed can choose from only two companies. I purchased the best plan offered by the better of the two companies. My plan is supposed to cover certain services, but in practice it often does not, and both the company and physicians (who can then charge full-price, rather than the negotiated insurance rate) are rewarded by doing so. I know from experience that fighting an insurance company is a waste of time; the company almost always wins appeals, and there is no practical recourse beyond appealing the insurance company's judgment. Physicians won't stand up for their patients, either, and why should they?

    I resent paying money to a company for a service it does not actually provide, and there's no way to know this in advance.

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  25. <>

    do you have any idea how much money, time, stress, blood, sweat and tears go into becoming a doctor? i'm in my first year of med school right now, and while my desire to be a doctor isnt driven by making a ton of money, no one would do it if they wouldnt be compensated for all the effort they put in. you read this blog... you know the shit that goes into being a resident. why shouldnt doctors make money? its not their fault that the ins system is screwed up, and while you might think a doctor should look into what your insurance covers before treating you, i promise you wouldnt be saying that if you were in a life threatening situation. doctors may run a ridiculous number of tests on a person, but thats also to cover their own liability. you say you wouldnt want a doctor running 100 tests but then they get sued for not providing the standard of care if something gets missed or goes undiagnosed. doctors are put between a rock (the ins companies) and a hard place (schmucks like you who think they're all out to get rich and dont give a hoot about the people they've spent 30 years getting educated to treat)

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  26. lisa: Yes, I actually do know how much work goes into being a doctor. I have a doctorate (sciences) myself, and I'm returning to school shortly for a second graduate degree. As for working hard? The members of my family who are active military work much harder than medical students or residents, for much less money and much greater risk. The "risk" of malpractice is a joke. Look it up. It's an irrational fear. The actual damage to the successfully sued is negligible.

    Lastly, it doesn't take 30 years to educate a physician. Let's add it up:

    13 years (counting kindergarten)... just like just about everyone I know

    4 years undergraduate... not too special, considering the devaluation of a college degree

    4 years medical school... less time than it takes to earn most other doctorates

    3-7 years residency

    I get 28 years, maximum, counting kindergarten. Perhaps you should review basic math skills.

    Anonymous Doc is one of the few med bloggers I respect. People like you are far more typical of the physicians and wanna-be physicians I encounter. That's why I opt out of what passes for healthcare in this country. I'm not afraid to die; I'm afraid of being tortured, financially damaged, made ineligible for insurance, then financially destroyed by a group of people who have no incentive to care about peoples' lives in general. As you said yourself, why would physicians do this if they weren't compensated? Gee, I'll ask my active military enlisted nephew why he does what he does, via Skype, since he's over in Europe and will be there throughout the holidays. I guarantee he isn't in it for the money. You???? Don't believe you.

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  27. 28 years... forgive me for rounding up. if you add the 2 years of post-bac i did to finish my science requirements you get 30. and your argument comparing med students to military personnel is a faulty syllogism. they are non comparable. i'm not saying military personnel dont work extremely hard. nor do you know how hard a med school student works, or a resident for that matter as you were/are neither. so instead of making a broad generalization about how physicians are all douche bags, maybe you should try giving back to the community yourself. it's really easy to sit on your pedestal and criticize. its much harder to get in the trenches and do some shit. ask your nephew, i'm sure he can tell you about it

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  28. Hmm, interesting conversation. I know it's off the topic of the blog post (which I find heartbreaking) but I wanted to comment on some of the resentment of MD's salaries I noticed in the comments.

    I resent MD's and their high wages a lot less than say actors or sports stars and theirs.

    The amount of debt a doctor has to incur is staggering to get their education. Skilled athletes will get a full ride scholarship, then if they're lucky, a ridiculously overpaid career afterwards. They generate money for their team/league, yes, but their contribution to society as a whole is a lot less than a doctor's.

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  29. As somebody who lives in a country that is supposed to have socialised care, I can say that doesn't work either. Welfare recipients don't have to pay anything; people above a certain income bracket can afford to pay for their care, through government tax imposed wage markers if they don't take up private health insurance.

    And in between fall I - not earning enough to be able to afford any sort of insurance, let alone health; yet not having the income to pay for private health insurance.

    I can very much relate to the unwell person you met. Currently, I am waiting (saving) to be able to afford the biopsy and ultrasound tests necessary to rule out breast cancer. The longer the amount of time it takes to save for this (or to be seen through the public health system of queuing - months, literally), the less I feel that I can afford treatment if it is bad news.

    I've refused hospital trips in the past because of the cost of paying an ambulance that I didn't call and that I can't afford.

    There are cracks in every system.

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