Bad Economy Leads Patients to Put Off Surgery, or Rush It

In a bad economy, patients are deferring elective surgeries or speeding them up in fear they might lose their insurance.

Comments: 51

  1. Speeding up or deferring care both have costs.

    Those who defer necessary care will become sicker, and, in some instances, die from untreated conditions.

    The legal secretary with the torn rotor cuff which impairs the external rotation of the arm and hand is a case in point. The longer the surgery is delayed, the more scar tissue, which can never be removed adequately or repaired, will form. The more scar tissue and badly placed healing occurs, the more pain she will be in and more and more it will affect her ability to do her job. (And on this I am speakng from experience having torn shoulder muscles and destroyed the internal rotation of the shoulder, and not realizing how serious it was and figuring it would heal, did not seek care. Within a few short years, the scar tissue and nerve damage resulted in orthopedic limitations and intractable chronic pain which left me completely disabled - and even one of the top 3 mediacal facilities in the US said there is nothing that can be done now to repair the damage.)

    On the other hand speeding up care in anticipationn of losing coverage leaves the person at risk of not being able to obtain coverage in the future. If they can not afford COBRA or have to later purchase individual coverage after exhausting COBRA, they have a reocrd of health problems. That record of health problems can easily make them uninsurable when trying to purchase individual coverage. If they find a new job wiwth health insurance after exhausting coverage, their new plan may exclude any care for the conditions which were treated for a period of time as pre-existing conditions.

    There are no good choices. They are damned if they do and damned it they don't.

    __

    On the issue of the economic impact of the drop in lucrative elective medical care on hospitals and physcians, I am always slightly baffled by the one claim they consistently assert. They are forever complaining that Medicare does not (a) cover all their costs and/or (b) allow them enough of a payment to give them sufficent profit.

    Here is a real easy idea for those who complain that the reimbursement rates do not cover their 'costs.'

    CUT YOUR COSTS!

    Granted there are fixed costs which can nnot be reduced - laons for equipment or facilities, real estate taxes etc.

    They can however lower the wages paid to physicians, nurses and others. For example, an anaesthesiologist can easily make in excess of $200,000 a year (salired employee of hospital) or an RN with a BA make $60,000 - 82,000 a year or a radiologist also in excess of $300,000 a year.

    When the customers can not afford the prices that yield such incomes, lower the price of their services!

    (And all the MDS who will whine 'but but I spent all those years in school and have student loans, save it. It takes just as many years and just as much money to get a PhD in biochemistry or history. Law school takes 1 year less but brand-new baby lawyers aren;t fit to be turned lose on the public until they have spent 3-5 years working as the dogsbody in a firm and learning their craft - and very very very few new lawyers get the obscene salaries made at the huge firms. Brand new prosecutors are lucky to see 1/3rd of those salaries or around $50,000 a year.)

    The lowering of incomes in the health care field will happen sooner or later. The US population as a whole simply can not afford the prices.

  2. On the bright side, at least some people in this article have insurance to begin with.
    Maybe after years of allowing illegal immigrants to swamp our hospitals and getting the American taxpayer to pick up the tab for the cost, we'll finally catch a clue. How much worse does it have to get?

  3. I did that. In 2005, when I was spending the last of the money I made during the dot.com, I learned that I would face a long convalescence if I had my aortic valve replaced. My doctors were convinced I needed the operation, but I of course wanted to postpone it as long as possible. Financial not medical necessity finally helped me make up my mind to have it done.

  4. Uuniversal healthcare, free at the point delivery should be a mainstay of a civilized society. It's not difficult to implement (unless you are a rich republican with shares in the insurance 'racket'). A decent country takes care of it's citizens without seeking profit.

  5. From what I am reading here, due to the way the health insurance system is set up:

    * People die unnecessarily.

    * People incur unnecessary pain.

    * Routine surgery becomes more complicated.

    * Ultimately there is often greater expense.

    Does someone want to argue that systems in other first-world countries are worse because you might have to wait if you don't have an urgent problem?

    It also seems there is endemic age-discrimination in the workplace requiring middle aged people to resort to plastic surgery to look younger. Wouldn't it be easier to try to eliminate the illegal discrimination rather than giving everyone over 40 nose jobs?

  6. I had left a job but paid for the insurance via COBRA for 18 months. After the 18 months we looked at new individual policies and investigator a number of options. We decided to purchase private family policies Blue Cross Blue Shield of Michigan. I have had previous problems with chronic lower back pain and receiving intermittent surgical therapy. We looked at the receiving coninued treatment and submitted documentation that we had no lapses in our COBRA coverages for 18 months. Although it was a prexisting problem we understood that it would be covered after they reviewed our previous coverage. NOw they sent us an email dening the coverage because the waiting period was not over. Tried to contact them today but them took the day off to save money. The only people that private insurer care about is their senior management and will deny and resist paying any benfits. These private insurers are fighting hard to prevent any single insurer type coverage. Although single payer systems may be inefficient hopefully there only goal will not be holding on t their money and paying extremely high salaries for their senior leader.
    In his second year as chief executive officer at Blue Cross Blue Shield of Michigan, Daniel Loepp earned $1,657,555, a 67% raise over his $999,351 salary and compensation in 2006, the company's 2007 financial records show. That seems like really a lot of money way more that any doctor I ever heard about. Even if he did not take off any time that is $31,788 per week or 398 dollars an hour even if he worked 80 hours per week. I am sure he is busy but 400 dollars per hour even if he worked 80 hours pre week seems a little high. They say that if they do not pay that much he will just go to another company. That reguires an open job and there must be some other good people that could do the job. It is not like they are professional athletes or entertainers.

  7. As a colorectal surgeon frequently treating patients with diverticulitis, I have to correct Zeff Ross' summary of the natural history of this disease. Patients who have repeated episodes of diverticulitis are actually not as likely to perforate and require emergency surgery. Patients with diverticulitis who perforate are usually asymptomatic before this happens and are completely unaware they even have the disease. Most patients with diverticulitis never require surgery if they merely change their diet to one that is high in fiber.

  8. The recession was really alarming, many people are now always wear that anxiety of maybe losing their job one day.They avail benefits that they are entitle of fear of totally losing it without enjoying it. This was practical step of them. But maybe for me instead of getting through a painful operation they should use natural way like drinking acai berry for losing weight

  9. How many insurance companies pay for "elective" surgery? Doesn't that term imply that there is no need for the surgery in the first place?

  10. America is essentially an immature, debased and in the end a vacant, shallow, corrupt and failed country with a painful and tragically unlimited potential but little or no cultural evolution let alone a working social contract that we - those not in that rarefied elite economic social class - can count or build our lives upon. I have had to search through the historical record and the cultural mythology and dynamics to really understand just how we took a wrong turn, however we did and it was more than just one turn. We do not value human life nor is there any reverence for it despite all of the legal and religious pomp and bluster on this subject. America has been and always will be just about making money, gaining and fighting one another for power and control over others as well the accumulation of social status and possessions. To show just how well the corporations here have managed to dumb down the populace and keep them stupid, dim witted and disengaged from their own futures, health and general well being, look at how silent they are in the midst of all of this. They will purchase vitamins instead of desperately needed medications and still remain mum and passive as per their social conditioning that has left them infantilized. They 'believe' internally that they are not worthy of being treated with dignity and respect. Until that changes, none of this will either. So for now I see no hope or chance of change in this country and may very well leave before it's too late. My heart is truly broken at the stupidity of my species.

  11. People are also putting off regular appointments and filling prescriptions because their private insurers are denying routine claims that had previously been covered.

    As a recent example, my brother has been with the same BCBS employer-sponsored insurance for at least 15 years. Six months ago they began denying his office visits and presciption for Lipitor though he has been treated for the same condition for several years. I've heard countless stories like this and worse in my 35 years as a nurse. It appears the insurers may be scaling up their shenanigans to collect more money for nothing.

    As the TV pundits are busy dissing the idea of addressing health care, they never discuss the abhorant actions of these private companies. They are just too busy criticizing inane and rediculous nonsense that they can't be bothered doing the work of reporting real stories. Jon Stewart sure got it right in more ways than one.

    Haven't we had enough of this kind of behavior in this country yet? We must open Medicare to everyone. What's the point in paying $500 and more a month for nothing? If these premiums went to Medicare it might go a long way toward helping the cost of universal coverage.

  12. We are currently facing this problem with our two twin daughters who will be undergoing spinal surgery. Two days ago a meeting was held at my husband's Social Service Agency and they just barely made it through to continued existence. This surgery is so expensive and with two family members instead of one patient we were horrified. Cobra would be out of our range and this needed surgery would have to be delayed to the detriment of our daughters. So now we have a three month period of coverage with a high deductible which will come out of our home equity. Our oldest daughter in college may need it soon due to a misdiagnosis when she was younger Her timing is problematic because she doesn't get out of school until after the 3 month period. She would also be giving up her job during this summer. Luckily, she is an ARA and has scholarships. If times were better, our insurance now would work well. In the past our co-pays especially for meds have acutually go beyond our current deductible. I don't mind the President working on several issues at once. It seems it's our only option at this point this there is severe crisis in the medical field and insurance industry. i hope this may lead to a more equitable medical insurace policy. I really am beginning to get angry at all those politicans on the Hill who never have to worry and stay up late worryng about the health concerns of their children in terms of recieving and getting the best care.

  13. Given the amounts of unnecessary surgical procedures, perhaps this a good thing.

  14. The time is already the present, as thousands of workers join the unemployment without medical insurance. Our Obama administration needs to realize, or at least acknowledge, that the #1 priority of USA is not providing more money to cure our economy, nor continuing the fight againist terrorism, or winning the wars in Afghanistan or Iraq. All that will soon past in a few years, and what will be left behind will be the smae problem we have had for too long: a nation that can not provide a basic need to sustain life: medical attention to its citizens. Our nation can afford and must provide uniform, equal medical benefits to all citizens. The medical industry can no long be like the present for-profit industry as too many providers (doctors, networks, clinics, insurance companies, etc) have become just like the failed investment houses of Wall Street. It is sad one must sacrafice medical help because one loses a their job or can't afford the "non insurance rate" that is charged. How much longer will our country allow this?

  15. What is missing from this timely article is the very expensive approach the patient is likely to take with Dr Kenneth Shaheen. As a plastic surgeon, he will likely do her reconstructive procedure in an "Ambulatory Surgical Center". This ASC generates a fee (which may go to the Doctor if he owns it) of anywhere from 400 to 800 on top of the physician fee. If an anesthesiologist is used, then this increases easily to more than another $1000.
    The safe, economic alternative exists: Mohs skin cancer surgeons are dermatologists who have the developed the skills to do these procedures in an office setting, saving the patient and insurance company lots of money. The market will probably encourage this trend.

  16. This type of behavior is predictable. I believe one consequence will be a measurable rise in the number of elective surguries done overseas (India and Thailand for instance) where knees and hips can be replaced just as safely and competently at a much lower cost, including air, than is available in the US.

    Wonder why medicare won't cover overseas surguries?

    Carpe Diem

  17. Why is this a new issue? When it only affected 20 million people, politicians and the media didn't care. Now that it affects 40 million adults - including former high flyers - it's become an issue.

  18. I used to work for a major insurer.

    I was forced out because I was bipolar. It's really quite easy for them to do.

    Now I can't get a job because I have to list that I may potentially have an episode and need "accommodation".(Try being honest with an employer about having bipolar disorder and your application will quickly find it's way to the "round file").

    I'm even willing to work for less in order to accomodate my disability.

    No go. It's easier to just not hire me.

    I could lie about it, tell a potential employer that I'm "fit for service", but my ethics won't allow me. Honesty upfront is more important to me the job.

    I find that doesn't pay off very well.

    Nobody will sell me insurance because of the diagnosis. Cobra is long since exhausted. I can't even get an "exclusion" for mental health.

    I can't afford proper health care or medications.

    I'm fortunate that my father will pay for a couple Psychiatrist appointments a month. Sometimes I get free samples. If the free samples run out, I'm forced to stop the medication due to basic fact that I can't afford it.

    I'm one of those people that "slipped through the cracks" and can't qualify for disability until I've exhausted my complete life savings paying for health care out of pocket.

    And you know what?

    I get charged 2-3x the amount that the insurance companies pay.

    And I don't get to "negotiate" a discount. There is no sliding scale.

    I guess that is my karma for working in an industry that is as much of a farce as our banking system.

    That is why I am a member of Dignitas.

  19. Employers have the power to continue medical coverage for laid-off workers, they choose not to. In the worst economic conditions in decades, it's time for employers to think creatively about how to do more. A few dollars trimmed from the top goes a long way for a dedicated crew at the bottom.

  20. It's time for some form of national healthcare.The forthcoming plan by president Barry Obama should HOPEfully do the proverbial trick!!!

    There's no reason whatsoever for the freest people in the world(Americans),should wait or rush through procedures of the medical nature because they lacked proper insurance coverage!!!The near deadly tactics these uninsured are forced by circumstance to endure, will cost the taxpayer in the long run!!For the uninsured,they could sacrifice their lives!!

    [email protected]

  21. This is just another example of the idiocy of our system of financing health care. I feel for these people, but I can't quite reach them. The American people have clung to this stupid system of health care thinking they would always be protected, and the hell with all of those with no means of health care at all.

    I have been paying out-of-pocket for my health care for thirty years, and have continually campaigned in my own small way for universal care. Most people's response has been lukewarm at best. We put band-aid after band-aid on our non-system, insuring this little group and that little group. Each band-aid leads us further away from universal care.

    Maybe people will wake up to the need for affordable universal health care as so many lose their jobs and realize that everyone without health insurance is not a lazy bum.

  22. We switched to the low budget state plan which covers very little. We have put off visits to specialists. We are lucky though that we have and can afford insurance unlike many Americans. There is something fundamentally wrong in this country where a person who works full time cannot afford adequate medical care. It is past time to get the insurance companies from coming between physicians and patients. Ask any physician. Insurance companies mandate how doctors treat patients by refusing coverage for what the doctors would order the patient have done.

  23. As a result of my "forced retirement" (I was given an offer I couldn't refuse - retire or get laid off!)I was given one year of free health insurance. After that I start paying COBRA, and after that although I may qualify for Medicare by then, I probably will have to take a reverse mortgage to pay for my wife until she reaches 65, two years after me. Since I am a diabetic and a heart patient and my wife is a two time ovarian cancer survivor, you can bet your booty that we are having EVERYTHING done NOW! We never miss an opportunity to have a test done to detect anything. Every ache and pain, every drop of blood from the wrong place, every medicine due for renewal. Nothing goes undone or not purchased. I am asking doctors for samples of drugs and stockpiling them. In the meantime, when I hear a politician who gets health care with no deductibles or co-pays, that is paid for by the government, administered by the government, sponsored by the government etc. complain about Obama's Health Care plans being "socialism", I get the urge to pour a recently used bed pan over his/her head!

  24. Horrors! Plastic surgery is now the main point in the Health Care issue? Something like; I lost my health insurance so I can't replace my face with the preferred model.

    Is this a do or die life threatening issue?

    The sad truth is that most people have multiple options in their life. Going to the doctor is not difficult. The Insurance issues are a different topic. In other words how to pay for the doctor visit! Cash is good!

    Most insurance doesn't, and shouldn't, include coverage for selective procedures for cosmetic procedures! And neither should some ethereal universal government care system. Period!

  25. Cosmetic surgery should not be covered by health insurance. This is the kind of excess that makes companies go bankrupt.

  26. I repeat "This country cannot even be considered one of the great countries in the world unless ALL people have access to affordable healthcare, not just for the rich or poor but FOR THE MIDDLE CLASS."

  27. Kudos for posting a story about people who are rushing to get that last minute nose job.
    I'm glad you are paying attention to people to who want elective surgeries-- specifically the vain people who want to fix that "ugly" nose.
    Why don't you pay attention the people who lost their jobs and don't have health insurance anymore who need important treatments.

  28. It is very painful to read thatUS government could not provide cheap and high quality medical services to the needy.if bailout can be provided for auto gaints and banks to fill deseal for their own planes, why government startits own hospitals to provide free medical assitance for poor and needy patients who suffer from job loss and recession.

    US should study excellant medical services run by government of India to provide free medical assitance to poor and needy in US and take intiatives to start medical services for patients. The present system of providing insurance to all citizen is seemed to be a failure .If it helps only bankrupted insurance companies, the time has come to go for alternative system. We should not feel nervous that we are going to adapt a socilist idea. If it is good, we should go for it along with present system our own people,s health and relief.

  29. Health security is missing in the'ICE" age for many both in developed and developing countries. But accessibility to clinics,doctors and even medical shops seems to be better in many developing countries.Though with the introduction of product patent replacing older version of process patent has raised the process of medicines in countries like India accessibility is better i feel.

  30. i'm confused how is getting a nose job in the same category as getting a knee replacement? and why are insurance companies covering this "procedure?" climb yourselves up and out of these social constructs ie. notions of beauty, happiness, success, and look around, Also question why it is that we are buying -hook line and sinker- the media (written, televised, radio, computer etc.)as it may be convincing us all to believe that we are in such dire straits, and in so doing, we fulfill what has been written

  31. Imagine a non-socialized fire department.

    So you have a fire in your kitchen -- what do you do?!

    You run to the living room to get the yellow pages. Frantically you thumb quickly to FIRE EXTINGUISHING. There are about 100 privately listed Fire extinguishing companies and you numbly try to find the closest one to you. After 2 or 3 minutes which seem like 2 or 3 hours you find the nearest one -- unfortunately there was no display ad for this particular company. You dial the number and hear, "for roof fires, press one. For electrical fires press two. For ..."

    Do the socialism fear-mongers understand that for some things socialism is actually the best way. Not everything, just SOME things. Like the fire department. Like doctors.

  32. I am currently on indefinite layoff. All benefits expire on July 1, 2009 so I have scheduled medical visits for all family members prior to that date. My real concern is that prescription coverage also expires, so we're checking on refill availability prior to losing this coverage. It would have been great if the obama bailout plan could have helped the unemployed but that is too much to expect.

  33. America is essentially an immature, debased and in the end a vacant, shallow, corrupt and failed country with a painful and tragically unlimited potential but little or no cultural evolution let alone a working social contract that we - those not in that rarefied elite economic social class - can count or build our lives upon

    Oh, please, do sit on a tack. Yes, parts of the social contract are torn at the moment--such as having a financial system--but there are plenty of loving, hardworking people who do a lot of charity work and never count it as a day well spent unless they have done something for someone else. http://hopeycopey.blogspot.com

  34. I have an idea:

    LET'S HAVE GOVERNMENT CONTROLLED, TAXPAYER FUNDED HEALTHCARE!

    Wait... and you know what will happen?

    YOU'LL BE PUT ON WAITING LISTS THAT LAST INTO THE NEXT CENTURY for your procedure. Just like in Canada. The people that can afford the procedures go to the private clinics.

    Everyone's "equal" in that situation, right?

  35. Hi Kevin, it’s been too long since I’ve last seen your work in print.

    Health care reform should encourage and in many cases allow more Americans to earn money to pay a more meaningful share of the costs for their health cares. In some cases, it seems they are denied earning even a nickel.

    In my case, I’ll have a near $50,000 cost for health cares that I could easily pay for if I were allowed to be paid - for even a small fraction of my work that has been demonstrating on the TV’s.

    Pray tell: By having that work done, I am doing my part to assist paying for US health care reform, adding to such medical research, and adding to the economy of that community!

    Oh, in passing, the company, by denying COBRA in 1986, that I had paid for, has had a lot to do with those current surgeries and their $50, 000 in costs.

    For US health care reform to have a prayer to succeed the wages of say 90% of the American people most be allowed to increase. Also,in ways that would not add to inflation, so it could be paid for.

    A way to assist that is vocational education and textbooks, textbooks and more textbooks; and regulations and regulators that would not deny US such improvements.

    The idea that I have advanced for health care saving accounts would work for All of US, the United States, and US, All of US.

    Pled: My work should never have been allowed on TVs, newspapers, and such to assist the evading of US Taxes in foreign bank accounts. And no American should ever have assisted in the doings of such.

    “US” as I created it for America would be representing the United States and US, All of US. Not at all right for evading US taxes in foreign bank accounts. Unthinkable tragedies since for the United States and All of US. US, the United States, and All of US, clearly said in but two letters.

    There is nothing more powerful for good than true creative thoughts in action – that would be to this Nations Laws and Clauses.

  36. Let's face it, both the health insurance companies and the medical community have failed to provide adequate financial advice on managing medical costs to patients, and managing medical costs is something they claim to be experts on. Both fight transparency and accountability as if they have something to hide, and meanwhile continue to reward themselves for doing such a good job. What is needed is a another business model. Since insurance companies and the medical community were given a change to do it right and they deliberately did it wrong, the replacement model should not favor them. The implied message should be, if you can't do it right when given the chance and the authority, someone else will do it for you, and what they do you won't like.

    About two years ago, I saw statements by the medical community bragging how smart they are and that they could have gone to Wall Street instead of medicine to make their fortune. Somehow, that justifies their pay and fees. I wonder why there is no rush to turn in their medical licenses and go do that now?

  37. 1. Nationalizing the Health insurance companies. The Blues, Cigna, all of them have driven up the healthcare costs.

    2. Hospitals need to take a hard look at the overhead costs. Excessive adminstration costs need to be trimmed and eliminated"

    3. Tort systems need more reform. " way to costly , health care lawsuits turned into a "Lottery" for many.

    All these cost "centers" need attention it takes smart and brave people to change these imbalances.

    My concern is we have a lot of intelligent people (JD's, MBA, MPH) "How many of them are really smart and brave to enact change ?"

    We throw the HCP's (Health Care Providers) under the bus , of course they are an easy mark.

    "Are all HCP's culpable for this mess? "No" some have contributed to the problem. They interesting fact is peer pressure and patient dissatisfaction is a great detterent. Due physcians deserve high incomes,

    Yes they do, just like we all deserve the best care possible.

    It is a complex problem , requiring smart people to fix it.

    Let's stop the whining and get to work fixing the problem.

  38. Timing of surgery often must include time before surgery to prepare the body for the physical trauma and stress, as well as the higher risk period post-surgery for recovery and possible complications requiring further medical intervention and insurance.

    Nutrition is critical to the safety and optimal recovery, especially for those patients which are clinically malnourished. In one recent clinical study of gastrointestinal surgeries, 57% of the US patients were technically malnourished BEFORE surgery. Therefore, if a patient is trying to accelerate or delay surgery, try to plan so that nutrition can be safely optimized before surgery.

    The US Surgeon General is just now releasing a "Call to Action" to patients and physicians for reducing risks from Deep Vein Thrombosis and Pulmonary Embolism. It emphasizes the increased risks after surgery and cancer therapy, for many months after surgery, for problematic blood clots. Abnormal blood clotting is again linked to nutrition (especially Vitamin K, which are explicitly avoided in surgery supplements like NutraSafe) and just getting patients mobile again.

    Therefore, patients must plan ahead and allow enough lead time to prepare there body for the trauma of surgery, as well as leave enough time after the surgery 1-6 months, for the high risk period for complications after surgery. Hope this helps some.

  39. COBRA is completely unaffordable for most people who lose their jobs. The system can also be be corrupted. When I lost my job last year the company I worked for handed me in-house paperwork that said I would write a check to them and for my family of 3 it would cost me $1441. a month and I was to write the check out to the company I worked for. When I was laid off two weeks ago I was told my COBRA would be $800 per month and I will write the check out directly to the provider. The type of coverage is exactly the same. Left wondering what was the extra $600 a month for? It certainly wasn't something I could afford.

  40. Don't worry, HHS Secretary Sibelius is working hard to solve this problem. She might have no experience in Health Care, but she is determined to get to the bottom of this... just as soon as she figures out what "elective" means.

    Obama shows his true colors in the Sibelius nomination. He's bought off by the insurance industry, and he doesn't give a rat's behind about universal healthcare.

  41. #34 writes: "YOU'LL BE PUT ON WAITING LISTS THAT LAST INTO THE NEXT CENTURY for your procedure. Just like in Canada. The people that can afford the procedures go to the private clinics."

    I happen to know that this is untrue of Canada and virtually every first-world health care system. There are in fact accurate statistics e.g. from Canada:

    http://www.cihi.ca...

    The Canadians report for surgery, for example, that median wait time is less than a month, and that nearly everyone (even the small percentage who has to wait) is treated within a year. Emergencies naturally are treated much faster.

    In any event, a system of triage should no triage poorer people or unemployed people as having lowest priority, it should triage less urgent care as having lowest priority.

  42. I want a health care system that provides us all with a basic level of care for serious illness and protects families from catastrophic expenses. It should be financed through progressive taxation. There should also be a layer to encourage all to obtain routine care and assist all in so doing as needs require, in order to minimize expenses overall.

    Finally, there should be a free market in supplemental services for those who desire and can afford premium products: Cosmetic surgery, faster access to elective procedures, private rooms, advanced offerings like genetic screens, Viagra, etc. This would become a truly competitive market once it has been disentangled from the complexities of the basic care arena.

    But the essential and necessary ingredient to bring rationality to the system and lower overall costs is the foundation of universal care. This will have a spillover effect to all businesses struggling to compete in the market under the burden of employee health costs that have nothing to do with their core mission as enterprises.

    It would be good for us as individuals, and it would be good for our economic well-being as a whole.

    It's not foolproof, and will require a degree of coercion for some participants, but that's the nature of government regulation. We can't continue in the way we have been going. The current byzantine system is only getting worse.

  43. The irony of it all.

    Conservatives, radical right wingers and anti-universal medical care insurance buffs argue that people should not have any bureaucrats tell them when to receive care or by whom.

    Now we see the result of private sector medical care and medical care insurance.

    It is unaffordable.

    It can be very dangerous.

    It often does not do what it claims to do.

    And employer arranged medical care insurance that includes HMOs and PPOs and other types of medical care insurance dictate when and who provides care.

    The sadness is that the irony is lost on those whose ideology does ironically just what they claim they do not want.

    The additional irony is that this same crowd parotting, as proud dittoheads, the right wing slogans that include "My money" and "fat, lazy government bureaucrats" are defending the fat(cat), lazy un-American, unpatriotic, immoral, unethical and knowingly wrong leaders and TV and radio shouters who care less about them then they care about themselves.

    This irony is played out by every conservative and right wing radical who denounces "big" government and "tax and spend" liberals as they get into their cars (most unlike the Reagan mythical welfarer in California do not drive Cadillacs) to pick up their unemployment, disability, tax stimulus, Medicare and Social Security benefits checks (although modern times now makes it possible for them to stay tuned to fox as the check is automatically deposited for them so they do not miss a moment of hatred against the welfare thiefs who supposedly are causing their taxes to increase and the immigrants who are taking their jobs as dishwashers and low paid groundskeepers).

    Is it not ironic? Or maybe it is moronic?

  44. there is not a Caterpillar plant in Elkhart,Indiana. Elkhart is the home to RV manufacturers.

  45. "(And all the MDS who will whine 'but but I spent all those years in school and have student loans, save it. It takes just as many years and just as much money to get a PhD in biochemistry or history. Law school takes 1 year less but brand-new baby lawyers aren;t fit to be turned lose on the public until they have spent 3-5 years working as the dogsbody in a firm and learning their craft - and very very very few new lawyers get the obscene salaries made at the huge firms. Brand new prosecutors are lucky to see 1/3rd of those salaries or around $50,000 a year.)"

    Ann, why stop at income in your comparison of the medical profession to biochemists, lawyers, etc? You've already established that $200K in education debt is not worth arguing about. But what about the liability? Work hours? Weekends? The overhead? Do you even know what it costs to start a private practice? What about the fact that every time I walk into an examination room, I'm opening myself up to a baseless lawsuit? I'm sure a Ph.D in biochemistry is an extremely bright and hardworking individual, but does he or she possess a skill whose demand far exceeds the supply currently available? Doctors' "salaries" have fallen steadily for some time now primarily due to a steady decline in reimbursements. Your premiums have skyrocketed, our remibursements have plummeted. Where did that money go? Do some more detective work and let us know.

  46. This article is just another piece of the picture of the distortions wrought by private medical insurance. The decision about when to have surgery should be based on medicine, not on finance. The article clearly points out that unnecessary elective surgeries are occuring simply because there is money for them, while necessary ones are being forgone because the money isn't there.

    Doctors are suffering a deterioration of their working conditions even if their pay remains twice as high as anyone else, patients are suffering more. In the U.S., more than 20,000 people a year die because of inadequate access to medical care, largely due to lack of funds. In other words, more U.S. citizens die every three months of this than have died thus far in the Iraq war. The number of other casualties, people who have been negatively impacted by having or not having private medical insurance is probably in the millions.

    Primary care doctors are not unmoved by this. Nearly all of them favor a single-payer system of universal health care. Nearly all patients do as well.

    Because I see this article are part of a larger picture of the distortions covered previously by the New York Times, I will list some of them:

    1.) people without insurance using expensive emergency rooms for routine care, due to the law that emergency rooms must treat all comers.

    2.) Doctors ordering unnecessary expensive tests based on their ownership or relationship to owners of diagnostic equipment.

    3.) Inability to get coverage if you are sick or have been sick,

    4.) Denial of coverage for "experimental procedures" that are not experimental,

    5.) Competition by nurse practitioners with doctors for patients,

    6.) Exponential growth of people who can't afford or get insurance,

    7.) Decreased competitiveness of U.S. industries who must compete against countries who provide their citizens with health care, while having to provide extremely expensive health care themselves,

    8.) Workplaces that cut health insurance benefits by employing people less than full-time,

    9.) Exponential growth in the cost of health care relative to overall inflation,

    10.) Increasing numbers of nosocomial injuries,

    11.) the decline of preventative and routine care,

    12.) insurers who would rather litigate than pay out claims,

    13.) fraudulent and abusive billing practices,

    14.) spouses who stay together or people who get married for the health insurance,

    15.) people who go abroad for cheaper, better treatments,

    16.) uninsured people charged more for the same services to subsidize the insurance companies' low rates,

    17.) uninsured people forced to cough up cash before each injection is administered,

    18.) HMO MBAs controlling doctors' practice of medicine

    ...the list continues ad infinitum.

    Any one of these distortions should be enough to get some reforms. The whole picture, however, is devastating.

  47. In response to Anne above, I would argue against the proposition that high salaries for nurses are a major contributor to runaway health care costs. Salaries for nurses will vary by region, specialty, and experience level, but the majority of nurses earn in the range of $40 - 60k per year, not $60-80k as she quoted. (http://www.allied-physicians.com... or http://www.payscale.com/research/US/Job=Registered_Nurse_(RN)/Salary). The nature of the work is emotionally and physically draining oftentimes with an unpredictable schedule. As well, nurses are often at the front line with sick patients and have occupational exposures to health risks that the average salaried non-health care worker does not. This is one reason why many hospitals struggle with a nursing shortage as there are too few students entering nursing school.

    As a physician, I think it is reasonable to question physician salaries. However, you cannot ignore the impact of rising medical debt on physicians in training. I agree with Anne that it can take just as long to complete a PhD. in biochemistry or history as it can to obtain an M.D. However, the funding pathways for these different training programs differ greatly. Unlike other graduate programs, there typically is no TA/fellowship support for medical school graduates with the exception of students in combined M.D./Ph.D. programs. As well, medical school graduates go through residencies lasting from 3 - 8 year before they are able to practice and begin earning an attending physician salary. In contrast, new law school graduates earn an associate's salary immediately out of law school.

    It's true that costs in medicine will have to come down, likely with a restructuring of the way that services are paid for (including physician salaries). However, if educational debt is not also reduced, then you will see an exodus of qualified new graduates from the medical field.

  48. I don't know where this idea that patients wait for months to see a doctor in socialized medical systems came from. I've been living in Sweden for three years now and I've never waited for more than a week to see a doctor. My experiences were similar when I lived in France.

  49. I think some commenters did not read an item that was repeated in the article: Medicare and Medicaid do not pay the full cost of hospital procedures and private insurance takes up the slack. Single-payer, government-monopoly insurance would eliminate the funding to take up the slack, resulting in delayed/denied access for all. Health-policy analyst John R. Graham calls this the "cost shift" and has long advocated that the government should reform the tax code to give health-care dollars to American families instead of American business and government programs. His analysis of the McCain health reform concluded that the average American family would have an increase in income of $9,00, plus a tax credit of $5,000 to buy guaranteed renewable health insurance portable from job-to-job and state-to-state. Too late for that I guess!

  50. In a country of 300 million people, universal health care is a pipe dream. People have to look out for themselves. People who have worked hard for their money should be able to keep it and pay for their own needs and not give it to the government to waste.

  51. In response to Anne above, Wow do you even know what you're talking about when it comes to the rationale behind wages for nurses and physicians???
    As a surgical nurse for the last 18 years in a Level I trauma center, I must be 100% on the ball, hit the ground running when I come to work. I must be completely accurate in regard to patient allergies,surgical counts, making sure the operative consent is signed (right patient for the right surgery on the right body part), making sure the whole surgical team does a mandatory Time Out before the surgeon makes the first incision, anticipating if the surgery has a great potential for blood loss and making sure blood products are on hand for that patient (not to mention the whole accurate checking in the blood thing with anesthesia before it is given to the patient).
    My job also requires me to go into several different
    specialties in 1 day of work. I may start the day with a surgical team doing a laproscopic appendix removal, then work with another surgical team that will do a fem-pop procedure, the on to the neuro team to clip a brain aneurysm, and then could end my day with a kidney transplant! I must be 100% accurate with patient and surgical care and ALSO know how to trouble shoot the very sensitive and technical equipment that can "go on the fritz" at any time during surgery then throw in a Code 4 and a maybe a trauma pt.
    I'm only giving my experience as an OR nurse but the other nurses I consult with from the Pre-OP to PACU, the ICU's and floors and clinics all work just as hard in striving for patient care excellence and are worth every cent of their salaries and then some.
    If you want to complain about salaries hands off hard working nurses and physicians, our salaries are a pittance compared to CEOs in corporate America and their boards, sports figures and celebrities.