entitlement to Free health care vs Paying for Health care

May 23, 2008

I have remained silent about entitlement up to now. And I don't have a dog

in this fight. I see both sides of the coin.

What I want to talk about is the BIG PICTURE of healthcare, and that's

preventive healthcare.

I'm reading a great book by a physician, Dr. Atul Gawande, a general surgeon

in Boston. Wherein he discusses the fight against devastating diseases such

as polio, smallpox, measles, and so forth.

We have obliterated smallpox; we are making progress against polio, but the

logistics of immunization are mind boggling, and it will be a miracle if we

ever wipe it out. Then there is measles, and a never-ending list of other

potential diseases that could wipe us out.

Now, what does this have to do with rights to health care? This: when we

deny healthcare to the least able to afford it, they will not receive

healthcare, and they will get sick, transmit their infections to the rest of us,

and

we will all suffer.

The illegal immigrant problem is immense here in Arizona where I live. The

effects on the trauma care system can be devastating, as in when, as recently

happened, ONE VEHICLE transporting 60 illegal immigrants crashed and killed 4,

injured 40, and tied up the EMS and Air Medical resources of two counties for

hours, saturated the hospitals, and none of the patients were insured or even

citizens of the US.

Potentially worse is those who enter the US from 3rd world countries where

tuberculosis is rampant. These folks are coming here in droves, and they are

often undiagnosed infective TB patients. Goodness knows what else they bring

here.

So we deny them access to healthcare because they can't pay for it. How

does that help us?

They end up as phantom disease vectors. They end up in jails, prisons, and

living in places where 20 people share one small house, infecting others as

they go. They find work in restaurants, hotels, construction, and so forth.

They are everywhere.

I hate to remind you of the lurking viruses and MRSAs and VMEs out there that

can be spread by those without healthcare.

So what should we do?

I frankly don't know.

Our current system does not work.

Who makes the money from our system of healthcare? Think about that.

If you think it's physicians, you're wrong. Only a few physicians get rich

these days. The Lasik folks, radiologists, some high powered surgeons, make

a lot of money, but a med school grad with a residency in family practice and

board certification will exit medical school owing anywhere from 1/4 to 1/2 a

million dollars, and they won't make anything like the salary that a WalMart

store manager makes. It will take them 10 years to break even.

But the President of Blue Cross Blue Shield will make multiple millions of

dollars. And he will improve his income by limiting the payments his company

makes to those who deserve the money--the healthcare providers.

We spend too much money on healthcare, but only because our spent dollars go

to the wrong people.

Will we ever correct this? Probably not. Not as long as politicians

exist.

GG

>

> So what happened to the day when health care wasn't FREE?Â My grandfather

> told me of the days when you paid what you could.Â Many times it would be

> bartered orÂ payed out.Â My grandfather told me of a time he had to have

stitches

> when he was 18. To pay for it he painted the halls.Â To get the paint he had

to

> do labor for the hardware store.Â Â Now, we think the government has to pay

> for our health care and we don't pay a penny.Â That's why Dr. Bledsoe, and

> others see patients who feelÂ entilted or won't do what they need to, to take

> care of themselves.Â If you make a patient pay for his servicesÂ they are

more

> likely to value them.Â If you they don't have to pay they aren't going to

value

> it.Â So I don't believe everyone is entitled to all health care.Â Only

> health care they are willing to pay for.Â UnwillingÂ to pay for it.Â They

don't

> need it.Â

> Want to make the health care better.Â Make people pay for it. Bring the

> price to something more inline of what we do.Â Then eliminate insurance

except

> for major instances.

> but that is just my 2cents worth.

> Â Tom & Marsha LeNeveu

> Paramedic, Future RN; & RN

> Fort Worth Texas

> Email: TomMarshaLeNeveu@TomMarshaLTom

> http://www.emstock.http

>

> RE: Councilman Proposes Payment Up Front

> BeforeAmbulance Ride

>

> Dr.Bledsoe: Healthcare is a right,our founding fathers put this in writing,

> in at least the Bill Of Rights and other amendments to our constititution

> .State government has followed too,with amendments specifically outlining the

> protection of public health.What I see here again is an issue known as

> walletectomy. We are concerned about the money.Can our patient pay? then he

deserves

> a ride to the hospital. We are the most afflluent county on earth right

> now.We have a sizeable and shameful portion of our population uninsured and

unable

> to access health care. We do not need to further ration healthcare. I find

> it shameful that we cannot endeavor to take care of our citizens better,and my

> medics tell me they are trying to help Iraqis get a system going.They have

> the right idea,take care of your people,now that Saddam is gone. I find it

> shameful in our country that we decides who need s healthcare based on a

> walletectomy. I don't like it when the dog and cat

> hospitals in Mexico do

> this and find it socially,and morally acceptable.WE Americans for one

> reason,we beleive in fair play and everybody should have access to health

care.This

> is what sets us apart from others on this planet who don't with few

> exceptions(Canada and Europe)

> Respectfully, Rabbiems. P.s I am now a retired army medic who has seen

> combat since Viet nam and its a touchy issue especially for Vets.

>

> " Bledsoe, DO " <bbledsoe@earthlink . net> wrote:

> It all comes down to:

>

> Is health care a right or a privilege?

>

> In the United States, it is a privilege. But, through unfunded mandates

> (OBRA, COBRA, EMTALA) the government gives people de facto rights to

> emergency health care and EMS. By making EMTALA comprehensive (very specific

> definition of stabilization) , the federal government makes EMS systems,

> hospitals and physicians give free care or be sanctioned. Then, the

> government pays less than it costs for people to operate a hospital or

> medical practice. I actually sat in on a meeting where the discussion

> centered around giving every Medicare patient who needed cataract surgery

> $100 and send them to Dallas because we were losing $260.00 per cataract

> surgery we were doing (90% Medicare). It is the typical government way of

> avoiding the pressing issue and fixing the system with a case of Band-aids.

> I am not some conspiracy geek--just call it as I see it. Given the way the

> US operates, a national health care system would be a cross between the

> Internal Revenue Service the United States Postal service.

>

> And people wonder why boutique hospitals and freestanding surgery centers

> and freestanding emergency departments are going up everywhere. You don't

> accept Medicare and then you don't have to take call!! You can turn away

> who you want. Before long, the only hospitals taking care of charity hits

> will be teaching and public hospitals. Money follows the surgeons and

> surgeons are leaving hospitals in droves for freestanding centers. I had a

> call from a recruiter today who is looking for emergency doctors to staff

> freestanding surgery centers after hours. They pay as much as an average

> emergency department and report that you will rarely, if ever, see a

> patient. They just need a doctor in house for medical legal reasons.

>

> BEB

>

May 24, 2008

In a message dated 05/23/2008 12:24:00 Central Daylight Time,

rick.moore@... writes:

I dare you find a physician willing to provide services on a barter

system or a hardware store willing to exchange product for labor for

that matter. If you asked someone today to paint the halls in exchange

for suturing a laceration that would violate their government given

civil rights and heaven forbid it be someone of color who would involve

the ACLU, etc, etc.

REM

the problem being that the IRS is watching most docs very closely now for

just this type of under the table exchange...and when they catch the doc, they

are insisting that the doc pays taxes on the full billed amount as if the

entire amount was collected in cash...when I was in clinical practice, we

occasionally accepted produce, etc, for payment on cases (don't ever remember

being

paid in live chickens, but did get a couple of dozen eggs one time).

That being said, there are a number of (non union) hospitals which have

arranged for patients/families to pay off medical costs by contributing

time/effort/labor/etc to the hospital. One that I heard of a couple of years

ago cut a

deal with a local landscaping company...the landscapers would keep the

hospital grounds up and in return, the workers got a significant discount on

medical care...as in billed at Medicare rates for copays rather than at the

full

'cash price' rates they would otherwise have had to pay.

another thing to consider: if a private doc does pro bono or other unpaid

charitable medical care, the only thing s/he can take off of his taxes are the

costs of the physical supplies involved...can't even take a deduction for any

extra office expenses involved.

And while lawyers bill an hourly rate for telephone consultations, and

expect to get paid for those minutes (and usually bill in 10 minute blocks even

for a 3 minute phone call), it's almost impossible for a doc to get reimbursed

for a 30 minute complex telephone consultation required to set up a patient

for further care...

ck

S. Krin, DO FAAFP

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May 24, 2008

Gene: Bravo. We in then EMS portion need to do our bit and be advocates for

Emergency patient care,as well as hospital and preventive care. Society is judge

by how we take care of those who have the least among us and we are doing a poor

job in the most affluent country. Regards,Rabbiems.

RE: Councilman Proposes Payment Up Front