John Goodman's statement last week that all those living near an emergency room already have insurance is as ignorant, cruel and wrong as any idea I have heard from anyone, much less a so called expert. I am a physician who has been involved in medicine for the past fifty years. I have seen Medicare evolve and have seen the present insurance system ruin the application of modern medicine. Instead of doing good, it has turned medicine into a profit center for business types and lawyers and over the years has left physicians wondering what happened to their control of medicine.
These days it is proper to call those I have always called patients their new name: CLIENTS. Another way to insert more distance between patients and physicians and show that medicine is just another business. It is not another business to me and most physicians. I remember the days when hospital administrators and physicians were on the same side. Now administrators are called CEOs and you know what that means. Medical education takes too long and consumes too much for anyone to try it for money alone. Most physicians do pretty well but work 50-100 hours per week. The reward in medicine comes from the patients and the science. It is a calling and a way of life, not a job. I truly resent some novice running for president without understanding of the basics or the problem thinking he or his trained monkey is an expert.
1. The US is at the bottom of industrialized countries in health care. Several numbers have been published but lower than number 40 is not far wrong. It wasn't this way before greedy people saw dollar signs. It is measured by comparing longevity, neonatal mortality, access to care, chronic illness and other parameters. America does however, lead in one area: cost. Politicians and business types like to criticize for one reason or another countries that include Britain, Canada, France and Scandinavian countries. They all do much better than we at a much lower cost. This includes the UK with its socialized program who provides better care at near half the cost. This is serious stuff and the bottom line figures are important.
3. Emergency rooms cannot do preventative health care such as blood pressure regulation that takes multiple visits and medication changes. End results of hypertension produce some of the most expensive parts of crisis care. There is high morbidity and death and these usually can be easily controlled. It is criminal to allow people to suffer these consequenses because even though they work hard they cannot afford medicine and care. Screening modalities such as mammograms and colonoscopies also are not available through emergency rooms. I am on the recovering end of treatment of cancer of the colon because I had access to colonoscopy and this is not available through emergency rooms. Only after a patient bleeds out or obstructs does this become an emergency and then it is too late and very expensive not to mention the suffering for the patient (non-client) and family.
4. John Goodman and Sen. McCain are clearly in the elite class where health care and drugs are not a problem,with or without insurance. We have a president who has made the same asanine statement about emergency rooms and has whined on and on about so called socialized medicine, but both he and the vice president have no problem accepting true socialized medicine at The US naval Medical Center or Walter Reed. It is only the middle class and poor that they want to protect from Universal medicine. In truth the main sources of socialized medicine in the US are the military and the VA systems. Medicare and State run health care programs for citizens are like the provincial system in Canada where the care is provided by private physicians and hospitals with cost limits for charges.
6. The private payers of health care have an overhead of between 20% and 30%. Medicare is run on a 3% overhead. The other 27% goes to shareholders and bigwigs that do nothing but skim off the top. It has been said by McCain and Bush as well as other Republicans that you don't want a bureaucrat making healthcare decisions. Where have these fools been for these last few decades? Private PPOs, HMOs and most of this alphabet soup have numerous restrictions of physician and hospitals. You must get clearance and approval and then some try to slow payment to get the float by making requirements for information, denial and other stumbling blocks. All these require physician time and large insurance departments to handle the insurance forms from thousands of providers all with different payments and requirements. It is a nightmare all to drain 30% of your healthcare dollar without providing even one ounce of care to you.
Let me tell you of my recent cancer experience using Medicare and AARP for my recent colon cancer treatment. I have no idea of the total cost but I have not had to deal with any bureaucrat; payments have been made on time and I get a statement of what has been paid. I have had no problems. I know my physicians get less that charged but they have the right to drop out. The smoothness of the system, the prompt payments, the lack of hassles and knowing the system make it worth while. It is pretty obvious why the Republicans like the present system that puts insurance companies first at the expense of all of us and gives the lawmakers a very nice return. Remember that 30% would go a long way to paying for those left out of the system now.