The Reality of Managed "Care"

http://www.latimes.com/news/local/la...522,full.story

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

My wife worked in this industry. The truth is that many hospitals don't manage their own emergency rooms. The management is farmed out to "professional managed care companies" that intentionally keep them understaffed.
Our local one is like that. I now travel 45min to the next town to the next hospital when I am in need of emergency care and am much happier with the service, even though they do not have a trauma center. I have a "deal" with both of the local EMS services (they FULLY understand), they will take me to the other hospital.
The last time I was taken to the ER with cardiac problems, to their trauma center I was "forgotten" and sat unattended for three hours. Had I not stabilized on my own from what the ambulance professionals had done for me, I would be dead now.
Most emergency rooms and many of the staffs are a joke.
What is really sad, this did not phase me. My wife has told me as bad or worse, and her's was a brand new ER with state of the art facilities.
I hope there is a good Samaritan law in that area.

[Spexxvet]

And people say there's nothing broken with our system, that we have the best healthcare system in the world. Makes you wonder what it would be like now, if the Clinton Plan had been adopted in the early 90s.

Like I said, I choose to go to a non-managed ER. Ours has problems, it is better than an entire, nationwide, managed-care system that is FUBAR beyond belief. Which is what it would be if managed by the government.

[Sundae]

My Mum (gently) moaned that her last Bank Holiday was spent in A&E with my brother. Although he is a grown married man, he doesn't drive and his wife was at work when he cut himself badly and needed stitches. When I sympathised and asked how long they were there she said mournfully, "An hour and a half..."

Only 6 years ago when I was hit by a car I waited 7 hours to be seen the first time I attended - as walking wounded I should say. When the advice I was given (incorrectly) to walk as much as I could bear caused my leg to swell and blacken I went back and had over 8 hour wait.

Government managed healthcare is a very risky option. The above is to illustrate how ours is finally improving - in some areas - but we are not a good example of how to manage it. And that's after 50+ years. Some countries manage it very well, but I think their taxes are far higher than the average US citizen would accept. I wouldn't want to be without the NHS, but healthcare EATS money.

[Spexxvet]

Originally Posted by Sundae Girl

My Mum (gently) moaned that her last Bank Holiday was spent in A&E with my brother. Although he is a grown married man, he doesn't drive and his wife was at work when he cut himself badly and needed stitches. When I sympathised and asked how long they were there she said mournfully, "An hour and a half..."

Only 6 years ago when I was hit by a car I waited 7 hours to be seen the first time I attended - as walking wounded I should say. When the advice I was given (incorrectly) to walk as much as I could bear caused my leg to swell and blacken I went back and had over 8 hour wait.

We hear these kinds of stories, too, even with "private" healthcare.

Originally Posted by Sundae Girl

Government managed healthcare is a very risky option. The above is to illustrate how ours is finally improving - in some areas - but we are not a good example of how to manage it. And that's after 50+ years. Some countries manage it very well, but I think their taxes are far higher than the average US citizen would accept. I wouldn't want to be without the NHS, but healthcare EATS money.

Either you pay high taxes or you pay high healthcare costs or healthcare insurance premiums - does it really matter where the money goes?

[glatt]

Originally Posted by Spexxvet

Either you pay high taxes or you pay high healthcare costs or healthcare insurance premiums - does it really matter where the money goes?

I want the money I pay to go to the health care professional, not some office worker being paid to shuffle papers around on their desk in some insurance company in Hartford. (edit: or in DC)

[xoxoxoBruce]

My Canadian relatives are very unhappy with their health care system.

[wolf]

Speaking as someone who spends an unfortunate amount of my work day arguing with insurance companies, it's not care that's managed, it's cost.

Incidentally, ANY hospital can override the insurance company's decision regarding treatment for a patient.

I do it all the time.

The L.A. Times story above seems to document a pretty clear case of what's called an EMTALA violation. Even if she was seen there three times in three days, the hospital has an obligation to provide an evaluation and "necessary stabilizing treatment."

[wolf]

Originally Posted by Spexxvet

And people say there's nothing broken with our system, that we have the best healthcare system in the world. Makes you wonder what it would be like now, if the Clinton Plan had been adopted in the early 90s.

It would be hell.

The system is no where near as broken as Hillary would like you to believe.

[BigV]

Originally Posted by wolf

Speaking as someone who spends an unfortunate amount of my work day arguing with insurance companies, it's not care that's managed, it's cost.
--snip--

Good point, wolf, right on target.

Which brings up the next questions: Our current health care delivery system has profit as it's primary motivating factor. Witness the story above, wolf's testimonial and countless others like it. Profit can be a wonderful motivator, but in the absence of profit, there is a corresponding absence of motivation. No motivation, no health care, and you get stories like this one.

A government run system would, supposedly, run on the energy of different motivations, since it would not be profit; mandate, perhaps, or duty. We're all familiar with the performance of government run programs, and, to be honest, they run the gamut from well run to abysmal. **All** systems have their flaws.

I think the best plan (which will still have flaws and weaknesses) would be one where there were different, complementary motivations. Profit *and* legislation, for example. We live in a world where the best systems have complementary parts. Your body has muscles that work in opposition, and work well. Our own government has separate aspects that work individually to drive the whole forward.

The wisdom of the "All things in moderation" applies to our current health care delivery system as well. Profit only has the flaws we see today. Government only would have different blind spots. But a well crafted combination of the two would easily surpass the performance we enjoy/tolerate/suffer today.

[xoxoxoBruce]

Originally Posted by wolf

Speaking as someone who spends an unfortunate amount of my work day arguing with insurance companies, it's not care that's managed, it's cost.

Not entirely.
Man has a couple stents put in around his heart.
Ins Co calls the Doc and asks why the man was not put on X medication, which is to treat high blood pressure?
Doc says the man never had high blood pressure.
Ins Co says their records show people on X, do better after getting stents, therefore the man takes X or they won't pay for the stent operation.
That's managed care.

Exactly, my wife used to tell me many stories like that. Of course she used to tell them to screw-off "pay it or we won't carry you any longer".

[piercehawkeye45]

A single payer system is the best system but the problem is getting it to work. Other first world countries have gotten it to work (for the most part) and now it is our time too.