Saturday, January 24, 2009

Health for the Few, Health for the Masses

The term "getting healthy" is a great way to provide a sense of purpose. The term "getting into recovery" is misleading. It leads the person to believe that s/he had a sense of health at one point, and many people in recovery only are familiar with their illness, their weight, their injury, their addictions. There isn't a sense of control of health. Yet, there IS a sense of loss, and that leads people in "recovery" to discover that they are only recovering feelings that lead them back to the pain they are supposed to be healing from in the first place.

Many of my friends are in different class struggles at the moment, and looking to find a place of "getting healthy". In the last five years, doctors in the area we live are leaving the world of HMO's and PPO's and opting for Concierge Health Care. When I was a child, we used to have a family doctor. He used to live in a house, worked out of the bottom floor, and we would visit him once every month for my allergy shots.

The same procedure under an HMO entails a wait of 40-45 days for an appointment, and an RN giving injections. Health isn't discussed. Back then, we'd pay in advance, for ten appointments, at $10 an appointment, which covered the cost of the shot. The doctor also noted changes in my skin, hair, eyes, and would take my temperature, and blood pressure. It was often far too low, in both, and he would schedule a regular appointment to ensure my asthma hadn't progressed.

The Concierge Service Doctors are similar in that they are supposed to treat you with dignity, as a preferred patient, as someone who deserves to be seen. The difference is that as a child, my parents paid a fee to a man who cared about my welfare, as the doctor who served to help my mother give birth, and who saw me from an infant to a pre-teen. The Concierge Service allows a doctor to put you on a preferred list, for a very high fee, and it only matters to him for a year. After that, you either need to give another enormous fee, (which doesn't include the cost of the medications, appointment, or incidental hospital care), or you are shuffled back into the system as a standard patient. You simply aren't a concern. The bottom line is the purpose of the profession, just as it it is for the HMO.

People have been rumbling for years that if we had a Universal Health Care System we would have and end to "have-have not's" method of care. Several of my friends were treated to the health systems in South America, Canada, and Europe. I've heard good and bad on both sides, and the bad stems from greed which still exists regardless of who is paying. A doctor, specialist, or hospital will gladly take cash over government vouchers, and will gladly put that cash paying patient ahead of the one who is assisted by the state. However, many countries have a check and balances system which prevents this, allowing Hospital Patient Advocates, or Ombudsmen serve as a legal proxy to the patient. The hospital answers to the advocate, and therefore the state, before answering to the patient.

For those who had bad health their whole lives, the idea that a Universal Health System will end that nightmare is just not realistic. It's a system that puts patients into Recovery, but not in promoting the future good health. It allows patients to feel trapped by their illnesses. This system is supposed to do much to help preventative care, and to help handle emergency care, but for long-term illnesses, there isn't a lot to be done except lead a patient to being "stable". Cancer patients, chronic pain patients, genetic disorder patients learn to maintain themselves, but it's rare that this system will cure or treat someone who would just take up more financial liability than someone who simply needs a flu shot.

Again, my years in the Veterans Health care system has been a constant struggle to get doctors to pay attention to symptoms rather than tests. These doctors are people who have no financial or educational gain to provide me with anything differently. If the system were run through a medical testing facility, I may have a fighting chance to know what it's like not being in a constant state of "recovery". Instead, I would be on the road to TRUE health, and I would learn what it would mean to have a normal, or at least as close to normal, state of being.

My husband has private insurance. I have a Medicare Program in addition to my Veterans because of disability. He and I receive similar care. My deductible is set by the agreement made between the insurer and Medicare. His policy is determined by the previous people on the plan, and the likelihood of future health based on past documented care. My disability payment is garnished to pay for my program. His employer set up an agreed amount he would pay for his. The wait times I experience are greater, and I do have to meet "criteria set by Medicare" before I am prescribed medication or procedures. That is the key difference. But, he is as likely to have the same surgeons, the same prescriptions, the same specialists as I do because they are approved by Medicare. In fact, he finds that he needs approval for prescriptions that aren't used often by people in his program, and that creates more issues for him.

If there were a Universal Health Care system set into place that allowed patients to elect a governmental program, or private program, it is likely that due the impact on the finances of small business owners, and larger corporate retirement programs, many people will end up in the government program. The cost of care privately has become prohibitive, and even substantially effects hiring policies of companies that are understaffed.

So what happens to the Concierge doctors? What happens to the finances of the hospitals, surgeons and specialists who rely on private paying citizens for their check? Some have said that doctors would receive better and free education to be part of the program, cutting millions of dollars every year from the Student Loans. Others suggest that the scientific sector would benefit because these doctors would have more reason to seek out private jobs within medical research. I don't know if either scenario is true, but it is certainly a step forward. Some doctors are working to keep the Concierge method in place, and to make a cultural difference between those who "have" government care and those who have Concierge care. The rich are expected to support the rich.

Today's Questions- If you are currently a patient in a governmental health care program, do you feel you are getting less care than someone in the private sector? If you are a patient with Concierge care are you concerned about the possible move towards Universal Health Care? If you are somewhere in between, do you find it hard to get basic or specialist care?


  1. There are sites, such as which run independently from drug companies. They're primarily overseas, and have the patient fill out pages of forms, including test results. The more complete information you have, the more complete information you'll get back. They do a free version, and of course, a fee version.

    The tv show House, MD, highlighted the biggest increase of sales that are online right now- the Doctor's who run "Consultations Online". It's a crap shoot there. Some doctors charge upwards of $1000 or more, others are in the $45 or so range- for a single page of information, based again, on how much information you give them.

    I'm reviewing a few sites that have cross-check database for symptoms, but a majority of these are also drug companies in disguise as Health Providers- and use the information to sell you their products. I'm hoping that the ones in Europe and South America are different than those I find in the UK, US, and Canada- primary care physicians posting their findings on specific diseases, and are partnered with and other database sites. They tend to provide information that's already given for free using Symptom Checker, but charge for the service, claiming "personalized results".

    Again, online- the information whether free, or greatly overpriced- is completely dependent upon the patient's input information. If you check out the MyHealthEVet sites, you will see that the Veterans have to go through a training session before they can view records online. But, this particular format is better than having the patient try to remember each and every test, each and every issue. Still, the limitation is that the information is only that which pertains to the care given by the VA.

    Finally, there are more sites like Google Health, and drug advocacy program sites, that show side effects, interactions, and other issues relating to the mixing of prescriptions, over the counter, and even supplements.

    I'll be posting the reviews of sites in an upcoming blog..thanks so much for your question!


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