The following exchange is from Dialogue Group 7, Thread 17.

1. Justice and the Economics of terminal illness
Mon, Dec 21, 1998 - 5:02 PM/EST
dorothy

How about changing the topic? Does anyone see a conflict of interest between HMO's for profit and holding down the cost of treatments? The bottom line is profit but the sick need treatment. Is this an ethical problem? I am working on a story about the shortage of morphine for cancer patients in India, which by the way, produces 80% of the world's supply of opium, the raw material from which morphine is one derivative. In the good old USA we have the same problem only we are not India. Our problem here is money and lack of compassion. In a very large study covering 3 years researchers found that when it comes to treating cancer in the very old Blacks and the Elderly suffer the most.Ponder this. Am I my parents' keeper? If not who is.
Dorothy

2. HMO?
Mon, Dec 21, 1998 - 5:16 PM/EST
Jazzy34

I was a Consultant for a Health Systems Agency. The mandate was to hold down costs by having a committe of health professionals & laymen decide which facility would be able to obtain expensive equipment to be used by the whole community. (My fondest memory was of being on the roofs of hospitals, wearing a hard hat and being the one to present the argument for which hospital would have the medical helicopter- or "Dash for Cash, as we called it- based at its facility)

The Agencies were scrapped all across the country mainly because of greed & bribery.

It was at this time that I became familiar with HMO's. I felt that they would eventually be run on a profit only basis and that patient care would suffer as a result. I refused to sign up with the HMO when I was working, preferring to pay more for the insurance we had previously. I think recent events have proved that my warnings (covering over 15 years) were correct.

IMO, health care (or the lack of it) should be a major issue in the coming Congressional session.

3. Attitude adjustment would help
Tue, Dec 22, 1998 - 1:25 AM/EST
Kevin

My wife went to Tulane University to get her Masters in Social Work. I was amazed when she would come home in the evenings and tell me about her class discussions. These students were attempting to get degrees in a compassionate discipline, one based on advocating for others in need and in need of external funding across the board. Yet the bulk of the young social workers held beliefs firmly against government funding of social programs, the rights of the consumer to privacy protection and services and endorsed mainly therapeutic models based on controlled decision-making rather than empowerment.

Is the profession doomed? I hope not. More likely this particular sampling of students came to the program with the idea that they would become private therapists for middle- and upper-class clients. They envision a private practice where hourly rates are always high, bills are always paid, and the problems -- while important and valid -- are not the same degree of seriousness as those found in subsidized clinics around our nation.

I share this as my only explanation for the decline in medical practice since the Marcus Welby generation. It is not the high costs of care and medicine that frightens me most, nor the lack of foresight our culture has in prevention and planning. It is the attitude that reduces clients to chores on the way to Chicago Hope's liposuction wing.

My grandmother, who recently died, spent the last year of her life mostly immobile from swelling and weakened by a nine-decade-old heart. One particularly scary visit ended with her going to a Rockford hospital, which was staffed mostly by young medical students doing their final E/R commitment before becoming specialists someplace else. I was livid at the way the doctors treated her, talking past her to my mother (it was my grandmother's heart that was the problem, not her ears or mind) and sneering in annoyance whenever she had the audacity to try to explain what hurt. I understand that in an emergency room, patients must be prioritized. An elderly woman on her last legs isn't as important, apparently, as the softball slugger's broken leg two beds down the way or the couple dozen other sad stories descending on the E/R at the same moment. Patronizing, however, is not the same as prioritizing.

By the time she was finally admitted to treat her dehydration, my grandmother had also been asked at least three times for the same basic information. Information on medication had been passed along from her nursing home, taken by the admitting nurse and then locked in some super-secret location that apparently no one in the rest of the facility had access to (or maybe they it was just easier to pester my grandmother than make a few internal calls and copies).

I can't wait to see "Patch Adams," which chronicles the aggravation one doctor caused his colleagues by trying to use humor to treat his patients like human beings. Maybe if enough would-be doctors see the movie, life may imitate art.

5. HMO
Tue, Dec 22, 1998 - 10:42 AM/EST
operabuff

Hi, guys, as a nurse I'm at the front line here! It wasn't so long ago that some insurance plans required discharge from the hospital 24 hours after the birth of a baby. Our postpartum unit used to get harrassing calls from the insurer: has she left yet, why not, why isn't her chart in medical records yet, it's been 24 hours! We've had a number of re=admissions of very sick mothers and babies, even though the stay has been extended to 48 hours, thanks to legislation. I've heard doctors arguing on the phone with an HMO clerk that the patient requires IV antibiotics, and the HMO insists on oral treatment. They weren't even arguing about discharge: IV treatment can be done at home by a visiting nurse! A patient with septicemia needs IV antibiotics, but her HMO would not pay for the home care.

We've also had cases of babies readmitted because of dehydration due to inadequate breastfeeding. The problem, of course, wasn't the breastfeeding, it was that the Mom and Baby didn't have the time in the hospital to learn how to do it right.
Women tend to get the poorest treatment from health care.It wasn't so long ago that insurance companies were calling for mastectomies to be done on an outpatient basis. It's truly frightening.

6. Women
Wed, Dec 23, 1998 - 9:41 AM/EST
Jazzy34

I recall years ago doctors on the golf course betting on who could do the fastest hysterectomy!

I have been lucky enough to stay away from any medical facilities for over 15 years.
I retired with 600+ of sick leave after just six years on the job.

I eat garlic, drink lots of juice, etc. Just want to stay OUT of the system

7. Healthcare
Wed, Dec 23, 1998 - 2:09 PM/EST
Maggiheart

Crazy, crazy world. Let's minimize costs by kicking patients out without the necessary time or treatment so that what, they'll come back again worse needing more expensive treatment??? Yeah, right, that makes it all better. Stupid, that's all I've got to say. Utterly stupid.

But how do you fix it?

8. What do the players want?
Wed, Dec 23, 1998 - 3:59 PM/EST
Kevin

Maybe the solutions are in looking at the players involved ...

9. The Insurance Companies
Wed, Dec 23, 1998 - 4:00 PM/EST
Kevin

The Insurance Companies -- Though "The Rainmaker" made me feel good by the end of the flick, I don't believe that kind of corruption is the rule, either in day-to-day operation or in intention. It does happen, though, as evidenced by the numerous testimonials about the ills of a system that's supposed to help cure ills. What do Insurance Companies want? Steady profit, first and foremost. That can be read two ways, as common-sense business or as greedy. Giving Insurance Companies the benefit of the doubt, let's just say that their goal is to make a sound business. That means being able to amply offset losses with the gains through premium payments. It also means that, as costs of losses go up, either the patient payments increase or the company starts fighting claims, or both.

10. The Medical professionals
Wed, Dec 23, 1998 - 4:08 PM/EST
Kevin

The Doctors, et all -- Medical professionals run the spectrum from altruistic healers to greedy opportunists, with most falling somewhere firmly in the middle. It may be idealistic in this era of sports physicians, plastic surgery and Viagra to believe that every med student is paying thousands of dollars and years of their lives in order to help needy patients. The power to heal is a big draw, certainly, and there may be great personal satisfaction gained by seeing a patient recover. But it's also the combination of prestige and financial security that brings people to Columbia to study. Doctors want and deserve to be paid for their skills and training, just like any other professions. They seek problems that will challenge them amidst all of the routine procedures and checkups. They want an efficient office to permit them to see as many paying customers as possible, and they want protection from their own mistakes. (Even healers are human.)

11. The Pharmaceutical Industry
Wed, Dec 23, 1998 - 4:08 PM/EST
Kevin

The Pharmaceutical Industry -- They are responsible for pushing the envelope on medical research, investing millions of dollars into new drugs and procedures that will save lives or alleviate suffering (physical and mental). The industry does appear to have a problem differentiating greater good from profit centers. When the business of research outweighs the benefits of research, I think something needs to be done to correct that thinking. These companies have to stay in business to be able to push the envelope and better modern medicine, but can't some of the profit be spent to meet the basic needs of the populous? Can't the "glamor" drugs and procedures be the money makers?

12. The Patients
Wed, Dec 23, 1998 - 4:09 PM/EST
Kevin

The Patients -- Aside from assurance that maintaining life won't cost the equivalent in dollars, I think patients just want to feel that the system isn't out to "get them." There are lobbyists for the Pharmaceutical and Insurance companies, and advocate associations for medical professionals, but there doesn't seem to be anyone looking out for the consumer. That SHOULD be the responsibility of our legislators, but they seem more intent these days to respond to the professional lobbies instead.

13. The solutions?
Wed, Dec 23, 1998 - 4:11 PM/EST
Kevin

Part of the key to this puzzle seems to reside in the costs. There doesn't appear to be much differentiation between basic needs and voluntary procedures. Whatever system we create should regulate -- heavily -- to provide the basic needs at little or no cost and allow the businesses to thrive on the voluntary medicine.

MOSTLY, however, it is in our societal aversion to prevention that costs us most. Ask any stock broker whether he/she would prefer to buy high or low, and the answer is always low. Ask any legistlator if they want to pay what seems like a lot of money today or pay a lot more money down the road, and they invevitably say they don't want to pay any money, if they can help it (a choice that inherently leads to option B). If insurance companies would spend their money on promoting preventative care and pay for all of those procedures, their risk would lessen tremendously and they would be in a position to approve more costly claims through attrition.

(Sorry ... my two cents appears to have compounded by the minute into something approaching a dollar.)

14. Women & Healthcare
Wed, Dec 23, 1998 - 5:31 PM/EST
Felix

Jazzy and Operabuff,

I would be interested in hearing more about comments with regard to differential treatment with regard to women & healthcare.

At the most mundane level, it is certainly the case that if a woman raises her voice to complain about something, she is normally told it can't be done. On top of that, she's labeled a Well You Know What I Mean. That could apply to more expensive medication to better inpatient treatment, etc.

I wonder how proactive some of these female patients are about demanding better standards and/or pursuing action against their insurance providers/hospitals in the event of negligence which can be demonstrated and verified.

There's a whole other discussion we can start about how much money is devoted to women's healthcare concerns, some of which have been receiving some attention lately, such as breast cancer and heart disease, as compared to men's healthcare concerns like prostate cancer, etc.

Women don't have the same bodies as men. They should have specialized health care centers with specially trained staff, particularly to deal with menopausal clients. In a perfect World, but pertinent to Kevin's comments, there is probably a market for it.

Best,
Felix