Posts Tagged Yankee
REAL Health care – in the trenches.
Posted by redlinedoc in Medicine, Universal HealthCare on October 12, 2010
I read Paul Romer’s The effect of Health Care Reform on others, a play on the vagaries of our dysfunctional healthcare system and putative illnesses of Mother Goose characters. I admit it (a guilty pleasure) I laughed. Then I reflected on the daily life in our Community Health Center, in Connecticut, located in poorest city of its size in the nation. The irony is just too much. We (nutmegers) are the wealthiest per captita state in the nation!
But- I digress.
A patient appears at our primary care clinic on Friday. Classic signs of cholecystitis (gall bladder attack). We hustle her by transport to the emergency room. Monday morning she’s BACK! At the emergency room, the nice physician gave her the name of several surgeons she could call to have her gall bladder fixed. None take her insurance.
An 82 year old lady lives in her car. Bernie (this is too good) Madeoff with the retirement funding. She can’t afford the taxes. She lives in her car.
A patient comes for diabetic medication, gets a glucometer (to measure the sugar), strips (to use in the machine) but the company doesn’t pay for the lancets to draw the blood from the finger. Urmmmmmm.
A patient drops a heavy object on her foot. She goes (of course) to the emergency room, diagnosed with a fracture but referred to the clinic so that she can have a cast put on. She is uninsured. I might add this over a five day period.
A patient comes with a kidney infection. No problem. Antibiotics. Oh – we don’t cover THAT antibiotic.
A patient, finally stabilized on psychiatric medication shows up for a refill. UhOh. You need a prior authorization. What? This patient has been taking this for a year. No matter. We need to consider the forms (they say) to make sure the patient is getting the best medication. Insurance oversight.
A letter arrived the other day from one of the major drug companies letting us know that they are going to be direct advertising to consumers for certain drugs so that they (the consumers) will know what best to ask for.
A young boy comes having (as children are wont to do) leaped off a picnic table and stepped on some glass. The local ER (no problem) sees the child, recognizes that there is glass ‘somewhere’ in the wound, sews up the wound, and sends the parents off in search of a surgeon who will see them on state insurance. Two days later. They arrive at our clinic looking for guidance. We are fortunate to have some favors to call in. He gets care.
Lest you think out there that is is a factor of my particular city, its not. As I speak with colleagues around the country, this is the rule not the exception. As insurers tighten the profit noose, looking to their bottom lines not yours, this is a frightening and every more common occurrence. As hospital emergency room expenses rise the quest to slide more care out to the community increases. Its shoddy. Its terrible. Its not good medicine, hell its not good care in the third world. It is however our current system.
Healthcare reform may change some of this but we are only at a beginning. I praise Paul for bringing a bit of humour to what is, for me, a very black, dark sad subject.
Just want to dip my beak …..
Posted by redlinedoc in Universal HealthCare on July 9, 2009
Strange you say. Governor Rell (I’m a yankee) just vetoed Sustinet. Sustinet? Sustinet was a plan to insure every citizen in Connecticut starting with the most vulnerable, including state employees and rolling in small businesses and non-profits to make a large coverage group competing with private insurance companies for benefits and coverages. No one would be forced to enter Sustinet (other than the current state medicaid/safetynet and employees) and it would have to stand on its own merit. It was broadly supported and overwhelmingly voted in both senate and house chambers in the state.
Why veto it? Governor Rell seems to have forgotten some history here. In the 1700′s the citizens of Connecticut recognizing that they didn’t want to replicate the Dickensian debtor prisons of England, established havens for those to sick or unable to work; town farms. The town farms were by no means a happy haven but residents there worked on the farm as they could, helped to be self sustaining, had some funding from the Selectman’s budget in the town and had food and clothings and housing and medical care. This, from the compassionate citizens of Connecticut. Fast forward. When larger government programs superseded the Town Farm System, the program became State Aid to General Assistance (SAGA) one of the safety net programs here in Connecticut.
No one wants to see SAGA patients. Getting referrals from primary care (I work in an FQHC) to tertiary or upper level care is nearly impossible. SAGA pays poorly for advanced care and since its coverage mostly (a devilish word) is for poor folk; Who cares. The devil in the mostly is that folks who have worked all their lives but had some dreadful disease may find themselves on SAGA. Folks who have a sickness in the family, monies wiped out by the vagaries of the current ‘he who has the gold makes the rules insurance system’ may find themselves on SAGA. The list goes on. The poor line up and are anointed with the least of the least.
Sustinet looks in ways to fix this, to level the playing field by making no distinction between rich and poor by allowing all access to health care. Bah Humbug they should pull up their bootstraps, you say. WHO will pull up the bootstraps. My 24 year old daughter recently fell into the hole between parental coverage and no coverage from work. Luckily she had her health. Needed medications, however, consumed a fair bite of her savings.
Whats with the beak dipping? Governor Rell is a leftover from the Rowland administration here in Connecticut. She distanced herself from John Rowland (who spent some time waiting for a better paying government job — quel suprise!). Republican administrations believe that business will make it all perfect. That the shareholder marketplace will bring equity and equanimity to the medical system. Each of the stakeholders will ‘dip his beak’ only taking a fair share of the monies, pleasing the boards and CEO’s. I think this more akin to crows feasting at the carcass. There isn’t much money and pleasing the shareholders never improved wellness. There is a finite supply of monies and pleasing the CEO’s and padding their golden parachutes never helped struggling parents with sick children. Dipping their beaks, sucking up the juice.
Ahh for sure, all that will be left of Sustinet will be the bones, no juice, no meat, no insurance, no coverage. And the fat cats will be daubing their beaks with linen napkins.