Aces High Bulletin Board
General Forums => The O' Club => Topic started by: medicboy on October 15, 2004, 01:55:13 PM
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I have come to the belief in the last few years that there will be a complete and total failure of the emergency health care system sometime in the next 10 years. Unless there is a major change in the way the medicare system is run. There are all ready some ambulance companies going out of buisness and even some hospitals looking for a loophole that will allow them to dump the ER side of buisness and just stay in Med-surg, and ICU.
Just an observation.
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Medicboy
What are the problems that are causing this. Why are emergancy rooms such a problem?
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We are losing mergency rooms at a rapid rate. I think it will be closer to 3-4 years.
The problems include:
People with no money or insurance who use the ER as a clinic.
Liability Insurance premiums.
Refusal of medical students to work in ERs for various reasons.
On our local news today, they cited a statistic for uninsured residents of Travis county: 25%. I have nothing to back this up with but my personal experience, but of those 25%, I would guess that 15-20% are illegal aliens.
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People with no money or insurance who use the ER as a clinic
This is a huge problem in Arizona. The many illegals here do not have health insurance so every time one of them gets a runny nose or a hangnail, they go to the ER since our ER's cannot turn people away as regular doctors can.
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Back in 1993 or 94 the panel that determines the financial layout of medicare (called HCFA "hic-fa") decided that emergency medicine and paramedics specificaly cost medicare too much money and came up with a plan to systematicaly eliminate medics from moderen health care. This plan was put into operation in 1999 and has been impliminted in stages. Each year medicare has "adjusted" the payment schedule for ambulance support and emergency payment. Of course this adjustment has gone down every year so that now we only get about 20% of what is billed, where it used to be close to 40%. Medicare makes up about 60-70% of most ambulances total income, so that 70% was just cut to 35%. Now most major insurances are following suit and cutting payments. During this metting of the HCFA in the early 90's the director (some lady and I dont remember her name) actualy said something to ther affect of: Paramedics are too expensive, people that 20 years ago would have never made it to the hospital alive (thus costing them almost nothing) are now arriving in ER's alive and spending weeks in ICU, running up hundreds of thousands of dollars worth of bills. We have to find a way to get rid of paramedics.
As far as air ambulances go you use to see the hospital based helicopter programs flying all the latest aircraft. Not any more, due to changes in the part a, part b medicare almost 80% of reimbersiment for hospital based aircraft was cut out. Now they are either flying aircraft like the EC-120 or the AS 350-b2/b3. Cheaper single engine aircraft. Most privet air ambulances (like the one I worked for in Cali) already flew these single engine birds.
Cost of insurance, maint, payroll have done nothing but go up, gross income has been cut by about 1/4-1/3 in recent years, just dont think most of these privet companies can do this much longer. (Most hospitals and ambulances are privetly owned.)
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What Steve said.
I had a pretty thorough food poisoning the morning after a party, and while trying to stay conscious and not throw up too much waiting in line at the Tempe St Luke's ER, all I remember is mexicans telling jokes and a few of them looking a little tired taking their time passing ahead of me.
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Medicboy, don't take this the wrong way.
I think a lot of problems extend from hospitals charging waaaaaay too much money to the people that have insurance and can pay their way. Look at doctors wages, nurse wages and even the wages of ambulance/emergency responders.
Doctors in all truth could cut their pay in half and still live nicely. However, one reason they charge so much is because of malpractice suits.
Nurses, skilled and educated as they are, are paid a heck of a lot of money. Why, because there is a shortage?
First responders, paid too much. You probably think I have no business talking about that, but in all actuality, I could have taken the EMT test after leaving the military and become one, but there is no way in hell I want to do that work. Is there a shortage of EMT's? I don't think so, but there is a lotta BS to put up as one.
Hospital equipment-outrageous costs and equally outrageous billings. This year alone I went through 4 MRI's, and if I had not had insurance I would have been a huge burden on someone else because those little 20 min tests are expensive....too expensive.
The whole health care system is fubar, and it starts with CEO's making too much. It might very well becoe federalised, and God help us if it does, but until prices come down I don't see it getting better. The industry needs to start self regulating itself.
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skilled and educated as they are,
Umm doesn't one acquire skills/education in order to get paid more?
Your typical RN makes something in the 40's. Do you really think that is being overpaid?
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Originally posted by Lizking
We are losing mergency rooms at a rapid rate. I think it will be closer to 3-4 years.
The problems include:
People with no money or insurance who use the ER as a clinic.
Liability Insurance premiums.
Refusal of medical students to work in ERs for various reasons.
On our local news today, they cited a statistic for uninsured residents of Travis county: 25%. I have nothing to back this up with but my personal experience, but of those 25%, I would guess that 15-20% are illegal aliens.
So that would leave 80-85% of that 25% that are not illegals. There are LOTS of uninsured workers. Most working for small buisnesses that don't offer benefits. Most of those that are insured are underinsured.
For your 3 points you offered a national healthcare system would eliminate these issues.
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Originally posted by Steve
Umm doesn't one acquire skills/education in order to get paid more?
Your typical RN makes something in the 40's. Do you really think that is being overpaid?
In a way I do and in a way I don't....now let me explain.
Nurses have a great deal of knowledge and probably handle about 90% of the doctors load, which makes you wonder why the doctors earn the amount they do. Are nurses trained too much and should doctors handle more of the load? That is the true question. For the load that nurses handle, they are paid appropriately.
Why stop there tho...why not go a slightly different route and get a doctorate instead of RN? A nurses anatmoy and physiology course is very intensive, yet what's to stop them from going pre-med?
I have a good amount of respect for health care practicioners from Doctor on down to EMT. Home health care and RN's are important in todays society. Are they as important to the degree we hold them to?
Look at your typical hospital staffing of just care providers from orderlies to nurses to doctors to candy strippers (if they still have them). For a nurses knowledge and capabilites, do you think they are being used to their fullest on normal wards? Could lower paid orderlies with proper supervision carry out many of the duties?
I'm certainly no hospital administrator, so I sure as hell don't know all the ins and outs of everything. But a revamp is surely needed and instead of going to the strictest of defenses, ask yourself is the system working as it is now.
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No RPM, I knew when I type it that it wasn't the best form, but what I meant was that 15-20% of the uninsured in Travis County are illegals.
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Originally posted by Lizking
No RPM, I knew when I type it that it wasn't the best form, but what I meant was that 15-20% of the uninsured in Travis County are illegals.
And that leaves 80-85% of the uninsured that are citizens. Just using your numbers.
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15-20% of the of the residents of Travis county are both illegal and uninsured. Is that clear?
The only stat I could find to back it up is that 28% of the residents of Travis County speak a language other than English at home.
http://quickfacts.census.gov/qfd/states/48/48453.html
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Wow, I speak 2 languages. Am I illegal?
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Do you speak your second language at home? That means as your primary language, my disengenous friend.
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I found some stats, but I won't bother posting much because you do not care to learn anyway. The known population of foriegn born in Travis county is 15%(not inclusing children), with a 127% increase since 1990. Of course most illegals do not get counted in the census, so you can safely double that.
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Yes, I have 2 primary languages. Me habla espanol y ingles. Any other languages would not be primary. My point being you can't judge their immigration status by the language they speak. You were trying to say earlier that you thought out of the 20-25% uninsured 80-85% of those were illegals. Since I have to explain your own thoughts theres not much point in continuing, is there?
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Well, I searched, but as you can imagine these are not easy numbers to find. The ones I found prove that it is significant, and at least equal to the lower end of my guess. Unless, of course, you do not trust the US Census as a source?
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I would not dispute the fact that there is a significant number of illegals in Austin and the numbers grow the further south you go. That is a fact.
I would also say most of those illegals are employed. That is a fact.
I would also say most of those employed are uninsured. That is a fact.
I would also say most of their employers are not paying proper taxes. That is a fact.
I would also say most of their employers are legal citizens. That is a theory.
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And I would agree with all of those points except the last. Again, I have personal knowledge in the area, and I would say that most illegals work for other illegals. Not by much, but more than 50%.
Typical scenario:
Jose comes to the US and gets a job as a laborer in the masonry trade, even though he is a skilled mason. He works hard, saves a little money and makes some contacts, then goes into business for himself. It is out of his pickup, of course, and he is a sub for legal companies, but he is a business man. He recruits and even pays to bring in more illegals and employs them. No taxes, no workmans comp, just cash on the barrelhead. By my educated guess in the Central Texas area, 90% of new homes are built with this form of illegal business and illegal aliens.
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And is Jose building houses for illegals or US citizens? They are the employer.
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No they are building them for legal home builders. Also, there is no shortage of legal masons, but the price that the illegals will work for is about 30% below what it should be, so they have conceded the market to them and do commercial and municipal work only, because stricter documentation is required.
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So it is the homeowners fault for hiring illegals in the first place. Sure, it's OK break the law when YOU get to save a few bucks. You just put another LEGAL mason out of work and he lost his insurance. You made it possible for the illegal to stay in Austin. Because he has no insurance he goes to the ER with the uninsured legal citizen, too. See where I'm going with this?
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Don't blame the victim. They are here illegally. Anything beyond that is spin.
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The victim? You know as well as I (and you even stated) the homeowners hired the illegals because they were cheaper. If a guy shoots himself in the foot, is he really a victim?
Oh, and it's not spin so much as it's a vicious cycle.
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Homeowners do not build their own homes. It is American companies subcontracting the work.
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The legals are hiring the illegals. At that point anything else is a direct result. They came here looking for work. No work? They move on.
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I agree.
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Originally posted by Goth
Nurses have a great deal of knowledge and probably handle about 90% of the doctors load, which makes you wonder why the doctors earn the amount they do. Are nurses trained too much and should doctors handle more of the load? That is the true question.
Beeing a physician myself I appreciate a well trained nurse more than anything else. It's true that they have a tremendous workload but they are not doing my job. Experienced nurses can help young doctors to focus on common problems and warn them on pitfalls but in the end it's the doctors responsability. Don't judge our workload by the things you observe as a patient. In todays medical practise the actual time at the patient is the smallest part of the work - sadly. Especially working in a medical clinic, as I do now, paperwork is the most time consuming act. Today you have to document every little bits and tads - it's really frustrating sometimes.
I work around 60 hours a week (more than the average hours for a employee) and earn just about the average pay. Plus I have studied for 6 years. I think that my workload and wages are appropriate.
In Switzerland emergency medical care still is a gov affaire and it puts hospitals at the edge of ruin. But that's the cost for saving lifes. How much is a life worth? Do 10 failed resusciations make up for 1 successful? Easy question if the 1 is close to you.
What is your health worth? Quality and span of life have increased steadily. Today people with serious diseases like Diabetes melliuts Typ I or Cystic fibrosis can live a (almost) normal life whereas they'd died at child age 50 years ago.
Do we need high tech equipment and expensive screening methods that require 100 examined patients to find 1 carcinoma in early, treatable stage? Easy if it's found in your body.
Personally I think health care is worth spending your money on. Why spend billions of dollars on military when the risk of dieing from a cardiovascular event is a million times higher than dieing from a terrorist attack?
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Hmmm... why do they not teach the concept of personal triage to high school students?
Hell... there's a life skill for ya... Knowing when it is the right time to go to the emergency room, or the urgent care, or make an appointment for later.
These are things that some of us seem to learn with experience, but this should be taught in high school.
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Sandman, take the Medicboy challenge. Visit 3 ER's near you. Just walk in and look aroud, won't take but a minute.
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They over charge like anything in medicine. I went to an ER not too long ago. Motorcycle accident with a car. I was fine and dandy but no, the ambulance guy made me lay on that surfboard. Then they wheeled me into ER and put me on the table. I told them I was fine but they cut my (ALL) clothes off and poured hydrogen peroxide all over me. Dam that hurt. Then the scubbed off my dead skin. Like ouch! All the while pouring hydrogen peroxide on me. And I was ok, not hurt. Not a broken bone. Then a few weeks later they sent a 1875 dollar bill home. Thanks alot. you know why they did this. This did this so I could sue the guy that hit me with his car. LOL!
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Hmmm.... I think I agree with him.
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I suppose its easy to complain and its probably better that they provide the service but +1800 bucks is alot of money. Alot of other people who are less fortunate rely on the professional service they provide. Ok Im stuck with the bill [/complaint]
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Nurses underpaid ?
Four years of college to work in an enviornment with a work tempo similar to a fast food place minus the blood and excrement and watching people die, except that instead of being responsible for someones fries your responsible for their life. Have a bad day at work and you may be exlaining it to a judge. And just because you graduate doesn't mean you have what it takes. I've seen a few new nurses flip out, and in a couple of cases literally go crazy, and even worse. And you think 40-80k is too much? Like working 16 hour shifts? I just finished a 32 hour day with one.
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Kirin get me a job in your country :D
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Intriguing topic
So what does one do? Turn away the illegals? Is that what it will finally take? There are few rewards for legal immigration, it seems more and more, those that come here illegally gain all the perks.
Gee, stupid me has been paying for my insurance.
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The only times I went to the ER they made sure they got their money. True, it was not a big city trauma unit. It was the only hospital for 60 miles. I remember the lady in the Decatur Community Hospital buisness office telling me they would not operate on my pregnant wife to remove a cyst the size of a kidney that was about to burst until I forked over a $2000 cash down payment. Oh yeah, they botched the operation.
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Originally posted by Kirin
Beeing a physician myself I appreciate a well trained nurse more than anything else. It's true that they have a tremendous workload but they are not doing my job. Experienced nurses can help young doctors to focus on common problems and warn them on pitfalls but in the end it's the doctors responsability. Don't judge our workload by the things you observe as a patient. In todays medical practise the actual time at the patient is the smallest part of the work - sadly. Especially working in a medical clinic, as I do now, paperwork is the most time consuming act. Today you have to document every little bits and tads - it's really frustrating sometimes.
I work around 60 hours a week (more than the average hours for a employee) and earn just about the average pay. Plus I have studied for 6 years. I think that my workload and wages are appropriate.
In Switzerland emergency medical care still is a gov affaire and it puts hospitals at the edge of ruin. But that's the cost for saving lifes. How much is a life worth? Do 10 failed resusciations make up for 1 successful? Easy question if the 1 is close to you.
What is your health worth? Quality and span of life have increased steadily. Today people with serious diseases like Diabetes melliuts Typ I or Cystic fibrosis can live a (almost) normal life whereas they'd died at child age 50 years ago.
Do we need high tech equipment and expensive screening methods that require 100 examined patients to find 1 carcinoma in early, treatable stage? Easy if it's found in your body.
Personally I think health care is worth spending your money on. Why spend billions of dollars on military when the risk of dieing from a cardiovascular event is a million times higher than dieing from a terrorist attack?
I have to agree, health care people work hard, in school and after. Little praise garnered other than going home and knowing that you are human too and have done the best you can.
You know...this is one of those hard arguments. Before I bow out and agree with a lot that has been said in praise of health care personnel I have to bite one more time.
Sadly, without war, there would not have been some pretty amazing advances in medicine. Oh...they might have happened anyway, but how many years would it have taken to learn trauma care without war.
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Some of the bad press might be a ploy. Blued Cross has recently put a stop to the huge increase in price of health care. A lot of HMO's and hospitals have went on the offensive, and one hospital in my area has stopped accepting Blue Cross. Its time insurance companies stop the idiotic price increases in health care. As was mentioned in the debates, consumers of health care are usually third parties - there is no quantity and demand dynamic. You have no say so how much your insurance pays for medical services - you are out of the loop. Its an unregulated monopoly with price fixing.
Its going to get ugly, but it has to. Hospitals are bussinesses and have been taking full advantage of their monopoly over the past 20 years. They're not going to give it up easily, and are going to plant some very scary stories. The health care industry is one of the largest and fastest growing in the US. It shouldn't be a monopoly, and right now, it is.
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While it is true that, as u said, tremendous achievments have been made especially in traumatic life support during the last two world wars one shouldn't be proud of it. But as it happens we cannot "un-learn" things. Hypothermic surgery protocols as been used in todays heart surgery are based upon the experiments done to concentration camps captives. We cannot deny what has been found with these unethical cruelties. We accept it for the good of our patients now.
War might be the father of all things but still it's no desirable whatever advancements it brings...
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I still fail to comprehend how turning a beurocratic (medicine) mess over to another beurocratic mess (our lovely Govt.) and expect huge drastic changes.
I hate goin to the Emerg. room bleeding like a stuck pig or in pain with a broken limb about to pass out and I have to wait in line because somone else has to use this facility as their primary care and all they have is the flu.
The Idea of community clinics has been sudjested once or twice in the current election.
AND making it so small business can pool money to buy insurence at the discounted rates that large corporations do.
This sounds nice to me. Add some tort reform and you're on your way to some real changes.
You can top it off even more by investigating pharmacuticals....they're becoming a greedy money grubbing organization who's lost track of what medicine is really supposed to do.
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Gunslinger, you are totally dismissing the fact they have triage for just that situation. In the ER it is not 1st come 1st served, it's most emergent cases 1st, everybody else later.
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Originally posted by rpm
Gunslinger, you are totally dismissing the fact they have triage for just that situation. In the ER it is not 1st come 1st served, it's most emergent cases 1st, everybody else later.
and what happens when they are all full up with, for the sake of argument lets just call them flu patients, which taxes there ability to care for others.
Then you go back to the cost issues. These "flu patients" can be seen and heald by a regular physician for a whole lot less than an ER room.
Heck....even minor stiches can be done elsewhere. Don't get me wrong I'm no expert, I've been banged up a time or too and I am fortunate that the Govt. pays for 100% of ALL my medical needs. Just seems to me an ineffiecient way to run things from an outside perspective of course.
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Health insurance costs in the U.S. have increased 50% in the last 3 years. Americans pay approximately $4-5,000 more per year for health care than those in other developed countries and have no better medical care to show for it.
I'm of the opinion that civilized societies should consider some services beyond police, highways and sewage treatment as essential infrastructure items.
America is a mature, wealthy and developed nation. It is a national travesty and embarrassment that other countries are able to offer more affordable health care, even if it doesn't break even on the balance sheet all the time.
What is a greater priority for running a deficit other than reasonably affordable health care for the taxpayers in a society?
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everytime I hear someone mention "Government Health care" I picture the last time I was in the DMV or county tax office, heck, even the post office ....
slugs moving even slower than a normal human being could possibly go, not worried about their job performance as they are confident they are not in fear of losing their job .... you think the lines are long in ER now? You think the gov could do it better than the private sector has done up to this point?? LOL
gov heath care ... no thanks
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In my experience government hospitals in the US are much better than private sector hospitals. If I had my choice I would rather be a patient at a government hospital.
The major difference is that government hospitals don't worry about making a profit. In fact the are very cost inefective. They generally have a higher caregiver to patient ratio, especially in peace time.
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My only experience with government run hospitals is the USPHS hospital in Seattle. Spent a few days there with a broken thumb. I didn't have a private room, but I didn't need one either. I was a Seaman and recieved the same care as a Rear Admiral with the identical injury. While he did have a private room, we had the same Doctor and Therapist.
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do you honestly think a gov run PUBLIC hospital would compare in ANY way to a military run one?
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Are you at all familiar with the USPHS?
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Comparing physicians and nurses to DMV and postal workers? By extension, firefighters, police and military personnel should be comparable to DMV workers also? That's a pretty pessimistic view of society and humanity there, Eagler.
And where did the idea of a government bureaucracy operating health services come from? Every answer to every question is not A or B.
Other options to financing and supplying health care are left as an exercise. :eek:
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All military hospitals are public hospitals. When I worked at BAMC during peacetime about %80 of the patients were civilians. A lot of times we didn't have any military patients. And I would say that about %25-35 of the caregiver staff was civilian also. It's not the quality that would be the problem with socialized medicine, it's that the enormous cost would be unsustainable.
That's just one of the many problems of having a population of 250 million. The majority of patients in this country are elderly, because of the gift of modern medicine many peoples' bodies are outlasting their minds. When we have cured geriatric dementia and alzheimers it will lift a great burden from the system.
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About ERs.
I think a lot of people don't realize that going to the ER is like waiting in line at the club. Patients in the ER are waiting for a vacancy to open up in the hospital so that they can get a bed. I find the average medical patient spends 6-12 hours in the ER before they get to their hospital bed. You see corporations and to some extent doctors like to get paid. So in their view an empty hospital bed is costing them money. So they like to keep fascilities full all the time.
And as far as a shortage of nurses, that's not quite true. Yes most often floors are short staffed, but that's not because there are not enough employable nurses in the job market. It's because the corporations staff the floors with the lowest number of employees legally possible. And eventualities like calling in sick, and scheduling mistakes often leave floors short staffed. Next time you're in the hospital take a look at the ID badges of the people taking care of you, or just ask them. Odds are that about 25% of them aren't employees of the hospital, they are agency nurses.
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Originally posted by Goth
Medicboy, don't take this the wrong way.
I think a lot of problems extend from hospitals charging waaaaaay too much money to the people that have insurance and can pay their way. Look at doctors wages, nurse wages and even the wages of ambulance/emergency responders.
Doctors in all truth could cut their pay in half and still live nicely. However, one reason they charge so much is because of malpractice suits.
Nurses, skilled and educated as they are, are paid a heck of a lot of money. Why, because there is a shortage?
First responders, paid too much. You probably think I have no business talking about that, but in all actuality, I could have taken the EMT test after leaving the military and become one, but there is no way in hell I want to do that work. Is there a shortage of EMT's? I don't think so, but there is a lotta BS to put up as one.
Hospital equipment-outrageous costs and equally outrageous billings. This year alone I went through 4 MRI's, and if I had not had insurance I would have been a huge burden on someone else because those little 20 min tests are expensive....too expensive.
The whole health care system is fubar, and it starts with CEO's making too much. It might very well becoe federalised, and God help us if it does, but until prices come down I don't see it getting better. The industry needs to start self regulating itself.
Not taken the wrong way but I have a few statements.
1: There is a BIG diference between an EMT and a Paramedic. For the most part a basic EMT is a 1 semester course and covers basic-mid level first aid and basic scene management. There is no indepth A&P, and no invasive skills. They prolly do get paid a fair wage for 3 months of education and the risk involved. I am a paramedic. Becoming licenced as a paramedic takes 2+ years in most cases and in those 2 years there is about 4 years of college level corses crammed together. It is not just a supplement intended for fire fighters and cops (as the basic EMT course is intended) it is a profession. I am able to do things that only a MD can do in the hospital. I can make judgement calls and give meds with out consulting an MD (unlike nurses). I am almost always the one in charge of a medical scene because I am almost always the one with the most training. If I mess up there is a good chance that someone dies. So what is that worth??? For someone with all that training and 12 years experience here in Montana I make $9/hr with no benifits, not even vacation. Is that over paid???????????
2: My wife is an RN, she has spent her entire career in the ER and currently the ICU. She has a 2 year degree and about 8 years of total experience and she makes $21/hr with nice benefits. DO I think she is over paid?? No, She works very hard and earns every dime.
3: MD's: Have you any Idea how much of their lives these people give up??? I also work as a Tele tech at the local hospital and see how often they get called in, woke up and bothered when it come to their pt's in the hospital. 60 hrs a week is a vacation. They might be over paid but not that much.
4: How much hospitals charge... Ok going to try to keep this simple. Say Burger King is a hospital. They are mandated by law to give everyone who asks for food what ever they want and can't ask for payment at that time, they have to take info which might be real or not and bill later. As a consiquince huge numbers of people go there to eat and they only get on average 30% of what they bill. SO for a whopper value meal they usualy charge say.... $3.00. But soon they realize they are only collecting on average $0.90. Less than they pay for the stuff to make the meal. They have to raise the price to $10.00 so that they get their average $3.00 per meal and don't lose money... That is the price you pay for those that don't pay for them selves, you want the service to be there when you need it, so those that can pay have to pay for those that can't or wont.
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Ok and the MRI's.... Ya the test only took 20 min, and the tech that took the pictures only made $8-10/hr, but that MRI machine cost the hospital about $1 million. They would never pay for that if they charged $100 per test would they???
Most hospitals are privet companies, they can't keep giving and giving and not get paid for their services can they??? Hence the Burger King anology.