Tuesday, August 25, 2009

A Little Bit of Reality

Here are some truths.

1.Every person admitted to a hospital is asked, in compliance with current federal regulation, if they have a living will(aka advance directive) and/or medical power of attorney. Every one. By law. If the person does not have one and is capable, they are offered a visit by a hospital employee specially trained to assist with the completion of the living will.

If granny comes in in a coma due to a stroke or heart attack or something else and she does not have a living will and no-one in the family nor her doctor know what her wishes are, it will be left up to the family to decide. And in most cases, no-one will want to be the one so poor granny has a vent tube shoved down her throat, an NG tube down her nose into her stomach, an IV inserted into her jugular through which a complex cocktail of drugs attempts to keep her heart beating and her blood pressure at a level compatible with life. There is a catheter inserted into her urethra up to her bladder to drain urine, there is a tube in her anus to drain stool. And despite even the most meticulous care, if she survives more than a few days, her skin will begin to breakdown and she will develop open large open sores. Then when the drugs don't work anymore, her heart will stop and a "code" will be called. Most of her ribs will shatter during the resuscitation process, perhaps even her sternum. This will go on until someone finally says enough.

And that is fine if that is what granny wanted - keep her alive at all costs no matter what. But what if she didn't want to be kept alive on a vent? What if she didn't want her heart kept beating artificially? What if she didn't want to be revived if she died?

And wouldn't it have been nice if she had been able to sit down and discuss this with her doctor in an appointment separate from one devoted to some medical problem? Had the medical terms explained? The possible complications and treatments of such for her individual case explained and discussed? So she could think about it? Have a conversation with her family about it? Calmly, not in the fear of an emergency?

2. Every person who presents to a hospital must be treated. Yes, in certain cases, they can be sent to another hospital, but in the end, every person with a medical concern is treated by a hospital whether they have insurance or not.

And just like the retail store that raises prices to cover for losses due to shoplifting, the hospitals raise prices to cover the losses for treating the uninsured. And insurance companies raise the price of premiums and cut services to cover for the larger hospital costs.

So, we are paying for the uninsured right now. The problem is that instead of paying for a doctor's visit to have blood pressure checked and then paying for blood pressure medication, we are paying for a person to come in with a full blown stroke due to sky-high blood pressures. We are paying for emergency department bills, ICU care for weeks, rehab if the person survives, then home care and now we have a person on disability who we will continue to pay the medical costs for.

It doesn't matter why the person does not have insurance. They can be working a part time job that doesn't provide insurance, they could be students who no longer qualify to remain on their parent's policy, they can be alcoholics living out on the street. They can be cheapskates who didn't want to pay and ran the odds.

It does not matter. We are paying for them anyway. We, who pay our insurance premiums dutifully, are still going to pay the costs of the uninsured NO MATTER WHAT. We pay with higher premiums, we pay with less coverage. We pay by having insurance companies dictate to our doctors what they can order, what drugs they can prescribe, how often a treatment may be given.

I, for one, would rather pay for a doctor's visit than a catastrophic illness that will end up costing millions.

And, lastly, as I asked a friend the other day, what has become of this nation? What has happened to compassion in this country? Why are we so hateful?

Loki sez: I thought humans helped those in need.


Anonymous said...

Unfortunately there are people turned away that don't have insurance.....the other thing that seems (as my mom would say) back-asswards...If you have insurance the provider ie surgeon will accept way less than they have billed....recently the surgeon's bill to my husband was $6700...they accepted $4500 from our insurance co....why couldn't the poor soul who has to pay cash pay the lessor amount???? I know sometimes a portion is "forgiven" but why not just START at that point and NOT make people beg for the lower charge when they don't have the money to begin with.
Pam, South Bend

jaz said...

Future generations are going to be shaking their heads sadly at this entire debate... just like every other industrialized nation is shaking their heads sadly at us right now.

It's all about keeping the money flowing into the pockets of the health insurance shareholders. That is what is at stake right now. Everything else is smoke and mirrors.

Pat said...

Well said, Janet. You know how parents-to-be watch a video in their prenatal class of an actual birth (well, at least we did back when dinosaurs walked the earth)? Maybe we need to have an actual code of an 85 year old posted on YouTube. Might change a lot of people's minds about this whole end of life counseling thing. Don't even think of coming near me with that vent tube!!!

Jessie said...

or maybe a neonatal code before a drug addict or teen gets pregnant?!?!?

JanetLee said...

Pam - everyone who presents to a hospital emergency room with a medical complaint must - by law - be treated or, if stable, transferred to a hospital that will treat. Now, doctors in private practice may decline patients. If you know of anyone turned away from a hospital ER, then you need to contact that hospital's administration.

Doctor's take what the insurance company gives them because most often that is all they are going to get. The difference they pass in higher prices, which causes the insurance companies to limit services, which caused doctors to raise their prices, which causes insurance companies to limit services.

And the wheels on the bus go 'round and 'round. Insurance execs get rich, family practice docs are run out of business and the average citizen with insurance gets less and less coverage every year.

Pat and Jessie - good ideas! I once had to run a code on a newborn and the father later said to me that he didn't even know it was possible for that to happen to an infant.