I feel that access to proper medical care is a human right. The ability to have, maintain, and preventably treat health and health problems is a human right. We all have a right to be healthy, and to be able to detect and prevent catastrophic illness whenever possible. Imagine what would happen to the public health if millions of uninsured patients walking around with possibly contagious diseases not being treated cuz of high costs. This will only lead to more problem and accrue more cost down the road. Now, that's different from access to any medical care - I don't think that access to say, plastic surgery is a right. That's a privilege in the majority of cases. For a country this size and wealthy, we have an extremely poor health delivery system. From a physician stand point, I can understand the frustration with all the paperwork and legal basis to cover but this is simply due to the poor system and this happened both in the private and governmental sector. I believe with universal health care, both parties - general public and medical providers - will benefit more whether it's the overall health or legal protection. Under governmental run program, at least there'll be somewhat sufficient oversight and cap on a lot of issues such as malpractice judgment or whatever. It will be efficient if it doesn't need to hop through all those political rings that are lobbied by no other than private sectors who tried at all mean to stop such a bill from being passed so that they can maximized the profit. I don't call the efficiency, I call that GREED. For you as a physician (assuming that you're one from the posts above), I can't imagine how you can possibly have a bit of hesitation about helping someone with medical problem that come through the doors. Yes, you have your life to live just like everyone else - bills, family, etc.. - but people's lives are in your hand. I can assure you that no matter what happened; at the end of the day, you will get paid from the insurance or whatever but once people die, that's it. If your priority is the paycheck every week/month, then perhaps you shouldn't be in the field. Also, what you deemed as non urgent health issues may be dire need for someone else who have no medical knowledge and are extremely concerned. As for the language issue, we are living in a land of immigrants. Yes, English is the primary language but you can't expect everyone to learn it. I am sure your parents were once an immigrants who probably struggled to communicate with their doctors upon a time; you not gonna tell people like your parent to learn English and come back for med care, do you?? You also want your parents to get equal access to quality healthcare too, don't you?? You don't want them to be sick or whatsoever simply cuz they can't speak the language. I would expect all doctors nowadays to be at least linguistically or culturally competent since they're serving a diverse population. Yes, we are Americans but we are ASIAN AMERICANs; not some whitewashed trash who totally oblivious as to where they're originally from.
Thank you, Ribsandbbqbeef (gosh, I feel like I'm having a discussion with my lunch, LOL...) I too, appreciate the continued airing of critical viewpoints, regardless of their stance, from someone who very obviously cares about the ultimate direction in the delivery of patient care; and yes it is indeed refreshing to talk here about something more substantive than the latest K-pop hit or TVB plot du jour. I agree with you that compassion fatigue, even for those who are of the most charitable leanings, is a common enough side effect of having to deal with a seemingly incessant stream of social or medical malcontents. The most dedicated and stalwart of providers can be brought to the brink of tears by just the right encounter, and it seems that those rare unpleasant presentations have become more the norm than not. I agree too that inappropriate presentations to the ER tend to exasperate even the best emergency specialist, but again, I disagree with your assignment of causality. IMHO, those patients only present to the ER when they "fall between the cracks" and it is this system of ever widening cracks that is the issue; allow me to explain. Years ago, the running joke in ER's was the drunken frequent flier; usually an undomiciled, intoxicated male vagrant that was brought in because of Samaritan activation of emergency services (police too, who chronically suffer the same compassion fatigue, generally drove by these guys unless they happen to unavoidably position themselves right in the middle of a busy vehicular roadway). As much as one can bitch and moan about such presentations (which can be decidedly physically, emotionally and legally challenging beyond the usual clinical scope), one accepted these as part and parcel of the setting within a busy urban emergency arena. What is different today is this; that frequent flier roster has expanded to include your typical brittle diabetic, uncontrolled hypertensive, asthma exacerbation, routine pediatric concerns, and a myriad of other complaints stemming from varying degrees of chronicity. The question then is, what are the reasons behind this demographic shift in demand for services to the emergency sector? That is, why are these other patients now coming to the ER in such huge and unrelenting numbers? A large part clearly falls within the "uninsured" categorization of presentations. But how does a patient land within this statistical heading; is it because the patient is a societal misfit or criminal deviant, one who is willfully determined to undermine an emergency department's scarce resources? Or is it because of life's circumstance, some unforeseen event (like a loss of employment, death of a bread winner, or age related ineligibility) that suddenly deprives a patient of his or her health safety net? Additionally, this category includes the foreigner (a visitor without insurance, and undocumented resident alike), who may be fearful of either the uninsured out of pocket costs, or contact with anything or anyone resembling an 'official' setting. Moreover, when faced with such perplexing and often cruel choices (putting food on the table, getting caught and deported, et cetera), does one go to the doctor for routine health maintenance issues or does one wait until things only become really intolerably bad before presenting oneself to the medical authorities for assistance (eg. that year long rash in your example above)? Your UPS and FEDEX analogy is actually quite prescient though not in the way that you would imagine. Doc in the Box, freestanding clinics in your local pharmacy would be the analogous UPS or FEDEX for the ER, simply because the ER system is already overwhelmed. These are great for patients that can pay out of pocket or have the insurance, but does little for the uninsured, who would then flock to the ER anyway. But what would you say if they suddenly didn't have to? For example, if that year long rash had been treated at a local government run free clinic, would they then appear a year later in your ER? Probably not. Likewise, if people had better diabetes or hypertension management at a free clinic, would they present as frequently in your ER in ketoacidosis or hyperosmolar coma, or hypertensive crises in chest pain, and with no way to pay? My point is, certain predictable and controllable clinical entities have persistently caused tremendous economic impact to the health care system. Things such as the need for immunization and well baby care are obvious as the money spent is returned many times over in preventive cost savings. Wouldn't that same preventive costs savings appear for other predictable clinical entities as well? I'm sure they would. What I'm advocating therefore, is essentially a socialized medical safety net that would prevent those who fall through the cracks from ever needing to go to the ER with non life threatening issues at all. Like you stated, you're boarded in emergency medicine; wouldn't it be great if you can just do what you love and not worry over other clinical distractions? Your taxation model for European nations is correct, however your assignment of that model to statistics regarding total health costs comparisons is inherently flawed. Firstly, it fails to take into account the much larger US population and the potential savings from our larger economy of scale. But forget that for a moment, more importantly it ignores the real fact that many of the costs incurred by European Union members are generated outside of the health care arena. Europeans pay nearly 60% total taxation because they're generously covered for everything from cradle to grave. They have a much shorter work week, much more extensive vacations, and a pension system that would leave your average American seething with envy. In the United States, the greatest drain on the national treasury is categorized under entitlements, of which social security pensions is the bulk. I once remember reading an article that stated all the other peripheral expenses incurred by government (eg, health care, unemployment, foreign aid, peace time military expenditure, et cetera), combined together, does not even come close to what is annually disbursed via entitlements. If you looked at the amount paid in US social security (roughly 45 percent of a worker's average retirement age paycheck) and compare it to the EU's (roughly 70 percent), you can easily see that a very large European tax base is necessary to fund such generous retirement benefit expenditures. So in essence, Europeans are taxed more not because of their nationalized health care systems, but because of a combination of other costs, principle amongst which is their overly generous retirement spending. However, this is the primary scare tactic that is often used by the anti-social medicine quarter, that to switch to "any aspect of social medicine would mean a rise of taxes to 60%." That is simply not true. Further still, your operational model is based on profits; that is, they have to make money. I envision a system that never makes any money and is just a government expense (like the fire department). We both agree that health care is costly; why then, do we need to give billions of scarce health resource dollars to "shareholders" who only care about profiting from someone else's ill fortune? As for price gouging pharmaceuticals, price caps do very little for an industry at large; what is needed is more competition. Look at what the Indian government did in 1970 with regards to medication patents. It essentially voided the patent process, which meant that anyone can make a generic. This drastically reduced prices across the board. There are such issues that become so important in terms of national and humanitarian interest that corporate greed should never be allowed to stand in the way of it. In closing, I agree that Moore's take on things are one sided and extreme, and he is absolutely tenacious when it comes to advocacy of certain agenda. However, his facts are hard to dispute; thus his conclusions are becoming increasingly hard to ignore. *** Addendum: I'm not sure if I understand what you meant by this, as you appear to be taking two contradictory positions. Can you please clarify as I probably missed your point; first this...: ...Is followed by this:
negiqboyz: I was thinking of how to word a response to your opinion that medical care is a human right; however I could not come up with a more poignant or accurate response than what one of my collegues had posted on his blog, so I will take the liberty of referencing Dr. Shadowfax here: "Rights are limitations on government power. Exactly. When we use the language of "rights," we are generally discussing very fundamental liberties, which are conferred on us at birth, and which no government is permitted to take away: free speech; religion and conscience; property; assembly and petition; bodily self-determination; self-defense, and the like. Freedoms. Nowhere in that list is there anything which must be given to you by others. These are freedoms which are yours, not obligations which you are due from somebody else. There is no right to an education, nor to a comfortable retirement, nor to otherwise profit by the sweat of someone else's labor." With that, I'd like to state for the record that HEALTH CARE IS NOT A RIGHT! It is a privilege. Sure it's nice to have it, and morally/ethically it would be great if everyone has access to it. However, it is not a god given right that we are born with. To get it, someone has to pay for it be it in wages to insurance companies, hospitals, doctors, nurses, medical equipment or supplies. Just because one wants it, doesn't make it a right. Billions of people throught thousands of years of history did not have health care as a right. It is not until the last century or so that this has become such an important privilege that people have developed a sense of entitlement for it. Even though it's not necessarily how I feel, but by semantics why should I pay for someone else's health when I can use that money to prolong and optomize my health or the health of my family instead? Morally and ethically, it's "nice" to help someone else, but it is NOT an obligation. I agree that health insurance companies and pharmaceutical companies are greedy which is the main reason why they are lobbying against universal health care. When I refer to their efficiency however, I'm talking about their ability to come up with new medications, medical technology and devices much more efficiently than would a government run institution because they are driven by profit. No matter how much you dislike the idea that their efficiency is driven by profit, there is no denying that they ARE more efficient in that arena. Without them you would not have all the new medications which are discovered every year. Please take a second look at my prior posts. I AM there to help ANYONE who's life or limb are in jeopardy regardless of race, language, or insurance status because that is what I'm trained to do and morally/ethically that's what I want to do. However I am NOT obligated in any way to treat anyone without an emergent issue because (a) I am not licensed to and (b) I have more than enough emergent patients who already occupy all of my time. I would love to treat everyone for everything if I had unlimited time, unlimited resources, and unlimited training. However, from what you posted, it sounds like you feel I should treat everyone with non emergent issues who walks through the EMERGENCY room even though I don't have the license to do that, I don't have any time to do that, and I don't have the resources to do that. What I WANT to do is very different from what I CAN do. People need to stop feeling so entitled to everything. Go to an urgent care center or a clinic for nonemergent issues. And don't tell me it is more expensive because an average cost per visit is $50-$100 compared to an average cost of $500 for an emergency room visit. So even though "English is the primary language [and I] can't expect everyone to learn it," but everyone can expect me to learn their language instead? What kind of logic is that? First of all, it is much easier for many to learn one language than for one to learn many languages. Second of all, this is MY home, and you are coming in for MY help. Not the other way around. I may accomodate you because I'm nice, but I don't have to. Also you have three choices, you can always leave and go see someone else who speaks your language, you can bring someone to translate for you or use the hospital translator if one is available, or seek medical attention in another country if you find this one so repulsive. No one forced you to come to me. And don't give me the "what if it's an emergency" scenario because for most true emergencies, they are self explanatory and treated algorithmically even if the patient doesn't say a word to me. How do you think I take care of stroke patients who are aphasic or nursing home patients who are demented and doesn't speak a lick of English? And FYI, my parents learned English before they immigrated to this great country. How the heck would pass the immigration interview if you didn't? They are fluent and have even picked up financial, medical, and legal English terms. If my run of the mill imigrant parents can do it, then so can anyone else. It's whether they want to or not. To the other readers reading this post, I apologize for my angry tone. However I am sick of people assuming that because one is a physician that he should be completely giving, that he doesn't need rest, that he doesn't need to be paid, that he should be all accomadating and completely self sacrificing to the entire world. We are people too. We have the same basic needs and feelings. We want to be paid, We want to have time to rest. We want to be helped too. So even though our compassion led us into medicine doesn't mean we don't have the same needs as everyone else. With the rapidity that the sentiment of entitlement exponentially rises in this country, you will likely need to brace for the day when the system collapses and no one gets healthcare. Just keep pushing the physicians and see. negiqboyz: I will reply to your insult of being "some whitewashed trash who totally oblivious as to where they're originally from." in another post. Replying to your post has drained me mentally. Ralph, I saw your post too and will reply later. Thanks for your patience.
Just a quicky reply to Ralph's addendum. In the first quote, I'm referring to the oversight of physicians and how they do their job. In the second quote, I'm referring to oversight of the pharmaceutical and health insurance companies and how they run their show. Thanks for pointing that out.
Ah... Thanks for the clarification. -cool ...and sauce for the goose so to speak, regarding your response to Negiqboyz; one isn't born with any inherent right to vote either, so should we not insist on that too?
here's a site you can check out about why health is a right http://www.righttohealthcare.org/index.htm there are a few more that i came across but the one cited is more easy on the reading .. others are crazily long so you don't wanna read it. i am not gonna restate my pov. even private com (pharma/biotech) do get gov funding for their development but when things are successful, us tax-payers still have pay a freaking high price for them. you call that fair? efficient?? yeah .. efficent in generating more revenues for the com at our expenses. you really think that these private sectors do not get any gov help with development at all then you read up on your pharma/bio news. if i recall correctly, gov actually fund about 90% of all the research development in the us .. all drugs development are some what benefitted from these research .. the only thing that private com do is manufacturing and putting things on the market. as for treating pt, no i don't mean you should treat everyone as you're not qualified/licensed to do everything but the thought and passion is what i am talking about. you shouldn't have a sligtest hesitation about treating these pt whether they pop up as emergent or non-emergent pt .. even if you can't treat them, i am sure you can always call someone on the floor or refer the pt to somewhere .. at the very least you can run the basic testings or whatever .. all er doc go thru the general med rotation so you're trained to do that. language .. your parents are educated; how many ppl do you think know how to read and write .. take my personal family for ex, my parents (54, 60 y/o) and grandma (83 y/o) who are uneducated .. education is a priviledge back in vietnam and korea .. learning is not easy when you are old and have family to take care .. my parents can't even find work cuz of their age .. putting food on the table was hard enough ... schoolin g to learn english?? think again. i didn't see my parent .. i was raised by my grandma practically cuz they were out at 5 in the mornign and came home at 11 at night .. it's easy for you to say when you come from privileged family and shit like that .. not everyone are that lucky .. try going to chinatown or little saigon or korean town and see if ppl speak ENGLISH. from what i read, you have never ever experience the dark side of things to understand what it's truly like being an immigrants cuz everything around you is english and perfect .. also ... you are OBLIGATED by law as a medical doctor/institution to treat patients who walk in your door regardless of race and insurance status .. by law, med insti have to provide the language interpretation. i know that for a fact .. and yes i have filed complaints about two physicians in the past with the med board and even sued one before for not accomodating to my parents' language and cultural needs. oh yeah .. i won the judgment but my parents donated the money to doc w/o border .. honestly, if i ever run into someone acting like yourself, i'll personally make sure that his/her license is revoke or kick out of the hospital. those options you mention above are absolutely unacceptable; enough to get you kicked out of hospital if that how you tell your pt. doc are not god but human too .. however, being in the profession is an indicatiion in itself about self sacrificing. you should always place pt first before your needs .. like i said, if you think $$, you shouldn't be in the field. it's not fair but yeah .. the profession requires a lot of self-sacrificing .. you knew it beforehand so don't complaint about it .. no one said being a doc is easy. whitewashed trash .. i didn't direct it to you per se but gnerally speaking unless you're feel like one ... lol ... man .. so choppy sry .. kinda tired from a long day .. don't wanna think anymore .. lol
The very libertarian interpretation of rights (as described above) is a good example of defective critical reasoning. Rights of liberty are a legal concept arrived at by man, society and through their formation of a system of governance; it does not exist in nature. By that I mean that rights are analogous to the value of gold, which is only valuable as an assign by man; it has value because we deem it so. Else, in nature, there isn't really any intrinsic preference for it over another type of rock. Similarly, the freedom or liberties as detailed above, is but a conceptual contrivance by men with similar philosophical leaning. Had one been born to another, starker political arena, the suggested precepts of rights "conferred (meaning 'given') at birth" would prove illusory; they exist purely and exclusively atop a foundation of our present society's social reasoning, nothing more. Hence, there isn't anything that is inherently given at birth other than the right to eventually die; that being the only true inalienable right that I can think of. Rights therefore, are not limitations on government power, but rather are themselves arisen from and subsequently empowered by government. If government did not exist and intercede on its behalf (by conferring or giving us such rights), such rights as discuss above could never exist. Hence this statement: "...Nowhere in that list is there anything which must be given (or conferred) to you by others" which comes after this statement: "...which are conferred (or given) on us at birth..." is a study in contradiction. The opinion as offered is thus baseless. Ergo, if society deems it necessary to do so, it may thus Confer at birth, upon all its citizenry, the right to free health care, and no amount of self serving libertarianism would be permitted to take it away.
In a continuation of this recent interesting discussion, this item was found in the news today: In a rush? For a quick synopsis, just read the red highlighted lines. Though this report detailed pharmaceutical interests in the European Union, my understanding is, that their business actions throughout the rest of the world is nearly identical.
thanks ralph but what happen to rib? guess too busy to reply .. lol too many accidents especially during holidays .. sigh.
That's only if he works in a trauma center. Otherwise, most of what he'll be getting is gastritis and chest pain presentations, along with the drunks. Or on the other hand, maybe we've presented points that he finds hard to refute <_<
In a continuation of some of the points that I'd made about making basic health care a societal right, support comes from a surprising quarter: In a rush? For a quick synopsis, just read the red highlighted lines. You gotta give credit where credit is due. In this case, Bush actually did something great. I just wish he would have had more moments like this.
