Asymmetrical Information

Just a month ago, a German immigrant was bitching to me about how he had to wait a whole month to see a doctor for back pain, and how this showed how the movie Sicko was true.

It turned out that he had never previously gone to a doctor, had no established relationship with a doctor and had never heard of urgent care clinics.

Sounds about right to me. My wife and I just moved and needed to get a Primary Care Doctor. My wife had to wait a little over a month for the initial appointment which she had two weeks ago. Since then she has seen two specialists, had full blood work-ups, x-rays, and cat scans. Next week she gets a colonoscopy. Of course we have pretty good insurance, but still.

My wait for the PCP was a little over two months and I go in three weeks.

Gulp!

Currently, I'm trying to get the favorite procedure for people everywhere (starts with the prefix 'colon-') and find that I'm in that darn single line (see earlier thread). I'm able to go to another performer, but I'd have to go through someone other than my basic care provider physican dude, (because he is part of this megalopolis health group) and finding someone with a good reputation here is a bit tough. They aren't all accepting new people.

So, I wait for one month while they schedule it, another month to wait for it after they schedule it (ok, its only two months), and then a month after that to be sure the information got back to my doctor so I can go back in and see him and get the results. Total time is going to take 3 months, if everything goes ok.

They may be good, technically, but their efficiency in this health group is really the pits.

Actually, the "103 degree fever and I'm coughing blood" patient gets to make a trip to the emergency room, probably via ambulance. Acute care we do very well in most parts of the country.

I'll offer up my experience, per your hypothesis. In the past year, I have had three different experiences:

1. New patient needing a routine physical. If I recall, this was 2-3 weeks wait, and I found myself with a terrific doctor. Score one for your theory.

2. Patient needing diagnosis/treatment: A couple months ago, I started having random dizzy spells. I was able to see my GP within a day, and could have seen Urgent Care even sooner. (JG score, 2-0)

2B. Patient needing diagnosis/treatment (specialist): However, once the initial treatment did not pan out, she referred me to an ENT for further evaluation. I called my previous ENT, and was given a 2.5 month wait. Other brief calls around were in the same range. (JG score: 2-1)

3. Patient needing surgery (some urgency): I was hospitalized last fall with an intestinal disorder. It was diagnosed (properly), and I worked with my GP and a GI to evaluate surgery. Both came to the conclusion, in May, that I required surgery, and should do so before my next attack.

I scheduled a consult with a surgeon two weeks out. It was cancelled by the surgeon's office, rescheduled for two weeks later, and cancelled again. My third appt would have been 7 weeks after I first called, assuming (despite the track record) that it had been kept. (JG Score: 2-2)

3b. I scheduled with a new surgeon, first available 3 weeks out. This was also rescheduled, but only by a week. My initial visit was 1 month in, my next available follow-up 3 weeks later (surgeon's vacation). At 5 weeks, I'll call this one a draw, though surgery itself still not scheduled. I am now 2.5 months after it was first recommended, with some urgency.

Overall, my guess is that the more specialized the help you need, the greater the chance for a long wait, but that 2-3 months really isn't uncommon. I'm not rural (NoVa), and while I prefer recommendations, I'm not searching for 'The Best' or picking only one doctor that will do.

I just realized that my early, quick new doctor experience runs counter to your theory. My experience is more or less the inverse of what you describe.

When I needed hospital care, though (with a looming possibility of surgery at that point), care was instant and available.

A couple of years ago I went to my PCP with stomach pain that was consistent with appendicitis (at least according to wikipedia and some other random medical websites). The women at the front desk said that I would have to wait 3 months to see the doctor since I had not stopped by previously for a routine check up.

I then tried to stop by an urgent care facility, where I was told that I needed to wait about a week to get in...since I had never tried to use the urgent care facility previously.

I spent the next 20 minutes or so driving around trying to decide if the stomach pain was bad enough to go to the emergency room. It didn't hurt very bad and I almost just went into work, but decided to eat the $75 co-pay and make sure nothing would rupture.

About 3 hours later I was under the knife having my appendix removed.

I'm not sure where my case would fit into the four categories of your GP patients. I am pretty young (24 at the time of the story) and stay in decent shape (still swim somewhat competitively), but it would have been nice at the time not to have to decide whether to eat the larger charge for somewhat minor pain that seemed like it may or may not be a very serious malady. I'm not someone who sits around and complains of the inequity of our health insurance system, but I think it is an interesting example of how the system can end up with some interesting results.

"I am flabbergasted by the number of progressives who have to wait months to see a doctor"

As a result of my wife's business I know several doctors, and one observation I've made is that specialists spill more money than GPs make. Two possible effects of that situation might be 1) more doctors becoming specialists and 2) GPs avoiding ultra high COL areas, many of which have heavy concentrations of "progressives". Though it hasn't apparently been your experience, I wouldn't be at all surprised to learn that someone in NYC with any sort of preferred provider restriction has some difficulty getting an appointment with a GP. That doesn't mean that's the situation in the entire country.

Also, this debate seems to ignore one of the core weaknesses of the idea of nationalized healthcare - I (and I suspect a lot of other people) can bitch all day about how the greedy insurance company that administers my health plan can't be trusted to support my well being, and still concede that there's one entity I trust even less in that area.

This is pretty true:

"This also tracks with the observation that America has a lot more specialists than other countries, and a relative shortage of GPs."

The reason for this is how much more attractive being (some kinds of) a specialist is. As you get older, find a spouse, have kids, (this often happens around the end of med school for many people) you eventually decide maybe you want to spend time with them. Then being a dermatologists with a 9-5 schedule becomes a great deal more attractive.

In normal fields, this wouldn't be a problem -- GP wages would rise (raising your prices is another problem too) until more entered the field -- but since the supply of docs is choked by the medical school/residency system (which also highly discriminates against foreign students) it's the least attractive choice that experiences the low supply of labor.

Brian, of course, to not discriminate against Foreign students/doctors, we could bring in a few hundred thousand from Pakistan or India, maybe a few from Saudi, and help populate our artificially-thin health care specialist ranks.

In 1970 when UC Davis was trying to keep the number of students input each year very low (even though they had millions in endowments for more students), the student newspaper called them to task for it. The answer from the Dean was that they weren't going to lower their entrance standards. Of course, this is when virtually everyone had a GPA of 3.9 or better, insanely high scores on their MSAT and the statement from that year's selection committee was that they had never had so many highly qualified students than ever before, and were sorry they could only bring in 10% of them.

Bust that ptotective natural health guild crap right out of the water with a broadside! Require everyone to be a GP for 5 years before going specialist...there are ways (vision of Hillary, sharpening a big, thick meat cleaver).

Okay, here's the recent nightmare scenario I just lived through:

Female patient has been going to the same primary care physician for years. Something happens to her leg. It gets all swollen up and the coloring is mottled. She calls the doctor to ask for an appointment, but, since she can’t walk on the leg without unbelievable pain, she can’t get into the office.

The Doctor’s receptionist calls back, says that the doctor can’t treat her if she can’t walk down the stars to see her. Receptionist says Doctor says that it sounds like a rash and to elevate the leg. Doctor never speaks to patient.

The following morning the leg is worse…significantly. Patient knows she has appointment to go see a rehab doctor regarding something else that morning so she does not take any action for the leg, figuring someone will look at it around 11am.

Rehab doctor looks at leg. Refuses to treat patient for rehab thing she was going in for. Identifies the problem immediately but will not tell patient. Sends her to walk-in clinic.

Patient sits in waiting room of walk in clinic for 4 hours. Walk in clinic diagnoses severe cellulose infection of the right leg, sends patient to ER so that she can be admitted.

Patient waits for 9 hours in emergency room to be given a bed in the hospital. She is finally given IV antibiotics at 9pm at night. Patient has, during this period, gone into renal failure. Her kidneys have shut down, her blood pressure is 81/36 and she is severely dehydrated.

Patient is transferred to room in General Medicine where she is subsequently put on three different IV antibiotics. The hospital has several liters of liquid going into her at the same time to get her blood pressure up and her kidney’s started. She is catheterized. A vascular surgeon comes and visits her to see about amputation. They do tests to make sure it’s not necrotizing facetious (the skin eating disease).

It is not. Her infection is going away. Her leg is better. Her kidneys are up and running. She is released from the hospital after about two weeks (with one release in the middle there where she got slammed back into the hospital within 48 hours with breathing trouble).

Please keep in mind, had her physician seen her the day she called this would have been diagnosed immiately or if the physician told her to go to the ER she would have. Had her physician even TALKED to her she probably could have made a diagnosis. In addition, once someone figured out what was wrong with her it shouldn’t have taken 10 hours…putting her into kidney failure, to get treatment.

There's actually more to the story, but there's no point in going into it. I just want to point out that this is someone with an ACCUTE, easily diagnosable and treatable problem.

Did you just write a post about anecdotal evidence?

"knocked out and a tube ....to see if you have an ulcer" seems expensive. If you had an ulcer, you'd know it.

I've also had a wide variety of acute and chronic medical conditions over the last 10 years. (although they've mostly all been fixed now). I've had waits longer than a month three times:

1) Consultation with an ENT who'd been specifically recommended.
2) Consultation with a neurologist in a situation that was 98% likely to be nothing.
3) [The annoying one] Getting in to see a pediatric ophthalmologist for my 4 year old. These are routinely 6-8 week lead times, and are a total cattle call once you are inside. But the 'pediatric' part seems important and worth waiting for...kids eyes are really different than adult eyes.

I've met with at least a dozen other specialists with 1-2 week waits, and have always seen a doctor in a critical situation within 48 hours.

That all being said, I think being in a metro area (I'm north of boston) makes a huge difference. Also my parents, in Portland, have had many 6-12 week delays in seeing cardiologists, although again they may be being picky.

Agreed Jane, my experience is not unlike yours. Three different health providers and all have been just fine. My current provider (the basic managed care option at my company, a modest utility) is great. I can usually make an appointment the same day if I need to.

-Whit

My dad worked with the AMA, and confirmed that their policy is to have as few doctors as possible. He came away from the experience understanding that the AMA isn't concerned with health care, but with its membership's salaries. In other words, the AMA is to health care what the NEA is to education: an obstacle. Between that and the terrible workload for GPs, it's easy to see why scheduling an appoinment on short notice is a rare feat.

Jane,
Perhaps you have Crohn's disease, as I do. The list of doctors certainly sounds familiar.

When I see my GI specialist I am often asked to come back again in 6 weeks for follow up. Her secretary then tells me that she has nothing open until the first of Juvember; so they double book me.
She does this all the time so that having gotten the appointment I wait (once for nearly 4 hours) in her office. The only thing I can attribute this to is that the insurance companies may be insisting that appointments be for no longer than 15 minutes.

My extended family has had good luck with doctors. An elderly aunt gets good and consistent care for her diabetes. I have a regular doctor I've seen for years and can usually get an appointment by the next day if I want to. Same with my dentist. My wife found a new, more local specialist within a week or two. Two relatives had to wait a few months for hip and knee replacements, but there were medical reasons for the delays and neither was urgent. My uncle received excellent emergency treatment and rehabilitation after a stroke. I can't remember ever having to wait more than a few days to get whatever care I've needed.

Kate, that's a tragic example. Wasteful, painful, and unnecessary. But I don't see how it's actually anyone's fault, except maybe the patient. Doctors can't diagnose accurately over the phone, and they can't abandon their other patients to make house calls. The rehab doctor was probably scared to death to diagnose outside his area of specialty. If the woman was in extreme pain and in need of acute care she should've called an ambulance and gotten that care. Or at very least called a relative or a friend and gotten a ride to the doctor. Instead she decided that the problem could wait. Understandable, especially since no one really wants to assume the worst, but surely she shares some of the responsibility.

I've found, in shopping in my insurance company's provider list that it is difficult to get in to PCPs that were trained in the US and/or went to above average residencies as most are closed to new patients. It's also easier to get into PCPs that are inexperienced.

Access to specialists is all over the map. Some have quick appointment times, some have huge waits. My mom was seen by an internationally known cardiologist for a possible stent placement in one day, but only because she was referred by her local cardiologist (who had trained with him). It's about the only way to get to see him. That cardiologist had to hand her off to a cardiac surgeon as stents wouldn't have worked and the surgeon is again, internationally known. He gets the toughest cases, sent from surgeons and cardiologists in the area.

This weekend we spent 3 hours in an ER so my son could get stitches. This beat the last time he needed stitches, working through his pediatrician and a specialist by about 4 hours.

In both cases, however, my son was triaged almost immediately -- then the wait started.(Failure to triage appears to be the key element in Kate's story; while the Doctor's over-the-phone diagnosis is problematic, anyone involved could have called an ambulance at any time).

So anecdotally, some physicians, some practices, and some hospitals screw up -- they either have bad policy or bad implementation. I'm lucky, apparently. The practice I go to has as a policy that you will be seen the same day if you think it necessary. The ER we visited this weekend had a sign on the wall stating that no patient would be turned away.

But can bad policy and incompetent practice be managed away? What's the transnational evidence on that?

I have had mixed experiences, and I have fantastic health insurance, and live in a large city very near a major teaching hospital.

For my PCP, I go to a large clinic with many doctors, and as long as I don't care who I see, I can be seen anywhere from next day to next week depending on how busy they are. If I want to see MY doctor, I will wait at least 2 weeks to a month.

My PCP sent me to a cosmetic surgeon to have a cyst on my face removed. It was a 2 month wait for a consultation, then a 3 month wait to have the procedure actually done. And this was the 3rd doc I tried, the first few were even longer.

I got an abnormal pap smear result and needed further testing. Initially, the wait for the special procedure clinic was a month, but I was lucky and got a cancellation the next week.

My experience? If you don't care what doc you see for PCP its no problem. To see a specialist, you will WAIT A LONG TIME.

To add a couple of anecdotes to the mix:

Three years ago I developed an obvious case of carpal tunnel syndrome as a likely result of some over-exuberant bench pressing. I got an appointment with my PCP on a couple of days' notice. And I had seen the PCP only once, for a sinus infection, several months earlier (a same-day appointment, by the way), so it's not like I was much of a regular. PCP refers me to a orthopedic surgeon. I was able to get that appointment in less than two weeks. The orthopedic surgeon wanted me to see a neurologist for further testing, and said that it probably would take "a couple weeks" to get an appointment. I never called the neurologist as the carpal tunnel quickly cleared up on its own. And note that none of these appointments were a matter of urgency, as carpal tunnel syndrome is annoying but not in any way dangerous.

Much more recent anecdote: a couple of weeks ago a family member had an eyelid infection, got an appointment with the family optometist within a couple days; the optometrist referred her to an opthamologist and got a same-day appointment.

I'm still trying to figure out how if we had national health care how this would be better? These doctors would be forced at the point of a bayonet to see more people? Work more hours?

How will wait times improve once we nationalize things?

It seems to be the case that left-wing employers select highly crappy healthcare providers. That makes me less willing to trust them with the rest of the nation's healthcare, not more so...

I, too am surpised at the waits. I just chose a PCP, and got a physical. The doctor's office knew it was generic physical / cholesteral / how am I doing test for a brand new patient. My appointment was 6 calendar days from when I called.

My wife, OTOH, has problems scheduling girly doctor appointments. In our state, the wait is pretty bad (her first appionment was like 3 months from when she called the office). However, PA is kinda hard on OB/GYNs wrt to malpractice insurance.

Yeah, I've never needed to wait months to see a doctor of any sort. The longest wait ever was three weeks, and that was when I was trying to get a new doctor during flu season.

It is not a bad idea to require everyone who wishes to do a specialty fellowship to also do 5 years of general medicine. But if you go that route then many more med students would get military scholarships and have school paid for, do 4 out of 5 years as a service doc then one year of general medicine, then fellowship. Also, specialties like radiology, ophthomology, derm, neuro, psych, would not be impacted since these folks just do one year of internal medicine (IM) before specialty training. If you were to insist on 3 years of IM for these specialties then neuro and psych would be mortally damaged since not enough docs are going into these specialties anyway.
As far as market incentives to enter IM or family practice, there aren't any since prices are set by Blue Cross/Blue Shield with the other payers following suit. If there aren't any primary care providers the press and patient blame greedy doctors (but my brother-in-law with a high school diploma makes as much as a prison guard as I do as a specialist)but don't blame the federal payer who sets reimbursement below expenses for most primary care offices. And it will get worse the more government interferes.
BTW, there is a drive to increase medical school admissions by 30% over the next 25 years. A number of small med schools will be opening so if you have a young relative who wants to be a sawbones tell them to look around at the new schools which will be taking students.

Oh, in relation to the prior post about the AMA limiting the number of doctors. The AMA has NOTHING to do with medical training. The main accrediting bodies, which help decide admissions ratios at allopathic (MD) colleges, are AAMC and LCME. These bodies accredit both american and canadian schools, set proficiency and admission standards and are both interested in increasing medical school admissions. The AACOM regulates osteopathic (DO) schools and has similiarly been growing their admissions.

I guess the point of my little story was not that the Pateint's doctor was absolutely incompetent (she was -- she ended up calling the husband of the patient and admitting she had made a mistake) but that even after the HOSPITAL diagnosed (and it was a huge, well respected, private, urban, teaching hospital with an exceptional reputation) the problem they still didn't do anything about for hours.

One of my best friends is an ER doc and said afterwards that the condition is increadibly easy to spot and treat.

The reason the patient didn't go to the hospital the day before was because it didn't hurt. The patient has a medical condition which does not cause her to have a great deal of feeling in her lower extremedies. Her personal physician knew about this. It was uncomfortable and unpleasent to look at but did not become painful until the evening she was admitted to the hospital...after her kidneys had shut down.

The point is, with better access to emergent medical care many of her issues could have been found without her spending a fortnight in the hospital spending YOUR Medicare dollars on the bed, the vascular surgeon consultation, getting her kidneys up and running, not to mention multiple courses of multiple IV antibiotics.

What I'm seeing on this web site is anecdotal evidence supplemented by politically inspired hot air. It's really a pity that Jane's employer or Time or NBC News or somebody doesn't do a report on health care systems here and and in western Europe. If they did, we'd find out the cost of implementing the various forms of universal coverage, the waiting times, the cost, and whatever else we need to make an informed judgement.

Kate,

What I'm missing is how getting the federal government even more entangled in the health care business will fix the problems which Patient experienced.

Does any agency or organization actually collect statistics on appointment waiting times? Or is it all anecdotal?

Mason - the US government does an exemplary job in handling medical care for the elderly and for veterans. This is universally acknowledged. How it would do in running a national health scheme is another matter. It would help if we had any reporting about how things are going in western Europe.
Peter - I'm convinced that statistics are available in government and academic studies on waiting times both here and abroad and on medical costs. However, even our best newspapers refuse to carry articles on such things. As I result, we are indeed reduced to anecdotes.

My guess is that roughly 1/2 of doctors are below average, regardless of the payer system or how many doctors there are, and the quality of care will depend on which half your doctor is in.

To Mike's point, there's an old joke:

Q. What do you call someone who graduated from medical school with the lowest rank in his class?

A. Doctor.

Considering the on-line personalities of some of the more voluble "progressives" involved, I strongly suspect that they expected everyone else to drop everything they were doing and serve them at their convenience w/r/t time, and when the appointment times offered conflicted with their busy schedule, blamed everyone else for their failure to adapt. I do know for a fact that one of the loudest whiners about this has access to one of the finest healthcare plans available in the USA today, and could have, any time he wanted to, walked out his office door and into the nearby hospital and promptly received the attention he needed. But he didn't, so it was everyone else's fault but not his.

Like you Megan, I've dealt with chronic illness for years. I have NEVER had a long wait for any SERIOUS situation, and I can't recall a single person I know who has (except a couple who elected the cheapest alternative plan offered by their employer, one infamous for bad service, but they were "never sick so who cares?" They did, once they needed it). What I do know is that, were the standard guidelines for cardiac care followed 6 years ago, I'd be pushing up daisies right now. (My symptoms were on the right side and the initial EKG showed no abnormality.) Fortunately, I did not have "managed care" and the doctor knew me well enough to arrange a prompt appointment with a cardiologist anyway. Three days later, after tests, he invited me to have my heart attack IN the hospital rather than ON THE WAY to the hospital. I accepted his offer, although it was terribly inconvenient for me schedule-wise.

One word "KAISER" ... When I had Kaiser the waits and the care were awful (e.g. weeks for a MRI, at least one-week to see GP). As soon as I changed from the zero paycheck deduction Kaiser Plan to the few dollars a paycheck deduction Blue Cross Plan the waits dropped to a week or less, I was able to 'fire' the doctor if need be (I was not tied to a particular clinic, could pick another one) regardless of doctor being seen. Lessons learned:"Kaiser sucks" and "You get what you pay for".

Stan,

If you think the US gov't. is universally recognized as doing an exemplary job at healthcare for veteran's and the elderly, you need to get out more.

Or just read the news.

I have spent the summer updating medical and dental appts for my 3 kids, finally having battery of visits/tests for myself (haven't been in 5 yrs). I accomplished all appts in a timely manner. I am from a family of doctors/nurses (who live elsewhere). The propaganda of Sicko, e.g. cherry-picking domestic medical horror stories while showing only the most glowing cases abroad is a disservice and frankly an insult to the generally outstanding care we receive in this country. The insurance costs/system are a problem, but can you imagine the GOV'T doing the medical care bureaucracy more efficiently? Think your state dept. of motor vehicles and the IRS and then multiply the size of the bureaucracy exponentially to administer health care to 300 million people. Gov't healthcare will not be any more efficacious than gov't schools, etc. Why doesn't Moore et al carry the horror stories of patients in Canada and the UK who wait 6+ months for MRIs or bypass surgery. One of my brothers-in-law is a surgeon in upstate NY. He reports that he operates on many, many Canadians who can no longer wait for serious surgery and come across the border to obtain treatment at astronomical expense. He also reports that Canadian doctors are leaving the much vaunted socialized system. He's seen five in the last two months relocate to his small city.

WE cannot let the biased media and certain political candidates lead us down the primrose path to a single-payer system without insisting on full disclosure.

Ask the questions about wait time for major problems. It is no accident that we have a private system and the best technology and treatments in the world.

I know we have to reform our insurance/drug cost system, but there are other ways to do it without creating a Hobbesian leviathan that will consume all of our tax dollars and leave us with lousy care. Only the elite with unlimited savings will be able to afford timely surgery, etc. in private hospitals when this is all over. The rest of us will have to take what the government mandates.

Beware!

I don't believe them. I had one experience when it was tough to see a Dr. When I was a small child our family dr retired and recommended a new Dr who had just started a family practice. I had him for approx 20 years, but around 1974 he went into the abortion business. This is in Wichita, Ks so it isnt hard to figure out who this was. He was always busy "in surgury" in his office and always ran behind, so you could count on a hour wait or better even with an appointment. I was young and had no medical problems and had times with no insurance so the only time I would go was if there was some problem with me. There was a gap from 1980 to around 1993 where I didnt go to the Dr at all. Around 93 I came down with a severe case of the flu. I called the Dr's office and was told they had no record of me. I told them I had been a patient of him since 1964 and that all my medical records were in his care. They told me that they had shipped my records to storage, and that the Dr was not accepting new patients. I argued with her and she said the Dr would call me back. He never did. I called around and found a Dr that was seeing new patients. I tried to make an appointment, but the earliest they would see me was 10 weeks later. I pointed out I doubted I would still be sick then. I could have gone to the emergency room, or one of the quick care facilities scattered around the city, but I didnt think I needed emergency care, so EVEN with my old Dr being a dick and being unable to find a new Dr, I still had a couple of options. 15 years later in a small town in Nebraska, my coworkers became concerned about me and made an appointment with the clinic that handled all the employees at that business. I am a contractor and therefor they had no obligation to see me, but they took me right in, diagnosed a severe problem, sent me to a heart specialists who saw me the same day. Sent me to the hospital for a echo-cardiogram that day. I ran a tab of $35K of which insurance paid for $31.5K of it.

In my experience, I have to wait longer to see my hair stylist than I do any doctor.

Jeeze, you all don't know nothing. The trick is to be friends with at least on doctor.

Me: "Hey Bob, my stomach hurts"

Dr. Bob: "Well Jim it might be your appendix, let me call my frind Joe the surgeon and he will see you this afternoon."

Me: "Thanks."

No fuss, no muss, this is how it works in Canada.

If you don't have a physician it can be tough. Although, the "Doc in a Box" clinics seem to take just about anyone. I can usually get an appointment within a few days.

When I worked the night shift at a large cell phone manufacturing plant, people would skip a day of work and show up the following day with a doctor's excuse. This happened all the time and most of the people were just scamming, yet they were able to see a doctor in less than 24 hours.

Which brings up another issue. How much effect on appointment wait times do people who go to see doctors when they don't need to, to get out of work/school or just to scam the system to get SSI have?

I've never had to wait long but then I only go to the doctor with broken bones, rupturing organs and illnesses the persist.

There will always be people who are willing to sacrifice everyone else's freedom so that they do not have to take personal responsibility for themselves. I am sorry that some people made some bad healthcare decisions about where to go for treatment first, but I am not up for a single payer system that, like Canada, gives almost instantaneous treatment for politically important diseases like breast cancer, and develops new drugs for ... wait for it, cervical cancer, but cannot find the time to diagnos ordinary lumps found in ordinary people.

It takes me longer to get a pair of pants altered than it does to see a doctor. Is this a great country or what?

Just a little arithmetic note...

Imagine that you have a system (call it, to pick a name randomly, the VA Health system) where 90% of the patients are served by 10% of the system, and 10% of the patients are served by 90% of the system.

-- When examining the system, 90% of it will be underutilized, and since the doctors and nurses and other employees in that 90% of the system will have abundant time and other resources, 90% of the system will be delivering excellent health care all of the time.

-- When examining the patients, 90% of them are dealing with frightfully overcrowded systems which are desperately trying to keep their heads above water and not screw up too badly too often in their rush while simultaneously not having too many people die waiting for care because they are not rushing enough.

I have three kids with a fourth coming soon, so we see doctors regularly. I've lived in a large metro area and now live in a smallish town. I've never had long waits, although when I tried to get in with a particular OB in the large metro area it was going to be 3 months, but another doctor in the practice was available immediately. We can always get an appointment with *one* of the docs in the pediatric practice same day when we need it. I might have to wait a couple of weeks for an initial OB visit, but if I need to see him urgently I can. My internist even opened up a spot for me, when I had never seen him before, because the emergency room doc had said I needed to see a regular doc right away. He saw me at lunch time.

It does help to have already established a relationship with the doc *before* you need urgent care. However, I have friends with no insurance who are able to find care right away, outside of the emergency room, when they need it, at urgent care clinics and other places geared to that type of situation. I'm sure in some parts of the country the situation is different, but for us these long waits have not been a reality.

Broke my arm on a Fridsy, it needed an operation, out by Monday noon. Needed regular visits for six weeks, scheduled physical therapy, no wait. Me and my family could always ger same day visits when needed and only twice needed the emergency room (one evening and the other late night). I can't imagine what everybodies problem is. And yes I live in the US

"Please keep in mind, had her physician seen her the day she called this would have been diagnosed immiately or if the physician told her to go to the ER she would have."

I think, given the symptoms, the patient here ought to made her own decision and headed for the ER once it was clear that the PCP office wasn't going to be helpful.

If you physically can't get to the doctor's office, this is just about the definition of emergency.

"Female patient has been going to the same primary care physician for years. Something happens to her leg. It gets all swollen up and the coloring is mottled. She calls the doctor to ask for an appointment, but, since she can’t walk on the leg without unbelievable pain, she can’t get into the office."

Kate:

Having also dealt with a leg infection that required a hospital stay, perhaps I can offer some advice to others. What your doctor did with the "take two Tylenol and call me in the morning routine" is not right, but my Momma always told me that it is your health and your life on the line, and if you have a serious medical condition, you have to communicate the seriousness of your condition.

As a medical culture of patients and doctors, as emergency conditions we take bleeding trauma very seriously, we take heart attack and stroke very seriously, but we tend to regard skin infection as a non-life threatening condition, where it was indeed a serious life threatening condition in the pre-antibiotic days to which we are slowly returning.

If you has a leg that badly infected that one cannot walk without serious pain, in my book that is an emergency condition because in your case in could have taken your life and it almost took your leg. That infected that it hurts to walk can progress to toxic shock within hours or less.

In my experience, the way the system works is that there is not much that is ever done over the phone. One has to get one's corporeal self over to the ER, the Urgent Care, or even to the doctor's office. If your HMO is all hot and bothered about use of the ER if you are still conscious and standing, just go over to your doctor's office without even bothering to telephone for an appointment -- just wave that swollen leg at a medical receptionist, and trust me, you will be properly triaged the same as going to the ER.

Over the phone, rash and swollen and leg hurts can be any number of conditions, but waving that leg in front of even the initial medical reception gate keeper will get the necessary attention. I believe the way the system works is that a medical case over the phone is something you can blow off, but a medical case on your doorstep activates the Good Samaritan, Hippocratic Oath, and Medical Malpractice Lawyer in the Next Office Suite all at once.

In your case you hurt too much to go down your apartment stairs, you either need to get a friend, a co-worker, a neighbor, or anyone you know to help you down those stairs and get you to that doctor's office, or if those options are not available, call 911 (What is your emergency? My leg is infected and hurts so bad I can't move.)

Every employer who runs a health care plan is into cost containment mode and is playing doctor by telling people for what conditions you can go to the ER (you had better have a stroke, heart attack, or a gunshot that is more than a flesh wound). What they don't tell you is that simply walking into your doctor's office during office hours functions as an ER for your leg infection -- one look at the leg will activate the Good Sam, Hippocratic Oath, and Lawyer-in-next-suite. The calling on the phone thing does not do anything and flopping your body over the door threshold of the doctor's office, urgent care, or ER is your responsibility.

The one thing I would fault health insurance and their cost-containment mode (the pressure comes from your employer or insurance company, not from your doctor, yet) is that they guilt people into believing that folks seeing doctors for "minor things" is driving up the cost of health care, and they put people into the mode "gee, is this really this serious, could I just wait it out?" Ford's Alan Mullaly now thinks he is a health care practitioner. But just remember that bodily presence activates the Good Sam, Hippocratic Oath, Lawyer-next-door modes.

The wait can depend on the specialist too. Down here in Texas getting to a dermatologist can be a long wait. When my daughter developed a persistent rash it was a 2 months before we could get her in.

I asked the doctor about the wait. She said there has been a marked increase in people not knowing how to handle sun exposure. Higher levels of melanoma being her situation. 1 out of 5 people she sees are in for that ailment having been referred by the GP.

Mock New Jersey all you want, but the experience of my family with doc's of all types has been great. Last fall, I began having numbness in my arms and neck pain. X-rays showed severe disc degeneration in my neck. When the insurance co. refused the MRI recommended by my PCP, I scheduled an appointment with one of the most respected neurosurgical groups in the state, within 1 week. The neuro knew by a few simple tactile tests that I had spinal cord compression (spinal myelopathy), and had the MRI and 2 other(ssep & emg) tests set up that day. When the test confirmed the diagnosis, Surgery was scheduled and completed about 2 months later.

When my Mom had symptons of heart disease, she did some research, picked one of the largest cardiologist groups in the state and was seen within a week. One week later she had an angiogram, and a triple bypass 3 days later.

The only time I had any problem was trying to get a dermatologist to look at some growths on my shoulder. The first one I tried to see had a 3 month wait, probably because she was well known, profiled as one of the "Best Docs" in NJ Monthly, etc. However, I asked around, found another dermo who I saw within a week and told me to have the growths removed, but it wasn't something that had to be done stat. So, I waited my 3 months to see the doc I originally wanted and had her do the removal.

Although many may find it hard to believe, Jersey is actually a great state to live in. Even though the cost of living is higher than other states, we have great schools, the shore, plenty of rural areas and proximity to NY city, and the highest per family income in the nation. Its not a bad place for a doc to practice.

"Female patient has been going to the same primary care physician for years. Something happens to her leg. It gets all swollen up and the coloring is mottled. She calls the doctor to ask for an appointment, but, since she can’t walk on the leg without unbelievable pain, she can’t get into the office.

The Doctor’s receptionist calls back, says that the doctor can’t treat her if she can’t walk down the stars to see her. Receptionist says Doctor says that it sounds like a rash and to elevate the leg. Doctor never speaks to patient.

The following morning the leg is worse…significantly. Patient knows she has appointment to go see a rehab doctor regarding something else that morning so she does not take any action for the leg, figuring someone will look at it around 11am."

She refused to go to the doctor because her leg hurt too much to go yet she manages to make it to a rehab doctor the next day? Sorry, her problems were caused by her not going to the doctor in the first place or calling an ambulance if she thought things were so panful she couldn't get out of bed.

As to my own experiences. I have been a member of four different HMOs and I have never had a problem getting into a doctor relatively quickly. Appointments with primary care docs take at most a week, and many times they fit me and my family in on the same day. And once we have seen the doctor for something, it is regular practice for them to even skip an appointment and give us a prescription over the phone for a known ailment. Also, my wife and one of my sons have had serious problems which required them to see specialists and they have managed to get those appointments in no more than a week or two. Finally, I had an injury that required referral to a surgeon which was done in a few days.

I don't buy these long waits either. Something stinks and it isn't always the health care system.

I was experiencing unusual bowel habits earlier this year. I got into to see my primary care physician within two days. She referred me to a gastro specialist.

When I was informed that it might take a month to see the specialist (this is around the Christmas/New Years Holidays), I asked if I could find my own specialist.

And I did. After a about half a dozen calls I found a specialist that could see me between the holidays. It took less than a week to get in. And ultimately, I got a colonoscopy done three days after that.

All it took was some legwork on my part to find and contact a doctor.

I'm always skeptical of the anecdotes regarding long wait times. And not just whether the stories are true, but whether the effort is being put in by the patient to speed things up.

Comments on the lack of GP's: One of the detractions of the HMO or PPO systems is that it pays for procedures and not for diagnosis. This has led to the explosion of specialists, because usually the PCP gets very little for diagnosis/referral, but the specialist gets paid for the actual procedure. This also explains the proliferation of non-general hospital care centers (Heart centers, MRI centers) since this takes the profit centers out of general hospitals. I don't have a ready solution for this issue without creating an even bigger issue, so I would welcome comments.

Also, I was recently diagnosed with a Pititary Adenoma which required MRI's and surgery (my peripheral eyesight was affected, therefore I could not drive). I went from diagnosis to surgery within 3 weeks. I tried to find out via internet what the wait would have been in Canada, and found a patient complaining that they would need to wait about 9 months for an MRI, another 6 months to see a surgeon, and probably a year after that for the actual surgery. With all its issues, I'll still take the US system.

Regardless of which side of the political divide you are on, no one wants health care to be under an entity headed by someone with the honesty of Bill Clinton or the wisdom of George Bush.

My last episode of medical care forced me to endure a minutes-long wait in an emergency room and a four day wait for a specialist. It is still on-going, so I don't have data on how long it will take between the final decision to slice and the actual surgery.

The mistake Yglesias is making (or perhaps, the deliberate deception he's engaged in) is that the claim isn't that you never wait in a free market medical system, but that you almost always wait in a centrally planned medical system. That emergencies can get delayed care, that critical medical attention can be forced to wait for weeks or months in a government health care plan.

Hmmmm.

1. I'm sorry but if you've got problems with your leg to the point where you cannot walk, then you call 911.

2. If you've got problems with your leg *and* you have a history of numbness or lack of feeling in that leg *and* you can no longer walk then you most definitely call 911.

3. Personally I've had 3 bleeding ulcers, 2 of which almost killed me as I nearly ran out of blood each time, a few near-fatal blood infections, a history of high blood pressure, congestive heart failure, end stage renal disease and a host of other issues.

The worst experiences in terms of wait times was 1 week for a visit to the PCP because my old PCP had died and a new doctor had taken over the practice. Otherwise it's been pretty quick.

Actually the longest wait I've had to deal with was in finding a new dentist. But that wasn't much over a couple weeks and was during the holiday season.

I made a mistake in a comment of mine about health care for veterans. Prior to the Iraq War the VA system provided very good care, as I said. However, it failed to anticipate the number of Iraq War casualties it would have to treat, particularly closed head injuries, and its treatment has indeed fallen short. The problems are even more severe in the case of medical care for active service members. I think this is due partly to a Bush administration practice of making appointments on the basis of politics rather than ability, and partly to the administration's assumption that Iraq would be a cakewalk. This is not, in my mind, an argument against universal health care.

How is it that the same people who think the VA Health system is irreparably broken ( and it might be) think MORE government involvement in healthcare is the solution? Anyone who's ever tried to get a cavity filled by a Navy dentist will probably tell you, another layer of bureaucracy is not the answer. When I was on active duty, I had a UTI ( common and incredibly annoying female issue) but was told ( I am not making this up) that the base doc's only do urine tests on tuesdays and thursdays. I paid to go to a walk-in urgent care clinic where I was seen, tested, diagnosed and given some samples while I waited for the prescription to be filled by the base, in under 2 hours. And then my government insurance refused to pay because I could have used the base doc, three days and possibly two raging kindey infections later. Yep, that's the system I want for everyone, if I was Satan.

Posted by: Peter on July 24, 2007 10:15 PM

Does any agency or organization actually collect statistics on appointment waiting times? Or is it all anecdotal?

HHS' Agency for Healthcare Research & Quality may collect or fund studies that collect this information.

ironmike:
"It is not a bad idea to require everyone who wishes to do a specialty fellowship to also do 5 years of general medicine. "

Actually, it's a terrible idea. General medicine is not medicine for dummies. To be a good primary care doctor you need to understand primary care!

Also, would you like to be told you have to do something for 5 years you have no desire to make a career out of? After 8 years of university education and before 3 to 7 years of postgraduate training in the specialty you actually want to practice?

"I am flabbergasted by the number of progressives who have to wait months to see a doctor."

People are wimps, that's why. I went through a period of recurring strep and I always had a conversation with the receptionist like this:

"I need a strep test. Is there sometime today I could come in?"

"The next opening Doctor has is Thursday, October 18, 2009."

"That's ridiculous, I'll just go to the ER. I'm in the HMO, by the way." (Which they know and I know means they'll help pay for my ER visit.)

"Um... he could see you at 10:15."

Really not that hard.

Just why anyone thinls the US has a market-based healthcare system is unclear. National health care proponents Himmelstein and Woolhandler reviewed OECD data from 2001, showing that 44.6% of health care expenditures in the US were paid by public systems such as Medicare, Medicaid, the VA and other military care, public health clinics, and other programs.

However, when one includes tax subsidies and public employee benefits, the current tax-financed share of health spending is nearly 60%.

That is, the majority of the US system is government-run or financed already. The ripples are wide and deep, and account for the supposed "private system" problems described. Now that WalMart and other stores have their own MDs, this claim of "months" for a wait is bogus. It only refers to closed systems that regulate choice, or describes an individual patient's ability to see a certain select doctor.

My wife is a primary care physician in Bolingbrook, Illinois (Chicago suburb) starting up an independent micropractice and she would certainly want to know where are all these patients frustrated at long waits as she could use the business.

She's offering same day appointments and will be reserving a couple of appointment slots so that even when her practice is full, you can still get in the same day if you call early enough. And regarding the "I can't get to the doctor" examples above, she does house calls if your insurance will cover the cost or you're willing to pay for it.

Stan - You suggest that all was well with veterans care in the US until that BAD MAN Bush came along with appointments based on politics rather than competence? Lets leave aside the delusional (and it is nothing less than that) view of veteran's care in the US as anything other than dysfunctional, and deal with the second part of your comment. Even if we assume that Bush's appointments are somehow the cause of some dramatic decline in the quality of care for veterans (care to offer any evidence?...didn't think so...), this only makes the argument against government run healthcare even stronger.

One of the most effective critques against government run healthcare is that it is likely to be politicized. Consider the simple question of funding priorities...AIDS affects only a small (though politically well-connected) minority, yet it receives a vastly disproportionate level of funding. One might care to debate the relative merits of various prioriies in funding both for research and care, but to suggest that politics don't enter into it is nonsense. A market-based system tends to punish 'poor' funding choices over time, but there is no such feedback in a government run system.

As for simple political agendas, consider a scenario where a President Bloomberg is faced with making appointments for those who run some future Federal Health Agency...want to make some bets on how political (as opposed to merit-based) those choices are going to be?

Interesting reading through the comments, as I'm in clinical training now and have experienced the long wait times from the other side (it's no fun for the doctors, either).

Stan--I sincerely doubt that are any easily-accessible databases or accumulated data on patient wait times. I had to sweet-talk a nurse into sweet-talking an outpatient clinical office manager into releasing a single day's data on when our patients had checked in vs when we had actually seen them. (It had been a particularly horrific morning in terms of wait times for our patients, due to a software program the schedulers' were required to use to book patient appointments, which allowed them to schedule patients without regard to whether we actually had rooms available to see them in.) Probably the data would only be acquired as a function of the public relations office, where people try to gauge patient satisfaction. Most of the data I've seen come out of those offices are questionnaire based, and while they might ask the patient if they felt like they had to wait too long, they don't actually acquire the data of how long the patient actually waited.

Hey, I just did a PubMed search on "clinical wait times" for studies. I only skimmed the first 40 titles (of 127), but of those that related to "wait time to treatment," 18 of were done either in Canada or Britain (the majority in Canada). Those done in the US focused almost exclusively on ER wait times. This would lead me to believe that the data Stan is referring to may exist in countries with nationalized health care systems, but I really doubt it's readily accessible in the states. Too many different systems.

This is a long post, but I had to include this quote from one of those abstracts I just skimmed:

"In Canada, it appears that current wait times for urological surgeries, such as for bladder cancer, are beyond the threshold recommended by national and international expert bodies."

Dude, that's a problem.

I also just read than in 2004 the average wait time for an MRI was THIRTEEN WEEKS in Canada. Granted I've spent my entire professional life in tertiary care centers, where we pitch FITS if we can't get an MRI for our patient within 24 hours. What's the experience out there? Once y'all get to see a doctor, have you ever had trouble getting the tests recommended?

Interesting reading through the comments, as I'm in clinical training now and have experienced the long wait times from the other side (it's no fun for the doctors, either).

Stan--I sincerely doubt that are any easily-accessible databases or accumulated data on patient wait times. I had to sweet-talk a nurse into sweet-talking an outpatient clinical office manager into releasing a single day's data on when our patients had checked in vs when we had actually seen them. (It had been a particularly horrific morning in terms of wait times for our patients, due to a software program the schedulers' were required to use to book patient appointments, which allowed them to schedule patients without regard to whether we actually had rooms available to see them in.) Probably the data would only be acquired as a function of the public relations office, where people try to gauge patient satisfaction. Most of the data I've seen come out of those offices are questionnaire based, and while they might ask the patient if they felt like they had to wait too long, they don't actually acquire the data of how long the patient actually waited.

Hey, I just did a PubMed search on "clinical wait times" for studies. I only skimmed the first 40 titles (of 127), but of those that related to "wait time to treatment," 18 of were done either in Canada or Britain (the majority in Canada). Those done in the US focused almost exclusively on ER wait times. This would lead me to believe that the data Stan is referring to may exist in countries with nationalized health care systems, but I really doubt it's readily accessible in the states. Too many different systems.

This is a long post, but I had to include this quote from one of those abstracts I just skimmed:

"In Canada, it appears that current wait times for urological surgeries, such as for bladder cancer, are beyond the threshold recommended by national and international expert bodies."

Dude, that's a problem.

I also just read than in 2004 the average wait time for an MRI was THIRTEEN WEEKS in Canada. Granted I've spent my entire professional life in tertiary care centers, where we pitch FITS if we can't get an MRI for our patient within 24 hours. What's the experience out there? Once y'all get to see a doctor, have you ever had trouble getting the tests recommended?

Marvel - at what level are you in training?

I'm an anesthesiology resident, just started my third year of training post-med-school. (The medical internship/residency/fellowship year runs from July to June.) My wife is a neurology resident, a year behind me.

I HATED clinic-based practices in medical school; not that I didn't see and understand why people did them, but I had no interest in them. Furthermore, although more education in more fields of medicine is always better, eventually people have to get out and earn a living, and telling them to work five years (and presumably at a resident's salary?) before pursuing an additional three to five years of specialist training is just going to kill any value to doing medicine. Remember your 20s? The time you spent hanging out, dating, maybe getting married, maybe even having your first kid? Medical school takes four years of that and puts you in a library studying. Residency takes three to five years, plus any fellowship you do (an additional one to three years), spent in the hospital. In one of the most cushy fields of medicine (in terms of lifestyle), I spend five to six nights a month in hospital (two of which are weekend days, meaning a full 24 hours in house; the others are 3pm-7am). I work about 65-70 hours a week. I have, now, six years of postgraduate training. I am paid $42000 a year. Most of my friends were making not much less than that straight out of college, during which time they were not accumulating debt at the rate of $30k/yr (and that's for a state medical school, where tuition is

Anyway, the most telling story from my perspective is Lucas'. Over a matter of $75 for an ER visit versus $25 (or thereabouts) for a clinic visit, you really considered not seeking a professional opinion about a life-threatening illness that you strongly suspected you might have? The last time a bathtub in my house stopped up - on a weekday - I called a few plumbers. I found one who could come that day. Come they did, and dig, and roto-root, and for an hour and a half of work that required at most six months of training, a thousand dollars' worth of equipment, and a willingness to get dirty, the firm was paid $180. Call around to doctors' offices next time you need a visit and offer $100 cash on the spot for an appointment within 1 hour. Tell me how many refuse.

That said, delays are awful in some specialties. My wife's clinic has a wait time of 6 months for an appointment; this is in no small part due to the enormous number of no-show patients they have. If you were to show up and wait for a cancellation at one of the three clinics a week they hold, you would be seen within a week or, at most, two. That clinic is one that does not discriminate on ability to pay; no matter your situation, you will be seen and treated for all illnesses, emergency or otherwise. The ones that do have rather shorter wait times - not surprisingly, people who pay for their own health care are quite a bit more reliable about showing up for appointments.

People without health insurance are overwhelmingly not the beloved media icons of the single mother (children are covered by Medicaid via the CHIP programs in every state in families making up to around 3x poverty level) or the elderly poor; they are people who either are young and (almost always correctly) believe that they will never need treatment that will be refused (e.g. trauma, which under EMTALA must be at least stabilized), or those who refuse to take the initiative to care for themselves. There is a common refrain amongst doctors who care for such folk, which was best summarized thusly: I will work as hard as possible and bend over backward for you, but I will not work harder than you do. It is frankly astonishing how many people do not believe that they bear any responsibility for their health.

No more ranting. Great post, great discussion.

Stan,

I have friends who actually use the VA system and none are overly enthusiastic about the level of service.

First, many have to drive hours to a VA clinic or hospital to receive care. If they need to see their doctor, they have to dedicate an entire day to the trip, not just a couple hours.

Secondly, its my understanding that the VA formulary, which is the list of approved drugs the VA will provide, is missing many of the major medications introduced in the last 10 years or so. The formulary leans heavily toward generic drugs to keep costs low, which precludes access to many namebrand drugs protected by patents.

Finally, a friend who needed knee replacement surgery had his procedure postponed time after time for more than a year before the VA scheduled the operation. In the meantime, an otherwise healthy 55 year old was stuck at home collecting disability because he couldn't walk. It took phone calls from our Representative and Senator to finally get the VA to proceed with the necessary surgery.

Had the above individual had private insurance, he could have had the surgery and completed rehab within weeks.

As for Medicare and Medicaid, these programs don't provide care, they write checks to care providers and some of those checks are insufficient to cover the actual cost of the services provided.

I personally know of one pharmacist who stopped accepting Medicaid patients because the paperwork hassles, insufficient payments, and payment delays as long as six months made the whole ordeal not worth the time and effort.

I also know several physicians who would prefer not dealing with Medicaid patients for the same reasons, but their sense of duty to the community and humanity has so far prevented any of them from dropping those patients, but that day is coming fast.

Now, on the positive side, my dad recently had emergency bypass surgery and Medicare readily covered the $250,000 cost.

It took one day to get dad an appointment with his PCP. It took one week to see the cardiologist. It took 24 hours to get into the catherization lab. And two hours later he was undergoing open heart surgery. Seven days later he was home.

Overall, the process was very responsive, but if my dad had been made to wait three to six months just to see the cardiologist, then he would be dead today.

Make government the single payer for health care, then government will ration the care to control costs, which means long wait times for necessary procedures, which means people die waiting in line like they do in Canada.

No thanks.

Dogwood, I appreciate the courteous tone of your message, and I realize I may be wrong about the VA. My sources of information say different things than yours, and I really don't know who's right. On another matter, I don't understand your argument. All Medicare does is make payments. It's not like the National Health in Great Britain, and it wasn't intended to be. It's just an insurance agency. That's all it is, and it's unfair to criticize it for not providing medical care. Furthermore, criticizing it for not being more generous in its payments is a little ingenuous. The current administration would like to kill Medicare by lowering payments and then saying "See, Medicare doesn't work." This is the classical definition of Chutzpah. Finally, and I think this is missing from this thread, some form of universal health insurance will come in the next few years despite libertarian objections. One sixth of the American population is without health insurance, and this proportion will surely rise as American industry cuts its medical benefits. If you don't believe me, read any Detroit newspaper. When the fraction of Americans without coverage gets large enough, the political system will respond. Trying to pretend that you can hold this back is like King Canute ordering the waves to cease. The challenge for libertarians (and for semi-socialists like me) is to meet people's legitimate needs for afordable medical care while containing costs and keeping as much of our freedom of choice as possible. Instead, what I see in most of these posts is blind opposition. I think it's stupid.

Stan,

Many of the uninsured are uninsured because they don't want to pay for insurance because they think they don't need it.

Large numbers of the uninsured are people in their 20s who believe they are invincible and therefore don't need or want to pay for insurance.

Others are in between jobs and their new coverage hasn't kicked in yet.

Some, however, are uninsured because they want and need insurance but can't afford it, or have pre-existing conditions that make it impossible to obtain coverage at any price.

One of the mistakes people make in prescribing solutions to the uninsured problem is assuming that everyone who is uninsured wants insurance. Some simply choose to spend their money elsewhere, which is a rational decision requiring no governmental interference or intervention.

Creating a government-run universal health care system simply because some people refuse to buy insurance on their own seems to be a solution in search of a problem.

There are folks who need assistance, but they are a minority of the population. Meeting their legitimate needs should not require trashing the existing system that serves the majority of people very well while providing us with the latest advancements in medical technology.

My comment about Medicare only paying bills was not a criticism, it was made in reference to a previous commenter who stated that the government does a good job providing health care. Probably a poor way of trying to clarify the issue. My bad.

Dogwood - Again, I appreciate the tone of your message. I promise this is my last post on this thread.

Frankly, I don't know how many of the medically uninsured are people in their 20's who feel invulnerable and how many are people who need medical insurance but can't afford it. I'm convinced there are statistics out there that can answer this question, just as I'm convinced that data from the countries that presently have universal medical insurance could tell us a lot about costs and waiting times for elective surgery. I'm also convinced that papers on this subject have been written, but are buried in the journals on medical economics. I'm frustrated less at the opponents of universal medical insurance - you have the same right to your views as I have to mine - than at the failure of the American press to address this subject.

Creating a government-run universal health care system simply because some people refuse to buy insurance on their own seems to be a solution in search of a problem.

No, you have looked the problem square in the eye and completely missed it. The problem with the people who refuse to buy insurance on their own is that they will get health care anyway. A combination of laws against refusing treatment, social programs for the poor, ethical standards of health professionals, and their community's charitable impulses will make sure that they will get treatment even if they didn't pay any insurance premiums.

And it's not just the premium-refusers who get sick who are the free riders, all of the insurance-refusers are free riders. Before anybody gets sick (back in the stage where they are deciding to refuse insurance) everyone has an risk of getting sick, and no one knows for sure which people will get sick and which won't. It's like if you stole 1 million lottery tickets each worth $1. You would be guilty of stealing $1million worth of stuff. You don't get to wait until after the lottery drawing, and then if the winning number isn't one of the ones that you stole you claim that you didn't steal anything of value, or if the ticket was there and the payout was $500,000, then what you stole was only $500,000, and the other 999,999 tickets were worthless. No, the value of what you stole is the value at the time the you stole it.

It's like if you bought 100 lotto tickets at a store, and then broke back into the store and stole $100. Nobody looking at the security camera footage of you stealing $100 from the till is going to be at all affected by your claim that it wasn't really stealing because none of your tickets were winners. If one of your tickets had been the big winner, then you would have been entitled to the winnings, and your burglery came before the lottery drawing.

Stan said

One sixth of the American population is without health insurance

So instead of focusing on the 15% Stan's solution is to blow up the medical system completely and put everyone in a health program run by george bush.

If we approached the homeless problem this way the government would bulldoze the homes of everyone and build new public housing for everyone.

That idea does not make any sense and neither does nationalizing the healthcare system.

Comments are Closed.