Health Care in US: a family's perspective

[Rajiv]

Re: Health Care in US: a family's perspective

This site because of it's posters wordwide locations and expertise has given me so much information. I seriously feel I may throw up.

A fairly recent chat with an Indian social worker in a large Indian hospital attached to a medical college

Every prescription from the doctors in room number xxx has the patients name, age -- no diagnosis -- only the word "ultrasound" -- it doesn't matter what the patient compalins about. The patient will go and get an ultrasound of any organ done from a private lab and will be charged Rs 500, and the doctor will get a kickback of 40% -- and, of course, they can only do this to the poor and uneducated, who are the main visitors to the OPD of this hospital. The rich and the educated will question the doctor if this happens to them.

[jhurt]

Re: Health Care in US: a family's perspective

Good article which brings up an important issue. I'm a physician. In reading the posts I think we miss the main issue in assigning blame to a few "unscrupulous" doctors or those "evil profit-driven" corporations:

The reason we use so much medical care in the latter part of life is because we were not designed to live so long. But for the vast majority of my patients death is the enemy to be resisted at all costs. Physicians nor corporations force dialysis or by-pass surgeries or insulin or "x" on anyone...our society seeks this out. Very few people are OK with dying. And so when grandma comes in at 90 years old with a hip fracture then the family says "Fix it." Doesn't matter that statistically she'll probably die in a year regardless and that she would be relatively pain free within a couple of weeks.

Reminds me of people who complain about paparrazi. The paparazzi are not the problem. The people who buy the magazines and create the demand are the problem.

Instead of looking for blame in the medical field or government or corporate America we should be looking to ourselves.

Truth is, people like Palin et al demonized Obama for implying ANY limits on medical care. Well, I'm very far from being an Obama fan but I can tell you that IS the future. We all want our cake and want to eat it to...fact is, as our baby boomers retire and age we simply cannot continue to pay for all these procedures and meds...much like our current pension crisis. Medical care is a big part of the impending "Poom" event and when it happens we won't be able to continue to live in this fairy tale world. Grandma gets a hip if her kids can pay for it...otherwise, palliative care.

I'm not saying that's right or fair...it just is...like it or not. But maybe we'll remember what is really important (this for another blog) and spend our time and resources there. Afterall, I am a dying man. I can fight it as much as I like but eventually we all lose.

[ThePythonicCow]

Re: Health Care in US: a family's perspective

Good article which brings up an important issue. I'm a physician. In reading the posts I think we miss the main issue in assigning blame to a few "unscrupulous" doctors or those "evil profit-driven" corporations:

Blame is often confusing tool. To fix something, we reasonably enough ask what, or who, went wrong. But when we lack a sufficiently valid shared understanding of the systems, dynamics and entities involved, we lack a proper basis for understanding either blame or remedy.

The reason we use so much medical care in the latter part of life is because we were not designed to live so long.

Chronic illnesses in people of advancing age are a recent epidemic.

In eons past, people more often died of trauma (the saber tooth tiger or the tribe over the hill won.) In centuries past, people more often died of infection (infectious disease spreads more easily in denser populations.) Either way, a few would make it to a ripe old age, often mobile and clear minded right up until the end, and even those with serious infirmities would be cared for by family.

Nowadays, in Western nations, we've substantially reduced death due to trauma and infection. However we have a rising epidemic of chronic illness (cardiovascular, cancers, auto-immune, etc). Many more people are infirm or chronically ill for many years, and almost all of these seriously unhealthy people receive substantial and ongoing medical care from professional providers.

I really do not think our bodies were designed to be obese, hypertensive, tumor ridden, brittle boned, inflamed and otherwise chronically ill. A substantial majority of us have bodies that really are designed to "live so long", and to do so relatively functional up until the near end. The industrialized chemical industries known as agriculture, food processing and pharmaceuticals are primarily responsible for this epidemic of chronic illness, in my view.

With proper nutrition, with avoidance of excessive toxic compounds, and with the good fortune or caution to avoid traumatic death or dismemberment, most of us can live to a ripe old age, mobile, clear headed and functionally healthy until the end is near.

Physicians nor corporations force dialysis or by-pass surgeries or insulin or "x" on anyone...our society seeks this out.

The mass marketing and other propaganda campaigns of major medical equipment and pharmaceutical businesses are succeeding.

Instead of looking for blame in the medical field or government or corporate America we should be looking to ourselves.

Ultimately it is always our responsibility, for the solutions can come from nowhere else. But only a proper understanding of what's going wrong can guide us to better exercise our responsibility.

Truth is, people like Palin et al demonized Obama for implying ANY limits on medical care. Well, I'm very far from being an Obama fan but I can tell you that IS the future.

Medical care is always limited, always a finite resource. Hopefully Palin was not decrying ANY limits, but rather decrying a major role for the U.S. Federal Government in establishing those limits. That's not its job, or at least should not be.

P.S. -- Oops - sorry Jay. Looks like I wandered off-topic again.

[Jay]

Re: Health Care in US: a family's perspective

A fairly recent chat with an Indian social worker in a large Indian hospital attached to a medical college

Not that it changes the ethics, but so I have a better understanding of the degree, what does Rs 500 mean to a poor Indian? Is that a soda or a years rent?

[Jay]

Re: Health Care in US: a family's perspective

P.S. -- Oops - sorry Jay. Looks like I wandered off-topic again.

I would just rather this not turn into an alternative medicine vs. westernized medicine rant. We have had plenty of excellent threads discussing that very subject.

[Jay]

Re: Health Care in US: a family's perspective

Maybe it all does start with debt, maybe my mind isn't big enough to comprehend it but it hasn't sounded convincing to me so far, sometimes these things take a while to settle but I have reading this stuff for quite a while now and it hasn't settled yet. Even if it does all start with debt, i think its market ideology that sustains it now, and many other problems that are so directly related to debt. Get rid of the market ideology - wich is just a set of relations that the powerful establish - and the problem of debt will be whole lot different.

I'm sure you understand that the free market that we all think we live in is not free at all, but highly regulated and increasingly so. Monopoly powers are on the rise and the barrier to entry for most anything one wants to do is much higher than it has been even in recent the past. We live in a world that we are told is dominated by socialist and capitalist ideologies battling it out in the public, but what is actually true is that our world is being defined by back room power plays that have more to do with a class structure with a very deep divide. This deep divide grows every day, and while the public fights over what the markets "look like", socialist or capitalist, red or blue, liberal or conservative, they are shackled with higher and higher levels of debt, making the class divide greater and greater. Those left and right arguments hide the important issue of the day and that is a massive transfer of wealth upward that has nothing to do with what we think should be argued about in the political arena, and everything to do with the way our monetary system is structured. And it is a silent prison. Much of the disintegration of our mores as a society are due to this process. It is reflected in every area of our economy. Anything that the dollar touches is affected, including medicine. Remember that dollars are created through debt which must be paid back plus interest. Look up and down not left and right.

[Rajiv]

Re: Health Care in US: a family's perspective

Not that it changes the ethics, but so I have a better understanding of the degree, what does Rs 500 mean to a poor Indian? Is that a soda or a years rent?

Rs. 500 is roughly $12

From What Is Poverty, Really? The Case of India

In 2008, the Union (national) Rural Development Ministry set up a commission to examine alternative methods of estimating poverty. The commission reported its findings in late 2009. At the outset, the Commission felt that monetary amounts specified by the Planning Commission for a minimal diet were too low. Instead of Rs. 356 a month per person in rural areas, Rs. 700 was considered necessary (Rs. 1,000 in urban areas). The Commission recommended that the proportion of the rural population living below poverty be raised to at least 50 percent. But even that figure was achieved by lowering the rural kcal requirement to 2,100, the same as in urban areas, and adding a minimum monthly cereal consumption of 12.25 kilograms. If the 2,400 kcal criterion had been kept, the percentage of India's rural population living in poverty would have risen to about 80 percent.

Two other Indian estimates are worth mentioning. The National Commission for Enterprises in the Unorganised Sector (NCEUS) was established in 2004 to examine ways to provide the welfare of that group. The unorganized sector comprises 86 percent of the Indian labor force and nearly always works below the daily minimum wage of Rs. 152 per day, have no benefits, pay no taxes, and often have little or no job security. Many are low-paid agricultural workers, workers in small manufacturing shops, or workers who deliver hazardous materials on bicycles. In its study, NCEUS set an overall minimum of Rs. 20 per day per person as its poverty cutoff and calculated that 77 percent of Indians live below poverty. The figure of Rs. 20 per day was cited in the Central Government's Economic Survey 2008-2009, but in recalculating poverty based on the 2004-2005 NSS it estimated that 60.5 percent lived in poverty nationally—72 percent in rural areas and 32 percent in urban areas.

---

Various Estimates of the Number Living Below Poverty in India, 2009


Source: PRB, based on different recent estimates of the percent below poverty.

---

World Bank estimates are given in the figure above for comparative purposes. The World Bank estimates that 41.6 percent of India's population lives below $1.25 per day and 75.6 percent live below $2 per day.

It is clear from the studies cited above that relatively minute changes in daily rupee cutoffs can add hundreds of millions of people to the poverty population.

[Jay]

Re: Health Care in US: a family's perspective

In 2008, the Union (national) Rural Development Ministry set up a commission to examine alternative methods of estimating poverty. The commission reported its findings in late 2009. At the outset, the Commission felt that monetary amounts specified by the Planning Commission for a minimal diet were too low. Instead of Rs. 356 a month per person in rural areas, Rs. 700 was considered necessary (Rs. 1,000 in urban areas).

So Rs 500 is a whole bunch to a poor Indian. Ouch. That makes 29% credit card rates look good. The game is the same everywhere at this point.

[Rajiv]

Re: Health Care in US: a family's perspective

So Rs 500 is a whole bunch to a poor Indian. Ouch. That makes 29% credit card rates look good. The game is the same everywhere at this point.

Just for a comparison with the poverty picture above, the doctors annual income from the medical college would be in the order of Rs 250,000 - 500,000 annually (Note: this does not include the kickbacks, or the private practice on the side)

[Jay]

Re: Health Care in US: a family's perspective

Just for a comparison with the poverty picture above, the doctors annual income from the medical college would be in the order of Rs 250,000 - 500,000 annually (Note: this does not include the kickbacks, or the private practice on the side)

And that puts physicians in what socioeconomic class there?

[Rajiv]

Re: Health Care in US: a family's perspective

And that puts physicians in what socioeconomic class there?

Top 5% -- possibly top 1% -- But that is not how they view it. India is two countries -- There is the India of the 80% and the India of the 20%. To the India of the the 20% the other India is a "Phantom India" that is somehow non existant -- even though they deal with it daily

[sishya]

Re: Health Care in US: a family's perspective

Rs. 500 means wages for 1.5 days of a coolie(day labourer) now.
Compare to a Physician making Rs. 15,000 to Rs.30,000 in a Hospital(with evening private practice).
Comapre to a call center employee talking to citibank credit card customers after training in US English making Rs.30,000 per month.
Thinks are skewed because of Globalization.

[sishya]

Re: Health Care in US: a family's perspective

Most do not make this kind of money. Many have kick backs but some do not. I knew doctors personally who used to make less than Rs.10,000 per month working as Pathologists in a
Christian Medical College+Hostpital, with no kickbacks. They also charged the lowest from patients - In 2000, they were charging around Rs.50 per visit. I personally know 2 married couples who were very poor after both doing their MD(after MBBS), getting married and traveling on public bus for their honey moon - not for the thrill but because they were poor.

One of the reasons that such kick backs become an enticement is because the pay scale is low. Govt Doctors get paid better but again there is caste Quota for lower class and such there.

[Rajiv]

Re: Health Care in US: a family's perspective

Most do not make this kind of money. Many have kick backs but some do not. I knew doctors personally who used to make less than Rs.10,000 per month working as Pathologists in a
Christian Medical College+Hostpital, with no kickbacks. They also charged the lowest from patients - In 2000, they were charging around Rs.50 per visit. I personally know 2 married couples who were very poor after both doing their MD(after MBBS), getting married and traveling on public bus for their honey moon - not for the thrill but because they were poor.

One of the reasons that such kick backs become an enticement is because the pay scale is low. Govt Doctors get paid better but again there is caste Quota for lower class and such there.

I was talking of the new UGC (University Grants Commission) scales of pay. Since the hospital/medical college I was talking about is state run, the pay scales correspond to the UGC Scale.

The pays have gone up fairly dramatically in the last six years. But the corruption I was talking about continues, and is quite prevalent.

That said, there still are many honest doctors in the system, but the corrupt ones poison the well.

[flintlock]

Re: Health Care in US: a family's perspective

I'm sure you understand that the free market that we all think we live in is not free at all, but highly regulated and increasingly so. Monopoly powers are on the rise and the barrier to entry for most anything one wants to do is much higher than it has been even in recent the past. We live in a world that we are told is dominated by socialist and capitalist ideologies battling it out in the public, but what is actually true is that our world is being defined by back room power plays that have more to do with a class structure with a very deep divide. This deep divide grows every day, and while the public fights over what the markets "look like", socialist or capitalist, red or blue, liberal or conservative, they are shackled with higher and higher levels of debt, making the class divide greater and greater. Those left and right arguments hide the important issue of the day and that is a massive transfer of wealth upward that has nothing to do with what we think should be argued about in the political arena, and everything to do with the way our monetary system is structured. And it is a silent prison. Much of the disintegration of our mores as a society are due to this process. It is reflected in every area of our economy. Anything that the dollar touches is affected, including medicine. Remember that dollars are created through debt which must be paid back plus interest. Look up and down not left and right.

Well said!