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Our Ridiculous Health Care System

post #1 of 26
Thread Starter 
A student of mine, an older woman who is one of Boston's "snowbirds" just returned from her winter in Florida. Early last fall, she had back surgery.

She was told to see a physical therapist at a hospital in Palm Beach. But there were about 20 people in the room, with one therapist, and not much supervision.
She ended up taking her list of PT exercises to the gym, and having her trainer spot her form as she did them.

The problem: Under medicare, patients can stay in physical therapy for as long as they want, even long after they've healed. Now this would be fine if it were the only way that these folks got some exercise, but from what I've heard, the environment is not really optimal.

Now take the other extreme. Someone injures themselves skiing. Recently, I have gotten many post rehab referrals that IMHO, should still be in PT! So for most of us, our regular health insurance will not cover enough PT sessions to ensure that we are properly healed!

Of course, this will vary with different plans, but its still a rather unsettling thought!
post #2 of 26

I don't know how many I would have been allowed by my plan, but I got 7 PT sessions for my AC joint and that seemed about right.

I continued at home with all the stuff I did in PT and that has worked out pretty well for me.
post #3 of 26
Thread Starter 
7 is probably okay for a separated shoulder. But I've seen a few people who only had 7 sessions for a sacro illiac joint problem. It seemed to me that they needed much more!
post #4 of 26
I'm always really interested to hear about how your system works because, as you may know, our National Health Service is under constant fire for its shortcomings.

For all its failings, though, I still believe in the free-at-the-point-of-use concept where what you earn and what medical conditions you may already have don't dictate the quality of your care. We all pay for the NHS through our taxes - which are about to go up for provide more funding - and we all have equal access to it.

It's far from perfect - under-funded, top-heavy with managers, big regional variations in waiting times, many crumbling buildings, staffing problems and so on - but the principle still holds good, IMHO.

What do you think? Should the UK go your way or stick with what we have, warts and all?
post #5 of 26
Thread Starter 
Scotski, I'm not quite sure what the answer is. Many years ago, when I was in Cambridge with my brother, he had an asthma attack at a friends house. The people just looked in the phone book and called a doctor, who arrived AT THE HOUSE in 10 minutes.
But I do understand, that there are problems with the system.

The irony of the American system, as James has pointed out, is that you probably get better care if you are unemployed.

Of course, I notice its effects when it comes to orthopedic injury. The woman I was speaking about was just thrown, barely supervised, into a room with 20 other people who were covered for their physical therapy "forever", where as I'm curious as to how many sessions James will get for a serious injury.
post #6 of 26
LisaMarie -

Don't even get me started on the physical therapy thing!!! :

Fortunately I was insured (good coverage PPO plan) when I badly broke my leg. My initial emergency surgery and 5 day hospital stay totaled over $26,000.00

I was allowed to begin physical therapy 12 weeks post injury/surgery. My knee barely moved, and my ankle was just about "frozen". I had developed a very painful condition called RSD which made my PT even more painful. I was a mess!!!

My insurance was doing its thing...paying for my office visits, x-rays, emg's, mri's, etc., but my plan only pays for $1500.00 of Physical Therapy ANNUALLY! Trust me when I tell you that generally you hit $1,500.00 in less than 3 weeks...and at 3 weeks into PT, I was no where near being able to be released! I required much manual therapy (had a therapist who specialized in it).

All my appeals were rejected...which I find humorous as I know I can be rated as "permanent partially" disabled due to the permanent loss of motion in my ankle!!! I know see a functional rehabilation specialist, along with my O.S.

To this day I become angry when I think that my insurance will support/pay for the several surgeries (4), hospitalizations, expensive tests, etc. that is has taken to put my humpty dumpty leg back together...over $62,000.00 to date, yet they do not find the rehabilitation part of recovery important! :

I have spent over $9,600.00 out of pocket on my physical therapy over the last 2 years...and that was with a very unique payment arrangement with my rehab facility! I would pay a kings ransom (if I was able) if it would make my leg/knee/ankle function like it used to!

I guess I just find it extremely short sighted that my insurance plan would pay all that money to save/put my leg back together, yet NOT know/define the difference between just HAVING the limb vs. a FUNCTIONAL limb. The function of the limb is what is the icing on the cake!

Okay, can you tell that I get a little worked up about this subject...sorry! It STILL burns me up!


[ April 23, 2002, 08:55 AM: Message edited by: Serenity ]
post #7 of 26
There is a huge discrepancy in the quality of PT even within the same healthcare system (HMO). I went last week to PT and it was less than useless. I didn't see much gym equipment, maybe a bike and some rubber bands. I was shown ONE simple exercise and, on my way out, was handed a xerox of stretches. That's it. I waited 2+ weeks for an appointment, in pain, and hoped this was the start of recovery. Disappointing.

I've been to PT with same HMO but in a different state and it was a night and day difference. They had a complete gym and worked with you every step of the way. Outstanding care.

I think it just depends on how well it's run. In my old state, I would get a customer satisfaction survey in the mail after every doctor visit. Never get one here.
post #8 of 26
Thread Starter 
Add to all this, there was some sort of bill out there that was going to disallow benefits to ski and other "adventure sport" injury.

The quality that WHG talks about is a serious issue. As JC Santana says, ther are still PTS giving leg extension machine exercises for torn ACLS!!

The only hope is good prevention. Many PTs have left the system because of these issues. They are now working at fitness centers!
post #9 of 26
IMHO, in genreal, most healthcare plans DO NOT value physical therapy and rehabilation. My plan lumps that $1,500.00 annual cap in with allergy and immunology and chiropractic (you can choose where you spend that money).

Prevention is always a good thing, but when the injuries happen (and they DO happen) the goal should be full functional recovery. IMHO, anything less will eventually leave the door open to further injury and MORE, expensive medical care down the road.

If the insurance companies did not "cheap out" on the front end, they could probably save themselves 10 fold further down the road.

: : :

[ April 23, 2002, 09:58 AM: Message edited by: Serenity ]
post #10 of 26
Thread Starter 
You are, of course, correct. Everything I've learned in the past year has to do with how injuires set up faulty movement patterns that lead to other injuries, ultimately costing the system more. Proper rehab is absolutely CRUCIAL in order to prevent this. What's even worse, some doctors won't even let their patients get tested. If you don't know what it is, you can't treat it!
post #11 of 26
the insurance i get at no cost to me through my employer has covered all my expenses related to my broken tibia and wrist. this includes 10 weeks of twice a week one on one physical therapy, a wheelchair, a special walker w/ platform for my arm, and various other household items. my er visit, surgery and a 5 day hospital stay w/ meds cost me $10 dollars.

whoo hoo for my employer and a great health care plan! oh yeah, i also get short term medical leave and donated sick time.

there has to be something good about all of this.
post #12 of 26
Thread Starter 
And I bet your company has a high employee retention rate!
post #13 of 26
As an insulin-dependent diabetic, please don't get me started on the US health care system... I've got more unpleasant stories than you can shake a stick at. In January, I finally passed the one-year point at my job, meaning that my diabetes was no longer considered a "pre-existing condition" by our company's insurance.

About the only time I've ever had decent (complete) health insurance coverage was when I was completely broke about eight years ago, and was somehow able to qualify for Medicaid -- now THAT is a good insurance policy! It pays to be poor!

I can't wait to see how much of my recent hospital costs (three days with wall-to-wall tests, a last-minute leg operation, a separate trip to the emergency room, a visit to an orthopedic surgeon, etc.) will fall into my lap.
post #14 of 26
The woman I was speaking about was just thrown, barely supervised, into a room with 20 other people who were covered for their physical therapy "forever
And we wonder why Medicare is the bloated, overblown, out of control, drag on the economy that it is.

And, let's see... the following was from Serenity!

Okay, can you tell that I get a little worked up about this subject...sorry! It STILL burns me up!

Sorry, just couldn't resist!
post #15 of 26
Thread Starter 
Lest anyone think thatI have no sympathy for seniors, this type of situation is not benefiting them one bit! Badly supervised PT is worse than no PT! We'd be better off if medicare paid for senior fitness programs, taught by certified specialists. This would be a fraction of the cost of physical therapy!
post #16 of 26
I just got the bill from the University of Utah Hospital that was charged to my insurance: almost $13,000 (including a 30-mile ambulance ride from The Canyons to the hospital)! :

I know as a fact that my insurance plan isn't in the same solar system as Sugar's... and I'm not looking forward to finding out what I'll be responsible for.
post #17 of 26
Sugar -

List of good things my injury has taught me...

1) Morphine is an outstanding drug.

2) Percocet will do in a pinch.

3) Alcohol and crutches don't mix well.

4) Alcohol and Percocet REALLY don't mix well!

5) A hot meal is something to be delivered.

6) A car ride (or any activity outside the home)
is something to savor.

7) A hot bath never felt sooooo good!

8) Hardware and power tools...applications I had
never thought of!

9) Different alloys do not mix well inside our
bodies...galvanic reactions.

10) Guys seem to think the scars are cool.

11) Patience and perseverance will pay off in
the long run.

[ April 23, 2002, 01:12 PM: Message edited by: Serenity ]
post #18 of 26
WVSkier -

Many who know me, probably find my nickname here contradictory to my nature.

Feisty, might be more applicable to me most of the time!

[ April 23, 2002, 01:25 PM: Message edited by: Serenity ]
post #19 of 26
All this and my friends still wonder why I wear a helmet and don't ski at mach 9 in certain places. I have a rather good health care plan but I really don't want to test it.

post #20 of 26
serenity - i'll see your morphine and raise you phyntenol. now there's a drug! whoo wee what a wild ride!

morphine made me itch but since they refused my repeated requests for more phyntenol (psst, hey doc how 'bout it? just one more hit, PLEASE?) i had to make due.

aarhead - helmet would have made no difference and as for speed - it was an area where you needed some speed or you would be hiking out of the bottom of the bowl. all in all i would much rather have hiked than crashed but it was a run i knew well. just poor condition (worse than i realized) and dumb luck.

[ April 23, 2002, 03:02 PM: Message edited by: Sugar_Snack ]
post #21 of 26
Sugar -

Before my accident I had never had any powerful pain killers...and I was scared to death of morphine. I told the paramedic in the ambulance that I did not want any, he called the Doc at the Hospital, and cooler heads prevailed. What was I thinking?!?

Phyntenol is VERY good...especially when combined with versed! Actually, anything which helped bring the pain level down I am truly grateful for!

I agree with you about the helmet, I was wearing mine, so thankfully no head injury! Speed...I would call average. For me it was as simple as catching an edge, and "going over the bars" (so to speak).
post #22 of 26
Sugar_Snack and jamesdelux:

A story that will likely warm your hearts and frustrate you beyond belief.

1998, my wife, son, a friend, grandma and I all travel to Europe. Shortly after arriving, grandma slips while walking along the Rhine River and hurts her leg. She can still walk, so we give the injury a few days to heal. 3-days later the leg is no better and we take her to a Doctor, who checks her out and finds the leg is fractured. Since he can’t help us (he refers us to the local hospital in Reutte, Austria), there is no charge.

In the hospital, granny is admitted to the Unfallen (sp?) ward. Wife is healthcare professional/anal retentive so, she calls all the Ortho’s she knows and finds the Doctors in Reutte to be very good. The Doctors want to keep granny in the hospital for 3 weeks with her leg elevated and cooling therapy to make sure the swelling is minimal. Then they will do surgery, repairing the bone with plates and pins. All followed by 1 to 2 weeks in the hospital recovering.

Being hospital savvy, I calculate the bill at $30,000 more or less, for 5 weeks, surgery, PT, and drugs. Ouch!!!!!

Since we are leaving in 3 weeks, the plan is truncated. I recalculate the costs at $24,000, for a 3-week stay, surgery, drugs and PT. Ouch!!!

After surgery and recovery, the bill came to a TOTAL of $3,000 + or – a few hundred. HUH!!!???

We return to the US and granny recovers nicely. Yeah, she is still mean as a snake, but she recovers.

I hope this warmed your hearts to see that some people do get great medical care at a reasonable cost. I am sorry but I think this probably frustrated you since you will likely be charged at the higher US rate.

The moral, get hurt in Austria. It will likely cost less than your deductible here.

Now, why the high US cost? 1. Drugs. The Manufactures charge the US private citizen the highest rates in the world. We need to stop this by requiring any company selling drugs in the US to sell them at the same price they are sold for overseas. That would raise the overseas price and lower the US price. As it is everyone else is free riding on us. 2. Dr. costs. Here they are wealthy. There they live comfortably but are not wealthy. 3. Hospital costs. We have way too many and more are built every year. Stupid!!! 4. Medicare and Medicaid. These programs pay less than the services cost so, the medical providers and hospitals up-charge you and I to cover their “shortfall”.
post #23 of 26
Originally posted by Maddog1959:
Now, why the high US cost? 1. Drugs. The Manufactures charge the US private citizen the highest rates in the world. We need to stop this by requiring any company selling drugs in the US to sell them at the same price they are sold for overseas. That would raise the overseas price and lower the US price. As it is everyone else is free riding on us.
I hate to disagree with you, but if you check out MIMS, the drugs price list (my dad's a pharamcist, so I have access to it), you'll discover that contrary to your statements regarding the rest of the world freeloading off the US, but the opposite is true.
For example: 200mg Ibuprofen (anti-inflamatory), pack of 100 in UK costs a pharmacy around £4.20 ($6), in the US two years ago, I bought a bottle of 500 for $14 (retail), or $2.80 per 100. So, the UK COST price is more than twice the US SELL price.

I think part of the price differences is the same thing which is unfortunately seeping into the UK now, which is the legal aspect of health care. Last year, £4.4billion was spent on clinical negligence in the UK by the NHS, which could have been spent saving lives, but some people believe taking money from healthcare is more important than providing a service to keep people alive.
(I know there are exceptions, but unless the quality, ability of doctors and surgeons, and technology has taken a massive nose dive, then why is it now costing the NHS £2.8bn more than two years ago, apart from we are turning into a nation hell-bent on destroying our healthcare system)

Oh, there goes the fox again on his rant about the money-grabbing nature of the sue-you society of "rights without responsibilities" that we live in.

Apologies to those who are blinkered.

post #24 of 26

The brevity of my post was at the cost of precision. The drug calculation does not generally work for any drug off patent. It only works for drugs still on patent. Why? Off patent drugs are generally produced by numerous manufactures while the patent drugs are manufactured or licensed by only one company. Thus, the costs difference of drugs like Aspirin and Ibuprofen is difficult to compare from country to country. The price difference is frequently more a function of cost of living and taxation as well as actual production costs. Remember, the Ibuprofen you bought at home was likely made by a homegrown company and was sold for what the market would bear, presumable in Ireland. The drug purchased in the US would follow different economic rules and would be priced accordingly. These drugs are not the problem in medical costs. They are competitively price with fairly narrow margins. This is so because the generic drugs don’t have development cost calculated into the price as the patent drugs do. And once the generic lowers the price, the name brand manufacture must follow suit to a great degree.

Patent drugs are another matter completely. These drugs are produced and sold internationally by a single entity and the price is controlled by that entity. In the US the price floats at whatever the market will bear. While in Canada, Mexico, Europe and virtually all other countries, the price is controlled by government fiat. In essence, the governments of these countries either steal the drug (China, for example) or they negotiate for inclusion of the drug into the countries formulary (a list of drugs legally available in the country). Since there are few exceptions where there is only one or even just a few drugs in a class of drugs, the negotiating government can exert great pressure on the drug company to lower prices by simply stating that if the price it wants is not met, the drug will not be on the formulary. The company faced with the prospect of not being able to sell its drug usually lowers the price (remember the competitive element that these companies are under. They also want to have the most prescribed drug, so numbers count as well as profits.). These negotiations have been known to include threats that the company will not have any drugs on the formulary, usually where there is a sole drug within a formulary class.

While the drug companies would like a more profitable system, they price the drug in the US to fully recover costs and make a modest profit. Any non-US sales are considered pure, or nearly pure profit. So, the cost of the drugs in the US is almost always higher (the great exception is any drug available under Medicaid or Medicare – very rare). The simplest way to research this (although not scientific) is to search for articles about seniors crossing the US/Canadian and US/Mexican borders to purchase drugs at much lower costs. Also, there are (or were) a number of European Apothecaries on the web, which used to ship to the US, with or without a doctors script for much lower than US prices. I recall much discussion about whether the US Customs Service would try to shut these companies down somehow.

My goal has never been to lower the US price at the expense of another group of people, but the R&D costs of these drugs is huge and should be recovered uniformly by all users, not just one discrete population.

My wife is a Doctor of Pharmacy employed by a large health insurer. She lectures nationally on these issues (maybe I can convince her to lecture in Austria next winter, that’s it, that’s the ticket!!!) I am an attorney with a medically related practice. My lectures don’t cover medical prices, thank God.

Fox, if I come, you will get a PM. Who better than you to take alpine pub-crawling?
post #25 of 26
That sounds like a plan, and we can discuss the costs and benefits of my favourite drugs: Alcohol & Taurine.

post #26 of 26
Since a few have thrown out the cost of their emergency care and follow up, I'll do the same.

Minor injury by all accounts, but here is the tally so far! Seperated AC joint.

Red and white truck to the ER, 7 mile including C-spine precautions---more than $500. Paid $25 deductible.

ER visit, including cat scan--$817.46. Paid $50.00 ER visit cost

Primary care guy appt to get referal to ortho guy---$25 deductible---who knows what actual cost was.

Ortho Guy, 10 minute visit to get referal to PT. $25.00 office cost. Again, no idea what the plan paid.

PT 7 times $25.00 visit cost. Again no idea what the plan paid.

Ortho guy, another 10 minute visit to see progress. No more PT. $25.00 office visit cost.

Primary guy. Another $25.00 office visit to declare me healed enough to carry on.

Known full costs for minor injury, more than $2000.00. My cost, lets see. I count $350?

Not bad although I do have free insurance from my wife's employer---a very family oriented firm. My total direct cost could have been lower, but family contribution to premium cost would more than offset.

I guess, in my case, I am pretty satisfied with the result and the out of pocket costs.
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