--
Richard Chudacoff, MD, FACOG
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
DoctorJoe@aol.com
Sent: Friday, July 31, 2009 2:49 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Health Care --> "everything free"
I guess I should start a new direction and see where everyone stands on
this. It's been discussed in a few places I've seen so far . . .
Especially since Medicare/Medicaid have come into being, a significant
portion of the population began to expect everything free. This was
aggravated by the so-called HMOs.
By "everything free" I mean each visit is free (except for maybe a miniscule
co-pay), prescriptions are free or very cheap, and you basically don't "see"
what you're spending (and with Medicare/Medicaid, YOU may NOT be spending
anything -- some other taxpayers are paying for you). You don't pay anything
at the site of care -- someone pays it in the background, basically
transparently from your point of view. This is a dangerous set-up and it's
caused the problems we're having now, IMHO.
When I was a kid, we were in one of the first HMO-type organizations,
certainly one of the first in Louisiana. It was a medical organization for
employees of the Exxon refinery. I remember going there for everything --
glasses, medicine, doctor visits, shots, vaccinations, everything. And the
cost was either nothing or very nominal. But SOMEONE paid for it -- the
company did, in effect giving you less paycheck and providing you "free"
medical care. It looked like a great perk.
[As an aside, I ALSO remember that the doctors we saw in that system were
some older doctors -- semi-retired? -- and some younger doctors who worked
there for a while and then went out and opened a "real" practice. I also
remember some scheduling issues, although I was young and I don't want to
say anything about that and get it wrong.]
The expectation that we have a "right not to pay" for doctor visits and
medications and etc. is what is ruining the American system. We expect our
"insurance" is going to pay for just about everything.
The concept of insurance is a mechanism by which you INSURE against some
catastrophic or rare expensive event -- like car insurance in case of a
collision. You don't (usually) have auto insurance for routine maintenance.
But in healthcare, that's what we have gotten used to. Basically, we want
insurance for routine health maintenance.
We need to reset the system so that "insurance" is for the big-ticket
expenses that occur from time to time. The day-to-day maintenance should be
paid for out of pocket by us. My thought is, if the system reset that way,
day-to-day maintenance items (for us, how about Pap smears, urinalyses,
vaginal cultures, etc.) should be cheap enough to afford.
On the other hand, surgeries and hospitalizations are the big ticket items
that insurance should cover.
Otherwise, we can look at medical care as a giant entitlement. I don't even
want to pay for aspirin. It's my health -- it should be free from the
government.
Joe P.
p://http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd=Julyst
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