Wednesday, October 13, 2004

The State of American Medicine

I usually would rather blog about Torah, or philosophy, but the blog on the ethical dilemma of American Medicine has sparked sharp words in the comment section. So, here it is, the status of medicine in America

We have the best medical system in the world. No question about it. No country has in aggregate the quality and quantity of doctors, hospitals, and equipment. Certainly other western european, japanese and canadian systems are quite good, and on the top level have similar expertise and equipment, but that top level is thinner than it is here in the usa, where there is an abundance of qualified personnel and equipment. The reason we have poor longevity ratings, bad infant mortality percentages, and a lot of sick people is because..... they are poor, and either dont have access, or dont care to have access to health care. The uninsured, and underinsured are the losers in our health care system. Their diabetes goes undiagnosed and untreated, hypertension poorly controlled, and they sometimes dont even go to the hospital if they are having a heart attack, for fear of the large medical bills. If they had care, or were convinced to go have care, the mortality would be less, babies healthier, etc. Its hard to have low infant mortality when many mothers dont get prenatal care. The system is great for people who use it, and who have insurance or can pay for it.

Malpractice. Whatever the cause, rates have been going through the roof, tripling in the last few years. Some hold that it is because of many lawsuits, and there is some merit to that. Some hold that rates have increased so that insurance companies can recoup what they have had to pay out for disasters, floods, 9/11, you name it. The reality is that in states with caps on non-economic damages(limits on money paid for pain, suffering and things like that, but not on lost wages, recouping hospital bills, etc.) malpractice rates are lower. Also, rates are higher in states that have a history of high jury awards(jury awards vary considerably from place to place, county to county, state to state). In some states, doctors are leaving because it is a lot cheaper to practice in a neighboring state, getting away from higher premiums. We are talking about numbers like $300,000 a year down to $50,000 a year for the same coverage. I will try to blog about malpractice issues another time, you may be surprised by my view.

Health insurance- premiums going up, covered services going down, payments for services staying the same, or going down a bit, despite increases in inflation, costs of doing business(malpractice insurance for instance).

to be continued, I'YH

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