Praetorian:
In response to your #16. The cost of medicine is high, far higher than what I feel is right and I have been a doc for 40 years. Ever asked yourself why? Try the fact that the majority of people in the hospital are either old or poor. It is an amazing thing that productive yournger people are not as sick as those who sit on their back ends all day (not the old folks). Now, these people are all on Medicare and Medicaid. Gues what, the government refuses to pay for their measure of care. For instance, if I do a heart cath on someone who is young, I get paid $600 for several hours of work. Under Medicare, you get paid $125 for the same amount of work. With Medicaid, you get maybe $70 or less if you are lucky, frequently you are not paid. Now someone has to pay for the small amount that our goverment allows. That someone is you. Understand that this is only one charge and the same rules apply to all doctors and the hospital cost, including use of product or supplies. So the high cost of medicine is actually a tax.
But then consider this, did I need to do the cath to begin with? Likely I could have treated the patient with drugs and achieved the same prognosis. But, Mr. Lawyer does not agree! So in order to cover myself and satisfy the concerns of the patient and family who know considerably more than I do as they read about their problem on the web or heard about it on the Today show, I do the procedure. Then proceed with about the same care as I would have before. Many factors go into the decision to use testing and procedures. In our society, legal aspects likely increase the cost of care by about 30% or so. In Canada, which does not have as aggressive of torts as we do, the number of heart procedures is 20% of ours with the same death and morbidity rate. Also, built into their system is an effort to reduce you ability to get medical care. They actually desire for you to die before medical care can intervene (this from Canadian doctors).
As to mediocore, absolutly yes!!! That is why everyone in the world comes here, if possible, to get mediocore care. Much of what you may be thinking of as mediocore may be the VA system and the inner city charity hospitals. But of course that can’t be right, those are run by the govenment!!!
But as a doctor I always think that what I am doing is mediocore, that way I strive to be better. Not the case in government run institutions. In the coming years you will here a favorite phrase that is used in the VA hospitals, “not in my job description”. If you are sick and have been laying in your own waste for 2 days, just think about how mediocore our system used to be.
