What to expect

OK, so last night I told you I would lay out some examples of your government managed health plan in action, and tonight I'm going to fulfill that promise. So let's see......
How about an entire healthcare system owned, managed, and run by the federal government. It's been around since 1930 give or take, and began to seriously run hospitals in 1945. Yup, the good 'ol VA Hospital system. Although the US government had had pension programs for soldiers going all the way back to the pre-Revolutionary conflicts, the VA as we recognize it came to be under Gen. Omar Bradley in 1945. On Feb. 1, 1946, Bradley reported that the VA was operating 97 hospitals with a total bed capacity of 82,241 patients. Hospital construction then in progress projected another 13,594 beds. Money was available for another 12,706 beds with the
construction of 25 more hospitals and additions to 11 others. (http://www1.va.gov/opa/publications/archives/docs/history_in_brief.pdf) Pretty good start, huh? While there are some good VA hospitals out there, it seems to me that most vets who have any other option avoid the VA hospital system. Over and over again, we here from vets who show up at 8am to see a doctor, wait all day, and are told to come back tomorrow at 4pm when the clinic closes for the day. Horror tales of unattentive staff, unsanitary conditions, and outdated equipment abounds. Even today, as our young men and women return from the gulf and Afghanistan, we hear tales of poor care within the VA system. This is the healthcare system that congress voted to give us on March 22, 2010.
OK, so that's just the VA. It's just a matter of too many vets to care of, because of the recent conflicts. If not for all the recent wars, the VA would be running fine. Well, we could argue the point of the VA bureaucracy being too burdened with regulations and government union contracts to be able to contract and expand quickly, as can be seen in the private sector, but instead, lets' go look at those other shining examples of government run healthcare, Medicare and Medicaid. Here's a few personal examples, from just the last few weeks.
A Medicare patient was sent to me for an endoscopy to check the stomach for a source for her anemia (low blood count). She was scheduled to be in the hospital for most of the next day receiving an Iron infusion, and so I offered to do the endoscopy at the same time. Nope. If we try to do both at the same time, Medicare won't pay for the endoscopy. We'll have to do it two separate days.
I removed a medicare patient's gallbladder yesterday. I normally do this surgery as an outpatient, with the patient going home from surgery without ever being admitted. Nope, can't do that. The patient has to be admitted for that surgery. And so, post op, I wrote admission orders and sent her to the inpatient floor. Once there, a nurse spent close to an hour filling out an "admissions packet," one of the myriad of things the government requires. This left her co-workers stretched to cover her patients while she was tied up with the paperwork. She went home from the floor an hour later, complaining about the delay in going home.
I am often consulted for evaluation and endoscopy (most commonly colonoscopy) for patients admitted with a GI bleed, or blood from the rectum. Once again, we have to work to coordinate discharge and the procedure, because if we do the procedure as an inpatient, we won't get paid for it. Instead, we wait until the patient is ready to go home, Discharge them, and wheel them down to surgery where we re-admit them for the outpatient procedure. Sounds efficient, doesn't it?
Another of my many tasks is to place special IV catheters for patients to receive 6 to 8 weeks of IV antibiotics. Ideally, this is done at home. But not on Medicare. Medicare dictates that it will not pay for home IV antibiotic treatment, and so these patients wind up either staying in the hospital for weeks to get the antibiotics, or have to be admitted to a nursing home. Now, wouldn't it seem that the best place for a patient to recover would be at home? It is, in 99.99% of cases, certainly safer.
This next example isn't with these government payment plans, but you can bet it will be coming soon from your government run healthcare provider.
I have had several opportunities to tangle with insurance companies, most commonly it the guise of the company benefits coordinator, a medical doctor usually. What happens is this: I call the insurance company to try to get my patient more "inpatient days," or maybe a particular procedure that I and the patient have discussed and feel is indicated. This is the conversation:

ME: "My patient isn't ready for discharge/needs procedure X"

Them: "Well, I'm sorry, but we've reviewed the chart, and do not feel that is appropriate"

ME: "OK, since you're going to manage this patient, could I please get your full name and qualifications, so I can transfer this patient to you, as you are apparently going to take over this patient's management"

Them: "Oh, no, we're not telling you what you can or cannot do, we're simple telling you what we're going to pay for. You and the patient can do whatever you feel is appropriate, it's just that we're not paying for it."

I've had to go through this with the private companies, but trust me, it's already happening with medicare/caid, too. What do you think is going to happen when "Them" is a faceless, nameless, government bureaucrat with quotas (set by other faceless, nameless bureaucrats) to meet on the other end of the phone line?

Whew!! I went way over what I had intended for this evening. I'm outta here. Tomorrow, some examples of State bureaucrats and their impact on health care.

Good night.