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Health Care Reform in the US: A Patient's point of
view by Sophia Barkat This is Health Care? I don't know about you, but I'm frightened by America's medical system. Every time I go to see a doctor for my tension/migraine/sinus headaches I am sent back with a prescription list -- most if which I throw away after one pill. I have to. They have ridiculous side effects. The first time I took a high-blood pressure pill to cure my headaches I could feel the brain pulsating. It was not fun. My doctor at the time, called it a "trial and error" process, a process I can't seem to be free of, even though I've changed many doctors since. It seems to me that privatization of Health Care, and deregulation of the industry has given us a "trial-and-error" method for curing mind-numbing headaches. My nurse-practitioner says I'm better off with just taking Midrin over and over -- though my neurologist completely threw that idea out the window. According to him, taking medicine all the time will give you more side-effect headaches, though he gave me a huge list of pills to last 6 weeks, himself. Also, I'm to be ecstatic I've already done 10yrs time of this menacing condition, and there's only 20yrs more to go before it's cured on it's own. Wow. It's a turning point in my life alright. And that's just my experience with American healthcare. I used to work at Prudential Securities in Philly. A certain employee there at the time went in for an operation of the knee, regular anesthesia. He never came out of the operating room. The hospital was not sued. Some people just aren't litigious enough to take on medical malpractice. Another story, but one not so clear-cut. A young man from Nepal, a family friend of ours, found out four years ago that he had colon cancer. He was admitted to the University of Pennsylvania Medical Center. Lucky for him he knew the Staff there as he worked in the radiology department for some years. We kept hearing he was on "trial drugs" with a 3yr time line. It meant if this didn't work there were other trial drugs. In December 2001, he died. The Univ. of Penn Medical Center is a research school for Cancer Studies. The news of his death didn't seem all too shocking. What the trail drugs were in his case I never asked. But since the research and the hospital have been the center of much controversy in recent years I can't rest thinking he may have been a victim of medical malpractice. In 1998, Allen Hornblum, social worker and U Pennsylvania Med. School graduate who had worked in Philadelphia's Holmesburg Prison, wrote a book that exposed how U. Penn Medical Hospital for years had forcibly run experiments on inmates at the prison to come up with various medicines. http://www.prisonactivist.org/pipermail/prisonact-list/2000-October/003208.html PrisonActivist.org ran an article by Marie Claire Dale, which said: "Hornblum's 1998 book, ''Acres of Skin,'' explored the physical and psychological effects of the testing and inspired a lawsuit filed this week in Philadelphia on behalf of 298 former inmates. The lawsuit claims the testing exposed the inmates to infectious diseases, radiation, dioxin and psychotropic drugs -- all without their informed consent. It names as defendants the city of Philadelphia; Dr. Albert Kligman, a University of Pennsylvania dermatologist who conducted much of the research and is credited with developing the acne and anti-wrinkle treatment Retin A; the university; and drug makers Johnson & Johnson and the Dow Chemical Co., whose products were allegedly used on inmates." Now with doctors like that who needs healthcare, right? INSURANCE COMPANIES & HMOs I visited my Bluecross Blue Shield doctor last week. He looked at my Midrin bottle and saw that I had taken only 6 out of the 20 my nurse-practitioner at another doctor's had prescribed, despite the fact I get headaches twice a day. He smiled, but didn't say much. "Shall I write you a prescription for Midrin?" he asked instead. I smiled back, and for an hour we bargained for the pills that are least likely to have side effects. If they don't work, I've already told myself I'm a no-show for a next appointment. I can always get Midrin filled up from any nurse practitioner if at all I have to take anything. It's not a problem I associate with Blue Cross Blue Shield in particular. I had to take that "trial drug" under Aetna's plan in 1997 -- the one which is only for high blood pressure folks, NOT me. I had to go to these doctors as they were under the insurance/HMO plan. If you're lucky, you'll get a doctor that does a Cat Scan first and then tells you what pills to take home. So, you can see, finding a doctor who is not rushing to fill his own coiffeurs with drug company pay offs before he does proper physical tests has been the toughest part about getting health-care for me. The Pain-killers Doctors will always try -- when they can -- to send you back with off-the-shelf painkillers rather than have the insurance company pick up the huge bill from your getting the proper tests done. It's nice that at least they ask, "have you tried off the shelf drugs like Aspirin and Tylenol?" If you nod a yes, they will send you home, an honest day's work done. But if you're gone to see your doctor, chances are you've tried the ones at CVS and Rite-Aid first and what you really need is healthcare! It's a good thing I read before I go to any doctor. I had looked up enough websites on headaches to ask mine questions about whether I should get a Cat-Scan. Apparently, there's ways to see if you need one. I did some floor exercises -- walking on heels, backward, sideways to reveal any apparent defects in my five senses. Doctor announced CATSCAN not necessary, but allowed it since I haven't gotten one as yet. So, good news. I'll finally get to see a picture of that problematic brain. Will it do me any good? Doctor says, most likely not, since headaches can be due to aneurysms of blood vessels which wont show up, though he feels confident it's not that either. What is it then? You're headaches are just headaches. People get them. Doctors try new drugs on patients. One day something works. I'm not new to this "trail-and-error" method. I flinch. I look at the sample pills and capsules he is giving to me to try before skeptics like me actually buy them, and wonder if they will work. What if there was no Aetna? That year on Aetna's plan I got very scared. It limited me to U Penn's Student Health Care -- cause hubby was a student -- and restricted me to seeing the same godforsaken doctors. I didn't feel like seeing those doctors. So I went without seeing a doctor for two years, treating myself with herbal and over the counter medicine. It sucked. A year later, I discovered HEALTH CARE SAVINGS plans while surfing the internet, where you pay a fixed dollar amount every month to get some minimal savings from seeing doctors frequently and from prescriptions. It was great. I used it. Saw a doctor. He was fantastic. But then I moved to Arizona, so I lost that doctor. Without Health Insurance in Bangladesh As many of you know, I'm from Bangladesh, where we have two options for people. Public Healthcare and Private Healthcare, and there is no such thing as healthcare insurance or savings plans. Public Healthcare means seeing a doctor in a Public Hospital, a doctor that can give you 5 minutes of his round and sometimes can't cause he's stuck at his private clinic where his patients can pay more. One of my aunts is a doctor. Thank god for that. Because we have some folks in the family who are forever in need of emergency healthcare. And public hospitals are cheaper. Knowing someone in the hospital opens doors. You will get great treatment. The cost is still high for middle-class Bangladeshis -- who are really the educated poor. Doctors, engineers, lawyers make about TAKA 100,000/month on private practice. That's $2000 per month tops. Professors at Universities who have done their Ph D's at Harvard, MIT, Oxford U. -- if they don't have some form of consulting income -- make Take 10,000/month -- that's just $200. An average professor must have another source of income for his family to survive. He will be spending Taka 10,000 in excess. So, you can see that people have no spending money. Hospital visits are unaffordable, and even if you can it's best to have an Aunt or Uncle who's a doctor. Otherwise the line for a bed is huge and everyone has paid a bigger bribe than you to get it. No. With our 130 million poor, we aren't going to have universal healthcare for poor nations like Bangladesh. Hardly anyone pays taxes back home. Most people don't where the next meal is coming from. What do you do then? Do you wait in line with all the other beggars to get a bed so you can have your kidney's removed on time? The market provides for some people, while the poor stand in line. Accident-prone child & Gifted Surgeons Ever since I was a kid in Australia -- far from the protective hands of aunts and grandparents -- I was an accident prone child. I have about as many stitches as one can get in one lifetime. Falling from trees, running through broken glass, daring the other kids to follow -- you name it I did it. But surprisingly, the doctors were good at stitching people up and I've never quite thanked them for it. I also had a benign tumor removed from a left leg. I was three, rambunctious, swinging from tree to tree, and then one fine morning I couldn't move my left leg. Loa and behold there was a three inch diameter swelling below the knee. Again I was at the hospital, but this time not for just regular stitches. I heard from my dad that it had been a tumor though they couldn't tell if it was benign until last minute, and that they had considered chopping off the leg in case it was. It was sheer last minute decision I heard, that the docs decided it was benign so I did get to keep the leg while the tumor came off. Thus I narrowly survived what might have become a case of medical malpractice. The gift of Insurance and more chaos for the rich By the time we left Australia in 1978, my student dad had spent all his savings on my health bills. It's no doubt that he was excited when his American employer covered him and family for health insurance in Bangladesh. It was one of the most costly plans I'd heard of -- if you take into consideration standard of living in Bangladesh -- but he was so excited by the whole idea of any health insurance that he gladly paid for it. The plan would pay for any health care expenses he and family incurred. He wasn't restricted to any doctors. That opened up his chances of seeing the best. The good thing about Bangladesh healthcare is that if you can pay for the treatment you will get it. The drug companies haven't become that smart yet that they will put you on a guinea-pig routine of drugs via your trusted physician. That way you're safer. But you will get sent home with a list of medicines alright, and in most cases the doctor will own the Pharmacy and will have at his/her disposal a huge list of drugs to sell. That increases his ability to make money without necessarily pushing one type of drug. Back home, the places where you hear about medical malpractice, if at all, are in the Operating Rooms. We have skilled surgeons but the good ones are all in the Middle East, and the one's that came back have huge waiting lists that you may not survive. Health Care Reform: How ? Well, you've seen all the scenarios. If you're in America you're a guinea-pig until you get lucky. If you're in Bangladesh chances are market prices will kill you before the doctor does. It seems to me that for people to get real healthcare vs. casino-style healthcare in the US without resorting to public healthcare that's not worth it and market health care that you can't afford as in Bangladesh, the following should be done: 1) Doctors' salaries, bonuses and benefits from HMOS/insurance companies should not be tied to how many drugs they prescribe to patients. 2) Doctors should not be prescribing medicine before doing proper physical tests on patients. 3) Drug companies/Doctors should not allowed to test drugs on folks in prisons, on patients, on foreign-aid recipients in lands with legal systems don't protect consumers. 4) Drug companies should not start treatment using trial drugs. 5) The Food and Drug Regulators should make sure that proper trails are made before making the medicine available and not wait 10yrs to ban it under political pressure. 6) Visits to doctors should not be so high at Public Hospitals so that everyone can see a doctor and insurance must be free for the poor and affordable to all. 7) Where nations cannot handle healthcare they should invite foreign healthcare organizations to provide alternatives but the countries should also have Health Care Bioethics Boards to make sure they aren't getting trial-drugs and if they find out they are, should have laws to pursue the criminal organizations. 8) Drug companies should not be allowed to renew patents on medicines more than 3yrs old, thus giving incentive to competitors for new drugs. 9) International trade of drugs should be made less stringent so as to allow better quality and cheaper drugs from entering the market, such that local companies feel competitive and are unable to control distribution markets. 10) Drug companies and insurance companies do not enter into contracts that limit what medicines a doctor may prescribe. 11) Drugs should not be okayed for sale by regulators if they have side-effects that create more health problems or risks. |
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