Health Care - The Future

When my mother started out as a Licensed Practical Nurse in 1960, she was paid $7.50 a day, for an 8-hour shift. When I began working as an L.P.N. in 1966, I made $9.50. In January 1967, the Minimum Wage took effect and my hourly wage was dramatically raised to $13.75, which may have included $.75 for working evenings or nights. By the time I began practice as a registered nurse in 1983, I was making about $14 AN HOUR.

Wages are not the only thing that evolved during the last half century.

As a young nurse in the 1960s, I was particularly sympathetic to the elderly. Surgery on a senior was very high-risk, not to mention costly, and was, therefore, discouraged and not often done. The cost-benefit analysis was not necessarily stated but, in general, it seemed to me that if the patient was about seventy or older, he/she was viewed as one who had lived a long life -- long enough.

When I was nineteen, I wrote about my perceptions of the treatment of the elderly in this country. Based on my own experiences, although the care was still very much patient-centered, I thought the elderly were the very lowest priority for doctors.

At that time, I didn't know anything about the business end of health care. But now I know that in 1965, when Medicare began, less than 50% of the elderly had health insurance. Unless the person had money, or found a charitable doctor or hospital, they didn't have many options. The same for the poor.

But as a result of the Medicare and Medicaid programs, the old and the poor became valuable commodities. These government programs, as well as the phenomenal advances in medical diagnosis and treatment, greatly enhanced the lives of the old and poor over the last 40+ years. And health insurers, doctors, and pharmaceutical companies are among the entities that have been greatly enriched, as the government reimbursements, particularly for care of the old and poor, have flowed into their coffers.

I don't know enough to understand the nuances in the current system that result in the dramatic daily reports about people not receiving health care, losing their homes, etc. But, in general, health care has been a lucrative industry for decades, and most people have become accustomed to a high standard of care. They may not think it is high, but it is when compared to the pre-Medicaid/Medicare days.

But these advances came at a great cost to most citizens, and brought us to the place we're at now.

And the place we're at now is not a good place because, despite the high taxes we pay, the government programs are in financial trouble, and insurance policy premiums continue to rise. Something had to be done... but what is the best approach to providing quality, affordable health care to everyone?

I don't know.

In my own practice, I witnessed the health care focus shift from PATIENT to PROFITS. When my place of employment changed from a general hospital to a medical center in the early 1980s, it became a big corporation, with the charitable nuns replaced by business managers. The change was reflected in all aspects of the facility, as every detail of care was weighed in terms of how much money could be made from a patient's pain and suffering - about how the most amount of money could be made by providing the least amount of care.

Medicare and Medicaid, mismanaged and under-regulated, got way out of control!

For many years, I have believed that far too many unnecessary surgeries are performed, and too many drugs prescribed. Many doctors get kick-backs from pharmaceutical companies every time they write a prescription. It's all about taking advantage of the current payment system... Lots of money has been made by lots of people, all at the expense of the taxpayers, to the point that the system is facing bankruptcy.

During the two years I worked in a convent, the nuns, who had good insurance, were very easy prey to doctors who saw the gold mine inherent in such a community. Surgeries for carpal tunnel syndrome, cataracts, and joint replacements were among the elective procedures performed on a high percentage of the sisters. And a podiatrist found reasons for nearly all of them to see him regularly and have good foot health by ordering his custom-made arch supports that cost a few hundred dollars each. At various times, I was appalled that an 85 year old would be given "Shock Treatments" (Electroconvulsive Therapy) or a heart bypass - or numerous dental procedures to save a tooth, rather than extracting it.

But people have become accustomed to the many options available to them, at almost any age, in the health care industry.

We desperately need solutions. And, admittedly, I was more in favor of an incremental approach because I am fiscally conservative and do not think we should do anything to add to the federal deficit.

Regardless of what I think, changes are coming very soon. Politics aside, because of being on the verge of bankruptcy, changes must be made. But whatever changes are made will result in a shock to many people. We will be living on a budget and, in time, the abundance of options that many people have now will disappear. How can it be otherwise?

My own thoughts are that there will be favorable and unfavorable changes and, in the end, not too many people will be completely happy. I think the costs of any new program will probably exceed expectations, and costs will have to be cut, one way or another. That is the part that people will like the least.

I see a health care system in the future as being far better for the rich.... because they will still be able to afford the realm of options they have now. But for average people, I think their choices will be more limited. The elderly will again be a lower priority, as they were before Medicare, and they will qualify for fewer procedures. After all, the elderly are extremely expensive to maintain and they will put a severe strain on the budget.

Cost-containment is going to be the name of the game, and what passes for "cost-containment" now will be unrecognizable in the future. Every patient and procedure will be subject to a cost-benefit analysis.... Will premature babies that often cost hundreds of thousands of dollars - or more - be saved? Will a 65-year old with liver failure be eligible for a transplant?

I guess we'll see because President Obama's health care plan is set to be the law of the land.

[And, since I live in a state that seems to permit a large percentage of the population to inherit the right to qualify for government assistance, I wish the government would dramatically cut welfare progams by actually investigating welfare and Medicaid recipients. Far too many able-bodied people here work at lucrative jobs, such as in construction, get paid big $$ under the table, don't pay taxes, and STILL collect welfare. - This goes on generation after generation..... to the point that it is so widespread that there are not enough investigators to scratch the surface of the problem. When it comes to the statistics, these people are included with the indigent that the goverment has to take care of.... In reality, they are given a free ride on the system, at the expense of taxpayers. It would be a huge savings if these slugs could be eliminated from the system.]