Why American health care is inching closer to veterinary clinic status

Have you ever owned a dog? If so, did you ever take him to the vet? I’m sure that even if you don’t own a pet, you understand the gist of the question, but now I’d like to ask it again in a different way. Before taking your animal to the doggie doctor, do you ask the little guy which vet he wants to see, or what treatment he wants to have? Of course not, that’s ridiculous. The animal doesn’t understand anything about their illness or injury, and besides, who is paying for their care? They should just be grateful that their magnanimous owner provides for their needs.

I’m saddened to say that in today’s healthcare environment many, if not most patients are being treated as if they are owned by their insurance company, or in the case of older patients, the disabled and the poor, it’s the government that functions as the de facto pet owner. This comparison also extends to most of America’s physicians who, like their veterinarian counterparts, work for and take their marching orders from “the owners.”

There are two basic problems with comparing “people care” to veterinary medicine. First, people are not domesticated animals, George Orwell’s satire not withstanding. For the most part humans have the ability to reason for themselves, make their own choices, complain when they are not treated fairly, and even possess the right to pursue litigation as circumstances demand. Despite these clear advantages, most people have passively allowed a set of faceless third party payers to dictate the who, what, when, where and how surrounding their healthcare, then blame the lack of personal service on the provider. Second, unlike government or corporate entities, the average pet owner actually loves the pet, and it is that affection that leads them to make compassionate decisions on behalf of their charge. It goes without saying, neither insurance companies nor the government love you.

Perhaps many find this comparison objectionable, and I can certainly appreciate that opinion, however, a closer inspection shows the American healthcare system is inching closer to veterinary clinic status every day. Payers contract with the providers for discounted payments without the knowledge of those who are most impacted. Eventually, when payments are slashed to the point of economic insolvency, the service is simply no longer available. This is precisely why many seniors are having trouble finding a doctor that will accept new Medicare patients and why a growing number of physicians are breaking the bondage of insurance contracts.

Much of what is being discussed in the media about death panels and rationed care is the direct result of the government’s attempts to control costs. In a veterinary clinic the overall cost of any animal’s care is determined not by what can be done as much as it is by what the pet owner is willing to pay for. Needless to say, there are not a lot of animals who receive hip replacements, heart transplants, chronic dialysis or chemotherapy. What makes us think that our healthcare owners will be any less willing to employ this same philosophy when it comes to decisions about your care, or mine.

We are already seeing the effects of the hundreds of thousands of pages of federal regulations on individual choices and fundamental freedoms. This is in spite of the fact the majority of Obamacare hasn’t even been implemented as yet. Starting with the mandate that all people buy health insurance and now mandating that insurance pay for specific reproductive related services is social engineering on its most basic level. What’s next, mandating that every American over the age of 50 get a colonoscopy based on the presumption that it is good for us, and therefore we should just take it?

The constitutionality of the new law was argued before the Supreme Court of the United States, and a decision is anticipated sometime this summer. Perhaps the whole thing will be thrown out based on the individual mandate and the lack of a “severability clause,” but the outcome is anything but assured. Even if the court finds it unconstitutional, there will be an immediate cry from those who have become dependent on government support, both patients and physicians, to replace it with another version. Eventually, we could still end up with a system much like they have in Great Britain, where healthcare is “free,” taxes are high and rationing is an obvious reality for all those who can’t afford private care.

Perhaps the most troubling and dehumanizing aspect of a government take over of “people care” is the loss of the individual’s legal rights. Unlike private insurance companies, the federal government has “sovereign immunity” from litigation in all cases of tort law, unless they specifically wave that right. Quite simply this means that if you are denied care based on a decision by a government board or bureaucrat, you will have no legal recourse.

The framework for the feds to take action that will ration certain types of care was included in the economic stimulus bill of 2009. Tucked inside that bill is a provision to spend $1.1 Billion on research to determine “Comparative Effectiveness” of various treatments. According to Robert Pear who authored an article in the New York Times, February 15, 2009, “The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.” What they fail to say is that this same method has been in use for some time in Great Britain, specifically to assess the relative effectiveness of costly treatments when weighed against the anticipated life expectancy of the individual. At some point you are simply too old to “benefit” from a hip replacement or coronary bypass.

One of the most difficult things that every pet owner eventually faces is the decision about how to deal with those final days. Rover’s cataracts have rendered him blind and he’s no longer able to make it outside to do his business. He’s not been eating, has lost several pounds and seems to have trouble even getting out of his bed. You take him to the vet and then comes the ultimate discussion. He’s had a long and healthy life, and its so sad to see him suffering like this. It really is the humane thing to do, isn’t it? Long pregnant silence … Okay, I guess it’s really for the best …

When you go home you find Rover’s empty feeding bowl and that old bed he slept on for all those years, and you feel bad about your heart wrenching decision for weeks, right? This is only natural, but under “universal people care” don’t expect the government to feel bad. Remember, they don’t love you, they just own you.

Robert Sewell is a surgeon who blogs at The Spirit of Healthcare.

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  • NormRx

    If people are not willing to spend their own money for a procedure with limited benefits why should the taxpayer?
    Some cancer treatments cost over $100,000 to extend a patients life by 4 months.  I would not spend that much of my own money on a treatment with such limited benefits, so why should I expect someone else to pay for it.  When I see stories have 90 year old people getting a colonoscopy screening  I am livid. 

  • sFord48

    So you want my dog to pay for his own cancer treatment?  Or do you think caring that you have to let your dog die is more important than treatment.

    Or maybe, you want me to pay for my own cancer treatment.  The endless complaints about insurance company and government programs controlling my healthcare seems quite ridiculous.  Why is it so horrible that the insurance company might say no to control costs when the alternative is to not get treatment because it’s not affordable to individual patients?

    Let’s get rid of the third payers so we can be “put to sleep” like poor Rover when we get sick.

  • http://twitter.com/drtwillett TheresaWillett MDPhD

       I certainly appreciate the vivid depiction of loss of control in healthcare. As a primary care doc, the ridiculousness of insurance (or lack thereof) is a very real danger to my patients. They are helpless in this setting, and unfortunately, many of their parents have been made so as well. 
       That said, there is an important place for mandates and rationing. Just because we can do something does not mean that we should. But just because an insurance company or contracting employer prefers not to cover something, that should not mean they should not have to. Capitalism has no safe place in basic healthcare. It has not led to healthy cost-cutting competition. It has not led to more personal responsibility on the part of patients and providers.  Honestly the thought of wealthy executives making determinations about what poor children and parents can get when they themselves are in no way affected by the decisions horrifies me. 
       Again, I strongly support the notion that there needs to be some rationing for the greater good- we simply cannot do everything possible for everyone.  Unless someone wants to pay out of their own pocket for an alternative or extraordinary option, all Americans should be subject to the same options and limitations in health access.  Even if we can never get private-sector insurance out of our health business, we should at least sever the forced connection on employers and insurance choices.  

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Why do you insult the veterinarians?

  • SaraJMD

    Actually, in taking my dog to the vet, I’ve thought that the dog is actually getting much BETTER health care than I am. The vet can tell me what things cost and understands that cost may be a concern.  The vet provides better customer service than any doctors my family has seen recently, calling back right away, etc. Perhaps this is because pet owners are actually their clients, rather than third-party payers, as in the human health care market.

    • rsewell

      The point is that pet owners are indeed the third party payer for the animal. Difference is you love your dog.

      • sFord48

        So only those that have someone wealthy that loves then can get care is your solution for healthcare reform? 

  • http://www.facebook.com/brianpcurry Brian Curry

    Feel better now?
    I’m going to venture a guess that somewhere, either in your house, your car, your office, online profile, wherever, there’s a Gadsden flag on display.
    What I read from you is that you have no solution. We have perhaps the least efficient health care system of any developed nation, and reform is sorely needed. Somewhere in the ballpark of half of all bankruptcies are related to health care expenses, and yet costs still continue to climb. Just about every single player at the table has seen the writing on the wall, and have agreed that something must be done. Yet you think PPACA should be repealed, and deride those that would seek to replace it.

    What would you do, instead? Stick with the status quo? Are you going to do the whole “best damn health care system in the whole wide world” shtick?

    FYI: Mandating insurance coverage is a regulation of the means of paying for interstate commerce. A colonoscopy is a medical procedure to which every competent patient has the right to consent or not. Regulating that people pay into a system for paying for a market that they will almost certainly enter at some point, and that the vast majority of Americans enter in any given 5-year period is an entirely different kettle of fish, and that you would compare the two demonstrates a lack of subtlety on your part that I find depressing.

  • civis isus

    Put a sock in it, Doctor Bob. You and your colleagues had your “free markets!” shot at it, for generations. You decided running up procedures was better for people than getting them healthy.  Now you’re reaping the whirlwind, and are feeling glum. Awwww. Do something of value for someone – get out of the way. 

    Oh, and take your pathetic, self-serving misinterpretation of ACA with you.

    • rsewell

      civid isus, or whatever your name is, I will not get into a lengthly debate with you or any other “progessives” because it will serve no purpose. I would only ask that you reveal your true identity, rather than hiding behind that lame handle, for no other reason than to allow me and other thinking individuals the opportunity to ensure we never get stuck with you as our “provider.” 

      • sFord48

        “… other “progessives” because it will serve no purpose…. me and other thinking individuals the opportunity to ensure we never get stuck with you as our “provider.” ”
        Thanks for providing your name…

        • lissmth

           sFord48, why do you say that other thinking individuals are mean?

      • http://www.facebook.com/josh.hyatt Josh Hyatt

        That is one of the most chlidish responses to a post I have seen in a professional forum. Congrats. Some “progressives” are thinkers and just because we may have a different opinion does not mean we do not think. The initial response was a bit over the top as well but if you are a “thinking” man as you claim, perhaps the best thing to do is let it go.

        The level of discourse is so sad. We have moved away from being able to discuss differences of opinions to hurling insults at each other. My mother taught me that “if you can’t argue both sides of the same point, you probably shouldn’t talk because it proves you don’t what you believe.” This is proof positive of this childish behavior.

      • Molly_Rn

        How old are you? Why do you respond like a 3 year old? Speaking about revealing your true self; pot calling the kettle black.

  • http://twitter.com/Hootsbudy John Ballard

    One of our family treasures is a pug that my youngest daughter found pictured on an online pug rescue site. We have no way to know how old he is but he is a perfect specimen, very photogenic and with a temperament sweet enough to be trusted with a toddler. But when she got him he showed signs of serious neglect. He was not housebroken and when found by the rescue people was near death from having been abandoned. We suspect he may have been used in a “puppy mill” for breeding purposes only and was put out, abandoned, either because the gene pool was so damaged his offspring were no longer viable or because the operators may have been caught by authorities.

    So what’s the point? This animal was damn lucky to be taken in by the rescue people and even more fortunate to have been adopted by someone who had the resources to get him to a vet where for the first time in his miserable life he had his medical issues addressed (chronic respiratory problems typical for the breed, unclipped toenails, wrinkles seeping with fungal infection) and could expect a much better quality of life.

    You want to compare people with animals? Try taking a look at the large and growing population of Americans for whom ordinary medical care is never, and has never been, a part of their life experience. Hell, some of them would be better off having the attention of even a competent veterinarian. I spent a career in the food business working with and among the working poor and I have seen personally what happens to those who cannot even afford what would actually be a very modest group insurance policy because they live from one payday to the next and even the employees portion of the premium is unaffordable. That is the group totally not taken into account by this writer.

    I have been reading and following the health care reform debate for the last several years and this is among the most cynical, callous, mean-spirited little hit-pieces I have come across. The sad part is not the post itself, but that so many equally misleading creations from inside the anti-reform echo chamber are appearing in otherwise respectable forums such as this.  And don’t hand me that old old “they get free care” trope. I have seen too many hard-working people living and working with chronic treatable medical issues, some of whom died or had to stop working because those treatable conditions did not receive even base-line attention. Anyone who thinks the patients who come to the ER for non-emergency care are getting adequate attention (or have to be chased away like drunks or those pesky homeless folk) is living in a bubble.

  • ofps

    This is kind of ironic – I pretty regularly hear my fellow thyroid patients say their dogs get better thyroid care than they do – that vets seem to “get it” more than their human counterparts – understanding that there is more than one test and treatment option to consider.

  • saraeanderson

    If you’re a doctor who frowns on CER, I have to wonder what it is you think you’re doing with your time and your patients’ money.  Either treatments work or they do not.  Some things are out of your hands, but if what those are can’t be determined, we’re just paying faith healers.  

    What I glean from the above is that there’s no way of knowing whether it’s worth using a particular treatment, but someone (not Dr. Bob!  Even a little!) should buy it just in case.  

    I have to fight this attitude with my own medical care, and it’s exhausting.  Being overcautious put me in a situation where I cannot afford to keep myself alive.  A collective (say, insurance payers) definitely can, and there’s no reason all the pre-diabetics out there need to keep whining about it.  

  • rsewell

    Obviously this post struck more than a few nerves. The point is people need to be aware that under any third party payment system, whether its under private insurance or a government payment system, patients are relinquishing control. There are currently, and will continue to be, consequences of that loss of individual liberty and freedom. Once Obamacare has been ruled unconstitutional, and it will be, we should start over with healthcare “payment” reform that starts with the patient. There needs to be input from real doctors instead of academics, the AHA, big pharma, self serving politicians and the corrupt payers. And no, I’m not talking about the lame duck AMA.

    • http://www.facebook.com/brianpcurry Brian Curry

       Oh, it will be? Love to see the crystal ball you pulled that one out of.

    • http://twitter.com/Hootsbudy John Ballard

      Nice try, Dr. Sewell, but you still don’t get it. Patients cannot “relinquish control” if they have no control.

      I totally agree with your point about the third party payment system. It causes beneficiaries of health care systems to have no “skin in the game” while simultaneously keeping them captive to the plan or system on which they are dependent, whether it be an insurance company, corporate group, Medicare or Medicaid. They/we are like the animals in the rescue operation I described in my example.

      But those fortunate enough to have access to the system — call it a veterinary system if you like — are still far better off than a large and growing population for whom that remains a fantasy.

      It is not realistic, politically, socially, professionally or economically, to exclude Big Pharma, the AMA, politicians, think tanks or academics from crafting any better system. I hate it. I truly do. But I also hate not having been born rich and good-looking and I hate all the mistakes I have made in my life. But we cannot go back and stuff the poop back into the elephant once it’s on the street. The best we can do is shovel it up and move on with the parade doing the best we can.

      I repeat my last sentence in case your scanned past it. Anyone who thinks the patients who come to the ER for non-emergency care
      are getting adequate attention (or have to be chased away like drunks
      or those pesky homeless folk) is living in a bubble. A few minutes ago I linked a relevant story for this holiday weekend that addresses the point I’m driving home. A group of people on Fifth Avenue is holding a banner asking “Were you there when they crucified the poor?”


      Notions of “individual liberty and freedom” are nothing but intellectual constructs for America’s underclass. And if you didn’t already know, intellectual constructs are about as foreign to that group as good medical care.

      Your post as well as this tepid comment about “striking more than a few nerves” only lets me know that the bridge many of us are trying to build has a very long way to go. I wish I could find the language to be more persuasive.

    • lissmth

       HSAs, high-deductible insurance, and transparent pricing.

  • http://profiles.google.com/andeevb Andee Bateman

    I always chuckle when I hear US doctors freak out over the NHS.  Truth here; there is tort limitation, to the point that if a condition is excacerbated by intervention, it is revised, or compensated within reasonable limits.  Also, the cost factor is laughable.  I pay slightly less in income tax in the US and get not alot for it.  In addition, I pay $12k per annum for private health insurance which may or may not cover the health care needs of my family.  In the UK, for considerably less ‘skin’ I pay to the NHS, I get comprehensive dental, eye and preventative care, as well as long term care should the need arise.  Does the NHS have issues? Of course, but there is always a venue for dispute or mediation should I need that.  I maintain dual citizenship for precisely this reason.  If the ACA is thrown out, I shudder to think of even the immediate fall out, let alone the long term crisis it will create.  C’mon USofA, join the civilised ranks of the first world.  This country needs single payer, in which we ALL have ‘skin in the game’ and all get to the goal line of comprehensive health care.

    • lissmth

      NIH’s biggest issues are exploding cost and a serious decline in common cancer survival rates.  It is not as bad as Canada, but much worse than the U.S.  The U.S. is also responsible for the greatest number of research breakthroughs and new technology.  We must not forget that the U.S. provides military protection for all
      the free world.  If the UK got its butt in trouble, guess who would be

    • lissmth

      Andee, if you are paying $12k/year in health insurance premiums, you have much, much more than “insurance;” you have prepaid health care.  For the same price you can get a high-deductible policy and have lots left over for an HSA.  After a few years, your HSA would grow and grow.  What is so hard to understand about that?  Eighteen months ago, a family of four could get a $10,000 policy for about $235 a month (in my zip code).  With Obamacare, the price is up about 50%.  Even then, think how much would be left over for an HSA.  Go to http://www.ehealthinsurance.com and check things out.  I don’t understand why anyone wants to give their health care freedom to the government.


    Comparative effectiveness studies are important.  The recent listing of “overused” procedures that a group of national medical specialty groups recently promulgated shows that such studies need not come from Uncle Sam and his bureaucrats.
    Memory is short.  Recall that a $100,000 bone marrow transplant was “thought to be” a wonderful treatment for breast cancer and it would not even be “ethical” to study its efficacy.  Advocacy groups sprung up and some states made it a mandated benefit for insurance providers and HOMs.  Nonetheless, when the technique was actually subjected to a randomised controlled trial, not only did it not work at all well but the treatment actually CAUSED huge morbidity and mortality.
    We even fight with our patients on the issue – how many patients demand antibiotics for a cold or spend a fortune on unproven megavitamens or other quack remedies?
    Finally, we certainly CAN differ from NHS – such CES need not be coupled to life expectancy.

    • lissmth

      Comparative effectiveness research applies to the “typical.”  What happens if your doc knows you better than the government?  Will he have to go through steps A – F before he can use Step G?  Why not Step G to begin with?  As government becomes more and more dictatorial, doctors become nothing more than trained monkeys who can check off the boxes.

  • LastoftheZucchiniFlowers

    All emotions aside: it’s about the ‘customer/client/patient’ and the ‘doctor/provider/practitioner’.  Decades ago doctors were paid by their patients: period.  Sometimes they were not paid and did a bit of bartering.  There was a lot of ‘professional courtesy’, now outlawed.  Additionally during those past decades doctors were THEIR OWN BOSSES.  This made a huge difference in how we felt, treated patients, and how we existed in the ‘mix’ – now an enormous wheel FULL of extraneous cogs with no real impact on patient care. And so the present reality is a function of the past.  I will be the first to say prior to the DRG years – money flowed rather shamelessly in our direction.  Often we deserved it, but not always.  My late father, and grandfather often took less money from poorer patients (which, btw, cannot be done today without designating a ‘sliding scale’ through the practice managers who are NOT physicians).  Again, when physicians abdicated their power to larger organizations because it ‘seemed easier’, or they thought there would be more time off, less call, etc. – EVERYTHING went south, including patient care.  There are very wealthy people on this earth who get the very best of EVERYTHING which includes health care that would make your head spin.  They are often unhealthy people (Dick Cheney), and frequently, they die in SPITE of their very expensive health care which is the BEST money can buy (the late King Hussein of Jordan).  Money still makes the world turn – but cannot always grant additional or better life.  Very philosophical discussion vis a vis ‘veterinary care’ recalls the scenario of yesteryear which I described above.  Vet’s patients are the human beings who pay the tab!  Hence, a nice relationship of give-take-respect and returned phone calls.  BUT did you ever visit the vet when the person in line in front of you has NOT PAID THEIR BILL in a few months?  I have.  Not a pretty sight!  Nothing’s free – nothing EVER was……

    • rsewell

      LastoftheZucchiniFlowers you have hit the nail squarely on the head. This post was not an indictment of Obama or the insurance industry, nor was it about the haves and the have nots. It was about the desperate need for us to return to a “human” relationship between people. To return to such an old fashioned idea requires something that is increasingly rare in out society – personal responsibility. I recognize that this philosophy is not universally held, and before the “hate mail” responses come rolling in I would just add that even the poorest of the poor can show personal responsibility which is typically met with kindness and compassion. This is what it means to be human, and in so doing men gain mutual respect and individual self-worth. 

  • ChuckPilcher

    Before I take my dog to the vet I ask 3 questions: Is this necessary? How much will it cost? Can I afford it?
    Once I answer Q 1 in the affirmative and go to the vet, I then ask the vet the same 3 questions. If American medicine made people and docs have the same “skin in the game” as I have when dealing with my dog and my vet, we would have a better system.

    • lissmth

      HSA accounts, high-deductible insurance, and transparent prices would increase quality and dramatically decrease cost.

      • ChuckPilcher

        This is fine for those with money, but our health statistics are good – not great – only for those with insurance. The 20% of Americans without decent health coverage bring our country’s overall health stats down to the level of Slovakia and Cuba. (Dartmouth Study). What’s the answer to that?

        • lissmth

          ChuckPilcher, prior to Obamacare, 85% were happy with their health insurance.  Did government have to take control of everyone’s health care?  Why not deal just with that 15%?

          • davemills555

            Yeah, 85 percent of those lucky enough to afford insurance and not to have been canceled for any number of bogus reasons, like being pregnant or like having had a wart removed at some point in your past! That 85 percent and the remaining 15 percent you speak of don’t include the 50 million Americans without any insurance because how can you be happy about something you’ve never had or could never afford to buy in a million years.

      • sFord48

        With my high deductible insurance my questions are …Can I afford to go to the doctor?  What is the most likely course the doctor will take?  Will I be able afford the most likely treatment or recommended tests?  What is the probability that nothing bad will happen if I skip medical care?

        Several years ago, I could have afforded a trip to the doctor, but not the treatment.   I played the odds with a potentially life threatening condition on my own.

        When I take my dog to the vet, and I cannot afford treatment, it is acceptable for me to have the dog killed.  Is this the system you want?

  • Molly_Rn

    What total BS. OK, so you are a Republican
    conservative. We get it. You are not open minded enough to support a system
    that will at least give healthcare to all Americans. It is clear that you don’t
    love or even care for those of us with pre-conditions (this came about because
    health insurance companies figure it out as a means to not pay for a normal occurrence.)
    Everyone is entitled to their opinion, but that said you are wrong and I am
    glad that you are not my physician.

    • lissmth

      Molly_Rn, have you looked at survival statistics for common cancers in the UK and Canada compared to the U.S.?  If you had that information, you would not be advocating for government takeover of our private health issues.

      • Molly_Rn

        I am familiar to the healthcare stats from Sweden and Denmark and they beat the US hands down. Medicare for all.

        • lissmth

          Medicare will run out of money in a few years.  How will you deal with it as you advocate “Medicare (government medicine) for all?  I don’t understand how people are so willing to hand over their well being to government.  Can anyone tell me what government does well?

          • Molly_Rn

            Not true. Medicare for all will be paid for by all of us except for those too poor to do so, but the rich will pay their fair share. It would be nice to have taxes actually go for something that benefits us unlike the Bush wars.

          • lissmth

             Molly_Rn, what is “fair share”?

          • davemills555

            About 30 percent of your ordinary income. No loopholes. No write-offs. No more gimmicks and games for the wealthy. A tax code that’s no longer rigged for the rich. Even capital gains is treated as ordinary income. Sort of like the “Buffett Rule”…

            Get it?

          • lissmth

            How do you come up with 30%?  Who decides what is fair?  Are you aware of the Laffer curve?  Does it matter to you?  Would 30% mean Buffet pays his taxes too? 

          • davemills555

            I don’t understand how people are so willing to hand over their well being to government?

            Huh? Our health care system has been run my private insurance companies for decades and look where we are! They ruined it! Private insurers add absolutely no value to the mix and yet they rake in hundreds of billions of dollars each year while they continue to push up our insurance premiums. Answer this question: What do private insurers do besides act as a middleman just to take a profit? What value do they bring to the table? I can’t think of one single thing they do that makes our health care system better, can you? If we go to Medicare for all, at least we will eliminate the private insurance companies. Something we should have done years ago!

          • lissmth

             But what happens when Medicare runs out of money ( as it is scheduled to do soon)?  Does that $70 billion a year lost to fraud and waste bother you at all?

      • sFord48

        Yeah, we in the US overdiagnos many cancers and then pat ourselves on the back how great our cure it is.  I would rather get my health care from Canada than tortured in the US.

  • http://www.facebook.com/josh.hyatt Josh Hyatt

    The difference is that people cannot often afford their medical treatment due to a many different reasons, high costs being the main reason, which is why we have insurance. I agree that people and providers definitely need to be more accountable for what services they provide but it needs to be measured and understood that even $100 for many people is a lot of money. It can be the difference between eating and not eating for a week or more.

    There is certainly no easy response to this crisis. There are good and bad things in the Accountability Act and that should be filtered through and refined. Which is what is being done at this point. All controversial laws go through this scrutiny, and that is good. That is how we get where we need to be. With all the administrative rules and interpretations, etc, the bill will be picked apart and tweeked to hopefully be what we need it to be, with everyone’s perspective and thoughts accounted for.

    My biggest concern is that if the law is struck in its totality, I believe the honest and honorable intentions for this legislation will be lost for a long time. The good stuff needs to be mined, the bad stuff re-worked, and the necessary stuff added.

    In my opinon, there are two big issues we face. First, our health care system has no identity, in that it does not know what needs or should be. Should we be focused on quality care or financially maintaining a juggernot? As a corporation has a defines its mission statement and develops goals to meet that mission, the health care system should do the same. If our goal is to provide quality healthcare to all people in a fiscally responsible manner, then we should take steps in that direction.
    The second, and most unfortunate thing, is that both sides have become so polarized that this cannot happen and the people left to suffer are all of us. We all pay for indigent health care with higher permiums, we all live in a sicker society than we did 50 years ago (even though we have better technology), and we will all be consumers of a health care medical care system with no identity.    

  • natsera

    About the person who screamed about the colonoscopy for the 90-year-old. YOU cannot predict life-expectancy for anyone. We have a 93-year-old woman happily folk dancing in our group, and she is mentally sharp and healthy, and it’s partly because she had a cancerous, but non-metastatic tumor removed 3 years ago. Determining the appropriateness of treatment should not be based on age, but on general health and comorbidities, as well as the wishes of the patient. I don’t know how long Alice will live, but I’m glad to have her dancing and not dead because someone thought she was too old to have the tumor excised. 

  • RMMnow

    I thought this was going to go in a totally different direction.  The last time I took my pet to the Vet I was fascinated to find that he was and had been using Electronic Health Records for some time.  He knew everything about my dog instantly and could find a problem list, med list and vaccine report immediately.  When I asked my PCP when I had my last tetanus shoot it took him thirty minutes in my paper chart to tell me he didn’t know.  Why are People Doctors so resistant to EHR?

  • dbierwi440

    Social Security, Federally controlled public schools (You take our highway funds in order to get…….)? Now this? It might make things more efficient for a few years, but it will fail. Failure is when something that does not reach its expectations. 

  • webhill

    I’m troubled that the author compares human medical practice to veterinary medical practice as if veterinary medical practice is a terrible thing. I am particularly troubled by this portion “You take him to the vet and then comes the ultimate discussion. He’s had a long and healthy life, and its so sad to see him suffering like this. It really is the humane thing to do, isn’t it? Long pregnant silence … Okay, I guess it’s really for the best …” which to me reads as if the author believes the veterinarian, in that scenario, is NOT of the opinion that euthanasia is actually the best option for the pet, but rather it is the only practical solution. In fact, in my veterinary practice, I see a lot of pets at the ends of their lives, and it doesn’t go as described here. Generally a pet comes in, sick, and a workup is done within the limits of the owner’s finances, and there is a discussion about prognosis and treatment options. If euthanasia is a reasonable option I will present it as one. If euthanasia is the only reasonable option because the pet’s condition is grave and it is suffering, I will of course recommend it. But then, there is no “pregnant silence” followed by “ok, I guess…” – generally instead there is usually either a sense of relief from the owner, or a huge outpouring of grief. And of course people feel bad after the loss of a beloved pet – but do they not also feel bad after the loss of a beloved grandmother — even though presumably grandma wasn’t put to sleep by her physician?

    I just feel like this author does not see veterinarians as dedicated medical professionals who work hard within limited means to provide yes, the most cost-effective but also the very best care available for their patients. And no, we don’t just do whatever the owner tells us to. Sometimes owners require education to understand why we will or will not be doing whatever it is they want to do for their pet, and we provide that education, and proceed with appropriate care. I don’t like the way veterinarians are portrayed as “taking marching orders” from pet owners in this article. It’s pretty obnoxious really.

    • rsewell

      Thanks for your thoughtful comments. I do indeed view veterinarians as dedicated professionals. I know several as friends and as patients. I think you misinterpreted my conversational style remarks as coming from the vet. Actually I was reliving a very personal circumstance within our family, and you are right it is like losing a family member. The point of this piece was not to demean veterinarians or even, as some have suggested, compare veterinary medicine with the healthcare that people receive. Rather, it was to point out how people are losing control over their own healthcare decisions, relying on the “good intentions” of the third party payers who are not always included to act as the patients advocate.

  • davemills555

    Why American health care is inching closer to veterinary clinic status?

    Uh, hey Bob, do you think maybe you might have it backwards!

  • http://www.facebook.com/josh.hyatt Josh Hyatt

    Reminds me of the old ethical question, “Would you rather go the world’s best vet or the world’s worst physician?”

  • KHSmith

    Thirty years ago, Americans had a world class “medical care” system that even managed to provide free care without braking the bank. That excellent system was cannibalized when the benefits of preventive care became apparent. Unfortunately, it was not recognized that the very successful business plan to provide for the expenses of the FEW who required “medical care” was NOT designed to pay for the development and implementation of a previously nonexistent  “health care” system for the MANY.

    Insurers (private and public) had to take control of expenditures so patients and care providers lost all control. The previously successful “cost shifting” of insured individuals paying slightly higher Medical services charges to provide for individuals without coverage has morphed into the unsuccessful “cost shifting” of the insured paying astronomical premiums to provide for the medical needs of the uninsured as well as the costs of the addition of a new “healthcare” system. 

    Medical and Health decisions will continue to be dictated until this is recognized and addressed.

  • lissmth

     Numbers are numbers.  If you want to refute hard numbers, it would help if you didn’t use something out of the Huff Post.

  • entre.amis

    And arguably your pet gets better care :)

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