Can You Afford Health Insurance? If Not, Read This!
By Jennifer Litz
Editor
There’s a small businessman in your community who doesn’t have health insurance. (He’s real, but his name will remain anonymous for obvious reasons.)
He’s not poor. He has a $600 monthly car payment, and a $1,200 mortgage. But insurance for his family of five would cost him $400 to $1,000. As is the case for many small businessmen, not receiving insurance through work makes it practically unaffordable for him.
And, he has found, inefficient. When his son broke an ankle earlier this year in gym class, this man secured treatment for his son—sans insurance—with three doctors visits that totaled $700—less than some of his monthly premium options.
This small businessman comprises a chunk of the uninsured population in Texas. The nationwide crisis is most dire in our Lone Star State. Stat sheets on the subject play on our reputation for having and doing everything big—not excluding our rate of uninsured, which sits at 24.5 percent, according to the Texas Hospital Association.
Who else comprises the uninsured? Maybe not who you’d think.
Dan Stultz, MD, CEO of Texas Hospital Association, offers a snapshot. “It’s along the Tex-Mex border,” Stultz says. “Demographics in those areas are higher in people of color—Hispanic, Asian, and African American. I don’t know if it has to do with appreciation of insurance, or the economic sense of it.”
San Angelo falls right under the ”orange” region in Stultz’s map— meaning a higher population of uninsured, “[like] most communities west of I-35 other than big cities,” Stultz says.
Let’s dispel who the uninsured predominantly are not: immigrants. Mike Campbell vouches for that. He’s CEO of the federally qualified health center, La Esperanza Clinic, which offers primary health and dental care on a sliding scale based on patients’ ability to pay.
“I’m sure there’s a piece [of immigrant service], but it’s less than five percent,” Campbell says.
Why should you care who has health insurance?
Tom Green County has an almost 30 percent rate of uninsured. If you fall in this category, you might qualify for programs you’re not aware of.
If you are insured—lucky you. You likely get your insurance through an employer. But you’re also subsidizing the shortfalls not covered by Medicaid, Medicare, and uncompensated care given the totally uninsured, according to some.
And everyone’s standard of health care suffers when sufficient funds don’t flow into the system.
The Sickening Scenario
Tom Green County hospitals (Community Medical Center, Shannon West Memorial, and Triumph) spent $53,044,336 on uncompensated care in 2006, according to statistics compiled by a cooperative between the Texas Department of State Health Services, the American Heart Association, and the Texas Hospital Association. That figure includes charity charges, so named for when a patient meets criteria lower than federal poverty level standards. Hospitals do not bill patients that fall into this category for services rendered. A smaller chunk (usually) of uncompensated care comes from bad debt charges and uncollectibles, which are bill balances not paid by those uninsured patients they were submitted to.
So how does one mosey into a health care facility and demand treatment without the ability to pay? Some primary care, private practice doctors will see patients regardless of insurance status or ability to pay. The biggest costs are racked up, however, when indigents and the uninsured show up to emergency rooms with a dire ailment—many times the result of lack of primary care.
Community Medical Center CFO Ed Romero runs through the usual situation. He says about 16 percent of the hospital’s ER visits are from people with no insurance.
“When you’re needing care, you go where you’re closest. In Tom Green County, an average of 28 percent or so are uninsured,” he says. “So coming to the ER, you’re going to the triage desk, [and we’re] not asking about insurance.”
Romero describes the next problem: finding a doctor for an unassigned patient after-hours. Hospitalists—specialty physicians that are available to deliver care in the hospital—help deliver immediate care. But after-hour physicians are becoming harder to find.
After a medical screening and ancillary tests are done, hospital administration gets demographic information on a patient. That’s when lack of insurance becomes apparent.
But rather than slap patients with a full-priced medical bill—say, $9,376 dollars for vaginal delivery with complications, as is the price quote at Community Medical—there are several avenues to give the uninsured a payment break.
Romero says Community has a contract with a group to see whether these types of patients qualify for SSI (Supplemental Security Income) or other governmental programs. The hospital also gives an automatic 15 percent discount to those who don’t have insurance.
“Another important feature—if a patient is not eligible for government assistance, we have our own assistance here,” Romero says. “[Patients] are referred to a financial counselor who goes and visits patients in their rooms, when it’s appropriate . . . and we’ll try to work with the families and see whether we can gather financial info, see if we can get some medical-related insurance claims. [We have a] charity program that allows for adjustment off the bill, 40 to 90 percent, depending on how patients meet eligibility. Here it mirrors the federal poverty guideline.
“But even with just 10 percent left, that can be difficult for families.”
But what of the costs to the hospitals, and everyone else?
Monetary Costs to the System
Community’s charity and uncollectible accounts have been rising. They comprised $12.2 million in ’06, and $15.5 million in ’07.
Shannon’s uncompensated care number is even higher. Bryan Horner says the hospital logged $35 million in charity charges, $12 million for bad debt and uncollectibles in ‘07. Horner says hospital administrators classify someone as a “charity” case if they qualify at the 200 percent level of poverty.
Horner doesn’t feel so charitable about charity care sometimes. And with good reason. He’s got some sobering statistics about the gap between the hospital’s charitable care vs. its reimbursement:
“Our charity care increased from $30 million in ‘06 to $35 million in ‘07; bad debt went from $9 million to $12 million in ’07,” Horner says. “Both [types of uncompensated care] are detrimental to hospitals as far as our ability to get reimbursed. Of course the charity care is not for profit, so we get to document our community benefit as a not-for-profit.
“There were nearly $47 million dollars in charges for Shannon of bad debt and charity in ’07. [That] probably costs us just around $15 million in costs that we incurred that no one paid us for. Shannon is not reimbursed for that, but as a not-for-profit, we’re not subject to federal income taxes and [other] taxes. [You] can probably have an appreciation that income taxes hospitals would pay versus $15 million in expenses for uncompensated care don’t quite equal.
“The numbers are growing both in people who just don’t want to pay or can’t out here in West Texas. Uninsured in Texas are the highest in the nation. When you split the state, west of I-35 probably has an overall uninsured rate higher than east I-35. It has to do with small employers versus large employers, etc.
“I would say people that don’t have insurance are hardworking people who happen to work for an employer who is small and doesn’t offer it—or if he does, the cost he’s asking the employee to pay is so high.”
Like Community, Shannon has different ways to help the uninsured pay for their services. As Horner points out, it behooves the hospital to help the uninsured pursue Medicaid or Medicare eligibility. Shannon also offers payment plans.
Many say the hospitals losses are passed on to those who can afford insurance—in more ways than one.
Tangible Costs to Health Care Quality
Texas Hospital Association CEO Dan Stultz, MD, tours the state talking to people about our problem. As the former CEO of Shannon Health System, he says uncompensated care is a bit worse for San Angelo hospitals, because it’s a referral center. It’s a hub where places like Abilene, Midland, Lubbock, Sonora, and others send their very sick to get care. “That’s a problem all over the state,” Stultz says. “They have their indigent program, but no transfer of funds for those sick people who have to go to a refer center.”
This is a common theme in the crisis of the uninsured: costs get passed along. And not just to big institutions. People who buy insurance have to pay for these costs, too, Stultz says.
“I think those costs that [hospitals] incur, not the charges, but the costs, have to be covered,” he says. “Those costs have to be covered—so they get passed along with higher rates to the insurance companies. Or for municipal districts, for citizens. Or [via] a bond issue to float when taxes won’t pay for it. From a small hospital to university hospital, somehow those costs have to be recovered.
“What I have heard—I’ve just heard—is between $1,200 and $1,500 per insured person is passed on in premiums annually to cover the cost of the uninsured. So you’re paying an additional $1,500 a year [for each person in your family because of the uninsured].”
But there are other, hard-to-quantify costs. Stultz says law enforcement has to deal with issues they wouldn’t if everyone that needed to be in mental health facilities could afford to be.
Diego Taylor of Rio Bravo Cancer & Blood in Del Rio agrees that the cost of a largely uninsured population is not just monetary, or sequestered to hospitals and indigents. In his view, it makes for overall substandard care.
Rio Bravo is a private practice specialty clinic. The doctors there won’t deny treatment to those who can’t pay. But Taylor says it’s hard to give comprehensive treatment to those who don’t have insurance to cover ancillary tests.
“The issue isn’t really so much our fee being paid to treat the patient,” Taylor says. “It’s getting all the diagnostic work done so we actually can develop or produce some information to give the patient. X-rays, bloodwork, and other types of pathology—we don’t do those things here. We do limited blood work. So there are certain therapeutic and diagnostic options that are not given to the uninsured.
“I mean, it’s an acute problem for that individual, but at a higher level from a macro-view, it’s a significant problem for the health system, and for all of us that are fortunate to have insurance. Because the level of service given is diminished.”
Taylor says the disjointed funding system for health care makes doctors skip tests for everyone.
“I’ve noticed there are certain patterns of care that have developed, where if you look at the literature and go to medical experts for protocol of treatment—on patients that are fully insured—you’re seeing steps are being skipped because there are so many uninsured or underinsured, and their payer—usually a commercial payer—does not like paying for this particular procedure.
“Month after month, [payment for these procedures] is always getting pushed back. So [doctors] stop doing [certain tests and procedures]. Because they’re not getting paid for it. Regardless of its efficiency. And that’s a direct result of our disjointed funding system,” Taylor says.
Something else that suffers from the disjointed flow of funds—medical equipment. “When it comes to making a decision about a large piece of equipment that could be $100,000, [institutions might] choose not to get that equipment because we know we won’t be able to pay for it with the revenue we’re bringing in,” Taylor says.
“So when people think, ‘those poor uninsured people,’ it’s really their own health care they should be concerned about,” Taylor says. “You can’t disjoint the two.”
So What Can Be Done to Put the System Back Together?
There are many ideas, and even more plans on the books to help allay the financial strain the uninsured place on hospitals and doctors. One pending Medicaid Supplement Program between Shannon and Community hospitals would have the federal government match their health care budget (also called the Tom Green County Indigent Health Care program) with $2.55 per dollar of the submitted budget (see sidebar).
Federally qualified health care centers (FQHCs) also help ease the burden of uncompensated care. San Angelo’s Esperanza Clinic provides primary health and dental care on a sliding fee scale, based on a patient’s ability to pay.
“So we can avert situations where people put off care and become so ill they have to go to the emergency room,” says CEO Mike Campbell. “If they come to us, we can address those issues early on before they get to that spot.”
The Esperanza Clinic gets a federal grant that makes up 40 percent of its total budget. The rest of it is made of Medicaid, Medicare, and private insurance payments.
The THA’s Dan Stultz says FQHCs like Esperanza Clinic have shown in other states to decrease the amount of hospital days and ER utilization; studies like this have not yet been completed in Texas.
Jack F. Houghton is CEO of Val Verde Regional Medical Center in Del Rio. His facility offers care to a particularly problematic region for the uninsured—the border. Houghton says people there are less likely to afford insurance because of the amount of indigents and small business employees.
“Let me say this—anyone that comes in who has no insurance and no means of commercial insurance or Medicare or Medicaid, we work with them on the basis of a 35 percent discount if they pay cash,” Houghton says. He also says there are people who qualify for programs like Medicare and Medicaid, but haven’t secured coverage. The hospital assists them in that as well. “It helps us because all of a sudden we’re in a position to get some compensation for the care,” he says.
Houghton is passionate about solutions from the other side of the spectrum—preventing skyrocketing uncompensated care costs. He stresses preventative care and special attention to certain demographics.
“One of the things they’ve done that’s significant—there are plans out there that deal with insurance that’s available for children to make sure they’re protected and able to get routine care,” Houghton says.
Houghton says prenatal care deserves special attention as well—“taking care of these moms-to-be, who need to be under the care of a physician during the pregnancy,” he says. “That is a high-risk area, and when something goes wrong it can become unbelievably expensive for the family, and for society, for that matter. That should be a focus and area where there is special attention given to compensation or some type of federal program to make sure these women get prenatal care. That will cut costs.”
Diego Taylor at Rio Bravo Cancer & Blood thinks a publicly financed health care system, still with private delivery, would be helpful and equitable. Rachel Beavan, an individual insurance agent in Del Rio, says it’s more complicated than that.
Beavan acknowledges that premiums are expensive. “If you’re an individual and you want to purchase individual insurance for your family, for a family of four it’s $600, and that’s an awful lot,” Beavan says. “But if you work out a plan where everyone’s going to have insurance, you’re not going to be able to have office visits. You won’t have all these things where you pay $25 to go to the doctor because your nose is running.”
Moreover, she says, the middle class will feel the crunch of government-mandated, subsidized insurance. “People on Medicaid are already taken care of,” she says. “People who don’t and can’t have insurance are the ones that are paying taxes. So if you want a plan where everyone’s going to have insurance, that means subsidies, which means taxes go up, which means insurance is going to be cheaper—but taxes went up to pay for that.”
Another problem, Beavan says, is that most people wait until after they have a known illness to try and secure a policy, when it’s either impossible or too expensive.
“The two things people want are maternity coverage, or their child has been diagnosed with ADD,” she says. “Neither one of those is covered in an individual policy, just in a group policy through an employer.
“But that’s what I find . . . [people] don’t want insurance until they need it. And you can’t insure for the known.”
These voices and concerns must coalesce for practical, pragmatic reform. Otherwise, everyone will suffer. Especially West Texans.
“The more uninsured there are, that is going to decrease the availability of insured people to get access to quality health care,” says Shannon CEO Bryan Horner. “Because you have doctors, now, looking at where they want to practice based on payer mix, demographics. So if you’re a doc coming out of residency, and you want to live in a state in the Northeast where it’s very unionized, and the unions require employers to have insurance, you’ll see those states have well-insured populations. You can go there, treat patients you see are going to pay, versus coming to West Texas where you’ve got almost 30 percent uninsured.”
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I do not understand why
I do not understand why everyone is against universal health care, will not cost anymore than
the war will it? as for military health care, only the ones without it complain. We were promised health care for life when we signed up for the military and it used to be free,not any more, however the premiums are within everyones budget and we can use civilian Doctors and hospitals if there is not a military equivilant nearby.Apart from medicaid it is the nearest thing to not being afraid to get sick.
All health care systems have problems, but none of the European plans will bancrupt a patient. I suppose if one is in
the insurance business or have stocks in the system,insurance,pharmacutical,research, or private hospitals it must be scary to even think of changing. I feel so sorry for these poor
people (not) as usual it is a case of "I am OK so it is not my problem"
How about looking outside the US with open minds instead of listening to propoganda.
I have lived in Europe and they are every bit as good as we are, in fact Doctors are more
interested in curing the patient than where the next vacation house is going to be built.
I have never seen a poor Doctor where there is universal health care by the way.
I am grateful to the Doctors who come to Del Rio and choose to stay because they are trying to improve our health care here. Of course we would rather go to the city to see a Doctor
because they have to be better, I do not understand the mind set. Has anyone sat in a doctors
office for 3 hours waiting to be seen? or made an appointment, maybe the next month or even
longer. Yes friends there are waiting lists and you are paying through the nose for the
privilege.By the way Europeans have the choice to pay for private insurance if they want to
and some corporations offer it, however if one is not able to afford this there is always
the National health care that looks after everyone.
i
The problem with alot of the
The problem with alot of the "European" or other places that employ universal health care systems isn't so much the healthcare or systems themselves, every system has problems, is the tax rates of the places that have the "universal" health care set up. We all know health care isn't cheap and I can't understand the mindset of anybody who thinks it's free. That health care isn't free or cheap without a high tax rate. What do you think the American people would do if the tax rate here bacame the same as say, Switzerland? Which has a tax rate of about 47% by the way. Thats how these "unversal" systems are paid for. The doctors and systems don't do all that work out of the goodness of their hearts. Imagine if the rate here in Tx went from 8.25%( I think it is) to somewhere up to around 47%?
You know Chris, I completely
You know Chris, I completely forgot about the tax thing. I remember that in Germany they taxed them twice a year. When I asked my neighbor why she was throwing out a perfectly good TV, a real nice rug and some good furniture I got an earful. Here's what she told me; they are taxed twice a year [I would guess so that it's not such a burden all at once], everything in the house is taxed and they are taxed per room. If it has a door it's a room she explained to me. This is why they have open floor plans and instead of closets they have wardrobes. She also told me that they tax the crud out of them based upon the number of electronics in the house and basically she could only afford to have one TV.
We Americans had a field day on what we termed "junk day" this was the week or so before the tax people showed up in each area. Sometimes the Germans would watch out the window and if someone that looked nice walked by they would run out and give you something real nice that they couldn't bear to trash but couldn't afford to keep.
This is not to even mention the taxes on Vehicles which was horrendous compared to ours.
Can you imagine some of our households having to pay a tax on each TV? and each computer? and each Play Station? As a country we would freak.
Someone in another post questioned if universal health care would cost less than the war on terror. I hate to tell them this but universal health care would probably cost in the order of a thousand times more per year ad infinitum. But I do have to admit it would be really refreshing to have more doc's that are more interested in curing you than making more money.
Your right , I wish we had
Your right , I wish we had more doctors that cared more about people than money also. I get a kick out of people who watch something like that idiot Michael Moores movie and jump on a bandwagon without doing a little research themselves. I'm not going to jump up and say one system is better or worse than the other.I don't know that, but so many people hear that alot of Europeans, and even Canadians( if I remember right Canada) don't have to pay for some basic health care, and so on and so on. Well, I hate to tell everbody they pay for it alright. Just look at the tax. It's not free as they think just because they don't get a bill.
bobmicheli....You must be
bobmicheli....You must be drinking too much wine yourself and it caused you to drift off in some abstract land. Some of your thoughts are really dangerous. I wonder if they really are your thoughts or just some abstract opinion you have come across and decided to push forward. To invite a pregnant woman to drink based on such flimsy information is really not worthy of passing along. The next thing you know you might be prescribing more recreational activities as healthy for mom and the innocent, helpless baby she is carrying and caring for. Shame on you!
As I understand most
As I understand most "universal" health care programs, those under the age of 50 stand to benefit. Seniors would not, primarily because of needing more specialized care. Waiting lists for that are long, the process cumbersome and frustrating. Look to Canada and Great Britain for examples. If a senior were to need a bypass, or knee replacement, or anything else to add to the quality and longetivity of life, he likely would not get it in time to benefit from it.
Just one more scary fact
Just one more scary fact that our Federal government spends an average of over 200 Billion more on
Health care then on the total department of defense.
2006 Department of defense 419 billion Health and human services 642 billion
2008 529 billion 707 billion
And I totally agree with you that there is a tremendous amount of fraud.
bob
I guess I should have
I guess I should have pointed out that I didn't disagree with the German Doc's I was just highlighting the polar positions that our two medical systems have taken. 82 Million Germans can't be all wrong :) Wine aside, Beer is a staple at a German table like Iced Tea is here in Texas. I would also point out that Hypertension is much more rare in Germany percentage wise than it is here in the U.S. I looked but wasn't able to find any statistics on liver or kidney damage. Not much good being de-stressed and then needing a transplant LOL
Thought you might find this humorous.
Sept 04
"Germany's Economics minister says beer is so healthy it should be available on the country's health service.
Minister Wolfgang Clement, 64, who can reportedly down a beer in 1.5 seconds, claims he can't get enough of the brew.
"People should be able to get prescriptions for beer through the national health system," he said.
The positive effects of beer were recently confirmed in a paper by Austrian professor Manfred Walzl of the Graz neurological clinic.
According to Walzl, beer reduces the risk of stroke and heart attack, improves circulation, and even acts as an aphrodisiac - if not taken to excess."
Just some more facts
Just some more facts Probability of dying under five (per 1,000 live births) U.S. (8) France(5) Italy (4) Germany (5) Japan(4) China (27) Cuba (5) Maybe the German doctor was right??
You might find this interesting
Since 1990 every bottle of wine, beer and spirits sold in the United States has carried the warning that "according to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects". If that has not been enough to add to the anxiety of women already concerned about their own health and the health of their fetuses, hundreds of newspaper articles and t.v. talk shows have been devoted to convincing women that if they have even a single drink during their pregnancy that there is a chance that their baby will be born deformed, addicted to alcohol or retarded.
It seems, however, as if the American government, medical authorities and media have not been telling American women the entire truth. Although the official message is "don't drink at all during pregnancy", a great deal of recent research and a re-examination of the alcohol-pregnancy issue show that there is no conclusive evidence to demonstrate that moderate drinking during pregnancy can harm the fetus.
According to Doctors David Whitten and Martin Lipp of the University of California at San Francisco, "the campaign against drinking during pregnancy started in 1973 when several studies showed that heavy drinking during pregnancy can cause the condition known as the `Fetal Alcohol Syndrome'". These studies demonstrated that the children of many alcoholic mothers were born with a cluster of severe birth defects. "What the government conveniently chose to ignore" say Whitten and Lipp, is that this syndrome is extremely rare, occuring only 3 times in 100,000 births, and then only when the mother drinks abusively throughout her pregnancy".
Lipp and Whitten, whose "To Your Health" was published in 1995, are among an increasing number of doctors and researchers who feel that pregnant women have no reason to fear drinking a glass of wine every day. As revealed by contributing editor Thomas Matthews in the August 31, 1994 issue of the "Wine Spectator" magazine which was devoted largely to this controversy, "there is even new research that shows that moderate drinking during pregnancy may actually help the development of the child after birth".
No one questions the fact that the consumption of large amounts of alcohol during pregnancy can harm the fetus. It has been well established, for example, that the children of women who drink more than 3 - 4 glasses of wine daily show significant decreases in birth weight and length than of women who drink 1 - 2 glasses daily, and it is generally accepted that having five or more drinks per day is especially dangerous to the fetus. Here, however, agreement ends, and Genevieve Knupfer of the Alcohol Research Group in Berkeley, California says that part of the problem comes about becuse many of the studies that reported adverse effects on the fetus used imprecise methodology. In several studies, for example, researchers arbitrarily defined "heavy drinkers" as those women who consumed more than one glass of wine daily.
Feeling even more strongly, Dr. Michael Samuels of New York City's Doctor's Hospital says that the data has been "turned around for the purpose of frightening women", and indicates that birth defects of any kind occur in 3 - 5% of babies born in the United States and only 1 - 2% of those can be related to the ingestion of alcohol. Based on the data of Samuels and other medical researchers, it becomes clear that less than 0.1% of all birth defects are related to alcohol, and that more than 90% of the affected children are born to women with a history of alcohol abuse.
More than this, not a single study carried out since the mid-1980s has shown a direct correlation between moderate alcohol consumption and birth defects. One study, of 33,300 California women showed that even though 47% drank moderately during their pregnancies that none of their babies met the criteria for Fetal Alcoholic Syndrome. The authors of this study concluded "that alcohol at moderate levels is not a significant cause of malformation in our society and that the position that moderate consumption is dangerous, is completely unjustified".
Some studies go as far as to indicate that light to moderate drinking may actually improve the chance of successful pregnancies. A 1993 study published in the "American Journal of Epidemiology" by Ruth Little and Clarence Weinberg concluded, for example, that there were fewer stillbirths and fewer losses of fetus due to early labor among women who consumed a moderate level of alcohol. That some alcohol can be protective against preterm birth is also supported by Dr. Martha Direnfeld of Haifa University who points out that when used properly, alcohol is known to stop unwanted uterine contractions, and thus has "saved many pregnanncies that might otherwise have spontaneously aborted". More than this, Dr. Robert Sokol of the National Institute on Alcohol Abuse in Detroit has shown that it is light drinkers and not abstainers who have the best chance of having a baby of optimal birth weight and in their book "Alcohol and the Fetus" and Doctors Henry Rosset and Lynn Wiener have presented data that shows that children of moderate drinkers tend to score highest on developmental tests at the age of 18 months.
Despite these and many other findings the United States government, the American Medical Association, the British Medical Association and the vast majority of American and English doctors continue to recommend complete abstention from wine, beer and spirits during preganancy. An examination of why this is true reveals that the issue is as emotional, ideological and political as it is medical. Well respected wine writer Janis Robinson, has declared that "in this our male dominated society, men feel entitled to lecture pregnant women on how they should best discharge their responsibilities to their unborn children". In a similar tone, Katha Pollit, writing in "The Nation" claimed that "all of these warnings allow the government to appear to be concerned about babies without having to spend any money, change any priorities or challenge any vested interests".
No one argues that there are no risks whatever in alcohol consumption during pregnancy, even at sensible levels, but as Thomas Matthews stated in his article in the Wine Spectator, "it is important to ask: risky when compared to what?" In her recently published book "The Myths of Motherhood", Shary Turner indicates that alcohol is far from the only risk factor pregnant women are warned against. Other items on the list include cafeine, chocolate, raw oysters, unpasteurized cheese, tropical fruits, drugs that alleviate cold symptoms, nail polish, suntan lotion and hair dye, all of which in some amount may harm the fetus. Turner's conclusion is that "the only risk free pregnancy is one that is meant less to benefit the baby than to imprison the mother in anxiety and self-reproach".
In the absence of 100% certainty about the issue, many continue to insist that abstinence is the best advice to give pregnant women. Others, however, see this attitude as illogical and have concluded that the risks and benefits associated with light to moderate regular wine consumption compare quite favorably with most other activities of daily life. Doctors Whitten and Lipp write that "light, regular wine consumption, or one or two glasses of table wine per day can be part of the healthy lifestyle for most people, including pregnant women". Gynecologists Howard Carp of Herziliya and Martha Direnfeld of Haifa also feel that women who were drinking healthfully before pregnancy are not putting their fetuses in danger if they go on drinking in the same way during pregnancy. Dr. Carp states that "an occasional glass of wine or any other drink is fine, no problem at all, and those women who drink a glass of wine once or twice a week with their meals or at kiddush should not feel any guilt or fear at all". Like Dr. Carp, Dr. Direnfeld acknowledges the harm of drinking in excess but feels that "a reasonable amount of alcohol, say a glass of wine per day, will not harm the baby".
It is true that all of the evidence has not yet been gathered, but it is difficult not to see the logic of the conclusion of the Wine Spectator: "When it comes to drinking, evidence demands in- terpretations and decisions require judgement. Women are capable of choosing for themselves."
© Daniel Rogov
Bob, at first I thought all
Bob, at first I thought all these were your original thoughts, until I figured out you'd just copied someone else's diatribe.
As I labored through it, I was struck with an obvious question. Would you not agree that every woman's susceptibility to alcohol varies with - oh, I don't know - weight, height, physical condition, age, temperament, and so on? Men, too, I'm sure, but we're talking about pregnant women here. And - by inference - might that susceptibility also accrue to the fetus?
My daughter-in-law holds a PhD in and teaches epidemiology (studies of the root causes and contributing factors of disease) at the University of Colorado Health Sciences Center and the Denver Children's Hospital where she is also a researcher. With what she knows and, in part on what no one knows, she wisely chose to eschew any alcohol during her pregnancies with my two beautiful grandchildren. It was a careful and deliberate choice, and not an easy one to keep; Marci and Rob enjoy good wines.
Unless you believe every woman is perfectly capable of knowing precisely what impact alcohol may have on her baby, such abstinence seems admirable and reasonable. Marci missed the occasional glass of wine, but, because of her choice, she was NOT tormented about the possibilities.
Why would you promote industry hype to suggest anything but erring on the side of caution? Marci agrees that a "glass a day" is probably not harmful, but the emphasis is on the "probably." "Many women can't stop at one glass," Marci said. The bottom line, she says, is that women should check with their doctors for specific advice based on what the doctor knows about his patient.
"Reasonable" choices? "Sensible" decisions? The doctors cited generously acknowledge the risk of "excessive" drinking but claim that "a reasonable amount of alcohol, say a glass of wine per day, will not harm the baby." That sounds pretty ambiguous, and mothers who choose to reduce or eliminate the ambiguity for nine months out of an 80-year lifespan can make all the difference in the entire life of the baby they're carrying.
As you know, there are religous denominations that don't want women to even have the right to choose whether to get pregnant, but the alcohol publicists say they can roll the dice with how well they manage the health of the baby. This article is industry hype at its worst in that it's conveniently incomplete advice.
Bill Sontag
Feature Writer
Southwest Texas LIVE!
Just some facts the United
Just some facts the United States spends more money per person on health care then any other country. (My question how can it get worse?)
Yet we dropped from 14th to 23rd in life expectancy. With countries like CANADA , Spain, France (good wine) Italy (good wine) Australia, GERMANY, United Kingdom, Portugal, Ireland and Grease to name a few. That live longer then we do.
Plus the statement that rich Canadians and Germans come here for health care. Please
someone give me a name of one of these people that came here because they feel our
general health care is better then Canada or Germany
One more point for today a couple of weeks ago I had 20 people in from all over the U.S. they are all cancer patients that have given up on our ability to cure them. They are all over at St. Joseph's in Acuna being treated.
They say with outstanding results. Does that mean that Mexico has better health care then U.S.?? Just a thought
bob
Well Bob, for me my
Well Bob, for me my contention was that none were any better than the other. They each have their problems. We do have more fraud in our health care industry than any other two nations combined. The Gov't is not regulating or enforcing anything to do with this properly. Yeah the rules are there but rules mechanics and outright crooks are making Billions off of the system.
The reason that people go outside of our country to get non-U.S. approved treatments is that they are at the end of their rope, as you noted. Some cancers can not be cured. The problem here is that many Doc's come to that conclusion and write off patients once the gamut of "approved" treatments has been exhausted. There is a reason why they do this. Our rules. Plain and simple. If they try something that's "out of the box" they can be sued by the patient when or if it doesn't work or lose their license to practice or both. The risk of condemnation is too great.
Mexico has almost zero control on their medical establishments, procedures, drugs safety and dispensation of the drugs among other things. And there is pretty much Zero accountability for their actions. If you go to Mexico, for example you have a much higher percentage of chance of getting a dirty needle than you do here. Not that it doesn't happen here either. But at least here they know they will go to jail for using a dirty needle deliberately. The bottom line is that I don't see Mexico or any other nations willingness to cut corners as an indictment on or proof of failure of our system. Don't get me wrong there are other things that I can point to as [failures] in our system, but as I said I can point to failures in theirs as well.
I'm sure that many European nations do find a lot of humor in our system of health care control's, " I know Germany, France and Austria do". They find them stilted, stuffy and out of date. Does they kill people? Yes, I'm sure they do. Is it worth it? I say that's up to the individual and their circumstances. They are our rules however and I believe that they save many, many more than they kill in any circumstance.
To the best of my knowledge the U.S. is one of if not the leading nation in the field of Neuroscience. Many people do come here for the care in that field. In the past it was transplant technology in general, I think France is leading that right now. There is something else that people come here for and I think it is burn treatment but I can't remember right now.
Our life expectancy has not dropped due to lack of medical care, it has dropped due to our lifestyles. I surely can't point any fingers as that would simply be a case of the teapot calling the kettle black, but as a nation we are into excess in almost everything. We don't eat, drink or live right. Obesity and heart problems are much to blame, I'm simply pointing out the facts since I'm part of the problem. I weigh 315 lbs and have hypertension.
I ended up in a hospital in Germany with stomach ulcers once. The attending Deutche Doc told me that I should drink more wine since it would relax me and was all out good for me. After I got back to the Military Hospital the American Doc said "don't even try it". Two different ways of thinking. Another time a German Doc told my pregnant wife that she should be drinking a minimum of two glasses of wine per day as it was good for the mom and the baby. Too much tension in mommy would tense up the fetus was his explanation. I called a family Doc friend back here in the states and she told me that that was crazy. Again two different ways of thinking.
It seems to me that a big
It seems to me that a big part of the problem isn't curing sick people, its keeping well people from getting (very) sick. If you are sick enough to get admitted to the hospital, you'll probably get excellent care and get well--but that's an expensive proposition.
If there were some way (and Lord knows I don't know how) to separate basic healthcare from advanced healthcare we might get somewhere. The primary care alternatives are in place--Physicians assistants and Nurse Practicioners--but we don't seem to utilize them as much as maybe we could.
I am also concerned about
I am also concerned about universal health care. We have all defined the problem but we as a country have not come up with a solution. I worked 5 years in Canada had over a 1000 employees this was in the 80’s. Health care was just not an issue, Never came up at company meetings, social events etc. The fact that Canadians come to the US for treatment is true. Remember Canada has a population of about 33 million compared to our 300 million. And their universal health care pays for it. Yes, we have some specialties not in Canada. I can also state people go to Canada for certain specialties like to Toronto because they have a world renowned eye care hospital there.
For my employees it just was not a concern. It obviously is here.
Every time I have people from Europe in the restaurant, which is quite often because they are on their way to Big Bend. I ask them about their health care. In most cases they are surprised that I asked. Again not a big issue.
Now, the conservative in me says we can’t afford it. Not with all the insurance rates our hospitals and doctors have to pay. The reason I say this an American can go to Europe for a medical procedure and the cost in most cases is 50% of what it is here.
There is no simple solution.
Just a thought if we started with newborns and assured that they were covered maybe we could find away to solve this problem over the next 20 -30 years. I see no quick solution to this problem.
Just my humble opinion
Bob
Hey Bob, I was in Germany
Hey Bob, I was in Germany for a number of years and yes they have Socialized Medicine but they do have problems. German's are generally unwilling to air dirty laundry in the way we American's will, but here's what I saw, yes you can go see a General Practitioner quite easily, and yes you can give birth quite easily. But, yes there are always but's aren't there; But #1 access to advanced health care is limited and on a waiting list. But #2 doctor's are under no great onus to perform or even perform well.
The parts of their medical system that I witnessed [more than once by the way] actually worked pretty much the same way our Military's medical system works. Those that have been in the Military will agree that the Military system is Ok, but they can all poke quite a few holes in said system.
Yes Germany invests just oodles of money into research and their version of the FDA has different rules and drugs get through faster. The effect of this is that Germany "appears" to be on the leading edge of Medical Science overall, a characterization which I disagree with by the way. To me being first is rarely good when experimenting with human beings although I do recognize that someone has to. Again, they do have their strengths just as any country does, but they also have their weaknesses.
On Canada, yes their Medical system does have it's strength's but it also has it's weaknesses. Again as in Germany advanced care and some emergency advanced care has waiting lists a mile long. The Canadian version of Socialized Medicine has those machines that I noted earlier that don't pay for us to have in many of our Hospitals. But I would like to point out that they don't have them in many either. Each Hospital specializes. For example if you have chest pains you need to travel to an emergency room, get stabilized and then get sent to that heart specialty hospital. Once there if you need a Cat Scan you have to travel again. Doesn't matter how dangerous that may be for your condition you have to go. Then if you had nerve damage from the heart attack you have to travel to another location and so on and so forth.
We on the other hand have all of these things in one place, we have Doc's that have to perform or get sued or go broke. We have an FDA that doesn't use us as human Guinea Pigs [ok well for the most part]. All this being said, yes parts of other's systems make ours look bad, but parts of ours make theirs look bad as well. Six of one half dozen of the other. What's a perfect system? I'd say one where everyone is treated equally, promptly and safely to the best of the entire Medical establishment's ability. No waiting lists, no malpractice and no decisions made by non-attending people or physicians. We may never reach perfection but we can sure strive to achieve it. Also before anyone lights into me, when I say no malpractice, I mean it in the context of unnecessary surgeries for profit or incompetents being identified and canned, not that patients wouldn't be able to obtain redress for wrongs.
That's why wealthy Canadians
That's why wealthy Canadians and wealthy Germans get their health care abroad, mainly the U.S.
Whether you have it or not
Whether you have it or not health insurance is an issue, be it cost or coverage.
Does anyone out there understand why there are deep discounts given to those who pay cash instead of paying through insurance? I do. For one, billing an insurance is costly both in time and resources some would call it “red tape”. Secondly for a provider it’s like playing Russian roulette. One wrong T crossed or a missed dot on an I and no payment. Also many insurances “Medicare and Medicaid” as well force providers to sign and agree that if they accept that Insurance then the provider can not bill the patient if the Insurance decides not to pay for whatever reason and trust me the reasons for non-payment are sometimes as thin as “well you should have known the diagnoses didn’t support the procedure that [we] allow even though the doctor ordered it”.
In addition to this Insurances set fee schedules that fix payment for anything resulting from any given diagnoses from Doc’s visits to meds and so on and so forth. Many providers are on a fixed income due to this. For example if you spend 100k on a machine and the procedure on that machine pays only $50 you had better be able to see a lot of patients with it or not even think about buying it no matter how many lives it might save.
And don’t even think about buying it if it’s a non-covered service for insurances.
Currently even those who have health insurance are getting shafted. The fee schedules that I mentioned also have a secondary effect of setting rules for certain things. For example, if you enter the emergency room with a diagnosable condition sometimes the condition will only pay for a day or two in the hospital. So the result is that if you don’t get better in that period of time or don’t develop another [different] diagnosable condition you are out or the hospital is out. It really doesn’t matter what your doctor thinks or believes in many of these instances.
Oh and in addition to the fee schedules there is a thing call a contract allowance. If an insurance moves in and snaps up 98% of an area that a provider works in then that provider had better sign a contract with that insurance or hang it up. Here’s what the insurances do at that point. They say if you want to do business with us take the fee schedule and knock off 40% before you bill us as a contractual allowance and oh by the way, you can’t bill the patient for the difference. If you do we will drop you. [cough Medicare cough!] The result is that as I pointed out above, the margin [when there is one] is so paper thin that no one will take a chance and keep any given patient in the hospital for one second longer than the insurance will pay. And this is just one example.
We don’t want Government controlled universal health care either. I’ve lived in countries that have it and it wasn’t pretty. Hopefully all who are reading this are sane enough to not believe that crack smoking idiot Michael Moore’s documentary “Sicko”. If you do I would ask why do so many Canadians have to come to the U.S. for their treatments.
Another point that I would make, is for everyone to look at how badly our Gov’s has screwed up the health care that it is in charge of. You know the one called Medicare? Does everyone out there know that there is a wave across the U.S. of Doc’s either rejecting Medicare patients out right or turning away all new Medicare patients?
Oh and should I point out that our Government can’t even build good levee’s why on god’s green earth would we want them in charge of Brain Surgery?
As many reservations as I
As many reservations as I have about it, maybe its time to seriously consider universal healthcare. I know the idea won't go over well with a lot of folks here, but I am left wondering what else we can do. Maybe someone else around here has spent more time thinking about or researching the issue and can help with some info.