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January 18th, 2007
01:02 am
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So, our cat decided to celebrate Appreciate a Dragon Day by ... politely waiting until after midnight to freak out and savagely bite my arm.

I've had cat bites before, but this one was a lot worse than I'm used to. At least one fang left a gap the width of a pencil eraser and tore down into muscle. I tried to tough it out by cleaning the area and irrigating the wound*, but after a night of bleeding and a day of increasing pain and restricted range of motion, I went to the hospital.

The doctor wasn't at all helpful, but I did at least get a prescription for antibiotics. (If the bite made it that far down, I'm not taking any chances.) And after spending probably about $200 on medical care, I was relieved to see that our friendly local drugstore had a special deal on the drugs I needed: Buy ten boxes of macaroni and cheese for $105, get the cefuroxime free.

One thing that I've been increasingly noticing is that every time I'm forced to deal with health issues, my loathing of Libertarianism rises a notch.

The usual argument for an American-type system is that having a broad variety of insurers and no government intervention keeps costs low and consumer options open. Which is to say, that market forces will work the same way for medical care that they will for, say, iPods. That the market for medical services is rational.

This is, flatly, bullshit.

What happened today is a great illustration of that point. When I got off job #1 and called in late to job #2 so that I could sneak in a trip for medical care, I did my best to find cheap care (since our insurance plan has a huge deductible and I knew I would end up paying everything out-of-pocket anyway). I went to Miner's Clinic, the local po'-like-me chop shop, only to discover that their walk-in hours had ended 45 minutes ago. At that point, I didn't see an option for immediate care besides the hospital (hello $300+ visit).

I could have chosen to postpone the visit. Were I buying an iPod, you'd better believe I'd have done so; money is tight this month and I hadn't budgeted anything for cat spazzing. But continuing to wait would have meant risking a much more serious (and costly) infection. As much as I can't afford a hospital visit, I REALLY can't afford in-patient care and weeks off from work.

I could have stopped and done research. Or could I have? I actually did make a few calls before I left the house, but kept running into a wall of voicemail, and with an increasingly painful arm and the clock ticking on business hours, I didn't have the time or focus to gather the information for an informed decision.

Even if I had, you can't gather that information! What was I going to do, call every health care provider in town and ask them for a quote on urgent care and antibiotics? It's ridiculous to think you can walk into a doctor's office knowing what your treatment will cost. (Even that is assuming the patient knows what the problem is. I've taken a wilderness first aid course and knew the course of treatment for animal bites. What payment questions does somebody with a mysterious hacking cough ask the nurse?)

When I got home, of course, kadyg recommended, "You should have gone to YubaDocs. They've been cheap before." Ah, yes. Well, if I'd had the luxury of time, etc.

Another failure of the market model is even more straightforward: Health care isn't a commodity, it's a necessity. Even if I'd chosen to refuse care ... at some point, since I've got a muscle laceration and high probability of infection, I would have to go to the hospital. I'm not choosing between no care and yes care, I'm choosing between preventive care and critical care. (Or death. Because, y'know, in a rational market, all rational consumers try to keep the dying option open. It's cheap.)

Supply and demand cannot make the market magically work here. Demand is fixed and choice is restricted.

None of this is even touching on the distribution of care. The U.S.' model of employer-subsidized care provides rich care for those with steady, affluent jobs; yes, well, good for them. Employer care fails completely in three cases: 1) The poor or unemployed; 2) the self-employed; and 3) those with sudden health issues that temporarily prevent them from working.

1) are the people who most need that safety net, because they don't have the money to pay for care; what a catch-22! 3) are exactly the people any sane system is designed to assist -- don't we all have an enlightened interest in keeping productive employees that way? But most employers can't afford to keep paying for someone on a months-long medical leave, and can't afford to leave their position open rather than hire someone else; whoops. And 2) are the people whose ill health subtly but deeply wounds the country. The self-employed are the nation's entrepreneurs, the country's artists -- those who take risks, move us forward. Why is it that we want to penalize them again?

Meanwhile, the current system of for-profit care means that everybody in the system is out to make money at the patient's expense. An insurer's job is ostensibly to ensure care for its subscribers ... which is exactly at cross purposes with the desire to make profits by collecting higher fees and restricting treatment. That medical system is unconscionable. "Evil" might not even be too strong a word.

And the counterarguments seem less convincing to me every day. "But Bax! In an eeeeeevil socialist system, you'd be paying for insurance whether you wanted it or not, and you'd be locked into a single plan instead of having all the wonderful choice of a billion health insurers!" Yeah, believe me, I would be crushed if I had to live in a world where I didn't understand the meaning of "pre-existing conditions." And it really would be awful to have insurance so arcane and useless that I could only get care by ignoring it and paying out-of-pocket ... oh, wait. Out of my last three insurers, not a single one has paid me even a single dollar in benefits. I've now been screwed by out-of-network costs, "pre-existing condition" costs, high deductibles and lack of prescription coverage within the last 12 months; the only thing that keeps me insured at all is the fear that I might get in an accident and rack up six digits' worth of debt. Contrast that with a system where the eeeeeeevil government tells me I have to use the $75,000 drug regimen instead of the $100,000 operation to fix my heart arrhythmia. I think I can live with that sacrifice.

So can most people, apparently. The Americans who most highly rate their quality of care are the ones who use government care: Veterans and senior citizens.

Unfortunately, I'm neither. So I get to sit here and stew over my $100 bottle of pills. There goes the money that I was hoping to save for dental care; my chipped front tooth has been bothering me for months, but since the American health care system is the finest in the world, neither of my employers offers dental and I get to try to decide every month between rent and pretty smiles.

--
* "Irrigating" a wound is the technical term for taking a syringe, filling it with water, aligning the syringe with the puncture, and OW OW OH MY GOD OW HOLY SHIT THAT FUCKING SON OF A COCKSMOKING OW PAIN. It is important because sometimes you can wash bacteria out this way. Or else you can shoot jets of water at your bodymeats until they bleed, and the blood washes out bacteria too.

Current Location: ~/computer_desk
Current Mood: angryranty
Current Music: U2, "Where The Streets Have No Name"
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From:sashajwolf
Date:January 18th, 2007 12:17 pm (UTC)
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In an eeeeeevil socialist system, you'd be paying for insurance whether you wanted it or not, and you'd be locked into a single plan instead of having all the wonderful choice of a billion health insurers!

In a socialist system, maybe. In the social market systems that most of Europe has, the first part is certainly true, but the second is only half-true. There are still lots of health insurers, so those who could afford private health care anyway (or whose employers will fund it) can still take their pick, but those who can't have a safety net that, for all its faults, is still pretty decent. In the UK, almost everyone who has private health insurance still uses the National Health Service for emergency care, and most women who choose to have children use it for pregnancy and childbirth, because the private hospitals struggle to provide a better service than the NHS in those areas. That helps keep down the resentment amongst people like me who are paying for both the NHS and their private provider of choice.
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From:the_siobhan
Date:January 18th, 2007 05:49 pm (UTC)
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Here in Canada there is a lot of resistance against allowing the private care option.

The fear is that those who can afford better care will fight to pull their funds out of the public system. If the rich are forced to use the same standard of care as the poor, they'll fight to keep the quality high.
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From:makuus
Date:January 18th, 2007 01:23 pm (UTC)
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(Hi, long time listener, first time caller.) I just wanted to thank you for the health rant side of the post. Thank goodness that there's someone else who gets (and can illustrate) just how piss-poor the healthcare situation is in this country for those without the good fortune to afford their own health insurance (or to work for a company that can supply it), who populate, oh, some ninety percent of my friends and acquaintances (I may have a biased sample set, however). It's something else to talk to a friend that really needs some sort of preventative care, but has no insurance, and is living paycheck-to-paycheck, when your only answer can be "um, try a clinic?" (sometimes followed up with "can I wire anything along?").
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From:baxil
Date:January 19th, 2007 04:57 am (UTC)
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Hi there, and welcome to ... um ... my comments section! (Since I can't welcome you to a journal you've been reading for a while.)

Health care is definitely a bigger problem among the artists and counterculture types that predominate among furry circles. I, too, have had the experience of dragging a friend kicking and screaming to a clinic for preventive care that really couldn't be put off any longer. (In this case, a diabetes test. Which was, in fact, the problem.)

But that it's a big deal among our circle doesn't mean there's a disconnect -- the problem is real, and it's real nationwide. I've had health insurance about half my life, and I've had nothing but hassles every time I need medical care whether I have insurance or not.

If you want to get a feel for the scope of the problem, browse through the blog Political Animal sometime. Health care is one of Kevin Drum's favorite recurring topics, and probably every statistic I've cited was one I found via his blog.

Also, just to comment on something downthread - I can't quite tell who was taking what tone, but in context it sounded like the Captain Obvious line was meant to say he agrees with you. (At any rate, you, me and baphnedia are saying the same thing, and I can't imagine his intention was to insult all of us.)
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From:baphnedia
Date:January 18th, 2007 01:59 pm (UTC)
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Wow, does ryuuzin listen to Captain Obvious too? Up here in Wisconsin, especially round where I live, health insurance for a family of four is usually the biggest bill (higher than rent or the house payment).

The difficulty of research is getting quotes before you pay. The patient has the right to a second opinion, but we typically don't have the time. The competitive system can work - if there's more transparency to their customer base.

If I know six places I can get an X-ray done, I can call all six and not get a price until after the work is completed. This does me no good. It's a possible solution - it certainly hasn't been tried yet.
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From:makuus
Date:January 18th, 2007 05:12 pm (UTC)
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Wow, does ryuuzin listen to Captain Obvious too?

Point in fact, I do. Thanks kindly for pointing that out.
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From:dancinglights
Date:January 18th, 2007 01:59 pm (UTC)
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Amen.

And the bullshit downside of people who get good employer care, where my husband will probably not be able to leave his job he absolutely hates in order to go back to school next year as planned, because our insurance is currently through his work, and he may be running into things that will become "pre-existing conditions" the second we move insurance to mine or grad-school-funded. Not that his insurance is any good and we won't be paying for tons of it ourselves. It's just better than mine. And this *is* "good" employer care.

I'm trying to work out if we can switch it to my employer's insurance mid-year even though it'll make treatment *more* expensive, just because I'm willing to keep my job longer to avoid pre-existing condition bullshit, and he won't have to stay at his.



I love your tag. I may start using it. I hope neither of us have to use it often.
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From:postrodent
Date:January 18th, 2007 03:20 pm (UTC)
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Ow, I hurt my neck nodding. :p Meanwhile I continue scheming to move back to Canada, and encourage disaffected Americans to do the same. C'mon, you all said you were gonna... :>
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From:baxil
Date:January 19th, 2007 05:02 am (UTC)
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But but but ... I'm a dragon. As much as I'd like to sneak into Kin's luggage on the way back from the convention, my tail would get stuck in the X-ray machine.

And then I'd have to deal with Homeland Security. And it would go on my Permanent Record.

(Plus there's cold. Look, could we just work something out instead where Canada invades the U.S. and takes over?)
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From:kevynjacobs
Date:January 18th, 2007 03:22 pm (UTC)
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Which cat? Let me guess...Precious?
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From:baxil
Date:January 19th, 2007 02:21 am (UTC)
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Ocras actually. As squirmy and high-strung as she is, Precious has never actually bitten anyone.
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From:dogemperor
Date:January 18th, 2007 03:25 pm (UTC)
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Well put--well put; especially the part in regards to insurance unavailability (or availability only at exhorbitant rates) really screwing over the Small Guy. (Seriously, health insurance is probably the biggest expense for small businesses and contractors who aren't going through a company; it's actually been estimated by multiple sources that if we went to a national healthcare plan (a la the NHS or the Canadian systems, where you have primary public care and the option to use private insurance if you like) it'd actually be *CHEAPER* for businesses--even counting the additional taxes that'd be required--than paying for healthcare through the insurance setups now.)

Then again, there are times I think that the way things are set up (re business law) is pretty much designed to screw the small business owner in favour of meganationals and Wal-Mart big-boxes. :P (Seriously, I've been looking into what would be required to start an in-home business making moccasins, because leather-sellers give discounts on material to be used in crafts you sell...it's something I like to do. For me to obtain a business license in my county, not only do I have to get the federal and state EINs first, but I have to have a home inspection to make sure my "workplace" is up to OSHA spec (uh, it's *needles* and *knives* and a shitload of leather, folks) and formally declare my home a place of business or I have to buy a storefront--not a whole lot of provision for someone who was planning on, oh, occasionally ordering elkskin or buckskin and making custom-fit mocs and moc boots for people along with other occasional arts, LOL. I may have to do further research to see if there IS such a thing as a variance in my own case or what all would be involved. Elsewise, I get to suck up and pay 15% more per leather purchase because I get to pay the normal folks' rate rather than the business/warehouse rate, and that would drive my costs up (as I would intend to charge for leather + labour).)

I'm just REALLY thankful that hubby is presently employed and has a decent healthcare plan; part of me is afraid of what would happen if he lost his healthcare.
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From:baxil
Date:January 19th, 2007 05:05 am (UTC)
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> part of me is afraid of what would happen if he lost his healthcare.

I hear you there. One of the lines that got yanked from my rant (it was a good line, but I edited the paragraphs around it and all of a sudden it obstructed the essay flow) was something to the effect of: "Fear is no basis for a health care system."
(no subject) - (Anonymous) - Expand
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From:tailypo
Date:January 18th, 2007 03:26 pm (UTC)
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You did the right thing. Cat bites are nothing to fool around with. If it breaks the skin, basically, you should go to the doctor and get antibiotics.

I got blood poisoning from a cat bite because I waited ~18 hours before going in. XD

My sister has had a cat bite infection too, and hers was antibiotic-resistant. That was fun.

(The cat in my icon has no teeth.)
(Deleted comment)
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From:packbat
Date:January 18th, 2007 04:53 pm (UTC)
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Re. the political rant: Same goes for education, too. The market system only works for iPods and the like, where there's no time limit on making the decision.

It's like something I read in a book once*: there's two ways in which science is advanced, through big discoveries like relativity and through the filling out of implications of these big laws, and people tend to ignore the latter because they forget how much work it is. It all follows from the big law, so you know it the instance you know the general rule, right? >:(

* ...and am grossly misremembering, no doubt.
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From:nolly
Date:January 18th, 2007 06:05 pm (UTC)
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I've got pretty good insurance through my employer. For most things, my co-pay is $10 or $20.

But non-insulin injectables are covered at 70%.
Which leaves me with 30%, or $438 a month. For one medication.
And I don't qualify for the drug company assistance program because I make too much. But I live in Southern California, where that money just doesn't go nearly as far; housing and gas eat most of it.

Good thing I like peanut butter.
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From:taral
Date:January 18th, 2007 09:32 pm (UTC)
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The problem is that the insurer's interest is in minimizing the amount they pay out. A service that makes money based on how much you save on medical care, within parameters *you* specify, would be a much better option.
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From:azhdragon
Date:January 18th, 2007 11:56 pm (UTC)
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whenever I read about the american "medical system", I thank whatever gods are listening that I live in Australia.

Yes, our health system has its problems. the public system is overloaded in many ways, and waiting times for non-life-threatening surgery are ridiculously high. But at least I know that if I'm sick I can go to my choice of doctor, be seen without having to pay anything, get a prescription (most of the common varieties of medication have a 'capped' expense) and get that prescription filled. I know if I'm seriously ill I will be able to go to a hospital and be treated without having to panic about 4, 5 or 6 figure debts. If I get extremely ill and require a lot of medications (more than 1 per week over a period of a year) then any further medications will be free or greatly reduced for the remainder of the year.

If I was employed, I could also choose to have private health care which would cover most non-elective/non-cosmetic surgeries and hospital fees, dental, etc. The one downfall of our public system is that it really doesn't cover dental unless you are on extremely low income, and even then the waiting list is something like 3 years. (/me ruefully runs his tongue over the broken tooth that needs extracting, but I can't afford to have it done).

The system is funded by a small surcharge on the taxes - I think offhand that it's something like 1% or 1.5% of one's pre-tax income. People on really high wages pay slightly more, to counterbalance those of us on the unemployed end who don't pay directly.

now, wrt the cat bite - you could have tried a mild solution of peroxide (2%?) as an irrigation. it tends to foam in the presence of blood, and the foaming action hopefully bubbles the bacteria to the surface and washes it away. this is a very very old remedy, but one that's still useful. peroxide solution should be available from a pharmacy, and is a good thing to have on hand for just such occasions.

bites are nothing to play around with - I had a bite (from a flea!) on my foot which became infected, and a coincidental accident to the same foot with a rock flung by a lawnmower caused a bruise in the same area as the infection. The infection spread into the bruise, and before I knew where I was my entire leg had swollen up with cellulitis. The infection started to eat away at the joint surfaces of the bones in my foot. I went to the doctor who took one look and sent me to the hospital, where I was admitted for 10 days, I spent close to a month in a wheelchair, a few weeks on crutches, and the best part of a year using a walking stick. I still have pain in the bones of my foot unless I wear good shoes. I'd hate to think what that would have cost me through the american health system, what with hospitalisation, many xrays and tests to confirm the damage to my foot, physiotherapy, etc.


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From:baxil
Date:January 19th, 2007 05:33 am (UTC)
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Thanks for the suggestion. Peroxide is widely available, and we even have a bottle right on the bathroom sink. I wouldn't irrigate a wound that deep with it, though. The sheer pressure of irrigation does more than the foaming action of peroxide, and irrigation stings quite enough without leaving chemical reactions at the site.
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From:thrames
Date:January 19th, 2007 04:10 am (UTC)
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And that's why I'm a Communist, in short.

But, to go in depth, that's partially the reason this country is spiralling into a shithole. When people have to decide between health insurance and food, they will always choose food, because while health insurance is extremely handy, you don't necessarily need, whereas one tends to starve without food. And the poor of this country can't afford decent health insurance, especially when, as you mentioned, health insurance seeks to screw over its users. Because of this, the poor are going to be chronically unhealthy with low-level problems (arthritis, minor illnesses, etc.) that they can't afford to effectively treat. This, horror of horrors to the libertarian, lowers worker efficiency and costs the capitalist a lot of money. And to people with consciences, it's pretty abominable that large portions of the population can be bereft of basic medical care that, with some relatively minor refanagaling of the budget of this country, can be given to them. And, hell, it might provide incentive for drug companies to lower the costs on their expensive prescription drugs because they can recoup the costs on the drugs in a shorter span of time (since, if I remember correctly, it costs usually around a billion dollars or more to develop a drug and thus drug companies get a 20 year period where they exclusively can sell the drug).

And, yet, single payer health insurance is some terrible, terrible bogeyman to the Right for reasons I can barely fathom outside of the tremendous paychecks from lobbyists. Hell, we wouldn't even necessarily have to raise taxes, just redistribute some of the budget (gank contracts from defense R&D that are trying to replicate existing systems of our allies that we can just procure from them much more cheaply, for instance). Would that be so offensive to them? Or is the horror of anything moderately Socialistic just too much, goddamnit, too much?
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From:kadyg
Date:January 19th, 2007 08:14 am (UTC)

The cat owner speaks

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Chris Rock made a point about health care once: His mother died of cancer many years ago before Rock hit it big. His father got the same cancer after Chris had been successful for several years and his dad is still alive today. The only fundamental difference was the amount of extra cash on hand to throw at the problem.

I also think that being employed is generally not a good idea with regards to health care. One's employer really shouldn't be that involved with personal health matters, but the system is skewed in such a way that only those tied to a corporation or very successful business can get treatment.

The whole thing sucks and the fact that health care debt is the leading reason for bankruptcy is also very telling. People aren't running up huge bill buying plasama TVs. They're spending every dime they can get their hands on to stay alive.

God bless America.
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From:zon14
Date:January 20th, 2007 12:26 am (UTC)
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How true. Both my mate and I now have experienced both sides of this so-called "Health Care System". At first we both resorted to prayer for about eighteen months to avoid any catastrophic health emergencies (which we did, thank the gods). Now on the other side with employer provided health care, and what looks like good care at that. I say looks like because now we never have time to like, actually USE it since we're on the road too much.
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