_____________________________________
_____________________________________
Wealthiest country in the world with this system of health care ? Rubbish!
Chris Chapin
_____________________________________
Hey Bob, you're right. Get a colonoscopy, Don't put it off. After 20 plus years working in the music business (Geffen, UMVD, BMG, Sony-BMG, Warner Brothers), I left and began a new career in the medical field as a surgical tech. Hated working in the hospital, but found a great little GI medical center with weekends off.
No one likes prepping and getting a colonoscopy, but I can't tell you how many times an older patient would come in for their first one, and boom, we find cancer. Had they come in sooner and had it done when they were supposed to, they may not be in the situation they find themselves in.
If cancer runs in the family, or someone adopted doesn't know their family medical background, those folks should have one more often.
Sure the prep tastes like crap, and it sucks having to fast for a day or more, but it just might save your life.
Mike Verzi
_____________________________________
Three stories about health care:
1) India, mid 1970's: My grandfather was a British-trained medical doctor in East Africa and India from the 1930's through the 1970's.
When I went to visit him in India, one of the neighborhood kids (a teenager) had wounded his hand. He went straight to my Grandfather's clinic. (His clinic was on the first floor of the apartment complex he lived in). My grandfather cleaned the wound, applied a band-aid / dressing, sent him home with a handwritten note for his parents on how to care for the wound, and told him to be more careful. He also didn't charge - he said it was a simple thing and it was "the right thing to do". No forms to fill out, no worries about lawsuits, and everyone was happy.
2) Japan - a few weeks ago: A friend of mine was travelling to Japan, and broke a bone, requiring hospitalization. She was worried about the bill. When the hospital staff presented her with the bill, and apologized profusely for presenting the bill. Since she wasn't a citizen of Japan, she ended having to pay the entire bill out of pocket. The total fee was $21.
3) US, California: A few months ago, I dropped a pair of pointy scissors on my foot. No major injuries but I needed a tetanus shot . . . on a Sunday. I have pretty decent insurance. I drove to the nearest urgent care. After waiting close to two hours, they finally saw me. I ended up paying close to $100 out of pocket for the urgent care, plus extra $50 on top of that for the tetanus shot.
—Meghan Gohil
_____________________________________
You are so spot on as usual. Due to some lingering issues from long Covid I have a team of private doctors and specialists. After going the insurance route I realized that although many of them are competent doctors you get 15 minutes and you're lucky if they remember what you told them the last time bc they have too many patients. Not to mention in an emergency it will take a few weeks to get in an appointment. It's no way to live and I feel awful for those who have to. So I have been fortunate to build a team of exceptional drs that basically act as concierge medicine (have their cell phones, emails , can always get in day of etc). I also agree about research and talking to as many experts as possible if you have something wrong you never know when and from who you may get a helpful nugget of information from. I keep insurance but that's really just for the chance of catastrophe for myself or a family member. Instead of fighting with them for the Pennies they will reimburse me I'm better off using the tax deduction (most ppl aren't aware of )for anything spent over 7.5 percent of income on health care . To me it's all worth it as the cost of the right healthcare is priceless!! Feel well
Best ,
Jarred Arfa
_____________________________________
My mother was a 6 figure/year real estate agent in Scottsdale AZ, knocking heads.
She refused western medicine against all our advice and solely went to a homeopath for decades.
Then she had two heart attacks. The resulting blood loss to the brain brought on early dementia and Alzheimer's.
Now at 84, she's in assisted living, getting her diaper switched out 5 times a day. She gets me constantly confused with my uncle.
It's no way to live…
Dave Streets
_____________________________________
I agree with you 100% -- the only reason my husband & I stay in LA is healthcare. Until 2017, we had a second home in Sedona, AZ where you can't see any specialist, even a GP for MONTHS – so our choice was Flagstaff ( 6-month snow warning) or Phoenix, and even when you go the 2 hours, your care there is in the hands of PA's, who were shockingly amateurish with no filter! We both wound up in the Sedona ER for chronic issues, and fortunately the Dr. was good, but it's not a long-term plan. So grateful that all our Drs. at St John's in Santa Monica : Rheumatologist, Internists, Urologist, Gastroenterologist, Pulminologist have been with us since 1996 and guided our care from a distance. Since SAG/AFTRA dumped coverage for Senior Performers during the height of Covid in 2020, it costs an extra $12-15,000/yr., Sadly, that now includes an Oncologist, but I prefer that to "wait & see," in AZ. Wish you were still here for Bob's Chicken Salad, I will always thank you for for the tip!
Denise Madden-Eckstein
_____________________________________
You're so right. Don't eat out. Drive an old car. It's hard to impress people with the need to save for a rainy day in the middle of a drought. I would love to leave LA after 32 years here, but with my own medical issues to deal with, my first prerequisite is moving someplace else where there's a top notch medical center, if not two or more. Unfortunately, any place with that amount of medical diversity is likely to be just as unaffordable as here.
Sorry you've got more to cope with. Hang in there.
Florie Brizel
_____________________________________
This is why I have to live within hours of NYC. I'm never giving up access to Sloan Kettering.
Michael Alex
_____________________________________
My wife and I are lucky to have great docs ... and a bunch of them. For the same reason you won't move away from LA, we will never move away from the DC area.
Alas, Father Time is undefeated.
John Hyman
_____________________________________
I couldn't agree with you more on the pitfalls of our healthcare system and seeing physicians regularly. I live in the SF Bay Area, blessed with the same level of healthcare you have in LA.
I now receive all my healthcare from the Veterans' Administrations system in San Francisco. Without a doubt, the best healthcare system I have ever used and a good model for non VA systems. I receive, dental, vision, hearing, psychiatric, pharmacy, all medical services and hospitalization at no additional cost to me. The price of admission, unfortunately, was high; a helicopter pilot in Vietnam, two Purple Hearts and shot down 6 times with permanent disabilities.
It is quality care, residents are from UCSF, one of the top medical centers in the country. The physicians do not watch the clock during appointments, and will actually follow up on the phone with me. I am always treated respectfully and receive a level of care I never received before in civilian healthcare.
Steve Greene
_____________________________________
Oh hell yes (to most of what you said).
I had two women friends who died from breast cancer; one was 32, the other 48. Both resisted and put off going to an actual oncologist, preferring their
naturalist healers until it was too late.
I have to say though, I disagree with you that doctors who won't take insurance and/or are "concierge" doctors are somehow better/more attentive than others who do take insurance. ALL of my physicians take Medicare and supplemental (yeah, you gotta have supplemental insurance). And they make plenty of money, believe me. AND they are top doctors at UCLA and Cedars.
With one's PCP, it's a bit more difficult. One only gets a max of 15 minutes with them, as you indicated. Which is a drag. But that's a result of the corporatization of medicine that we are now burdened with. It sucks. And the supplemental and Medicare are not cheap; we're paying five figures for two people. So no, I won't pay another $10-20K for someone who considers themselves above the fray as a concierge or who thinks it's too much trouble to bill Medicare.
Yes, I know that upkeep on that 50 ft sloop in the Marina is expensive but I only have one thing to say:
Concierge THIS...
Gregory Prestopino
_____________________________________
The labs and hospitals are trying to get me to pay my deductible upfront. They'll ask you for it. My deductible out of pocket yearly is $500 for a procedure/hospital visit. I have employee health insurance from my employer.
Had my prostate biopsied it was negative for cancer. I was told I'd get a 10% discount if I prepaid my deductible to the hospital prior to the procedure. Okay here's my $500. Turns out after insurance I had to pay $230 out of pocket. I tried to get my $270 back and it took forever. It took five phone calls with the hospital system to get my money back.
Had another trip to the hospital nothing was wrong ultimately, but they asked me to prepay my deductible again and I told them no. What a scam!
Back to the prostate biopsy it cost about $19k. I had to pay ultimately $890 out of pocket which included the $230 listed above. If you don't have health insurance I don't see how people can afford getting sick! The $890 was the best money I ever spent.
Cheers!
Tim Pringle
_____________________________________
I live in Stockholm and I´m 66.
Here we have an insurance that comes with your citizenship that says that you when you have paid 100 dollars for meetings with your assigned doctor (and resulting operations/ meetings with specialists arranged by your doctor for your specific your health problems/worries) within a 12 month period (starting on the date of your first consultancy) the rest of the twelve months are free of charge.
So yesterday I got an X-ray of my lungs (since I'm a long time smoker). It cost me 0 dollars. It was free of charge!
I'll be busy doing some other smoking tests (like a KOL-test) before my 12 month period runs out. Not only because it doesn't cost me anything, but that sure helps!
Måns Ivarsson
_____________________________________
Bob, Canadians read your latest email and can't believe that a civilized country like the USA still allows their population to live in fear of going to the doctor or the hospital due to the costs. I'm 69 years old. You know how much I've spent directly on doctor's appointments, tests or hospital stays in my lifetime? Exactly zero dollars.Yes, we pay higher income taxes up here than south of the border, but it's not like it's double the taxes Americans pay. The health care is high quality. And we are now benefiting from doctors and health care professionals from overseas choosing to immigrate to Canada rather than the USA because they feel more welcome and safer (due to the fact that very, very few private citizens own guns).The most expensive part of a doctor's visit or medical test for a Canadian citizen is the cost of parking. Today I read that over 25% of Canada's population was born outside Canada.
The insurance and medical lobbies are LYING to your citizens, to maintain their inflated incomes. (much like the Russian people have been lied to about the power of their military). Nobody should have to worry about losing their house because they need a critical operation. Having your taxes go to government-supported health care is not communism. Not every home has a fireman or a policeman. We pool our tax money to pay for those services so that they are there the few times in our lives when we need them. Health care should be no different.And the reduction nation-wide in overall stress and unhappiness is one of the reason Americans find Canadians so easy-going. Once you've lived somewhere with national health care, you would never go back.I know some of your readers will quote some exceptions of stories of Canadians waiting longer times for treatment, but keep in mind those are dug out by insurance and medical companies to support their positions, and are a very tiny percentage.There are always exceptions, and cases of people abusing the system, but most Canadians would maintain that our health care system is one of the main reasons they like living here. So many actors, musicians, and technical folks are moving back to Canada from L.A, NYC and Nashville because as they get past retirement age, the lure of government-subsidized (note, I'm not saying free) medical care makes so much sense. As Oliver Wendell Holmes Jr. once said, "Taxes are the price you pay for civilization".
To end on a happy note, I was at a Toronto Blue Jays baseball game a few years ago, when Montreal-born Russ Martin was catching for the Jays. He was at bat in a tie game, and the bases were loaded. A fan behind me shouted "Lean in, Russ, take one for the team!! You're Canadian, you've got free health care!!"
Regards,
Doug McClement
_____________________________________
Your newsletter is very timely. I live in Toronto Canada. Our much vaunted universal payer system in terrible crisis across our great country. At least 20% of Canadians have no GP. Primary care physicians are retiring at an alarming rate as the pressure of excessive patient loads, the aftermath of Covid, grinding amounts of paperwork and hard to serve aging patients makes family life impossible.
No Canadian politician will stick out his/her neck and advocate private insurance. "Universal healthcare" is a sacred cow. The activists won't allow even the mention of an orthopedic hospital for those who are willing to pay for a prosthetic hip or knee. Meanwhile you might wait a year just to see an orthopedic surgeon to get an assessment and then another year for surgery while you are suffer in extreme pain.
Emergency room waits are 16 + hours as the public goes to hospital for treatment of flu, migraines etc that could/should be done in clinics or urgent care centres.
A friend of ours recently fell and hit her head while at the mall. Security staff insisted that they call EMS. Paramedics took her to Sunnybrook Hospital in Toronto. She waited 13 hours to see a GP who told her that if she had no symptoms yet she is probably okay and sent her home. Meanwhile patients were arriving in pain and needing immediate care. It was so busy that they ran out of gurneys and some patients were laid out on towels on the floor.
Our system has collapsed! Those that are financially able are getting treatment out of country.
Sad. Sad. Sad.
Harvey Glasner
Toronto
_____________________________________
sorry bob you way off on this one. To date there is no evidence health checks do anything other than perpetuate health anxiety and line the pockets of salesmen masquerading as doctors. There will always be the anecdote of the missed rare (or even not rare!) diagnosis which features heavily on our mental because of cognitive bias but overall, physicals and poorly thought about screening are actually harmful. The truth is medicine is not the all powerful determinant on health the industry wants you to believe. Lifestyle and environment have far more impact (clean water, sewage, pollution,vaccines, diet, exercise, mental well being (the absence of neurosis and anxiety). The situation is far more complex than your recent newsletter suggests. I feel for the Americans forced to spend considerable sums of money and falling victim to the industry sales tactics. Even the question of which cancer will kill you vs which cancer you will die with is still not entirely clear. No one lives forever.
DECLARED INTERESTS - NHS FAMILY DOCTOR.
Robert Dylan
_____________________________________
I used to live in America.But I was young and very fit.I left California when I was 40 years old. My home base is Stockholm,Sweden now.My daughter lives in Temecula,Cal ,she is a nurse.She tells me all about insurance companies and doctor operations. All I want to say is.''Stupidity doesn't run in America.It gallops''
Best of health.
Tom Riviere
_____________________________________
I'm a software developer 20 years into my career -- worked in small and medium shops, one of which got acquired by IBM five years ago, and I quit to go independent because corporate isn't for me. I always had some kind of health insurance through my 20's and early 30's, used it occasionally (a broken bone, my wife giving birth to our son) but generally paid through the nose for TERRIBLE coverage and high deductible/copay. As a result of a freak, still-unexplained incident while we still had it, my wife had a spontaneous cerebrospinal fluid leak that left her laying in a hospital bed for 10 days where she received NO HELP and NO relief -- after being met with confusion from a variety of specialists and surgeons, a plucky, motivated intern identified the condition early on day 2. The solution was a simple mechanical procedure that we were actively denied, day after day after day, until I literally told Riverside Methodist Hospital to go f... itself, pushed my wife out in a wheelchair, went to OSU, and they fixed her immediately.
Wanna know what more than a week of Maury Povich on a CRT TV and steamed eggs cost? $55,000.
I ended up paying like 6 grand out of pocket after insurance chose at random what they were willing to cover. A bag of saline was like $100; the cost of a fruit cup would've bought me a Maserati.
I've had conversations with supremely coked-up dudes in the club toilet that were less arrogant and less aggressive than what we got from that bald-headed, know-it-all, prick of a neurosurgeon who told me "I've never seen this before so I have no idea, but I'm certain that you're wrong." when I explained what she needed done.
I was right.
Anyways, after I refused to be absorbed into the corporate machine, I was offered "affordable" COBRA coverage for however many months and it was like $4000 a month, completely insane. I never signed up.
Open enrollment comes around, I check out healthcare.gov -- to cover two adults and a child for the s...tiest plan available was still like $2500 a month -- no thanks!
It turns out that paying out of pocket for dental, (minimal, common) prescriptions and routine visits is orders of magnitude cheaper than carrying worthless, overpriced health insurance. If I get hit by a truck, I'm throwing my wallet into the sewer and telling the hospital that my name is Ricardo Montalbán, unhoused -- let 'em write it off, who gives a s... I paid $6,000 for eggs!
-Kevin Kaiser
_____________________________________
I've been a Kaiser member for over 50 years. It is a health maintenance olus health care organization, not a sickness treatment organization like most US health providers and doctors.
Preventive medicine, regular checkups ($35) are extensive and required. Labs $20. They've saved my life three times. Heart operation? Pacemaker? Brilliantly done. 2-3 k for the operations, 250 for the pmaker. And if they don't provide a service, they send you elsewhere and pay.
You are a victim of capitalist private medicine.
Call kaiser. You can join. No pre existing conditions problems.
This is the model for universal single payer health care.
David Rubinson
_____________________________________
Agreed. I just had surgery a couple of weeks ago. Nothing life threatening but serious enough. Without California health care I would have been in a bad way. I tell people all the time, it might be expensive out here but they care about things that need to be cared about like healthcare!
Mazi Ray
Los Angeles
_____________________________________
This is all excellent advice.
Since not everyone has access to, or can afford the "concierge medicine" that you have, I will add one thing: If you are fortunate enough to live where there is a teaching hospital, join their system over other available options. They will have the newest information and the most highly educated docs. They are usually profs at the attached medical school, for whom staying current isn't a luxury—it's a necessity. To be clear, there is a difference in standards of care from the consolidators that are cutting costs and the not for profit teaching hospitals that are not. Teaching hospitals associated with major universities are also hubs for research and clinical trials. That means the newest treatments are available to those with acute or chronic illness.
I offer this advice as a Survivor-to-Survivor counsellor for the Bladder Cancer Advocacy Network who has seen both the commercial and teaching systems up close. There is no comparison. It is why I also live near good facilities. I can't take the risk that my brother-in-law, who lives in a small resort town, took. He found out about the difference the hard way, nearly dying of a misdiagnosed cardiac issue that likely would not have happened at a better institution.
One last thing, if you don't have access to a major teaching facility and are diagnosed with a tricky problem, find a way to get care from providers who see your issue every day. Avoid general surgeons for anything more complicated than a tonsillectomy or hernia repair. Use a specialist who has 10,000 hours and a large number of reps with your procedure.
Jon Sinton
_____________________________________
Can't begin to tell you how timely your article is.
I used to say that it should be illegal to show prescription drug commercials on tv. After all, you need a doctor to prescribe them and the doctor should be telling you what you need, not the other way around. But we live in a very different world today. We have to take our healthcare in our own hands and be proactive.
Health insurance companies only care about denying coverage so that they can add to their bottom line. They don't care about you and me. When my wife gave birth to our third child, the doctor told her she had to stay in the hospital another day, but the insurance company denied the request and sent her home against doctors orders. Do the pencil pushers really think they know better than your doctor, or is it more about the bottom line than what's good for your health?
A number of years ago, I changed from my long-time doctor to a nurse practitioner (due to a change in my insurance). At my physical, I mentioned an issue I'd had for over a decade that caused flair-ups of pain. My prior doctor had treated the symptoms with pain killers. The nurse practitioner asked if I wouldn't rather solve the underlying problem, rather just treat the flair-ups. I looked at her in disbelief as she told me how to avoid the issue. I haven't had those pains since.
Years ago, my son had pain and went to an ER at a local hospital. They told him he had indigestion and sent him home with Tums. The next night he had emergency gallbladder surgery at a different hospital. When the first hospital sent him a bill, he told them where they could put it since they had misdiagnosed him.
Another son has recently had a health issue that he's been trying to address. He's been to numerous doctors. Lots of conflicting opinions on a diagnosis. He was in pain, so he went to a hospital ER . . . and then another, and another. 3 ER visits at 3 different hospitals in various parts of the city. He told me that all 3 were overflowing with people in the waiting rooms, hallways, outdoors, etc. Minimum of a 3 hour wait at any of them. And he said that COVID wasn't the problem. There just aren't enough staff and not enough space. And he got 3 different diagnosis and no real help. One doctor says that the prior doctor's diagnosis is ridiculous. Doctor needs a CT scan, but the insurance denies it. Doctor says, "he really needs it" and the insurance company says, "we'll get back to you in a few weeks."
My son's daughter (age 4) has been sick. He took her to the pediatrician. The doctor said it's a flu bug and it will go away. But she's had it for 3 weeks. My son suggests that she might have C. diff, but the doctor says that's impossible. So my son gathers a stool sample from his daughter and takes it in for analysis at a diagnostic lab. Turns out that my granddaughter has C. diff and they are seeing a gastro specialist tomorrow.
Yes, being proactive with your healthcare is more important than ever. Our current system is broken.
Russ Paris
_____________________________________
Americans will never truly be able to comprehend how truly disgraceful the rest of the world thinks it is that they don't have universal healthcare.
When I saw your email's headline I hoped maybe it would be a long screed advocating for it. But instead it's about getting good insurance, and how you should still pay to get checked up even though it's expensive.
It's like a trapped animals at the zoo.
Thanks
Michael Griffin
_____________________________________
Thanks for writing this and urging people to get checked as often as they can, but at least yearly.
I have just undergone my second cancer scare which started with a mole on my back that my wife urged me to get checked. I finally did and it was malignant melanoma. From there they ended up ripping out 4 lymph nodes because that's where melanoma likes to go., thankfully I was clean but it was a major operation which I will now recover from. Although it hurst and it all sucks, I am glad to go thru it rather than find out too late this spot on my back killed me.
Previously, on this day in 2003 I had a colon tumor removed that I discovered by paying attention to discomfort that I felt and going in to use my insurance I bitch about paying. Low and behold, stage 3. Cut it out, then 6 months of chemo. The chemo was worse than the cancer itself.
But here I am.
GET YOURSELF CHECKED. TODAY.
Danny Zelisko
_____________________________________
Great email Bob - totally rings true and may save a life or two.
My internist is an "MDVIP" concierge doctor, which means I pay for the privilege of being his patient. It sounds almost unfathomable, but it's worth every penny. He answers texts and emails almost immediately, and I can actually get him on the phone! Not sure if he takes Medicare; guess
I'll find out next year.
Anyway, thanks for encouraging people to take care of their health. I'm thankful for mine every single day. If you ever need to visit Hopkins Hospital (which I hope you don't), let me know - it's not far from my house and I can hook you up with a room in my building.....
Rich Madow
_____________________________________
Insurance is unaffordable until you need it -
Terry Anzaldo
_____________________________________
Ha -- 46 years I've been singing to myself "Doctor say's he's comin', but you got a permanent rash"
Andy Rosenzweig
--
Visit the archive: lefsetz.com/wordpress/
--
Listen to the podcast:
-iHeart: ihr.fm/2Gi5PFj
-Apple: apple.co/2ndmpvp
--
www.twitter.com/lefsetz
--
If you would like to subscribe to the LefsetzLetter,
www.lefsetz.com/lists/?p=subscribe&id=1
If you do not want to receive any more LefsetzLetters, Unsubscribe
To change your email address this link
No comments:
Post a Comment