Health Care

BS”D

Medical tourism is just the free market at its best. It is not ironic at all that the US could price itself out of non-emergency medical treatment as it has in everything else from software development to TV manufacturing.

EY doctors, especially US olim, also welcome patients from abroad in private centers to supplement or supplant their meager (but improving) Kupat Cholim compensation. British, Swiss and German doctors and clinics welcome wealthy patients from this part of the world (as do EY facilities since many of those patients are Jewish) and India is getting into the business now for the middle class. If insurance companies are squeezed more and more in the US and doctors refuse the lower and lower capitation payments then insurance companies will find it worthwhile to send patients abroad for non emergency treatment, and I could easily see Indian doctors from the US going back home to open clinics for that sole purpose.

Give the left enough time, and your average US emergency room will be as clean as a certain Rockland County poultry plant. And the doctors who aren’t good enough for the new Indian outsourcing clinics will be the ones staffing US emergency rooms.

BS”D

In fact the clinic for foreigners that I went to in Moscow employed Canadian, UK and Australian doctors who wanted to earn real money and be free from the stifling bureaucracy and limits on the level of care they could provide back home.

Unfortunately, the French-Asian firm which owned the clinic I used went too far and ran a bit of a fraud scheme themselves on the backs of healthy and well insured “lifestyle” (allergy, skin, high cholesterol, corporate physical, well child checkups etc) patients like myself and the doctors burned out or left due to ethical considerations. I realized what was going on when I wanted to buy cardiac aspirin and the doctor immediately offered to put it on my insurance, which would have meant a bill of $10 plus another diagnosis and therefore another consulting fee from CIGNA rather than $1.25 from me. I refused to let that happen both on moral grounds and because I could end up being put on a watch list of coverage abusers.

They would go so far as to ask me “Do you want anything else”? and I would of course reply, “Sure, whatever I can sell on the street!”

They were replaced eventually by Asians.

Its more properly run competitor, which did not accept my insurance, retained its foreign professionals, including Americans.

I could not believe the stuff I saw for sale within walking distance of the San Ysidro border crossing.

BS”D

You used to be able to get post transplant immune system suppressants in Moscow (Sandimmune), at street kiosks, OTC. Ditto for chemotherapy (Cytoxan)!

That was in the early 90’s at the time when it was a status symbol to have anything imported in your house, and it was probably expired stock bought by someone with more money than brains who could have used it for just about anything including attempting to poison a business rival. The products themselves were sent to Russia in odd lots that contained a little bit of this and a little bit of that. Those days are long since over here but in general all of Europe except the UK is not as strict as the US, Canada and EY when it comes to RX laws. Mexico and Asia are free for alls.

And you are not correct regarding Mexico; many of the hospitals promoting medical tourism have been serving Mexican citizens for decades and continue to do so.

BS”D

Some foreign hospitals have 2 levels of care provided at 2 different wings of the facility.

Ben Levi,

I thought I had responded.

A600KiloBear,

Some US hospitals have 2 levels of care. None of use will get the high level of care.

charliehall, one is not required to be a talmid chochom nor a rabbi to understand that it is a strin at best to try and say that the mitzva of Hshovas Aveida require Government Helth care.

As to why No one replied to Dr. Tendler, well in many Halachic circles he is not taken seriously especially since he tried to abolish metzizah bpeh.

BS”D

American VIP care is “off the charts,” whereas the level of care provided even in a Kings County or a Bellevue is much, much better than care in the socialized medical world.

I visited patients in the best hospital in Montreal years ago for yom tov and I was shocked by the facilities and the dinginess. (In fact the nicest part of the hospital was the psych unit because it was mainly a recreational environment but I can’t compare it to its counterparts elsewhere as the only other time I ever did bikur cholim on a psych unit was on a unit for patients who had harmed themselves L”A and I was really there for the staff to hear shofar). The Montreal hospital was comparable to Communist era facilities in Moscow, with the difference being that the Montreal hospital had known better days from the pre-socialized era whereas the Moscow facility had sunk into chaos from the lack of any system there at the time (now private insurance is available there and some facilities are improving).

Besides, most of the issues in the public hospitals are created by the lifestyles of the patients that they treat, and these lifestyle issues most notably encompass drugs, alcohol, abusive behavior/crime and arayois.

This is so sad. The arguments are become more and more far fetched, twisted into a pretzel to defend the indefensible. I’ve posted serious questions on health care reform in the CR; any responses were tangential at best. So sad that defenders of “health care reform” (a misnomer; I would use the term “health care erosion”) have not been able to rebut basic questions challenging this mess.

600kilo- your analogy to Sedom is apt and on the mark.

BS”D

Messing up should be a CRIMINAL offense for the doctor and civil for the hospital as many types of medical malpractice are in EY.

Recently an FSU trained anesthesiologist whom I would not even trust to trim my next steak got 6 years for ruining someone’s life and she was not on drugs or motivated by money. She is just your typical butcher who trained in the worst of the FSU and was able to buy her passing grades as the Soviet Union was collapsing. (However, the system that let her practice without proper retraining is very much to blame and she did get far too severe a punishment).

Then the worst doctors would weed themselves out and go into medical administration – or malpractice law!

“it is a strin at best to try and say that the mitzva of Hshovas Aveida require Government Helth care”

Rabbi Tendler never said that. And neither did I. He said we have to provide health care for all. Israel and France do it without a government insurance plan.

“As to why No one replied to Dr. Tendler, well in many Halachic circles he is not taken seriously especially since he tried to abolish metzizah bpeh. “

If you would read what he has published on that issue, you might just want to abolish it as well. It puts the lives of children in danger!

In any case, he is the single most respected expert in medical halachah outside of Israel and most frum physicians follow his Torah.

“we have our networks which ensure that medical care is paid for (RCCS, ROFEH International, the Syrian model organization, etc, etc etc). “

Those networks are too small to ensure that even all Orthodox Jews get care.

“What is needed is less government intervention and more incentives for more such hospitals and care organizations to be formed”

Your ideals are sound. Your arithmetic doesn’t work. To insure every Jew in America would cost billions — more than we spend on Jewish Day Schools! And we can’t even afford all the schools. Shall we tell the rabbis to close all the schools so that we can pay the health care bills, sending our kids to public schools?

People just don’t understand how expensive health care is.

“Sodom, on the other hand”

Sodom was where the poor were not helped by the rich. And in America, if you don’t have health insurance, you aren’t likely to get helped. Private charity funds don’t even begin to cover the needs. People die from lack of insurance, and the bills in Congress are the closest we’ve come to remedying that situation.

‘So sad that defenders of “health care reform” (a misnomer; I would use the term “health care erosion”) have not been able to rebut basic questions challenging this mess. ‘

I’ve rebutted them; it is just that some folks don’t want to admit that the consequences of the current system are that people are dying from lack of access to health care.

“Is the health care bill forcing me to buy an American health insurance that I don’t want nor need?”

You may not want insurance, but unless you are a millionaire, you need health insurance if you live in America. Period.

“CharlieHall, Where did you go? “

I’ve been busy writing a grant proposal. I’m also trying (and failing) to spend less time on the internet on non-work related matters.

BS”D

Add Sweden to the list of countries where suffering is caused by the Sdoimish system. A student intern who worked for me in Moscow told me a horror story which ended in the premature passing of a friend of hers from a treatable malignancy LA due to neglect.

She herself had to leave my employ earlier than scheduled because of the aftereffects of incompetent, essentially incomplete treatment of a very typical skiing injury that necessitated her having to undergo additional surgery. This need for surgery forced her to return to Schlockholm earlier than scheduled because had she postponed it to the date which would have been better for her (and for me) she would have lost her place in the surgery queue for another year or so. Had she been injured and treated in the US, or even for that matter under the expatriate coverage I had in Moscow, her outcome would have been very different and she would not have had to undergo 2 periods of temporary disability for one incident.

Her brother has a permanent facial deformity pursuant to a relatively minor injury, again due to the wonderful system in Sweden.

CharlieHall, to address your statement on health care.

You assert that it is mathamatically impossible to insure all Americans privatley.If that is so how can the Government do it

Well youwill assert by cutting costs?

Well which costs? Cutting comensation to Doctors so the best and brightest do not decide to enter the field?

Perhaps not,Perhaps it’sby cuttin 500 billion from Medicare wich will somehow be done without affecting the quality of care.

As to the point about Sodom.

In actuality the issue with Sodom was that one size fits all they cut shory people and long people to all fit one sized bed.

Sounds a lot like One Size fits all Socialism to me.

“Some people are dying due to lack of access to health care”

Actually as has been pointed out numerous timesemergency rooms are obligated to treat all people immiedietly upon arrival.

I would assert that many people would die if Government Health Care is implemented.

Regarding your point of needing Health Care.

First of all whether ot not it is needed it is constitutianally questionable if the government has the write to force someone to do anything. (Don’y bring in Car Insurance because it is precisley for that reason the govvernment can only require Liabilty and not Collision).

In addition teenagers and young adults often do nbot need health care period.

Welcome Back I look forward to reading your response.

BS”D

AS for Sdoim, on many threads here and elsewhere when hockers discuss fallen baalei tzedoko who end up in Federal Koilel, invariably one or two cynics said – they gave tzedoko – but with whose money?

When a businessman is convicted of taking someone else’s money, even if the money went to tzedoko, it results in a stay in Federal Koilel. Yet, that is exactly what the left wants to do – give tzedoko, to its own choice of deserving candidates, using other people’s money.

Lack of respect for private property and lack of freedom of choice is what Sdom was all about. In Sdom, there was one Merkoz haChessed – the one with the one size fits all bed and the macabre band of orthopadeic surgeons (trained where, I wonder) to make the person fit the bed. Anyone else who engaged in chessed was chayav misso!

Yes, that is the vision of the left. Socialist Sodom. The USSR. Union of Sodomite Socialist Republics. One size fits all, with legalized toeva and erosion of the family and community thrown into the (Hillary Clinton) machshefa’s brew.

I look out on the destruction and pollution wrought by the USSR of old and its misguided so called chessed every day. 20 years later, it has not been fixed. I also see the casualties of its health care system; disabled men and women who would have been healthy had they had the fortune to be born or treated in the free world during their youth. And that system isn’t fixed either, far from it. Obama is leading you down the same path, just not as dramatically and not as disastrously.

Ben Levi,

I don’t know how to respond to you when you keep bringing up arguments against a government health insurance program, and that is not what is up for discussion

A600KiloBear,

My wife is a physician and today almost all of her patients have New York Medicaid for her insurance. I asked her how many times she had had Medicaid deny coverage for a treatment she had recommended. The answer: Zero. I expressed surprise but she said that she was also amazed at how friendly they are and at how many things they cover. I then asked her how often she had denials of coverage when she worked in a clinic treating patients with private insurance. She said it happened all the time and that she spent huge amounts of time arguing with them. Your argument that government insurance always results in denials of service has thus been disproven. Unfortunately, New York is one of the few states to adequately fund Medicaid.

Bemused,

You are the one who is confused on moral issues as well as what insurance is about. The entire concept is spread risk around the entire community. Essentially, those less well off are taken care of by those who are better off. Do you really think insurance is immoral?

BS”D

Just proves my point.

Medicaid, which spends other people’s money, will pay for anything so long as the papers are filed right. That is why we read constantly about Medicaid fraud rings; the entitlement insurance programs are an easy target.

The private insurance, which spends money paid in by its customers, does due diligence. No one dies from a doctor having to prove his diagnosis and treatment; it only makes everyone do his job better. Besides, this in turn goes back to my experience here in the FSU. I can read. I understand when the lab tech tells me my cholesterol is 250 without the statin and 170 with or whatever my numbers might be. Therefore, I buy the statin, read the patient insert (online because I don’t read Ukrainian but that is besides the point) and I know what to look out for in terms of side effects. Now, that means that my insurance company does not have to worry about the clinic marking up $40 worth of Lipitor to $200 every month and charging $120 to them per visit for 4 visits a year and who knows what they would charge to the company for my annual ten buck blood test. Restore power to the consumer and get rid of the nanny state, and the private insurers will no longer be covering conditions that residents of other countries treat at the pharmacy and laboratory. With my insurance in Moscow I could have gone to the clinic every time I cut myself in the kitchen or bruised myself falling on the ice, and walked out with an OTC preparation billed as an RX, billed to CIGNA at 4x the highest street price along with the magic $120 per visit.

People with any insurance are prone to go to the doctor for sniffles, especially when they have time on their hands which a lot of people do now thanks to the leisure ethic of the US and the present situation. People who value time and work for a living, and don’t want nanny state interference, take care of things themselves. At one time, most Americans were the self reliant types. Now, it is the other way around and those who are entrusted with spending our hard earned money have to watch every dime because of abusers, including doctors who get so little now that they look for ways to pad.

This all started with the nanny state and with defensive medicine. Increasing the nanny state will only make Americans worse off in every way.

Bemused,

You are correct, insurance is moral. But millions of Americans can’t get it. This bill will change that. It doesn’t create a new governmental program.

What exactly is your problem?

And you seem to be as disconnected to reality when you rant and rave about government insurance — the HCR bill that passed the Senate creates no new government insurance program.

You’re right. The bill has no new government insurance program. But it does have the creation of a new department along with a bloated bureaucracy. The people in that department are not volunteers. They need to be paid. And where do you think the money will come from?

Charliehall it’s interesting that you sign off without really addressing any issues.

To require all to pay for everyone is actually immoral, the way the mishna in Avos describes it is “One who says yours is mine and mine is yours is an am haaretz” (from memory but I think it’s accurate. To explain the Mishna is beyond the scope of this post.

You state that Medicare funds everybody that Insurance is not willing to.

Let e get that we will add thirty million to a system pay for more treatments then everyone who currently has insurance pays for and still cut costs massivley.

I think Walter Mondale said it best, When he left politics he bought a motel which subsequently went bankrupt upon which he said “if I had know then what I know now about buisness I would have voted differently”.

To cap it all off you seem to wax eloquent about Medicaid (A government Health Insurance) yet state this Bill is not about Government Health Insurance. Is so why bring up Medicaid.

Sorry, I did not reply earlier but I was by the Dentist, No I do not have Dental.

As the one who actually depends on people having insurance so that they pay me for the medical care I give them, there are a few remarks that do not seem clear from the other posters. First, “A Healer who charges nothing is worth nothing.” (Bava Kama, I think) The professionalism of medicine enables the quality to remain high, though serious prospects of recovery from life threatening illness is really a phenomenon of the last century. There is very little divergent opinion that doctors like myself derive a personal and professional satisfaction from taking care of patients who benefit from the specialized skill and that fair payment is expected for having acquired the skills and for being available when needed.

Over time, in America at least, that basic Talmudic principle has gotten distorted. Accessibility of people who need care has become haphazard and payment to those who provide care has become inconsistent as well. There are three elements to reform: Accessibility, Affordability and Quality. Most of the world, including Eretz Yisrael have corrected the first two elements, everyone struggles with the third. It is only in America that cost does not run in parallel with quality. There are data from Medicare that show detrimental results of profligate care and better outcomes with less intervention. There are patients in my community who get all sorts of imaging studies of dubious benefit, expensive patent protected pills when $4 monthly generics will serve the purpose. Medical care is generated by the doctors but currently there is no means of restraining excess. Medicare has been a total failure in this. Universal accessibility has been achieved for Americans age 65+ via medicare. Quality is fairly good though inconsistent.

The other elements of the population score largely a zero in the elements of Accessibility, Cost Effectiveness, and Outcome data. For that reason, pretty much anything the elected officials do to intervene will serve as something of an upgrade. For those old enough to remember, there were privately generated cost containment efforts in the early 1990’s that sacrificed accessibility to achieve and created an overhead that really limited too little care to justify the expense of hiring case managers to oversight this. For the most part, what the doctors requested for their patients was reasonable and it was cheaper to let some extra expense go through than to hire people to contain them. The government is not likely to contain them either, nor are patients as consumers, even if medical insurance changes to a high deductible form.