Medicine Via Government Is A Mess
A doctor with "liberal leanings" who went into medicine believing government had an important role to play in healthcare experienced how that works in practical terms, and well, let's just say her thinking shifted somewhat.
Rebekah Bernard M.D. writes at FEE about working at a Federally Qualified Health Center:
While federally qualified health centers are not exactly government-run, they are heavily subsidized by government grants and payments. These systems receive significantly higher Medicare and Medicaid payments than other clinics, especially when they are in rural areas. In exchange for federal funding, clinics must follow the government's rules and protocols to the letter.For example, one of the requirements for federally qualified health centers is that they must maintain a certain number of physician assistants and nurse practitioners. Rural health clinics were the first sites to receive a federal mandate to hire non-physician practitioners.
For me, this meant supervising a physician assistant from day one. And within a few months, a brand new nurse practitioner was added to my list of responsibilities. Despite this extra workload, there was no time allotted in my schedule to provide education, review charts or discuss cases--nor was I compensated for my extra duties.
Federal regulations also create massive amounts of paperwork. While the medical staff worked hard to move patients through the registration process, my schedule often ran hours behind as forms were signed and documents reviewed.
...Bullying Tactics
This bottleneck often led to me starting my day late and working into the evening. When I started coming in a bit later than my assigned start time, knowing that patients would not be ready for me, I was given a stern warning by administrators.
This chastisement was commonplace. Compliance with federal regulations requires a team of office bureaucrats, and these managers acted as clinic enforcers. Medical providers were routinely warned, threatened, and bullied over minor infractions or for questioning policies.
At one staff meeting, a top administrator announced that he was going to "have a 'come to Jesus' talk" with the medical staff to respond to complaints about the electronic health record. At another meeting, a manager literally screamed in my face when I questioned an office policy. When I complained to a senior administrator, I was told, "You are welcome to leave any time."
But I couldn't leave.
You see, I had signed a contract with the government. As a National Health Service Corps scholarship recipient, I had agreed to work at a health shortage site for four years. In exchange, the program paid my medical school tuition. The penalty for breaking the contract was harsh: repay three times the tuition amount immediately or go to jail.
I was trapped.
So, I put my head down. I shut my mouth. I stopped suggesting improvements or changes that might make the system more efficient and improve patient care. I humbled myself before my managers and administrators, saying "yes, sir," and "no, ma'am."
This technique worked like a charm. No one screamed at me anymore. I even got a large raise.
But inside I seethed. My blood pressure spiked. My neck ached. I was anxious and depressed.
The day that my government contract expired was one of the happiest days of my life. I was free. Never again would I sell myself into indentured servitude--not to the government or any other agency.
When Doctors Suffer, So Do Patients
Instead, this left-wing liberal found herself leaning to the right, embracing free-market principles to achieve the very same dream of helping the underserved by opening a direct primary care practice.
In this new model, I care for many of the same patients I served at the health center--sans paperwork, burdensome regulations, and mid-level managers. My patients receive affordable, quality health care without the indignity of waiting in long lines or being forced to prove their financial eligibility.
While it has been several years since I worked in a federally qualified health center, studies show that these clinics are only getting worse. A study in 2013 reported significant declines in multiple measures, including professional satisfaction, work environment, and practice culture. In other words, doctors working at federally qualified health centers are at high risk of becoming burned out.
This burnout doesn't just hurt physicians. When doctors are miserable, patients suffer. Studies show that burned-out doctors have lower patient satisfaction, poorer quality of care, and are more likely to make a medical error, especially when they are depressed.
She ends her piece with this:
I still believe that government has a role in health care. But as the sole player in the health care system? Take it from someone with experience. This is the wrong answer.
No, government does NOT really have a "role" in health care.
If you think that government cares about you personally, you have a mental illness and need help.
Non-government help.
Radwaste at January 8, 2021 4:09 AM
We have examples of how government run health care works: Medicare & the VA System. This, I suppose, is another one.
But this seems more of an instance of bad bosses creating bad culture. Bad bosses can be anywhere. Bad bosses can be at St Anthony's (names made up) and the physician can have the freedom to take a job at Horizon or Unity where culture is better for staff and patients. In her case that contract held her hostage, adding to dissatisfaction.
I've only worked at one company for 40 years, so I have no experience outside this...so I am wondering if there are more bad bosses in government entities.
Vickie at January 8, 2021 5:28 AM
In medicine, like education, government can have a role in providing research, guidance, and structure, but should not, under any circumstance, be tasked with the actual distribution of said service.
Although, a solid counter-argument can be made that private foundations can adequately provide research, guidance, and structure without the interference of government bureaucrats.
Conan the Grammarian at January 8, 2021 6:54 AM
Conquest's First Law of Politics :
Everyone is conservative about what they know best.
phwest at January 8, 2021 8:33 AM
I dunno, we had a disastrous ski vacation in Chamonix a couple years ago... a kid we were hosting broke an arm, and my mom busted up her kneee, terrible snow that year... and I was quite pleased with the French health care system. Sure, the hospital was a bit shabby with peeling paint and cracks in the walls, but the care was quite good.
I was a bit panicky when the receptionist told me I'd have to pay out of pocket and get reimbursed for the kid, as they didn't take foreign insurance. But it turns out xrays and setting an arm fracture costs 80 euros, so...
NicoleK at January 8, 2021 10:41 AM
NikoleK, This is 1920’s medical care It should be cheap. I can set a simple fracture. It will heal on its own. It shouldn’t be expensive. Probably a bit more than you would have paid in Japan though.
Isab at January 8, 2021 12:57 PM
Why is that Europeans never understand scale? French ski towns with populations of about 10,000 ppl cannot be compared to the suburbs of our major metropolitan areas. My kid’s old high school has a population of 4,000 kids, as do the 4 other high schools in our area. That’s 20,000 high school students in just my small area of NW Houston. The whole metro area has a known population of around 7 million ppl, plus an untold number of ppl living here illegally. This is the reality of living in the US in any major metropolitan area. Our needs are complex and expensive. My guess is that, God forbid, should someone in your family need specialist care, you’ll have your butt on a plane and be back here ASAP bc the cheap, shabby hospitals of Europe won’t cut it with you.
Sheep Mom at January 8, 2021 2:20 PM
Last I checked (about 5 years ago) a doc'n'a'box over here will do x-ray and set for ~$125. 80 euro is $98.11, so a little cheaper. That was the no insurance, no muss, no fuss. Just pay at time of service.
Ben at January 8, 2021 6:09 PM
I had no idea it could be that cheap.
Crid at January 8, 2021 9:34 PM
My Mom ended up needing an operation for her knee (I don't know how much she ended up paying because I wasn't responsible for her like I was for the kid). She was indeed screeching about how she wanted to go home and be treated at Mass General, as she did not have faith. However this was not possible, so she ended up being treated in Sailanches and having her operation there. It went well. Granted, ski injuries is pretty much their specialty.
However, you do have a point. I -am- considering going to Boston to treat my kid's peanut allergy. While the hospitals here are not at all shabby like in France (it also isn't socialized), Allergy treatment is a specialty of Mass General. I am doing this because the allergist keeps putting off the treatment, and I don't want to wait until she is a teen to pull her out of school for treatment. I have a meeting with her in February which will determine what we do. If she keeps saying, "Wait until she is older", I will probably pull kiddo out of school for June 2022 (Figure Covid will be under control by then) and do it over the summer. I've already talked to staff at Mass General. Here's to hoping it won't be necessary!
NicoleK at January 8, 2021 10:14 PM
Not being accusatory in any way… But did the kid eat peanuts when he was young?
Crid at January 9, 2021 6:16 AM
It would have been about $500 if we had insurance, Crid. And that is the out of pocket expense. The insurance would be charged more on top of that.
Every step of the way we had to remind them no insurance. The antibiotics they chose, the cast material, and probably lots of other stuff changed once those magic words came out. What was the difference between $125 service and $500 service? How pretty the box the stuff came out of. As for actual health outcomes, no difference.
Ben at January 9, 2021 6:23 AM
I did everything I was supposed to. She ate peanuts when she was young (as per current recommendations) and had no reaction, I breastfed a couple years, we live in the country.... it fucking sucked.
Actually what really sucked was when she had a reaction in the States and we had to pay 10k upfront for the care which consisted of a couple epi pen shots, observation, an ambulance transfer, and more observation. Yes, our insurance reimbursed us, but we still had to front the money and had a couple months between paying and getting reimbursed where we were quite nervous.
NicoleK at January 9, 2021 11:20 AM
Sincerely meant not to accuse, but there's this school of thought that kids need a few servings in earliest years or they won't be able to tolerate them later.
When I was a kid, PB was a godsend to my mom. It was cheap, easy to store, ready to eat in seconds, and I adored it. We were fuckin' poor, and she liked nothing more than than her kids stinking of peanut butter, because it's full of protein. And we were happy. I've had thirty farms' worth of goobers over the years.
Crid at January 9, 2021 12:40 PM
This brings to mind a quote from Atlas Shrugged:
"Let them discover the kind of doctors that their system will now produce. Let them discover in their operating rooms and hospital wards that is it not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe if he is the sort who doesn’t.”
Rex Little at January 9, 2021 1:12 PM
Israel's health care system improved greatly once free-market reforms were introduced. This actually opened up the population to accept similar reforms in the rest of the economy, despite fear-mongering and self-righteous "togetherness" talk by the founding Leftists.
We now have a hybrid system with the government underwriting a basic basket of services, and HMOs selling plans with additional services.
One tiny detail that was key to the turnaround: EVERY procedure/prescription involves a copay.
Ben David at January 10, 2021 9:43 AM
Oh, I didn't think it was an accusation. And the recommendations were changing around the time she was born so I easily could have just not given her any.
I love peanut butter. It especially sucks since we're vegetarians and it's a good veg source of nutrition. But we eat cashew and almond butter instead. Which unfortunately is about three times as pricey but what can you do.
I wonder why other nut/seed butters only come in fancy organic. Why is there no Skippy or Jiff sunflower or almond butter?
NicoleK at January 12, 2021 1:42 AM
“I wonder why other nut/seed butters only come in fancy organic. Why is there no Skippy or Jiff sunflower or almond butter?”
NicoleK at January 12, 2021 1:42 AM
My guess is that to make them cheap, they are going to have to process them on the same equipment and in the same plants where they process peanuts.
Isab at January 12, 2021 10:03 AM
Hello Lenona if you're still reading: Skippy & Gif are cheap because they're full of corn syrup / sweeteners etc. The key word from Isab: Processed.
I'm glad you have the money and good taste to give your kids genuine nut butters!
Crid at January 13, 2021 7:47 PM
Whoops, Sorry... Nicolek, not Lenona.
I may have had a glass of wine, but you can't prove a thing. You have no evidence! There are no witnesses. You should consider the matter closed.
Let's move forward.
Crid at January 13, 2021 7:49 PM
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