HEALTH CARE TODAY STINKS

  I believe that I can be an authority on the subject of health care today having been born at home in 1920 at a time when women feared giving birth in the hospital due to the chance of a fatal infection. (see at end)

  As a 1940 medical student, a combat medical officer 1944-45 and a practicing physician from 1946 to 1990 as well as an administrator until 2000 I am familiar with all the changes through medicine’s golden ages of the 1950s-60s and the subsequent decline to today’s money driven business.

  Once care was given by physicians who had 9 or more years of training including 3 or 4 years of college, 4 years of medical school during which as in my case the first year of medical school could also count to a college degree. Internships were 1 or 2 years and specialized residencies up to 4 years. That would add up to a minimum of 8 years of training before one could get a license to treat patients.

The major part of today’s routine or initial health care is through PAs or NPs.

 The Medical Practice Assistants can be qualified through a Junior College (2 years) Vocational Institutes post High School both available through on-line programs. Some also require a year’s externship.

  Or by Nurse Practioners. This definition of NPs comes from Wikipedia: “to become an NP requires between 1.5 to 3 years of post-baccalaureate training, in addition to prior training and experience as an RN, though there are alternate routes to training. This is in comparison to physicians who are required to complete a minimum of 7 years of post-baccalaureate training. A new nurse practitioner may have between 500 and 1,000 hours of clinical training, compared with a family physician, who would have more than 15,000 hours of clinical training by the time of certification.

“While a doctor may refer a patient for specialized care, such as to a neurologist, the physician has a well-rounded education that overlaps with all specialties. An NP is a nurse practitioner.” ...

  Whereas the RN cannot prescribe medications, the nurse practitioner is licensed to do so, as well as diagnose conditions.

   Yes, you may finally see an MD for a few minutes. Even if he lays on hands, he is busy filling out a computer report.

Is there any comparison?

  American health care has deteriorated over the last 46 years when the Health Maintenance Act of 1971 was passed. Nixon expressed his support for the essential philosophy of the HMO, which John Ehrlichman explained thus: "All the incentives are toward less medical care, because the less care they give them, the more money they make. 
  In truth the insurance companies jumped on the band wagon as they organized groups of participating physicians and used specified contracted hospitals at compensation rates that were lower than the areas going charges.

  At the same time, they began to compensate doctors who staffed the hospital emergency rooms and not paying for outside physicians who came in to treat patients. Some policies limited the holder to the plan’s list (contracted) of hospitals and doctors.

  Prior to that the ERs were staffed by doctors on the staff who did not bill the patients as part of their hospital staff obligation.

 All hospital staff physicians were private practitioners not employees or full time based

 With the event of the HMOs physicians became providers and patients now were consumers; purely a business concept.

 The delivery of health care crashed with Obama care which encouraged hospitals and insurers to form vertical closed systems from which they benefitted from costs of delivery as well as control of the sources. Part of the change was the employment of Nurse Practioners or Practice Assistants as the primary delivers of health care.

  To counter these closed groups physicians began to organize in non-profit practioners groups. For 10 years from 1990 to 1200   served as Medical Director of the Central Jersey Independent Practioners which consisted of over 200 doctors in all specialties with privileges at Muhlenberg, Kennedy, and the New Brunswick hospitals   
   Besides my making sure members did not unethically bill for unneeded services,  I with the other executives negotiated contracts with acceptable reimbursement  with the area insurance company-there only was one in a specific part o f the state. We would end up slightly lower than THE GOING RATE but enough to maintain a practice.

  An example of how costs can be inflated today. I reordered a prescription which I have been taking for well over a year from a local drug store. I was using the generic and paid $4.95 and the insurance company (Medicare) paid $16.95 total $21.90. My secondary coverage pays for the costs not covered by Medicare. (the $4.95 When I picked up the Rx, I noticed that I had been charged $16.95.

  The pharmacist said it was an over the counter item and insurance would not pay for it. I questioned what insurance carrier used and was given the name of what I believed was the chain’s captive insurer. I did not feel that I should have to pay 16.95 for something that should costs me nothing. You will also note that as a prescription the item is inflated by about 15%. They are gaming the system.

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 Prior to the introduction of bacteracidal drugs even an infected tooth could result in blood stream spread and death.    
 The first antibiotic was part of a German red dye; Pronestyl isolated in 1936. The effective portion, sulfanilamide, was isolated in 1938. Various chemical modifications sulfonamides followed. Penicillin as an antibiotic was developed about 1940.  In 1944 as an intern in Syracuse we obtained 40,000 liquid units to be given IV and cured a patient with bacterial endocarditis, Oral forms became available during WWII, their use was strictly controlled.

  Big advances in traumatic surgical treatment started in the Spanish Civil war and explosively during WWII.

  In the past 4 decades there has been great advancements with the advent of computers and the replacement of x-rays with direct imagine.

  Other recent major advancements include the MRI, Micro-surgery, and invasive procedures. Yes, we are far technically advanced now than in 1960.