Never mind how long it takes the frickin HMO to pay the frickin bill, after a half-dozen cycles of "yes that's covered" "no that's not" "but you said it was covered" "It's not" "I'll get my lawyer" "no wait, maybe it's covered" "Yes it's covered, but we're dropping you or doubling your premium"

However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.

And that only counts "patients," i.e. those who get some sort of medical care. Those who go without care, i.e. those with no or inadequate insurance, aren't even counted in these statistics, and if they were it would come out even worse for us.

Also, surgeons prefer to spend most of their time performing surgery, thus the number of days spent in consultations before surgery will usually be much less than the days spent performing surgery.

The relative supply of GPs in this country compared to other nations is indicative of the many perverse incentives that underlie our health system.

I'm reminded of a conversation I overheard many years ago, when I was studying public health: in the medical school library of a major university, one medical student, discussing the career objectives of a mutual acquaintance, says to another med student, "He just doesn't know what he wants! I know what I want! I want a Ferrari!"

This is a great point. I love the idea of universal healthcare, but I've never really been sure how to respond to the waiting list argument.

I have reasonably good coverage, and it's usually a week or so to see a GP, and then 14-28 days to get in to see a specialist. I'd never thought about these delays being "waiting lists," but that's exactly what they are.

Thank you for pointing this out Kevin. This "wait time" stuff drives me crazy when my Mom, a Kaiser patient had to wait 2.5 months to see a dermatologist for an issue in their system. It's not like we have health care on demand here either, even if you do have insurance.

Next time somebody brings up "hip replacement in Canada," ask how many people in Canada are denied hip replacement altogether as compared to the U.S.

I made a dermatologist appointment in May. FOR NOVEMBER 15th!!!!! They said I could try calling each morning to see if anybody canceled. I asked if many people die of melanoma before getting in, and if I could have one of their slots. The secretary thought I was joking.

No shit. 6 month waiting list for dermatologists in this city.

Do any of these numbers for waiting times factor in the, what is it, 45 million people who don't have ANY health care, and, therefore, have waiting times approaching infinity?

It's great to compare waiting times of one type of health care system with another, but if we're comparing a universally insured population in another country to our system, shouldn't we be adjusting the numbers for the US system to include the full population, not just the subset who are actually covered?

JM brings up an important point. American doctors' primary interest is to be self-employed business persons, not healers or healthcare providers. I have no problem with doctors making perhaps ten times the median wage, but I would prefer they spend all of their time providing the services they are trained for rather than counting their revenues and managing a business. Doctors should be employees of clinics, not McDonalds franchisers.

The media bias against a rationally designed health care system that serves all was in full sight on Larry King and Blitzer in the last few days.

Although only Canada has longer wait times than US among the other similar countries, Dr. Sanjay Gupta on CNN chose to emphasize the example of Canada multiple times rather than the others.

I remember it took me six months to get an appointment with my 'primary care physician' when I was on HealthNet through work. Six months. The doctors in the group I was told I was allowed to see were booked. For six months. I had a heart murmur I wanted to get checked out, you know 'just in case'. And it was, "Sorry, you need a full physical with your primary care physician before we can send you to be checked out with a cardiologist."

It was two years before they deigned to send me to a cardiologist.

This was back in the late 1990s.

Thanks, guys.

Now that's a wait.

Five years ago I was suspected of having Multiple Sclerosis. It took me 90 days to schedule my first visit with a neurologist to begin the process of confirming the diagnosis. In talking to individuals newly diagnosed since then 90 days is the average wait for a first appointment across the nation.

I don't know why you think emergency room wait times are any better. You see the doctor that day, but my mom sat in a hallway in a wheelchair with a broken foot for 6 hours (with people constantly hitting her foot) before she saw a doctor. My sister took my 1 year old nephew--who was BLEEDING FROM THE HEAD--to the emergency room last year. A nurse slapped a bandaid on him and they waited 8 hours to see a doctor for stitches. Turns out the bandaid actually made the damage worse (the doctor's words) and he ended up with a scar that he wouldn't have had if he had had prompt, correct care.

Yeah; don't even get me started on dermatologists. Too late:
My GP noticed a funny bump/mole on my forehead, and recommended I get it removed right away, because it could be cancerous and spread. 2 month wait time for the covered dermatologist. I went to a plastic surgeon that afternoon (for cash, out of my own pocket), and he took it off, and had it sent to a pathologist, who found, lucky for me, that it was benign. But what the fuck - what if it had been malignant, and metastasized while I was waiting 2 months to see the in-network dermatologist? I could have been fucking DEAD.

BCBS bean-counters didn't see it that way. The plastic surgeon was not in the network, not covered. So I was out, an extra $200 that month. In addition to my premium, my co-pay for the original GP exam, lab fees, etc. As Michael Moore says - it's a racket.

Best healthcare in the world, after all, I only had to wait 6 weeks after pulling hip ligaments to see an orthopedic doctor at one of the better Kaiser hospitals in Northern California.

6 weeks.

I take it in France or Canada, the wait time would be more than 6 weeks, non?

Oh - I remember sitting in a Fresno, CA (we were on a family vacation), emergency room with a compound-fractured finger, for 8 fucking excruciating hours (that was after a 1 hr drive), waiting for treatment. (that was 1980, though).

When the doctor finally saw me, he said that they were trying to verify my insurance coverage, and I missed my slot.

It would be interesting to study how many insured people pay out of pocket to get immediate care because they're really sick and can't get in to see their regular docs.

Twice when I had very severe flu bugs and my primary couldn't get me in for two or three weeks, I've visited doc-in-the-boxes to get a quick exam and a Tamiflu scrip. Unlike many, many Americans, I was fortunate enough to have the cash to do this.

The worst part about the Blitzer treatment was the fact that they cut to a live shot of "Moore standing by to join us here in the situation room here in a momenent, but first a reality check . . . " -- cue 4 minute segment about fudged facts and surprising occurrences of Moore telling the truth. Do they do that to many other people they interview?

And then in the later exchange there is a giant argument about whether we pay 27 times (Gupta) or 28 times (Moore) what Cubans pay for medical care.

I can't even find a dentist in my city that's accepting new patients, either on or off my joke of a dental discount "plan". It's not for lack of supply locally--I could literally throw a rock and hit two dentist's offices from my work's front door. And there are, off the top of my head, four other dentists within two blocks.

The thing about medical care in the US that utterly frustrates me is not the care itself, it's the insane pile of crap we have to put up with in order to get the care.

OBF sez:

BCBS bean-counters didn't see it that way. The plastic surgeon was not in the network, not covered. So I was out, an extra $200 that month. In addition to my premium, my co-pay for the original GP exam, lab fees, etc. As Michael Moore says - it's a racket.

shortstop sez:

Twice when I had very severe flu bugs and my primary couldn't get me in for two or three weeks, I've visited doc-in-the-boxes to get a quick exam and a Tamiflu scrip. Unlike many, many Americans, I was fortunate enough to have the cash to do this.

This is one of the reasons why I gave up my gold plated expensive insurance a few years back and opted for much cheaper, high deductible catastrophic insurance and covering standard doc visits fully out of pocket. Not only is it *cheaper*, I can see whatever doctor I want when I want.

Two incidents for me:

It took almost 2 months to diagnose my latest knee injury, about 3 weeks to get the initial appointment, another 2 for the MRI, and about 3 weeks more for the follow up appointment to discuss the MRI. Then, the next possible surgery date was 3 months out. Luckily there was a cancellation, and I was into surgery in about 3 weeks. Just an ACL reconstruction, so not life threatening, but total time from injury to surgery was nearly 3 months, though it would have been at least 6 months if not for the cancellation (he's a hell of a surgeon, so I would have waited anyway). I was still getting insurance statements and bills (for my 10% of the costs) over a year after the surgery, because all the providers had to go back to Cigna 2 and 3 times to get their money, for that highly experimental ACL reconstruction.

My dermatologist doesn't take insurance anymore, he just gives his patients a form and lets them deal with it, kind of sucks, but I don't blame him, I just pay the doctor, it isn't worth the hassle. The last 2 times I called his office, I had appointments within a week. And he's cut his office staff in half, since he doesn't deal with the insurance companies anymore.

Hmmm....

Disputo: This is one of the reasons why I gave up my gold plated expensive insurance a few years back and opted for much cheaper, high deductible catastrophic insurance and covering standard doc visits fully out of pocket. Not only is it *cheaper*, I can see whatever doctor I want when I want.

This is a good solution for you, and I know you're not suggesting it's possible for everyone, but I just want to point out that many or most don't have those options. You either take what your or your spouse's employer offers (which may or may not have various levels of deductibles to choose from), or you pay for the best coverage you can afford if you're self-employed or temporarily unemployed.

In addition, being able to see any doctor you want when you want doesn't necessarily protect you from the long waiting times endured by people with primaries. Of course, you can shop around for the physician with the shortest wait.

Thanks, Kevin. Exactly correct.

The best I could do in Seattle to see an ENT was almost three months! This is a big city with a major medical school.

I never actually get to see an MD anymore. All I ever get is different kinds of nurses and physicians assistants. I haven't seen an actual doctor in years. Whenever I schedule an appointment they say, "You can see a nurse in three weeks or a doctor in two months," so I take the nurse.

The fact that BusinessWeek, not The Nation, is running this says the Big Biz push for national healthcare may just increase.

(Of course, they'll want to do it on the cheap, which won't fly well either.)

And, as JM notes, everybody wants to be a specialist. Why? Especially in a state like here in Texas, with little or no caps on tuition, med school costs are exorbitant.

My little sister last week had difficulty breathing. My mother called her HMO and they scheduled an appointment for four days later. When my mother pointed out that my sister might be dead by then, because breathing is rather important, they suggested my mother go to the local HMO 'emergency room.'

We'd been to that place before and my mother was convinced if my sister went there, it'd be hours before she was seen, if she was seen. Plus the doctors there are nice, but utterly clueless. After much fighting, she got an immediate appointment with my sister's doctor, who prescribed my sister steroids. Which my sister couldn't pay for, so she got some free ones from a friend in the medical business and she's now, thankfully, doing much better.

I want a working health care system...

The tales of long waiting posted here are quite surprising. I use an HMO in Southern California, and, except for the physical, for which the wait is around a few weeks, I have never had a to wait any significant amount of time for my care. The only bad experience I had was at Yale, in the university sponsored HMO, where I had to wait for over eight hours in the emergency for someone to take a look at my daughters head injury. But that was over twenty years ago.

PErhaps my experience is not typical.

Kevin, what demographic group is most likely to need the nonemergency procedures that you concede are pretty good in terms of waiting times? How are they primarily covered? How politically powerful is that demograhic group? What incentive do they have to change?

Kevin said: As in other countries, emergency care is generally pretty quick

Is it? This source says that the average ER wait time in the US is 3 hours, 42 minutes. And that's excluding travel time to the ER.

Large city hospital emergency rooms are always crowded with the uninsured poor who go there for all their health needs because they cannot just go to a doctor's office. If you arrive at an ER without being brought in by an ambulance, you will generally have to wait for hours before anyone talks to you. And sometimes getting there by ambulance doesn't change things that much either.

That link again.

If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S....

I go to a dermatologist in Kennewick, Wash., and they told my wife and I that if we're willing to wait several hours, someone will see us that day even if we don't have an appointment.

And this is in an area with a population of 200,000 people.

I recently had a cardiovascular event and was referred by the ER MD for a full stress test workup. I called and the next appointment was in 7 weeks. Only through the intervention of both the ER doc, who was nice enough to give me his cell #, & my GP, was I able to get an appointment the following week, which the doctor's office canceled at the last minute and rescheduled for two weeks later. The best health care in the work, yessiree.

After much fighting, she got an immediate appointment with my sister's doctor, who prescribed my sister steroids. Which my sister couldn't pay for, so she got some free ones from a friend in the medical business and she's now, thankfully, doing much better.

And she's also bench pressing 300 pounds ... oh wait, wrong kind of 'roids :)

BULLSHIT. Just plain BULLSHIT.

As it happens, my wife works the front desk for a very well-known and busy dermatologist here in north-central Orange County, CA. Santa Ana to be exact. Just across the street from Western Medical Center. Not exactly Beverly Hills or Newport Beach and not exactly Smallville, either. The patient range runs the gamut across all socio-economic lines.

I happen to know, for fact, that it is absolutely possible to WALK IN to the office on any day except Wednesday - when the office is heavily booked for cosmetic treatments - and you can see a doctor within 38 minutes. I have NEVER heard of my wife having to force ANY patient to wait 38 days, or 6 months, or anything like those to get in to get treatment.

We need to be more clear here. If you are trying to get a pre-auth so that you do not have to think about being on the hook for the $145 cost of the office visit, and are too unimaginative to work out a weekly cash payment schedule with the physician, then put the blame on your own personal expectations and the particular insurance carrier holding you hostage - NOT THE WHOLE SYSTEM.

Hip replacements, lung cancer treatments, brain tumors, infectious tuberculosis, etc., I have no practical experience with and you can all debate the like without complaint from me. But when people start using dermotology as the postor child for all that ills our society? No friggin' way am I accepting that.

Great post SoCalAnon.

Where are all these people that are waiting 6 months to see a doctor?

I live in a major midwestern city (1 mill+), and in my 40 years I've never waited more than a few days for doctors, even specialists.

Is it because I'm a conservative, and as such I pay my bills?

So there are plenty of dermatologists in Southern California so wait times are short. No one could have predicted that.

The 38 day average wait for a dermatologist is quoted here, and it seems to be for new patient appointments.

A separate study, based on responses from 100 dermatologists, comes up with similar results: 11 dermatologists did not accept new patients, and for the remaining 89 the average wait times were 33 days for new patients and 32 days for "established" patients. This study was published in the Archives of Dermatology.

Both studies emphasize that is a large geographical variation in these statistics.

presumably, SoCalAnon and sportsfan79 think all the posters with different experiences than theirs are simply lying, so they'll probably assume i'm lying too.

my sister dropped dead of a heart attack roughly 4 weeks ago. within 24 hours, i called my HMO to get a stress test. and you know what? in 2 more weeks, i'll actually get that stress test (i.e., 6 weeks waiting time).

my wife had some funny moles develop on her skin. she called and it took her 2 weeks to get an appointment to see her gp, and then 3 weeks more to schedule their removal.

this is all completly typical to our experience.

Terribly sorry to hear about your sister, howard. Thinking about you and your family.

OT Just returned from an eye exam (my first at 52 years old) and I paid the extra $29 to skip the drops. If my wife is a good comparison, it was a good investment to miss the blurred vision and light sensitivity. Thanks for the heads up on that one.

shortstop, thanks for the thought. i wouldn't normally raise so personal an issue here were it not for its direct relevance to the matter of waiting times, but i appreciate the supportive reaction.

I have a family history of various inherited ailments. But I also appear to have something in my genetic make-up that has (so far) protected me.

For the last 10 years, I've put my body at the service of academic medicine types and VC-funded biotech start-ups wanting to draw my blood and perform other tests to see why I'm in perfect health.

It's a great way to get free medical treatment (within reason) -- to the extent they don't reimburse me for my time and trouble.

There have been 6-month stretches where I've had weekly physical exams. But generally, I get medical attention, including an exam of some kind, at least once a month.

Which is when I mention all my minor ailments that I'd never bother a doc about if I had to make an appointment and pay for it myself.

I have health insurance that costs a fortune (I'm self-employed). But I only use it for prescription meds.

And another good thing, the medical center I visit for these tests is within walking distance of home.

I highly recommend others do likewise. Not by any means a solution for the country's health insurance problems or anything like that. But in individual cases like mine, it's a real blessing.

I forgot to mention. There's a huge demand for patients in medical research and clinical trials.

Even if you end up getting screened out of a study (you've never had the condition, you've had the condition, you haven't had it long enough, you've had it too long, you're too healthy or not healthy enough), just volunteering to participate can often get you a pretty complete no-charge work-up from a doctor.

You need not be the genetic freak I am.

In NYC, teeming with doctors and medical centers, I need to set up a mammogram appointment 6 months in advance. I assume that if for some unforseen reason I needed to change the appointment, I would have to wait an additional 6 months.

I wonder if Europe has a mandatory gatekeeping visit to your PCP before you're allowed to see a specialist. That that little formality can be counted upon to double the wait, or more.

The difference between liberals and conservatives boils down to how they answer the question:

"Should everything be for sale?"

>...[systemic problems in the medical system] are a result of supply and demand".

In the USA, doctors essentially control the supply of doctors. Would you rationally expect any other result than restricted supply and high prices?

I think this is pretty much common to any 'profession'. [Profession = a vocation controlled by a government-chartered 'Professional Organization']

I went to a college that actually got dental insurance for students halfway through my senior year. As I hadn't had a dental check in five years or so, being poor and then being a poor student, I was stoked. I called for a checkup the day I got the letter and to inform them my wisdom teeth were starting to hurt. I got an appointment for 4 months later, my last month of school. As luck would have it, I had a crown that fell off a tooth a month later and got an "emergency" appointment a few weeks after that.

Combine our spending levels with a more rational universal system and we could do even better.

Yeah, like we'd be able to give everyone the kind of coverage they have now, AND cover another 45 million people without spending any more money. It's a nice fantasy. The real world is rather different.

well, howie, suppose you explain to us just exactly how the real world is rather different.

and suppose you explain just exactly who it is that says we are going to everyone who has coverage now "the kind of coverage" they have now.

one of the giveaways that you're dealing with an ill-informed graduate of propaganda u is the reliance, snottily, upon a phrase like "the real world is rather different."

I live in a very spendy part of NJ where most of the doctors in the region live and work. There are so many doctors offices and hospitals (at least three of them within a 5 mile radius) that one would think getting medical attention would be a breeze, yes? I'm also a Federal employee with really "good" insurance.

My wait (at one of the best hospital emergency rooms in the region) with my daughter suffering rapid-onset pneumonia and having difficulty breathing because her lungs were filling up: Two hours. Then they said she probably just had a virus. I insisted on a chest XRay and the results predictable. Daughter finally got the care she needed.

Can you just imagine the things that happen to people without insurance, or less assertive parents? I never could; I always presumed people got the exact same care in emergency rooms . . .

. . . until the night I had a bad reaction to a new drug while clubbing in Atlantic City. You can just imagine what their inner city emergency room looks like. Anyway, I was alternating between "out cold" and "puking uncontrollably" and the staff must have presumed I was either a 1)drunk college girl, 2) a drugged up hooker, or 3)I have NO idea what they were thinking, but they weren't very nice.

They just left me there in the hall. Since I was not really conscious I don't know how long I laid there, but I believe I was in the ER for a total of 6 hours because it was 5am when I left.

Guess how I was "discharged." Can't fathom? OK, I'll tell you.

"Get up. You need to leave. We need the gurney."

I passed out again, don't know how long, but I awoke to the ER doctor yelling at me to go.

"I live in a major midwestern city (1 mill+), and in my 40 years I've never waited more than a few days for doctors, even specialists.

Is it because I'm a conservative, and as such I pay my bills?"
Posted by: sportsfan79 on July 11, 2007 at 4:59 PM
---
It could be the geographical area or state you live in. Health care access, wait times, etc., vary quite a bit depending on where you live:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=494551
Scroll down and look at Exhibit#2

Interesting to see the anti-universal health care folks extrapolating their personal experiences out onto the entire health care system.

Please feel free to ignore any and all inconvenient facts.

My father-in-law is suffering from back problems and needed to see a neurosurgeon. He called to make an appointment in early May with a neurosurgeon that sees patients in his hometown one day per week. The earliest available appointment at that office was at the end of September. He was able to make an appointment with this doctor at his main office, in a city 2 1/2 hours away from his home town, for mid-July, cutting his wait to see the doctor down from four months to only two months. I wonder if his wait to see a doctor would have been shorter is he was in Canada? I doubt it would be worse.

For all of you who think govt health care is so great you should try going to the local VA. My wife is a veteran an hurt her back so bad that she could no longer work. It took from April of 06 until November of 06 until she could finally get in to see a back specialist. All of this time she could not return to work because of the pain. The only way to get to see a doctor at the VA is the emergency room where the average wait time is all day. Her medications that she needs are mostly paid for but she has some that aren't on the VA approved list so we have to pay them because they are slow release versions of the drug. These medications have been around a long time. I have a hard time believing that anyone who actually lives in our country and sees the way our govt screws everything up could really want them to ration our health care. Another point, we were in the VA waiting room and a man asked the nurse when he could expect to be seen. His appointment was at 9 am it was now 1:30 pm and he had to be somewhere a 3 pm. The nurses response was for him to stop complaining his care was free wasn't it. A man or woman who fights for his country is not getting thier care for free.

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