Dr Monasterios letter1 to the NZMJ on health care in the United States invites comment. He tells us that he paid $US1000 for a 10-minute consultation in a hospital, and one hopes that he had insurance. His letter appears just days before a block on government spending in that country, and the row is about Barack Obamas healthcare plan, under which most people not covered by a plan, or by government assistance, will take out their own insurance, and, as I understand it, be penalised if they dont (See Wikipedia, Obamacare ) An individual mandate requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare, or other public insurance programs (such as Tricare)to secure an approved private-insurance policy or pay a penalty, unless the applicable individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service. The law includes subsidies to help people with low incomes comply with the mandate. In New Zealand, indigent and less-than-indigent patients are flooding into free casualty departments, and a whole new race of publicly-funded Emergency Care doctors is arising to manage them. When I entered general medical practice in Wellington in 1962, the fee directly charged to the patient was the equivalent of 50 cents. For an adult, it is now more like 50 dollars. That is 100 times what it was. People are ducking for cover, and the government, currently forking out well over 15 billion dollars per annum, is moving in to help them with money that it might, or might not, happen to have. At present rates of inflation, a fee charged at the rate of 100 dollars a minute for a consultation remains a none-too-distant, but not a desirable, prospect. I am pleased to see somebody talking about what he describes as an exorbitant bill handed to him in an American hospital. I am less certain about Dr Monasterios remarks about the supposed disadvantages of competing private health insurance. It is currently paying for a lot of work. Several members of my family were living in the United States nearly 20 years ago. Enrolled in group plans, they only ever made a modest co-payment for a consultation. Three confinements were paid for in full. The insolvency anxieties besetting government programmes were clear by that time. In 1995, I purchased in New York City a book by the presidential aspirant Ross Perot. Entitled Intensive Care; We Must Save Medicare and Medicaid Now , it contains a graph labelled (correctly) Runaway Costs of Medicare and Medicaid (in Billions). Another book that I bought in New York is called Bankruptcy 1995 The Coming Collapse of America and How to Stop It. Scary stuff. Anecdotal experience is OK up to a point, but did Dr Monasterio go to one of the hospitals that do Medicare work for the government. If he did, then maybe the institution has to balance the books by taking a bit more off the casual patients. With regard to the overall costs of medical care, I am not beguiled by the figures produced by Time magazine, nor by any other media comment. The situation is complicated. If you want to know how difficult it is, go to Wikipedia, and search for Medicare. You will find a good article and you will need 20 minutes to read it. The United States has its own way of doing things, and the doctors have to treat a lot of obese people. I have sampled online the websites of a few hospitals in the USA. Its largely hype about how good they are. They are not so different from the websites of our own District Health Boards, where you will find the services on offer, and a plenitude of telephone numbers, but you will not find out how much it costs to run a department. After struggling for an hour with the Capital and Coast DHB site, I did not find out what anyone was being paid not even the Board members. Plainly, I need help. By way of diversion, I went to the Canterbury DHB website, and I typed in psychiatry. I was conducted to Psychosis (Totara House). Just now I dont need Totara House, and Im going back to quizzes and cross-word puzzles. Most DHB websites are too dense, and they present financial information in a form that I cant manage. The CCDHB Annual Report for 2012 has a section headed Where the Money Went, but I could not ascertain who did what, and for what emolument or remuneration. The figures supplied, all 12 of them, added up to $897 million dollars. Elsewhere I think I found a figure of $846 million, but I cant be bothered doing it all again. What we do know is that health spending is open-ended, budgets are getting bigger, and some District Health Boards seem to struggle on from one annual deficit to the next.

Dr Monasterios letter1 to the NZMJ on health care in the United States invites comment. He tells us that he paid $US1000 for a 10-minute consultation in a hospital, and one hopes that he had insurance. His letter appears just days before a block on government spending in that country, and the row is about Barack Obamas healthcare plan, under which most people not covered by a plan, or by government assistance, will take out their own insurance, and, as I understand it, be penalised if they dont (See Wikipedia, Obamacare ) An individual mandate requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare, or other public insurance programs (such as Tricare)to secure an approved private-insurance policy or pay a penalty, unless the applicable individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service. The law includes subsidies to help people with low incomes comply with the mandate. In New Zealand, indigent and less-than-indigent patients are flooding into free casualty departments, and a whole new race of publicly-funded Emergency Care doctors is arising to manage them. When I entered general medical practice in Wellington in 1962, the fee directly charged to the patient was the equivalent of 50 cents. For an adult, it is now more like 50 dollars. That is 100 times what it was. People are ducking for cover, and the government, currently forking out well over 15 billion dollars per annum, is moving in to help them with money that it might, or might not, happen to have. At present rates of inflation, a fee charged at the rate of 100 dollars a minute for a consultation remains a none-too-distant, but not a desirable, prospect. I am pleased to see somebody talking about what he describes as an exorbitant bill handed to him in an American hospital. I am less certain about Dr Monasterios remarks about the supposed disadvantages of competing private health insurance. It is currently paying for a lot of work. Several members of my family were living in the United States nearly 20 years ago. Enrolled in group plans, they only ever made a modest co-payment for a consultation. Three confinements were paid for in full. The insolvency anxieties besetting government programmes were clear by that time. In 1995, I purchased in New York City a book by the presidential aspirant Ross Perot. Entitled Intensive Care; We Must Save Medicare and Medicaid Now , it contains a graph labelled (correctly) Runaway Costs of Medicare and Medicaid (in Billions). Another book that I bought in New York is called Bankruptcy 1995 The Coming Collapse of America and How to Stop It. Scary stuff. Anecdotal experience is OK up to a point, but did Dr Monasterio go to one of the hospitals that do Medicare work for the government. If he did, then maybe the institution has to balance the books by taking a bit more off the casual patients. With regard to the overall costs of medical care, I am not beguiled by the figures produced by Time magazine, nor by any other media comment. The situation is complicated. If you want to know how difficult it is, go to Wikipedia, and search for Medicare. You will find a good article and you will need 20 minutes to read it. The United States has its own way of doing things, and the doctors have to treat a lot of obese people. I have sampled online the websites of a few hospitals in the USA. Its largely hype about how good they are. They are not so different from the websites of our own District Health Boards, where you will find the services on offer, and a plenitude of telephone numbers, but you will not find out how much it costs to run a department. After struggling for an hour with the Capital and Coast DHB site, I did not find out what anyone was being paid not even the Board members. Plainly, I need help. By way of diversion, I went to the Canterbury DHB website, and I typed in psychiatry. I was conducted to Psychosis (Totara House). Just now I dont need Totara House, and Im going back to quizzes and cross-word puzzles. Most DHB websites are too dense, and they present financial information in a form that I cant manage. The CCDHB Annual Report for 2012 has a section headed Where the Money Went, but I could not ascertain who did what, and for what emolument or remuneration. The figures supplied, all 12 of them, added up to $897 million dollars. Elsewhere I think I found a figure of $846 million, but I cant be bothered doing it all again. What we do know is that health spending is open-ended, budgets are getting bigger, and some District Health Boards seem to struggle on from one annual deficit to the next.