Health Care

[Guest guest]

Up to now we haven't had any discussion on the U.S. President's health care

initiative which is a major issue here in the States. I'd be interested in

hearing pros and cons from this very intelligent group we have.

I'd especially like to have input form our members living in other countries

where the health care system is working better than here in the U.S. (where

actually it isn't working very well at all).

Thanks in advance for any input on this subject.

[Guest guest]

Don,While I certainly agree that we are entitled to our own opinions, I thought this listserv has an emphasis on truth that can be debated on interpretation of science.On that basis, your opinions of your PERSONAL experiences with health care in "socialized" system are rather worthless to the debate about the future of health care in the US.Most of the people who have an interest in CRON, have an inherent interest in health and its relationship to a long and quality life. Longevity without health is not the goal of this group nor, my personal goal. While we all wish we would never need medical intervention to achieve good health, even the healthiest of us will need to seek medical attention at some time in our life.Those of us in favor of health care reform in America understand that some assurance of basic access and affordability is consistent with a civilized society. When you give a figure of the number of people who choose not to have health coverage, you do not consider why they make that choice. When someone has to choose between feeding their family or paying outrageous health insurance premiums, the choice becomes quite personal. I could go on and one, but my post is based on over 50 years experience as a health care professional, and not out of the Republican talking points, as yours appears to be.One last point, The Golden Hour of trauma is now being reconsidered by the military. History has shown us that most trauma care standards have come from the military and a lot of weight is given to their vast experience. Maybe the French have it right. Considering all sides of an issue is the mature, intellectual thing to do, especially when it is as complicated, yet personal as health care.MJMOn Sep 12, 2009, at 6:51 PM, searcher555 wrote:

I've lived in two countries that had socialized health care. I didn't care for either one. My wife, or ex wife now, really didn't like the one where no matter what your ailment or what you were being checked for, you had to see your neighborhood doctor first. He was a general practitioner. If he or she didn't think you needed to see a specialist, then you didn't see one, or paid out of pocket for it. My ex sure didn't like getting female exams by a doctor that only received the minimum training on women's body parts.

In Texas, each county has a hospital tax. This is in indegent healthcare tax for the county hospital. I was billed 8,000 dollars for airlife when my son in law was shot and killed. An indigent wouldn't be charged.

So, from my standpoint, anyone that wants medical care can get it without paying, they just have to stand in line at the ER to get it. It's estimated that as much as 25% of the families that don't have healthcare insurance, don't have it by choice, preferring to save the money and run the risk, and attend ER's when needed.

We don't even need to talk about the French trauma system where a doctor is on each ambulance, and he stabilizes the patients at accident scenes before transport. Of course, severe trauma can't be resolved in the field, so there are many injured that die. The golden hour is a very rough frame of reference.

One major city in the US, would not allow ambulances on shooting scenes. The responding officers bagged the victim, threw them in a van, and transported. Very high survival rates.

A friend of mine is a chiropractor. She gets 18 dollars for a medicare visit. So she would have to crank them through at a rate

of more than 10 an hour to break even for office expenses and salaries, exempting hers, or lose money and treat them fairly, which she does.

Allowing the market to fully function would be a much better option than the government doing or meddling in the system.

Regards,

Don, Seguin Tx

[Guest guest]

For the record, I noted early on this discussion could be a can of worms. In the interest of "truth" lets try to keep this fact based, as much as possible. Accusing Don of reciting republican talking points, is a common partisan technique used to discredit statements while ignoring their content.I didn't take his comments as anything more than one rat anecdotal, but he has at least some first hand experience that most of us don't. I have learned more than I ever wanted to know about other country's healthcare systems, and have several decades of experience watching how politicians act. Predictions about the future are never perfect but even their own budget office predicts a huge cost (and those predictions are routinely low). I applaud the many promises made by "our" president on Wed night, but I frankly don't see how the math could possibly add up. My "opinion" of the present situation is that we are not in some short term crisis. We are feeling the same demographic pressure as the rest of the (western) world from an aging population who is living longer, with new and more expensive treatment options. FWIW the French public health system has been operating at a deficit for years (Pres Obama promised his heath care system would not borrow money or raise taxes). There are several areas of our health care system that are ripe for harvesting out waste or inappropriate profits. --Health insurance administration. We lose some 25-30% of every dollar spent to administration. Even Germany with private health insurance (heavily regulated) only cost 5.5%. Note: Medicare administration only wastes 3% or so. --Drug costs. We pay far more than most other nations for the same drugs. This should be normalized, which would eventually raise costs for every body else, but that's life. --Malpractice/Tort reform. The total cost from this is not just nuisance lawsuits and malpractice premiums, but "just in case" tests and procedures. But as a healthcare professional you should be aware of this. The difficulty with releasing or harvesting this fat or waste out of our system is that all three of these vested interests are over represented by lobbyists and campaign contributions. Remodeling the insurance industry from where it is to where we want it to go will cause much economic dislocation within a private industry, so they will resist. A more conservative approach is not to create a government funded competitor. There are many obstacles to competition that could be removed first (like state regulated monopoly or duopolies) Drug costs. They have traditionally avoided mandated price controls (here), and even practice some shady behaviors (like paying generic makers not to compete and subsidizing co-pays to influence users). Legal but not in our national interest for less expensive health care. I have seen what appears to be less long term research investment in anticipation of future price cuts (now they prefer to buy smaller drug companies). Let's go ahead and get this over with. More pain for a private industry that will resist. Finally the lawyers- At the risk of sounding partisan, I believe I am stating fact that they have strong influence with the current party in power and none of the legislation has bothered to address this third leg of the cost problem. In the president's speech he gave a nod to Bush's pilot program to reduce malpractice costs, but promising to restore a pilot program by executive order is a far way from tort reform legislation. The math is too convoluted to address succinctly but Don's anecdote about medicare under-compensating for services (albeit chiropractic) is not a unique observation. One non-profit hospital administrator suggested he was compensated at roughly 80% for medicare procedures, and being a non-profit he shifted those costs to his other patients. The plan to fund the new legislation calls for cutting hundreds of billions from current medicare spending while expanding the system. Some doctors already avoid medicare patients, I don't see this being addressed.I really wish the president could actually deliver what he promised but I just don't see how. Even the congress broke out in laughter when he said there were details to work out... I didn't find it that funny, the devil is in the details. He made an "artful" speech full of promises. He will be on 60 minutes tonight making more promises and perhaps throwing out his latest scare tactic (we will lose the insurance we already have). I don't have insurance so I am not scared. While I am not pleased that I will be fined if I don't buy his insurance under this new legislation. I suspect we will get a one sided bill of some sort . I am apprehensive about the likelihood of what we will get, but acknowledge the vote math in congress. That math they understand. Good luck to us all.... JROn Sep 13, 2009, at 8:39 AM, Jeanette Mannino wrote: Don,While I certainly agree that we are entitled to our own opinions, I thought this listserv has an emphasis on truth that can be debated on interpretation of science.On that basis, your opinions of your PERSONAL experiences with health care in "socialized" system are rather worthless to the debate about the future of health care in the US.Most of the people who have an interest in CRON, have an inherent interest in health and its relationship to a long and quality life. Longevity without health is not the goal of this group nor, my personal goal. While we all wish we would never need medical intervention to achieve good health, even the healthiest of us will need to seek medical attention at some time in our life.Those of us in favor of health care reform in America understand that some assurance of basic access and affordability is consistent with a civilized society. When you give a figure of the number of people who choose not to have health coverage, you do not consider why they make that choice. When someone has to choose between feeding their family or paying outrageous health insurance premiums, the choice becomes quite personal. I could go on and one, but my post is based on over 50 years experience as a health care professional, and not out of the Republican talking points, as yours appears to be.One last point, The Golden Hour of trauma is now being reconsidered by the military. History has shown us that most trauma care standards have come from the military and a lot of weight is given to their vast experience. Maybe the French have it right. Considering all sides of an issue is the mature, intellectual thing to do, especially when it is as complicated, yet personal as health care.MJMOn Sep 12, 2009, at 6:51 PM, searcher555 wrote: I've lived in two countries that had socialized health care. I didn't care for either one. My wife, or ex wife now, really didn't like the one where no matter what your ailment or what you were being checked for, you had to see your neighborhood doctor first. He was a general practitioner. If he or she didn't think you needed to see a specialist, then you didn't see one, or paid out of pocket for it. My ex sure didn't like getting female exams by a doctor that only received the minimum training on women's body parts. In Texas, each county has a hospital tax. This is in indegent healthcare tax for the county hospital. I was billed 8,000 dollars for airlife when my son in law was shot and killed. An indigent wouldn't be charged. So, from my standpoint, anyone that wants medical care can get it without paying, they just have to stand in line at the ER to get it. It's estimated that as much as 25% of the families that don't have healthcare insurance, don't have it by choice, preferring to save the money and run the risk, and attend ER's when needed. We don't even need to talk about the French trauma system where a doctor is on each ambulance, and he stabilizes the patients at accident scenes before transport. Of course, severe trauma can't be resolved in the field, so there are many injured that die. The golden hour is a very rough frame of reference. One major city in the US, would not allow ambulances on shooting scenes. The responding officers bagged the victim, threw them in a van, and transported. Very high survival rates. A friend of mine is a chiropractor. She gets 18 dollars for a medicare visit. So she would have to crank them through at a rate of more than 10 an hour to break even for office expenses and salaries, exempting hers, or lose money and treat them fairly, which she does. Allowing the market to fully function would be a much better option than the government doing or meddling in the system. Regards, Don, Seguin Tx

[Guest guest]

I think the bottom line is, we have a system that mostly works but many people think it's needs fixing one way or another.

I doubt models of other countries can be adapted to ours, because ours is much larger than most, but mostly because we deal in more than basic human need.

The advances in cancer treatment are phenomenal compared to a statement by the president of the American Cancer Soc, in 1972, that cancer would never be cured.

Milken proved them wrong.

We now save the lives of babies with birth defects, arguable I know, but some of those have IQ's that exceed yours and mine.

The life of ONE super baby could be the solution for many of the problems today.

IOW, we don't know what research will bring.

Maybe cars that don't have accidents, patients growing new organs, the secret of Alzheimer's disease.

There are so many open areas in health care, it looks like Swiss cheese.

Regards

[ ] Health care

I've lived in two countries that had socialized health care. I didn't care for either one. My wife, or ex wife now, really didn't like the one where no matter what your ailment or what you were being checked for, you had to see your neighborhood doctor first. He was a general practitioner. If he or she didn't think you needed to see a specialist, then you didn't see one, or paid out of pocket for it. My ex sure didn't like getting female exams by a doctor that only received the minimum training on women's body parts. In Texas, each county has a hospital tax. This is in indegent healthcare tax for the county hospital. I was billed 8,000 dollars for airlife when my son in law was shot and killed. An indigent wouldn't be charged. So, from my standpoint, anyone that wants medical care can get it without paying, they just have to stand in line at the ER to get it. It's estimated that as much as 25% of the families that don't have healthcare insurance, don't have it by choice, preferring to save the money and run the risk, and attend ER's when needed. We don't even need to talk about the French trauma system where a doctor is on each ambulance, and he stabilizes the patients at accident scenes before transport. Of course, severe trauma can't be resolved in the field, so there are many injured that die. The golden hour is a very rough frame of reference. One major city in the US, would not allow ambulances on shooting scenes. The responding officers bagged the victim, threw them in a van, and transported. Very high survival rates. A friend of mine is a chiropractor. She gets 18 dollars for a medicare visit. So she would have to crank them through at a rateof more than 10 an hour to break even for office expenses and salaries, exempting hers, or lose money and treat them fairly, which she does. Allowing the market to fully function would be a much better option than the government doing or meddling in the system. Regards,Don, Seguin Tx__________ NOD32 4389 (20090902) Information __________This message was checked by NOD32 antivirus system.http://www.eset.com

[Guest guest]

True, that's an unknown, but we also bring people into the ER who would die

if we let them die.

Some of these are thought to be " worthless " cases.

Also for demented people the argument whether to spend money, but those

people can be the saving factor if we use them to develop new meds for

dementia.

All these are driven by cost, triage, not technical.

Regards

Re: [ ] Health care

I could never see the logic of this kind of argument. We could also be

saving the next Hitler, or mass murderer.

On 9/13/09 12:39 PM, " jwwright " <jwwright@...> wrote:

We now save the lives of babies with birth defects, arguable I know, but

some of those have IQ's that exceed yours and mine.

The life of ONE super baby could be the solution for many of the problems

today.

[Guest guest]

First regarding 77% government and 23% private funding, I would observe that the government generally doesn't have it's own money, Either it borrows it, taxes citizens for it, or prints it. Germany is more sensitive than most about printing money so all the money they spend is the public's money raised by taxes or borrowing. The French run a health care deficit, I recall that the Germans have recently raised co-pays so they are probably solvent. Government spending is partial subsidies for low income workers and full subsidies for unemployed. ============I mentioned this for the comparison of administration cost for the insurance sector. The distinction of heavily regulated private insurance administering mostly public funds is not that great of an example (I didn't realize how great the government subsidies were). I am not touting the entire german approach which is suffering for the same demographic problems we are as a wholesale solution. They have even borrowed the co-pays concept to try to reduce wasteful consumption. JROn Sep 13, 2009, at 2:39 PM, surfbigrock wrote: JR, I don't see how Germany's system could be viewed as mostly private. From Wikipedia: " According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004." I have lived in two different developed countries - Canada, 1 year and Sweden, 3 years. While working and enjoying their hospitality, I required hospitalization 4 times, once in Canada and three times in Sweden. I would compare the service comparable to the U.S., with the exception that there was no waiting time in Canada and in Sweden, while the costs were dramatically lower than in the U.S. $10 dollars per visit. When in the U.S. under the coverage of an HMO, I had to see a general practitioner first before I could see a specialist. I also had to wait a year before I was covered due to the HMO's pre-existig illness clause. The GOP had a number of years in power and did a horrendous job in keeping health care costs down. Health care is too precious to allow "free market" forces to keep the costs low as the "free market" has utterly failed to do so in the past. Eventually prices will be regulated because the greed involved in the health care insurance industry will eventually drive health care too health too high and then the government will be forced to step in just like they were in the housing mortgage bubble. The bottom line is that there are numerous developed countries whose health care costs are dramatically lower than ours and the quality of care is comparable or better (as indicated by the life expectancy data from the CIA https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html) Nearly all these countries have the "public option". Ben , <robertsjohnh@...> wrote: > > For the record, I noted early on this discussion could be a can of > worms. In the interest of "truth" lets try to keep this fact based, > as much as possible. Accusing Don of reciting republican talking > points, is a common partisan technique used to discredit statements > while ignoring their content. > > I didn't take his comments as anything more than one rat anecdotal, > but he has at least some first hand experience that most of us don't. > > I have learned more than I ever wanted to know about other country's > healthcare systems, and have several decades of experience watching > how politicians act. Predictions about the future are never perfect > but even their own budget office predicts a huge cost (and those > predictions are routinely low). > > I applaud the many promises made by "our" president on Wed night, but > I frankly don't see how the math could possibly add up. > > My "opinion" of the present situation is that we are not in some > short term crisis. We are feeling the same demographic pressure as > the rest of the (western) world from an aging population who is > living longer, with new and more expensive treatment options. FWIW > the French public health system has been operating at a deficit for > years (Pres Obama promised his heath care system would not borrow > money or raise taxes). > > There are several areas of our health care system that are ripe for > harvesting out waste or inappropriate profits. > > --Health insurance administration. We lose some 25-30% of every > dollar spent to administration. Even Germany with private health > insurance (heavily regulated) only cost 5.5%. Note: Medicare > administration only wastes 3% or so. > > --Drug costs. We pay far more than most other nations for the same > drugs. This should be normalized, which would eventually raise costs > for every body else, but that's life. > > --Malpractice/Tort reform. The total cost from this is not just > nuisance lawsuits and malpractice premiums, but "just in case" tests > and procedures. But as a healthcare professional you should be aware > of this. > > The difficulty with releasing or harvesting this fat or waste out of > our system is that all three of these vested interests are over > represented by lobbyists and campaign contributions. > > Remodeling the insurance industry from where it is to where we want > it to go will cause much economic dislocation within a private > industry, so they will resist. A more conservative approach is not to > create a government funded competitor. There are many obstacles to > competition that could be removed first (like state regulated > monopoly or duopolies) > > Drug costs. They have traditionally avoided mandated price controls > (here), and even practice some shady behaviors (like paying generic > makers not to compete and subsidizing co-pays to influence users). > Legal but not in our national interest for less expensive health > care. I have seen what appears to be less long term research > investment in anticipation of future price cuts (now they prefer to > buy smaller drug companies). Let's go ahead and get this over with. > More pain for a private industry that will resist. > > Finally the lawyers- At the risk of sounding partisan, I believe I am > stating fact that they have strong influence with the current party > in power and none of the legislation has bothered to address this > third leg of the cost problem. In the president's speech he gave a > nod to Bush's pilot program to reduce malpractice costs, but > promising to restore a pilot program by executive order is a far way > from tort reform legislation. > > The math is too convoluted to address succinctly but Don's anecdote > about medicare under-compensating for services (albeit chiropractic) > is not a unique observation. One non-profit hospital administrator > suggested he was compensated at roughly 80% for medicare procedures, > and being a non-profit he shifted those costs to his other patients. > The plan to fund the new legislation calls for cutting hundreds of > billions from current medicare spending while expanding the system. > Some doctors already avoid medicare patients, I don't see this being > addressed. > > I really wish the president could actually deliver what he promised > but I just don't see how. Even the congress broke out in laughter > when he said there were details to work out... I didn't find it that > funny, the devil is in the details. He made an "artful" speech full > of promises. He will be on 60 minutes tonight making more promises > and perhaps throwing out his latest scare tactic (we will lose the > insurance we already have). I don't have insurance so I am not > scared. While I am not pleased that I will be fined if I don't buy > his insurance under this new legislation. > > I suspect we will get a one sided bill of some sort . I am > apprehensive about the likelihood of what we will get, but > acknowledge the vote math in congress. That math they understand. > > Good luck to us all.... > > JR > > On Sep 13, 2009, at 8:39 AM, Jeanette Mannino wrote: > > > Don, > > > > While I certainly agree that we are entitled to our own opinions, I > > thought this listserv has an emphasis on truth that can be debated > > on interpretation of science. > > > > On that basis, your opinions of your PERSONAL experiences with > > health care in "socialized" system are rather worthless to the > > debate about the future of health care in the US. > > > > Most of the people who have an interest in CRON, have an inherent > > interest in health and its relationship to a long and quality > > life. Longevity without health is not the goal of this group nor, > > my personal goal. While we all wish we would never need medical > > intervention to achieve good health, even the healthiest of us will > > need to seek medical attention at some time in our life. > > > > Those of us in favor of health care reform in America understand > > that some assurance of basic access and affordability is > > consistent with a civilized society. When you give a figure of the > > number of people who choose not to have health coverage, you do not > > consider why they make that choice. When someone has to choose > > between feeding their family or paying outrageous health insurance > > premiums, the choice becomes quite personal. I could go on and > > one, but my post is based on over 50 years experience as a health > > care professional, and not out of the Republican talking points, as > > yours appears to be. > > > > One last point, The Golden Hour of trauma is now being reconsidered > > by the military. History has shown us that most trauma care > > standards have come from the military and a lot of weight is given > > to their vast experience. Maybe the French have it right. > > > > Considering all sides of an issue is the mature, intellectual thing > > to do, especially when it is as complicated, yet personal as health > > care. > > > > MJM > > > > On Sep 12, 2009, at 6:51 PM, searcher555 wrote: > > > >> > >> I've lived in two countries that had socialized health care. I > >> didn't care for either one. My wife, or ex wife now, really didn't > >> like the one where no matter what your ailment or what you were > >> being checked for, you had to see your neighborhood doctor first. > >> He was a general practitioner. If he or she didn't think you > >> needed to see a specialist, then you didn't see one, or paid out > >> of pocket for it. My ex sure didn't like getting female exams by a > >> doctor that only received the minimum training on women's body parts. > >> > >> In Texas, each county has a hospital tax. This is in indegent > >> healthcare tax for the county hospital. I was billed 8,000 dollars > >> for airlife when my son in law was shot and killed. An indigent > >> wouldn't be charged. > >> > >> So, from my standpoint, anyone that wants medical care can get it > >> without paying, they just have to stand in line at the ER to get > >> it. It's estimated that as much as 25% of the families that don't > >> have healthcare insurance, don't have it by choice, preferring to > >> save the money and run the risk, and attend ER's when needed. > >> > >> We don't even need to talk about the French trauma system where a > >> doctor is on each ambulance, and he stabilizes the patients at > >> accident scenes before transport. Of course, severe trauma can't > >> be resolved in the field, so there are many injured that die. The > >> golden hour is a very rough frame of reference. > >> > >> One major city in the US, would not allow ambulances on shooting > >> scenes. The responding officers bagged the victim, threw them in a > >> van, and transported. Very high survival rates. > >> > >> A friend of mine is a chiropractor. She gets 18 dollars for a > >> medicare visit. So she would have to crank them through at a rate > >> of more than 10 an hour to break even for office expenses and > >> salaries, exempting hers, or lose money and treat them fairly, > >> which she does. > >> > >> Allowing the market to fully function would be a much better > >> option than the government doing or meddling in the system. > >> > >> Regards, > >> Don, Seguin Tx > >> > > > > > > >

[Guest guest]

searcher55 wrote:

>So, from my standpoint, anyone that wants medical care can get it

without paying,

> they just have to stand in line at the ER to get it. It's estimated

that as much as

> 25% of the families that don't have healthcare insurance, don't have

it by choice,

> preferring to save the money and run the risk, and attend ER's when

needed.

The " Catastrophic Care " theory of health insurance has a big flaw:

there are many chronic conditions where it's much cheaper to prevent a

crisis than it is to deal with one in the hospital.

For instance, I know an indigent person who has asthma. Through

welfare she manages to get albuterol, which she uses quite often. She

shows up at the ER several times a year with an acute asthma attack and

is hospitalized about once a year. It would be a lot cheaper to send

her to a specialist, who'd get her on inhaled steroids and would also

look for conditions that can complicate asthma: recent research shows

that nearly all cases of " treatment-resistant asthma " can be managed if

concomitant conditions are checked for and treated. Inhaled steroids

aren't the cheapest drugs in the world, but a year's supply is a

fraction of what the hospital claims the ER visit and nights of

hospitalization cost. She'd have a much better quality of life, and

might even get her act together enough to not be indigent anymore.

The story is similar with diabetes. Diabetes is best treated with

insulin, lifestyle counseling, and maintainance medications like

Metformin. This kind of care is less profitable, however, than

amputations and other procedures to deal with the impact of uncontrolled

blood sugar, and in areas like NYC, it's hard for people on the lower

half of the SES spectrum to get the care they need.

Health insurance for a family of three might cost about $12K a year on

the individual market if nobody in the family has a chronic disease. If

one or more persons, however, has a chronic disease, such as asthma,

high blood pressure, hypothyrodism, depression, you name it, the

cost of insurance can get into the range of $40K before taxes...

Conditions like that are quite common, and even a family that makes

$80K a year (well above the median) is going to think twice about

getting health insurance if they aren't getting it from an employer: I

mean, is it really worth half their income, when you could spend that

income on better food, vacations, etc.

------

Another " elephant in the room " is quality. This has two halves: (i) a

large number of common procedures and treatment methodologies don't work

and (ii) things inevitably get botched around hospitals.

For instance, increasing numbers of people are receiving expensive and

dangerous treatments for back pain that aren't backed by clinical

evidence, such as spinal fusion surgery and opiate drugs. In the

meantime, only a few lucky patients receive treatment based on Robin

McKenzie's research, a simple and inexpensive method of physical

therapy that helps most patients quickly. (I developed severe back pain

a few months ago, picked one of McKenzie's books for practitioners off

the shelf, modified his back extension exercises so they'd fit into my

lifestyle, and found myself pain-free in two weeks)

More than once I've seen a person get a course of opiate drugs for

chronic pain become a junkie -- typically the person is already involved

in the drug culture, so that the idea that you'd get drugs on the black

market isn't entirely foreign to them. A pot smoker is unlikely to get

enough oxycontin pills at a party or on the black market to get hooked,

but a month's prescription is enough to start an addiction that can

create more suffering than the original affliction. I know of one young

man who got opiates for back pain, became addicted, stole a

prescription pad, started forging prescriptions, and found himself in

jail shortly thereafter.

Then there's the whole imaging debacle.

For the most part, imaging is ineffective in guiding the treatment of

chronic pain. You'll find people with horrible pain that have normal

scans, and people with terrible-looking anomalies who are world class

athletes. Attempts to fix anomalies that aren't the real cause of the

problem can lead to expensive, dangerous and ineffective procedures.

I know a person who had ulcer surgery around age 60 -- the doctors found

that the tissue removed was cancerous, so they began regular G.I. tract

scans every six months. Well, health insurance spent plenty of money

on those scans, but they didn't detect the tumor that was the size of

grapefruit a few years later. He died 9 months later; about $250K of

treatment that made him miserable extended his life maybe 3 months.

Everybody knows somebody who's been in a hospital disaster.

I understand the concern that people have over the cost of malpractice

insurance, and I think something ought to be done in the area of Tort

reform. Still, shoddy practices are widespread at hospitals, enough

that I wonder if a few (thousand) more lawsuits would help.

For instance, the young lady with asthma I mentioned above once showed

up at a hospital with acute appendicitis. Confusion with diagnosis and

procedural delays meant that she didn't undergo surgery until her

appendix had burst. She struggled with peritoneal infections for about

eight months, and was in and out of the hospital for more than 8

months. We weren't sure that she was going to survive, and the

incident has had some lasting effects on her health.

A recent article in our local weekly newspaper told the story of a woman

who was admitted to the hospital for food poisoning, was incorrectly

diagnosed with H1N1 flu, dealt with a comedy of errors, and was

incorrectly given a painful IV injection. When I got food poisoning, I

stayed home, because I figured something like that would happen if I

went to the hospital.

Nobody knows what's going on.

Here's my own small story of health care waste. I recently got a scary

notice from my pharmacist that a medication I'd been taking for a while

required " pre-authorization. " I called my insurance and the people

there couldn't explain to me what was up. I called my doc, and

somebody from her office started talking with them. After three days I

called my doc back and the people there didn't know what was going on

either. A few days after that, I got a call from the pharmacist

saying I had a prescription ready and it turned out to be a generic

version of the med I was taking, something that had just come on the

market.

In the end this was a win-win situation: my insurance is paying less,

I'm paying a smaller copayment, and the generic is effective.

However, poor communication wasted my time and wasted resources here:

if the pharmacist had gotten a message that explained that the insurer

wanted to switch me to a generic, or if I'd been told that by the first

person I talked to on the phone at the insurer, I'd have felt like a

partner in controlling health care costs, not like a punch card to be

folded, spindled and mutilated.

[Guest guest]

By the way, here's one of the best articles of the year (IMO) on

American health care:

http://www.theatlantic.com/doc/200909/health-care

Another one is

http://www.nytimes.com/2009/08/26/business/economy/26leonhardt.html?em

Both of these are market-oriented, address real issues, and avoid

the debate between " I want single payer so daddy can pay my bills " and

" Get the government away from my Medicare! " that seem to dominate the

discussion today.

[Guest guest]

Thank you for the thoughtful comments .re: managing chronic conditions, it seems Aetna and others at least gave this lip service a decade ago. I though HMOs were supposed to be better at this. It seems this boils down to a results based system where providers are compensated for delivering good heath rather than how many procedures they perform. That's how it worked for the old witch doctor in the tribe. If too many people get sick and die, the witch doctor has a long cold winter.re; Asthma I think Walmart has already closed their low cost clinics (for now) as unprofitable, but Walgreens is still trying and IIRC they are tangled up with health insurance companies and established providers about trying to deliver lower cost maintenance care to Asthma patients. The health insurers won't cover them, and established providers don't want the competition. re: diabetes (at least type II) this is IMO mostly reversible with diet and exercise, but I don't know how to motivate individuals to do what it takes. The government taxing sugary drinks isn't going to do it. I like that some new computer games involve actual movement, while I'd prefer to see kids climbing trees and riding bikes (without motors),re; back pain, I believe some recent research has discredited spinal fusion as having a similar success rate to placebo (sham) surgery. While only one-rat, I had back pain as a youth that magically went away coincident to US Army basic training PT (physical training not therapy, but whatever works). re: malpractice and hospital/DR mistakes. The current amount of lawsuits don't seem to be doing the job, while smarter hospitals are doing some intelligent analysis of results to identify vectors for infection and repeated mistakes. I am surprised less patients are killed by hand scribbled prescriptions (probably thanks to competent pharmacists). I am waiting for broader consolidation of patient results data and incorporation of this real time experience base into local expert systems to second guess or guide individual doctor decisions. The lone gun approach doesn't make sense in the 21st century. These expert systems could serve as a check against malpractice liability, if the expert system made the mistake blame it. If the individual ignores the expect system they accept personal liability for the outcome. This should free up doctors from remembering old lessons so they can focus on effective communication with the patient, including non-verbal cues. Something computers will never replace (or not easily)re: Imaging. Agreed IMO it is overused, and over charged for... Since i don't have insurance I paid out of pocket roughly 2-4x what a MRI scan should have cost. In a self diagnostic attempt. You make a lot of good points that I don't hear addressed by legislators. I would like to hear more from the doctors in this debate? I have heard some early support from AMA for the administration with other DRs saying the AMA doesn't speak for them. Interesting times...JROn Sep 14, 2009, at 10:03 AM, A Houle wrote: searcher55 wrote: >So, from my standpoint, anyone that wants medical care can get it without paying, > they just have to stand in line at the ER to get it. It's estimated that as much as > 25% of the families that don't have healthcare insurance, don't have it by choice, > preferring to save the money and run the risk, and attend ER's when needed. The "Catastrophic Care" theory of health insurance has a big flaw: there are many chronic conditions where it's much cheaper to prevent a crisis than it is to deal with one in the hospital. For instance, I know an indigent person who has asthma. Through welfare she manages to get albuterol, which she uses quite often. She shows up at the ER several times a year with an acute asthma attack and is hospitalized about once a year. It would be a lot cheaper to send her to a specialist, who'd get her on inhaled steroids and would also look for conditions that can complicate asthma: recent research shows that nearly all cases of "treatment-resistant asthma" can be managed if concomitant conditions are checked for and treated. Inhaled steroids aren't the cheapest drugs in the world, but a year's supply is a fraction of what the hospital claims the ER visit and nights of hospitalization cost. She'd have a much better quality of life, and might even get her act together enough to not be indigent anymore. The story is similar with diabetes. Diabetes is best treated with insulin, lifestyle counseling, and maintainance medications like Metformin. This kind of care is less profitable, however, than amputations and other procedures to deal with the impact of uncontrolled blood sugar, and in areas like NYC, it's hard for people on the lower half of the SES spectrum to get the care they need. Health insurance for a family of three might cost about $12K a year on the individual market if nobody in the family has a chronic disease. If one or more persons, however, has a chronic disease, such as asthma, high blood pressure, hypothyrodism, depression, you name it, the cost of insurance can get into the range of $40K before taxes... Conditions like that are quite common, and even a family that makes $80K a year (well above the median) is going to think twice about getting health insurance if they aren't getting it from an employer: I mean, is it really worth half their income, when you could spend that income on better food, vacations, etc. ------ Another "elephant in the room" is quality. This has two halves: (i) a large number of common procedures and treatment methodologies don't work and (ii) things inevitably get botched around hospitals. For instance, increasing numbers of people are receiving expensive and dangerous treatments for back pain that aren't backed by clinical evidence, such as spinal fusion surgery and opiate drugs. In the meantime, only a few lucky patients receive treatment based on Robin McKenzie's research, a simple and inexpensive method of physical therapy that helps most patients quickly. (I developed severe back pain a few months ago, picked one of McKenzie's books for practitioners off the shelf, modified his back extension exercises so they'd fit into my lifestyle, and found myself pain-free in two weeks) More than once I've seen a person get a course of opiate drugs for chronic pain become a junkie -- typically the person is already involved in the drug culture, so that the idea that you'd get drugs on the black market isn't entirely foreign to them. A pot smoker is unlikely to get enough oxycontin pills at a party or on the black market to get hooked, but a month's prescription is enough to start an addiction that can create more suffering than the original affliction. I know of one young man who got opiates for back pain, became addicted, stole a prescription pad, started forging prescriptions, and found himself in jail shortly thereafter. Then there's the whole imaging debacle. For the most part, imaging is ineffective in guiding the treatment of chronic pain. You'll find people with horrible pain that have normal scans, and people with terrible-looking anomalies who are world class athletes. Attempts to fix anomalies that aren't the real cause of the problem can lead to expensive, dangerous and ineffective procedures. I know a person who had ulcer surgery around age 60 -- the doctors found that the tissue removed was cancerous, so they began regular G.I. tract scans every six months. Well, health insurance spent plenty of money on those scans, but they didn't detect the tumor that was the size of grapefruit a few years later. He died 9 months later; about $250K of treatment that made him miserable extended his life maybe 3 months. Everybody knows somebody who's been in a hospital disaster. I understand the concern that people have over the cost of malpractice insurance, and I think something ought to be done in the area of Tort reform. Still, shoddy practices are widespread at hospitals, enough that I wonder if a few (thousand) more lawsuits would help. For instance, the young lady with asthma I mentioned above once showed up at a hospital with acute appendicitis. Confusion with diagnosis and procedural delays meant that she didn't undergo surgery until her appendix had burst. She struggled with peritoneal infections for about eight months, and was in and out of the hospital for more than 8 months. We weren't sure that she was going to survive, and the incident has had some lasting effects on her health. A recent article in our local weekly newspaper told the story of a woman who was admitted to the hospital for food poisoning, was incorrectly diagnosed with H1N1 flu, dealt with a comedy of errors, and was incorrectly given a painful IV injection. When I got food poisoning, I stayed home, because I figured something like that would happen if I went to the hospital. Nobody knows what's going on. Here's my own small story of health care waste. I recently got a scary notice from my pharmacist that a medication I'd been taking for a while required "pre-authorization." I called my insurance and the people there couldn't explain to me what was up. I called my doc, and somebody from her office started talking with them. After three days I called my doc back and the people there didn't know what was going on either. A few days after that, I got a call from the pharmacist saying I had a prescription ready and it turned out to be a generic version of the med I was taking, something that had just come on the market. In the end this was a win-win situation: my insurance is paying less, I'm paying a smaller copayment, and the generic is effective. However, poor communication wasted my time and wasted resources here: if the pharmacist had gotten a message that explained that the insurer wanted to switch me to a generic, or if I'd been told that by the first person I talked to on the phone at the insurer, I'd have felt like a partner in controlling health care costs, not like a punch card to be folded, spindled and mutilated.

[Guest guest]

Another good article below for those of us who have employer-based health

insurance. We may be OK now, but market forces may change that for us fairly

soon. The time to act is now:

http://www.slate.com/id/2227984/

Diane

>

> By the way, here's one of the best articles of the year (IMO) on

> American health care:

>

> http://www.theatlantic.com/doc/200909/health-care

>

> Another one is

>

> http://www.nytimes.com/2009/08/26/business/economy/26leonhardt.html?em

>

> Both of these are market-oriented, address real issues, and avoid

> the debate between " I want single payer so daddy can pay my bills " and

> " Get the government away from my Medicare! " that seem to dominate the

> discussion today.

>