Archive for August, 2009
Turfed too
Posted by redlinedoc in Medicine, Universal HealthCare on August 22, 2009
It amazes me that in the land of the best healthcare we’re more in the business of denying care than providing it.
I get a call the other day that a kid has stepped on a piece of glass. Its off hours but I say “sure, bring him in, I’ll take a look”.
A pale frightened 13y/o arrives at the clinic with parents. Apparently yesterday he jumped up off a picnic table (in the way that 13 year old males do) and sprang directly onto a wine glass lying on the ground. The glass shattered into the bottom of his foot. The parents, correctly, take him to the nearest emergency room. He waits approximately 3 1/2 hours since its “only a bleeding foot”. Xrays show glass in the wound and the physician diagnoses tendon injuries to the tendons of the toes. Ahh, you say, a case for the surgeons.
Not so fast. He has a state option child health insurance. They sew up the foot (with the glass inside) and direct him to a private practice clinic the following day. He continues to bleed, slowly, through the night. Mom and dad pack him off to the local recommended doctor only to find that he (nor most others) do not accept this insurance. They are tempted to return to the emergency room but call me.
He cannot be treated here. He needs advanced care which we cannot offer to him. I make some calls with the assistance of our pediatrician. He’s transferred to a tertiary care facility. By 4PM he’s in an operating room and being cared for.
What went wrong? Why didn’t the emergency room transfer him inter-hospital when they realized they had a severe injury they couldn’t handle? Why did they refer him through out patient when clearly there was no real outpatient option?
Insurance. When the insurance pays so poorly that even the most basic of services are covered but lose money, then the hospitals, left to chose to bleed monies or to restrict services chose the latter. In the land of ‘the best healthcare” we are forced into rationing that healthcare based not on need, not on priorities but on the needs of the stockholders of insurance companies.
Again and again
Posted by redlinedoc in Universal HealthCare on August 13, 2009
Why can’t we pay for health care for everyone? Why is it that is this country we have such a divide? Is it our puritanical upbringing which says work hard and you’ll get your rewards?
Sadly folks, the Puritan’s didn’t have it all that wonderfully. Life was hard but it was short. There were no antibiotics, no x-rays, no casts, no real surgery (with anesthesia). Hospitals were to be avoided as pest houses and physicians themselves at the time knew they did little for their patients. Some cures were probably worse than the diseases.
If we have modernized medicine, why can’t we modernize the way we provide care for our citizens. Why do we in the land of the brave, home of the free, live with a 3rd world medical care system. Sure people come here. The Sultan of Brunei came here and got wonderful care. M. D., a fictional name, in the north end of Hartford got turfed. Hmmm. Would the divide and provision of care have to do with money?
Indeed it does. The wheels grind exceeding slowly for those with limited funding.
All the Michaels are dead…
Posted by redlinedoc in Universal HealthCare on August 13, 2009
How did we allow the discussion to move away from health to how we should save the health insurance industry? How did that conversation move from a public healthy option to saving the profits of some of the most profitable companies in the world?
As there is increasing talk in Washington about the AMA time clicks by. And to whom are the insurance companies responsible? Ahhh shareholders, the same folks who brought us the current bank debacle, to whom we the people pay extravagant sums so that they can support CEO’s in a style to which they’d like to become accustomed. As there is continued agglomeration of insurers, they flock together, eat each other, thereby decreasing real market competition, in the guise of bringing lower cost to the consumer.
In medicine we speak for the patient. In insurance they speak for the money. There’s an inherent split here. When it comes down to it, shall we authorize care OR shall we make 0.02 for the stockholder, the stockholder and CEO options always win out. Duplicity is the name of the game. When Hurricane Andrew roared across the South Florida Pennisula devastating the area. Aetna group was the major insurer holding more than 4 billiion dollars in losses. That past year they golden parachuted their worthy CEO for 987 MILLION dollars (or there abouts) and then cried the blues that they didn’t have monies for claims. Hmmmm
I personally have run into the dealings of insurers. Serveral years ago one of the Connecticut health insurers sent out a note that all billing should henceforth be sent to a POB in Enfield. We all did send claims there and as weeks went by and no claims information was forthcoming, we were told that the claims were lost or that they should be re-submitted. Whoops. Someone bad in the company made an error and there is no POB in Enfield for our claims. We’re really sorry but you’ll have to re-submit them all over again. Hmmmm
I’ve had several friends who’ve suffered death at the hands of insurers, not in any direct sort of way but the usual games playing with existing conditions and difficult to access portals.
Working in a safety net group we see patients bounced from one provider to another, mostly based on non paying insurances. I think most of us are insulted when the insurers talk about the Medicare program, and how it fails to work. It succeeds with a 5% overhead, a draconian fraud unit, and coverage that most of us envy. Are there faults? Are there fixes to be made? Of course. We can in one swoop, make our system succeed. It needs a government backed program, devoid of usurious profits, not socialism, just good medicine.
We need to recenter the discussion, not about death notes but about how to prevent the needless deaths from an unwieldy bloated system which spends much of its monies not on patient well being but on corporate well being. Straight speak or soon, all the Michaels will be dead
Irony rides again
Posted by redlinedoc in I never saw THAT coming on August 13, 2009
I’ve had a catbird seat for the construction of a new facility in the poor end of town where I work. Its a marvel of glass and concrete and steel and glass – oh I DID say glass. Indeed the glass rises nearly spire like to the roof at the front of this building. Wing like, the roof soars. It is a beauty to behold. One of the many problems, probably not foreseen on this ancient floodplain of a building site, is that water needs to go somewhere. Build a soaring roof and you have roaring drainage water.
The water comes off the roof so fast that it needs a cistern to slow the flow of the water. Cisterns were installed, thermos bottle looking affairs on concrete pads around the building. Voila, problem solved. Not so fast. The waters, not seen since the times of Noah, overwhelmed even this system digging up the ground. Solution: Riprap, stones to break up the water spilling from the cisterns from the roof. Ahh, architecture.
It is indeed a pretty solution, 4 to 4 1/2 inch traprock. Traprock has an irregular shape with sharp edges and pointy parts. It doesn’t move much. However, it is also about softball sized and easy to fit in the hand. About now there should be a D’oh much like Homer Simpson. Rocks. Windows. I believe the building will soon be in the glass business.
It has been something which when I point this out to people, step by step, they say “OH WOW”. Yea. Tinkle tinkle. Irony rides again!….
No Coffin Nails Here
Posted by redlinedoc in Universal HealthCare on August 5, 2009
Dr Dave Janda writes “The underlying method of cutting costs throughout the plan is based on rationing and denying care. There is no focus on preventing health care need whatever. The plan’s method is the most inhumane and unethical approach to cutting costs I can imagine as a physician. ” It is true that some rationing of care will ensue from any medical plan; however, the draconian results predicted by Dr Janda, “Translation…..if you are over 65 or have been recently diagnosed as having an advanced form of cardiac disease or aggressive cancer…..dream on if you think you will get treated…..pick out your coffin. ” just aren’t so.
For many years the Bureau of Primary Health Care has run FQHCs (Federally Qualified Health Centers), RHC’s and look alikes that serve primary care. The problem for Dr. janda is that much of specialty care hasn’t been included. What Dr. Janda doesn’t say is that he and his specialist colleagues are running away from a share alike program which would reduce very high production incomes for them.
Our health care, such as it is, is in a shambles. We rank below third world countries in our infant mortalities and our ability to care for our sick and elderly. Buy a coffin? Get off it Dr. Jandra, the coffin’s have been lined up for years. We consign our elderly to nursing homes, frequently staff them with the unwilling and untutored and wonder why grandma is worse than when she was at home?
Medical schools have for years been a part of this conspiracy, wondering why we have so few doctors going into primary care (the treatment and health care for most of us). We train physicians for very long periods of time, from medical school through the end of a residency for Family Practice can be eight or more years. The debt burden is usually around $200,000. Specialty care pays much faster, much more quickly than primary care. “Do the math” as they say at Wal-Mart. They know. The average salary for an internist nationally is 160,000 /year. However most solo-practitioners, the most common U.S. model, make about 1/2 that because of overhead and office expenses.
- What to do
- We should back away from the fiery rhetoric we know isn’t making progress just polarizing and scaring people.
- We should look at models which work. The FQHC model works well and is supported by the administration. It isn’t making coffins but prolonging life by bringing very high quality care to those who can least afford it.
- We should stop the insurance madness. We need a not for profit insurance system if that is what is to survive.
- Those who have the bully pulpit should be scrutinized for their connections. When unleashed there is a for fee scramble to modify the system to benefit narrow non-patient interests
- Health care access is a right. We are one of the few industrialized nations with disparities this great. This is not about new immigrants, people from other places, it is about us, the American People standing up and doing the right thing
We the torturers . . .
Posted by redlinedoc in Commentary of the times on August 14, 2009
My mind and my body shout “No, no its NEVER right never correct”. I was listening to NPR the other day regarding our coming to terms with torture. OUR coming to terms? That ‘our’ is ‘us’, We the People…
I have this open ended discussion with my family about this. How is this ‘us’. How did We the People. .. become Us the torturers….. How is this ever right.
I think it comes from trimming a bit off the Constitution, that rather dusty rag of a document which our Founding Fathers found so important. So we don’t really have free speech anymore since big brother listens in on our cellphone, phone and regular conversations with impunity and without warrant. Its that old bothersome ‘search and seizure stuff’ those good old boys found so awful from their British masters. Needing a warrant, probable cause and that rather outdated stuff. We need this to be free from terrorists. I’m becoming a bit terrified myself lately.
A young priest named Torquemada started a campaign of ‘information gathering’, a tongue torn out here and there, in the name of state safety. What information did he get. None. Nothing. What information did he in fact want. None. It was a campaign of terror. Torture. Terror. —hmmmm.
Throughout our long human history there are records of those who tortured in the name of state safety, abnegating the safeguards in their particular times, accruing power piece by piece. So, I ask my brood, how did we come from “preservers of democracy” to “torturers”. How do we see ourselves? What are the checks and balances, the ironsights of our democratic process?
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