Archive for category Medicine
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
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
Just want to dip my beak …..
Posted by redlinedoc in Universal HealthCare on July 9, 2009
Strange you say. Governor Rell (I’m a yankee) just vetoed Sustinet. Sustinet? Sustinet was a plan to insure every citizen in Connecticut starting with the most vulnerable, including state employees and rolling in small businesses and non-profits to make a large coverage group competing with private insurance companies for benefits and coverages. No one would be forced to enter Sustinet (other than the current state medicaid/safetynet and employees) and it would have to stand on its own merit. It was broadly supported and overwhelmingly voted in both senate and house chambers in the state.
Why veto it? Governor Rell seems to have forgotten some history here. In the 1700′s the citizens of Connecticut recognizing that they didn’t want to replicate the Dickensian debtor prisons of England, established havens for those to sick or unable to work; town farms. The town farms were by no means a happy haven but residents there worked on the farm as they could, helped to be self sustaining, had some funding from the Selectman’s budget in the town and had food and clothings and housing and medical care. This, from the compassionate citizens of Connecticut. Fast forward. When larger government programs superseded the Town Farm System, the program became State Aid to General Assistance (SAGA) one of the safety net programs here in Connecticut.
No one wants to see SAGA patients. Getting referrals from primary care (I work in an FQHC) to tertiary or upper level care is nearly impossible. SAGA pays poorly for advanced care and since its coverage mostly (a devilish word) is for poor folk; Who cares. The devil in the mostly is that folks who have worked all their lives but had some dreadful disease may find themselves on SAGA. Folks who have a sickness in the family, monies wiped out by the vagaries of the current ‘he who has the gold makes the rules insurance system’ may find themselves on SAGA. The list goes on. The poor line up and are anointed with the least of the least.
Sustinet looks in ways to fix this, to level the playing field by making no distinction between rich and poor by allowing all access to health care. Bah Humbug they should pull up their bootstraps, you say. WHO will pull up the bootstraps. My 24 year old daughter recently fell into the hole between parental coverage and no coverage from work. Luckily she had her health. Needed medications, however, consumed a fair bite of her savings.
Whats with the beak dipping? Governor Rell is a leftover from the Rowland administration here in Connecticut. She distanced herself from John Rowland (who spent some time waiting for a better paying government job — quel suprise!). Republican administrations believe that business will make it all perfect. That the shareholder marketplace will bring equity and equanimity to the medical system. Each of the stakeholders will ‘dip his beak’ only taking a fair share of the monies, pleasing the boards and CEO’s. I think this more akin to crows feasting at the carcass. There isn’t much money and pleasing the shareholders never improved wellness. There is a finite supply of monies and pleasing the CEO’s and padding their golden parachutes never helped struggling parents with sick children. Dipping their beaks, sucking up the juice.
Ahh for sure, all that will be left of Sustinet will be the bones, no juice, no meat, no insurance, no coverage. And the fat cats will be daubing their beaks with linen napkins.
Death by insurance –
Posted by redlinedoc in Medicine, Universal HealthCare on June 21, 2009
Yesterday I lost another, friend. Death by insurance read the certificate, or so it should have. Geno was a kind fellow, gentle soul, never made lots of money but found himself suddenly underemployed, a polite term for being older and getting paid for fewer than 20 hours a week, then finding there is no health insurance
Ok, you think. Let this guy pull himself up by the bootstraps. He did. He got a second job. Still no insurance. Then he got Diabetes. Oops. Its not quite like a third job because you pay them instead of getting paid. You work harder. The doc says you should have less stress. Ok. I’m working a job to pay the insurance and another to pay for food, now I have to pay rent because the diabetes job just doesn’t bring in enough.
Oops.
Now you can be on state sponsored insurance, some of the time. You feel really terrible. He did. He worked all his life and was always responsible. Now he’s a ward of the state and working. He gets headaches. He’s not feeling well. One day he falls. He goes to a doctor but they can’t see him because his limited HMO insurance wants him to see a doctor 40 miles south. He bucks the system but there are not many alternatives.
Finally he gets an appointment with neurology. He has a grade 4 astrocytoma; not a good prognosis. Although he has insurance for this and has coverage, because of his limitations (he has memory lapses and poor focus) after the tumor is primarily removed, he often forgets to take his medications or takes them improperly. Insurance has no use for home visits.
He slips. He has difficulties. The secondary job is history. The primary job lays him off. He’s now totally on the HMO. They say he’s ok free living. He has slips and fall. He’s ok free living. He forgets his medications. He’s ok free living. He asks for assist but they say he’s not elegible on this cheaper chicken HMO insurance.
He died yesterday. Now the HMO is off the hook. No more insurance payments. No doctor visits. No Gene. Seems like a good system. Death by insurance.
Lest you think this is an isolated incident -
Two years ago a friend of mine, a retailer, sucessful in business but a small retailer, began to have urinary tract pain. He had no health insurance because at more than 1500$ a month it was more than he could afford. Additionally, that amount was for catastrophic insurance, you see, as a child he’d had bladder problems and every insurance company pro-rated him. Finally he gets insurance. He’s had, what he thinks, is a bladder infection. Its been so severe that occasionally he sleeps in a bath tub with warm waters. Small catch. There’s a 90 day waiting period.
He goes to his doctor who, as he’d suspected, sends him to urology. They want to examine his bladder and because of prior difficulties with anatomy need to do this in a hospital. There’s this 90 day thing. We wait. He’s more comfortable but of course not better.
The bell rings. Its a bladder tumor. They biopsy – perhaps benign, although most are not. It is benign it seems. But theres a second troubling spot next to it. Not benign. The tumor is resected, he starts chemo and radiation and everyone is hopeful. There are all sorts of limits to this insurance policy he has – so greater exploration, whole body films and the like, aren’t done.
Two months forward, he’s a bit dizzy and falls. There is an ominous cracking sound in his neck. There’s a baseball sized tumor there. Now we do more work up. Its a metatastasis. Alas it was a death knell. When removed and the neck repaired a shower of tumors widely spread show up. After an enormous fight he choses to let go.
No more store. No more employees. No more friend. These tumors when seen early are frequently non-fatal. With time the outcomes are more dire.
Death by insurance.
Failed health, failed heathcare.
Posted by redlinedoc in Medicine on June 1, 2009
I write this entry as a physician working with in the system, having been in it for more than 30 years and watching the steady transfer of medical decision making away from the hands of physicians and into the hands of the payors, not the patients.
I’ve written elsewhere about this but a recent episode brings the inadequacy and hopelessness of the current system home.
A friend (not patient) develops some urinary bleeding. He calls. I suggest, doctor (and give him some names). There is a bit of a glitch. He’s a retailer but doesn’t have enough employees (small store) to qualify for group insurance and his individual rate is enormous. He waits.
He goes to the emergency rooms. They give him antibiotics and painkillers. They tell him ‘see his doctor’.
He waits.
He goes back to the emergency room. A note here. Emergency rooms are wonderful places for stopped hearts, lots of bleeding, run over by a bus. Emergency rooms are inappropriate places for continuity of care. He has no doctor. He pays out of pocket. He sleeps in the bath tub while the insurer waits 60 days from initiation. We protect our insurers, their stockholders.
It is now 15 months since the first symptoms.
Sadly, my friend has a bladder tumor, which at first appears to be non-malignant, but on closer examination is. No problem. These things are radiation sensitive. He goes for radio therapy and 6 weeks after discovery of the primary tumor (and excision) he falls, rushed to the hospital for a much larger spinal (neck) mass which has eaten at his spine. This too is radio-chemo sensitive.
Alas the removal of this tumor unleashes a string of others… and now there is no friend. He is waiting to die.
So, who done it? I’m not sure that early detection or regular physician visits would have altered this outcome; however in his early 50′s his chances would have been much improved. There is no primary care physician involved, it’s all specialists. As a sub specialist I realize my narrow view screen, my imperfect mirror for my patients; however, I do implore them to find a primary care physician (rapidly becoming a rare specie) to help them navigate the tricky flumes and waterways of our so-called system.
I do know that I have lost a friend. The community has lost a resource, and we are all, in Dunne’s words – ‘send no one to know for whom the bell tolls; it tolls for thee” lesser for this.
As a trained physician I know we all have our time, yet all of us in the healing arts fight death. I feel that the unseen co-conspirator here was an uncaring, blovinated system. By denying coverage to some we diminish us all.
You’ve been turfed!
Posted by redlinedoc in Commentary of the times, Medicine, Universal HealthCare on June 21, 2009
More of my patients are being turned away at the gates every day. Often they need advanced care which we at the primary care level can’t give them.
I have always felt that we were most lucky, we are a smallish state and have a training institution and hospital which are owned and operated by the state. This hospital should be seeing the those at the fringe, those in great need. For many years the hospital was located in the center of an immigrant community. In the 70′s it relocated to a suburban location, very upscale. At first there was a bus to take people from the community but that quickly was quashed. Now it takes two busses and a local jitney at the heath centet, about 2.5 hours, to get there. Not much of a barrier.
Patients going to his greater facility of learning often encouter trolls at the gates. Trolls? Admission to this center of ‘much higher learning’ requires the proper insurance, not some of the lower paying kinds that our patient’s possess. When they call, the answer is frequently, call back when you have better insurance.
A few weeks ago, after some harsh notes from our facility, several well dressed physicians show up to try to make arrangements to expedite the admission of our patients into the gleaming tertiary care facility, state owned and supported. To show magnanimity one of the docs takes out a card with driving directions and some special parking near his clinics. There is muffled laughter as we tell him that the majority of our patients don’t drive nor own cars. He’s a bit culturally disconnected.
Lest you think that this is peculiar to the country estate hospital, the in-city institutions answer similarly.
Recently a patient shows on a Friday afternoon, all hunched over, the Groucho Marx walk, right upper quadrant pain, rather classic gallbladder symptoms; a surgical problem. She is referred, complete with small note from the doc, and ambulance transported to the in citty emergeny room to prevent her from having to find transport. The attending physician there concurs but adds the diagnosis ‘shitty insurance’ and instead of wheeling Senora Patient to a holding area for surgical admission, gives her back a note with the names of two surgeons in the area saying she needs urgent and immediate care. She of course calls those offices only to find that neither surgeon participates with her insurance. Quel suprise! Monday morning, quite more hunched over she comes back to our primary care clinic, sicker, with the note and no scar. A nasty note and a phone call, she’s retransported and admitted for care. This is a good outcome?
With all the ballyhoo about insurance companies participating in health care, and contrary to their every present advertisements that ‘they take care of you’ we need remember that there’s a profit motive totally separated from any health provision. The recent squealing and wheezing from the health insurance companies and their paid compadres in government about the death of health care should we use single payor or government sponsored health care is quite self serving, serving only their investors.
The only investors in Medicare are we the users. Its far from perfect. It has a 5-8 percent overhead, unmatched anywhere in the insurance industry, even with draconian plans which provide and income source for the insurance companies not safety nor security for their policy holders.
We need to re-direct our efforts and energies toward providing a comprehensive Medicare type system. A single payor system will insure fairness. I see no reason why the private companies can’t compete for business as they do in every other country with single payors. Lets see them for what they are, trolls at the gates.
fairness, Health+insurance, Medicare, poverty, single+payor, turfed, underinsured
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