patrick.net

What Ronald Reagan said about the nine most dangerous words in the English language.

It does not make sense when paying for debt to the society adds debt to the society.

On another note, do not forget that welfare was created to make poverty sustainable. The best policy is to spread Capitalism at all cost. Please be reminded that only wealth creation can eradicate poverty.

Wealth redistribution invariably turns into poverty redistribution.

It is true that all men are created equal. But it is also true that all men are born without clothing.

"It does not make sense when paying for debt to the society adds debt to the society."

Wow, that makes too much sense. No way did a politician say that. Especially one who was re-elected!

Care to guess how much we spend on giving people an opportunity to pay their debt to society? What ever happened to common sense? Thomas Paine wouldn't have an audience today I'm afraid.

The story is good in that it shows that the ticketing/fines system is designed to create more fines. However, they were going to be evicted before the tickets and fines began to accumulate. Their co-tenants weren't paying their share, and they had to move.

The man sounds like a good guy - but why would he be installing a window for a friend in Section 8 housing? The landlord is responsible for keeping the home in good condition, not the tenant. Not saying that he's responsible for the lack of insurance, but his injury might have been preventable. Unfortunately, his future work prospects are limited due to his injury.

One thing is for sure, once people are in "the system," it's damn hard to get out.

This country can't stomach Capitalism, free market Capitalism. Gee, we'd have to do away with the billions in farm subsidies, billions in oil subsidies, tariffs on imports, no more auto, real estate and bank bailouts. Need I go on?

It's all smoke and mirrors folks!

Privatize profits, socialize losses...this is America.

The health care reform has to be all (universal HC) or nothing otherwise it's just another blank check for the insurance companies. As an RN every day I work I see ways to save huge $$$. Here's my example from yesterday: pt has been suffering from kidney failure (on dialysis) and cardiovascular disease for years. Due to poor diet management on top of all this the guy has been taking a dive the last few months. Ends up in the ICU with sepsis, suffers complications from the clotting cascade gone wrong due to the septic environment, suffers numerous infarctions (lack of blood flow) to the brain and other various parts from clots. Yes, there is always a chance of a miracle but this guy is a goner. The family wants nature to take it's course, God will take him when he wants him as they say. But in the mean time they want him on the ventilator, continuous dialysis, meds for BP support, lots of pain meds, etc. This guy is gonna last weeks in the ICU with all these interventions and we have to follow the family's wishes but try to educate them about what is happening and what his chances are of full if any recovery. And just like 80% of the time, the family stops coming in to see the patient cuz they can't stand to seem him in such bad shape but they don't want to make the decision to stop treatment. At some point the ethics board will step in.

This happens all too often, basically flushing $ down the drain.

Get your advanced directive and living will in order before your family tortures you in the ICU!

Leigh says

The family wants nature to take it’s course, God will take him when he wants him as they say. But in the mean time they want him on the ventilator, continuous dialysis, meds for BP support, lots of pain meds, etc.

Frustrating indeed. God would take him if they removed the vent and stopped dialysis. God (if there is one) created the scientists to make medications and develop treatments that extend quality & quantity of life - but God (if there is one) can't cure everything. It always pisses me off when the family "can't bear to see them this way..." yet they won't pull the plug. They'd put a dog down for less, but not a family member. I don't get it.

Drug companies & hospitals make more money if the patient lives and uses drugs, invasive treatments, etc. The more extensive the treatment, the higher the reimbursement.

Unfortunately, living wills can be revoked by "well-meaning" family members, and the doc/hospital will always err on the side of who will sue. Essentially, people will sue when the patient dies, not when they live. Even if the lawsuit has no merit, it's cheaper to settle than to go thru litigation.

We need reform. Unfortunately, this was an article in Time Magazine today:

http://www.time.com/time/politics/article/0,8599,1931595,00.html
How Drug-Industry Lobbyists Got Their Way on Health Care
"It's understandable the drugmakers would want a roll-call accounting of who their friends and enemies are, considering the size of the investment they are making on Capitol Hill: in the first six months of this year alone, drug and biotech companies and their trade associations spent more than $110 million — that's about $609,000 a day — to influence lawmakers, according to figures compiled by the nonpartisan watchdog group Center for Responsive Politics. The drug industry's legion of registered lobbyists numbers 1,228, or 2.3 for every member of Congress. And its campaign contributions to current members of Waxman's committee have totaled $2.6 million over the past three years."

Leigh,

Your illustration with the man on dialysis/life support is perfect. That is exactly why patients/families must be responsible for their OWN treatment costs!

If the family had to foot even part of the bill for that hospital stay I wonder how fast they would find the off button on that vent. The family would have every right to keep him on treatment if they are paying the bill. I am assuming that is not the case, but if it is more power to them. Let them spend their money as they see fit.

Elliemae, thanks for the elaboration...perfect follow-up as my next question for you all to ponder was going to be, 'Who makes money when patients like this are kept alive?"

I forgot to add "insurance companies." Because they write off their losses to the tune of millions of dollars each year.

A long time ago, I was told that when someone is in an auto accident, the insurance company takes an immediate write-off of the total amount of the policy limits. The write-off is later adjusted if the award is lower, but they end up making money on the deal. I don't doubt that this can be applied to health insurance.

and higher premiums. We, the peons ultimately pay for it.

How appropriate to stumble upon this: http://www.katu.com/news/national/65597452.html

The article says it can handle people up to 1,600 pounds. Oh, my gawd! But the cost of renting a specialty bed is high, and so would be the transportation costs.

And I am envisioning lots of on the job injuries for caregivers...cha-ching$

My employer rents 'size wise' beds for patients over about 275#, I am curious to know how many we rent at any given time.

No one should make any profits, we should just take all the assets of all Americans and distribute them equally. Then we should make sure we all have an equal size house in an equally nice but not too nice neighborhood with the proper medications and insurance.

Wow, that KOOLADE is GOOD! I don't know what came over me.

2ndClassCitizen says

No one should make any profits, we should just take all the assets of all Americans and distribute them equally. Then we should make sure we all have an equal size house in an equally nice but not too nice neighborhood with the proper medications and insurance.
Wow, that KOOLADE is GOOD! I don’t know what came over me.

Not sure what you were getting at with this but are you saying that pharma and hospitals have every right to milk these dying patients for profits while you and I continue to pay ever increasing higher premiums?!?!

Yes, companies do have rights to milk anyone. However, as a society, we do not have to enable them.

We are having a problem now because nobody cares. Since most people have some kind of subsidized health insurance through work or government, the health care industry are able to charge whatever they want.

We need to focus on lowering health care costs through awareness and responsibility. Now.

The pursuit of profit is a fundamental right of a corporate person. We must defend it with fervor. If we begin to forget the importance of profit, Capitalism will be hijacked and turned into an evil institution.

If A is excessively profiting from B, fault should be assigned to B. In this case, B is our society as a whole.

LOL, literally...Capitalism has already been hijacked. Or is that what you are getting at?

Or is that what you are getting at?

:-)

LOL. Good to see Peter P in top form as usual.

I'd like to point out that all the regulation, taxation and subsidies have effectively crippled competition in both health insurance and hospitals. The government has created a quasi-monopoly in both industries. People can argue that it's dangerous to let the medicine-insurance complex charge what it wants, because it could potentially just milk people when they have no choice. But that's the point. If milking really happened in an open system, a competitor would immediately arise to offer the same services at a lower cost, and thus create downward pressure on prices.

If we want a fairer system, then we should eliminate the dual pricing regime where hospitals can charge people a 5x difference in prices, based on factors they decide (typically whether or not the person has insurance). That discrimination just crushes the most vulnerable people, and it drives up prices for everyone who has insurance and/or money to their name. We should also cap lawsuit judgments against doctors, because malpractice suits drive up MD insurance costs and necessitate ordering endless cover-your-ass tests that are peripheral to diagnosis and treatment.

As far as I'm concerned, I'd like to see the entire medicine-insurance complex get tried under the Valentine and Sherman Acts. It's a damn cartel, with political ties and lobbying money to rival the 1920's Chicago mob.

If we want a fairer system...

Brand, I agree with you. Tort reform should also be a priority.

I think businesses should be able to have flexible pricing for different customers. However, price discrimination is a symptom, not a problem. It is a sign that an industry does not have enough competition.

The problem with competition in health care is that it can get VERY expensive. Imagining (MRI, CT, PET) is a multimillion dollar venture and the million dollar software updates are required in order to remain competitive. Diagnostic imagining is also one of the most overused diagnostic tools.

Everyone wants to be the top cardiac care center in the city (great Medicare reimbursement rates)...imagine the money needed to attract the top doctors, latest innovation, etc. Same with oncology, pediatrics, etc.

From wikipedia: http://en.wikipedia.org/wiki/Magnetic_resonance_imaging MRI equipment is expensive. 1.5 tesla scanners often cost between $1 million and $1.5 million USD. 3.0 tesla scanners often cost between $2 million and $2.3 million USD. Construction of MRI suites can cost up to $500,000 USD, or more, depending on project scope.

MRI scanners have been significant sources of revenue for healthcare providers in the US. This is because of favorable reimbursement rates from insurers and federal government programs. Insurance reimbursement is provided in two components, an equipment charge for the actual performance of the MRI scan and professional charge for the radiologist's review of the images and/or data. In the US Northeast, an equipment charge might be $3,500 and a professional charge might be $350.[44] Some insurance companies require preapproval of an MRI procedure as a condition for coverage.

In the US, the 2007 Deficit Reduction Act (DRA) significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit.[citation needed]

Imagining (MRI, CT, PET) is a multimillion dollar venture and the million dollar software updates are required in order to remain competitive. Diagnostic imagining is also one of the most overused diagnostic tools.

I suspect that if tort reform gets pushed through medical imaging will be much less used. How much of the diagnosis is of the CYA kind?

Everyone wants to be the top cardiac care center in the city (great Medicare reimbursement rates)…

I support socialized medicine (shocking?) but I believe whoever stuck with the bill should a have say on the treatment.

NOT MEDICAL ADVICE

FYI Radiologists are some of the highest paid doctors ($500k/yr is not unheard of) and often have the best hours. It's also an outsourced field. Doctors in India read the scans/images while we are all asleep her in the US.

How Doctors Think is a must read for everyone...http://www.jeromegroopman.com/

A big part of our problem is an uneducated, ignorant population that feels there is a pill for every ill, reads everything on the internet as fact and often makes care providers lives hell with their demands, threat of lawsuit , and noncompliance.

Note: the above statement makes me ineligible for any ethics board...I would have a third of my hospital cleared out!

In a past life (job), the hospital that I worked for was named one of the top cardiac hospitals in the country (or region?). One of the docs I worked with mentioned that if he paid $$$$ (like $20k or so), his living room could be named one of the top cardiac hospitals.

Leigh says

A big part of our problem is an uneducated, ignorant population that feels there is a pill for every ill, reads everything on the internet as fact and often makes care providers lives hell with their demands, threat of lawsuit , and noncompliance

Yea - give me an antibiotoic for a virus. That'll treat me and I'll feel like I got my money's worth.

A big part of our problem is an uneducated, ignorant population that feels there is a pill for every ill,

Very well said. They did not know the only real pill has more to do with what they should have done. Now they think attacking the symptoms will fix the problems (and I am not only talking about health care). Yeah right.

Or... the population is so well educated that it isn't. ;-)

To say that doctors order many procedures and diagnostic tests because of fear of lawsuit can be debated. I have overheard numerous conversations where reimbursement comes in to play and numerous studies have shown that some procedures are favored over others not because the outcomes are better but reimbursement rates are higher.

Yea - the system is pretty messed up.

Leigh (and other interested people):
Patrick & I are posting op ed pieces and interesting links to pertinent articles regarding healthcare & the elderly on the Nursing Home Page if ya want to take a look. Also check the nursing home forum for healthcare articles.

I don't believe that we should withhold treatment for people based solely on age, but I do believe that patients and family members can be very unrealistic when it comes to their healthcare options. Many people complete living wills but continue aggressive treatments because they aren't enouraged to consider their prognosis and quality of life.

People are forced to make decisions based on the information given to them by providers, which might be biased if the providers have a vested interest. For example, if a patient would benefit from hospice but is being served by a home health provider without a hospice component, they may never know about hospice or may be discouraged from looking into hospice. Another example is the patient who is referred to a dialysis center owned by his physician, or referred to a home health/hospice provider affiliated with their MD or the hospital.

An interesting link is http://www.usatoday.com/news/health/2009-10-14-dialysis-elderly_N.htm; this article discusses dialysis and the elderly.

Your thoughts?

The USA Today link didn't work but I saw a very recent article about hemodialysis and the elderly in our local paper, likely the same AP article. Being quite familiar with dialysis I can tell you some things that weren't mentioned in the article. Once your filtering system, the kidneys fail or are starting to fail not only is dialysis needed but strict dietary changes must be taken on because your kidneys can no longer get rid of the toxins and electrolytes and water. Dialysis patients are restricted to 1-2L of fluid a day since they can't get rid of excess fluid by urinating. They are at risk of fluid overload which taxes an already often failing heart and vascular system. Potassium and phosphorous is severely restricted: no dairy, no bananas, no oranges and orange juice, no beans, no beer, many meats are high phosphorous, the list goes on. Very low sodium as sodium causes fluid retention making it difficult to remove the fluid during the 3x/wk dialysis sessions. The kidneys also produce a hormone for red cell production so now these patients are at risk of anemia so they get iron and procrit/epo. They suffer from bone loss due to the high blood phosphorous levels. The get atherosclerosis from the calcium-phosphorous component. Their immunity is lowered due to constant abnormally high levels of uremia making these patients susceptible to every thing under the sun. Their clotting cascade doesn't always function effectively due to the elevated urea.

No one ever just has kidney disease, they usually lose function from diabetes or high BP. Imagine being on a diabetic AND kidney diet! Some elderly lose kidney function after an MI or stroke.

Are we improving the patient's lives with dialysis? Is it worth the costs? And I'm not just talking about HC dollars but lifestyle changes, too.

I have visited dialysis outpatient centers where I've witnessed elderly people crying and yelling out for help. In talking with the staff they say it happens all the time but the family pushes for it. I'd say, make a family member sit there through every 4 hour session 3X/week and see if it's still best for this patient (these patients that yell out are often suffering from dementia, too)

We have a saying in dialysis land: Dialyze to live not live to dialyze.

I'll check out the other links on Patrick.

I'm sure it was the same article - I found it under google links & don't know why the link no longer works. ugh.