Category: Health

The re-framing necessary to move away from talk of health care death panels

| October 23, 2013 | Reply

Here’s another excellent and succinct analysis by Dylan Ratigan, part of an mass emailing he recently sent out. Allowing conservatives to argue about “death panels” is a big mistake and here’s why — and BTW, the time to make policy is not as we gather around very sick people challenging each other as to who can spend the most to to extending someone’s last breaths by 3 months, bankrupting healthcare in the process. We need to grow up and get our heads out of fantasy-land. Let’s redefine healthcare in terms of sustainable and meaningful goals. Ironically, there is date that those who claim to be most confident in the existence of an afterlife insist on the highest rate of last-minute desperate expenditures. Here’s Dylan’s email:

Dear Friends,

Generally speaking, there are only two ways to earn money.

1. Charge a fee for goods or services.

2. Charge a mutually agreed upon percentage based on a future outcome based on the newly created value. This percentage can be in the form of equity or commission.

As it stands, healthcare in America is based on the first model. This creates a system with many, high fees generated by acute and traumatic care. The chart above, from this report by the International Federation of Health Plans, shows how much we are paying compared to the rest of the world:

In reality, this care is for only 5 percent of us at a given moment, yet accounts for 50 percent of what each of us spend on the service regardless of whether or not we are using it.

If this unfortunate reality upsets you, please relax…close your eyes….and imagine for a moment a healthcare model that uses the second model of income generation. One that is based on equity or commission based on a future outcome.

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Make that call to your elected representative – Make some noise.

| October 4, 2013 | 2 Replies

Here’s what’s on my mind. Many of us care deeply about social and political issues, and it does feel good to clarify each other’s thoughts here on FB, but it doesn’t change politicians views. I’ve ranted about U.S. warmongering online for almost a decade, and it hasn’t changed America’s obsession with war as the first tool of choice for attempting to “fix” social conflict.

Last week, I got a robocall from a voice that told me that Obamacare is going to destroy the United States. I don’t believe that. I also believe that Obamacare is full of flaws (I think the U.S. should guarantee ALL citizens a reasonable minimum level of health care doing an end-around private insurers, based on what is sustainable in terms of the overall budget–I would much rather prefer Medicare for all to Obamacare).

This robocall said to “Hit 1, to be transferred to Senator Blunt.” I hit 1. A man from Roy Blunt’s office answered the call and proceeded to horribly misrepresent several aspects of Obamacare. He proceed to tell me that his poll of choice showed that people from Missouri are heavily against the things offered by Obamacare. I told him that I didn’t trust the methodology and that I know 1,000 people who are not against the things offered by Obamacare. He tried to get off the phone. I challenged him to stay on the phone. I asked him whether there weren’t SOME decent aspects of Obamacare, such as eliminating exclusions for pre-existing conditions. He hemmed and hawed. He told me that costs will go up under Obamacare. I responded, “Costs for health insurance rose throughout the 8 years of George W. Bush. They go up regardless of who is the President.” I kept this twerp on the phone for 5 painful minutes (painful for both of us), and challenged Senator Blunt to do SOMETHING so that in a nation that has more resources than most, we don’t have people dying for lack of medical treatment. He actually seemed to be agreeing with me a bit at the end.

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Ralph Nader discusses a better approach to hernia repair surgery

| July 17, 2013 | 2 Replies

This article at Common Dreams is ostensibly a discussion about hernia repair surgery, namely, an option to be treated more humanely and cheaply in Canada than in the U.S. The discussion turns to deeper criticisms of the American way of providing healthcare, however.

Too many general surgeons and hospitals have on average over 10 times the rate of recurrence, four times the rate of infection, and often use expensive mesh both to replace lack of surgical skill and to speed up the operation. Plus they charge much more before they quickly say “sayonara.”

The Shouldice [Hospital, outside of Toronto] procedure is described by hospital officials as a “natural tissue repair that combines the surgical technique with the body’s natural ability to heal,” and takes, on average, forty-five minutes to complete. Except in rare circumstances, “the technique does not use artificial prosthetic material such as mesh because mesh can introduce unnecessary complications such as infections or migration, dramatically increasing the cost of the operation. Shouldice does not use laparoscopic technology because of the potential intestinal punctures and bladder and blood vessel injuries, which may lead to infection and peritonitis.” Shouldice staff note that laparoscopic surgery also requires general anesthesia and hugely higher costs for disposable items per surgery than is the case at their hospital.

There are about one million abdominal wall hernia operations yearly in the U.S. Hospitals and general surgeons for the most part do not use the Shouldice Procedure. Still the deplorable “quick and dirty” that invites overuse of mesh – about 80 percent of the patients – has become a perverse incentive for higher billings in the United States. Superior talent is needed for the more natural procedure used by Shouldice.

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End of life extravagance

| July 11, 2013 | Reply

In the Washington Post, Jonathan Kay writes:

Last week, I wrote a column about the problem of “unwanted care,” a term used to describe the aggressive, invasive, often debilitating heath treatments that are imposed on dying patients — frequently when they are senile or unconscious — during their last weeks or months of life. The example I provided, courtesy of Atlantic magazine author Jonathan Rauch, was of a 94-year-old man dying from internal bleeding and kidney failure in a U.S. hospital. Instead of providing palliative care, the doctors tried to get authorization to remove the man’s colon and put him on dialysis. “We are spending billions on health care that no one wants, and which often has no real effect except suffering and indignity,” I argued.

I often wonder how different it would be if we all agreed ahead of time in the abstract that insurance simply won’t cover extending the heart beats of people who are inevitably dying, either unaware or unconscious. I suspect that if standard health policy insurance money weren’t easily available, many of us would quickly decide that life was at an end, that it was a natural process, and that it is simply time for him (or her) to go.

With the aid of easy medical insurance coverage, though, many of us take the position that every heartbeat of life is sacred, even when the patient is unlikely to regain consciousness, and if that, only for a few more weeks in an extremely frail state. In big families where many members recognize the futility of extending unconscious dying life, there is often one or a few outspoken members of the family vocally urging that every last dollar must be spent to extent the number of heartbeats, guilt-tripping those members of the family who know how to accept dying as a part of life. As it is whenever something is declared to be sacred. Dying in the presence of easy insurance coverage is something to be fought at all costs, with no compromises.

Again, why don’t we all agree, ahead of time, that when the cost-benefit becomes lopsided, that there will not be any standard insurance coverage to extent the heartbeats of dying people with little hope of further meaningful life? When I ask people I know this question, they vote overwhelmingly in favor of this. As a society, we should draw that line in the abstract, so that those put in this position will have only the option or their own money (or buying a special policy for this purpose). As the above article concludes, “These are discussions that need to take place earlier in life, without a medical crisis looming overhead.”

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Do it yourself fecal transplants

| July 10, 2013 | Reply

Fascinating. Fecal transplants–yes, the transplants of poo from one person to another–have cured some extremely sick people and probably saved some lives. Yet the FDA enacted some regulations making the medical technique of transplanting fecal matter difficult. This left many people suffering from ulcerative colitis without an effective remedy, but still with a willingness to try the technique themselves.

The theory of the cure is that the intestinal bacteria (the microbiota) in some people are not well and and they need to be replaced with a collection of healthy bacteria. Given the current difficulty of finding a doctor to do the cure (given the current FDA restrictions) some people are stepping up to offer their own poo to help desperate friends and relatives. Here’s a general article regarding fecal transplants. Here’s a recent NYT story of one woman who successfully offered to help her friend. And for those who need to know how to accomplish a fecal transplant without the help of a doctor, here is a video produced by a women who has given fecal transplants to her daughter for about nine months, with resounding success. She describes the technique of performing the fecal transplant as “low cost, easy and effective,” accomplishing the transplant with the help of an enema kit and some kitchen accessories.

According to Wikipedia, many other conditions might benefit from fecal transplants, including autoimmune disorders, neurological conditions, obesity, metabolic syndrome and diabetes, and Parkinson’s disease.

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The horrendous cost of health care

| May 23, 2013 | Reply

These numbers from the Miliman Research Report are stunning. This situation cannot possibly be sustainable for most Americans, and I have little faith that the Affordable Care Act will reduce these costs. I want to believe that the ACA will address costs, but I simply can’t believe this. It’s also amazing that in light of these numbers, and in light of the recent blockbuster Time Magazine article, “Bitter Pill,” America seems incapable of having a rational conversation about what it really needs to do to reduce these horrendous costs.

Last year, when healthcare costs for the typical American family of four exceeded $20,000 for the first time, the Milliman Medical Index (MMI) compared the cost of a family’s healthcare to the cost of an average midsize sedan. This year, with costs exceeding $22,000 ($22,030), we note that healthcare costs for our family of four are almost as much as the cost of attending an in-state public college ($22,261) for the current academic year. The total share of this cost borne directly by the family—$9,144 in payroll deductions and out-of-pocket costs—now exceeds the cost of groceries for the MMI’s typical family of four. The out-of-pocket cost alone—$3,600 for co-pays, coinsurance, and other cost sharing—is more than the average U.S. household spends on gas in a year.

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About Americans

| May 2, 2013 | 1 Reply

I know that this article at Bananenplanet is filled with generalizations, but many of them rang true to me. Thoughtful article that suggests that Americans need to look in the mirror. Here are some of the main points:

  • We Know Nothing About The Rest Of The World
  • The Quality of Life For The Average American Is Not That Great
  • The Rest Of The World Is Not A Slum-Ridden Shithole Compared To Us
  • We’re Paranoid
  • We’re Status-Obsessed And Seek Attention
  • We Are Very Unhealthy
  • We Mistake Comfort For Happiness
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Pay for Delay

| March 31, 2013 | Reply
Pay for Delay

Why is it that generic drug makers sometimes delay entering the market, sometimes long after the drug patent expires? This is another tale in corporatocracy, told by Alternet:

[I]magine you’re a big-time drug company. You want to keep competitors off the market as long as possible. Your move is to basically sue the pants off the generic drugmaker for copyright infringement, setting in motion a long and tortuous legal process. And these usually end with “pay-for-delay” deals. The brand-name drug company pays the generic manufacturer a cash settlement, and the generic manufacturer agrees to delay entry into the market for a number of years. In the case before the Supreme Court, the drug company paid $30 million a year to protect its $125 million annual profit in AndroGel, a testosterone supplement.

It’s hard to see this as anything but bribery, designed to preserve a lucrative monopoly for the brand-name drug maker. In fact, this is what the Federal Trade Commission has argued for over a decade. They consider it a violation of antitrust law, arguing that the exchange of cash gives the generic manufacturer a share of future profits in the drug, specifically to prolong the monopoly. As SCOTUSBlog summarizes from the FTC’s court brief, in the regulator’s view, “Nothing in patent law … validates a system in which brand-name companies could buy off their would-be competitors.” Indeed, everyone wins with pay-for-delay but the consumer: the FTC estimates that the two dozen deals inked in 2012 alone cost drug patients $3.5 billion annually, with the brand-name and generic manufacturers splitting the ill-gotten profits.

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Best foods for the money

| March 5, 2013 | Reply

The Environmental Working Group has published this list of the top 100 most nutritious foods for those on a tight budget. This includes many of my favorite foods.

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