Friday, July 31, 2009

Why don't insurance companies give more donations to politicians?

Here is the top 100 donors to Congress. You see the AMA, dentists, pharmaceutical companies. You see everyone that's going to make out like a bandit when reform passes. I see a single insurance company represented. If the big evil health insurance companies are so rich, why haven't they been the biggest donors?

House Speaker Nancy Pelosi ridiculed criticism by Republican Senate Leader Mitch McConnell of Democrats’ health-care plans, saying he’s echoing an insurance industry which makes “exorbitant profits” at the expense of Americans’ well being.

Why aren't they turning those exorbitant profits into massive donations like the other businesses do? The industry that's made the smallest donations is being singled out as the root of all health care woes.

Thursday, July 30, 2009

Sacrifice, my butt.


KevenMD blogging about patient sacrifice required to reign in costs in abstract terms...


What if the pricey blue pill is actually better than the cheaper red one? What if it’s better but just a little bit? What happens when a yellow pill comes along, costing twice as much as the blue? What happens if there’s a new procedure that cures the ailment, but at an even bigger cost?


You healthy folks have the luxury of discussing this abstractly, but let's cut to the chase. Will I or won't I have to give up my no-side-effects Humira ($1600/month) and end up on Prednisone* ($16/month) instead? I've got a great GI that has kept me off that mess so far. What if in the long run prednisone and ostomies for prove to be cheaper than Humira for All? And if I make this sacrifice, what for? So someone else can get $30 off their next well baby visit?


Just sayin'


Nasty steroid side effects: high blood pressure, headache and muscle weakness. Prednisone also can cause puffiness of the face (moon face), growth of facial hair, thinning and easy bruising of the skin, impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back ("buffalo hump"), obesity, retardation of growth in children, convulsions, and psychiatric disturbances. The psychiatric disturbances include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior.

Blue Dogs Barking Up the Wrong Tree

"Poor people would get subsidies to help them buy care after spending 12% of their income on premiums, instead of 11% in the current bill."


The reformed reform plan is that an individual with a 50k income would need to come up with $5200 in premiums, no mention of deductibles, lowest tier in the exchange currently at 25% with out of pocket max of how much? Who can afford this? Why aren't HSA's considered?

Tuesday, July 21, 2009

I'm ready to get well now.

Daddy always used to say when I got hurt, "Think about how good it will feel when you get better." There is no getting better with this disease. It's not so much than any particular ache or inconvenience can't be handled, it's the day after day after day relentless nature of it that is like Chinese water torture.

Thursday, July 16, 2009

Global payment = global pain in the butt?

Looks like fee for service didn't control costs in Massachusetts so they want to switch to paying docs per patient. If the doctor keeps the patient healthy he makes some money. Polticians must imagine that physicians have some kind of voodoo magic to make patients lose weight and quit smoking. Will they be able to fire a noncompliant patient? Will they be able to say that difficult cases are beyond the scope of their practice? Will they be able to turn down a patient's 732,930th request for an appointment for pain killers, loneliness, or that disturbing ache in the pinky finger?

This brings to mind the schemes that are put in place in prisons to keep food budgets under control. If a warden keeps the budget down he's allowed to personally pocket some money.


In Alabama earlier this year, a federal judge ordered the Morgan County sheriff locked up in his own jail for contempt for failing to adequately feed his inmates. Alabama allows sheriffs to keep food money they do not spend, and the sheriff reportedly pocketed more than $200,000 over three years.

Well, I'm not going to be one of those people that a doc can keep healthy. I'm not sick because I'm fat, I don't have hypertension or diabetes or any other "lifestyle" disease, I have Crohn's and I'm going to be a big pain in the butt to treat for any doctor who is rewarded for healthy patients. Perhaps one of the ways that a GI will be able to save a little money from me is to not use conscious sedation during a colonoscopy , an oft repeated event in the life of a Crohn's patient.
Colonoscopy without sedation is common in Europe and Asia, and efficacy is
comparable."There have been several studies that show that if you have motivated patients, a significant fraction of them can have a colonoscopy without sedation," said Douglas Rex, MD, past president of the American College of Gastroenterology

That's right, folks, lack of sedation is one way to keep costs down. We might quite literally take this one up the ass if it becomes national policy.

Enjoy those govt provided "free" well baby check ups.

Don't bother with doc says NHS.

I make the rounds to various international newspapers and saw this advice in today's Telegraph on how to handle swine flu:

Official advice is stay at home and log on to the NHS Direct website, consult
the Swine Flu Information Line (08001 513 513) or your GP for advice by phone.

If swine flu is confirmed as a phone diagnosis, then
you will be given an authorisation voucher - this means someone who can act as
your 'flu friend' can collect it from your GP's surgery and take it to a chemist
to pick up Tamiflu (or the alternative anti-viral relenza, if you cannot take
Tamiflu, for example because you are pregnant).
'Avoid going to your GP surgery.There may be people in the waiting room with underlying health issues for whom swine flu could be very dangerous,' says Dr Baker.


Read more:
http://www.dailymail.co.uk/news/article-1199760/SWINE-FLU-Your-vital-questions-answered.html#ixzz0LQzM0YON


Is it even legal in the US to make diagnosis by phone? I have a low level UTI right now and I'm pretty sure I'm going to have to pay the $150 for the doctor visit that is required so that I can get the $4 cipro from WalMart. Just seems like there is a lot we could do to lower costs in the US without disrputing the lives of patients and the livelihoods of providers.

Govt should pay my bills so that I can have fun!

Tim Egan's opinion piece in the New York Times informs us that we wouldn't have to work in unfun jobs if it weren't for those pesky bills.

We all know somebody who is sticking with a lousy job because of the health care. Economists call this “job lock,” and it stifles entrepreneurship and mobility, among other things.

We may also know someone who has remained married to the wrong person for the same reason. Call this “marriage lock.”


http://egan.blogs.nytimes.com/2009/07/15/health-cares-historic-moment/

No worry about high taxes preventing financial independence, all this health coverage will be free or a "small increase in taxes." Once we get rid of those high salaried CEOs helath care will only cost $1 per member per month, don't you know?

Monday, July 13, 2009

Humira ceases to work?

Daily I've been getting more fatigue and more joint pain. Yesterday I felt aches and pains as if I had been beaten up and I wonder what the game plan is if the Humira stops working altogether. My usual modus operandi is to let everything get intolerably bad then call up the nurse at the office.

Meanwhile at the national level the health care coverage debate rages on and as a patient I have no idea what fate befalls me a few years from now.

Sunday, July 12, 2009

An enlightened comment

Sometimes the comments are more interesting than the articles. This one is to a WSJ article:

In my opinion, we should go to a "single payer" model where people pay for their primary care, much the way you might pay for a haircut or an oil change. For more expensive procedures, people should pay for at least some of the cost. Eventually, comparison shopping and the sheer pressure of people choosing to die rather than be bankrupted will force the prices down to a more rational level once again.


I got $100,000 in the bank, but I think I'll choose to die rather than spend it on medical care. Is that what would motivate the "choice"? A single payer system isn't needed for this scheme. As it is there are a few people forgo insurance and die, doesn't bring costs down.

Wednesday, July 8, 2009

An Extraordinary Belief

New York Times David Leonhardt says US health care system broken because of prostate cancer treatment. Or all the diseases he could have chosen! The US is ranked number one in prostate cancer survival rates, Leonhardt ignores this entirely and claims that it's prostate cancer treatment that is driving up the price of health care, actuaries would say the chronic diseases obesity and smoking cause are the lionshare's of their claims.

The most popular readers comments are always entertaining:

"Private insurance is the extraordinary belief that for-profit entities, with profit as their sole motive, will somehow provide good health care for the benefit of all".



Extraordinary claims require extraordinary evidence: The US has possesses the leading technology with the success rate to back it up. I'll go a step further for these skeptics: Private grocery stores is the extraordinary belief that for-profit entities, with profit as their sole motive, will somehow provide good clean food for the benefit of all.

Tuesday, July 7, 2009

French Health Care

This does not inspire confidence.

"Like Medicare in the United States, French NHI provides a great degree of patient choice."

http://www.ajph.org/cgi/reprint/93/1/31.pdf

Monday, July 6, 2009

Will "public option" really pay for the meds of the chronically ill

Sometimes govt insurance just doesn't pay for what you need. Two shots of Humira run my insurance co about $1600/month.

But several of these medications are expensive and can be difficult to get if a person doesn't have private drug insurance, said Dr. Kenneth Croitoru, a gastrointestinal specialist and researcher at Toronto's Mount Sinai Hospital. Although provincial government programs cover the costs of some of these drugs for individuals without private insurance, the programs don't cover some of the drugs that work best in people with IBD.
Bear in mind that 2 shots per month is the lowest or maintenance dose for Crohn's.


LINK