Tag Archive | "health care"

A story about our broken health care system.

broken-net

We have a broken health care system. People can’t get the help they need, and the broken parts don’t communicate with each other – as witness this story.

A woman, married and with a child, got pregnant. Her family’s income was about the median for her county, which made her eligible for Medicaid as a result of her pregnancy. Unfortunately, she miscarried. There followed several months of unexplained abdominal pains. Doctors and specialists were unable to diagnose them. They told her if she was in pain, go to the ER, which she did about a dozen times over six months. The ER, of course, treated the pain but did no diagnostics. They told her to go back to her primary care doctor for diagnosis. But neither the primary care doctor nor the specialists were able to identify a cause for her pain.

Then one day, a PA in the ER flagged her as a possible drug seeker because of her frequent visits. As a result, Medicaid put her on restriction, which means that only her primary care doctor can prescribe for her, and she can’t see any other doctor without a referral, and she can only get her prescriptions filled at one pharmacy (Walmart).

Here’s the fun part: her doctor told her to get a flu shot. Medicaid covers flu shots. However, Walmart doesn’t offer them, and since she is restricted to one pharmacy, she was unable to get one that was covered by her insurance.

Then there’s even more fun: she got pregnant again. She’s allowed to see an OB/GYN, because her primary care doctor referred her. But the OB is not allowed to prescribe for her, nor refer her to any other specialists. For that, she has to go back to her primary care doctor. The average wait time for an appointment is ten days. Ten days, when a woman is pregnant, can make the difference between a healthy baby and a miscarriage.

Her nine-year-old son was also eligible for Medicaid, until the family bought a $2,000 car. Medicaid determined that the car was actually worth $4,000, which put the family over the $3,500 limit for personal assets. That disqualified the son from Medicaid. There is no appeal over the value of a vehicle – they use a table that overrules both actual and market price.

I think Medicaid is a great program. But our system is so flawed that it doesn’t work for many people.

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Question doctors. Their advice isn’t always correct or safe

medical-symbol

A few years ago I was gardening and got some dirt in my eye. It got infected so I went to a doctor and told him what happened. They said, “That’s impossible, we see no sign of it,” and wanted to put me on highly toxic IV antibiotics for a month for some rare and much more serious disease. I refused, took the eye drops that were appropriate for dirt in the eye, and got better quickly.

Another time I was eating a pill and it stuck halfway down and dissolved while stuck to the side of my esophagus. After a couple of weeks of esophagus pain I went to a doctor to see what he could do to help. He literally refused to consider the possibility that a pill had stuck to my esophagus, told me I had a serious chronic disease, and instructed me to take four times the recommended dose of a nasty med for the rest of my life. I thought about that for a few days and then gave him the heaviest verbal thrashing one human being can give another. So I refused the meds and got better in another week, which is normal for a pill stuck in the esophagus.

Then there was the time I was due for surgery. They said take a certain antibiotic the day before. When I got home from the pharmacy I noticed, at the top of the instruction sheet, in capital letters, “WARNING: THIS MEDICATION CAN CAUSE PERMANENT HEARING LOSS.” I called up the surgeon and said, “I’m a professional musician by avocation as well as vocation; I would rather die without surgery than live as a deaf musician.” He said, “No problem.” It turned out there was another perfectly safe antibiotic I could take but they hadn’t thought about that.

The obvious conclusion? Question all health care providers, especially the ones who do not listen to the patient! Many years ago I studied and then practiced acupuncture, and was an active part of the alternative healthcare community in both Vermont and California from about 1977 to 1990. But I met so many untrained incompetent egotistical under-educated anti-scientific quacks that I became ashamed to be an alternative medical practitioner, closed my clinical practice, and went back to full time music.

Fresh, local, organic vegetarian food and nonstop music is my health care now, and if I absolutely have to go to a doctor, you can be very sure I ask a lot of questions and argue with many of the answers. We are in the dark ages of health care; it is a science that has not really been discovered yet. Be careful, my friends.

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We need comprehensive health care for all

Our health care system is so broken that people who desperately need medical help may not be able to get it.

My blogging here has bee a bit irregular lately. That’s because we’ve been preparing for my wife Sue to have cornea transplant surgery. She has Fuch’s Dystrophy, which clouds the cornea and eventually leads to blindness. They did her left eye yesterday and the operation is a success. Sue says she can see much better out of that eye now, just 24 hours later.

The operation is done by peeling the bottom two layers off the cornea, replacing it with the donor cornea, then holding it in place with an air bubble. Amazingly, this is an out patient procedure. Sue had to lie on her back for 18 hours afterwards to give the new cornea time to bind to the eye. Thus, we took turns watching her at night to insure she didn’t roll over.

Sue designed this foam pillow to insure she didn’t mover her head in the first 18 hours. Her retired engineer father assembled it!

Recuperation will take about two weeks. We are fortunate in that Sue works for the government so we have good insurance. But what’s happens to people who have no insurance? A friend of hers called last night to see how Sue was doing and mentioned she has scoliosis, is in terrible pain, and needs a custom brace. But Medicare doesn’t cover it and she can’t afford the several thousand it will cost.

It is just wrong that a prosperous nation like ours has such substandard health care that our friend must suffer in increasing pain.

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Health care: sparrows and cardboard boxes

Birds. Sparrows feeding in a park, ca 1920-1950. Theodor Horydczak (Library of Congress Prints and Photographs Division Washington, D.C.)

Several years ago I sat next to a Frenchman on a flight from Paris to Washington DC. He stated that his country considered access to health care a human right and asked why my country didn’t provide it to its citizens.

Two years ago we got a watered-down version officially known as the Affordable Care Act (ACA).

Now we have people kneeling in the street in front of the Supreme Court Building praying that the ACA will be overturned.

Which reminds me of one of my very favorite quotes about the American polity from commenter Davis X Machina at Balloon Juice–it’s now enshrined in the Lexicon:

“The salient fact of American politics is that there are fifty to seventy million voters each of who will volunteer to live, with his family, in a cardboard box under an overpass, and cook sparrows on an old curtain rod, if someone would only guarantee that the black, gay, Hispanic, liberal, whatever, in the next box over doesn’t even have a curtain rod, or a sparrow to put on it.”

Or health care either.

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Specialty MDs turn away most children with public insurance

Sixty-six percent of publicly-insured children were unable to get a doctor’s appointment for medical conditions requiring outpatient specialty care including diabetes and seizures, while children with identical symptoms and private insurance were turned away only 11 percent of the time, according to an audit study of specialty physician practices in Cook County, IL.

“We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance — even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children” said a study author.

Reimbursement amounts, incentives, and the mission of the health care provider are major factors, with reimbursements being key. It takes a long time for the government to pay and it often doesn’t pay as much as private insurance, plus the paperwork can be onerous.

Many doctors now are getting squeezed by insurance companies and the government. I know of one MD who despite his best efforts to manage insurance and having one employee who did it full time, was recently forced to join a group practice where they have several people who do nothing but insurance. A while back, my obstetrician cousin shut down her practice when her malpractice insurance jumped from $60,000 to $200,000 a year.

Our medical system is broken. Private insurance is difficult enough for doctors to manage. Public insurance is even worse and it pays less. Thus it’s no surprise, if disheartening, that MDs don’t want to take public insurance patients. There may be a class issue here too. If a child is on public insurance then the parents are probably on welfare and doctors may not want to deal with them. What a mess.

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Climate Change: How bad can it be?

It is easy to become lulled into intellectual somnolence by the seemingly gradual changes we are incurring in our weather. After all, just how bad can a couple of degrees be?

Oh, we wake up every once in a while when our catastrophe leads media reports on some hurricane, flood or tornado, especially if the event is half-a-world away. We all thought that the outbreak of tornadoes that struck the Southeast this spring was bad enough It truly was in Tuscaloosa. Then, we had to live vicariously through Joplin again. I remember May, 1971 tornado that hit Joplin. But we need to pay more attention to the facts of what is happening rather than jumping to unsubstantiated conclusions.

Heidi Cullen give a good summary of what we know about climate change and tornadoes in this post at Huffington Post and then repeated, with comments, by Joe Romm at Climate Progress I give you that link as Joe’s bracketed comments point to additional information

Still, we need more understanding than that and this Mother Jones summary of a report from the Union of Concerned Scientists does just that, bringing attention to the relationship between climate (temperature), ozone and health. There is a lot to piece together and the collage is not a pretty picture or a wonderful future.

The report, published yesterday by the Union of Concerned Scientists, concludes that CO2-induced temperature increases will worsen ground-level ozone concentrations (the kind coming from power plants and exhaust pipes, not the kind that shields the Earth from UV rays). Higher concentrations of ground-level ozone threaten the health of millions of Americans, an impact that could cost the US $5.4 billion in 2020.

As someone who suffered with asthma as a child, and that was long before we had inhalers or corticosteroids to deal with the symptoms. Asthma is not what I would wish on any child but that is what we are doing.

There are two recent takes on the effects of this. One is a post at Climate Progress that recognizes asthma as an environmental justice issue facing, primarily, people of color. The other is a rather straight forward determination that Californians will be the most affected and shows up on the KQED (SF) blog: Climate Watch. They both comment on the same report, just frame it differently.

This is going to be additive to the problems that we already have in California. A 2006 report from CSU Fullerton found that air pollution was costing California’s some $3 billion annually. Included in this finding were:

23,300 asthma attacks
188,000 days of school absences
3,230 cases of acute bronchitis in children

The authors updated and expanded that study in 2008. This time they included the corridor leading away from the port at Long Beach and all that diesel traffic. Now the cost to California was $28 Billion annually and the costs to our children, in terms of health and education were more striking;

Asthma attacks: 141,370
Days of school absence: 1,259,840
Cases of acute bronchitis in children: 16,110
Days of respiratory symptoms in children: 2,078,300

This is the base problem to which we are adding an additional load from increase pollution.
While the current economic conditions will alter the monetary value, the number of events do not change. Even with school funding being cut and cut, those lost school days deprive our education system of what it really needs to do its job as funding formulas use average daily attendance.

If Greens want to work for better education, if we want to lower the cost of health care, if we want a better future for our children, then we had better be spending a lot of time on the battle for a rational climate policy. It is as important as anything else we do, since it deal with everything at once: energy, the economy, health care, education. The economic cost for California would be as high as $1.8 billion / yr by 2020 if we do nothing. The cost to our children can not be so easily calculated.

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HR676: We Want Health Justice

Health care and health justice rap by Lonnie Ray Atkinson who says “This song is under the Creative Commons License: Attribution-NonCommercial 3.0. You are free to download this song and share it with as many people as you like (please respect and include attributions). I don’t want any payment for its use. I just want to contribute toward achieving health justice.”

HR676: We Want Health Justice. Lonnie Atkinson (click to listen)

It’s important that the people understand what it is we’re fighting for
we don’t want health care, we want health justice

First verse:

is it fiscally conservative to pay more for less
is it morally conservative to accept the deaths
that our system ensures when the insurance stops
is it worse to be a scandal or a laughing stock
ain’t ner’ one developed country wants what we got
they made the choice long ago to cover they whole lot
left examples for us so we could follow they lead
but that’s like godless talk for those who worship greed
heresy to imagine people before profits
narration: good thing we’ve already baptized most the congress
yeah they sold out in ’09 for the fake fix
secret handshakes with ever corporate hand in the mix
as long as there’s a dollar to be made you can bet
on a bill with more holes than some cheap fishnets
i said here a hole there a hole everywhere a loophole
here a hole there a hole just add to the bankroll
of politicians who let their constituents die
holding a loved one’s hand saying their last goodbye
i’m talking thousands upon thousands every year
tell me is the profit model gonna dry their tears
the richest country in the world, lord, what have we done
still all you hear them hollering is we’re number one
- but we’re not, y’all, we’re not
but yo, it ain’t too late for us to blow up the spot

Chorus:
so if you want health justice let me hear ya shout
everybody in and nobody out
if you want health justice let me hear ya shout
everybody in and nobody out
One Plan / One Nation / One Nation / One Plan
HR 676, y’all HR 676

Direct link to download the song (right click):

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Intermountain Healthcare. High quality, low cost health care

Recently a friend was rushed to Valley View Medical Center here in Cedar City UT by his wife after he became quite ill and was coughing up blood. They diagnosed him with pneumonia. His fever was very high. The hospital immediately filled him with liquids, antibiotics, and provided superb medical care. Three days later he went home. They unquestionably saved his life.

Valley View is part of Intermountain Health, who was specifically noted by Obama in 2009 for providing low cost, high quality medical care.

“We have to ask why places like the Geisinger Health system in rural Pennsylvania, Intermountain Health in Salt Lake City, or communities like Green Bay can offer high-quality care at costs well below average, but other places in America can’t. We need to identify the best practices across the country, learn from the success, and replicate that success elsewhere,” [Obama] said.

Plus, Intermountain works with patients on the bill. After consulting with our friends, who had financial reversals in the past and are now working nonstop to build a new life, Intermountain dropped their bill, which was already modest by most standards, by about one-third and gave them considerable time to pay.

This is how health care should work. Kudos to Intermountain Health.

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Virginia judge rules mandatory health insurance is unconstitutional

A U.S. District Court judge has ruled the “individual mandate” which says Americans must purchase health insurance by 2014 is unconstitutional.

“An individual’s personal decision to purchase — or decline purchase — (of) health insurance from a private provider is beyond the historical reach” of the U.S. Constitution No specifically constitutional authority exists to mandate the purchase of health insurance.”

Good. While parts of the health plan are exemplary, forcing mandatory purchases (and fining those who don’t have insurance) has always struck me as noxious and a governmental overreach.

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Healthcare! The topic of interest on the tip of everybody’s tongues

(Polizeros welcome our new contributor, Will O’ The Wisp)

Well, maybe on the tips of the tongues of those well-heeled, health-insured politicians. On the tips of the tongues of those whom health care reform is meant to assist? Food! Water! Shelter! Bills! Let’s go back to that first subject – Food. I admit, my friends, I have yet to read the full 2000-plus pages of the health care reform bill (But then, why should I be the first to read it?) but I am reasonably confident that there is not a discussion of food in it. Not in the availability sense, but rather in regards to how it should be consumed, and more importantly, subsidized.

There has been research (reach out to me if you want backup) that directly points back to our diet as the major factor in increased incidences of cancer, thyroid problems, diabetes, and other life threatening conditions. You, my friends, may know this already, but do you really think about all the chemicals and preservatives you consume with every bite of fast food and processed food that you take? If chemicals are used to preserve food, what do you think it does to your organs? And how does it effect your body function? And more importantly, why is the first response to illness or conditions such as acne to prescribe drugs? More chemicals? Is it possible that altering our diets to include more natural and organic foods could solve a majority of our problems? It is, my friends, it is.

But here’s the rub: The health care industry doesn’t want to promote those solutions because it hurts their bottom line, the whole health care ecosystem. Furthermore, it “hurts” our agricultural system, as it exists now.

Look at the graph. You see all those subsidies for corn? That would be for the corn that makes the corn syrup in all of the least-healthy foods we eat. And the corn that feeds the cows on the antibiotics that we eat. And the chickens and the pigs too. The corn is cheap, because of the subsidies, which makes the animals cheap, which makes our fast and packaged and processed foods cheap…and our fruits and vegetables and nuts relatively expensive. Which, in turn, means we eat fewer fruits and vegetables, experience a range of health problems ranging from cancer to obesity, and continue to drive up health care costs that are bankrupting the country, and encouraging more government intervention, because, well, no one just wants to take the initiative, personal responsibility, and eat more healthy.

Food subsidies from the government are a problem. But isn’t this what they wanted? What they bargained for? They create a problem so they can offer a solution. Each solution creates more problem. Stand up, my friends. Make your choice.

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