Wednesday, June 17, 2009

'"Complicated Patient" is the new scarlet letter..."

Dr. Wes has an open letter to patients regarding health reform:

Dear Mr. and Ms. Patient,

It has come to my attention that in order for you to enjoy success as patients in the new era of health care reform, you must start working now to prevent illnesses that might befall you. Do not, under any circumstances, eat or drink too much. Fast food might as well be considered illegal. Exercise three, four, five times a day, even if it means take time off from work. It goes without saying that you should not smoke. The government has data that demonstrates how you have become fat, lazy, and a huge burden on our health care system. Your non-compliance threatens the very fiber of our economy....

Also, do not be a surgical case that has any risk of failure. After all, "Complicated Patient" is the new scarlet letter as we work to cut even more costs. Fortunately, thanks to the new multitudes of guidelines for care that we must follow, I will be carefully interviewing you to assure that you fit into one of several pre-determined renumeration bins called "bundles." Please don't confuse me with more than one major disease since there is currently no way to handle this circumstance. I would suggest you pick the disease that bothers you most.


As a "Complicated Patient," who already does all of the above to take care of herself, I don't look forward to our new socialist overlords of health care.

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30 Comments:

Blogger Doom said...

Are psychiatric patients, by the very nature of the terms involved, complicated at the point of diagnosis? I would guess geriatric patients would be too, since, well, it is terminal. Then again, isn't that the point of the health care reform? Seriously. I could be wrong. I hope I am wrong.

10:43 AM, June 17, 2009  
Blogger njartist said...

Nurse Ratchet will be our caregiver.

10:46 AM, June 17, 2009  
Blogger HMT said...

I'm always shocked and amazed at how quickly the Canadian and European citizens were able to give up smoking, boozing and fast food once they went to socialized medicine.

Wait a minute...

11:02 AM, June 17, 2009  
Blogger GawainsGhost said...

Yeah, well, I'm 5'8", 145 lbs, slim, trim, and looking good.

People ask me all the time, how do you do it? How do you stay so slim and trim?

And I tell them flat out. Cigarettes and alcohol.

11:02 AM, June 17, 2009  
Blogger fred said...

"and make sure you have plenty of insurance...or else go to emergency ward and let those with coverage pay for you...this message approved by AMA."

ps: know a lot of guys using the VA and they do not complain about govt help!

11:10 AM, June 17, 2009  
Blogger Cham said...

American spend more for healthcare than any other country, yet, our mortality rate is dropping. We spend over $5K for medical care per year on average per person and other industrialized countries spend less that $3K. We currently rank #50 overall out of 200+ countries in expected lifespan.

European countries with socialized systems have programs that concentrate on disease prevention, we don't. Our healthcare system is designed to wait until one gets sick and then works on finding a remedy. We allow insurance companies to control payments and doctors to self-police. Americans want to freedom to visit the doctor they want whenever they wish for whatever they wish and they don't want the responsibility of paying the bill or taking any sort of preventative measure to avoid illness. They want what they want when the want it. It's getting to the point where a sizable chunk of the American population cannot afford medical insurance or medical care. Yet, it's a small wonder the doctors, the hospitals and the insurance companies are bellyaching the loudest at the very idea that something is going to change. These folks like things just the way they are. This is why the are using the Dick Cheney fearmongering tactic that life as we know it will come to a screeching halt if someone tries to manage healthcare spending.

I'm really sorry that I can't find the link to the video I saw last week on one of the news sites. It was 3 fat people sitting in a fast food joint eating burgers lamenting their increase in health insurance rates, figuring they could no longer afford to see their favorite doctors and were highly upset that life was going to change for them. According to them, it wasn't fair.

11:24 AM, June 17, 2009  
Blogger J. Bowen said...

ps: know a lot of guys using the VA and they do not complain about govt help!

I'm eligible for VA care but don't go because the VA in my area sucks. I pay for private care out-of-pocket when I need it.

By the way, what do those folks who get VA care think about the military health care system? My bet is that they have the same opinion that I have, which is that it should be avoided like the plague.

11:33 AM, June 17, 2009  
Blogger J. Bowen said...

I don't look forward to our new socialist overlords of health care.

I like that. Overlords...how fitting.

11:34 AM, June 17, 2009  
Blogger Vicki said...

Cham, you think the government is going to fix that and do a better job? Please. No entity the government manages is better. You think the Europeans don't have problems? Please. I don't know any Americans that want health coverage and don't want to pay for it. We do want reasonable costs.

I do wonder about those people who are born "complicated".

11:34 AM, June 17, 2009  
Blogger Roman Wolf said...

Fred,

I don't know what your friends are smoking, but the VA is probably the poorest healthcare system in an industrialized country.

http://www.marinecorpstimes.com/news/2009/06/ap_veterans_affairs_colonoscopies_061609/

Here is merely the latest antic from the boys at the VA(I could find much more than just this). Too bad you can't sue them, eh?

As for Cham's post, I'm crafting a complete rebuttal in a bit.

11:46 AM, June 17, 2009  
Blogger Cham said...

Vicki:

Smell the coffee, the system is already collapsing. 60% of personal bankruptcies involve a medical expense issue.

11:51 AM, June 17, 2009  
Blogger Joe said...

?American spend more for healthcare than any other country, yet, our mortality rate is dropping."

Unadulterated bullshit.

"We currently rank #50 overall out of 200+ countries in expected lifespan."

Bullshit statistic. Most deaths occur in the first year of life. The US counts infant mortality very differently than almost every country. Show me the life expectancy from age 2. Show me life expectancy from age 40. (Factor out American Indians and US life expectancy shoots up. Count only Minnesota, Utah and it shoots up even more. Count only non-smokers whites from Minnesota and Utah and it is on part with the highest numbers anywhere in the world. Yup, this is totally un-PC, but it's also the reality everyone won't talk about.)

Other points: fat people have lower mortality rates. The only predictive diagnosis for heart disease is high blood pressure (and that only works 30% of the time.)

Finally, if the US health care system is so bad, why do the rich of the world flock here for their medical care?

12:17 PM, June 17, 2009  
Blogger Roman Wolf said...

Cham, I'm going to merely assume that you are ignorant instead of disingenuous.

First off, the only fair measure of the amount of “healthcare”(as opposed to coverage) one is getting is the WHO's statistic on the level of “responsiveness”(or how quickly the system is getting to you) a system has. I do not know of one year where the WHO statistic of “responsiveness” didn't list the United States as number one. Mortality means far more than just the amount of healthcare one receives, it also reflects the riskiness of the lifestyle that people in that country lead. You ignore the plan fact that Americans live a far more risky lives than Europeans do. Further, it is because of our freedom that we can live these risky lifestyles. Coverage is also misleading because one can be “covered” yet never get healthcare when one needs it. Further, despite the far riskier lifestyles of Americans we live, on par only about a year(or two) less than most other European nations. We have our American healthcare system to thank for that.

Second, the amount of money it costs is moot as long as the populous wants to pay for it. In the United States, it's clearly shown that they still do. Just because food is vastly cheaper(in dollar amounts as opposed to real amounts) in Vietnam than in the United States doesn't mean that we're getting cheated on the price of food here. Further, our healthcare system funds in the way of 95% of all industrial research in the world(and much of the bulk of the academic research). Drug/medical device companies are able to bring new products to market in such a rapid rate thanks to the amount of money Americans are willing to spend on healthcare.

Hence when you see the sob story of the little old lady who can't afford the drugs she needs because they're too expensive. Just remember, if they weren't so expensive, they wouldn't of existed in the first place in all likelihood. Also you do not see that the FDA, due to there demands for such exacting testing, also dramatically raise drug costs here in the States. The Europeans don't have such exacting regulations. So, if you want to lower drug costs within our system, abolish the FDA.

Lastly, I want to address the rest of your post by talking about the formation of HMOs within the United States, but I must leave that till later.

12:32 PM, June 17, 2009  
Blogger J. Bowen said...

We currently rank #50 overall out of 200+ countries in expected lifespan.

By what measure? And does that measure account for things that have little or absolutely nothing to do with the quality of the health care in a given country...like the murder rate, workplace-related death rate, suicide rate, auto-fatality rate, and infant mortality rate?

Our healthcare system is designed to wait until one gets sick and then works on finding a remedy.

That's what doctors are trained to do! They're the mechanics of the human body. Disease prevention is a job for public policy since it involves behavior. Without incentives to live a healthy lifestyle, all of the hand-wringing by doctors about adequate exercise and a healthy diet is useless. You're not going to get people to live healthy lifestyles by changing who pays for health care. People respond to incentives in all settings. You want smokers to stop smoking and fat people to lose weight? Tax them at higher rates. By the way, if you get people to drop their bad habits, then they'll live longer. If everyone is living longer, health care expenses will go even higher.

We allow insurance companies to control payments

Why shouldn't insurance companies be allowed to control their money? If you want more control over your health care, pay for it yourself. There is a second Golden Rule besides the one most commonly known (the "do unto others" one). It goes like this: he who has the gold makes the rules. Americans have demanded in greater and greater numbers that others pay for a greater and greater share of their medical expenses over the past couple centuries. As the share of their medical expenses that they pay for has shrunk over time (it's currently around 15%), so has the amount of control over their medical care. If the American people want others to pay for an even larger share of their medical expenses, then they need to be prepared to have even less control over their health care.

It's getting to the point where a sizable chunk of the American population cannot afford medical insurance or medical care.

That's largely because people want to go to the doctor whenever they want and because of the government policies.

There are a limited number of general practitioners largely because of licensing regulations and because of the Medicare reimbursement rules. The number of doctors and nurses is intentionally limited by the state (largely at the behest of doctors and nurses themselves) via state licensing boards. To compound that problem, the government, via Medicare reimbursement rules, further limits the number of general practitioners by providing very attractive incentives to doctors to go into specialized medicine rather than into general practice (namely, it reimburses specialists at higher rates than general practitioners).

So, you start with a limited number of doctors because of the state and then further reduce the number of those that go into general practice via the incentive system and then magnify the problem by causing people to use more health care resources than they otherwise would by further insulating them from the true costs of health care via insurance and welfare programs...and people think the government should have an even greater role in the health care market? I say it's already made a big enough mess of health care. It's time to let the marketplace figure this out.

According to them, it wasn't fair.

Don't worry, you'll be paying for their triple by-pass soon enough...

12:37 PM, June 17, 2009  
Blogger J. Bowen said...

60% of personal bankruptcies involve a medical expense issue.

That's only because of how they responded to the incentives that were created by the government. In its efforts to put consumption into overdrive in the early- to mid-20th century had the unintended consequence of encouraging people to save less and less for their basic needs. You want fewer people to go into bankruptcy because of medical expenses? Change the incentives that encourage them to not save up for future medical expenses.

By the way, the Chinese are planning on doing the same thing.

Cham, I'm going to merely assume that you are ignorant instead of disingenuous.

You know what happens when you assume, don't you?

That aside, your comments about the responsiveness of a given health care system being the only fair measure of the quality of a health care system is spot-on. Unfortunately, most people don't read the WHO reports. They simply see statistics and say, "See. I told you Michael Moore was right!" I do read those reports (because I have large amounts of free time). The amount of irrelevant things that are included in their reports is amazing (for example, why would a country's health care system be penalized for not having strong-enough behavioral modification regulations when that's a public policy matter rather than a quality-of-health care policy?).

Second, the amount of money it costs is moot as long as the populous wants to pay for it. In the United States, it's clearly shown that they still do.

In economics, this is called opportunity cost. If you spend everything that you have to fight cancer, you haven't given up everything for nothing. You've given up everything for your life. Fighting cancer requires that you spend gobs and gobs of money. Once you've spent those dollars, they're lost to you. Hopefully, the fight was successful and you have your life in exchange. If you don't want to spend gobs and gobs of money fighting cancer, keep it and enjoy what little is left of your life. One way or another, the cost to you of having cancer is successfully fighting it and not having the resources that you used to fight it or having/doing whatever you want to have/do instead of fighting cancer but dying sooner rather than later.

1:03 PM, June 17, 2009  
Blogger Roman Wolf said...

Joe, J. Bowen,

Superb posts you two.

And before someone says we're not addressing all the factors, the healthcare system is like the weather. One person(or even a committee) will never be able to address all the variables that go into it.

Cham,

Did you know that many of the assertions on preventative care were made before? HMOs back when they were getting started claimed to have solved all the problems within the healthcare system by allowing preventative care by allowing people to see their primary care doctor whenever they wanted.

The problem is that most people don't follow physician advice on "lifestyle changes". And who would? Many of the finer and more enjoyable things in life(smoking, fine food, drinking) are also "dangerous" for you. While the gains from lifestyle modification are far in the future and commonly not tangible(and sometimes they're nonexistent). The only way that preventative care would ever work is either by the carrot or the stick. And both of those(if done by the government), by nature, impinge on an individual's freedom.

1:17 PM, June 17, 2009  
Blogger Professor Hale said...

Cham,
European countries focus on desease prevention.

In Europe you also cannot get Bacetracin because the approved "treatment" for minor cuts is exposurre to the air.

Drug costs in Europe and Canada are also cheaper than here because they simply copy our formulations without paying the royalties to the American companies that created them.

In France, you can get a prescription to visit Lourdes for a miracle. In Germany, you can get a prescription for a "Kure" or what amounts to a holiday at a spa. Why? Because such things are cheaper on the system and less complicated for the doctor than actually treating the patient.

But on the bright side, The last time I visited an emergency room in Germany, it was empty. We had to wait while the staff was awakened. Maybe it is because they don't have a federal law requireing every patient who shows up at an emergency room to get treatment, whether they can pay or not.

1:21 PM, June 17, 2009  
Blogger Rob Fedders said...

Did I hear people talking about socialized healthcare?
AAAAAAHHHHHH! (Rob flings self off cliff!)

Everything the government touches works at a 30% inefficiency rate compared to the private sector. Everything

Here in Canuckistan, it is typically 4-6 weeks to see a specialist – even if you are in the more serious categories of illness. And when you get to see one, and he’s just a plain quack, you don’t dare to tell him to get bent because then you will be waiting for a few weeks to see the specialist that originally referred you to him, so he can re-refer you onto another waiting list for several weeks. Remember, for some illnesses & surgeries, you must see more than one specialist.

We have healthcare funding shortages time and time again – this year too, my province is again $400 Million short, and so more hospitals & wards are closing. This has been happening for quite some time now, and many small towns now have vastly inferior healthcare.

People can sit on a waiting list for over a year – or two - to get lifesaving operations like a heart bypass.

The elderly are forced to accept inferior hip-replacement parts, as the good gov’t deems that their lifespan is not long enough to warrant paying for a better one. And no, they are not permitted to pay the difference out of pocket for a better one. Hip replacements too, have loooong waiting lists – for elderly people who have only a limited time that they can be mobile, even with a good hip. Would you like to spend 20%-40% of your golden years… waiting… waiting…

We are prevented by law from purchasing private health insurance – cause then we wouldn’t all be equal, would we?

We are prevented by law from having a two-tiered healthcare system – which many people want. As in the rich want to pay out of pocket for private healthcare services. But nope, then we aren’t equal… point out that such a system would also shorten the waiting lists for those who can’t afford to go private… tap, tap, tap… Hello! McFly! Did you miss the equal part? (As it sits, we do have two tiered healthcare – it is called paying out of pocket for American healthcare).

And they do use it as justification to pass laws in other areas of life. In my province, about a dozen years ago, they passed a law requiring all people riding a bicycle to wear a helmet… because, um, head injuries are costing the healthcare system too much. Uh huh, BULLSHIT! If they were really concerned about head injuries, they would require us to wear a helmet while driving our cars. I haven’t ridden a bike since the day they passed that law. It will be a frosty day in hell before I ride a bike with one of them fruity cans on my head. Although, I must say, I do remember 50% of the children I grew up with, becoming cerebrally damaged from bicycle accidents… I hear Manitoba has passed a law requiring all children to wear a helmet while tobogganing – I’ll bet the same arguments were used.

Sorry, gotta go! The ground is rushing up quick… AAAAAAAAHHHHHHH!!!!!! Splat!

1:39 PM, June 17, 2009  
Blogger J. Bowen said...

Speaking of regulating people's lifestyles...

Just like how the federal government tried to make rape a federal crime because in a very roundabout way it interfered with a woman's ability to engage in commerce, the federal government will find ways to manage every aspect of your life on the grounds that it in some way affects your health...only it will be more successful at doing so (thankfully, the statute making rape a federal crime was tossed by a federal judge).

2:50 PM, June 17, 2009  
Blogger I R A Darth Aggie said...

Let me note that Freddie Mac and Fannie May are government sponsored entities.

How'd that work out?

3:12 PM, June 17, 2009  
Blogger Hayek said...

My internist tells me that if the "best practices" concept is adopted in a national health care plan, the primary care doctors will only be interested in taking on the healthiest patients, which along with the other ramifications has the effect of dulling their skills. What a great concept!

3:12 PM, June 17, 2009  
Blogger class-factotum said...

Statistics are soooo useful. Like when the local news team in Memphis reported how my zip code had the highest mortality rate in Memphis. But neglected to add that a possible reason for all those deaths might be because there was a HOSPITAL in that zip code.

Infant mortality is not reported consistently around the world. People who are really sick come to the US for treatment. Guess what? Even our docs can't cure everyone, so sometimes those really sick people who have come here die anyhow.

There are all sorts of reasons that might explain certain stats.

4:58 PM, June 17, 2009  
Blogger Chuck Pelto said...

TO: All
RE: Heh

According to the information from the Congressional Budget Office (CBO), this new and improved program is going to cost me half again as much as I'm currently paying for my health insurance....via taxes, here and there and everywhere....

Some kinda improvement, that.

Regards,

Chuck(le)
P.S. The concerns about cost 'cutting' by getting rid of the 'inconvenient' is a serious concern.....

...but the bozos who are so enthralled with Obama will never hear it....until the last few beats of their own hearts as they are considered 'cost cutting'.....

6:17 PM, June 17, 2009  
Blogger Laura(southernxyl) said...

Health plan covers assisted suicide but not new cancer treatment

Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.

Instead, the letter said, the plan would pay for comfort care, including "physician aid in dying," better known as assisted suicide.


I get that taxpayers can't offer everybody everything, really. But it's kind of cold to convey to the patient that she can't have the treatment her doctor prescribed and offer assisted suicide in the same letter, don't you think? And I can't help but wonder if this is the kind of thing we're all facing if we let the gov't take over medical care for everyone.

7:00 PM, June 17, 2009  
Blogger Sad_Dad said...

Watch the documentary "SICKO" That opened my eyes. We are paying high prices for medicine because our Pharmaceutical Companies, and their lobbyists forced (to sell us out) our elected officials to vote for a law that the Pharmaceutical Companies created "big money for our elected officials" and the Pharmaceutical Companies. These companies have made it so we don't have any competitive pricing in this country for our medication, and we are forced to pay what the Pharmaceutical Companies are dictating to us. Something like an inhaler that cost .5 cents in Cuba cost us $125!!!! Does anybody see this???
Why do we “need” insurance companies? Is it “absolutely necessary” that we have insurance companies? They’re making our bills higher, tell us we are approved for an operation or not. Some people in this country that” have” insurance are dying because they are being turned down for operations that they need to stay alive. There are people that work for insurance companies and it’s their job to except or deny these operations that people need to live, they deny operations to people only to save the company money and the more money they save the bigger bonus they get but, at what cost? Must people die like this and for this reason? After all we are Americans and we are the best right! Well, are we? Inside these companies these people are looked at in a very high status symbol sort of way they get awards more bonuses for cutting off people from operations they need. This is the truth I’m not making this up. This is happening to people right here in the USA, we are the best remember.
It is clear to me that our government and Corporate America want us to fear government paid medical care systems. I visited my sister in Canada and I broke my ankle in her house falling down the stairs, she took me to the closest hospital and got it taken care of totally free, not one wallet was open by anybody at the hospital that I could see and I wasn’t even from this country. And the total amount of time I waited to see a Doctor was 5 minutes. 5 MINUTES!!! And I didn’t have to pay anything for the 30 day supply of medicine they gave me. I walked in broken and in pain and walked out on crutches without even needing money at all. That was awesome I couldn’t believe it. So tell me what is so bad about that system? I’ll tell you. Our government and Corporate America make us fear this system they want us to be afraid of it. By telling us things like this, it’s a communist system and we’ll become communist, or it’s a socialist system and that leads to communism. Please. They will do anything to prevent this from happening and not because of us turning into socialist and communist, it’s because they won’t be making the big bucks their making now anymore. It’s all about big money and nothing else but profit, and we are the cash cows. Believe it.

4:41 PM, June 18, 2009  
Blogger J. Bowen said...

You did not seriously reference an entertainment movie, did you?

6:02 PM, June 18, 2009  
Blogger Sad_Dad said...

I said it was a Documentary, not entertainment.

11:16 AM, June 19, 2009  
Blogger Sad_Dad said...

I also experienced it myself.

12:13 PM, June 19, 2009  
Blogger J. Bowen said...

Sicko is not a documentary. Documentaries contain factual information. Sicko is rife with inaccuracies and distortions. Like Michael Moore's other entertainment films, it is intentionally one-sided and doesn't even do a particularly good job at even that. You would do well to avoid...well...anything made by or said by entertainers like Michael Moore and Al Gore as their works only serve to lower your IQ...

9:46 PM, June 19, 2009  
Blogger Sad_Dad said...

LOL I'll have to remember that...

6:24 PM, June 20, 2009  

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