WhiteCoat

Healthcare Update — 02-04-2013

Chinese man runs out of money to pay for dialysis. Government “insurance” only pays half the costs of treatment (keep that in mind, Affordable Care Act supporters). Then human ingenuity kicks in.
The man builds himself a dialysis machine out of used and discarded medical equipment, mixes his own dialysis fluid, and has been dialyzing himself … and it has been keeping him alive for 13 years.
Doctors hearing about his unorthodox methods warned him about the risk of serious infection and “long-term complications” because he wasn’t using sterile water to make his dialysis fluid. Something tells me that if the complications were that likely, they probably would have happened in the past 13 years.
After getting outed in the media, the Chinese government then offered to provide him with assistance to pay for his treatment. He’s reluctant to take the government up on its offer.
I wonder what would happen to this patient if he was in the US.
Hat tip to @MedicalQuack

Just call them “assault” bacteria when you describe how they kill people – our legislators and the media will jump all over that. We can’t let ourselves become complacent over drug-resistant bacteria.

Interesting point … once doctors become employees, does their incentive to fill their schedule with patients decrease? Will they want to stay late in the office to see an urgent patient? Will they go on strikes and leave patients without health care? See how access to care decreases as the paradigm unfolds.

With increasing numbers of antibiotic resistant organisms in hospitals, do we need to start asking whether it is safe to go to the hospital? By the way, your ZeePack is becoming less and less effective against all types of infections because bacteria see so much of it prescribed, but for lunch these resistant organisms drink ZeePack cocktails and then have Levaquin hors d’ourves … and then they laugh at the people spending money on ineffective medications.

Medical device company Stryker cuts 1,170 jobs, citing the Affordable Care Act as the reason.
Medical device company smith&nephew cuts 100 jobs in the US due to the Affordable Care Act.
Then the IRS states that the least expensive health insurance plan available in 2016 under the Affordable Care Act will cost a family $20,000 per year. If you don’t pay up, you are forced to pay an extra tax/penalty.
Maybe we need to start calling it the UNaffordable Care Act.

The good news is that they won’t develop intestinal worms any time soon. The bad news is that the medication some drug dealers mix with cocaine and heroin may cause dangerously low blood counts and skin necrosis.

California patient becomes upset about incontinence which occurred after prostate surgery, goes to doctor’s office and shoots him dead.

Busting 5 malpractice myths? Some of the claims seem spurious to me.
HT to @epmonthly

101 year old Chinese woman declared dead and then wakes up at her funeral – just as she was being put in her coffin.
Now all I can think of when I hear stories like this is a YouTube video one of my co-workers once showed me.

New Surviving Sepsis guidelines have been released (.pdf file). Nice summary here. Norepinephrine is the pressor of choice. Initial fluid bolus of 30ml/kg recommended.
Hat tip to @kane_guthrie

If you want to kill your husband, putting poison in your hoo hah and asking hubby to have a whiff probably isn’t the safest way to go about doing so. There are just too many comments that can be made to this story.

More than 7,000 residents of Great Britain are receiving disability because they are too overweight to work. Costs for these patients total 28.5 million pounds. The article also notes that in the past two years, more than 100 people have had to be cut out of their homes in order to be taken to the hospital. In those cases, the family and friends of these patients are just as much to blame as the patients themselves.
Now excuse me while I go take cover from the comment fallout.

19 Responses to “Healthcare Update — 02-04-2013”

  1. GrumpyRN says:

    “Interesting point … once doctors become employees, does their incentive to fill their schedule with patients decrease? Will they want to stay late in the office to see an urgent patient? Will they go on strikes and leave patients without health care?”

    Doctors in the UK are employees of the NHS, GP’s(family doctors) are different they are self employed but get their money from government. However it does not tend to be a problem, doctors by their very natures and training tend to be workaholics. We have had to bring in laws keeping the amount of hours worked by doctors down. See the European Working Time Directive. Occasionally over the years I have seen doctors leave early and do as little as possible but they are in a very small minority and peer pressure stops it. Doctors from the earliest days of their training are told that they are special and are expected to behave as professionals. A doctor can be struck off for ‘unprofessional’ behaviour.
    As for unions they have the BMA which is a professional association which is supposed to look out for their interests when dealing with government and the public – unfortunately it has had some criticism lately for being too cosy with government.

    I have certainly noticed an increase in the number of ‘too fat to walk/breathe’ patients lately but too fat to work is just laziness and selfishness.

    • WhiteCoat says:

      Are physicians in the UK paid hourly, productivity, or salary?
      I have seen several physicians in the US curtail office hours after selling their practices to a hospital. I have also worked at county hospitals where lunch break takes precedence over just about anything else and where work stops at 4:25 PM so that people are out of the building at 4:30 PM.
      I can’t imagine that there is such a stark difference in attitudes in the UK. Maybe there is – but I just have a feeling that there has to be something more to it.

      • GrumpyRN says:

        Docs in NHS are paid a salary, you can find out more here, http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/

        All docs are paid the same depending on their grade. So ED consultant will earn in the same range as Neurosurgeon or Plastic Surgeon or Dermatologist etc. Remember only the family doctors (or occasional private doctor) have their own offices. A hospital doctor does not have a practice he has NHS patients referred to him by the GP’s or the occasional private patient again (usually) referred through GP’s.

        Also remember, doctors who are senior now did not have educational loans to pay. This is only on the juniors who are coming through now and is nowhere near the burden that US doctors have.

      • ThorMD says:

        I know several docs who sold their practices to hospitals and the issues is a little more complicated. First, they now have to use hospital-system employed nurses (many of whom are union). Union often regulates their hours and now they don’t have hiring/firing capability over their staff since the staff is hospital-system based. So the doc can stay late, but the secretary, MA’s and nurses can’t/won’t.

        All of my friends in these jobs get a barely minimum guaranteed compensation, and then the rest is RVU based. So if they don’t produce, they don’t get paid a lot. And the production metrics are ridiculous. In private practice, if they had a complicated office visit, they would just spend the extra time. Now, if its complicated, they turf it to the ER so they can meet their “quotas”.

  2. Matt says:

    I did enjoy this comment from your link to the study about malpractice:

    “Commenting on the article, American Medical Association (AMA) President Jeremy Lazarus notes that the two attorneys barely examine the tort system in California, where reforms have been successful. He said in a statement, “The AMA strongly supports California’s medical liability law as a model for one simple reason: it works””

    The one thing I’ve never seen on this site is a claim that somehow California is working for physicians. The only way it would have been funnier is if he’d said Florida.

    • WhiteCoat says:

      California is working for physicians how?
      MIRCA? Great. The pay is less than average, the tax rates are ridiculous, and the regulatory atmosphere is crushing. So physicians should flock to the state solely because it has good tort reform? There are many better places to practice medicine in this country.

      • Matt says:

        I was referring to the AMA President’s comment. I’ve heard many physicians, including you, talk about how tort reform was the key to access. Evidently that was only the key to access when you were saying/typing it.

        Just having a little fun with you – we both know tort “reform” is just insurer lobbying BS. Actual benefits to anyone but them are illusory at worst and short lived at best.

  3. Tyler S says:

    “Keep this in mind, ACA supporters”… What exactly are you getting at? That because the Chinese government only pays for half of dialysis treatment, we shouldn’t aid in the cost of treatment at all?

    • WhiteCoat says:

      Two points:
      #1 A government that has the power to provide you with everything also has the power to take everything away from you.
      When “coverage” doesn’t meet the cost of providing care, what does the government do to people requiring expensive care?
      #2 Insurance doesn’t equal health care. Never has, never will. This man had insurance, but still couldn’t afford needed health care.
      As we quickly head toward universal “insurance,” watch and see what happens to access to health care.

  4. pat says:

    smith and nephew has bigger problems going on that more than likely contributed to layoffs. maybe detail personnel for metal on metal hips?? or fines to the feds? they also merged two divisions in TN and MA last year resulting in redundant positions. stryker has had some issues as well.

    • WhiteCoat says:

      So the timing of all these medical device makers laying off employees when the ACA’s excise tax to medical device companies is about to kick in is just a coincidence?
      And CEOs of both companies are making up stories about the real reason for the layoffs?

      • Matt says:

        Well, with regard to CEOs making up stories, possibly. They’re advocating for something, and even when companies are badly mismanaged, you never see the CEO say “well, you see, I just messed up there. Made the totally wrong decision.”

        And with regard to medical device companies, the 2.3% tax isn’t what’s doing it, it’s “regulatory uncertainty”. This is the thing though, when the vast majority of your profits come from the government, then you’re always subject to regulatory uncertainty. You’ll note your link also says hospitals are cutting back on their purchasing. In other words, medical device customers aren’t buying as much. But here’s a blurb on some earnings roundups for some medical device companies, and what they’re telling their stockholders isn’t near the doom and gloom you’re reporting:

        http://www.massdevice.com/business-types/businessfinancial-news/earnings-rounduphttp://www.massdevice.com/business-types/businessfinancial-news/earnings-roundup

        I despise the ACA as much as anyone, but you should always have a little skepticism when companies’ layoffs are blamed on one sole thing.

      • ThorMD says:

        I can’t believe this, but I agree with Matt. I don’t think any CEO would be dumb enough to say “I am laying people off because I’m a bad businessman and made bad decisions”. And I can’t believe that they can’t trim their budgets by 2.3% in other areas to offset the money paid toward the new tax in order to save 100 jobs.

        They are trying to get publicity by making these types of statements. It’s working. I’m guessing that the CEO’s are active in local/state/national politics (perhaps the Repub party) and they’re trying to rally support and publicity for the candidate the next election cycle.

        I happen to be married to a CEO. They are masters of PR, spin, and getting their message out there.

      • JJ says:

        Matt,

        The 2.3% is a problem based on what the manufacturers are telling us. We were going to expand our examination facilities in our office. In 2006 the cost for the equiptment for the exam room was $8,500. This week we were quoted a price of 12K, as a “preferred price” from the same company with the same devices. We were told the ACA tax (2.3%) was part of it, there is also another new 2% tax which I had never heard of, and also much of the stuff comes from Switzerland and the dollar is much weaker than in 2006.

  5. SeaSpray says:

    I wonder if progressives that reelected him care about the job loss that actually began before the election and is worsening now? Did they get it or was agenda/party line more important? Triple premiums by fall for private ins for some? The 20,ooo.oo cost for family of 5 that doesn’t qualify for financial breaks because they make too much. And if making too much is anything like our current mdcd system so many people still don’t earn that much but fall between the cracks because it is above the meager qualifications to get assistance.

    It’s like everyone’s lives went upside down because of this. Except the rich. because they can afford what they want. This administration has done so much to HURT the middle class in this country and they’re not done.

    and I am not wanting anyone else’s money. I don’t say rich ..thinking I deserve my share of anyone else’s money. I am so sick of that mentality. We pay into our own insurance and were counting on it for retirement too.

    I just mean that these politicians are rich themselves and will never have to worry about health care payment/getting quality care. But now they’ve made it so that more and more Americans are losing and/or will lose their quality insurance that they pay into and counted on in the present and retirement.

    This administration says they are for the people …but they seem so out of touch with the people.

    I was reading recently that the way to pull a capitalist government down is to overload the system and this health care bill certainly has it’s part in that. And just wait till it all kicks in and long term consequences.

    I understand there are millions of uninformed people that voted for the free things and can’t see beyond their nose in front of them,and/or believed the talking points and couldn’t make informed decisions because the press didn’t report all the facts. And I understand that people wanted change from Bush and war and were hopeful. But I don’t understand how an educated person could think that this aca was a good thing?

    Perhaps someone can enlighten me and help me feel better about it all?

    • Matt says:

      It’s not just progressives. Plenty of “conservatives” in healthcare were on board. And remember, no one in healthcare was making any big move toward the free market. When this was proposed and not even the healthcare industry would come up with a viable alternative, it was a done deal. Even if the AMA hadn’t supported it.

      • SeaSpray says:

        Thanks for answering Matt. Even more depressing. And again …I ask W–H-Y-Y-Y?

        I also recall that hospitals and ins providers were on board with some part of it as they got some kind of short term benefit. ? if I am recalling correctly ..then deal with the devil.

        There are some good things about the bill. But the overall government reach/strangulation of our freedom of choice is both alarming and abysmal.

        But the people that voted ..again ..seeing everything going on ..how could they? And if the same republicans that stayed home because they couldn’t accept Romney …are they happy with the outcome now? because he would’ve won had they voted. And the kicker is for everyone anti Romney he was a moderate. And if for the love of God …why if the progressive voting public don’t like rich people then why do they and the press support extremely wealthy Kerry – wealthier than Romney, also pelosi gore, Obamas , etc?

      • Matt says:

        SeaSpray,

        Repubs wouldn’t have done anything to change it. You ever seen any big market based reforms from them? They’re all criticism, no solution.

    • DefendUSA says:

      SeaSpray…Boom! There it is. They don’t care because they’ve gotten and are getting theirs. I heard a man say the other day that he didn’t have to worry about shit, because he wouldn’t be around when the dues came due…and that is the mantra for all of the politicians who have been elected and evade fiduciary responsibility.

      But on that note, no matter how the media paints it, you and I have the capacity to fight on for what still makes us the most sought after place to live…because we can still create and produce no matter who tries to tamp it down. When the effects of O’care begin to be tangible, it is going to be overturned. We still have a chance at that. The thing we’re missing is the leadership to make the hard choices. Among you and I, and many here, don’t fall prey to it being “over”! THAT is what the left wants in all of their willfully obtuse ways, thinking it will never affect them and pretending the greatness. Just like anything…making a promise and not fulfilling it will come back in spades.

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