Tag: medical

Why There Is No Meeting of Minds Review

Posted onAuthorcahwyguy

By now, you’re probably noticing there is no Meeting of Minds review. That’s because we never made it to the show. We were at Valley Presbyterian Hospital, in the ER, instead.

Let me explain. Saturday evening, I started feeling funny. I attributed it to a migraine, and took a T3 and a Maxalt as I went to bed. I was fine Sunday morning, but around lunch time I had this odd ache between my collarbones. As it continued, and Karen thought I looked odd, we went to the ER at Valley Pres. Chest pains are treated seriously, and soon it was clear we wouldn’t make the 7:00pm show. It began to look less like a heart attack, and more like hypertension, as the lower number in my blood pressure was extremely high. I was admitted overnight for observation. Later today they did a stress test and an ultrasound, and my heart is fine. However, my blood pressure is still far too high. So it is off to a diet and exercise and doing what I can to lower it. For those of you that see me locally, I’m depending on you to call me on it when you see me doing something stupid.

Right now, I’m tired and have a headache (probably from lack of sleep Saturday night, when I had bad indigestion, and last night in the hospital). I’m working from home tomorrow, and will hopefully be back to a normal life, with a new diet, on Wednesday (well, I start the diet tonight).

P.S.: This is not the way I wanted to get caught up on podcasts.

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Prescription Drugs and Toyotas

Posted onAuthorcahwyguy

The other day I had a doctor’s appointment. During the appointment, we got to talking about the relationship between prescription drug ads and Toyotas—more specifically, about the fears related to prescription drug side effects and unintended acceleration. I thought I would share some of these thoughts over lunch.

Prescription drug companies advertise their patented products heavily. During these ads, they mention all the horrific side effects of their products, but most people ignore them because, (a) the ads are designed to emphasize the good, not the bad, and (b) for the most part, these side effects are extremely rare. But still, we worry about those extremely rare side effects: in fact, some of us won’t take particular medicine out of fear for the side effects.

Similarly, the instance of unintended acceleration in Toyotas is very rare. The OC register reports that there is a new tally of the death toll: 56 people have died due to the problem. Put on your critical thinking caps, and think. Fifty six. Toyota issued over 10 million safety recalls over this: 56 problems. Whipping out my calculator, that’s .00056% — translation, extremely rare. About as rare, if not rarer, than prescription drug side effects. Yet, people are abandoning the brand over it, declaring Toyotas as unsafe.

Perhaps irrational fears have taken over our society? More worrisome, however, is that the lack of critical thinking (and math and statistics understanding) will cause people to elevate the irrational fears over the more probable, rational ones.

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Rationing Health Care

Posted onAuthorcahwyguy

The Los Angeles Times has a good article this morning on the cancer screening debate, and the costs related to over-screening. Read it.

It got me thinking about the health care debate, the power of media, and how to lower the cost of health care. When people talk about the varying health care plans, one thing that comes across is that insurers shouldn’t ration treatment. In other words, we shouldn’t be told not to have a treatment because it is too expensive or not effective. We shouldn’t be told not to have a treatment because it is an overly expensive way of telling us nothing. We should have the right to choose our care. I agree with that, to a point, but I can also see that it is also a way for those paid by a fee for each service to continue making money, and for the insurers, be they government or private, to keep paying out and raising premiums. The media has a large role in this: medical shows routinely do test after test after test after test (after test after test, if you have Dr. House), without thought to the cost or the efficacy of the tests. The hospital dramas and the medical reality shows emphasize the importance of testing for that rare disease: what you have is never the obvious answer, can never be treated by the generic, can never be found by the simple test.

Our society overreacts to everything. Just as we feel that children shouldn’t run and play and explore unspervised because of that one child predator, we feel that we should do whatever is possible to extend a life. Damn the cost. Thus we’ll pay (or our insurers will pay) thousands each year for maintenance drugs to add an extra year to a life. From an overall societal view, can we afford this? What is this doing to our society?

And yet… we object to professionals telling us: you may not need that test. Perhaps we shouldn’t screen so often. Perhaps the cost of treating one additional cancer is less than the cost of all the false alarms and surgerys.

Where do we find that balance? How do we find the balance between the individual who wants to live as long as they can (a sentiment I can really understand), and the societal bodies that pay for the excess tests, the maintenance drugs, the surgical costs to investigate test findings, the late in life tumors from the extra radiation from the tests? Why would it be wrong for an insurer to ask, “Are you sure you need that test?” Why would it be wrong for them to pay less for something of questionable efficacy unless you can demonstrate that it works? Where is the line we should draw between the cost savings from this approach, and an individual’s right to have the care they want.

I don’t know the answer here. But as the recent mammogram controvery has demonstrated, this may be the third rail of health care.

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The Public Option (or) Banks vs. Credit Unions

Posted onAuthorcahwyguy

I’ve been thinking a bit about the defeat of “the public option” for health care in the Senate Finance committee bill, and it may not be as bad as folks fear. We need to remember our goal is not to have a public option — the public option is simply a mechanism to increase competition to bring down health care costs. If we remember that the goal is lower health care costs and not simply government involvement, there may be a way through this.

Let me explain. I’ve always thought of the battle for a public option to go against the soulless greedy private insurers 🙂 as akin to credit unions vs. banks. Credit unions affect the market by being shareholder owned non-profits, and the competition forces banks to either provide unique services or lowers the costs. In return, credit unions have limitations, such as not typically providing business accounts, or having limited fields of membership.

Suppose we were to focus on this non-profit model, which I believe is permitted under the Baucus proposal. Think of “health unions”, which are owned by the insured members, not shareholder. The incentive would be to lower costs for their members, not make profits and deny coverage. They might be given some tax advantages (I believe credit unions have some tax advantages) as an incentive for their existance, but might also be limited, like credit unions, to serving limited groups (perhaps geographic, perhaps employer based or school based — some common interest or thread). But such a model could still work on encouraging lower costs for health services without having the level of government involvement that folks fear about the “public option”.

If I recall correction, there have been efforts like this in other insurance areas: weren’t the “mutuals” actually owned by their policy holders, not explicitly for profit (think things like Mutual of Omaha). As I recall, when they went for-profit, they had to return some money to the policyholders/owners.

Would this work? Am I off base? It might be a way to a middle ground that will achieve the most important goal — improving the health care situation in this country. That’s what we should be working towards, not what this party or that party wants as the specifics.

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Critical Thinking Re: Health Care / Going to Pot

Posted onAuthorcahwyguy

This afternoon’s post-workshop review of LJ and the news brings to the fore two items related to health care:

Item The First. rjlippincott has an interesting post where he talks about the fact that we won’t really know the rules on government health care rationing from the bill — those rules will be decided by bureaucrats at the appropriate agencies once they are established. He’s right, but in again focusing on the government option, he’s missing a key point. I wrote a response, but want to repeat it here because it bears repeating. Those complaining about rationing in the government option are right: if there is a government option, it will do some form of rationing, and there will be some denial of care. Yes, in some cases treatment will be denied. You won’t be permitted, for example, to use those peach pits to treat your cancer. However, there are two very important things that are being forgotten:

  1. Private Insurers Already Ration Health Care. I’m sorry, but our current system already has rationing. It is part of any insurance plan: there is stuff that is covered, and stuff that isn’t. All those situations you hear about where folks were denied the treatment by the private insurer is rationing. Whether is it done by a public or private group doesn’t change what it is. Would you feel better when grandma is denied her experimental cancer treatment by Blue Cross vs. a Govt Cooperative? So let’s stop arguing about rationing health care. Whatever insurer we have is going to ration, private or public.
  2. The Government Plan Would Only Be An Option. No where have I seen anything about this government non-profit being a mandatory choice and being the only insurer. You don’t like the rationing regulations chosen by the government plan: then choose one of the private options. No one is holding guns to people heads and telling them to go with the government option. The only reason folks might be forced to go with the government option is if they can’t afford the private option. Guess what: in that case, at least some insurance is better than no insurance. They can always choose to pay for the uncovered treatment themselves without insurance. That’s what they would do now. The insurance they would have that is covered would still leave them better off than no coverage at all.

Sometimes, I think critical thinking is gone in this country. Suppose there were these “death squads” telling Grandma she couldn’t get her treatment under their insurance plan. What they forget is: nothing is stopping Grandma from getting the treatment on her uninsured nickel, as she does now. It just means the plan doesn’t pay for it. This whole death squad/rationing argument is a red herring, because nothing says uncovered services are not provided. They just aren’t on the insurer’s nickel.

As the President said last night: For those that have insurance, not much will change. They won’t be dealing with the government option at all. No massive bureaucracy for them, they get to deal with the streamlined, cooperative insurers like Blue Cross or Kaiser. If they can’t afford any of the private insurance options and choose the supposedly lower cost government/non-profit option, that “massive, government-funded, government-managed health care system” (or equivalent) will be much better than having NO insurance (which is what they have now). Further, they can always choose to pay privately for any uncovered care, as they do now. They still are better off based on what is covered.

The only gamble is that this thing doesn’t add to the federal deficit. That’s the larger gamble, and so we can only hope that whatever bill comes up, the financial projections are accurate (decisions are only as good is the input you’re given), and that the President is true to his word and won’t sign it if the analysis indicates it adds to the deficit. I’ll believe him on that one, simply because I think this doesn’t fall in the category of an emergency bailout.

Item The Second. One thing that surely won’t be covered by the plan is medical marijuana. And speaking of medical MJ (how’s that for a segue), the Los Angeles Times has an interesting map of all the dispensaries in the City of Los Angeles. I thought they had been popping up like weeds (pun intended) of late: this proves it, as do the ads in any edition of the LA Weekly. They are getting to be more numerous than escort services, and that’s saying something. 🙂

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