Health Care Thread

TheBeagle_sl said:

If I thought anyone actually valued your opinion I could dig up a dozen quotes of you blanket labeling everyone that disagrees with you as Obama lovers. You're not fooling anyone.

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Merlin is smarter than that fucking moron.

Amoxil (Amoxicillin) Drug Information: Description, User Reviews, Drug Side Effects, Interactions - Prescribing Information at RxList

Completely safe to self administer... Hemic and Lymphatic Systems: Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena from just one category. Also known to counteract blood anticoagulants for those one them requiring dosage adjustment. Probenecid can make it stay longer leading to a higher toxicity level from it than normal. Chance of anaphalyactic reactions.

Yep, sounds completely safe and something a doctor shouldn't monitor at all.

All to actually spend more money it looks like - amoxicillin is a $4 wal-mart/CVS/etc script and copays are rarely over $20-25 - whereas a month worth of mid dosage the "fishvox" way looks to be $30.

Big Phoenix_sl said:

Hey man you know grapefruit juice can fuckup heart meds? REGULATE GRAPEFRUIT JUICE!

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You're a special kind of stupid, you know that? You do understand by law that heart meds include that warning given by a pharmacist right? You know "regulating" that issue.

If Republicans won the presidency and created something like Obamacare (or call it Romneycare if that helps) do you think it would be 100% fraud proof? People defraud the government all the time, in every way imaginable. Almost every system the government has created has been defrauded at one time or another, nothing new here.

It would be designed to help businesses defraud the government better, and tied to medicare/medicaid/SS/VA benefits so that republicans can claim those are all horribly dysfunctional and need to be discontinued b/c the businesses they helped defraud those services are doing just that. See: USPS. Republicans are hard at work proving government is terrible by making government more terrible.

And that's the thing that tickles me, when a business defrauds the government for millions of dollars, not much is said, but when an individual does it for a couple thousand, AH SHIT FUCK THAT!!1!111!!!

The GOP is so concerned about fraud that they voted to cut over a billion dollars from the IRS's budget. Checkmate, libtards.

Vaclav_sl said:

Which "HC industry higher ups?" are you talking about here - are they the same ones that are trying to justify 40% of their costs going to "administrative costs" like refusing service due to a corner case and just people to run and harass people about getting paperwork perfectly before they pay out?

You're literally talking about a large portion of the problem that create the entire clusterfuck because of them wanting to force a ridiculously high profit margin and non-service related employment into the product.

And on "if you got all your necessary screenings" nonsense - that's complete fabrication, barring preexisting stuff or stuff that starts to show on a general physical the general recommendation is a physical every few years assuming there's nothing going on that's the start and the end of the line until you're getting old. [And when you're old, you're Medicare and not the general healthcare industry's issue - just like if you've got an incurable cancer, you get a free pass to apply for Medicare quickly if you've got something terminal which your example likely is included to help curb costs]

So in short, you're listening to the criminals that started the entire problem because they wanted to profit off of people's health and believing them.

(And there's plenty of cases where something caught early is easier to treat - look at Strep Throat vs. Rheumatic Fever for Christ's sake - one requires amoxicillin/penicllin for a week to treat, the other generally for 3+ YEARS and can cause problems that require heart surgery to fix - all because a case of Strep Throat is left untreated. It's one of the more extreme cases, but still a pretty telling one of migration which is terrible [Most cancers will migrate if they're caught too late as well - which of course means multiple avenues of treatment being needed rather than just one increasing cost appropriately])

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This data is coming from research for medicare. If you are in any way connected in the healthcare industry, you will very well know that medicare essentially dictates the payments that insurance companies bill - this doesnt occur directly per se but I don't know of a single major insurance provider that doesn't work on a system based on 'multiples of medicare' (ie when a group of physicians or hospital negotiate a contract they may negotiate a fee which is usually some multiplier of medicare reimbursement - usually this is greater than 1x but nowadays that isn't even a guarantee, but thats a different discussion).

To reiterate, I am basing everything I am saying off of MEDICARE expenses. Re: the subject of everyone getting screening was a hyperbole - while some basic estimates have proven what I said to be true, in reality the reimbursements would drop if the volume goes up - in other words if x increased number people go for screenings, then usually the $ reimbursed per screen by medicare will come down (this is historically what has happened and theres plenty of examples of it in the recent CMS schedules that have been published). Also, based on reality, there is no way our hc system has the infrastructure to support the necessary screening anyways, if everyone were to get their recommended studies. For example at some breast care clinics there is a 2-3 month backlog for screening exams even though there are hundreds of thousands of women who do not get all their appropriate/recommended screening.

Anyway I wish I did not bring that up because it was not my main point, but it does act as a nice segue for outlining the ugly truth. Speaking of breast screening, the USPTF (which CMS listens to 100%) not too long ago recommended a REDUCTION in mammo screening. This was met with an uproar by a lot of physicians in practice, because of all the ridiculous, questionable healthcare behaviors out there, mammo screening actually had a significant and strongly literature supported BENEFIT in mortality reduction. Instead, the USPTF picked out a few specific, and generally questionable papers, which showed either no or ambivalent benefit, and used that as an argument to reduce screening.

We all knew it was hogwash. But that's when many of us realized, its all about the bottom line for these people. The govt was looking for stopgap measures to reduce hc costs, and as a result damning untold scores of women to an early grave. But its so difficult to prove someone *could* have survived, once the change is made. It will be decades, possibly longer, before the data starts to show a slight, but significant increase in mortality (it may just be .1%, but that can still mean hundreds or thousands of mothers or daughters passing before their time).

Insurance company execs monitor and discuss medicare/CMS behaviors closely because it has a deep impact on their actions and constitutes a large part of the dialogue between them and the hospitals and providers. So we find out this stuff. And the general attitude coming down from the govt is - costs need to be cut. A big push for a long time was on preventive care, but more recent analysis shows that this does not have the impact it was once thought to have. And the reasons are as I discussed above - incidental findings resulting in over-management in a litigious environment, coupled with the (difficult to measure but very real) increased health care costs of an increasingly aging population.

Why are health care costs so much more now than they used to be, if our screening tests are so much more effective at preventing advanced disease and therefore presumably more expensive care? That 20 yr old you keep alive now, who may have otherwise died or had more expensive surgical costs a few decades ago, now lives longer and goes to the doctor more frequently, running up $1000s in medication costs (hypertension, etc), many more thousands in screening costs, and then several more thousands when hes old and demented and comes down with CAP and now needs an ICU stay.

None of this is to say screening programs are bad. Any ethical doctor needs to support preventive care as much as possible, because what matters most as a physician is (should be) improving and supporting the quality of life of a person, in addition to survival, and there is verifiable and irrefutable data that appropriate screening can and does improve morbidity. But do not be naive and think a significant fiscal benefit is derived. While some improvement in cost can be made by having a systematic tort reform of how malpractice works in this country (unlikely to ever happen), there is no humanitarian method to reducing costs of the aging patient borne of our healthcare advances. These fiscal issues analayzed by Actuarians and businessmen result in a push for other policies on the backend, things you dont see advertised.

So they're basing their ideas off of Medicare metrics for prevention when the data that Medicare/CMS has to go off of is primarily from those 65+ where it's well known that preventive medicine is going to be past the cusp already. Over 80% of Medicare recipients are in that age bracket, and the younger folks are disabled which of course is going to skew things as well.

Seems like a really bad batch of data to use. Anything beyond that is prevented by HIPA unless they've got tons of people voluntarily signing on to be part of their "test group" - so it seems likely it's that VERY skewed group.

Not to mention, in the past five years Medicare payment schedules have increased at a higher rate than regular payment schedules. (And the one being considered [might have past by now] for this year is monstrous)

And there's no question that plenty of things like Strep vs. Rheumatic Fever and other cases prove that while preventive care might not be ideal for EVERYTHING there's absolutely dozens of things that it helps with. But if you really want to get down to brass tacks, you know what the most fiscally sound way to treat anything is? Throw them on a morphine drip and let them die. Or even cheaper, euthanize.

It's bad data coming from people with a vested interest to generate a profit, possibly even based on bad data. (Since as I said the Medicare/CMS pool would be limited due to HIPA)

That's a bigger problem than you may realize - a lot of decisions are made off a skewed portion of the population. There have literally been actual screening studies which were shown in HUGE studies to be beneficial but were NOT approved by CMS as billable by medicare BECAUSE their population data didnt support it -meanwhile everyone under 65 gets hosed (This happened with virtual colonoscopy and probably other screening exams i'm not aware of).

your comment on morphine drip and let them die - it HAPPENS. a LOT. Especially with those guys who show up with metastatic lung cancer(which is a lot of people).

Once data is completely anonymized there is no need for privacy clearance. Medical literature, especially retrospective data, would come to a standstill if this were the case.

This is unrelated, but another big problem people should know about is the big push for primary care is resulting in a much larger number of nurse practitioners/PAs. Now I don't mean this in an offensive way, and I have seen my fair share of absolutely excellent NPs and PAs, (and some horrible MDs), but by and large, these NPs/PAs do not have the knowledge base a physician does and it shows when it comes to management. Now what does someone do when they know less? Order more tests of course! Anecdotally speaking I have noticed this time and time again. I think we will see a gradual surge in costs as a result of increased studies and tests being ordered by these guys, but I don't know if the proof is there yet.

Neighbor just passed about a year back from metastatic lung cancer exactly as you stated - but it was a voluntary choice that she was allowed to make for her. She fought for like 3 years then opted to stop fighting and ride it out with morphine for the last two months or so.

As for NPs/PAs - they don't order tests alone, they have to get consent from the MD that oversees them in order to order tests beyond simple stuff like ECG that have a trivial cost attached - so that's not really an indicator of the problem you're talking about, since the MD has to OK them. Perhaps some MDs are lazy and have overly cautious NPs/PAs but that's just a symptom of a bad combination that's more of a problem with the MD than the NP/PA. NPs/PAs aren't supposed to fly solo and should have the MD's input in anything once it gets to a level of concern.

Similar to how Pharmacy Techs vs. Pharmacists - PT's can do almost everything, but the Pharmacist is still supposed to oversee everything and double check. NP/PAs are meant as an extension of the MD's reach, not a replacement for it.

As for why there's a glut of NP/PA's look no further than the AMA which ties in with those people that you're discussing - they've stunted MD graduation rates to increase the value of the labor pool - which in turn creates the need for assistant careers.

I don't know where you are getting your info on np/pa - I can confirm with 100% certainty that np/pa providing primary care can order ct/mr , lab tests, and refer to other specialists, without anyone else's approval. You may be thinking of surgical np's who function more like a resident and do a lot of scutwork for the surgeon.

His aunt is a NP, his uncle is a PA.

lol

Pasteton_sl said:

I don't know where you are getting your info on np/pa - I can confirm with 100% certainty that np/pa providing primary care can order ct/mr , lab tests, and refer to other specialists, without anyone else's approval. You may be thinking of surgical np's who function more like a resident and do a lot of scutwork for the surgeon.

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Perhaps it's a Maryland thing, we are a bit law heavy in this state - wife and I use more than a few - and they constantly need to get a doctor's signature.

Of course of your list, two of those are the same with my experience - CT/MRI is the only one that our history with ours disagrees with. Lab tests are cheap to run for a great number (bloodwork we'd run on new hires ran us under $80 in bulk uninsured, I'm sure some are more in depth though - but ours was a pretty wide screen panel + drug test for that cost) and referrals are restricted or not based upon what the insurance calls for. (i.e. with Medicare I can get mine from anyone of any tier, with BC/BS previously I needed to get them from a GP MD or specialist - NP/PA were not permitted [note: this was 2005 though, so they were not that common yet - wouldn't be shocked if BC/BS is broader on such now])

[And no OneofOne - nothing over a RN in the family =p and the only one I ever talked business with [my mother] has been retired for over a decade now, about the same time her practice got their first NP - this is personal experience, remember we're a disabled couple, we spend tons of time in doctor's offices of which about a third is with NPs/PAs... I've stopped making any references outside of my own pool of knowledge]

[i.e. wife at pain management with her NP just Tuesday, NP recommended that she go to a plastic surgeon for her keloids that are starting to form and got a signature from the MD she works under - she came back and handed us the doubly signed referral, and then said "Oh wait, you're Medicare I guess I could've skipped grabbing his signature on that one - sorry for the needless wait" (paraphrase obviously) so obviously many, maybe even most, insurances do require it (or perhaps many PRACTICES require it as part of their own philosophy, which at the end of the day if most do it's the same as the insurance companies mandating it)]

More Than 10 Million Adults Gain Health Coverage Since Obamacare Began

An estimated 10.3 million American adults have gained health coverage since Obamacare enrollment began last October, with the biggest gains among young adults and Hispanics, according to a study published this week.

The findings by researchers from the Harvard School of Public Health, Brigham and Women's Hospital in Boston and the federal government are based on datapointing to a 5.2 percentage point drop in the U.S. uninsured rate since last Septemberfor Americans aged 18-64.

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