Surgery Monday Morning at 8:30AM

[Pelado]

Is this the official hopped up on narcotics thread? Wuap mentioned it but not sure if this is it or no. I'm on Day 4 of my "recovery" from sinus surgery. Percocet FTW.

I have to say that so far the recovery has really really sucked.

Sorry it's been so painful. Has the pain been decreasing each day, or does it seem static?

[cougjunkie]

Sorry it's been so painful. Has the pain been decreasing each day, or does it seem static?

Enabler.

[Pelado]

Enabler.

Perhaps.

[mtnbiker]

People engaged in the business of medicine (practically useless administrators, insurance executives, etc) rather than actual delivery of healthcare.

You could apply that to a whole array of job areas. Since my wife is an elementary school teacher, and I see the dumb things the district, state, and federal legislatures and administrators do, I'd lump education in there.

[SoonerCoug]

Wouldn't you have to have someone in the government do the administrative and insurance executive jobs?

I understand that medicare is loved by most. Why does that government administered program work where most programs run by the government are closer to how the VA is run?

Listen man, the VA is held to a higher standard. That's the part of this VA scandal that is missed. This is still no excuse for the very small minority of VAs that were gaming the system.

When I was a fellow at the VA, I would very frequently see patients the very same day that they were referred. Now that I'm exclusively at a top 5 hospital, I have zero open appointments in my schedule for 6 months, and I always overbook my clinic to see extra patients.

VA outcomes are every bit as good (or better in some cases) than non-VA outcomes. The facilities aren't pretty, but overall I think vets get pretty good care. If the VA can't provide something, they get sent elsewhere.

At the VA, docs have more time with each patient.

In terms of the scandal, vets are required to be seen within 14-30 days after referral. In the real world--at least in my specialty--we often can't see patients for several months and are forced to triage them. In other words, the VA is being held to a higher standard than private subspecialists.

Furthermore, you've got to realize the difference between perception of quality of care and actual quality of care. I have never, ever had difficulty obtaining an important medication for a patient at the VA. The approval process lasts about 2 minutes (email pharmacist, and pharmacist responds--always reasonably).

How about getting a medication approved through a fancy insurance company? Here is my typical scenario: Call insurance company. Put on hold for 20 minutes. Finally connected to a rural doctor. I explain that patient has Behcet's and needs TNF blocker or he will go blind. Rural doctor responds: "What's Behcet's?" I respond: "You did attend medical school, didn't you?" Three days later rural doctor calls me back to tell me drug was not approved but they might be willing to approve something else although he needs to talk to a superior first. Three weeks later they approve something that is totally unproven instead of what the patient really needed.

This it not to mention how deadbeat insurance companies will sometimes give prior authorization for medications that cost 20,000 or even 40,000 dollars and then refuse payment AFTER the medication has been given, saddling patients with huge debt.

Having a healthy population is an investment that gets a return. More healthy, working people means a healthier economy and more taxpayers. I can't tell you how many people I have seen who were working, responsible members of society who were bankrupted by a devastating illness and are now unable to work simply because their insurance refuses to cover the medications they need to get better. Usually what happens is these people go broke enough that they end up on Medicaid, at which point they finally get the meds they need.

Take immunizations. Every 1 dollar spent on an immunization gives society 25 dollars in return. Who wouldn't take that investment?? And what company would provide this for free?? No company would provide this for free, because the return on the investment doesn't come back to the company--it comes back to all of society. Healthcare is very much the same way. If you invest properly (free care, especially prevention, early treatment, etc), you will save more money. When something is in the interest of all of society and provides a return on the investment, the government should be covering or subsidizing its cost.

Another common scenario for me: 25-year-old women, college educated, working, gets lupus. She has insurance. Her kidneys will fail if she doesn't get CellCept, which probably costs a couple hundred dollars per month. Her insurance refuses to cover CellCept. She ends up not being able to afford the medication, so her kidneys fail. As soon as her kidneys fail, she ends up on dialysis and also automatically on Medicare. (All dialysis patients are automatic Medicare.) Since she is on dialysis, she can't work (dialysis is 3 days per week). Medicare covers all her healthcare costs for the rest of her life.

How freaking stupid is this? Provide the damn medication up front so she can go on about her life, save her kidneys, and keep working! Our system is backwards and people dont' realize it because they are married to ideology rather than facts. No other civilized nation on earth does it the way we do. Our system sucks and is absurdly expensive.

[OceanBlue]

This talk of how great hospitals are and how evil insurance companies are is a bit one sided. Then again I often hear hospitals and some doctors blame insurance companies for everything. I once worked for a large insurance company and we were getting complaints from brokers that a doctors office having trouble getting authorizations for primary care visits. We didn't understand the complaints because no authorization were needed for PCP visits. Finally an account manager went down to the doctors office one Monday morning and started hearing the girl at the front desk say the bs about prior authorization and confronted the office. Guess what ? The doctor wasn't even at the office and they instructed the girl at the desk to tell folks that story when the doctor was running late. I've got plenty more.

[SoonerCoug]

This talk of how great hospitals are and how evil insurance companies are is a bit one sided. Then again I often hear hospitals and some doctors blame insurance companies for everything. I once worked for a large insurance company and we were getting complaints from brokers about that a doctors office was having trouble getting authorizations for primary care visits. We didn't understand the complaints because there was no authorization needed for PCP visits. Finally an account manager went down to the doctors office one Monday morning and started hearing the girl at the front desk say the bs about prior authorization and confronted the office. Guess what ? The doctor wasn't even at the office and they instructed the girl at the desk to tell folks that story when the doctor was running late. I've got plenty more.

For-profit hospitals are horrible parasites (in my opinion). I think all hospitals should be non-profit. I don't recall saying that hospitals were necessarily great.

No one is saying that all doctors are good either. But at least they (along with nurses, pharmacists, etc) are the ones actually taking care of the patients.

The point is that there is tremendous parasitism at multiple levels within the system.

I would love to hear just one reason why insurance companies make American healthcare better than it would be with a single payer system. I have yet to see a single benefit to their existence. They take a huge percentage of the money and dictate care inappropriately, often using second-rate physicians as the consultants who decide whether or not to approve something.

I also feel negatively toward for-profit hospitals. It's a completely unethical phenomenon for a society that long ago decided to provide care to all its citizens. Make them non-profit or government buildings. They don't have to be shiny or fancy to be good.