What do you think about your health care?

 Health Care, Politics  No Responses »
May 242012
 

If you’re one of the 27% of Americans defined as having had a serious illness, medical condition, injury, or disability requiring a lot of medical care, or who had been hospitalized overnight in the past 12 months, you probably don’t think very highly of it.

In a poll conducted by the Robert Wood Johnson Foundation, NPR, and Harvard School of Public Health, of those 27% of Americans

…… more than 40 percent say that the cost of their medical care over the last 12 months has caused a “very serious” (20%) or “somewhat serious” (23%) problem for their or their family’s finances. …………One in six sick Americans say that there was a time in the past 12 months when they could not get the medical care they needed (17%). Among the sick Americans who could not receive care, 52 percent report that it was because they could not afford the needed care, and 24 percent say it was because their insurers would not pay for it. Lastly, about one in ten sick Americans (11%) report being turned away by a doctor or hospital for financial or insurance reasons at some time during the past 12 months when they tried to receive care.

Not only that, but many of those respondents also complained of quality of care issues,

  • ……..about one in eight sick Americans believe they were given the wrong diagnosis, treatment, or test (13%).
  • About a quarter of sick Americans say that their condition was not well-managed (26%).
  • A quarter of sick Americans report that a doctor, nurse, or other health professional did not provide all the needed information about their treatment or prescriptions (25%) – or they had to see multiple medical professionals, and no single doctor understood or kept track of all the different aspects of their medical issues and treatments (23%).
  • Three in 10 hospitalized Americans say there was poor communication among the doctors, nurses and other health care professionals involved in their care (30%).
  • About one in six sick Americans believe they did not get the tests they thought they needed (18%) [I find that hard to believe], while 15 percent of sick Americans surveyed were tested or treated for something they believed to be unnecessary. [That I can easily believe.]
  • Nearly three-quarters of sick Americans say they want their doctor to spend time with them discussing other, broader health issues that might affect their long-term health (72%), as opposed to just talking about their specific medical problem (21%). [Like that's ever going to happen, in a time of continually reducing reimbursements!]

Shocked! You should be, but then again, maybe not. I wasn’t. For-profit health care has never been about the patient. It’s only about profit, and how to maximize it.

Someday we [the US] will come to that realization, as those numbers increase [and they surely will], but how bad do the numbers have to get, and how many people have to die, or suffer needlessly before we do something about it?

A headline for the ages

 Health Care, Philosophy  2 Responses »
May 202012
 

CANCELLED SURGERIES COSTING HOSPITALS MILLIONS

From Anesthesiology News:

Between patient no-shows and cancellations on the day of surgery, hospitals are losing millions in revenue each year, researchers have found…….

Astonishing isn’t it! I might have even been appalled if I weren’t so disgusted.

Nowhere in the article is there any discussion of the possible harm to patients due to missed surgeries. Nowhere is there any discussion of why patients may have cancelled, e.g. cost to the patient in terms of missed work and/or lost wages.

Based on this article it would appear the only ones suffering here and risking harm are the health care providers.

For me, this article simply further highlight how inadequate our health care system is, and how distorted our value system has become in this country, when lost “opportunity costs” (profit) is what’s on the mind of health care providers the most.

But then again, a fee-for-service, for-profit health care system was never meant to promote concern for the patient!

 Posted by at 6:02 am

Through the “Donut Hole”

 Edie, Health Care  2 Responses »
Apr 302012
 

So Edie’s free lights are continuing their upward trend, and her doctor has recommended adding Vorinostat (Zolinza) to the mix (4 – 100 mg tablets per day for two weeks, then off a week). A recently completed clinical trial has shown it to be efficacious when combined with Velcade, and since the Velcade alone hasn’t been doing the trick, this seemed like the logical alternative.

The only problem with Vorinostat is it’s given in pill form. That means it comes under the Medicare Part D Prescription drug plan, and this drug is not cheap. $4,945 for a 14 day supply. Fortunately we were only on the hook for about $2,300, but it could have been a lot worse.

We would have been on the hook for the entire amount, if it weren’t for the Affordable Care Act [AKA ObamaCare], which mandated a 50% discount once you enter the donut hole. In addition, thanks to the Affordable Care Act (ACA), the amount of the discount provided by the manufacturer is also counted towards the Out-of-Pocket cost, and gets Edie to within $300 of the catastrophic coverage portion of Medicare Part D, where the cost of drugs is reduced dramatically.

Fortunately we’re able to afford the $2,000, but I can’t help but think about those who don’t have an extra $2,000 ($4,000 if it weren’t for the ACA) laying around? What do they do? Go without? Yeah, there are programs, but just how poor do you have to be before you qualify?

I never did understand the reasoning behind the “donut hole in the first place? What kind of mind(s) comes up with such a concept? I just hope it’s not the same minds that want to destroy the Affordable Care Act, and along with it many of the inequities it tries to correct in an otherwise dysfunctional health care system often working in a manner irrespective of patient needs.

Isn’t it enough having to endure a debilitating or life threatening disease? Do most people in the US really think it’s moral to make those same people also suffer the indignity and humiliation of financial ruin just because they had the misfortune of getting sick?

Wouldn’t it be nice if everyone in the US thought of health care as a right, rather than a privilege provided only to those that can afford it?

You can’t legislate morality!

 Health Care, Philosophy, Politics  3 Responses »
Apr 132012
 

You’d think yesterday’s death of a police chief, 8 days from retirement in New Hampshire, would finally shock everyone to that reality [although I doubt it], and realize what a colossal waste of lives and resources the war on drugs has been for this country.

Resources that would be better spent insuring everyone in this country had easy access to high quality, reasonably priced health care.

We learned it in 1933, when congress finally repealed the 18th amendment which tried to prohibit the sale and use of alcohol, but did nothing more than lead to a near complete breakdown of law and authority, and expand the influence of organized crime, that to this very day still wreaks havoc and generates corruption at all levels of society.

So why can’t we learn it now? It’s still taught in school isn’t it? Why after 40+ years haven’t we figured out what a colossal waste of valuable resources and lives the war on drugs has been. While the breakdown of law and authority has not reached the levels encountered during prohibition, there is no mistaking the lives it has cost, nor the magnitude and scope of the influence spawned by the world wide cartels controlling the drug trade.

As long as the demand exists for drugs, which have been in existence since the beginning of time, there will always be those willing to fulfill that demand. They’re called entrepreneurs. Others prefer the term criminal, but whatever you want to call them, they’re simply businessmen, fulfilling a need of society.

I would think at least Republicans would be applauding these job creators, not trying to stifle them!

It’s not called for-profit health care for no reason

 Health Care, Treatments  1 Response »
Feb 202012
 

I’ve been told on occasion by a doctor friend of mine, after one of my posts about how poorly or depressed I’m feeling, that I should take an anti-depressant. As most of you [should] know, I have always staunchly refused to do so, but not because I didn’t think they worked. It’s because I felt it wasn’t necessary, could do more harm than good, and I could deal with such feelings better without them.

And after watching last nights 60 Minutes, I feel vindicated in my approach. There now appears to be some evidence not only supporting my belief, but also casting doubts on the efficacy of anti-depressant drugs.

But why this should come as a surprise to anyone is beyond me.

I have constantly been preaching on the ineffectiveness of vitamins and supplements, and how you can’t boost your immune system. I’ve always believed it is simply a scam perpetrated by the vitamin and supplement industry to separate you from your hard earned money. Everything you need to maintain proper health and nutrition is available in it’s natural state.

So why should drugs be any different?

In a ‘for-profit’ health care system, with so much money involved, and so much time to bring new drugs to market, there will always be the incentive to skew results in the pharmaceutical industry’s favor, highlighting the good results, and sweeping the bad results under the carpet.

So it’s not surprising the pharmaceutical industry is fighting tooth and nail to dispel the [compelling] research of Dr. Kirsch, after all this is an $11.3 billion industry, and could put a serious crimp in the profits of the pharmaceutical industry. But regardless of the final outcome, this should be a wake up call, and a learning lesson to everyone.

BE SKEPTICAL OF EVERYTHING! (And not just in the health care arena.) Don’t be fooled by special interests, who appear authentic and concerned, but are truly only looking out for their best interests, and their bottom lines.

Rating US health care providers

 Health Care, My MCL  2 Responses »
Jan 272012
 

I’d bet if you took a survey in the US, you’d find most people are pretty happy with their current health care provider(s). Let’s face it, most people aren’t sick, and even when they do get sick, their own immune systems can fix most anything on its own. For most other ailments a visit to a primary care physician can easily diagnose and prescribe the necessary action to resolve the matter quickly.

So why do we even try to rate health care providers? I for one have never been a fan of health care provider ratings, because it can’t be done reliably. Health care is not an exact science. It is an art [of sorts], and trying to apply statistical measures to it are at best suspect.

Even trying to track the things that could be measured objectively, such as in patient infection rates, readmissions, etc. can’t be relied upon, because in a for-profit health care system, absent of regulation (like in the US), the incentive is to skew the data to produce positive results. And you sure can’t rely on data supplied by patients either, because most people aren’t knowledgeable enough about medicine, and are subject to personal prejudices.

Still that doesn’t stop people from trying. There’s a new website being developed by a multiple myeloma survivor, attempting to present data comparing survival rates of multiple myeloma patients by doctors, hospitals and regions in order to quantify the best in each category.

Despite the well intentioned efforts I’m sure this person has, I can’t help but ask myself why bother?

Certainly this information might be useful, but like I outlined above, you just can’t rely on the integrity of the data, especially, as in this case, when the data is being supplied directly by the doctors and hospitals being rated.

And even if you could rationalize the integrity of the data in this instance, the number of variables that exist [and not included] are endless, and difficult, if not impossible, to quantify.

For example, how far along has the disease progressed in a particular patient? How do we know if the health care providers, with the worst survival rates, weren’t just being inundated with the worst and most difficult cases? Identifying those health care providers as poor performers would not only be doing a disservice to the health care providers, but also to the patients who might steer clear of them.

And how do you quantify the aggressiveness of a disease? One thing I’ve learned throughout all this is, while there may only be one disease, there are numerous variants of each, some aggressive, and some not so agressive. Even if the doctors and hospitals were able to run all the tests necessary to categorize the aggressiveness of a disease (a cost which incidentally would be exorbitant), one has to keep in mind we are all different, and in any number of cases, those with poor prognostic indicators can perform extremely well, while those with good prognostic indicators can perform poorly.

Then there’s age to consider. How do you factor that into account? Are all 60 year olds in the same physical condition?

Just look at Joe Paterno. He died extremely quick after we first learned of his diagnosis. Do we really think he wasn’t receiving the best care? Should the hospital and doctor be penalized for that?

While I applaud the effort, simply because anything that keeps cancer survivors occupied, and not constantly worrying about their fate, has to be beneficial, I would be extremely skeptical of any of the ratings provided by this website, or any similar ones.

Posting on how to be better, more informed and proactive patients (one of the original goals of this blog), in my opinion, would be time better spent.

The only way to be sure we’re receiving the best possible care is to be knowledgeable of our disease. We’re not all blessed with being able to see a hematologist/oncologist that focuses solely on our particular disease, so asking the right questions, and supplying your doctor(s) with up to date information is absolutely vital.

Doctors are only human. They see many patients, all presenting differently. It would be naive to think any hematologist/oncologists has the ability to keep up with all the advances in the treatment of the myriad of cancers they deal with on a daily basis.

Staying informed and helping your doctor by supplying him/her with the latest information regarding your disease is something I have found every doctor I have had contact with to be very grateful for.

All you really need to know is, a proactive patient is a good patient, and the one who will likely survive the longest!

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