Obama

[Alex]

That is true. What with rationing all of their elderly and infirm to death you'd expect that to harm the life expectency number.

[scaeagles]

I read something interesting today. Well, two things. My daughter recently had knee surgery. From the time the doctor ordered the MRI until her surgery, it was 3 weeks, 3 days. The MRI was was 2 days later, and the surgery could have been sooner, but we scheduled it for after school was out. I was curious as to how this might have played out in the UK.

In 2006, the average wait in the UK for an MRI was 7.5 weeks. That's the most recent data I could find. In May of 2009, there was an article with the UK happy that average wait times for surgery had dropped to just under 3 months. That means 19 weeks or so for the MRI and surgery. So instead of an early June surgery, she would have had in in late October, and therefore would be missing basically her entire basketball season (she still hasn't been cleared to play by her surgeon some 2.5 months later, but should be in another couple of weeks). That means late January, and the season ends in early February.

I realize that this isn't a life saving procedure, but it sure would suck if she missed her sophomore season because she couldn't get surgery in a timely fashion.

[Alex]

Originally Posted by scaeagles

I realize that this isn't a life saving procedure, but it sure would suck if she missed her sophomore season because she couldn't get surgery in a timely fashion.

You'll be able to find all kinds of individual stats that show one advantage here or a disadvantage there. Helping the U.S. in these arguments is that our lack of a central health care system means that similar statistics are nearly impossible to find.

Here's a Business Week article (hardly a bastion of liberal tendencies) on wait times in the United States. Note that in L.A. they reported the wait time to even see an orthopedic surgeon as 43 days. And Americans are less likely to even seek medical treatment because of difficulty in seeing primary care physicians quickly.

But in the tradition of anecdotes, here's mine.

My then unemployed (and therefore uninsured) sister was 28 when she experienced a spontaneous pneumothorax requiring several weeks of hospitalization and eventually surgery on one of her lungs. She could not be scheduled for that surgery until she had coughed up a 10% down payment on the expected cost. Everybody involved knew that she would never be able to pay the other 90% but the decision was made to take whatever personal credit blow would result from defaulting on that debt in order to have surgery. Of course there was the matter of 10%.

What was 10% of a 2-hour surgery where they fudged the numbers to keep the cost as low as possible? $15,000. Which I paid out of pocket so my sister could continue to have two functioning lungs.

I'm out $15k. My sister is has destroyed credit. My mom suffered the humiliation of begging around for money. The hospital and doctors took a bath on their costs.

All becaue it turns out an otherwise pretty healthy (she's the only non-obese one in the family) 28 year old had a genetically unsound lung.

How would that have played out in the United Kingdom?

[Alex]

Not that my anecdotal evidence is compelling but I have yet to make a single friend outside of the United States who views the U.S. system as preferable (assuming, of course, that they're from a country with a functioning centralized single payer or single provider system).

Yes, a lot of them still want to move here despite that but they aren't coming for our shores singing about how the medicine will now be better for them.

[scaeagles]

I enjoyed this piece by a Duke University professor named John David Lewis. One may not agree with his conclusions, but he sure lays out a lot of very valid concerns in a very logical way.

[Alex]

Originally Posted by scaeagles

I enjoyed this piece by a Duke University professor named John David Lewis. One may not agree with his conclusions, but he sure lays out a lot of very valid concerns in a very logical way.

Well, he's certainly better at citing his issues. But the first one starts with a great big deception so I'm not hopeful the quality is going to be much better than the other list.

First, he completely fails to mention that the section he is concerned about has absolutely nothing to do with the new Health Care Exchange programs being established in the bill or new regulations required of private health insurance. The section he is quoting is an alteration to existing Medicare (really, why do I keep wanting to spell it Medicair?) coverage.

Second, while the section does indeed seek to create incentives for avoiding unnecessary hospital readmissions, the goal is not to deny coverage but to improve patient outcomes (here's an article explaining the idea behind it). Essentially, the idea is that it encourages the hospital to get it right the first time.

Finally, the first section he quoted says pretty much exactly the opposite of what he is suggesting it says:

(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

That is not saying that certain readmissions will be barred. It is saying that for procedures and conditions where there does not exist a sufficient history for evaluating what would be excessive, such readmissions will not be counted towards the total.

Fourth, this does not result in rationing of care. A hospital accepting Medicare patients will still have to take them for as many readmissions as are needed, but if they are seeing returns at a level way beyond stastical norms the hospital may not be paid as much.

That said, after such a horrible start with his first item a quick glance through the rest and things appear a bit more reasonable and generally highlights legitimate issues appropriate as points of policy discussion. Though he does continue the trend of ignoring things that are already done and thus implying that they're somehow new.

[scaeagles]

Of course we all have our own anecdotes. I could go into my surgeries (we haven't had a good sphincter story here in a long time), but I suppose that is pointless because the situations are completely different in that I had insurance and your sister obviously didn't.

I truly respect and admire what you did for your sister. That's what family is for. I have a friend (I coached his kid last year) who gave up a career as a professional athlete to donate a kidney to his sister (been out for two years, is in the process of attempting a comeback). However, stories like yours are the reason that something needs to be done. I am just not convinced that this is it. I am not from the school of "you don't like this idea? well tell me a better one". I have thoughts (many of which are founded in stuff I've read from the Heritage Foundation) but I don't suppose those are relevant to this conversation (as we are discussing this specific health care proposal).

[Alex]

Also, I would jsut like to say that "coughed up" in my sister's story was not an intentional pun. But I like it. Since she literally and figuratively couldn't have coughed it up.

[innerSpaceman]

I loved the "coughed up." Could have sworn it was cleverly intentional. Hmmm.

* * * *

Anectode time. I've basically liked my coverage. Because I never needed it till recently.


I'm not gonna bother to recall what kind of specialist is doing my throat-stretching procedures. It took 2 months to get an appointment with him. Nothing to do with insurance, just how busy his practice is. This is in Los Angeles, so I imagine it's both easier, and more difficult, to get in to see a doctor in this town.

But this is where my love of my insurance kicks in. I'm gonna have some giant tube with a funnel on the end shoved down my esophagus to stretch it. Oh, that's covered. But if I don't want to be wide awake during that procedure, that's up to me to pay for.

That's right, anethesia not covered. Oh, unless you go through a giant rigamorole appeals, begging, threatening process. Then it is. And I need the procedure done 3 times. Have to beg and plead, and threaten for the anethesia each and every time.


Don't get me started on my prescription drug plan. I think I'm going to have to start paying something out-of-pocket for a better one come next year. My doctor has me on over-the-counter meds because NONE of the half-dozen or so prescription drugs to treat my oh-so-rare condition of acid reflux are covered.


So yeah, I'd be one of theose people willing to roll the dice on something else. I've just put my toe in the water of more and more common use of health care as I ease into late middle-age ... and I'm unhappy enough to try something else.

[scaeagles]

Originally Posted by innerSpaceman

I'm not gonna bother to recall what kind of specialist is doing my throat-stretching procedures.

That would be a gastroenterologist. I had this done many times prior to my surgeries.