Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
In Texas Hospitals, You Don’t Get to Decide to End Care | Houston Press: 2016
[Full disclosure – I don’t know if this has been changed at this time.]
“In Texas it doesn’t matter what instructions you’ve previously given or what your relatives say: If you’re in critical condition, you’re dependent on machines to survive and hospital officials decide it’s time to pull the plug, you will die. And it’s completely legal.”
Remote Area Medical back in western Virginia, as the battle to expand Medicaid rolls on…
The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.
Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.
“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.
Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.
“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”
She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.
An account of cancer care in France.
When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.
The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.
Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.
That time was priceless.
There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.
My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.
One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.
I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”
“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”
I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?
UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.
I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet
In January, for the first time since my diagnosis 36 years ago, I will have an individual health plan that offers quality coverage for me and my family. I will save $628 every month on premiums. Best of all — I wasn’t even asked if I’ve ever had cancer.
Opinion: Cancer survivor: Obamacare got me covered – CNN.com
A Possibly Fatal Mistake – NYTimes.com
But the cancer has kept growing, and I went to the E.R. again on Sept. 17 when I found that I was losing all strength in my legs. They did an M.R.I. and saw that there were tumors pressing on my spinal cord. They have been treating me with radiation for three weeks now to shrink those tumors and will continue to do so for another week.
I submitted an application to the hospital for charity care and was approved. The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.
Some doctor bills are not covered by the charity application, and I expect to spend all of my I.R.A. assets before I’m done. Some doctors have been generously treating me without sending bills, and I am humbled by their ethic of service to the patient.
Some things I have to pay for, like $1,700 for the Lupron hormone therapy and $1,400 for an ambulance trip. It’s an arbitrary and haphazard system, and I’m just lucky to live in a city with a highly competent and generous hospital like Swedish.
Medical debts put patients at risk of financial collapse | Detroit Free Press | freep.com:
Frances Giordano found out she had lung cancer in June. After that, the bad news just kept coming.
First, she discovered that even with a good job and health insurance, her medical expenses were more than she could afford on disability.
Then she started slipping into debt, like millions of other Americans who don’t have the cash to cover their medical bills. Hospitals expect to be paid promptly and offer little leeway to insured patients. Unpaid bills go to collection agencies, damaging a person’s credit history for years.
Finally, she learned that fighting for her life was not her only battle or maybe even her toughest. When she finished her chemotherapy in December, she was fired. “Due to changes in business operations,” wrote her employer of more than six years, “we can no longer hold your position open.”
It arrived nine days before Christmas.
“I’m a good person,” the 58-year-old Giordano said. “I worked hard. Isn’t having cancer enough?”
– Sent using Google Toolbar
From Kaiser Health News Today:
Sometimes my husband Roger gripes about what he calls the British “nanny state.” So much is done for the English, he maintains, they can’t think for themselves anymore. Showers, for instance, are statutorily equipped with automatic shut-off valves on the thermostats. In case the water gets too hot. I remind him that the opposite of the nanny state is me in the U.S. with breast cancer and no steady job and insurance.
I had some wonderful doctors in New York, caring and helpful. But I also had to fight with my hospital there to get the tests I needed, and several of the specialists were so difficult to deal with I chose medical protocols to avoid them—no matter what the best option for treatment was. What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.
A nice piece about the nightmare that medicine is not in England. She left the US to go to England because she couldn’t afford the US health care system, and found out there were other bonuses to a differenet model of financing health care.
Broken healthcare and broken lives – latimes.com:
In the middle of one night during my training at a county hospital outside of Los Angeles, a 12-year-old boy arrived at the emergency room. He was having a seizure. From a brain scan, we made the terrible diagnosis: He had suffered a massive stroke. At best, he would be severely disabled for the rest of his life.
When I sat down with his mother to tell her the bad news, she told me that he had been a happy, healthy child through most of grade school. But there had been one other trip to the hospital. When he was 7, he’d had a stroke from which he recovered quickly and completely. His mother had been instructed to take him to a specialist to find out what was wrong so he would not have another stroke. But she was the family’s sole provider and simply could not afford the expensive out-of-pocket bills.
At first I was shocked and angry to learn she ignored a physician’s advice that could have prevented this tragedy. I quickly realized, though, that the true culprit was our broken healthcare system. Because this system denies millions of Americans access to care, my patient’s mother was forced to take a gamble on her child’s health. The result was a debilitating stroke that should have been prevented.
Until the system changes, health catastrophes like this will continue to be commonplace in America. Until we reform the system, Americans will continue to be forced to choose between feeding their families and taking them to the doctor.
From Doctors for America’s Alex Blum…
Daily Kos: A few anecdotes about medical care in America…
I posted this on DailyKos tonight. Please go read the rest and chime in!
On many levels, I hate to venture into anecdote territory when it comes to health care reform. I don’t think it informs the debate in a helpful manner, and yet, it seems to be one of the two major arms of the conservative campaign against health care reform. First, they argue, look how awful it is everywhere else and how wonderful we have it here in America with THE Best Health Care System in the World (TM) and second, they find even Medicare, Social Security and unemployment benefits ideological anathema.
I can’t do anything about the second one, but I do have something to
say about the first.