VA Health care, good enough for vets? by leadb

REAL WORLD EVENT DISCUSSIONS

VA Health care, good enough for vets?

POSTED BY: LEADB
UPDATED: Monday, December 17, 2007 11:40
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Tuesday, December 11, 2007 12:08 PM

I believe in solving problems, not sharing them.

Point well made. Medicine: Use sparingly and be proactive in your care (or assign someone to do it for you).

---------------------------------
Always look upstream.

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Tuesday, December 11, 2007 3:08 PM

LEADB

Quote:
Originally posted by Finn mac Cumhal:
Well, unlike you, I have not been a “have” for most of my life. Much of my life, particularly my early years, was spent on the “have not” side of the economic equation. I grew up very poor to a single uneducated mother. I kind of resent this implication that I’m nestled in my wealth. I know what it’s like to rely on free clinics, and I don’t see how socialized medicine can be that far from that. I went to my share of free clinics to deal with medical issues before they became life threatening. It got the job done, but it couldn‘t replace what I have now. I realize that 15% of the US must rely on free clinics, but I don’t think the solution is to essentially force the other 85% to do that too.

First, let me say I'm sure you worked hard to get to where you are; and by no means do I intend to imply you do not deserve what you have achieved.

I see now that your primary concern is you fear we would end up with... shall we say 'lowest common denominator' care? I understand your concern, but based on what I've heard from folks living in England, etc; I do not believe this would be the case.

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Tuesday, December 11, 2007 3:11 PM

LEADB

Quote:
Originally posted by canttakesky:
... "First do no harm." The question is, in each medical paradigm, how much of the need was/is iatrogenic?

Valid concerns. Thanks for raising them.

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Tuesday, December 11, 2007 3:31 PM

SIGNYM

I believe in solving problems, not sharing them.

Quote:
I see now that your primary concern is you fear we would end up with... shall we say 'lowest common denominator' care? I understand your concern, but based on what I've heard from folks living in England, etc; I do not believe this would be the case.

I have heard of problems in England, these complaints are from parents whose children have a rare condition similar to my daughter's (a fulminant and permanently disabling epilepsy condition like Landau Kleffner Syndrome). I hear even worse complaints from parents in Australia. But it doesn't have anything to do with the level of care or the amount of funding or lack fo advanced theoretical knowledge so much as that some British doctors have a god-complex, and Australian doctors have the same problem compounded by the "if your leg's not broke in five pieces you're not sick" frontier-macho syndrome.

OTOH I have a Canadian friend who had lymphoma and went through surgery, chemo, and bone-marrow transplant and he's now in full remission. They treated him well and with sympathy and he is very grateful for the care.

If I could create a system, it would have several parts:

Single-payer, government-funded insurance similar to Medicare.
Available "additional" insurance for experimental or optional treatments.
Special surcharge for smokers or people who are obese. (Treatments available for obesity of smoking cessation.)
National database on the outcomes of all treatments- including a compilation of case reports on rare diseases. (I have a special concern for that!)
More funding for basci research to research hospitals, and drug testing that is NOT funded by the drug companies.
National ranking of hospitals and doctors available online.

So since this pretty much steps on everybody's toes, it'll never happen!

---------------------------------
Always look upstream.

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Tuesday, December 11, 2007 4:51 PM

KIRKULES

Quote:
Originally posted by SignyM:

National database on the outcomes of all treatments- including a compilation of case reports on rare diseases. (I have a special concern for that!)
More funding for basci research to research hospitals, and drug testing that is NOT funded by the drug companies.
National ranking of hospitals and doctors available online.

I can agree with these ones. We should have had a National database of outcomes years ago but until recently many doctors have have opposed or not cooperated with these studies. I know someone who started a database for small hospital group for just a few procedures and found it to be a complicated and overwhelming task. First problem is how to decide what a positive outcome is. A surgeon will tell you that if the patient survives and has some post procedure improvement, that its a positive outcome. Of course the proper way to measure outcome is to measure the improvement in quality of life of the patient over the long term (5-10 years). We need to start now because it could take 10 to 20 years to build a usable system.

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Wednesday, December 12, 2007 4:24 PM

LEADB

Quote:
Originally posted by SignyM:
If I could create a system, it would have several parts:

Single-payer, government-funded insurance similar to Medicare.
Available "additional" insurance for experimental or optional treatments.
Special surcharge for smokers or people who are obese. (Treatments available for obesity of smoking cessation.)
National database on the outcomes of all treatments- including a compilation of case reports on rare diseases. (I have a special concern for that!)
More funding for basci research to research hospitals, and drug testing that is NOT funded by the drug companies.
National ranking of hospitals and doctors available online.

Sounds pretty good to me!

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Wednesday, December 12, 2007 5:49 PM

RUE

I have a vote and I'm not afraid to use it!

WAAaaayyy back when I was young(er) there was a surgeon's strike in Buffalo. And the mortality rate went way down - something like nearly 20%.

There was a lot of foot shuffling and explanation-making and some of it made sense. Yes people who needed 'elective' surgery like a gall-bladder removal who had it postponed would have eventually faced worse consequences in the future - sepsis for example. So some of that immediately reduced mortality rate was a trade-off against a higher future mortality rate. But some of it ....

***************************************************************
"Global warming - it's not just a fact, it's a choice."

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Wednesday, December 12, 2007 6:12 PM

RUE

I have a vote and I'm not afraid to use it!

To address CTSs post though. I went and purchased one of the articles (Is US Health Really the Best In The World, Barbara Starfield MD) - I was hoping to find how the figures were derived. Anyway, it wasn't a study, just an editorial, and she referenced other studies so I never did find out about the numbers.

But I found three competing sets of numbers looking up iatrogenic death.

There was the 1981 study that concluded 2% of deaths had iatrogenic contributions; a 1999 study indicating 71,000 iatrogenic deaths which was about 3% of all deaths in the US and the newer 225,000 figure from 2000 which is about 9% of all deaths. Not exactly conclusive.

However, what the editorial did stress was that wide social disparities in income, low primary care access and high-tech intervention were associated with higher overall death rates from all causes.

***************************************************************
"Global warming - it's not just a fact, it's a choice."

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Thursday, December 13, 2007 6:20 AM

CHRISISALL

Quote:
Originally posted by citizen:
To be particularly blunt, I find the fact that my Girlfriend, despite paying into the system, despite paying for procedures being unable to receive tests, let alone treatment is disgusting; especially in the richest country in the world.

I hear ya.

Agreeing Chrisisall

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Thursday, December 13, 2007 6:31 AM

CHRISISALL

Quote:
Originally posted by canttakesky:

In my view, a lot of the desperate need for health care is iatrogenic.

I go to the doctor only for the big stuff, except when my wife broke my leg in Aikido- she made me go. i said "Honey, it seems like a fracture that's in place- I just need to keep weight off it for a spell." But she wanted a Doc to look at it. He took the X-ray and told me that there was nothing to set- just to keep my weight off it for a couple weeks. $100 to find out what I knew.
I busted my nose and set it myself. Got pneumonia and cured it myself. Cut to the bone a few, etc. Salt and hydrogen peroxide and zinc take care of most things....why have a doctor do what you can do your own self?
Now if I get hit by a bus....

Self sufficient Chrisisall

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Thursday, December 13, 2007 6:35 AM

CANTTAKESKY

Quote:
Anyway, it wasn't a study, just an editorial, and she referenced other studies so I never did find out about the numbers.

That is disappointing. Thanks for looking it up. I can't believe you paid for it. JAMA used to offer its archives for free, but now it is only available to subscribers.

Edited to add: I forgot to make the point that these statistics don't take into account the fact that most inpatient folks are either old or very sick or both, and are probably more vulnerable. Thus an infection, drug side effect, or minor medical error that might not have killed someone else would finish these guys off--or they might have died from something else anyway. So figures might be inflated because of this. On the other hand, these stats don't include iatrogenic disability, so maybe it all balances out. I don't know. The guy who brought gravel to our driveway said his wife suffered a severe reaction (similar to Guillain Barre) from a flu vaccine that put her in residential rehab for 6 months. The docs acknowledged that it was a flu vax reaction too. How many cases exist like that, where death doesn't occur. but leads to an increased consumption of health care?

At any rate, we know that iatrogenesis occurs, and it occurs significantly. We don't know exactly how significantly, but we know it is enough that we should beware of it.

As an aside, I have gallstones. I used to have excruciating gallbladder attacks every 3 or 4 months, and went to the ER twice for pain relief. Then I discovered homeopathy, and took a remedy for 5 months. During this period, I started to get a gallbladder attack again. I rushed to my remedy and took a dose. To my amazement, it stopped the attack dead in its tracks. The pain didn't go away, but it didn't progress. It hovered there at its beginning stages for an hour and then disappeared. Usually, an attack will last about 4 hours. Although I stopped taking this remedy because of pregnancy and other issues, I haven't had another gallbladder attack again. It's been 15 months.

All that to say, NOT seeing a doctor for gallstones does not *necessarily* and inevitably lead to sepsis and whatnot.

My problem with nationalized health care is that I want to pay for the kind of health care I want, which is not the same kind as what everyone else wants. I don't see why I have to pay to support a health care system I see as inefficient, ineffective, corrupt, and sometimes downright dangerous. People who want that kind of system can pay for it themselves--and let me pay for my own.

Sig, your proposals sound very fair and reasonable. I would support it if it were voluntary. That is, I would support it if those folks like myself who don't want to participate don't have to. Let us opt out of the system, and you got yourself a deal.

Can't Take My Gorram Sky

Aude sapere (Dare to know). -- Samuel Hahnemann, M.D., founder of homeopathy

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Thursday, December 13, 2007 6:50 AM

CANTTAKESKY

Quote:
Originally posted by chrisisall:
Self sufficient Chrisisall

Every time I've ever gone to the doctor has been a waste of money, in hindsight. Every single time it would have been better if I had taken care of things myself with herbs, self-help OTC stuff, or homeopathy--in hindsight.

That is why we eventually just decided not to buy health insurance.

If we ever get hit by a bus...we'll just pay them in installments what we would have paid for premiums.

I would like to see a tax free medical savings plan for catastrophic care. All the existing medical savings plan we looked into are good for only one year--then it is use it or lose it. Doesn't make sense to me. Think of how much we can save if we paid our health insurance premiums into the plan in event of catastrophic care--and the catastrophe never happens.

Can't Take My Gorram Sky

Aude sapere (Dare to know). -- Samuel Hahnemann, M.D., founder of homeopathy

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Thursday, December 13, 2007 6:53 AM

SIGNYM

I believe in solving problems, not sharing them.

ot sure how a "voluntary" system would work, since it would depend on being funded by everybody, but I'll give it some thought and see if it's theoretically possible.

Oh, and one more item: Mandatory post-market adverse reaction reporting. Our current voluntary reporting system is a nightmare.

---------------------------------
Always look upstream.

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Thursday, December 13, 2007 7:09 AM

CANTTAKESKY

Quote:
Originally posted by SignyM:
ot sure how a "voluntary" system would work, since it would depend on being funded by everybody, but I'll give it some thought and see if it's theoretically possible.

Just pretend we're not part of the population. We don't pay, we don't get to use.

And if we change our minds when we get hit by buses, we don't get the group discount from having participated all this time. We pay higher rates out of pocket. Maybe you get "credits" from paying into the system, and your rates are determined from how many credits you have. Social Security currently uses this "credit" model, except it is how much you are paid depends on how many credits you have.

In private health insurance, the insurance gets discounts from hospitals. My nearly 3 week stay at the hospital cost $52,000 (not including physician fees). The insurance paid only $10,000 of that--the rest was discounted. If I hadn't been insured, I would have been liable for the entire $52,000.

Can't Take My Gorram Sky

Aude sapere (Dare to know). -- Samuel Hahnemann, M.D., founder of homeopathy

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Thursday, December 13, 2007 7:18 AM

FREMDFIRMA

I've only one thing to add to this, and for personal reasons.

Under this program, any doctor who throws in the towel on a patient who is alive and aware enough to express their wishes, because he believes they are "going to die anyway" - should be fired, have their license to practice revoked, AND be charged with attempted murder.

Do no harm should be taken to mean also to not allow it by inaction* or neglect.

-Frem

*-Yes, I know that can go places we don't want to, which is why I specified that the patient in question must be conscious and able to express their wishes.

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Thursday, December 13, 2007 7:26 AM

CANTTAKESKY

You know, I have to agree. Withholding necessary treatment is just as bad as causing harm itself.

I read a story about a black Alabama midwife practicing in the 50's. She helped women give birth at home successfully until she got her first case of placenta previa (where the thick placenta blocks the cervix, and there is no way for the baby to get out). Now if there is ever a case for a C-section, placenta previa would be it.

She dragged that poor mom to the hospital, where those bastards refused to admit the mother because she was black. Now in the 50's, there weren't a lot of black hospitals (I think Tuskegee was it). The poor midwife did what she could--she reached in there with her fist, got a good grip of the placenta, and pulled with all her might. She was able to save the mother, but not the baby.

She said that in her career, she encountered 10 cases of placenta previa, including this one. She was able to to save all the mothers in all 10 cases, but lost 2 babies altogether (the first and one other). It is to her credit that she was even able to save 8 of the 10 babies using the methods she was forced to use.

I think those doctors at that hospital need to be charged with manslaughter, at the very least.

Can't Take My Gorram Sky

Aude sapere (Dare to know). -- Samuel Hahnemann, M.D., founder of homeopathy

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Monday, December 17, 2007 10:26 AM

RUE

I have a vote and I'm not afraid to use it!

CTS

I did want to address a couple of points.

One is that only a certain (but well-known) fraction of people with gall-bladder problems will go on to sepsis. It was that fraction that was calculated for that instance (surgeon's strike). No one made the assumption that ALL people scheduled for elective G-B surgery would go on to a life-threatening condition.

The other is something you've discovered for yourself - 80% of people who go the doctor - or naturopath or other practitioner - would have gotten better by themselves. And with waxing/ waning conditions (gall-bladder, asthma) it's sometimes hard to tell if it went away on its own or due to some treatment.

From personal experience, I used to have seasonal asthma (summer) that was so bad you could hear me wheezing from 20 feet away. Somewhere along the line it sort of dropped off the radar with nothing having been done for it - though exactly when it stopped is hard to say. (It's like trying to remember your last hiccup.) It stayed away for roughly 15 years. But then it came back with a vengeance when I was in my early 30's and incapacitated me. I literally couldn't walk 10 feet without having to stop and struggle for air.

I've seen the same thing happen with other people's with recurring conditions. Trying to figure out what's working, if indeed anything is, is akin to what we call 'reading the tea leaves'.

***************************************************************
"Global warming - it's not just a fact, it's a choice."

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Monday, December 17, 2007 11:03 AM

CANTTAKESKY

Quote:
it's sometimes hard to tell if it went away on its own or due to some treatment.

True.

But stopping a gallbladder attack within seconds after a treatment--well.. that is what convinced me it was doing something. Placebo? Maybe, but who cares? The pain never came back again! I'm wicked pleased with that placebo.

Can't Take My Gorram Sky

Aude sapere (Dare to know). -- Samuel Hahnemann, M.D., founder of homeopathy

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Monday, December 17, 2007 11:09 AM

RUE

I have a vote and I'm not afraid to use it!

FWIW - MOST medical things I ignore - I like to think I'm a pretty good judge of what does and doesn't fall into the 'will go away on its own' category. But for the really important stuff I'm of the attitude that you throw everything at it you have - regular and alternative medicine alike. I don't believe in limiting your efforts to one OR the other. And once it gets better you have the luxury of being able to sort out the whys and wherefores at your leisure.

I also tend to be the family guinea pig for supplements, alternative medicine, vaccines (yes vaccines) etc. I've suggested B12 to a few who seemed to be having a specific kind of mentation - and have them improve. And I think I have come up with an all-natural treatment for the high BP that seems to run in the family. So far it's kept high BP at bay in a few members for almost a decade.

***************************************************************
The magic ingredient - potassium.

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Monday, December 17, 2007 11:40 AM

SIGNYM

I believe in solving problems, not sharing them.

CTS: AFA "optional" insurance. It's not as simple as just "ignoring" a population. The young and healthy will opt out whenever possible. That leaves the insured pool at higher risk and with higher taxes. If the taxes get to be TOO high, then the poor will also opt out. The wealthy... hell, if they can pay for their own medical care out-of-pocket, they'll opt out too. It would require some pencil-whipping to see if an "opt-out" option would cause the program to self-destruct.

---------------------------------
Always look upstream.

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