Friday, February 08, 2008

ARE YOU LISTENING?? (re National Health Care)

Our colleague from across the pond, Dr. Shroom (pictured at left) writes a blog that can be found here. He's a British ER doc practicing under the umbrella of the National Health Service (please correct me if I am mistaken doctor) which is a lot like what Hillary-care would be. In fact it seems to me that it's eerily similar to our current VA system which is fiendishly beuarocratic rationed-care. I should know, it's where I get my care.

Dr. Shroom was kind enough to comment on erdoc85's "Karma" post where erodc85 opined that, even though the patient whose life he was saving was an evil-to-the-core JCAHO paper-pushing monkey screaming for narcotics (they were almost the last thing he needed to stabilize his inferior myocardial infarction), the result was that in 40 minutes the patient was in the cardiac cath lab having his heart attack stopped in its tracks. The JCAHO standard is 30 minutes so erdoc85 will probably fall out of the 'core measure' goals established by JCAHO and others, and be appropriately punished perhaps (wouldn't it just be great) by the anencephalic ass-monkey whose life he saved. But I digress. Dr Shroom, working in a system that you, the public, seem to think will 'fix' our current crisis says the following...

Nice post. Nothing sums up, for me, the difference between the UK and the US better than the phrase "door to balloon at 3a.m 40 minutes... not excellent". Where [I] work, a large University teaching hospital, a regional centre for interventional cardiology, there is NO balloon out of hours. None. Ever. Go figure.

I, and many like me, will refuse to work in such a system and you, the public, consumers of health care, should rant and scream and picket and protest to stop it. Excellence will no longer be the goal of our care, medicocrity will be the goal and it will be quickly acheived. The idea is that all should suffer equally. The reality is that excellent care will still be available, but it will be for the rich only.

As it stands now excellent care is available to everyone in our country, period, and the money is coming from people with insurance, hospitals, and nurses and doctors in the form of pay cuts and declining reimbursements- and it's not nearly enough. It is killing us, and even criminals and illegals are GIVEN this care by law (see millions of prior posts on EMTALA). Patient's HAVE to own some responsibility for their health care, if they do not, Hillary-care or its clone will make all care here for normal folks just like DMV. I don't want it to happen, I am fighting against it, but until the voting public sees this it is inevitable.

And Dr. Shroom, please understand, I hold you in the highest respect. I am fairly sure from reading your blog that you are an excellent ER physician and probably better at it than any of us car-crash physicians on this blog. I am sorry that you are in a position of learned helplessness dictated to you from above, and, as a side note, if the Archbishop of Canterbury has his way and Sharia law becomes an alternative law of the land in Great Britain then I would run, not walk, over here. We've got a spot for you amigo, even if you are a limey.



  1. It's gets worse; Hillary wants to actually garnish the wages of those who don't sign up for her insurance. So the idea of free choice is moot. Last time I checked, my citizenship read American, not Russian.

  2. I feel the irony of ironies would be the head of N.O.W., or better yet the ACLU, being beaten sensless with a bag of rocks by some towel head, all the while preaching multiculturalism and a woman's right to pinch the head off her own fetus. Does anyone else hear the deafening silence from these groups regarding Sharia law and radical Islam?

  3. Once more 911 has a correct bead on the situation.

    911, You Deserve This

    Thanks to the Anon who educated me on these in a previous post!


  4. Again....HELLLLLOOOOO....great minds think alike.
    Incidentally, Scalpel argues on this post that we shouldn't be so rah-rah cardiac cath lab for STEMIs and thrombolytics are not as bad as we think.

  5. Happy to be of service; anything that spreads the gospel of Shroom; I think, perhaps, I should have said no door to PRIMARY balloon. If we thrombolyse you (streptokinase anyone) and it fails, you might get out of hours rescue angioplasty. Maybe...

  6. I think we should talk about British people on this thread.

    A couple of years ago, my best friend's British friend was staying with her for a bit for a vacation (they'd lived together as roommates when she lived in London). My best friend had a softball game, and I went and hung out with British Guy in the stands. Afterwards, the team and we friends went to the parking lot, and cracked open a few Miller Lites out of a few coolers which were strategically placed in the back of a pickup truck and proceeded to get buzzed in the parking lot.

    I noted British Guy to be like shaking with joy or something. I'm all "WTF, British Guy?"

    He's all: "I kahnt believe I'm in the United States drinking beah out of the bahk of a pickup truck after wohching a softball game. This is excellent! I'm going to hahf to email everyone I know when I get bahk. They will be so jealous!" British Guy had a big, stupid grin on his face the rest of the night.

  7. Healthcare Crisis? What Healthcare Crisis? Just looking at Shroom makes me forget all about such pedestrian matters. Now, help me get my feet into these damn stirrups! (And please remember to to call me "Love" or I will be very disappointed.)

  8. This one oughta get the blood pumping 911:

    NY state is trying to garnish the wages of EVERY physician by $50k to cover the cost of malpractice:

    I'm fairly liberal, but this is a preposterous abuse of physicians, especially the poor GPs and Pediatricians that are barely making over $50k as it is.

  9. I don't see why everybody can't have access to everything all the time, 24 hours a day, regardless of ability to pay. I think the problem is you rich doctors are sucking all the money out of the system. If you made less, then there'd be plenty for the rest of us.

    The American Voting Public

  10. Thanks 10. Now I'm convinced! I want a birthday cake made for my nephew right now. Sure, I've known for 2 months that his birthday was coming, but I want the cake NOW, and I want it free. It should be illegal for the bakery to be closed...and why do I have to pay for the cake? Everybody has a fundamental right to free cake on their birthday.

    Bostonian: First of all, sorry that you're in NY. Boston Rocks! I could spend hours (and have) in The Union Oyster House! Given your "doctor tax" info, watch the docs start to leave the state! After a while, some dumb-ass lib will begin to wonder where all of the docs went.


  11. What drives me crazy about ya'all conservatives is that you guys make it sound like all people without insurance are lazy, on government benefits, whatever. There is a whole subset of the population who work 40+ hours a week, pay their bills on time, and still do not have insurance. And sometimes those people need expensive medical care.

    /has about 10g in medical debt
    //doesn't answer the phone anymore. Stupid creditors.

  12. Good point Hannah, the insurance companies will have to raise my premiums if a bunch of lazy welfare bums are forced to purchase health insurance inorder to get their government handouts. Its like forcing the auto insurance companies to insure drivers with 6 DUIs, you can't charge them enough to pay for the accidents their gonna cause. I'd rather the uninsured just keep getting big bills, even if they don't pay.

  13. hannah,
    i am anxious to hear your solution. i was not aware that people were not allowed to purchase health insurance. especially those with jobs. that's weird.

  14. Hannah---you can complain or you can try to find another job. Hospitals generally insure anyone who is hired. "If you can work, you ain't that sick."

    A diabetic nurse attached to $5000 worth of insulin pump

  15. What drives me crazy is that you feel that you have a right to make me pay for your health care. I don't understand why people think that they have a right to something that someone else has to provide for you. My wife and I both are full time students, work part time, and yet we still have insurance because we realize that it is something that we can't do without. It's called figuring out what your priorities are and sticking with that. You can get your expensive health care. And you can often work out payment plans with the hospital in order to pay those bills. Quit expecting something for nothing. Entitlement has never worked well in society. And you're not entitled to my coffers.

  16. Its nothing to be proud of, but I was uninsured for a few years in my 20's. My cool motorcycle was insured, as was my car. I had cable TV, and if cell phones existed, I would have had one of those. I just bet that I wouldnt get sick or injured, and if I did, the hospital would have to line up behind the bank and Guido to get paid. And in medical school, when I was forced to buy insurance, I probably would have pawned it.

  17. two things...

    as Dr Shroom aludes to, it is not that SETMI patients don't get treated, it is that they get thromolysis either as an abortifactant for the MI or as a bridge to cath. that is not unreasonalbe, it's just not the currently optimal therapy in many STEMIs.

    bostonian in NY. "From each, according to his ability; to each, according to his needs." seems like Americans are starting to buy this. wonder who said it???

  18. i agree that that sounds reasonable. my only dig on that is that i do not want the government to administer it. tell me the last time a government beaurocracy up and said, 'well, our work is done here' we are shutting down.

    obversely, this does happen in the private sector either through failure of the business to compete efficiently, or becuase the success of the company allows them to offer better, new, or services. competition keeps costs down and this is delivered to the public.

    other than that we agree.

  19. 911, on that health insurance thing - it's not always as easy as that. My husband worked for a large company that went bankrupt. We had good medical insurance through them, and access to COBRA when they went under. COBRA, however, cost us close to $1600 a month. At his new place of employment they had only 20 employees and as a small business, they could not provide group health. No problem, we thought. We'll just buy a private plan. A good theory, but it only works if your family is completely (and I mean SPOTLESSLY) healthy. Our preschooler had vesico-uretral reflux as a baby, and despite it having resolved and being cleared by his urologist, he was uninsurable. I had something similarly ridiculous, and was also uninsurable.

    So now we've got 2 family members that qualify for insurance, and 2 that don't. It was less expensive to continue paying COBRA for all 4 than to try and go half on COBRA, half with private insurance. And don't get me started with what was offered as "insurance" for the healthy ones - even for a family that could afford $600 premiums (which many can't,) co-pays were 80%, as were emergency care and any testing or surgical procedures. We aren't expecting any of those, but it would be nice to know we're covered in case of the unexpected. Drug benefits were non-existent unless we paid $900 a month in premiums.

    No question, group health is the way to go. The company finally expanded its workforce a bit (just before our COBRA ran out!) and we're back on group coverage. But only after spending over $30,000 on COBRA premiums. And more and more employers here where we live are cutting hours, working people just under the full-time line, all so they don't have to pay for benefits. From personal experience, those folks have few choices. Nurse K, jobs are currently a little hard to come by around here. I'd bet a lot of people would choose regular employment with no group health to no employment at all. Hospitals may always provide insurance for those who are hired, but you have to have their desired skill-set to get the job in the first place.

    I don't blame the doctors, and I don't think socialized medicine is necessarily the way to go. Health insurance is seriously broken in this country, and it's affecting a lot of people. I'd bet that people who can't afford insurance are also some of the ones clogging your ER.

  20. mama bee,
    i too pay ridiculously high health insurance. you and i pay this high insurance to cover illegal aliens, people who choose not to have insurance, and the indigent. you are footing the bill for all the free care we are legally obligated to give away, much of it not needed. as an example. of all visits to the ER about 17% are sick enough to get admitted to the hospital. the others are either sick enough to require treatment (%30, and that's being generous) and the remainder is bullshit.

  21. Free health care for all works in its way; but it means everyone gets the same, suboptimal care. A private sector does exist in the UK, so if you want rapid treatment, or something not available on the NHS, you can pay for it.
    Personally, I like the idea of healthcare free at point of delivery for everyone. But it is open to abuse, and has to involve rationing, which many people here do not want to accept.

    Next, I call everyone 'love', especially when they're in stirrups; and we British are very easily amused, especially when living the cliche.


  22. dear dr shroom,
    we agree. in fact, we have gone one better by providing the best to everyone. in my 'network docs revisited' post there is a link to a post entitled 'hello taxpayers' and you will see what i mean.

    de facto we have what you have but, with all its problems, the NIS is funded. EMTALA is not.

    i do believe in basic care for everyone if they are a citizen or a documented guest. i also think we should provide compassionate care for illegals but as part of that care they should be repatriated or find a way to pay for their care .

    if i'm not mistaken australia has a two-tiered system. that's actually what i favor. basic coverage for all citizens, that will involve rationing of care and waiting, supplemental insurance can be purchased for those willing or able.

    hell, i just want to do ER medicine in a system with some stability. right now i have a paper cup and i'm bailing on the titanic.

    for me, i call all women 'sweetheart'. so far, no sexual harrassment suits.


  23. 911, what's the reason for that? Is it that health insurance companies have to pay more to the doctors/hospitals for our care as a result of those who can't pay? In theory, government and state agencies cover the Medicare patients, and the folks without insurance get bills they'll never be able to pay -- so presumably, the gap comes from raising costs to pay for the procedures that the uninsured have.

    I don't understand the relationship exactly. All I know is that health insurance companies are raising their premiums and trying everything they can think of to wiggle out of paying for things, right on down to denying life-saving medications because a generic equivalent doesn't exist yet. With all the things they refuse to pay, you'd think they would be making money like crazy.

    Anyway, I rarely have to go to the doctor. But if I'm in the ER and you're saving my life (or that of my family) you can call me anything you want.

  24. mama bee,

    honestly i'm the wrong person to ask. i only know the generalities because when i ask i get a headache very quickly. here are some things i do know.

    EMTALA is an unfunded mandate. certainly the cost of medical care had been increasing before EMTALA but what it did was, by force of law, mandate that we see all comers regardless of ability to pay for all 'emergency conditions'.

    they did not define 'emergency condition' and we on this end have not yet figured out a way to define it either. chest pain in a 20 year old is almost certainly not a heart attack but they do happen and no one wants to be the first, with EMTALA and john edwards clones hanging over us, to miss one.

    so, a huge game of cost shifting has ensued. insurance companies have been screwed because hospitals have increased charges to them for the insured to try to make up the shortfall for caring for the 'self-pay' patients. medicaire and medicaid have decreased their reimbursements to the point that we actually collect more from folks without insurance then we do from medicare/medicaid.

    reimbursements to physicians and nurses have gone down also in an effort to cover the shortfall.

    finally, there has been no significant tort reform nationally so we, again obligated to take care of everyone, are in the very strange position of being in the sights of malpractice attorneys (as we should be in most cases) for care that we give away for free. neither can we deduct from our taxes the cost of care given away which is, in my specialty, conservatively etimated at $150,000per year per emergency physician in the US.

    we, on this side, have no incentive to decrease our testing and lab and xray ordering for fear of missing anything. therefore the 20 year old with chest pain gets a 'million dollar workup' even though everyone involved in his care would wager thousands of dollars of their own money that the etiology of the chest pain is nothing dangerous.

    (as an example i just picked up a patient, 16yo with 'high blood pressure' brought in by ambulance because his mom is worried... he's huge and the cuff they used is too small to give a good measurement but even if his blood pressure is high this is not an emergency and something that should be followed by his pediatrician, but what the hell, this is free right? his bill will be over a thousand dollars.)

    also, EMS systems, mostly state/county run, are under the same onus of EMTALA. if you call, they haul. as stated elsewhere EMS has become a taxi service to the ER. sometimes EMS is called by non-payers and payers alike because they think that coming in by ambulance will get them to the front of the line in the ER (not true).

    each ambulance run costs at least $500 and the medics, some of my favorite people on the planet, make about what a pizza delivery guy makes.

    EMS folks and nurses are paid a pittance and it's getting worse. there is a huge nursing shortage. in the ER our good ones get burned out quickly and we can't fire our bad ones because there's no one to replace them with.

    much of this could be solved by simply insisting on a flat fee to be paid up front for every visit to the ER or by an EMS protocol demanding payment up front for the ridiculous calls.

    as soon as we try to do any of this however al sharpton or the aclu or their equivalent are on television playing the race card or the 'doctors don't care' card and they get the rent-a-mob with signs behind them and pretty soon the gutless lot that is the AMA or the hospital administrators or the local group of physicians surrender and go back to work.

    the ceo of my hospital system makes thirty times what i make. he has an MBA and works five days a week and sleeps at night and never has to tell a mom her baby died. he can't run a code but he can generate some paperwork!

  25. Do male exams ever require stirrups? What do I know, I lead a sheltered life. But I think we should all be humbled equally.

  26. dear lady cynic,
    no stirrups, but ETOTHEIPI has a special 'no hands rectal exam' that he performs on many of his patients. this requires a firm grasp of both of the patient's shoulders and a reassuring 'just relax... you'll feel a bit of pressure now' speech.

  27. Problem in this debate often stems from personal stories. Understandably, that's all most people have to refer to when thinking about the topic.

    There will never be a system (government or otherwise) that is 100% perfect. But any kind of "fix" needs to address the needs of the many over the needs of the few as crass as that may sound. (It's logic, not feeling).

    The ER must have some relief...either from lawyer abuse, patient overuse, or sheer volumes. Patients must take responsibility for their medical problems and seek appropriate care, and just like the Donut should expect to pay for the services you receive. Somehow, in the last few decades, medical care evolved from a privledge to an issue tantamount to a "constitutional right".

    I'm all for getting rid of Medicare, Medicaid, and 3rd party payors except in cases of catastrophic illness. That would make everything cheaper. You wanna bring little Benjamen into the ER at 4am for a fever, that's fine. But be prepared to pony up $100 rather than $25 for the convenience of not having to wait 4 hours for the clinic to open.

    There'll be sob and horror stories everywhere. We're all one illness away from being on Dateline....but you can't design and run a health system on the lowest and rarest denominator.

    I saw some stupid Oprah show (am I being redundant) a few weeks ago where they found these impossible medical stories and people were devastated both financially and personally. I thought to myself: here we go again...using isolated rare examples of problems to try and make the whole system appear corrupt, broken, and in need of complete overhaul.

    Though the later may be true...I'm just worried that they're gonna break it further since none of the candidates knows a damn about healthcare (Trivia Question: how many physicians were on Hillary's committee to overhaul medicine in 1992?)

    And by the way, if you're an illegal alien, you should have to pay for your health care just like I would in your country. This free care to illegals is BS.

  28. PS
    I should have said right at the beginning, thanks for the flag guys, and the job offer. I may just take you up on it... even if I am a Limey.

  29. Limey's are cool. Y'all just talk kinda' funny. Makes it sounds like yer smarter'n us.