Wednesday, August 05, 2009

Physicians for Reform

I assure you all that this post is either 100% organic or 100% synthetic depending on your preference.

So a group of docs has done the legwork and proposed a solution to our current 'crisis'. They are called Physicians for Reform, and aside from an ass-slapping good name they have proposed common sense solutions to the current debate that do not involve nationalizing 1/6 of our economy.

They had me at 'hello', but read through their proposals and see that they base their ideas on an M.D.O.D. must... skin in the game for all players. In other words, they opine that market forces, allowed back into our 'business' will correct much of the current mess. I'm 100% on board with this and can't wait to be able to answer the question, "How much does an EKG cost in the ER" with a dollars and cents response. A side benefit of this kind of plan is that people with clipboards will not have nearly as much to do, not as much smoke, not as many mirrors. Wonderful.


  1. Any system where you can get a straight forward answer to a simple question has to have some potential!

  2. Notice that not one single recommended solution:

    is under consideration in the bills being drafted for votes this fall. Now THAT'S malpractice!

  3. Well, I read about poor Barbara Wagner. I just have to say, as one who is not in favor of the current healthcare reform bill, that chemotherapy in her case is probably not the best choice for her quality of life.

    I do have limited experience caring for patients undergoing palliative chemotherapy. But I have extensive experience with chemotherapy administration in general, as my background is oncology hospice.

    As a hospice nurse, I've cared for several patients undergoing palliative chemo....not curative, just designed to extend life for (hopefully, but not guaranteed) a few months. I believe the chemo shortened their lives and increased their pain and suffering, in each case that I personally witnessed.

    Chemo, whether one is hoping for cure or just time, makes one extremely ill. Patients can't eat, experience extreme fatigue, nausea, vomiting, and/or diarrhea. If they can eat, nothing tastes good. Meds to alleviate the symptoms are limited in their efficacy, at best, and most have sedative side effects. You may get 3 extra months of life, but if you're kneeling over the toilet for 1/2 that time, is it worth it? Not to mention that once the nausea passes, the fatigue and loss of appetite often continue for some time.

    Unfortunately, if chemo doesn't make you sick, it's probably not hurting (or slowing the growth of) the cancer cells either.

    We don't have a lot to offer patients diagnosed with incurable cancer. In my opinion, palliative chemo offers false hope. On the other hand, the idea of receiving a letter offering physician assisted suicide is, come on!, directly out of the horror movies.....isn't it? You'll do us (and yourself) more good dead than alive....what a horrible thing to say to anyone.

    We do need to change the way we medically treat people at the end of their lives. Unbridled treatment is as ill advised as witholding proven, effective treatments. But it's an awfully slippery slope we're teetering on the brink of.....

  4. This whole issue is very close to my heart (obviously). I don't think I know enough about anything to be able to express a real, well thought out opinion. What I do know is that no one in the world except the physician and the patient should have the ability to decide what treatment is necessary or will be "allowed". People may think they know what they would choose when sick, but until you are there, you really have no idea.

    My life has gone so far off the path of "normal" in the past 4 years that my perspective on this is very different from where it was before. I used to think (as many people do) that a person's health is in their control. That if I ate properly, exercised and took care of myself, nothing bad would happen. That is not true. My doctors all say I am the healthiest unhealthy person they have ever met. There is nothing I could have done differently to avoid any of the things I have faced/am facing. Fortunately for me, we can afford to pay for the things that our insurance deems "unnecessary". If we could not, I'd probably be facing a recurrance of thyroid cancer in addition to my new issues.

    Liz-I am being respectful when I say this, but if you haven't had cancer or been faced with choosing whether to try chemo even though it may make you sicker/not work, you have no idea what you would want in that situation. I know you see what you see as an oncology nurse, but you can't possibly know what a cancer patient in that situation is living/thinking/feeling. I understand that you probably have very good intentions and are probably a wonderful nurse, but you just can't know what you don't know sometimes. Just because you may not think it is worth it, they may and it should be a choice left up to an individual and their doctor. Not an insurance company, not the government, etc.

  5. Also? Holy crap I left a huge comment. Sorry for leaving a comment longer than the post!

  6. Rad Girl is right on target.

    No one really knows what they will do in any given circumstance until faced with those situations. But in the end the individual and their doctor/family should make the final decision, not some nameless, faceless "committee." Yeah, it's messy, but then life IS messy.

    Isn't the liberal take on abortion that the decision should be between a woman and her doctor? Yet those same folks want to get in the way of the patient-doctor relationship when it doesn't include the unborn. Isn't that interesting.

    And Rad don't have to be a health care professional to have an opinion on this issue. You have much more insight than most of the politicians on Capitol Hill. Hope you're feeling better.

  7. I read through the proposals and agree with pretty much everything. However, what I have difficulty with is the practicality of myself figuring out if something is worth it. I'm not a doctor (although I'm going to school and hope to get into medical school) so figuring out if I should pay for a test isn't something I'd feel totally comfortable with. Or what if I'd like X and Y tests but don't have money in my HSA yet?

    I'm not saying this alleviates me of my responsibility at all. I just see this as something that would make it hard to sell to the average person. I'd appreciate some thoughts to help me form my own opinion.

  8. anthony,
    you raise a good point, however, decisions you make about your health care would always, should always be made in consultation with your physician. right now i do not often have time for that kind of interaction with patients because in almost every ER in the country we are balls to the wall 24/7 and many folks to not have primary care physicians. in my way of thinking about this it is a direct result of EMTALA, a law which made ER visits effectively free for folks without insurance or money. the problem here of course is that without 'skin in the game' these same folks have made the ER the destination for everything from skin rashes to bruised pinky toes. they have no disincentive to abuse and they do take advantage.

  9. I have this to say:

    You talk to your doctor and family, you look out the window and think, you have a gut check, then make a decision. Period. It is not about the amount of money.

    In my experience, you can always make payment arrangements with medical professionals.

    I am a very fortunate person that never has anything, apart from traumatic issues, impact my health; sometimes I get injured. Your situation is your own and I am not required to walk in your shoes. However, I live a dangerous life and get injured, sometimes.

    My point is, you look the doctor in the eye, you tell them you are going to pay cash and this may take a few years, and they will make you a deal. Always, in my too-eventful life of 49 years, they will make you a deal.

    I am not "allowed" to purchase a high-deductable, catastrophic policy. That is not my decision, that was made by my betters in Washington, D.C. and Tallahassee, FL. As such, even though I pay into an "insurance plan", I never use it. I carry a checkbook and credit cards and this entire issue is nobody else's business.

  10. CJrun has just given everyone a great secret. Physicians are so numbed to the whole process of billing and payment that if you come at them with cash you are likely to get an huge break in price. The funny thing is that insurance companies hate this if you then try to collect on your payment because it is not per their fee schedule. The only way I can understand this is that the whole house of cards is so tenuous that 'out of the box' thinking or deals makes cards tumble and people start asking questions like... 'hey, my buddy tim got x, y, and z at the hospital and he only paid X, but you guys charged me more than his whole bill', which is, of course, unanswerable unless you are running a con game.

  11. As most know, I have had a significant medical catastrophe. I am now somewhere past $750K, with 50% insurance payment, providing they stop denying coverage for things that they originally paid for!
    I can tell you all for sure , every doc, hospital, etc is more than happy to make payment arrangements for everything owed or adjust for your diagnosis..
    Just call their business office..

    Of course that means that you intend to PAY SOMETHING, instead of buying cigarettes or getting more downloads for your Iphone!

  12. Dear Radgirl:

    I so appreciate your comments. I personally have not had cancer (except a melanoma that was removed 10 years ago...and the sceptre of that stays with me). My parents both died of cancer. I have cared for many patients with cancer, all of whom I truly did/do care about.

    I fully admit that when it's my family that's involved, I become as radically in favor of any possible life saving treatment available as anybody else. I have no knowledge of your particular case, but I assume that you're relatively young (meaning physically stronger than if you were elderly) and that your cancer is/was more treatable than Barbara Wagner's (according to the website).

    I am not talking about any case in which one has a fighting chance of a cure. I'm talking about the effects of chemotherapy on a dying body. Barbara Wagner is/was hoping to receive palliative (not curative) chemotherapy. I've seen what palliative chemo can do. A dying body cannot rebound after weeks of chemotherapy that induces severe fatigue, severe nausea and vomiting, severe loss of appetite. A dying body is weak and will not become stronger. Chemotherapy devastates the healthiest body, nevermind one that is already compromised by terminal illness (and by the time the average Oncologist refers a patient to hospice the illness is extremely advanced, trust me). In the case of Barbara Wagner (as told by the website Physicians for Reform), I think that the patient's physical suffering would increase terribly if she were to undergo palliative chemo. I am concerned for patients who are known by the MD (not the insurance company) to be dying....chemo will not improve their quality of life, truly (if the chemo does not actually precipitate the patient's death) it will prolong the dying process, it will prolong their suffering. You don't get three (or however many) months of quality life wherein you visit with family and travel and shop and whatever is on one's priority get three months of nausea, fatigue, bodily wasting, and pain, in most cases. Longevity does not guarantee quality.

    So please remember, my remarks are directed specifically towards those cases whose cancer is beyond curing...and that is an entirely different proposition.

    I do fear for anyone with serious illness should this healthcare bill (as it is) pass....

    Take care, Rad Girl! May you live a long and happy life....(and may we all!).

  13. It's funny how the Democraps are ranting about "busing in" right wing groups to the town hall meetings on health care reform. They are the kings of busing unemployed ACORN hacks and did so at the meeting in Philly. Jack asses.