Saturday, August 15, 2009

Sick? Obummer.

This health care bill is the worst abomination since MTV stopped playing music videos and introduced 'reality TV' with all those circus-freaks.

The idea that funding primary care to the near exclusion of specialty care will produce savings is true only in that more people will die. Even the Congressional Budget Office poured cold water on the idea, but just so you non medical types can understand this argument a bit better let me tell you about preventive care and the theory and the reality.

The supposed savings from preventive care come from picking up diseases before they become manifest and preventing them. Problem is, screening exams and annual physicals, with some notable exceptions, are worthless towards this goal. Reams of medical studies prove this but the eggheads in Washington have, all of a sudden, become medical experts without reading any medical studies.

Ever wonder why we admit almost everyone with chest pain to the hospital (we do)? It's because even while one is having chest pain we do not have the capability in the ER to tell whether it is from the heart or not unless the patient does us the favor of showing us their heart attack on the EKG (about 50% of the time). Same with just about every illness. Screening, with the exception of, say, prostate cancer or colon cancer, is, right now, a huge money loser. We do not have 'screening tests', especially in the pre-morbid state, for most illnesses. Diagnosing most illnesses requires symptoms, clinical judgment, and then directed labs and exams.

And when life threatening conditions are detected you almost always need a specialist. Asking a general practitioner to stent a blocked coronary vessel would be like asking you to fix a jet engine. It's stupid. What this bill proposes is death... on a massive scale. You may feel great having your guaranteed health care, but having a nurse practitioner doing your gall bladder surgery is humoungously stupid. And if there is a shortage of specialists then who is going to do specialty procedures? This is the world stood on its head. This is liberalism gone mad. This is your future and it is a lie built on a falsehood backed up by a crazy Statist who can not talk sensibly without a teleprompter.

25 comments:

  1. This bill scares the shit out of me. I have two years of undergrad left now, and I can't even imagine what the medical world might be like by the time I am out of medical school. I want so badly to work as a surgeon, but I am truly frightened at the direction this bill is attempting to take healthcare.

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  2. dear charles,
    surgeons will not be needed in ten years. we are going to pass a law outlawing appendicitis.

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  3. Dang it 911, quit your scare..errr...evil mongering. It's not about outlawing appendicitis, it's about access to appendicitis for all!

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  4. Don't be frightened Charles, just plan a second source of income. Have you been working out? If you have, you have more earning potential than most of these guys... honey.

    -SCNS

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  5. Cant wait for when Ted Kennedy croaks and the hue and cry starts for free Glioblastoma Screenings... Might be a good time to sink some money in the MRI biz...

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  6. This post makes me feel sick to think about. I am a perfect example of why screening does nothing and can't prevent things. I am in great health...except for the parts of me that aren't.

    Scary stuff!

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  7. Read Mark Steyn this morning. He talked about an elderly British woman he knows who has had a recurring problem with her hand. Her British doctor (whom she visits every month) told her the cause was old age, and she should take the British equivalent of Tylenol. Steyn took her to a hospital in New Hampshire when the hand swelled up, and it was discovered she had gout, and was appropriately treated. Steyn said this was "the difference between health 'care'(going to the doctor every month to no purpose) and health treatment-and on the latter America is the best in the world"

    I say, Here, here.

    Stick a fork in Obamacare, it's done. Better yet, drive a stake in it.

    BTW, thank you all you doctors who work so hard.

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  8. British equivalent of tylenol? that would be paracetamol and it doesn't work for gout. indomethacin, allopurinol, colchicine... they work for gout and it's not a hard diagnosis to make... all it takes is a well placed needle and a lab that's open.

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  9. I think that was Steyn's point. No labs for that old lady, just a pat on the hand and a "there, there," and off you go with your paracetamol.

    Not exactly the kind of care anyone would hope for.

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  10. Disgruntled Internist9:01 PM, August 16, 2009

    You know how I know you have no idea what you're talking about? Because for some reason you think there are not millions of people walking around with undiagnosed and/or untreated diabetes, hypertension and hyperlipidemia. Furthermore, you imply that treating these people (with inexpensive drugs, by the way) would cost more than the expected complications from not treating them: heart attacks, kidney failure, congestive heart failure and so on. Quit listening to Rush Limbaugh and go back to your medical school epidemiology notes.

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  11. Disgruntled Internist,
    You Know How I Know You're Gay? NOT treating stuff is cheap, Heart Attacks, Strokes, Lung Cancer, much cheaper in the long run. That $4/month Metformins not such a great deal when you add in the extra 40 years of Social Security, Nursing Homes, etc etc.
    And we didn't even have an Epidemiology class, so Blow me,
    Thats how I know you're gay,

    Frank

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  12. The United States Government is of, for, and by the People. The public cannot participate in a government that runs on policies that are hidden.

    The government should be proud to release its carefully researched and supported policies. We deserve this as a free people. The press and public should be able to review these documents.

    I hope people of all parties and positions could agree that this is a fundamental. It is non-partisan to demand that the President and all politicians show how they have carefully researched their proposals.

    It is not our job to read tea leaves and pick apart 1000 page bills written in Old English to figure out what the bills are really saying. The whole idea of "legislative language" is to obscure what is going on. Whatever I extract or infer, I am drawing my own conclusions, and the government can say that I am misguided.

    We need proposed results, expected evolution, methods, justifications, comparative studies, past successes of similar policy, funding sources, expected difficulties, the works.

    Did Obama (or any politician) start with such a policy study, or not?
    If so, then where is it? If not, then he is a fool.

    Would Obama legislate from some scribbles on a cocktail napkin?
    Would he say "give me anything, I'll rearrange it later to do what I want"?

    We must demand: Where is the policy paper?
    If they refuse to release anything, then jeer: OK, so where is the cocktail napkin?

    A Few Words About Policy
    http://easyopinionsoutlink.blogspot.com/2009/07/few-words-about-policy.html

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  13. Disgruntled Internist (who very well may be a disgruntled sales clerk for all medical knowledge and rational thought processes exhibited)---

    They are not "undiagnosed", they are UNTREATED
    because dammit, that all you can eat buffet at Golden Corral is only $6.99 on weekdays and that $15 co-pay for their generic statin, antihypertensive, or oral hypoglycemic agent cuts into their ciggie and lotto money, moron! But don't worry, after the stoke or amputation they will want YOU to do everything to fix them....unless dialysis is on bad day, or they are out of town, or they say "screw it" and just show up at the ER in CHF after the 44 oz. Big Gulp and Cheese Fries!!

    Pattie, RN

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  14. Disgruntled Internist9:20 AM, August 17, 2009

    Screening for diabetes saves money in the long term: http://www.emaxhealth.com/1020/23/31589/routine-diabetes-tests-can-save-money.html

    Screening for hypertension has long been known to save money. Screening for high blood pressure: Recommendations and rationale of the U.S. Preventive Services Task Force. Rockville
    (MD): Agency for Healthcare Research and Quality; 2003. Available from:
    http://www.ahrq.gov/clinic/3rduspstf/highbloodsc/hibloodrr.htm

    Giving flu shots to preschool kids saves money: http://pediatrics.aappublications.org/cgi/content/abstract/106/5/973

    I've also read papers demonstrating the cost-effectiveness of colon cancer screening, cholesterol screening in high-risk individuals, alcoholism screening and pap smears (at appropriate intervals).

    So don't call me a douchebag, dumbass.

    The key thing is to implement screening tests and preventative measures with proven cost effectiveness.

    You're painting all preventative measures with one broad, politically conservative brush, 911doc, based upon a review article that shows some screening measures are cost-effective and some aren't.

    And what kind of doctor are you who thinks it's completely acceptible to have 45 million U.S. citizens walking around with no insurance, anyway?

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  15. Disgruntled Internist9:42 AM, August 17, 2009

    Frank--you and your ilk are the clearly ones pulling the plug on Grandma. Do your patients know you favor not treating them so they'll die early and won't become a burden on the taxpayers?

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  16. "So don't call me a douchebag, dumbass"

    Ya know I come here often, but don't really post because it's just more fun to watch the boys work things out amongst themselves. I so love all of you.

    -SCNS

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  17. Ohhh, so now Obama is willing to consider insurance "co-ops" as an alternative to their taking over all our medical lives. How sweet.

    Know what I think? I think Obama knew he'd never be able to pull off his original plan. If he could, great. But I think in the back of his mind, he had this, and other slightly watered-down alternatives, in his pocket to make us feel that we're getting a great deal on our terms. I have to hand it to him; it's brilliant.

    But it's still socialism and I don't care how Obama wants to paint it, he's taking away our freedoms at an alarming rate. He's hoping we're all too stupid and will buy into this latest ruse. If Americans balk at that, well hell, he's got another "concession" waiting in the wings.

    What scares me is that it may work.

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  18. I would like to know why being uninsured is such an awful thing. So there are 45 million uninsured? Why is it a given that this is a disaster? Is insurance really necessary for every damned procedure? I, for one, would rather pay cash for office visits, innoculations, and lab fees.

    Insurance should not be needed to pay for MOST medical treatment. Patients should be able to pay out of pocket, or via an established regular payment plan.

    Insurance is best used when it is reserved for catastrophic events. How much better off would we be if we all had low-premium, high-deductible catastrophic policies, personally purchased rather than provided by employers? The deductible could be an amount that is uncomfortably large, but which could be broken into multiple payments so as not to devastate a person's finances.

    I'm not even sure that insurance is the answer for covering the costs of people with serious chronic conditions. In some ways, I think having insurance to cover everything hinders the growth of some industries that could provide low-cost maintenance services.

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  19. dear DI,
    if that's your last word you can have it. all of that stuff is available now, free, at the health department, and at walgreens. alll that it takes to get it is to put down you x-box controller, your cigaretters, and your beer and get your happy ass there. you might try reading that NEJM bit more closely and with pictures. you came to my blog and insulted me... so you are, in fact, a douchebag and a thin-skinned one at that. douche-bag.

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  20. Don't you ever listen to me 911?!!

    DI is NOT a DB, it is a DLF....

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  21. Ok, the curiosity compels me ... what is a DLF?

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  22. I watch TV to get AWAY from reality. Not sure what I'm supposed to do now.

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  23. This is just the best collection of comments I've read in a long time! Thanks for the amusement....

    I side with the funny ones, Frank and 911Doc, also PeggyU (You are RIGHT), and Andrew Garland.

    PS: I, too, would like to know: What is a DLF?

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  24. Liz: Aha! DLF ... see comments to the thread labeled "Contest".

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