Luminous Landscape Forum
The Art of Photography => The Coffee Corner => Topic started by: LesPalenik on November 17, 2019, 06:44:56 am
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Interesting, but not surprising findings about artery clearing, stenting and bypass surgeries have been reported by researchers on heart disease treatments.
Many patients with severe but stable heart disease who routinely undergo invasive procedures to clear and prop open clogged arteries would do as well by just taking medications and making lifestyle changes, U.S. researchers reported on Saturday.
Just eliminating unnecessary stenting procedures could save the U.S. healthcare system $570 million annually, said Stanford University School of Medicine cardiologist and study co-chair Dr. David Maron. He estimates the cost per stenting procedure at about $25,000 and bypass surgery at $45,000.
The main goal of the trial was an overall reduction in deaths, heart attacks, hospitalization for unstable chest pain or heart failure and resuscitation after cardiac arrest. On these measures, the addition of stenting or bypass surgery to reroute blood flow around the arterial blockage was no better at reducing the adverse events than medical therapy alone. The invasive treatments did result in better symptom relief and quality of life in those who had frequent chest pain.
The findings do not apply to all heart patients, including those with blockages in the left main coronary artery, Hochman said. And, she added, “if you’re having a heart attack, stents save lives.”
https://www.reuters.com/article/us-health-heart-stent-idUSKBN1XQ0MR
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There was a really good documentary on this on Netflix a little while back. They were comparing two technologies that came around at the same time, stenting and a device that could be used to measure levels of a (I forgot exactly what) substances that correlates to clogged arteries.
The conspiracy theory was that since stents generate a lot of money, everything else was ignored.
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Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada. Over 1.8 Million stents are implanted per year in the U.S.
https://idataresearch.com/over-1-8-million-stents-implanted-per-year-in-the-u-s/
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Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada. Over 1.8 Million stents are implanted per year in the U.S.
Of course more are done in the US...after all it is the instant fix.
Peter
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Personally I thank heart stenting and carotid endarterectomy for saving my life.
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Of course more are done in the US...after all it is the instant fix.
Peter
I read the article yesterday. I had triple bypass last April when the doctors forgoed installation of stents during a catherization check after I failed a cardiac stress test. They found my arteries so clogged stents would not work, so they said. I was already on blood pressure reducing medicine, aspirin, lipid stuff and diabetes medicine. I had been complaining of chest pain. So my cardiologist would not even let me go home. He had me admitted right then. I had the bypass surgery 6 days later after the blood thinning aspirin had clear out of my system. Fortunately I never had a heart attack so my heart appears still very strong and I'm feeling better than I have for years. Also lost weight, my lipids are great and my diabetes check looks pretty good.
Would I have done anything different if I read this first? I doubt it. When your cardiologist tells you might have a heart attack any minute and won;t even let you go home to wait the week for the operation and take the chance, it's hard to argue about what to do. You kind of go along with it.
I still have to change the way I live because "new" arteries can clog in the future and diabetes is just a very bad damaging disease for everything in a body. In any case, I can't reverse the bypass. I just have to be thankful I'm alive and seem to be doing well currently . Now it's up to me going forward. And God.
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Personally I thank heart stenting and carotid endarterectomy for saving my life.
Glad you're doing well.
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Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada...
That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.
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Glad you're doing well.
Thanks, and right back at you!
I had the heart stent after a heart attack and the carotid endarterectomy after a series of transient ischemic attacks.
I'm not a medical man, but think the article is probably more relevant to those who are asymptomatic.
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I should mention the downsides of doing surgery instead of treating it with medicine. I was very depressed after the surgery even considering suicide for about two weeks. It could have been the anesthesia after effects that some people react so negatively too. Friends and family were very helpful during that period. I really needed their support. I was in a lot of pain and couldn't sleep in a bed for three months, resting in a recliner an hour or two at a time. My chest hurt a lot, due to the cutting through of the breastbone for the surgeons to get into my chest.. I couldn;t drive for 6-7 weeks. It was a very tough period for me.
But after that, things went a lot better. I'm feeling great. No more chest pain and the breathing is good. I lost weight, exercise regularly in a hospital where they montori me on an EKG. My chest is still numb where they cut the chest bone. Also, my leg is numb where they harvested the blood vessels used to replace the clogged heart arteries. So there are these downsides as opposed to just doing a change in diet and taking medicine.
I wanted to mention the down sides as well because it's part of the whole experience and choice people have to make if you're faced with the same decisions I was, hopefully never for my friends here. "Live long and prosper"
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That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.
You seem ill informed, or at least that's not how these procedures are carried out in my country. If you need it you need it. No budgetary constraints, that's something for after the procedures are completed. Everybody is insured, so budget is or will be available.
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PS: I think I was still posting here during those first two weeks. If so I got you guys to thank for getting me through that depressed period as well. All those arguments may have kept me alive. So thanks to you too. :)
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PS: I think I was still posting here during those first two weeks. If so I got you guys to thank for getting me through that depressed period as well. All those arguments may have kept me alive. So thanks to you too. :)
It may create higher bloodpressure now and then though ...
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It may create higher bloodpressure now and then though ...
Believe it or not, that's actually good. The cardio exercises I take is to exercise the heart. They want me to get my pulse up 30% over its resting rate. Blood pressure increases as well during this period. So fighting with you is actually strengthening my heart. Thanks for the exercise. You may be saving my life. :)
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This report demonstrates the importance of doing large long term evaluation trials so that the most cost-effective therapies can be standardized. The paper does not say that stents are 'useless' and should not be used but rather that for many cardiac patients, pharmaceutical therapy is as good and has fewer side effects. One problem with the US healthcare system is the amount of money that is spent on expensive interventions that do not lead to improved health outcomes or better quality of life. Almost anytime one goes to see an orthopedist about a joint malady an X-Ray is taken even though the diagnostic utility is often nil. Guess who owns the X-Ray equipment???
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Personally I thank heart stenting and carotid endarterectomy for saving my life.
Many lives have and will be saved with cutting edge medicine. Thank God for that. For many this disease is genetic issue. But so much of disease can be controlled and avoided with good habits. Not easy but doable, if adopted with a real commitment.
My point being that heart disease and it's causes are and have been well known for awhile now. I have family that have been saved by these procedures.
My now deceased father-in-law had many heart rebuilds, by-passes and an aortic partial replacement. No family history of cardiac issues. His was totally caused by bad habits. All of which were world known for decades. The food he ate and the smoking he did were the cause of his heart issues.
He did as he pleased.
"Science and the Tax payer will take care of it all", was his mantra. He was not alone in his thinking. His three sons are all of the same mindset.
I know many people that would rather under go through these procedures than change their behavior.
I was a type 2 diabetic for a number of years, all weight related. I finally got serious about things and lost 40 pounds. I now have normal blood glucose levels, blood pressure and all that goes with that horrific disease. I was able to drop all the related meds and feel so much better.
We all have a finite time to be what we are. I'm painting today...
Peter
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... If you need it you need it. No budgetary constraints...
Depends on who determines if you needed it and how long till you get it:
https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#bcb65c136b89
(Emphasis mine)
Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons.
Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral.
The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of "limited clinical value."
Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same "limited clinical value" label on them.
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This report demonstrates the importance of doing large long term evaluation trials so that the most cost-effective therapies can be standardized. The paper does not say that stents are 'useless' and should not be used but rather that for many cardiac patients, pharmaceutical therapy is as good and has fewer side effects. One problem with the US healthcare system is the amount of money that is spent on expensive interventions that do not lead to improved health outcomes or better quality of life. Almost anytime one goes to see an orthopedist about a joint malady an X-Ray is taken even though the diagnostic utility is often nil. Guess who owns the X-Ray equipment???
The problem with choice is that it's almost impossible for the patient to determine the best course. Everyone is hitting you with different options. Reasons to do this or that. Who do you believe? The pressure is enormous. You're trying to predict and calculate the future against each option which is impossible. How do you gage statistics and possibilities in your own case? The emotional pressure is enormous. Let's face it. Fear fogs up most rational thinking. Whatever you decide, luck plays a huge part.
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The problem with choice is that it's almost impossible for the patient to determine the best course. Everyone is hitting you with different options. Reasons to do this or that. Who do you believe? The pressure is enormous. You're trying to predict and calculate the future against each option which is impossible. How do you gage statistics and possibilities in your own case? The emotional pressure is enormous. Let's face it. Fear fogs up most rational thinking. Whatever you decide, luck plays a huge part.
There is no question that there is a great deal of truth to what you say. The key thing is to continue the long term research into evidence-based medicine. The paper under discussion in this thread excluded a lot of cardiac patients from the study as the investigators realized that there were some risk categories that will require intervention and stent implant. the key outcome is the use of stents should not be considered 'routine' for all cardiac patients. One of the difficulties with new medical advances is gathering long term outcome evidence. In my own field of pharmaceuticals there is a considerable amount that we still don't know even about Rx products that have been on the market for many years. Because we don't have good electronic medical records as many European county health systems do, it is difficult to do this type of outcome research. One of my last projects prior to retirement was managing what ended up as a $40M research program to come up with better ways of data analysis into drug safety and outcomes. It was really difficult as we realized from the outset that even common definitions don't exist. the US systems of records is pretty much focused on reimbursement codes rather than medical outcomes.
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Many lives have and will be saved with cutting edge medicine. Thank God for that. For many this disease is genetic issue. But so much of disease can be controlled and avoided with good habits. Not easy but doable, if adopted with a real commitment.
My point being that heart disease and it's causes are and have been well known for awhile now. I have family that have been saved by these procedures.
My now deceased father-in-law had many heart rebuilds, by-passes and an aortic partial replacement. No family history of cardiac issues. His was totally caused by bad habits. All of which were world known for decades. The food he ate and the smoking he did were the cause of his heart issues.
He did as he pleased.
"Science and the Tax payer will take care of it all", was his mantra. He was not alone in his thinking. His three sons are all of the same mindset.
I know many people that would rather under go through these procedures than change their behavior.
I was a type 2 diabetic for a number of years, all weight related. I finally got serious about things and lost 40 pounds. I now have normal blood glucose levels, blood pressure and all that goes with that horrific disease. I was able to drop all the related meds and feel so much better.
We all have a finite time to be what we are. I'm painting today...
Peter
That's good inspiration for others Peter. The problem for most people is that until something horrible happens, they tend dismiss bad things happening to them from their personal habits, good or bad. Such as in my case. The expression is, " Nothing focuses a person's attention like the hangman's noose. " It was good to hear about how you improve with diabetes 2, something I suffer from. It probably complicated my heart disease. So I'm paying more attention, not perfect though. It's so hard to forgo good food. :) I'm also not an exercise buff. I'd rather stare at a computer screen and type posts than actually move a muscle. But I have lost 35 pounds and that seems to help but still on medicine. Just got a 6.4 on my A1C which ain't too bad. Maybe my heart problem was God's way of telling me to straighten out and fly right.
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There is no question that there is a great deal of truth to what you say. The key thing is to continue the long term research into evidence-based medicine. The paper under discussion in this thread excluded a lot of cardiac patients from the study as the investigators realized that there were some risk categories that will require intervention and stent implant. the key outcome is the use of stents should not be considered 'routine' for all cardiac patients. One of the difficulties with new medical advances is gathering long term outcome evidence. In my own field of pharmaceuticals there is a considerable amount that we still don't know even about Rx products that have been on the market for many years. Because we don't have good electronic medical records as many European county health systems do, it is difficult to do this type of outcome research. One of my last projects prior to retirement was managing what ended up as a $40M research program to come up with better ways of data analysis into drug safety and outcomes. It was really difficult as we realized from the outset that even common definitions don't exist. the US systems of records is pretty much focused on reimbursement codes rather than medical outcomes.
The problem is nothing is simply black and white. If that was the case, we could use computers instead of humans to determine what medical procedures are best in each case. There are factors that cannot be inputting into decisions based on research.
Twenty five years ago I injured my left knee and ripped my meniscus. being in business, I filed the issue with my Workmen's Compensation Insurance Company stating it occured at work and not elsewhere, a requirement for a Workmen's claim. I was protected better with the Workmen's claim than a regular health insurance claim. Let's just say I may have been confused as to whether it occurred at work.
Anyway, I went to the three top orthopedic surgeons in NYC including one who handled all injuries for the NY Rangers hockey team. All three surgeons told me I need surgery on the knee to repair the meniscus. Well, a few days later I had this epiphany of guilt about the claim I made. I then sent a letter to the insurance company withdrawing the claim stating it occured in my home rather than at work.
The next day the pain went away. I never had the surgery. That's was 25 years ago. Every once in awhile, I get a twinge in my left knee. I'm not sure if that is from the left over injury or God reminding me to do the right thing.
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That's good inspiration for others Peter. The problem for most people is that until something horrible happens, they tend dismiss bad things happening to them from their personal habits, good or bad. Such as in my case. The expression is, " Nothing focuses a person's attention like the hangman's noose. " It was good to hear about how you improve with diabetes 2, something I suffer from. It probably complicated my heart disease. So I'm paying more attention, not perfect though. It's so hard to forgo good food. :) I'm also not an exercise buff. I'd rather stare at a computer screen and type posts than actually move a muscle. But I have lost 35 pounds and that seems to help but still on medicine. Just got a 6.4 on my A1C which ain't too bad. Maybe my heart problem was God's way of telling me to straighten out and fly right.
Thats the point. All need to take better care of themselves and support the same in family and friends. A1C 6.4 that's great...keep it up. You can get there and keep clicking shutters.
Peter
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I'm not sure if that is from the left over injury or God reminding me to do the right thing.
You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.
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You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.
"Magic Wand".....Interesting. That opens a whole other avenue of, I don't want to pursue.
Peter
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If you follow this guy in the video below, you will learn all about the new metabolic science. Many of his videos deal with the health issues you are discussing. It turns out the best indicator of heart attack risk is a coronary calcium test. And yes the heart and cardiology associations in the US did try to prevent governments and hospitals from adopting the test as a standard diagnostic tool. Well worth watching.
https://www.youtube.com/watch?v=WHPA6WX-2_k
https://www.youtube.com/watch?v=NSPcuGjstN4
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If you follow this guy in the video below, you will learn all about the new metabolic science. Many of his videos deal with the health issues you are discussing. It turns out the best indicator of heart attack risk is a coronary calcium test. And yes the heart and cardiology associations in the US did try to prevent governments and hospitals from adopting the test as a standard diagnostic tool. Well worth watching.
I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.
Jeremy
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I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.
Jeremy
Yes I agree Jeremy. Your description of their views is more accurate than what I wrote. However, the second video is more like a documentary and includes the fight to get the calcium test adopted as an option in hospitals because it is such a useful tool. It is nice to get a break form the news and LuLa.
JR
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The problem with studies like these is that they're done on a mass basis; that is, they tell you what happens when you look at a mass of people, and compare outcomes. But a heart attack doesn't happen on a mass of people -- it happens on one person, and the idiosyncrasies of any particular case overwhelm indications from a mass study. Looked at as a mass, there may be no significant difference in outcomes between treatment with drugs, and treatment with stents. In one particular case, there may be huge differences -- a stent can prop open a clogged artery *right now* while drugs may take a course of treatment, and if you need the help right now, then there is a huge difference for you, even if it's not even a blip in a study.
I honestly think that many of these studies are driven by two things: costs, and warring cliques of doctors. If you can show there is a significant drop in costs with drugs, rather than surgery, then the government and insurance agencies will be pushing hard for drugs, and that will have an effect on treatments. And while costs may drop, in any particular case, you may have a death that wouldn't have happened if the other course were taken. One death among thousands of treatments may not be significant. But you're not a statistic; you're a human being. You're concerned with one particular outcome, while a mass study isn't.
And, of course, these studies have a direct impact on how mass treatments are done, driving patients one way or another, and thus effect medical incomes. Even doctors like money. I am aware of at least one such medical war (between board certified plastic surgeons and "cosmetic surgeons.") There are probably others, and the drugs/surgery case may well be one of them.
I have two stents in my heart, and don't regret them one bit. I had a heart attack in 2007 that was so mild that by the time I got to the hospital, they did an EKG and said I hadn't had a heart attack. Then they found some kind of chemical dude [dude=I don't know what it was] that is only produced by a heart attack, so yeah, I had one, but there was no detectable damage. The docs did an angiogram and found material narrowing in two heart arteries, and placed stents to prop the arteries open. No trouble at all the last 12 years and I work out hard. I do think things like personal habits are significant: if you don't smoke, drink very little, watch your diet, get some exercise, you'll probably stretch things out as long as is possible. Which is all you can ask for, IMHO.
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I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.
Jeremy
Correct assessment. A useful lay review of this is here: https://www.nytimes.com/2018/04/02/well/live/the-value-and-limitations-of-a-cardiac-calcium-scan.html written by Jane Brody who is a very good writer on health topics.
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As Bart says, if you need it, you need it. And if you get when you need it, it can save your life.
But if the blockage is on the border line, often the stent is not necessary. Not only the actual stent but everything what goes with it - being put on Plavix or other similar medication, possible breakdown of the stent, and other complications which don't address the real causes of the blockage.
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That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.
Analysis by clickbait sound bite. :)
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You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.
I'm stubborn. I need to get hit over the head. Even then I don't listen. Last night I ate pizza. The worse for me. Very tasty though. :)
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That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.
What a crock of fecal material. The imaginary "death squads" were an invention of the cheesebrain Sarah Palin and her pals. They have never existed and do not now. Just another example of the right wing making things up to scare voters.
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... The imaginary "death squads" ... They have never existed and do not now...
I am repeating a quote from the article referenced in my reply #16:
Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral.
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I'm stubborn. I need to get hit over the head. Even then I don't listen. Last night I ate pizza. The worse for me. Very tasty though. :)
Eating a cheese and pepperoni pizza is effective for happy endorphins but not helpful to endothelium coating in your blood vessels.
A single high-fat meal can induce endothelial dysfunction, whereas low-fat meals generally neither improve nor worsen.
https://care.diabetesjournals.org/content/29/10/2313
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Eating a cheese and pepperoni pizza is effective for happy endorphins but not helpful to endothelium coating in your blood vessels.
https://care.diabetesjournals.org/content/29/10/2313
"Waiter, I'll have the anti-endothelial dysfunction hamburger please. Medium-well. "
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A new report published last week in the Annals of Internal Medicine, shows that the per-capita cost of administering healthcare is more than four times higher in the U.S. than in Canada.
In the United States, a legion of administrative healthcare workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year.
Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering healthcare is just $551 per person — less than a quarter as much.
https://www.latimes.com/science/story/2020-01-07/u-s-health-system-costs-four-times-more-than-canadas-single-payer-system?fbclid=IwAR32DQNH5K8M06qQvDw_aLhgzHWzcxsIrwMmf3tR36qAz3VJRbt2Y3RoPRo
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Just found this thread.
I have had two heart attacks.
After the second one, I was give a stent which was all conducted under private insurance. I had to pay up front, and it cost me €3,000 of which the insurance returned €2,000. I don't know what this charge covered - whether just the stent or the surgery, too.
Some years after that, and now under the state system, the cardio told me I needed another stent. This cost me nothing at all.
I think that was pretty good service under both systems.
Folks here who can afford it, often take out private insurance too because it sometimes gets things done more quickly. We ran within a parallel system too for many years, but eventually, after my wife discovered how good the state system was, we stopped paying the heavy private fee.
Rob
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A new report published last week in the Annals of Internal Medicine, shows that the per-capita cost of administering healthcare is more than four times higher in the U.S. than in Canada.
https://www.latimes.com/science/story/2020-01-07/u-s-health-system-costs-four-times-more-than-canadas-single-payer-system?fbclid=IwAR32DQNH5K8M06qQvDw_aLhgzHWzcxsIrwMmf3tR36qAz3VJRbt2Y3RoPRo
What I;ve noticed is the huge number of clerk and doctor assistants in medical offices, many just sitting around. Part of that may be due to the fact government picks up a lot of those costs. For example, all the argument how it's cheaper for Medicare and Medicaid to be administered isn;t true. The government contracts out all administrative work to private companies. That's mentioned in the article. But the article doesn;t mention how that affect costs. There's no incentive for medical groups to reduce staff as its paid for by government. So overall private administration costs include government programs. So the argument is silly because there is no comparison. Government as well as private administrative costs are done by private companies.
The problem is government. Now one really cares what things cost. If our entire medical industry went to government, America would not lower its costs like other countries. The government would just print money to cover additional deficits due to higher medical costs. AFter all., half of medical costs are already handle by the US government through Medicare and Medicaid. Just like colleges get handouts raising tuition cost 4x in the last couple of decades, the same will happen with a single payer medical plan. Of course America will eventually go for it thinking its free. We're suckers for things that we think we get for nothing.
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What I;ve noticed is the huge number of clerk and doctor assistants in medical offices, many just sitting around. Part of that may be due to the fact government picks up a lot of those costs. For example, all the argument how it's cheaper for Medicare and Medicaid to be administered isn;t true. The government contracts out all administrative work to private companies. That's mentioned in the article. But the article doesn;t mention how that affect costs. There's no incentive for medical groups to reduce staff as its paid for by government. So overall private administration costs include government programs. So the argument is silly because there is no comparison. Government as well as private administrative costs are done by private companies.
Most of these people deal with billing which is incredibly complicated. It's also a key reason why the US unlike other countries does not have an effective electronic medical records system (the VA is the one exception as their system is robust for the simple fact that they don't deal with billing issues). All the ICD coding values focus on reimbursement rather than medical care and outcomes. When I was at PhRMA we had a very big project that was designed to look at medical records for drug safety and outcomes. Whole new vocabularies had to be designed to accomplish this and that work which began in 2008 is still going on. Other countries can effectively identify adverse drug reactions and medical outcomes much faster than the US as their systems are outcome designed rather than payment designed.
The problem is government. Now one really cares what things cost. If our entire medical industry went to government, America would not lower its costs like other countries. The government would just print money to cover additional deficits due to higher medical costs. AFter all., half of medical costs are already handle by the US government through Medicare and Medicaid. Just like colleges get handouts raising tuition cost 4x in the last couple of decades, the same will happen with a single payer medical plan. Of course America will eventually go for it thinking its free. We're suckers for things that we think we get for nothing.
This is just a silly statement. Medicare really cares how much things cost and that's why their reimbursement rate is much lower than what private plans offer. You also ignore the fact that private plans set up networks of hospitals and doctors who agree to set reimbursement fees. We found this out the hard way some years ago when our excellent BlueCross plan would not fully reimburse the surgeon who did a gall bladder removal because she was not in network.
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Most of these people deal with billing which is incredibly complicated. It's also a key reason why the US unlike other countries does not have an effective electronic medical records system (the VA is the one exception as their system is robust for the simple fact that they don't deal with billing issues). All the ICD coding values focus on reimbursement rather than medical care and outcomes. When I was at PhRMA we had a very big project that was designed to look at medical records for drug safety and outcomes. Whole new vocabularies had to be designed to accomplish this and that work which began in 2008 is still going on. Other countries can effectively identify adverse drug reactions and medical outcomes much faster than the US as their systems are outcome designed rather than payment designed.
This is just a silly statement. Medicare really cares how much things cost and that's why their reimbursement rate is much lower than what private plans offer. You also ignore the fact that private plans set up networks of hospitals and doctors who agree to set reimbursement fees. We found this out the hard way some years ago when our excellent BlueCross plan would not fully reimburse the surgeon who did a gall bladder removal because she was not in network.
I agree Alan that one of the problems we have is multiple medical records. Each group and hospital has its own system. So it's hard for the patients to remember who's got what and for doctors to get information from other systems. ALso complicating it is the medical secrecy law to protect patients. It adds so much extra paperwork. Clerks need more sign offs to send medical records, insurance companies needs both spouses to sign off forms for each to handle the other insurance paperwork.
ANother problem is just sending medical records. Doctors refuse to use email so you can't attach records to them. Only more difficult to handle fax or regular mail is allowed. Another impediment to effective practices and requires more clerical work to be paid for to handle this extra work load. The medical law regarding secrecy should be modified to add some common sense rules instead of these incredibly difficult time consuming and costly procedures or at least allow an opt out to streamline the process. If I want to send my medical records or receive them by email, why should the government stop me? It's none of their business.
Regarding doctors who are not in insurance networks, doctors also opt out of Medicare. I learned that the hard way when I went to one who I had to pay the entire bill for the visit out of pocket because he opted out. Secondary insurance plans will not cover any of the bill if Medicare as primary does not accept the bill. You're on Medicare like I am. Be careful with that issue. I always ask before I go to a new doctor if he or she accepts Medicare.
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Regarding doctors who are not in insurance networks, doctors also opt out of Medicare. I learned that the hard way when I went to one who I had to pay the entire bill for the visit out of pocket because he opted out. Secondary insurance plans will not cover any of the bill if Medicare as primary does not accept the bill. You're on Medicare like I am. Be careful with that issue. I always ask before I go to a new doctor if he or she accepts Medicare.
A number of primary care docs are setting up concierge practices where one pays a large up front yearly fee. This way they keep the practice size small and offer more rapid and personalized service. That's the theory. My primary care doc switched over to this starting this month and I didn't make the journey with him. I think he was charging $1700/year/patient. I don't know how much longer he will be practicing as he's 75 or so and he was a sole practitioner all the years I went to him. He never took any insurance other than Medicare so I had to do all the paper work to get reimbursed. All my doctors accept Medicare.
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A number of primary care docs are setting up concierge practices where one pays a large up front yearly fee. This way they keep the practice size small and offer more rapid and personalized service. That's the theory. My primary care doc switched over to this starting this month and I didn't make the journey with him. I think he was charging $1700/year/patient. I don't know how much longer he will be practicing as he's 75 or so and he was a sole practitioner all the years I went to him. He never took any insurance other than Medicare so I had to do all the paper work to get reimbursed. All my doctors accept Medicare.
My sister before she died had concierge doctor in FLorida. A lot of the people down there have it. It's extra and not paid by Medicare. The advantage was when she got sick with cancer, he acted as her coordinator with other doctors to make sure they were coordinating with each other. he also showed up as times to look at her. He got her admitted at hospital and smooth the way when a patient doesn;t have that power. Your regular practitioner will not do those things usually. A concierge is like your personal medical assistant.
Concierge is a good word. It's like when you go to a hotel in a foreign city. You ask them to make arrangements and get tickets for the theatre, or museums, or cab service, airline tickets, or whatever. Plus they tuck you in at night. :)
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My sister before she died had concierge doctor in FLorida. A lot of the people down there have it. It's extra and not paid by Medicare. The advantage was when she got sick with cancer, he acted as her coordinator with other doctors to make sure they were coordinating with each other. he also showed up as times to look at her. He got her admitted at hospital and smooth the way when a patient doesn;t have that power. Your regular practitioner will not do those things usually. A concierge is like your personal medical assistant.
Concierge is a good word. It's like when you go to a hotel in a foreign city. You ask them to make arrangements and get tickets for the theatre, or museums, or cab service, airline tickets, or whatever. Plus they tuck you in at night. :)
In my experience, true hotel concierges are a thing of the past--except perhaps for really high-end hotels (which I do not frequent). But medical concierge services can be great. We are members of Duke's (which they call Signature Care). The doc will spend as much time with you as needed and not rush things to get off to her next 15 min appointment. We can contact her by email at any time and get a quick response. We can ask her any medical question by email and she will answer. $2500 a year (each) but worth it even though neither of us has had any serious medical issues. As our doc said: "This is the way medicine should be practiced." But our system does not permit access to this kind of care to all those who cannot afford the fee.
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In my experience, true hotel concierges are a thing of the past--except perhaps for really high-end hotels (which I do not frequent). But medical concierge services can be great. We are members of Duke's (which they call Signature Care). The doc will spend as much time with you as needed and not rush things to get off to her next 15 min appointment. We can contact her by email at any time and get a quick response. We can ask her any medical question by email and she will answer. $2500 a year (each) but worth it even though neither of us has had any serious medical issues. As our doc said: "This is the way medicine should be practiced." But our system does not permit access to this kind of care to all those who cannot afford the fee.
If everyone in America had concierge services, it would cost $825 billion, more than the entire defense budget. Even allowing for reduced rates, you're talking of immense costs. Plus where do you find all the doctors to do this? Be thankful you can afford it or are willing to sacrifice other things for it. That's the way things work in a free society. Other people would rather own a second car or go on a vacation. Everyone has a choice. If our system forced everyone to have it, then people would not be free to choose how they want to live. Freedom of choice is good.
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If everyone in America had concierge services, it would cost $825 billion, more than the entire defense budget. Even allowing for reduced rates, you're talking of immense costs. Plus where do you find all the doctors to do this? Be thankful you can afford it or are willing to sacrifice other things for it. That's the way things work in a free society. Other people would rather own a second car or go on a vacation. Everyone has a choice. If our system forced everyone to have it, then people would not be free to choose how they want to live. Freedom of choice is good.
As you say, concierge care for everyone is a pie-in-the-sky idea for many reasons. As for freedom of choice, I am all for it but am bothered by the fact that many people's freedom is severely limited by our economic system. Choosing between concierge care and second car is one thing, but choosing between the electric bill and your diabetes meds is another.
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As you say, concierge care for everyone is a pie-in-the-sky idea for many reasons. As for freedom of choice, I am all for it but am bothered by the fact that many people's freedom is severely limited by our economic system. Choosing between concierge care and second car is one thing, but choosing between the electric bill and your diabetes meds is another.
No one is suggesting that people die on the street. Bu there's got to be a better way than going to a single payer government system. There's already Medicare for people who can;t afford medicine. Maybe that could be expanded. But to do away with private medical care is dangerous and will hurt everyone in the end. Private medical care with competition and many companies and services always is a better system. It allows for choice, freedom, lower costs, better results, and more innovation.
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Well, the hospital stays for a day charged at $23,000 or $50,000 for a few days, as reported in another thread, is not a better system, it's a highway robbery.
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Medicare paid about quarter the charges for my bypass. That worked out to around $7500 a day in the hospital for 13 days including Cardiac ICU, surgery, surgeon, nurses, medicine, pre-operative, post, etc. So the $23,000 and $50,000 you mentioned seem rather high. Of course, hospitals have schedules they cannot go over with medicare. But I wouldn't pay their charges and let them sue where a court would pull back those numbers. Just because people charge, doesn;t mean they are entitled to whatever they want.
If I was a foreigner, I'd tell them to come to my country to get my money or settle for a low amount. They'll settle. As a final thought, you could send the bill to Trump and ask him to take care of it. He'll stick them with the whole thing.
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By the way, where I had the surgery at NY Presbyterian Hosp, it is the best heart hospital in NYC and the 2nd best in the country. So a lot of other hospitals will charge a lot less depending where in the country you are.
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Medicare paid about quarter the charges for my bypass. That worked out to around $7500 a day in the hospital for 13 days including Cardiac ICU, surgery, surgeon, nurses, medicine, pre-operative, post, etc. So the $23,000 and $50,000 you mentioned seem rather high. Of course, hospitals have schedules they cannot go over with medicare. But I wouldn't pay their charges and let them sue where a court would pull back those numbers. Just because people charge, doesn;t mean they are entitled to whatever they want.
If I was a foreigner, I'd tell them to come to my country to get my money or settle for a low amount. They'll settle. As a final thought, you could send the bill to Trump and ask him to take care of it. He'll stick them with the whole thing.
Just to be clear, it was 50K for ER visit, two days stay in the hospital, a trip the the surgical suite, than a another trip to surgury as an outpatient. That figure also includes all the meds, DR time, and associated costs. In the end everyone in this ordeal got to divy up only 12.k as paid by Medicare and my part b insurance policy. I was billed nothing additional. My point was Medicare only paid cents on the dollar of the hospital/DR bill. If that payment policy is extended to the entire US population it will destroy the medical profession in America as we currently know it. At least IMO.
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I've recently spent over two weeks in hospital having had five endoscopy procedures including two surgical endoscopy under general anaesthetic. I also had a multitude of X-rays, several CT scans and many medications. Twelve days peeing into a bag and being fed with a nasal gastric tube. I had my own room with TV and Internet access and all of this as an National Health Service patient.
I'm thankful for our free-at-the-point-of-access NHS. I'm very grateful to all the consultants, doctors, dieticians, nursing and ancillary staff, many of whom are first, second or third generation immigrants from all corners of the world. The NHS - and indeed the care sector - relies on their compassionate care: long may we continue to attract and welcome such folk to the UK.
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I've recently spent over two weeks in hospital having had five endoscopy procedures including two surgical endoscopy under general anaesthetic. I also had a multitude of X-rays, several CT scans and many medications. Twelve days peeing into a bag and being fed with a nasal gastric tube. I had my own room with TV and Internet access and all of this as an National Health Service patient.
I'm thankful for our free-at-the-point-of-access NHS. I'm very grateful to all the consultants, doctors, dieticians, nursing and ancillary staff, many of whom are first, second or third generation immigrants from all corners of the world. The NHS - and indeed the care sector - relies on their compassionate care: long may we continue to attract and welcome such folk to the UK.
My granddaughter told me that without foreign staff, our NHS would have to close. As a doctor in A&E, I believe she knows of what she speaks. They come from Spain, Greece, Egypt, India etc. etc. to give the UK a whirl.
And we had folks say "they come over here and steal our jobs..." If we could produce enough of our own - and keep them - there would be no need, but as life ain't a straight line, we need to be grateful for what we can still atttact.
And it's the same here on Mallorca: I have had docs from Morocco (one got me fixed up from my two heart attacks), from Cuba, from Argentina (for the irony lovers amongst us) and why? Because those people have internationally hot qualifications and they often use those skills to see the world, and I guess the Spanish deficit is also due to the fact that many of their guys are in Britain.
Were the extremists to get their way, those doors would close and Britain would become bereft of services because even if exceptions were made, why would those people come over knowing they might run into some idiot who takes exception to their accent?
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Just to be clear, it was 50K for ER visit, two days stay in the hospital, a trip the the surgical suite, than a another trip to surgury as an outpatient. That figure also includes all the meds, DR time, and associated costs. In the end everyone in this ordeal got to divy up only 12.k as paid by Medicare and my part b insurance policy. I was billed nothing additional. My point was Medicare only paid cents on the dollar of the hospital/DR bill. If that payment policy is extended to the entire US population it will destroy the medical profession in America as we currently know it. At least IMO.
But why would it, how could it? America has the highest prices, so any state control could reduce those prices to those of any country at the next top level, which would represent a huge saving to your country. Your overpaid cats would have nowhere better to go, so they'd be obliged to stick around; after all, they live in the best country in the world, right, with the best political system, I'm told? For sure, with the best music.
Your hospital prices are so high because you pay yourselves so much. We pretty much all have great equipment these days; guess where lies the difference that makes your US patients' eyes bleed?
It's only the ingrained fear of governmental controls that prevent it; less fear and you could even stop your kids getting shot in school.
Rob
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America has a lot of Indian doctors here today. Some are fine but I really don;t know how their qualifications compare to American trained doctors. My surgeon was Japanese recommended by my cardiologist. The other big thing going on is PA's - Physician Assistants. They do all the preliminary workups now when you see the doctors. EKG, temperature, heart pressure, history write ups, etc. Then the doctor spend a few minutes with you and collects his fee that has been abbreviated by the government in Medicare, a sign of the future for all medical care. These doctors have no problem working here in America. They're getting rich. What's to complain about? Better than what they'll make in India.
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But why would it, how could it? America has the highest prices, so any state control could reduce those prices to those of any country at the next top level, which would represent a huge saving to your country. Your overpaid cats would have nowhere better to go, so they'd be obliged to stick around; after all, they live in the best country in the world, right, with the best political system, I'm told? For sure, with the best music.
Your hospital prices are so high because you pay yourselves so much. We pretty much all have great equipment these days; guess where lies the difference that makes your US patients' eyes bleed?
It's only the ingrained fear of governmental controls that prevent it; less fear and you could even stop your kids getting shot in school.
Rob
The best people will drop out of Medicare and other government program. Tat will leave them only for rich people who could afford them. The rest of us will get the dregs. If the government disallow opting out of government programs, than many great doctors will just retire or not go into medicine in the first place. That will cut the heart out of better medical care.
Money talks. BS walks.
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What the hospital asks and what the insurance pays are unrelated things. Medicare in particular pays around 25-33% of the asking bill, which by itself is not really anchored in reality and the hospital knows it. Now, if you happen not to have insurance you get the same bill (or even higher in cases) but you don't have access to the lower rates, so it's a double strike: no insurance and asked to pay more. Usually those people can settle at some extent to closer to what the insurance would pay but even then it usually ends up being a lot of money. That's where the saying comes from, approx: you are one hospital bill away from bankruptcy.
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The best people will drop out of Medicare and other government program. Tat will leave them only for rich people who could afford them. The rest of us will get the dregs. If the government disallow opting out of government programs, than many great doctors will just retire or not go into medicine in the first place. That will cut the heart out of better medical care.
Money talks. BS walks.
I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.
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I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.
While there might be some truth in this I don't think it's that clear cut. Current US graduates have a significant debt to start with and currently there is a deficits of physicians overall (predicted to get worse), so if the number of physicians decreases, things aren't going to be better.
If US increases their US grads production (they won't, the bottleneck is not the number of med school spots but the residency spots) then there will be even more physicians anxious to pay their debt and looking mostly for the best paid spots.
Currently many of those "good doctors" are not overflowing with money, particularly the primary care. The deficit in primary care coverage is one the main reasons why US doesn't rank so well for its health system; prevention will always be cheaper and more effective than treatment.
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I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.
But the less competent ones will be the ones who stay. A doctor who's been around a long time won't become a cab driver. He'll just retire early.
For those thinking about getting into the medical field, there're a lot of good paying jobs that require intelligent people to study. Many will think, why should I go through 4 years of college, 3 years of medical school, internship, residence, work 16 hours a day, and all the huge expense I'll owe for my education just to get paid bupkis when I'm done? They'll become lawyers and then politicians or CEO's or engineers or whatever. Less qualified students will fill the slack in medical schools reducing the excellence of our medical industry. Money talks, BS walks.
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While there might be some truth in this I don't think it's that clear cut. Current US graduates have a significant debt to start with and currently there is a deficits of physicians overall (predicted to get worse), so if the number of physicians decreases, things aren't going to be better.
If US increases their US grads production (they won't, the bottleneck is not the number of med school spots but the residency spots) then there will be even more physicians anxious to pay their debt and looking mostly for the best paid spots.
Currently many of those "good doctors" are not overflowing with money, particularly the primary care. The deficit in primary care coverage is one the main reasons why US doesn't rank so well for its health system; prevention will always be cheaper and more effective than treatment.
Lots of good points, Armand. Most of us wind up seeing the specialists who want to do a battery of tests that cost a fortune; one of the reasons our medical costs are so high. What I've found is that specialists tend to all think alike. They all read the same medical studies. They look at the test results, check the current medical theories, and prescribe similarly with little thought about the unique patient.
It takes a special doctor, one with discernment and intuition to see through the numbers to provide help that matches the patient's real issues, temperament, psychology, and physical condition. It's like photographers. Many have tremendous technical capability to read exposure and edit and print a wonderful picture. Of a snapshot. There's an art in medicine just as there;s art in photography. It takes a special person to be able to do that. Who was it, Ansel Adams who said something about a perfect picture of a fuzzy idea, which comes to mind. If you find a doctor like that, who has the intuitive discernment, treasure him or her.