Morning Ed: Health {2017.20.15.W}

[He1] Between pagers and fax machines, hospitals don’t just keep patients alive but technologies.

[He2] Some might say that vaping is safe, but living 86,000,000 years would drive any sane man mad.

[He3] Smoking may kill you, but so may being told to stop smoking.

[He4] The New York Magazine has an interesting look at doulas.

[He5] I was all prepared to share in the outrage of this story, but these are actually important things and even if it means she has to charge more she needs to hire somebody to do them.

[He6] Brink Lindsey and Steven Teles argue that medical licensing is propping up health care prices. They are, but not in all ways that people suspect and it’s less clear cut than people think. I am skeptical that there are a whole lot of savings to be made by increasing the number of doctors (quite the opposite, possibly), but allowing non-physician to do more might. I recently paid $250 for a doctor to confirm that I had wax in my ears and a nurse to squirt fluid in there to get it out.

[He7] One area where we are not apparently likely to see savings is by allowing doctors to conduct business through emails. But maybe if we built less.

[He8] I don’t think we’re going to end up with single payer, but this is how we end up with single payer.

[He9] America’s worse opioid crisis of the 20th century.

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Will Truman is a former professional gearhead who is presently a stay-at-home father in the Mountain East. He has moved around frequently, having lived in six places since 2003, ranging from rural outposts to major metropolitan areas. He also writes fiction, when he finds the time. ...more →

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14 thoughts on “Morning Ed: Health {2017.20.15.W}

  1. [He8] – I think its totally fair as long as we *also* allow the patients not to pay for their healthcare if we didn’t use it that month.

    Or… if it turns out that all we really needed was fluid squirted in our ear.

    People with identical symptoms — such as abdominal or chest pains — may either have a deadly medical condition or a non-urgent issue. It is not fair for health insurers to expect patients to know the difference between a heart attack and something that is not life threatening.

    I mean, really…

    Bottom line… our healthcare regime sucks. Most of the SocialCons I know *especially* the business owners and/or institution presidents would be very happy to support a new health care model.


  2. He4: Fully recommend a doula. It’s a piece of mind that if nothing else, you have someone in your corner, who is not an emotional & exhausted basket case.


  3. He3- I quit smoking a couple years ago, after gradually tapering off over several years. I have since gained 50 pounds (exasperated by a severe work injury) and I am not a big guy. Makes you wonder…


  4. [He5] She might not need to charge more than other doctors even if she does need to pay for more hours of work from a health clerk – at 85 years of age, she’s probably got her med school student loans paid off, unlike many doctors.

    [He9] If, like me, you get the paywall not the article, you can use Chrome’s “inspect” feature, find the div class=”content-container”, and in its styles property, uncheck the “display=none” property.

    And, as per usual in articles like this, no recognition that the current crisis of fentanyl, like the various crises of heroin before it, were largely due to prohibition itself. Iron law of prohibition? Never heard of it! Why are my fingers in my ears, you ask? Just getting out some earwax. From both ears at once. While singing a little song to myself, lalalalalalalalalaIcanthearyou.


  5. He6 – what people don’t realize (and I know that you do) is that in order for the nurse to be able to squirt fluid in your ear to remove the wax, an administrative person had to answer your phone call and block off a 30 minute appointment for you, you had to come in and pay 20 dollars to an attendant to park in a garage, another administrative person had to check you in on a computer system from the 1980s that the clinic is required to use “because HIPAA” that costs 100,000 dollars a year to license, you had to wait for 45 minutes in the reception area because the previous appointment showed up 30 minutes late, another administrative person handed you an iPad that the clinic was required to purchase and implement because some MHA with power disproportionate to medical knowledge learned “iPads are good” in a 3-week quality improvement night course taught by another administrative person, you were escorted to the clinic area by another administrative person, weighed, had your temperature taken (because viruses), were asked some questions about socioeconomic status, whether you are being abused, smoking status, etc., given information from another administrative person about quitting smoking, eating vegetables, and exercise, as if you didn’t know these things were good for you, saw the nurse and told your story about earwax to the nurse, after 15 more minutes of waiting saw the doctor and told the exact same story to the doctor, who spent 12 years in postsecondary training and 30 seconds with you in order to go chart about your iPad responses, normal weight, normal temperature, status of not being abused, stage of change regarding your smoking status, unconcerning diet and exercise habits, and your earwax, in addition to documenting a 12-point review of systems for billing purposes, such that you have no cough, sore throat, impotence, borborygmia, pituitary apoplexy, etc. so that some other administrative person can assign codes that were devised by a 2000-person team traveling from all over the world for monthly conferences over the course of the last 12 years in order to bill your insurance company through your plan that is managed by a department of your employer’s office which liaisons with your insurance company, which will initially deny coverage for your visit because the doctor forgot to ask you about sexual risk factors and HIV status, but will then be approved after another administrative person audits the medical record and brings the discrepancy to the attention of the doctor, who then makes the adjustment 6 weeks later at 7PM once all the other notes for that day’s clinic are finished, before using a spoon with patent-pending LED lights on it that cost 120,000 dollars to develop in order to optimally scoop the earwax out of your ear once the noncompressible 0.9%, pH neutral saline which itself is autoclaved and manufactured in a facility in Wyoming and cost 65 dollars to manufacture, package, and ship to your clinic, has worked its way between the wax and the tympanic membrane, before depositing the wax laden spoon in the red marked biohazard containment unit for disposal by an additional individual properly trained in the disposal of biological specimens who completed a 2-day course on that topic taught by a trained certified administrator appointed by the hospital. No doubt you’re getting the best earwax removal care in the world! But really, who knows why healthcare in the United States is so expensive.


  6. He6:
    The paper argues that reducing licensing requirements and liberalizing immigration will lower physicians fees, thereby lowering medical costs.

    It does this by comparing American physician fees to other countries, and noting that ours are much higher.
    But left unexplained is the fact that other countries also have medical licensing requirements, and immigration restrictions.

    As with our thread about rents, I think the end result of market competition seems to be overstated.


    • They do talk about how a big chunk of the cost is the residency requirement, and the hard limits the AMA sets on med schools and new doctors. So it’s not just the licensing, but the whole credentialing system that is at issue.


    • Essentially all other developed countries impose limits on fees, one way or another. Eg, in Switzerland (IIRC) the insurers (operating as non-profits) negotiate fees with the care providers. If the federal government, which is actually paying the bills, thinks the agreed-upon fees are too high, they can arbitrarily lower them. Even in the US, insurer-negotiated fees are only a fraction of the “list price”.


  7. He5: They’re important things and, just as importantly to me, “I don’t have time to learn new stuff,” to be a disturbing answer from a doctor who went to medical school over a half century ago. That excuse wouldn’t fly if she was recommending lobotomies or saying there was no good research on whether smoking was bad for you. Part of being a professional is keeping up to date with the field and best practices.


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