On Wed, Jun 25, 2008 at 5:15 PM, Max B. Sawicky <[EMAIL PROTECTED]> wrote: > Gar Lipow wrote: >> >> On Wed, Jun 25, 2008 at 2:24 PM, raghu <[EMAIL PROTECTED]> wrote: >>> >>> Of course in the real world it is very likely that the folks who are >>> getting unnecessary treatments come from a different social class from >>> those who get too little.. >>> -raghu. >>> >> >> Maybe. The Black woman who was refused pain treatment is an IT >> administrator with a major corporation. The man with the broken neck >> is a corporate VP. The woman with the broken back - don't remember, >> but a really long way from poor. All three examples have really first >> rate health insurance - top tier never had to worry about whether >> either their doctor or their treatment was covered. >> _______________________________________________ > > > Rationing is likely to be more harmful to the poor than others. > An unnecessary procedure for one does not necessarily mean less for > someone else. Presently spending on the system is elastic, which as > indicated has both a good and a bad side. I don't see how less > expansiveness is going to bring more care to the poor.
But I'm not sure you get my point. Even in the present system, people with near top tier health insurance are being denied vitally needed care. Being sent home with a broken neck, even a hairline fracture is pretty fucking possible. Trying to throw someone out with a broken back is even worse. Denying pain meds to someone suffering migraines in the top half percent of pain for migraines is freaking cruel. (Even your average migraine sufferer suffers. People with really extreme migraines essentially suffer the torments of the damned. I don't know how to convey how bad it is. OK I think I can convey a lot because my friend has a very medically good pain management specialist who suffers extreme insensivity and foot-in-mouth disease. She sticks with him because he is willing to test stuff until he finds something that will control her pain. But one of the things he told her was "I'm really good you have not considered suicide. A lot of people at your level of suffering have to be talked out of killing themselves." And then the freaking emergency rooms don't want to fill his prescription. (He doesn't have the equipment to administer the stuff himself. He has persuaded UCLA to buy the appropriate equipment so he can administer medication himself rather than relying on the emergency room.) So I agree with you that we want to be very careful that "eliminating unneeded health care" is not an excuse to eliminate needed health care. But we also have another problem that our current system is already eliminating needed health care - not even to those who pay through the nose. I think the bottom line here is that if a cruel system creates understaffing, and an attitude to minimize treatment and consider patients as the enemy that good health insurance won't buy you an exception to that attitude. No insurance will still get you even worse treatment, and good insurance can get you stuff like treatment down the road, and stuff like my friend has - a really first rate pain specialist who will go out of his way to fight for her even if he says really stupid things sometimes. She would not get the treatment she had with mediocre coverage. But he also has to lobby for special equipment at a clinic he is associated with because even with insurance that covers every treatment she needs, and has pre-approved payment, emergency clinics still won't deliver it. Similarly the people with the broken back and broken neck did get re-diagonosed before they proved fatal. But both had to suffer a lot of pain, and you know there were real danger there. What if the nursing staff had been a little angrier and physically tried to throw out the woman with the broken back? It is not unknown, and that could have killed or paralyzed her. What the man had broken his neck on a Friday night instead of Sunday night and walked around with a broken neck for 72 hours instead of 16? Could have been more serious consequences than a night of agony. I think the lesson here is that health care is a system. You can't drive the guy in the back seat at a slow speed, and expect to continue to move the front passenger quickly. So I agree that undertreatment is a serious consequence of our current system, and serious for everything - even people with really top-tier health insurance. (Probably different for Bill Gates - he undoubtedly has boutique insurance where doctors come to him. Still if Bill Gates gets hit by a car he will be taken to the nearest emergency room, not the boutique. Gates probably has less chance of having a broken neck missed than even a $400,000 per year Senior VP from a mid-sized corporation. But I wonder if he does not have more of a chance of it happening here even to him than in France.) In terms of eliminating un-needed treatment, while there are ways of doing this without eliminating needed treatment, I'm with you in skepticism as to whether this would happen. Also you could save a hell of a lot just by making sure needed treatment was not skipped. For many sets of symptoms there are tests that should *always* be done. For most diagonses there are treatments that should *always* be prescribed. But there was a study some time ago where a really comprehensive study was done, and it showed that in 80% of cases one or more of these steps were skipped. Further there was a follow-up test program where doctors agreed to follow check list where they did these things in every case in return for extra-payment. They were not confined to doing the stuff on the checklist. They were free to do anything else they thought medically neccesary as well. But had to always do the stuff on the checklist. And in spite of the extra payments, costs went down. Diagnoses were made earlier. The rate of medical errors dropped drastically. And the program did not spread more widely, because doctors are highly insulted at the idea of following a checklist, and really resist this. _______________________________________________ pen-l mailing list [email protected] https://lists.csuchico.edu/mailman/listinfo/pen-l
