LMGTFY…
Not enough customers there to make it worth running the risk that a Republican plan (or, presumably, Trump administration action) would force them into running a loss.
I really don’t think they should be able to choose by county. You get the whole state or none of it. Picking and choosing where the population / money is just leaves the poor rural areas out, which is not okay.
There are a lot of options, regardless of the ability to pay, especially for children. In this specific case, none of those systems were refusing due to money… they just needed the baby which the other hospital refused to release.
Technically, there was some degree of ethical failure in their proclamation that they could help the child without ever doing an actual examination, and contradicting the doctors who had conducted an examination.
I suspect maybe they wanted to get some publicity.
They had an MRI. You realize that patients transfer all the time based on medical records and not physical examination on the account that we haven’t, as a species, figured out how to be in two places at once yet?
Contraction is a fact of life in the medical field, not an exception.
And to be clear, they probably had more than just the results of the MRI, charts and every no doubt.
This is the guy I’m talking about:
Note this:
Hirano, a neurology professor from Columbia University in New York, only had evidence from laboratory tests and a handful of patients with a different ,though related, condition to suggest that the experimental treatment might help Charlie.
“On 13 July he stated that not only had he not visited the hospital to examine Charlie but in addition, he had not read Charlie’s contemporaneous medical records or viewed Charlie’s brain imaging or read all of the second opinions about Charlie’s condition (obtained from experts, all of whom had taken the opportunity to examine him and consider his records) or even read the judge’s decision made on 11 April,” the statement said. The hospital also criticised Hirano for not declaring earlier his “financial interest” in some of the drugs he wanted to prescribe.
It may not, but medical exams have been used in the past for determining both life insurance and health insurance.
Pre-ACA on the individual market insurance would conduct a medical exam/record review. It often resulted in outright rejection (happened to me and they didn’t even tell me why) or ridiculously high rates.
ACA eliminated differential pricing based on health and collapsed age pricing from the actuarial accurate 5x more for 60-64-year-old than a 26-30-year-old to a mere 3x. This as we all know resulted in many young healthy people not enrolling in ACA unless they get subsidies.
(There is no economic or moral justification for this, but it smart political pandering on the part of Democrats)
So I what I’m suggesting (I should add almost all of my ideas are stolen from various Senate Republican proposals) is a compromise. Allow price discrimination based on health/behavior but cape the differential at a level of no more than double or triple the price of healthy. This still will result in subsidizing sick people, but also provide an incentive for people to live healthier
Putting a SWAG on some numbers. I’d see 26-29 year old pay $70/month for catastrophic a healthy 60 year $350 and unhealthy $1,050. Adding in ACA level deductible and total health care expenditure would over $20,000 which is crazy high but if we spend $10K/person on average somebody has to pay more. Fortunately, the highest income group is 55-64-year-olds. Now this doesn’t solve the problem of unhealthy 60-year-old who makes $40-50K, but it does prevent the absurdity of ACA providing subsidies for wealthy older Americans like myself.
Yet another article written by someone that doesn’t understand the practice of medicine. Same author, too.
It is ridiculous to claim that a doctor should not come to an opinion without seeing the patient. Seeing a patient is not nearly as useful as people like to think.
And, in fact, doctors give opinions all the time without seeing a patient. This may happen informally, which is known as a “curbside consult”. Or it may happen formally, as an “interdisciplinary case conference”. For example, a patient with breast cancer may be presented by her surgeon to all the other breast surgeons and oncologists, who come to a consensus about the best way forward without actually meeting her. The only thing that would be unethical would be for a surgeon to bill the patient without meeting her.
If you’ve ever been referred by your doctor to a specialist, there is a decent chance that your doctor and the specialist had a conversation about you beforehand, and the specialist suggested to your doctor how he might be able to help you. This case is really no different.
Yea, that is crazy doing it by county. Of course rural areas will have fewer people to sell to and probably fewer health facilities. Why aren’t they all covered by some state/Federal required coverage?
Except that he made the claim without examining the patient, or even reviewing all of the available medical records… And then once he did, he changed his opinion.
Nesrie, how likely is it that insurance companies simply haven’t built the necessary network to adequately serve people in those rural counties?
Serious question, not rhetorical.
Examining the patient equals seeing the patient. It’s not as useful as you think, and like I said it’s not necessary to form an opinion.
And of course all doctors can only make decisions based on the information they are given. There is no reason to expect an American doctor to have up-to-date access to English medical records. When the facts changed, the doctor changed his opinion. What would you have done?
Again, this is no different than what happens in the US. If you are referred by your doctor to a cardiologist, the cardiologist might know nothing about you other than you have hypertension. She agrees to see you, run her own tests, and then decide if treatment would help. If she then learns you also have glioblastoma, perhaps she will decide seeing you to discuss hypertension is no longer worthwhile.
Remove the thought process that you have to examine a patient in order to consult or make an opinion. Remove that thought entirely. It happens ALL THE TIME. Whether he read what he was given well enough, or if he was given enough information can be debated but the idea that you have to examine a patient before transfer is clearly coming from a misinformed public and not people in the field.
Well that’s hard to say because it’s participation based system. As a hospital system, probably one or a couple in sparsely populated areas, excluding specific specialists, it’s hard to imagine an entire health system not taking like a Fee for Service Blue Cross Blue Shield payor. .If you only have one physician in town, then they can easily choose not to take certain insurances but the question is… what are they taking today? I mean the exchanges don’t pay well but if the hospital tracks them differently, not all of them do, they don’t seem say worse than Medicaid. I mean if you are offering a insurance plan that’s so terrible none of the health systems or physicians will take it, I would the the answer is to offer better not drop the entire county and just go for the gravy trains in the cities.
It’s nuts to do this by county… whole state. I would say it should be whole regions to make it a good quality pool but the states have… different laws that could make that difficult.
My gut tells me they don’t want to go to areas with high unemployed and unhealthy people because they’ll lose money. I’m saying they should be required to do that if they want that juicy city nearby.
Fair enough, thank you.
And to put it another way, it’s pretty hard to find a physician who is not taking commercial insurance today, outside some specialists. So if he or she is taking Healthnet, Blue Cross,CIGNA today, why can’t they take it under the exchange unless someone bigger is in there gobbling up all the highly populated areas, cities, and only living the counties no one once. option b is it pays terribly, but at the site I worked at that tracked them separately, it wasn’t as bad as say Medicaid which many physicians do take under moderation, and the site I am at now, not hugely tracked separately. The percentage of people that came in under those plans was tiny compared to everyone else. Medicaid, Employer based, and Medicare dwarf the population on the exchanges… military can vary a bit on area.
Cancer, a really big accident… i mean of the really bad stuff, it doesn’t take much to sour a small pool and make it unprofitable. It’s hard to imagine that would happen though if the pool was the entire state, outside major disasters where other assistance comes into play.
I completely agree with you Juan, and the difference in attitudes is one of the big reasons I think America will have trouble with a single payer and/or it won’t save money.
Americans demand service damn it, Free shipping and 2-day delivery, money back guarantees. We want a vegan cream that tastes great for their decaf coffee, organically grown, ethically farmed, and served with a cheerful smile by a barista.
Frankly, my family is a bad abuser of health services. My 91-year-old mom, health has been failing for the last couple of years. We have primary care giver (plus a bunch of rotating ones since my mom has needed 24-hour care at various times). The primary giver takes mom to her doctor She writes up a report than my two sisters consult with DR. Google, Web MD, an RN who runs a senior care company, and often a Dr. friend or two. We give the primary care a list of questions to ask and which generally results in more test. No doubt everyone’s diligence has been good for my mom (they’ve collectively caught several mistakes.) However, the irony is that my mom is 100% ready to die and her kids are ok with it.
Regarding babies, for a couple of years I had a lovely roommate who was Yale-trained Nurse Midwife (basically a Nurse practitioner but specializing in babies).
Listening to her convinced me that America could save a ton of money (roughly $6,000/per birth) if instead of using doctors and hospital we could use more Nurse Midwives and birth centers. She worked in poor areas right after nursing school to get student loan forgiveness.
Her experience working in clinics was the similar to Juan’s. She’d see twice as many patients in the clinics as in private practice. She really enjoyed working with poor patients who were grateful to get any type of help at all. The upper middle-class patients asked a ton of questions, were very resistant to follow her advice as opposed to Dr. Googles and just in general acted entitled.
Middle class Americas won’t put up with factory farmed food, I find it hard to believe we will put up with impersonal, process driven health care.
I want to highlight something additional positive about Strollen’s good faith effort to put forward some alternative ideas on health care. Specifically, the things he did not mention. In this case, the omissions are positive. Strollen did not mention either “selling insurance across state lines” (which I addressed above) or tort reform, which in GOP speak typically means damage caps. As an insurance defense attorney I do feel that reasonable tort reform would be a good thing but there are two problems with the way it typically comes up in regard to health care: first, the monetary impact is generally exaggerated. The most optimistic projections I’ve seen are that medical tort reform could save 2% to 3% of health care premiums (which is probably about 1% to 2% of total health care costs). Which is more than zero but not going to “save” American health care. And second, damage caps don’t help with “trivial or frivolous suits”; by definition damage caps only affect high damage cases. Damage caps don’t lower premiums but they do disadvantage people with strong, high damage cases. Who do they benefit? My corporate overlords, insurance companies who hate uncapped risk with a great hate. So just as you can view “selling insurance across state lines” as really meaning “insurance deregulation”, you can also view damage caps as a benefit to insurance companies.
Strollen did not bring up either of these two arguments, to his credit. Given how hard I am on the GOP for lying and presenting “zombie arguments” I want to give credit to Strollen for presenting selected GOP ideas without doing those things.
Yeah, you should probably had be read the entire sentence there, instead of just quoting half of it.
Cause the second half of it was kind of critical to this.
And then the second sentence pointing out how, once he did that, he reversed his opinion.
The first half being incorrect and me addressing it has no relevance on whether or not I read your second half; it also doesn’’ make your first half more correct. And since I am sure you read my entire statement too, you’ll see I also addressed him maybe not going over it. But despite that slanted article, there was a second MRI. A reading of a second MRI months later does not equate to the first MRI being misread.
And of course, changing your mind, reading a MRI, reevaluation… not unethical by any standard.
The first half was a factually accurate statement of what happened.
The rest of the sentence was a completion of the thought, and not actually a separate statement at all.
I believe you are making an error here, if you are going to try and argue against incomplete sentence fragments instead of compete thoughts.
Dude, you didn’t exactly write an essay. You wrote:
“Except that he made the claim without examining the patient,”
Nothing wrong with that
“or even reviewing all of the available medical records…”
This is only wrong if he actually had access to all of the medical records (which is unlikely).
“And then once he did, he changed his opinion.”
Which is perfectly appropriate.