Archive for the 'Rants' Category

16
Mar
10

NSFW: Prius Truth

I do not dispute the fact that Toyota has experienced a few issues with their cars. I also am pretty sure that the situation has been WAY overblown by folks who are A) idiots, or B) opportunistic scammers looking for a payoff, or C) a combination of the previous.

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01
Jul
09

Bye Bye Vicodin?

You may have heard the news about an advisory panel for the US Food & Drug Administration’s recommendation that the maximum dose of acetominophen (Tylenol, etc.) be reduced on store shelves. It’s a head scratcher because of what the unintended consequences might be. The panel voted 24-13 to limit the maximum single dose of acetaminophen to 650 milligrams. The current single dose of Extra Strength Tylenol, for instance, is 1,000 milligrams. The thinking behind the advisory is that 56,000 people go to the emergency room annually for overdosing on acetominophen. About 200 die each year. In order to protect those folks, somehow taking the advised action will limit the hospital trips and death. Um, would it be safe to say that those folks who are stupid enough to OD on acetominophen will still do it? I mean, this action will only mean that dip shit will have to take more pills.

From the same meeting, the panel is preparing will recommend that Vicodin and Percocet be nuked. It’s tough logic to follow. The panel wants to reduce the OTC dosage of acetominophen for consumers, but leave combination products (such as cold medicines that have acetominophen and other medicines combined) available. But it wants to whack pain killers that have acetominophen and and other products (ostensibly, they will let the hydrocodone part of Vicodin be prescribed???) completely nuked. Their thought is that combination prescription drugs are bad (but OTC combos are fine). Let’s be realistic. Pain killers are combined with acetominophen because the synergistic effect of the two makes the pain killer work in a more efficient manner. That’s good. Separating the two will only lead doctors and patients to achieve the same result on their own (at more expense) without reducing the hospital trips from overdose.

More importantly, with fewer effective pain regimens available for OTC and prescription treatment… folks will, wait for it… Go to the doctor more often for more and different pain treatments. The net result being higher health care costs. Makes complete sense to me. So much for this administration’s desire to reduce health care expenses.

25
Jun
09

Health Care Trauma

You may have heard that there is a health care debate going on here in the United States. We have to DO something, dammit! The debate centers on what that something is and how that something will apportion health care resources to more folks. Ostensibly, the costs of health care render it out of reach for many and it is proposed that there be some way to make health care accessible to everyone.

Noble. In order to accomplish this we must establish that health care resources have a value (cost), although that actual cost is hard to fathom (more later). And we must also accept the fact that some can afford to pay that cost (at whatever mark it is set) and some cannot. In order to provide these resources to those who cannot afford it, those that can must subsidize those that cannot. I am acknowledging that point. And I understand that many folks are okay with this: whether through taxation, increased fees or whatever, those that can afford it will pay for those that cannot. This also happens to piss off a lot of folks. Namely, the “I don’t want to subsidize the welfare recipient who keeps on pushing out babies” crowd. That is understandable, too.

Let’s look at the cost of health care resources for a bit. I recently had a surgical procedure called a cervical medial branch block. It was done in a neighborhood surgical center and the dock shoved an icky needle into three different joints of my neck and did stuff. The staff was wonderful and the treatment appears to have had the expected results. The bills showed up. Facility charges, anesthesiologist charges, surgeon’s bill, post-op follow-up. Grand total that was billed to my insurance company was $40,000 (in round figures). My insurance company determined that my co-payment was to be $200 and the negotiated discount that my insurance provider had arranged with the medical group(s) resulted in a total payment to everyone of about $4,000. Or a grand total of combined payments of $4,200 on a bill of $40,000. So… is the true value of these services $4,200 or $40,000? I asked what would happen if I did not have insurance… I would have been billed the full amount, but the doctor would probably “work something out” with me. I know of a friend that had a similar treatment (didn’t quite work for her, though). The medical group that did her procedure was determined to be “out-of-network” on her plan. So the plan paid the bills according to *their* average discounted rate, she paid her co-pay, and the medical group waived the rest of the charge. The reality of medicine is that resource providers will attempt to maximize their return by charging the most to those who can least afford it because they have lost their leverage with insurance groups. In so doing, though, they have acknowledged what the true value of a given procedure really is. In my case, it’s $4,200, not $40,000. Why do they do this?

Simple. An uninsured person who needs the procedure I just had is going to ask how much it is. That person will be told that it is $40,000 and likely decide that they cannot afford it and do without. The doctor is happy because… he doesn’t have to go through the aggravation of administering a credit account that will take years to pay off. He’ll gladly take the discounted fees, regardless of which insurer pays under what circumstances because he’ll wind up with a known amount in a finite period of time. So why doesn’t the doctor just offer the “discounted” price to everyone? Let’s be realistic. The person that cannot afford $40,000 is likely not going to be able to come up with $4,000, either and is still going to need a payment plan that may or may not be paid in a timely manner. Far easier to just leave the price high and let the patient endure or go elsewhere. Sucks, eh?

But even if we standardize resource costs in medicine (auto repair shops go by a standardized pricing guide for just about every gig they do)… Let’s be realistic about the results of nationalizing health care. Everyone in the US getting “covered” (even if they cannot afford *any* cost) is going to result in more net dollars spent on health care. Even with the resource fees reduced by mandate. And nothing is really going to change with the fact that there will always be people who can afford and and people who cannot. By making certain that those cannot afford it still receive it, we are acknowledging that those that can afford it will be paying for those that cannot. I’m not saying that this is a great horror. It happens right now with private insurance. I am part of a large group of people that participate in my insurance plan. Premiums are pretty steep (and yes, I’m okay with my insurer making money on administering my plan). The fact of the matter is that there are folks in my plan who do not consume as many medical resources in dollar value as they pay in premiums. And there are those who consume far more in comparison to what they pay in premiums. One part of my group absolutely is subsidizing the other. National health care seeks to just enlarge the scope of this process with the added nasty perq of maybe Uncle Sam running the circus.

17
May
09

Moot v Mute

One of the things that annoys me most about most people’s butchering of language and semantics is the use of moot and  mute. It’s a moot point.

Moot point definition:A debatable question, an issue open to argument; also, an irrelevant question, a matter of no importance. For example, Whether Shakespeare actually wrote the poem remains a moot point among critics, or It’s a moot point whether the chicken or the egg came first. This term originated in British law where it described a point for discussion in a moot, or assembly, of law students. By the early 1700s it was being used more loosely in the present sense.

It is not a mute point.  That would infer that the point has the ability to speak. I’ve tried to teach my children that their ability to speak, be heard and make themselves understood is the most important thing they can master. Done well, command of language is a powerful and effective weapon. Done poorly, fumbling the skill leaves you bereft.

deprived or robbed of the possession or use of something —usually used with of<both players are instantly bereft of their poise — A. E. Wier> b: lacking something needed, wanted, or expected —used with of<the book is…completely bereft of an index — Times Literary Supplement>

13
May
09

Dewberry Bombs

I was reading Homesick Texan’s post on dewberries and luscious cobbler. She said “picking dewberries is a wonderful warm-day pastime. When I was young, my friends and I would march out to the wilder parts of my suburban Houston neighborhood—such as the bayou, vacant lots or the rough patch next to the golf course—and brave water moccasins, thorns and poison ivy to score some of these black orbs, warm from the sun and ready to pop in your mouth.” She’s absolutely right and I am beginning to think that we might have lived inthe same Houston neighborhood at around the same time (ish). I love dewberries and I can even put up with having to go through the dental floss event from hell after my profligate consumption. But there is one thing that I have learned to hate about dewberries: birds.

As much as people love dewberries, birds love them more. Black birds, mockingbirds, sparrows, titmice, cardinals, grackles, finches, warblers… They slurp them down with more glee than people. And they have the benefit of an aerial vantage, so they can get *more* dewberries than people. And then they crap. Some would think that pigeon crap is a burden. I’ll swap. For a good month in SouthEast Texas all the bird crap is purple. Not lavender, but that sickening yoghurt purple. And it’s everywhere. On your car, the sidewalk, the mailbox, the porch… Great splats and piles of purple poop. And if you do not wash it off immediately, it begins to assume the destructive/corrosive/quantum properties of red matter (go see the new Star Trek movie). My oldest daughter has actually been splatted on the forehead by a sated black bird as she tried to get into the family car. (Note: the shrieks of a 17 year old after said event can be auditorily challenging.) Purple poop *almost* makes me want to give up blackberries. But not quite. Especially since I’ll be making Homesick Texan’s cobbler recipe tonight…

Dewberry Cobbler
Crust ingredients:
1/2 stick of butter (2 oz.)
1 cup of flour (6 oz.)
1/2 cup sugar (3 oz.)
2 teaspoons baking powder
1/2 cup of buttermilk
1/2 teaspoon salt

Filling ingredients:
4 cups dewberries or blackberries
1/2 cup sugar (3 oz.)
2 tablespoons cornstarch
1/4 teaspoon cinnamon
1 teaspoon lemon juice

Method:
Preheat the oven to 350 degrees.
Place the rinsed berries in a large cast-iron skillet or nine-inch round cake pan, and toss the berries with the sugar, cornstarch, cinnamon and lemon juice. Let them macerate for 20 minutes. To make the crust, melt the butter on low in a pan, and then add the other ingredients. Dough will be slightly sticky, moist yet pliable. Pat out the dough and place it over the berries. Bake 40 minutes or until light brown and bubbling.

09
May
09

Managed Health Care

The following is a direct cut and paste from Houston’s Clear Thinkers blog. It was written by a health care practitioner to the author of the blog.

I’m down to ten days left there, and those days can’t go by fast enough for me.
The average number of admissions in a weekday day shift (7 a.m. to 7 p.m.) is 12.

We had 23 yesterday.

When you take the standard estimate of an average of 75 minutes necessary to complete a new patient admission to the hospital — with the attendant patient interview and data collection, physical exam, review of lab and x-ray results, formulation of treatment plan, preparation of admission orders, and dictation of the official patient history & physical for the medical record — the amount of work requested from our hospitalist group yesterday was 13+ hours over average. This is more than another full-time equivalent doctor, yet we can’t persuade the national hospitalist company managing the hospital to provide any more help for us.

As a consequence of the barrage of admissions, I did not complete my “morning” rounds on existing hospital patients until 6 p.m.  There were a couple of patients who could have been discharged from the hospital yesterday, but by the time we got to them, it was too late in the day to discharge them (area nursing homes won’t take transfers after 2 p.m.).

As you can imagine, this type of delay causes longer length-of-stay and more expense for the system.  And this does not even begin to address the mistakes in care that may have been (or more likely WERE) made due to all of us rushing around as if we were in a 12-hour long fire drill.

It’s a bad way to practice medicine.

Contrast this to my new situation, which is a hospital-administered program. They believe in and adhere to the notion that the risk is high that patient care is likely to suffer once a doctor is required to see more than 15 hospitalized patients per day. Inasmuch as they don’t have the heavy administrative overhead that national hospitalist companies are required to service, my new hospital can allow their docs to work at a more controlled pace and still make ends meet.

Ten more shifts and I’m gone.

Thanks for letting me vent.

That’s what we have waiting for us. There are a finite amount of health care resources available at a given cost in any “system”. And the management of those resources is what causes problems. Let’s face it, there are about 304,000,000 folks in the US and there just aren’t enough resources to treat everyone if they all get sick. Government mandated health care insurance for everyone cannot possibly encompass an acceptable quality of care. It’s the same with HMO type programs. People complain all the time about the crappy care they get in an HMO. But it’s more “affordable” than conventional private care. Better to wait weeks (months?) for an appointment with an assigned doctor who only has enough resources to give 9 minutes to assess, diagnose, develop treatment and move on? Bah!

17
Mar
09

Righteous Indignation: The AIG Edition

Senator Chris Dodd is miffed at AIG and thinks that the bonuses that were recently doled out by the ailing giant should be taxed. Governor Cuomo has his panties in a bunch and so does President Obama. All this posturing for political gain (I know, they’re politicians) is nauseating. But let’s get a few issues out from behind a fog that the politicians kind of glaze over…

  • Many of the bonuses that are being paid out are done so through contractual obligation. If AIG broke those contracts, they would likely have to wind up paying them out anyway after legal proceedings. Then you would have the cost of the bonuses plus legal fees. Those legal fees would come out of the bailout money, too.
  • Bonuses already are taxed. Ask anyone who has received one and they will tell you how much of a chunk the gubbermint takes out of the bonus. Does Dodd and company want to add on a special tax, an “evil capitalist tax”, above and beyond the normal tax rate for bonuses? Who would pay it?
  • Forgoing bonuses. All the AIG folks who were not contractually bound to receive bonuses have already had them whacked or eliminated. Many high level officials have given up a significant chunk of their base pay, too.
  • Retention bonuses. The linked article mentions those. It may not be exactly clear what those are, so let me explain it. AIG went into the crapper, employees heads were on a swivel as the situation worsened, news of the bailout spread amongst the rank and file, morale plummeted and a LOT of folks started looking for a new job. AIG knew that things would go from really, really bad to OMFG terrible if employees started filing out in droves. Sure, head count was going to get whacked, but AIG needed skilled employees to keep the machinery running. So they paid folks retention bonuses to keep them from leaving. It’s kind of hard to right a ship with no hands on deck.

I understand that much of what is going on just plain looks bad. And politicians are much more concerned with looks than they are with substance. My indignation has nothing to do with AIG paying out any bonuses or having a meeting at a swankienda that was already contractually obligated (if you’re gonna have to pay for it, you might as well use it). I’m pissed that the gubbermint is using my tax dollars to bail out ANY organization.