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The Medical Thread: We're experts on everything else; why not?

Swansong said:
Ugh. Is there no screening test available to you?
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For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.
 
psych said:
Like, say, preventive care?
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On a very, very basic level, sure.

The problem with healthcare is this insurance model we've developed. Insurance works fine for protecting you against catastrophic losses, like your house burns down. It doesn't work well for things that you may need more frequently, or think you need more frequently. None of us would choose an insurance model for food or clothing needs for instance. Our food system would quickly be as screwed up as our medical system.

But, unfortunately, we've gone a long, long way down this road and I'm not sure there is a great way out.

Now, admittedly, I take a fairly morbid view of healthcare. At the end of the day it isn't going to save us.
 
LynahFan said:
Yes. And there are literally hundreds of (socialized) government programs to ensure that people don't starve to death.

Sure you want to go down this route?
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There is a basic safety net, that honestly has more holes in it than netting, to address food needs in this country, but it is a long way away from socialized food. In fact, I'd suggest that the current safety net we have for healthcare, between medicaid and medicare, is probably a stronger and more widespread net than our food net at this time.
 
SJHovey said:
On a very, very basic level, sure.

The problem with healthcare is this insurance model we've developed. Insurance works fine for protecting you against catastrophic losses, like your house burns down. It doesn't work well for things that you may need more frequently, or think you need more frequently. None of us would choose an insurance model for food or clothing needs for instance. Our food system would quickly be as screwed up as our medical system.

But, unfortunately, we've gone a long, long way down this road and I'm not sure there is a great way out.

Now, admittedly, I take a fairly morbid view of healthcare. At the end of the day it isn't going to save us.
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So, according to you, what items should be socialized?
The insurance model is likely here to stay in this country, certainly for the foreseeable future. I doubt you’ll find anyone on this board who disagrees with you that the current setup is perverse and not health-centric for people in any way, shape, or form. But, I’m not so certain insurance companies are beyond the pale of capably handling Americans who aren’t already on some kind of govt. program for healthcare already.
 
SJHovey said:
There is a basic safety net, that honestly has more holes in it than netting, to address food needs in this country, but it is a long way away from socialized food. In fact, I'd suggest that the current safety net we have for healthcare, between medicaid and medicare, is probably a stronger and more widespread net than our food net at this time.
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For all its warts and shittiness and attempts at strangling it, including by Democrats (not so much in the recent past), SNAP does a fairly admirable job. Medicaid/Medicare are wonderful too.
 
WisconsinWildcard said:
For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.
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Crazy!

Medicare patients are now subject to a chunk of PAMA (Protecting Access to Medicare Act) that requires the documentation of Clinical Indications of Use, as well as documenting which approved tool you used to determine which specific advanced imaging order you're placing. It was a gigantic undertaking, but the end result is that a provider orders a CT scan and our system generates a score on applicability. Low score = higher chance of denial, and we also offer alternative orders, based on recommendations from the American College of Radiologists. Our docs were apprehensive but seemed to embrace it pretty quickly. All they really need to do "Extra" is choose which CIU. Of course, that isn't attached to the ICD 10 diagnoses (we looked into tying them together but HOLY HELL the cost).

It's odd, despite Trump and the GQP's nonstop meddling, CMS has taken some pretty substantive steps over the last couple of years to streamline and consistify (that totally ought to be a word) reimbursement. Even when I first started, if you pitched a project with "Medicare needs..." you'd get a bunch of groans. Now? Not so much. Meanwhile BCBS refuses to accept the fact that the times are changing and are denying valid claims over and over and over for insane reasons. We're definitely getting our money's worth from our legal department, that's for sure.
 
I can personally attest to the extreme difficulty getting things approved for covid complications. Basically four MRIs and it was a nightmare to get peer approvals. This will be a nightmare for years.

oh and still no explanation for my issues
 
Medicare runs at like 3% overhead. Private insurance is like 30%.

Fuck insurance companies. We'll pay for a quarter of it on executive bonuses alone. God I fucking hope hell is a CEO who can't afford to care for a family member.
 
WisconsinWildcard said:
For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.
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Greg? Dat you?
 
Deutsche Gopher Fan said:
I can personally attest to the extreme difficulty getting things approved for covid complications. Basically four MRIs and it was a nightmare to get peer approvals. This will be a nightmare for years.

oh and still no explanation for my issues
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Pfft. You're letting it dominate you. If you were stronger and Trump was still president, you'd be fine.
 
Kepler said:
Your point?
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Well, the post you quoted was in response to rufus who wrote something like "socialize needs, privatize wants." My point was this.

First, people are quick to include healthcare in the "needs" category, like somehow it's written into the Magna Carta or something as some sort of basic human right. I don't necessarily agree with that, but I recognize opinions may differ. I've always viewed it as a quality of life issue.

My second point was that if we want to get into the "wants vs needs" debate in terms of socialization, I think there are things that human beings "need" way more than they need healthcare, such as food, water, and shelter (maybe even include clothing in that). We socialize water, at least for a good chunk of the population, but I think that was done more out of practicality than out of a decision that water is a basic human right or need.

But we haven't done it for food or shelter, and I'm not sure we should. Again, I believe that "socially" we can do things to help or assist those who need it, but I don't think it just works for us to decide that government is now going to provide all food and shelter to us, paid for by the collective. But again, just my opinion.
 
SJHovey said:
Well, the post you quoted was in response to rufus who wrote something like "socialize needs, privatize wants." My point was this.

First, people are quick to include healthcare in the "needs" category, like somehow it's written into the Magna Carta or something as some sort of basic human right. I don't necessarily agree with that, but I recognize opinions may differ. I've always viewed it as a quality of life issue.

My second point was that if we want to get into the "wants vs needs" debate in terms of socialization, I think there are things that human beings "need" way more than they need healthcare, such as food, water, and shelter (maybe even include clothing in that). We socialize water, at least for a good chunk of the population, but I think that was done more out of practicality than out of a decision that water is a basic human right or need.

But we haven't done it for food or shelter, and I'm not sure we should. Again, I believe that "socially" we can do things to help or assist those who need it, but I don't think it just works for us to decide that government is now going to provide all food and shelter to us, paid for by the collective. But again, just my opinion.
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This coming from the party that socializes losses and privatizes profits.
 
SJHovey said:
Well, the post you quoted was in response to rufus who wrote something like "socialize needs, privatize wants." My point was this.

First, people are quick to include healthcare in the "needs" category, like somehow it's written into the Magna Carta or something as some sort of basic human right. I don't necessarily agree with that, but I recognize opinions may differ. I've always viewed it as a quality of life issue.

My second point was that if we want to get into the "wants vs needs" debate in terms of socialization, I think there are things that human beings "need" way more than they need healthcare, such as food, water, and shelter (maybe even include clothing in that). We socialize water, at least for a good chunk of the population, but I think that was done more out of practicality than out of a decision that water is a basic human right or need.

But we haven't done it for food or shelter, and I'm not sure we should. Again, I believe that "socially" we can do things to help or assist those who need it, but I don't think it just works for us to decide that government is now going to provide all food and shelter to us, paid for by the collective. But again, just my opinion.
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You never answered my question about what parts of healthcare you think should be socialized. Here, I’ll start off: I want health insurance for everyone to include substance abuse “coverage” that goes beyond the days it takes to merely sober them up. The ACA started the process, but it’s wholly inadequate. What’s more infuriating than that, though, is shelter as one of the basic needs. Our housing system is the worst of any of the social safety nets. Wholly inadequate. There isn’t nearly enough affordable low-income* housing. Section 8 is effective for the people it’s funded and allowed to serve, but there isn’t nearly enough Section 8 housing to go around, and that goes double for blue states and blue areas (the NIMBY liberals). Dozens of patients at my hospital are homeless, so even if they get sober, who the fuck wants to be sober and homeless?
 
Yeah, nobody really needs healthcare. Just man up and put some superglue on it, ask the Lord for deliverance, and/or self-medicate like a REAL 'Murican.
 
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