Stephen Brill Terry Gross Healthcare

[don]

Re: Stephen Brill Terry Gross Healthcare

Six or eight months ago my wife and I had a neighboring couple over for dinner. They quizzed us on our healthcare provider and when we asked them who they were with, they said they didn't have one. They're both in their early 60s. We were flabbergasted.

He's a retired HP engineer, she teaches Spanish at the local college, part time. Both were waiting for Medicare and despised Obamacare, hoping to avoid any penalties until they were 65. (Child-like, I know)

He will be 65 in September. A week ago he had a heart attack.

He was in IC for at least a week. Had a stint put in. Ongoing test results unfolded as:

Another stint might be needed.

No, there was substantial damage, especially to the electro-cardia region. He may need to wear a monitoring vest 24/7 for the rest of his days.

Then it got worse - a bypass would be needed.

He was taken off blood thinners in preparation for the surgery.

The day he was to go under the knife he was declared much better and released.

For a patient with no insurance and typical middle-class resources, what do you guys think may have gone into that rapid 180 degree change in diagnosis?

[jk]

Re: Stephen Brill Terry Gross Healthcare

it's not a change in diagnosis, it's a change in treatment. your implication, i think, is that the treaters decided to discharge him instead of further running up a bill they'll probably never collect. i think to even begin to address that would require more knowledge of what went into: "then it got worse- a bypass would be needed." so first you need to know what changed for them to recommend a bypass in the first place, when they hadn't been recommending it before.

[don]

Re: Stephen Brill Terry Gross Healthcare

it's not a change in diagnosis, it's a change in treatment. your implication, i think, is that the treaters decided to discharge him instead of further running up a bill they'll probably never collect. i think to even begin to address that would require more knowledge of what went into: "then it got worse- a bypass would be needed." so first you need to know what changed for them to recommend a bypass in the first place, when they hadn't been recommending it before.

They hadn't recommended it before because his condition was unknown to anyone. Yes, more information is needed, though I'm skeptical the principals are up to pursuing it. They rejoiced at the news of no bypass, no 2nd stint, no vest. After a steady, growing list of needed treatment, suddenly nothing. I'd want a second opinion . . . .

[jk]

Re: Stephen Brill Terry Gross Healthcare

They hadn't recommended it before because his condition was unknown to anyone. Yes, more information is needed, though I'm skeptical the principals are up to pursuing it. They rejoiced at the news of no bypass, no 2nd stint, no vest. After a steady, growing list of needed treatment, suddenly nothing. I'd want a second opinion . . . .

in his position, i'd want a second opinion as well.

[don]

Re: Stephen Brill Terry Gross Healthcare

Today he had 5 stints put in.

[dcarrigg]

Re: Stephen Brill Terry Gross Healthcare

Did he build more clinics and hospitals? No.

I've been one of the first to call out the tangled mess that came out of the sausage factory on the ACA. But obamacare did build a lot of clinics.

To quote:

The Affordable Care Act established the Community Health Center Fund that provides $11 billion over a 5year period for the operation, expansion, and construction of health centers throughout the Nation.

• $9.5 billion is targeted to:
o Support ongoing health center operations.
o Create new health center sites in medically underserved areas.
o Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites.
• $1.5 billion will support major construction and renovation projects at community health centers nationwide.

Overall, since the beginning of 2009, health centers have increased the total number of patients served on an annual basis by nearly 5 million people, increasing the number of patients served from 17.1 million to 21.7 million annually. During this time, health centers have also added more than 43,000 new full‐time positions, increasing their employment from 113,000 to more than 156,000 staff nationwide.

[DSpencer]

Re: Stephen Brill Terry Gross Healthcare

For a patient with no insurance and typical middle-class resources, what do you guys think may have gone into that rapid 180 degree change in diagnosis?

Obviously, it's possible that someone(s) made a financial decision at the expense of his health. However, I would tend to think that is unlikely. First of all, it's not usually wise to rely on second-hand accounts of what a doctor told a patient. That's especially true when the intermediary is not medically trained and is emotionally invested.

Also, I'm of the belief that most doctors are decent people who wouldn't let somebody die because they didn't feel like wasting a few hours. Cancelling on the day of surgery would also likely require a mini-conspiracy as there are many people involved. Even assuming they are just heartless misers there is the consideration that getting sued for malpractice would greatly outweigh the financial risks of non-payment.

btw, it is stent not stint.

[don]

Re: Stephen Brill Terry Gross Healthcare

Cynicism is increasingly near at hand, in every profession. Here in the Pirate State, medical fraud stories are commonplace, though they usually are over billing, not restricted care. Unneeded tests, procedures, etc. generally billed to the public via Medicare/Medicaid.

Lots of snowbird stories of them fighting off unneeded care by their Florida physician. Luckily their physician back home will defend them.

A growing end run is out-of-network billing. One doctor helping another.

Yes, I believe doctors still have a heart, though like my neighbors, it's diminished. Threaten their income/lifestyle expectations and see what happens. The bad economy, in a climate devoid of a common good, includes doctors too.

[charliebrown]

Re: Stephen Brill Terry Gross Healthcare

True story here about the outrageous costs of health care.

I was playing basketball and got tangled up with a 20 something and hit the floor hard. I had some nice big bruising around my knee, but then a week later the bottom of my leg started bruising and swelling and was very painful to the touch. I was going to wait it out, but a few days later I became dizzy. I thought this might be some kind of blood clot so I thought someone should take a look at it. The problem was it was 9:30 PM, all the 24 hour urgent clinics have been bought up the the mega-giant hospitals and there is no 24 hour emergency care so I felt compelled to go the hospital er.

I was checked in by a nurse, led to a gurney to wait for a doctor. Was seen by the doc for 15 minutes, who said you likely dont have a deep vein blood clot,
got an ultra sound, and was sent home

Bill $4500. I was surprised when the ultra sound bill was only $500. The rest were e-r charges. 4000 for 20 minutes of actual human contact, 15 from a physician who ran his hands up and down my leg and asked me if that hurts. With my shiny new high deductible plan mandated by HCA, My take home bill
will be 1100.

[jk]

Re: Stephen Brill Terry Gross Healthcare

Bill $4500. I was surprised when the ultra sound bill was only $500. The rest were e-r charges. 4000 for 20 minutes of actual human contact, 15 from a physician who ran his hands up and down my leg and asked me if that hurts. With my shiny new high deductible plan mandated by HCA, My take home bill
will be 1100.

although i think what's going on is exploitative as big health systems try to game a system that, otoh, is always threatening their revenues, i would add one comment. only a little slice of the 4000 was for your 20 minutes of treater contact. most of it was for having an emergency room standing, equipped, and open at all hours. there is a reason all the urgent clinics are no longer open 24 hours - it's expensive, and also they are limited in what procedures or tests they can do and bill for.

[don]

Re: Stephen Brill Terry Gross Healthcare

I visited my neighbor at home yesterday. He looked superficially fine, complaining about his new dietary regimen, etc. He died of a second heart attack this morning. Lots of grief to go around.

[shiny!]

Re: Stephen Brill Terry Gross Healthcare

I visited my neighbor at home yesterday. He looked superficially fine, complaining about his new dietary regimen, etc. He died of a second heart attack this morning. Lots of grief to go around.

I'm sorry for your loss, Don, and for his family, too. I hope they get an autopsy to show if he needed that bypass or not.

[DSpencer]

Re: Stephen Brill Terry Gross Healthcare

Sorry to hear that, Don.

[Woodsman]

Re: Stephen Brill Terry Gross Healthcare

...Lots of grief to go around.

Don, that's terrible news. My condolences to you on your loss. Take care of yourself and stay strong, friend.

Peace.

[don]

Re: Stephen Brill Terry Gross Healthcare

I'm sorry for your loss, Don, and for his family, too. I hope they get an autopsy to show if he needed that bypass or not.

I think his widow is taking the right course - what's the point, he's gone, and perhaps his heart was too weak for the procedure. Thanks for the support.