Friday, July 30, 2010

Health Care Reform or Medical Bailout Bill?

We have had the banking bailout, the auto manufacturers bailout, tarp funds, bailouts for days. Now we have the medical bailout under the guise of "Health Care Reform." I have been saying for a while that health care should be the next bubble to burst. We just can't have the expense of health care continuing its upward spiral. Health care is bankrupting government from the top all the way down to our cites and municipalities. It's bankrupting all of us. It just can't go on. Enter the federal government.

Our taxes are going to skyrocket along with energy so that we can keep on paying exorbitant medical fees. This isn't reform. It's yet another "bailout." All the crap about "tax cuts for the rich" is a crock. We all got a tax cut under GW! It's one of the few things that I approved of. Now we are all going to be taxed to death so that medical professionals, hospitals etc. can just continue on their merry way. There is nothing in this bill which will help "bend the cost downward." All that's in there is funding for a civilian army and taxing us all so that medical people can keep screwing us over. What about the rest of us? We are so screwed.

I have one of those alleged "gold plated" health care plans. It has a 2,500 dollar annual deductible. After that they pay a portion of the bill. That's for the family. However, I have to work 40 hours a week all month for that to happen. In this economy and the decimation of my business (construction) that's pretty iffy. I may garner enough hours for maybe 1 month of benefits. So for the rest of the time I'm uninsured. I can't even make my house payments regularly and now I get to pay a luxury tax on an insurance policy that I can't afford to use.

It gets better! If I don't buy the 1,300 dollar a month COBRA which there is no way I can afford, then the IRS gets to tax the crap out of me and levy fines and fees against me. So now I am paying 2 different taxes on top of the "health insurance." A "luxury" tax and a "no insurance" tax. The government in it's wisdom takes about 40% of my wages in taxes as I don't work all year. (construction) To them, it looks like I make a lot of money, although it isn't coming in all year they still tax like I'm rich.

In order to continue paying the outrageous bills for health care we had to have a medical bailout. This will not make things better, it's going to get worse. Here are some common sense ideas which DC won't listen to.

Put some teeth into "informed consent" laws. Fine these people for not following the law. I think that $10,000 per violation should get every ones attention! I also think that if the hospital personnel violate the parameters that the patient agrees to that the patient should not get billed for the violations. In my case that would mean that all the charges for general anesthesia would be crossed off. The charges for sedation drugs would be crossed off. The level of care charges, gone. The cast, the booties etc. all charges gone because *I* did NOT agree to this course of action. If the anesthesia provider does more than you required or accepted, such as shooting the patient up with the amnesia and control drug Versed without informed consent, or converting to general anesthesia against the patients wishes, then we patients don't have to pay that anesthesia provider. We don't have to pay for car repairs when done as described above, so why should medical care be different?

Put a cap on the number of people who are involved in our care. There is no reason to have all these people. There are CRNA anesthesia nurses making over 100,000 probably closer to 200,000 per year. (for a nurse!!!!!) The anesthesiologist who is allegedly watching the CRNA and that person probably makes between 300 g's and half a million dollars per year. Then there is a radiologist who looks at the x rays in the hospital. Who knows how much this person makes. I paid 15 bucks for this person to look at my xrays in the outpatient surgery complex even though I allegedly had an orthopedic surgeon. The surgeon should be able to read an x ray. How many circulating nurses does one need for a 70 minute operation? I don't know how much they make, but there were plenty of those. As for charging extra for levels of care? Ludicrous. It's the same nurse, why pay extra? Isn't the nurse SUPPOSED to watch us? Sooo unless we pay much more per minute, they don't care? (not bloody likely) Why can't the surgeon do our nerve block? Why do we have to have a CRNA? Can't the regular nurse give us pain medication? I had a machine that *I* could regulate when I was in the hospital for my femur! So please tell me why we have to have an anesthesiologist or CRNA for this. $800 for a nurse to give me a local (Beir block, second operation to repair the first) and some pain medication (Fentanyl and not much) is an outrage! There is no excuse for it! I had to pay some nurse extra to put a sloppily done cast on my arm. (while unconscious during first operation, and I still have that piece of crap just in case some health care worker comes unhinged at my suggestion) I came in with a perfectly good splint! So I was charged about 125 dollars for a cast which I wore home, where I promptly ripped it off so I could see what the hell had happened to me! Another pointless charge on the bill. How about 200 dollars for some "booties"? Are you kidding me? 20 bucks to rent a blanket!!! What the hell. I also got charged because there was a machine in the room, which was never used. It was there if it was needed so *I* got charged for it. A 300 dollar charge for "electronic transfer of data" back to the CRNA's workplace (I guess) 300 smackers for an e-mail or fax? Seriously?

By the way, dispute your bill. I got the outrageous fee for "electronic transmission of data" removed, the cast fee, the rental on the machine that was never used removed, the booties (if they had not gone ahead without consent I wouldn't have needed them) etc. I called my insurance company and complained. Do that too.

Hospital should be responsible for "hospital acquired infections" as well. Why should we have to pay because THEY didn't wash their hands? The way it is now, you have to pay for any additional treatment you get because of their negligence. That would save money. Ditto for ANYTHING done without informed consent or anything detrimental that occurs as a direct result of medical care.

Make hospitals justify their rates, just like your electricity supplier etc. does. That way the hospital can't just jack their rates to cover their own shortcomings, such as the hospital acquired infections and the lack of informed consent compliance. Along with this would be transparency on pricing. They can give a ball park figure and they need to be REQUIRED to. This would include all the little add ons that amount to astronomical sums by the end. $8 aspirins, 800+ dollar an hour charges for anesthesia nurses, cast nurses, x ray techs, hats, blankets, booties, suture material, drugs, levels of care, all included in the estimate. They have done thousands of the same surgery and they have an idea. Then the patient can negotiate to have certain items (like sedation) not done for cost savings. Bring your own aspirin for instance.

On informed consent, we need a standard of informed consent, not just whatever they all feel like telling. Right now it says that informed consent is whatever other people in the same position tell the patient. You can guess where that leads... No information at all. Just like this whole Versed thing. Nobody tells the patient anything about this evil poison. What they need to say is that Versed gives you amnesia and makes you totally obedient, it is NOT a pain killer. You will be walking and talking, answering questions and doing EXACTLY what they order you to do. They also need to divulge that with Versed, even if you scream STOP, they will not do so under the premise that you lack mental capacity to order them to stop, so the abuse will continue. Patients need to know that by allowing the use of Versed, they are waiving their right to stop the procedure at any time, as per the law. If you can imagine a particularly painful episode where you do NOT get amnesia from the Versed as I don't and are unable to stop them. My skin crawls at the thought. In my case, my inability to stop them was construed as consent for exactly what I had repeatedly said NO to, IE general anesthetic. So patients need to know that once you are knocked on your keester by Versed, the medical team can proceed with other things not covered on the informed consent because you "didn't object." This was my personal experience all documented. This abuse needs to stop.

There also need to be some laws to protect patients from the kind of abuse I see all over the web pertaining to "amusing" patients. I don't care if they are not named. It creates an atmosphere of contempt for patients to have these stories glibly written for all to see. I fail to see any amusement value in these stories whatsoever. Describing patients humiliation while drugged up isn't funny.

All these medical types also want "tort reform." They don't want to get sued for their breaches of the law or their carelessness. They want to be able to do whatever they want and get away with it. I have news for you. Very very few people get to sue for even the most egregious acts of medical personnel. Medical people are so well protected as of now that they can do whatever they want and if you complain they will threaten YOU with a lawsuit. (Please see my other post from today.) So, I have an idea. Let's have a civilian task force or mediation group. When the patient has a grievance about their care, let's have a committee of regular people look into it. Not anybody involved in medicine or filthy rich or famous. The latter 2 probably get vastly superior care and wouldn't have the frame of reference like most of us. This group would decide if the law had been breached and decide on an amount of money owed to the patient for the irregularity. It could be that they owe no money to the hospital, or some amount of compensation. Let's give the patients some power instead of only rich medical personnel (and their lobbyists) getting preferential treatment.

Back to Versed. There is no reason to use this medication in most cases. Most of the people I talked to were unaware that they weren't "out" that their mind was merely screwed with and they had AMNESIA. These people are upset that they were lied to and humiliated with Versed. I would venture to guess that most people find that this drug is unnecessary. Add to that the enormous SAVINGS to be had by NOT having sedation. Since most people would do just fine without this drug and it's waaay expensive, let's not allow its use except in extreme cases. Versed should be an OPTION albeit an expensive one. Insurance companies should NOT be paying for this as all it does is enrich the medical field, and cause ALL of our insurance premiums to go up. If the patient truly needs amnesia and wants to be totally obedient, then fine, they can pay extra for it. It is my contention that omitting just this one thing could save billions per year.

Here's a more controversial idea. Since medical care is a necessity, not really an option... Read about the "right" to health care in the reform bill. If this is a right, then we should be able to cap the salaries of medical personnel. The salaries that are being paid are so far out of whack with reality, that it isn't even funny. CRNA's should NOT be making $800 or so an hour. Don't argue with me on this, I have the hospital bills to prove it. That is what I was charged for your "services." It is my contention that these nurses should be making $30 to $50 an hour. Teachers with the same years of college don't get anywhere near this amount of money. The anesthesia job, ESPECIALLY in my case, could have been done by a regular nurse and the surgeon. They are just as hard to sue as the rest of the medical personnel, so don't even go to the malpractice insurance costs. Why add 800 bucks to the cost of a simple surgery. It makes no sense.

Along with the patient right to informed consent, we need to know who is performing our anesthesia. Supposedly this is the law, but like most laws pertaining to the medical field, they are unenforceable. An anesthesia nurse should clearly identify themselves as a NURSE and reveal to the patient that it is the patients right to have a real Doctor. There is no way I would have allowed a mere nurse to perform a dangerous nerve block (axillary) OR give me general anesthesia given my paradoxical reaction. Not in a million years. I had a right to decline this substitution which I was not given. Shouldn't I have the right to decide who I'm going to pay EIGHT HUNDRED DOLLARS to? The hospital REFUSED to allow me to speak to the "anesthesiologist" prior to the morning of surgery in the hospital. This also needs to change. It should be against the law to refuse patient access to the anesthesia provider. (again we need to figure out how to get medical centers to COMPLY with the law...) I should have the RIGHT to interview the anesthesia provider prior to appearing in the hospital to see whether this person is on the same page as I am... This is an important part of patient care and should not be left as buying a pig in a poke.

I might also add that at no time did the hospital correct my usage of the term "anesthesiologist." The person on the phone did not at any time inform me that an "anesthesiologist" would NOT be performing my care, that instead I would have a cheap imitation (my opinion) called a CRNA or "anesthesia nurse." This is a violation of my right to know who is going to be performing my care. I would certainly have cancelled surgery if I had known. An anesthesiologist is a DOCTOR not a nurse. This term should not be confused with "anesthetist." I clearly said ANESTHESIOLOGIST.

Where are the SAVINGS when we are forced to have a non Doctor perform health care? I'm not talking about just CRNA's although they are the ones *I* have had a problem with. I'm talking about ALL of the substitutes. We have NP's instead of GP's. We have AA's and CRNA's instead of anesthesiologists. Where is the savings for having this? Who is getting all the money that should be passed along to the patient as a savings? There should be laws about savings when accepting a lesser trained person to do our health care. Why should we be forced to have nurses instead of doctors and pay just as much money as if we had the real thing? This is also unethical. I don't mind seeing an NP, I just object because she costs just as much as the doctor does. We are under served here so I "get" that we need NP's! I just don't understand why there isn't some cost savings associated with it.

I also don't like that patients are forced to have separate visits for everything. If you have high blood pressure, there's an appointment for that. If you have eczema, separate visit. If you have any problem at all, it's all separate. Why can't we just pay for one visit and get it taken care of all at once? In my business this is called "milkin' it." Why are medical people getting away with this? We patients are trying really hard to contain our health care costs and we are meeting up with this kind of treatment. It's unethical and counter productive.

Make some laws to the effect that if a patient refuses any part of the procedure, that they can still get treatment. It's unethical to demand that patients tolerate abuse or Versed in order to obtain treatment. It's our right, our duty and our obligation as patients to set the parameters of care. We should not have our care held hostage to the whims of medical providers. In particular I urge you to look at colonoscopy providers. There is no end to the desperate attempts to force patients to accept additional significant risk by insisting on "sedation." It's all about money as far as I can gather because they have to go slower, can't charge for anesthesia etc. Here we patients are trying to get medical care without bankrupting ourselves and health care providers seem to be hell bent on doing the opposite. (Notice that I am NOT going into paradoxical reaction from Versed, just the money aspect of it. This drug is just BAD on so many levels.) Not fair, unethical and should be against the law. Then force them to comply.

So anyway, there is nothing like what I have outlined in the Medical Bailout Bill, oh, sorry, the Health Care Reform Bill. All there seems to be is more and more taxes, fines, fees and penalties which will drive the cost UP some more. One of the scariest parts is the claim that the new health care reform bill will REDUCE THE DEFICIT! So our illustrious leaders are going to finance their spending sprees (and civilian army) with HEALTH CARE dollars, which cost is already way out of control. I don't see the logic of this at all.

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