The Truth About SwedenCare – Klaus Bernpaintner – Mises Daily

Required reading.

As a Swede currently living in the United States, with actual experience of Swedencare, I must reply to the delusions propagated by professor Robert H. Frank in his June 15 article in the New York Times, titled “What Sweden Can Teach Us About Obamacare.”

It is surprising to read something so out of line with basic economic theory from an economics professor. But theory aside, it would have sufficed for professor Frank to have taken a field trip down to the nearest public emergency room to have his illusions irreparably shattered. The reality is that Swedish healthcare is the perfect illustration of the tragedy of central planning. It is expensive and — even worse — it kills innocent people.

There is nothing economically mysterious about health care — it is just another service. Like any other it can be plentifully provided on a free market at affordable prices and constantly improving quality. But like everything else, it breaks down when the central planners get their hands on it, which they now have. To claim that the problems are due to a “market failure” in health care is like saying that there was a market failure in Soviet bread production.

via The Truth About SwedenCare – Klaus Bernpaintner – Mises Daily.

Others have been down this path, do we have to do it in the typically American governmental (expensive, borderline incompetent) version? Can’t we just jump to the free market?

A Few Questions for the AMA | The Redheaded Pharmacist

Sing it!

The American Medical Association AMA just concluded their Annual Meeting of the House of Delegates in Chicago on Wednesday, June 19th. And it seems as if the profession of pharmacy was a topic of conversation. According to the AMAWire, one of the points of discussion for the delegates this year was pharmacist inquiries with practitioners to verify controlled substances. This is the statement they released in response that you will find on the AMA’s website: The AMA delegates “Issued a warning against “inappropriate inquiries” from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them unwarranted interference with the practice of medicine.” Forgive me for being a bit confused about the last part of that statement. I’ve always been under the impression that the duty of a pharmacist was to ensure prescriptions were written for a legitimate medical condition in the course of a practitioner’s normal scope of practice. If we are being accused of interference, shall we then be relieved of all responsibilities toward ensuring the best interests of our patients? Are we not the drug expert profession that is the last stop in the chain of treatment from provider to the patient?

via A Few Questions for the AMA | The Redheaded Pharmacist.

I met several CPR survivors today; I was involved with some of them

At the Fort Worth Municipal building, a gathering of AED/CPR survivors. I was told 10 of them; they came with their families, and there were a lot of lay rescuers and EMS, who as usual deserve the credit for a ‘save’, as if they don’t get the heart restarted in the field there’s not a lot we can do in the ER.

I was also told I was involved in the care of 4 of them. Crazy odds.

Two patients knew of me (probably from billing, frankly, none were awake in the ED), and they were 100% neurologically intact. We had nice chats, and I got my photo with both, but as I didn’t ask their permission to post them, I won’t.

Still, wow.

It’s incredibly humbling to have follow-up on a happy ED case, and when it’s neurologically intact CPR survivors, it’s the equivalent of a Moon shot for an ER guy, and today I got four. Four.

(It’s an occupational hazard in the ED that we meet/greet/diagnose/stabilize and disposition, and what that individual patients’ medical future holds we have no idea unless we go out of our way, and we’re busy enough nobody I know goes out of their way to follow up cases).

I am renewed. I’m not a Pollyanna doc (read the blog), but this has my attention: the practice has changed, and it works.

Hallelujah.

Our unrealistic attitudes about death, through a doctor’s eyes

We all die. Here’s just a snippet from this doctors’ experience:

…Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.

via Washington Post.

I’ve seen this many, many times in my ED; the child of the nearly-deceased who has been doing all the caring comes in, says essentially ‘let them die comfortably’, then come in the ones who haven’t been doing the work, haven’t seen the daily decline, and they browbeat the first into a retreat. ‘I think I misunderstood, we need to do everything’ they say to me while watching the floor; my job is nothing compared to the needless suffering they’ve consigned their dying parent to experience.

Shame on us for making dying foreign, and not the end of a life well spent.

All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post

Via @medskep on twitter:

Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.

via All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post.

There’s the truth, let’s not act like it isn’t.

An open letter to central line packaging engineers

Dear Sirs,

First, thank you for putting all the tools I need into one sterile package, minimizing the amout of running around finding little pieces to start central lines on my patients. (A central line goes into the central venous circulation, allowing the use of hypertonic medications and monitoring of venous pressures to guide fluid resuscitation).

Now, to my gripe: apparently none of you have thought about the order in which these devices are used when starting a line. Yes, everything has a special place, but it tells me you haven’t thought out the actual use of the kit when I have to dig the Seldinger wire out of the bottom of the kit despite its use being necessary very early in the process, and getting it out dislodges many of the other items from their pockets, then making the whole shebang a mess.

Therefore, I offer my assistance in designing a kit that makes more sense when it’s used.

Respectfully,

GruntDoc

FYI, here’s a nicely done animation of how to place a central line:

I do mine a little differently (direct sonographic guidance usually), but this is good for the gist. (The wire is there, but it’s really hard to see…).

Health-Care Costs: A State-by-State Comparison – WSJ.com

Nice graphs of spending by state, then another breakdown of where the money goes per state. Click through and enjoy the graphics.

Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state.

via Health-Care Costs: A State-by-State Comparison – WSJ.com.

An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog

It’s stuff like this that makes even trying to support the idea of private insurance untenable.

Mr. Stephen Hemsley:

I made an honest mistake, wasn’t given a fair opportunity to correct it and now my family’s COBRA coverage has been canceled by your company.

via An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog.

UnitedHealth, fix this!

Obamacare Incompetence | TIME.com

I link to Ezra Klein approvingly about one a decade, so…

Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.

This is a really bad sign.

via Obamacare Incompetence | TIME.com.

Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News

Appalling decision.

The document (from the DOD) reads in part:

“Passage of this legislation could directly and indirectly influence potential court-martial panel members, witnesses, or the chain of command, all of whom exercise a critical role under the Uniform Code of Military Justice (UCMJ). Defense counsel will argue that Major Hasan cannot receive a fair trial because a branch of government has indirectly declared that Major Hasan is a terrorist — that he is criminally culpable.”

via Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News.

But saying it’s not a terrorist attack doesn’t influence those same people? This is sophomoric at best, but bizarrely this is the Line from DoD officials.

Also, there’s a systematic robbing of the Fort Hood victims of benefits and now military awards, which is unconscionable.

For Shame.

Delusions of Benefit in the International Stroke Trial | Closer to the Truth

More TPa for stroke…

Delusions of Benefit in the International Stroke TrialResults of the largest and arguably most important trial ever of thrombolytics clot-busting drugs for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.

via Delusions of Benefit in the International Stroke Trial | Closer to the Truth.

Well, that’s not good.

NYC painkiller poster

From NPR:

Doctors who follow the advice will consider alternatives to opioids and prescribe only a few days’ worth of the drugs, if they decide that’s the best course for short-term pain relief. They’ll also avoid starting patients on long-acting opioids, like Oxycontin, and will refrain from replacing lost, or allegedly lost, opioid prescriptions without lots of due diligence first.

painkiller-poster_vert-41d783296ca44c5e35a435dd8c25bf5217907c5e-s3

 

I like it.

Some studies that I like to quote

Wow! Very nice.

Press Ganey, meet Wong-Baker

For those not actively engaged in the practice of medicine, this will mean nothing to you. For those of us in the trenches:

IMG_0847

I cannot wait for the day the government realizes this misguided effort is costing them Billions (and harming patients and providers).

 

IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News

“Affordable” Care act.

Under Obamacare, Americans will be required to buy health insurance or pay a penalty to the IRS.

The IRS’s assumption that the cheapest plan for a family will cost $20,000 per year is found in examples the IRS gives to help people understand how to calculate the penalty they will need to pay the government if they do not buy a mandated health plan.

The examples point to families of four and families of five, both of which the IRS expects in its assumptions to pay a minimum of $20,000 per year for a bronze plan.

“The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000,” the regulation says.

via IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News.

Unbelievable. Enjoy the Sticker Shock.