All Things in Moderation

Just a collection of recent health care news.   Posting it now before it gets stale.

Great essay from a hospitalist on end-of-life care in last weekend’s Washington Post Outlook section.    What was really interesting was the idea that advances in modern medicine are not the driver of the improvement in life expectancy.  According to the the CDC, “a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another four years. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years.”  The increase in life expectancy was caused by a vast improvement in the child mortality rate that was the result of improved sanitation, nutrition and advances in delivery.   He makes the point that interventions are really so family members can say “we did everything we could” when, instead they should be saying “we sure put Dad through the wringer those last few months.”  Particularly damning was a quote from a retired nurse: “I am so glad I don’t have to hurt old people any more.”

(Another essay worth reading by a doctor on how doctors die. — Mike)

RAND is out with a study on the individual mandate.  Dropping it would not cause a “death spiral” according to the report.  Instead about 12 million would not be covered an premiums would go up about 9.3 percent.  However, when you look at premiums by age group, the increase is only 2.4 percent.   Also, there’s another group that’s opposed to the mandate:  Single Payer Action, a physicians organization that opposes it on policy grounds that the mandate is not needed to regulate health care, filed a brief with SCOTUS.   “It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system.”

GAO is reporting that just because Medicare covers a preventive service, doesn’t mean that beneficiaries are using them.  “Despite Medicare’s expanded coverage and the removal of financial barriers for certain preventive services, research suggests that use of some preventive services may not be optimal.”

KHN and WaPo on the last trend at the ER.  Show up at the ER with a non-emergent problem?  It might be like some gas stations.  Pay first.   Usual suspects trot out usual complaints about barriers to care.

The HHS budget-in-brief is a great way to get an overview of what Obama has planned for FY 2013 for the department.  You can read by agency.

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There’s a localish murder trial that’s been getting a lot of attention due to the nature of the crime and those involved.

Basically, an on-again, off-again relationship between two rich attractive UVA athletes ended with him beating her to death.

You can read about the trail here.

He was convicted of 2nd degree murder and I’m pissed about it.  The jury decided that he didn’t mean to beat her to death.  Just beat her.   He received 25 years for the murder charge and 1 year for stealing her laptop after the fact.  (I don’t remember why he did that).   They opted for 2nd degree instead of 1st degree (life in prison) because of the intent.   Granted, I was following this mostly through radio broadcast updates when the alarm when off in the morning or on the ride home from work, so I don’t know all the details.   But my concern is more general anyway.

How is kicking in a door and beating your girlfriend to death, if you went there just to rough her up, any different that waiting for a shot at 500 yards with a scoped rifle?

In my opinion, there isn’t one.  Not any meaningful one anyway.  He wanted to hurt her and his actions resulted in her death.    I don’t understand why his intent is somehow a mitigating factor.   The intent was to cause harm.

I’m sure I’m missing something here.

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What can you say?  Must be nice to be above the law.    Here’s the story:  The director of the Tennessee Alcoholic Beverage Commission, which is tasked with enforcing marijuana prohibition, isn’t facing an investigation after drugs were found in her home.    I think our homes would be under siege by a SWAT team in a similar situation.      I know the War on Drugs will be hard to kill, but stories like this shows why, until prohibition is ended, we need to be out for justice.

Full story here.

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Nothing new, but Medicare, Social Security and other so-called mandatory spending are busting the budget.  But that spending makes for a sizeable re-election war chest. 

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Before you make up you mind to re-elect President Obama, here’s what you’re voting for, according to Glenn Greenwald:

Yes, I’m willing to continue to have Muslim children slaughtered by covert drones and cluster bombs, and America’s minorities imprisoned by the hundreds of thousands for no good reason, and the CIA able to run rampant with no checks or transparency, and privacy eroded further by the unchecked Surveillance State, and American citizens targeted by the President for assassination with no due process, and whistleblowers threatened with life imprisonment for “espionage,” and the Fed able to dole out trillions to bankers in secret, and a substantially higher risk of war with Iran (fought by the U.S. or by Israel with U.S. support) in exchange for less severe cuts to Social Security, Medicare and other entitlement programs, the preservation of the Education and Energy Departments, more stringent environmental regulations, broader health care coverage, defense of reproductive rights for women, stronger enforcement of civil rights for America’s minorities, a President with no associations with racist views in a newsletter, and a more progressive Supreme Court.

The entire essay is worth reading. He spends a lot of time on the dangers of partisan loyalty and how that will only get worse as the election gets closer. I think that’s the biggest problem. The “It’s okay — it’s out team” phenomenon.

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This essay looks at how doctors make end of life care decisions for themselves. They don’t subject themselves to what the rest of us do.

What are we getting for the money we spend: “What it buys is misery we would not inflict on a terrorist.”

More: “Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.”

This isn’t saying anything that I haven’t already said, so I’m just passing it along.

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I have a bluetick coonhound and can’t say enough about how wonderful they are. This one needs a home.

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