Least Common Denominator

I know that many people feel that defensive medicine does not exist but I did a little controlled study to see just what happens. Here is how it works. When a patient comes to the ER, they often get admitted by one of the hospitalist services. These doctors see the patient and are the general managers of their care. Because of liability reasons, if the patient has chest pain rather than work it up themselves and assume the risk, it is an immediate cardiology consult. Headaches, neurology. Diabetes, call endocrine. Pretty soon you have consultants jumping on the patient like fleas on a dog. Of course each of these consultations cost money. If the patient has insurance, each consultant charges their fee. Now here is the study. I looked at whether or not patient who were indigent had more of less consults. The answer was that they had more. The reason was simple. Indigent patients are less likely to follow up and more likely to sue. So, you consult more to make someone else responsible. As one of our ER docs put it, you are recruiting co-defendants. So, it seems that the least common denominator is not money, but liability.

Baker Act vs Stark Law

For those outside of medicine, Democratic US Representative from California Pete Stark is the one who has added many laws to regulate medicine into other bills to hide their initial effects. Many of us consider his laws to be at the root of why their is not more competition in medicine and why it is regulated into a beurocratic mess. Anyway, if you had any doubt of Congressmans Starks sanity, here he is explaining that "the more our country is in debt, the better we are off" and many more of his great "insights"!


http://www.youtube.com/watch?v=UjbPZAMked0&eurl=http%3A%2F%2Fjs%2Dkit%2Ecom%2Fapi%2Fstatic%2Fpop%5Fcomments%3Fref%3Dhttp%253A%252F%252Fglobaleconomicanalysis%2Eblogspot%2Ecom%252F%252F%26path%3D%252F2009%252F06%252Fus%2Dsavi&feature=player_embedded

I wonder when some California physician will just use the Baker Act on him in the middle of the House of Representatives?

Agricultural Stimulus

I got to see an old patient in follow up. I love him to death and he has been fighting different cancers for years. As I looked for another, I teased him about the smell of smoke on his clothes, by saying "Gosh, how much are those cancer sticks now with all those taxes?" His answer was priceless, "I know that you cant get around death, but the taxes are easy!" Before I went into my stop smoking talk with him for the 50th time, I had to ask him what he meant. Well, he is an old farmer and it isn't that hard to plant a half acre of tobacco for his personal use and the use of some of his friends. Infact, they have sort of a co-op. He grows it, another person cuts and drys it while another grinds it. They then roll their own. He did confide that sometimes people give him some money for it. Turns out enough to pay the rent. As to the taxes, he said "I'm 79 and I have had cancer 4 different ways and it aint licked me yet, I'm going to roll in that social security as long as I can until I break even on all the money the governement took from me!"

I wonder how many others are growing tobacco in their gardens?

COPD vs Obamanomics

In several ways patients with COPD (Emphysema) are like small business. In these patients the lungs are having a hard time getting oxygen into the blood. As a result the patients body compensates. As the lungs start to fail, the body starts shutting down all nonessential functions. The pateints lose weight, the kidneys and other organs barely function. To keep things going, the body then concentrates the blood by making sure that every cc of blood has as many red cells as it can to carry the vital oxygen to the deprived organs. The hyperconcentrated blood compensates for the lungs failure and the patients keep going. If these patients lose blood, bad stuff happens fast. Their body is already on the edge. You have to replace their blood. If you just give them fluid and dilute what blood they have bad things happen fast. In other words, you dilute the blood, they die.

Small business is very similar. As the economy decreases and people buy less, the business has to compensate. At first it can lower prices temporarily to try to keep the volume up. This is like breathing faster. Eventually however you burn up what ever profit you have and start to lose money. Because you have certain demands to stay in business (overhead) you cut where ever you can. Since the vital organs of a business are its employees, they get cut as much as possible. You then get to a point that you have cut all that you can and volume of business is low. So low that the only way you can stay in business is to increase the price of your product. This causes inflation because you had to raise the price just to compensate for the economy. This inflates the dollar because it takes more dollars to buy the same thing. So, what decreases this whole process? The answer is to decrease overhead or the stress on the system. For business, one of the big stressors is taxes! The other thing that needs to be done is to make the dollar stronger!

Instead, in Obamanomics you increases the taxes on business to further decrease their ability to stay afloat and mandate more costs per employee which speeds up and increases the cuts that have to made in the staff and lastly devalue the dollar by massive unbacked spending. So now you really have to increase the cost of your products just to stay in businees and really have to lay off as many people as possible just to stay in business. Thus raising unemploment and letting inflation run wild.

In other words, it is like a making a patient with COPD carry another patient on his back while running on a treadmill which you are making up hill while you literally suck the blood out of him.

"Not the Disabilty I was looking for!"

Saw a patient today with a plethora of complaints. She had worn her internist out with various complaints from low back pain to headaches, she had every article she could print out on the internet about fibromyalgia and after presenting these to her doc, she wanted him to back date forms so she could get both temporary and permanent disability. She was well known for hitting different ERs for narcotics and actually had been fired from her job because she had taken off for the beach when she claimed she was out sick. I ended up seeing her because in her work up he saw something. It was unrelated to any of her complaints. In fact it was asymptomatic. The problem was that it was very malignant. Melanoma is like that. The node meant that it was stage 4. The primary site can not be found. She will get her disability. It wont be some paperwork and checks from the government. It will be seizures, liver failure and death.

Anton-Babinski Syndrome

It is so hard to watch the politicians try to figure out the healthcare mess that for the most part they created. Rather that look at what is obvious, they turn a blind eye to the results of their meddling and continue to press on. When they are confronted with the damage that has been done by their actions, they act like the Black Night in Monte Pythons "Holy Grail".

It is all very simple, they have done to healthcare what they have done to our governmental spending. Long and short, its like the income tax. Those that support the "Fair Tax" are quick to point out that you would pay a lot more attention to what the government was spending its money on if you had to write a check out of your own pocket each month. Because they get the money before you do in the income tax, we really dont see it so they can spendit before we know it. The same is with employer paid healthcare and government healthcare. You dont feel the money coming out of your pocket so you dont care how much it is spent.

So, if you paid for healthcare out of your own pocket, you would be much more careful how you spent it! You would shop around to get the best deal. Oh, wait a minute. Congress made it so you cant shop around. They fixed the prices of all Medicare/Medicaid so there is no real competition for who can give the most for the money.

If you want to help more people get healthcare and drive down the cost, its easy. Give the people the money and let them spend it. Sure, some will decide not to spend it and pocket it. Then its their own problem. I would love to see hospitals become Wallmart and have specials and deals. I can just see it "After Thanksgiving Sale on mamograms and PSAs, we will even throw in a colonoscopy". (Of course, you cant do that because of Pete Stark).

Lets get rid of physicians having to contract with health insurance companies. Let physicians and hospitals post rates for their services and compete for patients and let patients spend their healthcare dollars as they wish. You pick if you want Hilton on Motel 6 healthcare. Get rid of insurance contracts with pharmacies. If the drug companies want to sell more meds, let them make it cost effective enough that the patient will want to pay for their drugs.

Of course none of this will happen as our elected officials turn their blind eyes to the results of their meddling in our healthcare system and ingnore the results of all the other countries who have already been done the same road.

Auditory and Visual Hallucinations

I was flipping channels and came accross someone explaining that the price of gas is going up because of the inflation of the US dollars in overseas markets. They went on to describe how unmatched federal spending and huge US debt is causing the price of commodities to rapidly increase of which oil is one. They then had an expert come on and show how inflation causes loss of jobs, increased interest rates and overall stagnation of business. The overall message was that the "Stimulus" was causing oil to go up which will further stagnate US businesses and then the rest of inflation will cause further US economic decline.

I couldn't believe it, it was on CNN! I must have been hallucinating.