Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[beej67]

Everybody else in the world is already burning the antibiotics up. Tightening their supply here does us no good, and in many cases can be fatal.

I had a friend who almost died from a superbug infection he got at a hospital. The surgeons did all sorts of insane (and expensive, to keep it on topic) procedures to him to try to keep him alive, which included implanting tubes all through his body to pump certain antibiotics. Nothing worked. As his teeth were falling out, he went to a dentist, who decided to simply proscribe him a different (very powerful) oral antibiotic. He was cured in two weeks. By the dentist. The surgeons made over a hundred thousand dollars off him first though.

All because he was having a boil on his foot lanced.

Everyone actually knows what the problem is, because everyone knows someone who's been through the ringer of our healthcare system. We just don't stop and think about what the problems are when we watch others, or ourselves, go through it. The problem is that nobody is allowed to do anything for themselves, everyone must see a doctor for every little thing, the doctors are all trying not to get sued, and the doctors know that they can prescribe anything they want and the costs will be shared. That's the source of the problem, and that problem will remain whether the costs are shared through premiums, or shared through taxes.



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[TenPenny]

Most doctors over the age of 45 don't see any value to electronic medical records either. With the learning curve and the cost, the payback isn't there to justify the investment.

 

[cranky108]

I do agree that a few things should be regulated, but they are already being over perscribed anyway. But regulate everything?

The problem with antibiotics did not start with doctors, I believe it started with feeding it to animals, which is largely unregulated. The organic, and probiotic movements are currently making a dent in that issue, but it still exists.

And the best part of having your foot lanced at home is not having to visit a unhealthy hospital. Notice I say unhealthy, and not unclean. Hospitals typically look clean, but as they have pressures to reduce costs, they miss things.

The problem with percription drugs, is the perception that a magic pill will solve everything, and it won't. Just look at the side effects on any of them.
The medical profession started this dream, and they need to fix it.

 

[KENAT]

The animal anti-biotic issue is only one aspect of the issue, and possible not the most significant.

People being over prescribed antibiotics, not finishing their courses as instructed, helping themselves to their friends/families medicine, diagnosing themselves and buying from pharmacy in other countries... are major factors in development of antibiotic resistant infections.

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[beej67]

Superbugs aren't evolving in homes, they're evolving in hospitals. The most important thing you could do to fight the superbugs is decentralize hospital care.

But nobody's going to do that, because hospitals are big money.

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[KENAT]

beej67, you are mistaken.

Part of the reason they are more obvious in hospitals is because the people there are already sick and so potentially more vulnerable to picking up an infection.

However, they also evolve at home/in the community.

http://newsinhealth.nih.gov/issue/Feb2014/Feature1

gives some information, or maybe you don't trust the govt but there you have it.

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[beej67]

Yeah, no, most of the people who catch MSRA catch it in the hospital.

http://www.scientificamerican.com/article/hospitals-and-superbugs/

MRSA causes some 94,000 invasive infections in the U.S. each year, resulting in almost 19,000 deaths—more than those caused by human immunodeficiency virus (HIV)—said a study published this week in JAMA The Journal of the American Medical Association. And "the majority of these cases appeared to be health care–acquired,"

Gehrke asked her ob/gyn why this had happened. "'These things happen in hospitals' is pretty much what he told me," she says.

It is difficult to pinpoint the source of Gehrke's infection. It may have stemmed from a dirty instrument used during her C-section or from unwashed hands or the contaminated gloves of a health care worker. But one thing is almost certain: she picked up the bug at the hospital.

Gehrke is one of millions of patients who have unwittingly contracted infections in hospitals, where they went expecting to get well—but instead got sicker. Every year nearly 100,000 people die of infections they developed in U.S. hospitals and healthcare facilities, a greater number than those killed in homicides and car accidents combined.

Pretty strong numbers.

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[KENAT]

beej67, you do realize there's a potential difference between where these bugs develop and where they are contracted don't you?

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[hokie66]

This from the Mayo Clinic. They have two categories, contracted in hospital and outside. I think beej67 is correct. My wife is a nurse, and she says some hospitals are worse than others. She works in a rehab hospital, and they take different precautions depending on which hospital their patients come from.

http://www.mayoclinic.org/diseases-conditions/mrsa/basics/definition/con-20024479

 

[beej67]

Read the Scientific American article, KENAT. The hospital environment breeds these things.

Gehrke is one of millions of patients who have unwittingly contracted infections in hospitals, where they went expecting to get well—but instead got sicker. Every year nearly 100,000 people die of infections they developed in U.S. hospitals and healthcare facilities, a greater number than those killed in homicides and car accidents combined. Some 1.7 million patients contract hospital infections annually, according to the most recent data from the Centers for Disease Control and Prevention (CDC).

Many of these infections are caused by multidrug-resistant superbugs such as MRSA and vancomycin-resistant enterococci (VRE). Heavy use of antibiotics in hospitals encourages the emergence of stronger and stronger bacteria. Exposing a bacterial strain to one antibiotic essentially weeds out the weak and selects the hearty bugs that can survive. Then the next generation of antibiotics is called on; eventually the bugs become resistant to that as well and the bacteria continue evolving until eventually no antibiotic can kill them. "You can end up with bugs that we really don't have medications to kill," says Allison Aiello, assistant professor of epidemiology at the University of Michigan School of Public Health. Experts estimate that more than 70 percent of all hospital-acquired infections are caused by bacteria that are resistant to at least one of the drugs commonly used to treat them.

Hospitals not only provide optimum conditions for the evolution of superbugs, but they also provide a plethora of inviting pathways for bacteria to get inside human bodies: open wounds from surgical incisions, catheter tubes running in and out of blood vessels and urinary tracts, and ventilators inserted through noses or throats and into windpipes.

The hospital environment is tailor made to breed superbugs. If we could somehow decentralize the surgical environment, even going so far as to move the equipment to the patient's home and perform the surgery there, then this tailor made environment would not exist to breed such superbugs. The rapid evolution of superbugs is because of the high density of surgical procedures done in one place, with a continued culling of weak bacteria between each surgery, in the hospital. It is the hospital environment itself at fault for the evolution of these things.

The article I linked is a good one, and fairly comprehensive, but it's only one of dozens that say the same thing. Superbugs are not created by too many people taking Amoxil for ear aches. Superbugs are created in hospitals where there is a high density of exotic antibiotic use and open surgeries to act as petri dishes.


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[JohnRBaker]

Here in SoCal, virtually all orthopedic surgeries are performed in specialized surgical centers, because there are NO 'sick people' in the building. 7 years ago I had my Right shoulder operated on and this past summer, my Left knee, and in both cases is was done at a dedicated orthopedic surgical center.

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[KENAT]

Beej67 I fear I fell into the trap of picking up on your specific wording as implying something it perhaps did not, partly based on recollection earlier posts implying that we should be able to go into pharmacies and pick up antibiotics as we see fit. Additionally some of my own wording may have been sloppy. If indeed this is the case then I apologize.

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[cranky108]

If people mis-taking antibiotics is a real concern, then why are they made into pills? Make them injectible only, or some other way to make there taking more difficult. What's the real problem, lazyness?

Why not make some medicines with ditastful side effects. Turns you whole mouth orange, tastes real bad, and smells like s**t (other than antibiotics).

No we make them look like gummy bears, with nice flavors. Easy to take narcotics, real bad thing.

 

[glass99]

If there are negative externalities to taking antibiotics, perhaps they should be taxed accordingly? Lets say a higher co-pay. Use the tax money to provide subsidized care.

 

[beej67]

No problem KENAT.

My point, or at least one of them, is that the "We'll burn up all the antibiotics!" is always trotted out by the medical industry as an excuse for making everyone in the USA go to the doctor for every little ailment that may require antibiotics. When in truth:

1) other countries don't do that, so the amount of "burning up" that happens here is inconsequential, and
2) our doctors just hand out antibiotics anyway, and
3) the really nasty antibiotic resistant bugs aren't being created by over use of common antibiotics for common infections, they're being created in hospitals by the concentration of people having surgery, which is...
4) ...exacerbated by our system's priority to "cut first, ask questions later," because our system is dominated by surgeons who have no financial incentive to recommend paths to health that don't involve expensive surgeries.

Here's one of many articles on the higher rates of surgery in the US:

http://www.ncbi.nlm.nih.gov/pubmed/8073310

US citizens in 1994 had back surgery at five times the rate the English did. That contributes to both our overall increased cost of shared medicine, and also to the increased breeding ground for superbugs, which in turn cost more money. But since back surgery has the fiscal benefit of being A) expensive, and B) covered, our doctors jump at that as the preferred option for treatment.

..and that won't change by switching to a government-payer health care model, either.

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[IRstuff]

"..and that won't change by switching to a government-payer health care model, either."

Isn't the lower rate of English surgeries cited done in a single payer system?

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[beej67]

Sure, but it's not "because" of the single payer system.

Medicare is a single payer here in the USA, and Medicare recipients do not have a lower rate of surgeries than insurance buyers. The payer is not the only difference between England and the USA. The systems themselves are different.

Now, if we go full Communism and not only do single payer, but also single provider, then the rate of surgeries goes down. We have evidence of that. It's called the VA, who let people die because they were lazy and didn't have to compete with private care for the patients dollars. Not even one of the country's most decorated and dedicated Army Generals could steer the VA towards a semblance of respectability.

On that topic ..the whole "VA Reform" movement just kills me. We have Obamacare now, and it's not going away no matter how much some of us would love it. So why have a VA at all? Just fire everyone, give vets an Obamacare voucher, and sell the VA hospitals off to the highest bidder. Problem solved.

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[IRstuff]

"Sure, but it's not "because" of the single payer system."

Right, but it's not the single payer system that prevents that from happening either.

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[hokie66]

In the article which beej67 linked above, the study found that back surgery rates were related linearly with the number of surgeons available to perform them. Therefore, the solution is less doctors.

 

[CELinOttawa]

Interesting. Perhaps Hokkie has a point. In Canada the number of Doctors, as well as the type, is controlled by the Doctors. I've always thought that was more to keep the costs up, but maybe it has genuine benefits as well...