RyanCare/TrumpCare

[Mountaineer]

Desert: My list is about screening tests, not diagnostic tests conducted as part of treatment of an established condition. Coronary angiogram is part of the latter. It would be very inadvisable to use it as a screening test. Check out the adverse effects/complications. Also, it's not clear that a blocked artery necessarily causes symptomatic disease.

Makes sense. I'm trying to figure out which screening test would be appropriate to detect heart disease.

A coworker died recently of a completely unexpected heart attack. I'm wondering if there is some screening test available that could provide warning to people. There may not be, I'm thinking.

Full body invasive catherization of arteries and veins down to 0.1mm in diameter, followed by cracking the chest, observation and palpation of exposed organs by a cardiac surgeon. That should tell one all that is necessary to determine if the plumbing is clogging.

[farjean2]

Full body invasive catherization of arteries and veins down to 0.1mm in diameter, followed by cracking the chest, observation and palpation of exposed organs by a cardiac surgeon. That should tell one all that is necessary to determine if the plumbing is clogging.

I got something in the mail the other day about some kind of intensive screening for heart issues that involved things like checking for calcification in the arteries, and things like that. It was being held at a local church, took about an hour, and cost around $175 if my memory is correct. If issues were found you could take the results to your doctor for further consultation.

Call me skeptical but I figured the whole thing was probably sponsored by a group of local cardiologists.

[Mountaineer]

Color me dense, but I don't quite "get" the obsession with subsidized medicine for everyone. Why single out medicine? Why not also subsidize my gasoline purchases, home utilities, restaurant charges, travel expenses, entertainment purchases, car payment, etc. if I "feel" they are just too high - certainly that is my RIGHT to not be burdened with all those high expenses? If I choose to buy insurance for my car, my home, my life, my long term care, my cat, my dog, and the like, why should I not be responsible for deciding (or not) to buy drug and health insurance - and be willing to endure the consequences, good or bad, of my choice? Is this just one more example of self-worship getting us into messes we could well avoid if we focused a bit more on the good of others instead of trying to maximize self-benefit no matter what? Damn the torpedos and full speed ahead!

[WiseOne]

Depends on what caused your co-worker's heart attack. If it was the usual clogged-artery kind, then yes there is indeed a screening test, as follows:

Do you get chest pain (including discomfort/squeezing feeling/unusual shortness of breath) on exertion? Like, running up a flight of stairs or fast walking?

If the answer is "yes", then go see a cardiologist as soon as possible.

Maddy, about your question: Yes there have been studies. I'm too lazy right now to look them up, but the proportion of patients with pre-diabetes who go on to develop diabetes is as small as you might expect. In order for pre-diabetes to be useful, the prevalence of diabetes would have to increase by a factor of 4 or 5 AND you'd have to show that nearly all arose from the pre-diabetic half of the population (which no one has done). No matter how dire the predictions get, I just can't bring myself to swallow that Kool-aid.

It is just SO much fun to bust up evidence-based medicine with simple logic. Here's one of my favorite examples: there are a lot of physicians who swear by an fMRI procedure to determine which hemisphere of the brain is dominant for language. fMRI is the diagnostic procedure that I most enjoy skewering as some of you already might know. Anyway, there's several studies "proving" the predictive value of fMRI for language lateralization, usually citing accuracy in the 80-90% range. However, I can beat them all with the following procedure: saying the word "Left". That's because >95% of the population is left language dominant. Too bad I can't bill for this procedure though.

[Tyler]

It is just SO much fun to bust up evidence-based medicine with simple logic. Here's one of my favorite examples: there are a lot of physicians who swear by an fMRI procedure to determine which hemisphere of the brain is dominant for language. fMRI is the diagnostic procedure that I most enjoy skewering as some of you already might know. Anyway, there's several studies "proving" the predictive value of fMRI for language lateralization, usually citing accuracy in the 80-90% range. However, I can beat them all with the following procedure: saying the word "Left". That's because >95% of the population is left language dominant. Too bad I can't bill for this procedure though.

Wow. A's in science, D's in statistics.

[Pointedstick]

Color me dense, but I don't quite "get" the obsession with subsidized medicine for everyone. Why single out medicine? Why not also subsidize my gasoline purchases, home utilities, restaurant charges, travel expenses, entertainment purchases, car payment, etc. if I "feel" they are just too high - certainly that is my RIGHT to not be burdened with all those high expenses? If I choose to buy insurance for my car, my home, my life, my long term care, my cat, my dog, and the like, why should I not be responsible for deciding (or not) to buy drug and health insurance - and be willing to endure the consequences, good or bad, of my choice? Is this just one more example of self-worship getting us into messes we could well avoid if we focused a bit more on the good of others instead of trying to maximize self-benefit no matter what? Damn the torpedos and full speed ahead!

Color ME dense, but I'm not seeing anyone here (or anywhere) obsessing about subsidized medicine for everyone.

In any case, yes, most people see health care as different than gasoline purchases, home entertainment, etc. I am saddened by the fact that you think they are the same. It is quite at odds with the sentiment expressed in your current signature.

I know, for example, that my in-laws see health care as very different. Yes, they have benefited from subsidies for the health care of their 41 year-old (though cognitively 5 y/o) permanently wheelchair-bound daughter, who has undergone multiple brain surgeries in her lifetime. Without subsidies, I doubt she would still be alive, because they could not afford the medical bills. Also, from what I have seen, they have sacrificed many things to ensure her well-being. It boggles my mind that you would see this as self-worship.

Health care is so contentious because it is--along with abortion, gun control, the death penalty, and war--a life or death issue. By making any policy or choice at all, the government is drawing moral distinctions regarding who deserves life and who doesn't. Human individuality implies and yields a diversity of opinions, making the issue irresolvable at the distributional policy level; any level of government distribution makes some group feel like a great injustice is being committed.

The only solution is to make it much less about life or death, which generally requires a marketplace of some kind--manipulated or otherwise. Food and water are likewise required for life, but due to markets, hidden subsidies, and municipal monopolies, they are so cheap that we barely see them as life-and-death issues because nobody starves or dies of thirst anymore in the USA. The solution is the same for health care: somehow get the price down so that more and more people are able to afford it on their own, without having to trigger people's moral feelings regarding to whom government should or shouldn't directly provide goods and services.

Any plan that doesn't target cash affordability is a joke, and will just be un-done or worsened by the other party when they regain control.

[Mountaineer]

Color me dense, but I don't quite "get" the obsession with subsidized medicine for everyone. Why single out medicine? Why not also subsidize my gasoline purchases, home utilities, restaurant charges, travel expenses, entertainment purchases, car payment, etc. if I "feel" they are just too high - certainly that is my RIGHT to not be burdened with all those high expenses? If I choose to buy insurance for my car, my home, my life, my long term care, my cat, my dog, and the like, why should I not be responsible for deciding (or not) to buy drug and health insurance - and be willing to endure the consequences, good or bad, of my choice? Is this just one more example of self-worship getting us into messes we could well avoid if we focused a bit more on the good of others instead of trying to maximize self-benefit no matter what? Damn the torpedos and full speed ahead!

Color ME dense, but I'm not seeing anyone here (or anywhere) obsessing about subsidized medicine for everyone.

In any case, yes, most people see health care as different than gasoline purchases, home entertainment, etc. I am saddened by the fact that you think they are the same. It is quite at odds with the sentiment expressed in your current signature.

I know, for example, that my in-laws see health care as very different. Yes, they have benefited from subsidies for the health care of their 41 year-old (though cognitively 5 y/o) permanently wheelchair-bound daughter, who has undergone multiple brain surgeries in her lifetime. Without subsidies, I doubt she would still be alive, because they could not afford the medical bills. Also, from what I have seen, they have sacrificed many things to ensure her well-being. It boggles my mind that you would see this as self-worship.

Allow me to clarify what I meant (of course, you may still think I'm a heartless bastard, but so be it). I'm appalled at those who want handouts and freebies that someone else has to pay for without choice in the matter. I'm all for people helping one another, just not at gunpoint or the government equivalent. What I'm saying is that I choose or not to purchase all types of insurance. Why make medical insurance different? I think it is totally reasonable to tell people that perhaps they don't need that large flat screen TV, cell phone, or cigarettes quite as much as they might need health insurance so they should choose wisely how to spend their hard earned welfare check. I equate those who pick the flat screen TV, cell phones, and a Starbucks twice a day over health insurance to be heavily into self-worship at the expense of others who have to foot the bill. I can almost hear them saying "to hell with everyone else, it's my right to enjoy those frivolous purchases and my right to expect others to pay for my health care". However, I realize you can't cure stupid. I would prefer a system where one self-financed routine medical stuff, i.e. get the insurance companies out of the equation for minor stuff (if they wanted to go to the ER for a cold, they are certainly welcome to do so as long as it is on their own dollar), and one purchased only catestrophic "major medical" insurance. I can't help but think if there were incentives to reduce health care use at the individual level (e.g. that snotty cold stuff is not ER worthy) costs would decrease substantially. I'm definitely not one for social engineering by the government, everything that is touched by big bro turns to shit, in my opinion based on observations over many decades. I would further say, if you are not a citizen, .... sorry, no free medical; cash on the barrel head if you need services. Is you mind still boggled?

[WiseOne]

Mountaineer, were you thinking that *routine* costs shouldn't be subsidized? Routine health care should be treated like the electric or telephone bill, or grocery bill: as necessities of life that each person should bear responsibility for paying. It's the high level, catastrophic costs that needs to be a shared expense. I'd love to see those two entities treated separately.

Interestingly, the main argument for lumping together routine & catastrophic health costs is to force as many people as possible to participate in preventive medicine, and keep coming back for routine followups with no fixed agenda in mind. Those things are a hard sell for very good reasons!

[Mountaineer]

Mountaineer, were you thinking that *routine* costs shouldn't be subsidized? Routine health care should be treated like the electric or telephone bill, or grocery bill: as necessities of life that each person should bear responsibility for paying. It's the high level, catastrophic costs that needs to be a shared expense. I'd love to see those two entities treated separately.

Interestingly, the main argument for lumping together routine & catastrophic health costs is to force as many people as possible to participate in preventive medicine, and keep coming back for routine followups with no fixed agenda in mind. Those things are a hard sell for very good reasons!

Yes to your first paragraph. No lumping together. No force, just free choice. I'm an advocate of personal responsibility in 99+% of cases. I do recognize there are outliers that may need to be considered separately - however, not too many people look at it that way. It smacks of political rhetoric that many get on their high horse for political gain to advocate making the <1% representative of the >99%. BS is all I can say to that. Sorry for venting, I'm tired and just finished cleaning up a mess of ice/snow/sleet/huge pile left by the street plower in front of my driveway. I'm not in the mood for Monday morning quarterbacks on the poor, poor pitiful who refuse to take accountability for their actions.

[farjean2]

It is just SO much fun to bust up evidence-based medicine with simple logic. Here's one of my favorite examples: there are a lot of physicians who swear by an fMRI procedure to determine which hemisphere of the brain is dominant for language. fMRI is the diagnostic procedure that I most enjoy skewering as some of you already might know. Anyway, there's several studies "proving" the predictive value of fMRI for language lateralization, usually citing accuracy in the 80-90% range. However, I can beat them all with the following procedure: saying the word "Left". That's because >95% of the population is left language dominant. Too bad I can't bill for this procedure though.

It's also too bad you can't get your money back when you diagnose your own condition which I have actually done on several occasions. The last was when I was having chronic stomach pain and after visiting a primary care doctor, having CT Scans, MRI's, blood tests up the Wazoo, and then I was sent to a Gastroenterologist and getting whatever that thing is where they put you to sleep and stick something down your throat. They found nothing wrong. So I had to resort to Google to discover something called "referred pain" in which the pain from arthritis in your back can be referred into your stomach. I suggested that as a possibility so they decided to give it a try with Lidocaine patches on my back which I needed a prescription for, BTW. Problem solved. Except for my back, of course. They only gave me a two months supply. I would need to see another kind of doctor if I wanted more. So I said no thanks, GFY, I'll learn to live with it.

That's just one of about 4 stories of my own that I can tell. Another was diagnosing rectal bleeding and a swollen lump under my jaw which really had me worried. I was referred to another gastroenterologist for a colonoscopy and an ENT doctor who prescribed sucking on lemon drops. Searching google on those symptoms I discovered that a cause may be an abscessed tooth. My primary care doctor didn't like me searching on Google and assured me that would be a very rare thing and was probably not the cause but I decided to go the dentist to have it checked out any way. It took her less than a minute to show me the pus-filled abscess in my mouth with a mirror and when I had a root canal the problem was solved.

And then there was my first wife's lung cancer from which she died and how long it took for anyone to order the tests even though the symptoms were so obvious they could smack you in the face with the help of google. That's actually a long story that's almost unbelievable. It took a whiff of chlorine gas in her face followed by visits to different emergency rooms on two different nights, one of which sent her home with two collapsed lungs, near death before someone finally did an xray and said, "gee look at that spot, maybe it isn't just allergies after all, but maybe a woman smoking for 50 years since the age of 13 might have lung cancer" and we should do some tests.

Well that's the end of my rant. I actually do have great respect for people who devote themselves to the practice of medicine but I tend to stay as far away from them as I can get.

[Tyler]

It's also too bad you can't get your money back when you diagnose your own condition which I have actually done on several occasions. The last was when I was having chronic stomach pain and after visiting a primary care doctor, having CT Scans, MRI's, blood tests up the Wazoo, and then I was sent to a Gastroenterologist and getting whatever that thing is where they put you to sleep and stick something down your throat. They found nothing wrong. So I had to resort to Google to discover something called "referred pain" in which the pain from arthritis in your back can be referred into your stomach. I suggested that as a possibility so they decided to give it a try with Lidocaine patches on my back which I needed a prescription for, BTW. Problem solved. Except for my back, of course. They only gave me a two months supply. I would need to see another kind of doctor if I wanted more. So I said no thanks, GFY, I'll learn to live with it.

I had a very similar experience. Last year I suffered from extreme acid reflux, to the point where it often left me gasping for breath and I thought I was having a heart attack. Taking antacids would help, but only temporarily. As a result, I barely ate and had a very tough time sleeping.

My primary doctor looked me over, confirmed nothing was seriously wrong, and prescribed me a PPI. I took that for a month with no improvement. I went back, and she basically said I should switch brands until I find one that helps and take them for life (just like she did). She was maybe 30. That was clearly ignoring the root cause, so I stopped the PPIs and saw a gastro.

He heard my story and signed me up for a series of very uncomfortable and expensive tests. About a month later, the results came back and they could find nothing wrong. I asked what he could do next, and he said I should set up another appointment and we could discuss more tests. Maybe surgery was an option. Knowing how useless the last round was, I decided to try my own thing first.

I knew from my own research while waiting for test results that acid reflux is sometimes caused by bacterial problems in the gut. I also found a good book on controlling acid reflux with diet. So I took an OTC probiotic and watched what I ate, and was basically cured within a few weeks.

In all, it took many months and many thousands of dollars funneled to the best doctors I had access to in order to eventually ignore their advice of lifetime medication and surgery and discover that very simple personal steps could fix my problem. Why they didn't simply recommend that from day one is beyond me.

[farjean2]

In all, it took many months and many thousands of dollars funneled to the best doctors I had access to in order to eventually ignore their advice of lifetime medication and surgery and discover that very simple personal steps could fix my problem. Why they didn't simply recommend that from day one is beyond me.

I suspect there are many stories like this in the Naked City. I have a lot more that I could share.

I find that with medicine it's like the old saying, "it's not what you don't know that bothers me, it's what you know that ain't so". The fact that a doctor will prescribe a lifetime regimen of medicine based on what is actually just the best guess he/she can make should be very concerning to any rational person.

[Tyler]

Yep -- that's good advice!

FWIW, I figured out for myself that the prescribed PPIs (which prevent stomach acid creation) were poor suggestions for my own problem when 1) my symptoms only got worse, and 2) drinking apple cider vinegar right before a meal made me feel better almost immediately. So Gumby was right that excess acid really wasn't the problem. For me, it was more about figuring out my food triggers, maintaining acid levels at a healthy level, and restoring a healthy gut microbiome. Basically, I chose good health instead of perpetual treatment. Pretty crazy, I know.

[Xan]

Oh Lordy. I aimed for the Reply button but clearly missed (and also didn't pay a lick of attention). Let me try again:

I'm going to try to see if I can fix the character display issues for older threads like that one.

Update: it may not be 100% perfect across the whole forum, but it should be pretty close. The old post linked to here now looks good.

[ochotona]

My favorite Trump quote during this process: "Nobody knew that health care could be so complicated."

OMG

[flyingpylon]

It all starts to make sense once you realize we have a uniparty government that doesn't actually want to repeal Obamacare.

[moda0306]

It all starts to make sense once you realize we have a uniparty government that doesn't actually want to repeal Obamacare.

Or if you realize that Trump is a master negotiator, and this bill would have been a disaster.

he is certainly proving masterful at ducking the nooses that the uniparty and their co-conspirators keep trying to get around his neck..

Um... didn't he want this bill? Wasn't it the "freedom caucus" that tanked it?

[moda0306]

It all starts to make sense once you realize we have a uniparty government that doesn't actually want to repeal Obamacare.

What do you think they want? To me, a health amount of Repubs in congress don't want Obamacare... slightly less than they don't want to be seen as taking healthcare away from folks.

Of course, they'll suffer it, because their insurance company donors can still profit handsomely.

[Tyler]

To me, a health amount of Repubs in congress don't want Obamacare... slightly less than they don't want to be seen as taking healthcare away from folks.

When things cool down, the bipolar dynamic makes me really wish someone would legitimately pitch MediumTexCare in Congress. Universal coverage for everything over $50k/year, and a truly free market under that threshold for people who want to buy insurance for that high deductible. They can even offer assistance for low income people to purchase that insurance so that nobody is left out, as because of the cap it wouldn't even be that expensive anymore.

Think about it -- moderates and even many Dems would crow about universal coverage for all with nobody bankrupted by a major health event, and the Freedom Caucus would still get the chance to talk about free markets, individual responsibility, and doing what they can to actually bring down healthcare expenses. Everybody wins -- even citizens for once.

[Libertarian666]

To me, a health amount of Repubs in congress don't want Obamacare... slightly less than they don't want to be seen as taking healthcare away from folks.

When things cool down, the bipolar dynamic makes me really wish someone would legitimately pitch MediumTexCare in Congress. Universal coverage for everything over $50k/year, and a truly free market under that threshold for people who want to buy insurance for that high deductible. They can even offer assistance for low income people to purchase that insurance so that nobody is left out, as because of the cap it wouldn't even be that expensive anymore.

Think about it -- moderates and even many Dems would crow about universal coverage for all with nobody bankrupted by a major health event, and the Freedom Caucus would still get the chance to talk about free markets, individual responsibility, and doing what they can to actually bring down healthcare expenses. Everybody wins -- even citizens for once.

Almost anything would be better than the current disaster, and MediumTexCare is no exception to that. It sounds considerably better than the piece of crap that just got defeated.

[Maddy]

I'm convinced that nothing meaningful will change until the lawmakers acknowledge that the problem is not coverage, it's price.

Here, finally, is a concrete proposal that aims to address the government-sponsored monopoly that is the fundamental cause of the "price" problem. It's being floated by Karl Denninger of the Market Ticker, who's not on my list of favorite people, but who is nonetheless 100% on target when it comes this issue. His contention is that if EXISTING antitrust legislation were enforced against the insurance/medical/pharmaceutical industry, prices would fall to a mere fraction of what they are now and there would be no need for insurance other than minimal, catastrophic, coverage.
https://market-ticker.org/akcs-www?post=231949

[Cortopassi]

I'm convinced that nothing meaningful will change until the lawmakers acknowledge that the problem is not coverage, it's price.

Here, finally, is a concrete proposal that aims to address the government-sponsored monopoly that is the fundamental cause of the "price" problem. It's being floated by Karl Denninger of the Market Ticker, who's not on my list of favorite people, but who is nonetheless 100% on target when it comes this issue. His contention is that if EXISTING antitrust legislation were enforced against the insurance/medical/pharmaceutical industry, prices would fall to a mere fraction of what they are now and there would be no need for insurance other than minimal, catastrophic, coverage.
https://market-ticker.org/akcs-www?post=231949

I stopped reading Karl a while ago, too negative for me. However, he always has had good ideas on healthcare, and continually states that no one, even on the right, will give him the time of day when it comes to this issue. So to expect such smart, grand sweeping changes like he proposes seems impossible for now, unfortunately.

[Jack Jones]

His contention is that if EXISTING antitrust legislation were enforced against the insurance/medical/pharmaceutical industry, prices would fall to a mere fraction of what they are now and there would be no need for insurance other than minimal, catastrophic, coverage.
https://market-ticker.org/akcs-www?post=231949

Regarding the pharmaceutical industry, if we regulate drug prices too much we'll see fewer drugs being developed. I'm curious what he has to say...reproduced below (and emboldened by me) :

Wholesale drug pricing in the United States must be on a "most-favored nation" basis. The impact of this would be to force a level price across all nations for drugs produced by any pharmaceutical company marketing both in the US and anywhere else in the world. Violations, including attempts to "offshore" via subsidiaries to evade this requirement are deemed criminal and civil acts. The civil penalty shall be 300% of the difference paid to the customer who got screwed, and another 300% for each instance of a prescription filled at an inflated price paid as a fine to the government. This would drive drug prices down by at least half in the United States and for many drugs by 90% or more. It would instantly and permanently end, for example, the practice of charging someone $100,000 for scorpion antivenom in Arizona when the same drug from the same company is $200 for the same quantity 40 miles to the south and across the Mexican border. Since all prices must be posted at the retail consumer level for both goods and services controlling the drug pricing problem at a wholesale level is both simpler and sufficient since competition will already exist at the retail pharmacy level.

I'm not convinced the practice of charging Mexicans less than Americans is a bad thing. Mexicans get a life-saving drug that they might not otherwise be able to afford, and the drug companies still get properly remunerated for years of research.

[Jack Jones]

Good, short article on how drugs are priced:

http://www.npr.org/2016/02/05/465748256 ... rug-prices

[Pointedstick]

I'm not convinced the practice of charging Mexicans less than Americans is a bad thing. Mexicans get a life-saving drug that they might not otherwise be able to afford, and the drug companies still get properly remunerated for years of research.

Why do Americans have to do everything? Why do we have to be the ones paying for the rest of the world's medical research? And defense, and...


Related to what Maddy posted, the New York Times ran a very relevant article yesterday:

https://www.nytimes.com/2017/03/29/maga ... -much.html

What a nightmare. Upfront pricing would do so much to fix this insanity.