Cash-Only Psychiatry

Fox News psych pundit Keith Ablow warns that having affordable insurance makes America soft and infantile.

But Fox News’ resident psychiatrist Dr. Keith Ablow may win the prize for the most outrageous reaction. In a column posted on and during an interview Monday afternoon on the network, Ablow claimed that the court’s decision will “iInfantilize” Americans:

ABLOW: [T]oday it could be healthcare, tomorrow it could be a hybrid vehicle that you are penalized financially for not buying. It takes control of your behavior in the way that a parent would of a child, and it diminishes us in terms of our autonomy and ability to achieve things even for liberty on the world stage, quite literally.

I’m only a nurse, but in my observation, mental illness takes control of people’s behavior in ways that devastate their own lives and the lives of people close to them. Mental illness often strikes in early adulthood, turning promising students into people who struggle all their lives with disability. People with mental illness are likely to suffer loss of earning power, to the point of living in chronic poverty. It’s not that people can’t recover, but mental illness is common, difficult to treat, and often undiagnosed. Good psychiatrists and counselors are often not available to the people who need them the most. This care is expensive, and when states are cutting costs mental health treatment programs disappear while the need grows.

If Dr. Ablow has refused gummint insurance, such as Medicare, Medicaid, VA— then he gets credit for being consistent. He would only spend his non-TV time ministering to the wealthy, but the wealthy suffer from mental illness too.

If he takes the gummint money and goes on Fox to try to shame people for wanting affordable health care– I think there’s a name for that kind of thing. Projection? Reaction Formation? Denial? Snake Oil Peddling?

Doing Well by Doing Good

This bit of good news points the way to saving money and lives…

The risk-adjusted rate of heart failure hospitalization fell from 2,845 to 2,007 per 100,000 person-years from 1998 to 2008 in a fee-for-service Medicare claims analysis by Dr. Jersey Chen of Yale University and colleagues.

That decline — the first ever documented in the U.S. — likely saved $4.1 billion in Medicare costs since 1998, they reported in the Oct. 19 issue of the Journal of the American Medical Association.

Saving money on health care is not done effectively by cutting benefits and shutting people out of access. The answer is to keep people healthier, by good preventive care and evidence-based practice. If you care about your future, you will support universal health care with strong government oversight and research into best practice. The life you save may be your own.

Lose Weight and Save Money with Canadian-Style Healthcare

Thanks to protect_democracy at Buzzflash for this link to a post by Robert Reich that puts the health care mess in terms you don’t have to be an economist to understand…

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

This rings so true to me. I saw a patient today and spent 3/4 of my time in such tasks as re-writing med lists with my quill and ink well and trying, through scrawled notes and talking to the patient, to figure out what he needed for home care. Next I get to call his insurance and wait on hold. I love being a nurse, I just wish I had gone to secretarial school first.

That’s part of the problem. Part of the solution is to open Medicare to all, enlarge the risk pool, cut administrative costs and also save lives and money by ensuring that a patient’s records are available to their doctors.

Reich mentions that home nursing helps prevent costly re-hospitalization, and that is my job. I spend more of my time filling out paperwork than I think is necessary for patient care, so I see some of the frustrating waste and inefficiency firsthand.

Another side of this that is not much mentioned is the terrible drain on our society by letting people get sick enough to go to the emergency room instead of helping them keep well with primary care. Well people who work and pay taxes are good, but if you talk about investing in health care it’s seen as charity for the unworthy and mindless sentimentality. Well, I’ve got news– there’s nothing pragmatic about letting people suffer– we pay more later.

This is from a recent research article from Open Medicine...

Canadian health care has many well-publicized limitations. Nevertheless, it produces health benefits similar, or perhaps superior, to those of the US health system, but at a much lower cost. Canada’s single-payer system for physician and hospital care yields large administrative efficiencies in comparison with the American multi-payer model.60 Not-for-profit hospital funding results in appreciably lower payments to third-party payers in comparison to for-profit hospitals61 while achieving lower mortality rates.62 Policy debates and decisions regarding the direction of health care in both Canada and the United States should consider the results of our systematic review: Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.

But let’s get down to the important issues. Americans are 10% more overweight than Canadians. This number takes into account the different ethnic makeup of the populations– with all the adjustments, Canadians can still fit into our old jeans.
Canada is a country where people consider a plate of french-fries sprinkled with cheese and smothered with gravy a light appetizer. Their main export is donuts. It’s freezing up there, and dark eight months of the year, so Canadians have no reason to go outside. Snow shoveling may burn some calories, but Canada is full of old people because their elderly just keep living and living. They just attach a snowblower to their scooter and ride to the Tim Hortons.

After careful analysis, I have to rule out diet and lifestyle

The only possible explanation is that a single payer health care system keeps people slim.

A Stupid Question

Slow news day for CBS, I guess. They have a flaming headline about the Obama administration’s plan to have Medicare cover the cost of testing for sexually transmitted diseases.

‘U.S. may pay for sex disease tests for elderly: Should taxpayers pony up?’

(CBS) If granny gets gonorrhea or gramps gets sick with syphilis, who should foot the bill to test them?

Taxpayers should pay. At least that’s what federal health authorities seem to think.

Read the rest of the story here.
It’s nearly content-free.

I guess this question needs to be answered, so here’s my expert opinion. Duh.

You want someone who suspects they have an infectuous disease not to get tested? That’s going to save money? Like when they show up in the ER with a raging pelvic inflammation or neurosyphillis? After exposing gods know how many other people?

I’m just surprised that these tests weren’t always covered. Most STD’s are easy to diagnose and treat. Counseling for prevention is part of the standard of care.

Well, I guess it’s a slow day at CBS. Or else they are trolling the news for something scandalous to attach to health care reform. Is Obama leading the nation’s elders into temptation? Will everyone just behave if they fear they’ll go blind and insane before the Alzheimers and macular degeration (covered by Medicare) gets them? Should we stop testing and treating younger people so they will be moral too?

Reuters covers the same story, minus the smirks, here.

Blind to the Good of Socialized Medicine

Again, not to pile on Rand Paul, but health care is my thing, and I’ve spent the last winter freezing my garbanzos at rallies for health care reform. So this is intensely interesting to me.

Should the taxpayers have to carry the burden of some old guy’s cataract surgery, or should we just let him go blind? Well, under the current nanny-state system he is covered by Medicare. Medicare patients make up the bulk of the business for eye surgeons.

So Dr.Paul has benefited directly and indirectly from government involvement in medical insurance, in research and in setting standards so that patients can trust something as precious as their eyes to a qualified doctor.

Very good discussion of this in Daily Kos.

And if you want to say to the visually impaired, ‘get a job’, here’s Steve Benin of Washington Monthly, taking apart Rand Paul’s distortion and mis-information about the Americans With Disabilities Act. Paul is again building a straw man, claiming the ADA requires things that it doesn’t.

Sarah Palin’s Plan

Sarah Palin has an editorial in the Wall Street Journal outlining her plans for health care. Cynics claim that she used a ghostwriter–that rumor should be easily debunked by comparing the syntax of that post to her other spoken and written statements. I await her vindication.

What stands out in the short piece is a surprising suggestion. Dismantling Medicare.

Instead of poll-driven “solutions,” let’s talk about real health-care reform: market-oriented, patient-centered, and result-driven. As the Cato Institute’s Michael Cannon and others have argued, such policies include giving all individuals the same tax benefits received by those who get coverage through their employers; providing Medicare recipients with vouchers that allow them to purchase their own coverage; reforming tort laws to potentially save billions each year in wasteful spending; and changing costly state regulations to allow people to buy insurance across state lines. Rather than another top-down government plan, let’s give Americans control over their own health care.

Now, there’s nothing in her editorial about insurance reform, except a passing acknowledgment that it might be a good idea but no concrete proposal to make it happen. And she wants to cut seniors from Medicare and hand them a voucher–to find affordable insurance in a market that is under-regulated and profit-driven. Will this work with the Town Hall people?

I talked to some younger people at the Town Halls who thought that anyone who made the ‘bad choice’ to be uninsured just had to take the consequences. If they had not been Christians I would have suspected them of Social Darwinisim. But the older people were very clear in their message–‘hands off our Medicare.’

Are they going to sign on to ex-Governor Palin’s plan to cut them loose from a government program to try their luck at reading the small print of unregulated, for-profit insurance plans? They have a lot to lose if they do. I think that’s why, needing a harder sell, she continues to claim that Medicare is about to start a Department of Death Panels. It would take serious scare tactics to get seniors to give up a program that works in favor of a gamble on which plan will accept them, be affordable, and be there when they need it.


Bedsores used to be common in immobile, debilitated patients. Early in my career in the 1980’s I saw horrendous sores in hospitalized patients. Muscle and bone exposed. The hospital nurses claimed it came from nursing homes, and nursing homes claimed it came from hospitals.

Preventing pressure sores is labor-intensive, requiring staff to turn the patients every 2 hours around the clock and treat signs of pressure aggressively. A red spot that doesn’t go away is a Stage I pressure sore. You don’t wait to treat until the skin breaks down. Pressure on skin is bad.

Pressure on nursing homes, however, is good. Bedsores are now the exception, not an inevitable consequence of age and disability. The heavy jack-booted inspectors from that government program, Medicare, deserve a lot of the credit.

Summit Commons, an East Side skilled-nursing center that had until Tuesday to correct deficiencies that were deemed serious enough to put some patients in immediate jeopardy from bedsores, has met the conditions to continue participating in the federal Medicare program.

It’s not that it’s not aggravating to have some state worker do the white-glove routine, when you are up to your armpits in work and feel like you’re bailing a sinking ship. Nursing home workers run their legs off trying to keep the patients clean and safe. Facilities have a financial incentive to keep staff as low as possible.

Having a big government program with the power stand up to big nursing home chains is protection for the patients. I am really happy that nursing homes generally are better than they were twenty years ago, and that bedsores are not acceptable.