Archive for the ‘Medicine’ Category.

The Left’s War Against Rural America

Is Obamacare’s Assault on Rural Health Care A Battle in the Larger War Against Rural America?

As I stared at blue sky above the pines on my property I knew my body was broken, and with a yelp slowly raised myself from the ground. I had taken my son’s dirt bike to get the mail, and on the way back to the house I decided to take a detour through the field to enjoy the beautiful Fall afternoon. As I rounded a turn in the corner of a grassy field I braked slightly, shifting my balance forward on the 125cc 4-stroke bike. At that moment the front tire hit a divot hidden by the grass, and I was sailing through the air, landing on the hard packed North Carolina clay on my shoulder. Amazingly my neck and head were pain-free, but I knew my shoulder was either dislocated or broken, and I worried that the pain in my side while breathing was symptomatic of a punctured lung. There was no dusting myself off from this one; I was going to need medical care and fast.

The two nearest hospitals were roughly 25 minutes away, and a 911 call to get an ambulance likely would bring it to an hour before I would reach either of them.

Both rural hospitals have issues. Their communities have been dying for decades, the textile industry that underpinned both having long ago left the area searching for cheaper labor in Latin American and Southeast Asia. One town resorted to tourism, playing up its ties as the site that inspired Andy Griffith’s fictional Mayberry in The Andy Griffith Show. The other town has been trying for years to become a small town known for its trendy restaurants and shops like nearby Blowing Rock, which itself was struggling to become more like trendy Asheville, a city that yearned to become North Carolina’s Sante Fe. But the popularity of the Andy Griffith Show has waned as its fan base aged and died along with Andy Griffith himself, and the City Fathers of the other town have ignored the new ideas that come with new residents, preferring to stick with the Old Boy Network for ideas, strangling growth. For example NASCAR was born only a few miles away from town, and hot rods, classic custom cars are still deeply revered here, yet the town banned cruising 10 years ago and killed the nightlife that had begun when teenagers and car enthusiasts had started hanging out in town.

The hospitals themselves have taken different paths. The one in Mayberry remains independent and small with a few dozen beds. It has a bad reputation based on several citations by the State for providing substandard care and its future is bleak. The other hospital built an entire new wing and emergency room in the expectation that the government would expand Medicare/Medicaid and that the hospital would be able to make money from higher reimbursements for providing care to the poor and elderly. It was a bad decision, and the hospital has been weighed down by the huge debt used to fund the expansion and the switch electronic medical records as Medicare/Medicaid reimbursements have been cut. It has since traded its independence for an “agreement” with one of the Mid-Atlantic’s largest for-profit hospital systems that is turning it into a referral hub for the hospital system. The system holds an option to buy the rural hospital but is in no hurry to exercise it. The hospital needs the health system more than the health system needs the hospital. While the local members of the hospital’s board may not understand that everyone else does.

I texted my son and he found me walking back to the house, holding my arm tightly against my body. I directed him to lock up the bike, put the dogs inside, and get my insurance card. One lesson I have been trying to teach him is the importance of keeping a cool head amidst trouble. As I’ve gotten older I’ve come to appreciate the value of this lesson. He then drove me about 35 miles to a large hospital  that happens to be owned by the same hospital system that has the agreement with the rural hospital mentioned above.

I discussed my thinking with one of the doctors who treated me. He doubted whether the hospital had the skills needed to treat my injuries on a Saturday evening. “They likely would have transferred you here anyway,” he said.  I would have wasted even more time as well as incurred the additional expense of 50 mile ambulance ride.

Most rural hospitals have staffing issues since they have to compete for the same medical professionals as suburban and urban areas. In the past this has meant rural hospitals paid more, and since Medicare/Medicaid reimbursed more for rural care they could afford it. Obamacare changed that; in order for the law to be budget neutral it built in cuts to medicare/medicaid that weren’t anticipated before the law’s adoption. The law has also increased penalties for re-admission, straining the budgets of rural hospitals even further. In the in-depth article “Rural Hospitals in Critical Condition“  USA Today reporters Jayne O’Donnell and Laura Ungar claim the Affordable Care Act aka Obamacare has damaged the survival of rural hospitals, pointing out that since 2010 over 40 rural hospitals have closed, forcing rural residents to drive long distances for medical care. O’Donnell and Ungar state the law’s requirements such as re-admission penalties and electronic health records added to the burden for rural hospitals.

“They set the whole rural system up for failure,” says Jimmy Lewis, CEO of Hometown Health, an association representing rural hospitals in Georgia and Alabama, believed to be the next state facing mass closures. “Through entitlements and a mandate to provide service without regard to condition, they got us to (the highest reimbursements), and now they’re pulling the rug out from under us.” (link)

Although painful and at least temporarily debilitating my injuries were not life threatening. But I’m reaching the age where my former life of a pack a day smoking, heavy drinking and bad eating habits are catching up with me, and a heart attack or stroke would not be considered unusual for a man of my age. In such an event every minute counts, and the USA Today article points out the importance of the Golden Hour where hearts and brains can be saved with medical intervention. Should the hospital in Mayberry disappear as seems distinctly possible, there will be people in its footprint who will have to travel for close to an hour to reach immediate medical care. Add in a 911 call to the volunteer fire department for  pick up by an ambulance and the loss of the hospital, even a poorly performing one, would be disastrous for the local community just as its been in the towns discussed in the USA Today article. Rural living is hard enough, but take away the safety net of a decent hospital close by and living here becomes downright dangerous for some.

Is this what the Obama Administration wants? It’s not as if the administration has embraced rural America. It disdains its values and laughs at its traditions. Worse it has implemented policies that go well beyond cutting funds to rural hospitals, policies that tear at the very fabric of rural life itself.

Ebola in America: How to Fund Research

This article in the New York Times points out a problem in medicine and the pharmaceutical industry: how to support research and development of treatments and vaccines for rarely occurring diseases or conditions that only affect the poor. As Ebola shows today these diseases have a habit of becoming egalitarian real quickly, citing the Ebola virus and the discovery of a vaccine 5 years ago.

 

Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.

 
Instead pharmaceutical companies chase after profits,  meaning that in the US tens of billions of dollars are spent on new erectile dysfunction drugs and cosmetic treatments such as botox injections, yet treatments for diseases that kill in poor countries such as malaria and chikungunya, or those that only affect a few in wealthy countries have to rely upon charity to fund their research.

Diseases don’t check your bank account before they infect you. Sure some diseases are more prone to the poor than wealthy due to sanitary conditions and other factors, but not all. A disease that strikes the poor abroad can easily take up residence among the wealthy at home, as the spread of HIV proved in the late 1970’s through early 1980’s, moving from Haiti to wealthy enclaves in the US.

So the question arises: How do we develop treatments for diseases that are uncommon and/or appear only in poor countries? Providing money to prevent an Ebola vaccine from being shelved is not a completely altruistic act given the reality of how contagious the disease is. The dollars spent today will not only save lives over there, they will also save our lives here.  But how do we fund it?

Although I hate taxes in principle, why not levy a 5% tax on all elective surgeries and lifestyle drugs? That money could be placed into a pool and used to provide grants for the research and development of treatments for diseases that are too rare to justify researching, or to subsidize treatments of diseases like malaria, Guinea worm, and drug resistant TB. Alternately the corporate tax laws could be amended to deduct the costs spent on these diseases on a 1-1 basis: for each dollar spent a firm’s tax burden is reduced by a dollar. Neither is a perfect solution and both are prone to avoidance, abuse and the usual “unintended consequences” which are inevitable in any public policy change, but the Ebola scare in the US should serve as a wake up call.

Almost a hundred years ago the Spanish Flu influenza virus swept through the country, killing millions of Americans in their primes. It touched every family, rich and poor, black and white, immigrant and native born. In my own family it killed a great-aunt and a young cousin and left two other cousins orphans. A few decades later Jonas Salk tamed the beast of polio which had been the dread of all families that came with the approach of the cool autumn. For the past half-century only HIV has risen to the level of concern, but that virus is actually quite hard to catch. It doesn’t survive outside the body of its host for long and cannot penetrate the skin. Besides we have tamed that with anti-virals, turning what had once been a death sentence into a chronic condition.

Ebola has more in common with the Spanish Flu than it does HIV. It can survive for lengthy periods on surfaces outside of the body. It can penetrate the skin. There is evidence that it can be transmitted through the air. And besides Ebola there are other viruses lurking abroad just a flight away from our borders such as MERS and SARS. Each plane arriving here is a dice throw, and eventually we are going to be on the losing end of the odds.

The recent Ebola scare in the US has shown the authorities are not prepared for another pandemic. It has also showed us the limits of our health care system. We need to take these lessons and learn from them to prepare ourselves and our society for the  next thing Mother Nature is going to throw our way. But America has a wonderful habit of hitting the snooze alarm until the very last minute. Hopefully it will awaken before more die here and millions die there.

Ebola in America: 2 Weeks In

Two days ago a 26 year old nurse in Dallas, Nina Pham, tested positive to the virus. She was one of Thomas Duncan’s seventy caregivers. Her diagnosis puts a pretty smiling petite face on a horrendous disease, and one can only hope that by discovering the disease early she will be luckier than the man she treated at Texas Presbyterian hospital.

 

We don’t know exactly how she caught the virus from Duncan. She wasn’t one of the responders who came into contact with him during his first visit to the hospital, after which he was sent home with antibiotics and Tylenol. Evidently she had worn the gear dictated by the CDC, “gown, glove, mask and shield,” yet still got sick. The CDC stated there must have been a “breach in protocol” but Ms. Pham doesn’t recall when it may have happened and neither do the investigators who have interviewed her. The CNN article notes “Or the problem could have been something else entirely.”

“Something else entirely” means maybe we don’t know this disease as much as we think we do, and after 40 years of research that isn’t very much.

Take for example the question of whether the virus is spread through the air. The CDC states unequivocally “Ebola is not spread through the air or by water,” but others aren’t so sure. “We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks,” writes Lisa M Brosseau, ScD, and Rachael Jones, PhD in commentary published by the Center for Infectious Disease and Research Policy (CIDRAP). According to CIDRAP Brosseau and Jones are nationally recognized experts on infectious diseases, not tin-foil hat posters from ZeroHedge.

Here’s the distinction between an airborne infectious disease and one spread through aerosoles. The common cold is considered to be an airborne virus, potentially spread from one person to another without landing on any surface. An aerosolized one is defined by Brousseau in a 2011 research paper as one where disease is spread through the air between people, or as Brousseau writes, “defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung.”

Notice any difference? Let me know if you do because I don’t.

I would expect that scientists would disagree about how a relatively new disease like Ebola spreads, but the CDC needs to be honest and it needs to assume the worst. The medical workers currently treating Ms. Pham need to assume the virus can be spread through the air and a 10 micron virus will spread through a facemask or around a plastic shield as if it weren’t there. They should wear respirators.

Americans need the Truth. Truth will deter panic more than empty assurances from pseudo-politicians in the CDC.

Update: A second hospital worker has tested positive to the disease, and it’s increasingly likely that Ms. Pham didn’t make a mistake removing her protective gear. Instead it’s looking like the CDC protocol for handling this disease is wrong and needs to be changed.

Since the advent of antibiotics and common vaccines we have been spared the pandemics that raged through our history like Bubonic Plague, Smallpox and Spanish Flu. These diseases not only killed millions, they changed our history countless times. Since these were tamed, however, the only large outbreak has been HIV so most of the experience of public health professionals has been with this virus. Unfortunately HIV and Ebola are very different viruses. HIV is quite weak outside the body. It breaks down quickly on surfaces and can only penetrate the skin through a wound. Ebola on the other hand is much stronger. It can remain virulent on surfaces for long periods. It easily passes through the skin and doesn’t need to gain entry to the body through a cut the way HIV does. Worse, the those infected shed much more of the virus through diarrhea, uncontrolled bleeding and vomiting. HIV doesn’t cause such symptoms making it much harder to transmit.

My guess is that the CDC’s protocols are based on HIV and if so, they are inadequate and must be changed. “(CDC director Dr. Tom Frieden) outlined new steps this week designed to stop the spread of the disease, including the creation of an Ebola response team, increased training for health care workers nationwide and changes at the Texas hospital to minimize the risk of more infections.”

Mistakes are going to be made, and demanding perfection is unrealistic. As long as we learn from the mistakes and deal honestly with their consequences we will eventually control the advance of this disease. Am I scared? Of course I am. This is a nasty disease but what other choices do we have?

Update 2: It gets worse. The second hospital worker, a nurse named Amber Joy Vinson, flew from Cleveland back to Dallas just 12 hours before she came down with a fever. The plane stayed in Dallas overnight and then was used for several flights the following day before being taken out of service today.

The likelihood of a passenger on any of those flights catching the disease from Ms. Vinson is low but it is not zero, and given the failures so far to stop the spread in Dallas I’m wondering whether it would have been too much to ask for hospital management and the CDC to make the following rule:

If you are being actively monitored for potential exposure to the virus (as Ms. Vinson was), don’t fly.

It seems like common sense to me.

One other note: We will soon be entering cold/flu season and millions will be developing fevers that are not caused by Ebola, providing a perfect screen for the disease to spread in. While perfection from the CDC may be too much to ask, we should expect them to at least up their game.

Update 3: Ms. Vinson knowingly boarded the plane with a temperature of 99.5 degrees. This is below the threshold of 100.4, but what the heck…

 

Noteworthy Article on the American Health System

This is one of the best articles I’ve read on the subject of American health care and medical insurance. It pretty much explains that the system is so bad that it is well beyond partisan bickering. Here’s a taste.

 

We all instantly recognize that it would be a disaster if we collectively decided that the way all cars should be purchased would be by having a job with a company that will provide you a car (with a tax break, and if you lose your job, you lose your car), and an insurer that will pay for gas and oil. Should you not be able to get a car that way, the government will buy you a car. We can easily imagine that, because the choices in the car sector would no longer be made by individual consumers but by powerful entities—the government, large companies, insurers—almost every car would be a hideous, hideously expensive, comically ill-designed clunker akin to the ones that became the butt of “Lada” jokes in the Soviet Union. Or consider what would happen if housing were provided the way we “provide” health care; the mere thought should send chills down one’s spine. But whenever we talk about health care, that part of our brain seemingly shuts off, and these simple truths become about as intelligible as an angry Klingon warrior.

 

+1 for Klingon warrior reference, but seriously, if you care about the shambles our medical system has become, read this article.

Ebola Observations: 3 Days After Announcement

So far the mass panic everyone expected to happen after the first case has not materialized. People are going about their daily lives and unless you are in the immediate vicinity of the hot zone in Dallas, things haven’t changed all that much. But being married to a medical professional provides a deeper glimpse into how people react. Dr. Wife is fielding questions about the disease and she is counseling people to keep calm, telling them that the spread of the disease in West Africa has more to do with the poor sanitation and hygiene, as well as unusual funeral customs, than it does from the virulence of the virus. “Wash your hands and don’t handle dead bodies,” pretty much sums up her advice, and so far it is working.

The next three weeks will determine whether people keep calm and trust the CDC and other authorities or whether they disassemble and panic. So far I am personally concerned with the response of the public health authorities. I’ve read about the specially designed treatment areas within local hospitals that have been set up to contain the outbreak, but no mention has been made about the bleach baths medical personnel are using when they exit a treatment area. Viruses can be tracked out of an area on your shoes, so medical personnel in Liberia wear rubber boots and step into a pan full of disinfectant after spraying down their bodies with bleach to kill the virus.

How not to leave a hot-zone

I also don’t understand why the people the Thomas Duncan was living with aren’t being quarantined at a hospital. We know they were exposed to the virus and there’s a good possibility they will come down with it. Placing them in a hospital would allow them to be monitored closely and more importantly, allow the decontamination of their living quarters, in this case an apartment. Apartments are not built to be isolation zones. Why are the authorities waiting to clean up the place?

Overall I am not impressed with the handling of this health crisis so far. It seems to me that authorities are taking this outbreak way too nonchalantly. I understand the importance of not causing panic, but we need the authorities to act transparently as well as effectively. Seeing these two public health workers leave a hot zone without any protective gear, an area where we know without a doubt a man was sick with Ebola, leads me to believe that they are underestimating this disease.

Ebola in America

Watched the CDC press conference concerning the first case of Ebola diagnosed in the US. Overall I believe the conference offered enough facts to avoid a panic. But CDC director Dr. Tom Frieden was asked two questions about the patient’s first visit to a hospital, where he was sent home, and offered no details.

This is the weakest link in the public health argument that he was using to assure the public. On Sept. 26, the patient was exhibiting symptoms and was likely contagious at this point based on Dr. Frieden’s explanation about Ebola transmission. The patient visited the hospital and came into contact with several medical personnel as well as other patients and staff, but was not diagnosed with Ebola and was sent home. That hospital was not identified, and Dr. Frieden avoided the questions concerning this failure to diagnose the patient. Two days later the patient went to Texas Health Presbyterian and was correctly identified as a possible sufferer of the virus.

While there is no need to panic, the CDC must remember that facts and the Truth reassure. Silence or avoiding straight answers like a politician do not.

 

Gambian Leader Claims He Can Cure Ebola

Gambian Dictator President-for-Life Yaya Jemmeh spoke on Gambian television and radio, claiming that the herbs he uses to cure HIV can also cure Ebola. Evidently he notified Sierra Leonian president Ernest Bai Koroma about the cure in a meeting at the UN General Assembly.

No word when Yaya will arrive in the Freetown to administer the cure to Ebola sufferers face-to-face.

Pill Heads in the Waiting Room

I am by nature a quiet man who avoids conflict except in the most unavoidable of circumstances, and as a recovering drunk with going on 14 years of sobriety under my belt I tend to cut people in recovery more slack than perhaps I should. But I have zero sympathy for junkies or addicts who refuse to admit they have a problem, and thanks to prescription drug abuse in this country there are millions of people staggering around who fit both profiles.

I just heard from Dr. Wife that there was a young woman screaming in her waiting room because she would not refill a prescription for 90 Xanax, along with others for pain killers, muscle relaxants and Ambien she somehow got from a variety of other doctors. Dr. Wife examined her and  found there was no medical reason for her to be on those medications and she was not going to prescribe them. Dr. Wife tried counseling the woman about the dangers of prescription drug abuse, how it’s easy to kill yourself and usually makes pain worse, and offered to help her get off the meds, but the junky started screaming obscenities at her and the staff.

I recommended punching her in the head but Dr. Wife and her staff got her out of the office without resorting to violence. I still think a punch in the head is warranted, perhaps two, but then again I’m not a doctor so I don’t know what the dosages are for punches to the head. Perhaps I should check with the LAPD.

There’s a special circle in hell reserved for the doctors and nurse practitioners who supply these junkies. It’s a lot more difficult to try to help these people than throw drugs at them. Helping them takes longer; it takes seconds to print out a script for OxyContin, sometimes 30-60 minutes to talk a junkie down, and what’s the billing code for that? Dispensing pills like some white-coated Santa Claus throwing candy off a firetruck will make you popular with your patients too, but at a price.

A few years ago in a nearby county one of my wife’s patients, an 11 year old boy, died in a car accident. His parents were pill-heads and high when they made an illegal turn in front of a tractor trailer. All three were killed instantly. I spoke to one of the first responders on the scene. He told me how the car had rolled over and how he found the boy hanging lifeless in the backseat. Empty pill bottles littered the scene. The accident happened in front of a popular restaurant in the county and every time I drive by it I can’t help but think of that little boy. I never met him, and it’s hard for me to explain, but I can’t help but sense there’s a hole in the fabric of spacetime where an innocent child died because of the mistakes made by his parents abetted by their health care providers.

Whenever Dr. Wife tells me about the grief she gets in the office from demanding pill heads, I think of that accident. There were the names of many doctors on those bottles, but not my wife’s. She cares too much for her patients to help them kill themselves – and others as they so often do. But other health care providers don’t give a crap, or worse, think they are helping these junkies by giving them the pills they request. These pill dispensing Florence Nightingales are just as delusional as their addict patients.  They wouldn’t think of handing car keys and a case of scotch to their teenage patients even if they begged for them, yet they can’t say know to adults asking for medications that are much more dangerous than alcohol. And it’s left to responsible health care providers like my wife to clean up their messes.

With Obamacare, falling reimbursement rates, unpaid paperwork and non-compliant patients doctors don’t need another burden in their professional lives, yet everyday they deal with addicts, and sadly, it’s a burden that the profession is partly responsible for creating.

Bandaging a Finger in New Jersey Shows Rot at Heart of US Healthcare

A NJ teacher cut his finger. After it wasn’t healing properly he visited the ER. No x-ray, MRI or anything more than a bandage, a tetanus shot and some ointment. He didn’t even see a doctor and was instead treated by a nurse practitioner.

He was billed $8,200 for the visit.

He called around and found the going rate at most clinics and hospitals was between $400 and $1000.

I’m not sure which is worse: the $8,200 bill from the ER he went to or the fact that the other hospitals and clinics he contacted charge $400-1000 for the same thing.

The cost of the bandages and sterile supplies was probably a few dollars max. I’ll guess $10 for the tetanus shot.  NPs in NJ probably pull in about $120k with benefits, and that’s on the high side. So if he spent 10 minutes bandaging the patient and another 20 minutes writing up the charge sheet and documenting the visit, we’re looking at $60 for labor. Add in hospital overhead consumed by the patient – everyone he spoke to that helped him in his visit, and the visit likely cost the hospital about $120.

In a free market system we could draw the line there and say, “So how do you justify netting $8000 for the visit?”

But our health care system is nowhere near a free market system.

Consider the fact that hospitals cannot legally turn anyone away due to their inability to pay. I’m not a lawyer and I do believe there are limits to this, but from the hospital’s perspective they can’t have lawyers triaging patients in the ER. So they end up providing free care – free to those who receive it but paid by everyone else.

So we have to add on an “indigent care” tax to that $120. How much do we add? That’s a very good question and one that’s not easily answered, but for fun let’s say $130 – turning the visit into a $250. We’re still a long way from $8,200 but you should begin to get a sense that things aren’t as clear-cut as they should be.

Then there’s the issue of Medicaid. Hospitals have to take it, but the reimbursement costs are notoriously below the cost or providing care. Therefore to keep the hospital profitable (for the few progressives who stumble on this post substitute the phrase “from not going bankrupt” for the “P” word) we need to add the cost of treating the medicaid recipients. How much should that surcharge be? How about $50. So now we’re at $300.

The particular hospital the teacher visited is a for-profit (progressives: substitute the word “evil” here) hospital. At this point the hospital can pretty much charge what it wants, so why not $8,200? When’s the last time you walked into a hospital or doctor’s office and seen a board with a list of services and fees on the wall? That used to be a common site but now it’s almost unheard of. Go into any body shop or auto repair mechanic and you will see signs telling you how much the business charges for labor and for common procedures to your car. Yet when you walk into a doctor’s office or clinic you have no clue to what your treatment will cost even if it’s something minor like bandaging a wound or getting a tetanus shot.

This may make it seem like the doctor is doing her work because she loves it, and that the nurses are taking care of you because that’s just the kind of people that they are. But the doctor has $200k in medical school debt and a mortgage, and the nurse has a kid in day-care that needs to be clothed and fed, and “kindness” doesn’t pay back student loans, mortgages or day-care bills. You are paying a high price for that ignorance but you just don’t know it.

The people who do are the ones without insurance or the under-insured who get hassled by bill collectors, and the few people like the New Jersey teacher who think $8,200 is ridiculous regardless of who pays it.

Americans need to grow up and become responsible for their own care, but that’s the long-term solution. The issue is how do we get there? We can start by mandating transparent pricing wherever medical care is offered. The mere fact this hospital would be forced to put “Bandage a Cut – $8,000” on the wall would likely drive down the costs of the service at that particular institution. Eventually people would become aware of the limitations of their insurance and act accordingly, just as people are aware that they pay more to get their cars fixed at the dealership rather than the local mechanic down the street.

The US healthcare system is such a mess that such a simple solution isn’t going to solve everything. The key is to “do no harm” and make the system worse such as what Obamacare has done.

 

Ebola – Don’t Panic But Don’t Underestimate The Virus

As someone who is married to a doctor who spends her vacations in Africa treating rural villagers I take Ebola very seriously, especially since quite a few medical personnel have died from the virus. Although this virus has been infecting people since the 1970s we know very little about it. In the past it has burned itself out by pretty much killing everyone who came into contact with it in the African bush. This time around it has made it to the cities, and news stories are circulating that it has left Africa and made it to Europe and perhaps the US.

The crazies are beginning to take notice. Michael Savage has slammed the CDC for bringing two Ebola victims, an American doctor and nurse, to the US for treatment. He asks, “Why have they brought an infected doctor and another patient from the area of contagion to Emory University in the U.S. when these individuals could treated just as well in Africa? Perhaps they are using these two patients as guinea pigs in a trial for a new vaccine from which billions are to be made if successful.”

Evidently Savage has never spent time in an African hospital. I have seen my share, and if your idea of a hospital is an American public high school nurse’s office except with fewer drugs, then you have a pretty good idea of what constitutes the average African hospital. They simply do not have the resources that Emory does. Could we bring Emory over there? Perhaps in a few months sure, but the Americans had hours to live. Was there a risk to bringing them here? Absolutely, but that risk had to be weighed against the likely outcomes for the two Americans. A few weeks ago someone found a stash of old smallpox vials that had been forgotten. We’ve been experimenting with dangerous biological organisms here in the US for decades; it’s not like this is the first time a virus as notorious as Ebola has been brought to US shores. So the risk was miniscule compared to the odds against the two Americans suffering from the virus. In my view it was the right decision. Oh, and Michael, the gist of your argument makes you sound as wackadoodle as the anti-corporate progressives.

Ebola is a frightening virus, but the way forward is to combat the virus with scientific research, not throwing up the walls and cowering in fear. And it certainly isn’t by using one’s favorite whipping boy to stifle a vaccine.

 

SCOTUS Hobby Lobby Decision Proves Flaw of Employer Based Health Insurance

Although I support the Hobby Lobby decision rendered by the US Supreme Court, the decision merely points to a bigger problem: employer based health insurance. As an IT professional I have frequently switched jobs or worked for myself, and the health insurance coverage available to me is expensive and often non-existent. I have bought health insurance on the individual market exactly as I do with my car insurance, and the fact that the individual market is regulated to death, provides little competition unlike the auto insurance market and is outrageously more expensive is puzzling. I can spend 15 minutes to save 15% on car insurance yet it would take me twice as long to find a provider in my area and determine which insurance products were available to me then cost me twice as much just doesn’t make sense.

Paul Waldman writing for the Washington Post points out that employer based health insurance is rare in the industrialized world and is the result of an accident of history.

 

The system has its real roots in World War II, when the government imposed wage and price controls. Although there had been some health insurance plans sold through employers before, when companies couldn’t offer increased wages during the war, they began offering health benefits instead. When the IRS ruled that those benefits didn’t count as income and so were tax-free, the momentum toward employer-sponsored insurance was all but unstoppable (the deduction for employer-provided coverage is now the largest tax expenditure in the federal budget, dwarfing even the mortgage interest deduction).

 

Waldman points out that through employer based health insurance I use pre-tax dollars to pay for the insurance whereas when I buy on the individual market I have to use post-tax dollars. This makes any health insurance I purchase on the individual market more expensive depending on my tax bracket.

Now we have the IRS involved in our health insurance system. What next? The EPA to regulate the amount of carbon dioxide we exhale? The NSA to handle our medical records? How about the VA to handle appointment scheduling?  It seems to me you couldn’t design a worse health insurance system than the one we have today.

So conservatives shouldn’t cheer the Supreme Court’s decision to loudly and liberals should stop freaking out. Instead they should work together to end this crazy legacy of World War 2 so that companies can focus on making money and employees can take care of themselves as they see fit.

Update: Laurie Rice, writing for the Atlas Society, adds this:

(G)overnment involvement in the market is the reason why so many women have to get insurance through their employer in the first place. That government involvement in women’s health means today’s contraception victory is tomorrow’s political bargaining chip, to be traded by people like Kathleen Sebelius. That state power is more inescapable, more inflexible, and more insidious to women’s freedoms than any Hobby Lobby conservative craft store could ever be. Feminists need to embrace free-market capitalism.

 

Feminists need to embrace free-market capitalism? Given the alliance with Big Government and Leftism I’m not holding my breath.

The Coming Two-Tiered Medical System

Scott W. Atlas, writing at the Wall Street Journal, warns about the coming two-tiered medical system.

About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.

In order to cut costs insurance plans are narrowing their networks, removing access to the best hospitals in the country (including Barnes Hospital in my hometown.)

For cancer care, the overwhelming majority of America’s best hospitals in the National Comprehensive Cancer Network—including MD Anderson Cancer Center of Houston, New York’s Memorial Sloan-Kettering, Barnes Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s—are not covered in most of their states’ exchange plans.

Elements of this are already in place. The best paying jobs on physician job boards are “closed practices” run by large companies for their employees, or concierge practices that do not accept insurance.

Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system. The American Academy of Private Physicians estimates that there are now about 4,400 concierge physicians, 30% more than last year. In a recent Merritt Hawkins survey, about 7% to 10% of physicians planned to transition to concierge or cash-only practices in the next one to three years. With doctors already spending 22% of their time on nonclinical paperwork, they will find more government intrusion under ObamaCare regulations taking even more time away from patient care.

Moving towards socialized medicine inevitably leads to a two-tiered system. Having lived for 5 years under socialized medicine in Japan, I’ve seen the both tiers, and the quality of care diverged significantly between them to the point where we chose a private hospital for the birth of The Kid. The only question will be whether the quality of care good enough for the vast majority of Americans, or the care will stagnate and decline as the best and brightest health care providers move into the higher-paying private practices and hospitals.

Obamacare Tax Is Here for Individuals Too

Pity the small business. The federal government treats small business owners as cheats and shows them no mercy. Every month small businesses regardless of size must file payroll taxes which include the other 7.5% of each employee’s FICA plus withholding taxes. Every quarter the business also must file estimated taxes for the current fiscal year. Life is simpler for W-2 employees. Most of the work is hidden from them because if the average worker was responsible for carrying his or her share of the burden to comply with local, state and federal regulations, there would be riots in the streets. So instead governments burden the employers who must write it off as the cost of doing business in our society, and workers believe their tax refund is a “gift” from a benevolent government.

Much is being said about Matt Drudge’s “Liberty Tax”, and it’s clear that none of the critics have ever had to file a small business corporate return. If they had they’d understand how taxes are collected in this country and would recognize that Drudge isn’t lying. One issue I haven’t seen mentioned, however, is the individual penalty. Although Congress has raised the issue of delaying the individual penalty for those who opt out of Obamacare, it doesn’t appear likely to pass anytime soon, meaning that the penalty is already in force. We just don’t feel it yet.

Those who opt out, or carry a policy that doesn’t meet Obamacare’s minimum criteria of providing maternity care to men or Viagra to women, should increase their withholding amounts immediately or risk a surprise tax bill next year. How much will the penalty be? Here is an ACA Penalty Calculator that will estimate the amount due next year. For example, if you are filing as single with no dependents and make $75,000 this year, you will pay an additional $649 in 2014 rising to $1,339 next year and $1,725 the year after that (assuming 3% wage growth). Assuming the worker didn’t want to be stuck with that bill and was paid 26 times a year, she’d have to boost her withholding amount by another $25 a check this year, another $26.50 the next, and another $15 in FY2016. Things get complicated real quick with other permutations. Nothing the IRS does is simple, and handling Obamacare penalties is no different.

Most people don’t think about taxes until a few weeks before they are due, so I don’t expect this issue to get much airplay until early next year. But if you don’t have employer-sponsored health care or your plan isn’t qualified, then don’t kid yourself. You’re paying the penalty now.

 

The Ethics of Altered Time Perception

The Daily Mail has a thought provoking article on the use of drugs and other methods to prolong the sense of time for criminals, making their incarcerations seem longer than their actual sentences. While the article does a fair job of covering the morality of using such drugs on prisoners, it completely ignores uses of the technology for more benign purposes.

Imagine a drug one could take that could make a two day vacation feel like a month. Or prolonging those instants of joy that spontaneously arise in our lives into minutes, hours or perhaps even days. Would any of us not take a drug that would allow us mastery of time, to fight the inexorable rush forward, reducing it to a creep at certain times of our lives? There are moments we want to last forever. Soon there will be an app for that.

The article raises profound concerns about what justice means, and as the technology comes into existence we as a society should consider each of them carefully. But are we prepared at all for the opposite? Could there be a downside to stretching out those joyful moments artificially?

The Painful Implications of Invertebrates Feeling Pain

Do invertebrates feel pain? Evidently some, like crustaceans do. “Brown crabs rubbed and picked at their wound when a claw was removed, as it is in fisheries. At times the prawns and crabs would contort their limbs into awkward positions to reach the injury…”

But the same article says we don’t have to feel guilty when we smash a stink bug. “Even in extreme cases, insects show no evidence of pain. Imagine a praying mantis eating a locust, [Wageningen University professor Hans] Smid says. With its abdomen opened up, the locust will still feed even while being eaten.” Good to know because I’ve become a regular American Psycho when it comes to stink bugs.

So Science has decided that animals as simple as hermit crabs feel pain. Yet we are led to believe that human embryos and fetuses prior to birth do not, and the research that states otherwise remains controversial. This isn’t a philosophical problem for me since I eat animals and oppose laws outlawing abortion in the first trimester. I accept both are murder. But it strikes me as a bit of a conflict when my liberal friends support abortion without restriction yet won’t touch an egg because of the suffering the hen went through making it.

I’ll start taking vegans seriously when I meet one who opposes abortion for the same reason they oppose consuming animal products.