I was on WBAI this afternoon, talking about the upcoming battle over healthcare reform. Check it out.
March 23, 2009: Health Action
http://archive.wbai.org/
Monday, March 23, 2009
Monday, March 16, 2009
Why It's Time IV: Stay Ahead of Your Illness
Okay, I'm not the only doctor out there who supports healthcare reform. I'm sure plenty of us docs have anecdotes that highlight the need for universal healthcare. And I don't want to be immodest.
But I gotta say, it's hard to imagine a better argument for universal healthcare than Juan Avista (not his real name).
Three years ago, Juan started having headaches. He tried Tylenol and Ibuprofen, and when those didn't work he went to his doctor. A slight loss of vision in his lateral fields, known as homonomous hemianopsia, led the doctor to get a CAT scan of the head.
Which is when they found the mass growing in his pituitary.
This sounds bad. But it's not as bad as you might think. Juan's mass is known as a prolactinoma, meaning a hormonal tumor that secretes prolactin. The treatment is not to open up Juan's brain and tinker with it, but to give him medications that block the effects of the hormone and thus prevent the mass from growing larger.
I'm writing about healthcare reform, so you can see where this story is going. Juan's medication cost $40 per pill, and since he worked part-time for UPS, he had no health insurance and had to pay out of pocket. He made an effort to take the medicines for a few months, but he was raising two children on $11 per hour and eventually he couldn't find the money for it.
When I admitted Juan to the hospital three days ago, he had been off his meds for five months. He had been having headaches again, and his vision was so blurry that he could barely tell how many fingers I was holding up. The CAT scan showed that the mass had almost doubled in size, and was pressing down on his optic chiasm, the place where the nerves that connect his eyes to his brain cross.
If Juan had been over 65, Medicare Part D would have covered at least part of his medicines. But he is 45. Now, maybe this doesn't need to be said, but let's say it anyway: if we kept the same Medicare structure, the one that senior citizens consistently give high ratings, and extended it to people between 18-65, we could solve all of Juan's problems, and those of thousands of other people caught between a diagnosis and a paycheck.
If we do nothing? Well, then Juan will continue to not afford his medicines, his pituitary mass will grow larger, and he will go blind.
At that point, or maybe slightly before, the neurosurgeons will decide to operate on him to remove the mass. He will have to undergo a very dangerous operation, since the pituitary is exactly in the center of the head, and is difficult for a surgeon to reach no matter what route is taken. Juan will require a long hospitalization and possibly further surgeries.
Who wins and who loses under this current healthcare system? The hospital wins, gaining reimbursements for multiple admissions and operations, rather than simple outpatient visits. The surgeons win: they only get paid when they operate, so preventing the need for surgeries is not likely to be a high priority of theirs. The big HMOs win too: since Juan didn't have a job that provided health insurance when he got his diagnosis, none of the HMOs will have to pay for his expensive care.
(By the way, it's worth noting that Juan had a full-time job with complete healthcare benefits from 1999 to 2004, but was laid off as the result of a merger. So none of the giant healthcare conglomerates --- not Aetna, US Healthcare, Tenet, or Humana, each of whose profits were greater than $1 billion last year --- will have to pay a cent to treat Juan's disease. But one of them collected between $60,000 - 80,000 from him in premiums. Does that seem fair?)
So there's our list of winners. Who are the losers? First, and most important, there's Juan: he would prefer to control his disease with a daily pill and be able to see his daughter's face, rather than undergo risky surgeries and hospitalizations.
The other loser is us, the taxpayers. We're the ones paying for Juan's expensive care, and the care for many other Juans out there who have fallen through the cracks.
It's our tax dollars and our health. (Not to use scare tactics, but any of us could find out tomorrow that we're Juan.) So why don't we use those tax dollars wisely, and ask our government for a healthcare system that emphasizes cheap prevention of early disease, rather than expensive technological treatments of late-stage disease?
It's time for a publicly accessible healthcare plan, that allows all U.S. residents access to the medicines they need. Does it really seem like too much to ask?
But I gotta say, it's hard to imagine a better argument for universal healthcare than Juan Avista (not his real name).
Three years ago, Juan started having headaches. He tried Tylenol and Ibuprofen, and when those didn't work he went to his doctor. A slight loss of vision in his lateral fields, known as homonomous hemianopsia, led the doctor to get a CAT scan of the head.
Which is when they found the mass growing in his pituitary.
This sounds bad. But it's not as bad as you might think. Juan's mass is known as a prolactinoma, meaning a hormonal tumor that secretes prolactin. The treatment is not to open up Juan's brain and tinker with it, but to give him medications that block the effects of the hormone and thus prevent the mass from growing larger.
I'm writing about healthcare reform, so you can see where this story is going. Juan's medication cost $40 per pill, and since he worked part-time for UPS, he had no health insurance and had to pay out of pocket. He made an effort to take the medicines for a few months, but he was raising two children on $11 per hour and eventually he couldn't find the money for it.
When I admitted Juan to the hospital three days ago, he had been off his meds for five months. He had been having headaches again, and his vision was so blurry that he could barely tell how many fingers I was holding up. The CAT scan showed that the mass had almost doubled in size, and was pressing down on his optic chiasm, the place where the nerves that connect his eyes to his brain cross.
If Juan had been over 65, Medicare Part D would have covered at least part of his medicines. But he is 45. Now, maybe this doesn't need to be said, but let's say it anyway: if we kept the same Medicare structure, the one that senior citizens consistently give high ratings, and extended it to people between 18-65, we could solve all of Juan's problems, and those of thousands of other people caught between a diagnosis and a paycheck.
If we do nothing? Well, then Juan will continue to not afford his medicines, his pituitary mass will grow larger, and he will go blind.
At that point, or maybe slightly before, the neurosurgeons will decide to operate on him to remove the mass. He will have to undergo a very dangerous operation, since the pituitary is exactly in the center of the head, and is difficult for a surgeon to reach no matter what route is taken. Juan will require a long hospitalization and possibly further surgeries.
Who wins and who loses under this current healthcare system? The hospital wins, gaining reimbursements for multiple admissions and operations, rather than simple outpatient visits. The surgeons win: they only get paid when they operate, so preventing the need for surgeries is not likely to be a high priority of theirs. The big HMOs win too: since Juan didn't have a job that provided health insurance when he got his diagnosis, none of the HMOs will have to pay for his expensive care.
(By the way, it's worth noting that Juan had a full-time job with complete healthcare benefits from 1999 to 2004, but was laid off as the result of a merger. So none of the giant healthcare conglomerates --- not Aetna, US Healthcare, Tenet, or Humana, each of whose profits were greater than $1 billion last year --- will have to pay a cent to treat Juan's disease. But one of them collected between $60,000 - 80,000 from him in premiums. Does that seem fair?)
So there's our list of winners. Who are the losers? First, and most important, there's Juan: he would prefer to control his disease with a daily pill and be able to see his daughter's face, rather than undergo risky surgeries and hospitalizations.
The other loser is us, the taxpayers. We're the ones paying for Juan's expensive care, and the care for many other Juans out there who have fallen through the cracks.
It's our tax dollars and our health. (Not to use scare tactics, but any of us could find out tomorrow that we're Juan.) So why don't we use those tax dollars wisely, and ask our government for a healthcare system that emphasizes cheap prevention of early disease, rather than expensive technological treatments of late-stage disease?
It's time for a publicly accessible healthcare plan, that allows all U.S. residents access to the medicines they need. Does it really seem like too much to ask?
Sunday, March 1, 2009
Down This Road?
The Boston Globe (fairly in touch with events in Massachusetts) recently declared the Mass. healthcare reform effort a failure:
Sad but true. We can continue to fear "socialized medicine" irrationally, or we can rationally embrace a simple solution: extend Medicare to all U.S. citizens.
Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system. What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.
The state's plan flunks on all counts.
Sad but true. We can continue to fear "socialized medicine" irrationally, or we can rationally embrace a simple solution: extend Medicare to all U.S. citizens.
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