New healthcare thread (part II)

I haven't been very active lately, largely because I've developed some sort of problem with my back. (It seizes and locks up, sometimes spasms, and sometimes it feels like sciatic nerve problem). I've been given an Ortho referral for XR and MRI, but - wait for it - I'm having trouble finding someone who takes my insurance because (wait for it) my parent company is in Tennessee, and I'm in Texas. It's uncomfortable for me to sit and type for long periods. One thing that helps is lots of water and mobility.

Now having bored you with that......

The longer I work in healthcare, the less I know what the actual answer to anything is. As you read, you'll understand why I don't disclose where I work.

Last year, I was at Cook County Health in Chicago. A government-funded, city funded hospital who takes in anyone and everyone "regardless of ability to pay" under the rubric of "healthcare is a human right." It won't surprise anyone that this is the most mismanaged mess in a city of mismanaged messes. The hospital workers are members of a union (SEIU), but their CBA explicitly forbids striking. This doesn't prevent the entire group from suddenly catching "the Blue Flu" as all the union members call in sick. They don't even need to do that, though; every damn one of them is on an FMLA of 12 weeks per year. They just call in ten minutes before work and say, "FMLA," and not a thing we can do about it. To keep the hospital functional, about 1/2 of their staffing is travel staff in the lab, nursing, etc. Indeed, my direct boss informed me they have spent $15 million PER YEAR over the last eight years on travel staffing to ensure the union can't grind the hospital to a halt. There's no annual performance review because your pay is determined by seniority and they're married to that "pension" like it's their second spouse. If you do a little searching, you'll see every time you turn around about the only solution the Chicago pols can come up with on everything is to raise a tax here or there, and the city's pension fund is ALWAYS in trouble. It's not that I even mind the concept of healthcare for everyone, I don't but seeing how it works both there and firsthand at the VA, it's not good. Chicago taxes everything. To give one example that shone brightly: the same Chick-fil-A meal that I get for about $12.25 in the South and about $12.76 in New England and maybe a tiny bit more in Denver is $20.13 in downtown Chicago. Taxes.

Now, if you've read this far, you probably think that means I'm in favor of the privately owned or "for profit" hospitals. Well, let's look at that one.

For years, I worked for HCA. Google them, they went from a pretty good family oriented company the year I began to a monstrosity of "if it looks like the patient is going to die in our hospital, discharge them so it's not on us." They are about as penny-wise and pound foolish an organization you'll ever see, and they literally don't care. When I quit after 16.5 years there in 2021, they took my salary and hired THREE $10/hour assistants to run tests but not result them and pocketed over $240/week by not filling my position - giving my tasks to other employees but not increasing their pay, either. Then there's where I am now.

There's a lot of potential where I am. Problem is, potential doesn't matter to people filing stock reports. So we are short staffed (like every other lab) and have zero continuity for that very reason. MY pay is actually quite generous for what I do, but the reality is they're trying to build a Lambo with 1973 VW parts, and it ain't gonna work. It's the same reason nobody fixes our political system: it will take 4-5 elections at a minimum, and the only thing that matters is "I have to win the next one."

And I don't even mind paying for the healthcare or deductible or whatever - but could someone just make it make sense?

See a doctor. Don't even bill me.
Send me for a lab. "Hey, this is a $700 lab and your part is $70."
Swipes card.
Days later - a bill arrives in my email that I owe them $21 more for the lab draw.
Second visit to doctor where labs are done.
"Oh, you owe $110."

I mean, again, I don't mind paying deductibles but none of this crap makes sense.
then my medicine is $54 without insurance but $18 with it.

And folks, don't tell me it's all explained in the brochure that nowadays I actually have to click some QR code and sign on to find out the details.

I got another bill from another doctor - post visit - for $112 the other day "because you haven't met your deductible." OK, I get that, but why didn't you tell me that when I was there?????

This week I'm headed to the dentist but at least that makes sense.
I don't have teeth cleaning insurance (which in all honesty is really all it is).
So I'll pay a little less than $400.

But at least I know going into the room for Pete's sake
sorry you’re dealing with that selma

i had serious lower back issues 25 years ago eventually requiring surgery. it was a miserable experience, but thankfully the surgery helped
 
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I haven't been very active lately, largely because I've developed some sort of problem with my back. (It seizes and locks up, sometimes spasms, and sometimes it feels like sciatic nerve problem). I've been given an Ortho referral for XR and MRI, but - wait for it - I'm having trouble finding someone who takes my insurance because (wait for it) my parent company is in Tennessee, and I'm in Texas. It's uncomfortable for me to sit and type for long periods. One thing that helps is lots of water and mobility.

Now having bored you with that......

The longer I work in healthcare, the less I know what the actual answer to anything is. As you read, you'll understand why I don't disclose where I work.

Last year, I was at Cook County Health in Chicago. A government-funded, city funded hospital who takes in anyone and everyone "regardless of ability to pay" under the rubric of "healthcare is a human right." It won't surprise anyone that this is the most mismanaged mess in a city of mismanaged messes. The hospital workers are members of a union (SEIU), but their CBA explicitly forbids striking. This doesn't prevent the entire group from suddenly catching "the Blue Flu" as all the union members call in sick. They don't even need to do that, though; every damn one of them is on an FMLA of 12 weeks per year. They just call in ten minutes before work and say, "FMLA," and not a thing we can do about it. To keep the hospital functional, about 1/2 of their staffing is travel staff in the lab, nursing, etc. Indeed, my direct boss informed me they have spent $15 million PER YEAR over the last eight years on travel staffing to ensure the union can't grind the hospital to a halt. There's no annual performance review because your pay is determined by seniority and they're married to that "pension" like it's their second spouse. If you do a little searching, you'll see every time you turn around about the only solution the Chicago pols can come up with on everything is to raise a tax here or there, and the city's pension fund is ALWAYS in trouble. It's not that I even mind the concept of healthcare for everyone, I don't but seeing how it works both there and firsthand at the VA, it's not good. Chicago taxes everything. To give one example that shone brightly: the same Chick-fil-A meal that I get for about $12.25 in the South and about $12.76 in New England and maybe a tiny bit more in Denver is $20.13 in downtown Chicago. Taxes.

Now, if you've read this far, you probably think that means I'm in favor of the privately owned or "for profit" hospitals. Well, let's look at that one.

For years, I worked for HCA. Google them, they went from a pretty good family oriented company the year I began to a monstrosity of "if it looks like the patient is going to die in our hospital, discharge them so it's not on us." They are about as penny-wise and pound foolish an organization you'll ever see, and they literally don't care. When I quit after 16.5 years there in 2021, they took my salary and hired THREE $10/hour assistants to run tests but not result them and pocketed over $240/week by not filling my position - giving my tasks to other employees but not increasing their pay, either. Then there's where I am now.

There's a lot of potential where I am. Problem is, potential doesn't matter to people filing stock reports. So we are short staffed (like every other lab) and have zero continuity for that very reason. MY pay is actually quite generous for what I do, but the reality is they're trying to build a Lambo with 1973 VW parts, and it ain't gonna work. It's the same reason nobody fixes our political system: it will take 4-5 elections at a minimum, and the only thing that matters is "I have to win the next one."

And I don't even mind paying for the healthcare or deductible or whatever - but could someone just make it make sense?

See a doctor. Don't even bill me.
Send me for a lab. "Hey, this is a $700 lab and your part is $70."
Swipes card.
Days later - a bill arrives in my email that I owe them $21 more for the lab draw.
Second visit to doctor where labs are done.
"Oh, you owe $110."

I mean, again, I don't mind paying deductibles but none of this crap makes sense.
then my medicine is $54 without insurance but $18 with it.

And folks, don't tell me it's all explained in the brochure that nowadays I actually have to click some QR code and sign on to find out the details.

I got another bill from another doctor - post visit - for $112 the other day "because you haven't met your deductible." OK, I get that, but why didn't you tell me that when I was there?????

This week I'm headed to the dentist but at least that makes sense.
I don't have teeth cleaning insurance (which in all honesty is really all it is).
So I'll pay a little less than $400.

But at least I know going into the room for Pete's sake
Here, their successor organization* sold out to Huntsville Hospital, the 6th largest public hospital chain in the country. So, we have no competition at all to speak of, in an area approaching a half million in population. A couple of years ago, they had eased out the long-time Administrator, an MD herself (full disclosure - she's a friend), and services deteriorated to the point that many doctors stopped placing patients there. I was placed there after a minor procedure overnight, ended up staying four days and was rendered a bill for a few dollars short of $400,000. You were lucky to get out when you did...

*I presume it was a successor, since it was an HCA hospital at one early point...
 
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I haven't been very active lately, largely because I've developed some sort of problem with my back. (It seizes and locks up, sometimes spasms, and sometimes it feels like sciatic nerve problem). I've been given an Ortho referral for XR and MRI, but - wait for it - I'm having trouble finding someone who takes my insurance because (wait for it) my parent company is in Tennessee, and I'm in Texas. It's uncomfortable for me to sit and type for long periods. One thing that helps is lots of water and mobility.

Now having bored you with that......

The longer I work in healthcare, the less I know what the actual answer to anything is. As you read, you'll understand why I don't disclose where I work.

Last year, I was at Cook County Health in Chicago. A government-funded, city funded hospital who takes in anyone and everyone "regardless of ability to pay" under the rubric of "healthcare is a human right." It won't surprise anyone that this is the most mismanaged mess in a city of mismanaged messes. The hospital workers are members of a union (SEIU), but their CBA explicitly forbids striking. This doesn't prevent the entire group from suddenly catching "the Blue Flu" as all the union members call in sick. They don't even need to do that, though; every damn one of them is on an FMLA of 12 weeks per year. They just call in ten minutes before work and say, "FMLA," and not a thing we can do about it. To keep the hospital functional, about 1/2 of their staffing is travel staff in the lab, nursing, etc. Indeed, my direct boss informed me they have spent $15 million PER YEAR over the last eight years on travel staffing to ensure the union can't grind the hospital to a halt. There's no annual performance review because your pay is determined by seniority and they're married to that "pension" like it's their second spouse. If you do a little searching, you'll see every time you turn around about the only solution the Chicago pols can come up with on everything is to raise a tax here or there, and the city's pension fund is ALWAYS in trouble. It's not that I even mind the concept of healthcare for everyone, I don't but seeing how it works both there and firsthand at the VA, it's not good. Chicago taxes everything. To give one example that shone brightly: the same Chick-fil-A meal that I get for about $12.25 in the South and about $12.76 in New England and maybe a tiny bit more in Denver is $20.13 in downtown Chicago. Taxes.

Now, if you've read this far, you probably think that means I'm in favor of the privately owned or "for profit" hospitals. Well, let's look at that one.

For years, I worked for HCA. Google them, they went from a pretty good family oriented company the year I began to a monstrosity of "if it looks like the patient is going to die in our hospital, discharge them so it's not on us." They are about as penny-wise and pound foolish an organization you'll ever see, and they literally don't care. When I quit after 16.5 years there in 2021, they took my salary and hired THREE $10/hour assistants to run tests but not result them and pocketed over $240/week by not filling my position - giving my tasks to other employees but not increasing their pay, either. Then there's where I am now.

There's a lot of potential where I am. Problem is, potential doesn't matter to people filing stock reports. So we are short staffed (like every other lab) and have zero continuity for that very reason. MY pay is actually quite generous for what I do, but the reality is they're trying to build a Lambo with 1973 VW parts, and it ain't gonna work. It's the same reason nobody fixes our political system: it will take 4-5 elections at a minimum, and the only thing that matters is "I have to win the next one."

And I don't even mind paying for the healthcare or deductible or whatever - but could someone just make it make sense?

See a doctor. Don't even bill me.
Send me for a lab. "Hey, this is a $700 lab and your part is $70."
Swipes card.
Days later - a bill arrives in my email that I owe them $21 more for the lab draw.
Second visit to doctor where labs are done.
"Oh, you owe $110."

I mean, again, I don't mind paying deductibles but none of this crap makes sense.
then my medicine is $54 without insurance but $18 with it.

And folks, don't tell me it's all explained in the brochure that nowadays I actually have to click some QR code and sign on to find out the details.

I got another bill from another doctor - post visit - for $112 the other day "because you haven't met your deductible." OK, I get that, but why didn't you tell me that when I was there?????

This week I'm headed to the dentist but at least that makes sense.
I don't have teeth cleaning insurance (which in all honesty is really all it is).
So I'll pay a little less than $400.

But at least I know going into the room for Pete's sake
Sorry you are going through this...just as a reminder -- run a blood test for multiple myeloma. My back was the same was and after several months my primary ran a blood testing IGG, IGA, etc...proteins, and boom -- I had a plasmacytoma on L4. Probably not, but you never know...
 
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Sorry you are going through this...just as a reminder -- run a blood test for multiple myeloma. My back was the same was and after several months my primary ran a blood testing IGG, IGA, etc...proteins, and boom -- I had a plasmacytoma on L4. Probably not, but you never know...

Indeed. Myeloma is one you don’t want to miss as our treatments have really improved for it over the last 20’years.
 
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sorry you’re dealing with that selma

i had serious lower back issues 25 years ago eventually requiring surgery. it was a miserable experience, but thankfully the surgery helped

I hope it won't come to that.

It flared up all of a sudden about 6-8 weeks ago. I'm hoping that maybe it's just the after effects of four years sleeping in different houses every couple of months often on lousy mattresses.
 
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The longer I work in healthcare, the less I know what the actual answer to anything is. As you read, you'll understand why I don't disclose where I work.

And I don't even mind paying for the healthcare or deductible or whatever - but could someone just make it make sense?

See a doctor. Don't even bill me.
Send me for a lab. "Hey, this is a $700 lab and your part is $70."
Swipes card.
Days later - a bill arrives in my email that I owe them $21 more for the lab draw.
Second visit to doctor where labs are done.
"Oh, you owe $110."

I mean, again, I don't mind paying deductibles but none of this crap makes sense.
then my medicine is $54 without insurance but $18 with it.

And folks, don't tell me it's all explained in the brochure that nowadays I actually have to click some QR code and sign on to find out the details.



But at least I know going into the room for Pete's sake

Although a national health service isn't a panacea... We were in Japan a couple of weeks back when my far better half developed severed abdominal pain about three in the morning. I was pretty certain it was a kidney stone (no idea why in this thin lady who drinks a gallon of water per day, but stones are finicky creatures) but worried about other things. By five it was unabated and she was quite nauseated, so she finally let me call the hotel front desk.

A few minutes later, three of the most efficient and kindly EMTs came hurrying in through the door and promptly settled that she was stable to transport and had us in an ambulance for a 25 minute trip to the regional hospital in Odawara. There I was taken to the registration desk where they worked through how to load her into their system and using Google translate walked me through the steps.

The better half was seen at the door by a nurse** and the ED doc who performed a stat ultrasound and got IV fluids started. After examining they sent her straight on to the CT which did show a stone. After which they gave her pain meds, checked blood work, and tested for a urinary tract infection. After about 4 hours everything calmed down and they discharged us with instructions to come back if anything worried us.

They had explained that they charge cash*, but gave us all the documents we needed to file for our travel insurance. We walked around a corner and they gave us the itemized bill and we paid up. We then walked across the hall and they handed us a filled prescription that the doc had prescribed.

Total cost = 518$

Had an Allianz policy in effect, sent them the bill and they reimbursed me the whole cost a couple of days after scanning it in on their app.

You'd have waited for hours to be seen here and the final bill would have arrived a month later for 5000$ or more. The CT alone would be charged at 2000$. You'd pay the same with BCBS as we paid OOP in Japan! Heck, if you had a deductible it would run 1500$ or more***.



* The triage nurse typed into Google Translate a note that said "We charge cash, but we would never turn anyone away who needed medical treatment at our facility if they cannot pay."

** Our nurse and everyone we encountered were very kind and polite. As a people the Japanese were some of the most polite people I have ever met.

*** Admittedly, this is a horribly complex topic that is far from simple and the simple scenario I recount here. But it underlies how broken the medical system is in the US, and how many players add little value while seeking to extract maximal dollars.
 
Here, their successor organization* sold out to Huntsville Hospital, the 6th largest public hospital chain in the country. So, we have no competition at all to speak of, in an area approaching a half million in population. A couple of years ago, they had eased out the long-time Administrator, an MD herself (full disclosure - she's a friend), and services deteriorated to the point that many doctors stopped placing patients there. I was placed there after a minor procedure overnight, ended up staying four days and was rendered a bill for a few dollars short of $400,000. You were lucky to get out when you did...

*I presume it was a successor, since it was an HCA hospital at one early point...

HCA is a really sleazy organization to put it mildly. They'd give the IRS a run for their money.

FWIW - a friend of mine who is a Psychologist with emphasis in Marriage and Family Therapy is about as conservative a person politically as you can imagine. Church of Christ (but not crazy), Aggie grad, married to an Aggie grad for 30 years now, typical Christian right Republican........she told me once that she was not opposed to going to single payer. Or something. Anything. Just something that would make sense so everyone knew. I was kind of surprised (knowing her) when she said, "There ARE worse things." This is a woman with a PhD and MD who has to deal with all of this stuff and it's a headache for her, too.
 
NYT Gift Article

We’re Living in a Tick Nightmare. It’s Time to Go to War.​


On a late-summer afternoon in 2024, an airline pilot and father of three named Brian Waitzel ate a hamburger at a barbecue in suburban New Jersey, and four hours later he fell violently ill. By nightfall he was dead. His family was left stunned and confused. What was the cause? Acting on a hunch, a physician friend contacted Dr. Thomas Platts-Mills, an allergist at the University of Virginia School of Medicine and an expert on alpha-gal syndrome, a tick bite-induced allergy to red meat.

When Dr. Platts-Mills studied the sample of Mr. Waitzel’s blood from the autopsy, he saw something familiar: high levels of antibodies specific to alpha-gal, a sugar molecule found most commonly in the saliva of the lone star tick. Another test revealed markers of anaphylactic shock, suggesting Mr. Waitzel had suffered a severe allergic reaction to the hamburger. His wife recalled that after a jog in a park weeks before his death, he had come home with a dozen bites on his ankles.

Mr. Waitzel’s became the first death attributed to alpha-gal syndrome from consuming meat ever documented in a medical journal. His death signaled a shift: Our uneasy relationships with ticks had escalated. It was not enough to worry about Lyme disease; now we could contract a severe allergy that could cause death from foods that many of us have eaten safely all our lives.
 
I was reading up on this and another quirk is that many people with no symptoms have alpha-gal antibodies in their system... The immune system never fails to toss curve balls...
 
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I was reading up on this and another quirk is that many people with no symptoms have alpha-gal antibodies in their system... The immune system never fails to toss curve balls...
Interesting - so if there’s no reaction to the presence of AGS is there a downside to the infection in that person?
 
NYT Gift Article

We’re Living in a Tick Nightmare. It’s Time to Go to War.​


On a late-summer afternoon in 2024, an airline pilot and father of three named Brian Waitzel ate a hamburger at a barbecue in suburban New Jersey, and four hours later he fell violently ill. By nightfall he was dead. His family was left stunned and confused. What was the cause? Acting on a hunch, a physician friend contacted Dr. Thomas Platts-Mills, an allergist at the University of Virginia School of Medicine and an expert on alpha-gal syndrome, a tick bite-induced allergy to red meat.

When Dr. Platts-Mills studied the sample of Mr. Waitzel’s blood from the autopsy, he saw something familiar: high levels of antibodies specific to alpha-gal, a sugar molecule found most commonly in the saliva of the lone star tick. Another test revealed markers of anaphylactic shock, suggesting Mr. Waitzel had suffered a severe allergic reaction to the hamburger. His wife recalled that after a jog in a park weeks before his death, he had come home with a dozen bites on his ankles.

Mr. Waitzel’s became the first death attributed to alpha-gal syndrome from consuming meat ever documented in a medical journal. His death signaled a shift: Our uneasy relationships with ticks had escalated. It was not enough to worry about Lyme disease; now we could contract a severe allergy that could cause death from foods that many of us have eaten safely all our lives.
A neighbor and friend spent 4 days in the hospital while they studied him for either meningitis/viral/bacterial infection. Turned out to be viral from a tick bite. Its was not Lyme but he has said nothing about alpha-gal. On our text he said they released him for full activity. We both walk our dogs (rarely together) and come close to the marsh at times. I am sure their are ticks aplenty around here.
 
NYT Gift Article

Here's an article about the man who died.

After a Mysterious Death, a Family’s Quest for Answers Leads to a Tick​

A JetBlue pilot’s illness looked like food poisoning, but it was actually an increasingly common tick-borne meat allergy that can be fatal.

The 47-year-old JetBlue pilot went to a barbecue, where he ate a hamburger, at roughly 3 p.m. He returned to his suburban New Jersey home and mowed the lawn for an hour. By 7:20, he was in the bathroom, vomiting. By 7:37, he was unconscious. Soon, his son was trying to resuscitate him.

The pilot, Brian Waitzel, was declared dead later that night. The conclusion of an autopsy: “Sudden unexplained death.”

Now, more than a year after Mr. Waitzel died, a team of doctors say they have found an answer.

The physicians linked his death to a growing menace: an allergy to red meat triggered by a tick bite. They published their findings last week in a medical journal, asserting that it is the first death of its kind linked to the tick-borne allergy, called alpha-gal syndrome.
 
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Based on my reading, a sterile male tick release would help reduce the prevalence of AGS and Lymes Diseases. Similar to the efforts to contain the screwworm in cattle and wildlife.
 
17-year-old Alabama teen helps save a 76-year-old woman who was unknowingly suffering from a brain bleed.Fannie Garner, 76 and Johnson Thompson, 17, have reunited after the teen helped the woman after he saw her stumble out of her car. Thompson was up working at 5 am because he couldn't sleep after flipping his lawn mower a week earlier.While working, he noticed a vehicle pull over across the street. "She got out of her car, and she was stumbling around. So, I went out to the end of our parking lot to check to see if she was okay. That’s when she explained to me she had a terrible headache and was wanting to know where the nearest emergency room was."Thompson pulled out a chair for Garner and then called 911.When Garner got to the hospital, she found out that she had an active brain bleed."I will never ever forget him. We already have plans for his graduation, and that’s next year," Garner said.


 
One thing I have tried harder to do as I grow older is to be grateful for what I have today. And every day.

So easy to get distracted by all the other things.

And gotta say......Captain Kirk looks fantastic for 95! :)

 
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One thing I have tried harder to do as I grow older is to be grateful for what I have today. And every day.

So easy to get distracted by all the other things.

And gotta say......Captain Kirk looks fantastic for 95! :)


When I started practice in 2006... Melanoma was a death sentence when it spread and the average survival was about 8 months with chemotherapy. Cures were very unusual, maybe 3% and only in a few limited cases.

The combo immunotherapies now show about a 50% rate of disease control at 5 years with 40% disease free and probably cured.

Developed in large part by the NIH...
 
When I started practice in 2006... Melanoma was a death sentence when it spread and the average survival was about 8 months with chemotherapy. Cures were very unusual, maybe 3% and only in a few limited cases.

The combo immunotherapies now show about a 50% rate of disease control at 5 years with 40% disease free and probably cured.

Developed in large part by the NIH...

Sadly, I lost a VERY good friend to it last year. I don't think any of us knew he had it until his wife posted he was in the hospital and battling for his life. Very sad and very unexpected.
 
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