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Healthcare Disaster in the making

1,459 Views | 7 Replies | Last: 5 yr ago by bigtruckguy3500
jb 00
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I am writing to bring attention to a serious consequence of government interference in our healthcare system that isn't getting the appropriate amount of exposure. One problem is that US doctors are benevolent workhorses that go along with change without resisting or questioning the repercussions.

I see this every day in multiple hospitals. This should scare the hell out of you as a patient.

American hospitals are rationing basic medical supplies and basic medicines. It hinders my ability to help you, the patient.

This month has a shortage of Normal Saline iv fluid and hydralazine blood pressure medicine.

This is super dangerous for pregnant women. Preeclampsia kills pregnant women. I only have 3 pre-approved medication options for blood pressure medications in an emergency. One of them is currently on restriction because of a shortage, and some women have an "allergy" or contraindication for using the second option. For some women, their body doesn't respond to the third option.

There is currently a major focus on reducing maternal mortality in our country. Why in our land of plenty is the death rate of pregnant women rising and we are having drug shortages and rationing of important medication.

The Medicare and Medicaid systems fix the price they will pay for Normal Saline and hydralazine to a low level. Therefore, the drug manufacturers have no reason to make the medication. So the supply is super low.

But, over 50% of patients on Labor & Delivery units are government paid patients. The hospital and drug company are not allowed to increase the price paid for the medication, even if there is a shortage. So the drug company has no reason to increase production.

You throw in the expense and risk of lawsuits to the drug company from 1-800-bad-drug, and the drug company says, "I am just going to stop making that drug all together."
Now, we lost the generic drug all together. Why make a lifesaving drug if you lose money on every dose that you make.

We are losing life saving, generic drugs because the government is setting artificially low prices. The most vulnerable members of our society, pregnant women and children are being denied access to easily effective healthcare every day in America today, we just don't realize it.

Free markets work. Government regulations are not the answer.

One other excuse for equipment supply shortages that those of us that work in hospitals are given is the damage that Puerto Rico has sustained from a hurricane last year. We need to look closer at this "hurricane damage" excuse.

Why do we have to export our manufacturing of our medical supplies to Puerto Rico? Why can't we manufacture them in Pennsylvania or Texas?

Price fixing and high cost to employ workers. Both government regulations.

The FDA is now considering changing protective and approval processes for "Therapeutic Equivalence" medication because of these shortages. Is it possible that these changes can open up our medication supply to dangerous manufacturing processes to cut costs?

The root cause of this is market manipulation.
The free market will solve this problem.

Government intervention started the problem, and more government intervention will only make it worse. This is endangering the health of our citizens. We can do better. We have done better in the past.



http://www.nber.org/papers/w17987

https://www.healthleadersmedia.com/clinical-care/fda-forms-task-force-solve-drug-shortages

https://www.syracuse.com/health/index.ssf/2018/08/hypothyroidism_thyroid_medication_recalled_westminster.html
wbt5845
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AG
So about a year ago, I took my son to get his wisdom teeth taken out. I was texting updates to my wife, who was working a renal operation that day. As she was telling co-workers about how our son was doing, the surgeon asked "how much is that oral surgeon getting paid to remove those wisdom teeth?" Turns out oral surgeon was getting $500 more than the surgeon because the patient was a Medicade patient.

In order to make ends meet, surgeons are doing 3 - 4 - sometimes 5 operations a day. Pre-op and post-op care cannot be what it used to be since he's getting less per hour to see you. Government interference is killing people.
BreNayPop
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AG
This is all true, plus some docs are gaming the system, searching out ways to ingratiate themselves to those who set their reimbursement rates. Its getting uber political.
bmks270
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AG
It's a government racket.

We pay $$$$$$$$$$ to insurance companies who use it to purchase politicians. Then we end up with crap care. The government is inserted between the customer (patient) and the business. So the customer can pay what they want for goods. And the business can't set proper prices.
htxag09
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AG
wbt5845 said:

In order to make ends meet, surgeons are doing 3 - 4 - sometimes 5 operations a day.

Don't get me wrong, I think the system is beyond broken and am a firm believer that doctors deserve to get paid for what they do. But really, doing 5 operations a day just to make ends meet? Little bit of an exaggeration, no?
jb 00
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That statement may be exaggerated, but the message is true.

For some specialties, for some locations in this country, the annual income will be very low per hour worked and per year of education training.

This drives the intelligent people out of the industry.

I believe that we really should have some of the smartest people treating you and your family with medicine and surgery.

The gaming people will be everywhere, you can't stop that completely. Don't drive the intelligent people who care out.

Please do your homework and research who your healthcare provider is. Remember, just barely passing gets you a degree as well.
txags92
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AG
The real problem is that we are skewing the relationship between buyer and seller. If you went to a market and found a farmer selling apples for $5 a piece, you would think the price was really high...but you could ask the farmer directly what makes them so special and decide whether the price was reasonable from there. The patient is rarely the true buyer anymore. Either an insurance company or the government is the one actually paying for services as they are received by the patient. So there is nobody there with a motive to want good care that is also interested in keeping the price down. The old saying is that everybody wants something good, they want it fast, and they want it cheap...but they can only have two. The patient wants everything good and fast, the insurance company wants it good and cheap, the government wants cheap. So the provider is going to go with cheap as a default...and then try to straddle some line between good and fast. In the case of saline or meds that people need, the provider has no incentive to speed up beyond what they can provide cheap and good, as the government won't pay them more to do it fast, but will penalize them heavily if they don't do it "good".
IslandAg76
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AG
So much for inserting the government into things and expecting increased efficiencies.

As mentioned above--I've watched, over the years, more & more layers of "for profit businesses" inserted between the patient and the Dr under the guise of increasing efficiency and saving money..IMO--Total BS!!
bigtruckguy3500
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jb 00 said:



One other excuse for equipment supply shortages that those of us that work in hospitals are given is the damage that Puerto Rico has sustained from a hurricane last year. We need to look closer at this "hurricane damage" excuse.

Why do we have to export our manufacturing of our medical supplies to Puerto Rico? Why can't we manufacture them in Pennsylvania or Texas?

Do you really think a company is going to voluntarily expose themselves to higher labor costs by manufacturing in Pennsylvania when a cheaper alternative is nearby? Even if one company does, another will find a way to cut costs by moving off shore, and more people will buy from them because it will be cheaper, so the original company will move off short. It's the free market. Even in the absence of any government regulation, companies are going to try to cut costs and compete with one another.

wbt5845 said:

Pre-op and post-op care cannot be what it used to be since he's getting less per hour to see you. Government interference is killing people.

The first part of your statement is true. However you made a jump to the second part without any evidence. If you have evidence, not anecdotes, please post it.

50 years ago gallbladders used to get taken out through an open operation, as did the appendix. It bought you 2-3 days in the hospital. Now it is done laparoscopically, and you can often go home the next day. Even day surgery was almost non-existent not that long ago. So yes, post op care has changed, and sure, some people may die because they are sent home early, but people died 50 years ago for being sent home early as well.

Also, depending on the operation 5 operations a day really isn't bad. I mean I know surgery residents that have done 10 in a day. And if you know the type of people that go into surgery, these are typically the people that thrive on suffering.

jb 00 said:


I believe that we really should have some of the smartest people treating you and your family with medicine and surgery.
The really intelligent people went to Wallstreet or are doing a 9-5 job and making just as much or more than most doctors. Even if doctor pay went up, those inteligent folks aren't going to give up quality of life.

txags92 said:

The real problem is that we are skewing the relationship between buyer and seller. If you went to a market and found a farmer selling apples for $5 a piece, you would think the price was really high...but you could ask the farmer directly what makes them so special and decide whether the price was reasonable from there. The patient is rarely the true buyer anymore. Either an insurance company or the government is the one actually paying for services as they are received by the patient. So there is nobody there with a motive to want good care that is also interested in keeping the price down.

Bingo. Everyone wants a free market in healthcare, but we are so many levels away from a free market that people's heads would explode if we truly whittled it down to one.

IslandAg76 said:

So much for inserting the government into things and expecting increased efficiencies.

As mentioned above--I've watched, over the years, more & more layers of "for profit businesses" inserted between the patient and the Dr under the guise of increasing efficiency and saving money..IMO--Total BS!!
Yup, all it does is add complexity to the system. Medicare decides to pay for a scooter because some lobbyist convinced a congressman that every old person needs one, and then all of a sudden you see nothing but scooters everywhere on TV commercials. People learn to game the system.

There is just so much bureacracy and complexity in the healthcare system that it just adds bloat and cost. Think about medical coders, billers, the people docs/hospitals hire to fight with insurance over denied claims, think about the people insurance companies hire to look for any mistake in charting to cut reimbursement rates. Then think about all the hoops a doctor has to jump through in his medical charting to make sure he gets to bill to the correct level - that takes time, and means he can't see as many patients per hour. And the advent of electronic medical records has slowed things down even further.

Another thing, did you know that if a patient is too rich to be on medicaid but too poor to afford insurance, a doctor cannot give them a discount? They will get fined by the government becaues in order to receive medicaid funds they have to charge the government the lowest rate they charge anyone else.


Again, I'm totally for a free market solution, and we can certainly move that way for elective care. I think incentivizing health savings accounts is the answer, and making people more responsible for their own medical care. But there is just so much complexity in the system right now that I can't even wrap my head around where to begin to move towards a free market system.
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