Health

There is so much to discuss in healthcare in this country
but there
are individual questins to be asked and answered also.

2. msgreer - 8/20/1999 2:41:56 AM

Do you have specific healthcare questions you need answered?

Do you
want to know where the lastest research is being done on a specific
healthcare issue?

Or do you just want to share your personal
experiences with the healthcare and or insurance system?

3. msgreer - 8/20/1999 2:44:17 AM

what about those nasty codes that appear on your insurance papers? Are
you curious in learning how to break those codes and empower yourself
with your individual carrier?

Let's get started.

4. Slackjaw - 8/20/1999 2:44:58 AM

actually, I have this mole...

5. msgreer - 8/20/1999 2:45:41 AM

Stick with me. I am learning TheMote system of posting.

6. msgreer - 8/20/1999 2:47:25 AM

Slackjaw

Cute very cute.

Dare I ask where this "mole" appears on your body?

7. Slackjaw - 8/20/1999 2:50:18 AM

yikes! Well, this is confidential, right?

8. msgreer - 8/20/1999 2:54:14 AM

And yes I am ready to discuss how our country delivers heathcare.

It is always a lively debate to have
but I am off to the shower as
I have client in the hospital and need to get there before the doctor
makes her rounds.

9. msgreer - 8/20/1999 2:55:51 AM

Slackjaw

Your mole is a confidential matter?

Get thee to a
urologist immediately!

10. msgreer - 8/20/1999 4:36:47 AM

Slackjaw

or do you need to take this question to the PENIS THREAD

heehee

11. Slackjaw - 8/20/1999 4:37:26 AM

wouldn't you like to know.

Tramp.

12. msgreer - 8/20/1999 4:42:14 AM

Slackjaw

Yes Yescall me a tramp.

Get the whips and leather out.

13. Slackjaw - 8/20/1999 4:56:57 AM

I'm sorry, this must be the wrong bordello. I asked for a nurse motif.

14. Slackjaw - 8/20/1999 4:57:19 AM

15. msgreer - 8/20/1999 5:15:00 AM

Slackjaw

Who says nurses don't have needs?
We are human!

Now
back to your mole problem.

The nurse is in.

16. msgreer - 8/20/1999 5:42:08 AM

From JAMA

Doctors say profit-starved Humana is targeting them for more saanings, but the insurer insists its claims reviewprograms aims to pay fairly for office-based services.

17. msgreer - 8/20/1999 5:42:49 AM

sannings=savings

18. msgreer - 8/20/1999 5:48:27 AM

Since Humana Inc., began reviewing office visit claims last month, Remigio G. Lacsamana,MD, has submitted 166 claims for review.

Each claim was downcoded from Level 4 t a Level 3.

Dr. Lacsamana charged that Humana,or the company it contracts with to perform these reviewa, is making these decisions automatically -- and unfairly.

"That tell you that they never reviewed them," said the Daytona Beach, Fl. internist.

But Michael McCallister, Humana's senior vice president of health systems management, see Dr. Lacsamana's experience differently.

His billling is not consistent with his treatement," McCallister said.

19. msgreer - 8/20/1999 5:52:05 AM

That disparity underscores a brewing conflict between physicians and submitting claims for payment for the two highest codes (Levels 4 and 5) and Humana's new claims review program targeting these codes for closer scrunity.

According to doctors Humana's policy is swamping them with paperwork and is a strtegy to squeeze more savings in the wake of the insurer's shrinking profits.

20. msgreer - 8/20/1999 6:01:38 AM

But McCallister aid Humana is simply responding to what it sees as a gradual "creeping up" of claim submitted by physicians.

"In what other industry would you write a check for a service where the only thing you had (to document the service) was a bill?" he asked.

"We are obligated to make sure that we are paying premium dollars out in an appropriate fashion. If we don't do that, we end up in a spiraling pattern downward," McCallister added.

Humana launched the program on July 1 in Florida, Kentucky and Texas and expanded it nationally in early August for both commercial and Medicare plans. Claims submitted by some 40,000 doctors are being reviewed by Aztec Medical Systems, Miami.

Doctors in the state where the program started said they suddenly began receiving letter from Humana elling them to submit copies of patient CHARTS for claims coded at either Level 5 or 4. Such claims would automatically be downloaded one level if physicians did not submit tht documentation within 14 days, Humana said.

21. msgreer - 8/20/1999 6:11:18 AM

But even after providing the additional documentation, Jeffrey Frank, MD, a neurologist in Louisville, Ky., said Humana still downloaded about 75% of his claims, resulting in a loss of about $20 for every adjusted claim.

Other insurers and the Health Care Financing Administration have audited his practice. "No one has ever found problems with our coding, and here Humana is downcoding 75% of our claims," he said.

Texas neurologist Sara Austin,MD, is annoyed that Humana is questioning her claims when the nature of her specialty requires intensive patient visits.

"I could see if they wanted to audit the outliers...but to do it to a neurologist is harassment. If a patient has a numb hand, it could be carpal tunnel syndrome, multiple sclerosis or a brain tumor. In 15 minutes, I can't decide one or the other," she continued.

Mary Self,MD, an endocrinilogist is in a four-doctor practice in Louisville, is worried that shipping patient claims to Florida for review will compromise patients' privacy.
downloading=downcoding.

22. msgreer - 8/20/1999 6:21:21 AM

She also said doctors should receive interest on their claims while they are undergoing the extra level of review. "It allows humana to keep our money for a few more weeks," said Dr. Self, whose group is terminating its Humanaa contact over the new review program.

Doctors also said Aztec only filed its state incorporation application on May 11, creating about its expertise. Physicians have voiced fears that Aztec receives financial incentives to downcode, a charge Humana officials denied. McCallister said Aztec receives a flat fee for each claim it reviews.

Humana spokeswoman Mary Sellers declined to give more information about Aztec's contract with Humana but said it performs claim review for other insurers. Aztec officials did not return phone calls seeking comment.

The new claims review program also has triggered an aangry response from state and local medical societies and large physician groups.

Both the Florida and Texas state medical societies have scheduled meeting with local Humana official. A large physicians' group in Austin filed a complaint with the Texas Dept. of Insurance over the issue.

Earlier this month, the Jefferson County (Ky.) Medical Society organized a meeting between Humana's medical director and area physicians. Despite a discussion doctors describe as "heated," nothing was resolved.

23. msgreer - 8/20/1999 6:53:08 AM

It is difficult to determine whether physicians are inappropriately upcodong or if insurers are trying to wring more savings from doctors, said an analyst wit William M Mercer Inc.
Many times, it's mixture of both.

Mercer's studies of physicians claims patterns have revealed that doctors sometimes skew their office visit codes toward the highest payment level instead of following the typical bell-shaped curve. But it is unclear whether that is due to inappropriately upcoding or billing for the additional time spent with patients.

In fact, confusion among Louisville physicians abut proper coding procedures prompted the Jefferson County Medical Society to organize educational sessions on the subject.

But with pressure on health insurers to cut costs, payment for physicians office visits is becoming a more visable target, especially since may doctors are refusing to accept contracts that include fee schedule cut.

"When companies can't push down the fee schedule anymore, they then scrutinize the heck out of claims.

24. msgreer - 8/20/1999 6:56:49 AM

NOW THIS IS NOT AS DRY A SUBJECT AS YOU MAY THINK.

Who do you want making medical decisions for you? You and your physician or some claim adjuster who is not only NOT in the examinating room with you and your physician but is more than likely sitting in a cubicle stamping "claim denied" before your claim has even been looked at by a physician?

25. msgreer - 8/20/1999 7:11:18 AM

CONSIDER THIS

If your doctor feels you need Level 4 or 5 care on an office visit and it will take more time for them to give you this care don't you want hope your doctor will take his/her time and be appropriately reimbursed for their efforts?

We are back to who makes the decisions.Is it between you as an educated consumer and your doctor or is there always to be a third party in that examining room with you?

26. msgreer - 8/20/1999 7:27:35 AM

DAMN

DOWNLOADING= DOWNCODING

my apologies

27. msgreer - 8/20/1999 7:29:37 AM

want help= help

please this is not the play pen. no comments are needed on my typing this morning.

28. ChristiPeters - 8/20/1999 9:24:42 AM

msgreer -

It would be easier to follow this if you could give a brief explanation of what is Level 5 care and what is Level 4 care.

29. msgreer - 8/20/1999 9:54:10 AM

ChristiPeters
There are 5 levels of care. On a routine office visit Level 3 is usually the code.

However if your doctor needs to do addtional testing which is avalilable to him/her in the office you maybe at Level 4.

Level 5 is the most intense. It usually means you have come in with an acute emergency ie numbness in an extremity or trouble with balance or vision and your doctor will need to spend more time with you. Decisions will have to be made if more testing outside the office is needed.

Does that help?

30. ChristiPeters - 8/20/1999 10:27:11 AM

Yes, thanks. That helps a lot.

31. theDiva - 8/20/1999 10:28:21 AM

ms g

32. ranheim - 8/20/1999 1:32:33 PM

I imagine that I am one of the few M.D.s here. My wife has been doing my paper-work for years. It helps that she was a MedTech (the old fashioned kind that did a blood sugar with a test tube and a Bunsen burner).

She does not want fights with either Medicare or Medicaide (which in LA is handled out of Arkansas). So she codes very conservatively -i.e. lower, probably, than that visit called for. But, since 1972 I can recall no question as to the skill level or time involved in a patient visit. For Humana's paper work company to challenge 75% of a doctors claims is unheard of!

Humana owned the hospital 4 miles away from me at one time. I did my best not to refer patients to that facility. I thought that they cut corners back them (15 years ago?).

33. ranheim - 8/20/1999 1:33:24 PM

I imagine that I am one of the few M.D.s here. My wife has been doing my paper-work for years. It helps that she was a MedTech (the old fashioned kind that did a blood sugar with a test tube and a Bunsen burner).

She does not want fights with either Medicare or Medicaide (which in LA is handled out of Arkansas). So she codes very conservatively -i.e. lower, probably, than that visit called for. But, since 1972 I can recall no question as to the skill level or time involved in a patient visit. For Humana's paper work company to challenge 75% of a doctors claims is unheard of!

Humana owned the hospital 4 miles away from me at one time. I did my best not to refer patients to that facility. I thought that they cut corners back them (15 years ago?).

34. ranheim - 8/20/1999 1:43:21 PM

#31

Training can run the gamut. But, in the huge % of cases, those people who would question a decision of mine would be minimum wage - or just above.

Isn't that a comforting thought.

My brother is a retired Cardiologist. Hassles like this are why he retired in his late 50s; unless a Cardiologist loses his hearing some of his most productive years are during his 60s. EXPERIENCE COUNTS WHEN IT IS YOUR HEART. But, arguing with in-house clerk-types (he was a member of a very large clinic in the suburbs of Minneapolis) who were bugging him because some insurance company had pulled the in-house personnel's chain over a quibbling matter added so much to his frustration that he retired rather than face more of same in the coming years.

He now goes in part-time and not a quibble is to be heard. And although paid at a lessor amount, he is much happier.

35. Thoughtful - 8/20/1999 7:23:38 PM

If I may ask a more personal question of the medical professionals here, my Mom (early 70s) has had a big problem with insomnia for years. She will feel tired and be able to sleep about 1 1/2 hrs and then wake up and be up for hours before she's able to get back to sleep. She now considers 5 hrs of unbroken sleep an excellent night and gets that maybe one night a week at best.

She asked about going to a sleep clinic, but I thought those would just track your sleep patterns and you need someone to interpret the results and treat you accordingly. Is there such a speciality as sleep doctors? Or is there some other specialty that covers this problem?

Thanks in advance.

36. Ranheim - 8/20/1999 7:32:32 PM

Thoughtful

Possibly msgreer will know more than I. Duke used to maintain one of the best sleep labs in the USA. But, that was 10+ years ago.

I know that there are so-called "Sleep Clinics" out there. There are none in my area of central Louisiana that I am aware of.

I can only give you anecdotes from my own practice; but, you mother's sleep habits don't sound too bad. The important thing to find out is "Is she satisfied?" Sometimes this age group will amaze you with what they consider NORMAL.

37. msgreer - 8/20/1999 7:39:28 PM

thoughtful

As we age our body requires less sleep
but sleeping is often a problem for the elderly.

From your post is sounds like your mother has had sleep "problems" for sometime.

My suggestion is your mother sees her primary care giver first. You want to make sure there is no underlying physical reasons for what you describe as her difficulty with sleeping. You will want to rule out not only possible physical ailemts which may be keeping her up but also depression.

This is the most undiagnosised problem for the older client.

And your mother's primary care giver can establish what medication she is on, whether she drinks caffeine or alcohol before bedtime
...there is alot to look into before a sleep clinic.

38. msgreer - 8/20/1999 7:49:10 PM

cont.

Does your mother follow a regular regime for bedtime each night? Some people who have trouble with falling asleep make sure they follow a certain ritual everynight. A warm bath, a glass of milk if her diet allows
whatever makes her comfortable.

Our resident physician is correct in that your mom's sleep problem you describe maybe annoying but does she feel rested after sleep regardless of the amount of hours she gets each night?

I am curious to know what she does when she awakes after the hour and a half of sleep and can't fall back to sleep.

Does she get up and start doing chores? Does she rest in her bed? Does she read a book?

Another thing I find to be of help is to remember the bedroom is for sleep and sex. If your mom can rest but not necessarily sleep this is helping her body.

Amd remember each person's requirements for sleep are different.

About sleeping clinics.. there are many. I don't know what part of the country you live in so I can give no suggestions. ranheim is correct in that Duke has a fantastic sleep clinic.

This maybe a question for
your mother's primary care giver.

I am certainly willing to research
sleep clinics in your area but that would mean letting me know the bigger cities your mother is close to.

Does this
help at all?

39. Thoughtful - 8/20/1999 7:51:59 PM

Thanks for the input. She's been to her primary doctor and discussed this with him many times. He just wants her to go on elavil, but she doesn't want to use that drug. (I can't blame her -- I was on it and hated it.) She has no caffeine, she's tried altering when she takes her premarin. She has ambien now, but knowing it's addictive will only take it at most once a week...usually less. She has tried melatonin, but finds that while she sleeps real well with it, after about a week, she starts getting "dopey" or "brain fog" where words and thoughts have more difficulty coming to her. She exercises regularly (treadmill, weightlifting) and is otherwise in very good health. She's active and social and doesn't fit anything that I would think of as depressed. I've also read where the ability to fall asleep with early wake up is more indicative of a physical problem rather than emotional. She's also tried the usual remedies like making sure she goes to bed at the same time, avoids exercising late at night, etc. Her doctor asked her if she feels ok, and she says yes, but to her that means she is able to get through the next day. She notices a distinct difference when she sleeps better in her performance and how she looks.

I post all this not because I'm looking for a diagnosis, but to try to respond to the points you've made. I think she's ready for something more than what her primary care physician is giving. That's why I ask about the sleep clinic. Hubby went to one for his snoring/sleep apnea, but he had an ENT who sent him and went over the results. So again I ask, is there a specialist she should see who handles these kinds of things?

40. Thoughtful - 8/20/1999 7:55:13 PM

Sorry, msG. cross post. I hadn't read your part two. I know of a sleep clinic, but can you just walk in and say I have a sleep problem...help me. I mean what kind of a doctor does someone with narcolepsy go to? Hubby's ENT was kind of obvious...but I'm at a loss here.

41. ranheim - 8/20/1999 8:45:49 PM

Thoughtful

If your mother's mind is made up that Ambien is habit forming/addicting - that is the last word. Unless you can convince her (always assuming that Ambien is working) that there is no such thing as an addicting drug in a 70 year old patient. Assume she takes it, safely and effectively, for the next 15 years. Has that "addiction" harmed her?

42. Thoughtful - 8/20/1999 8:53:18 PM

We are very reluctant to follow that line of thinking. They put my grandfather on percodan for his sore legs when he was 75 saying how long could he be addicted? Well 25 years later, he finally died from kidney failure associated with long term use of the drug and making life nearly impossible for everyone including accusing everyone of hiding his pills on him, his never getting them, etc. This went on in its severest form for 4 years -- to the point where even the visiting nurses declared him by far the worst patient they have ever seen. (Mom's mother made it to 96.)

43. Thoughtful - 8/20/1999 8:58:11 PM

So I guess the answer is that there is no "sleep specialist" category other than perhaps calling the sleep center itself and asking for a recommendation -- or convincing her to see a psychiatrist.

44. ranheim - 8/20/1999 9:06:19 PM

Thoughtful

What state do you live in?

I may have an M.D. friend nearby that could give me a name.

45. Thoughtful - 8/20/1999 9:25:30 PM

ranheim, I will send you an e-mail. Thanks for the offer.

46. ChristiPeters - 8/20/1999 9:25:56 PM

thoughtful -

I just got off the phone with msgreer. She wanted me to post to you that her WebTV has been giving her fits and she can't get online right now. She had another long post all ready for you, but couldn't get on to post it. She is calling her Service Provider now. If they can't get her back up and running, she is going to call me again tomorrow and dictate the post to me so I can put it up for her.

All -

msgreer also wanted to let y'all know that she is very committed to the Health thread and will be back as soon as she can.

47. Thoughtful - 8/20/1999 9:31:15 PM

Christip, that's great. Thank you both for your help. Sorry she's having difficulty -- been there, done that. I appreciate all your efforts. Thanks.

48. Thoughtful - 8/20/1999 9:34:27 PM

To continue with sleep problems, I thought most recently I read of a study that said it was assumed the elderly needed less sleep, because they slept less when in fact even older people should be getting 6-7 hrs each night. If not, there's something wrong -- be it medications, depression, etc.

49. ChristiPeters - 8/20/1999 9:37:04 PM

I also want to add a little of my own experience re: elavil. While it was originally developed for depression it has the side effects of nerve pain relief and making/helping you sleep. It is now prescribed almost as often for these side effects as for it's original purpose. So a physician prescribing elavil as a sleeping aid does not necessarily mean the Dr thinks the patient has any problems with depression or other emotional problems.

I was put on elavil for pain and it worked very well for that. I was not depressed. I don't know what your experience with elavilis, but mine has been bad for only one reason. I have experienced runaway weight gain on elavil. I have gained 100 pounds in spite of averaging 950 calories/day and eating a low fat, low cholesterol, low salt diet. The weight gain has caused high blood pressure and now borderline diabetes. Talk about the cure almost being worse than the disease!

I say almost, because when I started the elavil I was on so much pain I couldn't function. Now, thanks to five hospital procedures (and maybe a lot of meditation helped too.) My pain level has been reduced enough for me to get off elavil. I'm losing an average of 10 lbs a month with no other change in my lifestyle than the med change.

So, I guess what I am saying is that I totally understand any reluctance you or your Mother may have in regards to going on elavil, but that the doctor is not necessarily saying your Mom is depressed when suggesting it.

50. Thoughtful - 8/20/1999 9:45:23 PM

christip -- glad to hear you are off the stuff. I know it's not just for depression and know it's powerful effects as a sleep aid. But I've also seen it listed as one of the drugs that should be avoided by the elderly. Also, Mom is like me. I don't like drugs and avoid them if at all possible. I especially don't like playing guinea pig, having drugs thrown at me to see if they work and if they don't try something else. I would much rather know what's wrong first, then fix it.

I have no doubt that there is a large psychological component to her sleep troubles, though not necessarily depression. Rather, like the studies show that we learn to anticipate pain and suffer more for it, she's probably grown to expect that she won't sleep and then proves herself right more often than not. Me, I found a lot of my sleep problems went away with the TV. I turn it on to a dull show (no sirens). I listen enough to keep my mind from spinning over the things that happened today or I have yet to do tomorrow, but not enough to keep me awake. The TV shuts itself off after 1/2 hour, and I'm all set. About twice a week I will wake up early -- 2 or 3 am -- and it usually takes me a couple of hours before I can go back to sleep. Of course, by then, it's time to get up anyway. Even here, though the TV helps me doze off.

51. Bubbaette - 8/20/1999 9:51:17 PM

I have insomnia off and on. Some of the suggestions that
help me are:

Only spend time in your bedroom for sleeping -- not for reading or watching tv.
If you're tossing and turning, get up and go in another room til you get sleepy.

Exercise during the afternoon can help use up any excess energy, but I don't
know if this is suitable for your mom.

A warm bath before bed helps because it raises your body temp. Drowsyness
is a natural reaction as you cool down again.

I take ambien when it starts to affect my work.

52. Thoughtful - 8/20/1999 9:55:51 PM

All good suggestions -- Mom has used the hot bath thing with some success. I didn't know the cooling down was what did it. Interesting as she is a Reynaud's sufferer and tends to like to keep things hot. I know for myself that being too hot makes for poor sleep. Hmmm.

53. msgreer - 8/20/1999 11:07:21 PM

thoughtful

I am back. Some wonderful tech support young man in Redwood,California lead me through a host of exercies and here I am.

It appears you are getting alot of good information.I wanted to add melatonin should not be taken for more than 7 days in a row..10 days tops.

What your mother described as her side effects with melatonin are well recorded.

If ranheim can give you a recommmendation of where to go for further help with your mom I would surely contact him/her.

I am able to research where sleep disorder clinics or specialist in sleep disorder are located but I need to know where your mother lives.

See if ranheim can help
if not you can always contact me on this thread.

Good luck and please let us know what you find out and if your mother gets help.

54. theDiva - 8/20/1999 11:10:21 PM

Ms G

Please e-mail with an update on your previous missive. I'm anxious;y awaiting news.

55. msgreer - 8/20/1999 11:31:24 PM

Diva

check your email.

56. ChristiPeters - 8/20/1999 11:38:35 PM

Glad it's fixed, msgreer!

57. msgreer - 8/20/1999 11:48:41 PM

ChristiPeters

check your email.

58. ChristiPeters - 8/20/1999 11:51:47 PM

Got it!

Speaking of sleep - I just chased the hooligans into the bedroom. How much you want to bet that no sleeping occurs.

59. msgreer - 8/20/1999 11:52:28 PM

Another topic which is too close to my heart at the moment but could be an interesting topic is children taking care of their parents.

How is impacting your own life? How do you feel about it? If you have other brothers and sisters are they helping?

How does it feel down deep in your gut to take care of your parent and/or parents?

60. theDiva - 8/20/1999 11:54:01 PM

Ms. G

Check your e-mail.

61. msgreer - 8/21/1999 12:01:17 AM

Diva

email received.

one coming back to ya so give a check.

62. ranheim - 8/21/1999 7:46:41 AM

Thoughtful

Keep in mind that I'm a dunce when it comes to computers.

I tried your e-mail and the message was returned to me as un-deliverable. Which, in all likliehood, means I screwed up.

I have an M.D. brother-in-law on Cape Cod. But it will take some time for me to get to him. He owns a small yacht and lives to sail. I will have to catch him between sails.

I'll try to get back to you this weekend. Its 8:00 AM central daylight here.

63. msgreer - 8/21/1999 9:05:31 AM

ranheim

If thoughtful's mother is anywhere close to Boston there are several good sleep disorder clinics as well as doctors who specialize in this area.

I hope you will be able to give thoughtful a reference. If not please let me know as I am familiar with the Boston medical "establishment."

You're a good man, Charlie Brown.

64. msgreer - 8/21/1999 4:41:49 PM

I was called in on a case about a month ago. I took it pro bono.

The gentleman I was working with was a kind soul who just had been
through too much tragedy and sadness for one person.

I worked with
the Veteran's Administration and other health care facilities to get
this gentle sould the help he needed.

We became good friends. We spent
many hours together just talking. He often told me how much I was
giving him but let me say it was mutual.

Get to know an older citizen
in your community and you will be pleasantly surprised with the
pleasure of hearing old stories and tales only someone with many years
on them could tell.

Afew days ago I picked up the newspaper to read
he had called 911 as his despair had gotten too much for him. He
called for help. Why he didn't call me I never will know.

The police
came to his home to find he had a pointed tool in his hand. They
immediately treated it as a threatening situation for THEM.

What
follows is a letter to the editor I wrote and got published. The
local paper had been carrying his story from the beginning which I
am proud to say had to do with the fact I went to them and said we
need your help. This is what is going on with this man. Write about
it. Help us put abit of pressure on the medical establishment.

The letter reads

"Once again, a 911 call intended to avert tragedy has resulted in a
needless death, an "assisted suicide" as it were. Isn't it time for
police officers called to such a scene to be routinely armed with a
tranqulizer gun, spray pepper or Mace>To be trained to disable rather
than to kill a person armed only with a sharp object, be ita tool or
a kitchen knife?

Or does the fact that we have become a fear-ridden
culture encourgage officers of the law to "shoot first" and then
plead(with odds of seven to one) self-defense?

65. msgreer - 8/21/1999 4:47:07 PM

cont.A footnote to this sad affair: It is clear that "Steve", who had "slipped throught the cracks" of both the Veterans Administration and our so-called health care system, lost all hope due to chronic pain which threatened his livelihood and by lingering sadness and loneliness after the theft of his dog.

What a pity that this despair was extinguished rather than repair, that those cries for help triggered such an unnecessary, deadly outcome">

66. msgreer - 8/21/1999 4:50:03 PM

So my question is do we have it "right" with our health care system?

The answer is a very loud no.

I don't believe this is an isolated incident. It probably happens in some town everyday.

The question is what do we do to change or "fix" our own health care system so another "Steve" in not shot merely because the health care system failed him.

67. msgreer - 8/21/1999 4:53:30 PM

ALISTAIR

THE EDIT BUTTON...PLEASE.

I am getting embarrassed with how some of my posts look.

68. msgreer - 8/21/1999 6:25:22 PM

ranhein

you can reach me msgreer@home.com

69. msgreer - 8/21/1999 6:26:21 PM

ranheim

sorry about mispelling your name.

70. SpenceMirrlees - 8/22/1999 2:15:36 AM

msgreer:

It is counterproductive to search for a system with no cracks for people to fall through. They all have cracks; the goal is to find the one with the most acceptable cracks. Anecdotes do not help demonstrate that we are very far away.

71. msgreer - 8/22/1999 4:50:51 AM

Spencer

I did not have to "search" for a health care system that is full of "cracks">I live in one.

It is all around me.

I work in "our" medical system everyday.

This was just a story, a true one at that, that I happen to be apart of.

As we get to know each other you will find I have a hundred and one stories I could tell in regards to the "cracks" in our system.

I am not foolish enough to think it is only our medical health care delivery that needs "fixing".

I have yet to find a health care system which does not put some of its citizens at risk.

72. SpenceMirrlees - 8/22/1999 4:54:02 AM

I have yet to find a health care system which does not put some of its citizens at risk.

My point exactly. So what does it accomplish to point out that our current system places people at risk?

I do not doubt the veracity of your anecdote. My point is not that it's invalid but irrelevant.

73. msgreer - 8/22/1999 4:57:32 AM

cont.

I don't think it is necessarily a bad thing to tell a "story" when attempting to illustrate an aspect of our health care system that needs attention.

I find as a medical advocate the more I am willing to speak out the better results I get. Now it maybe one person or one issue at a time but atleast it is a beginning.

I like to discuss the reasons why we or another country fails its citizens so often but I have found in 10 years of business it oftentimes is these personal stories I relate that gets the faster action.

I also admit I have to know the laws regarding health care in this country or all the stories in the world will not be effective.

So I am up for any type of discussion.

I am sorry to hear you felt my relating a story was counterproductive.

74. SpenceMirrlees - 8/22/1999 4:59:39 AM

I am sorry to hear you felt my relating a story was counterproductive.

But I didn't say that.

75. msgreer - 8/22/1999 5:03:25 AM

Spencer

It is very important to tell stories which illustrate how our system fails. It begins a dialolgue between folks. And we have to start talking in order for these situations not to happen again.

In this particular case I am still working with the VA and several health care facilities not to speak of the police to find out where we all went wrong.

I know it is one small incident at a time but through discussion I hope this particular incident will not happen again.

This is what I do for a living. And I do it anyway I can to get people's attention and a dialogue started.

76. alistairconnor - 8/22/1999 5:05:45 AM

Yes you did Spence.

Obviously, it is important to characterise the flaws in any given system with respect to what happens to individuals. That gives the flavour of the system.

77. alistairconnor - 8/22/1999 5:06:51 AM

No edit button, MsG. Use the Preview box.

78. SpenceMirrlees - 8/22/1999 5:07:53 AM

It can also be very misleading to tell stories and only stories. It is not clear from your story, or from the doubtless hundreds like it that occur all the time, that this particular failiing of our system (still not sure what it was, actually--just a nondescript failing) is a matter of general concern.

79. SpenceMirrlees - 8/22/1999 5:08:28 AM

MsGreer: please show me where I said your relating a story was counterproductive.

80. SpenceMirrlees - 8/22/1999 5:13:17 AM

oh, 79 was to AlistairConnor, not MsGreer.

81. msgreer - 8/22/1999 5:21:28 AM

Spencer

It is "matter of general concern" to all consumers to know what is out there for them while weaving their way through the health care system.

It is my belief an educated consumer will get what they need. It is the other 98% of our citizens who out of frustration or not knowing their rights that throw up their hands and give in. And the results can be deadly.

What I am saying is in order to fix something you have to be willing to look at the "cracks". You have to be willing to stand up and say to the establishment this is not working. We need to found out why not and DO something about it.

You are not sure why my story "is a matter of general concern".

You would be if this man was your father. You would find yourself very concerned. And you might even be angry enough to find out why it had to happen.

Re relating my story as "counterproductive"... you didn't understand what I said before. It is oftentimes necessary to tell stories of such failings to get a dialogue going. Most people can relate to stories as opposed to dry discussion.

The specifics of our health care system and the laws that govern it are of great importance to me but I'll tell you when I am asked to speak as a guest say concerning caregivers for the Alzheimer's patient telling stories people can relate to helps get the crowd in a mood to act. Then comes the task of going through the laws that govern these injustices.

It is a place to start.

82. alistairconnor - 8/22/1999 5:23:29 AM

Site is Going offline now folks... see you in about 20 minutes?

83. msgreer - 8/22/1999 5:23:48 AM

found=find

84. alistairconnor - 8/22/1999 5:24:27 AM

Last Posts Please...

85. alistairconnor - 8/22/1999 5:51:44 AM

Welcome to New York everyone!

86. SpenceMirrlees - 8/22/1999 5:58:10 AM

what the...what happened? Oh, looks great. Love the new digs.

Now then. MsGreer, if your story is building to something more substantive, I will anxiously await that date. But, once again, I did not say your story was counterproductive. Nor did I misunderstand it. But you're not writing a novel; if you want a dialogue, start talking. We have all seen Dateline NBC and know people get screwed. What do you want to do about it?

You are not sure why my story "is a matter of general concern". You would be if this man was your father. You would find yourself very concerned. And you might even be angry enough to find out why it had to happen.

You know, I've always thought "what if it happened to you?" a lame argument when it comes to public policy. Yes, if it was my father, I would be very concerned. I would not necessarily expect you to be. So no, if it was my father, though I would be distraught, I would still not be sure why this is a matter for public policy to handle.

It is "matter of general concern" to all consumers to know what is out there for them while weaving their way through the health care system.

I completely agree. And after reading your story, or dozens like it you could tell, what have I learned about what is likely to be "out there"? I don't even know what crack this one man slipped through.

I'm not saying this person is not important to people. But should be base public policy on his particular experience?

87. alistairconnor - 8/22/1999 5:59:18 AM

If a million people all slip through the same cracks, then papering over them isn't good enough.

88. alistairconnor - 8/22/1999 5:59:50 AM

Spence needs some statistics. Sorry, haven't got any.

89. SpenceMirrlees - 8/22/1999 6:00:38 AM

87--

Yes alistair, I completely agree.

90. msgreer - 8/21/1999 2:17:29 PM

Spencer

I was posting when all of asudden the big change took place. Sorry for the interuption. But it does look good, doesn't it?

I was about to say when I finish investigating this particular incident I will get back to you and report what "cracks" I found.

As for statistics you are correct. I shall do my best to bring you statistics while discussing a specific issue.

Right now I have another project. Medicare fraud.

I see that everyday too. Did you know if you report Medicare fraud whether it be an individual doctor or clinic/hospital and the government investigates and finds there was fraud.. you the consumer who did something about it will get a check from our government for 25% of all monies collected by that fraud.

91. msgreer - 8/21/1999 2:24:51 PM

Spencer

You asked why I should be concerned when it comes to the failings of our health care system.

I get paid to be concerned. That is what a medical advocate/consultant does.

When a client comes to me for help they are paying me to stand up for them. They are paying me to ask the tough questions.

When dealing with health care issues folks are scared and vulnerable. They want someone who is not afraid to speak up and question what the hell is going on here?

I watch Dateline too so I know what you are saying. But oftentimes their consumer advocate tells a story to make their point when it comes to a failing in the health care system or the auto insurance business. They don't always give us the answers but by their reporting they make us wiser consumers with the hopes the information will enpower each of us to do something about a problem.

92. SpenceMirrlees - 8/21/1999 2:29:09 PM

You asked why I should be concerned when it comes to the failings of our health care system.

Actually, I don't recall asking you that about general failings...but I'm glad you are concerned anyway. I have no doubt that the people you work with are delighted and relieved to have someone on their side who can speak up.

What I want to know is, to what extent is that solution workable in general? If we clone several thousand msgreers and distribute them around the country, free for the asking to individuals, paid for by care providers, how much would that help?

93. msgreer - 8/21/1999 2:36:40 PM

Spencer

It is a good question. There are alot of advocacy organizations already in existence working of "cracks" and changing laws everyday.

I don't have an answer to how many msgreer medical advocates it would take to turn the system around.

What I do know is getting the message out helps educate the consumer and perhaps take some of the mystic the health care system thrives on out of the equation.

I do it one case at a time. I work with local, state and federal officials.

Am I changing the world? Probably not. But someone has to be willing to take the health care system on.

We are a very wealthy country. We have the resources to implement a better system. First we have to define each "crack" and start writing some new laws.

And I find it pretty scary when Congress can not even act on a Patients' Bill of Rights. You would think that would be a good starting place.

94. SpenceMirrlees - 8/21/1999 2:49:53 PM

Well, yes, we have the resources. The question is what you want to give up to make it happen, and limo rides to work for DC bureaucrats won't do the trick.

So, how many more plane crashes do you want to have?

95. msgreer - 8/21/1999 3:05:41 PM

Spence

I don't know we have to give up anything to make the health care system a viable one. If the laws already on the book were carried out some of these "crack" would fill in for themselves.

However when we are dealing with the special interest folks or lobbyists who have all the money in the world to buy a Congressperson's vote on a certain health care issue that IS something that needs to be changed.

Our system makes it very difficult for the average citizen to get what they need when they don't have the ability to write a big check to the folks who make the laws.

Thus it is back to a grass root effort to start making the changes.

I believe most Americans want changes in the health care system. They just don't feel they have the strength or know how to go about doing it.

96. SpenceMirrlees - 8/21/1999 3:10:01 PM

Naturally that depends on what you mean by viable. But if you want more than 4 in 5 Americans to have decent (and I use the term loosely) coverage, that will require more resources than are presently used on health care. That will require fewer resources elsewhere, presumably even accounting for any productivity enhancing benefits of better coverage.

97. msgreer - 8/21/1999 3:14:00 PM

A friend of ours once wrote me "I find it politically intolerable that
any nation with the means to look after its own should voluntarily
refrain from doing so".

I have an idea. Instead of the Congressmen and women going on those junkets the HMO's provide why don't they take 100 msgreer's aka medical advocates. I bet we could tell them about what is happening out there in the real world.

I am not holding my breath for an invitation. It is merely a suggestion.

98. SpenceMirrlees - 8/21/1999 3:19:21 PM

For that sort of political activity to work requires a much more fundamental change. One can't just ask people in the present political system to change their behavior--presumably they are already acting to their own best advantage. Asking them to contravene their incentives is futile.

What is needed if we don't like the way the policy process works is a new set of incentives.

99. msgreer - 8/21/1999 3:20:44 PM

Spence

There are millions and millions of dollars which could be saved by collecting on Medicare fraud alone. That is one financial resource which would put more money into improving the system.

Then there is the profit-greed motive which roles most of our HMO's and other insurance companies. I don't believe for-profit health care insurance companies need to give their CEO's 7 million dollar bonuses at the end of the year because they did their job so damn well it "saved" millions of bucks for them.

How about looking at our health care system of one not dominated by the mighty buck and one that concentrates on serving the people.

It can be done.

100. msgreer - 8/21/1999 3:22:21 PM

How is that for an incentive?

101. SpenceMirrlees - 8/21/1999 3:24:44 PM

frankly, not necessarily so good. If collecting on medicare fraud is such a great incentive, why isn't it presently being done?

102. SpenceMirrlees - 8/21/1999 3:25:43 PM

Best bet for incentives: make it so that "serving the people" results in more of the almighty buck.

103. msgreer - 8/21/1999 3:28:42 PM

Spence

Certainly you are correct when you say folk in the business are acting to their best advantage. It does not mean what they do goes to addressing the needs of the "4 out of 5" people you mentioned.

Of course changing behavior is a mighty big challenge. But in the case of the health care system it is long overdue. But is it right to sit back and watch millions of dollars being given to our political leaders for a vote when even that money could go to better use.

I always like to see the names of Congressmen/women who take money from lobbyists. I like to know how much it takes to buy their vote.

104. msgreer - 8/21/1999 3:33:22 PM

Spence

I think we are reaching that point where I bring up the one payer system.

If what we have now can only be patched up with financial incentives to those giving the care it is time to think about everyone gaining access to the same high quality of health care many of our citizens get.

Please...I am not against people making money. It is a matter of how much one needs to make when delivering a basic need.

105. SpenceMirrlees - 8/21/1999 3:34:22 PM

It does not mean what they do goes to addressing the needs of the "4 out of 5" people you mentioned.

Obviously. That's why we're having this conversation.

The point is, people will always use any system to their best advantage. So, best to make the sum total, if you will, of best advantages work out to a socially desirable outcome. That requires system level change.

106. msgreer - 8/21/1999 3:39:10 PM

BTW, collection on Medicare fraud is being done at this very moment. There are just not enough workers to catch it all. There are not enough workers to go from place to place and read the financial books of every doctor/clinic/hospital.

But little by little people are getting caught. It is such a huge problem and like the health care system it will take more people willing to work harder at finding these frauds and acting on them.

Remember there is a financial incentive to turn a doctor/clinic/hospital in for Medicare fraud. As I posted earlier if the government investigates a fraud you have brought to their attention and they collect any money they will send you a check for 25% of what they collected.

There is a financial incentive for anyone willing to stand up and call it as they see it.

107. ranheim - 8/21/1999 3:39:41 PM

I must be doing something wrong.

Should I preview prior to posting, the post gets lost in the "ether" when I hit the "post this message" button.

108. SpenceMirrlees - 8/21/1999 3:40:57 PM

test

109. SpenceMirrlees - 8/21/1999 3:41:47 PM

ranheim: once you preview, and you actually get to the "preview" screen, if you haven't made any changes to your post after looking at it, unclick the little box at the bottom of the preview screen.

110. SpenceMirrlees - 8/21/1999 3:42:10 PM

then click the "post" button.

111. msgreer - 8/21/1999 3:43:36 PM

Spence

"that requires system level change".

YES YES YES.

That is what I am saying. And I think I have made some suggestions re money given to Congressmen/women to buy their vote on a health care or insurance law.

Cut that out of the system and let our leaders vote what is best for their folks back home.

I wonder what the votes would look like if the people in Congress were not allowed to take any money from special interest.

112. SpenceMirrlees - 8/21/1999 3:45:38 PM

msgreer:

BTW, collection on Medicare fraud is being done at this very moment. There are just not enough workers to catch it all. There are not enough workers to go from place to place and read the financial books of every doctor/clinic/hospital. But little by little people are getting caught.

Obviously at any moment there is some fraud detection. But which do you think is accumulating faster, cases of medicare fraud or discoveries of medicare fraud?

Why are there too few workers to do the job? Maybe because it's not a good enough job? If the incentive is so strong, why isn't it happening.

Don't get me wrong, that line of reasoning isn't definitive. But it is suggestive. If the incentive is so great, why isn't it working?

113. SpenceMirrlees - 8/21/1999 3:46:58 PM

And herein lies the rub: a political system in which contributions cannot be made from so-called special interests is not on the horizon.

114. ranheim - 8/21/1999 3:49:37 PM

I would assume that there are PhD thesis by the gross on this subject. All one doctor can have are anecdotes; anecdotes are not statistics.

What is frustrating to me is that for the poorest of the poor here in Loouisiana :
1) my services are free
2) lab testing is free
3) x-rays are free
4) Rx medication is free
5) hospital stays are free (they aren't free : 1 - 5 cents on the dollar).

The problem lies in the fact that those eligible for these free services, don't know how the system works.

I'm sure that msgreer will tell you that she can usually steer this category of patient into the proper loop. However, it takes an inordinate amount of her time for this category of patient.

So another area where it comes down to education and is everyone educable. These people frustrate me.

I get pissed at the ones that claim helplessness!

115. msgreer - 8/21/1999 3:55:00 PM

ranheim

You are right. It takes me alot of time when working with the indigent consumer. But as you said it can be done.

Don't throw up your hands at the folks who say they can't deal with it all. Some of those people have been put on hold so often and for so long they know not what to do.

Education. That is what I stress. Let us educate the consumer so they can advocate for themselves.

116. msgreer - 8/21/1999 4:16:24 PM

Spence

Sorry for the interuption. I am at the hospital with a client now and will be most of the day.

Plus the pc I am working with keeps going into sleep mode.

Now you say contributions made from special interest groups are not about to change.

Why can't that change? Why can't our elected representatives... those jolly folks we vote into office to take care of our needs decide it is NOT in the best interest of our citizens to be making policy according to who gives you the most money.

There is something very wrong with the special interest groups and their tactics.

Money makes the world go round

the world go round

the world go round.

I can hear Joel Grey singing that out loud and clear in Cabaret.

Now to your other questions. Medicare fraud is accumulating faster than discovery.

You asked about the workers who daily look into such fraud... where are their incentives. They aren't in their paycheck that is for sure. This is another issue to visit at a different time. Alot of the incentive has to come from within as anyone who has been involved in a grass root effort will tell you. There have to be some people willing to fight for their principles knowing they better keep their day job while fighting.

I am in private practice and bill as I choose. I also work on a sliding scale when it is necessary for the client.
And I do pro bono.

117. msgreer - 8/21/1999 4:27:06 PM

Now it is time to get some f I will count the drops in both IV's hooked up to my client..

Part of my job. If the order is for 12 drops per minute and it is going at 21 it has to be dealt with.

I will be back.

118. msgreer - 8/21/1999 4:28:01 PM

f=food

119. msgreer - 8/21/1999 5:30:33 PM

I'm backkkkk.

120. msgreer - 8/21/1999 5:57:44 PM

test

121. msgreer - 8/21/1999 6:16:47 PM

www.test.com\

122. msgreer - 8/21/1999 6:17:41 PM

mailto:j@p.com
link="www.t.com"

123. msgreer - 8/21/1999 6:26:30 PM

test

124. msgreer - 8/21/1999 7:02:54 PM

To post a webpage link, you must...

1) type the title youn want people to read and finish with
Example: The Infoseek Search

To post an e-mail, add mailto: to the prior formula:
Marcy's

Another example:
To go and find out about html go to www.html.com or click on the link below Html Page

125. msgreer - 8/21/1999 7:07:03 PM

please disregard my testing.

126. msgreer - 8/22/1999 1:44:17 AM

HTLM made easy

127. msgreer - 8/22/1999 1:48:11 AM

arky

after you get in scroll all the way down and click on to the right of "show me".

I am not feeling so smart right now.

128. msgreer - 8/22/1999 1:49:24 AM

arky
obviously click HTLM first.

129. arkymalarky - 8/22/1999 1:54:05 AM

Thanks, Msgreer. I bookmarked it.

130. Thoughtful - 8/23/1999 4:19:19 AM

Well, my medical coverage is starting to pinch. I went to get a refill on my Celebrex this weekend and the pharm said, "That'll be $120." I said, "What happened to my $12 copay?" He checked and said I need some kind of authorization to use this medicine. I contacted the insurance people today and they tell me it'll take 24 hours to get approval/denial from them. I've only 3 pills left. AARRRGGGHH!

131. msgreer - 8/23/1999 6:23:27 PM

thoughtful

I have heard of this problem before.

It could be one of several problems.

Your insurance company gives the doctors a list of what medications they are allowed to write a prescription for. Yes, the doctor follows that list. Unless of course he/she feels strongly you need a specific medication not on that list.

If that is the case the physician has to get on the phone to your insurance company and plead your case and his.

Another possibility is your insurance company has changed some policy and you have not been notified yet.Obviously when you took it to be filled the pharmacist knew enough to say we need to get authorization.

If you want an immediate answer I would call the pharmacist. They know more than the doctors and insurance companies. They are kept upto date re changes faster than anyone. It is worth a try.

Excuse me I have to deal with an issue in the hospital where I am working today. I will get back to you.

Do you have anyother questions.

BTW, since you have been taking this medication and all of asudden you need authorization I can tell you one of the scenarios I have mentioned maybe taking place.

132. theDiva - 8/23/1999 6:26:53 PM

Ms. G

133. msgreer - 8/23/1999 6:30:33 PM

thiughtful

I must say it takes up so much time for a doctor to have to call an insurance/ HMO to ask for an okay on a certain medication or ask for authorization to send a patient to a specialist that they no longer have the time.

Some doctors actually hire someone to sit in their office and do nothing else but make these costs. And it ends up costing them a bundle.

You have to remember with most insurance/HMO's there is a FINNCIAL incentive for the doctor to not send their patients to specialist. Some insurance companies actually when contracting with a doctor write in a clause saying you are not allowed to discuss all the health care options open to your patient for certain diseases or other health care issues.

It's a dandy system.

And as Spence and I were discussing afew days ago we can't even get a Patients' Bill of Rights passed in Congress. Many of all our healthcare daily problems with the insurance companies would be solved to a great extent if the Democractic Patients' Bill of Rights got passed.

I will be back. I really have to sign off for abit.

134. msgreer - 8/23/1999 6:40:21 PM

Diva

I will yahoo you right away.

135. Thoughtful - 8/23/1999 7:48:15 PM

Thanks for your input MsG. Dr. must've said the magic words as I got a call back -- finally -- saying I've been approved for 12 mos. Thank goodness. After spending 2 years looking for a med that would ease my pain, I finally found one -- and then the insurance pain started! Sheesh!

136. ranheim - 8/23/1999 8:12:54 PM

As an M.D. I am somewhat ashamed to admit this - but, I am rural. Many of you are urban.

Do you/your family ACTUALLY save money in an HMO? May sound strange coming from an M.D. but I have no idea what your answer/s will be.

137. ChristiPeters - 8/23/1999 8:16:26 PM

msgreer -

I know you are busy, so take your time answering this.

I have an elderly aunt who has just undergone heart valve replacement surgery. It's been a week since the surgery, which supposedly "went well", but she is still in ICU. Is this typical?

This "Aunt" is really my Dad's double-cousin and was very close to my Dad and, hence, myself and my brothers. She and my Dad's much younger step-sister are the only ones left of that generation of the family. I am very worried about her.

(I'd welcome input from anyone else who knows anything about this, too)

138. msgreer - 8/23/1999 8:54:49 PM

ChristiPeters

i hesitate giving an answer only because i am not looking at the chart.

however i can say oftentimes people are in ICU for a week.

at this point do you know if there were ANY complications or did your aunt have other cardiac problems?

a valve replacement is major surgery. it maybe she is just not ready to go to the second level yet.

didn't you mention she had another health issue to me? a stroke if i remember.

all i do know is this the decision to keep her in icu is made by her doctor and cardiac surgeon.

i can understand your concern. is there anyone in your family that can get in touch with her doctor and ask your question?

139. msgreer - 8/23/1999 9:02:14 PM

thoughtful

glad to hear you were approved but why just for 1 year?

perhaps your insurance company wants to make sure you need this specific medication.

if you have to go through getting authorization every year don't you want to find out why this happen in the first place?

i keep saying call the pharmacist. she/he knows more about authorization questions than anyone. atleast i have found them to be very helpful to me in my business.

i am often the person on the line to HMO's/insurance co. trying to get authorization for a medication or a procedure. it has taken me along time to break their codes but i have done it. it helps when talking to them if you know their lingo. it is all such garble if you don't know the secret codes.

if i may ask are you with a HMO?

140. DocBrown - 8/23/1999 9:03:13 PM

Christi, you should also know that sometimes non-medical factors contribute to a person staying in an ICU for an extended period. All the stepdown units may be full or short staffed. A unit might be closed for cleaning or remodeling. A doctor with a lot of clout may be holding a block of rooms for his own purposes. These things happen all the time.

Is your Aunt awake and alert? As you probably know by now an ICU is an unpleasant place for patients and families. For this reason hospitals usually try to expedite awake and alert patients away from ICUs if possible.

141. ChristiPeters - 8/23/1999 9:09:06 PM

Oh, my poor Aunt is one of those walking miracles. Her heart was damaged by rhumatic fever as a child and she has had a pacemaker so long she's on her third one. No problems with them, they just wear out after 7-10 years or so.

She was in a major major car wreck when I was a toddler and had a stroke then.

Recently, she had an post-surgery infection (the pacemaker replacement) which kept her hospitalized on IV antibiotics for a couple of months.

She was scheduled for this valve replacement surgery awhile ago, but fell and hit her head and got a blood clot on the brain in the same area as her previous stroke. She had to recover from that before they could do this surgery.

She's 20 months younger than my Dad, so she's about 75 now. She is listed in "critical" condition in ICU.

For all the pain and trouble she has had in her life, she is unfailingly cheerful, deeply devout, and so sweet diabetics should stay away from her!

142. ChristiPeters - 8/23/1999 9:12:09 PM

Doc Brown - I think that my aunt is not awake. I only have my news second hand from my Uncle as passed on by my Mom. Mom is in Southern Michigan. My Aunt and Uncle are in Northern Michigan. I am in Texas. I want to go up there sooo bad, but can neither afford the airfare nor the time off work right now. It is driving me crazy.

143. msgreer - 8/23/1999 9:19:17 PM

ChristiPeters

I would expect the term "critical" to be used. What I would like to know is your Aunt "critical and stable.

stable in most medical settings means they have a blood pressure and pulse.

Have you thought of calling the doctor yourself?

He/she would need to know who you were before he/she would give out information but perhaps a family member in Michigan can make that call first.

It helps to talk directly to the doc.

And the nurses in ICU are usually helpful. But they will give information only to family members.

Let me know what's happening.

144. ChristiPeters - 8/23/1999 11:03:32 PM

I will. Thanks for the info that "critical" is "normal" in this kind of situation. I will call someone tonight.

145. Thoughtful - 8/24/1999 12:59:05 AM

MsG, I am with an HMO and I don't mind approval once a year for the drug, especially since it seems to be less effective over time for me. Besides, I've decided that my pain will be gone in Oct 99 -- 2 years after onset. I'm tired of it, so it'll be outta here!

Ranheim, yes I do save money with the HMO over the traditional health insurance -- provided I stay healthy. }:-) No deductible; OV=$15 co-pay; Rx=$12 co-pay; mail order Rx $11 for 3 month supply; no lab fees. This includes specialists provided I get a referral from Dr. first. Traditional plan was $250 deductible per person then 20% of all costs. But the HMO does put the screws to you if you want them to pay for something significant.

146. Thoughtful - 8/24/1999 1:00:11 AM

ChristiP, sorry to hear about your aunt -- sounds like she's really had a rough time of it. My thoughts are with you.

147. ranheim - 8/24/1999 1:02:23 AM

I just realized something! Dumb me!

Do most of you who belong to an HMO receive it as a perquisite?

I really shouldn't be posting as I'll be in Cape Cod for a week.

148. Thoughtful - 8/24/1999 1:07:05 AM

For me, the health care is provided by the company and it includes dental and some limited eyecare coverage. Funny, the company offers scads of life insurance -- are they trying to tell me something?!?

149. msgreer - 8/24/1999 2:31:36 AM

FOOD FOR THOUGHT

ABC Evening News reports the countries largest HMO, Kaiser Permanete, has a new plan in action in Colorado. If you belong to their HMO program and think you have an emergency and want to call 911 for an ambulance you have to call them first.

And who will answer the phone for Kaiser and make the decision whether you are having an emergency. Noneotherthan their technicians.

Training you ask? Most of the technicians you will reach have taken a 4 week training course.

Is this who you want making emergency decisions for you?

Paramedics in Colorado say the time it will take to make this call could be a life and death situation. They say certain emergencies can't wait while these Kaiser technicians decide whether you can ride in an ambulance. They contiunue to say it will cause great confusion among alot of people especially the elderly.

And this is going to all 50 states in 9 months

150. msgreer - 8/24/1999 2:41:13 AM

ranheim/thoughtful

the key words in thoughful's post on his HMO is "as long as I stay healthy".Good luck thoughtful. I fear where your HMO will be if you get very sick151. Dusty - 8/24/1999 3:16:42 AM

test test test test test

152. Dusty - 8/24/1999 3:17:16 AM

153. Dusty - 8/24/1999 3:17:34 AM

test

154. Dusty - 8/24/1999 3:18:01 AM

test

155. msgreer - 8/24/1999 3:19:35 AM

Dusty

Okay you all are testing the new format. I see this thread is back to the old look.

Someone stop me from saying "you all".

156. Dusty - 8/24/1999 3:19:51 AM

better but not yet fixed?

157. Dusty - 8/24/1999 3:20:52 AM

I fixed the width, but I can't seem to correct the italics

158. msgreer - 8/24/1999 3:22:45 AM

Dusty

I think it looks good this way. It is difficult to follow someone's post when it is so compact.

And why the arrows in the thread itself as opposed to at the end of the page?

I am sure there are reasons you are looking at new formats.

Test away.

159. Dusty - 8/24/1999 3:24:03 AM

You used a (em) tag, not normally used. I tried ending it but got an error, I'll try again.

160. Dusty - 8/24/1999 3:24:24 AM

There!!!

161. msgreer - 8/24/1999 3:27:51 AM

oops.

162. Thoughtful - 8/24/1999 4:07:08 AM

I know. Kaiser pulled out of our area awhile ago saying they couldn't make money.

A buddy of mine and his neighbor belonged to a local HMO that was started by area doctors. It ended up in bankruptcy and stopped paying bills. Fortunately, my friend only had a Dr. visit outstanding and only had to pay about $100. But his neighbor was receiving chemo and suddenly found out he was responsible for all those bills and bingo --over $100,000 in debt. Nice. Of course, the Drs who founded the HMO are untouchable, but you know they made money on the deal.

163. ChristiPeters - 8/24/1999 4:34:57 AM

I don't have an HMO, but rather a Network. If I go to a Network doctor, my health insurance pays 90%. If I live/work somewhere they have no Network or I need to see a specialist they don't have in the Network, they pay 80%. They pay 100% for cancer screening, annual exams, annual Superchem.

I can choose to go to a non-Network doctor/hospital, but then they only pay 50%. In an emergency, I can go to whatever facility is closest and I don't have to call them first. They pay 80% the cost of any meds, but if there is a generic and I (or the doctor) choose the name brand, they only pay 50%. There is no deductible to meet before they pay for the screenings and the meds, but there is for the rest of it.

I don't think I would work for a company whose only health coverage was through an HMO. I wouldn't join an HMO if I had any other choice.

164. msgreer - 8/24/1999 1:43:05 PM

Good morning friends

I continue to come to you from the hospital.

I got here at 5AM Eastern.

You have to get here early if you want to catch those doctors doing their rounds.

When you come to a hospital at 5AM it is a very quiet place. I should say the hallways are quiet as most nurses are doing charting and it is not time to go into a patient's room and wake them with the lovely light above their bed.

But it soon starts making all the unfamiliar sounds by 6AM. I say unfamiliar because any noise or movement to a person lying in bed can be a scary one. They don't know the routine of the hospital day and oftentimes a client will say "what is that noise, are they coming for me, is that the doctor in the hall?".

A hospital can be a frigtening place to be. I don't like hospitals myself and I know what is going on.

There must be a better way to help each patient feel more at ease while they deal with the health issue that put them in the hospital to begin with.

I feel posts coming from me on the politics of the hospital coming on.

Anyone have a hospital story of their own to share?

165. msgreer - 8/24/1999 1:51:50 PM

trike "coming on".

Excuse my grammar or lack thereof.

I hope to wake up any moment.

I might add the experience in a specialized unit as ICU or CCU is abit different than the Medical-Surgical Units.

166. msgreer - 8/24/1999 1:54:48 PM

cont.

In these units a nurse usually is assigned one patient. Of course this depends on staffing and the number of patients in the unit.

But is gives the patient one on one care and a true bonding experience begins between patient/family and the nurse.

167. alistairconnor - 8/24/1999 2:01:13 PM

I have never been hospitalised myself. The last time I was in a hospital was four years ago, before my father died (I am proud to say, he didn't die in hospital). It was rather eerie, because I used to spend a fair bit of time in that same hospital during the school holidays when I was a kid, annoying/helping the office staff - my father, a radiologist, used to work there in the sixties.

168. msgreer - 8/24/1999 2:46:40 PM

alistair

I agree with you on one thing. I would not allow any relative of mine to die in a hospital.

169. alistairconnor - 8/24/1999 2:56:04 PM

It's not easy, MsG. Once a dying person gets into hospital, it's not easy to get them out. Even for us, a medical family. My elder sister is a doctor, and I could see her being conservative about it, doing what doctors will do, wanting to be sure that everything was tried to keep him alive. When he instructed his doctors to stop giving him antibiotics, she had to admit, like them, that there was no point in him staying there. But even then, I had to do some moving and shaking to get him home, in time for it to make a difference for him.

Damn, I haven't thought about him much recently. I love him, and I miss him.

170. msgreer - 8/24/1999 3:11:03 PM

alistair

I know how difficult it is to get a doctor or even a family member willing to fight to get their loved one out of the hospital to go home to die. I am all to aware of what it takes. I have done it for so many of my clients over the past 10 years.

I have found it has gotten abit easier with Hospice becoming so well known and understood by families and doctors.

Living Wills also help when one wants to get the hell out of the hospital.

The medical establishment doesn't make it easy.

It makes you wonder about our system. When it comes down to it whose choice is it anyway?

If the medical establishment didn't look at death as a failure and realized it is going to happen to all of us it might help.

It is a natural event. And the wishes of the patient should always come first.

I didn't mean to bring up sad memories for you. I imagine you miss your father very much.

171. alistairconnor - 8/24/1999 3:16:57 PM

It's OK. I like thinking about him, and I enjoy the sadness too, if you know what I mean.

172. msgreer - 8/24/1999 3:22:38 PM

Alistair

Yes I do understand.

It may sound silly but whenever I watch a University of Michigan football game I think of my father and the years we watched UM football together. We had such fun.

And when UM fight song was being sung well we were up on our feet and singing.

And we were watching the game on television.

Wonderful memories.

173. ProfEmeritus - 8/25/1999 2:07:38 AM

Alistair and Ms Greer

I sure sympathize with your efforts, Alistair, and I am happy that they were successful. Your love for your father came through very clearly, and I am sure he appreciated what you did.

I have a son who is a doctor (internist), and he works out of a university hospital where he also teaches. He has written a text on internal medicine, and I proofed it. He made a special effort to induce doctors to be empathetic and take family feelings into account. He also practises what he preaches. He has told me of many cases (no names, ever) where he has encouraged the family to do what you did, Alistair. He is known as a doctor who has much feeling for patients and family. I feel certain that his patients would never need Ms Greer's services. I admire what you do, Ms Greer.

174. ProfEmeritus - 8/25/1999 3:03:25 AM

In the economics thread Thoughtful said that medical costs are falling because HMOs are becoming more popular. Popular is hard to believe. They have increased their senior patients because the cards are stacked in their favor. Medicare covers more for the HMO patients than for the independent patient. I would never choose an HMO after the many complaints I have heard from my senior friends who are forced to use them. Doctors are also very unhappy with HMOs because of their penchant for overruling medical decisions and the excessive red tape they require for patient treatment.

Ms Greer, these assertions are made by one who is only an interested observer, but no student of health care policy.

175. Thoughtful - 8/25/1999 4:53:36 AM

ProfE -- I didn't say with whom they were becoming more popular -- why those who foot the bill for medical insurance, of course...corporations and such. Earlier in this thread I posted the relative costs for us of the two insurance options my co. offers and the HMO version is cheaper --provided you stay healthy or provided you need care that is cheap, e.g., generic drugs, no unusual treatments. So the economic incentives are there. However, when they are hooking you into the HMO, they never tell you about the stumbling blocks they will throw in your way to make you pay more and them pay less.

176. ProfEmeritus - 8/25/1999 5:10:51 AM

Thoughtful

I figured that that was what you meant, and it is right. I just wanted to look at it from the user's viewpoint.

177. ChristiPeters - 8/25/1999 5:24:40 AM

I do not ever want to have to deal with health care for myself seriously ill. I hope and pray that I am healthy up until about two years past retirement, then I get hit by a truck or something and die instantly.I will thereby not only stave off lingering illness, but the prospect of being a homeless baglady all in one fell swoop.

178. ProfEmeritus - 8/25/1999 5:46:50 AM

Christi

At what age do you plan to retire? 99? At 65 your life expectancy with good health is probably about 15-20 years.

179. Thoughtful - 8/25/1999 8:05:36 PM

Yeah, a lot fewer of us end up in nursing homes than is commonly thought. I still am seriously considering buying nursing home insurance for hubby though as his mother, aunt, uncle, and grandmother all ended up there -- and he's so like them in so many ways. Considering I'm significantly younger than he, I suspect it would be good protection for myself...especially considering that without children, there will be no one to care for me in my dotage.

180. msgreer - 8/25/1999 8:23:00 PM

thoughtful

run don't walk in getting insurance for a nursing home as well as at home care.

you don't even want to know what nursing homes look like inside.,p>the abuse and neglect to our greatest resource .. the elderly... is widespread throughout the entire system.

a good nursing home costs anywhere from $3700-$4500 per month. anything else will buy you zero. and if you saw what it bought you you would never be able to place a loved one in such a facility.

it is important to get this kind of coverage BEFORE there is any diagnosis of dementia/Alzheimer's.

from years of experience i ask you to trust me on this one. should your loved one have any of the neurological degenerative disease diagnosis before you purchase this type of insurance you will not get it.

i will give you an example. i had a client who was showing the signs of alzheimer's. at that time she had no nursing home or at home insurance. i spoke to her children and said get her the insurance. right now. this is what is happening and if i take her to a doctor first

181. ChristiPeters - 8/25/1999 8:25:11 PM

ProfE -

Another 15-20 years!? Geeez, I hope not. Life isn't really all it's cracked up to be, y'know.

182. msgreer - 8/25/1999 8:26:38 PM

and get a dx. she will never get the insurance.

they did got her the insurance right away and within 6 months she was placed.

the insurance companies may not like my tactics but i don't live for their approval.

183. msgreer - 8/25/1999 8:27:30 PM

got=get

184. ChristiPeters - 8/25/1999 8:28:48 PM

msgreer -

...and your clients are darn lucky for it, too

185. msgreer - 8/25/1999 8:36:29 PM

ChristiPeters

thanks.

i just know what is out there.

i have no guilt whatsoever when i give suggestions like these to my clients/friends.

186. msgreer - 8/25/1999 8:39:12 PM

what happen to the rest of that post??

as i was so rudely interupted i was making the point it is not like the insurance business is one that makes it leaders live in poverty. and you can be sure they are getting good health care.

i could care less what they may think of my tactics. i don't much like theirs.

187. Thoughtful - 8/25/1999 9:37:21 PM

MsG., my mom-in-law is in a nursing home now. We paid down her assets at about $72,000 per year and now there are none. She's on medicaid. Of course, it didn't take long to go through it all, but fortunately her husband died a long time ago and her assets were just used to support her. It's a much bigger problem if there's a surviving spouse. My experience with nursing homes for the most part have been quite favorable. The places we've been are expensive, but clean, neat, careful and the people are caring. I've never seen any signs of abuse or neglect -- at least on the part of the workers. On the part of the families may be another story.

188. Judithathome - 8/25/1999 9:43:55 PM

msgreer:

Have you any suggestions of good policies to get (re:nursing home/home care) or companies to check out? What are the companies that give you fewest hassles in that regard?

If you would rather not answer me on-line, could you send me an e-mail? I have concerns because of family history on both my side and my husbands, too. JudithAtHome@mailcity.com

Thanks!

189. Thoughtful - 8/25/1999 9:50:31 PM

My company offers nursing home insurance and the open enrollment is in November so I think I'll check it out then -- they also just lowered the rates.

190. msgreer - 8/25/1999 10:29:32 PM

I want to add there are alot of dedicated CNA's and nurses that work in nursing homes. it is a VERY difficult job.,p.but there are many who feel the important of what they are doing.

i just wanted to give the recognition they have earned.

and there dedication to their clients and their families in never reflected in their paycheck.

i have made a list of 53 questions I ask when looking at any nursing home. afterall i have been doing it for 10 years. i also have a book with over 1400 pages which goes state by state and lists the best nursing homes in each county of each state. it also tells one when they were last visited for inspection, what was found and if corrections had to made they give them sometime to make the corrections.,p>anyone looking into a nursing home has the right to see these reports.,p>someone stop me. i could go on and on. i maybe giving more information that was asked for.

191. joezan - 8/26/1999 2:43:33 PM

My Managed Care Horror Story:

My sister is an RN, but hates working in hospitals. She raises and shows Irish Setters, and needs the freedom to be able to just take off on short notice for shows, etc. Quite often, she takes work through agencies which don't pay as much as she could get in a hospital, and offer little or no insurance benefits, just so she can have that freedom. Thank God she's always been healthy.

But about six months ago her asthma - which has not flared up in over 20 years - got bad enough that she had to go to the ER, and now has to have treatments. After that it wasn't that hard for my other sisters and myself to talk her into getting a "real" job, with benefits. So, she took a job in a doctor's office, whose employees belong to a HMO, and she's absolutely loved it.

Three days ago, she had a trainer over to her farm, attempting to break one of her horses, an Arab she's owned for a couple of years. After awhile she attempted to ride, and the horse took off like a shot, throwing her over the fence. When the trainer got to her she was still out cold, and remained that way till the ambulance arrived about 5 minutes later.

She woke up en-route to the ER not knowing who she was, and in great pain. At the hospital they checked her over and concluded she had a concussion, so she was sent for head x-rays. She had told the ER doc that she was having trouble breathing, and that she's asthmatic. So he listened to her chest and had the nurse administer albuterol. There was no skull fracture, so she was sent home with my other sister. Over the next 2 days her breathing was getting increasingly labored and the asthma treatments weren't helping, so she went back to the ER yesterday afternoon.

This time they sent her for chest x-rays, and found 3 broken ribs and a collapsed lung. They immediately inserted a chest tube...

...and sent her HOME!

Home...with a chest tube!

192. Thoughtful - 8/26/1999 3:31:46 PM

JoeZ, most interesting -- especially since my HMO requires you to pay for the ER visit if they don't admit you. Do they expect her to remove the chest tube herself? Or will they let a Dr. do that? Man! Maybe before too long, if you need surgery, they'll just issue a "do it yourself" kit, eh?

193. joezan - 8/26/1999 3:44:19 PM

Thoughtful:

Her plan requires a co-pay for ER care, whether she's admitted or not. And, if they determine the visit wasn't an actual emergency, she's gotta pay the entire bill.

When I was 18 I had a collapsed lung, with no other injuries (except for the hole where the knife went in) and had to stay in the hospital for 7 days! And the first 2 days were in intensive care! With all the trauma my sister suffered (she absolutely cannot move -everything hurts), you'd think they'd keep her at LEAST a couple of days...

When I found out she'd gone back to the hospital yesterday, and what they'd found, I called our pastoral care minister (an RN herself) who left work immediately to visit my sister. She was stunned when she arrived and found out they had discharged her.

194. msgreer - 8/26/1999 4:26:02 PM

joezan

what kind of hospital did your sister go to? it sounds like they have people walking around acting as if they were doctors.

I am sitting here trying to understand how they could miss a collapsed lung. the symptons she presented were enough for anyone working in ER that has a pea for a brain would be able to figure out.

has she spoken to her HMO to find out what their restrictions are on ER visits?

the hospital would know and if she had to give her HMO information to them perhaps that had something to do with it.

otherwise i have only one thing to add... everyone working on her that night are totally incompetent.

thank god she made it through.

a true horror story.

195. joezan - 8/26/1999 4:39:10 PM

msgreer:

Believe it or not, she used to work at this hospital - one of 2 big community hospitals in her county. She joked that perhaps that was why she received such crappy care. I don't know all the details of her coverage, but it was definitely a managed care decision.

I haven't said anything yet, but when I see her today I am going to suggest that she see a lawyer.

196. msgreer - 8/26/1999 5:02:43 PM

joezan

sounds like a good plan to me.

but remember we are not allowed to sue our HMOs just yet.

at time of service if she wanted to make a complaint she could have called her HMO and it would have gone through a review board which cantake weeks.

if you have been following the Patients' Bill of Rights discussions in the Senate you would see the Democrats want a clause put in allowing one to sue their HMO's. the Repubs do not. i say they DO NOT want the ability to sue in any Patients' Bill of Rights.

they say it would increase rates for all its members and price people out of getting coverage.

i don't know if the HMO's continue to treat life and death situations as they already do enough of thier folks will die and then new people can sign up for membership.

the HMO lobbyists have given the Repubs an enormous amount of money. and yes the have given the Democrats money too but about a third of what the Repubs have gotten.

197. msgreer - 8/26/1999 5:04:41 PM

thier=their

198. Judithathome - 8/26/1999 7:18:32 PM

msgreer:

I received your letter and thank you for responding in such a timely manner. I will look into this company first thing next week.

I hadn't really thought much about this until I read your remarks yesterday and it dawned on me, hey...this is not a bad idea at all and I really should check into it. Thanks again.

199. msgreer - 8/26/1999 7:23:02 PM

Judithathome

I hope it works for you.

Now I am off to the hospital again where I have been posting for the last week. I don't see I will have anytime to post until this evening but I will be back.

Carry on.

200. Thoughtful - 8/26/1999 7:27:38 PM

What's really interesting is reading about JoeZ's sister and how little care she's received vs. my Grandmother on Medicare who they couldn't do enough for. Man.

201. Judithathome - 8/26/1999 8:25:55 PM

To anyone who's been waiting with bated breath, as have I, for the bill to come in from my husbands visit to the ER last month: today was the day and I have the vapors over it.

$20.00......TWENTY BUCKS!!!!!!! I thought I had read it wrong. I am faint with relief.

202. ChristiPeters - 8/26/1999 9:14:38 PM

WHEW!

I'm happy for you!

He's all healed up now, right?

203. Judithathome - 8/26/1999 9:30:19 PM

ChristiP:

Yes, he's back in the "swing" of things, meaning he's already played golf twice and bought 2 new pair of shoes. I call him Imelda...he can not pass up a good sale on expensive shoes. (Thank god he refuses to pay full price for them!)

I was shocked that our insurance paid for everything. I guess I'd heard so many horror stories lately, I was just primed to be another one added to the pile. I suppose you can tell we rarely use our insurance...

204. ChristiPeters - 8/26/1999 11:16:04 PM

Well, that's the kind of shock that's nice to have.

205. msgreer - 8/27/1999 7:00:36 AM

judithathome

That is one good story about your insurance.

Please please enlighten us. What insurance company are you with?

Is it a HMO or private insurance?

If you choose not to share the name just say whether it is a HMP or private insurance.

Thanks

206. msgreer - 8/27/1999 7:01:23 AM

HMP=HMO

207. msgreer - 8/27/1999 4:03:24 PM

Thoughtful

CELEBREX ALERT

Trying to avoid errors and te need to re mane their wildly popular arthritis drug, Monsanto Co. and Pfizer In. have launched a campaign to make sure doctors and pharmacists don't confuse Celebrex with similar-sounding drugs. Celebrex sounds alot like Celexa, a depression treatment and Cerebyx, an anti seizure drug.

Since Celebrex was released in January, federal regulators have received 95 reports of dispensing errors blamed on health professionals confusing the pain killer with similarly named drugs.None of the cases involve serious injury of death...yet.

At the urging of the FDA, the companies have paid for advertisements in major medical journals to make sure doctors and pharmacists understand the difference between the soundalike drugs and the need to make sure they are writing out the right pill.

Marketing representatives are reinforcing the message during visits with doctors.

If the problem does not improve, the FDA could make the companies change the drug's name, which could threaten sales.

208. msgreer - 8/27/1999 4:11:41 PM

cont.

And you know anything that threatens a companies income will make them act quickly...atleast we can hope.

Monstanto already has changed the drug name fro Celebra, which federal regulators said sounded too much like other medications.

Of the 95 mix up cases, 22 involved a patient actually taking the wrong drug. With the rest someone caught the error in time.

"This is an accident waiting to happen" says Hedy Cohen, Vice President of nursing at the Institute fr Safe Medication Practices, a non profit group that tracks medication errors"."It's a matter of time until a person that is already sick gets the wrong drug and the chance for a erious injury can occur."

Celebrex has become the fastest selling new drug ever, with about 9.3 million prescriptions written since it debut. Sales of $1 Billion are expected this year, with upward of $4 Billion by 2002.

209. msgreer - 8/27/1999 4:16:42 PM

MORAL OF THE STORY

If your doctor hands you a prescription check it and make sure it is correct.

When you pick the medication up take a look at the name of the medication on the label. Make sure that is correct. Make sure your name is correct.

Once you pay for the medication and take one step out the door you own that medication. Even if you find a mistake after leaving the pharmacy you do not get your money back.

They will refill it correctly but you maybe out alot of money.

And make sure you have the pharmacist take the medication given in error off your records. Your insurance company knows everytime you get a medication filled.

From personal experience I have found if my damn records are going to be public I sure want them to be accurate.

210. msgreer - 8/27/1999 4:19:22 PM

HELPFUL HINT

If you are with your doctor and he/she recommends a medication for you ask him/her to CALL it into your pharmacy. They have all the phone numbers to call.

If you do that the medication will be ready for you when you get there. You won't have to wait while they fill it!

211. Judithathome - 8/27/1999 6:03:12 PM

212. Judithathome - 8/27/1999 6:04:51 PM

Toys, msgreer...toys. don't forget! Put 'em away.

213. Judithathome - 8/27/1999 6:05:57 PM

By the way, our insurance is Tri-Care, the coverage available to retired military.

214. msgreer - 8/27/1999 6:27:20 PM

judithathome

When I posted I had no idea it would come up in italics. I did nothing to try to post in italics.

So why did it happen?

I understand to put tags away but I am stumped as how the post went to italicas.

Any input up can give me I would appreciate.

It appears I need to go back and read the helpful tips CalGal has posted.

BTW, I am waiting for information on the second company I mentioned to you. I should have it today and will email you with all the information.

215. msgreer - 8/27/1999 6:28:56 PM

So why did the post above not come out in italics.

It is back to the books for me.

216. Judithathome - 8/27/1999 6:37:23 PM

msgreer:

Now all the italics are gone! Maybe the Mote doesn't like working on Saturdays. :-)

217. bloodnfire - 8/28/1999 2:24:05 PM

Missy, I didn't realize you were hosting a thread !, and here you have been so actively participating in Spiritual Issues. Anyway, forgive me. I have read half the posts in the Health Policy thread, and will catch up when I get back from work this afternoon.

Our cuddling is just great. Breasts are wonderful, (none more so than yours dear Missy), but brains are even more erotic ! My sincere compliments. :-)

218. bloodnfire - 8/28/1999 10:17:48 PM

Caught your post in the Spiritual Issues thread. Go ahead and explain what you do. It sounds most rewarding. Are you R.N. ? L.P.N.? Own your own business? WHAT? WHAT? WHAT? (You have already learned I am impatient :-). Whereabouts in Florida do you live? I just got back from a 1200 mile round trip down to Fort Lauderdale. I'm halfway between Tallahassee and Pensacola. Blessings on you. I really enjoy the weekends !! :-)

219. bloodnfire - 8/28/1999 10:27:40 PM

When you post, if you go over the 2,000 limit, highlight the excess in the 'Check for Dust' box. Put your cursor on 'Edit' and then 'copy'. Delete the highlighted part. Cast your mote with the remainder, then come back to the empty posting box, and after putting your cursor on 'Edit', 'paste' to the blinking cursor. Hope this helps?

220. msgreer - 8/28/1999 10:32:25 PM

bloodnfire

It certainly does help.

It was nice you took so much time to help me.

221. Thoughtful - 8/30/1999 1:19:20 AM

MsG. Thanks for the warning about the Celebrex -- I'll be sure to make sure I'm getting the right stuff.

You gotta wonder why/how they are allowed to name things so similarly.

222. msgreer - 8/30/1999 2:23:06 AM

thoghtful

I am so glad you saw the Celebrex post.

i have not been home lately. when i did come home i was always looking for you to tell you about my post.

It certainly does make one wonder about the need for similiarly-sounding medication.

You don't think it could have anything to do with MONEY do you?

I hope you are well.

223. bloodnfire - 8/30/1999 6:09:48 AM

Missy, you've got mail.

224. msgreer - 8/30/1999 8:53:44 AM

It is about 1am Eastern.

I got home from the hospital and as I usually do I threw my things down and headed for a hot bath.

I had spent another full day with my client.

Up until now I have choosen not to speak about this client. I am ready to post now.

The client is my mother.

I have been trying to get ahold of my own emotions and felt I could not talk about my mother until I felt abit more at ease.

I don't know how "at ease" I feel but I need to talk about my mother's medical issues.

Her problems started lasts April when she placed her companion of 8 years in a facility for the Alzheimer's patient. This is not a new experience for me or my mother because the two of us took care of my father for 8 years as he too had Alzheimer's Disease.

My mother went inot a deep depression after her companion was placed.

225. msgreer - 8/30/1999 9:01:23 AM

This fall was a serious one. And many of the symptons she presented with became worse.

At some point she suffered a second stroke. Her first one was in March '98. It was a very minor one and she was left with few problems.

But things began to change rapidly for her after this fall. Her headaches which were dull but round the clock became unbearable and she was put on a potent narcotic. She lost all gait/balance. She also lost her will to live.

I basically moved in with her. After watching what she was going through I decided she needed several medical evaluations.

My mother was checked by her internist, neurologist and a cardiologist.

The only concrete diagnosis was major depression. All her doctors felt her physical symptons were just apart of this depression.

As I said before she had sufferend another stroke.

To make along story short she ended up in ICU as an emergency case.

A CT showed she had a tumor in her brain as well as the fact she was bleeding in her brain.

She underwent immediate surgery to remove the tumor (which was benigh) and stop all the bleeders.

226. msgreer - 8/30/1999 9:06:13 AM

I was told she was critical and I should prepare for her death.

I was not ready to lose my mother and I just did not get into dealing with the possibilit she might die.

Post op complications set in and her brain began to swell. She was rushed back to surgery in order for a shunt to be put in to add in reducing the swelling. This is not an unusally complication of neurosurgery.

But I could tell I was losing her. And everyday when I was with her I could see this woman slipping further and further away from me.

I would like to add because I still have anger over this...I have 4 sisters. I called all of them and they were aware of the situation. I voiced a need for help. NO ONE came down to be with mom or me.

Now last Saturday I am home getting some down time when I get a call from some biggy at the hospital.

227. msgreer - 8/30/1999 9:13:32 AM

I was told my mother had taken a fall. I immediately said what are you saying were her guardrails down and she fell out of bed. She is still in ICU at this time.

No was the answer. 2 ICU nurses had gotten mom up for the first time to take afew steps to a chair so she could get out of bed and hopefully start healing.

These 2 highly trained ICU nurses DROPPED her.

Dont' even ask how that could happen.

We are taught in Nursing 101 how to break a fall.

In all my glory... I had pj's one, wet hair and no shoes I got to the hospital in record time.

When I got there my mother was still on the floor and screaming from pain. She had fractured her right hip.

After screaming at enough people she was given a large shot of pain medication.

I will leave out what I had to say to all the people who were huddled around her. I do know the President and CEO of the hospital was there and this is on a Saturday.

So now she is trying to recover from 2 neurosurgeries and she has a fractured hip too.

By the end of the day she was on the ortho unit in traction.

228. msgreer - 8/30/1999 9:19:06 AM

I got ahold of the only orthopedic surgeon I trust in this town. He came immediately.

But if all of this was not enough my mother was taking coumadin... a blood thiner given to her after her first stroke.

She could not be operated on until she was weaned off this medication and she had received enough Vitamin K so there would be no risk of her bleeding out while they gave her a total hip replacement.

Still no one from my family has shown up.

When it became crystal clear mom was critical and if any of my sisters wanted to see her alive again they would have to come before todays surgery.

Yes her hip replacement is set for late afternoon today.

2 of my sisters are coming but will not arrive before the surgery.

Did I mention I am named on her Living Will so all this time I have been making all the medical decisions. I still am.

My mother is still critical. And watching her die abit each day has been the most painful experience of my life.

As I have shared with some I am not ready to lose her.

229. msgreer - 8/30/1999 9:28:18 AM

It has been a nightmare from the very beginning.

I have advocated for her everyday.

I have watched every procedure and every medication she has received.

And I am listening to her telling me please leave me alone. I do not want to live. And I sure don't want to live this way.

I am totally exhausted. I do not remember when I got a good night's sleep.

My own doctor sent me home yesterday with medication and said get out of here and go to bed.

I ache. My heart aches. Sadness has taken over.

So now I have posted. I ask only for your prayers for my mother.

She is not out of the woods by any means.

There is no guarantee she will make it through her surgery today.

She just has so many complications to be going in for surgery again.

I don't know what else to say.

I don't know anymore words to describe how I feel or don't feel I should add.

I am hurting but in order to deal with this all part of me is numb.

I will keep in touch. I have asked ChristiPeters to post for me from now on and she has agreed to help.

I want to thank everyone who has had my mother and me in their prayers. It means alot to me.

I have to be at the hospital at 5am and it is close to 2:30am now.

I will see you again when there is time.

Thanks for giving me this forum to share my story.

230. bloodnfire - 8/30/1999 9:46:22 AM

We'll be thinking of you, and praying God to guide the surgeons' hands this afternoon Missy. Let us know how things go, and try to get some rest.

231. alistairconnor - 8/30/1999 9:47:34 AM

A big hug from me, MsG... I am listening, I am with you.

232. msgreer - 8/30/1999 9:52:44 AM

bloodnfire/alistair

thank you so much. i will take all the hugs i can get.

i did not even read what i posted. i just wrote it down.

i will make sure i get back to this thread and let you know how the surgery went.. i will be spending the night with mom so christipeters may post for me.

i have to be at the hospital so early because i have not signed the consent form yet. i have question for the surgeon.

i will take you hugs and prayers with me.

233. msgreer - 8/30/1999 9:54:32 AM

you=your

and how did those italics get in there alistair? i really did not post it that way.

234. SnowOwl - 8/30/1999 10:00:01 AM

My good thoughts are with you and your mother, msgreer. Please take good care of yourself as well as of your mother.

235. msgreer - 8/30/1999 10:22:27 AM

SnowOwl

I better start taking care of myself or I will find myself in the bed next to mom.

Thanks for your kind words.

236. ChristiPeters - 8/30/1999 4:13:44 PM

msgreer will, of course, be at the hospital all day today. However, she does have access to a PC and may get a chance to check in The Mote if you have any thoughts for her. If you don't have her email address and want to send her any messages, send them to me at christipeters@hotmail.com and I will pass them on.

I am praying for msgreer and her mother and any and all prayers and kind thoughts are welcome.

237. msgreer - 8/30/1999 5:17:07 PM

ChristiPeters

thanks so much for all your help.

i think everyone knows my emailaddress by now as i have posted it many times...

msgreer@home.com

They are taking mom down at 12Noon.

238. ProfEmeritus - 8/30/1999 6:01:21 PM

ms greer

I will be thinking of you and your Mom. I went through all that six years ago so I know how difficult it is on the family. We will pray for your Mom and put her in my wife's prayer chain.

I came over here to mention that I see my cardiologist in an hour to find out if my pacemaker and several medications are doing me any good, as shown by a recent echo-cardiogram. My wife is more uptight about it than I am.

239. PsychProf - 8/30/1999 8:14:51 PM

My best to MsG...

240. Thoughtful - 8/30/1999 8:42:51 PM

Oh, MsG, my heart aches for you. Your Mom is so unbelievably fortunate to have you in there fighting for her when she is unable to fight for herself. I know you have the strength to see this through, even though at times it may seem as though you don't.

Try not to think about your sisters -- they will have to deal with themselves. They are not your problem. Instead it's so important for you to focus on yourself and your Mom ... do what is necessary to see that you both come through this.

If it comes that you will have to say goodbye to your Mom, you will be able to do it with your heart open and your mind clear, knowing that you've done everything you can for her, knowing that you've been there for her, and knowing that no one can ever take away from you the things you both have shared...

Try not to borrow trouble -- take it as it comes. Deal with what you have to deal with as you have to. Don't try to take on any more than that.now that my thoughts are with you as you face this very trying ordeal, and know that I hope for the very best for your Mom.

241. Thoughtful - 8/30/1999 8:44:48 PM

That's "Know" my thoughts are with you....

242. Thoughtful - 8/30/1999 8:46:15 PM

ProfE, good luck with the cardiologist & the pace maker -- remember, you gotta have heart!

243. ChristinO - 8/30/1999 8:47:56 PM

MsG and ProfE,

My thougths are with you and your loved ones for successful procedures and speedy recoveries.

244. ChristiPeters - 8/30/1999 8:59:15 PM

ProfE - My Aunt has been on a pacemaker that she's worn out two of them (7+ years on each) and is on her third one. So they can be a real blessing and are tried and true technology.

Good Luck with yours!

245. ChristiPeters - 8/30/1999 9:00:27 PM

Hmmmm.....

I should have checked my dust

That should be "on a pacemaker so long that..."

246. ranheim - 8/30/1999 9:15:17 PM

I, too, feel for msgreer; I hope your prayers are answered.

Getting back a few posts to confusion arising because of similar names for Rx medication : I always write on my Rx what the medication is for; e.g. Take 1 tablet at bedtime to lower cholesterol. If your Rx bottles do not have the purpose on the label, ask your pharmacist if he/she would include that also.

Going way back : stays in a hospital when you can't see why or, actively, disagree with the medical establishment : sign out ama (against medical advice). This is not the Soviet Union! No hospital can DETAIN you against your will. I am not a lawyer; but, believe that signing out ama can be done even is every penny of the bill has not be accounted for.

247. DocBrown - 8/30/1999 10:05:09 PM

Msgreer, you and your family will be in my thoughts all this day.

Obviously you have a strong empathy for the experiences that medical and surgical patients go through in hospitals. You are concerned that your mother's complex condition will lead to a bad outcome.

Do not worry about that. The surgery is out of your hands and worrying about it only makes it worse.

FWFW, my Previous Employer was a major tertiary care hospital. I saw hundreds of complex "train wreck" cases, where the patient had multiple serious conditions at the same time. I know they have methods and treatments to deal with cases like your mother's, and the surgeons and MDs will do their best for her. Let them deal with it.

While they care for your mother you need to take care of yourself. Your mother's pain can be controlled with medication. Your pain is different. It can only be controlled by your own mind.

Be strong, msgreer.

248. theDiva - 8/30/1999 10:30:05 PM

Ms. G

Please tell me you've finally gotten some sleep. We'll continue to pray for you.

249. Thoughtful - 8/30/1999 10:52:50 PM

Re Rx, remember that with the internet, there's lot of Rx info available. For example, drugstore lists all the warnings, side effects, etc. for all the drugs they sell. I've also found useful info here.

250. ProfEmeritus - 8/30/1999 11:59:37 PM

You have been in my thoughts all day, even during my own long appointment with my cardiologist. I will email you about what was going on after everything is settled for you.

Thanks Thoughtful, Christin and Christi for the good wishes. The news couldn't have been better. A heart problem that could have been life-threatening has been reversed. The cardiologist was very pleased and said he didn't know if it was the result of the pacemaker (which he reset today), the medications I have been on since June or my life style. My wife volunteered that she thought is was a miracle.

251. ProfEmeritus - 8/31/1999 12:00:52 AM

The first paragraph was addressed to ms greer.

252. PsychProf - 8/31/1999 12:05:32 AM

ProfE...how do you plan to celebrate...how about "dance like noone's watching"...

253. ProfEmeritus - 8/31/1999 12:08:21 AM

PsychProf

254. ProfEmeritus - 8/31/1999 12:13:16 AM

PsychProf: My wife and I have already celebrated. We got on our bikes and biked to the Red Hook Brewery where I had my first beer in many moons and then a delicious lunch. I was told to be off alcohol until today; I had been a two glasses of wine consumer until that prohibition a couple months ago.

255. PsychProf - 8/31/1999 12:13:18 AM

Ha...ProfE...a concise post(253) w/o unnecessary rhetoric or verbosity.

256. ChristiPeters - 8/31/1999 12:17:03 AM

ProfE -

HOOOOOOORRRAAAAAAAAYYY!

I'm SO glad to hear your good news!



(now let's hope msgreer has good news, too)

256. PsychProf - 8/31/1999 12:17:03 AM

ProfE...let the good times roll.

257. ChristinO - 8/31/1999 12:19:44 AM

Wonderful news ProfE! Congratulations!

258. ChristiPeters - 8/31/1999 3:22:38 AM

More Good News!!!!

I just heard from msgreer. Her Mother's surgery was completely successful! Her mother came out of the surgery with flying colors, has been alert and coherent, and has expressed her great relief at the tremendous reduction in pain she has as a result of the surgery.

Msgreer is now home for a much needed sleep.

259. dusty - 8/31/1999 3:24:48 AM

Thats Great!!!! I'm glad to hear it!!!

260. bloodnfire - 8/31/1999 3:33:07 AM

Hallelujah!! Please God continue to bless MsGreer and her Mom. Help them both get some much needed rest.

261. arkymalarky - 8/31/1999 4:46:24 AM

I'm so sorry you and your mother have been having such a difficult time, Msgreer. Maybe today's good news of the surgery will be the beginning of a trend. You and your mother have my thoughts and prayers.

262. Thoughtful - 8/31/1999 11:58:18 AM

So glad to get the good news for MsG., MsGMom, and ProfE. I hope this is just the start of a serious run of good news for all.

263. ProfEmeritus - 8/31/1999 6:05:35 PM

Thanks all for helping me celebrate my good news. There was even more good news yesterday. My son found out from his neurologist that he wouldn't need an operation for a herniated disk.

264. vonKreedon - 8/31/1999 6:32:39 PM

I am so relieved to hear the abundance of good news from MsGreer and PE. As Thoughtful says, lets hope that this is the beginning of a run of good news for us all.

265. vonKreedon - 8/31/1999 6:50:27 PM

On the Health Policy front I offer the following for your consideration:

Science News
August 14, 1999
Vol. 156, No. 7

Modern Hygiene's Dirty Tricks
The clean life may throw off a delicate balance in the immune system
By Siri Carpenter

Sweeping along 14th-century trade routes, an infectious agent left a trail of incomparable devastation throughout Asia and Europe. In China, this plague slashed the population from 125 million to 90 million by the century's end. In Cairo, the Black Death, so called because of the dark, swollen lymph nodes that characterize the disease, claimed 7,000 lives a day at its height. Before it subsided, the plague had wiped out one-third of Europe's population.

In most of the world today, the plague has receded to a distant, if gruesome, memory. So, too, at least in developed countries, have smallpox, typhoid fever, cholera, diphtheria, and polio declined. One by one, infectious diseases that once ravaged society and preyed especially on children have been quelled by better sanitation, antibiotics, and vaccinations.

While raising barricades against deadly scourges, however, the industrialized world has also shielded people from the microbes and parasites that do no harm. Does it matter?

(Cont.)

266. vonKreedon - 8/31/1999 6:51:36 PM

A growing number of scientists now suspect that stamping out these innocuous organisms is weakening some parts of children's immune systems, allowing other parts to grow unchecked. Such an imbalance, they theorize, triggers a host of illnesses, including asthma, allergies, and even such autoimmune diseases as rheumatoid arthritis and the most severe type of diabetes.

This notion, called the hygiene hypothesis, arose from scientists' inability to explain the rising prevalence of asthma and allergies in many developed nations. The National Heart, Lung, and Blood Institute estimates that in the United States, for example, the incidence of asthma is now 1.75 times what it was in 1980, and for children less than 4 years old, 2.60 times the earlier incidence.

Pollution and allergens, such as mold and pollen, can take some of the blame, but not all of it. "One needs an explanation" for these trends, says Graham A.W. Rook of the University College London Medical School, who is one of the chief advocates of the hygiene hypothesis. "People should be getting healthier, not less healthy."

For several years, investigators have been uncovering signs that illness can result when the immune system lacks practice fighting bacteria and viruses. This evidence, however, has been circumstantial and too sparse to convince most scientists.

"It's greeted with some skepticism, and quite rightly, because we need more evidence," says Richard Beasley of the University of Otago's Wellington (New Zealand) School of Medicine. "In many respects, it's still early days, but the evidence is starting to build."

(Cont.)

267. vonKreedon - 8/31/1999 6:52:30 PM

Recently, several epidemiological and experimental studies have converged to put the hygiene hypothesis on firmer ground. Some researchers are already trying to create vaccines that mimic potentially crucial immune effects of the microbes that society has banished.

According to the hygiene hypothesis, the immune system is like a set of scales that sometimes tips sharply enough to send a person's health tumbling.

One arm of the immune system deploys specialized white blood cells, called Th1 lymphocytes, that direct an assault on infected cells throughout the body. Counterbalancing this, another arm of the immune system tries to hit the intruders even earlier. It produces antibodies that block dangerous microbes from invading the body's cells in the first place. This latter strategy exploits a different variety of white blood cells, called Th2 lymphocytes. The Th2 system also happens to drive allergic responses to foreign organisms.

At birth, an infant's immune system appears to rely primarily on the Th2 system. According to the hygiene hypothesis, the Th1 system can grow stronger only if it gets exercise, either through fighting infections or through encounters with certain harmless microbes. Without such stimulation, and ordinary colds and flu don't seem to do the trick, the Th2 system flourishes and the immune system teeters toward allergic responses.

(Cont.)

268. vonKreedon - 8/31/1999 6:54:19 PM

Early support for this view came from Julian M. Hopkin, now at the University of Wales Swansea, and his colleagues. In 1997, they reported on a study of 867 Japanese children given a vaccine against tuberculosis. Those who showed a strong Th1 response, indicating previous exposure to the bacterium that causes the disease, had far fewer allergies and asthma than did those who didn't show a Th1 response.

Furthermore, among the children who had allergies, some showed a decrease in allergy symptoms after receiving the vaccine. The ones with a strong Th1 response to the tuberculosis vaccine were six to nine times as likely to benefit as were children who did not have such a response.

In the past, some scientists speculated that the Th1 system required periodic infections, particularly in childhood, in order to develop properly, but most researchers now dispute that idea. Rook argues that the main problem may be that kids have become too squeaky clean. He suspects that children need contact not with disease-causing agents but with innocuous microbes in soil and untreated water, particularly organisms called mycobacteria, to give the Th1 system enough of a workout.

"The [lymphocytes] have got to be kind of marinated in this stuff in the early years of life," he says. If they aren't, he says, the Th2 system grows ever stronger, priming the immune system to overreact to allergens.

(Cont.)

269. vonKreedon - 8/31/1999 6:55:11 PM

Recent epidemiological research has further hinted that the cleanest environments may be the best breeding grounds for allergies and asthma. In the January Journal of Clinical and Experimental Allergy, Swiss researchers reported that hay fever was less common for farm children than for urban children or for rural children who didn't live on farms.

Several years ago, scientists found that children in large families,
particularly the younger siblings of brothers, had fewer allergies than children in small families did. Researchers speculated that exposure to the germs brought home by older siblings protected the younger children from allergies.

Bolstering that idea, a study in the Feb. 6 Lancet found that children from small families who entered day care before age 1 were less likely to develop allergies than those who entered day care later. No such difference emerged for children from larger families, suggesting that early day care may have stood in for the protection provided by dirty older siblings.

The antibiotics that thwart infectious diseases may also be spurring some immune disorders by killing off beneficial bacteria (SN: 11/22/97, p. 332). In the November 1998 Thorax, Hopkin and his colleague Sadaf Farooqi, now of Adenbrookes Hospital in Cambridge, England, reported that children who received oral antibiotics by age 2 were more susceptible to allergies than children who had no antibiotics, a finding that Beasley's group in New Zealand recently replicated.

The results, says Hopkin, may indicate that antibiotic treatment, which depletes the harmless bacteria within the gut, derails normal immune development in early life. A study in the May 1 Lancet by researchers in Sweden reinforced that idea: Children from families that avoid antibiotics and vaccinations have fewer allergies than other children do.

(Cont.)

270. vonKreedon - 8/31/1999 6:55:56 PM

Encouraged by the epidemiological studies that support the hygiene hypothesis, some investigators are now trying to prevent illness by pumping up the Th1 system artificially. A team led by Stephen Holgate at the University of Southampton in England is conducting human trials of a Th1-inducing vaccine to counter asthma. The vaccine is made from a mycobacterium called SRL172. In a preliminary analysis, the vaccine appears to dampen asthma patients' symptoms, the researchers announced last month. They should complete further immunological and clinical analyses by the end of September.

Despite promising advances, however, scientists acknowledge the limitations of the hygiene hypothesis. "We're desperately oversimplifying," says Rook. "We don't understand, really, why sometimes Th2 responses go crazy. Even I don't think [Th1-Th2 balance] is going to be the whole story. These are terribly complicated phenomena."

Without proper training early in life, some research suggests, the immune system can grow confused and lash out at inappropriate targets, including digested foods in the gut. At the University of Iowa in Iowa City, Joel V. Weinstock, David E. Elliott, and Robert W. Summers are examining the possibility that immune imbalances may contribute to the rising incidence of inflammatory bowel disease, a condition in which the lining of the intestines becomes chronically inflamed.

Unlike Rook, however, the Iowa researchers propose that the scales tip too sharply toward Th1 responses, leaving the Th2 response weakened. "Overall, I would disagree with Dr. Rook that we have severely altered our Th1 exposures," Elliott says. "It's true that we've limited our exposure to tuberculosis, and many of the viral agents have been controlled by vaccines. However, we still contact many, many viruses and bacteria that provide us with more than adequate Th1 experience."

(cont.)

271. vonKreedon - 8/31/1999 7:03:50 PM

Weinstock's group proposes that the Th1 dominance stems from a lack of parasitic worms called helminths. Despite parasites' bad reputation, the researchers contend that helminths are important members of the intestinal community. Throughout evolution, they say, the human immune system has grown to depend on helminths to suppress overly aggressive Th1 responses to bacteria, viruses, and dietary proteins. Because modern sanitation has largely eliminated intestinal parasites, the immune system sometimes begins to attack the lining of the gut.

In May, the scientists reported at the annual meeting of the American Gastroenterological Association in Orlando, Fla., results of experiments in which they induced in mice a condition similar to inflammatory bowel disease. Mice deliberately infected with helminths, however, were protected from the disease. Collaborating with another group, Weinstock's team has begun to investigate similar treatments for animals with autoimmune disorders, in which the immune system attacks parts of its own body.

The team has also begun treating a few patients suffering from inflammatory bowel disease by giving them a drink spiked with eggs from a harmless whipworm. Of six patients studied so far, all showed substantial improvement in their symptoms, the researchers reported at the May meeting.

The research is only an initial foray, the Iowa researchers caution, and controlled clinical trials are essential for evaluating the effectiveness of the treatment. Furthermore, they say, the precise role of Th1-Th2 balance in inflammatory bowel disease remains unresolved, as does the seeming contradiction between their research and the hygiene hypothesis' assumption that Th2 responses usually overpower Th1 responses.

(Cont.)

272. vonKreedon - 8/31/1999 7:04:52 PM

By separating people from their dirty origins, the modern antiseptic environment may have also provoked the medical equivalent of friendly fire: autoimmune diseases such as rheumatoid arthritis and type I diabetes.

The radical notion that infrequent exposure to infectious agents contributes to autoimmune diseases has generated far more controversy than the idea that allergies and asthma stem from such deprivation. In fact, says Michael B. Oldstone of the Scripps Research Institute in La Jolla, Calif., most scientists hold the opposite view, that if anything, infections help drive autoimmune diseases (SN: 6/21/97, p. 380).

However, a group led by Irun R. Cohen at the Weizmann Institute of Science in Rehovot, Israel, believes it as evidence to the contrary. These researchers find that rats raised behind germ-free barriers are more prone to developing arthritis and diabetes than rats raised in normal, germ-filled environments are.

According to Cohen, rats in the ultraclean environment don't develop the immune cells that can suppress autoimmune responses. If that's the case, he suggests, it may be possible to develop a vaccine to stimulate the aspects of the immune system needed to avoid autoimmune disorders.

"The immune system organizes itself through experience, just like the brain," Cohen argues. However, he notes, other factors, such as environmental toxins, probably also prompt autoimmune reactions. "I don't think cleanliness is the only problem. It's a complex system. The first thing is to ask the right questions, but we have to be patient about the answers."

(Cont.)

273. vonKreedon - 8/31/1999 7:05:05 PM

Ultimately, it may be that asthma, allergies, and other immune disorders are the price society has to pay for escaping the appallingly virulent infectious diseases that have struck down children over the centuries. Scientists aren't quite ready to accept that proposition, however.

"We might be able to do something clever that can actually get the best of both worlds," says Beasley. "I think, at the end of the day, that will be the challenge, because we certainly don't want to go back to the days of old."

(END)

274. ranheim - 8/31/1999 7:54:17 PM

vonK

A very interesting article.

I first read about this 10 or 15 years ago; that time in regard research into the HIV virus. More recently, as more and more vaccines are coming on the market, one hears about this from people who are in the anti-vaccine community. The most recent ruckus - a very small one -had to do with the Hepatitis B vaccine (I think its B - I don't personally give this vaccine - and my youngest is 30). A man who has access to both money and a financial newsletter lost a baby to this vaccine in the past year. However, he does not, by himself, have enough clout to over-come the riches of Merck - one of the makers of this vaccine.

Another group who is beginning to wonder is a few, conservative (in medicine - not politics)Pediatricians. But, in order to belong to the "union", they can't say too much.

Personally, for those of you with babies and young children, I can't see the utility of the very expensive series of 3 Hepatitis B vaccinations. This is almost totally a sexually transmitted disease (STD) - not quite 100%. I, personally, would not give it to any child of mine. I have 2 grandchildren; but, my son works for Merck (in their vaccine dept.). And he thinks dad is an old, fuddy duddy!

275. Judithathome - 8/31/1999 8:02:27 PM

In Hawaii, before you can start your child in school, you have to have a Hepatitus vaccination but I'm not sure which one.

276. ranheim - 8/31/1999 8:24:02 PM

The same is true in Louisiana.

But, you can go to your doctor and get a waiver.

277. ChristiPeters - 8/31/1999 8:24:45 PM

JudithAH -

I have now bought some glucosomine-chondroiten (or however you spell that), but haven't taken any yet. The pills are HUGE. I'm not sure I can swallow them.

Once I get up the courage to try, and assuming I succeed, is this something where I should see results right away or does it take awhile?

278. Judithathome - 8/31/1999 8:30:27 PM

It will take at least a week but probably more like two. I can miss 3 days worth and feel a difference but when I first started them, it took close to 2 weeks before I felt any improvement.

I know they are huge pills but you'll get used to them. I take an amino complex that is the size of a small pecan. I probably take more pills in a day than most people take in a month.

279. ChristiPeters - 8/31/1999 8:39:46 PM

Thanks, Judith. I'll try to start them tomorrow. I have been able to reduce my elavil from 50mg to 20mg, but lower than that and the pain is so distracting I can't work - it just sort of takes over. I haven't been pain-free in 15 years and probably never will be, but if I can keep it manageble without the side effects of the elavil, I'll be happy.

280. Judithathome - 8/31/1999 8:43:23 PM

Christi:

I took elavil back in the 70s but I thought I was taking it for manic depression? I was also on triavil...I remember we called them Ts & Es. Knockout combo...

281. Thoughtful - 8/31/1999 8:48:11 PM

I've taken glucosamine/chondroitin as well and I found it helps some, but not completely in relieving my pain. But I've heard lots of good things from others. The pills are huge though.

VonK, interesting article. Don't know where this all fits in, but in reading the article, a number of things came to mind --

People with intractable Lyme disease have found relief via Dr. Heimlich of the Heimlich maneuver fame, by getting themselves infected with malaria. Some suggest that there is a genetic component to lyme disease whereby some people's immune system can't recognize and thus won't fight the disease. Seems the malaria engenders such high fevers and strong immune responses that the lyme disease is killed off as a side effect.

Some have suggested a strong psychological element to allergies seeing as there is nothing inherently harmful from allergens. An example was someone who suffered severe hay fever until he recalled that at the farm as a child he was frightened by a tractor. Once he remembered it, his allergy went away. The body recognizes the stress reaction and looks for something causing the stress -- in this case the hay dust being breathed in -- and reacted as if it were harmful. Whether it's true or not, who knows? The immune system is so complex, it's hard to sort out what's what at this point...as the article itself suggests.

Interesting stuff nonetheless.

282. theDiva - 8/31/1999 8:55:11 PM

Christi

I've been taking the glucosamine since just before we left for Vermont, and I've felt the difference already. It took about a week for them to kick in.

283. ChristiPeters - 8/31/1999 9:32:09 PM

JudithAH - Elavil was originally developed as an anti-depressant. However, it is now prescribed as much for it's side effect of relieving nerve pain and as a sleep aid as it is for depression.

It is the only thing that has been able to control my pain without fuzzing my head up. A lot of traditional pain killers just plain don't work for me, including some pretty classic powerful ones. I don't know why, but my Dad had the same reactions as I to the same meds.

Elavil, however, has caused runaway weight gain for me. It looked like my choice was pain managed, but fat (with accompanying complications) or slim and in agony. Then I spent 18 months under the care of a pain specialist. Five procedures on my spine have greatly reduced my pain, but not eliminated it entirely.

284. Judithathome - 8/31/1999 9:54:46 PM

I think I recall a weight gain with elavil, now you mention it. I don't recall much about the 70s because I was on so many psycho drugs...my doctors mistook a bad marriage for insanity.

285. JJBiener - 8/31/1999 10:22:28 PM

Judith - my doctors mistook a bad marriage for insanity.

I think that is still a fairly common problem.

286. ChristiPeters - 8/31/1999 10:31:39 PM

JudithAH - according to my doctor, 100% of people on Elavil gain weight, but some more than others. Apparently my body, while being able to completely ignore percodan, morphine, darvon, sodium-penathol, valium, and various other meds we tried, goes absolutely overboard crazy on Elavil. I gained 80 pounds on 950 cal/day.

287. ChristiPeters - 8/31/1999 10:33:34 PM

JJ - It's not as common as it used to be, thank God, but it's still out there. The trick is to go to a young therapist and if you can find a female, so much the better.

The medical doctors who prescribed hysterectomies for unhappy women are also gradually being weeded out by retirement.

(IMO)

288. PsychProf - 8/31/1999 10:43:07 PM

ADHD Overdiagnosed

289. Judithathome - 8/31/1999 10:46:33 PM

Christi:

Message #287...been there, done that.

290. ChristiPeters - 8/31/1999 10:48:04 PM

hmmmm...

I don't know what's going on PP, but I haven't been able to follow your link. When I put my cursor over it, I see the URL on the bottom of the page, but when I click all that happens is that the butter-colored column on the right of the page blinks and turns clear rather than butter-colored.

I am having problems today. My Netscape communicator can't find the company home page. We also have IE on our PCs so I'm using that to get to the company intranet stuff. So the problem is likely on my end.

Could you post the URL without making it a link? Then I can just cut and paste it.

291. ChristiPeters - 8/31/1999 10:49:01 PM

Juditathome -

Empathy!

Sympathy!

292. ChristiPeters - 8/31/1999 10:49:46 PM

uhhhhh....

I typed "Judithathome"

honest! I did!

293. Judithathome - 8/31/1999 10:50:56 PM

PP:

It worked for me...I must say, 6% seems low; I think all 6% go to the samr restaurants I frequent, tho.


By the way, I fear my mouse is dying...how do you "repair" a sluggish mouse?

294. PsychProf - 8/31/1999 10:52:13 PM

Christie...hereyago...http://www.cnn.com/HEALTH/9909/01/adhd.overdiagnosis/

295. Judithathome - 8/31/1999 10:52:23 PM

Christi:

That's okay....you just typed in Italian!

296. ChristiPeters - 8/31/1999 10:58:03 PM

Thanks PP, interesting article. I have a nephew who is ADHD and i think he was correctly diagnosed. However, my next-door neighbor (in my old neighborhood) has a son diagnosed as ADHD and I think his problem more likely stems from a total absense of parental discipline and guidance. She doesn't even follow a consistent schedule with his Ritalin. She just gives him some whenever he is "hard to handle". So somedays he gets none, somedays he gets six or seven doses.

shudder

297. PsychProf - 8/31/1999 11:00:35 PM

Judith...indeed...my sons were tough at the ages of 2-4, so we ate at home more often. No ritalin for them.

298. Judithathome - 8/31/1999 11:15:50 PM

PsychProf:

I did the same, tho my son was usually well-behaved in public. But today, parents act as tho we should all be part of their psycho drama. I loathe seeing indifferent parents calmly grazing away while their kids wreak havoc on my dining experience.

299. PsychProf - 8/31/1999 11:18:06 PM

Judith...Ms PP, who shares your view, freezes them with a look that is well practiced...sometimes anyways...

300. Judithathome - 8/31/1999 11:31:41 PM

PP:

I did that once in the grocery store when a little cretin was yammering at the top of her lungs for chocolate: I glared in her direction and she started to weep to her mom, "Mommy, that lady looked at me!!!!"

301. ChristiPeters - 8/31/1999 11:34:43 PM

Judithathome and PP -

I totally agree with you both. I take Lil' Darlin' to restaurants. However, the kind of restaurant has always been age-appropriate. Also, for us, going to a restaurant is a combination of special treat and time to practice in public the manners we have been working on in private. At 11, she is old enough and practiced enough for just about anywhere, except for an unfortunate habit of occaisionally using her fingers to persuade fork-reluctant food to give in to it's fate.

302. ChristiPeters - 8/31/1999 11:35:42 PM

Powerful weapon ya got there, lady -- mine only seems to work on my own kid.

303. Judithathome - 8/31/1999 11:45:25 PM

I only use "the evil eye" in extreme cases.

304. Uzmakk - 8/31/1999 11:46:05 PM

Christipeters, was it you who recommended Raymond Chandler to me?

305. ChristiPeters - 8/31/1999 11:53:42 PM

Uzmakk - I don't think so. It probably was ChristinO. I am so used to being an alien in society, I seldom recommend any reading to anyone on the assumption that only the weird would like what I like.

306. Thoughtful - 9/1/1999 12:11:50 AM

Christip, re weight gain and elavil, I didn't gain any weight with elavil, though I was only on it 1 month. My mom in law & father have been on it for a few years without any weight gain. (Mom in law's weight is up 30 lbs. now, but that's because they feed her too much crap in the nursing home.) My dad actually has lost some weight while he's on it. When I was on Prednisone for 6 mos, I gained only about 4 lbs. though my face got noticeably rounder. On estratest, my weight shot up 4 lbs. in a week, but it was water weight which went away within a week after I stopped it.

307. ChristiPeters - 9/1/1999 12:12:46 AM

The reverse is not necessarily true. So feel free to recommend any good reads to me.

I am currently working my way through spudboy's book, magnifying glass firmly in hand.

308. ChristiPeters - 9/1/1999 12:14:26 AM

I used to read a book a day. I've been a bit busier the last few years. So I usually take two or three days to read a book now. I am always eager for 'new blood'.

309. Judithathome - 9/1/1999 12:27:48 AM

thoughtful:

Estratest is vile: I gained about 25 pounds on it over 6 months and went to the doctor with severe edema in my legs; he was stunned and took me off it immediately.

310. ChristiPeters - 9/1/1999 12:35:44 AM

thoughful - Interesting. I'm glad to know that tere are some who get more benefit than side effect from elavil. I wonder where my doctor got his 100% figure? Maybe he was simply being kind? or sympathetic?

shrug

311. glendajean - 9/1/1999 12:36:30 AM

If I ever sit next to any of you on a long flight, I hope that the conversation will be a little lighter. :)

312. ChristiPeters - 9/1/1999 12:39:01 AM

Anyway, it's pretty obvious that, for me, the elavil is the cause of the weight gain. Evidence = 1)weight gain with no change in lifestyle or eating habits with elavil; 2)continued weight gain with decrease in calories and increase in activities with elavil; 3)weight loss of ~10lbs/mo with no change in lifestyle but reduction in elavil.

msgreer has told me that other anti-depressants also are known to cause weight gain.

313. ChristiPeters - 9/1/1999 12:40:03 AM

Well, it is the Health Thread.

So we're talking about Health.

314. glendajean - 9/1/1999 12:43:30 AM

I once read that Wellbutrin was supposed to curb appetite and increase sexual interest.

The tricylic anti-s decrease sexual interest. (and make one dizzy when he or she stands up too quick).

315. glendajean - 9/1/1999 12:46:43 AM

Christi -- I was just kidding. You're right. This is the health thread.

And so I must depart. Partner and I are off for a long Labor Day weekend. All best to you all and see you again Monday or Tuesday.

316. Judithathome - 9/1/1999 12:48:37 AM

glendajean:

I don't talk about anything depressing on an airplane. On a flight to Germany, the guy I sat next to said he was delighted to chat with me; we talked books, movies, and plays all across the ocean. Of course, I'd have rather spent my time on the plane with my husband but he was already IN Germany.

317. ChristiPeters - 9/1/1999 12:48:49 AM

Enjoy!

318. ChristiPeters - 9/1/1999 4:02:45 AM

geeez, wha' happened? Did I kill the thread?

319. Thoughtful - 9/1/1999 7:36:10 PM

Either that or we all got healthy really quick!

How's MsG doin? I've been thinking about her and her situation a lot.

320. Thoughtful - 9/1/1999 7:37:54 PM

Does anyone know/remember the name of that tea that's supposed to help with toe fungus? I've picked it up -- very disappointing as I've always had healthy feet -- I walk barefoot a lot. Doc had me on lamisil and now on spondex? But I remember a long time ago Ann Landers or someone publishing letters from people who swore by this particular tea -- not for drinking, but for soaking one's toes in.

321. Thoughtful - 9/1/1999 7:39:09 PM

Hmmm. That was interesting -- I just got an little pop up screen asking me if I put my toys away when I didn't use any. Hmmm... AC, are you messing around again?

322. Dusty - 9/1/1999 8:42:17 PM

Thoughtful


That message appears at the bottom of your preview screen in every instnace. If it isn't in normal type, then you may have a problem.


I have had a problem with foot fungus. My doctor told me to soak my feet in tea, but it wasn't any special kind. We just bought the cheapest available. It worked!!!

323. ChristiPeters - 9/1/1999 8:49:07 PM

I have not heard from msgreer since she called me Tuesday night to tell me her mother's surgery was successful. She was expecting one of her sisters to arrive Wednesday and another today. So she may be very busy taking care of her Mom and catching her sisters up on all the particulars.

324. JJBiener - 9/1/1999 11:16:17 PM

I got an email from MsGreer today. She is doing all right although she is a bit frazzled by everything. I expect she'll be posting again in a day or two when things even out.

325. ChristiPeters - 9/1/1999 11:27:55 PM

JJ - Yep, I just heard from her, too. I have the same impression, frazzled and busy, but basically ok. She's probably doing a bit of lurking even as I type.

326. Thoughtful - 9/2/1999 12:16:23 AM

Thanks for the update -- my thoughts are with you MsG. My mom went through a rough time with her Mom up til her death last year and I know difficult doesn't even begin to describe the emotional hell these things put you through.

Sigh. It ain't easy being human.

327. Thoughtful - 9/2/1999 12:17:21 AM

Dusty, I musta hit the dust button accidentally as I never preview. Thanks. (I like Dusty better than the old handle BTW.)

328. Dusty - 9/2/1999 12:22:57 AM

Thanks. That's part of the reason I picked it.

329. msgreer - 9/2/1999 12:34:35 AM

hey the saying is "it not easy being green". aren't you a sesame street person?

330. msgreer - 9/2/1999 12:36:13 AM

i really did not feel like talking to anyone but i ready everyone's kind words i thought i would jump in.

and "it'snot easy being green" by none other than kermit the frog is and my daughter grew up on...

331. msgreer - 9/2/1999 12:37:55 AM

i can't put two thoughts together. i apologize.

maybe i need to get out more.

332. Dusty - 9/2/1999 12:45:19 AM

Nice to see you msgreer

333. msgreer - 9/2/1999 12:48:22 AM

It is wonderful to see everybody.

I was getting worried about the cocoon I had built around myself.

thanks to everyone.

i will never forget all of the support i am getting from all of you.

you're helping me more than you will ever know...hell i might just take a real shower and wash my hair.

334. msgreer - 9/2/1999 1:03:03 AM

HEALTH POLICY in the USA A TRUE STORY

Dr. A orders a certain medication for patient X. He discusses this with Ms.X's daughter. She approves.

Ms.X's daughter is reading her mother's chart and sees the medication ordered is not what comes up from pharmacy. pharmacy has sent another medicaition.

The daughter said how did this happen?

The wonderful honest nurse says it is the committee downstairs.

What commitee the daughter asks.

It seems their is a committe of administrators and doctors that look at all medication orders and decides if there is a cheaper medication that can be substituted.

it also seems the hospital has made a deal with several HMO's that if the hospital will use their medication they will give them 50% off on that medication. It also seems these HMO's have a list of medications they say are the same as any specific medicaition the doctor has ordered.

that is how the change was made. The doctor that ordered the medication was quite surprised when the daughter called him to discuss the situation.

335. msgreer - 9/2/1999 1:07:03 AM

The doctor was pissed and said don't they know this medication cause psychotic episodes in the elderly?

the daughter says yes i know it does.

the nice and very pissed off doctor says not to worry he will take care of it and he does.

NOW I ASK YOU is this acceptable to you?

Is it acceptable for a commitee to be making these decisions with an HMO without the patient knowing?

What happens to all of us if someone is not watching what goes on in the hospitals all across America.

I welcome anyone's opinions.

336. JJBiener - 9/2/1999 1:28:41 AM

Having spent a lot of time as a patient in various hospitals, I can attest to the fact that having an advocate watching out for you is extremely important. In my case my wife was able to do it. She was able to listen to doctors, ask questions, and keep track of everything when I was in no condition to do so. There were several times where she caught nurses ignoring orders, mistaking orders, and simply missing orders. There were also interns and residents who felt like they order anything they wanted even though I wasn't their patient.

I am not surprised that some doctors think they have the right to contradict another doctors orders. It reminds me of the old joke:

What is the difference between a doctor and God?

God doesn't think he is a doctor.

337. bloodnfire - 9/2/1999 1:31:56 AM

Hi Missy !! Good to see you back. What happens if there aren't advocates and overseers like you, is what happened to your Mom. The corrupt influence motivated by profit only, substitutes and 'second guesses' the doctors. You sound like you're recovering well. :-)

338. msgreer - 9/2/1999 1:59:37 AM

bloodnfire

i have had such wonderful support from the folks here i just took a deep breath and jumped back onto theMote.

my recovery will take some time. i am doing what i can for myself.

JJ

that is just one story of many i have re my advocacy work. you have it right when you say the greed motivation.

it makes me sick to my stomach.

i have never won a popularity contest with the hospitals here. and i could care less. i know my clients are being taken care of properly.

you were lucky to have your wife looking after you when you were in the hospital.

i tell everyone i meet please take someone with you if you have to go the er or you are going to be admitted into the hospital.

the thing with the true story i told is what must be happening to hundred of thousands or people who have no one to ask the hard questions. the ones who believe their doctor could do no wrong. and certainly the hospital has their best interests at heart.

339. msgreer - 9/2/1999 2:05:42 AM

JJ

those residents and interns are under the watch of a physician. they always feel they have to show they did something.

TO EVERYONE NEVER HAVE AN OPERATION IN JUNE. that is when the new residents and interns come in and they know shit about medicine at that point.

i should say NEVER have elective surgery.

340. AdamSelene - 9/2/1999 2:33:39 AM

Has anyone heard of the Mayo diet? It advises to eat bacon, etc., drink lots of grapefruit juice, and avoid starches? Well - the Mayo Clinic reports that it's a fraud.

However, my brother-in-law used a virtually identical diet and lost 25 lbs in 2 weeks, while stuffing himself on steak and other allowed foods.

The rational is supposed to be that the body makes most of its fat and cholesterol and that dietary fat and cholesterol is trivial. So the diet eliminates the precursers while allowing the real thing.

My first reaction was: bullshit. But when my BIL (who is much more gullible) tried it and lost 25 lbs... It made me wonder.

Any info out there in Moteville?

341. ChristinO - 9/2/1999 3:20:43 AM

Thoughtful,

You're looking for Tea Tree Oil. It is an extremely potent antifungal/antibacterial agent that's turning up more and more in the mainstream marketed products. It comes from the melaleuca (sp?) plant which currently only grows in Australia, I believe. In any case it is a miraculous thing and it will kick the crap out of foot fungus.

Make sure you dilute it, however, as it can irritate the skin----not always and not everyone but better to be safe than needlessly irritated. It will sting a little bit if you have abrasions but it's no worse than Bactine.

You can get it at most health food stores, I imagine. I used to have (maybe still do somewhere) a little booklet about 101 different things tea tree oil is useful for.


I'll send this to your e-mail in case you don't check by here.

342. ChristinO - 9/2/1999 3:30:02 AM

Adam,

I don't know anything about the Mayo Diet, but if he was allowed steak and bacon but not starches it sounds to me like it's based on the premise of ketosis. Yeah, it works, but it's impossible to maintain for long periods of time, you have to be careful not to dehydrate yourself, lack of starches and carbohydrates can increase your stress level and as with any rapid weight loss the body may tend to develop gall stones.

Ketogenic diets were a huge thing in the mid-to-late 80's because they got results so fast, but the bottom line is that they can be very dangerous particularly if you aren't under the care of a physician or dietician/nutritionist. They will take off weight quickly but they don't build good eating habits and the potential for long term harm is great especially for people who gain back the weight and then lose it again to gain it to lose it etc.

343. Thoughtful - 9/2/1999 4:29:45 AM

Thanks, ChristinO. Somehow, though, that doesn't sound like the tea I'd heard about. It had a specific -- odd -- name that I can't remember. However, sounds like even regular tea might do it. Probably something to do with the acids in tea that make life unpleasant for fungi. If the plant is the maleluca, they grow in FL and I know the plant can be very irritating.

Adams, see here for the negative side of ketogenic diets. Most people I know just can't maintain the diet for too long as people, especially overweight ones, crave carbos. I much prefer a sensible diet like weight watchers (I'm a lifetime member) that allows you to eat like a normal human being. You can eat anything you want -- just not as much or as often as you might. It also helps you choose healthy foods.

After all, you can loose weight eating nothing but chocolate, depending on total calorie intake, but it wouldn't exactly be healthy.

344. Thoughtful - 9/2/1999 4:44:46 AM

OK, I found the name of the tea: Pau d'Arco tea.

345. AdamSelene - 9/2/1999 4:57:37 AM

Thoughtful,

Thanks. Now if I can just convince my brother-in-law that those 25 lbs don't really matter and he really shouldn't be buying that new wardrobe...

346. msgreer - 9/2/1999 5:05:50 AM

Adam

if you want to know the physiology of the hig protein low carb diet pick up Dr.Atkins'New Diet Revolution.

This man has spent his entire life developing his theories about diet and disease.

It is good to know both sides of the story... pro and con.

I am not saying this is the correct route for your brother.

I read the book which has been on the NY Times bestsellers for years when researching his program for a client of mine.

I understand his theories completely.

Take alook yourself.

It is just more input.

347. msgreer - 9/2/1999 5:06:47 AM

hig=high

348. ranheim - 9/2/1999 3:11:08 PM

After 35 years in this profession, I have seen a great number of various diets. (The current fad in Louisiana is the Sugarbusters Diet).

All seem to work - short term. The problem with Americans is long term. Not enough discipline to remain on ANY diet long enough.

349. msgreer - 9/2/1999 3:32:24 PM

ranheim

Do you think if we could say change of lifestyle instead of diet it would help. The word diet immediately sets one up to fail, IMO.

350. Judithathome - 9/2/1999 5:20:14 PM

Thoughtful:

Pau d'Arco tea should work on fungus because it fights yeast...it is a strong antifungal and can be taken in capsule form, also.

Adam:

I lost 35 pounds on the Atkins diet but have gained back 10 over the last 6 months. However, my "new wardrobe" still fits and that is because of my exercise program: I am building muscle and toning up. My husband kindly tells me that the 10 pounds I've regained is muscle and maybe some of it is but not all. I don't look ready for the MsFitness contest yet!

The Atkins diet is okay for the initial weight loss but it's better to incorporate more veggies and carbs into your diet as soon as the first 6 weeks pass. I now restrict empty carbs as much as
possible but eat more of them than Atkins allows. However, I always ask for my entree at an Italian restaurant be served sans pasta because I'd rather eat the garlic bread or the canoli!

351. msgreer - 9/2/1999 5:33:55 PM

Judithathome

I agree with you re Atkins. The first 6 weeks will take the weight off and often motivates the person to exercise and watch the foods going into one's mouth.

I don't think making it a life time "diet" is a good thing. Although my client had wonderful results re her medical problems. She started to exercise full time after 1 week and is still in the exercise mode.

As I stated above maybe if diet is changed to lifestyle changes it wouldn't be so self defeating.

352. Judithathome - 9/2/1999 5:45:47 PM

msgreer:

That's what I've discovered. After losing the first 10 pounds, I hit a plateau so decided to start a moderate exercise program to boost my metabolism a bit. After daily exercise for a week, I became sort of addicted to it and have kept it up really well.

I am so glad to hear your mom is doing better. You were in my thoughts and heart.

353. msgreer - 9/2/1999 5:57:20 PM

JudithatHome

It is faith and pray that has kept me going and I thank you for keeping both mom and me in your thoughts.

BTW, did you ever take any of Atkins vitamins?

I stilll take them asnd I find them to be fantastic.

I also take many amino acids, herbs and minerals.

354. msgreer - 9/2/1999 5:59:03 PM

JudithAH

Mom is being moved to a rehab center this morning. There is nothing the doctors can really do for her now. It becomes her battle and will to live at this moment.

I don't know what
God has in store for her but I am taking one day at a time.

355. Judithathome - 9/2/1999 6:05:06 PM

msgreer:

I don't take Atkins vitamins because I've always taken a group I've put together over the years through trial and error and lots of study. I'm almost embarrassingly healthy and many friends my age marvel at the fact I only see the doctor once a year. I take a killer amino acid complex, a horse pill!

I take a huge amount of herbs and wouldn't be happy without them. If anyone saw the total number of pills I take each day, they would faint.

356. msgreer - 9/2/1999 6:12:32 PM

JudithaH

I would not faint. You should see what goes on in my household. People are amazed with what I take everyday.

I am currently researching the best non Western approach to HIV for a client. This is a great experience for I learn so much when I am lucky enough to get this type of assignment.

I am off to a meeting. The kinds nurses that have taken care of my clients want to see me. I don't blame them for it has been 3 weeks since I left all work behind.

Have a nice day and I will see you sometime over the weekend on betaMote.

357. ChristiPeters - 9/2/1999 9:18:26 PM

I lost 10lbs a month for 3 months by simply eating smaller portions of what I wanted and making sure I had the requisite number of serving of each food group. This meant I was actually eating more thatn I had been before as I have never been good at eating enough fruits and vegetables.

Of course this was all when I was down to 10mg/day of elavil. When the 4th procedure on my back went awry and I had to go back on the full dose of Elavil (50mg), I gained most of the weight back. Now that I am back down to 20mg (after procedure #5) I am losing again. However, I do not call this a diet. It is a permanent commitment to eating right.

(However, there is still a small part of me which would rather live on just steak, potatos, and popcorn! &:oD )

358. ChristiPeters - 9/2/1999 9:20:00 PM

(I don't know why, but for the last month "that" and "than" keep coming out as "thatn")

359. Judithathome - 9/2/1999 9:33:22 PM

I was ready to turn off my computer for the day but just had to share this last little tidbit with y'all.

The mail just brought a surprise; I think I mentioned that the bill for my hubbys emergency room visit was only $20.00. Well, I received another one today and it was a little bit more: $58,219.00. Yes, that's what it said.....

Naturally, I called them immediately and this frazzled woman read me a prepared statement that the computer is in the process of being switched over and that many, many of these erronous bills have gone out all over town and please, please just disregard the entire thing.

I told her I hoped the ER wasn't oberloaded with patients suffering from HEART ATTACKS after opening their mail!

360. Judithathome - 9/2/1999 9:34:20 PM

oVerloaded, not the German "ober".

361. JJBiener - 9/2/1999 10:14:54 PM

Judith - Most people wouldn't believe the number of pills I take every morning, either. Unfortunately most of mine are required just to keep me functioning.

362. ranheim - 9/3/1999 1:50:01 AM

Are all of us in this thread "pill happy"? I gobble down 25 - or so - vitamin/mineral/herb pills daily.

msgreer
For LA patients "lifestyle changes" is even worse than a diet. Until someone actually eats in central LA, you don't really understand what we have available here. And, traditionaly the liquor/beer/wine flow freely. So if you say "Change your life style"; that is translated : quit drinking; quit smoking; quit staying out late at night; quit chasing women (in the case of males - and the local females do their share of chasing as well!)

It seems to me that Christi's way works better locally : permanent decision to eat right - or "eat smart"!

363. bloodnfire - 9/3/1999 2:55:21 AM

I started taking Colloidalo Minerals today, and Vitamin E, on advice which I received several years ago, but have ignored. I am walking regularly (about five miles every two days), and have lost over 20#.
Primarily using the 'ChristiPeters' system, eat light and eat right.
I usually feel wonderfully well, thank God, but I'm told that these trace minerals will give an even bigger feeling of wellbeing. Anyone had any experience, pro or con ?

It's sure good to see you back and sounding good MsGreer. We continue to remember your Mom and you, hoping for a speedy recovery for both.

364. msgreer - 9/6/1999 1:08:13 AM

Patient Advocacy Information<1A>

365. msgreer - 9/6/1999 1:11:07 AM

Please ignore <1A>... just go to the link.

This is an organization I belong to. Check the different links provided.

I hope it helps answer questions as well as provide everyone with several email addresses to go to for questions.

366. msgreer - 9/6/1999 1:16:03 AM

Click on Board and Commitees. It will give you email address in your geographically area.

367. msgreer - 9/6/1999 1:26:50 AM

ALS UPDATE<1A>

368. bloodnfire - 9/6/1999 1:33:29 AM

That's an interesting link to the Society for Healthcare Consumer Advocacy, MsGreer. How long have you been with them? Sounds like an
ever-increasingly important service. Good to see you back. How's your Mom ?

369. msgreer - 9/6/1999 1:33:51 AM

More in depth info on ALS<1A>

370. msgreer - 9/6/1999 1:38:22 AM

bloodnfire

I have been with this particular organization for 7 years.

I maybe back posting but I still find the challenges with my mother to be difficult. I have a running list of problems with her hospital stays and Rehab Center.

I do not know how folks go to the hospital without an advocate.

371. msgreer - 9/6/1999 2:00:29 AM

test

372. ranheim - 9/8/1999 6:31:49 PM

This is a complete change of pace that I thought of possible interest.

David Hackworth, the ex-Korean War/Vietnam War officer who now writes an editorial on military affairs was at his usual hang-out in the editorial section of the Morning Advocate on Thursday.

I barely recall Harry Truman trying to make the draft permanent. Truman had been horrified at post WW II official reports that 34% of all draftees for that war had been turned down for physical/mental "defects". Truman/some of his advisors believed that a draft would get some of the young males in good enough shape so that they could pass the Army's physical. A war-weary congress refused to provide funds for a universal draft (for males).

Hackworth states that the current Army rejects upwards of 60% of recruits today! He adds that many of these (no % given) are due to prison record; school record (what is this?); drug usage; as well as physical and mental rejections.

Hackworth proposes a universal draft at age 18. I won't bother you with details. I am beginning to wonder if something like this aught to be done. More than 50% of children under 4 cannot climb up on my examing table!! They have to be assisted. When I started practice in the 60s this % was - maybe - 10%. All any of you have to do is to go near any elementary school and observe. There are way too many obese children.

How, other than the military, can the nation achieve better health/less obesity in our elementary school children? I am old enough to remember the minister Bob Richards of Olympic fame. Was it not Eisenhower who created the honorary job of Fitness Co-ordinator (some such) for him. That job continues to this day; each one telling us citizens that the young are becoming less physically able as the years go by. So the "bully pulpit" has had no positive effect. What options -other than a universal (both sexes) draft - are available to us?

373. ChristiPeters - 9/8/1999 8:10:14 PM

I am not sure about other places, but LD has been in three different school systems. None of them have PE every day. Her first school had no PE. The next city's elementary school had PE every third day. Her current elementary school has PE 4 days a week and 'health' the other day.

Maybe that would be a starting place?

Maybe if health clubs had stuff for kids to do? Or even let kids participate in aerobics with their parent/s? Most of the ones I've checked out won't let kids under 14 in "for insurance reasons".

374. ChristiPeters - 9/8/1999 8:11:38 PM

BTW, wouldn't a universal draft be a disincentive for physical fitness?

375. ranheim - 9/8/1999 10:29:59 PM

Others would have to answer for themselves.
The Berry Plan was the "doctor draft"; I believe it was dropped only after VietNam. Every medical student in their junior/senior years was well told "If you are healthy enough to practice medicine in civilian life; you are healthy enough for the military".

376. ChristiPeters - 9/8/1999 11:07:43 PM

ranheim -

You asked -

"How, other than the military, can the nation achieve better health/less obesity in our elementary school children?"

My post#373 had some suggestions.

Do you have any? What do you think?

377. ranheim - 9/9/1999 12:15:20 AM

I have a teacher as a neighbor. He tells me that he is amazed at the numbers of doctor's slips he receives each year asking that the student be excused from PE. I, too, am amazed at how many mother's ask me for excuses for their female children; very few ask for excuses for boys.

I don't - easily - excuse any child from P.E. But, many of my peers do. I think that the voluntary P.E. in the schools would not be the way to encourage physical fitness. I can still recall all the complaints from both boys and girls during my high school days about any PE class that caused one to break a sweat. "I'll stink in class!!" There were neither the number of showers needed for all the students; nor the amount of hot water needed for a shower after PE class. I would assume that many schools today face the same limitations.

Talk to any male of my generation (64) and he will tell you that boot camp was the hardest he had ever worked. I have heard very successful athletes say this as well. I understand that, with the exception of the Marine Corps, boot camp has been watered down. Too many boys "flunked" initially; we have the recent problem with upper body strength in females that has caused a further reduction in physical standards.

There are so few things in our daily existence that aren't warped by court decisions and threats by lawyers. I believe it would take an universal draft - severe limits on lawyers included - to institute the kind of conditioning program that I suspect is needed to put youth back in shape. Because the draft would be universal, parents could hold that (boot camp) over the heads of reluctant children.

My profession would have to develop sophisticated screening procedures to prevent a spate of deaths and injuries; at least early on.

378. bloodnfire - 9/9/1999 12:45:04 AM

Ranheim. I think it's a great idea, to have some sort of compulsory public service for a couple of years. I'd be interested to hear RustlerPike's views on this. As I understand it, Israel has such service, and probably one of the most fit populations in the world !!
The boys at our school have an average stay of 6 to 7 months, but every day they have two hours of Physical Exercise, rotating from the VolleyBall court to the Basketball court to the Weight Deck. It's amazing how well-toned the body can become with only 6 months of good food, regular exercise and ten hours of sleep every night.

379. ChristiPeters - 9/9/1999 12:51:47 AM

Ranheim

Hmmmmm....

I guess we have different experiences. I, as a parent, was appalled that my daughter was not getting daily PE in her last school. I never had a slip excusing me from PE. I wouldn't ask a doctor to give my daughter one and it never occurred to me that parents would do that. Even when she injured her elbow just before school started and had to keep it in a sling, I just asked her PE instructor to find exercises and things for her to do where she wouldn't have to use that arm.

Live and learn. Whatever are those parents who want their kids excused from PE thinking!?

Oh and I found boot camp to be a breeze, but then I had been working horses just before I went in, so maybe that's why.

380. PsychProf - 9/9/1999 9:45:27 PM

ECOLI PROBLEM

click on photo

381. msgreer - 9/11/1999 12:38:19 AM

I am interested in knowing anyone's experiece with Living Wills.

It need not be personal if you choose not to discuss it in that way.

What does everyone think about Living Wills these days?

Have the people you love discussed their wishes when it comes down to making those hard decisions?

If you are named on someone's Living Will are you ready and able to carry out their wishes?

I do know if a loved one is in the hospital faced with these decisions it can become a most testing time for all involved.

382. ChristiPeters - 9/11/1999 1:22:20 AM

Hi, MsG!

My mother has a Living Will and has discussed its contents with me.

I don't have a Living Will, but I intend to get one. I think it is easier to lay out exactly what you want in that kind of document.

For example, I haven't signed an organ donor card because I am afraid of my organs being taken before I'm quite done with them. My Grandfather "came back" after being declared dead three times. It makes me wonder what would have happened if he was an organ donor. Anyway, a Living Will gives me room to be very specific under what circumstances I want to be an organ donor.

(Of course, this is probably a moot point now. I'm not sure if anyone would want my organs now that they've been mashed by horse's hooves &:oD )

Then there are the issues of who makes decisions if I am unconscious, in a coma, or incompetent. I'd much rather make those decisions NOW myself rather than leaving it up to a Judge or whoever.

383. msgreer - 9/11/1999 1:45:11 AM

CP

The only problem you will run into concerning your Living Will is finding a person you trust to take over those difficult decisions should you be unable to make those yourself...thus a Living Will.
Also once you have made yours make sure it fits all the criteria for the state you live in.
Usually two name appears on a Living Will. The first being obviously your first choice to make those decisions but a second one in case that person it not available for some reason.

All my doctors have a copy of my Living Will. On my front door is a notice to all paramedics "SEE LIVING WILL IN REFRIGERATOR". This is in case they get called first.
The paramedics usually resicitate you regardless of your Living Will but they will take it to the hospital for you.
I also keep a copy in my glove comparment.
My lawyer has a copy as well as close friends.
You can have "See Living Will" placed on your driver's license also.
The most important thing I find is to have a discussion with your doctor and lawyer as to what your exact wishes are so there can be no mistaking what your wishes are.
Even after naming someone on your Living Will the hospital will question them ad naseum. They will want to make sure your friend truly knows what you want. And that you have discussed it with them over and over.
When family members are still alive alot of hospitals to avoid lawsuits may want to contact your family.
I would suggest talking to all of them.
Does this help?

384. msgreer - 9/11/1999 1:48:56 AM

Cp

Even with a Livng Will I have found many hospitals require two doctors letters saying you can not be resicitate.
All well in good except if these herioc doctors/hospitals say we can help her the next questions is what quality of life would you be left with.
A Living Will should cover these issues.

385. ranheim - 9/11/1999 2:57:32 AM

My wife and I both have living wills. Her brother, who lives in the same small town as we do; all three of our children know that NO heroic measures are to taken with either of us.

Both of us most fear an auto accident in East Armpit (you put in the state of your choice). I would anticipate in this case that one of the four designated would be notified after we were "all strung up". And, I believe, that is exactly what would happen should we be injured away from home. Para-medics, doctors, and hospitals are geared toward saving lives. A living will is the last thing in their minds.

I don't know of any solution for such a problem.

386. ChristiPeters - 9/11/1999 5:00:54 AM

Well, if I was worried about living too long damaged, I would have suicided after the horse trampled me in 1984. No, I am not worried about being kept alive - quite the opposite.

I have found out that when you are in pain from your head to your toes, when one side of you no longer wants to move, when you have no income, no food in the house, and utility termination notices and collection notices piled a foot high on the rickety kitchen table of your mobile home, when your friends have all left and the person you chose for your life's partner does nothing but hurt you, and you have no idea how you will get through the next day - still life is sweet and God provides and if you are just patient and trust Him eventually everything is ok. In fact, everything even gets better. The doctors said I wouldn't get better. The doctors said I would be in a wheelchair. Well, I can walk without a cane. I can tolerate the pain without meds. I can use my left arm again. I can SING again!

All since my life was almost destroyed - I have my wonderful daughter, a good education, a good job, a new house (a real house not a mobile home), and LIFE IS SWEET!!

Hell YES! I want to be resucitated!!!

387. bloodnfire - 9/11/1999 5:17:40 AM

That's one of the most wonderful testimonies I have read or heard in a long time, Christi, and that's saying something. My compliments.
I feel sorry for that poor individual who hurt you so badly when you were already struggling. You deserve better. It was their loss.

MsGreer, if the Doctors require two letters, even though they have been presented with a 'Living Will' which specifically instructs that NO HEROIC MEASURES are to be taken to resuscitate, who is expected to arrange the writing of the letters. Or are they to be prepared in advance too, and kept with the Living Will ?

388. msgreer - 9/11/1999 5:33:40 AM

bloodnfire

Thanks for correctly me. I meant to say if you are out of State and do not have your Livng Will with you it would take 2 doctors to write a letter saying either you can not be resitated or if you were you would be, excuse the expression, left as a vegatable.

Who prepares a Living Will? You do. But I caution you read it first. Make sure it covers EVERY area you can think of.

Florida came out in 1997 with Aging with Dignity. I don't think it covers all circumstances but it is a good place to start.

Yu can get a copy from Commission On Aging With Dignity

215S Monroe Street

Suite 620

Tallahhassee, Fl.32301.

They state this Living Will works in most states.

That is if you carry it with you all the time.

I got mine through the local Hemlock Society. They keep up to date on the very latest re State Laws.

You can also add anything that is not covered.

I know people who have their lawyers draw up their Living Wills as the laws change so often.

389. msgreer - 9/11/1999 5:44:30 AM

Bloodnfire

Who arranges the needed letters if one is out of town? Your loved ones.

ranheim

I must agree the medical profession is in the business to save lives. Death is seen as a failure. It is for that reason I urge Living Wills. I also urge taking an advocate with you.

Hospitals are now required to ask if a patient has a Living Will prior to any procedure. It they don't have one they throw one at you and tell you to read it over.

Hardly the time for a person to read and understand what it means.

The bottom line is make sure your doctor, lawyer, best friend, children, personal advocate named on your Living Will all have a copy of your Living Will. I have known of many cases where people have been out of state when an emergency happens and with no Living Will that fits that State's requirements you are out of luck. That is unless the State only requires 2 doctors to sign onto it.

You can have your own Living Will faxed to wherever you are but that is no guarantee they will honor it.

It also helps no matter what State you are in to have it on your driver's liscense.

I can't disagree with you when you say many hospitals disregard the whole thing even though it maybe on top of your chart. I have had too many experiences like this with clients of mine.

390. msgreer - 9/11/1999 5:58:02 AM

BTW

If you choose to be an organ donor that can go on your driver's license too.

391. God - 9/11/1999 7:39:04 AM

I am immortal. Next topic.

392. SnowOwl - 9/11/1999 7:40:45 AM

Just testing.

393. CalGal - 9/11/1999 7:44:19 AM

394. msgreer - 9/11/1999 8:07:25 AM

Sorry

I did not go for italics. It came out that way. This is not the first time this has happen.

395. JudithAtHome - 9/11/1999 5:22:35 PM

msgreer:

Thanks for the info on the insurance...it will help ud in our decision making, I'm sure.

396. ChristiPeters - 9/12/1999 1:39:30 AM

bloodnfire -

ummmm....

welllll......

sigh

It was not meant to be a testimony, merely an explanation why in my Living Will, I am more concerned with having the plug pulled too early than with my life being sustained too long.

That's what I like about the Living Will (unless I totally misunderstand the process). You write it specifically tailored to state what YOUR wishes are. So what YOU want - whether it is DNR or heroic measures or something in between - is what is in your Living Will. There are circumstances when I want heroic measures and circumstances when I want DNR and I can spell them all out.

I also think it is a good idea to review your Living Will once a year or so and update it if necessary as your circumstances or even your wishes change.

397. ranheim - 9/12/1999 3:21:56 AM

I have one very good lawyer friend. He tells me that Living Wills are like ordinary Wills. We "civilians" don't review either often enough; too frequently, he claims, it is a one-time thing.

What ChristiP. says is absolutely correct : if you have either one you MUST review it frequently!

398. msgreer - 9/13/1999 10:09:29 PM

JJ once said he didn't know whether it was harder to have a loved one die suddenly or a long painful death.

I don't have the answer. I do know I feel like I am on my last leg. My entire world is my mother. And of course the sleep I can get in from time to time.

Ihave lost all sense of time. I find the only way I know what day of the week it is is to look at a newspaper.

I am not posting for sympathy. I am glad I am the one here with my mother. I only know I feel as though I am losing myself too.

I know this will pass and my strength will return. I just needed to get it out.

I miss not being with my friends on theMote. I look at a stack of fascinating articles on Health Policy on the floor by my desk and wonder when am I going to post again. When am I going to come back?

Thanks for giving me a place to write my feelings.

399. msgreer - 9/13/1999 10:27:00 PM

Laughing... I miss laughter.

400. msgreer - 9/14/1999 11:53:43 PM

test

401. theDiva - 9/14/1999 11:55:05 PM

there you are, sweetie. I'm worried about you. Have you slept? Are you remembering to eat?

402. ChristiPeters - 9/14/1999 11:57:44 PM

Hi, msgreer!

I echo Diva - how are you doing?

403. msgreer - 9/14/1999 11:58:55 PM

Diva

I am getting some sleep but have no appetite.

I got sent home from the hospital when a doc friend of mine heard me coughing and coughing. He gave a quick listen and said bronchitis with the beginnings of pneumonia.

Needless to say I am home

I miss you sweetie.

404. msgreer - 9/14/1999 11:59:45 PM

Christi

I miss you too.

405. theDiva - 9/15/1999 12:01:26 AM

MsG

No need for me to lecture you about taking care of yourself, is there? Please just have some soup and get some rest. You've been on my mind all week....I miss you, too. I may or may not be around tomorrow. Gracie sounds as though she's coming down with something.

406. ChristiPeters - 9/15/1999 12:01:53 AM

msgreer -

Ye Gods! woman! Now you need someone to take care of you as well as someone to take care of your Mom. Would that I could hop a plane over and fuss over the both of you for a couple of weeks...

So sorry!

407. msgreer - 9/15/1999 12:02:16 AM

Diva and Christi

I know what would help me heal but I don't see THAT happening anytime soon. heehee

408. ChristiPeters - 9/15/1999 12:02:32 AM

I've had both bronchitis and pneumonia

409. ChristiPeters - 9/15/1999 12:02:50 AM

I didn't like it

410. theDiva - 9/15/1999 12:04:10 AM

snickering

Bad girl! I'm glad to see you're still strong enough to joke!

411. ChristiPeters - 9/15/1999 12:04:12 AM

Diva,

I hope Gracie can either stave it off or, if not, that whatever it is is mild and of short duration.

I hate being sick, but I hate it much much more when LD is sick.

412. theDiva - 9/15/1999 12:05:23 AM

Christi

Thanks. She's just all sniffly and scratchy. A dose of chicken soup and an early bedtime might be the thing. We'll see. Speaking of which, I've got to run.

Good night, darlings. Take good care.

413. msgreer - 9/15/1999 12:05:34 AM

Christi and Diva

This is not fun. I allowed myself to do to much for too many people. My body has just said if you won't slow down I will find away to get your attention.

It has worked.

414. msgreer - 9/15/1999 12:08:15 AM

Diva

I will be thinking of Gracie. I hope she stays well.If you came I would take you all for myself. I can always hire nurses for mom. She is to come home this Saturday.

Let us pray.

415. ChristiPeters - 9/15/1999 12:08:53 AM

msgreer -

Funny how the body will do that, huh.

Diva,

TaTa and have a good evening. Give Gracie a little hug from me when you are tucking her in after the chicken soup.

416. ChristiPeters - 9/15/1999 12:10:08 AM

msgreer -

Are you hiring a nures for you? or at least someone to come in and straighten up and cook for you while you stay tucked in bed, letting your body heal?

417. msgreer - 9/15/1999 12:13:17 AM

Christi

Don't scream at me but the answer is no. Do I need the help you bet cha.I am drinking water by the gallon, making it to the bathroom and crawling back to bed to snuggle with my comforter.

A cook that is what I would like to hire.

418. msgreer - 9/15/1999 12:14:55 AM

Christi

I don't have the energy to cook. I know you understand the feeling as you said you also had bronchitis and pneumonia.

419. msgreer - 9/15/1999 12:15:47 AM

Christi

Bad excuse huh?

420. msgreer - 9/15/1999 12:22:25 AM

Christi

That message was to you not Diva. If you came I would keep you all for myself.

I'll be in touch tonight for another episode of anotherworld.

Hopefully I will be awake.

421. ChristiPeters - 9/15/1999 12:28:04 AM

msgreer -

VERY bad excuse. Your body can't heal itself if you don't give it fuel. Aren't there any delivery places where you live?

422. msgreer - 9/15/1999 12:36:38 AM

Christi

Yes, Pizza and Chinese.

Doesn't quite appeal to me.

I am very tired so we can continue this tonight.

Okay?

BTW, there are several places I can order from I just have to get dressed and pick it up. Now there's an idea. I could call my freind downstairs, give her the money and have her pick it up

423. msgreer - 9/16/1999 3:25:02 AM

First, some observatiions on Pablo Casal.

I met him for the first time at his home in Puerto Rico just a few weeks before his ninetiethbirthday. I was fascinated by his daily routine. About 8am his lovely young wife Marta would help him to start the day. His various infirmities made it difficult for him to dress himself. Judging from his difficulty in walking and from the way he held his arms, I guesssed he was suffering from rheumatoid arthritis. His emphysema was evident in his labored breathing. He came into the living room on Marta's arm. He ws badly stooped. His head was pitched forward and he walked with a shuffle. His head was pitched forward and he walked with a shuffle. His hands were swollen and his fingers were clenched.

424. msgreer - 9/16/1999 3:32:18 AM

cont.

Even before going to the breakfast table, Don Pablo went to the piana---which, I learned was a daily ritual. He arranged himself with some difficulty on the piano bench, then with discernible effort raised his swollen and clenched fingers above the keyboard.

I was not prepared for the miracle that was about to happen. The fingers slowly unlocked and reached toward the keys like the buds of a plant toward the sunlight. His back straightened. He seemed to breathe more freely. NOw his fingers settled on the keys. Then came the opening bars of Bach's Wohltemperierte Klavier, played with great sensitivity and control. I had forgotten that Don Pablo had achieved proficiency on several musical instruments before he took up the cello. He hummed as he played, then said that Bach spoke to him here---and he placed his hand over his heart.

425. msgreer - 9/16/1999 3:37:30 AM

Then he plunged into a Brahms concerto and his fingers, now agile and powerful, raced across the keyboard with dazzling speed. His entire body seemed fused with the music; it was no longer stiff and shrunken but supple and graceful and completely freed of its arthritic coils.

Having finished the piece, he stood up by himself, far straighter and taller than when he had come into the room. He walked to the breakfast table with no trace of a shuffle,ate heartily,talked animatedly, finished the meal, then went for a walk on the beach.

426. msgreer - 9/16/1999 3:46:29 AM

After an hour or so, he came back to the house and worked on his correspondence until lunch. Then he napped. When he rose, the stoop and the shuffle and the clenched hands were back again. On this particular day, a camera and recording crew from public television were scheduled to arrive in mid-afternoon. Anticipating the visit, Don Pablo said he wished some way could be found to call it off; he didn't feel up to the exertin of the filming, with it innumerable and inexplicable retakes and the extreme heat of the bright lights.

Marta, having been through these reluctances before, reassured Don Pablo, saying she was certain he would be stimulated by the meeting. She reminded him that he liked the young people who did the last filming adn that they would probably be back again. In particular, she called his attention to the lovely young lady who directed the recording.

Don Pable brightened. "Yes,of course," he said,it will be god to see them again."

427. msgreer - 9/16/1999 3:49:53 AM

As before, he stretched his arms in front of him and extended his fingers. Then the spine straightened and he stood up and went to his cello. He began to play. His fingers, hands and arms were in sublimecoordination as they responded to the demands of his brain for the controlled beauty of movement and tone. Any cellist thirty years his junior would have been proud to have such extraordinary physical comnand.

428. msgreer - 9/16/1999 3:53:14 AM

Twice in one day I had seen the miracle. A man almost ninety, beset with the infirmities of old age, was able to cast off his afflictions, atleast temporarily, because he knew he had something of overriding
importance to do. There was no mystery about the way it worked, for it happened every day. Creativity for Pablo Casals was the source of his own cortisone.

Norman Cousins, Anatomy of an Illness.

429. ChristiPeters - 9/16/1999 7:01:15 AM

msgreer -

thanks for this inspiring story

430. JonesAtLaw - 9/16/1999 7:05:25 AM

Msgreer- here's to you having similar results.

431. bloodnfire - 9/16/1999 11:16:34 AM

Sounds like this wonderful illustration belongs both in your thread and in the 'Spiritual Issues' thread to me, MsGreer. What a gifted and gracious man Pablo Casals was!

432. msgreer - 9/16/1999 3:29:57 PM

Oct. 2nd is National Walk for Alzheimer's Disease. Come join us and help to find a cure.<1A>

433. msgreer - 9/16/1999 3:31:28 PM

try again<1A>

434. msgreer - 9/16/1999 3:34:57 PM

Sorry about the lost link.

I'll try another one.

435. msgreer - 9/16/1999 3:36:12 PM

Go the alzheimersdisease.org for lots of information.

436. PsychProf - 9/16/1999 3:59:47 PM

MS Greer...Here is the Alzheimers link

437. msgreer - 9/16/1999 4:17:38 PM

PP

Thanks so much. What was I doing wrong???

438. msgreer - 9/17/1999 3:29:38 PM

Dear Friends

I am out of here. I am going over to my mother's now.
As I have said to many people this is going to be a start of a new journey for me and my mother. I am dealing with what has become the parent-child reversal role. I am now caring for my mother who no longer can mother me. I have some anxiety about it but also see it as a privledge. When you think about it what better gift can I give to her than to love and care for her as she has done for me for so many years.

I hope to have the time to do some posting from her place.

Shalom

440. msgreer - 9/18/1999 6:15:10 PM

NURSING HOME HORRORS: Study finds repeated offenses common.

Some two-thirds of nursing homes cited in 10 states forpractices that harm residents commit at least one more serious offense within two years of the original charge.

That is the finding of the General Accounting Office (GAO), the intestigative arm of Congress, which recently completed a four-month study of nursing-home performance in 10 large states.

In a report to Congress, the GAO called for tougher and faster financial penalties against nursing homes whose practices endanger residents.

441. msgreer - 9/18/1999 6:20:13 PM

Previous studies have found that one in four of the nation's nearly 17,000 nursing homes have serious deficiencies that harm residents or threaten their lives. GAO investigators say hey are surprised to find so many nursing homes being cited repeatedly fo neglect and abuse.

"These are not isolated incidents," says William J. Scanlon, author of the new GAO report. "Often, there are clear indications hat the incidents were preventable."

The study demonstrates the "the problems haven't been solved," said Faith Mullen of AAPR. "Improving the quality of nursing homes is going to take persistent effort at the state and federal level."

442. msgreer - 9/18/1999 6:26:22 PM

The report endorses a plan by the federal Health Care Financing Administration (HCFC) to speed up penalties against the most dangerous nursing homes.

The proposal is STROMGLY OPPOSED by the INDUSTRY. The American Health Care Association, a federation representing more than 12,000 mostly for-profit long-term care providers, says overzealous inspectors and excessive paperwork make it more difficult for nursing homes to serve their 1.6 million rsidents.

The federal government sets the standards for care in nursing homes, but states are responsible for inspecting the homes and recommending sanctions to HCFA. In addition states can impose standards that are tougher than the federal government.

443. msgreer - 9/18/1999 6:32:04 PM

Legislation to increase staffing or impose other requirement on nursing homes has been debated in the legislatures of several states, including California, Delaware and New Hampshire.

In California, a coalition of comsumer groups is trying to enact the first comprehensive rewrite of state nursing home standards in more than 15 years. This bill is presently pending..

A year ago, a landmark GAO study focused on serious problems in that states nursing homes.

This year's GAO study examined records of 107 nursing homes in Colorado, Florida, Illinois, Massachusetts, Missouri, New York, Pennsylvania, Texas and Washington - states that account for nearly half of all nursing home beds in the nation.

444. msgreer - 9/18/1999 6:41:57 PM

The most common problem reported was pressure sores aka bed sores which often occur because staff members fail to ensure that frail residents are turned regularly in their beds.

Among specific findings in the study (and sit down for these)

One ursighome failed to notify the doctors two residents who had serios trouble breathing. Both residents died.

Another home failed to treat anxiety and depresion in a resident who as a result lost 42 pounds.

A home failed to record and report serios injuries from falls, including a broken neck.

Another failed to report apparent abuse of a resident whose dislocated shoulder was not discovered for atleast six months.

One nursing home was so negligent in treating pressire sores that one resident was found with bone exposed through such a sore.

445. msgreer - 9/18/1999 6:43:57 PM

sorry for the typos...

to be continuted.

446. msgreer - 9/18/1999 6:57:37 PM

BTW, the reason I have to leave this lovely story is because I have a 90 year old client (not my mother) who is in the hospital. She certainly needs around the clock care and I have that set up for her when is discharged. Her doctor says nope, she is going to a nursing home to get the care she needs. (this on top of the story I was just telling.)

I reassured the doc this women has been well cared for and that will continue. She does not want to go to a nursing home. His answer is by law I can send her there for 3 days and this can be taken to court if I think it is necessary.

About to ask this doc what percent does he get for each new patient he sends to this nursing home I decided to hold my tongue and call this woman's lawyer.

It won't happen but there is one very scared lady here.

ranheim...are you out there? Is anyone out there who has a comment. Has anyone had to deal in situations like this or close to it?

I am off to my mothers. From one sick bed to the other. Good exercise.

447. msgreer - 9/18/1999 10:58:53 PM

NURSING HOME STORY

GAO says the current system of punishing nursing homes is not adequate deterent to future problems.

Under current HCFA policy, states finding a serious problem usually give the home a grace period of 30 to 60 days to correct the problem and thereby avoid a state's recommendation to HCFA that the home be fined.

HCFA which is part of HHS, hs proposed expeanding the criteria for identifying facilities as problem nursing homes. Facilities where actual harm is documented in isolated incidents would trigger immediate penalties;the current standard for imposing such penalties is a longer record of harm to residents.

If the change were implemented, a far greater number of homes would be subject to immediate penalties for serious problems--nearly one in six US nursing homes, instead of about one in 100 now.

448. msgreer - 9/18/1999 11:04:03 PM

In addition, HCFA plans to begin fining nursing homes for each instance that a key federal standard is violated. The American Health Care Association hs filed suit in federal court to try to block HCFA's proposal.

The association says regulators should offer advice to nursing homes on how to improve care and that money collected through fines against nursing homes should be spent to improve those facilities.

In an industry that generates close to $80 billion in revenue each year, many nursing homes leave routine care in the hands of nurs-assistants who tend to be overworked, are not qualified to detect many medical problems and typically are paid about $7 an hour.

449. msgreer - 9/18/1999 11:11:11 PM

"There's alot of money in those corporations," says Lori Smetanka of the National Citizens' Coalition for Nursing Home Reform, a non-profit group that advocates quality improvements for nursing-home residents. If for-profit nursing homes are to receive government subsidies, "we want it tied directly to care, Ms Smetanka said.

Pat McGinnis, executive director of Calfornia Advocates for Nursing Home Reform, says states must continue to threaten repeat-offenders nursing homes with fines if care is to improve. "Once they know that the state is serious, they will clean up their act," she said. "You've got to hit them in the pocketbook."

In a separate action, nursing-home residents have files a class action lawsuit against GranCare, Inc., a
nursing home operator in Colorado, claiming that their rights have been violated by habitually substandard card. AARP has filed a "friend of the court" brief suppoorting the residents' claim.

450. msgreer - 9/18/1999 11:13:30 PM

I think it will be interesting to watch what happens in these cases. As "us" baby boomers begin to care for our parents the question is will we put up with this type of care?

Has anyone had an experience with a nursing home.... good or bad?

451. ranheim - 9/19/1999 12:40:46 AM

I have had nursing home(nh) patients in the past; none at current. I am fortunate as the nh in my home town is very well run. Don't get me wrong. NH are big business and any time there is the amount of money available - as there is in this business - there are going to be scoundrels and worse.

In post #442 there are two of the conditions faced by nh that cause the ownership and RNs to breathe fire. A patient's chart, today, is about 3/4 of an inch thick. I usually had someone page through all the junk to get to the section/s where a doctor writes progress notes and orders. Most of the remainder has nothing to do with patient care. All the rest of it is a "paper trail" so that bureaucrats and lawyers can go back at a later date and pin blame.

Have any of you been the boss when "inspected" by the government? In my last job as a dispensary commander (USAF) in Albuquerque I had this pleasure?! A one star general was in charge of the team; a full colonel represented the Surgeon General of the USAF. Prior to their inspection - a planned one - I had studied the reports of the past 3 or 4 inspections of the dispensary. We actually came out fairly well. But, the colonel was totally out of sorts with me. "You will make the following changes, Major!" No, I won't. In past reports, personnel from previous inspection teams has instructed the dispensary to do it the way were are; we are not going to change. "Oh, yes you are or we will put it in the report and write you up personally." Do what you have to do, Colonel; but, as I am going back to civialian life in 3 months, I won't pay too much attention. And that was the end of it.

In the USAF the group in question is called the "Office of the Inspector General". It is their job to find something wrong. If they can't, their ability for promotions will be compromized. It is exactly the same thing when a group from Baton Rouge comes to a local nh. They will find nits to pick.

452. msgreer - 9/19/1999 4:17:26 PM

ranheim

I have complete understanding regarding the enormous amount of paper work RN's and physicians have in nh.

Ihave been on both sided, for a short time in a nh. I found the paper work to be staggering. It left me with little time to attend to resident's needs thus I got out.However as a medical advocate I find myself saying yes the paper work stinks but it is the Care of each resident that conerns me at this point.

There is not excues for the type of abuses/neglect I wrote about. The fact most for-profit nh are under staffed and pay little should not be the problem of the resident. Each person is entitled to proper care. I wonder why thenh's even hand out the resident's their ptient's Bill of Rights. I bet that is more for the famililies than anything else.

453. msgreer - 9/19/1999 4:23:14 PM

I lookafter nay folks in nh's. Where there is obvious neglect/abuse I am hired by their families to report it to them. They usually keep me on a retainer to do my checks for just this reason. If I find abuse/neglect I then go through the "proper" channels to report it. I start with the Administrator's and DON. If necessary I write their state and federal reprsentatives. U contact the physicians. I make sure I document everything for as you know if it is not written it did not happen.

Regardless of the paperwork which I do agree is staggering the abuses/neglect I entioned above should never happen. I can find no excuse for it.

The fact most for-porfit nh's pay so poorly is one reason these abuses/neglect happen.

454. msgreer - 9/19/1999 4:26:36 PM

But when you look at the amount of money these for-profit organizations make it begs one to ask if your intentions are so pure whydon't you hire the help you need? One aid per 12 or more residents will not work.

Who are they kidding when they say give us back the money collected from fines so we can upgrade our services? I think I can fairly say they know exactly how to better their services and already have the finances to do so without being lead by the hand with basic instructions.

455. msgreer - 9/19/1999 4:30:45 PM

ranheim, when residents die because of abuse/neglect someone has to be held responsible. I find the workers do the best they can. It often comes down to the Policy each orgnization puts into place. IF they don't take the lead and say we will not tolerate such care for our reidents and help the staff work out the way to deal with problems it seems to be saying do what you have to get by. Be sure you pass those inspections. We don't care how you do it we just don't want regulators breathing down out necks.

I appreciate from your story there will always be regulators that abuse their authority but taken in balance to what is happening in nh I would rather error on the side of the resident's needs/rights.

456. msgreer - 9/19/1999 4:33:56 PM

The financially wealthy not-for-profit nh owners can not have it both ways.

Our citizens have every right to believe they will be treated with dignity and respect.

I dare say some of these owners would not put their loved ones in the very nh's they own.

I am not referring to private nh's which families also have to keep their eyes and ears open but at $4200/month the care is exceptional. I am talking abt everyday care.

457. msgreer - 9/19/1999 6:02:22 PM

HELP

I am currently putting together a list of sub threads for this thread. They will range from AMA medicine to alternative therapies.

If there are any special issues you want a sub thread devoted to please let me know.

I am here for a short time today and then offline for a day or two.

Thanks for your input.

458. msgreer - 9/19/1999 6:04:06 PM

BTW, I don't want this thread to belong only to afew. I would appreciate stories, input, questions from everyone.

459. Thoughtful - 9/19/1999 7:41:44 PM

Msg. I think a policy-oriented thread that would include things like nh funding, medicare/medicaid, hmos, and the like could be a thread. I also think a personal health thread would be useful where we discussed things like who to contact for specific concerns, cures for common ailments, personal issues, etc. I like the alternative medicine thread idea as well.

460. Thoughtful - 9/19/1999 7:47:19 PM

I have had direct experience with 2 nhs and indirect with another and I found no signs of abuse/neglect in any of them. I did find a difference in cost/services offered and certainly the help was always busy in all of them, but I never saw any kind of outright neglect or abuse, including during the visits I made during non-visiting hours. I find the quality of the admin staff critical for helping work the maze of paperwork during the admission stage and transfer to medicaid stage.

Where I have been very disappointed is in the quality of doctors who make the nhs part of their rounds. My experience is they are in it for the money and pay little attention to the healthcare needs of the patient despite mandatory 30-day visits. Frankly, unless I tell them to do something, they will do nothing...else they do too much to cover their tails. While my mom-in-law is undermedicated in my book, she has been x-rayed so many times I'm amazed she doesn't glow.

PS. I'm in the process of shopping for a new MD for her.

461. msgreer - 9/19/1999 7:57:32 PM

thoughtful

It sounds like you have the situation well under control.
I have great sympathy foryou re the docs you mentioned who make the rounds at the nh's.

There is no doubt in my mind they are in it for the money as you posted.

Good luck. If you need support along the way I hope I can provide it for you.

462. ranheim - 9/19/1999 8:24:34 PM

My office fee is $25. The fee for a nursing home visit is less. The only way that translates into money is that the doctor sees 50 or more patients in a very short time. I chose 50 for easy math : 50 x $20 =$1,000. Not bad for an afternoon of work! From my point of view, it is very difficult to write fast enough to do the chart work necessary on 50 different patients in one afternoon. I never tried this manner of seeing patients myself. I would try to limit my visits to 4 or 5 patients.

My local nh owner has "fired" at least two physicians who have treated nh patients in such a cavalier manner. She runs a tight ship.

If msgreer could come up with a pie-shaped graph and print it, that, I believe, would be instructive for all of us. e.g. no matter how much we complain about the cost of Rx medications, most of us will be surprized at what a tiny % of the total pie it represents. The last such graph that I saw was several years ago : more than 50% of the pie to hospitals. I think M.D.s had about 10 - 12%. Everyone is usually very surprized at how money spent on the totality of medicine is parcelled out.

463. Thoughtful - 9/20/1999 12:33:27 AM

Ranheim? $25 for OV? My MD charges about $100 per OV and the specialists charge even more.... maybe worthwhile to switch Drs! Are you taking new patients?
):-)

The ones who must really make out in nhs are the podiatrists who run from patient to patient clipping toe nails -- not my idea of a good time, but I bet the money's good -- covered by medicare too.

Also, I don't think the drs frequenting nursing homes here even do paper work -- when I called the doc about a question about my mother-in-law -- he had no idea what meds she was on and said that all that info is at the nursing home!

464. msgreer - 9/20/1999 12:48:32 AM

Thoughtful

I like all your suggestions. I will follow up and make the sub threads. I am in the middle of a Tropical Storm with a Hurricane watch so this week maybe out.

Ranheim

Charts are an excellent idea. Let me do some searching and see what I can come up with. I hope you don't think I believe there are no good nh's. I was just posting some of the many problems that face nh's, the residents, staff, physicians and administrators. You have to know you are the exception when it comes to physicians and their dedication to medicine and their clients.

465. msgreer - 9/21/1999 11:24:06 AM

Just so you don't think I am down on the entire medical profession I want you to know I received an email from a friend who said his experience with a nh was a good one. He did say he was there to watch over his loved one as well as the family.

I must apologize if I appear to always be on the defensive when it comes to the medical system in our country. I guess it goes along with what I see everyday.
I have to say I also see alot of wonderful things happening re medical professionals everyday too.

468. msgreer - 9/22/1999 3:12:50 PM

Post #466 and 467 have been deleted upon Elliot's request.

469. msgreer - 9/23/1999 7:35:30 AM

Tonight Political Incorrect had a great dialogue about people's right to smoke marijuana when they are critically ill. In particular they spoke of relieving nausea and pain. One person was absolutely against it stating it is illegal and a mind altering drug. Richard Lewis was at his best when he said "we wouldn't want anyone altering their mind with a joint because the death they are facing is so painful".

So what is the consensus? Should people be able to smoke a joint to relieve themselves of nausea and be able to eat or should people pop Pecodan and Morphine which may or maynot relieve their symptons? Don't morphine and percodan alter one's mental state also?

Bottom line was the pharmacutical companies do not want to have people smoking a joint. It would take away from their bottom line. Atleast that is what one of the guests said.

470. Nostradamus - 9/23/1999 7:40:17 AM

Drugs should be legalized and taxed. Same reasoning that abortion should be legal: 'My body. My choice.'

471. msgreer - 9/23/1999 7:54:26 AM

Nostradamus

I'm with you. I have always said this is my body and I will make my own choices thankyouverymuch.

472. ranheim - 9/23/1999 3:40:52 PM

Current pot laws give law enforcement powers that they should not have! e.g. kick down your front door should they suspect (smell?) pot. I am also very uncomfortable with seizure of property laws. So, get rid of all pot laws. The lawyers amongst us can tell us how stringent laws in regard booze are. I would suggest that pot be added to those laws, already in existance.

I still have not made up my mind on such things as heroin; cocaine.

The US govt really showed their butt in the laws against peyote (or was it a mushroom?) that have been used for years in some Indian (not the Indian sub-continent) ceremonies.

473. Dantheman - 9/23/1999 4:23:56 PM

I will qualify my statements by saying I have never used any illegal drugs, other than underage drinking (and I'm not running for political office). On the other hand, I had a grandfather whose bone disease was so painful, he averaged 12 percosets per day and still functioned. I am just not sure how. I once was prescribed percoset, took 1/2 of one and remember thinking I couldn't get out of the bed if it were on fire.
I think the determination as to the legality of drugs should be based on their harmful properties, including addictive nature. This would permit marijuana, but proscribe cocaine, heroin, etc. I am not in favor of government selling them (as is frequently proposed), seeing what a terrible job Pennsylvania does with alcohol.

474. bloodnfire - 9/24/1999 1:58:29 AM

Msgreer. When you are feeling completely recovered and can participate fully in this thread, how about addressing some aspects of 'Anatomy of the Spirit' as they relate to the holistic care of the human body ? I think, with your experience combined with your professional qualifications, it would make for a very stimulating thread. How about it ?

475. msgreer - 9/24/1999 7:39:46 AM

bloodnfire

That is a great idea. The book brings out many alternative medical thinking and could be discussed her.

Thanks for the suggestion and the encouraging words.

476. msgreer - 9/25/1999 5:37:24 AM

I want to clarify my thoughts on legalizing marijuana. I do not want to see the government legalize and tax marijuana.

However when it comes to using marijuana for medicinal purposes I support it. I don't have cancer. I don't have AIDS. I don't have glaucoma or a painful bone disease. If I did I would want the CHOICE to use marijuana to elevate the pain or nausea I had with these diseases as well as many others.

I have seen when all the narcotics we have to offer no longer help control pain. I have seen people waste from not being able to eat from nausea. I have seen whatever quality of life a dying person has be taken away from them while suffering sets in.

I have had friends turn to marijuana to ease their pain. More often than not it has helped. I can not understand why marijuana should be kept out our hands when we are on our final journey. If it helps in anyway to ease the pain I find nothing wrong with making it available.

GO TO natlnorml.org (National Organization to Reform Marijuana Laws)
You will find news about legalizing marijuana for medical purposes.

477. ranheim - 9/25/1999 10:56:04 PM

msg

Why?

The laws currently on the books (in regard pot) are a license for law enforcement to abuse their powers. And, in the local area, they do it frequently.

478. bloodnfire - 9/25/1999 11:17:28 PM

I want to understand your thinking too, Msgreer. I think the laws against the use of Marijuana are totally unrealistic, have resulted in our prisons being jammed with people arrested for posession and posession for sale, and have only served to 'jack up' the price.
That's the problem. There is so much corruption in police and law enforcement that too many people's income depends upon continuing the "War against Drugs", (a war which we have been losing ever since it was declared, imo).
We tell kids, "Just say 'no' to drugs". It isn't a question of 'just saying 'no' to drugs, it's a question of just saying 'no' to $100 easy per day (or considerably more), as opposed to $5 per hour for a part time job at McDonalds.
As an advocate of 'free choice', and "it's my body", your not being in favor of legalizing marijuana (which I believe is far less dangerous than alcohol) surprises me. But I respect you tremendously, so I look forward to your explanation.

479. Nostradamus - 9/25/1999 11:32:15 PM

Hey blood, you smoke dope? Groovy. :)

480. bloodnfire - 9/26/1999 1:52:15 AM

No I don't, but if I did I wouldn't inhale..... :-) Actually one evening, way back in 1966 my wife and I sat down with our three oldest daughters (who were then in their late teens) and tried smoking marijuana for about 3 hours, (inhaling like crazy). It did absolutely nothing for either of us. We have never tried it since. HOWEVER, if you or anyone else wants to smoke pot, or grass or do anything else with your body that I might consider dangerous, I think it should be your right to do it. Passing laws forbidding anything human beings want to do, only increases the price, (and provides jobs for lots of those in law enforcement). imho.

481. ProfEmeritus - 9/26/1999 3:03:15 AM

Whether legalized or not marijuana should be available to those for whom it is a comfort during serious or terminal illness. It is unbelievable that people are prosecuted for making marijuana available for medical purposes. In fact, it is a waste of resources to prosecute for any raising, sale or consumption of pot. All presently forbidden drugs should be made legal to relieve the present strain on our penal resources caused in part by prosecuting victimless crimes such as drug consumption. But if our society cannot become reasonable enough to abolish the present constraints on personal choice, we should at least take the simple step of approving medical decisions. I understand that almost all physcians consider restrictions on medical use of marijuana an interference with their efforts to relieve suffering.

482. ee - 9/26/1999 3:53:43 AM

As a recovering alcoholic/addict who started out with harmless pot smoking I think that the danger of pot is real. I suppose I would have had a tendancy to over indulge no matter what the substance was,but the fact is that I started with pot at a young age believing that it was harmless. It wasn't harmless for me and it doesn't appear harmless to be for a lot of people I see.

OTOH I don't think filling the prisons with addicts makes any sense,and I can appreciate the medical value. The pot clubs around here look to me like just that,clubs.


Msgreer: This looks like a great thread. I don't know why I've overlooked it, other than a lack of time

483. msgreer - 9/26/1999 4:09:56 AM

ee et al...Thanks for responding. I struggle with my feelings about legalizating marijuana. Perhaps I have been around alot of folks like ee. I do not mean that in a negative way. I just have seen alot of struggling with addiction.

I agree the prisons are full of one toke users and first time offenders. I don't agree with that. I don't want the police to knock down my door as ranheim suggested. What I would like to see is our government be called to task on the drug problem. I see it as a big problem with our government making political and financial gains while they look the other way and let drugs into our country. Perhaps this is very naive.

So if appears I am talking from both sides of my mouth maybe I am.

You'll excuse me if I continue to stuggle with this issue.

484. bloodnfire - 9/26/1999 4:16:17 AM

Appreciate your usual candor and honesty, msgreer. We all struggle with the pros and cons. This would make a great sub-thread I think. Wabbit would be glad to help you set it up, I'm sure. Sorry I can't help, but I'm a computer-illiterate.

485. msgreer - 9/26/1999 4:19:09 AM

ProfEmeritus

Not all doctors are against the use of marijuana. I can say that from experience.

It is not always easy to find the doctors who will understand the way they were taught pain management in Medical School has nothing to do with today's reality. It has taken JAMA along long time to even print studies on the use of marijuana in glaucoma patients.

One thing I do know I am for is the use of marijuana for medical purposes.

486. Ronski - 9/26/1999 7:53:14 PM

There are plenty of doctors and even more nurses who know the medical benefits of marijuana. In cases of extreme nausea, marijuana is often the only thing that provides relief. Nausea is often considered by the sufferer worse than pain, and the state-of-the-art anti-nausea drugs sometimes do not help in the worst cases, even if administered in an off-label way (such as by drinking rather than I.V.). The whole drug war is a crock, though, anyway. The coercive method cannot and has not worked. Never will. And it causes far more harm to our society than decriminalization would.

487. Thoughtful - 9/28/1999 1:51:07 AM

I'm not one for blowing my mind out with anything. I get a lot of mileage out of ginger ale! and when I drink water, it's usually on the rocks --straight up is too strong! However, of the drugs that are out there, I would rather see maryjane legal and alcohol illegal because of the effect it has. Many people respond to alcohol with belligerence whereas MJ tends to help people mellow out. I can't help but wonder if that was part of the reason why the first Woodstock was so peaceful where the last one was so violent. Don't have any stats on hand, but know that alcohol is a big component in many incidences of domestic violence --don't ever remember hearing that pot played a role.

Regardless, there are many, many drugs with harmful and addictive side effects which the medical community is allowed to dispense presumably because they do it carefully. I don't see why pot should be any different than those other drugs.

488. msgreer - 9/29/1999 8:58:40 PM

SUB THREADS

Thanks to wabbit most of my sub threads are up.

I wanted to say a couple of things. You will see "Reliable Health Links" which indicate this site has the HON or Health on The Net Foundation code symbol. Mayo Clinic recommends looking for the HON symbol when searching for reliable health care information. Mayo says anything with.com has something to sell and all information should be read with a grain of salt.

Check the sub thread out. It is rich with information.

I am still working on a good HMO link. I am waiting on GAO to for information on the Dems and Repubs Patients Bill of Rights.

If you have health issue you are specifically interested me please email me and I will get back to you.

489. msgreer - 9/29/1999 9:02:59 PM

SUB THREADS = LINKS

No sub threads... LINKS.

490. msgreer - 9/29/1999 9:09:06 PM

The link "Reliable" is in French and English.

When you go browsing you will find many of these links are universal not just national.

491. Cygnus X-1 - 9/29/1999 9:56:01 PM

At the risk of rehashing old posts, did anyone ever discuss here why healthcare is so expensive? Did they ever postulate that if the supply of money to pay for healthcare is unlimited, so too will be the price? And, that the only way to correct this is to limit the supply of money for healthcare which means that some will be able to afford better healtcare than others, and there's nothing you can do about it?

492. msgreer - 9/29/1999 10:09:42 PM

Cygnus

No, this issue has not been discussed.

There are many reasons health care has gotten so expensive in this country. Afew of the reasons include the new technology available in health care. One example is the 20 second MRI. It is an invaluble tool when someone comes to the ER with a stroke. But it is expensive. Also driving up costs is the fraud that goes on in the health care system. Hospitals, HMO's, clinics, physicians and other health care professionals milk the system. HHS investigates fraud but they are losing the battle.

Other areas that up health care costs is research ie gene therapy. It is the next step in medicine but very costly.

These are but afew reasons.

As for the thought that some people will always get better health care than others it does not have to be that way. There is an answer. It is the single payer universal health care system. I have never understood why a country so rich and so able to provide decent health care for ALL its citizens refuses to do so.

I had high hopes when I heard Bradley was going to introduce Universal Health Care. His plan didn't come close. Same old same old.

493. msgreer - 9/29/1999 10:23:37 PM

BTW,I refuse to believe there is nothing we can do in this country to make sure you get the same health care as the VIP's of the world who come here for some of the best medical therapies in the world.

SINGLE PAYER UNIVERSAL HEALTH CARE PLAN

California is deeply involved in studying and writing policy for single payer. I feel another link coming on.

494. Cygnus X-1 - 9/29/1999 10:23:45 PM

msgreer, Re Message #492
But why is an MRI so expensive? Computers used to be expensive, too. But, people only have so much money that they'll spend on computers. So, computer manufactures, in order to make money, found ways of making computers more cheaply so that they could sell to more consumers. Granted, some consumers have had and always will have better computers than others. But, these cheap computers still do quite a lot.

What would have happened if the government decided to have "universal computer ownership"? The gov't would hand out money to everyone to make sure they own computers. Why, then, would the computer manufactures have an incentive to make them more cheaply? The government will pay whatever it costs (or close to it).

You might argue that it can take bids. But what incentive does the gov't employees have to get the best deal? It's not their money. True, it's their taxes, but some rich corporations mostly pay it anyway.

495. Dantheman - 9/29/1999 10:31:41 PM

Cygnus,
I am trying to decide whether you are joking, but am unsure.
"But, people only have so much money that they'll spend on computers." Really? Then why has the expenditure gone up so greatly in the past 20 years? Why are there so many more computers being purchased by so many more people?
"Why, then, would computer manufacturers have an incentive to make them more cheaply?" Try, because there are more than 1 manufacturer, and the manufacturers are competing to get the most orders (whether from the government or from private purchasers). Similarly, under a system where consumers get to choose their health care provider (as the Clinton plan was) the HMO's would compete to get consumers to choose their plan over others.
"but some rich corporations mostly pay it anyway." Actually, individuals pay substantially more taxes than corporations.

496. msgreer - 9/29/1999 10:33:48 PM

Cygnus

Technology like the MRI is so damn expensive because there are restrictions on how many hospitals can purchase and use this specific technique. It is like when a hospital applies to start an open heart surgery unit. If there are several other hospitals in the area which already preform this task they are oftentimes turned down. The reasoning is if all hospitals had this privledge it would take away from the other hospitals revenue. I don't buy it. It oftentimes mean people have to travel great distances to get the health care they need.

As for your analogy with computers... computers are a wonderful thing to have. I would love to see all schools and libraries with sufficient numbers of computers to serve each community. But pc's are still a luxury despite the fact costs may seem reasonable to you. Health care is a right not a luxury.

When people have to make the decision whether to purchase health care of buy a computer the answer if obvious.

Single payer system does not mean hand outs. It means we all pay the same amount each year into a pool thus allowing ALL our citizens the same access to all advances in health care there is to offer in this country.

497. Ronski - 9/29/1999 10:36:57 PM

The expansion of technology is one reason why health care costs have risen.

But the primary reason, as Cygnus alludes to, is that anything subsidized becomes more expensive due to excessive utilization. It's the same with higher education.

Thank God Bradley came out with something far short of single payer. The Canadian system is a mess these days.

498. msgreer - 9/29/1999 10:43:15 PM

Ronski

Bradley's plan of giving tax deductions for the cost of a health plan for a family or individual will not help if the person can' afford the policy to begin with. There are millions of working class folks whose employers do not offer health insurance or if they do it is too expensive for them.

The Canadian system does not have to become our system. We do not have to follow their lead.

We are the only highly industralized country in the world that does not provide health care for all its citizens. I say there is something wrong with this picture.

499. PsychProf - 9/29/1999 10:44:48 PM

But we build a great bomb...

500. msgreer - 9/29/1999 10:46:09 PM

And there is another issue to consider. If a person has a pre-existing condition the HMO's/insurance companies have to offer them a health care plan. They do it alright but the cost is astronomical. Very few people can afford it. So they say we offer health care plans for everyone and then price them right out of the market.

501. Cygnus X-1 - 9/29/1999 10:47:01 PM

Dantheman, Re Message #495
You know, of course, that I'm serious. But, attempting to belittle my argument does no good.

The alleged fact that expenditures on computers are increasing is irrelevant. Each year, there is only so much a person will spend on a computer, car, house, etc. It's based on what they can afford.

Why are there so many more computers being purchased by so many more people?
Because they're cheaper than they used to be.

..manufacturers are competing to get the most orders
It's easier to increase profit by increasing the price. The reason computer manufacturers can't is that there is a limited supply of money coming from buyers. Thus, the competition is in who can reduce cost the best.

..the HMO's would compete to get consumers to choose their plan over others
But they wouldn't compete on the basis of price because people don't care how much doctors charge. Insurance (or Medicare) pays for it. They only care about getting more and more features.

502. Cygnus X-1 - 9/29/1999 10:51:48 PM

msgreer, Re Message #496
Health care is a right not a luxury.
From where do we derive that right?

But pc's are still a luxury despite the fact costs may seem reasonable to you
Are color TVs a luxury? Air conditioning? I believe the percentage ownership is 95% and 66% respectively.

Tou can get a PC for a few hundred dollars. The problem is, many don't see the need nor have they the desire to own one.

503. Cygnus X-1 - 9/29/1999 10:54:07 PM

msgreer, Re Message #498
We are the only highly industralized country in the world that does not provide health care for all its citizens.
Yet, we have the best healthcare. Why is that?

504. Dantheman - 9/29/1999 10:54:37 PM

Cygnus,
The point of my post is that the providers (i.e., the HMO's) will compete to get the largest number of customers signing up with them. Is there a real difference between HMO's competing to sign up customers based on price and competing based upon the number of features provided to customers?

505. ranheim - 9/29/1999 10:58:42 PM

Cygnus

I have never understand individuals who say "The USA spends 16% of its money (they never say whether this is before or after taxes) on all facets of medicine; the next highest in the world is . . . who spend only 9% of their money!"

Who is to say that 9% is a more correct figure than 16%; would you consider 29%? (How would you select a panel to analyse just this question?) Additionally, if citizens in the USA want to spend 16% of their money - irregardless of whether that % is too high - or not - why not let them? Noone has a gun to their collective heads. Maybe you have a Mercedes; I drive an 9 year old Ford Probe. Is your % figure for transportation too high? Mine too low?

If the way medical bills were paid an instant change would follow. Very, very few patients walk out of my office without paying their bill. Noone flashes an insurance card at my wife (she is my "office manager") and walks out. "Oh no! We will provide you with receipts and fill in forms properly; but, this is YOUR insurance NOT ours. You fight with them for payment". If the patient doesn't like that, there are no shortage of doctors in the immediate area.

All should look at a Plastic (Cosmetic) Surgeon's practice. Very few of these procedures are covered by private or government insurance. I will be that the fees charge by Plastic Surgeons are the fairest in the business. Because there is no insurance compnay or government body standing between the patient and the doctor warping the business aspect of medicine!

506. Cygnus X-1 - 9/29/1999 11:00:08 PM

Dantheman, Re Message #504
Yes! Who's going to pay the HMOs?

If they don't compete based on price, what incentive do they have to do things more cheaply?

507. ranheim - 9/29/1999 11:00:55 PM

I will bet

508. Dantheman - 9/29/1999 11:04:13 PM

Cygnus,
Because if they do things more cheaply, they can offer greater services for the same price, giving them an advantage in competition with other HMO's.

509. msgreer - 9/29/1999 11:04:14 PM

Cygnus

Bradley said health care for all is a right. He sighted the Bill of Rights...you know the pursuit of happiness. Bradley said it is difficult to pursue happiness if one is chronically ill or has an acute situation and needs immediate medical attention.

Regarding air conditioning and color tv's.. it might surprise you to know not everyone has these. I don't know where you get your figures. They don't seem accurate.

I invite you to spend a day or two with me when I see clients who do not have a color tv. I'll give you they may have a B&W but paying for prescriptive medication is far more important to them. I don't know what world you live in but people are making these choices everyday.

I was happy to see Bradly included cost for prescriptive medication in his plan.

Remember not all of us are on Medicare at this time. I believe Medicare just sent a huge mailing to millions of folks explaining the Medicare benefits and what the individual is still expected to pay. They discussed the many managed care routes to go. Unfortunately is was noted by the woman who wrote the letter not all seniors will understand. There are people with mental incapacities. They are many who just find it too confusing which is something I can relate to. It was mentioned Medicare is getting most of its calls regarding policy from the angry children who find their parents in an intolerable situation. I will have to find the article for you.

The children are trying to find the best supplemental insurance to go along with Medicare. What they are finding is one policy will pay for medication but leaves out 10 other services.

510. Ronski - 9/29/1999 11:12:09 PM

Health care is not a right. A right is something you are permitted to do that does not impinge on any other person's rights. You have a right to speak, assemble, petition, and worship. You do not have right to force another human being to give you material goods.

Health care for all is an important and desirable goal. It will be met far more quickly by unshackling the private sector and letting free enterprise produce it, as we let free enterprise produce other goods and services, than by further collectivizing the health care industry.

511. CalGal - 9/29/1999 11:20:40 PM

This nonsense of people not being able to afford insurance must stop. Healthy people can afford insurance and it won't cost them a couple hundred a month.

Sever the relationship between employment and insurance.

Health insurance needs to be like car insurance: the responsibility of the individual. Some government intervention required to ensure that insurance companies won't get abusive and that all individuals get the insurance that is required.

Subsidize the policies of the poor and the chronically ill. Make insurance costs deductible; tax employees who receive benefits through employment.

So let it be written, so let it be done.

Health insurance isn't a right. Let's make it an individual responsibility.

512. Cygnus X-1 - 9/29/1999 11:21:32 PM

ranheim, Re Message #505
There are 3 types of lies: Lies, damned lies, and statistics.

513. Thoughtful - 9/29/1999 11:21:35 PM

Ranheim, the 16% of spending is from the GDP accounts -- take all the goods and services purchased in the US (final purchases that is: not the purchase of iron to make steel or steel to make a car, but the car) by the government, business and consumers and that's the total. Of that 16% is spent on medical care.

Whether appropriate or not, it is significantly larger than in other nations, and is questionable in that the US, despite all this spending, has neither the highest average life span or the lowest infant mortality rate. This leads some to question if we are getting our money's worth out of all that spending.

514. CalGal - 9/29/1999 11:21:36 PM

This nonsense of people not being able to afford insurance must stop.

rewrite:

This nonsensical claim of people not being able to afford insurance must stop.

515. Dantheman - 9/29/1999 11:29:09 PM

Thoughtful,
Moreover, since the U.S. has a higher GDP than nearly all other developed countries in the world, on a per person basis, the difference in amount spent is even greater. That is, we spend roughly 16% of approximately $28,000 per person, while the British spend roughly 9% of approximately $20,000 per person. (I can't bring up the CIA Factbook to get better numbers).

516. Cygnus X-1 - 9/29/1999 11:34:38 PM

Well said, Ronski. However, don't let her (and Bill Bradly) get away with confusing the preamble with the Bill of Rights. Also, being sick has nothing to do with whether or not your right to pursue happiness is infringed.

517. Dantheman - 9/29/1999 11:35:46 PM

According to the CIA Factbook, UK GDP is $21,200, so 9% is $1,908.
US GDP is $31,500, so 16% is $5,040. Still think we're getting our money's worth?

518. Cygnus X-1 - 9/29/1999 11:46:39 PM

Dantheman, Re Message #517
Isn't this statistic lacking in meaning since it depends on, among other things, the actual and perceived health of the citizens? That is, doesn't it depending upon how content a society is with it's overall health?

Also, do these figures include private money in addition to the government subsidy?

519. Dantheman - 9/29/1999 11:54:28 PM

Cygnus,
My understanding is that they are total health care expenditures from all sources. Ask ranheim, though, since all I'm doing is translating his statistics into numbers. I've seen similar numbers in the Economist, and those were based on total spending.
As thoughtful pointed out, the results of our health care spending (life expectancy, infant mortality, etc.) are far from the best among the developed world.

520. ChristiPeters - 9/30/1999 12:09:43 AM

hourly pay = $8.50
40 hr week = $340.00
mo. gross = $1360.00
mo. net = $1088.00

rent = $465.00
gas (home) = $50.00
electric = $80.00
phone = $35.00
After-school
care (1 child)= $144.00
Groceries = $250.00
gas (car) = $40.00

monthly expenses = $1064.00

$8.50/hour is what my pay was when I worked for NASA. I don't remember my typical take-home, so I just subtracted 20% to get net. I did not have health or dental insurance coverage. The other figures are what I was actually paying. The groceries figure includes cleaning products, toiletries, etc. as well as groceries. Note that there is no figure for cable, couldn't afford that. Also could not afford a PC, let alone Internet service. No car payment, thank god. I had a 1979 buick which was paid for.

So you have net pay = $1088/month and monthly expenses = $1064/month.

Tell me again CalGal how I could afford a "couple of hundred dollars a month" for health care.

There are a lot of people who make this salary.

There are a lot of people who make less.

521. ChristiPeters - 9/30/1999 12:11:02 AM

Yep, the idea that there are people in the US who can't afford health care sure is nonsense all right.

NOT!

522. ranheim - 9/30/1999 12:11:42 AM

People those were NOT statistics!!

I used numbers only because I thought that my point would be made easier that way.

People are very, very different.

I have never had use for cars. All they do is cost me money that I would rather spend elsewhere. So is the % of my wages spent on the Probe too low?

Is the money I pay to my health insurance company every month too low? or too high?

The last movie I attended, Shelly Winters was fat in an upside down ship - forget the pictures name. Is that % too low a % of my income spent on going to the movies?

When it comes time to replace the "needle" of my record player - I have 5+ thousand LPs - I spend $5000. Is too high a % of my wages?

Now that you have the idea, why is the % of Thoughtful's GDP spent on medicine too high? What was the composition of the group enpaneled that made this determination? Don't we, as a nation, have a right to spend what we wish?

And be very careful comparing stats of this country's to another country. Thoughtful you used total lifespan and infant mortality. If a Scandanavian country's infant mortalities stats are used for comparison you should go to the stats for N. & S. Dakota; Iowa; Minnesota; Wisconcin for your comparison/s. You would be, then, comparing north germanic peoples with mostly north germanic peoples.

523. CalGal - 9/30/1999 12:12:16 AM

Christi,

I said, Healthy people can afford insurance and it won't cost them a couple hundred a month.

In other words, it can be had for much less.

I also said that the government could subsidize insurance costs for those that are lower income. I'm not sure if $8.50 an hour counts.

524. Cygnus X-1 - 9/30/1999 12:14:33 AM

Dantheman, Re Message #508
I just realized I didn't respond to this...
Increasing the number of customers doesn't necessarily increase profit let alone increase it enough to be worthwhile. True, HMOs do introduce some price pressure, but it is relatively insignificant as long as people don't treat insurance money as if it were their own.

Think about it: Do you ever get sick and not go to the doctor? If you do, is it because a doctor's visit is too expensive? Or, is it because you don't feel like going and waiting in some office?

525. CalGal - 9/30/1999 12:14:34 AM

Yep, the idea that there are people in the US who can't afford health care sure is nonsense all right.

Please note the difference between "insurance" and "health care". I am talking of insurance. Catastrophic coverage can be had for $60-80/month. If you don't have insurance through your employer and you make too much money to be on Medicare, then it's idiotic not to pay that money.

526. Cygnus X-1 - 9/30/1999 12:20:51 AM

ChristiPeters, Re Message #520
Gee, you should have had a roommate.

527. ChristiPeters - 9/30/1999 12:27:40 AM

CalGal -

Look at that budget again. There was $24/month 'cushion' there, not $60 to $80. It also totally ignored things like oil changes and clothing. I certainly couldn't find health insurance for $24/month to cover both of us. I "made too much money" for a family of two to get Medicaid or any kind of gov't subsidy that existed at the time.

My point stands - there are people in the US who cannot afford $60-$80 per month for Health Insurance.


Cygnus -

"Do you ever get sick and not go to the doctor? If you do, is it because a doctor's visit is too expensive?"

From 1988 until 1995 I did not go to the doctor when I was sick because it was too expensive. I did take my daughter to the doctor once I got smart, quit my job, and went on welfare, therefore qualifying my daughter for Medicaid. However, Medicaid did not cover me, only her.

528. Dantheman - 9/30/1999 12:36:07 AM

Cygnus #524,
"Increasing the number of customers doesn't necessarily increase profit..."
Why not? If there is an expected profit per patient of X, as long as X is a positive number (and no one is expected that HMO's will act as charities) then more patients equals more profits. In fact, more patients would decrease the risk that any one patient needs an unusually large amount of services, making the profits more secure. (ask the people running the Econ thread if this is unclear -- actuarial science is not my area of expertise).
As to being sick and not going to a doctor, I rarely even skip work when I'm sick. Seriously, the point of co-payments is to create an incentive for the patient to use only treatments which are economically justified.
However, that is irrelevant to the issue you framed: whether the HMO's have an incentive to cut the cost of providing medical services under a plan like Clinton's. As I've pointed out, they do -- if they can cut costs, they can either reduce prices for the same services or increase the services provided while charging the same price, either of which will attract more consumers to that HMO.

529. Dantheman - 9/30/1999 12:39:46 AM

#528 expected = expecting

530. CalGal - 9/30/1999 12:41:05 AM

Christi,

No, your point was that you couldn't afford $200/month. Which I agree. But you can't afford not to afford $60/80 a month. Find cheaper child care, find a roommate, cut back on groceries, take the bus, get a loan, put it on a credit card. Do what you have to do.

But no, instead you chose to do without and decide it was because you couldn't afford it. I imagine you managed to afford car insurance, didn't you?

People are too easily dissuaded from getting coverage. Instead they trust to fate and hope no accident will occur. That is their choice. But if they gave it the same priority that they give cars, childcare, and food--they could afford it. And they should.

That's my point.

531. Dantheman - 9/30/1999 12:46:57 AM

Sorry to post and run, but goodnight

532. Cygnus X-1 - 9/30/1999 12:59:33 AM

ChristiPeters, Re Message #527
From each according to his means. To each according to his need.
I don't mean to be critical, but it sounds to me that in this case, because of a "communistic" construct in our society, it was better for you to increase your need rather than your means.

533. Cygnus X-1 - 9/30/1999 1:04:19 AM

Dantheman, Re Message #528
In short, it may be that adding customers may disproportionately increase costs.

As for HMOs adding "features", since Americans seem to expect every health service to be available to them as if it were a right, I don't see how HMOs can compete unless they include all of them.

534. ChristiPeters - 9/30/1999 1:15:08 AM

I imagine you managed to afford car insurance, didn't you?

Actually, no.

There were no busses. This was the cheapest chidcare, etc ete.

CalGal - we will never agree on this. You are absolutely sure that there are ways that anyone, no matter how impoverished can get health care. You don't believe that there are people who are doing their damndest, and can't. $8.50/hour, for a family of 2 is not impoverished by any means and it would have been damned difficult even if I had known where and how to get private health insurance. I can't imagine how a family of four on minimum wage could possibly do it.

It must be nice to be CalGal, so secure and so sure how everybody could get whatever they need if they only tried hard enough.

You think I am wrong that some people cannot afford private health insurance.

I think you are wrong and callus, to boot.

Perhaps we should just ignore each other in this debate.

535. ChristiPeters - 9/30/1999 1:17:48 AM

#532 - Thank you Judge Cygnus.

I looked at my circumstances. I looked at what was available in the reality I was in, and I did what was best at that time in those circumstances to take care of my kid. Did I like it? No, but it served it's purpose while I went about changing my options by changing my circumstances.

You got a problem with that?

tough shit

536. ChristiPeters - 9/30/1999 1:18:50 AM

I think I will bow out of this debate.

No doubt you all know better than me.

537. CalGal - 9/30/1999 1:30:04 AM

Christi,

First off, don't take things so personally. There's no point. Just use hypotheticals if you can't manage to detach from things. I'm not callous. Nor did I mention anything about "trying". I'm not attacking you. I am merely pointing out that you are completely inaccurate when you say you could not afford health insurance. You had several choices and you chose to play the odds. That's fine.

The problem is that everyone in this country is tied to the notion that employment and insurance are joined at the hip. They are not. Health insurance can be obtained by anyone. I do not think we can switch over to requiring that everyone obtain their own health insurance without government protections. I stated many of them earlier. But I do think this notion of people "not being able to afford" health insurance when they have a car, child care, and gas money is absurd. They can afford it. They choose to go without. In part because they are so used to thinking of health insurance as something that an employer provides. Very few people realize what is available in terms of individual coverage.

And would you please stop substituting "health care" for "health insurance". They are entirely different things. I agree that at $8.50/hour you aren't going to be able to afford too many doctor visits for non-critical situations. That's how it works at the bottom of the income pool. But you should be covered in case you have
cancer.

538. ChristiPeters - 9/30/1999 1:51:44 AM

"I am merely pointing out that you are completely inaccurate when you say you could not afford health insurance"

I understand that that is what you are saying. You apparently don't understand that I am saying you are wrong.

I was trying to use an example of a real life situation where I knew the numbers to make the point that there really are people who cannot afford health insurance.

You disagree.

I say you are wrong.

I'm obviously not going to change your mind. You are definitely not going to change mine.

End of discussion.

I could argue the specifics of my example. Such as when you live in a town with no public transportation, giving up your car = giving up your job. Not an option. Going without childcare is not an option either. Even if I was a callus enough parent to leave a 5 yr old home alone, it is illegal. etc etc. However, that would be useless and would not change the fact that we disagree.

Just because CalGal asserts that on an internet forum that everyone can afford catastrophic health insurance doesn't mean it is true.

539. ChristiPeters - 9/30/1999 1:54:00 AM

Of course, you could say there is nothing to say that what I assert is true either.

Like I said. I'm bowing out. I'll come back when y'all are discussing another aspect of health care.

TTFN
&:o)

(nothing personal and I'm not upset, just not interested in going round and round to no purpose)

540. CalGal - 9/30/1999 2:07:36 AM

Christi,

All of those things are your choice. You could go to a soup kitchen every night--or every third night--for dinner and save money on groceries. You could have moved to a place with public transportation. You chose to leave health insurance last.

You could have done many things, rather than leave you and your daughter open to the disaster of a health crisis with no insurance. Oh--btw--insurance for children is $19/month. Did you get that for your daughter? It's in your ballpark and would have protected your daughter from your inability to pay for any medical catastrophe.

I'm willing to bet that you never went out and looked for health insurance. I'll bet you didn't find out if there was something less than $60-80/month. I'll bet that lots of people in that income range don't even look. Why? Because, as I said, in this country the mindset is "Employers offer health insurance". And if your employer doesn't, well, then, you can't afford it.

The mindset is what I object to. If people were actively considering health insurance, looking for it, not being able to find it--fine. But that's not happening.

If more people started looking, it is outside chance possible that insurance companies might start finding ways to offer incredibly cheap coverage. Hell, I bet that a few news stories of low income people looking for affordable health insurance would cause Congress to kick start a requirement that insurance companies offer baseline catastrophic coverage for, say, $40/month.

I haven't said that everyone can afford health insurance. For one thing, only healthy people can at this point. But most people can. Far, far, far more than are doing so.

541. Cygnus X-1 - 9/30/1999 3:32:09 AM

ChristiPeters, Re Message #535
Yeah, Yeah, I know. I'll take a laxative.

My problem is not with you. Everyone has to do what's best for themselves. My problem is with our welfare system that encourages people to make such decisions.

542. ChristiPeters - 9/30/1999 4:18:17 AM

Well, Cygnus, the great welfare debate usually makes as much progress as the the great gun control debate or the great abortion debate.

fwiw, here's my take. For the first forteen years of my adult life, I worked and supported myself and paid my taxes. Then I was injured, permanently disabled, and unemployed. I accepted limited welfare assistance - namely food stamps and medicaid for my daughter for four years while I went back to school. So now I am an Engineer and once again supporting myself and my daughter and paying more in taxes than my net annual income before I was injured.

So, gee, welfare acted as temporary help while I got back on my feet.

Sounds like it worked just the way it was designed to.

In spite of the urban legends and the anecdotes that sound so good in political speeches, that's the way it works for the majority of folks. who go on welfare.

543. msgreer - 9/30/1999 12:46:14 PM

As I get ready to pick up my dear friend for the drive to our state's major cancer center I find myself gasping for each breath. My dear dear friend got a dx. of ovarian cancer last Friday. One week later we are making the 60 mile trip to see her surgeon.

My health tip for the day is hug the ones you love.

544. ChristiPeters - 9/30/1999 3:24:12 PM

msgreer -

Excellent health tip, beneficial for giver and receiver.

545. Thoughtful - 9/30/1999 3:31:01 PM

calgal, I don't know where this cheap health insurance is coming from, but a friend of mine and his wife are both self-employed and looked for health insurance for individuals -- not part of a group. He found it alright. Insurance coverage for both of them -- no Rx or anything else -- just major medical was going to be $10,000 per year with a $1,000 deductible for each. Not what I would call "affordable".

546. Dantheman - 9/30/1999 4:14:04 PM

An interesting op-ed piece on health care debate

547. CalGal - 9/30/1999 4:52:26 PM

Thoughtful--$1000 deductible is not catastrophic coverage. In fact, if you changed the deductible to $2000, I think the cost drops nearly 50%. And even $2000/year isn't major medical only. Depending on what the coverage is, a $2000/year policy can be quite expensive. Did they want $10 doctor visits, or $35? And so on.

Toss in age--if they were over 45, it would be more expensive--and there's another good chunk. Health insurance is like life insurance--it gets more expensive as you get older. However, I would like those price hikes to be examined--I have a feeling they don't have to be that much more expensive.

And then you mentioned two people, not one. Two policies are generally cheaper than getting one family plan, but a lot of people still get the family plan, for no reason I can think of. But let's assume it's two policies.

So what you are really saying is that health insurance for one person with a $1000 deductible costs $5K a year, or $400/month. That's by no means outrageous. I imagine it is pretty close to what the two of them pay in car insurance, if they have new cars.

It should be fully deductible (and would be in the CalGal plan). Is it the $60-80 I was talking about? No, but then that was for major medical only--I picked the cheapest plan I could think of deliberately, since we were discussing low income people.

548. Ronski - 9/30/1999 5:32:38 PM

The liberal pap from Dionne is what we expect from him. What stands out is his ridiculous idea that government lowering taxes on the charitable sector in order to fight poverty is somehow government activism, i.e. liberalism. It's nothing of the kind. It's simply government getting out of the way so that people can help themselves and help others. The problem with Bush's proposals is they don't go far enough. (And I have no intention of voting for that gay-basher, anyway.)

549. Thoughtful - 9/30/1999 11:53:00 PM

Calgal, your idea of outrageous and mine are very different. Including the deductible, it's actually $600/month per person! $1200 per month is a nice mortgage payment, but not for medical insurance that doesn't cover any prescriptions -- and that wasn't total coverage. It would still pay for only, say, 80% of addtional expenditures.

Car insurance at $6,000 per year for one vehicle? I don't think so -- not unless it's a Ferrari.

550. ee - 10/1/1999 8:41:20 AM

I pay for my own health ins. policy (Kaiser) for myself,spouse and 4 kids. No prescriptions,$10 office visits. $475 a month. It's not cheap but I have to have it.

551. CalGal - 10/1/1999 9:20:52 AM

Thoughtful,

I pay around $4000/year for car insurance, so they'll get no sympathy from me. And I imagine they have two cars? Bet you they pay pretty close to that $6K.

But I think you miss the point. It is not an outrageous price for the coverage. It is also a hell of a lot more coverage than they need. People are spoiled by the fact that companies pick up the tab for far more insurance than people would get if they were paying for it themselves.

If they want luxury coverage they can pay luxury prices. Otherwise, they can get a $2000 deductible, pay a higher co-payment for doctor visits, and if they got hit by a major medical catastrophe, they'd be covered. Anything that wasn't covered would be deductible. Well, it would be after 7.5% of AGI, anyway. It should be more--especially for the self-employed, who aren't getting their insurance tab picked up as an untaxed bennie.

If we moved the responsibility for insurance to the individual, I think prices would drop quite a bit for the healthy. As I've said a couple times, there are certain things that should happen in order to ensure protection.

• Health insurance is mandatory for everyone (must provide policy # on income tax, for example)
• Insurance and all other medical expenses are deductible
• Company provided insurance is taxed
• Insurance companies must cover everyone; people can't be denied or have coverage cancelled.
• Government subsidizes insurance payments for chronically ill and the poor

552. Nostradamus - 10/1/1999 9:51:13 AM

Cal

$4000 a year? You must be a great driver.

There's no question that some kind of market forces have to be brought to bear on the health industry. Your solution is a sensible approach. Would you jail those who don't buy health insurance? If not, what would the penalty be?

553. proudnerd - 10/1/1999 10:00:29 AM

I pay around $4000/year for car insurance

You own a couple of lamborghini diablos, right ??

554. CalGal - 10/1/1999 10:07:00 AM

Heavens, no. I just live in California. Very ordinary car.

555. CalGal - 10/1/1999 10:10:51 AM

Would you jail those who don't buy health insurance?

No. But it would have to be more effective than the mandates on car insurance. I think it should be linked to taxes in some way--federal, not state.

One possibility: policies aren't allowed to be cancelled. If a person refuses to pay, the insurance company notifies the government, who garnishes wages.

556. ranheim - 10/1/1999 2:40:03 PM

Cal

I must be missing something. I doubt that health insurance premiums would go down much with universal coverage. Additionally, why would a healthy 21 year old - either sex - want to be insured? These are healthy people; unless they have some pre-existing condition. At that age they believe they are bullet proof. e.g. never one second think in terms of a serious auto accident.
I have refered to plastic surgery previously. The great % of nose jobs; tummy tucks; etc. are not covered by any insurance. So each individual has to make his/her own deal with the surgeon. THERE IS NO INSURANCE COMPANY OR GOVERNMENT TO INTERFERE! The patient truly pays the going rate. In my very rural area, we are about 90 minutes away from 3 centers where plastic sugeries are done. Believe me! The prospective patients know more about THIS procedure and this surgeon than they do about a possible heart by-pass. Crazy, I know! But, that is the way it is locally.

557. bloodnfire - 10/1/1999 5:32:06 PM

Ranheim. I could hear CalGal screaming from here !! You say..."Additionally, why would a healthy 21 year old - either sex - want to be insured? These are healthy people; unless they have some pre-existing condition. At that age they believe they are bullet proof. e.g. never one second think in terms of a serious auto accident." You might just as well say "Why would anyone with a car in good running order or not having had an accident yet buy car insurance?" Sure, healthy 21-year olds think they're bullet proof, but some still buy 'INSURANCE'. They don't need 'HEALTH CARE'. The American buying public, including one of the most gracious and communicative Doctors I've had the pleasure of listening to (Yourself :-) don't understand the difference. Insurance is purchased BY healthy people and sold by companies TO healthy people, so that if and when they become sick, there is compensation. I used to sell Major Medical coverage back in the 1960's in the early days of such insurance. Friends like msgreer, who have to contend with very expensive healthcare in the family for whom no insurance was available because of congenital conditions are faced with a major problem. CalGal observes, correctly, that for them, there should be a plan of assistance. Speaking for myself, I would be more than happy to have such a plan paid for out of my taxes, (while weeping over the fact that inevitably, with Government programs, waste would be an expensive part of it).

I also sympathize with ChristiPeters. At the time she was working for NASA, (who certainly could have afforded to provide either 'Insurance' or 'Caregiver Subsidy') she hesitated to spend money for coverage which she knew she needed but felt she couldn't afford. I have been there, done that.

558. ranheim - 10/1/1999 7:18:21 PM

#557

I admit that my thinking is warped; by two things.
1) I am extremely fortunate in that my wife, my three children (all in their 30s), and myself are very healthy. I have paid for PAP smears. The youthful cuts and bruises were minor.
2) In my USAF days and with welfare patients I have seen and am seeing the medical system abused on a daily basis. My initial thought in every instance is to 'get the government out'!!

All of "my rules" are out when one is speaking of the lame, the halt, and the blind. Pre-existing conditions are an area where, likely, nothing will be totally satisfactory as the medical bill here can be staggering. A state run/insurance co. mandated pool will probably be the only solution for such unfortunate people.

But, for the 95% of us with good health, can we try to keep the government out; insurance corp. out; employers out. I think my example of plastic surgery is a good one. Way too many of my patients tend NOT to inform themseves about their medical problems. UNLESS they are headed for a nose job; boobs; tummy tuck; etc. These patients do know what the risks are; what the recovery period should be; what the costs are; etc. Much more so than an ulcer patient; a diabetic; a by-pass patient.

I don't know what msgreer's experience is; it will be interesting to find out.

I realize that the above sounds crazy! But, that is my experience locally.

559. ranheim - 10/1/1999 7:31:02 PM

I certainly have benefited; you may also from the following anecdote. One of the first clinical lectures my class at Baylor Med School received in the late 50s was from an Urologist. He must have been in his late 60s at the time.

Boys (he never acknowleged my two female classmates) I want you to remember this (and I certainly never forgot) :

Your parents; the Baptist Convention (Baylor was still tied, loosely, to the Baptists back then); and the state of Texas are spending a lot of money on you. You will be paying these folks back if you realize :
1) 95% of your patient visits will be dealing with healthy people. Please don't kill them!
2) 2 1/2 - 3% of your patient visits are going to deal with patients who are dying. You can do nothing to change the end result. Make these patients comfortable; mind and body.
3) The other 2 - 2 1/2 % are the patients that you can do something about IF you can make the correct diagnosis. This is why all these people are spending a lot of money on you. We EXPECT you to learn how to recognize these patients!

And that has been, pretty much, my experience since 1961.

560. CalGal - 10/1/1999 9:02:35 PM

Blood,

Thank you for answering Ranheim. You correctly anticipated my response--including the squawk of outrage.

Ranheim--I do think prices would go down for the healthy individual. Right now, the individual purchaser is a very small percentage of the market. Were that to change, competition would probably start. Not a great deal of competition on price, perhaps--but options would vary. A 20-year-old might get coverage that included two visits a year and major medical--for $50/month.

561. CalGal - 10/1/1999 9:03:13 PM

Back to Blood:

Speaking for myself, I would be more than happy to have such a plan paid for out of my taxes, (while weeping over the fact that inevitably, with Government programs, waste would be an expensive part of it).

I would prefer that it be subsidization--if it's a government run program, ick. Then we're back with Medicaid, or whatever. I would rather that poor people be given a check every month (or year) for health insurance. They can buy the plan of their choice.

However, you are probably right that no matter what happens, waste or stupidity would occur.

562. CalGal - 10/1/1999 9:04:00 PM

One thing to keep in mind--it is very unlikely that any program is going to make life much better for the poor. Why? Because any plan that did so would come at the expense of the middle-class and the wealthy, and that just isn't going to fly. That is the main reason why I don't think single-payer will ever be accepted--the main people who benefit are the poor.

My interest is in decoupling insurance and employment. I still find it amazing that Hillary went to all the trouble of putting together a plan that continued that ridiculous association.

The problem with decoupling the two is the same one that exists for single-payer: it will upset the mostly employed middle-class, who are completely unconscious of the huge subsidization occurring to their benefit, and will resist any attempt to change it. They just want more and see no reason why they should have to suffer at all.

So my approach makes the middleclass cranky. But it has two advantages over single-payer:

1. the upper income folks, many of whom have more in medical deductions, instantly see the advantage.
2. the increasing number of contract workers will start realizing the advantages to having their own policy, rather than hoping to get hired.

563. msgreer - 10/1/1999 9:06:32 PM

ranheim

I think bloodnfire is referring to my mother and her home health-long term nursing insurance. She let her payments lapse. When she had her insurance agent file for reinstatement she was denied coverage.

I knew nothing about this. When I called her insurance company to start lining up nurses and physical therapists for her return from the Rahab Center I was told by the company she did not have coverage. It seems the insurance company reviewed her application for reinstatement and said no way... they didn't like all the new medical problems her agent included.

She has been paying for this policy for over 15 years. I have written an appeal for her but have yet to hear from the company. I was shocked to see she had not made a payment for close to a year.

She was well enough for them to sell the policy to her. They took her money for 15 years. Now she is too much of a risk for them.

Basically she is unisurable at this point. Luckily for her she has the private means to hire whatever health care professionals she needs. She has Medicare so that has helped abit. And she has me.

564. msgreer - 10/1/1999 9:09:54 PM

BTW, I can not understand her insurance agent. I know this guy. He is really a nice fellow and knows the insurance business. If my mother had checked with me re reinstatement I would have told her not to include half of what her agent reported.

I have had enough experience with insurance companies to know she did not have to include most of what he reported.

As I said she is okay now. I don't see her ever going to a nursing home regardless of her situation so she is damn lucky.

565. bloodnfire - 10/1/1999 11:14:40 PM

One of the problems with which Insurance Companies have to deal (and there are many) is that of 'Adverse Selection'. For example, many people 'lapse' their policies, Life, Health and Property, including Automobile. Those who seek to 'Reinstate' their policies, generally speaking, are those who suddenly find that they need the policies which they allowed to lapse. Others, who have also lapsed their policies, feeling fine, just keep on NOT paying their premiums.
Consequently the Companies face 'Adverse Selection' in reinstating their lapsed insureds, and are, quite understandably very very choosy.

I understand that we none of us feel a lot of sympathy for Insurance Companies, however, many do occasionally suffer enormous losses. The Company I represented in the 60's, The Washington National out of Evanston Illinois, was a leading pioneer in Major Medical Coverage. They took an enormous beating later and I don't know whether or not they are still in the field. I am NOT (I am delighted to say :-).

566. msgreer - 10/2/1999 4:40:15 PM

For those interested in The Atkins Diet tune into MSNBC at 11am Eastern. Dr. Robert Atkins, cardiologist, will be the guest for an hour.

567. bloodnfire - 10/2/1999 5:01:37 PM

Thanks for the suggestion re Dr. Atkins, msgreer. Didn't some Motie post that he lost considerable weight with the Atkins diet recently ?

568. msgreer - 10/2/1999 5:04:52 PM

bloodnfire

I believe Judithathome posted she used Atkin's for a jump start. She said she lost enough weight to help her with the motivation to exercise. I believe Judithathome said she is off Atkins. She is eating well and exercising.

569. dusty - 10/2/1999 5:04:53 PM

bloodnfire

Good points on adverse selection.

I understand that we none of us feel a lot of sympathy for Insurance Companies, however, many do occasionally suffer enormous losses.

How true. You might be interested in a similar point (and a proposal for improvement) that I made here, in the Current Event Thread


The Company I represented in the 60's, The Washington National out of Evanston Illinois, was a leading pioneer in Major Medical Coverage. They took an enormous beating later and I don't know whether or not they are still in the field.

They do still exist, as this indicates. They are part of the Conseco organization, but their standalone financials aren't so hot.

570. bloodnfire - 10/2/1999 5:31:27 PM

Dusty. Thank you so much for taking the time to provide your links. They were most interesting, and I too congratulate you on your article.
I see Conseco 'swallowed up' the Washington National, thanks to your link. It was founded and owned by the Kendall family, and was truly a Quality Company for many years. It still may be, but as you say, standing alone it doesn't appear to have spectacular financial strength. I assume they can thank their involvement with the very dangerous world of Major Medical Protection for that. It would be interesting to see their premiums for a 45 year old family man with a wife and three children for their $5,000,000 maximum lifetime benefit plan. I just don't want to have to click on their 'Please have a representative contact me' button in order to find out !! :-)

571. PsychProf - 10/3/1999 6:25:12 PM

STATS

572. PsychProf - 10/3/1999 6:27:33 PM

DEBATE LINKS

573. bloodnfire - 10/4/1999 12:34:55 AM

If those 'stats' are correct, PsychProf, it looks as though 70% of the population only have health insurance because it is provided through their work. The character, wisdom, ability, foresight, (check one) to buy privately appears, statistically, to be lacking.
What's needed, somehow, imho, is the kind of 'cradle to the grave' medical care available in certain provinces of Mainland China, WITHOUT the loss of personal freedoms which appear to be a part of the same communistic arrangement, (which includes not owning anything).
I suppose the 'compulsory' aspect of that involves 'taxation'.
Perhaps a private, non-profit organization, administered by a Board of Directors, funded by the Government solely in its capacity as a compulsory 'premium-gathering' entity, might eventually solve the problem ?

Does anyone have any factual, statistically-backed success story of a Socialized (Or National Privatized) Health Program which has worked ??

574. ranheim - 10/4/1999 6:11:32 AM

I have never liked - or thought that it was terribly pertinent - the figures quoted as "un-insured".

Its a bunch of crap in Louisiana. We have a Charity Hospital system that, while not as good as previously, is still very good. "Big Charity" in New Orleans was one of the PLUMS when I was involved in internships and residencies. I was never in the hospital; but, understand that it was much like JD in Houston. JD = Jefferson Davis which was the city/county hospital for Harris County when I was a student there. Both JD and Big Charity were wonderful training grounds for surgeons (gun shot wounds; knife wounds; car wrecks; + the routine stuff of every surgical hospital). I had delivered somewhere in the neighborhood of 110 - 120 babies by the time I had completed OB my senior year at Baylor. This number unheard of in most other hospitals.

So, even if you are shy about going to a private hospital or your town's municipal hospital, you should be able to obtain quality care. There are rules and regulations about "dumping" patients. msgreer would know these better than I.

I am going to try to get to some medical statistics that haven't been MASSAGED by the Democratic Party for your to look at - and be amazed!

575. msgreer - 10/4/1999 3:45:23 PM

ranheim

I am aware of your Charity Hospital system. It is a darn good one. We don't have that here. When I am with a client at our local community hospital who doesn't have health insurance it is impoortant for me to know the percentage of indigent folks that place is currently serving. By law our state has to give free services to 20% of these folks when they are serving others at 80% capacity. This includes all services offered by the hospital ie ER, OR, outpatient and floor services.

I oftentimes advise a client not to sign the paper which says they are to held financially responsible for the services they are about to receive. If I don't these people will be paying a debt of God knows what at $10/month for the rest of their lives.

Our other hospital "dumps" clients on the community hospital all the time. They won't give any services to those without insurance.

Did that 20% to 80% make sense?

576. msgreer - 10/4/1999 3:48:11 PM

ranheim

BTW, our other hospital does not admit to their practice of "dumping". But if you talk to paramedics they will tell you they do it all the time. Oftentimes paramedics will ask a person what insurance they have. If they don't have any they already know to go to the community hospital even if the other one is closer. It is a miserable situation and seems to always be under investigation.

577. Seguine - 10/4/1999 6:00:18 PM

BOSTON (AP) - A virulent strain of flu has reached the continental
U.S. from Alaskan cruise ships, threatening to start the flu season
early. Public health officials already are kicking off campaigns
encouraging people to get shots to prevent the disease, the
sixth-leading cause of death in the U.S. "Remember when you get your
shots, just think to yourself afterwards, it's just one shot for man,
one giant leap for public health," Massachusetts Public Health
Commissioner Howard Koh said Monday. Flu viruses follow well-worn
paths, starting in Asia and heading east. Alaska is usually the first
place in the U.S. to feel their effects, and the viruses then make
their way to the western U.S. and eventually the East Coast, said Dr.
Steven Mostow, associate dean of the University of Colorado Medical
School and an influenza expert.

578. Thoughtful - 10/4/1999 11:00:08 PM

BTW, we have car insurance and we pay under $4k per year -- for four vehicles.

Calgal, re your solutions, not everyone pays income taxes, not everyone has wages.

579. Rossi - 10/5/1999 12:10:29 AM

It's amusing to see how this country, the richest in the world, or so it claims, can't figure out how to give decent health care to everyone.
While the rest of the industrial world has had excellent single payer systems for decades, America is beating its head against the wall.
The solution is staring you right in the face - it's SINGLE PAYER SYSTEM.

Other industrial countries' health statistics are AT LEAST as good as American ones, and some parameters are better than in the US (like infant mortality, longevity, incidence of heart attacks, certain cancers, child obesity, etc.). This shows that single payer systems work and work well.

Yes, American medical "mechanics", i.e. surgens, are among the best in the world. But surgery is NOT medical care, it's medicine of the last resort.

You've tried everything else. You've tried the craziest political and economic contortions to fashion a system acceptable to every political and economic cook and every semi-literate Joe Schmoe screaming "Socialism" (and who wouldn't be able to tell Socialism from his ass). Enough is enough, isn't it? You're playing with fire - 40 million uninsured people is no joke. Your losing your job AND insurance with it, is no joke. Time to quit playing political games with people's health.

580. CalGal - 10/5/1999 12:15:58 AM

Rossi,

Single payer will likely never fly here, for one simple reason: it benefits poor people more than the middle class or rich. I must confess I'm relieved that it would never get accepted, because all of those advantages you tout make me desperately glad I don't live in Europe. Bleah.

And there is no reason why insurance and employment have to be linked, which is my own pet solution. Decouple them.

581. CalGal - 10/5/1999 12:16:14 AM

Thoughtful

Calgal, re your solutions, not everyone pays income taxes, not everyone has wages.

Well, I'd already said that poor people would be subsidized. There are a variety of exception methods that could be used to ensure people paid insurance.

582. Rossi - 10/5/1999 12:28:21 AM

Cal Gal:

Single payer system is the only system that makes sense. For one thing that's the only thing that de-couples employment and isnurance.
As to your being glad about not living in Europe, you can be forgiven - you simply don't know any better.

583. CalGal - 10/5/1999 12:38:41 AM

Rossi,

I lived overseas for a long time, and spent a decent portion of that time visiting Europe. It holds no charm.

For one thing that's the only thing that de-couples employment and isnurance.

No it isn't. It can be turned back over to the individual. You might not approve of that approach. But single payer is not the only method that decouples insurance and employment.

584. msgreer - 10/5/1999 12:51:28 AM

Rossi

Finally someone who agrees with me about the single payer health care system. It is discouraging to see this country which has the
finacial resources to take care all its citzens fight so hard not to do so. The single payer system WILL decouple employment and insurance.

It is sad to see those who shout the loudest against this system complain it would only help the poor. This is simply not the truth. It is the only civilized way to administer health care.

585. ranheim - 10/5/1999 12:58:34 AM

Rossi

Have you talked - personally - to any kind of physician who lives along our border with Canada? You just might change your mind. I have an M.D. brother-in-law who lives on Cape Cod. He is in a very small sub-specialty (zaps cancer with x-rays) so he has no personal knowlege. However, he is an avid skiier (spelling?). He claims that Canadian skiiers injured much prefer to have their injuries evaluated and treated in the USA.

Even someone 1750 miles away from the Canadian border (as I) has heard of Canadians coming to the USA for hip replacements; cataracts; etc. Lately I heard something about pacemakers as well.

Houston and New Orleans are FULL of wealthy patients from Mexico, Central America, and South America. I know absolutely nothing about the medical system/s in place in these areas.

Socialized . . . (fill in the blank) is fine as long as you don't mind waiting in line. During my 2 1/2 years in Moscow, the KGB employee who worked in our apt for my wife would sell her time - in line - at a shop that sold bread.

Medically, I am told that the waiting lines for everything have lengthened in UK; therefore, their private hospitals are thriving at a higher level and quicker than estimated. I have no personal knowlege; it has been 20+ years since I last visited the UK.

Don't denegrate surgery. Every facet of medicine is becoming "invasive". Sometimes with startling results (on the up-side).

586. CalGal - 10/5/1999 1:26:12 AM

MsG,

It is sad to see those who shout the loudest against this system complain it would only help the poor.

Read what I said. I said it won't be accepted because it primarily benefits the poor. No complaint. Simple reality check. The middle and upper classes are not going to accept a system that gives them less than what they have now. The middle classes are so used to having it all that they don't understand how much of their current benefits are subsidized and are still bitching for more.

This is simply not the truth. It is the only civilized way to administer health care.

No, it's not. There are other ways. I described one earlier that is far preferable to a method that treats everyone equally--which, like it or not, is not the American way. In general, we like to get treatment equal to what we're willing to pay for.

The problem with our current health care system is that the middle class is used to getting more without paying for it.

Besides, single payer in this country would rapidly revert back to Medicare for poor people. Upper income levels would opt out instantly--tax breaks for their policies wouldn't be far behind. Once those are in place, insurance companies would figure out a way to offer the middle class affordable insurance that would get them out of cattlecall hospital lines--leaving only the poor to be insured. Right back where we started.

Well, I suppose we wouldn't be right back where we started--we'd be pretty close to my plan. But it sure as hell wouldn't be what you envision. Never underestimate the ingenuity of Americans to figure out a way to foil government policies.

587. CalGal - 10/5/1999 1:26:38 AM

Now--before you start wringing your hands. Understand that this has nothing to do with approval or disapproval of your plan. (although I do think single payer would only work well with the European/Canadian variety of sheep.)

You can want single payer and its success until the cows (or the sheep) come home. But even if it were better than other possibilities, you can't be blind to the fact that it would require most people lowering their standard to raise it for others.

Not in the USA, ma'am.

588. Nostradamus - 10/5/1999 1:34:38 AM

I think MY plan is best.

End the war on drugs, collect lots of tax revenue.

What to do with all the empty jail cells? Simple.

Make getting sick ILLEGAL. Send sick people to jail, where those evil people belong. You could sentence people who get really sick to death.

Then you don't need a health care system at all.

589. ElliottRW - 10/5/1999 1:40:17 AM

I would be a big fan of decoupling employment and insurance, provided

1. There were no free riders (healthy people taking their chances, or people without assets mooching free health care).
2. The government still covered people who couldn't get affordable catastrophic policies on the free market.

590. CalGal - 10/5/1999 1:48:20 AM

Elliot,

I don't know if you saw my posts earlier, but I agree with both your listed requirements, and I think they are eminently doable. I also think that government subsidies should provide for both the poor and the chronically ill.

Government intervention would also be necessary to ensure that insurance companies didn't get out of line. Price hikes, coverage cancellation, and so on.

I disagree with your thoughts about employers. Employers provide insurance because they get tax breaks. It is incredibly inefficient.

592. bloodnfire - 10/5/1999 11:42:53 AM

Rossi. Your #579. "While the rest of the industrial world has had excellent single payer systems for decades, America is beating its head against the wall"
Would you be able to cite specific examples of countries where an "Excellent Single Payer System" has been working for decades ? I am most sincerely interested, and hope that some 'Motie' from one of those countries can 'fill us in' on how it is currently working.
Perhaps some Englishman or Englishwoman can tell us about the 'long lines' in the U.K. which Ranheim suggests are a part of their system ?

593. SnowOwl - 10/5/1999 1:05:16 PM

I can tell you a little bit about healthcare here in NZ, where our increasingly right wing governments have been doing their best to dismantle our national system.

There are waiting lists for some types of elective surgery, the length of the waiting list depending on where in the country you live. There is no problem with urgent surgery, at least not in my experience. A number of people do take out private medical insurance and are therefore able to have elective surgery done at private hospitals. I personally would not have private insurance, since I believe the more people who opt into it the more the government can opt out of what I believe is its responsibility to provide decent healthcare for all.

I shudder to think what sort of premiums we would have to pay, should private insurance become mandatory. My husband has had cancer and also has a heart condition (caused by a virus). One of my daughters has severe manic depression and has been in hospital for a year with a particularly bad episode. I'm not even sure we would be able to find a company who would insure either my husband or my daughter.

594. bloodnfire - 10/5/1999 2:12:17 PM

SnowOwl. Thank you for your response, and for sharing the challenges you have been facing with regard to health care for your family. It is sad, to me, that Conservatism, which purports such high ideals and ethics, seems to 'degenerate' somehow in it's extreme 'right wing'. I suppose there is similar degeneration at the edge of the 'left wing' ?
Whatever. I personally like the concept of 'Charitable' hospitals and medical care mentioned by Ranheim in a post of a couple of days ago. I believe we are to be our "brother and sister's" keepers, most especially the indigent and chronically ill. I'm just not sure the Government is the best 'Administrator' to have oversee such a program. If only 'power didn't corrupt'. (Perhaps it didn't until Camus made his statement ! :-)

Are there any other countries who'd care to report, as New Zealand just has ? Incidentally, SnowOwl, are there 'long lines' for services ? God bless you and your family.

595. msgreer - 10/5/1999 3:40:55 PM

SnowOwl

Thank you for your post. It sounds like you and your family have had a full share of pain. I will keep your family in my prayers.

I am curious about your universal health plan when it comes to mental illness vs. medical illness such as your husband's cancer. Are they are restrictions as to the care your daughter can get for maic depression? In this country a mental illness has such a stigma attached to it. And most insurance companies do not cover a mental illness as they do a physical illness. For instance one insurance company I am working with covers 16 outpatient services per year for the mentally ill. Whereas for the diabetic client they give nutritional counseling and up to 32 outpatient visits a year.

Oh that our health care system would understand preventative medicine. Some insurance companies in the States are beginning to cover alternative/preventative medicine. How is this covered in NZ?

596. Rossi - 10/5/1999 7:36:27 PM

ranheim:
You're a demagog. Or else, have no idea what you're talking about.
In your muddled argument you brought a KGB colonel, Canadian skiers, Socialism and long lines and god knows what else against the single payer system. Why don't you ask your CAnadaian skiers which system would THEY prefer? As to your MD brother in law - he's been long protected from foreign competition by AMA. As a result - and this is universally acknowledged - American doctors have no so-called "bedside manner", tey don't visit their patients in their homes, they prescribe hospital stays that are too short, in order to satisfy their bosses. As I said, American medical "mechanics" are good, hence interest in their skills - but that's no medical care, is it? Single payer systems comes in many varieties. You want it to work well, then you make sure it's well designed, appropriately funded, and staffed with competent people.

The 'take a pill and call me in the morning" medicine is laughable.
The for-profit pharmacopaeia and dental services are 19th century anachronism. The 48-hour pre-pro-post natal cycle is inhumane.
Apart from all of that, lack of single-payer national insurance is short-sighted, unintelligent, and irresponsible toward those, unfortunately already alive, but unable to afford to pay for private insurance.

I have one of the best medical insurance coverage available in US and it sucks. The primary physician-specialist referral system, where doctors are accountable not to yo but to some bean counters and their lawyers, is ridiculous. For profit health care is an absolutely moronic notion that's been discarded by every civilized society.

597. Rossi - 10/5/1999 7:48:40 PM

CalGal:

What do you mean "turned BACK over to individual"?
Did somebody take an individual's right to pay for his health insurance on his own? What a strange statement. I sure would rather pay $50 or $100/mo for a National Health insurance for my family than $800/mo for some private insurance? But if you want to do the latter, fine, it's your choice. Obviously if you let a National Health Insurance be run like, say, HUD, or IRS, then nobody will be happy about it. If you assume that ANY large Government program is Socialism and thus doomed to failure, perhaps then there's something fundamentally wrong with your system of government? Oh, and BTW,
US Post Office (one of the best mail delivery systems in the world) and NASA should be scrapped together with the Dept. of Education. - these are all Big Govt. programs, after all. Maybe it's trash time for the Constitution - it sure works much better for one, much smaller group of the population, than the majority.

Alternatively, I would aree to pay $800/mo for health insurance if I'm excused from paying all of my Federal and State taxes. That would be a fair "de-coupling" wouldn't it?

As to you European travels, I suspect you've wasted your time.

598. CalGal - 10/5/1999 8:28:18 PM

Rossi,

Do try to limit your response to the points that I've made, rather than let that unbalanced imagination of your run wild.

What do you mean "turned BACK over to individual"?

What I mean is that our tax system is set up on the assumption that employers are paying for individual health coverage. I am suggesting that this be altered.

I sure would rather pay $50 or $100/mo for a National Health insurance for my family than $800/mo for some private insurance?

This has nothing to do with anything I've said. I wasn't comparing my suggestion to single-payer, but to the current system.

If you assume that ANY large Government program is Socialism and thus doomed to failure, perhaps then there's something fundamentally wrong with your system of government?

Alas. Not only have I made no such claim, I've said that government intervention is necessary. I realize that it taxes your limited resources, but you'll have to try and customize your rebuttals, rather than assuming that there is only one argument against single-payer.

So try and pay close attention, Rossi: I am not arguing against single-payer. There is no reason to. It will never be accepted in the U.S. because the majority of Americans will never support it. Were it to be foisted upon us anyway, my prediction is that the rich and the upper middle-class would be gone in a heartbeat, along with a tax incentive for their troubles. The rest of the middle class would not be far behind.

The correct response, Rossi--assuming you've managed to follow along this far--is to argue that most Americans would accept single-payer. You would be wrong, but that's the next step to take. Barring that, find a John Birch conservative who is wringing his hands and wailing about Socialism so that you can have an opponent for the only argument you seem capable of making.

599. Rossi - 10/5/1999 8:31:43 PM

bloodnfire:

Of course, there are no magic bulets and perfect systems. To expect perfection on the cheap is either very American or very childish.

At the start, please assume that we're talking about relative qualities.
Having said that, I have experienced health care in Poland, Germany, Israel, Italy, US, and USSR.

Obviously the W. European systems had many superior aspects than E. European ones, primarily due to better medical technology and better national standards. However, I have not seen or heard of any unfair or callous, or negligent delays. Emergency services were slow in USSR and Poland but that's no argumanet against a single-payer system, because they were excellent in Germany and Israel.
Seeing your doctor was great everywhere - no delays whatsoever.
Getting sick days was much better than US - you take as many as you need and don't have to call work every day. Hospital stays were longer - complete patient recovery and rest were more important than
the portion of your employer's profits NOT earned due to your illness.
Hospitals were somewhat more overcrowded in USSR, Poland, and Israel than in Italy or Germany, or US.

In short, all problems with the single-payer systems I found were either a result of human error, negligence, poor training, inadequate funding,, et., i other words NOTHING fundamentally flawed was inherent in a single-payer system itself. Then again, if we're to talk about flawed, the curent American system takes the cake.

600. pseudoerasmus - 10/5/1999 8:50:43 PM

There are lots of errors about the healthcare system in Western Europe found in this thread. Perhaps the biggest blunder is to suppose that all or most countries in Western Europe have UK/Canada-style single-payer systems. They do not! This is laughable ignorance.

In particular, the German system is rather like the US system, with a combination of private (Privatkrankenkasse) and state (Gesetzliche Krankenkasse) payers, except that the state component is perhaps a bit more generous and the private component a bit more regulated. Likewise in France, where the private sector is forced by law to shoulder a significant portion of health insurance costs. In both countries, unions also play an important role in providing healthcare insurance. But the point is most Western European countries have mixed-payer systems, with de facto, not de jure, guarantees of universal healthcare coverage.

601. pseudoerasmus - 10/5/1999 8:51:59 PM

The USA would look more like Germany simply if it appropriated more funds for Medicare/Medicaid and forced health insurance companies to become a little more like HMOs.

602. Rossi - 10/5/1999 9:35:43 PM

pseudoersamus:

Have you ever used an HMO-type of organization in the US, for a period of time?

As I'm writing this, I'm looking at the bill for $1,260, for anesthesiology services, connected with a relatively minor, nasal polyps removal operation I had 1.5 years ago. The HMO, Empire BCBH (one of the largest in the US), has been refusing to pay for it all this time because my old Primary Care Provider (that's the new corporate term for "family doctor" now - Orwell would be mighty proud about such brilliant euphemisms) retired 4 days before the operation and I had "neglected" to choose a new PCP and have him co-approve the operation.

Needless to say, this problem takes away my time, grates on my nerves, affects my family and involves some assholes with MBAs and their spiritual brethren, the assholes with JDs. Mine is only one of MILLIONS of such stories all over the country, many much worse than that.

603. ranheim - 10/5/1999 9:37:06 PM

Rossi

I should have been more specific. I was commenting on #579.

In general, the health of the citizens of the USA is about as good as any other country you would like to compare it to.

As I have said previously, if you wish to compare a Scandanavian country's infant mortality statistics to ours, be a little cautious. I would compare stats from the two Dakotas, Iowa, Minnesota, and Wisconsin to a Scandanavian country. The backgrounds are similar. And statistics for blacks have been almost eliminated. I have no idea the % of blacks in Scandanavia; but, it should compare fairly favorably to the states I mentioned above.

I could not figure out why you blamed the medical profession for childhood obesity; heart attacks; certain cancers. Let my assure you that I do my best to prevent all three in my office. Here, the old saw applies "You can lead a horse to water but you can't make him drink."

The AMA is an interesting organiztion - I don't belong to it, by the way. It is way too socialist for my tastes. But, it does not directly control the number of M.D. produced each year. That wicked scoundrel, LBJ, siginifically increased the number of medical schools, therefore medical graduates, during his tenure. He was going to create competition! FAILED! Whether he was responcible for the increase in the number of procedures done to patients is debateable. There were advances in medicine due to the downsizing of various operative instruments that - very likely - would have increased the number of procedures even with a static number of doctors.

In any case, neither my brother-in-law nor myself is protected by the AMA. Anyone that can retain and regurgitate facts can get through med school. I did.

604. CalGal - 10/5/1999 9:46:41 PM

Pseudo,

You are probably right in what it would take to turn the US system into a German system. (BTW, I only know of England and Canada as single-payer systems. Snow's post indicates that they have single payer in New Zealand, as well. Any others? Or am I wrong even about them?)

However, if you check all the recent actions in Congress, they all involve limiting the right of HMOs to act like HMOs. Why? Because Americans don't like limitations on their health care. They aren't used to it. The only reason HMOs got such a hold on the country is because we are locked into employer provided insurance, and HMOs price in the early days blinded many morons to their obvious limitations.

So I don't think that the US will be moving to a German model anytime soon. I think it is more likely, although by no means certain, that HMOs will start to go under and fee for service will make a comeback in a cheaper form. If insurance companies would take my excellent advice, they could pick up some business by selling affordable policies to contract workers and lobbying for full deductibility of such plans--as well reducing the medical deductions ground floor from 7.5 to 1% for those who aren't getting insurance through their employers.

605. SnowOwl - 10/5/1999 9:59:51 PM

Thank you bloodnfire and msgreer.

bloodnfire, I believe in some areas of the country there are "long lines" for some types of non-urgent elective surgery. Obviously this is not satisfactory, but I don't think the blame can be put on the system, but rather on the way the government has decided to administer
funding.

msgreer,

All of my daughter's treatment both as an inpatient and an outpatient is covered by the national healthcare system. While discharged from hospital she is allocated to a community healthcare team. She receives as many visits from her community mental health nurse as is appropriate, depending on her condition at the time. These can range from daily to weekly or monthly. She will see her psychiatrist on the same basis, depending on need at the time. Similar programmes exist for people with other chronic illnesses, such as diabetes.

We do have preventative programmes, for example there is a breast screening programme available free to all women from the age of 50, or those who come from families with a history of breast cancer. Because my husband had colon cancer, which is highly hereditary, our sons are in a screening programme for that. Alternative health care is not available under the national system, if you're referring to such things as naturopathy, colour therapy or any of the "fringe" type of health care.

bloodnfire, I don't like the idea that one's health should be dependent on the charity of others. I believe it is the duty of the State to provide all of its citizens with good healthcare. There are obvious flaws in our present system, but these are to do with the way the system is administered, rather than any inherent flaws in the system itself.

606. CalGal - 10/5/1999 10:07:44 PM

Snow,

I personally would not have private insurance, since I believe the more people who opt into it the more the government can opt out of what I believe is its responsibility to provide decent healthcare for all.

It is this tendency that leads me to believe that single-payer would never work here in the U.S. Rich people would opt in to private insurance; insurance companies would then figure out how to market to the middle class, and it's all over.

607. pseudoerasmus - 10/5/1999 10:10:22 PM

I was not advocating HMOs, I barely know what they are. All I was saying is that Germany ends up providing healthcare to everybody though a combination of state insurance for the poor and forcing private insurance companies to provide HMO-like schemes. This is rather just like a more regulated version of the US system.

608. CalGal - 10/5/1999 10:11:21 PM

Pseudo,

Rossi makes up arguments that fit his rebuttals.

609. Ronski - 10/5/1999 10:25:37 PM

The only reason HMOs got such a hold on this country is that Congress mandated that all sizeable businesses offer HMO coverage in lieu of other forms of health care coverage to their employees. This was done in the 70s, after Congress recognized the success of Kaiser Permanente in California.

But Kaiser's success was built on sand. Kaiser made money in California in the old days because it marketed its product to young healthy people who needed little care. As the market aged, the costs went up dramatically. Congress has difficulty projecting the future costs of programs, and this was no exception.

Another example: Within eight years of Medicare's creation, the program's tax rate was twice the initial projections. At Medicare's start, Congress predicted the hospital insurance part would cost $9 billion in 1990, a $58 billion underestimate, according to the columnist Doug Bandow.

610. CalGal - 10/5/1999 10:33:41 PM

Ronski,

All that is true. But the reason that HMOs became so popular is because people are morons. (I am cranky, and not altogether serious.)

Anyone who did not see what was going to happen with HMOs has no excuse. Back in the 80s, the price of fee for service plans went up. HMO plans stayed low. People ignored the obvious downsides of HMOs and signed up in droves. Companies stopped offering fee for service plans because they were too expensive and not enough people used them.

Well, as you point out, the only reason HMOs could keep their costs low is because they were cherry-picking. Once they had to insure everyone, they had to cut costs, mandate more control, and so on.

What is absurd is that all the laws and restrictions are based on forcing HMOs to operate against their stated rules of operation. So we are fucking with their ability to do business. Prices will either go up or they'll drop out.

611. pseudoerasmus - 10/5/1999 10:36:06 PM

#608

Hahahaha. I think Rossi just made an honest mistake of interpretation, but your line is surprisingly witty.

612. Ronski - 10/5/1999 10:38:57 PM

Cal,

Even when I'm being serious I'm not always being serious.

I have given up on crankiness, however. I saw too much of it in my family. You know, sort of like the abstemious adult who saw too much drinking when a child.

613. CalGal - 10/5/1999 10:40:11 PM

Surprisingly? You wound me.

614. Dantheman - 10/5/1999 10:41:51 PM

CalGal,
"People ignored the obvious downsides of HMOs and signed up in droves."
Actually, they were given huge incentives to ignore the downsides, such as lower cost of HMOs (or even their employer no longer offering fee for service plans). And yes, I know you feel this is a good reason why employment and health care should be separated, I'm just pointing out the facts.

615. CalGal - 10/5/1999 10:46:56 PM

Dan,

If you note, I mentioned the lower cost. My point is that anyone who didn't realize the price of that lower cost is a moron. I had heated arguments with many folks back in the late 80s.

Your timing is off. Employers didn't drop fee for service first. Fee for service plans didn't disappear from the picture until the early 90s. This was after 5-7 years of fee for service prices going up (due to massive misuse by individuals who weren't motivated to act like true consumers) and fewer people selecting them (due to the fact that people were morons, see previous note about crankiness). Then they were dropped. By that time, the damage had been done.

616. SnowOwl - 10/5/1999 11:20:35 PM

This is an overview on how the NZ Health system works. NZ Healthcare System

It's fairly sketchy but it does give a brief outline of the basic system.

617. Rossi - 10/5/1999 11:47:44 PM

pseudoerasmus:
Surprising indeed. She must've picked it up at some cocktail party :)

618. Rossi - 10/6/1999 12:16:04 AM

If LBJ honestly wanted competition, he'd let in tens of thousands of well-qualified foreign doctors. But because of latent racism, condescention borne of ignorance, and AMA pressure, he didn't.
With its system of exhausting, draconian exams and residency requirements, AMA has kept many wonderful foreign doctors wishing to practice in the US at bay in order to protect unjustifyably high incomes of US doctors. AMA then, is no different than mafia. It's in that sense I blame the US doctors for the current situation.

However, excessive greed ALWAYS does its practioners in and the HMO "solution" was as justifiable as it was moronic (Cal Gal is right about that). A rebellion against the greedy doctors, pharmaceutical companies and assorted administrative thiefs affiliated with medical establishment and in the US. Only the US Congress and the very stupid are now surprised that HMOs engage in the kind of banditry that they were expected to solve. And it's going to be like this no matter what is done. Why? Simple. Public Health and Profit Motive are mutually exclusive.

A public good, by definition, cannot be subject to the rules of the market. It is not competitive - it has nothing to compete against. There's no Public Health 1, Public Health 2,.... Public Health N. There are no alternatives to Public Health, other than desease. We all agree that national defense is important and hence we have a single-payer system there - the US Govt. Yes, cost overruns, incompetence, disasters will happen but the need for the system itself is unquestioned. AND it covers everybody (ostensibly). Isn't Health equally important? Aren't healthy kids important. Isn't healthy population happier and more productive? Aren't healthier people more likely to produce healthier children? Isn't single-payer system more appropriate here too? To me, it certainly is.

619. CalGal - 10/6/1999 12:42:28 AM

A public good, by definition, cannot be subject to the rules of the market.

Health care is not a right--I believe that means it isn't a public good, either. The aspects of health that are considered a public good are monitored (e.g., infectious diseases). So whether or not "public health" and "profit motive" are mutually exclusive is really besides the point.

A rebellion against the greedy doctors, pharmaceutical companies and assorted administrative thiefs affiliated with medical establishment and in the US.

That is largely nonsense. Sure, some doctors were greedy. But they weren't the problem. The problem was that the market wasn't working, because the consumer wasn't exposed to the costs of his decisions. Fee for service plans that the employer paid for gave the consumer no reason to give a damn about prices. If the consumer doesn't care, why should the doctor? Or the pharmacies? They were just giving the consumer what was requested.

HMOs may look like a rebellion against the doctors. But what they are in reality is a method of controlling the consumer. HMOs limit the consumers options. In other words, since a consumer who isn't bound by price considerations won't act responsibly, the HMO takes away many of the consumer's choices and rations the health care provided. That the doctors are harmed by this is just a side effect.

More doctors in this country would probably not lower prices dramatically. It might increase the range of prices available. The cheap doctors would move to the rural areas, and provide cheap service. And some doctors might happily drop their prices to work with insurance companies. But this last is happening already. So I don't see any reason that prices would drop. The good doctors would be expensive, the crappy ones would be cheap.

620. Rossi - 10/6/1999 1:02:19 AM

Cal Gal:

"Health care is not a right"

Therein lies the biggest problem. It should be.

"That is largely nonsense."

Oh yeah? How old were you when the debate about health care costs was in its apogee? I remember it very clearly. Doctors being called bloodsuckers and all. Doctors were subject to the same popular invective, as the lawyers. Ah yes, perhaps you were out of the country then.

"The problem was that the market wasn't working, because the consumer wasn't exposed to the costs of his decisions"

This is the same nonsensical argument used by the Reaganistas-Friedmanistas among us. Are you saying that if I'm not
appropriately punished by the market, I'd buy more pills, stay in the hospital longer, be more careless with my health and drink more?
Seeing a doctor is not the same as buying pantyhose, you know. And I don't mean frivolous "medical care" like plastic surgery or orthodontia. How can I put to you so you'd understand - just because
you got two dresses at a "Buy one get One Free" sale, it doesn't mean you'd be wearing them at the same time, does it?

"Fee for service plans that the employer paid for gave the
consumer no reason to give a damn about prices"

And the consumer shouldn't give a damn. I want to pay certain affordable premium every month and get unlimited, high quality health care and not at all give a damn about costs. I don't want to limit myself or my family as to the amount and the kind of health care we get. I don't want the doctor I chose, to constantly look over his shoulder when dispensing medical opinions. If most of the civilized countries in the world have this right and can do it, so can America. It's about damn time.

621. ranheim - 10/6/1999 1:06:51 AM

Rossi

Just a word on foreign born MDs in the USA.

The USA does not take in too many MDs from either Europe or Japan. These doctors tend to remain at home. MDs from the "3rd World" should stay there. There is more need for them in their country of origin than in the USA. If you wish to call this latent racism, so be it.

My area of Louisiana is rural and poor. There is not a week that goes by that I don't see a patient in my office cussing out that 'specialist doctor that I can't understand'. That is complicated by the fact that English is the second language for a substantial % of my patients 60 and above. These people continue to speak "Cajun French" as their first language. The result, then, is a patient trying to understand in his second language; the doctor trying to speak in his second language. Frequently unhappy results.

622. Rossi - 10/6/1999 1:22:07 AM

ranheim:

Nonsense. Foreign doctors who pass the TOEFL test, as part of recognition of their professional credentials, deinitely know their English better than most Americans. As to your illiterate brethren down in Louisiana, well, they ought to learn English. This is America, after all.

And what do you mean "The USA does not take in too many MDs from either Europe or Japan". What do you mean "take"? USA can only take if it's allowed to take. Can you understand that? Secondly, there exists no economic reason for a Japanese or European MD to want to come to practice in the US. Yes, many Russian, Indian, African MDs would like to come to the US but many are prevented by the tests many Americn doctors would themselves fail, and by the policies and callousness of the bureaucratic monstrosity known as the INS.

623. ranheim - 10/6/1999 1:47:26 AM

I wonder why Europeans complain that most americans are insular and uneducated!? One of the prominent examples given is that we speak only one language. Some of us, badly!

Then in a tiny pocket of the USA where there is a second language spoken by preferance, they are "illiterate brethren"?

By the way : go back to the last paragraph of #620. Read it again. Are you serious?

624. bubbaette - 10/6/1999 1:54:52 AM

I hope that I'm worrying needlessly. Today at work, DH was standing right behind a person installing a florescent bulb. The installer dropped the bulb which exploded, and DH inhaled a cloud of gas that immediately closed around him. I've looked in OSHA and EPA which classify the gas in florescent bulbs as a hazardous waste, but I haven't been able to find out what, if anything, we should do.

DH has a sore throat and an awful "soapy" taste in his throat and lungs. Should I make him go see a doc?

625. CalGal - 10/6/1999 1:57:08 AM

Bubba,

Yes. I have no idea whether it's serious or not, but why fuck around?

626. ranheim - 10/6/1999 2:08:17 AM

bubba

You need to know what the gas/particles in the fluorescent are. This is one accident that has not been seen in my office.

I went to the Sylvania site : Lead and mercury were mentioned there. But, I could find no reference that said those two/something else make up the innards of a fluorescent bulb.

Based on past experience, plenty of fresh air will, likely, flush all, or most, of the inhaled gas/particles away.

BUT If he feels at all bad - off to see the doctor! And do your best to track down the contents of the bulb before you go.

627. CalGal - 10/6/1999 2:20:58 AM

Therein lies the biggest problem. It should be.

I don't really care much about "should". I'm more interested in "is". Or, in this case, "isn't". Since health care isn't a public good in this country, there is no reason why it can't be subject to market forces--with appropriate government intervention. You might want it to be that way, but there's nothing that says it has to be that way.

Doctors being called bloodsuckers and all. Doctors were subject to the same popular invective, as the lawyers.

So what? Your claim was not that doctors were hated. Your claim was that HMOs rose in rebellion to doctors. That is incorrect. HMOs are a means of controlling consumers, not doctors.

Are you saying that if I'm not appropriately punished by the market, I'd buy more pills, stay in the hospital longer, be more careless with my health and drink more?

You? Can't say--thus far you seem alarmingly stupid, so anything is possible. But people in general? Some might, some might not. Those aren't the problem areas, though. Consumers instead go doctor every time they have a sniffle, they agree to tests that really aren't necessary but that the doctor runs "just to be sure", they don't get the generic prescription, even though it has the same efficacy for far less money, they opt for the more expensive procedure whether or not it will actually do them more good, they demand medicine for their kids even when they don't need any, and so on.

In other words, people treat health care as a free service. When they had to start paying for it, they got cranky, so they switched to HMOs. When HMOs started limiting their access, they got furious and went to Congress.

628. CalGal - 10/6/1999 2:23:10 AM

And the consumer shouldn't give a damn. I want to pay certain affordable premium every month and get unlimited, high quality health care and not at all give a damn about costs.

Shrug. You have pretty close to that now. And you could get more if you decided to buy a policy yourself.

Frankly, you're the sort of moron I was referring to earlier. Your unreasonable expectations are the reason that the health care system is in trouble. So it affords me no small end of enjoyment to see how cranky you are about what you have. May there be many officious and incompetent claim administrators in your future.

And as you are waiting impotently for your reimbursement (silly man. going to the wrong doctor?), remember this: all your bitching and whining aside, you've got a long wait until the US finds single payer attractive enough to vote in.

629. bubbaette - 10/6/1999 2:42:10 AM

Thanks Ranheim, Cal. I can't get him to go to a doc and he says his sore throat's subsiding.

630. CalGal - 10/6/1999 2:52:00 AM

Well, smack him upside the head and take him to the doctor to check out the resultant bruises. While you're there, ask him to listen to his lungs.

631. ranheim - 10/6/1999 3:57:01 AM

Cal

You are truly bad!

632. bloodnfire - 10/6/1999 12:53:24 PM

Great to see the warm friendship developing between Rossi and CalGal.
I believe we've met Rossi in times past in a forum far far away.....whatever.
I too join Ranheim in asking if you were serious in that last paragraph of your #620...."I want to pay certain affordable premium every month and get unlimited, high quality health care and not at all give a damn about costs..

The paying of 'certain affordable premiums every month' with 'unlimited, high quality health care' was typical of this country's private and social programs in the sixties and seventies. Because no one 'gave a damn about costs' (which skyrocketed), many people found themselves without insurance, and uninsurable.

CalGal is right. The middle class are 'spoiled' in this country, and I'm not sure how we change that, or even if we can. I don't mean that most middle class people have a 'spoiled brat' attitude. I mean that the heavy (and very expensive for the taxpayer) subsidies paid by the employer are not something of which the typical employee is aware or about which they care. It is certainly time we all cared, imo.

Finally, regarding health care being a 'right' and whether or not it 'should be'. We do not leave our citizens sick in the streets here (although ambulances will go from hospital to hospital trying to fit the passangers ability to pay or not to the hospital). Nor do we have beggers (other than the occasional alcoholic or 'hippy' asking for change). We certainly need a national plan which works, and I have a feeling that the time is right, politically and because of the enormous pressure building between the HMO's and the Insureds, to do something about it.

633. Ronski - 10/6/1999 5:08:46 PM

"National plans" are what cause all the problems in the first place. What we need is to restore to health care the "invisible hand" of the marketplace.

634. Cellar Door - 10/6/1999 5:10:52 PM

And we all know what invisible hands do -- NOTHING.

635. Cellar Door - 10/6/1999 5:12:04 PM

How about putting Santa Claus in charge of Health Care. There's a PERFECT invisible hand. So much better than the Tooth Fairy.

636. Ronski - 10/6/1999 5:20:54 PM

Food, clothing, and shelter are provided by the invisible hand.

In the USSR, numerous Imperial Soviet Santa Clauses came and went, and food, clothing and shelter were always in short supply.

637. Bubbaette - 10/6/1999 5:22:17 PM

Not in my household -- shelter, food, and clothing are provided by the visible hands of DH and myself by dint or our work.

638. Ronski - 10/6/1999 5:36:38 PM

That's the point. The invisible hand is you. And everyone else who makes things.

639. Cellar Door - 10/6/1999 5:46:33 PM

What happens when invisible hands work in concert? Socialised Medicine.

640. Ronski - 10/6/1999 5:57:55 PM

Hands working in concert is the market, not socialism. Socialism depends on the "fatal conceit," the false notion that someone at the top can possess all the information necessary to make rational decisions for all the people underneath him.

641. bloodnfire - 10/6/1999 6:05:39 PM

Ronski Your #633. - 10/7/99 2:08:46 PM

"National plans" are what cause all the problems in the first place. What we need is to restore to health care the "invisible hand" of the marketplace." I suspect Rossi would disagree with you, and I have tried to help too many poor and indigent uninsureds in the past who have been slapped in the face by the 'invisible hand' of the marketplace to agree with you either. But I appreciate your thoughts.

642. Cygnus X-1 - 10/6/1999 6:07:21 PM

Here's an idea. If someone is injured, doesn't have insurance, and can't afford treatment, the government will pay nearest hospital to treat them. If there isn't enough tax money to pay what the hospital wants, then increase taxes on the rich. If there are no more rich, increase taxes on the poor. If no one has income anymore, enslave all doctors and make them work for free. If no one wants to be a doctor anymore, then conscript people into the "health army". If people start leaving the country, build a wall around the borders and post armed guards. I'm not sure what to anticipate next.

643. Ronski - 10/6/1999 6:33:39 PM

Bloodnfire,

People are not slapped in the face by the marketplace. There is no free market in health care in this country. Hasn't been for years. It is a mixed system, and government interference in the system causes dislocations needing your admirable efforts to help.

The market does not ensure everything desired by everybody. What it ensures is the most efficient distribution of the largest possible amount of goods and services.

There will always be a need for charitable care, as there is always a need for charity generally, and charity is another proven function of a free market. Until government interventions, it was routine for doctors to provide a third of their time free of charge to the poor. That was when medicine was still truly worthy to be called a profession.

644. Dantheman - 10/6/1999 6:47:46 PM

Ronski,
"What it [the market] ensures is the most efficient distribution of the largest possible amount of goods and services."

Shall we make a list of the necessary conditions to have this "most efficient distribution". I'll start:
1) perfect information on the part of buyers and sellers as to what goods and services are in the market and the prices thereof, obtained without cost.
2) lack of market power (monopolies/cartels/etc.) on the part of either buyers or sellers
3) no free rider problems
4) no externalities (where goods have costs not borne or benefits not received by the producers or consumers thereof)

Probably our econ experts can come up with more. _Any_ of these provides reason for the government to intervene to create a more efficient outcome. Do you want to defend the proposition that _none_ of them exist in the health care market?

645. Ronski - 10/6/1999 7:04:39 PM

Dan,

Libertarian economists abound who can defend a free market in health care.

Every time Congress has intervened in the health care system costs have risen disproportionately, which has created calls for new interventions. The outcome of this is clear: the eventual nationalization of all health care, and that would be a tragedy.

646. Thoughtful - 10/6/1999 8:20:20 PM

Re private health insurance, a buddy of mine belonged to a local HMO run by area doctors. As with other HMOs, they went belly up. Fortunately, my buddy only owed $120 for an office visit. His neighbor though had been receiving chemo and, though he thought he was covered for all his procedures, suddenly found himself in debt for over $100,000. So despite doing the right thing and purchasing health insurance, he still got bit in the butt. Of course, the doctors who started the HMO are still doing fine -- only the corporation went down.

647. Thoughtful - 10/6/1999 8:22:09 PM

The kicker is, my buddy has a pre-existing condition and shopping for new health insurance got increasingly expensive. Though he would like to retire to another state, due to health insurance, he is stuck in this state until he hits 65 and then can get Medicare.

This does not seem like an optimum situation to me.

648. Dantheman - 10/6/1999 10:20:22 PM

Ronski #645,
And pro-intervention economists can defend intervention. Other than proving that one's political views can affect one's arguments, what does that prove?
Do you want to argue that a totally market-based system would ensure, in your words, "the most efficient distribution" of medical services? If so, you need to prove that all of those issues I raised would be cured by a market system.

649. Ronski - 10/6/1999 11:11:07 PM

Dan,

Why? Interventionist economists have never proven that intrusions into the marketplace have done any lasting good. The ball is still in their court.

650. Dantheman - 10/6/1999 11:16:54 PM

Ronski #649,
Pish and likewise tosh. You are the one saying that the market is the most efficient way of delivering health care services possible. If you can't defend the statement, don't make it.

651. thrakkorzog - 10/7/1999 12:32:49 AM

Dantheman,

You seem to be raising the bar into the realm of theoretical ideal and therefore impossibility. I assume that there is no perfectly efficient system for automobile distribution in the United States either, but almost everyone who wants a car can get their hands on one. Granted, not all of us can afford a Lexus, but that is simply life.

I really don't see why the majority of people in this country would be incapable of making rational decisions about their health care. It really isn't all that different from any other commodity. I would assume that health insurance plans could be structured much like life insurance or car insurance where you pay certain premiums for certain coverage.

652. thrakkorzog - 10/7/1999 12:40:47 AM

Actually, why wouldn't the free market, with the consumer contracting directly with doctor or health insurance company, provide the most efficient means of health care coverage? Efficient does not mean perfect.

At least if the consumer were in charge, the ultimate decisions would be controlled by him (and I assume the consumer has the greatest interest in preserving his well being) as opposed to having these decisions in the hands of someone who has no direct interest in the consumer's wellbeing (say, an employer, who will probably put the company's bottom line first).

653. Dantheman - 10/7/1999 12:40:53 AM

thrakker,
Ronski said he could reach that bar, not me. Look at my #644 for reasons why the market solution is less than perfect. In my opinion, health care fails all 4 of my points.

654. Dantheman - 10/7/1999 12:44:30 AM

Sorry, but I have to leave. See you tomorrow.

655. thrakkorzog - 10/7/1999 12:53:41 AM

Dantheman,

In #644, you copied Ronski's quote that "What it [the market] ensures is the most efficient distribution of the largest possible amount of goods and services."

You then say later in your post that "_Any_ of these provides reason for the government to intervene to create a more efficient outcome".

I assume that your list describes ideal conditions for maximum market efficiency that I would be willing to wager exists nowhere in the real world (although I am sure one of the resident economists will correct me if I am mistaken). Therefore, I hardly think that just because the ideal free market conditions don't exist that ipso facto free market distribution of health care can never be the most efficient means of distribution (at least, that is what it appear that you are saying).

Now, Ronski appears to be saying that the market will provide the most efficient distribution, not perfection. You are arguing, it appears, that the government can provide more efficient distribution.

656. CalGal - 10/7/1999 12:59:50 AM

I don't see why it's not possible to let the market do the job properly. The government would still subsidize the solution, by providing deductions.

657. ranheim - 10/7/1999 1:55:02 AM

#652

Those conditions obtain in one field that I can think of : Plastic Surgery.

As I have pointed out previously, patients, knowing that Medicare, Welfare, insurance corp. etc. are NOT going to pick up the tab, go out and inform themselves. They are better informed than heart by-pass patients as to risks, costs, potential side effects, etc. AND NEITHER MY WIFE NOR I FILL IN ONE PIECE OF PAPER!!!!

Any "solution" that contains a heavy dose of government, will be just a tweak of the current, lousy system.

658. SnowOwl - 10/7/1999 2:26:27 AM

As I have pointed out previously, patients, knowing that Medicare, Welfare, insurance corp. etc. are NOT going to pick up the tab, go out and inform themselves. They are better informed than heart by-pass patients as to risks, costs, potential side effects, etc.

If this is the case doctors seem to be falling down on their job. Surely they should be informing the patients about risks, potential side effects, etc. so that the patients can make informed decisions about matters affecting their health.

The whole business of health care provision seems, in the end, to come down to the question of whether or not you believe access to adequate health care is a right. If so, you then have to consider how best to deliver a system that ensures people are able to exercise that right.

659. thrakkorzog - 10/7/1999 2:40:46 AM

Well, there is far too much information (on new technologies and techniques for example) out there for the most conscientious doctor to keep up with everything, even in his own specialty. Therefore, a doctor might in good conscience recommend a procedure that may not be the best alternative. All patients should make a habit of trying to get more information if at all possible on their condition and treatment alternatives (and most people in the US have enough education and access to resources to get some grasp on their situation).

660. ranheim - 10/7/1999 2:46:20 AM

SnowOwl

Patients are, frequently, given TOO much information; more than they can readily understand (there is the rare patient that really does listen to you; then reads.)

But, particularly when discussing risks, that well known hole that runs from ear to ear opens up. In New Zealand you must have an expression : "goes in one ear; and right out of the other!"

Many welfare patients treat my services as their right. e.g. in my state, a patient is allowed one visit to the doctor a month. A sizeable % of my welfare patients will utilize this visit in the last week of the month. For if he/she did not use the visit, they were being cheated. An interesting way of thinking; but, there it is!

Obviously, I would not like medical services to become a right.

661. thrakkorzog - 10/7/1999 2:48:24 AM

The whole business of health care provision seems, in the end, to come down to the question of whether or not you believe access to adequate health care is a right. If so, you then have to consider how best to deliver a system that ensures people are able to exercise that right.

What if you don't think health care is a right?

On the other hand, it doesn't matter whether you think of health care as a 'right' or not. The free market would still, in my opinion, provide the most efficient access to health care for the most people (not all, of course, because I doubt that could ever be possible except under ideal conditions which do not exist in the real world).

662. CalGal - 10/7/1999 6:02:58 AM

Why not view health care as a responsibility, instead of a right?

663. Cellar Door - 10/7/1999 6:56:28 AM

Who's responsibility?Since the statetakes it upon itself to protect us from enemies foreign and domestic, shouldn't our physical well-being figure in that mix?

Or maybe the state is merely interested in corporate property and everything else is left to fend for itself.

And die.

664. CalGal - 10/7/1999 7:06:41 AM

Sure. The state can subsidize the cost of health care. It does now. The only issue is how it will do it, and where the responsibility for the choice and the decisions lie.

Right now the cost is only subsidized if you are employed, and the responsibility for choice lies with the employer. No one has responsibility for the decisions, and Congress continually tries to pass more laws that will hold everyone even less responsible, it seems.

665. Dantheman - 10/7/1999 3:36:17 PM

thrakker #655,
No, I am arguing that the government has the ability to:
1) create the free flow of information often lacking in a market system
2) break up market power
3) compel people to pay their share of public goods and not be free riders
4) make the marginal cost to the consumers and consumers a better approximation of the societal costs.
I am not suggesting that the government perform the distribution, only that it has a role to prevent market failures.

666. Dantheman - 10/7/1999 5:26:50 PM

whoops -- consumers and consumers = consumers and producers

667. Rossi - 10/7/1999 6:36:42 PM

The health free-marketeers here are simply nauseating in their stupidity.

CalGal:
As are you. But not for your ignorant "practicality" - there's something about your person..

Anyway, sorry to have wasted my and your time. You don't have to worry about me anymore. You can have it "nice" again.

668. thrakkorzog - 10/7/1999 8:22:13 PM

Good lord, Rossi, what brought that on? Simply because some of us don't automatically swoon at the thought of being in a Canadian or German style health care system? Because some of us think that we the consumer have our best interests at heart and don't wish to rely on the noblesse oblige of a bureaucrat, whether in an HMO or a government agency? Because I don't want someone in an office far away deciding the value of my life or that of someone close to me, but would prefer to control my own fate?

669. thrakkorzog - 10/8/1999 2:21:40 AM

Ranheim,

I read your post regarding the Hep B vaccine over in Politics, and I wanted to ask you about it. We have a new baby (three months old), and I have not wanted her to get that vaccine (the risks seem to outweigh any benefit).

However, our HMO now has a combo vaccine that puts Hep B with the Meningitis vaccine. What is your view on the Meningitis vaccine? Should she have it, or should she have the combo, or neither of these vaccines (obviously all vaccines have a risk factor).

670. thrakkorzog - 10/8/1999 2:23:28 AM

Ranheim,

I have also read that in some cases doctors and medical groups get compensation for every vaccine given. If true, then they would have a financial incentive to encourage unnecessary vaccinations. Have you heard of such a program?

671. arkymalarky - 10/8/1999 3:33:08 AM

We have occasional breakouts of both Hepatitis B and meningitis in AR. Meningitis is a very scary disease for children. Every Hepatitis B outbreak I recall was traced back to some restaurant employee. They weren't widespread, but the disease was passed through general rather than intimate contact.

672. msgreer - 10/8/1999 2:32:47 PM

PhillipDavid

It appears your doctor is not recommending surgery at this time. One to two years in physical therapy? Does your physician feel this will "cure" your shoulder? Does he/she say you will gain full range with this long-term physcial therapy?

673. JonesAtLaw - 10/9/1999 6:55:20 PM

Pardon the spam- Msgreer, sorry to hear your results in small claims court. It was worth a shot. Hope that the consolation prize of additional service soothes the sting.

674. pseudoerasmus - 10/9/1999 7:30:26 PM

Ronski #649
Why? Interventionist economists have never proven that intrusions into the marketplace have done any lasting good. The ball is still in their court.

Oh, please. All economists argue the merit of interventionism to some degree. By the way, libertarian economists are few and far between.

675. SpenceMirrlees - 10/9/1999 10:09:24 PM

I wonder what would constitute proof, in Ronski's judgment.

676. SpenceMirrlees - 10/10/1999 8:32:38 AM

I also wonder why people who have so much trust in the invisible hand give so little examination to its intellectual foundations.

677. msgreer - 10/10/1999 10:41:36 AM

Under the heading of what would you do comes a client's family dilema.
The mother has Alzheimer's Disease. She has recently been dx. with cancer of the colon. She is absolutely not able to go through all the testing, surgery and chemotherapy that would be needed. So what does the family do?

At this time there are taking palliative measures only. But they find themselves overwhelmed with sadness and guilt.

Alzheimer's Disease. It is not a disease that belongs only to the person with the disease. It is one of many diseases which effects all the family.

What would you do if this were your loved one?

678. ranheim - 10/10/1999 3:45:39 PM

#669 & 670 thrak

I have only negative information - I am uninformed - for you.

I was not aware of a meningitis vaccine. I will check it out. Do you know who manufactures it?

It would be my initial impression that any meningitis vaccine would be similar to the pneumonia vaccine. There are hundreds of different strains of the bacteria that cause pneumonia. The current vaccine contains antigen against only 29 strains. And, of course, the vaccine gives no protection against a viral pneumonia. i.e. partial protection from the vaccine. Which is better than none at all. I have had the pneumonia vaccine personally.

#671 arky

Are you sure that it was Hepatitis B? You describe what was originally called Infectious Hepatitis. The new nomenclature names it Hepatitis A.

679. bloodnfire - 10/10/1999 6:00:52 PM

MsGreer. Regarding the family with the member who has Alzheimers and now Cancer of the Colon. If the individual is unable to go through the surgery, radiation and chemotherapy required to treat the Cancer, I can understand their taking palliative measures. What choice do they have ?
My heart goes out to any and all families who have Alzheimer sufferers as members. The whole family suffers more than we know.

680. msgreer - 10/10/1999 6:04:17 PM

bloodnfire

They really have no choice. They just need alot of support and reassurance the decision they have made is okay. You can imagine their guilt. Alzheimer's... one dreadful disease.

681. ranheim - 10/11/1999 3:58:43 AM

My wife called me in to watch the last portion of a John Stoessel (sp?)report. He was commenting on how the USA spends its health/research dollars.
Did anyone see the entire segment? I would be interested in your take.

I got there late, so don't chew me apart if I mis-understood. $2000 per AIDS patient vs $28 per diabetes patient. I would like to see the raw numbers as there are so many diabetics as compared to the relatively small numbers of AIDS patients.

We physicians often wonder how research money in medicine is spent. It is a well known fact that the "squeaky wheel gets the grease". But, that means year by year squeaking. Which the AIDS community is expert at. I don't fuss too much about AIDS research money as some answers as to how the immune system works will be forthcoming from this research.

But, if what I watched tonight continues to be the norm, I may have to re-think. The last two Miss Americas acting as shills for AIDS and diabetes. That little man, Fox, shilling for Parkinsonism. If it takes star power, who is going to try to sign Michael Jordan? This hardly seems a logical way of doing things! But, Congress never has been logical.

I wonder how Stoessel remains on network TV!? He must be a thorn in the side of the, essentially, liberal/left/progressive USA media.

682. msgreer - 10/11/1999 4:43:31 PM

I am taking off for 8 days to a small island in the Caribbean. I am actually bringing material with me to read and hope to do some posting. I did not see Stossel last night but I too have seen the chart of how our finances are divided re health issues. I remember AIDS getting the most funding per person as you reported but thought the amount was $1400.

I have no idea if I will get an answer but I emailed Mr. Stossel asking him to get me the information.

Stay well.

683. msgreer - 10/11/1999 4:44:52 PM

ranheim

I dont't know what happen in the last post. I put your name in before discussing Stossel's report.

684. Seguine - 10/13/1999 7:57:26 AM

"There are hundreds of different strains of the bacteria that cause pneumonia. The current vaccine contains antigen against only 29 strains."

I was under the impression that Chlamydia pneumoniae is the most common bacterium that causes pneumonia; there are others (C. psittaci, mycoplasma, I can't remember what else offhand). Of the 90-100 strains of C. pneumoniae that are known to exist, several are now drug resistant to everything but vancomycin and in some cases, perhaps not even that (although there are new, more powerful antibiotics just out since I read this). As of a few years ago, the CDC was working toward development of a vaccine effective against the resistant strains of C. pneumoniae, but hadn't come up with one yet. Unfortunately, the strains that existing vaccines protect against are not only not the drug-resistant ones, they're less common.

685. ranheim - 10/13/1999 5:12:09 PM

Seguine

The pneumonia vaccine is not perfect; never pretended to be.

As you indicate, "they" are constantly working on a new and improved vaccine that contains antigenic material against more and more of the common causes of pneumonia.

Right now it is better than nothing. And at its low cost is worthy of our consideration. My wife and I have been innoculated.

686. Seguine - 10/13/1999 9:55:27 PM

Rossi: "Public Health and Profit Motive are mutually exclusive."

Is that why investment in profit-generating medical technologies, drugs, and science generally has contributed to improved public health over the last 50 years? How did the profit motive fail to interfere with the achievement of the following statistics?

"The rate of infants who die before age 1 went from 100 per 1,000
live births in 1915 to less than 7.2 per 1,000 in 1997, marking a
decline the CDC [says is] unparalleled by other mortality reductions
this century. ... At the turn of the 20th century, six to nine out of every 1,000 women died of pregnancy-related complications. The rate was less than .1 per 1,000 in 1997. ... Delivery practices were the main factor in the high deaths among pregnant women--most births were in the home and obstetrics as a specialty was shunned by many physicians."

Sure, public investments have contributed and continue to contribute to public health, but profit has never been universally antagonistic to it. (Drug development is a primary example.)

687. Seguine - 10/13/1999 9:55:48 PM

As for those who bash HMOs, perhaps they are unaware that there is a difference between for-profit HMOs and non-profit HMOs: the latter provide better service in the estimation of those covered. I've had very good luck with two nonprofit HMOs; friends of mine have had good experience with a third. Most doctors I talk to dislike all HMOs because they remunerate very poorly (and dislike some HMOs in particular because they meddle with practice); but physicians consider other kinds of insurance co.'s no better wrt bureaucratic ineptitude, which from the doctor's standpoint is also costly.

CalGal: "[Insurers] could pick up some business by selling affordable policies to contract workers and lobbying for full deductibility of such plans--as well reducing the medical deductions ground floor from 7.5 to 1% for those who aren't getting insurance through their employers."

I have long wondered what prevents this from happening. My guess is that contract workers haven't been a significant enough part of the pie for long enough to make such measures seem economically or politically worthwhile.

688. CalGal - 10/13/1999 10:18:23 PM

Seguine,

That's why I think they haven't, as well. But it would behoove insurance companies to do this for reasons other than direct sales--namely, it would take them off of the hotseat.

Suppose if they started offering a major med policy specifically geared to lower-income workers. $2000 deductible, $20 co-payment if you go to the right doctors, everything else is paid for. Emergency care covered. $40/month, ballpark. $20/month for kids.

Is this a lot for lower-income people? It's $120/month for a family of 4, 1280/year. Not much more than car insurance in certain parts of the world.

But these people have to spend up to 7.5% of their income in order to begin to deduct medical costs. And insurance deductibility varies from year to year--in any event, they can only deduct if they are itemizing, which isn't the norm for lower income folks.

Insurance companies could use something like this as a wedge. They could lobby for tax credits for health insurance, making an issue of the subsidization that employees get.

They could then do the same thing for contract workers--in fact, they could start selling hard to people after layoffs. Too many people think COBRA is the only deal they have, even though it is incredibly expensive.

All of these might not make them much money in the short run. But it would substantially change the nature of the debate--come up with issues that would put the employed middle class, who have been annoyingly complacent in their whining, on the defensive.

Besides, it could start tilting the thinking towards individual responsibility--which is the best deal in town for insurance companies, if they'd just realize it.

689. SpenceMirrlees - 10/13/1999 10:30:41 PM

Ranheim, 681

This is health research money? I think the fact that there are so many more diabetics than AIDS patients, instead of being cause for consternation, may help explain why so much more is spent per AIDS patient.

Research of any kind involves large fixed costs -- costs that must be incurred whether there are 100 beneficiaries or 10,000 beneficiaries of the research. Labs must be set up, scientists and materials used in either case. With fewer AIDS patients, there are fewer people over which to spread the total cost (fixed cost + variable cost) of research. So the per capita figure is naturally going to be at least somewhat inflated.

Whether that will inflate the per capita cost by two orders of magnitude, I obviously cannot say a priori.

690. Raskolnikov - 10/13/1999 10:34:22 PM

I also think the fact that HIV is contagious, and diabetes isn't has a lot to do with it, as well as the fact that its victims tend to be younger.

691. SpenceMirrlees - 10/13/1999 10:37:33 PM

to clarify...

materials themselves are variable cost. The cost of setting up and maintaning relationships with suppliers is not so variable.

692. Seguine - 10/13/1999 11:56:23 PM

Spence,

Drugs are more and less profitable for pharma co.'s to make depending on a number of factors, but the two most important I'm aware of are 1)potency and 2)the pharmacological research that must take place after a drug is invented/discovered, to ensure its safety and FDA approval. (Avg time for testing between discovery and marketing of new drugs is something like 10 years.) The latter is a fixed cost, the former is variable.

The potency of a drug is not the same as its toxicity; rather, potency refers to how much you have to make of a drug in order to sell a given degree of curative effect. Potency determines in part how much the drug costs to produce since, all things being equal, it costs more to make 50 pills than five, three vaccines than one. Increasing potency ostensibly lowers cost of production, so can lower the consumer price of a remedy.

But by that token, if you develop a drug that will cost more to produce and/or test than the market for it will bear, chances are you're just not going to bother with it. That goes, too, for drugs that would likely help some substantial number of people but would harm a sufficient percentage that lawsuits should be expected to reduce their makers' returns (or harm their reputations). Ultimately, consumers' inability to pay for the cost of development keeps certain cures from being marketed even when they already exist, or where thy don't yet exist but research on them looks promising.

AIDS is now the leading cause of death in some non-industrialized nations. It affects far more people in Africa, I'm sure, than does diabetes. But Africa is a poor country and won't be able to pay for the development or purchase of an AIDS cure or vaccine. Ranheim should consider the cost of AIDS research in the US a form of foreign assistance. Maybe it will pay off in the long run.

693. Thoughtful - 10/14/1999 12:18:07 AM

Also, so far, AIDS is always fatal (I thought I read that those they thought were able to survive with the disease were only able to survive longer -- I may be wrong on this) whereas diabetes is quite survivable for most if properly treated.

694. Seguine - 10/14/1999 12:31:11 AM

"Too many people think COBRA is the only deal they have, even though it is incredibly expensive."

In my experience, COBRA is no more or less expensive than purchasing exactly the same health insurance directly (i.e., not under COBRA's aegis).

As for which "deals" are available, has it occurred to you that regulated HMOs help keep medical costs down in general, simply by competing with other types of insurers? Without them, there might be few affordable insurance options for your "whiny" middle class to individually, responsibly, choose from.

695. JudithAtHome - 10/14/1999 12:33:18 AM

Seguine:

Have you heard anything about Chlamydia pneumoniae causing heart attacks 6 or so months after infection in otherwise healthy individuals? I read something about this after my father died of a massive heart attack a few months after having a severe infection in his sinuses. He was a pretty healthy guy who walked every day and wasn't overweight or anything. I heard that the bacteria set up in the heart and when they reach a certain stage, cause cardiac arrest.

696. Thoughtful - 10/14/1999 12:41:30 AM

Call me hard-hearted Hannah, but regarding guilt and the care of patients with Alzheimers, I don't get it -- or at least I won't accept it. I've had to personally deal with 3 people in the family with Alzheimer's and health care, and am dealing indirectly with another. Two have died (one at 84, one at 96), one is still living. The one still alive is my mother-in-law, 85, who is in a nursing home now and has been there for 3 years. We have her DNR. In terms of care, my goal is to take care of the things that are easy to treat and which will keep her comfortable. But to put her through scary, painful procedures -- forget it. With her confusion and blindness, believe me, even an x-ray is a scary procedure for her -- she screams as if she's being skinned alive. I accept the fact that a) there's only so much I or anyone can do for her and b) she will not live forever no matter what I do or say or wish for her. If she's in pain or suffering, wishing her a speedy death is no more effective than wishing her a complete recovery. Her suffering will not change regardless of what I wish for her, therefore I would feel no guilt wishing for a speedy death if it would allieviate her suffering and mine. I know that at every step of the way -- from the time her husband died 10 years ago til now, I have done the very best I could for her with what I knew at the time -- perhaps even done too much. I've made mistakes, and will probably make some more, but I'm only human. I have no gift of perfect foresight to know what would have been best, but I have the best of intentions and have put forth the effort I have to give. That's the best I could do in the past and it will be the best I can do in the future. Heart aches, pain, stress, unsureness, missteps, frustration....sure. Plenty of those. Guilt? No way.

697. CalGal - 10/14/1999 12:52:16 AM

In my experience, COBRA is no more or less expensive than purchasing exactly the same health insurance directly (i.e., not under COBRA's aegis).

It is slightly more expensive than exactly the same health insurance policy purchased directly. I believe COBRA adds 10% on that? I forget the exact amount. Also, most companies pay a premium on their policies--what they make up for in group purchases they lose because they require guaranteed coverage, regardless of the health risk of the individual.

But people don't need the insurance their company provides, which has been my point throughout. They can buy major medical coverage for less than $100/month/person, which is much cheaper than COBRA. But too many people think that they can only get insurance through COBRA, rather than buying it themselves. Or they are convinced that they need all that insurance--which, in most cases, they don't.

The majority of the middle class gets benefits in the neighborhood of $4K/year per person subsidized by the government--and yet they still bitch. That qualifies as whining. I think the subsidization should stay; I just want the link between employment and subsidization decoupled.

I'm not sure what your point is to me re: HMOs. Any evil they have wrought was done with the assistance of the people who signed up for them back when they still had choices. The HMO product is useless insurance that I would never purchase; the HMO companies were fiendishly clever back in the mid-80s and provided the means for many clueless customers to select their way into the current mess. So you'll have to find someone else to argue about their iniquities with. I think they did exactly what they said they would, and anyone who bitches is a fool for expecting anything else.

698. Seguine - 10/14/1999 1:07:10 AM

Judith,

There's some evidence that C. pneumoniae causes plaque buildup on arterial walls, so could contribute to the causes of stroke and heart attack. The theory is that cholesterol accumulates on scarred arterial tissue in the course of the body's attempt to repair damage due to a C.p. infection. And C. pneumoniae does not always cause pneumonia. Often, it only causes a respiratory infection. Was your dad's sinus infection diagnosed as C. pneumoniae? (Probably no culture or bloodwork was done, so nothing certain would be known.)

The organism is so common that many more people have had it than develop the putatively linked kind of heart disease. So, although a couple of different studies have raised suspicions about the correlation between the bug and cardiovascular trouble, C. pneumoniae hasn't yet been proven to be causative. Just suspicious.

699. JudithAtHome - 10/14/1999 1:42:33 AM

Seguine:

Thanks for your response; this was in '93 and we'd never heard of C. pneumoniae so of course, no test. My dad was a strong person who was rarely ill. He was on a trip and staying in a hotel when he became sick. I knew he was really sick with something because one night when I'd called him, he said he needed to lay down and couldn't talk right then...for my dad to admit that, I knew he was very ill.

He was treated with strong antibiotics but I always thought possibly the infection could've been a contributory factor in his attack. Something we'll never know, I guess.

700. arkymalarky - 10/14/1999 2:36:21 AM

Wrt HMO's, I have no complaints about ours or what it costs, and I have the option of switching to traditional deductible coverage from the same company. As long as this is cheaper and preventative care is covered I'm happy with it, and they've never told me "no" about anything as long as my PCP suggests it. All the specialists, etc, I already would go to are on the list. Of course, this is a state-covered program in a small area without a whole lot of physicians and specialists to choose from in the first place, and I imagine that makes a difference.

Oh, and Ranheim, I'm almost positive it was B, though I'd have to try to find the information somewhere. It's been some months at least since the last incident in the news, which was traced back to a fast food chain in an AR town I don't remember. Sorry I didn't get back to you sooner.

701. Seguine - 10/14/1999 4:41:30 AM

"Wrt HMO's, I have no complaints about ours or what it costs, and I have the option of switching to traditional deductible coverage from the same company. As long as this is cheaper and preventative care is covered I'm happy with it, and they've never told me "no" about anything as long as my PCP suggests it. All the specialists, etc, I already would go to are on the list."

I can make exactly the same claim. So can a number of people I know. Moreover, the majority of complaints I've heard about HMOs are not about quality of care, or cost, but about bureaucratic foul ups such as the one Rossi (?) described, in which specialty care was billed to the patient because it was erroneously deemed unauthorized.

Where I live, it seems virtually all the doctors, hospitals, and major clinics accept my HMO. And I've had no difficulty finding good--even excellent--care.

702. Seguine - 10/14/1999 4:48:03 AM

"this was in '93 and we'd never heard of C. pneumoniae so of course, no test."

I don't think it's ordinarily tested for. And a blood test probably wouldn't have been conclusive anyway. There are several forms of Chlamydia (including the STD, and a respiratory disease of birds that people can catch, commonly known as psittacosis), all of which produce antibodies detected by the assay. There are secondary assays that can increase the odds of identifying a particular Chlamydia, but they're rarely done.

703. SpenceMirrlees - 10/14/1999 1:13:49 PM

Thoughtful, 692-693

I accept all of that, which of course still leaves room for fixed costs to account for somewhere between none and all (and probably a lot more than the former and less than the latter) of the two order of magnitude difference between per patient spending on AIDS and diabetes.

704. SpenceMirrlees - 10/14/1999 1:16:15 PM

per patient RESEARCH spending

In short, Stossel either let the accounting create some telegenic consternation for him, or is not aware of the effect.

705. ChristinO - 10/14/1999 10:46:40 PM

Anyone know anything about humidifiers in the treatment of asthma?

Doc says use one and I tried to, but it seemed to make things worse or maybe it's just because it feels like the air is thicker.

706. ranheim - 10/15/1999 1:05:11 AM

#705 Christin

As one might expect, asthma and humidifiers is an individual thing.

I always ask the mother to try one. Most asthma/hay fever patients feel better with a "wet" upper respiratory system; as compared to one that is "dry". Same thing in the lungs.

Every manufacturer says not to blow the vapor directly on your person.
Aim the flow only slightly away. Most patients feel better if there are no "smell goods" in the water.

707. ChristinO - 10/15/1999 1:14:10 AM

Thanks Ranheim,


I've been surfing around looking for other folks comments on this and find that I'm not alone in my quandry.

Extreme dryness is what brought this attack on----well the fact that the extremely dry hot weather aided whatever allergen that hates me to attack my system------and if it's too dry my lungs actually feel like they're burning, but I left the humidifier on all night last night and after about three hours I woke up wheezing and choking and had to turn it off and air out the room.

I'm pretty sensitive to colognes and perfumes anyway so I hesitate to use the medicament well of the inhaler. I prefer to "steam my head" over the stove so that I can better contol my intake.

Currently I'm just irritated because it seems that the series of antibiotics the Doc gave me isn't going to be effective and I can't see him again until Tuesday.

I'd better be well before I fly out next Thursday or heads are gonna' roll!

708. ranheim - 10/15/1999 1:40:26 AM

Did any of you catch Koppel on Thursday night? The subject was vaccinations and should they be mandatory. I had not realized that so much hell had been raised that Koppel would tackle the subject. The players were : Tim Johnson the network's M.D. consultant; a Dr. Katz who was on the team that developed one of the vaccines; and a Dr. Orient who took the position that immunizations should be a matter of private decision.

I found Dr. Orient's position difficult to defend. Much as I hate to admit it, this is one area where individual decisions may have to be limited. e.g. approximately 10 - 15 years ago there was a scare concerning the MMR vaccine (Measles/Mumps/Rubella - which is German Measles). Vaccination rates went down substantially - 10% or more. And, of course, within a year or two there was a mini-epidemic. Thousands of kids contracted measles; hundreds died; hundred more have permanent defects as a result. If these numbers can be trusted (I think that they can), maybe a loss of individual choice - one cannot start Kindergarten in my state without a current shot record - is warranted.

The problem is the amount of international travel these days. There are hundreds of thousands of cases of communicable diseases world wide. With the amount of international travel, we in the USA are just one vacationer away from a medical problem.

Her other point was the Nurnberg Trial forbade medical experimentation on humans. This is not valid. All of my med school class volunteered (snicker!) to be injected with a trial pertussis (Whooping Cough) vaccine. Even back in the 50s it was known that the "P portion" of the DPT shot could cause problems. The vaccine that was used on us students turned out to be a failure. As I recall, some of us had some viremia symptoms (headache; low grade temp; aches and pains; just feel like hell in general) but no one missed school.

709. ranheim - 10/15/1999 1:50:42 AM

Continued from #708

But, Dr. Orient did not get a fair shake IMO. Neither Johnson nor Katz answered her directly in her criticism of the Hepatitis B vaccine. As some of you already know, I am very suspicious of making that vaccine mandatory in newborns. (Mandatory in the sense that in my state a kid cannot start Kindergarten unless his/her shot record is current.) Hep B - don't confuse with Hemophilis Influenzae - is, essentially, a sexually transmitted disease. A baby is only exposed should his/her mother be a carrier; or dirty needles. There is nothing that can be done about dirty needles/etc. so long as we humans continue to make mistakes.

My solution for this predicament would be to trust all pregnant mothers. Currently, all pregnant moms are tested for Rh + or -; sugar; anemia; etc. This directed to any of you ladies who have been pregnant recently : have you been tested as to whether you are a carrier of Hep B?

If mama is a carrier, THAT baby is handled in a very different way. But, the huge majority of babies could wait - maybe to age 5 or so -for their Hep B vaccination. It can be a devastating disease; you want to prevent it if able.

710. bloodnfire - 10/15/1999 2:36:08 AM

I really enjoy your posts Ranheim. Wish our great grandchildren were
within reach of your capable and kind hands. You sound like just the kind of pediatrician children need. Bless you and your Office Manager Wife!! :-)

711. roseTTasTonE - 10/16/1999 3:58:03 AM

My name is Katie. My father posts here.

I need some help with a 7th grade school project dealing with high blood pressure.

Does classical music lower high blood pressure in people?

What other things lower high blood pressure?

Can you recommend any web sites that can answer these questions, and more.

I'm planning to do an experiment in school using classical music as a means of lowering high blood pressure.

712. CalGal - 10/16/1999 4:07:45 AM

Stone, haven't you learned anything about keeping certain information private? Anything at all? Christ. Don't you dare bitch about this later.

713. ranheim - 10/16/1999 5:24:21 AM

Stone

From Woodrow Wilson, through Warren G. Harding, through FDR we lost 3 presidents of 5 to high blood pressure. Yes, the president of the USA is a stressful job. But, don't forget, those people were just as intelligent as we. They just did not have the medications.

A long way of saying that there are many things - to include bed rest - that will lower one's blood pressure. But, upon returning to your regular duties, your blood pressure will rapidly seek its former high levels.

In a footprint to a book that I read a very great many of years ago, FDR took phenobarbital in an attempt to lower his b.p. It was a success; but, he could not put up with the side effects (drowziness; less mentally aware; etc.)

If associated with rest, I can see no reason that classical music (the type of music would depend on the individual) would not lower one's blood pressure - on a temporary basis.

Modern day medications are by far the most successful agents in lowering blood pressure to "normal" levels; yet allowing one to continue in your desired occupation.

714. msgreer - 10/16/1999 7:28:59 AM

Rose

Check posts #1777 and 1778 in Sports Thread.

715. msgreer - 10/16/1999 7:31:00 AM

Rose

Excuse me..I see 7th grade is the answer.

716. msgreer - 10/16/1999 2:56:30 PM

RoseStone

I will try my very best to get information to your daughter today. But please understand I am on vacation. A much needed vacation I might add. Today is a special one. Along with a friend I met down here we rented a sailing boat for the entire day and evening. He seems to have the same love of the sea as I do. I will bring my lap top with me and see what I can do. When is her project due?

I have been away from theMote all vacation except for last night when I couldn't help myself after the Red Sox win! In fact I have no idea what is going on in the world... I have made sure not to read a paper.
As I see it the news will be the same as it was before I left.

717. roseTTasTonE - 10/16/1999 4:26:32 PM

Thank you, ranheim and msgeer. I have a week to finish my project. Any help you can give is appreciated. My mother and father are helping me with this.

My grandfather is living with us and has high blood pressure. Most days, I help him test it with his portable Automatic Digital Blood Pressure Monitor made by Mabis: SmartRead Technology.

I am going to be a doctor when I grow up.

:) Katie :)

718. Thoughtful - 10/17/1999 7:17:18 PM

rosetta, the easiest place to go is the American Heart Assoc. which provides statistics and advice and lots of good basic info on high blood pressure. An interesting experiment you might try is to test the children's blood pressure when they are speaking and when they are not. I understand everyone's blood pressure goes up when they start talking.

You might have the children check the blood pressure in both the right and left arms to look for differences -- I know that can be significant -- ranheim could probably tell you why.

You might also have them see if there's a difference if they are standing and if they are lying down.

How about having them do some aerobics such as jumping rope and then testing their blood pressure and then again after a certain interval has passed to see how it quickly it comes down.

You can have them do the same thing with their pulse. Have them calculate the number of times their heart will beat in their lifetime at their resting pulse rate and their exercising pulse rate.

Most of the non-medication things to lower blood pressure tend to be longer term like diet and exercise.

Lots of cool things to play with here. If you have a stethoscope, have them listen to each other's hearts. We also enjoyed listening to the stomach when someone swallowed a cracker or something -- makes a really cool gurgle.

719. Thoughtful - 10/17/1999 7:18:56 PM

You can also have them do kind of a family tree thing to see if they can trace any high blood pressure/heart disease/stroke in their families...which is good info for anyone to know.

720. Thoughtful - 10/18/1999 8:26:46 PM

On another topic, one question in the medical field that has always boggled my mind is, "When should you see a Dr?" Many times, hubby refuses to go to the Dr. because he says, "He'll just tell me it's nothing and it'll go away by itself in a few days."

Friends of my parents, the husband had trouble rousing his wife one morning and finally when he got her up, she seemed ok, but had a terrible headache. She didn't go to the Dr. until nearly a week went by with this terrible headache. They admitted her immediately as she had a brain aneurism.

Are there any rules of thumb people can follow? Like if a fever is over x or if a sore throat lasts longer than x days? If you're unconscious for x minute? Stuff like that? Or a place to go to find out stuff like that?

I've been battling this laryngitis and my Mom-in-law's HMO sent out a book that's like a flow chart of yes/no questions by ailment which is to guide you as to when you need a Dr. I went through it and it said I didn't, but when I started coughing up green phlegm, I went as I know that's a sign of a more serious infection. But I only knew that because it happened to a friend of mine. Normally I just figure it's viral and will work itself out.

721. Thoughtful - 10/18/1999 8:28:13 PM

Of course the book from the HMO said nothing about that.

722. ChristiPeters - 10/18/1999 8:34:35 PM

Sorry to interrupt, but I have a message.

Msgreer has had a wonderful, relaxing vacation and is on her way home now. Unfortunately, she has been contacted enroute that her mother has had a major stroke and is in the hospital. So msgreer won't be on The Mote very much for awhile.

I'm sure your kind thoughts and prayers will be appreciated.

723. ChristiPeters - 10/18/1999 8:40:19 PM

Back to your point, Thoughtful - that has always been a problem for me too.

For instance, Lil' Darlin' has been vomiting everything and having diarhea since around noon on Sunday (which is why I haven't been on The Mote much). There is a stomach flu which regularly makes the rounds here. The Drs usually say just push fluids and wait it out, the more you throw up and eliminate, the faster you'll get this out of your system. So I didn't take her to the doctor yesterday. However, LD rarely gets this (hasn't had it in several years) and has never had it this long, so I made an appointment to take her to the doctor today.

Naturally, now she is getting better - she has color back in her face and has finally kept saltines down. I'm going to go ahead and take her to the doctor, but I feel a little foolish.

sigh

724. PsychProf - 10/18/1999 8:51:54 PM

Christie....don't feel foolish, rather feel like a fine mother.

725. Thoughtful - 10/18/1999 11:30:22 PM

Christip, send our thoughts and fortifiers to MsG who will need her super-hero strength again. So sorry she and her mom have to deal with all this.

I just went to the company Dr. to get something so I could sleep with this cough and he took me off the antibiotics the other Dr. put me on saying green phlegm means nothing -- so long as I don't have a fever or wheeze. Sheesh! That's just what I'm talking about. This doc told me to whisper not speak, where someone else told me whispering strains the voice even more. Someone told me to sip a little alcohol, and someone else told me to avoid it. Someone told me to drink hot fluids, someone else said it doesn't matter -- just drink fluids.

Man, I hope my immune system ain't as confused as I am else I'll never get better. Fundamentally, I think it's in charge and will get me well when it can. The rest of this stuff is just to make me feel like I'm doing something useful in the meantime.

Maybe the best advice is what I got from my family Dr. who said, "The best thing to do is stay away from doctors!"

726. CalGal - 10/18/1999 11:34:20 PM

I rarely take Spawn to the doctor. In his first year, he probably went 10 times, including checkups. Second year about 8 times? Year three he had a spate of earaches; it was probably 6. Year four, maybe three times. Year 5-9--0. Finally took him back because he needed a vaccination or something. And now the doctor tracks me down every year and insists on a checkup.

727. ranheim - 10/19/1999 12:57:34 AM

Thoughtful

Aren't doctors and the advice they give wonderful!? Remember! it is the PRACTICE of medicine. Some of the new docs like to think it is scientific. But, medicine is still an art.

On green sputum (phlegm): I tend to use antibiotics on smokers; try to avoid them on all others. The other group that usually end up on antibiotics is the day care kid. You want to make that junk as liquid and non-sticky as possible : therefore, use a vaporizer for external liquid and drink plenty of fluids for internal liquid.

Baylor was the home of Denton Cooley the famous heart malformation surgeon. As a part of a newborn workup, all babies had to have their blood pressure taken in all 4 extremities. Should there be a significant difference, the baby was considered to have a congenital malformation of the heart/great vessels - until proven otherwize.

728. ChristiPeters - 10/19/1999 5:38:22 AM

Well the Doctor's verdict is that, yes, Lil' Darlin' has our old familiar Southwest gastroenteritis (sp?) bug and pushing fluids and waiting it out is the best strategy. However, she also has a bladder infection (which, immo, may have been what provided an opportunity for the gastro bug to take hold, since, as I said, LD is NOT prone to this one). So she's on antibiotics for the the bladder infection and they are doing a culture to make sure this stuff will really kill it.

She won't be up to going to school until Thursday at the earliest and since she's still having diarhea, she might not be up to it then. Except for some recurring ear infections that responding immediately to treatment and stopped altogether when she was 2, LD has rarely ever been sick, and on those rare occaisions never before more than one day. My response has always been to just keep her in bed for the day and then she's been fine.

Oh well, this, too, shall pass. Our tempers may even recover, too.

729. ChristiPeters - 10/19/1999 5:39:08 AM

PsychProf -

Thanks for the moral support.

&:oD

730. msgreer - 10/19/1999 6:29:06 AM

Thoughtful

I wanted to thank you for your kind message. I appreciate you thinking of me. Take care of YOURSELF.

731. JJBiener - 10/19/1999 6:44:53 AM

MsGreer - I got your email and will respond soon. I hope all is well.

732. Raskolnikov - 10/19/1999 6:56:46 AM

Thoughtful:

"I've been battling this laryngitis and my Mom-in-law's HMO sent out a book that's like a flow chart of yes/no questions by ailment which is to guide you as to when you need a Dr. I went through it and it said I didn't, but when I started coughing up green phlegm, I went as I know that's a sign of a more serious infection. But I only knew that because it happened to a friend of mine. Normally I just figure it's viral and will work itself out."

Don't take this the wrong way, but I'm glad I'm not alone. I have had laryngitis for 5 weeks now, and it is getting very old very fast. I am ready to kill my doctors. Doctor Number One one prescribes an antibiotic (green phlegm led him to believe it was bacterial)which makes me sick. Doctor Number two prescribes a sulfa drug for five days. After the five days, and still no voice, Doctor Number 3 says that it more antibiotics won't do any good. After two more weeks, Doctor Number 2 (again) says that a five day course of the sulfa drug was too low, and I should have been prescribed a ten day course (when I point out that he was the one who prescribed it, he changes the subject). He then tells me I shouldn't come back unless the laryngitis is still there in *4 weeks*, at which time he would consider referring me to a E/N/T specialist. I was not happy.

I got him back though. He wanted to look at my throat with some sort of laryngo-scope, and wanted to numb my throat with a topical anesthetic. But he used too much, and stood too close, and when I coughed (a reflex action, I explained), I sprayed a good share of the anesthetic back into his face, numbing his lips, nose, and eyelids for the next two hours.

I hope this ends soon. I am getting damn sick of doing Burgess Meredith impressions.

733. msgreer - 10/19/1999 6:57:00 AM

JJ

It has been a long night as you can imagine. I look forward to hearing from you. One day at a time.

734. Raskolnikov - 10/19/1999 7:01:56 AM

and when it comes to "when to go in", I call up the clinic and talk to a nurse if I am unsure. I tend to err on the side of going to the clinic when it involves my kid. I have only been wrong in bringing him in once, when I thought he had an ear infection, but didn't.

In fact, I had to bring him in yesterday for an ear infection that I was somewhat doubtful of, but the Doctor said he had one. He entertained the staff by doing his impression of a frog that I had taught him earlier in the day. Nothing quite as funny as a 16 month -old jumping two inches up in the air from a squatting position, and yelling "ribbit!"

735. Adrianne - 10/19/1999 3:57:16 PM

Until Fang! was 10 months old, she only went to the dr for her "wellbaby" check ups. Then, over the next few months, she was getting sick every two weeks like clockwork - Hub and I were "refusing" to overreact and over-medicate (we're convinced that peds give kids antibiotics unnecessarily) - until she had a febrile seizure during a temp that spiked suddenly from about 101 to 105+.

Nothing like seeing your baby stop breathing, turn blue and arch backward like a fiddle bow to change your attitude about drs.

She goes in IMMEDIATELY now, at the slightest sign of fever. (shrug) Overprotective? Probably - but even tho I know (now) those seizures aren't dangerous for the kid, it screwed me up something royal, and I will do everything I can to make sure it neverever happens again.

As for me, I don't go to the dr, except the ob/gyn, and neither does Hub (except for a rash of work-related injuries a year or so ago).

736. msgreer - 10/19/1999 4:31:28 PM

Adriannne

I know exactly what it is like to see one's daughter seizure. I had 16 years of watching my daughter's eyes roll back, her entire body shake, stop breathing, turning blue and needing me to breathe into her sweet small mouth. I don't wish the experience on any parent. It is a difficult image to get out of one's mind. I wish good health to you and your daughter. Has she ever been an anti-convulsant medication?

737. Adrianne - 10/19/1999 4:43:17 PM

Ms Greer,

No, it was entirely fever-related, and probably a one-off. Although now when she runs even a degree of fever, either her Dad or I sleep with her, and we wake her up every 3 hours to give her motrin/tylenol alternating. If she runs over 101 we sponge her down.

I don't think I'll ever stop seeing that image in my head. It haunts me.

738. msgreer - 10/19/1999 4:51:15 PM

Adrianne

I understand how it must haunt you. It sounds like you and your husband are taking good care. Just the fact you have to watch her so closely is draining and frightening. My daughter lost oxygen at birth which left her mentally challenged with a severe seizure disorder. In her 3rd year of life her seizures started and she had up to 10-12 grand mals a day. I too sleep with her. I put bells on a string and gently wrapped them around her wrists so if her arms started shaking I would here the bells. Sometimes I would loosely tie our feet together so if her seizure movements started there it would wake me up immediately. She never minded this arrangement. This went on for 5 years until she had to be hospitalized for 5 years to get the seizures under control. End of story, she is seizure free. Well, she still has petit mal.

739. theDiva - 10/20/1999 4:49:15 PM

Ms G

I have to run off to a meeting (!), but I couldn't go without asking..........how is she? And how are you?

740. theDiva - 10/20/1999 4:50:05 PM

your mother, I mean.

741. Thoughtful - 10/20/1999 7:16:13 PM

Raski! I almost sprayed my mouthful of lunch all over my CRT at your last post! Reminds me of the time when I was hyperthyroid which can cause your reflexes to also get hyper -- Doc forgot and stood in the wrong place when he tapped my knee!

One doc told me the laryngitis would go away as soon as the congestion went away. I'm still congested so my voice isn't normal, but it's getting better. I've gone from an impression of rusty hinges through adolescent boy voice-cracking til now when I'm doing Lauren Bacall impressions!

Ranheim, I was always suspicious of drs who keep practicing but never get it right! }:-)

742. msgreer - 10/20/1999 9:01:38 PM

Diva

How is mom? Okay. The stroke she just had has affected her ability to walk. She has no balance or gait. It will not return. I brought her home last night. She is like dead weight. I had to get diapers as she can no longer walk to the bathroom. Oh, I was busy putting together a nursing plan of sorts for her. She is an invalid.
We all knew she was not in good shape and it became a matter of waiting and seeing what would happen next. Needless to say she is in shock. So am I for that matter. I immediately hired nurses until my sisters and I can decide the next step. I will more than likely move in with her. I can use nurses when I have to get out. I went out and got her a cell phone today. I programmed in every number she would need for any reason. She is pleased with this.

How am I,Diva? I am in shock myself. I look into my mother's eyes and see her pain. I look at her and see has certainly started her journey which will take her to a better and more peaceful place. Luckily we are talking openly about our feelings and fears. She told me she did not know what she would do without me. I reassured her I wanted to be with her and that we would work each issue/problem out as they came.

Interesting, Diva, I got an email from one of my sisters who said how much she appreciated me being her for mom. How did she put it...something like being the person all family members come to when in need.

743. theDiva - 10/20/1999 9:05:43 PM

Oh, Ms. G.......how I wish I could give you a hug and a bowl of soup. You probably could use some pampering. Need I say once again that you both will remain in my prayers?

744. msgreer - 10/20/1999 9:05:43 PM

cont.

And she said how much she appreciated all that I do. That is all well and good but I would like to scream out hey sisters of mine where do you feel you fit in in this scenario?

One day at a time.
As I said we were able to talk in depth about what is happening to her. She has always been an independent woman. Let's just say she would prefer not to live this way.

Thanks for asking sweetie.

How is the new job? Do they appreciate you yet? Do they know how lucky they are to have you?

745. msgreer - 10/20/1999 9:10:37 PM

Div2

No you don't have to remind me of your prayers. I know they are there and they comfort me. I don't want to bore everyone on theMote with all this. I will keep in touch and please do the same. Give me afew days to answer your email...

BTW, one of my biggest concerns is how my daughter will react to her grandmother when she comes home for the holidays. I am thinking of flying to Boston before she is to come home to talk to her directly on what to expect. Then we could fly home together.

My daughter basically has 3 pilars holding her up...me, her grandmother and the residence she lives in. Oh my.

746. theDiva - 10/20/1999 9:10:58 PM

The job is good, I'm still getting my feet wet, though. It may take a while for them to figure out how nuts I am, but I'm working on it.

747. msgreer - 10/20/1999 9:11:49 PM

Div2=Diva

748. msgreer - 10/20/1999 9:13:19 PM

Diva

Thank God for your "nuts' as you put it. I am sure they could use abit of MAMBO once in awhile.

749. JJBiener - 10/20/1999 9:15:26 PM

MsG - I just dropped in to check on you, but it seems like you are already being looked after. SuzyQ asked about you last night. I told her you are doing as well as could be expected under the circumstances. The next few weeks are going to be difficult, but I know you will make it through. Stay strong.

750. msgreer - 10/20/1999 9:19:30 PM

JJ

I know I will make it. Thanks to you and Suzy for your kind words. As we have said to each other this is her journey. I feel at peace letting her do it her way.

751. Thoughtful - 10/20/1999 11:05:41 PM

Oh MsG -- I'm so sorry to hear about your Mom -- another one of those "character-building experiences", but I suspect you've already had more than your share! Hang tough, kiddo. It sounds like you and your Mom are doing exactly the right things, though a shock hardly describes it.

My thoughts are with you. And don't worry about "boring" us here. If it helps you to talk to us about what's happening, we are all more than happy to listen and lend whatever support we can.

752. msgreer - 10/20/1999 11:18:00 PM

Thoughtful

That is the nicest thing anyone has said to me. Thank you for not making me feel like someone who is dumping on everyone.

I have been thinking about you. Do the docs you go to actually have degrees from recognized Medical Schools? I am not surprised by your stories. Are you still coughing up phelm? It concerned me when you said it was greennnn. When mucous is coughed up with a yellow, greenish or brown color it usually means there IS an infection. Does gargling with warm salt water soothe your throat?

It was green wasn't it or is my memory going as quickly as my mothers??

753. Thoughtful - 10/21/1999 12:09:30 AM

Don't worry about me. I'm on antibios and am getting better. The new cough med is letting me sleep and my voice is returning.

You've got plenty on your plate right now. Don't take on any more. You need to focus, focus, focus and pace yourself so you'll have what it takes to get through the upcoming days.

My only concern is whether you can handle having your Mom stay at home with you. While it's certainly what you both want, it may not be the best for several reasons:

• a regular home is not very well equipped to deal with someone who's not ambulatory -- beds, bathing, door width, shower/tub, etc. I'm so impressed with how easy it is for the nursing home where Mom-in-law is to handle the residents: PVC wheel chairs to use in the large roll-in showers, bed pillows for turning patients, hospital beds, tile floors, bed cranes, etc.
  
• trying to handle someone who is a dead weight -- even being a pro who knows what's she's doing -- can lead to back injury, etc. in which case you won't be able to help her as you may be in a bed yourself -- which would cause your Mom more worry too.
  
• it can't help but be very tiring and stressful for you as you will be "on" 24hrs/7days, even with help. You can't afford to let yourself get worn out, especially in light of your daughter.
  

754. Thoughtful - 10/21/1999 12:10:26 AM

You may not be ready for this yet, and I understand. I know you are still in shock over the whole situation. But I'll post this now so it will be here when you're ready.

My Mom & her brother cared for their Mom&Dad and then just Mom for 9 years total. When they finally put their Mom in the nursing home, my Mom expressed how drastically her relationship with her Mom changed for the better. She no longer had the burden of being the primary care giver: feeding, cleaning, bed changing, clothing changing, laundry, chores, chores, chores, etc. Instead she was able to spend as much time as she wanted with her Mom with her primary focus on her emotional well being and support. The time she spent with her Mom in the home were spent enjoying each other and bringing whatever light into her life that she could, not taking care of the meaningless but necessary.

Take it one step at a time. You know yourself and your situation best, and I'm sure you'll do what is best for everyone. Do keep us informed as to how things progress as you can.

755. bloodnfire - 10/21/1999 2:09:21 AM

Sounds like very sound advice, Thoughtful. MsGreer, all our thoughts and prayers go out to you and your family's situation. I agree that you should not worry at all about boring us. These are all health issues with which any one of us might have to deal sometime.
Please take good care of yourself. We need you and this thread. Blessings !!

756. Thoughtful - 10/21/1999 3:38:15 PM

MsG. Last night I remembered a most important consideration on caring for your Mom. My Mom-in-law had *something* happen, we still don't know if it was a mini stroke or something and we foolishly took her home instead of leaving her in the hospital after the ER visit. After us caring for her 24 hrs a day for a week, it became very apparent that this wasn't going to work and she would need a nursing home for the rest of her life. Because she went into the nursing home private pay without a prior hospital stay, we got no medicare coverage. We estimated it cost us an extra $12,000. In the back of my mind, I knew all that, but when it happened, I obviously couldn't think straight and made a wrong, very expensive choice.

757. Adrianne - 10/21/1999 3:55:52 PM

MsGreer

Have you read "Caregiving" by Beth MacLeod? It's been very enlightening for me, and is very supportive.

758. msgreer - 10/21/1999 3:58:29 PM

Thoughtful

Yes, I know about going from the hospital first and then into a nursing facility. You have brought up many good issues. Believe me I have been thinking about them as soon as her doctors told me there was nothing else they could do and discharged her. I appreciate all the time and effort of your posts. This is a difficult one for me. I have a very special and unique relationship with my mother. I don't think I can answer all of what you have brought up right now. I am in a mode that is hard to describe. I am familar with it. Give me afew days and I know I will come looking for you so we can talk.

My plate is full as you said... I have this weekend with mom and then to our cancer center with my best friend for her ovarian cancer surgery. I need to handle these things right now. If I stop right now I may fall down. I know what you are thinking...go ahead msgreer fall down and let someone help pick you up. I don't have that option now.

I want to tell you again how much I appreciate you being here for me. And that goes to bloodnfire and for everyone else.

759. ElliottRW - 10/21/1999 5:11:36 PM

Veering Off To Another Topic...

It occurred to me that health insurance with low deductibles, while possibly good for people who are extremely sensitive to costs, is a bad idea for most people. I mean, for only $5 a pop I call the doctor every time my daughters sneeze. This does not bode well for containing medical costs. Far better for the free market of medicine would be a $1000 deductible--now that would motivate me to watch costs.

So I propose an alternative solution: make people to pay deductibles in pain. So, if a person wants a $50 deductible, they also must pay $950 in pain and suffering (say, a series of electric shocks to the tongue).

For those who are insensitive to pain, we can use shame instead. So, if a person wants a $50 deductible, they also must pay $950 in humiliation. I like the idea of having people wear their hair like Alfalfa. Bald people could wear special wigs. Of course, this won't work for everyone: many people are quite shameless.

Finally, for those shameless people inured to pain, we simply ask them to wear badges identifying themselves as such. This should be well worth $950 a year.

760. ElliottRW - 10/21/1999 5:23:01 PM

An Even Better Proposal

Thursday October 21 4:53 PM ET

Put insurance decisions in patient's hands, says AMA

NEW YORK, Oct 21 (Reuters Health) -- The nation's largest physicians' organization is promoting a vision of healthcare reform that would shift the power to choose an insurance plan from employers to individuals.

In Thursday's issue of The New England Journal of Medicine, the American Medical Association (AMA) lays out its proposal to allow individuals to choose and own their insurance plans. The recommendations, first adopted by the AMA last year, call for employers to help foot the bill for health insurance rather than dictate what benefits employees may have. The plan also requires restructuring the tax system to help individuals buy private insurance outside of the workplace.

snip

761. ElliottRW - 10/21/1999 5:23:13 PM

Unlike the current system, in which employers typically offer one health plan and employees ``take it or leave it,'' the AMA plan would have employers contribute money toward employees' health benefits, but leave health plan choice up to individuals. Currently, Dickey and McMenamin report, just 17% of businesses that provide health benefits offer employees a choice of two or more plans.

To help individuals pay their share toward the health plans they choose, the AMA would change the way the tax system subsidizes insurance payments. Presently, Dickey and McMenamin note, the money that employers withhold from workers' paychecks for health insurance is taken out before taxes. Instead of excluding this money from taxes, the AMA proposes counting it as income, then granting individuals refundable tax credits to help pay for health insurance.

These tax credits would apply to anyone who buys health insurance, the self-employed, unemployed, and workers whose employers offer no health benefits. And, the authors write, tax credits would be granted according to income, so that poorer Americans would get relatively more money to put toward insurance.

According to their report, the tax exclusion granted to employer-based insurance totals about $75 billion per year in lost tax revenue. The AMA proposal would instead have the government collect this money, then return it as tax credits, dispersed according to income. This way, according to the AMA, all Americans would gain a tax benefit from having health insurance.
snip

762. ranheim - 10/21/1999 9:04:12 PM

ElliottRW in #759 mentioned something that caught my eye + in another thread Pelle could not believe that I made the comment that I did not think that medicine is a "right". In general, I don't believe in giving people very many rights. You should earn rights.

In any case, my 9 years in the USAF horrified me! I recall my own parents and the dictum of the 20s, 30s, and 40s : sick for 72 hours! Home remedies such as a vaporizer; aspirin (there was no Tylenol then); cool baths; massage; linament; splints; etc. were tried during this 72 hour period and should they fail, then to the doctor. My USAF experience was an eye-opener. When did your child become ill? This morning. Is there any fever? No. Well, what is wrong? I just wanted a check-up. This scenario played itself out multiple times every day. That is a complete and total mis-use of a medical system.

The main offenders were young wives with children. No ammount of talk would convince them that this was wrong. "Its my right; and if you won't treat my child, I'll report you to my husband's commander." It was extremely uncomfortable to practice medicine in this manner. DEMANDS! Backed up by threats. If one did go on report, the amount of paperwork was staggering! It became obvious to us that both the airman and his wife considered the dispensary as a part of his paycheck.

Since my USAF days, I have had Louisiana Medicaide as a challenge. The situation in LA is better in that there is a system of Charity Hospitals; started under Huey Long (A governor; then senator). The charity system takes a lot of pressure off as any LA resident can go to one of these facilities. If your income surpasses the current minimum, you will receive a bill. Community hospitals can an do send patients without funds from their facility to the Charity system.

763. Bubbaette - 10/21/1999 9:11:24 PM

Ranheim

I've wondered whether PPO's have added to the demands on physicians' time. As one of five children on an indemnity plan insurance, my parents pretty much had to have a prolonged temp of 103 or bones sticking out before we'd go to the doctor, because each visit required either full payment until the deductible had been met, or 20% copay after the deductible. I've inherited this reluctance to see a doc until an illness is severe or, if milder, has lingered on for several days unabated. However, whenever I have a case of the sniffles, hubby, sisters and co-wokers urge me to see a doc. immediately.

764. ranheim - 10/21/1999 9:22:13 PM

Cont. from #762

The Medicaide system is abused by a very solid minority of single mothers who do not have enough to do. I have heard them talk : "Today we will go WalMart; nobody can get a car tomorrow; on Wednesday we'll go to Ranheim's; . . ." They plan their week - to kill time and to amuse themselves.


Another form of abuse occurs in the last week of a month. "There's nothing wrong, doc. Just check her ears." This category of patient considers the monthly visit to the doctor (in LA, a patient is allowed 12 visits to doctors per year) as a portion of his/her benefits. And they are "losing money" if they don't use all 12 visits.

Would these abuses die off in a generation or two should there be universal medical coverage? I don't have the answer.

I believe that it has been established in the USA that under a universal coverage scheme, the bank would be bankrupted. Demand would soon exceed doctors and facilities ability to provide care; in addition to the cost.

Any co-pay scheme would have to be set up very carefully. It cannot be so expensive that the poor cannot utilize it. Yet the co-pay has to be high enough so that patients will hesitate and think prior to going to the doctor with a hangnail.

765. Ronski - 10/21/1999 9:39:14 PM

Any subsidization will result in over-utilization. It is only a question of how much over-utilization can be tolerated.

Remember: if you make something cheaper, you get more of it. Take crime: if you make crime cheaper (by lowering the cost to the perpetrators), you get more crime.

766. CalGal - 10/21/1999 9:56:00 PM

Ronski,

Um. Is there anything about the AMA's plan that sounds a tad....familiar?

I think they're stealing my stuff!

767. Ronski - 10/21/1999 10:06:31 PM

I know. The Federales are reading our e-mail (Don't use the words R*by R*idge, or W*CO, or Kathleen Willey, or cat), and the AMA is reading The Mote!

Privacy is dead.

768. ranheim - 10/22/1999 12:52:07 AM

Bubba

I don't have managed care in my area as there is no industry.
The largest employers in my parish are the school board and the sheriff's office - "state group" health insurance and they can see whatever doctor they wish.

My brother - a cardiologist in a very large clinic - has told me that he and his partner's experience with managed care was that there were a lot of cases of "worried well".

769. PelleNilsson - 10/22/1999 1:00:08 AM

Ranheim

In general, I don't believe in giving people very many rights. You should earn rights.

It is not clear to me how people would go about earning rights. But in any case some will fail. And what do you propose to do with them, if they have an accident or a serious, but curable, illness? Let them die unattended?

770. CalGal - 10/22/1999 1:07:16 AM

You don't earn rights, do you? I thought privileges were earned.

And Pelle, read the AMA's proposal above, which the bastards stole from me.

771. JJBiener - 10/22/1999 1:20:32 AM

Pelle - I want you to consider a scenario. You live in a country that has significant medical resources, but there his no public health insurance. People must either buy their own insurance (or their employer provides it) or pay for the services they receive. This system leaves 20% of the population with only emergency access to health care. A charity comes along and says they will provide insurance for those individuals who cannot afford insurance or to pay out of pocket. This charity calls you up and asks you to contribute to their cause. What would your response be? If I am judging you accurately, you would give generously to this charity, correct? I know I would. I don't know anyone who wouldn't.

With this the operative question becomes is it better to have a voluntary, charitable system, or a coercive, government system? How can you justify the latter?

772. ranheim - 10/22/1999 1:32:16 AM

Pelle

I live in the wrong state for "my feet to be held to the fire"; as they can go to the Charity system.

I was born in 1935 so I remember house calls AND the doctor giving of his time to the community. If I recall, the polio vaccines (shots first - then drops) were administered by doctors volunteering their time. There was gratis work by physicians then + the fondly remembered house call that was paid for by chicken/eggs; vegetables; fruit; today's catch of fish; etc.

Shortly after WW II there was the Hale-Burton act (I am not 100% sure of that name). The purpose was to place hospitals in small towns that did not formerly have them. Hundreds sprung up all over the lower 48. These were built with heavy government subsidies. These same hospitals have been closing in droves lately - bankrupt.

I remember that my father was strongly opposed. They - referring to citizens in general; doctors in particular - are letting the camel's nose under the tent. They just haven't smelled the bad breath yet.

773. PelleNilsson - 10/22/1999 1:46:32 AM

Ranheim evades the question by referring to the specific conditions in his area.

JJ posits a hypothetical case (what would you do if ...)

Let me rephrase. Is it possible for any civilised state to evade being the care provider of the last resort?

774. ElliottRW - 10/22/1999 1:50:06 AM

Pelle,

Is it possible for any civilised state to evade being the care provider of the last resort?

In general, the answer must, by definition, be no. But this doesn't mean that the state can't work through charities. If the charities are adequate providers of last resort, the state's burden is met.

775. ranheim - 10/22/1999 1:56:03 AM

In the pc USA, the answer is no.

In doctor's changing rooms in hospitals I have heard "Let the bastards die".

Speaking only as a human being, I don't see how I could let another human being die if I had the skills to save him. I might hold my nose tightly after the fact, though. As a physician, I have a moral responcibilty to render all the aid that I am capable of.

776. PelleNilsson - 10/22/1999 1:57:45 AM

I'm not familiar with American charities. Are they obliged to take in all comers who are not covered by regular health care schemes?

777. msgreer - 10/22/1999 2:00:58 AM

Pelle

No it is not possible for any civilized state to evade being the care provider of the last resort. As for getting our resident doc ranheim to give you a direct answer to your question..let's just say I will be waiting to see it. You bring up an issue this thread has discussed with much vigor. Is health care a right or a privledge? I say it is a right. I find myself in the minority but I keep saying it over and over. The good USofA is the only major industrial country which does not provide equal health care for all its citizens. Shame on us.

RANHEIM

Please do not take offense at my statement. It is just you did not give Pelle an answer. We all know you are a rare and special bird when it comes to delivering health care. I have enormous respect for you. We just don't agree on the right for health care for every citizen.

JJ

I give "charity" health care everyday. I take pro bono cases whenever it comes my way. Unfortunately I fear most people would not run to embrace your idea for health care. They give to their favorite "charities" but paying for someone elses health care would not appeal to the majority of our citizens.

778. msgreer - 10/22/1999 2:02:17 AM

industrial=industrialized

779. ranheim - 10/22/1999 2:02:41 AM

Pelle

It would be a plus for your USA peers to hear how the health system in Sweden works. Too many times we hear things from those who are disgruntled.

You seem to be very comfortable with the Swedish medical system. I am sure some comments would be welcombe.

780. CalGal - 10/22/1999 2:03:30 AM

I don't know anyone who wouldn't.

JJ, I know tons of people who wouldn't. I, personally, wouldn't give money to a charity such as you describe--in fact, I would lecture them at great length on their stupidity in not lobbying for government coverage for the poor. If you're counting on the good will of the people, the poor are fucked.

Besides, the government could afford it, since everyone who was employed would be paying taxes on their benefits.

781. msgreer - 10/22/1999 2:05:09 AM

Pelle

No charity in this country is obliged to take all our citizens in and provide health care.

782. msgreer - 10/22/1999 2:09:27 AM

"Let the bastards die"... the compassion overwhelms me.

783. ranheim - 10/22/1999 2:13:42 AM

msgreer

I didn't answer on purpose.

I would have to render aid.

But, the state? That is another matter! There are so many things in medicine that are compulsory already. Prescriptions for non-narcotic medications. Why? Vaccinations. Why? A degree to practice medicine. Why? This is just a start.

As I grow older, I begin to wonder about all of these things.

So much of general practice is common sense that one sometimes wonders. But, then I realize that my training was wonderful and that my experience has made most situations easy for me.

With the general level of thinking done in the USA, we could never return to the days of caveat emptor. But, for God's sake, a human has to be responcible for some things - or doesn't he/she?

784. ChristiPeters - 10/22/1999 2:13:50 AM

Well, Lil' Darlin' is well now - 10 pounds lighter and a bit on the weak side, but no more gastroenteritis.

yippeeee!!!!!!!!

I, otoh, will be fussing with my injured ankle for while yet. I told the tale over Harvey Wallbangers in The Mote Cafe.

msgreer - my thoughts and prayers are with you, as always.

785. PelleNilsson - 10/22/1999 2:22:42 AM

ranheim

With all due respect. It is not a question of what you would do, or what any responsible physician or nurse would do. We are talking system here.

And you have still not answered. Are you in favour of a system that condemns people to death or disability if they have not "earned the right to health care"?

786. msgreer - 10/22/1999 2:25:49 AM

Ranheim

Yes people do have to be responsible for somethings. It is just I don't put health care on that list. It is not like our country doesn't have the resources to provide health care for all. It is our priorities I wonder about. I understand your position. I like to read what you post. I guess it comes down to agreeing to disagree.

CHRISTIPETERS

What the hell is going on with you. When willyou get the MRI? Two months... when will you tell us the results of your tests. How much weight did Lil Darling lose? Did you say 10% of her body weight. I consider that to be substantial. How is she doing. Thanks for your prayers.

787. msgreer - 10/22/1999 2:33:19 AM

Ranheim

I agree with you when you say so much of general practice is common sense. But it is common sense to you because you have done it all your life. Do you really feel all your clients understand much of health care is common sense? I don't think so. Some people will always have the need to hear it from the doctor. I work with my clients to become informed consumers when it comes to their health care. I act as a facilitator. I do my best to show them how to be their own advocate. But you have to remember our medical system is not an easy one for MOST folks to go through. Alot of the blame for that falls on our shoulders as medical professionals.

CHRISTIP

Okay LD lost 10 pounds not 10% of her body weight. That's not great but it's better than losing a large percentage of body weight.

788. ranheim - 10/22/1999 2:42:44 AM

I think my answer about the state having ultimate responciblity in health questions will turn out to be variable. Or we will have to agree to disagree.

Msgreer put her finger on it in #786 "Its not like our country doesn't have the resources . . ." Yes, it does. Let us change the locale to Chad. Does the state in Chad have this same responcibility? Or because it is a relatively poor nation, Chad has less responcibility?

Go down the list of nations and ask "Does the state have responcibility?" Then ask "Can it pick up the tab?" Are our answers always the same? Or variable?

The state in the USA does WAY too much IMO. That is why I am reluctant to give a straight answer.

789. ChristiPeters - 10/22/1999 4:46:41 AM

msgreer -

The MRI is on Nov 4th. My follow-up visit for the results is Nov 11th. I'll be ok, ya know, just inconvenienced and ouchy for awhile longer. In the meantime, I am to be careful while walking as my left foot is unstable (like I didn't already notice that, doc?)

My Mom needs surgery on some hammer-toes. So this will work out ok. She'll come down here away from the cold cold Michigan winter. I'll help her out after she has her surgery and (if it comes to that) she'll help me out after my surgery.

Hopefully, all I'll need is the 2 month imobilization. However, this has made it way easier to talk my Mom into coming down so I can take care of her after her surgery. So it really is all for the best.

790. ChristiPeters - 10/22/1999 4:49:38 AM

Lil' Darlin' is fine now. One thing about gastroenteritis, it's hell while it lasts, but when it's over - it's over. It's weird. It's almost like flipping switches. You go from feeling fine to oh my god, death would be such a relief to feeling fine again, both times very sudden changes.

791. msgreer - 10/22/1999 7:43:00 AM

ChristiPeters

Are you home on Saturday?

792. msgreer - 10/22/1999 7:53:55 AM

Ranheim

Are you sure your degree is not in law instead of medicine? Pelle asks you 2 direct questions which require a yes or no answer regarding health care in our country and somehow you end up in Chad.
It really doesn't hurt to say no if that is your answer.

Pelle

Let me say Hospice does take all that apply regardless of insurance or not.

793. msgreer - 10/22/1999 7:54:49 AM

Good night all.

794. ChristiPeters - 10/22/1999 6:11:05 PM

msgreer - I am working Saturday and Sunday this weekend and next in order to catch up from being home with Lil' Darlin'.

795. msgreer - 10/22/1999 6:17:05 PM

ChristiPeters

Okay young lady. Why is it you have to wait for a week for the results on your MRI? You can ask for a wet reading that very day. They will call you doctor and you will hear the results. Then when you go in a week later you can read the actual report.

I am not sure I understand how you will handle 2 months of being immobile. What does that mean for work? When is your mom coming? Perhaps I didn't read you post carefully enough. I will be here for another 30 minutes so we have time to chat. If you don't get back to me I will find you this weekend.

796. ChristiPeters - 10/22/1999 6:48:38 PM

msgreer - I don't have to be immobile - just my foot and ankle. I assume that will mean some sort of cast. I am hoping for the kind with velcro straps so I can take it off to shower. Failing that, I'm hoping for a walking cast, as I don't want to spend 2 months on crutches. Still, whatever method is chosen, it is temporary and I'm sure I'll get through it just fine (albeit a bit grumpily).

797. ChristiPeters - 10/22/1999 6:50:37 PM

I'm not sure when my Mom is coming, but probably not before Nov 11th. At the very least I need time to get my guest room cleaned out and the bedding changed. Also I have not changed my birthday trip plans. I am going, come hell or high water!

798. msgreer - 10/24/1999 3:31:17 PM

I hate this world right now. My uncle is dying in AnnArbor from complications from Alzheimer's. My best friend is undergoing cancer surgery tomorrow. My mother is an invalid. I am just so damn angry.
I love my family with all my heart and now the last of this wonderful generation is going. I will be with my friend in Tampa knowing whenI get the call about my Uncle I have to rush to AnnArbor for the funeral as it has to take place within 24 hours of his death. This follows the Jewish tradition.

799. msgreer - 10/24/1999 4:32:34 PM

My Aunt has asked me to be one of the two people giving the eulogy. I am proud she asked me.

800. ChristiPeters - 10/24/1999 6:08:29 PM

msgreer -

sympathy aympathy sympathy

kind supportive thoughts and prayers are winging your way, too

801. JJBiener - 10/24/1999 6:12:22 PM

MsGreer - I can sympathize. My wife and her family have had a bad couple of years. Six aunts and uncles on her mother's side have died including her favorite aunt. There are only three siblings left from the original eleven.

802. msgreer - 10/24/1999 8:00:50 PM

JJ and Christi

I am calmer now. It just hit me this morning with such a force...I don't know what to say. I don't know how to pack. Do I bring my AnnArbor clothes with me to Tampa and go from there if I have to? I'm just talking to myself. It's not that I can't handle it but damn...

Thank you both so very much for your supportive words and clear understanding. Didn't I just get home from a vacation????

803. msgreer - 10/27/1999 6:06:04 AM

Does anyone know the details of the bill passed today in the House concerning physicians and assitted suicide? I only heard abit about it from the nurses in the hospital.

It seems any doctors taking part in assisting a suicide in the terminal ill would be dealt with "harshly" whatever that means. It was said if it passed it would negate the law passed in Oregon.

804. CalGal - 10/27/1999 6:07:58 AM

House Votes to Ban Doctor-Aided Suicide

805. msgreer - 10/27/1999 6:11:14 AM

BTW, a fellow Motie asked me for a copy of the study done in England regarding the study done on Fosamax and osteporosis. I finally tracked it down and it crossing the pond as we speak. When I receive it if anyone is interested in looking at it I will be happy to mail it out.
Basically the study showed Fosamax does not rebuild bone but merely keeps one from losing what bone density they already have. There is apart of the study which I would like to read more about concerning the effects of IV Calcium actually rebuilding bone. Until I read the study I can't give the particulars.

806. msgreer - 10/27/1999 6:18:07 AM

Calgal

Thanks for the link. In most living wills it is clearly stated a patient has the right to receive all and any medication which will alleviate their pain even if that specific medication will hastens the death process. It is obvious physicians needed that clause as many narcotics reduce respirations and can, I said can, aid in the death of a person.

807. msgreer - 10/27/1999 6:19:56 AM

What happen to my last sentence in above post? I was saying,
damn first Congress wants to be in our bedrooms and dictate morality now they want to be on our death bed too.

808. msgreer - 10/27/1999 6:21:52 AM

I would love to know how this bill would affect people being cared for by Hospice. There is no autopsy done on Hospice patients. Atleast that's the way it was when I was a Hospice nurse and I don't believe that has changed.

809. ProfEmeritus - 10/27/1999 6:24:23 AM

Ms Greer

The Jim Lehrer hour had a segment on the bill passed today by the House - passed by a large margin.

The bill does provide severe penalties for doctor assisted suicides, even by patient adminstered drugs authorized by the doctor. Penalties are up to 20 years of imprisonment. The Oregon Deputy Attorney General argued that such a law would be unconstitutional as an abrogation of powers reserved to the state. He also argued that an innocent doctor who simply prescribed drugs to relieve pain might be prosecuted. Who is to decide where the line is? The Congressman whose bill it is argued that the government would make the determination. Talk about big brother. This is yet another example of how the Republican Congress wants the government to supervise and interfere in our lives.

810. msgreer - 10/27/1999 6:31:46 AM

ProfEmeritus

How does the Repub Congress think they can enforce this law? When I was a Hospice nurse I knew of many clients who stack piled certain medications just so they would have some control of their own
death. It is the Hospice nurse that is called to attend a death. Granted we were responsible for counting and discarding all narcotics after a death but even that doesn't prove what may have hastened a death or not. Do the Repubs want us now to report all medications taken hour by hour by the dying patient? How would this horror of a bill implemented? Doctors already write prescription in 3's for certain narcotics. The government keeps a database of this information. How a person decides to take that medication can not always be put on the shoulders of the treating physician.

GET OUT OF DEATH. I WILL GO WHEN AND HOW I WANT, thankyouverymuch.

811. msgreer - 10/27/1999 6:32:54 AM

GET OUT OF DEATH=GET OUT OF MY DEATH BED.

812. msgreer - 10/27/1999 6:36:31 AM

ProfEmeritus

Check your email.

813. ranheim - 10/27/1999 7:04:55 PM

For any of you ladies who may be post-menopausal FORGET ABOUT FOSAMAX!

1) As msgreer said above, it does not have the power to increase the deposition of calcium into bone; like many other products (even exercise) it helps to prevent the leeching of calcium out of bone.
2) Fosamax has quite a few nasty side effects.
3) And, locally, it is over $2.00 a pill.

814. msgreer - 10/27/1999 7:40:42 PM

ranheim

I agree with you. My mother was given Fosamax and we are having lengthy discussions about whether she should be taking it or not.

Most of my clients who are post-menopausal are on it. Merck has done a great PR job on this one.

815. RickNelson - 10/28/1999 3:51:47 AM

I learned a cousin was found deceased, and questions remain.

These prose are part medicine and part knowing what page the story is on.







Shy, fast, trembling finger.
Why pull tumbling trigger?
Dry eyes, crying ended.
Sigh silenced, deadened.





It is a health issue to express death. The knowledge is finality and demanding.

816. msgreer - 10/28/1999 2:44:37 PM

RickNelson

Is there any news about your cousin?

I agree with you that death is a health issue. I know from my own experience the death of a loved one can leave devastation for the one's alive. I know I have not completely dealt with the death of a dear friend two years ago. I have my best friend making life and death decisions re her own health care now and it is a surreal experience..

For me I actually get physical symptons when I am grieving. This on top of the emotional pain and initial denial the death of a loved one brings. I am thinking of you.

817. RickNelson - 10/28/1999 3:25:28 PM

Today.


I know his wife and parents are tormented. Grandparents, in their 80's devastated. An aunt over-emotional already, now worse. His departure is now one which all of us will have difficulty to placing into context.

As a health issue, I have concern for why crisis intervention wasn't utilized? Not that I'm knowledgeable of intervention.

This type of horror is felt by the immediate family. Then winds its way through the extended family with different levels of intensity. It's a strange experience with emotions of saddness, anger, frustration, empathy, sympathy and whatever. Don't worry for me, pray for families who must endure this tragedy. Thank you.

818. msgreer - 10/28/1999 3:35:00 PM

WHERE IS THE HELP FOR THOSE AMONG US?

The decision of Rick's cousin to take his own life brings to mind
how much we live in the Dark Ages when it comes to suicide. This is the illness that dares not speak its name. Yet, nothing brings more awareness of the value and fragility of life, the reminder of how hard it is to keep one's balance, even in the best of circumstances.

We live in a time when we need to rethink issues of birth,life, death--not merely because our values are not humane or workable but because our thinking must evolve at the same rate as our technology.

Everyone, no matter how happy, goes through the meat grinder at some time; but fate puts our dragons directly in our own paths. But in this world, it is better to suffer from AIDS or cancer than depression.

819. msgreer - 10/28/1999 3:42:58 PM

cont.

If you are physically ill, you receive flowers and love. If you are mentally ill--- and who among us is not to some degree--you are a pariah.Suicidal depression is feared like a contagious disease of the dark and undeserving. With all our Freudian sophistication, physical illness evokes pity from frienmental illness,flight.

Yet, it might be an infinitestimal bit of chemistry that makes the difference---if there is a difference at all--the tiniest molecule of a chemical not yet discovered. IT is more socially acceptable to be a drunk or a murdered than to be suicidal. Meanwhie, mental health care becomes more expensive an exclusive to a privileged few. HMO's today give physical health issues more attention than mental illness.

At the same time, we continue the absurd notion that individuals do jot have the inalienable right to die when andhow they choose. WE even make those in our care with incurable pain stay alive rather than die peacefully. And if Congress has its way THEY will be in the business of regulating our personal physicians ability to treat us when we are terminally ill. Yet we have the audacity to think that such torture--physical pain that is.. is a part of God's plan, yet we rush to end the life of a suffering animal in the same circumstanceds.

820. msgreer - 10/28/1999 3:47:57 PM

Civil liberties are not abaout far more personal and invasive issues. he right to chose which mate we please' the right to die as we please. If there were a way for others to control our birth, you can bet it would be made a sin or illegal for anyone but the church or state to decide that for us,too.

Suicide is a taboo subject because it is about absolute freedom and responsibility for self, regardless of the fears others have of death.
There are some who feel that death is a rest, a time of reassess. Whatever it is, the First Amendment protects the minority from the majority view. The Bill of Rights is about total self-determination.

But what about those left behind? What about the emotional roller coaster they are left to live with? The unanswered questions and devastation tn an entire family?

821. theDiva - 10/28/1999 3:57:18 PM

Rick, I am so sorry....my prayers are with you and your family. I cannot fathom how you must feel, yet I feel for you. Be strong.

822. msgreer - 10/28/1999 4:00:30 PM

If we have a center for drinkers, smokers, eaters, co-dependents, why not for the suicidal? It is time to get this despair out of the closet and into polite conversation. There are many more things that humans have to be ashamed of than wanting a time out.

We live in a pivotal time when great changes in thinking are required in order for life to continue. It is a time as monumentous as when Copernicus proved that the Earth was not the center of the universe. Unless we stop pretending that life is something other than what it is, we all continue the suicide of mutual denial and certain death if we do not change.

We need a new morality, a better one, based on the heart--not of the mind. Where are our discussion groups, places the suicidal person can find proof they are really not alone and the struggle is eminently worthwhile? Where is our compassion? When is it time to speak out, scream, that those among us who fall into such deep despair are okay and that our society is here to support them?

November 20th has been named by Congress as Remember the victims who are left behind by the suicide of a loved one day. Mariette Hartley fought for this bill as both her father and brother commited suicide. Interestingly enough she was on Larry King Live last night with Rod Steiger, Phyllis Diller and Dr. Kay Jamieson discussing depression and suicide.

Rick, I am praying for you and your family. I can not begin to know of the depth of the pain you all are experiencing. I only know you too need support. Let me get you the information on November 20th and I will get back to you. I know there is a toll free number and website set up to help families dealing with this issue.

823. bloodnfire - 10/28/1999 4:27:18 PM

My heart also goes out to you Rick. We experienced a suicide in our family nine years ago, when our then 20-year-old granddaughter shot
herself to death. To this day we truly don't know why she did it. She left a journal which spoke of 'messing up', but we don't have any idea of the details.
I think what is part of the hurt is the obvious conclusion that, in their pain anyway, the suicide has looked around at everyone in their lives and decided that not one of us is worth living for. I read somewhere that a murderer kills one person. A suicide kills everybody.
Anyway, Rick, we hurt with you in your pain. We send love to your family. I don't think we ever 'get over it', nor are we meant to as I understand things. It's one of the most painful and ugly 'stones' in the mosaic of life, so many of which are gloriously beautiful.
I second MsGreer's sentiments that we need a new morality of the heart, and not so much of the mind. Actually I believe 'heartfelt morality' is God's morality. I think that's what He means when He says that..."The Letter of the Law kills, it is the Spirit of the Law which gives Life" (2 Corinthians 3:6).
Legalistic morality STINKS. I'm sick of Congress trying to impose that which they perceive to be 'Moral' by passing laws, most of which are totally unenforcable, and which only serve to 'jack up the price' of the perceived immoral practice.

824. JJBiener - 10/29/1999 2:00:57 AM

RickNelson - If there is anything I can do to help you through this time, let me know. You can email me at jjbiener@yahoo.com. I will check it periodically over the weekend.

Even if you just need someone to rant and rave at, I am a good target. Hang in. It gets easier.

825. CalGal - 10/29/1999 2:46:56 AM

Rick,

There are plenty of intervention services; these are often only helpful in cases where the person is acting out of an immediate and situational pain. People who struggle with an ongoing desire to die aren't usually helped by intervention--in fact, they often aren't helped by therapy.

Blood is right about the way the act is translated. That is, essentially, what the suicide is saying--that nothing in life is worth living for. For these people, life is a hell of a lot of work. It's hard for people who are in that much pain to remember that suicide is a fundamentally narcissistic act.

Still, people who have never felt suicidal tend to dismiss the reality of that emotional state--hence, suicide is often presented as "taking the easy way out". But there are people who struggle so long against the desire to die that it rather cheapens their despair to deem it a hasty or ill-considered act, much less something easy, given that it was so much work to hang around as long as they did.

Not all suicides are like this. But many of the ones that are otherwise inexplicable often make a bit more sense viewed in this light.

This, of course, doesn't make it any easier for the loved ones to bear--nor does it change the fact that, regardless of the reason, suicide is an act of violence against everyone involved. I'm very sorry for your loss.

826. arkymalarky - 10/29/1999 3:07:10 AM

Rick,
There have been some really insightful comments, so I have nothing to add but my sympathy for what your family is going through.

"But there are people who struggle so long against the desire to die that it rather cheapens their despair to deem it a hasty or ill-considered act, much less something easy, given that it was so much work to hang around as long as they did."

I believe this is very true in many cases. The one suicide I knew more than passingly certainly fit that description. He found living excruciatingly painful after descending into a deep depression which therapy and medication couldn't wrench him from, and his family was doing everything they could for him.

Bloodnfire,
I'm so sorry about your dear granddaughter. Your painful recounting of your thoughts and observations from direct experience were very enlightening.

827. bloodnfire - 10/29/1999 12:19:08 PM

Thanks Arky.

828. bloodnfire - 10/29/1999 12:28:19 PM

Rick, it's the beginning of a new day. I long to encourage you. We all wish that we could 'bring back' someone we love who has terminated their lives, don't we ? To put our arms around them, to reassure them that we truly love them, and value them, and that their lives are of infinite worth ?
While we can't do that for those who have 'checked out', we can most certainly do it for each other. That's what I do for you at this moment. Sitting here trying to type quietly so as not to wake the household, I remind you (and myself) that our lives are of infinite worth. As a fellow 'Motie' I truly care for you and have always enjoyed your posts. I pray the pain your family is going through is eased somewhat today, and that the love you share helps tremendously in that healing. God bless you my dear friend.

829. RickNelson - 10/29/1999 3:40:47 PM

Thank you so much for the kind gestures and thoughts.

Seeing his wife last night, she heard the shot and found him, poor dear. How horrible. The tears last night, the thousand or so people, family, coworkers, towns folk all poured out to support the family. It was immensely helpful. My aunt needed a big hug and I'm always good for those. As I wrapped her up in my arms, she cried. My Grandparents are supporting their son.

As I put my hand on his closed casket, I started. You've all been to these so I suppose, being overly detailed as is my wont, doesn't need to be now.

Well, the immediate family is in shock. The grandparents are going to put themselves in a roll for normalcy, we others are just supporting each other with tears and hugs. Man, lots and lots of hugs. This is what helps. Touch, physical touch.

Well, I'm ok with sharing, having done so for years now. Thanks again for the encouragement.

I'm open to this discussion wrt mental health. I don't know that I'm aggressive with it.


Being different, we all find our way around coping. With suicidal thoughts, I'm of the tell all type. I have trouble understanding closed individuals.

830. msgreer - 10/29/1999 4:25:57 PM

RickNelson

I have alot of trouble with closed minded people also. I don't understand what is so scary about discussing mental health. What are people afraid of? Do they think they might have to come face to face with their own fears and anxieties? Do they feel they might "catch" a mental illness if the issue is out in the open? Or is like with cancer... a word alot of people can't even say.. that if they are around a person with cancer they will get the disease themselves? It is a common reaction when the C word comes up.

You don't have to be "aggressive" when discussing mental health. You could help to enlighten alot of folks.

How lucky you are to have all those hugs coming your way. The magic of touch.

831. ChristiPeters - 10/29/1999 4:45:00 PM

I first attempted suicide at the age of 12.

Even now, I am only tied to life by the love and sense of responsibility I feel toward Lil' Darlin'. To me, death is an outcome much longed for, not one to be avoided or feared.

832. RickNelson - 10/29/1999 5:00:20 PM

Yes, for some fear must be a motivation for silence. Balancing this with knowing we all view life with different levels of sensitivity.

What defines that sensitivity is personal. What comes from it may be interpretable or it may not.

To express ourselves... I'm not to that yet.





We all must know there is living to do. That, is reason to live. The reasons to leave this is to complex, the text covering the topic must fill a library? Hey, but what defines living in the first place?

833. ProfEmeritus - 10/29/1999 5:17:05 PM

Rick

I have read all of the beautiful words of support for you. Be assured that Moties are like a family and when tragedy strikes one, it is felt by all of us. Our thoughts embrace you and especially his immediate family.

834. RickNelson - 10/30/1999 4:58:06 AM

Again, thank you all for the supportive tone. I think this is a topic we can continue to explore as we want to.


My cousin is layed to rest.



His death has touched a lot of people. So many friends came by to hug the family. So many crying. We loved that man. It's a sad time in this neighborhood.

835. joezan - 10/30/1999 5:20:40 AM

Rick:

I'm sorry to hear about your cousin. I'm very close to all of mine, and can't imagine one of them dying...in any manner.

You and yours are in my prayers.

836. ChristiPeters - 10/30/1999 6:07:48 AM

Rick -

My sympathy to you and your family on your loss.

837. RickNelson - 10/30/1999 2:25:56 PM

Christi, and all

The sermon was amazingly similar to my post number 832. So much so I've decided to express it.

I found the pastor(Catholic) getting into my thoughts, taking what I had posted then, and expanding upon it just as I was thinking. So, that tells me I'm not far off from what everyone else is thinking.

He wants it all to be brought to God, Jesus(I do this one) and the church. In contrast I want to know more about this complexity we call the mind. It's the emotions, the complex sensitivities we handle in different ways which needs looking at.

My life I have been self destructive, yet not suicidal. Perhaps that is the next level down from self destructive.


Others, Christi I mention you, ok, have made the next level apparent to themselves and live with it. For how long do we choose to live with this level? Some like my cousin have never even hinted at suicidal thoughts. He never let it be known of his internal torment. That means his case is as complex as it gets. We were all taken unawares. However, his family is a bit more closed than mine. His parents don't talk about emotions and mine do. That to me is exactly the difference which would open the door to discussion. That would let the one chance that maybe the finality of suicide might be averted, if the person thought emotions can be talked about and expressed.

Expressed in just about any form and method the person wishes to utilize. That will include crying, some screaming, some yelling, some waving of arms, some in your face, then some loving, some hugging, some loving, oh and did I mention, some loving.

Anyway, what do you all think?

838. joezan - 10/30/1999 6:12:17 PM

I think you're absolutely right, Rick. I've known lots of suicides - in my field it's a frequent fact of life. Every so often, we have to deal with one who "never let on", or "always seemed so happy".

Invariably, these are the hardest on the family, and for everyone else (imagine being the caseworker or therapist working with a person like this - they never let them know, either).

And, also invariably, they come from homes where it is not okay to express emotion. So sad...

839. bloodnfire - 10/30/1999 11:00:32 PM

It is so sad that countless millions of people have to 'wear a mask' in our society, pretending to feel and be totally differently than they actually feel and are.
Two excellent books, imho, for those who are working with people of all ages (and aren't we all ?) are "Real Boys - Rescuing our Sons From the Myths of Boyhood" by William S. Pollack, and "Reviving Ophelia - Saving the Selves of Adolescent Girls" by Mary Pipher. Both these authors explore the 'mixed messages' that the young of our society receive; indeed the mixed messages that, to a certain extent, we have all received.
Perhaps this is what drives an individual to suicide....the feeling that one has to pretend to be something that one is not. The strain gets to be too great.
One lovely thing (among many) about our relationship in The Mote, is that our anonymity should allow us to be ourselves to each other. That can be extremely therapeutic, don't you think ?
I appreciate your posts Rick, and encourage you to keep posting. You are doing a great job on expressing feelings which many of us have had at one time or another.

840. ChristiPeters - 10/31/1999 7:51:47 PM

Rick (post#837)-

I think CalGal said it fairly well. For some people, life is nothing but constant struggle and pain. If the amount of pain outweighs any reasons you have for struggling on in spite of the pain, then you leave. It is logical and sensible to do so - not irrational at all, imo.

841. CalGal - 10/31/1999 8:24:34 PM

I think there are people who might be helped if they felt they could express their emotions. But that's not always going to be the case. As I said--and as Christi echoed--for some people, life is just far too much work.

And it doesn't always have to be hard by other people's standards, either. No one really gets to judge another's life, or another's concept of effort.

The problem is that suicidal people tend to forget that, no matter how much work life is for them and no matter how useless and tired they feel, they have invariably made connections and found a place in other people's hearts. By killing themselves--in fact, by even wanting to kill themselves, they are telling those who are close to them, "You aren't enough. You are inadequate to offset the pain."

This is, to many suicidal people, entirely valid. They see nothing more unusual in this than in a terminal cancer patient choosing to take their own life--and are a bit impatient with loved ones who don't see it that way, who don't buy the concept of a terminal mental illness.

So then you have the loved ones saying, "Stay alive for [your children, your family, your wife, your parents, your friends], if you can't do it for yourself."

I am not sure that people realize how much of a "fuck you" that is to a suicide. The rest of the world stays alive because they want to. So some people are handed a life that hurts too much--which means that they are deprived of something so normal that most people don't even realize that some people aren't so blessed--and then they are told, well, stick around, please, because the rest of us--the ones that don't understand what it's like to be cursed--we need you. We love you. And we'll be upset if you leave.

842. CalGal - 10/31/1999 8:31:03 PM

And of course, the really shitty thing is this: that's exactly why they should stay around. Because it's rotten to people who love them, because the violation is so great that they will never understand, and nothing a suicidal person could ever do in life will ever do as much damage as they do in that sort of death. Making a cosmic joke out of everything: it hurts too much to stay, and they'd hurt everyone else too much if they leave.

Then there are those who think all of this is just so much whining on the part of the suicide. The "buck up! Quitcher bitching!" sorts, who think that some people do this on purpose, who are just too self-absorbed, too angst-ridden, too demanding of life for their own good.

As I said earlier, I think this dismisses the effort that most people in this state go through every day. Sure, there are a few people who do nothing but look for reasons to be miserable. But if you think that all a suicidal person needs is to buck up and get on with life, you're not listening to the pain involved.

And--just to forestall the inevitable--medication doesn't necessarily help.

843. ChristiPeters - 10/31/1999 8:43:02 PM

Well said, CalGal.

What stopped me the most recent time (not too recent) was in the midst of trying to decide what method of suicide would be the least traumatic for Lil' Darlin', I realized there is NO method of suicide that would not totally traumatize and mess up LD's psyche. So I didn't do it. Most of the time my heart is so filled with love for my daughter it dampens down the pain. Every now and then in the middle of the night I resent the fact that my love for her ties me to this Hell I live in.

844. CalGal - 10/31/1999 8:51:21 PM

Christi,

Something to always keep in mind: children of suicides never do well. This statistic holds up, no matter how you slice the numbers. The damage is unimaginable.

And waiting until they're 20 doesn't make it any easier.

845. ChristiPeters - 10/31/1999 9:06:19 PM

CalGal - How about when they're 30?

I know - bad joke.

One other thing that stops me (for now) is that I see people around me for whom life is not all pain. This give me the glimmer of hope that maybe I can find a way to get there, too.

In addition, my Dad, his brother, his mother, his maternal uncle, his maternal grandfather, his paternal aunt and his paternal uncle all died of different forms of cancer. I look like my Dad, I react to medications the same way as my Dad, hell, we even wear the same prescription glasses, and judging from her pictures, I am his mother's twin. So I figure my time in this hell is limited anyway.

I would characterize myself now, and for the past six years or so, as "passively suicidal". I am not going to do anything to off myself, but if I see a truck barreling down on me, I'll probably just stand there with a smile of relief on my face.

846. cazart - 10/31/1999 9:49:14 PM

ChristiPeters:

If you choose not to answer, I'll understand.

Why so down?

847. ChristiPeters - 10/31/1999 10:06:14 PM

cazart - It is a lifelong condition and telling it all would take up too much space and make me cry and I hate crying.

Let's just say if they made a soap opera about my life, no one would watch because it would be too unbelievable.

(For all that, I know people who have had it worse, so maybe I'm just a whiner)

848. ElliottRW - 11/1/1999 12:41:01 AM

ChristiPeters,

(For all that, I know people who have had it worse, so maybe I'm just a whiner)

You are not a whiner. I look forward to your posts.

Also, for perhaps the first time ever, I entirely agree with CalGal.

849. ee - 11/1/1999 7:55:28 AM

Chrisripeters: I'm sorry if you've been down this road but have you tried antidepressants? I've seen them work really well with people in my therapy group.

850. RickNelson - 11/1/1999 3:33:47 PM

Calgal,
I find what you say to be right on. It would appear that we who are left behind are all left with the big question why. We would think that wife, mother, father who are all living would be enough reason to live, yet they and we weren't.

I think the fights suicidals have, the proximity of offing devices, ie. guns, cars, bridges, etc... will ultimately catch the suicidal by suprise as well as us. They will find that one time where the emotions have welled up beyond any other time. And everytime they well up the time to end it has been clearer and clearer. Then this one monumental time, this time when a spark hits home, emotions are swallowed to bottomless depths, and the life is snuffed then and there. That's what my reaction is to this episode I'm knowing right now. That's my explaination to myself.

But, it could have been calculated as well. That's even harder to accept. The ability of his mind to shut out all the connections, all the desires, all life expecting notions and just go and kill himself. This hurts more, this angers more. It's the fuck of snuff off. Instead of thinking the person did it from overburdened emotional trauma, but for the reason of hurting those who love them. That's so hard, it makes me cry to think of it. That was not my cousin. It couldn't be. No!

I wish he would have found therapy and taken the drugs. Drug up the mind, let love come back in muddy waters. It's ok, it's love. That love is far more precious than life in my humble opinion. It's why searching for it is the strenuous job of youth. It's the love one wants from a fellow human. Just one other is enough. Just one who will be there. Listen to your ramblings and let you cry. Now I'm mushy and stupid. I trust all can take what they really want from this and leave the rest to my rambling.

851. ChristiPeters - 11/1/1999 5:14:47 PM

ee - yes.

(btw, there is a difference between being depressed and being in pain)

852. JudithAtHome - 11/1/1999 5:55:17 PM

...and there is a difference between being in physical pain and having mental pain. If pills could make the first bearable, one might avoid the second.


By the way, last week there was much talk in this or some other thread about the 11 year old on trial for murder; this morning we learned from the prosecutor that "Nat" had previously been charged with beating another child with a metal pipe and with various acts of avndalism and theft. Also, they've offered the defense attorney, Feiger, a deal where the kid would serve time in a juvenile facility til age 21 and then be re-evaluated...Feiger is playing this to the media as though only the death penalty is avaiable. His offer: the child get off scott free bcause this was shooting was an accident.

853. JudithAtHome - 11/1/1999 5:56:39 PM

...that's "vandalism".

854. bloodnfire - 11/2/1999 7:58:01 AM

Rick, I'm sure you're right that your relative just experienced that emotional crisis when everything fell into place, and he acted on the spur of the moment. You know him well enough to know that he wasn't being deliberately cruel to those who love him. You certainly are not rambling. I particularly agree with your statement.....
"Let love come back in muddy waters. It's ok, it's love. That love is far more precious than life in my humble opinion. It's why searching for it is the strenuous job of youth.".

Not just the 'strenuous job of youth'. Everyone, regardless of age, is looking for love. Not just a 'conditional' kind of love, either....'Providing I meet your expectations'....but an unconditional love, a love which 'just can't help it', a love which has to keep on loving in spite of the fact that the one loved sometimes acts like an idiot !
It sounds as though your relative was loved like that. Sadly, perhaps he just didn't realize it, or didn't feel it temporarily.

You sound like you're bearing up really well. Bless you.

855. ranheim - 11/7/1999 4:11:40 AM

My wife just hollered at me. Evidently Leslie Stahl of 60 Minutes had a segment on foreign-born M.D.s practicing in the USA. I missed it.

My wife told me that Stahl said that almost 25% of M.D.s in the USA are foreign born. Wasn't someone in this thread taking the AMA to task for making it difficult for an M.D. to get into this country?

Stahl's segment stated that this immigration is sponsored by Medicare. In monetary terms, each resident is worth $70,000 yearly -paid for by Medicare. The number of residents that Medicare will pay for has recently been capped; after many years of steady growth. Courtesy : Joe Califano?

The foreign medical graduates are permitted to remain in the USA because they go to an area or a town that says it has a need for an M.D. There are too few of us USA medical graduates who are willing to go into small town america; or the city ghettos.

As best as I can determine, there is not a shortage of USA medical graduates. They are distributed very poorly. It may have been lip service, but, in my day at Baylor, we were told by countless instructors that we were being trained to practice in Alice, Texas (a small town on the way to the Rio Grande Valley).

Additionaly, the debt load in those days was not as onerous as it is today. Several things factor in here. I graduated in a class of 88. Only 10 of us were married! In those days many of us males were taught that one did NOT get married until you could support a wife. Even with a working wife, staying single through school has to be cheaper (but, I have NO facts on this for those of you who demand a cite). When I graduated in 1961 I was between $5 - 10,000 in debt. I thought that was a mountain! But, today's medical school graduate usually starts borrowing money in college. Then medical school tuition is extremely high. The average debt owed by today's medical graduate is over $150,000 and my figure is at least 3 years old.

856. ranheim - 11/7/1999 4:34:01 AM

I may need to clarify a few points from above.
1). I was one of the single graduates. And only had that amount of debt due to very good summer jobs (much more difficult to obtain today - except flipping burgers for low wages). My school teacher father certainly could not help; especially since a brother, 2 years younger than I, also went to medical school.

2). Medicare paying $70,000 for a resident sounds like a Joe Califano/LBJ idea. Remember, LBJ's idea was to increase the number of doctors so as to increase competion. Until now, that has never happened.

3). I know there are economists in the Mote. I don't know how much medical school tuition has gone up as compared to inflation. It would be my guess that tuition costs rose much more steaply than nominal inflation.

4). Banks want their money paid back; even though most of these debts are backed by the government. Most med school graduates go on to residencies. Very few 'hang out their shingle' any more. When finished with their residency the debt load is usually a good deal more than when they completed med school. Thus, they look for a salaried position so that they can service their loan payment/s. This means a job at a clinic; usually in a town of 75,000 or greater.

5). This is not meant as an excuse, but, the young, male doctor is under pressure from his wife for the 'good life'; after years of supporting him/living as a student. This, along with the bank's pressure, focuses his mind on dollars more than it should.

857. CalGal - 11/8/1999 7:49:19 PM

HMO to Leave Care Decisions Up to Doctors.

United said it is taking the final say out of the hands of the managed-care bureaucracy and returning it to the treating physician because requiring doctors to get prior authorization was costing more money than it saved. Physicians complain that dealing with the industry's "health police" causes needless hassles and delays.

858. ranheim - 11/9/1999 4:47:14 AM

Executive Order #13199 by Clinton waives the right of informed consent by members of the military. Heretofore, before administering an 'investigational drug' to them, the DoD had to obtain Informed Consent.

Since Clinton - his advisors - seem hell bent on innoculating everyone in the military with the anthrax vaccine, I would like to see Clinton line up and take his shot. After all, in his role as Commander In Chief, he visits are various far flung military endeavors for photo ops. He, potentially, could be exposed as well.

859. ranheim - 11/9/1999 4:48:11 AM

are = our

860. bloodnfire - 11/9/1999 11:15:29 AM

From today's New York Times....

"More and more often, hospitals are reusing catheters and biopsy needles even though they are marked "single use only." Even though the devices are cleaned and sterilized, the practice is illegal."

If true, one more example of 'Cutting Corners to Make the Bucks' at the expense of the patient. What do you think msgreer ?

861. SpenceMirrlees - 11/9/1999 12:27:21 PM

Who's guessing she doesn't say it might actually be a way to save patients money that would otherwise just go to catheter corporations?

All depends on how cost savings are split between hospitals and patients, i.e., on how competitive the market is.

862. msgreer - 11/9/1999 3:45:57 PM

Spence

You only think you know me. Are you nuts, save money for the patient? IT KILLS PEOPLE. The introduction of bacterium from one body to another. Surely you should know as a patient advocate I WATCH OUT FOR THINGS LIKE THIS.

Sad to say I have been in procedures where health professionals have been told by hospital administrators to use
certain materials for evasive procedures on more than one person. This goes on in doctor's offices too.

I make my living making sure these things DO NOT happen.

863. ranheim - 11/9/1999 3:51:13 PM

I am old enough to remember the days when office nurses spent a significant amount of their time sharpening needles.

Give me one time use - throw aways!

864. msgreer - 11/9/1999 4:14:17 PM

I am going to try posting. All I get from every thread is posts starting from Message #1. TEST TEST TEST

865. OhioSTOPAS - 11/9/1999 4:43:10 PM

Ranheim (#858): You've got your facts wrong. Executive Order 13139 (not 13199 as you wrote) states that as a general rule informed consent is required, but provides procedures for waiving this requirement upon the existence of certain facts. See for yourself at http://www.pub.whitehouse.gov/uri-res/I2R?urn:pdi://oma.eop.gov.us/1999/10/1/8.text.2.

Furthermore, such waivers are permitted by a 1998 Congressional legislation, codified at 10 U.S. 1107(f). It provides, " . . . the requirement that the member [of the armed forces] . . . may be waived .. . if the President determines, in writing, that obtaining consent (A) is not feasible; (B) is contrary to the best interests of the member; and (C) is not in the best interests of national security."

Accordingly, the waiver procedure was created by legislation, not executive order.

866. SpenceMirrlees - 11/9/1999 9:32:57 PM

862

Um, msgreer, you did see the "SHE DOESN'T SAY" part of my message, right? That means, "you probably won't agree with what follows."

Any idea how many people die because of this in a year?

867. ElliottRW - 11/10/1999 3:53:54 PM

Health Economists--Anyone have an opinion on this?

Some hooha over the difference in veterinary and human drug prices:

Wednesday November 10 6:58 PM ET

Human prices twice animal rates for same drugs

NEW YORK, Nov 10 (Reuters Health) -- Eight prescription drugs cost twice as much when sold for human use than when sold for treating animals, according to a study released by US Representative Tom Allen (D-ME) on Monday.

• Differences in expected product liability risk.
• Differences in marketing costs.
• Price discrimination to maximize profit.

868. ranheim - 11/10/1999 5:18:09 PM

This situation has been around for all of my medical career.

I have never used the vet "equivalent" because I have never been sure whether the drugs, in fact, are equivalent. I have had farmer patients who have used injectible, "veterinary" penicillin on themselves - but, insist on "human" penicillin for their wives and family.

Until I KNOW that they are truly equivalent I won't use them. I have been fortunate in that I have not yet been sued. I don't want a law suit because I used a veterinary product.

869. ElliottRW - 11/10/1999 6:24:13 PM

ranheim,

Very interesting--I hadn't even considered the doctor's perspective. I had assumed that veterinary drugs--even when identical to human drugs--were never used by people. So when I mentioned product liability, I was thinking about the drug company's perspective: suppose a drug turns out to be defective and kills 100 patients--if they're cows it costs the company a lot less to make amends than if they're people.

870. msgreer - 11/10/1999 11:21:47 PM

Spence

My apologies for not reading your post correctly and jumping down your throat.

871. JJBiener - 11/10/1999 11:37:29 PM

MsGreer - How are things with you? I haven't heard from you for a while and I was wondering.

BTW, did you find out anything about migraine doctors yet?

872. msgreer - 11/10/1999 11:59:13 PM

JJ

Check your email

873. JJBiener - 11/11/1999 12:00:47 AM

MsGreer - Nothing yet. When did you send it?

874. msgreer - 11/11/1999 12:07:51 AM

JJ

30 seconds ago.

875. msgreer - 11/11/1999 12:09:43 AM

JJ

Your yahoo email.

876. JJBiener - 11/11/1999 12:27:51 AM

MsGreer - Back Atcha

877. msgreer - 11/11/1999 12:32:38 AM

JJ

Things do get better. Life goes on doesn't it?

878. JJBiener - 11/11/1999 12:46:31 AM

MsGreer - When I was in my 20's and spent a great deal of time in the hospital, someone asked me, "Don't you ever feel like giving up?"

I said, "Yes, but I don't know how." Sometimes I still feel like that.

879. Thoughtful - 11/11/1999 4:33:07 AM

Actually, my anecdotal experience was the other way. Vet tried to prescribe drug for cat which is same as drug for humans. I told him to write a Rx for me and took it to the local drug store where the price was less than half what the vet wanted to charge.

Why would pet drug costs be less? Maybe because animals aren't covered by insurance (generally) so supply/demand forces work much better. (How often I wish I could claim my cat as a dependent!)

880. Thoughtful - 11/11/1999 4:35:28 AM

msg, haven't been around much but I hope things are going well for you and your family.

I've had two deaths around me recently and I feel like I'm waiting for that 3rd shoe to drop. Trouble does seem to come in threes, no?

881. msgreer - 11/11/1999 4:41:50 AM

Thoughtful

I understand death all too well. I have been in Ann Arbor for the past days helping my Aunt take care of my Uncle who was dying from complications of Alzheimer's Disease. This was not a surprise to the family but when it happens it knocks you right between the eyes.
His funeral was last Sunday and I just got back. Thank you for your concern.

JJBiener

I don't know how to give up either. Sometimes my friends say how can you keep going? I say what is the alternative? That does not mean I don't feel pain like everyone else. It doesn't mean I can avoid grieving. And I have long ago learned there is not one among us that does not have personal tragedies touch their lives.

882. ChristiPeters - 11/11/1999 6:34:10 AM

Well, I got the results of the MRI on my ankle today. The thing the Doctor thought was torn isn't torn at all. In fact, my tendons and ligaments are all "intact". Nope, the culprit is a cyst of "significant size".


The doc "aspirated" it and gave me an injection. If that doesn't work, I will have to have surgery to remove it. He said it won't be a big deal - outpatient day surgery and I'll only miss about two days of work (as long as I promise to be "very very sedentary")

So here's hoping the shot works!

883. msgreer - 11/11/1999 6:47:11 AM

ChristiPeters

Good news.

BTW, I have been down all day. I'll be in contact tomorrow.

Good night.

884. msgreer - 11/11/1999 6:48:34 AM

CP

Not all day but most of the day. Plus I had a busy fun filled day.

885. Thoughtful - 11/11/1999 4:43:26 PM

christip...ah...er....give it your best shot...hope it gives you a leg up....put your best foot forward.

Sorry, I couldn't recyst the pun...I have a natural tendon to those things...hope it doesn't r-ankle you too much!

Stop me before I pun again!

886. ChristiPeters - 11/11/1999 5:11:54 PM

LOL!

Thanks Thoughtful!

887. msgreer - 11/12/1999 2:55:25 PM

Before everyone gets all excited about UnitedHealth changing so many of its policies there remains several unresolved issues.

1. They are taking the coverage for mental illness away until the "take another look at the costs". Inother words while giving the Primary Care Physician more freedom to choose the proper testing or specialist their patients need, the will not be extending that to psychiatrists or anyother mental health care professional. Case by case. Even then what they will offer for coverage for person afflicated with a mental illness will still not be enough. It never was.

2Why with all the new and better medication there is to offer persons with mental illness would a HMO deny this care?

3.Preventative care in all medical issues is what any insurance carrier with a brain should be investing their money in. If they want to see profits preventing a disease process will do it for them.

4.The PCP will still be watched by UnitedHealth as to care appropriate. They just won't be breathing down their neck daily. But the PCP does continue to get evauluated. They are still watching and a PCP who UnitedHealth feels is not going along with the program will be "talked" to.

So yes, it is a beginning. But it is just a beginning and many of the new initiatives came because they were scared as hell about the Patients' Bill of Rights passing. They didn't want to get sued. Now they are sharing that responsibility with the doctor. I know doctors must be held responsible for the care they give. It is just too early to get up on the table and MAMBO.

888. msgreer - 11/12/1999 3:02:27 PM

cont.

I have heard doctors and patient advocacy group hail UnitedHealth. Fine. But I have yet to hear one person say, hey what about the coverage for the mentally ill. It will be a day to rejoice when persons afflicated with mental illness can come out of their closet and have society accept the disease for what it is. Just another disease. Brain chemistry dysfunction. What is so horrible about saying yes, I have a chemical imbalance and I have to take such and such medication. Maybe if the professionals lead the way it would help take the stigma of mental illness fade into the sunset.

And no, care for the mentally ill does not have to cost more than care for the diabetic. Both can have complications which need medical attention. So why is it more acceptable to say I have insulin problems as opposed to saying I have a chemical imbalance. It's the same thing to me.

889. msgreer - 11/12/1999 3:03:38 PM

And while I am still thinking about it... proper care for the person with a mental illness could help put that person back into society as a productive worker and tax payer. All would win.

890. msgreer - 11/12/1999 3:30:47 PM

For Florida Residents UNITEDHEALTHcare HMO slashes benefits

In Sarasota County UnitedHealthcare's Medicare HMO will reduce benefits and raise decuctiblesin 2000. Most seniors are mainly oncerned about the changess to United's prescription drug benefits, which will slash coverage from $600 per year to $50.

UnitedHealth said the changes were necessary to contain costs. Otherwise, the HMO would face the prospect of paying out more than it brings in to care for seniors. "We had to diminish these benefits somewhere because we wanted to maintain a zero plan deductible for (members)," said Patt
Reed, a United spokeswoman in Tampa.

United has 7,780 Medicare subscribers in Sarasota County and another 2,414 in a county south of Sarasota. The HMO dropped its subscribers in near by Manatee County at the end of last year.

In Sarasota County, the government pays HMOs $475 per month to care for each Medicare subscriber but in Dade County the payments leap to $778. UnitedHealth says the payment amounts are calculated by the federal Health Care Financing Administration, which administers Medicare, based on average medical costs in each community.

cont.

891. msgreer - 11/12/1999 3:40:58 PM

Like many HMO's in Florida serving both commercial and Medicare customers, United has recently reported financial losses.

According to information from the state Department of Insurance compiled by the Florida Hospital Association, United lost $1.16 million in the second quarter of 1999 on revenues of $480 million. It did better in the first quarter, earning $1.8 million.

Besides prescription coverage, United has made other changes to its Medicare plans in Sarasota County. Next year, subscribers will pay

$20 to visit PCP (up from $10)

20% for sevices performed in an ambulatory surgery center (up from nothing)

$100 for ambulance sevices (up from $75)

$750 for each inpatient hospital stay, to a maximum of $750 (up from 4100 for each stay to a maximum of $600)

$500 per admission for inpatient mental health care (up from $100 for each stay, to an annual maximum of $600).

Is it little wonder Medicare HMO subscribers want a prescription plan from Congress.

892. msgreer - 11/12/1999 7:07:38 PM

CORRECTION

It should read $750 for in hospital stay, to a maximum of $750 (up from $100 not $4100 for each stay up to a maximum of $600)

893. ranheim - 11/14/1999 6:10:51 AM

I just talked to my middle child - the one at Merck.

The reason for the high prices of medicine, according to my son, is that the USA, portions of Europe, and Japan pay for everyone on the planet.

$250 million is considered to be the minimum today to "invent" a new drug; herd it through the FDA; market it. I don't know if the "drug detail men/women" who come through my office to introduce me to new products and remind to continue to use older products are contained in that figure.

Some of the Mote's members who live outside of the USA might comment on the price of pharmaceuticals in their contries. The best that my son can discover, prices of the various medications tend to be cheapest in Africa; then South and Central America. He knew nothing specific about Israel/the mid East; the Indian sub-continent; New Zealand.

Merck's policy with Canada appears to be that they sell a 'railroad car' full of one medication at a discount rate (volume) and then it is up to the Canadian National Health (its name?) to price it. e.g. the 'mom & pop' drug stores in my parish (county) bitterly object to WalMart and Eckerd's. They, like the Canadian government, are able to buy in quantity and pass some of the savings on to their customers. It is also the policy of the local WalMart and Eckerd's to advertise as loss leaders some of the more heavily used medications to get you into the store. Another thing the mom & pops believe should be illegal.

The uncetainty of a profit weighs heavily upon the heads of the large pharmaceutical corps. As I mentioned above, $250 million would be a good working figure to introduce a new medication. The drug then begins testings as directed by the FDA. Ten years is considered very fast for FDA approval! (I saw one medication that had been 16 years in this process.) Then marketing starts. This is a very long lead time with no surety of even breaking even.

894. ranheim - 11/14/1999 6:15:40 AM

cont from #893 above

I will mention one fairly famous failure of recent months. The roto virus vaccine as developed by American Home Products. That vaccine has been withdrawn from the market. As it stands now, that vaccine is a total loss to AHP. I am told that such failures are a yearly event. Some of you may own the stocks of pharmaceutical companies. You, likely, know more than I about the failure rate. Your broker would almost certainly know.

895. msgreer - 11/14/1999 6:32:06 AM

ranheim

I read an article afew days ago regarding Eckerd and Walgreen's fraud when filling prescriptions for Medicaid patients. Eckerd and Walgreen's fill only a portion of the prescription telling the Medicaid patient they are out of that specific med and to come back in afew days and they will give them the rest of the tabs/capsules.

However, they charge the government for the full price of the entire prescription regardless of the fact they did not fill it properly. The DOJ is in the middle of investigating this.
Eckerds and Walgreens say alot of the Medicaid patients do not come back for the rest of their medication.

The figures are staggering in the fraud these two large chains are pulling in. It was estimated Walgreen's was taking in over $26M with the scam and Eckerds about $22M.

The way the DOJ found out about this was from a pharmacy tech who witnessed Walgreen's doing this on a daily basis. I will have to find the article to give you his name.

So it seems like everyone is looking out for profits.

I am aware of the high cost of developing a medication. The pharmaceutical companies sell these medications to Canada as you said. But they don't jack up the prices at the USA does.

cont

896. msgreer - 11/14/1999 6:40:11 AM

There are thousands of Americans who cross the border to buy their much needed medication in Canada. 60 Minutes had a story on this. For these people it was a choice between heart or diabetic meds or eating.

Ranheim, are you aware of Claritin's little piece of work? Their patent is about to expire. What do they do? They lobby Congress to atleast hear them make a case why they should be able to extend the patent. Their statement was other companies will start making generic
brands and they won't live up to the quality of their product. Now if that crap wasn't enough they wanted to have a closed hearing on it. Normally these issues are in open for the press and public to hear.

Interestingly, a memo was leaked from some Repub on the Committee. It said if you want us to continue your patent, which is rarely done, you will have to get some Democrats to go along with it.It went on to say a liberal Democrat would be your best bet.

I am sad to report they got to Senator Torricelli (D-NJ). They gave him $22,000 for his personal campaign war chest and another $50,000 to a Democratic Committee he chairs. He went along with the idea of having the hearings in private. The decision the Committee made, if they have made one yet, is not public as far as I know.

897. msgreer - 11/14/1999 6:48:10 AM

ranheim

I have nothing against phar. companies making a profit. I agree that is the only way we will continue to get the advances in medication we need. But really, don't you feel they DO make a profit?
I find them just as greedy when profit is the bottom line. Oh yes, they want to find the miracle drug. And I am sure they want to do so for the better of mankind. But they also want the money that comes rolling in.

Why is it the average medication cost went up over 6% in 1999 which is far greater than the inflation rate.

I ask what is wrong with this picture.

And yes I do own stock in pharm. companies. But I researched each one of them before I bought one share.

You said your son works with Merck? It's late here and I am trying to remember all you said. My daughter went to a private school in NY State with a member of the Merck family. I must say they were very generous when it came to financially supporting the school.