Insulin Insanity

These stories are becoming more and more frequent:

As their minivan rolled north, they felt their nerves kick in — but they kept on driving.

At the wheel: Lija Greenseid, a rule-abiding Minnesota mom steering her Mazda5 on a cross-border drug run.

Her daughter, who is 13, has Type 1 diabetes and needs insulin. In the United States, it can cost hundreds of dollars per vial. In Canada, you can buy it without a prescription for a tenth of that price.

So, Greenseid led a small caravan last month to the town of Fort Frances, Ontario, where she and five other Americans paid about $1,200 for drugs that would have cost them $12,000 in the United States.

For profit medicine is a fucking disaster. The “profit” of a good medical system is a healthy and productive populace, a society where people can allocate their resources to productive things rather than being gouged for medicine and medical procedures, and where people are not miserable and stressed out about medical bills.

I am not god emperor, but if I were, the very first fucking thing I would do is mandate single payer, nationalize the production of critical drugs in which there is no research and development being done to improve the drugs but just straight up price gouging, and ban health insurance for anything but elective procedures. Because it’s been my experience that a large and vocal portion of the medical community are entitled whiny ass titty babies who think they deserve millions of dollars per year and will do anything to preserve their wealth and status, a belief in part created by the ridiculous costs of medical school and the absolutely insane practice of grueling residencies, I would nationalize medical school, too, and then cap salaries. I’d also expand the number of nurses and technicians who do the actual bulk of the work in the medical industry.

This will displace a bunch of people in the insurance industry and medical admistration and elsewhere, and that’s just fucking fine- we will need a robust regulatory community to keep an eye out for fraud and abuse. That should create a few jobs. And the flunky pretty boy douchebags and their cheerleader counterparts who flocked to pharmaceutical sales will just have to find honest work somewhere.

And don’t come at me bashing the VA saying this would be no better- veterans love the VA. A few fucking loudmouths don’t.

The end. There’s your fucking marching orders. Make it happen.






179 replies
  1. 1
    Jerry says:

    And don’t come at me bashing the VA saying this would be no better- veterans love the VA. A few fucking loudmouths don’t.

    For years and years, I only knew of the loudmouths and I just assumed that Tri-Care was total crap. A few years ago, I met a friend’s step-dad who happens to be a Vietnam combat vet and he set me straight on that topic. He said it was great and beats the hell out of any alternative here in the US. This was coming right on the heels of him taking advantage of PTSD assistance and it completely changed his life.

  2. 2
    redactor says:

    There is nothing wrong with the VA that adequate funding and an administration committed to making it work wouldn’t fix.

  3. 3
    burnspbesq says:

    That is one hell of an overreaction, there, Cole.

    Perhaps we might try enforcing the damn antitrust laws first.

  4. 4
    Kay says:

    I think the problem for the people who want to keep the status quo health care system is that it doesn’t work.

    If you can’t afford insulin in this country the for-profit system isn’t working. If it were chugging along like a well-oiled machine they could insist we keep it, but it’s 1. hugely expensive and 2. it doesn’t work that well for most people and doesn’t work at all for some people.

    I think all that polling we’re seeing where people are open to a radical restructuring is because the system we have is just failing all over the place. Can you “get” decent and affordable care? Yeah, sure, but that’s a REALLY low bar for “acceptable”- “one may possibly be able to get good care, given the following conditions…” – that’s not a validation.

  5. 5
    rikyrah says:

    There are lot of medical issues that bother me. But, since I discovered this problem through reading a random article…this just hits a raw nerve.

    THESE ARE PEOPLES LIVES ON THE LINE.

    And, it don’t make no damn sense. I smell collusion by the companies making insulin,.

  6. 6

    Kevin Drum has a couple of good posts.

    The Price of Insulin Is a National Disgrace

    Insulin and the Free Market: A Brief Inquiry
    Graph on the prices from various manufacturers. It sure looks like nobody’s enforcing the damn antitrust laws.

  7. 7

    @rikyrah: Indeed. How is this price gouging legal?

  8. 8
    Betty Cracker says:

    It’s an outrageous and ridiculous situation, and I am sick and goddamned tired of being told to be grateful for the status quo. I could add onto your rant with a tale of the absurd situation my daughter is currently dealing with after her recent accident, but it’s the same shit millions of Americans deal with every damned day. We shouldn’t underestimate the challenge of changing a fucked-up, corrupt system that represents a fifth or so of our economy, but maintaining a state of paralysis because it’s too hard is even worse. Things gotta change. This is unsustainable.

  9. 9

    If you like the VA as a model, you should be in favor of NHS rather than just single payer.

  10. 10
    John Cole says:

    @burnspbesq: STRAP IN I AM COMING FOR THE LAWYERS NEXT

  11. 11
    burnspbesq says:

    @rikyrah:

    I smell collusion by the companies making insulin,

    There’s no evidence of it. What there is plenty of evidence of is what the antitrust folks call “conscious parallelism.” Which is enough to win your case on liability. Bet then you come to the question of remedies …

  12. 12
    burnspbesq says:

    @John Cole:

    “I fart in your general direction.”

  13. 13
    namekarB says:

    And don’t come at me bashing the VA saying this would be no better- veterans love the VA. A few fucking loudmouths don’t.

    Instead of Medicare for All we should collectively be hollering for VA Healthcare for all

  14. 14
    The Moar You Know says:

    That is one hell of an overreaction, there, Cole.

    Perhaps we might try enforcing the damn antitrust laws first.

    @burnspbesq: Too late. Pharma has had plenty of chances to reform; they have failed. So, because we are literally dealing with life and death here, they need to have it taken away from them.

    “Enforcing antitrust laws” isn’t going to do anything but make lawyers richer….ha, oh wait, I think I see the issue here. For you.

    For the rest of us that need insulin and antivenin and a slew of other drugs that wouldn’t be affected by antitrust actions because they’re out of patent, no court can fix the issue that they’re simply not very profitable, and that no manufacturer is going to produce them unless they can grossly overcharge.

  15. 15
    raven says:

    @Jerry: I don’t have a “profile”, no “service connected” issues. Despite that because I was “in country” in the Nam I qualify for hearing aids and glasses. I’ve go to the local mini-clinic for about five years and have never been treated other than just fine. My work affords me “medi-gap” insurance so I’ll be using that when I retire in 76 days but I do wish I could use the VA prescription drug bennie but I’d have to make them my primary provider.

  16. 16
    NotMax says:

    @John Cole

    The classics never go out of style.

    ;)

  17. 17
    Ohio Mom says:

    Just about every discussion on this subject I’ve seen on the internet has at least one tiresome troll blaming diabetics for their poor eating habits, never mind that Type 1 is an automune disease, and that Type II progresses on its own schedule. Some Type 2s do everything they can and end up on insulin anyway, others do everything they shouldn’t and manage just fine on the pills.

    Then there’s the other tiresome troll hawking the cheap insulin at Walmart. I guess we’re all supposed to be impressed with the Waltons’ beneficence.

    Someone usually comes along to explain tne various types of insulin and the difficulties of regulating blood sugar levels on the antediluvian versions Walmart dispenses.

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

  18. 18
    Doug R says:

    That $1200 itself is about 3 or 4 times what it cost us here in Canada a few years back. We’re getting gouged too, just not as much as you guys.

  19. 19
    Kay says:

    And I’m sure you have all heard people tell you their experiences overseas with other health care systems, systems that actually work. Americans rave about them- it’s like they can’t believe these systems exist until they see them. But, for some unknown reason, we’re told ours is impossible to improve and we must keep it exactly the same.

    Are we the only country where people have this insanely complex payment system? People hate it, it’s expensive and cumbersome, why do we have to keep it? We’re just… doomed? Again, it’s like this low bar- like if it’s still functioning for 20% of people, well, that’s the best we can do! Can’t ask for more than that!

  20. 20
    Geoboy says:

    John – And why aren’t you god emperor yet? Alexandria Ocasio-Cortez would be my first choice, but I’d settle for you.

  21. 21
    Fair Economist says:

    At this point it seems a no-brainer for a large state to start its own insulin production. It will easily save enough on its own healthcare costs to justify the cost for a factory and FDA approval. Great opportunity for a smaller conservative state (to sell to neighbors) but they have hangups about “socialism” so it will probably be CA, WA, MA, or NY.

  22. 22
    The Moar You Know says:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    @Ohio Mom: America’s national sport is blaming victims.

    We only fairly recently got shamed out of blaming AIDS patients for their disease. Although I’m willing to bet well over 50% of Americans still do, but at least know to keep their mouths shut in public about it.

  23. 23
    burnspbesq says:

    @The Moar You Know:

    FYI, I’m an insulin-dependent Type 2 diabetic. And you haven’t even begun to make a case for the inadequacy of antitrust enforcement. It hasnt been tried. If it fails, we can talk.

  24. 24
    Kay says:

    @Betty Cracker:

    I could add onto your rant with a tale of the absurd situation my daughter is currently dealing with after her recent accident,

    Everyone has stories like that. Everyone. It represents millions of hours of unpaid work. I hear the stories and I just start counting hours- the phone calls, then they go to letters. Just to get the bill paid! This is an EXPENSE. The time. People don’t bill for it “unpaid health care access hours”, but if they did the whole system would be even more ridiculously expensive than it already is.

  25. 25
    Kay says:

    In defense of providers, a lot of them hate it too. They don’t want to be a billing entity or a collection entity. They want to provide health care, which is a difficult enough job.

  26. 26
    TenguPhule says:

    There’s your fucking marching orders. Make it happen.

    So you’re on board for the ensuing Civil War then? //

  27. 27
    satby says:

    My nephew is a type 1 diabetic with an insulin pump. He struggled through school because he also had ADHD, but is the only kid in my family who stuck to it for 5 years and graduated with a bachelor’s degree. His motivation was to become a teacher and help kids who struggled like he did. He’s not a teacher because he needed to get a job immediately, with great pay and benefits, to afford his insulin and insurance. He’s working in finance at a bank.
    Not just a life threatening issue (which it very much is) but an issue that robs us of people who could do valuable work but need to make money to afford their medications.

  28. 28
    TenguPhule says:

    @Kay:

    They want to provide health care, which is a difficult enough job.

    Problem is some of them want to provide it at a price unaffordable to most people.

  29. 29
    TenguPhule says:

    @John Cole:

    I AM COMING FOR THE LAWYERS NEXT

    Capped salaries and professional regulatory monitoring with teeth? I can hear the screams from an island in the middle of nowhere.

  30. 30
    Betty Cracker says:

    @Kay: This is true. My sister and her spouse, both healthcare professionals who make a shitload of money in the current system, are ready to burn it down along with the rest of us, even though they know it’ll mean a pay cut for themselves. They’re tired of the hassles dealing with 400 different insurance company rules and attendant bullshit too. They also know how it works in other industrial countries — warts and all — and agree that’s a hell of a lot better than the ridiculous kludge we’re stuck with here.

  31. 31
    NotMax says:

    @Kay

    Have said it before, shall say it again. The U.S. medical insurance framework is fizzbin on steroids.

  32. 32
    TenguPhule says:

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    They believe the strong must eat the weak.

    I wish I was kidding.

  33. 33
    debbie says:

    @schrodingers_cat:

    R&D! R&D!

    I think the government should take over research and development to save the pharmaceutical companies any concern about earning back their costs.

    The profit motive needs to be removed from this entirely.

  34. 34
    TenguPhule says:

    @NotMax:

    The U.S. medical insurance framework is fizzbin on steroids.

    more like PCP.

  35. 35
    TenguPhule says:

    @schrodingers_cat:

    How is this price gouging legal?

    Closed market that prevents external imports from competing. Industry wide collaboration on pricing. No checks or balances at the federal level and they employ a shit ton of lawyers to keep all of the above intact.

  36. 36
    TenguPhule says:

    @debbie:

    I think the government should take over research and development

    Actually most of the real research is still being done by the US government and universities. Companies simply buy it for pennies on the dollar, then do “research” to alter single molecules in the formula to extend the patents.

  37. 37
    Scott says:

    What caught my eye was that insulin could be bought without a prescription. What do Canada regulators believe that ours do not?

  38. 38
    Mandalay says:

    “For profit medicine is a fucking disaster.”

    Every single Democrat running for president has a mediocre campaign slogan. Every single one….

    Our Future is Now
    For The People
    Brave Wins
    Our Moment
    Join The Evolution

    They are all cringe inducing drivel.

    Any of them can only improve their chances by adopting “For profit medicine is a fucking disaster” as their campaign slogan.

  39. 39
    SFBayAreaGal says:

    This vet considers herself lucky and is very happy with the VA Palo Alto and San Francisco medical system.

    I’ve been treated for skin cancer, had my right hip replaced, get my physical and eye exams every year.

    If they can’t treat me within the system, they have sent me to the specialists that can.

    I wish everyone had the same medical benefits that I do.

  40. 40
    debbie says:

    @TenguPhule:

    First off, stop the patent extensions. Second, call them on their R&D bullshit; since the government knows exactly how much the company paid for a drug, limit the mark-ups accordingly. Period.

  41. 41
    JR says:

    The problem is that people are being pushed towards insulin analogs when just plain old insulin works great.

    The reason for this is that the patent on recombinant insulin expired years ago so manufacturers have moved away. The barriers to entry in this particular market are fairly substantial so it’s unlikely we’ll see new competitors on the horizon.

  42. 42
    Kay says:

    @Betty Cracker:

    I used to think providers were the problem but a lot of them really did get into it to help people and they’re miserable because they don’t think the system is set up to prioritize that. I took this workplace training once where they said the bigger the gap between what you think your job or profession is ABOUT and what you do every day is, the more miserable you are at work. That has to align, or you’re always in conflict.

  43. 43
    TenguPhule says:

    @debbie:

    Second, call them on their R&D bullshit; since the government knows exactly how much the company paid for a drug, limit the mark-ups accordingly. Period.

    For which we need the trifecta, executive, legislative and a SC majority.

  44. 44
    Kay says:

    My father loves the VA and he’s an incredibly cranky person and obsessive about cleanliness and order, so if they’re making him happy they’re doing something right.

  45. 45
    TenguPhule says:

    @JR:

    The reason for this is that the patent on recombinant insulin expired years ago so manufacturers have moved away. The barriers to entry in this particular market are fairly substantial so it’s unlikely we’ll see new competitors on the horizon.

    Which is why certain basic, not very profitable medicines should be produced by the Federal government as necessities.

  46. 46
    Steve in the ATL says:

    @John Cole: you were doing so well, and then this….

  47. 47
    sherparick says:

    @burnspbesq: The problem with drugs is the monopolies created by patent and copyright rules and the way they have been expanded by both legislation and litigation the last 40 years. For more details on what JC is talking about see;

    http://cepr.net/publications/b.....ct-of-2019

  48. 48

    @The Moar You Know:

    For the rest of us that need insulin and antivenin and a slew of other drugs that wouldn’t be affected by antitrust actions because they’re out of patent

    The patent situation with insulin is more complicated than you’re making out. Yes, the original patent on recombinant insulin expired quite a while ago*, but much of the insulin on the market has been further engineered to give it different/better pharmacokinetics. Many of those engineered forms of insulin are still be patent protected. And there are other regulatory barriers beyond patents that have tended to keep generic/biosimilar insulin products from coming to market, including some really brain dead decisions by the FDA that have scared away potential competitors for the time being.

    *This is a matter of intense personal interest, since my employer held that patent. We had a big, nasty restructuring when the patent ran out and we lost the revenue from it.

  49. 49
    Brachiator says:

    I am for universal health care. It doesn’t have to be non-profit. It doesn’t have to be single payer.

    I also want to see improvement in how service is delivered. In California, which seems to have some good programs, there are also tons of urgent care operations. Some people don’t have or don’t want primary care doctors and only seek care when obviously sick. Other folk cannot take off work and go to the doctor.

    Not enough doctors in poor and rural areas. Maybe we need more nurse practitioners and physician assistants.

    We made some good strides with the Affordable Care act. I once heard with my own ears a guy say that Obamacare had saved his life.

    We have time and the ability to do better and to do it right.

  50. 50
    Omnes Omnibus says:

    @Mandalay: True, that’s how “The rent is too damn high” guy became mayor of NYC.

  51. 51
    raven says:

    @SFBayAreaGal: What priority are you?

  52. 52
    opiejeanne says:

    @The Moar You Know: Oh Jesus Christ on a pogo stick! About ten years ago right after I’d been successfully treated for Hepatitis C a shirt-tail relation buttonholed me and insisted to me that it was spread by sexual contact. It’s not, according to the CDC (curse you Dr House for spreading this nonsense!). He’s a dentist. I asked him if autoclaves his instruments, knowing that dentists who weren’t using an autoclave had spread it to their patients. He blushed a little and left me alone. . I got mine in a “blameless” way*, from a transfusion in 1985, but JFC, so what if I’d caught it through sexual contact? Why does it even matter how you catch a disease???

    *And there it is, the inconsistency and victim-blaming that I share, declaring my method of contact blameless.

  53. 53
    tokyokie says:

    @Geoboy: I don’t think we want Cole as god-emperor. How could we ever find a crown big enough for his watermelon-sized noggin?

  54. 54
    Gravenstone says:

    @debbie: These days, most pharma R&D is conducted at start ups or universities, which then turn around and license or sell their discoveries to the big pharma houses – most of whom have severely curtailed their own in house R&D teams. R&D isn’t cheap is just a starting point. Adding on the business model of buying/licensing the IP developed by someone else builds that cost. The money does have to come from somewhere to pay for all that, but yes it is also heavily larded with excessive profit taking. I don’t have a simple solution for this, but it’s not as simple as many people like to make it seem.

  55. 55
    Wapiti says:

    @Scott: The Canadians probably figure that no one would use insulin unless they had to.

  56. 56
    Kay says:

    Also, not that anyone is keeping track or actually expected him to follow thru, prescription drug costs were one of the things Trump specifically promised to address, and like everything else besides giant tax cuts for rich people, he has not gotten done.

  57. 57

    @burnspbesq:

    That is one hell of an overreaction, there, Cole.

    We should definitely make this a rotating tagline.

  58. 58
    trollhattan says:

    @Kay:

    the problem for the people who want to keep the status quo health care system is that it doesn’t work.

    A really weird way to write “world’s bestest healthcare!”

    The myth endures, despite evidence and deaths to the contrary. I’m sure Mitch and Lindsay will fix it forthwith.

  59. 59
    NotMax says:

    While you’re at it, Mr. Cole, reinstate the ban on TV advertising of prescription drugs.

  60. 60
    TenguPhule says:

    @Steve in the ATL:

    you were doing so well, and then this….

    You didn’t help yourself by working against the Union. //

  61. 61
    Plato says:

    The Supreme Court has ruled against the Virginia House of Delegates in a racial gerrymandering case that represents a victory for Democrats in the state.It was a 5-4 ruling with Ginsburg, Thomas, Sotomayor, Kagan, and Gorsuch in the majority. https://t.co/q2TMwsrrSX— Kyle Griffin (@kylegriffin1) June 17, 2019

  62. 62

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    They just love blaming people for their own problems. If diabetes is a result of poor lifestyle choices, they can pretend they’ll never get it because they’re perfect and never do anything wrong.

  63. 63
    scuffletuffle says:

    Christ, I need a cigarette!

  64. 64
    Kay says:

    @trollhattan:

    That’s changed now, don’t you think? “World’s Best Health Care!” worked for 30 years and then people were like “ah, fuck it- that’s CLEARLY not true”
    Republicans don’t even say it anymore. Trump voters thought he was going to address prescription drug prices, which means “world’s best” isn’t working for them either.

  65. 65
    Mike in NC says:

    I’ve been really happy with Tricare but since I’m about to turn 65 have been automatically enrolled in Medicare, for which no doubt I’ll be paying a monthly premium of some type.

  66. 66
    J R in WV says:

    @The Moar You Know:

    @Ohio Mom: America’s national sport is blaming victims.

    We only fairly recently got shamed out of blaming AIDS patients for their disease. Although I’m willing to bet well over 50% of Americans still do, but at least know to keep their mouths shut in public about it.

    And what about the blaming of mental health sufferers? The existing medical treatments for mental health issues are primitive at best. They don’t know why any given drug can sometimes treat a given set of symptoms, or not. It’s like when barbers treated surgical problems, sort of. Or not.

    And just try to get a cost estimate even for a very typical procedure, like a joint replacement. I know every patient is different, and that emergencies happen during typical surgeries all the time. Hell we had a college athlete recently die on the table from a minor procedure during the off season.

    But telling a potential patient what a joint replacement typically costs is not black magic, it’s taking an average of the dozen procedures that are done every day in a busy surgical hospital and telling someone what than number is!! Can’t be done~!!!~

    And the insulin cost, for a drug invented decades ago and NOT patented because the doctor who invented it thought is was immoral to patent a life saving medication… words fail me… Profit based medicine is immoral theft based upon highway robbery. “Your money or your life,” the highwayman says, holding his pistol to your ear.

    The oncologist and the pharma sales rep say, “Your money or you die” – what is the difference here? If you can’t afford the $14,000 a month treatment, you die fast in accordance with the Republican health care plan. If you can afford it, maybe you get to see you kid graduate, or get married, or see you first grandchild!

    I’m with you, John. Tear up the corrupt failed “system” that makes big pharma wealthy and build a new system that covers everyone equally well. End the monopoly medical education market that keep the number of physicians low and the costs and availability sky high! And make Residents hours on duty like everyone else, one 8 hour shift a day!!! Who wants a doctor too tired to think treating them in an emergency?

    I’ve worked double shifts doing system conversions, and after a couple of days you are officially stupid!!

  67. 67
    Kay says:

    @trollhattan:

    The scarcity thing was used as a scare tactic too, but health care IS scarce in rural areas so that doesn’t work anymore either. My physician retired and I cannot get a new one. I had to use a nurse practitioner or drive 40 miles. It’s fine, she’s great, but since I’m getting “community health center” level care can’t I just pay for that instead of paying for “World’s Best!” :)

    A community health care clinic here would be an improvement over the private sector offerings. This market doesn’t work.

  68. 68
    Another Scott says:

    @Wapiti: Wasn’t there a Miss Marple or Midsomer Murders or something where the murder weapon was insulin (injected in someone who wasn’t diabetic)?

    Maybe it should be OTC except in small towns in England…

    ;-)

    Cheers,
    Scott.

  69. 69
    scuffletuffle says:

    @tokyokie: Woven willow branches…I hear they stretch when done right.

  70. 70
    trollhattan says:

    @Kay:
    If somebody can coax a leading Republican into saying “[Country X] has a better system that we should emulate.” then I’ll buy into the narrative having changed. It’s possible that already happened and I just missed it.

    Is the president* still threatening the pharmaceutical industry on pricing? He was on them for a while, but not lately I don’t think.

  71. 71
    raven says:

    @Mike in NC: You were a lifer?

    If you’re eligible for both TRICARE and Medicare Part A, then in most cases you must have Medicare Part B to keep TRICARE. Understanding how Medicare and TRICARE work together and when to buy Part B can be confusing. Review the following pages carefully to understand what you need to do to keep your TRICARE coverage:

    https://www.tricare.mil/Plans/Eligibility/MedicareEligible

  72. 72

    @Plato: Since you live in Chennai, I have a question for you. What political following do Sitharaman and Jaishankar have in TN? Also your thoughts behind the boomlets about Hindi imposition?
    Thanks.

  73. 73
    Kylroy says:

    @Omnes Omnibus: Exactly. Still, I think if you’re not one of the top dozen contenders, being that straightforward with your slogan (though probably not that vulgar) is worth a shot.

  74. 74
  75. 75

    @J R in WV:

    And what about the blaming of mental health sufferers? The existing medical treatments for mental health issues are primitive at best. They don’t know why any given drug can sometimes treat a given set of symptoms, or not. It’s like when barbers treated surgical problems, sort of. Or not.

    And America actually does have some of the better mental health care in the world.

    To be fair, these interventions are very difficult to design, test, and measure.

  76. 76
    Amir Khalid says:

    @Mandalay:
    Are you really so shallow that you judge presidential candidates by their campaign slogans?

  77. 77
    cckids says:

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    A lot of them are terrified. They see the devastation diabetes or other long-term conditions cause, and desperately want to believe that if they do everything exactly right, they will escape the same fate. It’s childish, whistling-past-the-graveyard thinking, and it is all too common.

    And some people are just mean assholes.

  78. 78
    J R in WV says:

    @opiejeanne:

    He’s a dentist. I asked him if autoclaves his instruments, knowing that dentists who weren’t using an autoclave had spread it to their patients. He blushed a little and left me alone.

    And there you go. He’s gleefully spreading who knows what to his patients to save a nickle on using that autoclave…

  79. 79
    Plato says:

    @schrodingers_cat:

    Both have zero name recognition, let alone any base. They are just party apparatchiks elevated by modi-shah combine. BJP thought that recent big win gave them the ‘mandate’ on hindi imposition and entire South said FU. The courts would have stopped that also but I expect BJP to try their dirty tricks again.

  80. 80
    jl says:

    @Major Major Major Major:

    ” That is one hell of an overreaction, there, Cole. ”

    If that is not made a tagline for the header, I am notifying the Bailiff of the Supreme Court that this miserable lefty blog is TREASONING its pledge of full-service blog life..

  81. 81
    trollhattan says:

    @Kay:
    Working in rural community development “back in the day’ I learned about the healthcare shortage–UDSA had studied it and there was even a federal forgivable loan program covering some portion of med school tuition as long as doctors worked a required number of years in a rural area after graduating. No idea whether that still exists. IIUC it’s becoming critical now but the issue has been known for decades. Ironic outcome for those dependable red state Republican voters hell bent on dragging their fellow citizens down with them.

  82. 82
    Julie says:

    @Scott: You can buy insulin without a prescription in the U.S., at least some types of insulin. For several years I bought vials of insulin at the drugstore for my diabetic dog. Now that insulin has gotten so expensive I think about all the insulin-dependent pets and their owners struggling to keep them alive.

  83. 83
    trollhattan says:

    China-Spain scoreless at the end–China’s keeper did her job and kept Spain’s many shots out of the goal.

    This is the best thing to happen in politics in years: Cat filter accidentally used in Pakistani minister’s live press conference

  84. 84

    @J R in WV:

    And just try to get a cost estimate even for a very typical procedure, like a joint replacement. I know every patient is different, and that emergencies happen during typical surgeries all the time.

    This is not unique to medicine, though. What hospitals could do is to quote average costs and then live with that. If the case is uncomplicated and easy, great, the hospital makes some extra money. If it has terrible complications, tough luck, but it’s the hospital that suffers rather than the patient. That would also provide hospitals a really strong incentive to figure out how to avoid complications, since complications would hurt their bottom line.

  85. 85
    smintheus says:

    If you’re going to mandate something, mandate a national health service in which medical care costs at most a nominal sum, for all residents of the country. No reason why people should suffer or die because of the cost of being sick.

  86. 86
    J R in WV says:

    @cckids:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    And a lot of them, the Theocratic Republican ones, believe that Gawd visits illness on sinners, and that if they get sick, they’re also going to Hell for some unknown sin they must have committed.

  87. 87
    caralee says:

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    It’s a disease that disproportionately affects minorities.

  88. 88
    Mandalay says:

    @Amir Khalid:

    Are you really so shallow that you judge presidential candidates by their campaign slogans?

    Fuck off with your straw man.

  89. 89
    Another Scott says:

    @Plato: Good news, indeed.

    Wonkette:

    After extensive litigation including a trip up to the Supreme Court in 2017, the District Court in the Eastern District of Virginia tossed 11 of the districts as illegal racial gerrymanders and ordered the maps redrawn in 2018. At which point, the Commonwealth of Virginia noped out and quit defending the old, craptastic districts, which should have been the end of it.

    BUT NO. The Virginia House of Delegates, which is still held by the GOP despite their party netting nine percent fewer votes than Democrats in the 2017 election, vowed to fight on.

    They told the District Court to go piss up a rope, because they sure as shit weren’t redrawing the map. Which is fine by us, since the Court hired an independent cartographer who drew fair lines for the 2019 primaries held last week. (Three guesses why Virginia likes to hold its elections in off-off years when no one is showing up to vote!) Then the Delegates filed an appeal to the Supreme Court on their own behalf, making themselves the new plaintiffs and rechristening the case Virginia House of Delegates v. Bethune-Hill.

    Justice Ginsburg, writing for the majority, held that the Republican legislators did not have standing to keep up the litigation, saying, “In short, Virginia would rather stop than fight on. One House of its bicameral legislature cannot alone continue the litigation against the will of its partners in the legislative process.” In his dissent, Justice Alito argued that the legislators do have standing as the parties who will be harmed by losing their seats if the districts are fairly drawn. But the majority said that the House of Delegates as a body has no legally recognizable interest in the identity or party affiliation of its members.

    Redrawing district lines indeed may affect the chamber’s membership, but the House as an institution has no cognizable interest in the identity of its members. The House has no prerogative to select its own members. It is a representative body composed of members chosen by the people. Changes in its membership brought about by the voting public thus inflict no cognizable injury on the House.

    […]

    Good, good.

    On voting rights, Native American rights, and maybe a few other things, Gorsuch seems to be on the good side. So far.

    Cheers,
    Scott.

  90. 90
    jl says:

    @burnspbesq:

    If you compare systems across countries, evidence is that Cole has a point about problems of for-profit motive in health care provision. Switzerland is certainly a very capitalist country. It’s mostly private health care system provides among the best levels of population health at about 10 to 12 percent of its GDP, and is similar in both respects to Australia, which I think has the Medicare for All plan which is most similar to the several versions that are being proposed by Democratic progressives for the US.

    Switzerland has removed the for-profit motive from its national health care system for the uniform basic minimum coverage and care insurance contract that everyone is required to have. The uniform basic national contract must be offered by all insurers on a non-profit basis, in return for a management fee, which approximates a moderate ‘normal profit’ for administrative services.

    I don’t know of a successful system in high income industrialized countries that allows for-profit provision of insurance for basic care. And in successful systems, for-profit providers are very heavily regulated, much more so than in the US. Anti-trust alone is not going to do the trick.

    So, Cole is right on this one.

  91. 91
    NotMax says:

    @J R in WV

    Some overlap with those steeped in fear and ignorance who believe it is catching.

  92. 92
    Gin & Tonic says:

    @Another Scott: Relatedly, Claus von Bulow has died.

  93. 93

    @Plato: I think they were chosen to draw a wedge along caste lines in TN. It has not escaped my notice on how many of the virulent pro-Modi handles on Twitter are self proclaimed TamBrams.
    Husband kitteh’s extended family* has gone Bhakt. Thankfully MIL and SIL are still pretty anti-BJP.
    ETA: They are Aiyars (sp?)

  94. 94
    texasdoc says:

    @debbie: In other words, pharmaceutical companies should be regulated like utilities: “You can make a profit, but not a killing!”

  95. 95
    ThresherK says:

    Anyone else remember a healthcare trade group TV ad called “Bus from Canada”? Had a website (busfromcanada.org, so you know it’s non-profit!) and everything.

  96. 96
    cckids says:

    @J R in WV: @J R in WV:

    And a lot of them, the Theocratic Republican ones, believe that Gawd visits illness on sinners, and that if they get sick, they’re also going to Hell for some unknown sin they must have committed.

    Yes, I’ve seen this firsthand. My mother’s oldest sister told me that my son’s disabilities were God’s judgement on me for getting pregnant before marriage. Because I was 19, exhausted and grieving, I just turned around and left (and didn’t speak to her for the rest of her miserable life). She was lucky I hadn’t yet acquired my current NFLTG attitude; her ears would have caught fire.
    Living 33 years with a child with serious medical issues showed me quite clearly how un-Christ-like most Christians are in real life. They’re the most hostile, ignorant, evil “humans” around.

  97. 97
    plato says:

    @schrodingers_cat: Majority of them are modi bhakts but as a demography, they are around 2% and hence can do jacksquat in the state elections or politics.

  98. 98
    low-tech cyclist says:

    @TenguPhule:

    Which is why certain basic, not very profitable medicines should be produced by the Federal government as necessities.

    Damn straight. The government can keep making the original drug once the original patent expires (without the one-molecule change that can be patented, but doesn’t do jack shit), sell it at cost, and pull the rug out from under all those price-gouging bastards in Big Pharma.

  99. 99
    Mike in NC says:

    @raven: Thanks. 30 year reservist. Been getting inundated with paperwork about my healthcare options.

  100. 100
    eemom says:

    @John Cole:

    STRAP IN I AM COMING FOR THE LAWYERS NEXT

    You will be greeted as liberators.

  101. 101
    Soprano2 says:

    My husband quit taking the fast-acting insulin for 3 months when he went to fill the prescription and found he was in the “donut hole”; it was going to cost him $400 for a one month supply where it had previously been around $150/mo. When he next went to his doctor, and the doctor found out he hadn’t taken it for 3 months, “magically” there was an insulin in a small bottle that cost around $50/month that he could suddenly get a prescription for; he had asked if there was something cheaper many times before, and had always been told no. The difference is that this insulin has to be refrigerated and he has to buy his own needles, but he was willing to give up some convenience to be able to afford it again. The cost of insulin in this country is a huge scandal that Democrats should be able to take advantage of.

  102. 102
    SFBayAreaGal says:

    @raven:
    Group 7

  103. 103
    Scott says:

    @Mike in NC: Yes, you’ll be paying the Medicare premiums, including some extra if your still working. You also get Tricare for Life (no charge) which acts as a Medicare supplement.

  104. 104
    germy says:

    @Gin & Tonic:

    Alan Dershowitz, in his book Taking the Stand, writes about Claus von Bülow’s dinner party after he was found not guilty at his trial. Dershowitz replied to the invitation that he would not attend if it was a “victory party”, and Bülow assured him it was only a dinner for “several interesting friends.” Norman Mailer also attended the dinner where, among other things, Dershowitz explained why the evidence pointed to Bulow not having murdered his wife. As Dershowitz recounted, Mailer grabbed his wife, Norris Church Mailer’s, arm and said: “Let’s get out of here. I think this guy is innocent. I thought we were going to be having dinner with a man who actually tried to kill his wife. This is boring.”

    (wikipedia)

  105. 105
    raven says:

    @Mike in NC: Yea, my organization has plan administered through AON that gives us a set amount of money and we choose medicare supplement and prescription plans. This is a University System and covers all system retirees. A retired stats prof runs the “Grump Retiree”FB page and the complexity of this are a constant topic. If a state prof struggle with it what do the people who pushed brooms for 30 years do?

  106. 106
    Betty Cracker says:

    @trollhattan: That is hilarious!

  107. 107
    mrmoshpotato says:

    @Kay:

    prescription drug costs were one of the things Trump specifically promised to address

    Sorry, but that falls under healthcare, and “Nobody knew healthcare could be so complicated.”

    We could’ve had an adult as President. But at least 77000 people don’t have to live with the knowledge that their votes put Hillary Clinton in the White House.

  108. 108
    lurker dean says:

    kavanaugh just authored an opinion and uses the quote ““It is sometimes said that the bigger the government, the smaller the individual.” law professor michael dorf tracked down the quote to an ayn rand web site and libertarian dennis prager. this is where our conservative jurisprudence is. i guess it’s no worse than scalia and a broccoli mandate, but it’s still shocking that such stupidity is relied upon by members of the supreme freaking court.

    In today’s 5-4 SCOTUS ruling that a private company administering a public access channel in NYC is not a state actor subject to the First Amendment, Justice Kavanaugh writes for the majority: “It is sometimes said that the bigger the government, the smaller the individual.” 1/— Dorf on Law (@dorfonlaw) June 17, 2019

  109. 109

    @plato: 2% is enough to poison the atmosphere if you are dominant in the media new and old. It is easy to break things than make them.

  110. 110
    La Nonna says:

    100% in agreement with the OP, our experience here in Italy’s national health system has been eye-opening for us former New Yorkers…yes, we pay slightly higher taxes, even as pensioners, but it works out to less per annum than Medicare and all its attendant extras would in the US. Italy’s results are really good for a per capita spend of about 2400 euros.

  111. 111
    Luciamia says:

    This would also mean the end of all drug ads on TV. Yes,please!

  112. 112
    Chief Oshkosh says:

    Little known factoid: The idea of a residency was created by a Johns Hopkins doc who felt that youngsters going into medicine should be dedicated enough to actually live at the hospital (hence “resident”) so that they could take all cases at all hours of the day, any day of the week. At the same time that he was creating this reality, he was totally hooked on cocaine, and that mania drove much of the program development.

    Years later, after he’d gotten the monkey off his back and he was thinking more clearly, he decried what he’d created and tried to get the world to change back to a saner approach to clinical training. By then it was too late — too many senior docs had figured out that is sure was sweet to have some scut handling patients who came in at 2 am, Sunday morning.

  113. 113
    patrick II says:

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    Possible socialism and higher taxes.

  114. 114
    trollhattan says:

    @Betty Cracker:
    Admit it immediately prompted thoughts of your Trump piggie treatments. :-)

  115. 115
    Chief Oshkosh says:

    @Ohio Mom:

    I’m left wondering what it is exactly that these people find so offensive about diabetes and diabetics.

    Higher prevalence in the African-descendent cohort?

    Just a guess…

  116. 116
    SFBayAreaGal says:

    @Mike in NC: How did they automatically enroll you in Medicare? I thought that was a choice if you wanted to join Medicare or just stick with your VA benefits.

  117. 117
    Ohio Mom says:

    @lurker dean: I know he has other identities (talk show host for one) but I always think of Dennis Prager as a professional Jew.

    That’s because I run across him in Jewish media explaining why his right-wing libertarian fascist schtick is actually what our sages proposed and taught.

    Anyway, I keep a mental list of people I’m excommunicating when I become the first pope of Judaism, and he’s on the list.

  118. 118
    La Nonna says:

    Comment eaten? I haven’t been on in a while.

  119. 119
    Amir Khalid says:

    @Mandalay:

    Fuck off with your straw man.

    ??

  120. 120

    @J R in WV: Where the kid works, they work 12 hour shifts(so she only works 3 days a week).

  121. 121
    Chief Oshkosh says:

    @tokyokie: He doesn’t care about a crown, but you’d better find his fucking bottle of mustard. NOW.

  122. 122
    mrmoshpotato says:

    @NotMax:

    While you’re at it, Mr. Cole, reinstate the ban on TV advertising of prescription drugs.

    No more ads about a drug magically improving everything in your life with everyone in it looking like Rick Scott? What about patients asking their doctors about drugs that the patients know nothing about?

  123. 123
    jl says:

    @Ohio Mom: Ahaziah, Ahab and Jehoram were prophets!

  124. 124
    J R in WV says:

    @Roger Moore:

    This is not unique to medicine, though. What hospitals could do is to quote average costs and then live with that. If the case is uncomplicated and easy, great, the hospital makes some extra money. If it has terrible complications, tough luck, but it’s the hospital that suffers rather than the patient. That would also provide hospitals a really strong incentive to figure out how to avoid complications, since complications would hurt their bottom line.

    No one expects to hold a professional to their pre-work estimates, at least I don’t. So often a plumber finds bad pipes when he opens up a wall or a mechanic bad pistons when doing a valve job, so too can a surgeon find very bad news when they open up a patient.

    But not to even give a ball-park estimate… not very professional.

  125. 125
    germy says:

    DMN staff photographer @TomFoxPhoto captured this image shortly before a gunman opened fire on the Earle Cabell Federal Building Monday morning in downtown Dallas. Fox was waiting to enter the building to cover a trial when the attack took place. https://t.co/y8fWYYuKjs pic.twitter.com/fE1kFlEy9j— Dallas Morning News (@dallasnews) June 17, 2019

    Why in hell is he wearing the 101st Airborne patch? pic.twitter.com/wMOGVBlDMD— Jac Higgins 🏳️‍🌈 (@Vette73) June 17, 2019

  126. 126
    Chief Oshkosh says:

    @Amir Khalid:

    Are you really so shallow that you judge presidential candidates by their campaign slogans?

    Are you really so naive as to think that campaign slogans don’t matter?

  127. 127
  128. 128
    plato says:

    U.K. Home Secretary Sajid Javid: Trump "should stick to domestic politics.""The president is right to be concerned about serious violence. He should be concerned about … his own country, which is more than 10 times higher than it is in the U.K."https://t.co/OqHovRUiW8— Kyle Griffin (@kylegriffin1) June 17, 2019

    When you have as asshole for president…

  129. 129
    Gin & Tonic says:

    @germy: Von Bulow, after his acquittal, apparently entered into some sort of agreement with Sunny’s children from her first marriage to never speak publicly about the matter. He kept that agreement until his death.

    Living in RI, the trial was of course huge news. I always assumed he was guilty.

  130. 130
    jl says:

    @Chief Oshkosh: William Stewart Halsted. Cocaine and morphine were legal drugs at the time, a lot of drugs were legal back then. But editors started to notice something was wrong when Halsted started submitting papers that were written while he was so totally coked out, they were gibberish. So, his friends persuaded him to cut down. I don’t think he ever got off it entirely. Halstead may have needed the dope to deal with his almost complete inability to deal with people in a normal way. He had debilitating shyness.

    Anyway, yes, medical residencies were modeled on Halstead’s pioneering surgical residency, which was founded by a coke fiend who had debilitating personality problems. So, I dunno, many roots to the problems with US health care, maybe.

    OTOH, Halstead was a pioneer in modern practices in sanitation and precise surgical technique, which when he started his practice, was considered stupid hocus pocus BS.

  131. 131
    raven says:

    @germy: Probably because he was stationed at Ft Campbell.

  132. 132
    Another Scott says:

    @Gin & Tonic: D’Oh, I should have remembered that.

    And it was a Miss Marple – Crooked House. Little is new under the sun…

    Thanks.

    Cheers,
    Scott.

  133. 133
    Gin & Tonic says:

    @Amir Khalid: Still here? Langeweische pretty exhaustively rules out every theory except a deliberate act by Zaharie, the pilot-in-command. He is very hard on Malaysian authorities at all levels for delaying and obfuscating. It’s worth a read, but I’m not sure how much is there to learn from it. Process geeks will get more out of it.

  134. 134
    debbie says:

    @germy:

    It appears he was a veteran. Won’t lift my ad blocker to look more carefully, but he posted on FB and seems right wingish.

    I’m old. What is that in his right hand?

  135. 135
    Yutsano says:

    @Amir Khalid: That was a bit random and needlessly hostile.

  136. 136
    Another Scott says:

    @debbie: More ammo for his gun (note that it looks like the magazine already loaded).

    :-(

    Cheers,
    Scott.

  137. 137
    raven says:

    @debbie: A magazine (people here like to call them clips then freakout when someone calls them what they are)

  138. 138
    jl says:

    @J R in WV: Many European countries require providers, on a regional and industry basis, to agree to legally binding price bands for services. The negotiations are usually between a professional association or industry group and various government regulators. It’s been a fairly effective method of cost control. I don’t know how much of it could be adopted in the US without some changes to federal and state anti-trust and freedom of contract laws.

    Anyway, you go in for a basic eye exam, in for a sprain, etc. the legally binding range of permissible prices for the service is posted with the government. So, a health provider living by predictable and transparent pricing can be done, and is done.

  139. 139
    debbie says:

    @Another Scott:

    Thanks. I thought maybe he was planning to film himself and his mission.

  140. 140
    Ohio Mom says:

    @jl: Halstead — He’s the fellow who invented the radical mastectomy for breast cancer. I knew I recognized that name (just googled him).

    It was a breakthrough for its time but a disfiguring, disabling surgery.

    Nowadays we understand that it is rarely necessary to remove that much tissue and muscle, though there was a lot of resistance, for a long time, among surgeons for adopting less um, radical approaches. Ironically, the Halstead mastectomy became its own sort of “stupid hocus pocus BS.”

  141. 141
    Amir Khalid says:

    @Chief Oshkosh:
    They don’t tell you much anything about the candidate’s merits. So I ignore them.

  142. 142

    : @Ohio Mom: I have list too, but for Hindus
    @Another Scott: Miss Marple isn’t in the The Crooked House.

  143. 143
    jl says:

    @Ohio Mom: Radical mastectomy is a horrible surgery, but for a long time it got results, when other techniques didn’t. When Obamacare was being debated, a recent rise in UK death rates from breast cancer was a scare story peddled by opponents. The rise in UK death rates from that particular condition were rising, or at least not declining as fast as in the US, even while women’s overall death rates in the UK were falling much faster than here.

    But, the problem with scare story was that the rise in death rates for breast cancer in the UK was partly due to the NHS being overly stingy on cancer screening and prevention, so the cancers were on average discovered later. And, UK doctors were more willing to try more moderate surgical techniques if the patient didn’t want a radical mastectomy. US doctors were far more reluctant to perform them, unless it was very well established the more moderate procedure has a higher cure rate, even if the patient requested it.

    Anyway, the reactionary scare story about the supposed Medieval horrors of health care in the UK didn’t have anything to do with the merits of Obamacare.

  144. 144
    Brachiator says:

    @Gin & Tonic:
    I always remember Jeremy Irons as Von Bulow in Reversal of Fortune and how he delivered the line in this exchange.

    Alan Dershowitz: You are a very strange man.
    Claus von Bülow: You have no idea.

  145. 145
    Another Scott says:

    @schrodingers_cat: That’s what I get for skimming Google results and Wikipedia too quickly and jumping to conclusions.

    Thanks.

    Cheers,
    Scott.

  146. 146
    scuffletuffle says:

    @NotMax: Oh Lord, how do you find these things?

  147. 147
    chris says:

    Oh good. Oh… shit.

    Racking my brain trying to come up with other times a secretary of state has visited CENTCOM HQ and not coming up with many. Perhaps it's because the secretary of state isn't in the chain of command https://t.co/pFe81Zm3kQ— Adam Weinstein (@AdamWeinstein) 17 June 2019

  148. 148
    Ohio Mom says:

    @Amir Khalid: Yeah but slogans work on a lot of people, e.g., MAGA. No harm in wanting our guy/gal to have every advantage.

    I always think back to the joke about Adlai Stevenson’s presidential bid: A suporter says, “You have the vote of every thinking American.”

    Stevenson replies, “I’ll need more than that if I’m going to get elected.”

    Sad and true. That was before my time but I’ve always felt like that was one of the elections I “lost,” along with Carter’s second run, Mondale, Dukakis, Gore, and Hillary. God what s depressing list…

  149. 149
    wvblueguy says:

    @raven: @raven: Raven I’m a Vietnam Vet and have no issues using the VA for all of my Prescriptions. I have had no issues with my Primary Care Provider at the VA adding scripts from the multitude of outside Drs I have to VA provided medicines. I was concerned that there was going to be an issue with my blood thinner that I have to take due to AFib. The VA had no problem prescribing Xarelto as opposed to Cumiden. I also have Medicare and AARP supplemental insurance. The VA always Bills whatever insurance you have for whatever treatment they can. I also have found that the VA works very well in sharing information with outside providers and vice versa if the DR is technologically astute. The list of “presumptive diseases” that apply to Vietnam Vets is long and will likely get longer. You might want to consult with the folks at the VA as to how you can tie everything together. I get the hearing aids and glasses as well and because I am a Type 2 Diabetic with other issues I get everything I need. I see no reason why you shouldn’t be eligible for VA prescriptions.

  150. 150
    Mnemosyne says:

    @Ohio Mom:

    Halsted pioneered his technique about 60 years before chemotherapy was discovered, so it may be fair to say that when surgery was the only available treatment, a more radical surgery may have been needed.

    But, yes, doctors are usually surprisingly resistant to changing what they learned as interns 20 years ago even when the new technique or discovery is better and/or safer than the old protocol. How friggin’ long did it take doctors to figure out that they needed to wash their hands?

    @jl:

    A lot of surgeons who were trained in the pre-anesthesia days developed drug addictions or other mental health issues because they had nightmares and flashbacks about their cases. Cutting into screaming patients and trying to finish before they died of shock will have that effect.

  151. 151
    debbie says:

    @chris:

    Why should they be spared from his Swagger? //

  152. 152
    J. says:

    And here I thought Cole was already king in West “By God” Virginia.

    I’m thinking new B-J bumper sticker: Cole for God Emperor 2020

  153. 153
    Yutsano says:

    @J.: Eh. Ask the Fremen of Arrakis how that all worked out for them.

  154. 154
    Ohio Mom says:

    @jl: Halstead’s basic idea, as I understand it, was that cancer radiated outwards (like the ripples on water after you toss a pebble in) so best to remove as wide a field around it as possible to stop it in its tracks. Sort of like plowing a fire break.

    There was no way he could have known what we know now about cancer genetics and the mutations that allow cancers to metacisize. He did great with the information he had, and yes, he saved many lives.

    I’m just a little irritated at tne surgeons who were slow to adopt better techniques. But I suppose doctors can’t win. Either they are reluctant to adopt newer procedures or they jump on something new that later is found to be harmful.

    As for the NHS, doesn’t seem to be much wrong with it that a little less austerity wouldn’t correct.

  155. 155
    jl says:

    @Mnemosyne: @Ohio Mom: What struck me about the research into the scare stories about UK breast cancer rates showing how awful commie socialized medicine in the UK is, was how scare stories can turn the truth on its head.

    Obamacare would greatly expand preventive care in the US, while one reason for worse performance of UK on breast cancer death rates was that the UK was too stingy on preventive screening for breast and other cancers.

    In the supposedly ‘one-size-fits all’ rigid NHS, UK doctors were far more willing than US docs to let a patient take the risk of a shorter life if she wanted to avoid a debilitating surgery. In that particular situation, patients had effectively more choice and patient preferences were more respected in the UK than in the US. But some of that was due as much, apparently, to the different traditions of medical practice in the UK and US as to the different health care systems themselves.

  156. 156
    Steeplejack (phone) says:

    My one-stop dose of rage for the day: “Trump Undercuts ‘Deep State’ FBI Conspiracy Theory.”

    This story has everything I need: Trump, Trump lying (but I repeat myself), Trump not being called on lying, other Republicans lying, Chuck Todd ignoring the lying, a call-back to James Comey’s colossal dick move in 2016, and “Democrat Party.” And Gym Jordan.

    I have been trying to limit my news consumption for mental health reasons, but even small doses are dangerous.

  157. 157
    chris says:

    @Mnemosyne: A lot of doctors were, and are for that matter, addicted to various things.

    Fun story from my grandfather. His first job after his residency in 1932 was in a small town north of Toronto. He was sent to take over for a middle-aged doctor who was addicted to ether of all things. The man would get a call, huff a little ether, and then forget to go. Granddad ended up taking over the practice and my mother was born there.

  158. 158
    rikyrah says:

    @cckids:
    Diabetes is a complex disease
    You just don’t need an endocrinologist.
    Everything else, you need a diabetic specialist.
    Ear, nose and throat
    Optometrist
    Podiatrist

    All should focus on diabetic patients.

  159. 159
    rikyrah says:

    @trollhattan:
    We get a lot of foreign doctors in rural areas because it eases their visa process.

  160. 160
    jl says:

    @chris: I remember a very aged oldster nurse in my family who practiced with docs out in the boondocks way back in the day, in 19-teens and 1920s. She said when you went out for an overnight trip for a child birth or accident, some docs would make sure to pack a supply of some drug or other to keep them fortified. Nurses thought a little cocaine was OK, but wouldn’t go with a guy who needed booze to settle his nerves.

  161. 161

    @rikyrah: Rs are trying to get rid of OPT, that allows international students on F-1 visas to work for a year after their graduation to gain experience in their fields.

  162. 162
    chris says:

    @jl: All doctors are very smart and perfectly capable of self-medicating.//

    I’ve been in AA for a while and have met a few doctors. Their stories from the profession are pretty scary.

  163. 163
    FlipYrWhig says:

    My pie-in-the-sky health care reform would be NHS/VA For All, but I’ll settle for nationalizing all primary care and generic drug production.

  164. 164
    cckids says:

    @rikyrah:

    Diabetes is a complex disease
    You just don’t need an endocrinologist.
    Everything else, you need a diabetic specialist.
    Ear, nose and throat
    Optometrist
    Podiatrist

    All should focus on diabetic patients.

    Of course. In my experience, the most exhausting, seemingly impossible task involved in living with any ongoing, complex disease or condition is how many doctors/specialists/etc you have to deal with; how much information you HAVE to collect, understand, convey to all the other specialists, all the while also dealing with day-to-day life, making a living, everything else. I’m not sure ANY insurance, no matter how good, gives people an overall case manager who can help with all that. And it is OVERWHELMING. The cost of failing, or doing a bad job at it, is death, either your own or your loved one’s. And, it seems to me, having professional oversight into complex conditions would quite probably save money for the insurance/government (since bottom line is their main concern) Tests wouldn’t be duplicated, information shared, leading to more efficient care with better outcomes. I’m sure I’m dreaming that that will ever be a possibility.

  165. 165
    raven says:

    @wvblueguy: Thanks, late but, thanks.

  166. 166
    rk says:

    Going to the doctor has become an academic exercise for me. He tells me what’s wrong and gives me a prescription. I can’t afford it and that’s the end of it.Took my kid to the doctor. He prescribed a coated motrin (with some antacid combination). $2700 for 60 tablets. Yup $2700 because insurance doesn’t cover it I don’t get the discount (which will bring it down somewhat). I pay through the nose for the insurance. These guys need to be hung from the rafters.

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    Ohio Mom says:

    @cckids: The local Children’s hospital does a very good job of coordinating care for children with complex needs.

    They have a variety of Clinic days dedicated to specific conditions where various specialists see the same patient in quick succession and then together create or monitor the treatment plan.

    So a child going for example to the Spina Bifida Clinic would see his neurologist, orthopedist, gastroenterologist, etc., all in tne same afternoon. The social worker stops by and makes sure all is going well with the school, insurance, and so forth.

    And then…these children grow into adulthood and age out, and that’s the end of that.

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    J R in WV says:

    @jl:

    Anyway, you go in for a basic eye exam, in for a sprain, etc. the legally binding range of permissible prices for the service is posted with the government. So, a health provider living by predictable and transparent pricing can be done, and is done.

    Of course, in the normal course of events, that is totally practical.

    But if they open you up for a gallbladder removal, and find pancreatic cancer, what then?! No one would expect surgery and treatment for that rudely discovered issue to be covered by the gallbladder procedure price.

    IIRC that actually happened to Ruth Baden Ginsburg, who fell, cracked ribs, MRI discovered the cancer… saved her life! Price no object at this point.

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    Ohio Mom says:

    @J R in WV: That’s happened happened to RBG twice.

    The first time, the incidental finding was very early stage pancreatic cancer. Almost always, there are no warning signs for early pancreatic cancer, by the time there are symptoms, it’s spread far and wide and is uncurable.

    I don’t know what they were looking for but it had to pale in comparison to finding that cancer.

    The cracked ribs led to finding cancer in her lungs. That was fairly recently.

    At this point, we should be insisting Justice Ginsburg get annual CAT scans.

  170. 170
    jl says:

    @J R in WV: In most countries with good system that still has private health insurance, Switzerland and Netherlands for example, you max out on your co-pays and deductibles and you don’t pay for anything over that, and then go into fully paid catastrophic coverage.

  171. 171
    Inspectrix says:

    Not all doctors are so self-interested to want the status quo.
    I do think the cost of medical school plus the brutality of most residencies tend to create a group of professionals who feel entitled at the end. There is a real drift away from the career paths of unglamorous fields like pediatrics, family medicine, and non-procedural specialties like geriatrics and endocrinology. These are specialties where prevention of disease or complications are core functions, yet these are not valued by the reimbursement structure. Unless the payor is forced to care for the individuals for their lifetime, there will be no incentive to prevent. We should not only be asking how to pay for hip surgeries, but we should work to prevent half of the hip fractures that will occur 10 years from now.

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    Ruckus says:

    @Jerry:
    @redactor:
    Like any other endeavor involving humans the VA can be a bit of a pain in the ass. It still beats the alternative in this country. I mean if you absolutely have no need for cosmetic surgery and live in or near Beverly Hills and want it anyway, sure, I’d say you might be better off. And not every VA employee is worth what they are being paid. But once again, any endeavor involving humans….. most are as good as I’ve ever seen. But it’s the system that I think that really makes it shine. Yes it’s medicine that’s nearly a conveyor belt system but it works. One can not be on their high horse to see this, but that’s the viewer’s problem, not the system.

  173. 173
    Ruckus says:

    @Roger Moore:
    And I am. As can be seen in any number of my comments on this issue over the years. There is nothing stopping people from not using the NHS or it’s sister systems. The VA is open to any vet who needs it, there may be income restrictions/copays but they are not unreasonable.

  174. 174
    Ruckus says:

    @Mike in NC:
    Another myth, Medicare is not free. There is a cost per month, taken out of your SS payment. Something over $100/month. That’s for seeing doctors. Hospital coverage is still free. This is part A and B. The SS website has all the info and it’s not that badly presented.

  175. 175
    Ruckus says:

    @J R in WV:
    You don’t like going to the ER at hour 46 of a 48 hr rotation and finding the doctor asleep standing up?

  176. 176
    Ruckus says:

    @lurker dean:
    It’s Kavanaugh. You didn’t actually expect any better did you?

  177. 177
    Ruckus says:

    @SFBayAreaGal:
    I had to opt out of Medicare B. Staying with the VA had nothing to do with Medicare. Mike in NC has TriCare and that requires that to keep it when you become Medicare eligible at 65, you have certain hoops to jump through. If he’s a 30 yr reservist I’m pretty sure that he can’t use the VA because it has certain requirements, 2 yrs active duty is the first, served in a combat zone, injured in the line of duty are a couple more the website VA.gov has all the info for the VA. I know nothing more about TriCare.

  178. 178
    Ruckus says:

    @Ohio Mom:
    Mom had breast cancer and had a radical mastectomy 50 yrs ago. She lived another 43 yrs, till 95. Sure, she was lucky but it did work. And at the time breast cancer was often a death sentence. If the cancer didn’t get you the surgery might. I know she had discomfort on occasion but the reality is that her daughter had breast cancer and died after radical surgery and 2 massive rounds of chemo 39 yrs later. We don’t always win against cancer. Some forms it’s almost never.

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    DHD says:

    it’s been my experience that a large and vocal portion of the medical community are entitled whiny ass titty babies who think they deserve millions of dollars per year and will do anything to preserve their wealth and status

    Welcome to … the Canadian healthcare system (but replace “millions” with “many hundreds of thousands”). But it still works better for those who really need it.

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