Information on working terriers, dogs, natural history, hunting, and the environment, with occasional political commentary as I see fit. This web log is associated with the Terrierman.com web site.
A long time ago, I lived in the United States of America. Now I live in the United States of Corporate America.Our country has been sold out.
For years my doctor, whom I "chose" myself, was who many consider one of the very best brain surgeons in the world, Dr. Ben Carson of Johns Hopkins. Not only a wonderful doctor, but an incredible human being, and I loved him. Then, because of the McScrooges at my insurance company, I "lost" him as my doctor for many years. When they came to terms, I "got" him back. I only got to "choose" once, and then the system made the next two moves. That's not freedom of choice in my book. Seahorse
Choice is always an illusion in the health care world. If you lived in Arizona and were low income and had no insurance, could you really choose Dr. Ben Carter who works in Baltimore? Could you choose your insurance if you lived in Baltimore and you worked a dollar-hour wage job, and all the insurance you had come from your employer? Suppose the insurance company said either: 1) You have to go to a Kaiser Hospital, or; 2: your problem is not covered as we have deemed it to be "experimental"? No Dr. Ben Carter then! Even world-class doctors like Ben Carter have only an illusion of choice. If you work for a hospital, they will often tell you their formulary for drugs and what devices they want you to use. Patients rarely even ask!And then, of course, there is the payola factor which is far more prevalent than people think. Do you think doctors and hospitals decide what shunt, artificial joint or pacemaker they use based upon some magical insight into your soul or a strong belief that brand A is better than brand B? Sometimes it works that way, but more often than not there are two or three or seven or eight competing devices or drugs that do the same thing. And which one do they put in or use on you? The most expensive one! And why? Because that's the one that can afford to give the biggest kickback to the doctor or hospital (a kickback often obscured by a "consultancy" agreement). There is almost nothing straight in health care because consumers are rarely competent to make health or insurance decisions. How do you chose a doctor? Reputation is nice, but what's it based on? Patient population pools are not the same from one location to another, not all doctors or surgeons are doing the same procedures with the same level of complexity, etc. In the end, it's much more of a shot in the dark than you imagine -- a bit like buying a dog or dog training from a famous breeder or trainer and hoping that the fame is there for an actual reason, and not simply a function of novelty, a well-written book, or a TV show.Another factor is that insurance coverage and premiums are an issue when you are NOT sick, but you are always hungry and the car always needs gas, and the electrical bill always needs to be paid, and so there is a tendency to skimp which is easy enough as the coverage documents rarely say what is ACTUALLY covered or where the deficiencies are.Finally, the entity that pays (an insurance plan of some sort) controls who is paid and what is paid for, while the doctor or hospital decides the drugs and devices.The bottom line is that buying health care is NOT like buying apples at Safeway, and in most cases there are no "do overs" if you do not like how it turns out.And what insurance plan is the one most accepted in this country, and which one has the highest patient satisfaction? Medicare and Medicaid... single-payer health care.P
Carson, man, Carson, though I'm sure "Ben Carter" is a wonderful guy, too. ;) I had a friend who was a very sharp nurse, and she said I should go to see him for my issue. This was before his books were written, the movie about him was made, etc., so those things did not exist to sway me. I'd never heard of him before I made an appointment to see him. Ends up, this is one person who actually exceeds his hype. Incredible rare air up there, and yet he is a soft-spoken, humble person. I'm self-employed, and in addition to the usual slings and arrows of navigating the "health" care system, I get to pay my outrageous premiums all on my own. Ditto for my self-employed husband. You haven't lived until you've walked a mile in our checkbook's shoes. Seahorse
Whoops -- Yes Carson. A typo -- see reference to books and movies. A fantastic reputation. Here's a serious question though: How come so much surgery is scheduled for so early in the day (i.e. the crack of dawn?) I figure the surgeons and nurses (etc.) have to get up at 5 am to be at work by 7. Is it to get it all in BEFORE they get start hosing down coffee and getting the coffee jitters?P
Hmmm...you could be on to something! Check-in for surgeries up there is usually O'Dark-thirty, and when added to the 2 hour commute for us was killer. Especially since (prepare for Terrierman blasphemy!) we don't drink coffee! In Dr. Carson's case, I'm not sure his religious beliefs allow for coffee (I think he's 7th Day Adventist?). I do know that he has an unwavering hand, which is my prerequisite for monkeying around inside my brain! Seahorse
I raised the question at work, and the answer which sounded most right is that it's the easiest time to make sure the patient has not eaten -- if they ate the night before, it's either passed or been reduced to the point it is not likely to come up during intubation. I forgot the reason might have something to do with the patient! Doh!P
HA! Makes total sense! I'd not have thought of it as I simply do EVERYthing Dr. Carson tells me to do (to include not eating). He tells you to pray the night before surgery, and even this non-believer does just that. Dr.'s orders!Seahorse
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