Bitter Pill: Why Medical Bills Are Killing Us

[kuronosan]

You should consider eating less red meat. I'm guessing your LDL is high and your HDL is low. Kinda sucks.

At least you're not diabetic. People get taken to cleaner with those medications.

CNV or CSR? You had to see retina guys, huh? They have a pretty cush lifestyle...

Choroidal neovascularization. Sucks.

[Ksandra]

With my insurance plan my wife and I can go see any specialist we want without a referral. In my opinion, needing a referral is necessary in some cases but in most cases it's not. Seriously. Why go see a family practitioner if you have gastritis symptoms when a specialist can just get it out of the way right then and there? More often than not you're going to get referred by lazy doctors anyway.

Do you not have family members that call you for medical advice? I don't mind the referrals because, quite honestly, people are generally too ignorant to know which specialist they need. They think they need a gastroenterologist when they need an EENT or vice versa. I have had family members call and say "my baby woke up with a dry diaper and she's been throwing up all night, what do I do...". Those aren't the people I want skipping referrals. It'd be far too inefficient.

At the time I was pregnant I was on BCBS and had to stick with them (pregnancy = pre-existing condition so other companies wouldn't take me). I have then switched to Kaiser and it almost makes me fume that more companies are not like them. Everything is centralized with them, so if I were to switch offices it would have been a non-issue.

One great thing is that they have a nurse call line where you can explain symptoms and they can tell you general advice and/or who you should make appointments with. And all the specialists will be at the same Kaiser center. I really really wish I had them forever ago. Granted, their prices I'm sure are still fucked on a lot of things, but outside of that their overall business model is really nice and I hope they spread throughout the country.

[Churchill]

I have drawn blood, given IV's, treated people with serious gunshot wounds, burns, blasts, etc. The drawing blood and giving IV's part is trivial and I'm pretty sure you could train a monkey to do it.

Fucking lol at trying to make it sound otherwise.

[Ragnus]

That's the funny thing. I think I have red meat only only once or twice a month. I mostly eat Gardein meat alternatives for protein. The slew of doctors found that my problem is that my liver is overactive and is constantly pumping cholesterol into my system at a rate that exceeds my cells' need for it. And yeah, that was a typo above. My bad cholesterol has always been the bulk of it in my system.

The generic version of the drug I'm on now is $12 a month with my insurance that I have through work. I asked what it was normally if I paid out of pocket and it's 10x that much.

[archibaldcrane]

Anyone use online spam "canadian" pharmacies? NPR did a big article on spam and the pharmacies that they promote, and found something crazy:

http://www.npr.org/blogs/money/2013/...siness-of-spam

In the course of Savage's research, he and his team placed over 800 test orders and typically received their chosen medications in a timely fashion.

"We've maybe only had one time where we didn't get anything," said Savage. They tested some of the drugs they received, and all had the proper amount of the active ingredient.

Savage says the vast majority of customers are ordering erectile dysfunction drugs. Others order painkillers or stimulants for recreational use. But up to 15 percent of orders come from people seeking medications to treat chronic health conditions, likely because they can't afford to purchase them through legal avenues.

[kuronosan]

I have drawn blood, given IV's, treated people with serious gunshot wounds, burns, blasts, etc. The drawing blood and giving IV's part is trivial and I'm pretty sure you could train a monkey to do it.

Fucking lol at trying to make it sound otherwise.

Have you tested the blood? No? Then shut the fuck up Captain Badass Military Guy. And no, you can't train a monkey to do. I've trained doctors to draw blood and they still don't get it right. Will you ever stop using yourself, the self-proclaimed awesome-at-everything-dude, as a landmark for the rest of the population?

We get it. You're fucking cool and awesome and a trained killer. You're not everyone else. Stop making it sound otherwise.

[Churchill]

Putting a label on the blood so it can be tracked, throwing it through a variety of tests. Yep, super hard. That's why we have people who aren't doctors do it, because it requires so much schooling that Jane the 2 year RN can do it as if she was a trained monkey.

You want to pretend drawing and testing blood/running a CMP is a fucking highly skilled ordeal, go ahead.

[kuronosan]

Putting a label on the blood so it can be tracked, throwing it through a variety of tests. Yep, super hard. That's why we have people who aren't doctors do it, because it requires so much schooling that Jane the 2 year RN can do it as if she was a trained monkey.

You want to pretend drawing and testing blood/running a CMP is a fucking highly skilled ordeal, go ahead.

Talk to me about the clinical significance of the results. Tell me the sources of error of each test in a CMP. Do it. Don't google it. Don't WebMD it. Tell me from the top of your head what can interfere with each assay, methodology, and reading, on every available assay there is.

Oh, and I also want you to explain to me some of the top sources of error of a cross-match and what you can expect to find in neonatal CBCs or trauma patients.

Drawing the blood and running the tests may seem trivial to people like you because the results seem to shit themselves out but believe me it is anything but.

[zoobernut]

I read this article yesterday and found it to be interesting and well written. It was also very disturbing. I have had similar experiences dealing with what I thought was something minor turning into a huge deal as well as my wife has. It really sucks when it happens. The other side to the equation is that dealing with insurance companies sucks just as much as dealing with the hospitals. The patient is stuck in the middle of a shitty situation with no one to help them.

[Churchill]

It takes 30m to do by Privates in the military...so I'm gonna stick with trivial.

Uh. Human Error? lol. Hb, hct, platelets iirc. Similar testing you would do as an EMT except you do it in a lab and pretend it takes a lot of training. I don't know shit for Neonatal. Fuck kids.

[kuronosan]

... derp double pasta

[kuronosan]

P.S. Church, the #1 source of shitty lab results are those Jane R.N.s that fuck up the draw and call the real phlebotomists in to get the sample.

edit:

It takes 30m to do by Privates in the military...so I'm gonna stick with trivial.

Uh. Human Error? lol. Hb, hct, platelets iirc. Similar testing you would do as an EMT except you do it in a lab and pretend it takes a lot of training. I don't know shit for Neonatal. Fuck kids.

You don't know shit at all. Stick to military stuff and leave the medical science to the medical people.

[Ksandra]

I dunno enough about the whole blood drawing thing. But to be fair to kuro, I have a severe fear of needles that is the result of years with RNs who can't get the needle in my vein and end up poking me like 10 times before either getting it right or calling a specialist. I don't have rolling veins just insanely tiny ones.

[Kryssan]

It takes 30m to do by Privates in the military...so I'm gonna stick with trivial.

Uh. Human Error? lol. Hb, hct, platelets iirc. Similar testing you would do as an EMT except you do it in a lab and pretend it takes a lot of training. I don't know shit for Neonatal. Fuck kids.

Mm, I understand what kuro is trying to point out here. I've been an EMT but that's as far as my medical training goes ( outside of the basic stuff you have to know for mass casualties in the military ). However, the point I believe he was trying to make, particularly with the above dichotomy on reading and analyzing the charts, is that while anyone can do it, that doesn't mean that anyone should do it.

I could take any reasonably competent person fresh from high school and train them to sit in front of a control board for a nuclear reactor at power and expect them to have no issues operating it ( in fact, this is what happens a lot of the time and one could say is a factor in many of the incidents and accidents we've seen ). Days or weeks with minor variations and problems to overcome, they could handle with probably little to no issue and feel quite comfortable doing it, without any actual knowledge of the theory behind what's going on. The problem is, when the shit hits the fan they're going to have no clue what to do, and worse, because they didn't know the theory they'll have had no indication it was about to happen which would have allowed them to prevent it in the first place.

So while the actual doing of something can be handled by trained monkeys, we would always prefer that someone who actually knew the specifics and theories behind something were the ones doing it. Unfortunately, there just aren't enough of those to go around so we'll probably always be doing it with the current best known methods.


Personally, I have little faith in military medicine as I've seen too often those same people you're discussing have blown over major problems because they didn't feel like dealing with it or they felt the person was whining too much ( the worst case of which nearly resulted in a student having a ruptured pericardium ). I haven't had much dealings with the civilian side of things to really color my views one way or another, though this problem I've seen on the military side probably also applies on the civilian side; the real question is to what degree.

[kuronosan]

Put it this way. If you were sick, who would you trust? The trained doctor or the guy using WebMD for android?

What Church is saying would basically be the same as me saying anyone can point a rifle at someone and shoot with pinpoint accuracy, making the Marines a joke.

[fantasticdan]

Anyone use online spam "canadian" pharmacies? NPR did a big article on spam and the pharmacies that they promote, and found something crazy:

http://www.npr.org/blogs/money/2013/...siness-of-spam

No, but I've bought (well, stockpiled really..) my medications from indian and russian online 'pharmacies' for practically nothing when I didn't have insurance for a while. Got everything fine on all three occasions from different websites.

[NynJa]

And here I thought americans laughed at Canadian Health Care citing "atleast we dont have to wait 12 hours to see a doctor"

[Ksandra]

And here I thought americans laughed at Canadian Health Care citing "atleast we dont have to wait 12 hours to see a doctor"

only the south. And we don't count those as people.

[kuronosan]

I dunno enough about the whole blood drawing thing. But to be fair to kuro, I have a severe fear of needles that is the result of years with RNs who can't get the needle in my vein and end up poking me like 10 times before either getting it right or calling a specialist. I don't have rolling veins just insanely tiny ones.

I have had to see patients that say nurses tell them they have bad veins and use small needles (which can ruin lab testing) and I will land their vein the first time.

I respect the way that Church offers his opinion but it's just plain infuriating to have someone who doesn't understand shit about a field to act like an expert.

[Ksandra]

ya usually when they get a specialist in they get it right away. Sometimes I feel like I should ask for one flat out anytime I need a needle, but knowing hospitals, they'd charge me extra for asking.