Category Archives: General Cynicism

$80,000 and 5 ER Visits: In American healthcare it’s the INCOME not OUTCOMES

An encounter with our health care system is worse than going to a used car lot. In the latter case you more or less know before the purchase what your cost will be, albeit the route to the final price is galling.

In the U.S. healthcare non-system the sky is the limit as providers hide prices and arbitrarily raise them without consulting with the consumer. Needless to say the buyer of services is ultimately liable for the full price.

“Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.”

“The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.”

Medicynical Note: When I lived in a third world country years ago, little kids would approach me at the open market and ask for baksheesh. Every time, every single time. They’d ask whether or not I gave.

Our healthcare system is a rabbit warren of rules and regs a little like that open market. Providers always ask for the gift and diligently game the system to maximize billings. Hospitals hide prices and years ago learned that they made more by itemizing every little thing and overcharging for each item rather than by providing a comprehensive price for a service. Adding to the confusion, prices charged insurers vary widely are often tiny fractions of that charged to customers without insurance.

And yes, the multimillionaire CEO’s of healthcare companies and health insurers could care less whether you get affordable care or whether you survived your encounter with the healthcare system For them it’s the company’s income not patient outcomes that is important. That’s America.

Guns….My Morning Reads

Medicynical Note: The other fatal epidemic in America. Guns terrify everyone and in the U.S. they are everywhere. A uniquely American problem (we lead the world in ownership and deaths) in a once civil society that absurdly maintains that it values life.

It should also be noted that in the other epidemic the U.S. also leads the world in deaths. What the hell is wrong with us?

Republican Salami Tactics Undermine Our Democracy

In Eastern Europe after WWII the Soviets consolidated power by undermining countries monarchies and fledgling democracies by subverting elections, the judiciary, police authorities and political parties. This strategy was termed salami tactics—undermining by a thousand cuts.

We are now facing a similar Republican/Trumpian strategy. They are literally taking apart our elections, Judiciary and soon our political structure with a thousand cuts. And sadly the Supreme Court seems a key part of this undoing.

This article from Slate explained salami tactics in 2019……its even worse now. Call it what you like our Democracy is threatened and maybe by this point finished as we know it.

Medicynical Note: Our republican friends are attempting to subvert the election process in states in which they control the legislatures; they are gerrymandering beyond all previous such actions; inhibiting the vote in areas where the opposition resides; not recognizing the validity of fully validated elections (they lost by millions) and are openly supporting violent insurrection. It’s happening now in the U.S.

Putin: Very Trumpian

Remarkable performance by Vladdy. Following Trump’s lead in inventing narratives that are counterfactual. Up is down—only because I say so.

While threatening war and massing troop at the border, claims the other side is threatening.—with no troops, no military presence……..just COVID.

Medicynical Noter: Chutzpah.

Religionists Can’t Resist : Hindu vs Christian

There is something about the preschool level “mine is better” than yours fundamentalist religion mentality that brings out the worst in man.

“To many Hindu extremists, the attacks are justified — a means of preventing religious conversions. To them, the possibility that some Indians, even a relatively small number, would reject Hinduism for Christianity is a threat to their dream of turning India into a pure Hindu nation. Many Christians have become so frightened that they try to pass as Hindu to protect themselves.”

In this case it is Hindus suppressing Christians living in their midst. Under Modi religious myopia has been been reinvigorated and been more the rule than the exception.

In this behavior India is not unique. Throughout the world religion the so-called force for “good” is the rational for supression and persecution of followers of other beliefs. Most religions, except perhaps for Quakers and the Baha’ and a few others, seem unable to resist attacking and discouraging others. That appears to be their nature.

Medicynical Note: And yes the U.S. that “paragon” of virtue in the world also suffers from religious sourced anarchy. The notion of separation of Church and State protected us from religious hegemony for 250 years. But now there are U.S. religious fundamentalists who maintain that their beliefs should be supreme and that government should be based on often ridiculous, highly ambiguous, vague, and medieval biblical interpretations.

The Only Fraud in the 2020 Election Was Named Donald

There have been many analyses of the vote in the last presidential election. Our former President claims it was a landslide in his favor and that he was defeated by voter fraud. That claim seems once again to have been debunked. The only fraud is Trump himself.

Medicynical Note: Many republicans including those on FOX news have supported Trump’s claim of voter fraud.

Turns out that there was very little fraud in the last election. What republicans really appear to be concerned about is ALL people voting. Imagine that, a so-called democracy, once the leading democracy in the world, under threat because one of the two major parties opposes the concept of universal sufferage.

You may recall: (from Wikipedia) Democracy (Greek: δημοκρατία, dēmokratiā, from dēmos ‘people’ and kratos ‘rule’) is a form of government in which the people have the authority to deliberate and decide legislation (“direct democracy”), or to choose governing officials to do so (“representative democracy”).

Israel’s Absurdity

No irony and no mulligans in the world of nuclear armaments.

But former Israel security officials are increasingly critical of the role Netanyahu played in opposing the original agreement and urging Trump to abandon it. These officials say the accord was imperfect but that the alternative has been worse.”

“This approach enabled “Iran to accumulate a lot more material, work on advanced centrifuges, and maybe other things that we don’t know about, all which brought Iran closer than ever before” to acquiring a nuclear bomb, said Yoel Guzansky, former head of the Iran desk at Israel’s National Security Council and a senior fellow at the Institute for National Security Studies (INSS). “The nuclear deal was flawed, but at least it put a lid on Iran’s advancement, which we don’t have now.”’

Medicynical Note: The only country in the Middle East with nuclear weapons accuses Iran of nuclear blackmail for trying to develop it’s own nuclear weapon (denied by Iran).

The shadow world of Middle Eastern intrigue reveals an incompetence a little like MAD Magazine’s spy against spy feature…….except that we are talking real people and real lives at risk.

Sad Story of Bad Judgment

It’s a case of god’s will going bad. Anyone think this guy deserved his fate?

Medicynical Note: His talibaneque beliefs lead to his downfall. From the time of Copernicus and Galileo religious believers have battled scientific facts and advances. But the world is not flat, Darwin was right, and yes, vaccines work. Repent ye true believers.

Nuclear By Gates…..Bury the Waste in Gates’ Yard

Bill Gates dabbles. He’s developed an elegant expensive highly technical garbage disposal system first deployed in a third world county. The only catch being that countries in the third world have neither the money nor the technical expertise to keep such endeavors going. Little has been heard since 2015 about this gadget aside from lessens learned communications from the Gates Foundation about future plans for this Rube Goldberg like processing system. One wonders how applicable economical and effective it will be for other locations.

Moving on Gates now is proposing pocket-sized nuclear energy plants for small towns and cities cooled with highly flammable liquid sodium……what could possibly go wrong?

Medicynical note: Gates dabbles and comes up with innovative but impractical solutions. That’s his modus. His waste plant had problems in it’s first iteration and will, i predict, never fly—I also said that to Orville and Wilbur. His pocket sized nuclear plants also seem to have little chance for success. Multiple locales using high risk energy producing contraptions doesn’t seem like a good idea either. However, should he succeed I would suggest burying the waste in Mr. Gates’ back yard. Nuclear power, with current inadequate safeguards and nuclear waste handling is akin to kids playing with matches.

The Price of Ignorance: American Healthcare Costs

Procuring and paying for healthcare in the U.S. is an exercise more opaque and yes, potentially even more expensive than buying a new car. Ever try and get a firm price for healthcare services? You’ll find that no one can give a total price and guarantee that’s what you’ll be charged.

We have a system of revenue generation not healthcare. Your doctor in modern America is an employee and has little to no control over his office. And doctor’s fees it turns out are only a small part of the total cost.

Adding insult to injury our non-system of healthcare is set up to charge the neediest the most.…..unless they are fortunate enough to have insurance of some type (Obamacare policies, Medicare, Medicaid or private coverage). In the wealthiest (maybe) country on earth we have a system of health care revenue that charges those with the least, the most.

Medicynical Note: I’m an elderly retired M.D. and am well covered by insurance. This year so far my Medicare/Medicare Advantage policy was billed $5,954 for services. Because they have agreements with providers they paid only $2,210.34 for the services with me paying a very modest $10/visit co-pay. Not a bad deal if you have the coverage.

If I were one of the un-insured the providers would charge the entire $5,954……ironically or perhaps by design charging those least able to pay, the most. It’s really an absurd way of paying for health care and is the only such faux health care system/revenue generation system in the industrialized world.

Health care costs in the U.S> are among the leading causes of bankruptcy. Such bankruptcies are unknown in other parts of the world.