Relevant and even prescient commentary on news, politics and the economy.

The Rich Stay Healthy, the Sick Stay Poor

Health and Economic Development Primer in one easy lesson (via SocProf’s Twitter feed):

This is not surprising to see the contrast between the prosperous (at least until now) areas, in green where chronic illnesses prevail but are diseases tied to aging, as opposed to the semi-periphery and periphery where infectious / parasitic diseases are prevalent along with accidental deaths. Obviously, to be born and live in a prosperous society makes life more secure on different levels.

Extending lifespans and expanding health has been, for the most part, a Macro story of discontinuities.

The rise of vaccines (with a possible contribution from the coincident rise of people getting a high school education) got the Developed World to the point where Major Organ Failure became a primary factor.

Lungs are first: pneumonia and tuberculosis don’t kill the young so often as they did. (Vaccines, testing).

The heart was next. Major advances in the immediate post-WW II (what the Europeans tend to call “post-war”) period—up to and through transplants and ever-advancing bypass surgeries—made it more difficult to die because your heart was weak or flawed.

The next step is the brain; rather more problematic, though progress gets made.

Note that the key assumption in all of the above is access to and use of the available advances. In a system that de facto rations by ability to pay (the U.S.), there is a greater likelihood that the rich will live longer—or, more accurately, that the poor will die unnecessarily sooner. Which is what has been happening.

This post dedicated to the memory of Isaac Asimov, who survived a heart attack for fifteen years and a triple-bypass that gave him nine more years of writing (though with collateral effects that would not occur today).

Health Care: Regulatory Inconsistency

by Tom aka Rusty Rustbelt

Health Care: Regulatory Inconsistency

When an elderly patient is in the hospital suffering from dementia, depression or schizophrenia, the hospital nurses may administer any psychoactive or anti-psychotic drug ordered by the physician within normal protocols and practices.

When the patient becomes a nursing home resident a few days later, the resident will often be denied the medication (even possibly anti-seizure meds) because the medication is assumed to be a “chemical restraint,” and the facility needs time to clear the regulatory hurdles.

(The federal government assumes nurses drug residents into stupors so the nurses don’t have to work as hard, ignoring that nurses cannot administer a vitamin without a physician’s order.)

This pharna roller coaster hurts the patients, but it is the law of the land.

Tom aka Rusty Rustbelt

Health Care thoughts: Reality is Ugly

by Tom aka Rusty Rustbelt

Health Care: Reality is Ugly

An Indiana baby with an extremely rare condition will not be receiving $500,000 experimental surgery at Duke because the State of Indiana cannot afford to pay the bill for the surgery.

The immediate howls of protest are directed at the Republican governor, but there are bigger issues here, and a comparative effectiveness program designed by Democrats could easily come to the same decision.

Stipulated, no one wants to see a baby die. No one. However…..

No system has infinite resources, and if the money was spent it would be care taken away from some other Indiana residents. Even if the economy were better.

On the other hand (as an economist might say) many common procedures were once experimental, that is how new surgeries and new cures are developed.

Fifty years ago this was easier, medicine was relatively primitive and babies died (including my infant cousins) because nothing could be done. Now, we have difficult, terrible decisions to make.

HT: Yahoo News

Health Care thoughts: Really, Really Bad Idea (?)

by Tom aka Rusty Rustbelt

Health Care: Really, Really Bad Idea(?)

The Food and Drug Administration has approved a proposal to liberalize the guidelines for lap band weight loss surgery (much to the delight of the company making lap bans).

Previous guidelines required a very high level of severe obesity OR severe obesity combined with hypertension or diabetes or etc.

New guidelines will likely double the number of persons qualifying for the surgery. (If i had high blood pressure I would qualify, and I’m not that fluffy).


Physicians are supposed to screen such candidates after exercise and diet have failed, or proceed when collateral medical conditions are very serious, this will potentially cause of rush of surgeries by patients who would be better off with fork control and more exercise. Many health providers think so, but aren’t likely to say so loudly in public.

The surgery does have side effects, and every surgery has infections risks.

And there is a significant cost for each surgery. There is no cost in driving past Krispy Creme.

Health Care thoughts: Religious, Gender and Cultural Issues

by Tom aka Rusty Rustbelt

Health Care: Religious, Gender and Cultural Issues

The Muslim population in the U.S. is now about 7 million, some having been here many generations and others being new immigrants. Muslims arrive with various cultural backgrounds and various degrees of cultural conservatism. Americans of other religions and beliefs also have cultural sensitivity issues as well.

This sometimes creates issues for health care providers, particularly caring for Muslim women.

A hospital on the east coast is being sued because the only EKG tech in the building at midnight was a male and a Muslim female in the emergency department refused the test, later leaving for another hospital.

Culturally conservative women have issues with male physicians and any state of undress. Many women of various persuasions prefer female ob-gyn care.

For most routine care women can find women physicians in this era, for emergency or specialty care this may not be readily possible.

Female patients (of all religions) in nursing homes often have problems with male nurse aides. Males generally do not care as much (although some males have an issue with care from very young women).

Most of these issues can be worked out, but sometimes the issues interfere with prompt care. Patients in more rural areas may have problems choosing providers. (In our rural Mrs. R has a male Muslim primary care doc, I have a male Mormon, so some rural areas are a little more diverse).

Just one more complication in a very complicated system.

HEALTH CARE thoughts: Resident Rights versus Caregiver Rights

by Tom aka Rusty Rustbelt

HEALTH CARE: Resident Rights versus Caregiver Rights

In 1987 the federal government passed a comprehensive “bill of rights” for nursing home patients. Most states followed.

The law gives nursing home residents wide protection, including (when mentally able) the ability to refuse care, meals and just about anything else they please.

Resident care preferences regularly create all sorts of difficult issues though, including:

Can white residents refuse care from black nurses and nurse aides? ( a common problem)

Can female residents refuse care from male caregivers? (the courts say yes on privacy grounds)

Can residents request care from specific employees (a latino requesting a latino)?

Can residents request care from specific employees just because they like the employee?

Mrs. Rustbelt has dealt with all of these issues (recently) and many more. Her first comment was “I only have to do 12 hours work in 8 hours, of course I need to referee a unit full of adult children. Grrrrr.”

According to a recent federal court in an Indiana case, if a white resident requests “no blacks” and the facility accommodates (according to Indiana law) the facility has discriminated against the employee.

Keeping in mind the average nursing home resident is about 78 years old with multiple physical problems and some level of mental and emotional impairment, this creates just a great big mess, and the facility loses in every scenario.

The unintended consequences of government regulation. Everyone suffers except the bureaucrats, and the lawyer who profit. Anyone got any solutions?

HEALTH CARE thoughts: The Durable Medical Equipment (DME) mess

by Tom aka Rusty Rustbelt

HEALTH CARE: The Durable Medical Equipment (DME) mess

So you go to an orthopedic surgeon with a complaint of back pain, and the surgeon orders a lumbar back brace for support.

Can you stop at a counter and buy the brace on the way out the door? Probably not.
Years ago some members of Congress (Stark, Waxman, thought it would be harmful if physicians profited from their prescriptions, but not harmful for others to do so, and thus has flourished a huge DME industry, ranging from hospitals and national chain pharmacies to mom-and-pop operations. (When I ran ortho centers we subbed out DME, too much hassle and compliance risk.)

Some DME providers get greedy and there has been a significant amounts of fraud in this area, most recently dealing with the ubiquitous motorized wheelchairs and power chairs of television fame.

But the latest DME fraud trend is really disturbing. DME fraud is being committed by phony “providers” who tend to be involved with organized crime, immigrant organized crime, computer hackers and identity thieves. These businesses do not exist, have no customers, provide no merchandise and steal billions from the feds with phony billings. Reading the indictments is enlightening.

(A few years ago nearly 50% of all of the diabetic supplies FOR THE ENTIRE COUNTRY were being billed from Miami – Dade County. Huh? Impossible of course. Miami appears to be a hot bed for immigrant crime.)

The feds caught on somewhat and set up a task force in southern Florida, and now are using the task force in Houston and possibly elsewhere.

Something here aggravates me. Getting a physician Medicare ID number, or adding a physician to an established group, takes a lot of time and a lot of paperwork, even though the physician is licensed and board certified. Apparently though any ambitious criminal can get a DME provider number with almost no hassle and start firing in billings. After a few months the operation closes down, takes the cash and billing starts for a new phony provider.

Medicare needs better management.

Tom aka Rusty Rustbelt