Just a “funny” story about my experience in the hospital

[Steve81]

A year ago, I was admitted to the hospital with acute pancreatitis; the heavy doses of painkillers they gave me caused me to develop a bowel obstruction, which resulted in a perforation. Fun times as you might imagine. 
 

I also happen to be a diabetic, which presented some issues. They didn’t allow me to eat or drink for two weeks (talk about a crash diet), and when I was finally able to put something besides ice chips in my mouth , I learned they had nothing in the way of diabetic friendly fare.

Essentially they you ordered whatever and they just shot you up with enough insulin to compensate. I mentioned that to the doctor, and while he agreed with the wastefulness of it all, he said he couldn’t fight the system. Apparently the hospital had outsourced the nutritional side of their operations, so that was that. One wonders how much insulin could be saved by obligating hospitals to have diabetic friendly meal options.

Edited August 11, 2023 by Steve81

[Phi for All]

9 hours ago, Steve81 said:

Essentially they you ordered whatever and they just shot you up with enough insulin to compensate. I mentioned that to the doctor, and while he agreed with the wastefulness of it all, he said he couldn’t fight the system. Apparently the hospital had outsourced the nutritional side of their operations, so that was that. One wonders how much insulin could be saved by obligating hospitals to have diabetic friendly meal options.

The cost of the extra insulin is less than the cost of maintaining meals for a specialty group. These types of decisions will always be made as long as medical treatment is administered from a privately-owned model. Profit is #1 and healthcare follows somewhere after that.

It becomes obvious when you look at the insurance side. Most insurance actually makes some sense. You have a house/boat/car/life that you can figure out the exact worth of in order to insure it properly, but medical insurance isn't like that. You can't know how much or how little medical treatment you may need over your life. I'm not sure how to do it, but medicine in general needs to stop thinking about how much money it can generate and start focusing on helping people live a higher quality, more healthful life.

[Steve81]

3 minutes ago, Phi for All said:

The cost of the extra insulin is less than the cost of maintaining meals for a specialty group. These types of decisions will always be made as long as medical treatment is administered from a privately-owned model. Profit is #1 and healthcare follows somewhere after that.

I would counter that diabetics are a pretty large specialty group with a greater propensity to be hospitalized than the “average” individual.

[studiot]

14 minutes ago, Phi for All said:

The cost of the extra insulin is less than the cost of maintaining meals for a specialty group. These types of decisions will always be made as long as medical treatment is administered from a privately-owned model. Profit is #1 and healthcare follows somewhere after that.

It becomes obvious when you look at the insurance side. Most insurance actually makes some sense. You have a house/boat/car/life that you can figure out the exact worth of in order to insure it properly, but medical insurance isn't like that. You can't know how much or how little medical treatment you may need over your life. I'm not sure how to do it, but medicine in general needs to stop thinking about how much money it can generate and start focusing on helping people live a higher quality, more healthful life.

 

9 minutes ago, Steve81 said:

I would counter that diabetics are a pretty large specialty group with a greater propensity to be hospitalized than the “average” individual.

 

Well this plays nicely with the other discussion about socialism + insurance.

 

To answr phi the american insurance indistry pioneered the use of Bayesian statistics when everyone else (mathematicians) was ridiculing it.

In those days the idea of insurance was a socialist idea of 'collective risk sharing' - that is the many collectively paying for the harm suffered by a few of their number, noting that the harm could be much greater than any individual couls support.

 

The operative word there being risk.

I seem to remember an older idea of business in general was the taking of a risk in order to receive  benefit (profit).

These days business seems to be promoting the idea of "business want certainty".

[Phi for All]

6 minutes ago, Steve81 said:

I would counter that diabetics are a pretty large specialty group with a greater propensity to be hospitalized than the “average” individual.

What are you "countering"? There's a percentage number where the bean counters determine that a new process will be more profitable for them, and they don't change until that percentage number is reached. Right now you're just 11 people out of 100 to them, so obviously that percentage is too low, and they continue to NOT offer anything that will cost them extra. 

The fact that you have "a greater propensity to be hospitalized" means that saving money when treating you helps them maintain profit more easily. I also worry that some cell therapy recently introduced will struggle if it works well, simply because it would impact the sale of insulin and all related products. Medicine and profit are not a good mix. When Salk developed the polio vaccine, there were DOCTORS who objected because they made a LOT of money prescribing braces and treatments for polio patients. They were angry that he ruined their investments.

10 minutes ago, studiot said:

To answr phi the american insurance indistry pioneered the use of Bayesian statistics when everyone else (mathematicians) was ridiculing it.

In those days the idea of insurance was a socialist idea of 'collective risk sharing' - that is the many collectively paying for the harm suffered by a few of their number, noting that the harm could be much greater than any individual couls support.

Insurance in the US changed just before I could take advantage of the old system, where one could buy medical insurance based on actuarial tables with premiums based according to your age. They knew by the numbers on average how much medical attention their clients would need in their lifetimes. If you were 20 when you signed up, you paid very little. The insurance company assumed you'd be with them for life, since a change in insurors means they base your premiums on your new age. 

Then Nixon and Kaiser got together and cooked up the whole "managed" healthcare system we have now. Monumental joke.

[Steve81]

8 minutes ago, Phi for All said:

What are you "countering"? There's a percentage number where the bean counters determine that a new process will be more profitable for them, and they don't change until that percentage number is reached. Right now you're just 11 people out of 100 to them, so obviously that percentage is too low, and they continue to NOT offer anything that will cost them extra. 

The fact that you have "a greater propensity to be hospitalized" means that saving money when treating you helps them maintain profit more easily. I also worry that some cell therapy recently introduced will struggle if it works well, simply because it would impact the sale of insulin and all related products. Medicine and profit are not a good mix. When Salk developed the polio vaccine, there were DOCTORS who objected because they made a LOT of money prescribing braces and treatments for polio patients. They were angry that he ruined their investments.

I’m was countering the implication that diabetics represent a tiny fraction of hospital patients. Given the 11/100 ratio you provided, combined with the fact that we spend more time in hospitals, that seems unlikely to be true, depending on one’s definition of tiny of course.

I’d also note that a balanced diet relatively low in carbohydrates benefits more than just diabetics as well. It’s not a cure all by itself of course for things like heart disease, but it certainly doesn’t hurt. The South Beach diet was developed by a cardiologist after all.

I do agree with the issues of a for profit medical system. The fundamental issue as I see it is, what wouldn’t you pay to save your life?

Edited August 11, 2023 by Steve81

[Phi for All]

18 minutes ago, studiot said:

These days business seems to be promoting the idea of "business want certainty".

Even outside of medicine, we're seeing that the only loans the banks are interested in are the ones that offer a small but almost guaranteed ROI. The mediocrity this is unleashing on the American public is disgusting. We're seeing a LOT of new restaurants that don't actually cook anything on their own, but rather have some kind of arrangement with their foodservice provider for instant meals of an astonishing variety. Many US restaurants now offer everything from pizza to tacos to fish & chips to cheesesteak sandwiches to burgers, with an emphasis on variety over quality.

9 minutes ago, Steve81 said:

I’m was countering the implication that diabetics represent a tiny fraction of hospital patients. Given the 11/100 ratio you provided, combined with the fact that we spend more time in hospitals, that seems unlikely to be true, depending on one’s definition of tiny of course.

It wasn't an implication at all. And why are you using a definition of "tiny fraction" based on you or me? Ultimately, it's the executive suite at the various healthcare providers who define the kind and amount of resources they'll spend on you or any group.

[Steve81]

1 hour ago, Phi for All said:

It wasn't an implication at all. And why are you using a definition of "tiny fraction" based on you or me? Ultimately, it's the executive suite at the various healthcare providers who define the kind and amount of resources they'll spend on you or any group.

Any thoughts about the rest of what I wrote, or do you prefer to be pedantic?

[Phi for All]

40 minutes ago, Steve81 said:

Any thoughts about the rest of what I wrote, or do you prefer to be pedantic?

I disagree that the fundamental issue here is "What wouldn’t you pay to save your life?" I think it's "Why should saving lives be based on what you can pay?"  Sorry if that's too pedantic. It's for-profit thinking that drives stupid decisions like the one you describe in your OP. Money over medicine. It's cheaper to jab you than to pay an outsourced third party extra to have the right meal on hand.

What if the fire department worked that way? "Your house is on fire? What wouldn't you pay for us to put it out?"

Me personally, I think making meals friendly to ALL patients recuperating from medical procedures is a big step towards humane healthcare. I can't imagine recovery without the right food to eat. Also personally, I think 11 out of 100 is a huge fraction when it comes healthcare. If it were up to me, I'd make fewer bombs and sink more money into cures. And in the meantime, stop wasting insulin.

[exchemist]

3 hours ago, Steve81 said:

I’m was countering the implication that diabetics represent a tiny fraction of hospital patients. Given the 11/100 ratio you provided, combined with the fact that we spend more time in hospitals, that seems unlikely to be true, depending on one’s definition of tiny of course.

I’d also note that a balanced diet relatively low in carbohydrates benefits more than just diabetics as well. It’s not a cure all by itself of course for things like heart disease, but it certainly doesn’t hurt. The South Beach diet was developed by a cardiologist after all.

I do agree with the issues of a for profit medical system. The fundamental issue as I see it is, what wouldn’t you pay to save your life?

 

I'm an outside observer on this, being in the UK, but it seems to me the basic problem with the US health system is that it is what is called a "broken market". The consumer has no leverage over the supplier and thus it is not a suitable subject for market competition to deliver an efficient outcome. As I understand it, most people in the US get health cover as part of their employment remuneration. The employer pays a charge to an insurer, who adds a mark-up to the charges it receives from the medical providers. So the end consumer of health treatment is 3 steps away from the provider and has no market power. Nobody in the chain has either the incentive, or the purchasing power, to shop around and drive down costs to keep the providers honest. In theory the insurer might have such an incentive, but in practice it is easier just to accept the charges, pass them on to the employers, with a mark-up, and get out on the golf course.  

In most other countries there is central purchasing of health provision by the government, by means of large and valuable contracts, professionally negotiated, and hard bargains can be driven. But that involves a role for "government" - which is anathema to all the American rightwingers, brought up  on the myth of individualism and Ayn Rand.   

Edited August 11, 2023 by exchemist

[CharonY]

3 hours ago, Phi for All said:

Even outside of medicine, we're seeing that the only loans the banks are interested in are the ones that offer a small but almost guaranteed ROI. The mediocrity this is unleashing on the American public is disgusting. We're seeing a LOT of new restaurants that don't actually cook anything on their own, but rather have some kind of arrangement with their foodservice provider for instant meals of an astonishing variety. Many US restaurants now offer everything from pizza to tacos to fish & chips to cheesesteak sandwiches to burgers, with an emphasis on variety over quality.

In gastronomy there is another issue at play. Salaries are typically the highest expense in a restaurant as the work is rather labor-intensive. In addition, the margins on food are often low, especially for freshly produced items. In most of North America (and increasingly elsewhere) there are more and more chains that that are simply more profitable as they have pre-cooked food and require less trained staff. 

At the lower price scale, often only family-run restaurants (which basically have cheap labor in form of family members) are likely to stay alive for a bit longer. This also means that there is a huge cultural loss to corporations here, which makes me rather sad (and supercharged by the pandemic).

 

41 minutes ago, Phi for All said:

Money over medicine. It's cheaper to jab you than to pay an outsourced third party extra to have the right meal on hand.

Also saves trained staff, similar to the actual restaurants. Also, insulin is dirt-cheap, if purchased in bulk by comparison. Finally even in non-profit systems, hospitals are run by administrators and not that frequently by medical experts. As such it is more about profit or balancing budgets (which is less bad but not by that much). There are a lot of stories from MDs who talk about how stupid administrative decisions interfere with their ability to care for patients. This is especially the case when it comes to atypical diseases. 

The delayed reporting and initial suppression of information during the early COVID-19 outbreaks is a bit of an administrative (though not operational) example of how checklists are taking precedence over medical judgement.

[Steve81]

1 hour ago, Phi for All said:

I disagree that the fundamental issue here is "What wouldn’t you pay to save your life?" I think it's "Why should saving lives be based on what you can pay?"  Sorry if that's too pedantic. It's for-profit thinking that drives stupid decisions like the one you describe in your OP. Money over medicine. It's cheaper to jab you than to pay an outsourced third party extra to have the right meal on hand.

What if the fire department worked that way? "Your house is on fire? What wouldn't you pay for us to put it out?"

Me personally, I think making meals friendly to ALL patients recuperating from medical procedures is a big step towards humane healthcare. I can't imagine recovery without the right food to eat. Also personally, I think 11 out of 100 is a huge fraction when it comes healthcare. If it were up to me, I'd make fewer bombs and sink more money into cures. And in the meantime, stop wasting insulin.

That was exactly the point behind my "What wouldn't you pay" comment. Because we're obligated to partake in the healthcare system (unless we wish to suffer or die), for a for profit healthcare system is inherently broken, especially accounting for the fact that physicians don't exactly grow on trees.

1 hour ago, exchemist said:

 

I'm an outside observer on this, being in the UK, but it seems to me the basic problem with the US health system is that it is what is called a "broken market". The consumer has no leverage over the supplier and thus it is not a suitable subject for market competition to deliver an efficient outcome. As I understand it, most people in the US get health cover as part of their employment remuneration. The employer pays a charge to an insurer, who adds a mark-up to the charges it receives from the medical providers. So the end consumer of health treatment is 3 steps away from the provider and has no market power. Nobody in the chain has either the incentive, or the purchasing power, to shop around and drive down costs to keep the providers honest. In theory the insurer might have such an incentive, but in practice it is easier just to accept the charges, pass them on to the employers, with a mark-up, and get out on the golf course.  

Correct. It's a holdover from the depression era, when wages were frozen to try and limit inflation. One "workaround" to help make employment more desirable was to offer an employer sponsored health plan, and take that from pre-tax earnings. That system hasn't sadly hasn't died yet.

Edited August 11, 2023 by Steve81

[Steve81]

@Phi for All

On the topic of why should saving lives be based on one’s ability to pay (after pondering this a bit on the drive home 😆).

While some may find it odd, I don’t view healthcare as a right, any more than I view food as a right. About the only positive rights that align with my worldview are things like the right to a lawyer, and that’s because the situation has been foisted upon you by the government.

That said, I’m not sure ones aptitude for excelling in capitalism is the defining point of their value as a human being either. This is particularly reinforced by the fact that we have unequal opportunities to succeed in the system. 
 

Of course there are matters of practicality as well. Diseases like Covid-19 thrive in an environment when there are plenty of incubators for it to take up residence in, and the ability of that virus to mutate enhanced the threat considerably. At least Covid was egalitarian enough not to discriminate between the haves and the have nots. Better than I can say about most humans.

Edited August 11, 2023 by Steve81

[OldChemE]

Personally, I am ambivalent on the benefits of government involvement in health care or insurance.  For over 30 years I worked for a very large corporation that elected to save money on health insurance by being self-insured.  They took a reasonable payment from my pay each month (slightly lower than typical premiums) and covered everything.  The beauty of that was that their profit motive required that they keep their employees productive.  They were very generous about health coverage simply because they wanted their employees at work, not on sick leave (they also went big on health maintenance with gyms located in their facilities so you could work out at lunch if you wanted, etc).  They also covered 'borderline' treatments, as long as it helped get the employee back to work (such as weight loss programs or surgeries).  Unfortunately, the requirements associated with the new insurance market under Obamacare forced them to stop self-insurance.  So-- in my case increased government involvement hurt.  My old employer still helps by paying a portion of my annual premiums, but now I too am subject to the profit motive of private insurance.

[StringJunky]

Governments need to be able to negotiate drug prices with the sellers. The point of contact for sellers should not be the doctors, as in private medicine; hello, oxycontin and fentanyl mess. money and dealing with patients should be kept away from each as far as possible. The decision-making on affordability should be whether the health system can pay for it and not the patient. Conversely, wealthy patients can't seek inappropriate treatments, like the analgesics mentioned, and threaten to move to a doctor that will supply them if refused. The ability to shop around can increase the risk of poorer health outcomes.

Edited August 12, 2023 by StringJunky

[CharonY]

27 minutes ago, OldChemE said:

Personally, I am ambivalent on the benefits of government involvement in health care or insurance.  For over 30 years I worked for a very large corporation that elected to save money on health insurance by being self-insured.  They took a reasonable payment from my pay each month (slightly lower than typical premiums) and covered everything.  The beauty of that was that their profit motive required that they keep their employees productive.  They were very generous about health coverage simply because they wanted their employees at work, not on sick leave (they also went big on health maintenance with gyms located in their facilities so you could work out at lunch if you wanted, etc).  They also covered 'borderline' treatments, as long as it helped get the employee back to work (such as weight loss programs or surgeries).  Unfortunately, the requirements associated with the new insurance market under Obamacare forced them to stop self-insurance.  So-- in my case increased government involvement hurt.  My old employer still helps by paying a portion of my annual premiums, but now I too am subject to the profit motive of private insurance.

The issue is that it works quite well if folks have only minor health issues. But once it gets serious, folks are facing a double-whammy. The company might fire them because of lost work due to illness, (and the likelihood of being irreplaceable has been shrinking in modern companies), and losing the insurance can result in massive debt (there is plenty of statistics to show that). Before ACA, pre-existing conditions could also be excluded from coverage. So yes, if you have a good income, a great job with excellent coverage, it might not seem like a problem. But for everyone else, the situation kind of sucks and statistics do show the negative impact on overall public health, especially for those with lower income.

That being said, public health is a team sport and if one lets someone suffer, sooner or later almost everyone will be affected negatively.

 

52 minutes ago, Steve81 said:

At least Covid was egalitarian enough not to discriminate between the haves and the have nots. Better than I can say about most humans.

It did discriminate, actually. Workers and other folks relying on work under unsafe conditions were way likelier to contract and die of COVID-19. Also related to that, countries with higher income inequality also suffered a higher health burden.

[StringJunky]

In the UK, our health contribution burden is about £40/$50/month for a low earner (£15) and £250//$300/month for a £30K earner. What is the typical equivalent contribution in the US for those salary bands?

Edited August 12, 2023 by StringJunky

[Steve81]

11 minutes ago, CharonY said:

It did discriminate, actually. Workers and other folks relying on work under unsafe conditions were way likelier to contract and die of COVID-19. Also related to that, countries with higher income inequality also suffered a higher health burden.

I wouldn’t say that was strictly COVID’s fault. It spread where it could, nothing more, nothing less. To wit, even Trump caught it; he just had access to bleeding edge medical care (also not the fault of a virus).

Edited August 12, 2023 by Steve81

[iNow]

6 hours ago, exchemist said:

So the end consumer of health treatment is 3 steps away from the provider and has no market power.

We also can’t spend time shopping around for which providers offers the lowest cost and best care after having a heart attack or getting hit by a bus. 

“Sorry, Ambulance Driver. I know we’re sort of in a hurry here, but let me first please check the ratings of the 27% of doctors nearby who actually accept my brand of insurance as a valid form of payment. I’ll tell you which one to drive me to here momentarily so long as I don’t bleed out first.”

Several steps away and there’s neither ladder nor staircase nearby to climb. 

That’s not a market. That’s a sham. 

[Steve81]

10 minutes ago, iNow said:

We also can’t spend time shopping around for which providers offers the lowest cost and best care after having a heart attack or getting hit by a bus. 

Indeed. To expand on my tale of woe, I was actually on a road trip when this all went down. Closest hospital was about an hour away, and that was it. I ended up in Spotsylvania, VA which was a giant sh*t show. The reason I developed a bowel perforation is because they assumed I just had gas instead of a bowel obstruction when I complained about severe abdominal pain. Fortunately I was able to transfer out to a far superior facility in Arlington.

Edited August 12, 2023 by Steve81

[iNow]

43 minutes ago, Steve81 said:

It spread where it could, nothing more, nothing less. To wit, even Trump caught it;

There is something more, though. One party and their news sources actively pushed back against the science of masking and immunization. Some still are. Those folks died and suffered in far higher numbers. 

And due to reasons of fragile ego and selfishness / inability to concern oneself with others, Trump was kind enough to take it one farther and spread the virus to the key leaders in his administration and everyone at Justice Amy C Barrett’s coronation ceremony. 

Last study I saw said almost 900,000 lives saved by masks and something like 2M more which could’ve been saved were it not for that desire to willfully spread ignorance and disinform people as another tribal wedge strategy. 

It’s not like humans were totally powerless to change the spread. We just concerned ourselves more with hollow notions of freedom than we did with the ability of our neighbors to continue living and how massive a role we each as individuals play in that as a society together. 

1 hour ago, Steve81 said:

That said, I’m not sure ones aptitude for excelling in capitalism is the defining point of their value as a human being either.

The funny part is that a real capitalist would realize government funded universal healthcare is both cheaper AND more effective than the disgusting grifter filled sludge of a healthcare system the US has today. 

Edited August 12, 2023 by iNow

[Steve81]

30 minutes ago, iNow said:

There is something more, though. One party and their news sources actively pushed back against the science of masking and immunization. Some still are. Those folks died and suffered in far higher numbers. 

And due to reasons of fragile ego and selfishness / inability to concern oneself with others, Trump was kind enough to take it one farther and spread the virus to the key leaders in his administration and everyone at Justice Amy C Barrett’s coronation ceremony. 

Last study I saw shied almost 900,000 lives saved by masks and something like 2M more which could’ve been saved were it not for that desire to willfully spread ignorance and disinform people as another tribal wedge strategy. 

It’s not like humans were totally powerless to change the spread. We just concerned ourselves more with hollow notions of freedom than we did with the ability of our neighbors to continue living. 

The funny part is that a real capitalist would realize government funded universal healthcare is both cheaper AND more effective than the disgusting grifter filled sludge of a healthcare system the US has today. 

All I can say to that is that I might welcome our future robot overlords if they improve on the mess we have today. 
 

The de-evolution of the Republican Party into what it is these days is just…sad. It’s never been particularly wonderful in my lifetime, but Republicans like Trump, Boebert, Greene, et al. make me pine for at least half way competent Republicans like Bush Sr. Say what you will about the man, but he wouldn’t be asking about injecting bleach into the body to fight disease, nuking hurricanes, etc.

 

Then of course you have fountainheads of knowledge like this:

Edited August 12, 2023 by Steve81

[TheVat]

32 minutes ago, Steve81 said:

All I can say to that is that I might welcome our future robot overlords if they improve on the mess we have today. 

They might be more willing to listen to scientists, given that scientists created them.  OTOH, there's also the nightmare scenario of Far Right coalitions that have AIs and feed them garbage data, the old GIGO problem.  Or SkyNet scenarios, where the AIs develop very different priorities from human ones.  

A bit late to the party here, so I'll spare you my usual rant against profit-centered medicine.  Others have pointed this out, and the gory details covered nicely.  I continue to devour vegetables and walk miles every day, in hopes of depriving our healthcare system the pleasure of sinking its poisoned talons into me.  Cheers.

[CharonY]

2 hours ago, Steve81 said:

I wouldn’t say that was strictly COVID’s fault. It spread where it could, nothing more, nothing less. To wit, even Trump caught it; he just had access to bleeding edge medical care (also not the fault of a virus).

Well, that is a matter of perspective- all it means is that the outcome  of these events cannot be seen in isolation- it is the overall system that determines outcome. And usually there is  a clear income-dependent situation. There are few  diseases (if any) that affect poor and rich equally.

[Steve81]

49 minutes ago, CharonY said:

Well, that is a matter of perspective- all it means is that the outcome  of these events cannot be seen in isolation- it is the overall system that determines outcome. And usually there is  a clear income-dependent situation. There are few  diseases (if any) that affect poor and rich equally.

I understand your point. When I made my statement on the egalitarian nature of of COVID, I was simply referring to the fact that it was happy to spread and infect whomever it could, up to and including the President of the USA.

The disparity in infection rates and outcomes matters of course for other reasons, but my thought was merely a statement of cynicism regarding human nature.

Edited August 12, 2023 by Steve81