Comments on: Reforming Medicaid http://www.kevinmd.com/blog/2006/11/reforming-medicaid.html Tue, 14 Feb 2012 11:46:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2006/11/reforming-medicaid.html#comment-68839 Anonymous Thu, 16 Nov 2006 05:16:00 +0000 http://clients.emmense.com/kevinmd/2006/11/reforming-medicaid.html#comment-68839 Common scenarios:<br/><br/>1.) My kid has a fever but sure looks fine but might need some tylenol. Wait though, that costs a few bucks at the drugstore. My medicaid will cover a visit to the ER without even a co-pay and even a prescription for tylenol. While I am there I will have my other 5 kids "check out" because I am here. With the money I saved on tylenol I can get a pack of cigs when I pick up the RX.<br/><br/>2.) Don't have insurance? Abuse your body into oblivion with laziness, gluttony, drug and alcohol abuse. You too could hit the renal failure, cardiomyopathy, back pain disability and the medicaid / medicare disability gravy train. Common scenarios:

1.) My kid has a fever but sure looks fine but might need some tylenol. Wait though, that costs a few bucks at the drugstore. My medicaid will cover a visit to the ER without even a co-pay and even a prescription for tylenol. While I am there I will have my other 5 kids “check out” because I am here. With the money I saved on tylenol I can get a pack of cigs when I pick up the RX.

2.) Don’t have insurance? Abuse your body into oblivion with laziness, gluttony, drug and alcohol abuse. You too could hit the renal failure, cardiomyopathy, back pain disability and the medicaid / medicare disability gravy train.

]]> By: Criminallopathhttp://www.kevinmd.com/blog/2006/11/reforming-medicaid.html#comment-68838 Criminallopath Thu, 16 Nov 2006 04:42:00 +0000 http://clients.emmense.com/kevinmd/2006/11/reforming-medicaid.html#comment-68838 The examples cited in the second post are exactly why a "bean counter" or someone else needs to determine necessity for procedures. On the other hand, if a higher up makes the decision, the providers should not be held liable. The examples cited in the second post are exactly why a “bean counter” or someone else needs to determine necessity for procedures. On the other hand, if a higher up makes the decision, the providers should not be held liable.

]]> By: The Grand Wazoohttp://www.kevinmd.com/blog/2006/11/reforming-medicaid.html#comment-68836 The Grand Wazoo Thu, 16 Nov 2006 02:40:00 +0000 http://clients.emmense.com/kevinmd/2006/11/reforming-medicaid.html#comment-68836 Above mistake:<br/>(Medicare is the second.) Above mistake:
(Medicare is the second.)

]]> By: The Grand Wazoohttp://www.kevinmd.com/blog/2006/11/reforming-medicaid.html#comment-68835 The Grand Wazoo Thu, 16 Nov 2006 02:39:00 +0000 http://clients.emmense.com/kevinmd/2006/11/reforming-medicaid.html#comment-68835 Some examples of Medicaid "overuse"-<br/>-Young female with abdominal pain that can be attributed to dyspepsia. Has hostile nature. Threatens to sue you, if you don't order a CT scan. CT scan is negative. Patient heard from relative about capsule endoscopy and wants one of those. Why risk your career on the 1:100,000 chance that the capsule endoscopy is positive, just to save taxpayers' money? So you order the capsule endoscopy. The patient doesn't care, she doesn't have to pay for any of the costs - there is no ownership/sense of responsibility.<br/>- Disabled, demented patient with nonhealing wound of lower extremity. Referred to a wound clinic. Gets hyperbaric treatment on a daily basis. Requires ambulette transfer because the patient is non-ambulatory. Very expensive, but who is going to say "no"? <br/>- Developmentally delayed adult with relatives who are powers of attorney that do not live nearby. Has soft tissue swelling that is probably benign - lipoma. Relatives want you to do everything, i.e. CT scan, surgery, etc. - but don't show up to any of the appointments (and just sign all the consents)<br/>At what point can you tell a patient - no, this procedure or this test is not necessary and yet avoid the very, very small possibility that there is pathology? Those who state that there are no extra costs due to defensive medicine are in an alternate reality. Of course, defensive medicine exists and does add to the exorbitant cost of healthcare! Why would any practitioner stick his/her neck out to forego a test or procedure to a patient just because of saving costs to the taxpayer? From the patient's standpoint, he/she doesn't have to pay for it, so why not get it? From the healthcare provider's standpoint, why should I risk liability? Just order the test and make the patient happy. This healthcare crisis is like a speeding locomotive with no brakes and Medicaid is the first car on the train. (Medicaid is the second.) Some examples of Medicaid “overuse”-
-Young female with abdominal pain that can be attributed to dyspepsia. Has hostile nature. Threatens to sue you, if you don’t order a CT scan. CT scan is negative. Patient heard from relative about capsule endoscopy and wants one of those. Why risk your career on the 1:100,000 chance that the capsule endoscopy is positive, just to save taxpayers’ money? So you order the capsule endoscopy. The patient doesn’t care, she doesn’t have to pay for any of the costs – there is no ownership/sense of responsibility.
- Disabled, demented patient with nonhealing wound of lower extremity. Referred to a wound clinic. Gets hyperbaric treatment on a daily basis. Requires ambulette transfer because the patient is non-ambulatory. Very expensive, but who is going to say “no”?
- Developmentally delayed adult with relatives who are powers of attorney that do not live nearby. Has soft tissue swelling that is probably benign – lipoma. Relatives want you to do everything, i.e. CT scan, surgery, etc. – but don’t show up to any of the appointments (and just sign all the consents)
At what point can you tell a patient – no, this procedure or this test is not necessary and yet avoid the very, very small possibility that there is pathology? Those who state that there are no extra costs due to defensive medicine are in an alternate reality. Of course, defensive medicine exists and does add to the exorbitant cost of healthcare! Why would any practitioner stick his/her neck out to forego a test or procedure to a patient just because of saving costs to the taxpayer? From the patient’s standpoint, he/she doesn’t have to pay for it, so why not get it? From the healthcare provider’s standpoint, why should I risk liability? Just order the test and make the patient happy. This healthcare crisis is like a speeding locomotive with no brakes and Medicaid is the first car on the train. (Medicaid is the second.)

]]> By: kaiserfraudhttp://www.kevinmd.com/blog/2006/11/reforming-medicaid.html#comment-68830 kaiserfraud Wed, 15 Nov 2006 23:34:00 +0000 http://clients.emmense.com/kevinmd/2006/11/reforming-medicaid.html#comment-68830 Arg - the "moral hazard" argument. Here's an idea: help people find something to do that gives them a place in society and alleviates the symptoms that make them seek relief from a pill bottle. <br/><br/>The health care crisis isn't about an epidemic of bad character, it's about a bunch of policy weenies who can't figure out that we either need full employment or we need subsidized unemployment. Unsubsidized unemployment makes people sick, both physically and mentally, and sometimes the illnesses are contageous. <br/><br/>We can only pretend we don't see the casualties of our PLANNED UNEMPLOYMENT system for so long. Arg – the “moral hazard” argument. Here’s an idea: help people find something to do that gives them a place in society and alleviates the symptoms that make them seek relief from a pill bottle.

The health care crisis isn’t about an epidemic of bad character, it’s about a bunch of policy weenies who can’t figure out that we either need full employment or we need subsidized unemployment. Unsubsidized unemployment makes people sick, both physically and mentally, and sometimes the illnesses are contageous.

We can only pretend we don’t see the casualties of our PLANNED UNEMPLOYMENT system for so long.

]]>