Thursday, September 8, 2011

American Healthcare Issues

First off, let me say this isn't an argument for why we should leave health care in America the way it is, or pushing for universal coverage. I'm just doing a little nit-picking and general complaining over a few things.

One of the things I intend to bitch about came up on a blog by Renaissance Guy about a guy with an infected tooth who ended up dying. He went to the local emergency room and they gave him a prescription for some pain meds and an antibiotic and told to go get his tooth pulled. He was uninsured.

The big thing I wondered is why they couldn't have had some doctor come on in and just yank the infected tooth out and go from there with the pain meds and prescription.

One commenter, who goes by the moniker Plainly Spoken, said:
I would suspect that is because ER’s are not equipped for dental work and do not have dentists on staff. I would further think this is because there are not significant numbers of people going to ER’s for dental issues. Also, I would suspect that the large majority of dental emergencies occur because so many people ignore dental issues until forced to deal with them (which may well come from a lack of dental insurance and/or ability to afford dental care).

Fair enough opinion, but still I have to disagree that the people who work in the hospital aren't capable of pulling out a friggin tooth. They have local anesthetics, they have scalpels to cut away the gum if necessary, they have clamps to hold things out the way, and I'm sure something resembling a pair of pliers. Add some gauze to the hole when your done and give the guy some pain meds.

To which another commenter going by Spherical Time replied to my solution:
I think doctors are unlikely to attempt surgery that they haven’t trained for, especially with as few preparations as getting a scalpel, clamps, and a pair of pliers (and the gauze and painkiller).

That’s a good way to kill a patient

As to ST's first paragraph I agree. Although one caveat I might add is how many ER doctors got formal training treating gunshot wounds? Sooner or later it has to be figured out. As for removing a tooth, it isn't exactly rocket science. Yes, it is better to be trained in the professional manner, however, its still pulling a tooth. Take an X-ray to see what the tooth looks like altogether, then yank that puppy out of the guy's mouth. I would assume the reluctance of a doctor in an ER to do such a thing would be more insurance/malpractice/lawsuit related than the ability to do minor in house surgery.

As to removing the tooth killing a patient, I disagree. I've had a few teeth forcibly removed without the help of a trained professional, and I never died from it. I felt like I'd rather have died than deal with that kind of pain, since when it comes to my mouth I'm a big wimp, but somehow I survived it okay.

The stories we were given as kids, and some people may have actually experienced, about tying string to a loose tooth and a doorknob, or pulling a bad tooth out with pliers, they aren't just stories. That kind of thing actually happened... in one's own home, by the babysitter, or whomever.

Heck, for decades, if not centuries, both dental and medical care were administered where ever it was needed. They didn't require a big fancy building and a staff of specialists for every possible scenario in order to do the job. If a guy needed a big gash cleaned and stitched, the old saw bones (doctor) would do it right in his own house which sometimes doubled as his office, or at the patients place. If a guy needed a tooth removed, they removed the dag-blamed tooth.

Who needs big fancy buildings, a board of directors, insurance executives and legal departments to fix minor issues before they become major ones that might require all of the above? Hell, I have known quite a few elderly people who made a trip to the hospital for some reason or another and refused to stay, after the doctor made the decision to keep them, because they knew damn good and well that staying in the constantly sterilized environment might actually be more dangerous in the form of getting a bad antibiotic-resistant staph infection or pneumonia, than going home to heal up from whatever ailment they suffered from. They can check in by phone, or visit the clinic to be followed up with or monitored, and only choosing to stay in the hospital if things get really really bad that they actually physically REQUIRE hospitalization.

But then again, thanks to lawyers, if the doctors don't toe the line and something goes wrong, the patients family can sue the pants off of them. Whether it happened in the hospital or because the doctor didn't make them stay. I do argue for tort reform in the medical field. Not a full on "you can't sue the doctors for shit" kind of tort reform, but for putting a little common sense back into the system. If the doctor fucks something up, sure sue him. Get the cost of the medical requirements covered by the doctor, hospital, and/or their insurance companies. Get the lost wages to the family in the event of death or permanent disability. Even get your mental anguish and pain and suffering payments if you want...not $10 million dollars worth of pain and suffering by any means, but some smaller, more reasonable figure would be fine in my eyes.

I know life is precious and priceless, especially if it is yours or a loved one's, but some of these lawsuits that award millions in damages on top of the economic scope are ludicrous. I don't care if the guy is a $5 million dollar a year CEO of some corporation or some barely making handyman. Cover the health care costs for life for screwing him up, a reasonable wage recovery amount (in the event of the little guy, give him his last 20 years of work he would have done if it hadn't been for this medical "mistake"; as for the CEO, he can do with less than 20 years at $5 million per), and some capped compensation for your pain and suffering.

I'm not a big fan of lawyers and their ability to make a ton of money from your lawsuit while you get a pittance when something goes wrong in the medical business. I'm not a big fan of the insurance and hospital execs who get big pay for essentially "running" a corporation already tracking to succeed regardless of him being a member of the board. I'm not a big fan of the big pharmaceutical companies who insist on pushing their drugs onto everyone at a steep price, and working their damnedest to keep the generic versions from being available, or their working with insurance companies to keep erectile dysfunction drugs covered while not covering other types of more relevant lifesaving drugs and forcing the customer to pony up every penny for them.

I mean look, I'm not anti-regulation. I believe there has to be some regulations to protect all parties involved, but often times we over regulate things, and use too broad of a brush with those that exist that actually stymie the process in some instances.

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