I spent my career in pediatric lung transplantation. It has been an ironclad rule that transplantation should not be offered to patients with cancer history unless a durable remission was present. There seems to be more to the story than the author states and is an example of the dangers of throwing stones when the facts are not clear. I do agree that physicians have given up too much decision-making power to powerful entities and, for many, clinical medicine has become a game to extract a good lifestyle. I was a pediatric physician and few of us got rich in our work. I was particularly sad to watch the pediatric community to fail to rise up against the establishment with school closures. Too many pediatricians kept their noses to the grindstone and deferred to the experts. Now far too many of the public do not trust or respect doctors. Beware the cute blanket condemnations of any large industry.
There is another dimension to consider beyond the expense. The demand for lungs to transplant exceeds the supply. There is a waiting list. Transplanting this cancer patient means delaying or denying transplantation to someone else dying of lung disease. There is a moral duty to allocate organs where they can provide the greatest benefit.
do we value a day? what if it is your day? we are so use to measuring QoL scores & life yrs lost, that this becomes a difficult q. so long as the access is fair: im not sure the fact it is closer to curative, in the life yrs remaining, for other conditions matrs (* or trading one condition for at least a different one, as the case may be.) i am *legitimately* unsure.
if invisible met theory holds, swift reoccurrence is a concern. so, i suppose thr is a line? i just have not yet entirely walked it all thru. <10y survival anyway, for other conditions, seems equally relevant. no evidence is a fine place to draw lines, i agree w that, as a general principle. NSCLC transplants have been done before, why was it not done properly (why is *everything* not done properly?) & thats the point.
if the pt agrees, & has a willing medical team, im not sure i can easily argue 'no.' id more readily back drawing the line at credible data, wholeheartedly, were research practice not so fundamentally damaged. but it is. ill meditate on it further.
I generally agree with the points in this article. All i can do is pray for this woman and her children in this horrible situation.
We should also consider this from a different angle. What is Mr Goldstone doing here? Are these heart felt pleas for a friend that just got swept up on social media, with a ground swell of grassroots support that is now shaming the insurance company to approve the procedure to mitigate the PR nightmare? Or is he wielding his influence (VP says he is a reporter) to benefit a friend in a special situation? Or does he have an axe to grind with insurance companies?
Her story is so very common, sadly. None of the dyjng people i see have anyone tweeting about them. Or at least, no one reads their tweets.
Im a layperson and I cannot thank you enough for writing these think pieces. I may not understand all the technical terms but I have learned so much nonetheless . Thank you.
“Sounds like the gender-reassignment surgeons at Vandy whose department was shut down were asked to pull weekend call.” Ha, Ha. I suspect most are not aware of (a) The mutilating surgeries being done on children without any evidence-based supporting data for the purpose of “gender reassignment”
I’m no fan of for profit insurers and it seems crazy that they initially approved this. Haven’t we learned enough about immunosuppression and cancer in the past 2 years?
When I went to Iceland this October there were ads for a company providing Hospice Care. These ads specifically pointed out that death is part of life, and we want to die with dignity. I believe that this message has been lost in America society. Americans have been presented with the belief that they can live forever if they listen to the health care community and the pharmacies. We need to start focusing on Palliative care in this country so we can actually prioritize health care spending.
We do not want to go as far as places like the UK, which I know doctors who immigrated to America told me the older people get limited care, but at the same time we need to realize there are limits to the funds available to keep people alive. I know insurance companies in one state left the state because they were spending millions of dollars a year to keep one child alive.
Insurance companies don't pay anything. It's all the subscribers paying for insurance insurance coverage that do. All every insurance company is is a funnel that takes in coverage payments and spits out just enough to satisfy coverage demands. To keep a profitable result, they either take in more paying customers, raise rates on existing customers, cut their payouts or get rid of "expensive" customers. If you are rich enough, you do not need insurance.
I agree that the docs should not have offered the procedure and CIGNA should not have agreed to cover it at first. However, this reads ripe for a good lawyer to make a few bucks off both CIGNA and Vanderbilt for “psychological harm” to the patient. Perhaps CIGNA should be fined the amount of the cost of the procedure (the $ being used to fund Cancer research, but not at Vanderbilt) and Vanderbilt fined the cost of the procedure (the $ used to pay for the patient to have the procedure done somewhere else).
"The affordable care act limits their profit on revenue to 20%. As such, they actually do not want to keep health care costs low. They want to grow costs over time"
This is a misunderstanding of the ACA. Insurers must pay 80% of their revenue in claims. The other 20% covers all their expenses and whatever is left is profit. Typically that number is 3 to 4%.
But the principle is correct. In order to increase their profit, they have to increase the amount making up the 20%. Or buy a PBM and drive up drug profits. Or do whatever the market forces implemented by the ACA will let them do to make more profit.
Don’t even get me started on misplaced priorities. It seems snake oil continues to be for sale. And financially predating on the most vulnerable is exactly what took me out of the healthcare business. Hell at least the mafia was honest about their intent.
The patient, doctors, and the hospital should be free to proceed with any procedure at whatever terms they agree on. The insurance company should pay whatever they are required to pay under the terms of their contract with the patient. None of it is the business of anybody else.
The operative word in the question posed in the title of the article is "should". Of course it should not cost you or me anything. That is the problem with collectivist thinking. It leads to collectivist systems and everyone wants to live at other peoples' expense. That is why they always fail. Unfortunately the failure may take place very slowly and cause much pain and societal problems along the way.
we print the money. thr is no such thing as 'expense' , let alone 'at other peoples'.'
thr are only true resources, & fair distribution.
which is what inherited wealth & stock mkt gambling (& allowing collection of capital * at all * , frankly) damages permanently. the rest is propaganda to keep the sys in place. the sys that serves only those thieves. think beyond what youve been told, as if discovering the concepts for the first time. see if anything youve said makes sense to you after that. _JC
thr is no natural mkt, thr is a bondage system, the raw flow of which is maintained by Gvt players for taxation & control: & that is called 'money' or 'money printing.' your taxes do not pay for things, we burn it & print more.
for a Gvt run healthcare system 'money' (& expense by extension) is not relevant. only true resources matr. in an unperverted sense, 'money' could be used to facilitate trade & serve societal goals. the corporate socialism that we currently have in place doesnt serve anyone, ultimately not even the wealthy. it means research is ruined (even for billionaires) & funnel systems like 'insurance' are able to skim MASSIVE middleman fees, w further perverse incentives that go w that.
thr is no 'at other peoples' expense': that misunderstands economics. but youre retired now, have a look at the MMT scholars, see if you dislike the re-frame. & let me know in the comments some time going fwd if something stands out. _JC
Although it is not clear to me because of the way you phrase things, we might have a few areas of agreement. I am quite well versed in economics and adhere to the Austrian school as presented by Murray Rothbard. If your reference to MMT means "Modern Monetary Theory", I am very familiar with that. It is simply warmed over and relabeled Keynesian economics which is pushed by the establishment and the government and is responsible for most of the trouble we are in today. I highly recommend Rothbard's seminal work, "Man, Economy, and State" as a corrective for that nonsense.
we print the money. thr is no such thing as 'expense' , let alone 'at other peoples'.' thr are only true resources, & fair distribution.
which is what inherited wealth & stock mkt gambling (& allowing collection of capital * at all * , frankly) damages permanently. the rest is propaganda to keep the sys in place. the sys that serves only those thieves. think beyond what youve been told, as if discovering the concepts for the first time. see if anything youve said makes sense to you after that. _JC
You repeated it in the same garbled syntax. I asked for plain English. By the way, we don't actually print the money. The Federal Reserve creates it out of thin air. In normal discourse other people's money refers to transfer payments from taxpayers to the recipients that can most successfully lobby the government.
ive addressed this in the other reply: but, yes. as a stand in for Gvt it is technically the Fed (w the exception of 'revenue' already in circulation, which includes 'other peoples' taxes.' but it is still not relevant.
tho i do like the 'of course no1 shld have to pay'. it did confuse me however, given your other points. _JC
I'm still wondering if the patient is fully jabbed and boosted? Sorry if bad taste. I'm so sick of the medical industrial complex ruling people's lives, 9r acting as if they do.
but id wager theyd probs forbid the surgery if they werent. bc that is the sys we have allowed. it is likely the medical team all have to be as well. science be damned. _JC
I spent my career in pediatric lung transplantation. It has been an ironclad rule that transplantation should not be offered to patients with cancer history unless a durable remission was present. There seems to be more to the story than the author states and is an example of the dangers of throwing stones when the facts are not clear. I do agree that physicians have given up too much decision-making power to powerful entities and, for many, clinical medicine has become a game to extract a good lifestyle. I was a pediatric physician and few of us got rich in our work. I was particularly sad to watch the pediatric community to fail to rise up against the establishment with school closures. Too many pediatricians kept their noses to the grindstone and deferred to the experts. Now far too many of the public do not trust or respect doctors. Beware the cute blanket condemnations of any large industry.
There is another dimension to consider beyond the expense. The demand for lungs to transplant exceeds the supply. There is a waiting list. Transplanting this cancer patient means delaying or denying transplantation to someone else dying of lung disease. There is a moral duty to allocate organs where they can provide the greatest benefit.
do we value a day? what if it is your day? we are so use to measuring QoL scores & life yrs lost, that this becomes a difficult q. so long as the access is fair: im not sure the fact it is closer to curative, in the life yrs remaining, for other conditions matrs (* or trading one condition for at least a different one, as the case may be.) i am *legitimately* unsure.
if invisible met theory holds, swift reoccurrence is a concern. so, i suppose thr is a line? i just have not yet entirely walked it all thru. <10y survival anyway, for other conditions, seems equally relevant. no evidence is a fine place to draw lines, i agree w that, as a general principle. NSCLC transplants have been done before, why was it not done properly (why is *everything* not done properly?) & thats the point.
if the pt agrees, & has a willing medical team, im not sure i can easily argue 'no.' id more readily back drawing the line at credible data, wholeheartedly, were research practice not so fundamentally damaged. but it is. ill meditate on it further.
another gr8, & thought provoking, piece. _JC
I generally agree with the points in this article. All i can do is pray for this woman and her children in this horrible situation.
We should also consider this from a different angle. What is Mr Goldstone doing here? Are these heart felt pleas for a friend that just got swept up on social media, with a ground swell of grassroots support that is now shaming the insurance company to approve the procedure to mitigate the PR nightmare? Or is he wielding his influence (VP says he is a reporter) to benefit a friend in a special situation? Or does he have an axe to grind with insurance companies?
Her story is so very common, sadly. None of the dyjng people i see have anyone tweeting about them. Or at least, no one reads their tweets.
Im a layperson and I cannot thank you enough for writing these think pieces. I may not understand all the technical terms but I have learned so much nonetheless . Thank you.
“Sounds like the gender-reassignment surgeons at Vandy whose department was shut down were asked to pull weekend call.” Ha, Ha. I suspect most are not aware of (a) The mutilating surgeries being done on children without any evidence-based supporting data for the purpose of “gender reassignment”
(b) Vanderbilt surgeons being all-in on these surgeries for the publicly stated purpose of making lots of money. Here is a link to the article and the incriminating video: https://www.dailywire.com/news/huge-money-maker-video-reveals-vanderbilts-shocking-gender-care-threats-against-dissenting-doctors When physicians lose sight of, or outright reject, “first do no harm”, they are deserving of public rejection, not polite conversation.
Kind of like when we offered bone marrow transplants for metastatic breast cancer….
I’m no fan of for profit insurers and it seems crazy that they initially approved this. Haven’t we learned enough about immunosuppression and cancer in the past 2 years?
When I went to Iceland this October there were ads for a company providing Hospice Care. These ads specifically pointed out that death is part of life, and we want to die with dignity. I believe that this message has been lost in America society. Americans have been presented with the belief that they can live forever if they listen to the health care community and the pharmacies. We need to start focusing on Palliative care in this country so we can actually prioritize health care spending.
We do not want to go as far as places like the UK, which I know doctors who immigrated to America told me the older people get limited care, but at the same time we need to realize there are limits to the funds available to keep people alive. I know insurance companies in one state left the state because they were spending millions of dollars a year to keep one child alive.
this is equally an important point. _JC
Insurance companies don't pay anything. It's all the subscribers paying for insurance insurance coverage that do. All every insurance company is is a funnel that takes in coverage payments and spits out just enough to satisfy coverage demands. To keep a profitable result, they either take in more paying customers, raise rates on existing customers, cut their payouts or get rid of "expensive" customers. If you are rich enough, you do not need insurance.
i agree w this. insurance is one of the many 'money funneling middle-man' positions in society that best be done away w. w prison time, ideally. _JC
Sounds like the gender-reassignment surgeons at Vandy whose department was shut down were asked to pull weekend call.
I hated weekend call
I agree that the docs should not have offered the procedure and CIGNA should not have agreed to cover it at first. However, this reads ripe for a good lawyer to make a few bucks off both CIGNA and Vanderbilt for “psychological harm” to the patient. Perhaps CIGNA should be fined the amount of the cost of the procedure (the $ being used to fund Cancer research, but not at Vanderbilt) and Vanderbilt fined the cost of the procedure (the $ used to pay for the patient to have the procedure done somewhere else).
"The affordable care act limits their profit on revenue to 20%. As such, they actually do not want to keep health care costs low. They want to grow costs over time"
This is something far too few people think about
This is a misunderstanding of the ACA. Insurers must pay 80% of their revenue in claims. The other 20% covers all their expenses and whatever is left is profit. Typically that number is 3 to 4%.
But the principle is correct. In order to increase their profit, they have to increase the amount making up the 20%. Or buy a PBM and drive up drug profits. Or do whatever the market forces implemented by the ACA will let them do to make more profit.
Don’t even get me started on misplaced priorities. It seems snake oil continues to be for sale. And financially predating on the most vulnerable is exactly what took me out of the healthcare business. Hell at least the mafia was honest about their intent.
The patient, doctors, and the hospital should be free to proceed with any procedure at whatever terms they agree on. The insurance company should pay whatever they are required to pay under the terms of their contract with the patient. None of it is the business of anybody else.
Until it costs me. Then it is my business. That’s the hard part. Everyone is for unlimited care until it costs them.
The operative word in the question posed in the title of the article is "should". Of course it should not cost you or me anything. That is the problem with collectivist thinking. It leads to collectivist systems and everyone wants to live at other peoples' expense. That is why they always fail. Unfortunately the failure may take place very slowly and cause much pain and societal problems along the way.
re repost: sz, the 2nd cut paste response was for another cmt, i didnt realize youd be notified. _JC
we print the money. thr is no such thing as 'expense' , let alone 'at other peoples'.'
thr are only true resources, & fair distribution.
which is what inherited wealth & stock mkt gambling (& allowing collection of capital * at all * , frankly) damages permanently. the rest is propaganda to keep the sys in place. the sys that serves only those thieves. think beyond what youve been told, as if discovering the concepts for the first time. see if anything youve said makes sense to you after that. _JC
You lost me after "we print the money". Can you restate it in plain English?
thr is no natural mkt, thr is a bondage system, the raw flow of which is maintained by Gvt players for taxation & control: & that is called 'money' or 'money printing.' your taxes do not pay for things, we burn it & print more.
for a Gvt run healthcare system 'money' (& expense by extension) is not relevant. only true resources matr. in an unperverted sense, 'money' could be used to facilitate trade & serve societal goals. the corporate socialism that we currently have in place doesnt serve anyone, ultimately not even the wealthy. it means research is ruined (even for billionaires) & funnel systems like 'insurance' are able to skim MASSIVE middleman fees, w further perverse incentives that go w that.
thr is no 'at other peoples' expense': that misunderstands economics. but youre retired now, have a look at the MMT scholars, see if you dislike the re-frame. & let me know in the comments some time going fwd if something stands out. _JC
Although it is not clear to me because of the way you phrase things, we might have a few areas of agreement. I am quite well versed in economics and adhere to the Austrian school as presented by Murray Rothbard. If your reference to MMT means "Modern Monetary Theory", I am very familiar with that. It is simply warmed over and relabeled Keynesian economics which is pushed by the establishment and the government and is responsible for most of the trouble we are in today. I highly recommend Rothbard's seminal work, "Man, Economy, and State" as a corrective for that nonsense.
Agree 100%
we print the money. thr is no such thing as 'expense' , let alone 'at other peoples'.' thr are only true resources, & fair distribution.
which is what inherited wealth & stock mkt gambling (& allowing collection of capital * at all * , frankly) damages permanently. the rest is propaganda to keep the sys in place. the sys that serves only those thieves. think beyond what youve been told, as if discovering the concepts for the first time. see if anything youve said makes sense to you after that. _JC
You repeated it in the same garbled syntax. I asked for plain English. By the way, we don't actually print the money. The Federal Reserve creates it out of thin air. In normal discourse other people's money refers to transfer payments from taxpayers to the recipients that can most successfully lobby the government.
ive addressed this in the other reply: but, yes. as a stand in for Gvt it is technically the Fed (w the exception of 'revenue' already in circulation, which includes 'other peoples' taxes.' but it is still not relevant.
tho i do like the 'of course no1 shld have to pay'. it did confuse me however, given your other points. _JC
I'm still wondering if the patient is fully jabbed and boosted? Sorry if bad taste. I'm so sick of the medical industrial complex ruling people's lives, 9r acting as if they do.
lest we forget (as so many seem to want to)
but id wager theyd probs forbid the surgery if they werent. bc that is the sys we have allowed. it is likely the medical team all have to be as well. science be damned. _JC
Touché! Well-played, ma'am.