American healthcare

Why American Women Aren’t Living As Long As They Should

One of the great victories of the 20th century is that humanity became much smarter about health. We figured out refrigeration, immunization, and that smoking isn’t actually good for you, and we began living longer.

In 2006, the average life expectancy at birth was 75 years for American men and 80 years for women, compared with just 48 years for men and 51 years for women in 1900.

But new research shows that while life span has been on a positive overall trajectory for mankind, it’s been on a not-so-positive trajectory for the U.S. in particular: Americans’ life expectancies might be increasing, but those of other nations are increasing much faster, particularly among women. From 1980 to 2007, for example, the life spans of 50-year-old women in the U.S. had increased by about 2.5 years. But in Japan and Italy, it had increased by 6.4 years and 5.2 years, respectively.

And now, researchers are scrambling to understand why it is that American women are dying sooner than than those in other first-world countries.

Read more. [Image: Barbara Kinney]

My problem this year.

NY state, where (on Long Island and in NYC where rent for rooms and studios let alone real apartments are 99 times out of 100 over $1000) says I’m too rich for Medicaid since my approximately $16000 as a single woman is 150% over an arbitrary poverty line that should be much higher for places like Long Island with an extremely high cost of living. (Moving isn’t an option living paycheck to paycheck and with having to care for a parent with a “catastrophic” health classification whose income is half mine)

I don’t discount the good it did for people with preexisting conditions or those (in NY’s case) over $900 and under $1500 that now qualify for Medicaidunder the expansion, or people under 26 whose parents get employer insurance but otherwise..

We need universal health care. Making it illegal to not have health insurance is not universal health care.

Universal Healthcare Doesn’t Mean Waiting Longer to See a Doctor

Opponents of healthcare reform have, historically, argued that we should be wary of imitating foreign healthcare systems because people in other countries have to wait longer to see the doctor. Cheaper, more universal care, the argument seems to be, comes with the tradeoff of slower care.

This is not necessarily true, according to new numbers from the Commonwealth Fund, a nonpartisan organization that studies industrialized healthcare systems around the world.

The organization surveyed between 1,000 and 5,400 people in 11 industrialized nations. The first thing they found is fairly well-known: American healthcare is mind-bogglingly expensive, as compared to that of other Western democracies.

Read more. [Image: h.koppdelaney/flickr]

In L.A. court Wednesday, “Beverly Hills 90201” star Shannen Doherty revealed that she has invasive breast cancer that she says went untreated due to a lack of insurance.

Doherty is suing Tanner Mainstain Glynn & Johnston, a business management firm who was tasked with paying out her Screen Actors Guild medical insurance premiums. According to the suit, the company neglected to pay her insurance premiums during 2014, so she was unable to visit a doctor during this time, as she normally would have done.

The “90210” star’s lawsuit says she may have to undergo a mastectomy and chemotherapy that could have been avoided

How long do you think Jupiter Jones sat in the waiting room at the fertility clinic before they called her for her appointment?

Do you think the Keepers were like
“Hmm, well we’ve killed all the medical staff and taken their place, everything is all set up, just waiting for the girl to arrive, but ok we’d better make her wait 45 minutes with some used up magazines or else she’ll know we’re not actually doctors…”

Turing Pharmaceutical founder and CEO Martin Shkreli defended his 5,455 percent hike in the price of a drug used by pregnant women and immunocompromised patients, saying that “Daraprim is still under-priced relative to its peers.”

Despite the fact that “it costs very little to make Daraprim” and that the company was still profiting off sales of it at $13.50, Shkreli said that his company was “practically giving it away” before raising the price per pill to $750.

“This drug was making $5 million in revenue,” he said, “and I don’t think you can find a drug company on the planet that can make money on $5 million of revenue.”

“To save your life — was only $1,000″

consumerreports.org
What Hospitals Don't Want You To Know About C-sections - Consumer Reports

But a C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks.

“C-sections increase the risk of mortality and complications,” says Kent Heyborne, M.D., chief of obstetrics at Denver Health Medical Center, which had the lowest C-section rate of any hospital in our Ratings with at least 5,000 low-risk deliveries over the two-year period included in our analysis. “But we’re just now becoming aware of the down stream effects.”

Carol Sakala, Ph.D., director of Childbirth Connection programs at the National Partnership for Women & Families, agrees. “Unless there is a definitive need for a C-section, vaginal birth has major benefits for moms and babies, both in the short term and throughout the course of their lives,” she said.

To begin with, although having a C-section may sound like a shortcut, it’s not. Speros says that although her C-sections went smoothly, it still took much longer to recover from them than it did from the vaginal birth of her third son.

And like others who’ve had abdominal surgery, she has lingering numbness at the site of the incision. Nineteen percent of women who’ve had a C-section report pain at the incision site being a major problem in the two months following delivery. That’s according to Listening to Mothers III, a national survey conducted by Harris Interactive for the Childbirth Connection of 2,400 mothers who gave birth to single babies in a hospital from July 2011 through June 2012. That compares with 11 percent of women who gave birth vaginally who cited a painful perineum (the area between the vagina and anus) as a major problem. And women with C-sections were more likely to say that the pain lasted six months or longer, too. 

Moms who deliver a first baby by C-section are about 90 percent more likely to deliver their second baby that way, too. 

Life-threatening complications are rare whether babies are born vaginally or by C-section. But compared with women giving birth vaginally, healthy, low-risk women undergoing their first C-section were three times more likely to suffer serious complications—such as severe bleeding, blood clots, heart attack, kidney failure, and major infections—according to a 14-year analysis of more than 2 million women in Canada published in 2007 and cited by the new ACOG/SMFM guidelines.

And the risk of complications increases with each subsequent cesarean delivery. “Once you’ve had a C-section, there’s a big chance that all future births will also be by cesarean,“ Main said. "And that’s when the risks really start to rise.”

Vaginal delivery for uncomplicated births is also better for babies. They are less likely to suffer breathing problems and more likely to be breastfed, perhaps because it’s easier to get breastfeeding going when mothers are not recovering from major surgery. Some research suggests that over the long-term, babies born vaginally may be slightly less prone to chronic ailments such as asthma, allergies, or obesity, perhaps due in part to a protective effect from beneficial bacteria transferred from the mother during birth.

consumer reports on C-sections. Even capitalism disagrees with how this procedure is done now! There’s a ton more information in the click through. Highly encourage you to look through!

That awkward moment when somebody says 'We have the best healthcare system in the world!'....

And you then wonder:

  • If they’ve ever been outside of the United States and/or gotten medical treatment outside of the United States
  • If they’ve ever been told they have ‘preexisting conditions’
  • If they’ve ever been chronically ill & uninsurable
  • If they’ve spent their life savings paying for medications 
  • If banging your head against a wall will be more productive than trying to explain to them why their statement is incorrect

youtube

Thought this was a bloody good video. No, I am not being paid to say that.

Recuperating at home #3

It’s hard to go on Facebook and have to pretend that I am not facing cancer or recovering from surgery. Only about three of my closest friends know.

All of my other friends are former colleagues or former students, and they all have ties to the school where the ex works. My daughter and I are on his insurance as part of the agreement (I pay him half the cost, even though it costs him no more to cover me and our daughter than it would to cover just our daughter).

Florida is an ‘at will’ state, which means that employers need no reason to fire you if you don’t have a contract that states differently. The contract he has is barely worth anything; they have let people go mid year (mid day, even) for no reason other than “Principal’s discretion.”

The insurance company re-negotiates costs with the employer each year based on dollar amounts paid out for employee health care the previous year. So, it is in the employer’s best financial interests to only employ relatively healthy people (and families).

At some point, I assume they will find out who cost them so much money in surgery and other procedures. I don’t know if patient privacy laws keep it from them, though I believe they are meant to keep it private.

In ant case, the sooner my IRL friends and acquaintances know, the sooner those bosses will know, and the sooner my access to health care (and the ex’s job) is in jeopardy.

Thanks to ACA, there MIGHT be insurance I could get instead, but it would be nearly twice as expensive (I checked), and there would be a gap in coverage until it got going, and it might not cover the specialists I see.

Welcome to America. Health care is a privilege, not a right. The poor and/or unlucky need to die quickly and stop wasting the time & money of the privileged few.

TL:DR - The support and interaction from you people here on Tumblr is SO important to me. It is basically all I have right now.
So umm...guise...

I’m all for like, ‘free market’ or whatever in the 'healthcare’ industry in this country. That’s awesome. I’d totally take part in it if it were available for people with pre-existing chronic conditions, but considering I’ve been turned down every time I’ve tried to get health insurance in the past 5 years, I have a feeling like insurance companies ain’t gonna show me any love unless they’re forced to. 

I’m willing to give them money, & at the moment they won’t even take it from me because I’m 'sick’. 

Can Ted Cruz and that dude that I made an ass out of with a pharmacy receipt last week start an 'it ain’t that expensive to be sick’ fund for me? I’d take happy photos every time I went to the doctor or went to the pharmacy to get drugs that help me stay alive. It’d be awesome.

nejm.org
"Dead Man Walking"

“Shocked” wouldn’t be accurate, since we were accustomed to our uninsured patients’ receiving inadequate medical care. “Saddened” wasn’t right, either, only pecking at the edge of our response. And “disheartened” just smacked of victimhood. After hearing this story, we were neither shocked nor saddened nor disheartened. We were simply appalled.

We met Tommy Davis in our hospital’s clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient’s privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences.

The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening’s end he’d been sent home with a diagnosis of metastatic colon cancer

.

The year before, he’d had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he’d need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, he’d simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment.

Mr. Davis had had an inkling that something was awry, but he’d been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we’d found it sooner,” he contended, “it would have made a difference. But now I’m just a dead man walking.”

For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn’t afford bus fare to a dermatology appointment. We sometimes pay for our patients’ medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country’s response to this problem has, at times, seemed toothless.

In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure

was recently evaluated in the clinic. She couldn’t afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn’t possibly pay.

However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it’s a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can’t confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer

, and his abdominal pain and obstipation would surely have been urgently evaluated.

Elected officials bear a great deal of blame for the appalling vulnerability of the 22% of American adults who currently lack insurance. The Affordable Care Act (ACA) — the only legitimate legislative attempt to provide near-universal health coverage

— remains under attack from some members of Congress, and our own two senators argue that enhancing marketplace competition and enacting tort reform will provide security enough for our nation’s poor.

In discussing (and grieving over) what has happened to Mr. Davis and our many clinic patients whose health suffers for lack of insurance, we have considered our own obligations. As some congresspeople attempt to defund Obamacare, and as some states’ governors and attorneys general deliberate over whether to implement health insurance exchanges and expand Medicaid eligibility

, how can we as physicians ensure that the needs of patients like Mr. Davis are met?

First, we can honor our fundamental professional duty to help. Some have argued that the onus for providing access to health care rests on society at large rather than on individual physicians,3 yet the Hippocratic Oath compels us to treat the sick according to our ability and judgment and to keep them from harm and injustice. Even as we continue to hope for and work toward a future in which all Americans have health insurance

, we believe it’s our individual professional responsibility to treat people in need.

Second, we can familiarize ourselves with legislative details and educate our patients about proposed health care reforms. During our appointment with Mr. Davis, he worried aloud that under the ACA, “the government would tax him for not having insurance.” He was unaware (as many of our poor and uninsured patients may be) that under that law’s final rule, he and his family would meet the eligibility criteria for Medicaid and hence have access to comprehensive and affordable care.

Finally, we can pressure our professional organizations to demand health care for all. The American College of Physicians, the American Medical Association, and the Society of General Internal Medicine have endorsed the principle of universal health care coverage yet have generally remained silent during years of political debate. Lack of insurance can be lethal, and we believe our professional community should treat inaccessible coverage as a public health catastrophe and stand behind people who are at risk.

Seventy percent of our clinic patients have no health insurance, and they are all frighteningly vulnerable; their care is erratic, they are disqualified from receiving certain preventive and screening measures, and their lack of resources prevents them from participating in the medical system. And this is not a community- or state-specific problem. A recent study showed that underinsured patients have higher mortality rates after myocardial infarction,4 and it is well documented that our country’s uninsured present with later-stage cancers and more poorly controlled chronic diseases than do patients with insurance.5 We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance.