Questions

I want this blog to be an actual forum.  When I am the only one dictating the discourse then it is not achieving its ideal.  I also realize that the policy debates are complex and few can claim even competency in this area.  I do not claim to be an expert, but I believe I offer some level of insight.  If you have a question, comment below.  In time (please be patient) I will try to answer them.  Some I will answer below in the comment section.  Others I may turn into a post on the main page.  Be aware though that I claim some knowledge in the policy and politics realm, but not in the nitty-gritty details of insurance plans, Medicaid, or Medicare (i.e. How do I get enrolled?  Am I eligible?, etc).   Thanks for posting.  I hope I can answer some questions, and I am excited to be relieved of the sole responsibility of guiding this discussion. 

4 responses to “Questions

  1. Hi.

    Hopefully, i understand the aim of this Comment section.

    My grandfather just had a stroke. The doctors claimed that he could not be treated with a medicine to dissolve the clot, since he got to the hospital more than 3 hours after the stroke occured. If blood-thinners were to be treated, the risk of Internal bleeding would exeed the chances of brain recovery (since after 3 hours, brain tissue is most likely to be dead), or so they claimed.

    However, just one hour before he got to the hospital, all the simptoms of his stroke suddenly vanished. he could speak normally, and even write freely. After about 10 minutes, he, again, could barelly speak. His simptoms were even worse than before.

    Although i am no expert in this field, it seemed to me that blood flow, and oxigen with it, could get to the brain tissue for several minutes, and revive it. I think the name of this is TIA.

    Therefore, my question is: If he had a TIA for 3 hours, and was checked into the hospital just one hour after that, would it not be possible to treat him as if the stroke occured only 1 hour ago? wouldn’t most of his brain cells still be alive?

    In my humble understanding, only the shortest interval in which his brain did not receive oxigen matters, in the decision whether or not to give him a medicine to dissolve the clot.

    I’m afraid the doctors ignored or didn’t hear this information (as they seemed, to my utter fury, busy with something ELSE at the moment!!!)

    With many thanks,
    And hopes to ease my anger,
    Ron.

  2. Lucas, I ran across the following article in my local paper, reprinted from the Washington Post. It describes a bi-partisan effort to get employers out of the health insurance equation. Thought it might be of interest to your readers.

    http://www.sacbee.com/110/story/429814.html

    Bob

  3. Ron,

    I am no doctor, just a mere physical therapist and a health policy student so I cannot give you a professional opinion. My training is lacking not only in credentials, but especially in pharmaceuticals. Everything I say here should be taken with a grain of salt. However, from the history you provided it would seem that your grandfather had at least a ten minute time period in which he had blood supply to his brain and that any damage done up to that point was not immediately apparent. So it would indicate that something could have been done. Again, I’m not in a position to say much more.

    I am better suited to answer question regarding policy – even insurance questions than I am medical questions.

  4. Bob,

    The ideas presented in that article are very similar to one of the prototypes suggested by the Institutes of Medicine. This route has real potential, but in order to get there and for it to work several things have to be worked out. Like most things in the popular press the article makes it seem much simpler than it is. I imagine you realize that. A few questions that jumped out at me are:

    1. They mentioned risk adjustment, which is needed in this scheme. I want to know more about how that would work. The system would have to take away any incentive for cream skimming (meaning selecting healthy people over sick people). Right now the employer model eliminates this problem for the people with employer-based insurance. Without good risk adjustment the problems that effect the individual market will be more widespread.

    2. Would health insurance be mandated? If it is not adeverse selection will continue to be a problem. Meaning the sick will buy insurance. The healthy will not. Insurance premiums will remain high as they will have a disproportionate amount of sick people.

    3. In order for the market to drive the system the consumers will need to have some sort of standardized and easily accessible ways to determine quality. This could be accomplished through the “exchanges.” but at this time consumers have no quality information and this is key for a market system especially in health care. Quality measures should be available for doctors and insurance plans. This will increase the burden on providers, but an electronic health record will make this easier.

    4. Their cost estimates seem misleading. The say it would save the nation $336 billion over ten years. This reform might save money for the entire system (“the nation”)as a whole, but its seems that it will raise government funding considerable (“every family would receive a fixed-dollar credit”), but would lower business expenses. It is drastically changing who pays for insurance. More burden on the government meaning more taxes, but less on the employer meaning increased wages and a bolstered economy. It’s a trade-off, but I thought the article was not totally clear on this cost issue.

    5. The politcial feasibility of this reform is unknown. It seems easier than single payer, but less feasible than the Presidential hopefuls’ plans, and hence, why I guess the canidates have not been pushing such reform. I’m fairly sure that Clinton, Obama, and Edwards weighed this option, but for political reasons (not policy) decided not to go that route (The republicans don’t seem to interested in drastic reform so this plan would be ruled-out quickly). The tax burden would be high!

    This idea has a lot of potential, but the magic is in the details. After I discuss quality more I hope to discuss both the Presidential plans and the four prototypes laid out by the Institutes of Medicine.

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