Here’s an August 2024 bill for a walk-around heart monitor that was used by a patient in February 2024:
The price to an uninsured person would have been more than 10X the real price of the service ($3985 vs. $331).
I still can’t understand how it is legal for health care providers to lie in wait for the unwary uninsured patients and hope that someone slips through the cracks somehow and becomes liable for more than 10X the regular price for a service.
I’m convinced that more than 90 percent of the medical bill bankruptcies and disputes in the U.S. would be eliminated if the Feds established a “If you want to feed from the Medicare/Medicaid trough, you can’t bill an uninsured patient more than a 15 percent premium over the Medicare price” rule.
I can’t figure out why Science hasn’t converged on opposite sides of the Atlantic regarding vaccines. Let’s leave COVID aside for the moment since one’s level of coronapanic is inevitably a political decision. Let’s look at the respiratory syncytial virus (RSV) vaccine. The technocrats in the UK say that Science told them this is for people 75-79 and for pregnant people of any age:
(Of course, by Massachusetts standards, the best protection for a 28-week-old baby is abortion care, legal at every stage of pregnancy and “on-demand” through 24 weeks.)
What does Science say on the western side of the Atlantic? The RSV vaccine is for people aged 60-130+ (CDC):
The NHS says that the flu vaccine is for those 65+. The CDC?
Everyone 6 months and older in the United States, with rare exception, should get an influenza (flu) vaccine every season.
An indestructible 15-year-old is, therefore, never more than a year away from a flu shot in the US while he/she/ze/they is 50 years away from his/her/zir/their next flu shot in the UK.
Let’s turn now to coronapanic. In the U.S., Science says to get one shot at age 6 months and then keep getting injected regularly:
In the UK, the Sacrament of Fauci starts at age 75. In other words, a person must be 150X older in the UK compared to in the US to receive a COVID-19 vaccine. There are usually some error bars in Science, but does anyone know of an example where there is a factor of 150X between a Scientific result in the US versus somewhere else in the world?
Related:
Lost in the coronapanic shuffle, an April 2020 paper from the Annals of Internal Medicine: “The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality” (Anderson, Dobkin, and Gorry). They looked at the UK where hardly anyone gets a flu shot under age 65 and almost everyone gets one at age 65. “Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons.” (in other words, the flu shot might prevent a few days of illness, but it doesn’t reduce the death rate)
Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.
The book notes that the British government refuses to pay more for a new drug than the value added by that drug in terms of quality adjusted life years compared to cheap generics or other existing treatments. In the U.S., by contrast, the government and private insurers pay whatever the pharma company asks or, perhaps, a discount off whatever the pharma company asks.
The Biden Administration saves 6 billion and then loses tens of billions with bad drug policy
They lowered the price of a drug that has no good evidence it is better than older drugs. Consider Entresto (above). Entresto— sacubitril valsartan 160mg BID— beat enalapril 10 mg BID in PARADIGM. Since then it failed in post MI and in HFpEF. It’s one the few drugs that ‘works’ in HFrEF but not post-MI. The dose tested in Paradigm was the MAXIMAL Entresto dose with a dizzying dose of ARB. But few people get this dose in real life. There is NO EVIDENCE that the prescribed doses in the US in 2024 (lower than maximal dose) are better than ace-s, which are dirt cheap.
You can lower the price of drugs, but you lose when you spend billions on covid drugs that have no evidence of efficacy. In recent years the Biden administration approved COVID boosters for toddlers, and spent 10 billion on Paxlovid. There is no evidence either of these interventions work in the current climate. So congrats on your 6 billion in savings, too bad we blew 10 billion on unproven products. (Net impact -4 billion dollars)
For every drug you negotiate prices on, the FDA is approving at least 5x as many new drugs based on poor evidence.
Summary: some things never change!
(The relative cost efficiency of the British health care system combined with the descent into Third World status for Britain is kind of confusing. The U.S. plainly wastes at least 10 percent of GDP via health care (closer to 15 percent if we compare to Singapore). How is it that we’re still so much more prosperous than the UK and most European nations?)
How do Americans go bankrupt after seeking health care?
A friend’s child had some back pain after a fall. A hospital billed $27,321.50 for an MRI (it says “4 services” below, but it was really just one encounter with the MRI machine; some different body parts and contrast). That’s what an uninsured person (“a mark”) would have been chased for, eventually into bankruptcy if necessary. What’s the real price of this service? I.e., what does the hospital actually expect to get paid from a typical patient (insured either privately, via Medicaid, or via Medicare)? About $1,287:
(And, of course, the results were inconclusive, so the value of the $27,321 MRI was $0.)
A well-done Audible recorded book and, probably, a good book in print/Kindle form: Cook County ICU. A few things that I learned from it…
The modern insurance/Medicare/Medicaid system requires that hospitals seeking to get revenue give each patient a concrete diagnosis prior to hospital admission. This results in inferior care because the doctors treating the patient become anchored to the initial diagnosis, which is often merely a guess.
Never agree to be a consultant to Hollywood. The author accepts a request to work as a medical advisor for The Fugitive (Harrison Ford plays a vascular surgeon) and puts in a huge number of hours on the project. Money is never discussed. He eventually gets a check for $1,100 (in pre-Biden money) for his work on a film that earned almost $370 million (pre-Biden dollars) at the box office.
From the author’s point of view, there were huge advances in medical technology over his 40 years of practice. The electronic medical record wasn’t one of them, however. It has delivered few benefits, in his view. The practice of having a physician look at a screen and type at a keyboard while interviewing a patient is particularly harmful.
Being sued for divorce is a common way to transition out of the middle class and into the free clinic where the author worked after retiring from the big hospital.
HIPAA is ridiculous, making it easy for insurers, hackers, and the government to get your medical information, but not you or your family members.
Cold is far more deadly to humans than heat. Although we are assured by Science that a warmer climate will result in near-term extinction of humanity, in Chicago it is the cold winter that kills people, not the hot summer.
Not every anecdote is equally rewarding, of course, but there are a lot of great ones!
An Ordinary Man: The Surprising Life and Historic Presidency of Gerald R. Ford reminds us of the 1976 panic regarding a respiratory virus: a strain of influenza called “swine flu”. This was the genesis of the modern muscular CDC. Congress appropriated $500 million in pre-Carter/pre-Biden dollars. The CDC said that every American should get vaccinated (Republican Ford publicly accepted the sacrament; Democrat Jimmy Carter refused it). The vaccine was rushed to the market, greatly enriching four pharma companies who also were indemnified from any liability. This indemnification turned out to be useful. The vaccine was at least 10X more likely to cause Guillain-Barré Syndrome (paralysis) than it was to protect the injected person from death due to influenza (contemporary CDC page on the subject).
Abram Saperstein, who changed his name to Albert Sabin, was recruited to sell the idea of universal vaccination. Sabin was famous at the time for having created the oral polio vaccine. After a few months, however, Sabin concluded that the rushed-to-market swine flu vaccine was more likely to harm than help and that a 1918-style epidemic was unlikely.
Speaking of Jimmy Carter, the book notes that his campaign promises were similar to Javier “Chainsaw” Milei’s in Argentina. Candidate Carter promised to reduce the number of federal agencies from 1,900 to 200, for example. What did President Carter deliver? A brand new Cabinet-level Department of Education that kicked off decades of tuition inflation at American colleges and universities via subsidized student loans and grants.
Personal health anecdote: Following the example of Jimmy Carter, the greatest president in our nation’s history, I ignored CVS’s constant reminders of flu vaccine availability. In early January, embedded in Boston with the nation’s smartest and most assiduous mask and vaccine Karens, I got a truly horrible cough/flu. I cursed myself for ignoring CDC advice. After limping home on JetBlue (I actually wore a mask in hopes of protecting fellow passengers!) I went to a German-trained physician here in Palm Beach County and tested negative for both COVID and influenza.
Related:
“The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality” (Anderson, et al. 2020; Annals of Internal Medicine): “Turning 65 [the age at which people in the UK become eligible for flu vaccines from the NHS] was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons” (in other words, the flu shot might help some people avoid a brief illness, but it doesn’t reduce the chance of being killed by the flu)
“Carter’s Flu‐Shot Plan For the Ill and Elderly Termed Short of Goal” (NYT, 1979): [the CDC director] also defended the program against criticism by Dr. Albert B. Sabin, who developed the oral vaccine for polio. Dr. Sabin, who is associated with the Medical University of South Carolina, said that he did not believe that the influenza vaccine would help many people because new virus strains kept cropping up. and required changes in immunization formulas. He said that vaccines containing major new strains became available only after the new strains already had their major impact.
“The problem with socialism is that you eventually run out of other people’s money,” said Margaret Thatcher. She didn’t count on the U.S. Congress and Federal Reserve being willing to print however much was deemed necessary to achieve the ruling party’s goals.
One thing that the technocrats couldn’t print, however, is hospital beds. With just a trickle of undocumented immigrants over the past couple of years (compared to the flood that Texas has received), it seems that Massachusetts is running out of health care system capacity.
Massachusetts General Hospital in Boston announced Friday that it has been dealing with an ongoing “capacity disaster” and that it’s in desperate need of more beds to help combat the “unprecedented crisis.”
The hospital has been operating every day for the past 16 months in “Code Help” or “Capacity Disaster” status, despite the worst days of the COVID-19 pandemic being a thing of the past, a spokesperson for the medical center said.
According to the hospital, “Code Help” occurs when inpatient beds and monitored hallway stretchers are full, and “Capacity Disaster” is triggered when the emergency department is full, all hallway stretchers are being used, and there are more than 45 inpatients boarding in the emergency department awaiting a hospital bed.
“This program is fairly low-touch and minimalist, yet it had a meaningful effect,” says MIT economist Jonathan Gruber, co-author of a new paper detailing the study’s results.
Separately, as the authors note in the paper, extending formal health insurance to undocumented immigrants “remains politically untenable” for the most part. On the other hand, jurisdictions might examine if other approaches increase care while, in this case, lowering emergency room traffic.
“There’s this tendency with health care to think that if you give people health insurance, you’re done,” Gruber says. “This study is saying the right system combines insurance as financial protection with other kinds of [tools].” He adds: “There is just huge potential to use data and science to get people to where they need to be in terms of getting the most efficient care.”
With data and science, all problems can be solved!
No evidence of additional protection against wound infections with the use of sterile gloves for wound repair in the ED compared to clean gloves was found.
Let’s ask Dr. ChatGPT:
Speaking of wounds, we can remember as we light the kinara this evening, for the second night of Kwanzaa the likely headwounds of the women who were hit on their heads with toasters by Professor Dr. Dr. Maulana Karenga, Ph.D., Ph.D., the creator of the holiday.
Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.
The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.
The author and editors forgot to capitalize “Science”!
This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need. “We really tried to put the focus on, how can you apply some of this stuff to things that are happening in your everyday lives already?” Lauren Harvey, a psychologist at the University of Sydney and the lead author of the study, told me.
But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.
Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.
Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.
Related:
from America’s paragon of mental fitness… “Remarks by President Biden on Expanding Access to Mental Health Care” (whitehouse.gov): “… we can all agree mental health care is healthcare. It is healthcare. It’s essential to people’s wellbeing … Nearly 70 percent of our kids who seek me- — care for mental health or addiction cannot get it. … Insurers still make it far too difficult to get mental health care. … Our plans would require health insurance plans to identify the gaps in the mental health care that they provide.”
One defining principle of our age is that a damaged human is an economically useless human. Parents weren’t nice to you? You can be mean to others for the next 75 years. Back pain at age 50 when working for the government? Retire on disability (see “A Disability Epidemic Among a Railroad’s Retirees” (NYT): “Virtually every career employee [at the government-owned Long Island Rail Road] — as many as 97 percent in one recent year — applies for and gets disability payments soon after retirement. … The L.I.R.R.’s disability rate suggests it is one of the nation’s most dangerous places to work. Yet in four of the last five years, the railroad has won national awards for improving worker safety.”) Back pain at age 50 when scraping by on minimum wage? Segue to SSDI and Medicaid-funded opioids.
Elon Musk (the book) is a good inspiration to power through the pain, both emotional and physical. Tending to confirm The Son Also Rises: economics history with everyday applications, his mom’s mom was divorced and Elon’s mom was divorced and Elon himself is now thrice-divorced. Elon’s mom could be brutally frank and Elon’s dad was just plain brutal, as was life growing up in South Africa.
His most searing experiences came at school. For a long time, he was the youngest and smallest student in his class. He had trouble picking up social cues. Empathy did not come naturally, and he had neither the desire nor the instinct to be ingratiating. As a result, he was regularly picked on by bullies, who would come up and punch him in the face. “If you have never been punched in the nose, you have no idea how it affects you the rest of your life,” he says. At assembly one morning, a student who was horsing around with a gang of friends bumped into him. Elon pushed him back. Words were exchanged. The boy and his friends hunted Elon down at recess and found him eating a sandwich. They came up from behind, kicked him in the head, and pushed him down a set of concrete steps. “They sat on him and just kept beating the shit out of him and kicking him in the head,” says Kimbal, who had been sitting with him. “When they got finished, I couldn’t even recognize his face. It was such a swollen ball of flesh that you could barely see his eyes.” He was taken to the hospital and was out of school for a week. Decades later, he was still getting corrective surgery to try to fix the tissues inside his nose. But those scars were minor compared to the emotional ones inflicted by his father, Errol Musk, an engineer, rogue, and charismatic fantasist who to this day bedevils Elon. After the school fight, Errol sided with the kid who pummeled Elon’s face. “The boy had just lost his father to suicide, and Elon had called him stupid,” Errol says. “Elon had this tendency to call people stupid. How could I possibly blame that child?”
When Elon finally came home from the hospital, his father berated him. “I had to stand for an hour as he yelled at me and called me an idiot and told me that I was just worthless,” Elon recalls. Kimbal, who had to watch the tirade, says it was the worst memory of his life. “My father just lost it, went ballistic, as he often did. He had zero compassion.” Both Elon and Kimbal, who no longer speak to their father, say his claim that Elon provoked the attack is unhinged and that the perpetrator ended up being sent to juvenile prison for it.
How about back pain, the standard American initiative-killer?
For his forty-second birthday, in June 2013, Talulah [Riley; photo below] rented an ersatz castle in Tarrytown, New York, just north of New York City, and invited forty friends. The theme this time was Japanese steampunk, and Musk and the other men were dressed as samurai warriors. There was a performance of Gilbert and Sullivan’s The Mikado, which had been rewritten slightly to feature Musk as the Japanese emperor, and a demonstration by a knife-thrower. Musk, never one to avoid risks, even needless ones, put a pink balloon just underneath his groin for the knife-thrower to target while blindfolded. The culmination was a demonstration of Sumo wrestling. At the end, the group’s 350-pound champion invited Musk into the ring. “I went full strength at him to try a judo throw, because I thought he was trying to take it easy on me,” Musk says. “I decided to see if I could throw this guy, and I did. But I also blew out a disc at the base of my neck.” Ever since, Musk has suffered severe bouts of back and neck pain; he would end up having three operations to try to repair his C5-C6 intervertebral disc. During meetings at the Tesla or SpaceX factories, he would sometimes lie flat on the floor with an ice pack at the base of his neck.
(I didn’t understand the appeal of SSDI and opioids until, at around age 50, I decided to repeatedly throw a friend’s 7-year-old onto a couch. This required a twisting motion and, the next morning, I could barely move.)
Elon Musk worked like a demon for years after this injury (I think that we can be confident that the surgeries did not render him “good as new”) and also after the malaria+Stanford misdiagnosis that nearly killed him (see previous post).
Maybe all of this damage will eventually catch up with him, but until then I think we can all look to Elon as inspiration to stop making excuses!
