Thursday's Thoughts

• Starting several years ago while travelling in multiple states in succession and particularly all over Texas I noted new hospitals going up- everywhere. It may be pure coincidence as I understand the long term nature of planning and funding of construction projects but it seemed possible those organizations were readying themselves to cash in on Obamacare. Again, I know hospital districts sit on land for years in anticipation of expansion and it wouldn't be a stretch for them to forecast cashing in on an expanding role of government funding and having plug and play plans for development when the time is right. As disastrous and expensive as it will be- fortunes will be made off the redistribution of money the ACA brings.
• How much is a life worth? Is it what they bring to their family in the form of money to support them? Is it a million dollars- a gazillion if it is your kid or granny?
• Money is a factor in healthcare- somebody has to make the money to pay it- nothing is free. 
• Pretty soon you'll run out of other peoples money.
  
• Money is factor- in everything. If we can keep granny alive in a vegetative state with literally no quality of life the decision whether to withdraw that support in practice is always in direct proportion to who is going to pay. While yes, rich folks are more likely to be better educated and informed and make better choices, if granny is soaking up the family fortune as a houseplant, support will be withdrawn when it is time. A low class family that isn't even kidding itself about paying grannies bill and wants to cash that welfare check that is due in a couple of days? Talk to them about withdrawing support- they will directly tell you they will sue the organization. They will dismiss talk of withdrawal of support out of hand. They have no concept of the costs involved- it never occurs to them. They aren't paying.
• Sound mean or ignorant? I have been asked to keep people alive so that a family can get social security or other benefits multiple times. Not hundreds or dozens of times but easily 4 or 5 times directly and could have guessed family members were tempted to ask or that was the real reason they were worried if granny could possibly live past midnight that night many, many times.
• As a matter of fact, one family needed granny to live past midnight of the day I was working. They were doing their best and raising other family members children. The things I did for granny were not meant to prolong that life per se- they were to promote her comfort but I could be accused of prolonging her life until early the next morning.
  
• Healthcare costs in this country are literally ridiculous and I've never heard or read a good answer for why. Recently a patient started crashing on us in our clinic. He was severely dehydrated and as I recall had an old heart condition. We sent him to the hospital- 2 blocks away. The ambulance transport was 1000 dollars. He was admitted and discharged 36 hours later with a nearly 9000 dollar bill. No surgery, no invasive testing, no MRI- how is that even possible?
• We are our own worst enemy.
• The average cost of a lung transplant is a half a million dollars. A person could smoke until they destroy their lungs- their loss of function in direct proportion to their behavior and we pay for it. We pay for it now. What will this be like with an expanded role of the feds in healthcare?