http://www.theatlantic.com/health/archive/2013/02/on-purposely-getting-arrested-to-get-life-saving-surgery/273282/
QuoteOn Purposely Getting Arrested, to Get Life-Saving Surgery
Sometimes going to prison can be an unfortunately rational health care decision.
A 41-year-old man who was incarcerated came to see me recently. A few years ago, he'd been incarcerated. While in prison he got in a fight, which led to a CT scan. He hadn't broken anything, but the scan did surreptitiously show two aneurysms. Both were in his hepatic artery (the artery that feeds his liver).
They were small, so the doctors kept an eye on the aneurysms without doing surgery. But the next time they checked, they had nearly doubled in size.
He was referred to a surgeon at a different hospital than the one I work at, and underwent an angiogram, to see the aneurysms better. The surgeons there said that he was sure to die if they did not intervene, and that they should schedule a surgery within the coming weeks.
Fortunately for him (or so he thought) he was released from prison one week later. When he returned for his pre-op visit, though, he was told that since he'd been released from prison, he no longer had insurance to cover the operation.
He asked what he should do. The told him to figure out how to get insurance.
I think this patient would be the first to admit that he had made numerous mistakes in his life. And he had paid a significant price for them. He truly was ready to make changes, to live positively, to help those around him. But, not knowing what else to to, it occurred to him that the easiest way to get the care he needed would be to get back in prison.
The next week, he went to a department store and, making sure a security guard saw him, pocketed some moisturizing cream. He looked up at the guard, smiled, and walked out.
After he was arrested, he wrote a note to the judge saying that he needed to get back into prison for a year, to get an operation. He told me the judge said "I'll give you 14 months, go get your surgery."
***
A recent study showed that out of over 2,300 bankruptcy filers in the United States in 2007, greater than 60 percent of them were caused at least in part by medical illness. It is hard as a physician to watch patients and families who are scared, facing these difficult times in their lives, also knowing that they are going down a pathway to bankruptcy from which they may never recover.
There are those that feel that everyone should have full medical care provided regardless of age or socioeconomic status, and a single-payer (government) system would be best suited for that. Others argue that this would be both too expensive and too inefficient, and would lead to even higher costs than already exist for healthcare. Perhaps costs could be better controlled if patients had skin in the game, and had to make choices about what care they would like with some responsibility for paying for the treatment they receive.
In my own field, transplant surgery, patients have to be insured to be eligible for transplantation. This is generally not a problem for patients with kidney failure, as anyone with a work history becomes eligible for Medicare regardless of age or disability status.
Any patient with end stage liver disease who does not have insurance (and is not eligible for Medicare) has the option of trying to qualify for state-funded Medicaid (which includes demonstrating both poverty and disability), stealing moisturizing cream from a department store, or dying.
I have personally taken care of a number of patients who did not want to put their family through the formidable weight of bankruptcy and opted for number three.
Even for our veterans, who do have coverage through the VA systems, only have access to transplantation at five centers in the country. They are also held to stricter criteria about who eligible for transplantation than those outside of the VA system. My general sense is the access to transplant is much less for vets than for those outside this system. Some of them might be better off going to the department store.
The Affordable Care Act will address some of these issues, at least striving to provide some sort of coverage to everyone, although given the resistance of many states and unclear plan regarding expanding Medicaid -- which as a system does require patients to be essentially bankrupt -- there will still be large gaps in coverage in many of the patient populations that may need it most.
***
Some say that many patients with liver failure have done it to themselves -- that their disease is the result of choices they made in their lives (including previous drug use that led to hepatitis C, or alcoholism). These diseases don't represent all patients that need liver transplant, but certainly a significant portion. But most people who think this way aren't the ones who have to go to a patient's room, look into his scared eyes while he is surrounded by his spouse and children, and tell him that he is going to die in the next few months and there is nothing we can do. "Actually, we could totally save you and give you another decade or two of life but unfortunately you don't have insurance, and it's your own fault, anyway."
When I was growing up, my dad (who went back to medical school when I was in third grade) used to regale my brothers and me with stories from the trenches during dinner. One story in particular stands out. The patient needed surgery, but he had no insurance. So the plan that my dad and his team hatched (sorry dad, hope you don't get nailed for this) was to have this patient go in front of the emergency room at noon that Monday (a convenient time for everybody), collapse, and complain of acute abdominal pain. He was quickly whisked into the emergency department, deemed to have an acute abdomen, and taken to the operating room for definitive surgery. As long as it was an emergency, the hospital had no choice but to offer the treatment.
With the current shortage of organs, though, a patient in need of a transplant who did this same thing wouldn't be so lucky.
***
I should tell you how the case of the lotion thief ended. I took him to the operating room, removed his two aneurysms, and replaced his hepatic artery and its right and left branches with reversed internal iliac artery from his own leg. Surgery went great, and he recovered nicely. I just hope he stays in prison long enough to get some follow-up care.
*starts singing*
And I'm proud to be an American, where at least I know I'm free....
:glare:
If you're gonna do death panels, why not start in prisons??
Quote from: merithyn on February 26, 2013, 10:37:14 AM
*starts singing*
And I'm proud to be an American, where at least I know I'm free....
:glare:
Go to Cuba, commie.
Quote from: Ed Anger on February 26, 2013, 10:40:48 AM
Quote from: merithyn on February 26, 2013, 10:37:14 AM
*starts singing*
And I'm proud to be an American, where at least I know I'm free....
:glare:
Go to Cuba, commie.
:(
I'm trying to get out of here.... I'm trying....
Only one thing to do.
Bow your head in shame, America.
Quote from: merithyn on February 26, 2013, 10:46:24 AM
Quote from: Ed Anger on February 26, 2013, 10:40:48 AM
Quote from: merithyn on February 26, 2013, 10:37:14 AM
*starts singing*
And I'm proud to be an American, where at least I know I'm free....
:glare:
Go to Cuba, commie.
:(
I'm trying to get out of here.... I'm trying....
Try harder.
But don't forget to vote for progressives from overseas. Best of both worlds. :)
I've heard stories like this before.
QuoteAfter he was arrested, he wrote a note to the judge saying that he needed to get back into prison for a year, to get an operation. He told me the judge said "I'll give you 14 months, go get your surgery."
What a shockingly nice judge. He could just as easy have gone "I'll give you 11 months, 30 days"
The funding system is broken. We need a single payer.
I'm unconvinced this 41-year old man would have gone to see a doctor initially even if he could afford it.
When I worked in NC, they had lay-offs in the Department of Corrections because the organization wasn't prepared for "Meth Mouth". Meth heads were getting free dental work (mainly bridges and whole dentures) and it caused the dental budget to increase from a small amount to an astronomical expenditure. Prisoners would refuse parole until their false teeth were finished.
Quote from: Strix on March 01, 2013, 09:10:49 AM
When I worked in NC, they had lay-offs in the Department of Corrections because the organization wasn't prepared for "Meth Mouth". Meth heads were getting free dental work (mainly bridges and whole dentures) and it caused the dental budget to increase from a small amount to an astronomical expenditure. Prisoners would refuse parole until their false teeth were finished.
If only we had a non-prison system where meth addicts could get their teeth fixed for free!
Quote from: garbon on March 01, 2013, 09:21:56 AM
Quote from: Strix on March 01, 2013, 09:10:49 AM
When I worked in NC, they had lay-offs in the Department of Corrections because the organization wasn't prepared for "Meth Mouth". Meth heads were getting free dental work (mainly bridges and whole dentures) and it caused the dental budget to increase from a small amount to an astronomical expenditure. Prisoners would refuse parole until their false teeth were finished.
If only we had a non-prison system where meth addicts could get their teeth fixed for free!
It is odd that people want Universal Health Care but that seldom includes Dental or Vision which most people value above a lot of other medical problems.
Quote from: Strix on March 01, 2013, 09:24:49 AM
Quote from: garbon on March 01, 2013, 09:21:56 AM
Quote from: Strix on March 01, 2013, 09:10:49 AM
When I worked in NC, they had lay-offs in the Department of Corrections because the organization wasn't prepared for "Meth Mouth". Meth heads were getting free dental work (mainly bridges and whole dentures) and it caused the dental budget to increase from a small amount to an astronomical expenditure. Prisoners would refuse parole until their false teeth were finished.
If only we had a non-prison system where meth addicts could get their teeth fixed for free!
It is odd that people want Universal Health Care but that seldom includes Dental or Vision which most people value above a lot of other medical problems.
I can have a tooth pulled for $250, and get a pair of glasses for the same price, appointment included.
To diagnose an ulcer, it cost me $7500. Not treat, mind you, but to diagnose. To treat it cost me another $150.
See the difference?
Quote from: merithyn on March 01, 2013, 11:12:40 AM
Quote from: Strix on March 01, 2013, 09:24:49 AM
Quote from: garbon on March 01, 2013, 09:21:56 AM
Quote from: Strix on March 01, 2013, 09:10:49 AM
When I worked in NC, they had lay-offs in the Department of Corrections because the organization wasn't prepared for "Meth Mouth". Meth heads were getting free dental work (mainly bridges and whole dentures) and it caused the dental budget to increase from a small amount to an astronomical expenditure. Prisoners would refuse parole until their false teeth were finished.
If only we had a non-prison system where meth addicts could get their teeth fixed for free!
It is odd that people want Universal Health Care but that seldom includes Dental or Vision which most people value above a lot of other medical problems.
I can have a tooth pulled for $250, and get a pair of glasses for the same price, appointment included.
To diagnose an ulcer, it cost me $7500. Not treat, mind you, but to diagnose. To treat it cost me another $150.
See the difference?
Yeah I'm seeing you make poor comparisons. Now mind you still not on the same level but one crown can set you back a couple grand.
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
Quote from: garbon on March 01, 2013, 11:19:06 AM
Yeah I'm seeing you make poor comparisons. Now mind you still not on the same level but one crown can set you back a couple grand.
Not if you pull it. That's my point. You have less expensive options for dental and vision. They may not be preferred, but there are still ways to go about it that won't bankrupt you. That is not the case for medical.
There was no cheaper way to determine if I had an ulcer. There is no cheaper way to set a bone or treat bronchitis.
Quote from: merithyn on March 01, 2013, 11:36:15 AM
Quote from: garbon on March 01, 2013, 11:19:06 AM
Yeah I'm seeing you make poor comparisons. Now mind you still not on the same level but one crown can set you back a couple grand.
Not if you pull it. That's my point. You have less expensive options for dental and vision. They may not be preferred, but there are still ways to go about it that won't bankrupt you. That is not the case for medical.
There was no cheaper way to determine if I had an ulcer. There is no cheaper way to set a bone or treat bronchitis.
Ah I see what you're getting at. Though on that front, you could always just "survive" with your ulcer (a la Mono) and just have your bones heal as they will.
What is wrong with you people?
Quote from: merithyn on March 01, 2013, 11:12:40 AM
I can have a tooth pulled for $250, and get a pair of glasses for the same price, appointment included.
To diagnose an ulcer, it cost me $7500. Not treat, mind you, but to diagnose. To treat it cost me another $150.
See the difference?
Somebody has to pay for that MRI machine. :P
Quote from: derspiess on March 01, 2013, 12:06:10 PM
Quote from: Bluebook on March 01, 2013, 12:03:27 PM
What is wrong with you people?
You tell us.
(https://languish.org/forums/proxy.php?request=http%3A%2F%2Fspamusers.com%2FWiki%2Fimages%2Fc%2Fc7%2FItsatrap.jpg&hash=811c504f87b2da65ffc96027e2c0917db2ad81c4)
Quote from: derspiess on March 01, 2013, 11:30:10 AM
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
For the love of god, don't go to Wally World for eye stuff. Please.
Quote from: Ed Anger on March 01, 2013, 12:29:04 PM
Quote from: derspiess on March 01, 2013, 11:30:10 AM
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
For the love of god, don't go to Wally World for eye stuff. Please.
Have you done it?
Quote from: garbon on March 01, 2013, 11:57:34 AM
Ah I see what you're getting at. Though on that front, you could always just "survive" with your ulcer (a la Mono) and just have your bones heal as they will.
Again, you're missing my point.
A sore tooth hurts. An ulcer hurts. A broken bone hurts.
You can fix the tooth for a couple of hundred dollars so it doesn't hurt anymore. You cannot do that for an ulcer (which first has to be diagnosed so that you even know that it's an ulcer and not cancer) or a broken bone. So while yes, you could live with it, the point is that in order to live pain-free you have to spend a considerable amount more money for medical work than you do for dental.
Which is why people aren't harping about free dental or vision care. One can get by without. One cannot, really, get by without medical without going bankrupt, living in pain, or dying.
Quote from: Ed Anger on March 01, 2013, 12:29:04 PM
Quote from: derspiess on March 01, 2013, 11:30:10 AM
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
For the love of god, don't go to Wally World for eye stuff. Please.
:unsure:
Why not? The kids have all gone there for years, and we've always had great experiences.
Quote from: derspiess on March 01, 2013, 12:31:16 PM
Quote from: Ed Anger on March 01, 2013, 12:29:04 PM
Quote from: derspiess on March 01, 2013, 11:30:10 AM
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
For the love of god, don't go to Wally World for eye stuff. Please.
Have you done it?
My mom did some years back. Tried to tell her not to. The glasses prescribed were waaaaay off. I think they had a retard on duty that day. I wanted to shank the eye doc.
Got her to go to a real eye wizard, got her a rightous prescription.
Quote from: Ed Anger on March 01, 2013, 12:35:28 PM
Quote from: derspiess on March 01, 2013, 12:31:16 PM
Quote from: Ed Anger on March 01, 2013, 12:29:04 PM
Quote from: derspiess on March 01, 2013, 11:30:10 AM
I might try out Walmart's $38 deal for a pair of glasses, for shits & gigs. I wear contacts pretty much exclusively and only throw on my glasses if I have to get up at night for something, so little risk if they turn out ugly.
For the love of god, don't go to Wally World for eye stuff. Please.
Have you done it?
My mom did some years back. Tried to tell her not to. The glasses prescribed were waaaaay off. I think they had a retard on duty that day. I wanted to shank the eye doc.
Got her to go to a real eye wizard, got her a rightous prescription.
I'm getting my prescription from my regular eye doc :contract:
I warned ye. :cool:
Quote from: Ed Anger on March 01, 2013, 12:42:08 PM
I warned ye. :cool:
Worst case, they'll be my backups. And like I said, I primarily wear contacts.
Anyway, if a certain something comes my way later this year I may have the cash to drop on laser surgery and be done with all the contacts/glasses silliness.
I talked to my eye doctor about laser surgery last fall. My vision is so poor that even after I got it, I'd still need glasses. :blush:
My lasers are fine.
Quote from: Caliga on March 01, 2013, 12:54:34 PM
I talked to my eye doctor about laser surgery last fall. My vision is so poor that even after I got it, I'd still need glasses. :blush:
I've been told mine is just good enough to where I wouldn't need them. I've just about convinced myself to do it.
As an aside, a couple years ago I was out for dinner/drinks with a couple co-workers adamantly trying to talk me into laser surgery. I told them their otherwise solid arguments were undermined by the fact that they both were wearing glasses at the time, despite having had the surgery.
Quote from: merithyn on March 01, 2013, 12:34:00 PM
Again, you're missing my point.
A sore tooth hurts. An ulcer hurts. A broken bone hurts.
You can fix the tooth for a couple of hundred dollars so it doesn't hurt anymore. You cannot do that for an ulcer (which first has to be diagnosed so that you even know that it's an ulcer and not cancer) or a broken bone. So while yes, you could live with it, the point is that in order to live pain-free you have to spend a considerable amount more money for medical work than you do for dental.
Which is why people aren't harping about free dental or vision care. One can get by without. One cannot, really, get by without medical without going bankrupt, living in pain, or dying.
I thought we were talking life threatening which an infected tooth and ulcer both can be (though presumably an infected tooth has little recourse beyond medicine/extraction). I didn't realize we were just discussing a system to keep people free from pain - which doesn't even in happen in a system where everything is covered.
I'll agree about your final statement (though not sure all can afford dental care as you suggest).
Quote from: derspiess on March 01, 2013, 01:02:04 PM
Quote from: Caliga on March 01, 2013, 12:54:34 PM
I talked to my eye doctor about laser surgery last fall. My vision is so poor that even after I got it, I'd still need glasses. :blush:
I've been told mine is just good enough to where I wouldn't need them. I've just about convinced myself to do it.
As an aside, a couple years ago I was out for dinner/drinks with a couple co-workers adamantly trying to talk me into laser surgery. I told them their otherwise solid arguments were undermined by the fact that they both were wearing glasses at the time, despite having had the surgery.
:lol: Shit!
I've been thinking about getting it but I still feel a little too young for the risk it represents.
Quote from: garbon on March 01, 2013, 08:27:51 AM
I'm unconvinced this 41-year old man would have gone to see a doctor initially even if he could afford it.
No one is going to show up at the doctor's office to get their hepatic artery aneurysm diagnosed. They are asymptomatic until they rupture. As the story describes, it's usually an incidental finding on abdominal CT done for a different indication. Whether he could afford a regular office visit or not is beside the point. If it were diagnosed he'd have no way to pay for the surgery. But we as a society still have to pay for his expensive emergency room and ICU stay when the thing ruptures thanks to EMTALA. Our system doesn't work well. We need a single payer. It's fiscally and morally retarded to socialize the treatment cost only when it's at the most expensive point possible in the disease course.
Conservatives either need to push for repeal of EMTALA and let these people die after we turn them away from the waiting rooms due to lack of insurance, or they need to grow the fuck up and accept Medicare for all.
Quote from: Fate on March 01, 2013, 01:23:29 PM
Quote from: garbon on March 01, 2013, 08:27:51 AM
I'm unconvinced this 41-year old man would have gone to see a doctor initially even if he could afford it.
No one is going to show up at the doctor's office to get their hepatic artery aneurysm diagnosed. They are asymptomatic until they rupture. As the story describes, it's usually an incidental finding on abdominal CT done for a different indication. Whether he could afford a regular office visit or not is beside the point. If it were diagnosed he'd have no way to pay for the surgery. But we as a society still have to pay for his expensive emergency room and ICU stay when the thing ruptures thanks to EMTALA. Our system doesn't work well. We need a single payer. It's fiscally and morally retarded to socialize the treatment cost only when it's at the most expensive point possible in the disease course.
I see and can agree with your last bit - which not coincidentally is the only relevant part to my post. :D