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July 25, 2007

More Waiting Times in the US

The LA Times reports that uninsured adults in Los Angeles are waiting more than a year for gallbladder and hernia surgeries. Indeed, the Harbor-UCLA medical center just told the county's clinics to simply stop referring non-emergency gallstone, hernia, orthopedic, or neurosurgery patients till the hospital worked through its year-long backlog.

The clinics, predictably, are responding by sending these patients to emergency rooms, further overwhelming ERs with patients in terrible pain, but not technically suffering from an emergency. Yet. So they're being turned away, though no doubt going into debt or having their wages garnished as they attempt to pay off the bills. Meanwhile, In the absence of the necessary surgeries, we're holding these folks together with belts and trusses -- literally:

Hernias occur when part of an internal organ protrudes into muscle, often after a person strains to move a heavy object. A supportive belt or truss can help hold in the organ, but the belt can be painful and interfere with work, especially in jobs that involve manual labor or standing all day.

Organ poking out and pressing on a muscle? Here's a girdle!

Say it with me, kids: In this country, we ration by income.

July 25, 2007 in Health of Nations | Permalink

Comments

"Say it with me, kids: In this country, we ration by income."

Do the people you are saying this to not already know that? And do they care because in the end this fits in nicely with their view of market as god?

Posted by: akaison | Jul 25, 2007 11:37:56 AM

Akaison,

yes.

Posted by: Phil | Jul 25, 2007 11:47:36 AM

Ah, the joys of truncated data.

Posted by: Barry | Jul 25, 2007 11:54:14 AM

"Ah, the joys of truncated data."

What does the above quote mean?

Posted by: akaison | Jul 25, 2007 11:57:41 AM

Nearly everything in this country is rationed by income, including what does or doesn't get done in Washington. Does anyone think Obama or Clinton would have a chance of getting elected if they had 100 bucks in their campaign account? Money for better or worse makes this country tick.

Posted by: Dingo | Jul 25, 2007 11:59:45 AM

Uhm- so roads, telephone, the internet that you are using right now, etc were all based on just money. Not any communal aspect to these things at all. I love with people make these kinds of statement across something like the Internet which was all about community in order to make it happen.

Posted by: akaison | Jul 25, 2007 12:01:51 PM

Our national road system and the internet were both developed for originally military purposes, not for peace, love or happiness. The telephone? What motives most inventors? I would bet it would be money, far above any sense of cummunity. Last I checked they weren't handing out iphones next to the food stamps at the welfare office. If you don't think decisions are made because of finances each and every day and in this country, the richest in the world, you must have just walked out of the garden of Eden.

Posted by: Dingo | Jul 25, 2007 12:13:54 PM

roads were built for military use? you lose credibility when you say shit like that. and what of education- what was it built for? what about parks- what are they for? all of the things I mention were started before the modern fdr based state we have now. thats why i choose them. you can't win this argument dingo- so my advice is to stop embarassing yourself with simple minded responses

Posted by: akaison | Jul 25, 2007 12:39:45 PM

Dingo was imprecise. When he said "national road system," he meant the National Interstate and Defense Highways Act of 1956, championed by Eisenhower, which created the Interstate Highway System. That's a very important, but ultimately limited, subset of all our roads. Obviously, all other roads are public works, created for the common good, which includes, but is not limited to, the easy and efficient movement of commerce.

Dingo is being disingenuous when he suggests nothing is done for the common good. Contrary examples are too many to list.

Posted by: Rick | Jul 25, 2007 12:51:44 PM

Akaison I can think of nothing better than if I lose credibility with you. If you think money drives nothing in our lives, do live in the gumdrop plains or lollipop forest? Even Rick in his defense of you mentioned "easy and efficient movement of commerce". I don't deny things are done for the common good, but to deny things are not done for the bottom line as well is not telling the entire story. Obama and Clinton make that point about 70 million times combined. I think it it far from crazy to say that money drives the majority of policy in this country in one way or another.

P.S. Let me know where I can get the free iphone.

Posted by: Dingo | Jul 25, 2007 1:15:57 PM

Think anybody charged with making these decisions on who gets care has ever worked a job requiring manual labor?

Posted by: Jim 7 | Jul 25, 2007 1:26:05 PM

The situation with Harbor-UCLA is a bit more complicated than that. While the wait times are real, some of that crush is due to the reductions (and eventual shuttering?) of King-Drew. Then there was the oversight UCLA was suppoded to be providing King-Drew, and maybe was - or wasn't - which contributed to King-Drew's current woes with the accrediation authorities. You'd have to read the full article, and previous stories in the LA Times to get a flavor of what an unholy mess this is. LA County politics meets medicine and the results are predictable. All of LA's hospitals will be taking up even more slack if King-Drew actually closes. This situation could get a whole lot worse befopre it gets better.

Posted by: mk | Jul 25, 2007 1:27:18 PM

The telephone?

Actually Bell got involved in developing the telephone because his wife was deaf and he was interested if the technology could help deaf people.

In any case, the telephone is an intesting case-- the more people have a telephone, the more valuable that an individual telephone becomes linearly and more valuable the entire system becomes, quadratically (Metcalfe's Law-- look it up). As a consequence, for the public good, the government decided to support policies that would spread access to telephone service to as many people as humanly possible in the USA, even if they were geographically isolated. It is a great example of a good that creates a lot of public value, and ensuring universal access was done precisely to support the public good.

The boomer and WW2 generations, who grew up in the eras in which we adopted mass vaccination, rural electrification, universal telephone access, and the national highway system (the "national defense" aspect was an excuse to get some small-government types in congress on board) have a much deeper attachment to the concept that many government initiatives serve the public good in a tangible way, without which everyone would be worse off. That Dingo made the argument that he does shows how detached he is from the reality that many Americans grew up with.

Posted by: Tyro | Jul 25, 2007 1:27:31 PM

For better or mostly worse that is the reality we are dealing with today. Money affords access which drives policy. Longing for the days of Marcus Welby are not going to make them come back.

Posted by: Dingo | Jul 25, 2007 1:38:16 PM

you are calling turning this country into one of the leading economic powers in the world was a bad thing? bizzaro to say the least

Posted by: akaison | Jul 25, 2007 1:39:58 PM

by the way i am glad we are having this conversation- as someone said it shows the level to which you are disconnected from anything resembling american life or reality.

Posted by: akaison | Jul 25, 2007 1:40:38 PM

Jim7,

Manual labor is so far off the radar screen for so many of our market driven theoreticians. These are the same folks who think raising the social security retirement age to 70 is no big deal.

The other day I was leaving a construction company where I represent the workers. There was a pallet of cinder blocks outside and out of curiousity I went to pick one up. I am a pretty good sized guy and lift weights regularly. I was stunned that I could not pick this block up with one hand. I then struggled with two hands. It was an awkward size, rough as crap and weighed about 60 pounds. I thought about picking these up and setting them one after another, eight hours a day in 95 degree heat or 35 degree cold, and felt renewed affection for my JD.

The idea of having to do this with a hernia, while donning a truss is unthinkable.

Posted by: Klein's Tiny Left Nut | Jul 25, 2007 1:41:51 PM

Yes, we do, and in the minds of the people making the decisions, that's a feature, not a bug. If we changed to a more fair system, people with money might have to wait sometimes too, and they don't want to.

Posted by: beckya57 | Jul 25, 2007 1:58:21 PM

Don't worry the guy with the hernia is expendable, there are plenty of undocumented workers to do that sort of thing.

I am entirely connected to life and reality, I deal with life and death every single day.

Posted by: Dingo | Jul 25, 2007 2:05:34 PM

If you think money drives nothing in our lives, do live in the gumdrop plains or lollipop forest? Even Rick in his defense of you mentioned "easy and efficient movement of commerce". I don't deny things are done for the common good, but to deny things are not done for the bottom line as well is not telling the entire story.

Putting aside all else dingo, you lose credibility when you misstate what others and yourself have previously said. Akaison never claimed that "money drives nothing in our lives". That's your own invention. Likewise, no one denied the role of the bottom line in decision making, merely its primacy in every circumstance.

While you now say that you don't deny that things are done for the common good, there isn't the slightest hint of any such concession in your prior postings. Instead you make categorical assertions such as:

Nearly everything in this country is rationed by income, including what does or doesn't get done in Washington. Does anyone think Obama or Clinton would have a chance of getting elected if they had 100 bucks in their campaign account? Money for better or worse makes this country tick.

That certainly sounds as though you deny the role of common or public interest in the life of the country. Perhaps you simply overstated your position.

Also of interest:

What motives most inventors? I would bet it would be money, far above any sense of cummunity.

Just don't bet on Benjamin Franklin or you'll lose. As a matter of historical interest, Franklin never patented his most successful invention, the Lightning Rod. He made this decision explicitly to insure that there would be no bar to its free and wide spread use. He considered that the general benefit to the commonweal outweighed his personal interest.

Posted by: WB Reeves | Jul 25, 2007 2:13:49 PM

"In this country, we ration by income"

Nope. We ration by price and one's ability to pay... 2 different things.

Posted by: hmmmm | Jul 25, 2007 2:25:03 PM

I am entirely connected to life and reality, I deal with life and death every single day.

Thankfully, the mere possession of a graduate degree never made me think I knew everything. It made me realize that I was extremely good at what I was extremely good at, and that most people are the same way. You're extremely good at being a doctor (at least I hope you are). Public policy issues, not so much.

Posted by: Tyro | Jul 25, 2007 2:27:23 PM

Another thing about "public goods" is that the government can't -- and it's wrong for them to -- attempt to strictly control how they will be used, mostly because we just don't know what the economic value of each use of a public good is ahead of time. Sure, the highway system quantifiably improved the ability to move goods across the country, but it also made it possible to solidify more distant family and social connections and improve other intangibles that had an economic impact on the country. We had no idea what kind of uses we would find for the phone system until we started putting the phone system in everyone's hand and let them start using it for a nominal fee, even if it wasn't obvious how economically beneficial it was to roll phone service out to certain areas (and, in any case, the United States didn't want to face a future in which some parts of the country had access to modern utilities and others didn't).

Dingo is arguing that any public intiative can only be justified by clear, tangible economic benefits accessible only by those who are going to use them for the specified purposes.We don't do that here-- and it applies to health care issues as well: we should ensure that everyone in the country is "pulled along" into the modern era of health coverage, just like we did with electricity and telephones. To a certain degree, we can probably quantify many of the benefits in terms of relieving companies of spending so much on coverage for their employees and improving the health of employees, but we don't know how people will use their new found freedom to pursue other ventures, professions, and develop ideas that they didn't have the freedom to do before. Dingo thinks my line of reasoning doesn't even exist.

Posted by: Tyro | Jul 25, 2007 2:43:08 PM

I never made any policy proposals, but that being said whatever policy is enacted, IF, it is enacted. I hope the majority of decisions are made by physicians. Interventions and what is deemed worthy need to be decided with heavy physician involvement. You know, those that actually do it for a living rather that what a politician and their handlers would have us believe is the right decision.

Posted by: Dingo | Jul 25, 2007 2:44:59 PM

"In this country, we ration by income"

Nope. We ration by price and one's ability to pay... 2 different things

I think this qualifies as a distinction without a difference. At least as far as the patient is concerned.

Posted by: WB Reeves | Jul 25, 2007 2:45:14 PM

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