Dr. Thompson's Blog

What a Covid 19 Hospitalization Could Cost You

An interesting article in yesterday's New York Times by Sarah Kliff outlined what treatment for Covid 19 could cost a hospitalized patient. Of course Trump's treatment cost him nothing, even though he put the taxpayers to the extra expense of helicopter and limousine rides, plus all the needed secret service. 

The cost of if Remdesivir with Medicare or Medicaid  would cost $2,340. Without these programs, it would cost $3,120. A Covid test could cost anywhere from $100 to $1000 or more. Hospital care without insurance could cost $61,912 and with insurance it would be $31,575. An air ambulance would be about $21,698.

Of course. if repeated X-rays, CT scans etc. were needed the hospital charge could be much more. Nothing was given about charges for the steroids that Trump was given or the antibody cocktail. Also if an ER visit was needed before a hospital bed was found that charge would have to be added also. 

The virus is deadly and must not be taken lightly. Trump has been trying to play down its effects even though he could well still be shedding the virus. One MD said the virus could be shed for 10 to 20 days. We have not been told if Trump has  yet had a negative test for the virus. 

 

Biden's Healthcare Plan

We have not heard much about Biden's plan for our healthcare because of the Corona Virus mess. In today's New York Times, there was a very good article by Paul Krugman outlining what Biden has suggested. Trump and the Republicans have said for 4 years that they had a great plan to replace Obamacare but we have not been given any details. Trump hates President Obama so much that repeated attempts have been made by him to gut the Affordable Healthcare Act. Amy Coney Barrett if put on the Supreme Court also appears willing to vote against the ACA which would mean 20 million people would lose  their healthcare and  pre-exiting conditions would not be covered. 

The Biden plan would not be Medicare for All which would be a disaster but would have a  public option where people could buy into Medicare. It would also reduce premiums for the middle class and be sure  pre-existing conditions are covered. Low-income people would be automatically enrolled in the buy-in option. I don't see any mention of making drug prices more affordable but we can hope. Drug prices are completely out of control and the drug companies are making millions of dollars. Even when a new miracle drug has been found for something like spinal muscular atrophy the price of the drugs are beyond what most parents can  afford. 

The Importance of a Second Opinion with a Serious Medical Problem

Medical care has changed so much in the last several years that the importance of  a second opinion, if there is a serious diagnosis is even more important. The glory days of medicine are certainly over. Yes, we have lots of good things, but research seems to have become more important than everyday patient care. Recently, I have been told about a woman who has had breast cancer and now has a mass in her abdomen. A biopsy was done that revealed cancer, but I don't know if someone competent looked at the biopsy slides. When I was seeing neuromuscular patients and reviewing muscle biopsies from across the U.S. I was appalled at some of the unreadable muscle biopsies I was sent, particularly when the patients had been given a diagnosis based on the unreadable biopsies. Even well-known medical centers may have pathologists with limited training.  

Instead of doing a pet scan to see if there were any metastatic lesions, the woman was told to  take a laxative and eat a limited diet. Instead of surgically removing the mass  and probably part of the affected bowel, she was told that surgery would decrease her immunity. What did the doctor think a metastatic mass would do? This is a relatively young woman' who very much needs a second opinion in a different hospital. I suspect she is being left to die.  All biopsies should be reviewed by an expert in the field of the medical problem. I was once giving a talk in a major hospital about muscle diseases and a doctor in the front row in the audience asked several questions. Later he introduced himself and said he was the head pathologist. He admitted that muscle biopsies were not part of his training and he agreed to send any further biopsies  to people I recommended. 

What Could Happen with Another Conservative Supreme Court Judge

It was a great loss when Justice Ruth Bader Ginsburg died yesterday. She was an outstanding woman and a great fighter. Now Trump and his group are gleeful thinking they can get rid of the Affordable Health Care Act and leave thousands of  people without medical care. That would be a tragedy and the poor, the disabled and minorities will be hurt the most. I have never understood why there is no Republican health care act when Trump keeps saying there will be. How could any caring individual deprive thousands of the ability to see a physician or go to the hospital ? That is inhumane.

Not only will Obamacare be at great risk, but pregnant teenagers, poor women and those with an inheritable lethal gene will be at risk. Abortions are already being impacted, but if a woman with several disabled children, such as  Duchenne muscular dystrophy,  realizes she must continue having children with a lethal disorder that is cruel and wrong. I had one  mother of three boys who all died from Duchenne dystrophy and her sisters also had  boys with the disorder.  The woman's  husband disappeared, so no more children were fortunately born with the disorder. One mother who had two boys with the disorder told me she had no idea what she would do if she could ever have time for herself. Her whole life was taking care of her two boys with no help, little money and no time for friends or fun.  

Your Choice of Medical Care Can Make a Difference in Your Life or Your Child's.

I have seen some very good medical care and some that is unbelievably bad. My parents had a doctor they loved but he was most inadequate and would ask me what tests to order for my mother! I was in Northern California, he was in Southern California, and I was a pediatrician. I found an excellent internist for my parents but they refused to change. I suspect it was partly for financial reasons, since the  doctor was in Kaiser. My mother died of a stroke and I am not sure the doctor ever saw her. 

A good friend never saw an M.D but was being cared for by a nurse practitioner in an HMO. I urged  him to see an M.D., but he liked the nurse practitioner. He  died suddenly at age 59 and was a brilliant man. It was a great loss.

A remarkable woman who helped many children told me a few years ago about a medical problem she had that her HMO doctor ignored. I urged her to change doctors but she did not. A year later my friend was found to have diffuse cancer and had several very bad and painful years. She died recently. She could have afforded to get a second opinion or change doctors, but she did not. 

I am always puzzled about how patients make medical choices. Even extremely bright patients make strange and unusual choices. If you chose a doctor, you want to check where he or she went to school, if they are board certified and also read some of the reviews that patients write. Your life or your child's may defend on it. 

Lobbyists and Health Care

While many people are hungry or at risk  of losing their homes because they are unemployed, the health care lobbyists are working hard and have been very successful. Hospitals and others are paying lobbyists thousands of dollars to be sure they are included in the different laws  Congress has passed to help businesses. Hospitals are suffering because elective surgeries are markedly decreased and because their CEOs often make several millions of dollars.

One of the major lobbying firms is Brownstein, Hyatt, Farber and Shreck. They were able to see that Tenet Healthcare received more than 1.4 billion dollars in Cares Act grants and loans. This is while small businesses are in trouble or having to close and people are relying on food banks to feed their families. Several of the lobbyists have personal connections to Trump and his  group. 

I am told by a Washington insider that many of the bills which come out of Congress are written by lobbyists and may be as long as 800 pages. Walgreens has received 35.2 million, Johnson and Johnson 15.1 million and Eli Lilly 7.6 million. 

I hear about healthcare in other countries and wonder how the U.S. can be doing such a bad job. Money here seems so much more important that good patient care. If you have money you can get good medical care, particularly if you join a Boutique medical practice or have a connection to a hospital. I would be ashamed to make the salary some doctors get when there are poor people and others who can not afford even basic medical care. Yet  Trump keeps trying to get rid of the Affordable Healthcare Act because he is so jealous of what President Obama accomplished

Dangerous Medical Advice

I am greatly appalled at the medical advice that Trump and some of his group keep giving. First it was bleach that was going to cure the virus, then it was hydro-chloroquine which can be very deadly and now it is convalescent plasma. Trump even got the head of FDA to give an emergency authorization for the use of this plasma in patients with the corona virus. The  doctor was trained as an oncologist, but then became a hospital administrator. Even most medical students know you do not prescribe a new treatment that has not been put through standard double blind tests on thousands of people to show it would be effective and not dangerous. I guess it is more important for Trump to say there are new treatments for the virus, so he can be re-elected. In doing this he is putting people's lives in real danger. I wonder what will be the next wonder drug or treatment he will push?

If he tries to push a vaccine before it is safe, there will be illnesses and deaths. People will also be afraid to  have the vaccine if and when it is actually safe.  I certainly understand that. We have enough problem now with parents who will not let their children be vaccinated for diseases like measles, polio, tetanus and diphtheria and other illnesses. These children are being put at great risk. because of this. 

Mail Problems and Health Care

I am greatly concerned that Trump and the new Postmaster General will do everything they can to slow down the delivery of mail before the election. I was amazed to read that 1.6 billion prescriptions are sent to veterans, seniors, and others through the mail. Fighting the virus is bad enough but having to fight to get your prescriptions is completely wrong. Of course when Judge Berry, Trump's sister said he was "cruel" I guess  if veterans, seniors and others do not get their medications, it is of no concern to him.  

I think every one of us who have or had veterans in our family, knew veterans, or are worried about seniors have to speak out and not allow this to happen. Prescriptions have become so expensive, I wonder how the average citizen is able to manage. There are some organizations that offer help with the cost of prescriptions.  Partnership for Prescription is one and their website is www.pparx.org and their telephone number is 1-888-477-2669.  GoodRx and similar discount groups also offer help with the cost of prescriptions. It seems so wrong that the CEO, Larry Merlo, of CVS which also owns Athena Insurance made 36.5 million last year. No wonder the cost of prescriptions is so high. I would be embarrassed to make a salary like that particularly when there are so many people in this country  who are now jobless and homeless. 

Be Aware of Medical Misinformation, Unnecessary Tests, or Medications

Medical misinformation or unnecessary tests can cause a lot of problems and hurt patients.  There are some excellent Internet sites such as the Mayo Clinic, but even medical books can have statements that are incorrect.  Several years ago an article of mine was published about a Duchenne muscular dystrophy patient who had a child. I had sent blood from the patient, his wife, and child to a prominent geneticist at USC Medical Center to ensure the child was the son of the father.  Probably still in medical books today you may read that Duchenne dystrophy males are unable to  have  children. The Internet has several websites that contain erroneous information, so it is always wise to check with a physician you trust if you have a medical question. When you see an M.D., it is also wise to ask why a specific medical procedure, X-ray, MRI or blood tests are needed. My  granddaughter saw an internist for a physical exam at a California medical school. However, the physician did not take a history or do a physical examination but instead ordered a bunch of lab tests, none of which were indicated. The one test she should have ordered was not ordered. She also never called my granddaughter to give the results of the tests.  So bad medicine exists even in medical schools. If a new medicine is prescribed, you want to be sure it does not interact with any other medication you may be taking. Too many physicians do not check about interactions. A good pharmacist can help if you have questions. Some medicines should not be taken on an empty stomach, so that is also wise to check. 

The Problems with Telemedicine

I have a neighbor who is a psychiatrist and telemedicine works well for him and his patients. I am not sure about payment because Medicare and some insurance companies do not pay for telemedicine consultations. However, he is not one of the greedy doctors, so for him helping his patients is what matters. 

The there is the other side of telemedicine. A woman who is probably in her eighties and lives in a senior center was having terrible back pain. Her insurance company referred her to a pain specialist. It turned out the woman was a DO and not an M.D. or orthopedist. She talked to the patient by way of telemedicine and said she would  prescribe some medicine and also order back X-rays. She did not order an MRI of the back or refer her to an orthopedist. After seeing the X-ray report she was going to order some injections into the back when my friend called me. I was appalled. How could any M.D. or D.O. order injections and medicine when she have never examined the patient? It would be like me as a pediatrician using telemedicine to decide if a child had a strep throat, an ear infection, or something like meningitis. That is just very BAD medicine and should not be allowed. My friend promised to cancel the appointment for the injections and find an orthopedist or a spine surgeon. 

The only way a medical problem can be addressed is by taking a good history and doing a complete physical examination. I could never survive in an HMO like Kaiser where a doctor is limited to the amount of time he or she can spend with a patient. I have picked up some amazing things by being thorough and also knowing my  patients and their families. Oh for the good old days of medicine!