The Cost of Dying

My friend Burt sent along this clip of a recent "60 Minutes" story detailing the incredible costs of end-of-life care.

It's a compelling and provocative story, although I don't share the pessimistic view of ICU care that the piece espouses.

Still, great food for thought.



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Uncomfortable Arithmetic — Whom to Cover versus What to Cover

New in the latest issue of the New England Journal of Medicine, a couple PhDs with Harvard credentials admit that no matter what health care reform looks like, the money isn't unlimited.

The government won't be able to cover everyone for everything.

"[E]ventually, we will have to engage in the difficult discussions required to choose whom and what our public insurance programs should cover," the authors admit near the end of the article. "Some might call this rationing, but the reality is that millions of Americans now have no access to lifesaving medical technologies at the same time that public resources are being devoted to covering less-effective therapies for less-serious conditions. We find that sort of rationing hard to justify."

Interesting article, if only for its honesty.

Read it here:

Uncomfortable Arithmetic — Whom to Cover versus What to Cover

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America

Still obsessed with health care reform, still feel like a babe lost in the woods when it comes to the details.

The New England Journal of Medicine has been a great source of many interesting articles on the subject, and I've linked to one of the more recent, excellent examples below.

There's a grim case study in the article about Atlanta's Grady Hospital that had to shut down its dialysis unit after losing upwards of $50,000 per uninsured patient per year.

I think more frontline providers in EMS need to pay attention. Ultimately we're the ones that will bear the burdens of whatever chaos the bureaucrats and politicians wreak.

America’s Safety Net and Health Care Reform — What Lies Ahead?

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Cleveland Rocks!

Maybe it's a sign of things to come.

Maybe Cleveland is just the first EMS system to admit officially that 911 has become a farce.

Either way, I agree with this post on the Happy Medic blog lauding a report in the Cleveland Plain Dealer regarding Cleveland EMS's decision to refuse priority service on nonsense.

The plan instead seems to be to hold toe pains and VNA referrals for patients with UTIs until enough units are in service so that a cardiac arrest doesn't get a delayed response while everyone else is tied up driving sad people all over Kingdom Come.

Like everything else in our industry, it may be a laudable plan but it's mainly been chosen because a lack of money dictates it.

Maybe someday EMS decision-makers will make the right calls based solely on their rightness.

For now, money will have to do.

A Gap In The Thin Blue Line

When I was hired as a medic in The Big City, one of the first things the veterans told you was that we had an incredibly close relationship with the WPD.
Solidified over decades working side-by-side with Worcester's thin blue line, one of the biggest responsibilities we new guys had, outside of patient care, was to NOT screw that relationship up.
WPD officers were to be treated as our own, and if, God forbid, one of them were to be hurt on our watch, we were expected to move Heaven and Earth to care for them.
It didn't take long on those city streets to understand why.
Simply put, the men and women of the WPD are the best cops around.
They watched our backs and were a big reason working in The Big City was once one of the best paramedic jobs anywhere.
Officer Mark Bisnette was among the best officers on a department full of great officers.
A brother Marine, Biz was one of those officers who always seemed to have a smile on his face and a little time to shoot the breeze with the ambulance crews.
In a city chock full of people who get off on antagonizing the police, I never saw Biz have a bad word for anybody.
I've always been amazed by the way WPD officers defuse potentially violent situations on a daily basis without resorting to violence.
To me, that's got to be on the list of things that differentiates great cops from average ones.
WPD officers always know the players on their routes, always seem to have a great feel for street-level human psychology and motivations, and clearly know how to put this knowledge to use keeping the city safe.
I think this combination of attributes explains why officer-involved shootings in Worcester are incredibly rare.
People who possess this ability are equally rare, and Biz definitely had it in spades.
It's just one of the many reasons he will be missed.
Worcester Police Officer Mark Bisnette, 38, was off-duty early Saturday morning when he was killed in a single-car accident in a nearby suburb.
He leaves a wife and four children.
RIP Biz. You are one of the best.