A Hospital Bill Example: Ruptured Appendix Removal

[FutureCTDoc]

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Again, you live off of handouts.

Until you're not, stop whining about other people who just want to mooch.

In other words...GET A JOB. Jeez.

I do work.

 

[morning]

Yea man, don't you know you're not allowed to have an opinion on anything until you've experienced it?

How dare you have an opinion on the war in Iraq without being the president first! How dare you have an opinion on abortion without having one! How dare you have an opinion on dropping acid until you've tripped balls in the back of a van!

No, the analogous situation would be me getting an abortion, then trying to stop others from getting an abortion. See?

You receive major handouts. You live your entire life off of someone else's hard work. And then you complain that other people want to do the same thing (in your mind, that is, although no one is ever going to be supported cradle to grave by the state the way you apparently are by your parents.)

 

[RadioCure]

No, the analogous situation would be me getting an abortion, then trying to stop others from getting an abortion. See?

You receive major handouts. You live your entire life off of someone else's hard work. And then you complain that other people want to do the same thing (in your mind, that is, although no one is ever going to be supported cradle to grave by the state the way you apparently are by your parents.)

No, the analogous situation would be getting an abortion from my friend and then trying to stop the government from funding abortions. See?

Also, I was not the one complaining about people wanting handouts, and I think it was a bad point to make. My post a few above this shows that.

 

[Parts Unknown]

The same with non-payers. It is immoral to take my labor and to not compensate me.

Hmm, most of the autopsies I perform provide no extra compensation for my group or, by extension, myself. I have no doubt that a certain percentage of my daily work aids patients who cannot, for whatever reason, pay the hospital.

Is this immoral? Should I be upset?

 

[45408]

No, the analogous situation would be me getting an abortion, then trying to stop others from getting an abortion. See?

You receive major handouts. You live your entire life off of someone else's hard work. And then you complain that other people want to do the same thing (in your mind, that is, although no one is ever going to be supported cradle to grave by the state the way you apparently are by your parents.)

You've really milked this one for all of its worth, and it's getting pretty old now. Yes, we realize that children are raised by their parents. SHOCKING. Call someone who cares.

 

[FutureCTDoc]

Hmm, most of the autopsies I perform provide no extra compensation for my group or, by extension, myself. I have no doubt that a certain percentage of my daily work aids patients who cannot, for whatever reason, pay the hospital.

Is this immoral? Should I be upset?

You're volunteering to, you're donating your services. You've made the choice to give uncompensated, it hasn't been foisted upon you. I might choose to give uncompensated care on my terms, however to use it and not ask for my consent to give the care away is a vastly different story.

 

[Parts Unknown]

You're volunteering to, you're donating your services. You've made the choice to give uncompensated, it hasn't been foisted upon you. I might choose to give uncompensated care on my terms, however to use it and not ask for my consent to give the care away is a vastly different story.

Am I "volunteering"? I certainly don't enjoy having 3+ hours of unpredictable extra work. I'm not getting an extra dime for it. Perhaps the group could collectively refuse to do them anymore (nobody else cares for them, either), and the hospital would be forced to contract them out. Or I could just try to pawn them off on the other pathologists as often as possible.

When it comes to surgical specimens the hospital certainly doesn't tag ones from non-paying patients and give me the option of not doing them. I certainly have better things to do than rinse the semi-solid contents out of ischemic Hep C-positive intestines in preparation for overnight fixation.

Is this starting to sound coerced and immoral, yet?

 

[FutureCTDoc]

Am I "volunteering"? I certainly don't enjoy having 3+ hours of unpredictable extra work. I'm not getting an extra dime for it. Perhaps the group could collectively refuse to do them anymore (nobody else cares for them, either), and the hospital would be forced to contract them out. Or I could just try to pawn them off on the other pathologists as often as possible.

When it comes to surgical specimens the hospital certainly doesn't tag ones from non-paying patients and give me the option of not doing them. I certainly have better things to do than rinse the semi-solid contents out of ischemic Hep C-positive intestines in preparation for overnight fixation.

Is this starting to sound coerced and immoral, yet?

I would refuse it. Assuming there is no prior care and no issue of abandonment I probably wouldn't do it. You can force the hospital and I probably would. I know one NSx group that asks for 300K a year as a fee to provide call for a local hospital. Why don't you? It sounds like you're being forced to do it and you shouldn't have to freely give out your labor and effort unless you wish to.

 

[morning]

No, the analogous situation would be getting an abortion from my friend and then trying to stop the government from funding abortions. See?

Also, I was not the one complaining about people wanting handouts, and I think it was a bad point to make. My post a few above this shows that.

I actually thought I WAS responding to FutureCTDoc. Sorry 🙁

Hmm, most of the autopsies I perform provide no extra compensation for my group or, by extension, myself. I have no doubt that a certain percentage of my daily work aids patients who cannot, for whatever reason, pay the hospital.

Is this immoral? Should I be upset?

I for one think the morality of these situations are far beyond the grasp of most people.

Take dialysis treatment - Medicare provides it, with almost no restrictions, for anyone who needs it. This is probably because when you're in stage 5 ESRD, dialysis is absolutely necessary. Without it, you're likely to die very quickly. We can pretend that not providing healthcare to people isn't actually killing them, but not when it comes to dialysis - death comes so immediately and so obviously that it cannot be ignored or pretended away. And yet people like FutureCTDoc believe that the folks on dialysis are stealing from everyone else.

A man who steals cars to pay for dialysis treatment is doing nothing but prolonging his own life. What are we to do? Stand around and watch him die? I can't imagine that if someone's spouse, child, sibling, or parent was dying and there was nothing they could do but steal to save their lives...they would do it. There is NOTHING I wouldn't do to save a sibling's life.

 

[45408]

Take dialysis treatment - Medicare provides it, with almost no restrictions, for anyone who needs it. This is probably because when you're in stage 5 ESRD, dialysis is absolutely necessary. Without it, you're likely to die very quickly. We can pretend that not providing healthcare to people isn't actually killing them, but not when it comes to dialysis - death comes so immediately and so obviously that it cannot be ignored or pretended away. And yet people like FutureCTDoc believe that the folks on dialysis are stealing from everyone else.

ESRD rarely comes out of the blue, and death doesn't really occur any faster from CKD than many other disease processes. For some strange reason, the federal govt took it upon itself to pay for dialysis (but not lung cancer, pancreatic cancer or any other number of very fatal disease processes). There are plenty of people who get dialysis who really shouldn't, and because of this, the feds are perpetuating a problem.

A man who steals cars to pay for dialysis treatment is doing nothing but prolonging his own life. What are we to do? Stand around and watch him die? I can't imagine that if someone's spouse, child, sibling, or parent was dying and there was nothing they could do but steal to save their lives...they would do it. There is NOTHING I wouldn't do to save a sibling's life.

Who you kill your other siblings? 🙄 The melodrama is moving.

 

[Parts Unknown]

I would refuse it. Assuming there is no prior care and no issue of abandonment I probably wouldn't do it.

On the other hand, refusal of an autopsy would leave the hospital in the position of paying an outside party for the service, which would certainly not be good for the relationship between the hospital and my group.

Moreover, while I don't get anything extra added to my paycheck, autopsies usually provide a beneficial service to the families of the decedents. This could mean giving a young couple the green light to have another pregnancy (for stillborns with questionable genetic problems), or confirming that nothing else could have been done to save grandpa from his neurosyphilis.

It would also seem most odd for me to ignore certain surgical specimens based on inability to pay. Doing so would not win me any friends with my colleagues, who are trying to develop and assess treatment strategies for these individuals. It also doesn't seem like a very good strategy for maintaining a healthy community and productive workforce. In a roundabout way, doing that minority of specimens fosters the professional work environment, tends to the relationship between the group and the hospital (which allows me to do the majority of specimens), and services the community in which I live, and these are all good things for me.

When I was rotating on psych in medical school I had two affluent, educated patients who had, for lack of a better term, lost their marbles and ended up seeking care in our urban, indigent hospital. One was actually a physician. I have also personally known two doctors who killed themselves. Both had mental health issues, one lifelong, the other developed them over the months that culminated in his suicide. I still think about these individuals to this day; they have helped to keep my ego in check. For all I know, I could wake up tomorrow hearing voices. In five years I could be that guy on the median with the cardboard sign. That could be my colon getting rinsed in the sink.

All that said, you will likely practice in a era where there is much less uncompensated care. It will be interesting to see it emerge.

 

[Parts Unknown]

For some strange reason, the federal govt took it upon itself to pay for dialysis (but not lung cancer, pancreatic cancer or any other number of very fatal disease processes).

Dialysis technology became feasible in the 1960's, but it was prohibitively expensive. The public saw people dying (including children and young adults) from kidney disease simply for lack of funding and resources. Congress responded by establishing dialysis pilot projects, and when Medicare passed in 1965 it covered treatment for kidney disease. This obviously left those under 65 still flapping in the breeze. A Congressional Committee was formed in 1966 (the Gottschalk Committee), and in 1967 it recommended universal, federally funded coverage for ESRD.

Given the typical Congressional pace, various legislative proposals were put forth and killed over the next few years. It wasn't until 1972 that Senator Vance Hartke (D-Indiana) introduced a successful amendment to the Social Security Act that extended ESRD coverage to the entire populace. There you have it.

 

[Kaustikos]

Dialysis technology became feasible in the 1960's, but it was prohibitively expensive. The public saw people dying (including children and young adults) from kidney disease simply for lack of funding and resources. Congress responded by establishing dialysis pilot projects, and when Medicare passed in 1965 it covered treatment for kidney disease. This obviously left those under 65 still flapping in the breeze. A Congressional Committee was formed in 1966 (the Gottschalk Committee), and in 1967 it recommended universal, federally funded coverage for ESRD.

Given the typical Congressional pace, various legislative proposals were put forth and killed over the next few years. It wasn't until 1972 that Senator Vance Hartke (D-Indiana) introduced a successful amendment to the Social Security Act that extended ESRD coverage to the entire populace. There you have it.

And that's how gov shot itself in the foot

 

[45408]

Dialysis technology became feasible in the 1960's, but it was prohibitively expensive. The public saw people dying (including children and young adults) from kidney disease simply for lack of funding and resources. Congress responded by establishing dialysis pilot projects, and when Medicare passed in 1965 it covered treatment for kidney disease. This obviously left those under 65 still flapping in the breeze. A Congressional Committee was formed in 1966 (the Gottschalk Committee), and in 1967 it recommended universal, federally funded coverage for ESRD.

Given the typical Congressional pace, various legislative proposals were put forth and killed over the next few years. It wasn't until 1972 that Senator Vance Hartke (D-Indiana) introduced a successful amendment to the Social Security Act that extended ESRD coverage to the entire populace. There you have it.

Oh, I'm generally familiar with how it all happened. It's also the reason why Medicare doesn't cover anything for anyone else under 65.

 

[morning]

Who you kill your other siblings? 🙄 The melodrama is moving.

My sister is on dialysis because both of her kidneys were destroyed in a crush injury.

Luckily, she has worker's comp.