Futile care.

Started by cittykat
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That was a pretty poorly written article. Declaration of brain death (death by neurologic criteria) does not "legality allow hospitals to remove life support" because of some weird loophole. Support is removed because they are actually dead. Only in New Jersey is death by neurologic criteria (the proper term) not legally death. Side bar, it was the ultra-orthodox Jewish community that prevented NJ from adopting that legal standard. Similar issues sometimes come up with some groups of Muslims (one of my former colleagues was involved in a case where they sent a brain dead patient back to Saudi Arabia at the family's insistance). The Catholic church, and I believe most large Protestant denominations have accepted the definition. I haven't cared for enough Orthodox christians to know their church's stance. Somehow linking this to the anti-abortion movement into this seems a stretch.

I'm not sure if rules are different in Texas, or for minors, but in states where I've practiced adult critical care, I do not have to tell the family that I am proceeding with brain death testing (although, I do). Once the patient is determined to be dead, the family gets a short period to get family present when we remove the tube, but it's happening regardless of their objections. If they're very vocal and against proceeding (in those cases, usually refusing to leave bedside and physically obstructing care or making threats), risk management and security are notified first. In this rare situation, the hospital admin, after talking to the lawyers, gets back to us and has security remove family (my state has pretty good laws regarding assault and threatening health care professionals at work). I've only personally had to go down that pathway once.
 
Send the parents the bill. That’s how we really need to handle futile care.

And not this is not a morale dilemma. We waste so much money end of life (yes even pediatrics) care. We can easily save 10% on GDP on futile end of life care in the USA

25% of medicare spending on a person is within the last 12 months of their lives. These are undisputed facts.
 
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aneftp said:
And not this is not a morale dilemma. We waste so much money end of life (yes even pediatrics) care. We can easily save 10% on GDP on futile end of life care in the USA
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I would guess this is off by about an order of magnitude, but I don't really want to do the math. Depends a lot on what is deemed "futile" as not every dollar spent during someone's "end of life" should be considered futile.

10% of GDP is over 3 trillion dollars. All healthcare spending in the country is 5.7 trillion (medicare, medicaid, private insurance, etc...).
 
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rowsdower88 said:
I would guess this is off by about an order of magnitude, but I don't really want to do the math. Depends a lot on what is deemed "futile" as not every dollar spent during someone's "end of life" should be considered futile.

10% of GDP is over 3 trillion dollars. All healthcare spending in the country is 5.7 trillion.
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69% of statistics are made up 100% of the time. lol
 
Regardless everyone handles grief differently. I’m pretty stoic. I took zero days off when my dad died. I took zero days off when my dog died.

This surgeon canceled all his cases for the day when his dog died.
 
aneftp said:
Regardless everyone handles grief differently. I’m pretty stoic. I took zero days off when my dad died. I took zero days off when my dog died.

This surgeon canceled all his cases for the day when his dog died.
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When my dog dies I may quit medicine altogether and become a permanent mourner. Parents? Lmk if you need someone to talk to the coroner/undertaker 😉
 
psychbender said:
I'm not sure if rules are different in Texas, or for minors, but in states where I've practiced adult critical care, I do not have to tell the family that I am proceeding with brain death testing (although, I do). Once the patient is determined to be dead, the family gets a short period to get family present when we remove the tube, but it's happening regardless of their objections. If they're very vocal and against proceeding (in those cases, usually refusing to leave bedside and physically obstructing care or making threats), risk management and security are notified first. In this rare situation, the hospital admin, after talking to the lawyers, gets back to us and has security remove family (my state has pretty good laws regarding assault and threatening health care professionals at work). I've only personally had to go down that pathway once.
Click to expand...

Wtf! That is terrible! It's like you're proud of killing someone's family member. What if they wanted more time to see if they recover, or wanted a second opinion?? If my 4yo was declared "dead" by you and immediately extubated against my objections I would literally find you outside the hospital.
 
Greenbayslacker said:
Wtf! That is terrible! It's like you're proud of killing someone's family member. What if they wanted more time to see if they recover, or wanted a second opinion?? If my 4yo was declared "dead" by you and immediately extubated against my objections I would literally find you outside the hospital.
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No one recovers from brain death. Are you even a doctor?
 
cchoukal said:
divert discussion to the ACA in 3.... 2..... 1.....
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We were referring to misleading stats. Anyway can lead stats the way they want.

Simply put. Futile end of life cost the economy a ton of money. There is no disputing that.
 
Lab Lover said:
Yes it has happened. See DSA members for proof.
Click to expand...
Reminds me of this story:
Lawyer: "Doctor, before you performed the autopsy, did you check for a pulse?"

Witness: "No."

Lawyer: "Did you check for blood pressure?"

Witness: "No."

Lawyer: "Did you check for breathing?"

Witness: "No."

Lawyer: "So, then it is possible that the patient was alive when you began the autopsy?"

Witness: "No."

Lawyer: "How can you be so sure, Doctor?"

Witness: "Because his brain was sitting on my desk in a jar."

Lawyer: "But could the patient have still been alive nevertheless?"

Witness: "Yes, it is possible that he could have been alive and practicing law somewhere."
 
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Greenbayslacker said:
Wtf! That is terrible! It's like you're proud of killing someone's family member. What if they wanted more time to see if they recover, or wanted a second opinion?? If my 4yo was declared "dead" by you and immediately extubated against my objections I would literally find you outside the hospital.
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  • Coma: The brain is injured and unconscious, but it still has some electrical activity and function. Recovery is possible.
  • Vegetative State: Higher brain function is lost, but the brainstem still controls breathing and heartbeat. Recovery or improvement can sometimes happen.
  • Brain Death: No brain activity or brainstem reflexes exist at all. No one has ever recovered from true brain death.
 
Lab Lover said:
No question...But would healthcare suck less if the ACA never passed? Not sure, but I don't think so.
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It put the nail in the coffin for physican owned hospitals. Which weren’t a major player anyways. But insurers and the AHA wanted to kill the option claiming doc owned hospital can cherry pick patients. The law was anti physician.

And made the exchanges even worse for those making more than 400% of poverty. 90% of People are completely dependent on subsidy on the exchanges vs zero percent were dependent on the individual market prior to the ACA

But getting back to the futile care. I am a big proponent of death panels. We waste so much money like i posted before on healthcare. We all done the GI patient with Mets everywhere and anemia hg 7. Outside of active bleeding why the heck are they doing double procedure? Just give them blood if they are symptomatic and wait. But they do these unnecessary procedures. 99% of the time they find nothing if the patient isn’t symptomatic.

And as for the brain dead kid. Give them a week or two to grieve on the ventilator. No one wants to lose a child. Totally understandable. But costs and reality need to set in for these parents.
 
kidthor said:
What's the alternative though?
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Alternative is most non doctors in the health industry game want to keep the status quo going.

It’s all fake fighting
No one wants to be to play the socialize medicine cause it means less money for everyone.
 
UscGhost said:
I think we have been waiting for the Republican alternative..

Any day now..
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Because once you start giving away free stuff. It’s hard to take it back.

The time to kill it was 2013 but Benedict judge Roberts destroys any chance of it.
 
Burned_Out said:
The ACA sucks....IMHO
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My daughter’s in grad school. She’s on an ACA plan and she likes it. But then again, I have a United healthcare HDHP and I like it too. Most people complain about United Healthcare but to me they’ve been worth every penny.
 
cittykat said:
My daughter’s in grad school. She’s on an ACA plan and she likes it. But then again, I have a United healthcare HDHP and I like it too. Most people complain about United Healthcare but to me they’ve been worth every penny.
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Non ACA pre 2014 plans for people ur daughter age were less than $100-150/mo full medical college for men and women with around a $1500 deductible. With NO SUBSIDY REQUIRED.

Women did have to pay a $200/mo extra maternity rider in case for pregnancy and needed maternity coverage. That was optional premium in many private insurance. ACA proponents said that’s not fair to the woman to have to pay more. Many women opted to have no pregnancy coverage to save money. And if they got pregnant they would cry help. It’s not fair. I have a pre existing condition and insurers won’t cover my pregnancy.

Fast forward to 2014. Becuase the ACA demanded both men and women have pregnancy coverage. You would think insurers would split the difference and maybe charged men and women say $250/mo for the same coverage since men had zero percent chance of getting pregnant.

In theory in 2014 the woman would pay $250/mo (vs $350/month in 2013 with the maternity rider) and men would pay $250/mo. But nope. Insurers immediately jacked up the rate to $350/mo-400/mo for both men and women in 2014

That’s how the insurers took advantage of the ACA.

Your daughter is likely paying $500-600 a month in premiums for the ACA exchanges in 2026 prices with some sort of deductible. May or may not need subsidy (90% of people get subsidies now) because most cannot afford paying $500-600 PER PERSON per month premiums. The subsidies lower the premiums to $100-300/month.

It’s a game to insurers cause they know they get the full jacked up $500-600 month in premiums cause govt subsidies in 90% of cases.
 
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aneftp said:
Non ACA pre 2014 plans for people ur daughter age were less than $100-150/mo full medical college for men and women with around a $1500 deductible. With NO SUBSIDY REQUIRED.

Women did have to pay a $200/mo extra maternity rider in case for pregnancy and needed maternity coverage. That was optional premium in many private insurance. ACA proponents said that’s not fair to the woman to have to pay more. Many women opted to have no pregnancy coverage to save money. And if they got pregnant they would cry help. It’s not fair. I have a pre existing condition and insurers won’t cover my pregnancy.

Fast forward to 2014. Becuase the ACA demanded both men and women have pregnancy coverage. You would think insurers would split the difference and maybe charged men and women say $250/mo for the same coverage since men had zero percent chance of getting pregnant.

In theory in 2014 the woman would pay $250/mo (vs $350/month in 2013 with the maternity rider) and men would pay $250/mo. But nope. Insurers immediately jacked up the rate to $350/mo-400/mo for both men and women in 2014

That’s how the insurers took advantage of the ACA.

Your daughter is likely paying $500-600 a month in premiums for the ACA exchanges in 2026 prices with some sort of deductible. May or may not need subsidy (90% of people get subsidies now) because most cannot afford paying $500-600 PER PERSON per month premiums. The subsidies lower the premiums to $100-300/month.

It’s a game to insurers cause they know they get the full jacked up $500-600 month in premiums cause govt subsidies in 90% of cases.
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Costs and subsidies vary by county in our state. She’s a poor grad student on a blue shield silver+ plan. It costs $7.90/month. Network is excellent. Annual out of pocket max is $1400.
 
We simply have greedy hospitals and procedurists doing unnecessary end of life things like peg in the USA in regards to end of life futile care.

“Studies indicate similar high early-mortality rates following feeding tube placement. Aggressive end-of-life interventions remain more common in the US healthcare system due to differing financial incentives, cultural expectations regarding artificial nutrition, and defensive medicine practices, ”
 
cittykat said:
Costs and subsidies vary by county in our state. She’s a poor grad student on a blue shield silver+ plan. It costs $7.90/month. Network is excellent. Annual out of pocket max is $1400.
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You aren’t stating the true cost. That’s my point. My 25 million plus net worth sister has her kid on Medicaid for free. Along with half the medical students in his affluent super high end top 5-7 medical school. They all play the Medicaid game due to the ACA.

The true non subsidized cost for ur daughter is really much more than $7.90 a month.
 
aneftp said:
We simply have greedy hospitals and procedurists doing unnecessary end of life things like peg in the USA in regards to end of life futile care.

“Studies indicate similar high early-mortality rates following feeding tube placement. Aggressive end-of-life interventions remain more common in the US healthcare system due to differing financial incentives, cultural expectations regarding artificial nutrition, and defensive medicine practices, ”
Click to expand...


Sometimes I wonder what happened to all those people we trach/PEG’d during Covid.
 
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aneftp said:
You aren’t stating the true cost. That’s my point. My 25 million plus net worth sister has her kid on Medicaid for free. Along with half the medical students in his affluent super high end top 5-7 medical school. They all play the Medicaid game due to the ACA.

The true non subsidized cost for ur daughter is really much more than $7.90 a month.
Click to expand...


I don’t think she cares what the true cost is or even thinks about it. There are much wealthier people gaming much more than a few hundred dollars/month to buy health insurance. That’s the American way.

Of all people you know that.
 
UscGhost said:
I think we have been waiting for the Republican alternative..

Any day now..
Click to expand...
RINOs and dems killed the alternative. Trump is going to let the current ACA system fail, as it was designed to fail by dems. I would like to go back to the old system. It was cheaper. Before you say but you won't be covered for life-saving treatments.....well, the insurance companies are not going to cover you anyhow under the current ACA. Every insurance plan (i.e., United Healthcare) I've had under the ACA has rejected my family's medical treatment for things like rotator cuff tear, umbilical hernia, etc. They don't care and the ACA is not going to force them to cover anything. If they won't cover the small things, the hell they will cover your cancer treatment.
 
Burned_Out said:
RINOs and dems killed the alternative. Trump is going to let the current ACA system fail, as it was designed to fail by dems. I would like to go back to the old system. It was cheaper. Before you say but you won't be covered for life-saving treatments.....well, the insurance companies are not going to cover you anyhow under the current ACA. Every insurance plan (i.e., United Healthcare) I've had under the ACA has rejected my family's medical treatment for things like rotator cuff tear, umbilical hernia, etc. They don't care and the ACA is not going to force them to cover anything. If they won't cover the small things, the hell they will cover your cancer treatment.
Click to expand...


Is coverage by United Healthcare different if you obtain it via ACA vs your employer? I have United Healthcare through my employer and they have been very good about covering extremely expensive (7 figures) cancer treatment. Monthly specialty pharmacy bill alone is over $40k. Never had a single delay or denial even for off label use of an expensive drug before an even more expensive FDA approved treatment became available. I do wonder if cancer center doctors or their staff just know how to get things approved quickly.
 
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aneftp said:
It put the nail in the coffin for physican owned hospitals. Which weren’t a major player anyways. But insurers and the AHA wanted to kill the option claiming doc owned hospital can cherry pick patients. The law was anti physician.

And made the exchanges even worse for those making more than 400% of poverty. 90% of People are completely dependent on subsidy on the exchanges vs zero percent were dependent on the individual market prior to the ACA

But getting back to the futile care. I am a big proponent of death panels. We waste so much money like i posted before on healthcare. We all done the GI patient with Mets everywhere and anemia hg 7. Outside of active bleeding why the heck are they doing double procedure? Just give them blood if they are symptomatic and wait. But they do these unnecessary procedures. 99% of the time they find nothing if the patient isn’t symptomatic.

And as for the brain dead kid. Give them a week or two to grieve on the ventilator. No one wants to lose a child. Totally understandable. But costs and reality need to set in for these parents.
Click to expand...


This doc owned hospital cheaped out (as they tend to do), went CRNA only, and was shut down.




Our Facilities | Physicians Surgery Centers (PSC)

www.psc-asc.com www.psc-asc.com
 
cittykat said:
I don’t think she cares what the true cost is or even thinks about it. There are much wealthier people gaming much more than a few hundred dollars/month to buy health insurance. That’s the American way.

Of all people you know that.
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yes she cares about the true health care premium costs. Let’s just stop this denial.
You may say she doesn’t care. I’m talking about the true cost of the just the health care premiums alone without subsidies until reality sets in it will cost her $600 a month or even more for a young adult.

Look at the public freaking out when the “enhanced “ health care premiums subsidies were expiring a couple of years ago

www.commonwealthfund.org

ACA Marketplace Subsidies Expiration | Commonwealth Fund

Learn how the expiration of the ACA's enhanced premium tax credits could lead to higher premiums, marketplace instability, and loss of coverage for millions.
www.commonwealthfund.org www.commonwealthfund.org

Someone making 400% of poverty and near the cliff facing a substantial increase. Her premiums would go from $7.50 a month to more than $600 a month in premiums plus co pays and deductibles if she were to make 60k or so. (Assuming she’s single). She would care.

Many of us have posted some of us or people who know pay well over 30k, almost 40k a year in premiums alone for a family of 5 depending on plans we choose. That is simply unaffordable for a family to pay if they make just over 400 percent of poverty. How is some family making say 170k gonna to afford 30k in premiums?

You can’t be serious if she doesn’t realize or care someone is subsidizing her premiums.
 
cittykat said:
Is coverage by United Healthcare different if you obtain it via ACA vs your employer? I have United Healthcare through my employer and they have been very good about covering extremely expensive (7 figures) cancer treatment. Monthly specialty pharmacy bill alone is over $40k. Never had a single delay or denial even for off label use of an expensive drug before an even more expensive FDA approved treatment became available. I do wonder if cancer center doctors or their staff just know how to get things approved quickly.
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United healthcare denied my general surgeon friend’s ozempic prescription in 2026 when he went self employed via exchanges

When he was employed by a major hospital system. It was approved. He’s a known diabetic. Already getting some neuropathy. Been on metformin and other diabetics drugs for years. The usual diabetic documents to prove it including recent blood word. Ozempic was approved and he only paid $40 co pay a month for it in 2022-2025. And yes. Ozempic is expensive and fda approved as we all know.

So even known diabetics get it denied.

Every United healthcare plan with different employers has different agreements. And ACA United is not the same in many cases as major employers
 
aneftp said:
United healthcare denied my general surgeon friend’s ozempic prescription in 2026 when he went self employed via exchanges

When he was employed by a major hospital system. It was approved. He’s a known diabetic. Already getting some neuropathy. Been on metformin and other diabetics drugs for years. The usual diabetic documents to prove it including recent blood word. Ozempic was approved and he only paid $40 co pay a month for it in 2022-2025. And yes. Ozempic is expensive and fda approved as we all know.

So even known diabetics get it denied.

Every United healthcare plan with different employers has different agreements. And ACA United is not the same in many cases as major employers
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the idea of someone with a 25M net worth not paying for quality health insurance is a very questionable choice, I don't think most would do that to their kids.

the idea that the excess costs of health insurance are mostly related to poor people "scamming" the system is a very questionable perspective, how about the CEOS, admins, corporate profit? your right I dont want to make less money with private health insurance reform, but I want the health insurance companies and cronies to make way less

that surgeon, like the 25M networth individual, should have not been cheap and bought a real plan that would have covered his needs from the beginning, hes not the target audience of that ACA. Yes that plan should be cheaper, but its not poor people fault, its the ones with the huge bonuses really even working in healthcare: ceos, admins, corporate stockholders
 
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cittykat said:
Is coverage by United Healthcare different if you obtain it via ACA vs your employer? I have United Healthcare through my employer and they have been very good about covering extremely expensive (7 figures) cancer treatment. Monthly specialty pharmacy bill alone is over $40k. Never had a single delay or denial even for off label use of an expensive drug before an even more expensive FDA approved treatment became available. I do wonder if cancer center doctors or their staff just know how to get things approved quickly.
Click to expand...
yes they are likely very different plans with the ACA plan reimbursing providers similar to medicaid numbers, and providers being forced to see ACA patients for a loss, vs a premium united plan where the reimbursements are high and the provider is happy to see you
 
Going to give @aneftp his annual reminder that after the ACA was passed healthcare cost increases decreased annually. Prior to the ACA passing, healthcare costs were increasing ~6.9% annually (over the 10 years prior) and after it passed they increased at ~4.3% (over the subsequent 10 years).

Were we living in a world without the ACA, healthcare costs would likely be much higher today.

econofact.org

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact

econofact.org econofact.org
 
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Hoya11 said:
the idea of someone with a 25M net worth not paying for quality health insurance is a very questionable choice, I don't think most would do that to their kids.

the idea that the excess costs of health insurance are mostly related to poor people "scamming" the system is a very questionable perspective, how about the CEOS, admins, corporate profit? your right I dont want to make less money with private health insurance reform, but I want the health insurance companies and cronies to make way less

that surgeon, like the 25M networth individual, should have not been cheap and bought a real plan that would have covered his needs from the beginning, hes not the target audience of that ACA. Yes that plan should be cheaper, but its not poor people fault, its the ones with the huge bonuses really even working in healthcare: ceos, admins, corporate stockholders
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Her kid is 26 now and can’t be on parents plans. He’s completely healthy.

Like I said. The old pre ACA says. He pays $100/mo for premiums instead of $500-600 a month. There is some weird formula she pays him a small w2 compensation from her LLC/s corp to make it look like he’s poor wage earner. He’s got 750k already in various trusts growing each year but the ACA doesn’t even consider assets It only considers income.

Do I troll here? Yes absolutely. But it’s true. These are real things my nephew and sister are doing in real life. Showing the stupidity of the ACA and how it doesn’t do “means testing for Medicaid expansion”. With regular Medicaid the government absolutely does means testing.

But with Medicaid expansion the government (state) does not do any means testing.

The target of the ACA was a very select few people who had preexisting conditions. Less than 0.5-1% of the entire USA population who were truly uninsurable on the individual market. But now you got 20 million people begging for free cash or dependent on subsidies.
 
rowsdower88 said:
Going to give @aneftp his annual reminder that after the ACA was passed healthcare cost increases decreased annually. Prior to the ACA passing, healthcare costs were increasing ~6.9% annually and after it passed they increased at ~4.3%.

Were we living in a world without the ACA, healthcare costs would likely be much higher today.

econofact.org

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact

econofact.org econofact.org
Click to expand...
You are quoting old data bruh.

With recent inflation we are once again seeing a rapid re acceleration of healthcare costs over 7%

“
2023: 7.4% — Spending accelerated significantly to $4.9 trillion ($14,570 per capita).


2024: 7.2% — Total spending reached $5.3 trillion ($15,474 per capita), accounting for 18.0% of U.S. GDP.


2025 (CMS Estimate): ~7.3% — Projections indicate continued elevated growth before gradually moderating later in the decade

Microphone drop. Proving my point once again.
 
aneftp said:
You are quoting old data bruh.

With recent inflation we are once again seeing a rapid re acceleration of healthcare costs over 7%

“
2023: 7.4% — Spending accelerated significantly to $4.9 trillion ($14,570 per capita).


2024: 7.2% — Total spending reached $5.3 trillion ($15,474 per capita), accounting for 18.0% of U.S. GDP.


2025 (CMS Estimate): ~7.3% — Projections indicate continued elevated growth before gradually moderating later in the decade

Microphone drop. Proving my point once again.
Click to expand...

This... doesn't at all disprove that the ACA slowed the rate of healthcare cost increases or that healthcare costs would be lower today were it not to have passed. You understand that right?

It is entirely possible that without the ACA, instead of a 7.2% increase in 2024 we would have seen an 8% increase or greater.

You seem to need this reminder at least semi-annually. People forget how high costs were rising pre-ACA.
 
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rowsdower88 said:
This... doesn't at all disprove that the ACA slowed the rate of healthcare cost increases or that healthcare costs would be lower today were it not to have passed. You understand that right?

It is entirely possible that without the ACA, instead of a 7.2% increase in 2024 we would have seen an 8% increase or greater.

You seem to need this reminder at least semi-annually. People forget how high costs were rising pre-ACA.
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And your theory doesn’t mean anything either if the ACA had not been put in place. All you see is the cost going from from 2001-2009 (it slowed down briefly in 2008/2009 because the economy crashed ) or whatever data point you want to make. And I show you the costs going right back up.

Yes or no. 0% of people on individual markets needed subsidies before the ACA.

The answer is zero percent needed subsidies. We have had this conversatio many times before. So now we have a 80-90% needing subsides. It’s not like the actually number of paying customers has increased. I’ve showed numerous times the only gains for the ACA were from Medicaid expansion and putting kids on parents plans.

And yes we have these conversations over and over.

So republicans have a plan to replace the ACA? Nope.

I’m a realist. The only fix is universal healthcare that no one wants to pay for.

But for you to keep on preaching the be benefits (the free give away program) of the aca and never acknowledge the weakness is so far out in left field.
 
aneftp said:
All you see is the cost going from from 2001-2009 (it slowed down briefly in 2008/2009 because the economy crashed ) or whatever data point you want to make.
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Sure. This is the data point I want emphasized:

A 2020 Health Affairs study noted annual healthcare spending growth decreased from 6.9% (2000-2009) to 4.3% (2010-2018) post-ACA.

aneftp said:
But for you to keep on preaching the be benefits (the free give away program) of the aca and never acknowledge the weakness is so far out in left field.
Click to expand...

Not at all what I've preached.
 
rowsdower88 said:
Sure. This is the data point I want emphasized:

A 2020 Health Affairs study noted annual healthcare spending growth decreased from 6.9% (2000-2009) to 4.3% (2010-2018) post-ACA.



Not at all what I've preached.
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Correct. I read the same data you read. That’s why I mentioned the inflation years after the article.

We both can agree there is no true fix without everyone going “all in” universal healthcare meaning poor and rich people need to pay into the system. Exempt a few select very poor individuals. Get rid of every waste such as administrative work duplication or services. Get rid of aha. Get rid of insurers. Unfortunately it would send the economy into a 1935 era depression.

So we keep plugging holes here and there

The easiest fix was a very limited means test for the truly uninsurable (aka the public option with zero room to expand without constitutional amendments) . Requiring a super majority vote of states to expand it.

That likely would have satisfied everyone But Congress doesn’t like to think out of the box

Now we have a program where the super rich such as my sister get to get free healthcare for her son. Who should be the least deserving person to get it. It’s a dirty secret medical students use in states with Medicaid expansion by the way.

Notice very few medical students on these boards want to chime in. Some do post on Reddit about it. And schools are playing a cat and mouse game trying to force their students onto school insurance especially during 3/4th years
 
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sevo00 said:
this isnt something id brag about.
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It’s about handling stress. We have some mentally weak people.

Even the asa has become mentally weak. Publishing guidelines how to handle death and stress of patients in the OR. How team members should if possible take the rest of the day off. We discussed this a few years ago when then statement came out.

This is the same Asa who can’t come up with blanket statements how big of bmi is too big in stand a lone surgery centers. So they can’t come up with standard statements about bmi 55 in ent asc. But can come up with statement about grief?

www.asahq.org

Statement on Peer Support After Unexpected Outcomes - Treatment of the "Second Victim"

www.asahq.org www.asahq.org
 
aneftp said:
It’s about handling stress. We have some mentally weak people.

Even the asa has become mentally weak. Publishing guidelines how to handle death and stress of patients in the OR. How team members should if possible take the rest of the day off. We discussed this a few years ago when then statement came out.

This is the same Asa who can’t come up with blanket statements how big of bmi is too big in stand a lone surgery centers. So they can’t come up with standard statements about bmi 55 in ent asc. But can come up with statement about grief?

www.asahq.org

Statement on Peer Support After Unexpected Outcomes - Treatment of the "Second Victim"

www.asahq.org www.asahq.org
Click to expand...
You said everyone handles grief differently. So is it mental toughness or that some people handle it differently?
 
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