Today I had to – literally – crawl from my wife’s car to my house. Because I couldn’t walk. Life is what happens while you were making other plans.
About six months ago I sprained my right ankle in kung fu class. It gave me occasional pain, mostly in cold weather, but I thought it was healing and I could just let it heal. Until about two months ago when I was out with friends on a chilly evening and my ankle folded up under me, just lost the power to support me entirely.
I escaped serious injury from the concrete pavement because I am really good at falling down without hurting myself. This is a skill you learn in early childhood when spastic palsy compromises the motor control in a leg. But it meant I had a prompt need to find out what was going on in there.
A couple of visits to doctors and an MRI scan later we determined that I had developed one of the more unfortunate possible sequelae of a sprain, a thing called an osteochondral lesion. This is what happens when an area of bone in the load-bearing area of the joint erodes away, so the cartilage above it is no longer supported. If the unsupported cartilage is then damaged, the long-term result can be crippling arthritis of the joint.
In my case, it seemed I had gotten lucky. The cartilage seemed undamaged in the MRI images. The indicated procedure is to go in with an arthroscopic probe and squirt synthetic bone into the lesion. Once it hardens it can support the cartilage so it doesn’t take additional damage.
I waited nearly a month for the surgery. Two weeks ago, while still waiting, my ankle folded under me as I was cooking breakfast. This time I wasn’t so lucky. I tucked in the right way to avoid injury from the floor, but the back of my head hit an errant chair leg, producing a laceration that bled copiously on the kitchen linoleum.
I picked myself up, applied pressure with a towel, called my wife, and informed her that when her errand was done she’d need to take me to the ER. A short but extremely expensive visit later I returned with three staples in my head and an MRI scan reassuring everyone that I probably hadn’t taken any permanent damage.
I think the medical staff got that before the MRI, because my main coping mechanism for hospital stress is wry humor aimed to make the people attending me laugh. I do it because this helps me feel in control of my situation, but in this particular case it conveyed something else that was useful. Comic wryness is, after all, pretty much impossible to maintain when you’re concussed or shocky.
Home again home again. It’s nice that even at 61 I’m a physically tough person with a high pain threshold and a thick skull who is actually rather difficult to injure – my school name over at the kung fu kwoon is “The Mighty Oak”. And I like that I can be self-reliant and stoic under stress. But thank you, I’d prefer not to have this confirmed by repeated injuries…
I had that surgery about eighteen hours ago. And ended up crawling from my car because none of the medical people talked about or planned for my post-operative problems until after I was out of anesthesia. Pain management was as far as they got.
It was not made clear to me in advance that I wouldn’t be able to put any weight on the joint for a minimum of two weeks, at risk of compounding my troubles. A nurse handed me a pair of crutches as an afterthought, but everyone’s specialties we so siloed that it didn’t occur to anyone to ask if I knew how to use them, let alone whether the impaired motor control in my uninjured leg might disqualify me.
So now it’s oh-dark-thirty the next morning, I’m writing this because the anesthesia and the four hours or so of shut-eye after I got home have left me all slept out for the moment, and I’ve learned from experience that quietly coding or writing until I’m tired enough to sleep again is better for me than tossing and turning.
I was scheduled to give the main keynote at South East Linux Fest on the 14th (this was well before I even knew I was going to need surgery, let alone how close to the event it would be). I’d have to do it from a wheelchair, now. I don’t have a wheelchair yet; we’re hoping to get one tomorrow. It may not be practical at all depending on my medical state, and I can’t even get my post-op check until after SELF. It’s hard to predict whether I’ll be able, and in a mere ten days I don’t think the odds are very good.
Part of the reason this is a public blog post is as my subjunctive apology to everyone who was expecting to see me at SELF, in the all-too-likely event that I can’t be there. Right after I post this I’m going to put a link to it on SELF’s IRC channel and recommend to the organizers that they find someone else to keynote.
I’m not entirely sure a wheelchair will fit in the corridor and through the doors of my house. Until I can verify that, I move by knee-walking or crawling. Besides forcing one to learn how to fall well, another perverse benefit of a palsied leg (or legs) is that the body compensates by making the arms and shoulders abnormally strong; this is helping me now as I frequently have to hoist myself around by main strength. Just getting from the floor to a toilet seat isn’t entirely trivial even so.
I’ve ordered a pair of carpenter’s kneepads for next-day shipping from Amazon. Improvise, adapt, overcome!
Cooking isn’t practical; the ritual of The Breakfast is denied to me until I’m back on my feet. Fortunately I can sit at my desk and type with my right leg elevated, as I am now doing.
There’s no real pain yet; the nerve block is still operating. That will probably change within the next 24 hours. When it does, there’s a vial of Percocet (oxycodone and acetaminophen) pills a’waitin. Which I’m going to try hard not to take, because opiates scare me shitless. Still, my stoicism has limits and they might be tested this time.
There was some damage to the cartilage. The orthopedist said that if it fails to heal well I may need an ankle joint replacement. I am guardedly optimistic about this, as I do have a history of healing quickly and well from trauma (that nasty scalp laceration cleared up inside of a week). But the downside could be dire.
Finally…if you’ve ever thought that you might join my Patreon feed, now would be a really good time. This…adventure..has blown a $6000 hole in my budget and the expenses aren’t over yet. There’s that post-op check at minimum, and probably physical therapy afterwards, and that’s if all heals well; otherwise it’ll be much, much more expensive.
UPDATE: For the rest of the story, read the next post…
Get well soon.
What would have happened if you were living paycheck to paycheck and couldn’t take any debt? (honest question)
>What would have happened if you were living paycheck to paycheck and couldn’t take any debt?
The hospital would have mulcted other people for my ER bill (which offends me, nobody should have to pay my freight but me) and I wouldn’t have been able to afford the surgery at all.
And *hollow laughter* I haven’t seen a paycheck in 8 months. Cisco promised NTPsec money for some features it wanted, we delivered, the money hasn’t landed yet. We know why – our contact explained a process screwup – but there’s no telling when it will actually get unstuck.
The reason I ain’t entirely broke is that I made enough money from an expert-witness gig back in 2006 to have…not retirement money, but a nice cushion. Especially because I live simply, have carefully avoided acquiring costly habits, and am good at getting other people to donate expensive gear when I need it for a public-service project.
Still, that’s eroding fast. Medical bills are heavy. My Patreon feed doesn’t even cover the monthly bills. I’m worried about the future.
Wow, suckage. Four years to Medicare, too. The knee-roller is a good idea.
ESR: So sorry to hear of this.
But get yourself a knee scooter: https://www.amazon.com/s?k=knee+scooter&ref=nb_sb_noss_2
Better yet, go rent one from a nearby medical supply/rental place.
My wife broke her foot a few months ago. I rented her one for a month for
$40 and it enabled her to do almost everything she was accustomed to doing, including standing at the counter and cooking meals. And it will fit through most any doorway. It also helps avoid the malaise associated with being always in a sitting position.
>Better yet, go rent one from a nearby medical supply/rental place.
DuckDuckGo isn’t turning up good local rental options, but looks like I can buy one relatively cheap on Craigslist. Shall investigate further.
I see people using these all of the time in the convention business. They all seem to like these gadgets a lot – and that’s for people who have to move around for miles per day while being injured.
Make sure to get one with a full-circle turning radius – where the frame is high enough and the wheels are small enough to let the front end overlap the frame. Best for getting around in tight spaces.
> knee scooter
I used an office chair to get from the bed to the toilet when my leg was being rebuilt.
Getting onto the toilet was easy enough. Getting back up was quite an experience; enough that a decade later when replacing the bathroom ceiling, I put in hardpoints where I could hang a trapeze bar if I have to. I’m looking at knee replacement in the relatively near future; I’ll have everything ready before then.
The worst part of foot or leg surgery is when you stand up, blood runs downhill. You normally don’t notice; when you have broken tarsal bones it feels like someone just ran over your foot with a truck…
Getting onto the toilet was easy enough. Getting back up was quite an experience;
During my wife’s time of injury I got her one of these. Looks really hokey, but worked like a champ. And it comes on and off easily for anyone in the house who’d prefer not to use it.
https://www.walgreens.com/store/c/drive-medical-12027ra-elevated-raised-toilet-seat-with-removable-padded-arms/ID=prod6041799-product
$6000? Have you considered flying to Singapore and getting it done there? AFAIK Singapore is the only country where the prices of medical procedures are advertised, meaning they actually have a real market in that, unlike the fake market in the US and the non-market of Europe, so it would likely have been much cheaper.
I was curious if the taxpayer-financed healthcare system of Europe does have the same liquid-bone treatment. Went googling “Osteochondrale Läsion” and the most reliable looking source I found https://fuss-sprunggelenk-akademie.de/sprunggelenk/schmerzen-im-sprunggelenk/osteochondrale-laesion-im-sprunggelenk.html does not even mention liquid bone. It says that the surgery done in Germany changed in recent years, as formerly they would reattach larger pieces of cartilage, does not say how but mentions it requires drilling, so probably doing it with the usual surgical metals. But in recent years bone and cartilage cell transplants were also introduced, which is better than the reattachment. First from taking cells and regenerating them for 6-8 weeks, then using something they call acellular matrix membrane, which saves the regeneration time but still mentions “long aftercare period”, which sounds longer than your 2 weeks.
At any rate this sounds like an older therapy. It seems Germany in this field at least is lagging behind recent US technology, which, besides waiting times, are the typically predictable features of socialist medicine. Now another thing I should figure out how much the German taxpayer gets to pay for this outdated kind of surgery and then I would have a proper comparison, but that is harder to find.
Could you perhaps ask the docs in which year they stopped using cell transplants or acellular matrix membranes for this and started using liquid bone in the US? It would help gauging how big the technological gap is.
@Winter you keep arguing the European system is better, so go googling the Dutch translation of “osteochondral lesion” and see if you find any reference to liquid bone surgery.
I thought about replying in a cranky fashion, but concluded that this is not the right time for a political discussion.
Empirical, not “political”.
My Google-fu finds only cartilage liquid injection as replacement for liquid inside joint itself, as a common (though maybe not that common) therapy here in Poland.
I have found however references to European Union sponsored finished project on “Injectible Medical Ceramics for Bone Repair and Augmentation”.from 2016.
>Injectible Medical Ceramics for Bone Repair and Augmentation”.from 2016.
That’s what I got. It may be hard to find elsewhere; I happen to live near what seems to be the largest single concentration of high-grade medical talent and facilities anywhere on the planet. For example, the world’s top-rated PT/rehab hospital is ten minutes from my house.
If you can afford (meaning you pay yourself) the newest medical technology, you’ll get it over here, same as in the US.
Although the socialists keep complaining about “two-class medical care”, it’s a fact and will stay that way.
As an average patient you may not get the newest kind of treatment, but the system will fix whatever you have, at no cost for the medical care itself (moving to a wheelchair-compatible apartment is not covered, for instance, but the wheelchair is). EG amalgam tooth fillings are free, ceramics may cost extra.
Bottom line: what would be an economic non-issue for the average EU citizen, can mean non-affordability for a large part of the US population (6000 $ RIGHT NOW is unaffordable for someone with 30k/year who is forced to live paycheck to paycheck).
And keep in mind that the same affordability is given for any retired person.
Surgery Center of Oklahoma advertises their prices: https://surgerycenterok.com/
>$6000? Have you considered flying to Singapore and getting it done there?
Surgery itself only $3200. The restrt is co-pays for doctor visits, a hideously expensive MRI at the ER, and other costs I can’t reduce with medical tourism, Besides, have you ever tried to fly interrnational when one foot isn’t weight-bearing.
I second the kneel scooter, narrow, goes almost anywhere. Our experience was purchasing was less than one month of rental.
Glad you’re OK after the fall – lost a relative to a head injury from falling over.
My thoughts and prayers – I know, I know – and hope you get well soon.
>Glad you’re OK after the fall – lost a relative to a head injury from falling over.
Hell, that wasn’t even the worst knock on the head I’ve taken recently. A week or so before that ankle was diagnosed I took a fall I wasn’t expecting and didn’t handle it as well as I usually do – bounced my head off the concrete floor pretty hard.
Everyone was worried about concussion and I would have been too in their shoes, but I have an rather large trouble-finding-hats-to-fit head with a proprtionately thick skull. I was fine.
You know we have a hard time keeping your head from swelling…
>You know we have a hard time keeping your head from swelling…
…but you’re up to the challenge, because what are friends for?
Get some rest. If you haven’t got your health, you haven’t got anything.
>Get some rest. If you haven’t got your health, you haven’t got anything.
I’m sleeping whenever I feel tired enough to, whatever time it is. I’ve found by experience that combining that with light work and writing is better for me than trying to force myself to rest on a schedule.
> I’m sleeping whenever I feel tired enough to…
This is random, but I am reminded of an old martial saying “Eat when hungry, sleep when tired.” I looked it up, and it appears to have roots in Zen Buddhism.
Ouch, man. That is a rough cascading failure to undergo and I am truly sorry. Pamper that ankle, even after you think it’s fine — inasmuch as cartilage can heal, it heals slowly.
Sorry you’re having all these problems. I’m currently pretty broke, but I’ll try to come up with a small donation. Thanks for all the software!
Setting a bit to look at my bank account and what I might shave off.
What are your thoughts on a complete artificial foot or leg at this time? I live near Johns Hopkins APL; I know they’ve done a pair of arms for a poor bloke a few years back, and I wonder how much they’d be willing to front for the chance to do a relatively easier operation.
Plus, who knows, maybe we could add more features like a built-in Raspberry Pi or cat’s scratching post, or additional processing power to add to the Greater Beast whenever you, uh, boot it.
Be a man. Amputate.
Develop a linux-powered prosthesis.
Conquer the world with tux-enhanced amputee elite military veterans.
.. use gravity and walking to generate electricity.
Use the space for an antenna.
A knee scooter is a great idea. I’ve had a few friends use them with leg / ankle injuries.
I’ve upped my Patreon. Sorry you’re dealing with this. I recently had to take my wife in to the ER for a small head scrape (4 staples to close a cut when something fell off a shelf) and it was astonishingly expensive. Worked out to about $500 per staple.
Long-term, how is this going to influence your martial training? (Are you still training?) Will you be forced to abandon it or do it in some limited fashion? (e.g. primarily weapons)
If you learn you do have to (or choose to) end it, would you consider writing a “retrospective” article going over why you got into it, why it was useful, and the like? You’ve written some really interesting things on this before.
>Long-term, how is this going to influence your martial training? (Are you still training?) Will you be forced to abandon it or do it in some limited fashion? (e.g. primarily weapons)
That’s not yet clear. It will depend on how well the bone and cartilage heals.
> martial training
You can be back at the range long before you’re able to do much at the dojo.
FWIW, most gyms have equipment that will let you do a reasonable workout from a bench. You probably already know how fast you can lost muscle tone and how long it takes to get it back.
Eric, are you familiar with the Surgery Center of Oklahoma?
>Eric, are you familiar with the Surgery Center of Oklahoma?
I am. But it’s a long way from here.
Sorry to hear of your woes. Sorry also that I have to ask a stupid question – a quick visit to your patreon page didn’t elucidate – can I make a one time donation, since I too do not have a steady income? If not, perhaps we can make another arrangement, by email?
If you click the ‘Donate’ button toward the upper right on this page it will take you to a PayPal login that will allow you to donate one-time or monthly.
Thanks Michael, but I don’t have a PayPal account, but I do have a UK issued mastercard debit card which works from a GBP or USD bank account, or it allows me to transfer funds in either currency – if I know the recipient’s name, gmail address, bank account # and APA, and the address on the bank account. Any further assistance would be appreciated.
You don’t need a paypal account to make a donation through paypal.
>can I make a one time donation, since I too do not have a steady income?
The PayPal tip jar supports that. Thanks.
If you feel like spending more money a consultation with an Occupational Therapist would probably be worth your while. They’ll tell you about what gear you need and how to get it cheap. They’ll also spot subtle things around the house the untrained eye can miss; “You’re going to trip on that rug” or “That towel bar won’t take your weight forever; install a proper grab bar” and so forth.
Also, all this improvisation and innovation you’re doing is reinventing wheels. A good OT has seen it all before and can fast forward your adaptation process. Everything from moving stuff around in your kitchen to proper wheelchair transfer technique.
Good luck!
>If you feel like spending more money a consultation with an Occupational Therapist would probably be worth your while.
See, that’s the problem. Unless my Patreon feed gets fatter I am very twitchy about spending more money.
The benefit driver isn’t what a PT/OT knows, it’s what he knows that I need to know and can’t figure out myself. I mean, I can do basic physics and body mechanics and movement planning – martial artist, which see.
If the doctor recommends one at my postop followup in two weeks I’ll go with it.
Well this is it. I’m a martial artist and a physics grad, and my OT wife definitely knows things I don’t.
If you get a good OT then your background and skills will mean that the engagement will be very cost effective; a high bandwidth transfer of knowledge and you’ll be done.
If you get the right person who can hold up their end of the bargain.
>If you get the right person who can hold up their end of the bargain.
Not worried about finding a good one, as I’ve said before the quality of the doctors around here is very high.
It may be relevant that my mother was an OT before she married. I read her books.
I got a bad sprain back in 1965 in a pickup soccer game in Germany and didn’t take care to heal it correctly. It has been an occasional problem ever since in just the way you describe. My best cure has been weight lifting and learning to walk with my feet pointing out a bit more.
Eric, not to be nosy, but why didn’t your medical team put you in an air cast. Everyone I know who’s had a serious foot/ankle/leg injury in the last eight years has had one. From what I can see, managing on crutches with an air cast is far better than crutches alone.
>Eric, not to be nosy, but why didn’t your medical team put you in an air cast.
I don’t know, but the fact pattern presents two possible explanations.
1. An air cast is not helpful when a limb cannot be weight-bearing at all.
2. There was nobody on the med team whose job it was to think about my post-surgical coping problems on any level other than pain management.
The fact that I had to crawl from my wife’s car to my house is symptomatic of a serious lack of forward planning. I didn’t have the information to do that planning, and the doctors who did didn’t really think of it as part of their job to even inform me of the problems, let alone ways to meet them.
I almost certainly should have had a knee scooter when I left the hospital.
> 2. There was nobody on the med team whose job it was to think about my post-surgical coping problems on any level other than pain management.
I would respectfully suggest that your case presented novel issues that escaped everyone’s attention. (How many CP-afflicted patients do they treat in a year? A decade? Had as patients during their respective trainings?)
In addition, from my personal F2F observation, you mask / compensate for your issues quite successfully. This may have inadvertently led them to assume that you could be more successful in their “normal course of treatment” than you turned out to be.
This is one of the reasons I can be a right bastard when The Bride of Monster has to deal with medical issues addressed by people other than her neurologist. Because her Myasthenia Gravis complicates everything, we have to make sure everyone knows that. We had a lot of trouble finding Ob/Gyn with experience handling MG patients, and by the time Monsterette 2 came along, the one who delivered M1 had died in a car crash.
Speaking of “masking”; a casual observer would have no idea what TBoM’s disability is, which can lead to the impression she’s not disabled at all. She can usually walk more or less normally, at least for short distances, but there’s always the risk that she’ll suddenly find herself unable to lift a foot the 7″ required to climb stairs.
You might see us hang the handicapped parking placard from the rear-view mirror of a car and wonder why we have one. But you might also see her at work using a wheeled walker, not just to steady herself when walking, but also to hold 2-3″ notebooks she has to shuffle between her office and the file room, where she’s often barely strong enough to lift one on/off the shelves.
If you see us go on an escalator, you’ll note I always go up right behind her and down right in front of her, expecting she might lose her balance and fall against me at any moment, which would allow me to catch her before she gets too far over.
>How many CP-afflicted patients do they treat in a year?
Even someone with a normally functioning left leg would be best served by a knee scooter in my situation. And it should have been someone’s job to wonder about questions like “Does the patient need to get up exterior stairs to get into his house?”
I’m not faulting any individual, but the system has a problem. Too many silos, not enough holism.
I hope you get well soon Eric!
Just out of interest: do you have any kind of health insurance at all? What were to happen if you developed an illness which requires ongoing care/checking/medicine?
I’m asking this as a German citizen who follows and is interested in American discussions about healthcare. My 59-year-old mother was diagnosed with breast cancer 10 months ago. All in all, the combined medical care she has received during the first four months after diagnosis amounted to roughly 100,000 Euros. I don’t know about the hormone therapy she’s receiving since January, but I bet it’s not cheap either. Everything except for a very tiny amount for some medicines was and is paid for by the public health insurance. Would you be able to deal with a situation like this?
>Just out of interest: do you have any kind of health insurance at all?
I do.
>What were to happen if you developed an illness which requires ongoing care/checking/medicine?
Those costs would be covered, but the deductibles would swiftly drain my savings account.
>Those costs would be covered, but the deductibles would swiftly drain my savings account.
Are there health insurances without any deductibles? Are these uncommon or too expensive?
>Are there health insurances without any deductibles? Are these uncommon or too expensive?
Both. You have to be very wealthy to afford that kind of gold-plated plan.
The underlying problem is that many, many layers of government subsidy and regulation – combined with guild behavior by practitioners (including artificially restricting the supply of MDs) – has baked cost disease into the system at every level. It doesn’t help that we carry most of the world’s costs for medical and pharmaceutical research, resulting in the perverse phenomenon of American drugs being less expensive in Europe and Asia than they are here.
The Surgical Center of Oklahoma and a few other free-market rebels have shown what the medical system would look like with real market discipline. Costs could be an order of magnitude or more lower, but so many different interests make bank off the massive inefficiencies and rent-seeking that it’s hard to see how reform can happen short of a systemic collapse.
And if you’re wealthy enough to afford a no-deductible plan, you can afford to have a high-deductible plan and a huge MSA, which costs less to have.
The reform is going to happen because doctors are dropping out of the bureaucratic morass and setting up practices that do not accept any kind of insurance (the patient can submit a copy of the bill to an insurer for reimbursement, but the doctor has no contact with insurers, which means having a lot less overhead). Unless this practice is made illegal, it’s going to grow.
Yes, the concept is known as a direct primary care practice, and my understanding is that these are rapidly becoming quite popular within the medical field. [Note that link site is for the certifying org for family physicians in America, and thus is targeting their message not to patients, but small-business, family physician practices. Surely the idea has moved beyond just a few free-market rebels, when it can get a nod of support from the guild…]
>> Costs could be an order of magnitude or more lower, but so many different interests make bank off the massive inefficiencies and rent-seeking that it’s hard to see how reform can happen short of a systemic collapse.
I’ve spoken with Dr. Joshua Umbehr of Atlas MD about the possibility of funding a chain of direct care clinics and related surgical units. You think a clear free market alternative would help reform along?
>You think a clear free market alternative would help reform along?
Abso-fucking-lutely.
If alternatives like the Surgical Center of Oklahoma were more visible, ordinary people crushed by medical costs would have grounds to demand an accounting of why they’re paying the crazy amount they are. None of the answers would stand scrutiny, because they all come down to over-regulation and rent-seeking, And rent-seeking driving over-regulation.
Having been in medical billing, I mostly agree with you. The exact nature of the problem is obvious from the inside… there are some very expensive insurance policies, which I assume are given to high-ranking executives and so forth, that will essentially pay anything even vaguely reasonable. Did you bill a standard, 10-minute doctor’s visit for $500.00? No problem. Did you charge $700.00 for a liver-panel? Sure, we’ll pay! So there’s a perverse incentive to make your rates as high as possible, even if you know that most insurances won’t pay that much. (You know this because your medical business has contracts with those insurances which regulate how much they will pay, and how much the patient’s co-pay will be.) But in every medical business there are some patients who have much better insurances than others, so high prices will always be the name of the game, because those few really good patients can be worth 5-10 times as much as an ordinary patient (depending on what you are billing them for.)
The second problem is that doctors/hospitals/clinics are not allowed to have more than one set of prices, (that would obviously be unfair) and are required to charge against their current price list, so when the poor person without insurance comes in the door, they’re frequently faced with the $700 liver-panel I noted above. This makes it possible for the medical business to capture those high-dollar-value insurance payments, but puts ordinary people through hell!
While publicizing the Oklahoma Surgery Center is definitely a good idea, the real solution would be to require all medical businesses to make a public price list and post it somewhere obvious. A further wrinkle would be to have them post their average payment received for each procedure,* and accept that amount from an uninsured person, or someone who is out of plan.
* This is because there are a lot of little procedures and prices that can be thrown into the mix, and sometimes an insurance will pay all of them. For example, when billing laboratory work, you can legally bill up to six items besides the main procedure, including needles, gloves, sample containers, etc. and most insurance companies will pay (seemingly at random) for one or two of the six items it’s possible to bill for, and while they usually do so at a startling discount, keyboard macros make billing multiple items really easy! This is why you’ll see sterile tubing billed for $10.00/foot, or amoxicillin sold for $200/pill – some insurance company is going to pay for it – so it’s not really an “outrage,” so much as the expected outcome generated by the existing rules.
Re: cost disease. I’ve used many providers that take either direct payment or bill the customer’s insurance company. I was horrified (the first time, years ago) to see my insurance being billed for multiple times what they’d have charged me directly for the exact same medical service.
Sure, there’s some extra cost to the provider to do my insurance paperwork, but not that much more.
It has been a problem for a *long* time.
Back in the 1980s my wife needed surgery. That was back when the hospital sent you a bill, and your insurance company sent you a check, and you squared things with the hospital. I was looking at the bill and saw they were charging for four days’ stay when she’d only been in there for two. I called the hospital and got the runaround, so we paid out-of-pocket for a consult with her doctor, who went through the dozen-page statement with his pencil, saying “I didn’t ask for this” and occasionally “I don’t even know what this is!”
Talking to the hospital again turned out to be nonproductive, so I called our insurer, who was out of state. I had to take off work to catch them during their office hours. I spent, in those pre-Breakup days, almost a full day’s pay in long-distance charges.
The insurer – AETNA, if anyone cares – was uninterested.
“Will the check cover the bill?”
“Yes, but more than half of the bill is fraudulent charges.”
“So? You have enough money, right?”
“You don’t care? It’s your money they’re trying to steal.”
“Why are you calling us?”
After that highly unsatisfactory call I gathered my paperwork, including the doctor’s annotated copy, and went off to the hospital’s billing office in person. And walked out with a “PAID” statement and enough money to buy my wife a very nice two-year-old Mazda RX-7.
I’d taken off work three times, paid for my doctor’s time, and run up a humongous phone bill. I’d butted heads with the hospital and the insurance company. I got treated like a fool for trying to do the right thing.
That’s one reason your insurance rates are so freakin’ high.
My wife really liked that RX-7…
It is weird that a monopsony (monopoly buyer) cannot push the price lower than that. I mean, public health insurance is a monopsony. Even when there are a 110 Krankenkassen at the end of the day the GKV is a monopsony. So even if a monopsony cannot get a better price, it implies that prices in the US are not extremely inflated, the issue is mostly just high deductibles then. This is important, because I thought the prices are inflated. I thought in the single-payer countries i.e. almost all of them what you mentioned cannot be more than like €10K, not €100K, because the monopsony buyer dictates the prices and the real operating costs are surely much lower. So the real, actual operating costs of four months of cancer treatment are really €100K, $110K, even when a monopsony buyer squeezes every cent out of it? This is weirdly large.
The phrase you’re looking for is “regulatory capture.”
May you have a swift and complete recovery.
I tried to donate with my credit card via PayPal, but I just got a “Something went wrong” response. Maybe I’ll try again later. It would be great if there was a more privacy respecting way to donate, though.
Blog post request: why are AI / actually useful robots always vaporware? It is always just right next around the corner and will happen very soon now and then it does not ever happen. It is always experimental, not used in production. Is consciousness, or whatever else one needs to put in them to make it happen a harder problem than expected? But if yes why do we tend to keep underestimating it? E.g. https://insights.dice.com/2018/12/05/where-amazon-delivery-drones/ or, I was told by my programming professors in 1994 or so that limited-AI level “expert systems” are going to diagnose my conditions Real Soon Now (in fact in the US they told that already in late late eighties), 25 years later still doctors diagnosed your ankle. Even the term “expert system” just silently got extinct.
Geeky ER doc and former academic here. Random thoughts about why human doctors instead of software still diagnose things like ankle sprains or fractures. I suspect the problem is multifactorial; pick the explanations you like best.
– Usually the diagnosis for ortho stuff, given the right images, is the easy part. The hard part is parsing what the patient tells you into deciding what tests to order in a manner that won’t bankrupt the patient. Most patients are very imprecise communicators. As ESR states, MRIs are very expensive; I’ve only worked in one ER where it was standard to order them for ankles at all.
– Until we also develop the robotics to replace the X-ray/MRI/whatever imaging techs with machines as well, you’re still gonna end up paying the salaries of techs, RNs, etc, even if you could get the doctor out of the picture. And you still need (or at least most normies need) a human with a modicum of warmth to explain the results to you. Whether that person is a doctor, PA, NP, or whatever, they’re still making more than the average US salary.
– Similarly to the self-driving car liability problem, Americans and their lawyers like specific humans to take responsibility so they can sue them if something goes wrong. If (simplifying your example) we farmed out all image interpretation to computers, assuming we even have the technical capability, the first lawsuit would probably create a chilling effect for whichever company made that software.
– The main business of most academics is actually marketing: publish papers and promote themselves. If you’re good at spin, it’s pretty easy to publish a toy AI paper with a cool-looking result in a sandbox and sweep the tricky bits under the rug “for future work”. It’s much harder to make something that works in the wild. Realizing this was the main thing that made me leave academics and go to med school.
As someone in software engineering and EMS, I second all of this. There can be cases where AI is useful – the company that is attaching computer vision to all chest CT scans to look for pancreatic cancer is one such case. But that’s because there are a lot of CT scans to look for unrelated things, pancreatic cancer is very rare, very deadly, very easy to miss in the early stages, and is most effectively treated early-on.
Also, patients are, as a rule, *terrible* historians. One of my patients early-on I asked if they had any history of heart problems. They said “no”. “What’s that scar on your chest from?” “Oh, my triple-bypass”. *Facepalm*.
You need a good line of questioning and a way to recognize when things don’t add up in order to figure out what might be going on. It’s even worse when someone has multiple concurrent medical problems. Enough unrelated symptoms and everything looks like lupus. Or cancer. Or psych problems. You need to be able to generate effective questions to separate what is a current problem from ongoing problems.
And at the end of the day, most techs in the ED are going to specialize in a few things. So even if the diagnosis is going to be computer-guided, you are going to need a person to perform the required procedures. So either you get a lot of low-paid specialists who do a narrow range of things, or you get one generalist who can do most of the things. That generalist is usually referred to as a physician.
> I’ve ordered a pair of carpenter’s kneepads for next-day shipping from Amazon. Improvise, adapt, overcome!
And that, folks, is what a coper’s mindset looks like.
Wishing you a speedy recovery ESR!
>And that, folks, is what a coper’s mindset looks like.
The kneepads got here this morning. Big win, the crawling I have to do is much less painful now.
Also my mother found a loaner wheelchair to replace the service chair I’d been using. The real thing with big wheels I can work with my arms. Being able to move myself around is greatly morale-enhancing.
This is actually one of the use cases for my body’s hemi-paralytic compensation – my arms and shoulders are strong enough that I could maneuver it like a pro immediately.
Eric,
I just learned of your fall listening to The Linux Link Tech Show. I’d not expect you to remember, but I’ve had the honor of meeting you at Penguicon and SELF. Rest up and get strong. When a fire claimed our old home, I made sure the new one was designed with wide doors and corridors with mobility in mind as my Dad was already in a power chair. Unfortunately, Dad never saw the new house. I don’t know how this brings any comfort, just if you ever have an opportunity to buy/build, think towards the “golden” years.