Dialysis meets Single-Payer video

[plugger]

I thought the doctor had an interesting point of view:

http://www.youtube.com/watch?v=wVtGJNuylWY

[kristina]

I couldn’t agree more: we do need preventative medicine everywhere!

But this is such obvious common sense, is there a reason
 
why this form of medicine does not exist on a grand scale world wide?

[tyefly]

   Interesting...  its true.... preventive medicine does happy often enough

[RightSide]

He annoyed me as soon as he said you get on dialysis because you "have killed your kidneys."  I don't want that guilt trip laid on MY head, because I don't deserve it.

I didn't do anything to kill my kidneys.

Not all types of kidney disease can be prevented.  Not in the current state of the art in medicine.

My biopsy confirmed that I have "primary focal segmental glomerulosclerosis" (primary FSGS).  The latest and greatest information is that primary FSGS is caused by one of several genetic mutations.  I didn't give myself FSGS by anything I did.  I had no diabetes, no high blood pressure, no other serious illnesses.  I led a healthy lifestyle. But it did not avail.  My parents gave me FSGS by having unprotected sex on the wrong night, and conceiving me to be born with this mutation. 

Those of you with polycystic kidney disease didn't "kill your kidneys" either.  It too is a genetic disorder, frequently inherited.

Finally, a number of studies have failed to show that preventive medicine will lower health care costs significantly.  The reason is that preventive medicine costs money too.  You will be doing screening, medication, expensive blood tests, etc., for a population of 300 million Americans, throughout their lives, to try to prevent perhaps 150,000 cases of kidney failure (the other 50,000, like mine, cannot be prevented by the current state of the art in preventive medicine).  So screening and treating 3,000 people just to prevent one or two cases of kidney failure isn't necessarily going to save the country money.

[KarenInWA]

He annoyed me as soon as he said you get on dialysis because you "have killed your kidneys."  I don't want that guilt trip laid on MY head, because I don't deserve it.

I didn't do anything to kill my kidneys.

Not all types of kidney disease can be prevented.  Not in the current state of the art in medicine.

Thank you, RightSide.  I agree with everything you said.  I don't know what is causing my kidneys to fail, but I know I didn't do anything to make it happen.  I  know plenty of people who abuse their bodies a LOT worse than I have ever even dreamed of, let alone do.  Not everyone is responsible for being dealt a crappy hand in life.

KarenInWA

[kristina]

The subject of preventative medicine is not so cut and dried as indicated.

I suffer from a genetically inherited disease (confirmed at my diagnosis) called Mixed Connective Tissue Disease (MCTD)
under which there are numerous conditions like Systemic Lupus (SLE) and photosensitivity etc.
Like the examples given here I did not ask for this disease it is purely genetic and I can’t do anything about it,
it is in me. But, I can with medical help do a great deal to stop it flaring-up and causing major organ damage,
plus I can also avoid a great deal of minor aggravations.

I can do this with preventative strategies and here I do not mean solely blood-tests and prescribed medicines.

Of course, prescribed medications can prevent the exacerbation of a medical condition,
whereby it is controlled from getting out of hand. But, I also mean other types of preventative strategies.
 
I think the word “medicine” may be the confusing word here because it means something
like a prescribed medicine from the doctor.
Possibly, the subject should  be broadened out to mean “preventing medical conditions”
which incorporates both medicines and other strategies.

In my case I have to prevent SLE/MCTD flare-ups by keeping out of fluorescent light, eating the correct foods
( to avoid flare-ups caused by some types of food) , and to keep the stress-levels as low as possible
because stress is a major trigger for Lupus-flare-ups.
I need to keep my weight to be at a healthy minimum, and I need my blood pressure
regularly monitored and controlled (by the correct and minimum amount of antihypertensives).

I need doctors competent and knowledgeable enough, who can react fast, carefully
and with medical competence when I present worrying symptoms.
(I suffer from multiple drug-intolerance, I am also allergic to Penicillin).
 
This is prevention of the exacerbation of my medical conditions.
 
So, it is not solely medicines which form the strategy of preventing medical problems,
and it is not having regular blood tests.
 
All my major medical catastrophies could have been easily avoided
if I would have had some simple medical advice
and in other circumstances a course of antihypertensives to bring my blood pressure down.

This would have avoided my kidneys first failing, the cerebral haemorrhages and the stroke
and my kidneys failing now.
 
That is why I firmly believe that preventative medicine is needed
to use this phrase in its broadest meaning.

 

[Rerun]

The man failed to mention that these Dialysis Centers are making huge profits off Medicare and sick people.  If all health care did that Medicare would be broke in a week.  Instead Dialysis Centers will make Medicare broke in about 5 years.  If we go to universal health care they can NOT make such huge profits.  It will have to be non-profit where people make a living, but they don't make a killing.

[Bill Peckham]

There is a perversity about CKD care. Right now most people with CKD 3 and 4 will die of cardiovascular disease before they ever need dialysis. If they were under the care of a doctor delivering great preventive care then they would receive treatment for their CVD, with the result being they live long enough for their kidneys to decline to the point where they have to use dialysis.

Good preventive care might mean more people on dialysis. And as you delay people needing to use dialysis you'll tend to have older and sicker people being treated.

It's kinda weird to think of it this way but having old and sick people on dialysis is what we are trying to do and if you look at USRDS data the dialysis population has been aging and getting sicker. That's good, oddly enough.

Consider a man 50 years old, CKD3. Without any care he dies of CVD at 52. With care he avoids heart attack, gets bipass and at 60 without further care his kidney decline and he needs to use dialysis, dies at 64. With on going care his CKD is identified and he slows its progression before finally needing dialysis at 68, dies at 74.

That would be a good outcome - another 22 years but as this happens generally the people using dialysis will be older and sicker. And of course the untalked about X factor. It would have been cheaper if he had had the heart attack and died after a brief hospital stay.

The video implies but never addresses the need to account for the value of those 22 years. People had their husband, brother, father for 22 years, their grandfather maybe. That's the value that has to be reckoned. Keeping people off dialysis is a tough nut to crack with healthcare, universal or otherwise. You really would have to talk about healthy living and even then I and many others would need to use the treatment.

[Stoday]

Absolutely right, Bill P.

In the UK the NHS fell into the same trap when it was formed in 1948. It was then thought that with a universal health service the need for hospitals would fall, as the health of the nation improved. Didn't happen that way, of course.

[Bill Peckham]

Absolutely right, Bill P.

In the UK the NHS fell into the same trap when it was formed in 1948. It was then thought that with a universal health service the need for hospitals would fall, as the health of the nation improved. Didn't happen that way, of course.

It's still a good outcome people just had incorrect expectations or hadn't thought it through (or politically it was easier to let people reach misguided conclusions). We want to have a medical system that largely takes care of the old and sick, that is the goal and it will be expensive. That's what we have to come to grips with - the better job we do the more expensive it will get.

With that in mind the cost of the US system is a feature not a bug - there, problem solved.

[plugger]

I have to admit the doctor could have worded things better with his "killing your kidneys" remark, but I hope he wasn't implying most people bring the disease on themselves.  If he just wanted to get people's attention it looks like he succeeded!

Anyway, I liked his point that hospitals in his area wouldn't have to close if we had single-payer.  And if you listen to organizations like Physicians for a national health program and the Congressional Budget Office we would actually be saving money with single-payer.

But if you are already for it, maybe the above links will help with your friends.

[RightSide]

He annoyed me as soon as he said you get on dialysis because you "have killed your kidneys." ....
Not all types of kidney disease can be prevented.  Not in the current state of the art in medicine.

Thank you, RightSide.  I agree with everything you said.  I don't know what is causing my kidneys to fail, but I know I didn't do anything to make it happen.  I  know plenty of people who abuse their bodies a LOT worse than I have ever even dreamed of, let alone do.  Not everyone is responsible for being dealt a crappy hand in life.

KarenInWA

You're very welcome.

What type of kidney disease do you have?  FSGS like me?

I had a similar discussion with my neph just last week.  He told me that from the research he's heard about, each of our genomes carries an average of eight alleles for various serious chronic disorders.   IOW, besides the genes that give some of us kidney disease, we may have genes for seven other diseases that we haven't yet contracted!

What causes one of those alleles to be expressed (manifest itself as an actual disorder)?  Sometimes it's lifestyle, yes.  Sometimes it's an environmental influence you have not much control over, like air pollution.   Sometimes it's a subclinical viral infection you didn't even notice at the time.  And sometimes it's a matter of luck.

Look at Dana Reeve, Christopher Reeve's widow.  She got lung cancer and died of it, even though she had never smoked and no other causes could be identified.  With some unfortunate folks, their genomes make them susceptible to developing it at some point.

I hope no one was indecent enough to ever suggest to her that "You killed your lungs, Dana."

[KarenInWA]

What type of kidney disease do you have?  FSGS like me?

RightSide, I don't really know what kind of KD I have.  I have never had a biopsy, and now that my kidneys are so far gone, my transplant team thinks it is not necessary.  Of course, I could still go for one just to get info for a transplant, I'm just not too sure what I want to do.  From the blood and urine tests I have had, I have been diagnosed with Chronic Glomerulonephritis/Renal Insufficiency.  I do not fit the "normal" profile for a CKD patient, but from what I understand, that is not as uncommon as I once thought.  It really is about being dealt a "bad hand" in life.  And no, Dana Reeves certainly did not do anything to bring on her lung cancer.  I get really defensive when people "put the blame" on those who are ill. Even if you lead a not-so-healthy lifestyle, some are still more prone to things than others.  Heck, I once knew a man who died of a heart attack while riding his excercise bike at home! He was in his early 40's, athletic, and in very good shape.  Who would have thought he had clogged arteries??? 

KarenInWA

[onestronglittlelady]

Single payer health care ~ hmmmm. You have to have a job to pay into the health care system. So what happens when there are not enough people working to pay into the system? Do you make the people working pay more? Just my .02 cents.

[mogee]

Finally, a number of studies have failed to show that preventive medicine will lower health care costs significantly.  The reason is that preventive medicine costs money too.  You will be doing screening, medication, expensive blood tests, etc., for a population of 300 million Americans, throughout their lives, to try to prevent perhaps 150,000 cases of kidney failure (the other 50,000, like mine, cannot be prevented by the current state of the art in preventive medicine).  So screening and treating 3,000 people just to prevent one or two cases of kidney failure isn't necessarily going to save the country money.

Preventive medicine is already practiced universally.  The leading cause of death in North America is cardiovascular disease.  To prevent cardiovascular disease patients are given statins to reduce cholesterol and blood pressure medications- two therapies that directly target the risk factors that are harbingers of cardiac insufficiency and heart failure.  In Ontario flu vaccines are now available to everyone without cost.  It is demonstrably cheaper to give every resident a vaccine than to pay for office visits and hospitalizations for a much smaller number of individuals who will become infected and experience severe illness.

The trick is knowing what works and what is simply wasteful.  There is no ideology or theory that replaces systematic study, diligence and attention to detail.  But one thing is certain: American healthcare is broken when the only option available to many is to deal with medical problems at the emergency ward.  It is easy to see why an uninsured (or underinsured) American would fail to get a check-up for 25 years, then suddenly appear at an emergency ward with chest pain and a sense of impending doom.  Americans need less ideology and more pragmatism if they are going to catch up with the rest of the developed world.