Knee replacement

[Orestes Munn]

Glad you got to the boat, Not a bad time to be off the water, all in all, but the weather up here was stunning and today would have been perfect for a sail with the wife, if my brother hadn't had his little event up in NYC. Heading back on the train now and looking forward to something cold, fizzy and strong, when I get home.

Wife's lube shot hurt like the devil. The attending held her leg down, while the res probed for the joint space without ultrasound guidance, hitting nerve and bone. Then the pressure when the stuff went in was the worst. Poor, tough, old girl! Glad I wasn't there; I would have passed out. She did say that her sister, also a lame ex-jock, had a great response, though, so she's optimistic.

[Bull City]

That sounds pretty awful. The PA who gave me mine said that they do it in three parts because of the large volume of material going in, otherwise it would cause discomfort. She also said it takes several days to see if there is any relief. Hope it turns out well.

[Orestes Munn]

Military medicine. She's doIng OK, thanks. You keep up the strong recovery!

[LarryHoward]

Military medicine. She's doIng OK, thanks. You keep up the strong recovery!

Now you know why I chose the TRICARE Standard "point of service" option plus supplemental insurance to cover the higher co-pays. At least I get to pick who hurts me.

[Rob McAlpine]

Geez OM, that sounds gruesome. She's tougher than me.

Glad you're doing well Bull.

[Orestes Munn]

Went out sailing for a couple of hours in high teens and chop and now, after a rather stout drink, spouse says she has experienced a noticeable improvement in knee wellbeing. Go know.

Larry, I cling to the myth that an O-6 physician and family can still get good care at a big, quasi-academic, MTF. I am still overwhelmingly grateful for what WRAMC neurosurgery did for me and the speed with which they did it. I know a guy who took the same problem to Kaiser at about the same time and he's walking with a cane because they dicked around. Of course my surgeon is now retired and working at GWU...

[LarryHoward]

Went out sailing for a couple of hours in high teens and chop and now, after a rather stout drink, spouse says she has experienced a noticeable improvement in knee wellbeing. Go know.

Larry, I cling to the myth that an O-6 physician and family can still get good care at a big, quasi-academic, MTF. I am still overwhelmingly grateful for what WRAMC neurosurgery did for me and the speed with which they did it. I know a guy who took the same problem to Kaiser at about the same time and he's walking with a cane because they dicked around. Of course my surgeon is now retired and working at GWU...

When my civilian urologist backed out of a uterectomy due to complications, I was at Georgetown in less than 24 hours to see one of the leading guys in this area and in surgery there in 4 days.

I had great care on active duty and terrible care. It was hard to know when you were getting which. Overall, I thing military docs do a lot better with healthy folks and minor/major trauma (given their normal patients are 18-50 and in generally good health).

[Bull City]

Following what Larry said, I was in the Navy for few years in the 70s, on a destroyer. One time out, the squadron doc rode with us, and we chatted a few times. I recall he said that the duty was very boring - mostly healthy, young males. On the other hand, during the same period, my brother-in-law was a Navy pediatrician at a Marine air station in Hawaii. He and his family loved it.

[Olaf Hart]

A colleague commands the Aus Army reserve medical corps.

He says the army only really needs venereologists and sports physicians ....

[Orestes Munn]

I belive U.S. military medicine covers about 5 dependants and retirees for each active duty service member.

Incidentally, wife is noticing a pronounced reduction in knee pain after lube injection and can now concentrate on how shitty her other knee and various hips and ankles feel.

[Bull City]

Orestes, I'm glad SWMBO is experiencing some relief.

I'm starting to do some new tricks: I can walk quite nicely without crutches, I can climb and descend stairs using both legs (although I need to hold on). With "coaxing" from the Physical Therapist, I get 111 degrees flexion and I'm a tiny bit short of full extension. I'm ready to go for a sail!

[Ish]

My doctor says anyone giving painful injections just doesn't have a clear idea of how things work. The first time he shot my knee he felt around and made a little dot with a pen. No pain. The several times afterwards he just eyeballed it and not one hurt more than a mild prick. The surgeon who is doing my knee gave me the last shot and it hurt like hell. My usual doctor is a wizard with a needle, however.
Wearing my knee brace has been a major plus while sailing, but I have a very strange tan.

[LarryHoward]

I belive U.S. military medicine covers about 5 dependants and retirees for each active duty service member.

Incidentally, wife is noticing a pronounced reduction in knee pain after lube injection and can now concentrate on how shitty her other knee and various hips and ankles feel.

While true, the only retirees seeing military docs are some of them in the catchment area of major military medical centers. The rest of us get told to see "participating civilian providers" so it might be more accurate to say that the medical coverage addressees 5 dependents and retirees for each active duty member. We could fix that with universal care.......

[kimbottles]

I belive U.S. military medicine covers about 5 dependants and retirees for each active duty service member.

Incidentally, wife is noticing a pronounced reduction in knee pain after lube injection and can now concentrate on how shitty her other knee and various hips and ankles feel.

While true, the only retirees seeing military docs are some of them in the catchment area of major military medical centers. The rest of us get told to see "participating civilian providers" so it might be more accurate to say that the medical coverage addressees 5 dependents and retirees for each active duty member. We could fix that with universal care.......

We could fix a lot wrong with medicine with universal care........

[Orestes Munn]

Yup. Don't get this old Pinko started!

[kimbottles]

Yup. Don't get this old Pinko started!

We are going to get along just fine Dr. Munn.......

[Bull City]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

[Bull City]

My doctor says anyone giving painful injections just doesn't have a clear idea of how things work. The first time he shot my knee he felt around and made a little dot with a pen. No pain. The several times afterwards he just eyeballed it and not one hurt more than a mild prick. The surgeon who is doing my knee gave me the last shot and it hurt like hell. My usual doctor is a wizard with a needle, however.
Wearing my knee brace has been a major plus while sailing, but I have a very strange tan.

I've had little to no discomfort with numerous injections into the knee: cortisone and the hyaluronic acid (lube gel). All were done by physician assistants.

[kimbottles]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

Speaking only for myself (however influenced by one of my younger brothers who is a doctor), I favor single payer health care.

[Orestes Munn]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

I could go single, like Canada, oligo, like Germany, or almost any coherent system with fewer hands in the pot and a reasonable floor under quality of coverage. People should also have a deluxe private option.

[kimbottles]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

I could go single, like Canada, oligo, like Germany, or almost any coherent system with fewer hands in the pot and a reasonable floor under quality of coverage. People should also have a deluxe private option.

Yup! Everyone should get decent generally equal healthcare. And it should not be expected from their employer as that makes for way too many variables. Buy up deluxe private options, yes.

[LarryHoward]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

I could go single, like Canada, oligo, like Germany, or almost any coherent system with fewer hands in the pot and a reasonable floor under quality of coverage. People should also have a deluxe private option.

Yup! Everyone should get decent generally equal healthcare. And it should not be expected from their employer as that makes for way too many variables. Buy up deluxe private options, yes.

Absolutely. My only caveat is that the base has to be sufficient for the majority of need. While I really like the quality of basic care in Australia and the availability of private insurance to supplement, my SIL got decent care for some mental health issues under the basic care when she was in crisis -as in picked up in her nightgown in the street corner following the voices. Once stabilized through inpatient care (voluntary or not) she would get pretty poor follow up care until the next crisis. We would get the 2AM calls several times yearly, 12,000 miles from the crisis. Once we learned about the availability of supplemental coverage, we bought it for her with a focus on MH, dental and preventative coverage. Night and day difference with continuity of caretaker, visiting nurse (take your meds, are we dear?), etc.
Point being that the baseline care seems a lot like an HMO. Good care for healthy folks with episodes of trauma, illness and injury but lacking where continuity is is needed.

[kimbottles]

By universal care, do you (pinkos ) mean single payer as well? Sometimes they go together. I understand that Nixon favored single payer. FWIW, at one time D. Trump did too.

I see benefits in both.

I could go single, like Canada, oligo, like Germany, or almost any coherent system with fewer hands in the pot and a reasonable floor under quality of coverage. People should also have a deluxe private option.

Yup! Everyone should get decent generally equal healthcare. And it should not be expected from their employer as that makes for way too many variables. Buy up deluxe private options, yes.

Absolutely. My only caveat is that the base has to be sufficient for the majority of need. While I really like the quality of basic care in Australia and the availability of private insurance to supplement, my SIL got decent care for some mental health issues under the basic care when she was in crisis -as in picked up in her nightgown in the street corner following the voices. Once stabilized through inpatient care (voluntary or not) she would get pretty poor follow up care until the next crisis. We would get the 2AM calls several times yearly, 12,000 miles from the crisis. Once we learned about the availability of supplemental coverage, we bought it for her with a focus on MH, dental and preventative coverage. Night and day difference with continuity of caretaker, visiting nurse (take your meds, are we dear?), etc.
Point being that the baseline care seems a lot like an HMO. Good care for healthy folks with episodes of trauma, illness and injury but lacking where continuity is is needed.

Completely agree about excellent base care.

Susan and I have used the HMO Group Health of Puget Sound now for 30+years. Great care and great docs if you know how to use the system. They did a wonderful job on her invasive breast cancer (Bilateral, both breasts!) and we both love her Oncologist (after I fired the first one.)

The care we have received from Group Health has been the best, and we are very demanding clients because we know way too much about health care and we interact aggressively with the docs. They seem to like that, so we get along with them very well.

Everyone should get the care we have received these last 30+ years. Sadly that does not happen for everyone in the USA.

[LarryHoward]

My experience with managed care led me to an excellent, but relatively expensive supplemental policy to my "free" retiree care. I have a choice of an HMO style, low copay plan or a high copay point of service plan. I use the POS plan. Most years, the supplemental cost exceeds what my copays would have been but every 3-4 years, somebody goes in for surgery z(apply for my son, knee stuff for me, etc. and the supple tap pays off big.

The POS with no gatekeeper means I get to pick the doctor, not some administrator. In a rural area officially designated a "medically underserved area" picking the doc means a lot.

I'm grateful that between the retiree plan and my supplemental, we have excellent care. We owe good medical care to everybody in this country. In my mind ACA is not it.

[Orestes Munn]

The ACA is a chimeric and expensive compromise that was conceived when it became obvious that single payer (Medicare for all) or anything that froze the insurance companies out or reduced their "vig" was politically impossible. It cannot be defended on any grounds except the fact that it has expanded care to many people. Perhaps, we can arrive at something more rational and affordable in the future.

[kimbottles]

Medicare seems to work somewhat, why not just expand it to everyone? Then we can get down to tweaking it until we make it efficient, fair and effective.

(If we reform our stupid income tax system and get rid of all of the special deals we could even afford it while lowering the tax rates.)

Good lord, I sound like a liberal.

[LarryHoward]

Medicare seems to work somewhat, why not just expand it to everyone? Then we can get down to tweaking it until we make it efficient, fair and effective.

(If we reform our stupid income tax system and get rid of all of the special deals we could even afford it while lowering the tax rates.)

Good lord, I sound like a liberal.

Scary, isn't it?

[BeauV]

I think Dr. Munn nailed it. Unless there is a popular vote, which universal single payer might win, there is absolutely no way it will happen. One need only take a brief read of the donations made by the insurance companies to understand why. What we are really talking about is putting some very large and profitable insurance companies out of business. These companies are actually owned,in large measure, by pension funds. Effectively legislating them out of business would have massive financial impacts, I fear we'd have to simply buy them and distribute the value to their shareholder (many of us). By comparison, this would be massively more disruptive financially than nationalizing the railroads or airlines.

[Bull City]

I think it's correct that the ACA did five main things: (1) expanded care to more people through subsidies, (2) eliminated the pre-existing condition exclusion, (3) stopped companies from dropping people when they are really sick, (4) instituted mandatory coverage, (5) established exchanges. Unfortunately, it did not do very much to contain costs.

I support these reforms. As to the "mandate," since our society will not let someone die on the street because they can't afford care (not yet, anyway), people who can afford health coverage, should pay for it. Otherwise, they run the risk of freeloading off the community.

A single payer system makes a lot of sense. I heard that Duke University Hospital employs more people in the finance and insurance areas than in patient care. It's probably justified in the current world, but it just doesn't seem right to me. The multiple payers we have in the system cause a lot of administrative overhead.

On hospital costs, I found the attached article, Bitter Pill: Why Medical Bills Are Killing Us, Steven Brill (Time February 20, 2013), was excellent and very disturbing. He is complimentary of Medicare's efforts to contain costs.

A small example of such containment: I just got the Medicare statement for the surgeon's bill for my knee replacement. The bill was $6,500, Medicare approved $1,300 and paid 78%. My supplemental plan should pick up the rest.

It is a very complicated problem, with a lot of moving parts, and not many easy answers. But it is something that we need to start chipping away at.

I also agree that health coverage should be severed from the employer. This gives some employers what I feel is a false notion that hey have some say in how the healthcare dollars are spent. I just don't buy it.

Bitter Pill.pdf

[LarryHoward]

I think Dr. Munn nailed it. Unless there is a popular vote, which universal single payer might win, there is absolutely no way it will happen. One need only take a brief read of the donations made by the insurance companies to understand why. What we are really talking about is putting some very large and profitable insurance companies out of business. These companies are actually owned,in large measure, by pension funds. Effectively legislating them out of business would have massive financial impacts, I fear we'd have to simply buy them and distribute the value to their shareholder (many of us). By comparison, this would be massively more disruptive financially than nationalizing the railroads or airlines.

While I don't necessarily disagree, subsidizing large publicly held companies by raising costs and increasing complexity for the entire country is to me a bad case of "too big to fail." They are held by pension funds because they are profitable and seen to be safe. In my mind, guaranteed stability and profitability without risk should earn low returns, not double digit returns on the back of taxpayers. The market would adapt and, if transitioned in a reasonable, the market would adapt and the investor capital wold find new homes.

Enough political drift. Bull. Happy to hear your recovery is going well.