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Aging Prisoners Strain The System

The New York Times article (Unkind Life For Young and Old, Aug 7) highlights yet another way the US wastes money. It costs $100,000 a year to maintain an aging prisoner, and prisons aren’t exactly geared for “aging in place.” They have unsafe stairwells, a ban on canes and of course no geriatricians on staff.

Geriatric prisoners rarely pose a threat to society so there’s little reason to keep them.

Jamie Fellner, author of a Human Rights Watch, was quoted in another article as saying, “Age should not be a get-out-of-jail-free card.” But why not?  In some countries, people over 70 do not go to prison, period. I doubt that we’d see many people over 70 suddenly going on crime sprees; the rare cases of white collar crime, like Madoff, could be handled with supervised probation or fines.

Comparison shopping for medical tests? Ridiculous!

The New York Times :Why We Should Know The Price Of Medical Tests.

My comment: 

Oh come on … the outrageous amount we spend on health care isn’t driven by saving a few bucks here and there on price-shopping.

Just for starters, Medicare pays $300 million a year for pre-op tests for outpatient cataract surgery, when research shows these tests have no impact on outcomes. Then there are billions spend on “end of life” care because doctors and hospitals disregard DNR and DNI, even when the correct forms are in the charts.

And the billions spent on “preventive care” that doesn’t prevent anything; at most you get risk reduction, usually a small amount.

And the inflated hospital charges ($147 for a Tylenol, $500 for a bag of salt water). I’d be willing to bet that 30-50% of these “medical tests” are not even necessary.

So now they want sick people to shop around to save a few bucks? And a hospital can say, legally, that prices are secret so you can’t even if you want to?

No wonder we’re not hearing much about the Mafia. They’re probably running the medical industrial complex.

Health Care Waste: Useless Medical Procedures

A really good article from the New York Times. What’s scary is that useless procedures have no more validity than witchcraft or alternative medicine, yet they’re accepted and reimbursed by insurance companies. Doctors don’t like questions like, “If I have this test and the results are positive, what will you do? And what is the effectiveness of that treatment?”
 Medical Procedures May Be Useless, or Worse

Highlights summarized here:

From a report that appears in the August issue of Mayo Clinic Proceedings: Out of 363 studies reported in the NEJM from 2001-2010, 146 found that the current drugs or procedures were no better – or even worse – than those previously used.

Over 40% of “established practices studied” were ineffective or harmful
Just 38% were beneficial.
Remaining 22% were unknown.  

Examples of harm:

— routine use of hormone therapy in postmenopausal women;

— high-dose chemotherapy and stem cell transplant for breast cancer

— intensive  lowering of glucose levels of intensive care patients (which increased mortality and conferred no benefit)

The article quotes a doctor who says that procedures often seem to “make sense” despite evidence of benefit. For instance, if you have cholesterol-clogged arteries, it seems reasonable to open them up – but this procedures doesn’t increase survival.

The advice to patients: “You shouldn’t ask how does it work, but whether it works at all.”

Okay, guys, we get it. Now just how many of us are going to get booted from a doctor’s practice when  we attempt to put this in practice?