The RT Cave specializes in sharing facts, opinions, satire, irreverent humor, and interesting stories in respiratory therapy and also describes about COPD Anatomy, COPD Diagnosis, COPD causes, treatments and facts.
So, my pharmacist says I can only get one inhaler a month. I cannot buy one until it's been 30 days since I bought that last one. So, what gives insurance companies the power to control you like this? Let's discuss.
"There is the golden rule: He who controls the gold makes the rules. If the gold is controlled by the government, the government will make the rules, and you will do exactly as you are told. That's how it works. It's a law of nature. It's like the law of gravity: It's not something you can escape. That's the reality."
In America we have a system of only a few insurance companies. This is not the fault of capitalism. It is the fault of too much government. I explained this in my post, "Discussing Healthcare Solutions."
If you have too many regulations on insurance companies, only those with the most money will be able to continue on. These wealthy insurance companies can afford to lobby Congress. They champion for more regulations as they know this will make it impossible for their smaller competitors to continue. And eventually all we are left with is these larger insurance companies.
We let this happen. It was the result of too much government control. Government control is what we wanted as this was supposed to fix the problem. But, it has only made it worse. And, to go back to our quote above, "He who controls the gold controls you."
That is how insurance companies get to tell you what you can get and how much you can get.
Back when there was lots of competition, these insurance companies did not have this power. So, in that older system insurance companies yearned to offer a product you wanted at a price you could afford.
If this meant filling the prescription exactly as ordered by the doctor, then so be it. That was how I was able to get three albuterol inhalers every time I picked up a prescription at the pharmacy. And sometimes I did this more than once a month. The insurance company wanted to keep me happy so I continued to stay with them.
Today, however, toss making us happy out the window. With little competition, these insurance companies have grown large. They are, in essence, monopolies. And they get to set the rules. And one of their rules is you can only get one inhaler a month, even if your doctor orders more; even if you NEED more.
So, now you know. It is not capitalism that allowed this to happen. It was our eagerness to allow Congress to fix the problem. And usually this means more government, not less. And therein lies the problem. Many blame capitalism. But, the truth is is, capitalism is the solution. Get rid of or at least cut back regulations. Create space for smaller competitors to enter the market. This is the only way to gain control back from these insurance monopolies.
Going where no one else wants to go. We’re mature adults, so I think we can have this discussion. We can be nice. And this is how I would like to discuss healthcare solutions. Let’s begin.
First, what do I think? You get your chance below.
Okay, let’s just get it out into the open. Many of my friends think the government is the solution. They want universal healthcare. They say it works in Canada. They say it works in Britain. They say it works in this country or that country.
Yet, when I talk to people from those countries, they aren’t happy about their healthcare either.
So, is government really the answer. It seems to me the government has been tinkering with healthcare since before I was born. And the problems keep getting worse and worse, not better and better.
Democrats do this. And so too do republicans. Look at Mitt Romney in Massachusettes. Look at Trump, who wanted to replace Obamacare with Trumpcare. It’s all government controlled, just different strategies for controlling. And, quite frankly, as an asthmatic I have seen inhaler prices spike faster than a speeding bullet. And this is way more than the rate of inflation.
And where has government control of healthcare gotten us? It’s made it almost impossible for insurance companies to stay in business. The only insurance companies still around are the ones who can afford the most expensive lobbyists. They lobby for things like Obamacare, which in turn make it even harder for their competitors to stay in business. And so their competitors go out of business, and they end up with large insurance monopolies.
Ditto for large hospital groups. They have been eating up smaller hospitals that have been regulated out of business. Government has created so many regulations that these smaller hospitals can no longe afford keep their doors open without signing merger agreements with these larger hopsital groups. Just go to the ER for asthma and you will see first hand this has in no way resulted in lower healthcare prices. I recently paid more than $700 for an ER doctor to prescribe me prednisone
Ditto for pharmaceuticals. Now we often refer to them as “Big Pharma” and we often blame them for the expensive asthma medicines. We say they are greedy. But, let’s be honest here, if I was the CEO of a “Big Pharma company, and I had the power to get rid of my competition simply by lobbying congress, I would do it in a heartbeat. It’s just smart business.
So, it’s not Big Pharma, and it’s not big insurance, and it’s not big hospitals, that are responsible for this crisis. And, yes, it is a crisis. When asthmatics can no longer afford the medicines they once paid for out of pocket, it’s a crisis. And sorry, I don’t think it’s the fault of these companies. Now, they are definitely not innocent here. But, the main fault can be put on the feet of Congress.
It just seems like every time there’s a problem someone in Cogress sees it as an opportunity. They say things like, “Ah, you have a problem. What can we do to help? What can we do to buy your ote. And of course they buy it with other people’s monty. Ah, let’s create another bill. Let’s create another regulation. Let’s create more government.”
They say it will work. They convince us it will. And the end result is it never does. And they they attempt to solve it with even more government. And it still doesn’t work. And yet we keep supporting for and voting for this nonsense.
What I propose is the exact opposite.
I do not know anyone, republican or democrat, who is happy with the current healthcare system. And the current approach to healthcare is government involvement. And obviously it is not working. So why not do the opposite.
Why not try capitalism?
It’s the only option that has never been tried with healthcare. Many of my friends say it won’t work. But how do they know when it’s never been tried.
What happens when half the people get free or discounted healthcare? The answer is everyone who pays has to pay more to make up for those who don’t pay. And if everyone has free healthcare, then people who work will still have to pay for it anyway through higher taxes. So, either way people like me are going to pay for your free healthcare. And let’s be honest here, people like me are barely getting by as it is.
As noted above, big pharma became big pharma because their competition went under. And the less competition the higher the prices. It’s simple economics 101. And this is what has happened with healthcare. The price of healthcare has risen higher than poeple can afford. It has risen faster than what a capitalistic market would allow.
For example, a store that charged $100 for a gallon of milk would go out of business in a capitalistic system. The businesses that stay are those that have a great product or service at the best price. And the more competition you have the better the product or service and the lower the price.
Another problem with healthcare right now is there’s little incentive for smart people with great ideas to jump into the healthcare arena. So this limits creativitity and it limits options. So, there could be someone out there with a better product, a better medicine, maybe even a cure for asthma. But we won’t see it because our current system blocks that person from entering the arena.
And that’s why capitalism is so great. People have the potential to make profits by creating products or services that we want or need. They can make a profit off making our lives better. Their success is determined by how well they meet our needs. That’s capitalism.
So, my solution to the healthcare crisis is to get the government out of it.
"Her sats were in the high 80s. So, I took the nasal cannula out of her nose and put it into her mouth."
I cringe every time I hear this. And I hear it at least once a month. Multiply that by 22 years and you get 264 times. That's 264 times someone has said that to me, or something similar.
Back in the day I'd take the cannula out of that person's mouth and put it back into their nose where it belongs.
For crying out loud! It's called a nasal cannula, not mouth cannula. Just the idea that someone puts something that was in a person's nose and puts it into their mouth sounds gross to me. How about you?
"But, the sats shot up from 88% to 95% after I did it!"
Yes! True. But you can accomplish the same thing by other methods. You can turn the flow from 2lpm to 3 lpm or higher if needed. You can use a mask. You can use a Venturi Mask. That's what they were invented for. You can use a simple mask. So many better ways to increase oxygen and oxygen levels than by inserting a gross cannula into a person's mouth.
I have tried explaining the science to people. In the past, I have explained how the sinuses act as reservoirs. As 100% oxygen enters the nares from the cannula, it builds up in the sinuses. When you inhale you are inhaling this oxygen plus some room air. So, you are still getting oxygen.
"But they have a stuffy nose!"
So! They still have sinuses. Air is still getting in.
"But they are mouth breathers!"
So. Even if you breathe in through your mouth, you are still going to entrain air and oxygen from the sinuses. You will still be inhaling that oxygen.
"But... But... the oxygen sat went up when I did it."
So, this is when I give up. And I no longer use science. Today, I just keep quiet about it. If the nurse wants to put a nasal cannula into a person's mouth, and the patient lets it happen, I just keep silence.
There are people trying to control the way you live. They want you to wear sunscreen because they make money off sunscreen companies. Even studies showing sunscreen doesn't protect against melanoma are brushed off. It's because they know if they tell you to do something you will abide and do it. It will become a fad of sorts. It will become a myth that can't be unbusted.
But then you have people like me. I'm a skeptic. When everyone is thinking something, I become skeptical. And then I look into what they're saying and find that there's not one iota of evidence to support it. But, despite that, every doctor says you need to wear sunscreen. Even when studies show it's not true, they say, "Nope! You still need to wear sunscreen! Doesn't matter what the evidence shows!"
You have these scientists who have a political agenda. They can't get politics out of their science. And so even when the studies they perform disprove their agenda, they find some way of spinning it, even within their own studies. You have industries controlling the research. A good example is pharmaceuticals. Who do you think funds much of the inhaler research? It's not non-profits. Most of it is funded by big pharma.
Keep reading my blog and I will give you plenty of examples of this. I mean, how may global warming believers have chimed at some point that we only have ten years to live if we don't do something to stop it. And then that ten years comes up and we are still here and nothing has changed and no one ever calls them on their poppycock fear mongering. No one! Except people like me. And I bet there's those reading this that think I'm the idiot Because I don't go with the fad. I"m not the sheep, so I'm the idiot.
So, when I hear these things I think to myself, "Where's the evidence?" And even if they offer evidence, is it real. A good example of this is global warming. They offer lots of evidence that there is global warming. But, 100% of this evidence is computer modulated data. Did you know that computer modulated data is only as good as the data put into it. If you put crap into it you will get crap out. So, in reality, it's not evidence.
So, that's why I question even this global warming/ Global cooling/ Climate change stuff. It's just industries, political activists, trying to push forth their agenda. And good people buy into it hook, line, and sinker. I won't let that happen to me. And I hope you don't either.
Don't get me wrong. I love the environment. As God fearing person, I will do everything in my being to keep the Earth safe and clean. But I'm not buying into a fad. No way. Not this guy. I'm not going to support a theory, where the solution to it is destroying the economy.
And when you do what they say, and you make the changes they want, and nothing changes, no one calls them on it. Ha Ha. So many times this happens. Then they blame people like me who didn't support it. But they fail to look at their own beliefs to really see if they are truly valid.
Do they work? Is their science unbiased? Do their policies truly work? I'm the skeptic who says it probably doesn't work and it's probably not true. Evidence is that we are still here on God's Green Earth.
So, they say it's conventional wisdom. But, conventional wisdom is not always right. Sometimes, it's even proven false and they won't admit it. They just continuing to push forth their myth on behalf of a political agenda on behalf of industries.
You know I love exposing medical myths. You now, that running will ruin your knees. Or that oxygen will stop people from breathing. Or that wine will open your arteries and prevent heart attacks. Another one is that we should all use sunscreen to prevent melanoma. That is another myth worth noting here.
It's a fad. One person says it and everyone else doesn't even question it. It's what you call group think. And I've always been the skeptical one. If everyone else is thinking one thing, you know there's something wrong with it. And there usually is. There's usually some study somewhere that proves them wrong. Or, in the case of the hypoxic drive theory, over 100 studies.
So, I have worn sunscreen at times in my life. And I make my kids wear it, at least if we are going to be sitting at the beach all day. Or, at least I do this until they have nice tans. Once they have nice tans what's the point? When I was a kid I never wore sunscreen. And we always had nice tans. And we never got melanoma. After your skin was nice and dark, we never got sunburns. We never got skin cancer.
Some people with certain skin conditions need sunscreen. If they don't use it they will have this problem or that. They will get sun burned easily. I'm not talking about using common sense. But, for the most of us, there is absolutely no evidence that sunscreen prevents melanoma. If you are going to get it, you are going to get it regardless of whether or not you use sunscreen. We all get something. There's no point in fear mongering.
This past week my daughter participated in track and field day. I was told to send my daughter with sunscreen. I did not. She already has a tan on her face and arms. There was no need for her to use sunscreen. Other parents chided me for this. And guess what? My daughter did not get burned even though she didn't wear it. Ha ha. I win.
But, my point is, sunscreen is nice sometimes. But, it isn't always needed. You don't need to pour it on to prevent burns when you already have a tan. At least that's how it is for many of us. It will not prevent melanoma. It will not prevent skin cancer. All those people who think it does are just being sheep. They are just going along with the crowd. It's just group think.
I am usually outside long before beach season. I have already been out in the sun. I sit out on my porch every day it's sunny. I started by sitting out for minutes at a time. Now I'm up to an hour. I have a nice tan. By the time it's warm enough to go to the beach I have a nice tan. And when everyone else is putting on sunscreen, I'm already lying in the sun and enjoying it.
And there's always someone who is just piling it on. And this person says to me, "John, aren't you going to wear sunscreen?"
And I say, "Nope! I don't wear it."
Then they say something like, "Well, you need to wear it. You don't want to get a sun burn. You don't want to get skin cancer."
And I say something like, "I'm fine."
And then they look at me funny, like I'm the one who doesn't know what he's talking about. When, all along, I'm the one with the evidence on my side.
Look, there was one study recently showing sunscreen didn't prevent cancer. A Reuter report even noted this study. Then they continued to ignore the study findings and continued to be sheep.
The report said, "There isn’t much evidence to conclusively prove that daily sunscreen use can prevent most skin cancers, a research review concludes."
But the author ignores this and writes, "But that doesn’t mean we shouldn’t use sunscreen, doctors say. It just means it’s unethical to do experiments testing the effectiveness of sunscreen by randomly assigning some people to use it and others to skip it."
So stupid. That's what you call fake health news.
Now, you can site a study showing sunscreen did not prevent people from getting enough vitamin D. The article is from NCBI. And even the study analyzers say in their conclusion that they didn't even study high doses of sunscreen.
Look, most kids are recommended to wear so much sunscreen that they get no sun to their skin at all. I go home when my kids wear this stuff and they are white as sheep. So, no studies on how those high doses affect vitamin D absorption. But they (the sheep that be) say this is still not a reason to avoid wearing sunscreen.
See, it doesn't matter what the evidence shows, they still spin it to sell their spin.
Look, there's no evidence that sunscreen prevents anything. In fact, a recent study actually showed that sunscreen was preventing people from absorbing enough vitamin D. And there's no way to get vitamin D except from the sun.
Oh, you want to know how these fads start. It's because of the people giving the grants. They give out grants to do these kind of research. And, of course, the people giving out these grants have agendas (i.e., big pharma, i.e. politicians). Yep! They have agendas. And as long as your study results conclude what they want you to conclude, you keep getting the money.
And, for God sakes, do you think God would give us the sun and then make it unhealthy for us? I don't think so. But that's beside the point.
Healthcare has a history of myths. In fact, medical history is about 99.9% mythical. And this runs even into our modern medicine. Sad to say, much of what is known today about medicine is a mythical. I have given many examples of this on this blog. And there's no better place to start than with weight loss.
You have to drink 8-10 glasses of water every day to lose weight.
So, now you know about weight loss myths. This should help you find a better weight loss program that works for YOU. Personally, I'm working on a program that allows me to continue doing and continue eating the things I enjoy.
I recently wrote a post for asthma.net called, "Murphy's Laws of Asthma." I figured this idea can be applied to our profession too. You know, what can go wrong will. So, without further adieu, here are Murphy's Laws For Respiratory Therapy.
When you're in a hurry to chart, that little circle will go round and round and round and round.
When you finally get a chance to sit, every person who could possibly annoy you will.
As you approach the time clock, you'll realize you left your badge at home.
If you forget your badge, someone behind a door you need your badge to get into will need you.
When you get home after a long, hard days work, you'll realize you still have your work phone in your pocket.
The day you're slow and have hardly any patients is when you're most likely to forget to do your treatments.
If you get to work hoping for a good day, shit will hit the fan.
If it's slow and your coworkers are sent home early, shit will hit the fan.
Right at the moment you're hoping to go home early shit will hit the fan.
After you get all gowned up and enter an isolation room, you'll realize you need something not in the room.
After you get all gowned up and inter an isolation room, your phone will ring.
You took your medicine out of the Pyxis. When you get to the room and get the nebulizer out of the bag you can't find your medicine.
Your home and having a nice relaxing evening. You make the mistake of answering the phone and it's your work wanting you to come in.
When you are in a hurry and need a piece of equipment STAT, it won't be where it's supposed to be.
If you have the ETT ready expecting to intubate a patient, the patient will be fine.
If you are called to be on standby because a patient in ER does not look good, and you do not have your ETT ready, is when you're most likely to need it.
When the ER doctor you most enjoy working with is working, you won't be needed in the ER. But, when the ER doctor you least enjoy working with is working, you will be needed in the ER, and frequently.
Feel free to add to this list in the comments below.
I'm a big fan of doctors writing prescriptions and pharmacies filling them. But, the big insurance companies decided one day that they were in charge. Now they control both doctors and pharmacies.
And it's the pharmacists who take the flack for this. This is unfortunate. I often pride myself on not taking my anger and frustration out on the middle guy. But, the pharmacist is the one who has to tell me I can't get a medicine I went there to get.
"I have one prescription for you," she said, and she started to leave to go get it. But I interrupted her.
I said, "No. Not one. I called in two."
She stopped in her tracks, and turned to face me at the register. "Your insurance will only cover Proair. It will not cover Symbicort until the 8th."
I said, "But it's the 4th. So, your saying my insurance company wants me to go without my steroid for 4 days. That's a long time to go. The last time I did that I ended up in the ER."
And that was true. I did end up in the ER. It cost my insurance company thousands of dollars compared to the measly hundreds for the inhaler.
She said, "Are you only taking 2 puffs twice a day? If you do that one inhaler should last a month."
I said, "The insurance company fails to realize that people aren't perfect. What happens when a person with asthma loses an inhaler? So, we're supposed to go a month without one?"
She said, "It's only 4 days.
Yeah! Not something you say to an asthmatic. lol. That kind of set me off. And then I did apologize, as it was just the pharmacist, the middle guy. Still, it is very frustrating when you can't get the medicine you need to breathe. Nothing major. It's just breathing.
Some asthmatics may be fine going without for a few days. But the way my asthma has been lately, that person is not me.
Interestingly, you go without your controller because you only get one a month. And you end up in the emergency room. That's thousands of dollars, as compared to a hundred dollars for an inhaler. So, when they don't fork out for controllers, sometimes it kind of comes back to bite them in the end. But, apparently, they don't think of it that way.
One of the perks of being a blogger is I get invited to participate in events in various states. This year, as a part of national asthma month, I was invited to Washington D.C. to participate in an asthma blogger summit and Asthma & Allergy Day on Capitol Hill. Usually on these trips I try to plan for some time to set off on my own to do some tourist activities.
I'm not a hard person to entertain. One of my favorite activities is just going for walks and enjoying the scenery.
After the Asthma Blogger Summit on May 8 we were invited to a happy hour. I think they hold events like this so we can network. I'm not a big fan of socializing. I'm also not a big fan of networking. But, still, it's still nice to do to some extent. When I attend these events, I like to have a few beers to take the edge off.
By the time happy hour ends I have a nice buzz. I'm not drunk by any means. But, I'm feeling pretty happy. So, this is how it was when I set off on my walk through Washington D.C.
We were not far from the Capitol, so that was the first place I planned on visiting. I was actually hoping that the Capitol was open to tourists. But, as I walked up the steps there was a guard standing behind a roped in area. A sign said the capitol was closed to tourists.
I have read many things describing the historic buildings in Washington D.C. For some reason, I always pictured the Capitol, the Washington Monument, the Lincoln Memorial, and the White House to be real close to each other.
But, as I stood on top of the capitol steps, and turned around, I saw that the Washington Monument was quite a distance from the Capitol. As I Google it, I see it is 1.2 miles. I did not know this as I set off to see it with my own eyes. And it was here that I realized how far apart all of these structures actually are.
There is a great big field between the Capitol and the Monument. I think there were 3-4 baseball games that were going on in this field. I was impressed at how much open space there was. And, of course, on the way to the Monument is the Vietnam Veteran's Memorial. It was quite impressive to see the names of all those who died protecting our freedom. And then there's the Washington Monument.
As I stood near it, I was another structure in the distance. Again, I was quite naive about how far apart these structures stood. I figured I'd go for a walk and easily be able to see all of them.
At this point I was that there was another long, grassy field with another large structure in the distance. As I trekked the 1.2 mile walk to it, I soon realized it was the Lincoln Memorial. I was impressed at how large Abe was.
Here I decided I should continue walking to the White House. But Google Maps said it was another half hour walk. Yikes. It was eight o-clock and I kind of wanted to get back to my hotel. I entered my hotel in Google Maps. It said that I had an hour walk home. This was when I realized how far I had walked. So, I decided to skip the White House.
I never did get to the White House. So, hopefully I get invited next year. If I do, I will schedule a tour. I also learned that they do have tours at the Capitol.
So, I am going to (if I'm invited next year) plan a tour of that too. That will be neat to do. Love history. Love walking. It was fun. But, boy was I tired when I got back to the hotel.
Attached are some pictures of my trip.
I would like to add that all of this is compliments of the Asthma & Allergy Network. They are the ones who organized the 2nd Annual Asthma & Allergy Summit and the 22nd Annual Allergy & Asthma Day on Capitol Hill.
So, it's neat to have opportunities like this. It's one of the perks of blogging. And, again, I never imagined that blogging would come to this. It's kind of an honor.
There are some good reasons for charting. Some computer systems allow us to bill as we chart. We also chart so you and others can monitor to see how the patient progresses over time. But, another, perhaps most important, reason for charting is for litigation purposes. Basically, you chart based on the 1% chance you might end up talking to a lawyer.
So, let's say a patient dies in the ER. The family is a suing family. They love to sue. So, when their dad died, they sue. The nurse is named in the litigation. Pretty much anyone who's name the family new was named in the litigation. You were not named, for some reason. Maybe it was because you were in the room when the family wasn't.
Either way, the hospital lawyer wants to see you. So, it's just you, the hospital lawyer, an assistant of some kind, and a stenographer. The stenographer is a lady. She says, "Okay, Mr. Lawyer is going to ask you some questions. We want you to state in a clear voice your answers. If you are asked yes or no questions, we want you to state clearly a yes or a no. Is that clear?"
You say, "Yes."
She says, "Great. That's exactly how to do it." She smiles. Then she clicks away at her stenographer machine.
Then it's the lawyers turn to talk. He clues you in as to what has transpired up to this point. He says, so far, it has been determined that the nurses did a poor job of charting.
According to their charting no sats were charted. The family claims the patient died because the nurses didn't monitor the patient closely enough. They didn't care. Because of their neglect the patient died; their dad died.
So, that's where you come it. The hope is that something in your charting will prove that the patient was fine; that the patient was fine before he suddenly, unexpectedly went into cardiac arrest. The hope is that the patient died NOT due to healthcare related neglect.
So, it's just you and the lawyer. You are in the hospital board room. It's a big room with a big table. You are sitting across from the hospital lawyer. The layer says, "Okay, before you is a copy of your charting. Can you read to me what is in your charting the last time you charted on the patient."
You read: "The patient's lung sounds were clear. The patient was in no respiratory distress. The patient was in semi fowlers and was pleasant. The patient noted no change with treatment."
The lawyer said, "Can you read the vitals that you charted?"
You say, "The Spo2 ws 98% on room air. The heart rate was 80 and the respiratory rate was 20."
The lawyer says, "What was the sat again?"
You say, "It was 98%."
"Did you chart any other sats?" he asks. "Did you give any other treatments? Also, what was the sat you charted for each treatment."
You say, "Yes. I gave 4 breathing treatments during the time the patient was in the ER. With each treatment the sat was 98% on room air."
"At what times did you give the treatments?"
"I gave them at 12 a.m., 12:30 a.m., 12:45 a.m. and 1:15 a.m."
"So, the sat was 98% with each treatment."
"The patient was in no respiratory distress with each of these treatments, according to your charting that you have in front of you. Is that true?"
The lawyer says, "Great. T'hat's all we need!" He stands. He reaches across the table and offers to shake your hand. You shake his hand. He says, "If we need anything further we will give your boss a call."
The case never goes to court. The reason is because you charted so accurately. The nurses didn't chart any sats. Because you did in this made up case, you saved the hospital possibly millions of dollars.