Michigan Disability Resistance

Another initiative that will kill people with disabilities with costly care....

http://bit.ly/2kyp2qR

RenalWeb links to a front page New York Times article When Ailments Pile Up, Asking Patients to Rethink Free Dialysisby Gina Kolata. This is the article's leed:

Of all the terrible chronic diseases, only one — end-stage kidney disease — gets special treatment by the federal government. A law passed by Congress 39 years ago provides nearly free care to almost all patients whose kidneys have failed, regardless of their age or ability to pay.

Access to Medicare does not equate to "nearly free care" and not everyone has earned Medicare access.

Right now Medicare leaves about $50 per treatment unpaid and the responsibility of the beneficiary (Medicare routinely pays 80% of approved charges). Given 156 treatments a year this amounts to about $7,800/year unpaid, just for the dialysis ... in addition the beneficiary incurs 20% of the cost of doctors, nondialysis medications and any other medical care required outside the dialysis unit.

Also, not all individuals with ESRD are eligible for Medicare, about 10 to 15% will never have access because in addition to a diagnosis of ESRD, one of the following criteria must be met (PDF link):

1. The individual must meet the required work credits under Social Security, Railroad Retirement or as a government employee 
2. The individual is receiving Social Security or Railroad Retirement benefits 
3. The individual is the spouse or dependent child of a person who has met the required work credits or is receiving Social Security or Railroad Retirement benefits. 

Currently the required work credits under Social Security is 40 quarters - 10 years of paying into the program - there is a detailed explanation here. 

But the article's error laden leed is not even its worse offense. It continues:

But the law has had unintended consequences, kidney experts say. It was meant to keep young and middle-aged people alive and productive. Instead, many of the patients who take advantage of the law are old and have other medical problems, often suffering through dialysis as a replacement for their failed kidneys but not living long because the other chronic diseases kill them.

No no no. Dialyzors who are "old and have other medical problems" have access to Medicare due to age or disability, "patients who take advantage of the law" are few: only about 25,000 people have access to Medicare as a consequence of Section 299I of the Social Security Amendments of 1972.

The article does shine a light on an important discussion about end of life care and informed consent. That's an important subject, however, it is only tangentially related to the ESRD Entitlement. The point of the article is that caring for the elderly is expensive and aggressive treatment may not always be in the interest of the ill. That is a serious discussion our electorate should have but has not been able to have; this article makes that discussion even more difficult. 

http://bit.ly/2kyuPg8

In a survey, 91% of emergency medicine physicians say they have recently experienced a drug shortage and 44% say their facilities are inadequately prepared for a surge of patients during a disaster. 

The vast majority of emergency room physicians face shortages of key medications and doubt whether their organizations are "fully prepared" for a disaster, polling data shows.

The poll's findings were released today by the American College of Emergency Physicians in Washington, DC. The survey, which was conducted from April 30 to May 7, has 247 respondents.

"Hospitals and emergency medical services continue to suffer significant gaps in disaster preparedness, as well as national drug shortages for essential emergency medications. These shortages can last for months, or longer, and constitute a significant risk to patients," ACEP President Paul Kivela, MD, FACEP, said in a prepared statement.

The poll's findings are alarming. "Emergency physicians are concerned that our system cannot even meet daily demands, let alone during a medical surge for a natural or man-made disaster."

Most emergency medicine doctors are facing struggles with drug shortages, according to the ACEP poll:

http://bit.ly/2sl9pGu

A South African team has created the ZiBiPen, which delivers a shot of adrenaline from a replaceable, $16 cartridge.

The reusable pen costs $80 and is intended to last five years.

The standard for treating anaphylaxis, the EpiPen, is single use, must be replaced regularly, and is expensive.

A team of South African biomedical engineers have built a cheap replacement for the EpiPen that could revolutionize the emergency treatment of anaphylaxis, a severe allergic reaction that can be triggered by food or insect bites.

Called the ZiBiPen, it delivers a shot of adrenaline in the form of a replaceable, $16 cartridge.

“The cost of the pen is $80 and we are testing to make it last up to five years,” said Gokul Nair, who helped develop it alongside fellow University of Cape Town’s Medical Devices Lab alumnus Giancarlo Beukes.

That is a fraction of the cost of the dominant device on the market, the EpiPen, which sells for $600 in a pack of 2; lasts only up to 18 months; and can only be used once.

“When we originally did research into the cost of the devices on the market, we found that delays in the distribution chain can mean South Africans only receive their devices with six months before expiry, which made it unaffordable for South Africans,” said Nair, who originally designed it for a master’s project at the Division of Asthma and Allergy at the Red Cross Children’s Hospital.

The rising cost of the EpiPen has seen a class action lawsuit against manufacturer Mylan. The lawsuit claims the company is engaged in an illegal scheme to dramatically increase the list price, which ten years ago was $88, reported CNBC.

Adrenaline auto-injectors are inserted in the thigh, through the clothes. The shot slows the allergic reaction, buying precious time to get users to a hospital.

http://bit.ly/2sjAcD5

A recent New York Times article described a harrowing situation faced by some people who inject drugs and develop endocarditis, a life-threatening infection caused by bacteria that enter the bloodstream and settle in the heart. The article described doctors in Tennessee deciding whether to perform repeat costly heart surgeries on patients who were re-infected with endocarditis as a result of ongoing illicit drug use—and at times declining to operate. This scenario is not unique to Tennessee. National Public Radio tracked similar cases in Massachusetts last year, noting that providers around the country are dealing with the same dilemma. A 2017 Health Affairsstudy found that severe infections such as these have been soaring in line with the opioid epidemic.

Physicians making a choice about whether to operate is arguably a reflection of how the health care system continues to treat people with a substance use disorder as less deserving of care and treatment than people with other chronic diseases. If doctors—inspired by the desire to motivate patients—were to deny life-saving treatment to diabetes patients unable to control their blood sugar, they likely would be met with widespread outrage by the public. While the individual providers profiled in the Times piece want to help their patients survive and maintain recovery from drug abuse, the patients appear to perceive a system that conveys distaste at best, and hostility at worst, to those suffering the acute ill effects of injection drug use.

However, the deeper failures here are not at the clinical level: They are failures of policy. The scenario described by the Times reflects the results of three significant policy gaps: states’ failure to expand Medicaid, insufficient support for needle exchange programs, and an inadequate number of evidence-based substance use treatment programs. 

http://bit.ly/2GUeR8I