He's got his $50 million. System seems to be working OK for him.

Nope. Little, to no, chance of that either. Hypoxia from over sedation would more likely affect the frontal lobes. If he had hypoxia severe enough to produce brain stem injury, he would have associated severe cognitive dysfunction as well. If this guy's symptoms are real, he would appear to have a cerebellar/brainstem lesion, such as a tumor or stroke. Only problem with that is, Ambien would have no effect on it. A serious "reaction" to sedatives would be of the allergic type and would not result in such a focal deficit. Can't prove it, but I think this guy is either faking his symptoms (most likely), or has some type of psychogenic dysarthria.
>> ^ReverendTed:

>> ^snoozedoctor:
I say probably fake. TMJ dysfunction does not result in the dysarthria this guys appears to exhibit. Because it's symmetrical, it would almost have to be a central brain lesion of some sort. Nerve injury from dental extraction would be unilateral and involve sensory, not motor nerves. Whatever this guy exhibits, it has nothing to do with a dental extraction.
Unless they're using TMD to mean something other than Temporo-Mandibular Disorder, I agree that it is extremely unlikely that it's post-extraction trauma. Possible neurological defect as a result of over-sedation or reaction to the sedative?

I say probably fake. TMJ dysfunction does not result in the dysarthria this guys appears to exhibit. Because it's symmetrical, it would almost have to be a central brain lesion of some sort. Nerve injury from dental extraction would be unilateral and involve sensory, not motor nerves. Whatever this guy exhibits, it has nothing to do with a dental extraction.

Excellent.

I retract one statement about physicians I work with "no medical decisions are based on anything other than what is in the best medical interest of the patient." Not true. The great majority of the time it's not too little care, but too much care. Judgment is lacking on when to withhold, or stop, heroic measures. It's often from pressure from family members, fear of lawsuits, or just guilt should they not to "everything possible." Just because you "can" doesn't mean you "should."

In my particular specialty, I have no choice but to be my brother's keeper, which is as it should be. I treat with the same diligence the drug dealer shot by the police or the 5 year old child bitten by the family pet. Every physician I work with does the same. No medical decisions are based on anything other than what is in the best medical interest of the patient. My comments on personal responsibility are made from the perspective of my being a tax-paying citizen of a country that struggles under the weight of a medical system that is a bloated bureaucracy servicing a population of consumers with unrealistic expectations.
I totally agree with your comments on addiction. It's poorly understood and hard to treat. If we had a therapy that was effective, I'd be all for paying for it. But we don't. Psychological counseling is of little benefit. A person doesn't stop smoking, or lose weight, until they are ready. Too often it's because they have a debilitating disease caused by same. I have a few friends that smoke. I've tried to get them to quit. I've described the slow death of emphysema, the air hunger, feeling like you're running a race that never ends, although it does when you die. There's not many worse ways to go. But their response is the same, "I'm not ready to quit." Too bad.
One of the great misconceptions US citizens have, is the criticism that physicians are "controlled" or "puppets" of the system, that they receive kickbacks for referrals, etc. These people have never had experience trying to manage physicians, that's for sure. There's not a more fiercely independent group in any work force. They HATE being told what to do and they are the most ethical group of professionals I've ever encountered.

Recognizing, of course, that medical technology manufacturers are funded by their total sales, not just the US system.

Exactly what is preventive medicine? It's basically don't smoke, don't drink too much, eat right, exercise, and wear your seatbelt. Oh, and don't text while you drive. So, most of it is just personal responsibility. Then there are the screening tests, mammograms, PSAs.....most of which are being cut back because of lack of evidence they improve outcomes and because they probably lead to many unnecessary tests. Immunizations are a great example of preventive medicine that works.
The Emergency treatment and active Labor Act of 1986 was an unfunded mandate that required hospitals to provide emergency services and obstetrical care to all patients presenting for emergent care, regardless of their ability to pay or citizenship. So, nobody is denied emergent care in the US health-care system. Of course, the real problem is uninsured patients that have non-emergent health-care problems.
The complexities of the current US system will make it very difficult, if not impossible, to completely convert to a single payer, National Health Care Plan. Perhaps it may evolve as a parallel public system, similar to the VA system. Regardless, the major problems with the current system are not being addressed. The heroic measures to save a few elderly people, without realistic hope for recovery, are consuming resources that could be used to provide health-care for younger citizens with some hope for a good quality of life. The threat of lawsuits are resulting in physicians ordering tests and consultations that are unnecessary and may add up to a full 10% of all health-care costs.
One often overlooked result of a "for profit" system is the investment in medical technology. The US is by far the World's largest exporter of medical devices. We invented and manufactured the MRI and CT scanners, and much of the high tech devices that other countries use in their National Health Care Systems.
>> ^criticalthud:

@snoozedoctor
personal responsibility is not really the issue. actual access to healthcare is.
yeah, americans are fat, stupid, and lazy, and eat like shit, but the "for profit" status of western medicine and the insurance and pharma scams aren't really helping matters.
one of the big problems with a "for profit" system is that preventative medicine is not nearly as profitable as medicine that bills by procedures.

Sorry about your plight. Long term disability is a rare thing after recovery from influenza. You obviously ran into some bad luck and I hope that turns around for you. Actually, I don't think advocating personal responsibility is an interesting or unique position for a physician in the least. Promoting health and prevention of disease is part of our oath. With 1 out of 5 Americans still smoking and 1 out of 3 obese, we are clearly losing the battle. Sorry, but it's not my responsibility to hide the Twinkies, or the Camels and drag people to the gym. If citizens want better health outcomes from their health-care system, they should do their part. The quality of what comes out is only as good as what comes in.



>> ^kceaton1:

Yep I got hit with the same thing, the one-two punch. My side, it was sickness (swine flu, no joke), ending with long-term disability (plus surgery). That cost me my 40-50k job, but luckily I have parents that are helping me try to see through this. Otherwise, I would be a bankrupt statistic and most likely dead.
BTW, @snoozedoctor I understand your beef with "PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH", but that is a very interesting position to hold especially concerning what your oath has to say about that. I assume you're a professional in your field; perhaps you should take up that stance with doctors concerning those fields and see what you could flesh out other than: "throw'em under the bus".

Mostly anecdotal babble. Health outcomes are heavily influenced by cultural habits of eating, drinking (alcohol), drug abuse, physical activity, and genetics. The great majority of US citizens with private health insurance are "safe", to use her term, although certain policies may have lifetime caps on certain types of care, like mental health, which is BS in my opinion. The US leads the world in outcomes in many of the most complex diseases, such as hematologic malignancies.
She is right about a few things. The major reason health-care expenditures have greatly outpaced inflation is the rapid advancement of technology. The true health benefit of all this technology is questionable. The life expectancy in Mexico is just short of the US, despite spending about 10% of what the US spends per capita.
National Health care systems control expenditures by making budgets. Budgets = rationing. Ultimately, US citizens will have to come to grips with the fact that health care spending cannot be an open-ended account. Judging by my interactions with patients, that's not going to be anytime soon. Several things that could be done right away that would make a great difference in overall health-care spending are; eliminate coverage for any medical therapy lacking outcome data to support its efficacy, tort law reform, and PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH. Quit smoking, lose weight, and exercise. Bariatric surgery should not have to be a substitute for will power. But, such is the American way.

In the multitude of recent posts/blogs/discussions about eating the rich, one name is consistently absent of criticism, even prior to his death, Steve Jobs. Net worth over 6 billion dollars, doing no philanthropic work to speak of (as compared to the often vilified Bill Gates), and not one of the many billionaires pledging half of their estate to charities (check out "the giving pledge". Why not Jobs? "Cause dude, like, you know man, he made cool stuff."
Anyone that cannot see the benefit to society, the multitude of companies and people employed that simply augment and support apple products, from iphone covers, to sound docks, on, and on and on, well......if you can't see that, no wonder you don't understand and appreciate capitalism at it's best. True, I don't think money motivated Steve Jobs, I'm quite sure it didn't, but he wasn't keen on giving it away.
If you don't like your lot in life, do what I did, borrow money, do 8 years of post-grad training working 80 hour weeks, get a job, pay back your loans and have a lifestyle above the mean, get yourself on the Board of a charity and give 10% of your income to charities that you trust will distribute money to people that really need it. I didn't do all that work to give money to someone that wants to sit on their ass. I guess I'm what's wrong with this country, an ordinary dude that wants to get ahead.

I have yet to hear one of the protesters voice a plan. I'm with Cain, I don't know what they want. Was there greed involved in the sub-prime fiasco....YES. WE ALL KNOW THAT. PEOPLE ARE, BY NATURE, GREEDY. Congress's explicit approval of sub-prime lending, under the banner of "affordable housing for all" was mostly a lefty dem deal, (I think I hear Barney Frank somewhere), although both sides of the aisle should have been pistol whipped for letting such an obvious fleece go on for so long.

And another advantage of consumption tax is the ability to capture some of the revenue lost from cash only transactions, on which taxes are evaded, dare say, even on illegal drug transactions. Assuming that currency stays in the US, at least some revenue is generated when it is spent. I made the mistake of being honest with a household employee I had for 2 years. I diligently filled out the necessary IRS forms and sent them in, reporting income, taxes withheld, etc., only to have the IRS screw the whole thing up and it took me weeks and much headache to straighten out such a simple thing. No wonder people would rather hand the employee cash under the table. Seems to me the fairest thing might be some form of balanced tax with a simplified progressive federal income tax and a federal sales tax.

Admittedly, I haven't read much about administrating sales tax before, but this study from WA State seems to contradict your numbers. For small retailer the cost of collection was around 6% and that went down to less than 1% for large retailers. That would seem very efficient. Would it be different if it were a National Sales tax? Asking, cause I don't know the answer.
http://dor.wa.gov/content/aboutus/statisticsandreports/retailers_cost_study/default.aspx

>> ^heropsycho:

The problems with consumption taxes are:
A. Not progressive enough, which could admittedly be overcome, but how you could would be tedious. What are retailers gonna do, ask to see your tax statement everytime you buy something? It would have to be based on type of purchase, which would be very difficult to structure it to be progressive enough.
B. As I've mentioned numerous times, sales taxes cost too much to collect. Income taxes are over 90% efficient. For every dollar charged, it only costs less than ten cents to collect and enforce income tax. Last I checked, it costs about forty cents on the dollar to collect and enforce a sales tax. You'd then have to charge everyone more taxes to make up for the inefficiencies.
That's honestly where I'd advocate abolishing sales tax within every state, and have the state legislature raise everyone's income tax a small percentage, so everyone would pay slightly more in income tax, but no sales tax. If done correctly, everyone would pay less in taxes overall, and the state governments would get more in tax revenues due to eliminating inefficiencies inherent in a sales tax. That should be something everyone could get behind.
>> ^GeeSussFreeK:
@Peroxide I am hardly right wing, and many state use something other than income tax. Usually sales tax, which is at a flat rate. So, it is already there to be seen really. The US government used to subside nearly completely on tariffs as well, which is also flat. Long tradition of flat, sales taxes around the world, so I don't know exactly what you mean by your comment. Consumption taxes seem more fair as it taxes people who do and use things as they do and use them. Which I think was one of the arguments that was being thrown around as to the level of fairness. If you drive a gas hog of a car, you pay more consumption tax....makes sense to me! If you wanted to make it progressive, you could change the rate on certain things, or offer food stampish things to people that are low income, basically forfeiting their tax back to them in the way of rebates. Lots of different ways to handle it. I just know that now, I can't file my taxes without the help of a computer. And even then, I don't know if it is right. At any time the government could audit me and really, I wouldn't know how valid their claim would be. How many of you are sure that you aren't guilty of tax fraud? Have you read the X million lines of tax codes?

*promote