Skip to main content

View Diary: "I have to get my hip replaced now, because ObamaCare is cutting that off for old folks" (367 comments)

Comment Preferences

  •  Best practices though (39+ / 0-)

    are based on evidence based research outcomes.

    That is great if the surgeries worked well for your dad, but with the very old, a lot of times surgery can result in a worse outcome rather than a better one. Examining the outcomes in a broad patient population, and using that to help guide decision making about when surgery is likely to be helpful, isn't a bad thing. That doesn't mean it would have to be the only deciding factor.

    •  ^ this is absolutely right. Thank you! (6+ / 0-)

      Wish I could give your comment multiple recs.

    •  And when hospitals are rated on (6+ / 0-)

      The effectiveness of care, they may start to shy away from performing surgeries on the very old, simply because the outcomes are iffy and its going to negatively impact their ranking.

      I really think this has hospitals freaked. I would love to see data on the number of joint replacements in the elderly, and the change over the last 10 yrs.

      I'll bet it's gone up a huge amount. And I'll also bet that many of those outcomes were not the best.

      But the hospitals still get paid, because Medicare doesn't throw up a lot of obstacles.

      •  it isn't the age. It is a lot of other factors (1+ / 0-)
        Recommended by:
        mmacdDE

        However with surgery there is always the risk of death, stroke or cardiac complications.

        Another thing to compare the number or rate to is the rate in other countries. We Americans are not that anatomically different.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Thu Dec 13, 2012 at 05:46:21 AM PST

        [ Parent ]

      •  60 minutes had an expose on for profit hospital (1+ / 0-)
        Recommended by:
        417els

        in  Texas doing unncessary surgeries and having to meet a quote of operating on and hospitalizing like 2o pct or more of their elderly patients on medicare or risk losing their jobs.   Doctors were quitting over this as they would get bad reviews for not doing more surgeries or admitting more people on medicare. These for proift hospitals that are privately owned do tend to want to operate on and hospitalized medicare patients.

        If you did not see that program, check it out online ..as it may be available for view online somewhere.

        Follow PA Keystone Liberals on Twitter: @KeystoneLibs

        by wishingwell on Fri Dec 14, 2012 at 02:20:47 AM PST

        [ Parent ]

    •  And it also doesn't mean (6+ / 0-)

      You don't treat the problem. There are always options other than surgery.

      How many younger patients with crappy or no health insurance don't get needed surgery? I'd bet a good many. And they'd likely have better outcomes than the vast majority of 80 yr olds.

      Ravi Shankar died a few days ago. He was 92.

      According to the article in the ny times, he'd had upper resp and heart ailments in the last yr, and had heart valve surgery LAST THURSDAY. Why? He was 92. It's not like it was going to vastly improve his quality of life, or give him another 10 yrs. and it obviously didn't.

      But I'm sure the doctors got paid...

    •  I'll believe in "Best Practices" vs individual (2+ / 0-)
      Recommended by:
      pee dee fire ant, 417els

      care the day "Beyond Petroleum" says "No, No- we can't cut corners! That's dangerous!"

      Now I now those are two completely different scenarios. I just don't want people like my friend who got her knee replaced in during her mid-80s to feel that kind of pressure. This emotional pressure to fix or not fix is even worse when applied to assisted suicide. I personally believe that a person should be allowed to choose death and get away with not being prosecuted for it, but I'm not ready to make it actually legal for doctors and family to influence a decision like that...To say that there are no death panels and decisions will not be made based on statistics may be technically true, but there is a subtext here that cannot be denied and needs to be discussed.

      •  But, (3+ / 0-)

        who's to say the 'individual care' is really based on what is best for the individual? I think that is the point.

        In a fee for service system the doctor has an incentive to do more procedures, whether or not it is likely to benefit the patient. Examining past outcomes in a similar population can help answer the question of whether or not it is likely that a procedure will actually be helpful.

        Older people get procedures all the time that end up being more harmful than they are helpful. My grandmother is one, she died shortly after bypass surgery around age 80 several years ago. I don't know how long she would have lived if she had not had it but I bet longer than she did with the surgery.

    •  Yes my grandmother was told it was too risky (0+ / 0-)

      to do an optic nerve surgery when she was in her mid 8os, possibly because it was a neurological surgery. But then grandma, while in good health and lived into her 90s, had some other issues like being quite overweight with angina and high blood pressure.

      But interestingly she survived 2 broken hips and hip replacement and a colostomy.  They did slow her down a lot and did land her in a nursing home but she was 90 by then.

      Follow PA Keystone Liberals on Twitter: @KeystoneLibs

      by wishingwell on Fri Dec 14, 2012 at 02:18:04 AM PST

      [ Parent ]

Subscribe or Donate to support Daily Kos.

  • Recommended (135)
  • Community (63)
  • 2016 (52)
  • Environment (42)
  • Elections (38)
  • Media (36)
  • Republicans (36)
  • Hillary Clinton (32)
  • Barack Obama (30)
  • Iraq (30)
  • Jeb Bush (30)
  • Law (29)
  • Climate Change (29)
  • Culture (28)
  • Trans-Pacific Partnership (27)
  • Civil Rights (26)
  • Labor (21)
  • Economy (21)
  • LGBT (17)
  • Science (17)
  • Click here for the mobile view of the site