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Showing posts from June, 2012

What does the Supreme Court decision about the Affordable Care Act actually say?

On June 28, 2012, the Supreme Court of the United States voted to uphold most of the disputed provisions of the Affordable Care Act, allowing the legislation to stand. I read the syllabus and some reasonable portion of the opinions. The link is here:

The two issues considered by the court were:
1. Does the constitution allow the government to withhold Medicaid funding from states which do not choose to participate in expanding Medicaid to citizens who sit below 133% of the poverty line?
2. Can the government require citizens to buy health insurance?

There was lively discussion. Chief Justice Roberts argued that it is not constitutional for the government to take away Medicaid funding as a way of forcing states to comply with Medicaid expansion. Justice Ginsberg felt that this could be construed as amending the Medicaid program and was within Congresses legislative prerogative. Eventually they agre…

Thank you doctor for finding that blood clot in my lung--you saved my life! (not)

Pulmonary embolism is a condition in which a blood clot that forms somewhere in the veins of the body moves with flowing blood into the right heart and then out into the lung (or lungs.) It is a common cause of sudden death, since a very large clot can cause the heart to fail and reduce the oxygen level in the blood. The blood clots that cause pulmonary emboli usually form in the deep veins of the legs, sometimes in the large veins of the pelvis and rarely form in the heart. Some people with pulmonary embolism have symptoms that are vague, like dizziness, cough, chest pain or shortness of breath. When they are evaluated they usually have an increased pulse rate, often a low-ish oxygen level, and occasionally report coughing up blood. A person who has a small pulmonary embolus may have really mild symptoms and then flip a very large clot later which can be devastating, so we evaluate many people for pulmonary embolism who have very atypical symptoms. We have a blood test, the d dimer, …

More tongue clucking about the cost of medical supplies: why do veterinary supplies cost so much less?

The other day at my home hospital (which I love and think does a great job of controlling costs and treating patients appropriately) I was sitting around with the intensive care unit nurses and discovered some more irksome facts about how much things cost in hospitals. I had just learned how to place a PICC line (peripherally inserted central catheter) from a nurse anesthetist. When a person is critically ill it is important to have access to the blood stream in such a way as to allow lots of fluid to go in quickly or to make sure that medications that can be irritating to small veins (like potassium and blood pressure support medications) get where they are going without causing damage. That means that a catheter (an IV) needs to go into a central vein. It can go by way of a large vein in the neck or upper chest (the internal jugular vein or subclavian vein) or it can start in a smaller vein in the arm; that catheter is a PICC line. PICC lines can get clotted off, because they are lo…