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I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling

I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling but most of the pts were private pay. Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby.

cameronh90 7y ago
I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.
- hydrox24 7y ago
  > The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.
  - onion2k 7y ago
    I think there needs to be an acceptable palliative care option rather than attempting to extend the life of someone in their 80s. That's not really euthanasia. Accepting death is inevitable and making the last days of life comfortable seems like a better use of money than an operation that will give the patient a few more years of frailty at best.
    - michaelmrose 7y ago
      I would want to live another few years even being frail in fact most people would.
      - onion2k 7y ago
        most people would You're wrong. There are many factors in play (family, friends, isolation, stress, money, pain, etc) around the individual's choice, but studies often find that the majority of older people would prefer a palliative approach to end of life. For example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ Sadly there aren't many studies around this topic. It's important, especially when so many people assume that older people just want to 'not die' rather than listen to what they actually want.
      - wongarsu 7y ago
        I personally knew a guy who was diagnosed with cancer and instead of treatment chose to spend his last few months with his family and then just die. This was in Germany, so all healthcare would have been payed for. A major reason was minimizing suffering for his family, having a good conclusion instead of prolonged suffering with unclear end date.
        chewz 7y ago
        My uncle got diagnosed with cancer at 93 and his initial choice was similiar (I have to die of something in the end). But the family convinced him to try the therapy and it worked. He is still after two years alive and relatively well.
        ovi256 7y ago
        Different types of cancers are entirely different diseases with different outcomes. Your uncle was part of the lucky ones.
        seamyb88 7y ago
        Your living uncle just cost you HN karma points, for some reason.
  - CuriouslyC 7y ago
    If someone wants to die, let them fucking die. The fact that people consider this "contentious" is utterly ridiculous. How can you possibly justify telling other people to go on living if they don't desire to do so? Seriously, mind your own fucking business.
    - elygre 7y ago
      This is why I consider it “contentious”: «On February 13, 2014, Belgium legalized euthanasia by lethal injection for children,» from [1]. «Even the controversial head of Belgium’s euthanasia commission is concerned that a well-known Belgian psychiatrist is allowing too many of her psychiatric patients to be euthananised,» from [2]. 1: http://www.patientsrightscouncil.org/site/belgium/ http://www.patientsrightscouncil.org/site/belgium/ 2: https://www.bioedge.org/mobile/view/belgium-euthanasia-doctors-split-over-psychiatric-illness/12490 https://www.bioedge.org/mobile/view/belgium-euthanasia-docto...
      - CalRobert 7y ago
        'The law states a child would have to be terminally ill, face "unbearable physical suffering" and make repeated requests to die - before euthanasia is considered. ' https://www.bbc.com/news/world-europe-26181615 https://www.bbc.com/news/world-europe-26181615 Perhaps the law is not being applied this way, but I think the idea here is "this poor child is in agony with no hope of improvement and keeping them alive is torture in a sense" - not "let's take terminally ill children lightly"
    - Ntrails 7y ago
      > If someone wants to die, let them fucking die. That is not what the assisted suicide debate is about. The debate is about the right to kill someone who cannot do so themselves.
      - kube-system 7y ago
        Not to mention, it’s not exactly clear as to who is able to make that decision.
billforsternz 7y ago
Counterpoint: Bernie Sanders is just 2 years short of 80. He seems to be a vigorous man who had a temporary medical setback, then was restored to full health by stent insertion.
- melling 7y ago
  Jimmy Carter was treated for brain cancer in his early 90’s. https://www.cancerresearch.org/join-the-cause/cancer-immunotherapy-month/30-facts/20 https://www.cancerresearch.org/join-the-cause/cancer-immunot... He’s still alive 4 years later.
  - nosianu 7y ago
    So we are using extremely carefully selected individual examples now to come up with policies for everyone? Right then. And no, just because something works to "save (or extend) one life" does not mean it should be tried for everybody, because "hope". If you read the article - which says nothing surprising anyway - you balance your very few successes with lots and lots of bad cases. For some few to live longer a lot of people have to suffer more. Completely orthogonal, but since the path this thread took shows people care a lot (too much) about individual examples, I saw this more than once in my own family. My 94 year old grandmother broke here hip, surgery was ruled too dangerous, so she was driven back to her retirement home - where she only spent her last year, when care became too difficult at home - and spent the rest of her days just lying in her bad waiting to die. There was no good option left. That's just how it is near the end. I'm just saying this to show that I'm not talking about something that I only know from discussions such as this one. Also, both my grandmothers (who both made it into their nineties) had surgery in their 80s and both suffered significantly. Their brains were not the same afterwards. Anesthesia is not easy on the brain, even on top of any stress of the surgery itself on the body. There was a significant difference in mental abilities in both my grandmothers when comparing how they were before and after their surgeries (both had them for broken bones that occurred due to age related osteoporosis). And they both had pretty good starting points, others are much more frail at those ages.
    - 7y ago
jmkd 7y ago
You mention the art on the walls and the koi pond as if they are spurious examples of unnecessary spending, when many studies point to the great value in such environmental factors in healing.
- fiblye 7y ago
  If you’re spending millions on art, you’re a museum, you’re being swindled, or you’re trying to find a clever way to shift your cash around. And I doubt hospitals are debuting rediscovered Van Gogh works. Buying affordable works from local artists can fill a massive hospital for well under a million.
  - larnmar 7y ago
    Or Van Gogh prints, for that matter.
- Ididntdothis 7y ago
  I guess there are cheaper ways to achieve that. I think they are more to impress people.
  - jmkd 7y ago
    The responses here decrying the cost of the artwork and suggesting replacement with prints denies any and all value to artworks as profound objects, and could easily be as mis-applied to museums themselves. For those lacking understanding of the value of art in this context here is a good recent piece of research with many useful references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/
- Broken_Hippo 7y ago
  I think the real issue is that these folks are profiting so much as to afford the art while folks have trouble paying for hospital stays. There are so many ways to get original artwork on the walls for a much cheaper price tag, after all - and things get even cheaper if one looks into prints.
Ididntdothis 7y ago
"Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby." That's one thing I ave noticed in a lot of US hospitals and doctor offices. Everything is very shiny and new and costs a lot of money.
- vkou 7y ago
  It's the invisible hand of the market at work. Obviously, patients are preferring to pay premium for treatment hospitals with expensive art and swanky facilities.
  - Ididntdothis 7y ago
    I wonder if they preferred it less if they had a way to find out how much the hospital costs before treatment.
    - kube-system 7y ago
      That would make sense, at least for the people paying the costs themselves. The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company. The last time I need non-routine care, the only thing I cared about was: 1. Is this doctor good? 2. Is this doctor/hospital in-network?
      - RugnirViking 7y ago
        "The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company" The money doesn't come from nowhere. If everybody thinks like this, your insurance costs more money. If you don't pay for your insurance personally, how about just straight up being paid more by your company?
        kube-system 7y ago

cameronh90 7y ago

I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.

hydrox24 7y ago
> The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.
- onion2k 7y ago
  I think there needs to be an acceptable palliative care option rather than attempting to extend the life of someone in their 80s. That's not really euthanasia. Accepting death is inevitable and making the last days of life comfortable seems like a better use of money than an operation that will give the patient a few more years of frailty at best.
  - michaelmrose 7y ago
    I would want to live another few years even being frail in fact most people would.
    - onion2k 7y ago
      most people would You're wrong. There are many factors in play (family, friends, isolation, stress, money, pain, etc) around the individual's choice, but studies often find that the majority of older people would prefer a palliative approach to end of life. For example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ Sadly there aren't many studies around this topic. It's important, especially when so many people assume that older people just want to 'not die' rather than listen to what they actually want.
    - wongarsu 7y ago
      I personally knew a guy who was diagnosed with cancer and instead of treatment chose to spend his last few months with his family and then just die. This was in Germany, so all healthcare would have been payed for. A major reason was minimizing suffering for his family, having a good conclusion instead of prolonged suffering with unclear end date.
      - chewz 7y ago
        My uncle got diagnosed with cancer at 93 and his initial choice was similiar (I have to die of something in the end). But the family convinced him to try the therapy and it worked. He is still after two years alive and relatively well.
        ovi256 7y ago
        Different types of cancers are entirely different diseases with different outcomes. Your uncle was part of the lucky ones.
        seamyb88 7y ago
        Your living uncle just cost you HN karma points, for some reason.
- CuriouslyC 7y ago
  If someone wants to die, let them fucking die. The fact that people consider this "contentious" is utterly ridiculous. How can you possibly justify telling other people to go on living if they don't desire to do so? Seriously, mind your own fucking business.
  - elygre 7y ago
    This is why I consider it “contentious”: «On February 13, 2014, Belgium legalized euthanasia by lethal injection for children,» from [1]. «Even the controversial head of Belgium’s euthanasia commission is concerned that a well-known Belgian psychiatrist is allowing too many of her psychiatric patients to be euthananised,» from [2]. 1: http://www.patientsrightscouncil.org/site/belgium/ http://www.patientsrightscouncil.org/site/belgium/ 2: https://www.bioedge.org/mobile/view/belgium-euthanasia-doctors-split-over-psychiatric-illness/12490 https://www.bioedge.org/mobile/view/belgium-euthanasia-docto...
    - CalRobert 7y ago
      'The law states a child would have to be terminally ill, face "unbearable physical suffering" and make repeated requests to die - before euthanasia is considered. ' https://www.bbc.com/news/world-europe-26181615 https://www.bbc.com/news/world-europe-26181615 Perhaps the law is not being applied this way, but I think the idea here is "this poor child is in agony with no hope of improvement and keeping them alive is torture in a sense" - not "let's take terminally ill children lightly"
  - Ntrails 7y ago
    > If someone wants to die, let them fucking die. That is not what the assisted suicide debate is about. The debate is about the right to kill someone who cannot do so themselves.
    - kube-system 7y ago
      Not to mention, it’s not exactly clear as to who is able to make that decision.

billforsternz 7y ago

Counterpoint: Bernie Sanders is just 2 years short of 80. He seems to be a vigorous man who had a temporary medical setback, then was restored to full health by stent insertion.

melling 7y ago
Jimmy Carter was treated for brain cancer in his early 90’s. https://www.cancerresearch.org/join-the-cause/cancer-immunotherapy-month/30-facts/20 https://www.cancerresearch.org/join-the-cause/cancer-immunot... He’s still alive 4 years later.
- nosianu 7y ago
  So we are using extremely carefully selected individual examples now to come up with policies for everyone? Right then. And no, just because something works to "save (or extend) one life" does not mean it should be tried for everybody, because "hope". If you read the article - which says nothing surprising anyway - you balance your very few successes with lots and lots of bad cases. For some few to live longer a lot of people have to suffer more. Completely orthogonal, but since the path this thread took shows people care a lot (too much) about individual examples, I saw this more than once in my own family. My 94 year old grandmother broke here hip, surgery was ruled too dangerous, so she was driven back to her retirement home - where she only spent her last year, when care became too difficult at home - and spent the rest of her days just lying in her bad waiting to die. There was no good option left. That's just how it is near the end. I'm just saying this to show that I'm not talking about something that I only know from discussions such as this one. Also, both my grandmothers (who both made it into their nineties) had surgery in their 80s and both suffered significantly. Their brains were not the same afterwards. Anesthesia is not easy on the brain, even on top of any stress of the surgery itself on the body. There was a significant difference in mental abilities in both my grandmothers when comparing how they were before and after their surgeries (both had them for broken bones that occurred due to age related osteoporosis). And they both had pretty good starting points, others are much more frail at those ages.
  - 7y ago

jmkd 7y ago

You mention the art on the walls and the koi pond as if they are spurious examples of unnecessary spending, when many studies point to the great value in such environmental factors in healing.

fiblye 7y ago
If you’re spending millions on art, you’re a museum, you’re being swindled, or you’re trying to find a clever way to shift your cash around. And I doubt hospitals are debuting rediscovered Van Gogh works. Buying affordable works from local artists can fill a massive hospital for well under a million.
- larnmar 7y ago
  Or Van Gogh prints, for that matter.
Ididntdothis 7y ago
I guess there are cheaper ways to achieve that. I think they are more to impress people.
- jmkd 7y ago
  The responses here decrying the cost of the artwork and suggesting replacement with prints denies any and all value to artworks as profound objects, and could easily be as mis-applied to museums themselves. For those lacking understanding of the value of art in this context here is a good recent piece of research with many useful references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/
Broken_Hippo 7y ago
I think the real issue is that these folks are profiting so much as to afford the art while folks have trouble paying for hospital stays. There are so many ways to get original artwork on the walls for a much cheaper price tag, after all - and things get even cheaper if one looks into prints.

Ididntdothis 7y ago

"Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby." That's one thing I ave noticed in a lot of US hospitals and doctor offices. Everything is very shiny and new and costs a lot of money.

vkou 7y ago
It's the invisible hand of the market at work. Obviously, patients are preferring to pay premium for treatment hospitals with expensive art and swanky facilities.
- Ididntdothis 7y ago
  I wonder if they preferred it less if they had a way to find out how much the hospital costs before treatment.
  - kube-system 7y ago
    That would make sense, at least for the people paying the costs themselves. The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company. The last time I need non-routine care, the only thing I cared about was: 1. Is this doctor good? 2. Is this doctor/hospital in-network?
    - RugnirViking 7y ago
      "The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company" The money doesn't come from nowhere. If everybody thinks like this, your insurance costs more money. If you don't pay for your insurance personally, how about just straight up being paid more by your company?
      - kube-system 7y ago