Because Uncle Sam doesn't want to pay what you'd pay for healthcare were you to pay out of pocket, he decided to set criteria. So unless criteria is met, your grandma cannot get the BiPAP or oxygen she needs.
A good example of this came up recently at my work. The patient is an end stage COPD/ pulmonary fibrosis patient. She benefits greatly at night with BIPAP. It keeps here CO2 from rising and it helps her oxygenate.
However, Uncle Sam doesn't care about this patient as much as he cares about his wallet. So he set a criteria where the only way he will pay for BiPAP before a sleep study is done is if the patient meets the following criteria.
1. A sleeping SpO2 of 88 percent over five minutes
AND...
2. An ABG on whatever oxygen the patient will be wearing at home (or on room air) that shows a CO2 of 52 or greater.
Yet this patient has a sleeping SpO2 of 85% and her ABG showed a CO2 of only 50.5. Based on the government criteria she doesn't get BiPAP. She, thus, is on the losing end of the government ration. Uncle Sam cares not about this wonderful old lady that I've grown to love.
So many politicians say there are no such things as death panels. Yet is this not the same thing? It's rationing to decide who lives and who dies because Uncle Sam is frivolous with his money.
The lady lived another 2 months, and never received the BiPAP that may have preserved her life a while longer, and made breathing more comfortable for her while she was still here. Thanks Uncle Sam.
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you need to learn to use the system ABG first thing in the am, before she wakes up, after sleeping without BiPAP
ReplyDeleteJudging by two recent medical experiences in my own family, even if the lady, or her friends and family, or church, or community fundraisers, had wanted to pay for her treatment, that likely would not have been allowed.
ReplyDeleteSo this isn't merely Uncle Sam's rationing. This is 1984 with a vengeance.
Anne
1. The problem with doing it just after taking the patient off BiPAP is it would make her values look better. We want them to look as bad as possible. I know that sounds bad, but that's what the government policy forces us to do.
ReplyDelete2. It is kind of like 1984 isn't it. I loved that book by the way. I loved the real year 1984 too, because my Tigers won the World Series.
And if she--because she was a senior--had decided to opt out of Medicare in order to buy her own insurance, she would have been required to give up her Social Security. Sheeesh!
ReplyDeleteInsurance companies have been doing this for years.
ReplyDelete