Years Pass, but Brooke Greenberg Remains a Toddler. No One Can Explain How or Why.
By BOB BROWN
June 23, 2009
Brooke Greenberg is the size of an infant, with the mental capacity of a toddler.
She turned 16 in January.
“Why doesn’t she age?” Howard Greenberg, 52, asked of his daughter. “Is she the fountain of youth?”
Such questions are why scientists are fascinated by Brooke. Among the many documented instances of children who fail to grow or develop in some way, Brooke’s case may be unique, according to her doctor, Johns Hopkins School of Medicine pediatrician Lawrence Pakula, in Baltimore.
“Many of the best-known names in medicine, in their experience … had not seen anyone who matched up to Brooke,” Pakula said. “She is always a surprise.”
Brooke hasn’t aged in the conventional sense. Dr. Richard Walker of the University of South Florida College of Medicine, in Tampa, says Brooke’s body is not developing as a coordinated unit, but as independent parts that are out of sync. She has never been diagnosed with any known genetic syndrome or chromosomal abnormality that would help explain why.
I’ve been a critical care nurse for 12 years. I rarely find out about the costs my patients incur as they get care in my unit, though occasionally I hear figures. One gentleman, who had open heart surgery to fix one of his heart valves had to come back 3 months later for a re-do. His wife told me that they had just received the bills that added up to almost $200,000. That was about 8 years ago.
Not long ago I learned that the charge per day in intensive care units like mine was now $11,000. Not unrelated to that fact, just the other day, one of our patients who was a ‘self pay’ (read ‘no insurance’) was quickly and quietly packed up and transferred to the county hospital for the remainder of her critical care stay which was going to be several days.
ludlow’s diary :: ::
Though I am not a health care economist I do believe that the true costs of care are incomprehensibly skewed as everyone in the system scrambles to make up for ‘self pay’ patients who would most likely never in a million years have the astronomical amounts needed to cover care while the private insurers and Medicare and Medicaid negotiate greatly reduced prices from that ‘retail’ cost. And it is further skewed by plain old greed.
The whole system is such a many-headed hydra monster! And if you try to reform it bit by bit you end up with a 10,000-paged bill that still fails the American People. Just as with the many-headed hydra who immediately regrew one and sometimes more heads when one was lopped off, when you attempt to reform and regulate an aspect of the similarly poisonous insurance/pharmaceutical complex, one or more new problems spring up. The ‘hydra’ can’t be regulated or compromised with. It needs to be taken out in order to make the system safe for everyone. Once that is done, Problem. Solved.
Just today the Senate HELP Executive Committee discussed medical liability and ways to handle malpractice suits. Included in the discussion was an amendment from Senator Enzi (that he said he developed with Montana Max!) to have Medical Courts decide malpractice cases. These ‘courts’ would not be trial-by-jury but rather have some entity (who in my view would be in the insurance industry’s pocket, limiting the industry’s expenses) decide who was wronged and how much if anything they should be compensated. At least that crazy idea was rejected by the committee.
What would happen to medical malpractice costs under Single Payer? With no private insurance companies zealously trying to guard their bottom line? The Physicians for a National Health Program tell us this:
It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.
From the moment I arrived, I asked almost everyone I encountered about McAllen’s health costs—a businessman I met at the five-gate McAllen-Miller International Airport, the desk clerks at the Embassy Suites Hotel, a police-academy cadet at McDonald’s. Most weren’t surprised to hear that McAllen was an outlier. “Just look around,” the cadet said. “People are not healthy here.” McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.
On May 21, Oklahoma Gov. Brad Henry today signed into law historic tort reform legislation, saying House Bill 1603 by Rep. Dan Sullivan and Senate President Pro Tempore Glenn Coffee will help improve the legal process without impeding a citizen’s access to the courts. The measure would help curb frivolous lawsuits and reduce costs associated with the justice system, among other things.
“This legislation enacts reasonable and responsible reforms that improve the civil justice system without impairing a citizen’s constitutional right to have his or her legitimate grievances appropriately addressed in court,” Gov. Henry said.
“It is perhaps the most comprehensive tort reform measure in state history, and I want to thank all the parties who were involved in crafting this bipartisan legislation. Now it is time to put this issue behind us and give the new reforms an opportunity to work.”
The Legislature overwhelmingly approved the measure last week in a bipartisan vote. Today, legislative leaders applauded Gov. Henry’s action on the bill.
“This is a huge day for Oklahoma,” said Senate President Pro Tem Glenn Coffee. “Thanks to the good faith efforts on the part of health care and business interests, legislative leadership, the Trial Bar and Royalty
Owners, we can proudly proclaim that Oklahoma is open for business. We have made it possible for Oklahoma to keep our best and brightest physicians, and assure that those legitimately wronged will have their day in court.
“I thank the Governor for signing this legislation and helping move Oklahoma a giant step forward.”
“This law represents a truly bipartisan effort between legislative and executive leaders, doctors, trial attorneys, mineral owners, the business community and numerous other affected groups. As with most compromises, this isn’t a perfect bill by our standards, but we believe it is true reform that
will ensure access to quality, affordable health care while encouraging economic development and jobs creation in our state,” said House Speaker Chris Benge, R-Tulsa. “This is an historic day for our state and is one that should make the people of Oklahoma proud.”
HB 1603 will become effective on Nov. 1, 2009.
A message to all physicians from AMA President Nancy H. Nielsen, MD, PhD.
As our country hurtles toward health system reform, Medicine has been at the table during the discussions. The American Medical Association and the specialty and state society leaders have had access to and have been engaged with the White House and the key committees in Congress.
We have been working closely with top Obama administration officials and key staff members of both parties. We have given our best advice, and we have taken the time and effort to carefully consider all views. In truth, we’re not just at the table; we’re helping set the stage for our nation’s future.
But as Sen. Jay Rockefeller (D, W.V.) said recently, “There’s too much happy talk. It’s time to start thrashing out decisions on the tough issues.”
We couldn’t agree more, which is why we need to keep focused on precisely what the issues are that are driving the current debate.
The first is cost. Our nation spends more than $2 trillion per year on health care, and there is nothing in today’s health system to stop costs from increasing beyond our nation’s ability to pay for it.
In fact, everywhere you look you can see the cracks: 46 million uninsured; millions more underinsured; patients putting off preventive care and buying needed prescriptions to save money for things like rent and food. If we all don’t control costs, our nation is in deep trouble.
Physicians can’t and shouldn’t be held responsible for all medical costs, obviously. But we order and are involved in many of the costs, way beyond our own services. We deserve to be paid fairly for our services.
We also have a professional responsibility to be just stewards of finite resources. We have to be concerned about what works better than something else, about what costs more (for our individual patients and our country) than something else, and about honoring the wishes of our patients while giving them information on which to base informed choices.
We also have a right to point out the administrative costs we physicians have had to bear in this fragmented health care “system.”
The second issue driving debate is quality. We’ve taken a leadership role on quality throughout the history of this association, not just recently. But recent history is instructive.
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