White Coat Underground

Rush Limbaugh doesn’t get it

Or if he does, he’s even a worse person than I’d realized. After suffering chest pain in Hawaii he was evaluated in a hospital. When discharged today, he held a briefing in which he praised the U.S. health care system as being the best in the world and remarked that he sees nothing wrong with it at all. He also stated that he received no special treatment. (I don’t have links yet, as it was just on TV.)

Such unmitigated arrogance. Such hateful, uncompassionate ignorance. Chest pain can be a useful example of how we approach health care in the U.S., so let’s dig and see how spectacularly wrong Rush is.

Since Rush is staying in a nice place, he is likely near a nice hospital. There is a great disparity in availability of certain health resources. On arriving at the hospital Rush likely received immediately medications that can slow damage to an ailing heart muscle (including morphine). He also would have undergone an EKG and various lab tests to see if he was actively having a heart attack. And he apparently underwent cardiac catheterization, a specialized procedure in which a cardiologist can look for heart blockages. If the hospital is a specialty center with a heart surgery team on call, the cardiologist can also open up arteries if necessary. If he had been having a heart attack and this hadn’t been a specialty center, he would have been given clot-dissolving medications instead. This is still an effective immediate intervention, but some patients cannot have it for medical reasons, and in some patients it is not as good in the long run. About a third of patients with a heart attack get the drug instead of catheterization because only about 25% of acute care hospitals are equipped for the procedure. These hospitals are not evenly distributed.

In addition to specialty care being limited geographically and economically, there are significant racial disparities in cardiac interventions (and as you know, this usually doesn’t work out well for the black guy). And if a patient manages to land in a specialty center and have the best procedure done, there are still problems. A certain kind of cardiac stent works better than others, but if you have one place, you have to be on a particular expensive medication for at least a year. If you can’t afford this medication (clopidogrel) then you are at high risk of having your stent close up. Hopefully your doctor knew of your financial situation and was able to place a bare metal stent rather than a drug eluting one, but in the heat of the moment, who knows?

This doesn’t take into account the care received before and after the event. Rush presumably has excellent access to health care and access to good preventative care. Many Americans do not have access to basic primary and secondary prevention resources, including drugs, doctor visits, dietary counseling, affordable healthy foods, and exercise programs. Many poor patients discharged from the hospital after a heart attack cannot afford the cardiac rehabilitation and medications necessary to prevent further attacks.

To look at our system, and compare it to other industrialized democracies and not see the problems is either willful ignorance or malevolent mendacity.

Comments

  1. #1 phisrow
    January 1, 2010

    Given that this is Limbaugh we are talking about, my guess would be both wilful ignorance and malevolent mendacity…

  2. #2 storkdok
    January 1, 2010

    It’s probably both. Rush is just being himself.

  3. #3 Dan
    January 1, 2010

    “High risk of having your stent close up” is a relative statement. Medscape has a literature review of the risk of late stent thrombosis in drug eluting stents. The actual risk seems to be around 2-3%, unless you are one of the few individuals who don’t respond to clopidogrel. What I am seeing are patients given drug eluting stents and then 2 years or more later, they are still on clopidogrel at great expense. It’s apparent that we are creating a group of patients who are probably going to be taking clopidogrel for the remainder of their lives.

  4. #4 Dave
    January 1, 2010

    i think the whole thing was a set up.rush has been a real nobody lately,i have not seen anything about him on the Google news for quite awhile..then he’s over in Hawaii the same time as the POUS and has “chest pains” and comes out of the hospital a few days later declaring “USA is tops”..note the hospital did not say heart attack but pains consistent with one.Dr’s just go by what you say pain wise.if you say “truck on my chest” then ok thats a heart attack..but rush always knows what to say..does he not..i’ll wait untill some blogers over there give us the real picture of health care in Hawaii,and not the people like rush but the ones in those dirt street shacks i see on the Cops programs..

  5. #5 dsmccoy
    January 1, 2010

    “He also stated that he received no special treatment.”

    I wish he could see just how “special” his treatment would have been if he had checked in anonymously and told them he had no health insurance.

  6. #6 duckdroppings
    January 1, 2010

    Attention whore-boy Rushie just wanted a fix and more press than Obama.

  7. #7 WcT
    January 1, 2010

    Dr’s just go by what you say pain wise.if you say “truck on my chest” then ok thats a heart attack

    This is completely incorrect. We do not put you through a dangerous procedure like cardiac catheterization on the basis of “Oh there is a truck on my chest!”

  8. #8 Pascale
    January 1, 2010

    If you have insurance in the US, you probably don’t think there is a problem. It’s only when you change jobs and find out you are no longer insurable that you see the problems.

    Let’s face it: Rush is a big fat idiot. I have no reason to defend him. But his perception of American health care is that of many Americans.

    OK, I have said something “reasonable” about Rush. I can be snarky for the rest of 2010.

  9. #9 Dianne
    January 1, 2010

    Are drug eluting stints still used much? I remember a couple of recent studies that seemed to suggest that bare metal might be as good or better.

    Also re how well the current system is working, part of a conversation I had with a hepatologist a while ago…”He’s the perfect candidate for a liver transplant (followed by a list of characteristics I won’t repeat for HIPAA reasons)…except that he doesn’t have insurance and we can’t transplant him until he can put $10,000 in escrow to pay for anti-rejection meds.” You can’t transplant someone who can’t pay for anti-rejection drugs: they’ll reject the liver and die horribly and sooner than they would have without. So here is a patient who is likely to die when he could have been saved because he is poor. The system is working perfectly? I don’t think so.

  10. #10 Jim H
    January 1, 2010

    We do have the best health care system in the world. Even a fat ass slob can live into their 80’s here.

  11. #11 Radioactive afikomen
    January 1, 2010

    We do have the best health care system in the world. Even a fat ass slob can live into their 80’s here.

    As long as we’re making rhetorical fallacies here:

    Los Angeles is the healthiest city in the world. The world’s oldest person lived there after all!

  12. #12 DrWonderful
    January 1, 2010

    I’ll agree with you here, if you care.

  13. #13 Badger3k
    January 2, 2010

    If Rush can afford a drug habit and be able to take trips to Hawaii, then he probably can afford better health care. He doesn’t care about anybody else, so of course he’ll say that current health care is the best – he got treated, after all.

  14. #14 "GrrlScientist"
    January 2, 2010

    access to health care in america is a system meant to selectively get rid of society’s undesirables; the impoverished, the unemployed, nonprofessionals, nonwhites … the fact that the current economic situation has created a lot of collateral damage is something that still escapes the average american, even after they share the medical and financial plight of the less fortunate for a few months.

    unfortunately, big fat loudmouthed bullying addicts like lush rumball have never experienced restricted access to health care, and never will.

  15. #15 Johanobesus
    January 2, 2010

    You forgot the part about how people may not even go to the hospital to begin with. When you aren’t rich or blessed with good insurance, going to the hospital is expensive. Some people may have to weigh the risk of dying from a heart attack with the costs of going to the emergency room with a false alarm.

  16. #16 RMM Barrie
    January 2, 2010

    PalMD

    Rush presumably has excellent access to health care and access to good preventative care

    Rush “earns” between 28 and 33 million dollars per year, or about $116,000 per day at the low end. Even in the U.S. that is difficult to spend in the hospital every day.

    As to preventative care, access yes, smart enough to follow any protocol; no, as one short look tells me that.

  17. #17 Arnold T Pants
    January 2, 2010

    Rush Limbaugh remains a big, fat idiot. One thing, though. In his press conference, did it look like he has lost weight?

  18. #18 Dan
    January 2, 2010

    @Arnold Pants: Rush Limbaugh has lost a lot of weight. You must not have been following him in the last two years, or you would probably know that. He has not made a secret of his attempts to lose weight. And the psychiatrists have a work for calling people “big, fat idiots.” It’s called “projection.”

  19. #19 misanthrope
    January 2, 2010

    So Mr Limbaugh receives circa $30000000 compensation for his valuable exertions. It is strange that even in the depths of recession so many people manage to rake it in big time in dubious ways. How rich is Deepak and why is Oprah a billionaire for pity’s sake?

    The question is rhetorical, the answer the reason for my moniker.

  20. #20 History Punk
    January 3, 2010

    “And the psychiatrists have a work for calling people “big, fat idiots.” It’s called “projection.””

    Sometimes a cigar is just a cigar. Sometimes, a big fat idiot is merely accuracy in labeling.

  21. #21 JForbes
    January 3, 2010

    This guy does not have a heart so there is no heart attack. Any chest pain he experiences is gas. He has plenty of gas, which builds up when he stops talking for just a moment – resulting in chest pain. He probably was eating when this happened.

  22. #22 James Sweet
    January 4, 2010

    Even if we forget all about quality of care, the fact is if this happened to me, there wouldn’t be much of a Christmas in 2010 for the Sweet family. And I have a damn good job, and health insurance through a multinational employer, i.e. I’m in the higher percentiles in terms of my ability to weather a storm of medical bills. But 20% (yeah, the best plan my employer offers still has 20% co-pay for major procedures) of this kind of shit is still thousands of dollars.

  23. #23 OleanderTea
    January 4, 2010

    I’d LOVE to see Rush try to get health insurance on his own, not through his employer. Overweight, over 50, cigar smoker, heart problems, drug addiction, history of pilonidal cyst, and I’d bet high blood pressure and cholesterol, too…

    ….yeah, the great insurance comapnies would be lining up to insure that guy.

  24. #24 Mark Moore
    January 4, 2010

    Let’s stay on point: Regardless of the present expense of health care , why do you proponents of govt. health care think THAT represents an improvement over present conditions? The “anything would be better” answer is not an adequate response , so don’t bother typing it.
    Outside its constitutional requirements , what does government deliver more broadly, cheaply and efficiently than the private sector? I would argue that even WITHIN its mandated responsibilities , govt. often fails to fill needs adequately. It’s bearable when the trains are late , but imagine if your actual health and life depended on a system run by government employees? Any takers now?
    And why hasn’t our media done any thorough reporting on already existing govt. medecine in other countries? We only get “happy factoids” from them because they really don’t want the complete toll of successes vs. failures of socialized medecine rattling around in our empty skulls confusing us. After all , our beloved President only has our best interests at heart , and we shouldn’t interfere with that. Morons.
    Mark Moore

  25. #25 Dr. Pablito
    January 4, 2010

    Oo lookie! A libertarian in his natural habitat! Careful now, they spook easy. Watch him! Note the typical markings and the call. They’re still easy to identify, even if they’re becoming more rare.

  26. #26 Mu
    January 4, 2010

    Rush was absolutely honest, he loves a health care system that provides the best care possible to those that can afford it. And he sure didn’t get any special treatment any other millionaire wouldn’t have gotten for the same price.

  27. #27 D. C. Sessions
    January 4, 2010

    Outside its constitutional requirements , what does government deliver more broadly, cheaply and efficiently than the private sector?

    You mean besides water, sewer, waste removal, fire protection, roads, postsecondary education, health care, basic research, … ?

  28. #29 Mark Moore
    January 6, 2010

    For the record , I don’t consider myself a Libertarian and thus perhaps do not scare quite so easily. And I did laugh at the Life of Brian reference , quite apt. But I did ask about services OUTSIDE govt’s constitutionally mandated responsibilities being provided better , more efficiently and more cheaply than the private sector.
    Care to try again , this time to the point?

  29. #30 MonkeyPox
    January 6, 2010

    Unless I’ve misread things, none of the services he mentioned are mandated in the Constitution, so I’m not getting your question.

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