Doctors in California unable to offer vaccinations

[ponderingturtle]

Link (http://www.npr.org/blogs/health/2010/07/26/128774343/calif-docs-struggle-to-keep-up-with-the-need-for-whooping-cough-vaccine?ft=1&f=1003)

But many doctors, particularly those in rural areas, are struggling to afford vaccines for their patients. Proposed legislation in California would compel health insurers to fully cover the costs of vaccines to doctors, reports American Medical News, a publication of the American Medical Association.


About half of family doctors and pediatricians who responded to nationwide survey said they had delayed buying some vaccines financial reasons, according to data published in Pediatrics in late 2008. A CDC analysis, published in 2009, concludes that most pediatrics practices either just break even or lose money in providing vaccinations.

Seems that insurers often pay less for the vaccination that it costs the doctor to buy the vaccine.

[BenBurch]

Vaccines should not only be free, but mandatory.

[Bob Blaylock]

Vaccines should not only be free, but mandatory.


Not possible. It costs money to produce these vaccines, to distribute them, to administer them. These costs have to be paid one way or another.

[BenBurch]

Not possible. It costs money to produce these vaccines, to distribute them, to administer them. These costs have to be paid one way or another.

Where you have a public health system, as we are beginning to here in the USA, a vaccination program more than pays its own way by reduction in morbidity and associated costs to that system. And as it increases worker availability it also boosts the economy and allows the tax rate for that health system to be remain stable or to actually be reduced.

[ravdin]

Vaccines should not only be free, but mandatory.

I have to disagree with your heavy handed approach. I'm fine with free vaccinations (well, no such thing as "free", but taxpayer funded). But we don't need a paternalistic government that is empowered to force us to take our shots, whether we like it or not. Let's face it- the government is too incompetent not to make a mess of it. If we have to put the decision in the hands of idiots, I'd way rather trust uninformed idiot parents than uninformed idiot bureaucrats.

[McHrozni]

Vaccines should not only be free, but mandatory.

There is a small risk with each vaccine. Individually those risks almost always outweigh the cost to your health, but if you sting yourself up with everything that you can, you'll quite likely end up with one of the many vaccine-caused aliments, which will cost the system much more than the gain from this.

McHrozni

[Estellea]

There is a small risk with each vaccine. Individually those risks almost always outweigh the cost to your health, but if you sting yourself up with everything that you can, you'll quite likely end up with one of the many vaccine-caused aliments, which will cost the system much more than the gain from this.

McHrozni
"Vaccine-caused aliments[sic]"? Could you please elaborate?

Este

[JoeTheJuggler]

I definitely sympathize with mandatory, publicly funded vaccines. (And most schools require at least some of them, with some exceptions.)

It's really a public health measure (even though it also benefits the individual), so I have no problem with the taxpayers footing the bill.

[McHrozni]

"Vaccine-caused aliments[sic]"? Could you please elaborate?

Este

Perhaps not the best choice of words - I meant the side-effects of vaccines, which can range from nil to minor nuisance to death. Getting a shot for something you're likely to encounter is a good thing (unless you die of it or something, but the chance of that is near nil), but getting a shot for just about anything, regardless of your risk to get it, is in itself an unnecessary risk.

There is also that vaccines do cost money and shooting up everybody with everything would (in all likelihood) cost significantly more than the savings made.

McHrozni

[Rolfe]

Vaccines all free at the point of use here, paid for out of taxes. Not mandatory, though there were times during the Wakefield scandal we sort of wished they were. Some children now dead would have been alive if they had been.

There are situations where vaccination is contraindicated, though that would be easily solved by a doctor's exemption certificate - or I suppose until woo doctors started making a killing by selling exemption certificates for trumped-up reasons.

How it's done here is by paying the doctors an incentive to get a certain percentage of their patients vaccinated. It's then their job to talk the patients into it. Mostly works, although there are a few idiots who declare that the doctor is only doing it for the money, yes he really wants to inject your child with an evil poison because the government is paying him to do it.... :nope:

After school age, it's often done through the schools and the children have to actively opt out. My godson refused his meningitis vaccine because he has a needle phobia, stupid boy.

With the flu vaccine, the doctors go through their lists of patients picking out the priority groups, and if you're in one of these groups you get a letter inviting you to make an appointment or attend a vaccination clinic, or for people who can't get out, the nurse will go to their home to do it. (I had made an appointment to take my mother last autumn, but before it arrived the nurse just showed up at the house unannounced to give her a health check, and gave her the vaccination while she was there.)

A few years ago I fell in the house and cut my head open. When I went to the hospital to have it treated, the nurse who stuck the edges together took the opportunity to fill me up with everything she had handy. And a couple of years ago when I took my mother for her flu vaccine, the nurse didn't just do me at the same time, she decided to do me for pneumonia while she had me at her mercy.

None of this is compulsory, but they are quite keen on the preventative medicine kick. (For routine stuff like mammograms, they don't just ask you to make an appointment, they send you a letter telling you to show up at a certain time, and please just call to change it if that's not convenient, otherwise, be there.)

It can be done, guys.

Rolfe.

[Nursefoxfire]

I have to disagree with your heavy handed approach. I'm fine with free vaccinations (well, no such thing as "free", but taxpayer funded). But we don't need a paternalistic government that is empowered to force us to take our shots, whether we like it or not. Let's face it- the government is too incompetent not to make a mess of it. If we have to put the decision in the hands of idiots, I'd way rather trust uninformed idiot parents than uninformed idiot bureaucrats.

And leaving it to the "uninformed idiot parents" leads to this:
http://www.care2.com/causes/health-policy/blog/6th-infant-dies-in-california-possibly-from-whooping-cough/

Some 1,500 cases of whopping cough have been reported in California this year---nearly five times as many as last year.

MSNBC had a great interview with Dr. Nancy Snyderman regarding this horrible state of affairs:
http://www.msnbc.msn.com/id/21134540/vp/38444985#38444985

[ponderingturtle]

And leaving it to the "uninformed idiot parents" leads to this:
http://www.care2.com/causes/health-policy/blog/6th-infant-dies-in-california-possibly-from-whooping-cough/


The thing is notice that this is also about whooping cough vaccinations in california. Given that some to many doctors in california do not offer the vaccination it plays a roll in it as well as parental wishes.

[Nursefoxfire]

Perhaps not the best choice of words - I meant the side-effects of vaccines, which can range from nil to minor nuisance to death. Getting a shot for something you're likely to encounter is a good thing (unless you die of it or something, but the chance of that is near nil), but getting a shot for just about anything, regardless of your risk to get it, is in itself an unnecessary risk.

There is also that vaccines do cost money and shooting up everybody with everything would (in all likelihood) cost significantly more than the savings made.

McHrozni

Evidence? 1500 reported cases of whooping cough in California this year, with 6 infants dead, and you're trying to tell me that's cheaper than an immunization?

[Nursefoxfire]

The thing is notice that this is also about whooping cough vaccinations in california. Given that some to many doctors in california do not offer the vaccination it plays a roll in it as well as parental wishes.

If you listen to the Dr. snyderman interview, she states that many of the cases are from Marin County, just north of San Francisco, where parents are under- or deciding not to vaccinate their children. This is a conscious decision by the parents, and it's leading to death.

[ponderingturtle]

If you listen to the Dr. snyderman interview, she states that many of the cases are from Marin County, just north of San Francisco, where parents are under- or deciding not to vaccinate their children. This is a conscious decision by the parents, and it's leading to death.

That is true, but it is also true that this is also contributing to the low vaccination rates.

[zooterkin]

Not possible. It costs money to produce these vaccines, to distribute them, to administer them. These costs have to be paid one way or another.

In this context, "free" means "free at the point of delivery".

[Michael Mozina]

Link (http://www.npr.org/blogs/health/2010/07/26/128774343/calif-docs-struggle-to-keep-up-with-the-need-for-whooping-cough-vaccine?ft=1&f=1003)



Seems that insurers often pay less for the vaccination that it costs the doctor to buy the vaccine.

It seems to me that the basic objection to that particular vaccination was the low rate of incidence (in the past) and the perceived (very low) danger of that particular vaccination. I think at the time there were stories coming about about a possible link between autism and some of the chemical preservatives used in various vaccines. That concern might have played a role in our decision making process as well.

I don't know if that's even a valid perception by the way, but the way our family doctor explained things to us 18 year ago, it "seemed" to us as though the whooping cough vaccine was the most optional of the vaccines, and therefore our kids did not get that particular vaccine although they did get a number of other vaccines. Whatever they needed to have to enroll into school we did, but anything that seemed "optional" and seemed unnecessary (at the time) we didn't do.

[ponderingturtle]

It seems to me that the basic objection to that particular vaccination was the low rate of incidence (in the past) and the perceived (very low) danger of that particular vaccination. I think at the time there were stories coming about about a possible link between autism and some of the chemical preservatives used in various vaccines. That concern might have played a role in our decision making process as well.

That has nothing to do with that story in the link, it is about doctors in small towns needing to take out $20,000 in loans to be able to administer vaccinations and losing money on every vaccination.

[Bob Blaylock]

In this context, "free" means "free at the point of delivery".


Which is a dishonest use of the word “free”.

All it means is that it's being paid for by someone other than the one who is actually receiving it.

[paximperium]

Which is a dishonest use of the word “free”. Really? Is there other context the word "free" used for any product?

All it means is that it's being paid for by someone other than the one who is actually receiving it.Yup. What about it?

[I Ratant]

If you listen to the Dr. snyderman interview, she states that many of the cases are from Marin County, just north of San Francisco, where parents are under- or deciding not to vaccinate their children. This is a conscious decision by the parents, and it's leading to death.
.
"California requires that children receive the full slate of vaccinations for pertussis, measles, and other infectious diseases before they can attend school. But the requirement is waived if parents file a "personal belief exemption" (PBE), which need not be based on religion or medical necessity."
.
Momma and Daddy and Jennie McCarthy know best.

[BenBurch]

Which is a dishonest use of the word “free”.

All it means is that it's being paid for by someone other than the one who is actually receiving it.

Free Software = Paid for by the programmers who sought no compensation for it in the hope that you will contribute to the project as well.

Free Lunch = Paid for by the saloon in the hope that you will come in and drink.

TANSTAAFL and all that... Free means exactly that.

[Michael Mozina]

That has nothing to do with that story in the link, it is about doctors in small towns needing to take out $20,000 in loans to be able to administer vaccinations and losing money on every vaccination.
I guess I was pondering the cause of the resurgence of Whooping cough in particular just having read the article itself. I did go back and listen to the audio and I have a better understanding now of the complexities involved.

It really doesn't make any sense to me that even Blue Cross/Shield would not reimburse the full cost of the shot to the doctor even if there was some variation in the price to the clinic involved.. I can see how larger medical groups can get better prices on the same product however so I can see how things get "complicated" when it comes to reimbursing the Doctor.

[catsmate1]

Vaccines all free at the point of use here, paid for out of taxes. Not mandatory, though there were times during the Wakefield scandal we sort of wished they were. Some children now dead would have been alive if they had been.

There are situations where vaccination is contraindicated, though that would be easily solved by a doctor's exemption certificate - or I suppose until woo doctors started making a killing by selling exemption certificates for trumped-up reasons.

How it's done here is by paying the doctors an incentive to get a certain percentage of their patients vaccinated. It's then their job to talk the patients into it. Mostly works, although there are a few idiots who declare that the doctor is only doing it for the money, yes he really wants to inject your child with an evil poison because the government is paying him to do it.... :nope:

After school age, it's often done through the schools and the children have to actively opt out. My godson refused his meningitis vaccine because he has a needle phobia, stupid boy.

With the flu vaccine, the doctors go through their lists of patients picking out the priority groups, and if you're in one of these groups you get a letter inviting you to make an appointment or attend a vaccination clinic, or for people who can't get out, the nurse will go to their home to do it. (I had made an appointment to take my mother last autumn, but before it arrived the nurse just showed up at the house unannounced to give her a health check, and gave her the vaccination while she was there.)

A few years ago I fell in the house and cut my head open. When I went to the hospital to have it treated, the nurse who stuck the edges together took the opportunity to fill me up with everything she had handy. And a couple of years ago when I took my mother for her flu vaccine, the nurse didn't just do me at the same time, she decided to do me for pneumonia while she had me at her mercy.

None of this is compulsory, but they are quite keen on the preventative medicine kick. (For routine stuff like mammograms, they don't just ask you to make an appointment, they send you a letter telling you to show up at a certain time, and please just call to change it if that's not convenient, otherwise, be there.)

It can be done, guys.

Rolfe.

Yep, once you get apathy on your side.

[MikeMangum]

"Vaccine-caused aliments[sic]"? Could you please elaborate?

Este

http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

For example:
What are the risks from DTaP vaccine?
Getting diphtheria, tetanus or pertussis disease is much riskier than getting DTaP vaccine.

However, a vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of DTaP vaccine causing serious harm, or death, is extremely small.

Mild Problems (Common)

Fever (up to about 1 child in 4)
Redness or swelling where the shot was given (up to about 1 child in 4)
Soreness or tenderness where the shot was given (up to about 1 child in 4)
These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses.

Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, for 1 to 7 days (up to about 1 child in 30).

Other mild problems include:

Fussiness (up to about 1 child in 3)
Tiredness or poor appetite (up to about 1 child in 10)
Vomiting (up to about 1 child in 50)
These problems generally occur 1 to 3 days after the shot.

Moderate Problems (Uncommon)

Seizure (jerking or staring) (about 1 child out of 14,000)
Non-stop crying, for 3 hours or more (up to about 1 child out of 1,000)
High fever, 105 degrees Fahrenheit or higher (about 1 child out of 16,000)
Severe Problems (Very Rare)
Serious allergic reaction (less than 1 out of a million doses) Several other severe problems have been reported after DTaP vaccine. These include:

Long-term seizures, coma, or lowered consciousness
Permanent brain damage.

I would say that permanent brain damage could probably be classified as an 'ailment'. ;) Of course, that sort of thing is extremely rare.

[MattusMaximus]

There is a small risk with each vaccine. Individually those risks almost always outweigh the cost to your health, but if you sting yourself up with everything that you can, you'll quite likely end up with one of the many vaccine-caused aliments, which will cost the system much more than the gain from this.

McHrozni

Do you have any evidence for this claim, such as statistics to back up your assertions, or are you spinning this out of thin air?

[thaiboxerken]

Not possible. It costs money to produce these vaccines, to distribute them, to administer them. These costs have to be paid one way or another.

If it's good enough for the military, why not for civilians?

[MattusMaximus]

My brother's a pediatrician, and he informed me of this federally-subsidized program in the U.S. called the Vaccines For Children program (VFC) (http://www.cdc.gov/vaccines/programs/vfc/default.htm) whereby parents can vaccinate their children and Medicaid, I believe, picks up the tab (or most of it). Now, just how well various states advertise this fact is a different story.

So, you see, it appears we already have a program in place in the U.S. to do just what many here are talking about.

[tesscaline]

My county health department (which is in the US) offers vaccines at little to no cost, based entirely upon one's ability to pay. Even if you don't qualify for any financial break in the costs, the most expensive vaccine they have costs $15. All the public schools here advertise the county health department's vaccine clinic on their enrollment forms. So, it's not exactly hard to find out about...

[dudalb]

Which is a dishonest use of the word “free”.

All it means is that it's being paid for by someone other than the one who is actually receiving it.

And that might be cheaper then having to deal with epidemics because of lack of vaccination.
So you are against ANY government involvment with health?

[Bob Blaylock]

All it means is that it's being paid for by someone other than the one who is actually receiving it.

Yup. What about it?


It isn't free. Someone is paying for it. That the someone who is paying for it is not the same one who is receiving it does not make it free.

[zooterkin]

It isn't free. Someone is paying for it. That the someone who is paying for it is not the same one who is receiving it does not make it free.

It does to the person receiving it, at the point that they receive it, and that can be an important factor in the uptake of something like a vaccine that will benefit all. No-one is pretending there is no cost associated with providing the vaccine, and "free" is a common shorthand for "free at the point of delivery".

[Rolfe]

Jeez, Bob's objection would just about wipe out one of the most common usages of the word "free".

Free gift! No it's not, the shop had to pay for the item, so it isn't free even if they give it away to the customer.... :nope:

Rolfe.

[Rolfe]

There is also that vaccines do cost money and shooting up everybody with everything would (in all likelihood) cost significantly more than the savings made.


Evidence?TM

No, srsly, this is a cold-hearted calculation frowned on even in veterinary medicine, on animal welfare grounds. To allow some individuals to suffer from a painful and distressing illness just because it costs less than vaccinating the flock or herd is a bit of a no-no, actually.

Does the concept of public health have no meaning for you?

Rolfe.

[ponderingturtle]

My county health department (which is in the US) offers vaccines at little to no cost, based entirely upon one's ability to pay. Even if you don't qualify for any financial break in the costs, the most expensive vaccine they have costs $15. All the public schools here advertise the county health department's vaccine clinic on their enrollment forms. So, it's not exactly hard to find out about...

It made the point that there are clinics that have vaccines, but that people are less inclined to go to them when they say have health insurance and a doctor that they like. They are also not necessarily convenient to the rural areas mentioned in this piece.

[Bob Blaylock]

Jeez, Bob's objection would just about wipe out one of the most common usages of the word "free".

Free gift! No it's not, the shop had to pay for the item, so it isn't free even if they give it away to the customer....


I usually object to the use of the words “free” and “gift” in that context as well. By definition, a gift is free, and is given with nothing required in exchange.

Many times, in the business context, a “free gift” is something you get as a bonus for buying something. “Buy this great Widgets for $19.99, and we'll throw in, at no additional charge, this free Doohickey!”

No, the Doohickey is not free, and it is not a gift. In order to get it, you have to buy the Widget. The more honest way to advertise this deal would be that you are being offered both the Widget and the Doohicky together for what is advertised as normally being the price of the Widget by itself.

[ponderingturtle]

Jeez, Bob's objection would just about wipe out one of the most common usages of the word "free".


I am sure that when ever Bob sees a sign like "Free T-Shirts" he goes up and argues with them that the shirts are not really free.

[3point14]

I usually object to the use of the words “free” and “gift” in that context as well. By definition, a gift is free, and is given with nothing required in exchange.

Many times, in the business context, a “free gift” is something you get as a bonus for buying something. “Buy this great Widgets for $19.99, and we'll throw in, at no additional charge, this free Doohickey!”

No, the Doohickey is not free, and it is not a gift. In order to get it, you have to buy the Widget. The more honest way to advertise this deal would be that you are being offered both the Widget and the Doohicky together for what is advertised as normally being the price of the Widget by itself.

Then could you please define the word 'free' as you understand it? When is it correct to use it?

[I Ratant]

...
There is also that vaccines do cost money and shooting up everybody with everything would (in all likelihood) cost significantly more than the savings made.

McHrozni
.
Shooting up everyone in the vicinity of smallpox conditions killed smallpox forever!
Pretty much benefits billions of people.

[Estellea]

http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

For example:

I would say that permanent brain damage could probably be classified as an 'ailment'. ;) Of course, that sort of thing is extremely rare.Yes, it is a rare adverse effect of mass vaccination but the risk/benefit/cost of vaccinating for pertussis is, by far, less risky and more cost effective than not.

I think that McHrozni's point was that not all vaccines have that same benefit and when mass vaccinating, in certain countries, with all the vaccines available, there can be diminishing returns.

Este