07 March 2011

Austerity rules, baby!

I'm hoping to be able to get back into blogging a bit now that life is edging back ever-so-slowly towards normal, albeit an uncommon and rarely used sense of the word "normal." The new normal, anyway.  I haven't been quite absent from the blogosphere over the past few weeks and months; I've still managed to keep up a brisk skim of posts and headlines. I would read something interesting and think, out of reflex, "Oh, that's gotta go on the blog," but then I'd get distracted by a shiny object and forget about it.

So I'll start with something easy and near to my heart; it combines Emergency Medicine, economish, and politics. You may have heard about the budgetary tussles ongoing in DC. The newly-elected tea partiers in the House are pushing their leadership to reduce the deficit by cutting some $61 Bn from non-defense discretionary spending this year. Now, this may surprise some of you, but I have a modicum of sympathy for this. I've always been a budget hawk and I thought Clinton's greatest legacy was the budgetary surplus he bequeathed on the nation. Sadly, the current plan is puerile -- extend tax cuts and write off the revenue component of balancing the budget, ignore defense spending, and indiscriminately slash spending across the board. It's pathetic. And that's just in conception, in the abstract -- bear in mind that real, specific cuts in spending are way tougher to swallow than the theoretical cuts the cognoscenti talk about.

Consider, for example, Poison Centers.

There are 57 of them nationally. Turns out they're funded by the states, federal funding, and charitable donations. I did not know that. I just assumed that they would always be there, like I assume that when I call 911 a professional dispatcher will pick up the phone. In our state, a couple of years ago, the Governor slashed the funding for the poison center, in a desperate effort to produce an all-cuts balanced budget. This nearly shut the service down altogether, and it was only through a last-minute partial reprieve and a reduction in services that the service remained open at all. If I recall correctly, the medical director is working without a salary still.

So now, I see this in the lame-stream media (NYT):

PENNY AND POUND FOOLISH: Cutting Poison Control



Eliminating nearly all the money for poison control centers would save $27 million — not even a rounding error when it comes to the deficit. Yet it is so foolish that it perfectly illustrates the thoughtlessness of the House Republican bill to cut $61 billion from the budget over the next seven months.

The nation’s network of 57 poison control centers takes four million calls a year about people who may have been exposed to a toxic substance. In three-quarters of all cases, the centers are able to provide treatment advice that does not require a visit to a hospital or a doctor, saving tens of millions of dollars in medical costs.

While a single visit to an emergency room can cost hundreds or thousands of dollars (often paid for by the government), a call to a poison center costs the government only $30 or $40. A study in the Journal of Medical Toxicology estimated that the poison centers saved the State of Arizona alone $33 million a year. Louisiana eliminated its centers in the 1980s but restored them when it realized how much money they saved.

The centers, which collect poison reports, can also act as an early warning system for pandemics or large toxic exposures, allowing a quick response.

The federal government pays about 20 percent of the cost of the centers, with states, cities and philanthropy picking up the rest. Many strapped state and local governments have cut back their financing, and experts say that the virtual elimination of federal money would force many centers to close and sharply damage the effectiveness of the national network.

History repeats itself as farce, and tragedy.

The take-home point, of course, is not that budget cuts are inherently evil or to be avoided. It's that they're hard. Federal money goes to services which are essential (or at least in this case, cost-effective). Federal money goes to services that are popular. Federal money goes to services with a powerful constituency. If the budget is ever to be balanced, it will require hard and unpopular choices, including tax increases, cuts in services, cuts in defense and possibly cuts in entitlements. But to just go through the budget and essentially zero-out critical services is either unserious or nihilistic, either of which would, sadly, be a reasonable description of the process we are seeing to date.

Oh, in case Google brought you here because you searched for for the Poison Center phone number: it's 1-800-222-1222



  1. Everything would be cheaper if lobbyist money wasn't built into the cost.

  2. Animal Poison Control requires a credit card up front. Perhaps we should have some similar setup for human poison control. When a client of mine calls me about a possible intoxication of a patient, either the client can call poison control themselves, or I can do it on their behalf (and bill them for it, or use a client-provided credit card for it), and the option of a per-hour fee, or a per-case flat fee is available. Last I checked I think it was $35 or $40 per case, and I can call back and consult with the veterinary toxicologist as many times as I need to on the same case. I would imagine something like this SHOULD be able to count as a medical expense through a health savings account or whatever they call those, right? I would also expect that if a human's physician had to contact a place like this and pay a fee and bill it to the person, there should be insurance coverage, right? But I know nothing about that. In the veterinary world, pet owners pay for this service, though.

  3. The problem with a per-use fee is that it discourages use, which has the unintended consequence of increasing the use of a more-expensive service (i.e., the ER). Sure, *most* people will pony up the $30 to find out if their toddler eating the play-doh is actually OK, but all it takes is a few governmentally-funded patients going to the "free" ER instead of paying Poison control for the equation to start looking pretty negative for the government. this is because the ER bill will easily be not ten, but a hundred times the cost of the phone support.

    Also, the really nice thing about poison control is that most of the time they can tell the patient that it is safe to stay home -- I assume they have some liability protection. This is in contrast to nurse advice lines that clinics, insurers and hospitals set up, which over-refer patients to the ER (in my humble opinion)

  4. It would be great to invest (I know, crazy talk) in web-based service instead of phone. Even cheaper than phone support, and if Cisco can do it then Poison control should be able to as well.

  5. Don't forget that Poison Control is also utilized alot by ERs and Psych Emergency Service ERs. Poison Control is a specialty in and of itself, in my opinion, and as an RN I have always called poison control at the earliest available moment in an ER for anything that wasn't absolutely straight forward. I utilized them extensively and ALWAYS in coordinating care and admissions from ERs to psych emer services/psych care. Many times they have been a saving grace in insuring the patient gets optimum care including appropriate repeat labs etc, as well as insuring appropriate hours and parameters of monitoring in an ER. They have also been invaluable with some patients in justifying to idiot insurance companies WHY the patient needs care and monitoring and can't just "go home." I have always documented this with the poison control specialists name etc. Many are pharms, some Docs, some nurses, some DVMs. I know that many Docs I worked with over the years appreciated also having the poison control info. No healthcare provider in the world of health today, can know EVERYTHING!Poison Control is very valuable to lay people, but equally value to healthcare professionals in my opinion as well as adding a layer of liability protection for healthcare providers who utilize them and follow their excellent recommendations.


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