Newsweek tries to refute the “Five Biggest Lies In the Health Care Debate.”
But I’ve heard much bigger lies than the ones in this article.
I mean, are people really showing up angry at town hall meetings over fears that “the government will set doctor’s wages”?
Misinformation – or just plain old confusion – about our health care system is common. To try to help fix this, I offer five of the biggest, most commonly repeated misconceptions I hear regularly about the U.S. health care system.
1. Government plays a relatively small role in American health care. Government actually plays a big role. In 2007, federal, state and local governments paid for more than 46 cents of every health care dollar – more than $1 trillion. In fact, since 1980, the government has paid at least 40 cents of every dollar, and as early as 1960 – 5 years before Medicare – government paid a quarter of health care expenses. Government is a massive health care customer and has the impact one might expect such a big customer to have.
2. Health insurance companies drive the increasing cost of care in America. Not true, and here’s why: perhaps 200 million Americans don’t get their coverage from a health insurance company.
Most of these people, or a family member, work at one of the thousands of companies that self-insure (the rest are covered by government programs). What this means is those companies take the health care risk themselves, and use an insurance company mostly to handle the bills. For these companies, the cost of health care directly affects their bottom line. It’s one of the reasons employers have implemented so many programs to try to help their employees live healthier lifestyles, make sure they’re getting good care, and many others. Some data suggest it is working to control health care costs.
The exception is small groups and individuals. They have to buy health insurance, and face few, expensive options. There are many reasons for this, which I’ve blogged about extensively here. One of the most important is that there is not a truly competitive market for this kind of coverage. Still, many of these insurance companies are not-for-profit (some say as many as half of Americans with health insurance are covered by non-profit plans), and so it cannot be that profit drives the premium increases they, too, experience.
3. America has a free market in health care. Health care may be the most heavily regulated industry in America, with layers of state and federal regulation of care and insurance. For example, your doctor can only practice in the state in which he is licensed. If he wants to move to another state and be a doctor there he can’t do it unless he’s gone through a licensing process in that other state.
One of the most important reasons why the market for health insurance is so uncompetitive is that it, too, is regulated by 50 different state bodies. If an insurer wants to sell in another state, it has to go through an extensive process in order to do it, and be subject to all kinds of mandates and other requirements that make it very impractical to do so. It makes for a market that is much less dynamic than it could be.
I suspect one reason people call the U.S. system a “free market” is that rich or well-connected people can get better care than those who are less fortunate. This may be true, but this is just a reality of the human condition, not the health care system.
4. There is an Obama reform plan, and you’re either for it or against it. Much of the media – and even Chuck Norris – describe the various health care reform ideas as part of an “Obama plan” or “ObamaCare.” But other than broad outlines of what the President thinks are important principles, the President has not proposed any plan. Most of what people are talking about – including the entirety of the Newsweek article I started this post with – is the 1,017-page bill from the House Ways and Means Committee. While there are indications that the President is going to propose something concrete in the coming days, calling what is on the table Obama’s plan is more politics than reality.
5. Rising health care costs are a uniquely American problem. America’s not the only country suffering with rising health care costs. In Canada, for example, the government of British Columbia has seen its health care costs increase by 45% over the last 6 years. It’s created a budget crisis, and efforts to steadily increase the premiums it charges consumers and employers. The U.K. has actually experienced a higher rate of growth in health care costs than the U.S. over the last several years. So while it is true that the cost problem is worse in America than in in other countries, this is a matter of degree, not of kind.
I’ve heard lots of others, but these are the ones I most commonly run into.
What kinds of misconceptions have you heard?
*This blog post was originally published at See First Blog*
It used to be that we’d get all our kids settled back to school and then enjoy a bit of a pause before the other shoe fell with the inevitable concern over another flu season. With Swine Flu, Influenza H1N1 not taking a summer vacation and showing no signs of letting up, we didn’t have that luxury this year.
I went onto My Fox Boston this morning and talked with Keba Arnold about this very unique flu season with 2 influenza strains traveling among us and offered some practical tips to not only prevent the flu but be ready should it impact your town’s schools:
Don’t try and absorb everything at once. Focus on prevention today and I’ll help keep you informed as we learn more about the flu shots your family will need, when they will be available, and any breaking CDC alerts that are important for your family’s well being during the flu season.
*This blog post was originally published at Dr. Gwenn Is In*
When you were last enraptured by my physical exam series, I was explaining the different directions doctors use to confuse themselves and everyone else. I am happy to leave that land of relativity and now re-embark on the actual human body. I am sure this relativistic view of direction was invented by some liberal anatomist intent on socializing the human body. It is a stop on the road to death panels, in my opinion.
It’s good to get that posterior to me.
My distraction (I get distracted, you know) happened as I was trying to explain how the shoulder works. Since the shoulder moves in so many directions and with such huge angles, I felt it was necessary to totally confuse you and so hide any chance you would pick up my ignorance. It’s always good to keep your readers snowed. So, after spending a whole post making poems about the shoulder (that will no doubt go down in the anals annals of poetry about joints) and another post about the confusing directions we doctors use to confuse other doctors, I will now talk about the actual exam of the shoulder.
As you probably have been taught, the shoulder is the joint that attaches your arms to your body. Some people refer to the top of their torso as their shoulders (as in “shoulder straps”), but this is not what I am talking about. The shoulder is supposed to be the joint between three bones:
The humerus – which is the long bone in the upper arm, and got its name because of its habit of playing practical jokes on the ulna. The other bones are always inviting the humerus to parties.
The clavicle – also known as the collarbone. This bone actually looks nothing like a collar, and it resents the implication.
The scapula – called the shoulder blade. The collarbone is jealous because the scapula has a much cooler nickname. This causes the scapula to snicker often at the clavicle’s wimpy nickname.
The Wilderness Medical Society held its Annual Meeting in Snowmass, Colorado from July 24-29, 2009. The meeting was very well attended and once again demonstrated that the Society is the hub organization devoted to advancing the science and clinical practice of wilderness medicine. The format this year was to add a great number of presentations suggested by, and in many cases, delivered by members. In this and subsequent posts, I will present some of the wisdom offered in these presentations. For each post, I will put up a photograph I took while hiking in the Maroon Bells Scenic Wilderness Area.
Wayne Askew, Ph.D. and his colleagues taught on the topic of planning and preparing food for wilderness expeditions. Their goals were to allow the participants to develop an appreciation for the role that food and food planning plays in successful and enjoyable backcountry recreation; understand the similarities and differences between small and large group food planning; estimate energy and other nutrient requirements for individuals and groups; review guidelines for planning nutritional support for backcountry expeditions and recreation; and observe demonstration of recipes and preparation techniques for some useful backcountry food items.
A number of terrific observations were made. In no particular order:
1. Food planning is very important in outdoor activities, with emphasis on the word “planning.” One can enhance backcountry travel and survival with good nutrition.
2. Food planning is also important for morale. If people are hungry, malnourished, or unsatisfied, they are not “happy campers.”
3. The food planner for a trip or expedition should be chosen carefully, and should take care to take into account the dietary preferences of the participants.
4. Energy requirements for specific activities related to physical performance and caloric expenditure can be calculated and taken into account for food and meals planning.
5. There are sometimes foods for special needs (e.g., such as allergies, deficiencies, diseases, etc.). While many of the participants can handle their own needs, whomever is managing food should be aware.
6. There are persons who specialize in wilderness nutrition planning. They advise expedition planners on food, water and logistics; plan menu and food supplies for backpackers, wilderness tour groups and expeditions; assist in search and rescue operations; consult with food companies specializing in backpacking foods; and cook food.
7. If a person wants to accomplish nutrition planning, he or she should have a basic knowledge of human nutrition, understand human physiology and the role of food nutrients in extreme environments, know how to utilize food item selections to provide recommended nutrient intakes, and be a good cook in the outdoors.
Food planning by definition means thinking about food in advance. Dr. Askew and his colleagues recommended answering the following questions:
How much room is in your pack?
How much weight can you carry?
How long will you be traveling?
Where are you going?
How much fuel will you need and will you have access to water?
With whom will you be traveling?
Factors that affect food choices in the backcountry are food preferences; weight, perishability, taste and texture of foods; space in the pack; duration of trip; availability of water and fuel for food preparation; environmental conditions; experience with food preparation; special dietary needs; and personal beliefs.
This was a terrific educational experience, with terrific information such as this Planning Guide Nutritional Standards for Backpacking Food for One Person for One Day, based upon U.S. Army AR 40-25 Nutritional Standards for Operational Rations:
Energy (kcal) 3600 (will vary depending upon activity level)
Protein (g) 100
Carbohydrate (g) 440
Fat (g) 160
Vitamin A (RE) 1000
Vitamin C (mg) 60
Vitamin E (mg) 10
Calcium (mg) 800
Iron (mg) 18
Sodium (mg) 5000-7000
Fiber (g) 20-35
Finally, consider the following recipe for energy bars. This is one way to prepare less expensive and more nutritious (than store-bought) bars for personal use. As recommended by Askew and colleagues, you can be creative with this recipe, and use a variety of fruit, nuts, and grains. It is sufficient to make approximately 20 small bars.
Preheat oven to 350°
½ cup brown sugar
1 egg
¼ cup peanut butter
2 tsp vanilla extract
½ cup apple juice (unsweetened)
1 cup whole wheat flour
1 cup quick cooking oats
½ cup wheat germ
½ tsp baking powder
½ tsp baking soda
¼ tsp salt
½ tsp ground cinnamon
½ cup dried fruit (raisins, apricots, dried cranberries, etc.)
½ cup chopped nuts (walnuts, almonds, peanuts, etc.)
½ cup semi-sweet or dark chocolate chips
Mix dry ingredients in one bowl, wet ingredients and added “goodies”
(chocolate chips, raisins, nuts, etc.) in another, then combine. Spread the batter over a lightly greased cookie sheet about ½ -¾ inch thick. Use a spoon dipped in hot water to press the batter into the sheet and shape to the proper thickness. Bake for 10-15 minutes. Allow the pan to cool completely before cutting into bars. The bars can be refrigerated or frozen for longer shelf life.
Nutrition Information: calories 140, protein 5 grams, carbohydrates 20 grams, fiber 2 grams, fat 6 grams (saturated 1 gram) (% of calories from carbohydrates = 52%)
“We already have two girls at home and we want a son. We have too many girls.” My eyes welled with tears as I thought of the fate of this poor, helpless baby who had no voice, no rights, and who was about to be “attacked just because she was female.”
I pulled the ultrasound image from the chart and my heart quickened. The image was of the perfect outline of the precious little baby girl sucking her thumb. The timing of the ultrasound image was perfect.
I proudly showed them the image, and the look and emotion on their faces changed.
“That is our baby?” they inquired. “We didn’t think it had that much form, and she is sucking her thumb already?”
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