December 13th, 2010 by DrWes in Opinion
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The greatest minds are assembled to discern the answer in healthcare reform. Powerful interest groups are aligned to design solutions to protect their turf. Rubrics, formulas, slogans and taglines get designed, spun, pitched and thrown out. The burden of finding alignment, an answer, a plan that suits everyone seems insurmountable — unless we don’t.
The idea of a fit for all is an illusion. Justice and equity are seen differently. We imagine some public consensus at our own peril. But honesty has been in short supply. To paraphrase Oprah: What do we know for sure?
Some people want a relationship with a trusted doctor who knows them well. They want to pick the doctor, the neighborhood and the hospital they attend. Others want immediate access and have little trust or interest in a personal relationship with a doctor.
Some people want interchangeable access to medical care in the most convenient venue — they care little if it occurs at Walgreens, doc-in-a-box, by a nurse practitioner or by a newly-minted resident — it is about access that fits their lifestyle, which may be at a late hour and may be chosen by shortest waiting time at an ER. To others, this type of medical care is anathema. Read more »
*This blog post was originally published at Dr. Wes*
December 10th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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I case you didn’t hear the news, the American healthcare system is in financial crisis. One of the biggest culprits indicted in this crises is “unnecessary care,” with estimates ranging from $500 to $650 billion (total spending estimate is $2.6 trillion) going toward things labeled “unnecessary.” Personally I think this is an underestimate, as it doesn’t take into account the some big-ticket items:
- Brand name drugs given when generics would do.
- Antibiotics given for viral infections (and the additional cost due to reactions and resistance).
- Unproven costly care considered “standard of care” (PSA testing, robotic surgery, coronary stents).
- The unnecessarily high price of drugs.
One of the main reasons I am an advocate of EMR is to measure and analyze care, eliminating that which is wasteful, futile, or even harmful. The biggest burden on our system is not the fact that we have a hyper-complex payment system that hides the true cost of care. The biggest burden is the wasteful care that this system agrees to pay for. In fact, I suspect that the main reason our system has become hyper-complex and covert in its spending is to hide this waste from prying eyes.
It sounds easy: Just eliminate costly unnecessary care and save the system. While you are at it, why not bring world peace, eliminate poverty, and make a detergent that cleans, softens, and deodorizes all at once? Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 8th, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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“So, what do you think about the election?”
“So, what do you think about Obamacare?”
“What do you think about this healthcare situation?”
I get these questions throughout my day. My patients are mostly suburban and white, so their view is overall on the conservative side. Yet I have found that few see the results of the election as a hopeful sign for healthcare. I don’t either.
Anyone who reads this blog regularly knows that I am a “flaming moderate” when it comes to politics. I don’t have much faith in anyone who identifies too strongly with one party of the other. I am really angry with congress and their lack of gonads to work on really coming up with solutions. Interestingly, my patients, regardless of their political leaning, agree with much of what I say. Here are the things they all seem to agree with:
1. Congressional politics is hurting us. Members of congress (both sides are equally guilty) are more focused on what is good for their party than what is good for those who they represent. If a democrat is elected to this district, I expect him/her to represent all of the people in that district, not just the democrats (the same is obviously true for republicans). This doesn’t mean they must lose all of their ideology, but ideology should be a means, not an end. The reason to hold an ideology is to come to solutions to problems with that ideology as a vehicle. The goal is to help the people you represent through your ideology, not bang them over the head with it. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 2nd, 2010 by DrRob in Better Health Network, Health Policy, News, Opinion
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The top vote-getting answer on my poll about what people feel about the election: Different lunatics, same asylum. We are getting jaded by our system. Being the “flaming moderate” that I am, I find it hard to hear the substance of the rhetoric on either side, just the shrillness and rancor of the voices.
From the physician’s perspective, it is very hard to know who to favor in this election. The democrats seem to love lawyers and hate tort reform, and they also favor an expansion of government. The republicans love big businesses and “free market,” accepting the bad behavior of insurance and drug companies as “the market working itself out.” They both seem hell-bent on sticking it to the other party at the expense of getting anything done — and this in a time of crisis for our industry.
The results of this playground brawl between the two gangs of bullies is that all of us wimpy kids (the ones without power) end up lying bloody in the dirt. Here are the facts as I see them about healthcare in our country:
1. It costs far too much. The top item on the agenda needs to be cost control. The only way to control cost is to stop paying for things that are unnecessary or for which there is a cheaper alternative. I know that’s not simple as it sounds, but so much of the discussion is about coverage and how things are paid, while the real issue is not who pays, it’s what and how much gets paid. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 2nd, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, Humor, Opinion
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Have you ever thought: “What if I won an election and was put in charge of an administration?”
Halloween weekend seemed the perfect time for considering the fantasy (or some would argue the horror) of a DrJohnM administration. (Let it be known, I have some leadership experience: I lead local group rides with some success. A community organizer of sorts.) But for the sake of college-like dreaming, let’s consider government under my realm.
First off, clearly the present-day political costumes would have to change. There would be a ban on suits, ties (MRSA-spreading), and uncomfortable shoes. People think better if they are dressed in comfy clothes. It works for Google.
Of course, since I am a practicing doctor, a focus of my administration would be on healthcare reform. And like our current president, I would also have “expert” panels — only my “fix healthcare” panel would look very different. To illustrate these phenotypical differences, let’s consider some of my panel’s inclusion and exclusion criteria.
Panel exclusions:
Anyone with a 4.0 GPA. You are out. Sorry, there are plenty of other think tanks for you, in pretty cool places too, like Cambridge, Ann Arbor, and Palo Alto. A very wise retired urologist once told me that B students nearly always make better doctors, and surely those who tried other things in life (besides the classroom) will make better real-life decisions. Read more »
*This blog post was originally published at Dr John M*
