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Fix Healthcare Soon Or The Patient Will Be Beyond Saving

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*

How Will Today’s Elections Affect Healthcare Reform?

All eyes are on today’s mid-term elections and how they’ll play out across the country. The results are likely to affect the recently enacted healthcare reform legislation, Politico reports. Although repealing the legislation would be difficult, Republicans may be able to challenge its implementation if they gain control of the House. Attempts to modify the law could require a delicate balance since, as noted by the Washington Post‘s Ezra Klein, some of its provisions, such as coverage for dependents age 26 and younger, are individually popular.

Reuters has published a Q&A on what the election results could mean for the healthcare reform law. The Wall Street Journal is asking readers to weigh in on whether the legislation is affecting their votes. (Politico, Washington Post, Reuters, Wall Street Journal)

*This blog post was originally published at ACP Internist*

Traditional Science Vs. Public Health Quackery: Does Health Lose?

I recently read an article by Heather MacDonald entitled “Public Health Quackery” that has not left my thoughts since. The truth in regards to what determines health is being argued in the article.

At the heart of the article, MacDonald seeks to contrast the traditional science approach with the miasmatician approach to the fundamental question of the role of individual behaviors vs. socioeconomics on the determinants of health. MacDonald summarizes the miasmaticians’ beliefs of health determinants as being exclusively influenced by socioeconomics thereby dismissing any and all influences on health by individual behaviors.

Her primary argument in favor of the traditional science belief in individual behaviors as determinants of health is as follows: Traditional science bases assumptions of truth on data that is valid by scientific standards vs. miasmaticians’ assumptions of truth from biased, “flimsy” data. In other words, “quacky” ideas come from “quacky” data thus are not likely to be true. Read more »

Progressive Healthcare Rationing: What Will It Look Like?

In prior posts, DrRich introduced his readers to Ezekiel Emanuel, M.D., Ph.D., brother of Rahm, eminent medical ethicist, and one of the White House’s chief advisers on healthcare policy. Dr. Emanuel was one of the authors of that recent paper in the Annals of Internal Medicine which admonished American physicians that resistance is futile. He has also famously called upon American physicians to abandon the obsolete medical ethics expressed in the Hippocratic Oath.

The reason the ideas (and pronouncements) of Dr. Emanuel are important is that he presumably will be a major “decider” in determining who will serve on the GOD panels, and how those panels will operate to advance his (and Mr. Obama’s) program of healthcare reform.

So, before we leave Dr. Emanuel to his important duties, let us take one more pass at the views he has expressed, regarding the direction of American healthcare, which we can expect to see manifested in government guidelines and policies in the coming years. In particular, and especially relevant to the subject of this blog, let us view how Dr. Emanuel would direct the rationing of our healthcare. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Is Looking At “Long Term” Impossible In Our Healthcare System?

I spent last week in Gothenburg, Sweden covering the European Committee for the Treatment of Multiple Sclerosis (ECTRIMS) meeting. Lots of good science, lots of excitement over the new oral and targeted therapies coming on the market to treat this awful disease. But what I want to write about isn’t the science, but about how it will play out in the brave new world of healthcare in which we all live in today.

For instance, consider the first oral therapy to hit the market: Gilenya (fingolimod), which the FDA approved in September. Last month Novartis announced the price: $48,000 a year.

This is not a rant against the high cost of drugs, however. It is a rant against the inability of our healthcare system to take the long view of the impact of such drugs, a view that is particularly important with a chronic disease like MS that strikes healthy young adults in their early 20s and 30s. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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