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Showing posts from September, 2009

Where does the money come from and where does it go?

All water is recycled. The drip from my nose was, at one point, the drip from someone else's nose and so on. And the same goes for money. There is a limited amount of money, as it represents resources, but it doesn't just go away when we spend it. So, with health care dollars, the problem with the 2.3 trillion dollars going to pay for health care isn't exactly that 2.3 trillion dollars, it is where it comes from and where it goes.An example in point: A friend of mine was just diagnosed with a particularly nasty form of brain cancer, glioblastoma multiforme. It is the most common malignant brain tumor, and it just killed Ted Kennedy. I don't have any idea how it chooses its victims, but it seems clear they have no fault in the process. He has already had 2 MRI scans, brain surgery and 5 days of hospitalization around the brain surgery. He also had an ambulance ride and several doctors' visits. He hasn't got the bill yet, but my guess is that he has just…

Excuse me Mr. Obama--here's the money you were looking for...

Now, like the beginning of a mudslide, there are people, doctor people, writing about why it costs so all fired much to deliver medical care in these United States. There are articles in the New England Journal of Medicine, that staid periodical with the plain white cover, and just this week an article in the Journal of the AMA which explains exactly how the costs of medicine can be curbed, resulting in better care.

The sound of this message is a murmur that is steadily increasing in volume. I'm not entirely sure that anyone in lawmaking positions is hearing it yet. Perhaps when it gets really roaring they will.

I was feeling frustrated by the apparent near inaudibility of this message until today at about 1:30 when, while walking on an old logging road, I realized that it doesn't really have to be heard by law makers. Now, if they did hear it, they could be substantially relieved to know that costs are going to go down, but they don't even have to know that. Perhaps it will…

Senator Baucus' proposal--are health care co ops a bad thing?

I just skimmed the 223 pages of the health care proposal by Senator Baucus, with a focus on the health care cooperative suggestion and the mention of medical malpractice reform.

There are lots of sections in this proposal, and most of them contain good ideas. Achieving all that is in it would be a humongous and monumental amount of work. It also nearly completely misses the boat in terms of cost savings.

But..

The proposal suggests that we establish health care cooperatives as an alternative to presently available insurance plans, that work about like Group Health does now. Group Health is a cooperative based in the northwest which provides full health care services to members for what looks like a reasonable price compared to what most health insurance costs. It provides basic services easily, emergency services competently, and focuses on prevention. It provides good care for serious illnesses of all kinds, and skimps a bit on cutting edge technology and medications. Sometimes members…

What American health care system, exactly?

People throw around the expression "American health care system" like it was something that actually exists. Britain and Canada have health care systems, and in the US of A we have things like Kaiser and Group Health and the VA which are health care systems, but we don't have "A health care system". What we more accurately have is a bunch of professionals who provide services that are sometimes random and sometimes coordinated, having to do with caring for peoples' health and diseases.

Because we don't have a health care system, it is hard to fix it.

Most of our health care is delivered by people who see themselves as individuals delivering a service. In addition to delivering the service, these individuals want to make as much money as they can, consistent with keeping the client happy and healthy. This model does not lend itself well to cost efficiency.

Today our office was provided lunch by a well dressed representative of a medical equipment company. T…

What if I had 3 minutes to make my case

What if I had 3 minutes with a health care czar to ask for what I think we need

Okay, the timer is running...


1. Reduce costs of health care by a. reforming the malpractice system at a federal level to reduce malpractice insurance costs and reduce "cover-your-ass" medical spending b. introducing cost transparency, whereby providers and patients know what everything costs and can make informed decisions and c. creating teams of healthcare professionals to identify waste in practice and administration.

2. Insure everybody by expanding medicare to cover those who can't afford insurance, and revamping medicare to encourage a "medical home" model that provides care for patients through primary care providers who know them well. This would include better coverage and compensation for patients and providers who participated in the new medicare program, and education in cost effective and appropriate medicine to providers of care.

Bedtime story

Once upon a time there was a big country with not very many people living in it. They were farmers, and ranchers and teachers and people who sold things that other people needed. There were doctors, too, who gave advice to the sick, did minor surgery and comforted the dying. The doctors could set bones, bandage wounds and tell people approximately what was wrong with them, but they couldn't do much to fix people who were sick. Eventually the doctors made schools to teach each other what they knew, and educate new doctors who would know a bunch of things right off, rather than having to learn them as they went along. The new well educated doctors were respected because they were able to help people who really needed help, so smart young people wanted to be doctors. In the medical schools the teaching doctors were able to discover new ways to treat the dread diseases that they saw, and so the job of doctoring was associated with more respect. With the respect came good pay. When …

What's wrong with spending trillions of dollars on health care

A couple of years ago I decided that the reason that Americans spend so much money on health care is because it is our national pastime. In Brazil they like soccer and Carnival, and in France they like fine wine and good food. In the US, we like our MRI scans, our bypass operations, CAT scans and the whole gory and dramatic process of getting them and discussing them. When we have a spare moment, we talk about going to the doctor and what tests the doctor ordered and what the doctor said. We have other hobbies, true, but we are very interested in things medical.

When I developed this theory of health care as a national pastime, I saw it as interesting and neither particularly good nor bad. It seemed that any national pastime costs money, and the money that is spent on it goes to pay the salaries of the many people who provide the goods and services related to the pastime. Since medical care consumes such a large amount of money, it must support many households whose wage earners mak…