Skip to main content

Gaming the new system?

Last night I attended a program put on by the hospital about health care reform. The first speaker had clearly spent a great deal of personal time and energy working with folks who really didn't want the health care reform bill to pass. He had a good ole boy presentation style, peppered with sarcasm and full of predictions of imminent doom for the world as we now know it.  The only saving graces for his talk were that the food was excellent and that he used so much insurance and benefits jargon that the majority of the audience quit listening to him.

The second guy was more balanced.  He identified himself as a moderate republican, and though he didn't particularly like the health care bill as a whole, he presented a pretty balanced review, and looked at ways we could allow it to improve health care.

His major points included the fact that "accountable care organizations" (ACOs) are likely to become a dominant way to deliver health care, with their focus on coordinated care of patients from hospital to clinic to home. An ACO will consist of doctors, nurses, hospitals and supporting staff who will provide full spectrum health care for patients and be reimbursed based on the severity of the patients' illnesses and the quality of their care. Challenges for these organizations will be functioning in small communities and working out who gets what money for what job.

He addressed the idea that the bill would be repealed, and argued that it is extremely unlikely, even if the next administration is republican dominated, for that to happen. Many of the bill's early achievements will be so attractive to the majority of Americans, including expanded health care coverage for preventive services and to the uninsured or underinsured, as well as breaks for small business presently strapped by high health insurance costs, that dismantling the whole thing would be suicidally unpopular.

Apparently this second guy, a Washington lobbyist, will be working with our hospital to help us qualify for some of the grants available in the bill for organizations wanting to innovate in health care delivery. Many of these grants are particularly applicable to a small community such as ours, and could help us move in directions that we have discussed in the last year.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting it for tr

Old Fangak, South Sudan--Bedside Ultrasound and other stuff

I just got back from a couple of weeks in Old Fangak, a community of people living by the Zaraf River in South Sudan. It's normally a small community, with an open market and people who live by raising cows, trading on the river, fishing and gardening. Now there are tens of thousands of people there, still displaced from their homes by the civil war which has gone on intermittently for decades. There are even more people now than there were last year. There is a hospital in Old Fangak, which is run by Jill Seaman, one of the founders of Sudan Medical relief and a fierce advocate for treatment of various horrible and neglected tropical diseases, along with some very skilled and committed local clinical officers and nurses and a contingent of doctors, nurses and support staff from Medecins Sans Frontieres (Doctors Without Borders, also known as MSF) who have been helping out for a little over a year. The hospital attempts to do a lot with a little, and treats all who present ther