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Showing posts from January, 2011

repealing health care reform and rescinding payment for end of life counseling

This last week brought a couple of disappointments.
The House of Representatives passed a bill to repeal the health care reform package: This was expected and "largely symbolic" since the senate will not approve it and the president will not sign it. I think that it is not largely symbolic, but rather largely strategic. It has the psychological effect of making people remain confused about exactly what health benefits they will have, on top of the confusion that already exists due to the complexity of the present bill. Because of confusion and insecurity about the provisions of the health care bill, hospitals and doctors are acting slowly to take advantage of the changes that are scheduled to occur, and so positive changes that would be more likely to make the primarily democrat backed plan look good to American voters will be less evident. As a physician, the stuttering pace of change is frustrating and discombobulating. Congress decided that they will not pay for counselin…

Thoughts about civility, love and positive change

Martin Luther King Junior wrote:

"The ultimate weakness of violence
is that it is a descending spiral,
begetting the very thing it seeks to destroy.
Instead of diminishing evil, it multiplies it.
Through violence you may murder the liar,
but you cannot murder the lie, nor establish the truth.
Through violence you murder the hater,
but you do not murder hate.
In fact, violence merely increases hate....
Returning violence for violence multiples violence,
adding deeper darkness to a night already devoid of stars.
Darkness cannot drive out darkness; only light can do that.
Hate cannot drive out hate; only love can do that."

Congresswoman Gabrielle Giffords is now a rehab facility to learn how to walk and talk again and the families of the folks killed in Arizona are trying to put the shreds of their lives back together and to make sense of what happened on January 8th, 2011. The angry rhetoric and reflex blaming is quieting down among politicians and political commentators. Martin Luther Kin…

Is the individual mandate constitutional and, more interestingly, is it a good idea?

Today in the New England Journal of Medicine authors ask the rhetorical question "Can Congress make you buy broccoli?"

We would undoubtedly reject a requirement to buy broccoli, but on the same subject, is it reasonable that the Affordable Care Act requires every American (with few exceptions) to buy health insurance?  Although Congress has required citizens to do various things, including pay taxes to fund Medicare, it has never before required that we buy a product from a private company. 

Why do we need to buy health insurance from private companies? Mainly because providing a federally funded "public option" for health care coverage was so unpopular among conservatives that there is no public option, and so if we must be insured, our options (unless we are old, disabled or very poor) are limited to buying insurance coverage from the existing private insurance companies.

Despite the fact that private insurance lobbies supported the passage of the health care ref…

Seeing the light: let's use Medicare to change the world

In medicine, third party payers have been partly if not mostly responsible for price inflation and inefficiency. Because an individual does not pay for most of his or her medical care, there is no incentive for that person to insist on fair pricing and excellent service. Because the third party--an insurance company that may be private or government funded--is not actually receiving services, there is no incentive for that payer to insist on quality, and in most cases higher costs can simply be passed on to the insured.

A solution to this problem could be direct payment for services by the patient, but such a transition would be difficult since prices are already so high that services are unaffordable, and we are deeply entrenched in the third party payment system.

So how do we get our third party payers to act as individuals, and insist on good quality and affordable costs? Right now there is a significant pressure on Medicare to reduce its costs, and so Medicare is a very good place…

Medicare and the lemming-like desire for more government funded healthcare

This week in my hometown newspaper two articles from the Associated Press were featured, representing some major issues about Medicare’s ongoing viability. The first article presented numbers about how the average person’s Medicare tax contributions compare to their average Medicare expenditures. The most often quoted figure (this data is rapidly achieving viral status) is that an average couple earning $89K a year will contribute $114K to Medicare over their work life and require $355K in expenditures by the end of their lives through Medicare. The second article looked at a poll conducted in November of 2010 in which 1000 US citizens age 18 and older who were asked various questions about their feelings and preferences with regard to Medicare, given that it appears to be unsustainable without significant changes. The actual data can be accessed at this link:…