health care reform
palmd | May 26, 2010As my regular readers know, I'm not a big fan of our current health care system. Our bloated, industry-driven system manages to deliver less effective care at a higher cost than most other industrialized nations. The system is Byzantine, unnavigable, and dangerous, and is kept that way in the name of the Holy Market. But health care can benefit from practices that are decidedly un-capitalist, at least in the Milton Friendman or Ron Paul sense.
Like aviation, health care must apply risky and expensive practices to large numbers of people in dangerous situations. This process is made safer by…
palmd | March 22, 2010It's hard to imagine the that the hyperbolic rhetoric that characterized the health care reform debate could get any worse (death panels, etc.). But it will. Representative John Boehner (Asshat-OH) started it of last night with what amounted to a call for the overthrow of our democracy.
"Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens.
"And we all know why it is so.
"We have failed to listen to America.
"And we have failed to reflect the will of our constituents.
"And when we fail to reflect that will - we fail…
grrlscientist | March 10, 2010tags: Obama Now Experiencing Presidential Puberty, cultural observation, social commentary, news report, health care reform, parody, satire, humor, fucking hilarious, television, Colbert Report, Stephen Colbert, Ezra Klein, streaming video
Stephen Colbert interviews Ezra Klein, who explains the reconciliation process that Democrats need to pass health care reform and what Republicans can do to drag it out indefinitely.
The Colbert Report
Mon - Thurs 11:30pm / 10:30c
Action Center - Health Care Bill - Ezra Klein
www.colbertnation.com
Colbert Report Full Episodes
Political…
palmd | January 1, 2010Or if he does, he's even a worse person than I'd realized. After suffering chest pain in Hawaii he was evaluated in a hospital. When discharged today, he held a briefing in which he praised the U.S. health care system as being the best in the world and remarked that he sees nothing wrong with it at all. He also stated that he received no special treatment. (I don't have links yet, as it was just on TV.)
Such unmitigated arrogance. Such hateful, uncompassionate ignorance. Chest pain can be a useful example of how we approach health care in the U.S., so let's dig and see how spectacularly…
palmd | November 14, 2009An easy way to kill a debate on health care policy is to use the "R" word. We saw this early in the HCR debate with overheated talk of "death panels" and other nonsense. But we ignore the real issue of rationing at our own peril. Those of us who favor real HCR must embrace rationing, coopt it, show our opponents how it is inevitable.
Nowhere is the the Right more hypocritical than the issue of health care rationing (OK, maybe with sex stuff, but...). Everyone who studies American health care knows that we already ration; we just do it irrationally. Current rationing allocates resources…
palmd | November 3, 2009The mainstream media is finally catching on to a disturbing story--the insertion of faith-healing and other non-scientific practices into health care reform. Health bloggers have been on this story for a while, showing us that Senate Bill 1679 currently contains language that would require support for faith healing practices:
The essential benefits provided for in subparagraph (A) shall include a requirement that there be non-discrimination in health care in a manner that, with respect to an individual who is eligible for medical or surgical care under a qualified health plan offered through…
palmd | October 26, 2009When I see a patient at the office, I spend time developing trust, forming a therapeutic alliance, thinking through their physical complaints, examining them, and applying the best evidence to formulating a plan for maintaining their health. It's a lot of fun.
Less fun is the part where I try to get paid. To bill an insurance company, I must use numeric diagnostic codes that best fit what I'm seeing, and I must pick a code representing a level of service, that is, how hard I worked.
The diagnostic codes are referred to as ICD-9 codes, and the service codes are called E/M codes. Not all ICD-…
palmd | October 19, 2009A few weeks ago, I wrote a little about hospitals "dumping" patients. At least around here, it's a rare problem. But what about people who don't get dumped but have no place to go?
Let's take "Mrs. Anton". She's 68 years old and has metastatic breast cancer. She's going to die of the disease, but probably not this week or next. She is admitted to the hospital for a fall, but nothing is broken and there's no reason to keep her. Her husband has been caring for her, but he's a little guy and can't handle the day-to-day care which includes cleaning her, changing her diaper (she can't get to…
palmd | September 30, 2009The state of Michigan is facing massive budget cuts which will further eviscerate the Medicaid program. If the legislature passes it's budget as planned, massive cuts to Medicaid will reduce federal matching funds further limiting access to health care for the state's many uninsured. It's not clear if there is a way out of this, other than a massive overhaul of the nation's health care system.
But lawmakers are looking for termporizing measures. One of these is to levy a tax on doctors. This is insane.
Medicaid pays pennies on the dollar so many physicians (my practice included) cannot…
palmd | September 14, 2009I got a little cranky earlier during a facebook discussion, then heard the voice of a friend in the back of my head saying, "Blog it! Blog that shit!"
And I was about to, when the hospital called with a minor crisis, and then I realized it was the probably one of the last nice days of they year, so I went to the pool with the family, then my wife made a yummy dinner...you get the idea. Anyway, here's the deal. I was reading this piece in the Times about a woman with a complex disease who died at least in part because of our Byzantine health care system. It was a familiar story.
And it's…
palmd | September 11, 2009In the current debate over health care, the Right is pissing me off. They are whining about a "government takeover" that will lead to rationing and death panels, but also about runaway costs. Guess what?
You can't have it both ways.
I just got off the phone with a Major Private Insurance Company. In order to save costs, certain tests must be pre-approved. In this case, I spent about twenty minutes on the phone, first with a clerk, then with a nurse (interspersed with a number of long hold periods). In the end, the study was approved. (I've never made such a call for a Medicare patient…
ddobbs | September 10, 2009This debate has become a test of whom we will trust. Are we going to trust the Republicans, with their predictions of dark disasters that will result from going along with a President they do not believe should be allowed even to speak to our schoolchildren?
Atul Gawande, on Obama's speech, via the New Yorker
ddobbs | September 8, 2009
Matt Taibbi tells us what he really thinks.
Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world :
via Rolling Stone, and well worth a read.
ddobbs | September 8, 2009From my wanderings. We'll start with the happy stuff
Salmon return to Paris! (photo: Charles Bremner, deep in Paris)
Mind Hacks tours some really old brains.
Zuska speaks wisely of health care reform.
The Guardian serves up some glass viruses (smallpox is pictured above).
Neuroskeptic covers a paper that is both encouraging, in its finding that EEG seems to predict antidepressant response, and infuriating, in that it withholds the information anyone else would need to replicate it. NOT GOOD.
The Wall Street Journal checks out cool tools to track the flu.
terrasig | September 7, 2009
. . . or as Dr Barrett refers to it more accurately, Insurance Reform.
On Friday, Sarah Avery of the News & Observer reported on her interview with the now-retired Pennsylvania psychiatrist who started the Quackwatch.com website in 1996 following years of investigating fraudulent health practices.
From the Quackwatch Mission Statement:
Quackwatch is now an international network of people who are concerned about health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere. Founded by…
palmd | September 4, 2009You really should be reading Zuska's pieces. As usual, she cuts through the crap to the meat of the issue. Go now and read.
palmd | August 31, 2009For the last five hundred years, white America has feared black America. When physical chains were broken, the fear only increased. Rumors of black on white atrocities frequently circulate in white communities that live on the edge of black communities. As my home town integrated, rumors of white women being raped weren't uncommon. One particularly tenacious rumor had it that a white boy had been castrated by a group of black men at a local mall.
All of these rumors were, of course, untrue, and served as both a barometer of fear, and a tool of control. If fear could be maintained,…
palmd | August 30, 2009China's a communist country, totally different from the capitalist U.S., right? They probably have some sort of socialized health system that makes Canada look downright libertarian. Right?
No.
I was talking to a friend (who I'll call "Pu") this week. She was surprised that I had to bend over backward to get someone insulin.
Pu: "In China, this would never happen."
Pal: "Really? You mean because the State would take care of it?"
Pu: "No. In China, you pay a deposit for your care, and have to pay as you go, or that's it. Can't afford insulin? Tough. Go home and die."
Hmmm...socialist…
palmd | August 30, 2009From time to time we see an article (usually from LA) about hospital patients being "dumped" on street corners. I don't know how wide-spread this problem is, but the systemic problem that leads to this is common and serious.
Most American hospitals are required to render emergency care to anyone who comes in the door. In practice, this means hospitals provide a great deal of uncompensated care. For example, if some guy with a couple of bullet holes is dumped in front of the ER by his "friends", the hospital is required to stabilize him. But let's say they then wish to transfer his care…
palmd | August 25, 2009The Right is desperate---desperate to derail any sort of health care reform. Notably absent from their diatribes is any debate on the merits of one plan or another. They know that the only way to convince Americans to keep the terrible system we have now is to make them think that any reform would be worse. And so they are blowing their dog whistles, talking about "culture of life" and "culture of death", and along the way encouraging ignorance about one of the most important aspects of medical care.
Any rational person knows that there are no proposed "death panels"---it's a blatant lie…