Categories
culture politics

Causes and Symptoms


Photo by Center for American Progress

In the practice of medicine we have come a long way from the days when doctors could do little more than treat the symptoms their patients were experiencing and hope that they were physically strong enough to recover from the underlying condition that was producing the symptoms. There are still times when doctors are limited to treating symptoms – such as when a condition has not been diagnosed yet or when it is so far advanced that it is beyond the reach of our available medical care – but generally in modern times our doctors seek to treat the underlying cause of a problem rather than the symptoms. We need to do more of that in the healthcare industry – especially as it relates to our most pressing chronic condition in the industry: uncontrolled costs.

The first step in treating an underlying problem is to correctly identify it. As is often the case with health problems, our healthcare industry is suffering from multiple underlying problems which interact with each other in ways that magnify their combined effects and often make an accurate diagnosis difficult to make. Thankfully we have had people interested enough in this issue for long enough to have made some headway in identifying at least some of the more pronounced underlying problems. These include the cost of new medicines and health care technologies, weakening of market influences in our health care decisions, misaligned incentives in the system, and inefficiencies in the practice of medicine (like misdiagnoses, inaccurate record keeping, reliance on emergency care by some patients, and problematic record sharing between parties).

I can’t claim to have solutions to all of these underlying problems, nor can I be sure that these represent a complete set of the real problems driving our symptom of skyrocketing costs. On the other hand, I am confident that the way we will solve the problems in our healthcare industry will follow the same pattern that people used to solve the problems that the practice of healthcare has become so adept at addressing. It will require many individuals and groups tackling the problems from a variaty of perspectives and experiementing with a variety of solutions. It won’t be done simply by turning the problem over to government and expecting them to insist on providers not charging outrageous amounts for the care we wish to receive (which is essaentially the premise behind the Affordable Care Act).

While I am anything but optomistic about the eventual benefits of the Affordable Care Act, I am encouraged at many other examples of private organizations taking steps to identify and address various of the systemic problems that afflict our health care system. Some of the initiatives I know of which give me hope is the innovative ways that some companies try to reduce health care costs without reducing employee benefits (Walmart, for example), the growing prevalence of individuals having high deductible insurance plans coupled with health savings accounts (which helps to introduce stronger market forces and healthier incentives into the health care system), efforts to bring more transparency to health care from groups like Pricing Healthcare, experiments in combining data-mining with hands-on care to reduce the costs associated with statistical outliers, and the rise of Direct Primary Care Practices and retail clinics.

We are nowhere near solving this problem and we need much more in the way of innovation and fresh perspectives but we have reason to hope that this problem will be cured in time.

Categories
culture

The Scary Flu Monster

Flu ShotsPhoto By UIC Pharmacy

It always frustrates me when politics and fear drive institutional decisions rather than making decisions based on facts. One of my biggest pet peeves in this area is the hype surrounding the flu vaccine. I was reminded of this today when I heard about the new study casting doubt on the effectiveness of the vaccine.

To be clear, I am not at all opposed to people choosing to get vaccinated, nor am I opposed to organizations providing incentives such as free access to the vaccine in hopes of helping more people to choose to get vaccinated. My problem comes when organizations mandate that people get vaccinated – which is becoming more and more popular in health care organizations regardless of whether any employee or class of employees has any significant likelihood of having any patient contact. I also have a problem with all the public disinformation campaigns where the flu vaccine is heavily pushed by giving the impression that they are more effective than they really are.

The study that I heard about today indicates that the flu vaccine is effective in just over half of those adults who receive it. This is fully 1/3 less effective than has previously been claimed.

Along with that I was disappointed with the way the story was presented by KSL. They talked about the study and how disappointing it was to have this finding coming at the beginning of the flu season. That is in line with their reports last week that the flu was reaching epidemic proportions already early in the flu season. That statement would not bother me except that it’s hard to call this the beginning of the flu season when they were reporting 5 months ago that flu season was right around the corner. That made me question how long flu season is. As is often the case – Wikipedia provided the answer:

In the United States, the flu season is considered October through May. It usually peaks in February.

In other words, this is halfway through the flu season and approaching the peak. I guess they could argue that we are at the beginning of the peak of flu season but that is misleading at best when they have been promoting the flu shot for 5 months already.

Secondly, since I was at Wikipedia I wanted to get some information about the effectiveness of the vaccine that was not tied to this shocking new study. What I found there was even more disappointing to me. All my life I have been taught that the flu vaccine was most important for the physically weaker members of society like elderly and young children. Imagine my surprise when Wikipedia informs me that:

The group most vulnerable to non-pandemic flu, the elderly, is also the least to benefit from the vaccine.

So now I can see that the vaccine is less effective than previously claimed and that those who have been most encouraged to receive it are least likely to benefit from it. In a final blow to the hype surrounding this vaccine I also learned that, although we are strongly encouraged to get vaccinated each year:

protection without revaccination persists for at least three years for children and young adults.

This leads to one of two conclusions. Either vaccination every year is excessive or else we are fighting a losing battle against a disease that mutates every year so that we must be perpetually subjected to a vaccine that is barely 50% effective.

I don’t know about other people but that tells me that mandating that people receive the vaccine is based on an agenda that goes well beyond the facts – and I hate the very idea of such fear mongering.

Categories
culture politics

Do We Have Reason To Celebrate?

Photo by malfet_

It’s July 4th. Many of us in the United States are taking the day off from whatever our occupation. We will generally be spending time with family and/or friends. Food will be a big part of the day for many. Fire season may prevent this for some but fireworks are traditionally part of the experience. If you ask people what today is the answers will vary. Some will tell you it is the Fourth of July. Surely we are not simply celebrating a random date on the calendar. Others will say it is Independence Day. (My son just called it Parade Day.) What independence are we celebrating?

I know some people who will complain that those who celebrate the 4th of July are failing to see what we are supposed to be celebrating – they insist that it should be called Independence Day. Personally I like calling it Independence Day but I don’t think that what name a person attaches to the festivities is a reliable indicator of how well they remember the original purpose of the celebration.

This morning as I try to get prepared for all the running around with seven children (hoping that with sufficient preparation we can experience real enjoyment rather than hyper exhaustion) I began to wonder, do we have reason to celebrate anymore?

Categories
National State

Repeal vs Lawsuit vs Nullification


photo credit: Smabs Sputzer

Ever since the passage of that rancid piece of legislative sausage labeled health care reform Republicans have been talking about repealing the bill. Some even talk about “repeal and replace” as their goal. Alongside that rhetoric (and that’s pretty much all it is at this point) there has been the action taken by the Attorneys General of many states to file suit against the constitutionality of the bill. My purpose here is not to discuss the issue of health care reform; rather, it is to talk about the differences between these two legal paths out of this reform as well as another path which is fundamentally different—nullification—which thus far has not been actively pursued by most opponents of the bill.

Categories
National

Reality Bites


photo credit: erin m

Before the health care vote even started candidates and elected officials opposed to this atrocious excuse for health care reform were pledging to repeal it if passed. They have asked citizens to support those who are willing to repeal this bill. When it passed they renewed their pledge. That’s great on paper but the reality is that we are unlikely to ever have the super-majority necessary to override a veto should a bill to repeal ever pass. That means that efforts to repeal would have to wait at least three years until we got a president willing to repeal this monstrosity. Sadly the voters have shown many times that they do not have a three year attention span. As for congress, I find it miraculous that they had a two year attention span on this issue—perhaps they managed because they completely abandoned paying any attention to how much the voters disliked this particular piece of rancid sausage.

Categories
National

Don’t Rely on the Altruism of Baby Boomers

David Brooks must have thought yesterday was April Fools Day – that or he thinks he’s getting old so he decided to pen a column painting a rosy picture for seniors by coming to a senile conclusion. In The Geezers’ Crusade he comes to this wildly impossible conclusion:

It now seems clear that the only way the U.S. is going to avoid an economic crisis is if the oldsters take it upon themselves to arise and force change. The young lack the political power. Only the old can lead a generativity revolution — millions of people demanding changes in health care spending and the retirement age to make life better for their grandchildren.

Categories
culture State

Defined Benefit Pensions: A Failed Experiment


photo credit: inspecie.co.uk

After the town hall meeting I attended on Wednesday I have been thinking about pension plans generally. The state of Utah is looking at changing their pension offerings for new employees to save the state from future financial ruin. I have seen other companies go through that process already. As a nation we have seen the cost of defined benefit pensions contribute mightily to the downfall of GM and Chrysler as well as having a hand in the struggles throughout the airline industry not so many years ago.

As I thought about all these examples I realized that even a fully funded defined benefit pension program is a gamble for any organization. Employees like the security, but it is an inherently risky proposition to offer such a plan.

Categories
General

A Real Christmas Gift

President Obama, Harry Reid, Nancy Pelosi, and other congressional leaders among the Democrats hailed the passage of the Senate health “reform” bill as a Christmas gift to the American people. That’s about the equivalent of trying to convince the chief income earner(s) in a home that the real gift of Christmas for them is the increased balance on the credit card (or the reduced balance of their checking and/or saving’s accounts) rather than the presents they got.

In response to the news that the bill had finally passed my wife had a great idea for a real gift that the Senate could give us for Christmas some year (besides repealing that bill). If they have the authority to mandate that we buy insurance that opens up a world of possibilities. First and foremost her suggestion is that they should mandate that everyone in America should get an answering machine. Just imagine and end to:

Ring . . .

Ring . . .

Ring . . .

Ring . . .

Ring . . .

Ring . . .

Ring . . .

Ring . . .

The person you are calling is not available. *click*

I’m quite confident that universal telephone answering machines would have a positive impact on interstate commerce.

Categories
National

Reid Has a Moment of Sanity

I was very surprised when reading about the results of the Senate vote on health care.

Senate Majority Leader Harry Reid, D-Nev., initially cast a “no” vote.

The explanation we are given is that he was exhausted – which makes sense considering the amount of all-night negotiations and arm-twisting that he has been doing recently.

It reminds me of a friend of mine who grew up in Boston. By the time I knew her she had been out of Boston long enough to lose the accent. one time I called her early enough in the morning that she was still waking up and her natural Boston accent was prominently on display in her voice. When the defenses are down the truth shines through.

I guess it just goes to show that when his defenses are down even Harry Reid knows that this is a horrible piece of legislation.

Categories
National

It’s Not Too Late to Change Your Mind

Conservatives, for right reasons and wrong reasons, are united in opposition to the current health care reform legislation. Unfortunately many liberals are falling into the trap of “stand by our guys” that already landed us in NCLB, Medicare Part D, and Iraq during the last administration (for which I apologize to all my liberal friends even though I opposed all of those). Of course liberals have little reason to listen to a conservative like me so rather than make my own argument today I’ll share the conclusion from Fire Dog Lake:

The Senate bill isn’t a “starter home,” it’s a sink hole. It needs to die so something else can take its place. It doesn’t matter whether people are on the right or the left — once they understand the con job that’s about to be foist upon them, they agree. That’s why Harry Reid and President Obama are trying to jam it through as fast as they can, before people get wise. So email the list to your friends and family, tweet it and spread the word.

I was going to add my own perspective when I first started reading that, but it is too well done to be condensed. Go read all 10 Reasons to Kill the Senate Bill.

Many people, liberal and conservative, seem ready to give up because the Senate already cleared their first 60-vote hurdle. That’s exactly what Reid and his company of non-representative public officials would love to see. Please don’t give up yet or settle for this poor excuse for reform. We may not agree on all the right directions, but almost everyone who’s paying attention knows that this legislation is not anything close to what we need. Let’s not allow the Senate to pass this just so they and the president can say they passed something – that is simply not a good enough reason.