Laughter is the best medicine!

Healthcare--service delivery, insurance, portability, coverage--is serious business. However, even in the face of life-and-death decisions, occasionally a beam of levity emerges. Often, it seems even funnier because of the extremem alternative. Here are some examples:

1. Check out the Summer 2009 Lahey Clinic magazine (they didn't print a URL in the issue, so you will have to root around on the Internet). In New England, the Lahey Clinic is one of the top medical empires, rivaling even esteemed Mass General Hospital. But, in the article entitled, "New Wing To Open This Summer", white-haired white men in suits are pictured as the drivers behind the project. But, the hilarious--if pathetic--photos attest to the lack of understanding these senior executives have about the needs--and interests--of their patient base.

There are five non-people photos. The first shows the building. This is, of course, an example of the navel-gazing vision of 19th-century New England mill owners; the edifice complex. In a way, they want to show their tomb, as they believe it is something that will outlive them, and that succeeding generations will remember THEM because of the building they caused to be built; a.k.a. paid for.

This pales in comedic comparison to three of the four other shots, depicting (a) The Sophia Gordon Cancer Center, The Pain Center, and Opthalmology's State-of-the-Art (SOTA) Clinic. Well, let me rephrase that description. Pictured are NOT the cancer treatment facility, or pain center treatment rooms, or cutting-edge (no pun intended) eye treatment equipment. What the pictures do show are--wait for it--WAITING ROOMS!!! That's right. They're giving patients--people in pain, fear, and medical need--better, more modern, roomier places in which to WAIT FOR TREATMENT!! The fourth picture, of the new Emergency Room, shows not SOTA treatment rooms, but a pristine, well-lighted carefully constructed sign-in desk and filing cabinet (no doubt for paper files, which are SO 20th century).

You can't make this stuff up! But wait, there is more!

2. Read "The Immortalists", an article in the July 26 Boston Globe Sunday magazine by a freelance writer (and boomer) Jennifer Graham. The lead sentence reads:  "The baby boomers are the first generation that will-let's be honest-actually live too long." While she doesn't mention the word "euthanasia", that is exactly what she means. I won't quote other parts of the article here, but I will mention how she justifies expressing this opinion:  "Meanwhile, maybe they could lighten up on the All Bran and hit the trans fat. Just sayin'. For posterity's sake." Well, when it comes to being made into Soylent Green, Jennifer Graham can have my place in line.

That's the current phrase that's being used by all manner of people to justify their loony, loopy opinions:  "Just sayin'." I think the Globe printed this article because the author does make an attempt to take a tongue-in-cheek tone, but she totally fails. I'm just sayin'.

3. Like The Wall Street Journal? Who doesn't? It's a non-stop source of comedic content. Take, for example, the Friday, August 7th, front-page article headlined, "France Fights Universal Care's High Cost". The lead example provided by the author, David Gauthier-Villars, of the collapse of the French system--widely acknowledged as the finest health care delivery system in the world--is that a woman named Laure Cuccarolo went into early labor and had to call the local fire brigade to take her to hospital 30 miles away! C'est horrible!! In the United States, these things happen all the time. Thousands of moms have given birth in taxi cabs, subways, apartment bathrooms, etc. Mostly, they're just victims of circumstances, traffic jams, and poor planning. Years later, I bet their kids get a kick out of being told their godfather is a Russian taxi driver. 

The real reason, of course, that the Journal printed this story is not because it has any real news or even feature story value, but because propaganda theory demands such an approach. After all, if you can't attack the best example from the opposition of why its approach makes sense, then you try to tear that example down. Some people will believe it to be true. And, for the propagandist, that's the key:  Not whether something is true or false, but whether it is believable.

I am sure you can add to the list of examples I've provided--and, I wish you would. There is a tinge of gallows humor about all these citations, because we realize instinctively the insidious intent of the authors. Still, it is good to step back and laugh in the face of so much seriousness.

I'm just sayin'.

Let me know your thoughts.

No One Is Willing To Say, "Yes!"

Lots of people say, "No!" to President Obama's proposed healthcare reform package; mostly Republicans, whose entire legislative strategy for this session of Congress can be summed up in that one word. Unfortunately, even some Democrats are saying, "No!", too. Why they are doing this is a mystery, because if Obama's plan fails to be enacted, the Democrats will have handed the next election to the Republicans. 

Even in the contorted realm of political logic, this one defies description. Here's the situation:  the Democrats control both houses of Congress and the White House. Celebrating this outcome the day after the elections, any Democrat--be he yellow dog, blue dog (why do politicians have to have colors for everything?)--would be justified in thinking, "Now we're gonna turn things around and get this country back on its feet!"

But, hey--these are politicians we're talking about. They've got no spine or moral compass. All they care about, regardless of which party they're in, is getting re-elected. Want an example? If you were a U.S. Senator in 2002, knowing then what you know now, would you elect Harry Reid to be your leader? He's a textbook definition of gutless wonder. And Nancy Pelosi in the House? All I'll say is that she's even worse than Reid.

However, they're what we've got to unite the legislative troops behind President Obama's many initiatives, healthcare reform being the most pressing and immediate. We need people who can stand up and say, "Hell, YES! I'm gonna support my President and his programs!" Obama must feel like he's being nibbled to death by ducks. Here he's the head of a party that has all the pieces in place to go out and make real change in this country, to turn it around from the descent into Hell the previous administration engineered over eight years of rule by the foulest, most despicable, inbred, power-mad, war-hungry criminals this country has ever seen.

Even my wife, who is one of the smartest people I know, complains that she doesn't want a plan that takes her tax dollars to subsidize the healthcare of people who are obese and unexercised because they brought on their own health problems, like diabetes and heart failure. She's drunk the Republicans propaganda Kool-Aid, leading her to link this societal problem to Obama's healthcare reform package. THEY'RE MUTUALLY EXCLUSIVE! TWO SEPARATE PROBLEMS! YOU CAN WORK TO FIX THEM BOTH AT THE SAME TIME WITHOUT ANY CROSSOVER!

What do I mean? Obama's plan addresses the three key aspects of healthcare:  coverage, services, delivery. When his plan is enacted--never mind getting true universal coverage, like the rest of the civilized world--yes, fat people and their problems will be covered. BUT, THEY'RE NOT FAT BECAUSE THEY'RE COVERED. THEY'RE COVERED BECAUSE THEY'RE AMERICANS. Two separate problems. Get it?

Let me know your thoughts.

You can't make these names up!

Here's a quote from today's New York Times: "Richard Kronick, a professor at the School of Medicine at the University of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would." A doctor named Kronick--what are the odds?--especially with the topic he researched.

It would be interesting to see his research protocol for this study. After all, beyond the superficial data points that can be known--age, sex, marital status (but, how many times married? I bet not), homeowner or renter, etc.--the information one gathers is squishy at best.

For example, of what illness(es) did each person in the study die? As an example, I'll use my mother. She had kidney failure and was on dialysis three times a week for about six years. She also developed Alzheimer's, gradually and insidiously, over many years. She had pulmonary problems, due at least in part to smoking for about 40 years (she quit for the last 18 years of her life). The list continues: Macular degeneration, cataracts, migraine. But, the cause of death listed on her death certificate is acute aortic stenosis. Yes, she had health insurance, which covered just about every treatment and prescription. The question is: If you put her into your research categories of "Had Insurance" and "Lived to Age . . .", what have you learned? Very little, in my opinion.

This is a point I've mentioned before, but it bears repeating; in fact, this blog is in large part dedicated to hammering on this point until at least a majority of people in this country (and, elsewhere) accept it as valid: The people who make the decisions about your, and my, healthcare options, insurance, and eligibility are people who know the price of everything but the value of nothing. As a society, we have not evolved to the point where the fruits of innovation, discovery, initiative, and concern for the well-being of others are valued much less than the ability to show a profit. Until we do, healthcare--and education, childcare, work opportunities, etc.--will generally go to the people most able to afford them. This is a kind of rationing, which is the topic of the article from which the quote at the outset is taken.

As Damon Runyon once wrote, “The race is not always to the swift, nor the battle to the strong, but that's the way to bet.”

Let me know your thoughts.

We're in trouble . . .

. . . now that Professor Michael Porter published his new book about how to cut health care costs. To his credit, Professor Porter espouses a solution based on the principles that he lives and dies by and teaches to students at the Harvard Business School. But, as soon became clear during an interview on WBUR (an NPR affiliate at Boston University), Professor Porter's solution is a classic ivory tower confabulation having no relationship with the realities of health insurance and delivery of health care services.

His solution? Let's change the way we pay health care providers for their services. Instead of paying a fee for service, which we do now, Professor Porter proposes to pay physicians and others based on health care service outcomes. On the surface, this might seem to be reasonable. After all, when you take your car in to be repaired, you get a warranty on the work performed. Bring it back within the warranty period if anything specific to the repair goes wrong, and they'll fix it for free. Closer to the topic, a patient, or whoever is responsible for issuing payment, might determine that it took little Johnny three weeks to get over his cold rather than the "normal" recovery time of seven days. As a result, Johnny's pediatrician would be paid less. If little Johnny has a relapse (how do we know it's the same cold?), the doctor might receive no payment because of the unsatisfactory result of his treatments.

This is about as logical as Broadway Danny Rose saying to his paramour, when she tells him bad guys shot her ex-boyfriend through the eyes, "Oh, my god, he's blind!" "No, you idiot," she retorts, "he's dead!!"

A medical example might make this more apparent. Say you have a hernia repaired. How long does the doctor have to wait before h/she is paid? Well, if it's done laparoscopically, you walk out of the hospital the same day--the so-called outpatient procedure--and recuperate at home for 10 days-two weeks before resuming normal activities. If it's done with an incision, there's a two-day hospital stay, followed by six weeks of recuperation, during which you can't lift anything. Regardless of which kind of repair is done, any surgeon, if you ask (most patients do not), will tell you that the real test of a surgical repair comes 10 years after the repair. If it's still solid after all that time, you can think of yourself as "cured". Does the doctor have to wait 10 years to get paid?

Or, suppose you break a leg. Dr. Porter and a fair number of other folks with, as my father used to say, "more nerve than brains," will tell you that market forces will determine the path to the most cost-efficient solution to the problem. In other words, much as if you were buying a refrigerator or a computer, you will compare prices, brands, customer experiences, and other things that will lead to a wise purchase.

But, wait a minute! YOU HAVE A BROKEN LEG! YOU ARE IN PAIN! PERHAPS YOU CAN SEE THE BONE COMING THROUGH THE SKIN--A COMPOUND FRACTURE!! You are not going to shop around for the best price for treatment. You are about to go into shock. You must get to the nearest hospital STAT! "I don't care! Just end the pain", you tell the emergency room people as they track down the orthopaedic surgeon on call.

In that scenario, who will evaluate the doctor? On what basis will the evaluation be performed? Did you remember to ask the doctor about his warranty policy? It should be clear by now that Professor Porter and that tribe of business-oriented, cookie-cutter solution-loving people he represents--those who know the price of everything but the value of nothing--offer loopy approaches to problems that can't be measured or contained. They are squishy and fluid, not solid and of fixed shape.

So, avoid the trouble this kind of approach brings. Everybody knows the real solutions to the problem: single-payer, universal coverage, cradle-to-grave coverage. Demonstrating that they will do the job and contain the costs is the next real challenge.

Let me know your thoughts.

An adage I like says,"The good surgeons cut quick." Well, this country needs a good surgeon--it would be a great addition to the duties of Surgeon General--who will amputate the dead parts of our current health care system and put in place the solution all Americans know deep down we need. The rest of the civilized world already has a variant of this health care solution, so their rulers and citizens have some standing when they shake their heads and marvel at how we screwed our system up. Here's an example, one among many I could cite, that illustrates just how contrarily our system operates. I spoke with a woman I know who said she works at a major cancer treatment facility in Boston. When I asked her what she did there, she said she helps cancer patients navigate the health care system: Where to go to get the best deal on their prescriptions, how to understand the labyrinthine requirements of their health insurance(s), why their coverage no longer is in effect, and all the other things someone in the grip of an American medical empire has to deal with. She would be out of a job in France, The Netherlands, Denmark, Cuba, Mexico, England, and many other countries. Why? Because the governments and citizens of these countries long ago embraced the concept that, in return for allowing an elected group to rule, the rulers had to provide many things for the common welfare; among them, health care for all. They look at America and think we are crazy. When it comes to health care, they are right. http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/06/15/a_singular_solution_for_healthcare/

This article states the case for single-payer health care simply and eloquently. Read it and you will begin to understand what could be ours, if only we would stand up and fight for it.

Today's Wall Street Journal carried a story about small businesses dropping the healthcare coverage they offer employees. The president of one company, a metal fabrication firm in Texas, felt terrible about taking this action, not least because one of her employees is being treated for prostate cancer. This means he still has cancer, still needs treatment, but, thanks to the current economic situation in the United States and the fact that health insurance premiums continue to "rise" (whatever the reasons), this poor fellow now has no way to pay for treatment. This got me to thinking:  Why do health insurance, delivery, and care costs rise, and why are these increases taken for granted as an article of faith?

First, consider that while rising health care costs affect many countries, we are unique in one respect:  In all industrialized countries in the world--except the United States--the situation described above would never arise. In fact, the rest of the civilized world considers such a situation barbaric because it means that the state is willing to allow someone to suffer and/or die because he can't pay for something. That's because the compact between their governments and peoples implicitly assumes and explicitly states that (a) the people agree to cede power and a large part of their income to the state; (b) in return, the state agrees to act in the best interests of all citizens (and, often, non-citizens) by providing for the common defense, education, employment, retirement, delivery of health care, and administration of all of these areas.

Our compact covers all these areas, too, but with one key difference:  The United States is the only country in the world where citizens receive health care based on whether they can pay for it at the time they need it rather than as a right of citizenship and common human decency.

So, the question remains:  Why do these costs rise continuously, annually, and, seemingly, inevitably? I look to you folks to help me find the answer(s). After all, this is a subject that affects everyone in America. I look forward to your posts, especially your explanations. Everybody has strong feelings about the current system, but not everyone can posit an explanation. Even fewer can offer solutions. But, together, we can--indeed, we MUST--figure these things out.