TIme Magazine Health Care Excerpt

I like this. Why, because it is proactive and logical. The system we are running now by expanding health care coverage is a bit like helping hunger by giving everyone a twinkie. Unless we think about what the real costs are we can't find an effecient solution to achieving our goal of improving the health of the american people, and therefore, in many ways not extending care (I mean checkups nonewithstanding) but reducing it.

The Link: http://www.time.com/time/nation/article/0,8599,1902708-4,00.html

The Author: Karen Tumulty Friday, Jun. 05, 2009

The Excerpt:

"5. How will we bring down costs?
The problem with American health care, those who have studied the system will tell you, is not that we get too little care but that we use too much. By some estimates, as much as 30 cents of every health-care dollar is spent on medical treatment that is unnecessary, ineffective, duplicative or even harmful. Changing all that is going to require revamping health care from top to bottom, starting with the way health-care providers are reimbursed. While the current system pays them for the amount of care they provide, real reform would put more emphasis on the quality of that care and the outcomes it achieves.

If there is an ideal out there, Baucus says, it can be seen in the kind of medicine already being practiced by Kaiser Permanente, the Mayo Clinic, Intermountain Healthcare and Geisinger Health System, which manage to hold down costs and get better results. Their operations have fostered closer teamwork among care providers. Also important will be electronic record-keeping that saves time and avoids errors, and comparative-effectiveness research that gives doctors and patients a better sense of which treatments work best. And a reformed health-care system would put more emphasis on preventive care and managing such chronic conditions as asthma, heart disease and diabetes that now account for 75 cents out of every medical dollar spent."

Excusing the Elderly

I used to excuse the elderly their prejudice as the last of a dying breed, hardened by years when any critical thinking (however un-applied) had peaked and been solidified by its decline and perpetuated by either habit or a sense of comfort in a changing world. Yet today after reading the news of the 88 year old white supremacist (i would say ethnic supremacist) who opened fire and killed a security guard at the DC holocaust memorial, I realize prejudice is serious and inexcusable at any age. While the battles to open a mind may be more hard won, they are necessary and cannot be ignored. I am shocked by what people do with guns and the power with which they give over to the weapon. It is a weak human that crutches the gun, and a sick one who shoots it, but I lived in my own delusion that with age came a reinstatement of innocence, (or at least a harmless arrogance that passed for it). My deepest sympathies for the guard and his family. I am forever grateful to his commitment to freedom, expressed in his committed defense. It is strange that holocaust deniers who like to claim horrific acts against the minority never occurred make their claim with a horrific act against the same minority. But then if reason were ever applied to violence there would be none. So we as a people still have much more to teach.

Do-Gooder Doctors?

An article in the Sunday Washington Post yesterday (May 31,2009) by Harlan Krumholtz discussed how more doctors are likely to report turning to medicine for job stability than to fulfill a need to "do-good" and help people. The author goes on to report that doctors in job interviews now look for opportunities to have time to go to a child's soccer game and he reports that a survey asking if doctor's would be willing to work more hours even for more money received few affirmative responses.

I may be missing the boat here, but that seems like nothing to complain about at all. It seems that more doctors each focused on fewer hours would prevent burnout and delay the glossing over of one's eyes from seeing too many patients and problems in a day, month, year. It would allow different perspectives and opinions into the hospitals and clinics, so a patient could perhaps easily seek two great minds instead of one, for what is to them their ultimate concern of their health. It also seems to me, that greater social networking of doctors with society in their free time may enhance their empathy. Even the author of the post article, had framed the discussion the in context of a friend seeking medical advice. Perhaps if doctors engage in their children's schools, community picnics or recreational activities they will come into contact with more of those real world problems in people that inspire their work and put a face with a diagnosis.

I ought to note that the article did not focus on these points above for long and overall brought to bare a great discussion on accountability measures for doctors and hospitals. It suggested that by collecting and reporting on patient data/doctor success we would allow patients to choose based on quality care, which is how we are accustomed to choosing even the most trivial things like hair cuts. So there is no need to be left high and dry when trying to choose in whose hands to place our safety. Accountability is the way to discover which successful practices to propagate and which failing practices to abort, it is the way to progress to a stronger medical system, and yet he notes, there is little incentive to become accountable. The article itself is insightful and important and by nitpicking my few points, I don't mean to appear to disagree.

I guess it's just after seeing how hard my do-gooder doctor friends work in their fields, that I need to suggest a more sensitive system to them as people. As their happiness and health, like an another, should not be disregarded lightly.

Pirates

NPR says the somali pirates do it out of necessity, as they have no other work, so one of the options was to recruit these people as paid members of a coast guard, impressive way to think outside the box!

Flu Stuff

Some author/ historian (John Berry - the Great Influenza) on NPR today (May 5th) talking about the 1918 flu claims that the government tried to hide the epidemic to keep up moral for the war effort - that once people were lied to they had no trust, to the point where fear kept neighbors from bringing each other food in cities and rural areas and some died from starving to death. It is these messages of history that can teach us more in a moment that without record we could perhaps ever understand in a lifetime. Let us study history to learn why we value truth!

Supreme Choices

Here's one on the appointee for Justice Souter's Supreme court seat (too bad my 3 hour wait on the steps of the Court last tuesday didn't earn me a seconds viewing time at the last of these 9 together...)From the Washington Post article (Sunday May 3rd) by Christina Boyd - Washington U, and Lee Epstein - Northwestern Law, "When Women Rule, It Makes a Difference"

"In research that we conducted with our colleague Andrew D. Martin, we studied the votes of federal court of appeals judges in many areas of the law, from environmental cases to capital punishment and sex discrimination. For the most part, we found no difference in the voting patterns of male and female judges, except when it comes to sex discrimination cases. There, we found that female judges are approximately 10 percent more likely to rule in favor of the party bringing the discrimination claim. We also found that the presence of a female judge causes male judges to vote differently. When male and female judges serve together to decide a sex discrimination case, the male judges are nearly 15 percent more likely to rule in favor of the party alleging discrimination than when they sit with male judges only. This holds true even after we account for judges' ideological leanings."

The Interdisciplinary Approach

In college I was a major advocate for the interdisciplinary approach. It is silly to believe life acts in the same isolation as a college major. In studying economics we did not stoop to consider human behavior or psychology, in studying public speaking we did not discourse on the morality of truth and deception, in political science we did not discuss natural resources.

I remember trying to work out with my school administration a program that would take a current events topic and present it before a panel of academics from various disciplines so they could offer a picture of how their like-minded peers would see the problem and then broaden the discussion to how those of the panel working in a cross-disciplinary manner could brainstorm a solution. I graduated before the project went anywhere.

Today I read an article where a professor suggested grad school become more interdisciplinary with students taking on a more broad and inclusive focus for their studies. Funny how I can admire an interdisciplinary approach to problem solving, yet I still hold to the value of specialization. In our current world we have an abundance of information, to expect each person to specialize in it all is unrealistic. I do not mind human beings splitting up the work to focus on parts. There is a certain fear that in looking at too small a piece of a picture you cannot find a real solution, the same way NASA has outsources pieces of its shuttles only to bring them all together to find it cannot make a working rocket. But as humans, I think we can be privy to coordination and specialization, I like to call the plan "society by posse".

If we can aggregate groups of experts targeted to specific problems with the open-mindedness to respect each others professional expertise, we can still have people with finely detailed knowledge but an overall collective which can problem solve towards the big picture. I think the National Science Foundation in its reports does a good job of this type of aggregation. It is just like I envisioned back in college. We do not need people to become generalists, we need people to communicate and coordinate, but that comes with certain costs arising from the difficulty of organization and as such must be arranged by an outside source. So those who don't want to specialize can be among the big picture generalists who aggregate specialists.

So, I have to disagree with the author of the article who wants all graduate education to become broad. After all it was a woman collecting the cute little pterapods of the sea for some completely unrelated scientific experiment who noticed they were all killed in transport due to the acidification of the small container's water with the output of their own CO2. It was she who in reporting that occurrance discovered how current CO2 emissions could acidify the ocean to the point where these creatures, the food base for the whole food chain of the sea would disappear. And that's just one of the many examples of how a focused and seemingly obscure scientific interest has re-directed the course of knowledge by accident! I simply cannot say if a group of generalists would have been able to discover that at all.