health care reform
palmd | August 24, 2009People who support our current abominable health care system like to cite Canada's supposed failures as an example of what could happen to us. The argument is a non-starter---it's a straw man designed to scare people. We are a very different country, with a different economy and different needs. Even with a single-payer system, we are unlikely to have the exact same successes and failures as the Canadians. Still, the Right has latched on to any lie they can to try to scare us. That's why a recent article from my hometown newspaper is so upsetting.
Any of us who have practiced medicine…
palmd | August 23, 2009I'm really trying to understand this. Really. Why is the outcry against health care reform so much louder than the call for reform? I have a very hard time believing that a majority of people are against some sort of improvement in our system. Around here, people are losing their insurance right and left. But they sometimes seem more scared of reform than of remaining uninsured.
Those of us in favor of a single payer system are shut out of this one. "Medicare for all" is uttered only quietly among well-known co-conspirators. When people who oppose this plan, or even just oppose the…
palmd | August 21, 2009Last night's Daily Show was hands down the best discussion of the health care reform insanity on TV, radio, or web. What interested me the most was how McCaughey revealed some of her real agenda, and how she actually brought up some almost-right points. Even more surprising, Jon Stewart misunderstood some bits that need fleshing out, so here we go.
We've met McCaughey before as the right wing wacko pushing the death panel idea. She does a good job hiding her real agenda for a while with Stewart, insisting on her support for public health care, and for end-of-life discussions. Let's review…
palmd | August 19, 2009In his latest comment, Philip H has accelerated my reluctant discussion of health care reform. In fact, it was Philip who bullied me into writing about this topic in the first place. I've been avoiding wading into this mess, but being on the front line, it's in my face every day.
What he says in his latest comment is this:
[T]he idealogical leap PalMD is asking for is a good one, but it misses the mark. The leap we need to make is that healthcare is not a good, like Cheerios, or cars, or flatscreen tv's, that exists in anything like a free marketplace.
Commenter Donna B. makes a tangent…
palmd | August 18, 2009Once again, I'm sucked into the discussion on health care reform. I despise this topic, because so much of what is wrong with our current system could be fixed relatively easily, if Americans could just take an ideologic leap.
Most of us have heard of "pre-existing condition (PEC)" clauses---those rules that allow insurance companies to deny payment for care based on your previous history. There's a lot of facets to this, and laws vary tremendously (your results may vary). For example, a company may simply refuse to insure you (although some companies don't have that choice, but they can…
palmd | August 17, 2009I had a chance to watch the President take questions at town hall meetings this weekend. He sought out opposing views, and handled them brilliantly, responding to them rather than giving empty answers. He also didn't talk down to the audience. The pity is that the take home message in the news today is that he may abandon his push for a "public option". This would be a grave mistake.
This President is no dummy. He gets this issue. When a citizen asked how private insurers can possibly compete with a government plan, he responded in great detail, explaining how changes need to be phased…
palmd | August 15, 2009This is, of course, an absurd question. Getting all 300 million of us to agree on this isn't going to be easy. But a parody circulating on the internet shows how misunderstood we Americans can be.
National social programs are relatively new in the States---Medicare, the plan that gives medical care to those over 65, is only forty years old. Social security, the national pension plan for people who have worked legally for a wage, is about sixty years old. Welfare programs for the poor are often tolerated at arm's length with the nose held.
But while many view these programs with disdain or…
ddobbs | August 11, 2009Massive feature finished, should be in print this November ... but more on that later. By way of returning to blogdom, a few of the few notables I've had time to read lately:
Effect Measure, usually quite restrained about predictions, joins quite a few others in predicting the swine flu will hit us pretty hard this fall. (The U.S. has already had 6,506 hospitalized cases and 436 deaths, despite it not being flu season. And while we've been tracking health-care debacles debates and pondering Palin, the flu has been hitting the southern hemisphere pretty hard.) Now, not later, when you're sick…
palmd | August 10, 2009The Right likes to hold up Sarah Palin as a beacon of morality and virtue in an irredeemably corrupt world. But with her latest words, she has shown herself to be either an immoral, lying sack of crap, or severely cognitively impaired.
And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether…
palmd | August 6, 2009A short while ago I wrote about a fear-mongering piece in the Wall Street Journal, written by Betsy McCaughey. It turns out that my imagination was insufficient to comprehend the scope of her audacious mendacity. McCaughey is one of the thugs pushing the lie that the health care reform bill would mandate euthanasia counseling. Her deceitful comments were picked up by Rush Limbaugh and others, and spread across the wackosphere. So what did she say?
The health care reform bill "would make it mandatory -- absolutely require -- that every five years people in Medicare have a required…
palmd | July 30, 2009You can count on the Wall Street Journal for pretty good reporting and for extremist right-wing wackaloonery on the OpEd page. Today, they deliver the latter, with bonus fear-mongering at no extra charge.
The piece is entitled, "GovermentCare's Assault on Seniors" and that pretty much sums up the content of the article. Unfortunately (at least, for the moral health of the author), there is little below the headline to justify the inflammatory headline.
Setting aside the oxymoronic tone that simultaneously lauds Medicare and condemns government involvement, the piece is one big mendacious…
palmd | July 30, 2009OK, in parts I and II we talked about health care problems specific to patients and to medical science. Now, on to the providers themselves. Before you start whining about how doctors need to suck it up, remember that you are entrusting your lives to us, and that you should want good people to go into medicine and stay there.
Physician-related problems
Medical education: It is long and very costly. In the U.S., we do not follow a vocational model as many other countries do. Here you must complete a four-year university degree, a four-year medical degree, and a residency program (at…
palmd | July 29, 2009In part I, I presented you wish some admittedly artificial categories of problems in our health care system. First we discussed patient-centered problems. Today, we'll look at problems posed by medical science and practice itself.
Medical science
The science of medicine is not always compatible with the practice of medicine. Medicine is still largely a cottage industry, with hard-working, independent practitioners working in small or medium-sized practices. Aside from licensing statutes, there are no official guidelines that doctors must follow to be officially "certified". Once a…
palmd | July 28, 2009Yes, I know, the two are not mutually exclusive, but I still think it's a good title. The latest bit of evil idiocy? More fanning of fears about health care reform. Don't misunderstand, there's plenty of potential pitfalls to health care reform, but Rush is an idiot. He calls it "Five Freedoms You'll Lose Under Obamacare". Let's see what he's talking about.
I'll let you in on his absurdist intro just for the fun of it:
One of the best points that anybody could make in describing the uniqueness and greatness of this country, do you realize that the history of the world is tyranny? The…
palmd | July 28, 2009I know only one certainty regarding health care reform in the US: I won't be a significant policy maker. And neither, likely, will you. But that doesn't mean we shouldn't educate ourselves, try to understand the problems and potential solutions, because whatever our government implements over the next year, health care reform is going to be a process, rather than a single, achievable endpoint.
I've been consciously avoiding writing this piece, but people keep bugging me. One of the reasons I've avoided it is because I'm not a policy expert, and I don't want to do the extensive research…
palmd | July 26, 2009Lawmakers and the public in general have no idea how the business and practice of medicine operates. None. When you read statements from many representatives, you see such simplistic, anhistoric thinking that pessimism about health care reform is the only logical response.
Or so it seems from media reports. The New York Times, whose quality seems to be dropping by the femtosecond, reported this week on salaried vs. traditionally paid physicians. This could have been a terrific article, if the reporter knew anything.
Let me catch you up a bit. Doctors are generally paid in one of two ways…
palmd | July 14, 2009I've got a lot of patients who are worried about health care reform. Most of it is expressed in right-wing radio talking points. They quite literally believe that they will no longer be able to choose their doctor, or that other doom and gloom events are imminent.
Have they no experience with government? Health care reform isn't going to happen quickly. When it does, it will likely have an American character. While socialized medicine works very well in some other countries, Americans just aren't into it, even if it were to work. Whatever I may think about it, it's a non-starter.…
ddobbs | July 4, 2009In case you missed them (or miss them, and want to read again ...)
The (Illusory) Rise and Fall of the "Depression Gene"
DIY circumcision with nail clippers Go figure.
Oliver Sacks meets Jon Stewart
Wheels come off psychiatric manual; APA blames road conditions
Alarming climate change chart of the day
Swine flu count in US hits 1 million; can't wait till flu season!
Will government involvement drive up health-care costs?
What if you could predict PTSD in combat troops? Oh, who cares...
ddobbs | July 3, 2009It's been 26 years since health-care reform failed. Does the debate reflect anything that's happened since?
From The Columbia Journalism Review:"The idea that we've made a great breakthrough just isn't so," says Jonathan Oberlander, a health-policy expert at the University of North Carolina. "Most of the plans today are direct descendants of what was proposed for the '93-'94 debate. The debate reminds me of one of my favorite movies, Groundhog Day.
With few exceptions, like the fine series last summer by NPR that explained how a number of other countries handle health care, the press has…
ddobbs | July 3, 2009Opponents of a public health-insurance plan pose two main objections: that it will create an 'unlevel playing field' that will harm the private market for insurance (an odd objection, since that playing field already tilts quite sharply away from patients' pockets and health and toward the wallets of the health-insurance industry); and that government involvement will raise costs.
These objections seem to hold sway to the degree we limit our discussion to what already exists in the U.S. As with squabbles about the problems with our educational (non)system, the picture gets clearer if we…