Labor Day Weekend Notes

It's Saturday in Prescott, and we are sitting here, inside, with rain pouring down. With coffee. It's a good day. I hope that your weekend is as good as mine has been so far.

August has come and gone without a health care reform bill. Mostly, that's a good thing. The bills that have been floating through Congress have been monstrosities, keeping all the bad parts of our current system while adding more bad things on top. The demagoguery on both ends of the political spectrum continues to be nauseating, but then that has not changed for at least my lifetime.

My academy, the American Academy of Family Physicians, supports reform that would insure everyone, but I think most of us remain skeptical about the federal bureaucracy doing a better job than private industry has done. An editorial by Hugh Hewitt points out that everyone is being asked to sacrifice for a better health system, except for one group: Trial lawyers. One of the huge drivers of health care cost is the tort system, and if Congress and the President were serious about decreasing costs and using that money to cover everyone else, they would address the problem of the costs of liability suits in our country.

I suspect we'll see that problem addressed by our legislators right after a flock of pigs fly over the White House. In formation. Going south for the winter.

In the past few weeks, the incoming head of the Canadian Medical Association has written in the press that their system is woefully inadequate, and cannot continue on its current course. You can read the article about her statements at:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

She appears in the article to be calling for a private plan alongside the public health system, which I find very interesting. For many years, it has been illegal in Canada for physicians and patients to go outside their public system, so patients have only the American system to get around the waiting times and inefficiencies of their system.

I can't really defend our current system, but when you read in the press about all the bad problems, remember that you need to know the context of the statistics that are used on both sides. Many of them follow the old saw that there are liars, danged liars, and statisticians....

Have a lovely weekend and a marvelous September.

Five More Shopping Months 'Til Christmas...

The month of July is over, and the various other shoes have not yet dropped. No vote, yet, on health care reform in Washington. The bloviators have started telling us family docs that we're going to make more, and the big bad specialists are going to make less. Translation: We'll make less, and they'll make a lot less.

Our various medical societies are signing onto reform with the illusion that they can help shape the legislation by helping to pass it. If history is a faithful guide, then the politicians will use that support until it is too late to reverse the votes, and will then slice those who help them into tiny bits. We never seem to learn.

I have a reform idea in four parts:

1) Make group insurance illegal. The whole concept of employer-based insurance skews the risk in insurance such that it cannot make sense for the whole populace.

2) Use community pricing. By setting fees and prices for insurance locally, there will be local control and local factors that cannot be managed efficiently from Washington.

3) No refusal for pre-existing conditions. This must be done in order to cover the whole public, but it must be combined with:

4) Mandatory purchase. Everyone must buy insurance, no matter what their situation or reasons for not wanting to do so. This spreads the risk over the whole public, not just those who are healthy enough to buy private insurance.

If my program were adopted, it would require no new government programs, other than using part of the IRS to monitor insurance purchase, and possibly a system to help those who really, really can't afford the insurance. Maybe their 'earned income credit' could go to insurers instead of to the individual, to buy a catastrophic coverage insurance at low cost.

Anyhow, I don't have any illusions that reasonable change will occur. Such is my faith in the United States Congress.

Be well, and stay cool....

Late June Musings

Several topics, medical and not, come to mind on the evening of Fathers' Day. First, it was a marvelous day that ended with all my kids and grandkids at the house for a cookout and croquet. They have all left, now, and my hearing may return to normal someday soon. I feel truly blessed to have all of them living close, and willing to come over to humor their dad and granddad.

Second, I think the adults in Washington are awakening and realizing that you can't just say, "Shazamm!" and fix the American medical system. George Will wrote a good column that points out many people who don't have insurance get it within six months or so, and that many choose not to buy insurance when they have both the right and the income to do so. In fact, millions who qualify for Medicaid (AHCCCS in Arizona) don't even sign up, when it would cost them nothing for the privilege. The cost for the program that has been advanced by our President is so large that terms used for it (astonomical, astonishing, gigantic, mind-blowing) seem small and inadequate. I'm concerned that the damage to our medical system if it is adopted would be permanent, without any hope of regaining what we have now.

Third, just for fun, the books I'm reading or that I've read recently:

The Omnivore's Dilemma, by Michael Pollan. The author follows industrial food production, along with 'organic' foods of various types, ending with an exercise in hunting and gathering. I found it delightful, and for the first time in my life have purchased some foods labeled 'organic,' with some understanding of what that means.

unChristian: What a New Generation Thinks about Christianity...and Why It Matters by David Kinnaman. This is a wake-up call for anyone who is part of the established church in America, no matter which denomination or lack thereof he or she belongs to.

Why Evolution is True by Jerry Coyne. The author is a professor of evolutionary genetics, and his is a description of the facts supporting evolution. Whether one believes that evolution happens or not, this is a must-read for those who want to be well-informed on the topic. I think we need to still the rhetoric on this subject, which unnecessarily pits scientists against theologians, when the two sides can be so easily reconciled.

An Inconvenient Book by Glenn Beck. Light reading that is somewhat politically incorrect and definitely from the right side of the political spectrum.

ReThink Your Life by Stan Toler. This is a "mind diet" that can lead a person to deeper understanding of him/herself in the spiritual realm.

William Shakespeare, a Compact Documentary Life by Samuel Schoenbaum. This was just loaned to me by a friend, who promised that it was the definitive work on whether Shakespeare really wrote the plays and sonnets attributed to him.

This list does not include any popular popcorn novels currently in my possession, and there may be others I've forgotten. I'm also getting ready to start The Tipping Point, Malcolm Gladwell's first book. I've already read Blink and Outsiders by the same author, and I heartily recommend anything he writes, past or future.

Well, now I'm ready to start another week, so off to the races. Be well.

Insurance and Medicine for the Future

So far, we don't have much detail about the plans for changing our medical (health care) system. From the liberal side of political discourse, we keep hearing how horrible everything is, and how difficult it will be to make changes, and all of us will have to give up something to make the system work. From the conservative side, we hear how bad socialized medicine will be, that the government-run medical system will be hopelessly expensive and inefficient and that people will die from the reduction in care.

Here's what I know: so far, when the feds say that are going to do something, the result is quite often the opposite of the published purpose, and that they are pretty bad at creating anything of value in our society. When they talk about tinkering with the medical system, I shudder, because they can do so much harm in such a short time. The medical systems in Europe largely act under a socialistic framework, and they make decisions that we in the U. S. find repugnant. For instance, years ago in Great Britain, if a person was over 65 years of age, they could not have cardiac bypass surgery. They were old, the thinking went, and so should go ahead and die. As I understand it, the policy changed eventually, but that sort of mindset would never have made it to the starting point in policy-making for American insurance systems.

I really expect not much to change, because there are powerful forces aligned against such change. Large employers don't want people to be able to get insurance outside their employ, as that lessens their hold on good workers. The insurance industry doesn't want change, as their profits are likely to drop, or they might cease to exist entirely if the feds take over. The pharmaceutical industry does not want change of any sort, because all the plans discussed so far involve reducing cost of medications, and choices of medicines to take. The government is not likely to allow real change because, like it or not, many of the lawmakers owe too much in favors for the support of insurers and drug companies, so even if our president wants change, there will likely be extreme opposition to that change.

If we could just see some real discussions about this without politicians trying to demagogue the issues for their own personal benefit, then I think we could see real change. But we're kept in the dark with pseudofacts and hyperbole, designed to scare people into accepting laws and policies they would never allow if they knew what was really in them. I just hope that we physicians will be able to continue to keep our offices open and to see patients without the feds or insurers getting in the way too much.

More Flu

A week has passed, and the news about the flu is both reassuring and worrisome. The H1N1 virus appears to be no worse than any other seasonal flu, so the fears about a new "super-flu" have receded. It does not appear that we are back in 1918, when millions worldwide died of a new type of influenza.

However, there are as of today (May 10, 2009) 2254 confirmed cases of H1N1 flu in the United States, and the death toll in Mexico has been raised to 48, according to Reuters. That fits with the toll from a seasonal flu, but if this had been a "super-flu," then mortality would no doubt have been much higher. And with this being a new type of flu, it is a trial run for the real thing if (when) it comes along.

Most authorities think that we are overdue for a severe form of flu, by about 20-30 years. The appearance of severe pandemics of influenza has followed a pattern of one about every 30 years, and our last extreme flu was in 1968, when the Hong Kong flu took 70,000 lives in the U. S. Even that epidemic was not as severe as some others, including the Asian flu in the 1957-8. Much of the decrease in severity may be the result of better medical care, better sanitation, and immunization.

One wag on the radio said that there was concern about the swine flu combining with avian flu, such that pigs would indeed fly....

So, if you think you've got the flu, stay home. Watch daytime TV. That alone will be enough to make you love your job when you return to it.

Swine Flu Notes

As you might expect, I've been following the news about the swine flu closely. Here's my take on it: What I hear is 10% fact and 90% hysteria. The H1N1 virus is a new strain of flu, and that is pretty scary. We haven't had a completely new type of influenza that is transmissable between humans for many years. If this one turns out to be an extremely severe form of flu, it could be devastating worldwide. It does seem to be spreading rapidly from state to state and country to country. And influenza kills about 30,000 people in the United States every year, even without a new strain of the virus.

However, the hysterical ramblings of poorly-informed journalists may actually do more harm than good. It appears now that the deaths from swine flu in Mexico total about 7, not 150 as originally reported. Closing most public places, as they have done in Mexico, is certainly an over-reaction. Closing schools where cases have occurred, especially elementary schools, may be reasonable. It's hard to get third-graders to wash their hands every time they touch their noses or cough. But let's get real--This is a virus, not a magical curse. If you are reasonably careful, you are unlikely to either acquire or spread this illness.

As far as vaccines, I do not expect a vaccine before fall. Given the disastrous experience in our nation with the last swine flu scare, I hope that our government will take measured, careful steps that follow the same protocols used for flu vaccines now. During the Ford administration, the federal government caused production of a vaccine that was not fully tested, and the result was a seven-fold increase in neurologic complications (Guillain-Barre Syndrome) for a flu that turned out to be a minor problem. In other words, they over-reacted to a virus that never became a pandemic.

I must say, I never expected to hear the President of the United States to be telling people to wash their hands....

Joining the blogging universe

Becoming part of the blogosphere has been a daunting prospect for me. I don't want to be a boor, or a pedant, too silly or too serious, too personal or too generic, too transparent or too obtuse. But I'm getting too old and cranky to care all that much about others' opinions of me, so I guess I'll just say what I want to say and if you don't like it, you can argue with me or go fly a kite. Come to think of it, flying a kite sounds really fun right now.

I'm intending to include some medical information, largely my opinions on medical topics that may be in the news. I may get onto politics occasionally, as that field impinges on medical matters. I'll probably deflate "alternative medicine" regularly and with feeling. I view "alternative medicine" as an oxymoron, since most of the practices are decidedly nonscientific and anti-medicine.

If you want to comment, please feel free to do so, and I welcome agreement and disagreement alike. If I'm wrong, prove it to me. If you agree with me, tell me why and how it matters to you. Most of all, I hope this will be a fun outlet, and that maybe it will enlighten you, or at least make you think.