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.
Sunday, June 21, 2009
Saturday, June 6, 2009
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.
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.
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