So how do I solve my dilemma of motivation and focus? By hanging out with my wife and writing on my blog, of course. But let me confess: I may or may not have spent the majority of my not-at-school-time today running the gauntlet of online assignments so all is not lost.
To add to one of my many methods of getting myself refocused and recognizing that there is more to medicine than alveolar gas exchange I offer you, my faithful reader, a question and open forum to speak your opinion. What is your opinion of medicine and healthcare? What's wrong? What's right? What should be done?
I've found myself slightly frustrated and perplexed at others' views of the current state of healthcare in our country and what is or is not being done to remedy any problems. I can't help but wonder, as I think everyone should, if I've become too closed off and set in my ways (or, let me be real, if I need to do a better job of articulating my point and its obvious truth to others).
I've found myself slightly frustrated and perplexed at others' views of the current state of healthcare in our country and what is or is not being done to remedy any problems. I can't help but wonder, as I think everyone should, if I've become too closed off and set in my ways (or, let me be real, if I need to do a better job of articulating my point and its obvious truth to others).
So let me have it. I'll read them all, mull it over, and post my thoughts/summary/response after a couple of days.
Until next time.
Until next time.
11 comments:
Our health care system is busted, no doubt about it. It's old, bloated, and needs to be reorganized and trimmed. No question about that.
The issue is the time in which to revamp it. Democrats want to do it yesterday. It's a political game for them, and they want it done so they can pad their resumes.
What SHOULD happen, on the other hand, is a more deliberate, thought-out process. In other words, SLOW DOWN, Washington. We don't "need this done now," Obama. You've played that card too much already. For something as massive as revamping our health care system, we need to slow down and come up with an option that is a good balance and compromise.
It is, after all, affecting everyone in this nation. Not just the deaf Democrats in power.
I wasn't planning on entering the discussion, but it seems like Glen Beck posted so someone needs to say something logical.
Americans are behind Europeans in terms of education, environmental sustainability, and (generally) health care and we need to do SOMETHING.
In terms of education: I was not a fan of "No Child Left Behind" as a system to fix education, but it was AN idea. It moved toward a positive goal and most schools found ways to cope and maybe make some positive changes.
Similarly, Health care is made up of independent, yet connected, people with a multifaceted, yet basic, goal: improve quality of life. If this legislation allows some Americans a higher quality of life, but is an imperfect plan, it is worth it.
As a teacher, I bitched and moaned about "NCLB" but I can't determine its validity in the short term because the lives that the bill may affect positively. Likewise, a health care bill giving tax dollars to people with preexisting conditions or other marginalized cases cannot be judged by how much or little the government spends, but on the lives it may save or improve.
Honest opinion: we should not provide "death care" or "slob care". That would change everything. Bonus opinion: focus on and reward people for wellness.
I attended a health care forum hosted by Bob Dole at the Dole Institute. It brought people from various parts of the health care industry (except insurance – that guy didn't show up, and apparently they rarely do). All I remember is that somebody – some expert – quoted a stat that something like 80% of health care costs for a patient's last stay (or maybe all stays?) comes in the last 3 weeks. That's death care, and I don't want to put my buck behind it.
If you don't take reasonable measures to be well, then I don't want to pay for your care. I don't know what those measures need to be, but they should probably be few and straight-forward. "Vegetables" comes to mind. "Corn syrup" comes to mind. Most importantly, they need to be auditable; it should be inexpensive and objective to determine if the guidelines have been met. Too many people develop chronic illness from their lifestyle and then that raises my costs. That's slob care, and I'm ag'in' it.
The government should either compete with, strictly regulate, or obsolete insurance companies. My suggestions above apply in the first two options. I don't know how to obsolete it.
Insurance companies manage risk by randomly pooling its subscribers to disperse costs. That's the origin of employer-provided care; the employer is an easy and (usually) effective way to randomly pool people. I think that model is over-simplified. Insurance costs should be hierarchical based on how healthy I am, right now (yearly re-appraisal?), according to my doctor. This appraisal should not include my medical history – just my current health and the results of that audit I mentioned above.
Primary care physicians should be paid more than specialists. Sure, specialists paid more for their education and are favored by supply-and-demand and such, but this is mucking up the system. It's upside down: specialists have the least contribution to a society's health, and yet they are rewarded the most. GPs are the front-line and need to be treated as such. Their clients-per-day are like students in a classroom and need to be minimized so they can receive the attention and advice needed for wellness.
Basically: reward people for a healthy lifestyle, punish them for an unhealthy lifestyle – deal with it libertarians, if you want insurance. Change the payment/appreciation of GPs versus specialists to reflect that emphasis on wellness. Make a regular check-up more viable and less expensive. Most radically: don't spend tons of money treating dying people or people with extremely rare diseases – it's just not as useful for the society, nor fair to the other people in that risk pool.
Also, reform in the insurance and medical services industries will have non-trivial consequences for any intimately related industries, including pharmaceuticals. Someone needs to research drugs, but that business-model is currently as messed up as the RIAA – it's all about intellectual property, baby.
(You asked for it.)
Wow, did you get 3 different opinions or what? I find myself agreeing with bits of each, but I don't have a solution. I don't think that their is a solution. There are going to be pros and cons to everything/anything that is decided. People hate change, for the better or for the worse. I have to say that overall, I agree with Tyler.
I don't know what to do, but I do know that it's absolutely ridiculous that healthcare and prescriptions costs so much. It's ridiculous that those of us with pre-existing conditions, even those that couldn't help it, even those conditions that don't increase a cancer risk, are un-insurable. If we didn't have a good health insurance through Ron's work, I wouldn't be able to have insurance. BCBS denied me twice because of endometriosis. It's endo, not cancer, not some life-threating disease. Now I'm covered through Ron and they still won't cover my meds.
It's ridiculous how much our health care system is ran by drug companies. But it's equally ridiculous to think that it can be fixed overnight. There are going to be kinks and flaws, there are going to be unhappy people. That's life. But a new system that saves lives? that's what I'm for.
Lol, was that Glenn Beck commented leveled at me? I don't know what the solution is. I only think that Obama's tactic of "we must pass everything now, no questions asked" is dishonest and insulting.
How is that illogical? How is wanting to take the time to figure this out illogical?
Doctor Proctor,
I'm gonna approach this from somewhat of a design angle because that's what I'm most familiar with.
I don't have a very in depth understanding of what is going on with medical reform here in the US or in other countries.
I don't think the government should have access to medical records.
I don't think the government should have the right to determine, based on set criteria and yes/no symptom checksheets, whether or not an individual receives medical care or not.
Those are just my opinions though, offered with, as before stated, very little understanding of the present situation.
I do agree with Mr. Sommerville, a.k.a. Glenn Beck, when he says that the government needs to slow down when developing a new system of health care. (Quite often poor designs are produced because those working on them did not take the time to sit back and consider the long term repercussions of the decisions they were making.) They need to stop talking, sit down and really think about all the aspects and possible scenarios so as not to create yet another piece of legislature riddled with holes which ends up being more of a burden to the people than a blessing.
In my classes, it is constantly stressed that the majority of products designed in a given year fail miserably due to poor design. Quite often, this failure is due to a lack of consideration for the user during the design process.
Designers come up with an idea, develop it and then put it onto the market, quite often without even considering how easily it will interact with those who actually use it on a day-to-day basis. The designers are designing for themselves, not for the people who will use their design. That's the problem, if you're designing something for your own fulfillment and with only you in mind, odds are it'll work great for you while leaving the majority of people who interact with it wondering what the hell you were thinking.
To Be Continued...
Too often it seems politicians forget about the people who live outside the marble halls in which they sit, making decisions and pushing for new laws and legislation which seem right or logical to them and which they personally are very passionate about but which do not necessarily benefit the public. There's nothing wrong with being passionate about something you believe, but ultimately, politicians should be servants of the people, servants of those who have selected them as representatives. So, when they go into their rooms with high vaulted ceilings, beautiful colonial style wood furniture and classical paintings, they are doing so because we elected them to be there and therefore elected them to make decisions not necessarily based on their goals and ambitions but based on our situation and needs.
It is their job to view the current national and global situation from every possible angle. It is their job to make sense of things and then approach the problem with the goal of improving the lives of those they serve.
Health care is a huge issue. An issue for which no solution will please everyone. However, much like a design, it is an issue which has problems, foreseen roadblocks, stumblings, pitfalls and challenges. It is also a system which has millions of users. Good designs are carried out from beginning to end with the user's well being in mind, not the designer's wants and desires.
To Mr. Frisby, I say, do unto others as you would have done unto you.
To the politicians of this country, the servants of the people, I say:
Drop the agendas.
Know the people.
Understand the situation completely.
Make sense of things.
Revamp the healthcare of this staggering country for the fulfillment and benefit of the majority (the people) not the minority (the government).
Products designed without adequate consideration for users fail.
Legislation passed without adequate consideration for the people fails.
That's my two cents. Take it for what it is: the musings of a design student with practically no understanding of this whole health care issue... but with musings none the less.
I am going to start by saying this is going to be a long comment. The most important thing I have to say is that I am a primary consumer of the health care system, and because of this, I think I have a lot of stake in this debate. I have biliary atresia (which you might already know Matt), a pediatric liver disease that affects 1 in 20,000 children. There is a surgical procedure, known as the Kasai procedure, that can help elongate the child’s ability to have his/her own liver, but most children either die, from not being diagnosed soon enough (the symptoms are similar to baby jaundice), or have a liver transplant young in their life. Most adults who are my age do not have their own livers. This makes me a medical rarity. Because of the excellent STUDENT health care that my parents had when my dad was a graduate student, the price of the surgery and massive hospitalizations I went through cost only this: the price of the booties my mother bought in the hospital gift store. Amazing to see how health care has changed in the last 22 years (and not for the better).
My medical bills run about $29,000 every time I go to the hospital, which is about 1-2x a year. I have many suggestions about how to change the health care system, starting with the fact that I think it should be free (through the increase of taxes, which benefits all, because honestly, anyone can get sick at anytime). However, idealistic as I am, I realize that this is probably never going to happen in the US, because another great stakeholder, the insurance/pharmaceutical companies make money. I, as a patient, and a social work student, will never make money, just spend health care monies. No difference that the work I will do and am doing is changing the world (I digress).
I would like to state some of the things I would like to see (would like to DEMAND to see) change in health care ASAP.
1) Pre-diagnosed conditions/major disease diagnosed later in life should be covered. Isn’t that the point of health care? I am dropped from my parent’s health care in April. At that time, because my parents are part of group insurance, I will have the “luxury” of going on COBRA, the unemployed health insurance, for 18 months, which is $500/month. After this, if I become too sick to have a job, or get a job that does not provide group insurance, I will have to go into the high-risk insurance pool, which is $14,000/year. No biggie, right. It’s not as if that’s more than I pay for a year of college. Ridiculous.
2) Deductibles/insurance charges should be appropriate and affordable. The way insurance charges now, even people who CAN pay for it, are having a hard time affording it. On expensive medicines, my insurance only pays 40%. That means, if I have a med that’s $500 (which I’ve had), I still have to pay $300 out of pocket. That is obscene. To coincide with this, insurance companies should be severely regulated, especially in the billing departments. Hospitals can choose to bill something however they want, and depending on this, insurance can choose to pay whatever they want. This is how an ordinary lab draw suddenly becomes outpatient surgery (trust me this has happened). Insurance providers need to be open and clear with their clients about prices, and both hospitals and insurance providers need to have a regulated pricing schedule. No surprises and no making bullshit income off other peoples’ misery.
3) Moreover, on the regulation, insurance companies need to stop being so awful. My current insurance requires me to not only make sure that the hospital/doctor’s office is covered by my insurance, but also ANY practitioner that touches me is covered (including surgeons, anesthesiologists, and nurses). I’ve had situations where everyone in a surgical procedure has been covered except a nurse (we checked before hand), and the insurance didn’t want to pay for ANY of the surgery. That’s appalling. If the building/agency is covered, everyone in that agency should be covered. And stop doing bullshit like “lab cards” where you can only go to certain labs, or certain doctors. That’s what so many people are afraid of with government run insurance, but most insurance already do this. Insurance companies make staying alive a hassle.
4) I want to reply to a comment below, written by Nicolas Frisby, which I found a little disturbing.
First: “Primary care physicians should be paid more than specialists. Sure, specialists paid more for their education and are favored by supply-and-demand and such, but this is mucking up the system. It’s upside down: specialists have the least contribution to a society’s health, and yet they are rewarded the most.”
I think that’s easy to say if you’re mostly healthy. When it comes down to it, my primary care physician isn’t going to save my life. I hardly see my primary/general practitioner, but see my specialist frequently. The only people who have saved my life, and made it so I am almost 23 and have my own liver have been excellent GI specialists, and they SHOULD deserve extra pay. THEY KEEP PEOPLE ALIVE. And isn’t health care to the benefits of those who are sick, not those who are healthy?
Second: “Most radically: don’t spend tons of money treating dying people or people with extremely rare diseases – it’s just not as useful for the society, nor fair to the other people in that risk pool.”
That’s super offensive. The purpose of health care is to keep everyone alive. If they had this mentality a century ago, how many people would have made it now? How many diseases would they have said were too “rare” and never would be cured? I have an extremely rare disease, and money should be spent. Health care is for those who are SICK. Thus, those who are sick, even if they are sick with something rare, should be helped, and money should be spent on them.
Okay, that’s all I have to say for now. I might come back to this. Please post any comments or questions you might have. I’d love to hear from you.
Please read my blog for more info about me: http://mchakrabarti.wordpress.com
Also,
This is a wonderful article by Paul Krugman for the New York Times about health care reform. I highly suggest you check the link out. Here’s a tidbit to get you excited:
"Finally, some Democrats want to just give up on the whole thing.
That would be an act of utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care — remember, both houses of Congress have already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual.
And anyway, politics is supposed to be about achieving something more than your own re-election. America desperately needs health care reform; it would be a betrayal of trust if Democrats fold simply because they hope (wrongly) that this would slightly reduce their losses in the midterm elections.
---
Bear in mind that the horrors of health insurance — outrageous premiums, coverage denied to those who need it most and dropped when you actually get sick — will get only worse if reform fails, and insurance companies know that they’re off the hook. And voters will blame politicians who, when they had a chance to do something, made excuses instead.
Ladies and gentlemen, the nation is waiting. Stop whining, and do what needs to be done."
Please read more here:
http://www.nytimes.com/2010/01/22/opinion/22krugman.html
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