I may have a piece published soon about my patient Jorge (not his real name) who I took care of in the Bronx. It deals with issues surrounding parks, the Yankees, green space, and 161st Street.
Stay Tuned!
Wednesday, February 15, 2012
Sunday, August 30, 2009
Sunday, July 19, 2009
Saturday, June 6, 2009
The Long View
It's Saturday. Maybe this is a good time to take the long view of the current healthcare debate.
The conservative revolution, which officially began in 1980 with Reagan's election, is now over. It accomplished many things, some of them good. After the bold experiments of Johnson's Great Society, a little reminder of the power of free-market capitalism was probably not a bad thing.
Over the two decades that conservatives tinkered with our government, their successes and failures became clear. Some areas of the economy thrived with a free-market boost, and others faltered.
It turns out that the free market was bad for healthcare. We kept loosening and loosening, giving the HMOs more and more rope. And guess what they did with it?
During GW Bush's presidency, there was a growing sense of frustration and desperation. These private HMOs were supposed to control costs and streamline delivery. We were supposed to have great care with lower costs.
But the opposite happened. Costs continued to spiral upward, and Americans were still denied care at unacceptable rates.
When your only tool is a hammer, you see nails everywhere. So GW Bush nailed healthcare --- with the free market. He did everything he could to promote private insurance, gave them subsidies, kept them from having to compete. All to promote the private insurance system. And what happened? Still millions of Americans without a doctor, and still sky-high costs.
Which is why today, a majority of Americans support a public health insurance option. We aren't idiots, and we've been paying attention.
So it's time to accept that the free market system just doesn't work in healthcare. I'm not saying this as an ideologue. I'm saying this after watching (and working within) the healthcare system during the 90s and 00s.
Plenty of free-marketeers have come to the same conclusion. Check out this article from Motley Fool, a well-known financial website. The people at Motley Fool are die-hard capitalists, and they argue that a public plan is actually the most capitalist choice.
It would have been nice if things had gotten better when we deregulated healthcare, like in the telecom industry. But they didn't. The opposite happened: costs rose, patients were still denied care, and frustration exploded.
So don't let anyone tell you that this is an ordinary liberal vs conservative debate, because it's not. This is not a battle of ideologies. This is a battle between people who are looking clear-eyed at the past twenty years of healthcare, and people who are clinging to ideology without looking at the world.
The conservative revolution, which officially began in 1980 with Reagan's election, is now over. It accomplished many things, some of them good. After the bold experiments of Johnson's Great Society, a little reminder of the power of free-market capitalism was probably not a bad thing.
Over the two decades that conservatives tinkered with our government, their successes and failures became clear. Some areas of the economy thrived with a free-market boost, and others faltered.
It turns out that the free market was bad for healthcare. We kept loosening and loosening, giving the HMOs more and more rope. And guess what they did with it?
During GW Bush's presidency, there was a growing sense of frustration and desperation. These private HMOs were supposed to control costs and streamline delivery. We were supposed to have great care with lower costs.
But the opposite happened. Costs continued to spiral upward, and Americans were still denied care at unacceptable rates.
When your only tool is a hammer, you see nails everywhere. So GW Bush nailed healthcare --- with the free market. He did everything he could to promote private insurance, gave them subsidies, kept them from having to compete. All to promote the private insurance system. And what happened? Still millions of Americans without a doctor, and still sky-high costs.
Which is why today, a majority of Americans support a public health insurance option. We aren't idiots, and we've been paying attention.
So it's time to accept that the free market system just doesn't work in healthcare. I'm not saying this as an ideologue. I'm saying this after watching (and working within) the healthcare system during the 90s and 00s.
Plenty of free-marketeers have come to the same conclusion. Check out this article from Motley Fool, a well-known financial website. The people at Motley Fool are die-hard capitalists, and they argue that a public plan is actually the most capitalist choice.
It would have been nice if things had gotten better when we deregulated healthcare, like in the telecom industry. But they didn't. The opposite happened: costs rose, patients were still denied care, and frustration exploded.
So don't let anyone tell you that this is an ordinary liberal vs conservative debate, because it's not. This is not a battle of ideologies. This is a battle between people who are looking clear-eyed at the past twenty years of healthcare, and people who are clinging to ideology without looking at the world.
Thursday, June 4, 2009
Why we need an alternative to the AMA
I read an article by Atul Gawande in the New Yorker yesterday that, for me, captures exactly why the National Physicians Alliance is an essential organization at this moment in history.
The author visits regions of the country where healthcare is very expensive, and places where it's very cheap. He hunts for sleazy healthcare executives who are intentionally over-utilizing, but he doesn't find them (or not too many of them). What he does find is lots of doctors:
This is a wake-up call for doctors. Those of us (and I'm looking in the mirror here) who like to blame insurance companies and drug companies for sky-rocketing healthcare costs --- we need to reread that paragraph above. He's absolutely right. We can blame PhRMA for making expensive drugs, but we can't blame them for writing the prescriptions. We can blame HMOs for denying the needed CAT scan, but we can't blame them for ordering the unnecessary scan.
Gawande concludes that all the insurance reforms and public plans will not solve our healthcare problem. Only when medicine returns to a patient-centered focus will we be able to control costs. Changing the culture of the medical profession is not just a lofty goal, it's an economic necessity.
To me, there is no more powerful argument than this for why the National Physicians Alliance exists and must continue to grow. Gawande connects something that even the most hardened conservative cares about --- the growth of healthcare costs --- to something that we all believe, the need to rebuild the covenant between patients and doctors.
I would urge everyone to read this article, or at least the conclusion. His way of framing the subject is the perfect tool to recruit supporters to our cause in general and our organization in particular.
The author visits regions of the country where healthcare is very expensive, and places where it's very cheap. He hunts for sleazy healthcare executives who are intentionally over-utilizing, but he doesn't find them (or not too many of them). What he does find is lots of doctors:
Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.
This is a wake-up call for doctors. Those of us (and I'm looking in the mirror here) who like to blame insurance companies and drug companies for sky-rocketing healthcare costs --- we need to reread that paragraph above. He's absolutely right. We can blame PhRMA for making expensive drugs, but we can't blame them for writing the prescriptions. We can blame HMOs for denying the needed CAT scan, but we can't blame them for ordering the unnecessary scan.
Gawande concludes that all the insurance reforms and public plans will not solve our healthcare problem. Only when medicine returns to a patient-centered focus will we be able to control costs. Changing the culture of the medical profession is not just a lofty goal, it's an economic necessity.
To me, there is no more powerful argument than this for why the National Physicians Alliance exists and must continue to grow. Gawande connects something that even the most hardened conservative cares about --- the growth of healthcare costs --- to something that we all believe, the need to rebuild the covenant between patients and doctors.
I would urge everyone to read this article, or at least the conclusion. His way of framing the subject is the perfect tool to recruit supporters to our cause in general and our organization in particular.
Sunday, May 31, 2009
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