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mallorys_cameraStayed too long w/the erstwhile Terri Gordon in Evanston. By the time I finally hit Minnesota Sunday, it was nine o’clock at night, the sun was setting. Possibly the most beautiful sunset I have ever seen: some trick of the upper latitudes made the sky seem convex; microscopic ash from a volcano eruption in the faraway Philippines bent the dying light into a magenta dome.
As soon as it grew dark, I got lost. Naturally. I have no sense of direction and a basic distrust of maps – I mean, what if “they” are trying to confuse me by falsifying the documentation, huh? Ya ever think of that?
So I drove around the black country roads of rural Minnesota for close to four hours, amusing myself by thinking up new titles to add to the great John Sandford oeuvre. Stupid California Driver Prey. Middle Aged Woman With Extremely Poor Night Vision Prey. Sandford’s a Minnesota homeboy. If you believe Sandford, the black country roads of rural Minnesota are teeming with serial killers.
I also solved the health care crisis.
First I had to listen to a lot of radio, NPR, alternating with Glenn Beck. Both seemed whack. In retrospect the last presidential election no longer seems like a choice between a good candidate and a bad candidate, it seems like a choice between two bad candidates. Obama’s stimulus plan is horrifying beyond belief, and his health care revision was so unworkable that not even the House of Representatives is considering it. Instead they have recycled Mitt Romney’s hugely unpopular Massachusetts program.
Hel-lo, Obamber! Access is not the most important health care issue. Escalating costs are the most important health care issue! See, if you controlled the costs – slowed inflation – people might be able to afford health insurance without a gun to their head. This isn’t really that difficult a concept. Or it shouldn’t be.
Escalating health care costs are a four-pronged phenomenon:
Numero One: Malpractice insurance premiums, particularly in specialties, keep going up and up. Solution? Tort reform.
Numero Two: The number of unnecessary procedures – i.e. procedures that are done not strictly as part of the diagnostic process but to rule some highly esoteric possibility out – keeps going up and up. See Numero One. Additionally, enact legislation that prohibits diagnosticians and insurance companies from owning cath labs, MRI distributorships, etc, etc. There’s a whole lotta double dipping going on here, and nobody addresses that.
Numero Three: It’s axiomatic that some huge percentage of all medical costs throughout a person’s lifetime (estimates run between thirty-three and sixty percent) are incurred in the twelve months before he or she finally dies. As a society, we can’t afford that – particularly when Medicare and Medicaid are picking up the tab. We need to convince the American consumer that death is a natural process, that the trip across the river is a bee-yoo-tee-full part of the journey. Hey! If government propagandists can sell the evils of tobacco, they can sell that.
Numero Four: Finally… there are too many doctors! Note that American medical schools tacitly acknowledge this – they graduate approximately 18,000 baby MD’s per year. But before these doctors can start steamrolling your wallet, they have to put in a few years of indentured servitude as hospital interns and residents. There are around 30,000 hospital intern/resident slots, and the difference is made up by graduates from foreign medical schools who tend to stick around once that residency is over.
Do we really need all those doctors?
In large urban centers, you have an over-representation of doctors, most of them specialists. Oddly enough – in direct contradiction to basic laws of supply and demand – this has had the effect of driving the price of their services higher. (Is this because health care becomes a luxury item? Or is this just the classic supplier-induced demand scenario?) Meanwhile, in huge portions of the country where the population is not as concentrated, there is an under-representation of physicians; outside a hospital you may wait months for an appointment with a cardiologist.
Get rid of all those fucking doctors! What are most of them doing anyway? Writing scripts for Michael Jackson? Advising you to lose 10 pounds and get more exercise? A physician’s assistant can do that at one-third of the cost! Hell, a nurse practitioner can do that at one-quarter of the cost!
Cutting labor costs works for every other industry, why not health care?
Reached the circus by 1am.
Took me an hour or so more to fall asleep.
Up by five to drive to wherever Today’s Town (now Day Before Yesterday’s Town) was.
I was a zombie for a couple of days, and it wasn’t until this morning that I felt halfway human again.
I’m old.
I forget that sometimes.
As soon as it grew dark, I got lost. Naturally. I have no sense of direction and a basic distrust of maps – I mean, what if “they” are trying to confuse me by falsifying the documentation, huh? Ya ever think of that?
So I drove around the black country roads of rural Minnesota for close to four hours, amusing myself by thinking up new titles to add to the great John Sandford oeuvre. Stupid California Driver Prey. Middle Aged Woman With Extremely Poor Night Vision Prey. Sandford’s a Minnesota homeboy. If you believe Sandford, the black country roads of rural Minnesota are teeming with serial killers.
I also solved the health care crisis.
First I had to listen to a lot of radio, NPR, alternating with Glenn Beck. Both seemed whack. In retrospect the last presidential election no longer seems like a choice between a good candidate and a bad candidate, it seems like a choice between two bad candidates. Obama’s stimulus plan is horrifying beyond belief, and his health care revision was so unworkable that not even the House of Representatives is considering it. Instead they have recycled Mitt Romney’s hugely unpopular Massachusetts program.
Hel-lo, Obamber! Access is not the most important health care issue. Escalating costs are the most important health care issue! See, if you controlled the costs – slowed inflation – people might be able to afford health insurance without a gun to their head. This isn’t really that difficult a concept. Or it shouldn’t be.
Escalating health care costs are a four-pronged phenomenon:
Numero One: Malpractice insurance premiums, particularly in specialties, keep going up and up. Solution? Tort reform.
Numero Two: The number of unnecessary procedures – i.e. procedures that are done not strictly as part of the diagnostic process but to rule some highly esoteric possibility out – keeps going up and up. See Numero One. Additionally, enact legislation that prohibits diagnosticians and insurance companies from owning cath labs, MRI distributorships, etc, etc. There’s a whole lotta double dipping going on here, and nobody addresses that.
Numero Three: It’s axiomatic that some huge percentage of all medical costs throughout a person’s lifetime (estimates run between thirty-three and sixty percent) are incurred in the twelve months before he or she finally dies. As a society, we can’t afford that – particularly when Medicare and Medicaid are picking up the tab. We need to convince the American consumer that death is a natural process, that the trip across the river is a bee-yoo-tee-full part of the journey. Hey! If government propagandists can sell the evils of tobacco, they can sell that.
Numero Four: Finally… there are too many doctors! Note that American medical schools tacitly acknowledge this – they graduate approximately 18,000 baby MD’s per year. But before these doctors can start steamrolling your wallet, they have to put in a few years of indentured servitude as hospital interns and residents. There are around 30,000 hospital intern/resident slots, and the difference is made up by graduates from foreign medical schools who tend to stick around once that residency is over.
Do we really need all those doctors?
In large urban centers, you have an over-representation of doctors, most of them specialists. Oddly enough – in direct contradiction to basic laws of supply and demand – this has had the effect of driving the price of their services higher. (Is this because health care becomes a luxury item? Or is this just the classic supplier-induced demand scenario?) Meanwhile, in huge portions of the country where the population is not as concentrated, there is an under-representation of physicians; outside a hospital you may wait months for an appointment with a cardiologist.
Get rid of all those fucking doctors! What are most of them doing anyway? Writing scripts for Michael Jackson? Advising you to lose 10 pounds and get more exercise? A physician’s assistant can do that at one-third of the cost! Hell, a nurse practitioner can do that at one-quarter of the cost!
Cutting labor costs works for every other industry, why not health care?
Reached the circus by 1am.
Took me an hour or so more to fall asleep.
Up by five to drive to wherever Today’s Town (now Day Before Yesterday’s Town) was.
I was a zombie for a couple of days, and it wasn’t until this morning that I felt halfway human again.
I’m old.
I forget that sometimes.
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no subject
Date: 2009-07-15 06:39 pm (UTC)and i live ten blocks away from 3 hospitals in manhattan!
so i really have to disagree with number 4.
no subject
Date: 2009-07-15 07:28 pm (UTC)(Don't mean to be snippy but I can assure you the plan before the House of Representatives will do nothing to speed up future gastroenterology appointments.).
Also unless you're trying to get pregnant or rule out ovarian cancer, it's very common for endometriosis to be deduced on the basis of dysmennorhea/rectovaginal exam, and for medical treatment -- bcp, non-steroidal anti-inflammatories -- to be commenced on that basis. I used to be a nurse, and will probably have to go back to being a nurse again thanks to the economy. You'd be amazed at how many conditions are treated without definitive diagnosis.
no subject
Date: 2009-07-15 07:38 pm (UTC)i had an ultrasound! and the only evidence they found that it was endometriosis (apart from the symptoms) was the fact that birth control completely solved the problem after about 3 months. :/ and now i have to pay 30 dollars a month copay for the rest of my reproductive life.
question: do you agree that it's auto-immune? i've been trying to see a gastroenterologist because i think i have several auto-immune problems. apparently endometriosis isn't confirmed as auto-immune but i'm interested in your view.
no subject
Date: 2009-07-16 08:22 pm (UTC)But honestly? I don't know anything
no subject
Date: 2009-07-20 06:23 am (UTC)i think we have to re-allocate the doctors we have, at least if we are going to cover everyone. of course, lots of them aren't going to be keen on doing (and getting paid for) g.p. work.
no subject
Date: 2009-07-20 11:41 am (UTC)But see they don't have to do the GP work. The GP work can easily be done by nurse practitioners and physicians' assistants who can be paid less. Honestly, I can still diagnose most run-of-the-mill medical complaints -- on the basis of a nursing education that is now 30 years old. (I say I "can", but of course I may not -- the AMA is not just a professional organization, it's also a very powerful union." )
There's a great book I would recommend to you if you didn't have a life -- it's 400 plus pages long. Paul Starr's Social Transformation of American Medicine.
no subject
Date: 2009-07-20 12:41 pm (UTC)No doubt that it is a powerful guild.