Employer Mandates: Been There, Done That
Great Op-Ed from David Himmelstein and Steffie Woolhandler in the NYT about single-payer and employer mandates. The latter have been tried many times in many forms, and they still are failing.
Archive for December, 2007
Top Photos of 2007:
December 17th, 2007
Fat Lady, Sing!
And with that, med school was over. Kind of anti-climactic if you ask me.
I MADE IT!
(Okay fine, I still have to take Boards Step 2 CK and CS, and take ACLS, but really. I made it.)
The eTime Home Endoscope
For the guy or gal who has everything comes the “eTime Home Endoscope.” Nope, not kidding. The BoingBoing review: “Disgustingly Effective.”
How To Give Bad News
A good stepwise process, for future reference in residency, from a lecture today in Family Medicine. This applies to both deaths and bad news in terms of studies, lab results, etc. (It’s also often a good idea to have the social worker or chaplain with you if you can.)
- Make a setting. Don’t do it in a hallway, go find a private, quiet place to sit and talk.
- Introduce yourself. Often the family has seen a number of different people caring for their loved one–doctors, nurses, techs, etc–so reiterate who you are, especially to the significant other.
- Ask what they know already. It gives you a sense of their knowledge level, what they might be expecting, what they’re worried about, so you don’t repeat anything or speak above or below their level of understanding and medical knowledge.
- Make a “preperatory statement.” This readies and focuses the loved ones for what they’re about to hear. A good suggestion from the lecturer: Don’t say “I have some bad news.” Try, “I have something very important I need to tell you right now.”
- Deliver the news. Be brief, direct, and succinct, 25 words or less.
- Pause, wait for a response. Be there and be present.
- Arrange a follow-up for later. A phone call, a card–it doesn’t have to take extraordinary effort.
- Take care of yourself. It’s emotionally trying and exhausting to do this, so allow yourself to grieve however you may express that, too.
Bad Residencies, Please
Dear Residency Programs,
Could you please stop being so damn good? It’s truly quite exhausting ending pretty much every interview day and really liking each of you. I wish I had a boyfriend/partner/whatever that would rule places out so I could cross them off my list, because when it’s between excellent and excellent, making any sort of ranking is damn near impossible.
Yours,
graham
Maine’s Reforms Not Working
ABSTRACT : Since enacting comprehensive health care reform in 2003, Maine’s Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives: DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children. While these programs are making health coverage more affordable to low- income individuals, small firms, and sole proprietors, with subsidies targeting those most in need, by late 2006, the initiatives had enrolled less than 10 percent of previously uninsured residents. To pay for this expanded coverage, Maine has utilized savings in the overall health care system due to lower uncompensated care and cost controls. However, the funds raised thus far are insufficient to pay for greater subsidized enrollment in Dirigo programs, leading to a search for other financing sources to sustain the program.
Canada’s Socialized Innovation
Canada’s single-payer system began in 1957, with several revisions years later. Man, 50 years under a socialized medicine, government-run scheme. Canadians with their single-payer system clearly have no motivation to innovate–because where’ the profit? Funny, then, that Canada’s had plenty of medical innovations :
- 1958 World first surgical treatment on cerebral aneurysms. (Lawson Health Research Institute — London, Ontario)
- 1960 First implanted mammary artery into the heart wall in order to restore functionality of the heart. (McGill University Health Centre Research Institute — Montreal, Quebec)
- 1965 First artificial knee joint in the world created. (McGill University Health Centre Research Institute — Montreal, Quebec)
- 1969 Discovery of a carcino-embryonic antigen, a tumour marker for cancer. (McGill University Health Centre Research Institute — Montreal, Quebec)
- 1987 World’s first pacemaker cardioverter defibrillator is implanted. (Lawson Health Research Institute — London, Ontario)
- 1989 Discovery of the gene which, when defective, causes cystic fibrosis, the most fatal genetic disease of Canadian children today. (The Hospital for Sick Children — Toronto, Ontario)
And on and on and on…
KevinMD Wants A Response
My response:
- The most heavenly social program is hell underfunded.
- Blind faith? When have any single-payer folks ever said we blindly support single-payer and appropriate government appropriations (say that three times fast)? Will health care reform be easy? Pass one law and everything magically gets fixed? The wool’s not pulled that tightly over my eyes. Fixing the health care system isn’t going to be easy, and it isn’t going to be cheap. It will take years of planning, tons of effort, and lots of discussion. But of course it can happen.
Why do I think we need to do it? Because of the mess. The mess of billions of dollars wasted on duplicated tests and administrative overhead. The mess that millions of people in the richest nation in the world decide between eating and buying their medications (which would often prevent doctor and ED visits in the first place), or that many honestly consider waiting out an appendicitis because they lack insurance and know their financial lives will be ruined by a $50,000 hospital bill. The mess that fragmented care complicates care so greatly. The mess that other countries can apparently do it–and for cheaper–and we apparently can’t. I could go on.
Why do I think we can do it? Because we’re America , god damn it. We’re the land of opportunity. Innovation. Creativity.
We invented the car. We flew at Kitty Hawk. Electricity. The telephone! We created a system of railroads across a gigantic country. And then later, we made gigantic highways to cover it even better. We can do whatever the hell we want with this country–that’s the beauty of it! And you’re honestly telling me we don’t have it in us to fix our own health care system? To take better care of ourselves? That it’s not possible? Of course it is! (I sometimes wonder what our health care system would be like today if our leaders back in 2001 fought so strongly for fixing our health care system the way they fought so strongly to fund and go to war. A trillion bucks could go a long way.)
Do I think the government funds things correctly currently? Often, no. Does that mean that it can’t in the future? Of course not. Do I think it’ll take a massive, gigantic change to our government and culture to fix things? Absolutely, just like it will take a massive, gigantic change to fix our health care system. People always bitch and moan about “the government,” but what is the government but its citizens?
And by the way, I’ve never gotten an answer from you HSA supporters as to how in the hell they’re going to make a dent in our health care expenditures.