Friday, June 26, 2009
Thursday, June 25, 2009
This one's a keeper. That didn't come as a surprise -- anyone who could crank out as many best sellers as Edna Ferber did had to be capable of at least telling a decent story. She could do more that, though. Danielle Steele tells stories; Edna Ferber could actually write. I was vaguely familiar with Ferber's work before I started So Big, the novel that won her the Pulitzer in 1925. I doubt there's a person on the planet who hasn't seen Showboat (there have been four movie adaptations to date) or Giant (Elizabeth Taylor, James Dean!), and I'd felt obligated to read Come and Get It because I graduated from high school in the town (Hurley, Wisconsin) that allegedly served as the model for the rowdy brothels and bars community Ferber so colorfully describes. I'd never gotten around to reading So Big, though.
Wednesday, June 24, 2009
Tuesday, June 23, 2009
Sunday, June 21, 2009
Saturday, June 20, 2009
I really am older than dirt.
It's an intriguing article. The first thing the author discovers is that the clinicians and health care administrators in the area had no idea they ranked first in the country for patient costs. As far as they all could tell, no one was going out of his or her way to push treatments that weren't needed. So they posit that perhaps the problem is that McAllen just has a higher than average percentage of unhealthy people. It is, after all, a poor area with an extremely low average household income, which in turn suggests lousy diets, obesity, and clogged arteries.
Well, that theory gets blown out of the water pretty quickly. Turns out that the while the local populace looks like they'd be key candidates for things like heart disease and its attendant high dollar procedures (echocardiograms, angioplasties, by-passes, etc.) the average number of procedures done in McAllen isn't noticeably higher than any some parts of the country and is actually lower than cardiac procedure rates in regions that have lower overall costs.
What it comes down in the end turns out to be pretty predictable: physicians, hospitals, and other providers who have come to see patients as a revenue stream. No one thought that he or she individually was pushing unnecessary procedures, but it turned out the overall culture with its emphasis on profits and revenue streams encouraged doctors to do just that. McAllen has high medical costs per capita because the system, both private insurance and public programs like Medicare, incentivize high dollar procedures. The more procedures that get done, the more patients that cycle in and out of waiting rooms, the more money the doctors make. (In contrast, the Mayo Clinic in Rochester removes the financial incentive by putting physicians on straight salary; there's no linkage between number of patients seen and the size of their paychecks.) In McAllen no one is seeing the system as a whole -- they're just viewing each patient, each procedure, as a unique cash transaction in itself. Ironically, despite having all this high dollar medicine available, the overall morbidity and mortality rates for McAllen aren't so hot. Turns out that as clinicians focus on revenue streams, they lose sight of prevention. So the elderly in McAllen get a lot of colonoscopies (over $3000 a pop) and echocardiograms ($1400) and not enough flu shots ($20 at the local Walgreen's?).
Plus, of course, the fact that a procedure can be done doesn't necessarily mean it should be done. Every invasive procedure introduces the risk of infection or other complications, every "routine" surgery carries with it the possibility of an allergic reaction to anesthesia, wounds that refuse to heal, blood clots, you name it. So between the de-emphasis on preventive health and the excessive ordering of various procedures, the folks in McAllens end up dying sooner than the American average.
I must say that conclusion floored me. At the very least, one would expect that if clinicians are ordering all sorts of tests and things there'd be a pay-off of some sort for the patient: better quality of life, increased longevity, whatever. Nope. No such luck.
The author basically comes to the conclusion that what the American health care system needs isn't a change in who's paying for what because switching who signs the checks isn't going to address many of the fundamental problems in the system now. What the system needs is to go back to being patient-centered. Unfortunately, in a culture that prizes profits above all else, that isn't likely to happen any time soon.
I did learn one interesting thing. In addition to the Rochester, Minnesota, area, there are some other parts of the country that stand out for putting patients first in the health care equation. One is Grand Junction, Colorado. It ranks really high in terms of both quality of care and patient satisfaction. That's were my mom lives. No wonder she never has anything bad to say about her doctors or Medicare.
Friday, June 19, 2009
Food maker Nestle USA on Friday voluntarily recalled its Toll House refrigerated cookie dough products after a number of illnesses were reported by those who ate the dough raw.
The company said the Food and Drug Administration and the Centers for Disease Control are investigating reported E. coli illnesses that might be related to the ingestion of raw cookie dough.
Tuesday, June 16, 2009
Monday, June 15, 2009
*I read Gilead (2004 winner) way out of order; otherwise I'm working my way up the list from oldest to most recent.
Sunday, June 14, 2009
I think the one thing that had me wanting to reach right through the screen and strangle someone was the repetition of a flatout lie, over and over, that the problem with Medicare and Medicaid is the horrendous paperwork, just how incredibly inefficient the government is at processing claims. The Medicare program spends less than 5% of its budget on administrative costs, i.e., the paper shuffling, while the private insurance companies are spending well over 30% on administration.
Of course, there is one huge difference between Medicare and Aetna et al: the person running the Medicare program works for us. No multi-million dollar CEO salaries driving up administrative costs. Medicare is part of Health and Human Services. People may bitch about bloated government bureaucracies, but you can get an awful of lot of GS-5 clerks for the price of one private sector executive. Yes, the chief administrator for Medicare is making 6 figures, but not dramatically so. The senior executive service tops out at under $200,000 annually, although there would be locality pay adjustments on top of the base salary. Compare that with the over $15 million that the CEO for Travelers carried home in 2006.
Nonetheless, Medicare is derided for being expensive, cumbersome, and poorly managed. No wonder I felt like scrubbing floors -- the alternative was brain bleach, and that's hard to come by.
(The other thing that drives me right up a wall, of course, is hearing over and over that we don't want government bureaucrats making decisions about which medical procedures are necessary. Given that the first words out of my doctor's mouth every time he's contemplating ordering a lab test or prescribing a different drug are "I'm not sure your insurance covers this, let me check first," that argument doesn't have much traction with me.)
Saturday, June 13, 2009
Thursday, June 11, 2009
Patient A: 30-something woman with a husband and young daughter is diagnosed with breast cancer. Despite receiving first class care, the cancer metastasizes and becomes systemic. After approximately five years, she dies.
Patient B: slightly older woman, single mother with a teenage daughter, is diagnosed with breast cancer. Her cancer progresses in much the same manner as Patient A, and approximately 5 years after the initial diagnosis, she dies.
So what's the difference? First, Patient A never had to argue with her doctors about whether or not her insurance would pay for a particular treatment, never had to worry about her own co-pays and deductibles, and did not leave her family holding a stack of medical bills several feet high. She and her family went through hell, but the one thing they never had to deal with was the possibility of her not being treated because she couldn't afford it.
Patient B, despite being a public school teacher with a supposedly comprehensive health insurance plan through her employer, wound up relying on loans from relatives, spaghetti dinners, bake sales, and other fund raisers, worried constantly about money, exhausted her sick leave so found herself with no income, and died many thousands of dollars in debt. Given the debilitating effects of stress on the human body, a person can't help but wonder what impact worrying about money had on her disease.
And why the different financial scenarios? Patient A lived in Sweden; Patient B lived in Michigan. When we live in a country where people who are employed full-time at what are supposedly decent, middle-class jobs and have what are supposedly good health insurance benefits find themselves relying on charity to pay for their prescriptions, something is seriously wrong.
My friend Tracy frets occasionally about end of life issues, like being maintained on life support when she really wouldn't want to be. I always tell her, hey, you want to make sure no one tries any heroic measures? Just show up at the Emergency Room of most hospitals without insurance.
On a related note, in terms of how a universal system might actually work, Utah Savage had a good post on the realities of living with Medicare a day or two ago. It's worth looking at.
Tuesday, June 9, 2009
Monday, June 8, 2009
Sunday, June 7, 2009
Saturday, June 6, 2009
Thai police officers investigating the death of David Carradine, the American actor who made his name in the "Kung Fu" television series in the 1970s, say he most likely died of asphyxiation, possibly when an autoerotic sex game went wrong.
Carradine, 72, was found naked in a closet in an upscale Bangkok hotel on Thursday with cords around his neck and his genitals. The police are checking DNA found on the cords, but say they found no signs of a struggle, suggesting that Carradine might have either tied himself up or submitted voluntarily to his incapacitation.
And you know, I'm not sure which is worse -- the fact the dude was stupid enough to do something like this to himself, or the rather appalling mental image of a naked 72-year-old has-been celebrity.
Friday, June 5, 2009
Tuesday, June 2, 2009
I won't make it on to an actual jury, of course. That would be too much to hope for. In fact, odds are that when I call the night before I'll discover the closest I'm getting to the courthouse is mailing the questionnaire back.
(My team lead is going to be thrilled by this news, I say sarcastically. July 13 is the day I'm supposed to be back in the office following a 2-week vacation. She just signed off on the leave request yesterday. I think I'll wait awhile to share this news with her.)
Monday, June 1, 2009
From the Rude Pundit:
The Rude Pundit wants this fucker put into detention at Gitmo, no motherfuckin' questions asked. Yeah, that's right. He wants the guy who assassinated Dr. George Tiller fuckin' hooded, chained, put on a cargo plane with fuckin' headphones on so he can't hear shit, and flown across that little bit of ocean to Cuba, man, our little colony on the bay. And when that cocksucker gets there, the Rude Pundit wants him interrogated, interrogated like a terrorist oughta be interrogated, strippin' off his clothes and pointing and laughing at his scared, tiny cock, slammin' him up against a fake wall over and over and over, slapped in just the prescribed places. Fear up that motherfucker. And who knows what plots he's involved in? Who knows how many radical fascist Christianist sleeper cells are waiting to blow away more abortion providing doctors, destroy their hospitals, attack the mothers themselves? How can you be sure? Because the authorities asked him? Because he said he was acting alone? You trust the killer?There's more. Go check it out.
Fuck that. Lay that backwards ass, shack-dwelling mule fucker out. Tie him down and tilt him back. It's time for the cloth and the water, 20 seconds at a time, oh, fuck yeah, 83, 100, 150 times, he'll talk. Shit, he'll tell you how much he's fucked his sister by the time you're done with him. Then put him in solitary, toss his Bible in the john when he pisses you off, slap him around some more.