Wednesday, March 31, 2010

Can Apple's iPad make me an early adopter?

Anyone who knows me knows that I'm never the first one to jump into a new technology. I had a Blackberry for a while but found little reason to read emails on the run, and the buttons are too small anyway. I still don't have a high def television or even a flat panel. But I gotta say that what I've seen of the iPad seems impressive. Portable, yet large enough to be practical; this may revolutionize magazines, medical journals, books and movies... and all matter of communication. Much will depend on battery life, but the future is here.

Bring on the ACOG app! Here are full professional reviews: Mossberg and Pogue.

Tuesday, March 30, 2010

Monday, March 29, 2010

G'Morning with John Boehner

Don't tax my tanning bed!


Saturday, March 27, 2010

Is the health care reform bill right for the US?

I was asked by a physician's assistant, who happens to be Republican, what I thought of the Democratic health care reform bill. Isn't it just a big costly government program? Why am I not Republican? She asks, "You're such a smart man. Do you really, really, really believe this health care reform is good for the US?????", and then she attaches this lovely email chain-mail screed:

Let me get this straight. We're going to be gifted with a health care plan
written by a committee whose chairman says he doesn't understand it,
passed by a Congress that hasn't read it but exempts themselves from it,
to be signed by a president who also hasn't read it and who smokes,
with funding administered by a treasury chief who didn't pay his taxes,
to be overseen by a surgeon general who is obese and financed by a country that's broke.
What the hell could possibly go wrong?

Of course, it was a MUCH larger font and mostly in bold.

My answer:

I am not that smart... certainly about such things as policy. You have more experience dealing with the uninsured and under-insured, trying to get people into the system when they are sick. I know that the current situation is unsustainable. We cannot have 46 million people without insurance; 1 out of 4 people under 65 don't have any insurance and estimates are that another 20 million are under-insured. Do you really think that is sustainable? The current bill has been grossly mischaracterized as a "government takeover" when it is actually just insurance reform on the margins. The main provisions-- limiting pre-existing illness, preventing cancellation for illness, requiring basic coverage, expanding Medicaid, increasing insurance competition across state lines-- have been long overdue and all could have been passed individually very easily. I'm not sure what all the angst is about, other than the Republicans making hay while the sun shines, getting campaign contributions by stoking fear (what else is new.) The GOP had 10 years in power and did nothing-- nothing -- as the number of uninsured doubled and the percentage of our GDP going to health care went from 11 % to 17 %.

The Medicare Part D prescription plan signed by Bush in 2003 and passed by the GOP Congress is 1) more expensive, 2) covers a smaller number of people and only for prescriptions, 3) transfers more public money to private companies by disallowing price negotiation and 4) was NOT paid for AT ALL (100% is borrowed money). Seriously, Medicare Part D is such a boondoggle compared to the current insurance reform that it's not even worth discussing. Of course, the Republican legislators who wrote the bill are now lobbyists making millions from the industry.

I want to be a Republican, I really really really do. I would like to pay less taxes, drive a bigger car, make more money, lose weight, look more handsome... but let's get real. When my federal income taxes dropped in 2002, my property taxes and sales tax went up, and our public debt skyrocketed, because roads need to maintained and schools need to be funded-- and unnecessary wars became, well, necessary. I simply don't think our country can afford the Republican party. Their unnecessary wars (Iraq), corruption (Abramoff), deregulation of the financial industry (SEC, Lehamn, AIG), bank bailouts, auto bailouts, farm subsidies, payouts to the pharmaceutical industry (Medicare Part D) have or will cost me a bundle.

Are the Democrats perfect? No. But I think they are better than the GOP, that's my opinion. I think they understand the health care bill better than you give them credit for; all of the provisions in the bill have been discussed, studied and dissected for 20 years, none of it is really new or revolutionary... and personally, I think it will prove to NOT be enough, but that's just me. I truly believe the way to go is single-payer Medicare-for-all as basic coverage for preventive care, and allow people to buy insurance for better coverage as they choose-- that's the French system in a nutshell and it has better access at a much lower cost. But the GOP will get everyone stoked to win votes and we will continue to overpay for our health care. Under the current system, knee replacement salesmen make $300,000 per year; private insurers take billions of tax dollars through Medicare Advantage plans; largely because the regulatory arm of Medicare has been gutted and we have this fetish about worshiping "free markets" that don't exist.

The recent bill just passed will make YOUR life easier just by having more people required to sign up for Medicaid for which they already qualify. Furthermore, reimbursement will be higher and even working people will be required to have some coverage. So, you will have less hassle about getting folks into the system when they need it. But are all the problems solved? No. Nobody really knows exactly how it will work, and most experts agree that the bill will have to be tweaked as we go... but I have every confidence that the GOP will take seats in November and gut the bill, cutting regulation, reducing coverage, paying more-- not to doctors and PA's-- but to oxygen vendors and medical device manufacturers and drug makers. That's what the GOP does.

When I get emails like the one you sent, I just roll my eyes. We get what we deserve. The industry hacks have done a superb job of mischaracterizing the current health insurance reform bill: Mission Accomplished. The corporate elite want nothing more than to keep the rest of us unwashed and angry at our government so they can keep raking in the dough. The top 500 executives in the health insurance industry average over a million dollars per year. Ron Williams at Aetna made $24 million last year. I'm not saying that the government should mandate anything about executive salaries-- and neither are the Democrats-- but the system needs to be reformed. Insurance companies add no value to the health care product. Do they improve quality? Did Aetna show you how to do LEEP's or manage abnormal pap smears? What does society get in return for the $24 million paid to Ron Williams? We just pay premiums to them and they take 20% off the top, and try NOT to pay for services by increasing the hassle, and then drop us when we get sick.

That's my mini-rant. I have no problem with the principles espoused by the Republican party-- small govt, personal responsibility, etc-- but their actions NEVER follow these principles. They are more spendthrift and take less responsibility when they screw something up. Remember "weapons of mass destruction"? When the UN tells you over and over that there are no WMD and then you spend a trillion (borrowed) dollars, kill 100K civilians, maim 40K of your own soldiers, only to find out that you were wrong and the morons at the UN were right, how can you even show your face in public. Idiots, and that idiocy is costing you and me a lot of money-- more than any measley health insurance reform.

Sorry you asked?

Thursday, March 11, 2010

Bleeding to Death...

Excerpt from Malcolm Gladwell's 2002 essay on Nicholas Taleb (pictured at right), Blowing Up, and reprinted as part of his latest book What the Dog Saw:
"We cannot blow up, we can only bleed to death," Taleb says, and bleeding to death, absorbing the pain of steady losses, is precisely what human beings are hardwired to avoid. "Say you've got a guy who is long on Russian bonds," Savery says. "He's making money every day. One day, lightning strikes and he loses five times what he made. Still, on three hundred and sixty-four out of three hundred and sixty-five days he was very happily making money. It's much harder to be the other guy, the guy losing money three hundred and sixty-four days out of three hundred and sixty-five, because you start questioning yourself. Am I ever going to make it back? Am I really right? What if it takes ten years? Will I even be sane ten years from now?" What the normal trader gets from his daily winnings is feedback, the pleasing illusion of progress. At Empirica, there is no feedback. "It's like you're playing the piano for ten years and you still can't play chopsticks," Spitznagel say, "and the only thing you have to keep you going is the belief that one day you'll wake up and play like Rachmaninoff." Was it easy knowing that Niederhoffer -- who represented everything they thought was wrong -- was out there getting rich while they were bleeding away? Of course it wasn't . If you watched Taleb closely that day, you could see the little ways in which the steady drip of losses takes a toll. He glanced a bit too much at the Bloomberg. He leaned forward a bit too often to see the daily loss count. He succumbs to an array of superstitious tics. If the going is good, he parks in the same space every day; he turned against Mahler because he associates Mahler with the last year's long dry spell. "Nassim says all the time that he needs me there, and I believe him," Spitznagel says. He is there to remind Taleb that there is a point to waiting, to help Taleb resist the very human impulse to abandon everything and stanch the pain of losing. "Mark is my cop," Taleb says. So is Pallop: he is there to remind Taleb that Empirica has the intellectual edge.

Monday, March 08, 2010

Health Care Free Market --Part I: Vouchers

Nothing gets a small government conservative hopping mad faster than saying an industry-- any industry-- cannot be fixed by the invisible hand of the free market. And, honestly, I tend to take that side on nearly every issue. Things like labor wages and education would all come to heel if more free market were allowed access. My personal experience, having been raised in Chicago with public schools that were inferior and costly due to social and disciplinary problems, saw the benefit of parochial schools. Although my mother paid higher city property taxes, she felt the need to shell out after-tax dollars to pay private school tuition as well. My school had excellent lower income students who did well and were able to attend only because they received a tuition grant or waiver. My thought was always that even more low income students would have benefited from private schools had there been a voucher program in Chicago. This is not to say that the public schools were not sufficient, but for those who have preferred private schools, why not offer them a choice and let the market decide?

Medicare is a Voucher System

Conservatives who favor school choice vouchers should view Medicare-for-all as the ultimate voucher system for individual choice in health care as well. So why do I favor single payer, Medicare-for-all, in medical care? Isn't that a complete disconnect? Answer: NO. In fact, Medicare-for-all, which is preferred by a majority of physicians and a vast majority of primary care providers, is the perfect mechanism to give choice. Every individual would be empowered to go wherever they pleased for health care and new life would be breathed into the marketplace, even reviving the moribund institution of private practice. Currently we force low income people into health care providers just like we do kids with inner city schools, but a Medicare card [NOT Medicaid! Please don't ever confuse the two] would free the individual to seek out quality care as they see fit.

Just Like Education

Damn, this sounds so paradoxical. But with further thought, medical care has many parallels to elementary education: 1) everyone needs it, 2) some people simply cannot afford it, and 3) the general welfare of the republic is improved by it. I always wonder why the exact same conservatives who are staunch advocates of school vouchers don't see the similarities with Medicare. Mistakenly, many conservatives advocate a voucher system to buy health insurance-- which really only adds another layer of bureaucracy between the patient and the doctor. I couldn't imagine a world where we have to first have a government bureaucracy to determine who gets an insurance voucher and then release this person-- maybe disabled, maybe low functioning-- into the insurance sales market. This seems like an impending disaster.

Instead, give everyone Medicare. Of course, instill the other free market mechanisms such as fee transparency for better price discovery, progressive co-pays for non-preventive care, and even supplemental private policies (NOT subsidized with federal money) for those who feel they want them. Take out all tax deductions for health care which would bring market prices down and provide more tax revenue to pay for the plan. If further funding is needed, consider a value-added consumption tax as proposed by other voucher advocates.

Medicare would make life easier for everyone

Medicare has a huge bureaucracy already in place that serves infirm, old and disabled people very well with extremely high consumer satisfaction and quality ratings. By adding everyone into the risk pool the economies of scale would increase and the cost-per-person would decrease. Several studies already show that Medicare has lower administration fees than private insurance companies. Problems cited with these studies are that they use "revenue" as the denominator and Medicare reimburses more dollars per live covered, it will always look to be more efficient. That's a valid complaint; so the answer is to first compare Medicare with private insurance head-to-head for a trial period in order to determine efficiencies. Allow 55 year-olds to to buy into Medicare in a pilot program and compare costs with privately insured 55 year-olds. My guess is that Medicare would blow Aetna and the others away... which is precisely the reason the insurance lobby is so adamant against such a trail, such as a public option.

Dealing with bureaucracy is the bane of patients and doctors alike; but the current system is unwieldy primarily because of the number of differing plans with various arbitrary standards, drug formularies and forms to file. Just by making the paperwork standard and electronic, life would be easier. In effect, we'd be reducing the bureaucratic morass by eliminating the multiple private bureaucracies.

Next Up

Ron Paul is a resolute free market proponent who has practiced medicine. In my next post I will discuss Dr. Paul's free market solution to health care costs and tell why his solution is defensible on an economic level, but not on a human or social level.

Federal funding of Abortion: the bogeyman that isn't

Democratic Michigan Representative Bart Stupak (at left) is burnishing his pro-life resume by fighting the abortion straw man in the current health care reform debate. Jonathan Karl on ABC News has a short story which clearly shows that Stupak is disingenuous at best about the abortion coverage.

The Senate's HR 3590 has language that explicitly denies use of federal money for abortion except in cases of rape, incest, or if the mother's life is in danger.


Page 1164 FUNDS.—Funds awarded under a grant under this section...
(B) may not be used to provide abortions.

How much clearer can it be?

Stupak and other pro-life congressmen point to the Manager's Amendment which has a provision calling for further funding of Community Health Centers for indigent care. Currently 1200 such centers operate and provide basic medical care in under-served areas. I can find no information that these centers provide federally funded abortions and my hunch is that they do not since this would certainly have caused an uproar before now. Pro-choice groups have furnished information packets instructing these clinics how to offer abortion services, but this is certainly not evidence of federally funded abortion.

In particular, the National Right to Life (NRL) has provided an extremely misleading position paper that all but accuses Community Health Centers of using federal funds to provide abortions-- which they most assuredly do not. Pro-choice individuals and groups are respectful of conscientious objections to abortion provision, so why can't the NRL be respectful enough to refrain from partial truths?

Last December, Senator Orrin Hatch (R-UT) wrote an editorial with the same inaccurate false concerns about abortions funded by federal tax dollars. Furthermore, Hatch made the odd claim that the Senate bill could force medical providers to perform procedures "that violate their conscience." Huh? Is he implying that the Senate bill would require physicians to perform abortions?

Page 123 of the Senate bill: (3) PROVIDER CONSCIENCE PROTECTIONS.—No
individual health care provider or health care facility
may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.

The deliberation is obviously off the rails.

Let's face it, anti-choice representatives who are emboldened to political action committees for funding and support will stop at nothing to create false furor over abortion at every turn. The fact is that abortion rights are protected by the law of the land and painting every legislative debate with the brush of abortion only paralyzes progress on such important things as health care reform. Stupak and his ilk need to get over it; either pass legislation that outlaws abortion, or just shut up already. What's next, holding up road maintenance funds because good public roads will only make it easier for women to get abortions? Or will we just outright prohibit public roads to be used to go to the doctor altogether?