Now why is the Red Cross have to defend its practice of treating the Taliban, and of training them in first aid?

They are a neutral organization.

And, don’t people realize that armed forces medics treat enemy forces all the time? Its part of the job of being a medic, or a doctor in war. You treat EVERYONE.

Alright, I was at Harry’s Farmers market yesterday, looking for okra. But, their okra just looked nasty, so I passed on it. I picked up some dried “Black Mission” figs for a treat for the birds.  So, when I got in home, I gave all the birds a fig (well the finches get to share a fig). Then I decided to try the nasty looking things for myself. And promptly told the birds “Enjoy those, because these just became Richard food”.

These things are exceptionally good. Not so good for diabetics, since they are over half sugar (Its natural sugar, but its still sugar) (so they are candy) but they are high in fiber, so they are a bit better than actual candy. Plus you actually get some nutrients. Still, they are best in quite small doses, to satisfy a sweet craving.

Man, they are nasty looking though.

I’ve never been a coffee drinker. BUT, I am trying to switch to coffee from coke (soda to you damn yankees). And you know what? Coffee is actually pretty darn good. I guess millions of people are occasionally right. I’m looking forward to trying the various styles of coffee. Plus, it has health benefits – which coke most certainly does NOT.

And, it shows an amusing habit of mine, that I do a lot. I bought this one cup coffee maker in January of 2009. I just took it out of the box in May of 2010.

When Carmen was my roommate, that would drive her up the wall. I would order something from Amazon and then not even open the Amazon box for a couple of months. She would occasionally say something about how I “obviously didn’t need x” because it was still in the box. I would point out that A) It was for a specific project that I wasn’t yet doing. And, B), that I knew exactly where it was. Mind, a project can be on my “to do” list for YEARS before it gets done. Like the coffee pot that is opened 1.5 years after being bought. (And it works great too. I should have opened it earlier).

Computers cost health care money. To me, this is common sense. I see it at work even – things would be cheaper without most of the systems I make my living supporting. Computers are overhyped, and overused.

All too often, executives think if they throw enough technology at a problem, it will somehow turn their organizations into shining beacons of success. But in the end, technology is rarely the cure, it simply amplifies the existing organizational culture.

Exactly – this also occurs when you realize that computers are tools. I love computers for their own sake, and they are how I make my living. However, its equally obvious that too many people see them as a panacea. This also ties in to kids – I don’t think kids should be on computers before high school age. Their isn’t any advantage to them being on computers, and tons of drawbacks. Computers are not complicated, and they aren’t difficult to learn. A kid will get far more value out of three hours spent playing in the mud, racing bikes with siblings, squirrel hunting with their dad, playing in a water fountain in the city, or any other thing you can think of, than they will by spending those three hours on a computer.

It runs right into a pet peeve of mine as well. Folks who simply memorize where menu options, or things of that nature, are, without learning the theory behind what they are doing. Learn the theory, learn the language, and you are interface dependent. Figuring out that the menu choice is 3rd down on the 3rd menu is piffle – look at help, look on an internet search engine. It doesn’t take long to learn help, or a search engine.

Rather rambling, disjointed, etc, but those are my random thoughts on a few subjects.

One answer to growing health care costs, is to go abroad. There is a push for medicaid to cover expats living in Mexico. This is only fair, since these folks did pay into the system all their lives. And, it will serve to drive prices lower in the U.S.

Resistance to the expansion of Medicare to Mexico is coming from some health-care industry groups like the American Medical Association and the American Hospital Association, according to David C. Warner, who teaches public affairs at the University of Texas LBJ School. Warner says these groups see it as the beginning of a slippery slope that will lead to expansion of Medicare coverage to places like China and Eastern Europe where health-care costs are rock bottom.

Whats most galling about the health care debate, is the utter lack of concern about its constitutionality. Mandated health care – by the federal government, is unconstitutional. Yet this is being ignored. I suppose this is to be expected, since only lip service has been paid to the constitution for decades.

That said, since that battle is long lost (and yes, I’m damn bitter about it), here are three baby steps that could be taken, which would help with the health care system. Unconstitutional? Yep, they are.

1) Require hospitals, doctors, etc to provide full inclusive price lists up front, to anyone, for any reason. If they have a deal with particular health insurance company, full details should be available to the public. This list also covers anyone practicing on their premises, using their equipment, etc. You want to know what open heart surgery with placing two stents costs at this hospital? You can find it out, in advance. This includes full histories of the providers – years experience, complaints filed against them, education, etc.

2) Make flexible spending accounts employer independent. You can put money into an account each year specifically for health care costs, and this money is pre-tax. I.E, your medical costs are not taxed, up to however much money you put into it. And yes, you lose some (but not all) of this money if its not used by years end.

3) Loosen the regulations on doctors. Why shouldn’t the guy down the road advertise that he can set simple breaks in limbs? Or brain surgery? If you can see that he has no experience, whats the danger?

After a reasonably short time frame – 10 years or so, reevaluate these steps.

The long Atlantic health care article (20 pages) is worth reading and pondering in its entirety.

However, I know folks are “lazy”. As a teaser, I used the summarize feature on Macintoshes (under the services menu) to shorten the article down. You can scan the below to see if you want to devote more time and energy to the article. The Summary was set to about 15% of the article, sentences format.

There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

…But some experts, it seems, have come to see many of these problems as inevitable in any health-care system—as conditions to be patched up, papered over, or worked around, but not problems to be solved.

…But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. … We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

…Everyone I know has at least one personal story about how screwed up our health-care system is; before spending (another) $1trillion or so on reform, we need a much clearer understanding of the causes of the problems we all experience.

…Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation.

…By what mechanism does society determine that an extra, say, $100 billion for health care will make us healthier than even $10 billion for cleaner air or water, or $25 billion for better nutrition, or $5 billion for parks, or $10 billion for recreation, or $50 billion in additional vacation time—or all of those alternatives combined?

…As new tests and treatments are developed, they are, for the most part, added to our Medicare or commercial insurance policies, no matter what they cost. … If the amount we spend on care had grown only at the general rate of inflation since 1970, annual health-care costs now would be roughly $5,000 less per American—that’s about 10 percent of today’s median income, to invest for the future or to spend on all the other things that contribute to our well-being. To be sure, our society has become wealthier over the years, and we’d naturally want to spend some of this new wealth on more and better health care; but how did we choose to spend this much?

…But by making housing investments eligible for special tax benefits and subsidized borrowing rates, the government has stimulated not only the construction of more houses but also the willingness of people to borrow and spend more on houses than they otherwise would have.

…There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.

…Society’s excess cost from health insurance’s administrative expense pales next to the damage caused by “moral hazard”—the tendency we all have to change our behavior, becoming spendthrifts and otherwise taking less care with our decisions, when someone else is covering the costs.

…Every time you walk into a doctor’s office, it’s implicit that someone else will be paying most or all of your bill; for most of us, that means we give less attention to prices for medical services than we do to prices for anything else. … Combine these two features of the system with a third—the informational advantage that extensive training has given physicians over their patients, and the authority that advantage confers—and you have a system where physicians can, to some extent, generate demand at will.

…Well, Medicare spends almost twice as much per patient in Dallas, where there are more doctors and care facilities per resident, as it does in Salem, Oregon, where supply is tighter.

…If it’s true that the insurance system leads us to focus on only our direct share of costs—rather than the total cost to society—it’s not surprising that insured families and uninsured ones would make similar decisions as to how much of their own money to spend on care, but very different decisions on the total amount to consume.

…Perhaps the greatest problem posed by our health-insurance-driven regime is the sense it creates that someone else is actually paying for most of our health care—and that the costs of new benefits can also be borne by someone else.

…At $2.4 trillion and growing, our nation’s health-care bill is too big to be paid by anyone other than all of us.

…Because under Medicare’s current reimbursement system (which generally pays more to physicians who do lots of tests and procedures), geriatricians typically don’t make much money.

…The experience of other developed countries suggests that’s true: the government as single payer would have lower administrative costs than private insurers, as well as enormous market clout and the ability to bring down prices, although at the cost of explicitly rationing care.

…The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age.

…But as long as our government shovels ever-greater resources into health care with one hand, while with the other restricting competition that would ensure those resources are used efficiently, sustained high profits will be the rule.

…And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.

…And whatever their purpose, almost all of these regulations can be shaped over time by the powerful institutions that dominate the health-care landscape, and that are often looking to protect themselves from competition.

…High-tech equipment has been dispersed to medical practices, recovery periods after major procedures have shrunk, and pharmaceutical therapies have grown in importance, yet over the past 40 years, hospitals have managed to retain the same share (roughly one-third) of our nation’s health-care bill.

…Their argument is the same one that’s been made before by regulated railroads, electric utilities, airlines, Ma Bell, and banks: new competitors, they say, are using their cost advantages to skim off the best customers; without those customers, the incumbents will no longer be able to subsidize essential services that no one can profitably provide to the public.

…Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high.

…Analyzing data from the American Hospital Directory, The Wall Street Journal found that the 50 largest nonprofit hospitals or hospital systems made a combined “net income” (that is, profit) of $4.27 billion in 2006, nearly eight times their profits five years earlier.

How do we know whether the value of hospitals’ charitable services compensates for the roughly 100,000 deaths from hospital-borne disease, their poor standards of customer service, and their extraordinary diseconomies of both scale and scope? … We don’t know how many hospitals would even survive if they were not so favored under the law; anyone who has lost a loved one to a preventable hospital death will wonder how many should.

…And it wasn’t really paying for the quality of his care, either; indeed, because my dad got sepsis in the hospital, and had to spend weeks there before his death, the hospital was able to charge a lot more for his care than if it had successfully treated his pneumonia and sent him home in days.

…Individual consumers, of course, don’t benefit from these discounts, so they receive their bills at full list price (typically about 2.5 times the bill to an insured patient). Uninsured patients, however, pay according to how much of the bill the hospital believes they can afford (which, on average, amounts to 25 percent of the amount paid by an insured patient).

…It’s astonishingly difficult for consumers to find any health-care information that would enable them to make informed choices—based not just on price, but on quality of care or the rate of preventable medical errors.

…Whether it’s new drugs to control previously untreatable conditions, diagnostic equipment that enhances physician productivity, or minimally invasive techniques that speed patient recovery, technology-driven innovation has been transforming care at least as greatly as it has transformed the rest of our lives.

…I don’t even know the price of many of the diagnostic services I’ve needed over the years—usually I’ve just gone to whatever provider my physician recommended, without asking (my personal contribution to the moral-hazard economy).

…If you do an Internet search today, you can find LASIK procedures quoted as low as $499 per eye—a decline of roughly 80 percent since the procedure was introduced.

…Rather than blaming technology for rising costs, we must ask if moral hazard and a lack of discipline in national health-care spending allows health-care companies to avoid the forces that make nonmedical technology so competitive.

…In its own twisted way, this makes sense: moral hazard, driven by insurance, for years allowed providers to create enough demand to keep new MRI machines humming at any price.

…Technology is driving up the cost of health care for the same reason every other factor of care is driving up the cost—the absence of the forces that discipline and even drive down prices in the rest of our economy.

…The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did.

…I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

Is in the Atlantic, and is written by a democrat who believes the government should provide a social safety net (I.E, one component of which is a guaranteed access to health care.) (For the record, like most libertarians, I too believe that their needs to be a social safety net, but that it needs to be provided by society, NOT the government.)

Article here.

Tip: When reading one of the long articles, broken up into too many pieces, look for a “print” link. Click it, and read the resulting single page. You don’t have to finish the print, just close the page when done.

I’m not going to attempt to summarize the article. Its too darn good not to read and ponder in its entirety. I am going to quote two parts, that are particularly salient.

I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.

These are the impersonal forces, I’ve come to believe, that explain why things have gone so badly wrong in health care, producing the national dilemma of runaway costs and poorly covered millions.

And one thing that is far too true, and which is largely ignored, or forgotten.

And the primary goal of any large noncompetitive institution is not cost control or product innovation or customer service: it’s maintenance of the status quo.

Here are a few of the objections I have to single payer health care – this is not a comprehensive list, by any means.

1) Its unconstitutional. I won’t belabor this point, because its a lost one. The constitution hasn’t been followed for almost 100 years now. The point still holds true.

2) It won’t be fair. Fair, and Just, would be every single individual paying the exact same amount. It won’t happen. People will try to claim its regressive – which is a false concept. The poorest citizen should pay the exact same amount as the richest one.

3) It makes indentured servants of doctors. Why should doctors be told how much their services are worth? Is it fair to tell someone what they can do with their skills?

4) It creates a powerful incentive for further regulation. I’m a fat bastard. If single payer passes, how long after costs start spiraling out of control, until the government puts a “fat tax” on foods, like soda, fried foods, etc? After all, why should everyone else pay the increased health costs that my being a fat bastard will impose? A perfectly valid point – one that is admirably solved by making me (and me alone) responsible for my health care. (Which means that present insurance does need to be reformed).

5) Erosion of privacy. If single payer health care passes, then all medical records will be digitized, and computerized. I work with computers for a living. I don’t want this – its a lose, lose situation. Scope creep will kick in, and that nice central database will be used for law enforcement purposes. (Similar to how SSN’s and employment are used to track dead beat dads, nowdays).

6) It weakens states, and strengthens the federal government. Its damn hard to “vote with your feet” when all places are alike.

Furthermore, it fails to address the core problem. Why is health care so expensive? You can travel to India for heart surgery and pay 25 to 30% of the cost that you will in the United States. Why is that? Is it because of increased regulation in the United States? If so, then wouldn’t it make more sense to lower the regulatory burden to decrease costs?

Finally, its based on a false notion – that health care is an entitlement, a right, that everyone should have equal access to. This is horribly false. What it does to doctors is a crying shame.

A growing trend is “medical tourism”, practiced by american citizens. Its where you go oversees to get your medical care.

As U.S. health row rages, many seek care in Mexico

Just one link of quite a few that I have (its an interest of mine).

I’ve just read it, so I haven’t had time to digest it yet….. but its a very, very intriguing article. Well worth your time to read.

The Wrong Cure
Better incentives, for doctors or insurers, won’t lead to better health care.

A dying ten year old girl wanted to see the Pixar movie UP. She was near death and too ill to go to a theater.

Pixar sent an employee with a DVD to her house.

She died seven hours after seeing the movie.