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Fixin' Healthcare

Wednesday, May 28, 2014

Prevention Of Harm To Oneself

Should people be prevented from doing harm to themselves? When that involves immediate and drastic harm the answer is yes. Suicide for example. When the harm is more gradual and less obviously acknowledged the response is more debatable. Smoking and junk food for example. Over time the linkage between cause and effect becomes more obvious and society chooses to act. Even then regulations are less effective than social norms. The wrinkle comes with the large commercial enterprises built upon bad habits. It is a long and arduous path to a healthy society and the future belongs to the children. When people make better choices, no one will sell the bad choices. If I'm not mistaken the sales of soda in the U.S. is declining. Most people want to look good and feel good and sooner or later they learn what it takes to accomplish that goal. In that regard a free market society is the best option. Business enterprises follow their customers or they go out of business. Just don't forget those children  

Sunday, May 18, 2014


Georges Clemenceau said that war is too serious a matter to entrust to military men. There are, however, examples of military men who warned against war that politicians rushed to embrace. The same principle should be applied to health insurance, and Medicaid is a prime example. It could be a program to improve the health of the most vulnerable and sickest portion of our society or just another gold rush in a poorly conceived health system. A study from the University of Michigan reveals that the poorer health of surgery patients covered by Medicaid results in more complications, longer hospitalization and higher cost than patients with private insurance. I doubt that comes as a surprise to medical people, even surgeons. But, how urgent is the surgery? A wise surgeon once told me surgical skill is easier than knowing when to operate. Sad to say the hospitals will take the first step into the breech in order to brake their financial loses. Meanwhile, the medical community will continue to complain that medical decisions are taken out of their hands by administrators, bureaucrats and politicians.     

Granted the Medicaid population has more health problems and more serious health problems than the general population and certainly more than the population with private health insurance. During the early stages of expansion of Medicaid there will be financial strain. But what better population could there be to link health care with medical care to improve health status. Somewhere there needs to be a demonstration that the health care/medical care community can manage this problem. It is a more comprehensive approach than emergency rooms and surgical suites. I remember when during the early development of Family Medicine as a medical specialty they emphasized behavioral science. Maybe schools of public health should be a more active component in the struggle. Perhaps the University of Michigan will rise to the challenge now that they have highlighted the problem.      

Saturday, May 17, 2014

Health Risk

People don't understand health risk. This leaves the door open for those who will to play politics and make money with the issue. Perhaps one day there might be foolproof diagnostic procedures, surgeries and drugs that will detect and treat disease without error or consequences at a low cost. But those days appear to be in the distant future. Meanwhile, secondary prevention as it currently exists is a loser both from a health and economic point of view. There is more than sufficient evidence to demonstrate the health and economic benefits of primary prevention starting with vaccinations and continuing with lifestyle including physical activity (exercise), nutrition, sleep and stress relief. The best thing the government could do for health is provide the opportunity for education, meaningful work and physical and economic security. In that regard, health insurance is as much, if not more, economic security than it is health security. Just as secondary prevention is not as beneficial as primary prevention, medical care is not as beneficial for optimum health status as health care.     

Tuesday, May 13, 2014

Overtreating Medicare Patients

This study on the magnitude of over-treating Medicare patients should come as no surprise to anyone. Over or under is in the eyes of the observer or the recipient and this is especially true in healthcare. Are there any unbiased opinions in health? Depends on whether it involves you or not. And, then, there is the business of medicine which involves both pressures to generate revenue and to save costs. Throw in politics and you have a witches brew. Coming to do good is getting to be ever more difficult. But people can do better for themselves by appreciating that the highest technology for health is contained within their body. Utilizing that technology is a personal and a community task with the potential for achieving a level of health far beyond that of any medical intervention.    

Tuesday, May 06, 2014

Health Insurance and Death Rate

In Massachusetts the implementation of mandatory health insurance coverage resulted in a significant decrease in death rate. It would appear this occurred mostly among poor patients with serious illness. If this holds up to further scrutiny it would confirm this is the group with the most to gain from mandatory health coverage. It would also indicate the most important aspect of the Affordable Care Act for improving health is the Medicaid provision.