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  • Archive for the 'Health Care' Category

    The Revenge of John McCain.

    Posted by Michael Kennedy on 1st December 2018 (All posts by )

    John McCain Was elected to Congress in 1982 and elected to the Senate in 1986 taking the seat previously held by Barry Goldwater. In 1989, he was involved in the “Keating Five Scandal.

    The five senators—Alan Cranston (Democrat of California), Dennis DeConcini (Democrat of Arizona), John Glenn (Democrat of Ohio), John McCain (Republican of Arizona), and Donald W. Riegle, Jr. (Democrat of Michigan)—were accused of improperly intervening in 1987 on behalf of Charles H. Keating, Jr., Chairman of the Lincoln Savings and Loan Association, which was the target of a regulatory investigation by the Federal Home Loan Bank Board (FHLBB). The FHLBB subsequently backed off taking action against Lincoln.

    The late 1980s were the era of the Savings and Loan scandals.

    The Federal Home Loan Bank Act of 1932 created the S&L system to promote homeownership for the working class. The S&Ls paid lower-than-average interest rates on deposits. In return, they offered lower-than-average mortgage rates. S&Ls couldn’t lend money for commercial real estate, business expansion, or education. They didn’t even provide checking accounts.

    In 1934, Congress created the FSLIC to insure the S&L deposits. It provided the same protection that the Federal Deposit Insurance Corporation does for commercial banks. By 1980, the FSLIC insured 4,000 S&Ls with total assets of $604 billion. State-sponsored insurance programs insured 590 S&Ls with assets of $12.2 billion.

    Inflation in the late 1970s and early 1980s led to pressure on Savings and Loan institutions that had been lending money at 6% to home buyers but savers were demanding higher interest rates to compensate for inflation. The S&Ls were caught in the “Borrow high and Lend low” vise that led to their demise.

    My review of Nicole Gelinas’ book on the 2008 economic crisis includes some discussion of the 1986 problems.

    The story of the 2008 collapse begins in 1984 with the rescue of the Continental Illinois Bank. Here began the “too big to fail” story. Two things happened here that led to the crisis. One was the decision to bail out all depositors, including those whose deposits exceeded the FDIC maximum. Secondly, the FDIC guaranteed the bond holders, as well. Thus began the problem of moral hazard. Another feature of this story was the role of Penn Square Bank, which had gone under two years earlier in the wake of the oil price collapse, which devastated many of its poorly collateralized loans in the oil industry. Both banks had been caught seeking higher returns through risky investments. Penn Square, however, had been allowed to collapse. Continental was rescued and that began a trend that the author lays out in detail through most of the rest of the book.

    The 1986 crisis and the 1989 scandal affected McCain deeply. He was a freshman Senator and was probably included in the group for two reasons. First he was the only Republican and Second, Keating, a Phoenix developer, was a constituent. McCain was humiliated and his ego was as big as all outdoors.

    His reaction to his humiliation was once of the worst pieces of legislation in the 20th century, The McCain-Feingold Act.

    In 1995, Senators John McCain (R-AZ) and Russ Feingold (D-WI) jointly published an op-ed calling for campaign finance reform, and began working on their own bill. In 1998, the Senate voted on the bill, but the bill failed to meet the 60 vote threshold to defeat a filibuster. All 45 Senate Democrats and 6 Senate Republicans voted to invoke cloture, but the remaining 49 Republicans voted against invoking cloture. This effectively killed the bill for the remainder of the 105th Congress.

    McCain, still in his “Maverick mode and still running on ego, persisted.

    Read the rest of this entry »

    Posted in Big Government, Elections, Health Care, Personal Narrative, Politics | 19 Comments »

    Where is health care going ?

    Posted by Michael Kennedy on 28th August 2018 (All posts by )

    UPDATE: A new analysis of Obamacare’s role in the conversion of American Medicine to an industry with corporate ethics.

    The health system is now like a cocaine junkie hooked on federal payments.

    This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress. The irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman.

    Hospital groups, the American Medical Association, the AARP and groups like them are on board too. They are joined by the Catholic Bishops and groups like the American Heart Association and the American Lung Association. (If you are donating money to any of these groups you might want to think again.) This multi-billion dollar health industrial complex has only one solution to every Obamacare crack-up: more regulation and more tax dollars.I practiced during what is more and more seen as a golden age of medical care. Certainly the poor had problems with access. Still, most got adequate care, either through Medicaid after 1965, or from public hospitals, many of which were wrecked by Medicaid rules and by the flood of illegal aliens the past 40 years.

    Obamacare destroyed, probably on purpose, the healthcare system we had. It had been referred to by Teddy Kennedy, the saint of the Democrats Party as “a cottage industry.” As far as primary care was concerned, he was correct. What we have now is industrial type medicine for primary care and many primary care doctors are quitting.

    So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.

    There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.

    “There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.

    There are several reasons, I think. I have talked to younger physicians and have yet to find one that enjoys his or her practice if they are in primary care. That applies to both men and women. Women are now 60% of medical students. This has contributed to the doctor shortage as they tend to work fewer hours than male physicians.

    A long analysis of physician incomes shows that 22% of females report part time work vs 12% of males.

    Physicians are the most highly regulated profession on earth. The Electronic Health Record has been made mandatory for those treating Medicare patients and it has contributed a lot to the dissatisfaction of physicians.

    THE MOUNTING BUREAUCRACY
    This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

    If I remember my arithmetic, that adds up to 99% unhappy with the EHR.

    Most primary care physicians I know are on salary, employed by a hospital or a corporate firm. They are require to crank out the office visits and are held to a tight schedule that does not allow much personal relationships with patients. The job satisfaction that was once a big part of a medical career is gone.

    Posted in Health Care, Medicine, Obama, Politics | 43 Comments »

    Retrotech, Revitalized

    Posted by David Foster on 24th August 2018 (All posts by )

    A triple-expansion steam engine, which was used for water pumping in Phillipsburg NJ, has been restored to operating condition thanks to a small group of dedicated volunteers.  The engine, which pumped 6 millions gallons per day to a reservoir 265 feet above its level, was built in 1913 and was in continuous operation until 1969, when it was put into standby status (the pumping duties having been taken over by electric pumps) and finally removed from service in 1982.  Here’s a video of its final run in 1982, which has turned out to not be so final.

    The boilers have not yet been restored; test runs were done using a portable commercial rent-a-boiler as the steam source.  The team intends to restore one of the boilers as well in the future.

    When people think about the vast improvements in health and lifespan over the past century and a half, attention tends to be focused on antibiotics, better medical care, x-ray and scanning equipment, etc.  Public water systems, enabled initially by waterwheels and especially by engines like this one, played an important role as well.

    The restoration team has a Facebook page, here.

    See also my posts 301 Years of Steam Power and 175 Years of Transatlantic Steam.

    Posted in Energy & Power Generation, Health Care, History, Tech | 7 Comments »

    CON Does Seem Like an Appropriate Acronym

    Posted by David Foster on 5th August 2018 (All posts by )

    Thirty-five states and the District of Columbia currently impose certificate-of-need (CON) restrictions on the provision of healthcare. These rules require providers to first seek permission before they may open or expand their practices or purchase certain devices or new technologies. The applicant must prove that the community “needs” the new or expanded service, and existing providers are invited to challenge a would-be competitor’s application.

    …from a Mercatus article on healthcare “Certificates of Need”, linked by The Advice Goddess.

    In most other industries, collusion of providers in order to keep supply down–and, hence, prices up–is considered an antitrust violation and can carry heavy civil and criminal penalties.

    Does anyone see any legitimate public-policy rationale for the requirement for the CONs in healthcare?

    Posted in Big Government, Business, Health Care | 20 Comments »

    Citizens, Subjects, and Audience

    Posted by Sgt. Mom on 30th April 2018 (All posts by )

    I am distracted this week, through having to oversee and assist with a spot of home renovation, and the launch of Book Six of the Luna City Chronicles – One Half Dozen of Luna City, which is available as of today in print, Kindle and other ebook formats – although by no means have I not paid attention to various news hiccups which caught my fleeting attention as they went past.

    As a parent, I can’t help but be sympathetic and supportive of little Alfie Evans’ parents, whose medical situation was as heartbreaking as it was mysterious and likely terminal. Just as I cannot help being viciously cynical regarding the decision by hospital and National Health Service administrators to set the poor tot on the so-called Liverpool Care pathway. Over the strenuous objections of his parents, the church which his parents apparently belonged to, any number of advocates for the rights of parents – all life support cut off, including oxygen, nourishment and water, with the powers of the State and its police minions standing by to enforce the dictates of the state. Read the rest of this entry »

    Posted in Anglosphere, Big Government, Civil Liberties, Current Events, Health Care, Media, The Press, Trump | 38 Comments »

    “ObamaCare Fines Nailed The Working Class In 2017 And Other Unpopular Truths”

    Posted by Jonathan on 29th July 2017 (All posts by )

    Investor’s Business Daily:

    Preliminary data from the 2017 tax season are in, and they’re shocking. Not only does it look like the working class bore the brunt of ObamaCare individual mandate penalties this year, but people with relatively modest incomes apparently paid a lot more than the Congressional Budget Office anticipated.
     
    [. . .]
     
    The 2017 tax data offer new evidence that there’s much to be gained by moving away from the individual mandate and much to lose by sticking with it. Tax returns that had been processed as of April 27 included 4 million that paid ObamaCare fines (officially known as individual shared responsibility payments), with an average payment of $708.
     
    What is striking about the data is that the average payment is barely higher than the minimum payment of $695. Since people were required to pay the greater of $695 or 2.5% of taxable income above the filing threshold ($10,350 in 2017), one takeaway is that most of the $2.8 billion in fines paid through April appear to have come from people with modest to moderate incomes. As a frame of reference, CBO’s 2014 analysis implied that the average mandate payment for this tax season would be roughly $1,075 and that the total amount paid by people earning up to three times the poverty level would barely exceed $1 billion.

    There is much more interesting information in the article. Worth reading in full.

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    Posted in Big Government, Economics & Finance, Health Care, Obama, Politics | 19 Comments »

    Access, Access, Access

    Posted by Ginny on 3rd July 2017 (All posts by )

    “Access, Access, Access” Rick Perry repeated to Bret Baier. It seemed a grilled candidate’s non sequitur to Baier’s question: weren’t many Texans uninsured? But I was struck by its truth. Insurance is of little use if no doctors take it, no medicine is available, deductibles and premiums are unmanageable. Positive rights – to food, to medicine, to jobs – are not rights. The theory never stands up to experience.

    Perry’s run was brief; now, his task is encouraging access to energy – of all kinds. Trump seemed an example of excess – still is, I guess. But a nation not just energy independent but energy dominant is one empowered, free. And we can free others: a Europe not beholden to Russian oil is a healthier Europe. Neither Trump nor Perry invented fracking nor could Obama stop its success. But this administration respects it, clears the way for its natural flow.

    Access, access, access – how much does access to energy change our lives each day? How many are alive today because of access to energy forms unknown or at least unused 300 years ago? (Without air conditioning, I would have left my husband years ago. Then, again, he might have come with me.) Consider, though, the other extreme: we would be shocked to hear of elderly couples found frozen in the depth of winter, not uncommon in other times and places. How much more food is generated because of cheap energy? How broadly is food distributed?

    Read the rest of this entry »

    Posted in Americas, Energy & Power Generation, Entrepreneurship, Health Care, Human Behavior | 12 Comments »

    Worthwhile Reading – Science and Technology Edition

    Posted by David Foster on 15th May 2017 (All posts by )

    It seems that octopuses have the ability to edit their RNA dynamically.

    An interesting piece on FDA regulation and medical device innovation.

    Zymergen has automated part of the drug discovery process via a combination of robotics and machine learning.

    Was big data analytics (more specifically, excess faith in same) a major cause of Hillary Clinton’s electoral loss?

    Is there an artificial intelligence misinformation epidemic?

    Cotton spinning – a quintessential technology of the Industrial Revolution – returns to England.

    But to what degree will spinning, as well as weaving, cutting, and sewing, be replaced by 3d printing of clothing?

    James L Taylor Manufacturing, a 106-year-old company making clamps and other woodworking tools sold to producers of furniture, flooring, and cabinets, recently introduced a robotic nester…it replaces the work of a human nester who “snatches boards coming off a conveyer belt in random lengths, hastily rearranges them so that each row of one to five pieces is so long, and bundles the rows into a stack.” One mill in Mississippi placed an urgent order for 3 of these (at $115K each) with the explanation: “I have eight nesters and four of them just called in sick.”

    What is especially interesting about this is that the robotics system was not developed by hiring consultants from MIT or Silicon Valley; the company’s chief engineer (also part-owner of the company) designed the machine himself and wrote the 7000 lines of C++ code to run it.  Reminds me of the cucumber sorting machine developed by a Japanese guy to help out on his parents’ cucumber farm..although that system was developed for the family’s own use rather than as a saleable product as with the robotic nester.

    Posted in Business, Entrepreneurship, Health Care, Medicine, Tech | 6 Comments »

    Dodd-Frank, Obamacare grew out of same faulty reasoning

    Posted by Kevin Villani on 6th March 2017 (All posts by )

    The current partisan war over the Dodd-Frank Act is just one dispute in a broader ideological divide about the government’s role in industry. This dispute, which has deep historical roots, includes a similar battle over Obamacare. The common disagreement at issue with both laws — now in the cross hairs of a GOP-controlled Washington — is the extent to which politicians should subsidize their constituents indirectly through regulation of private companies.

    The Affordable Care Act governing health insurers was about 1,000 pages, and Dodd-Frank governing most other financial institutions was more than twice that. Both stopped short of nationalizing their respective industry, instead generating more than 10 pages of regulation for every one page of legislation, although many view nationalization as an eventual but inevitable consequence, particularly for health care.

    The distinction between public control and public ownership is the primary distinction between the competing mid-20th-century ideologies of fascism and communism. In contemporary terminology, this distinction is between crony capitalism and nationalization, neither of which can be reconciled with competition and freedom of choice.
    Read the rest of this entry »

    Posted in Big Government, Business, Capitalism, Crony Capitalism, Economics & Finance, Health Care, Obama, Political Philosophy, Public Finance, Systems Analysis | 10 Comments »

    Hillary Clinton’s Alinskyite Attacks on Pharma Companies

    Posted by Jonathan on 25th August 2016 (All posts by )

    “Pick the target, freeze it, personalize it, and polarize it.” (Saul Alinsky)

    Hillary is clever to go after individual companies. If she attacked the pharma industry as a whole, it could unite politically in response and perhaps gain political support from other industries that would reasonably see themselves as similarly vulnerable. But individual companies have no defenses against this kind of attack. By singling out one victim she discourages other industry players from doing anything in response, because any company or industry group that responds risks being targeted in the future.

    She has done this kind of thing before. She will probably keep doing it because it’s politically effective. Her attack on Mylan destroyed a large amount of wealth, and probably not just for Mylan’s shareholders. Today Mylan’s CEO is groveling in the media. As with past political attacks by Hillary and others on vaccine manufacturers, yesterday’s attack on Mylan will discourage pharma companies from introducing valuable new products and will reduce the availability of current products. We will probably see more of this kind of extortionate behavior by the federal govt if she is elected, because that’s how the Clintons operate and because a Hillary administration would appoint more lefty judges and DOJ and regulatory officials who would go along with it.

    Posted in Big Government, Crony Capitalism, Economics & Finance, Health Care, Leftism, Markets and Trading, Politics | 42 Comments »

    Why Importing Foreign Doctors May Not Solve the Shortage.

    Posted by Michael Kennedy on 17th April 2016 (All posts by )

    MoS2 Template Master

    The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

    How is the plan to import foreign doctors working out ?

    Not very well.

    Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
    Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
    Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

    First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

    Read the rest of this entry »

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    Posted in Big Government, Education, Health Care, Immigration, Medicine | 15 Comments »

    The Doctor Shortage revisited.

    Posted by Michael Kennedy on 1st April 2016 (All posts by )

    33 - Lister

    I have previously written posts about a coming doctor shortage.

    They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

    The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

    This is all well and good. What happens when a patient comes in with a serious condition ?

    The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

    I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

    I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.

    Read the rest of this entry »

    Posted in Big Government, Education, Entrepreneurship, Health Care, Medicine | 19 Comments »

    A Tale of H1B Workers in Dallas‏

    Posted by Trent Telenko on 25th January 2016 (All posts by )

    This H1B American worker replacement program for multi-national megacorporations is getting real. It isn’t limited to the IT industry workers and Disney actors training their own H1B visa replacements any more. It is now hitting the American health care industry in the skilled medical technician level, many of whom are college educated American citizen minorities, at least here in Dallas.

    I just saw the local CVS pharmacy I use replace several college educated, Black Female, Hispanic female and Hispanic male Pharmacists, with Indian H1B workers last week.

    The reason this sticks out in my wife went to pick up a changed 30-to-90 day prescription of mine for which the CVS Pharmacy has insufficient meds. A typical case of Indian “IT help desk hell” occurred with two people with incomplete knowledge of the issues of my meds, with the H1B worker trying to get 90 days of prescription price from my wife for 30 days of meds. No transaction happened.

    I can only wonder what a seventy something retired senior trying to get his or her meds are dealing with this corporate H1B visa imposed communication problem?

    And I also wonder about all those minority med-techs I see replaced here in Dallas are dealing with this?

    The same way white male 40-to-50 something White male electrical engineers have in Silicon Valley for the last 15 years? The corporate versus middle class politics of this are poisonous in this Presidential season.

    Consider the implications for the Black vote for Trump in Nov 2016. Trump’s Florida polls show him with _40_%_ of the below $25,000 a year black males over his plan to close the Mexican border with a wall. If Trump gets the same 1-in-5 vote that Richard Nixon got in 1972 with Obama’s 2008 and 2012 turn out percentages, he will take at least 45 states in the electoral college.

    This is the electoral power of a real “closed borders” Presidential candidate.

    And the corporate K-Street political contributor class behind both political parties still doesn’t see it coming.

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    Posted in Civil Society, Customer Service, Health Care, India, Politics, Polls | 28 Comments »

    New Era Drugs and Death

    Posted by Carl from Chicago on 17th January 2016 (All posts by )

    One of the most fascinating shows that I watch is called “Drugs, Inc.” on National Geographic, which describes the “business” of drugs from its creation (chemicals) or growth (agriculture), through transportation (to America or Europe) and then to distribution (street level), along with interviews with drug abusers and their families.  I did a blog post about this show here if you are interested.

    Unlike television shows with a “narrative arc” of redemption, the business of Drugs, Inc. shows users as ever-insatiable and ever-addicted to the various drugs that are investigated by the show.  Drug dealers are meeting demand that exists and is never questioned; the only risks to the dealer are competition from other cartels / distributors or the police.  The fact that demand will always be there assuming the quality of the product is solid is taken as a given.

    When they interview addicts their lives are not glamorous and often are morose and filled with regrets.  The addicts may take an hour to find a place on their body to inject the drug, they steal from their own families, and they live brutal and dangerous lives in order to acquire the cash to make the next fix.  The traditional high school movies that tried to scare you off drugs have nothing on this systematic and pragmatic approach to just watching the destroyed lives of drug users as they live to support their next fix.

    Read the rest of this entry »

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    Posted in Business, Current Events, Health Care | 17 Comments »

    More evidence that Obamacare is just expanded Medicaid.

    Posted by Michael Kennedy on 2nd November 2015 (All posts by )

    I have been saying that Obama care is just Medicaid for all. As time goes by, here is more and more evidence that this is the case.

    The latest evidence is in The Wall Street Journal and behind a pay wall but I will quote some of it.

    But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.

    In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.

    But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

    And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.

    My earlier objections to Obamacare were that it promises too much and pays too little.

    As it turns out, Medicaid patients can’t get appointments with physicians.

    “America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine | 6 Comments »

    Medicine: The Public-Health Model is Wrong

    Posted by Jonathan on 30th October 2015 (All posts by )

    This Theodore Dalrymple post is a variation on a conventional argument whose unstated main premise is that medical cost decisions should be evaluated from a public-health perspective.

    The annual medical is a kind of ceremonial or ritual which, according to its critics, is without rational foundation despite the fact that so many patients, and perhaps a majority of doctors, believe in it. This proves that superstition is not dead: but perhaps that is no fatal criticism of the annual medical after all, because superstition will never be dead. If it does not attach to one thing, it will attach to another.
     
    [. . .]
     
    In fact, most medicals are bureaucratic procedures rather than exercises in getting-to-know-you (as The King and I put it). The doctor asks a few questions, ticks some boxes on a computer screen, performs a perfunctory physical examination equivalent to examining a cubic inch of haystack to find a pin, and does a few selected blood tests, the interpretation of whose abnormal results (if any) will be far from straightforward. In fact, what has been done and measured in annual medicals over the years has changed, without any change in their ineffectiveness.

    Ineffective for whom?

    The answer depends on who is paying the bill. If it’s third parties such as govts or insurance companies then the conventional argument has merit: maximizing system utility is an important goal. However, if patients control their own medical spending then the main goals should be whatever the individual customers want them to be.

    Dalrymple’s analyses are usually much better than this one. Perhaps his frame blindness in this case is a function of his background with the NHS.

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    Posted in Health Care, Medicine, Systems Analysis | 14 Comments »

    The Doctor Shortage Update.

    Posted by Michael Kennedy on 5th October 2015 (All posts by )

    There is an interesting piece today in the Daily Mail about young NHS GPs quitting and going to Australia.

    In the past five years, the number of GP appointments made by Britons has risen from 300 million to 370 million a year, an increase of more than 20 per cent.
    The number of GPs employed to meet that demand has risen by around 1,600, or just over five per cent.
    All of which has led to the second major factor behind their exodus — in the UK, they often feel terribly overworked; after moving they find themselves having to spend far less time at the coalface.
    ‘More and more British GPs talk about the pressure they’re under,’ says Guy Hazel. ‘I’m not sure the general public understand how mentally draining it is to see 35 to 40 patients a day. All the British GPs I know are exhausted.’
    An Australian GP, by contrast, will see 20-25 patients per day.

    This concerns the young, newly trained doctors. I posted some concerns about the issue of primary care in the US.

    Primary care here is referred to as “General Practice” in Britain and they seem to be having a loss at both ends of the doctor career.

    Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

    According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

    Read the rest of this entry »

    Posted in Big Government, Britain, Health Care, Medicine | 9 Comments »

    Melanoma and Pregnancy.

    Posted by Michael Kennedy on 26th September 2015 (All posts by )

    This is just a brief post to mention that that today’s Daily Mail has an article about a pregnant women with a spreading melanoma. In my book, linked on this site, I have a chapter on melanoma and several stories of patients whose melanoma went wild during a pregnancy. There is no report in the medical literature that supports this connection. Most reports deny any connection, although a few mention some negative prognosis.

    The literature continues to be split on the role of pregnancy in melanoma; however, most recent series show no difference in survival. Multiple studies have failed to show significant effects of female hormones on melanoma cells or on the incidence or progression of melanoma.

    In my book, I describe several cases where pregnancy would “awaken” melanomas that had been removed years earlier or would stimulate worrisome growth in moles. Two of my patients had extensive metastatic melanoma during pregnancy that disappeared after the baby was delivered, in one case with my help. Both women were disease free many years later and neither had another pregnancy.

    How interesting that this young woman has developed metastatic melanoma during pregnancy. I wonder how it will turn out.

    Posted in Health Care, Medicine | 4 Comments »

    C. Steven Tucker on “Against the Current” with Dan Proft

    Posted by Lexington Green on 23rd September 2015 (All posts by )

    Steve Tucker

    My friend Steve Tucker may be the foremost expert on the Obamacare legislation. He was interviewed on Dan Proft‘s video show Upstream Ideas.

    Steve has an infuriating tale about being targeted by the IRS because of his public criticism of the Obama administration. The blatant abuse of government power by this administration is an outrage and a disgrace. The migration of the “Chicago Way” to Washington DC is a story which is suppressed, and the victims are ridiculed and dismissed by the mainstream media, if they are mentioned at all.

    One of the best things I ever did was go to some early Chicago Tea Party events. I met many wonderful, patriotic people. Steve Tucker is one of the best.

    Posted in Health Care, Obama, Tea Party | 3 Comments »

    A Day at Ypres

    Posted by Michael Kennedy on 13th September 2015 (All posts by )

    We spent today at Ypres an the huge military cemeteries from the battles of the Ypres Salient.

    This was an early battle of WWI and the “first battle of Ypres” occurred at the end of “The Race to the Channel.” I have read a bit about the First World War but it really comes home when you are standing the place that consumed the British youth in 1914 to 1918. The First Battle ended the Race to the Sea and began the trench warfare of the next four years.

    We visited the “Sanctuary Wood Museum today, and I took some photos of the trenches which were preserved all these years by then owner of the small cafe where we had a beer.

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    Ypres

    These trenches are the originals preserved by the property owner who probably has cleaned out debris over the years. The owners of the cafe are the children of the original owners of the property who preserved these relics. Their museum has many objects no doubt excavated from the fields around.

    Recent highway construction, which has now been suspended, has bodies buried in a trench during the war, which are preserved.

    The bodies of 21 German soldiers entombed in a perfectly preserved World War One shelter have been discovered 94 years after they were killed.
    The men were part of a larger group of 34 who were buried alive when a huge Allied shell exploded above the tunnel in 1918, causing it to cave in.
    Thirteen bodies were recovered from the underground shelter, but the remaining men had to be left under a mountain of mud as it was too dangerous to retrieve them.
    Nearly a century later, French archaeologists stumbled upon the mass grave on the former Western Front in eastern France during excavation work for a road building project.

    The road building has been suspended for now but every construction project in this area uncovered evidence of war dead. Today we visited an enormous memorial for the war dead whose bodies were never recovered. It is called the Menin Gate Memorial and the names of 54,000 dead are posted on the walls representing most of the dead from the Ypres Salient who could not be identified.

    Menin Arch Memorial

    The sheer number of dead whose bodies were destroyed, or lost, is staggering.

    The city of Ypres (pronounced by our hosts as “eep” has been rebuilt as it was destroyed in the war.

    Ypres

    The cathedral was rebuilt from a stump of the tower. The bottom 20 feet to so was protected by rubble and is in better shape. The entire city was rebuilt completely.

    British WW1 Cemetery, Ypres

    The city is surrounded by British war cemeteries of which there are about 150, each with about 500 to 1,000 graves.

    Osler Grave

    One grave that particularly interested me was that of Sir William Osler’s only son who was killed by shrapnel while serving as an artillery officer in 1917. His fathers friends had tried to save him and his last words, reflecting many young men who were wounded, “Surely this (wound) will get me home. ” His last words.

    Today, we arrived at Brussels and will do some touring tomorrow of the Waterloo Battlefield. We passed on the road one of Wellington’s battle fields from the 18th century.

    The TV tonight is all about the “refugees” which we saw a few of today in Brussels.

    Posted in Europe, France, Health Care, Military Affairs, Personal Narrative, Photos | 6 Comments »

    The Coming Shortage of Doctors.

    Posted by Michael Kennedy on 3rd August 2015 (All posts by )

    33 - Lister

    I’m sure everyone is tired of my pessimism about politics so I thought I would try something new. Here is a piece on pessimism about health care.

    This Brietbart article discusses the looming doctor shortage.

    Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

    A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

    They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

    The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

    This is all well and good. What happens when a patient comes in with a serious condition ?

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    Posted in Health Care, Medicine, Politics | 22 Comments »

    Still Too Early – But Perry Makes Some Points

    Posted by Ginny on 6th July 2015 (All posts by )

    Most here haven’t commented on the darting and illusory fortunes of the huge Republican field; I’d mentioned earlier that Perry would have trouble – double or triple BDS syndrome, a bit too much of an Aggie for Texas, God knows for the rest of the country. But that great t-sipper, Kevin Williamson, discusses the case for Perry after a strong speech. That’s worth reading and both Williamson & Perry are worth while.

    Perry’s fighting, turning arguments around to free market principles, to the human: he did this earlier on the relatively friendly Fox’s Chris Wallace. Wallace pressed him on the number of uninsured Texans. Perry didn’t fight him on those grounds but on the far more important, far more serious, and far more consequential grounds of “access.” Access in Texas to health care has risen sharply with Perry’s policies. And, let’s face it, if there is enough access, all the assurances of insurance are pretty useless. Or, as Venzueleans found out, Chavez had promised to meet their every need – government promises of toilet paper and oil were there, access was not.
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    Posted in Entrepreneurship, Health Care, Medicine, Politics | 17 Comments »

    Obamacare Lives !

    Posted by Michael Kennedy on 25th June 2015 (All posts by )

    obamacare

    UPDATE: The decision is analyzed at Powerline today with quotes from the decision.

    The Affordable Care Act contains more than a few examples of inartful drafting. (To cite just one, the Act creates three separate Section 1563s. See 124 Stat. 270, 911, 912.) Several features of the Act’s passage contributed to that unfortunate reality. Congress wrote key parts of the Act behind closed doors, rather than through “the traditional legislative process.” Cannan, A Legislative History of the Affordable Care Act: How Legislative Procedure Shapes Legislative History, 105 L. Lib. J. 131, 163 (2013). And Congress passed much of the Act using a complicated budgetary procedure known as “reconciliation,” which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. Id., at 159–167.

    Therefore, Roberts rewrote it. Nice !

    Today, the Supreme Court upheld the Obamacare state exchange subsidies.

    The Supreme Court has justified the contempt held for the American people by Jonathan Gruber. He was widely quoted as saying that the “stupidity of the American people “ was a feature of the Obamacare debate. This does not bother the left one whit.

    Like my counterparts, I have relied heavily on Gruber’s expertise over the years and have come to know him very well. He’s served as an explainer of basic economic concepts, he’s delivered data at my request, and he’s even published articles here at the New Republic. My feelings about Gruber, in other words, are not that of a distant observer. They are, for better or worse, the views of somebody who holds him and his work in high esteem.

    The New Republic is fine with him and his concepts.

    It’s possible that Gruber offered informal advice along the way, particularly when it came to positions he held strongly—like his well-known and sometimes controversial preference for a strong individual mandate. Paul Starr, the Princeton sociologist and highly regarded policy expert, once called the mandate Gruber’s “baby.” He didn’t mean it charitably.

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    Posted in Big Government, Civil Society, Conservatism, Current Events, Economics & Finance, Health Care, Leftism, Medicine, Obama, Politics | 30 Comments »

    A Bleg.

    Posted by Michael Kennedy on 16th June 2015 (All posts by )

    cover.

    I have a new book out on Kindle that is now published. It is called “War Stories: 50 Years in Medicine.”

    I’ve been working on this for 20 years and kept having to revise it as I would put it down and then go back to it after ten years. I finally decided to rework it and publish it two years ago. My students were reading the draft on my laptop while I was editing so maybe it will be interesting.

    It is a memoir of patients. They are all patients’ stories that I have tried to describe accurately and to describe what we did then. Sometimes I screwed up and I tell those, too. Sometimes we did the best we could and we now know better. Some of these cases are still hard to explain.

    Two of them, in the chapter on Melanoma, are about young women who developed major melanoma metastases years after the primary was excised but when they had become pregnant. The melanoma went wild in pregnancy, in one case ten years later. In the other, three years after I had removed the primary, she developed extensive metastases while pregnant. She refused abortion and I thought it would cost her her life. In both cases the melanoma vanished after pregnancy ended. In one case, the woman, last I heard, was free of melanoma 25 years later. The other was free ten years later. The medical literature says pregnancy has no effect on melanoma. Neither ever became pregnant again.

    Another case is an example of the only supernatural near-death experience I have ever heard.

    The book starts when I began medical school in 1961 and describes experiences with patients, including my summer working with schizophrenic men in 1962. I have a series of stories about patients I saw as a student and sometimes intersperse stories from later that are about similar cases and events. One that is amusing, I guess, is about my very first pelvic exam, on a 40 year old prostitute who had just gotten out of prison and enjoyed it thoroughly. I had a dozen student nurses as witnesses. I do have some biography in it but try to keep it to minimum.

    After the first eight chapters, I go on to residency and then finally to private practice. I continued to teach and there are a few of those stories. There is a chapter on ethics including my thoughts on euthanasia and “benign neglect.” Toward the end of my career, I started and ran a trauma center in our community hospital. I also did a fair amount of testifying in court in both trauma cases and some civil cases where I testified for plaintiffs and for defense. I consider it a compliment that Kaiser Permanente had me testify for their defense even though I had also testified against them.

    Anyway, the book is on Kindle and I hope somebody is interested. It has some similarity to my medical history book, which I plan to do a Kindle version of once this one is launched. In this one, I spend some time explaining the diseases in a way that I used to explain to patients and I still do to students. Without some basic understanding, most of these stories would not make sense and I hope the explanations are not too dull. If so, all comments are welcome. If anyone likes it, feel free to post a review on Amazon. Two reviewers from the first book in 2004 told me to let them know if I did another one and I have contacted them.

    If anyone wants to discuss the book here, feel free to add comments.

    Posted in Biography, Blegs, Book Notes, Health Care, Medicine, Personal Narrative | 16 Comments »

    Why Doctors Quit.

    Posted by Michael Kennedy on 29th May 2015 (All posts by )

    Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

    It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

    1) Safe: Avoids injuries to patients from care intended to help them
    2) Equitable: Doesn’t vary because of personal characteristics
    3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
    4) Timely: Reduces waits and potentially harmful delays
    5) Efficient: Avoids waste of equipment, supplies, ideas and energy
    6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

    In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

    I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”

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    Posted in Big Government, Health Care, Medicine, Politics, Science | 17 Comments »