Health Care

Education and traditions.

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In my years in medicine, which began in 1961 or even earlier with premed, I met a few very colorful teachers. From time to time, I would like to profile some of them lest they be forgotten as people and remain only an entry in a dusty bound volume in a library. One such was a neurosurgeon named Aidan Raney. When I began to do a little research on him, I found that Google searches turn up only his son, a very good cardiac surgeon in Newport Beach. I remember the son as a high school student I met once.

When I was a third year medical student, my medical school had a program in which students could spend a summer with private practice physicians to see what the life was like. I spent a summer with Aidan Raney. I wasn’t so much interested in neurosurgery but wanted to see more of it before I committed myself to a career. Doctor Raney had been the first neurosurgery resident at the new Los Angeles County Hospital after it opened in 1933. The old hospital, now torn down, had been in service since about 1913. The University of Southern California medical school, which had closed in 1920 as a consequence of the Flexner Report, reopened when the new hospital opened and graduated its first class in 1932.

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But the evidence is right there – right there! – in front of you.

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(paraphrasing a conversation)

Me: Hi, I’m calling about my AMA dues notice?
AMA representative: Yes?
Me: I’m not a member currently. I’d like to be removed from your mailing list, please. I don’t plan on becoming a member any time soon, so I don’t need the dues notices.
AMA representative: Okay.

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From the AMA website a couple of days before the vote: “Washington, D.C. After careful review and consideration, the American Medical Association (AMA) today announced its qualified support for the current health reform bill as a step toward providing coverage to all Americans and improving our nation’s health system.”

Also from the AMA website (where they have a counter “counting down” to the 21% Medicare Physician cuts with the admonition to “take action now”:)

“Resolving the problem now is the fiscally responsible course to take. Relying on past methods of postponing the immediate crisis will only increase the cost of a permanent repeal. Congress can no longer afford to kick the can down the road.”

Does anyone want to explain the above statement to me? Seriously, I’m trying to understand what the organization might mean with that statement about fiscal responsibility – as they ask members to call and complain about cuts to physician medicare payments. What was that about CBO scoring again? I’m a dunce at all of this, so I ask for help from the readership! It’s a real question….

“What people need to know is that Obama’s plan evades health care’s major problems and would worsen the budget outlook. It’s a big new spending program when government hasn’t paid for the spending programs it already has.”

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– From this Robert J. Samuelson article in the Washington Post (via Instapundit).

Many CB readers likely have read the above article, which does a nice job challenging certain aspects of the intellectual and policy “group-think” at the heart of ObamaCare. But never fear – I’m sure the same political class that sends its children to private schools in D.C. will cheerfully take its place in line with the rest of us should the “reform” fail to live up to expectation.

Update: Ezra Klein interviews Rep. Paul Ryan.

A rapacious and greedy Technocracy

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technocracy

Obama health care plan online. (Relax. It’s a joke. Or, is it?)

The image is by editorial cartoonist Winsor McCay and I came across the image at the wonderful art blog linesandcolors.

Update: In the comments, Michael Kennedy adds: “CBO says there are not enough details to score the new “bill.” What else is new?”

Yes. What else is new? Also, this via Drudge: “An unapologetic Danny Williams says he was aware his trip to the United States for heart surgery earlier this month would spark outcry, but he concluded his personal health trumped any public fallout over the controversial decision….This was my heart, my choice and my health,” Williams said late Monday from his condominium in Sarasota, Fla.”

Be aware: If the health care plans don’t work as smoothly as gamed by the white paper crowd, the connected will exempt themselves from the worst of it. They always do. Do Senators tend to fly coach?

So, doesn’t change mean change?

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“The small bill aims to make health insurance more accessible, affordable, and portable — without increasing government control, jeopardizing the quality of care, or breaking the bank” Small-Bill Proposal for Sensible Health-Care Reform

“We have to learn to do health care in fundamentally new ways in the next twenty years. The changes needed are much more radical and sweeping than anything envisioned in the current legislation — and it will take a very different mindset to make them happen. The current bill is a classic example of steady state, blue social model thinking: it is more interested in keeping the status quo going by pumping more money into it than it is in the basic restructuring needed to build a system that will work in the future.” Walter Russell Mead

The latter excerpt (thanks to LG for the link) highlights, in a way, the frustration I experience practicing in a teaching hospital. It’s all chasing zanaflexhome state and federal dollars and arguing reimbursement rates. Well, naturally. But the really innovative things that we could do? Who, exactly, is doing them stateside? The “cash-only” doc drop-outs? Walmart, Walgreens and CVS clinics? Concierge practices and out-sourced medical diagnostics? I suppose government regulation makes it impossible to be innovative in the most radical way.

Seriously, I am so in the weeds with the day-to-day – just crushed by it – that I have no idea. We should be thinking innovation and nimbleness, and instead, our thinking is staid, staid, statist-ly staid. Because the Walter Russell Mead post makes the point that technology is going to throw the medical profession for a loop, and I think we are not ready to absorb those changes as a profession. Despite all the academic blather (because of ?), we are not ready.

What do you think are the important health care trends the current national “discussion” is missing?