…with an unbelievable ending.
First, links to stuff you may have missed.
–A joint oped with Ben Spielberg on why work requirements for Medicaid are a really bad idea. House R’s tried to win over their hard right colleagues by adding this to their benighted health care bill, which by now you know failed anyway. But I fear it ain’t going away.
–Speaking of Ben, here’s a link to our podcast episode #5, on health care, of all things, with an absolutely kickin’ musical interlude and a…um…long joke by Ben.
–I contend, and events suggest I may be right, that for the R’s, health care reform is a lot harder to pull off than tax cuts. So why did they start with health care? Here’s why.
–Finally, off the top of the old noggin’, I just scratched out a bunch of explanations as to why the R’s failed to repeal/replace O’care. See what you think, and add your own additions in comments.
Now, I plan to not think about health policy all weekend. Instead, I’ll watch and listen to this mind-altering performance of Mozart’s Violin Concerto #3 by the incomparable Hilary Hahn. If the cadenza at the end of the first movement doesn’t give you chills, please check your pulse, as you may have perished. To say that this music/performance is the universal opposite of the R’s health care plan isn’t quite right–they don’t belong to the same universe. But you maybe know what I mean. There is still a lot of good in the world, if you know where to look for it.
How in the world can you describe what the Republicans are trying to do as “health reform”? Talk about accepting the Republican framing of an issue! There is no “reform” there whatsoever. It’s just pure evil. How can anyone describe abolishing insurance for over 20 million people, and consigning a few tens of thousands to an unnecessary death, and a few hundred thousands to loss of their life savings when a major health crisis hits, as anything other than pure evil? Are Democrats capable of feeling passionately about anything, or is civility the only value?
Well, health care delivery is complicated. Complicated mainly because medicine is ultimately fighting death and the 2nd Law of Thermodynamics. Thanatus always wins,,, I am reminded of the Orphic Hymn:
“Thy sleep perpetual bursts the vivid folds
by which the soul, attracting body holds :
common to all, of ev’ry sex and age,
for nought escapes thy all-destructive rage.”
Thus, nobody escapes the grip of Death and the lamentations of disease. It is part of Nature, and thus, it is not RATIONAL to insure against an event certain. Ah, the folly of “Health Insurance”! Is this not the institutional aspiration of our conquest of Death?
We must nevertheless act with Charity and Compassion to all fellow humans (and the rest of Creation) and make the passage in this “valley of tears” as light and pleasant as possible.
If we are to develop a process to correct our current system, we must not confuse the issues of the cost of health care and the cost to society required to satisfy that cost. I think the current narrative has confused both issues and made them equal. Big mistake.
We must control the cost of health care and align it to evidence based and outcome validated treatments. The rubber meets the road in this instance in the physician-patient relationship. The physicians must exert leadership using those treatments that are empirically validated, And, the patients must accept personal responsibility in their care and in their life choices. Cigarette smoking, opiate addiction, weight control and sedentary lifestyles are just examples of poor health choices. Physicians must guide their patients as they choose these lifestyles and as they choose treatment options for the diseases they have encountered. Society and its government structures must provide the needed substrate to promote a healthy lifestyle: decreased pollution, promotion of activity, equitable distribution of income, affordable homes and education so that we can make better rational choices.
Health care reform is then societal reform! How intellectually arrogant can we be by thinking that a piece of legislation can change such a structure? It is not surprising that both ObamaCare and the Ryan/TrumpCare will fail,
We can and should do some changes (in the periphery?) that should be easier:
1. Provide Medicare with the ability to negotiate with the pharmaceutical companies
2. Prohibit the direct marketing of pharmaceuticals to MD’s and the media
3, Provide the sale of insurance products across state lines
4. Decrease the onerous regulation of health care, including the development of an Electronic Medical record that is universal or the ability of ENR’s to “talk” to each other.
5. Data acquisition that directs future care (Evidence based medicine).
6. Seriously attack fraud and abuse
7. Using the Pareto Principle focus on: opiate addiction, automobile accidents, obesity and the cost of high risk populations (the great majority of Medicare expenditures occur in the last year of life of Medicare recipients).
This is longer than I intended, but it just gives you a flavor of the complexity of the issue. If we are to “solve” this, it must be a bipartisan effort, for Theratus is neither a Democrat or a Republican – they both will be in his grip.
Regarding Mozart # 3 Violin Concerto – I have Anne-Sophie Mutter with the Berliner Philharmoniker and Herbert Von Karajan on – for inspiration…
One could look at other countries with lower costs for different varieties of proven solutions. However, American lifestyles are also sicker than most, which needs to be addressed too. How to solve this culturally? If one can’t even get smokers to quit or curtail use, what hope is there for eating?
What percent of increased costs in America is the result of lifestyle? Fortunately none. The U.K. has high levels of obesity for example, but low costs. Ok, maybe not zero relationship, in that we don’t want to emulate U.K.’s system, but health can not possibly be a heavily weighted factor given this condition.
I must add that Medico-Legal reform and robust error mitigation must be part of this formula
Mozart? How about Bud Seger and “That old time rock n roll.” That kind of music just soothes the soul.
Are written transcripts of the podcasts available?
Nope, sorry! Agree about the old time rock ‘n roll, though. Was just watching old TAMI shows on YouTube last night–amazing stuff.
There’s nothing like good classical music to tickle the brain.
I have a suggestion in response to recent legislative developments:
Please look into providing encrypted access to your blog. Nobody should have the right to invade and sell our thoughts as ISPs are trying to do. Any site without an HTTPS connection is open to unfair eavesdropping by greedy, exploitive behavior.