"Testing, Testing" great article about health care reform in The New Yorker

[Blackjack200]

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=all

Hopefully it doesn't ask you to subscribe, it didn't ask me.

Anyway it's just a really good article about the complexity of the problem of health care costs and how we will need to try a bunch of different things until we find what works. Dr. Gawande suggests that agriculture in the early 20th century was a problem similar to health care, with lots of small, local producers doing things their own way and costs that were crushing the US economy (the average family in 1900 spent almost half their income on food).

Gawande doesn't really get into the question of universal care so much, other than to point out that if we don't get costs under control, UHC could be destroyed.

It's an article that doesn't fit neatly into the traditional Democrat-Republican-Liberal-Conservative divide, so I expect the thread to sink like a stone, but cheers to anyone who cares to read and comment.

 

[cubeless]

just let people self prescribe for about half the pharmaceuticals out there to remove the cost of the doctor visit... people will make at least as good a choice as they do for stocks in their 401k's... that will help drop prices hugely... and bring on the end of the usefulness for a few more classes of drugs just that much sooner...

 

[GuitarDaddy]

Excellent article, this should be required reading for all involved in the healthcare debate.


It highlights the similarities between the current health care crisis and the agricultural crisis of the early 1900's and shows that for problems of this size and complexity there is no "silver bullet" or quick fix solution. It also shows how a concerted piecemeal trial and error approach to the agricultural crisis over time exceeded all expectations and played a big role in the US becoming a superpower. And it underscores how critital it is to take the first "baby steps" in the right direction as proposed by the current legislation.

This article forces you to step back and look at the bigger picture and understand that the current proposed legislation as sweeping as it may seem is just the first step in a long road to get where we need to be. And that in a journey of this length there will be "missteps" and compels us to move forward as we realize that the only true mistake we can make is to do nothing.

 

[GuitarDaddy]

just let people self prescribe for about half the pharmaceuticals out there to remove the cost of the doctor visit... people will make at least as good a choice as they do for stocks in their 401k's... that will help drop prices hugely... and bring on the end of the usefulness for a few more classes of drugs just that much sooner...

^^ Obviously didn't read the article

[facepalm]

Yeah, thats what we need everyone self medicating, thats the ticket
Since picking stocks is just like prescribing medicine this will work perfectly

 

[Thump553]

The author of that New Yorker is a surgeon. Here is a link to an audio version of roughly the same article that has been running on NPR recently:

http://www.npr.org/templates/story/story.php?storyId=121229972

And I agree-a refreshingly nonpartisan and truly objective viewpoint on the healthcare debate well worth at least reviewing by all, except for those only interested in reinforcing their partisan talking points (like death panels or "public option or nothing"). If only I could persuade that buffoon from my state, Joe Lieberman, to spend ten minutes listening to this.

 

[cubeless]

^^ Obviously didn't read the article

[facepalm]

Yeah, thats what we need everyone self medicating, thats the ticket
Since picking stocks is just like prescribing medicine this will work perfectly

ah, but back when you went to the pharmacist and he whipped you up something... now we have mass produced pills that should drive the costs down just like mass produced food... say something like any of the $5 scripts that walmart will do should not require a doctor's sig...

and, if you put the time and effort into deciding what stocks to pick then it is much like putting the time and effort into diagnosing an illness... alas both endeavors are fraught with uncertainty, since you only have your experience, intuition, and the facts at hand to make the decision... sometimes you make a good choice, sometimes not, but it's the same for a 'professional'...

this is the model in a number of other countries (see 'french system' posts) and would take a huge chunk out of current medical costs, and let doctors focus on the real problems (like mis-diagnosed and mis-medicated illnesses)...

 

[CADsortaGUY]

Excellent article, this should be required reading for all involved in the healthcare debate.


It highlights the similarities between the current health care crisis and the agricultural crisis of the early 1900's and shows that for problems of this size and complexity there is no "silver bullet" or quick fix solution. It also shows how a concerted piecemeal trial and error approach to the agricultural crisis over time exceeded all expectations and played a big role in the US becoming a superpower. And it underscores how critital it is to take the first "baby steps" in the right direction as proposed by the current legislation.

This article forces you to step back and look at the bigger picture and understand that the current proposed legislation as sweeping as it may seem is just the first step in a long road to get where we need to be. And that in a journey of this length there will be "missteps" and compels us to move forward as we realize that the only true mistake we can make is to do nothing.

Uh, the whole comparison is faulty. We don't currently have small providers. We have many providers divided into areas that are heavily regulated by the gov't. That is not even close to being the same as the thousands and thousands of family farms of the early 1900s. It's a nice attempt though at trying to lull people into the "it's ok to just take a baby step to socialism" trance.

 

[yllus]

Really great article.

 

[Thump553]

One of my former college roommates became a pharmacist. My former boss was a pharmacist before becoming a lawyer, and I got to know and represented plenty of pharmacists. I have the highest respect for that profession, they are far, far more than pill counters. Drug interactions by prescribed medications put my father in the hospital twice before we got a handle as to what was going on-showing that even with highly trained and dedicated professionals making the judgments there are still dangers. Self-prescribing Rx drugs is, quite frankly, one of the stupidest ideas I've ever heard. Comparing it to stock picking is absurd. The vast increase in Rx caused problems and amateur misdiagnosing would drive up health care costs-in both dollars and lives-enormously.

 

[Blackjack200]

It's an article that doesn't fit neatly into the traditional Democrat-Republican-Liberal-Conservative divide

Uh, the whole comparison is faulty. We don't currently have small providers. We have many providers divided into areas that are heavily regulated by the gov't. That is not even close to being the same as the thousands and thousands of family farms of the early 1900s. It's a nice attempt though at trying to lull people into the "it's ok to just take a baby step to socialism" trance.

lol, I was wrong. I guess for most it is a non-partisan article, but for a few extremists, there will always be some way connect it to their singular cause.

 

[CADsortaGUY]

lol, I was wrong. I guess for most it is a non-partisan article, but for a few extremists, there will always be some way connect it to their singular cause.

I was commenting on the comments of GD. Also, and your article doesn't fit nicely into the blah blah blah - sure. But as I pointed out to GD it's faulty in it's comparison.

 

[Hayabusa Rider]

ah, but back when you went to the pharmacist and he whipped you up something... now we have mass produced pills that should drive the costs down just like mass produced food... say something like any of the $5 scripts that walmart will do should not require a doctor's sig...

and, if you put the time and effort into deciding what stocks to pick then it is much like putting the time and effort into diagnosing an illness... alas both endeavors are fraught with uncertainty, since you only have your experience, intuition, and the facts at hand to make the decision... sometimes you make a good choice, sometimes not, but it's the same for a 'professional'...

this is the model in a number of other countries (see 'french system' posts) and would take a huge chunk out of current medical costs, and let doctors focus on the real problems (like mis-diagnosed and mis-medicated illnesses)...

Ahh, nostalgia. When there were a handful of medications which were more placebo than anything else. Now we have powerful medications which are effective, but the interplay with medical conditions and other medications are so complex that it takes six years of education now to master it. Physicians themselves do not understand it all. That is why we make dozens of calls to them every week.

I mean it would cull the population if we did it as you suggest, however the cost of a new liver or kidney might offset that at bit.

Everyone is an expert on the internet.

 

[Blackjack200]

Ahh, nostalgia. When there were a handful of medications which were more placebo than anything else. Now we have powerful medications which are effective, but the interplay with medical conditions and other medications are so complex that it takes six years of education now to master it. Physicians themselves do not understand it all. That is why we make dozens of calls to them every week.

I mean it would cull the population if we did it as you suggest, however the cost of a new liver or kidney might offset that at bit.

Everyone is an expert on the internet.

Pfft, what do you know? I'll just take a handful of barbiturates, wash it down with a couple shots of Scotch, and call the doctor in the morning.

 

[GuitarDaddy]

Uh, the whole comparison is faulty. We don't currently have small providers. We have many providers divided into areas that are heavily regulated by the gov't. That is not even close to being the same as the thousands and thousands of family farms of the early 1900s. It's a nice attempt though at trying to lull people into the "it's ok to just take a baby step to socialism" trance.

I,m not surprised in the least that the relevance of this article is lost on you. Don't bother thinking for yourself and just keep on quoting your socialism rhetoric.

And to those that believe I'm putting a partisan spin on it, think what you will. I really don't care which party initiates reform, the dems currently seem to be the only ones willing to move forward but that doesn't mean that will remain the case. This will be a long, long process and will not be the work of one administration or one party

 

[CADsortaGUY]

I,m not surprised in the least that the relevance of this article is lost on you. Don't bother thinking for yourself and just keep on quoting your socialism crap spoon fed to you by the right wing establishment

lol, someone doesn't like that his comments were identified for what they are. YOU brought up baby steps in regards to the current legislation - and THAT is exactly how the far left is going to play this(admittedly so) because allowing more gov't control is the first baby step they need for their takeover of HC.
But yeah, keep trying to hide from the truth if you must...

Anyway, my comments on the article stand - the comparison is faulty.

Edit - the relevance wasn't lost btw, it's just that some will lap up the comparison without thinking(ie: you) and just nod away since it basically suggests more gov't control.

 

[CADsortaGUY]

The author of that New Yorker is a surgeon. Here is a link to an audio version of roughly the same article that has been running on NPR recently:

http://www.npr.org/templates/story/story.php?storyId=121229972

And I agree-a refreshingly nonpartisan and truly objective viewpoint on the healthcare debate well worth at least reviewing by all, except for those only interested in reinforcing their partisan talking points (like death panels or "public option or nothing"). If only I could persuade that buffoon from my state, Joe Lieberman, to spend ten minutes listening to this.

Uh, he's hardly "nonpartisan". Have you looked at his history?

 

[GuitarDaddy]

lol, someone doesn't like that his comments were identified for what they are. YOU brought up baby steps in regards to the current legislation - and THAT is exactly how the far left is going to play this(admittedly so) because allowing more gov't control is the first baby step they need for their takeover of HC.
But yeah, keep trying to hide from the truth if you must...

Anyway, my comments on the article stand - the comparison is faulty.

I actually like your comments and find them comical, but your slipping a little, you didn't mention anything about socialism or take the opportunity to refer to the president in a deragatory manner

 

[CADsortaGUY]

I actually like your comments and find them comical, but your slipping a little, you didn't mention anything about socialism or take the opportunity to refer to the president in a deragatory manner

The article isn't about the BHO. It's about how this "surgeon" is trying to sell the legislation this time around. You see, he played a part in previous attempts...
Oh, and the socialism aspect of all this is apparent to anyone looking at this even halfway clearly. The excuse that it's only a "baby step" doesn't make it "ok". It needs to be called out at every step since the pushers know it wouldn't fly if they tried it all at once.

 

[Blackjack200]

lol, I can't believe you put surgeon in quotes

Do you think he's lying about that too?

 

[cubeless]

Ahh, nostalgia. When there were a handful of medications which were more placebo than anything else. Now we have powerful medications which are effective, but the interplay with medical conditions and other medications are so complex that it takes six years of education now to master it. Physicians themselves do not understand it all. That is why we make dozens of calls to them every week.

I mean it would cull the population if we did it as you suggest, however the cost of a new liver or kidney might offset that at bit.

Everyone is an expert on the internet.

hmmm... so then all the countries that don't regulate all drugs the way we do should start doing so? that might run the cost of their healthcare up a bit...

and the writer wants to solve all the big problems but can't fix his own wasteful habit that he mentions with the 'disposables'... i'm sure there's plenty excuses why he can't, but the place to start is usually with the little things...

 

[CADsortaGUY]

lol, I can't believe you put surgeon in quotes

Do you think he's lying about that too?

I take it you have no clue who the guy is.

Oh and Frist was a "surgeon" too but he was a politician when policy was being talked about.

 

[Blackjack200]

I take it you have no clue who the guy is.

Oh and Frist was a "surgeon" too but he was a politician when policy was being talked about.

I read his wikipedia page. He's a published scientist (JAMA) and a MacArthur fellow. What, he loses all credability because he worked for the Clintons 20 years ago?

 

[CADsortaGUY]

I read his wikipedia page. He's a published scientist (JAMA) and a MacArthur fellow. What, he loses all credability because he worked for the Clintons 20 years ago?

nowhere did I state he "loses all credability" you twit.

Do you think his past political positions(not just for the Clinton's mind you) are relevant? I think that if someone wants to claim "refreshingly nonpartisan and truly objective viewpoint" they best look into that person's past before making the claim.(yes, I know it wasn't you who stated that, however, what you quoted stemmed from that)

 

[WhipperSnapper]

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=allAnyway it's just a really good article about the complexity of the problem of health care costs and how we will need to try a bunch of different things until we find what works.

We don't need to "try a bunch of different things". Other nations have already done that. What we need to do is to examine what other nations have done and then scrap our system and adopt what has proven to be the best system and what would be the best system for us, perhaps the British or French systems.

The problem is that a huge number of wealthy interests stand in the way of that kind of reform--pharmaceutical companies, insurance companies (which would be put out of existence), for-profit hospitals, medical billings specialists, insurance brokers, insurance company employees, and everyone else whose jobs would be eliminated in order to realize the greater efficiency of these other systems.

 

[Hayabusa Rider]

We don't need to "try a bunch of different things". Other nations have already done that. What we need to do is to examine what other nations have done and then scrap our system and adopt what has proven to be the best system and what would be the best system for us, perhaps the British or French systems.

The problem is that a huge number of wealthy interests stand in the way of that kind of reform--pharmaceutical companies, insurance companies (which would be put out of existence), for-profit hospitals, medical billings specialists, insurance brokers, insurance company employees, and everyone else whose jobs would be eliminated in order to realize the greater efficiency of these other systems.

And yet again the answer is France.

How, precisely, with our system of taxation and our health care infrastructure do you propose to reach the much quoted 1/2 price figure? There's not nearly enough that exists in private insurance to get to that goal.

The Dems were screaming when it was suggested that an analysis be performed in advance of legislation. It was "you just are siding with insurance companies!" without a single response of how to get this done in a vacuum of knowledge. No, Democratic legislators don't need to know anything other than how to write a piece of legislation. Right. s

Precisely, specifically, fundamentally, in some detail (in other words not "FRANCE!") is this done?

Oh while people are at it, how does one "simply scrap" the most complex and extensive system ever seen on the face of the planet and start over? Which politicians get to practice medicine? What's the cost in lives and money of doing so? It isn't going to be free.