Here's a picture of this year's corntacular challenge!
Sunday, November 8, 2009
Corn Activities
A few weeks ago we went to a corn maze -- excuse me, maize maze -- and it was... fun? What to say about a labyrinth of produce? Is corn truly a vegetable? Thanks to a handful of flashlights and an excess of clues it was not terribly difficult or very scary. The kettle corn was delicious, however, and they did have a corn cannon with which to shoot corns out of. All in all it took about 45 minutes to complete and after eating a little more corn we went home.
Here's a picture of this year's corntacular challenge!
Here's a picture of this year's corntacular challenge!
Sunday, October 18, 2009
Standing in Mud for a Song
Last week, complements of Ro, I went to Austin City Limits. Without exaggeration it was the hottest, sweatiest, and muddiest I have been in a good time. Which, coincidentally, makes for a pretty good time. The temptation to slip and slide about the muddy knolls was present but I remained dignified. Plus no one else was doing it.Although the two bands I truly wanted to see, Dave Matthews and Flogging Molly, had played the day before, I still got to see a bunch of bands I had never heard of (David Garza, The Dead Weather, and Heartless Bastards) and two bands I had heard of but, really, never heard (The Toadies and Pearl Jam.) It turned out one of David Garza's band mates also apparently does hula hoop tricks? By the end of the evening when Pearl Jam finally came on for their two appointed hours we were shoulder to shoulder with countless thousands of other people in what was likely the greatest exchanging of germs the nation has seen in years. I may or may not have been standing on top of someone. I definitely got to first base with the back of the dude's head in front of me.
Despite knowing all of only three or four songs, Pearl Jam was still pretty great. There was not a whole lot in the way of pyrotechnics or special effects, just deafening music that gave me phantom vibrations and tinnitus for about three days afterward. Crowd surfing was attempted but resulted in the guy being thrown over a shoulder and promptly into the gack, and moshing was impossible due to the complete inability to shift one's body weight. Live music it seems is powerful stuff even if much of it is unintelligible. I suppose that's why any respectable nationalist uprising or religious revival always has a good chorus. Post concert we ate at Wendy's -- and I do believe even the food tasted better.
Tuesday, October 13, 2009
The Pushiest Dog
Last week I house sat for some friends. After eight days of drinking all their Dr. Pepper I called it and went home, a resounding success. Aside from a brief visit from the police due to my inability to effectively turn off the alarm system the stay was uneventful. What was eventful, however, was their dog. Or rather, dang that's a pushy canine.My friends are the proud owners of a Siberian Husky -- Sienna. How it survives in San Antonio I am not entirely sure, but I believe it hibernates in the freezer from the months of June to September. Although friendly and unassuming in appearance, she has the perseverance and single minded focus of... a Siberian Husky? Perhaps a very focused and relentless Siberian Husky. Regardless, when she wants her walks she will let you know, and she wants her walks all the time. My daily strolls proved insufficient, however, and so every afternoon upon returning from work I would sit on the couch only to be repeatedly, in 3-4 minute cycles, interrupted by a very eager Sienna. Typically she would bound up to the couch, get as close to me as possible, make a few mildly disconcerting-sounding dog noises, and then spin in circles a few times. If ineffective she would either then give me peace for a few moments or proceed to lick my legs. If I refused walks this loop would then proceed on for hours. And If I gave her walks then it was time she let me know she wanted to play, the whole process repeating itself. Unfortunately while her need for walks was satisfiable enough, her need for play was a little more difficult to meet. Considering she seemed happiest just jumping around the living room, though, perhaps she was demanding less play and more frolics.
Sienna aside, there were two bulimic cats to take care of as well. Thankfully they were relegated to the lower level of the house. Whenever I ventured to the kitchen, though, I would be welcomed by their incessant meowing to be fed no matter the time of day or time of most recent feeding. I would have happily fed them to their early obesity-related demises had I not been warned that overfeeding leads to throwing up behind the furniture so instead I agreed to ignore them and they agreed to keep meowing whenever I went downstairs.
The similarity in tactics shared amongst all the household's animals may not have been purely coincidental, though, as near nightly the dog would amble over to the top of the stair case where one of the cats would be waiting. After exchanging greetings or stares or telepathic cartoon thoughts, whatever, the cat would then carry on a 1-2 minute lecture during which, presumably, Sienna would take careful mental notes for the following day. I broke up one of these pow-wows one evening more out of curiosity than anything else, and the next day I returned from work to a 30 gallon bag of down feathers torn up and strewn about the living room.* A word of warning I dutifully heeded. No way I'm going out like a strange plastic bag of feathers.
I will admit though. As much as I at times wanted to, and sometimes did, yell at the dog to leave me alone, and as many times as I teased her with the leash when it was walky time, I miss her a bit. Dogs are one of the few animals that seem to make us love them more even as they drive us further crazy. She's a good dog, that Sienna. Her friendliness; her pushiness; her beady, red eyes and all.
* The destruction of the bag of fluff may or may not have happened after my pet conference interruption.
Monday, September 28, 2009
Internal Medicine: After Dark
I just finished Night Float. It was crap. It turns out taking care of people with the lights out -- though much like taking care of people with the lights on -- is much less rewarding. I should have seen this coming considering the omens. Within the first five minutes of the first shift my intern lost an eye to the tarp covering the scrub stacks. He was only briefly incapacitated and was left only with a small bruise on his eyeball, but for a short moment I was torn between resuscitation and calling to find his back up.
Anyways, Night Float. Six times the number of supervisors with none of the actual supervision. Plus medicine consults, plus 72-hour consults, plus out of hospital transfers, plus morning report, plus an endless cycle of freetriplescore.com commercials on late night TV. Add to all those new responsibilities a generous supply of next day second guessing and general orneriness from the primary teams, and myeh. Truthfully, I would of rather been kicked in the junk. Now we'd have to haggle over the details, but nevertheless, do it again, kick me in the junk.
The hours themselves weren't that bad mind you; I actually slept rather well. Similarly not knowing what meal to eat at any particular time of day was disorienting but three breakfasts in a row never hurt anyone. My interns were both by and large good, solid citizens, and work load wise we truthfully got off relatively light. It was just the nature of the job, of being subject to a multitude of divergent interests leading to an inability to sufficiently satisfy any which made Night Float a lonely, thankless task. I suppose it developed character, but only if paranoia is a character trait.
It's done and over now, though. May we never do it again.
Anyways, Night Float. Six times the number of supervisors with none of the actual supervision. Plus medicine consults, plus 72-hour consults, plus out of hospital transfers, plus morning report, plus an endless cycle of freetriplescore.com commercials on late night TV. Add to all those new responsibilities a generous supply of next day second guessing and general orneriness from the primary teams, and myeh. Truthfully, I would of rather been kicked in the junk. Now we'd have to haggle over the details, but nevertheless, do it again, kick me in the junk.
The hours themselves weren't that bad mind you; I actually slept rather well. Similarly not knowing what meal to eat at any particular time of day was disorienting but three breakfasts in a row never hurt anyone. My interns were both by and large good, solid citizens, and work load wise we truthfully got off relatively light. It was just the nature of the job, of being subject to a multitude of divergent interests leading to an inability to sufficiently satisfy any which made Night Float a lonely, thankless task. I suppose it developed character, but only if paranoia is a character trait.
It's done and over now, though. May we never do it again.
Thursday, September 10, 2009
Exit 25
This past month I earned my Geriatrician Merit Badge. In order to do so I had to start five campfires, diagnose ten cases of dementia, and administer twenty-five Exit 25 interviews. Thankfully the second and third tasks are related as it turns out there is no better way to diagnose dementia then to disorient the elderly and there is no better way to disorient the elderly than the Exit 25 exam.
Although the most recognized and often feared aspects of dementia tend to circle around the increasingly noticeable memory loss that slowly penetrates the minds of the afflicted, this is not the truly incapacitating aspect of dementia and the scare is only superficial. Memory loss makes life inconvenient and tends to sap away from us much of what makes us unique individuals, but it by itself does not lead to the helplessness commonly seen in demented patients. If you or I are forgetful we simplify tasks, standardize routines, write down lists and so on. There are a variety of ways to compensate and people are adaptive animals if nothing else. What truly makes dementia a terrible disease is its effects on executive function: our ability to plan and act. Without this there is no ability to adapt and, as the disease progresses, there is no ability to lead a normal life. Young children often have wonderful memories, it's the poorly developed frontal lobes which make them act as young, dependent children. And so that's why the Exit 25 interview was developed.
The Exit 25 is a series of twenty-five questions designed in a variety of ways to primarily test a patient's executive function and cognition. And it does this -- it seems -- primarily by disorienting and making as uncomfortable as possible the target of the interview. Although some parts are fairly standard consisting of the "remember these 3 objects" and "repeat these phrases," many are not. They range from tests of primitive reflexes and learned behavior by pushing and prodding on the patients' hands and arms in a variety of manners (and also tapping on their lips) while continuously telling them to "just relax", to asking them to stick out their tongue and say "ahh" for an uncomfortably long period of time, to a series of complex hand maneuvers that I still have not quite completely mastered myself. The best parts, however, are the ones I can rarely do without laughing.
The first is simple enough. Complete part 19 and then suddenly and without warning clap closely and loudly by the patient. If they do nothing but eye you curiously then they're in the clear. If they look about or motion uncertainly that's one point on the dementia scale. And if they clap back at you, a phenomenon called echopraxia, then it may be time to take the credit cards and car keys.
In a similar vein, the best portion of the test also consists of an abrupt, awkward transition from regular questioning. Part 10 is followed by a three second silent stare into the eyes of the interviewee followed by a polite and matter of fact "thank you." If the patient responds with a questions like, for example, "what the hell are you doing?" then they're good. If they again get anxious and flustered that's one point against them. And if they say, "you're welcome," well it may be time for a death panel consultation. My favorite response to date has been a panicked, "is this part of the test?! Is this part of the test?!" with simultaneous darting of the eyes to every part of the room.
In all seriousness the Exit 25 interview seems to be a consistently effective tool for screening and monitoring dementia, and will likely be an increasingly important one as it is more extensively used. Unfortunately I always feel bad doing it on my patients. It also takes a good twenty minutes to complete the whole bloody thing. Considering the main measure seems to be confusion and disorder, I almost feel as if yelling and shaking a gnarled stick at the elderly for a minute could have much the same sensitivity and specificity at a fraction of the cost in time. It's a shame I won't be going into geriatrics; I could have revolutionized the practice.
The best part of geriatrics was not terrorizing the elderly; however, it was the absence of call and two day weekends. Beautiful. And the worst part, conversely, wasn't trying to then persuade demented people that they were in fact demented, but rather the senior citizen two handed handshake I now find habitual. For whatever reason I found myself clasping with both hands the single hand of patient and/or accompanying family member in a gratuitous gesture of friendship. They seemed to appreciate it well enough, but some of my colleagues not so much. Men weren't meant to double hand clasp the hands of other men, and many a muffled look of befuddlement has been exchanged between myself and another as a result. It is either a sign of my great empathy or my folie à deux that I have become more like the elderly in treating them. Or perhaps it's just two more points on the dementia scale.
Although the most recognized and often feared aspects of dementia tend to circle around the increasingly noticeable memory loss that slowly penetrates the minds of the afflicted, this is not the truly incapacitating aspect of dementia and the scare is only superficial. Memory loss makes life inconvenient and tends to sap away from us much of what makes us unique individuals, but it by itself does not lead to the helplessness commonly seen in demented patients. If you or I are forgetful we simplify tasks, standardize routines, write down lists and so on. There are a variety of ways to compensate and people are adaptive animals if nothing else. What truly makes dementia a terrible disease is its effects on executive function: our ability to plan and act. Without this there is no ability to adapt and, as the disease progresses, there is no ability to lead a normal life. Young children often have wonderful memories, it's the poorly developed frontal lobes which make them act as young, dependent children. And so that's why the Exit 25 interview was developed.
The Exit 25 is a series of twenty-five questions designed in a variety of ways to primarily test a patient's executive function and cognition. And it does this -- it seems -- primarily by disorienting and making as uncomfortable as possible the target of the interview. Although some parts are fairly standard consisting of the "remember these 3 objects" and "repeat these phrases," many are not. They range from tests of primitive reflexes and learned behavior by pushing and prodding on the patients' hands and arms in a variety of manners (and also tapping on their lips) while continuously telling them to "just relax", to asking them to stick out their tongue and say "ahh" for an uncomfortably long period of time, to a series of complex hand maneuvers that I still have not quite completely mastered myself. The best parts, however, are the ones I can rarely do without laughing.
The first is simple enough. Complete part 19 and then suddenly and without warning clap closely and loudly by the patient. If they do nothing but eye you curiously then they're in the clear. If they look about or motion uncertainly that's one point on the dementia scale. And if they clap back at you, a phenomenon called echopraxia, then it may be time to take the credit cards and car keys.
In a similar vein, the best portion of the test also consists of an abrupt, awkward transition from regular questioning. Part 10 is followed by a three second silent stare into the eyes of the interviewee followed by a polite and matter of fact "thank you." If the patient responds with a questions like, for example, "what the hell are you doing?" then they're good. If they again get anxious and flustered that's one point against them. And if they say, "you're welcome," well it may be time for a death panel consultation. My favorite response to date has been a panicked, "is this part of the test?! Is this part of the test?!" with simultaneous darting of the eyes to every part of the room.
In all seriousness the Exit 25 interview seems to be a consistently effective tool for screening and monitoring dementia, and will likely be an increasingly important one as it is more extensively used. Unfortunately I always feel bad doing it on my patients. It also takes a good twenty minutes to complete the whole bloody thing. Considering the main measure seems to be confusion and disorder, I almost feel as if yelling and shaking a gnarled stick at the elderly for a minute could have much the same sensitivity and specificity at a fraction of the cost in time. It's a shame I won't be going into geriatrics; I could have revolutionized the practice.
The best part of geriatrics was not terrorizing the elderly; however, it was the absence of call and two day weekends. Beautiful. And the worst part, conversely, wasn't trying to then persuade demented people that they were in fact demented, but rather the senior citizen two handed handshake I now find habitual. For whatever reason I found myself clasping with both hands the single hand of patient and/or accompanying family member in a gratuitous gesture of friendship. They seemed to appreciate it well enough, but some of my colleagues not so much. Men weren't meant to double hand clasp the hands of other men, and many a muffled look of befuddlement has been exchanged between myself and another as a result. It is either a sign of my great empathy or my folie à deux that I have become more like the elderly in treating them. Or perhaps it's just two more points on the dementia scale.
Thursday, August 13, 2009
The Long Delay
Intern year is done. Let us reflect.
The best way to describe my sentiments on residency to date is: one long delay. For three years my life will be on hold and, hopefully, once these three years are over with I will emerge from hibernation three years older, a little smarter, a little slower, and a little more grizzled; ready to live my life once more. Aside from the rapid accumulation of medical knowledge I do not anticipate this experience netting me anything of significance. Which is a shame, because most of it has nothing to do with residency.
Don't get me wrong. I dislike residency as much as the next medical resident. It's just I don't have very good reason to. Aside from my ample complainings already documented, it ain't that bad. Things are busy and the hours are long, but not so long as to preclude a life outside the hospital for those with enough pluck. Unfortunately that life never seems to have taken place. I don't often do the things I like for lack of like-minded friends, don't often spend time with good friends for lack of common interests, and my chastity has never been less questioned. I got no God, no dog, no woman, waning patriotism, and little time or idea where to find these things. I'm not sad or mad, just frustrated. I've got it good -- That is one thing I do know even if I don't always feel it -- but unfortunately blessings don't necessarily a good life make. And so I wait. Twiddle my thumbs a little longer, hold my breath a little longer, futz around a little longer. (Longer with Big Red!) Keep going to work because that's what I do, and keep going home because that's where I live. I wait for the job to reset, friend pool to refresh, and for the time to once again look forward to something.
So that's how I feel about intern year. I did a lot of things, and then I moved on. End of Act One.
At least I got money. Mmmm assets....
A picture from my apartment. If only I had a balcony. Or a little gratitude.
The best way to describe my sentiments on residency to date is: one long delay. For three years my life will be on hold and, hopefully, once these three years are over with I will emerge from hibernation three years older, a little smarter, a little slower, and a little more grizzled; ready to live my life once more. Aside from the rapid accumulation of medical knowledge I do not anticipate this experience netting me anything of significance. Which is a shame, because most of it has nothing to do with residency.
Don't get me wrong. I dislike residency as much as the next medical resident. It's just I don't have very good reason to. Aside from my ample complainings already documented, it ain't that bad. Things are busy and the hours are long, but not so long as to preclude a life outside the hospital for those with enough pluck. Unfortunately that life never seems to have taken place. I don't often do the things I like for lack of like-minded friends, don't often spend time with good friends for lack of common interests, and my chastity has never been less questioned. I got no God, no dog, no woman, waning patriotism, and little time or idea where to find these things. I'm not sad or mad, just frustrated. I've got it good -- That is one thing I do know even if I don't always feel it -- but unfortunately blessings don't necessarily a good life make. And so I wait. Twiddle my thumbs a little longer, hold my breath a little longer, futz around a little longer. (Longer with Big Red!) Keep going to work because that's what I do, and keep going home because that's where I live. I wait for the job to reset, friend pool to refresh, and for the time to once again look forward to something.
So that's how I feel about intern year. I did a lot of things, and then I moved on. End of Act One.
At least I got money. Mmmm assets....
A picture from my apartment. If only I had a balcony. Or a little gratitude.Tuesday, August 11, 2009
A Profit Motive for Your Life
Eddie Spaghetti is a man of means. Looking to multiply those means he looks around for a good investment. Upon doing so he discovers Jose Conseco's Steroids and Bats Emporium. Jose, wanting to expand into the baseball business as well, is in need of some fresh investment capital. They talk, they sign contracts, and shortly Jose Conseco's Steroids and Bats Emporium becomes JC's Steroids, Bats, and Balls Super Center. The very first day Joe, Mo, and Flo all arrive in need of steroids, bats, and balls respectively. They collect their products, pay the cashier, and the transactions are completed. Everyone is happy; it's a fine business. It is not from kindness that Jose sells Joe, Mo, and Flo their goods, however, nor the charity of Eddie which leads him to lend money to Jose, but rather because what they all hope to obtain from the deal: profit. It is the profit motive which compels them to act, and it is the profit motive which makes them good people.
Eddie Spaghetti, now enriched, looks for another business opportunity. He finds Darryl Strawberry and his Baseball Glove and Medical Insurance Warehouse. Looking to expand, they talk, they sign contracts, and shortly D. Strawberry's Baseball Glove and Medical Insurance Warehouse expands into four neighboring territories. The very first day Joe, Mo, and Flo arrive at the store all coincidentally in need of health insurance. They peruse the options, discuss with the agent, and the transactions are completed. Joe and Mo leave with insurance, but Flo does not. Flo, it seems, is from San Antonio and her diabetes, polycystic ovarian syndrome, hairy chin, and compulsive cigarette use have precluded her from being insurance eligible. Mo has chronic medical issues himself, having lingering lung problems from contracting tuberculosis while working in the Peace Corps years back, and so has to pay a higher premium, but he is simply happy to have any coverage at all. That year Mo's tuberculosis, thought beaten, returns and is found to be multi-drug resistant. Due to pre existing condition exclusions and high copayments Mo is later led to file for bankruptcy. Some people are happy, some people are not; it's the health insurance business. It is not from the stinginess of Darryl that he denies Flo coverage, nor the greediness of Eddie that leads him to reject the claims of Mo, but rather because of what they all hope to obtain from the deal: profit. It is the profit motive which compels them to act, and it is the profit motive which makes them bad people.
As often stated I make no claims of being an economist. I did my two semesters in college, found them to be moderately interesting, and then moved on. Pareto efficiency and fiduciary relationships tend to give me seizures. Thankfully, the economics of health insurance are relatively straightforward. Whereas in most industries the profit motive spurs towards better products for less money produced more efficiently -- by practically speaking reducing costs and competitively pricing -- this is not so with the business of medical coverage. Instead in the health insurance industry product supply and demand are both constrained by the nondiscretionary nature of most medical care, cost management is limited by the science of medicine, and negative selection drives insurers to discriminatory distributions of coverage. Practically speaking, profit is obtained by maximizing coverage of healthy people and minimizing coverage of the sick. This may work for a large percentage of the population that is healthy or only mildly ill, but it will never and can never succeed in providing adequate care at reasonable prices to that sizable segment of the population with serious, chronic medical disease or the significant portion of the population that will find itself one day burdened with the same. It is not because of lack of competition nor lack of compassion, but simple, straightforward economics. You can not make money off of a Down Syndrome child and there is no profit to be had from lymphoma and leukemia.
And so socialism.
Socialism as a theory is currently empty. It is no way to run an economy. Nevertheless, there are lessons to be learned and numerous possible isolated applications to be had, and it is essential that we as Americans, with our historical fear of anything smelling of communism, remember this. Especially in our current and likely numerous future debates about health care. Socialized fire protection, socialized police security, socialized national defense, and socialized park systems are all industries long since collectivized, and happily so. Although there is today some debate about further privatizing education and many utilities the fact is for most these industries' histories they have contributed to a better and more prosperous nation and even today they continue to provide reliable, cost-effective business to those desiring their services. Few complain that the police department has a monopoly on preserving domestic order or that there is no competition to watch over our parks and maintain our monuments. Whether we realize it or not, we are in many ways a partially socialized nation already. Somethings are best tackled in spite of any profit that can be derived.
Such it is with health care. We can tweak and adjust, modify and massage, hope and pray, and we will never find a comprehensive solution or even a partial coverage solution at a reasonable price using private coverage. No matter how deductibles are calculated or plans are managed, medical insurance will remain expensive and outside the hands of a good number of people. Even Obama's hybrid system that satisfies no one and confuses everyone will not likely significantly change things. Universal coverage on the other hand abandons the false pretense that money can be made providing adequate health care and simply focuses on doing the best for the most with what we've got. It will certainly add some to our waits and reduce some efficiency, no doubt, but what do we have now? Our hospitals are already full, good people already fall through the cracks, care is already being rationed. Without the burdensome bureaucracy that accompanies herding a dozen different insurance programs and without the waste pervasive in the system as a result of poor communication and repeat testing the added costs would by most calculations likely be minimal. If the entire rest of the Western world can get by doing it -- if the French and the Italians can manage it -- certainly we can do one better. In the end universal health care is much like democracy; it is not a great option, but it is certainly the best one. There is, unfortunately, no "good way" to take care of people. And nothing makes this more clear than the economics of it all.
The OECD, US, and health care.
Medical insurance and bankruptcy.
Conservative case for universal health coverage.
Eddie Spaghetti, now enriched, looks for another business opportunity. He finds Darryl Strawberry and his Baseball Glove and Medical Insurance Warehouse. Looking to expand, they talk, they sign contracts, and shortly D. Strawberry's Baseball Glove and Medical Insurance Warehouse expands into four neighboring territories. The very first day Joe, Mo, and Flo arrive at the store all coincidentally in need of health insurance. They peruse the options, discuss with the agent, and the transactions are completed. Joe and Mo leave with insurance, but Flo does not. Flo, it seems, is from San Antonio and her diabetes, polycystic ovarian syndrome, hairy chin, and compulsive cigarette use have precluded her from being insurance eligible. Mo has chronic medical issues himself, having lingering lung problems from contracting tuberculosis while working in the Peace Corps years back, and so has to pay a higher premium, but he is simply happy to have any coverage at all. That year Mo's tuberculosis, thought beaten, returns and is found to be multi-drug resistant. Due to pre existing condition exclusions and high copayments Mo is later led to file for bankruptcy. Some people are happy, some people are not; it's the health insurance business. It is not from the stinginess of Darryl that he denies Flo coverage, nor the greediness of Eddie that leads him to reject the claims of Mo, but rather because of what they all hope to obtain from the deal: profit. It is the profit motive which compels them to act, and it is the profit motive which makes them bad people.
As often stated I make no claims of being an economist. I did my two semesters in college, found them to be moderately interesting, and then moved on. Pareto efficiency and fiduciary relationships tend to give me seizures. Thankfully, the economics of health insurance are relatively straightforward. Whereas in most industries the profit motive spurs towards better products for less money produced more efficiently -- by practically speaking reducing costs and competitively pricing -- this is not so with the business of medical coverage. Instead in the health insurance industry product supply and demand are both constrained by the nondiscretionary nature of most medical care, cost management is limited by the science of medicine, and negative selection drives insurers to discriminatory distributions of coverage. Practically speaking, profit is obtained by maximizing coverage of healthy people and minimizing coverage of the sick. This may work for a large percentage of the population that is healthy or only mildly ill, but it will never and can never succeed in providing adequate care at reasonable prices to that sizable segment of the population with serious, chronic medical disease or the significant portion of the population that will find itself one day burdened with the same. It is not because of lack of competition nor lack of compassion, but simple, straightforward economics. You can not make money off of a Down Syndrome child and there is no profit to be had from lymphoma and leukemia.
And so socialism.
Socialism as a theory is currently empty. It is no way to run an economy. Nevertheless, there are lessons to be learned and numerous possible isolated applications to be had, and it is essential that we as Americans, with our historical fear of anything smelling of communism, remember this. Especially in our current and likely numerous future debates about health care. Socialized fire protection, socialized police security, socialized national defense, and socialized park systems are all industries long since collectivized, and happily so. Although there is today some debate about further privatizing education and many utilities the fact is for most these industries' histories they have contributed to a better and more prosperous nation and even today they continue to provide reliable, cost-effective business to those desiring their services. Few complain that the police department has a monopoly on preserving domestic order or that there is no competition to watch over our parks and maintain our monuments. Whether we realize it or not, we are in many ways a partially socialized nation already. Somethings are best tackled in spite of any profit that can be derived.
Such it is with health care. We can tweak and adjust, modify and massage, hope and pray, and we will never find a comprehensive solution or even a partial coverage solution at a reasonable price using private coverage. No matter how deductibles are calculated or plans are managed, medical insurance will remain expensive and outside the hands of a good number of people. Even Obama's hybrid system that satisfies no one and confuses everyone will not likely significantly change things. Universal coverage on the other hand abandons the false pretense that money can be made providing adequate health care and simply focuses on doing the best for the most with what we've got. It will certainly add some to our waits and reduce some efficiency, no doubt, but what do we have now? Our hospitals are already full, good people already fall through the cracks, care is already being rationed. Without the burdensome bureaucracy that accompanies herding a dozen different insurance programs and without the waste pervasive in the system as a result of poor communication and repeat testing the added costs would by most calculations likely be minimal. If the entire rest of the Western world can get by doing it -- if the French and the Italians can manage it -- certainly we can do one better. In the end universal health care is much like democracy; it is not a great option, but it is certainly the best one. There is, unfortunately, no "good way" to take care of people. And nothing makes this more clear than the economics of it all.
The OECD, US, and health care.
Medical insurance and bankruptcy.
Conservative case for universal health coverage.
Socialism!
Subscribe to:
Posts (Atom)
