How American Health Care Killed My Father
David Goldhill, The Atlantic, September 2009, page 38

This article profoundly effected my views on the health care debate. I wasn’t happy with either side of the debate, but wasn’t sure how a better plan would look. It’s an extremely complex issue. I like David’s ideas very much.

When it comes to the current debate about health care/insurance reform the Republicans on the right are disingenuous, crazy and blinded by their hatred for a black president. The proposals on the left are merely Band-Aids and do not address, nor will they fix, the causes of our medical mess.

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government · health care · politics · the atlantic

Today Kirsten underwent her third operation in the fight against her pituitary tumor.

Supra-Orbital Craniotomy
Kirsten Uhler, Cogitations, August 23, 2009

Instead of going in through her nose like the previous two times they went straight through her forehead skull. Her neurosurgeon, Dr. Florman, doesn’t shave. Instead, he parts the hair, cuts between the hairs, folds the face down, drills a hole in the skull, removes as much tumor mass as possible, patches the skull hole with a metal plate and screws, and sews the skin back in place. I know. I don’t like it more than you.

Kirsten is a tough girl. She rarely mentioned her surgery and said she wasn’t much nervous.

They called to tell her they were ahead of schedule and were moving her surgery up to 14:30 from 15:30. That cut down our picnic time, but we didn’t mind. We ate in the grass in the shade of a tree just outside the hospital on Portland’s Western Promenade. It was a fantastic morning.

Surgery prep was fairly routine. She got an IV and signed her life away (literally). Dr. Florman came in to review the procedure, and then the anesthesiologists did the same. Then they wheeled her away.

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brain surgery · craniotomy · kirsten · pituitary · surgery · tumor

The July/August 2009 issue of Technology Review is especially good. In it there are articles on Wolfram Alpha, cap and trade, Obama’s technology stimulus, and nuclear fusion. It also contains an entire section on cloud computing and a thought-provoking essay on privacy in the age of Facebook.

A Pound of Cure (subscription required)
Andy Kessler, Technology Review, July/August 2009, pg. 75

The health-care industry’s reluctance to digitize its records is rooted in a desire to keep medicine’s lucrative business model hidden. Dangling $19 billion in front of a $2.4 trillion industry is not nearly enough to get it to reveal the financial secrets that electronic health records are likely to uncover–and upon which its huge profits depend. In those medical records lie the ugly truth about the business of medicine: sickness is profitable. The greater the number of treatments, procedures, and hospital stays, the larger the profit. There is little incentive for doctors and hospitals to identify or reduce wasteful spending in medicine.

According to a 2003 article by Dr. Steffie Woolhandler in the New England Journal of Medicine, administration accounts for 31 percent of expenses in the U.S. health-care industry, or more than $500 billion per year. (To put that in perspective, Google has spent well under 10 percent of that on all its R&D.)

I always laugh when people argue that a government health care system would be inefficient. I think they must never have visited a doctor’s office or dealt with their own health insurance company.

government · health · health care · insurance · policy · technology review · united states · usa

Why We Must Ration Health Care
Peter Singer, NY Times, July 15, 2009

I was first introduced to Peter Singer when I read his thought-provoking book, Rethinking Life and Death: The Collapse of Our Traditional Ethics.

In this New York Times Magazine essay, Singer persuasively argues that we should make health care decisions based on the economics of treatment. This should be obvious, but many feel that it is immoral to place a dollar value on human life. That absurdity is untenable.

What do you think of formulas that attempt to place a dollar value on an individual? How much are you worth?

We need a health care rationing system that is economical.

The essay should be read in its entirety. Here are a few of my favorite excerpts.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.”

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death · ethics · health care · life · peter singer · policy · singer · united states · usa

It’s nice to hear the anti-marriage drumbeat intensifying.

Let’s Call the Whole Thing Off
Sandra Tsing Loh, The Atlantic, July/August 2009, pg. 116

Sandra Tsing Loh is getting divorced. In this article for The Atlantic magazine she explains the usual trajectory of relationships and why monogamy is unnatural. She uses this to argue that the current model of marriage is outdated. Serial monogamy, she says, is a much more natural model for human beings.

I am a critic of both marriage and monogamy and agree with much of Loh’s analysis of each.

Why do we still insist on marriage? Sure, it made sense to agrarian families before 1900, when to farm the land, one needed two spouses, grand-parents, and a raft of children. But now that we have white-collar work and washing machines, and our life expectancy has shot from 47 to 77, isn’t the idea of lifelong marriage obsolete?

What I do not agree with, however, is that relationships must necessarily end in order to start fresh with someone new. A more utopian model is polyamory, where individuals are free to love more than one person at a time. Each person satiates different needs and at different levels. This is what we should strive to achieve to maximize happiness.

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divorce · marriage · open marriage · the atlantic

The Cost Conundrum
Atul Gawande, The New Yorker, June 1, 2009

I once had a discussion with a friend who argued that the United States has the “best” health care system in the world. I nearly fell out of my seat when confronted with the absurdity. Could an intelligent person really believe such a thing? So what if we have the most highly skilled doctors and well-equipped medical facilities if those things don’t appreciably adds to our healthiness?

Medical problems contribute to more than 60% of all bankruptcies in the United States. There’s also the HUGE problem of job lock. Our health care system industry is an expensive and harmful disaster that is devastating both our health and our economy.

Atul Gawande, in this essay for The New Yorker, persuasively argues that it is not the payer who is culpable, but the system which turns physicians into market-savvy business persons. When the focus is on the money–as it is far too often–and not the patient, costs escalate and care declines.

Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

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capitalism · free-market · health · health care · socialized medicine · united states · usa

Health system discourages innovation
Andy Sullivan, Reuters, May 28, 2009

I’ve been talking about “job lock” since long before I knew there was a term for it. It is perhaps one of the most devastating consequences of our troubled health care system industry–and one that barely receives mention. Innovation and entrepreneurship are what made this country great. Our health care system is destroying far more than our health; it’s wrecking our economy and global dominance.

Economists call this phenomenon “job lock,” and studies suggest that it keeps between 20 percent and 50 percent of workers from leaving their current jobs.

Because health insurance is tied to employment in the United States, workers who leave their jobs can see health bills skyrocket if they strike out on their own or take a position with a company that offers fewer benefits. Workers who would like to retire early stay on, unable to qualify for the government’s Medicare program until they turn 65.

As head of the National Federation of Independent Businesses, Todd Stottlemeyer frequently encountered would-be entrepreneurs who let their ideas go stale and their products languish on the workbench because they did not want to shoulder their own health care costs.

Troubling.

New Jersey saw a 14 to 20 percent rise in entrepreneurial activity due to a 1993 law making it easier for the self-employed to afford health insurance, a study by Philip DeCicca of McMaster University in Hamilton, Ontario found.

A major problem with most proposed solutions to rising health care costs and covering the uninsured is that there is little support for abandoning employer-based health insurance. The Democrats want to reduce costs and make insurance affordable for all. That’s great, but insurance companies ARE cost, and provide zero value. They make their money collecting premiums and denying care. Perhaps a public insurance option would give would-be entrepreneurs the security to leave their job and the health care benefits that went with it.

The Republicans have introduced a plan that would give each family a tax-credit to pay for insurance and remove incentives companies have had to provide health insurance to their workers. Perhaps these benefits could be converted to cash which would allow employees to shop around, thereby ending the problem of job lock.

Job lock is a real problem and should be a primary consideration in any health care discussion or proposal.

business · economy · entrepreneurship · health care · innovation · job lock · usa

Skye and I scooted and peddled, respectively, to the Dairy Queen in Saco this afternoon. As we sat and enjoyed our Original! Blizzard® Flavor Treats on an outdoor bench a thick, pungent, familiar, delicious cloud of marijuana smoke wafted through our airspace. I quickly turned around to ascertain the source of the delightful aroma and was humored by the discovery. It was two frail old ladies in a white minivan.

On the rear window was affixed a sticker of a marijuana leaf emblazoned with Genesis 1, verse 29.

And God said, Behold, I have given you every herb bearing seed, which is upon the face of all the earth…

I nearly spit my Original! Blizzard® Flavor Treat. ROFL!! I should have inquired of them whether they would be willing to adopt a grandson.

Pot grannies

blizzard · dairy queen · hash · marijuana · munchies · pot · weed

Skye Danler

Each week Skye has Math Team one day after school. I usually leave the other two at home and drive to Skye’s school to pick her up. A few weeks ago I was stuck in Portland and unable to make it in time. I called Skye and told her she could either wait for me to arrive or just walk home.

Her excitement was palpable. “Really?”, she asked. We went over a few ground rules and basic pedestrian safety. I told her she had to call me when she left and again when she arrived home. She did, and has been walking ever since. A few times I’ve biked her scooter to her so she could scoot home instead of walking. Once she met Kirsten and I at the Dyer Library and gave to us her backpack so she wouldn’t have to carry it. (more…)

free range · freerangekids · independent · parenting · safety · security · skye · society · trust

Perfectly Happy
Drake Bennett, Boston Globe, May 10, 2009

I am passionate about happiness. I find myself reading all I can on the subject. I think most people spent too much energy and resources trying to attain happiness in ways that are often counterproductive. Most people are terrible at relationships, take too few risks and work to stay within predefined social constructs to their detriment.

Science can help focus our energies on those things that are more likely to appreciably increase happiness. It seems a bit counterintuitive–especially to those of us who struggle financially–that winning the lottery doesn’t make people happy. The research also illuminates one reason long-term relationships often fail: the initial happiness surge of new love eventually wanes.

In recent years, cognitive scientists have turned in increasing numbers to the study of human happiness, and one of their central findings is that we are not very good at predicting how happy or unhappy something will make us. Given time, survivors of tragedies and traumas report themselves nearly as happy as they were before, and people who win the lottery or achieve lifelong dreams don’t see any long-term increase in happiness. By contrast, annoyances like noise or chronic pain bring down our happiness more than you’d think, and having friends or an extra hour of sleep every night can raise it dramatically.

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boston globe · happiness · lottery · poverty · research · Science · wealth