tag:blogger.com,1999:blog-82178679626626107092024-03-08T13:43:34.468-08:00Musings and questionsMatt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-8217867962662610709.post-92088206652773356932012-12-19T04:40:00.000-08:002012-12-19T04:41:39.791-08:00<!--[if gte mso 9]><xml>
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</xml><![endif]--><i><b>Disaster in Newtown</b></i><br />
<br />
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<br /></div>
<div class="MsoNormal">
At the moment I am thinking about mental health services. I
just read an article in Mother Jones magazine about how PTSD can actually be
contagious in a family. Anger and hyper-awareness and nightmares have been
passed on from a returned soldier to his wife and eventually his young
daughter. This is well documented in the magazine and is by no means unique.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I
am jumping ahead a bit chronologically to the horrific disaster in Newtown
Connecticut in which 20 children ages 6 to 7 and four adults were slaughtered
with an automatic rifle wielded by a lone gunman who shot his way into an
elementary school and fired indiscriminately at a first grade class and some
teachers and principal who tried to protect the children. Many of the children
had multiple gunshot wounds. The shooter, of course, committed suicide when the
police arrived and as is so often the case he was described as a shy
misanthropic loner who was protected by his mother (and the mother was the
first victim with six bullet wounds while she was lying in bed). As is so often
the case in this scenario, the shooter was ignored by his classmates and peers,
thought to be shy, and the parent did not seek help for his angst.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We see this over and over with these massacres. A young
person, usually male, who has a history of being "on the outs" with
his society and probably very resentful of the fact, works up a rage about
his life and life in general and wants to strike out at anything and anybody nearby.
Usually the victims are chosen at random and have nothing to do with the
reasons for the shooter's rage. Rage can sometimes be manifested in writings as
in the case of the Unibomber and the Army psychiatrist at Fort Hood.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Mental health services in this country are in a shambles.
There are many reasons for this, but perhaps the most cogent is the attitude of
the general public towards psychiatry and its practitioners. It is often held
that mental illness or psychological problems are a sign of a weak person or a person who is
"weird", and also that the practice of psychiatry in general is laughable and subject
to multiple parodies. Certainly people with serious mental illness such as
schizophrenia or paranoia can indeed act "weird" or even sociopathic,
and the stigma of this kind of behavior is often generalized to anyone with
mental health problems. What's more, from my decades of experience dealing with
psychiatrists, I have come to believe that many are ineffectual and sometimes
even harmful to their patients. On both coasts, I have seen way too many
reputable psychiatrists whose idea of therapy is first to make an official
diagnosis (for insurance purposes) and then prescribe medication and see the
patient infrequently thereafter. One prestigious psychiatrist with a statewide
reputation allegedly responded to a patient's initial request for an
appointment by setting up the initial visit at the electroshock therapy room. I
have known probably three or four psychiatrists who actually perform
psychotherapy and when they do, they are often invaluable. But they are in my
experience (and I realize this is selection bias) fairly uncommon to actually
rare. Psychiatric social workers, in my experience, have a much better record
of actually performing useful and effective therapy, usually using what I have
seen and what many experts recommend as the most effective technique: "CBT
or Cognitive Behavioral Therapy". It's probably more effective than other
more traditional forms of therapy and certainly more so in many cases than
formal psychoanalysis. What's more, it's goal oriented and much less cumbersome
for both therapist and patient.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
An equally severe problem is the fact that mental health
therapy is often very poorly reimbursed. Insurance plans, understandably, wish
to reimburse activities for which there are tangible results, such as surgery.
Psychiatry frequently has vague or muddy outcomes and there
has never been, in my opinion, a comprehensive, scientifically sound outcomes-analysis which could be
used by insurance companies for purposes of funding. Therefore, the benefits
are limited in both amount and time and often ridiculously ineffective.
Psychiatry stands near the very bottom of the reimbursement pyramid for medical
treatments as does psychiatric social work. For that reason, some people who would be
very good at the field decide not to enter it. I worked in a drug
rehabilitation facility in California where the needs of addicts extended over
several weeks of therapy, often inpatient, for which the reimbursement was 3 to
4 days per year. As I say, I do not blame the insurance companies as they want
to see results for their money. Nonetheless, because of the stigma involved,
the lack of effective therapists, and the poor reimbursement, good mental
health service in this country is uncommon and too often ineffective. I feel very
strongly that disasters such as the recent school massacre could have been
prevented if this were not the case. But it is. So now what do we do?</div>
Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-79210009444806926582011-11-04T07:54:00.001-07:002011-11-04T07:54:33.873-07:00Reaganomics<p>Remember Reaganomics and trickle-down? Well, the Republicans not only remember it but they are still advocating it. <br /> <br />The idea that reducing taxes will increase business revenue and therefore improve the economic status of the country has been a long-standing tenet of Republican policy. <br /> <br />Well, it doesn't work. Even David Stockman, Reagan's Old Budget Director, admits it now. Finally we have adequate evidence to establish that reducing government expenditures actually hurts the economy and that downsizing government costs tens of thousands if not hundreds of thousands of jobs. <br /> <br />The proof is summarized in a marvelous article in the latest <em>Mother Jones</em> magazine, by Kevin Drum, entitled "Rich People Create Jobs!". <br /> <br />I would like to quote the article here but it is copyrighted and I'm a little uncertain about my legal obligations here.</p> <p>But if you possibly can, get a copy of it and read the article. If you still believe in Reaganomics after this I don't think anyone can convince you of the truth. But many Republican leaders still feel that they would love to, in the words of Grover Norquist, "shrink government until it's small enough to drown in the bathtub". We may actually see this work if the Republicans continue to build their power and that, my friends, is a very, very scary proposition.</p> Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-52668756193405395982011-10-25T06:13:00.000-07:002011-10-25T06:59:13.714-07:00Can Democrats and Republicans Agree on anything?The impasse in Washington is as strong as ever. Democrats stand for helping the poor and unfortunate and curtailing the excesses of commercialism, whereas Republicans stand for encouraging private enterprise and increasing individual wealth. But enough of that – we all know it.<br /><br />There is one area, in my opinion, that can be a bridge of peace between the two parties. That is the field of government regulation. Republicans hate regulation and Democrats feel it is essential to prevent runaway capitalism, such as the housing fiasco. So where could we meet in the middle?<br /><br />Here's an idea which I would like to share with you. I agree with the Democrats that regulation is essential as there are too many people who will do anything to make money. I agree with the Republicans that regulations are onerous, time-consuming, and stifle enterprise.<br /><br />Regulations are written by lawyers for lawyers and they try to plug all the possible loopholes with verbiage and multiple details. This leads to documentation which is extremely voluminous and hard to read and what's more it is full of jargon and acronyms.<br /><br />No matter how detailed and carefully drafted a regulation becomes, there are teams of lawyers that can find loopholes and exploit them. Large corporations hire such teams and they have been quite successful in finding loopholes. Individuals are saddled with the same regulations but do not have the resources to exploit them. What's more, many regulations are counterintuitive and – dare I say – plain stupid. I refer the reader to a fine book entitled "The Death of Common Sense" by Philip Howard, an Atlanta attorney, for discrete examples of such stupidity.<br /><br />What's more, the people who design and distribute regulations seem to have forgotten that ordinary humans have to read them and fill out forms. The regulations that I have seen in the health field epitomize this problem. Acres of singlespaced fine print interspersed with blocks to fill in, multiple pages requiring full personal identification on each, and the like. Just the appearance of some of the forms to fill out is daunting.<br /><br />It seems to me that this is one problem that could be worked on by both sides and the result would be favorable to big business and to small business alike. There is plenty of talent in this country and it is waiting to be tapped. Here is a great spot to begin.<br /><br />For example, my suggestion would be gradually to do away with regulations and forms and substitute regulation by humans instead. I know, I know. Humans can be arbitrary, selfish and capricious if not downright dishonest and we don't want people like that regulating us. So here's an idea to mull over: yes, have regulators who watch over what we all do and check to be sure that we are not breaking the law or going against the best interests of society. But not regulators who intimidate and are power-hungry and intransigent. How to do that?<br /><br />Criminologists tell us that the best deterrent to crime is not the severity of punishment but the likelihood of getting caught. What's more, the current climate of regulation seems to be "gotcha" when a law is broken or a regulation flouted. To me, that is counterproductive. I would like to see regulators have the ability and skill to carefully monitor the enterprise to which they are assigned and when they find a deviation or a tendency to act against laws or the good of society issue a simple and nonthreatening warning: "this is not something you should be doing. Please stop it."; then they continue watching and if the activity is not stopped they issue a somewhat more ominous "you are still doing it and you are going to be in trouble if you continue it".<br /><br />At this point, the regulator notifies a superior body of what is going on rather than taking any individual action himself and the superior body then, being aware, is prepared to take an action. This will eliminate individual insolence and hubris because the regulator does not have the power to punish but only to observe and warn. but of course the regulator's warnings are based on specific laws or the intent of legislation as interpreted by his superiors and by the Congress.<br /><br />Of course, this is a very crude and inchoate beginning to the discussion but I want to get opinions from those better prepared to deal with the question than I so please contribute!Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com1tag:blogger.com,1999:blog-8217867962662610709.post-79357588615676553862011-09-05T09:24:00.000-07:002011-09-05T09:56:54.403-07:00WImpy Democrats?Well, the President's popularity is dropping, and I think I know why. He needs a strong dose of Trumanism. I read in the latest issue of <span style="font-style: italic;">Mother Jones</span> a good rationale for his strangely wimpy response to vicious and largely telling attacks on his leadership. His strategy seems to be: appease the Repubs as much as possible to squeeze through whatever reforms and upgrades he can. To an extent, he can show success, such as the earned income tax credit, maintenance of unemployment compensation, avoidance of the catastrophe looming around the debt ceiling, and the like. But the price he is paying could cost him a second term and if the Repubs ever get control of the White House, let alone the Senate, it's back to the 19th century, and the gradual undoing of all the reforms of both Roosevelts. I suppose that our country could survive that, but what a country it would become. Robber barons in complete charge, a wider gulf between rich and poor, cheating and manipulation on every side, and perhaps even a class war.
<br />So I think that his choice, though understandable, is disastrous. It''s time for him to get on national TV and call the country to the fray. If the people who said "I don't vote because........" were to get themselves to the polls, the problem would take care of itself. The lunatic fringe would be drowned in a sea of truly enlightened patriotism and common sense. Our president needs to say that the mess we are in is the direct result of lax government regulation, not too much government. That can be proven.
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<br />The current Tea Party would bring catastrophe to the country if their anarchic message were to carry. No more clean water, clean air. Acid rain. Clear cutting our national forests, Coal smoke everywhere. No minimum wage. More jobs sent overseas. Stock manipulation galore, not to mention commodities and energy. I could go on and on.
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<br />But will he speak out? I seriously doubt it. And thus the outcome of the next election is also seriously in doubt, and all the folks who sit on their hands in November will get what they deserve and take the rest of us along with them.
<br />Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-7994578582580075302011-08-23T08:20:00.000-07:002011-08-23T09:43:27.428-07:00Our friends the RepublicansThe more I study the current crop of Republicans the more convinced I am that there is one common trait which seems to run in the majority: selfishness. It was well characterized by the British in the comment "I'm all right Jack – the hell with you".
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<br />Republicans seem to feel that if they are fortunate, hard-working, and skilled enough to have a good life or what they think is a good life, they should denigrate and scoff at those who were not fortunate or hard-working or skilled or all of the above.
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<br />They point out that this attitude is what made this country great and the more I think about it the more I agree with them. During most of the 19th century expansion, development and industrial growth were in the hands of single-minded entrepreneurs whose only goal was success in their endeavor and cared little if at all for the people they brushed aside or stepped on in the process.
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<br />But the side effects were disastrous, leading to a severe and deprived underclass, labor strife up to and including attempted murder of factory owners (such as Henry Clay Frick), and a dramatic gulf between the very rich and the working poor. The Republican Theodore Roosevelt recognized this social disaster and began the process of government regulation which has been expanded ever since as the entrepreneurs found more and more devious and clever ways of getting around regulation.
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<br />So the Republicans would like to return to those days with no income tax and little regulation so that they could again trample on the less fortunate, aggressive or ambitious of our citizens, without a single thought of what got them to be successful and whether it was indeed morally justifiable.
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<br />From the standpoint of creating a great nation, the Republican state of mind was extraordinarily effective but from the standpoint of creating a just and smoothly working society is totally disastrous and that's where we stand today, on the brink of a disintegrating social contract. The Democrats are not very effective in countering this since some of the emphasis of the party is controlled by plaintiff's attorneys whose primary goal is tort litigation against industry and its leaders rather than support of and aid to the working poor, the disabled, the mentally disturbed and deficient, and the chronically ill and dis-functional.
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<br />This could all be nicely taken care of by the voters, especially those who do not want to see our country deteriorate into the situation we found in the 19th century. But I keep hearing, from people who would agree with the above, that they have "given up on politics" and are not interested in redressing the problem at the ballot box. Talk about your self fulfilling prophecies! There are so many nonvoters whose hearts are in the right place but who sincerely believe that politics is merely a game and they're not playing. That attitude is so scary it makes my hair stand up and it is a major cause for the mess we are in now. I don't know what can be done about it except to express my opinion, so there it is. What do you think?
<br />Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-33455272018360172192009-02-11T06:49:00.000-08:002009-02-11T07:01:51.339-08:00Christian Hypocrisy?I have no quarrel with Christians who are trying to follow Christ's teachings, albeit with many failings, as long as they don't start trying to change society to fit their ideals. Then they become hypocrites.<br /><br />For example, those who say that the Bible is the given word of God, and that everything written in it is to be taken literally, then claim to be following God's commands, and are praying to a group in a church or on TV. Then they flout the command in Matthew 6:5 -<br /><br />"And when you pray, do not be like the hypocrites, for they love to pray standing in the synagogues and on the street corners to be seen by men. I tell you the truth, they have received their reward in full. <span id="en-NIV-23289" class="sup"><br />6 </span>But when you pray, go into your room, close the door and pray to your Father, who is unseen. Then your Father, who sees what is done in secret, will reward you. <span id="en-NIV-23290" class="sup"><br />7 </span>And when you pray, do not keep on babbling like pagans, for they think they will be heard because of their many words.<br /><span id="en-NIV-23291" class="sup">8 </span>Do not be like them, for your Father knows what you need before you ask him."<br /><br />And those with worldly goods, who claim to be devout Christians, and flout the command in Matthew 6:19 -<br /><br />"Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. <span id="en-NIV-23303" class="sup"><br />20</span> But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. <span id="en-NIV-23304" class="sup"><br />21 </span>For where your treasure is, there your heart will be also."<br /><br />So TV evangelists, who scoot around in private jets and live in palatial surroundings (whether or not the title is in their name) are, by Jesus' own words, hypocrites. So why do Christians treat them otherwise? And wealthy citizens who profess to be devout Christians, are likewise.Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-72315777602323466222008-07-07T09:28:00.000-07:002008-07-07T09:54:07.842-07:00Advertising, Bribery and the First Amendment<span style="font-family: arial;"><br />I have almost stopped watching network TV. Once in a while I'll catch an important sports event, but that's about it. Network news is marginally interesting at best, scheduled programming is boring to revolting, but the real reason I have stopped is advertising. Not only are the advts. creeping </span><span style="font-family: arial;"></span><span style="font-family: arial;">up </span><span style="font-family: arial;"> </span><span style="font-family: arial;">on program content </span><span style="font-family: arial;">in length and number (most egregious is the number posted just before the weather forecast on the news) but their material is more and more nauseating. One of the reasons that I watch international soccer is that there's no stoppage of play and thus no advts. can sneak in.<br /><br />Advts. are not only upsetting of themselves but they destroy the carefully crafted mood of good drama. How can you follow a demonstration of major grief or anguish or terror with a smarmy housewife pitching floor wax with a stupid grin?<br /><br />Anyway, commercials are here to stay. And anyone who can stand them should be able to watch. But, then, why the ineffectual and ludicrous regulations about content? Take the clearly mandated ones about automobile leasing. First, the hype. Then come the legally required facts about the lease, printed in dirty grey, 10-pitch lettering, scrolled at unreadable speed. Or on the radio, spouted by a trained pitchman at half volume like a tobacco auctioneer. No wonder our government is regarded as a toady to commercial interests. Here's proof all can see or hear every day. Whom are we kidding? It's literally nauseating.<br /><br />And drug ads. As a retired physician I have been as guilty as most in accepting largesse from Big Pharma and believing some of what I am told without confirming through scientific studies and double-checking the claims. But I'm not proud of it, and would be delighted if all ads. for prescription drugs, and all pitches to physicians were to stop. It's dead wrong and it's dangerous.<br /><br />But there is the First Amendment. Corporations are as free as individuals to speak out on any (well, almost any) subject. I would love to see a law banning marketing of prescription drugs, both to patients and to physicians. But I fear that such a law would be unconstitutional.<br /><br />I would love to see the FTC really force advertisers to comply with the spirit of regulations, not just their letter, and stop the hypocrisy. But as long as the electoral process is like an auction of influence and power to the highest bidder, that ain't gonna happen either.<br /><br />Comments?<br /></span>Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-65689700040165386822008-07-01T03:46:00.000-07:002008-07-01T03:58:45.224-07:00Second Amendment thoughtsI have been reading some ideas from the second amendment debate. Those who favor gun control use the argument that if the framers had intended free use of guns by the citizenry regardless of participation in a militia, they would have left out the first part of the sentence and just stated that "the right of the people to bear arms shall not be infringed". But they didn't leave it out.<br />Opponents of gun control use legal precedent to bolster their argument that the courts have largely favored individual rights, starting with the Reconstruction when freed slaves were allowed to arm themselves against lethal Klan aims. They favor the right of law-abiding citizens to arm themselves for hunting and self defense.<br /><br />To me, the problem comes down to this: what do we do about law-abiding citizens who buy arms and then become non-law-abiding? And what about non-law-abiding citizens who haven't been caught yet? I don't hear much debate on this question, which is buzzing along just beneath the surface. Just yesterday an employee in Henderson, KY blasted away at work, killed 5, then himself. Up until the moment of his action, he was law-abiding.<br /><br />What do we do about him and his ilk? Do we treat him like a tornado or a lightning strike? Shrug, and say that there is no way to protect us against him? Or do we all start carrying concealed weapons, so that if he shows up at work or on the campus and pulls out his gun, there's a slim chance that one of us will plug him before he opens fire? Why is this dilemma so egregiously American? We don't read about this in Sweden or France or Germany (gang violence excepted). Why is it such an exclusively American phenomenon?<br /><br />I'd love to have a dialogue on this.Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-32468362544220339062008-04-05T05:31:00.000-07:002008-04-05T07:32:36.909-07:00Fixing the Healthcare MessAs a retired physician, I am aghast at the state of the art in my chosen field. There is no doubt that marvelous tools exist to diagnose and treat as never before, but at what cost? And who can take advantage of them?<br /><br />The cost of drugs is too great. Primary care is spotty and hard to reach. Specialty care is a cottage industry. Politicians haven't a clue. Health Insurance is an oxymoron.<br /><br />As I see it, there are three main areas of attack: funding, motivation and organization. Listen up, then please respond. Together we can start to deal with this farrago.<br /><br />Let's start with motivation, which will lead into funding. Let me state from the outset that I believe that the majority of my colleagues are motivated to heal the sick and many, even at the risk of financial setbacks. However, the whole issue of motivation is on its head. All the major forces in healthcare motivate the physician and surgeon to <span style="font-weight: bold;">perform. </span>See patients, do tests and procedures. That's where the money is.<br /><br />The word <span style="font-weight: bold;">doctor</span> comes from the Latin "docere", to teach. Not to perform. Teaching patients and other laypersons is widely neglected in the field, and poorly motivated, if at all. Yet the best weapon we have in Medicine is the informed patient.<br /><br />Therefore, to begin the correction process, we need to address this error in approach. We need to motivate our professionals to teach. And there is no more powerful motivator than money. I have a suggestion on how this might be accomplished.<br /><br />First of all, diminish the reward for doing to be equalled or surpassed by the reward for teaching. This will accomplish the admirable goal of having the physician pay more attention to what his patient understands about his body, its troubles, and his options.<br /><br />Each physician would receive a base yearly stipend determined by his years of training, years of experience and the inherent risks of his field (i.e., neurosurgery would be paid at a higher rate than dermatology). On top of this, a bonus system would increase the stipend based on three criteria: maintenance of continuing education, patient satisfaction, and hours of practice.<br /><br />Continuing education would be revamped. Isolated courses would be downplayed and ongoing, home-based, programmed learning substituted, with frequent pop quizzes for credit, and periodic reviews. The subjects for the programs would be chosen by each physician based on her actual clinical encounters. What she sees most often and what he feels most in need of study. However, the program would be structured to include eventually the broad scope of the field.<br />Scores on the quizzes and reviews would be determinants for the bonus.<br /><br />Patients would receive from the office at each visit a confidential questionnare, to be mailed to a secure site, on their degree of satisfaction with the visit. They would be clearly led to understand that the physician's income depended on their submitting the questionnaire. This would lead to a form of passive rating of the visit. Non-submission would be a subtle criticism. Beloved doctors would get a higher percentage of responses. On the questionnaire would be such questions as "Were you seen in a timely fashion? Were the staff friendly? Did you understand what you were told? Were you given the opportunity to ask questions? Did you feel rushed? Were you given materials to refresh your memory? On a scale of 1-10, how satisfied were you with the visit?" The ratings would be analyzed and the bonus adjusted according to the answers and the percentage of submissions.<br /><br />The physician would be invited to submit his hours of operation, including study time, and this self-rating would be checked by the payor against objective measures such as number of patients seen coupled with patient satisfaction, submisison of quiz results, and the like. A bonus would be paid but there would be a maximum time allowed for increased reimbursement to discourage burn-out.<br /><br />There would be reimbursement for doing procedures, but it would be scaled down to discourage doing them for their own sake. The reimbursement for doing should never equal, let alone exceed, that for teaching.<br /><br />The result of this approach should be that of empowering the patient to make more rational decisions, and reducing the moral bullying that goes on in so many medical and surgical offices. The patronization that says "I am the expert here, so do what I say". This should reduce the all-too-frequent occurrence of expensive and marginal medical adventures and therefore the cost of care.<br /><br />Next, we should do away with the whole concept of "health insurance". An underwriter once pointed out to me a simple truth in the insurance business in the form of an aphorism: "never insure against the inevitable". This introduces the concept of "actuarial risk". To put it simply, if something is likely to happen, it is financially unwise to insure against it. That is <span style="font-weight: bold;">not</span> to say that one shouldn't plan for it and prepare for it. But insurance is a special kind of preparation that is designed and engineered to reduce the burden of infrequent to rare occurrences, such as tornadoes, forest fires, car crashes and the like. Not health care. Especially not preventive medicine.<br /><br />In the insurance model, if you are insured against an occurrence, you and your fellow subscribers pay a stipend to an agency each month and then if you are hit with a disaster, funds are disbursed to pay for reparation. In the health insurance industry, you pay the stipend, but then turn around and collect with each medical encourter, which is far from uncommon. This has the result that you pay the health insurer to cover your office visit and tests <span style="font-weight: bold;">plus</span> the cost of administration. So if the administrative cost, is --say-- 20%, you end up paying $120 for every $100 of care you receive. This is definitely not in your best interest.<br /><br />So do away with "health insurance" and substitute a more direct and less costly way to pay for care. I like the model of "health savings accounts" in which each patient sets aside income to cover the cost of health care, and each patient decides how it is to be spent. But, this model needs much tweaking. Many, if not most people will not be willing to spend their own money for preventive care, unless they are taught its importance and the cost of ignoring it is made crystal clear. This requires education and motivation, and those cost money. Perhaps a hybrid model would work. Doctor income would come from a public pool and procedures would be paid from health savings, with a catastrophic insurance backup. That is, you pay for your mammogram, but if you get hit by a truck or require a liver transplant, insurance covers it. I need feedback on this from wiser heads.<br /><br />As to the cost of drugs, there is a simple and effective remedy: outlaw advertising of all prescription drugs. This includes TV ads and pharmaceutical reps in doctor's offices and medical meetings. A large percentage of the cost of drugs is in marketing. When the choice of a drug comes from -- as it should -- the results of objective controlled studies done by disinterested third parties, plus recommendations of expert panels when such studies are missing or inadequate, the cost will plummet. Pharmaceutical companies will spend their income on research and development, instead. If the profit motive leads (as it has recently) to disincentives to create certain classes of medication, such as antibiotics, a public utility would be created to develop them.<br /><br />I want to hear contrary or supplemental ideas and will debate them gladly and enthusiastically with anyone. But no <span style="font-style: italic;">ad hominem</span> arguments will be entertained!Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-69720085900631975272008-01-20T08:05:00.001-08:002008-01-20T05:06:29.753-08:00Tax rebate?<span style="font-size:100%;"><span style="font-family:times new roman;">So, our leaders are thinking of giving us all a tax rebate, adding to the federal deficit. We might as well be getting it from Beijing, since the Chinese are rapidly buying up our debt with their trade surplus. And what will we do with the money? Many of us, myself included, would use it to repay credit card debt. In that case the money will pass from one lender to another. Can anyone tell me how this will help our economy?<br /></span></span>Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com0tag:blogger.com,1999:blog-8217867962662610709.post-38023213428675543492008-01-20T05:07:00.000-08:002008-01-20T05:21:40.131-08:00President McCain?<span style="font-size:100%;"><span style="font-family: times new roman;">There are many things to like about John McCain. He is trying to be honest about his beliefs, even in the face of hostility from his own party. He is avuncular. He is a war hero. He has a low-key, down home delivery.<br /><br />But, oh, some of his ideas! They sound hare-brained to me, even dangerous. Like using ex-Chair Greenspan as a principal financial advisor. That devotee of Milton Friedman and Ayn Rand wants to do away with most government regulation. The ghosts of Jay Gould, William Frick and Diamond Jim Brady must be stirring in whatever special hell they reside thinking of the fun their present-day counterparts would have. We've already seen a taste of it, with the attitudes of the FCC, the CPSC, and the FDA toward industry.<br /><br />And then there are his ideas about health care. One was to pay physicians to keep people well instead of caring for their illnesses. How many of them would switch out of cancer therapy, AIDS treatment, diabetes care etc. into running gyms and fat farms? John, John! Perhaps his critics are right. Perhaps the Cong did a bit of damage.<br /><br />I still like and admire him, though.<br /></span></span>Matt.Cushinghttp://www.blogger.com/profile/17246111133910626952noreply@blogger.com2