Visions define us.
Viewpoints alter our assessment of the facts.
Mine. Yours. All of ours.
The more we realize it, the more productive our discussions will ultimately be.
Sometimes, visions affect us so much so that we have no real interest in empirically reviewing what we already want to believe. Evaluating and re-evaluating the reality created by our beliefs intrigues us very little. We prefer to see the evidence that supports our vision. And, we ignore the rest.
A clash of visions plays out all around us—economically, politically, and socially. Here’s one example in the debate over healthcare reform policies.
l’ll begin with this graph from Our World in Data:
The X-axis is health expenditure. The Y-axis is life expectancy. The United States appears by itself at the bottom-right of it. And, here we go…
Spare tires have become TERRIBLE.
What is the matter with those things?
We call them donuts. But this comparison is a disgrace to the donut. Powdered sugar is more durable.
As for a balloon? I’ve seen sturdier ones at a birthday party.
It wasn’t always like that. It used to be a real tire. Then, something happened. And, its function suddenly became atrocious.
Even the jack suffered a similar fate. It became two chopsticks with a plastic twisty piece overnight. Did all of the automobile manufactures just get together and determine it was time to anger their customers?
Maybe. But, if being a part of America’s healthcare system has taught me anything, it’s that madness frequently has even simpler beginnings.
* * *
Shortly before I entered medical school, a change in healthcare delivery was already taking affect. It was called Hospital Medicine.
Don’t let me confuse you. Yes, we already had medicine going on in hospitals. But, this was indeed something new.
Different doctors (called hospitalists) were beginning to take care of you whenever you ended up in the hospital. These hospitalists weren’t your main doctor—the one who you saw frequently in the clinic. They were different. Your main doctor didn’t go to the hospital anymore.
We’ve been trading freedom for security.
One day at a time.
The former previously defined us—the “Land of the Free”—but apparently that’s less so, now.
They tell us we’ve dwindled down to being the 15th most free nation in the world. Fourteen other countries provide their citizens more personal freedom.
There was a day when someone said if we lost freedom here, there would be no place to escape to. That we were the last stand on earth. But, our actions seem to suggest we find freedom to be over-rated.
* * *
Two things that are frequently misconstrued about healthcare came to my attention after reading a recent article by a writer I respect.
I don’t agree with this author on everything. Far from it. But, she comes across as someone you can discuss legitimate issues with—regardless of your point-of-view.
She’s a self-proclaimed Liberal, who apparently voted for Trump. (Seems she wasn’t the only one.) In her article, she provided healthcare advice to our next President.
My intent is not to refute it. Much of it, in fact, I agree with. But, I want to elaborate on two things that came to me after reading a quote in this article. I will examine the concept of (1) shopping for healthcare, and (2) how it relates to your life.
Here’s the quote:
“Beep,” went the machine.
I left a message and hung up.
My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.
I was leaving a message on his behalf.
You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers every day. It’s the system we’ve come to expect for both the extreme and the routine in our medical care.
Most of us dislike it.
But, we’ve been taught we can’t afford it any other way. The cruel paradox—of course—is that the majority of us are being out-priced by the status quo.
Mr. G’s medicine was working fine. It’s the only one of its type that he has tolerated without side effects. The insurance company covered it last year. They changed their mind about it this year. And, until we accept the logic that entrusting third parties to pay for our health might be harmful to our health, they will be the ones who keep getting to decide.
I was told I could appeal the decision waged upon Mr. G by getting in touch with a “doctor” working for the insurance company.
If you read that again, it’s an unbelievably humorous statement.
Physicians, scientists, and researchers are routinely condemned by the most virtuous of stone throwers for having even the slightest lean toward a conflict of interest. Yet, having me appeal your insurance case to someone who works for the insurance company remains noticeably absent from their aim.
I enjoy documentaries. My wife says she enjoys watching them with me. The way I usually see it, they help her fall asleep.
But, not this one.
Not Poverty, Inc.
If you haven’t watched it, you should. We both enjoyed it.
It’s not one of these pick-a-political-side kind of shows. For the record, people across the political spectrum have endorsed it. The film has won like forty honors and twelve awards that I know absolutely nothing about. But, if you watch it, you’ll get the gist why.
We occasionally need disruptive thinking. Something to challenge our perception of reality. We actually need more of this when contemplating healthcare delivery, too. But, I’m not talking about that right now.
Poverty, Inc. is about poverty… and the humanitarian aid we use to fight it.
It’s also about government. And, business. And, how the collusion of these things isn’t solving poverty at all. Like I said, you should watch it. It provides you a fascinating perspective.
I won’t give it all away, but there are a few predominant themes that unfold in the film as you watch it.
I wrote previously about the ongoing federal approval process for a medical device known as the WATCHMAN™, now available to treat certain patients at risk of stroke.
As expected (and really just because it’s how things get done around here) the Centers for Medicare and Medicaid Services (CMS) has compiled a 32,000 word decision memo related to how it intends to pay (if at all) for patients receiving this approved device. This memo is commonly referred to as a coverage determination.
A thoughtful piece was also written recently by Dr. John Mandrola on this very topic. He and I usually share many of the same goals, although admittedly, we differ from time to time on how best to obtain them.
Regardless, Dr. Mandrola’s piece is full of clarity and is very supportive of CMS’s intent to require an evidence-based formal “decision tool” to be used by the physician and the patient prior to implanting the WATCHMAN™.
We are told this is a problem.
It occurs when the bar is lowered for what’s considered a real disease. For example, overdiagnosis presumably exists when we incidentally discover slow-growing cancers in older people. Basically, when we find a cancer that may not kill someone sooner than Father Time. And, as the story goes, we treat the cancer with lots of medicines, tests, and therapies–since the more diseases we diagnose in American medicine, the more treatments we recommend, and the more money we make, right?
After reading my latest post about conflicts of interest in healthcare, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful.
Since hostility is never my goal, I thought I’d give it a try.
I read for an entire evening on butterflies–their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother liked them. She lived for nature. Flowers. Birds. Butterflies. She stayed with me once as a child when my parents were out of town. She would literally drive only 10 MPH on the road if anything remotely beautiful were visible out the window. Butterflies included. During her visit that year, I intentionally directed her down the ugliest roads in town so we could get to where we were going more quickly. I know it sounds bad, but that’s what I did.
Pharmaceutical drugs cost too much. The new ones are always so expensive.
Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drug-maker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.
The government should regulate things more so we can get it cheaper.
Case in point. One new medication now available to cure a chronic liver disease costs about $84,000 per treatment course. The actual production cost for the company that makes the drug is supposedly around $100. Granted, the company paid $11 billion for the patent rights, and then took a risk that the drug would even get through Food & Drug Administration (FDA) approval. But, ultimately it did, and this year alone, the company will likely receive over $17 billion in revenue from it.
Wow. Then, they likely will make more profits next year.
And, the year after.
Why isn’t the government protecting us from such pharmaceutical price gouging? Where are the regulations? We need them.
Here’s the bitter irony.