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…
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.
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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:
It’s business as usual at the office.
Another Fall season is here.
It’s time, once again, to sort through all the madness.
I wish it were “Midnight Madness.” Because, I like college basketball. That’s the name we give to the first formal practice of the season. The one where you get a glimpse of your local team’s talent.
Unfortunately, that’s not what I’m talking about at all. But, there are some similarities.
For example, the madness (I speak of) spans numerous midnights and deals with a practice—albeit a physician operated one.
My office is currently back at it again trying to figure out how we can continue to see Medicare patients. One day soon, we might just give up. But, if you are one of my Medicare patients, don’t call me in panic. Call your congress member instead. Click here if you don’t know who that is.
My recent post appeared to catch the attention of Mr. Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS):
My article recapped another day of insanity within our healthcare enterprise, and yes, taking a look, Mr. Slavitt, would be greatly appreciated.
Choosing to see, however, is my challenge for you—for as a friend reminded me, you seem to be very good at “feeling our pain.”
But, I must admit, thanks to you, I was contacted by a CMS official overseeing the startup of MACRA.
For those that don’t follow healthcare policy closely, MACRA is our government’s latest medical project. Another soon-to-be-implemented healthcare law with 962 pages of rules, including the most recent method devised to pay physicians, something known as the Merit-Based Incentive Payment System (MIPS).
CMS was seeking my perspective on MACRA and MIPS.
My written response to them—edited only somewhat for brevity—is shared below:
I arrived with my family. I handed the usher our tickets.
We entered the auditorium. The stage was lit. We were directed to our seats.
We were there to watch an OPAS Junior production—a performing arts play for families and children.
The performance would soon be what we paid for, an enjoyable Sunday afternoon event with my wife and boys.
The actors and actresses did their job. They appealed to us, the audience. They danced, sung songs, provided humor, and so forth. They were there for us that day. And, we were there for them.
We paid for their performance. And, they gave us one.
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A compelling strategy has consumed American healthcare. It’s known as pay-for-performance. It’s trying to replace our unknown fee-for-service model, because it seems more logical.
There is a single CT scanner in town.
A certain number of scans are done with it each month.
Suddenly, a second scanner is installed at a new location across town.
True or False:
The total number of CT scans being performed will remain the same with two scanners now available.
The answer is false… at least within our current system. Someone has studied it. Adding another scanner increases the utilization of scanning.
Is this a good thing or a bad thing? Careful, now. It’s an entirely different question. The answer, of course, is maybe, or maybe not. You need more information.
My oldest son is almost a second grader.
He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test.
The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the Exit Level test to graduate high school.
There’s good and bad with standardized testing, and I’m not going to debate that point today. Instead, I’m going to tell you about a new proposal involving public school teachers.
Imagine, just for a moment, that we decided to pay our school teachers differently next Fall. It’s an intriguing idea, so bear with me. In fact, let’s pay school teachers based solely upon the scores their students achieve on the STAAR test.
Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.
I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.
I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.
This article was written by Dr. Megan E. Lewis Grotefend, MD, and first appeared online here. The article is being re-posted simply because it is brilliant.
Imagine going to your favorite restaurant.
You are greeted at the door by the hostess, who seats you and takes your drink order. You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate torte for dessert. Soon after, the food is brought out and it is delicious! You have time to enjoy your food. You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met.