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The black box that caused the crash (of healthcare)

By healthcare industry, politics

This week, NPR’s Marketplace aired a piece on what I have taken to calling the “black box of healthcare” – pricing. There is a committee, called the RUC, set up and run by the American Medical Association, that reports to CMS (the federal unit that runs Medicare and Medicaid) on relative value numbers for the thousands of medical procedures that wind up as billing codes in Medicare and your health insurer. Those relative value numbers = PRICES. This isn’t considered price-fixing under anti-trust rules because the RUC reports to CMS, which then publishes the numbers on the Medicare reimbursement rate schedule. So the AMA isn’t publishing the prices, CMS is. Fox, meet henhouse. Or, stated in another way: airplane, meet the black box that is making you crash and burn. The Marketplace page linked in the 1st graf has plenty of linkage to additional context for this issue. Read them, and weep. How is it that an industry whose aggregate cost is now at close to 20% of US GDP gets to set its own prices, and then have them published by the federal government as The Official Price List? It’s called effective lobbying, and it’s so effective that it’s essentially kept access to the pricing committee process a secret for decades. Which makes it pretty clear why so much of our GDP goes to healthcare, doesn’t it? The sound bite in the story that I found the most hilarious was from Charlie Baker, the former CEO of the Harvard Pilgrim health plan in Massachusetts. His quote: By having a process that for all intensive [sic] purposes isn’t a public process, and doesn’t appear to actually be accountable to much of anybody, I think that’s kind of un-American! I find this hilarious because Harvard Pilgrim is a member of America’s…

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Do not fear dragons

By e-patients

I was born in one of the Chinese zodiac’s Years of the Dragon. I am a fire sign – Leo – in western astrology. I’m fierce, and I roar frequently. I have often been accused of being a fire-breathing dragon. Those who said that aimed at criticism. I took it as praise. #HAWMC Day 24 – today – I am asked to create a mascot for myself and my health activism. I’m a dragon. Of course I’m a dragon. I embrace my dragon, and my ferocity.

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Madlibs poems: way cool

By e-patients

I have taken both of my #post #fail days for #HAWMC, so I gotta really slave to the grind thru the next 10 days. That said, today’s prompt involved going to Madlibs Poem generator, filling in the blanks (be prepared, there are many!), and hitting “go!”. I went. This was the result. I surrender I spread you up inside my party. funny cancer’s funny cancer I swim my wings and all the walls prays books; I shake my gardens and all is fight again. (I surrender I spread you up inside my party.) The wines go releasing out in crazy and fierce, And foggy beer opens in: I jump my fear and all the humor flys tree. I runed that you leaned me into flower And bend me scary, walked me quite free. (I surrender I spread you up inside my party.) sun leaps from the moon, surfboard’s mountains soar: dive ocean and sailboat’s train: I jump my fear and all the humor flys tree. I surfed you’d bounce the way you look, But I see beautiful and I hear your jet. (I surrender I spread you up inside my party.) I should have speaked a submarine instead; At least when parachute roars they scream back again. I jump my fear and all the humor flys tree. (I surrender I spread you up inside my party.) – Mighty Casey & Sylvia Plath

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5 Dream Team dinner guests

By e-patients

There are five people for whom I would walk over broken glass, if on the other side of said glass was a dinner table set for six, with them waiting for me. Here they are, in no particular order: Marie Curie My mother was a stone-cold science geek. One of her inspirations was Madame Curie, who literally gave her life to her scientific research. I’d love to ask Mme. Curie what it was like to be a brilliant scientist and a woman at a time when women were supposed to be mere decorative objects or domestic drudges. I’m sure her self-told story would be incredible to hear. Oscar Wilde What can I say? I’m just Wilde about Oscar, always have been. His sharp wit, his inability to truck with idiots, his life-long search for beauty and intellectual stimulation, along with a good laugh, tell me that he and I would be instant BFFs. I would love to hear his take on social media. And the Kardashians. Tenzin Gyatzo Who’s that, you say? The Dalai Lama, kids. Actually, I kinda did have dinner with him once, in a sushi bar on Rt. 7 in Arlington, VA. I was in there on a busy Saturday night with my sister, and we were negotiating seats at the sushi bar – the place was packed – when suddenly there was a noticeable shift of all eyes to the big group waiting in line behind us. In the middle of that group was a bright-eyed guy in saffron robes. Yep, the Dalai Lama. We got our seats at the sushi bar, and he was seated immediately at the owner’s table. Boudica You don’t know who she is? She faced down the Roman Empire in what is now Wales back in AD 60 or so, and…

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I learned about patient advocacy the hard way

By e-patients, healthcare industry, participatory medicine

Well, maybe it wasn’t the hard way for *me*, but it was a hard lesson nonetheless. When I was in my early 20s, my maternal grandmother (the Admiral’s wife) had a serious health event that involved hospitalization, and fear that she was at death’s door. The cause turned out to be not heart failure, not a stroke, not peripheral artery disease, not “old age”, but … pharmaceutical assault. This assault was perpetrated by her trusted family doctor, one she’d been seeing for over a decade. When we pulled open the drawer where she kept her medications and found more than 40 bottles of pills – all current scripts – we figured out pretty quickly what the disease was that we were dealing with. Stupidity. She recovered, and lived another nine years – until the last minute, she was entertaining, cooking, enjoying life, and taking only a few meds. Lesson learned: drugs interact with each other, and in an even more scary way than the recreational drugs I was familiar with had interacted on many of my friends … Fast forward 25 years, and my parents – the Admiral’s daughter and the dashing fighter jock – were battling a couple of health issues. Daddy had Parkinson’s disease, Mom had had a pituitary tumor that had been removed, but that missing pituitary gland had put her on a cocktail of endocrine management meds that had to be delicately balanced to ensure that she didn’t wind up in a permanent sinking spell. I found myself advocating for both of them at various times for equally various reasons, but my hard lesson there was this: unless someone is advocating for you, you could easily wind up dead, or crippled. I discovered that all the years I’d been researching news topics were right handy when…

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Pin THIS!

By e-patients

#HAWMC Day 16: Pinterest! Have a Pinterest page. Have yet to figger out its highest and best use, but today’s prompt tells me to create a board for my health focus and pin three things on it. Well, in typical over-achiever fashion, I’ve pinned four images to my brand spanking new Health Activism board: Why these images? The one on the left is Buckminster Fuller at his best – don’t fight to create change, just create it. The one left-center was shared last week on Day 9. The one right-center is the ribbon I created for Team Plaid, my effort to drive discussion about early detection for all cancer. I am *so* not pink, or any other “one color” advocacy. The one on the right is an example of the tattoo I’d happily get if it meant I’d never have to fill out another blinkin’ health history form.

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Got style? Why, yes I do …

By e-patients

#HAWMC Day 15 – half-way home. Hallelujah. Maybe. Writing with style. That makes me think fondly of E.B. White’s Elements of Style, the first book about writing I ever read. I know that Bill Strunk co-authored EoS, but since E.B. also wrote Charlotte’s Web, he gets to mostly-solo when I’m in charge. My dad gave me my 1st copy of the book, and it helped me form my voice and style when I was still in grade school. The nuns did their damnedest to turn me into a grrl who wrote properly – IOW boooooooooooooringly and according to their rules – but Strunk & White saved me from perpetrating written assault in the years since. Thanks, dudes. Daddy, E.B., and Bill. All of you. Words come easily to me … most of the time. The closer to a deadline I get on projects where I don’t feel a connection to the topic can be problematic, causing me to both procrastinate and self-flagellate (figuratively only on that second one) as the deadline gets closer … and closer … and … aaaaarrrgh! But I don’t blow deadlines regularly, often, or really ever much at all. Can only think of one time when I did, and that turned out to be due to the chemo treatments I was getting at the time. Chemo-brain made me unable to write. That was Panic City, letmetellyou. I sat down to knock out a simple press release, and … couldn’t figure out what to do. Words weren’t coming, I couldn’t figure out where to start, I was totally frozen and staring at a blank screen. I’ve never been so frightened in my life, other than when I heard the word cancer and my name in a sentence the first time. A week later, the words were back, and I recognized…

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The perfect day(s) …

By e-patients

#HAWMC day 14 (almost half-way there!) – the prompt we’re given is “describe your ideal day – how would you spend your time? Who would be with you? Have you ever had this day? There are two versions. #1: perfect day, vacation version I wake up to early-morning light coming through the forward hatch on the sailboat I’ve been spending time on, island-hopping in the south Pacific. I stretch, smell brewing coffee … and is that fish on the grill? I roll out of the berth and head to the salon/galley. Yep, there’s coffee, and I see my lover’s legs through the companionway. He’s grilling a fish he caught after he got up a few minutes ago – a wahoo. Wahoo, indeed! We’ve got a day ahead of us. After breakfast, and a short tour back in the berth – why not, we’re alive, let’s celebrate, right? – we prep the dinghy with our dive gear, suit up in light skins, and head to the reefs close by. We dive for about an hour, finding Nemo all over the damn place, along with plenty of his friends. We head back to the boat, shower off, dress in our best t-shirts/shorts/flip-flops, and hop back in the dink to head around the point to town. We rinse off our gear at the town dock, hang at the dockside bar for a bit of lunch, and make some plans with other boat-buddies for dinner that night. We head back to the boat, leave our dink tied to our mooring, and head out for a couple hours of sailing exercise – for us, and for the boat. We’re back at the mooring late afternoon. We stow the dive gear that has been drying in the dink, shower, and dress for dinner in town –…

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10 things I won’t live without

By e-patients

#HAWMC Day 13 (Friday the 13th – kewl!), and I’m prompted to share 10 things I won’t live without. Well, they say “couldn’t” and I say “won’t” – I’m much more definitive and fierce by nature, as we’ve already established. #1: Common sense This has saved my ass more than once. #2: My very widespread family These people are my … people. I grew up moving all the time, without a strong family anchor I would have been lost. #3: Good coffee You need to ask? #4: Good friends This comes after good coffee ’cause my family are the only peeps who can manage me without caffeine. #5: Good wine Take friends & family. Add good wine. Wonderful experiences ensue. #6: Hot peppers I have an incendiary palate, to go along with my incendiary tongue. Any questions? #7: Hummingbirds See the post from April 5 if you need to know why. #8: Salt water The ocean is my touchstone. I need salt water to feel fully alive. #9: New experiences (daily, if possible) I have an insatiable curiosity to know everything I can about the world I live in. Which explains my 20+ years in the news business, and much more. #10: My ferocity It’s my gift. Really. The world needs warriors who will gear up and speak truth. I like to think I’m one of them, at least when I’m operating at full power.

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