Last week’s post called medicine in the U.S. a monopoly. I took some heat for using that metaphor from some of my economist and journo colleagues, and realized that I needed to make a clarification: Medicine is a game of Monopoly, not a true economic monopoly. My very-snark-infested point was, and always is, that the pricing model in healthcare in this country is about as fair as a crap game or, perhaps, a round of Monopoly. More grist for my point arrived this week in the form of a TIME special feature, Bitter Pill: Why Medical Bills Are Killing Us. In it, reporter Steven Brill walks the reader through the chaos behind a veil of secrecy in healthcare pricing, starting with an under-insured man’s treatment at MD Anderson Cancer Center in Texas, which involved waiting – while wracked with the chills and fever caused by his non-Hodkin’s lymphoma – in a crowded hospital reception area until the check for his treatment cleared. He wound up having to use a credit card to pay $7,500 toward his medical costs before they’d initiate his chemotherapy. By the way, MD Anderson is a non-profit hospital. A close review of that man’s hospital bills revealed a 400% markup on many of the cancer drugs in his chemo treatments. Another example in the TIME feature is one involving a $21,000 false alarm – a woman was having chest pain, and was taken by ambulance to a local hospital. After testing, it was discovered that she was suffering from indigestion. The Medicare billing for the trip would have been around 80% less than what the woman – who didn’t have insurance – was billed for the hospital visit. However, since she was 64, and not eligible for Medicare, she was billed $21,000. Yikes. At the root…
When you hear the word “monopoly,” does it fill you with a warm and fuzzy feeling? (Unless you’re Hasbro, you really should say no, unless you’re a cyborg.) Healthcare is a monopoly. We can’t DIY cancer treatment, or surgically repair a broken hip for ourselves, so we have to go to the medical-industrial complex to regain our health if we wander into the weeds, health-wise. We also have deep difficulty accessing pricing information. I’ve talked about that here over the last few years. Maybe not a monopoly in the financial-reg sense of the word, but it sure is mighty like a game of Monopoly. This “chaos behind a veil of secrecy” (all credit for that phrase belongs to healthcare economist Uwe Reinhart) has created the impression in healthcare customers that there’s no way to tell what something will cost before you buy it. You checks the box and takes yer chances. No Get Out of the Hospital Free cards. No pass-the-admissions-counter-collect-$200 option. That’s a rotten way to run a railroad (one of the original monopoly industries in US history), and an even worse way to run a hospital. Dan Munro wrote about this, and the star-chamber cabal that actually sets the prices in healthcare, the RUC, on Forbes.com yesterday. I’ve talked about the RUC myself. And the search for price transparency, which seemed such an outlier activity just a couple of years ago, is now popping up in the Well blog on the New York Times site, as well as on Reuters. The Reuters piece has the addition bonus of quotes from my buddy Jeanne Pinder, founder of ClearHealthCosts.com. (Yesterday was a big day in medical price transparency.) This is the central reason I registered the hashtag #howmuchisthat with Symplur, the healthcare hashtag registry. We all have to start demanding that prices be visible, and that the RUC stop cabal-ing…
Yesterday (Monday, April 2, 2012) the US Supreme Court handed down a 5-4 decision on the legality of strip searches in jails and prisons. The news is not good for anyone who gets arrested – guilty or not – and proves that the precept of “innocent until proven guilty” is sinking beneath the surf of paranoia that has marked the last decade, and has been a dark underbelly of the American character since Columbus landed all those moons ago. Which leads me to reflect on the fact that it appears that the more open and social global society becomes, the more paranoid some sectors of society in turn become. Look at the George Zimmerman/Trayvon Martin incident in Sanford, Florida. Would Martin have been in danger of being pursued and shot by a self-appointed neighborhood watch volunteer if it were not for some serious societal paranoia that drove Zimmerman to feel that he needed to wander the streets strapped with a 9 mil? Full disclosure: I’m a gun owner. Additional full disclosure: if someone breaks into my house when I’m there, they run a risk of getting a face-full of lead. However, I don’t walk in paranoia when walking the streets of the city where I live. And I didn’t on the streets of New York City for the 27 years I walked there, even though I often found myself in dangerous places because of my work in TV news. The Kinks song “Destroyer” says it all: Silly boy you got so much to live for So much to aim for, so much to try for You blowing it all with paranoia You’re so insecure you self-destroyer Paranoia, the destroyer Paranoia, the destroyer As a culture, I think we need to take a long hard look at how we view our fellow…
The headline on this post is inspired by both the 1992 Clinton campaign meme, and by my personal belief – shared by many – that education in the U.S. is in trouble, and will sink us if we don’t act decisively and quickly to change a broken system. The infographic tells the story. You can click it to open up the source in a new tab, and get the full weight of the problem broken down pretty darn well. Some high(low?)lights: only 30% of U.S. students in K-12 are grade-proficient in math and reading 70% (that’s SEVENTY PERCENT, my friends) of 8th graders can’t read at grade level Every 26 seconds, an American kid drops out of school (can you say “brain drain”?) There are only 50 million skilled workers in the U.S. – there are 123 million skilled job openings (still wonder why jobs get outsourced?) In Finland, South Korea, and Singapore, teachers are drawn from the top 1/3 of college graduates. In the U.S. they’re typically from the bottom 1/3 of college graduates. Looks like the old cliché “those that can’t, teach” might be true? Newly-minted lawyers in the U.S. make, on average, $115,000 per year more than a newly-minted teacher here. Newly-minted engineers and lawyers earn less than teachers in South Korea and Singapore. Is that math you can understand? The U.S. comes in at 30th in math, 23rd in science, and 17th in reading when stacked up against global competition. Is the picture starting to become clear to you? We’re in trouble, not just right now, but our future’s looking pretty dim, too. If we can’t educate our children at a level that makes them – and our society – competitive globally, we’re looking like Rome after the lead poisoning set in: bleedin’ dim, and getting…
Paula Deen did what every middle-aged woman who’s just been diagnosed with diabetes does: she went on the Today Show to announce that she’d still be cooking with plenty of butter, salt, and sugar. She’d just be practicing moderation. Yeah, I’m kidding. About the Everywoman part, but not about the rest of it. To top it off, the Butter/Salt/Sugar Queen is also going to shill for Novo Nordisk, the maker of diabetes treatment medications. There are so many things wrong with this picture, and this message, I honestly don’t know where to begin … but here goes. After spending almost 30 years making and pushing foods that are literally gateway drugs to the insulin-dependency rehab zone, the Butter/Salt/Sugar Queen is now in the club herself. What a great chance for her to make a difference in the lives of the women she influences, and the families they prepare meals for. But no. It’s ever so much more fun to push even more high fat/salt/sugar recipes … and the insulin to go with ‘em! The diabetes epidemic in the US – and elsewhere in the developed world – started in the Wretched Excess ’80s, when restaurants took a page from the drive-thru playbook and started to super-size their portions. I remember the first time I noticed this, in a restaurant in the Washington DC suburbs that, among other things, served a heaping platter of cinnamon-butter rolls – huge things – as the bread basket. The portions for the entire menu were lucullan (look it up) taken to an extreme. I fell for the con myself over the years, and have the GAS (Giant Ass Syndrome) to prove it. Luckily I’ve escaped the diabetes dx, and I work hard to make sure I keep it that way. Humans are hard-wired to survive, like any other animal. The problem…
My good friend Andrew Spong posted something today on his blog that I took one look at and said, “STEALING THIS!” It’s not really theft if you give 100% credit, though, is it? Andrew talks about his “I have” project, and uses this image to drive the point home: What is the “I have” project, exactly? It’s crowd-sourcing health information in a way that makes it accessible and understandable to someone who’s just heard their name and [insert diagnosis here] in the same sentence. Patients, clinicians, experts of all stripes. That he’s kicking this off with “I have breast cancer” has high impact for me, because I just marked my 4-year breast-cancer-versary yesterday. That original diagnosis day – and before, and since – have been in turn marked by more Google searches than a human could count about breast cancer, oncology, radiation, lymphedema, lymphoma, lumpectomy, hormone suppression therapy, and a partridge in a pear tree. This is incredibly important. I’m not a PhD (Andrew is), so I trust him to kick this off and make it fly. Really. Here are the goals for the project, as he states them: What are the ‘I have’ project’s goals? To offer definitive answers to the question ‘I have [disease state]. What should I do?’ To produce 1 page signpost summaries of the most reliable, relevant, patient-focused, outcomes-oriented, evidence-informed health information available for a wide range of diseases. To publish outputs compiled with SEO best practice in mind to be promoted through social networks and communities in an effective way with the intention that they should appear above the fold on the first page of Google results for the disease they address. Even the best health information is useless if it isn’t discoverable. To harness the expertise of healthcare professionals, patients and curators in co-creating and sharing the…
After spending [redacted] years in network news, covering every Presidential race from 1980 to 2004, my level of exhaustion and cynicism when it comes to politics is … epic. I vote in every election, because dammit-that’s-my-right-as-a-citizen, but often it’s a case of holding my nose and doing the best I can with the (rotten) choices I’m offered. When I was invited to Capitol Hill last Tuesday, Dec. 13, to be in the room when a new Make Congress Work initiative was announced, I accepted with some of that exhaustion and cynicism. But like the old news warhorse I am, I saddled up and rode up I-95 to see what I could see. What I saw made me feel like someone who’s been wandering in the wilderness for … ever, who stumbles upon a tidy little town that welcomes the weary wanderer with open arms. And gives her a job: help spread the news about the tidy little town. Help it grow into a big ol’ city. So think of this as metaphorical political tourism. You can come along on the trip and enjoy the scenery with me. Oh, come on, work with me, people. I’m a writer, and sometimes a comedian. I’ll bring this all home, I promise. Here’s what happened: over 400 people showed up in the Caucus Room at the Cannon House Office Building to talk with, and listen to, a literal parade of bipartisan leaders from all points of the political compass. The point? To break the chains of gridlock that have the folks we elected to represent us in a constant state of get-nothing-done. That point was tidily contained in a 12-point plan to literally make Congress work. For its pay, for its privileges, and most importantly for the CITIZENS THAT ELECTED THEM TO OFFICE. OK,…
The concept of mobile health and mobile medicine is enticing. “There’s an app for that” when applied to managing a chronic condition like diabetes, or navigating cancer treatment, sounds like real 21st century healthcare, doesn’t it? Tomorrow (Dec. 1, 2011) I’m on a panel that’s part of mHealthCon at Rutgers University, a conference where a plethora of mobile app developers and thought leaders will be talking both the idea and the practical app of mobile in healthcare. Our panel is self-described as the American Idol judges – I’m Simon, including the scowl potential – and we’re expected to give meaningful and frank feedback to the app developers that are in the session preceding us. Leading the conversation will be my buddy Bob Brooks of WEGO Health, and sitting with me in judgement will be Amy Gurowitz (who’s gonna channel either J-Lo or Ellen, she hasn’t decided yet) of MS-OL and MS SoftServe, as well as the founder of Divabetic, Max Szadek (he’s Paula). The challenges that mobile health development face were summed up brilliantly by Dr. Kenny Linn in a post on the US News health blog: Apps have … advantages over traditional medical texts. The information is always current, whereas many textbooks are already dated by the time they hit shelves. If I have a question, I can look up the answer on my smartphone without leaving my patient’s side. But smartphone apps also have downsides—despite their enormous potential to improve the quality and convenience of healthcare. While textbooks undergo rigorous review by experts, apps vary in quality and don’t have to be vetted for accuracy or safety. That point was driven home to me recently when a colleague shared a nifty app she’d downloaded that acted as a mobile electrocardiogram (ECG) monitor: Just place your finger tip on the smartphone’s camera, and your heart rate and electrical rhythm appear on screen. Visions of chucking…
Heaving scrums from coast to coast are occupying public squares to protest what seems to be the greatest concentration of personal wealth since the Gilded Age at the end of the 19th century. Their ire is directed at Wall Street, which does bear some of the blame for the epic meltdown of the US – and global – economy over the last four years. The biggest share of the blame, however, really belongs on another street entirely: K Street. The street of lobbying dreams, chock full of high-dollar law and PR firms that work Capitol Hill relentlessly on behalf of everything from AARP to zoologists. Individual taxpayers have no access to K Steet influence, unless they’re members of an interest group – like the aforementioned AARP – that has enough chedda to hire a lobbying firm. Congress, both the House and the Senate, depend on special interest money to mount successful election campaigns. The electorate – the taxpayers, we individual voters who head to the polls to hold our noses and do the best we can with the choices offered – are offered those choices for national office based on who can raise the most money, and spend it to get our attention. And now that corporations are people – thank you, Citizens United – they are under no restraint whatsoever when it comes to political donations. Have you completed the calculation yet? Here’s what it boils down to: Corporate $ + K Street (Congress) = We’re Screwed That may seem simplistic, but it captures the essence. Do not mistake me – I am a capitalist. I believe that every citizen – including corporate ones – has the right to appeal on behalf of his or her interests to elected officials. Where we find ourselves today, though, is at a…
Let’s not be turkeys this Thanksgiving. Let’s not start fights with the relatives while we’re together for the weekend. Don’t let it matter that someone voted for Obama, or is backing Newt. Let it ride that somebody’s a Dallas Cowboys fan (that’s work for me) or passionate about defending Penn State (it’s a great school, with a great history). Accept the fact that Aunt [whoever] will always bring the thing you absolutely hate to eat. Put a teaspoonful on your plate, and suck it up. Or hide it under some mashed potatoes. Surrender to the idea that, at Thanksgiving, we are brought together to be thankful. Here’s my list: My family, who I love to death (even if sometimes one or the other of you will get on my last nerve) My friends, who are from all points of the globe and give me hope that I’ll visit each and every one of you (promise? threat? you decide.) My customers, who have kept me afloat in some really interesting-in-the-Chinese-curse-way times (divorce + cancer = challenging fiscal cocktail. Trust me on that one.) My healthcare team, who kept (and keep) me firmly planted on the planet (they all help me find the funny) A short list, but it’s got some serious meat on its gratitude-fueled bones. What are you grateful for this year? Be grateful for too much turkey, if you’ve got that. Be grateful for annoying family, because it means you’re not alone. Be grateful for living in a free country, if you do – if you don’t, you can earn the undying gratitude of your community by driving an Arab Spring within your borders. Be grateful that you’re alive. I have studied history, and the human race is at a point where we can learn to link together in…