24 June 2009
Health Care Cost Control
Dr. Mark Sklar calls for a reasonable program of health reform in his OpEd article in the June 23, 2009, Wall Street Journal, “A Doctor’s Reflections on Health Care Reform.” Achieving its three main elements—public incentives for preventing chronic disease, increased doctor reimbursement for office visits, and medical malpractice tort reform—requires the leadership of doctors.
It is a little disingenuous for Dr. Sklar to complain about insurance coding as “harassment of dedicated physicians.” Unfortunately, we have developed a medical diagnostic system that replicates the “House” model: consider every illness as potentially unusual and subject the patient to an unlimited battery of tests until every diagnosis is exhausted before selecting the correct one.
That methodology costs plenty. It seems that cost effectiveness is a missing part of our nation’s medical training.
Dr. Mark Sklar calls for a reasonable program of health reform in his OpEd article in the June 23, 2009, Wall Street Journal, “A Doctor’s Reflections on Health Care Reform.” Achieving its three main elements—public incentives for preventing chronic disease, increased doctor reimbursement for office visits, and medical malpractice tort reform—requires the leadership of doctors.
It is a little disingenuous for Dr. Sklar to complain about insurance coding as “harassment of dedicated physicians.” Unfortunately, we have developed a medical diagnostic system that replicates the “House” model: consider every illness as potentially unusual and subject the patient to an unlimited battery of tests until every diagnosis is exhausted before selecting the correct one.
That methodology costs plenty. It seems that cost effectiveness is a missing part of our nation’s medical training.
20 June 2009
Iran’s Green Revolution
The demonstrations in Iran following the presidential elections of June 12, 2009, challenge sectarian dominance of the democratic political process. The demonstrators and supporters of the three rivals of President Ahmadinejad don’t question the election process itself, and probably acknowledge the accuracy of the vote tally.
The religious power structure in Iran has co-opted the democratic political system. Mousavi’s Green demonstrators are calling for secularization of that system. They have lost their faith in the wisdom of integrating Islamic dogma with principles of government. The strength and unity of the Iranian clergy allows them to determine the outcome of elections and parliamentary deliberations; there has been a growing dissatisfaction among the urban middle class with that state of affairs.
The result of the demonstrations will ultimately be a new revolution in Iran, as the numbers of reformers increases from the current 36% of the population to a majority. As every change in Iran, this will take time—but only a little longer.
The demonstrations in Iran following the presidential elections of June 12, 2009, challenge sectarian dominance of the democratic political process. The demonstrators and supporters of the three rivals of President Ahmadinejad don’t question the election process itself, and probably acknowledge the accuracy of the vote tally.
The religious power structure in Iran has co-opted the democratic political system. Mousavi’s Green demonstrators are calling for secularization of that system. They have lost their faith in the wisdom of integrating Islamic dogma with principles of government. The strength and unity of the Iranian clergy allows them to determine the outcome of elections and parliamentary deliberations; there has been a growing dissatisfaction among the urban middle class with that state of affairs.
The result of the demonstrations will ultimately be a new revolution in Iran, as the numbers of reformers increases from the current 36% of the population to a majority. As every change in Iran, this will take time—but only a little longer.
16 June 2009
Competing with a Public Health Plan
It is surprising that Scott E. Harrington, in his OpEd article, “The ‘Public Plan’ Would Be the Only Plan,’ in the June 15, 2009, Wall Street Journal, believes that a public health insurance plan would drive private insurance out of business. The reason for a public plan, on the contrary, is to make it possible for private companies to make money by insuring the health of the majority of the population.
When society makes the political decision to provide equal quality health care for everyone, it clearly chooses to deal with the inequality of the cost of caring for everyone. Just as Medicare fills the needs of the elderly, who for the most part are no longer employed, another public plan is necessary to fill the medical needs of the chronically ill so that private payers, employers and individuals can cover the occasional and catastrophic illnesses of the majority of health care customers.
The economic ideology of the U.S. posits that the private sector is able, through well-regulated competition, to fill the needs and desires of the community more efficiently and at less cost than the government. However, when some of those needs and desires can only be filled at exorbitant cost and society deems that for reasons of equity those costs should be shared by everyone, then it is time for the government to step in. Limiting the public intervention to paying for the care of the chronically ill will leave the bulk of the health insurance system in the hands of private companies.
It is surprising that Scott E. Harrington, in his OpEd article, “The ‘Public Plan’ Would Be the Only Plan,’ in the June 15, 2009, Wall Street Journal, believes that a public health insurance plan would drive private insurance out of business. The reason for a public plan, on the contrary, is to make it possible for private companies to make money by insuring the health of the majority of the population.
When society makes the political decision to provide equal quality health care for everyone, it clearly chooses to deal with the inequality of the cost of caring for everyone. Just as Medicare fills the needs of the elderly, who for the most part are no longer employed, another public plan is necessary to fill the medical needs of the chronically ill so that private payers, employers and individuals can cover the occasional and catastrophic illnesses of the majority of health care customers.
The economic ideology of the U.S. posits that the private sector is able, through well-regulated competition, to fill the needs and desires of the community more efficiently and at less cost than the government. However, when some of those needs and desires can only be filled at exorbitant cost and society deems that for reasons of equity those costs should be shared by everyone, then it is time for the government to step in. Limiting the public intervention to paying for the care of the chronically ill will leave the bulk of the health insurance system in the hands of private companies.
09 June 2009
Pandemics and Globalization
The recent concern about the H1N1 (Swine Flu) pandemic confuses the novelty of the responsible virus with the inexorableness of globalization. Ease of travel between distant continents give epidemics a more rapid impact on the world’s general health than in the past. Instant dissemination of the news about the spread of a previously unknown disease raises the public’s consciousness of the scourge more quickly than before.
A pandemic, therefore, is a technological phenomenon as much as a medical one. The important consequence of the issue raised by Dr. Altman in his article, “Is this a Pandemic?” in the June 9, 2009, New York Times is the selection of tools to use to combat this and similar contagions. While waiting for the development of immunological medicines to defeat the cause of the disease, a globally coordinated strategy must instill wise control of interaction between individuals and groups of individuals. Just as critical are measures to dampen sensationalist media coverage of an increasingly frequent feature of our globalized environment.
The recent concern about the H1N1 (Swine Flu) pandemic confuses the novelty of the responsible virus with the inexorableness of globalization. Ease of travel between distant continents give epidemics a more rapid impact on the world’s general health than in the past. Instant dissemination of the news about the spread of a previously unknown disease raises the public’s consciousness of the scourge more quickly than before.
A pandemic, therefore, is a technological phenomenon as much as a medical one. The important consequence of the issue raised by Dr. Altman in his article, “Is this a Pandemic?” in the June 9, 2009, New York Times is the selection of tools to use to combat this and similar contagions. While waiting for the development of immunological medicines to defeat the cause of the disease, a globally coordinated strategy must instill wise control of interaction between individuals and groups of individuals. Just as critical are measures to dampen sensationalist media coverage of an increasingly frequent feature of our globalized environment.
03 June 2009
Community Organizing on a National Scale
The email campaigns by Organizing for America, signed by Barack Obama, Joe Biden, Mitch Stewart and perhaps others, on behalf of Supreme Court nominee Sonia Sotomayor attempt to transform the Congressional confirmation process into a national referendum. There is probably no danger that her appointment to the Court is in danger of failing; however, the exercise will give this organization good practice for legislative battles in the future. It may also convince Obama’s supporters that mobilizing their collective will in this way makes the federal government, and particularly the Congress, more responsive to the will of the people.
Members of Congress were not elected to parrot the expressed currents of opinion in their constituencies. If they were their election would no longer be necessary at all—the Internet or Twitter could be used as a substitute for representational deliberation.
Aren’t the peoples’ representatives supposed to know their constituents well enough accurately to reflect their preferences? It’s a result of modern human laziness and the refined expertise of influence peddlers that the model of representational democracy no longer works the way the Framers of the Constitution had in mind. Perhaps Organizing for America intends to demonstrate how to combat expensive commercial media campaigns by virtually kicking the public in the butt with regard to the Sotomajor confirmation issue. It will take more than a few specific issue-oriented efforts by Organizing for America, however, to change (ah, that word) the way the U.S. government operates. The harder and more essential task is to make something like OfA into an effective instrument for enlisting continuing and thoughtful involvement in government by all citizens.
The email campaigns by Organizing for America, signed by Barack Obama, Joe Biden, Mitch Stewart and perhaps others, on behalf of Supreme Court nominee Sonia Sotomayor attempt to transform the Congressional confirmation process into a national referendum. There is probably no danger that her appointment to the Court is in danger of failing; however, the exercise will give this organization good practice for legislative battles in the future. It may also convince Obama’s supporters that mobilizing their collective will in this way makes the federal government, and particularly the Congress, more responsive to the will of the people.
Members of Congress were not elected to parrot the expressed currents of opinion in their constituencies. If they were their election would no longer be necessary at all—the Internet or Twitter could be used as a substitute for representational deliberation.
Aren’t the peoples’ representatives supposed to know their constituents well enough accurately to reflect their preferences? It’s a result of modern human laziness and the refined expertise of influence peddlers that the model of representational democracy no longer works the way the Framers of the Constitution had in mind. Perhaps Organizing for America intends to demonstrate how to combat expensive commercial media campaigns by virtually kicking the public in the butt with regard to the Sotomajor confirmation issue. It will take more than a few specific issue-oriented efforts by Organizing for America, however, to change (ah, that word) the way the U.S. government operates. The harder and more essential task is to make something like OfA into an effective instrument for enlisting continuing and thoughtful involvement in government by all citizens.
