Cell 2 Soul: The Humane Health Care Blog

Is Healthcare a Right?

by Atul Gawande
New Yorker, October 2, 2017
Link

This is a timely and informative essay.

Gawande meets with some old friends in Athens, Ohio, where he grew up, to discuss their take on the question. It is kind of a trip down memory lane for him.

The meat of the essay comes about halfway through when he discusses the work of the Oxford political philosopher Henry Shue who postulates that basic rights include physical security, water, shelter, and health care. Meeting these basics is among governments highest purposes and priorities.

I think the goal should be security. No matter how bad things get this shouldn't be what you worry about, namely healthcare.
When people in a society get very different deals on things like healthcare, the pact with the government breaks down. That's what is happened with American healthcare.
The reasons go back to a seemingly innocuous decision made during the Second World War. In that time, the administration permitted increases in health insurance benefits and made them tax-deductible for employers. It didn't seem like a big thing at the time, but ever since we've been trying to figure out how to cover the vast portion of the country that doesn't have employer-based health insurance. Therefore, we had to stitch together different rules and systems for each of these categories and the result is an unholy expensive mess that leaves millions of people un- or under-protected. As a country, where pretty much everyone gets options like K – 12 schooling we've been reluctant to address the Second World War mistake and establish a basic system of healthcare coverage that's open for all. The prospects and costs of healthcare in America very wildly and incomprehensibly according to your job, your state, your age, your income, your marital status, your gender, and your medical history, not to mention your ability to read fine print.
Do we want?

• Medicare for all
• Each state to have its own plan for care
• A nationwide market place where we all choose among a selection of health plans
• Or personal accounts that we can use to pay directly for healthcare?

Any of these could work. Each has been made to work universally somewhere in the world.

As a country, we don't have any of these at this time. Gawande's article is a lucid introduction to this area, and worth reading and studying for healthcare providers, the public, and all students.

The Fake Freedom of American Health Care

By Anu Partanen
NY Times, March 19, 2017

"The trouble with a free-market approach is that health care is an immensely complicated and expensive industry, in which the individual rarely has much actual market power.  

The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care. And the point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom.

I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures."

Excerpts from an amazing op-ed in the NY Times. It pretty well says it all in a pleasant "nordic" way.

Overkill by Atul Gawande

The New Yorker, May 11, 2015  Free Full Text.

This is a long, but invaluable, introduction to the topics of over-diagnosis and over-treatment.  The Lown Institute has impressively addressed this topic for the past three years or so and a cadre of physician scientist and clinicians around the world have been interested in subject as well.  In his polished way, Gawande covers the issue for the lay and professional reader.  He asks:  What can we do about the avalanche of unnecessary medical care that is harming patients physically and financially.

Download Excerpts from Gawande's Overkill

 

The Right Care Declaration

A Message from Vikas Saini and Shannon Brownlee of the Lown Institute:

The Declaration of Principles of the Right Care Alliance.

“The Right Care Alliance is a movement of clinicians, patient advocates, community leaders, and patients who see that overtesting, overdiagnosis, and overtreatment are endemic to modern health care – they are built into the culture of modern medicine. We see overuse as the flip side of the coin of undertreatment and lack of access, and a major cause of harm to patients."

They came to “understand the power and importance of coming together, to share our concern about practices that harm patients, and our belief in the moral necessity of working together to reduce overuse”

With colleagues, Vikas and Shannon created The Declaration of Principles of the Right Care Alliance.  Please read it and consider joining this Alliance by signing this declaration.  It will demonstrate your solidarity with the movement to assure all of us compassionate, safe and appropriate care.

 

Our Moral Stain

"When it comes to health care, most liberals are committed above all to ensuring that every American has insurance. In their view, the greatest achievement of the health care reform act is to finally erase the moral stain of the United States' being the only major developed country without universal coverage. But we also hold the questionable distinction of having the world's most expensive health care system - what about cost control?

This is a fine opinion piece by a thoughtful academic physician.  Reading it made me think, "We have met the enemy and it is us."  As a physician, I particpate in the scandalous cost of health care every day.  All of us do unnecessary tests.  All of us prescribe expensive meds when cheaper ones would work.  All of us do more procedures than needed because that's where our reimbursement comes from.  It's one thing to recognize this in the quiet of one's home -- it's another reality in the clinic.

Emanuel's essay is a good springboard for thought.  See: Download What We Give Up for Health Care

 Image is from CartoonStock.com

Marginal Notes: When the soul breaks

Physicians who have been sued are changed people.  Many of them are resilient and return to medical practice—with a healthy dose of mistrust and a touch of paranoia.  Others elect to leave the profession entirely.  Those who continue to practice remain vigilant, ever mindful that at some point they can be sued again. >>more

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

If Air Travel Was Run Like Health Care...

Jonathon Rauch, a staff writer at the National Journal has written a compelling article on Health Care delivery.  The seven minute video based on this is brilliant, funny, poignantly true and more direct..  It summarizes the frustrations patients and care givers deal with daily in the attempt to navigate the medical-industrial complex.  For a memorable video see: You Tube.

"Hello! Thank you for calling Air Health Care, the airline that works like the health care system. My name is Cynthia. I will provide you with outstanding service. How can I give you travel care today?"

Rauch's essay can be read at the National Journal.

Strangely, this video recalled a fine skit the late Hawaiian comedian, Rap Repleinger, produced in the 1980s.  This, too is available on You Tube.  See:  Room Service.

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Marginal Notes: A Socratic dialog on health care reform (VI)

Toward the evening of a long day, the philosopher Socrates finally makes his way to the home of Hippocrates, the father of medicine.  >>more

The final in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato, Aesculapius, Apothos, and Litigius.

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: A Socratic dialog on health care reform (V)

After leaving the pharmacy of Apothos, Socrates finds himself pursued by Litigius the solicitor. >>more

The fifth in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato, Aesculapius and Apothos.

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: A Socratic dialog on health care reform (IV)

The philosopher Socrates seeks advice from Apothos the sorcerer for a potion or pill to dampen the discomfort in the wound on his foot and learns a bit about standards of practice in the pharmaceutical industry.  >>more

 

The fourth in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato and Aesculapius.

 

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."