"I wish they would only take me as I am" - Vincent Van Gogh               "How Can I believe in God when just last week I got my tounge caught in the roller of an electric typewriter?" - Woody Allen              "Our truest life is when we are in dreams awake" - Henry David Thoreau              "I took a speed reading course and read 'War and Peace' in twenty minutes. It involves Russia" - Woody Allen            "When promulgating esoteric cogitations, eschew platitudinous ponderosities" - Mark Rowan, my father            "Up, sluggard, and waste not life, for in the grave there will be sleep enough" - Benjamin Franklin             "What really interests me is whether God had any choice in the creation of the world." - Albert Einstein            "Welfare's purpose should be to eliminate, as far as possible, the need for its own existence" - Ronald Reagan            "It's odd that you can get so anesthetized by your own pain or your own problem that you don't quite fully share the hell of someone close to you." - Lady Bird Johnson              "I still want to be the candidate for guys with confederate flags in their pickup truck" - Howard Dean

Friday, October 09, 2009

Credit where credit is due

A few weeks ago President Obama had a little media dust-up by calling Kanye West 'a Jackass'. Never had I agreed with the President more. However, this is clearly not a statement that a president should be making about a private citizen (no matter how big of a douche-bag that private citizen may be). President Obama made this statement off-the-record, however--it was publicized inappropriately.

Today's somewhat shocking news that the President has been awarded the Nobel Peace Prize brought another Obama statement that I found reassuring. "I am both surprised and deeply humbled by the decision of the Nobel Committee. To be honest, I do not feel that I deserve to be in the company of many of the transformative leaders who have received this prize." Classy. A President being honored with such an award should be a proud moment for America, and I think it still is...but I also think that any honest observer can recognize that there isn't much basis for the award. Perhaps the President will make great strides towards world peace..but not yet. Turning down the award would be incredibly poor form, and I think that the President's self-deference in his public statements are perfectly appropriate.

Overall I think today's award says much more about the Nobel committee that it does about our President. If I were a past recipient or a current contender, I would consider todays decision a bit offensive. But I don't think President Obama could have handled it better.

Thursday, September 03, 2009

Pres. Obama's School Speech

For the past two days the topic of conservative talk radio has been the President's planned speech next week, to be broadcast to schoolchildren throughout the country. While I can understand some of the concerns that conservative talkers have expressed, I think those concerns have been exaggerated and blown way out of proportion.

Personally, I think its a great idea for the President of the United States to address children during their first week back to school. Much in the same way that the President can wield the bully pulpit in driving legislation, so too can he use it to encourage children to stay in school, work hard, and be respectful young citizens. I hope the President does it again the next three years (and I hope President Romney does it the following 8 ;)

Of course, the President could use it as an opportunity to politic; to try to extol the virtues of health care reform, etc... And I would consider this incredibly inappropriate. However, there's no indication that he plans to do so, and I think it would be a politically stupid move. Furthermore, I consider it wrong to convict him of exploiting children before he has done a thing.

Thursday, August 13, 2009

My thoughts on the Health Care Debate

I've been notably absent from this blog for some time now, but with the current state of affairs surrounding health care insurance reform, I figured I should jump back into the fray. What really motivated me was a short clip from President Obama's recent NH town hall.
In the above clip, the President describes how we pay our primary care physicians so poorly, yet pay surgeons quite generously. He's absolutely right on this fact, though he has greatly exaggerated the numbers. A surgeons fee for an amputation is in the ballpark of maybe $2,500. Frankly, I whole heartedly agree with the President that our health care is structured in a way that disproportionately rewards treatment over prevention. Yet, I see things through a slightly different lens.

First of all, a dominant reason why a primary care physician is paid a "pittance" is because of government run programs like Medicare and Medicaid. With medicare reimbursements below what the market dictates, physicians and hospitals make up for this by increasing volume. That means that physicians have less time to spend with each patient, reducing their ability to perform the time-intensive interventions that the President is discussing. With rhetoric about cost-controls in the current legislation, and proposed cuts to medicare reimbursement, how am I to believe that this will improve--in fact, I would anticipate that it would worsen.

That's not to say that addressing this issue isn't important, though I believe that it could be done in a more efficient way. Decoupling private insurance to a) employment and b) state of residence or community would be a good start. With our current system there is actually a disinsentive for insurers to pay for preventative care, because as soon as you change jobs they will no longer be your insurer, and thus your amputation will be on someone else's dime. If it is in an insurer's best interest to keep you as a customer for a longer period, then it will be in their interest to reward cost-saving preventative measures.

Second, while a public option would have incentive to reward preventative care, they would also have an incentive to withhold costly care. We see this over and over again in country after country. While I do believe that America can accomplish things that others can't, why should we expect anything different in our country? It always reminds me of a scene in Arrested Development, where Tobias and Lindsay are discussing ways to improve their marriage.
Tobias: You know, Lindsay, as a therapist, I have advised a number of couples to explore an open relationship where the couple remains emotionally committed, but free to explore extra-marital encounters.
Lindsay: Well, did it work for those people?
Tobias: No, it never does. I mean, these people somehow delude themselves into thinking it might, but... but it might work for us.

Third, I notice the irony here when the President brings up medication management. Proper use of medication is a vital component of diabetes management, as it is for so many chronic diseases (hypertension, vascular disease, etc...). Whereas studies have shown that medications greatly reduce overall health care costs, their use will undoubtedly be welcomed under the Democrat health care plan, despite the fact that pharma has been a whipping boy of the left for years.

Lastly, I have grown weary of President Obama's repeated attempts to portray physicians as greedy. It seems that in his eyes physicians are willing to subject their patients to painful and expensive unnecessary procedures for the sake of enriching themselves. Whether they are taking out kids tonsils, or directing them towards amputations, he seems to believe that doctors only care about money.

We all agree that we need reform, but let's not throw the baby out with the bathwater.

Monday, February 09, 2009

RE: Sacha

Sacha left some lengthy comments on my previous post, and I felt responses would be more appropriate as a new post. I'm not that interested in addressing all Sacha's points, considering my original post was an off-the-cuff opinionated response. Regardless, I thought some deserved attention.

You're putting in a lot of hard work to get that medical degree. Then you will work very, very hard as an intern and resident. What if graduates of foreign medical schools could be brought in to work at lower wages?

They can. Unfortunately, many residency programs, as well as the USMLE create artificial barriers to their successful employment (medicine is little more than a union). This summer and past fall I worked with an Iranian-born surgeon who attended medical school in the UK. Despite scoring a 99 on his american licensing exams, he is having trouble finding employment. It certainly is a boon for American born students who don't have to meet the same benchmarks, but it hardly seems like its in the best interest of their patients.

Suppose that the medical field operated in a less restricted market, and more foreign-trained physicians could enter the field. You're right that if they worked for less pay, then physician reimbursement would drop, and health care costs would be (slightly) reduced, without a reduction in quality of care...in fact, more likely an improvement in quality of care. It certainly wouldn't help me, as an individual with a clearly invested interest, but it would certainly be of benefit to society as a whole. And if the reimbursement rates dropped, then smart people who otherwise would have been doctors will go into other professions: dentists, lawyers, PhD's, engineers, etc... where they will be more lucratively rewarded.

Besides, since when is competition a bad thing? By your same train of logic, we should prevent the importation of foreign produced products. If Honda weren't allowed to sell cars on US soil, clearly General Motors would be better off. Without needing to worry about producing quality products at an affordable price, they would be virtually guaranteed people to purchase their products. Sounds great.

Also, in your original blog post, you talk about how "An engineer who designs a new products creates jobs: secretaries, product testers, factory workers, people to market the product..." really? I don't think an engineer gets his/her own secretary, and the product testers and factory workers are likely located in Malaysia or Taiwan. It may create marketing jobs, but do we really need more people to go into the "sales" profession?

My father is an electrical engineer (and he has had his own secretary in the past, incidentally). Just to cite a concrete example, several years ago he designed a new, state of the art product. Sales went up. People in the factory (located in the US, fyi) couldn't work enough overtime to meet demand, and the company hired more people to help build the products. Furthermore, the company hired 2 additional engineers to help with R&D. At his current employer (also with factories in the US), things aren't much different.

The same is true for numerous other professions. A surgeon can't exist in isolation. Consider a simple total-joint-arthroplasty. There are multiple nurses and tech's in the OR with the surgeon, not to mention those in pre-op and post-op. An anesthesiologist is required for the procedure. People are employed to clean up the room after the surgery, to manufacture and sell the prosthesis, people paid to bill for the procedure, people involved in the supply chain that got the prosthesis to the hospital...and secretaries to schedule the surgery, schedule the blood donation, coordinate the OR schedule, etc....

Tuesday, February 03, 2009

RE: American Worker

The Coalition for the Future American Worker has a new television ad stating that we are currently bringing in 1.5 million new workers, which is poor policy in a time when millions are being laid off, stating "Ask why we keep bringing in 1.5 million foreign workers a year to take American jobs."

This seems like an incredibly simplified way to approach the issue. What isn't stated in the 1.5 million figure is the number that have advanced degrees in fields such as computer science, engineering, medicine, etc... Such imports fill positions that require immigration to meet domestic needs. Personally, I think its better to have a foreign engineer residing in America--where they will pay taxes and contribute to our economy--than in India or China, promoting outsourcing. Additionally, these highly-skilled workers actually create jobs. An engineer who designs a new products creates jobs: secretaries, product testers, factory workers, people to market the product, etc... Frankly, as I've said in the past, we should be increasing the influx of these workers.

The issue of the unskilled workers is open for more debate. There certainly is overlap with many American workers, particularly those most likely to make minimum wage, but I think this is in large part a function of minimum wage restrictions...and is more than I want to type about now.

Monday, January 26, 2009

An Odd Incentive Structure

One argument I often hear regarding Universal Health Care (that I rarely give much credence to) is that it is a conflict of interest to have the same people that are charged with funding your retirement be in charge of prolonging your life. In other words, it creates an incentive to provide less than stellar care, because it means a reduction in social security payouts. Again, I don't think this is a strong argument, despite the fact that it may be technically true. I just can't believe that any policies would be enacted that would see this to fruition.

However, a similar sort of conflict of interest seems to be too much for Speaker Pelosi:
STEPHANOPOULOS: Hundreds of millions of dollars to expand family planning services. How is that stimulus?

PELOSI: Well, the family planning services reduce cost. They reduce cost. The states are in terrible fiscal budget crises now and part of what we do for children's health, education and some of those elements are to help the states meet their financial needs. One of those - one of the initiatives you mentioned, the contraception, will reduce costs to the states and to the federal government

Now, there are certainly valid reasons for wanting to extend family planning services. Similarly, I think it is valid that the state supplies services such as education and health care for children (although maybe not to quite the extent that the current congress has decided). Yet, this exchange strikes me as creepy; that the third most powerful person in our government (and one unlikely to be strongly opposed by her senate counterpart or the executive branch) believes that she should be targeting birth rates in order to balance the government's checkbook.

Again, there are certainly valid reasons to support family planning: reduce the number of abortions, promote womens health, etc... This is certainly not one.

Wednesday, January 21, 2009

And so it begins...

He's sticking to at least one campaign promise....
U.S. President Barack Obama may order a hold on a proposal issued in the final days of the Bush administration to expand offshore drilling in previously banned areas, an Interior Department official told Reuters on Wednesday.

Shortly after being sworn in on Tuesday, Obama ordered all federal agencies and departments to halt pending regulations until they can be reviewed by incoming staff.

An Interior official said the department is waiting for clarification from the White House on whether a proposed draft of a five-year plan to lease areas in the Atlantic and Pacific waters for oil and natural gas drilling can go forward.
The link is HERE.