Dec 30 2012

New Years and Changes

Every year, as I enjoy the holidays with my family I’m always surprised how much things change: the town I grew up in, my family, my sister’s children.  For me, a lot has changed in the last six months.  In June, I started having problems following a conversation when discussing patients with my fellow physicians.  At the time, I was on a stressful rotation in my residency, and so I chalked it up to that.  I then started having problems with fatigue and balance as well, and the combination of my symptoms advanced to the point where I needed to take a leave of absence from my residency.  Being sick and unable to work has given me a lot of time to think about the role change plays in my life, and about change in general.

I have never been afraid of change, and I try to view it as an opportunity to grow.  I identify myself as buddhist, at least in part.  One of the main teachings in buddhism that is important to me is about the impermanent nature of life.  Life is not static, and things are always changing; that is simply the nature of things.  For me, the holidays help to emphasize the changes that are going on in the world I know, as well as the changes that are happening to the people I care about.  It is exciting to watch my nephews grow up and become their own individual people.  It’s amazing to meet my computer teacher from elementary school again, and realize that the last time I saw her was almost 20 years ago, and yet I still recognized that I knew her.

Despite this view of change, part of me is still sad about the impermanence of things in life.  I realized this while I was riding in the car with my family around the town I grew up in.  Open spaces that once were are now filled.  Business that I used to frequent now closed.  I know that it is inevitable for changes like this to happen, but on some level I am afraid of it.  It came to me that the reason seeing this change makes me nervous is because it emphasizes my own mortality.  Life moving forward means I’m moving forward: towards death.

It is said that death and taxes are the only things that are givens in life, and death is usually a scarier proposition then taxes.  Change is also a given in life, and it scares many people almost as much as death does because, in a way change lead to death.  We all must grow old, and at some point we will die.  That is simply a fact of life.  My New Year’s resolution is to embrace the change in my life and to try not to be afraid of it.  We may have some control over the direction of where my life heads, but so much is out of my control.  Change is going to be there regardless, so I might as well roll with it.

Dec 7 2012

About This Blog

Much of the focus on the healthcare discussion has been status quo versus a single payer system.  The idea being that if we can simplify payments and increase coverage, we can decrease overall costs and provide healthcare to millions of uninsured Americans.  As noble a goal as this might seem, it still ignores a number of fundamental issues.  We currently spend more per capita on healthcare then any nation in the world by a margin of $2000 per person in 2008.  With a total population of 300 million people, that equates to $600 billion dollars a year more than any other nation.  Yet based on The World Health Report in 2006, we ranked 39th for infant mortality, 36th for life expectancy, 43rd for adult female mortality,42nd for adult male mortality, and overall ranked 37th.  Changing who pays for healthcare in this country isn’t going to fix these problems.  The system needs to change.

Nothing less then a complete reconstruction of healthcare in this country will suffice.  43 million people in the US lack any sort of healthcare coverage.  Many of these individuals use the emergency room for primary care issues, or for medical problems that could be handled at a much lower cost by physicians in the community.  Preventative care is also non-existent for this population.  Uninsured people received $116 billion in health care from hospitals, doctors, and other providers.  37% of that was paid for out of their own pockets and government programs and charities covered another 26%.  That still left almost $43 billion of that care unpaid for.

Of the persons who do have coverage, many are either not covered for the care they need and are required to pay for medical care out of pocket.  Bankruptcy rates with significant medical causes (medical debt greater than $5000, loss of income due to medical problems, or mortgaging of the debtors home to meet medical expenses) contributed to as many as 62% of bankruptcies in 2007.  This was increased from a rate of 46% in 2001.  There is also little to no coverage for preventative medicine, including diet and exercise education, which could be used to help prevent or reduce numerous medical conditions.

A single payor system will likely help ameliorate but not solve many of these problems.  Putting band-aids on the current system is analogous to the direction that healthcare has gone in this country – we are treating the symptoms and not the problem.  However, the state of healthcare in this country is also indicative of many of the problems we are starting to face as a society.  The idea of community is becoming more and more fractured.  Many of us do not know our neighbors anymore, at least not like we used to.  As a country, we are becoming more and more focused on productivity, and less worried about human capital.  Are individuality has become so strong that many often think more about what is good for themselves than what is good for society as a whole.  This mentality needs to change, or else we will continue the downward slide that has already begun.

My aim with this blog is to comment not only on healthcare, but also on various aspects of our society.  I hope that it will help people reevaluate many of the problems we are facing.  There are many ideas about where we can head from here as a country, and it is important that we take as many viewpoints into consideration as possible.  Feel free to comment on any of my posts, I would like for this to be somewhat of an open forum.  As long as responses are respectful and thoughtfully done, I will not suppress them.  I hope you enjoy my blog.