Ward on Words

Lots of hullabaloo over Paul Ryan's op-ed piece in the Wall Street Journal, you know, the one with the headline that reads: The GOP Path to Prosperity. Given how devoted the GOP is to their very rich base, I shudder to think about how they define prosperity. And since their path prior to this has led to much of the nation being placed on rickety life boats in danger of being swamped by the wake of the big yacht sailing majestically away on rising tides, I don't have much hope this path will be built for the likes of me. But the scariest sentence ever seen in the WSJ is not found in Ryan's op-ed piece. Doesn't mean his piece isn't scary - it's actually very scary to think we will get rid of this massive post-recession deficit by apparently gutting Medicare for those of us not old enough to need it right now.   [Can we really say, as Ryan does, that Medicare has a flawed incentive structure that "rewards states for adding to the rolls?" Or are sta...

Atul Gawande wrote one of the most talked-about stories on health care - his story on the over-use of medicine in McAllen, Texas. (You can find it here .) I sent off a bunch of my questions to him and received a thoughtful response from him not long after. His comments on why he selected Medicare costs to develop "the baseline scenario" are instructive: "We do need broader data than medicare but there are so many fragmented private insurers one cannot gather easily a comprehensive picture of the US practice patterns." That is a key issue, in my view. A major roadblock to real reform, in fact. We are setting out on a tumultuous journey to control costs in medicine, but because of the fragmented nature of the private sector, it is impossible to gain this "comprehensive picture of the US practice patterns." There is a problem using Medicare as the example of the cost conundrum. Medicare pays at a lower rate than private insurers pay. There are ...

I am a rebel, I suppose, a van-driving soccer mom of a rebel - one who works as a freelancer, who married a freelancer. We work out of our basement, I as a writer, my husband as a photographer. We love what we do - we love the clients we have the good fortune to work with - we love the fact our careers make us more available (sort of) to our children. The price for our rebellion against the corporate way of working is that we must buy our own health insurance plan for our family. We pay $600 a month for a the privilege of paying for the first $4000 in medical costs. It's a major medical crash and burn plan. It's what we can afford. We are healthy. We see the doctors primarily for annual check ups. Occasionally, a child has an illness that requires us to head over to the doctor. Otherwise, we see little of the medical establishment. My twins had their five-year-old check up recently. Required for school, as are eye exams (not sure of cost yet) and dental exams ...

It is supposedly "required reading" in the Obama White House - and many of the blogs I read point to it as "the" source for answers on the health care crisis in America. It's Atul Gawande's story on the "cost conundrum" of providing medical treatment in McAllen Texas, which appeared in the June edition of The New Yorker magazine. Tonight, I finally had the chance to read the story. And it left me with more questions than answers. Gawande points to McAllen as what’s wrong with American medicine today, but takes pains to point out that McAllen is actually the second most expensive health care market in America – coming in behind Miami. So why is McAllen – the “outlier” – actually proof of what is wrong? It is an extreme example of the problem, not necessarily a reflection of the ordinary, every day “average” world of the garden variety medical practitioner. Gawande compares McAllen to El Paso – in that they have similar demographics (pove...