Ward on Words

Some interesting links on a widely discussed topic... Whole Foods CEO John Mackey's controversial WSJ Op-ed piece (Confess that I started laughing when I read the Maggie Thatcher quote he opens with... "The problem with socialism is that eventually you run out of other people’s money.” Same could be said of bankers and their utilization of OPM.) BusinessWeek story on the uproar caused by Mackey's op-ed (Story ends by noting that shares of Whole Foods had risen 27 cents.) A primary care physician talks about the pressures he faces on the job , which include a diminishing salary and the ongoing need to educate patients about why an expensive test is not immediately needed.... Story in the LA Times on how the insurance companies have gained the upper hand in the reform. "'It's a bonanza,'" said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Polic...

So this was how it was supposed to happen - my father would not feel pain; he would not feel agony; the end would come swiftly and relatively easily, probably around Thanksgiving. That's what we were told by the doctors the summer after I graduated from college. My father had kidney cancer - and had been born with just one kidney, which had complicated the treatment. When remission ended and the cancer returned, my father made the decision not to pursue aggressive treatment to prolong his life. He'd watched his beloved wife die of cancer ten years earlier and saw no point in extending the agony that comes with dying of such a disease. I was the oldest of three girls. My father was a widower. My two younger sisters went off to college a week after that initial "end of life discussion" and my father and I were left alone to contemplate the end of his life. For some months, it was as the doctors had told us. Not too much pain or discomfort. A growing wea...

Death panels. Rationing. Morality . This is what we talk about when we talk about health care reform. The conversation seems to have veered in a direction that takes us further away from reform and closer to chaos. The simple truth is that the health care system we have today is unsustainable. We cannot continue to afford steep increases in the cost of health care. If we focus our efforts on adding more people to a broken system, health care will bring us all to bankruptcy sooner, rather than later. As one who is self-insured, I've got a huge stake in the health care debate surging across the country right now. To me, the issue is not really an issue of morality, nor should it be reduced to a conversation about providing health care to the uninsured. It's about fixing a broken system that touches each and everyone of us at different points in our lives. Birth requires health care. For most of us, dying takes us into the health care system as well. And at nu...

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 ...

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...