Skip to main content

Posts

Why We Can't Control Medical Costs.

Most of us are skeptical that insurance companies are devoted to our health.  Answer the following question.  Do you think your insurance company is more interested in your health or in controlling costs?  Pretty tough question, huh? There is a tension between medical quality and medical costs.  If we had a system that offered perfect quality, it would be unaffordable.  If we imposed rigid cost controls, then medical quality would be compromised.  Where do we draw the line?  It is clear to most of us that the medical industrial complex is riddled with waste.  Keep in mind that one man’s medical waste is another man’s income.  For example, physicians define waste as excessive charges by hospitals.  Government officials define waste as excessively high drug prices.  Patients define waste as high co-pays and deductibles.  Drug companies define waste as outrageous legal expenses to get drugs to market and to defend against frivolous lawsuits.  Primary care doctors define waste as

Discussions at Thanksgiving Tables in 2016

While folks across the country were gathered around their holiday tables, I suspect that conversations were not focused on the First Thanksgiving when the Pilgrims broke bread with the Wampanoag native Americans over a 3 day feast in 1621.  There was no pumpkin pie or cranberry sauce served then, and it was more likely that venison was on the table than turkey.  Sometimes, myths are more fun than facts. The First Thanksgiving at Plymouth I surmise that the many of our Thanksgiving dinners were sites of spirited discussions regarding a recent political earthquake that convulsed this country.  Indeed, over the past 3 weeks, I have departed from this blog’s medical commentary, to offer some thoughts on what occurred and why. The nation is sorely divided, but I sense that there will be healing, depending upon everyone’s ability and willingness to listen deeply and absorb the views of reasonable folks whose opinions differs from ours.  Reasonable people are rarely all righ

Breaking News! Trump Chooses Conservative Advisors!

Let the whining begin!  Donald Trump, the president-elect, has chosen Mike Pompeo, Michael Flynn and Jeff Sessions to serve as CIA director, National Security Advisor and Attorney General respectively.  Here’s the shocker.  They are all conservative!  Let me offer some guidance to the demoralized and deflated liberal, I mean ‘progressive’, political left.  When the nation elects a president who resides to the right of the political center (leaving aside that where Trump truly resides is an arguable question), he is going to choose personnel who share his philosophy.  Trump ran hard on immigration, trade, anti-terrorism policy and the Supreme Court.  Now elected, he should be expected to assemble a team that will further the objectives that he campaigned on.  Isn’t this what we expect when a candidate gets elected? I think that Trump’s appointments mentioned above – all of whom are qualified – cause the left to hyperventilate in an effort to distract their base from their horre

Trumped!

Many folks talked about the possibility of an October surprise prior to our recent presidential election.  Rumors swirled of an FBI bombshell, more WikiLeaks or a Russian hack attack.  The predictors were off by a month.  We received instead a November surprise that many view as apocalyptic.  The nation was shocked, as were the candidates, despite Trump’s minions’ confident public exhortations of victory.  How did the press and the punditocracy get it all wrong?   Even days prior to the election, many pollsters were placing Clinton’s chances of victory in the 75-90% range.  An Unexpected Guest We are beginning to understand how a man who has never held elective office, who by all accounts is a boorish and vulgar narcissist, could vanquish 17 Republican adversaries to gain the nomination and then handily trounce the Clinton political machine on November 8th.    The brash outsider prevailed over the consummate insider.   We are beginning to understand why his unending stream

Clinton and Trump Give the Nation Chest Pains

Oftentimes, physicians and patients face bad options.  I wish that the choices that patients faced were all good ones, or at least had one option that was likely to yield a favorable result.   This scenario is further complicated as medicine is an uncertain discipline with moving goal posts and changing facts.  We make decisions and recommendations based on the current state of facts and our medical knowledge and experience.  We may counsel a patient against surgery, only to discover days later in retrospect that an operation would have been the right choice.  An adverse outcome may result from an excellent decision.  There are many medical circumstances when the options are equally foreboding.   A man may be suffering frequent episodes of angina, chest pain caused by hardening of the coronary arteries.  He is on maximal medical treatment, but the symptom persists.  This is not only limiting his life activities and pleasure, but also significantly increases his risk of a heart att

Clinton vs Trump Agonizes Millions

Physicians and patients often face tough and agonizing choices.  Sometimes, there are no good options available.  On other occasions, there are two seemingly reasonable choices in front of you, but there may be a very different outcome from each pathway.  For example, a patient may be advised by a surgeon to submit to the scalpel while the gastroenterologist counsels to opt for another 48 hours hoping that the medical situation will improve.  Which physician is correct?  They both may be right.  If the patient were to deteriorate 24 hours later, then the operation that had been favored by the surgeon would have been the better choice.  If, however, the patient were to improve spontaneously a day or two later, then avoiding high risk surgery would be clearly favored. Physicians make decisions based on knowledge and experience.  Often, there is a conflict between knowledge and experience that physicians struggle to resolve.  For example, a doctor may have read in a medical study tha

Sign up for a No Frills Colonoscopy

Cleveland took a major economic hit a few years back when United Airlines cut most of its flights from our city.  An airport is the heart of a metropolis.  Lack of their direct flights means that business meetings, leisure travel, conventions and trade shows will likely opt for more convenient locales. This was a business decision for United which I am sure was rational.  Nevertheless, their gain was our loss. As a result, we have had several low cost carriers who have swooped in to gain market share.  We have Frontier, Spirit, JetBlue and now Allegiant.  Not a day goes by that I don’t receive an e-mail blast from one of them announcing fares so low that it seems simply not possible.  Many of the flights’ stated fares are less than it would cost me to drive to the destinations.  How do they do it? Of course, the fare price that is stated is not what you will pay.  The total cost of your flight has been fractionated resulting in an a la carte payment system where every additional se