Category Archives: Healthcare

healthcare thoughts

It’s interesting to me how supporting government-run healthcare has become more or less standard for Democratic candidates.  I can’t argue that people – all people – should have access to healthcare, but I feel a lot of people don’t understand that what people get with government-run healthcare is not the same as what we get here.  I can mainly speak to Ireland and the UK, so that’s what I’ll talk to.

  • If you are in the hospital in Ireland, you’ll likely find yourself on a ward.  If not, you’ll be sharing a room.  As far as I can tell, wards don’t even exist on US hospitals anymore, except maybe in the ICU or whatever.  Private rooms are not a standard thing like they are here.
  • If you need some kind of treatment for something that’s not life-threatening, you’ll likely have to wait.  A long time.  Here’s a random example of an article on patients waiting 9 months or more to get shots for macular degeneration.  I didn’t KNOW that people had to wait a long time for that treatment, but I guessed they did.  My dad has macular degeneration, and it’s terribly time-critical to get treated.
  • When my American grandma got cataracts, she made an appointment and got them removed.  When my Irish great-aunt got cataracts, she got put on a waiting list, and a year later, she got them removed.
  • In Ireland, people unsatisfied with public health care pay for private health insurance.  15% of health care expenditures came from private insurance, and 40% of Irish people have some type of private insurance.  My aunt found a lump in her breast.  She was unsatisfied with the care she was getting from the public healthcare system, so she sought private treatment and surgery to have it removed.
  • Healthcare is like an HMO.  I’ve enjoyed being on a PPO for over a decade.  As a kid, my parents had an HMO which was super annoying because you couldn’t just go see a doctor if you had a problem.  You needed a referral.  Not a huge deal, but public healthcare tends to follow the HMO model – your GP is a gatekeeper.
  • Education requirements are WAY less to qualify as a doctor in other countries outside the US.  It takes five years to qualify as a doctor in Ireland.  In five to six years, you can qualify as a surgeon or specialist.  That’s out of high school, folks.  I actually think this is a good thing, but unless the model is changed, doctors here are going to expect to be paid more.
  • GPs in Ireland make $77,000 a year.  GPs in the US average between $140,000 and $190,000 a year, depending on the source.  And we have trouble finding enough GPs even at that salary level.
  • As far as I can tell, Medicare is great in the US.  But the rest of us are subsidizing it heavily.  Not only that, I’d assert that the US subsidizes healthcare around the world through paying through the nose for pharmaceuticals and advanced operations and equipment not available elsewhere.  New treatments are debuted in the US, and after they’ve been shown to work well, they move to the rest of the world.  A random example of British kids trying to get to the US for cutting edge cancer treatment.  Cancer treatment is very effective in Europe, but many of those effective treatments were developed and paid for here.
  • Despite the fact that a full 12% of Americans are uninsured, cancer survival rates are comparable between the US and Europe.  12% of Americans don’t even have healthcare, but survival rates are the same.  Why?  Shouldn’t they be much higher in Europe?  (It varies with type of cancer; for some types, survival rates are higher in the US, others higher in Europe, but comes out roughly even overall.)

I honestly believe healthcare will not be any cheaper whatsoever if we go to governement-run healthcare in the US.  I suspect that globally, the rate of advancements in healthcare will declines.  I would LOVE to see the US stop subsidizing drugs for the rest of the world, and perhaps government run healthcare would enable that.  I do believe it’s a moral obligation of this country to provide healthcare to all its citizens.  I’m not sure Medicare for all is the way to do that.  Maybe it is.  If Medicare for all IS the right answer, I definitely would be in favor of a gradual expansion – gradually reduce the eligibility age and add in children at the same time.  So, year one, move eligibility to age 55 and also make all children under 1 eligible.  People could still retain private insurance if they wished, but I imagine many or most wouldn’t.  Private insurance would experience a slow decline over the next 30 years while it adapted to a role more similar to that which it plays in Europe.

 

politics

Obama has come out with some positive proposals lately.  When I read that he was pushing for free community college I was super excited.  For about five seconds.  Then I realized it has zero zilch nada chance of passing congress and that it was political grandstanding on his part.  I think it’s a fantastic proposal and well worth spending money on – and I’d be willing to pay higher taxes to support it.  I could go on about why it’s a great idea, even if it’s pricey, but it’s pointless.  It’s not going to happen, at least not during Obama’s presidency.  Seriously the best thing about Georgia is the Hope scholarship.  I’m not sure what it’s status is today, but fifteen years ago, it was an amazing thing.

Then, today I read he’s pushing for six weeks paid maternity leave for federal workers.  On the one hand, this would be a great thing.  Are there federal workers out there not currently getting paid maternity leave?  My NASA counterparts get six weeks, don’t you, even without sick leave?  So, I’m a little confused.  Second, what about the rest of the country, all the non-federal workers who actually need the leave?  If this was really important to Obama he would have brought it up sooner.

On the bright side, I read that the percent of families suffering major financial insecurity due to medical costs dropped five percentage points in 2014 (from 2013, I think.)   I think it’s safe to say that Obamacare gets the credit.  That is a plus.  I just hope the Republicans don’t dismantle Obamacare.  While it’s obviously not a great system, I have yet to hear any counterproposals.  My first would be, how about the US stops funding the pharma companies all on its own and the rather smug Europeans and Canadians get to start pulling their weight?

I read in the NYT the other day that people with health insurance use the emergency room more than those who are uninsured.  Remember when we were going to save money by insuring more people because they’d stop using the ER?  In retrospect, that POV was rather insulting to the uninsured.

Harvard health costs

Cry me a river.  Don’t get me a wrong.  Employees should always advocate for themselves, and I don’t blame Harvard employees for doing so.  However, anyone who works in the private sector will have little or no sympathy for Harvard professors being forced to pay $20 co-pays and have a $250 deductible.

My benefits cost has gone up, and my actual benefits have gone down year after year.  This is at least in part due to Obamacare provisions that, in some cases thankfully, don’t benefit me – 1 million lifetime max being made illegal, healthcare for kids 21 to 26, and no longer being allowed to deny people with pre-existing conditions.  I don’t oppose any of these provisions, but you don’t get anything for nothin’.  If you factor in healthcare, while I got raises, some years, the healthcare cost negated that raise completely.  However, it’s hard to call it a paycut, because Blue had to shell out a lot of extra money as well to cover the 80%/50% (individual/family) share of the premiums.

Five years ago, I had excellent health coverage.  Now I’d describe my health care coverage as OK.  Thankfully, no one has had a serious illness to really test it.  It’s certainly not cheap on Cobra.

legalizing pot

These days I have no stomach for reading about sick kids.  It’s not like I ever enjoyed it, but lately, I can’t help but replace the child with L in my mind.  I’m no big proponent of marijuana legalization.  It annoys me when my neighbors smoke pot or when people smoke pot at parties, or pretty much any time when I’m around.  However, I have never understood why medical marijuana should be illegal.  I think a doctor should be able to prescribe whatever a patient needs to make them better, and marijuana should certainly be an option.  I’ve read two stories recently about young children whose lives appeared to be massively improved by marijuana.  In the first case, the child was taking these unbelievably powerful drugs which were basically killing her – and were still not doing a great job stopping the seizures.  But her doctors were hesitant to recommend marijuana, something so benign by comparison.  The second is the headline on CNN today.   This child said  “mama” for the first time after marijuana finally mitigated her seizures after everything else had failed.  Among other things, it’s so inexpensive compared to some of the drugs around.  It just breaks my heart reading about these poor kids.  Thank God they’ve finally found something to help.

We moved yesterday.  I had more contractions yesterday  than I’ve had the entire rest of my pregnancy combined, but we got through it.  Now our house is complete chaos.  I had breakfast in a mixing bowl with a baby spoon and B’s cereal.  Hopefully we’ll be able to get a little bit organized tonight.

proud

I’m so proud of my sister.  This is her second quote – this time on Yahoo finance:

“We’re pleased to integrate Teladoc into Castlight. In doing so, we can help our employer customers realize even greater benefits from their telehealth service than if it is a stand-alone company benefit,” said Maeve O’Meara, vice president of Product Management for Castlight Health. “The power is in leveraging the Castlight platform, making it that much easier for an employee to find and use Teladoc when they need it.”

The fact that her company is doing something worthwhile is all the better.

this and that

What better way to start the new year than by reading the news?  First I find out that Mr. Duck Dynasty, who prior to his anti-gay comments I had never heard of, is saying you should marry women at 16.  Really, who cares?  This guy is clearly a moron.  Why are we giving him CNN headlines?  It’s simply spreading his message to people who would never otherwise have heard it.

Then, I see that Sotomayor has issued a stay on the part of the healthcare law that requires providing plans with birth control.  It was unclear to me from reading the article who that affected.  I believe very strongly that women should have access to birth control.  On the flip side, I can see how some very small groups should be able to get an exemption, such as a charitable order of nuns.  Schools and hospitals, in my opinion, should absolutely not get an exemption, and it’s a little horrifying to me that so many of our hospitals have these close religious ties.  I really wish the Catholic church would get over its objections to birth control.  It just really doesn’t make sense to me.  The world would have a serious populations problem without birth control.  Sex only inside marriage – OK, I can see the rationale.  By no birth control inside marriage?  Why ever not?  I take this personally for two reasons.  First, morning sickness was debilitating for me during my first pregnancy.  I think it would physically extremely harmful for me to go through several pregnancies like that.  In general, I think it’s unhealthy for most women to go through more than 5 or 6 pregnancies.  (There are always exceptions, and the younger you start, I’m sure the easier it is.)  I suppose there is always the rhythm method.  Second, the primary treatment for PCOS for someone not trying to conceive is the birth control pill.

There have been lots of pregnancy and birth announcements on Facebook lately.  A friend from my prenatal water aerobics class (pregnancy), my first cousin (birth), a former co-worker (pregnancy), and former high school classmate (birth) just to name a few.  I suppose people used to find out about these things by reading birth announcements in the newspaper.

 

incognito

There’s no such thing as a free lunch.  From the NYTimes – Digital medical records don’t save much money (if any) and have mixed results in improving care.  I’m too lazy to link, but I also found it extremely unsurprising to learn that increased preventative care does not save money.  Reducing costs most likely means reducing quality of care, but here in the US, we subsidize the rest of the world in many ways, and we’re probably at a place on the cost-benefit curve where the slope is fairly low.

We had a rough time getting I to sleep tonight.  But she is so adorable, basically at all times.  I love that she loves playing games these days.  She loves peekabo.  She’ll play with her blanket, with her bib, with whatever she’s got handy.  She loves it when I play, and she’ll pull the blanket off me or whatever I’m hiding under.  She ever plays with inanimate objects.  Today, she was covering up the dinosaurs on her pajamas and playing peekabo with the dinosaur.  So cute!

She thinks the wave sign means Daddy.  Basically, at some point I realized I should teach her to wave.  Waving is just not something I do normally, and we never started with I around, so I started saying “Hi Daddy” and “Bye Daddy” whenever B entered and left the room.  We have done Hi and Bye with other people as well, but B comes and goes a dozen or more times a day, thanks to his work-at-home scheme.  These days, if I say something about Daddy, she’ll start waving.  It’s so adorable.  If we walk by his door, she sometimes starts the waving sign with her hand.

I also love that she loves books.  She loves books above all things – textbooks, board books, regular kids books, novels, even catalogs.  She just loves flipping through them, turning the pages over and over, examining this and that.   I bring home stacks of books from the library for her and me to look through (as if I don’t have enough on my shelves.)  We used to read through all her books regularly, but it’s become much harder because she has so many, between the ones she owns and the ones we have out from the library.  We read all of them yesterday, and it must have been 20 books.   Her favorite book is O Is For Orca.  I can’t really recommend it because I don’t know what she sees in it, but she just loves it for some reason.

Today, she learned to “play” the xylophone for the first time.  She got two xylophones for Christmas.  Playing a xylophone is more complicated than you’d think.  You have to manipulate the mallet such that the end strikes the keys and then is lifted again.  She’d done it by accident a few times, but today she was able to do it with some consistency.  Naturally, every successful effort was greeted with plenty of applause on my part.  Until today, I’d gotten much more use out of the xylophone than she had.  (My favorite tune is The Gift to be Simple.)