More on health care

This article from the New Yorker is long, but should be required reading for every educated American.

If I may summarize here (please read the whole thing), the article suggests that a focused and holistic approach to the healthcare of the neediest (ie, costliest) healthcare users can bring about significant declines in the net expense for for both that needy subset AND the whole of the population.

Apparently, a few high demand patients can contribute a massively disproportionate amount to the total health care expenses of the broad population.

The article also teases out some other threads of interest to this blog: questionable care at the hands of doctors, the business-ification of health care, even the tension between the individual and the group referenced in the prior post.

The amazing success of some of these small scale projects, taken together with a recent NPR story I heard about Kaiser-Permanente and their model predicated on paying doctors fixed salaries with a bonus instead of a "bill for service" and the efficacy of this approach leads me to believe that we have real and scalable solutions to our health care mess at hand, but need a strong, collective push to get the nation on board.

medical sloppiness

Good (but disturbing) stuff from Newsweek on bad medical advice.

Sorry for the massive slow down in posting here - it will be pick up and in the meantime if I "reblog" something it is because I found it germane to the meta themes I'm concerned with in my writing and thinking.

babies and alcohol

Can we talk about mommies drinking during pregnancy or nursing?

Is that allowed?

I feel like this is one of those issues that leaves reason, science, and measured responses out.

But I would like to talk about it.

******addendum**************

From BabyCenter.com:

 "...the alveoli take proteins, sugars, and fat from your blood supply and make breast milk."

This is interesting, and raises more questions for me.  From when my baby-mamma was checking her blood sugar multiple times a day (watching for gestational diabetes) we know that there is a significant lag between something going in your mouth and that same stuff hitting your blood.  In general, that lag seems to run ~ 1.5 hours to 2 hours.

And yet, the baby advice literature suggests that if Mommy does want to drink a little alcohol, it's best to do so just after a breast feeding session.  How does this make sense when the gap between feedings is supposed to be 2 - 3 hours (at our current stage of development)?  It would seem that the advice has Mommy going to feed baby at about the same time the booze would actually be getting into the blood supply.

This is the kind of stuff that makes me frustrated with medicine and education about baby-raising.

on self experimentation

alternate title: reviewing 4-Hour Body.

OK, so I read the book.  It did take me longer than I thought; the book is long, and as I told a friend it's a sort of "kitchen sink" approach that is probably better suited to a blog environment than a standalone book.

This is going to be a long and winding post, so I'll offer a micro-review up here, above the fold, and talk more about the details and my plan to incorporate some of the ideas from the book in my own quest for self-improvement below the fold.

The book is a masterpiece of marketing.  The author, Timothy Ferriss (wealthy and famous from his previous book 4-Hour Workweek) leveraged a lot of "new media" and some other clever (or annoying; it's subjective) mechanisms to get the book a great deal of exposure.

The book addresses a handful of topics of interest to most people: how to lose weight (body fat); how to build muscle; how to improve your sex life (the experience itself, not necessarily the quest for partners); how to sleep better.

His contention is that there are some basic "hacks" that people can employ to get more out of what they have already, one example being that while people have to eat, we do not have to eat refined carbohydrates (anything white, per the book).

So the short review conclusion is that I got value from the reading, and can recommend portions of the book to others for reference, but I found the style lacking and most of the real content highly derivative of other well known sources from recent years.

For more, and for my personal application, click on through.

the mysteries of maternal medicine

alternative title: "The obscurity of obstetrics".

I may have been enjoined not to write much here about our personal experience with the baby doc industrial complex, at least until ours is born, but I can share other people's thoughts.  This post on BoingBoing by a guest blogger captures some of my frustrations (I'm quoting a choice bit, but read the whole post for his context)

Our child birthing class teacher: "Oh only 5% of babies are actually born on their due dates."

Me: So are half born before, half after?

Teacher: "Oh you can't know when the baby is going to come."

Me: I get it. I just want to know the statistics.

Teacher: "The baby will come when it is ready."

I asked on obstetrician.

Doctor: "The due date is just an estimate. There is no way of knowing when the baby will come."

Me: But of your patients, what fraction delivers before and what fraction deliver after the due date?

Doctor: "I try not to think of it that way."

Right.  And so it goes. 

our little joey...

(that means baby kangaroo!)

The NY Times ran an article this week on "kangaroo care", and it's encouraging and sweet and in some ways so obvious...

Again, I appreciate the medical community and their tools and their science and their drugs, and when those types of interventions are necessary, I welcome and advocate their use.  But I see so many instances where the intervention becomes the norm, and it stresses me out.

How does the saying go?  To the man with a hammer, everything looks like a nail?

on price transparency in health care

Are you concerned with the cost of "health care"?  I think everyone in the States is concerned, but there appear to be a few critical disconnects and troubling social phenomena around the topic.

A few thoughts, in no order:

1. health insurance =/= health care.
2. a lot of people know what they pay for insurance, but a lot of people have no idea what they pay for health services
3. "people" hate the idea of "socialized" medicine, except (apparently)
1. when they qualify for medicare
2. when they are on a group plan through work
3. when they live in the States
4. there exists a deeply entrenched, "selfish actor" hypocrisy in the rhetoric around health care

The next time you go to the doctor or the pharmacy, ask them for a price list for their services/products; take note of their reaction.

If you want to take it to the next level, ask if there are different price lists for different payers (insured, medicare, cash, etc) and ask what they expect to actually get in final payment from those various payers.

It's my opinion that there exist some rational and fairly straightforward "fixes" to the health care cost explosion, but that most people don't actually want to change the system.