Walking for your health and fitness. (Stories from my walking)
Wanda Watkins was out taking her exercise walking in her neighborhood when she encountered a big boar. The animal scared her; so leaping into the bed of some neighbor’s truck, she dialled 9-1-1. After animal control and police arrived she found that the pig, which had shambled up to her, making soft sorts of snorting sounds, was a neighbor’s pet. She had seen him out the night before while taking out garbage, and so was a bit on edge while she was walking.
Barbara knows everyone who walks in Heritage Park in the morning, as well as the main keeper of the grounds. So she was asking about what was going on, as I walked around in her “counter via” path with her for a while. Susan the main grounds keeper told us the tents were going up for a school supply give away by one of the non denominational churches in the area. They meet in the movie theater, which explains the Sunday morning traffic there. They were organized to a faretheewell, and the park was full of people with their kids coming for free school supplies. Susan also told us about the rail accident in the morning. Some man fell asleep on the tracks. When the train was coming, he sat up, held his hand up as if to stop the train, but it didn’t. The tracks were closed for several hours in the wee hours cleaning that mess up.
From my photo journal: I spent the Fourth of July holiday at the home of a local realtor (the kind that’s built a large local firm.) She’s had to rebuild twice since Katrina, but it’s all coming together. And it was lovely to be invited to play games and celebrate Independence day in a truly “old lady” style. I even took sparklers. And the bulkhead at dusk just called to the camera which I toted along as well.
Wretchard once again provides great blog leads. He quotes extensively today from Daylight’s Mark I’ll snip and exerpt a bit myself, as it’s a considered discussion of the medical reform moving through congress, inexhorribly as grass through a cow….
It’s a long excerpt, and the whole thing is worth reading if you’re interested in a pov expressed in “non bumper sticker” terms.
Now, how would I go about deciding what to cut and how to save money and “bend the future cost curve”? I would rate behaviors & services on a scale of evil (which for this discussion I define as greed:utility ratio). So things that I’d like to see happen that I think would curb costs without degrading current or future quality of care would be:
1. Significant tort reform…
2. Assigning the cost burden of unnecessary or likely futile services to patients or their families
Eliminating television and direct to consumer pharmaceutical marketing …
3. Breaking the oligopolies of health insurance coverage present in many states …If ever there was a reason for anti-trust intervention, this is it. Consumer choice is constrained… and costs are dramatically increased to patients and physicians. The solution to this is not creating a government monopoly of health care, but using deregulation & anti-trust law to allow cross-state insurer competition, and nurturing novel health care coverage systems … Government could do a great service by jumpstarting the infrastructure to create such a true free market but it should not take over such a market.
4. Encouraging charity care: Lawyers can treat pro bono work as a tax deduction; hospitals treat charitable services (which are often overcharged in the first place) as a tax write-off and get income tax exemption for being nonprofits. Physicians currently have no such benefit.
5. Cost Transparency: …quite often indigent patients get stuck with full charges while Medicare or large insurance company patients get charged much less due to contractual arrangements. This process is just insane. If the rich or foreigners want to pay for concierge care and first-class service, so be it. But for the system as a whole, doctors should be allowed to set their own fees … waive standard fees for the poor (remarkably, underbilling is considered fraud), and charges should be transparent and consistent.
6. Encourage innovation: Increasing tax credits for R&D, establishing prizes for translating discovery for big problems, and extending patent protection for new molecular entities while limiting patent extension for me-too drugs …would promote advances in drug and device development and maintain America’s edge in science & technology.
Is the likely Democratic plan a good idea?
I have to say no. Expanding Medicare & Medicaid for all opens the door to government price controls, which will devolve into wait-lists, poor quality personnel, salaried staff (who by definition are incentivized to give minimum effort), increasing physician refusal to see Medicare & Medicaid patients, and underinvestment in research and facilities (see Great Britain, and Canada). The Australian system, where public hospitals are well-funded and physicians can choose to accept government rates or charge higher, might be a viable option. The VA system (which was held up as an example by Hillary Clinton) is good at certain things (traumatic brain injury, spinal cord injury) but is poor at infrastructure maintenance, efficient clinic and surgical flow, and customer service; further, its costs are held down as much of VA health care is in reality delivered by residents. The proof of the pudding on the VA is that the vast majority of VA patients are enlisted personnel; the retired officers go elsewhere.
Which of the plans bouncing around have useful ideas?
I think the Daschle-Dole idea of giving tax credits to all who pay income or payroll taxes to purchase health care is a good thing – equalizing the playing field of those with employer health coverage and those without. We want health insurance to be available to all contributing or productive members of society, but we don’t want free health care as a dole to contribute to persistent unemployment.
Lots of other bits and pieces drifting through my life. But enough already.