btw2.net

I’m doing my blogging at PortfolioLife.

The part worth noodling on:

…The U.S. health-care system has two distinct parts — financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part — employer-based coverage and individual insurance — accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent.

The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.

To the extent that any health insurance scheme involves spreading among members of society the financial risk of getting sick, all insurance “socializes” the risk. This is, of course, not what people mean when they level charges of “socialized medicine.” This term is never used in reference to police protection, fire departments or highways — all of which are provided by government.

Properly speaking, socialism is when the state owns or controls the means of production. Thus “socialized medicine” is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.

Only one part of the U.S. system really is socialized medicine: the veterans’ health-care system, which is wholly owned and operated by the federal government. Veterans love the system and vigorously oppose any suggestions of dismantling it and integrating them into civilian health care. By many measures, this bastion of socialized medicine may constitute the highest-quality and most efficient part of American health care….

It is absurd to call an expansion of government payments for health care in the existing private delivery system socialized medicine. Politics may be full of hype, exaggeration or partisan bickering, but there should be no place for overt deception. A serious debate about whether and how to reform the American health-care system requires that we eliminate comments whose only purpose is to mischaracterize and misinform….

‘Socialized Medicine’ Quackery
By Ezekiel J. Emanuel, The Washington Post, October 8, 2007
Ezekiel J. Emanuel, an oncologist and
the author of “No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence,”
chairs the Department of Bioethics at the National Institutes of Health.
The views expressed here are his own.

Today The Health Care Blog has a post - The Perpetual Health Care Crisis By Jeff Goldsmith.
It begins:

I began teaching health policy almost thirty years ago with Odin Anderson at the University of Chicago Graduate School of Business. Like me, Odin was a sociologist, and one of his hobbies was tracking the sociology of our nation’s “healthcare crisis”. He found that the health care “crisis” waxed and waned (as measured by press mentions and journal articles), but never disappeared. It had been going on for twenty years by then, so I guess we’ve now been in “crisis” for fifty years. The American health care “crisis” is not acute illness - rather it is like a chronic disease which flares up periodically, accompanied by fresh prophecies of impending doom and calls for someone on a white horse to fix the problem.

From 1970 to 1993, health costs roughly doubled as a percentage of GDP. All the way along, prophets of doom forecast that the country would simply fall apart when health costs exceeded 8%, then 10%, etc. . Our economy somehow continued growing and innovating, and the health system got steadily more capable at managing our illnesses the entire time. No-one I know would trade our present, very expensive health system for the cheaper one we had in 1965 or 1980….

There are several things to keep in mind as we delve into our “crisis”:

1. Medical care is not the same as health care. Health care involves illness avoidance as well as the treatments of medical care.
2. Many leaps have been made in both medical care and health care.  And, like Jeff Goldsmith, I wouldn’t got back to 1965 or 1980 for cheaper health care.
3. Some folks rely on their doctor to keep them healthy. The doctor can help but the “patient” does much of the health benefit effort by managing their lifestyle. (yes, heredity can short circuit all of that. but try anyway.)
4. While the cost of health care has gone up, the practice of medicine has changed dramatically. Some doctors are still trying to manage their practice like its 1980. The doctor and their patients are ill served by that lact of a progressive effort.

And I’ve found value in the ideas in this book.

The graying of the Web
By Matt Richtel, The New York Times, September 11, 2007
via Cnet news.com

Older people are sticky.

That is the latest view from Silicon Valley. Technology investors and entrepreneurs, long obsessed with connecting to teenagers and 20-somethings, are starting a host of new social networking sites aimed at baby boomers and graying computer users.

The sites have names like Eons, Rezoom, Multiply, Maya’s Mom, Boomj and Boomertown. They look like Facebook–with wrinkles.

And they are seeking to capitalize on what investors say may be a profitable characteristic of older Internet users: they are less likely than youngsters to flit from one trendy site to the next….

Social networking has so far focused mainly on businesspeople and young people because they are tech-savvy and are treasured by Madison Avenue.

But there are 78 million boomers–roughly three times the number of teenagers–and most of them are Internet users who learned computer skills in the workplace. Indeed, the number of Internet users who are older than 55 is roughly the same as those who are aged 18 to 34, according to Nielsen/NetRatings, a market research firm….

They are sticky. And the older they get, the stickier they get. One thing that will slow this down is that as they age they tend to lag on technology. They tend to have slower devices and connections.

I think the new sites take that into account some but perhaps not enough.

subscribing to sites you want to have let you know when something new is postedand you can catch a glimpse before heading there
and finding out it isn’t as interesting a post as you’d hoped.

RSS made simpler

How Stuff Works
Their motto is “It’s good to know” - yup
They can help you help others.

Years in the Making, Powerful Yahoo Mail Is Worth the Wait
Walter S. Mossberf, Wall Street Journal
Complete with video report.

Mashable is a geek’s good friend, sometimes good for non-geeks too

Both of my grandmothers lived to 99. Both grandfathers to 87. So I’ve thought my timeline was in between those numbers.

But my dad will be 90 this Saturday. My mom is 87 and still drives. My dad and I both talk to her about how to adapt her driving to her age.

I pickup my son this morning so we spend some vacation time before the weekend trip to my folks’ city, and the family festivities there. Then he and I will spend some vacation time there before he heads off to his town.

One of my dad’s sisters had Alzheimer’s. The paths of aging vary wildly. We plan. But we never really know what path may be before us.

Zen and the Art of Coping With Alzheimer’s
The New York Times, Second Opinion, By Denise Grady, August 14, 2007

During the YouTube forum with the Democratic presidential candidates in July, the first question about health care came from two middle-age brothers in Iowa, who faced the camera with their elderly mother. Not everybody with Alzheimer’s disease has two loving sons to take care of them, they said, adding that a boom in dementia is expected in the next few decades….

“It is well to remember that the entire universe,
with one trifling exception,
is composed of others.”
      John Andrew Holmes.

quoted by Tim O’Reilly

notes from the field

Suffering Differently
By Ethan Watters, The New York Times Magazine, August 12, 2007

After the 2004 tsunami in Asia, many mental-health experts agreed that a “second tsunami” of mental illness in the form of post-traumatic stress disorder would strike the region. Like doctors rushing to the outbreak of an epidemic, American counselors and trauma researchers soon arrived on the scene hoping to pass on useful knowledge about PTSD. A few years on, however, their efforts have raised a troublesome question: Were they bringing the wrong treatment to the wrong people?

At issue is not whether tragic events like the tsunami trigger debilitating psychological distress and even mental illness — everyone agrees that they can. The question is over the extent to which survivors’ cultural beliefs shape their symptoms. If culture has the impact that some researchers suggest, the PTSD diagnosis may be of little help (and even do potential harm) when applied wholesale in other countries.

In the last 25 years, PTSD has had a remarkable ascendancy in American psychiatry and in public consciousness. Proponents of the diagnosis assert that experiences of fear or horror often spark a cluster of 17 broad symptoms, including intrusive thoughts, memory avoidance and uncontrollable anxiety. The concept of PTSD also encompasses notions of how best to overcome the disorder, usually through measured re-exposure to the original trauma supervised by a counselor. PTSD, many Americans assume, describes the way that all humans react to trauma.

Gaithri Fernando, an expert on trauma from California State University, questions that assumption. “Researchers and counselors who came to Sri Lanka after the tsunami did find some PTSD symptoms,” Fernando says. “But it was not the nightmares or flashbacks that most of the population was concerned with. The deepest psychological wounds for Sri Lankans were not on the PTSD checklists; they were the loss of or the disturbance of one’s role in the group.”…

Eye on DNA Headlines for 12 August 2007
by Dr. Hsien-Hsien Lei, Posted August 12, 2007
includes:

Matt Ridley writes in The Agile Gene:

If personality is created by parents, peers, or society at large, then it is still determined; it is not free.

In some ways the news that our genes are important contributors to our personality should be reassuring: the imperviousness of individual human nature to outside influences provides a bulwark against brainwashing. At least we are determined by our own intrinsic forces rather than somebody else’s.

A more non-trauma, non-DNA US culture view at: Culture, Counterculture #1