2.17.2011

Ode to the Cure (my 200th post)

An insatiable maw consuming 18% of our GNP;
that it cannot go on screams out like a banshee;
and though we spend twice as much as the very next;
we live not as long and lag behind more than 30 in most respects.

Blame for this state is enough to go around the globe a dozen times;
That it is the fault of another, each special interest quickly chimes;
Patients blame the docs who blame the insurers who blame the feds;
and don’t forget the neocons who claim any fix will make us all Reds.

We can blow up the world more than a thousand times;
We can move an army to destroy a regime for both real or imagined crimes;
We can endlessly debate which path or no leads to heaven;
But we can’t vaccinate all kids or provide simple care for at least 1 in 7.

Suggesting that universal coverage might be a fair start;
Has self-serving pols rattling china on their tea cart;
Some moron can try be be coy by suggesting we must all buy a gun;
A family an illness away from bankruptcy may not be ready to join in his fun;

Legislators are quick with a resonating sound byte;
but sadly they don't really have a dog in this fight;
they pass rules all the time that they don't have to employ;
requiring them to abide by what we get might be a sound ploy.

One things for sure, keep this up and a collapse is near;
Then better hope you need no care for one who is dear;
Tea party nay sayers may celebrate what they claim is for freedom a victory;
but to die from neglect, seems to be for a great nation somewhat contradictory.

As one in medicine’s trenches for a quarter century I know what I speak;
wait much longer and harder will it be to find the care that you seek;
Ignore those who believe the phrase health care reform is a kind of profanity;
To avoid the peril that Einstein reminded defined insanity.

Is there any hope, any direction other than over the edge?
any means to avoid the collapse or a means our bets to hedge?
The answer is yes but the cost will be high, though not in dollars;
The only answer is sure to stir a great chorus of hoots and hollers.

No doubt you have already heard the dire rumors;
We can neither afford nor staff to the levels needed to care for the Boomers;
Not if we persist in our national predilection for acute care late in the game;
Only a shift toward prevention, wellness and early detection will these costs contain.

Bricks and mortar systems are impressive with scanners and the latest high tech toy;
But using robots to cure one while others get nothing, any claim to national greatness must destroy;
The cost of one mechanical heart for a former VP;
could vaccinate thousands of kids from many a working family.

The limits are few on the options for those with means;
but nothing is left to provide the poor with the simplest of health screens;
The rich are told, ‘well here of the list of things that might provide some limited good’;
But to offer the most basic care to the poor a doc must don the cloak of Robin Hood.

Test after test is used to define an insured’s problem in detail;
those without means wait outside an ED to be seen at a pace that would bore a snail;
Clinical judgement and communication has fallen by the wayside on the path to a cure;
Why do one test when three can be had for 10 times the price just to be sure.

Oh yes, a doc will claim that they do too much because they are liable;
but as a real excuse that just isn’t viable;
yes lawyers and suits are a nuisance, that much is sure;
but tort reform isn’t where we’ll find the cure.

The real key to reform is a mindset that must be corrected;
if our rendezvous with disaster is to be deflected;
Less the purview of the doc is the change that is required;
More effort than nothing from the patient is needed lest we remain in red ink mired.

Prevention wellness and optimized care lower cost and improve the quality of care;
But for these the individual not the doc is the one who must the responsibility bear;
The Bard was right when he said that the fault resided in ourselves;
Not as some would claim on a pharmacy’s shelves.

Americans have demanded a system that at ‘goal line D’ gets ever stronger;
So that they can smoke, drink, eat, and veg in front of the TV all the longer;
A life of sloth and neglect requires expensive fixes as is our convention;
Ben Franklin, it turned, out was too conservative by far in the value of prevention.

And it’s not just inattention that has its costs as some choose an alternate who claims to cure with water or prefer some Asian needles;
or crystals or prayer or twists to the spine or the ground carcass of some beetle;
that is your right but should not the failure then be your own?;
not shared with those who prefer the direction that the light of science has shown.

But science is but part for the ability to pour money down a hole with greater precision;
Is not what should drive every health care decision;
It’s more than a question of ‘yes we could’;
But can is not now, nor ever, the same as should.

Everyone dies in the end - a sorry fact from which there can be no buffer;
Medicine blurs the edges between preserving life and extending the time one will suffer;
But for every futile act wasted at the end of one’s time on earth;
solace could come from knowing the savings could help hundreds at the time of their birth.

Why a spiritual nation fears the undiscovered country so much;
is a topic of much interest to those who work closely to death's touch;
for we see every day that there can be far more sinister fates;
than to die whether eternal bliss or the void is what awaits.

We must find a balance far different from what we do today;
more attention to staying well than being rescued is really the only way;
and then we can afford to care for all as befits a great nation;
yet still have enough for acute care just not as our sole fixation.

They say that freedom always comes at a cost and it's socialism we should fear;
but our health care freedom currently runs a tab of two trillion each year;
robbing us of jobs and crippling our industries with insurmountable costs;
but opponents to reform offer nothing but rhetoric while our treasury exhausts.

Should we consider our health as an island that to a greater sphere need not connect?
Or in this was Donne once again correct?
The individual must be responsible for their own destiny as this is the answer not another;
and try to get in the habit of remembering that your clinician is not your mother...




17 comments:

Pliny-the-in-Between said...

The results of that little, highly unscientific poll are in. Of seven people who responded, only one related never having had a health care decision impacted by one or more of the selections presented. It's interesting that 5 people related that a lack of insurance had at some point delayed seeking care. The cost of medication was also commonly cited, as was lack of a primary care doctor. As I said, it wasn't scientific and some people may have chosen to not respond because they had no beef with their health care. Good for them. All this was nothing more than a preamble to what follows: A brief discussion of where medicine may be heading in this country. Everybody that knows anything about health care in the US is pretty convinced that the system is on the brink of collapse. Somewhere between 3-5 years at most. If we are going to do anything we need to be doing it fast. A colleague said it pretty well, I think:

"We can neither afford nor staff to the levels needed to provide the volume and breath of health care required by our rapidly aging population. The exponential growth of health care expenditures is bankrupting the country. We must move toward a new model of health care delivery. The best alternate model involves substantial redistribution of resources and responsibilities away from traditional bricks and mortar care toward individual and community based care teams and a shift in emphasis away from acute care toward prevention, wellness, chronic care management, and early detection of disease or risk. This will create large displacements and disruptions in existing clinical resources (clinicians, hospital systems, etc.) and intensive investment in engaging individuals to actually participate in and share responsibility for their own care. Such a drastic reorganization cannot occur overnight. It must be accomplished in stages. Each stage must be designed within a framework of the long term vision not as a piecemeal patch. Each stage must mitigate long term risks while providing a well-defined payoff in improved quality and reduced costs at each stage."

In short, individuals must take a greater roll in their own fate and rely less on modern medicine's ability to pull their bottoms out of the fire at the last possible moment in time.

GearHedEd said...

One of the reasons I asked about Watson the other day was because when Alex Trebek was giving his talk at the beginning of the first installment, he talked briefly about applications of Watson's technology. The first thing to come up was as a diagnostic database / records keeping wizard.

My first thought was "I'll bet Pliny could appreciate this!" (If he hadn't already worked on it hisself...)

Harry C Pharisee said...

I agree, more than in spirit Pliny, but I fear economic libertarians will take advantage of the idea of necessity for disease prevention through individual responsibility.

--------

Ed and I were on a similar wavelength by the way. I was thinking to myself, "I wonder if Pliny could briefly explain why I should give two hoots about Watson?"

Pliny-the-in-Between said...

I'll post something about Watson (and why it's interesting) in the next week or so.

Pliny-the-in-Between said...

Harry, I understand that fear. There are a number of similar slippery slope arguments that reform efforts run into. several converge on the issue of rationing care. Rationing of care already happens because of economic libertarianism. Cheney gets a heart assist pump while kids get taken off the medicaid roles. He has money and clout so he gets the toy.

We also have actuarial rationing that prevents those wit pre-existing conditions from getting insurance because they cost more.

So what's my point and one we should argue about intensely- we already ration care because of labels and conditions many of which are no fault of an individual. If no economic disincentives exist (or incentives for good behavior) then no one is compelled to act differently until it's late in the game.

The data is astounding - if prevention wellness and early detection of new disease was linked to optimized care for chronic ailments, it is possible that $1 trillion dollars could be saved each year. Each year.

It's a lot like our energy consumption - we can go along as we do and use it up or we can sacrifice a little along the way and go a lot farther.

GearHedEd said...

Yeah, except the politicians and corporations have a vested interest in maintaining the status quo, and they have the power to keep things that way until the next crisis.

That sucks.

Pliny-the-in-Between said...

Actually the major corporations (employers) are the ones that are pushing the reform agenda. Not out of goodness but because of economics. it costs them to much. They rae pressuring their insurance Carriers to get this done.

One of our guys was at a national meeting where the head of HR for a company that has come up in this thread told his insurer that their products sucked.

So the insurers are scrambling to control the costs.

It's this change that makes me think something will happen.

GearHedEd said...

Well, when I said "corporations", I was mainly referring to Big Insurance and Big Pharma, mostly...

Pliny-the-in-Between said...

Pharma may not like this but the insurers are getting behind it. That makes sense since prevention and wellness saves them money.

GearHedEd said...

Maybe there is some light at the end of the tunnel...

if Skynet doesn't get us first...

:o)

Pliny-the-in-Between said...

Skynet won't get a chance MIKE will get us first...

Harry C Pharisee said...

Pliny,

Since I agree with you for the most part, we come to the necessary cliche of what the heck can I do, simply petition my congressman?

Pliny-the-in-Between said...

Well Harry, that may help but I think the biggest thing we all can do is begin the conversation with our families about healthier lifestyles. Also, there will be opportunities for individuals to participate in studies that will be starting soon. Lastly, everyone should contact their insurers and tell them you want to be enrolled in prevention and wellness programs - and that there should be some incentive if you are.

Pliny-the-in-Between said...

Another thing Harry, is to sit down with family (particularly the elderly) and make sure your wishes are known and advanced directives are in place. Unfortunately today if a family hasn't had the talk, and one family member balks about some limits to care the clinicians will usually defer to the one who objects just to not stir anything up. If family isn't clear about things then the default is usually to do everything even if much of it is futile care.

mac said...

Brilliant witing, Pliny.

I don't have much to add to the health care debate...other than:

Iam sure the outrageous amount I pay for in$ufficient in$urance woud go a long way towards paying for a legitimate health care plan if used properly.
If it would make the right wing fear mongers happy, we could call it a premium instead of a tax.

Harry C Pharisee said...

"If it would make the right wing fear mongers happy, we could call it a premium instead of a tax."

Sad but true.

Perhaps Don sang the words too soon.

"Armchair warriors often fail, and we've been poisoned by these fairy tales..."

mac said...

I came back a second time
having seen you desire for comments that rhyme.

I could relate a story,
give you the details, oh so gory
with very little glory.

A while back, my son and a buddy were fighting and fussin.
He came home bloddy with a percieved concussion.

A trip to the ER
revealed but an ego scar
But Fucks
I'm still out 900 bucks.