CossEffective » garrett

Commentariolus Medicus

garrett — Mon, 14 Dec 2009 02:43:24 +0000

As legend has it, while being arrested for his believes (based upon evidence) that the Sun, rather than the Earth, was the center of the universe; Nicholas Copernicus said of his captors: “I cannot admire enough those who accepted the heliocentric (earth as the center of the universe) doctrine despite the evidence of their senses.”

The difference between this statement of 5 centuries ago and today is simply the issue to which it is applied, and the date. For Copernicus it was aimed to those who held on to the notion that the Earth was the center of the universe, today the same could be applied to the notion that government ownership, specifically health care will produce efficiency. If this past century has taught us anything, its that governments don’t do healthcare well, still despite the evidence of our senses, our congress seem committed to its treacherous course.

Based upon the evidence of your own senses, what remains true, self-evident, observable and non-controversial is that no one else but you does your healing for you, or your dying for you. Only you live with the results of medical practice, good or not. There is no outsourcing, no cost-shifting, or possible means by which you can personally enjoy the benefits of healthcare while pushing the risk of its individual consequences on to someone else. You own it.

This makes the current healthcare debate personal. It would take a delusion of universal magnitude to believe for one minute, that a greater involvement of the government into our personal healthcare is in any way be an improvement. Of course, you are free to believe that government healthcare is better, but that would be foolish and you would be wrong. What is being proposed is about a few people feeling good about doing something they hope may be good, knowing in the end, they personally can no’t bear the full cost of any decisions they have made.

There are many more simple though less glamorous reforms that would be so much more effective, but they lack the flamboyant appeal of what is being proposed today. Lowering the deduct-ability threshold for out-of-pocket healthcare expenses, interstate purchasing of healthcare insurance and personal savings accounts that roll forward and accumulate over time allowing individuals to claim higher deductibles, and in so doing enjoy lower insurance premiums. But this is about theater, not reason.

Thomas A. Coss, RN

Senate Committee on Healthcare Reform

garrett — Wed, 15 Jul 2009 23:07:13 +0000

Senate Committee sent out an incomplete healthcare reform bill today seeking approval by the entire Senate. This is the latest in a series of Potemkin Villages the president can view while bobbing along in his dingie propelled by two oars: self importance on one side and hubris on the other.

There was a time in our history when 9 out of 10 people in the US worked in agriculture and some how the government didn’t see a need to reform agriculture. Similary, general manufacturing peeked in the use peeked in 1958 with over 40% of the us labor force working in manufacturing, where was the crisis then? Now with healthcare involved in 17% of our GDP and less about 10% of the US labor force, somehow we need “reform”, I’m not buying it.

For this to work, you must first believe that when smart people enter into government services they somehow become infinately more intelligent, and therefore better positioned to make your medical decissions. If that is your beilef, please inform me of any situation in which that exists. I would love to see it.

Healthcare Reform and the Coss Conundrum

garrett — Sat, 07 Mar 2009 19:51:14 +0000

There are a lot of hopes placed upon the role of healthcare IT to address the ills of the healthcare industry, some are legitimate, many are not. One such limitation I call the Coss Conundrum which goes like this.

Suppose for a moment that you and I are in a business arrangement in which your responsibility is to beat me unmercifully about the head and shoulders with a stick; my responsibility is to provide you with a stick. Just how big a stick would you expect? If you’re thinking anything bigger than a standard yellow pencil, you’re likely to optimistic.

Here in lies the conundrum. The stick, in this case, is healthcare provider information, and it is here where the government’s efforts run up against the pragmatics of broad based implementation. Why would any private practicing physician pay money for an information system if, like the conundrum suggests, the practitioner feels that the information may be used like a stick with which to later be beaten? Few will speak of this out loud, but the issue is real and legitimate. Any mishandling of patient clinical data, either to violate the privacy of the patient, or even to punish the choices of the practitioner, results in the same limitation.

Using information needs it’s own sets of ethics and guidelines. The technology, thought considerable, for the EMR is not sufficient to understand, there remains the evolutionary psychology and professional ethics to provide the assurances required for adoption.

Tom