Tuesday, January 30, 2007
Global Warming
This subject has come into my sphere a lot lately. Which is a good thing.
The major magazines that I subscribe to: the Economist, Scientific American, and Inc. have all recently run front-page articles describing the challenges behind climate change, how to fix the problem scientfically, economically, and with entrepreneurship. This alone has been enough to convince me of the major problem that we face in the coming decades.
Then I saw An Inconvenient Truth
Now everything has completely hit home for me. There is no doubt any longer that this is one of the biggest problems that humanity and indeed the earth has ever faced. Rising levels of CO2 threaten life on earth as we know it. It's very plausible that the antarctic and greenland ice shelves will break off within the next hundred years and the Earth's sea level with go up anywhere from 10 inches to 10 feet. This is enough to wipe out the homes of over a billion people and kill millions and millions of different species.
I would like to believe that earth has a built in control for rising CO2 levels. After all, the climate has shifted back and forth between ice ages and periods of warming for hundreds of thousands of years. How is this period of warming any different? It's very different because the level of CO2 is so far above where it has ever been on our planet. The highest concentration CO2 has ever reached is around 300 ppm. Then it drops off sharply and we descend into an ice age. We are currently about 370 ppm and still rising precipitously. The planet is already getting hotter, but we won't be in serious trouble until the ice shelves melt. Could be 50 years away, could be 20. My guess is that I will see it in my lifetime, unless significant changes are made to the way we obtain energy.
It's happening. It's time to wake up and do something about it before we alter our planet beyond recognition.
The major magazines that I subscribe to: the Economist, Scientific American, and Inc. have all recently run front-page articles describing the challenges behind climate change, how to fix the problem scientfically, economically, and with entrepreneurship. This alone has been enough to convince me of the major problem that we face in the coming decades.
Then I saw An Inconvenient Truth
Now everything has completely hit home for me. There is no doubt any longer that this is one of the biggest problems that humanity and indeed the earth has ever faced. Rising levels of CO2 threaten life on earth as we know it. It's very plausible that the antarctic and greenland ice shelves will break off within the next hundred years and the Earth's sea level with go up anywhere from 10 inches to 10 feet. This is enough to wipe out the homes of over a billion people and kill millions and millions of different species.
I would like to believe that earth has a built in control for rising CO2 levels. After all, the climate has shifted back and forth between ice ages and periods of warming for hundreds of thousands of years. How is this period of warming any different? It's very different because the level of CO2 is so far above where it has ever been on our planet. The highest concentration CO2 has ever reached is around 300 ppm. Then it drops off sharply and we descend into an ice age. We are currently about 370 ppm and still rising precipitously. The planet is already getting hotter, but we won't be in serious trouble until the ice shelves melt. Could be 50 years away, could be 20. My guess is that I will see it in my lifetime, unless significant changes are made to the way we obtain energy.
It's happening. It's time to wake up and do something about it before we alter our planet beyond recognition.
Friday, January 26, 2007
Duality
A recent comment on all the medical posts on this blog has inticed me to write about the duality of my life. When I was still a little kid in high school, I wanted to be an airline pilot. I loved flying and I worked hard to get my private pilot's license when I was 17. I went to college with the goal of getting through as fast as possible and moving on to a career in flying. While in college, I discoved my other passion for biological science. I don't like doing research or lab work, but I loved the classes I was taking in Immunology, Cell Biology, and Genetics. I also discoved that I love to teach. I got a huge kick out of explaining biological concepts to students, and I realized that the reason I really loved it was because I was using the knowledge that I loved so much to help someone.
Now I faced a dilemma. I loved biological science and I loved to fly. How do you sythesize those two passions into a career? My advisors and mentors would often say that I just needed to make a decisive choice and make the other a hobby. This may end up being true, but it feels like they're telling me to decisively cut off my right arm or my left arm. The ghost of the other arm will always be there. So I have decided to try to combine my two passions. The goal is to use aviation to transport me to places of medical necessity. A perfect day would involve me waking up early, flying to some rural clinic, helping as many people as I can, and then flying home. I may not make much money, but if I can do that every day, I'll be happy. Maybe I can throw a little teaching in there too.
"Just as we have two eyes and two feet, duality is a part of life."
Carlos Santana
Now I faced a dilemma. I loved biological science and I loved to fly. How do you sythesize those two passions into a career? My advisors and mentors would often say that I just needed to make a decisive choice and make the other a hobby. This may end up being true, but it feels like they're telling me to decisively cut off my right arm or my left arm. The ghost of the other arm will always be there. So I have decided to try to combine my two passions. The goal is to use aviation to transport me to places of medical necessity. A perfect day would involve me waking up early, flying to some rural clinic, helping as many people as I can, and then flying home. I may not make much money, but if I can do that every day, I'll be happy. Maybe I can throw a little teaching in there too.
"Just as we have two eyes and two feet, duality is a part of life."
Carlos Santana
Thursday, January 25, 2007
Bush's Medicine
George Bush has a new plan for health care. I love the Economist and I generally fall in lockstep with their writers and editors on most issues. Economics and politics are, after all, the most influential pursuits. I have yet to make up my mind if the troop surge is a good idea or not, but I just can't buy into George's vision of health coverage.
In 2003, the prez created Health Savings Accounts The idea was that people would be forced to pay for more routine, preventative care and smaller health expenses like prescriptions. This would lead to more price discrimination by consumers and drive the price of these services down. People would still be covered for catastrophic emergency procedures once the deductible kicked in at around $2000. I signed up for one, thinking it made the most sense financially, and agreeing that this is the way health care should be provided.
Then things start to run into trouble. I immediately developed a few small medical problems (Good old Murphy's Law). These were not things that required huge surgeries or other interventions, but I needed to see a doctor and get some drugs. I ended up with a bill around $500, which is a substantial amount of money for recent grad. This has lead me to not want to seek preventative care for anything. I don't even want to go to the doctor for my yearly checkup because that would cost me $200. This is fine for me because I'm young and relatively healthy, but what about poor people who just can't afford this type of savings account.
I imagine a family with two kids, two incomes, a house, and not much savings. They are living paycheck to paycheck, are able to pay for the insurance itself, but are unable to put much money in any kind of savings account, health or otherwise. They are still trying to pay back the expenses incurred while she was pregnant, and one of the children gets sick. He's been exhibiting a fever and crankiness for about four days now. The mom is really worried and wants to take him to see the doctor, but she knows that extra $200 will break their budget. They wait for a few more days and the child has taken a turn for the worse. He is now tired all the time, won't eat or drink, and still has a fever. They take him to see the pediatrician and he diagnoses the child with late stage bacterial meningitis. They rush the child to children's hospital and start agressive antibiotic treatment. They manage to fight off the infection, and the child recovers normally, but they blew through the deductible and now have several thousand dollars in medical expenses that could've been saved had the mother taken the child to see the pediatrician a few days earlier.
This type of situation is cropping up all over the place, and similar situations are happening to people who can't afford insurance at all. I understand Bush's desire to turn medicine into an efficient market where people pay for the services they receive, but it just doesn't work like that. The average consumer can't make informed decisions about health care like they can about cars or produce or movies. They have to see someone who has at least 11 years of graduate level training. Once they are informed about their diagnosis they can do a lot of research on the internet but getting that diagnosis requires years of training. And people are not the best judges of the consequences of their medical actions. I would bet the parents in the previous example had never even heard of bacterial meningitis before their son was diagnosed with it and had no idea that waiting a few extra days would cost them thousands more dollars.
So, with Bush's latest health proposal, I am understandably skeptical. He's basically trying to get rid of employer-based health care. Don't argue, you know that's what he's trying to do. This would free up a huge expense for a lot of companies and put the choice in the hands of the consumer. I have been both self-insured and on employer-based insurance and I can tell you for a fact that I am much more likely seek care when I am on employer health insurance than when I am self-insured. I don't want to pay $200 to go to a doctor when I may or may not be sick, but if someone else is paying the lion's share, then I feel better about seeking preventative care.
I guess the problem I have is that Bush is attacking the wrong factors inflating the costs of medical care. Bush is assuming that medical costs are skyrocketing because people are abusing their insurance coverage. If we make consumers feel a little price pain each time they go to the doctor, they will become more discriminating and prices will go down. What he doesn't realize is that prices are going up precisely because of that insurance coverage. There is so much waste in the medical insurance and billing bueracracies that doctors are forced to increase their prices just so insurance companies will continue to pay at the current level, otherwise their reimbursement would be dropping. These inflated prices are unattainable by the uninsured person. All that extra charge goes straight to the insurance company's bottom line.
We need to develop a system that promotes good medicine first and foremost, gets provided to the most amount of people possible, and then comes at a low price. The best medicine is preventative, a country as wealthy as ours should be able to provide care to everyone, and the price of not taking care of someone is too high. Attack insurers first, pharmaceutical and medical device companies second, and leave the doctors and other health care providers to practice their art.
In 2003, the prez created Health Savings Accounts The idea was that people would be forced to pay for more routine, preventative care and smaller health expenses like prescriptions. This would lead to more price discrimination by consumers and drive the price of these services down. People would still be covered for catastrophic emergency procedures once the deductible kicked in at around $2000. I signed up for one, thinking it made the most sense financially, and agreeing that this is the way health care should be provided.
Then things start to run into trouble. I immediately developed a few small medical problems (Good old Murphy's Law). These were not things that required huge surgeries or other interventions, but I needed to see a doctor and get some drugs. I ended up with a bill around $500, which is a substantial amount of money for recent grad. This has lead me to not want to seek preventative care for anything. I don't even want to go to the doctor for my yearly checkup because that would cost me $200. This is fine for me because I'm young and relatively healthy, but what about poor people who just can't afford this type of savings account.
I imagine a family with two kids, two incomes, a house, and not much savings. They are living paycheck to paycheck, are able to pay for the insurance itself, but are unable to put much money in any kind of savings account, health or otherwise. They are still trying to pay back the expenses incurred while she was pregnant, and one of the children gets sick. He's been exhibiting a fever and crankiness for about four days now. The mom is really worried and wants to take him to see the doctor, but she knows that extra $200 will break their budget. They wait for a few more days and the child has taken a turn for the worse. He is now tired all the time, won't eat or drink, and still has a fever. They take him to see the pediatrician and he diagnoses the child with late stage bacterial meningitis. They rush the child to children's hospital and start agressive antibiotic treatment. They manage to fight off the infection, and the child recovers normally, but they blew through the deductible and now have several thousand dollars in medical expenses that could've been saved had the mother taken the child to see the pediatrician a few days earlier.
This type of situation is cropping up all over the place, and similar situations are happening to people who can't afford insurance at all. I understand Bush's desire to turn medicine into an efficient market where people pay for the services they receive, but it just doesn't work like that. The average consumer can't make informed decisions about health care like they can about cars or produce or movies. They have to see someone who has at least 11 years of graduate level training. Once they are informed about their diagnosis they can do a lot of research on the internet but getting that diagnosis requires years of training. And people are not the best judges of the consequences of their medical actions. I would bet the parents in the previous example had never even heard of bacterial meningitis before their son was diagnosed with it and had no idea that waiting a few extra days would cost them thousands more dollars.
So, with Bush's latest health proposal, I am understandably skeptical. He's basically trying to get rid of employer-based health care. Don't argue, you know that's what he's trying to do. This would free up a huge expense for a lot of companies and put the choice in the hands of the consumer. I have been both self-insured and on employer-based insurance and I can tell you for a fact that I am much more likely seek care when I am on employer health insurance than when I am self-insured. I don't want to pay $200 to go to a doctor when I may or may not be sick, but if someone else is paying the lion's share, then I feel better about seeking preventative care.
I guess the problem I have is that Bush is attacking the wrong factors inflating the costs of medical care. Bush is assuming that medical costs are skyrocketing because people are abusing their insurance coverage. If we make consumers feel a little price pain each time they go to the doctor, they will become more discriminating and prices will go down. What he doesn't realize is that prices are going up precisely because of that insurance coverage. There is so much waste in the medical insurance and billing bueracracies that doctors are forced to increase their prices just so insurance companies will continue to pay at the current level, otherwise their reimbursement would be dropping. These inflated prices are unattainable by the uninsured person. All that extra charge goes straight to the insurance company's bottom line.
We need to develop a system that promotes good medicine first and foremost, gets provided to the most amount of people possible, and then comes at a low price. The best medicine is preventative, a country as wealthy as ours should be able to provide care to everyone, and the price of not taking care of someone is too high. Attack insurers first, pharmaceutical and medical device companies second, and leave the doctors and other health care providers to practice their art.
Monday, January 22, 2007
Single Payor
In Defense of Single Payor
Great, articulate, explanation of what a single payor system would look like.
I especially like the part exposing the middlemen involved in the health care system. Doctors, nurses, techs, paramedics, pharmaceutical companies and medical device companies should all be able to make a living from people's sickness because they are working to alleviate it. Wall Street brokers, insurance salesmen, and businesspeople should not be allowed to profit from people's illness. It's just wrong.
Great, articulate, explanation of what a single payor system would look like.
I especially like the part exposing the middlemen involved in the health care system. Doctors, nurses, techs, paramedics, pharmaceutical companies and medical device companies should all be able to make a living from people's sickness because they are working to alleviate it. Wall Street brokers, insurance salesmen, and businesspeople should not be allowed to profit from people's illness. It's just wrong.
Sunday, January 21, 2007
Crazy
Pilot dies after takeoff.
For the people unfamiliar with flying, there are safeguards against stuff like this. Military aviation has instilled a tradition that pilots are supposed to be the finest physical specimens humanity has to offer. Who else is going to survive the rigors of high G maneuvers while being able to spot an enemy airplane from 30 miles away? In reality, a pilot's judgement and experience are much more important determinants of safety than eyesight, but the military sticks to their guns.
In the civilian world, things are a little more lenient, but not much. In order to fly a powered aircraft, a private pilot must have a at least a third class medical certificate that is renewed every 36 months. A third class medical is an examination of a person's eyesight, hearing, reflexes, and mental acuity. In order to move into the realm of commercial pilot, a pilot must have a second class medical certificate which is renewed every 12 months. This is a slightly more involved examination that can have lab tests associated with it. Finally, to become an airline pilot, one must have a first class medical. This is an involved medical examination that can take several hours if it's the first time the doctor has seen the pilot. This has to be renewed every 6 months. That's right, airline pilot's are examined every six months by a doctor to see if there is any chance that something like this could happen. So the odds of this are pretty small.
I'm not even going to speculate on what might've happened. Condolences to the family, friends, and coworkers.
For the people unfamiliar with flying, there are safeguards against stuff like this. Military aviation has instilled a tradition that pilots are supposed to be the finest physical specimens humanity has to offer. Who else is going to survive the rigors of high G maneuvers while being able to spot an enemy airplane from 30 miles away? In reality, a pilot's judgement and experience are much more important determinants of safety than eyesight, but the military sticks to their guns.
In the civilian world, things are a little more lenient, but not much. In order to fly a powered aircraft, a private pilot must have a at least a third class medical certificate that is renewed every 36 months. A third class medical is an examination of a person's eyesight, hearing, reflexes, and mental acuity. In order to move into the realm of commercial pilot, a pilot must have a second class medical certificate which is renewed every 12 months. This is a slightly more involved examination that can have lab tests associated with it. Finally, to become an airline pilot, one must have a first class medical. This is an involved medical examination that can take several hours if it's the first time the doctor has seen the pilot. This has to be renewed every 6 months. That's right, airline pilot's are examined every six months by a doctor to see if there is any chance that something like this could happen. So the odds of this are pretty small.
I'm not even going to speculate on what might've happened. Condolences to the family, friends, and coworkers.
Friday, January 19, 2007
Brilliant Politics
Health Care Players Offer Plan for Uninsured
I first heard this story last here on NPR. At first I thought is was going to be another failed health care reform bill, but this sounds like the real deal. The number of disparate groups who have come together to get behind this proposal is astonishing. That alone lends it significant weight, but the really brilliant part about this proposal is the emotional weight it involves. The main thrust of the proposal is to get the large number of uninsured children in this country covered by basic health insurance. There is no way that any Senator or Congressman wants to have a vote against providing health coverage for children on their record. The only way people could kill this bill is in committee and I doubt the Democrats will let that happen. So, I think we'll see some significant health care reform pretty soon.
Aside from the political considerations, I can't figure out if this is a good idea or not. On the positive side, I want to see every kid covered. Kids develop so many preventable or easily treatable diseases that if left untreated could seriously scar them for life. Nobody wants to see that. On the other hand, a massive expansion of another social program is not what our government needs for the future. Within the decade we are going to be crushed by social security and medicare entitlements, and nobody knows where the money is going to come from for those. I am of the opinion that we should do the right thing and worry about paying for it later, but that kind of behavior can eventually come back to bite you pretty hard.
I first heard this story last here on NPR. At first I thought is was going to be another failed health care reform bill, but this sounds like the real deal. The number of disparate groups who have come together to get behind this proposal is astonishing. That alone lends it significant weight, but the really brilliant part about this proposal is the emotional weight it involves. The main thrust of the proposal is to get the large number of uninsured children in this country covered by basic health insurance. There is no way that any Senator or Congressman wants to have a vote against providing health coverage for children on their record. The only way people could kill this bill is in committee and I doubt the Democrats will let that happen. So, I think we'll see some significant health care reform pretty soon.
Aside from the political considerations, I can't figure out if this is a good idea or not. On the positive side, I want to see every kid covered. Kids develop so many preventable or easily treatable diseases that if left untreated could seriously scar them for life. Nobody wants to see that. On the other hand, a massive expansion of another social program is not what our government needs for the future. Within the decade we are going to be crushed by social security and medicare entitlements, and nobody knows where the money is going to come from for those. I am of the opinion that we should do the right thing and worry about paying for it later, but that kind of behavior can eventually come back to bite you pretty hard.
Monday, January 15, 2007
It's Official
I'm in!
This is where the dream starts. I got the notification last week that I have been admitted to one of my top schools. I get to join the elite ranks of people who call themselves "doctor." I get to be a part of the brilliantly broken system that is in place today and hopefully change it for the better, but more importantly, I will get the chance to change someone's life fundamentally for the better. If I can do that for even one person, then I can die knowing I lived a fulfilled life. And that's really what this is all about.
Maybe they'll let me fly occasionally too.
This is where the dream starts. I got the notification last week that I have been admitted to one of my top schools. I get to join the elite ranks of people who call themselves "doctor." I get to be a part of the brilliantly broken system that is in place today and hopefully change it for the better, but more importantly, I will get the chance to change someone's life fundamentally for the better. If I can do that for even one person, then I can die knowing I lived a fulfilled life. And that's really what this is all about.
Maybe they'll let me fly occasionally too.
