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2013

Interesting headline is it not? What it really says is doctors are rushing to have a lower income. Don’t believe it. Back in the 1980s doctors rushed to HMOs, especially the individual practice association (IPO) type. They did this as a defensive mechanism to protect their interests and their income. I find no reason to believe things are different now. Contrary to popular opinion these doctors in Medicare ACOs will still be paid on a fee for service basis. They will be eligible for bonus payments if they save money. Is it in their best interest to save money? Time will tell. However, faced with the threat of having ones fees cut and faced with increased pressure from insurances companies, the perception of a Accountable Care Organization may be an attractive strategy.

You might find the full article of interest. There are not many of us around these days who remember the gyrations of health care over the last fifty years. After all, at one time second opinions and pre-admission testing was going to be our salvation. I’m thinking we are entitled to a hefty amount of cynicism.

From Forbes.com
Bruce Japsen, Contributor
PHARMA & HEALTHCARE | 4/27/2013 @ 12:30PM

Doctors Rush To Obamacare’s Accountable Care Approach
Nearly one in four doctors are in or planning to link with an accountable care organization within a year, a new Medscape study shows. AFP/Getty Images

The number of physicians participating in the emerging medical care delivery system known as “accountable care organizations” (ACOs) has tripled as the health care industry moves further away from fee-for-service medicine.

Filed under: Healthcare
quinnscommentary

He was strange, and I liked strange people. He invested in conversation and that’s how I knew he would probably get it. People who appreciate words usually get it. Now, pay close attention.

Sabino

One afternoon we were talking about time and how time is, essentially, a concept. Everything about time is a hundred-percent man-made, from the clock to the calendar and the idea of seconds and years. As we guessed at how the first person invented it, we tried to define time in terms of things that actually were rather than things that were supposed.

Are you still with me? If we were talking about, maybe algebra, we’d have to define unknown values in terms of something that is sure before we can go on. And that’s what we were trying to do. We were trying to prove the nature of time–something we weren’t sure really existed–by recreating it with parts that we were sure of. Parts like change.

Now, change is scientific. When we get down to the subatomic (or whatever the smallest unit is these days, I’m not sure) level, everything changes. There are poems going around saying that our bodies change completely every six months or seven years; and while I’m not sure if that’s absolutely true, the point of the matter is that everything moves. Even in an empty room, things happen. Dust gathers, air moves. I don’t know much about space, but my romantic notions of stars mean that I imagine space as changing and moving too. Everything changes.

Everything.

So he and I decided that time was nothing more than the unit at which change took place.

And we said what if, hypothetically, we could have a room where absolutely nothing moved? There was no air, dust and mold didn’t gather, atoms for some reason didn’t move, nothing breathed or grew old, and everything was incredibly and perfectly still. Would time exist in this little room?

Obviously, there was no way to make our little experiment happen. But we chose to believe that time didn’t happen in that room because change didn’t happen in that room. That was comforting because, within the expanses of our ignorance, we made believe a supposed impossibility. We made time stop existing, at least in theory. Or maybe just in our imagination.

Brandon Christopher Warren

Now, I split this train into two.

First: I know you probably aren’t reading this, M, but I want to pretend that you are. When you left, you didn’t say goodbye, but you did say you would be gone for two years. Well, it’s been two years. And I realize we never talked about how much change could happen in that much time. Or whether you would come back to see it.

I’ve changed. I bet you have, too. But you’re still the strangest person I know, although I’ve tried hard to find someone close. I wonder if you still don’t feel much. I still feel too much, and I remember you all the time, M. I’m sure you’ll get it. You always got it better than nearly anyone did. I hope that doesn’t change either, no matter how much time passes by.

Second: in a daydream, somebody asked me what I would like to do if I could stop time for a little while. I brought back this time-theory to mind and I decided I couldn’t answer that question because, as long as I’m still doing something, then time is still passing by.

Instead, I asked my daydream friend if feelings counted as change, as something happening, moving, or being done. Because if it didn’t, then that’s what I want to “do” with stopped time. I want to find the happiest, most important second of my life, and just pause. Thoughts won’t flow, feelings won’t change, nothing will interrupt to ruin it, and everything will just stay suspended in existence seemingly infinitely.

Friends, maybe that’s what forever really is. Maybe we won’t find “forever” in trying to make things last a long time, but instead in finding one second that is good enough and letting it hang in its place, unbothered by the ones that come before or after it. Maybe that’s it. I like that.

Filed under: Overthinking, People Tagged: change, friends, memories, personal, philosophy, time
Freshly Pressed: Editors’ Picks

Part of Obamacare imposes a penalty on hospitals for excessive re-admissions of Medicare patients. The idea is that hospitals need to do a better job preparing patients for discharge and also to provide better follow up after discharge.

There is considerable controversy over the program. Is it working, is it necessary, is it having an adverse affect on some hospitals, is follow up care the hospitals responsibility?

I don’t know the answers, but like most people I assumed patients were discharged appropriately and their doctor followed them from that point. Apparently, faith in the health care system is misplaced.

Read this excerpt from a letter to the editor in support of the program:

Supported by the right financial incentives, hospital leaders are organizing systems of care that didn’t exist before to help patients get the care they need after they leave the hospital.

Who knew financial incentives (penalties) could create new systems for health care?

Of course I am kidding, we all knew our blind faith in all aspects of the health care system were misplaced … didn’t we? Nevertheless, to think we are getting less than optimum care because there was no incentive to do so is scary stuff.

Just remember, if there are incentives to not provide care, there are just as strong incentives to provide too much care. Obamacare contains several programs to lower costs by changing how health care is delivered which means somebody is making less money. That may be desirable for both savings and better health care, but the real test is how those with less income compensate for the loss. Think about it.

Filed under: Healthcare, Medicare
quinnscommentary

Shared journals were an early form of social media, and the mass-media era may have been a historical aberration. These were two of the claims made by Lee Humphreys, a communications and media research at Cornell University, who gave a talk this week at Microsoft Research’s Social Media Collective. I agree with her on both counts, of course, though I would trace the sharing of journals back further, to the commonplace books of the 16th and 17th centuries.

Humphreys has examined in detail how people in the 19th century would share their diaries with visiting families and friends by reading aloud, in order to tell them what had been going on in their lives. She has also analysed the diary entries of Charlie Mac, a soldier in the American Civil War, which he copied out and sent home as letters to his family (and anyone else they wanted to share them with). Women in the 19th century, she suggests, kept journals as a way to be remembered, a form of self-expression and self-empowerment; it was only in the early 20th century that diaries and journals came to be seen as private documents. Today’s blogs and social-media updates therefore mark a return to a tradition of social sharing of personal writing. One consequence of this argument is that it undermines the notion that today’s social-media users are self-obsessed to a historically unprecedented degree. It also highlights the fact that social media is not a new phenomenon.

In my forthcoming book “Writing on the Wall” I make a similar argument about an earlier form of journal, the commonplace book. This was a kind of scrapbook, popular in the 16th and 17th centuries, into which people would copy items of interest to create a personal trove of valuable information. Commonplace books that survive from the Tudor period contain a huge variety of texts, including letters, poems, medical remedies, prose, jokes, ciphers, riddles, quotations and drawings. Sonnets, ballads and epigrams jostle with diary entries, recipes, lists of ships or Cambridge colleges and transcriptions of speeches. Collecting useful snippets of information so that they could be easily retrieved when needed, or re-read to spark new ideas and connections, was one of the functions of a commonplace book. But the practice of maintaining a commonplace book and exchanging texts with others also served as a form of self-definition: which poems or aphorisms you chose to copy into your book or to pass on to your correspondents said a lot about you, and the book as a whole was a reflection of your character and personality.

People would sometimes lend their commonplace books or miscellanies to their friends, who could then page through the entries and copy anything of interest into his or her own book. The similarities and overlaps between several manuscript collections compiled at Oxford University indicate widespread sharing of both individual texts and entire collections among students and their tutors, for example. Like internet users setting up blogs or social-media profiles for the first time, compilers of commonplace books seem to have relished the opportunities their newfound literacy gave them for projecting a particular image of themselves to their peers. Only a minority of the texts that people circulated were original compositions; most material was quoted from other sources. The same is true of modern social-media systems: posting links and snippets found elsewhere is standard practice on blogs, Facebook and Twitter, and on some platforms, such as Pinterest and Tumblr, more than 80% of items shared are “repins” or “reblogs” of items previously posted by other users. Then as now, people enjoy being able to articulate their interests and define themselves by selectively compiling and resharing content created by others. The mere act of sharing something can, in other words, be a form of self-expression—something that was as true centuries ago as it is today.

(Picture credit: Commonplace book from the James Marshall and Marie-Louise Osborn Collection, Beinecke Rare Book and Manuscript Library, Yale University, via Flickr)

Freshly Pressed: Editors’ Picks

Great Guns (Photo credit: Wikipedia)

From the WSJ front page April 4, 2013

Arkansas eliminated prohibitions on carrying firearms in churches and on college campuses. South Dakota authorized school boards to arm teachers. Tennessee passed a law allowing workers to bring guns to work and store them in their vehicles, even if their employer objects. Kentucky shortened the process for obtaining licenses to carry a concealed gun.

One group says there is a clear link between liberal gun laws and violence, another says there is less crime when people are allowed to carry guns.

I am hooked on the History channel series Vikings. They all walk around with swords, knives and axes to protect themselves from the other Vikings who walk around with swords, knives and axes. In one episode a women nicely gutted another Viking who tried to rape her and was promptly accused of murder… she got off, sort of. A relative’s vengeance resulted in her village being obliterated. The good news is she saved her swords, knives and axes. All this was in the 10th century.

It is clear we have made a great deal of progress, at least with the type of weapons we carry to school, church and work.

Forget for a minute whether there is a right to carry a gun, heck I’ll even assume there is. Let’s talk about the social environment, the psyche if you will, that causes Americans to feel the need not only to be armed, but to accumulate multiple firearms for self protection. Is that truly the state of the American society?

The pros and cons read one review: http://fair.org/home/the-self-defense-self-delusion/

To assess the benefits and costs of pervasive gun ownership—there are currently 300 million firearms in the U.S., and roughly 80 million gun owners (CNSNews.com, 2/4/13)—it’s useful to compare the self-defense numbers to the gun crime numbers.

The National Institute of Justice reported that in 2005, “11,346 persons were killed by firearm violence and 477,040 persons were victims of a crime committed with a firearm.” Or, to put it in starker terms, the FBI’s Crime in the United States report for 1998 found that for every instance that a civilian used a handgun to kill in self-defense, 50 people lost their lives in handgun homicides.

With a gun murder rate about 20 times the average of other industrialized countries (Washington Post, 12/14/12), it’s hard to argue with Hemenway’s conclusion (Harvard Injury Control Research Center, “Homicide”): “Where there are more guns, there is more homicide.”

A New England Journal of Medicine study (10/7/93) in 1993 concluded that a gun in the home raised the chances someone in a family will be killed by nearly three times, with the danger to women—who are more likely to be killed by a spouse, intimate or relative—even greater. A 1997 study in the Archives of Internal Medicine (4/14/97) reinforces that danger, finding that the homicide risk for women increased 3.4 times in a home with one or more guns. Taken together with the heightened risk of suicide and accidental deaths posed by guns in the home, these numbers demolish the argument that guns enhance family protection.

Based on the above statistics, there is a 0.15% chance of being a victim of a crime committed with a firearm.

Related articles

• 12-year-old accidentally shoots, kills 14-year-old brother: Another example of gun culture run amok (thegrio.com)

Filed under: Pure Opinion (That’s mine, by the way) Tagged: Gun control
quinnscommentary

From the LA Times May 2, 2013

California Insurance Commissioner Dave Jones said the nation’s largest health insurer, UnitedHealth Group Inc., is imposing unreasonable rate hikes on about 5,000 small businesses.

Jones said Wednesday that UnitedHealth couldn’t justify the average annual increase of nearly 8%, which reflects both higher premiums and a reduction in benefits. He said the rate hike, which went into effect Wednesday, affects up to 45,000 small-business employees and dependents and represents .5 million in higher costs.

“At a time when small businesses are struggling to survive, UnitedHealthcare’s rate increase is just one more unwarranted economic burden on California’s small business owners and their employees,” Jones said.

UnitedHealth, based in Minnetonka, Minn., said it was “disheartened” by Jones’ comments and that the average annual increase for these customers is less than 2%.

Looking at this objectively and reading the sentence I placed in bold, can you see any logical connection between a rate increase of any size and the assertion that small businesses are struggling? In fact, there is no connection between the two. If there were, then the same logic would apply to every expense these businesses incurred. If in fact the proposed rate increases were “unreasonable” or “unwarranted” the employer could switch carriers as they would with any supplier, but that is not the real point.

The point is that as long as we allow politics and inflammatory rhetoric to set policy we are never going to solve the health care cost problem. Insurance companies need to make money, but they are not stupid, they don’t arbitrarily raise premiums that attract political and customer ire, especially in today’s climate.

Premiums are going up because health care costs are going up and because the Affordable Care Act significantly increases costs for those organizations providing coverage and paying the bills be it a self-insured employer or an insurance company … and that’s the truth.

You know, living on a fixed income I don’t think the increase I just received in property taxes is warranted. Do you know a politician I can talk to?

Filed under: Healthcare, Politics
quinnscommentary