Atul Gawande on the importance of preventative care and the disastrous Senate "health" bill

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So let’s have Medicaid for everybody. By imposing Medicaid’s payment structure on doctors, clinics and hospitals we can cut costs by 40 percent overnight. I’m sure they can all easily whack that amount out of their budgets.

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This Administration isn’t failing that test. They are knowingly and deliberately peeing on it because they have been bought by the ultrarich and they are determined to give good financial head to their corporate puppet masters because they think they will be rewarded for it, and the literally could not care less how many Americans they kill or cripple doing it. It may not be quite yet time to vote from the rooftoops, but it is time to pick a rooftop and learn the best route to it.


It’s not surprising why the Patient Protection and Affordable Care Act is so disliked among people of means. Preventative care in the form of a trip to the doctor costs about the same as the surf and turf at the local chop house or a good beaujolais. Never mind that’s a week’s wages for the masses.


That must be why the AMA and AHA are such vocal advocates of Trumpcare…oh, wait, they are opposed to it. Huh. They must like bankruptcy…or your oversimplified analysis is oversimplified.


Simple solution isn’t perfect.

So let’s do nothing?


Trolls gonna troll; not provide any useful input.


Better yet, how about Medicare for everybody?


ETA: Here


Well, the opposite of doing nothing is the state doing something, and a Libertarian can’t have that, nosirree.


Are you referring to me?

Right - the market’s had seventy years for the invisible hand to work things out. The state had 5 or so years (with overwhelming opposition from half the elected part of government) and it wasn’t immediately perfect, so obviously that’s been a dismal failure.

Let’s go back to the “market” to work things out - maybe Travis Kalanik can disrupt healthcare same as he’s disrupted taxis and ethical behavior.


Here’s how a friend recently described his experience of preventative care in a civilised country:

  1. Goes to doctor every year for a checkup. Shows health card as “payment.” No private insurance companies to deal with for either doctor or patient.

  2. Last checkup, at age 50, asked doctor if he should finally get stress echocardiogram because of family history of heart disease. Doctor said ok and set up a referral at the lab of the doctor’s choice. Beancounter at insurance company does not second guess doctor.

  3. Makes appointment, goes to lab, gets tested on state-of-the-art imaging equipment. Shows health card as “payment.” No private insurance companies to deal with for either doctor or lab.

  4. Labs come back, doctor calls him back in because of slight abnormality. “Payment” for appointment as in Step 1, above. Doctor provides non-urgent referral to cardiologist that the patient researched and requested.

  5. He makes the appointment with the specialist in a month’s time. Cardiologist’s office does not ask for health insurance.

But yeah, these situations end up so much better when the bad ol’ state isn’t involved, as is the case in The Land of the Free.


“But with socialized medicine he might have to wait” I am always told.

How long are people with no health insurance at all waiting to see a doctor? Even those of us with insurance avoid the system whenever we can because of the deductibles, the gotcha charges, the paperwork, all of the bullshit - and as a result we have health outcomes some developing countries would be ashamed of.

So many great things about this country, but jesus christ, this complete blindspot around healthcare is fucking crazy.


Unless one is wealthy, one also has to wait in the U.S. My friend says that you probably have to wait a bit longer than you would in the U.S. to see a specialist, but if it’s urgent you’ll be fast-tracked according to a standard triage system.


Triage is French for Communism!

The system we’re headed for is one where the truly deserving all have their own private doctors, and the 99% can visit the Free Clinic, and yes, the waiting list is several years long, and their budget has been cut to the point of sharing tongue depressors. But at least we don’t have to wait like those Socialist countries!


Nope, not all.


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It’s like a perverse version of Stalin’s (apocryphal?) quote: “a single death is a tragedy; a million deaths is a statistic.”

Four hundred is a number you can get your head around. You could meet them all in an afternoon, and invite them all over for a BBQ. Hell, the four hundred highest earners throw weddings with more people in attendance. Most of them have probably been to each other’s weddings, and the weddings of their kids.

But three-quarters of a million? Eh. That’s too big. I don’t know those people, therefore they aren’t really real. And things that aren’t real can’t really be harmed. So an impossible harm balanced against a tangible benefit? That’s a no-brainer.


And how does the current GOP plan of cutting taxes on people making over $200,000 and making the people who have no money pay higher costs actually fix the problem either?