Tuesday, January 19, 2010

Aggregating Intelligence (DailyJava Forum), and The Demise of Sickcare

The new forum for oftwominds.com readers, DailyJava.net is now open for aggregating our collective intelligence.

Reader Dan K. has invested time, money and energy to bring the new forum to life: DailyJava.net forum. The forum (hosted offsite, reader moderated) can be read by anyone, but you will need to register (a quick process) to leave comments or start a new thread.

Fellow author and blogger Chris Sullins and I have posted some starting threads, and we welcome your civil participation.

My hope is that the forum will become a mechanism for aggregating our collective intelligence.

My standards of conduct and civility are simple: write as if you were facing other readers in person, unarmed and up close. Anonymity is not an excuse for incivility. Incivility has degraded our culture and society enough; joining this forum means you accept a higher standard.

The forum is the ideal place to share substantive ideas, links, tips, experiences and commentaries. My 2,000+ commentaries, stories and meanderings are already here on oftwominds.com; what would benefit us all is an aggregation of intelligences.

For a start: when you write me an email, why not post it on the forum as well? A huge number of interesting emails never get shared because I am simply overwhelmed by the hundreds of emails I receive every month. The forum enables great commentary to bypass my overloaded inbox.

There are roughly 5,000 daily readers of this site. If 5% frequent the forum from time to time, I think we'll have a lively and informative "gathering place" of ideas, solutions, links and commentaries.

As you probably know, one of my favorite sayings is "A healthy homecooked family meal and a home garden are revolutionary acts." Why is this so? The entire Survival+ critique and principles of prosperity are based on radical self-reliance and reciprocity. Removing fast foods, unhealthy prepared foods and agribusiness "factory food" from your diet is a way of taking control of your own life and health. In a society gripped by a pandemic of "lifestyle"-caused chronic diseases and a sickcare system careening toward inevitable insolvency, then taking control of your own food, cooking and health is far more revolutionary than carrying a sign around in a street demonstration.

To that end, What's for dinner at your house? has been updated with new recipes. In the frantic year-long effort to complete the 140,000 word Survival+, I neglected WFDAYH. No more; here is a delicious array of reader-submitted recipes:

Cod with sautéed vegetables & wild rice (Eugenio Minoli)

Corned Beef and Cabbage (Freeacre)

Cornbread Meatloaf (Bob Waldrop)

Three Bean Casserole (Constance Basset)

Split Pea Soup (Alberto Farinas)

Turkey Soup (Dustin Brace)

Rhubarb Salsa (Pam & Pat)

In other news, my gifted friend Mike Dakota has finally released his first CD.Click on the link to listen to some of his songs and buy a copy of the CD (or download it if you prefer).

I have good news for readers in the U.K. and E.U. countries: Survival+ is now available from a private bookseller via amazon.co.uk for 10.76 pounds (and 2.75 shipping) which compares favorably with the cost here in the States (10.76 GBP = $17.58 in USD).

Please note that amazon.co.uk does not stock the book itself, though I have requested they do so.

I have been unable to find an Australian bookseller which lists Survival+. I have tried thenile.com.au and bookworm.com.au without success. If any reader from Oz ever locates a local source for Survival+, I would greatly appreciate that information, as I can list their link on this site.


My feature article on AOL's Daily Finance, Is Fee-for-Service What Ails America's Health Care System?, attracted dozens of comments. Those from doctors and nurses describe how the current "sickcare" system is truly broken beyond repair.

J.D.W., M.D.

I just read your editorial about FFS medicine which is, as you mention, the predominant way medical care is paid for in the US. I am a physician, a hospitalist for the past 10 years, and have been in practice for almost 30 years. I could not agree with you more. The FFS system, and the entitlement mentality that it engenders, are powerful forces which cannot be controlled by minor changes – bandaids – to the system.

The root problem is a cultural one and will require a major shift in how Americans view healthcare, the commodity. Many, if not most, Americans are of two minds when it comes to this topic. They have a decidedly entitlement approach when it comes to their own healthcare or that of their family. But they have a much more capitalist view of healthcare for others, especially the (growing population of) disenfranchised. Americans are easily frightened by the spectre of socialism, the ultimate bogeyman, and they’re often told that any kind of national healthcare program would be an irreversible step in that direction. (Apparently, many people still don’t realize that one of our biggest national entitlement programs, Social Security, has a bad word in its title!)

You are also correct in saying that despite hundreds of mandates, guidelines and even price caps on various services, the medical community (hospitals and providers) can and do find ways to increase revenues. A great example of this, and how it actually increased total costs, is the use of endoscopies, like gastroscopies and colonoscopies. Several years ago Medicare, soon followed by private insurers, significantly cut the amount of money they would pay doctors who perform these procedures. They did this to cut costs, right? In actual practice, what happened resulted in significant increase in costs. Rather quickly after the decrease in reimbursement went into effect, doctors began doing more and more of these procedures. There are other reasons brought forth to explain this, e.g., changing guidelines in recommending screening colonoscopies, but I’m sure that most doctors who do these highly reimbursed procedures simply figured they had to do more in order to make up the lost revenue. That should be budget neutral, but if you look a little further you realize that these additional procedures also obligate hospital and facility costs, pre-operative testing costs, not to mention the costs associated with complications that can occur from these procedures.

These “unanticipated costs” are much more than the professional fees doctors could charge even before the reductions went into effect.

You mention another excuse for the rapid rise in healthcare costs: technology. That argument does carry some weight, but I immediately think of advancing technology in other areas like personal computers and communications. We have seen tremendous advances in things like pc’s and cell phones, as well as their availability, yet costs have actually come down for many of these products and services.

You may be right that the pending healthcare legislation will do little more than be an “expansion of the status quo.” I am truly of two minds about this situation. I feel that this country should have a national healthcare system of some sort, and continuing on our present course will lead to disaster. But I don’t think we Americans – or our government representatives – have the will to make, and put up with, the necessary changes to have a decent national health care program. Maybe someday....



Darlene F., FNP-BC

I enjoyed your Fee For Service article. I am a family nurse practitioner and I agree totally. But the hardest part is that the end result is that there will be rationing of health care. And believe me it has already started. I believe that it will be worse for the baby boomers because we have had the luxury of having medical treatment at our beck and call. And if costs get too high then the young, the sick and the elderly will die first. There is not one person in Congress who understand what is about to come because they all living in this moment. What happens when everything is just too expensive in health care, who will be the first to go?

A couple months ago one of my co-workers friends died of a massive heart attack. He worked in construction. He did not have insurance. He got sick at work and said he could not go to the ER because he had no insurance. He went to the bathroom and died.

So many of the patients who come in cannot afford medications. I try to use the Walmart list of $4 medications. And believe you and me, I use the same list when I go to the doctor. I once had a discussion with a drug rep. I asked why medications were so high in the USA and you can go to Canada and get meds cheaper. He told me first all pharmaceutical companies must recoup monies used for testing and research of new drugs. That was understandable but he told me that USA paid more because the other countries did not pay their fair share so USA pays.

There is so much wrong with health care in the USA. What has to happen for us to learn? And please forget Congress because by the time they figure it out it will be too late. Thanks for listening. I was just glad to see that someone really cares.



Cathy K., R.N.

RE: Perverse Incentives and a Government Doomed to Collapse(January 14, 2010)

"Patients have no incentive to maintain their health."

I think it is far worse than that. I think the perverse incentives in the system actively discourage patients who are seeking health.

Here's another story, how Vioxx saved my life.

Vioxx is a pain killer that was pulled some years ago after causing a number of cardiac illnesses and sudden deaths. Just after viox came out, I was prescribed this drug for pain related to my back by a specialist my family doctor referred me to. After two weeks on it, I started feeling kind of funny. I woke up one night unable to breathe and feeling heavy. I was a little blue around the lips.

I went to the doctor the next day and reported this incident. He asssured me it was anxiety and had nothing to do with the Vioxx. I assured him it was not anxiety and the Vioxx was going in the trash. He became quite apoplectic on the importance of me taking the Vioxx. This was when Vioxx first came out so maybe he was getting a kickback or maybe he didn't like uppity patients.

Anyways, I threw out the Vioxx along with the doctor and started a quest.

I was on seven other medications at that time. I looked up all their side effects and realized that many of my symptoms, notably my rapid heart beat and daily indigestion problems could be from the medications. I went to my family doctor and explained my new plan to get off all my medications, eat right, use nutritional support, lose weight and regain my health. She was not on my team. That would make me a noncompliant patient and endanger my treatment. Two other local physicans concurred.

Not taking the medications was not an option. They were probably afraid of lawsuits and are not trained to cure disease but rather trained to manage the symptoms with medications.

So I threw all the drugs away with the doctors, lost a hundred pounds, ate a healthy diet, and no longer have tachycardia or high blood pressure or gerd or multiple herniated discs or fibromyalgia or or gyno problems or chronic fatigue or anything. This was a two year process that was painful and scary on my own with research from the internet. In retrospect, with more knowledge under my belt as a nurse, it may have been actually dangerous. Now I would still do it, just wean myself off the meds instead of tossing them all at once. But, all's well that ends well.

The point I am making here is that not only does a patient have no incentive to maintain their health, the medical profession discourages health seeking behavior. Doctors make more money from patients on prescription drugs who have to come back to get their refills. Doctors make more money on patients with chronic disease. Prescription drugs treat the symptoms of chronic disease, they do not cure. Prescription drugs can also carry substanial risks and can cause the symptoms of chronic disease.

This is apparently one of those perverse feedback loops you go on about. Life style changes, diet, and the amazing human body can work together in sync to cure chronic disease. There is no money to be made from patients who come to that understanding. You are pretty much on your own.

This is ironic to me being a nurse now. I routinely pass meds to patients who take between 10 to 20 meds a day. Plain old common sense tells me there is no way that ten to twenty pills a day can be good for you. I would never voice this observation at work of course as that would be totally politically incorrect. And prescription drugs can be necessary and life saving. Many nurses get really upset with patients who refuse to take their medications and label them noncompliant and act as if they are children and attempt to berate them into taking the medication, I, however, because of my experiences, respect each persons right to choose what goes in their body.

I have a word for this now--medicalized. I was medicalized. I was fairly young when I injured my back. No doctor ever explained the common sense options available to me. They just literally piled on the meds and I thought the doctor knew best. The medications caused side effects and so I got medications to treat the side effects of the original drug. I did not understand this at that time. Many people I know are medicalized. It seems if you go to a doctor, you will walk out with a prescription. More than half my nursing class seven years ago were on antidepressants. I am sure over fifty percent of the population is on some sort of medication. With no drugs passing my lips, I feel positively un-American sometimes.

The American population is becoming medicalized. It is feeding an industry with far too much power. I don't want to be part of the food chain.

Thank you, readers, for these excellent insights into the sickcare system.

In case you missed yesterday's commentary on the stock market: Is The Stock Market Top In?


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