The More Things Change...

I found an old photocopy of a book I read in college for my journalism class called "Breaking the News" and I'd copied the section health care reform. 

Here are some quotes that could have been written today, rather than in 1998:

"...the market for medical care did not operate in the same way as markets for imported cars, or houses, or anything else...the health care market differed from other markets in that people don't even do the paying themselves, at least not at the time they get the care. I n a perfect market situation, the purchaser will have free choice among many alternatives, he will have full knowledge about the selections and he will have an incentive to economize. In the medical market the customer often has non of those things...the patient is often the object of this process rather than a participant in it."

Sounds the same, right? Despite attempts to make health care more transparent, people largely make their decisions based on "is this covered by my insurance?" or more commonly, "I hope this is covered by my insurance...I guess we'll find out."

"Businesses were in a panic about medical expenses, and so were any public officials responsible for a budget. The United States spent twice as large a share of its national income on medical care as the average for other developed nations. The money bought the world's most advanced and high-tech treatment for certain maladies but it also left the US with a higher infant-mortality rate and a lower life expectancy than in other advanced societies."

Panic, check. Highest infant-mortality rate, check. Lower life expectancy, check. And we are still spending WAY more than other countries on health care: OECD data shows the U.S. spent 17.1 percent of its GDP on health care in 2013, 50 percent more than France and almost double the United Kingdom's spending. 

"The strongest argument for single payer is, strangely, that it would be anti-bureaucratic. The great administrative nightmare in American medicine is the need to keep track of dozens of reimbursement forms from dozens of insurance companies, each with its own rules about payment rates and authorized courses of care."

Bureaucratic nightmare? Yep. Possibly we've gone further in our agreement that routing health care through employers is a difficult way to cover stay-at-home parents, entrepreneurs and small business owners. So, as we look at the future of American health care...what can we expect? Surely, change. But what kind? Time will tell. 

The Emperor of All Maladies

The book, The Emperor of All Maladies by Siddhartha Mukherjee, was a rarity in it's history, breadth and insight into cancer. In fact, it's cleverly subheaded "A Biography" as if cancer is a single unit with an identity. I enthusiastically recommended it to people, who gave me odd looks I guess because why would they want to read a big book about cancer?

I'm surprised by how the film by Ken Burns and Barak Goodman changes the experience of consuming the information in a different way. Seeing the cancer patients is so much different than reading about them. The interviews with patients and doctors bring home so much more sharply how it feels to be fighting this beast. Like in episode two, a surgical oncologist undergoing surgery for breast cancer with her fellowship mentor. 

Another very effective use of film as a medium is the news clips. How we fight cancer has been controversial, and I think that is often overlooked. We might all want to cure it, but the road to get there has been full of misguided attempts and battles of ego. At one point, everyone thought things like high dose chemotherapy, radical mastectomies and deeper margins were the way to go -- basically overwhelming the systems to the highest degree possible without killing the patient. 

What I think is important about this history is that we need to look back and see that while our  knowledge was good, it was incomplete. Or it was based on bad assumptions. So, I see it as a call to look up, think differently and collaborate -- that's what's needed for us to move in one direction.