Thursday, January 12, 2017

Future Ins and Outs

I have been reading, watching, and listening to progressive deep thinkers, heavy social breathers, and alarmed liberal hysterics.   
Collectively, they seem to think the end of the earth may not be near, but you can see it after the Trump election.

These critics believe sun, wind, tide, and bio-based sources of energy are in, and fossil fuels,  fracking,  an drilling for oil are out.  Globalization is in, and nationalism are out.  Collaboration across the social spectrum is in,  and individualism and entrepreneuralism  and taking advantage of economic opportunities is out.   Waste is in and recycling is out.

According to these critics,  Trump and his followers believe(Peter Senge, The Necessary Solution: How Individuals and Organizations Working Together to Create a Sustainable  e World,   Trump et all have these unsustainable beliefs.

·       Energy is infinite and cheap.
·       There will always be enough room to dispose of our waste.
·       Humans can’t possibly alter the global environment. Weather patterns will remain stable no matter how we act.
·       Basic resources such as water and topsoil  are unlimited. If limits or problems are encountered, markets and new technologies will reallocate financial resources so we can continues with our current ways of living and working.
·       Productivity and standardization are keys to economic progress.
·       Economic growth and rising GDP are the best way to “lift all boats and reduce social inequities.

Another deep thinker,  Thomas Friedman, of the New York Times, says larger forces  - Moore’s Law (microchips will double in efficiency every 2 years), globalization (interconnections and interdependence secondary to the Internet), an Mother Nature (climate change and biodiversity loss) are accelerating and will either save us or destroy us.   He says since 2007 we have been changing fast because of Iphones,  advances in silicon chips, software, sensors, and networking, and these forces are transforming society irreversibly.

In health care, critics maintain, only collaboration  between government and NGOs (nongovernment organizations) will save us from our follies/  The solution will require collaboration in the form of accountable care organizations,  medical homes, integrated health organizations,  bundled pricing, and measures of improvement tied to  physician and hospital reimbursements, and universal care. Universality in care will lead inevitably to learning organizations, and the use of artificial  intelligence4  and elegant algorithms that will supplement and supplant clinician experience and intuition  and interpretations.   For example,  artificial intelligence and algorithms will replace interpretation s of radiologists and pathologists to interpret images on ex-rays and slides.

All will be well and better in health care if we oly listen and heed the Big Thinkers.  aim for universal coverage, erase social injustices,   achieve standardized outcomes, and collaborate across all health care spectrums.

If other words, if only we defy human nature and level all playing fields,  we will have harmonious outcomes. 

Friday, January 6, 2017

End of ObamaCare and Mortality Deadline

 J.Oberlander, PhD, a health expert at the University of North Caroline, has ana article in the January 5 New England Journal of Medicine.  It is entitled "The End of ObamaCare."   Oberlander says that with the Trump election, ObamaCare is dead and awaits Republican replacement.  In his concluding paragraph. he says, :The ACA's enactment represented a major toward making health  care a right in the United States. Now after another landmark election, health care reform in the Untied States is headed backward."

This is his opinion and is not shared by the majority of the American public, who, in over 95% of polls disfavored ObamaCare because of its failed promises, spiking premiums, unaffordable deductibles,  and narrowing of choice of doctors, hospitals, and health plans.

Another reason may be the ACA's ineffectiveness in improving the health of the majority of Americans.   The latest evidence of this is the Center of Disease's announcement that the average mortality of Americans declined from 7,89. to 78.8 years in 2015,  the first such drop in living memory.  This decline occurred after 7 years of ObamaCare, whikch was designed to achieve a triple
aim- better health, lower premiums, and enhanced collaboration between health care providers.

What's going on? According to the CDC, the spike in death rates and the decline in mortality is due mostly to obesity (35% of us are obese) and its aftermaths - diabetes. heart failure, and strokes, and to the opioid and heroin epidemic (30,000 deaths in 2015).

These deaths are not necessarily due to ObamaCare, but to cultural factors - overeating carbohydrate-rich diets, lack of exercise, and to economic despair secondary to a slow growth economy, and over-reliance on opioids and cheap heroin to treat pain.tes or regulate health in the face of a slow economy, and ats attendant poverty, social disarrage and violence,  paritisan political divisons.  Nor does enhanced coverage of health care form 20 million SAmericans necessarity ensure better health. lower death rates, or collaboration between health provides.  Health care coverage is not the same as increased access to care , in face of reluectance of doctors to accept more Medicare or Medicaid patients,  unaffordable premium, , co-pays, and deductibles.