I recently produced a film, called "Money-Driven Medicine," based on the book of the same name by Maggie Mahar, which looks at the way that our business model for medicine has badly damaged the patient doctor relationship.
"What's that?" you may say. I thought that it was those damn government bureaucrats that were trying to get in between me and my doctor.
Well, the director of this film, Andy Fredericks, followed doctors all over the country who are deeply frustrated that the current system, whose goals favor profits over good, efficient and humane health care. In one scene, for example, a hospital refuses to share a possibly life-saving protocol with another hospital for fear it would lose its "competitive advantage." In many other sequences, doctors complain that, in the current system, they are forced to embrace wasteful and expensive (and extremely profitable) procedures while patients wonder why it is that they can quickly get expensive tests - like MRIs - but have to wait weeks to see primary care physicians (who are the most in demand) because so few doctors can afford to become general practitioners.
"Money-Driven Medicine" explores how a profit-driven health care system squanders billions of health care dollars, while exposing millions of patients to unnecessary or redundant tests, unproven, sometimes unwanted procedures, and over-priced drugs and devices that, too often are no better than the less expensive products that they have replaced.
More than two decades of research done by the Dartmouth Institute for Health Policy and Clinical Practice reveals that one out of three roughly one-third of our health care dollars - or nearly $600 900 billion of the $1.7 $2.6 trillion that we spend annually - is wasted on products and procedures that provide no benefit to the patient.
"But this isn't just a waste of money. This is hazardous waste - waste that is hazardous to our health," says Mahar, a healthcare fellow at the Century Foundation where she writes the healthbeat blog.
"When a patient is subjected to an ineffective treatment he is, by definition exposed to risk without benefit. We need to squeeze this waste out of the system. If we do, we have enough money to provide high quality, affordable and sustainable care for everyone."
Here's a clip from the film, in which Dr. Don Berwick, warns about the dangers of an unregulated competitive "war," in which, too often, the patient is "collateral damage."
In the days ahead, as insurance companies and pharmaceutical firms try to prevent any "government interference" in health care, it will be important to remember, that the goal of our health care system is not to reward providers; it is to deliver the best and most cost-effective health care to patients. Assuming that profit-oriented corporations always have patients' best interests at heart could be a fatal mistake.
The Trump Foundation mostly takes in other people’s money, but it appears it doesn’t have legal permission to solicit donations.
The problem with telling people to follow the money is they just might take you up on it. Donald Trump’s campaign has adopted that mantra in reference to the Clinton Foundation, but it applies to him in uncomfortable ways, too.
First, there’s the fact that he won’t release his tax returns, making it hard to follow the money and raising questions about what might be hidden there. Second, there are his forays into Cuba, apparently in violation of the embargo. Third, there’s the latest scoop from The Washington Post’s David Fahrenthold, who finds that the Donald J. Trump Foundation was operating without a required license.
As Fahrenthold previously reported, the Trump Foundation is peculiar: Unlike many other similar charities, it’s stocked with other people’s money. Trump himself has given barely any money to it since the mid-2000s, although he did direct income from places like Comedy Central to the charity, possibly without paying taxes on it. Instead, he has raised money from other donors, which he has used to, among other things, settle legal cases against him, all while basking in the glow of his apparent charity.
The Republican nominee doesn’t have many fans in the black community. But those who back him share similar personal and ideological characteristics.
Following a recent pickup basketball game in Connecticut, where guards are often let down in more ways than one, two black men made a confession to the group: They plan to vote for Donald Trump. One was a police officer who valued the Republican nominee’s support for law enforcement. The other’s vote was more against Hillary Clinton than it was for Trump—his way of expressing how upset he was with President Bill Clinton’s 1994 crime bill and for being stopped several dozen times for “driving while black.” As members of the most overcriminalized demographic in the United States, it’s unsurprising that law-enforcement concerns are central to these men’s politics. But that they’d arrive at supporting Trump for entirely different reasons is an interesting paradox.
An etiquette update: Brevity is the highest virtue.
I recently cut the amount of time I spent on email by almost half, and I think a lot of people could do the same.
I’m sure my approach has made some people hate me, because I come off curt. But if everyone thought about email in the same way, what I’m suggesting wouldn’t be rude. Here are the basic guidelines that are working for me and, so, I propose for all of the world to adopt immediately:
Best? Cheers? Thanks?
None of the above. You can write your name if it feels too naked or abrupt not to have something down there. But it shouldn’t, and it wouldn’t if it were the norm.
Don’t waste time considering if “Dear,” or “Hey” or “[name]!” is appropriate. Just get right into it. Write the recipient’s name if you must. But most people already know their names. Like they already know your name.
Lawmakers overrode an Obama veto for the first time on Wednesday. A day later, they already had regrets.
The enactment on Wednesday of the Justice Against Sponsors of Terrorism Act should have been a triumphant moment for Republican leaders in Congress. They had succeeded, after years of trying, in overriding a presidential veto for the first time and forcing a bill into law over the strenuous objections of Barack Obama.
But the morning after brought no such celebration for HouseSpeaker Paul Ryan and Senate Majority Leader McConnell—only pangs of regret.
“It appears as if there may be some unintended ramifications,” McConnell lamented at a press conference barely 24 hours after all but one senator voted to reject the president’s veto of the legislation, which would allow victims of the September 11, 2001 terrorist attacks to sue Saudi Arabia in U.S. court. On the other side of the Capitol, Ryan said that he hoped there could be a “fix” to the very law he allowed to pass through the House—one that would protect U.S. soldiers abroad from legal retribution that the Obama administration had warned for months would follow as a result of the law.
Despite an array of calculating tools, comparing financial-aid packages is still an incredibly dense and circular process.
As almost any parent of a high-school senior knows, figuring out the true college price tag is confusing. While the full annual sticker price can be as much as $60,000 or $70,000 at a private college and more than $55,000 at an out-of-state public college, experts say that many students will end up paying considerably less. Sizable merit and need-based aid packages take the sting out of those big numbers.
Students, however, typically have to wait until the spring, when their acceptance letters arrive, to learn the amount of those awards, making it difficult for families to effectively plan a long-term budget and posing significant obstacles for first-generation students who may not be aware of all the financial options.
After Andrea Wulf won the Royal Society’s highest honor for her book The Invention of Nature, a writer at The Guardian attributed it to a new fondness for “female-friendly” biographies among prize juries.
Last week, the Royal Society held its ceremony to honor the best popular-science book of the year. I was there, having had the good fortune to be one of the finalists for my recent book, The Hunt for Vulcan. I didn’t expect to win—partly because of my baseline pessimism, partly because of the strength of the competition, and partly because I had set out to write a kind of miniature, a brief book on a quirky topic. Whatever the reason, I was right: I didn’t.
The event itself was good fun. Each of the authors read a passage from their work; the head judge for the prize, author Bill Bryson, led us in a brief question-and-answer session, in which we compared notes on what moved us to write about science. Then came the moment of truth. Venkatraman Ramakrishnan, the president of the Royal Society, approached the podium, opened the envelope, and announced that Andrea Wulf had won for The Invention of Nature.
With the death of Shimon Peres, Israel has lost its chief optimist. And the prime minister remains paralyzed by pessimism.
The Book of Proverbs teaches us that where there is no vision, the people perish. The people of Israel, now bereft of Shimon Peres, will not perish, because survival—or, at least, muddling through—is a Jewish specialty. But the death of Israel’s greatest visionary, a man who understood that it would never be morally or spiritually sufficient for the Jews to build for themselves the perfect ghetto and then wash their hands of the often-merciless world, means that Israel has lost its chief optimist.
Peres was, for so many years, a prophet without honor in his own country, but he was someone who, late in life, came to symbolize Israel’s big-hearted, free-thinking, inventive, and democratic promise. Peres came to this role in part because he had prescience, verbal acuity, a feel for poetry, and a restless curiosity, but also because, gradually but steadily, he became surrounded by small men. One of the distressing realities of Israel today is that, in so many fields—technology, medicine, agriculture, literature, music, cinema—the country is excelling. But to Israeli politics go the mediocrities.
The Commission on Presidential Debates issued a cryptic statement acknowledging some audio issues Monday night.
After critics savaged his performance at Monday’s first presidential debate, Republican nominee Donald Trump alighted on several culprits: Hillary Clinton, the moderator, and especially his microphone.
The claim was met with some skepticism, but on Friday afternoon, the Commission on Presidential Debates seemed to confirm his claim, at least in part. The commission, which controls the debates, released a cryptic statement that reads in full:
Statement about first debate
Sep 30, 2016
Regarding the first debate, there were issues regarding Donald Trump's audio that affected the sound level in the debate hall.
We’ve called the commission to ask what that means, but have not heard back yet. Presumably, they are receiving dozens of such queries.
Terry Spraitz Ciszek, a homemaker in Fayetteville, North Carolina, talks about changing perceptions of women in the traditional economy and those who choose to leave their careers to raise a family.
For many women, the decision of whether or not to go back to work after having a child remains a fraught one. After all, returning to a job after maternity leave often means facing significant workplace challenges and even a decrease in earnings. On the other hand, there is also frequently a stigma attached to women who leave the workforce temporarily to raise their children or become long-term homemakers. Oftentimes, the decision for new mothers to rejoin the workforce can be seen as a reflection of the state of the economy. The number of stay-at-home mothers fell consistently for decades—from 49 percent in 1967 to a low of 23 percent in 1999—before bouncing back to 29 percent in 2012.
The ability for one parent to stay home, for kids or otherwise, is often viewed as a luxury of upper-middle class life. But even for the households that can afford it, the financial implications can extend beyond the loss of one steady income: A hypothetical 26-year-old female worker with a salary of $44,000 a year could lose about $707,000 in lifetime income ($220,000 in income, $265,000 in lifetime wage growth, and $222,000 in retirement benefits) from taking just five years off to care for a child.