- 6/29/2017 9:55:46 AM
@T Sweeney: The only reason I brought up the idea of subsidized concierge care was as to provide a hypothetical example of an extreme. But you are right; the talk of concierge care in and of itself is another issue.
Regardless, I think it is fair to say that most everybody is well meaning here; after all, we all get sick and we all have known people who have had various maladies. It's all just methodology, interpretation of economics, and personal values.
- 6/28/2017 10:54:36 AM
All well stated, Joe... and we seem to agree on the major point: Access. Quality of care gets to be a quagmire, and it distracts from the larger issue of treating people who are sick or have life-threatening conditions. But the propriety and ethics of concierge care feels like a separate conversation. Obamacare took a run at baseline level care... if that can be improved on, great.
- 6/22/2017 11:48:50 PM
@Terry: Healthcare should of course be accessible at a certain threshold. As someone who sees and fully appreciates both sides, however, I think the issue that *is* fairly debatable is where and how that threshold is placed -- i.e., speaking as to free-market vs. socialized healthcare (vs., for that matter, the strange hybrid of the two that the ACA has created). I think the vast majority of us can agree, on the one extreme, that emergency rooms shouldn't turn away broke gunshot victims, and on the other extreme, that public money probably shouldn't be raised and expended so every single person in the world can have the kind of 24-hour top-level concierge care that normally costs someone hundreds of thousands if not millions of dollars a year (as nice as that would be, there would be (1) extremely high costs leading to extremely high taxes and (2) an enormous talent shortage in the medical field, with both factors, among others, meaning economic unsustainability).
I'm not sure if this figure is still true, but I remember about 7 years ago or so that if you discounted homicides and traffic accidents, the US had the highest life expectancy in the world -- speaking to the quality of our healthcare (as well as the nature of our transporation infrastructure, and our crime issues). IMHO, it is fairly debatable both ways, with compelling arguments on each side, as to whether or not that would be the case with a socialized healthcare system (a la Canada or the UK).
But then, that goes to the crux of the issue: access to healthcare -- which is very different from actually having good healthcare.
There's a big difference between getting in the door of the crowded nightclub and getting into the VIP room.
The other issue: doctors and healthcare organizations worried about malpractice liability -- meaning that tests and other diagnostic/preventative procedures (such as the procedure I had that was ultimately not strictly necessary -- except that there was no way to 100% determine that without actually having the procedure) get ordered much more frequently despite judgment or data analysis. (This is not to say I'm in favor of malpractice reform to curtail liability; I am decidedly not. But this is a very real issue.)
Fortunately, hospitals and other organizations are fighting the access-to-good-health battle on other fronts -- by doing outreach and offering nutrition education, evangelizing and facilitating exercise and other healthy habits, etc. I know a number of C-suiters at hospitals and healthcare organizations who stand by these programs as having among the biggest health impacts on a community.
- 6/20/2017 2:47:49 PM
In re "Technically, I could have done without [the expensive procedure] -- if I didn't mind the risks of doing without..."
And this is where the "Healthcare is a privilege, not a right" argument starts to break down for me. The least we can do as a nation or a collection of taxpayers is insist that something as basic as healthcare be accessible and affordable.
Staggering that we still have to have this conversation in 2017.
- 6/20/2017 2:44:35 PM
While tempting to blame the silo dynamic on technology, there's a cultural silo phenomenon as well that technology may not be able to break down easily (especially for municipal governments).
- by impactnow, Blogger
- 6/14/2017 12:18:39 PM
Lyndon, sadly its the US that is lagging in other countries transportation systems are so much more evolved and they are already smart. Our infrastructure has not caught up with the rest of the world and our residents are paying the price in higher priced commutes and longer commute times and ultimately a diminished quality of life.
- by Lyndon_Henry, Blogger
- 6/2/2017 5:59:15 PM
I think we're going to continue seeing silos all over the place. It will be quite a while before smart cities are the norm. Simple communications issues aren't often solved by digitizing so there's little hope for automation until we see a fundamental shift in thinking (and spending to make sure everything actually does communicate with every other system as intended).
I agree it will be quite a while for the totally wired "smart cities". Even public transportation systems haven't become totally "smart", although they're ahead of the pack.
Totally wired cities flourish in sci-fi films. In reality, not so much ...
- 5/31/2017 12:26:26 AM
@Seth: Tell me about it. Reminds me of a *very* routine medical procedure I once had that completely maxed out the deductible I had at the time!
Technically, I could have done without it -- if I didn't mind the risks of doing without.