John T. Rowe, MD

Health Care Spending

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Health Care Spending:  A Few Inconvenient Truths

          As we look into new ways of ensuring that all Americans have access to affordable health care, there are a few inconvenient truths that must be taken into account.  Carolyn Johnson recently reported in The Washington Post, that ‘the top 1 percent of health-care spenders use more resources, collectively, than the bottom 75 percent’.  Or, looking at the data another way, ‘the bottom half of spenders all together rack up only about 3 percent of overall health care spending’.  So, in moving forward with health care reform we must recognize this decades long pattern of health care expenditures in the United States.  In short, a small percentage of us account for the vast majority of healthcare spending, while most of us use minimal health care resources and are well satisfied with the care we receive.

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Earbuds and Hearing Loss

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Earbuds Can Cause High Frequency Hearing Loss

           Each generation has its own brand of music and its own way of listening to it.  Over the years we have evolved through the record turntable, transistor radios, boom boxes and now the ubiquitous earbuds and headphones.  The one thing that has remained constant from one generation to the next is the volume, where it has always been ‘the louder the better’. 

          The current ‘plugged-in’ generation can now tune out their parents, their teachers and even their friends for most of the day as they isolate themselves from the world.  While this in itself poses significant social dangers, there is also a serious physical danger to be considered.  One in six teenagers now has high frequency hearing loss due to listening to loud music through headphones. 

          As a result, the American Academy of Pediatrics now recommends that adolescents should be screened for hearing loss three times between the ages of 11 and 21 years.  When using earbuds, the volume should be low enough to be able to hear conversations ‘out in the real world’ and others should not be able to hear any noise coming from the earbuds. 

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The Health Care Debate

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Health Care: A Right or a Service?

          As we contemplate how to disentangle ourselves from the Obamacare debacle, here are a few thoughts and questions to consider from a physician’s perspective.  First, we must decide whether we believe that health care is a right or a service.  If health care is a right, then isn’t legal assistance also a right?  Shouldn’t all lawyers then be nationalized as well?  If health care is provided by the federal government, will it just become another method of income redistribution as it has been for Medicare?  Many do not realize that the amount seniors pay for Medicare goes up as income goes up.  Will the revenue collected for any national health care program just become another pot of money that can be dipped into for other unrelated expenditures as it has been for Social Security?

Nationalized Health Care and the National Debt

            In 2008 the National Debt was $10 trillion.  By 2016 it had doubled to $20 trillion.  Whichever way we go on the health care issue, it must be compatible with a substantial lowering of the national debt.  The preexisting condition provision must be strictly regulated in order to make any health care system fiscally sound.  Enrollees must begin making contributions to the plan as soon as they ‘graduate’ from their parents’ plan at age 26 and they must maintain continuous coverage throughout their lives to be eligible for benefits.  Allowing someone to receive health care benefits at the last minute would be akin to buying insurance for your home after the fire starts.  The Affordable Care Act purportedly covers 20 million individuals, a figure which is thought to be an overestimation.  Assuming that it is correct, then this poorly conceived plan covers only 6% of the current U.S. population of 325 million.  Would it really be that difficult to transition these folks by attrition back to a well-regulated free market based healthcare system that includes assistance for the needy?

Do We Really Need Nationalized Health Care?

          In 2008 the United States had the best medical care in the world.  Anything we do now must at least restore health care to that same high level of service.  Before the inappropriately named Affordable Care Act, few citizens of the United States went without health care.  Laws mandated that everyone, regardless of their insurance coverage or financial ability, be seen in emergency rooms.  Many low income families were cared for in city and county hospitals located right in the neighborhoods where they lived.  Many of these public hospitals are affiliated with medical schools and teaching programs where eminent professors of medicine made daily rounds on these patients.  Were these folks any better off under Obamacare?  All things considered, one has to wonder what the motives were behind this ill-conceived dalliance with socialized medicine.  Fortunately, we now have the opportunity to reclaim our world class system of medical care.

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Doctors Burdened with Regulations and Paperwork

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Doctors Spend Half Their Day Doing Desk Work         

          I recently had a routine preventive medicine check-up and was pleasantly surprised when my doctor sat down directly facing me while he took a detailed history.  He then did a thorough examination after which he discussed his findings before asking if I had any questions.  This young physician who I was seeing for the first time did all this in a manner which made me feel like I had his undivided attention, even though I knew he must be very busy.

          This is the way I was trained to ‘see’ patients, but, unfortunately, all too often health care providers now sit facing a computer while they take the history and then do only a cursory examination.  Physicians are not to blame for this change in how medicine is practiced.  All this has come about because health care providers are overwhelmed with regulations and are under constant pressure to cut costs.  Other factors that contribute to this shift away from doctor-to-patient ‘face time’ include the transition to electronic medical records,  the need to practice defensive medicine due to fear of frivolous malpractice law suits and the additional time that now must be spent answering patient concerns raised by ‘Dr. Google’.

          In an article published this month in Annals of Internal Medicine, Christine Sinsky, et al. describe the results of their study on ‘Allocation of Physician Time in Ambulatory Practice’.  They found that physicians spend just a little more than one quarter of their day with patients and almost half of their day doing desk work, which includes working on electronic health records.  According to this study, a physician spends a significant amount of time doing office work even while in the exam room with the patient.  Of course, all of this leads not only to patient dissatisfaction, but physician burnout as well.  With major changes in health care looming on the horizon, this would be a good time to reassess how health care is delivered, including how doctors and patients interact.   

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Discipline for Children

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How to Say, ‘No!’  Discipline for Children

          In this age of indulgent parenting I thank God every day that my parents were strict and did not try to be my best friend.  They were firm, but always loving.  They knew their role as parents and always worked as a team, supporting one another in carrying out the difficult job of child-rearing.  I was truly blessed to have such wonderful parents and I only wish that every child in this world was as fortunate.  The result of my folks’ common sense parenting was having two happy, well-adjusted adult children who enjoyed their company throughout the years.  I wanted to share this video that reflects my parents’ philosophy of raising children, which I think is particularly prescient in light of what’s been going on lately at some of the college campuses in our country.

 

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