Catastrophic Care – How American Health Care Killed My Father – And How We Can Fix It

Catastrophic Care – How American Health Care Killed My Father – And How We Can Fix It

By

David Goldhill

Infections from a hospital stay killed David Goldhill’s father in 2007, one of more than 200,000 deaths annually caused by medical error.  The medical bill was huge and fully paid by Medicare.  David wanted to know why it happened and why a business was paid after such a colossal error.  This would not happen in a market driven business.  This book is the result of Mr. Goldhill’s quest for answers.

The major premise of Mr. Goldhill’s book is that the patient is not the customer.  The actual customers are what he calls “surrogates” and these are private insurers, Medicare and Medicaid.  All of these are institutions begun with the best of intentions that have grown into unwieldy, inefficient behemoths over the last 45 years and have established a culture in our Health Care arena that is going to be difficult to change.

Originally, health insurance was in place to take care of “catastrophes” and not the common cold or the equivalent.  We have turned an insurance into a “payment mechanism” over the years.

The “surrogates” have become the consumers and are driving the market. They are profit driven, not market driven and have created a 3rd party administration that continues to drive up the price of health care and not the efficiencies.  The “Surrogates” along with the pharmaceuticals operate with a unique set of rules and, ironically, the higher premiums are, the higher the profits.  Medical costs go up [not down as in true competition], premiums go up, profits go up, and the true consumer [the patient] suffers from increasing costs.

In a true market scenario, prices drop and things become better and/or more efficient.  The most obvious analogy is computers.  The first laptops were thousands of dollars; you can now buy a better one for about $350.00.  Lasik surgery and most cosmetic surgeries prices drop because of competition.  Why?  They are not covered by insurance, thus no surrogates.

We, as the patients, have come to accept the status quo.  We go crazy when a gallon of gas rises by 10 cents, however, just accept the fact that medical procedures continue to escalate because the surrogates are in control and we are just paying the deductibles.  The surrogates benefit from rising prices.

So, what about the Affordable Care Act [Obamacare or ACA]?  More of the same.  We need to create a new system that is not procedure driven, is a true marketplace and is driven by the true customer, the patient.  This will take a minimum of a generation; however, it can be done.

Mr. Goldhill presents a possible scenario that places the patient in control and promotes transparency in costs in the medical field.  His suggestion is a combination of a very high deductible in true catastrophic insurance, health accounts and health loans.  I am not sure if that is the answer, but he presents a convincing argument and makes it very clear that the present situation in health care is unsustainable.

My suggestion is that you read this well-written and well researched book and get your legislators to do the same.  Thanks to Mr. Goldhill for presenting such a well articulated case in a tremendously complex situation.

Thanks for reading,

Mike

Salt, Sugar, Fat: How the Food Giants Hooked Us

Salt, Sugar, Fat:  How the Food Giants Hooked Us

By

Michael Moss

Obesity, processed foods, marketing to kids, etc. are almost daily news today as we face a health epidemic, not just an obesity epidemic.  The food giants, large corporations have made it a science to lure the public, with a huge emphasis on children, into eating cheap, convenient, unhealthy foods.  Mr. Moss has done an excellent job of describing how these corporations have knowingly spent and made billions of dollars on these efforts and are hugely responsible for today’s health epidemic.

On April 8, 1999 representatives from Pillsbury, Kraft, Nabisco, General Mills, Procter & Gamble, Coca-Cola, Mars and Cargill met in Minneapolis to discuss the burgeoning obesity epidemic and what they should do about it.  Together these companies represented 700,000 employees and $280 billion in annual sales.  The presentation which was conducted by a representative from Kraft explicitly portrayed the obesity epidemic and why they as corporations were largely responsible and how they could now help correct it.  A well intentioned effort, however, it all came to naught because of the voice of one man, Stephen Sanger, the head of General Mills at that time.  Sanger was “the man” in those circles and no one defied him.  Thus, it was back to “business as usual” and they continued to pour billions of dollars towards the health epidemic we have today.

Who has heard of the “bliss point”?  This is a measurement largely credited to a man named Howard Moskowitz.  Howard is the guy employed by the U.S. Army who added sugar to Meals Ready to Eat (MRE’s) to make them more palatable to our service men and women.  From there Howard became a key player at General Foods and Phillip Morris and discovered the “bliss point” which is the precise amount of sugar or fat or salt that will snare the consumer.  By adding these cheaper, addictive ingredients instead of costlier, healthier ingredients Phillip Morris and company were able to pump up the value of their stock.

Consider Betty Crocker who is a fictional character invented by General Mills for the sole purpose of marketing their unhealthy, processed and refined foods.  Legions of women were hired to go out and give cooking classes in the name of Ms. Crocker which included recipes all containing the products of General Mills.  Ms. Crocker’s cookbooks have become a part of Americana lore.

It was determined by laboratories funded by these corporations that babies do not like salt for their first 6 months of life.  Strategies were invented and implemented to train these babies to “like” salt.  Many of those babies today are either dead from or suffer from hypertension.

I could go on and on; however, I’ll save that for Mr. Moss who has written an excellent eye-opening book.  I must close with Mr. Moss’s message, though…

We are in control!  Yes, we have been the victims of unfair marketing; however, we are the ones operating the knives and forks.  In the transparency of today, we must arm ourselves with the knowledge of healthy vs. unhealthy foods and use a little will power.  After all, when it all trickles down, we are the ones buying the foods and contributing to today’s and tomorrow’s health epidemic.

Thanks for reading,

Mike

The Creative Destruction of Medicine

The Creative Destruction of Medicine

By

Eric Topol, M.D.

Dr. Topol has written a book describing the effects of today’s “digital revolution” on our medical culture.  This revolution is driving “collaboration and crowd sourcing”, “customized consumption”, “cloud computing”, and “constant connectivity”, what he refers to as “the C’s”.  The C’s drive us to one of the “D’s”, “data driven culture”.

Traditionally, pharmaceutical companies have tested drugs by “population based” trials, which, in their most accurate form are terribly inaccurate.  In its most simple form, in a population based trial, a drug is tested on a certain number of people; works on a certain percentage, then is approved and used on a 100% of the population.   In other words, one dose fits all.  It does not take into account individual characteristics that can cause harmful side effects, or segregate parts of the population that the drug will not help.  Thus we have a drug prescribed to a large part of the population that it either hurts, or has no affect.  A prescription for sickness and loss of huge dollars.

In today’s digital landscape, the technology is emerging for “evidence based” medicine.  Evidence based medicine will be individual based vs. population based.

With new technology we are able to “capture the data”.  Sensor laden devices are shrinking and can be embedded on the person to monitor vitals of all sorts.  These sensors include embedded nanosensor chips, “chip tattoos”, and more.  “There is an app for that” has and will have new meaning.  Doctors will have apps on their smartphones that will measure your vitals while you are at home in comfort.  So will you.  Remote monitoring will achieve new levels and eliminate many office visits and the doctors that accept the new technology will be able to take care of more patients and the doctors that don’t will see their practices diminish.  Personal visits will be a HIPAA compliant “Skype” call.  All of this without the onerous “office visit”. 

Remote monitoring, accurate data collection, data transparency and sharing will all contribute to a healthier population and result in hospital populations shrinking.  In other cases, the patient will remain at home.  Hospitals will be reserved for the severely ill.

You will have access to the central database enabled by all of this “data capture” and will become more educated as to your own health.  Between your self-education and the doctor’s access to all of the available information, diagnoses will be more accurate, mistakes will be greatly reduced and a new era of “transparency” will have arrived.

DNA sequence documentation is also emerging and will result in proper treatments for illnesses.  As Topol says “ routine molecular biologic digitization of humankind is just around the corner”.

3D printing of human organs has the possibility of eliminating the need of spending time on a waiting list for a kidney or other organ.  Currently 3D printing has expedited the process of manufacturing artificial body parts (knees, etc.) and lowered the cost.  Electronic Health Records and Health Information Technology will connect virtually every citizen, physician, clinic, and hospital enabling a transparent diagnosis tailored to every individual.

Yes, there are many potential downsides, but they are outpaced by the benefits.  I could go on and on, however, Topol has covered these and many other subjects I have not mentioned.  This is a book that gives you a good look into medicines past, present and future.  The future looks good for the consumer and the progressive doctor.

Thanks for reading,

Mike

“A great book should leave you with many experiences, and slightly exhausted. You should live several lives while reading it.” William Styron

Vero Beach, Florida

The Last Storyteller

by

Frank Delaney

What is a “Seanchai”?  A Seanchai is an Irish storyteller, a bard, someone who maintains and relates Irish history verbally and by memory.  Irish history has been passed on by these Seanchaithe traveling from village to village, telling their stories in the living rooms and kitchens of the rural Irish people for centuries.

Ben McCarthy is an Irish story collector, employed by the Irish Folklore Commission traveling and collecting stories throughout the Irish countryside.  Ben’s mentor, James Clare (another story collector), bequeathed his most precious resource to Ben while on his deathbed.  John Jacob Farrell O’Neill was known as the most powerful remaining storyteller in Ireland (possibly the world), the last great Seanchai.  Up until James Clare passed him onto Ben, James had jealously guarded John Jacob as his own.  Now Mr. Delaney begins to weave a story of Ben McCarthy’s life while paralleling this journey with Irish stories told by John Jacob in the best of Irish traditions.  Ben falls in love, marries his love, loses her, finds her again, skirts dangers with the IRA, arranges for the murders of 3 men, condemns himself for his actions and begins a path to redemption.

This is but a short list of the travels and travails of Ben McCarthy.  The reader is exposed to an intimate view of Ireland in the 1950’s, the hard lives of the Irish in the rural countryside, the violence and the subterfuge caused by the conflict between the IRA and the English.

These narratives are full of Ben’s introspections as he faces one hurdle after another.  My contention would be that it is near impossible for any human being to read this book and not be able to relate on many levels with Ben and his troubles.  Not only can you relate, you learn more about yourself while enjoying the journey and you understand why these Irish folks looked forward to the visits of the Seanchai.

In “The Last Storyteller”, Mr. Delaney has written a multi-dimensional novel that is enjoyed from many perspectives.  Follow Ben’s journey while he is transformed into the next great Seanchai with the help of John Jacob O’Neill.


Thanks for reading,


Mike

The Ninth Orphan

Vero Beach, Florida

The Ninth Orphan

James & Lance Morcan

Imagine a 31 year old man who has been bred and trained from birth to be the perfect secret agent.  In the course of his job, he finds a huge fortune in booty previously squirreled away by the Japanese in World War II which just happens to be worth about 250 billion dollars.  Actually, his job was to find this fortune for his employers to help finance their efforts to take over the world.  Yes, “take over the world”. 

He has had growing discontent in his job, realizing that if he tries to leave, he will become the next “mission”.  The defection of any of the agents bred and trained by this super secret organization cannot be tolerated.  The location of this treasure trove becomes his opportunity to break away once and for all, and live like a fairly normal human being.  The agent decides he can sell this secret instead of reporting it to his bosses and disappear for the rest of his life with the proceeds.  Realizing there are not a plethora of candidates that make up a market for his “goods”, he contacts the Chinese (who most of the treasure trove was stolen from in the first place) and arranges a sale of 150 million dollars for the secret.   

This is the beginning of a tumultuous journey involving the kidnapping of a beautiful French photographer, who just happens to be the daughter of a very high profile, influential retired diplomat.  Throw in pursuit by Omega (the super secret organization), the CIA, MI6, the Chinese, travel from Baguio in the Phillipines to Paris, France  and every twist and turn than you can imagine.  That’s just it, you can’t imagine it.

Sound a little over the top?  Well, it would be, except that James and Lance Morcan have constructed a fast reading novel following this plot that actually makes this seem believable.  I literally picked up my laptop (I usually just read hard copy books) early on a Sunday morning, and closed up my laptop that night finishing the book.  I admit I took a couple of breaks to eat and other necessities, but this book dominated my day and I enjoyed the heck out of it.

The agent’s name is Sebastian Hannar, the beautiful photographer is Isabelle Alleget and as I mentioned, the name of the super secret organization is “Omega”.  James and Lance have obviously researched their material and you put the book away wondering if something like this could really take place or, is it taking place somewhere?

Do yourself a favor, read this book, enjoy the journey and find out the surprise ending.   

Thanks for reading,

Mike

“When I get a little money I buy books; and if any is left I buy food and clothes.” Desiderius Erasmus

Shadow Country

By

Peter Matthiessen

When was the last time you spent literally hours and hours in the Everglades experiencing “old Florida” at the turn of the 19th Century? I just did, and man, was it cool.

Peter Matthiessen has taken the original “The Watson Trilogy” (originally 3 different books) and has woven it into one very “brief” 892 page enthralling novel.

The book relates the “Watson Legend” in 3 different parts. The first relates the legend through the eyes of many different people involved with E.J. Watson. The end of Mr. Watson occurs at the beginning of the book, which sounds unusual; however, when reading the book it begins to make sense. The rest of the book is searching for the why. The subject is, in some ways a simple man, but in others very deep and complicated. The first part takes you through the whole story through these different perspectives and creates and leaves many questions.

The second part is seen through the eyes of Mr. Watson’s son, Lucius, who is searching for answers.

The third is through the eyes of Mr. Watson, himself, and this last part fills in many gaps that have been created by the first 2 parts. You are left with much food for thought.

Through all of this you spend most of your time in the Florida everglades between 1890 and 1910 with some trips to North Florida, South Carolina, Oklahoma and Arkansas. Mr. Matthiessen’s wonderful style of writing gives you the feeling of being there in the swamps experiencing the cruelties and beauties of Old Florida.

Slavery, the Civil War, World War I and the development of Florida are backgrounds for this riveting story and illustrate the cruelties and racisms of the time. Sometimes you find yourself saying “Oh that’s why it happened, but I still can’t excuse it.” This was a time where there not only was no internet and cell phones, but not even land lines or radios. Communication was nothing like it is today, one of the results being a certain “lawlessness” or a law that was dictated by events and environment.

So, we begin a story where the subject is shot to death by 20 or 30 of his neighbors. Then the story moves back in time to lead up to that event through many sets of eyes. A lot of times I will judge a book on how sorry I am that it has ended. I can’t tell you how sorry I was to find no page 893.

Pirates of Barbary

 "I'll die one of two ways: With a book in my face, or running on the beach. And either way I'll die with a smile on my face." Bob Sulek

Pirates of Barbary

Corsairs, Conquests, and Captivity in the 17th Century Mediterranean

By

Adrian Tinniswood

Mr. Tinniswood’s new book on “piracy” is particularly relevant in light of today’s problems off of the coast of Somalia. While this may seem to be a “new” problem to many, it certainly is not as his book illustrates so well. The book is a collection of very colorful, dramatic and true stories of yesterday’s pirates. They have many similarities to today’s pirates; however, today’s probably will not gain the panache of yesterday’s.

“Pirates of Barbary” starts in the early 1600’s. Those were the days when a small group of men in a small boat with scaling ladders, few weapons and sheer nerve would commandeer a much larger vessel for ransom. These men were part of a sophisticated system of a state sanctioned, state regulated, public-private partnership used to grow the coffers of the pirates and the government. Gosh, that sounds a little familiar, don’t you think?

What do the names John Nutt, Richard Bishop, Peter Eston and Sir Henry Mainwaring have in common? All were Barbary pirates that were offered pardons by King James I, if they promised to come home to England and behave. Oh yes, they were allowed to keep all the booty. Probably the most famous and successful was Sir Henry Mainwaring who not only was pardoned but was also appointed to Vice-Admiral of the Royal Navy by King James. Actually, it makes sense when you realize what a problem piracy was, and the knowledge Sir Henry possessed of other pirates and piracy, in general. It was such a problem that King James ended up offering a blanket pardon to approximately 3,000 British subjects who had participated in piracy at that time.

In 2009, the U.S. Navy established a task force to take care of this problem once and for all. Oh yeh, Thomas Jefferson established a U.S.Navy task force in 1801 to do the same thing (which happened to be the beginning of the U.S. Navy). Both had success, however, have not cured the problem.

What Mr. Tinniswood helps make clear is that the solution was and remains onshore. As long as there are governments and pseudo-governments that support and profit from piracy, it’s going to be around. The ocean is just too darn big to police (even today). We have to deal with the people and organizations that back these efforts in diplomatic and other ways. There have been major successes in the distant past that have been the result of aggressive onshore efforts that are well documented in this book. Recently FBI agents captured Mohammad Shibi, who negotiated the ransom for the 4 American captives who were recently killed by Somali pirates. The agents had the help of Somalian authorities and, actually did this in Somaliland. Hopefully, this is a step in the right direction to resolve our “piracy problems” of the last 500 years.