DOCTOR
AUTHOR
COMMUNITY ORGANIZER
MICHAEL FINE
What's Crazy in Healthcare
by Michael Fine, MD
Healthcare professional by Nick Youngson CC BY-SA 3.0 Pix4free
What's Crazy in Healthcare: What’s Crazy About Healthcare and the Presidential Election
by Michael Fine
September 21, 2024
Before I start talking about the current presidential campaign, I thought I’d disclose my biases. I’m an independent with complicated political views: fiscally conservative, small government oriented, socially progressive but not woke. I don’t love our choice this year, which seems to me to be the choice between Julius Adolph PT Trump and Tweedle Dum and Tweedle Dee – the current VP seems smart and capable but is running a weak-wristed campaign in which she isn’t really saying much beyond don’t vote for the other guy.
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What's Crazy in Healthcare: What’s Crazy About Living With Dementia
by Michael Fine
September 12, 2024
Basically, everything is crazy, for the caretakers of people living with dementia. If you have dementia, it’s hard for you, because you can sense what you don’t know or understand, and sometimes see the apprehension and disappointment in the eyes of the people you love, and feel that but too often don’t understand it, which is part of the cruelty of dementia itself.
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What's Crazy in Healthcare: What’s Crazy About your Doctor not Coming to see you in the Hospital Anymore
by Michael Fine
August 9, 2024
Hospitals pulled the support of primary care doctors and chased us out of the hospital. They replaced us with hospitalists, who took turns being a patient’s doctor. Sometimes they switched every week. Sometimes every two weeks. Sometimes once a month. But sometimes every few days, so if you are in the hospital, the person taking care of you is now someone you’ve never met, and who isn’t likely to know you or your family.
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What's Crazy in Healthcare: What’s Crazy is That COVID is Back
by Michael Fine
July 20, 2024
Basically, everything is crazy, for the caretakers of people living with dementia. If you have dementia, it’s hard for you, because you can sense what you don’t know or understand, and sometimes see the apprehension and disappointment in the eyes of the people you love, and feel that but too often don’t understand it, which is part of the cruelty of dementia itself.
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What's Crazy in Healthcare: What’s Crazy About Primary Care in Rhode Island
by Michael Fine
July 12, 2024
First some good news! The Rhode Island General Assembly passed two bills and created one study commission that helps us start getting better access to primary care in Rhode Island.
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What's Crazy in Healthcare: What’s Crazy About Hospitals in Rhode Island this Week
by Michael Fine
June 21, 2024
The whole thing is crazy. And expensive. And sad.
But we have met the enemy, and they are us.
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What's Crazy in Healthcare: What’s Crazy About Eye Ointment
by Michael Fine
June 14, 2024
Eye ointment? Yes, eye ointment. You see, in late April, CDC announced there is a shortage of erythromycin eye ointment, which turns out to be a big deal. What? Isn’t erythromycin one of the oldest antibiotics that exist? Aren’t here a hundred or a thousand other eye ointments? Who cares about one old medicine?
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What's Crazy in Healthcare: What’s Not That Crazy About Making Sure Pharmacists Are Part of The Primary Care Team. But It’s Crazy to Think Pharmacists Alone Can Solve the Health Care Mess
by Michael Fine
June 6, 2024
I’m not sure where I stand on letting pharmacists bill insurance directly. On the one hand, pharmacists are critical and valued members of the primary care team and provide services that greatly benefit patients. On the other hand, fee-for-service billing, billing a patient or their insurance company every time a clinician of one stripe or another sees a patient, is part of what has destroyed primary care itself, and should be shown the door as soon as possible. So letting pharmacists bill fee-for-service doesn’t sound like it will fix anything.
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What's Crazy in Healthcare: What's Crazy about Letting Business People and Lawyers Control Health Care
by Michael Fine
May 29, 2024
What the heck is going on?
What the heck is going on is this: health care has been taken over by bureaucrats, administrators, and lawyers, who know only how to protect (and some would say enrich) themselves and their organizations, people who don’t know anything at all about medicine, but feel embolden to make decisions that cost patients’ lives.
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What's Crazy in Healthcare: What's Crazy about Unionizing Healthcare Workers
by Michael Fine
April 27, 2024
Breaking news tells us that pharmacy professionals at two CVS corporate retail stores in Rhode Island, in Wakefield and in Westerly, want to join The Pharmacy Guild, a trade union that represents pharmacists ands pharmacy technicians, joining their colleagues from around the country who are engaging in similar union activities at CVS and Walgreens Boots Alliance – and other companies as well. Emergency room physicians, anesthesiologists, and medical residents are unionizing -- and striking -- as well.
What’s going on here?
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What's Crazy in Healthcare: What's Crazy about Healthcare and Private Equity
by Michael Fine
April 8, 2024
And there, in a nutshell, is what’s crazy in health care today. Health care is filled with ethical motivated people, who want to help people, but also want a decent life and a reasonable income. But then there are all sorts of folks with MBAs and money to spend, who want to buy up or buy out the people who care, push up the cost, and make money for themselves out of the deal.
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What's Crazy in healthcare: What's Crazy in Healthcare Times Two
by Michael Fine
January 8, 2024
A friend in her sixties called to ask if she should take the new RSV vaccine, which is being heavily promoted to people over sixty. That it is being so heavily promoted is driving me a little crazy.
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What's Crazy in Healthcare: What's Crazy about Hepatitis, HIV, and Colon Cancer
by Michael Fine
December 6, 2023
We can improve the public’s health in the US and do so affordably. And eliminate Hepatitis C, HIV and colon cancer. We just need a health care system that provides primary care to all Americans, in every American neighborhood and community.
It’s crazy we haven’t provided primary care to all Americans. And it’s crazy to read plans like Dr Collin’s, which talk about only one disease and don’t focus on what we can and should do together as a nation, which is to provide primary care to all.
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What's Crazy in Healthcare: What's Crazy about Getting a FMLA Form Filled out
by Michael Fine
October 2, 2023
Now think of all those forms. The back-to-school notes, which schools require because they don’t trust parents to be truthful; the 11-page Medicare Home Health Certification and Plan of Care form required for people getting home health, which must be filled out every two months. Eleven pages. No one understands it, not the doctors who fill it out, and not the home health nurses whose computers fill out most of it. I doubt anyone at Medicare understands it. There’s a form to help poor people from getting their electric or gas service turned off in winter and there are workers’ comp forms.
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What's Crazy in Healthcare: Primary Care in Rhode Island
by Michael Fine
September 3, 2023
Why is it so essential to have a family doctor physician you trust? The answer is straightforward. Everyone needs a healthcare advocate who knows them, their family and their community, who understands healthcare and medicine, and can guide you when you’re sick and help you prevent avoidable diseases and early death when you are well. In a world filled with confusing medical information and profit-driven interests, having someone you can rely on to provide honest advice is crucial.
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What's Crazy in Healthcare: COVID and Florida
by Michael Fine
July 25, 2023
During the pandemic, it wasn’t possible to know how states and nations compared regarding their management of the pandemic, because the disease spread in surges. A state or nation that was doing well this week might be doing poorly the next. The question always was, which place would have the lowest case fatality rate at the end of the pandemic — the lowest number of deaths per capita — after most people had become immune and pandemic spread stopped. It was possible that our short-term strategies, like masking or social distancing, might have produced short-term benefits but no long-term mortality advantages. Technically possible. I wanted to wait until the end of the pandemic to see, because it is scientifically important to keep an open mind.
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What's Crazy in Healthcare: What's Crazy about Generic Medications
by Michael Fine
June 18, 2023
What does Flonase cost? $16 at Target. $15 at Walgreens. $26 at CVS but for twice as many sprays. But there is a generic that costs $9.69 at Target and $9.18 at Walmart and $20 at Walgreens. I pushed hard and found five bottles for $25 or about $5 a bottle on Amazon and each bottle has 144 sprays, or twice as many as most other generics. Which means it likely costs $1 to $2 to make. (Interestingly, it costs $40 in Canada, where it is still prescription, so thank you FDA for doing at least one thing right and making it generic here.)
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What's Crazy in Healthcare: What's Crazy in Minnesota
by Michael Fine
May 23, 2023
The Mayo Clinic has hospitals in Rochester, Minnesota; Phoenix and Scottsdale, Arizona; Jacksonville, Florida; Abu Dahbi; and an outpatient clinic presence in dozens of locations across a number of different states and countries, including London.
It’s a “non-profit organization committed to clinical practice, education and research.” It has $16.3 billion in revenue, $15.7 billion in expenses with an operating income – what would be called profit if it was a for-profit — of $595 million in 2022. The budget for the State of Rhode Island, for 1 million people, was $15.1 Billion in 2022. The Minnesota budget for 2022 was $60 billion, for 5.7 million people, by comparison.
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What's Crazy in Healthcare: What's Crazy in Healthcare Today
by Michael Fine
April 19, 2023
In the United States, we have a health care market, not a health care system that provides the same set of essential services to all Americans. We’ve all gotten used to that – it makes for health care that is confusing and impersonal. But most of us can’t figure out how to change it, so we suck it up and take what is dished out, and are grateful that emergency rooms exist to pick up the slack, so that most of us don’t die from trivial injuries or dread diseases, most of the time.
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