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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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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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.

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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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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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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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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 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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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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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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