Sick, sick, sick.

Oh, EKA, you’re singing my song!  I’ve never met a cocktail that didn’t love me back…I have fond memories of the Cincinnati’s of my youth (that’s beer and root beer)…then there’s nothing like a great Kentucky Bourbon for sipping in the evening.  A hot sultry summer night needs a great Mojito.  If it’s a ballpark you gotta go with the crowd and have a ice cold beer. An nothing less than Polish brandy to chase away the signs of sniffles.  Wherever I am I do as the natives do…

This is news?

thanks Susan…I’d forgotten about Christopher Buckley! 

I’m also relieved Anna Gunn’s character Skyler finally had thier baby girl.

I was begining to think she was terminally pregnant for nearly two seasons!

I have been facinated by this well written show as well and disturbed about the second to last episode as you were Warrior…it’s an interesting dilema what happened to the girl friend in that story, I would have hoped I would have reacted differently.

There is not one I would follow anywhere since Molly Ivins…

Thanks Joan for the reccomendation, I will check out Jane Brody!

What Can a Texas Town Teach Us About Healthcare?

By Joseph Antos

June 1, 2009, 6:17 am

Atul Gawande has written another brilliant article about our ailing healthcare system for The New Yorker. His description of the symptoms—high spending, low value—is compelling. Just don’t look here for a cure.

Gawande, a wunderkind physician who figured prominently in the Clinton health reform effort of the 1990s, tells us about McAllen, Texas, where the people are poor and the healthcare is expensive. Medicare spends about $15,000 to treat the average senior in town for a year—almost twice the national average. This in a town where the average income hovers around $12,000.

The tour through south Texas is depressing. It’s not just that they’re spending so much of your tax money. It’s also that the patients are almost certainly not getting better or regaining a better quality of life for all that healthcare, and they may be worse off for all the poking, prodding, and cutting that go on there. If only we could get the doctors in McAllen to behave like their colleagues in Minnesota, people would do at least as well as they do now but at a much lower cost.

The only problem: we don’t know how to turn high-utilizing physicians into models of conservative practice. The first impulse is to do no harm, but we also want our doctors to ask whether an intervention will do any good—and whether it’s worth the cost in money and personal suffering.

Gawande sees a solution: change the way the business of medicine is practiced. Instead of leaving doctors and hospitals in their “untenably fragmented, quantity-driven systems of healthcare,” force them into “accountable-care organizations” (ACOs).  ACOs would promote collaboration, higher quality, and more prevention, while discouraging overtreatment, undertreatment, and “sheer profiteering.”

Sounds great. So great that Gawande is prepared to penalize providers who don’t form such organizations. But, despite the enthusiasm of experts (including Mark McClellan, physician and former administrator of Medicare), ACOs do not exist and it is not clear how they would accomplish what has been promised.

Even Gawande admits that this would “by necessity” be an experiment. As he says, we do not know what the necessary ingredients are that account for the success of systems like the Mayo Clinic and Geisinger Health, and we do not know how to transplant them into the bloated health system that typifies most of the country.

What he doesn’t say is that we cannot solve our health system problems by top-down solutions that focus solely on the suppliers of healthcare. If a reformed health system is to succeed, it will have to engage patients to take more responsibility for their health spending decisions. And it will have to respond nimbly to the demands of its customers—something that is sorely missing today.

Clearly, there’s a problem in McAllen. But it’s bigger than one town in Texas, and it won’t be solved by the latest policy platitude.

Add my wishes for your speedy recovery!

"Spacey says the Tonys should be taken over by PBS, with the genius Mike Nichols directing, and should be given the formality and inclusiveness that the theater deserves".

What a wonderful idea…anyone listening?

The comparable Phyllis Newman…so good to see her and so deserving of the award for her The Phyllis Newman Women’s Health Initiative! Congrats.

Thanks Joni, what a wonderful interview!

How beautiful, I am grateful to know you!!!

Then we have to teach them that they represent us.  I live in a district that is represented by a corrupt official who put out a little gem of a letter a week before the election.  I personally contacted his office and told him I will be distributing my own letter next election season.

Many sites want to hear your stories…

please tell them to http://finance.senate.gov/sitepages/contact.htm