Where does the money come from and where does it go?

All water is recycled. The drip from my nose was, at one point, the drip from someone else's nose and so on. And the same goes for money. There is a limited amount of money, as it represents resources, but it doesn't just go away when we spend it. So, with health care dollars, the problem with the 2.3 trillion dollars going to pay for health care isn't exactly that 2.3 trillion dollars, it is where it comes from and where it goes.

An example in point: A friend of mine was just diagnosed with a particularly nasty form of brain cancer, glioblastoma multiforme. It is the most common malignant brain tumor, and it just killed Ted Kennedy. I don't have any idea how it chooses its victims, but it seems clear they have no fault in the process. He has already had 2 MRI scans, brain surgery and 5 days of hospitalization around the brain surgery. He also had an ambulance ride and several doctors' visits. He hasn't got the bill yet, but my guess is that he has just racked up close to $100,000 in medical costs. Everything, so far, has been necessary. But the costs of everything are significantly higher than they would need to be if procedure prices were as low as a competitive market could make them.

So the money comes from my friend, a teacher making maybe $45,000 a year, and his insurance company and it goes to a neurosurgeon, emergency room doctor, 2 hospitals, and indirectly to the makers of various medical equipment and supplies. It also goes to the many administrators who push pens regarding insurance payments. If he is responsible for 10% of the costs, he's already looking at 10K out of pocket.

As he enters the next phase in his treatment, he will spend tens of thousands of dollars over the next 6 weeks getting radiation therapy and then chemotherapy, at an expected cost of $5000 a month, for which he will foot some percentage of the bill. The money will come from him, his insurance company, and go to an oncologist, a radiation oncologist, a hospital that does the radiation, and a drug company that produced and markets his chemotherapy agent. And a bunch of administrators pushing pens in a system more complex than anyone could shake a stick at.

His situation illustrates a problem that will not be solved by doctors getting together and streamlining and making more effective the care they deliver. The care that he is going to need over the however long he has to live is just way too expensive, and his portion of the cost is way too high.

If he happened to roll the jackpot and live a long time, he will exceed his insurance's lifetime max of 2 million dollars in less than 10 years.

It is clear to me that there needs to be significant pressure to bring down the costs of big ticket items, procedures and certain medications, and that the system of insurance coverage needs powerful tweaking, either by regulation, replacement, or effective competition, in order to protect people from financial ruin. Just having a public option won't achieve this, but a public option, with standardization of coverage, and regulation of private insurance companies, could do this.

Excuse me Mr. Obama--here's the money you were looking for...

Now, like the beginning of a mudslide, there are people, doctor people, writing about why it costs so all fired much to deliver medical care in these United States. There are articles in the New England Journal of Medicine, that staid periodical with the plain white cover, and just this week an article in the Journal of the AMA which explains exactly how the costs of medicine can be curbed, resulting in better care.

The sound of this message is a murmur that is steadily increasing in volume. I'm not entirely sure that anyone in lawmaking positions is hearing it yet. Perhaps when it gets really roaring they will.

I was feeling frustrated by the apparent near inaudibility of this message until today at about 1:30 when, while walking on an old logging road, I realized that it doesn't really have to be heard by law makers. Now, if they did hear it, they could be substantially relieved to know that costs are going to go down, but they don't even have to know that. Perhaps it will just be a pleasant surprise.

It is going to happen that medical care will become more streamlined and more effective, because it is really what everybody wants. And when people start talking about it, it will happen. In talking to doctors of all description, including those who make lots of money from procedures, I've found that virtually everybody is feeling uncomfortable with waste in medicine, and those of us who are in the position to be leaders have started to do things to make change happen.

The next step that I'm going to take is to have a conference at my hospital, most likely a repeating event, in which providers (I hope this will include nurses and therapists) will discuss the things that we do that are costly and don't really help anybody, with the overall goal of sharing thoughts and eventually developing new policies. The radiologist who first got me thinking about all this and I talked about it yesterday, and he will talk to the person who sets these things up this week.

Senator Baucus' proposal--are health care co ops a bad thing?

I just skimmed the 223 pages of the health care proposal by Senator Baucus, with a focus on the health care cooperative suggestion and the mention of medical malpractice reform.

There are lots of sections in this proposal, and most of them contain good ideas. Achieving all that is in it would be a humongous and monumental amount of work. It also nearly completely misses the boat in terms of cost savings.

But..

The proposal suggests that we establish health care cooperatives as an alternative to presently available insurance plans, that work about like Group Health does now. Group Health is a cooperative based in the northwest which provides full health care services to members for what looks like a reasonable price compared to what most health insurance costs. It provides basic services easily, emergency services competently, and focuses on prevention. It provides good care for serious illnesses of all kinds, and skimps a bit on cutting edge technology and medications. Sometimes members have to wait for services if the providers get busy. The basic idea behind cooperatives from a doctor's point of view is that we get paid a salary to take care of a certain number of patients, and provide those patients all the health care we are qualified to do, and refer out to other providers or services as necessary.

I worked for Group Health from 1989 to 1993 or so, and had a baby while insured with them. The total cost for prenatal care and delivery was $5, which I paid for use of the TV in the delivery room (which I didn't actually watch). As a provider, I was occasionally quite annoyed when I wanted to prescribe a new medication for a patient, and they wouldn't pay for it until I had tried 3 or more ineffective medications with tons of side effects, but no one ever died because of that.

It will be difficult to establish functional health care cooperatives on a large federal scale in time for them to absorb all of the people who need insurance now, but it would be well worth the effort. A cooperative such as Group Health has the ability to mandate cost effective strategies for taking care of patients, and if that began to be part of the way medicine was practiced in the US, it might spread to the fee for service arena, as the overall culture of care changed.

The problem is that it would be slow, but then the strength of it would be that it would be slow.

The changes that need to happen in health care are so large that going too quickly might entirely bust something that is only mostly busted right now.

Still, to get a health care cooperative up and running well will take years, and will be a bumpy road for each individual cooperative, which gives little relief to people who need medical care now.

A public option, if it were identical to medicare, would have the difficulties of medicare, with a set of rules that don't make good sense, and reimbursement that is low enough that many providers opt out of caring for patients insured with it. If we could make a public option plan available and also improve medicare at the same time, with a medical home model, this would be better than cooperatives, but if that can't happen, all would not be lost if we were able to get in motion good, solid, viable health care cooperatives.

There was exactly one paragraph in the bill about malpractice, saying the the "sense of the senate" was that states should take this change in health care delivery as an opportunity to change the liability system so that it actually works. I can see that perhaps the inclusion of broad and powerful malpractice reform in a health care bill might kill it, but I am disappointed nevertheless. Tackling malpractice is vital to reducing costs and there is actual energy and motivation to do it now.

What American health care system, exactly?

People throw around the expression "American health care system" like it was something that actually exists. Britain and Canada have health care systems, and in the US of A we have things like Kaiser and Group Health and the VA which are health care systems, but we don't have "A health care system". What we more accurately have is a bunch of professionals who provide services that are sometimes random and sometimes coordinated, having to do with caring for peoples' health and diseases.

Because we don't have a health care system, it is hard to fix it.

Most of our health care is delivered by people who see themselves as individuals delivering a service. In addition to delivering the service, these individuals want to make as much money as they can, consistent with keeping the client happy and healthy. This model does not lend itself well to cost efficiency.

Today our office was provided lunch by a well dressed representative of a medical equipment company. This salesman was sent by his company to show us a device, an inflatable vest, that bumped and vibrated to help patients with lung conditions get rid of their congestion. I can see that it would be helpful, but he said the cost was $15,000, most of it paid by Medicare. So his company had made something that was pretty darned good, but cost as much as a car, and shouldn't. If there were an actual health care system, that system would include the medical equipment company which would be encouraged to produce the fancy doohickey for less money.

If we are to make a bunch of independent providers deliver cost effective health care, we either need to regulate costs, which might work, or allow the market system to push down costs.

Seven Tips on How to Really Enjoy Your Vacation

When is the last time you were 'really' on vacation? No Blackberry, no cell phone, no faxes at the hotel? You can take a vacation. You need to take a vacation. Your family and friends need you to take a vacation. Actually being on vacation is a choice. And here are some tips to making the choice work for you.If you start with your briefcase and triple check that you have the powercords for your Blackberry and your laptop when you begin to pack for your vacation, you definitely need to read on.
















If you make a to-do list of the things you need to get done for work while you are gone, you better read on.

Even if you only plan to call in for your messages “a couple times a day,” you’ll want to continue reading.

The urge to work while on vacation has never been stronger. Our busy schedules and the constant availability of technology adds to the pressure we all feel. With contact so easy, and with the lines between work and home so blurred during the rest of our lives, it is easy to see why vacation can be a struggle for any of us.

If you want to put more balance in your life and vacation, read on. These practical tips will help you (and your family) enjoy your vacation more, guaranteed.

1-Choice

If you want to have a vacation that is more vacation and less work, it all starts with a choice. Am I willing to, and will I, leave the Blackberry off and not check my voice mail? While it is easy to make this statement, making the choice might be very hard. Hard or easy, in the end, it is as simple as a choice. If you choose not to work or be distracted by work-related items while on your vacation, you won’t be.

2-Urgent vs. Important

The ease of contact that technology brings us makes this choice even more clear. 30 years ago if you went on vacation it was harder to be sucked back into work because there weren’t so many easy ways to be in touch. With the cell phone, laptop, and internet everywhere, it is easy to assume that everything back at work is urgent.

3-Most of it isn’t.

The decision or mental "tug" to work while on vacation is about the urgent things in life. Your family (or your vacation in general) is quite likely more important to you, but it is the perceived urgency of the work that draws us back in. Remember what is really important to you. During a vacation is an especially good time to remain focused on the important; and not the merely urgent things in our lives.

4-Remove the Distractions

Leave your phone in the room; your Blackberry will be just fine in the drawer. If you leave the gadgets in your room all day instead of carrying them with you everywhere you go, you’ll be far less likely to check your messages while you’re in line for the ride or sitting by the beach.

5-Communicate Clearly

If you do have to work at all while on vacation, set boundaries and gain agreement with your traveling companions. If there is a particular thing that you have to do, let everyone know what it is - they will more likely support you if they know about it and how important and/or time critical it is. Then do only that thing! Don't use that as an "opening" to work as much as you feel you need to.

6-Segment Your Time

I am writing this as the rest of my family sleeps. This allows me to be fully engaged in my vacation, and still finish something that truly needs to be done. If you must work, budget the time tightly, and do it when it least impacts those important people with you.

7-Have a Plan

Have a plan at work before you leave. Change your voice mail and email announcement to let people know you aren't in touch for several days. This will leave you with fewer urgent items on your return, and lower your anxiety level while you are gone.

Keeping these six things in mind will give you greater balance and help make your next vacation as refreshing and rejuvenating as it can be. Take these actions and you’ll have your best vacation ever, and you will return better equipped both mentally and physically to be highly effective back at work.

Potential Principle – When you are on vacation, you need to be on vacation! Recognize that while your work may be urgent, your vacation and the people you are spending it with are truly important. Keeping this in mind will help you have the vacation you deserve. See ya!

What if I had 3 minutes to make my case

What if I had 3 minutes with a health care czar to ask for what I think we need

Okay, the timer is running...


1. Reduce costs of health care by a. reforming the malpractice system at a federal level to reduce malpractice insurance costs and reduce "cover-your-ass" medical spending b. introducing cost transparency, whereby providers and patients know what everything costs and can make informed decisions and c. creating teams of healthcare professionals to identify waste in practice and administration.

2. Insure everybody by expanding medicare to cover those who can't afford insurance, and revamping medicare to encourage a "medical home" model that provides care for patients through primary care providers who know them well. This would include better coverage and compensation for patients and providers who participated in the new medicare program, and education in cost effective and appropriate medicine to providers of care.

Which to prefer between Hotels, Vacation Homes and a B&B

When it is time to take the family on vacation, most of us think only about getting a hotel room. Sure, we might also consider a tent campground, a RV or travel trailer, and possibly even a beach condo, but how many of us realize that we have more choices for a place to sleep while on vacation?
















Well, there is a lot of difference between a hotel, a vacation home and a B&B (The Bed and Breakfasts) . And people like me are still not familiar with terms in respect to what services they provide and at what cost. So let us see them one by one.

Hotels.
The main idea behind the hotel industry is to provide a great number of accommodation especially to people who are very wealthy and they need a place to stay while on their business tour. So in terms of having a true vacation, staying in a hotel does not suit many people's taste.
As they have to spend a lot and they are completely dependent on the hotel management in regards to services, food, amenities etc.
Hotels really are not all that they are cracked up to be and can provide many ugly surprises.

Vacation or Holiday Homes rental
I have to say that when I finally discovered vacation home rentals, I was pleased to no end. If I am going to spend $120 per night, you simply cannot beat the vacation rental experience.

Especially when you are doing several nights at your vacation destination, the vacation rental makes a whole lot of sense. If you are yet aware of it, the vacation home rental is exactly what it sounds like. It is a home that you can rent, in the same way that you rent a hotel room, with a major exception. That exception is that the rental has separate bedrooms for the guests, a full kitchen, a fenced backyard for the kids to play in, sometimes a swimming pool to swim in, and a comfortable living area, frequently with a big screen HDTV in it.

Think about the homes of your friends, and then think about the nicest home that you have been to. A vacation rental is generally even nicer than the homes of all of my friends and family.

The Bed And Breakfast (B&B)
The bed and breakfasts (B&B) are an ideal solution for living the good life, but they are not always suited to bringing the kids along on your vacation. A bed and breakfast is a small lodging establishment that offers overnight accommodation and breakfast, but usually does not offer other meals. Typically, bed and breakfasts are private homes with fewer than 10 bedrooms available for commercial use.

In the constant struggle to find holiday accommodations, many people see the best and worst of what can happen while on a family vacation.

Unfortunately, vacations more often create abnormally high stress levels, when one is supposed to be trying to relax. As a result, many families frequently prefer to stay home when vacation time comes. But the good news is that there are better options available to anyone looking to experience a family vacation to remember - a vacation that is memorable for all of the right reasons.

In the end I really appreciate that you read my post and I am sure you must have gained some knowledge from it. Take Care!

Your Vacation Destination-What Aspects to Keep in Mind before Planning

Who doesn't love to go on a long relaxing vacation? We all do, but the problem with it is in selecting the right vacation destination. People often spend very much on their vacation which is not even far from their hometown. It is often considered a big headache to select the right travel resort for your vacation. After all the hassles in selecting the right spot, then raises your budget issue. There are too many things to consider when you select your vacation destination, like the distance, air fare, hotel reservations etc. You can always hook up to the internet for your hunt for the perfect vacation spot.
















Every person wants to save a part of their hard earned income for that perfect vacation where he or she can have some quality time with family and friends. Even though you have planned for the vacation since a year, everything might go wrong at the time of the vacation. You should know every detail included in planning for a perfect vacation. Because, it is not easy to plan for a perfect memorable vacation as you need to keep every aspect in your mind and then go ahead.

Nowadays, you cannot blame anyone but yourself for missing a wonderful vacation opportunity. Currently it is very much easy to find the best suited vacation for you. We normally tend to ignore every opportunity that comes our way unknowingly, because it is very much common in our life. Thus we shouldn't regret.

Nowadays, with the growing need of vacations, you can find every possible vacation destination packages over the internet. There are many deals based on various categories like cheap, luxurious, bay side, hill stations, ski resorts, cruises, adventure trips and much more. As there are many deals available over the internet for the same vacation package by numerous agents, you can go for the best deal by comparing their prices and facilities given.

Many people think of Walt Disney World for their favorite vacation destination. Internet has plenty of information about Walt Disney World too. You can find numerous vacation deals, amusement park packages, and best options for your memorable vacation. You can also search for good cruise packages; make sure that you know what you are searching for. Make a decision based on your priority. Like there are many types of vacation packages available based on numerous aspects like, groups, comfort, luxury, cost etc. You can even get information on vacation for corporate and students. Search according to the dates and time of your planned vacation, otherwise you will end up to postpone your vacation.

Every thing matters while planning for a vacation. Just managing money for the vacation is not enough. Keep these aspects in mind and you will be able to have a perfect vacation, and is sure to be memorable for years to come! See you next time. Take care.

Vacation Homes are better than Hotels in more than one way !

For tourism and vacationing Europe is a very beautiful region of the world. Every 1 in 3 Americans wish to vacation in the breathtaking Europe. Some people like to visit Europe because they have their European heritage like French, Italian, German etc. etc. and others wish to go just to have fun and have a good time. Travelers from all around the world have read so much about the beautiful Europe that it remains at the top of their holiday destination (I wish I had the money to travel to Europe!). We often see the beautiful movies filmed in the European heavenly locations, their diverse culture, food, languages and so much so that we all crave to tour this continent.


However, if you plan to vacation in Europe the first thing that comes to your mind is which hotel you are going to stay in. You will be terribly spending a lot of time surfing through the best hotels available there; but not anymore since nowadays there has grown a brand new trend called ‘Holiday Homes’ or “Vacation Homes”. These are just the properties owned by different individuals who want their properties to be rented out and become a source of income. Today, vacation homes or holiday homes are found not only in Europe but anywhere in the world.


These homes are getting popularity by leaps and bounds and the reasons why vacationers or tourists prefer them over the regular hotels seem many. Some of the most common and more logical are listed below:

First most hotels are normally very expensive. On the other hand, holiday homes don’t charge you as much for almost the same amenities plus their charges are even negotiable. On top of that they provide you a homely atmosphere.

In a hotel you get merely a room while when you rent a vacation home it means you are getting the whole house. So the space you get in a holiday home is by no means comparable to what you get in a hotel. Besides, you get your own drawing room, your own dining room, your own kitchen, your separate car parking, even your private garden and a balcony. Can you get all these things in a hotel for almost the same charges?

Now we come to very crucial issue guess what? Yes, you have guessed it right! The food (which is for many people the sole reason we live our lives). Of course we holiday to have some good time and what more fun we can have if we own the kitchen. Just order the ingredients from the local market and have our favorite meal cooked or prepare ourselves (if we are a good cook!). While even in the best of hotels we are always dependant on the hotel menu for all our breakfasts, lunches and dinners during our stay. So, we do not have to suppress our desire to eat our favorite meal when we hire a holiday home. We are like the kings ourselves!

Privacy to some people is everything. Again vacation homes have won the lead. In hotels same entry and exit ways are used for all the guests, however especial you are. You confront a lot of people, sometimes it gets crowded and that is what many people especially celebrities don’t like. You have to use the same swimming pool shared by many. However, vacation homes offer you unparalleled privacy; you have your private pools which are to be used only by 
you and your family. Your own private dining, your separate entry and exit ways and everything are only limited to you and your family. And that extra care makes you feel special and nice. Needless to mention, that it creates a tranquilizing environment too.

Vacation homes particularly the European ones are situated in the countryside, but the hotels are in the cities only. Hence, you experience an aesthetic view from the windows of your holiday home which really is very eye-softening.

If the holiday home you rent is situated in the rural area then it gives you the opportunity to explore the countryside by walking into the villages to visit the locals. Get to learn about their culture, their lives etc. If you love more urban setting, a beach house would be perfect to know the local people by living among them.


Holiday homes are available for rent with a wide range of different price-tags depending on their sizes, what luxuries and amenities they will offer you, are they newly built or constructed 20-30 years back. So you have to see your needs and your pocket.
Last but not the least if you want to get the real taste of a region; want to know their people; then always stay in vacation homes because most hotels are situated in more urban areas. You get the chance to see only the tourist hot spots. Whereas holiday homes offer you the opportunity to mingle with the people if you want to! Take yourself great care see ya. 

How to rent your vacation property

Are you one of the people who want to turn their properties into successful vacation rentals, but still confused where to start from? Then read on, you will surely benefit.

If you have a nice property to rent it out for vacations, then its time to tell the whole world about it. Today, in this ‘online age’, you can easily introduce your vacation property to a large number of people who can be your potential guests.

It is really important that you provide more and more information about your vacation property as it is an important part to market anything. You can get a good insight when you put yourself in the shoes of the potential guest about what they may want and where they might look for. You should post enough information like anything from local restaurants to the historic attractions and from medical facilities to the theme parks. You might be thinking that one person may not ask so many questions like these, but then you forget that there are thousands of people who look for different kinds of information according to their taste and interest. Am I right?

Now, first decide what amount of money you are willing to spend to advertise your vacation property? It is important to set the annual spend relative to the expected returns.

You can join the online property marketing sites and forums and ask them the rates for annual membership to display your property. Here an important thing to note is that suppose if your area is seasonal, then it become highly unlikely that you will go for the full one year listing at premium rates.

At the vacation property listing websites, you get the value for your money as they really work hard to expose your vacation home to thousands of vacationers globally. The online advertisement works much better to attract more prospects for your holiday home compared to the print media as now it has wider reach to the people.

Also you can go for your own website. It may sound a bit difficult, but investing in this could boost the earnings. You can set up the website either with a simple design or opt for a big, glitzy one, the more you invest, the more you get. Initially it will have to compete with other countless sites to attract visitors; it may not be possible to beat the property marketing sites in terms of search engine rankings, but it is proven fact that owing a personal website shows a professionalism in the eyes of potential vacation guests.

You can mention the website name on your business cards and ads, it will really help. And if you decide to have your own website plus an ad space on a leading vacation property, then you can make it beneficial in two ways. First the ad on a property listing site will have the URL of your site, so the visitors will definitely visit your site from there too if they find the initial information interesting. So, having a personal vacation property website will always help to market your property.

Second the advertising on multiple sites always benefits as more people come to know about your property. Just look for the best available deals for price, traffic and other things.

Always plan the advertising in advance and not at the last minute before the available dates. It helps generate interest and bookings too.

Make sure the utilities work properly and add any extra comforts you can like DVDs, books etc. Always remember that word-of-mouth works best for repeated business, so the more excellent service you give to the guests, the more guest you get through them.

Last, but not the least thing, keep in mind that first impression really matters. People spend their hard earned money on their vacations to have good times. You should show as much as possible photos of your property and they should be actual and clean. If a guest does not find an amenity that was advertised in the ad, then it is 100% sure that not only will he never return in the future, but also you will get a ‘bad word’ as he will post negative comments on the site about you and your property, so please refrain from such tricks. Hope you will employ all those tactics mentioned here and must have benefited and enjoyed this post. See you next time. Take care !

Maldives Holiday- A True Dream Vacation Getaway

Do you love the sun and beaches? Are you looking for an exotic dream vacation? If you answer is yes, then a Maldives holiday is a perfect pick for you! Maldives is a place where travelers keep coming back due to its marvelous tourist destination privileges with a promise of breathtaking and refreshing experience for any vacationer. Whether you are looking for a great electrifying water experience or longing to soak in the sun and sea water, you can never go wrong. There is a wide selection of activities or areas to visit, including;


Water Activities and Sports
What is a tropical holiday without beaches and water? No Maldives holiday is complete without beach and water experience especially its world famous white sand beaches. After all, it is the pristine beaches why this vacation place went to top of most travelers' list. Enjoy all the water activities such as snorkeling, scuba diving, windsurfing, parasailing, and even fishing, either hand-reel or deep sea. You can also love the sun and water.

The Capital City, Male
The Capital City Male is a tourist attraction in Maldives and the hub of trades, commerce, business, and other industries. Male is situated just near the airport and is a true tourist attraction. You will find local handicraft shops and marvelous nation museum. At the museum you will discover a great collection of various artifacts.

Art Gallery
Esjehi art gallery is found just on eastern part of Sultan Park in Male. Esjehi holds workshops for the Maldives artists to convene. A trip to Esjehi is like knowing the people of Maldives because a great collection of the arts is done by local artists.

Mosque
The Grand Friday mosque is another place you must not miss on your Maldives holiday. The Grand Friday has a unique architectural design and is a popular and top major tourist spots in Maldives.

Fish Market
Here you will find a variety of local fresh fruits, tuna, fresh and dried fish, and vegetables. It is not only for having great varieties of fresh foods why the fish market is famous but how unique and clean it is, which the tourism government ensures for all the people to take enjoy.
So go on, for your next Maldives holiday and make it a true dream come true! Take care bye now.

Bedtime story

Once upon a time there was a big country with not very many people living in it. They were farmers, and ranchers and teachers and people who sold things that other people needed. There were doctors, too, who gave advice to the sick, did minor surgery and comforted the dying. The doctors could set bones, bandage wounds and tell people approximately what was wrong with them, but they couldn't do much to fix people who were sick. Eventually the doctors made schools to teach each other what they knew, and educate new doctors who would know a bunch of things right off, rather than having to learn them as they went along. The new well educated doctors were respected because they were able to help people who really needed help, so smart young people wanted to be doctors. In the medical schools the teaching doctors were able to discover new ways to treat the dread diseases that they saw, and so the job of doctoring was associated with more respect. With the respect came good pay. When doctors were actually able to do something for patients the patients were more willing to pay good money for what the doctors had to offer.

Pretty soon the only people who could get into the medical schools to become doctors were the smartest students, and they were often from rich or influential families. A job with good pay and immense respect was hard to beat, so qualifying for it became very competitive. The prospective doctors didn't realize, though, how hard it would be to learn the increasingly huge amount of book facts and practical skills that were taught at the medical schools. The time and effort that were spent educating these students was huge as well, and so the cost of going to these medical schools rose. The young doctors, despite their good families, often were not able to pay for school and went into debt and they were sometimes ill or sad because of how hard they studied.

The ever more effective and fancy procedures that the young doctors learned were very expensive, but they were also the only thing that might stand between a sick and suffering person and death. There was no question. The sick and suffering person had to have them. Since the procedures were so expensive, nobody could really afford to pay for them. Cleverly, the communities of people produced a whole industry that would pay for the medical procedures that people couldn't pay for themselves, using money that was contributed by everybody, even when they weren't sick.

The doctors became more powerful, as a profession. In order to make them accountable to their patients, the communities of people hired lawyers to tell them when they had done wrong, and the lawyers told the doctors that if they didn't behave, they would have to pay lots and lots of money. The doctors then started doing more and more for the sick and not so sick people so that the people would like them and not sic the lawyers on them. But the more things the doctors did to make the people happy, the more money the people spent and eventually all the money in this entire country was spent on the stuff that the doctors did, and there was no money to spend on other things the people needed.

A wise matriarch who lived on top of a mountain saw that the whole thing had gotten utterly and ruinously messed up, and so she did something that was so wise and so creative that all of the happy people who lived in that country spoke of it around their kitchen tables of an evening, for long generations. But I'm not entirely sure what she did. We can, though, write the rest of the story any way we like, so long as the ending comes out happy.

What's wrong with spending trillions of dollars on health care

A couple of years ago I decided that the reason that Americans spend so much money on health care is because it is our national pastime. In Brazil they like soccer and Carnival, and in France they like fine wine and good food. In the US, we like our MRI scans, our bypass operations, CAT scans and the whole gory and dramatic process of getting them and discussing them. When we have a spare moment, we talk about going to the doctor and what tests the doctor ordered and what the doctor said. We have other hobbies, true, but we are very interested in things medical.

When I developed this theory of health care as a national pastime, I saw it as interesting and neither particularly good nor bad. It seemed that any national pastime costs money, and the money that is spent on it goes to pay the salaries of the many people who provide the goods and services related to the pastime. Since medical care consumes such a large amount of money, it must support many households whose wage earners make medical equipment, administer to insurance companies, provide direct care etc.

Then came the realization that our nation's health care budget is rising faster than any other segment of that budget, that our national debt is rapidly increasing, and that a rising national debt threatens to wreck our economy. At the same time it has become clear that much of the money spent on health care is spent on unnecessary care, inflated procedure costs and administrative waste. This wasted money does eventually make its way back into the revenue stream, but without creating any product of value.

In the federal budget the biggest expenses are medicare/medicaid, defense and social security (about 20% each). Social security gives us a safety net in retirement and in disabling circumstances. Defense spending, at its best, provides for a structure that keeps the bad guys from messing with us. Medicare provides for maintaining health and treating disease in people who are at the age of retirement, or unable to work. Other budget items include money spent to maintain roads, pay for police and public works, support education. In the ideal world, all of this money not only pays the salaries of citizens, it also creates something we value. Money that is spent on things that are truly waste, if not spent that way, will remain in the revenue stream as disposable income. ( I would argue, on another point entirely, that money spent to build beautiful shiny bombs that are then blown up to destroy people and property in unwinnable wars is money more extravagantly wasted that that spent on a needless CAT scan.)

We come back, again, then, to what is wrong with spending trillions of dollars on health care. I would argue that spending money wisely on health care creates something we value. Spending vast amounts of money on things that don't make anybody healthier or happier is wasted money, and the extent of that waste goes considerably beyond what I can consider a national pastime and becomes more of a self destructive addiction.