The parole officer in the California kidnapping case.

The parole officer covering “Creepy Phil” totally blew it. Neighbors were complaining that children were living in the backyard in tents. He missed it. He reported to his superiors that all was well at the Garrido homestead…

Meanwhile, a young woman had been kidnapped and raped for 18 years and subsequently mothered two young children who were likely going to be held hostage the rest of their lives. Those three children are permanently scarred emotionally, physically, and sexually.

The parole officer missed it.

Imagine a similar situation where a child was irreparably harmed for life, but the person who harmed a little girl was an obstetrician who made an honest mistake during a difficult birth. There are ads all over the United States with lawyers hunting these doctors like vultures. An honest mistake, a child with cerebral palsy, and a $10 million dollar lawsuit later, this doctor’s reputation is forever damaged.

What will come of this parole officer? Did he have “malpractice” insurance just in case he missed an obvious clue that 3 children were being held hostage for 18 years that led to three permanently emotionally damaged children?

The obvious answer is no. He will likely be fired and he’ll go and get another job probably in the same line of work and pay absolutely nothing for making such a devastating mistake.

A child’s life = A child’s life. Right?

Doctor making a mistake does not equal parole officer making a mistake.

Why the double standard? Both cases have similar outcomes…except in the case of the parole officer, three children were harmed.

What if the government awarded X-prizes?

…of $1 billion to the company/town who can show that they can deliver healthcare at half the cost of today’s $8,000 per person price tag? I would think that would mobilize the positive outliers. Read this interview with Atul Gawande in it’s entirety (also listen to this interview with him on NPR about positive outliers)…but here’s a good snippet of what I’m talking about:

One thing that really struck me about your piece was that you focused much more on the question of care providers than insurance providers. The political conversation tends to do the opposite. Want to talk a bit about that distinction?

I had a hard time connecting the dots. My vantage point on the world is the operating room where I see my patients. And trying to think about whether a public option would change anything didn’t connect. I order more than $50,000 worth of health care in a day. Would a public or private option change that?

People say that the most expensive piece of medical equipment is the doctor’s pen. It’s not that we make all the money. It’s that we order all the money. We’re hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don’t get that. Neither one has been very effective thus far.

Do you think much that we’re hearing in the political conversation is responsive to the issues you pointed out?

Part of the difficulty is that it’s very hard. But you can learn from good hospitals. They do peer review, for instance, and that changes what doctors do in their offices. They blunt the financial incentives in various ways that we haven’t studied at all. It’s kind of ridiculous that there haven’t been very many people putting feet on the ground and studying what the positive deviants are doing. There are hundreds of examples out there. They’re not just the Mayo Clinic and not just Grand Junction. Go to Portland, Oregon; Temple, Texas; Pensacola, Florida. These are places that are doing something differently.

But getting there requires a change in local medical cultures and rebuilding local medical systems. All medicine is local just as all politics is local. But let’s create a cadre of researchers who go into these communities and figure out what’s going on and spread the word.

The Washington debate – there are smart reasons to think about including a public option in the mix, but we have not been thinking hard enough about how we control costs and make a better system. I think it’s achievable in about 10 to15 years, and maybe even faster. I can tell you three things that will transform McAllen overnight. But CBO doesn’t score them.

So what are the three?

First, they spend more than $3,500 per Medicare beneficiary on home visits. El Paso is around $800. McAllen is spending more than half what many communities spend on their entire health care expenditures. The doctors there have to disinvest from these home health agencies and come to agreement on when those visits are worth using.

At the end of life, McAllen spends $22 per person on hospice but more than $3,000 on ambulance rides. In a place like Portland it will be more than $400 on hospice and around $500 on ambulances. Increasing use of hospice, offering that as an option and working as a community on how to manage end of life, would be a smart move.

Work on basic cardiac prevention like getting people statin drugs. Most studies have shown you’ll lower the cardiovascular disease rate by 25 percent and lower the number of procedures ordered. This was done in by Kaiser of Northern California, and they became the first community I’ve ever heard of where heart disease stopped being the leading cause of death.

If you took those three things and worked on them for a year, you could go from $15,000 per person per year to less than $10,000.

Why we need better options for health care



I talked to my mom this weekend, and as usual, she brought me up to date on the goings-on of my hometown. She’s the principal at the elementary school, and last weekend, one of her teachers received some bad news. Her daughter, who is 30, married and has 3 children, found out she has liver failure and needs a transplant to live. The problem? Her daughter doesn’t have health insurance.

[Read the rest]

I fully agree…

But are we willing to bankrupt the middle and lower classes to allow the current business model of healthcare and inefficient and uncoordinated processes of healthcare delivery to persist?

Or are we, as citizens of humanity in the greatest country in the world, going to come together for the sake of one another, and demand a new process for delivering healthcare combined with a new business model that makes healthcare affordable for us all?

The current solution of “here are 50 million new customers…carry on” will bankrupt the middle class in less than 20 years.

We are America people. We can do this. It will be from the ground up, given the fiasco happening in DC. But I have full faith in the ridiculously driven intelligent and good people of our country who simply want something better for themselves and for their fellow humans.

Why we need better options for health care

The dullest blog in the world


Closing a window

July 6th, 2009

A window was slightly open. I decided that I did not need it to continue to be so. I closed it and securing it using the window handles.

Turning on the computer

July 5th, 2009

I was seated in my computer chair. I reached out my hand and pressed the ‘on’ button. After a moment the computer turned itself on.

Tidying some pencils

March 16th, 2006

Some pencils were scattered around on my desk. I picked them up one by one. I placed the pencils in the drawer which I use to store pencils.

The dullest blog in the world

GE / Nuclear Power / Saving the world…

I was privileged enough to meet Eric Loewen. He works for GE’s nuclear energy division. They’ve invented something called a PRISM reactor. It uses nuclear waste for power.

The US uses 3 terawatts of energy every year. The nuclear waste already buried across America can produce 300 terawatts of energy using a GE PRISM reactor, thus powering the US for 100 years with no new mining.

Why am I spending a day with people like Eric Loewen? You’ll find out in December. Good times.

A PRISM reactor is a fourth-generation nuclear power station which runs on the nuclear waste generated by all the previous generations of nuclear power stations.

PRISM is GE’s name for an integral fast reactor, or IFR, and it’s a pretty great technology. The amount of fuel which already exists for such reactors would be enough to power the world for millennia — no new mining needed. Fast reactors also solve at a stroke the problem of what to do with the vast amounts of nuclear waste which are being stockpiled unhappily around the world. They’re super-safe: if they fail they just stop working, they don’t melt down. And they can even literally replace coal power stations:

One nice thing about the S-PRISM is that they’re modular units and of relatively low output (one power block of two will provide 760 MW). They could be emplaced in excavations at existing coal plants and utilize the same turbines, condensers (towers or others), and grid infrastructure as the coal plants currently use, and the proper number of reactor vessels could be used to match the capabilities of those facilities. Essentially all you’d be replacing is the burner (and you’d have to build a new control room, of course, or drastically modify the current one). Thus you avoid most of the stranded costs. If stranded costs can thus be kept to a minimum, both here and, more importantly, in China, we’ll be able to talk realistically not just about stopping to build new coal plants but replacing the existing ones, even the newest ones.

And best of all they’re eminently affordable: Loewen showed that they could be profitable selling energy at just 5 cents per KwH — which means that you don’t need to price carbon emissions at all to make these power stations economically attractive. With pricing on carbon emissions, of course, they become even economically compelling.

But then you have to come up for reality:

“Our political system’s ability to deal with real problems has been degraded to such an extent that I sometimes wonder whether the country is still governable.”

Paul Krugman (via ambivalence, justinday)

GE / Nuclear Power / Saving the world…