It’s my blog and I’ll post when I want to

I don’t want to be one of those silly people who only writes a blog post once a month and profusely apologizes for it every time, so instead I’ll just be one of those silly people who posts once a month and doesn’t even bother apologizing.  Here goes!

• I’ve pretty much completely decided against joining the AMA, which is something that I was on the fence about in my last post.  I went to one meeting and learned that my school’s AMA chapter’s unofficial motto is “The AMA has a seat at the table, and if you’re not at the table you’re on the menu.”  I don’t like the idea of being part of something that has such defensiveness build into its self-image: “we don’t really agree with what our parent organization does, but since they have power we might as well try to work within the establishment.”  After sitting through a bunch of PowerPoint slides about how to actually go about acting on your opinions and ideas within AMA (introduce and pass a resolution within the school chapter, which goes to the state chapter, which goes to the national medical student section, which goes to the national House of Delegates, which goes to the Board of Trustees, which lobbies legislators), I knew for sure that it wasn’t for me.  Since I know I’m only one person, and a relatively powerless one at that, I think my time and energy would be better spent participating in an organization that is already working toward what I believe in.
• On that note, I attended a meeting tonight for Physicians for a National Health Plan.  I felt like PNHP was much more my style than AMA, both in terms of its politics and its general vibe — most of the people there seemed more interested in having a substantive discussion about health care than gunning to sign up for the AMA’s national conference without even talking about their opinions first (for example).  I don’t necessarily agree with everything that was said at the meeting, particularly with regard to incremental change (I don’t think a public option is useless or detrimental just because it’s not a nationwide single payer plan), but I did like the fact that there was actually something there to agree or disagree with.  And while I might argue about the details, the fact is that I do support a single payer plan; I just think it’s important to be realistic about what kind of reform is politically viable right now and not let the perfect be the enemy of the good.  I’m planning to attend another PNHP event next Thursday (this time a city-wide one), so hopefully I’ll manage to post about that.
• Speaking of the public option, I was glad to hear the President mention it in his speech last night, implying that it’s not 100% off the table (although I doubt it will actually be passed in any final version of the bill).  I really enjoyed the speech — I thought it was great for getting progressives fired up but emphasizing that we will need to compromise, and I thought there were enough concessions and shoutouts for conservatives to avoid completely alienating them (although I’m not sure any minds were changed, and the Ted Kennedy segment was a bold move — if I were a Republican, I might have felt like it was a little manipulative to take advantage of someone’s life and death like that).  But all in all, props.  It may have been the $7 Sam Adams (hey there New York prices) or the DC politico nostalgia talking, but I definitely texted THE TIME FOR GAMES HAS PASSED mid-speech to a friend (caps in the original).
• And while we’re in the topic of the Obama speech, let’s veer for a second into my favorite thing outside of health care: Internet memes!  Joe Wilson Is Your Preexisting Condition is by far my favorite website of the day.  Check it.

Does joining the AMA mean you sold your soul for a set of flashcards?

Or does it mean that you have realistic expectations about how to effect real change in American medicine?  Sorry for the long absence, folks — I’ve been busy getting orientated to med school, but now that I’m back I have lots and lots and lots to talk about.  Right around when I started this blog, the American Medical Association (AMA) was getting a lot of negative press for failing to come out in favor of a public insurance option, while the far less prestigious American Medical Student Association (AMSA) was supporting the public option (of course, now it looks like no one’s getting any kind of public option, but the thought counts for something).

Now that I’m starting med school, I have the option of joining either one (or possibly both, I’m not sure yet whether or not they’re mutually exclusive) of these organizations.  Back in June, I was almost certain that if I joined either one, it would be AMSA.  The AMA seemed too conservative on an ideological level, and just too mainstream on a personal level.  AMSA’s more progressive stance on health care reform and student-run, underdog vibe seemed like a better match.

But I’m already thinking about changing my mind.  A second year student pointed out that AMSA is a short-term solution, while AMA is a professional organization that you can stick to for the rest of your career, making it possible to actually make changes over a longer period of time.  Plus, despite what Nicholas Kristof and others have pointed out about the AMA’s dinosaur status, it’s still the organization that politicians and private citizens look to as a representative of the medical community.

Those arguments, though, depend on a glass-half-full,”ask not what your country can do for you” perspective, which is noble, but maybe not really true.  By joining AMA, I have absolutely no delusions that I would win the organization (or even one person) over to any of my views.  More likely, I would just belong to an organization that didn’t represent the way I actually felt, and I would have to make excuses (to myself and others) for why that was the case.  And of course, I’m worried about too quickly becoming what my dad calls one of “those doctors.”  But joining AMSA presents the opposite problem: I agree with the positions, but are they just empty words if the organization has little influence?

Lots of second years have pointed out that AMA membership comes with perks: a JAMA subscription, scrub pants, anatomy flashcards for the iPhone (no temptation there, fortunately).  I could be reading too much into it, but it’s not a decision I want to make quite that lightly.  I’ll keep you posted.

Loan forgiveness for salaried doctor jobs would make my life

I wasn’t the only person who had something to say about Atul Gawande and Co.’s most recent NYT effort, and a couple people even got their responses into the newspaper (of course, that involved sending a real letter, but no matter).  My favorite by far came from Paul Wortman, psych professor emeritus at Stony Brook University.  Wrote Wortman:

The writers note that when the incentive for fees is eliminated through salaries, costs are significantly reduced. With medical students typically graduating with a debt of $140,000 for their education, the incentive to generate such excessive fees is set in place.

One obvious way to change all of this is for the government to pay for doctors’ medical education if they accept a salaried position.

There’s no good way for the government to pay for a medical education ahead of time, nor is that even necessary.  There are already loan forgiveness options for going into primary care or other fields with major doctor shortages (and it’s not like medicine gets special treatment, either: law school grads who go into public service get similar offers).

Choosing a salaried position in any specialty is another important way for med school grads to reform the system at an individual level, and loan forgiveness could be an incredibly powerful incentive.  As much as I idealistically think I’ll definitely choose a salary over a lucrative fee-for-service position, that will be a much tougher decision to make when I’m facing down the equivalent of a small house in debt — signing my Perkins loan note this week was almost enough to make me start trying to convince myself that doing colonoscopies all day long could actually be pretty cool.  And for people who are even more on the fence than I am, loan forgiveness could be a total game-changer (for the win).

Obama agrees to disagree, but only if you know what you’re talking about

A big hat tip goes to little bro JB for catching Barack Obama’s New York Times health care op-ed before the hard copy rolls up to our front door early tomorrow morning.  The piece starts off with the usual heartstring-tugging anecdotes about people who are denied coverage because of pre-existing conditions, then quickly cuts to a four-point breakdown of what reform will do for us:

1. Provide a non-employer-based health insurance option for the uninsured
2. Bring costs down
3. Make Medicare more efficient
4. Increase insurance company accountability

From there, we’re off on a whirlwind tour of preventive care (it saves lives and money!), a quick disavowal of a government takeover, a snarky but well-deserved rebuke for the naysayers (“We are bound to disagree, but let’s disagree over issues that are real, and not wild misrepresentations that bear no resemblance to anything that anyone has actually proposed”), and an optimistic statement of confidence/plea for help in the coming weeks.  The article is a solid reiteration of the major pro-reform talking points, and of course (despite his line about “the loudest voices”), the President’s voice is the loudest of all, so it’s great that he’s pushing so hard this week in the town hall meetings and in articles like this one.

Interestingly, though, the Times piece doesn’t directly or even indirectly mention a public insurance option, and those exact words are growing increasingly tough to find at the town halls, too.  The article also fails to specifically address the scare-mongering about government-sponsored death panels (maybe because it’s completely insane, but enough people believe it that it could actually get in the way of reform, and you can’t have too many refutations).  It’s certainly not a bad article, and I’m not sure what kind of ask-not-what-your-country-can-do-for-you miracle I was hoping for, but I’ll know it when I see it (hopefully soon).

Prescriptions blog brings me one step closer to directly jacking NYT content

Come on, Times.  I’ve already waved the white flag by allowing you to permanently hold the biggest tag in the tag cloud, proving to everyone that the single largest shareholder of my health care related opinions is totally mainstream.  Now you’re making it even tougher with your sick (pun completely intended) new health care reform blog, Prescriptions.  With FAQs, live blogs, a recurring feature on health care systems in other countries, and recommended reads from Slate, Politico, the Wall Street Journal, and the like, this is basically a one stop shop for in depth but manageable health care coverage.

Luckily I’m starting school next week and I’ll be able to up my education-related original content, which should keep me from resorting to an all-Prescriptions link dump.

TPO Resurrection

At this point, all 2 of my loyal readers could be forgiven for thinking that I had thrown in the blogging towel.  Not so, guys, and you better not have deleted me from your Google Readers just yet.  While it’s true that I was busy with a completely self-inflicted personal issue and many, many episodes of Miami Social and Real Housewives of Atlanta, I’m back for reals (for now).

And what better than an Atul Gawande op-ed in today’s Times to drag me out of semi-retirement?  It’s worth a read, mostly because this guy is one of my heroes and can’t quite do any wrong, but it’s not super novel.  Okay, salary instead of fee-for-service (holler!) and data-driven evaluations of how often and in what instances specific tests and treatments should be deployed.  Good call, but we’ve heard it all before.

Can Democrats and Republicans get along in co-op city?

It seems I’m all about the Slate love this week.   On last night’s episode of Countdown, Keith Olbermann implied that the difference between a nationwide health care cooperative and a public option was negligible.  I totally didn’t get it: how could a patient-run insurer/HMO be the same thing as a government-owned insurance provider?  So off I ran to the internet, where I discovered this gem of an article by Christopher Beam.  The money quote:

If Congress passed a bill that was national, injected significant startup funds, and guaranteed the lowest possible rates, the result would come pretty darn close to a public option.

Oh, now I get it.  Read the rest of the article and you will, too.

New York magazine’s Daily Intel breaks its own awesomeness record

So I’ve been spending a lot of time lately trying to decide on a favorite website.  Videogum?  Washington City Paper?  Facebook?  I eventually came to the conclusion that Daily Intel, New York magazine’s news blog, is my favorite website of all time.  And today I got even more evidence to support that conclusion.  Because in addition to stellar Gossip Girl and NYC Prep recaps, weekly Sex Diaries, and more Albany political analysis than I ever knew I wanted, Daily Intel also turned out a baller cheat sheet of the who what when where why and how of the health care debate.

It’s called a democracy, not an I-do-what-I-want-ocracy

In the same vein as Tim Noah’s piece about the constitutionality of an individual mandate, Mike Madden’s piece in Salon presents and then shoots down 5 conservative talking points about health care: that the proposed bills represent a slippery slope toward government-sponsored euthanasia, that taxpayer money will be used to pay for abortions, that the bills would ban private health insurance, that the government is incapable of running a health care program, and that a government-run insurance plan will ration health care whereas private insurers don’t.

The item on this list that I find the most disturbing is the one about taxpayer-supported abortions.  As Madden points out, pro-choice legislators have already suggested that customer premiums, rather than government money, could be put toward abortion coverage.  But to me, that’s not even really the issue.  The issue is that abortion is legal in the United States of America.

Certainly, a large percentage of Americans think abortion is morally abhorrent.  But lots of people are opposed to the wars in Iraq and Afghanistan for equally sound moral reasons, and billions of taxpayer dollars are spent on defense every year.  For that matter, some people hate the speed limit, or the drinking age, but that doesn’t mean that their tax money can’t be used to enforce these laws.  If you live in the United States and you pay taxes here, then the government gets to decide how that money is spent.  Of course, the point of a representative democracy is that those spending decisions are in some way connected to what the public wants.  But if Americans elected enough representatives who are willing to allow health insurers to pay for abortions, then individual beliefs have no place in preventing that from happening.

Senate Finance Committee cuts costs, but without a public option or employer mandate, what’s the point?

20-plus years of schooling and they’ve got the Senate Finance Committee on the day shift, working to get a health care bill passed by September 15th (the day after Gossip Girl’s Season 3 premiere.  Coincidence?).  Much like the two House bills (which passed on July 15th and July 31st), the Finance Committee’s bill would expand Medicaid, and like one of the bills, it would raise revenue — but through an excise tax on insurance companies that sell really expensive policies, rather than through individual taxes on wealthy Americans.  The bill is also likely to prohibit insurance companies from denying coverage because of pre-existing conditions.

The bad news, though, is that the Finance Committee proposal calls for cooperatives instead of a public insurance option.  Cooperatives are better than the bloated tower of health care capitalism that we have right now, but they are not a substitute for a government-run insurance option that will keep costs down for all Americans.  And the employer mandate is a key step on the road to universal coverage.  Hopefully the Senators will change their minds about these two important issues before their bill reaches its final version.