Reflections on healthcare

May 10, 2009 at 1:27 pm | Posted in Healthcare | Leave a comment

The week started with a sore throat. Rare, for me, but not unknown. It progressed to a full-fledged cold, one that eventually required a phone consultation with my doctor’s nurse. Then Saturday I awoke from fevered dreams to find that my temperature was 102!

Convinced that I had somehow caught Swine Flu, this latest and scariest version, I went to the Emergency room. We have a very good medical center here, and the Emergency Department personnel, as well as the Medical Imaging people, were highly professional, friendly, and obviously competent. I was tested, poked, prodded, and put in a bed that was designed by a particularly talented member of the Spanish Inquisition: I’d have signed a false confession just to get out of it.

But they would not give me a drink of water…after pleading and begging, one of the nice ladies gave me a Styrofoam cup with some ice chips in it. You see the policy is that you can’t have anything to eat or drink until you have been “seen” by the doctor. (I hate that terminology. They ought to say “consulted with.”)

You have to understand…they have implemented the Hospitalist concept. That means that when you go to the hospital you don’t get to see your doctor, you get to see only doctors who work for the hospital, or hospitalists. Sounds efficient, but of course the doctor you see doesn’t know you from Adam, and has only the most limited access to your records. (That part is getting better, but doesn’t solve the problem.)

My doctor, whose name escapes me (well, he doesn’t remember me, either) compressed 75 years of medical history and philosophy into (I think) five questions, told me I don’t have Swine Flu, and commented that my mouth was dry. I restrained myself, and calmly explained that I hadn’t had anything to drink for lo these many hours, and could I please have some water. I don’t remember what he said, something like, “Hmmmmm,” I think. But credit where credit is due: a few minutes after he wandered off, one of the ladies showed up and asked whether I would prefer water, orange juice, apple juice, or Sprite. And came back in a few minutes with nectar of the gods in a container that said “Apple Juice.”

After the results of the tests, pokings, and proddings came back, so did the doctor. He said that I had bronchitis and, reverting to the Doctor-as-God concept, told me that I was to stay overnight.

You see, this is where the Hospitalist concept falls down. Even if he had access to all my records, the hospitalist doesn’t actually know me. If he knew me, he would have known that taking more antibiotics is not a reason to hospitalize me. I can, and will, do that at home instead of using resources the hospital could use for somebody else.

Having been on this planet for three quarters of a century, my priorities are to have the best possible quality of life, not necessarily the longest. As far as I’m concerned, my doctors are consultants to make recommendations on how to pursue my health goals. I am involved, and I am informed. I do not diagnose myself (except in fevered awakenings). Nor do I ask my doctor for some drug I saw on TV. His job is to tell me what I need to take.

I generally follow my doctors’ recommendations, because once they realize that I am informed and involved, and smart enough to do the right thing—they give me good advice. But last night…I slept at home.


What’s wrong with this picture?

May 2, 2009 at 11:24 am | Posted in Banking, Congress, Economy, Politics | 2 Comments

A couple buys a house. They make the mortgage payments regularly for years. Then the guy loses his job, or a spouse gets sick and the bill is far beyond what the insurance covers, or some other disaster keeps them from being able to make the payments they signed up for.

The bank forecloses. It kicks them out, and puts the house on the market, where it sits…and sits…and sits.

If it’s a rental property and the owner defaults, the bank kicks out the tenants (even those who have been faithfully paying their rent) and forecloses. The property goes on the market, and sits…and sits…and sits.

The property doesn’t sell because the real estate market sucks. It’s vacant, so vandals show up and do what vandals do. Over time the uncared-for property deteriorates. The property looks bad because it is bad, so the value goes down even more. Other properties in the neighborhood lose value because nobody wants to live next to a vacant, run-down property.

Who loses in this situation? The people who defaulted lose, of course. The renters lose because, even though they’ve paid their rent, they get evicted. The neighbors lose because their property isn’t worth as much as it was and if they need to sell…well, it’s a negative feedback loop.

But do you know who else loses? The bank. They have a property that’s losing value. They’re paying real estate taxes and maybe minimal maintenance, but they can’t sell it because the market keeps dropping. And they’re getting no income from the place. None. Zero. Nada.

Fannie Mae stopped evicting renters from foreclosed properties in February, giving them month-to-month leases until the property is sold. Good idea: not only does it give the renters what they signed up for, but it gives Fannie Mae some income. Any bank could do that, but very few have. They’d rather kick out the tenants and lose money.

After all, they lobbied very hard to defeat a measure introduced in the senate Thursday. It would have allowed bankruptcy judges more flexibility to modify the terms of mortgages, and would have given the banks some income, where they now have…none. Zero. Nada.

Maybe I’m missing something, but it seems to me that it would be a good idea to keep renters in foreclosed properties and to work with people who are having problems paying their mortgages so they can pay something even if they can’t pay as much. That would keep them in their homes while giving the bank some income.

But then I’m not a banker.

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