Up in the air

5am in MSN. 6am in ORD. 10am in LGA. Waiting for the 3rd leg to ROC.
Today is the start of my 2 month journey on the road. Let's call it
the grand Tour of America and Its Major Airports and Transportation
Infrastructure (TAIMATI).

Speaking of acronyms, yesterday we learned about SALT, a mnemonic for
disaster emergency response triaging in the field. S= sort. A= assess.
L= LSI. T= treat. The idea is that when there are limited resources,
triage is key to maximizing life saving measures for those who are
most likely to benefit from receiving care. Okay, "duh" you say. But a
catastrophic event is not the only time resources are limited. While
it doesn't feel as acute, the present state of health care is viewed
by many as a situation with limited resources. On the wards I see
physicians attempting to curb excessive test ordering in good faith,
but ordering only the hemaglobin instead of the H and H barely scrapes
the surface of grappling with limited resorces. I contend that, as
distasteful as it may be, it does not hurt to go through the mental
exercise of capping health care resources at different limits and at
least hypothetically prioritizing care, as we did in our disaster
preparedness course today. At the mere mention of rationing care,
people sling political career ending venom, like "death panels" and
"socialist medicine". But we accept that prioritizing and rationing
are reasonable in a disaster. Isn't this a disaster yet? I wonder what
the cost of Medicare would be if we decided to withold care that was
not expected to extend life beyond a few months. Twenty-five percent of Medicare recipients are spending 85% of Medicare costs, and much of this is during the last months of life.

We should be paying attention to what the profit driven entities are
doing. The pharm beomoth isn't jumping into cancer research just
because people buy pink or yellow wristbands, save yoghurt caps, and
walk 5k from time to time. They smell money. And we would be naive not
to pay attention. It doesn't have to be a battle ground, but it can
lead us to a better understanding of the perverse incentives
structures that are churning below.

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