Occassional Dimes

Robert Parker: Charlie Rose devotes a full hour to the world's most influential wine critic.

Unrest in Tibet (plus elections in Taiwan): Recent hour-long discussion on KQED's Forum.

The remaining entries are on health care related topics.

Treating the Numbers: Treating the numbers refers to the tendency of some Doctors "... to get a patient's test results to a certain target, which they assume will treat — or prevent — disease. But earlier this year, a study on a widely used cholesterol drug challenged that assumption."

Publicly-funded clinical trials of prescription drugs: Researchers highlight the many benefits of junking the current system, which relies heavily on Big Pharma.

Outsourcing the Patients: U.S. insurance companies are realizing that it is cheaper to have medical procedures performed overseas -- even after the cost of travel for patients and their families are included. Let's see if this revives supersonic travel!

Medical Tourism and Thailand: Not only are more Americans checking into Bumrungrad Hospital in Bangkok, the hospital has announced an alliance with Blue Cross and Blue Shield of South Carolina. Bumrungrad is one of the top hospitals in Thailand.

Previous Dimes can be found here.

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Occasional Dimes

micro-wind technology in San Francisco:

" ... the 34-year-old engineer has pioneered the city's first permitted micro–wind project, a six-foot-tall cylindrical turbine that currently sits on his roof and sends juice into the energy grid ... (it) generate(s) between 300 and 600 kilowatt hours of energy per year, or about 10 percent of a typical home's energy needs. ... A one-turbine system will cost around $5,000, though Pelman estimates that rebates will reduce the price by $1,500."

Coal In China: An audio slide show from NPR.

Health Care in the U.S.: Yet another great episode on Fresh Air. I was surprised to hear that Australia and Germany have Health Care systems that are similar to the U.S., and according to Jonathan Oberlander, both systems contain practices that could be replicated here.

Big Coal: Renewable energy supporters need to understand how the coal and oil industry work. Big Coal and Oil on the Brain are well-written guides to these incumbent energy sectors.

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Single-Payer Systems

Sicko may be Michael Moore's best film yet, but I do not agree with him that a single-payer system is the way to go. Both the UK and France have a mix of public and private healthcare providers, while Canada is the poster child of a single-payer system. Interestingly short films to counter Sicko are starting to appear on YouTube, and organizations like Timely Medical Alternatives are being cited by opponents of a single-payer system.

Moore cites the postal service and the school system as examples of where the government plays a large role, and concludes that the medical system is too important to leave to private entities. While I use the US Postal Service 90% of the time, I do like having the choice of using UPS or FedEx when I want to really track my packages (the US Postal Service tracking pales in comparison). Similarly, some parents prefer sending their kids to private educational institutions. Politically speaking, it is easier to sell a system that gives people choices.

Ideally we make Medicare available to anyone who wants it, and let the HMO's compete with Medicare. The competition will make both systems more "customer friendly" and we all benefit from having a responsive system. I think most people will opt to use the Medicare system for all but a few of their needs, while some people will opt to go with HMO's completely.

The devil is in the details of course. To lower costs, the US system needs to streamline its Information Technology and billing/claims systems, have meaningful TORT reform to lower malpractice insurance, lessen the grip of the AMA and allow foreign trained family doctors an easier path towards practicing in the U.S., allow Medicare to negotiate directly with pharma, etc. These recommendations alone imply going against lobbyists representing lawyers, doctors, and big pharma! Perhaps electoral reform (i.e. public financing of elections, instant runoff, etc.) is the necessary first step to have any meaningful shot at getting things done. Hmmm, electoral reform sounds like the perfect topic for the next Michael Moore film :-)

At the end of the day, any national healthcare system has to scale to 300M people, and still pay for itself. Tax increases may need to be part of the equation. Immigration reform will need to be enacted: the U.S. has legal and illegal immigrants on a scale that other developed nations would have a hard time absorbing.

Most importantly, as Michael Moore points out, there needs to be an adjustment in attitude in the U.S. We need to go " ... from a nation of me's, to a nation of we's".

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