After a long day yesterday of Mardi Gras-ing that concluded at 1 am, the effects of a viral illness, and the lingering effects from travel, I am not up for too much heavy thought. Instead, I will call your attention to several items that have recently caught my attention:
- I think that Atul Gwande is probably one of the best “thinkers” in medicine today. I picked up his books Better and The Checklist Manifesto while in DC. I cannot recommend them highly enough.
- While in DC I had several staffers of our deeply red delegation say “You know that Congressman ____ is against ObamaCare, but can you share with me what you feel is working.” I made them aware of my belief that with or without the ACA, the horse was out of the barn in terms of reorganizing care. I wish that I had read this article by Elliot Fisher before my visit, in particular this passage which would have given me much more authority:
Outside of Medicare, almost 100 provider organizations are already working with private health plans toward contracts containing the core elements of the ACO model: payment tied to improving patient care across the continuum and reducing overall spending growth. Other ACO-related initiatives are emerging at the regional or state level (e.g., Vermont) or through state Medicaid programs (e.g., New Jersey and Texas). At least 12 states have enacted legislation to facilitate accountable care reforms.
- Lastly, I am going to weigh in on the Making Catholics Pay For Pills/Hating Planned Parenthood/Hating The Susan Komen Foundation controversy only briefly enough to point out that prior to modernization of childbirth, 1 in every 150 births ended in the death of the mother. As the average woman likely had 4 to 6 pregnancies in the 1920s, probably 1 out of every 20 women died in childbed. Today, that number is 8 in 100,000 births in a large part due to antibiotics and C-sections, but also due to pregnancy spacing afforded by contraceptive technology and many fewer pregnancies in older women. The average woman (thanks to pregnancy planning) has under 2 pregnancies so the absolute decline in deaths due to childbirth is about 10000%. The reduction in breast cancer deaths despite A LOT of attention has only been about 20% at best. Maybe God is trying to tell us something.