peter-steiner-i-m-sorry-sir-but-dostoyevsky-is-not-considered-summer-reading-i-ll-h-new-yorker-cartoonTime once again for the summer hiatus, where I spend some quality time with my family, work on other projects, and in general try to stay out of trouble and on the beach as much as possible. For those of you who are looking for a way to become more informed on health policy from a primary care perspective, I have put together several suggested areas of focus.

  1. Population health: The buzzword for the next year is population health. As those of you who read my stuff know, traditional medical care is necessary but not sufficient. America’s “best health care in the world” system will continue to be expensive (#1) and not very effective (#37) until we acknowledge that a whole lot more than doctoring goes into health. For a primer, RAND (link here) has published a synopsis on what works and what doesn’t in this arena. This paper is a good start. Once you get your feet wet, my friend and fellow blogger Josh Freeman has published his book Health, Medicine and Justice: Designing a Fair and Equitable Healthcare System (available on Amazon) which, though focused on our broken system, has a lot of insight about how an emphasis on population health could take us in a better direction.
  2. Palliative care: Death comes to us all. As I watched the movie “The Judge” all I could think about while watching the Robert Duvall character was how movie Frank Burns was old now,which meant I was old, too. In the movie, Robert Duvall’s character has colon cancer (“Stage IV, the worst”) and is suffering from “chemo brain.” His chemo is administered by his GP in his lake house and, aside from hitting the dude on the bicycle and not remembering, it is a pretty idyllic cancer life. He apparently stops chemo and goes on to live for another year, dying  while fishing with his son after they have dealt with old baggage. While health care delivery wasn’t an integral part of the movie, patient choice and shared decision making was. We as Americans say we want that kind of life and death. We seldom get it. Atul Gawande lost his father several years back and has written an exceptional book entitled Being Mortal. It is an excellent read and provides insight into the mismanaged way we deal with chronic illness and terminal care as the inevitable happens.
  3. Obamacare: The Affordable Care act is 5 years old. When all is said and done, this act has begun the process of retooling our care delivery system. For the latest update on what is or is not happening, RAND has provided a summary of where we are after 5 years to get you up to speed (link here). You say you need to walk before you can run? Though I haven’t read is, Ezekiel Emmanuel is one of the architects of the law and has a book out detailing what the law was supposed to do and is doing (link here).  Emmanuel is an ethicist and a very good writer, and I suspect his book will offer some keen insights into why the law has been shaped in this way. From the observer perspective, Steve Brill’s book offers an exceptional synopsis of where we have been and where we are going. If the Supreme Court rules rules in favor of King (in King v Burwell) and dismantles the law, you can read what the conservative response may be for under $4 here. Hurry, though, if the law is struck down prices might go up.

Y’all have a safe and fun summer.

Allen