Demystifying Medicine One Month at a Time


‘100% Meat and Meat Byproducts’

This week I was reminded of ALPO dog food commercials of my youth, in which cowboy-turned-space captain Lorne Greene assured us the product was “100% meat and meat by-products.”


Two concurrent news stories brought that haunting phrase back to me:

  1. The revelation that two escaped convicts had tools (hacksaw blades) smuggled to them inside packages of meat.
  2. The story about Chinese authorities cracking down on a meat smuggling ring involving tons of 40 year-old meat that had been frozen, thawed, and re-frozen dozens of times.

Really ew.

rainbow white houseSupreme-Court-Saved-Obama-Care-Once-Again-6I agree with the correspondent who wrote: “…countless people [will be] forced to ponder the benefits of vegetarianism…”

Oh: And if you’re not that ‘into’ current events, just know that this week the arc of the moral universe of the United States of America bent sharply towards justice.


The Chief Justice upheld the honor of his institution. (USA Today)

The decision has been handed down from the highest court in the land.

Obamacare has been upheld. Chief Justice John Roberts skillfully parsed the individual mandate by calling it what it really is, a tax.

To make health care more widely available more affordably, it seems logical that we all have to share in the cost burden. Taxes are anathema to many of our citizens. But in life, you get what you pay for.

A few thoughts on health care reform:

1. Though no one is saying it, business leaders are not altogether unhappy with the decision. For the first time since WWII, the Affordable Care Act gives us the opportunity to uncouple employment from health insurance. To be sure, the legislation says that companies with more than 50 employees must offer insurance to their employees. But it also provides a penalty for not doing so–one that many companies are now weighing as a business cost more reasonable and less unpredictable than group health insurance. If the states and/or federal government truly can develop health insurance exchanges that offer lower-cost individual plans, then employees at such companies will be forced onto the open market. The upside of this is that no one will be locked into a job they hate simply because of its health benefits. Another potential upside is that firms will start hiring again–less scared off by benefit costs for employees.

2. There’s enough federal dollars in the legislation aimed at innovation that we will finally be able to break the stranglehold of “fee-for-service” health care. [Fee-for-service: the more medical care delivered, the higher the payment–regardless of quality. More is just more. Remember, though, more is not better.] It will take many years. But by stopping the spending orgy that is fee-for-service and allowing quality-based models of reimbursement, we may actually see the pace of health care cost inflation decelerate.

Last thought: Atul Gawande wrote an excellent reaction to the SCOTUS decision that puts health care reform in its historical context as a longstanding societal “wicked” problem. It’s worth a read. Click here.

Tea Leaves

The Supremes, aka SCOTUS

Got your Ouija board ready?

What does your crystal ball portend?

Hey Nostradamus: Which way will the Supreme Court vote?

Depending on where you stand, what you believe, and which way the winds are blowing, you can find just about ANY prediction of how the Supremes will rule tomorrow.

There was so much anticipation on Monday of this week, when it was rumored that the court would hand down all its final decisions.

Why wouldn’t the Supremes go for three more days of Kabuki, attention-hogging, and creating a silent, black-robed spectacle?

Wouldn’t you?

Gotta hand it to ’em, though: No one leaks nothin’ around E Capitol and 1st St.

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