From Andy: Big Health Care Reform Should Start at the Bottom
Greetings,
As the Health Care debate around our country rages on, waxing and waning with each poll, I thought it was time to throw in some overlooked or outright discarded ideas. Bringing real access to health care to everyone without massive cost increases or symbolic coverage requires a total rethinking of how we do some things. Due to various regulations and liability issues as well as financial considerations most doctors now immediately after being in medical school go for specialty’s. Due to the cost of medical school and student loans it is not easy to make a livelihood as a doctor as a general practitioner of medicine. Now I realize that may be hard to believe due to prices that you are charged for going to a doctor but consider this first. Medical school can cost from 12-20K a year with books and other fees. This doesn’t include eating either. Now multiply that by 8 years to get a doctoral of medicine and you are looking at 96-160K in student loans cost. Don’t believe me google it and check. So you are fresh out of medical school with 100K in student loan debt. Now add whatever it costs to have a standard of living in your area. This puts most doctors out of medical school in a pretty big bind. Imagine having a house or apartment bill every month in student loans costs on top of all your bills. It doesn’t take much imagination to see why it is 50.00 or more just to see a doctor without insurance. Now add malpractice insurance to the equation. That can run from 20K to 200K depending on state and field the doctor is in. The point of all of this is we can pummel large health care companies as they are easy and in many ways justifiably part of the problem. But we are really only throwing a band aid on a gunshot wound if we don’t consider the entire system from college to hospital to managed care. So here are some suggestions or ideas for everyone to think about.
1.) Provide all or a portion of a pre-med students tuition to become a doctor up to General Practitioner with a few rules: they must maintain a suitable grade point average, depending on the level of financial help provided agree to work for a length of time at a government hospital facility or non-profit hospital for a standard wage, agree if they don’t maintain a proper grade point average or leave the position early they will be responsible for the loan or portion left that was given to them. If they fill the requirements they do not have to pay back the loan.
2.) Reform Malpractice laws. This can be done in a number of ways like setting a set percentage that lawyers can receive from winning a lawsuit while suing a doctor (in many cases lawyers take 40% area) to a realistic level, setting limits (reasonable) on how much a person could receive from a settlement ( I am in favor of this personally as long as the amount is fair and also if the injury or error causes permanent injury that the responsible party provides to have the costs of the injury for the duration of it.), reduce the timeframe that a patient can sue a doctor for an injury are all possible ways to do this.
3.) Streamline procedures involving medical practices and review them regularly with the heads of hospitals and doctors to ensure that the people doing the work are crafting the procedures.
4.) Enact Chargeback Rules. If you sue a doctor and your case is proven fraudulent or frivolous an award should be given to the doctor for the lost time and damage to his practice from the person accusing him.
5.) As lawyers have a rule that they must do a certain amount of pro bono work a year for people maybe adding in a rule of that nature may be worth looking at as well.
All of these ideas are just smaller pieces to a bigger puzzle but I haven’t read or heard of anyone in the “overhaul” of our health care mention anything close to this. We have spent so much time focusing on how big companies screw us we don’t or haven’t paid attention to how the actual doctor’s get pressured and screwed all the time. If we started with the fundamentals of health care at the bottom and worked up reforms may come in smaller packages but they would be real. Currently as it is we are trying to reform health care by replacing the board of a company not asking or listening to all the workers of that company what could be done to really change things for the better. Well writing about the entirety of the Heal care bill and debate would make a full time job I just wanted to throw in my two cents on it. See you all next time.
mkoby.com Adds a New Writer
Tomorrow you will see a new post from a new author here on this blog. The new author, Andy Snow, is a close personal friend of mine that I have known for many years (well over a decade at this point). He is probably one of the smartest individuals I know, and can bring a lot to a discussion, including alternate viewpoints, new ideas, and just plain old debate. Hopefully some of his ideas will bring open discussions to this website, and while I have always encouraged open debate on this blog I want to ask that it always remain civil (please, lets not be trolls).
Hopefully tomorrow’s post from Andy isn’t his last and we will see many more posts from him in the future.
Book Review: Getting Real by 37signals
A few weeks ago, I found 37signals’ book “Getting Real” online. I had heard/watched DHH’s infamous “How to Make Money Online” presentation so the idea of a book written by the people at 37signals sounded interesting. The cool thing is that you can read the entire book online, for free. After reading about one third of it online I decided I need my own physical copy to keep on my bookshelf. Seriously it’s that good.
If you are in the technology business and you work on web applications (or even non-web applications), you need to give “Getting Real” a good solid read. It is filled with principles, that while might seem strange at first, are excellent rules to live by in this “Web 2.0″ world. The ideas of “underdoing your competition” and “release early and often” might seem strange in a business that has long believed in outdoing your competitors and waiting till the product is “perfect” (which can only be achieved with 10 managers, 50 developers, business analysts, and about 1,000 pages of useless documents) but in a place like the world wide web, mean little.
The main arguments presented in the book aim to keep things small, easily adaptable, simple, and even on occasion releasing crudely looking products (with the intent of cleaning up over time) are things that I have been discussing with a friend of mine for many years. The book is in some ways an anti-big business book, and isn’t to be considered a rule book, but it is a game changer. It’s ideas will cause some people to laugh, laud, and dismiss it entirely; for these people they will do so at their own peril. This book causes one to think about an internet business in a different way. It’s really not about the pumping up the stock option price so you can sell to Google, it’s about how to run a successful business on the internet so you don’t have to sell to some company with deep pockets. It’s about starting and running a business and how (as a small company) you have an advantage over your larger competitors.
Overall I throughly enjoyed reading this book. The essays are short (less than 2 pages in most cases), concise and get their point across quite well in their minimal space. If you’re looking at doing web applications either in an existing company, or you are considering starting your own, this book is a “can’t miss” read.
Learning the Ruby Programming Language
I’ve set out to learn a new programming language (for several reasons that will be disclosed at a later date), the language of choice was Ruby, so that eventually I could learn some Ruby on Rails for the purpose of getting back into web development. I have found a couple of nice ways to help with learning the Ruby programming language.
Ruby Koans
A couple weeks back while attending a geek dinner, someone at the table mentioned the Ruby Koans as an interesting way to learn the Ruby programming language. They were right. What are the Ruby Koans? They are a set of unit tests all set to fail and the object is to make each test past, one at a time. The goal is that, as you complete the code to make each test pass, you eventually learn the Ruby language. I’ve been doing them for the last week and a half with great results. I’m by no means an expert in Ruby but I am learning some interesting things about the language.
RubyQuiz.com
RubyQuiz.com is an archive website of the first 150-ish quizzes that took place on the Ruby Talk mailing list. While the quizzes still happen on the mailing list, this website only has the first 156 quizzes posted to the mailing list. The idea is that you are presented with a problem that you must solve using the Ruby language. Several solutions are provided for each quiz so you can compare your answers. It’s a great way to get your mind thinking in a Ruby way, once you’ve become familiar with the language (see the Koans above).
FourSquare Wises Up, Now Useable
Previously, I wrote about why I prefer Gowalla over FourSquare. If you’re not sure on what Gowalla or FourSquare are, they are location based social networking sites. The main gist is that as you go to stores, malls, movie theaters, school, and so on you “check in” at those locations. On Gowalla you can find, drop, and pickup items, while on FourSquare you get points for checking in.
The reason I prefer Gowalla to FourSquare was quite simple, you could check in from anywhere and you didn’t have to know the address because the Gowalla iPhone application relied on the GPS in the iPhone to mark the spot. FourSquare’s requirement that you input an address was both annoying and (to me) a major reason to stop using the service. Well as of about two weeks ago, FourSquare announced that they would all you to check in from anywhere and that the next iPhone application update would use the GPS component to check in with, entering a address was now optional.
Since this change, FourSquare’s iPhone application has seen more use from me. It’s still not on my first iPhone screen (Gowalla’s not going away anytime soon), but it’s on my second and I have found the overall experience of FourSquare to be much more enjoyable then before. Gowalla still has a better overall user experience in my opinion, its more consistent. Also, being from Texas, I have to give a little love to Texas companies and Gowalla is stationed here. So for the time being I’ll use both services. I still like FourSquare’s game better than Gowalla’s. The point system on FourSquare is nifty and the mayor concept adds just a little more competition amongst friends. The people at Gowalla have long proven that they are not just sitting around so it will be interesting to see how the combat FourSquare’s latest changes.
Beekin – All That’s Left Behind
Today marks an important day for both a close personal friend of mine and myself. The release of my friend’s band Beekin’s album entitled “All That’s Left Behind” is today. Why you can probably see the immediate importance for my friend, you might be asking “why is this important for you, Michael?” and the answer is fairly simple. With the release of this album I (officially) become a published songwriter.
I’ve known Erick, the lead singer for many (many) years, and one of the songs on this album is a hold over from a band we were in together years ago. That song, “Traditional Thorn” sums up a lot of harsh feelings we were feeling towards the Christian music industry when it was written and is the direct result of the band being told they couldn’t play certain songs because they were “too loud” (this was back when the idea of Christian rock was still foreign to most church goers). The lyrics to “Traditional Thron” have been modified a little since their conception but the overall message is still there and the song still rocks to this day. The other song, I helped birth is “Finally Fading” while I didn’t help with the lyrics too much, I did devise the title and initial chord progression for the song allowing Erick to work with some others to bring the song to full growth.
“All That’s Left Behind” is currently available from iTunes and Amazon Mp3 store. It is also available directly from the Beekin website. So please check out this CD, it’s honestly one of the best things they have done.
