Back to comment about health Insurance and employer based benefits.
Do you realize that the exact reason we do not have a national plan or universal to access to a universal plan is the employer based system which
1- is discriminatory ( try getting a group plan for small biz with some chronically ill employees)
2 segments the market for the benefit of , well, guess who, the insurance companies
3- reduces wages paid to employees ( everyone knows wages have not risen under bush but did you know that employer costs ( employee comepensation which counts heath insurance) has? This could have been wage increases.
4- keeps out small business and the self employed- work for the man ??? or else!
5- promotes wage slavery those who work in undesirable positions merely to obtain insurance.
6- Watch how fast a national plan or universal access would emerge if the work force was not indentured servants ( see health insurance hostages) .
The Doctor Factor
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Linda Goodman, who was diagnosed with metastatic pancreatic cancer in 2006, felt a "human connection" to Dr. Robert Fine the day she met him. Fine, director of experimental therapeutics at Columbia University's Herbert Irving Comprehensive Cancer Center, routinely spends two hours with patients ("I'm not here for the money," he says) and works nights and weekends in his lab, where he has formulated new chemotherapy cocktails that show promising results for this angriest of cancers. The average survival for people with pancreatic cancer that has spread to the liver is six months; Goodman has made it to 18. Like Mayer, Fine won't discuss odds. "I want my patients to live their life living," he says. "I don't want them to live their life dying."
Goodman, 58, has been so impressed with her doctor's kindness, his creative thinking and the passion he brings to his research that she and her family raised $185,000 for Fine's lab, helping to pay for the three Ph.D.s who work for him. The giving doesn't stop there. On chemo days, Goodman presents Fine with his favorite corned-beef sandwich and chocolate éclair. "He's been incredibly devoted to me," says Goodman. "Sometimes I don't know if I'm going to get better or not. He's one of the people I don't want to disappoint."
Compassion, empathy, understanding. It all starts with a doctor's ability to communicate with his patients—not just about their CT scans, but about how they're coping. In "Cancer Care for the Whole Patient," a report published by the Institute of Medicine last fall, researchers found that health-care providers frequently fail to recognize the emotional and social problems their patients face, like depression or a lack of information about their condition, which can demoralize them and hinder their treatment.
In the past, most doctors learned how to connect with patients by trial and error or, if they were lucky, from mentors. Today, virtually every U.S. medical school offers a course in patient communication. And in 2004, the National Board of Medical Examiners added a new section on "communication and interpersonal skills" to its nationwide test. One recent day at Georgetown, young doctors-in-training practiced by interacting with "standardized patients," actors who unloaded a list of symptoms, then graded their practitioners on a checklist that included "introduced self warmly" and "paid attention to both my verbal and nonverbal cues."
Teaching a humanistic approach is imperative, says Mass General's Schapira. And it needs to be retaught after students graduate. In a survey published last year, Schapira and colleagues found that one third of oncologists do not routinely screen their patients for psychosocial distress—an umbrella term that includes emotional and social difficulties, as well as psychiatric disorders. And most of those who do aren't using effective screening tools. The problem: distressed patients may be less likely to adhere to treatment and more likely to suffer. The IOM report calls for a new standard of care, including routine checks for distress. And Schapira herself hopes to launch a humanistic curriculum for oncology-program directors through the American Society of Clinical Oncology. Key lessons: how to break bad news and how to handle end-of-life care. "We have to move away from an era that says you either have it or you don't to an era that says these skills can be enunciated, modeled and learned," she says.
At Mass General, health-care workers learn from each other at lunchtime meetings sponsored by the Kenneth B. Schwartz Center, named for its founder, a 40-year-old nonsmoker who died of lung cancer in 1995. Schwartz felt so strongly about the kind care he had received—from his oncologist, Dr. Thomas Lynch, and from nurses and technicians, too—that he left $25,000 in his will to establish a program dedicated to empathic health care. Today, "Schwartz Center rounds" are conducted at 145 U.S. medical institutions. At Mass General, a young patient with Hodgkin's disease recently talked about cancer's stigma (do you disclose all on a first date?) and told doctors she appreciated humor. "Knowing what to do medically isn't the challenge," says Lynch. "The challenge is connecting with the patient."
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