Price competition in healthcare (dental)

The Atlantic has an interesting article up about how more Americans are heading down to Mexico to get their dental work done. The reason can be seen below:

I am only surprised this hasn't happened sooner. Right now, taking advantage of price differences like this is mostly limited to people of means (free time to go to Mexico, money to get there, presumably paying in cash). But it's not just dental work anymore; cardiac surgery in India can start at just $3200.

Whether this delivery of better care for less money will ever happen within the borders of the US, of course, remains to be seen.

"Patient Profiling" and Maximizing Your Doctor Visits

I encourage anyone who sees a physician in the US to look at these two articles:

Are You a Victim of Patient Profiling? - Dr. Pamela Wible

Dr. Gopal Chopra - 5 ways to maximize your doctor's visit

The first article is written concerning the ways in which doctors can stereotype patients and come to inaccurate conclusions. It's almost impossible, in medical education, to avoid doing this; medical education is pretty well obsessed with the "typical presentation" of diseases, which seems reasonable on the face of things.

Young woman with a sudden decrease in energy, weight gain, fatigue? Hypothyroidism! African-American woman with enlarged lymph nodes? Sarcoidosis! Middle-aged woman with fatigue, stiffness, paresthesias, and terrible sleep? Fibromyalgia!

(Seriously, sarcoidosis is almost a running joke in my class at this point. Per our exams and Step prep, apparently every African-American woman who goes to the doctor has it. Except its actual incidence is 1-40/100,000. It's a rare disease, guys.)

So the current heuristic-based system works great, unless you have an atypical presentation of a disease or just a rare disease. This can be a problem. Physician visits are almost always scheduled to be short, unless you have a concierge doctor. Occasionally you can get lucky, and find a primary care doctor who is older and made his or her money decades ago (or who at least has stopped caring about maximizing revenue). My personal experiences with doctors right out of residency has not been incredibly favorable--while they have a good chance of being at the top of their game in terms of medical knowledge, many of them have just figured out 3 things:

1. They have a lot of debt (on average $170,000 per the AMA)
2. They are finally at the stage of their life where they can make Serious Money...
3.  ... if they see as many patients as humanly possible

These 3 things do not really correspond to your goals as a patient: to maximize your time with the doctor, quantitatively and qualitatively. So, towards that end, I recommend you read the CNN article by Dr. Chopra.

Of that list, I personally feel the most important point is the following: Don't be afraid to challenge the doctor if you think he/she is wrong.

I like to think I'm a reasonably informed person, and for quite a while I ended up seeing a physician who incorrectly thought I had rheumatoid arthritis, based on an early miscommunication. This was, as you might imagine, a tremendous waste of time, and I ended up on medicine I didn't need and delayed when I actually began to receive useful treatment elsewhere. I was somewhat confused by the diagnosis at the time, but I have a well-developed instinct to go along with whatever medical professionals say. So I went along with it until it became painfully obvious that nothing was working... 2 years later. This was a huge mistake.

One final thing, of course. If you don't like your doctor, find another. Life is too short.

This is a joke, right? No?

Apparently a group known as the Satanic Temple (1) exists and (2) wants to erect this statue outside the Oklahoma legislature. I think it will look great next to Moses. 

I'd love to know what they plan to do with this statue if Oklahoma decides Satan isn't on their list of approved legislative deities. It sounds like they raised $30k to build it, so I assume this statue will eventually be going somewhere.

And if it does get put up outside the legislature, it will make a great road trip destination.

Graph of the Day

This isn't my area (in any way whatsoever) but this was the most interesting thing I've read all day. Main article: http://www.vox.com/2014/5/1/5671834/this-map-is-bad-news-for-chinas-economy-good-news-for-americas

China will stay a big center of global manufacturing — it's still reasonably cheap, it has the infrastructure, it has the roads and the ports, and it has the supply chain. But that is slowly changing, which is why you're going to see more companies shift their manufacturing to other places: ultra-cheap southeast Asia, Mexico (which has raised its productivity significantly), and fingers-crossed maybe even to the United States.

This is from vox.com, whose main claim to fame as far as I knew was luring Ezra Klein over from the Washington Post. With more stories like this maybe they can permanently establish themselves as a new, interesting news source.

The other major China story going around seems to be that China's economy has eclipsed that of the US if you look at PPP, which is true but inspires the most awful articles about how the US must surely be doomed this time. The real question, I think, is why China? What about India? 

Amartya Sen has an answer for that question, taken from last year's NYT (and bonus analysis c/o the World Bank). It's worth a read--his rough answer is that India is a democracy, and it's made a tradeoff for greater democracy instead of economic growth-- but I wasn't sure whether he really offered any solutions. Stating that India is a democracy is true, but I don't know whether it answers the Really Big Question: what can India do to jump-start its long-awaited economic growth?

(I found several references to India's economy as "the sleeping elephant." China of course is a dragon, a half-awake one or something. I await economic reporting on the giant beaver to our north, or the punchy 'roos of Australia. Surely it's only a matter of time.)