Wednesday, July 25, 2012

The Gun Debate

Several factors in the gun debate border on medical and safety topics for the general public. To that end, I've given a fair amount of thought to the matter. If you'll indulge the borderline political debate, the following explains my take on the issue, from a health perspective.

In the past, I've spoken at length to a few of my European colleagues who deal with the health consequences of blunt force and knife injuries with much higher frequency than gunshot wounds. Most of them attribute this to the gun laws of most European nations which require a full blown proficiency test and background check for owning a firearm.  It's easy to obtain or create a bladed or blunt weapon, so violent crime still exists. Murder happens, but neglecting military and paramilitary activity, fewer large scale massacres occur with regularity. Gun crime also occurs in the small scale, but not as frequently as here in the states. In fact, one German coroner with whom I spoke as a medical student, visited Kentucky on exchange to learn more about gunshot wound pathology, since he saw fewer than 70 gun crimes a year on average. 

This illustrates a pertinent point. Fewer people owning guns can minimize but not completely eradicate gun crime. As the popular saying goes "if owning a gun is a crime, only criminals will own guns." While I understand the sentiment and see the need for defining sides in a debate, a middle ground does exist that would satisfy people on both sides of the debate. 

The European system still allows the average citizen to own a gun, protecting the right to bear arms, but anyone requesting the permit must demonstrate an ability to use the gun properly, safely and with restraint. If, as several of those I've heard and seen arguing state, any limits prevent ownership, I will again point to the driver's licensing system already in place. Do we simply hand keys to a 16 year old and let them have free reign over a 2 ton pile of metallic death? No, we first insure that they are able to appropriately comport themselves as a driver. Tests, both written and practical, to prove proficiency in operation of the vehicle and knowledge of the traffic laws, give some semblance of assurance of safety. The debate still rages over whether this is adequate. Many states require formal driver's instruction and a permit period lasting months or years to protect the citizens on the road. Why should a gun, which carries significantly more responsibility and has similar power to end life quickly, be any different.

The average citizen (or the child thereof) could easily obtain appropriate instruction in the safe use and care of firearms and obtain a permit to do so, satisfying the desire to uphold the second amendment. However, not everyone will pass the test and background check(just like the driver's test, which has a reported 20% failure rate GMAC), especially those with a history of violent crime. It would also be useful to field questions to evaluate the psychiatric fitness of the owner, which also exist to a certain extent on the driver's test. That level of evaluation prevents unskilled users and possibly violent persons from simply walking into a store and walking out with an arsenal. The common defense and well-maintained militia still have access to firearms with which to defend their possessions and the country at large. And those of us who don't like being shot have some sense that, just like the slim margin of safety on the highway, we are safe in our homes. Or in a movie theater. Or at church. Or at a football game. Or at school. 

Friday, February 17, 2012

Long Time, No Type

It's been a fairly long time (over 5 months) since I posted anything to the blog.  A whole host of factors conspired to make it lower on the priority scale. That being said, I've still been following the tech route.  I'm still involved in social media. More than ever before, I know that these things changed business fundamentally with their arrival. I understand that I have to participate to remain relevant.  What I don't want to do is sound like I'm complaining too much.  My first world problems pale in comparison to 90% of the rest of the world, and I feel no compunction to use the internet as a whining room.
I've been blessed with a great business opportunity, a great family and a chance to do something I love in a way that I want to do it. There's been adversity, which often spawns writing, but there hasn't been a great deal to promote the kind of writing I think matters.

Until now.

Over a year ago when we began planning this endeavor into Direct Medicine (Concierge, Flat Fee), we decided to accept Medicare for the first year, as a service to those patients who were unsure if they wanted to commit to a $75 monthly fee alongside their Medicare. Forms were filled out and submitted.  Phone calls were made. 5 Months Later, we still have no Medicare provider numbers for ourselves or the company.  The government bureaucracy, in its infinite wisdom, provided us with 6 different answers to the same question, none of which appears to be the correct one.

We no longer plan on accepting Medicare.

In an era when physicians can receive jail time for Medicare fraud, we agreed that the need to accept Medicare was far outweighed by our fear of making an ignorant mistake and winding up with fines or imprisoned. If this many errors occurred with only the application, how can we be sure that the same errors or worse won't happen with the claims process.

An interesting phenomenon has arisen from our decision. Our Medicare bearing patients have decided to stick with us and pay the fee. They seem to prefer it. It's simpler, more direct and they know exactly what their primary care costs.

It's a symptom of a system with big problems.  Insurance, meant to help those who couldn't afford the high costs of advanced medical procedures, has become the healthcare equivalent of the lottery.  You pay into it, hoping to never use it, and when you need it, the returns on investment don't cover the first 20% or more. As is true with the lottery, health insurance has become a tax on people bad at math.