Category Archives: Poli-kicks

Some Nuance on Opioids

We need both quantitative and qualitative subtlety about the opioid epidemic. Dr. Marcia Angell brings both in this review of a cluster of related books. Since you’re busy trussing a sheep or stuffing a souffle I’ll executive summarize it:

  1. Street drugs now kill many more people than prescription painkiller addiction.
  2. Prescription painkillers are the only way to make a breath breathable for those in significant pain

If you’re looking for some light holiday reading, prose that reminds you of the season’s glitter, flip through Angell’s writing on medical approaches to addiction.

Peace and love to all.

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They colonized white people too

Ravages of colonialism, Brexit edition.

It would have been easier, perhaps, if it was all as overt as potato jokes. But what kills you is the ignorance; what grinds you down is how much they don’t know about the past and, if they do know, how little they care. It’s a strange and maddening thing to discover about the people who shaped your country’s fate and who are poised to do so again.

I learned this about British youth when I lived in Ireland for a mere 5 months and visited a friend studying in Cambridge. Otherwise lovely college students thought Ireland was part of the UK. In 1997.

Bonus A/V on the persistence of struggle:

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Burn Burn Burn Burn Burn Burn Burn

These f-kholes want the state to force women to carry unwanted pregnancies to term. They also want to reduce funding for contraception. For health care. For child care. For public education. They want to impose this clusterf-k of hardship so bad that they have voted to put a rageaholic drunk who asserts on the record factually erroneous legal  shit, and who’s been credibly accused of criminal behavior, into the highest court of the land really fast right now before anyone gets a chance to bring additional if-you-listen-to-women-you-know-they’re-true sexual assault and rape charges forward and before the blue wave that I’m atheisticly praying so hard may actually happen.

But this blog post is funny.

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Ottessa Moshfegh Proves I’m the Zeitgeist

Note: this post was composed almost entirely before nearly every person I know, women or not, carrying a traumatic past or not, was triggered all f-ing day yesterday and most of today by the spectacle of a composed, poised, intelligent woman trying to fight an iceberg of low-information, woman-hating PEOPLE WHO RUN OUR GOVERNMENT. However, perhaps a literary theory-type post celebrating as heroic a woman who withdraws from this constant heartbreak in a yearlong chemical haze may be well-timed?

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Worldbuilding

As a parent, a day-gigging child health policy specialist, and a night-gigging radical lefty former academic, I enjoyed this piece on how to reject the politicization and moralization of children.

With innocence as its baseline, the liberal idea of children seeks to make natural (but also to moralize) a property relation between child and parent. “Innocence” is code for powerless — a way to fetishize the child as both dependent and sub-human. This idea of the child is indistinct from private property. 

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Health Policy Post! My Actual Day Job!

I work at a state Medicaid agency that’s planning to cut payments to doctors who can get that dough back by improving their patient outcomes. It’s generally called “paying for value.” Its opposite, “paying for volume,” pays docs for the number of services they provide, rather than their patients’ improved ability to bike to the river.

Clearly we need to pay for health care quality instead of for however many brains one can stuff into an MRI machine.

But we also know that social factors–jobs, education, immigration status, housing and food security–determine up to 80% of a person’s health. Not their doctor. Not their genes. Not their kale smoothies or meditation apps.

So paying doctors for outcomes may not make much sense for doctors who primarily serve people with low wage jobs in polluted neighborhoods and who generally live without the kind of accumulated advantages that allow me, for example, to hit the bookstore for something to read on the airplane, which I’m flying tomorrow to a small town with a fantastic pastry shop and a famous theater.

Dhruv Khullar points out that scoring doctors who take public insurance against doctors who don’t, and paying them less when their patients inevitably can’t manage their chronic conditions as well, will probably result in lower-income people getting worse care.

And we haven’t yet figured out how to use the health care system to address people’s actual health needs: food, safe and secure housing, child care, decent wages.

I’ve been saying this around the office for a while, that value-based payments may punish doctors for poverty the same way that teacher evaluation systems punish teachers for poverty.

But Dr. Khullar is a doctor published in the New York Times, and I’m a pee-yoo-rocrat blogging for about 3 readers (hi guys!).

So not that I can do much about it, but I’ll spend my Fourth of July thinking about how to leverage health care funding streams to mitigate social inequity. Also cake. Happy Fourth.

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