#libby watson

Here’s a list of people Dan and Phil should have on their podcast:

Manifesting Dan and Phil on Charlotte McDonnell’s new podcast.

I’ve always thought there’s a sort of spiritual element to really severe migraines, or at least some brain chemical interaction that replicates spirituality; certainly there’s some mental thing going on beyond pain that makes you feel trapped in a sort of eternal prison, like you’ve always had a migraine and you’ll always have one. This is part of what migraine sufferers mean when we say it’s not just pain, not to minimize how bad pain is. You pass into another realm, where misery mediates every sensory experience.

I’m not convinced that switching to value-based payments, which reward hospitals for improving outcomes and reducing readmissions, wouldn’t just punish poorer hospitals and further encourage better-off systems to focus on the wealthy and healthy; switching hospital financing alone can’t fix the myriad health problems that drive these inequalities in the first place, like food deserts and shitty jobs and thousands of other social determinants of health. You can be the best doctor on Earth, but if you treat someone with four chronic conditions who can’t quit their job at the Carcinogen Inhalation Facility without losing their bad health insurance, you’re fighting an uphill battle.

I bring this up because of a study released this week by friend of Sick Note Adam Gaffney et al, which demonstrated that though Americans spend more time with doctors than they used to, they spend less time with primary care doctors and more time with specialists. This is not because visiting specialists is a better way to stay healthy, or a more efficient way to run a healthcare system. But providers, particularly hospital systems that also own primary care practices, do make more money this way. You see a hundred people on the street a day here who desperately need just a little bit of routine primary care; clinics like the Remote Area Medical one pictured above fill up with hundreds of people who couldn’t afford to see any doctor, let alone a precious specialist, for years. We can’t find a way to fill that need, but we can funnel comfortably resourced white ladies with computer jobs and mild hypochondria to four separate specialists in ten minutes. That’s innovation, baby.