Well, what can I say? Another fantastic voyage through rural America. I stand (can't sit after 513 miles) in awe of this great land.
I decided to slab it from Chicago through Indiana; to get to the good stuff.... The only downside to biking in Chicago is that you have to ride an hour and a half to get to something nice and rural. So, I did the obligatory 90/94 dance to northwest IN, then picked up 65 S to IN'apolis. As I mentioned, <classic> farmland slab (in need of repair).
I continued 65 S to Louisville. I could smell the fear and sweat from the ABR exam and slight chill ran down my spine despite the temp in the high 70's. At Louisville, I picked up the 64 E slab to Lexington. As nice a ride as slab can be. I passed, though did not visit, the Kentucky Bourbon Trail; something to be sampled, I'm sure, perhaps with RDC driving. I also passed the National Retirement Home for Retired Thoroughbred Horses. Had to stop and take a picture to show the REL. As I was stopped by the side of the highway, a very nice fellow rider (in military fatigues) stopped just to make sure I was OK. What a great gesture!
But that was just the start. Just east of Lexington, I picked up the Kentucky Mountainway (402) instead of slabbin' 75 S. In retrospect, the wisest decision I've made in quite some time... For this route, itself in great condition and equally adequatelly hilly and twisty, led me through Natural Bridge Resort State Park (I didn't see the bridge) to KY 11. KY 11 is, as my friend AP, also a rider, says, is a <little slice of heaven>. In addition to passing through small hamlets with names like, <travellers rest>, I had the opportunity to visit Morrocco (IN), Paris (KY?) and Egypt (KY) all in one day. Without even knowing exactly where I was going 11 led me to 30 led me to 421 all three winding their way to and through the Daniel Boone National Forest. A thousand shades of green surrounded me as I leaned into each and every curve. The road curves in all 6 degrees of freedom (if you count the bank of the road); truly a challenge. I could not have thought of a better training course for the Dragon that awaits me.
When my buttocks just couldn't take any more, I GPS'd the nearest hotel and followed the forest to Manchester.
Another note, I must have passed at least 500 bikers today; all out enjoying the beautiful day and the graceful curves of Kentucky.
To think, I get to do this again, tomorrow?!
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Sunday, May 31, 2009
Day 1, Mile 297 Near Louisville
The ride continues well. This part of Indiana starts to look like what I imagine Kentucky to be. Now scattered in amongst the corn and soybean farm there is the occaisional horse farm. Several with horses grazing at their leisure. The number of horse trailers on the road is increasing; as is the number of bikers! It is a glorious day for riding and everyone is taking advantage. Gas up and onward.
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Day 1, Mile 173 Indiana part 1
A quick jaunt through Chicago to northwest Indiana. 65 south to Indianapolis. A perfect day for riding: great weather, light traffic. Though the roads show numerous opportunity for <shovel ready> stimulus work.
The farmland is a patchwork of greens and brown. The air (beyond Gary) is clean and fresh.
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The farmland is a patchwork of greens and brown. The air (beyond Gary) is clean and fresh.
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Day 1, Mile 0: Home on the Range
It is a beautiful morning, the sun shining brightly in a clear blue sky. A welcome change after a long winter, and a rather cold and rainy spring. It is the perfect weather for an early start. The trajectory begins with a jaunt through Chicago to the Skyway. Down 65 to Indianapolis. More later...
4th Annual Ride-2-SIIM BEGINS!!
Well, it's that time of the year. Time to saddle up XRAY and take her through the Tail of the Dragon to the Society of Imaging Informatics in Medicine meeting, this year in Charlotte, NC!
"We do these things, not because they are easy but because they are
Friday, May 15, 2009
Tuesday, May 12, 2009
The Unfortunate Health Care Industry Letter
(Disclaimer: Though a physician, I am not and have never been a member of the AMA. This essay highlights one good reason why not. Of course, the Groucho Marx-ism also applies.)
There is a tremendous amount of hubbub surrounding a recent letter from the leadership of the American Medical Association, the American Hospital Association, the Advanced Medical Technology Association, the Service Employees International Union and America’s Health Insurance Plans to President Obama. In this letter,
There is a tremendous amount of hubbub surrounding a recent letter from the leadership of the American Medical Association, the American Hospital Association, the Advanced Medical Technology Association, the Service Employees International Union and America’s Health Insurance Plans to President Obama. In this letter,
"they are pledging to cut the growth rate of national health care spending by 1.5 percentage points each year — an amount that’s equal to over $2 trillion."
No one in their right mind does not recognize that the health care pie needs to be shrunk and that thereafter, growth of the pie needs to be constrained. Mr. Krugman, in a recent op-ed piece, is, to my mind, rightfully, skeptical. The crux, as he states so succintly, is,
"Remember that what the rest of us call health care costs, they call income."
There is no doubt that we, physicians, need to recognize that we need to shift the income, efficiency and accuracy curves toward the latter away from the former. If, as a medical student or physician that bothers you, then you should probably consider a career in widgets or plastics. The same can be said for health care institutions represented by the AHA.
The AMA and the AHA have, however, made a huge mistake in allying themselves with the rest of the industry. Of the six signatories of the letter, which one most clearly doesn't belong? The AMA represents (unfortunately) doctors. The AHA represents hospitals. One could argue that SEIU represents, at least, a class of patients. No question, these three need to be at the table.
But what about PHRMA and AMTA? As Mr. Krugman notes,
The AMA and the AHA have, however, made a huge mistake in allying themselves with the rest of the industry. Of the six signatories of the letter, which one most clearly doesn't belong? The AMA represents (unfortunately) doctors. The AHA represents hospitals. One could argue that SEIU represents, at least, a class of patients. No question, these three need to be at the table.
But what about PHRMA and AMTA? As Mr. Krugman notes,
"After all, several of the organizations that sent that letter have in the past been major villains when it comes to health care policy."
... and
"There’s also the Pharmaceutical Research and Manufacturers of America (PhRMA), the lobbying group that helped push through the Medicare Modernization Act of 2003 — a bill that both prevented Medicare from bargaining over drug prices and locked in huge overpayments to private insurers."
Yet, Phrma and AMTA, their drugs and devices, are critical components of healthcare. Their problem lies in capitalism. To misquote Churchill (“It has been said that democracy is the worst form of government except all the others that have been tried.”), "capitalism is the worst form of economic model for healthcare except for all the others that have been tried". In capitalism, "Greed is good", devices and drugs don't get inspected and tested as much as they should and not everyone can drive a Cadillac.
No, the real outlier, is AHIP, America's Health Insurance Plans. The health insurer's make no meaningful contribution to the delivery of health care. In fact, they are a barrier to the social contract between the provider and the patient. An expensive impediment at that. Once there is recognition that universal health care is a fundamental human right then we no longer need health insurers to profit from risk stratification; we are all in this together.
We need to grow beyond the fear-mongering myth that a single payor plan would mean "government control" of health care. As the recent financial industry meltdown showed, we just need responsible "government regulation" of a single payor system.
The AMA and the AHA were wrong to join in a letter with AHIP. They legitimized AHIP as part of the solution rather than exclude them as a source of the problem.
No, the real outlier, is AHIP, America's Health Insurance Plans. The health insurer's make no meaningful contribution to the delivery of health care. In fact, they are a barrier to the social contract between the provider and the patient. An expensive impediment at that. Once there is recognition that universal health care is a fundamental human right then we no longer need health insurers to profit from risk stratification; we are all in this together.
We need to grow beyond the fear-mongering myth that a single payor plan would mean "government control" of health care. As the recent financial industry meltdown showed, we just need responsible "government regulation" of a single payor system.
The AMA and the AHA were wrong to join in a letter with AHIP. They legitimized AHIP as part of the solution rather than exclude them as a source of the problem.
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