Who's to blame for health care highway robbery?

H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is on to something. Writing in The New York Times on July 4, 2013, Welch says the cost of medical care in the United States is, or nearly is, criminal.  And he says care providers (hospitals, MDs, universities, and drug and device companies) "are the ones benefiting."

Right, but they're not alone.

Payers are part of the crew.
As a former employer, I know first hand what it costs for a small business to insure its employees. As a former employee of several large organizations, I know the deep discounts that big employers and government agencies qualify for—easily 50%—and pass along to their employees. 

Also, having worked for several insurance companies, or payers as they are becoming known, I've seen the other side. Maybe you have, too. If you get statements from your health insurance company, you can get a feel for how payors negotiate reimbursements with the some of the providers that Welch fingers. And if you read business journals or job postings, you know how health insurance is dominated by huge companies and can get an idea of the salaries they pay.

Small fry? You're screwed.
Add Welch's provider set to the payor set and WOW. Let's just say there's plenty of money being made on the backs of employers of all sizes, but mostly on the backs of the rest of us.

Small-fries pay through the nose: employers, people who buy their own insurance and, God help them, people without insurance who need medical care but don't qualify for free care.

What's wrong with this picture?

I do...I don't...

Ding-dong DOMA is dead! I'm still celebrating the Supreme Court's ruling that the Defense of Marriage Act is unconstitutional. I agree: the state can't marry some but not others based on gender. And I'm over the moon for the men and women I know,  as well as those I don't know, who are now free to tie the knot. 

For those who choose to marry, best wishes! 

For those who don't, welcome to the emerging majority!

More U.S. adults opt out of marriage
As reported by The Economist, the marriage rate is way down in the United States. Since 1960 to December 2011, the ranks of the married have slid from 72% to 51% of U.S. adults, while the never-married portion of the population has nearly doubled, from 15% to 28% of U.S. adults. Racially, today's paper-thin married majority of 51% breaks down to 55% of whites, 48% of HIspanics and 31% of blacks. If current population growth for people of color holds, the marriage majority will evaporate very soon.

Makes perfect sense to me.

La meme damn chose

Sorry! I didn't mean to disappear. Took me longer than expected to decide on, and navigate a job change. In the meantime, we have returned President Obama to the White House, managed to break the gridlock in Congress (on immigration reform of all things), and been buffeted and buoyed Supreme Court rulings. More on all of that later.

While plenty has changed since my last posting, we're still stuck in the Eisenhower era when it comes to gender coding of toys.

Deja vu all over again
As French critic-journalist Jean-Baptiste Alphonse Karr said, the more things change, the more they stay they same. Writing in The New York Times, Elizabeth Sweet reports the comeback of gender stereotyping of toys, ironically, as the presence of women in the workforce soars to more than 70 percent.

How do we get toy marketers to return to the enlightened 1970s, when Sweet says "very few toys were explicitly marketed according to gender." Maybe it's time we told toy marketers to stop dictating what constitutes "appropriate" play behavior for girls and boys.