Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, October 1, 2013

Pick Two

Many years ago, I watched a Showtime special, with the comedian, Yakov Smirnoff, doing a one man show. He ended with a Q&A session:

Q: Is your name really Yakov Smirnoff?

A: No, it's Jack Daniels.

Q: What's health care like in the (former) Soviet Union?

A: Well, it's free. And you get what you pay for.

C'mon, people. This is where the US is headed. Remember the Design/Engineering adage?

Good, Fast, Cheap. Pick Two

Here are a couple of articles to check out:

Lower Health Insurance Premiums to Come at Cost of Fewer Choices

'Affordable Care' or a Rip-Off?

I've said it before but it bears repeating. Coverage does not equal care. The Affordable Care Act may make it possible for people to buy a plastic card with a number that they can give to doctors and hospitals. This doesn't mean they'll get good care. It doesn't even mean they'll get any care.

'“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”'

Good, Fast Cheap. Pick Two.

Get the picture?


  1. Really like the diagram. After seeing managed care in action - I think it comes down to picking 1. But then again their "good" is usually from a PR perspective as in let' do exit interviews on the patients after they are read scripts so that they will rate us more highly. Maybe you need to add a "perception of good" bubble to the diagram for that reason.