General


Unreasonable Health Choices

Long before reaching 65, most people know all too well the costs of decades of going against their own best interests by engaging in practices they knew carried risks for their health – as with smoking or overeating. In at least some respects, they resonate to Oscar Wilde’s “I can resist everything except temptation.” Even […]

Balancing adequacy and sustainability: lessons from the Global Aging Preparedness Index

The world stands on the threshold of a stunning demographic transformation brought about by falling fertility and rising life expectancy. It is called global aging, and it will challenge the ability of many countries to provide a decent standard of living for the old without imposing too big a burden on the young. The GAP […]

Japan – and then there was one

Population: 127.4m 65 years and over: 23.9% Life expectancy at birth: 83.9 years Population in 2050: 99.7m Everybody knows that Japan is ground zero for global ageing. The youngest of the developed countries as recently as the mid-1970s, it is now the oldest – and its age wave will continue to roll in for decades […]

Reimagining Geriatrics

A little over a year ago, I found myself burning out and realized that my work life was unsustainable.  I’d been working at a Federally Qualified Health Center, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around […]

Preparing for the Final Exam of Life

Recently, I was taken aback by being asked to deliver the memorial eulogy for our departed classmates at our upcoming 50th year High School Reunion. Why me, I asked? Isn’t there a Priest or Rabbi in our class who is used to doing something like this? That question not only did not seem to matter […]

Public pensions need to evolve

The Ontario Teachers Pension Plan recently released a new documentary on the sustainability of pension plans titled “Pension Plan (ev e looSHen).”  It presents interviews with practitioners and experts from Canada, the United States, and The Netherlands.  The tone and conclusions of the film really resonated with me. The theme of the documentary is that […]

Two Common Sources of Overtreatment

Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is “waste.” At the very least, “waste” is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well. I recently saw a friend at a party. Since […]

How Hospital Care Should Work

This is a corny essay by a man who, having recently undergone surgery, was reminded of those people who, in tending to our health, urge us to focus on what issues properly define life.  First it was the emergency room where I observed the palpable concern on the face of a woman whose only job […]

Ageism and Social Insecurity

Right after this New Year, when we all became a year older, a headline in the January 3rd Chicago Tribune grabbed my attention. “Congress problem? Aging America. Budget debate is really about the needs of baby boomers vs. younger generations: Safety needs for seniors vs. jobs, education.”