A Stream-of-Consciousness Health Reform Blog

April 23, 2010 – Stream-of-consciousness writing (SOCW) is spontaneous , emotional, and unstructured. You see stream-of-consciousness writing everywhere today – on Facebook, Twitter, and on blogs. Blogs are essentially SOCW on-line daily logs. They are about connecting with your interior universe.

Here’s my SOCW for today on health reform.

I spent the morning on the final editing of Health Reform Maze, my book out in June. It’s essentially about the ups and downs, ins and outs, complications and consequences of health reform.

I don’t think reform as presented in the law will work very well.

Its ultimate inner workings are up for grabs and will depend on the outcome of current budget debate and on the 2012 Presidential election. The big issues will be soaring cost, State’s rights, the law’s constitutionality, taxing the haves versus providing for the have-nots, and how to cut Medicare and Medicaid costs and benefits without outright rationing or human creulties.

I have no idea about reform outcomes, but I know some sort of reform is necessary. I lean towards incremental market reforms. I like the idea of a double mandate with a lid - a national privately-run system with universal coverage, health plans being forced to accept all comers, and a catastrophic ceiling after which government subsidies kick in. Health savings accounts and vouchers and block grants may hasten the process. Some sort of government oversight, a health SEC, will probably be necessary, but government ought to oversee with a light hand, and let markets do their wonders.

My 53 year niece is dying of rapidly progressive pancreatic cancer. It is terribly sad situation. There is no hope for her, and I’m not at all confident we have a solution to pancreatic cancer in the near future. The solution may be genomic.

It is the day before Easter, and all I can do is to pray for her and pray that research will pay off soon. In the end, spiritual solace, pain relief, and comfort are the best we can offer her and others with terminal pain,

There is not much physicians can do about health reform. We can object to the cost of the present law. We can complain about its onerous regulations and its proposed “innovations,” which are mostly about models restricting the economic behavior of doctors by herding them into new business models with restricted budgets.

Doctors will react in two ways – one, by becoming employees of hospitals and two, by bailing out into concierge practices and other innovative models free of third party payment schemes.

For existing models in which doctors stay in practice, surviving will be all about productivity, efficiency, and practice management dominated by IT applications. I do not believe we will soon have a national inter-operative electronic system connecting everybody with everybody else real-time unless so-called Cloud Computing, off-loading software and hardware onto off-site Internet systems catches on big time at a price hospitals and doctors can afford. It might.

The search for productivity takes strange twists and turns. Doctors, slowed by as much as 30% by the time it takes to enter data into electronic medical records, are turning to humans to speed things up. Doctors are hiring “medical scribes” to transcribe for them. One California-based scribe company, ScribeAmerica, has 800 employees in 21 states. Another, PhysAssist in Fort Worth, has 600 employees. Mostly ER doctors are hiring scribes, but other specialists, like ophthalmologists, are hiring scriveners too, usually young people interested in a medical career.

If you the doctor are slowed by an e-medical record.
And you seek to have your former productivity restored.
Consider hiring a medical scribe.
The scribe will promptly transcribe.
And you will no longer be slowed by the keyboard.
In other words, humanly restructure,
with less electronic infrastructure.

Thus ends my spontaneous outburst.