Thursday, August 30, 2012

What’s It All About?
August 30, 2012
What is it all about?

What is it of thee you shout?

Is it the economy stupid?

Is that your true cupid?

Is it your ideology ?

It that your reality?

Is it personal likability?

Or impersonal desirability?

Is  it  the country’s misdirection?

Are we at a critical intersection?

Is it Medicare?

Is it Obamacare?

Is it  abandonment,

Of the next generation?

Is it individualism?

Is it  collectivism?

Is it enterprising innovating entrepreneurs?

Or is is bureaucratic regulating saboteurs?

Is it freedom and democracy?

Or serfdom and autocracy?

Is it Big Brother?

Or one another?

What, in your parlance,

Is the proper balance?

 What’s it all about?

What is it of thee you shout?

When push comes to shove.

What and who is your turtle dove?   

Wednesday, August 29, 2012

Republican Message-  Put Aside Poetry,  Govern in Prose

You campaign in poetry but govern in prose. The poetry of campaigning is lofty, gauzy, full of possibility, a world where problems are solved just because we want them to be and opposition melts away before us. The prose of governing is messy and maddening, full of compromises and half-victories that leave a sour taste in one's mouth. Governing is specific where campaigning is usually vague.

Paul Waldman, “ Campaign in Poetry, Govern in Prose,” American Prospect, November 10, 2010
August 29, 2010  - No doubt  you  have your  favorite line from last night’s Republican convention from speeches delivered  a host of GOP governors,  the bevy of female speakers,  Ann Romney, and Chris Christie, the tough-guy governor of New Jersey.
However, my favorite line came from Artur Davis (born 1967),  who served as a Democrat  in the House of Representatives from Alabama from 2003 to 2011. Davis converted to the Republican Party earlier  this year.  

His comment, which follows, is noteworthy because Davis  is black and seconded President Obama’s nomination  in 2008. 
Of his initial backing of  Obama,  Davis said,
“Do you know why so many of us believed? We led with our hearts and our dreams that we could be more inclusive than America had ever been, and no candidate had ever spoken so beautifully," said Davis, the Harvard-educated lawyer who has been mulling a run for office as a Republican from his new home in Virginia.
Then came his punch line,
"Let's put the poetry aside, let's suspend the hype, let's come down to earth and start creating jobs.”
This line struck me as emblematic of  the whole theme of the Convention.
Let’s put aside the gauzy poetry.
Let’s talk about the hard facts and tell the hard truths about.:

·         The $16 trillion dollar deficit.

·         The 23 million unemployed, underemployed, and those who have stopped looking for work.

·         America’s dismal future as we approach the fiscal cliff.

·         The replacement of physicians by bureaucrats bearing metrics, protocols, and algorithms.

·         The shrinkage of the middle class with its loss of income and hope.

·         The record low in small business startups and the record number of regulations strangling them.

·         The distrust of big government and fear of  losing personal freedoms to Big Brother.

My reaction may surprise you.   I occasionally write verse, and my son Spencer is a nationally known poet, who may someday become the poet laureate .
Perhaps in November,   President Obama’s poetic style of  campaigning will triumph.   Perhaps at next week’s Democratic convention in Charlotte,  speakers will deliver memorable lines that will resonate with poetry verse   that will  splat  “You didn’t built that” against the wall.  Perhaps government knows best for the rest of us.
Tweet:    Republicans say  they will govern in prose –telling the hard truths , making  the tough decisions, and putting the poetry aside.


Tuesday, August 28, 2012

The Health Reform Gospel
Go ye into the entire world, and preach the gospel to every creature.
The Holy Bible: Matthew
August 28, 2012 - President Obama has remained strangely silent about Obama care’s virtues, perhaps because of its unpopularity, so it remains for others to bring his gospel to the masses.    One articulate spokesman for Obama’s health law is David Nash, MD, MBA, dean of the Jefferson School of Population Health in Philadelphia
Here, in an editorial in the summer 2012 issue of Prescriptions for Excellence in Health Care, a newsletter supported by E.L. Lilly USA, LLC, Nash explains why implementation of the law is needed now – to improve the health of the population and quality of care.
While I believe the consequences of Obamacare outweigh its benefits, it’s important to hear the other side of the argument.  These are selected excerpts from Nash’s editorial “Population Health and Health Reform – Inseparable Concepts.”
“With 45% of us suffering from at least 1 chronic condition and more than 49% million of us lacking health insurance, the need for a population health approach has never been more urgent.”
“Population health takes aim at some of the basic shortcomings in our traditional health care delivery system: namely, enhancing health and wellness through prevention and lifestyle changes, reducing and eliminated waste and errors, eradicating disparities, improving transparency and accountability, and improving care coordination – a goal shared with health reform.”
“How does  the Patient Protection and Affordable Care Act (ACA) incorporate the principles of population health?  First and foremost, it creates a new framework for health care delivery in the United States by adopting a comprehensive national strategy for quality improvements, the which is clinically integrated systems-based practices.  This should result in care that is coordinated across all diseases, providers, and care settings over time. Importantly, hospitals and health systems will be required to extend their quality oversight processes as they pose collaborative relationships with physician and other entities.”
The Accountable Car Organization (ACO) program, a prominent feature of the ACA, will have a major influence on extending quality oversight processes to putpatient settings, which is where Americans receive the overwhelming majority of their health care services.  A shared savings move, the ACO will require participating providers to use the tools of population-base care to achieve the cost savings necessary for success.”
The patient-centered medical home and ACO models that feature prominently in health reform contain aspects of care deliver that fall under the umbrella of population health.  These efforts and related new payment models are an attempt to identify and  eliminate inefficiencies in the system. “
“Rather than simply following the rules of reform, health care leaders must fully understand and follow the intricately  related tenets of population-based care as these will have a major influence.”
There you have it: the basic tenets of the Obamacare gospel.
This lofty rhetoric on Obamacare goals and difficulties of implementation  remind me of the story of the husband and wife watching their children play in the newly laid concrete in the sidewalk in front of their home.  The husband is livid with rage.  The wife says, “But Dear, I thought you loved children.”  He responded,” In the abstract, but not in  the concrete.”
Tweet: The goals of Obamacare – to improve the health of the American population and to impove its quality- are admirable, but hard to implement.

Monday, August 27, 2012

Unintended Obamacare Consequence:  Increased Charges for Services of Hospital-Employed Doctors

Same Doctor Visit, Double the Cost: Insurers Say Rates Can Surge After Hospitals Buy Physician Practices; Medicare Spending Rises, Too
Anna Wilde Mathews,  headline, Wall Street Journal,  August 27, 2012, Marketplace Section Article

August 27, 2012 – In my book The Health Reform Maze: Blueprint for Physician Practices (Greenbranch Publishing, 2011), I devote a number of chapters  to an unintended consequence of Obamacare - higher costs across the board.  
One of these consequences is twice the rate of charges of hospitals for employed doctor services  as independent doctors for procedures or visits  performed by the same doctor, for the same procedure , for the same visit ,  often in the same location  where the doctor previously practiced independently. 

This  same-o rise-o is becoming commonplace. More than half of physicians are now hospital employees, and, according to Merritt Hawkins, the big physician recruiting  firm, the number of employed doctors may grow to 75% of all physicians in the next decade.  Charges for physician services, in other words, are likely rise for 75% of physician services.
In the words of the WSJ article.

"As physicians are subsumed into hospital systems they can get paid for services at the systems’ rates, which are typically more generous than what insurers pay for independent doctors.  What’s more, some services that physician previously performed at independent facilities, such as imaging scans , may start to  be billed as hospital outpatient procedures, sometimes more than doubling the costs."
Here are five examples: of these increased costs:

One, diagnostic colonoscopy,  doctor’s office, $402,86, hospital facility, $876.45,  118% increase
Two, electrocardiogram, doctor’s office, $19.06, hospital facility, $35.28, increase 85%
Three,  cardiac nuclear imaging, doctor’s office, $503.41, hospital facility, $749.65, increase 49%
Four,Chest x-ray with dye,  $292.72, hospital facility, $361.35, increase 23%
Five,   Medicare charge for 15 minute doctor visit,  $70, for hospital-outpatient visit, $124, increase, 77%
Source:  Advisory Board Co.
How can this be?  After all, Renown Health, a hospital system in Reno,  Nevada, says of its owned cardiologists, hospital employment helps “eliminate duplication, improve coordination, and reduce hospitalizations.  With more proactice management for patients with heart disease, we are working to improve the health and well-being of our patients.”
Such much for good intentions.   This point of view  overlooks the obvious:  under Medicare, hospitals charge a “facility fee: ” for maintaining the buildings and grounds,  for covering  the cost of losing services and uninsured patients, for  the administrative infrastructure required to meet government regulations, for paying Medicre penalties for 30-day readmisions All of this  costs money. 

Besides, a hospital with dominant market share with monopolistic facilities and doctors can negotiate higher prices.  Also hospitals recognize that  doctors working for a hospital tend to work shorter hours with higher benefits and in general and tend to be less productive than they were in independent private practice. Hospitals insist that  even with increased prices, they must struggle to break even on acquired physicians and may end up by decreasing physician incomes
The moral of this story may be: With health reform, the more things change, the more they remain the same and the more they cost.
Tweet:   As hospitals acquire more physician practices,  the higher the costs of physician services become.

Spreading the Mayo
August 27, 2012Kaiser Health News has a policy of offering its content free as long as one gives Kaiser Health News credit for reproducing the material.   The following article appeared in the August 23, 2012 issue of Kaiser Health News.  Mayo has a great idea here, indeed a terrific innovation, and it deserves to be commended.
Mayo Clinic Seeks To Extend Its Reach With Series Of Affiliations Around The Country
By Judith Graham
After three hours of difficult labor, the new mother had a vaginal injury unlike any that Dr. Michael Brown had seen before. It wasn’t life threatening, but it was uncomfortable. The obstetrician turned to his computer and searched the medical literature. Nothing relevant came up.
Then, he put in a request for an electronic consult with the Mayo Clinic, which has an affiliation agreement with his Grand Forks, N.D., hospital. Within 24 hours, a Mayo obstetrician got back to him, telling him about a similar case he had consulted on in Duluth, Minn.
Brown treated the woman as recommended and three weeks later she had recovered. "For a bread and butter obstetrician like me, it's amazing to feel that the Mayo Clinic has your back," says Brown, who's 62 years old and also the mayor of Grand Forks, a small city that hugs North Dakota's eastern border.
It's examples like this that the Mayo Clinic hopes to foster is as it rolls out a new strategy of affiliating with hospitals and health systems across the country, a response to a chaotic healthcare environment.
Capitalizing on its reputation for top notch medical care, Mayo previously relied primarily on patients traveling to its main campus in Rochester, Minn., as well as satellite campuses in Jacksonville, Fla., and Phoenix and Scottsdale, Ariz., and a regional health system it has built in ­­­­­­­­­­­­­­­­­Wisconsin, Iowa and Minnesota.
"Our model has been that the patients come to us," said Dr. John Noseworthy, Mayo's president and chief executive officer, at a February press conference. "Increasingly, going forward … we also wish to extend the reach of the Mayo Clinic, taking our knowledge, taking our experience, and sharing it with others."
For new affiliates, that means getting quick access to consultations from Mayo specialists and to an electronic database in which clinic physicians share cutting-edge medical information, as well as periodic advice about how to improve operations, for an annual subscription fee.
For May, "it's a very smart market preservation and expansion strategy in a reforming marketplace," says Daniel Zismer, director of the master of health administration program at the University of Minnesota School of Public Health.
The strategy could be risky, potentially diverting management's attention away from the clinic's core business and diluting the value of its sterling brand, says Allan Baumgarten, a Minneapolis healthcare consultant. Yet business-as-usual is also risky in this era of health reform, notes Tom Cassels, executive director of research at the Advisory Board, a Washington, D.C., consulting company.
And Mayo isn't alone in seeing new opportunities. Other well-known medical centers such as the Cleveland Clinic, M.D. Anderson Cancer Center in Houston and Geisinger Health System in Danville, Pa., have been pursuing a similar affiliation strategy. "We're all striving to find the model of medical care that will be most effective for tomorrow," says Fred DeGrandis, head of the Cleveland Clinic's Community Physician Partnership and Quality Alliance.
Mayo has captured the most attention because it's been moving more aggressively than other systems in the past year, triggering speculation about the nature and extent of its ambitions.
Changes In The Marketplace
Across the country, hospitals and healthcare systems are buying up physicians' practices and merging and acquiring each other at an accelerating rate under the assumption that consolidation will help them survive and thrive.
Some of those changes have been prompted by the federal health overhaul signed into law in March 2010. Even if Republicans prevail in turning back that law, several health policy experts predict that this massive restructuring of the healthcare marketplace will likely continue.
That could have a negative impact on Mayo, which serves more than 1.1 million patients a year and relies on referrals from medical providers throughout the U.S. With consolidation and a related trend -- the creation of new medical networks that operate like managed care plans -- providers may be less willing to continue sending patients to the clinic. "When you look at Mayo’s depth of sub-specialization, they need a vast market to draw patients from, and access to those patients is a concern right now," Zismer said.
But fear isn't driving Mayo's new strategy, executives insist. They say the clinic wants to be a leader in the effort to get hospital and physician groups to work together more effectively to improve quality and lower costs. "It’s all about how do we build a sustainable, high value health care system," Dr. Noseworthy says.
With affiliations, which don’t require significant capital investments, Mayo has plenty of money to invest in new medical services technologies, such as proton beam accelerators going up in Arizona and Minnesota, other experts note.
The vehicle for those affiliations is the year-old Mayo Clinic Care Network, which now includes seven members and is poised to expand further. Current members are NCH Healthcare System of Naples, Fla.; Dartmouth-Hitchcock of Lebanon, N.H.; Altru Health System of Grand Forks, N.D.; Arizona State University Health Services of Tempe, Ariz.; Heartland Health of St. Joseph, Mo.; Kingman Regional Medical Center of Kingman, Ariz.; and Sparrow Health System of Lansing, Mich.
How The Network Operates
Affiliated physicians get the ability to consult electronically with Mayo specialists about patients who are difficult to diagnose or treat, usually within about 24 hours. (Clinical information is shared electronically through a custom-designed, web-based system, and if physicians need to talk they do so.) Essentially, these patients go to the front of the line, ahead of other people seeking Mayo Clinic consultations. Plans call for shortening the timeframe even further, and "we’re working on real-time e-consults," says Mary Jo Williamson, the network’s administrative director.
The relationships don't revolve around securing a steady stream of patients for Mayo from other health systems, officials say. "They haven’t been aggressive about pushing referrals," says Brian Turney, chief executive of Kingman Regional, which has brought six Mayo-trained radiologists onto its staff since announcing the affiliation last October.
Altru Health System is actually sending fewer patients to Mayo's medical campus in Rochester, 400 miles away, than it had before the affiliation. "We're bringing Mayo Clinic knowledge and expertise here instead of patients having to go there to get it," says Dennis Reisnour, chief planning executive of Altru, which owns an acute care hospital, a rehabilitation hospital and more than a dozen clinics in the Grand Forks region.
Choosing whom to affiliate with is important, and Mayo staff carefully vet candidates to determine if they’re financially stable, well run, and if their values and medical culture are compatible. While affiliates can advertise the relationship, they can’t claim they’re officially part of the Mayo Clinic. (That designation is reserved for facilities Mayo owns and operates.) Altru hopes the arrangement will allow it to remain independent and "continue to do better in a changing world without being owned by a bigger provider," Reisnour says.
In exchange, "we would hope that they will think of us if a complex patient needs to leave the community," says Dr. David Hayes, medical director of the Mayo Clinic Care Network.
Also, affiliates get access to AskMayoExpert, an extensive Mayo-created database that includes so-called "care pathways" spelling out what should be done, when, and how for patients with various medical conditions. And they receive consulting services from Mayo experts on matters such as improving patient satisfaction, creating better systems to monitor quality care, or building medical teams that collectively manage patients.
For example, Arizona’s Kingman Regional Medical Center has started employing more physicians, and it wants them to better coordinate medical services. Mayo pioneered integrated, team-based care, and several of its doctors are advising Kingman about strengthening physician leadership.
But collaborations work both ways, and Mayo stands to be benefit from them as well. The clearest example of that is Mayo’s recent affiliation with Dartmouth-Hitchcock, an academic medical center known for groundbreaking studies of varying medical practice patterns and their impact on the health of large populations. Both organizations are members of the High Value Healthcare Collaborative, a group of major medical centers established last year to share data about medical practices and outcomes.
"We can help (Mayo) on the analytic side because our expertise is how you look at populations and measure outcomes, the value of care, and the cost of care. And they can help us learn about the science of execution in the delivery of healthcare," said Dr. James Weinstein, Dartmouth-Hitchcock’s president and chief executive.
Dr. Weinstein's view of the future and the potential of this collaboration is radical. "My vision is that we're going to have 15 major (healthcare) systems in this country," he says. "We can’t support 5,000 hospitals, all of them doing their own thing."
Still unresolved is whether Mayo will join with its affiliates in accountable care organizations or other new structures being promoted under the federal health law to care for patients while assuming financial risk. Officials say that’s not the goal of the Mayo Clinic Care Network, but they don’t rule out the possibility altogether.
"Let’s face it: We don’t know where this is going to go, but this gives us more flexibility in terms of figuring out how to work in this new environment," says Dr. Noseworthy, Mayo’s chief executive. Of more immediate importance, he says, is "learning from affiliates and sharing with them our best knowledge" as new models of medical care are develope
The point is echoed by the Cleveland Clinic as well. With affiliations, that Ohio-based organization can expand its research efforts and clinical trials to a broader population, says DeGrandis, chair of its community partnerships. "As you provide more and more service in a clinical area, there’s more and more learning, and the opportunity to provide that care more effectively increases."
Tweet:  Mayo Clinic Is spreading its expertise and reach  by offering e-consults to affiliated clinics in the rest of the U.S.

Fixing Obamacare’s Broken Promises
Hell’s broken loose.
John Milton (1608-1674), Paradise Lost

August 27, 2012 -  These days you often see the word “broken.”
The U.S. health system is said to be “broken.”
In the movie Hope Springs,  a marriage is said to be “broken.” The marriage is compared to a deviated septum. The marriage counselor  says the only means of fixing the nose  is to break it and start all over.
And,  of course,  the promises of Obamacare are said to be “broken.” In the August 26 National Review Grace-Marie Turner of the Galen Institute gives “An Overview of Obamacare’s Broken Promises.” It needs to be said that promises were not necessarily broken because of flawed policies,  but because of circumstances beyond anyone's control.
A few of these broken promises include:

·         Health insurance: “If you like your health insurance, you will be able to keep your health insurance” — when at least 20 million people are likely to lose their job-based health insurance, according to the CBO, and as many as 80 million people could be forced to switch plans to comply with Obamacare, according to McKinsey.

·         The deficit: “We will not add one dime to the deficit.” If the president wants to use the Medicare-savings provisions to extend the life of the Medicare trust fund and not to fund the new entitlements created by the law CBO estimates the fiscal impact would be “a net increase in federal deficits of $260 billion” through 2019.

·         Health-care costs: Mr. Obama promised during the 2008 campaign that, under his health reform plan, health-insurance premiums would go down by $2,500 a year for every family by the end of his first term. But they actually have gone up by nearly as much — from $12,680 in 2008 to $15,073 in 2011.  During the past four years, the average family has spent a total of $12,230 more on private health insurance, while the average individual has spent $4,163 more.

But how do you fix the health law’s broken promises?

Hint: It won’t be easy even if Mitt Romney is elected and repeals Obamacare as promised.

In “Romney’s First 100 Days, ” in David Leonhardt, the Washington Bureau Chief  of the New York Times, speculates Romney  may use the Reconciliation process, under which filibusters are prohibited and only a simple majority of 51 Senate votes, rather than 60, is needed.  Republicans could not repeal all of the health law with reconciliation, but they could undo most of the insurance expansion which relies on government subsidies for the uninsured.  And they could, perhaps, restore much of that $716 billion taken from the Medicare fund to finance Obamacare.   They could  shrink Medicaid.  Ryan’s budget envisions 75% less Medicaid spending.  Federal spending now makes up 22% of the American economy, compared to 3% a century ago.  The choice will be to continue expanding spending on Medicare and Medicaid, which make up the bulk of government spending,  Or, says Leonhardt, “as a Romney administration would, it can take a more laissez-faire path than any  wealthy country has previously tried.”

Tweet:  Obama has broken his promises to being able to keep your doctor, on not adding a dime to the deficit, and on cutting  premiums by $2500.



Sunday, August 26, 2012

Medicare Advantage Plans: The Facts

Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.
John Adams (1735-1826), In defense of British soldiers involved in Boston Massacre (1770)
Now, what I want are Facts. Facts alone are wanted in life.
Charles Dickens (1812-1870)), Hard Times (1854)

August 26, 2012 -  A good friend and I were having a spirited discussion about Medicare Advantage Plans. I insisted Obamacare doomed these Plans.   My friend said it was a good thing because the Plans cost too much.
As it turned out, we were both wrong. Medicare Advantage Plans have grown 60% in last 5 years, a good part of it since Obamacare was enacted 2 ½ years ago,   Medicare Advantage premiums are down 7 percent, and enrollment is up 10%. More than one-fourth of Medicare’s 50 million enrollees now participate in Medicare Advantage Plans, with more certain to come.
A premise of the health law is that consumers will benefit from market competition, as they have.  The government will set up markets, known as exchanges, where seniors can shop for private insurance and get subsidies to help pay for them. In the traditional fee-for-service Medicare, government bears the financial burden. Under Medicare Advantage, private insurers share the burden.  Government and private plans  compete.
Democrats were full of dire predictions about market involvement in Medicare.  Democrats claimed competition, engineered by avaricious private plans, woulf  increase costs, even though costs of the Medicare prescription drug law, passed in 2003, are 30% less than predicted. 
This 30% decrease in projected costs , over the course of nearly 10 years,  has startled Democrats who predicted adverse effects.  Nancy Pelosi in 2003 proclaimed“Most seniors will be worse off.  This is the beginning of the end of Medicare as we know it.”  Senator Tom Harkin of Iowa said,  “We hear the claims that private-sector competition will draw down costs and save Medicare.  Nonsense !”  Worse yet for some Democrat doomsayers,  seniors are leaving traditional Medicare, "Medicare as we know it," to join private market-driven plans created and managed by evil HMOs.
Government control vs. market competition sometimes makes for strange bedfellows and unexpected results.
Source:  Robert Pear, “Despite Democrats’Warings, Private Medicare Plans Find Success, “ New York Times,  August 26, 2012.
Tweet: Both political parties are mostly satisfied with private Medicare Advantage and drug benefit plans despite dire predictions to the contrary.

Saturday, August 25, 2012

Humor – and Lack of It – in Presidential Campaign

One man’s sense of humor is another man’s sense of humus.
August 24, 2012 –  To  Mitt Romney’s remark in Michigan yesterday about himself  and his wife, Ann “ No one ever asked to see our birth certificates.  They know this is a place where we were and raised”, Obama’s campaign retorted angrily, “ Romney embraced the most strident issue in his party instead of standing up to them.  Embracing unfounded conspiracy theories distracted from the real issues. America doesn’t need a birther-in-chief.”
To the "birther-in-chief" retort,  Romney responded, “I’ve said throughout this campaign and before.  He was born in the U.S.  This was fun about us and coming home.  And humor, you know, we’ve got to have a little humor in this campaign.” 

A little humor may be in order, but so far Romney’s humor often comes across as wooden and forced and not his strong suit.
Humor is tricky.  As humorist E. B. White said, “Humor," said White, "can be dissected as a frog can, but the thing dies in the process, and its innards are discouraging to any but the pure scientific mind."
But as Peggy Noonan said of Romney in today WSJ,”America Meets Mr. Romney,"
He must use humor, for three reasons. One is that wit breaks through and sharpens all points. Another is that it is natural to him. Before the voting in Iowa, he wryly told a friend that the caucuses were like the LaBrea Tar Pits: "No one comes out the way they went in." On a conference call recently, he asked a question of his staff. No one answered. Mr. Romney waited. "Bueller? Bueller?" he said, in a perfect imitation of Ben Stein. “Third, President Obama can't stand to be made fun of. His pride won't allow it, his amour propre cannot countenance a joke at his own expense. If Mr. Romney lands a few very funny lines about the president's leadership, Mr. Obama will freak out. That would be fun, wouldn't it?”
Why is Obama so sensitive and so easy to outrage? 
  • It may come from his background.   In the film "2016," now in local theatres,  based on Dinesh Souza’s book,  The Roots of Obama’s Rage," the narrative is that Obama was born in Hawaii, but harbors strong  anti-colonialism beliefs from his time spent in Indonesia,  from visits to his father’s homeland, Kenya, and from his work as a community organizer in Chicago.  These beliefs are that wealthy developed nations got where they are by pillaging  poor nations and that individual wealth in America depends on bilking and robbing the poor.  That one of his first acts as President was to send the bust of Winston Churchill, whom he regarded as a greedy colonialist, back to regarded by some as evidence of his mindset.
·         It may also come from tDemocrat Party  believers who assert that  they, and only they,  are to be taken  “seriously” as the governing party, as the “serious” protectors of the underclasses, which includes the middle classes, of America; and as the only "serious "intellects.  Their political opponents, they maintain, represent the wealthy and business classes,  who are only interested in exploiting  the rest of us.  Consequnetly, Democrats tend to be devoid of a sense of humor and are unduly defensive and sensitive to any humor used to portray them as reckless 'tax and spend liberals" or as proponents of the philosophy,“Damn the Deficit, Full Speed Ahead."  We shall see how this line of thinking plays out in the November elections.
Tweet:  Romney’s remark about his and wife’s birth certificates triggered outrage among Dems who saw the remark not as  humor but as a smear.



Friday, August 24, 2012

Interview with Unconventional Health Care Reformer
Keywords; Entitlement programs,  political conventions, health reform,  lower costs, health savings accounts,  health access, consumer cost-sharing
It is not difficult to be unconventional in the eyes of the world when your unconventional is but the convention of your set.
Somerset Maugham, MD, (1874-1965),  The Moon and Sixpence
Q: As the Republican and Democrat conventions approach, you claim to be unconventional in your thinking on health reform. 

Just how unconventional are you?
A:  Very.   I think unconventionally.  With either party, The  only thing I agree upon is that Obama and Romney have vastly different visions.
Q:  How different ?
A:  Obama says government should run the show. Romney says the market should.
Q: What’s your vision?
A: A little of both.  Government could define  the overall benefits , but the market should compete on the bid. 

Also untold stores should be told.
Q: And what are those untold stories?
A:  I’ll give the top six.
One, that open-ended entitlement programs in the U..S. and Europe and elsewhere, are unsustainable and a leading cause of the international recession.    Inevitably,  universal social welfare programs collapse because of overpromises and underdelivery of ehalth services..
Two, that universal coverage programs produce long waits for care, rationing, and poor results for cancer, heart disease, diabetes, and disabling joint diseases.
Three, that centralized government programs can’t anticipate or control or even distribute care at the level of the market and inevitably limit freedom of choice.
Four,  that in the U.S. the health care and medical industries are the most productive economic sector  in terms of employment and create positive rather than negative economic impacts for communities.
Five, that the Obamacare strategy of cutting hospital revenues and doctor incomes by 40% over the next ten years are a recipe for a huge health care access crisis in 2014 and 2015 with a massive doctor shortage.
Six, the only way to truly cut health costs is to have consumers and employees know and share some of the costs out of their own pocketbooks.  As Milton Freidman said,  “There is no such thing as a free lunch.” But there is something known as the third rail of American politics – touching the third rail, known as free entitlement programs, and getting electrocuted and run out of politics on the third rail.
Q:  So how do you avoid being electrocuted?
A:  By giving Americans the facts- that the end result of “free” entitlements is loss of individual freedoms and  the path to national bankruptcy.  Medicare and Medicare now contribute  47% of the national debt, and are on the way to 90% if left unchecked. Medicare and Medicaid will sooner or later crowd out equally  worthwhile uses of government money – like roads, bridges, education, and the military.
Q: What can doctors do about this?
·         We can point out adverse consequences of Obamacare.

·         We can acquaint ourselves with the true costs of care – like excess administrative expenses, brand name drugs rather than generics,  life style excesses and abuses, lack of timely preventive measures – and direct our patients towards lower-cost solutions.

·         We can lobby  for expansion of health savings accounts and we can pull out of 3rd party arrangements that increase our overhead, take time away from patients, and artificially increase costs.

·         We can tell the public, legislators, and reformer that we can no longer afford to care for Medicare and Medicaid patients, and will no longer accept new government program patients.

Q: But isn’t accepting needy government patients not only unconventional but unacceptable for a healing profession.  Doctors are supposed to altruistic – caring for the sick, the disabled, and the poor- regardless of ability to pay.
A: Tell that to our creditors, medical student loan collectors, and colleges where we want to send our children.
Q: And what should physicians tell the public?
A: Tell them the U.S. cane no longer afford open-ended entitlement programs that crowd out money for research, education, infrastructure, the military, and other social welfare programs.
Tell them you cannot afford to accept new government progams that do not pay enough to cover your overhead.
Tell them that they are going to have to share and know the true costs of care. 
Tell them they may have to forego or delay lifestyle and lifesaving procedures  like joint replacement, coronary stents and bypasses, bariatric surgeries, or pay for them out of their own pockets or out of their health savings accounts.
Q: Thank you for your unconventional thoughts on the eve of the political conventions.

Tweet: Reducing entitlement program costs isn't   come at politcal price of limited access and greater consumer costs.