Saturday, May 31, 2014

Obama – First Class Intellect.  Second Class Temperament

A second class intellect.  But a first class temperament !

Oliver Wendell Holmes, Jr (1845-1935), Of President Franklin Roosevelt, 1933

Of President Obama,  it might be said,  he has a first class intellect,  honed at Harvard Law School and by his radical  mentors,  but a second class temperament,  defined by his own self-assessment.    Indeed, Valerie Jarrett,  his ardent in-house admirer, says he easily bored.  He seems to regard himself as the smartest man in the room,  in the nation,  and on the planet. 

His words reflect his belief  in his soaring intellect,   transformative  ideas, and soaring words.   His  actions bespeak his disdain for the mundane details of management  and governance.    

As Peggy Noonan wrote in today’s Wall Street Journal “ The VA Scandal is a Crisis in Leadership,”  may 31 and June 1, 2014.

“Making sure things work is not his job.  Words are his job…The talks about health care for three years, it debuts with a terrible rash, and he’s shocked. Why didn’t it work? He told it to!..The word is everything.  The act, the deed, the follow-through, the making it happen deosen’t seem to loom large on his agenda of concerns…Managing isn’t interesting,  like the art of talking.”

But his intellect  doesn’t restrain his imagination of who is to blame when things go wrong.   He imagines wrong-doing and policy-failures  are someone’s else’s fault.  As for himself,  he is faultless to a fault.  His faults do not to himself occur.  Someone else down the intellectual food-chain is to blame.  And often he attributes faults whenever they occur to imaginary straw men,  to whom he attributes things they never said but he believes they feel deep in their unworthy souls.

In the foreign policy arena he says these straw men “want to invade every country that harbors terrorist networks,” or who :think military intervention is the way to avoid nuclear war,  or  who believe “ every problem has a military solution,”  though his critics never said these things he imagined and which he cannot quote.

On the health care front,  he claims these imaginary straw men believes that  market solutions dictate the allegedly hostile and predatory actions of greedy actions of doctors, hospitals, businesses, and insurers,  though these players simply assert free enterprise is more efficient than government;  that  the opposition party the medical establishment  are conducting economic wars on women,  minorities, and non-white races and depriving them of health care they desperately need.

Obama’s  imagination  resembles the wings of an ostrich.   It enables him to run for cover and to escape from his critics,  but it does not allow him to soar as a leader.

Which brings me to the dictionary definition of temperament,  that  unique constitution of an individual that permanently affects his manner of thinking, speaking, feeling, and acting . Temperament is that natural disposition, that unusual personal attitude as manifested by peculiarities  of feeling, temper, and action.

Tweet:  President Obama has a first class intellect and a second class temperament, a combination that may lead to a crisis in governing and leadership.

ObamaCare Nursery Rhyme

Solomon Grundy,

Born on a Monday,

Christened on Tuesday,

Married on Wednesday,

Took ill on Thursday,

Worse on Friday, 

Died on Saturday, 

Buried on Sunday,

This is the end

Of Solomon Grundy

Solomon Grundy Nursery Rhyme

It is Saturday morning,  the day after General Shinseki, head of the VA and Jay Carney, the President’s press secretary,  resigned.    

Their resignations may be why I am thinking of the Solomon Grundy nursery rhyme.   When the President’s men resign in pairs,  it may signal we are nearing the end of a Presidency and two programs the President proclaimed as his signature “achievements,” reforming the VA and national health systems.

General Shinseki’s and President Obama’s fates  are inextricably interlinked.  The VA and ObamaCare are massive federal bureaucracies.  Both are well-intended.  Both were  started to protect their constituents and may end by harming those they were designed  to serve.   Both are inefficient administratively .  Union demands  tie each  in knots,  and in each bureaucrats cover their tracks, their rears, and their bonuses through technocratic trickery and media obfuscation.     

ObamaCare was born on a Monday (November 2008 election),

Christened on a Tuesday ( January 2009 Inauguration Day),

Married on Wednesday ( March 2010 ObamaCare passage), 

Took ill on Thursday ( March 2010 to June 2014 national  polls opposing its various provisions),

Worse on Friday ( May 30,  2014, political pressures demanding ObamaCare and  VA revisions and culminating in Shiseki resignation),

Died on Saturday ( May 31,  2014,  vulnerable Democrats everywhere demanding  Shinseki resignation and are backing off ObamaCare support),

Buried on Sunday ( November 4, 2014,  midterm elections, which will decide if ObamaCare is to be buried, modified, replaced or repealed).

There. That is the end of my Saturday morning nursery rhyme.  If there is a moral to this tale, it may be that children are not the only ones fed fairy tales and nursery rhymes.

Friday, May 30, 2014

Video Link  to my May 9 talk  Before the American Association of Physicians and Surgeons in Minneapolis can be viewed at:

The talk,  entitled “Direct Pay Independent Practice: Remnant of the Past and Wave of the Future,”  is 20 minutes long.

My new E-book Understanding ObamaCare: Travails of Implementation: Notes of a Health Reform Watcher is now on Amazon. The Kindle edition sells for $3.99.   You may be interested in reading it since ObamaCare may determine  the outcome of the November midterm elections.  You may also order the book from Westbow Press, a division of Thomas Nelson Publishers,  or its 35,000 outlets, which include bookstores, who  can help order the book for you.   This is the first of 3 E-books on ObamaCare.  The second book will be called ObamaCare Revealed,  and the third will be ObamaCare: Dead or Alive.
Richard L. Reece, MD, 1-860-395-1501,

Thursday, May 29, 2014

Innovation Adoption Curve and Direct Pay Independent Practice 

The curve representing a continuous frequency distribution with a shape having the overall curvature of the vertical cross section of a bell; usually applied to the normal distribution. 

Bell-Shaped Curve

You are probably aware of the bell-shaped curve.  At its peak,  half the people or events or whatever you are measuring are to the left of the peak or below it and half are to the right of the peak or above it.  Half the people , for example, have an IQ below 100, and half above 100.

Well, there is something similar called the Innovation Bell Curve.  It is about the frequency of people adopting a new innovation.  

The adopters fall into these categories  as follows.

·         2.5% , Innovators – tend to be young, educated, prosperous, and risk-oriented.

·         13.5%,  Early adopters - younger, more educated, leaders , but less prosperous

·         34%, Early majority-  conservative but open to new ideas, active in community

·         34% ,  Late majority -   older, less active, fairly conservative, and less prosperous

·         16%,   Very conservative older, less active, less likely to be community leaders

Why am I telling you this?    

Because, according to Josh Umbehr, MD, and his  two partners, in the Atlas Concierge Medical Group in Wichita, Kansas,  all  three concierge physicians,  all three  in their early 30’s,  are saying  other primary care physicians , who are adopting and switching to concierge/direct pay practices independent of 3rd parties (government and insurers),  are precisely following this innovation adoption curve.   

According to  current surveys of  primary care physicians,  and to 3 young concierge physicians in Witchita,  between 11% to  14% of physicians have switched  to direct pay practices devoid of 3rd party involvement.     

 For whom does the bell toll?  Umbehr says the bell tolls for concierge medicine.

Based on the shape of the adoption bell  curve and the shape and speed of adoption,   Umbehr  et  al predict that 80% of primary care physicians will  be in concierge/direct pay/cash only or cash friendly practices within 5 years.

Josh Umbehr should not be taken lightly.  He and his father, are running for Lieutenant Governor and Governor of Kansas in the Libertarian ticket, the only father/son team to do so in the nation.    And Wichita, as you may know, is home of the Koch Brothers, a powerful force in conservative politics.

 Josh  and his medical partners are crisscrossing the country talking to physician groups and associations, including the American Association of Physicians and Surgeons and the American Academy of Family Physicians, about  their predictions.  They are finding receptive audiences.   They point out that direct pay practices dramatically reduce the need for staff,   cut overhead,  increase incomes,  and  enhance satisfaction of patients and participating physicians.   

Among the benefits they tout are these:  same day appointments,  unlimited time spent with patients,   wholesale medications,  whole sale lab tests,   and bundled prices included in the retainer fees for most diagnostic and therapeutic services performed in a primary care office.

If their  prediction pans out, it will come as either  a rude shock or a pleasant surprise   to many Americans, who get the predominance of their care through Medicare, Medicaid,  and  employer sponsored  plans  or individual plans.   Shock will come to those who have learned ObamaCare would lower premiums and deductibles and give them access to doctors.  The pleasure will come from personal care by personal physicians.

What are the characteristics of  concierge/direct pay/cash-only/ 3rd party free  physicians?
The Concierge Medicine Research Collective, an independent health care research and data depository of the concierge and direct primary care industry's trade publication, Concierge Medicine Today based in Atlanta, GA released a 3-year summary of its analysis on the popularity and growth of the concierge medicine and direct primary care marketplace. They asked physicians from across the U.S. from December 2009 to December 2012 questions pertaining to their concierge medicine and direct primary care practice, patient satisfaction, business strategies, revenues and more. 

The analysis revealed the following results:
  • Nearly 70% of current U.S. concierge medicine and direct primary care physicians operating practices today are internal medicine specialists.
  • The second most popular medical specialty in concierge medicine is family practice.
  • A surprising finding in this study was the increasing number of concierge cardiology,
dental and pediatric practices opening from February of 2010 to December 2012.
  • The combined average annual income of a typical concierge medicine [and direct care] patient is between $50,000 to $200,000 per year.
  • Average annual compensation/salary of concierge doctor is between $100,000 and $300,000 per year.
  • The typical age of concierge doctor is between 40-59 years of age.
  • 77% of a concierge [and direct primary care] patients are between the age of 40-59 years old.
  • A concierge medicine doctor who provides 24/7 cell phone access receives the majority (83%) of phone calls from their patients during normal business hours, Monday thru Friday.
  • 62% of direct care and concierge medical offices employ between 1-2 office employees.
  • The most common reason why patients using concierge medicine call their doctor: Prescription Renewals (38%); Cold/Flu Symptoms (19%); Back Pain (14%); and Headaches (13%).
  • Most concierge doctors and direct primary care physicians treat six to eight patients per day.
  • More than 70% of concierge [and direct primary care] doctors will visit with their patients between 30-60 minutes per office visit, enough time to discuss case history, examination, other symptoms, treatment options and strategy for care.
  • Patients using concierge medicine [and direct primary care] comply with scripts and recommendations far more due to the doctor’s routine personal follow-up with the patients and explaining the importance of compliance and other treatment options.
Tweet:    Between 11% and 14% of primary care physicians may soon switch  to direct pay/concierge/ cash only 3rd party free practices, and this percentage could grow to 80% within five years.