Friday, October 24, 2014

Satisfaction with Physicians High, Trust in Medical Profession Low

The October 23 issue of the New England Journal of Medicine contained an article “Public Trust in Physicians – U.S. Medicine in International Perspective” which contained contradictory findings among 29 ranked countries.

Country Rank Satisfaction with Last Visit Trust in Medical Profession
Switzerland 1 1
Denmark 2 2
United States 3 24
Australia 4 10
Norway 5 12

Why does satisfaction with doctors during the last visit rank so high and trust in the medical profession rank so low?

The three authors , Robert Blendon, John Benson, and Joachim Hero, all from Harvard, offer the following speculation from a 29 country survey conducted from March 2011 to April 2013.

1) Some countries ranking above the U.S. 24th trust ranking had universal health systems, which the authors say “seems unlikely as a dominant factor."

2) Broad nonspecified cultural changes in the United States, resulting in only 23% of the public expressing a "great deal or quite a bit of confidence in the system" (Gallup).

3) 47% of Patients with low incomes are significantly less trusting, but ranked 7th in doctor satisfaction.

4) Medicare patients were significantly more likely than young Americans (69% to 55%) to trust doctors, and men were more likely than women to trust doctors (63% to 55%).

5) The U.S. political process, with extensive media coverage, makes physician advocacy “more contentious” than in other country.

6) The U.S. medical profession does not share in the management of the health system, as it does in other countries.

7) High health costs tend to make the public less trusting of doctors.

The authors vaguely conclude, without being specific, that trust in physicians could be improved “if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation’s health and health care.” In my opinion, most professional associations have done so, but their stands have been lost in the media fog and controversy surrounding ObamaCare and its implementation.
Benefits and Limits of Health Care Intervention

No participant in controversial , unfinished enterprises can pretend to unblemished objectivity. No claim is made that the discussion here is confined to the facts or the facts as presented are argued with scientific detachment.

Townsend Hoopes, Undersecretary of the Air Force, in Limits of Intervention, David McKay and Company, 1969

As ObamaCare, as we know it and President Obama meant it, draws to an end, the words of Townsend Hoopes resonate. Hoopes was describing the approaching end of the Vietnam War, and how military intervention was being de-escalated. Similarly some ObamaCare aggressive health reform policies will be modified or reversed.

It strikes me we are in a period of reversing many, but by no means all, of the policies embodied in the Patient Protection and Affordable Care Act. Some of these policies, such as expanding the pool of the insured and recognizing the plight of minorities and the poor, are beneficial. Other policies, intervening in the private affairs and choices of citizens, are harmful and have reached their limits.

Limits of Government

Government , and its intervening bureaucracies, can do only such much to improve the health of the nation. Government can purify the water, eliminate environment hazards, introduce public health measures to prevent and contain infectious disease, outlaw or make prohibitively expensive drugs and cigarettes, monitor deleterious human behavior, and supplement and regulate the education of health professionals.

But government cannot eliminate poverty, guarantee family cohesion, enforce education, change the negative ways they choose to live, limit their freedoms and choices, or redistribute health and wealth benefits without disrupting society. Nor can government ignore the consent of governed, or the activities of political enemies, domestic and foreign, should either consistently oppose , flaunt, and undermine government programs.

Limits of Medicine

Modern medicine has its benefits. It has effectively eliminated infectious disease in developed countries, developed drugs and surgical interventions to cure disease and degenerative conditions, and, by one means or another, lengthened life spans from 47 at the turn of the century to the 80s and beyond today.

But medicine has its limits. It cannot expand life expectancy indefinitely. It cannot reverse the end of life or the conditions that produce that end. It cannot reverse the irreversible. It cannot alter one’s genetic predispositions. It cannot, in most cases, change the life style or embedded behaviors of patients, whom it sees only occasionally and then only for limited times. People lead their lives outside of bounds of medicine. It cannot change the career choices of its practitioners, who tend to choose lucrative specialties, who prefer to practice in attractive urban surroundings, who like to exercise their clinical judgment and practice autonomously rather than bow to government mandates.

Limits of Technology

We live in an age of technological marvels. These marvels include the Internet, artificial intelligence, social media connectivity, robotic substitutions, genetic engineering, space exploration, satellite monitoring of earth, air conditioning, hydraulic extraction (fracking), data measurements of health care population outcomes, and instructional and mandatory protocols. These activities have unquestionable benefits.

But they do not replace personal human interactions. They do not replace human narratives. They do not replace human creativity and collaboration. They are supplemental, not elemental in improving the human condition. One cannot change humankind through technology alone.

Thursday, October 23, 2014

Are Democrat Senate Races and Obamacare Fixable?

If I were to write a campaign jingle for vulnerable Senate Democrats, it would go like this.

Change it.

Rearrange it.

Fix it.

But don’t nix it.


I say his because of the jumble in the political jungle. Although Americans oppose ObamaCare by 51% to 38% on average in national polls, Hart Research Associates and Public Opinion Strategies found 54 percent of respondents say they want lawmakers to repair ObamaCare, while 28 percent say they want to eliminate it. Another 17 percent say they want the law to remain as is. Still, Real Clear Politics predicts the GOP will win the Senate by a 53-47 margin.

According to the latest polls, with 12 days to go before midterm elections, Democratic Senators are vulnerable but their races are close enough to be fixable.

• Mark Udall, Colorado, trails 47% to 44%

• Mark Begich, Alaska, behind 48% to 45%

• Jeanne Shaheed, New Hampshire, ahead 48% to 45%

• Mary Landrieu, Louisiana, trails 48% to 43%

• Kay Hagan, North Carolina, in lead by 46% to 44%

• Mark Pryor, Arkansas, behind 47% to 41%

The key for Democrats to fixing their races may lie in changing and rearranging their relationship to the President and to ObamaCare itself. The Senators have responded in different ways – by distancing themselves from the President, by not inviting him to their campaign events, by not admitting they voted for him, by not mentioning they voted for ObamaCare, by simply not mentioning him by name, by saying they will fix the health law but not replace it or repeal it.

In a Real Clear Politics video, Chris Matthews, that stalwart Obama supporter, takes umbrage at Democrats for refusing to say they voted for Obama by saying “It’s like Obama had Ebola.”

The New York Times, the pro-Obama litmus test and the Bile of Liberalism, complains of a “Democratic Panic.”

A Republican backed American Commitment ad headline reads, “Democrats Will Never Fix ObamaCare.”

Karl Rove, who has been called the " Republican Architect,” “Bush’s Brain.” and the “Texas Terminator,” writes an article in today’s WSJ entitled “ObamaCare Returns as an Election Albatross,” citing waves of policy cancellations and price increases as portents of doom for Democrats on election day. Rove chortles,” Democrats created ObamaCare, passed it , own it, and will suffer because of it. The holy grail of liberalism for decades, the present health law may end up as a decisive cause of two epic midterm defeats for the Democratic party.”

I would not be so sure. The Democratic albatross is a sea bird that can stay aloft for decades, feeding on Republicans in its talons. President Obama and his formerly fellow Democrats are masterful politicians, capable of flying high and seizing victory out of the beaks of defeat.


(Doctor Reece, author of over 3600 Medinnovation blogs over the last 7 years, with over 2.1 million readership views, is available for speaking engagements on the future of health reform. For more information, call 1-860-395-1501 or write doctor.reece@gmail.com)

Wednesday, October 22, 2014

Eight Business ObamaCare Penalty Escapes

We cannot escape history.

Abraham Lincoln (1809-1965)

Firms Try To Escape Health Penalties.

Anna Mathews and Julie Jargon, title of WSJ front page article, WSJ, October 22, 2014.

When the history of ObamaCare is written, it will record that American businesses sought multiple ways to escape the $2000 penalty on businesses.

The penalties were supposed to start this year, but for political reasons, the Obama administration delayed them until after the November midterm elections for firms that employ 100 people or more.

Small businesses, which employ over 90% of Americans, say the health law penalties retard employment of full-time workers and cut profitability, especially for firms with primarily low-wage workers.

There are basically eight ways to avoid health law penalties.

• One, hire fewer full-time workers.

• Two, hire more part-time workers, working less than 30 hours a week, and not offer health care benefits.

• Three, push full-time workers into Medicaid, which state and federal governments jointly fund, and for which the employer pays no penalty.

• Four, offer bare bones, or “skinny” plans, that cover preventive care but exclude major benefits like hospital care.

• Five, hire part-time workers when full-time workers leave.

• Six, offer workers Health Savings Accounts plans with high deductibles which encourage workers to pay out-of-pocket to meet deductiblea.

• Seven, stop enrollment in plans of spouses, families, and domestic partners.

. Eight, don't expand.

Some cynics say the Medicaid switch is part of the ObamaCare strategy to use Medicaid expansion as a prelude to a universal single payer system.

Others say shunting patients into Medicaid is shifting people into a substandard care system, in which delays are legendary and in which only 45% of doctors are now accepting Medicaid patients (Jeffrey Singer, MD, “ ObamaCare Shunts My Patients into Medicaid, “ WSJ, October 21, 2014).

Ultimately, patients will learn their costs are increasing NS their care is suffering , albeit in the name of increased “health care coverage.”

In the end, the Medicaid shift may backfire on employers and government.

As Abraham Lincoln explained, “ If you once forfeit the confidence of your fellow citizens, you can never regain their respect and esteem. It is true that you may fool all the people some of the time’ you can even fool some of the people all of the time, but you can’t fool all of the people all of the time.”

(Doctor Reece, author of over 3600 Medinnovation blogs over the last 7 years, with over 2.1 million readership views, is available for speaking engagements on the future of health reform. For more information, call 1-860-395-1501 or write doctor.reece@gmail.com)
The Choice

The difficulty in life is the choice.

George Moore (1851-1933), The Bending of the Bough

Whether Americans know it or not or appreciate it or not, the November 4 midterms offer a choice.

Depending on your philosophy or ideology, the choice may be between.

• Economic growth and Economic Stagnation

• Prosperity and Social Justice

. Free Enterprise and Government Regulation

• Equal Opportunity and Equal Results

• Promises and Performance

• Lifting All Boats and Mooring All Boats

• Ethnology and Homogeny

• Self- interest and Public-Interest

• Reality and Rhetoric

• Facts and Feelings

• Objectivity and Subjectivity

• Magic and Illusion

• Concreteness and Abstraction

• Liberalism and Libertarianism

• Ayn Rand and Barack Obama

You know about Obama, but you may not know Ayn Rand. Ayn Rand (1905 – 1982) was a Russian-American novelist, philosopher, playwright, and screenwriter. She is known for her two best-selling novels, The Fountainhead and Atlas Shrugged, and for developing a philosophical system she called Objectivism. Born and educated in Russia, Rand came to the United States in 1926. She achieved fame with her 1943 novel, The Fountainhead.

In 1991, the book-of-the-month club conducted a survey asking people what book most influenced their lives. The Bible ranked number one and Ayn Rand’s Atlas Shrugged number two. In 1998, the Modern Library did another survey was based on more than 200,000 votes cast online by anyone who wanted to vote. The top two on that list were Atlas Shrugged (1957) and The Fountainhead (1943).

The two novels have had six-figure annual sales for decades, running at a combined 300,000 copies annually during the past ten years. In 2009, Atlas Shrugged alone sold a record 500,000 copies and Rand’s four novels combined sold more than 1,000,000 copies.

Among the intellectual cognoscenti, Ayn Rand is best known for philosophical theory of Objectivism. It states that the proper moral purpose of life is the pursuit of rational self-interest. She maintained the only social system worth considering is the full respect for individual rights as embodied in laissez faire capitalism, and objective reality is the only true measure of success.

The worlds of academia and progressive politics reject Objectivism as inhumane and socially unjust. But capitalists and conservative thinkers believe Objectivism explains why America is the most affluent and innovative nation on Earth, and why it has a certain “magic” that makes it such a magnet for immigration and risk-taking entrepreneurs ( Charles Murray, The Magic of America: How Ayn Rand Captured the Magic of America ( Federalist, October 16, 2014).

One can argue the merits of Ayn Rand’s philosophy whether capitalism is the most successful social system or whether it has a certain entrepreneurial magic. One can debate whether Adam Smith of the 1776 Wealth of Nations fame holds the key to social progress and can improve your life (Russ Roberts, How Adam Smith Can Change Your Life, Portfolio, 2014). One can even postulate that capitalism, with its doctrines of economic empowerment and entrepreneurship, is the capitalistic cure for poverty, terrorism, and epidemics (Hernando De Soto, ” WSJ, October 11-12, 2014). But one cannot deny that Ayn Rand is a inspirational novelist that has captured the imagination of millions of people.

One of these people is Josh Umbrecht, MD, a concierge physician in Wichita, Kansas. Umbrech named his three person medical group, the Atlas Medical Group because he admires Ayn Rand. Here is an excerpt of the interview I conducted with Doctor Umbrecht.

Q: “ I read you came to this model, because one or all of you had read Ayn Rand’s 1957 book, Atlas Shrugged, and you adopted her philosophy as your philosophy. Indeed, so much so, that you named your practice “Atlas MD.”

A: Yes, we all have read her book. I have read it 11 times. Her philosophy is “Objectivism,” that the science of economics has objective answers that you can be logical and thoughtful about. Her book is a justification of capitalism that brings the most protection to the individual. Money is the root of all this is good. It a a voluntary exchange of goods for all parties involved. The love of money is to love what is good.”

When voters go to the polls on November 4, they will be voting, among other things, on whether they agree with President Obama’s philosophy of big government with its makeover of American capitalism and its health system or whether they approve of Ayn Rand’s philosophy of laissez faire capitalism with individual choice. President Obama has said repeatedly that his policies are on the ballot. So are Ayn Rand’s.

(Doctor Reece, author of over 3600 Medinnovation blogs over the last 7 years, with over 2.1 million readership view, is available for speaking engagements on the future of health reform. For more information, call 1-860-395-1501 or write doctor.reece@gmail.com)

Tuesday, October 21, 2014

Election Indignation

I would rather remain with my unavenged suffering and unsatisfied indignation, even if I were wrong.

Dostoevski (1821-1881), Brothers Karamazov

Even if I am wrong, I believe indignation will drive midterm election results. Voter indignation is strong displeasure at political and economic results deemed unworthy, unjust or base. The elections will reflect righteous indignation at what’s happening to the world and to themselves.

In the U.S. results will signify indignation of the middle class, who will express their displeasure at the collapse of their incomes, at the redistribution of their wealth and health benefits, at their inability to find good jobs, at the rising income inequality between the middle and upper classes, at the perceived favoring of the non-white minorities over the white majorities, and at governmental incompetence.

It will be indignation that accounts for white men and married women voting Republican. It is indignation that drives the Tea Party. It is indignation for the white middle class being called bigots for defending the police, for being offended for calling for voter ID, for being accused of conducting a war on women, for calling the IRS targeting of conservatives scandalous, for questioning the handling of Benghazi, the Iraq withdrawal, the ISIS victories, the lack of an Ebola travel ban.

In health care, it is indignation about health plan cancellations, broken promises about keeping your doctor and health plan, rising premiums, soaring deductibles, and omnipresent co-pays, the botched federal health exchange website, the negative affect of ObamaCare on full-time hiring, difficulties in finding doctors that will accept you or your health plans.

The list goes on. It is not fun being called prejudiced when you are down and out and concerned about providing for yourself and your family because of your social class or the color of your skin.

Right now the tunnel is dark. But there is light at the end of it. With the election and events beyond, illumination will come. Economic growth will resume, the Keystone Pipeline will flow, gas prices and heating costs will drop, tax reform will occur, Ebola will be contained, ISIS will be slowed, politicians are both sides of aisle will learn lessons, civil wrongs will be righted, and the magic of the American brand of capitalism will continue to attract the huddled masses and lighten their health and economic burdens.

I may be wrong , but as an optimist I see the doughnut, not the hole. I predict the bright lights of imagination and innovation will put indignation in the shade, where it belongs.