Sunday, November 1, 2009

Interview with Health Reform Platitude Expert: Dr. Seemore Knowitall

Nothing produces such an effect as a good platitude.

Oscar Wilde, 1854-1900

A platitude is simply a truth repeated so often people get tired of hearing it.

Stanley Baldwin, British Politician, 1867-1947

Platitude: An idea 1)a truth admitted to be true by everyone; and b)that is not true.

H.L. Mencken, 1880-1946

Q: Dr. Knowitall, tell me, is it true you are an expert in health reform platitudes?

A: Yes, I know my platitudes like the back of my hand. I see more, and I know more. My platitudes are absolute, self-evident, unchallengeable, full of virtue, and devoid of details and specifics.

Q: What are your favorite platitudes?

A: Health care is a right, and it must be made more affordable, accessible, and of higher quality for all. Universal coverage is a moral imperative for civilized nation, no matter what the tax or national debt consequences. Under our present health reform proposals, future generations of Americans may find health care less affordable, premiums higher, access more difficult, doctors harder to find, waits longer, the system less responsive with fewer amenities, and taxes higher with fewer benefits, but they will welcome the reformed system because it will be "free" and paid for by other people's money and the national debt.

Q: If health reform is such a good thing, why does it face such political difficulties?

A: That’s easy. “Special interests” are the fly in the health care cost ointment. They are an evil force. They maintain the tyranny of the status quo.

Q: What is a special interest?

A: A special interest is any profit-making enterprise that is part and parcel of the “medical-industrial complex,” a vast industry on the make and on the take. A special interest is interested only in increasing its profits, protecting its markets, and rewarding its avaricious leaders and stockholders. Special interests are not interested in the common interest.

Q: What is the common interest?

A: The common interest is the common good.

Q: The common good?

A: Yes, the common good. The common good is the consensus on what is good and equitable for humankind, whereby all persons are equal and equally receive health benefits regardless of health, income, race, gender, or social status. If redistribution of income is necessary, so be it. The misery must be spread and rationed equally.

Q: Why have we as a society not reached this consensus on goodness?

A: That’s easy, too. My platitudes are: lobbyists for the special interests keep costs high, and politicians callously take lobbyist money to get re-elected, regardless of the common good. Private money from lobbyists is the root of all health reform evil.

Q: But aren’t there lobbyists for and against reform? Aren’t lobbyists for reform, like AARP, bad , by definition?

A: No, special interests for the good are not lobbyists. They are advocates for the common good. Advocates for the good are are good because they have good intentions, are pure of heart, and are devoid of commercial ambitions. This nobility of spirit may lead to adverse consequence, but adverse consequences such as high taxes and bureaucrats practicing medicine, are not bad because they are heart-felt efforts for the common good.

Q: What is the basic problem with American health care, which cost twice that of any other nation?

A: Three things. One, needless waste. Two, failure to identify and reward high performers and punish low performers. Three, bad business models.

Q: Needless waste?

A: Yes, needless waste. One third of what we spend on health care is wasted.

Q: Says who?

A: Says I, says the Dartmouth Institute and says President Obama and Peter Orzag, his budgetdirector. They know, and I know needless health care waste will bring the U.S. down as a moral and competitive nation because the costs are unsustainable and cruel. Furthermore, the waste is unjustifiable and inexcusable.

Q: Those are harsh words. Why do you and they use them?

A: Because Medicare data indicates high spending regions of the country spend one-third more than low-spending regions and get the same results. That does not make sense because everybody ought to get equal amounts of money for equal results. Such regional variations are simply inexcusable and account for $830 billion in wasteout of the $2.5 trillion our nation expends.

Q: But suppose different regions of the country are not equal – socioeconomically, culturally, and levels of disease?

A: That is impossible. You are saying that some are more equal than other. That violates the laws of goodness and social equity. We are one nation and ought to have homogeneous care and standards. Regional heterogenieties are not allowed.

Q: How do you account for these differences between regions?

A: It is mostly greed, due to overspecialization, over-utilizations, overuse of technology, and perverse incentives of our fee-for-service system.

Q: Could over-infusion of federal dollars and unfettered access without Medicare monitoring to it be a factor? Take Miami. It is full of Medicare and Medicaid storefront scams run by criminals using lists of patients and doctors to bilk Medicare and Medicaid. Total Medicare fraud and abuse runs about $600 billion of the $430 billion Medicare spends. What about this criminal abuse?

A: That goes with “free” federal entitlement programs and is something government has to tolerate. It is a burden we have to bear with openhanded government handouts designed to help the poor.

Q: How do you correct and compensate for other drivers of cost?

A: In data we trust. We must make sure all hospitals and doctors collect data, disseminate data, and use data to spot and separate high and low clincial performers. And we must make sure the three legs of the “Health Care Iron Triangle” – quality, cost, and access – are even and do not teeter in favor of the private sector.

Q: Health Care Iron Triangle?

A: Yes, Health Care Iron Triangle. The quality must be there, as measured by data, the costs must be evenly distributed everywhere to everyone, and access must be unlimited, no matter how dislocating or disrupting this may be to the status quo and no matter how much we swamp the caregivers, how long the wiating lined, and even if many hospitals have to be shuttered and how many doctors driven out of practice to make the three legs even. The ensuing Iron Triangle – battles between government bureaucrats, direct beneficiaries, and the profit-mongering medical industrial complex – particularly the latter, are inevitable.

Q: Why must we have that dysfunctional federal system? Private sector health care is the only growth sector of the American economy. It employs 14 million people and is having a positive impact on the domestic and national economy. Besides, 89% of people are satisfied with the care they receive under private plans.

A: That may be, but it is unsustainable, inequitable, and inaccessible to more and more Americans. Besides it is monopolistic, oligopolistic, and capitalistic, and only a totally monopolistic profitless socially oriented public option on an uneven playing field can ensure competition.

Q: What is needed to save our national health to sanity and equity?

A: One, a medical- government-complex with individual and employer mmndates designed to bring everybody into line for the common good. Two, new business models for the private sector that meet government guidelines, with higher taxes for all if necessary.

Q: I see, and what might those new business models be?

A: Hospitals and doctors and affiliated health professionals organized into integrated accountable health organizations with 200 or more salaried physicians offering bundled services with capped budgets determined by the government.

Q: How do you do that?

A: To achieve that and build its expensive infrastructure, we will have to tax the profits of the medical-industry complex, do away with fee-for-service for doctors, and integrate everything. Fee-for-service, to take an egregious example of a capitalstic monstrosity, is an incentive to do more and is intolerable and incompatible with the common good. We simply must stop medical profiteering – the source of most of the high costs and troubles with inequitable access. This profiteering is nothing more or less than rationing by dollars, cherry-picking the low-hanging fruit of those who can pay or of low risk and rejecting those who cannot pay or are too sick to treat profitably. It is an abominable two tier system.

Q: We struggle today with a price blind and quality silent system, with inequitable tax treatment of coverage, extensive government regulation of benefits and squelching of marketing innovations. Some say there already is a government-induced dysfuntions. What are your favorite government platitudes for fixing the health system?

A: I foresee four platitudinal solutions.

1. Install inoperable information technology systems with standards. Costs will plunge, and quality will rise.

2. Measure and publish quality information on the Internet, and people will buy prudently and avoid bad doctors.

3. Measure and publish price information on the Internet, and consumers will shop intelligently.

4. Promote quality and efficiency on the Internet, and reward those who offer and purse quality, competitive care.

In short, get everybody wired,real-time, all-the-time, and all will be well.

Q: Why can’t we just bypass the heavy hand of government with more direct market adjustments, such as,

• Tax equity for all

• Portability of those 1500 private policies out there

• Freedom to choose one’s doctor and health plan

• Transparency of costs

• Unhampered interstate commerce

• Health savings accounts with patient ownership of policies

• High deductible policies with catastrophic coverage

• Tort reform to cut defensive medicine costs

This approach conforms to the principles of Thomas Jefferson – small government, equal opportunity for all, access to markets with a personal sense of what things cost, compliance with commonsense of the people, and freedom for individuals to pursue or ignore life, liberty, and life saving and life-restoring behaviors.

Jefferson said these principles as emblematic of the “Spirit of 1776.” Perhaps we ought to re-invigorate that spirit.

A: You cannot do that. It violates the principles of government-directed command and control universal coverage.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.


Michael Kirsch, M.D. said...

Dr. Knowitall? Perhaps, your pseudonym should be U.R.Dreaming, M.D. Quite a health care reform with list. Should be a snap to implement it. Just step into those ruby slippers and click your heel three times.

Michael Kirsch, M.D. said...

Should have said wish list, not with list!