Tuesday, September 7, 2010

Health Reform Continental Divides

The Continental Divide of the Americas, or merely the Continental Divide or Great Divide, is the name given to the principal, and largely mountainous, hydrological divide of the Americas that separates the watersheds that drain into the Pacific Ocean from (1) those river systems that drain into the Atlantic Ocean or Arctic Ocean.


America is a vast continental nation. Its health system has its own continental divides with rivers of thought flowing into different oceans.

• The West versus the East
- The West, the land of Kaiser and other huge medical groups, and the East, with its solo and small group practices.

The North versus the South - The liberal, more affluent, more managed North, and the conservative, poorer, more independent South.

Washington, D.C. and New York City versus Outlanders - Cities of political and financial power, with lower unemployment and more money, and the disconnected masses outside the Beltway and Wall Street alienated by attitudes and circumstances.

• Government Reformers versus Practicing Physicians
- Idealistic, technocratic experts from on high and realistic pragmatic practitioners on the ground.

The Save-Medicare-By-Saving-Medicare-Money- By Making-It-More Rational-and-Efficient Crowd versus the Keep-Medicare-As-It-Is Recipients and seniors who say never the Twain shall meet.

The Lawyers versus the Doctors - The We-Will-Protect-You-from-Doctors –While-Collecting-One-Third-of –Casino-Malpractice- Winnings and Physicians who say lack of tort reform is costing the system $100 billion in defensive medicine and malpractice premium costs.

The U.S. –Has- An- Exceptionalist Health System versus Our Health System-s- -Just-Like-Any-Other-Nation's-Health-Health-System-and-Probably-Worse- Globalists – and those who ask: Are we the Shining City on the Hill or Not?

High Tech versus High Touch - The Holy Grail of Information Technology and Science enthusiasts who insist their way is the only way to go and those who say Medicine is still a personal, humanistic, and unpredictable Art.

• Congress versus the Doctors
- Health care is too important to be left to doctors and those who ask: what is more important to patients than doctors.

The Big Spenders versus the Big Cutters - We will save money by covering 32 million more and those who say: you have got to be kidding.

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