Sunday, February 26, 2012

"SGR" - Title for Health Reform Book

To dream – the impossible dream

To fight – the impossible foe

To bear – with impossible sorrow

To run – where the brave dare not go

To right- the uprightable wrong

To love- pure and chaste from afar

To try – when your arms are too weary

To reach – the unreachable star

Lyrics from “The Impossible Dream" – Man of La Mancha, 1972 Musical

February 26, 2012 - Last night I awoke with a start. The lyrics of “The Impossible Dream” were resonating in my head.

My impossible dream was what to name a dream book. The book would consist of my blogs. It would cover the period from March 2010, when the health reform law passed, to June 2012, when the Supreme Court pronounced its decision on the law’s constitutionality.

It would be concern what’s happening at the intersection where politics, technology, and health reform collide. It would be 1000 pages long - too long for a paper book and too expensive to produce. The return of investment would be too meager. It would be, in short, an impossible dream, a publisher’s nightmare.

So SGR would have to be an E-book. E-books lend themselves to enormous, eclectic, e-technologic subject matter. This book would qualify on all e-counts.

In my dream, the book at first lacked a title. But that hesitancy was short-lived. In short order, I came up with the title of SGR.

One word book titles are in vogue.. Two books on my personal library shelves came to mind Next by Michael Lewis and Blink by Malcolm Gladwell. In today’s New York Times book section, I count 25 books with one word titles – Moneyball, Outliers, Blackout, Wonderstruck, Inheritance, Fablehaven, Pure, Crime, Blood, Visuals, Switched, Matched, Fallen, Lethal, Raylan, Quiet, Unbroken. Auschwitz, Taken, Bonnie, Ameritopia, Liebesod, Girlchild, Iago, and Bossypants. My favorite is Bossypants, perhaps because my book was done by the Seatofmypants, not a bad title by the way.

My SGR title beats them all in my dream. Why? Because it would be an acronym and algorithm wrapped into one. It would be a book that captured the essence of the 2700 page health reform law in one fell stroke.

Acronyms, after all, litter the law - PPACA, GAO, CHIP, ACA, ACO, PCORI, IRS, CMS, and IPAB – to mention a spacious few.

Reform’s most famous algorithm is SGR – Medicare's Sustainable Growth Rate formula.

Congress concocted the SGR in 1997 to make sure Medicare physician expenditures didn’t exceed GDP. CMS updates and calculates SGR annually and passes it on to Congress for approval.

• Each year the SGR produces unrealistic numbers calling for draconian cuts in physician pay.

• Each year since 2002, Congress chucks aside the SGR. Its cuts would surely cause physicians to abandon Medicare patients. This would be unacceptable to voting seniors.

• Each year a Congress proposes “doc fix.”

• Each year the “fix” proves to be an impossible dream. It costs the government too much, drains too much money from other government programs, and alienates senior voters.

In my book, SGR would stand for “So Goes Reform“ The book would be about sustaining the unsustainable. It would be about how Congress changes positions faster than the speed of light. The actions of the Congressional elite led me to compose this limerick. “There was a Congress who thought itself bright, whose speed it deemed was faster than light, it set out one day, in a relative way, and returned the previous night.” In the case of Congress, the previous night is the 1997 SGR.

I thought of other titles as well.

AC- DC. This acronym stood for - "After Conception – Darkness and Confusion", which refers to the passage of the health reform law and ensuing controversies in D.C. I rejected this title as too cute and too cynical.

Will Obamacare Survive? Sequel to The Health Reform Maze,my previous book.This title was too pejorative and too self-serving.

Everything You Ever Wanted to Know about Health Reform but Were Afraid to Ask. This moniker has already been used in books about sex by Dr. David Reuben in 1969 and by Woody Allen in a movie in 1972 and by countless others on countless other subjects. Too overused. Anyway, I did not want my title to imply the 2700 page PPACA law violated somebody’s bodies, individual rights, and religious rights.

Period. End of dream. SGR would be my title.

Tweet: SGR, for “So Goes Reform,“ for the Congressional formula for Medicare paying doctors, might be a good title for a book on health reform.


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