Sunday, June 30, 2013

Where in the World is Kansas on Obamacare?
What’s the Matter with Kansas?  How Conservatives Won the Heart of America
Title  and subtitle of 2004 book by Thomas Frank, founding editor of The Baffler author of One Market Under God
I’ve been trying to figure out where Kansas stands on health care.  Kansas is the geographic center of the U.S. It’s a Republican state. It  has rejected  Obamacare’s health exchanges. 

But it has also produced Kathleen Sibelius, who has been Secretary  of Health and Human Services (HHS) since 2009.  She served as Democratic governor of Kansas from 2003 to 2009.  She is the public face of Obamacare. She is the federal official in charge of implementing Obamacare.
On the other hand, in 1998 the Kansas Republican party’s platform in 1998 called for “ no federal intervention in health care,” and last week, its Republican senator, Pat Roberts, in the Weekly Republican Address,  noted that if the national government couldn’t guarantee that the health exchanges would be ready by October 1, 2012, the exchanges should be shut down and Obamacare repealed.
Here is the text of his address.
SEN. PAT ROBERTS: “I am honored to represent the people of Kansas in the United States Senate. Let me be the first to wish you and your family a happy Independence Day as our nation recognizes our hard won freedoms.

“As we celebrate the fourth, it will be a mere 89 days until the October first deadline when millions of Americans are forced to purchase health insurance in a special marketplace or ‘exchange’ overseen by the federal government.

“Health care as you know it will change. Do you know how much your new plan will cost? Do you know what it will cover? Will you be able to see your family doctor? Will your personal health information remain private? Private and safe? Will you lose the health insurance plan you like? Will the high costs force your employer to make you a part-time employee, change your plan or just drop your coverage altogether?

“Simply put, will you and your family have the health insurance you need to ensure your well-being?

“Right now, you can’t answer these questions and neither can the Obama Administration.

“The Government Accounting Office found problems with the exchanges and could not ensure they would be up and running by the October first deadline. Time is running out. As one of the Democrat authors of the bill said, American families are facing ‘a train wreck.’

“Well, who is going to answer these questions? How will this massive federal government takeover of health care work? Even President Obama says there may be some ‘bumps’ and ‘glitches.’

“Well, in California those bumps and glitches are all too real for the 50,000 patients who will lose their coverage. Aetna, a major national insurer, will no longer offer individual market plans there. Those 50,000 people are expected to turn to the exchange. Well how many more insurers will follow suit?

“Too little is known about the exchanges. The fear is that only the sick will pay to join the exchange without young healthy people to foot the bill, then all costs will further skyrocket.

“Young healthy people find the exchanges so costly and objectionable that the administration is drafting the NBA and the NFL to pitch Obamacare. Good grief!

“Already we know premiums for many Americans will rise. Some estimates have found they will double, triple or even quadruple.

“Now folks, it wasn’t supposed to be this way. Before Obamacare was forced through Congress in a misguided partisan federal takeover of health care, we had a rare opportunity to create real change. We should have expanded access to care for those in need while protecting the all-important relationship between you and your doctor.

“Yet, partisan politics got in the way. President Obama signed the bill without one Republican vote.

“A year ago this week, the Supreme Court affirmed what we said all along, this law is a new tax on American citizens. Therefore, the IRS is responsible for compliance. Yes, that’s the same IRS that intimidated Americans for their beliefs with unlawful scrutiny and audits and fines and then lied about it to the Congress. The American people do not trust the IRS – not with their taxes and not with their health care.

“You remember the President’s promise, that ‘if you like your health care plan, you can keep it’? Not true for millions of Americans.

“Now Kansans understand all of this and they are fearful. Many are in the middle of life saving cancer treatments, or facing major heart surgery or a chronic health challenge like diabetes or arthritis. All those folks have doctors and treatment plans but face uncertainty about what the new law will bring.

“Now that’s why I have introduced a bill in the U.S. Senate to ensure that the exchanges and the mandated tax cease to exist if the Administration is not ready October the first. We need to make the right kind of change to the health care system… change that doesn’t include higher taxes, higher premiums and decision-making by government bureaucrats rather than our own doctors.

“We must put an end to the fear and uncertainty. Those ‘bumps’ and ‘glitches,’ the president talks about? It’s a train wreck, folks, and we have to get America out of the way.”

Upon reading these words, Kathleen Sibelius must have  recalled  the words of Dorothy in The Wizard of Oz when Dorothy said, "Toto, I've a feeling we're not in Kansas anymore."  The only difference is that the man behind the curtain is another wizard,  President Barack Obama.

Tweet:   The 2 faces of Kansas are:  1) Kathleen Sibelius, HHS head, in charge of implementing it; 2) Senator Pat Roberts, who wants to shut it down.


U.S. Health Reform from 30,000 Feet 25 Years Later

In 1988 I wrote And Who Shall Care for the Sick?  The Corporate Transformation of Medicine in Minnesota.  Today,  The New York Times, in an Executive Pay Column,  indicated  Stephen J. Helmsley, CEO of United, last year pulled down $13.9 million in total compensation. United is Minnesota’s largest single employer and has revenues of over $110 billion.
These figures say much what has happened to health care over the last 25 years.   It has moved front and center as one of America’s fastest growing national industries. It now consumes $2.7 trillion and 18% of GNP.  Everybody says its growth is unsustainable, and national reform must rein its costs in.
Scant evidence exists that this reining in is “bending the cost curve down, ” The rise of the Internet and the social media continue to  herald every medical “breakthrough,” every lung transplant for 10 year olds and every  heart transplant for former vice-president.  Americans continue to obsess over access to the wonders of medical technology,  and despite the public’s compulsion to lose weight,  eat more organic foods,  and down more dietary supplements and vitamin,  we grow fatter and older each passing year.   We  continue to equate health care with health,  although health care accounts for only about 15% of the nation’s health,  the rest related to poverty,  educational levels,  other socioeconomic differences, bad living habits, and our culture in general.
The problem with health reform and bringing down costs comes down to human fallacies and fantasies.  
·         We want to have our cake and eat it too,   to lower costs and lower taxes while increasing benefits and health yields.  

·         We want a “free lunch” from government entitlements without paying for them ourselves. 

·         We want more compassionate primary care physicians, but we don’t want to pay them more, and we don’t want to acknowledge their debts, in time spent getting there, 12 to 15 years, and in educational expenses, $150,000 to $200, 000 on average. 

·         We want all those wonderful  wellness products to save us from our bad habits. 

·         We fantasize about routinely living past 100 or even 120 while fantasizing about remaining forever young.  

·         We crave and stress  more individualism through our iPods, iPads, and other mobile devices by connecting with each other every minute of every day, while consolidating into ever larger Internet-based organization providing ever large amounts of health and disease based information,  some of it real, some of it spurious, without knowing which is which.

·         We want to think analytical computer-based artificial intelligence, through outcomes research and IBM’s Watson,  can save us from our intuitive follies,  but in our commonsensical  heart of hearts, we know it ain’t so.  

The news tell us  we are headed towards an Obamacare “train wreck.”  The polls say the majority of us disagree with the new health law.   

What shall we do?  I suggest we look at the world from 30,000 feet and take a deep breath.  

It’s dizzying  experience. Oxygen is in short supply here.
Tweet:  Oxygen is in short supply at 30,000 feet when viewing the accomplishments of health reform over the last 25 years.

Saturday, June 29, 2013

Enroll America Putting Lipstick on Obamacare Pig
To “put lipstick on a pig” is a rhetorical expression that making superficial is a futile step for disguising the true nature of a product.
Meaning of “lipstick on a pig”

Enroll  America, Obamacare formidable PR team, is on a roll and on the road.  Over the next 100 days, using its PR skills, polished during the recent successful presidential campaign, Enroll America aims to sign up millions for Obamacare’s health exchanges, a fundamental first step to make the health law a success. 
Enroll America’s message will be ubiquitous – on TV, the Internet, and print media,  in state fairs,  in door-to-door knocking, from  churche pulpits, and at major  sports events.  Show biz and sports celebrities will endorse it. Kathleen Sibelius, HHS Secretary, is raising private monies to bankroll the Enroll America effort, and she hopes major league sports organizations, such as the  NBA, the NFL, and MLB, will come on board.
The problem with the PR campaign, however, may be not every person or organization will buy, carry, or transmit the message.  The NFL has  already said it will not play ball.  The American public,  physicians,  conservatives, small business people, and the young and health remain  skeptical.  

For good reason.  So far, three years after passage,  Obamacare’s promises – lower health care premiums,  wider access, and better care – have yet to be realized.  Americans fear even higher costs and higher taxes with care disruption with loss of access to health plans and doctors.
Will this widespread disillusionment with the law cause Enroll America to falter, or even fail? Or will the Administration's PR skills prevail?  PR may win.  The Obama team is putting over $8 million on the line.
Stephen Hayes of the conservative Weekly Standard, in a recent piece “ Putting Lipstick on the Obamacare Pig," says government PR has limits. Obama cites the business communities’s actions related to Obamacare – 20% have laided off workers,  41% have delayed hiring,  and 55% think Obamacare will raise the cost of doing business.
In view of these and other obstacles,  Hayes says  Enroll America faces an uphill climb.  It will be akin to “putting lipstick on a pig.”  The pig, presumably, is Obamacare dressed in big government clothing.  This earthy metaphor will surely evoke other proverbial expressions, “a pig’s ear, “ A pig in a poke,” “pearls before swine,” “You can’t make a silk purse out of a sow’s ear,” “ A hog in armor is still a hog,” and “ The law is a machine in which you go in as a pig and come out sausage.” Some may even quote anonymous expressions like “Congress is like a hog. You must take a stick and hit it on the snout.” Obamanite  may even blame the public for being " as independent as a hog on ice.” Whatever happens or however you want to put it, Enroll America is taking Obamacare 's health exchanges to market.  As the nursing rhyme says  “ To market, to market, to buy a fat pig, Home again, home again, jiggety-jig.” We shall soon see if the jig is up, and how America's households will react.

Tweet:  Enroll America,  part of Obama’s PR election juggernaut, is on the road again, selling Obamacare health exchange, to a skeptical public.

Friday, June 28, 2013

E-Book,  on Health Plans, Their Proponents and Their Distractors
The engine that drives enterprise is not Thrift, but Profit.
John Maynard Keynes (1883-1946), a Treatise on Money
I’ve been working on an E-book, chronicling my thoughts on health plans and health reform.  
CMS has jsut announced health plans have ssued a $500 million rebate to 8.5 million employers and health plans, That annoucment  prompts this book.  CMS portrays this rebate as an Obamacare triumph, as nailing those heartless health plan bastards  that prey upon innocent citizens  or reject their suffering from pre-existing illnesses or other problems over which they have no control. 
 I am no fan of managed care, or the role health plans play in managed care.  But I believe if private health plans did not exist, we would have to invent something like them to cover those not covered by government.   CMS now subsidize  something like 110 million of 315 million Americans, while health plans insure something like 160 million.   This 160 million figure is likely to decline when employers recognize the extent and expense of Obama-qualified and endorsed health plans.
As the following blog post titles suggest,  other things are going on at the health plan-Obamacare intersection.   Health plans are doing a tremendous amount  of data mining, and they are using thise data to set premiums and manage care.   In 2003,  many major health plans settled with doctors in a Miami courtroom, by agreeing to pay over $100 million to set up a couple of physician foundations, now reduced to one, which is run the Physicians Foundation, a non-profit organization representing over 500,000 physicians in state medical societies.     Restrictive managed care have faded , due to delays of physician payments and bundling of fees, and using primary care physicians, as gatekeepers to minimize specialty care and hospitalization, The gatekeeper approach  has proven to the unpopular with Americans who reserve the right to go the specialist of their choice.   Nevertheless,  health plans continue to narrow their providernetworks.    In the last five year, a variant of health plans, health savings accounts,  has risen to the ascendancy, as employers and workers alike have realized they can save  significant premium expenditures,by shopping for care and setting aside tax-free money for retirement.
Another significant development has been concierge practices and cash-only or direct payment practices,  wherein physicians escape 3rd party scrutiny and overhead expenses, by  asking for payment on delivery of services.  Finally, there has been a growing movement of small businesses to self-fund, as most major corporations do, to minimize the expenses entailed in meeting  Obamacare provisions.
Blog Posts, with dates of entry and titles

1. June 1, 2007, Decline and Fall of Restrictive Managed Care

2. June 22, 2007, The Physician Health Plan Tango

3. September 20, 2007,  Employer Driven Reform Hits Connecticut

4. October 13, 2007,  Ranking Doctors Using Claims Data

5.  Janaury 19, 2008,  Physicians and Health Plans – Forecast for Managed Care

6. May 3, 2008, Short Take on Health Plans

7. October  10 , 2008,  Managed Care Memoir

8.  January 31, 2009, Health Savings Accounts, Skeptics and Believers

9. February 14,  2008,  HSAs Tied to High Deductible Plans

10. April 14 2009, Health Plans, The Skunk at the Health Reform Political  Party

11, May 1, 2009, Private Health Plans in Trouble

12. May 22, 2009, Managed Care,  How Doctors React to Being Managed

13. August 21, 2009,  Health Plan Bureaucracies Costs to Doctor

14. September 20, 2009, Beyond Private Health Plan  Attacks

15. October 29, 2009,  AARP Members Air Doubts about Obamacare

16. March 1, 2010, Savings Achieved Through  Health Savings Accounts

17.  September 25, 2010, Why Obamacare Attack on Health Plans Isn’t Working

18.  March 20, 2011, Some Health Plans Are More Equal Than Others

19.  July 17, 2011, Health Savings Accounts, A Return to the Obvious

20, October 27, 2011, Defined Contributions, High Deductible, Vouchers, HSAs, HRSs

21, April 21, 2012, Wisdom of People, Key to Reducing Health Costs

22, June 11,2012, UnitedHealth to Keep Some Health Law Provisions

23. October 12 2012,  AARP and UnitedHealth Group

24. February 13, 2013,. HSAs Tied to High Deductibles

25, March 14, 2013, Are Health Savings Accounts Wave of Future?

26. March 28, 2013, Health Reform Endgame

27. April 8, 2013,   A Practitioner’s Journey from Solo Practice, to Managed Care , to Obamacare

28. May 9, 2013,  Can UnitedHeath Data Fix the System?

Tweet:   Health plans insure the majority of Americans. Obamacare portrays these plans as villains in driving up costs which is half the story.

Health Plans and the 80/20   Medical Loss Ratio Rule
Pareto Principle (The 80/20 Rule), the law of the vital few, states that for many events 80% of effects are the cause for 20% of the causes.
Definition of 80/20 Rule
If you’re an Obamacare aficionado,  you’re likely to argue that the Medical Loss Ratio, the 80/20 rule that requires health plans to  spend at least 80% on premiums and less than 20% on marketing, executive pay, and administrative costs, is responsible for lower premiums.  
If you are a health plan customer who has seen his/her premiums rise by 20% or more over the last year since Obamacare passed,  you will challenge this argument.  Ditto for small businesses with 50 or more employees,  the young and healthy, and people in individual or small group markets who face steeply rising premiums because they must now buy comprehensive, government approved plans, pay penalties, or face the IRS.
But, CMS may counter.  Look,  we investigate all health plans who raise rates more than 10%, and we just announced U.S. Insurers will have to rebate $500 million to employers and individuals, an average of over $100 to 8.5 million employers and individuals. 
This doesn’t seem to impress Americans,  66% of whom in the latest polls who look with disfavor upon Obamacare and 82% of whom say they like their current health plan.   Although President Obama famously promised premiums for families would fall by $2500 by 2016, the opposite seems to be true.  And there is widespread apprehension about “rate shock” once Obamacare officially kicks in.
Who is the villain – government or health plans – when it comes to high costs?  
I don’t know, but in the U.S, government involvement seems to foster higher costs, and fraud and abuse is much more rampant in federal than in private programs.   I know this,  the Obama administration has tended to treat health plans as the skunk in the reform garden party.   They claim health plans are overly profitable,  rig the system to cancel or exclude those with pre-existing illness,   and spend too much on Medicare Advantage Plans, overspend  for excessive marketing and executive pay,  and otherwise abuse their capitalistic privileges.  
The federal mindset seems to be: for-profit health plans are easy to hate because it charges premiums to stay in business  , government is easy to love when it provides “free” entitlements to stay in power.
If you’re a health plan CEO, it’s no fun being a skunk in the health reform fight. But deep down, these CEOs know how only they have the data and savvy to administer health benefits. Reformers and Obama officials may talk a big game, but do they have the game to administer public plans or  to compete with private plans? 
The truth is government cannot do without the skills data sets and skills to administer federal plans.  The truth is most consumers want the freedom to pick their own health plans, based on need, rather than government-endorsed plans, based on extending political power.  The truth is most workers would rather payer lower premiums based on personal responsibility engendered by the fastest growing segment of the health plan market,  health savings accounts, rather than rely on government

Tweet:   CMS has announced health plans must pay $500 million in rebates to employers and individuals for abusing the 80/20 Medical Loss Ratio rule.


Thursday, June 27, 2013

Obamacare a Masterpiece of Confusion
Confusion now hath made his masterpiece!
Shakespeare (1564-1616), Macbeth
Democrats To Sebelius: Confusion Over Health Law Persists
Politico reports that congressional Democrats shared concerns with Health and Human Services Secretary Kathleen Sebelius that seniors, among others, remain fearful about the health law's impact on their benefits. Meanwhile, the Los Angeles Times explores a loophole that could allow insurers to avoid some of the law's provisions for another year and The Associated Press reports the individual mandate exemption has been broadened for Native Americans.
Politico: Dems To Kathleen Sebelius: Seniors Confused On Obamacare
Congressional Democrats told Health and Human Services Secretary Kathleen Sebelius on Wednesday that Americans are still very confused about the health care law — including older people who worry that Obamacare will change their Medicare. Sebelius went to the Hill for another update with Democrats on Obamacare rollout. HHS this week overhauled its website, focusing more on the exchange enrollment, which starts Oct. 1
Tweet: Kaiser Health News reports Democrats are confused about Obamacare: 65% of Americans disapprove of the law, a masterpiece of confusion.

Wednesday, June 26, 2013

E-Book,  Obamacare Implementation Trials and Troubles
It almost looks as if analysis were the third of those “impossible professions” in which one can be quite sure of unsatisfying results.  The other two, much older-established are the bringing up of children and the government of nations.
Sigmund Freud, MD (1856-1939)
I am engaged in composing an E-Book, soon to  available soon on, on the trials and troubles of Obamacare Implementation.  It is a hot subject right now because signups begin  in 100 days for Obamacare health exchanges and because it will be a central issue in the upcoming November 2014 elections.   The outcome of these events may determine whether the Affordable Care Act eventually succeeds or fails.
I will base my E-book on these previous Medinnovation blogs.

E-Book,  Obamacare Implementation,  Trials and Troubles

Medinnovation blog posts on Implementation of Accountable Care Act

1.       January 3, 2007,  In Final Analysis, It’s Implementation, Not Ideas, That Count

2.       August 10, 2010, Health Reforms Fans Messaging and Implementation Difficulties

3.       April 10, 2011,  $105 Billion for Implementation

4.       December 14, 2012,   An Uncommunicative Bureaucracy Causes Health Care Uncertainties

5.       April 3, 2013 Obamacare Implementation Blues

6.       April 13, 2013,  Obamacare and Important Media Sources

7.       April 29, Uncertain Physicians and Health Reform

8.       May 3, 2013. Caution! Obamacare Train Wreck Approaching

9.       May 24, 2013, Obamacare Implementation in Doubt

10.   10June 6, 2013, Selling America on Obamacar

11.   June 11, 2013, Can Obama Be Trusted?

12.   June 12, 2013, American Culture and the Obama Transformation

13.   June 13, 2013,  For New Doctors, The New Commencementarians

14.   June 14, 2013,  Is Congress Guilty of Hypocrisy over Obamacare

15.   June 17, 2013, The Obamacare Radar Detector

16.   June 18, 2013,  Second Thoughts by Physicians and Others over Obamacare

17.   June 19. 2013,  Obamacare May Fail to Sign Up Young and Healthy

18.   June 24, 2013, Obamacare Starts in 100 Days

19.   June 25, 2013, Selling Obamacare, Will It Ever Work?

For me, the central questions are: Will Obamacare survive, thrive, or improvise? 

I have a hunch it will survive but not thrive and will be full of improvisations, better known as compromises.  Some of these have already occurred, dropping of long term care provision, taxes on medical devices,  backing off of waivers for Obama allies, and the probable extinction of the Independent Payment Advisory Board.   

In my view,  Obamacare’s implantation troubles stem from:  its unipartisan,  arrogant, and clandestine  passage;  its writing of a 2700 page indecipherable bill because its compositon  by inside Beltway Congressional staff and lawyers;  its  expanding of Medicaid by sacrificing Medicare,   its deep cuts of hospitals and physicians,  its lack of clarity and obsessive secretiveness, its anti-small business and anti-physician attitudes,  its excessive bureaucratic regulations and costs,  its broken promises – lower costs, greater efficiencies, and better outcomes;   its over-reliance on data and EHRs as tools to make medical care more “scientific; ” its overlong four year introduction designed to mislead public on its costs;   its brazen attempt to completely and comprehensively restructure a system 70 years in he making rather than approaching it incrementally;  its one-size-fits-all  standardzation of all policies regardless of age, sex, and needs[ and  its contempt for market reforms such as health savings accounts.

Tweet:  I am working on a E-book, soon to be available on, which will detail trials and troubles of Obamacare implementation.



Tuesday, June 25, 2013

Notable and Quotable, Selling Obamacare: Will It Ever Work? Peter Suderman|Jun. 24, 2013,
“How many times must Obamacare be sold? In April, the Obama administration confirmed that it would spend another $8 million marketing the health law, following up on a $3 million marketing campaign from last fall. And last week,Time reported on new efforts to market the law to the young and healthy adults that are crucial to the law’s success. A TV ad has already been released, and Time’s report says that “at the White House, health care implementation has become an obsession.”
“The big problem? The law is unpopular, still. And “that unpopularity threatens one of the law’s most ambitious goals”—the stability and success of the health insurance exchanges that are the centerpiece of the law. The administration’s response to that problem looks rather like a government-run version of what you might expect from a beer company introducing a new product: social media campaigns, commercials, and partnership possibilities with professional sports. “
“Will it work? One never knows, but years of efforts by the administration and its allies to market the law haven’t worked before.”
“Before the law was passed, Democratic supporters insisted that opposition would fade quickly after it became law. ‘The minute the president signs the health care reform bill, approval will go up,’ Bill Clinton said in 2009. But it didn’t, not then, and not later. Indeed, with 43 percent of the public saying they have unfavorable views of the law, and just 35 percent saying they favor it, public opinion is less supportive of the law than when it passed in 2010.”
Tweet:  In view of Obamacare's continuning unpopularity,  will the $8 millon new sales compaign to re-sell it to the American public work?

Monday, June 24, 2013

Obamacare Starts in 100 Days
Public opinion’s always in advice of the Law.
John Galsworthy (1867-1933)
Promises, large promises, is the soul of advertising.
Samuel Johnson (1709-1784)

Brace yourself.  Gird your loins. Open your minds.  And you taxpayers, open your pocketbooks. Obamacare, projected to cost $2 trillion or more over the next decade, is on now about to begin.
Sign-ups for Obamacare’s health exchanges starts in 100 days on October 1, 2013.  And, today, Enroll America, Obamas inspired and funded coalition of community organizations launches its advertising push to sell Obamacare to the American public, particularly to the uninsured, underinsured, and the young and health.
Enroll America’s 100 day education and enrollment blitz will feature a new government website, call centers, house calls, and an intensive PR campaign. The campaign will host 75 events in 27 states.  It will include TV and Internet commercials, talk show events, brochures at health fairs, sermons at churches, and even knocks on your door – all instructing you how and when to sign up.
The sign-up message will go something like this:
"Come one. Come all. We’re all in this together. Sign-up now.  Obamacare is the Law of the Land. It provides better, essential, comprehensive care at lower rates.  Your government is  protecting you and will pay for your health care coverage."
The campaign will seek to persuade the young and healthy, who now pay an average of $854 a year to sign up for the exchanges,   whose plans run an average of $5800 a year in premiums.  This may be difficult since it requires the young and helathy to act against their own economic interest, and since they know that they can sign up later when they need the coverage.  Besides, the $95 penalty for not signing up is trivial.
It will be a hard sell, and it will need to be .  Only 35% of Americans approve of Obamacare,  only 19% feel it will  leave them better off, only 33% of those aged 18 to 35 believe health insurance is “worth the cost,” and only  40% of Americans know the law even exists.
The advertising campaign will need luck.   As a June 18 WSJ editorial said,
Good luck getting the millennials to sigh up when plans aren’t merely more expensive but when the exchanges malfunction, or doctors don’t accept exchange coverage because some checked the wrong box, or any number of myriad administrative problems. HHS is promising an iPhone and apps store, and what it is about to deliver  is a rotary dial and switchboard that doesn’t work.”
The sign-up faces two formidablem fundamental  obstacles:
One, technical.  The government’s computer infrastructure isn’t ready to transmit data to other government agencies – HHS, Treasury,  Homeland Security, and the IRS to see if an individual qualifies for government tax subsidies.
Two, educational.  The government must reach and persuade millions to sign up, to better their lives and health, and to make the sign-up process understandable  in the face of blown deadlines, regulatory snarls, and general chaos.

Tweet:  Sign-ups for Obamacare health exchanges begins in 100 days, and Obama’s Enroll America campaign is underway.

Sunday, June 23, 2013

Do Wellness Programs Work, and If Not , Why Not?
To wish to be well is part of becoming well.
Seneca (4 B.C.  to 65 A.D.)
Wellness, wellness, wellness – the mantra goes.  Lose weight, exercise, eat right,  consume fruits and vegetables,  avoid sweets and salt,  lower your cholesterol, and you will feel swell, and you will be well.
Wellness sells.  Just ask merchants who sell weight-losing diets,   nutritional supplements, vitamins,  and organic and gluten-free food.  I am all for corporate wellness programs.
I agree with this thinking and most of these developments.  It’s a good thing Americans are so health conscious. This consciousness accounts for much of our increased longevity.  
I was astonished, then, to read this statement by two well-known wellness consultants, Al Lewis , author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care ( Wiley, 2013) and Vik Khana, who writes the Khana on Health Blog.
“There’s only one problem. Workplace wellness programs don’t work.  Such programs, which have been around for more than two decades, are ineffective at reducing costs, lack support in the medical literature, are unpopular enough to require incentives, and occasionally are even harmful to employees.”
How could this be? Everybody knows wellness is the right thing to do. Everybody knows you need to know how to get well and stay well.  Every worker wants lower premiums if they are healthy.
So what’s the problem?  Our two consultants tell us wellness programs produce negligible health improvements,  the programs cost more than they save, employees do not always provide reliable information,  employees who should participate are  often the ones who don’t need to , and wellness programs  generate unnecessary tests, the performance of which costs too much and may cause harm.
But in the process, the programs create such desirable amenities as on-site gyms, walking tracks,  corporate sports teams, healthy cafeteria food, and free nicotine patches. 
But, sad to say,  corporate wellness programs do not seem to carry over to life outside the company.  Wellness in the workplace, or talk about wellness in the doctor’s office, do not seem to carry over into the home.  Why not?  It may be because people resent others interfering with their private lifes, or gathering personal information that may be used against them.
But on a more cosmic scale, it may be because employees are human, and as humans, they usually revert to life-long habits and pleasures.  As Samuel Johnson (1709-1784) said, “We are all prompted by the same motives, all deceived by the same fallacies, all animated  by hope, obstructed by danger, entangled by desire, and seduced by pleasures.”  Which is another way saying, “Humans will be humans.”  I wish it were otherwise, but doing the right thing will pay off in the long run.
Tweet:  Corporate wellness programs are a $6 billion industry but signs of effectiveness are rare. Still, they are worth a try
Source:  “Here Comes ObamaCare’s “Workplace Wellness, “ Wall Street Journal,  June 21, 2013.

Saturday, June 22, 2013

Hospital and Healthcare Administrators More Optimistic Than Doctors about Obamacare

It is difference of opinion that makes horse races.

Mark Twain (1835-1910),  Pudd’nhead Wilson’s Calender

Merritt Hawkins and Associates have just released a survey indicating healthcare administrators are more upbeat about their choice of careers than doctors.

This is no doubt true when it comes to Obamacare.   The healthcare law favors healthcare organizations over individual physician practices. 
That’s why the health law advocates Accountable Care Organizations, why they would like to see bundled bills replace fee-for-service, why the favor the federal expansion of Medicaid. After all, Obamacare basically offers government subsidies of at least 30 million Medicaid and other underserved and underinsured populations.  
 Better to be paid by gvovenment for these people, than privately swallow the loss. Besides, it’s much easier for government and administrators to track and “hold accountable” large healthcare organizations than individuals or small groups.  

To cope with Affordable Care Act regulations requires application of administrative, capital, marketing, and technological resources.   This reality plays to the administrators’ strengths.  This is something they were trained to do.  Not so for physicians, who were trained to deal with one-on-one relationships with patients and with other doctors.   How physicians will deal with their new subservience to or partnerships with  administrators in now in the process of evolving.

In any event, here’s what Merritt Hawkins has to say about different points of view of administrators and physicians.

‘It has been accepted wisdom in healthcare for some time now that hospital and other healthcare facility administrators and physicians look at things through very different lenses.”

“A new survey Merritt Hawkins completed on behalf of Trinity University’s Department of Healthcare Administration indicates that even in an era of physician/hospital alignment, that may not have changed.”

“The survey examines the morale and professional perspectives of over 400 alumni of Trinity University’s nationally prominent Master’s in Health Care Administration Program who now are in leadership roles in hospitals, medical groups and other healthcare facilities around the country. In general, the survey found that morale and optimism among these leaders is high, even given the current challenges facing virtually all types of healthcare facilities.”

“Over 92% of survey respondents feel positively about being in healthcare administration today, over 87% described their morale as positive, 87% would recommend healthcare management as a career to young people, and 86% would select healthcare management if they had their careers to do over.”

‘These findings contrast sharply with a national survey of physicians Merritt Hawkins recently conducted on behalf of The Physicians Foundation. In this survey, only 32% of physicians felt positively about the medical profession, only 42% described their morale as positive, only 42% would recommend medicine as a career to young people, and only 66% would choose medicine if they had their careers to do over.”

“For healthcare facility managers, the glass appears to be half full, while for physicians, it appears to be half empty. Though the survey report outlines some reasons why this may be so, I would be interested in hearing what others think may be the cause for these contrasting view. Those who would like a complete copy of survey results are welcome to email me at”

Travis Singleton is Senior Vice President of Merritt Hawkins, the nation’s leading physician search and consulting firm and a company of AMN Healthcare (NYSE: AHS). He can be reached at 800-876-0500 or

Tweet:  Hospital and healthcare administrators are much more optimistic (92% positive) than physicians (32% positive about their profession and the future.



Thursday, June 20, 2013

What The Experts Say About Communicating with Patients by Email
You've got mail.
Title of 1998 Film, Sleepless in Seattle

Email has changed the worlds of personal communication.

Email has:

·         Placed the U.S. Postal Service in deep debt because people no longer use personal letters to communicate.

·         Replaced handwritten notes to invite others to weddings, funerals, bar mitzahs, showers, birthday parties and other social events.

·         Rendered “thank you” notes passé.
But one group – physicians – has held out. Doctors hesitate to communicate with patients by email. The reasons are legend.

·         Emails carry significant  medical-legal risks.

·         Third parties do not usually compensate for emails.

·         Email may replace patient visits where clinical judgments and payments occur.

·         Emails are impersonal:  you can’t judge a patient’s physical appearance,  body language,  vital signs by email, or clinical condition by email

Yet polls show patients overwhelming prefer physicians who communicate by email.  Emails, in concert with telephone calls,  have become indispensable for informing patients. Emails are convenient, fast, and save time, e.g. in fulfilling prescriptions and informing patients about lab or procedural results.

The Wall Street Journal has weighed in by asking a panel of experts this question; Should doctors communicate with their patients by email?

Here, in part, are experts’ answers:

·         Jeffrey Flier, MD, Dean of Harvard Business School.

Excellent communication between physicians and patients is a core requirement of effective medical care. Like so many aspects of medical care, there is no single approach to communicating that will meet the needs of all physicians and patients, or that will apply across all circumstances. But as email has become increasingly commonplace in our society, incorporating its use into medical practice is unavoidable. If its use is properly structured, email communication can offer significant benefits to physicians, patients and the broader health-care system.

·         George Halvorson,  CEO  of Kaiser Permanente

Yes. Absolutely. Doctors should connect with patients by email. Email is one of the best ways of connecting between doctors and patients. A secure message line that allows doctors and patients to exchange information can be extremely convenient, logistically respectful for the patient and a very flexible way for physicians to get needed information to their patients.

·         Gurpeet Dhaliwal, MD. Associate Professor of Clinical Medicine, at U. of California San Francisco

Email communication is ubiquitous, efficient and convenient. Patients want it, and many doctors do too. Every other industry maintains electronic communications with its customers, but in health care the debate inexplicably drags on.

Email is simply another form of communication like face-to-face exchanges, phone, mail or texting. Each medium has a different profile of strengths and flaws, but their financial, liability and privacy issues have many similarities—and all can be managed/.

·         Peter Provonost, MD, Professor, anesthesiologist, Johns Hopkins School of Medicine

Yes. Email provides an efficient and effective means for patients and physicians to communicate, although it is a tool that should supplement, not supplant, face-to-face interactions. Renewing prescriptions, scheduling a visit, ordering and following up on tests and communicating non-worrisome test results can all be handled via email. This can be a time-saver for the patient and physician, allowing in-person visits to be dedicated to working towards that individual’s health goals.

·         J.D. Kleinke,  Medical economist, resident fellow, American Enterprise Institute

Of course, and it is bizarre that in 2013 we are still asking this question. Electronic communications pervade all elements of our lives, have radically transformed all other spheres of economic life and culture, and bring efficiencies to human interactions we could no longer imagine life without.

·         Pamela Barnes, MD, president and CEO of EngenderHealth

Communicating with patients via email has enhanced many public health interventions, including use of oral contraceptives, HIV medication and sunscreen. With growing access to smart and mobile phones globally, SMS/text messaging has also been successful, especially for sending reminders to take medication, scheduling follow-up appointments, or making payments. In some remote areas of the world, text messaging provides new opportunities to reach patients with health information, organize transport to health services, and/or contact health workers. Ultimately, no matter where one lives, e-communication is an excellent tool to supplement—not replace—a trip to the doctor.

·         Susan Devore, President and CEO of Premier Healthcare Alliance

U.S. workers spend about 30% of their office time on email, typing 42,000 words a year – that’s equivalent to a 166 page novel! Yet less than 6% of us have used email to communicate with care providers.

Email can’t–and shouldn’t–replace hands-on care delivery, especially in emergencies. But research tells us that patients and physicians find email communication to be beneficial, saving both time and money while improving satisfaction. I know for obvious, minor issues such as a common cold or inquiries about routine test results, I’d prefer virtual interaction instead of time-consuming and sometimes costly face-to-face office visits.

Tweet;  Health care experts and thought leaders overwhelmingly support physician email communication with patients as an inevitable trend.