Thursday, December 31, 2015

Obama Political Dictionary
This being the last day of 2015, with 7 years down for the Obama and 1 year to go, this seems a good time for definitions of what he and his administration have been all about.
·         Obamanology -  President Obama’s transformative and transcendental progressive philosophy. 

·         Obamanation-   President Obama’s beliefs in action – that the United States is not an exceptional nation,  that it  is not the world’s policeman, that it ought to withdraw from all wars,  that it ought to placate and emphasize with one’s enemies,  and that it ought to lead the world “from behind,” and that it ought invest in domestic infrastructure rather than in foreign affairs.   An unfortunate term because of its close kinship to the word “Abomination” and misleading implication that the President’s policies are a mess.

·         Obamanite – A  follower of President Obama, such as Valerie Jarrett and close advisors in the White House bunker, not be confused with former Secretaries of Defense – Leon Panetta,  Robert Gates, and Chuck Hagel – all of whom resigned and wrote negative books about their White House experiences. 

·         ObamaCare -  Popular name for health care law,  The Patient Protection and Affordability Act, also known as the ACA,  a convoluted hybrid combination of government and private interests,  designed to take effect in 10 years,  and unanimously  opposed by Republicans  also by a clear majority of Americans in multiple national polls.

·         ObamaScare  Tactics deployed by opponents of ObamaCare,  focusing on its broken promises of keeping your doctor and health plan,   escalating premiums and deductibles,  narrowed choices of consumers,  cost overruns,   bureaucratic complexities,  and leaving 30million to 35 million uninsured. 

·         ObamaFair – A term highlighting President Obama’s frequent comment that all he seeks with ObamaCare and other policies  that everyone pay their “fair share,” especially the rich, upper middle class, and American businesses,  and that all outcomes for all Americans would  be equal and fair with his income redistribution  policies.

·         Obamanomics -  Obama economic policies,  featuring high taxes on the “rich,”  the highest corporate income taxes in the world,  multiple regulations, and slow economic growth if necessary.

·         Obamanemisis  -  Jonathon Gruber,  MIT economist,  originally  said by Democrats, but  later denied,  to be close economic advisor and architect of ObamaCare,  who  asserted  in videos before multiple audiences that Obama and advisors intended for federal government, not states,  to run all exchanges and that health plans was not designed to have patients retain their original doctors and health plans.

·         Obamalateral – Refers to  President Obama’s  unilateral executive actions bypassing Congress and Constitution,  and  lateralling  controversies to Supreme Court. 

·         Obamatechwreck-  Colloquial expressions  referring to catastrophic launch and glitches  in October 2013 of health exchanges  resulting from inept health information management and lack of dry run prior to launch.  Also used when referring to Montana Senator Max Baucus warning before launch of an impending “train wreck.” Baucus and other Senators either resigned or failed to run in subsequent elections, leading to GOP control of Senate.  Baucus is now ambassador to China.

Wednesday, December 30, 2015

Lists of Where People Live the Longest
The secret of a long life consists of not shortening it.

I’ve been reading a 1976 book on Vilcabamba, Ecuador,  Los Viejos, Secrets of Long Life from the Secret Valley.  The author is Grace Halsell, a free lance writer.  She lived with the people in Vilcabamba for a year,  sleeping on rough boards  in their huts, eating their food, walking their mountain trails,  interviewing them to find their secrets of living to 100 and beyond.   When she was  there  the people of Vilcabamba had no  electricity,  no refrigerators,  no motorized vehicles,  and they lived and  ate  off   the land
 She attributed their longevity to living within their means, never  retiring,  relying on their two doctors – their left leg and right leg- to get around,  eating no beef,  getting their proteins from cheese, vegetables, and nuts,  and staying socially active and loving each other.
As it turns out,  accounts  like Halsell’s of extraordinary long lives  in a handful of places – the Soviet state of Georgia , Hunza Valley in Pakistan, and the Valley of Vilcabama in Ecuador -  have been misleading for a variety of reasons -  lack of accurate birth and health records,  exaggerated pride of natives in their purported longevity,  and  higher than normal average age due to migration of the young to the cities.
But  this exaggeration of extraordinarily long lives should not distract from the fact that people in these places share certain things that prolong their lives -  regular physical exercise;    avoidance of smoking and reliance on drugs and alcohol,  consistent engagements in mental,social activities, and productive hobbies  like gardening ,   clean environments  free of  pollution,  and cultures that re-inforce healthy life styles  and value seniors as members of their communities. 
There may be other factors as well – living on islands removed from toxic  and violent environments,   climates that encourage outdoor exercise,  less stressful rural life styles,   cooperative community  living,   low consumption of processed foods, and easy access to fruits, vegetables, and other foods with high anti-oxidant content.
That’s  enough of a preamble.  Here are places, states, and nationsl where people live the longest.   The United States is not among the leading nations in terms of longevity.  Depending on which list you consult – we rank between 34th and 40th in longevity, with an average of live expectancy of 81 for women, and 76 for men.

Top Five Longevity Places
1.       Okinawa

2.       Sardinia, Italy 

3.      Loma Linda, California 

4.      Nicoya, Costa Rica

5.      Icaria, Greece

Top Five States in U.S. for Longevity, Overall
1.         Hawaii, 81.3

2.        Minnesota, 81.1

3.      Connecticut, 80.8 

4.       Utah, 80.2
5.       North Dakota, 79.6

Top Five Countries for Longevity, Male, Female
1.        Japan, 80, 87 

2.       Spain, 80.86

3.      Andorra,  80.86

4.      Australia, 80.85
5.      Switzerland, 80,85

(34th U.S,  76, 81)

These lists beg an obvious question.  Why do Americans live less long?  The answers, I suspect, reside in these interrelated factors,  not necessarily in this order,  stress and  fast-paced living,  early deaths from motor  accidents and gun  violence,  income inequality and poverty ,  decline in family cohesion,  overuse of drugs and alcohol,   incessant smoking,  rampant obesity,   poor diets eaten on the run, fast food and processed food with too much carbohydrates and sugar at the expense of fresh fruits and vegetables, and limited  access to affordable care.  Taken together, these things shorten our lives rather than lengthening them. 

Tuesday, December 29, 2015

What’s  In Store for U.S. When Lecturer-in-Chief Leaves Lectern
I’m not going to lecture you.   Not until you fetch me a podium and a teleprompter .
Anonymous, On President Obama’s governing style
President Obama is in his element when he is lecturing Americans  and looking down from the bully pulpit.   Perhaps this governing style dates back to his days as senior lecturer at the University of Chicago or to his years as a community organizer, when he mobilized and united  heretofore unorganized minority groups  to challenge and conquer   the majority establishment.
Obama is effective as a lecturer -  articulating  his exposition,   reprimanding,  and criticizing political opponents in a sometimes angry, always cerebral, and usual condescending  fashion. 
Unfortunately, Obama, who promised to unite the country  as a transformational president,  leaves in his wake a deeply divided country ( Gerald Seib,  “Growing  Ideological Divide in U.S. Political Landscape,” WSJ, December 29, 2015),  as evidenced by these poll results.

·         Supports health law,  Dems 73%, GOP 14%
·         Supports gay marriages,   Dems 63%,  GOP 14%
·         Supports immediate climate change action, Dems 62%, GOP 13%
·         Backs environmentalist causes,  Dems 52%, GOP 23% 

·         Supports unions,   Dems 52%, GOP 15% 

·         Supports Black Lives Matter movement, Dems 46%, GOP 6%

·         Supports  business interests,  Dems 26%,  GOP 56%

·         Supports NRA, Dems 11%,  GOP 69%

·         Listens to talk radio, Dems 5%,  GOP 38% 

Until 2016 presidential elections,  divided ideologies will cause chaos to be in the saddle and to ride American politics.  Not until he unsettled unsaddling occurs and not until 2016 will President Obama’s legacy be settled.

Comparisons of U.S. Health System to Other Nations
Comparisons are odious, because they are impertinent – making one thing the standard of another which has no relation to it.
William Hazlitt (1778-1830),  Table Talk

Here are comparisons of the United States to other developed countries in the western world.  You may find more detailed information  in The HealthCare Handbook; A Clear and Concise Guide to the United States Health System.  As you read these points,   keep in mind that  only 15% of a nation’s health outcomes depend on its health system, but on such things as poverty,  education levels,  family cohesion, violence and accident rates,  and,  above all,  on its culture.

·         The U.S. spends 17% of GNP on health care,  more than any other nation. 

·         Health care is the fastest growing industry in the U.S. employing 10% of its populace. 

·         The U.S. has fewer physicians, hospital beds, physician visits, and hospitalizations than most other industrialized nations. 

·         85% of Americans have a regular source of care, but 25% have difficulties accessing care.

·         Life expectancy in the U.S. is rising fast, but not as fast as in other developed countries, where it is 83 for women and 80 for men compared to 77 for women and 75 for men in U.S. 

·         The U.S. lags behind in infant mortality,  maternal mortality,  and preventive care  but ranks above other nations  in cancer care,   heart care,  and care of chronic diseases,   research and education,  diagnostic  imaging, and other  health care technologies.

·         Americans prefer local and regional health solutions,  are reluctant to accept government mandates coverage with rationing,  feel they are capable of making their own health care choices,   seek equal opportunity access to high tech solutions,  prefer pluralistic payment systems, and allow market-based and federally-based institutions to co-exist and compete.

Monday, December 28, 2015

The EMR Absurdity

What shall I do with this absurdity-

Oh heart , Oh troubled heart- this caricature,

That has been tied to me,

As to a dog’s tail.

William Butler Yeats (1865-1939

Most doctors agree.   EMRs (Electronic Medical  Records) are an absurdity.  They’re inoperable,  are user-unfriendly, don’t connect to other EMRs, are hard to decipher,  fail to  tell the patient’s story, distract from patient eye-to-eye contact,  don’t  add to quality care, and waste the physician’s time and effort spent endlessly checking boxes .  

EMRs aren’t “meaningful,” to doctors and patients.  The “Meaningful Use” of EMRs, which requires doctors to follow  complex protocols to fill in boxes is absurd.

Don’t take my word for it.   Read these excerpts from two articles contributed to The Health Care Blog.

One,  “The only measurable change from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from  our time  with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives.”

Margalit Gur Arie, “Why Meaningful Use Has to Go,” The Health Reform Blog,  December 28, 2015

Two, “Dear Santa,

I’ve been a very good doctor all year. I have checked all my boxes and aced all my Meaningful Use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:
1) I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniature window.
2) I wish the patient’s next appointment date was displayed next to any incoming report I have to review.
3) I wish I could split my computer screen so I could see an X-ray or consultation report or a hospital discharge summary.
4) I wish, when I open a patient’s actual visit note for today, the place where I do my documentation, that I could automatically see at least the beginning of the latest of every category of information
5) I wish my EMR would know that prn medications, such as nitroglycerin, are not meant to be used for only a limited time.
6) I wish my EMR would automatically display the patient’s kidney function and allergies next to where I pick what medications to prescribe.
7) I wish my EMR wouldn’t alert me to drug warnings and interactions that are too obvious to need reminders for.
I’m sure if I tried, I could think of an even ten wishes, or maybe even twelve – one for each day of Christmas. But these seven things illustrate the underlying, fundamental wish I have: that my EMR will evolve to be more user friendly. I wish, now that the basic functionalities of EMRs are in place, that somebody comes back to people like me and asks how to take this thing to the next level."
Hans Duvefelt, MD, All I Want For Christmas: Seven Things I Wish My EMR Could Do,” Hans Duvefelt, MD, December 19, 2015

Will ObamaCare Survive, and if Not, Why Not, and in What Form?

You see things, and you say, “Why?” But I dream things that never were, and I say, “Why not?”
George Bernard Shaw (1856-1950)
I do not believe ObamaCare will survive in its present form. 
At risk of survival are individual, employer, and religious mandates and taxes on medical innovation companies and “Cadillac health plans.  Not at risk are exclusions for coverage of those with pre-existing conditions and young adults under their parents’ plans.
Why won’t ObamaCare survive as it now exists?
·         It  has proven to be unworkable in many respects.

·         It is inconsistent with American cultural values of freedom and pluralism and the right to choose.

·         The majority of the  middle class opposes the health law, and is angry, afraid, and uncertain about their  health care, as well as the direction  of the country, domestically and abroad.
Since its inception nearly 6 years ago, in repeated national polls, Americans have opposed the health law  by 7 %  to 10% margins.  The public has seen broken promises of keeping your doctor and health plan.   It has seen premiums rise by an average of 12.5%  accompanied by  unaffordable deductibles.    As one observer lamented, “It’s like having no insurance at all.”
To be fair, the public  knows 15 million people have gained subsidized coverage through health exchanges and Medicaid,   but this coverage has  often come at the expense of 150  million Americans covered by private plans  who have seen wages lag,  taxes rise, health costs mount,  and access to providers narrow.
Uncertainty about  ObamaCare’s future reigns.    People are asking:  If ObamaCare fails, what are the alternatives?  
No one knows.  All we know for sure is that somehow we shall have to provide care for the 15 million newly insured.  As a New England Journal of Medicine puts it,
 “ Many conservatives still advocate ‘repeal and replace,” but the almost –certain backlash  against taking coverage from more than 15 million Americans make it hard to imagine this rhetoric become reality, even if Republicans control Congress and the White House after 2016  (B.D. Sommers, “Health Care Reform’s Unfinished Work- Remaining Barriers to Coverage and Access,” NEJM. December 17, 2015).
The Heritage Foundation,  a conservative think tank has put forth 5 proposals  that would make an alternative to ObamaCare acceptable ( see  for how to get Heritage’s ebook, A Guide to to a Better Alternative to ObamaCare,  which fleshes out the details to these 5 proposals).
1.       Promote personal choice and ownership of health insurance.

2.      Enable free market to respond to consumer demands.

3.      Encourage portability of coverage.
4.       Help civil society and free markets and states to assist those in need.
5.      Protect the right of faith, conscience, and life.
At the moment, these proposals are, of course,  mere words that  have yet to assume con concrete reality or to withstand political and partisan scrutiny or voter approval.
Meanwhile it may be worthwhile examining the American creed as set forth by our forefathers.
·         One, government is best that governs least.
·         Two,  majority rules.
·         Three, equality of opportunity.
It can be argued that at one time of another,  the Obama administration  have violated the  three components of this creed. 
·         One, through executive orders and policies,  it has governed most and compiled a federal budget deficit that exceeds that all previous presidential administrations combined.  
·         Two,  the House and Senate now have GOP majorities that  do not rule but are checkmated by the Obama administration..   

·         Three,  the majority of Americans feel , because of falling wages and a slow growth economy, and the administration’s stress on equal outcomes  and redistribution of incomes, they are being denied equal opportunity.
Instead,  in response to these perceived violations and low average approval ratings, compiled by Real Clear Politics of the president (43%),  Congress (13%),  wrong direction of country (66%),  and health law (42%), President Obama , instead of taking personal responsibility  and admitting policy failings,  to paraphrase President Lincoln, has adopted this philosophy , “ You can blame all of the critics  some of the time; you can even blame some of the critics  all of the time, but you can  blame all of the critics  all of the time.” In their turn,  some critics call this narcissism, others a Messianic complex.
ObamaCare is a massive social experiment  that is unworkable for many  people most of the time. We shall have to wait to see how the majority of voters react to bigger government,  to ignoring the will of the majority of voters, and to less opportunity because of a faltering  low growth , 2% of GNP during  Obama’s two terms ,the lowest  recovery rate from a recession since World War II.
My guess is the outcome  of the 2016 election will hinge on how voters respond to these questions.
·         One,  do you feel more secure  about your  future and the future of the country than you did in 2008?
·         Two, are you better off financially? 
·         Three,   is your health care more affordable and accessible?

Friday, December 25, 2015

Have a Warm and Merry Christmas

You, yes, You:   have a Warm and Merry Christmas.

It’s seventy degrees in this New England isthmus.

In New Orleans they say when it’s hot and sultry,

That’s the ideal time to commit adultery.

But Old Saybrook, Connecticut isn’t New Orleans.

Not by any stretch of the mind or other means.

And  I want to keep my wife,

And preserve my current life.

But enough of this idle chitter chatter

Let’s get down to the heat of the matter.

The mercury here is forty degrees above the norm

Is this hot spell a sign of a coming apocalyptic storm?

Is it  a warning global  climate change  has   arrived?

Will we of Christmas snow be forever  deprived?

Has this heat  wave made me balmy willy nilly?

Do I have heat stroke that had made me silly?

I know not but I’m going to enjoy it while it lasts.

It has never happened during any  Christmas past.

So have a warm and merry Christmas day,

Have a red-hot holiday.

Wednesday, December 23, 2015


Ordinary health, remember, is highly gambit prone.

Stephen Potter,  One-Upsmanship

The  health reform movement  is essentially a game of one-upsmanship,  involving those on both sides of the issue who seek to  gain an advantage  by deploying certain gambits. 
The Obama administration has been particularly adroit at the game through the use of the following gambits.

·         Big Brother Gambit  -   This also called the Big Government  Ploy. This is a highly effective gambit.   Through sheer bulk,   after all,  Big Brother represents  330,000 million people,  controls the biggest chunk of the health care population with 150 million in Medicare, Medicaid, and health exchanges,  and spends roughly $1.5 trillion a year on health care.  The Big Guy is not only the Big gest Donkey but the 800 pound Gorilla in the room.  Not only that, Big Brother (and possibly Big Sister to be)  has the most managerial talent and health policy experts at its beck and call.  Through what the Office of Management and Budget (OMB),  the Congressional Business Office (CBO)   Centers of Medicare and Medicaid ( CMS), and  those occupying or representing the Bully Pulpit say, Big Brother  proclaims government gospel,   and  the Ruling Class gospel,  ooften goes  without fear of being contradicted.


·         The  Guilt Trip-  ObamaCare is also a guilt gambit.  Its partisans maintain  that market-driven care suffers from   woeful ack of compassion among  hard hearted conservatives,  who wrongfully complain that   Obama  is  covering more of the population using  OPM (Other People’s Money).    Everybody knows that nobody, left or right, wants to see people dying in the streets for want of money to pay for medical care.    The gambit here is to show that those opposing  ObamaCare  have no heart and are only concerned about making profits for their special interests, not the public’s interest.   The is best done by repeatedly saying that the United States is the only developed nation on the planet without universal coverage, that the U.S. has the widest income inequality gap in the universe,  and that the poor,  the bereft, and the needy are falling through unseemly  cracks in the safety net.

·         The Humpty Dumpty -   This is perhaps the cleverest gambit.   Its proponents assert that if ObamaCare falls off the wall,  all the GOP’s men and all the GOP’s elephants won’t be able to put ObamaCare together again, and the people’s  health will suffer thousands of unnecessary deaths and millions of economic indignities.

·         The Full Continuum -   Life is a continuum.   We are born, we live, and we die.   At each stage,  we see a doctor.   Ergo,  health care and each disease  must be a continuum provided by a continuum of services provided by government,   physicians,  nurses, other caregivers, and health care professionals.   Therefore,  it follows that the only way to pay for this continuum is through one lump sum from one source. Guess who?

·         The Absent  Alternative -   A favorite and irrefutable gambit among  Obamanites is to ask – What’s the alternative? – and then to assert -  The opposing party has no alternative!  And of course it doesn’t.    Republicans are split into competing factions – each with its own alternative,  none with enough  authority or a sufficient  majority   to present one single coherent plan to overcome ObamaCare. And none of this silent majority has yet to articulate  alternative of  how to cover those new  20 million formerly uninsured now insured  and  now subsidized under ObamaCare  health exchanges and Medicaid. How does one disentangle those now entangled in the federal safety net without appearing cruel and heartless?

·         The Complexity, the MetaData, MegaMandates,  MegaTaxes, and MegaRegulations Gambits-   These gambits are best considered together.    Their underlying theme is this:  ObamaCare is hopelessly, bewilderingly, fiendishly   complex.  It affects different people at different times in different ways and involves billions,  even trillions of health care transactions.    Consequently  ObamaCare will take 10 to 15 years to understand and  implement and cannot be interrupted lest it disrupt  the chain of events leading to universal coverage,   greater choice of doctors and health plans,  and  lower premiums for consumers and free care for all.   Monitoring this process will require megamandates, megataxes  for  individuals and businesses to fund  it all and metadata and megaregulation compiling and analyzing all those transactions to  monitor it all and prevent private fraud.

Once you execute all of these gambits,   you will effectively defuse the anti-Obama establishment and their complaints about broken Obama promises,  inability to keep their doctors and health plans,   skyrocketing premiums and deductibles, and an unpaybackable  national debt. 

At last,  the public will know and appreciate  the health law is for its own good and the common  good. We are all on the Titanic together.  And the public  will no longer heed   conservative propaganda proclaiming that Obama’s legacy can be erased ( Phil Gramm and Michael Solon, “Cheer Up,  Obama’s Legacy Can Be Erased,"  WSJ, December 20),  or the Heritage Foundation’s e-book,  A Guide to a Better Alternative to ObamaCare, now available  at, for they  will realize there is no better,  viable, reasonable,  rational, empathetic , compassionate  alternative to ObamaCare.