tag:blogger.com,1999:blog-60768393276742158252024-03-17T03:15:43.695-04:00Medinnovation And Health ReformWhere Health Reform, Medical Innovation, and Physician Practices Meet - The Leading Voice for Medical Innovation on the InternetRichard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.comBlogger4018125tag:blogger.com,1999:blog-6076839327674215825.post-119829719392917462018-02-07T14:46:00.001-05:002018-02-07T14:46:43.258-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
February 7, 2018<br />
<br />
Strarting Up Blog Again<br />
<br />
I notice I have not posted a blog since June of 20\17. I’ve been busy writing a book and doing research on my new book “A Physician’s Notes on Health Reform.” I plan to market it on Amazon.<br />
At the moment, the health reform world has gone silent. The political parties are in gridloack. Other issues - the government shutting down, sexual harassment,and tax reform - have dominated the headlines. Last week, however, the CEOs of Amazon, Berkshire Hathaway, and JP Morgan made a big splash, They announced they were forming a news company, as yet unnamed, to bring down costs and increase costs and to kill the health cadre tapeworms. They were short of details, but indicated technologies, led \by Amazon, would play a big role, at least for the 1.2 million employees of the 3 companies. Kevin Pho, MD, has made a smaller splash by announcing he has formed at Physician Speaking Group to help physician speakers spread the word of their discontent and to play a larger role in health reform. I have become part of that group, which now has 453 physician speakers. Where health reform goes from here, no one knows. It may hinge on the 2018 midterms. If Democrats prevail, Bernie Sanders et al will make a big push for Medicare-for-All.</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com49tag:blogger.com,1999:blog-6076839327674215825.post-87366108690365133272017-06-30T13:56:00.001-04:002017-06-30T13:56:19.729-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="font-size: 14pt; line-height: 19.9733px;">Chapter Two of Proposed Book: Universal Care, Multiple Payer In, Single Pay Out , But Who Shall Pay? For What? And Who Shall Deliver Care?<o:p></o:p></span></b></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be a centralized single-payer government system? <o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be through increased income and payroll taxes, or perhaps, a value-added tax, applied to all consumer goods except food, purchased by the poor, the rich, and everybody in between?<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be by open-ended entitlement programs - expansion of Medicare, Medicaid, ObamaCare subsidies, and those in other government programs?<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be Medicare or Medicaid for all, fulfilling the dream Bernie Saunders and other socialist dreamers?<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be paid disproportionally by redistribution- mandates on the rich, the young, and the healthy?<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Shall it be paid by taxing the profits of organizations in the so-called medical industrial complex and other for-profit entities?<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Finally. Shall it even be necessary if the universal basic income for all Americans, as is now being proposed, becomes a reality?<o:p></o:p></span></div>
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<b><span style="font-size: 14pt; line-height: 19.9733px;">Questions<o:p></o:p></span></b></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">These are some of the questions that haunt the body politic and the American people.<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">These are questions I’ve been writing about since I graduated from Duke Medical School in 1960 and completed my pathology residency in 1965. </span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">That was the year Medicare and shortly thereafter Medicaid passed. Together these two programs cost taxpayers over $1 trillion and consume huge chunks of the $3.2 trillion government spent on health care in 2016 with no end in sight.<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">Over the last 50 years, I have practiced medicine, served at editor of the <i>Minnesota State Medical Journal,</i> and several national newsletters (<i>The PHO Report, the Reece, Report, and Physician Practice Options</i>), formed an integrated physician-hospital organization, composed over 4000 Medinnovation and Health Reform blogs, and written ten books on health reform. <o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">In addition, on the innovation front, I have initiated and developed an Internet-based differential diagnosis program and a health measurement program . The differential diagnosis program correctly identified over 80% of diagnoses and was issued in hundreds of thousands of reports over a six year period. The health measurement report, which identified patients as below normal, normal, or above average , depending on whether they fell inside or outside a normal range of 80 to 120. In study of over 4000 Oklahoma state employees, the average HQ was 77, largely due to obesity , hypertension, diabetes, pre-diabetes, and dyslipidemias. From these studies, I concluded it was theoretically possible to establish the diagnoses of over 90% of patients before seeing the doctor, and one could measure the health of large populations of patients and how they could improve their health.<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">My books have dealt with the corporate transformation of medicine, physician shortages, the successes and failures of ObamaCare, and the tangled politics of health reform.<o:p></o:p></span></div>
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<span style="font-size: 14pt; line-height: 19.9733px;">As I write the future of health reform is as uncertain, and the ideological clashes surrounding this reform are as deep and divisive as ever, as shown in these two editorials in the Wall Street Journal and the New York Times, which are, of course, on opposite ends of the ideological spectrum.<o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 19.9733px;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span style="font-size: 14pt; line-height: 19.9733px;">“The liberal solution to every government failure is always more government. The California single-payer-bill reflects the left’s Platonic ideal, with the promise of free care for everyone for everything. Patients would be entitled to an essentially unlimited list of benefits including acupuncture and chiropractor care as well as all medical care determined to be appropriate by the member’s health care provider. They could see any specialist without referral. There would be no restraints on health care utilization or costs. Patients could get treated for all maladies by any physicians at no cost.”</span><span style="font-size: 14pt;">(</span><i style="font-size: 14pt;">Wall Street Journal</i><span style="font-size: 14pt;"> editorial,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">“California Single Payer Dreaming,” May 27-28, 2017).</span></div>
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<span style="font-size: 14pt;">Not to be outdone,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">the </span><i style="font-size: 14pt;">New York Times </i><span style="font-size: 14pt;">editorial board had its say.</span></div>
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<span style="font-size: 14pt;">“Any doubts about the senseless cruelty underlying the health care agenda put forward by </span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">President Trump was put to rest last week two government documents. One document was the Congressional Budget Office’s detailed analysis of the Trumpcare</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">bill passed by the House this month.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">The budget proposed billions of dollars of cuts to programs that funded research into new cures,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">protects the country against infectious disease and provides care for the poor, elderly, and people with disabilities.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">The CBP analysis said Trumpcare would rob 23 million people with health insurance while leaving millions of others with policies that offer little protection from major medical condition.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">All of which would be done in service of huge tax cuts for the richest Americans.”</span><i><span style="font-size: 14pt; line-height: 19.9733px;">(New York Times</span></i><span style="font-size: 14pt; line-height: 19.9733px;"> editorial, “Trumpcare’s Cruelty, Reaffirmed, May 28, 2017).</span></div>
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<span style="font-size: 14pt;">There you have it – the gulf, chasm, and abyss between two conflicting ideological opponents </span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">talking past on another while blaming each other.</span><span style="font-size: 14pt;"> </span></div>
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<span style="font-size: 14pt;">There is a third school of thought about</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">how</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">to bridge</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">the gulf – machines </span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">bearing artificial intelligent and elegant algorithms</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">to measure outcomes to show who is right and who is wrong by using data to supplement and even replace faulty</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">human nature.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Machines, in other words, can become human, and humans can become machines.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Machines have their own set of problems.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">They are designed by humans, big data is not knowledge or wisdom, brains are often more reliable than machines, and data alone often infringes upon privacy, security, and confidentially between patients and physicians.</span></div>
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<span style="font-size: 14pt;">But no matter what ideology you subscribe to and no matter what technology you use to enhance efficiency, the question remains: who shall pay?</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Three states have had a stab at introducing single payer to achieve universal coverage -</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Vermont,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Colorado, and California.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">All have failed</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">because political leaders of each state have come to grips with the realities that single payer costs would be prohibitive, requiring state government to raise taxes and employers to raise payroll taxes to levels their citizens would not accept.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">In California,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">the single-pay cost would be at least $400 billion annually .</span><span style="font-size: 14pt;"> </span></div>
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<span style="font-size: 14pt;">Besides, superimposing single payer on the present structure would be unbelievingly disruptive to hospitals, medical supply chains,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">and the 16 people needed to support each individual physician.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Still</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">40% of Democrats favor single-payer but just 28% of all Americans favor such a move. In California, about half the money to support single-payer would come from existing public money spent on health care.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">The rest would come from taxes, in a state which already has the highest state income tax at 13% in the4 nation.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">A handful of aspiring politicians in other states –New York, New Jersey, Rhode Island, and Massachusetts have proposed single payer bills , but the appetite is not yet there for the country outside of California and the upper East Coast.</span></div>
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Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com28tag:blogger.com,1999:blog-6076839327674215825.post-6574266333663702382017-06-30T13:16:00.004-04:002017-06-30T13:16:52.992-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: 14.0pt; line-height: 107%;">This is First Chapter of my new book: </span><b><span style="font-size: 18.0pt; line-height: 107%;">Multiple Payer Care In, Single Payer
Out<o:p></o:p></span></b></div>
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<b><span style="font-size: 18.0pt; line-height: 107%;">Who Shall Pay? For What?
Who Shall Deliver Care?<o:p></o:p></span></b></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">Chapter One<o:p></o:p></span></b></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">Notes on Donald Trump’s
Rise to the Presidency<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 107%;">Before I get into the role of money in Trump’s election, let me set the stage by talking about what
events in the days immediately before
and after his election. I believe the election outcome rested heavily
on health care events. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">On November 1, I began jotting down notes on Trump’s
improbable rise to the presidency. On
that day, health plans announced average
premium rises of 25% and unaffordable deductibles, and insurers began to abandon ObamaCare markets . <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">Here are my notes at the time.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">“<b>November 1</b> - The
Presidential election is one week away.
Polls project Hillary Clinton as a sure winner. Newspapers universally endorse her, as do
Wall Street bigwigs and hedge phone managers. The mainstream media has kowtowed
to Clinton. Foreign governments, anticipating
her ascension, have given $140 million to the Clinton Foundation, and hundreds
of thousands of dollars to speeches by her husband. </span></div>
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<span style="font-size: 14.0pt; line-height: 107%;"> <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">The mainstream media, in particular the <i>New York Times </i>and the <i>Washington
Post</i> , portray Trump as a
demagogue, a bigot, a fascist, a
homophobe, a misogynist, a white supremacist, and as intellectually and
psychologically unfit to be the nation’s leader. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">“On the positive side, Hilary Clinton vows to continue Obama
policies. In health care, his policies
have million from the uninsured into
the exchanges and 14 million into Medicare. “<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">“But the economy is sluggish with a 2% growth rate over 8
years, and middle American workers in fly-over country feel forgotten and
neglected with frozen wages. Many
consider themselves victims of broken health care promises that you can keep
your doctor and health plans and your premiums will decline.”<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">“Like many physicians. I have come to believe ObamaCare is
unworkable and unaffordable. It unfairly
blames fee-for-service doctors as one of the a principle cause of health care
inflation. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">The truth is we have a health system that reflexes the
desires our pluralistic society. It is a society that wants a mix of government and private
care with access to high technology.”<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">“<b>November 2</b> –
Today I would like to make these points
– universal care is a noble, desirable goal but a one-size- fits-all system is
a pipe dream; government cannot
effectively manage care retrospectively from Washington, data along cannot
replace physicians’ experiences or intuitive diagnostic and treatment
skills, universal access is difficult
because physicians have the options of not accepting Medicare, Medicaid and
ObamaCare patients, and President Obama
et all made the critical mistake of ACA passage without a single GOP vote. Instead he chose to seek standardization om
s pluralistic diverse nation,
mismanaging ACA implementation with over 300 software glitches in
healthcare.gov, misunderstanding the nature of insurance risk and how to compensate for risk
shortfalls, and failing to comprehend
that America is a center-right capitalistic society favoring choice and
entrepreneurialism over self-righteous moralistic government control. America has embraced the computer revolution
but wants high touch combined with high tech. and minimal intrusion into the
privacy and confidentiality of the patient-physician relationship. Government intervention, in short, has its
limits.”<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">November 3</span></b><span style="font-size: 14.0pt; line-height: 107%;"> - This week Bill Clinton observed
ObamaCare is a “crazy system” with 25 million more insured but accompanied by a
doubling of premiums for the rest of Americans.
Mark Dayton, governor of Minnesota, noted, after projected premiums
increases of 50% to 67% in his state, stated “The Affordable Care Act is no
longer affordable.” As Samuel Johnson
(1707-1784) ruefully concluded, “The Road to Hell is paved with good
intentions.”<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">November 4</span></b><span style="font-size: 14.0pt; line-height: 107%;"> -
Candidate Trump keeps saying the election is “rigged” in favor of the
media, academic, and bicoastal elite. I
disagree. The election is not
rigged. The media-academic- political-
establishment elite have simply reached a unanimous conclusion - HillaryCare and the safest harbor for the
status quo, and Donald Trump is too much of dangerous gamble.<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">November 5</span></b><span style="font-size: 14.0pt; line-height: 107%;"> -
How dangerous is Trump? Well,
according to the <i>New York Times</i>
editorial board, very dangerous. He has
a ‘history of coded race-baiting in lockstep with the alt-right, the Ku-Klux
Klan, racists and misogynists. It is simply Clinton-hatred that supports a
candidate who also stands for torture, hatred of women, immigrants, refugees,
people of color, people with disabilities.
A sexual predator, a business fraud, and a liar who runs on the promise
to destroy millions of immigrants and jail his opponents.”<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 107%;">The millions who support Trump and attend his rallies don’t
recognize the Devil described by the Times.
They are more concerned by the lack of good-paying jobs, the slowest
economic recovery since World War II, the doubling of health care
premiums, the highest business income
taxes in the World. Double taxation, by
U.S. government and government where U.S. companies have headquartered their companies, leaves
$3 trillion parked abroad, and a Democratic candidate and a bicoastal
elite that dismisses them as
“deplorables.”<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">November 7</span></b><span style="font-size: 14.0pt; line-height: 107%;"> – One day to go and Hillary Clinton
still heavily favored. She is
resting, preserving her energy, before
her anticipated election. Measnwhile, Trump is holding multiple rallies amidst signs
that blacks, Hispanics, and millennials
might not turn out in requisite numbers, and that people who have never
voted before may turn up at the polls to volt for Trump. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">November 9</span></b><span style="font-size: 14.0pt; line-height: 107%;"> – It’s all over, and Trump won the
electoral college by 305-220, mainly by capturing key Midwest states,
Pennsylvania, North Carolina, Florida, and other Southern, Southwestern, and Midwestrern states in
middle America.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-size: 14.0pt; line-height: 107%;">It’s too early for an autopsy, but in my opinion, these factors were
important.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Americans
in these states and rural America were sick and tired of
being told how good things were, and of being labelled as white
supremacists, bigots, homophobes, misogynists, and of being forced to buy
insurance they felt they did not need, of being relegated to part-time work.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Americans
are a proud patriotic people. They were
weary of being told they no longer lived in an exceptional nation, that they should apologize for being
advocates of right of center capitalism and personal responsibility, that the
future resided in becoming a European-like
social welfare state, and that globalism would inevitably supplant their
national culture. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Hillary
Clinton had no message other than “It’s my turn,” or <br />
“It’s time for a woman president,” or “I
will extend President Obama’s policies.”
These messages had no resonance among voters looking for change and
economic growth that improved their circumstances.<o:p></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com7tag:blogger.com,1999:blog-6076839327674215825.post-1424928447734997372017-06-28T19:10:00.001-04:002017-06-28T19:10:21.894-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 18.0pt; line-height: 107%;">Book Proposal<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-size: 18.0pt; line-height: 107%;">I am working on a book about universal care. Here is the introduction. The book’s chapter may follow in future
blogs. At present, the book has not undergone final editing.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-size: 18.0pt; line-height: 107%;">The book:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-size: 18.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 18.0pt; line-height: 107%;">Title Page<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 18.0pt; line-height: 107%;">Multiple Payer Care In,
Single Payer Out<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 18.0pt; line-height: 107%;">You Can’t Please All of
the People All of the People All of the Time<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 18.0pt; line-height: 107%;"> Who Shall Pay?
For What? Who Shall Deliver Care?<o:p></o:p></span></b></div>
<div style="border-bottom: solid windowtext 1.5pt; border-left: none; border-right: none; border-top: solid windowtext 1.5pt; margin-left: .5in; margin-right: 0in; mso-element: para-border-div; padding: 1.0pt 0in 1.0pt 0in;">
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt; mso-padding-alt: 1.0pt 0in 1.0pt 0in; padding: 0in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Quotation Page<o:p></o:p></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt; mso-padding-alt: 1.0pt 0in 1.0pt 0in; padding: 0in;">
<i><span style="font-size: 14.0pt; line-height: 107%;">To the American people, who believe government should serve the people not just the elite.<o:p></o:p></span></i></div>
</div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Opening Quotes Page<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i><span style="font-size: 14.0pt; line-height: 107%;">You can please some of the people all
of the time, you can please all of the people some of the
time, but you can’t please all of the people all of the time..<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Abraham Lincoln<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i><span style="font-size: 14.0pt; line-height: 107%;">Compassion should not be measured by
the size of the safety net, but by the number no longer on the safety net.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Jack Kemp, Congressman <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i><span style="font-size: 14.0pt; line-height: 107%;">Republicans have accepted that the
electorate sees health care not just as a commodity, like purchasing a steak or
a car. It’s something now people have the sense that government ought to
guarantee.<o:p></o:p></span></i></div>
<div style="border-bottom: solid windowtext 1.5pt; border: none; margin-left: .5in; margin-right: 0in; mso-element: para-border-div; padding: 0in 0in 1.0pt 0in;">
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-padding-alt: 0in 0in 1.0pt 0in; padding: 0in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Charles Krauthammer,
MD, <i>Fox
News </i>and <i>Washington Post</i>
contributor<o:p></o:p></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-padding-alt: 0in 0in 1.0pt 0in; padding: 0in;">
<i><span style="font-size: 14.0pt; line-height: 107%;">There is no such thing,
as a free lunch.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-padding-alt: 0in 0in 1.0pt 0in; padding: 0in;">
<b><span style="font-size: 14.0pt; line-height: 107%;">Milton Friedman<o:p></o:p></span></b></div>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Introduction <o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">\</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">American universal
coverage, single payer or otherwise, is
not on the immediate horizon. <b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Why not?<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">First,</span></b><span style="font-size: 14.0pt; line-height: 107%;">
<b>the GOP-Democrat split over
ObamaCare versus TrumpCare.</b> The
two sides, for ideological and other reasons, can’t agree what constitutes the
greater good. The split boils down to
the divide between the
medical-industrial-complex , with its pragmatic emphasis on margins to stay in business, and
the media-establishment-complex, with its moral mission to show its compassion to stay in power.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Second, the embedded structure of our current system,
dating back to World War II. </span></b><span style="font-size: 14.0pt; line-height: 107%;">Today this structure has five functioning systems covering these
populations 1) Employer
coverage (150 million); 2) Medicare (55 million); 3) Medicaid (75
million); the Veteran’s Administration (7 million); 4) ObamaCare health exchanges
(10 million); and Independent markets
(50 million), where the uninsured and underinsured reside. Overlap and interaction exists between the five. Government has a hand in all sectors, and
insurers are engaged in most. Inflation
and premium spikes in the crucial health
exchanges spill over into the other sectors.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Third, American cultural obstacles .</span></b><span style="font-size: 14.0pt; line-height: 107%;">
Americans in middle America tend to bec onservative in their politics.
They stress jobs, economic prosperity,
individual responsibility and choice.
Those on the left tilt towards a social welfare state. What complicates this relationship is the
sheer magnitude of health care spending, now about one-sixth of our
economy. Health care is a major
employer. Medicare and Medicaid are the
life-blood of hospitals, other health care employers and members of the
medical-industrial complex. Its members depend on profit to exist cannot be deprived of that profit without
economic consequences. <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Theme<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Every book
needs a theme to give it coherence and purpose.
<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">The theme of
this book? To foretell that guarantees of universal coverage, in one form or
another, sooner or later, probably later, will inevitably take place in America. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">But it will
not be “socialized medicine,” strictly government led and controlled, the
anathema of many middle Americans. Socialism is not in our DNA.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"> Universal coverage will not be free. Estimates
of the cost of a single payer system for the U.S. vary from $18 trillion to $32
trillion over the next decade. Estimates in California over its proposed single
payer system are $400 billion over current costs for the first year.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Costs<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Health care
in America is twice that of any other country.
Health care now consumes 1/6 of the Gross National Product. It employs one of eight of us. It is the
largest single employer of Americans of
any business sector, and has accounted for 37% of jobs since the 2008
recession.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">\</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">In no
country in the world, even those with universal coverage, does government pay
for all care. The percent of care paid
by government in these countries varies from 70% to 90% compared to roughly 40%
to 50% in the United States. Private insurance picks up the slack for those
seeking care or refuge outside of government care.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Why is U.S.
care so expensive ? The reasons are
technological, financial, cultural, and structural. As a society we assume newer, more invasive,
higher-tech, and more specialized care are always better. We have set up a system prioritizing
and rewarding specialty care and
punishing or minimizes primary
care. </span><span style="font-size: 14pt;">And over the
last 10 years, since</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">Apple’s IPhone
ushered in the information age in 2007, we have come to believe Artificial
Intelligence (AI), apps, and algorithms,</span><span style="font-size: 14pt;">
</span><span style="font-size: 14pt;">fueled by Big Data, much of it generated by electronic health
records,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">will lower costs, increase
efficiency, and serve as a panacea for better,</span><span style="font-size: 14pt;">
</span><span style="font-size: 14pt;">more universal care. </span><span style="font-size: 14pt;"> </span></div>
<div class="MsoNormal">
<span style="font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">We shall see
if digitization will transform care for the better. It
will be disruptive, potentially replacing medical specialists like radiologists
and pathologists, and it may generate massive unemployment, even among skilled
workers.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"> Ours is a system providing incentives for procedural and hospital-based
care and specialists. It is a system that results in an average
compensation of $194,000 for internists and a $525,000 for orthopedists(
Medical Group Management Association 2013 survey). It is a system that
increases support staffs of specialists,
fosters specialty technological innovations, functions best in large institutional settings, and increases appeal to medical
students. Understandably, these
students, who graduate with an average debt of $150,000, chose specialties
offering higher pay and shorter hours over primary care.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Two of every
three American doctors are specialists.
In other countries, the ratio is
one of three or even less. Evidence
from these countries indicates primary care produces lower costs, mortality,
and greater patient satisfaction. Primary
care physicians have become U.S.
medicine’s second class citizens.
(Louise Aronson, MD, “ A Tale of Two Doctors – Structural Inequalities and the
Culture of Medicine,” <i>New England Journal
of Medicine</i>, June
15, 2007).</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">As I ponder
these developments, I’m reminded of a 1959 book by an English surgeon,
Doctor Heneage Olgivie, entitled “No Miracles Among Friends.” Doctor Olgivie formed a travelling surgical
society whose members told of their latest innovations. One member, an American, said he had developed a new approach
to remove tonsils. The other
members asked what was so astonishing about that. The American replied, “Because I removed them from behind.”<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">In America,
said to be land of the free, we believe in small government and individual’s ability
to conduct ability to conduct one’s affairs and to make one’s choices. Universal
care, American style, will not be single
paper. Instead it will be
joined at the hip with freedom of choice.
We will have a system covering
all, but will be coupled with a private system, as is this case with most other countries, which have private insurance
to serve as choices outside of government. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">Some choices
will exist outside the realm of government and its insurers. In the end, if
projections of what universal coverage would cost under California are correct,
a single-payer system would cost 50% more than what health care currently
costs, and the extra expense would have to be covered with increased taxes.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">This is a
book about who shall pay for care, a
subject I explore in Chapter One. It
sounds cynical to say universal care is
all about money or to base a book on following health care money as the pay to
coverage for all. But money, or perhaps
I should say profit is at the root of the deep structural problems ingrained in
our system. No health care institution
or those that provide care cannot do so at a loss and stay in business. As a catholic nun CEO of a major hospital
system said, “No margin, no mission”.
Besides as Milton Berle remarked. “When it comes to my health. money is no object.” Or, as a cynical doctor
friend of mine quipped, “In health care,
money isn’t everything, health is 2%.”<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">No Villains<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">This book
seeks no villains, profit-making or otherwise. We are all a little bit liberal
and a little bit conservative No one is
singularly to blame for the current
state of American imperfect health care system.
There are no easy answers or perfect solutions to our health care woes.
Compassion alone will not be enough. Whatever
evolves, it will not be simple, and it will not be free.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;">What we
should seek is a balance between government and free markets. As H.L. Mencken remarked<i>,” For every complex problem, there is a clear and simple answer, and
it is wrong.</i>” The ACA, the Accountable
Care Act or ObamaCare, or the ACA, had
its faults. So too does the AHCA , the
American Health Care Act, or TrumpCare.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;">Optimism<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<br />
<div style="border-bottom: solid windowtext 1.5pt; border: none; mso-element: para-border-div; padding: 0in 0in 1.0pt 0in;">
<div class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext 1.5pt; mso-padding-alt: 0in 0in 1.0pt 0in; padding: 0in;">
<span style="font-size: 14.0pt; line-height: 107%;">I am optimistic about the end game, balanced Universal
Coverage. In Winston Churchill’s words,
“You can always count on the Americans to do the right thing, after they have
tried everything else,” and …,“The
inherent vice of capitalism is the unequal sharing of blessings; the inherent
virtue of socialism is the equal sharing of miseries.” <o:p></o:p></span></div>
</div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com9tag:blogger.com,1999:blog-6076839327674215825.post-26947513925502476502017-06-28T15:08:00.000-04:002017-06-28T15:08:41.099-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Bleeding Hearts, Death Predictions, and GOP Health Law</b><br />
<br />
Give Democrats credit. <br />
<br />
Democrats know how to speak with one voice. The chorus of voices have received their main talking point against the GOP's America Health Care Act, <br />
<br />
That point is: 22 million people will lose their health plans, and hundreds of thousands of these people will surely die from lack of care at the hands of the cruel Republicans. <br />
<br />
Democrats who have made these predictions of wholesale deaths include: Barack Obama, Hillary Clinton, Bernie Sanders, and Al Franken (author of "Al Franken - Giant of the Senate"), and countless others. <br />
<br />
The Republican alternative is portrayed as a "Slaughter of the Innocents"at the hands of ruthless and heartless politicians without a heart but with plenty of money. It's the needy suffering from the greedy. It's the rich exploiting the poor. It's tax cuts of the rich versus care cuts for the poor.<br />
<br />
The message is, of course, that only those currently received care from compassionate subsidized ObamaCare plans will survive if the debacle known as the American Health Care Act is not enacted.<br />
<br />
Not mentioned in this chorus of bleeding heart voices are these facts. Millions of people have already lost their doctors and health plans and access to their hospitals because of ObamaCare policies, and there are no reports of mass deaths from the ACA. A report from a large controlled study of Oregon Medicaid patients indicates that patients on Medicaid have no better results than those not on Medicaid. Medicaid patients have a hard time finding access to doctors, only 45% of whom accept new Medicaid patients because of low reimbursements and punitive regulations that negatively effective the doctors' bottom lines.<br />
<br />
Republicans have a hard time countering the Democrats' compelling emotional arguments which are highlighted by plaintive anecdotes of potential loss of coverage of those by those now subsidized by a "compassionate" government. <br />
<br />
Never mind the unsubsidized middle class no longer able to afford higher premiums and sky-high deductibles. Emotional arguments are more effective than rational arguments about the unsustainable costs of open-ended federal programs. </div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com11tag:blogger.com,1999:blog-6076839327674215825.post-5157179078455567382017-01-12T13:08:00.000-05:002017-01-12T13:08:28.789-05:00Future Ins and Outs<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: 18.0pt;"></span><span style="font-size: 18.0pt;"></span><span style="font-size: 18.0pt;">I have been reading,
watching, and listening to progressive deep thinkers, heavy social breathers,
and alarmed liberal hysterics.<span style="mso-spacerun: yes;">
</span> </span></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">Collectively, they seem to think the end of the earth may not be near,
but you can see it after the Trump election.</span>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">These critics believe sun,
wind, tide, and bio-based sources of energy are in, and fossil fuels,<span style="mso-spacerun: yes;"> </span>fracking, <span style="mso-spacerun: yes;"> </span>an drilling for oil are out.<span style="mso-spacerun: yes;"> </span>Globalization is in, and nationalism are
out.<span style="mso-spacerun: yes;"> </span>Collaboration across the social spectrum
is in,<span style="mso-spacerun: yes;"> </span>and individualism and
entrepreneuralism<span style="mso-spacerun: yes;"> </span>and taking advantage of
economic opportunities is out.<span style="mso-spacerun: yes;"> </span>Waste is
in and recycling is out.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">According to these
critics,<span style="mso-spacerun: yes;"> </span>Trump and his followers
believe(Peter Senge, <i style="mso-bidi-font-style: normal;">The Necessary
Solution: How Individuals and Organizations Working Together to Create a
Sustainable <span style="mso-spacerun: yes;"> </span>e World,<span style="mso-spacerun: yes;"> </span></i>Trump et all have these unsustainable
beliefs.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 18.0pt;">Energy is infinite and cheap.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 18.0pt;">There will always be enough room to dispose of our
waste.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 18.0pt;">Humans can’t possibly alter the global environment. Weather
patterns will remain stable no matter how we act.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 18.0pt;">Basic resources such as water and topsoil <span style="mso-spacerun: yes;"> </span>are unlimited. If limits or problems are
encountered, markets and new technologies will reallocate financial resources
so we can continues with our current ways of living and working.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 18.0pt;">Productivity and standardization are keys to economic
progress.</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 18.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-size: 18.0pt;">Economic
growth and rising GDP are the best way to “lift all boats and reduce social inequities.
</span></i><span style="font-size: 18.0pt;"></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">Another deep thinker,<span style="mso-spacerun: yes;"> </span>Thomas Friedman, of the <i style="mso-bidi-font-style: normal;">New York Times, </i>says larger forces<span style="mso-spacerun: yes;">
</span>- Moore’s Law (microchips will double in efficiency every 2 years),
globalization (interconnections and interdependence secondary to the Internet),
an Mother Nature (climate change and biodiversity loss) are accelerating and will
either save us or destroy us.<span style="mso-spacerun: yes;"> </span>He says
since 2007 we have been changing fast because of Iphones,<span style="mso-spacerun: yes;"> </span>advances in silicon chips, software, sensors,
and networking, and these forces are transforming society irreversibly.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">In health care, critics
maintain, only collaboration <span style="mso-spacerun: yes;"> </span>between
government and NGOs (nongovernment organizations) will save us from our follies/<span style="mso-spacerun: yes;"> </span>The solution will require collaboration in
the form of accountable care organizations,<span style="mso-spacerun: yes;">
</span>medical homes, integrated health organizations,<span style="mso-spacerun: yes;"> </span>bundled pricing, and measures of improvement
tied to <span style="mso-spacerun: yes;"> </span>physician and hospital reimbursements,
and universal care. Universality in care will lead inevitably to learning
organizations, and the use of artificial <span style="mso-spacerun: yes;"> </span>intelligence4<span style="mso-spacerun: yes;">
</span>and elegant algorithms that will supplement and supplant clinician experience
and intuition <span style="mso-spacerun: yes;"> </span>and interpretations.<span style="mso-spacerun: yes;"> </span>For example,<span style="mso-spacerun: yes;">
</span>artificial intelligence and algorithms will replace interpretation s of
radiologists and pathologists to interpret images on ex-rays and slides.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">All will be well and better
in health care if we oly listen and heed the Big Thinkers.<span style="mso-spacerun: yes;"> </span>aim for universal coverage, erase social
injustices,<span style="mso-spacerun: yes;"> </span>achieve standardized outcomes,
and collaborate across all health care spectrums.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 18.0pt;">If other words, if only we
defy human nature and level all playing fields,<span style="mso-spacerun: yes;">
</span>we will have harmonious outcomes.<span style="mso-spacerun: yes;">
</span></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com34tag:blogger.com,1999:blog-6076839327674215825.post-72347068397603751702017-01-06T15:21:00.001-05:002017-01-06T15:21:41.277-05:00End of ObamaCare and Mortality Deadline<div dir="ltr" style="text-align: left;" trbidi="on">
J.Oberlander, PhD, a health expert at the University of North Caroline, has ana article in the January 5 New England Journal of Medicine. It is entitled "The End of ObamaCare." Oberlander says that with the Trump election, ObamaCare is dead and awaits Republican replacement. In his concluding paragraph. he says, :The ACA's enactment represented a major toward making health care a right in the United States. Now after another landmark election, health care reform in the Untied States is headed backward."<br />
<br />
This is his opinion and is not shared by the majority of the American public, who, in over 95% of polls disfavored ObamaCare because of its failed promises, spiking premiums, unaffordable deductibles, and narrowing of choice of doctors, hospitals, and health plans.<br />
<br />
Another reason may be the ACA's ineffectiveness in improving the health of the majority of Americans. The latest evidence of this is the Center of Disease's announcement that the average mortality of Americans declined from 7,89. to 78.8 years in 2015, the first such drop in living memory. This decline occurred after 7 years of ObamaCare, whikch was designed to achieve a triple<br />
aim- better health, lower premiums, and enhanced collaboration between health care providers.<br />
<br />
What's going on? According to the CDC, the spike in death rates and the decline in mortality is due mostly to obesity (35% of us are obese) and its aftermaths - diabetes. heart failure, and strokes, and to the opioid and heroin epidemic (30,000 deaths in 2015).<br />
<br />
These deaths are not necessarily due to ObamaCare, but to cultural factors - overeating carbohydrate-rich diets, lack of exercise, and to economic despair secondary to a slow growth economy, and over-reliance on opioids and cheap heroin to treat pain.tes or regulate health in the face of a slow economy, and ats attendant poverty, social disarrage and violence, paritisan political divisons. Nor does enhanced coverage of health care form 20 million SAmericans necessarity ensure better health. lower death rates, or collaboration between health provides. Health care coverage is not the same as increased access to care , in face of reluectance of doctors to accept more Medicare or Medicaid patients, unaffordable premium, , co-pays, and deductibles.<br />
<br />
<br /></div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com21tag:blogger.com,1999:blog-6076839327674215825.post-7948319866884557262016-12-06T15:41:00.001-05:002016-12-06T15:41:15.870-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Winners, Losers, and
Moral Victories</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: Calibri;">Winning isn’t everything,
it’s the only thing.</span></i></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Trump Philosophy, as
expressed by Vanderbilt football coach, Red Sanders, in 1953</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: Calibri;">If you lose, it’s a
moral victory.</span></i></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Democratic
Philosophy, after 2016 presidential election</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">President-elect Donald Trump, during the campaign, said the
election was all about America winning again,<span style="mso-spacerun: yes;">
</span>thereby making it great again.<span style="mso-spacerun: yes;">
</span>Maybe,<span style="mso-spacerun: yes;"> </span>but after a close
election, winners and losers have two points of view.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Points of View</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">One</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans – We won, you lost.<span style="mso-spacerun: yes;"> </span>Get over it.<span style="mso-spacerun: yes;">
</span>Suck it up, Buttercups.<span style="mso-spacerun: yes;"> </span>Melt
down, <span style="mso-spacerun: yes;"> </span>snowflacks.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats<span style="mso-spacerun: yes;"> </span>- You won
the electoral college, but we won the popular vote.<span style="mso-spacerun: yes;"> </span>That is a moral victory for our side.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Two</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans -<span style="mso-spacerun: yes;"> </span>What
American workers think, is what counts.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats-<span style="mso-spacerun: yes;"> </span>What the
American intelligentsia conceive and believe is more rational, more
compassionate, and more moral.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Three</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans – Pride in our national heritage beats globalism
and produces a greater,<span style="mso-spacerun: yes;"> </span>more prosperous economy.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats -<span style="mso-spacerun: yes;"> </span>Globalism will win in the end in an
interconnected world because economic tradeoffs are necessary <span style="mso-spacerun: yes;"> </span>and more compassionate. </span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Four</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans -<span style="mso-spacerun: yes;"> </span>Strict
adherence to the Constitution is what makes America great.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats -<span style="mso-spacerun: yes;"> </span>The
Constitution must be a living document,<span style="mso-spacerun: yes;">
</span>adjusted to greater trends in the world.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Five</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans -<span style="mso-spacerun: yes;"> </span>We listened
to the silent majority which represents American culture.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats – The new majority is the collective vocal
minority.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Six</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans <span style="mso-spacerun: yes;"> </span>– Winners
<span style="mso-spacerun: yes;"> </span>win because they understand<span style="mso-spacerun: yes;"> </span>the common will.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats<span style="mso-spacerun: yes;"> </span>- To win
one must pay attentions to what other nations want,<span style="mso-spacerun: yes;"> </span>even if these nations may to play for
dabbling in American politics.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">Seven<br />
</b>Republicans – To win a true nation must define and defend its borders.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats – To be a true part of the world community, one
must have open borders and accept all comers.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Eight</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans<span style="mso-spacerun: yes;"> </span>- A
rising tide, based on lower taxes and fewer regulations, lifts all boats.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats -<span style="mso-spacerun: yes;"> </span>A rising
tide enriches the rich, leaving the poor to drown without a safety net.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Nine</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans – Bottom-up enterprises, based on freedom to
innovate, bubbles up and enriches all.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="mso-spacerun: yes;"> </span></b>Democrats –<span style="mso-spacerun: yes;"> </span>Trickle-down innovation does not work and
discriminates.<span style="mso-spacerun: yes;"> </span>Only trick-down government
control works.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Ten</span></b></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Republicans – Big Media, big Money, and a big Ground Game
lost.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Democrats – Alternative Media, alternative financing, and
popular rallies lack moral coherence.</span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">When it comes to winning and losing in politics, there are
always two points of view, each a little Conservative, and each a little
Liberal ,each a little more business-like, each a little moral.</span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com3tag:blogger.com,1999:blog-6076839327674215825.post-12340441406478200552016-11-30T16:02:00.002-05:002016-11-30T16:02:23.440-05:00Elements of Health Reform: Lessons Learned<div dir="ltr" style="text-align: left;" trbidi="on">
The cat is out of the bag, the toothpaste is out of its container, and the genie is out of the bottle.<br />
<br />
Trump has been elected. Tom Price, MD, a fierce opponents of ObamaCare has been selected as head of HHS, and Republican leaders have declared repeal and replacement of ObamaCare as first on their legislative agenda.<br />
<br />
What are lessons learned from this unlikely turn of events, which will doom Obama's signature domestic program and likely lead to a Republican alternative plan, as yet unnamed? What will happen to those 20 million Americans now subsidized on health exchanges and Medicaid? No one knows at this point, and it is unlikely we will know precisely until months after President's Trump's debut.<br />
<br />
In my case, after 50 years of writing about health reform, I have come to these conclusions.<br />
<br />
<ul style="text-align: left;">
<li>The U.S. Constitution- The U.S. Constitution, said by one historian as the greatest legislative compromise, in Western Civilization, is alive and well. Its electoral college provision held up and will not be overturned. And the checks and balance concept has prevailed, much to the chagrin of Democrats.</li>
</ul>
<ul style="text-align: left;">
<li>Failure to Compromise in Bipartisan Nation -Largely because President Obama failed to compromise in designing and implementing the health law, passing it without a single GOP vote, ObamaCare is now destined for oblivion</li>
</ul>
<ul style="text-align: left;">
<li>Rhetoric Not Enough -President Obqma, a gifted speaker and campaigner, did not achieve his promised results, filed to build a Democratic leadership team, and did not listen to the people. Consequently, he left the Democratic party in shambles</li>
</ul>
<ul style="text-align: left;">
<li>Center Right- America is a center-right capitalistic nation that believes in personal responsibility, economic prosperity, and equal opportunity rather than government control, economic stagnation, and equal outcomes. </li>
</ul>
<ul style="text-align: left;">
<li>Limits of Centralized Government -A centralized government cannot manage individual choices at the level of doctor-patient relationship.</li>
</ul>
<ul style="text-align: left;">
<li>Health Costs Difficult to Control -Health care costs are difficult to control when comprehensive benefts are offered but not deliveredand because everybody wants to live another day and because , in the words of comedian Berle, "When it comes to my health, money is no obstacle.</li>
</ul>
<ul style="text-align: left;">
<li>Demand for Lifestyle Improvement-One of the untold tales of health reform is the demand of aging patients for access to life-style technologies - joint replacements and cardiac stents - that support their lifestyle.</li>
</ul>
<ul style="text-align: left;">
<li>Ignoring of Insurance Risk - ObamaCare did not lower premiums or deductibles because it made calculations of actuarial risks impossible and did not take into consideration that insurance is based on balances the costs of illness against health.</li>
</ul>
<ul style="text-align: left;">
<li>Absolute universal coverage, noble in intent but impossible in attain America, which cherishes choice, individual freedom, and access to the best medicine has to offer, cannot be acheived in America<br /></li>
<li> Nature of Humanity - People, being human and not robots, will continue to behave badly and ignore habits of good health in search of earthly pleasures as long as health technologies offer an out.<br /></li>
<li>Freedom of Choice - Freedom of choice of doctors and health plans and hospitals are part of the fabric of American culture.</li>
</ul>
<ul style="text-align: left;">
<li>Benefits of Prosperity - Beleif in economic growth as a universal solvent for most problems is embodied in President Kennedy's statement, " A rising tide lifts all boats, and in the provess etends to soften or paper over social inequities.</li>
<li> Orwellian Observation - In <i>Animal Farm</i>, George Orwell commented, "Some animals are more equal than others." This applies to health reform, even is Big Brotther is watching.</li>
<li>Unequal Blessing, Equal Miseries - Winston Churchill said, Capitalism offers unequal sharing of blessings, while Socialism confers equal sharing of miseries.</li>
<li>Necessity of Organizations - In the complicated world o health reform. most advances require organizations managed growth and perpetuity operating within the matix of indvidual ezcellence.</li>
<li>The fuure excellence of American health care depends on govenment and private orgnization working in trandem with health professinals.</li>
<li>America in the future will have a dual system - one operating within the context of government government regulations and value-based outcomes and the other based on direct cash contracting of patients with doctors.</li>
<li>Political Aprodisiac - Control of health care is a political aprodisiac . A broad siocui saftey netw will always be necessay.</li>
<li>Governent Innovation - You cannot bottle or direct or crate innovation at the federal level, Spontaenous imaginative individuals seeking better solutions form the bottom up is necessay.</li>
<li>Pure Ideologies - Pure ideiologies, either liberal or conservative do not usuall owrk.</li>
<li>Language of humanism - elegant language of humanism, spiced with straight talk, insprirtion, and humility is a necessary is essential for developing a workable system that does not break the national budget.</li>
<li>Limits of IT - Algorihms and appas, no mater what their scope or ingenuity, will never replace or replace,human intellegence and imgination and ablility to cut to the chase.</li>
</ul>
<br />
<br />
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com2tag:blogger.com,1999:blog-6076839327674215825.post-23925188172637386422016-11-26T14:11:00.000-05:002016-11-26T14:11:05.390-05:00Majority in Battleground States and Trump Knew Country Was Headed in Wrong Direction<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why did Trump Win?<span style="mso-spacerun: yes;">
</span>Because majority of voters in battleground states knew country was
headed in wrong direct?<span style="mso-spacerun: yes;"> </span>In poll after
poll, nearly 70% of voters in these states said so.<span style="mso-spacerun: yes;"> </span>It was a stark statistic, and it rarely
changed<span style="mso-spacerun: yes;"> </span>by more than<span style="mso-spacerun: yes;"> </span>1 or 2 percentage points.</div>
<div class="MsoNormal">
Voters knew something had to change.<span style="mso-spacerun: yes;"> </span>And this lust for change elected Trump.</div>
<div class="MsoNormal">
The number foretold where the majority of people stood and
how they are likely to vote.</div>
<div class="MsoNormal">
People knew the sluggish economic growth of 2% was wrong.</div>
<div class="MsoNormal">
People knew taxes were too high and regulations were too
burdensome for<span style="mso-spacerun: yes;"> </span>economic growth.</div>
<div class="MsoNormal">
People know transferring<span style="mso-spacerun: yes;">
</span>jobs abroad made no sense.</div>
<div class="MsoNormal">
People know opening up borders to illegal immigrants was
misguided.</div>
<div class="MsoNormal">
People know abundant fossil<span style="mso-spacerun: yes;">
</span>fuels, especially natural gas and even coal </div>
<div class="MsoNormal">
made for affordable energy and was the engine of American
prosperity.</div>
<div class="MsoNormal">
People knew doubling and even quadrupling of health premiums
coupled with unaffordable deductions made seeing a doctor, even for routine
care, was virtually impossible.</div>
<div class="MsoNormal">
Who, in the main, were these people?<span style="mso-spacerun: yes;"> </span>They were the people of Middle America-<span style="mso-spacerun: yes;"> </span>skilled workers, small businessmen and women,
the common folk – the glue of American society.</div>
<div class="MsoNormal">
The people yearned for straight talk rather than the
politically correct jargon of the elite.</div>
<div class="MsoNormal">
The people knew the U.S. Constitution guaranteed that
American government was of the people, for the people, and by the people, not
of the elite, for the elite, and by the elite. The elite were D.C. politicians,
the well-to-do in bicoastal population centers, the newly rich in Silicon
Valley,<span style="mso-spacerun: yes;"> </span>academics in universities, the
college educated and those with advanced,<span style="mso-spacerun: yes;">
</span>the heads of corporations, health system, and above all else,<span style="mso-spacerun: yes;"> </span>liberal journalists, and media moguls.</div>
<div class="MsoNormal">
Fly-Over Country</div>
<div class="MsoNormal">
The intelligentsia, , concentrated in major cities and on
both coast,<span style="mso-spacerun: yes;"> </span>spoke mostly to one
another.<span style="mso-spacerun: yes;"> </span>They were doing fine, getting
richer and richer.<span style="mso-spacerun: yes;"> </span>They regarded Middle
American as fly-over country, populated by consumers of their products and
message, a swamp of mediocrity, full of evangelicals deplorables, bigots,
misogynists,<span style="mso-spacerun: yes;"> </span>racists, homophobes,<span style="mso-spacerun: yes;"> </span>none of whom recognized the glories of
upper-crust compassion,<span style="mso-spacerun: yes;"> </span>globalism, <span style="mso-spacerun: yes;"> </span>apps, algorithms, <span style="mso-spacerun: yes;"> </span>and the solutions offered by sum, wind,
and<span style="mso-spacerun: yes;"> </span>fossil-fuel shutdown as the solution
to climate change.<span style="mso-spacerun: yes;"> </span>They looked upon the
middle of America and its ignorant middle class as swamp – a swamp that needed
to be drained and converted to higher causes.</div>
<div class="MsoNormal">
The Swamp Fox</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Enter the Swamp Fox, Donald Trump..<span style="mso-spacerun: yes;"> </span>As a longer-term charter members of the
wealth elite, he knew the thinking of the political and commercial establishment.<span style="mso-spacerun: yes;"> </span>He sense that that a populist movement as
afoot in Middle America- the center right of American politics.<span style="mso-spacerun: yes;"> </span>He could feel it in his bones.<span style="mso-spacerun: yes;"> </span>He sense in the huge throngs that flocked to
his rallies.<span style="mso-spacerun: yes;"> </span>He knew that a mix of
patriotism,<span style="mso-spacerun: yes;"> </span>and a desire for pride in
American, and identify as Americans was in the air.<span style="mso-spacerun: yes;"> </span>People wanted a return to economic
prosperity which he, and he alone, could unleash through tax reductions, loosening
of regulations,<span style="mso-spacerun: yes;"> </span>repeal of ObamaCare, a
plan to make America energy independent , <span style="mso-spacerun: yes;"> </span>and making America proud and great and
secure.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
Keys to His Campaign</div>
<div class="MsoNormal">
The keys to campaign were to make Americans proud of
themselves,<span style="mso-spacerun: yes;"> </span>to promise economic
prosperity, to assure them that nationalism transcended globalism,<span style="mso-spacerun: yes;"> </span>and to ridicule and outfox his opponents
through manipulation of the media.<span style="mso-spacerun: yes;"> </span>He
mocked his opponents,<span style="mso-spacerun: yes;"> </span>lambasted the
media, and made himself a constant presence on TV,<span style="mso-spacerun: yes;"> </span>social media, and on Twitter.<span style="mso-spacerun: yes;"> </span>He questioned the conventional wisdom.<span style="mso-spacerun: yes;"> </span>He<span style="mso-spacerun: yes;">
</span>declined conventional<span style="mso-spacerun: yes;"> </span>funding
sources,<span style="mso-spacerun: yes;"> </span>he said he did not want to be
anybody’s puppet or to be beholden to them.<span style="mso-spacerun: yes;">
</span>He financed much of his campaign. <span style="mso-spacerun: yes;"> </span>Somehow he became known as the blue-collar
billionaire,<span style="mso-spacerun: yes;"> </span>the champion of common
people.<span style="mso-spacerun: yes;"> </span>And, first and foremost, he
vowed to drain the swamp<span style="mso-spacerun: yes;"> </span>of the<span style="mso-spacerun: yes;"> </span>corrupt establishment in all of its form.</div>
<div class="MsoNormal">
ObamaCare</div>
<div class="MsoNormal">
Trump promised to retain Medicare and Medicaid, the faster
growing segments of the national debt, while opening up health car to market forces
<span style="mso-spacerun: yes;"> </span>through expanded health savings accounts
and erasure to state line.<span style="mso-spacerun: yes;"> </span>A competitive
system, he maintained, would be wonderful.<span style="mso-spacerun: yes;">
</span>He did not say just how – how to cover the 8 million uninsured now
insured in health savings accounts, how to <span style="mso-spacerun: yes;"> </span>finance th 12 million who joined
Medicaid.<span style="mso-spacerun: yes;"> </span>He would delegate Medicaid to
the states through block grants, and somehow the states would expand access
while reducing costs.</div>
<div class="MsoNormal">
According to an ancient sage,<span style="mso-spacerun: yes;"> </span>the fox knows many things, but the hedgehog,
who is closer to the gou8nd, knows one big thing.<span style="mso-spacerun: yes;"> </span>What is the health system’s one big thing? <span style="mso-spacerun: yes;"> </span>What combination of government programs and
market-based cased will work for the benefit of all?<span style="mso-spacerun: yes;"> </span>What will be Art of the Health care
deal?<span style="mso-spacerun: yes;"> </span>Time will tell.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com2tag:blogger.com,1999:blog-6076839327674215825.post-36511147565258683632016-11-16T11:25:00.002-05:002016-11-16T11:25:49.308-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Silence Not So Golden</b><br />
<br />
We usually measure a man - or a woman- by what they say, what they do, how they act, and by their body language, how they carry themselves.<br />
<br />
But we rarely judge them by what they don't say, what they don't do, what their body language reveals and when they remain silent.<br />
<br />
These things seem to be different with President Obama. He is being judged by his silence and delayed comments on controversial issues such as not using the term "radical Islamic terrorists: his failure to comment on Kate's Law and the Mexican felon who gunned her down; his muteness to take the side of the police in police assassinations; his not mentioning the doubling of health care premiums, the quadrupling of deductibles, and the narrowing of choices of doctors and health plans; and most recently , his silence in the wake of violent protests against the Trump election.<br />
<br />
No doubt Obama regards his silences as a subtle protest social injustices, not worthy of a political correct message. He may be correct, but his critics say his silences are acts of moral cowardness, of hiding behind his true beliefs.<br />
<br />
Silence, it is often said, is golden,<br />
Except, of course, when certain events unfolden,<br />
Then one should seek to clearly express<br />
Of one's failed policies to confess,<br />
Then one's embolden critics one is beholden.</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com3tag:blogger.com,1999:blog-6076839327674215825.post-45154025953095512632016-11-15T12:33:00.001-05:002016-11-15T12:33:37.603-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Red, White, and Blue</b><br />
<br />
Imagine the United States as a red sea with blue coasts and scattered islands of blue.<br />
<br />
The sea is turbulent with white -waves splashing up against the blue coasts and engulfing or threatening to swallow islands of blue.<br />
<br />
Imagine these environmental scene in political terms over the last 8 years and the changes it has wrought. Under Obama, there are 11 fewer Senate sets, 60 House seats, 14 fewer governorships, and 900 fewer seats in state legislatures. Now that is a sea change. <br />
<br />
Turning the red seat blue again will be difficult. It will call for changing Middle America's attitudes towards centralized government. It will pit the forces of prosperity against the forces of equality. It will call for Americans to trust Wall Street, progressives, academics, and the elite more than their gut and desire for a place in the sun again. It will be the desire for choice, freedom, and opportunity against mandates, controls, and regulations. It will require Democrats to discard its aging leadership and its Clintonism attitudes for younger leaders who pay more attention to the need for more economic growth in the nation's midsection where pride in America still reigns supreme.<br /><br />
<br /></div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com1tag:blogger.com,1999:blog-6076839327674215825.post-7968458764881610262016-11-10T14:31:00.001-05:002016-11-10T14:31:17.354-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Private Independent Practice; The Way It Was , When Time with Other Physicians and Patients Counted</b><br />
<br />
The November 10 issue of the <i>New England Journal of Medicine </i>has an article :The Meaning and the Nature of Physicians' Work."<br />
<br />
It opens with this paragraph:<br />
<br />
" Medicine was a fundamental order. Doctors' lounges were central locations where community internists, specialists, and surgeons ate together, socialized, and 'curb-' each other for patient consultations. Charts were dept on paper and were often indescribable."<br />
<br />
I expressed this picture in my 1988 book <i>And Who Shall Care for the Sick: The Corporate Transformation of Medicine in Minnesota."</i><br />
<br />
<i>"R</i>emember the good old days when your fellow physicians were collegial colleagues; when hospitasl were charitable institutions catering to the sick;<i> </i>when youir success depended on your reputation among your peers; when you built reputations in a year or two and paid off your banker; when you and your office girl handled all your office affairs; when word of your medical skills spread by word of mouth from one patient to another and from one doctor to another; when you were one of the few specialists around; when marketing was unnecessary because being a doctor with good bedside skills was enough, and when advertising was enoggh. Those days are over for you and hospitals."<br />
<br />
And I might add, the gathering of doctors in hospital staff rooms to compare notes, to make referrals to enjoy doctor-to-doctor camaraderie, to share the jobs of practicing medicine are over over. Now, as a primary care physician you are forced to stay in your office to make ends meet and to make electronic heath record entries and to make 3ends meet because of Medicare, Medicaid, and Health Exchange cuts. You now have to hand over your hospitalized patients to hospitalists.<br />
<br />
Why is this? Well. it has to do with the corporate transformation of medicine, and the demands of documentation over the needs of doctoring, Medicine has become a huge business, comprising nearly 20% of GNP. And it has to do with the ingress of the Internet and the availability of data to anybody and everybody, including insurers, government officials, and consumers themsleves. And above all else, it has to do with time - the time formerly spent face-to-face with colleagues in hospital staff room and time spent with with patients.<br />
<br />
As the authors of the <i>New England Journal of Medicine </i>piece comment:<br />
<br />
" We believe in the coming years, the U.S. medical community will hve to rethink the human-computer interface and merge the real patient with the Ipatient. We hve the opportunity to radically redesigned rmedical record systems; initially created for fee-for-service billing, as our organizations shift towards bundled payments, capitation, and risk sharing. Perhhaps virtual scribes and artificial intelligence will eventually reduced our documentation burden.<br />
<br />
And perhaps not. Perhaps the majority of physicians will switch to direct payment and concierge medicine to escape the time-consuming hassles of electronic health records. If the Trump election reveals anything, it reveals the unpopularity of EHR data among physicians accounts for much of physician discontent because it consumes time away from patients. It reveals data documentation has its limits, as revealed by the false predictions about the election outcome among across the media, policy makers, pundits, and Silicon Valley aficionados. Data reliability is limited by human data reliability. The American middle class and blue color workers between the East and West Coasts in fl-over-land does not rely on or care bout dta. They car about their livelihoods, their families,l and their cultural traditikns.<br />
<br />
<br />
As the <i>New England Journal </i>authors conclude, Among physicians, "technology cannot restore porfessinal satisfactions. Our professional will have to rebuild a sense of teamwork, community. and the ties that bind us together as human beings. <i>We believe that will require spending more time with each other and our patients, restoring some rituals that are meaningful to both us and the people we care for and eliminating those that are not."</i><br />
<br />
Time spent with one another, in other words, is of the essence, and cannot be replaced with data.<i> </i></div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-65731475613594077202016-11-09T15:51:00.000-05:002016-11-26T12:48:08.709-05:0021 Reasons Why Trump Won Election<div dir="ltr" style="text-align: left;" trbidi="on">
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The American people had grown sick and tired of:<br />
<br /></div>
1. Of being talked down to in condescending, contemptuous, and deplorable terms.<br />
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2. Of being told what to do, how to live, and how to think.<br />
<br />
3. Of being called bigots, racists, sexists, misogynists and for being belittling for using "politically incorrect language of for simply being evangelicals and Catholics.<br />
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4. Of being regarded as "stupid" about politics; as one millenial in Nevada commented for not joining a health exchange that charged twice what it would cost for simply paying a mandated penalty, "We may be young. We may be healthy. But we are not stupid."<br />
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5. Of being incapable of understanding the nuances of politics and money and federal control.<br />
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6. Of being over-regulated and over-taxed and over-controlled by centralized bureaucrats in Washington.<br />
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7.Of being mandated to pay financial penalties for not being insured in order to pay for the care of the sick and elderly.<br />
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8. Of being promised explicitly and falsely by the President that they could keep their doctor, health plan, and hospital ant that where premiums would be $2500 less for a family.<br />
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9. Of being told that gainful full-time employment would steadily and inevitably rise even though 95 million Americans had quit looking for a job.<br />
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10.Of being deprived of the opportunity to choose their own doctor and health plan or that they would only have the choice of one or two health plans.<br />
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11. Of being unable to shop for health care outside of narrow networkds and plans outside of their state of residence.<br />
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12. Of not being informed that every region of the country ultimtely had to have a homogeneous standard of care.<br />
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13. Of being lectured that because of the global economy their wages would be leveled or frozen through integration and trade agreements or that thier job might be eleminated.<br />
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14. Of being instructed that America was not longer an exceptional nation of freedom and opportunity and its neo-colonial nature should be a subject for apology.<br />
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15.Of being told that a systemic war on women was being waged by American men.<br />
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16. Of being conditioned to believe that independent physicians , acting alone without third party guidance, were incapable of delivering high quality care and must be replaced by teams of data-driven supplemented "providers".<br />
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17. Of being informed that only the media, political, academic, financial, or management "establishments had the wherewithal and know-how to do what was best for the health of the American people.<br />
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18. Of being indoctrinated with the concept that a coalition of vocal minorities could dominate and silence a mute majority.<br />
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19, Of being told that a combination of solar, wind, and electrical cars would could supplant American fossil fuels as a source of affordable energy for American households.<br />
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20. Of being pounded with the idea that ordinary blue collar workers lacked the common sense and technical skills to build and sustain an entrepreneurial, innovative, and fair and balanced capitalitstic economy for the common good.<br />
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21. Of being divested of the fact that the greatest compromise of the western world, the U.S. Constitution, with its checks and balances, still is the best instrument for serving a diverse democracy.</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-52826761274997948122016-11-07T13:14:00.001-05:002016-11-07T13:14:04.070-05:00New York Times Ridicules Trump<div dir="ltr" style="text-align: left;" trbidi="on">
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">New York Times </span></i><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Ridicules Trump</span></div>
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<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Well,
it’s one day before the election.<span style="mso-spacerun: yes;"> </span>The <i style="mso-bidi-font-style: normal;">New York Times, </i><span style="mso-spacerun: yes;"> </span>the Bible of Progressives,<span style="mso-spacerun: yes;"> </span>is taking its final shots at Donald Trump,
portraying him as a dangerous demagogue while praising Hillary Clinton as a
demigod destined to save America’s future in a dangerous world.</span></div>
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<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">To
wit:</span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Farah
Stockman and Nick Corasanti : “The Steep Costs of Bitter Barbs: Global
Prestige.”</span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">“America’s image stands tarnished in the eyes of itw own
people and the world…Rarely has its political system subjected to such
widespread scorn and ridicule…In Europe 85% of people in a recent Pew Research
poll have no confidence in Mr.Trump doing the right thing regarding world
affairs.’ “</span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Frank
Bruni:<span style="mso-spacerun: yes;"> </span>“Why This Election Terrifies Me”</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">“The
America on display on this election<span style="mso-spacerun: yes;"> </span>isn’t
a fair and ethical place and it seethes with hatred…His incendiary words and
unconscionable <span style="mso-spacerun: yes;"> </span>silences give a green
light to bad actors; the anti-Semites who harassed Jewish journalists on
Twitter; the white nationalists who threated to intimidate minorities at the
polls; the misogynists<span style="mso-spacerun: yes;"> </span>who hurled inprintable
slurs at Clinton.”</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Nicholas
Kristoff: “Reasons to Sy: ‘I’m With Her,’ “</span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">“There
are strong grounds to vote for Clinton regardless of her opponent. ..Of course,
for many, the greatest appeal for Clinton is that she’s not Trump.<span style="mso-spacerun: yes;"> </span>He simply falls outside the norms:<span style="mso-spacerun: yes;"> </span>A Fraudster who seems a racist, who has
cheated people at Trump University and regularly through his career, who boasts
of sexual assaults and whom 17<span style="mso-spacerun: yes;"> </span>women
have accused to improper behavior, who has flip-flopped 138 times by one count
and who lies every 5 minutes by another, and who has less public servie than
any incoming present in history.”</span></div>
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<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Times </span></i><span style="font-family: "Georgia","serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>editorial board” ”Imagining the Country on Nov.9.”</span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">“It
is a history of coded-race baiting that puts the Republican establishment in
lock-step with the Alt-right, the Ku-Klux Klan; the racists and misogynists and
nut jobs…For some it simply Clinton hatred that allow them to jusifiy support
for a candidate that stands for torture, reckless war, hatred of women, immigrants,
refugees, people of color, people with disabilities. <span style="mso-spacerun: yes;"> </span>A sexual predator a business fraud who runs on
a promise to destroy millions of immigrants and to jail his opponent.”</span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Had
enough of left-wing hatred and Trump character assassination.<span style="mso-spacerun: yes;"> </span>I have.</span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">In
its characteristic fashion,<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">The Times</i>, its reporters, and columnists
fair to mention:</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">The
slowest economic recovery from a recession in 49 years,<span style="mso-spacerun: yes;"> </span>with no annual growth of 3 %.</span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">94
million Americans who have quite looking for work.</span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">The
highest business profit tax in the world which has caused corporations to park
$3 trillion overseas because of the absurd 35% tax on corporate profits.</span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">A
doubling, even an sextupling of health care premiums accompanied by unaffordable
deductions with less choice of providers,<span style="mso-spacerun: yes;">
</span>and an explosive doctor shortage.</span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">An
angry voiceless American middle class crushed by a stagnant economy and for frozen
wages who feel a loss of liberty and freedom<span style="mso-spacerun: yes;">
</span>under an administration and a successor who vows even more relations and
higher taxes.</span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com1tag:blogger.com,1999:blog-6076839327674215825.post-85885194234969874162016-10-27T11:54:00.001-04:002016-10-27T11:54:01.664-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">November Bombshell</span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Wikileak
surprises keep coming, but biggest bombshell may be premium increases, due to
kick in on November 1.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Premiums
will go up an average of 25% but will increase dramatically in some states –
Arizona 116%, Oklahoma 69%, Tennessee 63%, Minnesota 59%.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">These
increases are significant because <span style="mso-spacerun: yes;"> </span>Obama
promised premiums would decline by $2500 per family and consumers would be able
to keep their doctor and health plan.<span style="mso-spacerun: yes;">
</span>Neither promise has worked out.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">So
we are left with this situation- broken promises and narrow choices of doctor
and premium and deduction spikes the middle class cannot afford.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Bill
Clinton says ObamaCare is “crazy” with 25 million <span style="mso-spacerun: yes;"> </span>Americans more uninsured being subsidized but many
more millions suffering double, triple, or quadruple<span style="mso-spacerun: yes;"> </span>unaffordable care.<span style="mso-spacerun: yes;"> </span>Governor of Minnesota,<span style="mso-spacerun: yes;"> </span>Mark Dayton,<span style="mso-spacerun: yes;">
</span>formerly a fervid ObamaCare supporter,<span style="mso-spacerun: yes;">
</span>says the health law is no longer affordable and must be changed, even
repealed.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">What’s
gone wrong?</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Dubious.
Even false assumptions.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Assumptions</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">One,<span style="mso-spacerun: yes;"> </span>ObamaCare would be a step forward towards universal
health care.<span style="mso-spacerun: yes;"> </span>Instead studies in two
states,<span style="mso-spacerun: yes;"> </span>Vermont and Colorado,<span style="mso-spacerun: yes;"> </span>have shown universal care in their states
would be exorbitant and unacceptable to their citizens.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Two,<span style="mso-spacerun: yes;"> </span>ObamaCare would prove to popular with public.<span style="mso-spacerun: yes;"> </span>Instead more than 500 polls have shown only
three polls indicating favorability among the public.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Three,<span style="mso-spacerun: yes;"> </span>one could tinker with insurance risk factors,
such as excluding those with pre-existing conditions from calculating<span style="mso-spacerun: yes;"> </span>premiums <span style="mso-spacerun: yes;"> </span>and making it impossible to charge women more
than women.<span style="mso-spacerun: yes;"> </span>So, we have an unbalanced system
with soaring premiums.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Four,<span style="mso-spacerun: yes;"> </span>millenials would join health exchanges and
pay costly premiums rather than fork up $695 for not being covered.<span style="mso-spacerun: yes;"> </span>Wrong again.<span style="mso-spacerun: yes;"> </span>Premiums cost twich as much as the penalty. As
one millennial said,<span style="mso-spacerun: yes;"> </span>“We may be young
but we are not stupid.”</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Five,<span style="mso-spacerun: yes;"> </span>by crowding doctors into Accountable Care
Organizations and having those organizations<span style="mso-spacerun: yes;">
</span>being led by primary care doctors beholden to hospitals,<span style="mso-spacerun: yes;"> </span>one could save Medicare money.<span style="mso-spacerun: yes;"> </span>This hasn’t worked out yet,<span style="mso-spacerun: yes;"> </span>and many of the original “Pioneer ACOs: have
dropped out of ACO program,<span style="mso-spacerun: yes;"> </span>including
its poster child,<span style="mso-spacerun: yes;"> </span>Dartmouth.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Six,<span style="mso-spacerun: yes;"> </span>Doctors would accept<span style="mso-spacerun: yes;"> </span>pay reductions, based on routine EHR data measuring
quality outcomes and proper diagnostic and procedural use,<span style="mso-spacerun: yes;"> </span>because they could not do otherwise,<span style="mso-spacerun: yes;"> </span>i.e. participate in Medicare, Medicaid, and
health exchange programs.<span style="mso-spacerun: yes;"> </span>Wrong.<span style="mso-spacerun: yes;"> </span>Many doctors, 10% to 50%, are not
participating in programs<span style="mso-spacerun: yes;"> </span>or are
switching to direct pay,<span style="mso-spacerun: yes;"> </span>concierge,
medicine to avoid 3<sup>rd</sup> party regulations,<span style="mso-spacerun: yes;"> </span>penalties, and hassles.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">And
so it goes.<span style="mso-spacerun: yes;"> </span>Insurers and doctors are withdrawing
from most markets.<span style="mso-spacerun: yes;"> </span>Doctors are not
accepting federal programs, or or are slowing services for federal sponsored
patients.<span style="mso-spacerun: yes;"> </span>Talk of a death<span style="mso-spacerun: yes;"> </span>spiral of ObamaCare is rampant,<span style="mso-spacerun: yes;"> </span>and, if Trump is elected,<span style="mso-spacerun: yes;"> </span>ObamaCare will be repealed.<span style="mso-spacerun: yes;"> </span>If Clinton becomes president,<span style="mso-spacerun: yes;"> </span>she promises big changes, or a public option,
as a giant step forward towards total government control.</span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com1tag:blogger.com,1999:blog-6076839327674215825.post-70241172267000034432016-10-22T11:31:00.002-04:002016-10-22T11:31:47.799-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Trump Keeps Seizing
Defeat from Jaws of Victory</span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Given
a sane Donald Trump and the fact that 70% of Americans think the country is
headed in the wrong direction,<span style="mso-spacerun: yes;"> </span>you might
think he would win the election in a landslide.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>But according to Peggy Noonan in today’s WSJ,
Trump is not a sane person.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Through
his inappropriate, often crude, and inflammatory remarks,<span style="mso-spacerun: yes;"> </span>he keeps seizing defeat from the jaws of
victory.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">His
policy prescriptions to change the direction of U.S. are sound and reasonable
and may revitalize America.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Among
the current problems are these.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">A
stagnant economy with 1% growth.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">The
highest corporate tax in the world.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">A
staggering national debt of $20 trillion.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">The
possible collapse of the economic viability of the American middle class with
growing economic equity.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">An
unpopular and unworkable health reform law, well on the way of doubling
premiums,<span style="mso-spacerun: yes;"> </span>imposing an average of $1000
deductibles<span style="mso-spacerun: yes;"> </span>as the price for seeing a
doctor, which may not be the one you would choose,<span style="mso-spacerun: yes;"> </span>and the massive withdrawal of insurers from
multiple markets,<span style="mso-spacerun: yes;"> </span>leaving<span style="mso-spacerun: yes;"> </span>one or two choices of health plans,<span style="mso-spacerun: yes;"> </span>does not bode well for the future.</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">The
loss of the Middle East with the explosive growth of ISIS outside of Iraq into
32 countries.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">But alas,<span style="mso-spacerun: yes;">
</span>Trump cannot help himself from firing off fatuous tweets or declaring
war with juvenile comments on those who disagree with him.<span style="mso-spacerun: yes;"> </span></span>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">What Trumps needs are<span style="mso-spacerun: yes;"> </span>a sense of deprecatory humor and graciousness
towards his enemies.<span style="mso-spacerun: yes;"> </span>But these traits
are not part of his nature</span><span style="font-size: 18.0pt;">.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<div class="MsoNormal">
<br /></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-8982822642400317912016-10-10T19:02:00.004-04:002016-10-10T19:02:41.223-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Shifting
Sources of Power and Equality</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">All
animals are equal but some are more equal than others.</span></i></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">George
Orwell,<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Animal Farm</i></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">As everybody knows,<span style="mso-spacerun: yes;">
</span>social trends shift.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">These equality shifts, often decades in the making, include:</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from masculine to feminine.<span style="mso-spacerun: yes;"> </span>Women now dictate power shifts – in politics,
in boardrooms, in the professions.<span style="mso-spacerun: yes;"> </span>We
shall soon have a woman president, more corporate women CEOs, more women
lawyers and doctors and other professionals.</span><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from traditional conservative values
to more progressive secular values.<span style="mso-spacerun: yes;"> </span>We
see this everywhere, from attitudes towards gender equality, to same sex and
cross-racial marriages, to more permissiveness towards teens,<span style="mso-spacerun: yes;"> </span>to more acceptance of marijuana use.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from nationalism to globalism.<span style="mso-spacerun: yes;"> </span>Immigration across borders is growing,<span style="mso-spacerun: yes;"> </span>more international trade is the norm,<span style="mso-spacerun: yes;"> </span>more acceptance of other cultures is said
to be desirable,<span style="mso-spacerun: yes;"> </span>international travel
and education is on the rise.</span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from straight unadorned talk to political
correctness. Politically correct speech is telling people what you think<span style="mso-spacerun: yes;"> </span>they want to hear without offending anybody
in a totally tolerant world.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from individualism to corporate and
large group activities.<span style="mso-spacerun: yes;"> </span>You see this
particularly in medicine.<span style="mso-spacerun: yes;"> </span>The social
media<span style="mso-spacerun: yes;"> </span>ostensibly has fostered individual
ism,<span style="mso-spacerun: yes;"> </span>but in reality,<span style="mso-spacerun: yes;"> </span>Facebook, Twitter, and iphones<span style="mso-spacerun: yes;"> </span>and <span style="mso-spacerun: yes;"> </span>the like are social collectivism activities
and account for the world’s fastest growing international corporations.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from privacy to transparency.<span style="mso-spacerun: yes;"> </span>With emails and algorithms and open
computer systems<span style="mso-spacerun: yes;"> </span>and electronic health
records,<span style="mso-spacerun: yes;"> </span>credit cards,<span style="mso-spacerun: yes;"> </span>and big data tracking,<span style="mso-spacerun: yes;"> </span>nothing is private or confident anymore.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 10pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The shift from human decision making to machine
decision making.<span style="mso-spacerun: yes;"> </span>The use of machine
learning and algorithms<span style="mso-spacerun: yes;"> </span>over humans to
solve and monitor complex problems.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Some of us yearn for the good
old days when men were men, and women were women, and you could tell the
difference; when you knew where you stood<span style="mso-spacerun: yes;">
</span>based on values embedded over generations;<span style="mso-spacerun: yes;"> </span>when you accepted the belief that it was the
right thing to be patriotic and that your <span style="mso-spacerun: yes;"> </span>country stood for what was good and noble; <span style="mso-spacerun: yes;"> </span>when you acted on the basis of what was good
for you was good for society and did not need outside management; when individual
privacy <span style="mso-spacerun: yes;"> </span>and confidentiality<span style="mso-spacerun: yes;"> </span>were respected; when you didn’t need an
algorithm to tell you how to act or think;<span style="mso-spacerun: yes;">
</span>when you said what you meant and meant what you said.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Ah, yes, those were the days.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"></span></o:p></span> </div>
<br />
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<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></i></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></i></div>
<br />
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<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
<div class="MsoListParagraph" style="margin: 0in 0in 10pt 0.5in;">
<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></i></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></i></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com1tag:blogger.com,1999:blog-6076839327674215825.post-693788734659783012016-10-10T16:45:00.002-04:002016-10-10T16:45:18.657-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Second Presidential
Dabate Transcript – ObamaCare Comments<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p> </o:p></span></b></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Ken Karpowitz has a question. </span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Karpowicz</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: The Affordable Care Act known as Obamacare, it
is not affordable. Premiums have gone up, deductibles have gone up, copays has
gone up, prescriptions have gone up and the coverage has gone down. What will
you do to bring the cost down and make coverage better? <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: That first one goes to secretary Clinton. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Clinton</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: He wants to start it, he can start it. No, go
ahead, Donald. <o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: No, I'm a gentlemen, Hillary. Go ahead.<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Secretary Clinton.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Clinton</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: I think Donald was about to say he’s gonna
solve it by repealing it and getting rid of the Affordable Care Act. And I'm
going to fix it because I agree with you. Premiums have gotten too high,
copays, deductibles, prescription drug costs and I have laid out a series of
actions that we can take to try to get those costs down. But here's what I
don't want people to forget when we’re talking about reigning in the cost that
has to be the highest priority of the next president. When the affordable care
act passed, it wasn't just that 20 million people got insurance who didn't have
it before. But that, in and of itself is a good thing. I meet these people all
the time and they tell me what a difference having that insurance meant to them
and their families. But everybody else, the 170 million of us who get health
insurance through our employers got big benefits. Number one, insurance
companies can't deny you coverage because of a preexisting condition. Number
two, no lifetime limits which is a big deal if you have serious health
problems. Number three, women can't be charged more than men for our health
insurance, which is the way it used to be before the affordable care act.
Number four, if you are under 26 and your parents have a policy, you can be on
that policy until the age of 26, something that didn't happen before. So I want
very much to save what works and is good about the affordable care act. But
we’ve got to get costs down, we’ve got to provide some additional help to small
businesses so that they can afford to provide health insurance. But if we
repeal it as Donald has proposed and start over again, all of those benefits I
mentioned are lost to everybody. Not just people who get health insurance on
the exchange. And then we would have to start all over again. Right now we are
at 90% health insurance coverage. That's the highest we have ever been, in our
country. I want to get to 100% and get cost down and quality up.<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Secretary Clinton, you are out of time. Mr.
Trump, You have two minutes.</span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: It is such a great question and it’s maybe the
question I get almost, more than anything else. Outside of defense. Obamacare
is a disaster. You know it, we all know it. It's going up at numbers that
nobody’s ever seen, worldwide. It’s-nobody has ever seen numbers like this for
health care. It's only getting worse. In 17, it implodes by itself. Their
method of fixing it is to go back and ask Congress for more money. More, more
money and we have right now almost $20 trillion in debt. Obamacare will never
work. It’s very bad, very bad health insurance, far too expensive, and not only
expensive for the person that has it, unbelievably expensive for our country.
It’s going to be one of the biggest line items very shortly. We have to repeal
it and replace it with something absolutely much less expensive. And something
that works, where your plan can actually be tailored. We have to get rid of the
lines around the state, artificial lines, where we stop insurance companies
from coming in and competing because they wanted President Obama and whoever
was working on it, they want to leave those lines because that gives the
insurance companies, essentially monopolies. We want competition. You will have
the finest health care plan there is. She wants to go to a single player plan
which would be a disaster. Somewhat similar to Canada. If you ever noticed, the
Canadians, when they need a big operation, when something happens, they come
into the United States in many cases. Because their system is so slow, it's
catastrophic in certain ways. But she wants to go to single payer, which means
the government basically rules everything. Hillary Clinton has been after this
for years. Obamacare was the first step, Obamacare is a total disaster and not
only are your rates going up by numbers that nobody’s ever believed, but your
deductibles are going up. So that unless you get hit by a truck, you will never
be able to use it. It's a disastrous plan and it has to be repealed and
replaced.<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Secretary Clinton, let me follow-up with you,
your husband called Obamacare “the craziest thing in the world”, saying small
business owners are getting killed, premiums doubled, coverage is cut in half.
Was he mistaken or was his mistake simply telling the truth?<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Clinton</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: No. I mean, he clarified what he meant and
it’s very clear. Look, we are in a situation in our country where if we were to
start all over again, we might come up with a different system. But we have an
employer-based system: that’s where the vast majority of people get their health
care. And the affordable care act is meant to try to fill the gap between
people who are too poor and couldn’t put together any resources to afford
healthcare, namely people on medicaid. Obviously, Medicare which is a single
payer system which takes care of our elderly, and does a great job doing it, by
the way, and then all the people who were employed, but people who were working
but didn't have the money to afford insurance and didn’t have anybody, an
employer or anybody else to help them. That was the slot that the Obamacare
approach was to take. And like I say, 20 million people now have health
insurance. So, if we rip it up and throw it away, what Donald is not telling
you is we turn it back to the insurance companies the way it used to be. And
that means that insurance companies get to do pretty much whatever they want
including saying look, I'm sorry, you have diabetes, you had cancer—<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: --Your time is up—<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Clinton</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: --Your child had asthma, you may not be able
to have insurance because you can't afford it. So let's fix what's broken about
it, but let’s not throw it away and give it back to the insurance companies.
That's not going to work. <o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Mr. Trump, let me just follow-up—<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: I want to -- just one thing. Hillary,
everything is broken about it. Everything. Number two, Bernie Sanders said
Hillary Clinton has very bad judgment. This is a perfect example of it. Trying
to save Obamacare—<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: --Mr. Trump, you’ve said you want to end
Obamacare, you’ve also said you want to make coverage accessible for people
with preexisting conditions. How do you force insurance companies to do that if
you are not mandating that everyone has insurance?<o:p></o:p></span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: You’re going to have plans. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: What does that mean?</span></div>
<br />
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<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Well, I’ll tell you what it means. You’re
gonna have plans that are so good because we’re going to have so much
competition in the insurance industry, once we break out the lines and allow
the competition to come.</span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Are you going to have a mandate that Americans
have to have health insurance?</span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Trump</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Excuse me. President Obama by keeping those
lines, the boundary lines around each state and it was almost done until just
towards the end of the passage of Obamacare. Which by the way was a fraud. You
know that. Because Jonathan Grouper, the architect of Obamacare was said, he
said it was a great lie, it was a big lie. President Obama said you keep your
doctor, keep your plan. The whole thing was a fraud and it doesn't work. But
when we get rid of those lines, you have competition and we will be able to
keep preexisting, we’ll also be able to help people that can't get, don't have
money because we are going to have people protected. And Republicans feel this
way. Believe it or not, we’re going to block grant into the states we’re going
to block grant into medicaid so we will be able to take care of people without
the necessary funds to cake care of themselves. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 0pt;">
<b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">Cooper</span></b><span style="color: black; font-family: "Helvetica","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";">: Thank you Mr. Trump. <o:p></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com2tag:blogger.com,1999:blog-6076839327674215825.post-91329994732178996942016-10-09T13:45:00.000-04:002016-10-09T18:38:21.562-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">What’s
Cooking on Eve of Second Presidential Debate</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">If you pay close attention to what’s cooking in the eve of
tonight’s presidential debate,<span style="mso-spacerun: yes;"> </span>the
consensus is clear.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><strong>Cooking of Trump Goose</strong></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">What’s cooking is Donald Trump’s goose.<span style="mso-spacerun: yes;"> </span>His vulgar tape of 11 years ago has finally
done him in.<span style="mso-spacerun: yes;"> </span>If not a cooked goose, he
is definitely a dead duck, unfit to replace the present lame duck.<span style="mso-spacerun: yes;"> </span>Trump, it is said, is sexual predator and
dangerous demagogue posing as a presidential candidate.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">So the media and the editorial boards of major
newspapers,<span style="mso-spacerun: yes;"> </span>including<span style="mso-spacerun: yes;"> </span>the conservative <i style="mso-bidi-font-style: normal;">Arizona Republican,<span style="mso-spacerun: yes;"> </span>Dallas
Morning News, </i><span style="mso-spacerun: yes;"> </span>and <i style="mso-bidi-font-style: normal;">The Wall Street Journal</i> would have us
believe.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">They may be right, for once again the gaffe-prone Donald
Trump is stewing in the juice of<span style="mso-spacerun: yes;"> </span>his
past, his temperament, and his character.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><strong> Unfortunate Part of the Cooking Controversy</strong></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The unfortunate part of this boiling controversy is
that<span style="mso-spacerun: yes;"> </span>it<span style="mso-spacerun: yes;">
</span>overshadows other salient issues.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Some 70 percent of Amerifcans, mostly living in fly-over-country
between the Eastern and Western left coasts, think American is headed in the
wrong direction.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">These middle-of-the-country folk are concerned about these
issues.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The tepid 2% growth of the American economy over
the last 8 years.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The effective unemployment grate, if you include
those who have stopped looking for jobs, of 10 percent/<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The stagnation of<span style="mso-spacerun: yes;"> </span>wages and savings.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The erosion of middle class cultural values in
the wake of rampant secularism.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The decline of<span style="mso-spacerun: yes;">
</span>American prestige and power on the world stage secondary to<span style="mso-spacerun: yes;"> </span>globalism,<span style="mso-spacerun: yes;">
</span>failed foreign policies, and the rise to terrorism.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12pt; line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The frustrations of the “silent majority” which
as been drowned out by the vocal minority , especially in academia,<span style="mso-spacerun: yes;"> </span>the press, and other strands of the liberal
elite.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="font-family: Georgia;"></span> </div>
<ul style="text-align: left;">
<li><div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="font-family: Georgia;">The "crazy" ObamaCare system, which Bill Clinton notes covers 25 million uninsured Americans while soaking millions more Americans with double digit premium and unaffordable deductibles while narrowing their choices of doctors and hospitals.</span></div>
</li>
</ul>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">It’s enough to give you goose bumps about America’s future.<span style="mso-spacerun: yes;"> </span>People are worried the present
administration’s policies and their consequences have killed America’s golden
goose.<o:p></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com1tag:blogger.com,1999:blog-6076839327674215825.post-16148517371351271572016-10-07T12:03:00.000-04:002016-10-07T12:03:01.129-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">ObamaCare
Chaos</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">In Minnesota,<span style="mso-spacerun: yes;">
</span>Oklahoma, and Tennessee,<span style="mso-spacerun: yes;"> </span>three
states in which I have lived or practiced,<span style="mso-spacerun: yes;">
</span>ObamaCare premium rates are skyrocketing into the 50% to 67% range,<span style="mso-spacerun: yes;"> </span>insurers are pulling out and citizens are
losing plans and choices, and chaos reigns.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">What does it all mean?<span style="mso-spacerun: yes;">
</span>I was speaking to Dave Racer, a conservative publisher in
Minnesota.<span style="mso-spacerun: yes;"> </span>He says ObamaCare is unstable
there, and major insurers are either increasing premiums,<span style="mso-spacerun: yes;"> </span>capping enrollment,<span style="mso-spacerun: yes;"> </span>or pulling out of health exchange markets.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>He
says if the Democratic Farmer Labor Market wins the next election there,<span style="mso-spacerun: yes;"> </span>a universal coverage plan will be on the
horizon within 18 months.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">ObamaCare
Alternatives</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">If ObamaCare health exchange markets fail, and ObamaCare
goes down the tube, these options remain.</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Universal single payer,<span style="mso-spacerun: yes;"> </span>unlikely no matter who wins the presidency<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">A public option, if Clinton wins, with other
fixes, such as ending<span style="mso-spacerun: yes;"> </span>individual and
employer options, moving the 55 to 65 crowd into Medicare, raising taxes for
everyone.</span><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">ObamaCare repeal, if Trump wins, with a
market-based plan – competition across state line,<span style="mso-spacerun: yes;"> </span>expansion of health saving accounts,<span style="mso-spacerun: yes;"> </span>management of Medicaid by states – and God
knows what else.</span><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Management of clinical medicine by machines and
algorithms,<span style="mso-spacerun: yes;"> </span>if progressively minded government
experts have their way (Z, OBermeyer,M.D. and E.J. Emanuel , MD. of Harvard and
Wharton (“Predicting the Future – Big Data, Machine Learning and Clinical
Medicine, NEJM. September 29.” </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"> Ekekial
Emaneul Opinions</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Ekekiel<span style="mso-spacerun: yes;"> </span>Emanuel is one of the principle architects of
ObamaCare.<span style="mso-spacerun: yes;"> </span>He blames the Republicans for
the health law’s problems and says with more government money poured into<span style="mso-spacerun: yes;"> </span>“risk corridors,”<span style="mso-spacerun: yes;"> </span>the health exchanges could be stabilized and
insurer death spirals could be prevented,</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Emanuel and co-author argue,
that given time and money could solve complex clinical problems and “open up
vast new possibilities in medicine.”<span style="mso-spacerun: yes;">
</span>Machine learning will one, “dramatically improve the ability of professionals
to establish a prognosis,” two,” displace much of the work of radiologists and
anatomical pathologists,” three, “improve diagnostic accuracy.”</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">My
Opinion</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">In my opinion, the health law’s
travails result from the ACA being<span style="mso-spacerun: yes;">
</span>passed without a single Republican vote, thereby triggering partisan
opposition, <span style="mso-spacerun: yes;"> </span>and from ignorance of the
concept of insurance risk <span style="mso-spacerun: yes;"> </span>by not
allowing insurers to ask about pre-existing conditions.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt 0.25in;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">As far as “machine learning”
goes,<span style="mso-spacerun: yes;"> </span>I would point out that electronic
medical records, have been a bust in the medical marketing space,<span style="mso-spacerun: yes;"> </span>neither increasing efficiency, or improving
quality in terms of diagnosis and prognosis.<span style="mso-spacerun: yes;">
</span>I doubt that diagnostic<span style="mso-spacerun: yes;">
</span>algorithms will significant displace radiologists or pathologists.<span style="mso-spacerun: yes;"> </span>Data has a place as a supplement, but not as
a replacement of these specialties.<o:p></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-84397157310409048532016-10-04T11:55:00.001-04:002016-10-04T11:55:18.296-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif";">Why
Oba</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">maCare
Faces an Uncertain Future<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">With the presidential elections rapidly
approaching, both candidates admit ObamaCare is in trouble due to public
unpopularity,<span style="mso-spacerun: yes;"> </span>heavy losses among insurers
in health exchanges,<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>insurer withdrawals in multiple states leaving
only one choice in 6 states, and soaring premiums (up to 67% in Minnesota.<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Brief History of Modern Health
Reform<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">In 1965, Congress passed the Medicare Act,
which was quickly coupled <span style="mso-spacerun: yes;"> </span>with Medicaid
legislation.<span style="mso-spacerun: yes;"> </span>That was the beginning of
modern health reform. <span style="mso-spacerun: yes;"> </span>The HMO Act of
1973 <span style="mso-spacerun: yes;"> </span>followed with DRG legislation close
behind.<span style="mso-spacerun: yes;"> </span>ObamaCare became law in
2010.<span style="mso-spacerun: yes;"> </span>In 2016,<span style="mso-spacerun: yes;"> </span>ObamaCare’s fate will be determined by the
Presidential election, with Hillary Clinton promising to fix it and<span style="mso-spacerun: yes;"> </span>Donald Trump pledging to repeal it.<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">ObamaCare Unraveling<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">With spikes of average premiums of 23% for individual
health exchange markets<span style="mso-spacerun: yes;"> </span>scheduled for
2017,<span style="mso-spacerun: yes;"> </span>17 of 23 non-for-profit
consumer-oriented plans collapsing,<span style="mso-spacerun: yes;"> </span>and
major insurers, including Blue Cross Blue Shield plans , withdrawing from
health exchange markets,<span style="mso-spacerun: yes;"> </span>ObamaCare may <span style="mso-spacerun: yes;"> </span>be unraveling.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">This may happen no matter who wins the
Presidency, even if the Obama administration pays $5 billion to 175 insurers<span style="mso-spacerun: yes;"> </span>from the obscure Treasurer’s Judgment Fund to
rescue “risk corridors” to satisfy legal claims against the government and to
circumvent Republican opposition.<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">A Great Idea in Shambles<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">In the eyes of progressives,<span style="mso-spacerun: yes;"> </span>ObamaCare remains <span style="mso-spacerun: yes;"> </span>a great idea, a giant step forward towards
universal coverage.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">What went wrong?<span style="mso-spacerun: yes;"> </span>In a September 29 Health Care Blog,<span style="mso-spacerun: yes;"> </span>“Fail to Scale: Why Great Ideas in
Healthcare Don’t Thrive Everywhere.,” Jeff Goldsmith , a National Advisor to
Navigant Healthcare,and Lawton Burns, a professor at Wharton, <span style="mso-spacerun: yes;"> </span>put their finger on a central flaw in the law.
<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">No Single Bullet, Sweeping <span style="mso-spacerun: yes;"> </span>Solutions Nationally<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">“A failure to understand and respect the role
that local culture and market conditions for health system innovation
profoundly limits the effectiveness of “single bullet” policy solutions….Perhaps
a healthy respect for non-economic factors in health system behavior—often
rooted in local and regional circumstances and in institutional culture—might
be a corrective for those who see sweeping ‘national”’ solutions to complex
problems.”<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">No Replicable, Expandable
Regional Models<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Policy makers and economists failed to recognize
that there is no model for health reform that is replicable and expandable <span style="mso-spacerun: yes;"> </span>to other sections of the country. What works
in California (Kaiser’s top-down <span style="mso-spacerun: yes;"> </span>integrated model with owned hospitals and physician
employees),<span style="mso-spacerun: yes;"> </span>may not work in the Midwest,
South, or East( provider-led-organizations (IPAs) practices),<span style="mso-spacerun: yes;"> </span>or<span style="mso-spacerun: yes;"> </span>in
the Southwest an , or with hospital dominated systems (Connecticut), or with
academically-rooted large practices ( Harvard,<span style="mso-spacerun: yes;">
</span>Johns Hopkins, Duke).<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">U.S.<span style="mso-spacerun: yes;"> </span>A Pluralistic Populist Culture<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">The U.S. has a pluralistic, populist, polyglot
health system.<span style="mso-spacerun: yes;"> </span>Its citizens and its
physicians cherish individual choice and privacy.<span style="mso-spacerun: yes;"> </span>Physicians instinctively<span style="mso-spacerun: yes;"> </span>reject condescending lectures from elites in
Washington about what is morally right.<span style="mso-spacerun: yes;">
</span>No single model works well in every region of the country.<span style="mso-spacerun: yes;"> </span>It is political arrogance to think that
centralized government can impose a single model or structure of care, e.g.
Accountable Care Organizations, upon physicians or health care organizations.
It is political ignorance that you remove all insurance risk by accepting all
comers regardless of their pre-existing conditions or that you can pass a
national health law without a single Republican vote.<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Political and Social Forces
at Work<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Yet<span style="mso-spacerun: yes;"> </span>the
U.S. can no longer sustain rising costs of<span style="mso-spacerun: yes;">
</span>health care<span style="mso-spacerun: yes;"> </span>which will soon
consume 20% of the national budget. <o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Political and social forces are at work in both
the government and private sector in a search for solutions to rising costs and
uneven quality.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">ObamaCare has enrolled 8 million largely
subsidized people its health exchanges and 5 million in Medicaid; <span style="mso-spacerun: yes;"> </span>it has implemented data-based value systems to
measure what it will pay doctors and hospitals; it has tried to expand Accountable
Care Organizations; and it has forced physicians and hospitals to collect data
through widespread use of electronic health records. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Provider Reaction<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">The private sector has reacted with unprecedented
hospital and medical group consolation, and with proliferation of urgent care
centers, retail clinics,<span style="mso-spacerun: yes;"> </span>direct pay concierge
medicine,<span style="mso-spacerun: yes;"> </span>and other outpatient centers
and facilities.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">In the process, it has aggravated growing
physician shortages,<span style="mso-spacerun: yes;"> </span>and it has produced
a system in which primary care physicians are being replaced or supplemented by
physician extenders (physician assistants and nurse practitioners.<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">How Physicians Have Responded
with Uncertainty : Physicians Foundation Survey<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">How have physicians responded to these sweeping
changes?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">According to the just released 2014 Physicians
Foundation national survey, which follows 2012 and 2008 surveys, the reaction
has been mixed .<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">The 2014 survey has over 17.000 responses to
650,000 questionnaires sent to practicing physicians.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Of those who responded.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">46% gave the ACA a grade or D or F, while 25%
gave it an A or a B.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>81% said
they were overextended or at full capacity, while <span style="mso-spacerun: yes;"> </span>only 19% said they had time to see more
patients.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">50% would still recommend medicine as a career.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">53% indicated they were employees of hospitals
or medical groups, and only 17% were solo practice while 35% were in
independent practice.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">44% said they planned to take steps to reduce
patient access,<span style="mso-spacerun: yes;"> </span>24% did not take
Medicare or limited it, and 38% did not see Medicare patients or limited their
access.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">33% participated in ObamaCare health exchanges,
and 28% had no plans to do so.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">They said they spend an average of 20% of their
time on non-clinical paperwork.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">85% had electronic health records,<span style="mso-spacerun: yes;"> </span>46% said EMRs increased their efficiency,
while 24% said it decreased their efficiency.<o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">26% participated in Accountable Care Organizations
but only 13% believed ACOs would enhance quality or <span style="mso-spacerun: yes;"> </span>decrease costs.<o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Responses Not All Negative<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Not all responses were negative. 44% said
morale was up, an increase of 12% since 2012, and young physicians under 45
were more optimistic than their elders.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">A Changing of the Guard<o:p></o:p></span></b><br />
<br />
<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">Clearly there is a changing of the guard – from
independent practice to hospital and large group <span style="mso-spacerun: yes;"> </span>employment, from fee-from-service to
data-based reimbursement,<span style="mso-spacerun: yes;"> </span>from
individual responsibility to measured accountability by government and
corporate entities and employers.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Georgia","serif";"><br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span><br />
<br />
<span style="font-family: "Georgia","serif";"><o:p><span style="font-family: Times New Roman;"> </span></o:p></span><br />
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-78901133010379999192016-09-28T14:16:00.001-04:002016-09-28T14:16:19.814-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Three
Trends I Missed in 2004</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Twelve years ago,<span style="mso-spacerun: yes;"> </span>I
wrote a book <i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span>“The Doctor In America: Inside the Physician
Culture.”<span style="mso-spacerun: yes;"> </span></i>The book was never
published.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>At the time, I was editor of a newsletter <i style="mso-bidi-font-style: normal;">Physician Options, </i>was a contributor to Healthleadersmedia.com,
<span style="mso-spacerun: yes;"> </span>and had just published a book <i style="mso-bidi-font-style: normal;">A Managed Care Memoir, </i><span style="mso-spacerun: yes;"> </span>an account of my personal journey through the highways
and by ways of managed care across the U.S.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The book contained 19 chapters, containing commentary on the<span style="mso-spacerun: yes;"> </span>physician culture and resistance to
change,<span style="mso-spacerun: yes;"> </span>new directions for 2005, improving
Care in independent practice,<span style="mso-spacerun: yes;"> </span>hospitals
and physicians interactions ,<span style="mso-spacerun: yes;">
</span>revitalizing primary care,physician <span style="mso-spacerun: yes;"> </span>interaction with pharma, consumer driven care,
<span style="mso-spacerun: yes;"> </span>the power <span style="mso-spacerun: yes;"> </span>Health Savings Accounts, and the question: “Can
physicians adapt to consumerism and patient-centered care?”<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">In the new directions chapter,<span style="mso-spacerun: yes;"> </span>I cited 8 trends.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>From a youthful
society to an aging society obsessed with looking younger<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From inpatient to outpatient care<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From prescription drugs as an incidental expense
to an intolerable cost burden<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From costs absorbed by employers to costs
shifted to employees<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">5.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From national to world concerns about infectious
disease<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">6.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From enough physicians and nurses to shortages
of both<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">7.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From laissez faire medicine to activist programs
to prevent and managed disease<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 10pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">8.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">From a la carte care to standardized care ti
improve quality, consistency, and outcomes<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">What I failed to see<span style="mso-spacerun: yes;">
</span>were the massive movements to hospitalists,<span style="mso-spacerun: yes;"> </span>to physician extenders,<span style="mso-spacerun: yes;"> </span>and to ObamaCare.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraph" style="margin: 0in 0in 10pt 0.5in; mso-list: l0 level1 lfo2; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> <strong>
</strong></span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><strong>Hospitalists </strong>-<span style="mso-spacerun: yes;">
</span>From its inception in 1996,<span style="mso-spacerun: yes;"> </span>the
number of specialists called “hospitalists” has grown from a few hundred to
50,000.<span style="mso-spacerun: yes;"> </span>The two physicians who first
described<span style="mso-spacerun: yes;"> </span>“hospitals,”<span style="mso-spacerun: yes;"> </span>we have these words, “This new field is
substandially larger than any suspeciality in internal medicine (the largest of
which is cardiology with22,000 physicians, about the same size as pediatrics
(55,000(, and in fact larger than any specialty except general internal
medicine (109,000) and family medicine (107.000),<span style="mso-spacerun: yes;"> </span>Apr9oximately 75% of U.S. hospitals… now have
hospitalists).<o:p></o:p></span></div>
<ul style="text-align: left;">
<li>
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><strong>Nurse as Physician Extenders</strong> <span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Thomas Bodenheimer MD and Laurie Bauer, RN, of the Cetner of Excellence
in Primary Care (T.B.) and the School of Nursing (L.B.) at th University of
California in San Francisco, make these predictions ( “ In the primary care practiced
of the future, the physician’s role will increasingly be played by nurse
practitioners (NPs).<span style="mso-spacerun: yes;"> </span>In addition, the
150 million adults with one or more chronic conditions will receive some of
their care from registered nurses (RNs) functioning as care manager.”<span style="mso-spacerun: yes;"> </span>This is because of primary care
shortages.<span style="mso-spacerun: yes;"> </span>The number of primary care
entrants is 8000, but the number of primary care physicians<span style="mso-spacerun: yes;"> </span>retire each year will reach 8500 by 2020.</span></li>
</ul>
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"></span><br />
<ul style="text-align: left;">
<li><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"></span><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><strong>ObamaCare </strong>-<span style="mso-spacerun: yes;"> </span>In 2004,<span style="mso-spacerun: yes;">
</span>I failed to anticipate<span style="mso-spacerun: yes;"> </span>that a
national health reform law,<span style="mso-spacerun: yes;"> </span>the Patient
Protection and Affordable Care Act of March 2010, would be enacted, even though
national pressures were building to protect patients against rising costs and
medical bankruptcies. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Like everybody else I also failed to see the
economic collapse of 2008, which made the election of President Obama
inevitable.<span style="mso-spacerun: yes;"> </span>We are now more than 6
years into ObamaCare, also commonly referred to as the ACA.<span style="mso-spacerun: yes;"> </span>Although it has reduced the number of
uninsured by 20 million and lowered the number of uninsured to just above
9%,<span style="mso-spacerun: yes;"> </span>the ACA (Accountable Act) has been
unpopular from the onset, largely because it has failed to live up to its
promises of keeping your doctor and health plan and lowering premiums.<span style="mso-spacerun: yes;"> </span>Instead millions of Americans have been
forced to switch doctors and health plans, and their premiums have increased by
$7500 rather than the promised $2500 reduction.<span style="mso-tab-count: 1;"> </span>The
fate of ObamaCare will be determined by the 2016 presidential election.<span style="mso-tab-count: 3;"> </span></span><span style="font-size: 18pt; line-height: 115%;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;">
</span><o:p></o:p></span></span></li>
</ul>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: 18pt; line-height: 115%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-41263481139969893822016-09-25T20:57:00.001-04:002016-09-26T11:37:01.810-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Debate:
An IQ (Intelligence Quotient) Versus an EQ (Emotional Quotient) Contest </span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">It’s 24 hours before the Hillary Clinton-standoff. <span style="mso-spacerun: yes;"> </span>The debate is <span style="mso-spacerun: yes;"> </span>billed as the biggest TV draw since the Super
Bowl,<span style="mso-spacerun: yes;"> </span>pitting a non-emotional woman of
experience and <span style="mso-spacerun: yes;"> </span>substance against an angry
male <span style="mso-spacerun: yes;"> </span>ignorant of nuanced <span style="mso-spacerun: yes;"> </span>political and diplomatic <span style="mso-spacerun: yes;"> </span>issues but<span style="mso-spacerun: yes;">
</span>focused on business outcomes .<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Going in, the polls indicate a virtual tie.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">The stakes are huge.<span style="mso-spacerun: yes;"> </span>According
to the WSJ,<span style="mso-spacerun: yes;"> </span>one third of voters will
make up their minds after witnessing the debate.<span style="mso-spacerun: yes;"> </span>To no one’s surprise, the NYT jumped the gun
by endorsing Clinton <span style="mso-spacerun: yes;"> </span>as an even-minded. It
berated Trump as an empty-headed bigot full of lies and deceit.<span style="mso-spacerun: yes;"> </span>This NYT’s attitude is exemplified by its
listing of Trump’s “31 biggest whoppers” from September 15 -21. No mention is
made of polls showing that 60% of <span style="mso-spacerun: yes;"> </span>public
thinks Hillary Clinton is distrustful. Instead. <em>The Times</em> endorses Clinton of her intellect, experience, and courage.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Most agree Hillary Clinton carries the torch for the status
quo and <span style="mso-spacerun: yes;"> </span>the Obama legacy with a shift to
the left , free-college education and so forth, <span style="mso-spacerun: yes;"> </span>while Donald Trump claims the Obama-Clinton
legacy is a disaster for the economy and for America’s leadership in world
affairs. </span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">So far, not much is being said about the state of health
reform.<span style="mso-spacerun: yes;"> </span>Ms. Clinton says she will fix
what’s wrong with health reform, with more taxes and a public option, giving government
more control.<span style="mso-spacerun: yes;"> </span>Mr. Trump says
ObamaCare<span style="mso-spacerun: yes;"> </span>will be repealed,<span style="mso-spacerun: yes;"> </span>health saving accounts will make consumers
more accountable,<span style="mso-spacerun: yes;"> </span>state lines will be
erased as barriers to competition,<span style="mso-spacerun: yes;"> </span>and competition
will lower premiums ,<span style="mso-spacerun: yes;"> </span>and Medicare,
Medicaid, and Social Security entitlements real remain untouched, thanks to the
booming economy under his watch.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">It’s up to the voters who decides who wins the debate and
the election.<span style="mso-spacerun: yes;"> </span>Will it be the sophisticated
elite, intelligentsia, <span style="mso-spacerun: yes;"> </span>celebrities,<span style="mso-spacerun: yes;"> </span>the mainstream media, the Obama coalition, <span style="mso-spacerun: yes;"> </span>and vested Wall Street interests <span style="mso-spacerun: yes;"> </span>represented by Hillary Clinton?<span style="mso-spacerun: yes;"> </span>Will it be the raw silent majorities,<span style="mso-spacerun: yes;"> </span>and the American middleclass, and blue collar
workers, two-thirds of whom think the country is headed in the wrong direction?</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Or will it be ObamaCare, the progressive movement that has
insured 20 million of the previously uninsured?<span style="mso-spacerun: yes;">
</span>Or will it be middle class and young taxpayers, who resent ObamaCare’s
redistribution health policies at the cost of soaring premiums, unaffordable deductibles
and loss of their preferred doctors</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">That ObamaCare is unraveling<span style="mso-spacerun: yes;"> </span>there is little doubt.<span style="mso-spacerun: yes;"> </span>Insurers are pulling out of most health
exchange markets.<span style="mso-spacerun: yes;"> </span>Government sponsored
plans are collapsing.<span style="mso-spacerun: yes;"> </span>Premiums in 2017
will be $7500 higher than promised in 2010.<span style="mso-spacerun: yes;">
</span>Physician and hospital networks are narrowing. And multiple critics are
warning the dreaded ObamaCare’s dreaded “death spiral” is at hand.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">What and who has undermined ObamaCare. <span style="mso-spacerun: yes;"> </span>Some say it’s the failure of the health law
to live up to its promises.<span style="mso-spacerun: yes;"> </span>Some say it’s
because insurers were unable to estimate risk because they could not ask about preexisting
conditions.<span style="mso-spacerun: yes;"> </span>Some says it’s due to the individual
and employer mandates.<span style="mso-spacerun: yes;">
</span>Some <span style="mso-spacerun: yes;"> </span>say you simply can’t achieve
increased coverage with affordability at the same time.<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span><br />
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;"></span><br />
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">Most say Americans simply don’t
want to give up their plans or physicians.<span style="mso-spacerun: yes;">
</span>People don’t want government dictating <span style="mso-spacerun: yes;"> </span>which services they should receive and from where.<span style="mso-spacerun: yes;"> </span>Americans want their health care services
delivered <span style="mso-spacerun: yes;"> </span>a la carte rather than as a government
buffet where everyone is equal but some are more equal than others and where
government policies promise homogenation and standardization.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "georgia" , "serif"; font-size: 12pt; line-height: 115%;">In the end, I believe the debate will be about policy
details,<span style="mso-spacerun: yes;"> </span>or<span style="mso-spacerun: yes;"> </span>transgressive e-mails, but about emotional
entrails concerned over<span style="mso-spacerun: yes;"> </span>our decline as
a society and a nation.<span style="mso-spacerun: yes;"> </span>The voters’
reaction may well be a gut rather a mind reaction.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: 18pt; line-height: 115%;"><span style="font-family: "calibri";"><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0tag:blogger.com,1999:blog-6076839327674215825.post-81784050879645124232016-09-23T13:50:00.006-04:002016-09-23T13:50:59.412-04:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Health
System Harms</span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">First,
do no harm.</span></i></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Hippocratic
Oath<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">When American physicians graduate from medical school, we
generally take the Hippocratic Oath to do no harm to patients.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">This oath is sometimes hard to achieve since medicine is an imperfect
art and often requires invasive care,<span style="mso-spacerun: yes;">
</span>toxic medications,<span style="mso-spacerun: yes;"> </span>and
treatments with unpredictable<span style="mso-spacerun: yes;"> </span>and fatal
outcomes. Differential diagnosis<span style="mso-spacerun: yes;"> </span>may
produce the wrong diagnosis,<span style="mso-spacerun: yes;"> </span>and the
right diagnosis may evolve over time.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">What complicates matters are high expectations among
patients,<span style="mso-spacerun: yes;"> </span>the perception that perfect
outcomes are the norm, <span style="mso-spacerun: yes;"> </span>the growing
belief that<span style="mso-spacerun: yes;"> </span>huge amounts of data
generated by electronic medical records, and Internet accessible, frequently
false, information <span style="mso-spacerun: yes;"> </span>promoted by the
social media will<span style="mso-spacerun: yes;"> </span>improve the quality of
care.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Because of pressures to make the right diagnosis under the
pressure of time constraints induced<span style="mso-spacerun: yes;"> </span>by
federal regulations and<span style="mso-spacerun: yes;"> </span>entering <span style="mso-spacerun: yes;"> </span>data on EMRs, American physicians feel under
siege and are growing <span style="mso-spacerun: yes;"> </span>paranoid <span style="mso-spacerun: yes;"> </span>for taking the blame for escalating costs and
for taking the blame for imperfect results.<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>Physicians feel like hamsters
forced to run faster and faster. <span style="mso-spacerun: yes;"> </span>This
paranoia, and the demands for<span style="mso-spacerun: yes;"> </span>entering
more and more patient data and absorbing the cost of more and more federal
regulations weighs heavily on the medical profession. </span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The situation is not helped when the AARP Bulletin , with 50
million readers, <span style="mso-spacerun: yes;"> </span>in its 2016 September
edit, has this headline emblazoned on its front cover Warning! How the Health
System Can Harm You.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">In the article, Richard Laliberte, lists these 12 ways the
health system can cause harm.</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.25in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Wrong Diagnosis<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.25in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>Sloppy
Practices<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 10pt 0.25in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">Lax Hygien</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">4. Poor Communication</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">5. Dismal Discharge Planning</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">6. Drug Blunders</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"></span><span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;"><br />
7. Knowledge Gaps<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">8. Dangerous Doctors<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">9. Buried Information<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">10. Outpatient Black Holes<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">11. Small Thinking<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">12.<span style="mso-spacerun: yes;"> </span>Physician Burnout<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">All of these harms can and do occur under time and regulatory and
medical legal pressures, <span style="mso-spacerun: yes;"> </span>but also may
give a false sense of<span style="mso-spacerun: yes;"> </span>alarm about their
frequency of occurrence <span style="mso-spacerun: yes;"> </span>the health system.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">The author concludes:</span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Georgia","serif"; font-size: 12pt; line-height: 115%;">“Be an assertive patient – but not an obnoxious one.<span style="mso-spacerun: yes;"> </span>Don’t act as well-meaning clinicians are deliberately
crewing up your care, or threaten to call your lawyers.<span style="mso-spacerun: yes;"> </span>Be friendly and respectful, and don’t wastr
carrgivers’ time on extraneous complaints they can’t so anything about, such as
parking or the cost of medications.”<o:p></o:p></span></div>
</div>
Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.com0