Health Care Reform – David vs. Goliath

Restoring Quality Health Care – A Six-Point Plan for Comprehensive Reform at Lower Cost – Scott Atlas, M.D. (Hoover Institution Press)

It doesn’t take a genius to figure out that when the Democrats in Congress passed the so-called Affordable Care Act (AKA - Obamacare) they sold the American people a bill of goods. The original bill topped out at over 2700 pages and since then the Obama administration has issued in excess of 20,000 pages of regulations to implement the clearly flawed plan.

Aside from all of the baloney about keeping your doctor and your plan and saving you money; the goal of some of those pages was an effort to improve the quality of the care delivered in the United States. While I won’t engage in an argument with idiots who think that Cuba’s health care delivery surpasses that available here in the States, as someone who’s day job is in health care, I will say that there is always room for improvement in the delivery of care. The problem is that the government and regulations are probably the worst possible vehicles for driving improvement.

In the time since Obamacare passed and was signed into law, there has been an ever shifting sands of rules and regulations that health care providers have been forced to address; each coming with a higher and higher price tag. Much of it boils down to additional reporting and paperwork and the manpower needed to handle it all. One unfortunate side effect is that health care providers have tried to maintain cost and larded this mountain of additional work on existing staff, which drags down their ability to actually provide care.

 

As if to illustrate my point about the government being the worst vehicle to drive up quality, Scott Atlas, M.D., a Senior Fellow at Stanford University’s Hoover Institution and a member of Hoover Institution’s Working Group on Health Care Policy, has served up the new book, Restoring Quality Health Care – A Six-Point Plan for Comprehensive Reform at Lower Cost. Minus the end notes and index, Dr. Atlas managed to offer up a concise and comprehensive plan in an easily read 99 pages.

Many of Dr. Atlas’s suggested reforms involve the streamlining of processes; process improvement is one of the cornerstones and goals of any strong health care provider, so it would make sense that a physician would bring this approach to the table. Process improvement…not a government bureaucrat’s long suit.

Dr. Atlas also suggests injecting market based reforms into the health care process, including the expansion of and incentivizing of Health Saving Accounts (HSA) for all Americans. Atlas even goes so far to suggest that HSAs be issued at birth like Social Security numbers. By beginning the process early, incentivizing people to contribute to the accounts through tax breaks, making the HSA portable, and allowing these account to pass to family members without taxation upon a patient’s passing, a deeper level of understanding and control over health care spending would become ingrained in a society. This is a clear market force that would drive up quality.

Dr. Atlas also explodes the myth of Medicare excellence. He describes Medicare as being “a disjointed and antiquated system designed for decades long passed.” Again he offers a common sense reform for streamlining the bulky, bloated and confusing systems of Parts A, B, and D which only serve to increase administrative costs and baffle the seniors the plan was designed to aide. As Atlas points out in the book, the cherry on top of this mess is the plan fact that the Medicare system is in dire financial straits.

While the government tried to “fix” health care with a lumbering, bloated, Goliath of a plan, Atlas choose to go the route of David and offer up a quick, nimble plan to reform and improve the quality of health care we all receive.

The Great Health Care “Fix”

The Patient Will See You Now: the Future of Medicine is in Your Hands – Eric Topol, M.D. (Basic Books)

America’s Bitter Pill – Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System – Steven Brill (Random House)

Reinventing American Health Care – Ezekiel J. Emanuel (Public Affairs Books)

A staggering amount of ink, paper, hot air and treasure has been expanded in a seemingly never ending debate over how to best improve the current state of the health care in the United States. Some have deluded themselves into buying into the fantasy that the Affordable Care Act, aka; Obamacare was the so-called magic bullet that would once and for all fix the deeply flawed, ridiculously overpriced U.S. Healthcare system.

Unfortunately those delusional folks couldn’t be more wrong; the Obamacare legislation is the worst example of how Congress creates new laws, a mish mash of bad sausage making that slaps together so much contradictory information into a greasy mess of differing constituencies, that does nothing to actually improve care for the patient or lower costs for that sub-par care.

So despite decades of chatter, hand wringing and debate we really haven’t moved the ball. Three new books attempt to tackle the problem and at times bring strikingly similar points of view to bear and at others approach things from diametrically opposite perspectives. In the end only ones comes close to what will actually bring an impactful change to healthcare, albeit one that still has some hole that remain to be filled.

Dr. Ezekiel Emanuel, a physician and bio-ethicist by trade, was one of the architects responsible for the sloppy sausage making that went into Obamacare. His take on fixing healthcare comes in the form of his book Reinventing American Health Care, which is a mix of a clearly misplaced, misguided victory lap for his work on Obamacare and what he envisions as the next steps to continue that process.

 

Emanuel is a glaring example of a socialized medicine, universal healthcare-type who buys into the belief that government control is the only correct path to the delivery of healthcare. Its sounds like a case of, Obamacare was a good first step, but there is still more work to be done.

Emanuel makes some downright astounding predictions about what he sees as the future of healthcare, including:

·         The end of insurance as we know it – happening by 2025

·         The end of employer sponsored health insurance – happening by 2020

·         The end of health care inflation – happening by2020

·         The emergence of digital medicine and the closure of hospitals – happening by 2020

While I believe some of these predictions, which may be seen as bold by some, will likely happen, it won’t be for the reasons Emanuel lays out. Clearly Obamacare has failed miserably on one of the cornerstone claims that was made about it; reducing the cost of healthcare and health insurance. In fact, costs have continued to not only increase, but increase dramatically. Those costs will make it impossible for businesses, big and small, to continue to provide/underwrite the costs of insuring their employees.

As to ending health care inflation, this one is laughable on its face for a multitude of reasons. The most basic reason is one of the fundamentals of understanding economics, which clearly Emanuel and many in the Obama administration, including the President, don’t quite grasp; supply and demand. We are on the leading edge of aging baby boomers starting to hit the age where they we see the need to utilize health care at a greater rate, thereby increasing the demand, while the supply; doctors, nurses, etc., has remained relatively stagnant or actually decreased; which will lead inevitably to increased costs.

It is only with the emergence of digital medicine that Emanuel comes close to a correct prediction. Dr. Eric Topol delves much more deeply into the impact of the technological evolution and digitization of health care; more on that later.

Journalist and as he makes clear, a broad range participant in the health care system, Steven Brill takes a swing at improving health care by pumping steroids into his already pumped up take on the U.S. healthcare system. Brill expands on his epic 2013 Time magazine article, the 40,000 plus word piece entitled Bitter Pill – Why Medical Bills Are Killing Us, in the form of his new book, America’s Bitter Pill – Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System.

Like Topol and Emanuel, Brill serves up a heaping helping of heart rendering stories about seemingly ordinary, average, American citizens who have gotten caught up in the staggering costs of the U.S. healthcare system. Anyone who has had a hospital stay or had a family member have a hospital stay to battle disease or illness, simple or complex, has been the recipient of a mind-numbingly complex, nearly impossible to read, let alone understand, medical bill. Depending on the type of illness and course of treatment rendered, maybe more than one bill.

These sob stories have the desired effect; outrage at the high costs involved and a backlash against a seemingly secretive medical industrial complex. Brill’s solution to the problem involves the creation of large, regional health care systems being formed and assuming the role of not only provider, but of insurer for the patients they treat. This model is currently being explored in Western Pennsylvania by the University of Pittsburgh Medical Center (UPMC) and it’s insurance division. The logic Brill provides is that the insurance arms would keep close watch on the providers and the providers would be loathe to overcharge or over treat the patients covered by the insurance side, thereby keeping costs in line.

The glaring flaw in both Brill’s plan and in that of Emanuel’s socialist approach is that both keep the person purchasing the health care service outside the loop of the decision making process, which is what got us into the position that we find ourselves now firmly locked.

The only author who comes close to actually getting to what will fix the problem with our healthcare system is Eric Topol, M.D., a practicing cardiologist and researcher. In his new book, The Patient Will See You Now: the Future of Medicine is in Your Hands, Topol correctly raises the question, “Is there any other walk of life when services are purchased, but the purchaser does not take ownership?”

 

The problem stems from the simple fact that the patient, the reason for the service in the first place has been marginalized out of the process by third party insurers and by medical providers. Until we return control of the purchasing decision back to the patient, then the U.S. health care system will continue to be a nightmarish maze of high costs, relatively lousy results and endless problems. With that control back in the hands of the patient/consumer, comes competition for health care dollars and with that competition will come a combination of lower costs and improved service/care.

Brill and Emanuel would prefer to keep control in the hands of a third party who dictates not only what care looks like, but where you can receive it, and how much of it you can receive.

Topol makes the case that it is unlikely that the current system will willingly make the choice to hand control back to the consumer, but it is more likely that the consumer will seize control through the means of digital tools that continue to evolve and become more readily available to the average consumer in the form of smart phones and applications.

While those tools will help consumers to jump back into the process, there is still a role for physicians to play in the prescribing of medications and delivering care not in the traditional hospital setting, but on an outpatient basis which renders another level of control back to the patient. It’s not so much a case of self-medication as it is a better informed consumer making better choices for their own care.

Topol also makes a strong case against what I can only call lazy medicine with doctors doling out meds by the bucketful. Topol spells out in detail the outrageous use of medications, notably the multi-billion dollar scams for things like attention deficit and hyperactivity disorder (ADHD) with over $9 billion in prescription drug sales annually and the anti-depressant prescription marketplace, which racks up tens of billions in sales on an annual basis, with most recipients of the meds not meeting even the most basic of medical need for the drugs. It’s doubtful that the real costs of the societal and medical impact of the reach for the prescription pad, better life through chemicals mindset, could ever be truly measured.

Obamacare is a Train Wreck

I have a pretty basic question for all of the folks who think that Obamacare is great: Exactly how does it improve healthcare? It seems like forever that we have heard that there are 30 million or more uninsured...which has nothing to do with healthCARE. HealthCARE was fine; it's how we pay for healthcare coverage that is the problem. The Obamacare "fix" is to make healthcare more expensive for everybody...great fix!

This train wreck is having a negative impact on the economy, business and jobs...great fix! It really has not done one thing to address the shortages of doctors and nurses and how they will help provide care to all of the new people in the system?

In order to explain Obamacare, the Kaiser Family Foundation (hardly a conservative group) put together a cartoon...yes a cartoon!  It‘s actually very well done and might even help Nancy Pelosi to understand "what's in it." This clip concludes by proclaiming that after all is said and done after Obamacare kicks in, that about 30 million Americans will still be without healthcare coverage! Ever feel like you are chasing your own tail? These people are bozos and if you think that this Obamacare train wreck will fix anything then you are a bozo too!

 

Dahlkemper Talking Political Vision Is Laughable at Best

I am always amused by how some politicians view themselves. I laughed out loud when I read accounts of former Congresswomen Kathy Dahlkemper’s announcement that she was tossing her hat into the race for the Democrat nomination for County Executive against incumbent Barry Grossman.

Dahlkemper laughably proclaimed that Erie County’s top job called for more visionary thinking on economic development, poverty and stemming the areas perpetual brain drain. My first reaction was what was her first clue? And the second was REALLY?! Political vision from a women whose only experience in public office came in her one term in Washington, where she served as a reliable rubber stamp for Nancy Pelosi and Barrack Obama.

Pardon me, but W T F?! How can anyone possibly take this women seriously? Her vote in the affirmative for Obamacare has saddled not only Erie County, but the entire United States with one of the most detrimental to business pieces of legislation in the history of the country! The economic devastation that this bill will cause to the country will only continue to grow as its multiple parts begin to take effect.

Talk about poverty…Ms. Dahlkemper’s vote will spur businesses that are teetering on the brink of insolvency to go under and others who have ability to choose to depart Erie County and take their business elsewhere. Imagine Erie without GE Transportation. Not a pretty picture as that proverbial snowball rolls down hill and comes to rest at Ms. Dahlkemper’s feet.

The biggest problem with economic development in Erie County has nothing to do with a lack of political vision on the part of its County Executive, but an unwieldy web of competing entities struggling for funding and trying to cling to their own piece of the turf. It’s pretty hard to be effective when you have more than 20 groups posturing for a place in the spotlight. No one wants to give an inch in their little fiefdom, so nothing gets accomplished.

Now imagine someone as clueless as Kathy Dahlkemper bumbling and stumbling into the mess. While Grossman hasn’t done much to fire innovation in his first term the thought of Dahlkemper in that role is a truly frightening thought!

Betsy McCaughey – Beating Obamacare: Your Handbook for Surviving the New Healthcare Law (Regnery Publishing)

During the debate over the Affordable Care Act, which better known as Obamacare, then Speaker of the House and well known MENSA member Nancy Pelosi famously proclaimed “we have to pass the bill so you can find out what’s in it.” Unlike the genius Pelosi and I would safely bet a preponderance of the then members of the House and Senate who voted for this legislation, former New York Lt. Governor and health policy advocate Betsy McCaughey has actually read the 2572 pages of this convoluted law in its entirety.

McCaughey was a tireless campaigner against the passage of this mess and as now delivered a concise rendering of what the law actually says and does to the American people and the U.S. healthcare system in Beating Obamacare: Your Handbook for Surviving the New Healthcare Law.

While the chatter leading up to the passage of the law painted a wonderful picture full of all of the tremendous benefits that the American people would reap under this new approach to healthcare. But like so much that comes out of Washington, the American people were sold a bill of goods and the promised savings and improvements to healthcare delivery have already been proven to be an outright lie even before much of the law takes full effect.

McCaughey spells out the reality of the healthcare law including;

• The implementation of the largest tax increase in the last 20 years

• The tremendous cuts to payments that doctors, hospitals, and many other healthcare providers will receive for care delivered to the elderly.

• Why a massive number of employers who currently provide healthcare insurance are considering dropping those plans or cutting down the number of folks who participate in the benefit by slashing workforce or the number of hours workers currently work.

• If you’re wondering about the huge growth in the number of IRS employees being added to the federal payroll that is the mechanism that will be used for reporting and tracking if you receive employer provided healthcare and how much employers contribute to the cost of those plans.

 McCaughey spell out the cold, hard, reality of Obamacare in direct, easy to understand language that arms readers with the truth about what’s actually in the law. Beating Obamacare: Your Handbook for Surviving the New Healthcare Law, should be required reading for so-called best and the brightest on Capitol Hill who foisted this 20 pound legislative turd onto the American people. I would hope that Ms. McCaughey would also be kind enough to send a personally signed copy over to Supreme Court, Chief Justice John Roberts whose misguided vote allowed this nightmare to continue.

Marty Markary M.D. – Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (Bloomsbury Press)

Full disclosure up front: my full-time career is in the health care field on the marketing side rather than the clinical. Even before I went to work in health care, I was fascinated by the reports of avoidable medical errors and the harm, if not outright death that they caused. The numbers that get thrown around are staggering, in the neighborhood of 100,000 deaths per year according to some reports.

But what is at the root of those errors? In Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Dr. Marty Markary, a surgeon at the prestigious Johns Hopkins Hospital would have you believe that it is a combination of contributing factors, but the blame rest solely at the feet of hospital administrators and the incompetent practitioners and unsafe practices that they allow to continue at their facilities.

While there is certainly ample evidence to support Markary’s claims, by the same token I think he is too quick to downplay other contributing factors including: ambulance chasing attorneys, the government at both state and federal levels, and even the patients themselves.

Markary claims that transparency would cure many of the ills in healthcare, but he neglects to account for the massive costs of litigation, risk management and the increase in costs that go hand in hand. Hospitals, both non-profit and for profit feel the need to circle the wagons to protect themselves from the vultures overhead.

While regulation is necessary to ensure competent care delivery, the government also contributes to the problem with its lack of uniform interpretation of its own regulations on the state level and don’t even get me started on the rules and regulations involved with Medicare, HIPPA, and the tangled mess of Obamacare.

While Markary is quick to indict the health care system he chooses to ignore the patient’s contribution to the problem of medical errors. I would have to bet that on more than a few occasions in his career Dr. Markary has been confronted by a problem that’s root cause can be traced to a patient that was less than forthcoming with information about their own health status or their own habits and vices. And if we are being truly honest, how many of us as patients haven’t told our doctors the whole story about our condition or maybe waited a little too long between visits to address a health issue?

Certainly there are incompetent, over-worked, under-staffed, situations that occur in healthcare that contribute to the problem Markary puts forth, but the issues are certainly much more global in nature than he would have you believe.

Dirty Harry vs. Kumar...

Based on star power alone...who would you vote for? The RNC had multi Academy Award winning, Clint Eastwood, one of the most successful Hollywood box office draws in history; vs. the DNC with actor Kal Penn who is most famous for playing the dope smoking slacker Kumar (in the Harold and Kumar movies) and a Doctor who offed himself on House...guess he must have seen what the world would be like for doctors under Obamacare.

Go ahead,,,make my day!

I thought Obamacare was about “free” healthcare for everyone? Apparently I misunderstood…because based on their recent comments the Democrat party is now, suddenly concerned about the transfer of wealth and the Obamacare bill was really about government forcing personal responsibility.

Here is a small sampling of the new look, Democrat leadership’s comments to the media:

“This is a penalty on free riders,” said Senator Chuck Schummer (D-NY)

It’s not a tax on the American people,” House Minority Leader Nancy Pelosi (D-CA) said Sunday on NBC’s “Meet The Press.” “It’s a penalty for free riders.”

 “This penalty says you cannot be a free-rider,” White House chief of staff Jack Lew told Fox News.

“[W]e shouldn’t have free riders in the system who drive up everyone’s healthcare [costs],” Obama campaign strategist David Axelrod said on MSNBC’s Morning Joe.

"When it came to championing the health care legislation, President Obama made sure that although everybody -- the vast majority of Americans have health insurance coverage, we want to make sure that if you're a free rider, if you roll the dice and get sick and use the emergency room as your primary access point for health care. Those health care costs are going to get shifted to all of us. And if you choose not to carry health insurance, this legislation says you're going to pay a small penalty so that we don't have to pay for you rolling the dice," DNC chair and Congresswoman Debbie Wasserman Schultz (D-Fla.) said on MSNBC today.

“The massive so-called tax increase they’re talking about is the freeloader penalty,” Maryland Gov. Martin O’Malley (D) said on CBS’ “Face The Nation, “which would affect at most 1-2 percent of people that could afford health care and instead want to be freeloaders on the rest of us with uncompensated care.”

Apparently Gov. O’Malley didn’t quite understand his talking points fax…it’s FREE RIDER…not FREE LOADER!

Seriously…do these asshats really think that anyone is buying this? This is the best they can concoct to try to defend our clueless President who arrived in office by proclaiming that no one earning $200,000 or less would be subject to a tax increase? How does this TAX increase, help to reduce the cost of healthcare?

Here’s a hint…IT DOESN’T!! These drooling morons don’t quite grasp the fact that people who can afford health insurance, but choose not to buy it aren’t what’s driving up the cost of healthcare! Those people will receive a bill from their hospital or physician and here’s a unique concept, they will be expected to pay for the service they receive!

It’s those people that Obama and his ilk claim they are “helping” with this flawed legislation, those who don’t have or can’t afford health insurance that jack up the costs! And how does this TAX increase do anything to prevent these folks from being FREE RIDERS on other people’s dime?! "This is a penalty on free riders," said Sen. Chuck Schumer, D-N.Y.This is a penalty on free riders," said Sen. Chuck Schumer, D-N.Y.This is a penalty on free riders," said Sen. Chuck Schumer, D-N.Y.

Dahlkemper Parades Her Stupidity

Former Erie Congresswomen Kathy Dahlkemper just can’t seem to contain herself, insisting on parading her stupidity.
The Weekly Standard, picked up on a press release fired off by the oxymoronically named Democrats for Life of America, denouncing the Obama administration’s decision to force religious institutions like Catholic schools and other institutions to pick up the tab for employee contraceptives under the Obamacare health care reform plan, which has Dahlkemper claiming that she would not have voted for the bill had she known this would be the outcome.

"I would have never voted for the final version of the bill if I expected the Obama Administration to force Catholic hospitals and Catholic Colleges and Universities to pay for contraception,” said Dahlkemper. "We worked hard to prevent abortion funding in health care and to include clear conscience protections for those with moral objections to abortion and contraceptive devices that cause abortion. I trust that the President will honor the commitment he made to those of us who supported final passage."

The story has been picked up by the Drudge Report and the Blaze, leading to reader comments calling Dahlkemper stupid, lazy, incompetent, naïve and worse.
I find it odd that it wasn’t that long ago that Ms. Dahlkemper proclaimed publicly how proud she was of her vote for the Obamacare bill because she helped to author the part of the virtually unread bill that extended parental healthcare coverage to offspring to 26 years old. Now she suddenly came to the realization that she had been played like a cheap fiddle by Obama and his minion Nancy Pelosi just to get her vote.

Maybe it’s time for Ms. Dahlkemper to come to grips with the fact that voters sent her packing largely based on her Obamacare vote and to borrow a line from heavy metal poets Motley Crue, “don’t go away mad, just go away.”