Monday, February 3, 2014

Health System: Beginning and Ends with Politics

I have never considered myself a politically influential  person. I always considered my self to be conservative independent and never registered for any particular party.  I had some hope for the Tea Party movement which has erroneously called the Tea "Party"  The Tea Party Movment began as an idea and attracted those of all political persuasion. It's based upon fundamental beliefs about America and the documents and laws from which it sprang.

Largely because it was supported by Sarah Palin, who at the time was a Vice-Presidential candidate with John McCain and the Republican Party. Palin  was labelled a "right wing" politician.  However the TPs ideas also fit well with many democrats.

Gradually I have been swept along and have become politically active largely because of my role as a physician and sometimes leader in some circles.  My circles are small and I probably have few followers.

For over 30 years as a physician  I dealt with older patients, and children as in my specialty of ophthalmology.  In the last fifteen years the economics and science of medicine changed immensely. As science and technology improved it economically impasted the financing of healthcare with changes in administering payments and requiting prior authorizations to perform many procedures, both diagnostic and therapeutic.  In order to facilitate these new mechanism bureaucracy fluorished along with the attendant cost.  As regulatory functions increased cost skyrocketed, and efficiency declined. The added addition of health information technology which promised to reduce cost actually increased cost and reduced efficiency for many reasons.  The return on investment is moot.

Much as the title of this post as Charles Krauthammer succintly summarizes America's choices and directions, 'It all begins and ends with politics'.

So too has the decision and formulation of the Affordable Care Act. Perhaps this is why it is so chaotic and poorly implemented.  Political choices come down to the court of last resort. (Let's vote on it)  The best decisions are rarely chosen by a vote. If a law is passed subject possibly to constitutional doubt the question is sent to the Supreme Court where frequently the decision rests on an obscure readily available consitutional guarranttee of certain rights.

Conflict and opposition are the soil of politics.

The Affordable Care Act is now the law of the land.  However like most laws it will be amended as circumstance warrants.

Health Train Express has been swept along in the past year, from healtth information technology and reform to political inflluence.

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