Travel Subsidy on the Health Train Express

The real 'deal'

The American Medical Association came out in favor of the House Democratic health care bill when the House Democratic leadership promised the doctors $230 billion in new spending to cancel out any future Medicare physician cuts (which are scheduled under an existing law called the Medicare Sustainable Growth Rate Formula). As a result, the doctors don’t have to give up anything under the health bills, and would actually pick up $230 billion under the House bill over 10 years.

Hundreds of 'sound bytes' and snippetes of highly charged statements are read daily by patients, providers and decision makers. Unfortunately for the uninformed (and even the informed) ferreting out the 'truth' is very difficult.

Both Republicans and Democrats seek the position to regain p ower, or retain power.  One has to take with a grain of salt, analysis from either side of the aisle.

It's up to we the people to analyze and make your own decision regarding health issues, and be certain your opinion reaches your representatives.  Avoid being a leftist or a right winger.

Perhaps we should not make any decision this year in the midst of economic upheaval from which we have not yet recovered.

Bailing out banks, financial institutions, automobile industry have left us all a bit depleted and in no position to make such a critical decision.

Professionals cast a jaundiced eye upon statistics and projections of healthcare financing.  In reality it is difficult to imagine health care costs in 2016, while dealing at the present moment with a diffiicult system that is challenging to navigate for providers and patients alike.

I like to compare health reform to  the end goal of  orbiting  a satellite. The most effective means of accomplishing this task is by 'staging' a rocket with three booster segments.

It would be almost impossible to accomplish this task with a 'one stage rocket'. This is also true of health reform. 

One Small Step

Gravity acts to keep objects on earth and our present health system also retards change with inertia.

Here is some of the last weeks analysis.

WSJ's blog on health and the business of health.

Claims that health reform will be disastrous for businesses and government are wrong, writes Gary Locke, the U.S. secretary of commerce in an op-ed in the WSJ. Making his case for reform, Locke says that climbing health care costs already cost American businesses jobs and revenue, as well as entrepreneurship, and that isn’t sustainable. “In the short term, health-care costs pose a major problem for companies and their employees,” writes Locke. “In the medium and long-term, these costs pose serious challenges to our economy.”

Fixing Health Care will be good for the Economy

How Hospitals Could Profit from Health Reform

Rick Peters writes in The Health Care Blog

del.icio.us Tags: health reform,health train express,bailout plans

A Missing Passenger of the Health Train

Edward (Ted) Kennedy, D, Mass, departed from the Health Train yesterday. A significant voice in health affairs has left the stage. Not much more can be said by me when others have so elequantly described his life, and times.  Health Train Express offers condolences to his family and constituents.

A moment of silence.....

Ramblings on the Health Train

 

My day here at the government run undisclosed location started off with my morning read of health related blogs, pundits, and rumor mongers.

Buckeye Surgeon from Ohio presents a personal interview with two of his medical school chums, one in private practice and the other who is employed by the Cleveland Clinic. Rather than trusting media sources and medical management statistics, Buckeye decided to do his highly statistically significant study with a cohort of two…..My take on the interview is that some doctors like to work in a group practice, while others are individualists, and like to work alone or in a smaller controllable environment, where you have a choice of wallpaper color, who you hire and fire, and are accountable for just about all you need to practice medicine, and all that you perform. That is what is so unique and vibrant about our health care system….choices for physicians and patients.

Over at MedPolitics , and RealClear Politics The discussion turns to the uninsured.

Here is the “scoop” from t he CATO Institute regarding the uninsured, and who they really are.

 

del.icio.us Tags: uninsured,medpolitics,health train express,buckeye surgeon

Lieberman--A Voice in the Wildness

Joseph Lieberman, (IDem) Senator from the nutmeg state, CT boldly goes where no man goes before...a voice of reason, perspective and quiet reasoning. (typical of Lieberman).

One of the Senate's most powerful Democrats, Joseph Lieberman  said  Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.

"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.

One of the Senate's most powerful Democrats said Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.

"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.

"I'm afraid we've got to think about putting a lot of that off until the economy's out of recession," he added.

"There's no reason we have to do it all now, but we do have to get started. And I think the place to start is health delivery reform and insurance market reforms."

 

 

Although we physicians recognize perhaps more than most that out health system is flawed, most know that this must be accomplished in small steps, focusing first on defects in our insurance system, which lead to the increasing numbers of insured, and increasing overhead to physicians and our society in general.

In the back of each our minds are the millions of uninsured who present in our offices, on an hourly basis,  in the emergency department and public health clinics. 

The term "The Public Option" thus far remains clouded in hyperbole, sounds good or bad, depending  if your leaning is to the left, or to the right.

For many "The Public Option" remains a poorly disguised euphemism for Socialized Medicine.

del.icio.us Tags: lieberman,public option,recession

Value, Security, Beauty and Elegance

Mark Smith, CEO California Health Care Foundation, (video link)  spoke at the Microsoft Connected Health Conference meeting in June.

Comparisons between Richard Nixon’s Health Reform Proposals and Obama’s proposals..as described by Mark Smith, illuminate the similarities and differences. Read what a staunch conservative Republican proposed for a national health universal payor program.

Mark Smith and the things to get ‘right’

1. Standards
2. How will we wire doctors …nagging fear
3. Attributes for providers:
   1. Simplicity, Adaptability, Functionality
4. Attributes for “patients”
   1. Value (for the patient) solve the patients perceived needs.
   2. Security and privacy issues
   3. Beauty, elegance (something ‘they want’)

Dr Smith presented what doctors and patients would like from health IT developers.

K.I.S.S.

Health care financing in itself is a morass of complicated systems. Those who wish to make it as simple as possible, are mistakenly driven toward a universal payor model. What lurks behind the scene with that model is unknown and unintended levels of bureaucracy and the considerable expense of reorganization of the entire system.

It seems public opinion is focusing on these elements:

1. Eliminate cherry picking by private payers, elimination of exclusionary policies and waivers as well as predatory premiums.

2. A public option (which could be temporary) for lapses in employment, and/or insurability, or disability

3. Developing an actuarial insurance base that includes all citizens of the United States.

4. Elimination of free care for undocumented aliens.

5. Elimination of reimbursements based upon procedural coding.

6. Transparency and private oversight of government insurance plans and development of health IT.

7. Improve physician availablity for both primary care and specialty physicians by ''federalizing' medical licensure. Present state regulations amount to restraint of free trade. State licensing largely depends upon national testing standards.

K.I.S.S.  Keep it Simple, Stupid !

The SERMO-AMA Disconnect

Kevin MD today makes some keen observations about the recent dissolution of the AMA – SERMO connection. The sad fact is the outcome weakens the credibility of both organizations. No one knows what the ‘pre-nuptial agreement’, nor what investment in hard cash we as physicians made in SERMO. It would be nice if there were some transparency, other t han the posturing of either side.

My view is that we as physicians were hurt by these events. Neither side seems to want to own accountability for the rupture in the partnership. My guess is that The American Medical Association reacted like a ‘hurt parent’ when confronted by SERMO with the ‘truth’. The AMA and it’s board obviously did not see the relationship as mutually beneficial. The American Medical Association seems to have treated SERMO as a mere ‘marketing opportunity” for the AMA. They never really saw this relationship as a true “partnership.” Partnerships require trust, and trust requires time and actions to prove it’s worth. The AMA lost the opportunity to hear from the disenchanted physicians who no longer belong to the AMA. Perhaps the AMA thinks that by withdrawing its support for SERMO, it will wither and die. SERMO will find a number of other suitors. Mere numbers do not make any organization strong. Many ordinary decision makers and the general public no longer see the AMA as representative of doctors, and the AMA now shares the stereotyping as just one more special interest lobbying group.

Even as an early supporter of SERMO, and Dr. Palestrant’s meteoric rise in medical social networking, as well as major media, I feel somewhat chagrined, and can feel the angst of Dr. Palestrant….

I do not know the inner workings or the need for capital that SERMO required when the partnership was formed. The AMA is a much more mature and well structured organization, not dependent on the actions of one man. Dr. Palestrant seems to act alone, however I do know that I once served on an advisory council. I haven’t heard anything about that council for several years.

The fact that so few replied to the survey about the AMA is not surprising, given that most surveys have a very low yield . Also, given the fact that most doctors only occasionally sign into SERMO occasionally most missed the actual survey itself.

The fact is that doctors need the AMA, and also need organizations such as SERMO.

Other organizations have made the same observations