Wednesday, October 25, 2006
There will no doubt be concerns about a clinic environment as has been brought up in our comments by our most loyal viewer and blogger himself, Bruce. I believe this is stirred up by visions of free clinics from the inner cities in the seventies and eighties. I believe actual experiences people have had at an efficient and well run clinic would alter some opinions. Also, doctors offices have become a clinic of sort, in the sense that they may have various practitioners and services available, and in the worst way in that and who has not had a long wait at their doctor in the last decade, as they overbook their schedules to make up for cancellations and the lower reimbursements they get from insurers? I am not making this proposal to make either patients or physicians unhappy, as both are groups I am trying to help with my work. Rather, I am trying to recommend that in many instances we take the business out of medicine, that has reached a point where to maintain a thriving business, a physician may have to get too aggressive, and areas that a physician, in general, may not want to have to deal with anyway. Give the business end to the businesspeople who spend their entire day just worrying about that stuff. Also, it can be set up to give physicians clear direction, incentives, and a communal atmosphere of working on the patients behalf, instead of the Utilization Review Committee of a far distant insurer sitting around making those decisions. For the patient, the biggest change could be one of location, and possibly less convenience in this area, but, for follow-up and specialists, possibly more convenience, to offset this for those who will need the most care and visits. There will be no perfect solution for every constituent, but there is no perfect healthcare environment now, for just about anybody. The key will be to maintain what is great and innovative about our system, and combine that with the comprehensive reforms necessary to secure the system for the future, and at the same time to move progress forward in, among important areas; infant mortality, healthful longevity, infection control and the minimization of mistakes at every juncture of care. This will need to come about through better treatment for drug and alcohol use and nutritional understanding, better preventative medicine and better community awareness of what healthy eating and general health habits are, more open yet secure collaborative information systems and more stringent guidelines over antibiotic use along with better use of the information systems coupled with a team approach to practice which could yield better and more consistent medicine. All the tools we need exist or are being developed. We need open mindedness and willingness from the top echelons of our goverment down to each and every medical provider and consumer. We need to understand that there is a crisis. We need a crisis mentality. We have not seen one from our government officials since the early nineties. It is time to focus on these national issues now, before they will cost ten times as much, and with much more painful solutions, for our children and children's children in the future.
Saturday, October 21, 2006
|I do not believe a government run single payer system is right for American healthcare. It would, however. solve the crisis of the uninsured and therefore, if all else is ignored for too long, it will probably come to that. I believe there is an alternative to that vast change of the system, and to the pointless and toothless minor plan changes the conservatives try to foist upon us whenever there is an outcry that the government is ignoring healthcare reform. Meaningful reform can keep what is best about our system: free markets, competition, innovation and vitality while wringing out huge swaths of cost and unfairness. We are going to examine some broad concepts here. I hope you will be able to journey with me soon into the intricacies of the situation by holding a book written by me and read by you. That still remains to be seen. So.... Since I believe that government run plan would be lethal to some because when the payer is so vast and stands above regulation by enforcing it, you will see rationing and no culpability when there are nasty results. Look what the government wrought just by implementing rules in ERISA to allow HMO's to deny care without being sued. They did this to basically allow HMO's to flourish, since this was the basic tenet of HMO's--controlling costs. The problem of the HMO's, much like for a government payer, is when you are very sick, and they can either keep paying for care or deny it and hasten your death...from a profit, or cost reduction perspective, what would you do? I think every health plan should be required to supply their policy holders with life insurance too, thereby creating an incentive to keep you alive! (I'm being facetious, by the way, because they would merely create a securitized pool for that risk and spin it off of their books and thereby circumvent the spirit of the act). Anyway, you can see that I do not believe that the core of saving money and cutting costs in the healthcare system is by denying care. And yet, together, we will journey into a basically free market plan that will cut far more costs then many in governemnt ever thought possible. Ihave worked in healthcare and created a plan for the uninsured. I have worked with a lot of providers. There is waste and unintended opportunity for profits out there for independent practitioners. There are incentives to deny good medical care built into managed care. So where do you go for good affordable medicine? Hospital clinics. Practitioners that feel they are using the resources of their own organization and being watched by experienced administration with healthcare backgrounds can walk the fine line between wasteful and miserly care. Utilizing work flow and six sigma process improvement techniques; adopting technology, utilizing professionals such as RN's and Physician Assistants, we can design clinics that run efficiently and in a timely manner without sacrificing all the good elements they bring to the table. Government oversight and auditing is also streamlined in this realm. I am not advocating we abolish independent practitioners or we restrict their access in the plans. I call for the design of copayments to be structured to make it less costly to go to the clinics, and you would pay more for the option to go to the independent practitioner of your choice. In this way, you would pay some of the difference in savings your plan would lose by your choice of practitioner. We will continue to look at straight medical care for a while before returning to Mental Health which requires a somewhat different reorganization. And Dental, which will see some changes as well.|
Friday, October 06, 2006
While I commend your righteous indignation, and I enjoy the implosion of the GOP as it scrambles to figure out who to support and who knew what, when, I can only ask the question: "What is wrong with you?" This is what got your ire up? We have barely fought the war on terror---a little work in Afghanistan, some intelligence work here, otherwise we have just played war games---with our childrens lives, I might add. But that didn't upset you. An ill conceived and pointless war in Iraq got no reaction. Our soldiers dying--not much more of a reaction. Tax cuts for the wealthiest and back to huge budget deficits for the country barely got a blink. Record gasoline prices and record oil company profits---you stopped buying SUV's but didn't complain much to the government. We don't protect our ports any better than we did at the time of 9/11. We phone tap our own citizens, watch them on the internet, hold prisoners around ther world without due process and torture many innocent, and some guilty, people throwing away the rule of law and the Geneva conventions---that help protect our own soldiers, among many other positive things it accomplished, but that barely gets your notice. We haven't worked on healthcare or tax reform in the last six years (unless you count that deficit inflating tax cut). We haven't moved the country ahead, haven't fought the war on terrorism very well, and none of this really mattered to you. But, Foley---oh yuck,---- well there you go! Understand, I try to not be inherently partisan and I only enjoy the GOP implosion because I feel they have been holding this country back from many important advancements and improvements like meaningful healthcare reform since they took the Houses in 1994. And they have been destroying what makes this country great since 2000. There have been Republicans that enhanced our standing in the world, seemed to care about all Americans, and had some bold ideas, but that was a while ago; the last one that really made a difference was Nixon, and he screwed up his own legacy. Reagan tried, but for each strength he showed, he hurt too many of the poor and downtrodden to be a true American hero. George H.W. Bush seemed to actually want to be a good President, but like Jimmy Carter, intentions were not enough, and those two were just lacking something that makes the difference between being just a good person and making it as a good President. I just find it funny that in the last six years Geroge W. and company could wreck so much of this great nation, get your kids killed while mostly not actually fighting the good fight, and spent much of the last five years using the excuse of 9/11 to turn America into some strangeChristian-KGB-Jihadist nation of preemptive warring, torturing, imprisoning without recourse, illegal bugging, illegal spying, paranoid intolerants that barely fight the real terrorists, did not catch Bin Laden, and still don't feel the need to secure our ports---Oh Yeah, in fact they wanted to sell the management of our ports (some of them) to citizens of the same part of the world they say are full of the terrorists. HELLO. Foley is a hypocritical low life supposedly fighting to protect our children while fighting to get in line to prey upon them as well. He was coddled by the GOP powers that be who knew what he was "up to" so to speak, for some time. Nevertheless, that is when you decided to wake up and smell the coffee? Maybe you just can't get your head around all that other stuff. Maybe you needed Foley to give you a local focal point. Maybe when you think about the billions a month we spend on the Iraq war, and our dead soldiers, all to make the world safe from--Saddam Hussein---wait, you say, we were safe from him when we had sanctioned his nation's ass back to the dark ages with a decade of embargo. That's what we all thought until George W. fresh from his semi-successful fight in Afghanistan (semi because he kicked the Taliban's butt, and that's something, but didn't finish off Al-Qaeda or Osama) thought he could really beat Saddam and his starved for 10 years band of hooligans--so he manufactured a crisis. And as is often the case when fools rush in where wiser men fear to tread---it didn't go the way he thought it would. In fairness to our President, it wasn't only him who believed all that nonsense. You can add Cheney and Karl Rove to that list. If I were Canada, Sri Lanka or Togo, I would be quaking in my boots right now, because I have heard through the grapevine that those three wise men, W. Bush-Cheney-and Rove--think they need a clear and decisive victory and they have created a database of nations they think they have the battle tested wits to defeat, and also those nations that they think our country either hates enough or doesn't know enough about, to wage a war against them. France made one of those lists, but we are pretty damn sure they do have weapons of mass destruction so our 3 sages pushed it off the list. Canada, actually is thought of kindly by many Americans, but it seems they polled an unusual number of surly hockey fans while preparing their study. And except for Sri Lankans and Togo, uh, Togo-onians?, well, people from Togo, they found that no one else really knew where these places were, or cared. The fortunate thing for these nations is that the 3 sages have only tested their wits in battles over the TV remote, because as we know, none of them felt the need to answer their own country's call for assistance back in their younger days. The bad thing would be, of course, that our soldiers, the finest the world has ever known, would actually be doing the fighting. So what is it gonna be America? Is Foley going to be the catalyst that gets you off your butts and using your America granted (they still haven't taken that away) right to vote, and start making a real difference starting this November? Or will countless Canadians and Togo-onians have to pay for your apathy???