update to date posts
Confused about Health Care reform? Dismayed? Here is the front and center issue and why a year’s worth of debate was a strategic mistake. Jobs, the economy and education in America top the polls.
They missed the golden opportunity … financial banking reform.
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Keith Olbermann, always impassioned, penetrating and reflective. The chorus rises: this bill with it’s mandated participation in the insurance protection scheme cannot be supported.
A bad and corrupt bill is worse than no bill at all. The President’s high stakes gamble is overtaken by the raging storm of job insecurity and … the economy.
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Howard Dean at his most articulate and unambiguous self. The time has finally come. There is nothing left to support. It’s now face saving time. It is not about Joe Lieberman. He’s just become the Mannie Ramirez of the Senate.
“It’s not health care reform … and it’s too bad it’s come this.”
“You are going to be forced to pay, on average, 27% of your money to pay CEOs $20 million a year…”
[starts at about 4:08 into this clip]
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This just in from Robert Reich. Many of you have received this.
Hi. I’m Robert Reich, former Secretary of Labor under President Clinton and currently a professor at the University of California.
You’ve probably heard about a possible “deal” in the Senate to do away with the public option.
I’m here to tell you that this is no deal: it’s a gift to Big Insurance, plain and simple.
To which Captain Renault of Casablanca would have retorted:
“I’m shocked, shocked to find that gambling is going on in here!”
We have repeated the same so many times: the insurance racqueteers ultimately will not lose this great battle of wills. And the gang of 5 who are now trying to finalize your Christmas present … are not much better.
Current picks for a Longevity Hall of Fame:
Jack LaLaine — still going strong. Our human laboratory of optimal health.
George Burns — an interview at age 94 was daunting
The Rolling Stones — still creating. Who would have ever guessed?
Sophia Loren — still stunning in her 70’s
Dave Brubeck — the voice is a bit weary, but he plays with the same virtuosity as ever in a recent Jazz at Lincoln Center appearance. Over 50 years!
John Glenn — flys into space a generation later at age 78.
Clint Eastwood — the mark of rare genius — continues creating new and award-winning epics.
Where is this train wreck headed? Wending its way through the various Senate and House subcommittees, the health care reform debate of 2009 is approaching a crescendo. What do we have to show? The question I posed in a previous post still has yet to be answered – just what is the problem? Is the problem greater access? Is the problem escalating insurance premiums? Is the problem stratospheric and ruinous hospitalization bills? Is the problem rapidly declining quality of care? Or is this simply become a matter of whose team wins? The bill fails — the president sinks.
Andrew Weil concludes:
But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy.
We have seen the emergence of “evidence-based medicine” in the last 10 years. This has been an effort to further legitimize and give scientific basis to common medical therapies. A medical version of “show me the money.” I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational. Although the reality is medicine is not nearly as scientific as asserted. Only 10-20% of medical practice is based on sound scientific principles. This rankles most physicians who believe that conventional medicine is scientifically-based. The highest form of medicine is the practiced art using scientific principles and technology.
A series of US Task Force recommendations are being rolled out by the Department of Health and Human Services. These are well-intentioned and rational. Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective. The trap is “effective” as you will see.
After countless months the debate marches on. Congressional House and Senate bills proliferate. I have lost track. It is beyond our comprehension trying to read through each of these bills.
There have been many lost opportunities. This has never been about health care reform. This is about health insurance regulation. If you carefully sift through all the heartache stories and testimonials, you will see the real drama – unexpected hospitalizations. So the real crisis is coverage of catastrophic loss – astronomical hospital bills. Routine appendectomy — $50,000. Complicated heart attack — $250,000+. Catastrophe loss should have been the starting point.
Insurance is not the answer. It is the problem. Insurance subsidizes high costs.
What is the message? What do you want?
The World Health Organization definition of health has not changed since 1949. We were asked this the first day of medical school. No one answered correctly:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Political strategists play with focus groups to achieve Machiavellian goals. Issues can be framed positively or negatively. In a recent series of soundbites with Republican and Democratic response tracks, Republican strategist, Frank Luntz, found the political segment that was most effective for both Republican and Democratic viewers was the one that featured a female physician. She was real, conveying substance and legitimacy. See Luntz explanation of focus and metaphors. For an even more revealing look at looking at mind-control watch The persuaders — one of the most eerie documentaries FrontLine ever produced.
This week the President met with “selected physicians” to shore up his support.
This entire public debate would have had been far more successful with tighter focus and goals — health insurance reform and regulation. We may be on the verge of another government giveaway.
John Podesta, President Clinton’s Chief of Staff, was interviewed on the Charlie Rose show last month. His words were quite prescient.
“We’re very close to finally doing what for 60 years presidents and congresses have been trying to do which is to produce quality, affordable health coverage for every American.”
And therein lies the killer paradox. Affordability implies universal access. Universal access implies quantity. Quality and quantity are mutually exclusive. You don’t go to Costco or Target or Wal-Mart for quality service. If you’re lucky, you may find quality merchandise. But not service.
Health maintenance organizations (HMOs) were heavily promoted by the Nixon administration in 1973 to contain costs — Managed Care. We physicians had another name for it — “mangled care.” The largest of all HMO’s today, Kaiser Permanente, demands minimalist, algorithm-based, cost-driven medicine. Lonnie Bristow, a former President of the AMA, recently called this “a work in progress” at a town hall meeting here in Northern California. Indeed, a work in progress.
Want to know the simple formula for HMO Medicine? And by extension the cost-savings approach to medicine? It is a very simple formula.
Lives x Capitation = Revenue
That’s it. It’s all a numbers game. Notice what drops out? Quality! Not even factored into the equation. Using a simple mathematical model you can see that cost-driven medicine (managed-care) is incompatible with quality of care. And that is what we all experienced, those of us who have practiced in HMOs in the past. All of us.
The administration and congress is using the same old arguments proffered over 30 years ago. We will be saved by the cost-cutting gods. The Green Visor man. The guy that eventually wraps up every car deal. Read Dr. Bernadine Healy. Then from Kip Sullivan of Labor Notes:
Biemiller went on to say that HMOs ‘can provide better quality medical care at lower cost than the fragmented fee-for-service system’ and that the savings HMOs could achieve were ‘enormous.’ His only significant reservation about Nixon’s HMO bill was that it would have subsidized for-profit HMOs. But because there is no evidence that managed care is less toxic in the hands of nonprofit than for-profit HMOs, this reservation was of little significance.
Harvard and Stanford trained Dr. Margaret Hansen aired this short segment on KQED radio — the lost art of medicine. Ancient voices from Andalusian Spain, Maimonides, echo similar sentiments every bit as fresh today as when written in the 12th century.
Medical practice is not knitting and weaving and the labor of the hands, but it must be inspired with the sole filled with understanding and equipped with the gift of keen observation; these together with accurate scientific knowledge are the indispensable requisites for proficient medical practice
The ancient wisdom of the Greeks was lost to Western civilization for 1000 years after the fall of the Roman Empire that had succumbed to endless corruption, incompetence and sybaritic excesses. Greek culture and knowledge passed to Byzantium and Islam. I appear as either a dinosaur/curmudgeon like Paul Muni in the Last Angry Man or a messenger from the future. We were taught the “laying on of the hands” was essential to diagnosis and healing. Great medicine is the accomplished art, intuition and inductive logic of the physician with the wise use of modern technology. Attributes of the 15th Century Surgeon should still be emulated: the eye of an eagle, the heart of a lion and the hands of a woman, the gentleness of a lamb and the patience of a saint.
Service, expertise and time. That is the challenge. Will you receive necessary and deserved time, expertise and personal service or simply a 10 minute expedient and tangential encounter? Is this the face of medicine?
The new medicine awaits — like the Phoenix rising — the paradigm shift.