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Health Care: The Day After

Health Care: The Day After

It was never about Health.  It was never about universal health care.   Access does not equal care and certainly not quality care.   Yes, one side “won.”   This is not a victory for you.

It is not a left-wing agenda.  It is not socialized medicine.  This is the first time the Federal Government has mandated the purchase of a private party product.  And from the very racketeering group that is the root cause of the problem in the first place.   What a travesty.   Another government subsidy.   Effectively amounts to another “government bailout.”

As Michael Moore wryly said:

The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it.

This is not the same as a state mandate for auto insurance.

The State of California is unrelenting on this point.  Driving is a privilege!  It is not a right.  If you do not drive, you are not mandated to purchase auto insurance.  Furthermore, the reality is auto insurance does not cost $5000-12,000 annually.

This is the first major landmark piece of legislation in American history that was passed by such a narrow margin without a single Republican vote.   Social Security passed with bipartisan support in 1935 — 81 Republican Congressman and 16 Republican Senators.   In 1965  Medicare passed with bipartisan support —  70 House Republicans and 13 Senate Republicans.  In 2010 there was not one single Republican vote.   And the margin in the House was razor thin — 220 to 212.

It also violates a well-tested political strategy — sell it first to the American people who will then pressure Congress to pass new legislation.  The public is not aboard.   The latest Quinnipiac and Washington Post polls show the public still opposes this landmark Act.

AT&T has already made plans for a $1 billion write-off in advance of cost shifting.   And legal staff is hard at work looking for technical loopholes.  This just in from Robert Peer at the New York Times:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message.  If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

Everyone is giddy about “the win.”   This is only the end of the beginning.

Remember the Telecommunications act of 1996?   It was enacted to guarantee local competition amongst the major carriers.  It never happened.

Now watch this interview with Michael Moore:

Health Care Reform: Myths and Misunderstandings

Health Care Reform: Myths and Misunderstandings

Too often have I written about the endgame.  Shades of Mark Twain — reports of my death are exaggerated.  But this really is the ninth inning.  The problem is the president is looking for the long ball — the out of the park home run.  When he should have been hitting singles, or emulating the great Joe Montana — short yardage high percentage gains — not Hail Mary passes.

Ave, Imperator, morituri te salutant

The secret fate of all voting democratic House members.  The arm twisting in the house rises to epic proportions not seen since the days of the infamous Tom DeLay – the Hammer.

This will be a bad bill.  You are all unwitting pawns in this game.  It will solve nothing.  It cures nothing.  It has emboldened the insurance racketeers and Big Pharma.  It has only one potential good outcome — Rush Limbaugh has promised he will leave the country.

They have rolled Howard Dean and Dennis Kucinich.   Other voices have been marginalized – Bernadine Healy, Robert Reich, Norman Goldman of Talk Left, Marcia Angell. And who will benefit from a fatally flawed passage?   The rising unaffiliated — the independent vote.  This is a Greek tragedy.   A Pyrrhic victory.

We are all too aware of the right wing echo chamber.  A well orchestrated score promoting stereotyped rat a tat answers.   How do they do this?

The same may be true in on the left as well.  We hear platitudes and assertions over and over again without challenge.

1. United States ranks number 37 in the world in healthcare.

Why repeat this assertion over and over and over again?  Because it makes a false point.

This figure is derived from life expectancy in the OECD  (organization of economic cooperation and development) countries.  The spread is narrow – less than five years.

My friend Burton Goldberg, one of the most successful publishers of alternative medicine, constantly beseeched me on this issue — investigate life expectancy derivations.  Life expectancy is a highly complex mathematical formula that balances death with infant mortality.

A country with a high infant mortality has a lower life expectancy rate – at birth.

For the most perplexing reasons, the United States still has a relatively high infant mortality rate.  If the figures are adjusted for life expectancy after the age of 60 we rate number 5 in the world.   If life expectancy figures are adjusted after the age of 80 we rate number 3 in the world.

In other words, as we advance in age, the effect of infant mortality is factored out and the real life expectancy becomes more apparent.  We are not number 37 in the world.  We are in the top three.  Life expectancy figures beg a revised definition.

Life expectancy change with age
US Life Expectancy — 3rd place by age 80

Furthermore, life expectancy is a dreadfully  inadequate measure of the health of a nation.  It says nothing about the quality of life.  HDI, (Human Development Index) may be a better measure.]  It says nothing about vibrancy, activity, mental health, social health, sexual health, or productivity.   It simply means that you crossed the finish line at a particular age.   No matter whether you dashed across or fell across the finish line and died.

In Anti-Aging Medicine, we talk about “squaring the curve.”  Increased Health Span and not Life Span.  A healthy life until old age followed by sudden death.  Not a slow inexorable painful march to the end.

2. The medical system suffers from over utilization.

Not as I see it.   Quite the opposite.  I see scores of patients who have pleaded for years for adequate and thorough lab testing only to needlessly suffer through unnecessary dysfunctional states   This is a natural consequence of HMO and PPO medicine.   Bottom-line cost-recovery medicine is a zero sum game.

3.  If you do not pass this bill everybody will end up in the emergency room.

There is such an appalling lack of medical input in this entire debate.   Urgent care medicine had its roots in the 1980s.   Originally funded and promulgated by astute entrepreneurs and ex-emergency physicians, these facilities answered the need for acute medicine outside of an emergency facility.   There are more than 8700 Urgent centers visits vs. 4600 emergency departments.     [And by the way, Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while covering 120 million people a year.]

This is market-oriented medicine.  A workable and elegant solution in response to a market demand for immediate care outside of exorbitant emergency rooms.   They are successful and see all comers.   In Atlanta alone, my good friend Jordan Rice, one of the leading Urgent Care entrepreneurs in the country boasts of the ability to see any and all comers — Medicaid and cash paying patients.

Even the original Medicare bill of a 1965 garnered 13 Republican votes in the Senate and 70 Republican votes in the House.  To pull every legislative trick in the book only underscores the thinness of support for this ill-conceived rewrite of our society.  To be honest, Michelle Obama’s anti-obesity campaign could have more far-reaching effects that all 2700+ pages of this legislative lunacy.

Health Care Reform: Pleasing Everyone and No One

Health Care Reform: Pleasing Everyone and No One

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.

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Political Health Endgame: You Deserve Better Solutions

Political Health Endgame: You Deserve Better Solutions

Post-war Britain, and Londoners in particular, had suffered mightily after two years of punishing aerial bombardment.  The East End of London had been reduced to rubble.

Winston Churchill, arguably the greatest leader and politician of the 20th century, was turned out of office.  A new day dawned.  Anuerin Nye Bevin, a “firebrand” Socialist, was determined to remake the British health care system.  On July 5, 1948 he became the first Minister of Health.   Out of his uncompromising efforts was born the National Health System.  Bevin became known as the father of the NHS.  The pride and joy of Britain today.   Out of crisis comes opportunity.   And so it is today.   With crisis, opportunity comes aknocking.

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… Waiting for Merlin

… Waiting for Merlin

And now we wait for the speech of a lifetime.  The make or break — defining speech.  We wish this unreal set of expectations on no one.

Medicare for all?

Let me renew this debate with trilogy of  blogs over the next week.    First with a set of charts and diagrams laying the foundation for the daunting statistics that face us.

First consider this simple chart plotting the inexorable rise in yearly total health care expenditures from 1960 to 2016  (estimated).  There is barely a perceptible sag at about 1995 .   To imagine an external force (the government) having any measurable effect on this curve stretches the imagination.

National health care expenditures Statistical Abstract of the US
National health care expenditures Statistical Abstract of the US

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Wither Now Health Care?

Wither Now Health Care?

[originally posted on Huffington Post]

The Patriarch of the Kennedy Dynasty has passed.   Whither now health care reform?  Why is this important?

For the last 40 years Edward Kennedy was the voice of the under-represented.  His lifetime goal was a more perfect and accessible health care system in the United States.   He worked tirelessly to achieve these goals.  We are told that he counseled Barack Obama in the early days, “I will support you openly under the condition that you make health care the centerpiece of your administration.”  Wise counsel.  But this may have been a strategically and untenable position.  Like the myth of Sisyphus, since the days of Franklin Roosevelt every president has aspired to a more perfect health care system.

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end game or round 2

end game or round 2

It has come to this.  This deadline will come and pass.  It will not be met.  What happened?

Strategically, to frame health care reform as the defining and pivotal achievement of this administration was a setup.  The new administration entered under a wave of jubilation and hope.  I shared these sentiments.

In 1964, Lyndon Johnson entered the office of the presidency with a mandate for change.  A mandate to finish what had been started in the three previous years under an inspiring but a feckless young president.  Johnson was the consummate politician.  He knew how to twist arms.  He knew the Senate intimately.  As so aptly put by Linton Weeks of NPR:

President Johnson was famous for staring down, shaming, cajoling, strong-arming, coaxing, sweet-talking legislators into doing his bidding. Johnson spoke directly to lawmakers. Sometimes very directly. Through manhandling and manipulation, Johnson was able to push through legislation affecting public health for the elderly, fair housing, voting rights and other programs that brought sweeping social change.

Obama came in with a new agenda.  This was to be the reincarnation of Martin Luther King or Mahatma Gandhi.  Leading by example.  Without rancor.  But Washington is a shark tank.

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