We Can Have a Reformed Healthcare System – Do we want one?

FreshLook1

Health Reform 2.0

 

Beyond partisan divide lies pragmatic solutions.

(I have been engaged in a significant effort for the past year or so and not able to publish my work – that process has completed. My work on a reformed healthcare system has not abated, in fact there are others now adopting many of the concepts described here.  If you find these ideas valid, please refer to others. We can reform our healthcare system. We can do so much more easily if we do it from within.)

Introduction

How do we ever expect to gain an effective, efficient and affordable healthcare system when every discussion of healthcare becomes instantly divisive? Calling the recent health reform law the ACA or the Affordable Care Act alienates some on the right that feel this affords legitimacy to legislation that should not exist. Alternately, referring to the law as ObamaCare removes any hope of consideration of the ideas that follow by some on the left as the illegitimate ranting of greedy right-wing conservatives who are only out to exploit and hurt the poor.

In the end, it is clear that whether you call it the ACA, the Affordable Care Act or Obamacare, this law itself is neither fixing nor breaking our healthcare system. The issues the act does address are too many steps removed from the root causes of the problems to effectively fix anything. In fact, we work from the premise that we are trying to correct a system that is not, nor has it ever been, a “system.”

Why we still need more reform

There are numerous systemic flaws in what we call our healthcare system. Yet perhaps the biggest issue we have with achieving a goal of effective, efficient and affordable care for all Americans lies within ourselves. Benjamin Franklin advocated for a style of “compromise through tolerance.” We no longer value this form of solution. Today almost all of our debate is mired in an all-or-nothing outcome based approach. This “I win – you lose” desire is epitomized in the latest healthcare legislation and the ongoing and unproductive debate. Further, what we consumers actually expect from our healthcare system is so far from the reality of what it can deliver to be almost unbelievable in its naiveté.

The debate continues to rage with selected arguments used to support some positions with what appears to be a purposeful ignorance of other issues. Yes, parts of the law are working for the benefit of individuals. Yes, parts of the law are failing because the overall costs are rising. We have problems with the composition of networks, the beginning of restrictions on both access and extent of care and a realization that the cost projections, like Medicare and Medicaid in 1964, are woefully underestimated. The problem with both sides of the arguments for the laws success or failure is that nothing in the law was meant to address the systems fundamental problems. Rightly or wrongly, the law was written for the most part to gain control over, and drive profit out of, the healthcare system. And none of this is actually helping us get what we need or what we want.

A new approach is needed

It is now crystal clear that the methods, some would say madness, that we have promulgated over the past 225 years to define the mechanisms we needed in order to provide healthcare to Americans have worked both spectacularly, and miserably, depending on your perspective and measures. America’s healthcare system has become a collection of practices, methods, and mechanisms that neither integrate nor properly manage the efficient, effective and appropriate level of care that citizens need nor does it provide an appropriate method to deliver the care we want.

How we got to this point

It is thus compromise on the basis of tolerance for others’ opinions that lead us to good solutions . . . – Benjamin Franklin

During the same 225 years, our overall understanding of America and our expectations of services have materially shifted. We now expect significantly more from our country – and by extension, its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of tolerance in compromise as we once did. This has led to a frozen governmental structure where we are trapped between two ideological extremes. Everything we now attempt to do becomes locked in an all or nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of changes, often in the form of rules and laws, to try to affect corrections to one part of this non-system or another. All of these approaches, in the parlance of medicine, have affected the symptoms of the disease but they have not cured the underlying fundamental problems.

We must identify and agree on the fundamental problems

In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Americans, we must first address the fundamental issues, disconnects, and problems of our historical non-system. In order to begin to actually address the needed fundamental fixes – therefore deal with the disease not the symptoms – we need to first identify and agree on what the fundamental problems are.

We have many beliefs about healthcare, and its underlying core of modern medicine, that have caused us to establish a set of unrealistic and unobtainable expectations when it comes to the care we receive. Much of what we believe about healthcare and the practice of medicine is wrong. We have ingrained these myths into the basic discussion of care so tightly that what we say is often obviously disconnected from what we actually mean. We speak of single payer systems, and specific cures for diseases. We routinely confuse popular beliefs or historical methods with actual scientifically backed best practice. We misunderstand the true extent of medicines capabilities, effectiveness and the cost of their increasing side effects. We conflate our heath needs with our health wants and ascribe equal weight and priority to both. We have so disconnected ourselves as consumers of care that we do not truly understand the real effect of the care we receive. More often than not it is our body’s natural ability to heal that is the cause of our perceived benefit, not what modern medicine can reliably deliver.

We have such fundamental flaws in our care system that the simple process of seeking care is now statistically one of the most dangerous activities we can do in our lives. 264 people per 100,000 die each year as a result of seeking healthcare. The next deadliest activity is that of being a commercial fisherman – think Deadliest Catch – where only 200 per 100,000 who practice this line of work dies.

Clearly, America is caught in this crossroads. Since we are now trapped between two ideological positions. It is because it is so often that neither party can find ground for compromise due to intolerance that we often say, “The only thing that we tolerate today is intolerance!” The principal of tolerance was a key characteristic that made America the leader of the free world it became. Specifically in the pursuit of efficient, effective and affordable healthcare we will need to regain this principal.

The Plague of Myths

  • We believe we have a healthcare system
  • We believe that we already have, or are near to having, cures for everything
  • We believe what is good for us as individuals is good for the human species
  • When it comes to healthcare we think that what we want is the same as what we need
  • We either believe only government should have the role of providing care or we believe that government should have no role at all
  • We believe that America can afford it – whatever it is
  • We believe that Employer Sponsored Insurance has been a good thing
  • We believe Co-Pays and Deductibles have helped lower costs and reduce consumption, and
  • We also believe that American Healthcare costs too much.
  • We believe many, many other myths as well.

It is in the codification of these myths that we have defined a healthcare system that can never meet our expectations. In summary, this thing that we call a healthcare system is really a collection of self-predatory practices and methods that promulgate massive increases in costs, erosion of effective checks and balances, little accountability and responsibility, and exponential unintended consequences to patients, providers, facilitators and program sponsors. Luckily, we have discovered a solution!

There is a solution

The solution to our healthcare systemic conundrum will require quite a bit of work, much debate and a healthy dose of tolerance. In the end, we believe we can find a compromise that will yield a much simpler, stronger, efficient and affordable system for Americans to get the care they need in crisis and also the care they want by choice. It is in the assured concept of an effective safety net for all, integrated with American’s need for choice that holds the key. Both parts of the system simply cannot exist without full integration as they will become predatory and consuming of each other. They must exist in a manner that systemically provides certain controls, checks and balances. Price certainty, transparency, portability and effectiveness need to be codified as requirements of any solution. At the same time, effective allocation of appropriate regulation, oversight and responsibility at the federal, state and individual level also need to be integrated into any system. Any solution must provide an effective safety net for all the helpless while filtering out the clueless – who inadvertently significantly increase costs and utilization of scarce resources – and the fraudsters – who purposely defraud the system in order to inappropriately receive disproportionate and unnecessary gain while also consuming available resources from those who desperately need them. Finally, the solution shall at its safety net, basic care level, provide the same access, scope and treatment options for all regardless of income or means with no additional hidden costs, taxes, fees or shifting of costs from one side of the system to the other.

We Need a Bifurcated System

Life Care – Market

  • A solution that converts “Patients” from inactive recipients of ineffective health services, to active Participants in the selection, management, delivery and prevention of care.
  • Assures price certainty, cost transparency, and full care portability. Assures coverage regardless of pre-existing condition or disease state. Provides full cost disclosure for all parts of healthcare, no hidden reimbursement systems, no rebates and no self-propagating cycles that obscure full and true cost
  • Requires no Deductibles, no Co-Pays, no hidden fees – all costs easily defined, certain and accountable
  • Allows no government “Death Panels” instead provides a representative citizen group, appointed by the states, of participants, facilitators, providers and sponsors that are empaneled to determine what constitutes basic health needs, treatments and therapies and establishes effective payment rates for providers under basic LifeCare Plans
  • Assures appropriate, effective, and efficient delivery of basic health needs. Delivers the ability to seek the provider(s) of their choice – No Networks
  • Effectively balances care outcomes expectations to healthcare’s ability to deliver effective services. And, Improves Participant outcomes
  • Transforms employers from the provider of healthcare to facilitators of wellness and prevention.
  • Incentivize employers to provide stipends to employees to help afford basic health needs, LifeCare plans and effectively plan and save for Quality of Life Advantage services.

Life Care – Plans

  • All companies wanting to sell health insurance should be required to sell basic LifeCare plans
  • All LifeCare plans from all insurers should be identical in scope, breadth and extent of treatment.
  • Treatments should be to standard best practice protocols for the care that people need to survive, be productive and maintain viability – but doctors should not be bound to the published protocols, preserving their, and their patients, choice.
  • Reimbursements for services should be fixed, based on the best practice protocol. LifeCare plan services and Quality of Life care services can be mixed by providers adding choice to basic offerings.
  • All LifeCare plans can be purchased from any insurer in any state regardless of where people live
  • Premium pricing should be based on the initial age and sex of the plan purchaser, and should stay the same, subject to COLA, for the rest of their life as long as coverage is uninterrupted
  • All licensed providers in America should be eligible to accept reimbursements under any LifeCare plan – Eliminating the need for networks
  • An in-force LifeCare plan becomes the basis for any healthcare coverage through the LifeCare market.

LifeCare is where Americans will receive fair and equal basic services and treatments that are geared to keeping us alive and productive. There must be a structure that provides efficiency, wide breadth but manageable effective extent of care, transparency, transportability, simple access through one point of administration, coverage certainty, improved outcomes, full access and affordability. We should eliminate extraneous constructs like care networks, co-pays and deductibles. This side of the care continuum will be focused on delivering the care that people need. This is the core of a national health safety net.

Life Care – Safety Net

  • The basic LifeCare plan becomes the core of any safety net offering.
  • The state and federal governments should no longer contract, or pay directly, for services. When necessary the government should step in and provide premium payment support.
  • Permanently Disabled – should receive monthly subsidies to pay for their LifeCare policy as long as they maintain eligibility
  • People in need of temporary support – displaced workers, catastrophic event or other support should be provided through premium loans. Once assistance is no longer appropriate, the amount advanced should be converted to loans amortized over the remainder of productive life (as an example to age 68).
  • Participants keep their providers and continue with coverage unabated in their community with no stigma nor interruption of coordination of care

We need a safety net. To have an effective safety net, everyone needs to have it. It needs to be incorporated into our overall system. It needs to use the same infrastructure and be seamless when needed. It should be immediately available upon eligibility

Quality of Life Care – Market

·         Quality of Life Care begins where the LifeCare plan ends

·         While the LifeCare system is predicated on high volume, highly efficient, pre-fixed low cost routine treatment modalities with some free market effects to lower cost, Quality of Life providers should evolve to be more market driven in nature.

·         Quality of Life Care should be where individuals get the additional care and treatment they desire based on their own individual priorities, responsibilities and choice.

·         Participants can choose to pay for Quality of Life Care services at the time of service through any means acceptable to the provider(s).

·         Participants can pay via cash, through tax free Life Health & Wellness Savings Accounts or they can purchase Quality of Life Advantage plans from any qualified health care insurer, or all three!

 

Because we are human, we strive to want and obtain more. We need a system to provide for choice without preying on others to get it. In fact, we need to have those who exercise choice participate in order to help increase the economies of scale for those who do not want, or can’t afford, choice. Quality of Life Care is the place where patient choice holds sway and value drives margin for providers.

We need two markets but one infrastructure and we need to enable people so they can self-actualize in order to have choice. If not effectively integrated, these two systems would prey on each other the same way our current structures have preyed on each other over the past 70 years.

If properly integrated, these disparate systems become mutually supportive systems and give us the best model to both pay for care for the helpless, minimize the cost of the clueless and the fraudsters and provide choice and increased margin to satisfy people’s wants.

Life Health & Wellness Savings Accounts

  • Like existing HSAs these accounts form the basis for healthcare payments via either the LifeCare or Quality of Life Care markets.
  • Not mandatory – Highly encouraged through significant tax incentives for both the individual and employer
  • While there should be limits to annual deductibility there are no lifetime caps
  • Unused balances remaining after death can be passed tax-free to beneficiaries
  • Means-tested larger contributions should be eligible based on certain catastrophic illnesses
  • Plans should be required for state or federally funded LifeCare premium support loans or permanent disability premium support.
  • Employers should get a tax deduction (up to a maximum amount) for monthly stipend to employees regardless of how employees use the funds
  • Employees should loose tax deductions on amount of funds not spent for eligible healthcare services and should also be subject to a penalty for funds ineligibly spent

We have HSAs today and HSAs but they are not effective and they do not clearly enable our access to an effective healthcare system. We can have effective HSAs and we can enable access to Quality of life care as we age and we can do so at less cost to the system and the country than the current system does.

Single Point of Administration Full Coordination of Care & Benefits System

  • Repurpose the current healthcare exchange infrastructure
  • One universal point of administration to locate, research, apply for and coordinate all care services.
  • True Participant Centered System coordinating Facilitators, Providers and Sponsors with the Participant (patient in the old system) as the center point for all care coordination. Through a virtual care group infrastructure, Participants, or their designated facilitators, maintain full control of all their information regardless of location.
  • Providers will now be aware at point of application and eligibility for all potential benefits from, federal and state programs to philanthropies, charities, institutionally sponsored programs, etc. reducing double claims, doubled services and double costs.

Regardless of how the system is constructed or evolves, we need to integrate the disparate parts to gain economies and efficiencies to provide for the care needs of participants in the low-cost economic LifeCare Side while providing a value based choice market for services people want in the Quality of Life side. We also can go a long way to reducing costs through the elimination of duplicated services, duplicate payments, fraud and abuse currently over half of every healthcare dollar spent.

National LifeCare Congress NLCC

We need a national regulatory body as a key part of any construct. It needs to be fully representative, it needs to cover all economic strata, all disease states, and all specialties, in the four legs of the healthcare stool:

  • Participants – include representatives from a fully representative economic, ethnic, geographic and disease-state sub-groups,
  • Facilitators – representatives from various sub-groups; faith-based, social workers, case workers, family/friends, guardian-ships, parole/probation, volunteer and public service, etc.,
  • Providers – representatives from physicians/doctors, nurses, nurse practitioners, pharmacists, therapists, etc. and representative subspecialties within these groups and
  • Sponsors – Federal, State, Municipal, Philanthropies, Corporate, Insurers, etc.

Other Key Points

  • NLCC is designed as a bi-partisan national governing body appointed by the various states composed of representatives from the four key healthcare constituent groups; Participants, Facilitators, Providers and Sponsors.
  • Representatives have a 3 year term – initial terms staggered
  • When a rep’s term is up the position should be randomly assigned to another state to appoint that rep position.

Summary

We have only scratched the surface as to the features and benefits of these solutions.  We have not touched on specific bipartisan agreed upon goals, nor have we spoken of the integrated objectives that need to be crafted into any solution. These are available on the Health Reform 2.0 Website at http://healthreform2dot0.org under Principals, Goals & Objectives.  We have not discussed in-depth the impact of our own myths and misunderstandings about what is really deliverable in terms of the scope and extent of care from medicine today. We also have not had the space to discuss how the solution provides for a true “Participant Centered” approach which is also key to lowering costs, lowering excess utilization and improving outcomes. These and many other topics are discussed in the draft Whitepaper, Summary Sheets and Articles on the Health Reform 2.0 website.

We believe that the solutions we proposed will fit neatly into a comprehensive approach that Americans will be able to embrace. We do not expect everyone to like every solution proposed in the system but, we do believe in the end these solutions are designed fit closely together to solve for a marketplace that will provide Americans with an affordable, cost-effective, efficient, fair and appropriate market, and safety net, required to get the Life Care they need; while preserving the options for a choice based system to get the additional Quality of Life Care they want. We do not want this to be seen as “The Solution,” but as a series of solutions that are interconnected. These ideas are not inviolate and must surely change. To achieve the goal that we seek, will require a Franklin style compromise, either from a renewed interest in bipartisan, bicameral solutions in Washington DC or from the real power-base of America – the American People.

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Why Ebola petrifies us: One reason is healthcare’s unobtainable expectations.

Ebolacare givers practice safe procedures

Ebola caregivers practice safe procedures

Petrified & Angry

We are petrified of Ebola. It is a deadly disease, but we are much more scared of this today than we were of Polio, and Tuberculosis years ago. Why?

In the 1940s and 50s, modern medicine was a bit less advanced than we are today.  We had many more diseases to be afraid of.  Polio was an epidemic. Outcomes from Polio were not particularly good. Tuberculosis (TB) was a significant issue as well.  People with TB were quarantined.

Travel in that period was not as easy and ubiquitous as it is today yet, we routinely restricted affected people’s movements. In some cases we incarcerated them in sanitariums to protect the public at large. Despite these actions and the lack of effective treatment for these, and many other, diseases, people were no where near as panicked then as we see them today with the current Ebola crisis.

People who grew up in this era will tell you that most Americans accepted the dangers these microbes presented as a regular part of life. Sure, they were afraid of the diseases but they recognized that they had little control over potential infection. If they became infected they understood that HealthCare did not have cures. While there may have been many things to help ease the symptoms, odds were usually not very good that they would see their symptoms eliminated. Continue reading

Breast Cancer and Environmental Causes: Links not as clear as we’ve hoped.

The latest research is finding that real links between environmental causes, genetics and occurrence of Breast Cancer continue to be elusive. Perhaps, it’s for a reason. Are we thinking of cancer in the wrong way?

Published in Aquila Style (click to read original article)

Published in Aquila Style
(click to read original article)

October is National Breast Cancer Awareness Month.

The above graphic is from an interesting article titled, Suprises in Hunt for Environmental Links to Breast Cancer, published by , 6:30 pm Monday, 11th November 2013 on http://www.aquila-style.com. The article is about one of the latest studies trying to find a definitive link to breast cancers’ origins. Many studies have tried to find links to environmental and genetic causes. So far the research has not been definitive to say the least. We do know that genetic mutations are present in many cancers, but we also know that they are sometimes not there in some – where we expect them, and are there in many – where do not see the cancer develop.

“We have still got 80 percent that has got to be environmental,” said Reinlib, who is part of the Breast Cancer and the Environment Research Program (BCERP) program that has received some $70 million in funds from the US government since 2003.

The above quote from the article seems to indicate that there is clear evidence that the causes simply have to be environmental because we have ruled out that family history is the main indicator. Yet, this may be a false premise as well.  Just because a white jelly bean is not vanilla flavored, does not mean it must therefore be coconut flavored. It can be any flavor at all or have none! Most of the research into environmental, family history and genetic mutation indicators have shown relatively slight correlation to the actual development of breast cancers.  These indicators may statistically increase the chances a few percent but they do not provide definitive guidance that one will, or will not, get cancer.

Recently, some researchers are starting to discuss cancer, less as a disease — even though the outcome is devastating on the individuals and the family — but more of a naturally occurring process — perhaps necessary in the species. Perhaps this same process that sometimes evidences as cancer, is a natural part of the core engine that drives natural selection to improve the species. Changing how we think about and classify cancer may have more of an effect on how we learn to adapt to it than “cure it” as time goes on.

We have found many genetic markers in the past decade or so that we felt were the main drivers of disease, like the BRACA genes for breast cancer, only to find that they turned out to not be specific. BRACAs were considered a key indicator specifically for breast cancer but recently has been shown to exist for prostate — not much of a surprise as prostate and breast tissues are histologically very similar — lung and now many other cancers as well. BRACAs are more likely broad based cancer markers as time will likely tell.  Most genetic markers are likely relatively nonspecific. In fact, our genes may be good blueprints for building the body and its systems but may not be the control point for what happens with these things when they are built.

Further, genetic markers themselves have been know to not be definitive for the occurrence of a cancer. You can have the markers and not get the cancer, and you can sometimes have the cancer and not have the markers. Some other researchers now believe there is a different biochemical system at work. Undiscovered, this other system has been dubbed epi-genetic — meaning above the gene. Numerous studies over the past 15 years have indicated the presence of some other control point. Don’t forget that it took many decades for actual chemistry of DNA to be identified and proven; even though we understood the theory of its presence for many years.

It is likely in the years to come we will find more answers to these new questions and new theories will fundamentally change how we think of cancer and reset our expectations on its treatment and occurrence.

Please remember all those who have died due to this horrible disease!

Continue reading

Report Reveals Employed Physicians Losing Money for Employers

http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf

The Physicians Foundation has once again published their excellent report, 2014 Survey of America’s Physicians Practice Patterns and Perspectives. The Foundation once again contracted with Merritt Hawkins – a subsidiary of AMN Healthcare – to conduct the survey. For those of us who like these kinds of reports, this one carries some of the interesting trends and data from their 2012 report forward, and adds a number of pertinent and timely new questions to the mix. The 2014 report is chocked full of interesting information, trends, data points and facts about how physicians are responding and adapting to the Affordable Care Act. Over the coming days we will be assimilating more of this information and relating it to other trends, reports and raw data. Keep checking back as we do so to stay abreast of this new information as it is digested, analyzed and evaluated.

As so often happens, one small entry grabbed our attention as it is highly indicative of a trend-line that is becoming of significant concern to us and many others. The foundation reports that for 2012 the median LOSS for an employed physician – meaning a doctor that is an employee of a hospital or group practice, a Continue reading

Doctors NOT taking insurance may actually be a good thing for healthcare!

man_question_mark

Questioning Our Preconception of HealthCare

In an Aug. 23, 2014 Reuter’s article called, “‘I don’t take insurance’ not always a doctor deal breaker,” author Beth Pinker, explains how this typically plays out for a person seeking care.

As more and more people realize the extent of the funds they will need to spend before they gain access to insurance coverage — the average deductible is now $5000 — Physicians are waking up the fact that insurance and government reimbursements are too low for their “business” of medicine to survive. Recent numbers indicate that 40 to 50% — in some cases more — have already decided to opt out of insurance and move to so called concierge, i.e. retail, medicine.

The attraction for the physician is faster payment, and in most cases, a higher margin on the services performed. One of the big drivers is the total size of the pot of deductibles that will need to be spent for full insurance to kick in for the insured.

Some argue that the average deductible is not really $5000, that it is closer to $3000 per year. Still, with over 186 million insurance policies in the U.S. this lower estimate yields a total available market — called TAM by marketers —  of $500 billion that must be spent before insurance coverage kicks in. Any marketer will tell you, this Continue reading

When Mammograms Lie: An article by Sharon Kirkey published on Canada.Com

When Mammograms Lie: How cancer can sneak past our greatest screening techniques

Just because the results of your mammogram are negative, doesn’t mean you don’t have cancer

By Sharon Kirkey, Postmedia News May 23, 2014 (CLICK THE LINK TO READ THE ARTICLE)

“Four months after her mammogram came back “normal,” Susan Quinn-Mullins discovered the lump herself, a smooth, hard mass on her left breast the size of a big marble. An ultrasound revealed a tumour nestled deep in dense breast tissue. It was stage 3 — aggressive, invasive breast cancer that was spreading to the surrounding lymph nodes…”

Breast Density Types

Breast Density Types

This interesting article not only chronicles the story of people who initially relied on mammography to check the health of their breasts but also serves as an incitement over the undue reliance on this as the sole modality. It also brings in some contra posing views on the debate over dense breast notification laws.

Breast Cancer is the number two killer of women in America, lung cancer is number one at the moment. The issue of dense breast related problems in imaging has been long known but for the most part hidden. It is a sordid tale Continue reading

Article 4 – The Plague of Myths – Myth 3: We Can, and We Should, Live Forever!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

This is the fourth of a series of articles that are being published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!

We all want to live longer

It is clearly an historical ideal to live longer. We all, for the most part, desire not to die anytime soon. I am sure that for most of us it is a completely natural instinct to continue to live. We often find it morally abhorrent to want to die prematurely – like from suicide. It would be completely counter intuitive from what we know about the survival instinct, and the laws of natural selection to decide to become premature feedstock for the organisms that prey on us. Our individual desire to survive is primitive and persistent for most of our lives. And it is safe to say we have been built this way! Continue reading

Article 3 – The Plague of Myths – Myth 2: Healthcare, It’s Good for What Ails You!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the third of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

Do our expectations of Healthcare match reality?

We have a large number of myths that govern our beliefs about our current Healthcare system – or non-system to be more accurate.  One of the larger set of myths that drive our perceptions of both the positives and negatives of our healthcare system are our beliefs and expectations as to what we should get from healthcare and the underlying medicine.  We believe, that modern medicine has cures for almost anything we face.  We believe that the continual research and discovery that has occupied much of the past 164 years has led to a firm and almost complete understanding of the science of disease, injury, and treatment.  We believe that there is little difference in cost between the things we need for survival and the things that we want to improve our lives.  We believe that the current methods of treatment and the discoveries we have made over the past 80 years are making us a stronger more robust species.  We believe that the doctor is typically the best and most qualified person to deliver the care we need. And we believe that in most cases going to the doctor is safe and leads to improvements in our health. These are just a few of the myths and misconceptions we have about the current state of medicine and what we should expect from our healthcare system. Continue reading

Article 1: Introduction to the Real Healthcare System

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the first of a series of articles that will be published over the coming days and weeks. The series articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Published Articles

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

 We don’t have a system

When it comes to America’s, so called, Healthcare System, one of the biggest reasons that most of the attempts to “fix” our healthcare system have consistently yielded more unintended consequences than benefits is that we treat the symptoms of the disease not the disease itself. We have a number of misconceptions about our healthcare system and the first and foremost is that we believe that it is, in fact, a system.  It’s not!  It never has been.  What we think of as our healthcare system is really nothing more than a disjointed, tangled collection of practices, methods, procedures, policies, laws and guidelines that have been developed over the past 200 plus years.  Most of this collection of things were developed for the furtherance of one failing group or another.  Most were promulgated to preserve the business of individual practitioners – doctors, physicians, pharmacists, hospitals, pharmaceutical manufacturers, insurers, nurses, therapists, program sponsors, etc. With rare exception, many of this collection of things were not focused on the needs of the patient. Continue reading

What’s next for our Healthcare System: Leading to real fixes or total collapse?

A new approach is needed

It is now crystal clear that the methods, some would say madness, that we have promulgated over the past 200 years to define the mechanisms we needed in order to provide healthcare to Americans have worked both spectacularly, and miserably, depending on your perspective and measures.  America’s healthcare system has become a collection of practices, methods, and mechanisms that neither integrate nor properly manage the efficient, effective and appropriate level of care that citizens need nor does it provide an appropriate method to deliver the care we want.

How we got to this point

Tolerance-RealCompromiseDuring the same 200 years, our overall understanding of America and our expectations of services have materially shifted.  We now expect significantly more from our country – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of tolerance in compromise as we once did. This has led to a frozen governmental structure where we are trapped between two ideological extremes. Everything we now attempt to do becomes locked in an all or nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of changes, often in the form of rules and laws, to try to affect corrections to one part of this non-system or another.  All of these approaches, in the parlance of medicine, have affected the symptoms of the disease but they have not cured the underlying fundamental problems.

We must identify and agree on the fundamental problems

In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Americans, we must first address the fundamental issues, disconnects, and problems of our historical non-system.  In order to begin to actually address the needed fundamental fixes – therefore deal with the disease not the symptoms – we need to first identify and agree on what the fundamental problems are.

Clearly, America is caught in this crossroads. Since we are now trapped between two ideological positions. It is because neither party can find ground for compromise because we have lost the art of tolerance that I often say, “The only thing that we, as Americans, tolerate today is intolerance!” The principal of tolerance was a key characteristic that made America the leader of the free world it became.

A series of articles

What follows over the next few days to weeks will be a series of articles in which we will lay out a set of principles, that encapsulate solutions for the issues and goals that have been laid out by both sides of this debate repeatedly over the past seven years, beginning with the authors first encounter with a major Senate bill in 2007, and as identified in the authors reading of every formative bill from each committee whose work ultimately contributed to, or argued against, the final legislation for better or worse since then.

For those of you that would like to cut to the chase and read the more academic whitepaper it is available here: HealthCare Reform – Beyond Partisan Divide Ver 1

There is a solution

The solution will require quite a bit of work, much debate and a healthy dose of tolerance. In the end, we believe we can find compromise that will yield a much Continue reading

4 Straight Years of Slowing Health Care Costs: Really?

man_question_mark

U.S. Marks 4 Straight Years of Slowing Health Costs(click to read the article) so blasts the headline from ABC News today, January 7, 2013. Like so much of the debate over Healthcare reform, many that read the article will walk away believing that things relating to healthcare costs are really improving—along with the economy. After all the article proudly says that the percentage that healthcare costs make upon of the Gross Domestic Product (GDP) has declined for the fourth straight year. This must be a good thing—one would think! But, like so much of the reporting Continue reading

Value Based Insurance: it sounds so – “valuable”

Value based insurance, sounds so - valuable!

Value based insurance, sounds so – valuable!

Value Base Insurance Coverage, it sounds so — valuable. But is it really valuable? Is Value Based Insurance Coverage (VBIC) what you really want — what you may need? Well, perhaps, that simply remains to be seen. As we move through the implementation of the Affordable Care Act, ObamaCare, VBIC will become the next big thing we need to pay close attention to. You can be sure that soon this item will be getting quite a bit of ink as the potential ramifications become apparent.

Like so many things in life, the reality of this “value” based system may be fraught with unintended consequences for the individual and massive values and benefits for Continue reading

The ACA Exchange Poster Child – Covered California: Works for some, not for others

CoveredCaCalifornia, has long had the reputation as being one of the most progressive, or liberal, states in the nation. Often in a neck and neck battle with New York over who gives more free-stuff to its people at any given time, California long ago adopted the philosophy that what is good for some should also be good for all. The concept of income redistribution though higher taxes is not a new one for California residents.  Yet this state, nicknamed “the Golden State,” and home to Hollywood, Biotech, Oil and Silicon Valley fortunes often confounds because there are also strong anti-tax forces that from time to time rise up and limits California’s spending power through measures like Proposition 13. Continue reading

Obamacare Insurance Cancellation: Welcome to the #ObamaNation

Welcome to the ObamaNation where we know better than you!

Welcome to the ObamaNation where we know better than you!

The cancellation letters people are now receiving for their earlier choice based plans– you know the ones that President Obama said they could keep, PERIOD–out of courtesy and perfect declaration should open with this line,

“Welcome to the #ObamaNation where we know better than you!”

Those of us who have warned of these effects under the law, and a number of other predictable negative outcomes that are only beginning to show up, have been called fear mongers, and haters. The shouted counter argument becomes a diatribe of how this law is going to be so great. How it will provide insurance for so much less cost. How it will lower the cost to the nation and the individuals. How you will get whatever you want and have to pay almost nothing for it! Continue reading

ObamaCare becomes DemoCare: Demolishes Middle Class!

DemoCare demolishes  America's Middle Class

DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. Continue reading

Dan Brown’s Inferno: A Coming Global Crisis?

Light summer reading

    Population Graph from "Inferno" by Dan Brown

Population Graph from “Inferno” by Dan Brown

In his latest book, Inferno, author Dan Brown explores a world where past symbols and artifacts from Dante Alighieri’s Italy, and his famous work The Divine Comedy, become the vehicle to unravel a diabolical and deadly plot of a modern day bio-terrorist. I originally grabbed this book because we were coming to the close of summer and I just finished working on a series of articles about the current issues of our healthcare system that will be appearing later this fall. Frankly, I was looking for a diversion from the complicated world of healthcare reform and Obamacare. I wanted a respite, a brief mindless romp in Dan Brown’s always entertaining world. Having read much of his prior work, I was confident that Mr. Brown would not let me down.

I found this work characteristically suspenseful, interesting, thought provoking and fun to read till I got to the following section which, in the story, lays the groundwork for the epic conflict between the antagonist, Bertrand Zobrist , a world renowned biochemist and leading geneticist and the protagonist, Elizabeth Sinskey, M.D. Continue reading

Orange Countey Register says, “Women’s deaths from painkillers ‘an epidemic'”: But, its nothing new!

Screenshot (4)To read the original article click here!

The rising rate of addiction for women in America seems at first blush a historically startling event. But its not! America has had a long, long history of dancing with the devils of hard drug addictions.

While the article calls these rates historically the highest, they factually are not. In the late 1800s and early 1900s, the addiction rate to cocaine, Continue reading

President Trumpets Obamacare Rebates as Deadline Approaches: Beware of Greeks Bearing Gifts!

President Trumpets Obamacare Rebates as Deadline Approaches - Time Swampland

President Trumpets Obamacare Rebates as Deadline Approaches – Time Swampland

Nought from the Greeks towards me hath sped well. So now I find that ancient proverb true, Foes’ gifts are no gifts: profit bring they none.” So observed the great philosopher and teacher Sophocles about 430 BCE.  Today we loosely translate this as, “Beware of Greeks bearing gifts!

No quote could be more apropos in regard to the supposed $500 million in insurance rebates being sent to 8 million Americans under #Obamacare. Like most ponzi schemes, at first blush this appears to be a great deal for America and Americans. Continue reading

Women & Addiction: History replayed!

Drug Addiction in Women Article

http://www.usatoday.com/story/news/nation/2013/07/02/drug-overdose-deaths-women/2483169/

Ever since Samuel Hopkins Adams first exposed the evils of the patent medicine industry, in 1905 in a series of articles published in Colliers Weekly, it has been ‘patently’ clear that women have often historically been the prime target for the sale of prescriptive and Continue reading

Tax Code Driving ObamaCare Implementation: California’s ACA Odyssey Preview

Click to access the Original Article by John Gonzales

John M. Gonzales reporting for the California Healthcare Foundation Center for Health Reporting wrote a must read article called, How the U.S. tax code will drive Obamacare implementation, starting April 15. I strongly suggest all read it.

The negative effects of Obamacare on costs and care were immediate, and the ongoing negative effects are just starting to be disclosed and to build. Yesterday, I participated at a Health Care Summit put on by Continue reading

Does fear of death cause our irrational drive to unlimited healthcare?

Recently I have been wondering how we have arrived at the point where our desire for unfettered, and unlimited access to health care is rapidly outstripping our ability to pay for the care we desire. Our understanding of our supposed healthcare system is so specious that the myths of our expectations far outweigh the reality of the system we think we have to deliver it. In fact, we have built an entire culture of props and supports around patently false beliefs that underscore everything we expect and require from healthcare. To a great extent we are obsessed in Continue reading

Lunacy in America: Progressive Thinking, Progressive Tax Plans and Flu Season Deaths

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The Frontiers Of Medical Privacy – Forbes www.forbes.com

Every time I think the lunacy that is becoming pervasive in America has gone as far as it can, I am again astounded by another extension of instability of thought.

This article attempts to conflate the effort of researchers to use cellular material harvested from an African America woman during a cancer treatment procedure, with involuntary sterilizations that Continue reading

Columbia, the Gem of the Ocean?

Introductory Note:

First let me apologize for the personal tone of this article. I typically try to focus on issues and solutions and not on my own personal reflections. This past week, among other things, I have been working with a group of parents from the school where our 8th grade children are about to graduate. We are working to create a video that captures the 8th grade class’ experience from kindergarten to graduation. In essence, to marvel at the growth and maturation of these modern examples of humans as they move from cute cuddly yet blissfully ignorant small animals, into wonderful, intelligent motivated, caring examples of the best of humanity. And, to wonder at this progression as it prepares them for the next steps of their own lives and time Continue reading

Charles Blahous Channels Wilbur Mills: Warns states to not expand MediCaid!

Charles Blahous, Medicaid Trustee warns state to NOT expand MedicAid

Charles Blahous, Medicaid Trustee warns state to NOT expand Medicaid (image by Charles Blahous)

In an excellent article, Charles Blahous, one of Medicare’s Trustees, warns states of the dangers of the expansion of Medicaid.  He makes many of the same arguments that I have been making for quite a while, his warning, as a Medicare Trustee, may finally cut through the background noise and get some people to actually pay attention.  You can read the full Report by Mr. Blahous here: http://mercatus.org/sites/default/files/Blahous_MedicaidExpansion_v1.pdf

Mr. Blahous reminds me of Wilbur Mills who Continue reading

Steve Brills Article, “Why Medical Bills are Killing Us:” is a lesson of right and wrong at the same time!

Steve Brill's Time Cover Story (Click to read)

Steve Brill’s Time Cover Story (Click to read)

Time Magazine contributor Steven Brill has created a bit of a sensation due to his recent, February 20, 2013, article and Time Magazine cover story entitled, Bitter Pill: Why Medical Bills Are Killing Us: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LkTuy5lv.  Mr. Brill caused controversy both due to the length of the article, 26,000 words, and his revelations about the high prices and seemingly arbitrary pricing methods in our so called healthcare system.  His article has prompted a number of other reporters to pick up the themes and provide both points Continue reading

The problem with “The Chart”

This morning as I did my news walk, I came across this article talking about the most important chart in American politics.  And as you can imagine it caught my eye. I find charts and graphs to be either extremely informative or extremely deceptive. Seldom is there a middle-ground.  Often the deceptive charts are constructed specifically for that purpose. It is seldom a surprise to find such charts in an article about politics.

This chart was one of the exceptions that prove the rule.  But not in the way you might imagine.  “The Chart” is deceptive, but I do not believe it is purposeful in its deceit.  Why not, you may ask?  Because the story it is trying to communicate would be stronger if the authors actually new the truth behind the problem.  But, like so much today, the surface suffices to make an argument.  The other details make the argument more difficult to communicate as the story can get Continue reading

Coca Cola Superbowl Ad stirs cries of racism

Coke ad stirs controversy, but this article takes the argument from the sublime to the rediculous

Coke ad stirs controversy, but this article takes it from sublime to ridiculous (click to read article)

Having heard of the controversy over the Super Bowl ad by Coca Cola the past few days, this morning I was captured by the above article.  I expected it to be along a similar vein of remarks showing how Coke was insensitive to Arabs and painting them in a bad light.  When I first heard this argument on the TV news, I was looking for the Association of Los Vegas Showgirls to show up any minute and complain, followed by the African American Cowboy Association, National Hispanic Cowboys,  etc…

What stopped me in my tracks was not the casual assertion of racism due to insensitive stereotyping in the pursuit of parody that I was Continue reading

On Football, Smoking, Soda and Obamacare: There is a spending problem!

Yes Football is a violent sport!

Yes Football is a violent sport!

After reading a recent spate of articles on how the president should, could or would ban or regulate football, I started to wonder what my father or grandfather might say? Then I wondered, how we got to this place where things that others choose to do to themselves is now our responsibility to monitor, manage, restrict and pay for?

50 years ago if we  spoke to our parents about the federal government making laws regulating football, or restricting peoples access to cigarettes and punitively taxing soda, they would think we had lost our minds.  Cleary, Continue reading

More Challenges to the ACA (Obamacare)

No Taxation Without Representation!

No Taxation Without Representation!

From Boston Massachusetts

By now, we all know that the Supreme Court upheld the insurance mandate of the Affordable Care Act (ACA) also known as Obamacare.  To recap, 26 states brought action to have the mandate, declared as an unconstitutional expansion of federal power under the commerce clause, the necessary and proper clause, and as a minor point its taxing authority.  The Supreme Court agreed with the states and found the mandate unconstitutional under the commerce clause, and the necessary and proper clause. However, in what many felt was a stunning decision by Justice Roberts­—and judicial over reach, the court upheld the mandate as a Continue reading