Health Train Analytics

No degree of dullness can safeguard a work against the determination of critics to find it fascinating.
  - Harold Rosenberg

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This is my preface for today's stories

It's the end of 2008, and between nodding off and consuming egg nog there are some interesting blog writings, analyses, and reports emanating from various congressional reports, foundations, and health care think tanks.

If you are a pessimist the tanks are half empty or even empty, if you are an optimist the tank is half full.  If you are like most people, the 'tank' is meaningless and does not apply to the real world.

There is a certain amount of common sense that is lacking in many things we now have to deal with in our daily lives.

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Robert Laszewski in THCB writes about two reports from the CBO detailing the options for reform of health care policy.

Caution, this is over a 600 page report, all written by Peter Orszag, Director of the CBO.

Mr Orszag is President-elect Obama's nominee for Director of the Office of Management and Budget.

Key Issues in Analyzing Major Health Insurance Proposals

Budget Options for Health Care (Volume 1)

Federal Perspective on Health Care Policy and Costs

Abbreviated summaries of the articles are here.

Key Issues

Budget Options, Volume 1

• Robert Laszewski opines, "After reading these two reports, totaling more than 400 pages of some of the most valuable health policy analysis I have ever seen, I now know that I had no reason to worry that the CBO would just tell the politicians what they wanted to hear."
• "It is also clear that, whoever the Congressional Democratic leadership appoints to succeed Orszag, a marker is down. The CBO is on the record about what the likely reform options will cost before anyone had a chance to bring political pressure to bear. And, that just might have been intentional."
• "The work contains an inventory of about all of the health care reform options being discussed complete with a thorough cost/benefit analysis detailing their impact on federal spending."

More details are forthcoming for the reader at The Health Care Blog, 

NAIVE POLICY MAKERS NEED NOT APPLY

 

I agree with Docanon that this is the best article on the subject I have read thus far.  Kudos to Mr. Laszewski......and to Peter Orszag.

del.icio.us Tags: OMB,Peter Orszag,Health Insurance proposals,federal perspective,congressional reports,health care think tanks

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Content for 2008 Health Train Express

The end of 2008 certainly has been remarkable. What unexpected cataclysmic events await us in 2009? Will what we have experienced in 2008 give us a better understanding of other impending chaos, without our taking serious proactive measures, rather than retroactive reflexes.??? Read more at Health Train Express

Monthly Content for Health Train Express—December 2008

Primary Care

Interruption

Express 2008

Denoument

Brain Train and Fitness

Transitions

Transparency

Bailout

Cooling Down

Throwing Money

Consensus

Transition Team

Arogant Physicians (Surgeons)

Hypoprimarenia

And have a safe and blessed Christmas.

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Primary Care needs to get on the Health Train Express

Richard Reece MD of Medinnovation Blog is the rare breed of specialist (in his case, pathology) who waves the flag and cheers on the family physician, and general practitioner in their battle to survive.  Even I as an ophthalmologist will join his efforts and realize if primary care can be picked off then all of us are very vulnerable.  No specialist should be excited about the impending doom of PCPs and the secondary loss of patient access to healthcare in America. 

The American College of Physicians has sent a letter to President-elect Obama via HHS Secretary designate Tom Daschle requesting a ten percent bonus for primary care physicians alloted from the economic stimulus package.

Tom Daschle has been handed to our physician group without our input and/or comments. He has still yet to be confirmed, and all readers should make comments regarding his appointment. Daschle knows bupkas about caring for patients, and may be a great negotiator 'across the aisle' and deal maker to get healthcare legislation passed.  Perhaps the message has not been presented to our group.

Mr Daschle correctly analyzes our problems in the article he published in the Huffington Post.  Re Progressive Solutions to Health Care.

However, his ideas about a 'Federal Health Board,  for Healthcare' comes at a very inopportune time given the failure of our Federal Reserve Bank  for the Financial Markets.  It is doubtful that an agency of that size could truly keep track of anything.....

del.icio.us Tags: american college of physicians,medinnovation,hhs,federal health board,Daschle

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Health Train Interruption

Sorry I have been away the past week, moving from California to Georgia.  I've been looking for a 'retirement phase out" and appear to have found one.  Once I settle in I will be able to alot scheduled time to my newly acquired fondness of blogging.

Known for it's peanuts and peaches and pecans

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Health Train Express--2008

The end of 2008 seems a good time to review the state of health information technology and the progress of Electronic Medical Record implementation.

Much has not occured since 2003 when GWB appointed David Brailer MD as the National Coordinator for Health Information Technology (ONCHIT). Initially, like all new things, ONCHIT attracted a great deal of publicity.  It stimulated the organization of CCHIT, a national certifying authority for producing interoperable information systems, assuring the compatibilty of different vendor offerings to move toward a goal of the National Health Information Network.

During the ensuing years, the most successful vendors became CCHIT certified, but now without annual costs paid for by the vendorss themselves to become certified each year.  These applications also are the largest companies and the most expensive software.  While bolstering interoperability, at the same time many vendors have disappeared because of  the CCHIT requirement.  The industry consolidated leaving fewer vendors.

All of the media excitement and cheerleading is now led by promises (mostly empty) of bailout funding.  Admittedly some states have ponied up to the bar with funding for EMRs. However, these 'integrated systems and EMR are limited to mostly public sector agencies. Little money has trickled over to private practice.  And this group needs it  most.

MRI (The Medical Records Institute) released it's Status Report, 2008, by it's  CEO C. Peter Waegmann.

iHealthbeat regularly charts the progress and adoption of EMRs several times each year.  It is my estimation that these figures are biased.   Many users report the use of EMRs which do not offer many functionalities which should be inherent in an EMR.

It is true that some practices have adopted electronic prescribing. and one or two other functionality.

The Chart below is taken from National Health Care Surveys done by the CDC.

The fact that EMR adoption has lagged does not take into  account the adoption of health information technology available via the internet and other sources.  The parallel development of Health 2.0 online services and mobile devices, such as smartphones, Personal digital assistants, and others hand held devices reflect the interest and willingness of physicians to utilize IT when cost effective. Adding to this strong trend is the deployment of high speed 3G cellular technology which empowers internet use almost anywhere.

A new survey found that 58% of U.S. physicians surveyed go online for clinical information at least two times per day. More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

By now, most providers are familiar with software offered by third  parties as downloadable applications.

In 2008, 84% of physicians surveyed reported using the Internet and other technology to find information about pharmaceuticals, biotechnology and medical devices, up from 64% in 2004, according to a survey

 

Utilization of Health IT by Patients

A new survey found that 31% of non-elderly Americans with private health insurance and Internet access have used an online physician or facility finder. Meanwhile, 16% reported using an online health plan selection tool and 10% have used an online health care cost information tool.

Privacy Issues

In 2008, 62% of U.S. adults age 21 and older said they were not too or not at all confident that electronic health records would remain confidential, while 12% of survey respondents said they were extremely or very confident that EHRs would remain confidential

The area of explosive growth of health IT is in electronic prescribing. 

Fueling this growth is CMS's indication that users will receive a 2% bonus for using ePrescribing.

What does 2009 have in store?

iHealthbeat reports:

Nearly half of health IT professionals surveyed said that Democratic control of the White House and Congress will strengthen efforts to promote patient safety and the use of health IT, according to a new survey from the Healthcare Information and Management Systems Society.

Fourteen percent of respondents said that Democratic control of the White House and Congress will weaken efforts to promote patient safety and the use of health IT, while 29% said that it would have no impact and 9% said that they did not know what kind of effect it would have, according to the survey.

Meanwhile, 20% of respondents said that President-elect Barack Obama's proposal to spend $50 billion over five years on health IT is sufficient to advance health IT adoption, while 46% said that the funding would advance health IT adoption but that additional funding would be required to truly accelerate adoption. Fifteen percent of respondents said that Obama's proposed health IT funding is insufficient.

Results are based on a November survey of 622 health care IT professionals.

Source: HIMSS, "2008 Presidential Election"

 

This appraisal is based upon uncertain funding, intense competition for federal dollars, an exploding federal deficit, and many other unknowns. 

 

del.icio.us Tags: privacy issues,onchit,obama health proposals,medical records institute,cchit,health it utilization by patients,health it utilization by providers,emr adoption,pda,smartphone

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Health Train Express--Denoument

Today we are changing from the train to an airliner. I do my best 'creative thinking', or perhaps I become a bit delusional at 40,000 feet. Perhaps it is the reduced atmospheric pressure or  decrease in oxygen.  No matter...it is the end result here that is important rather than the science.

An economic survey, or just reading the news tells us that financial institutions have failed.  Our industrial production base has changed, and what was once the bastion of middle class attainment, the automobile companies in the United States have tanked.

As I fly over the United States I see Wall Street in ruin, empty houses, unfinished home construction, and

a hole in the ground where the world trade center used to stand, the midwest where steel factories and other heavy manufacturing plants lay rusting in the cold damp winters, and in the warm humid summers.

We in health care bemoan our sad state of affairs as health  care costs have risen seemingly without end and naysayers who say most of our money is 'wasted' with little evidence for better outcomes and better health. 

Actual facts dispute this. Evidence and statistics show that mortality has changed. Fewer heart disease deaths, a drop in mortality from infectious diseases, and relatively more deaths from cancer. The increase in death and morbidity from cancers may more be a reflection of  increasing survival .

Despite these facts healthcare has now become a major backbone of  financial flow....health care provides employment for millions of Americans. 

The economicengines of the United States are service industry,  healthcare, education,  government (at all levels), regulatory agencies,public safety,the judicial system, technology, and communications. ( I leave entertainment as another driving force)

My previous post relates to the merger of health, prevention and entertainment.

Stepping back from all of this I think, what better use of our resources is there than keeping one another healthy.  What finer product is there than the human body?  What product grows and maintains itself automatically for up to 75 to 85 years?

 

del.icio.us Tags: entertainment,wall street,industry,automobile,world trade center,midwest,healthcare,economic crisis,technologoy,education reform,mortality,cancer,heart disease

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Brain Train Express

For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

Flaghouse  

PE & RECREATION

SPECIAL POPULATIONS

ACTIVITIES FOR LIFE

SENSORY SOLUTIONS

FITBRAINS

PHYSICAL FITNESS VIDEO TRAINING

POSIT SCIENCE BRAIN FITNESS PROGRAM CLASSIC

TRY AN INTERACTIVE DEMO HERE

EXERCISE IN A BOX

DANCE  DANCE REVOLUTION

 

BEFORE

 

AFTER

EVIDENCE BASED MEDICINE

del.icio.us Tags: excercise based medicine,evidence based medicine,health video games,brain fitness video games

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Brain Train Express

For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

Flaghouse  

PE & RECREATION

SPECIAL POPULATIONS

ACTIVITIES FOR LIFE

SENSORY SOLUTIONS

FITBRAINS

PHYSICAL FITNESS VIDEO TRAINING

POSIT SCIENCE BRAIN FITNESS PROGRAM CLASSIC

TRY AN INTERACTIVE DEMO HERE

EXERCISE IN A BOX

DANCE  DANCE REVOLUTION

 

BEFORE

 

AFTER

EVIDENCE BASED MEDICINE

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Health Train Express Transition

The gulf between the macrocosm of health policy planners and the microcosm of health care providers, ie physicians, grows wider day by day.

Evidence of this abounds as other participants in the health process compete for a seat at the table of transition teams for the new Obama administration.  

What does Tom Daschle really know about providing healthcare to that patient on the exam table?

His choice was as an arbiter for political disagreements and an attempt to create the coalition to pass some type of health care legislation.  One cannot even begin to predict the outcome....whether it will call for a universal payor plan or another throwing of the dice in regard to reimbursement plans, or another game of insuring the uninsured by shuffling the deck of poker cards.

Health care unfortunately has become a game of chance.

Will you have a job?  Will you become disabled?  Will you become uninsurable? Will you be able to find a family physician? Will you, will you , will you?

Medicine and Politics seem to be following a new course of increased transparency of their own process. The internet has led to this development but still lacks user friendly search engines and other health 2.0 applications to find, organize and interpret raw data and commentary.  If one visits the Obama Transition Web site,  and searches you will find numerous sources and opportunities to participate .

 

Senator Tom Daschle is now the designated head of Health and Human Services.

The issues are complex and the economy has now complicated it further.  A bailout and stimulus package is a false hope. The  real problems are systemic.  Throwing money at our failed health care system is almost as bad as giving it to the IRS.

del.icio.us Tags: daschle,hhs,bailout,failed health system,obama transition web site,family physician,disabled,unemplloyed

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Health Care Transparency and others

New buzz word "Transparency" is upon us all.  Wikipedia lists a number of industries, and uses for this term, however it does not list 'healthcare".  I am not sure what that means.

Much of today's post will not relate to health train express, so I will link you to my posts over "there".

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Health Train Express Bailout 2018

Medpolitics has an  article written by  Paul Hseih MD regarding parallels between the home mortgage crisis created by 'universal home ownership' encouraged by not so wise financial market manipulations, and 'universal health care" as is being currently proposed by the Obama administration.

Paul Hsieh, MD is the co-founder of Freedom and Individual Rights in Medicine.

Are we at the beginning of a "Health Care Bubble"  destined to failure?

More bubbles please!!

del.icio.us Tags: health care bubble,obama health care,universal payer

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Cool Down the Health Train Express

How would you like to become a popsicle?

A cardiologist in Louisiana has developed a non invasive technique to cool down the body of patients with strokes, acute myocardial infarction, for any disease whose body temperature can rapidly be cooled (ie, within six to ten minutes) to produce hypothermia. 

It has long been recognized that hypothermia slows down the metabolic processes and improves the liklihood of healing without further damage to vital organs such as the brain, heart, kidneys, and liver.

This technique has been in use for decades for transporting donor organ tissues.

The device, is demonstrated by Paul McMullen M.D., cardiologist at the Ochsner Clinic, named "THERMOSUIT HYPOTHERMIA THERAPY.  It is currently undergoing clinical trials at a number of Universitys and Heart Centers.  

The therapeutic modality is already in use in Europe and approved by CE (Conformite Europeene). for use in hospitals

"Way cool"  Pick your flavor(s).

del.icio.us Tags: hypothermia,cardiac arrest,myocardial infarction,stroke,clinical trial

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Throwing Money at the Health Train

As long as we are at it, how about throwing  50 or 100 billion toward those underpriveleged hospitals and doctors.  This is a national crisis which undermines  the health and welfare of all.   Get it while the spigot is flowing.  Do we want cars or health??

iHealthbeat reports: 

Lawmakers Consider Adding Health IT to Stimulus Package

Congressional health care leaders are considering adding health IT provisions to an economic stimulus package being developed by aides to President-elect Barack Obama and congressional staff, Government Health IT reports.

Congressional sources say that one strategy would be to attach the Wired for Health Care Quality Act to the economic stimulus legislation (McCloskey, Government Health IT, 12/4).

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and ranking member Mike Enzi (R-Wyo.) introduced the bill (S 1693) to create a national electronic health record system more than a year ago, but privacy issues and funding concerns prevented the legislation from reaching the floor.

On Thursday, an aide to Enzi said the senator has not seen enough details of the economic proposal to know whether adding health IT to it would "blow the budget."

Blow the budget??  You mean if all this stimulus package fails it will be the providers and hospitals that caused it all.

Health Policy Experts Urge Caution

At this week's annual e-Health Initiative conference in Washington, D.C., health policy experts raised concerns about driving health IT adoption through a financial stimulus program.

Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said that efforts to finance health IT would be most effective if they are linked to specific standards or functional and performance requirements focused on health outcomes.

He said that although direct financing could increase health IT adoption, he is "not sure that by itself, it would lead to better care."

Democratic National Committee Chair Howard Dean, a physician and former governor of Vermont, cautioned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted prior to purchasing (Government Health IT,

Unlike the financial world and credit fiasco, as well as the impending demise of the big 3 (not so big anymore), throwing money at the healthcare system will not cure the problems..

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Health Train Express Consensus

While most folks have been tuned to the recent financial crises, industry bailouts, mortgage melt downs, there have been significant proposals from the health insurance industry, set forth by the American Health Insurance Plans (AHIP),

The Wall Street Journal reports:

Ideas about how the U.S. can achieve universal health care are coming thick and fast. The insurance industry itself is stepping up to the nation’s suggestion box with another proposal.

The trade group America’s Health Insurance Plans, or AHIP, called for universal coverage, a more centralized insurance market and cost-reduction that would slow the growth of the nation’s ballooning health-care spending by 30% in five years.

Consensus is emerging on universal healthcare, as reported in the New York Times

del.icio.us Tags: AHIP,universal health care,consensus,wall street journal,health savings

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President Obama's Healthcare Transition Team

Every physician and almost every potential patient has dealt with the chaos and inequity of our current non-system. It takes an enormous effort to navigate to and from a medical clinic, hospital, navigate forms, bills, and payments, what is covered, and what is not covered.  What used to be  a rather simple transaction between doctor and patient has degenerated into a blizzard of paperwork, information technology and more. While HIT is promoted as a 'cure' it also raises many questions as to expense, privacy and converting healthcare providers into data entry clerks who will utilize more time entering data than caring for patients.

Healthcare transparency is upon us, and also health care policy planning.  Tom Daschle has the following to offer.  All of us should 'bury' him with our ideas.

Health Train Express applauds this relatively new approach

del.icio.us Tags: health transition team,Tom Daschle,you tube video

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Arrogant,Abusive, and Disruptive on the Health Train Express

In today's email newsletters one from the New York Times caught my eye.

This is old, but still disturbing news. The article fails to mention what steps hospitals, medical staffs, and others have initiated to curb these episodes.  Human behavior is at times unpredictable. What is also not mentioned is the disciplinary process, nor the response of the attending surgeon in their example.

It is also very interesting the article mentions (as an afterthought) that the incidence of these 'outbursts' have diminished recently. Could this be attributed to the mandate of decreased hours for residents in training.

It also does not attribute what the support staff did ,if anything, to enable this type of behavior.  Does the nursing supervisors, and hospital administration have an avenue and procedure when this occurs.

This article is entirely one sided. How about this picture?

We have surgeons in the operating room, who bear total responsibility morally, ethically, and legally who may have been up for 24 hours or more, may have had their office hours disrupted to be in the operating room, at times at night with unfamilar and at times untrained personnel doing a procedure.  Thrown into a life and death situation under these circumstances can tip an otherwise 'balanced surgeon' into 'anger'....Throwing a scalpel can be construed as assault with a  deadly weapon.  There are legal means of dealing with this situation, far beyond hospital discipline.

The New York Times lumps all episodes of surgeon unhappiness or anger into one category.  Do they include a loud admonition to nurses that are talking, or an anesthesiologist playing loud rap music or  even playing music without the consent of the operating surgeon?  Is blood squirting up to the ceiling because a nurse or assistant was not paying attention to the operation?  Did a critical piece of equipment fail causing irreparable damage?

None of these episodes can be lumped into one category, and each must be addressed individually.  All hospitals  now have procedures and mechanisms to avert this behavior. 

Compared to other issues in our health care system, the uninsured, the inaccesiblity and unfunded mandates, this is a miniscule problem for American Health Care.  There must be other issues the NY Times can print to fill up their space.

 

del.icio.us Tags: rage,nurse abuse,arrogance,disciplinary action,physician anger,healthcare,uninsured

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Hypoprimarenia

Post  tryptophane tremors

Why are there  not enough

Primary Careologists?

This sounds very familiar. The problem with medical school begins in the first year. Most of the two preclinical years have little to do with practicing medicine. Those trained in some basic science in the last several years of college realize very quickly that medicine has little to do with science or curiosity about science and/or health. It is more like elementary school for doctors…just like you learned reading, writing and rythmatic to prepare you for middle school, and high school to learn trig, algebra and calculus. What you learn during those first two years is nomenclature, and linguisitics…much like any vocation which has specific terms. Lawyers learn how to speak ‘lawyerese’, computer scientists learn ‘geekology’. These first two years expand your vocabulary, which few other people can or will understand.

The second two years of medical school expose medical students to some clinical work, which they will perform only if the intern and resident are overwhelmed with their duties, don't want to be bothered, since they consider it 'scut work'. If the clinical material is scarce it will be monopolized by the intern/resident. Actually the medical student rotation may bear little resemblance to the actual clinical work that a mature physician will do in his practice. Ordinary medical stuff is usually lacking in a university or tertiary medical center where formal training takes place.

So what actually occurs is that each medical student must make a choice of what he will do with very little chance to experience a specialty or general practice prior to having to select a specialty or match for postgraduate training. In addition to this major shortcoming, the free standing postgraduate year of what used to be called internship is now called pgy 0, or 1, whatever the term is these days. This is also another reason why PCP, or primary care providers are so rare. (this used to be called general practice or family practice for you really young guys.) Many young doctors used to take an internship, then go out and practice general medicine for a few years to get a real taste of what they like or don’t like about each brand of medicine. Yes, Johnny it is possible to do this, and quite safely if apprenticed with an older physician. I did it in the U.S. Navy aboard a floating naval ship LPD-10  in the middle of a war.

Primary Care Can  Be Fun

LPD-10 U.S.S. JUNEAU

The Well  Deck (partially submerged) on LPD 10 

U.S.S. JUNEAU (L)    SUPPLY SHIP (R) underway refueling, and  transfer of doctor as well.  (not for the squeamish)..the cable goes up and down about 50 feet as the ships ride the waves.

 

I was able to do so because of my strong general medicine training in med school and INTERNSHIP. This is because the internship required and demanded competency in general medical,pediatric, surgical and OB/GYN.( I and my classmates delivered over 100 babies during our senior year of med school. Those who had OB in their third year also did the same.) After the navy experience I chose to do general medicine and even became medical director of an emergency department…. It was 6 years before I specialized, some by choice and others by necessity.

Early on I was not sure what I liked or disliked. The clinical part of medicine bears little if any relationship to the science of what you study in the first two years of medical school. You may love endocrinology, or cardiac physiology, but find the clinical aspects of gyn, proctology, or cardiac resuscitation, or surgery revolting. You may like ENT but the thought of treating nosebleeds at 2AM a turn off.

The bread and butter of medicine has little to do with what you see or do at University Tertiary Medical School.

And you are being trained by a guy with one more year of training than you have experienced. Not only that, but he or she will be ranking you, in many cases. Those ‘professors’ who run the department are off giving lectures, writing speeches, or patting some other professor from eithr your institution or another one, on the back.

Being on call every other night, or dealing with very sick patients has little resemblance in internship to practicing general medicine, pediatrics, or other specialties. The journey through med school and internship may be more a journey of avoidance rather than seeking fulfillment.

Sometimes doctors near or at the end of their formal training are uncomfortable entering the ‘real world’. Some chose to go on because of this and subspecialize, some even do multiple fellowships, in neurology, ophthalmology, oculoplastic surgery or other areas.

Some even decide to avoid ‘real medicine’ by becoming academicians. (which is another whole story on dysfunctional adult behavior)

When you reach the pinnacle of success in your own practice and look outward at your colleagues you will find clusters of physicians in a group who trained at one particular institution or another…the Harvard guys, the Yale guys, the UCLA guys…

all self selected into their own tier. My experience is that they are neither smarter or dumber that the rest. Only some patients think that is really important. I often times would have to ‘bail them out or show them some ‘ordinary thing’ that they never saw at the IVORY tower university. Perhaps they saw 100 cases of Sarcoid or Wegener’s granulomatosis, but never managed an Alzheimer patient, or chronic congestive heart failure,nor managed a new diabetic that was not in severe ketoacidosis

And finally our realm of medicine has been invaded by nurse practitioners, physician assistants, retail health clinics, and more.........Why go to school to study over 15 years to do a job that a nurse can be trained to do.  No, the won't have the depth of knowledge or experience....but the insurers, and payors could care less.  The only ones hassled for credentials are the MDs and specialists.....

Most young doctors don't realize that 90% of what they will  do is in an outpatient setting, so who really needs a hospital unless your insurer requires it, and then you can find either a hospitalist or specialist to do all the hospital or paperwork...

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Health and Human Services

Quackbooster nominated for HHS Secretary.

Cabinet Secretarys seem to play musical chairs and/or musical titles.  HHS Secretary Mike Leavitt was formerly head of the EPA.

from  Quackwatch:

Tom Daschle, who is President-Elect Barack Obama's nominee for Secretary of Health and Human Services, provided strong support to unscientific practitioners while serving in the U.S. Congress from 1979-2003.

Daschle has not made intentions clear as to whether or not he will run again for office; however, he  signed on as a Senior Policy Advisor with the K Street law firm Alston & Bird.^[15][16] Health care interests, including CVS Caremark, the National Association for Home Care and Hospice, Abbott Laboratories and HealthSouth, are among the firm's lobbying clients.^[4] The firm was paid $5.8 million between January and September 2008 to represent companies and associations before Congress and the executive branch, with 60 percent of that money coming from the health industry 

from Wikipedia:

Daschle was first author on a book concerning health care coverage which was published on February 19, 2008, titled "Critical: What We Can Do About the Health-Care Crisis". One review stated "Daschle's book delineates the weaknesses of previous attempts at national health coverage, outlines the complex economic factors and medical issues affecting coverage and sets forth plans for change."^[22]

You may recall that Daschle failed to be re-elected to his senate seat. He also, in June 2008 lost the democratic primary in South Dakota. 

From Quackwatch, a web site dedicated to exposing Medical Quackery,

During several sessions, he was a prime supporter of "access to treatment" legislation intended to weaken state licensing boards. A 1997 version, for example, would have given individuals the right to have nearly any desired treatment and permitted practitioners to provide any treatment that would not pose an "unreasonable risk." 

Although couched as efforts to preserve patient freedom, such bills would thwart regulation of physicians who engage in quack practices such as chelation therapy.

Tom Daschle has been a fervent supporter of Barak Obama during his presidential campaign.  It is not his commitment toward improving health care in America, but a 'political appointment as payback for supporting newly elected Barak Obama.

I hope that the AMA and all specialty societies have pounced on their lobbyists, congressional committees and sends out an email to all members to write their congressman to oppose this nomination and not confirm  his nomination. 

del.icio.us Tags: hhs,epa,daschle,leavitt,quacks,south dakota,quackwatch,cvs,Alston&Bird,Healthsouth

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World AIDs Day

December 1st next week marks another annual event.

HIV/AIDS awareness day, presents an opportunity to educate, promote testing,and obtain posters, marketing materials and plan an event for your area.

The web site asks bloggers to participate in a  number of ways.

Participate!!!

There are many ways.

Take Action

There are many ways you can take action in response to HIV/AIDS:

• get tested for HIV
• practice safe methods to prevent HIV
• decide not to engage in high risk behaviors
• talk about HIV prevention with family, friends, and colleagues
• provide support to people living with HIV/AIDS
• get involved with or host an event for World AIDS Day in your community

del.icio.us Tags: HIV,AIDS,WORLD AIDS DAY

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Engage with Grace

 

Again, re-posted from November 2008

 

This weekend there is a 'BLOG RALLY' taking place. Matthew Holt of The Health Care Blog promoting  Engage with Grace.

The blog link contains video and text regarding this worthwhile viral marketing message regarding end of life care.

One of the issues regarding the escalation of health care costs is the magnitude of expenses during the last one or two years of life.

Engage with Grace addresses this issue and calls  for promoting the message.

HealthCare in America, written by Kenneth Fisher,   M.D.  also the author of  " In Defiance of Death" (available at Amazon) closely mirrors what Engage with Grace is all about.

Dr. Fisher is featured on "Monday Night Live" sponsored by Kalamazoo Community Access TV.

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Cyberchondria

Quote of the day:

I have been through some terrible things in my life, some of which actually happened. - Mark Twain

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Are you examining and possibly treating  a cyberchondriac? 

Perhaps our review of symptoms should now include a new category under mental health. An important question may be 'how many hours a week do you spend searching the internet?'

As reported in the New York Times,

"If that headache plaguing you this morning led you first to a Web search and then to the conclusion that you must have a brain tumor, you may instead be suffering from cyberchondria

A recent research report completed by Microsoft (those folks who now bring us "Health Vault" reveals the nature of web searches in the are of health and medicine.  The article written by Ryen White and Eric Horvitz .

The authors posit,   "This information can assist people who are not healthcare professionals to better understand health and disease, and to provide them with feasible explanations for symptoms. However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure. . . . Our results show that Web search engines have the potential to escalate medical concerns. . . . We also demonstrate the persistence of post-session anxiety following escalations.....Our findings underscore the potential costs and challenges of cyberchondria."

The search cohort was highly biased because the participants all worked for Microsoft, a group most likely more knowledgable and with access to internet search engines on a daily basis.

And so my fellow bloggers, Val Jones, Edwin Leap, Emergiblog, Rural Doctoring, Suture for a Living, and the Happy Hospitalist, add this to your diagnostic acumen.

The question for us, is 'does this drive up the cost of healthcare?"

Wait one,  I am going to run a "google' on that....

 

 

del.icio.us Tags: Information Storage and Retrieval,Information Search and Retrieval,Search process,Query formulation,Medical search,Cyberchondria

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Erratum

Whoops! In the last post I credited Dr Rowsey as the 'inventor of lasik'.  I was mistaken.  However, he is a certified VIS-X instructor. A change has been made in the original aticle.

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Health Train at The Mission Inn

I spent the afternoon yesterday with my former classmate who has had an illustrious career in Ophthalmology.

John James Rowsey MD, a corneal specialist, and former Chairman of the Department f Ophthalmology at University of South Florida  travelled to California from Florida to ask how to get  physicians involved and become stakeholders in health care reform.

  Idea Man

  I am not sure I gave him an adequate answer while we were enjoying a fabulous brunch at a National Historic Landmark,

The Mission Inn in Riverside, CA.

 

I could not immediately crystallize my thoughts , but this morning I have a long laundry list of ideas.

Jim works for and with Senator Tom Coburn (Oklahoma) travelling each month to a different state to present details of bills pending in congress regarding health care reform.  On this trip he spoke to the Los Angeles County Medical Association and the Orange County Medical Association.

How to become a stakeholder in healthcare reform?

1. Contrary to popular opinion and recomendations by our illustrious professional societies, group lobbying is now stigmatized by 'earmarks'  and 'buying votes'. The addition of individualized advising is even more effective.  If you want to slow down or defeat a purpose, give it to a committee and medical organizations who will surely discuss it to death, and by the time it is presented the advice will be moderated, fuzzy, and  not have it's original message or intent.  A LONE VOICE IS EASILY HEARD IN THE WILDERNESS OF CHAOS AND CONFUSION

2. Knowledge is Power

a.You would not attempt to do a new procedure without careful study and skills.  So too is advising congressional, and state elected officials. 

b. Develop a solid knowledge base about issues, and background history.  There are many sources on the internet by experts in health care policy reform.

References:

Power Players  Senator Henry Waxman, Tom Daschle,

SematorsTed Kennedy and Hillary Clinton 

Senator Tom Coburn,  Max Baucus

 

Experts: Stuart M. Butler, PhD     Edmund F.Haisimair,

Robert E. Moffit Ph.D.,   Dennis G. Smith,  

Nina Owcharenko,  Joseph Antos,  Scott Gottlieb, M.D.,  Aparna Mathur, Brian Klepper, David Kibbe,  Sarah Arnquist, 

Resources:  The Heritage Foundation,

Center for Healthcare Transformation,  Robert Wood Johnson Foundation

Books:  Google Books, 

Blogs:  The Baucus Plan,  Health Care & Communications Blog,  Health Train Express, 

Wall Street Journal HealthBlog,  The HealthCare Blog, Richard Reece MD at Medinnovation (he has written ten books on health care reform, the latest ones, being:  Voices of Health Reform, Naviagating the Maze of Health Coverage and Accessm, and Innovation Driven Health Care.

In the interest of limited space I have had to leave out many other experts.

3. Avoid being driven by financial concerns.

The financial concerns should be addressed  in the context of patient care, patient access, outcomes, and quality of health care.

4. Patient (Consumer) Involvement 

Print and place in your waiting areas one page 'shout out' topics on healthcare reform. Place a highly visible poster alerting your patients to this information. Have a topic of the month.  If your clinic or office has a monthly newsletter, devote a section to health care reform issues.

TOWN HALL MEETINGS

This approach worked very well from the 'come from behind' politicians who wound up being the front runners in the final election. (McCain and Obama)

It also may serve healthcare reform issues as well.  Sponsors can include  chambers of commerce, Lions Clubs, Kiwanis, Public Libraries,  and other community service organizations, as well as senior service centers.

Seizing on the momentum of the presidential election and the promise of change on a historic scale, a grassroots "conversation" about health care reform under the Obama administration began Thursday with town hall meetings around the nation, including several in the Bay Area.

Participate in SERMO and/or iMedexchange, both social media networking sites. SERMO has a section on politics and health reform.

1. There is more, much more, however this will give you a starting point.

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Health Train Daschle

What's your take on this new announcement today regarding Tom Daschle's most likely nomination to replace Mike Leavitt as head of HHS.?

What is the connection here? What does Tom Daschle really know about health care? We could at least say that Mike is a physician, MD.

Mr Daschle recently published a book "

Critical: What We Can Do About the Health-Care Crisis

 

Since 2007, Daschle has been an advisor to the law firm of Alston & Bird LLP. Although Daschle is not a registered lobbyist, his firm was paid $5.8 million between January and September to represent companies and associations before Congress and the executive branch, with 60% of that money coming from the health industry.  I didn't see any physician representation in the list of associations he represented in D.C.

Another familiar name that signed on with Alston & Bird after he left Bush's administration is Tom Scully, aslo a former head of CMS.

 

Health IT insiders say they support President-elect Barack Obama's reported pick of former Sen. Tom Daschle (D-S.D.) to be the next HHS secretary, Healthcare IT News reports.

The Obama transition team has not yet formally announced the nomination, but sources are confirming that Daschle has accepted the position.

Sources also report that Daschle will serve as the top health care adviser, or health care czar, to the Obama White House, Healthcare IT News reports.

John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston,

said Daschle has "a deep understanding of the need to increase the value of health care in this country by reducing costs and enhancing quality."

Former Speaker of the House Newt Gingrich (R-Ga.) said, "Sen. Daschle has long been committed to reforming health care so that all Americans get quality, effective care," adding, "Daschle promotes greater transparency, paying for quality care and a fully electronic health system."

DOES THE AMERICAN MEDICAL ASSOCIATION GET TO VOTE ON THIS APPOINTMENT? 

You can check in on this issue with your representatives in D.C. Let them know if this is a thumbs up appointment or thumbs down.

What are the issues Daschle is focusing upon?

Daschle says Medicare should pay more for care that leads to good outcomes, and should stop paying for unnecessary or harmful treatments .    He also argues that all Americans should be required to buy health insurance — a key difference from Obama, 

Perhaps the most striking part of Daschle’s plan is his call to create a Federal Health Board, modeled on the Federal Reserve Board that manages monetary policy. The basic idea is to create an institution, run by experts, that answers to the government but is “largely insulated from the politics and passions of the moment,” he writes.  Perhaps most importantly, the Board would assess the effectiveness and costs of various treatments.

“Like monetary policy, health-care policy shouldn’t be subject to the whims of subcommittee chairmen and special interests,” Daschle continues. 

According to what I read this promises to be a battle of the titans, Kennedy,Clinton, Henry Waxman,

del.icio.us Tags: healthcare czar,daschle,kennedy,waxman,clinton,federal health board

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Health Train Next Stop Bagdad

Panel Confirms Gulf War Syndrome Is Real and Causes Are Definable

WASHINGTON, Nov. 17 -- The Gulf War illness was caused by pyridostigmine bromide pills taken by U.S. troops to neutralize the effects of nerve gas attacks and by exposure to neurotoxic insecticides, according to a VA advisory panel.

These two factors amounted to a definable scientifically valid illness with significant nervous system symptoms often still affecting veterans of the 1991 conflict in Kuwait and Iraq, said the Research Advisory Committee on Gulf War Veterans' Illnesses

At the same time, the report exonerated a number of other suspects in symptoms reported by returning veterans of Operation Desert Storm, including depleted uranium, anthrax vaccine, infectious diseases, and stress. Much of the report echoed a meta-analysis on acetylcholinesterase inhibitor exposure published earlier this year by Beatrice A. Golomb, M.D., Ph.D., of the University of California San Diego, a member of the committee. (See Chemical Exposures in Gulf War Caused Veterans' Illness)

The committee was chaired by James H. Binns, former principal deputy assistant secretary of defense. Its scientific director was Roberta F. White, Ph.D., chair of environmental health in Boston University's School of Public Health

Commentary by the author: 

It's only taken more than fifteen years to figure this one out. My guess is that a fourth year medical student had the answer years ago....  Of course this was probably obfuscated by the Pentagon, the VA, and the DOD. 

There is little doubt that this syndrome has also affected our troops during our presence in Iraq over the past 6 years. The government will probably launch another study spending millions more to prove this as well.

Physicians now must advocate for our warriors to be compensated and treated adequately.  Any 'stigmata' assigned to them for '" seeking disability" or medical care by the VA warrants more priority than bailing out the financial crooks and sociopaths. responsible for wrecking our economy, be they corporate executives, investment banks, credit card companies,

'nuff said

del.icio.us Tags: gulf war syndrome,mwd,insecticides,desert storm

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Health Train Survey

The results of my survey on Sermo have just been released.

I am posting the question and the results here

QUESTION: IF OBAMA WINS THE ELECTION WHAT WILL BE THE RESULTS IN TERMS OF HEALTH CARE CHANGES??

 

ANSWERS"

If Obama wins Tuesday, I think Wednesday I'll get up, take my kids to school, go to work, come home, have a beer with my wife and soak in the hot tub. Get over yourselves, people, you sound like a bunch of Nostradamus wannabees.

8%  

(3/36)

No

6%  

(2/36)

Be afraid, be very afraid.

6%  

(2/36)

All those anti-Obama doctors will be investigated by Medicare and the IRS. BestGuess will be Secretary of Health and Human Services.

3%  

(1/36)

I will be very sad.

3%  

(1/36)

STOP already!

3%  

(1/36)

   Answer added by respondent

View full results for this posting

Select your answer:

1.
Yes

Yes

2.
No

No

3.
It will mean the end of free markets and democracy as we know it................

It will mean the end of free markets and democracy as we know it................

4.
All those anti-Obama doctors will be investigated by Medicare and the IRS. BestGuess will be Secretary of Health and Human Services.

All those anti-Obama doctors will be investigated by Medicare and the IRS. BestGuess will be Secretary of Health and Human Services.

5.
November 5th and further will be just fine...nothing changes that dramatically in the US with the election of one person.

November 5th and further will be just fine...nothing changes that dramatically in the US with the election of one person.

6.
Expect more bread and circuses, and massive federal deficits as far as the eye can see.

Expect more bread and circuses, and massive federal deficits as far as the eye can see.

7.
If Obama wins Tuesday, I think Wednesday I'll get up, take my kids to school, go to work, come home, have a beer with my wife and soak in the hot tub. Get over yourselves, people, you sound like a bunch of Nostradamus wannabees.

If Obama wins Tuesday, I think Wednesday I'll get up, take my kids to school, go to work, come home, have a beer with my wife and soak in the hot tub. Get over yourselves, people, you sound like a bunch of Nostradamus wannabees.

8.
Be afraid, be very afraid.

Be afraid, be very afraid.

9.
Whether he wins or loses, Sermo will be a better place without all these biased opinionated political posts.

Whether he wins or loses, Sermo will be a better place without all these biased opinionated political posts.

10.
I will be very sad.

I will be very sad.

11.
STOP already!

STOP already!

12.
I'd like to add my own answer

Enter your answer here

I'm not interested

I'm not interested

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What if Obama wins?

For the sake of argument, imagine (and you may not have to) on Tuesday Obama is elected.  Do you think he has the ability to transform free market capitalism into limited sociallism affecting only the healtcare sector, without major disruption to the industry? 

Do you think the congress will approve what he wants.  How will business react to his proposed changes.

Does his election really reflect the desire to transform health care into a socialized universal payor system,  or a reaction to the last 8 years?  Is this a move for making things better, or just a knee jerk reaction to CHANGE?

I'm not interested

Tags

business, capitalism, free market, payor, socialized, universal

Category: Politics & Reform

Posting ID: 28747

Posted on November 02, 2008 by gmlevinmd123

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Comments (25)

25

Whatagas  Anesthesiology

Posted Nov 02, 2008 at 3:33 PM

His election has much less to do with the general public's desire to change healthcare and almost everything to do with the notion that George Bush, and by extension, the republicans, have driven America in a direction where the world hates us, we can no longer have reasonable (i.e. non-polarized) debate on important issues, we are ignoring the biggest threat to the planet's existence (global warming) since that big meteor 65 million years ago, we are reigniting the crusades, and we are ignoring the plight of the 1/3 of the world's population that lives in abject poverty, all while throwing away our own future for the sake of next quarter's earnings.
Obama represents, rightly or wrongly, a return to the premise that Americans are fair, reasonable, charitable people who want to succeed by virtue of competition, not brute force. The fact that he intends to socialize and possibly destroy health care is a secondary concern.

davids1959  Psychiatry

Posted Nov 02, 2008 at 3:34 PM

Voters are not making their decisions on the candidates health care policies. That said Obama is not advocating, "transform free market capitalism into limited sociallism affecting only the healtcare sector." He is proposing universal axis to care.
www.barackobama.com

sflyn1  Ophthalmology

Edited Nov 02, 2008 at 3:42 PM

I think these discussions would be both more productive and less tense if we refrained from using emotionally-charged words such as 'socialism' when framing the debate.

nsmurali  Gastroenterology

Edited Nov 02, 2008 at 3:50 PM

The problems facing us are so grave that neither candidate has proposed solid solutions. Their talking points were prepared 2 years ago and they had no clue of the looming economic crisis. My guess is we will have some kind of a "Medicaid for all" type of catastrophic coverage and the rest of the stuff will take a back seat. Unless the connection between jobs and healthcare insurance is severed, it is unlikely that US can create well paying jobs. We will see more under $100K/year jobs leaving the country for more competitive markets. . All along the lobbyists were very powerful. Now these insurance companies have been weakened, the American industries have been mortally wounded. In the same context, if solution(s) to the healthcare inequities are not found this time around, we probably will never have an economically viable healthcare system in this country.
It is too simplistic to say Obama is trying to spread the wealth. That is pure nonsense. No one has any answers. One thing for sure. If we go on like this, we will not have to spend any more money on a national security force as the US will no longer be attractive to anyone including the terrorists!

suvarov  Internal Medicine

Posted Nov 02, 2008 at 4:34 PM

"Socialism" is no more charged than, say "capitalism", which is to say, not at all.
And almost no voters are paying attention to either candidate on healthcare. That isn't what this election is about.

epector  Family Medicine

Posted Nov 02, 2008 at 4:36 PM

Agree with sflyn1. Avoid terms like "capitalist," "free market" (a joke because for physicians there IS no free market. Payers, patients, employers, & govt hold us hostage and we play by others' rules, we are not free!), "socialist" (what exactly is this? Communism, fascism, government regulation, government payment?). Another loaded, confusing terms: access (and Davids1959, I think "access to insurance" is what has largely been debated, not access to CARE.). I think most of us favor reducing health care disparities that are identifiable based on economic condition, race, gender, or age; but we can likely never eradicate maldistribution of physician workforce or specialties, "the poor ye have always with you," and all countries have a system the wealthier can access independently of a govt-run system.
What I hope may come from my own miniscule efforts, and all intelligent discussions of health care reform, is to FIRST identify problems, THEN identify possible solutions, WITHOUT labels or ideology getting in the way. IMHO, ideology has been part of the difficulty the last 8 years.
What will happen if Obama is elected? The sun will rise on Wednesday, he will take office in January, study many issues for 6 to 9 months, develop some agenda items, Congress will debate them for another year, and maybe about 2011 we will see something resembling "change," and coherent programs and processes. Then Obama will begin his reelection campaign, and the Congress will need to be the ones carrying the torch for meaningful health reform. We "little people" need to keep applying pressure throughout this period, regardless of who assumes office in January. A vigorous leader is only one part of the solution. We are also part...and must stay vocal!

c130nav  Anesthesiology

Posted Nov 02, 2008 at 4:51 PM

If Obama is elected and the democrats obtain a super majority in Congress, I think you will see a number of changes within 6 months.
Listen to Barney Frank lately? Already making plans.

c130nav  Anesthesiology

Posted Nov 02, 2008 at 4:53 PM

Recent bumper sticker :
Your wallet . . . the only place where Democrats want to drill.

sayaah  Otolaryngology

Posted Nov 02, 2008 at 5:19 PM

First, Obama is first and foremost a politician and probably smart enough to know better to lead more from the middle than the extremes.
Second, the economy is going to put a damper on most big spending programs and probable tax hikes for a while.
Third, neither Onama or Congress - Reid, Pelosi, Frank, Conyers, Schummer, Kennedy - are going to sit idly by and let the other determine what is going to happen.
Fourth, in 2006 many of the Democrats winning were moderates and conservatives and will not go along with far left proposals. Will have to see who is elected now.
Fifth, there is no doubt the pendulum will swing back to the left, after Reagan and Bush 43. Remember Clinton, after the Hillary's health care fiasco, governed from the middle. Under Bush 43 the pendulum went far to pro corporate side - Bush was not a compassionate conservative as he said, but a corporate conservative.
Very likely Washington will become more liberal than it has been but not as much as many fear and not as much as some would hope.
For the decades the Democrats controlled Congress it was controlled by a coalition of northern liberals and southern conservatives and the southerners being re-elected more, had the positions of power. so it was not a liberal Congress. In 1964 with LBJ's landslide the Democrats had a super majority and LBJ had great difficulty getting the civil rights legislation passed because of the southerners, many Democrats, filibustering.
There is an old saying that when the Democrats form a firing squad that they form a circle. I doubt if that has changed.

healdoc  Family Medicine

Edited Nov 02, 2008 at 5:24 PM

maldistribution of doctors, not enough general doctors, not enough med schools, these are some of the problems,
maybe some specialists should do part time general practice, maybe just 10% of their practice
we rely too much on foreign doctors

rarmstrong  Surgery, General

Posted Nov 02, 2008 at 6:38 PM

I believe that epector is correct. The realities of an Obama presidency will not resemble the campaign rhetoric. The realities of sitting at the desk in the Oval office will be sobering. There will be some changes and policy shifts, there will be impassioned speeches on the Senate floor...and then the standard business of government will proceed...slowly, as it always has. Business and industry will continue to function. The war in Iraq will quiet down as it already is doing. We will negotiate for a permanent military presence in Iraq, similar to Germany and Korea, which is what John McCain has been referring to all along. Health care, for us, won't change much, but there will be more regulation.

sflyn1  Ophthalmology

Posted Nov 02, 2008 at 6:44 PM

epector writes:
<What I hope may come from my own miniscule efforts, and all intelligent discussions of health care reform, is to FIRST identify problems, THEN identify possible solutions, WITHOUT labels or ideology getting in the way. IMHO, ideology has been part of the difficulty the last 8 years. >
A breath of fresh air. Amen.

arcmdface  Endocrinology

Posted Nov 02, 2008 at 7:02 PM

Agree with nsmurali. I would like to add that it was the super-strong Unions that mortally wounded the big 3 carmakers (part of which were the unsustainable costs of labor contracts). Obama will encourage a resurgance of that leading to more jobs migrating out of the country. McCain on the other hand is going to squeeze more out of Medicare with more RACs. etc. I still p/o ed about him not voting for the Medicare bill this summer.
Neither of the candidates has even a slightest of ideas about curing the ills of the health care situation. The system has to be either a completely capitalistic one or completely socialistic. This current situation is not sustainable.

rarmstrong  Surgery, General

Posted Nov 02, 2008 at 7:13 PM

We have a very mixed system currently, neither capitalist or socialist, that has existed for a long time. It has been tweaked, squeezed and played with for years, and this has resulted in what we have today...a mess. Changing it is a political nightmare, for anyone, from any party. It is likely to hobble along, crippled by waste and excess, for many more years, as the party in power takes credit for very, very small changes(improvements).

edwestrfld  Anesthesiology

Posted Nov 02, 2008 at 7:52 PM

Arizona is going to be an interesting test case, as we are getting ready to pass an amendment to the state constitution that would forbid any entity, government, or otherwise from restricting or abridging your freedom to choose who you want providing your health care and how you pay for it.

BestGuess  Psychiatry

Posted Nov 02, 2008 at 8:05 PM

Obama iis not advocating socialism. Whatever gave you that idea?

daverey60  Family Medicine

Posted Nov 02, 2008 at 8:10 PM

There is more to life than Medicine. Yes, we are deep in it, and are sustained (or demolished) by it. Healthcare reform is not the only issue here, and as fate would have it, no one candidate has the "cure-all" for all our ails. There had never been a candidate that had all the answers- not before, not now, not ever. I think it is quite clear that we can not see a perfect president. If we want one, or try to push for one, we are as at fault as our patients and the lawyers who try to assume we're all infallible as physicians.
I agree with epector that choosing a president is just the start. Change in this system is slow. We are all trying to move a mountain, figuratively speaking. It takes time. It may even take a few terms if we want change.
God help us (sorry to "offend" the atheists among us).

cazzon  Family Medicine

Posted Nov 02, 2008 at 10:03 PM

After eight years of an A'ho, we'll now get to try B'HO. But if he sells out to lobbyists, you can just call him ho'.

dmmmd1  Gastroenterology

Posted Nov 02, 2008 at 10:17 PM

<<Obama iis not advocating socialism. Whatever gave you that idea?>>
His own words. Most popular, his unrehearsed explanation to the plumber, of why he wanted to spread the man's wealth around. The implication being that although the man would have worked hard for his money, there were others who needed it more.
"From each according to his ability, to each according to his needs." Socialism, pure and simple.

sflyn1  Ophthalmology

Posted Nov 02, 2008 at 10:29 PM

<"From each according to his ability, to each according to his needs." Socialism, pure and simple. >
Uh, no. That's communism. "To each according to their contribution" is socialism.
en.wikipedia.org

c130nav  Anesthesiology

Posted Nov 02, 2008 at 10:43 PM

So, Obama is advocating communism ?!

sflyn1  Ophthalmology

Posted Nov 02, 2008 at 10:54 PM

That's right, c130. Obama is advocating communism.

bzaneh  Emergency Medicine

Posted Nov 02, 2008 at 11:13 PM

The problem is he is not going far enough to socialize medicine. He backed away from a one-payer system to everyone with a job has to buy insurance. The insurance companies will still rule. We either need to go to an insurance-less system where everyone pays out of pocket or negotiates a payment scheme with each provider; or a system where everyone is covered for a set list of medical events and diseases and the government pays all without denial of care or denial of reimbursement. The problem with the later is that it will cost us 30% to 40 % tax on every dollar you earn.

cazzon  Family Medicine

Posted Nov 03, 2008 at 9:54 AM

Tax hikes during a recession are a disastrous idea. Will B'HO's admin emulate the Jimmy Carter years, or the FDR years?
The question you should ask is, what if McCain wins? That is a scary thought. If there aren't riots in the streets by the "disenfranchised", you can bet the ballots will be tied up in the courts for weeks. And that would be just as disastrous.

nsmurali  Gastroenterology

Posted Nov 03, 2008 at 11:34 AM

It is a matter of demand and supply. As far as medical services are concerned I anticipate a very steep drop( as much as 50%) from current rates for everything--procedures to drugs. ...American industry is fighting for its life. We have such a defunct education system that employable grads will not be coming forth for two decades even if we were to make drastic changes today. One glimmer of hope.., the best and brightest will enter manufacturing area ans hopefully the sciences instead of going to wallstreet.

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