Travel Subsidy on the Health Train Express

The real 'deal' The American Medical Association came out in favor of the House Democratic health care bill when the House Democratic leadership promised the doctors $230 billion in new spending to cancel out any future Medicare physician cuts (which are scheduled under an existing law called the Medicare Sustainable Growth Rate Formula). As a result, the doctors don’t have to give up anything under the health bills, and would actually pick up $230 billion under the House bill over 10 years. Hundreds of 'sound bytes' and snippetes of highly charged statements are read daily by patients, providers and decision makers. Unfortunately for the uninformed (and even the informed) ferreting out the 'truth' is very difficult. Both Republicans and...

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A Missing Passenger of the Health Train

Edward (Ted) Kennedy, D, Mass, departed from the Health Train yesterday. A significant voice in health affairs has left the stage. Not much more can be said by me when others have so elequantly described his life, and times.  Health Train Express offers condolences to his family and constituents. A moment of silence..... ...

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Ramblings on the Health Train

  My day here at the government run undisclosed location started off with my morning read of health related blogs, pundits, and rumor mongers. Buckeye Surgeon from Ohio presents a personal interview with two of his medical school chums, one in private practice and the other who is employed by the Cleveland Clinic. Rather than trusting media sources and medical management statistics, Buckeye decided to do his highly statistically significant study with a cohort of two…..My take on the interview is that some doctors like to work in a group practice, while others are individualists, and like to work alone or in a smaller controllable environment, where you have a choice of wallpaper color, who you hire and fire, and are accountable for...

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Lieberman--A Voice in the Wildness

Joseph Lieberman, (IDem) Senator from the nutmeg state, CT boldly goes where no man goes before...a voice of reason, perspective and quiet reasoning. (typical of Lieberman). One of the Senate's most powerful Democrats, Joseph Lieberman  said  Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over. "We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program. One of the Senate's most powerful Democrats said Sunday that President Obama...

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Value, Security, Beauty and Elegance

Mark Smith, CEO California Health Care Foundation, (video link)  spoke at the Microsoft Connected Health Conference meeting in June. Comparisons between Richard Nixon’s Health Reform Proposals and Obama’s proposals..as described by Mark Smith, illuminate the similarities and differences. Read what a staunch conservative Republican proposed for a national health universal payor program. Mark Smith and the things to get ‘right’ Standards How will we wire doctors …nagging fear Attributes for providers: Simplicity, Adaptability, Functionality Attributes for “patients” Value (for the patient) solve the patients perceived needs. Security and privacy issues Beauty, elegance (something...

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K.I.S.S.

Health care financing in itself is a morass of complicated systems. Those who wish to make it as simple as possible, are mistakenly driven toward a universal payor model. What lurks behind the scene with that model is unknown and unintended levels of bureaucracy and the considerable expense of reorganization of the entire system. It seems public opinion is focusing on these elements: 1. Eliminate cherry picking by private payers, elimination of exclusionary policies and waivers as well as predatory premiums. 2. A public option (which could be temporary) for lapses in employment, and/or insurability, or disability 3. Developing an actuarial insurance base that includes all citizens of the United States. 4. Elimination of free care for undocumented aliens. 5. Elimination of reimbursements...

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The SERMO-AMA Disconnect

Kevin MD today makes some keen observations about the recent dissolution of the AMA – SERMO connection. The sad fact is the outcome weakens the credibility of both organizations. No one knows what the ‘pre-nuptial agreement’, nor what investment in hard cash we as physicians made in SERMO. It would be nice if there were some transparency, other t han the posturing of either side. My view is that we as physicians were hurt by these events. Neither side seems to want to own accountability for the rupture in the partnership. My guess is that The American Medical Association reacted like a ‘hurt parent’ when confronted by SERMO with the ‘truth’. The AMA and it’s board obviously did not see the relationship as mutually beneficial. The American...

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Daniel Palestrant, MD

Dan Palestrant, CEO and founder of Sermo.com has made the rounds of three media giants CNN,  MSNBC,  & CNBC. In a friendly face-off with the AMA and other organized medical groups, Dr. Palestrant ably demonstrates that the AMA does not accurately represent many physicians. Of the 800,000 physicians less than 250,00 are AMA members. What is fascinating to me is that SERMO began only three years ago as a meeting place for grand rounds, and physician to physician interaction regarding interesting clinical cases and treatments.  Members must be authenticated as duly licensed and credentialled MDs or DOs.  Sermo's 110,000 members represent all specialties of medicine from family practice to all specialties....

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Mr. President: 'Shut up!'

The above title is my own..GML The $50,000 Gangrenous Foot By Buckeye Surgeon "This one just takes the cake. We're definitely going to need another Beer Summit after President Obama's latest gaffe: "If a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, $50,000 immediately the surgeon is reimbursed. But why not make sure that we're also reimbursing the care that prevents the amputation? Right? That will save us money." The ignorant arrogance, it just oozes. Vascular surgeons are getting 50 grand to lop...

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The Great Medicare Debate Part I JFK-Annis 1962

1962 and 2009, what do they have in common?  Let's watch and listen to this presentation by John F Kennedy at the 'birth of medicare'. I was there as a pre-medical student....it seems we have not come very far since then.  $12.00/month for medicare premium... Originally presented as a program that required proof of need. JFK used the argument that the government had the duty to promote the 'general welfare"....sounds good to me....

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WAR GAMES

War Games? An interesting article appeared in iHealthbeat during the past month. iHealthbeat is a part of the California Health Foundation www.chcf.org and also publishes on the internet at www.ihealthbeat.org The article points out what ‘we’ are up against with the coming health care reform, and the massive infusion of capital into health IT. Several clips from the article: War Game Forecasts Future of Electronic Records by Leonard M. Fuld and Kim Slocum Dateline: April 3, New York, N.Y.: Microsoft makes a play for Allscripts, then failing that attempt, pursues Kaiser Permanente to create an exclusive EHR-PHR agreement with the pre-eminent managed care behemoth. Allscripts independently cuts a deal with a large health care company...

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Which Health Plan is Better??

Those of you who have read my two previous posts realize how fortunate we are to have Dr.Tom Coburn as a U.S. Senator. He uniquely represents  physicians (as advocates of the patient). and is highly articulate, and well informed.  His comments on the previous posts were from the Health, Education, Labor, and Pensions Committe during their discussions on SR 325. WHICH HEALTH CARE PLAN IS BETTER?? The Patients Choice Act   S 1099  or: The Democratic House Bill  HR 3200...

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The failure of cost comparitive Medical Care

THANK YOU TOM COBURN Part I is on my previous blog post....

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Health Train Express--Personal Observations

  I was just responding to a thread between several of my former classmates from GWU Med School.  After composing it and reading it I realized my thoughts probably reflect those of you who read my blog.    Dear Gary,     I thank you for your letter to Al.  Your continued leadership is a blessing.  Jim  Rowsey  On Aug 8, 2009, at 7:52 AM, Gary Levin wrote: > Dear Al, > > Sorry my response was so abbreviated.  I was thinking a great deal > about what you said about opposition vs. leadership. > > As you and I know this is a very complex  "industry'. Each segment > responds to market pressures in it's own way. > > I agree that physicians must be leaders, as we have...

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How many rules does it take to make a Ruler?

Matt Holt, last week proposed these two basic rules to guide us in health care reform: Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care. Rule 2 A health care reform bill needs to limit the amount of GDP that is going to health care to its current level, with an overall aim of reducing the share of health care going to GDP. This week Uwe Reinhardt expands a bit: Writing in his blog in the NY Times, Uwe Reinhardt sets out three overarching goals of health reform 1. Financial barriers should not stand between Americans and preventive or acute health care that they sincerely believe will address...

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SERMO AND MSNBC.COM

Another word for SERMO. Dan Palestrant (founder of Sermo) was on MSNBC.com for another ‘debate’ with “established’ organized medicine. This time it was with the head (/Dr. William Struck ) of the Bassett Hospital in Cooperstown, New York. The argument again was about ‘salarizing’ physicians as a means of cost containment. Viewers of this ‘sound byte’ need to know about Bassett Hospital.. Bassett Hospital operates in a rural area of Northern New York. It is a pristine small community with a fairly large drawing area of a lightly populated region. Solo private practice in that communitiy would be untenable economically. Bassett Hospital also is affiliated with Columbia University School of Medicine, and has multiple training programs for residents from Albany Medical Center (over 100 miles...

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Summer Recess

As some of us prepare for the long awaited "August" vacation, remember that your elected congressman, senators are also spending time in their congressional districts.  Keep them busy at this critical time and voice your opinions on health reform.  Things are reaching a critical mass, and this now has national attention, with everyone weighing in...Make our voices heard, fellow physicians and health care workers. It is apparent that some beginning of health reform will take place. Most opinions revolve around increasing availability of primary care, levelling  reimbursements between primary care (family practice for you other dinosaurs) and specialty care.   Rather than over all revolution it seems that the insurance...

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Health Train Express and Calculus

Health reform created a weird calculus of outcomes, decision makers and political intrigue by Catherine Rampell Update | 2:11 p.m. List of states has been corrected. My colleagues David Herszenhorn and Robert Pear had an article on Tuesday on the Baucus Six — the group of six senators tasked by their parties to hammer out a new health care package to be considered by the Senate Finance Committee (and then, presumably, the full Senate). The senators are from Maine, Iowa, Montana, North Dakota, New Mexico and Wyoming. A colleague noted that it’s a somewhat odd group to be asked to design a new health care system, given their constituents. Whom, exactly, do these senators represent? They come from some of the country’s least populous states, with no true urban centers to speak of. None...

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