Rarely do stories occurring on opposite sides of an ocean so perfectly compliment one another.  Yet last week Santa Barbara Congresswoman Lois Capps described the new health care reform legislation as “a big gamble”, one whose effects could not be known with any degree of certainty.  This from a strong proponent!  Well, this week I read of some interesting developments in England where similar language was used.  Both are likely true, and it is fascinating to see the evolution of government administered care 60 years hence.  Gambles indeed, let’s take …

Ideally we will dissect more of these things over the coming weeks and see where that gets us. Our concerns are not political- just our means. The real issue here is not policy, or even possible fibbing, its what this all means to how we do our day jobs. Despite the anger, sadness and fear, we still have doctoring jobs that pay the bills and we still like those jobs. The question for us is how long this state of affairs can last…

About six months ago we published this little gem. It outlined what happens after an Obamacare passage? Today no doubt there is talk of repeal. This is good, we think. But, absent that, what was the plan? Lets have a look….

Great. Our President literally handing out checks to seniors— to influence their opinions about a political concept. Its like we are back at Tammany Hall again.

Just quit your job – ins’t HCR Empowering

One key problem has always been how the health care system in America would cope with millions of new patients seeking primary care in the absence of new facilities or professionals to provide the service.

A few months back, I wanted to write a letter to the President and invite him to join me and my partners in our daily goal of providing the best medical care possible. Besides shedding some light on the daily real time decisions we are making on a minute by minute basis, I wanted him to get a view of the humanity that passes throughour hands regularly. One of the objects of my invitation was to point out the utter waste in health care especially in programs run …

If you wonder why the election was really lost in one of the bluest states in the land, you have to go no further than the Left’s response to the results. Quite simply, “It’s not our fault, the Republicans did this to us.”
The Washington Post’s EJ Dionne’s lame, blame game lacks only the now tired reference to George Bush:
Republicans in Congress will be empowered to hold to their course of obstruction by Sen.-elect Scott Brown’s victory.
At some point, Obama’s ambitions were destined to collide with the views of …

During this ‘down’ time where the powers that be in Washington determine how to get the sad specimen of a HCR effort reconciled, we have taken advantage of the lack of chatter out there to focus on some basics. We started our Sage Advice columns– with some good responses…and for this post, we return to the “Explainer” concept we began over the summer.
For this post, we choose the concept of Moral Hazard. It is a term used often, by many; so it is important that you, the reader, fully understand …

It goes without saying that any effort as massive and complex as the one being undertaken by those in Washington is bound to have myriad effects– some of them desired and planned, others, many others in fact, that are less than desirable and quite unplanned. There is a vast hinterland though of effects that many would have (and did indeed) predict but most hoped like the dickens would just not happen. There is always wishful thinking in the world– we are guilty of it ourselves each and every day during …

Spare me the stories of your “genius” tech-savvy child who can name every country on Google Earth, or how, because of your iPhone, BlackBerry and three cell phones, you juggle 20 tasks at once and never miss any business—even at 4 a.m., because you sleep with your portable devices. Does anyone care that technology is destroying social graces and turning people into rude jerks? I’m not just talking about lighting up a movie theater with an iPhone to send text messages or yelling into a cell phone in public. But since when did it become acceptable for technological interaction to supersede in-person communication?

An idea has taken hold in the minds of legislators, academics and many private citizens that medicine suffers from a paucity of “quality” and that this deficit underlies the often quoted statistic that the United States spends more on healthcare than any industrialized country, but by many metrics, suffers worse health than those spending far less. Few practicing doctors would disagree with the notion that medicine is rapidly changing. Although the exact nature, extent and timing of that change are topics for more thoughtful consideration elsewhere, that such change is …

A few weeks back, the Washington Times ran a really great piece by its Emeritus Editor Wes Pruden. The article calls attention to facts not present in the current discourse. Facts are funny, we know, in the world of politics. One persons truth is another’s cause to rebel. Our public discourse more closely resembles the world of John Adams and the Porcupine Gazette or William Hearst and Yellow Journalism than it does the staid world of the NYT and WP and WSJ as the papers of record. But, there are …

We open a new column today, Christmas, called Sage Advice. For our first post, we reprint a little nugget from the NYT (Aug 2008) from our personal files. We thought of this as we scanned the news late yesterday and were keen to appreciate the anger that Blackeberry users were feeling because of their service interruption. They were disconnected for a few brief moments– and well, they felt sick. We’re here to help with the sickness part. Read this– and relax.

The video speaks for itself. Representative of the kinds of things we are seeing– its hosted by two doctors. Always a plus.
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Thank the lord for the AMA in times such as these.

It sad actually. It is no surprise to our readers that we are not avid supporters of the current HCR plan as it now exists. That being said, there remain serious issues with healthcare and a public in support of reform as Mr. Obama inherited in March of 2008 has soured to the point where the concept is essentially revulsive. Making this all so much for sad is that the focus has been shifting slowly away from the actual reform debate in the Senate and instead on to Harry Reid. …

A quote from the New York Times on the Democrats reaching an agreement regarding the public option. This is part of their solution.
Under the agreement, people ages 55 to 64 could “buy in” to Medicare.
Are these guys for real? Medicare is going bankrupt. And their solution is to offer people the “incredible opportunity” to buy into the system. Next thing you know they will be offering all of us a million acres of land underneath which sits a limitless supply of sweet crude oil that …

Sadly, the current debate about coverage expansion is not at all relevant to the quality issue. The implementation of IT and Electronic Health Records, the better use of evidence-based guidelines, even payment reform– all of these may actually get at the issue of our quality and spending. Not however coverage expansion.

Edward Gibbon was not a historian. He was just fascinated by history and wanted to chronicle what happens when great city-states fail. Perhaps another Gibbon awaits us and he will use this kind of non-sense as evidence of our fall– long before we knew it was happening. God help us all.

The other day one of the surgeons we work with used this statistic to show the “problems” with the American health care system. We took exception and pointed him to this post from July. We decided to re-publish it for two reasons: because it is still a very common misconception even after months of health care discussion and two, as a reminder to us to follow up with another post on this topic and the topic of life expectancy. The other often mentioned quality problem in the US. Here’s to clearing up the things you knew which aren’t actually true.