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…

The problem with the health care reform process was it was driven by a multitude of agendas. Many of these agendas were based on political ideology as much as anything else. Neither of those statements are particularly earth shattering. They are to be expected in a political debate especially amongst politicians, lobbyist and pundits.
Where we hope we don’t get ideology-driven agendas is in science. Especially a science whose direct end result is someone’s life. Unfortunately, this is not the case. Academics is a cauldron …

These articles get at the core issue of HCR from both sides: the administrative/hospital one, and the personal/patient one. Both offer the same insights and raise the same questions. Our contribution to this little dialogue? No matter what rules and laws are put in place to ‘reform’ health care, the fundamental issues that had the Bennett’s making the decisions they made, and the doctors making the ones they made– those issues all remain intact and untouched. Obamacare is foolish. Worse, after reading these articles it becomes plainly evident that Obamacare is also a mirage.

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 …

Clinical Benchmarks and Their Implicit Social Pressures
It appears as if the concept of quality has implanted itself firmly into the medical superstructure. depending on whom one listens to, widespread adoption of quality improvement measures will have effects ranging from moderate improvements in delivered care to a huge cost savings coupled to enormous improvements to the entire healthcare delivery pathway. Presently, the Center for Medicare and Medicaid Services (CMS) and the Congress have mandated the adoption of quality measures be tied in some way to reimbursement to hospitals and providers. Regardless …

Well Dr. Orient, our hats are off to you. That simple, that clear. Bravo.

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.

With the Senate beginning deliberations on a final bill which will make it to Conference (where the herculean task of reconciling with HR3692 occurs), a number of things are still very murky. Yet, a fair number of things that are common to both bills have emerged and the collective impact of those changes on the actual practice of medicine are pretty clear. And pretty alarming.
Te WSJ has a good piece on “Rationing Commissions”. Their title is a bit feisty, but their general arguments are sound. They say:
“Like most of …

This is our summary of what follows from HR 3692. It is not looking good right now.

That we are engaged in the exact same debate as 15 years ago should be sobering to all of us. As a society, we have come no closer to wrestling with this issue and settling on anything resembling consensus. Is healthcare a right? Perhaps we should be talking about this more.

Prevention can, and will fail to prevent. We better recognize this before we invest our hopes into this black hole of a concept and then wake up one day and find that instead of feeling sad for that reckless person who ignored all our good advice, we instead punish him and tell him “we told you so big man”– and send him back to his path and away from the help that we are so desperately trying to provide to everyone with this current debate.

In the last post of this title I described why Infant Mortality is a poor measure of a society’s medical success.  The main reason: it is a carefully watched statistic and therefore one that Governments manipulate to improve their image on the world stage.  Many countries use non-standard definitions which allow them to exclude the highest risk infants from reported statistics thereby improving their reported outcomes.  In fact, researching the prior post, I learned that there really is NO standard definition of an “infant”, a problem which makes country comparisons …

In the debate on health care reform we have been bombarded by an enormous amount of information. It has taken a fair amount of work to decipher this information as it has flown out of pretty much every media outlet. A revolving door, talking point is the hysterical search to find the Holy Grail of health care systems. The politicians and pundits have been looking for this system so they can make the case for a one system fits all health care model in this country. The …

Recently we all were surprised to learn that President Obama received the Nobel Peace Prize for, for, what exactly was it for?  The head of the Nobel Committee and former Prime Minister Thorbjoern Jagland defended the selection saying they were “capturing the spirit of the times, the needs of the era.”  This drew criticism not just from the usual sources (Glen Beck, Rush Limbaugh) but from the Progressive media as well.  In a piece titled “Obama’s Nobel Farce” Daily Beast columnist Peter Beinart stated, “I like Barack Obama as much …

It is a bit of a shock to us that we are actually praising a piece by Alain Enthoven in a recent Kaiser Health News column. Mr. Enthoven is a distinguished academic in the area of health policy and has much to say over the years regarding HCR and his ideas. We have not always seen eye-to-eye with him and his views, but he is thoughtful and cogent and that counts for alot in our book.
His piece is titled Please Don’t Call It Health Reform and in it …

We are your doctor if we help you, if you do not, if you ignore us, or if you cannot afford us. We care always, unconditionally and universally. We are your only advocates most of the time and most of us, not only love what we do, but could not imagine ever doing anything differently.

President Obama has repeatedly cited Medicare as proof that the Federal Government can get Health Care right.  Liberal talk radio lambastes Seniors who attend town-hall meetings in opposition to a government taker-over of health care, by pointing out that they are already on a Government program.  In Fact HR 626 and many Progressives feel current proposals are unnecessarily complex when all we really need to do is extend Medicare eligibility to all Americans.
But many of us who are in the health care profession see Medicare in a far different light.  …

HR 3200 and Illegal Immigrants: Obama vs. Wilson

Wednesday night we witnessed what could only be deemed a masterful performance by President Obama stumping for his vision of health care reform.  During the speech many were stunned at the sudden outburst of Rep. Joe Wilson (R-S.C.), who blurted out “You Lie” when Obama stated that illegal immigrants would NOT receive government funded health care under H.R.3200.  Since that time Rep. Wilson’s presumptive challenger in 2010 has received $750,000 in campaign contributions from around the nation, while Mr. Wilson has taken in …

We came across Mr. Hannaford’s writing some months back and have made reference to his work on TBM. Best known for his time with Governor Ronald Reagan, Mr, Hannaford was instrumental in helping Mr. Reagan be elected to the Presidency. During the Reagan years, Peter remained closely involved with the administration and acted as an advisor to the President. We are so very fortunate in that Mr. Hannaford has written a piece for specifically for us!

The other night we had the incredible opportunity as practicing physicians to speak to a crowd of almost 500 people. Our job was to answer their questions about health care and the reform efforts. Here at TBM, we realized this was a very rare moment. Most of the talking heads about health care are not practicing physicians. Even those with MDs after their names have spent their entire career studying health care not delivering it. Big difference. A number of great questions/topics came up …

With all the data and words and emotion swirling about, AND, recognition that our time is finite and we cannot post everything with the detail that we would prefer, we have created a new link section on TBM. Under ‘White Papers and Resources’ you will find a treasure trove of data and resources. Have at it!!
Be warned, some of it is a bit scary.

While a health insurance cooperative is an intriguing idea, it is hard to see how it would operate in practice. No detailed description of how the Cooperative would operate has yet been released to the public. It is particularly difficult to imagine how the Cooperative would get underway.

This is an ages old problem, our struggle with how to deliver medical care to as many people in the best way possible for the least amount of resources. It would do everyone some good we think to spend some time reading these articles. We are not, and have never been, alone.

The way we see it, the question is not whether or not the situation presently is problematic, it is (as we have amply discussed in other posts). People are having lots of trouble with our current system and the blame and solution rests across a wide area. But, to recognize this fact yet aim to turn everything upside down for what amounts to about 5% of the population seems irresponsible and a far cry from the utilitarian philosophy on which our Constitution is based.

Blogs that aim to explain, rather than simply comment, seem to be in demand by many people at present.