Na Na Na Na, Hey Hey, Goodbye!

John Edwards has dropped out of the race for president. Hopefully, he will not go back to terrorizing innocent physicians and chasing ambulances. The champion of frivolous litigation can now do his part to improve the health care of America by staying out of the courtroom. DocBrain wishes him well in all his non-political, non-legal endeavors.

P.S. Memo to Obama and Hillary: Do not choose this man for veep!!!!

USA 2.0

USA 1.0

The USA is the country founded on the concept of independence. It's foundation was based on the concept of natural human rights that the government cannot abridge because these rights derive from the Creator of all things. It's unofficial motto is "can do". It is the country of optimism, of each average Joe and Jane having the opportunity to take it to the next level. It is the country where the rule of law, based upon reason, is the only law of the land. It is the country of charity, good will to others, of morality based upon the belief in the power of good people to change the world.

USA 2.0

The USA is a country of unequals: of rich and poor, white and non-white, citizens and undocumented aliens. It is the country where success is a measure of vice and failure a measure of virtue. It is the country where equality is the main goal. It is the country where the concept of a Creator is disparaged and central government reigns supreme. It is the country where we expect our government to provide for us. We "can't do" without our government's help. It is the country of debt. Where each of us who has any measure of success owes each of us who has not succeeded, whether by lack of effort or lack of ability. It is the country where common sense and good intentions have been supplanted by laws, rules and regulations. It is the country where patriotism is a bad word and being less than equal entitles you to a pass on gracious behavior, good manners, bigotry, and even following the laws of the land. It is the country where the ladder of success must be blind to individual differences but enforcement of the laws must not.

DocBrain thinks Washington needs an uninstall program to get us back to USA 1.0

Comments?

I'm from the AMA and I'm here to help...

What is needed is push back against managed care, against government regulations and inadequate fee schedules, and against a malpractice system that harms the many for the good of the few. Physicians take an oath to care for the sick, not to micromanage paperwork. The American Medical Association is the largest voice of physicians and the one organization that could make a difference. It has the power to reframe the debate on health care. Instead, it is focusing on universal health insurance and policing its ranks for "quality". The AMA has lost membership over the years precisely because it has ceded the high ground to the government, managed care and malpractice attorneys. It has ceded the framing of health issues to these forces, placing physicians unfairly and wrongly on the defensive. These other forces have increased the cost of health care, blaming us physicians for it. Health insurance is largely unaffordable, but not because physicians are being overpaid, nor because pharma companies are soaking the ill.

The AMA needs to take the offensive. Remember, if you are not part of the solution, you are part of the problem.

Where I stand

The economy: With free trade, workers here are competing against workers in other countries. Some of these countries have lower taxes and/or lower standards of living. People living in these countries are able to buy more goods and services with less money, so there is a competitive advantage. The only jobs that don't suffer are those that require physical presence and/or special certification. In order to live the high life here, we must find a way to improve the buying power of the dollar. The best solution is to reduce taxes and regulations to enable a more competitive environment.

Energy: We need energy, but we should not waste it. Telecommuting needs to be encouraged. High speed trains and luxury buses need to be developed to supercede autos and planes. We need to make city streets safe for walking, biking, and small motorized vehicles (scooters, Segways, mini-cars, etc). We need to streamline and automate traffic flow so that stop and go driving is significantly reduced. We need to go nuclear, solar, wind, water, and geothermal. Renewable biofuel energy needs to be developed and mainstreamed. Special tax credits need to be enacted for research, development, and early adapters.

Health Care: Quality life is precious. Tax unhealthy foods. Use the power of the media and free market to make a healthy lifestyle "cool". Return health care professionals to the center stage of health care. Get the businessmen, attorneys, and government out of health care delivery. Let the free market establish the value of health care.

Immigration: There are more people in the world who want to come here than there are jobs for them. There are more jobs for people who want to come here than we currently admit as legal aliens. The goal is to bring everyone in the country who is working into the tax and insurance structure so they pay their own way. If a person is not covered by private health insurance and/or is not paying taxes, that person is not entitled to stay here unless that person is a US citizen. All people who living here who are not US citizens need to be documented; any who are unemployed are to be deported unless they find an appropriate job within a specified period of time, perhaps 3 months. They may be given a certificate that would allow them easy re-entry when an appropriate job becomes available, but until such time, they must leave. We must control our border to reduce the cost of documentation, job verification, and deportation. Obviously, all hardened criminals are to be deported.

Iraq war: We must not become an occupying force. We must give Iraq a chance to survive as a democracy. The world is a catch 22 place. If we abandon them, they will fall back into a primitive, anti-western, pro-jihadist mindset, and will be a source of harm to us. If we work with them, they will eventually come to cherish liberty and freedom as we do. They will develop a strong market economy and a love for modern education and will eventually challenge us on the field of economic combat. Like China. I would rather see an economic conflict than a military one. The world is going multinational and global, so go with the flow.

A better system?

DocBrain has flamed on about the current problems in health care. However, a criticism without a solution is just hot air. So, here is a solution to the health care crisis.

The Health Co-op

Just as farmers gather together in groups and sell directly to groups of individuals, so a health care co-op would work.

Health care providers, hospitals, and pharma companies would form a group to sell health care to families and individuals. No governmental agencies or insurance commissions with arcane and multitudinous rules and regulations. No friction from middle men trying to limit access to evaluation and management options to ensure their own hefty profit. Within the group, there would be free exchange of information, including off label but effective use of medications, now prohibited by federal law. The system would provide a specific reimbursement schedule for harm as part of the contract, eliminating the need for malpractice suits. Patients would be encouraged to try to find ways to help the providers improve delivery and services. Providers would not have to micromanage documents and instead would be able to focus on providing excellent care, with individualized assessments geared to optimize individual care rather than group regulatory compliance. Any excess funds would go back to the families and individuals as dividends or rebates. Co-ops could cooperate with each other across the country providing a network of coverage. The cost of such a program would be much less than the current system, making insurance more affordable to the poor. Profits would go back to the health care system, either in research and development of new products and drugs, or to local providers and hospitals to update and improve local services. All providers would have to have their health care provided by the co-op, leading to self interest in having an excellent system.

Of course, getting the government to release its power-hungry fingers would pose a major problem, but one that, over time, voters could do something about.

Health Care in America

DocBrain just took the www.vajoe.com candidate test. Rudy is his man. And yet, Rudy misses the boat on health care. As does every other candidate. I will say that he misses it somewhat less than others, but still misses the mark.

The key issues at ground level.

If you are part of the government, you are part of the problem. Some examples.

• The FDA determines not only safety, but applicability. This slows down the approval process and limits dissemination of information about unlabelled but effective uses of health care products. Doctors are expert at reviewing the medical literature and claims of effectiveness. We went to school for that. That is our job.
• Doctors, hospital administrators and nurses are patients, too. We know where the problems are. If we don't know how to fix them, we will ask. If regulations were the answer, no one in America would die. We are so busy with stupid, pointless, and unflexible regulations that we don't have time to deal with sick patients.
• You are setting the standard for reimbursement through Medicare, and that standard is inappropriately low for what is required. Reimbursement is tied to documentation, not to provision of quality service. The documentation requirement does not reflect quality, but does allow draconian enforcement of "fraud" or where the doctor bills for spending more time with the patient than with the chart. Drop the chart minutiae reviews and penalties and allow us to do our jobs. Better yet, get out of the health care marketplace.
• Reform malpractice laws. The adversarial system works well in many circumstances, but not in health care. See other posts in this blog, but the short answer is that people stick to positions when they are threatened; they do not solve problems. Most patients want problems solved. A few think they want obscene rewards, but find that these do not produce happiness or satisfaction, except for the malpractice attorneys.

If you are part of managed care, you are part of the problem.

• When you graduate medical school, take the history eye to eye with the patient, examine the patient, review the tests and other reports, become current with the literature, then and only then, can you prescribe testing or treatment for a patient. And you are responsible for what you find out and what you have missed. Managed care tries to control interactions, testing and treatment without the prerequisite responsibility, hiding under the curtain of "we don't say what to do, only what we will pay for".
• If managed care has a fiduciary duty to its subscribers. Managed care organizations have no business contributing to charity, advertising in sports stadiums, acquiring large real estate holdings, or stockpiling billions for acquisitions or other non-delivery issues. It is not their money. It is the subscriber's money. There needs to be a code of ethics for managed care.
• Just because you know the bureaucratic line doesn't mean you know what is right. Procedures, treatments and referrals are denied based on outdated and simplified, but codable software. Again, just pay for what the doctor and the patient agree are needed. We are not ripping you off. Honest.

If you are a malpractice attorney, you might be part of the problem.

• A mistake is a mistake. A bad outcome is a bad outcome. The twain do not always meet. Delivering health care is like playing roulette. Occasionally you land on 00. No one is to blame. Don't penalize physicians for their personality. Your duty as a malpractice attorney is to help us fix the system by helping those who are harmed by a mistake, not to use weasel techniques to convince a jury that those injured by an act of God or a random occurrence deserve retribution from the providers. If you have a valid case, I would hope that the physician/hospital would want to settle and move on. That has been my experience and observation. If there is strong resistance, you probably have a bad case.
• You are helping individual patients. You are not improving health care. You probably are worsening health care and are certainly increasing costs for everyone. Can you deal with that?

If you are part of the problem, you will try to obfuscate the issue and blame doctors, hospitals, pharma, the uninsured, whatever. I am on to you. Many people are.

I just wish that the politicians would open their eyes.

...and justice for all

"Why was government instituted at all? Because the passions of men will not conform to the dictates of reason and justice without restraint."

The Federalist 1787
Alexander Hamilton (who ironically died in a duel in 1804, an expression of passion if there ever was one!)

"Everybody wants to rule the world"

Tears for Fears

Justice is the ordering of principles, people and things. There are many approaches, from the divine right of kings to John Rawls position that justice should favor the least advantaged. There are principled approaches, utilitarian approaches, "natural" approaches, and referenced approaches (ie, Bible, Koran).

There is no natural equality of appearance, talents, skills, intelligence, temperment, health, longevity, or abilities. We accept this as given.

Some elements of inequality are related to natural inequality. For example, parents with the right combination of the above natural tendencies will tend to provide a more nurturing environment for their children. A parent may also provide capital to promote a fuller education and additional life experiences.

Then, there are the inequalities that government produces. For example, a government that preferentially supports children of unwed mothers will lead to a disproportionate number of broken homes among the poor, leading to further inequalities as these children have to overcome the less nurturing childhoods as well as poverty.

Justice is a very complicated issue. Fairness, or the belief that everything needs to be divided up equally, is based on the untruism that life should be fair. DocBrain has seen many examples of the unfairness of life. Bad things do happen to good people. The poor can starve; the rich can be stripped of their wealth by confiscatory taxation; the good can be imprisoned and the guilty go free. It is the duty of all of us to try to make life fairer, but it will never be fair.

Here are a few issues:

• Accumulation of wealth is a temporary thing. Even billions can be dissipated in a few lifetimes. People rise out of poverty every day. Redistribution by the government is neither necessary nor sufficient to create justice. Instead, it stifles the innovation and industriousness needed to rise and saps the desire to achieve if it all can be taken away at the whim of politicians doing the bidding of the masses.
• Where government gets involved, the marketplace becomes distorted and this does no one any good. The example DocBrain is most familiar with is health care. There once was a belief that those who were poor got less health care because they were too embarassed or too afraid to seek out care in charity clinics, so a system of medical assistance went into existence. Guess what? The poor still avoid seeking care, even though it is paid for. This phenomenon has been observed in other countries as well. The poor are no better off, but the government has now increased costs. Hospitals and health care providers have to suffer a myriad of regulations, none of which have been clearly demonstrated to improve the lot of the patients and yet generate large costs. As the costs to comply with governmental regulations go up, the costs to administer health care goes up, and insurance companies have arisen as the evil step-children of government to suck more money out of the taxpayers and provide less care through "managed" services. If the government and managed care organizations left health care to the professionals and if a new system of malpractice that was based upon problem solving rather than affixing blame arose, we would have a more affordable system. Truly, the heroes in health care are the providers (physicans, nurses, therapists, hospitals, technicians, etc), the equipment and pharmaceutical companies, and the suppliers of goods to the community (pharmacies).
• Merit is a good thing. Any system that rewards based on something other than merit is on shaky grounds. When you raise your children, you provide some things for them out of love, but if you provide them with everything, they will be sapped of the drive needed to earn their own way, to make life have a meaning other than taking. While one can define merit on an individual basis, this does not always benefit society, and actually can lead to a form of enslavement of the skilled, bright and able. Merit needs to be defined on a societal basis and needs to be subject to the forces of capitalism. No one has developed a viable society that is based on anything other than enlightened self interest. While one can theoretically argue that an altruistic or egalitarian society would be the best, this flies in the face of the need of people to strive for something other than the inner feeling of accomplishment and giving. People need an external measure, be it power, prestige, or wealth. While these aren't the end all and be all, they are necessary as carrots to move us forward. No carrots and no progress.

Brave New World

Once upon a time, in the heartland of Liberal North America, the government attempted to tax the citizens for the most popular afternoon beverage of it's day...tea. We all know from the history books what happened. Arguably, that was the start of the American Revolution.

Fast forward 234 years and change venues to the most democrat-run city in America...Pittsburgh, PA. The democrat party prides itself on being liberal, the voice of the people. No one in Pittsburgh citywide government has been anything other than a democrat for over 75 years! The county is also mostly controlled by the democrats due to their overwhelming majority within the city. So, what did these fine public officials do? They decided to levy a tax on the most popular afternoon beverage of our day...beer! Pumping an Iron has been a Pittsburgh pasttime for decades. And, faced with such an affront on their liberty, what did the democrat citizens of Pittsburgh do? With few exceptions, they have praised Dan Onorato (D), the County Commissioner, and have even suggested that he would make a fine governor of the state based upon his decisive action!

Moving on to the heartland of the USA, we get to the Iowa caucuses. We have the winners: the preacher who attacks his opponents and the inexperienced ex-drug user who doesn't need to salute the flag, with the shyster malpractice attorney close behind. Are we really that desperate, America? Let the preacher go back to saving souls, the inexperienced Obama earn his stripes, and the malpractice attorney go back to channeling the dead souls of babies as he sues doctors for unstoppable acts of nature.

Yeah, that's how I really feel.