Uproot Healthcare

Forest Fires, Earthquakes, Tumors, Titanic, & Healthcare

by Deane on January 18, 2012

Henry David Thoreau wrote that, “All perception of truth is the detection of an analogy.” Let’s use analogies to comprehend the seemingly incomprehensible: healthcare in the U.S. Below, the word “they” refers to power brokers in Washington, on both sides of the aisle, and in the White House.

They are concentrating on one vein on one leaf of one tree, while the whole forest is ablaze.
They remain intensely focused on a tiny germ under a microscope while an earthquake is destroying the lab.
They have precisely lined up all the deckchairs on their magnificent new, “unsinkable” ship – the Titanic.
They are applying anti-acne cream to a patient with a brain tumor (T).

The basic truth described in these analogies may seem obvious to you and me, but apparently, it escapes people who work within the Beltway. They are focused on the trivia while the big problem gets worse.

The “doctors” for the critically ill U.S. healthcare system – our Representatives in Washington – are altering financing and expanding regulations, apparently without any understanding of why patient Healthcare is sick. As a result of their treatment, the patient is deteriorating. Indeed, patient Healthcare is dying, and when it goes, we will go with it.

The following is a list of Healthcare’s signs and symptoms. Every good nurse or doctor knows you don’t treat these.

Spending too much, both individually and as nations
Lack of health care goods and services
Shortages of trained personnel
Limitations in access
Errors and adverse impacts
Variations in both quality and payment for similar services.
Medical bills were formerly the leading cause of personal bankruptcy in the U.S. until the 2009 real estate collapse. Medical bills have now “slipped” to second place.

The list above does not include the causes of patient Healthcare’s woes. Those are the things you do treat, like perverse incentives, action without evidence, spending that delivers no value, suppression of market forces, and preventing learning.

You cannot cure over-spending by spending even more, as does the PPACA (Patient Protection and Affordable Care Act, called “Obamacare”). You determine where the dollars are going – the “spending” – and decide which of those expenditures is “over-”, meaning which dollars we are spending that show a negative cost/benefit ratio.

The Beltway-doctors say they are “fixing” healthcare by infusing competition through health exchanges. Those exchanges actually expand government control of healthcare and thereby, they suppress the free market forces that give consumers better, cheaper, and quicker. Even as Congress promises lower insurance costs through Federally mandated exchanges, you and I see our insurance premiums skyrocket.

Congress reduces payments to providers and at the same time, they pay more to themselves. We get fewer doctors and nurses but more bureaucrats. Trillions are paid to healthcare – the system – leaving less and less for health care – the service. As Robert Moffit of the Heritage Foundation testified before Congress, “One cannot get more of something by paying less for it.”

The only people we can count on to act in our best interests is us, not as in U.S., but as in you and me, We The Patients speaking as We The People. What should we do?

Sick patients, such as Healthcare, should be treated by people who practice good medicine. The self-proclaimed healers of Healthcare in Washington repeatedly shout: “Trust me! I have your best interests at heart!! Pay no attention to who is funding my re-election campaign.” You can easily see how patient Healthcare is doing under their fine care.

The following are the basic principles of good medical practice, whether the patient is a sick person or a sick system. This is what the Washington-doctors are NOT doing.

Evidence based decision-making
Treat causes, not symptoms.
Long term (cost + risk) / benefits analysis
Partnership with the patient

What should We The Patients do? First, we must accept the job of becoming We The Doctors for patient Healthcare. If we wait for someone else, it won’t get done, and certainly will not get done right.

Next, we must accept the fact that the “system” we currently have cannot be adjusted, managed, tweaked, or reformed to make it efficient and effective. It is not just a broken system. It is no system at all. We need to create a real system, one that works…for us.

Congress is guilty of nanomanaging Healthcare, which is “a thousand times worse than micromanagement.” They substitute logic and passion for hard data and cost/benefit analysis. We must demand that all Congressional actions have evidence in advance of legislation. Such evidence must include, as the engineers say, both problem definition and proof of effect.

Finally, though we are temporarily acting as Doctors for Healthcare, we also remain We The Patients. It is crucial that we demand a partnership with the Federal government. We want the exact opposite of how we were treated with regard to PPACA.

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Health Care Costs Are In Tight Control

by Deane on December 17, 2011

Economist Robert Samuelson has declared that health care costs are “out of control.” Though one hesitates to disagree with a widely syndicated columnist, Samuelson is 180 degrees wrong. Health care costs are IN control – very tight control – by Washington.

Health care as two words refers to goods and services delivered by hospitals and providers to be consumed by patients. The word costs, when referring to what providers and institutions must pay, is determined primarily by government regulation and bureaucracy rather than by labor costs, supplies, or MRI machines. Payments to providers and institutions –what the government calls costs – are predetermined by the government. The bill submitted by a provider is generally irrelevant.

Whether you describe excessive national expenditure of money as costs or as payments (reimbursements), spending is strictly controlled by the government. It is not “out of control” at all.

Note first that when the PPAHCA (“Obamacare”) reduced Medicare “costs” by 21%, they cut Medicare payments (to providers). Therefore, they cut services to patients. As Robert Moffit of the Heritage Foundation testified before Congress, “you cannot get more of something by paying less for it.”

Meanwhile, PPAHCA increased spending ON – the costs OF – the federal healthcare bureaucracy by six whole new agencies, hundreds (? thousands) of bureaucrats added to the payrolls, and multi-thousands of new rules and regulations. So the government controls and increases spending to/on itself, while it controls and decreases spending on patients.

Need proof? Of all the money spent on “healthcare” in 2010, 40% – that is over $1 trillion – …disappeared. It went in to healthcare but provided no health care. That statistic was before PPAHCA, which could raise the disappearing dollars to half (!) of all healthcare spending.

Samuelson goes on to use the recent OECD (Office for Economic Cooperation and Development) report to explain U.S. overspending: steep prices and abundant provision of expensive services. Hogwash! As Dr. Samuelson knows, “price” is meaningless in healthcare in terms of what gets paid.

As a doctor, I can charge whatever I like for doing a cardiac catheterization in a baby. The actual bill can read $2000, $4000, and sometimes over $5000. Regardless of what you call my price, charge, or bill, I get $387. That is what the government pays. So the price may seem steep but the payment is peanuts.

For Medicare, just as for my caths, payments are now lower than the cost-of-doing-business. So if you want to know your Medicare doctor can no longer see you and is not accepting new patients, it is because she gets paid less by Medicare than her costs to keep the office doors open.

How much of healthcare spending is for administration and regulations? No one knows because no one measures. Government administration guesses at how much it directly pays itself, and conveniently ignores the costs – to providers and the public – of the ever-expanding mountain of regulations.

Samuelson rightly asserts that, “the system needs a fundamental overhaul to deliver more value for money.” No one disagrees…except those in charge. In order to determine value, one must measure cost, measure benefit, and compare the two. Does the government measure either the benefits of health care or the benefits of healthcare? The answer is a resounding No!

So how can you-the-consumer, whom I call We The Patients, assess value? If you only know part of the numerator and none of the denominator of a cost/benefit ratio, you can’t.

Finally, Professor Samuelson practices really bad medicine … on healthcare. He jumps directly from symptom identification (overspending) to treatment plans (vouchers or single payer) without going through the critical step of root cause analysis.

If you want to cure anything, whether it is a sick person or a sick system, you must treat the cause(s) of illness. Overspending is only one part of the sickness in healthcare. If we try to fix it without resolving its root cause as well as the other causes of illness in the system, we are certain to fail, just as Obamacare – with its expanded control – is certain to make healthcare, We The Patients, and America sicker.

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Town Hall Meeting, 12/8/11

by Deane on December 13, 2011

A town hall meeting was held about healthcare at the Albuquerque Art Museum, Albuquerque, New Mexico. The meeting had two parts.
• First, there was a screening of the film “Sick and Sicker,” written and produced by Logan Darrow Clemens. The film analyzes the Canadian healthcare system based on the assumption that full implementation of the PPAHC (Patient Protection and Affordable Health Care Act, also called “Obamacare”) in the USA will produce a system similar to Canada’s.
• After the film, there was an unstructured, free flow open discussion about healthcare among the 47 attendees, moderated by Deane Waldman, author of “Uproot U.S. Healthcare.”

QUESTIONS (ITALICS) AND RESPONSES

Doesn’t it make more economic sense to spend our limited healthcare money on the young and not on senior citizens who won’t live that long and will not be as productive as the young? [Note: The questioner appeared to be at least 65 years old.]

In a purely rational economic sense and speaking only for the nation not the individuals, the answer was yes: spend more on those who can contribute more.

Waldman the moderator then offered a different approach. He claimed that we had enough money to care for both young and old, but only if healthcare money actually went to health CARE. Forty percent of all our healthcare spending goes to the bureaucrats and insurance company CEOs rather than to doctors and nurses who serve We The Patients. In 2009, that was over $1 trillion “healthcare” dollars that produced no health “care.”

You talk about the need to balance demand with supply: unlimited demand with limited supply. Who should do the balancing?

There are only two choices for the “balancer” of supply and demand. It is either the government by decree who rations health care, or the individual through the market forces who balances his or her demands for care with his or her own healthcare dollars.

Insurance companies are bad: they totally get in the way between doctor and patient.

Several responders in the audience immediately agreed. Waldman agreed as a physician saying doctors frequently cannot do what the patient needs because of insurance companies, but also because of the government as an insurer (Medicare and Medicaid). However, he continued, it is fundamentally a system problem. We do not reward the outcomes that people want: good health and long life. The system rewards – with profit or power – those who give the least care.

In the flow of conversation, the moderator asked a question of his own. “Let me have a show of hands. If you could throw out all 535 members of Congress, no exceptions whatsoever, plus the occupant of the White House, would you do it?”

In response to that question, almost before the final words came out, the vast majority of the audience enthusiastically raised their hands.

While I agree that insurance companies are a cause of the rising costs, there is also the practice of defensive medicine.

There were many nodding heads and several mumbled about tort reform but no one responded aloud. So Waldman spoke up, saying that we do not need tort “reform.” We need tort replacement. We need to dismantle the adversarial malpractice system and create one that will do what we want: compensate the injured and improve outcomes. (He then made a plug for his book “Uproot U.S. Healthcare,” which describes how we might do that.)

We need to restore the [direct] doctor-patient connection.

Everyone agreed with this statement. The moderator then reminded the audience that part of such a connection was direct payment. The audience seemed to have no problem with doctors making money. It was the government taking and controlling their money that rankled them.

What is the next step if Obamacare is repealed (overturned by the Supreme Court)?

Again, there was silence, with the audience expecting Waldman to answer, so he (I) did. Repeal of PPAHCA or not, either way healthcare is terminally ill and needs radical treatment. We cannot keep tinkering with a system that does not work and can never work. We The Patients – homage to We The People – need to become doctors for sick healthcare. “Uproot U.S. Healthcare” shows us how – it gives us power.

What happens if the Supreme Court strikes down the financial requirements in Obamacare but the Federal Government keeps the mandate to provide care regardless of payment source?

This was addressed specifically to the moderator. Waldman said, “So what? Nothing changes.” Either way, hospitals and doctors are legally bound to provide care for people most of whom cannot pay. Though care is federally mandated, the government does not pay.

Waldman brought up the question of illegal residents and health care for them. Discussion followed including the history of numbers (of uninsured “Americans”) as well as how European healthcare systems handle illegals (they don’t). The audience then demanded that Waldman give his personal opinion on what should be done.

I answered as follows. We as a nation should decide this important question. We The People should not accept what the pundits say or the President (or I, Deane) think is right. WE as a People should have a national dialogue, and then we should decide what is right.

I am a veteran and was injured in Vietnam just as our soldiers are now coming back injured from the wars in Iraq and Afghanistan. What is going to happen to health care for Veterans?

Nothing good. As shown in the film Sick & Sicker, the Province of Quebec now spends over 40% of its entire budget on healthcare and yet people are dying waiting in line for services. When those in power, “the system,” must decide between paying the providers or paying itself, guess who gets the short end of the stick. With limited resources, care services (and patients whether veterans or not) suffer, while the bureaucracy survives and thrives.

Medical school enrollment is down; people are leaving the healthcare profession. How common is this? How bad will this be for us?

As the film Sick & Sicker showed, the Canadian government aggressively pared down the number of physicians in its efforts to control costs. This resulted in millions who simply cannot find a doctor. From 1995 to 2006, applications to U.S. medical schools fell almost 20%. There are currently over 500,000 unfilled nursing positions in the U.S.

“How bad will it be for us?” The moderator had nothing optimistic to respond. He reiterated that We The Patients must become active in our own self-interest and fix healthcare.

What will I do if Medicare reimbursements fall below the doctor’s cost and the doctor won’t see me anymore?

Medicare reimbursements HAVE fallen to below financially survivable numbers for doctors, and doctors are refusing to see Medicare patients. The film showed what will happen: people will wait, people will suffer, and people will die.

At the back of the meeting room there was a poster advertising moderator Waldman’s book and asking people to post question to be answered on this website. One such posted question was the following. “What are the strategies for a successful medical model after we find Obamacare unconstitutional?”

The answer is, as emphasized in “Uproot U.S. Healthcare,” to practice good medicine on healthcare. That means We The People must agree on a set of principles that will govern healthcare and then demand a new system based on those principles. That model and only that model will work.

CONCLUSION

People with different views exchanged their opinions. There was difference. There was honest exchange of divergent ideas. People demanded evidence when other people spoke out.

This was quite different from the staged events in 2009 that called themselves town hall meetings. This town hall was a great success because it was real dialogue. It was a small (okay, a tiny) step in the right direction – the path toward consensus.

The Rio Grande Foundation plans to hold more such town hall meetings around New Mexico. We urge other think tanks throughout the nation of whatever persuasion to do the same.

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Hopefully, We Need Not Repeat 1776.

by Deane on December 11, 2011

The parallels are worrisome, even frightening. In many ways, people now living in the United States of America have returned to circumstances of our revolutionary forbearers. Hopefully, George Santana was not referring to us: “Those who cannot learn from history are doomed to repeat it.”

In 1776, there was an hereditary British aristocracy that was totally out of touch with the everyday class, in fact preying on it. Today we have an elite class of professional politicians with apparently lifelong tenure in Congress and their minions in a massive bureaucracy that controls the populace by overseeing regulatory compliance.

In 1776, the ruling class protected and extended their power using a military often built through impressment. Today, the power elite fosters a class of government dependents who, in order to protect their government handouts or bailouts, keep the elite in power through the ballot box.

Three nights ago, I moderated a town hall meeting on healthcare. [That meeting will be described shortly on this web site.] In the course of our dialogue, I called for a show of hands asking, “If you could, how many of you would vote out all, repeat all, 535 members of Congress?” Instantly, almost the entire audience enthusiastically raised their hands.

In 1776, King George III dictated to a group of colonies, separated from him by great distance. Today, we have an elected monarch (President) who preaches at (not even to) us, who is totally out of touch with reality. Like King George, the President is separated greatly from his subjects but Obama’s isolation is because of ideologic blinders.

The President blames the rich – not his own policies – for all our national woes. He wants to control the nation in order to redistribute its wealth. We The People want to be independent and free. We, the creators of wealth, want to become rich, not destroy them. As true liberals and therefore followers of John Locke, we deplore being dependent on the government, resent control by the government, and like the Founding Fathers, we will resist.

In 1776 (actually it was 1765), the Stamp Act was imposed on us. It took our money without our consent. As colonists, we declared it unconstitutional. Today, we have “Obamacare” or the PPAHCA, which is similar, almost identical.

The cry of taxation without representation and using our own money against us seems all too appropriate today. Think of our involvement in foreign wars, job-killing legislation, the favored handling certain (campaign contributor) groups, bailouts, and Solyndra.

In 1776, the monarchy – the government – controlled our lives, our liberty, our property, and our precious honor. In response, we declared a Bill of Rights, which was not a list of RIGHTS at all. It was a list of constraints against the government imposing its will on us. Our nation was founded in defense of one single right for Americans: to be free.

There is one huge difference between 1776 and today. Then, we were powerless unless and until we took up arms. Today, we do have power: the power of a single vote multiplied by hundreds of millions.

This is not a call for another armed, bloody revolt. This is a cry for bloodless revolution, called democratic change.

As “government is the problem, not the solution,” We The People should change our government. We must throw out the current power elite: 535 members of Congress plus the White House. We need to depopulate the bureaucracy and force the regulators and overseers to do something productive instead of confiscatory. Then, we should repopulate the Beltway with people who remember what we did and why we did it 235 years ago.

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