Whom Should We Believe?

by Deane on June 5, 2013

The single greatest strength of the Internet is its freedom: from censorship, expurgation, or adjustment. The single greatest weakness of the Internet is that very strength: anyone can put out anything in plain view no matter how wrong or biased.

For users of the Internet like me who seek accurate facts and reliable information, the problem is to distinguish wheat from chaff, the truth from … something that smells. Two recent articles highlight our difficulty.

On the widely read Huffington Post, the President of the American Federation of teachers, Randi Weingarten, assured us that the Affordable Care Act (ACA) is working. She wrote the following on 04/20/13.

“Millions of previously uninsured people have gained healthcare coverage; the law has begun to rein in healthcare costs; consumers are starting to realize savings; patients have greater access to preventive care; and carrots and sticks throughout the healthcare industry are spurring moves to improve quality.”

Five days before that in the American Spectator, healthcare economist David Catron blogged that, “The Wheels Come Off Obamacare.” He was referring of course to the same ACA as Weingarten. Selected quotes from his article are below.

“This hopelessly Byzantine health care “reform” law is an implementation nightmare.” ACA’s CLASS [Community Living Assistance Services and Supports] Act had to be “repealed in January.” Congress also voted “to repeal Obamacare’s job-killing 2.3 percent excise tax.” “Even the much-touted Obamacare provision that we were told would eliminate the ‘pre-existing condition’ scourge is proving to be a bust.” “When Obamacare was first shoved down our throats, we were told that it would cost $898 billion. Now the projected cost is over $1.6 trillion. Meanwhile, many of its taxes are now in effect and it is forcing health insurance premiums through the roof.”

Two prominent individuals, writing in two respected online venues, report success and failure of the same Law, a Law that affects every American, even (especially) those not yet born.

Who is right? They can’t both be. How do we peons decide?

Many people start with the person: judging the message by the messenger. You might easily think, “Well, if the President is saying it, then it must be true.” Let me offer two recent examples. Then you decide.

President Bush (#43) assured us there were weapons of mass destruction (WMDs) in Iraq. That was the ostensible reason for starting the War. How did that work out? Then there was President Obama claiming that the attack in Benghazi was caused by a silly but offensive video that almost no one viewed, made by a nutty Coptic American.

(I won’t lower myself to use President Clinton as an example. I will leave you with two words: Monica Lewinsky.)

Clearly, if you cannot trust a US President to always speak the truth, you cannot use the messenger as an indicator of accuracy of the message.

The answer is simple and hard. As they say in legal proceedings, what does the “weight of evidence” tell you? If the military found no WMDs in Iraq, they probably weren’t there. If the military analysis reveals careful pre-planning for Benghazi, it was the opposite of a “spontaneous reaction.”

What about ACA? Is it working or failing? Who is right, Weingarten or Catron? What is the weight of the evidence?

There are numerous reports that can give us hard evidence: statistics about what is happening now. Projections about what will happen are not hard evidence.

Health insurance premiums are up 18-32% so far. That is evidence you can see for yourself in your bills for premium payments. More and more employers are cancelling their support of employee health insurance, accepting the ACA penalty as a cheaper alternative.

The Pre-Existing Conditions Insurance Plan (a part of ACA) has cancelled all further enrollments. This leaves over 267,000 people stranded, denied the insurance that they were promised.

Employers are cutting work hours, letting people go (euphemism for pink slips) and certainly not hiring any new employees. They are seeking any way possible to stay in business given the tremendous increase in their costs created by ACA. The Medical Device tax, which was not successfully repealed, remains in force crushing young start-up companies because the tax is 2.3% of gross receipts, not profits.

Over thirty percent of US doctors can no longer afford to accept Medicaid-insured patients, and the number is rising. Meanwhile, millions are supposed to be added to Medicaid roles. Who will provide their care?

As for ACA cutting costs, you do the math. ACA is now scheduled to spend between $1.6 and $2.7 trillion, which is more than has been spent on the Wars in Iraq and Afghanistan, combined. That is spending that must be added to the national deficit.

Now go back and review the quotes by Weingarten and Catron. Then you  decide, based on the weight of evidence, who is blowing smoke and who is telling it like it is.




Freedom Is Not Free.

by Deane on May 23, 2013

 Nothing in this world is free, nothing.

Not even freedom. Especially not freedom.

With freedom comes choice –

They cannot be separated.

The free man must always choose,

And with choice comes consequence.

The free man is responsible for his consequence.

Freedom is never ever free, of responsibility.


Should She Be A Doctor?

by Deane on April 20, 2013

Last weekend, after I gave a speech at a public forum about healthcare, a woman came up to the podium and asked me a question. “My daughter was just accepted to medical school. Do you think she should be a doctor?” This should have been the easiest question ever, but was the opposite.

I come from a family of physicians going back more than three generations. It is what we did, what we were. At a family gathering several years ago, I counted at least 14 men or women who were practicing physicians. Three of the fourteen doctors had married medical school classmates, raising the ‘family’ number to seventeen.

Our family believed that the highest calling for a human being was to heal other human beings. So, it should have been easy and immediate for me to say to the mother at the podium, “Of course, your daughter should be a physician. There is nothing better in the entire world!” It pained me not to say that.

A recent Wall Street Journal article written by another physician, more precisely ex-physician Dr. Ed Marsh, expresses several emotions all too common in the community of health care providers: doctors, nurses, and allied health personnel. We are angry, frustrated, and confused.

Prematurely retired Dr. Marsh summarized: “The glow of the personal relationship one might have with one’s patients [the reason we get up in the middle of the night for you] is being [actively] extinguished.” He speaks for virtually all doctors, nurses, and care providers, everywhere, not just in the US.

Dr. Marsh is anything but an isolated case. I too gave up clinical medicine last October, most reluctantly. I love caring for babies and still miss doing it. Forty-to-fifty percent of practicing doctors are now thinking about early retirement.

The national data on provider shortages is clear. From 1995-2008, admission applications to US medical schools fell by almost 20%. Last year there were 110 accredited training positions in heart surgery in the US. Sixty applied. There are roughly one half a million unfilled nursing positions here.

Compared to other nations, the US ranks #1 in spending on healthcare by a very wide margin. In 2010, we spent 17.6% of GDP. Germany, in second position, spent 11.6%.

What did We The People get for all that money? The US is #34 in infant mortality; #40 in population longevity; #81 in hospital beds per 1000 people. The US is #52 in doctors per 1000 people (2.3) but we maintain our top position in lawyers per 1000 people (3.7).

The explanation for the personnel shortages, as well as early retirements like Dr. Marsh and me, was made public many years ago. The #1 dissatisfier of care providers was job environment. Money – lack of it – was not statistically significant. Interestingly, the #1 satisfier of care providers was job content.

Put as bluntly as possible, we love caring for patients and hate the environment or system in which we are forced to do it. This distinction is quite timely in view of a recent Harvard Business Review article titled,  “The Happiest People Pursue the Most Difficult Problems.”

The author, Rosabeth Moss Kanter, wrote the following. “The happiest people I know are dedicated to dealing with the most difficult problems. Turning around inner city schools. Finding solutions to homelessness or unsafe drinking water. Supporting children with terminal illnesses. They face the seemingly worst of the world with a conviction that they can do something about it and serve others.”

Kanter is both right and wrong. I love the act of caring for sick babies with congenital heart disease. I hate having to fight, threaten, cajole, and sometimes, outright lie in order to get those blue babies what they need.

Twenty years ago, management guru Carl Weick gave us the answer, without knowing it. His classic 1993 paper “The collapse of sensemaking in organizations: The Mann Gulch Disaster” described the “cosmology episode,” where the basic rules of life do not exist, and the world makes no sense.

In a cosmology episode, you throw a ball up into the air, and it never comes down. In a cosmology episode, the sun rises in the south. In a cosmology episode, black is white and red is orange but may suddenly change to green.

In healthcare today, the patient perceives the provider as an enemy: cosmology. What do providers experience? Answer: cosmology episode in the form of roadblocks where there should be wide-open freeways; reasons why they can’t do what the patient needs; and punishment for doing good deeds.

The ball didn’t come down? No sun rising in the east? Provider trying to save you is labeled a “perp” (perpetrator)? Makes no sense, no sense at all! That is the world in which today’s health care provider lives.

No wonder care providers are confused, frustrated, and angry. Wouldn’t you be? No wonder they are leaving healthcare (the system) even though they love providing health care (the service).

(This article previously appeared in American Thinker. It is worth your time reading the comments, especially from other practicing physicians, most of whom have quit, for the same reason as I did. While this is most sad for us as providers, it is [or should be] terrifying for We The Patients.)

What should I have answered the mother of the pre-med student? If you were in my shoes, what would you say?

Note about author: Deane Waldman MD MBA is or more accurately was a pediatric cardiologist who retired from clinical practice saying, “I cannot practice good medicine under Obamacare.” If you really want to understand what is happening and why, read his forthcoming (July 2013) book, The Cancer in Healthcare.



Shouldn’t the people we vote into power provide role models for how We The People should behave? I would hope that is a rhetorical question, but apparently it is not.

Obesity is by far the most costly and yet preventable illness facing the United States. The doctor who is the titular head of the US healthcare system would naturally lead the effort to address the problem. How much credibility does US Surgeon General, Dr. Regina Benjamin (panel A below), have in the fight against obesity when she is its poster boy?

On the subject of obesity, watch for a sequel to Cutting healthcare costs by killing patients (2/27/13), called “Cutting healthcare costs by saving patients.”

Organizationally, the IRS is under the control of the Dept of the Treasury. You would naturally expect, as I did, the Secretary of the Treasury to set an example for all tax paying citizens. What kind of role model was former-Treasury Secretary Timothy Geithner, a man who forgot or mistakenly filed his tax returns?

The President of the US clearly is or should be our best role model, a paragon of honesty and integrity that we all should emulate. (“Honest Abe” Lincoln immediately comes to mind.) How does one then understand the pattern of lies of which President Obama has been proven guilty?

As evidence, consider the following: Obamacare (where you cannot “keep your doctor if you want to”); the slaughter of four Americans in Benghazi (Hillary Clinton fell on her sword to protect the President); and most recently, “I had nothing to do with that” (the Sequester.) Read Bob Woodward’s article that proves the author was, indeed, Obama.

To provide full disclosure, Democrats are not the only people in Washington who provide us with “reverse role models.” When thinking of Republicans, the names is John Mitchell (Attorney General under Nixon) and Spiro Agnew (39th US Vice President) immediately come to mind.

However, the bulk of “blame and shame” belongs to Democrats. They consistently assert ownership of the moral high ground. It is therefore ironic and frankly alarming to find that their claim to moral superiority is as disingenuous as most everything else they say.


Cutting costs by killing patients

March 1, 2013

UN Resolution 260 (III) – Convention on the Prevention and Punishment of the Crime of Genocide – was signed on December 9, 1948. It memorializes a worldwide consensus against State-sanctioned killing of people by groups. The convention protects “national, ethnical, racial or religious group[s].” The Convention forgot to protect a group called the expensives. Nation-States […]

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