Medpolitics, A Political Network of US Doctors -

Paging Dr. Galt : Health Care from the Producer's Perspective

EvanMadianosMD — Wed, 02 Sep 2009 13:28:13 -0400

Much of the debate over the health-care bill starts and stops in the wrong place. It dwells on the experiences of health-care consumers—but the story actually begins with the producers of health care, the doctors, nurses, hospitals, drug companies. Without these producers, no health care is available for the consumers to buy—at any price. So we need to begin by looking at the current legislation from the perspective of the producers.

So far, President Obama's efforts in that direction merely betray the inability of a lifelong leftist to see private enterprise in any terms other than the standard Marxist caricatures about "greed" and exploitation. He made that jarringly clear in his attacks on doctors, whom he has

Let's take the example of something like diabetes, one of—a disease that's sky-rocketing, partly because of obesity. Partly because it is not treated as effectively as it could be. Right now if we paid a family—if a family care physician works with his or her patient, to help them lose weight, modify diet, monitors whether they are taking their medication in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately the surgeon is reimbursed.

That part about surgeons being paid fabulous sums of money for amputations turns out to be a total fabrication. The actual reimbursement for such a procedure is less than $1,000.

Obama also explained for us the workings of the tonsillectomy racket.

Obamacare: Where's the innovation?

EvanMadianosMD — Mon, 31 Aug 2009 17:04:39 -0400

Obamacare: Where's the innovation?

By MICHAEL P. TREMOGLIE

THE TWO MOST significant aspects of the healthcare reform being proposed by President Obama:

A. The plan offers nothing that hasn't been rejected already.

B. And it fails to address two major cost issues.

During his recent ABC appearance, Mr. Obama gave a glimpse of his cost-containment strategy. Responding to a question, he said, "We can let doctors know . . . maybe this isn't going to help," maybe the patient is "better off not having the surgery but taking the painkiller."

Unsaid was who would be the "we" who was going to "let doctors know." But what Mr. Obama did refer to, inadvertently, was what used to be called in the early and mid-'90s - when I was a managed-care executive - medical management using "clinical practice guidelines."

This meant an actuarial company would establish an extensive database of medical procedures that were the most effective and efficient. Then the list was used by HMOs to decide the treatments patients received.

This approach was soundly rejected. The public, politicians and providers derisively referred to it as "cookbook" medicine.

Obama has merely recycled it under a new name, "evidence-based practice."

The Brookings Institution, a liberal think-tank, recently published a paper about health-care reform that made several recommendations.

One was, "Use comparative effectiveness results to support innovative coverage and payment policies . . . help support novel payment policies that will be more effective at rewarding evidence-based practice."

" 'Evidence-based medicine' is the au courant term," said Dr. Celeste Mruk, of Bala Cynwyd Medical Associates. Mruk is a clinical assistant professor of medicine at Penn, and well-versed in the finances of medical services.

One_ Single Payer System- the Musical

EvanMadianosMD — Mon, 31 Aug 2009 01:13:45 -0400

One_ Single Payer System- the Musical

Starring B.O., Harry Reid, Nancy Pelosi....

Now this woulod be funny....:)- if it wasnt' true....
Obama's new Broadway sensation on YouTube...:)-

http://www.youtube.com/watch?v=MQ_tAe87ELo

Rationing I: Price Distribution Is Not Rationing

EvanMadianosMD — Fri, 28 Aug 2009 16:53:48 -0400

By Ari Armstrong

The Health-Care Bureaucracy-Formation Bill

EvanMadianosMD — Mon, 24 Aug 2009 00:23:43 -0400

The Health-Care Bureaucracy-Formation Bill

by Robert Tracinski , editor www.TIADaily.com
Aug 19, 2009

Facing a broad public rejection of President Obama's health-care bill, our Kamikaze Congress is contemplating the political suicide of ramming the bill through against the people's loudly expressed wishes, using the brute power of a Democratic majority without even the window dressing of support from moderate Republicans.

But these congressional leaders are just whistling Dixie—an apt metaphor, since their real problem is their inability to convince Southern "Blue Dog" Democrats. The health-care bill was never held up because moderate Republicans refused their support. It was held up because moderate Democrats refused to support it.

More likely, the Democrats will attempt to water down the bill and offer fake compromises such as the substitution of government-backed health-insurance "co-ops" for the "public option"—a distinction without much of a difference.

Over the weekend, the White House briefly indicated its support for this tactical retreat, only to backtrack when faced with opposition from far left congressmen in the House. That reversal actually makes the dropping of the "public option" more likely.

We're Winning

EvanMadianosMD — Wed, 19 Aug 2009 16:42:47 -0400

We're Winning

-Robert Tracinski, editor www.TIADaily.com

Excerpt:

"Why are we winning in the battle against socialized medicine? Partly because we have the facts on our side. Here are a few more of them.

Michael Tanner clearly explains how the entire rationale behind the Obama health-care plan is based on a myth: the 47 million uninsured. He breaks down the various people who make up this group and shows how the claim that these people are cruelly being denied health care is a lie. (Michael Ramirez also has a good cartoon summarizing this data.)

Health Care "Ghimmitude"

EvanMadianosMD — Wed, 19 Aug 2009 10:32:18 -0400

Health Care "Ghimmitude"
by Robert Tracinski, editor www.TIADailycom

Excerpt from TIADaily.com:

" My article on Obama's war on health insurance, published at RealClearPolitics and in a shorter version at Investor's Business Daily, focused on the issue of individualism versus collectivism.

In thinking about that focus, I realized a notable difference between the 1994 health-care debate and today's. Back then, the administration and its supporters put much more emphasis on the idea of a "right to health care."

Obama has not emphasized that, partly because he is deliberately doing the opposite of what Hillary Clinton did, and partly for a more insidious reason.

A "right to health care" emphasizes the individual's prerogative to demand that a good be delivered to him. It is an attempt to steal the individualistic language of rights for a collectivist purpose.

But the whole emphasis of Obama's program is cost cutting, which emphasizes, not what the government is going to provide for you, but what it is going to deny you. That's why we're all talking about "death panels."

In short, Obama has sold the program in a way that inadvertently emphasizes the fact that you will be dependent on government for life-or-death needs, making individualism versus collectivism into the central issue.

I say all of that to introduce a brilliant formulation of this issue from a legal blogger.

He calls it "ghimmitude"—a combination of "gimme" and "dhimmitude" which brilliantly captures the way in which the leftist chooses to sell his soul, giving up his birthright of independence in exchange for a handout from the state.

"Health Care Ghimmitude," William A. Jacobson, Legal Insurrection, August 4

Real Debate Is Individualism Vs. Collectivism

EvanMadianosMD — Tue, 18 Aug 2009 09:18:57 -0400

By ROBERT TRACINSKI

The goal of the Democrats' plan for health care reform is coming more and more out into the open: They want to eliminate health insurance.

This is the line of attack the Democrats have chosen as they've gone into the August recess:

Private health insurance companies are evil, and big government is here to save us from them.

According to the New York Times, President Obama is planning an "August offensive against the insurance industry." It is "a campaign of increasingly harsh rhetoric" that is "intended to drive home the message that revamping the health care system will protect consumers by ending unpopular insurance industry practices, like refusing patients with pre-existing conditions."

That part about pre-existing conditions gives the game away. Health insurance companies refuse to cover pre-existing conditions for the same reason that you can't insure your automobile after you crash it.

Insurance is a form of financing for the unexpected and unpredictable. It is not a mechanism to force somebody else to pick up the tab for expenses you have already incurred.

Do the Democrats even understand what insurance is? Insurance is a form of financing. It is a contract under which a health insurance company agrees to pay for medical bills that could run into the tens of thousands of dollars, if you are hit by a bus or are diagnosed with cancer, so that you don't have to pay for those bills out of your income or savings.

So let's ask the question the left never asks: How is it possible for an insurance company to pay for these giant medical bills?

Welfare, Not Insurance

Obama's Death Panels: Whose Life Is It, Anyway?

EvanMadianosMD — Sun, 16 Aug 2009 00:29:13 -0400

Obama's Death Panels: Whose Life Is It, Anyway?

The Real "Death Panel" Threat Is the Morality of Collectivism
by Robert Tracinski editor, www.TIADaily.com

"The big story of the past week is the controversy over "death panels"—Sarah Palin's term for the idea that "my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care."

The basis for this claim is two different provisions put forward in various
versions of the (still not completely written) health-care bill.

The first is a proposal to establish a panel of medical experts who would
determine which treatments are supposedly most cost-effective and thus will be paid for under a government-run system—and which will not.

In a New York Times interview in April, which makes very instructive reading in the current debate, President Obama explained that "part of what I think government can do effectively" is to be a "broker" "between patient and provider"—that is, between you and your doctor—"in assessing and evaluating treatment options."

He continued: "And certainly that's true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control."

The example he gives? Whether his ailing grandmother should have been allowed a hip replacement in the final months of her life.

"End-of-life care" he said, is an area where "you just get into some very
difficult moral issues. But that's also a huge driver of cost, right? I mean,
the chronically ill and those toward the end of their lives are accounting for
potentially 80 percent of the total health care bill out here."

The Whole Foods Alternative to ObamaCare

EvanMadianosMD — Sat, 15 Aug 2009 23:46:27 -0400

The Whole Foods Alternative to ObamaCare

By JOHN MACKEY

“The problem with socialism is that eventually you run out
of other people’s money.”

—Margaret Thatcher

"With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system.

Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems.

20 Questions for Your Congressman

EvanMadianosMD — Tue, 11 Aug 2009 11:12:44 -0400

20 Questions for Your Congressman
by Robert Tracinski, editor www.TIADaily.com

"The smear against small-government advocates who have confronted their congressmen at town hall meetings is that they are an "angry mob" who just want to shout down advocates of Obama's health-care bill. In fact, these protesters have come to the meetings to ask some tough questions—questions that should have been asked by the mainstream media.

So when you head off to a local town hall meeting during the August recess, focus on asking good questions. I don't mean just rhetorical questions intended to make a point, but also real questions that require a substantive answer.

As a guide to help you prepare for your local town hall meeting, here are my suggestions for 20 questions you can ask your elected representatives about the economics, history, politics, and morality of Obama's health-care plan. If your elected representative will answer these questions, it will tell you a great deal about his principles (or lack of them) and his goals.

It might also tell you about his method of making decisions: does he just repeat canned talking points, or does he really think about your questions? And if he won't answer your questions—if he doesn't have the guts to do anything but preach to the converted at union-sponsored rallies—well, that gives you all the answers you need right there, doesn't it?

But don't just ask these questions of your congressmen. Ask them of your friends and neighbors, of newspaper columnists and reporters, of local doctors and businessmen and others in positions of influence. These are the kinds of questions we should all be thinking about and trying to answer, if we are going to subject this legislation to the scrutiny it needs before Congress votes on it.

Contempt for the Governed

EvanMadianosMD — Sun, 09 Aug 2009 12:25:15 -0400

Contempt for the Governed

by Robert Tracinski, editor www.TIADaily.com

"Faced with a full August of "Town Hall Hell," in which they would be forced to face constituents angry over six months of bailouts, runaway spending, and an attempt to socialize medicine, the Democrats have decided on their response: to denounce their constituents as "angry mobs" and to do their best to avoid them.

Our political system is based on "the consent of the governed." This approach is the opposite: contempt for the governed.

Some congressmen have decided to cancel their town hall appearances. Others are filtering out the audiences, packing them with union members and other advocates of socialized medicine, while keeping out anyone who might show signs of public dissent.

TIA Daily reader Robert Fudge reports on his experience at an event in Tampa which has gotten quite a bit of attention:

Health-Care Reform: A Better Plan

DrO — Sun, 09 Aug 2009 00:34:41 -0400

In the latest Washington Post, Charles Krauthammer offers a plan that "strips away inefficiencies from the existing system before adding
Obamacare's new ones -- arbitrary, politically driven, structural
inventions whose consequence is certain financial ruin."

Krauthammer should know: he was a doctor, a psychiatrist at Massachusetts General Hospital before becaming a political commentator. So what he proposes is a plan based on 2 simple ideas: a tort reform (to eliminate the risk of the looming arbitrary lawsuits against doctors and hospitals) and health-insurance reform ("severing the link between health insurance and employment").

It is a shame that neither AMA, nor other organisations or leading political figures propose such a sensible plan!

Top Ten Reasons to Avoid the Massachusetts Model for Health Care

EvanMadianosMD — Thu, 06 Aug 2009 12:30:27 -0400

Top Ten Reasons to Avoid the Massachusetts Model for Health Care

By Paul Hsieh, MD, Freedom and Individual Rights in Medicine

www.WeStandFirm.org

http://www.westandfirm.org/blog/2009/08/top-ten-reasons-to-avoid-massachusetts.html

The Boston Herald website includes this short discussion, "Top Ten Reasons to Avoid the Massachusetts Model for Health Care".

http://www.bostonherald.com/blogs/news/lone_republican/?p=598&srvc=home&position=recent

Their points include:

The War on Health Insurance

EvanMadianosMD — Mon, 03 Aug 2009 21:34:07 -0400

The War on Health Insurance
by Robert Tracinski, editor, www.TIADaily.com

"The goal of the Democrats' plan for health-care reform is coming more and more out into the open: they want to eliminate health insurance.

Barney Frank has been caught on video admitting that the "public option," which is the centerpiece of the current legislation, is just a step toward what is called a "single-payer" system—a euphemism meant to hide the fact that the single payer is the government.

(Frank was prompted into the admission by an advocate of "single payer" who opposes the current bill because it doesn't socialize medicine fast enough—which gives you an idea of the contrary pressures on the Democratic leadership.)

It turns out that this is the key kernel of opposition to the Obama health-care bill among the general public. People do not want to be forced out of their existing private health insurance. They are terrified of being deprived of any options other than government-provided health care.

So the Democrats' answer to this has been, not to reassure people that they will be allowed to keep their existing coverage—since this lie has proven too transparent to maintain—but instead to vilify the health-insurance companies.

As the article below describes, this is the line of attack the Democrats have chosen as they go into the August recess: private health-insurance companies are evil, and the Democrats are here to save us from them.

You can see this reflected among the left's supporters in the press, as in a sneering hatchet job in the LA Times, in which insurance companies are accused of—well, it's not all that clear what they're accused of, except maybe being "functional monopolies."

That's pretty rich when you consider that the left's preferred plan would mandate a "single payer"— the very definition of a monopoly.