Are We Feeling Better Yet?

The President’s Reform of the U.S. healthcare system is in full swing. Are we feeling better yet?

You should feel better since the age limit for Medicaid has been increased to 26 years. Now your 25 year-old can be covered. This is helpful since he cannot get a job. No one is hiring additional workers due to the financial penalties (one mustn’t call them taxes) imposed by HR 3590 (Obamacare).

At least, you must be relieved about the elimination of the “pre-existing condition” exclusion on health insurance policies. Of course, you may well lose your job (and with it your health insurance) because of Obamacare. Didn’t think of that?

U.S. companies did their due diligence, which Congress did not. Corporations such as Medtronik, AT&T, and Deere Machinery calculated how much additional expense Obamacare would add to their bottom lines, with no offsetting revenue. They then reported their findings publicly, which produced great Democrat ire.

Anyone who has ever balanced a checkbook – which people in the Beltway obviously have not – knows that if costs go up in one area (like insurance you are required to purchase by law, see HR 3590) and you cannot make more money, then you have to cut costs somewhere else.

So U.S. companies are cutting back on their workforces. The politically correct acronym is RIF, reduction in force. That is what you and I call being laid off, losing our job.

Does Obamacare make you feel better now that you do not have to get up in the morning to go to work? The good news is that with no job and no income, you can join your son on the roles of Medicaid.

No doubt your chest swells with pride that Obamacare avoided injecting those nasty, capitalist market forces into healthcare. Profit motive has no place in the business of healthcare, right? Though real-world people wanted a clause to allow insurance companies to compete across State lines, that was not included in the Bill. So what if your health insurance premiums are going up? At least you can say you stayed with the liberal agenda.

But one thing certainly must make you feel tingly all over: no Americans will lack health insurance. Well…maybe not. There are two small-ish problems and a giant one.

Small problem (#1) is that no one knows how or IF Obamacare will actually get the uninsured to become insured. According to the GAO, at least 24% of uninsured Americans are so by choice. They do not want to sign up.

Not-so-small problem (#2) relates to illegal residents. Are they covered under Obamacare or not? They do get care now and will continue to receive care. The unanswered question is whether hospitals and doctors will get paid. The sidestepping on this question by the Democrats was worthy of first prize on Star Search. Not feeling so good? Sorry, but we also have to consider the BIG problem.

The big problem is simple. Health insurance does not equal health care. Obamacare is driving nurses and doctors right out of medicine. So, even if you have insurance, who will care for you? Can you see Nancy Pelosi using a stethoscope, Harry Reid wielding a scalpel? I bet that is giving you chest pains.

I hate to rain on your parade, especially when you’re not feeling well. There is finally the cost of Obamacare. Over $2 trillion (with a “t”, not even a “b”) will be expended, mostly on a massive increase in the federal bureaucracy. HR 3590 creates 68 new grant Programs, 47 bureaucratic entities, 29 demonstration projects, six whole new regulatory agencies, six compliance standards, two new entitlements, and a large expansion of the IRS.

These are dollars we do not have. Therefore, these are dollars the government will have to print (‘create money’), adding to our already bloated deficit. So, the queasy feeling you now have will extend to your children and grandchildren because they will have to pay for all this spending.

Feeling sick? Nauseous? Trouble Breathing? Unfortunately, there are no doctors, no nurses; you have no job, no insurance, and a deficit you cannot possibly afford. Nonetheless, what you think you are feeling must be incorrect. After all, President Obama said he would fix everything. Since you know he means well, he must be doing right. Right? RIGHT?! Oh sorry, I forgot you also have trouble with hearing and eyesight.

System MD

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Obama’s Problem: He Can’t UNlearn.

Ask anyone who has studied the process of learning. The hardest and most critical step is unlearning what you know, something our President clearly cannot do.

On November 2nd, the American people gave our President a clear and unambiguous message: we do not like what you have been doing and we want you to change direction. It was obvious at his press conference on November 3rd that he did not hear or failed to understand the message. Why?

The more successful one is, the harder it is for that person to unlearn. The higher you go, the more proof you get that you are right, whether you are CEO of a company, Chairman of Surgery, or especially the top of the food chain: President of the U.S. Why should you question what you know or do? The title on your door proves that what you know is right.

A wise person (notice that I did not write a smart person) wrote a bumper sticker: “Don’t believe everything you think.” This aphorism is highly practical for two reasons.

First, whatever exists and is true today, the one absolute certainty is that tomorrow will be different. Second, until and unless future outcomes prove that you were right, you may be wrong.

When I was a child, doctors used to shrink the tonsils with x-rays. Thirty years later, we learned that irradiation produced thyroid tumors. Such treatment, once considered best medical practice, is now malpractice. Things change.

At Columbia (presumably), then-Mister Obama learned that socialism is the best, most humane political system. It is probably no accident that radical socialists Cloward and Pivens were also Professors at Columbia.

The President may have been a very smart student then but is now a very poor unlearner. Three compelling facts seem to have no impact on him.

Fact #1: Capitalism is the reason why the USA is the richest, most productive nation. As we are witnessing, the means by which China is becoming an economic powerhouse is through implementing capitalist principles.
Fact #2: Socialism and its entitlement mentality are very obviously failing in Europe. Cases in point: Greece, Great Britain, etc. The extreme form of socialism is communism. The world knows where that led.
Fact #3: Most Americans want the U.S. to stay capitalist and reject any move toward the left, toward socialism.

Despite these facts, President Obama refuses to say or even consider that his policies are flawed and unwanted, that he needs to unlearn, and that he must change direction.

With the way things are going, some are beginning to question whether our children will have better lives than we have. To achieve continuous improvement requires continuous unlearning. To learn the new and better, you must let go of the old: what you currently know is true. Unlearning is something President Obama demonstrably cannot do. Is it any wonder that things are not improving?

Having an “Undo” button may sound like a great idea. However, you must unlearn what you know in order to undo what you did. President Obama cannot do this. Therefore, even if he had an undo button, he wouldn’t use it. Obamacare should be what Billy Cristal called in the movie Cityslickers, “A Do-over.” You have to unlearn the old before you can learn the new-and-better, and then do-over.

Since the President we currently have is incapable of unlearning and will not change, regrettably we will have to change Presidents (two years’ hence).

System MD

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Don’t Repeal Obamacare: ‘Fix’ It!

An OPEN LETTER to House Republican Leadership:
Should you try to repeal Obamacare? No, for three reasons: 1) The President has already promised that he will veto any repeal; 2) There are a few (minor) good things, such as elimination of pre-existing condition exclusion and extension of Medicaid age eligibility; and 3) There are better ways to deal with this flawed Act than another bitter partisan floor fight.

The new Congress should do what the previous Democrat Congress did not do: their homework on H.R. 3590, what business calls its ‘due diligence.’

No one outside the Beltway would urge their company CEO to spend lots of corporate dollars without first doing a detailed cost/benefit analysis to prove that the gain is worth the outlay. The President says we should trust him: Obamacare will be good for us. The American people have said we don’t and it won’t!

I say, let the evidence speak. Don’t let bombast, bias, and scotoma prevail over hard data.

To fix Obamacare, first create a non-partisan Commission (HAC, or Healthcare Allocations Commission) staffed with a majority of practicing nurses and doctors, leavened by economists and management experts. This Commission will be tasked with advising the House Ways and Means Committee on which provisions of HR 3590 should be funded and which should not.

Next require all Directors tasked with implementing Obamacare – there are at least six new agencies –to submit to the HAC within six months a cost/benefit analysis based on evidence of their Agency, the new regulations, or any other activity embodied in the Healthcare ‘Reform’ Bill that will impact patients or our national bottom line.

Each analysis must include hard evidence in two parts: Costs and Patient/National Benefits.
* COSTS include money – immediate, long-term, and avoided costs – as well as other resources such as personnel, physical plant, capital equipment, disposables, and consumables.
* BENEFITS must list outcomes patients that patients such as increased lifespan; rapid, quantified restoration of health when sick; and national gains in productivity. [If they say that they cannot prove these real benefits, ask yourself why should we pay them with real dollars?]

We all know that the previous Congress should have done this BEFORE they imposed Obamacare on us. So let’s demand that the Obamacare bureaucracy do its homework…or else. I will be fascinated to see how anyone can argue against requiring evidence-based cost/benefit analysis before adding $2.7 trillion to an already unsupportable national deficit.

Talking heads on both the right and the left, and every national poll agree that the national deficit and job creation should have been and should be Washington’s top priorities. To increase jobs, Government must unshackle American business, not add new taxes, penalties and more costs as included in Obamacare.

The Deficit Reduction Commission will be reporting to the President and to Congress shortly. It seems obvious to everyone except the President that the U.S. should NOT spend $2.7 trillion (dollars that we do not have) on a new entitlement UNLESS that entitlement can prove it has a positive cost/benefit ratio?

Both President Obama and Republican leadership are now starting to talk about reducing government waste. You and I and every person who wants to solve problems more than live by partisan allegiances, we all know that new bureaucracies and associated regulatory compliance cost huge sums of our money. If cost/benefit analysis is negative, is that not the definition of “government waste?”

Republicans now in the majority:
Fix Obamacare and stop increasing government waste by creating a HAC.

System MD

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The ‘Fat Lady’ Is Mute.

A recent online article opined “It Is Over” for the Democrats in Washington: they are about to experience a crushing defeat in upcoming midterm elections. Unfortunately, after the words “It is over,” we must insert a very big BUT. As the saying goes, “It ain’t over till the fat lady sings,” but I hear no singing.

Most Americans oppose what the Democrats have done. Over 50% want Obamacare repealed. How, you ask, can any clear-thinking American reject President Obama’s free health care for all? Answer: Americans are good capitalists, at least outside the Beltway. We know that anything “free” is a chimera that ends up being grossly too expensive. We get less for more whenever something is supposedly free.

Further, we observe the failure of ‘free health care’ in Europe. Yet, that is precisely what the President and his Director-designate of Medicare, Dr. Don Berwick, want to enact here.

The British NHS has been forced to cut back drastically on health care services. If you are British, over 60 years old, and need either kidney dialysis or heart surgery, the NHS says too bad, no care for you. If you are a terminal British citizen (any age) and need hospice care, government-run health system will no longer provide.

Americans like neither what Congress has done so far nor the direction the Democrats are taking us: toward socialism. The Democrats and the President would vehemently deny that charge but what else do you call government control of resources as well as “redistribution” [President’s Obama’s word] of wealth?

The Democrats and their agenda will be repudiated. But, where is the fat lady? [No aspersions are intended on the body mass areas of either Republicans or Democrats. I am trying to be poetic.]

While the Republicans spout the right words about limited government and fiscal responsibility, they seem poised after November to do…nothing. It appears as though they are about to waste a great opportunity.

If they do not repeal Obamacare, then their words have no meaning. If they do repeal it, what substantive plan do they recommend to begin actually fixing healthcare? I see none. What we hear is minor adjustments to the existing system rather than what must be done: radical change.

In medical terms, the Democrats took a sick patient named healthcare and made the patient worse. That is malpractice. The Republicans suggest stopping the bad (Democrat) medicine and placing a band-aid on the cancer. That too is malpractice.

The Democrats claim they have fulfilled three of the five promises they made in 2008: Healthcare (and all we got was a tee-shirt exclaiming how great Obamacare is if we were only smart enough to understand), Education, and Reregulation. Education remains mired in confusion as the Democrat party continues to serve their actual constituencies: the unions. What do the Republicans propose that will inject a truly results-based education system instead of what we have now. The ‘result’ we want are educated citizens and productive workers. Do test scores correlate with those outcomes? Where is the data? What has been proven to work? THAT is what the Republicans should be offering us.

The Democrats claim that the reason for our present economic doldrums is Bush-era deregulation. Their cure is therefore Reregulation, which is code for greater government control over our financial lives. Americans want neither de- nor re-regulation. We want an environment that encourages (and rewards) hard work and entrepreneurial activities. We want more (and more and more) rich people, not turning rich people into poor people. Thus, anything that discourages business from taking risks – hiring people and expending capital – is exactly what we DON’T want. The Democrats have done that. Will the Republicans reverse this trend?

In the past, I have written that what we want is a level playing field on which good capitalists can compete to everyone’s advantage. The President wants to level the players with his “redistribution” approach. The problem with a sports analogy is that all such games are zero-sum: in order for someone to win, someone else must lose.

The American financial system called capitalism is NOT a zero-sum game. More and more people can ‘win’ without necessarily more and more losers. That is the beauty of capitalism. Though we have a large discrepancy between haves and have-nots in our country, we have many more “haves” than any other country in history, ever!

When we say to the Democrats ‘it is over for you,’ we need to say with equal force to the Republicans replacing them, give us solutions that work, not minor adjustments of what we have now.

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Is U.S. Healthcare Truly “Broken?”

In response Obamacare: Will Someone Please Kill It Before It Kills Us, most agree that Obamacare must be repealed. Some people even question whether healthcare is actually “broken” in the first place. One responder wrote: “Where is the evidence of that? In what way is it broken?” This challenge cannot go unanswered.

Objective evidence-based analysis of the U.S. healthcare system leads to the well-worn doctor joke: ‘I have good news and bad news.’ Every assertion below has ‘hard’ scientific proof. What follows is fact, not unsubstantiated opinion.

First, the good news:
YOU HAVE A DATE WITH (fill in your favorite sex symbol).

Americans have better health care outcomes than most others: better survival rates for common cancers than Europeans; better preventative cancer screening than Canadians; better access to chronic disease treatments; greater and much faster access to new technologies; less waiting times for care than in either Great Britain or Canada; and higher patient satisfaction here than in most European “universal health care” countries.

Next, by any measure you choose–patents applied for; new drugs or procedures; Nobel prizes, etc.–the U.S.A. is the most medically innovative country on the planet.

Finally, American-trained providers are considered the best. The super-rich fly from all over the world to the U.S.A. for their medical care. They do not go to Rochester Minnesota (Mayo Clinic) for the weather.

Now, the bad news:

The ‘bad news’ is financial, provider shortages, and outcomes.

The U.S. spends more per capita on healthcare ($4, 631) than any other nation. Interestingly, eight countries have annual increases in national spending greater than ours. Until the recent U.S. real estate collapse, medical bills were the leading cause of personal bankruptcies.

Forty-five million American residents (13% of our population) have no health insurance. Interestingly, 24% are uninsured by choice: they qualify for government assistance programs but refuse to sign up. Also, 25% of the 45 million uninsured are illegal residents.

Healthcare is very inefficient with our dollars: almost 40% of the trillions we spend each year provides no care at all: it is consumed by the healthcare bureaucracy. Despite draconian cuts in reimbursements just passed by Congress, Medicare – the Program touted by Nancy Pelosi to be the model for our whole country – will go broke by 2017.

In addition to its financial woes, healthcare has personnel issues. There are not enough doctors and nurses for our current health care needs. What will happen when (if) Obamacare adds 30-45 million more people to the roles of the insured?

In 1972, 95% of U.S. physicians reported they were professionally satisfied. In 2004, that number was 26%. Applications to U.S. medical schools have fallen off roughly 20% over the past 15 years. Forty percent of doctors over age 50 are considering early retirement.

While the U.S. is first in per capita healthcare spending, we are either 33rd or 46th (depending on source) in terms of infant mortality. Though this fact is often used to attack the U.S. healthcare system, it is unclear how much is due to epidemiologic issues such as illicit drugs or genetics and how much can be squarely laid at the healthcare system’s doorstep.

Wait times for care in Emergency Rooms can exceed 13 hours. The reported drug error rate is 1.13 for each and every patient admitted to a U.S. hospital. The number of avoidable, doctor-induced U.S. deaths is estimated as high 98,000: that is equivalent to one jumbo jet liner crashing every day killing all passengers, each crash caused by pilot error.

Finally in terms of outcomes, people can be injured during health care. Our medical malpractice system fails to compensate the vast majority of injured patients. It is extremely costly (multi-billions a year at a minimum), produces defensive medicine, and does not improve medical quality.

While there are many good individual parts of U.S. healthcare, as a system it is critically ill. It does not produce the outcomes we want and produces many outcomes we do not want. Healthcare is incredibly inefficient, drives providers away, and is drowning our country in red ink. According to many U.S. business leaders, our healthcare so-called system is dragging down U.S. global competitiveness.

U.S. healthcare truly is a “broken” system.

System MD

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