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All items for January, 2010

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The Democratic Congress Does Not Know What To Do About Healthcare

Stanley Feld M.D.,FACP,MACE

 

The Democrats having no clear path going forward on major healthcare legislation. They have put healthcare reform on hold.

They should shred and burn the present healthcare reform bill. It will not Repair the Healthcare System.

The traditional media has published quotes from elected officials. These quotes make it clear that elected officials really do not understand the problems in the healthcare system much less repair them. All the Democrats want is to pass a bill. They think passing a bill will save President Obama’s presidency.

Many Democrats up for election are starting to face reality. The American people want healthcare reform. They do not want this healthcare reform bill. The process the Democrats and the President have used to advance the healthcare reform bill has only made the public more cynical and suspicious of the President and the Democrats in congress.

Democrats up for election are afraid of the same backlash seen in Massachusetts, New Jersey and Virginia. They are backing off President Obama’s healthcare reform bill.

The President has not backed off his healthcare reform plan. He is willing to bring the entire Democratic Party down in the 2010 election because of his convictions. He does not want to understand that his healthcare reform plan makes no sense. His statement during the State of the Union address is riddled with half truths. It’s plan will not serve the interest of the American people. It will increase government control of citizens’ lives, increase the deficit and increase the profits of special interests.

“The Senate majority leader, Harry Reid, Democrat of Nevada, deflected questions about health care. “We’re not on health care now,” Mr. Reid said. “We’ve talked a lot about it in the past.”

He added, “There is no rush,” and noted that Congress still had most of this year to work on the health bills passed in 2009 by the Senate and the House.”

Nancy Pelosi wants President Obama’s bill passed. She does not have enough Democratic votes in congress. She is mapping out a way to complete a health care overhaul in coming months. It looks as if the Democratic leadership and the President want to sneak the bill over, under, or through the fence using procedural tricks.

It is just what the public does not want. Public opinion could not be clearer.

At the same time, two centrist Democrats who are up for re-election this year, Senators Blanche Lincoln of Arkansas and Evan Bayh of Indiana, said they would resist efforts to muscle through a health care bill using a parliamentary tactic called budget reconciliation, which seemed to be the easiest way to advance the measure.”

Recently, President Obama has said that he would support that approach.

Representative S. Hoyer added, “I think by next week we need to come to focus on the way we want to move forward.”

“Frankly, we’re trying to figure out what is possible,” Mr. Hoyer said.

Mr. Hoyer does not know what to do.

Representative Charles B. Rangel, Democrat of New York and chairman of the Ways and Means Committee, said, “We are not passing the Senate bill period.”

I think it is pretty clear Mr. Rangel does not want to swallow a healthcare reform bill he does not support.

“Senator Joseph I. Lieberman, independent of Connecticut, urged caution, saying, “The White House and Democratic leaders should reach out one more time to Republicans to see if they can find a common ground.”

Reaching out must be done in a honest and sincere way, My way or the highway will not work. The President has to formulate a bill that is bipartisan and directed to serving the interest of the people. His healthcare reform bill does not do that.

Senator Dianne Feinstein, Democrat of California, said Democrats were assessing their options on health care. “It’s a timeout,” she said. “The leadership is re-evaluating. They asked us to keep our powder dry.”

Ms. Lincoln, who faces one of the toughest re-election bids among Democrats, said, “I am opposed to and will fight against any attempts to push through changes to the Senate health insurance reform legislation by using budget reconciliation tactics that would allow the Senate to pass a package of changes to our original bill with 51 votes.”

Ms. Lincoln is co
rrect. The people are tired of closed door tricks. President Obama promised us transparency and bipartisan debate during his presidential campaign..

Mr. Bayh said, “It would destroy the opportunity, if there is one, for any bipartisan cooperation the rest of this year on anything else.”

It will also destroy Mr. Bayh’s chances of getting reelected.

The Senate Republican leader, Mitch McConnell of Kentucky, said White House comments on health care suggested Mr. Obama was not listening to the American people.

What do I think? I think the bill should to shredded and burned. It is a terrible bill for all the reasons I have outlined.

The government is broke. It is spending over 1 trillion dollar more a year than its revenue. Adding another entitlement program makes no sense no matter how well President Obama presents the case. His case is hollow. He has intensified cynicism and mistrust.

Congress and the President must take a hard look at where the healthcare dollars are being wasted. They then have to fix the inefficiencies in a constructive way.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • mary hays

    why should money be taking out of medicare for the presidents heath care plain
    the sentors and congress have taking so mush money out for ear marks that is why ss is in trouble now. we worked hard for our ss and it’s your money not sentors or congress or the president so leave it alone

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What Is The Medical Loss Ratio?

Stanley Feld M.D.,FACP,MACE

Why did the healthcare insurance industry, big pharma, and the medical device industry sponsor a fund raiser for Democratic Senatorial candidate Martha Coakley in Washington D.C.?

She would represent the 60th Democratic vote in the Senate. The 60th vote in the Senate would prevent a Republican filibuster and assure passage of President Obama’s healthcare bill.

Why would the healthcare insurance companies want this bill to pass when President Obama promised the public that his healthcare reform plan would control the healthcare insurance industry abuses and profits?

President Obama’s healthcare bill is good for the healthcare insurance industry’s business!! How is it good for the healthcare insurance industry’s business?

The bill would force more people to buy healthcare insurance. The result would be an increase in profit. The healthcare companies are not bothered by preexisting illness because the increased actuarial risk will be subsidized by President Obama and ultimately the taxpayer.

President Obama’s healthcare bill permits the healthcare insurance industry to control the healthcare dollars. Its profits are protected by maintaining the present accounting standard for the calculation of the Medical Loss Ratio.

Few people understand the rules for calculating the Medical Loss. The rules for calculating the Medical Loss Ratio permits the healthcare insurance industry to rip off the purchasers of healthcare insurance. (The government, the employees and individuals). The healthcare insurance industry is the administrative service provider for all. It sets insurance premiums through the Medical Loss Ratio.

If the government wanted to do something significant to lower the cost of healthcare, it would change the accounting standards use to calculate the Medical Loss Ratio. A change in rules would decrease the grotesque profits made by the healthcare insurance industry.

The accounting methods for the Medical Loss Ratio are to the disadvantage of third party payers, patients and patient care.

The definition of Medical Loss Ratio is Incurred Claims divided by Earned Premiums. In order to provide a better idea of the true meaning of Medical Loss ratio it should be defined as the earned premiums divided by the incurred claim.

This accounting sleight of hand is to the healthcare insurance industry’s advantage not the public. The Medical Loss Ratio should reflect insurers’ expenses for paying claims. However, it also reflects overhead and investments that can be duplicated, inflated, and abused. The slide below indicates other expenses included in incurred expenses.

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The greater the incurred expenses, the less money is available to cover medical expenses. The artificial Medical Loss Ratio justifies increases in premiums by the healthcare insurance industry to cover the decrease in money available to pay medical claims even as physician and hospital reimbursement decreases.

President Obama’s healthcare reform bills are not fixing the accounting standards that generate enormous profits for the healthcare insurance industry because of inflated incurred expenses at consumers’ expense.

What exactly are we paying for with our healthcare dollars? Sixty-five cents of every dollar goes to the healthcare insurance industry. Only fifteen cents of every healthcare dollar goes to physicians and twenty cents of every healthcare dollar goes to the hospitals.

There is something terribly wrong with this expense load.

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George Axelrod, President Obama’s senior adviser does not understand these numbers. He said in a TV interview recently:

“One thing we ought to do, the House bill has in it provisions that — that says that if they fall below a certain level of return of these medical loss ratios — in other words, the amount of money that they spend on actual health care, that they — they need to rebate some of that money to consumers. That seems like a good idea.

Year after year taxpayers have paid higher and higher premiums to the healthcare industry for inflated incurred expenses. Most of the incurred expenses are for the healthcare insurance industry’s inflated overhead.

If Mr. Axelrod believes that the healthcare insurance industry will lower its incurred overhead expenses and give refunds to payers for premiums I have a bridge to sell him.

President Obama should be focused on the Medical Loss Ratio accounting standard. If he did the fair thing there would be no need for his disastrous healthcare reform legislation.

President Obama’s healthcare reform plan is not for the people by the people. It is for special interests. The special interests are government and its control as well as the profit of the healthcare insurance industry. It is not about patients, affordable care and improvement in the quality of medical care.

This is the underlying reason the healthcare insurance industry sponsored the
Washington fund raiser for Massachusetts Senatorial candidate Martha Coakley in order to maintain the sixtieth seat in the Senate.

President Obama’s healthcare reform bill is good for the healthcare insurance industry’s business.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Michael Kirsch, M.D.

    Stanley, I agree with the point that you suggested at the end of your post that the moribund health care plan was more about government than about health. This is why the Democrats, in my view, were so zealous and trying to ram it through. If the government could (ultimately) take over health care, then everything would be in their reach. Amazingly, the Massachusetts electorate did not drink the Kool Aide.(BTW, I think you meant David Axelrod, not George.) http://www.MDWhistleblower.blogspot.com

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A New Series: Father and Son #2

 

Stanley Feld M.D.,FACP,MACE

Brad asked how I think I influenced his development as a child. I think I taught him about leadership, perseverance, patience, problem solving, pattern recognition, innovative thinking, and compassion for others. The irony is I believe he taught me more than I taught him.

Mutual trust and respect must go hand and hand with the love for a child. Kids are people too. They have the same emotional responses to perceived events as we do as adults.

One of many incidents of mutual respect comes to mind. Brad was 11 years old in the 6th grade.

Brad 1975009

My accountant, at that time, was an avid stamp collector. I thought learning about the sub culture of stamp collecting would be a terrific intellectual experience for both of us. My accountant took us to several stamp shows and taught us how to value stamps. We started collecting. We accumulated a nice stamp collection. The collection had great potential to increase in value. We both learned a lot and grew together in the stamp collecting business.

Brad was very proud of his stamp collection. One night at dinner, Brad asked if he could bring a couple of sleeves of stamps to his 6th grade to explain the joys of stamp collecting. I said “sure.”

At dinner the next evening he told us someone had stolen his stamps. He left them in his school desk pocket during recess. They were gone when he got back to his desk. He explained that he was certain he knew who stole the stamps.

I asked him how he knew who stole the stamps. He told me about a wise guy kid who was always intimidating his classmates. This kid bullied other kids and constantly took things from them.

I remember a kid like that in my 6th grade class. He was always hitting us up for pennies.

I asked Brad what he wanted to do. He said he wanted to figure out how to get his stamps back. He had already spoken to the teacher. She said she would talk to the boy.

I thought that was a great first step. I said I would call the teacher in the morning. I spoke to the teacher. It was obvious to me she did not want to get involved.

I then asked to speak to the Principal. When I explained the situation to the Principal, she volunteered to speak to the teacher. She then set up a meeting with both boys and their fathers.

I cancelled my scheduled patients from 10.30 am to 2pm on the day of the meeting and came to the school. Brad told me he was more convinced than ever that the boy took the stamps. Other kids told him he had taken things from them but they did not have the courage to complain.

The meeting started at 11 a.m. There were two fathers, two boys and the Principal present. After I explained the situation the boy’s father became indignant. I said,” hold it.” We have evidence that your son has been a bully to other kids in the class. He has intimidated them and taken things from them. He is the most likely person in the class to have taken Brad’s stamps.

The father wanted the proof. I told him we would be happy to produce the proof. The pressure on the boy was too much. He admitted taking the stamps. He promised to return them in the morning. The boy’s father was enraged and embarrassed. There would be no attempt by the father to understand the boy’s behavior.

Both the father and son apologized to us. Brad and I accepted the apology. I could just feel how proud Brad was of me. I expressed how proud I was of him for sticking up for his rights.

This bonding experience is one of many. It lasts to this very day. The proof of this bonding between us can be seen in Brad’s introductory blog to this series.

Our goal is to explore why our relationship works and help others if we can improve their relationship with their kids.

  • Ananth

    Lovely story.. Thanks for sharing.

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Medicare Is Going To Lose Its Workforce

 

Stanley Feld M.D.,FACP,MACE

President Obama’s Healthcare Reform Bill will not work. It is based on decreases in physician reimbursement while forcing physicians to increase overhead with unaffordable electronic medical records. More and more physician groups and practices are starting to realize that they cannot make a living from the reimbursement from Medicare. They are quitting taking new Medicare patients and trying to get rid of the old ones by not taking assignment.

President Obama’s idea is to force physicians to be more efficient producers. It is very difficult to force anyone to do anything they cannot afford.

President Obama also believes that physicians over test patients in order to make money. Wrong! Much of the over testing comes from the practice of defensive medicine. Many physicians have been sued for under testing. No one is sued for doing a test. Yet there is not a word about malpractice reform in either version of the healthcare reform bill to decrease testing by eliminating defensive medicine.

President Obama’s solution is to prohibit physicians from testing in their office even though it is more convenient and efficient for patients. Ancillary services can help with overhead and does increase physicians’ efficiency of care.

In fact, the fees for the ancillary services in a physicians’ office are generally much less expensive than the fees for ancillary services in hospitals. President Obama ignores this fact. He believes physicians over test for profit. This might be true in some cases. However, this abuse can be discovered with the information technology system we have at present. He believes he can force physicians to tests less if it is outsourced to the hospital.

Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program.

The administration is beginning to feel the kick back from the physician community. I think this kick back will escalate in the coming months. It will worsen the delivery of medical care.

“President Obama last year praised the Mayo Clinic as a "classic example" of how a health-care provider can offer "better outcomes" at lower cost.”

How were better outcomes determined? The question is unanswered.

Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.”

Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates.

In Arizona alone it lost $120 million dollars. The losses are usually made up by cost shifting to the private insurers and private patients. These losses are getting harder and harder to make up by cost shifting.

"Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."

The media has reported that Mayo Clinic has only dropped accepting Medicare in a small clinic in Glendale Arizona. It has been reported as an insignificant event by the traditional media. Mayo Clinic is being very civilized by not eliminating participation in Medicare in all the clinics at once. The Mayo Clinic is sending a message to President Obama and his future plans. It will also be a signal to physicians throughout the country.

Ninety two percent (92%) of family physicians accept Medicare. Only about 73% of those are now accepting new patients. This reduction in participating physicians comes on top of a shortage of primary care physicians.

Patients struggle to find any specialist who will accept Medicare. This experience is greatest in the specialties of neurology, oncology, and gynecology. Cardiology is next.

Last week Cardiologists filed a lawsuit in U.S. District Court for the Southern District of Florida, charging that the government’s planned cutbacks will deal a major blow to medical care in the USA.

It will force thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.

The lawsuit is an attempt by a group of medical specialists to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

"What they’ve done is basically killed the private practice of cardiology," says Jack Lewin, CEO of the American College of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the USA.

The government’s response was politeness. It will hide behind regulations made as a result of congressional mandates. The result is typical bureaucratic gobbledygook.

Jonathan Blum, director of the government’s Center for Medicare Management, says the agency is bound by law not to increase spending when making reimbursement decisions each year.”

“Lewin and other heart specialists met with Sebelius on Dec. 8 and explained their concerns. "I thought she was very empathic," he says, but Sebelius has yet to take action.”

Kathryn Sebelius will not take action. Neither she nor President Obama really understands the problem much less the solutions. One cardiologist said it is an efficient way of getting rid of cardiologist and ration access to care.

"It’s so absurd, it’s kind of funny," he says. "I know ACC doesn’t think it’s funny but I do.”

It isn’t funny. It is an unintended consequence of government control of healthcare. Healthcare should be consumer driven not government controlled. Government should make appropriate rules to level the playing field for all stakeholders and then get out of the way.

A cardiologist in Silver City, N.M. not far from the Mexican border said,

"The closest cardiologist to me is 150 miles away. With all these cuts coming, it will make it impossible for me to break even seeing 40 patients a day.

Does anyone want the government and its 118 new bureaucracies to take over medical care?

What is the problem?

  1. The government is broke.
  2. They have to reduce expenditures .
  3. Physicians are the weakest link, politically, in the healthcare system because they are ineffectively represented.
  4. The government will not fight the healthcare insurance industry’s lobbying.
  5. The government will not fight the Plaintiff attorney’s lobbying.
  6. The government will continue to waste taxpayers dollars on stakeholders who add little value to the treatment of sick patients.

It is about time groups of physicians started to make some noise

Congratulations goes to the Mayo Clinic and the American College of Cardiology.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.< /i>

  • Michael Kirsch, M.D.

    Yes, I agree that the President’s statement that physician’s recommend medical procedures primarily to make $$$, was false, insulting and downright boneheaded. For a humorous view on this serious subject see http://bit.ly/5oZ0IG

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Something Fishy Is Going On!

Stanley Feld M.D.,FACP,MACE

The administration and the media are working hard to keep the public’s eyes wide shut.

Democrat Martha Coakley was supposedly the most electable Democrat in Massachusetts to fill Ted Kennedy’s seat in the Senate. She is in trouble and the Democratic Party is pulling out all the stops.

Her opponent Scott Brown said it all in their debate.He said it is not Ted Kennedy’s senate seat, it is not the Democratic Party’s senate seat, IT IS THE PEOPLE’S SEAT.

 

 

If the Democratic Party is not listening to the people, the people should kick it out of power. The Democratic Party is not listening to the people.

The State of Massachusetts has always been oriented left of center politically. However the state has suffered financially from the failed Massachusetts universal healthcare plan experiment. I have presented all the reasons for its failure. The main reason is control of the healthcare dollars remains in the hands of the healthcare insurance industry.

President Obama’s healthcare reform plan is a close copy of the Massachusetts plan. It keeps the healthcare insurance industry in control of the healthcare dollars. Any Democrat and the President will deny it. They keep telling us they will be controlling the healthcare insurance industry.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Massachusetts+healthcare&x=0&y=0

If the Democrats lose this seat they will lose vote #60 in the Senate for President Obama’s healthcare bill.

If they lose vote #60 President Obama’s health-care bill the bill will unravel.

Even worse, Representatives and Senators up for reelection in 2010 are threatened by an independent voter rebellion in the rest of the country,.

It is time for a full court press by the Democratic Party . The Democratic Party had a fund raiser in Washington for Martha Coakley .

Guess who sponsored the fund raiser?

The lobbyists for the healthcare insurance industry, big pharma and the medical device companies. .

How come?

My guess is President Obama’s healthcare reform bill is to these companies advantage, not the peoples’ advantage despite what President Obama continuously says. These organizations want the Democrats to retain the 60 votes needed to pass President Obama’s healthcare reform bill.

Below is the invitation and list of sponsors of the fundraiser

Americans have to wonder and open their eyes to what is going on. Why should these organizations want this bill to pass?

The answer is simple. It is good for business!!!

 

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Who are these sponsors?

“Of the 22 names on the host committee–meaning they raised $10,000 or more for Coakley–17 are federally registered lobbyists, 15 of whom have health-care clients. Of the other five hosts, one is married to a lobbyist, one was a lobbyist in Pennsylvania, another is a lawyer at a lobbying firm, and another is a corporate CEO. Oh, and of course, there’s also the political action commitee for Boston Scientific Corporation.”

Here are some of Martha Coakley’s fundraiser hosts with some of their current health care clients:

  • “Thomas Boggs, Patton Boggs: Bristol-Myers Squibb
  • Chuck Brain, Capitol Hill Strategies: Amgen, BIO, Merck, PhRMA
  • Susan Brophy, Glover Park Group: Blue Cross, Pfizer
  • Steven Champlin, Duberstein Group: AHIP, Novartis, Sanofi-Aventis
  • Licy Do Canto, Raben Group: Amgen
  • Gerald Cassidy, Cassidy & Associates: U. Mass Memorial Health Care
  • David Castagnetti, Mehlman, Vogel, Castagnetti: Abbot Labs, AHIP, Astra-Zenaca, General Electric, Humana, Merck, PhRMA.
  • Steven Elmendorf, Elmendorf Strategies: Medicines Company, PhRMA, United Health
  • Shannon Finley, Capitol Counsel: Amgen, Astra-Zeneca, Blue Cross, GE, PhRMA, Sanofi-Aventis.
  • Heather Podesta, Heather Podesta & Partners: Cigna, Eli Lilly, HealthSouth
  • Tony Podesta, Podesta Group: Amgen, GE, Merck, Novartis.
  • Robert Raben, Raben Group: Amgen, GE.”

The companies in the healthcare insurance industry that are represented are Blue Cross/Blue Shield, Cigna, Humana, HealthSouth and United Healthcare.

All the leading drug companies have lobbyists on Coakley’s host committee: Pfizer, Merck, Amgen, Sanofi-Aventis, Eli Lilly, Novartis, Astra-Zeneca, and more.

HMOs (like Aetna) do not have lobbyist in Martha Coakley’s top tier of hosts. However, the healthcare insurance industry is represented by two lobbyist representing America’s Health Insurance Plans (AHIP).

The drug companies have four lobbyists representing the Pharmaceutical Researchers and Manufacturers of America (PhRMA) and one representing the Biotechnology Industry Organization (BIO) The final host list was not available.

“If Coakley pulls it out, this is the crowd that will have brought her here. If health-care reform passes, this is the crew that will have won.”

 

 

I believe that before a Representative or Senator should be allowed to vote for this bill they should be required to take a comprehensive multiple choice questions test on the meaning, implications and potential unintended consequences of the provisions of President Obama’s Healthcare reform bill. Only if they receive an over 65% grade should they be permitted to vote.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Michael Kirsch, M.D.

    If Coakley wins, as I expect she will, the real news is that the GOP gave her a real run. This is a Democratic state where Ted Kennedy was a senator for nearly 5 decades. If Massachusettes is wavering on Obamacare, there are Democrats throughout the country who may not be so anxious to drink the Kool Aide. http://www.MDWhistleblower.blogspot.com

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A New Series: Father and Son

Stanley Feld M.D.,FACP,MACE

Brad mentioned in his blog, that we have weekly discussions on Skype.

This past week Brad came up with a brilliant idea. He understands my passion about a lot of things. He feels I have taught him a lot. He wants to explore my influence on him in public view. This would enable our readers to learn something about the way we recognize patterns and approach problem solving.

These traits are not genetic. They are acquired. He was interested in discussing how I influenced his development. I thought it would be fun.

He proposed that we write a series of blogs each describing our view. We would post each other’s entry on our own site. We would try to describe the origin of those influences.

He also proposed that we discuss our view of my influence from the vantage point of him as 9-12 year old. He figured that would be his most impressionable age. I would look at it from the point of view of me being a 38 year old clinical endocrinologist building an endocrine practice, adding partners, and raising two boys with Cecelia.

He has always been enchanted by my ability to say things such as “if you are not on the edge you are taking up too much space.”

Brad is a creative leader in information technology venture capital. It should be obvious to everyone that I am very proud of him. He has had much press lately. He has a monthly column in Entrepreneur Magazine , has recently been quoted in the New York Times, and has given an extensive interview about venture capitalism in Boulder Colorado to the “Fast Company.”

Brad stimulated my curiosity with this request. I would like to understand his view of my impact on him. I thought we could have some fun with our impressions of our influence on each other.

The teacher usually learns more than the student. My view is I have learned more from him than he has learned from me.

This will give us both the opportunity, in public view, to discover the influence we have had on each other.

I hope readers have as much fun with this experiment as I believe I will.

  • Shane Taylor

    As an owner of a healthcare technology startup here in Boulder (and extremely passionate about VC, technology, and healthcare – and where they intersect), I have become a reader of both your blogs. I am also a father with much interest in being the best I can be at that. I am very much interested in this discussion because Brad is an amazing leader in the community and has taught many people like me an enormous amount – and I am extremely humbled and grateful. I would love to have some insight about the dynamics between the two of you the from one of the most influential people that has taught him.

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Did Americans Get Any Healthier Over The Past Decade?

Stanley Feld M.D.,FACP,MACE

 

President Obama finally admitted that we are at war with terrorists. He said there are problems in the massive intelligence bureaucracy.

It “failed to connect the dots of intelligence.” If the agencies were coordinated Umar Farouk Abdulmutallab, a known terrorist, who paid cash for his ticket, did not carry luggage and did not have a proper visa would not have been permitted to board the plane to Detroit on Christmas Day.

It was not a failure to connect the dots. There are systems defects in the bureaucracy. The intramural politics of bureaucracies prevents important information from moving up the food chain.

Robert Baer makes this point clear in his book “See No Evil 1988”. The CIA does not have agents in the field that understand local politics.

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The author, working in the Counter-Terrorism Center when it was just starting out, has an extremely important story to tell and every American needs to pay attention. Why?

“Because his account of how we have no assets that are useful against terrorism. There are four other stories within this excellent book, all dealing with infirmed bureaucracies.”

The administration’s response to the potential terrorist attack demonstrates Robert Baer point.

The National Counterterrorism Center’s NCTC and CIA—have a role to play in conducting (and a responsibility to carry out) all-source analysis to identify operatives and uncover specific plots like the attempted December 25 attack. . . .”

The agencies were not coordinated and missed the obvious terrorist.

How does this relate to the Healthcare Reform debate?

The Democrats in congress and President Obama’s administration are about to pass a terrible healthcare reform bill. The bill misses the obvious. An example of an ineffective bureaucratic agency is the Healthy People Project

The goal of healthcare reform should be to help Americans receive effective healthcare. I have contended that increasing bureaucracy and the cost of maintaining a bureaucracy does not deliver better healthcare or make Americans healthier. President Obama’s healthcare bill expands government bureaucracy.

Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”

 

Real repair of the healthcare system is missing:

Real healthcare education,

Real cultural changes in eating and self responsibility,

Real enforceable food production legislation,

Real tort reform,

Real healthcare insurance reform,

Real chronic disease management systems education for both physicians and patients.

These real changes will help decrease the cost of medical care.

Unfortunately none of these changes are in President Obama’s healthcare reform bill. Instead there are 118 new boards, commissions, and programs doing its thing to generate reports and pilot studies.

Atul Gawande in a recent New Yorker article pointed out that President Obama’s healthcare reform bill offers pilot studies.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.


Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude.”

I have pointed out in the past that poorly designed pilot studies are a waste of money.

Dr. Gawande tries to illustrate the potential value of a pilot study and justifies President Obama’s healthcare reform bill.

The federal government published preliminary results of the Healthy People Project health goals for the nation from 2000 to 2010. Its healthcare goals have not been achieved.

There are more obese Americans than a decade ago and not fewer. We eat more salt and fat, not less. More of us have high blood pressure and diabetes. More of our children have untreated tooth decay, obesity and diabetes.

The lack of control of these diseases result in their complications.

"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That’s a balance that’s sometimes a challenge to strike."

This is bureaucratic jargon. It is one thing to ask the country to achieve these goals. It is another thing to get people to change their habits. The Healthy People Project has been in existence since 1980.

After more than 30 years, the goals aren’t well known to the public and only a modest number have been met.

“About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent. Worse, the nation actually retreated from about 23 percent of the goals.”

I would say this expensive bureaucratic pilot study was a failure.

Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. In 2000, 25% of all adults were obese. Now, about 34 percent of adults are obese. Twenty eight percent of Americans had hypertension in 2000. Today 29% of Adult Americans have hypertension. The Projects goal was to reduce hypertension to 16%.

“To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.

"That’s evidence of a healthier nati
on," Koh said.”

You have got to be kidding!! Is this what we want from President Obama’s Healthcare Reform bill, 118 new bureaucratic agencies? There is something wrong here.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Permalink:

Did Americans Get Any Healthier Over The Past Decade?

Stanley Feld M.D.,FACP,MACE

President Obama finally admitted that we are at war with terrorists. He said there are problems in the massive intelligence bureaucracy.

It “failed to connect the dots of intelligence.” If the agencies were coordinated Umar Farouk Abdulmutallab, a known terrorist, who paid cash for his ticket, did not carry luggage and did not have a proper visa would not have been permitted to board the plane to Detroit on Christmas Day.

It was not a failure to connect the dots. There are systems defects in the bureaucracy. The intramural politics of bureaucracies prevents important information from moving up the food chain.

Robert Baer makes this point clear in his book “See No Evil 1988”. The CIA does not have agents in the field that understand local politics.

.

The author, working in the Counter-Terrorism Center when it was just starting out, has an extremely important story to tell and every American needs to pay attention. Why?

“Because his account of how we have no assets that are useful against terrorism. There are four other stories within this excellent book, all dealing with infirmed bureaucracies.”

The administration’s response to the potential terrorist attack demonstrates Robert Baer point.

The National Counterterrorism Center’s NCTC and CIA—have a role to play in conducting (and a responsibility to carry out) all-source analysis to identify operatives and uncover specific plots like the attempted December 25 attack. . . .”

The agencies were not coordinated and missed the obvious terrorist.

How does this relate to the Healthcare Reform debate?

The Democrats in congress and President Obama’s administration are about to pass a terrible healthcare reform bill. The bill misses the obvious. An example of an ineffective bureaucratic agency is the Healthy People Project

The goal of healthcare reform should be to help Americans receive effective healthcare. I have contended that increasing bureaucracy and the cost of maintaining a bureaucracy does not deliver better healthcare or make Americans healthier. President Obama’s healthcare bill expands government bureaucracy.

Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”

Real repair of the healthcare system is missing:

Real healthcare education,

Real cultural changes in eating and self responsibility,

Real enforceable food production legislation,

Real tort reform,

Real healthcare insurance reform,

Real chronic disease management systems education for both physicians and patients.

These real changes will help decrease the cost of medical care.

Unfortunately none of these changes are in President Obama’s healthcare reform bill. Instead there are 118 new boards, commissions, and programs doing its thing to generate reports and pilot studies.

Atul Gawande in a recent New Yorker article pointed out that President Obama’s healthcare reform bill offers pilot studies.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude.”

I have pointed out in the past that poorly designed pilot studies are a waste of money.

Dr. Gawande tries to illustrate the potential value of a pilot study and justifies President Obama’s healthcare reform bill.

The federal government published preliminary results of the Healthy People Project health goals for the nation from 2000 to 2010. Its healthcare goals have not been achieved.

“There are more obese Americans than a decade ago and not fewer. We eat more salt and fat, not less. More of us have high blood pressure and diabetes. More of our children have untreated tooth decay, obesity and diabetes.”

The lack of control of these diseases result in their complications.

"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That’s a balance that’s sometimes a challenge to strike."

This is bureaucratic jargon. It is one thing to ask the country to achieve these goals. It is another thing to get people to change their habits. The Healthy People Project has been in existence since 1980.

After more than 30 years, the goals aren’t well known to the public and only a modest number have been met.

“About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent. Worse, the nation actually retreated from about 23 percent of the goals.”

I would say this expensive bureaucratic pilot study was a failure.

Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. In 2000, 25% of all adults were obese. Now, about 34 percent of adults are obese. Twenty eight percent of Americans had hypertension in 2000. Today 29% of Adult Americans have hypertension. The Projects goal was to reduce hypertension to 16%.

“To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.

"That’s evidence of a healthier nation," Koh said.”

You have got to be kidding!! Is this what we want from President Obama’s Healthcare Reform bill, 118 new bureaucratic agencies? There is something wrong here.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

clip_image002

 
  • Michael Kirsch, M.D.

    …and we won’t be getting any healther over the next decade. While the ‘reform’ will increase access, a worthy objective, it is otherwise promoting stagnation or actually reversing progress. Where is the cost control in the pending legislation? Will Medicare recipients be content with less care? Will physicians still see Medicare patients with continued erosion in reimbursement, or should we cut these patients loose like the Mayo Clinic’s Arizona satellite? Will defensive medicine ebb in the absence of tort reform? Will the public’s appetite for expensive medical technology disappear? Will medical quality improve? If it does, it will be in spite of health care ‘reform’. I think that as the public grasps what awaits them,which may take time, that there will be a backlash. My summary is that this will all cost much more than they say and deliver much less than they promise. http://www.MDWhistleblower.blogspot.com

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Did Americans Get Any Healthier Over The Past Decade?

Stanley Feld M.D.,FACP,MACE

 

President Obama finally admitted that we are at war with terrorists. He said there are problems in the massive intelligence bureaucracy.

It “failed to connect the dots of intelligence.” If the agencies were coordinated Umar Farouk Abdulmutallab, a known terrorist, who paid cash for his ticket, did not carry luggage and did not have a proper visa would not have been permitted to board the plane to Detroit on Christmas Day.

It was not a failure to connect the dots. There are systems defects in the bureaucracy. The intramural politics of bureaucracies prevents important information from moving up the food chain.

Robert Baer makes this point clear in his book “See No Evil 1988”. The CIA does not have agents in the field that understand local politics.

.

The author, working in the Counter-Terrorism Center when it was just starting out, has an extremely important story to tell and every American needs to pay attention. Why?

“Because his account of how we have no assets that are useful against terrorism. There are four other stories within this excellent book, all dealing with infirmed bureaucracies.”

The administration’s response to the potential terrorist attack demonstrates Robert Baer point.

The National Counterterrorism Center’s NCTC and CIA—have a role to play in conducting (and a responsibility to carry out) all-source analysis to identify operatives and uncover specific plots like the attempted December 25 attack. . . .”

The agencies were not coordinated and missed the obvious terrorist.

How does this relate to the Healthcare Reform debate?

The Democrats in congress and President Obama’s administration are about to pass a terrible healthcare reform bill. The bill misses the obvious. An example of an ineffective bureaucratic agency is the Healthy People Project

The goal of healthcare reform should be to help Americans receive effective healthcare. I have contended that increasing bureaucracy and the cost of maintaining a bureaucracy does not deliver better healthcare or make Americans healthier. President Obama’s healthcare bill expands government bureaucracy.

Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”

 

Real repair of the healthcare system is missing:

Real healthcare education,

Real cultural changes in eating and self responsibility,

Real enforceable food production legislation,

Real tort reform,

Real healthcare insurance reform,

Real chronic disease management systems education for both physicians and patients.

These real changes will help decrease the cost of medical care.

Unfortunately none of these changes are in President Obama’s healthcare reform bill. Instead there are 118 new boards, commissions, and programs doing its thing to generate reports and pilot studies.

Atul Gawande in a recent New Yorker article pointed out that President Obama’s healthcare reform bill offers pilot studies.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude.”

I have pointed out in the past that poorly designed pilot studies are a waste of money.

Dr. Gawande tries to illustrate the potential value of a pilot study and justifies President Obama’s healthcare reform bill.

The federal government published preliminary results of the Healthy People Project health goals for the nation from 2000 to 2010. Its healthcare goals have not been achieved.

“There are more obese Americans than a decade ago and not fewer. We eat more salt and fat, not less. More of us have high blood pressure and diabetes. More of our children have untreated tooth decay, obesity and diabetes.”

The lack of control of these diseases result in their complications.

"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That’s a balance that’s sometimes a challenge to strike."

This is bureaucratic jargon. It is one thing to ask the country to achieve these goals. It is another thing to get people to change their habits. The Healthy People Project has been in existence since 1980.

After more than 30 years, the goals aren’t well known to the public and only a modest number have been met.

“About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent. Worse, the nation actually retreated from about 23 percent of the goals.”

I would say this expensive bureaucratic pilot study was a failure.

Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. In 2000, 25% of all adults were obese. Now, about 34 percent of adults are obese. Twenty eight percent of Americans had hypertension in 2000. Today 29%
of Adult Americans have hypertension. The Projects goal was to reduce hypertension to 16%.

“To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.

"That’s evidence of a healthier nation," Koh said.”

You have got to be kidding!! Is this what we want from President Obama’s Healthcare Reform bill, 118 new bureaucratic agencies? There is something wrong here.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

clip_image002

 
  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.