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HEALTHPLANUSA.NET |
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Community For Affordable Health Care |
Vol IX, No 2, July, 2010 |
Utilizing the $1.8 Trillion Information Technology Industry
To
Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare
Through
innovation by moving from a vertical to a horizontal industry
In This Issue:
1. Featured Article:
Bad Medicine
2. In the News:
Federal Largess Allows Crime to Flourish
3. International
Healthcare: Greece Told to Privatize HealthCare before Bailouts
4. Government
Healthcare: Around the World
5. Lean
HealthCare: Going Horizontal
6. Misdirection
in Healthcare: Why Doctors Don't Want Free-Market Medicine
7. Overheard
on Capital Hill: Jefferson's
tender lament didn't make it into the Declaration
8. Innovations
in Healthcare: Health Care's 'Radical Improver'
9. The Health Plan
for the USA: An Increasing Challenge: A
Stranger in our Midst
10. Restoring
Accountability in Medical Practice by Moving from a Vertical to a
Horizontal Industry:
The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall
Street Journal, is the most prestigious meeting of chief and senior
executives from all sectors of health care. Renowned authorities and
practitioners assemble to present recent results and to develop innovative
strategies that foster the creation of a cost-effective and accountable U.S.
health-care system. The extraordinary conference agenda includes compelling
keynote panel discussions, authoritative industry speakers, international best
practices, and recently released case-study data. The
8th Annual World Health Care Congress will be held April 4-6, 2011
at the Gaylord Convention Center, Washington DC. For more
information, visit www.worldcongress.com. The future is occurring
NOW.
* * * * *
1. Feature Article: BAD MEDICINE – ObamaCare Begins by Joseph Bottum, Editor, First Things,
May 2010
Bad Medicine
The Public Square - A Continuing Survey of Religion, Culture, and
Public Life
Joseph Bottum, Editor
A
kind of exhaustion always settles in, murky and miasmatic, after battle. The
nation's conservatives foresaw the apocalypse if the Democrats' plan for
health-care reform passed, and on Sunday—yesterday, as I write—it did pass. The
world didn't end. The people didn't rise up in rage. Furious lightning didn't
descend from the heavens to smash the apostate Capitol into rubble.
Of
course, watching the ring of applause and self-congratulation around the podium
in the House of Representatives, one could see that the nation's Democrats were
also thinking of the apocalypse—albeit, in happier terms. But, on Monday
morning, the Rapture didn't come, either, and the stony places of the earth
didn't blossom with sudden flowers. Despite the left's predictions, the rise of
the oceans didn't slow, and the planet didn't heal, and the lame didn't walk,
and the blind didn't see.
Instead
of falling—or rising, if the left proves correct—on the great wave of
Armageddon, we must wait, in this trough of exhaustion, to learn what happens
next. Our apocalypse is a slow one; it smothers us in whimpers. And here on
Monday morning, all that remains is a sense of the impending. Something
is slowly coming, something is slouching toward us.
I
don't know exactly what that something is. Neither do you. Neither does
the president or the Congress or the Senate, or anyone else who forced this
change upon us. Change they wanted, and change they got—but change to what? The
actual text of the bill makes little sense, as nearly everyone admits, but,
then, as House Speaker Nancy Pelosi explained, the point wasn't really to get
an intelligible bill. The point was to get any bill. To get the nationalization
of health care rolling. To start the socialization process. To turn the corner.
The point was to change the American system—in the belief that, once changed,
the system can never change back.
Perhaps
the courts will stop this. Certainly much of the bill will end up in lawsuits.
The requirement that people buy insurance—and wasn't that the strangest thing
in the bill? I know, Judy! We can punish those hated insurance companies by
forcing everyone to use them!—has an unconstitutional feel to it, and it
is, in any case, directly outlawed by such states as Virginia and Idaho. To
court we must go, and in court we'll find out . . . whatever it is that we'll
find out. I don't know what the courts will end up saying. Neither do you, and
neither does anyone else.
Meanwhile,
the November congressional elections are coming, and the health-care bill is
already the major issue on which conservative candidates are running. That the
Republicans will gain some midterm seats is predicted by all political
pollsters. That they will win enormously, picking up the ten seats they need to
control the Senate and the forty they need to control the House, is predicted
by some. That they will find the twenty-five votes in the Senate and the 112 in
the House they need to override a presidential veto is predicted by no
one—although such gains are necessary for undoing this bill, through normal
political channels, before the 2012 presidential election.
Politicizing
Politics
But,
then, normal political channels are exactly what seem to have disappeared in
the process by which the health-care bill came into being. "All this talk
about rules. We make them up as we go along," said Congressman Alcee
Hastings during the health-care debates, and right he was.
Commentator
after commentator has insisted that America has grown highly politicized over
the last decade. Maybe even over the last half century, since calmness hasn't
really existed in the public square since Eisenhower was president. And even
then, the bitterness of Adlai Stevenson's defeated supporters was palpable, and
the civil-rights battles were beginning to rage, and the hipster and the
organization man were emerging, and the playboy was being born, and the
communists threatened the nation, and the Cold War fed the apocalyptic
imagination . . .
I've
always been dubious about claims of a great calm consensus, a golden age, that
once existed in any stretch of American time. Politics is political, by its
very nature. It's where people of ambition meet and push on one another their
ambitions—a process that cannot ever be calm.
The
American Founders understood this, and they set up a system where the ambitious
could stage their fights, without doing too much collateral damage to the rest
of us. And any investigation into history will reveal that the nation has been
politicized, in the sense of having a highly charged political atmosphere, from
its founding.
Still,
the commentators who feel the nation is caught up in a new kind of
politicizing—a new type of rage and a new style of activism—are not wrong,
exactly. One clear change in recent years is the emergence of a factionalism
that we've never quite known before in American history.
The
Founders understood the dangers of faction, of course. Alexander Hamilton famously
issued a warning against it in the ninth of the Federalist Papers, and
James Madison worked on the answer in the tenth, where he defined faction
as "a number of citizens, whether amounting to a minority or majority of
the whole, who are united and actuated by some common impulse of passion, or of
interest, adverse to the rights of other citizens, or to the permanent and
aggregate interests of the community."
The
solution, Madison thought, is representative democracy. Direct democracy, all
the people voting on all the issues, is too likely to be swayed by the passions
of the moment and the interests of small crowds: "A pure democracy can
admit no cure for the mischiefs of faction. A common passion or interest will
be felt by a majority, and there is nothing to check the inducements to
sacrifice the weaker party. Hence it is, that democracies have ever been found
incompatible with personal security or the rights of property; and have, in
general, been as short in their lives as they have been violent in their
deaths."
Madison
won that argument; representative democracy he wanted, and representative
democracy he got. The dangers of factionalism didn't thereby go away, however.
A representative system, the interposition of elected officials and procedural
rules between the people and the law, only dams up factional dangers—to the
enormous frustration of those who gain what they believe to be popular mandates
and then discover that they cannot simply do whatever they want. (Remember the
angry columns this year by several liberal commentators, which said that the
Senate's filibuster rules are an unconstitutional outrage, when the election of
Massachusetts senator Scott Brown cost the Democrats their sixtieth Senate vote
and looked as though it might derail the health-care bill?) And when a great
surge washes over the dam, factionalism is translated from a danger of the
populace to a danger of the representatives.
Whatever
its rightness or wrongness, the national anger at George Bush over the ongoing
wars pushed up to the top of the dam in 2006 and brought the Democrats control
of both the Senate and the House. And there it might have stayed, or even
receded, had the financial crisis of 2008 not come along. Add that flood on top
of the earlier ones, and there was swept into office a supermajority of highly
charged, highly motivated, and highly factionalized individuals.
Am
I alone in thinking that things like the health-care bill are not what voters
thought they were getting? In the passion of the moment, they wanted Bush's
supporters chased out. And the voters got what they wanted—along with something
they didn't want: the election of a class of officials comparable to the
Republican radicals of 1866 and the Democratic extremists of the 1974
post-Watergate tide. The flood carried faction into the Congress.
Consider
our current situation with this fact in mind: Not a single Republican, in
either house, voted for the Senate's version of the bill, which is now the law
of the land. Logically speaking, there is a faint possibility that this is
because the current crop of Republicans are themselves too factionalized to
join in a great national project (one of the curious effects of a flood
election is that moderates on the losing side are among the most likely to be defeated,
since the hardliners had already managed to face down ideological opposition in
previous elections).
But
the polls, which show a majority of the public opposed to the bill—59 percent,
according to a CNN poll published this morning—suggest the opposite: The
Democrats who forced through this incoherent bill are acting as a faction. The
dangers that Hamilton and Madison struggled to control in the populace are
beyond control when they wash into the Capitol.
"Are
we now in a world where there is absolutely no recourse to the tyranny of the
majority?" asks the serious economics blogger for the Atlantic,
Megan McArdle. The opponents of the health-care bill did what the old system
suggested they do: They went out and convinced the public that now was not the
time for such a major change in a country that is already financially strapped.
In January 1993, when the Clinton health-care task force was created, nearly 60
percent of the American people supported reform. In July 1994, when the effort
was declared dead, almost 60 percent of the people opposed it. Responsiveness
to public feeling—remember Clinton's "permanent campaign"?—meant the
defeat of the bill.
By
some polls, less than 20 percent of Americans opposed the Democrats'
health-care proposals in January 2009. Over 50 percent did by January 2010—but
unlike the process in 1994, popular feeling made no difference this time
around. "If you don't find that terrifying," McArdle notes, "let
me suggest that you are a Democrat who has not yet contemplated what Republicans
might do under similar circumstances. Farewell, Social Security! Au revoir,
Medicare! The reason entitlements are hard to repeal is that the Republicans
care about getting re-elected. If they didn't—if they were willing to undertake
this sort of suicide mission—then the legislative lock-in you're counting on
wouldn't exist."
The
Republicans will surely be back in power at some point. Maybe after the 2010
congressional and 2012 presidential elections, although I'm somewhat convinced
that a major Republican victory this November is Obama's best chance for
reelection in 2012, for it would give him something to run against, and a kind
of pure running againstness—Hope! (in what?) Change! (to what?) Not
Bush!—has always been his best form of action.
Regardless,
when the day comes that Republicans rule again, why shouldn't they do what the
Democrats have now done? How can they not do what the Democrats have now
done, ignoring the voters who put them in office and pushing through a radical
agenda?
The
conservatives aren't stupid. They'll surely see that if only the liberals get
to use these changes in the American political system, then politics has become
a ratchet that bites in only one direction: Push back in the other direction,
and all you get is running room to tighten the nut some more. No conservative
leader could allow that to happen. If these are the new rules of the game, then
the Republicans have to play along. And when politicians cease to care what
their constituents believe, we no longer have a representative democracy. We
have, instead, a democratically elected tyranny—changing sides from time to
time, but still disconnected from the people. Is it too much to think, with
Madison, that such things are likely to be "as short in their lives as they
have been violent in their deaths"?
. . .
Electing
Tyranny?
The
process by which this health-care bill came about has baleful effects
throughout the American political scene. The banishment of the pro-life
movement to one party will produce only ugly results, and although abortion is
not, in itself, a religious issue, it parallels a faith divide in this
country—a divide no one in their right mind should want echoed in the
definitions of our political parties.
Meanwhile,
the American populace, which strongly believes we cannot afford this, is angry
at being ignored. The civility of the Capitol, such as it was, is further
reduced. And representative democracy has taken a beating, perhaps even pushed
down toward a system in which we are free only to elect the tyrants who will
rule us until the next election. This bill was badly thought-through economics,
badly constructed legislation, and badly conceived ideology. All in all, just
plain bad medicine. But the worst of it may lie in the process by which it came
about. Is this the manner in which we wish to be ruled? . . .
Machiavelli
may have been right to claim that we judge more from appearance than from
reality, but the difference between the two sometimes may be deeper than we
think. On October 5, 2009, President Obama held a photo-op speech on the White
House lawn. Standing with him were 150 physicians who supported the president's
plan for health-care reform. The doctors invited to the event had been told to
bring along white lab coats (just in case they should need to examine a patient
or two along the way, of course). Inevitably, a few docs forgot to bring their
coats, and at the event, as cameras whirred, Obama staffers could be seen
handing White House–issue white coats to les médecins sans manteaux.
As
Obama addressed the uniformed group, he asserted that "Nobody has more
credibility with the American people on this issue than you do." There are
two ways to interpret this flattering line: Either it was genuine, and Obama
will follow the lead of the doctors' credible voices, or it is disingenuous and
patronizing.
Unfortunately,
neither possibility works in Obama's favor. A poll conducted in 2009 by Investor's
Business Daily and TechnoMetrica Market Intelligence suggested that
physicians are not nearly as uniform in their approval as Obama would like us
to think. The poll found that more than two-thirds of doctors opposed Obama's
health-care plan, and 45 percent would consider leaving medicine altogether or
taking early retirement if the proposed plan were to become a reality. . .
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article . . .
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* * * * *
2. In the News: Federal Largess Allows Crime
to Flourish
Strapped Police Run
on Fumes, and Federal Pot-Fighting Cash
By Justin
Scheck, WSJ, June
25, 2010
IGO,
Calif.—Shasta County Sheriff Tom Bosenko, his budget under pressure in a weak
economy, has laid off staff, reduced patrols and even released jail inmates.
But there's one mission on which he's spending more than in recent years: pot
busts.
The reason is
simple: If he steps up his pursuit of marijuana growers, his department is
eligible for roughly half a million dollars a year in federal anti-drug
funding, helping save some jobs. The majority of the funding would have to be
used to fight pot. Marijuana may not be the county's most pressing crime
problem, the sheriff says, but "it's where the money is."
Washington has long allocated funds to help localities
fight crime, influencing their priorities in the process. Today's local budget
squeezes are enhancing this effect, and the result is particularly striking in
California, where many residents take a benign view of pot but federal dollars
help keep law-enforcement focused on it.
To make sure
his office gets the federal funds, Sheriff Bosenko since last year has spent
about $340,000 of his department's shrinking resources, more than in past
years, on a team that tramps through the woods looking for pot farms. Though
the squad is mostly U.S.-funded, the federal grants don't cover some of its
needs, such as a team chief and certain equipment. So, Mr. Bosenko has to pay
for those out of his regular budget.
He doesn't doubt the value of pursuing pot farming, which
he says is often the work of sophisticated Mexican gangs and leads to other
crimes like assault. But other infractions, like drunken driving and robbery,
may have a bigger direct impact on local residents than pot growing, he says.
The pot money is "$340,000 I could use somewhere
else in my organization," he says. "That could fund three officers'
salaries and benefits, and we could have them out on our streets doing
patrol." . . .
Read
the entire news item and related posts . . .
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* * * * *
3. International Healthcare: Greece
Told to Privatize HealthCare before Bailouts
By Alieta Eck, MD
Some people learn from others' mistakes, and some have
to "learn the hard way." Will America follow the lead of
countries who have actually tried their own version of ObamaCare, or could we
still learn from their mistakes? In a remarkable statement, the
International Monetary Fund has recommended that, before any bailouts are
considered, the Greek government must privatize transportation, energy and
health care to rein in costs. The IMF recognizes that increased
government involvement in health care does not save money. It also does
not lead to better health care.
In 1983, when the socialists were in power, Greece
established "health care for all." Today government spending is
unsustainable and Greece is awash in red ink. Talks of budget cuts and
program cutbacks are causing rioting and bloodshed.
The Greek system is employer- based but the Greek
Ministry of Social Health and Cohesion has enacted strict regulations so that
innovation cannot exist. Employers must choose from government-approved
insurers, with rates and benefits packages clearly delineated. This
sounds much like ObamaCare– private but heavily regulated insurance.
According to Michael Tanner of the Cato Institute,
"the Greek health care system is funded through payroll taxes, general tax
revenue and bribery." Tanner, Michael D. (2008) "The Grass Is Not
Always Greener: A Look at National Health Care Systems Around the World" Cato Policy Analysis no.
613.
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Government Medicine Only Gives Access to a Costly
Waiting List.
In America, everyone has access to HealthCare at all
times. No one can be refused by any hospital.
* * * * *
4. Government
Healthcare: Around the World
Critics
of the U.S. health care system frequently point to other countries as models
for reform. They point out that many countries spend far less on health care
than the United States yet seem to enjoy better health outcomes. The United
States should follow the lead of those countries, the critics say, and adopt a
government- run, national health care system.
However,
a closer look shows that nearly all health care systems worldwide are wrestling
with problems of rising costs and lack of access to care. There is no single
international model for national health care, of course. Countries vary
dramatically in the degree of central control, regulation, and cost sharing they
impose, and in the role of private insurance. Still, overall trends from
national health care systems around the world suggest the following:
Although
no country with a national health care system is contemplating abandoning
universal coverage, the broad and growing trend is to move away from centralized
government control and to introduce more market-oriented features.
The
answer then to America's health care problems lies not in heading down the road
to national health care but in learning from the experiences of other
countries, which demonstrate the failure of centralized command and control and
the benefits of increasing consumer incentives and choice.
Read the entire article
. . .
Read
entire article in pdf . . .
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Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean
HealthCare: Going Horizontal Rather than Vertical by James P. Womack
One of my favorite value-stream walks is with the
senior managers of several organizations who share and jointly manage a
value-creating process that stretches all the way from raw materials to the end
customer. I've been taking walks of this sort for more than 20 years and I
usually see the same thing: Smart, hard working managers, each trying to
optimize their portion of the value stream and wondering why there is so much
inventory, interruption, and waste along the stream and why it is so hard to
truly satisfy the customer waiting at the end.
This is what I usually see because we live in a world
where everything is oriented vertically - departments, functions, enterprises,
and, very important, individuals - despite the fact that the flow of value to
the customer is horizontal across all the departments, functions, and
enterprises. And - here's the really odd part -- every manager and employee
touching the value stream knows intuitively, just below the surface, that value
flows horizontally and that customers have no interest at all in the vertical
constraints interrupting the flow.
So what's the problem? Why is it so hard for us to act
horizontally rather than just work around (or simply ignore) the enormous
problems of being vertical?
I hate to say, but the problem begins with you and me.
We are all points along the stream, standing tall in our own estimation, and
our first objective is to optimize ourselves, our own point! Given this, it's
not surprising that we first seek to optimize our department (where our boss,
our personnel evaluation, and our career path reside) and then our function and
then, maybe, our enterprise, with no energy left over for optimizing the whole
stream.
But let's not be too hard on ourselves. Our personal
objectives, compensation, and career trajectories strongly direct us to look
up, for fear of falling down, rather to look from side to side in hopes of
doing better. We aren't so much bad people - at least I'm not! - but good
people working in a bad management process. However, unless we can devise a new
framework for thinking together about the horizontal flow of value in a way
that makes everyone better off, we will all continue to act as we always have.
The predictable result is frustrating work lives and an exasperating experience
for customers.
How can we do better? The first step is simple. Take a
walk together along the stream to see, and to reach agreement on, what is
really happening and the problems the current state causes managers, employees,
and customers. Then draw a map that everyone touching the stream can see and
post this as the baseline. This step always produces amazement and then relief
that all of the dysfunctions and conflicts are finally out in the open.
Next, assign someone to lead a team involving every
function and firm touching the value stream to envision a value-creating
process that better solves customer problems while saving time and money. Then
ask why this can't be created and seek the root cause. Part of the problem may
be technical and some outside help may be needed when skills are lacking. But
in my experience the critical problems are more likely to be organizational
across multiple functions and enterprises. For example, money may need to be
spent at one point (for facilities, equipment, training, new packaging of
goods, etc.) and behaviors may need to change at this or other points to create
a better result for the whole stream.
But why would the managers of the factory or the
warehouse or the retailer do this when all of the benefit goes to one or a few
points elsewhere along the stream? And why would employees cooperate in
rethinking work when they may individually have more work or no work at all?
The answer, of course, is that they won't and everyone involved will spend
their time instead on explanations of why the failure to improve performance is
everyone else's fault. A classic prisoner's dilemma in which everyone gets to
stay in their vertical jail!
So the job of the value-stream leader - who it should
be noted has no authority over most and perhaps all of the departments and
firms involved - is to take responsibility for the performance of the whole
value stream and discover ways to make everyone along the stream whole as the
stream is improved. In the end the senior leaders of all the departments,
functions, and firms will need to agree with the plan, arrange compensation
mechanisms for those who would otherwise be losers, and make sure that everyone
touching the stream has incentives aligned with the goal of optimizing the
stream. But the first step is to raise consciousness, create the vision,
highlight the problems to be overcome, identify the costs of improvement along
with the benefits of success, and describe the ways to offset costs with
benefits to achieve a positive sum solution. Without this first step, starting
with a simple walk together, we will all continue along our vertical path,
where value stream performance is a stagnant, horizontal line.
Best regards,
Jim
James P. Womack
Founder and Chairman
Lean Enterprise Institute, Inc.
P.S. LEI has just released a path-breaking workbook
with practical advice on how to do what I have just described. Robert
Martichenko and Kevin von Grabe have distilled their many years of experience
developing logistics systems, initially in collaboration with Toyota, into a brief
workbook on optimizing "fulfillment streams" (their helpful term for
the entire flow of value from raw materials to customer.) Building
a Lean Fulfillment Stream introduces the critically lacking management
tools of the Fulfillment-Stream Council and the Fulfillment-Stream Leader. It
utilizes a case study, based on their extensive experience deploying lean
logistics far beyond Toyota and the auto industry, that shows you how to apply
these and other important concepts such as the Total Cost of Fulfillment. I
hope you will go to
www.lean.org for further details on this workbook, including chapter
downloads and a Q&A with the authors.
Feel free to forward this message
to suppliers, customers, or colleagues who are implementing lean -- or should
be. (You may also quote portions of this e-letter. But please remember that it
is protected under U.S. and international copyright laws. That means you can't
use it commercially, post, or republish it without written permission in
advance from the Lean Enterprise Institute. For permission, write to cmarchwinski@lean.org ) Permission was granted.
© Copyright 2010 Lean Enterprise Institute, Inc. All rights reserved. www.lean.org
If this e-letter was forwarded to you, visit www.lean.org
to subscribe. Just click the "Become a Member" link on the right to
get a free subscription and access LEI's valuable content about implementing
lean principles in production, service, administration, and healthcare value
streams.
-Lean Enterprise Institute, One
Cambridge Center, Cambridge, MA 02142, (617) 871-2900.
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The Future of Health Care Has to Be
Lean, Efficient and Personal.
* * * * *
6. Misdirection in Healthcare: Current
doctors have paid huge costs to be where they are.
Why
Doctors Don't Want Free-Market Medicine By Theodore Levy
The Freeman | Ideas On Liberty • July/August 2010 • Vol. 60/Issue 6
You may have heard that the AMA and "America's
physicians" favor universal health care. That's true of the AMA, but that
organization represents fewer than 20 percent of the nation's doctors. And it's
true of many academic university physicians, but anecdotally it is obviously
untrue of most doctors in private practice. Many of those docs desire to
"get government out of medicine."
But those physicians have a problem, of a sort that
"getting government out of medicine" doesn't solve.
I'll describe the problem in a moment; but first, an economic interlude:
When special interests get special grants of power
from government, they benefit, of course. But the benefits—what economists call
rents—are not static. Over time they tend to dissipate, because the prices of
the factors of production required to obtain them are bid up. A new market
equilibrium is formed. Some examples:
·
The chattel-slave system
present during the first century of this country's existence gave the lie to
the noble words of the Declaration of Independence that all men are created
equal. I have much sympathy for abolitionist William Lloyd Garrison's famous
epithet that, because it sanctioned slavery, the Constitution was a
"covenant with death and an agreement with hell." But slavery
persisted. Economic historians have asked why. Nobel laureate economist Stanley
Engerman, in his work Time on the Cross, coauthored with Robert Fogel,
investigated the tricky economics of slavery. . .
·
Few people think today
that Social Security is a good deal. Young people doubt it will be around when
they retire. Middle-aged people and those recently on Social Security know they
could have done better had they been allowed to invest the money themselves in
a diversified low-risk portfolio. Granted, those who turned 65 in the early
years after FDR began the program benefitted, as they received benefits without
incurring costs. But those days are long gone. Now people on Social Security
may only break even, and surely in the future they will suffer a financial
loss. Nonetheless, current recipients don't want the system to end, because
they'd lose even the little money they're counting on.
·
In New York City and
other large metropolitan areas, before you can legally drive a taxi, you have
to purchase a medallion (license) from the government. The nominal price of a
medallion is not high, but to restrict the supply of cabs the municipality
sharply limits the number sold. So (as with ticket scalping) in the resale
market the price is much higher than the face value, sometimes several hundred
thousand dollars or more. The system benefitted the taxi companies operating at
the time licensing was enacted—unsurprisingly, these were the very companies
that lobbied for them—because restricting medallions restricted taxi supply and
increased the amount the companies could charge their customers. But it didn't
help make a larger profit for the taxi owners who came along later, because the
larger fees they were able to earn from a lower supply of cabs were offset by
the exorbitant cost of the now-expensive medallions. And yet, although making
only market incomes, the current taxi owners have every incentive to maintain
the medallion system because eliminating it now would cause them an even
greater loss when the market price of medallions fell to zero.
What does any of this have to do with medical care?
Medical licenses are like taxi medallions. The AMA assiduously sought the
licensing of medical professionals from its very beginning in 1847. At that
time, ironically, schooled physicians had little more to offer patients than
charlatans did and often caused more harm than good through what was known as
"heroic therapy," treatments like leeching and the use of arsenical
purgatives. Finally, about a hundred years ago, medical services were
cartelized. After the release of the Flexner Report (1910), the number of medical
graduates declined by approximately half over the next decade, a decrease
falling disproportionately on minority and female physicians.
The question is not whether it's a good thing to have
better-trained doctors; the question is whether overtraining is possible, and
how to know without market competition whether we've reached that point. A
recent physician survey asked if doctors thought every M.D. needed all the
training he received to be able to provide high-quality care. Many respondents
answered no.
Perhaps doctors as good as those currently practicing
could be trained in six or seven years—rather than the 12 or more today.
Perhaps a combination of less human training but better computer diagnostics
would be of value. Perhaps an apprenticeship model would work better than the
current didactic educational model. Without a competitive market, there's no
way to tell.
No doubt most physicians are sincere when they say
they can't imagine a system with less training that would protect the patient
from charlatans. But it's also true most citizens under Soviet rule couldn't
imagine how shoes would reach market without central command, and no doubt at
least some plantation owners were sincere in their concern that if slavery
ended, the slaves would not know what to do or where to go.
Most everyone has met a bad doctor. And yet he, too,
spent four years in medical school and passed the boards as presently
constituted. If quality were the only consideration, isn't that evidence that
four years plus residency is not enough? Should medical school be eight years
long? The point, of course, is that extra training before practice has a cost
as well as a benefit.
Just as the economic rent (the excess earnings over
the amount necessary to keep the factor of production in its current use) from
taxi medallions was dissipated over time as the cost of obtaining the
medallions increased, so too the economic rent of a medical license over time
does not go to doctors but rather to those who can charge doctors more to meet
the license and practice requirements. In the decades after Medicare spending
increased the income of physicians, the price of medical school skyrocketed. So
while licensed doctors made more money, becoming a doctor with a license cost
more money. Doctors all complain about the high cost of malpractice insurance,
but few realize that one reason such insurance commands a high price is that
doctors can pay it.
Current doctors have all paid huge costs to be where
they are today. Yet many of them describe trouble breaking even financially,
even though the average doctor makes a great income compared to the average
American. Like those currently collecting Social Security, they would be hurt
by a change in the system that lowered their incomes.
So most doctors do not really want "less
government" in health care. They want the type of government control and
regulation that restricts supply and limits innovation to that which directly
benefits the medical cartel. They don't want nurses doing things—even simple
things—without physician supervision for the same reason dentists don't want
dental hygienists to do even simple basic cleanings without dental supervision.
They prefer to view ancillary personnel as subordinates rather than competitors.
Like most other licensed professionals, they complain only about the
regulations that harm them to the benefit of others, not those that benefit
them at the expense of others.
Society was better off ending slavery and would be
better off ending the Ponzi scheme of Social Security and the legal cap on taxi
medallions. But there are always special interests who will be hurt by socially
beneficial reforms. No one likes to see himself as a special interest. But
physicians as a group would likely be financially harmed by a true free market
in health care, one that ended not only the burdensome regulation doctors all
complain about but also the restrictions placed on who is legally allowed to
offer services labeled as "health care," restrictions that redound to
physicians' benefit.
Fortunately for the physicians, almost no one is
calling for a free market in health care. Doctors want regulations that free
them to practice as they wish, while still having the government assure that
everyone can get health insurance and thus pay doctors for practicing as they
wish. Patients want as much care as they need and desire, paid for by others.
Insurance companies want to maintain their cozy relationships with state
regulators, built up over years, and not have to compete nationally, and are
therefore opposed to calls to end the prohibition of interstate sales of health
insurance. Everyone calls for help from the State, which, as Bastiat pointed
out, is the fiction by which everyone tries to live at the expense of everyone
else.
Article
printed from The Freeman | Ideas On Liberty: http://www.thefreemanonline.org
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Well-Meaning
Regulations Worsen Quality of Care.
* * * * *
7. Overheard on
Capital Hill: July 4, 1776
Declarations by Peggy Noonan, WSJ, July 4, 2010
The tenderest words in American political history
were cut from the document they were to have graced.
It was July
1, 2 ,3 and 4, 1776, in the State House in Philadelphia. America was being
born. The Continental Congress was reviewing and editing the language of the
proposed Declaration of Independence and Thomas Jefferson, its primary author,
was suffering the death of a thousand cuts.
The tensions
over slavery had been wrenching, terrible, and were resolved by brute
calculation: to damn or outlaw it now would break fragile consensus, halt all
momentum, and stop the creation of the United States. References to the slave
trade were omitted, but the founders were not stupid men, and surely they knew
their young nation would have its date with destiny; surely they heard in their
silence the guns of Fort Sumter.
Still, in the
end, the Congress would not produce only an act of the most enormous human and
political significance, the creation of America, it would provide history with
one of the few instances in which a work of true literary genius was produced, in
essence, by committee. (The writing of the King James Bible is another.)
The beginning
of the Declaration had a calm stateliness that signaled, subtly, that something
huge is happening:
"When in
the Course of human events it becomes necessary for one people to dissolve the
political bands which have connected them with another, and to assume among the
powers of the earth, the separate and equal station to which the Laws of Nature
and of Nature's God entitle them, a decent respect to the opinions of mankind
requires that they should declare the causes which impel them to
separate."
This gave a
tone of moral modesty to an act, revolution, that is not a modest one. And it
was an interesting modesty, expressing respect for the opinion of the world
while assuming the whole world was watching. In time it would be. But that
phrase, "a decent respect to the opinions of mankind" is still a
marker, a reminder: We began with respect. America always gets in trouble when
we forget that.
The second
paragraph will, literally, live forever in the history of man. It still catches
the throat:
"We hold
these truths to be self-evident, that all men are created equal, that they are
endowed by their Creator with certain unalienable Rights, that among these are
Life, Liberty, and the pursuit of Happiness.—That to secure these rights,
Governments are instituted among Men, deriving their just powers from the
consent of the governed."
What followed
was a list of grievances that made the case for separation from the mother
country, and this part was fiery. Jefferson was a cold man who wrote with great
feeling. He trained his eyes on the depredations of King George III: "He
has plundered our seas, ravaged our coasts, burnt our towns. . . . He
is at this time transporting large Armies of foreign Mercenaries to compete the
work of death, desolation and tyranny . . ."
Members of
the Congress read and reread, and the cutting commenced. Sometimes they cooled
Jefferson down. He wrote that the king "suffered the administration of
justice totally to cease in some of these states." They made it simpler:
"He has obstructed the Administration of Justice."
"For
Thomas Jefferson it became a painful ordeal, as change after change was called
for and approximately a quarter of what he had written was cut entirely."
I quote from the historian David McCullough's "John Adams," as I did
last year at this time, because everything's there. . . .
Poignantly,
with a plaintive sound, Jefferson addresses and gives voice to the human pain
of parting: "We might have been a free and great people together." *
What loss
there is in those words, what humanity, and what realism, too. . .
America and
Britain did become great and free peoples together, and apart, bound by a
special relationship our political leaders don't often speak of and should
never let fade. You can't have enough old friends. There was the strange war of
1812, declared by America and waged here by England, which reinvaded, and
burned our White House and Capitol. That was rude of them. But they got their
heads handed to them in New Orleans and left, never to return as an army.
Even 1812
gave us something beautiful and tender. There was a bombardment at Fort
McHenry. A young lawyer and writer was watching, Francis Scott Key. He knew his
country was imperiled. He watched the long night in hopes the fort had not
fallen. And he saw it—the rocket's red glare, the bombs bursting in air, gave
proof through the night that our flag was still there.
And so to all
writers (would-be, occasional and professional) and all editors too, down
through our history: Happy 234th Independence Day. And to our British cousins:
Nice growing old with you.
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*It hurt
Thomas Jefferson to see these words removed from his great document. And we
know something about how he viewed his life, his own essence and meaning, from
the words he directed that would, a half-century after 1776, be cut onto his
tombstone. The first word after his name is "Author."
* * * * *
8. Innovations
in Healthcare: Health Care's 'Radical
Improver'
Watertown, Mass.
'It's a little bit like
talking to a young prince," says Jonathan Bush, chairman and CEO of
Athenahealth, a major player in information technology services for physicians,
of his recent visits to Capitol Hill. "'So—tell me about this market thing
that your people use,'" he says, mimicking the political royalty with a
grin and extending his forearm. "'Wait: I must catch my falcon!'"
Athenahealth's
headquarters, on the banks of the Charles River outside Boston, is a world away
from D.C., and it's clear, as he continues his metaphor, that Mr. Bush enjoys
the distance: "And these princes, they mean well and they're lovely,"
he says, "but they're living in this alternate universe where there's no
such thing as a market in health care and they don't understand why one might
be remotely useful."
He pauses. "That's
weird to me."
Mr. Bush is an outlier in
the generally buttoned-down world of the health industry. He's exuberant,
hyperactive, speaking in frenetic running monologues; it's not hard to see why
the political class might be taken aback: "I still have to keep going to
Washington and sucking up," he says, switching metaphors. "Because
the problem is when you have a baby with an Uzi, right, they might accidentally
mow you down. But here's the thing . . . they're brilliant people. It's just
that the idea of a market in health care never occurred to them."
As Mr. Bush sees it, the
profound problem with U.S. health care is that there's "no landscape of
choices, or choosers." Due to the complexity of America's third-party
laundromat for health dollars—your doctor's clerical staff bills your treatment
to an insurance company picked by your employer, and it pays him with your money
via premiums or foregone wages—"few doctors in America know the actual
value of the services they render."
Athena's core business
helps them manage their practices and get paid, but the larger purpose of the
company, which he and board member Todd Park co-founded in 1997, is to try to
shore up health care's resemblance to a normal market. It has grown into one of
the country's most innovative health IT firms.
Athena began as a San
Diego birthing clinic and floundered because it couldn't cope with back-office
volatility. All transactions were conducted on paper. No one understood how to
navigate the dense and bewildering coding rules for dozens of different
insurers or the fee schedules for government payers like Medicaid. Claims were
denied with no explanation or vaporized in purgatory. The clinic went bankrupt
in 18 months.
With Mr. Park (who has
joined the Obama administration), Athena designed a program to digitize records
and automate billing. It now colonizes the wilderness of paperwork and habitual
financial chaos that defines running a doctors office, and it is also moving
into clinical record-keeping for individual patients. Some 15,000 physicians in
43 states use Athena as a virtual office, a number that is growing at an annual
30% clip.
It is a massive logistical
undertaking. Athena's main facility is housed in a decommissioned World War II
arsenal on the Charles, where 30,000 pounds of paper is processed every month,
most of the tonnage being paper checks. Incredibly, doctors also receive on
average 1,185 faxes each month—mostly lab results—and those are
handled too.
State Medicaid programs,
by the way, are easily the worst payers, according to Athena's annual ranking.
In New York, for instance, claims must be tendered on a dead-tree form instead
of electronically and in blue ink—black is grounds for rejection—and then go on
to spend a full 161 days, or almost a half year, in accounts receivable.
While
streamlining this disorder frees up time for the company's clients to treat
patients, it also throws off vast data, which are fed in central servers,
aggregated and analyzed. This "athenanet" system is among the few
health-tech offerings based on "cloud computing"—in the sense that
the applications are accessed on the Web, instead of a computer's hard drive, allowing
constant updates and refinements. If a regulation changes or an insurer adjusts
a payment policy, it is reflected on athenanet almost in real time; on the
clinical side, the program can adapt at the same rapid pace as medicine itself.
Mr. Bush thinks
the main benefit is the "collective intelligence" that he is starting
to weave together from the 87% of American physicians who practice solo or in
groups of five doctors or fewer. "We found one of the last few remaining
crowds in health care, which are these independent practices. Now you can argue
that this decentralization is not the best thing in the world," but what's
most important, he argues, is that "they're still allowed to go and make
their own decisions."
In effect, as
the network gets bigger, it gets smarter, while opening the space for
innovations to feed off one another and spread. There really can be
"radical improvement" in health care, Mr. Bush says, but only if
there are "radical improvers" able to set themselves apart and lead
the forward advance. "No one ever says, 'Here's to the average,'" he
declares pointedly.
The Athena
model is superior to most electronic medical record systems, or EMRs, which are
generally based on static software that are inflexible, can't link to other
systems, and are sold by large corporate vendors like General Electric. One
reason the digital revolution has so far passed over the health sector is sheer
bad product. The adoption of EMR in health systems across the country has been
dogged by cumbersome interfaces, error propagation and other drawbacks. In
2003, for instance, Cedars-Sinai in Los Angeles dumped a $34 million
proprietary system after doctors staged a revolt.
Athena also stands in marked contrast
to most of the wider health-care market, which Mr. Bush argues is homogenized
and rigid, and getting more so. The problem is "easily fixed by releasing
some power into the arms of consumers and cutting employers and certainly the
government out of it," he says, turning to ObamaCare. "Certainly I'm
not commenting on the amount of wealth redistribution that we should do as a
society. Fundamentally I believe we need some, and whether the amount we're
doing today is enough or too much or not enough, that's not my thing. If we
feel like rich people should pay more for not-rich people's health insurance,
that's fine.
"But
just give them the money," he cries. "It's totally inefficient wealth
redistribution because they can't get creative with it. They're not allowed by
law to get creative with it."
What Mr. Bush means is that the
government imposes standardized rules and mandates with no concern for how much
they will cost or who will bear the burden. Given the choice, consumers might
decide on cheaper policies that cover some services but not others, or decide
to run more risk.
Yet for all the talk about expanding
coverage, Mr. Bush says the real problem is that "You can't buy what you
want." Another way of putting it is that "America will have one car.
Everyone will have access to transportation, which means that everyone will
have a black Escalade, with spinners. That's it. There's no Hyundais, no
bicycles, no nothing."
And it's
scandalously unfair. "These poor people who clip the things off the backs
of cans to make the tomatoes cheaper are subsidizing the hypochondriac who gets
his shoulder done with an arthroscope because it clicks when he serves at
tennis."
Under ObamaCare, Mr. Bush says,
"everyone is going to get health care according to the wise-men benefit
panel, who will tell you exactly what it is, and then they'll run out of money,
so every year the wise panel will just squish the benefit a little. People will
start to say, well, that's not going to work for me." For this reason he
doesn't think central health planning will have any longevity, and eventually
people "will start leaking out into the [private] market once we run out
of Obama energy."
His company, he thinks, will play an
important role in such a world, where individuals would have more
responsibility for weighing trade-offs—which, he believes, is the only lasting
way to enforce discipline in health spending: "Today it's so complicated
that the average consumer—and this is what the academics say—you can't put the
average consumer in charge, it's too complicated. Yeah it's too complicated! So
let's make it not complicated," he says. Athenanet generates "clean
information," the basic price signals about health care that "a
regular old consumer could look at and say, 'That's worth it' or 'I'd rather do
this one on the other side of Route 128 that does it cheaper.'"
Mr. Bush is less sanguine about the
White House cost-control approach of better living through technocracy and
"Benthemite micromanagement." As an illustration he singles out the
idea of dispensing bonus payments to hospitals that find ways to reduce
Medicare spending. If the bonus is higher than what the hospital would have
been paid under the status quo, then Medicare is worse off—but if the bonus is
less than what the hospital would have earned otherwise, in what sense is it an
incentive to change? In other words, "I'm going to give you a dollar bill
for every 10-dollar bill you give me?" Mr. Bush asks incredulously.
The irony is that Athena will likely
benefit from the Project Mayhem that is about to begin. "It's probably
terrible that all this new bureaucracy is being created," Mr. Bush says.
"But there's going to be 50 new Medicaid-type plans in these insurance
exchanges, run by the same insurance commissioners, these same sort of
glazed-over-looking state secretaries of health. You know, just not really the
brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in
the country by a factor of four! Mother of pearl! So I feel a little bit like a
robber baron. I am going to make oil money dealing with them."
The double irony
is that Athena—while Mr. Bush might not put it in such an impolitic way, but
then again, maybe he would—is also showing that the status quo for all its
flaws is capable of organic change and real progress without the blunt-force
trauma Congress is likely to inflict. Or in spite of it.
Take the nearly $47 billion in
stimulus cash the White House has budgeted to prime the pump for health IT
adoption. Mr. Bush says he's glad his industry is getting more attention from
the bully pulpit, but that "It is kind of too bad that all these software
companies that we're really close to putting out of business, these terrible
legacy companies, with code that was written in the '70s, are going to get life
support. That's why I call it the Sunny von Bülow bill. What it is, basically,
is a federally sponsored sale on old-fashioned software."
"It's designed like a box-buying
campaign," he continues. "You get this fixed chunk of money for a few
years, you get to pay off your EMR, like its a thing. People in Washington think
in terms of things that we'll buy and then they'll be there. Buildings. Roads.
Tanks. What Lockheed Martin makes. Things.
"And this isn't that. This is a
market: its a set of agreements, it's a language. What's needed is a way of
exchanging value and making choices, that's ethical—and, you know, nobody,
nobody, not nobody, has said a word about that.
Mr. Rago is a senior editorial page writer at
the Journal.
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* * * * *
9. The Health Plan for the
USA: An Increasing Challenge: American Thinker
By Robert Weissberg, Prof of Political Science
As
the Obama administration enters its second year, I –and undoubtedly millions of
others –have struggled to develop a shorthand term that captures our emotional
unease. Defining this discomfort is tricky. I reject nearly the entire Obama
agenda, but the term "being opposed" lacks an emotional punch. Nor do
terms like "worried" or "anxious" apply. I was more worried
about America's future during the Johnson or Carter years, so it's not that
dictionary, either. Nor, for that matter, is this about backroom odious
deal-making and pork, which are endemic in American politics.
After
auditioning countless political terms, I finally realized that the Obama
administration and its congressional collaborators almost resemble a foreign
occupying force, a coterie of politically and culturally non-indigenous leaders
whose rule contravenes local values rooted in our national tradition. It is as
if the United States has been occupied by a foreign power, and this transcends
policy objections. It is not about Obama's birthplace. It is not about race,
either; millions of white Americans have had black mayors and black governors,
and this unease about out-of-synch values never surfaced.
The
term I settled on is "alien rule" –based on outsider values,
regardless of policy benefits –that generates agitation. This is what bloody
anti-colonial strife was all about. No doubt, millions of Indians and Africans
probably grasped that expelling the British guaranteed economic ruin and even
worse governance, but at least the mess would be their mess. Just
travel to Afghanistan and witness American military commanders' efforts to
enlist tribal elders with promises of roads, clean water, dental clinics, and
all else that America can freely provide. Many of these elders probably privately
prefer abject poverty to foreign occupation since it would be their poverty,
run by their people, according to their sensibilities.
This
disquiet was a slow realization. Awareness began with Obama's odd
pre-presidency associations, decades of being oblivious to Rev. Wright's
anti-American ranting, his enduring friendship with the terrorist
guy-in-the-neighborhood Bill Ayers, and the Saul Alinsky-flavored
anti-capitalist community activism. Further add a hazy personal background --
an Indonesian childhood, shifting official names, and a paperless-trail climb
through elite educational institutions.
None
of this disqualified Obama from the presidency; rather, this background just
doesn't fit with the conventional political résumé. It is just the
"outsider?" quality that alarms. For all the yammering about George
W. Bush's privileged background, his made-in-the-USA persona was absolutely
indisputable. John McCain might be embarrassed about his Naval Academy class
rank and iffy combat performance, but there was never any doubt of his
authenticity. Countless conservatives despised Bill Clinton, but nobody ever,
ever doubted his good-old-boy American bonafides.
The
suspicion that Obama is an outsider, a figure who really doesn't
"get" America, grew clearer from his initial appointments. What
"native" would appoint Kevin Jennings, a militant gay activist, to
oversee school safety? Or permit a Marxist rabble-rouser to be a "green
jobs czar"? How about an Attorney General who began by accusing Americans
of cowardice when it comes to discussing race? And who can forget Obama's weird
defense of his pal Louis Henry Gates from "racist" Cambridge,
Massachusetts cops? If the American Revolution had never occurred and the Queen
had appointed Obama Royal Governor (after his distinguished service in Kenya),
a trusted locally attuned aide would have first whispered in his ear, "Mr.
Governor General, here in America, we do not automatically assume that the
police were at fault," and the day would have been saved.
And
then there's the "we are sorry, we'll never be arrogant again"
rhetoric seemingly designed for a future President of the World election
campaign. What made Obama's Cairo utterances so distressing was how they grated
on American cultural sensibilities. And he just doesn't notice, perhaps akin to
never hearing Rev. Wright anti-American diatribes. An American president does
not pander to third-world audiences by lying about the Muslim contribution to
America. Imagine Ronald Reagan, or any past American president, trying to win
friends by apologizing. This appeal contravenes our national character and far
exceeds a momentary embarrassment about garbled syntax or poor delivery. Then
there's Obama's bizarre, totally unnecessary deep bowing to foreign potentates.
Americans look foreign leaders squarely in the eye and firmly shake hands; we
don't bow.
But
far worse is Obama's tone-deafness about American government. How can any
ordinary American, even a traditional liberal, believe that jamming through
unpopular, debt-expanding legislation that consumes one-sixth of our GDP,
sometimes with sly side-payments and with a thin majority, will eventually be
judged legitimate? This is third-world, maximum-leader-style politics. That the
legislation was barely understood even by its defenders and vehemently
championed by a representative of that typical American city, San Francisco,
only exacerbates the strangeness. And now President Obama sides with illegal
aliens over the State of Arizona, which seeks to enforce the federal
immigration law to protect American citizens from marauding drug gangs and
other miscreants streaming in across the Mexican border.
Reciprocal
public disengagement from President Obama is strongly suggested by recent poll
data on public trust in government. According to a recent Pew
report, only 22% of those asked trust the government always or most of the
time, among the lowest figures in half a century. And while pro-government
support has been slipping for decades, the Obama presidency has sharply
exacerbated this drop. To be sure, many factors (in particular the economic
downturn) contribute to this decline, but remember that Obama was recently elected
by an often wildly enthusiastic popular majority. The collapse of trust
undoubtedly transcends policy quibbles or a sluggish economy -- it is far more
consistent with a deeper alienation.
Perhaps
the clearest evidence for this "foreigner in our midst" mentality is
the name given our resistance -- tea parties, an image that instantly invokes
the American struggle against George III, a clueless foreign ruler from central
casting. This history-laden label was hardly predetermined, but it instantly
stuck (as did the election of Sen. Scott Brown as "the shot heard around
the world" and tea partiers dressing up in colonial-era costumes). Perhaps
subconsciously, Obama does remind Americans of when the U.S. was really occupied
by a foreign power. A Declaration of Independence passage may still resonate:
"HE [George III] has erected a Multitude of new Offices [Czars], and sent
hither Swarms of Officers [recently hired IRS agents] to harass our People, and
eat out the Substance." What's next?
Robert Weissberg is Professor of Political
Science-Emeritus, University of Illinois-Urbana.
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* * * * *
10. Restoring
Accountability in Medical Practice by Non Participation in Government Programs and
Understanding the Devastating Force of Government
·
Medicine and Liberty - Network of Liberty Oriented Doctors, www.MedLib.ch/, Alphonse Crespo, MD, Executive
Director and Founder
Medicine & Liberty
(MedLib) is an independent physician network founded in 2007, dedicated to the
study and advocacy of liberty, ethics & market in medical services.
- We support professional autonomy for doctors and liberty of choice for
patients
- We uphold the Hippocratic covenant
that forbids action harmful to the patient
- We defend responsible medical
practice and access to therapeutic innovation free from
bureaucratic obstruction
- We work towards a deeper understanding
of the role and importance of liberty & market in
medical services
MedLib is part of a wide movement of ideas that
defends
- the self-ownership principle &
the property rights of individuals on the products of their
physical and intellectual work
- free markets, free enterprise and
strict limits to the role of the State
·
Entrepreneur-Country. Julie Meyer, CEO of Ariadne
Capital, (Sorry about the nepotism,
but her message is important) recently launched Entrepreneur
Country. Read their manifesto for information: 3. The bigger the State
grows, the weaker the people become - big government creates dependency . .
. 5. No real, sustainable wealth
creation through entrepreneurship ever owed its success to government . .
. 11. The triple play of the internet,
entrepreneurship, and individual capitalism is an unstoppable force around the
world, and that Individual Capitalism is the force that will shape the 21st
Century . . . Read
the entire manifest . . .
·
Americans for Tax Reform, www.atr.org/, Grover Norquist, President, keeps us apprised of the
Cost of Government Day® Report, Calendar
Year 2010. Cost of Government Day (COGD) is the date of the calendar
year on which the average American worker has earned enough gross income to pay
off his or her share of spending and regulatory burdens imposed by government
on the federal, state and local levels. Cost of Government Day for 2008 was
July 16th, a four-day increase above last year's revised date of
July 10th. With July 16th as the COGD, working people
must toil on average 197 days out of the year just to meet all the costs
imposed by government. In other words, the cost of government consumes 53.9
percent of national income. If we were to put health care into the public
trough, the additional 18 percent would allow the government to control 70
percent or nearly three-fourths of our productivity and destroy our health care
in the process. We would have almost no discretionary income. ATR also keeps us
informed of the campaign promises. You may have noticed that President Obama
has broken his central campaign promise – a "firm pledge" that
Americans making less than $250,000 would not see "any form of tax
increase." He first broke this pledge sixteen days into his presidency
when he signed a 156 percent increase in the federal excise tax on tobacco. And
Obamacare contains 21 tax increases – several of which violate his
"firm pledge". Get your Obama care
at . . . . To protect you from these tax hikes, Americans
for Tax Reform presents the "Obama Tax Hike Exemption Card". The card
fits neatly in your wallet and contains a list of the tax hikes signed into
law by President Obama that violate his tax pledge, as well as a few other
taxes that have been threatened: a European-style Value-Added Tax, Cap and
Trade taxes, and even a federal soda tax. How to use the card: Step
1: Present the card to merchants, employers, and tax authorities. Step 2: If challenged, pleasantly ask:
"Are you calling President Obama a liar?" Click here to find out of your
member of Congress voted for these taxes. "I can make a firm
pledge. Under my plan, no family making less than $250,000 a year will see any
form of tax increase. Not your income tax, not your payroll tax, not your
capital gains taxes, not any of your taxes." "If your family earns less
than $250,000 a year, you will not see your taxes increased a single dime. I
repeat: not one single dime."
--Candidate Barack Obama, Sept. 12,
2008
·
National Taxpayer's Union, www.ntu.org/main/, Duane Parde,
President, keeps us apprised of all the taxation challenges our elected
officials are trying to foist on us throughout the United States. To find the
organization in your state that's trying to keep sanity in our taxation system,
click on your state at www.ntu.org/in-your-state/.
On August 19 you can start working for yourself. It takes nearly 8 months of
hard work for every American to pay for the cost of government. Read more . . .
·
Evolving Excellence—Lean Enterprise Leadership. Kevin Meyer, CEO of Superfactory, has a newsletter which
impacts health care in many aspects. Join his evolving excellence blog . . .
Excellence is every physician's middle name and thus a natural affiliation for
all of us. This month, read his The
Customer is the Boss at FAVI "I came in the day after I became CEO,
and gathered the people. I told them tomorrow when you come to work, you do not
work for me or for a boss. You work for your customer. I don't pay you. They
do. . . . You do what is needed for the customer." And with that single
stroke, he eliminated the central control: personnel, product development,
purchasing…all gone. Looks like
something we should import into our hospitals. I believe every RN, given the
opportunity, could manage her ward of patients or customers in similar lean and
efficient fashion.
·
FIRM: Freedom and
Individual Rights in Medicine, www.westandfirm.org, Lin Zinser, JD,
Founder, researches and studies the work of scholars and policy experts in the
areas of health care, law, philosophy, and economics to inform and to foster
public debate on the causes and potential solutions of rising costs of health
care and health insurance.
· Ayn Rand, a Philosophy for Living on Earth, www.aynrand.org/site/PageServer, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of Op-Ed articles, some of which you and I may disagree on, go to www.aynrand.org/site/PageServer?pagename=media_opeds.
* * * * *
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Del
Meyer
Del Meyer, MD, CEO & Founder
DelMeyer@HealthPlanUSA.net
Satyam A Patel, MBA, CFO, & Co-Founder
SatyamPatel@HealthPlanUSA.net
HealthPlanUSA,
LLC
www.HealthPlanUSA.net
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words
of Wisdom
Success is not final, failure is not fatal: it's the
courage to continue that counts. -Winston Churchill
The best thing about the future is that it comes only one
day at a time. -Abraham Lincoln
A people that values its privileges above its principles
soon loses both. -Dwight Eisenhower
Liberty without learning is always in peril; learning
without liberty is always in vain. -John Kennedy
Failure is but the opportunity to begin again more
intelligently. -Henry Ford
Investment in knowledge pays the best interest. -Benjamin
Franklin
Recession is when a neighbor loses his job. Depression is
when you lose yours. -Ronald Reagan
Some
Recent Postings
April 2010 HPUSA Newsletter
. . .
This
Month in History
This
Month in History – July was Freedom Month and Now is Enslavement Month
July 1 marks the beginning of the
month in which so many nations, including our own, gained their freedom.
Canada became a self-governing dominion of Great Britain on this
day in 1867.
France celebrates the anniversary of its first revolution on July
14.
Such other nations as Algeria, Argentina, Columbia, Belgium, Peru,
Liberia and Venezuela gained self- government and freedom during this month.
Our theme this month is freedom—freedom from several points of
view: first, how do we keep it and second, what do we do with it. Third, we have to decide how strongly we
are committed to it.
Today, we have a memorable
reminder of the sad fact that freedom means different things to different
people. Today is the anniversary of the beginning of the Battle of Gettysburg
in 1863, a battle memorable both for the bravery and dedication of those who
fought it and for its role as a turning point in the Civil War. The Battle of
Gettysburg, as Abraham Lincoln said a few months later, must be remembered so
that from its honored dead "we take increased devotion to that cause for
which they gave the last full measure of Devotion." In the largest sense,
that cause was, again as Lincoln said, "that government of the people, by
the people, for the people shall not perish from the earth."
Medicare went into effect in the United States on this date in 1966. Many
well-to-do seniors paid for their private health insurance for some years and
finally succumbed to become enslaved to the government for their most personal
privacy. In 1970, my father finally gave up paying his Blue Cross/Blue Shield
and White Cross policies premiums and sadly just had Medicare. He felt sad for
the country that his parents came seeking freedom from the Father of government social insurance, German
Chancellor Otto von Bismarck in 1866. As with any entitlement, there is never
an objective appraisal of what alternatives would have kept our nation from enslaving
themselves, our children and our grandchildren. Charles
Ponzi, Bernard Ebbers, Enron, Lou Pearlman, Ivan Boesky, Michael
Millikin, Dr. Bill McGuire, Bernard Madoff, ($65 billion), PG & E, and others were
mere pikers compared to the grandiose Ponzi schemes that Roosevelt, and Johnson
pulled off in 1933 and 1966. It took Reagan and 30 years to reverse the process
of living on our children's and grandchildren's future. Will it take another 30
years to survive the current administration's Ponzi Scheme of $ trillions that
will outdo Roosevelt & Johnson combined and also enslave us? Or will we
fade into the history of human misery being subject to the devastations of
government by Kings, Emperors, Dictators, Czars, and other Ruthless Rulers. We
could fade into slavery by not even firing a shot or giving serious resistance.
What a tragedy from becoming so comfortable with our freedom that we failed to
understand the daily risks. Will we then become so comfortable with enslavement
like the people of Russia when Communism was overthrown? Some actually wished
for the return of the dictator to be told when and where to buy their daily
bread, even if it was only once a week. Starvation was more comfortable and
secure to them than freedom.
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