Welcome

Welcome

Dear All,

I am starting this blog to reserve a spot for my numerous thoughts. Instead of boring my wife with hour long political discussion, I have turned to the internet to have a broader discussion and to keep my marriage in tact.

For the next few months my focus is health insurance reform. I am a member of PNHP(Physicians for a National Health Program pnhp.org) and have had a very fulfilling career as a Family Physician. Along the way I have been certified in Family Practice 5 times, earned an MPH in Maternal Child Health, and was boarded in Geriatrics as well as Pediatrics. I served on numerous local hospital committees, established and became chairman of the Winchester Hospital Family Practice Department. I served on the North Shore Health Planning Council in the 80s, had a stint as Chairman of the Board of Health in Reading, Ma. I have also been active in local Democratic politics. I have visited with health information experts at Beth Israel Hospital(Dr. Halamka), spoken with legislative offices on health care issues(Sen Richard Moore and Sen Tolman), and I have met with my personal rep to Congress, John Tierney. I designed and developed a functioning EMR for my office and have upgraded it with help from a software developer. It is now also a part of one of my colleague's office. This is the expertise and experience I bring to the discussion. Oh I've also been a patient having undergone 2 major surgeries in the past 10 years.

The Rules of the Blog: No global terms like right and left. Let's hear the ideas. We want to promote discussion, not destroy it. Conservative and liberal are OK if you mean by Conservative a traditionalist who wants any change, if any, to come slowly. Liberal is OK if you mean someone ready to test out completely new ideas and desires more dramatic change. The conversation is then what do you want to keep and why and the flip side, what do you want to change and why. Profanity is OK if you're really that upset or overwhelmed. Anything you write should be backed up from reasonably reputable sources. If others don't think they are, they certainly are free to refute what has been cited.

So all this boils down to how you think about health care. Is it a commodity that is a global necessity for existence? Is this a privilege reserved for those who can afford it? Can anyone accurately predict what their health care needs will be from year to year? Words such as competition and choice do not operate in the same way in this sphere as it does with other things we buy. So let's start here and see what you have to say on the nature of health care. How do you want to be treated and how do we get there? Dr. Donald Green

Mindlessness VS Mindfulness

This is the key issue.  Do we run our lives like some old movie or do we evaluate our experiences with some of our god given intellect.   It seems a large swath of the population wants to wander through life without questioning if there are better options.  According to Dr. Langer, a Harvard pyschologist, our well being is dependent on our ability to think.  Mindlessness is deadly.

Racist or Scared?

As we watched the Feedom Works demonstration in Washington DC this past week it became the backdrop for the tears in the national fabric. They were stirred up by leadership to accept an enslaving agenda, i.e. not allow those who are without have no chance to improve their lot. They use fear mongering techniques that have no basis in reality.

The device used is to make government the boogy man and at times, the black President himself. So many have put words into Jimmy Carter's mouth, a critic of some of the marchers. He only identified some of these protesters as racist. The past president pointed out that among those who are using personal ad hominems against the present president, a large portion are racially based. He purposely left out those who had an ax to grind on their taxes or having government involved in health care. In this light President Carter is right on.

In the group that consider their hero, Joseph Wilson, Rep from S. Carolina, also admire his support for waving the Confederate flag over that state's Statehouse. He has called the Confederacy an "honorable history." If this isn't racist, what is? If when directly asked if he was racist, he stated he wasn't because he lives closeby to blacks. Huh?

A universal paid for national health plan helps individuals, business, government, and our collective psyche, and our pocket book. Anything less is shooting yourself in the foot and stretching the divide in an unhelathy way of wealth distribution. Yes even captialism must ensure that a significant number of the population has a livable income. Without it we come to a ignoble collapse of our way of life.

Two Letters Aug 27, 2009

Here are two letters I wrote today. The first is to Paul Krugman asking him to reply to those who whine about deficits and government intervention. The second, in a similar vein, is an email I sent to C-Span directed to M. Scully who was happy to point out the failures of our present private insurance versus Medicare but continues to insist on free market solutions:

Dear Dr. Krugman,

The problem, like in the commentaries to your article on the deficit, belonging to the opposition goes over their head unless it is spelled out in their own lexicon. This includes phrases like passing debt onto future generations, etc. Always missing in the conversation is the productivity of our workers and the hope it will produce more full fledged tax payers eventually. Also since it is the top 10% of income earners that will benefit most from the present programs, it is understood they will pay for it through higher taxes eventually. Like any debt. it is incurred, does its work, and then is paid for.

You just wonder who the real capitalists are anyway. The present whining group against the deficit and health care reform have no faith, it seems, in the future earning potential of our citizens given the proper education, training, and support. Health care reform, itself, especially Medicare For All, enables greater availability of capital, better workers, and higher profits and incomes. It should be a capitalist's wet dream. Instead they cry socialism when it is they who so readily seek government largess when they are in trouble. It is time to identify who's who. Those of us who want real reform is because we are capitalists. Those that don't are asking for even deeper government socialist intervention. Who's kidding who? Dr. Krugman, your style of writing carries weight and clarity. Could you illuminate this in an article directed to these phony capitalists and erstwhile socialists in sheep's clothing? The tongue is in the cheek but I hope you understand what I mean.

By the way, c-span had an excellent 3 part program on Washington Journal going over all parts of Medicare, A though D. It was wonderful and eye opening. It should be mandatory viewing for every concerned citizen, our President, and all members of Congress.

Dear Washington Journal:

Sorry I couldn't do this on air but wish to thank c-span for presenting these very knowledgible people on Medicare to the public. Hopefully it will make issues clearer as we move forward in the health care debate.

I am a Single Payer supporter and the rationale for this became even clearer this morning. The discussion between the two participants weighted the arguments towards a Medicare For All system. More money for services would be available by avoiding the overcharges by the private sector(some $400 billion dollars) and a simplification of the process as all parts along with the rest of our citizens would be rolled into one. Mr. Vldeck actually endorsed the role of private insurers in the Medicare system as claim processor, their only valuable participation, at an extremely competitive price for its users. He even acknowledged supporting private efforts to coordinate care and paid for by our government if it removed unneeded excess. These are proper uses of the capitalist system in its payment mechanism for health services. So if you ask me, Mr. Scully should rethink what capitalism's proper place in society is. The answer may move him to Mr. Vldeck's side of the equation and we'd all be better off. How many times do the so called free marketers get a chance to impoverish and cause unnecessary death of our citizens before they realize they are shooting themselves in the foot. They are causing harm not just to others but to themselves and their families now and in the future.

To The Workers In The Health Insurance Industry

It must be disheartening if you are one of the many employees of the health insurance industry to feel the resentment of policy makers and fellow citizens. The industry you work in is being blamed for a lion's share of the cost overruns of the health care expense in this country. However you are not to blame since you are, like any other loyal citizen, trying to earn a decent living for your family. The problem is the companies you work for have not fulfilled the bargain that established them. HMOs were created in the 1970s on the idea if people were guided properly through the health care system with a primary care gatekeeper and offering inexpensive preventive care everyone would be a winner. It didn't turn out that way. Those in your management embraced a model that no longer serves your fellow Americans well. It did for a few years but when they started to be more on their own, adding bureaucracy, and making deals that were too costly and consequently cost shifting to the subcriber, an ongoing era of double digit premiums ensued. Of course I'm sure a different view was portrayed in meetings and memos but ultimately it is clear that the path chosen by company executives has added expenses that no longer can be sustained by the general population.

To cover their tracks you were told it was the government that was the source of their problems. Medicare and Medicaid were not pulling its fair share according to their view. This is not true and in fact the current drastic situation would have come sooner if Medicare hadn't balanced out the shortcomings of HMO's business plan. For years your government was paying 130% of costs to hospitals, allowing heavy discounting to corporations such as yours. The spicket dried up in the 1990s with the Balanced Budget Act. Medicare reduced its payments via a DRG system to establish payments that paid essentially for costs. Since the insurance companies were no longer pulling their load, negotiations with the hospitals resulted in higher fees for their services. So now insurance companies had to increase their enrollments or cost shift to employer clients and subscribers. This process included some very expensive deal making inflating company negotiating and marketing teams. You should know that bureaucracy in private insurance has grown 1500% over the past 20 to 30 years. An astounding number.

All this is not your fault. However it must put a scare into you that moving to a more centralized efficient sytem will mean loss of jobs in your line of work. It cannot be sugar coated, this is true. The private health industry as it now constituted is dying. However there must be an effort to value your work contributions and no reform should take place if it adds to your misery. This would be highly unfair. This will take leadership from the President and proper action from the Congress. A tall order, I know, but not inconceivable. Other countries have made this transition and, quite frankly the handwriting is on the wall, There are too many people working in the insurance business to be sustained. It is no longer serving the needs of society. HR676, the Medicare For All Bill, now in the House of Representatives sets aside $20 billion dollars recognizing that layoffs will occur and provides for training and movement to more up to date services. If those of us who want to fix health care payment neglect you, our fellow citizens, we have not fully accomplished a fair solution to this problem.

There is a silver lining. Your own health insurance will cost less and the societal savings overall will allow entrepreneurs or present businesses to hire more people, create new positions, or even raise incomes. That would certainly be nice for a change. In this entire health care debate, you are the forgotten people and as a fellow countryman, your very survival should be part of the picture. We can not substitute one kind of suffering for another if it can be helped. Please join us in the Single Payer movement for the sake of your future, your family's future, and the future of your nation. We need your voices also to make sure you are not left out or mistreated for the work ethic you have shown. However there is also a caveat. Without changes the problem will grow and you will be left in a high and dry situtation. This must not happen.

Condolences to the Kennedy Family

In deepest sympathy for your loss and ours. I named my little 12 foot portable boat that I take out into Nantucket Harbor adorned with scratches and stains, "Almost Perfect." Although somewhat battered, it takes me to those most beautiful parts of the Island that are out of view for most visitors to this Isle. It is this kind of conveyance I saw in our senior Senator. Buffeted by life's rough obstacles, he led the way to better lives for so many. Rest in peace, Senator, you did good, almost perfect.

Private Health Insurance, A Free Market Failure

Dear Dr. Herrick, I, myself, am not arguing that health care is a “public good” or “public utility.” Health care is a human necessity. When people are sick or want to keep themselves well this is the service we almost all rely on. Is there any doubt in your mind that this is so? If impoverishment and death is the outcome when it is not available because of inability to pay, this really begs the issue. This suggests it is not following market place rules. Businesses are suppose to enhance wealth both to its owners and its users. I would refer you to Kenneth Arrow’s treatise on why health insurance does not fit the usual competitive model of the market place. It can be easily googled.

You could set aside money your whole life and still be behind the 8 ball if you get sick. Instead of hoarding it in this manner why not pay for meaningful insurance according to your ability to pay through a central mechanism. This removes the worry and tension and fulfills an essential part of the social contract. Rich or not so rich benefit when the population is as healthy as it can be. Thomas Paine: “No one joined a society to be worse off.”

To some extent everyone agrees treatment can not be withheld from anyone. People cannot be refused care in an ER or hospital whether they can pay or not(sort of like your defense argument). However this approach is both an overly expensive and insufficient way to deliver care. It would be less expensive and more life saving to give this group of people health insurance.

Public Health is already an accepted necessity. In addition without individual care in the range of affordability and accessibility our survival is in danger. I have already alluded to the numbers of dead and the loss to the economy because of our present system. It just stands to reason if everyone has this need but its costs in the society are too great, then a government imposed tax and/or regulations to pay for it is the next logical step. Will there be problems or complaints? Undoubtedly, but we in the US do not even come close to the 86% satisfaction rate of Canadian Medicare, for example. Anecdotal horror stories aside, reports from other developed countries echo this result.

By fixing this major hole in our economy we will provide more capital and opportunities to private entrepreneurs. Wasn’t it health insurance premiums for employees active and retired that helped sink GM?

Simply put, a rational health care system is presently out reach financially for too many people. It is time for Medicare for all.