HEALTHPLANUSA. |
QUARTERLY NEWSLETTER |
Community For Affordable Health Care |
Vol X, No 2, July, 2011 |
Transforming the $3 Trillion HealthCare
Industry into Affordable HealthCare
By Utilizing the $2 Trillion
Information Technology Industry
Through
innovation by moving from a Vertical to a Horizontal industry
Thus
eliminating $1 Trillion wasted
Insuring
every American without spending the Extra $1Trillion Projected.
To purchase a copy of
the business plan, become an entrepreneur,
and changed the course of healthcare history, go to the bookstore at
www.healthplanusa.net/index.asp
In This Issue:
1. Featured Article: World Health Report 2000 was an intellectual fraud
2. In the News: Why Medicaid Should Be Easier to Fix than Entitlement Programs
3. International Healthcare: From the
Stockholm-Network of Think-Tanks
4. Government Healthcare : While the US Gov’t is insolvent, the states aren’t far behind
5. Lean
HealthCare: Every industry is
getting lean; we no longer have a choice.
6. Misdirection in Healthcare: Misdirection in
our Country at Large
7. Overheard on Capital Hill: Rumors from Texas
8. Innovations in Healthcare: Telehealth
9. The
Health Plan for the USA: Level B: Emergency Rooms, Urgent Care and Surgi-centers
10. Restoring Accountability in Medical Practice by Moving from a Vertical to
a Horizontal Industry:
Announcing
The 1st Annual World Health Care Congress Latin America, October, 2011 in
São Paulo, Brazil
The World Health Care Congress (WHCC) convenes the most
prestigious forum of global health industry executives and public policy
makers. Building on the 8th annual event in the United States, the 7th annual
event in Europe and the inaugural Middle East event, we are pleased to announce
the 1st Annual World Health Care Congress - Latin America to be held in
October, 2011 in São Paulo, Brazil.
This prominent international forum is the only conference in which
over 500 leaders from all regions of Latin America will convene to address
access, quality and cost issues, including Latin American health ministers,
government officials, hospital/health system executives, insurance executives,
health technology innovators, pharmaceutical, medical device, and supplier
executives.
World Health Care Congress Latin America will address escalating challenges such
as improving access to quality care, financing and insurance models for health
care, driving innovation in health IT, promoting evidence-based medicine and
clinical best practices. World Health Care Congress Latin America will
feature a series of plenary keynotes, invitational executive Summits, in-depth
working group sessions on emerging issues, as well as substantial business
development and networking opportunities.
* * * * *
1. Feature
Article: World
Health Report 2000 was an intellectual fraud of historic consequence
A
profoundly deceptive document that only marginally measured health-care
performance at all.
The World Health Organization’s World
Health Report 2000, which ranked the health-care systems of nearly 200
nations, stands as one of the most influential social-science studies in
history. For the past decade, it has been the de facto basis for much of the
discussion of the health-care system in the United States, routinely cited in
public discourse by members of government and policy experts. Its most
notorious finding—that the United States ranked a disastrous 37th out of the
world’s 191 nations in “overall performance”—provided supporters of President
Barack Obama’s transformative health-care legislation with a data-driven argument
for swift and drastic reform, particularly in light of the fact that the U.S.
spends more on health than any other nation.
In October 2008, candidate Obama used the
study to claim that “29 other countries have a higher life expectancy and 38
other nations have lower infant mortality rates.” On June 15, 2009, as he was
beginning to make the case for his health-care bill, the new president said:
“As I think many of you are aware, for all of this spending, more of our
citizens are uninsured, the quality of our care is often lower, and we aren’t
any healthier. In fact, citizens in some countries that spend substantially
less than we do are actually living longer than we do.” The perfect
encapsulation of the study’s findings and assertions came in a September 9,
2009, editorial in Canada’s leading newspaper, the Globe and Mail:
“With more than 40 million Americans lacking health insurance, another 25
million considered badly underinsured, and life expectancies and infant
mortality rates significantly worse that those of most industrialized Western
nations, the need for change seems obvious and pressing to some, especially
when the United States is spending 16 percent of
In fact, World Health Report 2000
was an intellectual fraud of historic consequence—a profoundly deceptive
document that is only marginally a measure of health-care performance at all.
The report’s true achievement was to rank countries according to their
alignment with a specific political and economic ideal—socialized medicine—and
then claim it was an objective measure of “quality.”
WHO researchers divided aspects of health
care into subjective categories and tailored the definitions to suit their
political aims. They allowed fundamental flaws in methodology, large margins of
error in data, and overt bias in data analysis, and then offered conclusions
despite enormous gaps in the data they did have. The flaws in the report’s
approach, flaws that thoroughly undermine the legitimacy of the WHO rankings,
have been repeatedly exposed in peer-reviewed literature by academic experts
who have examined the study in detail. Their analysis made clear that the
study’s failings were plain from the outset and remain patently obvious today;
but they went unnoticed, unmentioned, and unexamined by many because World
Health Report 2000 was so politically useful. This object lesson in the
ideological misuse of politicized statistics should serve as a cautionary tale
for all policymakers and all lay people who are inclined to accept on faith the
results reported in studies by prestigious international bodies.
Before WHO released the study, it was
commonly accepted that health care in countries with socialized medicine was
problematic. But the study showed that countries with nationally centralized
health-care systems were the world’s best. As Vincente Navarro noted in 2000 in
the highly respected Lancet, countries like Spain and Italy “rarely
were considered models of efficiency or effectiveness before” the WHO report.
Polls had shown, in fact, that Italy’s citizens were more displeased with their
health care than were citizens of any other major European country; the second
worst was Spain. But in World Health Report 2000, Italy and Spain were
ranked #2 and #7 in the global list of best overall providers.
Most studies of global health care before it
concentrated on health-care outcomes. But that was not the approach of the WHO
report. It sought not to measure performance but something else. “In the past
decade or so there has been a gradual shift of vision towards what WHO calls
the ‘new universalism,’” WHO authors wrote, “respecting the ethical principle
that it may be necessary and efficient to ration services.”
The report went on to argue, even insist,
that “governments need to promote community rating (i.e. each member of the
community pays the same premium), a common benefit package and portability of
benefits among insurance schemes.” For “middle income countries,” the authors
asserted, “the policy route to fair prepaid systems is through strengthening
the often substantial, mandatory, income-based and risk-based insurance
schemes.” It is a curious version of objective study design and data analysis
to assume the validity of a concept like “the new universalism” and then to
define policies that implement it as proof of that validity.
The nature of the enterprise came more fully
into view with WHO’s introduction and explanation of the five weighted factors
that made up its index. Those factors are “Health Level,” which made up 25
percent of “overall care”; “Health Distribution,” which made up another 25 percent;
“Responsiveness,” accounting for 12.5 percent; “Responsiveness Distribution,”
at 12.5 percent; and “Financial Fairness,” at 25 percent.
The definitions of each factor reveal the
ways in which scientific objectivity was a secondary consideration at best.
What is “Responsiveness,” for example? WHO defined it in part by calculating a
nation’s “respect for persons.” How could it possibly quantify such a
subjective notion? It did so through calculations of even more vague subconditions—“respect for dignity,” “confidentiality,” and
“autonomy.”
And “respect for persons” constituted only 50
percent of a nation’s overall “responsiveness.” The other half came from
calculating the country’s “client orientation.” That vague category was
determined in turn by measurements of “prompt attention,” “quality of
amenities,” “access to social support networks,” and “choice of provider.”
Scratch the surface a little and you find
that “responsiveness” was largely a catchall phrase for the supposedly unequal
distribution of health-care resources. “Since poor people may expect less than
rich people, and be more satisfied with unresponsive services,” the authors
wrote, “measures of responsiveness should correct for these differences.”
Correction, it turns out, was the goal. “The
object is not to explain what each country or health system has attained,” the
authors declared, “so much as to form an estimate of what should be possible.”
They appointed themselves determinants of what “should” be possible “using
information from many countries but with a specific value for each country.”
This was not so much a matter of assessing care but of determining what care should
be in a given country, based on WHO’s own priorities regarding the allocation
of national resources. The WHO report went further and judged that “many
countries are falling far short of their potential, and most are making
inadequate efforts in terms of responsiveness and fairness.”
_____________
Consider the discussion of Financial Fairness
(which made up 25 percent of a nation’s score). “The way health care is
financed is perfectly fair if,” the study declared, “the ratio of total health
contribution to total non-food spending is identical for all households,
independently of their income, their health status or their use of the health
system.” In plain language, higher earners should pay more for health care,
period. And people who become sick, even if that illness is due to high-risk
behavior, should not pay more. According to WHO, “Financial fairness is best
served by more, as well as by more progressive, prepayment in place of
out-of-pocket expenditure. And the latter should be small not only in the
aggregate but relative to households’ ability to pay.”
This matter-of-fact endorsement of wealth
redistribution and centralized administration should have had nothing to do
with WHO’s assessment of the actual quality of health care under
different systems. But instead, it was used as the definition of
quality. For the authors of the study, the policy recommendation preceded the
research. Automatically, this pushed capitalist countries that rely more on
market incentives to the bottom of the list and rewarded countries that finance
health care by centralized government-controlled single-payer systems. In fact,
two of the major index factors, Health Distribution and Responsiveness
Distribution, did not even measure health care itself. They were both strictly
measures of equal distribution of health and equal distribution
of health-care delivery.
Perhaps what is most striking about the
categories that make up the index is how WHO weighted them. Health
Distribution, Responsiveness Distribution, and Financial Fairness added up to
62.5 percent of a country’s health-care score. Thus, almost two-thirds of the
study was an assessment of equality. The actual health outcomes of a
nation, which logic dictates should be of greatest importance in any
health-care index, accounted for only 25 percent of the weighting. In other
words, the WHO study was dominated by concerns outside the realm of health
care.
Not content with penalizing free-market
economies on the fairness front, the WHO study actually held a nation’s
health-care system accountable for the behavior of its citizens. “Problems such
as tobacco consumption, diet, and unsafe sexual activity must be included in an
assessment of health system performance,” WHO declared. But the inclusion of
such problems is impossible to justify scientifically. For example, WHO
considered tobacco consumption equivalent, as an indicator of medical care, to
the treatment of measles: “Avoidable deaths and illness from childbirth,
measles, malaria or tobacco consumption can properly be laid” at a nation’s
health-care door.”
From a political standpoint, of course, the
inclusion of behaviors such as smoking is completely logical. As Samuel H.
Preston and Jessica Ho of the University of Pennsylvania observed in a 2009
Population Studies Center working paper, a “health-care system could be
performing exceptionally well in identifying and administering treatment for various
diseases, but a country could still have poor measured health if personal
health-care practices were unusually deleterious.” This takes on additional
significance when one considers that the United States has “the highest level
of cigarette consumption per capita in the developed world over a 50-year
period ending in the mid-80s.”
At its most egregious, the report abandoned
the very pretense of assessing health care. WHO ranked the U.S. 42nd in life
expectancy. In their book, The Business of Health, Robert L. Ohsfeldt and John E. Schneider of the University of Iowa
demonstrated that this finding was a gross misrepresentation. WHO actually
included immediate deaths from murder or fatal high-speed motor-vehicle
accidents in their assessment, as if an ideal health-care system could turn
back time to undo car crashes and prevent homicides. Ohsfeldt
and Schneider did their own life-expectancy calculations using nations of the Organisation for Economic Co-operation and Development
(OECD). With fatal car crashes and murders included, the U.S. ranked 19 out of
29 in life expectancy; with both removed, the U.S. had the world’s best
life-expectancy numbers (see table above).
But even if you dismiss all that, the
unreliability of World Health Report 2000 becomes inarguable once you
confront the sources of the data used. In the study, WHO acknowledged that it
“adjusted scores for overall responsiveness, as well as a measure of fairness based
on the informants’ views as to which groups are most often discriminated
against in a country’s population and on how large those groups are” [emphasis
added]. A second survey of about 1,000 “informants” generated opinions about
the relative importance of the factors in the index, which were then used to
calculate an overall score.
Judgments about what constituted “high
quality” or “low quality” health care, as well as the effect of inequality,
were made by people WHO called “key informants.” Astonishingly, WHO provided no
details about who these key informants were or how they were selected. According
to a 2001 Lancet article by Celia Almeida, half the responders were
members of the WHO staff. Many others were people who had gone to the WHO
website and were then invited to fill out the questionnaire, a clear invitation
to political and ideological manipulation.
Another problem emerges in regard to the
references used by the report. Of the cited 32 methodological references, 26
were from internal WHO documents that had not gone through a peer-review
process. Moreover, only two were written by people whose names did not appear
among the authors of World Health Report 2000. To sum up: the report
featured data and studies largely generated inside WHO, with no independent,
peer-reviewed verification of the findings. Even these most basic requirements
of valid research were not met.
The report’s margin of error is similarly
ludicrous in scientific terms. The margin for error in its data falls outside
any respectable form of reporting. For example, its data for any given country
were “estimated to have an 80 percent probability of falling within the
uncertainty interval, with chances of 10 percent each of falling below the low
value or above the high one.” Thus, as Whitman noted, in one category—the
“overall attainment” index—the U.S. could actually rank anywhere from seventh
to 24th. Such a wide variation renders the category itself meaningless and
comparisons with other countries invalid.
And then there is the plain fact that much of
the necessary data to determine a nation’s health-care performance were simply
missing. The WHO report stated that data was used “to calculate measures of
attainment for the countries where information could be obtained . . . to
estimate values when particular numbers were judged unreliable, and to estimate
attainment and performance for all other Member States.”
According to a shocking 2003 Lancet
article by Philip Musgrove, who served as editor in chief of part of the WHO
study, “the attainment values in WHO’s World Health Report 2000 are
spurious.” By his calculation, the WHO “overall attainment index” was actually
generated by complete information from only 35 of the 191 countries. Indeed,
according to Musgrove, WHO had data from only 56 countries for Health
Inequality, a subcategory; from only 30 countries for Responsiveness; and from
only 21 countries for Fair Financing. Nonetheless, rankings were “calculated”
for all 191 countries.
Musgrove gives specific examples of overtly
deficient data that was directly misused by WHO. He stated that “three values
obtained from expert informants (for Chile, Mexico, and Sri Lanka) were
discarded in favor of imputed (i.e. estimated) values” and that “in two cases,
informants gave opinions on one province or state rather than the entire
country.” Musgrove wrote to Christopher Murray, WHO’s director of the Global
Program on Evidence for Health Policy at the time, on August 30, 2000, about
the study’s handling of the missing statistics: “If it doesn’t qualify as
manipulating the data, I don’t know what does . . . at the very least, it gravely
undermines the claim to be honest with the data and to report what we actually
find.”
If World Health Report 2000 had
simply been issued and forgotten, it would still be a case study in how to
produce a wretched and unreliable piece of social science masquerading as
legitimate research. That it served so effectively as a catalyst for
unprecedented legislation is evidence of something more disturbing. The
executive and legislative branches of the United States government used WHO’s
document as an implicit Exhibit A to justify imposing radical changes to
America’s health-care system, even in the face of objections from the American
people. To blur the line between politics and objective analysis is to do
violence to them both.
Despite the compelling studies that undermine
this erroneous document, many government officials, policymakers, insurers, and
academics have continued to use it to justify their ideology-based agenda, one
that seeks centralized, government-run health care. Donald Berwick, later up
for the position of Obama’s director of the Center for Medicare & Medicaid,
used its questionable data to make a grand case against the U.S. health-care
system in 2008: “Even though U.S. health-care expenditures are far higher than
those of other developed countries, our results are no better. Despite spending
on health care being nearly double that of the next most costly nation, the
United States ranks thirty-first among nations on life expectancy, thirty-sixth
on infant mortality, twenty-eighth on male healthy life expectancy, and
twenty-ninth on female healthy life expectancy.” (This last bit came from
updated 2006 WHO data.)
What we have here is a
prime example of the misuse of social science and the conversion of statistics
from pseudo-data into propaganda. The basic principle, casually referred to as
“garbage in, garbage out,” is widely accepted by all researchers as a
cautionary dictum. To the authors of World Health Report 2000, it
functioned as its opposite—a method to justify a preconceived agenda. The shame
is that so many people, including leaders in whom we must repose our trust
and whom we expect to make informed decisions based on the best and most
complete data, made such blatant use of its patently false and overtly
politicized claims.
http://www.commentarymagazine.com/article/the-worst-study-ever/
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
* * * * *
2. In the News: Why Medicaid Should Be Easier to Fix than Entitlement Programs
Capital Ideas By: John R. Graham, Pacific
Research Institute, 6.1.2011
Congress
remains gridlocked on many important issues but not every politician is afraid
to challenge the unsustainable growth of Medicaid. Consider S. 1031, by U.S.
Senator Tom Coburn.
This measure would increase local control over Medicaid spending and improve
the incentives that have led politicians to trap ever more low-income citizens
in poverty and the poor access to care that characterizes this top-heavy
system.
Medicaid is often described as an “entitlement,” but that is wrongheaded.
Medicaid is welfare, targeted at low-income Americans. And Medicaid should
be easier to fix, politically, than two other troublesome programs.
The politicians who invented Social Security and Medicare asserted that these
programs would be funded by payroll taxes in order to foster the illusion of
entitlement. We pay for the benefits in our working years, and the benefits
arrive after we’ve retired. It’s all nonsense of course.
The taxes we pay do not go into accounts that belong
to us. Rather, they pay current retirees and fund other government programs.
Nevertheless, it is exceedingly difficult to convince people of the truth that
we have not paid for our Social Security or Medicare. But Medicaid
spending, to which nobody is “entitled,” is now greater than Medicare spending.
This has occurred because Medicaid's funding formula incentivizes the political
class to overspend. For every dollar a state politician spends on
Medicaid, the federal government pitches in at least one dollar –
or even more, as a result of the misnamed “stimulus” of 2009 – via the Federal
Medical Assistance Percentage (FMAP). The federal government actually rewards
states for making more residents dependent on Medicaid.
S.1031 would transform the federal government’s funding for Medicaid, but it would
transform it into a “capped allotment.” This was the model of the successful
welfare reform of 1996, which reformed Aid to Families with Dependent Children
(AFDC) into Temporary Assistance to Needy Families (TANF).
The number of average monthly recipients dropped from more than 12 million in
1996 to fewer than 4 million in 2008 – and low-income Americans faced better
incentives to seek productive work. We have recently experienced a successful
example of a reform in this direction.
Rhode Island received a waiver on the last day of the Bush administration that
capped its total (state and federal) Medicaid spending at $12.075 billion
through 2013. At the current rate, it looks like the actual spending will be
about $9.3 billion – with no evidence of reduced access to care. And Rhode
Island’s waiver preserved the flawed FMAP.
Coburn’s S.1031 introduces even better incentives, from which all states and
taxpayers will benefit. It gives states more control over their program dollars
to get rid of waste, fraud, and abuse. It encourages states to make Medicaid
providers accountable to the neediest patients in their communities, instead of
remote federal bureaucracies. Finally, it will protect taxpayers from
politicians’ worst impulses to spend unaccountably.
It is generally recognized that TANF, which passed with bipartisan support,
produced positive outcomes. It is long past time to introduce similar reforms
to Medicaid. The current stalemate on the debt limit should not prevent
Congress from taking up S.1031 at the earliest convenience.
Read John R.
Graham’s entire report at the PRI . . .
Feedback . . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
* * * * *
3. International
Healthcare: From
the Stockholm-Network of Think-Tanks
The Stockholm
Network is the leading pan-European think tank and market oriented network.
This new section of Gesundheit!
explores individual healthcare systems throughout Europe and analyses the
landscape for reform. It begins by looking at the United Kingdom and assesses
the National Health Service in light of radical proposals for change by the UK coalition
government. Since 1948, patients in the
United Kingdom have had free access to the National Health Service (NHS) – a fully
public, single payer, universal healthcare system.
Upon its introduction, its chief architect,
UK minister of health Aneurin Bevan, argued owerfully that “money ought not to be permitted to stand in
the way of obtaining an efficient health service” and thus established the
founding principle of the NHS: that it should exist free at the point of use. .
.
The NHS is financed through mandatory
payroll taxes that are paid by employees, whilst employers also contribute
through national insurance payments. All citizens working in the UK are
required to make these contributions if they are calculated as earning over a certain
level per annum, currently set nationally at around £7,000 upwards for income
tax. However, payment of such taxes is not a prerequisite for treatment in the
NHS.
In fact, anyone who is a resident in the UK
can access NHS services free at the point of use. One of the few exceptions to
this, in addition to dental and optometry services outlined above, exists only
in England for prescribed pharmaceuticals. English patients in the NHS are
sometimes required to pay a fixed co-payment or prescription charge (currently
£7.40), although this affects only around 10% of all pharmaceuticals prescribed
in the NHS once a host of exemptions are taken into account. . .
In addition to moving commissioning powers
to GPs, the planned reforms of the NHS will also introduce the principle that
commissioners should be able to buy services from “any willing provider” so as
to create greater competition between services. The idea is to facilitate a
greater range of accredited providers, including those from the private sector,
as opposed to formal tendering processes that can often restrict competition. .
.
In truth, the plans to restructure the NHS are far from
finalised and the government has recently decided to pause
the legislative process, in the face of a wide range of criticism over their
plans. In particular, opposition from key health professionals, such as the
British Medical Association and the Royal College of Nursing, has created the
impression that reforms are being undertaken without bringing key stakeholders
onside. Furthermore, the promise to
increase health spending in real terms until 2015 will also be difficult to
maintain given current fiscal constraints and high inflation, although it is
likely that this pledge will be honoured even at the
expense of other priorities.
Read the entire Stockholm-Network report on the United
Kingdom . . .
Feedback . . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
Government medicine does not give timely access to
healthcare, it only gives access to a waiting list.
The radical proposals of the UK appear to be without
significant vision.
* * * * *
4. Government Healthcare and Other Entitlements: While the US Gov’t is insolvent, the states aren’t far behind
Next month will
be pivotal for most states, as it marks the fiscal year end and is when
balanced budgets are due. The states have racked up over $1.8 trillion in
taxpayer-supported obligations in large part by underfunding their pension and
other post-employment benefits. Yet over the past three years, there still has
been a cumulative excess of $400 billion in state budget shortfalls. States
have already been forced to raise taxes and cut programs to bridge those gaps.
Next month will
also mark the end of the American Recovery and Reinvestment Act's $480 billion
in federal stimulus, which has subsidized states through the economic downturn.
States have grown more dependent on federal subsidies, relying on them for
almost 30% of their budgets.
The condition of
state finances threatens the economic recovery. States employ over 19 million
Americans, or 15% of the U.S. work force, and state spending accounts for 12%
of U.S. gross domestic product. The process of reining in state finances will
be painful for us all.
The rapid deterioration of state
finances must be addressed immediately. Some dismiss these concerns, because
they believe states will be able to grow their way out of these challenges. The
reality is that while state revenues have improved, they have done so in part
from tax hikes. However, state tax revenues still remain at roughly 2006
levels.
Expenses are
near the highest they have ever been due to built-in annual cost escalators
that have no correlation to revenue growth (or decline, as has been the case
recently). Even as states have made deep cuts in some social programs, their
fixed expenses of debt service and the actuarially recommended minimum pension
and other retirement payments have skyrocketed. While over the past 10 years
state and local government spending has grown by 65%, tax receipts have grown
only by 32%.
Off balance
sheet debt is the legal obligation of the state to its current and past
employees in the form of pension and other retirement benefits. Today, off balance
sheet debt totals over $1.3 trillion, as measured by current accounting
standards, and it accounts for almost 75% of taxpayer-supported state debt
obligations. Only recently have states been under pressure to disclose more
information about these liabilities, because it is clear that their debt
burdens are grossly understated.
Since January,
some of my colleagues focused exclusively on finding the most up-to-date
information on ballooning tax-supported state obligations. This meant going to
each state and local government's website for current data, which we found was
truly opaque and without uniform standards.
What concerned us the most was the fact that fixed
debt-service costs are increasingly crowding out state monies for essential
services. For example, New Jersey's ratio of total tax-supported state
obligations to gross state product is over 30%, and the fixed costs to service
those obligations eat up 16% of the total budget. Even these numbers are
skewed, because they represent only the bare minimum paid into funding pension
and retirement plans. We calculate that if New Jersey were to pay the
actuarially recommended contribution, fixed costs would absorb 37% of the
budget. New Jersey is not alone.
The real issue
here is the enormous over-leveraging of taxpayer-supported obligations at a
time when taxpayers are already paying more and receiving less. In the states
most affected by skyrocketing debt and fiscal imbalances, social services
continue to be cut the most. Taxpayers have the ultimate voting right—with
their feet. Corporations are relocating, or at a minimum moving large portions
of their businesses to more tax-friendly states.
Boeing is in the
political cross-hairs as it is trying to set up a facility in the more
business-friendly state of South Carolina, away from its current hub of
Washington. California legislators recently went to Texas to learn best
practices as a result of a rising tide of businesses that are building
operations outside of their state. Over time, individuals will migrate to more
tax-friendly states as well, and job seekers will follow corporations.
Fortunately,
many governors are addressing their state's structural deficits head on.
Unfortunately, there is a lack of collective appreciation for how painful this
process will be. Defaults in a variety of forms by states and municipalities
are already happening and more are inevitable. Taxpayers have borne the initial
brunt of these defaults by paying higher taxes in exchange for lower social
services. And state and local government employees are having to renegotiate
labor contracts that they once believed were sacrosanct.
Municipal bond
holders will experience their own form of contract renegotiation in the form of
debt restructurings at the local level. These are just the facts. The sooner we
accept them, the sooner we can get state finances back on track, and a real
U.S. economic recovery underway.
Ms. Whitney
is CEO of Meredith Whitney Advisory Group LLC.
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean
HealthCare: Every
industry is getting lean; we no longer have a choice.
David J.
Gibson, M.D.
Director, Clearway Health Solutions
You may have missed reading a thought provoking
article from Thomas Freedman in the NYT yesterday. The article entitled Average
Is Over (see attached below), is particularly relevant as it relates to the
political debate that is evolving with a trajectory that is progressively being
divorced from reality. All the politicians are promising jobs, jobs,
jobs. Obama wants more government spending to bring back jobs as
demonstrated in his SOTU speech last night. The Republicans are promising
that the market will return jobs if the government is downsized and taxes are
lowered. What happens when both are proven to be wrong which will become
evident soon after the election later this year? It is not a pretty
picture to contemplate.
The following are a couple of excerpts from Freedman’s
article:
“In the 10 years ending in
2009, [U.S.] factories shed workers so fast that they erased almost all the
gains of the previous 70 years; roughly one out of every three manufacturing
jobs — about 6 million in total — disappeared.”
Most of the current job creation is now focused in the
relative low paying and previously non-exportable service sector.
Hospitality jobs such as waiters and waitresses are an example.
Now, these jobs can be exported to the IT sector. Consider
the following”
Last April, Annie Lowrey of Slate wrote about a start-up called “E la Carte”
that is out to shrink the need for waiters and waitresses: The company “has
produced a kind of souped-up iPad that lets you
order and pay right at your table. The brainchild of a bunch of M.I.T.
engineers, the nifty invention, known as the Presto, might be found at a
restaurant near you soon. ... You select what you want to eat and add items to
a cart. Depending on the restaurant’s preferences, the console could show you
nutritional information, ingredients lists and photographs. You can make
special requests, like ‘dressing on the side’ or ‘quintuple bacon.’ When you’re
done, the order zings over to the kitchen, and the Presto tells you how long it
will take for your items to come out. ... Bored with your companions? Play
games on the machine. When you’re through with your meal, you pay on the
console, splitting the bill item by item if you wish and paying however you
want. And you can have your receipt e-mailed to you. ... Each console goes for
$100 per month. If a restaurant serves meals eight hours a day, seven days a
week, it works out to 42 cents per hour per table — making the Presto cheaper
than even the very cheapest waiter.”
This is relevant within the context of our unleashing
market forces within the health care sector of the economy. Informed
consumers, as has been demonstrated in every other sector of the economy, will
predictably reform the industry and drive creative destruction that has been
avoided in the past for all the reasons we have previously discussed. The
provider cost per unit of service will be quickly reduced in order to compete
in a competitive market. The use of IT to increase productivity will
become an imperative. The resulting loss of HC jobs and the reduction in
compensation will be an assault on one of the last relatively affluent job
option within today’s U.S. economy.
This message is not intended to argue against our introducing available market consumer forces into the HC industry. This will occur with or without our involvement. Rather, I am speculating on the collateral unintended effect that this fundamental shift in the industry’s structure and organization will have on the general economy.
David J.
Gibson, M.D.
Director
Clearway Health Solutions
davidjgibson@reflectivemedical.com
AVERAGE IS OVER
By THOMAS L. FRIEDMAN, NYT | January 24, 2012
In an essay, entitled “Making It in America,” in the latest issue of The Atlantic,
the author Adam Davidson relates a joke from cotton country about just how much
a modern textile mill has been automated: The average mill has only two
employees today, “a man and a dog. The man is there to feed the dog, and the
dog is there to keep the man away from the machines.”
Davidson’s article is one of a number of pieces that have
recently appeared making the point that the reason we have such stubbornly high
unemployment and sagging middle-class incomes today is largely because of the
big drop in demand because of the Great Recession, but it is also because of
the quantum advances in both globalization and the information technology
revolution, which are more rapidly than ever replacing labor with machines or
foreign workers.
In the past, workers with average skills, doing an average
job, could earn an average lifestyle. But, today, average is officially over.
Being average just won’t earn you what it used to. It can’t when so many more
employers have so much more access to so much more above average cheap foreign
labor, cheap robotics, cheap software, cheap automation and cheap genius.
Therefore, everyone needs to find their extra — their unique value contribution
that makes them stand out in whatever is their field of employment. Average
is over. . .
What the iPad won’t do in an
above average way a Chinese worker will. Consider this paragraph from Sunday’s
terrific article in The
Times by Charles Duhigg
and Keith Bradsher about why Apple does so much of its manufacturing in China: “Apple had redesigned
the iPhone’s screen at the last minute, forcing an assembly-line
overhaul. New screens began arriving at the [Chinese] plant near midnight. A
foreman immediately roused 8,000 workers inside the company’s dormitories,
according to the executive. Each employee was given a biscuit and a cup of tea,
guided to a workstation and within half an hour started a 12-hour shift fitting
glass screens into beveled frames. Within 96 hours, the plant was producing
over 10,000 iPhones a day. ‘The speed and flexibility is breathtaking,’ the
executive said. ‘There’s no American plant that can match that.’ ” . . .
Read
the entire article at the NYTimes . . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
The Future of Health Care Has to Be
Lean, Efficient and Personal.
* * * * *
6. Misdirection
in Healthcare: Misdirection
in our Country at Large
Occupy Wall Street
By Dr. Thomas Sowell
The current Occupy Wall Street movement is the best illustration to date of what President Barack Obama's America looks like. It is an America where the lawless, unaccomplished, ignorant and incompetent rule. It is an America where those who have sacrificed nothing pillage and destroy the lives of those who have sacrificed greatly.
It is an America where history is rewritten to honor dictators, murderers and thieves. It is an America where violence, racism, hatred, class warfare and murder are all promoted as acceptable means of overturning the American civil society.
It is an America where humans have been degraded to the level of animals: defecating in public, having sex in public, devoid of basic hygiene.
It is an America where the basic tenets of a civil society, including faith, family, a free press and individual rights, have been rejected.
It is an America where our founding documents have been shredded and, with them, every person's guaranteed liberties.
It is an America where, ultimately, great suffering will come to the American people, but the rulers like Obama, Michelle Obama, Harry Reid, Nancy Pelosi, Barney Frank, Chris Dodd, Joe Biden, Jesse Jackson, Louis Farrakhan, liberal college professors, union bosses and other loyal liberal/Communist Party members will live in opulent splendor.
It is the America that Obama and the Democratic Party have created with the willing assistance of the American media, Hollywood, unions, universities, the Communist Party of America, the Black Panthers and numerous anti-American foreign entities.
Barack Obama has brought more destruction upon this country in four years than any other event in the history of our nation, but it is just the beginning of what he and his comrades are capable of.
The Occupy Wall Street movement is just another step in their plan for the annihilation of America.
"Socialism, in general, has a record of failure so blatant that only an intellectual could ignore or evade it."
—Thomas Sowell
Thanks to Dr. Loofbourow for bringing this to our attention. 11-13-11
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
Regulations under
Obama will worsen not only Freedom, but Quality of HealthCare.
* * * * *
7. Overheard on Capital Hill: Rumors from Texas
New Whispers of Perry 2012 Bid for the White House
For months, Texas Gov. Rick Perry has told
potential donors and Republican higher-ups he has no interest in running for
the White House in 2012.
But
over the past two weeks, political advisers and friends say, Mr. Perry has
changed his tune on a possible presidential campaign. In private conversations,
they say, the three-term governor said he worries that the current GOP
contenders have yet to stir real excitement within the party and may struggle
when facing President Barack Obama.
"He thinks there is a void [in the
current field of candidates], and that he might be uniquely positioned to fill
that void," said one Perry confidant who talked to the governor last week.
In these
conversations, the governor has emphasized his own track record in bringing
jobs to Texas, which has created more jobs than any other state in recent
years. That success, he has told supporters, would position him well in an
election that will likely pivot on jobs.
The conversations add detail on Mr. Perry's thinking. He
generated political buzz two weeks ago when he told reporters he planned to
"think about" a presidential run after the Memorial Day weekend. He
added, with a smile, "But I think about a lot of things."
In
these conversations, the governor has emphasized his own track record in
bringing jobs to Texas, which has created more jobs than any other state in
recent years. That success, he has told supporters, would position him well in
an election that will likely pivot on jobs.
The
conversations add detail on Mr. Perry's thinking. He generated political buzz
two weeks ago when he told reporters he planned to "think about" a
presidential run after the Memorial Day weekend. He added, with a smile,
"But I think about a lot of things." . . .
At the same
time, Mr. Perry, 61 years old, is making a number of national appearances this
month, including an address next week to an annual dinner of the New York
Republican Party. Last week he announced an August summit in Houston and
invited all the nation's governors to attend. He described the event as a
"day of prayer and fasting" focused on "the healing of our
country."
A
former Air Force pilot, Mr. Perry served six years in the Texas state
legislature before becoming the state agriculture commissioner. He was
lieutenant governor for one year before taking over as governor when his
predecessor, George W. Bush, became president in 2001.
Mr. Perry has recently built a base among
tea-party groups and conservatives by hammering on state's rights and attacking
the Obama administration for its health-care overhaul and interventions in the
economy. This year, he backed an array of measures appealing to social
conservatives, including a requirement that all women considering an abortion
have a sonogram first. . .
Mr.
Perry's record has brought him raves from the likes of Rush Limbaugh, who told
his national radio audience last month that if Mr. Perry jumps in, "it's a
brand-new day, and it starts all over again."
Few dispute that assessment. "There is
no question if he got in the race he would change the dynamic very
quickly," said Henry Barbour, a prominent GOP operative and nephew of
Mississippi GOP Gov. Haley Barbour. "He is central casting, he can raise
the money, and he has deep ties with the grass-roots." . . .
Read the entire article on
Rick Perry in the WSJ,
subscription is required . . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
What the Governors are Telling Congress?
* * * * *
8. Innovations in Healthcare: Telehealth
5 steps to consider for making the most of Telehealth
Michelle McNickle | Web Content Producer | January 20, 2012
Telehealth
services offer substantial opportunities for healthcare cost savings, as well
as a proven effectiveness with improving patient care, particularly in rural
areas. However, to get the most bang for the buck, there is still much work
that needs to be done.
“With
the widespread adoption of EMRs, digital health records provide
physicians/clinicians with the remote monitoring capabilities to communicate
with their patients,” said Fred Pennic, founder of HIT Consultant and
senior advisor at Aspen Advisors.
This
remote access to care saves time and money by allowing physicians to work with
more patients and by cutting out travel expenses for people in rural areas —
many of whom find travel to be a financial and physical hardship.
Pennic believes there are some key endeavors that need to take
place for the full positive effects of telehealth
medicine to be felt. He offers this food for thought: Read food for thought. . .
1.
Establish an incentive-based program. According to Pennic,
sustainable funding is vital to the successful, widespread adoption of telehealth. “Creating more incentive-based programs or
grants will provide agencies and other organizations with the funding necessary
to overcome the start-up costs associated with implementing such initiatives,”
he said. Recent research has proven the potential cost savings of such initiatives
can be substantial, making the case for incentive-based programs to get telehealth initiatives up and running that much stronger.
For example, after evaluating a telehealth program,
researchers at Stanford University, found spending reductions
of approximately 7.7 percent to 13.3 percent, or $312 to $542 per person per
quarter.
[See
also: Telehealth's potential savings pegged at $4.3 billion.]
2. Develop the
infrastructure. “Having adequate infrastructures [in place] to support
these initiatives are imperative,” said Pennic.
Infrastructure is the “heart of telehealth,” he said,
and includes investing in equipment such as fiber optics, broadband/wireless
coverage, video, computer, voice and imaging.
3.
Improve telehealth reimbursements. As it stands
legislatively, said Pennic, there’s no universal
reimbursement policy among public and private sectors governing the
reimbursement of telehealth services — something he
believes is imperative to its widespread adoption and success. “Current payment
for telemedicine services, such as offsite reading of medical images, includes
Medicaid, Medicare, employers and private insurers,” he said. “However, payment
is limited for interactive consultations and chronic-care patients.”
[See
also: Telehealth
services make business sense.]
4.
Foster user acceptance and confidence in telehealth. “Perhaps the greatest
challenge in telehealth is increasing the user
acceptance of technology, for both clinicians and patients who aren’t tech
savvy,” said Pennic. Ideally, he said, successful telehealth programs must be able to easily integrate the telehealth process into healthcare and patient environments
seamlessly. And although we know the federal Medicare program for seniors and
disabled Americans doesn’t currently reimburse for telehealth
and home monitoring services, a recent article is saying that could quickly change due to
the upswing and acceptance of telehealth programs In
fact, according to Dr. Joseph Kvedar, director of the
Center for Connected Health at Partners Healthcare in Boston, the future is
“quite bright” for payment and reimbursement programs. Statics have proven telehealth’s effectiveness, the article states, with
confidence in its ability to reduce readmission rates growing.
5.
Allocate resources and time. In addition to meeting technology requirements, said Pennic, successful telehealth
programs must have the proper allocated resources and time necessary to ensure
its widespread adoption. “People and processes are the key components to
effective telehealth utilization,” he said. Agreeing
with Pennic is Laurence C. Baker, PhD, a professor of
health research and policy at Stanford. After studying
a Healthy Buddy telehealth program, which
was used by Medicare patients in the Northwest, he found two main aspects
played most into its success: the first being the “tight” integration of
information and care management, and the second was the device itself, which
was patient-friendly and easy to use.
Follow Michelle McNickle on Twitter, @Michelle_writes
9. The Health Plan for the USA: Planning the
Patient-Centered Health Plan for America
Level B:
Emergency Rooms, Urgent Care and Surgi-centers (Continued
from April 2011 section 9)
A graded co-payment for every level
of service- See April Issue for Level A—Hospitals
Level B: Hospital Emergency Rooms,
Urgent Care Centers, and Surgi-centers.
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
10. Restoring Accountability in Medical Practice by Non Participation in
Government Programs and Understanding the Devastating Force of Government
· Citizens Against
Government Waste, www.CAGW.org, America’s Taxpayer’s Watch
Dog.
Porker of the Month will introduce you to
some of government's worst pork-barrel offenders.
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
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Words of Wisdom,
Recent Postings, In Memoriam, This Month in History . . .
What makes a
standout student?
1.
Featured
Article: A Member of the European Parliament’s
Warning to America
2.
In the News: On Tax Day, Friday,
April 15, 2011, Atlas Shrugged Opens
3.
International Healthcare: NHS breaches target for hospital waits By Nicholas Timmins,
4.
Government Healthcare: Medicare’s Benefits exceed Contributions by 300 Percent
5.
Lean HealthCare: Lean HealthCare requires defunding ObamaCare
6.
Misdirection
in Healthcare: Hospitals taking over private practices
7.
Overheard on Capital
Hill: After the Welfare State
8.
Innovations in
Healthcare: How to become an Entrepreneur?
9.
The
Health Plan for the USA: A graded copayment on every level of service
10. Restoring
Accountability
in HealthCare by Moving from a Vertical to a Horizontal Industry:
The Economist | from the print
edition | May 5th 2011
Read the entire article and obituary in the Economist . . .
This Month in History – July was
Freedom Month and Now is Enslavement Month
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.
Feedback . . .
Subscribe to
HPUSA . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .