HEALTHPLANUSA . NET
Community For Affordable Health Care
Vol V, No 3, October, 2006
Utilizing the $1.5 Trillion Information Technology Industry
To Transform the $1.8 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
* * * * *
1. Feature Article: Capitalism: The Movie, The Atlantic Monthly, March 2006
The Agenda: First Principles: Capitalism: The Movie:
Why Americans don’t value markets enough—and why that matters by Clive Crook
Capitalism is not much loved, even in the
parts of the world it has served best. If only one country were to dote on free
Seen a movie lately? Watched television or read a newspaper? The culture that speaks to Americans, and hence to the Western world, radiates suspicion of free enterprise—cordial and restrained, as a rule, but dubious nonetheless. Yes, the system does work, says this culture, and there appears to be no alternative. But what a shame this is, it continues, because capitalism rewards our worst and most selfish instincts. “Greed is good” may stock the shelves, but is somewhat less than inspiring.
Popular culture understands that the market
economy creates material prosperity, albeit for some more than others. It seeks
out and worships business celebrities. But at the same time it sees the system
as spiritually—and politically—corrupting. As viewed from
What is most striking, so far as the movies’ treatment of capitalism goes, is not the hostility of films whose main purpose is actually to indict corporate wickedness. . . It is the idea of routine, reckless corporate immorality—maintained as though this premise were inoffensive, uncontroversial, and hardly worthy of comment—that drives movies whose principal interest lies elsewhere, whether in the human drama of contemporary geopolitics. . .
The point is not that such movies, or the culture more generally, argue that capitalism is evil. Just the opposite: it is that they so often merely assume, innocently and expecting to arouse no skepticism, that capitalism is evil.
In this, of course, the culture is not really driving attitudes. It is expressing widely held (though not very closely examined) beliefs; it is itself responding to demand. And disenchantment with commerce goes back an awfully long way. Samuel Johnson was already confronting an age-old tradition 250 years ago when he said, “There are few ways in which a man can be more innocently employed than in getting money.” So was Adam Smith, shortly after, when he wrote, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.” Smith was not praising selfishness, by the way; he did not believe that greed is good. He was explaining how commerce can spontaneously harness a base worldly instinct to an enlightened social purpose—an idea that people, one Industrial Revolution later, still find implausible.
Capitalism is prey to excesses, self-evidently, and it creates, or leaves unattended, a host of problems that decent societies must address by other means. Even so, the prevailing culture of suspicion and disappointment is at odds with the facts. Mainly, what is missing is awe. Premodern scholars (Karl Marx is an exception) could scarcely have imagined the material advance that capitalism has delivered. Certainly Adam Smith never dreamed that his “invisible hand” would arrange things so well.
In the late 1980s, as Mikhail Gorbachev
embarked on his perestroika program of economic reform, Soviet officials were
sent abroad to see how things were done in the West. One visited
That, in fact, was the reaction of an
intelligent man. It is fantastically improbable that markets work, at scale, as
well as they do. It is astonishing that in an economy of
And it gets better, because this infinitely
complicated, decentralized system has an obvious affinity with personal
liberty, in a way that a centrally directed system never could. Market
exchange, after all, is voluntary; under central planning, you are told what to
But does it matter, really, if people are less comfortable with the idea of capitalism than they might be, or should be? Up to a point, to be sure, this skepticism serves a purpose, drawing attention to ills and injustices that might otherwise be ignored. But there is a cost: the mood of discomfort and suspicion is a pity in itself, to the extent that it is unwarranted. Also, it fosters a demand for, or tolerance of, frivolous or wasteful interventions by government.
In comparison with other rich countries,
It is difficult to see where any heightened appreciation of the market system is going to come from. Economists, presumably, ought to be supplying it. Unfortunately, in most cases, communicating a sense of wonder is not among their gifts. In some ways, teachers of economics are probably making matters worse. As practiced in universities, economics continues to turn inward, with ever more emphasis on math, quantitative methods, and narrow specialization. You can make a case for that, but it silences the discipline on the thing that matters most. Also, people are suspicious of economists: they see them as agents of a suspicious doctrine. And it so happens that a variety of studies have shown, notoriously, that training in economics inclines people to be more “rational”—that is, more selfish and less inclined to cooperate. This does not commend economics to the rest of us.
Corporate leaders and right-of- center politicians who set up as spokesmen for free enterprise are worse. They speak of capitalism’s virtues, then get down to the real business of subsidies, import protection, tax relief, and other favors. People see through it, and find their prejudices confirmed. The conflation of the interests of business with the interests of the nation is virtually an organizing principle of the Right. Yet in reality those interests are usually opposed—as Adam Smith again pointed out. What best serves a nation’s economic interests is competition—it’s why markets work, when they do. But competition hurts individual businesses, and most CEOs hate it. Don’t look there for intellectual enlightenment.
How about a movie in which a firm prospers under threat of competition by selling things that people want at an affordable price, paying its workers the market wage, and breaking no laws, thereby advancing the common good? Well, you see the problem.
To read the entire article, the URL for this page is www.theatlantic.com/doc/200603/capitalism.
And so, my fellow Americans, ask not what your country can do for you -- ask what you can do for your country.
John F Kennedy
* * * * *
2. In the
News: The Population Boon, WSJ Editorial,
"How will we house the next hundred million Americans? . . . How will we educate and employ such a large number of people? How will we provide adequate health care when our population reaches 300 million?" -- President Richard Nixon, 1969
President Nixon didn't live to
see his questions answered, but this week the
Around the time the country's
population hit 200 million, biologist Paul Ehrlich, always good for a bit of
doom and gloom, compared "
At bottom, the debate over population revolves around a single question: Are human beings a burden, or a resource? The former view is embodied by the Ehrlich and Nixon quotes above. More bodies mean more mouths to feed, house and provide for. At a certain point, in this perspective, you run out of stuff.
The latter view holds that people
don't just consume things. They make them too. More bodies mean more minds,
more innovation, more dynamism and more progress. The history of the world as
Simply put, the reason is
prosperity. For decades, economic growth has easily outstripped population
growth, giving the
To read the entire article (subscription required), go to http://online.wsj.com/article_print/SB116138882623099625.html.
Population growth is projected to
continue and reach 400 million in 37 years. At current growth rates, the
That is in stark contrast with
many other developed countries.
A look behind the growth:
Growing Population: Population growth is determined by three factors: births, deaths and immigration. Americans have among the highest birth rates in the developed world -- 14 births for every 1,000 people each year. Also, modern medical technology has allowed the mortality rate to fall to roughly eight deaths per thousand people annually. In comparison, Germans have eight births and 10 deaths per 1,000 people annually.
Aging: While the population is growing, the makeup of that population is changing. Today's elderly population is the largest it's ever been. People aged 65 and older currently account for 12% of the population. By 2050 that will be closer to 21%.
To read the entire report (subscription required), please go to http://online.wsj.com/article/SB116139743144399837.html?mod=todays_us_page_one.
* * * * *
"The coalition parties are currently working on turning the agreed key points into a draft bill," Mr. Müntefering told rbb-Inforadio. "There are some points which are very detailed and that have yet to be tackled."
The reform has proved to be unpopular with the German public as it proposes cuts in spending at the same time as increases in contributions.
In July, the cabinet approved plans to raise the current 13.3% average insurance premium by around 0.5 percentage point from next year, while using tax funds to partly pay for children's health insurance from 2008. The Finance Minister has said it is still unclear where the tax money should come from to pay for the children's insurance premium.
Write to Andrea Thomas at firstname.lastname@example.org.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
In a State Economy, just being in line, even if it’s not going anywhere, gives a feeling of security.
* * * * *
4. Medicare: Governor vetoes measure for universal health care, by Clea Benson
Gov. Arnold Schwarzenegger on Friday vetoed a bill that would have created a universal health care system run by the state.
Senate Bill 840, written by state Sen. Sheila Kuehl, D-Santa Monica, would have abolished the role of private insurance companies in health care. Instead, the state would have covered everyone. Theoretically, the system would have been financed by taxes on individuals and businesses that would have replaced the health premiums that both now pay to private insurers. Doctors and hospitals would have remained private.
Schwarzenegger said two weeks ago that he intended to veto the measure.
In his veto message Friday, the Republican governor said government-run health care was not a solution. About 6 million Californians are uninsured.
"I want to see a new paradigm that addresses affordability, shared responsibility and the promotion of healthy living," Schwarzenegger wrote. "Single-payer, government-run health care does none of this."
In a statement, Kuehl said she was disappointed by the veto. "The reasoning behind the governor's opposition to universal health care is truly inaccurate, which is no surprise considering he has refused to meet to discuss the issue."
-- Clea Benson, Bee Capitol Bureau
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean HealthCare: Lean Consumption, by James P. Womack and Daniel T. Jones
This article is a preview of the next leap in lean thinking described in the forthcoming book by James P. Womack and Daniel T. Jones
[We have featured Lean Production previously as a model for health care. In this article, we feature Lean Consumption as it could relate to health care. Where “service provider” is used, think physicians and the health care team. Where “customer” is used, think of the patient and his or her perspective on their needs. Where “retailer” is used, consider the hospital and surgicenter role. Lean health care is coming. Let’s make it work for everyone.]
Over the past 20 years, the real price of most consumer goods has fallen worldwide, even as the variety of goods and the range of sales channels offering them have continued to grow. Meanwhile, product quality—in the sense of durability and number of delivered defects—has steadily improved.
So, if consumers have access to an evergrowing range of products at lower prices, with fewer lemons, and from more formats, why is consumption often so frustrating? Why do we routinely encounter the custom-built computer that refuses to work with the printer, the other computers in the house, and the network software? Why does the simple process of getting the car fixed require countless loops of miscommunication, travel, waiting, and defective repairs? Why does the diligent shopper frequently return from a store stocking thousands of items without having found the one item that was wanted? And why is this tiresome process of consumption backed up by help desks and customer support centers that neither help nor support? In short, why does consumption—which should be easy and satisfying—require so much time and hassle?
It doesn’t have to—and shouldn’t. Companies may think that they save time and money by off-loading work to customers, making it the customer’s problem to get the computer up and running, and wasting the customer’s time. In fact, however, the opposite is true. By streamlining the systems for providing goods and services, and making it easier for customers to buy and use them, a growing number of companies are actually lowering costs while saving everyone’s time. In the process, these businesses are learning more about their customers, strengthening consumer loyalty, and attracting new customers who defect from less user-friendly competitors.
What these companies are doing has a familiar feel: Just as businesses around the world have embraced the principles of lean production to squeeze inefficiency out of manufacturing processes, these innovative companies are streamlining the processes of consuming. In the early 1990s we popularized the term
lean production to describe the ultra-efficient process management of
our exemplar firm,
“But surely,” you say, “when it comes to consumption, less can’t be more.” Actually it can be, for both consumer and provider. Lean consumption isn’t about reducing the amount customers buy or the business they bring. Rather, it’s about providing the full value that consumers desire from their goods and services, with the greatest efficiency and least pain.
The key word here is “process.” Think about consumption not as an isolated moment of decision about purchasing a specific product, but as a continuing process linking many goods and services to solve consumer problems. When a person buys a home computer, for example, this is not a onetime transaction. The individual has embarked on the arduous process of researching, obtaining, integrating, maintaining, upgrading, and, finally, disposing of this purchase. For producers and providers (whether employees, managers, or entrepreneurs), developing lean consumption processes requires determining how to configure linked business activities, especially across firms, to meet customer needs without squandering their own—or the consumer’s—time, effort, and resources.
The way to do this is to tightly integrate and streamline the processes of provision and consumption. The challenge is not simply logistical: Lean consumption requires a fundamental shift in the way retailers, service providers, manufacturers, and suppliers think about the relationship between provision and consumption, and the role their customers play in these processes. It also requires consumers to change the nature of their relationships with the companies they patronize. Customers and providers must start collaborating to minimize total cost and wasted time and to create new value.
That may seem like a doubtful proposition. But some companies—along with their customers—have started the culture shift that will make lean consumption possible. And they’re finding that everybody wins.
While lean consumption would be a sensible idea in any era, we see several convergent trends that we think make it inevitable and, indeed, a competitive necessity now.
With the regulated economy steadily contracting, consumers have a broader range of decisions to make, from how to invest retirement funds, to what telecommunications provider to use, to what airline to fly at what price. At the same time, they must cope with a growing profusion of choices as producers relentlessly customize their offerings, pursue product niches, and increase their sales channels.
In this demanding environment, information technology is steadily blurring the distinction between consumption and production. Consumers are doing increasing amounts of unpaid work on behalf of providers, such as entering data into Web-based order forms and tracking the progress of their own orders. And these consumers are spending more and more time and energy to obtain and maintain the computers, printers, PDAs, and other technological tools needed to solve routine problems—for themselves and for providers.
This growing burden on consumers might be sustainable if not for the changes consumers themselves are undergoing. Household configurations in every advanced economy are transforming in ways that create additional time pressures and energy drains. Two-wageearner and single-parent households, where no one has time to manage consumption, are increasingly common; and aging populations are confronted with an expanding array of choices but have declining energy to address them.
Collectively, these trends give rise to the consumer’s emerging dilemma of more choices to make and products to manage with decreasing time and energy. Yet the situation also creates a major opportunity for providers.
The concepts underlying lean consumption boil down to six simple principles that correspond closely with those of lean production.
1. Solve the customer’s problem completely by insuring that all the goods and services work, and work together.
2. Don’t waste the customer’s time.
3. Provide exactly what the customer wants.
4. Provide what’s wanted exactly where it’s wanted.
5. Provide what’s wanted where it’s wanted exactly when it’s wanted.
6. Continually aggregate solutions to reduce the customer’s time and hassle.
Let’s examine these principles one at a time. . . To read the entire article, please go to the URL below.
Making Lean Consumption Work
We believe that consumers will be quick to learn their role in lean consumption. Most of us would surely embrace the opportunity to solve our consumption problems completely, getting just what we want, when we want it, where we want it, at an attractive price from a small number of stable providers, with no waste of our time, and with no unpaid work. The real challenge lies with the retailers, service providers, manufacturers, and suppliers that are not used to looking at total cost from the standpoint of the consumer and are even less accustomed to working with customers to optimize the process of consuming. Lean production has clearly triumphed over similar obstacles in recent years to become the dominant global model. Can lean consumption, its logical companion, be far behind?
Some people look at things that are and ask 'why?'
I look at things that aren't and ask 'why not?'
John F Kennedy
* * * * *
The prophets of gloom, Ehrlich and Nixon and other Malthusians, didn’t think we could provide food and health care to 300 million Americans. But as we saw in the forgoing articles, we are living longer and healthier lives, outstripping the countries with state health care. Our population will be 400 million by 2043, and by 2075, our population will be 600 million Americans. Can you fathom the wonder of it all? We will still be providing the world’s best health care to this enlarging population, exceeding the Countries of Europe with government health care despite their decreasing population.
Here we are with less than one-twentieth
of the more than 6 billion people on our planet. And we have the greatest
wealth brought about by the freedom and economic foresightedness of our parents
and grandparents who came to this country to escape the oppressive governments
Why would anyone even think of trying to emulate the socialistic medical structures of European Medicine? They have failed their own people and will continue to fail. Why would we want to import failure? Single-payer health care is a dead issue.
There are many bright and innovative ideas surfacing in American Medicine. This Quarter HPUSA is presenting another integrative approach. See section 8 below.
By 2050, the world population is
expected to increase to 9.1 billion from 6.5 billion today. Nine countries are
expected to account for half the world's projected population increase:
Medical Facts: Free Enterprise will provide health care to 9.1 Billion on this globe. State Medicine can’t provide it to 400 million in the EU today. Most of them still like the security of waiting in line.
* * * * *
One group Capital Hill and White House could always depend on for support in a war effort was the 25 million veterans and the 45 million family members – all voters.
I see veterans
every week. Some of them have been irreparably harmed by the war in
This is being reproduced by the war in the Mid East. The prevailing sentiment, which was also vocalized by my patient above, is that we are the most powerful nation on the face of the earth and our government doesn’t have the will to use that power to eliminate or at least conquer the enemy. Veterans feel that the government is allowing our military to be used as canon fodder on their one-year-or-so activation. Many of these veterans have such severe psychiatric problems from their experiences in the third world that they will never be able to function normally in society again.
Veterans, including their spouses, see no problem in using whatever weapons we have to destroy the enemy just as in any other world war. They feel the enemy is showing the world that we are a paper tiger rather than a power house to be reckoned with. By not using the force available to us, these 70 million voters may just elect the other political party into power that would make us even more like a paper tiger. War and politics is a dangerous combination. The health fall out is beyond comprehension for most of us.
* * * * *
8. What's New in US Health Care: The Intersection of High Tech and Total Health
What does it take to create truly engaged health care consumers? Along with tools, information, and quality care, it also requires consumers to participate in managing their own medical care.
Kaiser Permanente is making an
unprecedented investment to help providers and consumers alike participate in
managing health care. Kaiser Permanente HealthConnect™ will integrate members’
medical records across the country into one seamless network. Kaiser Permanente
–HealthConnect is a major innovation – it’s the largest civilian health care
information technology system ever implemented in the
Through www.kaiserpermanente.org, members will have access 24 hours a day, seven days a week to key portions of their Kaiser Permanente electronic medical record, in addition to existing features like appointment scheduling, prescription refills, and health education resources. KP members will have the freedom to manage their health care when it’s most convenient for them.
They’ll be able to:
View future doctor appointment information.
Access summaries of recent office visits
Print immunization records
View summaries of ongoing health conditions
Exchange secure messages with their doctor’s office
View selected lab results
Segments of Kaiser Permanente
HealthConnect are already up and running in
Simply shifting responsibility to consumers for health care funding won’t control escalating health care costs. Consumers need tools to help them make better decisions and improve their health. Kaiser Permanente’s care delivery system is designed to keep members healthy by focusing on preventive medicine. We’ve always been committed to member education and engagement. HealthBuilder (HRA) by Kaiser Permanente is another big step down that path.
Resources available include the following:
Research a health condition, learn more about treatment options, and get in-depth information from trusted sources to help you make decisions about your health.
Look up detailed information on thousands of drugs, including instructions, side effects, and precautions.
Our featured health topics section offers tips for healthy living and trustworthy information on common conditions.
Find a Kaiser Permanente medical office, pharmacy, or hospital using our online search tool.
Allows members to refill prescriptions, make nonurgent appointments, and contact medical professionals online, and enroll in health classes and programs at many Kaiser Permanente facilities.
[The above was
sent by a member of Medical Tuesday who is the owner of a large insurance
agency. He just received this information after Kaiser Permanente completed the
introduction of their HRAs in
* * * * *
About this time every year, we get a number of requests from Blue Cross, Blue Shield, Hospitals, IPAs, Workers Comp, and just about everyone we do business with to complete recredentialing applications. Some want separate credentials for their HMO, PPO and premium divisions. Even at two hours to complete each one, the 12 packets is still two days of unpaid work a year.
HPUSA, our working group for a truly free and open health-care system, has several basic tenets. One is that the plan will accept licensure as the measure of acceptance. Any licensed physician, hospital, urgent-care center or other service provider can electronically bill the system with just their licensure which can easily be crosschecked.
The ICD9 codes have become overbearing. On every laboratory or x-ray request, we are required to list the ICD9 diagnostic codes. For some laboratory requests, one has to look up several. Every diagnosis in our medical records requires and ICD9 code. Adding up several minutes on every patient comes to an hour or so a week or about 50 hours a year, or an additional week of work without pay.
HPUSA feels that it is not important to an insurance carrier to know why a patient is being seen by a family doctor, an internist, a pediatrician or an obstetrician. That a patient goes to see a physician for any medical reason is sufficient cause to pay reimbursement for the office call. Thus, HPUSA will save one week’s wages per year.
The CPT codes are becoming a criminal net for the federal bureaucrats to arrest doctors for using the wrong code. To check off the individual items discussed or examined if laboriously recorded to come up with one of five levels of complexity, is labor intensive and adds nothing to a patient’s care. Again, HPUSA feels there is no need for the large number of CPT codes that are revised each year making it more complicated than necessary.
HPUSA feels that an internist’s office call is about the same as other internist's office calls and there is no need to have five levels of CPT care. It will all average out. A nurse practitioner in an internist’s office will provide the same level of care as a NP in another internist’s office. Hence, that level of care will also average out with out separating into multi-levels. A visit to see the medical assistant for an injection or a BP reading will also average out with other MAs in internist’s offices and will be reimbursed on that level. Every office only needs these three levels of care defined by the Doctor, the Nurse or the Medical Assistant rather than the current cascade that CPT enforces. Hence, there are no CPT codes in the current working model for HPUSA.
This will also save a similar 50 hours a year in researching codes and trying to figure out exactly what the Feds want. It could save doctors tens of thousands of dollars if the government disagrees with your determination.
To keep this plan truly market based, our working co-payment level for office calls is 30 percent. This will make every patient police his own needs and he will not obtain unnecessary care. This eliminates a whole army of review nurses saving $millions.
At this time, we are looking for an insurance carrier willing to do a fully market-based plan where the system will bring about the leanest possible health-care consumption. We think doctors and other providers will immediately see the benefit of this. We welcome your input.
* * * * *
PRIVATE NEUROLOGY is a Third-Party-Free Practice in
* * * * *
Stay Tuned to the MedicalTuesday and the HealthPlanUSA Networks and have your friends do the same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp and enter you email address and join the 20,000 members who receive this newsletter. If you are one of the 50,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above.
Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff. Sections 1-5 are entirely attributable quotes in the interest of the health-care debate.
Editorial comments are in brackets.
ALSO NOTE: MedicalTuesday and HPUSA receive no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Spammator Note: MedicalTuesday and HPUSA use many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp
Del Meyer, MD, CEO & Founder
Words of Wisdom
Your thoughts become your words. Your words become your actions. Your actions become your habits. Your habits become your character. Your character becomes your destiny. –General Dave R. Palmer
People who complain about taxes can be divided into two classes - men and women. -Anonymous
Some Recent Postings
July HPUSA Issue: www.healthplanusa.net/July06.htm
April HPUSA Issue: www.healthplanusa.net/April06.htm
January HPUSA Issue: www.healthplanusa.net/January06.htm
This Month in History