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HEALTHPLANUSA . NET |
QUARTERLY NEWSLETTER |
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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. Featured
Article: Capitalism:
The Movie
2. In the News:
The Population Boon; 300 Million and Growing
3. International Medicine: Germany to Postpone Health-Care Changes by
Three Months
4. Medicare: California’s Governor Vetoes Measure for Universal Health
Care
5. Lean HealthCare: Lean Consumption, by James P. Womack and Daniel T. Jones
6. Medical Myths: We Can’t Provide Health
Care to 300 Million Americans?
7. Perspectives on Capital Hill: The White
House May Be Losing the Veterans Support
8. What's New in US Health Care: The Intersection of High Tech and Total Health
9. Health Plan USA: Free Market in Health Care
-A Work in Progress
10. Restoring Accountability: in Medical
Practice, Insurance and Government Programs
* * * * *
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
enterprise,
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
do—or else.
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.
The official
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.
* * * * *
3. International
Medicine:
"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.
http://online.wsj.com/article/SB115767495785157062.html?mod=todays_us_page_one
Write to Andrea Thomas at andrea.thomas@dowjones.com.
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
Sacramento Bee,
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
http://www.sacbee.com/296/story/28096.html
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?
http://custom.hbsp.com/b01/en/implicit/custom.jhtml?pr=LEANER0503C2005030462
Some people look at things that are and ask 'why?'
I look at things that aren't and ask 'why not?'
John F Kennedy
* * * * *
6. Medical
Myths: We Can’t Provide Health Care to 300 Million Americans?
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
of
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.
* * * * *
7. Perspectives
on Capital Hill: The White House May Be Losing the Veteran’s Support
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.
Kaiser
Permanente hospital and medical office locations
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
* * * * *
9. Health Plan
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.
* * * * *
10. Restoring
Accountability in Medical Practice, Insurance and Government Programs
·
PRIVATE NEUROLOGY is a Third-Party-Free Practice in
* * * * *
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Del Meyer
Del
Meyer, MD, CEO & Founder
HealthPlanUSA,
LLC
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
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