Comments

Excellent! Thoughtful! Timely! Thank you! It is pretty amazing what we'd like to think is out of our discretion simply because we are waiting for someone else to do it. We often follow the leader in practice and thought process whether we go into a ditch or rise to the next level. What I find incredibly useful here are the small things that do not require massive overhaul that can be done a regular basis to assist in the healing of patients and in bringing healthcare costs down.

Leadership is important but I always like to ask who is leading and what are we following.

The word "healing" here is used purposefully, as healthcare seems to largely be about the maintenance of bad health as opposed to holistically addressing the dis-ease, not to even mention preventative measures. Of course, this would require all of us to look at our bad habits and this we rarely like to do until we are damn near dead and this goes for our personal and professional lives. I understand this. But this we must do. The slides are thoughts to get us there.

Thanks again, TP, for such clarity of thought and actions. The slides are beautiful and appreciated.

Posted by Judith Ellis at July 28, 2009 10:44 AM

Tom - as far as I am concerned you sum up the entire healthcare debate in these words:

"Do we acknowledge that people issues-capabilities involving the entire staff affect outcomes far more than capital-technology issues?"

When we get healthcare leaders who let go of power and give it to front line folks the solutions become clear, obvious and easy.

Please keep rattling the healthcare cage :-)

Posted by Trevor Gay at July 28, 2009 12:00 PM

Reading again, the already happening and hope are palpable. We would be so much further along if we just do what we already know to do. Leadership is so very key. Most of us prefer to follow and even leaders followed/follow in the footsteps of others. So, we are always being led. "Without a vision the people parish." There is vision here.

Posted by Judith Ellis at July 28, 2009 12:03 PM

Tom, you've hit a nail square on the head. One of the things I learned quickly in my years in health care is that leaders in that industry tend to adopt a "wait for orders from on high" approach to change. It's almost always reactive and not proactive. I say "almost always," because (as you point out) some ARE doing an excellent job. Much like the quote "All great work is done in defiance of management," some (but not most) hospitals and health care providers serve as living proof that even within the constraints of a largely out of control monster of a system it is possible to provide improved outcomes, better patient and staff relations, and operate in the black ink. I have issues with benchmarking in health care, but I am totally for figuring out how the make the rare but effective leadership thinking that is scattered about the industry contagious. Too bad we can't genetically engineer that and slip it in with the latest flu vaccine. We could really use a good epidemic of that.

Thanks again for your efforts in this arena. Very much needed.

Posted by Dan Gunter at July 28, 2009 1:48 PM

http://www.nytimes.com/2009/07/24/opinion/24krugman.html?_r=1

You linked to Peggy Noonan's view of Obama's
(Obamacare) last press conference. Heres a link to what Paul Krugman thought of the press conference.

Posted by zorro at July 28, 2009 4:29 PM

In the NHS you are wait listed until you meet "Trevor" at the gates of Hell "... welcome TP ..." he chirps "... indeed - welcome to the front-line my beloved friend ..." :>)

http://vodpod.com/watch/589395-the-doors-light-my-fire

Posted by UK Love at July 28, 2009 8:05 PM

What I wonder about is the AHA view on preventative care. It feels to me as if we have a health crisis more than a healthcare crisis although I cannot disagree with any of Tom's points once the diagnosis through recovery cycle begins. The US boasts increasing morbid obesity rates and then we act surprised when healthcare costs soar. Put down the Ben & Jerry's Cherry Garcia, it's time for my run.

Posted by David Porter at July 28, 2009 8:40 PM

We must begin to think like politicians to understand our plight.

Fatter Americans may die sooner than social security eligibility = more money for government and social security. GOOD

Lean Americans live longer = more expenditures and government dependence on programs later in life. BAD

The US government says they want programs that will make Americans healthier, but at what cost? You can't have your cake and eat it in this system.

Solution: Taxing the very items that are contributing to making Americans fatter...soda pop. Tax the items, hope people continue to ingest soda pop like crazy, and then take the proceeds to make them healthier. Didn't we try this with cigarettes, cigars, and booze? Why don't we lower the taxes and costs associated with these products?

Forget running. Get out the Ben and Jerry's and get busy. That should be Social Security's mantra, "A benefit we hope you'll never have to take."

Opposing forces are at work with our current day healthcare issues and social security.

Posted by Scott Peters at July 28, 2009 11:46 PM

Got it. If we get sick, don't linger on, just move on to the other side as rapidly as possible. Maybe we can at least get some pain medication while we wait...

Posted by David Porter at July 29, 2009 7:16 AM

I saw a Blondie comic strip today that made me think of Tom. http://www.arcamax.com/blondie/s-585957-763261 Not sure if it will be the same strip tomorrow, this is the one from 7/29/09.

Posted by RandySpangler at July 29, 2009 7:20 AM

In my (inexpert) view, number 7 should be absolutely at the top of the list, by a long way. It's fundamentally the What and Why question, whereas many of the others are How.

Posted by RobCH at July 29, 2009 8:32 AM

David,

Absolutely. Pain meds, a bullet possibly, assisted suicides, etc.. The express lane so-to-speak for reaching your destination in a timely fashion. Less burden all around.

Michael Jackson likely got what he wanted. He went to sleep forever, gained his fame back, and the public is more tolerant of his infamous sleep-overs. He kept on insisting with medical providers that they give him stronger stuff to eliminate the pains of reality. Buddha said it best, "Life is pain." Hopefully death isn't.

Comfortably numb :). Our obsession with wanting to live longer comes at an enormous expense, it's also terribly vain. Gotta run, I'm craving an Angry Burger from Burger King. I can feel my arteries clogging just thinking about that tasty treat.

Posted by Scott Peters at July 29, 2009 10:48 AM

Scott Peters - Stay away from the philosophical stuff, my boy, will ya?, and stick to the ranting about affirmative action and young black boys who undoubtedly deservedly beat your butt as a kid, as you have written of here. You are better at such rantings.

Do you feel a radio talk show coming on? Perhaps Trevor will join you there, as I see that you so value him and he values your work. I know that you also value the work of C-Love/UK-Love. But stay away from the irony please; you don't even come close to what he does, like him or not. Just saying.

(UK-Love - I've been loving the videos from Tina to The Doors!)

Regarding Michael Jackson, here is a speech given at Oxford that puts to shame anything you have ever written here or anywhere else from what I've read. The minute that you can prove the accusations that you've written here about MJ that is the minute your words here may mean anything. Fat chance, eh?

http://ebmeierjochen.wordpress.com/2009/07/14/the-oxford-lecture-michael-jackson-talks-about-life-%E2%80%93-his-own-and-ours/

I know people that knew MJ personally who cannot conceive of him doing what was said of him. Did you know him?

Posted by Judith Ellis at July 29, 2009 11:47 AM

No. 13 reminds me of what is within our span of control, and how can we create adaptable healthcare organizations?

Another point to consider for inclusion is: 'How will we know when we're succeeding in the future? And by consequence, what new metrics need to be created?'

Posted by Jim Taggart at July 29, 2009 12:32 PM

Jim - That's an excellent point. Thank you. I guess a very basic metric would be levels such as obesity decreasing or fewer cases of heart disease. This is where the holisitc and preventative measures really matter.

Posted by Judith Ellis at July 29, 2009 12:37 PM

One smile headed your way, Judith.

Posted by David Porter at July 29, 2009 2:00 PM

And another headed your way, David!

Posted by Judith Ellis at July 29, 2009 3:20 PM

Do I know him? No

Did he pay out millions upon millions to some of these families to avoid legal battles? Absolutely...did he do this because he was innocent? Doubtful. Your skewed sense of MJ's judgement as proper speaks for itself.

Are you breaking the rules, once again, of the Peters Blog? Why...of course.

The Being Brand reigns true once again...Don't forget, I am UK Love!

With regard to my experiences and exposure to other races and relations, you have no idea. Yet, the color of my skin is white, which puts me and certain police officers at a disadvantage. Maybe Mr. Peters should invite us all for a beer! Let's not forget your issues with Latinas and jumping to conclusions.

You've been asked time and time again to not address individuals, yet you still do. Yawn...

There really is no irony in my statements...most, if not all, decisions with regard to government and humanity deal with money in mind, not people. This is true in American corporations today too. Look at the wonderful state you're living in. Maybe Canada will take a few of our northern states in a trade for oil exploration.

Posted by Scott Peters at July 29, 2009 5:47 PM

And the answer to my AHA question under the "Focus on Wellness" section.

http://www.aha.org/aha/advocacy/annual-meeting/09-issue-papers.html

Posted by David Porter at July 29, 2009 5:55 PM

Judith – I would be grateful if you don’t drag my name, unsolicited, into discussions. I seem to recall you have spoken here about your opposition to making unsolicited comments. Please do not do this about me. That is all I wish to say on this matter.

Posted by Trevor Gay at July 29, 2009 6:58 PM

Scott Peters - Your comments are lame.

Trevor - I will use your name as I see fit as you may do the same of mine. If the shoe fits, wear it. If not, kick it.

Posted by Judith Ellis at July 29, 2009 7:59 PM

"Don't forget, I am UK Love!"

If you are UK Love, Trevor is a masochist. I do not think he's that. He has written very highly of your book.

Posted by Judith Ellis at July 29, 2009 8:09 PM

Once again I'm lame, or an ape, a joke, or some other unnecessary put down. I agree with Trevor. Follow the rules of the blog and quit dragging people into discussions. I offer a different perspective, popular or not.

My affiliation with Trevor as a friend is independent of my posts. He is a friend and I enjoy his blog and thoughts.

Posted by The Joker at July 29, 2009 9:46 PM

Trevor,

Based on the response, you're getting a good dose of the Being Brand; very contradictory to what the brand should be.

Simplicity is the Key my friend.

Posted by The Joker at July 29, 2009 9:48 PM

Scott Peters - I did not say that you are lame. But now that you mention it let me think about it. So, are you now saying that you are not UK Love? I think my point has been well taken. Otherwise, Trevor would be a masochist who praises your book while being repeatedly ripped into as he is no match for the ironic sometimes seemingly sadistic one. :-) But like I said. I don't think Trevor's a masochist and as a self-professed friend you would not be so inclined to respond in said manner.

Posted by Judith Ellis at July 29, 2009 10:05 PM

Trevor is too nice to get into quips of ironic nonsense...I'm not. I'm glad you have everything figured out.

Posted by The Joker at July 29, 2009 10:36 PM

Going daringly off topic for a moment and considering healthcare, I saw a snippet of a piece on CNN this morning about the complete absence of standardised nursing procedures ("we pick it up as we go along" - quote from one nurse) in US hospitals. This was the result of a study into how infections are spread/carried within the hospital working environment via catheters and other shared equipment. Seems to relate to a good number of TP's points.

Posted by RobCH at July 30, 2009 6:48 AM

TPC overnight polling is in & all agree that Scott & Trevor frequently proclaiming their man love for each other is to be celebrated - even the sharing of their swimsuit photos & plans to develop a "manssiere" - brilliant! :>)

Posted by UK Love at July 30, 2009 8:42 AM

David - Thanks for the AHA link. There is a lot of good information there. An article that I found particularly interesting is "Hospital's Tax-exempt Status." A few years back I put in an offer to buy a very large mixed-use hotel that had apartments, shopping and shops. Across from it there is a theater and a historic mall. I had a brilliant idea to buy all three: the hotel, theater, and mall, rebuilding the area. The hotel wasn't very profitable and the theater was doing so-so. (Both have great bones with great amenities. The theater has an art-deco design. Nice.) The mall was still profitable.

I came to discover that the theater was owned by the hospital which is also in the area and that the city was running the theater. I met with city officials and later discovered that there was an intertwined relationship with the city and the hospital which essentially bound them together, as non-profit hospitals, if I'm not mistaken, are not supposed to own property. Many, in fact, do. I guess it's all about the arrangement.

The idea is that non-profit hospitals benefit the community in ways that the for-profit hospitals don't and are allowed tax-exempt status because of it. I am not sure of this, having not thoroughly looked into this matter. But working through the deal, it sort of felt like other tax-exempt organizations that operate in many ways with regards to bonuses and compensation as for-profit organizations but are tax-exempt. Blue Cross and Blue Shield readily comes to mind.

All rules and procedures regarding direct health and costs, including tax-exempt ones, should be reviewed on a continuous basis for efficiency and accuracy. Our problem seems to be that we begin a rule that becomes law for an eternity or began procedures that are not followed consistently. I'm thinking now of the simple procedures that TP often mentions regarding healthcare.

All rules and procedures need constant review. Perhaps then we can pay for healthcare for everyone.

Posted by Judith Ellis at July 30, 2009 8:48 AM

The "Focus on Wellness" section is great, although it's usually a matter of application and getting Congress focused on what the People really need which includes getting big business lobbyists out of healthcare matters. It is completely foolish to think that an industry's interest will not be paramount. We've seen this reel again and again.

Posted by Judith Ellis at July 30, 2009 8:58 AM

Its not Congress or big business thats the problem
as I see it. Its what people are willing to believe. The whole 'socialized medicine' argument works with a chunk of the population even though the same argumnment was pushed by the AMA in the early 1960's by spokesman Ronald Reagan in an attempt to shoot down medicare. Also, we fall for the idea that when taxes go up, we are 'punishing people'. We complain about the money made on wall street, but still fall for the argument that the people who make the most money are the most productive.

And then we are so easily distracted and impatient. The problems with the economy are due to practices that began in the late 1970's. But for some reason, we fall for the idea that the fact that the stimulus money has not fixed everything, its time to blame Obama. And race is still a big divide. The President mispeaks and the country discuuses it endlesely for days on end.
And then we just can't back off the idea that market solutions are always the best even when we are swimming in an environment that should remind us every day how stupid a notion that is. There is no free-market in heathcae because much of the time there is only one treatment and that treatment will save your life - you don't have the choice to 'not buy it'.
As Americans, we need to find a ballance between individuality and what is good for the society. If we lose out to the Chinese in the 21st century, I believe it will because they will have figured out the right ballance between colectivism and individuality before we did.

Posted by zorro at July 30, 2009 10:55 AM

UK,

We had the manssiere all ready to go with Billy Mays and discovered the copyright belonged to the Being Brand. So unfortunate... - :> brilliant.

The photos are a wonderful idea and if the idea moves my place to becoming a Cool Friend or some other notable, I'd be happy to share them; almost as wonderful as Biedermann in the Arena X-Glide.

Peace and Love...epecially to my newly declared man friend.

Posted by The Joker at July 30, 2009 10:58 AM

Some excellent points here, zorro. (Nice name, by the way, though the syntax is familiar :-) They are appreciated. Thank you.

Thanks also for the Krugman article. As Mr. Krugman, I was incredibly impressed with President Obama's sheer command of the many issues involved in healthcare. It was quite impressive indeed. There are four presidents that I can remember actually listening to and this president never ceases to amaze me with his grasp of issues and ability to articulate them. It's stunning.

Regarding Ms. Noonan, she is sometimes all over the place, but typically gushy and nostalgic about the years gone by when she was the great speech writer for Ronald Reagan. But the missing contributory is Ronald Reagan himself and as you have noted above, he was not always right on all the issues. But, of course, no president ever is. This is the reason for the checks and balances of power between the branches of government.

I lost a great deal of respect for Peggy Noonan when she jumped on that Palin bandwagon and beat the hell out of it until she realized that Americans by and large weren't buying ignorance wrapped in “cute” colloquialisms. (But I appreciated her stance on the Iran situation. There was nothing political there.) Self-interest can be a great motivator. In fact, it is often the sole motivator. I find it very difficult to believe that many are motivated by ideas; instead, many seem motivated purely by ideology and self-interest, whether detrimental to the whole or not.

This "Obamacare" article seems purely political. It is disrespectful to Congress and the American people where some are honestly seeking to address this serious issue. (Some are also merely sitting on the sidelines wishing for failure. This has been the written agenda.) This is not President Obama's healthcare. As he noted during the last press conference, he has a physician as the president that travels the world with him. It is an attempt to frame the argument for political points. I'm so sick of this. I cut the network news off regularly because of this and watch C-Span.

Yes, I understand the reasoning behind the "Obamacare" label. But it is neither catchy nor smart; it's purely political and considering the seriousness of the issue, it particularly inappropriate. Although, it does appear that in many cases politics rather policy sways the public. (Your point was not lost above.) TP has added the issue of procedures that matter terribly. Which comes first policy or procedure. It seems that procedures cannot occur without policy when talking about healthcare issues, perhaps with any issue. It is a matter of what and how. Do we ever determine how a thing is to be done without first determining what needs to be done?

It seems to me that it is not President Obama who has misjudged the American people as Noonan writes, but she herself. It appears that she seeks to shape the debate with her words that fall way short of the command that President Obama has on the issues and the pulse of the American people. What seems to be lost here with the administration is presentation. President Obama is one voice in meeting the people’s needs with regards to healthcare. There is Congress to consider. The Blue Dogs seem to be coming along now, hopefully not for the ride but for real change.

Noonan, like many Congresspersons, seem to be pushing political agendas and looking ahead to 2010. The healthcare issue seems like a mere sideshow. A lot of it seems to be about who has the power and not who as the best interest of the People.

Posted by Judith Ellis at July 30, 2009 12:09 PM

This article is dead-on; there are so many subjective decisions made at hospitals and health care centers it's almost disturbing. I recently read an article, written by a college student, about how her local hospital couldn't classify her as bulimic only because she didn't weigh below a certain number of pounds. She had to talk with upper management for almost a week and argue her way into treatment.

On another note, I don't know if it will be possible to measure the success of our new public health care programs, because the majority of world powers have had this option for so long. I think we should just concentrate on the best ways to pay for the programs while making them competitive with private health care.

Posted by Kye Swenson at July 30, 2009 1:52 PM

UK Love and Scott. I love you both - Just living up to my name guys :-) Anyway - Thanks for the humour - good to know it is alive and well here with you two. Life is too short for too much seriousness. Let our 'Being Brand' be fun!

Posted by Trevor Gay at July 30, 2009 2:51 PM

Kye - The bulimic article you mention is scary. I am assuming that such unfortunately happens all the time where patients are considered as statistics. I guess a bit of this is actually good and normal, as typically a set of circumstances is usually representative or the result of a certain disease. But not using common sense is another problem altogether. Also, for someone to argue their way into a bulimic program is quite unusual, as denial seems to be associated with that particular disease. I hope she got the help needed. One of my college housemates at Michigan was bulimic and it was a very sad situation.

Regarding concentrating on how to best pay for the new programs and competing with private healthcare, it seems obvious that the healthcare industry based on their lobbying efforts, to the tune of millions of dollars daily, sees the government option as eliminating competition. Perhaps it also has something to do with controlling costs by bumping people when they need care the most. This to me is one of the most egregious practices.

What I find interesting are those who say the government never does anything well. I have no worry whatsoever that my mail will arrive. I only forget some times that it's a holiday. But like other entities I'm sure waste needs addressing and innovation needed. So, where private industry intruded on what was basically public, why not now include an option that is public into a system that is largely private? Weren’t the same arguments that we hear now made when social security was created? It's good that the health of our seniors was not in the markets as many who now oppose this new healthcare initiative wanted.

Posted by Judith Ellis at July 30, 2009 3:56 PM

I found it quite ironic that Fox News, which takes a shot at the failure of government whenever possible, seemed to be very enthusiastic in its celebration of the 40th aniversary of the first man on the moon.

The reason some in Congress are opposing the current healthcare reforms (which they proudly state in public) is because success in healthcare reform would be good for the Democratic Party.
Suppose Democrats took public positions like this when opposing the Republicans when the GOP were in power. I'm sure it would be labeled (and rightly so) as unpatriotic.

By the way, yes the same arguments we hear today about health care were preented when social secuity was created. And it was opposed by the Republicans - as was the minimum wage and the 40 hour work week and on and on.

Posted by zorro at July 30, 2009 4:23 PM

Quote from the Noonan Article

"Americans in the most personal, daily ways feel they are less free than they used to be. And they are right, they are less free."

This is the same line of crap that her old boss, Ronald Reagan pitched when he worked as a spokeman for the AMA (which at the time would not allow black Drs to join).
In the early 1960's Reagan went around the country telling people that Medicare would take our freedom away and turn the country socialist.

Posted by zorro at July 30, 2009 5:29 PM

I wholeheartedly agree about the unpatriotic label that would be attached to Democrats and agree that many acting in Congress are doing so unpatriotically--not that there are opposing views, but that are not many being presented. I gather there are some Republican amendments in this healthcare reform bill but by and large it appears that many in Congress are simply bad mouthing it and doing nothing themselves. This mustn't be acceptable.

The political policies and tactics of the likes of Karl Rove were resoundly defeated and we mustn’t return to them. I remember my very Republican-Rush Limbaugh-loving-very wealthy-senior executive friend saying to me early on in the election, "you just wait the gloves will come off and the Democrats will drown at the end." He was so assured. Such political maneuvers and tactics had worked for so long that he just knew that they couldn't fail now.

My friend, whom I love dearly and have known for many years, misread the mood of the country and instead counted on dirty tricks and policies to secure his station where the markets run amuck unrestrained by regulation. He makes money in a bull or bear market. But the dirty tricks did not work then and they should not work now. What should work are honest efforts to improve the healthcare system from all sides. Opposition is not the problem; the lack of ideas and political maneuvering is.

Posted by Judith Ellis at July 30, 2009 6:03 PM

Zorro – great comments. We had precisely the same thing over here when the Conservatives opposed the setting up of our welfare state in the post war mid 1940’s. And, led by Winston Churchill, they violently opposed the creation of our National Health Service. The Conservatives claimed the NHS would be the ruin of the medical profession – what bull***t that proved to be.

Aneurin Bevan a Socialist (Labour Party) was the Minister of Health in 1948 and he was the founder of the NHS in that year saying ‘No longer will wealth be an advantage nor poverty a disadvantage” – that remains a fundamental principle of the NHS 61years later.

It seems to me Conservatives have an aversion to anything remotely called ‘society’ or ‘community’ and they continue to promote ‘individual’ over ‘society’ (or what I call “I’m alright Jack”).

‘Profit rules’ and the myth of ‘trickle down economics’ remains the Conservatives belief. I simply don't believe that happens in the real world.

Thank God for people like Mr Bevan who stood up against all the most powerful lobbies like doctors and Conservative supporters in big money businesses. He stuck out for a universal health care system in Britain based on equality of access to free health care at the point of delivery based on clinical need not ability to pay. It was a great victory for socialism. He was born and raised in a working class family and worked down the coal mines in Wales before entering politics. People like Bevan KNEW far more about fairness and inequality than Conservative politicians.

This mythical ‘freedom restriction’ argument makes me laugh heartily. I live in a VERY FREE country and we have a universal healthcare system. You are right Zorro - it is absolute crap to talk about restriction of freedoms simply because there might be a universal healthcare system. People in Britian who can afford it can (and do) opt to pay for private healthcare if they want that. They have absolutely zero restrictions on their ‘freedom’ to make that choice.

What the ‘wealthy’ don’t have is any more of a right to free healthcare than the poorest member of our society. Long may this universal right continue.

Choice and a universal system ARE compatible bed fellows and crap is the best way to describe any opinion that suggests that is not the case.

Posted by Trevor Gay at July 30, 2009 7:19 PM

We would hope that President Obama and Congress would first understand what is occuring within our borders and secondly in other places in the world, the good and ill, and determine and devise solutions that best fit "We the People" of the United States. Every country has its history and usually its own currency; these things are typically not the same.

Posted by Judith Ellis at July 30, 2009 10:12 PM

I know that this thread is getting thin and I think we all need to sit down and "Have a beer" (import or domestic???), but I wanted to ask if anyone had taken a good look at Tom's slides for that AHA conference? In it he speaks a lot about an article in The New Yorker called "The Cost Conundrum -- What a Texas town can teach us about health care." It was written in June by a surgeon named Atul Gawande.

I printed the article out and I read it over the past several days (yeah... I guess I am ADHD. I should have that checked.) I finally finished it this morning and it is a MUST READ. You can access it here: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Without regurgitating the whole article, his main thesis (caution: spoiler) is that the medical establishment in McAllen, TX have become businesspeople first, doctors second. Their focus is on the financial bottom line and it has permeated the business culture of their whole area to the point that their per capita billing for Medicare is up to three times higher than other areas of the country AND THE CARE IS NOT NOTICIBLY BETTER.

As Judith will attest (since she took a look at my blog) I am probably a bit more conservative than most of you that frequent this site. I will blame the government at the drop of a hat if I feel it is warranted (see: Gov't drops Cash for Clunkers program as it runs out of money 4 days into the program.) I am the kind of person that can usually come up with a plausable solution in my mind for just about any problem if I think about it for a while, but this Health Care "Crisis" defies solution in MY mind.

I own a company that provides IT support for about 75 small and medium sized businesses. Five years ago, we used the "break/fix" business model. We waited for the phone to ring and when someone had a problem we fixed it and billed them by the hour. I didn't think that we really billed what the problem was worth because if I looked at my ACTUAL hours spent, the cost was rather large. If I billed $100/hr (a reasonable fee for my skill level) and I spent 5.5 hours removing a nasty virus from your computer, would you feel good about paying me $550? No one wants to sink $550 into a three year old computer and get nothing more from it than to have it act just like it did the day before...

About five years ago, I thought about this situation over the course of about a year. I was going broke being fair. How could I provide a service to clients, document and bill EVERYTHING I do (after all, if you bill hourly and don't log the work, you don't get paid) and make it fair so that their monthly bills are consistent and they don't feel like they are being ripped off? I finally decided to try a new concept that we now call "Managed Services." The idea is simple: charge a monthly fixed fee based on the number of servers and workstations (and a few other metrics) in an organization and cover everything. I ended up creating three plans, all three covered ALL maintenance, helpdesk and planning (virtual CIO) labor and the other two would factor in replacing your servers every three years and/or replacing your workstations every three years. If you got the top of the line plan, your IT labor costs were practically fixed for the duration of the contract. Industry averages for this sort of plan range from $40-$130 per month per seat depending on the level of coverage.

Why did I lay this all out here? No, it is not an infomercial for my company. After reading this article, I saw a stark parallel between what the doctors are going through and what I was going through. When you are in business YOU NEED TO MAKE MONEY. Doctors aren't the wealthy guys they used to be 30-40 years ago. With the advent of massive control by Medicare and insurance companies squeezing practitioners more and more for lower costs over the past several decades, it is increasingly difficult for a doctor to do his job and still make a good living. He felt he was leaving money on the table. The payers of his bills have strict controls on what they pay him per procedure, so he has to hire more people to keep track of every little thing that he does, so that it can be billed. Beyond that, how can he make any more money? He has NO control over his profit margin except by keeping his expenses low (that's oxymoronic isn't it?) So... he just does more procedures, he covers his @$$ against lawsuits and he makes more money to boot. Win-win! He also goes into 'partnership' with other health care entities and does 'pay-for-play' to bring his business to a particular lab or diagnostic center.

Now, the practice of medicine is starting to resemble Chicago politics or slotting fees for shelf space in a grocery store. IT IS STARTING TO SOUND LIKE A PLAIN OL' BUSINESS.

Twenty years ago, Managed Care was a buzzword being tossed about. The name stuck but the concept never caught on. HMOs were supposed to 'maintain' your health, but most people that purchase health insurance want PPOs, not HMOs.

Perhaps we need to look at a medical system that more resembles what we in the IT services community have evolved to than what evolved on Wall Street.

Philosophy alert: I think very few people are born 'evil'. Self-interest, however, is a profoundly human trait and as we gain responsibility for family and employees, it becomes more important to maintain our own self-interest because we have so many people depending upon us for their livelihoods. Given the choice of making less money or more, who wouldn't choose more? As Tom Peters tells us everytime he speaks, remaining the same IS NOT AN OPTION.

I see the current House Bill(s) as being mostly stick and very, very little carrot, except for those special interests who could influence the writing of the bill and barter for their buy-in support. Where is the incentive to get schooled for four years plus three years plus residency plus all of the crap that goes with being a doctor??? I see the incentives melting away with each new measure to 'control costs'. Perhaps we need to see if "Managed Services" for humans could work out. In my business we cover the labor plus we make a small percentage on whatever we sell. Perhaps that could work in the medical realm where you make something off of additional procedures, but it is not their bread and butter.

Most of us who have adopted this new business model are doing well. Not Warren Buffet well, but we are not losing money. I hire technicians. Practices hire doctors (technicians for humans.) I am a tech, but primarily I am a businessman. Most techs are not business people... they are techs. Most doctors are really not business people, they are doctors. You can have a small practice and make decent money or you can have a large practice (lots of techs) and make serious money. There is your scalability.

Is this the perfect way to go? I don't know, but I haven't heard anyone really talking about it, since the government cannot mandate this sort of thing (and that is what governments do... mandate things (see the story of the scorpion and the frog.)) The movement needs to be organic and it could take years to mature. What helped my business adopt managed services was advances in 'practice management' software and also huge advances in software that allows me to remotely manage and control all of those computers. In medicine, Practice Management (PM) and Electronic Medical Records (EMR) software have had huge advances recently, so maybe now it the time for a huge paradigm shift in the medical business. We can only HOPE.

Randy

Posted by RandySpangler at July 31, 2009 8:03 AM

Another Krugman article.

http://www.nytimes.com/2009/07/31/opinion/31krugman.html?_r=1

Posted by zorro at July 31, 2009 8:21 AM

While legislation and steps toward providing health care access and insurance coverage are definitely overdue, there remain a lot of unaddressed conflicts within the industry. As an example, insurers requiring a list of predetermined tests in order to confirm a diagnosis prior to treatments, juxtaposed to professional "boards," etc. promoting aggressive treatment.

Case in point: insurers often require documentation of a list of tests prior to performing an appendectomy in order to prove the necessity of the procedure. Meanwhile, an "academy of surgeons" tells its member surgeons that at least a certain percentage of appendixes surgically removed should turn out to be "normal," otherwise, they aren't being aggressive enough. The gist: one overseeing group (the payors) says "Be conservative," while another group (a body of professional surgeons) says "Be aggressive." So, if the appendix turns out to be normal, the tests should indicate the same. The crux: the insurer says "We're not paying for it." So who DOES end up paying for it? The patient pays out of pocket, or the cost shows up in a general increase in charges for ALL procedures as a means of "absorbing it."

This type of battle and difference of opinions and approaches is common in the health care industry. It is a very complex beast. I hope Americans realize that if and when legislation and plans go into effect to provide "universal health care," it's going to be a very rocky road and is sure to be a long ride.

It's a given that the enactment of such legislation is going to necessitate serious adjustments within the industry -- an industry that is rarely proactive and not highly adept at handling broad, sweeping changes.

The bottom line is that we are looking at kicking off a chain of events that will take years. Assuming President Obama and Congress can put into place decent legislation, I see a great likelihood of the resulting difficulties causing the changes to be seen as bad, poorly thought out, and a mistake -- even if they are none of those. History has shown us that matter such as this -- where the benefits will take a long time to realize -- often lead Presidents to be looked upon poorly... until decades or centuries later, when we look back at who actually had the guts initiate much needed change and the history books are by then calling them heroes.

I don't want to sound like a pessimist or naysayer. On the contrary, I am a realistic optimist -- one who has been deep inside the belly of the health care beast. Mark my words, things will seem to get worse before they get better. But the way things are being done today is not working to the mutual benefit of Americans and health care providers. We have to start somewhere. Even if it's a rough lunge followed by some backfires, it's actually very encouraging to me to finally have a President that is bent on doing something about it. I don't expect him and Congress to get it 100% right coming out of the gate.

Change is never easy. This one is going to be really, really hard. If anyone thinks the battle over getting this legislation passed is hard, just wait 'til you see what happens AFTER it passes. But we're Americans. We're used to fighting and working our way through things. I actually see the potential for America -- within 25 years -- to transform our health care system into something that other countries study and want to emulate.

If we can fight in two or more wars at the same time in the interest of freedom and democracy, we damn well ought to be able to win this internal war in the interest of human decency and outright caring.

Posted by Dan Gunter at July 31, 2009 9:44 AM

Thanks, Zorro, for the second Krugman article. It's very thoughtful. I was up writing most of the night until around 5:30 AM and saw a series of debates in the House on the health care reform bill on –Span. It was actually quite good to listen to all sides of this issue. Rep Weiner (D) of New York proposed a bill that essentially forced members of the House to vote to eliminate Medicare.

Of course, all members voted to keep it. Weiner wanted to put it on the records for those who are harping about socialized medicine—how it is a step towards socialism and how it will destroy the relationship between you and your doctor. This is a leap I don't see happening. It seems more likely that the insurance business, which makes some $600 BILLION DOLLARS annually, has a vested interest in maintaining the status quo.

As none voted against the Medicare Act made law 44 years ago yesterday, representatives could not now go back to their states with socialist scare tactics as Medicare is a government plan that works and that seniors enjoy, not to mention the Veterans Administration and DOD that are also ran rather efficiently.

The reality, as it seems to me, is if the government plan is an option and the private plan is better we can opt out of it. But, of course, with insurance companies making "$600 BILLION DOLLARS a year" that go "into their pockets and not into healthcare,” as Weiner noted, you can see why millions daily would be spent on lobbyists. What‘s wrong with a choice?

Posted by Judith Ellis at July 31, 2009 11:52 AM

Dan,

I hope that our current president can make it past the nine month point without some sort of catyclism occuring that takes his mind off of what he is working towards. Uh, well... as a conservative, I hope we don't have a catyclism, but I do not like the direction that he is heading us toward, I just don't want it to be a catyclism that diverts him.

Yes, health care needs dramatic change, but forcing through a poorly thought out kludge of a bill written by an extrememly liberal committee is not change I can believe in.

Pol Pot brought dramatic change to Cambodia, but I don't think it was the change that everyone was really looking for. (No... I am NOT comparing Obama to Pol Pot. Put that weapon back in its holster, please.)

As my nearby disertation states, I don't think that the change we need if we really, really want to fix the health care situation in this country can be thrown together in 3 months with MASSIVE arm twisting by congressional whips. This bill, along with Cap and Trade, and along with the takeover of GM is agenda driven. That is how politics works. These fundamental changes we are working through in the first 6 months of this administration will transcend many future administrations, so we must get these things right for ALL Americans, not just the ones that happen to have a plurality in government.

Posted by RandySpangler at July 31, 2009 12:06 PM

Pol Pot? Speaking of Pot, Randy Spangler, what in hell are you smoking? Your rejoiner is no explanation or excuse. We get your extremism exactly. Get real, man.

Posted by Judith Ellis at July 31, 2009 12:22 PM

Randy, if you need an example of dramatic change,
you don't need to go as far away as Cambodia.
George Bush brought dramatic change to the United States.

Posted by zorro at July 31, 2009 12:44 PM

Bravo, Zorro!

Posted by Judith Ellis at July 31, 2009 12:46 PM

Judith, you mention $600 billion a year. Is this income derived exclusively from providing medical insurance to individuals and employers? What is a reasonable rate of return/profit margin? Are these insurance companies publicly traded companies? If so, wouldn't they be interested in making a profit? I am trying to figure out why so many people think this industry (health care and related services) should be a not-for-profit industry, so your answers will go a long way to help me. From previous articles we now have the banking industry as not-for profit and the health insurance as not for profit. What else is on the list? Who makes the determiniation of "excessive"? I need help with this concept!!

Posted by cigarman11 at July 31, 2009 12:53 PM

Wow, piling on and getting beat up by a straw man with a little ad hominem thrown in for good measure. I love the abuse.

BTW, I posted another message from my other computer and it hasn't gotten past the moderator yet. That was the message I was refering to in my previous post. I think you will like it.

Posted by RandySpangler at July 31, 2009 1:11 PM

Bill Marr had a comment about health care and making a profit that I liked, but I know will go no where in changing anyone's mind. But I will repeat it anyway. To paraphrase, here is what he said. Not everything has to make a profit. Money is good, and profits are good, but some things are off limits. For example, sex is good, but that doesn't mean its ok to have sex with your sister. Health care for profit, particularly at the levels mentioned above, falls into the same category.
Free Market assumes you have a choice to not buy the product. That's where the word 'free' comes from. When you need healthcare, you have a choice - its called do or die. Nothing else in our economy is like this.

Posted by zorro at July 31, 2009 1:13 PM

You got it right Randy. George Bush has the brains of a strawman.

Posted by zorro at July 31, 2009 1:19 PM

Cigarman - Yes, these are publicly traded companies and I sincerely have no problem with the money being made. One of my biggest problem is the attempt to lockout others who might be competitors, including the government. The reality is that when Fed Ex and UPS got into the ring, it did not eliminate the government but it sure caused them to up their game. ("What can brown do for you?" I liked that ad campaign.)

Regarding the whole not-for-profit issue you raise, if you read what I wrote earlier, I think perhaps that while such companies do a lot of good, many of them operate as for-profit entities with regards to bonuses and salaries. THERE IS A LOT OF PROFIT IN NON-PROFIT. Blue Cross and Blue Shield is a non-profit. Taxes are not paid, but if they are largely operating as a for-profit perhaps taxes should be considered. I would say that perhaps the same should be said of many mega churches of which my family is intimately associated. Everything should consistently be up for review and reconsideration.

Please, you don't want to get me going on the banks. (I know your voice. Quite adept are you, but I'm cool with it.) Their profit is essentially derived from low interest rates that THE GOVERNMENT gave them while they upped their interest rates and did not renegotiated as was the plan during the original TARP the loans of homeowners.

There is no work involved in this. Anybody can be profitable with those kinds of terms. Profit was simply made off the backs of the people while the people financed their failed "innovations" while they got hundreds of millions of dollars on the front end and the back end. Goldman Sachs and others are now profitable, largely through AIG, but would be insolvent if it wasn't for the largesse of the government.

Excessive is when you cannot maintain your business and it requires a government bailout to do so and in doing so you are given billions of dollars because you are too big too fail and reap billions more in record time and very little changes. The next excessive welfare bank government gravy train will come around again in about another seven years--so it seems.

I'm off to a meeting now. Perhaps I shall return and say more. You should know me by now. :-)

Posted by Judith Ellis at July 31, 2009 1:21 PM

Be a man, Randy Spangler, and stop whinning! I guess you were caught with your pants down. And "no... I am NOT comparing" Randy Spangler to an exhibitionist. "Put that weapon back in its holster, please.)" How's that for "non" analogies? No fun, eh?

Posted by Judith Ellis at July 31, 2009 1:31 PM

Randy,

Conservatives, albeit ones that speak their minds, will have difficulty surviving without some shots on this blogspot. 1M plus jobs being lost under this administration is catyclysmic with regard to economy, health care, and all of the disastrous stuff that comes with unemployment.

If you believe the abuse is bad, wait until UK Love gets ahold of ya :> I understand what you're saying and the answers won't come easily and not without some pain.

The people of Ohio have summed it up well for the most part. Obama scrambled back to the state because his popularity was tanking since the election. Their message, "Hope alone isn't going to do it." Unless you can take hope to the bank and cash it, the American people, especially in Ohio, aren't paying much attention to the blah-blah coming from the government, any of them.

We have more important matters of beers at the White House that involve local matters of police brutality. Neither one of the gentlemen moved on their position under the quaint setting of a maple tree or whatever. Priorities my friend and I'm glad that you enjoy the abuse...get used to it!

I think I shall break into my own home tonight so the police can waste their time and I may receive a golden ticket to the Willy Wonka factory.

Posted by The Joker at July 31, 2009 1:47 PM

Has anyone heard the rumor that Obama wasn't born in the United States but instead was born in Alabama?

Makes ya think.

Posted by zorro at July 31, 2009 1:51 PM

Judith, I agree with several of your points but you mentioned "the government" several times. I don't believe the government should be a competitor in the free market system and that is where we may differ. The govenment should police monopolies to assure that "excessive" doesn't happen, not create itself as a competitor. There are times when there is or should be no free market for a good or service (the military) and the government is needed to create that good or service. But the philosophical question is when is it right for the government to step in? Should there been a bank bailout, but prior to that, what caused the need for a bailout? Could governmental policies been the root of the problem (housing for all with little/no ability to pay.) I don't know the answer to these questions but I don't believe the government as a competitor is the answer. I believe in life, liberty, and the pursuit of happiness. I believe the government's responsibiity is to protect those rights.

Posted by cigarman11 at July 31, 2009 2:06 PM

I really have to go...like right now!!! But let me say this in parting. I agree with you, Cigarman, about the role of the government to regulate to avoid abuse. But the government has long been in the business of profiting. Not only does it profit from the postal service, but many see war as profiting with big business as its ally.

As it is the government's responsibility to assure the rights and safety of its people, I can see that it may be necessary to step in on occassion. My biggest problem with the banks is that there seems to be some kind of bailout every seven to ten years or so. In this sense, the government becomes partners with these for-profits, but it seems almost like it is an entity in and of itself a part from the People when the disparity of benefits is so vast, even thought the People finance it.

I was initially for the bailout of the banks, but the more I read I became utterly disillusioned with the whole thing, especially when it became clear that their interest and the People's interest run counter in many cases, even though it is the People who sustained them. The government has many responsibilities. It is not only to protect our rights, but to maintain statehood and community. Perhaps as Keynes thought intervention is necessary. But every seven to ten years without any changes in policy and regulation? I think not!

By the way, many see war as big business. Was it Eisenhower who spoke of the Industrial-Military Complex? Gotta go!!!!!!!!!!!

Posted by Judith Ellis at July 31, 2009 2:32 PM

http://www.nytimes.com/2009/07/31/opinion/31brooks.html?_r=1

Here is an article by David Brroks. I like it because I think it affirms something I've benn thinking about a lot lately. We (as citizens) need to choose people who are trustworthy to govern us and then trust them to do the right thing. Watching cable news and reading blogs, what is apparent to me is that everyone has an opinion even when they have no idea what they are talking about. Even Obama falls into this trap. He decided to comment on the Gates incident which was something he probaly had no time to follow, but still gave his opinion. (Its the first time I've seen him do that)

Posted by zorro at July 31, 2009 5:08 PM

I must admit that I too fell into the trap of speaking before knowing all the facts with regards to the Gates matter, as I had repeated what I read in a network news online article which read that a lady called 911 and said that there were "two black men" breaking into the house. This is not what the 911 caller said at all and I, in fact, appreciate what she did say. I don't, however, think that she should be heralded as a hero for simply doing the right thing. Yesterday, she held a news conference and I promptly cut it off. She did what she should have done. Period.

Posted by Judith Ellis at July 31, 2009 5:54 PM

"For example, sex is good, but that doesn't mean its ok to have sex with your sister. Health care for profit, particularly at the levels mentioned above, falls into the same category. Free Market assumes you have a choice to not buy the product. That's where the word 'free' comes from. When you need healthcare, you have a choice - its called do or die. Nothing else in our economy is like this."

Zorro - excellent - thank you! I love that and agree with the sentiment entirely. To me there is something kind of ethically 'sick' about making a profit from errr ... errr.... sickness ....

Or is that just my naive and rose-tinted spectacles view?

PS - To save some people here some time answering that question just tick the correct answer to my question:

Yes

or

Yes

Posted by Trevor Gay at July 31, 2009 7:36 PM

First the lady (caller) is a racist...

Then the truth comes out and she shouldn't be heralded because "everyone" should make the phone call the way she did.

Meanwhile...people in the US are running around cutting unborn babies out of women and leaving them for dead (the women), allegedly (charged) with murdering their children because they want to party more and not be a parent, or better yet, allegedly kill their entire family because of an affair with a woman.

Do we, as Americans, realize how many phone calls won't be made tonight, tomorrow, or next week? Do we not realize that turning this entire Gates ordeal into a race issue will have less people getting involved in the future? Did Gates thank the police for responding? No. Did he thank the neighbor for calling to protect his property? No. He was arrested for disorderly because he was acting like a moron; likely drunk to boot.

I attended a homeowner's association meeting last night and a police officer addressed the neighborhood. Because I live in a military town, he stated that one of the largest risks we run as a city is the number of gang members entering the armed forces. They are trained well, they behave quite well in the service, and leave to go serve gangs in neighborhoods post exit. Why? Because it's a career path.

As I was listening to this, I was thinking, "Is it really that bad for our children?", that they must resort to gangs after they serve our country? Healthcare didn't seem to be that big of an issue after I heard the policeman last night.

Trevor----seeing as you're my newly declared man friend, I first read your question as rose-tinted testicles. And of course, the answer is "yes" : )

Posted by The Joker at July 31, 2009 11:32 PM

I am used to being castigated by libs. Doesn't bother me. But I love to break arguments and statements down like Mr. Maher's. If healthcare should be free, then why not water, food, basic shelter, transportation to get to work, oh... sorry, I was describing North Korea, wasn't I?

All this bantering reminds me of a fencing match. Parrying and play-stabbing each other, pretending like we are trying to kill each other, then the round is over, we take off our protective garb and shake hands. Nothing changes, a few points are scored and we wait for the next game.

We have seen many examples of nations that were run by socialists, communists and fascists (classic fascists like Hitler and Mussolini, not the current mis-use of the word FASCIST to describe Bush and Cheney) and none of them turned out too well. I cannot think of any countries in the last century that were allowed to be run by conservatives so that we can compare outcomes. Now I know some of the cynics out there will say that the military dictatorships of Central and South America were conservative governments, but they are more like repressive strongmen. No comparison (be honest, not cute.)

So... that is my piece. No minds will change from this debate. Now, I am going to crawl into my comfortable bed, happy that Senator Chris "Angelo who?" Dodd will get great care at Sloan-Kettering for his prostate cancer because he is just a normal guy with great health insurance.

Posted by RandySpangler at August 1, 2009 12:16 AM

Tom,

I am quite happy that you are focused in the healthcare space. The industry desperately needs guidance if even a small part of the EHR ROI is going to be realized.

Where there is no vision providers and facilities will perish. The collective we cannot afford to let that happen.

Regards,

Posted by Carlos Leyva at August 1, 2009 7:48 AM

You are quite correct Carlos - I too am delighted Tom continues to focus on health care. We need influential people like Tom to rattle cages very loudly to remind the powers that be that CARING for patients and their families must ALWAYS come before money and profit. There are millions of dedicated workers doing fantastic work in health services all over the world. Healthcare is a labour intensive service. I used to be responsible for a large budget in my healthcare career that was 92% wages - i.e. people. That is not untypical. Unless we care for - indeed 'love' our healthcare employees the patients and their families have absolutely no chance. The managers locked away in their warm comfortable offices who are busily writing complex management reports full of bull***t that no one reads and who haven't seen a patient in the last several decade just don't get this simple stuff Carlos! :-)

Happy Saturday all from the great Bard William's home county.

Posted by Trevor Gay at August 1, 2009 8:10 AM

"Healthcare" - picture kids running in the ancient Siskiyou mountain foothills above Ashland for 15 miles - addicted to the new drug of seratonin-endorphin - listening to beautiful San Francisco's Mr. Lewis - who groupies nicknamed "monsterman".

http://www.youtube.com/watch?v=Q1PVrVJQoU8

Posted by TrueLove (formerly UK) at August 1, 2009 8:22 AM

"Where there is no vision providers and facilities will perish. The collective we cannot afford to let that happen."

Yes, Carlos!

Posted by Judith Ellis at August 1, 2009 9:49 AM

Randy,

China, with all of its faults and human rights violations, emerges as the great world power of the century. I'm not sure about their healthcare system, but people will have to take what's given to them or else.

I like the analogy with fencing and sparring partners. Kinda like the sheepdog and wolf clocking in and out for the day with a good game of cat and mouse.

I agree with your points. All anyone must do with regard to healthcare and government is follow the money trail. The money trail doesn't lie and it usually doesn't move in the direction of front liners or everyday folks.

Posted by The Joker at August 2, 2009 11:42 AM

Prayers for Jack Welch who Tweeted about his back problem pre-July 4 & has been in the hospital with a staph infection since then - when a front line "nurse" apparently gave him cortisone shots in that painful back. Hmmm - front line - staph infection - hospital - what a surprise?

He still has weeks required to be hospitalized to make it. So much for being worth $500M+ & getting the finest "front line healthcare". Had it happened in the devilish UK NHS he would have been long gone.

The NHS is 60+ years of failure.
60+ years of cost overruns.
60+ years of doing more harm than good.
60+ years of Labour union fraud, waste & abuse.
60+ years of Hell on Earth for "Great" Britain.
60+ years of planning 1 of every 2 British "careers" being in the NHS.

The UK front line is vastly overpaid, overcompensated & pampered. Give them a sanitary checklist to perform, trust them & they betray you like Judas to Jesus. Playing on their iPhones, Blackberries, & iPods while patients go without and too often are inflicted with virus.

Madness of Labour - is it any wonder UK Love escaped before his last $100M was taxed to dust?

Madness of Gordon Brown. Between 1999 and 2002 Brown sold 60% of the UK's gold reserves at $275 an ounce. The decision to announce the sale and the timing resulted in a 10 billion pound loss.

60% of the gold reserves madness - is it any wonder that the UK is close to bankruptcy with that kind of Labour front line "leadership"?

Will the last decent citizen turn out the lights as they leave the UK - to leave it to the madness of the Labour front line street urchins and football hooligans?

I give my all in the name of TrueLove - is it too much to ask of others?

http://www.youtube.com/watch?v=4SvA90J-YqM

Posted by TrueLove at August 3, 2009 4:57 AM

My most sincere thanks as always to TrueLove for arguing my case far better than I can for universal healthcare. I was sorry to hear of the Mr Welch tragedy in a US hospital. Like so many million of patients in the US he is of course the victim of a private healthcare system not a universal one.

I adore TrueLove’s sense of humour but it is a massive insult to dedicated front line healthcare staff to make such generalisations. Maybe one day you or your family might appreciate that dedication.

PS – I'm sure it was an oversight but you didn’t include this one on you list:

60 + years of totally outperforming the US two-tier healthcare system.

Posted by Trevor Gay at August 4, 2009 3:51 AM

I have just being in hospital today for a procedure, and there is something reassuring about the fact that people can have access to competent health care. No doubt there are problems with distance and isolation, so perhaps the access is easier in the denser areas of population.

Still it gives the sense that you are part of a decent and civilized country, and the house that you return to, and the savings such as they are, still belong to you.

I had less cause for concern about missteps on this visit, suggesting that quality of care is under review.

The other thing that I am struck by, in Australia, is the diversity of the staff that I think helps to reinforce the quality of respect for individual patients. A public health system, and in this case one not without cost problems, has an intrinsic democratic quality.

The social outcomes are as important as the individual ones. Management is about values.

Posted by wmmbb at August 4, 2009 4:32 AM

"The other thing that I am struck by, in Australia, is the diversity of the staff that I think helps to reinforce the quality of respect for individual patients. A public health system, and in this case one not without cost problems, has an intrinsic democratic quality. The social outcomes are as important as the individual ones. Management is about values."

wmmbb - Amen and thank you.

Our NHS system in the UK also has many problems - not least cost pressure. Nevertheless I still have massive pride that we can give a free health care guarantee as a RIGHT for our most vulnerable citizen just as for the richest person in the UK. There is something about that which gives me a warm feeling about my country despite the pessimists, scaremongerers, doomsayers and cynics about universal healthcare.

Posted by Trevor Gay at August 4, 2009 5:35 AM

Bob Stone, author of the newly released book, The Ethics Challenge: Strengthening Your Integrity in a Greedy World, wrote a sweet and succinct post, "Birthers and Deathers." He writes about long-time Republican congressman Jim Leach's philosophy based on a most wonderful phrase:

"The temper of and integrity with which the political fight is waged is more important for the health of our society than the outcome of any issue or campaign."

--Reinhold Niebuhr

Here is Bob Stone's post:

http://bobstonesethicschallenge.blogspot.com/2009/08/birthers-and-deathers_01.html

What is occurring with Dick Armey's lobbyist planned effort using the likes of Bible-waving intimidating screaming protestors to shout down the likes of Kathleen Sebelius, Secretary of Health of Human Services, and Arlene Specter at town halls, is disgraceful and disrespectful to the process of democracy. These wingnuts are not interested in intelligent rational discussions on health care reform. They are bought and paid, philsophically or actually, to disrupt and delay the process. This is not about the People but about the corporations.

Dick Armey needs to be sent Bob Stone's post. His tactics are disgraceful. But I'm sure he would not care because it is after all about him and his pocket and not the pockets and health of the Amercian People. How unpatriotic! Dick Armey should be ashamed of himself. But the sad thing is that he probably isn't, having undoubtedly been engaged in such for a very long time. You don’t get dirty and disregard the People after you leave Congress. There should be shame in this man's game. But it's good that his lobbying efforts are getting national attention.

Posted by Judith Ellis at August 4, 2009 8:03 AM

Twenty eight percent of Republicans and 52 percent of the South believe that Obama may not be an American citizen. What scares me is these people choose to ignore facts. Willfully ignoring facts seems to almost be a defining characteristic of the Republican party. Another example is the Republicans who deny the science behind Global Warming. People like Armey who are in influential positions who fan this ignorance are not just unpatriotic, they are sociopaths.

Posted by zorro at August 4, 2009 9:12 AM

Physicians need better information management for better decisions with fewer errors. Because this technology threatens physician status, the profession has strongly resisted adoption.

An interesting system developed many years ago by Lawrence Weed, a physician, is what he calls the "problem-knowledge coupler". Search PubMed for (Weed L[Auth])

His company (in which I have no financial interest, only better medicine):
http://www.pkc.com/

Blurbs from his company's press page:
http://www.pkc.com/pkc_in_the_press.aspx

Realizing the Vision for IT in Healthcare
Digital Healthcare and Productivity
http://www.bio-itworld.com/hitw/newsletters/2006/12/21/24393

“’There's a very fundamental and serious flaw in the infrastructure of medicine,’ Lawrence L. Weed, M.D., said to close the Institute for Healthcare Improvement's 18th annual National Forum on Quality Improvement in Health Care.”

What Your Doctor Doesn’t Know Could Kill You
Boston Globe
http://www.boston.com/news/globe/reprints/071402_whenyourdoc/

“A computer program that provides vast amounts of information for diagnosing and treating patients could revolutionize the practice of medicine. So why won't physicians use it?”

Posted by John at August 4, 2009 9:16 AM

The beauty of a free society, and a free blog (thx TP), in which conservative, bible-toting, do as I say not as I do thinkers, and liberal, radical, my views are the best, the world is coming to an end, do as I say not as I do thinkers is that everyone has a voice.

The people who hide behind religion have their right to do so, whether or not the facts are built on science or fantasy. Much like religion, much of science is funded to make money.

The people who are radical and preachy about how people live, even though their arguments are largely skewed and built upon 1/2 truths, are more than entitled to share them.

The people in the middle, many of whom are on this blog continue to search for the truth by asking more questions and making observations.

Whose facts are correct in today's age? There are so many supposed facts that contradict other facts that are built upon other facts, what is one supposed to believe?

Here is one fact that cannot be disputed, our government under leadership of either party (sans Bill Clinton's administration) spend enormous amounts of money; so much that they can't balance a budget. They are looking to bring more items like healthcare under their control. How about the story of a $15M airport approved for Alaska in a town of less than 200 people? Once again, I stand behind earlier comments that Congress and our government continue to spend without checks and balances and throws good money after bad.

While people believe that global warming is our largest contemporary problem or wars with unstable nations are a bigger problem, there are several authors who believe that government may be our largest contemporary problem of this century. You only have to go back 250 years or so to understand how the Constitution was developed and what the government has evolved into. I'm not sure if the founding fathers would have dreamed or realized that the government would be funding private enterprise to keep it afloat, while the government competed against other companies that weren't taking bail out money. The simplicity of our government back then and complexity of it today was not born out of necessity, but the greed and need for government to fund itself via politicians.

Solution: Let me keep more of my money and not let the government make decisions for me. The banks have taken money, misappropriated it, and needed my tax dollars to bail them out so our financial system didn't collapse. Cut taxes, cut government spending and programs, and eliminate a co-dependence that is continuing to grow. Let's not forget that our manufacturing plants couldn't compete with foreign nations because of over regulation and enormous costs to look out for the people's welfare. What can we say now that most of these people are out of work; after looking out for their welfare.

If what Zorro says is true, the free market will take care of itself over time, even after poorly funded private and public programs collapse completely.

Posted by Scott Peters at August 4, 2009 10:55 AM

How you can read my response above and conclude anything about the free market is beyond me.
Here's the quote from the article Judith posted.
‘The temper of and integrity with which the political fight is waged is more important for the health of our society than the outcome of any issue or campaign.’
There is a lack of intergity in the campaign against health care, the ignoring the science behind global warming, the stance of the Republicans who are against Soyameyer and on and on. BTW our manufacturing plants are regulated in ways that they are not in China and the Chinese have enormous problems with polution. Also, the US outsources jobs to Canada because labor is cheaper there due to the health care in Canada. The finantial system alomost collapsed because everybody bought into the idea of less regulation. The biggest failure of the American Government in the past decade was/is the war in Iraq and it was started by the Republican president who left office 6 months ago. Senator Jim Demint and conservative columnist William Kristol have both proudly stated that they want health care to fail because it would put the Democrats in good stead with the middle class - in other words, they don't want health care reform, because it will work and will be good for the middle class which will give the Democrats a leg up when it comes to elections. To put it in terms of a business, if the Republicans ran a coffee shop that had lousy coffee and lousy service, while the Democrats ran an excellent coffee shop, the Republican solution would be to burn down the Democrats coffee shop. And then proudly admit it.

Posted by zorro at August 4, 2009 11:46 AM

Having said all that, I have no idea why the democrats put provisions in thier bills like 'paid abortions' or 'paid end of life councelors'. Neither of those are servives that are driving the need for affordable health care insurance. The Democrats seem to know exactly what to put in a bill that oponents can use as sound bites that go viral.
It's almost like they have people in the party that are accually working in 'deep cover' for the conservatives. I'm waiting for the day when a Peta lobbyists get a provision to pay for health care for pets and wildlife that gets injured on ones property.

Posted by zorro at August 4, 2009 2:27 PM

Zorro,

Pretty simple explanation. Healthcare is not a do or die issue, you will die anyway unless you have figured out something we don't know. There are several religions (scientology for instance) and people that prescribe to holistic approaches that have very differing views from healthcare mongers. There are many doctors that are moving to the middle with regard to balanced lifestyle, holistic approaches, and some medicine if needed. In some cancer treatments, if the cancer doesn't kill you there may be a good chance that you may not survive the treatments.

There are plenty of solutions being offered in opposition to modern day medicine. Even in extreme situations where you're passed out and losing blood, there are some religions that forbid blood transfusions and other treatments and let death take over. So who's really making the choice?

In general health and well being, we have all kinds of choices in America and many of them begin with preventive care.

With regard to your quote:

Bill Marr had a comment about health care and making a profit that I liked, but I know will go no where in changing anyone's mind. But I will repeat it anyway. To paraphrase, here is what he said. Not everything has to make a profit. Money is good, and profits are good, but some things are off limits. For example, sex is good, but that doesn't mean its ok to have sex with your sister. Health care for profit, particularly at the levels mentioned above, falls into the same category.
Free Market assumes you have a choice to not buy the product. That's where the word 'free' comes from. When you need healthcare, you have a choice - its called do or die. Nothing else in our economy is like this.

I was playing on your "do or die" statement with regard to free markets and healthcare. This really isn't the case at all and according to Springer and other talk show hosts, there are plenty of people that chose to hump family members.

I'm not agreeing or disagreeing, but in a free market, including the financial systems, things will take care of themselves over time. People who don't operate at the highest level of integrity will fail over time, even if we've chosen to invest with those organizations; Madoff is a great example of this dynamic, some people made bad decisions with trusting this guy.

I personally don't like either party and will vote libertarian in the next election. We should elect people who run on a platform that "...if I don't work many people out of a job with government, including myself, over time, then I haven't done a good job."

Money should stay with people, including those spending it on healthcare.

By the way, sometimes when you "do" in the overly invasive healthcare system, this may lead to your untimely death because of infection or other stuff. It's not just do or die. With regard to the do or die statement, taxes fall into the same category...

Thx for the commentary, I have enjoyed it!

Posted by Scott Peters at August 4, 2009 5:19 PM

Zorro,

If Bill Clinton was able to work with the Korean government in a humanitarian effort to pardon the journalists, that shows the power of sometimes working outside the scope of the government so-to-speak. Very brave of Clinton to put his own interests second and sit down with the leader of North Korea.

What's most important is that two Americans look like they're coming home; that type of diplomacy may be needed instead of bomb dropping and war. Kudos to the latest humanitarian effort, now we turn our eyes toward Iraq.

Posted by Scott Peters at August 4, 2009 5:28 PM

Scott - you may like this quote from the great pacifist Mahatma Gandhi.

"Liberty and democracy become unholy when their hands are dyed red with innocent blood." - Gandhi

Posted by Trevor Gay at August 4, 2009 6:02 PM

Trevor,

I do. I think Gandhi was an alien because of how he thought and operated...really not of this world.

I've got a birthday card that has cartoon drawn/colored men's bathroom. In the bathroom, there is a priest at the sink completing the act of washing his hands. Above him there is a caption of "Holy Water". Panning to the right a little bit, there is a stall with the door closed. Above the stall is the caption of "Holy Shit".

I guess many things depend on perspective...

Cheers

Posted by Scott Peters at August 4, 2009 10:19 PM

Here is an example of why healthcare should not
be driven solely by free market forces. Its just not the same as Ipods, Air Jordans and Frapachinos.

http://www.huffingtonpost.com/johann-hari/the-horrifying-hidden-sto_b_251365.html

Posted by zorro at August 4, 2009 10:49 PM

http://www.bmj.com/cgi/content/full/333/7582/1279

Another link of interest. Its an idea from a Nobel Prize winning economist from Columbia University as to how to promote drug discovery.

Posted by zorro at August 4, 2009 11:31 PM

Maybe we can take the "cash for clunkers" program to the healthcare system.

Perhaps:

cash for catheders
cash for kidney stones
cash for gold caps

Cash for clunkers...what a great way to help out the starving public living in tent camps across America. Gee...I wonder if the program is more about trying to assist a terrible auto industry, that the gov has recently invested huge public monies in, than the American people?

One very small example of how the government will run a program to serve their own interest. People are literally homeless and starving; give the $4500 to them in food credits or living expense.

How about this? Many people seem very concerned about the well being of the planet for the future of our children. Yet, the same people can't balance a budget and spend endless amounts of money supporting lobbyists and special interests. We may very well have a beautiful planet, but the quality of living/life may continue to decline for the nation. In 40 years when our children owe 50 trillion in debt and interest rates are 30-40%, I wonder what they'll think. If politicians were really interested in the future of our children, they wouldn't laden their interests with enormous amounts of payback money. The government, as I understand it, will spend $34,000 per household this year. Hmmmm...priorities. Statistic in the other day that the federal income tax revenue has regressed to record low levels not seen since the 1930's. Yet, we have record spending in Washington. Who on this blog runs their business that way?

Posted by The Joker at August 5, 2009 9:43 AM

Joker,
What would you be saying if no one took advantage of cash for clunkers? I bet it would go something like this
"What a stupid program. No one even has enough money to buy a new car even after getting 4500
dollars towaords one from the Obama administration. They have no idea how to stimulate the economy"

Posted by zorro at August 5, 2009 10:07 AM

Zorro,

Maybe after we play a game of hypothetical government, we can play Go Fish or something exciting.

I would prefer if the government just gave me the car...period. Why go through the headaches of trading in and dismantling my old vehicle. Just give me a new one!!!!

Layoffs up in July and reverse previous months direction. Oooopss. I'm not fond of either party as mentioned before, and anyone can spend their way to prosperity, not everyone can pay for it (as we've seen with millions of Americans). GM should come out with some new names for vehicles like the Polar Bear or Artic Shelf. Now we're diggin' where there's taters!

Maybe I wasn't clear enough in the first post, the program is stupid and serves a certain class of consumer; it's not meant for the poor folk who won't qualify in the first place. This may be, should I dare say, a bit of classism. Those who can qualify and afford to buy a vehicle can take advantage of this program.

Maybe money should go to assisting the poor or kids without healthcare...just thinking out loud.

Posted by The Joker at August 5, 2009 3:13 PM

Politics and Healthcare are so intertwined, that
it is impossible to have an honest discussion about health care without pulling politics into it. Here is a snippet from the Bill Marr about the conservative group called 'The Family'. If you find youself in opposition to Obama's health care reforms, you need to take a look at this snippet to get an idea of some of the people who agree with you. To hype it in Tom Peters style,
If you value your country and its legacy, you must see this video.Period.
http://www.youtube.com/watch?v=zr69bhccD-Q

Posted by zorro at August 5, 2009 3:16 PM

Returning to the main topic: "Cross-functional communication is arguably enterprise issue #1; in healthcare it's about as bad as it gets"

I completely agree. Three years ago I had what was supposedly a fairly minor operation. For reasons unrelated to the quality of my health care, it turned into a 5-month saga involving multiple hospitalizations (including 2 trips in an ambulance) and 5 more surgeries.

But when I did have problems with the hospitals, it was all because of poor communication: e.g., I wasn't prepped because the nurse wasn't told to do it, so an operation had to be postponed for 24 hrs. As a result, my insurance had to pay for another day's stay in the hospital, adding a big chunk of unnecessary expenses to the bill. Multiply this by the number of communication failures that a large hospital has in the course of a day, and you've got enough money to buy health insurance for hundreds of uninsured children.

Posted by Paula at August 6, 2009 5:04 PM