…………………..
……..
Progressives are Cinderella at the ball. It’s 11:45 and they’re still dancing. 
In just a quarter-hour, they’ve been told, they’ll turn into pumpkins, but they’re still dancing. The clock is visible and the ticking is audible. Fact is, we’re all Cinderellas dancing at the ball.
Scott Walker campaigned on stopping the music in Wisconsin and sending all of the dancers home. He foresaw the mass-smashing-pumpkins debacle. Some saw it with him and he was elected governor. Progressives in Wisconsin, however, are rioting to keep the music playing, and to stop his interrupting the dance.
……………………
This past week I had the good fortune to be a guest of an executive of Team Health — a firm providing hospitalists for physician management and staffing in emergency medicine, radiology, anesthesia, critical care and pediatrics — at a conference in Orlando, Florida provided by CVS Caremark.
A keynote speaker was Michael Leavitt, he an entrepreneur, a former three-term governor of Utah, 
EPA head under President George W. Bush, then his Secretary of Health & Human Services to implement Medicare Part D. Leavitt has also been an ambassador and negotiator around the globe. Incidentally, Leavitt said that the finance minister for the Peoples Republic of China did a Scott Walker on him all the way back in 1998 vis-a-vis U.S. Government deficit spending, and specifically healthcare entitlements . . . that before Medicare Part D. Leavitt also said that having a government bureaucracy like HHS try to manage the healthcare system, as in under Obamacare, is absurd.
Leavitt said that healthcare in America — and much of the rest of the world for that matter — has been in a “compassion mode” for many decades, but is now facing “global dispassion forces.” If I were to translate for those not afraid to step on a toe or two or ten, I’d translate to “progressive mode” and “economic and fiscal reality” respectively.
In trying to foresee to where “healthcare” in America will evolve, Leavitt noted a trend toward “connectedness”. Back in the day we discovered, for example, that PC-networks were better than mainframe computers. Airlines have moved toward global codesharing. Maybe even the likes of Facebook and Twitter are examples. Here again, though, I’d note that the airlines at the top of the heap in terms of customer-satisfaction rankings are not networked or codeshared. I’d postulate that this connectedness is a function of seeking a way to deal with government regulation and red-tape, not to better-compete in free markets.
So Mr. Leavitt wonders whether specialty clinics will connect with traditional insurers, whether hospital systems will connect with specialty clinics, whether independent service providers like primary physicians will connect with specialty clinics or hospital systems. How, he wonders, will the need for connectedness play out? What will the system look like? I note here that Leavitt asserted unequivocally that there will not be in America’s future a government-run healthcare system.
It's quarter-to-midnight, folks.
Even pre- Patient Protection and Affordable Care Act (H.R. 3590) the largest buyer (payer) of medical and pharmaceutical services in America was the United States Government. So we knew then and know even moreso now who the 800-pound gorilla in the room is. Why is CVS Caremark opening medical clinics within their retail pharmacies? Because there is a growing shortage of primary-care physicians. Why is there is a growing shortage of primary-care physicians? The United States Government limits what they may charge, based on formulae vis-a-vis Medicare payments. Given office-overhead costs of 65% of billings, becoming or remaining such a doctor has become markedly less-attractive and -feasible. Bottom line is that, though we don’t have healthcare socialism, we do have healthcare fascism . . . even pre-implementation of “Obamacare”.
More than fifty percent of the U.S. population suffers from chronic disease. Much of that results from lifestyle choices. We eat too much and exercise too little. We smoke and drink. We intake too much salt. We drive and ride rather than walk and climb. We consume too many oxidents and not enough antioxidents. Too much processed foods and not enough natural foods. Way too much sugar.
Then we obfuscate our issues by talking about “healthcare” rather than “medical care”. 
Fact is that only you can care for your health, that by making good decisions and avoiding bad ones. Medical and pharmaceutical care in large part is what you need after lots of bad choices and behaviors. A doctor cannot make you well, only unsick. Well is up to you, and you alone.
If, boys and girls, we still had 1950s medicine and pharma, we wouldn’t be having a bill called “affordable care”. One way Canada keeps medicine “affordable” is by having fewer MRI machines in the whole of its country than we have within the city limits of Philadelphia. And atop what we in America have circa 2012, just as brand-name drugs are overtaken by generics, we are just bringing aboard and online “specialty drugs” or biologics. These are injections or infusions specific to your DNA, your chronic diseases combinations, your allergies, and your lifestyle. Expensive? Big time. Affordable? Not if you take the bus. Not even if you hail a taxi. If you do limo and private jet? Yup.
So now we have the conflict again characterized by Leavitt as “compassion mode” versus “dispassion forces”, or what I called “progressivism” versus “economic and fiscal reality”. Since most cannot afford these “specialty drugs” and since governments are light years past being able to even pretend that they can provide them within their budgets and even credit lines, should those individuals who can personally afford them and who want them be disallowed from buying them, and pharmaceutical firms be disallowed from selling them? Said another way, in order to be “fair” should fascism incinerate any and all personal liberty, you know, that unalienable right thingy from the Creator?
It’s 11:58 p.m., two minutes to go, Cinderella. What should we do?
Well, $5.6 billion — 10% of Medicare Part D spending is going for these “specialty-tier” benefits, most to those who also receive federal subsidies to help with Medicare copays. The marketplace is upside-down with the economic and fiscal cliff at hand, and our quarterback at the White House is running the two-minute drill.
None of this, as I see it, can make a nanowit of sense unless and until anyone may offer any product or service they wish and at any price they wish, and anyone can buy any product or service offered that they both wish and for which they can pay. If I were a medical or pharma pro, I’d charge fee-for-service. If I were an insurer, I’d charge fee-for-risk. Please note that a pre-existing condition isn’t risk; it’s certainty.
If I were an insurance company and you called me to buy fire insurance on your already-aflame home, I’d sell it to you . . . for twice the appraised value of your home and contents. Similar for “health” insurance. And regardless of whether I were one of those or neither of those, I’d remain mindful that there’s no such thing as a free lunch or free health.
You may get, but that must be given. You must do in order to deserve. You must plant in order to reap. You must harvest in order to either eat or trade. You must do-for in order to get-from.
Obamacare is just an ends to a means…..
Hmmmmmmmmmmm. Awfully good point, FOH.
I think what I meant to say was, ‘a means to an end’…..is there such a thing as dyslexic Alzheimer’s?
I remember when my parents had medical insurance, we had an agent that came to our home and discussed coverages with my parents. I just knew him as “the insurance man is coming over tonight so behave”. Back then, insurance covered medically necessary hospitalization and surgical procedures as well as catastrophic events like cancer, heart attack — you know, all the statistically-usual near death type stuff; and, the insurance provider threw in annual check-ups to boot. There were no “group” health plans where doctors and clinics were tied to major health organizations and hospitals. For that small bit of assurance, my parents paid a couple hundred bucks or so a year for a family of 5 (that was back in the early sixties) It was not part of a benefit package from an employer.
All non-life-threatening viral or bacterial illnesses or injuries of the outpatient variety were strictly fee for service the payment for which didn’t threaten to bankrupt the family, though mom wasn’t particularly pleased with us when we needed a doctor visit due to contusions, lacerations and assorted deep wounds requiring the administration of antibiotics, stitches and/or tetanus shots.
Now a days, you owe most clinics a couple hundred bucks just for making an appointment and showing up — before any medical exam or procedure ever takes place. Why? The government got involved — to help.
I remember those days. We don’t have medical insurance so at least our local doctor cuts the cost per visit but it is still no bargain….
Well yeah, our docs know I’m paying outta pocket too, but it still costs because all our nearby clinics are partied to big systems. There aren’t any small one-doc operations here anymore (unless you’re looking for a veterinarian) they’ve all been driven out of the Biz.
BTW, very funny the dyslexia-Alzheimer’s syndrome. Now that’s the definition of bass-ackwards!
To my knowledge each and every state in the Union has plundered the unalienable right to liberty with its regulations and dictates to medical and pharmaceutical insurers. In addition, they have violated the 14th amendment as well.
Atop that the U.S. Government has plundered life, liberty, and property with Medicare, Medicaid, CHIP, and much more. The whole of it is the work of progressives to and for whom “liberty” is defined situationally and in the context of the “societal good”.
And we need to hold our individual States responsible.
We hold these Truths to be self-evident, that all Men are created equal,that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the Pursuit of Happiness.
-Thomas Jefferson (1776)
If you want to understand the real Declaration of Independence, do not repeat the preface.
-Woodrow Wilson (1911)
Now you understand.
-Remiehzla (2012)
I’ve read about both Jefferson and Wilson. Is Remiehzla some sorta imaginary friend or something?
DrPete I see the word AlkzheimeRemiehzla Cream of Wheat’s mirror image perhaps?
oooopps, my meaty beaty big and bouncy digits accidently pressed the l and k simultaneously causing a mis-spell of Alzheimer-RemiehzlA. Who the hell was Alzheimer anyhow? I forget. Or was that Remiehzla? I can never remember…
Well heck I’m really up a creek without a paddle. Can’t dance worth a darn.
Great read here, DrPete.
Even if true, Mrs. AL, — and I have my doubts — all here KNOW that you OWN the ball.
That is an interesting observation about connectedness. I had not thought about it before in terms of medical care. I learned something new.
Thanks, Pat. Join me in trying to make the last day that I learn also be the last day I live. Let’s emulate Mrs. AL.
Excellent presentation, DrP! I especially liked the use of metaphors.
In a lot of cases, they clearly illustrate the point at issue. And yours here is that socialism doesn’t work. It can’t. It denies the basic realities of human nature.
I’ve often used a joke to illustrate the same issue. Here it is. Lucky you!
A wealthy doctor, in his manse, is having a real problem with the hot water flow to his shower, so he calls in a plumber.
The plumber arrives. He hauls out his toolbox and gets to work. Ten minutes later, he walks up to the doctor and presnts him a bill for $300, explaining that the pilot light on his water heater had gone out and that he’d had to relight it.
The doctor goes ballistic: “THREE HUNDRED DOLLARS??? For TEN MINUTES of your time???? That’s freaking outrageous!!!!!”
“Why”, the doctor continues, “that works out to $1800 an HOUR! Hell’s bells… I’m a DOCTOR, and I don’t make that much!” he sputtered in complete outrage.
The plumber just stared at him, and replied, “When I was a doctor, I didn’t make that much, either.”
(rim-shot on the drums: pah-tah-PAK!)
Auto mechanic and a man in the dessert with a broken-down car. On request to fix the car, the mechanic raises the hood, reaches in, twists something, and tells man to start it up. Varooom.
Mechanic writes bill for $300. Man complains that it only took seconds to fix. Mechanic re-writes bill. Fix – $1. Knowing how – $299.
Thanks for the doc-plumber story, and the compliment on my metaphors.