Allow Me To Explain... Healthcare Reform in the US is Doomed

I had some people comment on my last rant about health care for all in this country. What most people DO NOT understand is that the current policy proposal is much like the system that Massachusetts has been running for years. And, contrary to the opinions from those who feel like giving free medicine to all, it is not working. And it is harming the welfare of doctors, specifically those in specialty fields. And it is creating worse health care.

Read this and then I'll happily debate with you over the current proposal. I'm all for healthcare reform. I really am. But I'm not for agreeing with, "oh yea, let's cover everyone with some extra taxes and cost cutting measures". Why don't we actually solve the problems that exist rather than throw an expensive band aid at it?.


From the ACC:

July 8, 2009

If you don't read another edition of this publication, read this one. Then read it again and get ready to join the ACC's fight for the viability of your practice! CMS late last week proposed mind-boggling cuts to cardiology that could be 30 percent or higher beginning in 2010. Taken together with the payment cuts cardiology already has experienced, this wrongheaded proposal represents a real threat to your practice and to the patients you serve.

Let's break down the horrible numbers. The proposed rule slashes Medicare payments by more than 11 percent for the average cardiology practice as a result of a badly managed practice expense survey. Out of thousands of cardiology practices solicited this survey is based on input from approximately 50. Somehow this small sample size showed that CV practices have experienced a 30 percent reduction in practice costs.

Does that match up to the numbers in your practice? Of course not. This survey has no credibility and CMS chose to disregard the standards it previously put in place to ensure the quality of practice expense data. We believe this is a significant departure from previous policy and may be a violation of the law. It is ironic that the agency that purports to support an evidence-based approach to medicine is making major decisions based on shoddy and incomplete data.

It gets worse! As if the 11 percent were not bad enough, most of the core cardiology services face cuts ranging from 20 to 40 percent. Add in the regularly scheduled SGR cuts of more than 20 percent and practices could see possible payment cuts ranging from 25 to almost 50 percent.

This is not what we meant by putting quality first. The timing couldn't be worse. Just as we're moving forward with real proposals for health care reform that would improve quality, reduce waste, slow spending and improve the viability of CV practices, along comes this CMS hatchet job. Arbitrary price controls do not equal reform and will only lead to greater disparities in health care.

That's the bad news. The good news is that this proposal is subject to revision. Your ACC is fighting this change at all levels through CMS, Congress and the Administration. ACC President Fred Bove, and your elected officers and Washington-based staff are all over this crisis on your behalf.

Working closely with our partner cardiovascular societies we are developing a detailed response to CMS and working the halls of Congress to bring political pressure to bear on the agency. We are reaching out beyond cardiology to engage other specialties like oncology that also face daunting cuts that will inevitably impact patient diagnosis and treatment. On the regulatory side, ACC staff is working closely with the Advocacy Steering Committee and the CV RUC to prepare a substantive analysis and response to this proposed rule. We anticipated this action from CMS and have identified technical expert consultants who can assist us with our analysis and help propose alternatives.

We have been rocked by this proposal and now it's time to roll! Here are four key ways you can get involved:

* The ACC has launched a grassroots campaign to get Congress involved. Go to www.acc.org/can and send a letter to your members of Congress explaining in detail how 20 to 40 percent cuts will impact your ability to practice medicine.
* Take part in a video campaign that can be shared with members of Congress, regulatory officials and the public. Upload a 30-40 second video about the impacts of large-scale cuts on your ability to provide patients with the right care at the right time. Email Molly Nichelson at mnichels@acc.org to have it posted for you on ACC Advocacy's YouTube" site. Don't own a video camera? Submit your story via the ACC's online forum, "The Lewin Report."
* Take part in the ACC's "Cut the Cuts Roadshow" and volunteer to give your own or facilitate an ACC-taped presentation on the implications of the cuts on cardiology to your hospital or practice group. Email qualityfirst@acc.org for more information
* Get involved with your local Chapter's efforts: this could include volunteering your practice to host a "Cardiologist for a Day" event, writing op-eds and more. Go to www.acc.org/chapters for contact information or email qualityfirst@acc.org.

Free Magazine Subscriptions - Forbes and BusinessWeek

 

Two of my favorite magazines. Well worth it. Free. If anyone reads magazines anymore. Actually, I like magazines because they're very portable and easy to read. Especially in the bathroom. Newspapers are too inconvenient. Thus the demise of newspapers.

Anyway, here are the links. They're free. No credit cards. Just answer a few questions and give 'em your address. I usually fill out a fake name. And use my spam email address so as not to be bombarded by spam. I recommend you do the same. You don't have a spam email address you say? Well time to create one. By the way, Forbes is an awesome magazine for those who haven't spent much time reading it.

Business Week (here)

Forbes (here)

Obama is Making Me a Republican! Americans Need To Take Responsibility!

I voted for him. Much to the dismay of my family. Not because they are war mongering Republicans, but because they are fiscally conservative and scared to death of a Democrat's "big government".

I shunned them. Praising Obama. Loving the thought of having a leader the world respected. Hopeful that we wouldn't be mired in war for the rest of my life. Scorning Bush at every chance and how he single-handedly ended the supremacy of the greatest nation the world had ever seen.

The first six months of Obama's presidency, I was elated. He was taking a different tone and stance on everything. I admired him and loved the direction America was going. Then slowly, cracks appeared in his armor. At once, a person I had thought was a moderate Democrat has become the most left winged socialist I could have imagined. I really hope this is just a figment of my imagination. And that I'm jumping the gun. But he's coming dreadfully close to mirroring some Chavezian policies.

I was raised in a family that rewarded hard work and dedication to school and life. It's part of what drove me to get my MBA and continue to push myself to achieve, even when others viewed my situation as ideal. I've learned not to take things for granted: life, friends, family, finances, and happiness.

I've watched as my parents worked tirelessly to provide for my brother and me. To give us things they never had so that we could live a life they had only dreamed of. And they succeeded.

But change is upon us if Obama has his way. See, we're not being rewarded for hard work and dedication anymore. And we're not at fault for mistakes we make. It's called responsibility. And there doesn't seem to be any culpability anymore. It's disgusting me! My dad is making less money than ever, as a physician. 30 some years of service. And he earns less than he ever did. What other field pays you less the longer you work? Name one. Sure, some of you will scoff... "he's a doctor, he earns plenty". Yea, he spent 10+ years after college in training (that's ten less earning years). He saves people's lives. He's on call. He spends the worst 30 seconds of people's lives with them - having to tell people they are dying. Or telling family members their loved ones have died. If you're complaining about prices. Take it up with your insurance provider. They're making plenty. But enough about that.

America used to be the Land of Opportunity - where your dreams came true if you worked hard. People aren't working hard anymore. They're sitting around and waiting for handouts. This sounds sustainable. Maybe a little adversity would actually make us stronger.

Just my 2 cents.

What's on Tap for Vyoo?

This Saturday is our impending wide beta launch. While I'm excited about actually getting things opened up a bit more, I'm also tempered. We're working on hiring a new UI designer who I've spent quite a bit of time with trying to create a good design. She's made some tremendous recommendations and put us on track to have a great UI. Unfortunately it won't be close to ready for the launch. At the point where the UI is good, I'll feel a lot better about everything. The UI right now is a bit messy. But that's what you get when you have developers try to make UI revisions.

Looking for mentors:
I've started to more aggressively look for a mentor. Someone who can help define a strategy in order to approach investors, partners, and others we'll need help from. I've looked for one in the past, but I was apparently not ready for it. I guess the only advice I can give is that you'll know when you're ready for one.

Looking for investors:
After Saturday, we'll start to aggressively pursue the financing track, determining who and what we'll be looking for. This is where I'm assuming our b school background will really pay off.

Student Loan Bailout. Sort of.

There's a new federal load program for people with Stafford and Grad PLUS loans. It's taking the place of the current system. Most b school classmates of mine used Stafford loans. These new rules will reduce your payments and also make you eligible for loan forgiveness after 10 or 25 years. The former if you work in the public/government sector. It will also generally reduce your monthly payments and prevent compounding of interest accrual if you're on deferral.

The payments are based on your earnings and how they related to the poverty level. Even people with six figure salaries could qualify, so it makes sense to check it out.

You should contact your lender to see if you qualify. You can read more details here.

Revenue Models for Startups, Facebook, and Twitter

I've been thinking a lot about revenue models for these Web 2.0 companies that nobody can seem to monetize. While we have a monetization strategy for Vyoo, others do not and will not anytime soon. One possible solution is completely changing the model.

Problems: the traditional advertising model does not exist on Facebook or Twitter. And it won't. I reason this because people don't go to Facebook to make purchases and Twitter is quick, continuous consumption of streamed data. Sure you could throw in ads here and there but it would ruin how Twitter works.

So what about public funding? I'm saying this as an absolute opponent of more government. I hate the healthcare plan. I hate taking over the automobile industries. I hate bailing out Wall Street. Mainly because these industries made mistakes. They should be able to survive and thrive if they were run properly and had smart strategies. But there's some rationality to public funding for certain things that cannot operate without it. Like the funding of some baseball parks for example. Because ultimately they provide a value for the community as a whole which wouldn't be entirely possible without the funding. So how about public funding for sites that provide real value to our people and the government. Twitter has been instrumental in getting the word out in Iran. It's been so important the the State Department asked Twitter not to go down for its scheduled maintenance during the crisis.

Yankee Stadium cost the tax payers of New York nearly $2 billion (here). And having taxpayer money go to Twitter or Facebook doesn't hurt anyone - like some of these bailouts do.

What Happened to the American Dream? No To Socialization! Of Medicine or Anything Else!

I voted for Obama. I'll be the first to admit it. And while he's doing a great job in some respects, he's doing a downright terrible job in others. What I'm most concerned about are his socializing tendencies. You've already heard me bitch about saving the automobile industry. I think it's an utter joke.

Let me sum it up for you in a few sentences. All of the jobs that proponents of saving the auto industry claim would be lost if GM/Chrysler, etc. were shut down could easily be replaced if we spent that money building new supply chains for electric or hybrid cars. Give Tesla Motors 50 billion and they'll be hiring tens of thousands of workers to keep up with the demand for their products. It's a joke. And anyone notice how GM is "all of the sudden" coming out with socially responsible and environmentally friendly cars when they claimed that they didn't have the technology just a few years ago. What a bunch of BS. I'm getting pissed writing this.

But it's not only autos that really kills me. It's health care and every other industry he's trying to socialize. The US has the most advanced medicine and health care system in the world. Hands down. Yes it's expensive. Because these people train for years to provide American's with the quality of care they deserve. And. They save LIVES! Put a price on that while your auto industry gets government handouts. So instead of really revamping the system to make it more affordable, while keeping the quality of health care high, we're ruining the system. There are lots of examples of ruined systems already, even though Michael Moore would like you to think otherwise. Take a look at Massachusetts for example. Here are some problems:

1) Long lines
2) Decreased overall quality of care
3) Lack of interest in medicine
4) Increase in taxes

"No sir, we can't look at you now. I know you have heart problems, but see, we have a line. Take a number". Want that to happen to you?

Healthcare in the United States is 15% of GDP. The highest in the developed world. And that's where the problem lies.

To cut costs, the government continues to cut reimbursements to doctors. Yes, they are reimbursing the care givers less. Not figuring out a way to make healthcare more affordable. So they expect doctors to treat you the same way, but now we're going to pay them less. A lot less. Yea, no worries. Those 4 years in med school, 4 years of internships, years of residency, and your fellowship? That several hundred thousand in debt from school? Don't worry about that. You're 38...you have time to make that back. And while you're at it, we have new regulations that require you to update your office technology, sell your lab equipment back to the hospital so you can't make a profit, accept uninsured which we won't reimburse you for, and you have to work more hours just to make what you used to earn. What other profession pays you less the longer you work? There are no promotions or stock options in medicine.

So here's what needs to be done. Screw the insurance companies. Let's do something about that. Make them compete. Right now they get to cherry pick who they accept. Make them accept everyone. Provide tax relief for those buying their own health care or paying for their health care out of pocket in some way. And how about the pharmaceutical companies. They're printing money. Figure out a way to get prescriptions for less. I mean, shit, we can get them less in Canada, and they're made in the US. Socializing medicine WILL NOT WORK! It's not working in Massacusetts. Or Canada (long lines). Or Sweden (outragoues taxes). Or anywhere else. Not in its current incarnation.

Another reason it won't work is because nobody will want to go into medicine anymore. What was once a prestigious field where the brightest and best students flocked will now be an assembly line job. Please don't ruin our health care system.

And while I have many ideas, here's a proposed solution that highlights most of them. And it's from a Senator, so maybe we'll see it (here).