“It’s a Slam Dunk”

Look, it is time to get serious.  Yes, America needs real health reform. And, no, ObamaCare ain’t it.

The “reform” law that was passed last year reforms nothing. It simply adds more bureaucracy, more regulation, more inconvenience, and more cost to a system that is already too bureaucratic, too regulated, too inconvenient, and waaaaaay too costly.

In every way that matters, ObamaCare makes a bad situation worse. We will get into the details of how it makes things worse as this blog rolls on, and we will offer suggestions on how to really reform health care.

But first let’s take a moment to consider why Congress enacted a law that was so misguided. You have followed the back-room shenanigans and deal making and outright corruption that secured the votes. But those were just the expediencies of the moment – the sausage making of Congress. It’s how Congress, indeed any political body, works. The Republicans do it, too. In fact, your state legislature, town council and school board all do it. They trade favors, make deals, hire friends and family members, form alliances of convenience. It is why we should minimize the influence of any and all political bodies.

What really caused this disaster is the intellectual bankruptcy and laziness of the “health policy community.”  These are the people who are supposed to be the experts. As corrupt and ignorant as Congress may be, it won’t sign-off on something unless it is endorsed by the people who are supposed to know what they are talking about. These include health economists and other academics, think tanks, journalists, and specialists working for trade associations of interested businesses.

The problem is that all these people know each other. They attend conferences together, go to parties together, talk to each other on blogs and list-serves, and sometimes even mate with one another. They become dear friends. And, like dear friends everywhere, they are reluctant to be critical of each other. They are subject to the worst kind of Group Think and begin to parrot the party line. People who disagree with the conventional thinking are soon labeled as being disagreeable and ostracized from the community, even mocked and ridiculed.

It isn’t only in health policy that this occurs. Any close-knit community will experience the same phenomenon. A recent deadly example was the “intelligence community” and its universal agreement that Saddam Hussein had weapons of mass destruction. Congress and the Bush Administration took their word for it – “It’s a slam dunk” said CIA Director George Tenet.  Who can argue with that?

Interestingly, business does not usually work this way. In business, the views of contrarians are welcomed. Investors have a lot of money at stake and they want to make sure that they are not missing some fatal flaw before they move ahead with a new product or marketing strategy.

Political decision makers, including whatever “policy community” is involved, do not share that concern. They don’t have anything personal at stake. Whatever happens, it is not their money on the line and very often they are not even subject to the same programs they are inflicting on the rest of us. Examples would include “urban renewal,” public housing, welfare, and now ObamaCare.

We will be exploring in some depth how this misguided conventional-wisdom and group-think has warped decision-making in health care. Stay tuned.


12 Responses

  1. Greg, what is sorely needed now is an analysis of each division of Obamacare and how much it will really cost and how destructive it will be to the doctor-patient relationship (my obsession) and hurt patients long term. Then, how easy will it be for congress to stop it. Regards, Andy Barada

  2. How right you are Greg, and thanks for not changing your directness. Many of these country club intellectuals are parrots because they don’t know the difference between a symptom, a problem, and the cause of a problem. Sure, there are some exceptions, but many of them could never make it in private enterprise.

  3. Did you see my proposal to replace the Medicaid system in NJ? It costs $9 billion/year out of a total $33 billion budget, doesn’t pay the physicians and allows people to go to the expensive ER whenever they have a sore throat.

    We have proposed having doctors volunteer in free clinics for 4 hours a week in exchange for the state covering their entire practice for medical malpractice.

    No claim forms, no payments to physicians, no unnecessary ER visits, no bureaucrats– just free care to the poor.

    No cost to the taxpayer unless there is a malpractice claim. And lawyers are much more hesitant to sue the state than docs with private med-mal insurance.

    This is true charity, not an entitlement.

  4. Great idea Greg! Real reform will happen outside of the political process by entrepreneurs and experts like you. What we need is solutions that free humans want, can understand, and manage with their own money. I say build a fence around DC and let them do their thing to each other. Just “Leave us Alone”!
    The command and controllers do not know that there is a communication revolution going on outside and that they will be passed by. Young people like their freedom to access information instantly and truth will win out. They will demand value and honesty. Thanks, Greg

  5. The one thing that no one seems to want to talk about is the simple fact that the price fixing by CMS in the 14,192 CPT codes is the heart of the issue. Doctors need to set their own prices, and patients need to decide where to get a wart removal, and where to get brain surgery. That’s the model we built at http://www.MediBid.com and now American doctors are competing with overseas docs, and they are actually competitive.

  6. The “policy community” has a lot of the same players as the Clinton Task Force on Healthcare Reform. There’s a combination of vested special interests (as in information technology venders and Big Phrma), ideologic zealotry (as in academics) and a combination as in the Robert Wood Johnson Foundation and other do-gooders. Docs in the trenches are not part of the picture.

    • It’s the group think that Greg was talking about. It’s easier to control the opinions of a few dozen people with name brand recognition than it is to try to justify a false assumption.

      I think there’s a name for that political model…

  7. The issue is a critical lack of critical thinking.
    Suggestions for dealing with the issue welcomed.

  8. Good idea Greg. I’ll be following your blog and throwing in a comment now and then. Keep up the good work!

    It has now become obvious to the majority of Americans that ObamaCare has got to go. Rasmussen just reported that the majority of Americans now believe the law will be repealed. Let’s not disappoint them!



    Thomas W. LaGrelius MD, FAAFP
    Diplomate of the American Board of Family Practice and Geriatric Medicine
    Skypark Preferred Family Care, a Concierge primary care medical practice established in 2005
    23451 Madison Street, Suite 140
    Torrance, CA 90505
    310-378-6208 http://www.skyparkpfc.com
    President, Los Angeles County Medical Association Southwest District
    Director, Los Angeles County Medical Association
    Chair Emeritus, Founder and VP, INDOC http://www.indoc.com 310-214-9921
    Board Chair and Immediate Past President, AAPP the national concierge doctors professional society
    http://www.aapp.org 877-746-7301
    Past President, Director and Secretary SBIP http://www.sbipmedicalgroup.com 310-534-8805

  9. Fine post, Greg. Love the new blog. Bob

  10. I was disappointed to hear you will discontinue the newsletter format in favor of the old blog format. The initial comments confirm that this will indeed be another old boy network made up mostly of doctors, and the primary purpose is self-stroking. Ironically, the first entry criticizes policy makers for being too much of a “close-knit” group — exactly what this new blog format represents. If there is ever any disagreement or contrarian viewpoint posted here I will be extremely rare.

  11. reetings. I follow your site to wish you continued success.

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