Sunday, November 10, 2013


From Consumerism to Outcome-ism and beyond where the sun is not allowed to shine.

The world is about to be turned upside down, or it might already have. So let us look at the word consumerism. I surmise the dictionary does not lie;

con·sum·er·ism n “the protection of the rights and interests of consumers, especially with regard to price, quality, and safety.”

Now what in those words is derogatory against the consumer…? “Nothing,” I presume you would say. But as the high and mighty would suggest, it is bad. Medicine intended for consumers in the form of consumerism is bad, very bad. So they in their infinite wisdom or lack thereof have suggested and now promulgated, that we go to “outcome-ism.”

Oh that is just terrific. Remember the debacle in the making with the “Pay for Performance,” or P4P as those google-eyed with the idea seem to want. Ah yes that is exactly what this Outcome-ism is.

Now if only we were just viewers then P4P would work wonders

out`come`ism n “the exploitation of the physicians and their patients for monetary restraints.”

“So what?” You might say. Well, my dear Watson, did you ever hear of the fact that there might be some smart doctors on the other side who can win this fiscal battle easily. For instance, stop seeing patients with co-morbidities, reduce exposure to patients in the Intensive Care Units, crop and prop the healthy and make them your followers and leave the ones that need the most help out to the secondary and tertiary care centers so as to reduce the shrill of this tenor of outcome-ism from closing the doors to their practice of medicine. And if not that, then just leave medicine to others! Oh yes did I forget to mention that doctor practices are ever-increasingly shuttering the doors, as are the hospitals in the name of what some Kool-Aid drinkers would say, “quality.” A little disclaimer must follow: The share of the economy devoted to health care increased from 7.2 percent in 1970 to 17.9 percent in 2009 and 2010. In 2010, the U.S. spent $2.6 trillion on health care, an average of $8,402 per person. 

At 17.9% of GDP the healthcare costs should be reduced. Yes indeed! But the mechanism is not to add more layers of middle-management bureaucracy that have nothing more to do with medicine but to extract that all mighty dollar for their own needs. Oh yes, if do not know this little fact, then here is the enlightenment for you: The administrative costs in medicine (read CEOs, CFOs, CTOs, CMOs, COOs, CIOs) have increased by 3000% -yes you read that correctly, while the physician income since 1975 has increased below COLI. But that trifle fact is a mere irritant to be massaged out of the equation. Just for the "ding"of it all from NEJM old article: In 1999, health administration costs totaled at least $294.3 billion in the United States,or $1,059 per capita, as compared with $307 per capita in Canada (If comparisons with Canada are not found to be odious). And should you get testy on this subject here is another Revenue and Cost of Goods associated Profit Margin for the Hospital and the Doctor: Medicare pays on average$18,000 for a total hip replacement – $16,336 to the hospital and $1,446 to the surgeon. Why if you must understand the strings a bit further, here is a quote from Forbes: $360 billion spent annually for administrative costs as estimated by the Centers for Medicare & Medicaid Services (CMS), and the fact that 85 percent of excess administrative overhead can be attributed to the insurance system. Administrative costs for physicians are in the range of 25-30 percent of practice revenues and insurance-related costs are 15 percent of revenues, according to a National Academy of Social Insurance report for The Robert Wood Johnson Foundation. 
And the spending outlays from the U.S. Government will increase: Federal health spending is projected to grow from 5.6% of Gross Domestic Product (GDP) in 2011 to about 9.4% of GDP by 2035.

The Reason Health Care Is So Expensive: Insurance Companies

So what should we do about it. The most simple of all equations is to, putting it in simplistic terms, "let all parties have a skin in the game!" You know the old thing called "Self-Responsibility," that thing. Oh I know the worthy wordy wild crowd will say, "heartless thug"to that and what about the poor people who have no coverage and pretty soon they will write a heart wrenching article about a homeless person who died because he could not have access and then pull in some arbitrary facts from the "Big Data Corporation" (BDC) and create a compelling article that will stamp itself on all those "feeling hearts." But slow down there a moment cowboy, think critically for a moment. If those that can pay and get reimbursed from their insurance companies as in the old days continue to do so and those that cannot can be subsidized by the government and private concerns this in itself will really cut the price of care down by at least 50% if not more. And lets not forget the Tort Reform (the one that keeps the lawyers restless and paying more than $2000 to the Congressional Trial Lawyers lobby per lawyer annually) that will reduce the unnecessary diagnostics by a simple measure of 30-50% of all (CYA) diagnostic costs. The doctor will have to prove his worth in caring for the patient and not the reimbursement schemes while tied to the flicker of a glowing screen, the patient will have to think twice before running to the doctor for simple ailments of colds and sniffles that cure themselves and in the end the 17.9% of GDP will shrink significantly to reduce the Federal Debt, the $1 Trillion annual interest payment on that $17 Trillion debt and the dollar will strengthen, the future inflationary pressures will decrease and the FED will be forced to stop printing money even for the Dollar as a global currency reserve (FED balance sheet running around $3.7 Trillion. (I might be off by a few billions). Ah yes a win-win for all!

The overarching meaning in the Central Planning Committees subtlety is “we the government want not to pay the doctors for your needs and we will decide if your needs are truly needs! We were once, “of the people, for the people and by the people,” but lately we grown smarter and better and “you the people (know nothing), we the government (Know everything and are INefficient-but you don't know what that means)!”

So who loses in the end? All.

“All are pun-ish-ed!”

“What me Worry?”

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