tag:blogger.com,1999:blog-56432232012-02-03T11:37:45.593-05:00Health Care AnewExploring the health care system of tomorrow. Richard Wittrup, Blogger. Comments are encouraged and appreciated. Just click on the word COMMENTS at the end of each posting.Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.comBlogger5081100tag:blogger.com,1999:blog-5643223.post-19527947064013077172012-02-03T11:37:00.001-05:002012-02-03T11:37:45.603-05:00Don’t Depend Totally on Government
The temptation of politicians to appeal to the disaffected
is an important limitation on their ability to implement reform.
Massachusetts
is currently providing a vivid example.
Some time ago, in the name of health care cost reduction, a law was
enacted requiring health insurance companies to offer so-called “tiered”
policies that, in return for lower Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-32163961770778299302012-01-30T16:10:00.000-05:002012-01-30T16:10:21.380-05:00
Getting Health Care Providers to Reduce Cost
During a recent conversation about the health care
situation, a physician friend said that he could not remember ever ordering a
test or making any other medical decision for the purpose of increasing his
income. Knowing him to be an honorable,
conscientious person, I said that I believed him but then went on to ask
whether he could remember Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-83942273166022500042012-01-14T15:59:00.001-05:002012-01-14T15:59:22.796-05:00
Get Over It!!
There is a cartoon called Non Sequitur that appears regularly
on newspaper comic pages.
The one I saw in the January 9 edition of the Omaha World
Herald showed six grim reapers, complete with scythes, sitting around a table
with stacks of paper in front of them.
The cartoon was labeled “The HMO Review Board” and there was a bulletin
board on the wall with the words “Days Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-6381920199124062442012-01-04T20:05:00.000-05:002012-01-04T20:05:46.464-05:00
Who are the Hospital’s Customers?
Savvy hospital administrators have regularly maintained the
public position that the institutions they managed were devoted to serving the
needs of their patients.
But the successful ones knew that their real customers were
the doctors who brought the patients.
That situation arose from the phenomenon and role of private
medical practice. Hospitals asRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-35192562855861417012011-12-27T10:08:00.000-05:002011-12-27T10:08:11.498-05:00
Moving Responsibility from Individuals to Institutions
Listening to the radio while driving home from a shopping
trip yesterday afternoon, I was much taken by a story about how hospitals in Massachusetts are
refusing to allow elective inductions of obstetrical labor or caesarean
sections before the 39th week of pregnancy.
It seems that with the great improvements in neonatal care, mothers
Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-64101806652889223352011-12-08T18:35:00.001-05:002011-12-08T18:36:56.087-05:00Effective Competition
I have long believed that the best way, perhaps the only
way, to get health care providers to become serious about cost control was to
create competition that caused them to fear losing patients unless they did so.
I have also believed that because the economics of health
care are unique, the forms taken by the competition would also have to be
unique.
Well, we now Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-18322769379791405402011-11-30T15:21:00.001-05:002011-11-30T15:24:38.565-05:00
At Last!!!
Early in my career, I observed that if any other form of
organization had a service as popular as the hospital emergency room, it would
be promoting it vigorously instead of fighting it, as hospitals were doing then
and continued to do for years thereafter.
Now I note that the Boston Globe Magazine of Sunday,
November 27 carries an ad by suburban Newton-Wellesley Hospital
headed Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-81363011400944446532011-11-28T19:33:00.001-05:002011-11-28T19:34:24.308-05:00
Part D as a Model?
Wife Marilyn and I have received word that the monthly
premium for our Medicare Part D Prescription Drug policies will be reduced next
year from the present $45.80 to $38.90.
One drug that Marilyn has been taking will no longer be covered, but a
generic substitute is being offered. She
has yet to decide about that.
Adoption of the Part D program during the Bush II
Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-47979576254150943052011-10-29T15:35:00.000-05:002011-10-29T15:35:58.959-05:00
A Place
for the For-Profits?
I have long been skeptical about for-profit, investor-owned
hospitals, suspecting that they would be more diligent in serving the interests
of their owners than those of their patients.
I have tended to the opinion that such hospitals might perform
acceptably as long as their patients were being cared for by private practice
physicians who see themselves as more Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-91068852330568929272011-10-26T14:00:00.001-05:002011-10-26T14:00:10.252-05:00
Still No Interest in Prevention
Most doctors in America will be sued at some point
during their career.
That is the lead-in phrase of a front page story in the
August 18 issue of The Boston Globe reporting the findings of a Harvard study
that appeared in the New England Journal of Medicine. Study of claims data for 41,000 physicians for
the period 1991-2005 showed that 7.5 per cent of Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-72559747649464110122011-09-18T17:00:00.000-05:002011-09-18T17:02:14.366-05:00Fourth in the SeriesThe following is the fourth suggestion on health care reform included in the Commonwealth Fund report to the National Governors Association, as reported by former Vermont governor James Douglas in the May 23 issue of Modern Healthcare:“Payment systems reforms: We need to pay for health care based on quality, not quantity. Most payment structures compensate providers for eachRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-47945786952691687802011-09-09T08:48:00.001-05:002011-09-09T08:50:09.857-05:00Market Competition in Health CareAs a means of getting cost under control, market competition in health care is an idea that sounds good but the prospect of implementing it makes us nervous. When we are sick or injured, we want to think we are getting the best care available without regard to economic considerations.But the idea persists and Blue Cross Blue Shield of Massachusetts has taken a Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-33977503987936195792011-09-03T10:24:00.000-05:002011-09-03T10:25:44.439-05:00Why Universal Coverage is so Hard
On the face of it, the idea that everyone ought to have health insurance seems to be such a good one that it makes one wonder why getting it accepted is so hard.
A clue is provided by an obscure story that appears on page 12 of the September 2 issue of the New York Times.
It seems that for some time now, Grady Memorial, Atlanta’s safety-net hospital, has been Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-23324179028173406862011-08-17T14:15:00.000-05:002011-08-17T14:16:11.606-05:00Third in the Series
The following is the third suggestion on health care reform included in the Commonwealth Fund report to the National Governors Association, as reported by former Vermont governor James Douglas in the May 23 issue of Modern Healthcare:
“Primary care and prevention. We need to encourage everyone to have a medical home with a team of caring professionals to coordinate care. Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-13074797984905115812011-07-30T10:07:00.000-05:002011-07-30T10:08:51.734-05:00Second in the SeriesThe second suggestion on health care reform included in the Commonwealth Fund report to the National Governors Association, as reported by former Vermont governor James Douglas in the May 23 issue of Modern Healthcare, was as follows:“Care coordination and disease management. Chronic illnesses account for the overwhelming majority of health care costs. Those with a chronic Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-86478885694459826692011-07-29T08:04:00.001-05:002011-07-29T08:07:57.245-05:00Health Expenditures and LongevitySteve Wenner sent me a graph he had come across showing for a number of Western countries and Japan life expectancy on one axis and per capita health expenditures on the other. The results for each year from 1970 to 2008 were plotted on a line along the graph.The US line was well below that of all the other countries. Wenner’s conclusion was that “we are paying Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-13108427712515032902011-07-15T18:25:00.000-05:002011-07-15T18:26:59.414-05:00A Series of ObservationsIn the process of catching up on my reading, I came across an article by James Douglas, a former governor or Vermont (Modern Healthcare, May 23 2011). Douglas was chairman of the National Governor’s Association in 2009. He opens the article by relating his decision to focus during his chairmanship on “Improving our system of delivering healthcare to the American people.”Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-84120251903271877752011-06-24T18:01:00.001-05:002011-06-24T18:04:03.372-05:00Ambivalence about CompetitionOur attitude towards competition in health care is one of deep ambivalence.We generally approve the principle of competition, believing that it leads to improved performance, innovation, and efficiency - results that are greatly needed in modern health care. But when it comes to our personal situations, we want to believe that our health care providers are focused Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-63617534468848465282011-05-04T15:33:00.001-05:002011-05-04T15:36:42.528-05:00The Age of the Female CEO?The April 18, 2011 issue of Modern Healthcare featured “The Top 25 Women in Healthcare for 2011.” 44% of them were executives in hospitals and health care systems – reportedly a significant increase compared with a similar list published two years ago.The article called to my mind that two institutions with which I am familiar are now headed by women. Nancy SchlichtingRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-28345127590914591592011-04-30T16:53:00.000-05:002011-04-30T16:54:48.542-05:00The Difficult Politics of Health Care ReformEarlier this week, wife Marilyn and I between us had three physician appointments on the same day. Both of us had lab work and I had a hormone injection.In every case the services were provided in attractive, modern, well-equipped facilities. Personnel were professionally competent (so far as we could tell), courteous, and attentive. Each appointmentRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-41149025330309102422011-04-03T09:57:00.001-05:002011-04-03T09:59:06.872-05:00The Amazing Tolerance for Non-Management in Health CareHere we are, more than a decade into the twenty-first century and much farther than that into the information age and our system of delivering health care still can’t keep reliable track of what medications a patient is taking. According to an article that appeared in the March 11, 2011 issue of H&HN, the journal of the American Hospital Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-28869656723187632011-03-17T17:47:00.001-05:002011-03-17T17:49:44.188-05:00Finally!!!It is always gratifying to see opinions in public print that agree with one’s own.Last Sunday’s New York Times gave me that pleasure in an editorial commenting on an agreement that had been reached between the administration of recently elected Governor Cuomo on the one hand and, on the other, the state’s hospitals and the union that represents many of the hospitals’ workers. The Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-91530859173087599502011-03-11T19:09:00.000-05:002011-03-11T19:13:09.923-05:00The Real Nature of Non-ProfitBlue Cross Blue Shield of Massachusetts, a non-profit organization, it taking some public flak over the eight-figure golden parachute it recently awarded to departing CEO Cleve Killingsworth and also over the five figure stipends it has been paying to members of its Board of Directors.One of the Board’s responses has been to suspend its stipends for the rest of the Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-25391681346367882352011-03-04T12:26:00.001-05:002011-03-04T12:28:38.006-05:00The High Cost of IgnoranceWhile we live in a time of great erudition with space travel, miracle drugs, artificial intelligence and all the rest, great gaps of ignorance remain.The February 28, 2011 issue of The Boston Globe included an editorial decrying the “inoperability” among electronic medical records created at different locations and with different software. This results in different Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-55489390249881705262011-03-01T17:05:00.001-05:002011-03-01T17:08:28.690-05:00Getting Over ItThe left-leaning, policy guru elite of health care have never been very fond of hospitals, which are seen as a bureaucratic, financially-oriented part of the corporate world. Under the control of the bankers, lawyers and industrialists who populate their governing boards, they have the image of catering more to wealthy donors and affluent doctors than to the common and needy Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-40320318361711945002011-02-22T18:11:00.001-05:002011-02-22T18:14:54.876-05:00More on Economy of ScaleBlog reader and fellow parishioner Steve Wenner asks if I could provide some insight why large hospitals fail to realize economies of scale.The short and truthful answer is that I can’t say that I know the reason and, apparently, neither can anyone else.But I can speculate.A number of years ago my interest was piqued and I went to the Business School library of the Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-69347694549411729782011-02-12T15:57:00.001-05:002011-02-12T16:00:25.745-05:00A Threat to Big HospitalsOne of the most enduring myths in health care is the belief that hospitals get more efficient as they grow. The belief is based on the economic doctrine of economy of scale, which holds that unit costs go down as volume rises. It happens not to apply in hospitals – at least in hospitals of common size – but the myth has persistently survived the common knowledge that Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-17462350521583255402011-02-07T18:31:00.001-05:002011-02-07T18:34:11.756-05:00Management of CareAs I have no doubt mentioned before, it is our general belief as a society that human activity is more efficient and productive if it is managed.We apply that belief to almost every activity in which we are involved, with the notable exception of health care. In health care, we manage hospitals, we manage clinics, we manage laboratories and insurance companies, but as a generalRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-5252438456801107222011-02-03T18:34:00.001-05:002011-02-03T18:35:50.874-05:00Legal Complications of Healthcare ReformIt seems that the issue of the legality of the mandatory coverage provisions of the Patient Protection and Affordable Care Act, aka health care reform, is not as simple as I thought. Responding to my posting of January 25 on the subject, Jim Walworth points out a number of complications.For one, the constitutional grant of authority to the federal Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-9744485005850736922011-01-26T16:19:00.000-05:002011-01-26T16:20:36.221-05:00Healthcare as an Economic Plus? If our food is to be produced by migrant workers and huge farming machines, if most manufacturing is to be done in China and third world countries, and if information processing is to be done by Indian clerks and computers, what work will be available to ordinary Americans? Maybe providing health care is one of the answers. There have been a number of reports in Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-13948548956802263642011-01-25T18:31:00.000-05:002011-01-25T18:32:54.176-05:00A Moot QuestionOpponents of the recently enacted health care reform legislation are arguing that it is unconstitutional – that while federal government is authorized by the constitution to regulate commerce, it is not authorized to require individuals to engage in commerce by making it mandatory for them to purchase health insurance.I’ve listened to people arguing both sides of that issue and Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-24547091769688554122010-12-01T09:39:00.000-05:002010-12-01T09:41:04.273-05:00The Unspeakable Demise of Private PracticeIndependent private medical practice is going the way of the family farm. The strength of the emotional attachment to it makes it politically hazardous to talk about it and scandalous to come out in favor of it, but changes in technology and the economy are making it unsustainable and obsolete and it is only a matter of time until it disappears Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-34607900710069885042010-11-26T18:23:00.000-05:002010-11-26T18:24:59.422-05:00Not Yet Ready for Accountability in Health CareThere seems to be a growing interest in the idea of accountability in health care, but not in the prospect of actually implementing it.Evidence of the interest is found in the recently enacted Patient Safety and Affordable Care Act (aka health care reform) which makes provision for something called Accountable Care Organizations – entities that Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-88187204911014213932010-11-13T18:35:00.001-05:002010-11-13T18:37:21.140-05:00The Rationale for Mandatory Health InsuranceA cardinal feature of the recently enacted Patient Protection and Affordable Care Act, aka health care reform, is the mandatory health insurance provision, which requires everybody (with defined exceptions) to have health insurance or pay a penalty. During the legislative debate, it was repeatedly pointed out that some people have not been able to Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-362267453505410982010-11-12T09:48:00.000-05:002010-11-12T09:49:33.292-05:00Doing It AgainIt looks as though we are about to do it again.High and rising cost is a major issue in health care and there is great interest in doing something about it. But rather than holding doctors, hospitals and other providers responsible for getting their costs under control, with due rewards for those who succeed and penalties for those who don’t, we try to tell them how to do it. The Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-45918122988103492972010-10-29T17:45:00.001-05:002010-10-29T17:47:12.479-05:00Doctor NurseIt occurred to me many years ago that to the extent medicine is a science, we don’t need doctors.Science is the means by which we identify what we are willing to accept as facts. Lab results are one example. When the lab reports that my fasting blood sugar is 200 mg/dL, we don’t need a doctor to decide that it is higher than normal. Neither, in a smaller but still large number of Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-66654743941143858742010-10-22T08:00:00.001-05:002010-10-22T08:03:00.263-05:00An Issue That Won’t Go AwayAt the beginning of my hospital administration career some fifty-odd years ago, a cardinal principle of health care was that life was to be extended at all cost. If there were “hopeless cases” in which doctors did somewhat less than they might have (which there no doubt were), nobody talked about it.Things are no longer that simple. I am reminded by an article Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-69813136950619168112010-10-09T14:25:00.001-05:002010-10-09T14:27:52.801-05:00Not-for-Profit vs. Commercial HospitalsThe long-running debate over whether hospitals should be operated as not-for-profit or as commercial organizations is brought to mind by the desire of the Boston Archdiocese of the Catholic Church to sell its hospitals – years ago consolidated into a not-for-profitn organization named Caritas - to a commercial company. Hospitals were created initially to Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-24386147335955578512010-10-06T18:46:00.000-05:002010-10-06T18:47:13.489-05:00Like to Malpractice Prevention articleMy most recent posting regarding malpractice prevention referred to an Entry Point piece in the September issue of Health Affairs.For those interested in following up further, the piece can be seen athttp://content.healthaffairs.org/cgi/content/abstract/29/9/1565Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-52595289550611389792010-10-05T08:03:00.000-05:002010-10-05T08:04:19.277-05:00An Ounce of PreventionI have long said that the problem with malpractice is that there is too much of it. Measures to limit the size of settlements and to simplify the process of litigation may or may not be good ideas, but surely the best solution would be for the malpractice not to happen in the first place.Apparently, others are beginning to share that view. A lead-in article in the Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-71767006751180882892010-09-30T07:46:00.000-05:002010-09-30T07:47:42.929-05:00Big ChangesChapter 2 of health care reform in Massachusetts deals with efforts to control cost. The main result so far has been a recommendation from a study commission to scrap the traditional fee-for-service method of paying doctors, hospitals, and other providers of health services. Fee-for-service is seen as giving providers an incentive to increase their income by providing services that Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-8022719565755385262010-09-23T07:25:00.002-05:002010-09-23T07:30:19.781-05:00Thinking and Acting AnewI long ago observed that the United States was the first country in the history of the world to overspend for health care. One might fault the distribution of those expenditures, but it is generally accepted that the total amount being spent is excessive. That has never happened anywhere before.From that, I concluded that none of the traditional remedies associated with Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-21239795755558059252010-09-20T18:31:00.000-05:002010-09-20T18:33:04.706-05:00More on Accountable Care OrganizationsThe field of health care has always been vulnerable to fads and buzz words and the latest one is Accountable Care Organizations, with the inevitable acronym ACO. In brief, an ACO is an organization that can be held accountable for the total health care of an individual or a group. It responds to the lack of overall responsibility and accountability that Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-52391347442277595672010-08-30T18:28:00.001-05:002010-08-30T18:30:21.696-05:00The Central Role of Hospitals in Health CareHospitals are taking on the central role in the provision of health services. It is not something they have sought and is something that we as a society have yet to acknowledge, but it is happening, and at a fairly rapid pace.This was brought to my attention by the August 9 issue of Modern Healthcare, which listed the top 100 hospitals as determined byRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-89337796511091501482010-08-23T14:39:00.002-05:002010-08-23T14:44:28.480-05:00Bring on those Germs!!!My grandmother immigrated to America by boat as an infant. She told me that she was sick the whole way and that her mother expected to find her dead every morning of the trip.She then lived a healthy life. In the days of quarantine for things like scarlet fever, she was the one to deliver food and supplies to the isolated household because it was generally known that she Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-48876021377243916212010-08-22T18:45:00.000-05:002010-08-22T18:47:46.731-05:00A DisagreementMichael Dukakis thinks that the Massachusetts Certificate of Need (CON) law ought to be more vigorously enforced. I think it should be abolished. Dukakis has twice been governor of the state and in 1988 was the Democratic candidate for U.S. PresidentCON laws require providers of health services to get government approval for major capital expenditures or the initiation of new Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-18162610691348350292010-08-19T13:18:00.001-05:002010-08-19T13:21:10.732-05:00Test for Alzheimer’s?An e-mail from Health Care Anew follower Ed Ablard calls attention to the emergence of diagnostic methods (spinal tap and PET scans) that are highly accurate in diagnosing Alzheimers, but less so in predicting dementia.It raises issues of who should have these tests and what should be done for those who come up with positive results.In present circumstances it seems likely Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-48518339608007854642010-08-17T10:44:00.001-05:002010-08-17T10:47:01.326-05:00Medical HomesThere has been quite a bit of talk lately in health care circles about something called Medical Homes. The American College of Physicians expands the term somewhat and defines it as follows:“A Patient-Centered Medical Home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomesRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-10086799379605869972010-08-13T15:02:00.001-05:002010-08-13T15:05:36.573-05:00What not HowThe hospital journals are full of talk about computerizing medical records, reflecting the scramble for the incentive money included in the recently enacted health care reform legislation.It reminds me of a lesson I learned early in my administrative career. My boss thought that the daily close-out procedure being used by the cafeteria cashiers was too cumbersome and asked me to Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-17765338045125437532010-08-07T08:13:00.000-05:002010-08-07T08:14:49.145-05:00Is Boston Getting Serious about Healthcare Reform?Some time during the early 1970’s I was in a meeting with the clinical chiefs of what is now Brigham and Women’s Hospital in Boston. Mention was made of a particular surgical procedure. Dr. Frances Moore, Chairman of Surgery at the Peter Bent Brigham Hospital, labeled it as experimental. Someone protested, saying that it had been done Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-67162875338329657722010-08-04T18:43:00.000-05:002010-08-04T18:45:02.046-05:00Signs of Progress The other night I happened upon a PBS television program about the historical development of surgery. One thing that struck me was the difficulty the profession has had in adapting to advances in practice. Hand washing before delivering babies and controls on the use of chloroform as anesthesia were offered as examples, both failing to be widely adopted for decades despite Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-34105680056496541192010-07-08T15:32:00.000-05:002010-07-08T16:00:31.586-05:00Change Comes HardA part of health care reform in Massachusetts was the creation of a special commission to deal with the cost issue.Some months ago, that commission declared that the first step would be to reform the payment system by doing away with fee-for-service. Under fee-for-service, providers get paid separately for each item of service. As a result, they get paid more if they do more. Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-7932563836882310182010-06-21T08:38:00.000-05:002010-06-21T08:39:31.443-05:00Bad News on the Cost FrontWhenever we get serious about the cost of health care, it is inevitable that some of the measures taken will be unpopular.Whether unpopular measures will be tolerated by the public depends on the level of concern about the cost issue.Polls in the past have indicated that the cost of health care ranks high among the issues of public concern.However, a poll reported in theRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-64825667647106246622010-06-08T18:25:00.001-05:002010-06-08T18:27:35.750-05:00Single Payer and PoliticsNational Health Insurance (also known as single payer) has many advocates who offer a number of arguments to support it. However, there are less favorable implications that need to be included in the debate.They include the inevitability of decisions that seem arbitrary and political interference.A clear example was the subject of an article in the May 31, 2010 issue of Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-74386727713621824472010-05-23T18:14:00.000-05:002010-05-23T18:16:02.134-05:00A Step Towards Global PaymentThere is a growing consensus that somehow our current fee-for-service system of financing health care is an important cause of high cost and needs to be replaced.Under fee-for-service, providers get paid for each office visit, lab test, x-ray, hospital admission, etc. So the more they do, the more they get paid. It is generally believed that this incentive causes Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-65227696278925911832010-05-16T14:45:00.000-05:002010-05-16T14:46:55.423-05:00Don Berwick and the Cost of Health CareDon Berwick, Harvard pediatrician and founding executive of the Institute for Healthcare Improvement, has been nominated by President Obama to head the Centers for Medicare and Medicaid Services (CMMS). As its name implies, CMMS is the federal agency in charge of Medicare and Medicaid.Republicans are already taking aim at the nomination, alleging that Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-8670526023403036332010-05-04T08:18:00.000-05:002010-05-04T08:20:17.894-05:00Cost Still Not of ConcernThe recently enacted health insurance reform law will increase the overall cost of health care more than was implied by the Obama administration during the legislative debate.That is the conclusion of the chief Medicare actuary, Richard S. Foster, as reported in the April 24 issue of The New York Times. His study indicated that a result of the law would be to increase Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-52166758461880887582010-05-02T09:29:00.000-05:002010-05-02T09:31:10.767-05:00Breaking Up PartnersThe Massachusetts General Hospital and Brigham and Women’s Hospital, both Harvard affiliated, are the health care power houses of Boston. In 1994 they merged to become Partners HealthCare.In the Boston area, it is very difficult to sell a health insurance policy that does not cover services from MGH and the Brigham, which are thought of as being at the pinnacle of modern Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-8008985735432035752010-04-16T10:07:00.000-05:002010-04-16T10:08:28.325-05:00Individuals and InstitutionsWife Marilyn just got a new knee. She was admitted to the New England Baptist Hospital in Boston early on a Friday, operated on later in the morning, and discharged to home the following Monday.This was her second total knee replacement. Her first one was about a year and a half ago, also at the Baptist, but by a different surgeon.When discussing the first operation,Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-21130852406707541892010-04-08T13:51:00.000-05:002010-04-08T13:53:06.168-05:00When does more become too much?It is often, though not always, the case that more is better. But there always comes a point at which more becomes too much.Thanks to the advice and generosity of Chris Van Gorder, CEO of Scripps Health in San Diego, I have recently finished reading a book titled The Heart of Power by David Blumenthal and James Moroni, respectively of Harvard and Brown Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-90683974914652073052010-04-04T17:09:00.000-05:002010-04-04T17:11:29.422-05:00Should Doctors Have Bosses?As a general rule, we believe that human activity is more productive and more efficient if it is organized and managed. One prominent exception is patient care. Hospitals are organized and managed. Medical groups are organized and managed. Rehabilitation centers are organized and managed. But the actual care of patients is for the most part left in the hands of Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com3tag:blogger.com,1999:blog-5643223.post-67429921754595512482010-03-31T14:54:00.000-05:002010-03-31T14:56:17.874-05:00Meaningful UseThere are two ways for organizations to make use of information technology. One is to conceive of a better way of doing something that it makes possible and then use the technology to do it. The other is to apply the technology to what is being done in the hope that something good will come from it.Hospitals and doctors seem to have opted for the ‘hope’ approach.The federal Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-30168962793226620482010-03-25T15:33:00.000-05:002010-03-25T15:35:21.486-05:00A Political SpeculationLike millions of others, I voted for Barak Obama with unrealistic expectations. That may explain my disappointment with how he has dealt with the issue of health care reform.Listening to his remarks during the campaign and the first months of his presidency, I came to hope that with his eloquence and ability to deal with complex issues, he would lead the American people Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com5tag:blogger.com,1999:blog-5643223.post-78238738006081003862010-03-24T10:47:00.000-05:002010-03-24T10:48:51.720-05:00Health Insurance EmbellishmentsA year ago, the talk was about health care reform. Then as the legislative process got under way and politics took over, the subject morphed into health insurance reform. More recently, there has been increasing reference to health care overhaul. Yesterday The Boston Globe published a list of the subjects covered in the legislation adopted by the US Congress last Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-14965059683226291652010-03-18T18:58:00.000-05:002010-03-18T18:59:42.795-05:00Europeans and Single PayerAdvocates of single payer frequently point out that the people of Europe seem to like their universal coverage systems and ask why it is that we can’t have one as well.I think I have the answer to that. Europeans think their systems are better than what existed before but insured Americans aren’t convinced that single payer would be better than what they have.In this Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-59746044511338434592010-03-04T12:28:00.000-05:002010-03-04T12:29:29.760-05:00Just Say NoShould a physician be allowed to prescribe a test or treatment, provide it, and then collect for it?That question first came up with drugs and the answer was, and remains, a clear no. The idea is that when making decisions about prescribing medications, the doctor should not be tempted to make money by prescribing inappropriately. But over the years the issue has gotten fuzzed up, Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-16514511567571642492010-02-26T11:19:00.000-05:002010-02-26T11:21:48.115-05:00No Single Payer in Our TimeDespite the determined persistence of its advocates, we are not likely to see a single payer program adopted in the United States in our time.There are several reasons. Perhaps the most important is our high level of health care spending, which provides generously for those who have health insurance. The larger portion of premiums are being paid by the employer or by Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-35340639996680529852010-02-10T09:49:00.000-05:002010-02-10T10:03:03.736-05:00Chaos and Organization in Health CareIf the health care delivery system is going to deal effectively with the issues of cost and quality, it will have to get organized.That is the theme of a book I have just finished reading. Its title is Chaos and Organization in Health Care. It was written by Dr. James Mongan, CEO of Partners Health Care System (now retired) and Dr. Thomas Lee, Network Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-13266891627370488342010-02-04T16:17:00.001-05:002010-02-04T16:20:12.913-05:00 EMRsUntil you have tried to develop a computer application, you will not appreciate the number of steps involved in the most mundane of human activity. Take, for example, paying a bill. That routine chore involves getting access to the bill, a checkbook, and a pen, picking up the pen, filling out the several blanks on the check, etc., etc., etc. If you were to program a computerized robot to Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-61399086017685851122010-01-30T10:04:00.000-05:002010-01-30T10:05:46.749-05:00A Job for the ACOIn an Op-Ed article in the January 25 issue of The Boston Globe, pediatrician Claudia Gold recited the sad tale of Emily, a patient who was returning for care that she (Dr. Gold) was not able to provide. Emily was returning because her psychiatrist was no longer accepting her insurance.Dr. Gold used this situation as an example of the need to change the direction of health care.Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-7205607787077377302010-01-28T11:50:00.001-05:002010-01-28T11:51:58.368-05:00Rights and Consequences“Americans for Responsible Health Care is dedicated to protecting the right to choose your own doctor, the right to the procedure you need at the time and place of your choice.”That statement was part of the organization’s full-page ad in the January 21 issue of The Boston Globe thanking the voters of Massachusetts and congratulating Scott Brown on his election to the U.S. Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-30555765606504371802010-01-21T09:33:00.000-05:002010-01-21T09:35:39.923-05:00Maybe Ben Nelson Did ItThe unexpected victory of Massachusetts Republican Scott Brown in the election to fill the US Senate seat vacated by the death of Ted Kennedy was no doubt caused by many factors, but is commonly attributed in large part to a public uprising in opposition to the health care reform legislation being promoted by the Obama administration and the Democratic Congress.It is not Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com5tag:blogger.com,1999:blog-5643223.post-25215626951238204552010-01-20T09:45:00.000-05:002010-01-20T09:47:09.585-05:00Is Our Health Care Delivery System “Broken?”Many critics have concluded that our health care delivery system is “broken.”A recent reminder of that was an Op-Ed article that appeared last October in My San Antonio. It was authored by Ruth Berggren; physician, UT faculty member, and long-time family friend. The title is “Our health care delivery system is broken.” The article was called to my Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-8011786484806990762010-01-13T18:08:00.000-05:002010-01-13T18:10:04.079-05:00ACOsA recent Associated Press article told the story of a Dover, Delaware pediatrician who had been arrested and charged with more than 50 felonies related to sexual abuse of his patients. The arrest followed a mother’s report to police of the doctor’s abuse of her 2-year old daughter.The story indicated that there had been complaints about this doctor dating back almost a decade. The state’s Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-86566629500319382352010-01-12T11:15:00.000-05:002010-01-12T11:16:55.660-05:00Yes, ButBen Nelson, Democratic U.S. Senator from Republican Nebraska, has gained considerable notice lately for his vote in favor of the Senate version of health insurance reform. In defense of his vote he has been airing a television ad, in which he predicts that the legislation for which he voted would lower families’ costs, protect Medicare, and reduce the deficit.The front page feature Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-83130062910413711432009-12-09T18:24:00.001-05:002009-12-09T18:26:39.556-05:00Smoke and MirrorsHearing President Obama say that he would refuse to sign a health care reform bill that added one dime to the deficit, my skeptical mind suspected that some financial smoke and mirrors ultimately would be involved in meeting his requirement.According to a front-page article of the December 5 issue of the New York Times, legislation adopted by the U.S. House of Representatives andRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-21365328399856873042009-12-04T10:16:00.000-05:002009-12-04T10:17:42.283-05:00AARP and Health Insurance ReformAARP has been active in support of the Obama approach to what was once called health care reform but is now referred to as health insurance reform. That caused my ears to perk up when I heard the AARP television ad for its Medicare supplemental insurance policy.Midway through the ad the background voice, supported by large print, assured the listener that with Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-54952678008218595362009-11-27T11:44:00.000-05:002009-11-27T11:46:12.311-05:00On the Hazards of Cost ReductionThe recent flap over mammograms is a vivid illustration of the difficulties to be faced by anyone who attempts to seriously address the issue of the cost of health care.Unless you have been hiding under a rock the last few days, you will know that the U.S. Preventive Services Task Force, a federally chartered group responsible for developing recommendations on Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-26393330867654490932009-10-31T07:02:00.000-05:002009-10-31T07:03:39.181-05:00Meaningless Use?The American Recovery and Reinvestment Act of 2009, better known as the economic stimulus package, includes a whopping $19 billion to support the development of electronic (i.e., computerized) health records to be used by hospitals and doctors.In order to be eligible for grants, applicants must demonstrate that the application they wish to develop will have a “meaningful use.” Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-34179117387349152702009-10-27T17:04:00.000-05:002009-10-27T17:06:19.979-05:00Unrecognized Issue in Health Care ReformOne of the things I find interesting about the current health care reform debate is the number of issues that are going unrecognized and undiscussed.One is the issue of national health insurance or, as it is more euphemistically known, single payer.There is a sizeable group of people, including much of the left wing of the Democratic Party and almost all ofRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-50570325898126482272009-10-05T09:47:00.000-05:002009-10-05T09:49:22.455-05:00Harry, Louise, and Global PaymentThe health care powers-that-be in Massachusetts want to abolish fee-for-service in favor of what is being called global payment. Global payment is a softer term for what used to be called capitation – a system in which the insurance company pays a provider organization a flat amount per month per subscriber, in return for which the provider is responsible for Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-71122239998072950142009-09-30T17:49:00.000-05:002009-09-30T17:51:27.865-05:00Does Cost Need a Crisis?Public support for the Massachusetts health care reform program is slipping and concerns about the cost of health care are growing. Those are the results of a survey reported in the September 28 issue of The Boston Globe. During the past year the approval rate for the program dropped from 69 per cent down to 59 per cent. So a substantial majority still approves. But 43Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-84474024272780221722009-09-23T07:54:00.000-05:002009-09-23T07:56:54.052-05:00No Health Care Reform YetI can’t be the only one who has noticed that what was once called health care reform and referred to often as overhaul of the health care system, is coming with some frequency to be referred to as health insurance reform, occasionally even by the White House.It only goes to show how intractable our health care crisis really is. The core problem is that health care costs Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-72438850578528408292009-09-21T14:26:00.000-05:002009-09-21T14:28:45.721-05:00Flour, Coffee, LBJ and the Cost of Health CareThe September 20 issue of the Sunday New York Times carried a collection of quotations from President Lyndon Johnson. All were related to LBJ’s successful effort to enact Medicare.LBJ had a colorful way of speaking and all of the quotations were interesting, but one in particular caught my eye. It was taken from a conversation with his Vice Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-48551751304455155222009-09-17T17:11:00.000-05:002009-09-17T17:14:31.787-05:00Primary Care HospitalsEarlier this week I was visiting my home town of Harlan, Iowa (pop. c. 5500) when my almost-83-year-old prostate gland shut down my plumbing. In addition to the resulting discomfort, the incident caused more than a little anxiety since I was scheduled to fly back home to Massachusetts on the following day.Needing care, I went to the Emergency Room of Myrtue Medical Center, Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-20834215350323069042009-09-05T14:20:00.000-05:002009-09-05T14:23:11.620-05:00“Interfering” in Clinical PracticeEugene Litvak, professor of health care management at Boston University, has made a name for himself by becoming an expert in the way patients move through hospitals and by showing hospitals how they can become more efficient by improving that movement.His story was the subject of an article in The Boston Globe that appeared on August 30, 2009 under the byline ofRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-40823967180969714602009-09-03T08:33:00.000-05:002009-09-03T08:35:13.755-05:00A Suggestion on RationingLong-time friend Peter Kilborn submitted the following comment in response to my posting about the Massachusetts proposal to abandon fee-for-service as the way of paying for health services in favor of “global” payments; i.e., capitation.“Capitation immediately raises the fear of increased rationing. If the provider gets only a fixed sum to treat me, it will want to limitRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-14550874160446672372009-09-01T17:19:00.001-05:002009-09-01T17:21:50.159-05:00Real Health Care ReformAlmost everyone who comments on health care is critical of the fee-for-service system of paying providers. They agree that paying separately for each lab test, office visit, CAT scan, etc. gives hospitals, doctors, and other providers an incentive to use more of these services, even when the benefit to the patient is marginal or perhaps lacking altogether.When Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com4tag:blogger.com,1999:blog-5643223.post-27339214376197068212009-08-20T16:37:00.000-05:002009-08-20T16:38:57.674-05:00Please be Clearer, Mr. PresidentThough I have no illusion that he will ever see it, I have sent off the following letter to President Obama:……………………………..Mr. President, if you want to know why your health care reform program is drawing so much flak, you might find at least some of the reasons in the Op-Ed piece that appeared under your name in last Sunday’s New York Times.To begin, the title of Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com2tag:blogger.com,1999:blog-5643223.post-61887691944319036462009-08-18T08:54:00.000-05:002009-08-18T08:55:32.773-05:00Efficiencies That Cost MoreEarly in my hospital administration career I came to the conclusion that whatever I undertook to do to improve efficiency always cost more money. People would come to me with programs they wanted to mount or changes they wanted to make and often would defend their ideas at least partly on the grounds that they would improve efficiency. But when we got down to details, Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-14919342483949766472009-08-03T18:27:00.000-05:002009-08-03T18:29:01.309-05:00Political Correctness and Health Care ReformPolitical correctness and the associated conceptual confusion account for much of the difficulty being experienced in achieving meaningful reform of health care.The point is amply illustrated in an article by Victor Fuchs, a renowned Stanford University health economist, now retired, that appeared in the most recent issue of Web Exclusives by the highlyRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com3tag:blogger.com,1999:blog-5643223.post-59054171823721178682009-07-30T09:18:00.001-05:002009-07-30T09:18:28.306-05:00Why Health Care Reform Is So HardThose who wonder why health care reform has proved to be so difficult need not blame the pharmaceutical and health insurance lobbies, however powerful and self-serving they might be.Instead, they need only read last Sunday’s New York Times (7/26/09). The Times devoted the full two page-length columns of its editorial section to a subject it titled Health Care Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-89622005247925911322009-07-27T16:40:00.001-05:002009-07-27T16:42:32.671-05:00Thoughts on Health Care Reform from WesburyStuart Wesbury, long-time friend and colleague, former association executive and academician, and regular reader of this blog has composed the following letter-to-the-editor. Although I don’t agree with all of it, I deem it to be is well thought out and worthy of consideration. …………………………..Finally, the Congressional Budget Office has cleared the air. Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-13885348304442359162009-07-20T18:23:00.000-05:002009-07-20T18:24:23.597-05:00Response to ValpodocValpodoc responded to my posting entitled Recommendation as follows:……………….“Let me get this straight. Your solution is to make the doctors, employees of the hospitals. An [sic} the hospital administration would then "fix" the problems. Sounds like government healthcare with a different name.”…………………This comment offers an example of the hazards of trying to deal briefly with Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com1tag:blogger.com,1999:blog-5643223.post-81855709151330780922009-07-12T16:16:00.002-05:002009-07-12T16:20:14.058-05:00RecommendationIn the context of a discussion on another subject, long-time friend Bob Odean reminded me that in all my blogging, I had not been very forthcoming on my own views on solutions for health care reform.Summarizing those views in a page or so may be presumptuous, but I’ll give it a try.I would first recommend that steps be initiated on a national basis to consolidate the professional (Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com4tag:blogger.com,1999:blog-5643223.post-39155474710266466992009-07-03T11:44:00.000-05:002009-07-03T11:46:08.259-05:00Competition vs CompetitionWe Americans have a strong faith in the potential of competition as an inducer of higher levels of performance. We are less aware that competition can take different forms with correspondingly different results.The June 21 issue of The Boston Sunday Globe included an article about competition between two health care providers in the Boston area. It seems that Beverly Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-81810076548460116512009-06-25T08:17:00.000-05:002009-06-25T08:18:11.549-05:00Cautionary TalesI’ve been known to characterize single payer (national health insurance) as an arrangement for freezing the existing health care system in place and then slowly starving it to death.The freezing part was illustrated by President Obama during his recent press conference when he assured those who were satisfied with their current health insurance plans and physicians that they couldRichard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-11015611623975361542009-06-20T13:58:00.000-05:002009-06-20T14:00:06.538-05:00Cost Versus Coverage in Health Care ReformHealth care reform has come down to a contest between two issues, cost and coverage.Cost is an issue because nearly 17% of our economy is now devoted to health care and that number continues to rise because expenditures for health care are rising faster than the growth of the economy as a whole. Students of the issue foresee the day when the government Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-70462394749625851822009-06-13T14:17:00.001-05:002009-06-13T14:19:28.087-05:00Process vs. Content In Health Care ReformPolitics is a competitive activity with contests, winners, and losers. One consequence is that it tends to be more concerned with process than with content.Nowhere is that more clear than in the current effort at the federal level to enact health care reform. The print pundits and the cable talking heads are giving little attention to the legislative Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com0tag:blogger.com,1999:blog-5643223.post-13780758227438765822009-06-08T17:14:00.001-05:002009-06-08T17:16:50.510-05:00Being Distracted by AppearancesA widely noted feature of the health care reform plan being developed by the Democrats is a health insurance agency to be operated by the federal government in competition with private health insurance companies, including Blue Cross Blue Shield.The proposal speaks to the general perception that health care can be reformed by reforming health care insurance. The Richard Wittruphttp://www.blogger.com/profile/10989851443772182737noreply@blogger.com5