Physicians

Can Social Media Save Healthcare Reform?

Daniel Palestrant is the Founder & CEO of Sermo, the largest online physician community, and a friend of THCB’s from the Health 2.0 world. Lately Dan has been seen on cable TV representing the 110K+ Sermo members in the health reform debate—including a very public break-up with Sermo’s former partners at the AMA, which has endorsed the House 3200 bill. I’ve been asking Dan, if his members’ don’t want the House bill, what do they want? This is the piece he sent me in reply—Matthew Holt

Daniel Palestrant

Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the “dirty secret” of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.

True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:

1. There is very little actual healthcare reform going on.

2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week “The Health Insurers Have Already Won”.

At Sermo.com we seem to be seeing Governor Dean’s prediction come true.

More than 110,000 US physicians use the Sermo.com platform to fact check, problem solve, critique and learn from each other in real time. And as the most critical reform of our lives is making news all around us, Sermo is emerging as a clear and unified physicians’ voice in the healthcare debate. For example, within 36 hours of the first version of House reform bill coming out, the 21 members of the AMA board of trustees endorsed the bill. In the following week, 11,000 physicians logged into Sermo and voted on whether or not they support the bill. An astounding 94% stated that they do not. The physicians’ voice became the canary in the coal mine, and we’ve all seen what’s happened to the AMA’s support and support for the bill since then.

This week, social media takes another step forward as the physicians of the Sermo community announce the Physician Appeal, opening a channel for direct communication between physicians and policy makers, cutting out the influence of special interest groups. What doctors on Sermo.com want is simple, and it doesn’t take 1100 pages to say. We believe that creating real change means:

1. Reducing unnecessary tests and procedures through tort and malpractice reform,

2. Allowing doctors to spend more time taking care of patients by making billing more transparent and streamlined (creating an alternative to CPT codes)

3. Insurance reform to ensure that physicians are making medical decisions with their patients, not insurance company administrators.

4. Revising the methods used for calculating reimbursements so that there will be enough qualified physicians to provide patient care.

Perhaps most telling, not one of the things that physicians consistently rank as the most important steps to true healthcare reform are even mentioned in the current versions of the reform bill. If Governor Dean’s prediction is accurate, that the truth will bubble up through social media, well then it appears we have a long way to go in this reform process.

More on Sermo:

Livongo’s Post Ad Banner 728*90
Spread the love

39 replies »

  1. If people don’t have insurance, can’t or won’t pay, why do we feel obligated to save them?
    Why not just let them die?
    This is the traditional, conservative approach.
    Given this alternative, I think a lot of people would find a way to finance their health bills or buy insurance.
    By the way, the INSURANCE COMPANIES are the primary reason everything costs so much now. Current health costs are like the government paying $300.00 for a hammer.

  2. i’m 22, i’m a photographer/graphic designer, i’m in debt from college, i can’t afford even an efficiency/studio apartment so i live in a friend’s basement, i can’t afford to keep my car insured and on the road, i’m in good health, why should i have to pay for your health care? To be honest, i think health insurance is a good thing to have, but if you cant afford to feed yourself from paycheck to paycheck, why should i have to pay for health care? shouldn’t i be spending my money paying for rent?, paying for Transportation? buying groceries? repaying student loans? i’m in good health cuz i try to eat healthy and i excersize, i have a budget that i stick to and i still have trouble affording the bill to just barely live, why should i pay for your health care, cuz god knows working 40+ hours a week leaves no time for me to use your healthcare. I promise you if this obamacare passes, i’m quitting my job and going on welfare cuz i’d rather be a bum then robbed from.

  3. Doctors talking to policy makers is great but in Oakland California young artists are looking at letting patient video conference with elected official from the waiting room. This project looks very powerful because it’s patients. It’s a public hospital, it doesn’t get more real.
    http://whatruwaitingfor.com/blog/

  4. So, let me get this straight. Less than 10% of Sermo’s membership thinks the healthcare bill is a bad idea, and this is “news” of some sort? What about the other 90% of Sermo’s members? Do they not care? Or do they log on once and never return??
    This sort of “data” should be taken with a healthy grain of salt, because it is not scientific nor unbiased. It represents a clearly vocal minority of physicians, and says nothing about how doctors — in general — feel about the healthcare reform proposed by Congress.
    Daniel Palestrant is first and foremost a businessman, trying to sell mindshare (and future VC funding) in his business — Sermo. This is nothing more than a shameless plug masquerading as editorial content, which lacks any new *objective* information or data.

  5. If you wish to see the scorecard of foreign exchange holdings of a focused country so small and without natural resources and compare it to the vastness of the USA–it is a shock to the mental and business health of America. We need to get our professors teaching! We need to get our regulators working or decline to continue to be–Salary Takers— See:
    http://singaporerental.com/topics/economics/

  6. Ladies and Gentlemen:
    As a Californian(with family roots preceding 1860) I am concerned over the mess there and the mess in Wall Street,Main Street,Post Office,non stop spending by Dept of Defense. The American taxpayer is seeking leadership in every facet of life. I propose we get our Health lives in order now, but take the time to do it right. Singapore has taken 40 years to educate key professionals in the world’s greatest universities and labs. Systems have been developed that are cost effective and patients live better lives as they become part of their own medical management team. Health care in Singapore has been on a 20 year planned program of continuous improvements in cost,service, and delivery of every facet of health care. Please contribute a partial solution or more for the overall creative talents and skills need to be addressed to serve the taxpayer as well as the caregiver– See the following:
    http://www.HealthCare2009.singaporerental.com
    Best wishes, Jim

  7. rae,
    Medicare spends around $7,000 per member, of which $700 is fraud and abuse losses. Money wasted becuase Medicare does such a poor job administering claims. They spend another $350 to $560 on actual administration.
    even if your 14% figure is correct that is only $980. How does paying more for single payor improve anything? How blindly are you trumpting liberal propoganda that you can’t even cut and paste it correctly but you have no idea why your saying what your saying. Have you given any thought at all to what you advocate?

  8. According to Alexa the web traffic to Sermo is only 62.8% from the US, and if you look at the demographics it mostly represents medical residents and interns (25 to 34) not practicing Physicians and it is far from representative of the Physicians in practice
    In fact, the American College of Physicians (160,000 US Internists the ones who provide the bulk of primary care to senior’s) “believes that America’s Affordable Health Choices Act of 2009 (H.R. 3200) merits internists’ support, even as ACP continues to work for improvements throughout the legislative process”

  9. Matthew;
    You should ask Dr. Palestrant about the “physicians’ letter to the American public” which was much touted on Sermo as the ultimate physicians’ proposal for health care reform. It was supposedly signed by 10,000 physicians (including myself). This was supposed to be presented to the public months if not a year or more ago, after many previous months of discussion over its exact wording, etc. I have not seen evidence of this letter yet in any public media. I have not bothered to go back and find out what happened to it.
    The Sermo physicians’ inability to even get out this simple communication is a microcosm of why docs will never lead efforts at health reform. So I guess the fall-back position is to have Dr. Palestrant speak for them, supposedly.
    And you forget that members of Sermo are not a randomly selected cross-section of physicians. They include, as a commenter above noted, those who like the extra $$ rewards obtainable, those who like soapboxes, and a few bystanders like me who concluded it’s not worth our time.
    In summary, I wouldn’t put too much stock in Dr. Palestrant’s comments nor what happens on Sermo. I would look to the professional societies for a somewhat more considered and professional, should we say, attitude.

  10. FYI Palestrant was a surgical resident (e.g WAS a licensed physician) who was unable to continue his training because of a back injury. Which is when he started Sermo. If Sermo has 110K registered members, that means that if 10,000 of them comment and have answered polls, it’s pretty typical of most online forums–for example THCB gets about 3-10,000 visits a day and about 30-100 comments, and of course many comments are from the regulars. And I think personal attacks on Palestrant and suggestions that Sermo is not real are ill conceived.
    So I think Sermo, while not being a scientific survey, does represent what doctors as a whole think. And when you know that Sermo docs tend to be over-representing docs 40+ in private practice, their opinions become clear.
    The problem is that those doctors all agree that malpractice is bad and should be fixed, and that insurers should stop bothering them and pay them more.
    Which, as both Nate and Peter agree (yes, they can agree on something!) is a recipe for more out of control physician-driven utilization.
    Whether Sermo’s community can come up with a real set of solutions to the health care crisis is to me unlikely. If there were an obvious set of solutions that would be great for all doctors, and yet also good for society, I think we’d have heard by now.

  11. I belong to Sermo and got into it’s network when they solicited me through medscape( another doctors online forum). Many on Sermo are not active members nor do they participate actively, About 5-10% poat 98% of their comments and postings. Specialists only care about their incomes. Tort reform is a total myth,why train 10 years and not use sound judgement, because easy to do al the things where you have no skin( neither doctor or consumer). Primary care is so ill treated that it is shocking how they did not revolt and break away from and start their own revolution. Sermo is fabricating some of the numbers to look good.

  12. I echo Christopher’s sentiments that physicians, hospitals, and other providers have had a large hand in creating the expensive mess we are in. For decades, hospitals and physicians collected fee-for-service payments that led to the perverse, volume-based incentive system we have now. In the ’90s this led to managed care and utilization review, then a backlash against MCOs, then another 15 years of continued rapidly rising costs and governments gun-shy at attempting real reform. We physicians must become active in the reform process, not to improve our reimbursements and salaries and protect our own special interest, but because the country needs it.
    I also echo Cmhmd’s statement about Sermo and Palestrant. Let’s be clear: he and Sermo do NOT speak for most physicians. His poll is unscientific and the poll questions are vague; so is his recently posted petition, which has collected only about 1,900 signatures.
    I was curious who Daniel Palestrant, the Sermo CEO, exactly is. I googled him and went to the sermo website for his bio. You may already know this, but his bio is filled with a list of the businesses he has started-up and sold and the money he has made doing it. At the end of the bio are his medical credentials, which includes an MD from duke and having “trained in General Surgery at Beth Israel-Deaconess Hospital, in Boston before leaving to launch Sermo.”
    I gather that he has not been a licensed practictioner from this bio, but I couldn’t confirm this from my google search.
    You may also know, doctors’ participation in Sermo forums is heavily incentivized by cash payouts, funded by pharma and other industry. It’s been a very attractive extra revenue source for many of my residents in training.
    I’m not one to arrogantly assert that people who are not practicing physicians cannot have an important say on health care reform. But several things concern me about Palestrant’s use of his company for speaking on behalf of doctors on HC reform: 1) he may have business interests motivating his and Sermo’s positions, 2) he is a one-man spokesperson for doctors, though he himself has not independently practiced, 3) despite this and only 1,900 signatures for his petition, he has made an awfully wide outreach to the media on HC reform; a google search of his name reveals the extent of his reach so far.
    Let’s make sure to have critical scrutiny of those who speak out on HC reform, especially when truthfully, there is much diversity on the topic among the wide array of physicians.

  13. Insurance and health care are not the same thing. IMO, never to be humble and well informed, insurance is one of the main problems. Another is the whole current medical paradigm of disease, drugs, despair, depression, death. Another is the big pharma stranglehold on congress, the FDA and advertising. I don’t want insurance, I don’t want to pay for insurance, I don’t and won’t go to doctors that treat according to insurance dictates and/or get paid by drug companies to prescribe useless and harmful drugs for purposes for which they were not approved (and approved for conditions for which they were obviously and provably not effacacious. Nobody is entitled to insurance, nobody has a right to insurance. To life, liberty and the pursuit of happiness, yes you have a right. I don’t want to pay for other’s bad lifestyle choices and most chronic illnesses that make up the majority of health care expenditures, like diabetes and heart disease, preventable and reversible, even many cancers, if people didn’t eat wrong, exposure to toxins, smoking, legal drug use. Heed the words of Thomas Jefferson “If people let government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as are the souls of those who live under tyranny.” Do not encourage tyranny by calling for mandatory and/or universal insurance coverage. We need a new health paradigm, not more of the same garbage, insurance and drugs that got us here.

  14. rae if you think 1 in 7 HC dollars goes to executives you deserve to be unemployed and locked away so you never reproduce or inflict statements like that on the public again. Please think about what you said, work out the math, and reconsider. If you need some help go to yahoo finance and look up what the CEOs actually make. It’s just scary to think there are people with the legal right to vote that think things like that.

  15. Ya know, we need to get rid of the insurance companies entirely and bring back to life the single payer option they killed! They’re only about the money. 1 dollar out of every 7 goes to executives in the insurance companies. My long time job is being surplussed, and i’ll be without insurance, which the writer above insinuates i deserve. We ALL deserve insurance! Government is there to serve us, not rule us, anymore. The majority of people want insurance for everyone. It’s time we, the people demand govenment serve us, for we are the majority.
    Anyone against health care, is paid off, or duped. Lies are rampant to dispel the truth, but it will come forth. We need to rise up together, to make sure it is sooner, than later!

  16. In answer to the title of this post, YES, social media can help to save health reform, but only if we strive for true openness and collaboration. Unfortunately, that is not what Palestrant and Sermo are pushing for right now.
    While millions of Americans want to talk about the issues at the heart of this debate, Palestrant is once again on a self-serving mission. Many of the comments posted here are exactly the type of discussion this country needs to have, but Palestrant seems more intent on using his 10 minutes of fame to promote Sermo and punish the AMA for severing ties with his company. So let’s stop bashing the AMA over CPT codes simply because Daniel is trying to make waves and instead let’s focus on the real issues in this debate.
    Healthcare reform is too important, to complicated and to polarizing a subject to waste any more time with self-serving agendas. We need an open, honest and transparent discussion between all the key stakeholders and social media is absolutely a means to achieving that end. Rallying the same group of physicians on Sermo to vote in another survey so Palestrant can claim he’s the voice of physicians doesn’t provide any practical steps toward improving the plight of physicians and patients in this country…it only helps Daniel feed his ego by citing another unscientific poll.
    So instead, let’s use the pervasiveness and persuasiveness of social media to engage each other on the real issues. And one of the biggest is…MONEY. At the end of the day, that’s what this comes down to. How much will healthcare cost each of us individually and collectively through fee for service, insurance premiums and taxes over the next 20 years. We currently spend more per capita on healthcare than any other nation and costs are projected to surge past 20% of GDP by 2018. This is sheer madness when we consider the actual state of healthcare in a country when 50 million Americans are uninsured and our quality measurements (life expectancy, infant mortality, etc) fall far short of those in other leading countries around the world.
    Now, I fully admit that many of us need to take personal responsibility for leading healthier lives but at the same time I and countless other Americans want to know how physicians, insurance companies, vendors like Sermo, government agencies and others responsible for delivering care can work together to reduce these mounting costs and increase access to quality healthcare for all. Maybe Palestrant should spend more time thinking about how Sermo can actually provide value to physicians and thus help to answer this question instead of pushing his own self-serving marketing agenda.

  17. Everything itemized on the wish list is physician-centric. That is part of the overall problem, we see it repetitively in statistics on excesses and overutilization. While I have no argument against physicians being justly compensated, I do have serious issues with agendas that are entirely aimed at making it easier and more profitable for physicians.
    None of these suggestions by this organization will change the fundamental challenges presented by a broken system, i.e., we cannot pay for it no matter who ends up on top of this charade debate. But one thing I’d hope to see here is physicians ringing in with a clear endorsement for healthcare that is accessible and affordable. That will require a massive shift in the paradigm and an even more massive shift in physician mindsets. Our system, starting with medical education and progressing through the spectrum of delivery models must change. We either do that proactively, with physicians getting off their collective backsides and making their intentions (and I hope that includes access and affordability)known, or we get crushed by the cost clacier which is picking up speed.
    Physician apathy is epidemic, and now physicians are paying for it.

  18. Palestrant is certainly entitled to his opinion. I’ve been on Sermo and have entered the fray, but it is dominated by the usual suspects, so to speak. Aggrieved, self-entitled, blow hards who want to get more but are never willing to give up anything. They reject any responsibility as medical professionals in advocating for those without access to health care, they reject the ACP Charter on Medical Professionalism as the work of eggheads, and they are hopelessly out of touch with most physicians. (They don’t think they are out of touch, because nobody bothers to argue with them in the physicians’ lounge anymore. Most just roll their eyes and take their coffee elsewhere.)
    Thank God they are a fringe group. A loud one, I’ll grant, but there is a reason all of the major physicians’ organizations are favoring serious HC reform including a public option: because it is the right thing to do. Look at the list: AMA, ACP, AOA, AAFP, ACOG, ACS, as well as the American Cancer Society and many others. And yet, the loudmouths dominate the media.
    So, Palestarnt can speak for that cadre on Sermo, but he does not even speak for a fraction of physicians, in reality.

  19. Social media provides transparency.
    Transparency lubricates market competition.
    Insurance companies don’t always love transparency.
    I am guessing this — when I used to do cell phone pricing strategy (AKA “get everyone on the WRONG plan”), I found that the more diabolically complicated the pricing schemes, the less the company/market likes transparency.
    Change will come from the outside. (Technology, WalMart, other countries).
    It is a good time to be a social health service.
    People are still good.
    Fair profits await.

  20. An extended comment, if I may, on Palestrant’s words. First a little background.
    In 1988 I published And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota. At the time, I was editor-in-chief of Minnesota Medicine, the monthly journal of the Minnesota Medical Association. I was concerned managed care would drive doctors out of independent primary care, reduce them to mere functionaries of corporate interests, weaken doctor-patient relationships, and discourage medical students from entering HMO dominated medicine.
    As it turned out, I was partially right. Independent primary care physicians are on the wane; solo practice is dead as a doo-doo bird in Minnesota, most physicians now work as salaried employees of hospitals; primary care practitioners are a threatened species, with a current shortfall of 50,000 nationwide , estimated to reach 200,000 in 10 years; current and future medical students are more interested in specialties with better life styles and higher pay.
    Meanwhile, partly as a reaction against the time-consuming bureaucracies surrounding data-based pre-authorization policies, the humanism movement, i.e. patient-centered care with doctors engaging patients as partners in shared decision-making is on the rise.
    Also on the ascendancy is evidence-based medicine, data-based care. In some respects, documented care has replaced doctor care as a mainstay of clinical practice.
    In How Doctors Think, Jerome Groopman, MD., a professor of medicine at Harvard, has this to say,
    “Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment – distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctors needs to think outside their boxes, when symptoms are vague, or multiple and confusing or when test results are inexact. In such cases – the kinds of cases where we most need a discerning doctor – algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor’s thinking, they constrain it.
    Similarly, a movement is afoot to base all treatment decisions strictly on statistically proven data. This so-called evidence-based medicine is rapidly becoming the cannon… But today’s rigid reliance on evidence-based medicine risks having the doctor chooses care passively, solely on the numbers. Statistics can’t substitute for the human being before you; statistics embody averages, not individuals.
    According to a recent article in the New England Journal of Medicine (“Keeping the Patient in the Equation – Humanism and Health Care Reform,” August 6, Page 554-555). Groopman and {amela Hartzband, another Harvard academic says the humanism movement and the evidence-based practice movement are on collision course. Evidence-based medicine is based on the premise that, given the best available data and clinical protocols and guidelines and standardized procedures and guidelines, outcomes will improve and medicine will rest on a scientific foundation. Furthermore, evidence-based care plays to the strengths of Interment medicine, viz, health 2.0, clinical algorithms, data mining, and predictive modeling.
    Evidence-based medicine has a ring of logic and credibility, and it gives critics rational tools to contain costs while improving care. But it has hidden flaws too. It is based on retrospective statistical generalities rather than individual patient and doctor expectations during a doctor-patient encounters; it may reduce the patient-doctor exchanges to statistical exercises based on sometimes equivocal cost effectiveness data; it may handcuff doctors who wish to give desperate patients one last hope of cure; it puts federal and private bureaucrats in the position of making clinical decisions based on retrospective data; it assumes ubiquitous data loaded and data acquiring EMRs will improve care and will be cost-effective, which has not been the case in the United Kingdom (“Effects of Pay for Performance on the Quality of Primary Care in England,” July 23, 2009, page 368- 377). According to British researchers in the same article, using computers to meet quality criteria may disrupt the continuity of care. Finally, so-called evidence-based care fails to address the main health reform concerns of American physicians.
    As noted above, according to Palestrant, founder and CEO of Sermo.com, the four main health reforms needed as reflected in the opinions of 110,000 physicians participating in Sermo, are:
    1. Reducing unnecessary tests and procedures through tort and malpractice reform,
    2. Allowing doctors to spend more time taking care of patients by making billing more transparent and streamlined (creating an alternative to CPT codes)
    3. Insurance reform to ensure that physicians are making medical decisions with their patients, not insurance company administrators.
    4. Revising the methods used for calculating reimbursements so that there will be enough qualified physicians to provide patient care.
    These concerns have merit. They are not trivial and are not addressed in the House Bill, H.R. 3200. I would add that unless these concerns are addressed, physician demoralization will continue ; the physician shortage and the number of physicians not accepting new Medicare and Medicaid patients will surely grow. Universal coverage without access to physicians will be meaningless.
    Finally, I bring attention of readers to a chapter in my book, Obama, Doctors, and Health Reform, on the work of Dr. Palestrant, in which I make the following observations based on a conversation with him.
    1) Through a web of rules and regulations, and outdated reimbursement rules, the deck is stacked against physicians and discourages innovations.
    2) A genuine and deep physician “supply and demand” disequilibrium exists for American physicians.
    3) The “perfect information: quest, based on retrospective health plan and Medicare data, is unrealistic.
    4) A shift to consumer-centered care, making them conscious of what they’re paying fork, market transparency of prices and outcomes, and personal responsibility is underway.

  21. Even after so much of talk, we don’t seem to understand the basics to control costs.
    1) Basic healthcare (mostly preventative) must be provided to every citizen by the Govt in the interest of the country’s GDP and overall cost. Generally speaking, it is the care what primary care physicians provide with some basic lab tests + common drugs.
    2) For everything else, patients must be involved in the payment process. This may be done by higher level of co-pays and lower premium. This would force the people ask the doctors if MRI is required, for example. In other words, this would take care of tort reform, defensive medicine, end-of-life care, etc. For this the cost and quality data must be made available.
    The current problem is that making unlimited care available for a fixed insurance premium and that too is not known to the public (mostly paid the employers).

  22. if we cannot afford the current Medicare program and the states cannot weather any further expansion of Medicaid, how in the world can anyone believe further growing the federal intrusion into health care could possibly be affordable, let alone Pres. Obama’s laughable goal of being “paid for” by new taxes and cuts in Medicare …. we have to cut Medicare just to keep Part A from going bankrupt now
    I have several posts re: these issues at http://taxpayersrights.wordpress.com

  23. None of these suggestions by your organization to reform healthcare are game changing or bend the curve. They are typical of what you would expect from doctors. They are designed to make their life easier, but would do absolutely nothing to get everyone covered in this country and really bend the cost curve.
    It it really just more of the same. Until you take some of the for-profit out of the healthcare-industrial complex you will not get good overall outcomes. The profit incentive is too strong to continue to increase prices, overbill and not cover the most expensive patients.
    There needs to be some discipline brought to the system. Although a government run system is not perfect, it has proven time and time again around the world that it can meet the larger public good goals and can do it at a cheaper price. There is just too much money being made in the U.S. healthcare system by insurance companies, doctors, hospitals, suppliers, etc. etc. and it is to the detriment of the large public good.
    The system will eventually destroy itself, as only the most wealthy will be able to afford healthcare as more and more wealth rationing occurs and as it continues to make the U.S. economy uncompetitive.

  24. Peter- the ” insurance industry lackey”?? He want to ABOLISH private health insurance and institute a single payer system. Get thee hence, FL PCP. Go take care of patients.

  25. Could providers all support primary care for everyone if we dropped the billing and gave them a flat fee of $500 per person per year? Most providers have panels of about 2,000 or more but you could cut that in half, eliminate nearly all of your administrative billing staff and gross 500,000 a year. Over time more docs would go into primary care as a result, providers would have time to do preventive care and patients would be valuable assets.
    In Seattle there are more and more practices both small group practices like Qliance and Swedish community clinic and entire systems like Group Health that are moving to the medical home model. Same day 30 minute appointments, unlimited visits (as needed), preventive care, simple blood work on site included in low cost $45 to $70 a month fees and most of their clients are low or moderate income.
    Lets start here.. Everyone will either pay out of pocket, have their employer or insurance company cover it (flat fee 1 year minimum no billing) with subsidies for low income. Once we have this solved we can move onto what insurance is really supposed to be fore.

  26. Nate,
    When I reference “physicians” I am, of course, referring to practicing physicians; not those in academia, salaried by HMOs, HBR economic wonks or those who have whored themselves out to the insurance industry.
    Four-year Bachelors degree, two-year post-baccalaureate work in neurophysiology and biochemistry, four-years of Medical School, research scholarship in myonuclei formation, three years of Family Medicine residency, two-year Masters in Business Administration. Board certified and licensed in two states. IQ score 172, 20 years ago.
    Not stellar, but good enough to post on this lame blog.

  27. I made the prediction long time ago about the reality of healthcare reform at my blog. It is sad truth. I wish my predictions were wrong.
    It is so sad. What I have said and still believe is that if one has been affected by the financial crisis, they would understand that the healthcare crisis will be several magnitude worse. It would be next to impossible to solve….as there is no equivalent to injecting cash in the system – the way we did for the financial problems.
    Sad thing is that we are selling our future for the sake of few dollars in salary. Make no mistake that those who benefit today from the lack of reform would be the one also paying price for it. It is just they may be last in line.
    As long as America is great, their greed will be rewarded..but what they are doing now by derailing healthcare reform is now driving America down the third world countries.
    Wait when chinese rule America….Wait, they already do. It is their trillion dollar that is helping the economy.
    Wake up.
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  28. FL PCP any time you want to whip IQ scores or HC Knowledge put it on the table buddy. You can start by searching for my numerous previous post that say exactly what I do, far from insurance company lacky I make my living taking premium away from insurance companies. Equal part to that is taking money away from corrupt physicians digging both hands into my clients’ pockets.
    As a supposedly educated physician you should know better then to use sweeping generalizations like “All physicians want to limit unnecessary intrusion” Many hospitals and docotrs are aligned with evil insurance companies to mutually benefit each other at the expense of consumers, see MA BCBS and Partners Health. How do you explain KP and any other staff model HMO?
    Care to discuss what physician actions preceipitated pre-cert and prior auth?

  29. Peter and Nate are ignorant blowhards– insurance industry lackeys, who understand neither the complexity of the practice medicine nor the dedication of physicians. Since their role in life is as insurance salesmen, their opinions have no value in directing the evolution of healthcare. The infusion of a marginally-educated opinion results in a disservice to patients and an insult to practicing physicians.
    Dr. Palestrant has the support of an enormous number of physicians, primarily because the collective purpose is to create a doctor-patient environment that provides high quality care for patients and compensates doctors for the arduous, lengthy educational effort required to becomes physicians.
    All physicians want to limit the unnecessary intrusion of insurance companies. The needless formation of prior-authorizations, pre-certifications and formulary step edits insults doctors and creates a danger to patients, who are frequently denied needed medical imaging, treatment and medications, so corporate executives and shareholders can make billions of dollars in compensation. If you want true healthcare reform, eliminate the insurers, bureaucrats, polticians, trial lawyers and salesman from the equation—all are leeches. The doctor and the patient should decide the best course of treatment.

  30. I think Sermo is a superb medium for unmediated communication with policymakers.
    The AMA endorsement was a cynical move that damaged further the organization’s fading credibility with its membership and the policy community. Sermo’s poll simply and powerfully confirmed what I’ve seen and heard in physician circles. I don’t know a single doc that supported the House bill, and many who are appalled with the level of public ignorance of the issues that affect their ability to serve their patients.
    Bravo, Daniel!! (Too bad no-one has the guts to take on the self-referral that fuels McAllen’s obscene utilization and costs).

  31. There was a really interesting article in my local paper the Review Journal Sunday. Our county hospital sucks, bleeds like a hemophiliac after a knife fight. This year it is projected to lose $70 million, it is spending $24 million to treat 80 illegal immigrants who use the ER for Dialysis treatment. They wait until they are sick enough for federal law to require UMC to treat them. These people know how to game the system, the entire hospital deficit could be contributed to illegal immigrants. This shortfall is not made up by the public plans they already pay less then the cost to deliver care. This cost is covered by private group insurance and tax payors.
    When we start discussing easy solutions to our health care problems shipping illegal immigrants home has to be at the top. This along with tort reform would be two of the reforms receiving the highest level of support across all political ideologies yet both have been completely left out of the reform discussion.
    Why is it simple reforms with wide support that don’t diminish the quality or amount of care are not even considered? Further proof nothing about HR 3200 or Obama in general is really about improving the system.

  32. The public option is dead. Long live the public option as the coop health plans option.
    With $6 billion, give or take a few, as seed money, a natonal health insurance coop will be a government-owned and run/controlled health plan. It will be subsidized by Congress unless the GOP comes in and fixes the mess the Dems are trying to get us in.
    Supposedly, the coops will be governed by “members.” Who are these members? Not career insurance executives who can make it in the private sector. Not experienced business leaders who can make it in the private sector. Not anyone with any real experience or expertise in health care.
    Political hacks. The homeless and uninsured, not to mention the uneducable and probably the sick and unhealthy. Mostly, though, political hacks.
    So where would this leave physicians?
    The hacks won’t sympathize with “high paid” docs who always demand pay before performance and make them wait hours for service.
    Trial lawyers will make sure their political hacks help run the coop or coops. Tort reform is going nowhere for a long time, I’m thinking.
    Having seen the lousy decision making many docs did before insurers cracked down on the incompetents, why would any insurer turn them loose now? Having served on a hospital peer review committee, I can assure you that docs are like lawyers, cops and NBA players. They protect their own. Self regulation doesn’t work in any industry and certainly not in medicine, nursing or any of the health care professions. It only takes a couple of cheats to ruin things for everyone else, and there are more than a couple of cheats in every profession and market. If you hate the insurers’ fraud detection systems, blame your crooked colleagues even if you think there are only a couple of them.
    Yes, primary care docs should be allowed to make more money, but what political hacks in cooperative health plans will go for that?
    I hope the 110,000 members of Sermo can come up with better ideas and with ideas that are not all about making their lives easier and their practices more profitable.
    If the docs were truly concerned about health insurance reforms, they’d be for:
    1. Pre-empting states’ corrupt health insurance laws and regulations so that insurers would act like insurers and patients would be given strong financial incentives to make wise use of preventive, primary and acute medical care services.
    2. Mandating that individuals buy high deductible, catastrophic health insurance that is community rated by each insurer and carries no life-time coverage caps.
    3. Equal tax treatment for all insurance buyers. Subsidize all equally as a percent of income or provide no tax incentives, which wouldn’t be necessary if we were all required to buy health insurance.
    4. Tort reforms, yes, so that there is a level playing field, not so the current system is turned on its head and favors providers.
    5. Anti-trust laws that break up insurers and providers that dominate local, state and regional markets. Competition works when politicians let it.
    6. Eliminate mandated insurance coverage of primary care and preventive services, which should be paid for out of pocket. This would make the catastrophic insurance affordable for more people, and it would make providers compete based on the prices they charged for primary and preventive services, which would be good for the best competitors and for patients.
    7. Eliminate the federal laws that require providers to take care of illegal immigrants so that the 200 million privately insured don’t subsidize the feckless business community and politicians who refuse to secure our borders.

  33. “1. Reducing unnecessary tests and procedures through tort and malpractice reform,”
    Myth, won’t happen, especially in McAllen TX and the like, and hospitals where we’ve seen fraud billing (up-coding) and where billing reductions threaten budgets and bonuses.
    “2. Allowing doctors to spend more time taking care of patients by making billing more transparent and streamlined (creating an alternative to CPT codes)”
    I still think most doctors will just use this to advantage to run even more patients through the treatment mill.
    “3. Insurance reform to ensure that physicians are making medical decisions with their patients, not insurance company administrators.”
    Get your premium paying checkbook ready.
    “4. Revising the methods used for calculating reimbursements so that there will be enough qualified physicians to provide patient care.”
    You mean enough high paid specialists? Anyone going to rural America or inner cities?
    When costs start to hit and hurt the people who opposed the public option I’ll be there to say, “I told you so.”

Leave a Reply

Your email address will not be published. Required fields are marked *