Friday, August 1, 2014

ObamaCare – A Festering Boil

What happens to a dream deferred?

Does it dry up

like a raisin in the sun?

Or fester like a boil –

and then run.

Does it stink like rotten meat?

Or crust and sugar over –

like a syrupy sweat?

Or maybe it just sags

like a heavy load.

Or does it explode?

Langston Hughes(1902 -1967), Harlem (1951)

What will be ObamaCare’s fate?

That question may largely be answered in the November 4 midterms.

In the interim, ObamaCare is festering like a boil. The boil may burst spontaneously with 8 million gaining coverage or it may be drained by its political opponents.

In the meantime, internal pressures are building within the boil with most agreeing the abscess is a mess.

• In Colorado, 339, 561 health plans have been cancelled: in Nevada 90,000 cancellations have occurred.

• In 3137 of America’s 3144 counties, premiums in the individual markets have gone up an average of 49% for 82% of women and 91% of men having rising premiums.

• Administrative incompetence in managing continues to build with HHS admitting it cannot resolve 89% of eligibility issues surrounding who got subsidies and who will get them in the future.

• The question persists whether nearly 5 million Americans receiving subsidies got them illegally if one sticks strictly to the wording of the ACA: oy may be up for the Supreme Court to decide.

• The House of Representatives has sued President Obama, mostly on the issue if he exceeded his authority of delaying the individual mandate and whether by doing so violated article 1 and 2 of the Constitution. The Supreme Court may have to decide that one too.

And so the Obamacare boil festers.

Will it be drained by political gestures?

Will it be lanced by Supreme Court sequesters,

with Justices'paying homage to judicial ancestors?

Thursday, July 31, 2014

Private Practice Future Under ObamaCare

Government is certainly all pervasive. But is truly strong? Is it only big?

Peter F. Drucker (1909-2006), “The Sickness of Government,” chapter in The Age of Discontinuity, Harper & Row, 1967-1968

Governors’ mansions and state legislatures, in the courts, among health care providers, and most importantly, around the kitchen tables of ordinary Americans. Battle lines are being drawn in the Congressional and state races for the 2014 mid-term elections to be held on November 4, 2014. Majority control of the House and Senate in the U.S. Congress and thirty-six Governors’ seats are at stake. Practicing physicians are on the frontlines of the ACA debates.

Kathy Means and Ken Monroe, "The Patient Protection and Affordable Issue Beyond the Horizon into 2015", The Physicians Foundation, White Paper, 2014

As is my wont, I have been reading two things at once – one is a 1967 book by Peter F. Drucker, the imminent social and management theorist, The Age of Discontinuity (1967): the other is a 44 page white paper,” The Patient Protection and Affordable Care Issue Beyond the Horizon into 2014, Part II” by two well-known and widely respected Physician Foundation consultants, Kathy Means and Ken Monroe,

• I will let Drucker speak for himself, “There is mounting evidence that government is big rather than strong; that it is fat and flabby rather than powerful, that it costs a great deal but does not accomplish much..In the seventy years or so between the 1890s to the 1950s, mankind, especially in the developed countries, was hypnotized by government. We were in love with it and saw no limits to its abilities or good intentions. It promised: “Utopia is here – all that is needed is to take everything away from the “wicked, selfish interests.” Once they had been eliminated, the right course of action would emerge from “the facts” and decision would be rational and automatic, and would be turned over to government…The British, in adopting the “free” health service believed that medical care would cost nothing. There are, of course, never enough rich people to carry the burden of any general service. The best we get from government is competent mediocrity. What is impressive is the administrative incompetence. Every welfare state reports the same confusion, the same lack of performance, the same proliferation of agencies, of program, of forms, and the same triumph of rules over results. “

What Drucker was saying, of course, is that government cannot be everything to everybody in a pluralistic society calling for specialized competencies among individuals and organizations. For examples of this incompetency, look no further than the disastrous launch, the rapid rise in health care premiums, and the coming bailout of health plans due to demographic miscalculations of who might enroll in ObamaCare exchanges.

• Fast forward to 2010 to 2014.the first 4 ½ years of ObamaCare – with its expansion of big government and the passage of a massive, complex health law which promised to offer coverage of everything for everybody, and a botched and incompetent implementation of, while retaining your doctor and your health plan, and lowering your premiums. One of its hidden premises was that we would have reform those “wicked” overpaid, under performing, fee-for-service physicians. We would reduce their pay by 30% or more, eviscerate those “overvalued codes,” introduce an elaborate coding system that would systematically decrease or bundle their pay, force them to work on salaries, attack the fees of overpaid specialists (e.g, cardiologists, orthopedists, radiologists, ophthalmologists), decrease reimbursements for imaging procedures and laboratory work, and restructure and restrain hospital fees and penalize hospitals in every way possible.

For more on the critical issues facing physicians, go to the Physicians Foundation website, and download “The Patient Protection and Affordable Care Issue Beyond the Horizon into 2014, Part II.”
ObamaCare Consequences Reported This Last Day of July

Laws have consequences.


• Spending $15 billion more of government funds for doctor training will go disproportionally to Northeastern teaching hospitals, critics assert.

• Just 6 states and D.C. will use new Medicaid money to raise pay of primary care doctors.

• is not yet ready to enroll more people on November 15, 2014 – next signup period- due to multiple flaws on back-end of website.

• Government Accounting Office (GAO) concludes was badly planned , had insufficient oversight, and was poorly implemented, despite $840 million spent on its oversight and implementation.

• GOP-led House of Representatives votes 225-201 to sue Obama in first-of-its-kind lawsuit over historic constitutional checks-and-balance fight. Obama says it’s time to stop “hating;” GOP says there’s a time for hate and a time for lawyers.

• House of Representatives easily approves long-over-due VA $17 billion overhaul providing private care outside VA, hiring of more doctors and nurses, and rewriting rules to fire 5 senior executives.

• Humana, Wellpoint, and Cigna report lower earning or losses due to recent ObamaCare signups and higher than expected enrollments of sick, women, and older people, setting stage for health plan bailouts. Sign-up problems may sldo cause sharp spikes in health care premiums.
Video Link to my May 9 talk Before the American Association of Physicians and Surgeons in Minneapolis can be viewed at:

The talk, entitled “Direct Pay Independent Practice: Remnant of the Past and Wave of the Future,” is 20 minutes long.

My Kindle book, by the same name, is available on Amazon for $9.97

My new E-book Understanding ObamaCare: Travails of Implementation: Notes of a Health Reform Watcher is now on Amazon. The Kindle edition sells for $3.99. You may be interested in reading it since ObamaCare may determine the outcome of the November midterm elections. You may also order the book from Westbow Press, a division of Thomas Nelson Publishers, or its 35,000 outlets, which include bookstores, who can help order the book for you. This is the first of 3 E-books on ObamaCare. The second book will be called ObamaCare Revealed, and the third will be ObamaCare: Dead or Alive.
Richard L. Reece, MD, 1-860-395-1501,

Wednesday, July 30, 2014

Mark Twain and Health Reform

It’s not as bad as it sounds

Mark Twain (1835-1910), speaking of Richard Wagner’s music

Last night I was watching a PBS documentary on Mark Twain by Ken Burns on PBS . I was struck by Twain’s humor, worldliness, pride in America, racial tolerance, and grasp of how grass roots Americans think.

I got to thinking about what he would say about health reform. I went looking for Twain quotes that might apply to health reform and ObamaCare, and I came up with these.

• There’s a million in it!
In our day, it’s more like $3 trillion.

One of the brightest gems of New England weather is the uncertainty of it. Ditto, ObamaCare weather. It’s hot and cold with gusts of wind. But it's not the heat, it's the humility.

• The Child of Calamity!
Otherwise known as unintended consequences, such as 1 in 5 Americans deciding not to have any health plans at all. They have decided they're too costly.

I said I didn’t know. Obama’s stock answer when he learns of an unexpected scandal, “ I didn’t know. I learned it on the news.”

All the modern inconveniences. Such as coping with ACA rules and regulations and unexpectedly high premiums

When angry, count four, when very angry, swear. When very, very angry, vote.

Nothing so needs reforming as other people’s habits. Individuals in a Democracy are stubborn. They don’t want government mandating what they should do and not do and why and what they should pay and otherwise tinkering with their freedom.

Put all your eggs in one basket and – and watch that basket. The basket is known as the one-size-fits-all basket which contains all the services you or others might theoretically need.

• Noise proves nothing. Often a hen who merely laid an egg cackles as iif she had laid an asteroid.
Obama may have laid an egg, and no amount of cackle or crackle will make it into an omelette.

• Laws are sand, customs are rock.
Culture shapes our health system engine, throwing sand in the gears doesn’t make it run better.

• It is a difference of opinion that makes for horse racing.
And Senate races.

I could do it as easy as falling off a log. ObamaCare is not a log.

• The report of my death is an exaggeration.
So is the death of ObamaCare.

Familiarity breeds contempt and children. And frustrations with

All kings are rapscallions. That goes for politicians, too.

• All I know is that man is a human being – that is good enough for me.
And it is good enough for the uninsured and the middle class.

• When it doubt, tell the truth.
Sometimes that’s hard when you’ve broken your major promises about keeping your doctor and health plan and lowering premiums.

• Be good and you will be lonely; be good and you will be eccentric.
It’s easy to be good when you’re spending other peoples’ money, but you may end up lonely and eccentric.

• I have been reading the morning paper. I do it every morning - well knowing that I shall find in it the usual depravities and basenesses and hypocrisies and cruelties that make up civilization.
Welcome to the health care debate.

• I have had a “call” to literature, of a low order- i.e.humor. It is nothing to be proud of, seriously scribbling to excite the laughter of God’s creatures.
It is sad to say, but there is nothing funny to be said about ObamaCare.

Tuesday, July 29, 2014

Obama Impeachment as Fundraising Tactic

Dems Can’t Stop Talking About Impeaching President Obama

Mike Lillis, title of article in The Hill, July 29, 2014

Think about it, threat of impeachment,
Is heaven made for demagogic preachment.

Boehner may call impeachment talk a "scam".
But to Dems, it’s verbal battering ram.

You can call Obama’s critics racists,
You can even call them Tea Party fascists.

When Boehner proposes to sue the President,
Dems know what he has in mind isn’t pleasant.

The prez says, go ahead: sue me, impeach me.
He knows odds for success will not come to be.

Besides, in the land of Obama milk and honey,
Talk of impeachment raises gobs of money.

And if the President is expert at anything,
He's an expert on the fund raising thing.