Category Archives: Random Access

Random Access, the op-ed.

Senator Tries to Allay Fears

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A Senator “tries to allay fears”?

You gotta be kidding me. We ought to be far more afraid of what the pariahs in Washington do than anything else in the news this year.

Senator Bill Nelson (D-FL) doesn’t like the Baucus bill.

The Baucus bill (along with HR3200) cuts the projected growth in Medicare by $4-500 billion over the next 10 years. Senator Nelson is afraid of one part of the biils, the one that cuts Medicare payments to insurance companies providing Medicare Advantage policies. That’s about $40 billion over those 10 years.

Cutting government spending is a good thing, right?

Adding (or keeping) government spending is a bad thing, right?

Not so fast.

The pariahs of Washington have balanced the Health Care Takeover by cutting the one place (Medicare) that already shifts some 75% of the cost of health care to Somebody Else. Cutting another $40 or $50 billion out of Medicare sounds like a great plan. Until you notice that it is the usual political sleight of hand. Cutting another $40 or $50 billion out of Medicare just shifts some $40 or $50 billion more of the cost of health care to Somebody Else.

I fear being Somebody Else.

Allay allay in free.

Senator Nelson is right not like the Baucus bill. But he is right for the wrong reasons.

Last Day of Summer

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Today is the last day of summer here in North Puffin.

[sigh]

Since the rotation axis of the Earth is almost perpendicular to its orbital plane, today is the last day in which we have more light than dark. An equinox occurs twice a year when the constant tilt of the Earth’s axis aligns the Sun vertically above the Equator. In the coming winter months the Earth’s axis will incline farther and farther away from the Sun and we will gladly entertain thoughts of Global Warming as we stoke the wood stove in a vain attempt at Local Warming.

Schizophrenic weather.

Pretty cool here this morning at 48̊ outside and 60̊ in the bathroom when I arose. On the other hand, it is sunny and mild with the thermometer headed perhaps for the upper 70s. That means an afternoon for shorts and sandals bracketed by flannels morning and night. Not cold enough to start the wood stove. Too cold not to. My fingers and my bald head got colder just typing that.

I need a sale on toques.

Last night I sat on the deck looking out over the Lake. A couple of errant ducks paddled around thinking duck-like thoughts and a lone fisherman cast his line occasionally from a boat drifting in the shallows. The late afternoon sun continued to warm me after a couple of hours of yard work. The deck offered an oasis for an adult beverage, a bowl of peanuts, and the final chapters of Wicked Prey, John Sandford’s latest beach book set against the Republican convention last year in Minnesnowta. The sunset painted the sky as character Letty West returned to school with her new name.

The lush, kaleidoscopic foliage display will start soon. Some of the brain dead locust leaves here in North Puffin began dropping in July but our canopy will stay mostly green for another week or maybe tow. As a photographer, I will celebrate and luxuriate in the colors of our hills and valleys but I will miss the long days of summer.

People ask, this time of year, “What’s your favorite season?” Fall is grand for its colors. Winter brings quiet solitude and peace. Spring signals rebirth. Me, I like Daylight Savings Time.

Some pan Daylight Savings as an artificial construct but I find it more comfortable to have that extra hour of daylight during my waking hours. In fact, I believe … I believe … I believe we should insist that Congress prescribe an extra hour of daylight in every day, winter and summer, spring and fall. Congress believes it can legislate human behavior; why not change some natural law, too.

Today is the last day in which we have more light than dark. I hope that is not a metaphor for the political dark ages now approaching.

SODY POP

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A new tax on soda pop has been proposed as a way to “fight obesity” and, just as an aside, provide billions for health care reform.

Taxing a “sin” is a really really great idea that really really works as a methodology to eliminate the sin.

Smoking incidence as a percentage of the population has declined pretty much every year since 1965. In 1998, 29.9% of the population smoked some form of tobacco. In 1998, 24.0% smoked. According to the latest National Health Interview Survey, 22.8 percent of the general adult population now smokes.

The rising price of cigarettes has gotten a few of the 50 million or so smokers to quit. The rising price of cigarettes may have kept a few of the 250 million or so non-smokers from starting.

Peer pressure, advertising, and (most important) bans on smoking in most public places is the real driver in the moderate decline in percentage. In absolute numbers, more people smoke more cigarettes today than in 1965.

Yeppers, raising taxes really works to change behavior.

Taxing soda pop is not about fighting obesity. Taxing soda pop is all about raising new billions in taxes. Taxing soda pop will not reduce the costs of health care “reform,” either. Those billions will go into the general fund.

Have you noticed that, every time Congress collects more taxes, the deficit goes … up?

The idea that taking more money from us will make us behave better is snake oil, pure and simple.

Hey! Here’s a behavior we could change. How about we throw out the boneheads who want to sell us this snake oil.

Hitchhikers

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I picked up Jody Beauregard hitchhiking yesterday. Jody is a sweet, gentle man who has worked on Tom Ripley’s truck for the last decade or so. He takes off every fall to hunt and usually can put up enough meat to last him through the year. I had never seen him hitchhiking before.

“Where’s your Bronco?” I asked him. He usually cruised the roads in about a 1970 Ford with a cracked rear window and rust holes patched with political bumper stickers.

Jody took a while to think about the question.

“Engine calved,” he said.

“What do you plan to do?” I asked.

“Tom had promised to sell me his red Roadmaster for $1,500,” Jody said, “but he traded it in on that Clunker deal and got $4,500 for it. It was a pretty good car but I couldn’t pay that much.”

The CARS program took nearly 700,000 “clunkers” off the roads replaced, as the official press release told us, by far more fuel efficient vehicles. The program processed $2.877 billion in rebate applications and put more than half the cash into foreign brands. It has taken a lot of excellent cars off the road, including a 1985 Maserati Biturbo in Plattsburgh and Tom Riley’s very nice 16 year-old Buick, including all of the clunker stock the poor will drive tomorrow but none of the real clunkers the poor drive today. Good planning on the part of the peeps who would run U.S. health care, U.S. stockbrokers, and the U.S. auto industry.

Tom Ripley is my garbage man. Here in North Puffin, garbage collection is private enterprise; we all contract with one of the haulers who has a route in our area. I like Tom. He’s friendly, always on time, and comes right up on the porch to pick up the trash cans. He even (usually) latches the storm door when he puts the cans back. He owns a couple of used garbage trucks that he bought at the state auction and usually has a couple-three pickups that he runs around his route every Sunday before church. He had originally planned to trade in his ’73 Chevy pickup under the CARS program but it was too old. It is a terrific truck but it gets 10 mpg winter and summer. 10 mpg empty and 10 mpg pulling a camper. A little rusty and a lot beaten but still on the road after 36 years. But it was too old to qualify for the clunkers program.

Cars traded must have been manufactured less within the last 25 years, have a fuel economy of 18 miles per gallon or less, and be insured and registered and drivable.

“The 350 in that Roadmaster purred,” Jody told me. “Tom put tires on it just the year before last. Paint was great — actually the whole body was pretty darned good. And the A/C worked. I’ve never had a car with A/C that worked. No rust, runs good, like the song says.”

“I’ve ridden in it,” I said. “Pretty good car.”

Jody looked out the side window for a half a mile. Not many leaves are turning yet and no deer in the fields; he was thinking about the car.

“Yeah. It’s not fair, you know. I need a car now and there just nobody’s got anything to sell. People are even snapping up old beaters like my old Bronco ’cause they can’t find anything else to drive.”

“That Buick would have lasted you 10 more years.”

“Yeah,” he sighed. “Got better gas mileage than anything I’ve ever owned, too.”

How to Fix It, Part II

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Beware of those who would have you fight the alligators
When you really came to drain the swamp.

To fix the American Health Care system, we must start from this simple premise: Health care in America is fundamentally broken.

Proponents tout a million programs across the country as the ultimate savior of American medicine. They are not. Few address the number one problem, the cost of medicine, and none in a meaningful way. My plan takes on cost. U.S. health care will cost two trillion dollars this year or more than $6,600 per person for every man woman and child in the U.S. The President’s plan has no workable solution to reduce that $6,600 per person for every man woman and child in the U.S. and we apparently don’t even treat 41 million of those folks. If we don’t take on the cost, health care will cost $13,000/year for every man, woman, and child in America in nine years. Nine years.

A child born as the President speaks tonight will cost from $5,000 to $8,000 for a vaginal delivery to more than $12,000 for a cesarean delivery. Dramatically more if there are complications. In nine years, when those costs have doubled, that baby will be only in third grade.

“What’s your answer?” President Obama asked.

Here’s my answer, Mr. President. Remember Mark Twain. This plan shows how to redesign the system from scratch. It will work as long as we can keep it out of the hands of the U.S. Congress who would impose new fees on the health care industry as a way to “hold down costs.”

There is no distinctly native American criminal class
except Congress.
— Mark Twain

THE HARPERCARE PLAN
Hey, if the President can name it after himself, why can’t I? This is, after all, my story.

We may have the best or the worst doctors on Earth. I don’t care. We may have the best or the worst insurance clerks on Earth. I don’t care. We may have the best or the worst ambulances on Earth. I don’t care.

Fixing “health care” has nothing, absolutely nothing to do with what doctor lives in your town or how you pay to buy a drug or how you get to the clinic. We’ll handle all those issues after some groundwork.

At its most basic, Health Care has one essential job to do: to heal people. We can ask our Health Care system only to keep people from getting sick or injured and to treat people when they do. No more and no less.

To sculpt an elephant is easy. Take a big rock. Chip away everything that’s not an elephant. To design a health care plan, chip away everything that’s not a white elephant. That means to throw away the insurance companies and the Medicare and the VA. Throw away the free clinics and the Beverly Hills face lifters. Throw away the drug reps and the TV ads.

Start from scratch.

Start from what we actually need to fix. One patient. One disease or injury.

ORGANIZATION
A Commission from Scratch
The HarperCare plan creates a small multi-disciplined Independent Commission to analyze the problem and write the solution. We must hold the group to no more than 12 high ranking people from diverse industries. Why 12? That works for juries, doesn’t it?

  • A respected doctor
  • A successful hospital administrator
  • Some knowledgeable consumers/patients
  • An investigative journalist
  • Two triumphant entrepreneurs
  • A couple of senior engineers who understand Value Analysis
  • A couple of “Wildcards”
  • One famous, well-respected, smart guy.

The world listens when Dr. Bill Cosby evangelizes about education; we need the Bill Cosby of medicine.

What Rufus calls “wildcards” and I call loose cannons are the non-stakeholders who bring fresh ideas to the mix. Remember Mark Twain. Congress critters will never come up with a solution. They don’t have the skills or the knowledge or the patience and will not sit on the Independent Commission. Insurance CEOs, most docs, and even consumers all have too many ingrained prejudices. And it is important to leave out the singing pigs.

Build a support staff

  • CPAs (bean counters) to run the numbers
  • Researchers
  • A Value Analysis expert to serve as moderator.

AUTHORIZATION
I absolutely hate the idea of another czar. Unfortunately, this Independent Commission needs political power and ability to effect change.

  • This political commission must have Cabinet-level appearance and clout.
  • This Independent Commission must fold in one year.
  • Congress must have only pass/fail power over the findings.

CHARTER
The HarperCare Independent Commission must decide what diseases and injuries to treat, how to integrate discoveries of new diseases and treatments, how to track patient histories, and how to pay the bills. That’s it. No more. No less.

The HarperCare Independent Commission will craft the plan and draft the Federal and State legislation needed both to authorize the plan and to assure Congress cannot re-engineer it.

PROCESS
The HarperCare Independent Commission will use the two keys to success for designing a new system or product: (1) Use a structured thought process based entirely on function; and (2) Beat on the participants to keep them focused. Commission members must check their pre-judgements at the door. The Independent Commission will use a five-stage process grounded in Value Analysis: Prepare a list of needs, Gather information, Generate concepts and programs, Analyze/Evaluate the programs, and Write the Law.

Many people including the President want to list current state of the art (how the government collects the revenue, who has the best hospital, where patients travel, what costs be shed, and so on) before anything else gets done. That’s where we are now. That technique guarantees tunnel vision. It assures that every President, congressman, insurer, doctor, and consumer will pimp for patching the old existing Checker Cab with some fancy new air conditioning when we really must create a sleek new race car out of thin air.

The Independent Commission must list what the Health Care system must do first. In detail.

They can go gather information about what’s on the ground after building the list, but they must not taint the function list with their prior knowledge of treatments or payment plans.

A. PREPARE NEEDS

1. List required functions (what the Health Care system must do)
a. Use a measurable verb-noun format such as “repair laceration” or “diagnose strep throat.”
b. Generalize the function to “treat accident trauma” or “treat infection.”
c. This will be a very long list but it is crucial that it does not attempt to create a dictionary of illness — rather, it will become an encyclopedia of disease, injury and wellness categories.

3. Decide how alternative therapies will be measured and quantified

B. GATHER INFORMATION

1. List current state of art in prevention
a. How is each disease or injury category typically prevented today
b. What non-traditional prevention techniques are used in each disease or injury category today?
c. What prevention techniques are on the horizon?
d. What prevention techniques have been made obsolete by newer or more expensive ideas?
e. Who is doing it?
f. What could they do?
g. What must prevention not do?

2. List current state of art in treatment
a. How is each disease or injury category typically treated today
b. What non-traditional treatment systems are used in each disease or injury category today?
c. What treatments are on the horizon?
d. What treatments have been made obsolete by newer or more expensive therapies?
e. Who is doing it?
f. What could they do?
g. What must treatment not do?

3. List current state of art in payment
a. How is each disease or injury or treatment paid for today?
b. Who is doing it?
c. What does it cost to pay the bills?

C. GENERATE PROGRAMS

1. What (else) will do the jobs listed in the function list?
a. Look at traditional, nontraditional, outdated, and new treatments
b. Is anyone doing that now? Who?
c. What could their treatment do?
d. What must their treatment not do?
e. What does it cost?

2. Measure and quantify alternatives
a. What are the alternate ways of meeting requirements?
b. What else can perform the desired function?
c. Does it accomplish expected results?
c. What does it cost?

D. EVALUATE PROGRAMS

1. Look at all the methods found in Steps B and C. Look at all the existing doctors office and clinic and hospital practices found in Step C. Which ideas are the best?

2. Develop and expand ideas
a. What are the impacts?
b. What is the performance?
c. What does it cost?

E. PRESENT RESULTS

1. Write the Law

2. Take the new Health Care System to the People.

RESULTS
Remember Mark Twain. If we have the will, 2009 can be the year we find the way.

At the end of this process we will have a 10-page law for a health care system that heals people. We will have a health care system that keeps people from getting sick or injured and to treats people when they do, a health care system that costs just half or less of our 2009 spending nationwide, and a health care system that holds future cost increases to the rate of inflation.

For the record, I have the professional and personal experience to back up this plan. I was born in a hospital and grew up immersed in a hospital auxiliary that my mother chaired. I founded a rural health center and served on the Board of Incorporators of a regional hospital. Harris Corporation trained me in Value Analysis, a process tool I have used successfully to design products and systems.