Category Archives: Throw Da Bums Out

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.

How to Fix It, Part I

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Rufus challenged me to create a Nobel-level treatise on fixing the health care system. We’ll start from a simple premise: Health care in America is fundamentally broken.

New England Journal of Medicine reports that “Health care spending represents a growing share of our national income and is projected to increase from 16% of the gross domestic product today to 20% by 2018.”

Regular readers will remember that we built our current Health Care system pretty much on the Johnny Cash model for his 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 automobile. It is an amalgam of rubber bands, reams of forms, and television advertising all held together with sloganeering bumper stickers and Post-It™ glued dollar bills.

The President will address a joint session of Congress in prime time on Wednesday, September 9. He hopes to refocus attention on his own blueprint for ObamaCare.

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

Senator Harry Reid and Speaker Nancy Pelosi (D-CA) released this statement to the president: “Our nation is closer than ever to achieving health insurance reform that will lower costs, retain choice, improve quality and expand coverage.”

Remember Mark Twain.

Everybody in this discussion, from the most fervent ObamaCare supporter to the most ardent contrarian, has a good answer for patching up the rusty old car that runs on three cylinders and has two flat tires. It might keep us going to the next exit, but it won’t carry the family across the country on vacation.

The same Democrats pushing patches on the current system want to reinvent the automobile from the ground up but all they want to do with health care is find a few more people to cover and a way to make taxpayers pay for it.

The same Republicans opposing changes to the current system want to keep that clunker but all they can to do with health care is try to divert the money their counterparts want to flow to Washington.

“Foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States,” Nicholas D. Kristof wrote in the N Y Times.

Sorry, Mr. Kristof. You’re w-w-w-w-w-w-wrong. Americans don’t reject reform and Americans don’t want the current system. Americans reject a situation that will drive the entire country into bankruptcy when they get sick.

There are a million great individual programs; most have been reported — in the news, on blogs, and by everyone with a talk show — as the ultimate savior of American medicine. They are not. No one will take on the number one issue: cost. Saving grandmama is a laudable goal but saving grandmama and using the ER as a walk in clinic and requiring nine insurance clerks for every doctor and the thousand other complaints are the reason 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. ObamaCare has no (nada, de zero zip) provisions 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.

Guess what adding 41 million people to the rolls will cost.

Trouble is, programs like Oregon Health Plan ration care to hold down costs.
Trouble is, programs like Whole Foods’ HDHP ignore underlying costs by teaching patients to use fewer services.
Trouble is, programs like Medicare hold down costs by shifting them to Somebody Else.

I’m tired of being Somebody Else.

“What’s your answer?” President Obama asked in Ohio on Monday.

Remember Mark Twain.

“What’s your answer?” the president asked because he didn’t expect a response.

Here’s my answer, Mr. President. Tomorrow, before the President speaks, I will show how to redesign the system from scratch. Do not expect to hear in the hallowed halls of Congress a single word of what you read here.

Next up, How to Fix It, Part II

Labor Day? Really?

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On this day named for Laborers on which we do not Work, it is worth noting that politicians do not create jobs, no matter what they say.

The Van Jones brouhaha is about jobs.

Nancy Sutley, White House Council on Environmental Quality and Van Jones’s boss said in a weekend statement, “Over the last six months, he has been a strong voice for creating 21st-century jobs…”

Uh huh. Politicians do not create jobs.

On her site speaker.gov, Nancy Pelosi (D – CA) writes about the final G.R.A.F.T. Act, “This legislation will jumpstart our economy, create and save 3.5 million jobs.” She uses the phrase “create jobs” or “create really really outstanding jobs” 41 times

Uh huh. Politicians do not create jobs.

The site michigan.gov trumpets that, “Thanks to Governor Granholm’s 21st Century Jobs Fund, this new economy is actually taking shape… The first round of awards has already provided funding to 67 companies and projects, creating thousands of jobs…”

Uh huh. Politicians do not create jobs.

Michigan is closer to the truth. Politicians give away OPM to businesses that create jobs. “OPM” is “Other People’s Money,” something politicians think they have an infinite supply of and that We the [Other] People know is running out.

It is Labor Day and we are not laboring. Politicians will create no jobs today, either, but they will walk in parades and pretend they have.