I'm posting tonight as the final tallies are being made of Iowa's caucus votes. With Mike Huckabee's strong victory, the mainstream conservatives who make up the backbone of the Republican party have spoken loudly and clearly. The elitist "thought-leaders" of the GOP have been humbled by a man whose very campaign is anathema to establishment Republicans. The margin of Huckabee's victory over Romney tonight surprised even me, and I've been hoping for a Huckabee win for months. I will say that Huck's margin would have been even greater but for his recent unwarranted attack on the Bush foreign policy, but that error will likely be forgotten in the avalanche of favorable press from tonight's big victory. Even now, the television talking heads do not appreciate the strength of the Main Street Steamroller, but I believe Huckabee can win the GOP nomination and the Presidency.
How can Mitt Romney overcome the hard truth that three out of four Iowa GOP caucus voters, after intense media exposure to Romney, chose someone else? I don't think Romney can overcome tonight's result. McCain will clean Romney's clock in New Hampshire five days from now, but I do not believe Republicans will nominate McCain for President. McCain has alienated too many GOP faithful with his apostasies on immigration, tax cuts, and First Amendment free speech restrictions. I also do not believe Thompson's 3rd place tie with McCain tonight is enough to keep his candidacy alive. Huckabee will blow him and everyone else away in South Carolina, forcing Thompson's withdrawal and leaving Giuliani as the sole alternative to Huckabee.
I am surprised by the results on the Democratic side. I would not have thought, prior to today, that Hillary could possibly finish worse than second in Iowa, but it looks like she may finish behind Edwards. I do not believe Edwards did well enough tonight to survive. He needed a victory or at least a close second to make a legitimate case for viability. I'm happy with this result, because I feared Edwards as the strongest general election threat for the Democrats. Obama's strength amazes me, and I wonder how Hillary will frame the debate in New Hampshire over the next five days. I suspect lots of muck and mud will be thrown at Obama in New Hampshire, and if Hillary loses that primary, look out! At that point, Democrats would be in full self-destruct mode.
I look forward to the next five days. We live in interesting times.
Thursday, January 3, 2008
Saturday, December 22, 2007
Huck's Mistake Involves Integrity
"George W. Bush has resolutely led our nation on a new course, a course not sought by America on September 11, 2001, but a course that rightly affirmed the value of honor and liberty and life. I thank God for his wise leadership and his calming and steadfast policies, policies that in some ways with hindsight could have admittedly been improved, but policies all too quickly attacked, and now being vilified despite the best news from Iraq in over a year." These are the sentences that should headline any foreign policy apologetic by any mainstream conservative seeking the Presidency.
Unfortunately, Governor Huckabee has sunk disappointingly to the level of others who've forgotten the GOPs Eleventh Commandment. Not only has the lightly regarded pseudo-Commandment been breached, far more Huckadamage has been done with his patently fact-challenged attack on the Bush Administration's "arrogant bunker mentality." I say patently false because of those pesky things, facts, that get in the way of a good poll-tested focus group opinion. Never mind the support of England, Poland, Australia, and numerous other countries. Military personnel of these countries are fighting and dying, not because they're stupid, but because their nations' leaders see the same Islamofascist threat that Bush sees.
I don't think a man of integrity ought to be so driven for personal gain that he impugns his own President in time of war and energizes those opponents of our nation's success, both foreign and domestic. I especially believe this when the President has plainly stated his case for his actions, and when after hard times his plans seem to be beginning to work.
Huckabee's poll numbers took a noticeable dip a couple of days ago, a timing coincident with his "arrogant bunker mentality" quote. That Huckabee would write such a screed gives one pause to reconsider other claims of ethical lapse against him. My point is not that the other accusations have merit, nor would they have any traction absent "arrogant bunker mentality," but it is that this whole blunder was completely and totally avoidable, and is even now fixable with a simple apology. I pray that an infection of good sense will gently waft throughout Huckabee headquarters, and that said apology will be forthcoming.
Unfortunately, Governor Huckabee has sunk disappointingly to the level of others who've forgotten the GOPs Eleventh Commandment. Not only has the lightly regarded pseudo-Commandment been breached, far more Huckadamage has been done with his patently fact-challenged attack on the Bush Administration's "arrogant bunker mentality." I say patently false because of those pesky things, facts, that get in the way of a good poll-tested focus group opinion. Never mind the support of England, Poland, Australia, and numerous other countries. Military personnel of these countries are fighting and dying, not because they're stupid, but because their nations' leaders see the same Islamofascist threat that Bush sees.
I don't think a man of integrity ought to be so driven for personal gain that he impugns his own President in time of war and energizes those opponents of our nation's success, both foreign and domestic. I especially believe this when the President has plainly stated his case for his actions, and when after hard times his plans seem to be beginning to work.
Huckabee's poll numbers took a noticeable dip a couple of days ago, a timing coincident with his "arrogant bunker mentality" quote. That Huckabee would write such a screed gives one pause to reconsider other claims of ethical lapse against him. My point is not that the other accusations have merit, nor would they have any traction absent "arrogant bunker mentality," but it is that this whole blunder was completely and totally avoidable, and is even now fixable with a simple apology. I pray that an infection of good sense will gently waft throughout Huckabee headquarters, and that said apology will be forthcoming.
Saturday, December 15, 2007
Huckabee's Mistake
Here's a quick post on a wonderful snuggly rainy Saturday. Family games in front of the fire and Miracle On 34th Street are on tap for later. I wanted to post today because I'm concerned about the first real mistake I've seen the Huckabee campaign make.
Mike Huckabee's decision to write an article for a respected (ie mainstream elites) foreign policy magazine was probably necessary, but he's made a pretty severe tactical error by his forceful criticism of the Bush Administration's so-called arrogant "bunker mentality." What, pray tell, would Huckabee have had George Bush do in a post-9/11 environment when the consensus of the intelligence community pointed toward Irag's possession of weapons of mass destruction? Remember that the leadership of France and Germany based their foreign policy on opposition to America's interests. Remember the noxious corruption of the UN, evidenced in the Oil For Food scandal. Remember that, conversely, many nations, including England, Australia, Poland, and others have been staunch allies of Bush Administration policies. Remember also that, pre-9/11, candidate George Bush campaigned on a platform of "humility" in American foreign policy. The recognition of the civilized world's mortal danger from Islamic terrorists forced the change in Bush's foreign policy approach, and thank God for George Bush's willingness to face the threat. I certainly don't agree with everything the President has done, but it's helpful to no one at this point for Republican Presidential candidates to use such incendiary rhetoric.
Not only am I disappointed in Huckabee for making these statements, but it raises legitimate questions about his willingness to stand up to the liberal elites' conventional wisdom on any number of other issues. I've been a huge Huckabee supporter, in part because of his willingness to stand up for social and cultural truths unpopular on the East and West Coasts. Huckabee allayed my initial concerns about his commitment to limited government and personal liberty with his Second Amendment support and his advocacy of the FAIR Tax. If his purpose in writing this article was for short-term media approbation, his character is not as strong as I'd thought. If he actually believes such silly claptrap, his judgment and philosophy are suspect. I admit I haven't read Huckabee's article, but only seen excerpts from it, but even if the reporting on the article is incorrect, Huckabee should have had the good sense to see how the article would be portrayed.
None of the exogenous attacks on Huckabee that I've seen could harm him significantly, in my opinion. Unfortunately, this unnecessary and self-inflicted blunder has the potential to stall the enthusiasm of his supporters and his appeal to those voters for whom national security is the paramount issue. Even if Huckabee survives the Romney and Thompson attacks in Iowa and New Hampshire, this article supplies Rudy Giuliani with plenty of ammunition to use against Huckabee later in the nominating process. What a big mistake! I hope Mike Huckabee has the good sense to back away from these comments, and the quicker the better.
Mike Huckabee's decision to write an article for a respected (ie mainstream elites) foreign policy magazine was probably necessary, but he's made a pretty severe tactical error by his forceful criticism of the Bush Administration's so-called arrogant "bunker mentality." What, pray tell, would Huckabee have had George Bush do in a post-9/11 environment when the consensus of the intelligence community pointed toward Irag's possession of weapons of mass destruction? Remember that the leadership of France and Germany based their foreign policy on opposition to America's interests. Remember the noxious corruption of the UN, evidenced in the Oil For Food scandal. Remember that, conversely, many nations, including England, Australia, Poland, and others have been staunch allies of Bush Administration policies. Remember also that, pre-9/11, candidate George Bush campaigned on a platform of "humility" in American foreign policy. The recognition of the civilized world's mortal danger from Islamic terrorists forced the change in Bush's foreign policy approach, and thank God for George Bush's willingness to face the threat. I certainly don't agree with everything the President has done, but it's helpful to no one at this point for Republican Presidential candidates to use such incendiary rhetoric.
Not only am I disappointed in Huckabee for making these statements, but it raises legitimate questions about his willingness to stand up to the liberal elites' conventional wisdom on any number of other issues. I've been a huge Huckabee supporter, in part because of his willingness to stand up for social and cultural truths unpopular on the East and West Coasts. Huckabee allayed my initial concerns about his commitment to limited government and personal liberty with his Second Amendment support and his advocacy of the FAIR Tax. If his purpose in writing this article was for short-term media approbation, his character is not as strong as I'd thought. If he actually believes such silly claptrap, his judgment and philosophy are suspect. I admit I haven't read Huckabee's article, but only seen excerpts from it, but even if the reporting on the article is incorrect, Huckabee should have had the good sense to see how the article would be portrayed.
None of the exogenous attacks on Huckabee that I've seen could harm him significantly, in my opinion. Unfortunately, this unnecessary and self-inflicted blunder has the potential to stall the enthusiasm of his supporters and his appeal to those voters for whom national security is the paramount issue. Even if Huckabee survives the Romney and Thompson attacks in Iowa and New Hampshire, this article supplies Rudy Giuliani with plenty of ammunition to use against Huckabee later in the nominating process. What a big mistake! I hope Mike Huckabee has the good sense to back away from these comments, and the quicker the better.
Tuesday, December 11, 2007
Quick Political Round-Up
I'm writing tonight after a several week period of being too busy for my own good, and too busy to post. Tonight's subject is political prognostication. I'm gratified to see, in the GOP race for the Presidential nomination, that my favored candidate, Mike Huckabee, is surging. Huckabee has succeeded in courting the mainstream media, who do not understand that a big-time pastor has the same skill set as a major corporate CEO. I now believe Huckabee will win Iowa, and he is approaching an even money shot at winning the nomination. I do not believe any of the attacks on Huckabee I've seen so far will stick, and the attacks may actually serve to legitimize him.
I still think Giuliani is the national front-runner. Romney will probably be crippled after New Hampshire, and finished after South Carolina. Here's why Romney will fade: John McCain will exceed expectations in New Hampshire, probably finishing a close second to Romney. A narrow and fading victory by Romney in New Hampshire will further shred an image that will be in tatters after Iowa. I don't think McCain has enough mainstream Republican support to capitalize on what I expect to be his New Hampshire success. Huckabee will dominate South Carolina, forcing Thompson's withdrawal. This will set up the February 5 battle which will probably decide the nomination, with the advantage to Giuliani over Huckabee on the basis of money and organization. This scenario should not be surprising, as I've for months predicted the GOP fight would wind up being between EITHER Huckabee or Thompson and Giuliani or Romney. Thompson's fizzle is the direct result of Huckabee's fire, though I had expected a better campaign performance than Thompson has thus far shown. It's all thrilling to watch for a political junkie like me. We'll see how my predictions turn out, but right now Huckabee is riding his wave, and I'm right there with him.
On the Democratic side, it's fun to watch Hillary squirm. Can you imagine the staff meetings with Hillary over the past two weeks as her internal polling has tanked? I have written before of Hillary's political tin ear, which I've hoped would doom her general election prospects. Until recently, I've never thought, though, that she could lose the Democratic nomination. Her organization looked too strong and her competition too weak. I've had to rethink this over the past two weeks, but I still cannot credibly imagine the Democrats handing their nomination to a candidate as weak as Obama or Edwards. If Hillary does indeed lose Iowa, and five days later does not win strong in New Hampshire, look for crisis-management mode among the Democrat muckety-mucks. It will likely manifest itself in the form of a major Draft Al Gore movement. All bets would be off at that point, with a major dogfight between Gore and the Clintons. In any case, I believe that scenario unlikely, and I still think Hillary is likely to win the Democratic nomination. Never underestimate the Clintons. They are capable of anything.
I still think Giuliani is the national front-runner. Romney will probably be crippled after New Hampshire, and finished after South Carolina. Here's why Romney will fade: John McCain will exceed expectations in New Hampshire, probably finishing a close second to Romney. A narrow and fading victory by Romney in New Hampshire will further shred an image that will be in tatters after Iowa. I don't think McCain has enough mainstream Republican support to capitalize on what I expect to be his New Hampshire success. Huckabee will dominate South Carolina, forcing Thompson's withdrawal. This will set up the February 5 battle which will probably decide the nomination, with the advantage to Giuliani over Huckabee on the basis of money and organization. This scenario should not be surprising, as I've for months predicted the GOP fight would wind up being between EITHER Huckabee or Thompson and Giuliani or Romney. Thompson's fizzle is the direct result of Huckabee's fire, though I had expected a better campaign performance than Thompson has thus far shown. It's all thrilling to watch for a political junkie like me. We'll see how my predictions turn out, but right now Huckabee is riding his wave, and I'm right there with him.
On the Democratic side, it's fun to watch Hillary squirm. Can you imagine the staff meetings with Hillary over the past two weeks as her internal polling has tanked? I have written before of Hillary's political tin ear, which I've hoped would doom her general election prospects. Until recently, I've never thought, though, that she could lose the Democratic nomination. Her organization looked too strong and her competition too weak. I've had to rethink this over the past two weeks, but I still cannot credibly imagine the Democrats handing their nomination to a candidate as weak as Obama or Edwards. If Hillary does indeed lose Iowa, and five days later does not win strong in New Hampshire, look for crisis-management mode among the Democrat muckety-mucks. It will likely manifest itself in the form of a major Draft Al Gore movement. All bets would be off at that point, with a major dogfight between Gore and the Clintons. In any case, I believe that scenario unlikely, and I still think Hillary is likely to win the Democratic nomination. Never underestimate the Clintons. They are capable of anything.
Saturday, September 1, 2007
Thankful Thoughts
I'm posting today from beautiful Perdido Key in Orange Beach, Alabama. We arrived last night and have had a glorious morning playing on the beach. The weather is great, and the beach is perfect--with just enough other beachgoers for our children to make friends and have playmates, but by no means crowded. I've already had the chance to eat some gumbo and shrimp, so life is good.
It's an emotional trip for me. It's my first visit here in three years, since we evacuated this very place on the day Hurricane Ivan hit. Our two bedroom Gulf-front condo (which we co-own with another couple and the bank) took a pounding, and the restoration has been slow, difficult, expensive, maddening, and depressing. When I was here last, my children were babies, I was a partner and board member of one of the largest multi-specialty physician practices in the Southeast, I was busy in church teaching Sunday school every week and serving on the pastor search committee,and I was not yet forty years old. Today, I'm an exhaused almost-43 year old who has weathered a tumultuous year building my own solo internal medicine practice, a venture which has been both consuming and liberating, both frightening and comforting, and stressful yet strengthening.
This brings me to the title of this post--thankfulness. I am most thankful to my wonderful wife, who has stood by me while I have upended her life, and who has been instrumental in building what is now clearly a successful solo medical practice. Thanks to her unconditional love and her willingness to allow me to take risks, we have built what I believe is a unique medical practice, one that is making a difference in people's lives, and one that is positioned to withstand the turbulent times ahead for primary care medicine. Not only has Mary Kaye stood by me, steadfast, but she has home-schooled our children with measurable success, and along the way she's managed to complete re-licensure as a physical therapist to boot, providing much-needed financial support for our family during my practice start-up. Not one woman in a million could have accomplished what she's done, and I'm so proud of her I could burst. Oh yes, that's not to mention that I've also relied on her to take the lead in all the dealings required for restoration of our condo. In all things, in every aspect of my life, she has made better anything I've been part of. I love you, Mary Kaye.
I'm also thankful to God, who has blessed me with Mary Kaye and three wonderful, intelligent, rambunctious, and unique children. They are a joy. Granted, they are expensive, tiring, and exasperating, but they are mainly a joy. I revel in them even as I take seriously my responsibility to raise them. God has also blessed my practice, and I see His hand evident whenever I take the time to look. A close friend who has been a pastor has remarked to me how energizing it is to minister to people, even in the face of an exhausting schedule, and I see that also in my work--I feel a God-given sense of satisfaction and fulfillment when I help people through my medical practice. I almost feel that to talk about that God-given motivation may somehow cheapen it or open it to ridicule, so I won't dwell on it, but it's there, and it's real, and I'm thankful to God for His blessing in bestowing it.
The kids are studying the founding of America in their history lessons, and their study has opened my eyes anew to God's blessings on our nation. We all ought to be thankful to be Americans. I will often rant and criticize about political issues, but I must remember to be more thankful for our system of government. I do believe God had a special and unique plan in the founding of our nation, though I shudder in fear at how far we've strayed from His principles.
I'll close for now, with plans to post again during our vacation. Beach and nap and seafood are calling, and I'm thankful for them, as well...
It's an emotional trip for me. It's my first visit here in three years, since we evacuated this very place on the day Hurricane Ivan hit. Our two bedroom Gulf-front condo (which we co-own with another couple and the bank) took a pounding, and the restoration has been slow, difficult, expensive, maddening, and depressing. When I was here last, my children were babies, I was a partner and board member of one of the largest multi-specialty physician practices in the Southeast, I was busy in church teaching Sunday school every week and serving on the pastor search committee,and I was not yet forty years old. Today, I'm an exhaused almost-43 year old who has weathered a tumultuous year building my own solo internal medicine practice, a venture which has been both consuming and liberating, both frightening and comforting, and stressful yet strengthening.
This brings me to the title of this post--thankfulness. I am most thankful to my wonderful wife, who has stood by me while I have upended her life, and who has been instrumental in building what is now clearly a successful solo medical practice. Thanks to her unconditional love and her willingness to allow me to take risks, we have built what I believe is a unique medical practice, one that is making a difference in people's lives, and one that is positioned to withstand the turbulent times ahead for primary care medicine. Not only has Mary Kaye stood by me, steadfast, but she has home-schooled our children with measurable success, and along the way she's managed to complete re-licensure as a physical therapist to boot, providing much-needed financial support for our family during my practice start-up. Not one woman in a million could have accomplished what she's done, and I'm so proud of her I could burst. Oh yes, that's not to mention that I've also relied on her to take the lead in all the dealings required for restoration of our condo. In all things, in every aspect of my life, she has made better anything I've been part of. I love you, Mary Kaye.
I'm also thankful to God, who has blessed me with Mary Kaye and three wonderful, intelligent, rambunctious, and unique children. They are a joy. Granted, they are expensive, tiring, and exasperating, but they are mainly a joy. I revel in them even as I take seriously my responsibility to raise them. God has also blessed my practice, and I see His hand evident whenever I take the time to look. A close friend who has been a pastor has remarked to me how energizing it is to minister to people, even in the face of an exhausting schedule, and I see that also in my work--I feel a God-given sense of satisfaction and fulfillment when I help people through my medical practice. I almost feel that to talk about that God-given motivation may somehow cheapen it or open it to ridicule, so I won't dwell on it, but it's there, and it's real, and I'm thankful to God for His blessing in bestowing it.
The kids are studying the founding of America in their history lessons, and their study has opened my eyes anew to God's blessings on our nation. We all ought to be thankful to be Americans. I will often rant and criticize about political issues, but I must remember to be more thankful for our system of government. I do believe God had a special and unique plan in the founding of our nation, though I shudder in fear at how far we've strayed from His principles.
I'll close for now, with plans to post again during our vacation. Beach and nap and seafood are calling, and I'm thankful for them, as well...
Saturday, August 4, 2007
Progress Report
Today's post will not be my typical laser-focused gem of nuanced and knowledgeable insight. I am fighting off a cold and Mary Kaye is off to a scrapbooking convention, so today is a lazy day home with the kids. It is an opportunity to post on several topics I've touched on in the past, however.
Plans are apace for the Open House my office is having August 23. The Open House is being held to celebrate the completion of our first year of practice. We never held a Grand Opening because we were too busy from the start, but I wanted to celebrate what I believe is a successful start for our efforts at delivering primary health care in a different and better patient-centered model. We also wanted folks to see our expanded office space, which we just finished remodelling a couple of weeks ago. We have almost doubled our office's square footage, and have doubled the number of patient exam rooms. Another reason for the Open House is to introduce Tina McCall, our new nurse practitioner, to my patients. Tina's presence will help us tremendously as we strive to be conveniently available to patients, and we want to give folks a chance to meet her, as well as to publicize that work-in appointments, especially on Fridays, will be more available. Finally, we wanted to use the Open House in a low key manner to introduce the new Premier Wellness option that we are now offering. As I've noted before, Premier Wellness is an optional retainer-based program in which patients pay an annual or monthly fee in return for a wide-ranging annual Wellness Review, as well as guarantees of quicker work-ins and generally enhanced levels of office time spent discussing health issues.
I have developed the Premier Wellness program in an effort to insulate myself and my patients from what I fear are impending devastating public policies regarding reimbursement for health care services. My fear is that, as third party/government payors exert more and more influence on health care policy, the traditional and precious relationship between doctor and patient will be irreparably harmed. Only a socialist would argue that the individual's best interest is always concordant with society's, or the government's. Unless the patient is paying for the service, someone else is calling the tune. The practical result, I fear, is that without Premier Wellness or something similar, all primary care doctors will be forced into becoming "office visit mills" with limited time and little satisfaction for both patient and doctor. If I can develop a model in which patients feel valued and empowered and really "cared" for, a model in which the patients themselves decide the value of the services and whether to pay for them, then I will have protected some modicum of the traditional relationship between doctors and patients. I will have also salvaged that ideal which should motivate physicians--the concept of servanthood.
Too often, conservatives cede the moral high ground to liberals who preach generosity and unity, but the truth is that none of the ideals I've spoken of above can occur unless the staff is paid, the rent is paid, and the monthly bills are paid. I love the old joke about liberals, that they're so generous they'll give you the shirt off someone else's back. I'm here in the trenches, trying to care for folks, but I'm also saying that providing the care people want costs money, and that's a truth that needs to be faced. My Wellness option isn't for everyone, but neither is any other single option. The thrust of my position, however, is that patients need to control the system, and that will not happen unless they are also paying the bills.
With regard to Premier Wellness, I'm excited that the response to my initial offering has exceeded my expectations. I have already seen one patient this week as a Wellness patient, and I believe that this patient felt , dare I say it, pampered and well cared for. I was able to take the time to speak with a specialist about one of this patient's health problems, and arrangements were made for an expeditious office visit with the specialist. This was all able to be accomplished because I was able to allocate extra time with this patient. Time--that is the most important asset I have to offer patients, and the commodity that patients are being deprived of in today's system.
I am also trying to find other ways to add value to the product I offer Wellness patients. I have arranged a substantial discount for membership at a local water-based therapy center, and I hope to arrange access to an entity that offers gym and exercise equipment. I would also like to have my Wellness patients meet annually with a dietitian for nutritional counselling, and I'm going to try to add that benefit at no extra cost to the patient. Offering these and other benefits will help these patients achieve their goal of good health and access to personalized care that is convenient for them. I am proud to be part of the process.
I'll close with a word about Presidential politics. It goes without saying that all the Democratic proposals regarding health care are horrible. Among the Republicans, there is a glimmer of sense. Giuliani, whom I've slammed for his pro-abortion stance, has made headlines recently with an outline which seems to try to apply market principles to health care spending by making individual health care premiums tax deductible. This proposal is good in that it weakens the artificial and harmful linkage between employment and health insurance. Mike Huckabee, who I believe is the most engaging and credible conservative in the race, has a good strong tax policy proposal called the FAIR tax. I need to learn more about his health care spending proposals. Huckabee needs to do well in an upcoming Iowa straw poll next week. I hope he does.
Plans are apace for the Open House my office is having August 23. The Open House is being held to celebrate the completion of our first year of practice. We never held a Grand Opening because we were too busy from the start, but I wanted to celebrate what I believe is a successful start for our efforts at delivering primary health care in a different and better patient-centered model. We also wanted folks to see our expanded office space, which we just finished remodelling a couple of weeks ago. We have almost doubled our office's square footage, and have doubled the number of patient exam rooms. Another reason for the Open House is to introduce Tina McCall, our new nurse practitioner, to my patients. Tina's presence will help us tremendously as we strive to be conveniently available to patients, and we want to give folks a chance to meet her, as well as to publicize that work-in appointments, especially on Fridays, will be more available. Finally, we wanted to use the Open House in a low key manner to introduce the new Premier Wellness option that we are now offering. As I've noted before, Premier Wellness is an optional retainer-based program in which patients pay an annual or monthly fee in return for a wide-ranging annual Wellness Review, as well as guarantees of quicker work-ins and generally enhanced levels of office time spent discussing health issues.
I have developed the Premier Wellness program in an effort to insulate myself and my patients from what I fear are impending devastating public policies regarding reimbursement for health care services. My fear is that, as third party/government payors exert more and more influence on health care policy, the traditional and precious relationship between doctor and patient will be irreparably harmed. Only a socialist would argue that the individual's best interest is always concordant with society's, or the government's. Unless the patient is paying for the service, someone else is calling the tune. The practical result, I fear, is that without Premier Wellness or something similar, all primary care doctors will be forced into becoming "office visit mills" with limited time and little satisfaction for both patient and doctor. If I can develop a model in which patients feel valued and empowered and really "cared" for, a model in which the patients themselves decide the value of the services and whether to pay for them, then I will have protected some modicum of the traditional relationship between doctors and patients. I will have also salvaged that ideal which should motivate physicians--the concept of servanthood.
Too often, conservatives cede the moral high ground to liberals who preach generosity and unity, but the truth is that none of the ideals I've spoken of above can occur unless the staff is paid, the rent is paid, and the monthly bills are paid. I love the old joke about liberals, that they're so generous they'll give you the shirt off someone else's back. I'm here in the trenches, trying to care for folks, but I'm also saying that providing the care people want costs money, and that's a truth that needs to be faced. My Wellness option isn't for everyone, but neither is any other single option. The thrust of my position, however, is that patients need to control the system, and that will not happen unless they are also paying the bills.
With regard to Premier Wellness, I'm excited that the response to my initial offering has exceeded my expectations. I have already seen one patient this week as a Wellness patient, and I believe that this patient felt , dare I say it, pampered and well cared for. I was able to take the time to speak with a specialist about one of this patient's health problems, and arrangements were made for an expeditious office visit with the specialist. This was all able to be accomplished because I was able to allocate extra time with this patient. Time--that is the most important asset I have to offer patients, and the commodity that patients are being deprived of in today's system.
I am also trying to find other ways to add value to the product I offer Wellness patients. I have arranged a substantial discount for membership at a local water-based therapy center, and I hope to arrange access to an entity that offers gym and exercise equipment. I would also like to have my Wellness patients meet annually with a dietitian for nutritional counselling, and I'm going to try to add that benefit at no extra cost to the patient. Offering these and other benefits will help these patients achieve their goal of good health and access to personalized care that is convenient for them. I am proud to be part of the process.
I'll close with a word about Presidential politics. It goes without saying that all the Democratic proposals regarding health care are horrible. Among the Republicans, there is a glimmer of sense. Giuliani, whom I've slammed for his pro-abortion stance, has made headlines recently with an outline which seems to try to apply market principles to health care spending by making individual health care premiums tax deductible. This proposal is good in that it weakens the artificial and harmful linkage between employment and health insurance. Mike Huckabee, who I believe is the most engaging and credible conservative in the race, has a good strong tax policy proposal called the FAIR tax. I need to learn more about his health care spending proposals. Huckabee needs to do well in an upcoming Iowa straw poll next week. I hope he does.
Saturday, July 28, 2007
Patient Driven Health Care
It seems that a perfect storm of events has occurred over the last several weeks which has brought the discussion of health care delivery in the United States to the fore. The federally funded but state administered Medicaid plans, for example, are woefully underfunded and lacking in sufficient primary care and specialty care, and patients' frustration with a system which does not serve their interests has reached a critical mass. I've seen several recent newspaper articles on the subject, and just about all the Presidential candidates have their own ideas (mostly bad) about how to fix things.
But wait, you say, Medicaid is just a welfare program for the poor and chronically ill. You have Medicare, the federal government run program available (mandatory, actually) for those over 65. Didn't that program add a nice new drug benefit last year? It's saving me a bundle on my meds. What you soon-to-be Medicare patients don't realize is that when you turn 65, your doctor automatically gets paid about 30% on average less money for the exact same office visit with you, compared to when you didn't have Medicare. And it's illegal for you or your doctor to negotiate any fee higher than "Medicare allowable." How many doctors with full practices will be anxious to add new Medicare patients into their slots, which could be filled with non-Medicare patients paying 30% more for the exact same work? The answer is, Not Many, and therein lies a huge problem most people nearing 65 aren't even aware of. But it's real, and it's coming.
Unfortunately, another truth is that Medicaid, the federally paid but state managed health care system for the poor, pays so poorly that growing numbers of primary care and specialty doctors are refusing to lend their legitimacy to this fiasco by participating. Meanwhile Medicare payments to primary care doctors are down 9% in 10 years in inflation-adjusted dollars, and draconian cuts in payments to providers are on the way. Limitations in choice of, and even access to, providers are looming on the horizon.
Well, perhaps I'm guilty of overdramatizing a problem. Let's look at where all the new medical school graduates are going to finalize their training and choose their specialties. And over the past ten years, we've seen a stunning and unique drop in the students choosing general internal medicine, a drop of nearly 50 percentage points in ten years. These graduates are voting with their choice of specialty, and they are voting to choose more money over less, less work over more, respected work over ridiculed work, daytime work over night time.
The picture that I've drawn is one of a broken system, specifically a broken payor system. The health care you're given is still generally top notch, but that may not be for long. Clever, capable, driven young men and women will find other and easier routes to glory and service, without the debt, and where their services are appreciated. You appreciate your primary care doctor, you say? Well, unfortunately, the third party payor who pays your bills generally doesn't.
I'll give one actual example for your consideration. I recently bought a machine that allows me to assess for the presence of peripheral arterial disease. Having the machine helps me provide better care to my patients, most of whom have multiple risk factors for arterial disease. Incredibly, I get reimbursed more from Medicare for performing the test than I do for the office visit in which I use those test results to formulate a treatment plan! Not only do I get paid more for doing the test, but, even more ridiculously, it takes 5 or 10 minutes to read and interpret the test, while an office visit is 15 to 20 minutes on a good day. I'd be better off to stop caring for patients and just do ABI testing full time. Stories like this will be repeated and repeated until we finally realize that, in order to restore some balance to the health care market, patients must be put back in charge of their own health care spending.
The solution? I suspect there may be many solutions, but one solution for my small medical practice is to attempt to remove myself from being in bondage to the third party payors. I will attempt to offer to patients a guarantee of such a pleasurable and low-stress office visit environment, care that is focused on meeting the patients' needs, with bonus perks for Wellness-related services, that these patients will be willing to pay me an annual retainer just to get to be part of the practice--to have access to the annual Wellness review, the guaranteed work-in times, the "no-waiting" policy, the quarterly newsletter, the portable medical records on CD-ROM, the dietitian consultation, the massage, the discounted Aquatherapies and gym membership, and my personal cell phone number.
Having a cohort of patients who are focused on Wellness and who identify me as their doctor--that will make me no longer a slave to the third party payors, but will instead restore me to the traditional physician's role of being a servant of the patient. Instead of the government or Medicare or insurance companies determining what my services are worth, it will be the patients--the consumers of my services--who decide what they are worth. Nationally this concept is referred to as "patient-driven health care," and it results in excellent patient satisfaction survey numbers.
I believe in this concept so much, and I am so fearful of the status quo in medicine, that I am implementing a patient-driven, retainer-based protocol in my own practice. The response has been very encouraging, and I no longer have any real doubt as to its success. These patients have every right to expect from me top-notch medical care, efficiently delivered, in a manner that fits their schedule, not my own, and I am motivated to deliver for them and to be accountable to them for the results.
I'll let you know how it works out.
But wait, you say, Medicaid is just a welfare program for the poor and chronically ill. You have Medicare, the federal government run program available (mandatory, actually) for those over 65. Didn't that program add a nice new drug benefit last year? It's saving me a bundle on my meds. What you soon-to-be Medicare patients don't realize is that when you turn 65, your doctor automatically gets paid about 30% on average less money for the exact same office visit with you, compared to when you didn't have Medicare. And it's illegal for you or your doctor to negotiate any fee higher than "Medicare allowable." How many doctors with full practices will be anxious to add new Medicare patients into their slots, which could be filled with non-Medicare patients paying 30% more for the exact same work? The answer is, Not Many, and therein lies a huge problem most people nearing 65 aren't even aware of. But it's real, and it's coming.
Unfortunately, another truth is that Medicaid, the federally paid but state managed health care system for the poor, pays so poorly that growing numbers of primary care and specialty doctors are refusing to lend their legitimacy to this fiasco by participating. Meanwhile Medicare payments to primary care doctors are down 9% in 10 years in inflation-adjusted dollars, and draconian cuts in payments to providers are on the way. Limitations in choice of, and even access to, providers are looming on the horizon.
Well, perhaps I'm guilty of overdramatizing a problem. Let's look at where all the new medical school graduates are going to finalize their training and choose their specialties. And over the past ten years, we've seen a stunning and unique drop in the students choosing general internal medicine, a drop of nearly 50 percentage points in ten years. These graduates are voting with their choice of specialty, and they are voting to choose more money over less, less work over more, respected work over ridiculed work, daytime work over night time.
The picture that I've drawn is one of a broken system, specifically a broken payor system. The health care you're given is still generally top notch, but that may not be for long. Clever, capable, driven young men and women will find other and easier routes to glory and service, without the debt, and where their services are appreciated. You appreciate your primary care doctor, you say? Well, unfortunately, the third party payor who pays your bills generally doesn't.
I'll give one actual example for your consideration. I recently bought a machine that allows me to assess for the presence of peripheral arterial disease. Having the machine helps me provide better care to my patients, most of whom have multiple risk factors for arterial disease. Incredibly, I get reimbursed more from Medicare for performing the test than I do for the office visit in which I use those test results to formulate a treatment plan! Not only do I get paid more for doing the test, but, even more ridiculously, it takes 5 or 10 minutes to read and interpret the test, while an office visit is 15 to 20 minutes on a good day. I'd be better off to stop caring for patients and just do ABI testing full time. Stories like this will be repeated and repeated until we finally realize that, in order to restore some balance to the health care market, patients must be put back in charge of their own health care spending.
The solution? I suspect there may be many solutions, but one solution for my small medical practice is to attempt to remove myself from being in bondage to the third party payors. I will attempt to offer to patients a guarantee of such a pleasurable and low-stress office visit environment, care that is focused on meeting the patients' needs, with bonus perks for Wellness-related services, that these patients will be willing to pay me an annual retainer just to get to be part of the practice--to have access to the annual Wellness review, the guaranteed work-in times, the "no-waiting" policy, the quarterly newsletter, the portable medical records on CD-ROM, the dietitian consultation, the massage, the discounted Aquatherapies and gym membership, and my personal cell phone number.
Having a cohort of patients who are focused on Wellness and who identify me as their doctor--that will make me no longer a slave to the third party payors, but will instead restore me to the traditional physician's role of being a servant of the patient. Instead of the government or Medicare or insurance companies determining what my services are worth, it will be the patients--the consumers of my services--who decide what they are worth. Nationally this concept is referred to as "patient-driven health care," and it results in excellent patient satisfaction survey numbers.
I believe in this concept so much, and I am so fearful of the status quo in medicine, that I am implementing a patient-driven, retainer-based protocol in my own practice. The response has been very encouraging, and I no longer have any real doubt as to its success. These patients have every right to expect from me top-notch medical care, efficiently delivered, in a manner that fits their schedule, not my own, and I am motivated to deliver for them and to be accountable to them for the results.
I'll let you know how it works out.
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