Don Berwick is a patient centric, consumer oriented radical

The recess appointment of Dr. Donald Berwick as head of CMS has incited a furor among politicians outraged at what they claim are his advocacy for rationing and fondness for Britain’s National Health Service.

To support their claims, these politicians are using Berwick’s own words, in a way eerily reminiscent of the recent Shirley Sherrod debacle.

It started with Glenn Beck, master of the one-word quote, and then slipped over into more mainstream politicians.

What’s really troubling about all this, in addition to the blatant political motivation, is Berwick is pretty closely aligned with core conservative values.

Don Berwick is now, and has always been, a patient-centric, consumer-oriented ‘radical’ who’s concept for the ideal system is one that is almost entirely patient-focused. Here’s Berwick’s ideal health plan from a piece by Ezra Klein:

1. Hospitals would have no restrictions on visiting — no restrictions of place or time or person, except restrictions chosen by and under the control of each individual patient.

2. Patients would determine what food they eat and what clothes they wear in hospitals (to the extent that health status allows).

3. Patients and family members would participate in rounds.

4. Patients and families would participate in the design of health care processes and services.

5. Medical records would belong to patients. Clinicians, rather than patients, would need to have permission to gain access to them.

6. Shared decision-making technologies would be used universally.

7. Operating room schedules would conform to ideal queuing theory designs aimed at minimizing waiting time, rather than to the convenience of clinicians.

8. Patients physically capable of self-care would, in all situations, have the option to do it.

“I suggest that we should without equivocation make patient-centeredness a primary quality dimension all its own, even when it does not contribute to the technical safety and effectiveness of care,” he says.

Pretty radical, indeed – returning power to the patient, from the practitioner.

If Berwick’s opponents just took a minute to read what the guy really stands for, they’d discover he’s pretty much aligned with many ‘conservative’ principles – self responsibility, ownership, consumer-centered policies and practices.

Unfortunately, they just don’t care about who Berwick really is – they’ve decided he’s the stick they’re going to use to beat this Administration, regardless of whether he’s good, bad, or indifferent.

As Maggie Mahar noted in Health Beat, “Thomas Scully, who led the CMS under President George W. Bush [said of Berwick] : “He’s universally regarded and a thoughtful guy who is not partisan. I think it’s more about … the health care bill. You could nominate Gandhi to be head of CMS and that would be controversial right now.”

Joseph Paduda is the principal of Health Strategy Associates, and blogs at Managed Care Matters.

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  • http://www.twitter.com/alicearobertson Alice

    This wouldn’t be the same Ezra Klein who runs the left-wing Journolist group that tramples on words to the point one can hardly find the truth? The NHS is so problem-plagued…who in their right mind would say it’s patient-oriented? And isn’t the budget getting cut in the UK by the new administration before the country sinks into the sea?

  • David Allen

    Pretty funny that the author doesn’t seem to realize the problem with what is being advocated. It is one thing to own your own business (hospital, practice, clinic, etc.) and to adopt any approach you like in treating your customers If you think it will be possible, financially reasonable, and a plus for patients to do all of the things Berwick seems to be a fan of – then go for it! But it is another thing to be a ‘patient-centered radical’ while being in a government position where he is likely to force these ideas down the throats of hospital administrators or physicians.

    • Alina

      Interesting. Since you mentioned “forcing these ideas down the throats of hospital admin or physicians”, care to comment on which of the above points you disagree with and what in your opinion is wrong with them?

      • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen, MD

        The point I’m trying to make is that unless you are actually running the business you have no business (pun intended) telling others what they must do in it, what services they must offer, what visiting hours should apply.

        But if you want me to put on my administrator/owner hat – I’ll take a look. In my experience, visitors (family, etc.) are great for patient comfort while also providing useful information, being powers of attorney, etc.. On the other hand, they can markedly increase the work load for nurses and physicians – especially in the ICU when the nurse is already attempting to handle all of the paperwork, IV access, urine measurements, special tests, etc.. It seems reasonable to me that a hospital will set some limits to visiting so that this other important work can get done more efficiently. Again, this is not currently my job, but it is not unreasonable to assume that limiting visiting hours are related to that issue.

        Choosing your own clothing is also an efficiency issue. Are the patient’s going to wash their own clothing too? Are we going to monitor and discuss with patients every item of clothing they can or can’t put on and then refer disagreements to the physician? Does that belt contain any metal making it unsafe for the MRI machine, etc, etc.

        Patients already choose their own food in my hospital

        Patients already have access to their own medical records. As far as them ‘belonging’ to someone – that doesn’t really make sense. If I write some notes about a patient they are my, or the hospitals notes, which you can have access to if you like – but not to modify as you see fit.

        But again the larger point: I should have no more right to tell hospitals these details as I have to tell Starbucks how to prepare coffee. :)

        • Alina

          “The point I’m trying to make is that unless you are actually running the business you have no business (pun intended) telling others what they must do in it”

          I agree with you….as long as these businesses behave properly. But there are instances when an insurance company has a 97% market share or a healthcare system composed of several hospitals has also monopolized the market. What would then be the difference between a government vs. a privately run plan?

          “On the other hand, they can markedly increase the work load for nurses and physicians – especially in the ICU when the nurse is already attempting to handle all of the paperwork, IV access, urine measurements, special tests, etc” I’m not sure how the relatives would interfere with these tasks or increase the time spent. During the couple of days that I spent in the ICU with a relative some months ago I’ve never seen the doctor and the nurse barely stopped by once. I even had to ask for the patient’s meal to be delivered as the nurses were on the computers the whole time, all day long. Oh, and all let’s not forget the price which I think is just as wonderful as the service: insurance company paid $21k, but if one would have been uninsured the price tag would have been $96k, excluding the doctor’s fee (several thousands) and other “miscellaneous” also several thousands. All this for 2 days spent in the hospital.

          If you’ve ever been a patient in one of these places you know that you need your family so you have someone care for you. Otherwise you’re just another number and they get to you whenever….

          About the whole clothing thing, I would not necessary need to have my own but I would appreciate it if I could have something different that would not leave me half naked provided by the hospital.

          “Patients already have access to their own medical records.” Not really. As a patient I don’t get to see my test results unless I ask my doctor for it. In Europe the patient goes to a lab for example and does a blood test, she or he would receive the results of that test. In the US the lab is not allowed to give you this information. Even when you try to transfer your medical records to another physician it takes forever and it’s extremely annoying because it interferes with you continuing your care.
          “As far as them ‘belonging’ to someone – that doesn’t really make sense. If I write some notes about a patient they are my, or the hospitals notes” Not quite. Let’s say that you hire a consultant to do a study for you. You pay the consultant and in exchange he/she provides you with a report. Since you paid for this, that report belongs to you. Same thing here. The patient pays the physician to find out what’s wrong with him or her. There is a report at the end of this process and that belongs to the patient :)

        • http://www.healthecommunications.wordpress.com Steve Wilkins

          Dr. Allen,

          That’s same hospital administration who feels that “patient centered care” is being shoved down their throat had better not then turn around and promote in their advertising how patient centered their hospital is.

          Steve Wilkins
          Mind the Gap

          • David Allen

            Alina,

            You make very good points about the overall poor quality of hospital services and other good points besides.

            Nurses actually do work very hard, but they are sometimes given patient loads that are simply too large. And you know why they are on the computer all the time, don’t you? Well, they have to document EVERYTHING. And, in addition, do-gooder government folks keep thinking that hospitals don’t know how to do things, so they develop ‘core measures’ and then hospitals are forced to try to document that they are meeting these core measures by filling out forms, and paperwork, and charts – while the poor patient is still waiting for their IV to be changed.

            But let’s take a step back here. Do you think hospitals don’t actually want to make the patient experience as good as possible? They do, they would love to, and yes, Steve, they would also love to advertise about it.

            But the reality is that they often can’t . Many hospitals go out of business because they don’t make ends meet. The business owner must look at the whole picture (the pluses and minuses) of each additional service they provide and how they provide it. It is very easy to say ‘I’m going to provide the best’ without looking at the pluses and minuses.

            But, Alina, you are on to something. Ask yourself why the service is currently so bad in the hospital. Is it because of the free market – or something else? Why would customer service be so bad in this sector of the economy especially? Could it have anything to do with the massive amount of regulation of the industry or the fact that the government spends 50% of all spent health care dollars? Could it be that the rules of Medicare billing are so complex that even the experts can’t agree on what is ‘correct’ billing. Could out of control lawyers and laws have anything to do with it? Instead of brow-beating those who are still trying to provide a reasonable service in this environment – you should focus on the real issues. These problems stifle innovation, create a climate of fear, and ultimately degrade the end product.

    • Mike

      It’s pretty clear to me that you have not read http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf . Until you have and you truly understand what Dr. Berwick advocates for and *why*, I consider your comments about him uninformed hyperbole. Unfortunately, I also consider them to be typical of many, but not all, physicians and hospital administrators. The world is changing. It’s not slowing down for old-fashioned, boxed-in thinkers. Keep up or get left behind… and watch your business dwindle while it all unfolds.

  • Alina

    I see nothing radical about most of these proposals and I think they are great.
    #5 really hits home. I’m originally from Europe and I could never understand why the patient doesn’t receive his/her test results here in the US. In Europe the auxiliary facility gives you the results directly. It’s pretty simple – it’s your body, hence you should receive the results of tests done on that body. In the US it takes forever to get this information and even then you have to pay for it. Crazy!

    Alice, you’re saying NHS is “problem-plagued.” Have you heard of the US system, you know the one that leaves tens of millions of uninsured and under-insured without care? How would you feel if you would be one of them?

    I don’t think anyone in UK goes bankrupt to pay for medical bills and I don’t think that UK hospitals go after people’s homes so they can get their hugely inflated fees that are 3 times more than what an insurance company would pay. Also, no matter how you slice it, the US (not UK) is below par in quality when compared to many other countries. Healthcare is not a luxury. Leaving people without care it’s purely inhumane.

    • Mike

      Very well said. Bravo.

  • http://www.twitter.com/alicearobertson Alice

    Did Donald Berwick really say this (below)? It seems to be true, but somedays it’s hard to tell. I am sure he’s a wonderfully good-intentioned person, so this isn’t personal….but it has the potential of hurting everyone…and it’s probably why we may have a complete switch in November….it’s because talk is cheap….liberalism makes people feel good…but it’s unrealistic.
    He is in tune with the current administration, but because he is a bleeding heart liberal, and if you say anything you are vilified on a personal level instead of an ideological level. I am a compassionate conservative who wants to help others….but does the question really come down to losing jobs and businesses going under to help the poor? Surely, this will cause more suffering? Sometimes liberals lack logic while proclaiming their self-righteousness. Anyhoo…..back to the regularly scheduled program:

    quote: To the NHS: “… You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. … Britain, you chose well. … Is the NHS perfect? Far from it, far from it.”

    • Alina

      How many times do we have to hear the same unsubstantiated claims? For any imperfections that the NHS may have, the US system is that much worst.

      “Liberalism it’s unrealistic.” The system you’re advocating is feudalism, all under the guise of free market.

      “I am a compassionate conservative who wants to help others” It’s nothing compassionate about thinking that’s ok to keep people without healthcare, while at the same time thinking that’s ok for the insurance CEOs to make $124 million/year for doing absolutely nothing.

      “…but does the question really come down to losing jobs and businesses going under to help the poor? Surely, this will cause more suffering?” Well, the answer is YES (and we’re not talking only about the poor). We could do without this whole insurance business since they don’t add anything good to the mix. The relationship between patients – insurance is more like signing a contract under durress than anything else. It’s not a true business transaction by any means.

  • jenga

    Then why were they too scared to even make the argument? Why are we hearing this line of thinking now and not 2-3 months ago? What makes him too good to sit down for a job interview before he takes charge of the largest healthcare system on the planet? Nothing about the list 1-8 is radical or revolutionary. It is already done. Except for one, how does he propose to deal with increased exposure and risk to patients such as during flu season by lifting restrictions. I guess it’s “patient centric” if you let everybody infect each other. The guy has found a nice way to make a buck over the years. How many pediatricians do you know that pull down 800 grand a year? Alot of questions here my guess, no answers.

  • SmartDoc

    Pure propaganda about a exceedingly powerful individual who refuses any scrutiny or questions about his agenda.

    The American people would soundly reject this person if he were properly vetted by Congress as the Constitution required.

    • http://www.twitter.com/alicearobertson Alice

      You are right the public was denied this:

      <<>>>>>>>

      • http://www.twitter.com/alicearobertson Alice

        Ugh forgot about the html coding. Let’s try again:

        Twila Brase, president of Citizens’ Council on Health Care, said the recess appointment means that the American people will be denied public Senate hearings where Berwick would have to explain the problems surrounding the British system.

        “We are disappointed that President Obama chose to avoid the transparency of the Senate confirmation process,” Brase said.

        Now 43 million Medicare recipients will be dependent on the controversial funding and treatment decisions Berwick is likely to make with his new position.

  • bev M.D.

    Here we go again. I am reprinting some references from Dr.Berwick’s direct writings/speeches that I submitted to the last post on him. I suppose this one is meant as a rebuttal.

    http://www.time.com/time/magazine/article/0,9171,1186717,00.html

    http://www.kaiserhealthnews.org/stories/2010/june/30/donald-berwick-resource-guide.aspx?referrer=search (particularly watch the interview as it gives more insight than the written pieces)

    • http://www.twitter.com/alicearobertson Alice

      Hi! But TIME was going to rename themselves Obamatimes! :) But I can understand why you are quoting them. I read Time, Newsweek and US and World Report just to keep up on what the liberals are saying (it’s usually slanted or missing elements, but I still like to poke around there). The quote I sent was directly from Berwick from his speech, so it is his own words not commentary from people who like him. I am sure he is ever so lovely, but let’s scrutize what he is really saying. I mean come on redistribution of the wealth?

      Okay, let’s do a quick formula here. I will use France as a formula (as I shared I lived in the UK and almost all our relatives live there. I was going to call them and get more and scarier stories, but I will wait). Okay let’s say I make $70,000 a year and pay about 30% weekly in all my taxes, that would equal $21,000 off my pay, then add the French 21% mandatory for my healthcare on the single payer system. That 21% would be close to $15,000, but for argument let’s lower it to $14,000. So right there I lose half my salary for healthcare and taxes, and there will be more taxes for very high road taxes, etc. and I still have co-pays, etc. And then my employer has to match that $14000 which causes less jobs. Then the government is now about $10 billion or more under on the health care. We know what that means. Higher pay taxation to cover the services. What happens when it goes up 30% and more jobs are lost, and we end up spiraling out of control as Britain is and Britain is sinking under social problems and expenses that could bust them. So what’s the answer…….cut more medical programs and services, not new machines, less staff.

      So, yeah, Berwicks answer is bloody brilliant isn’t it? Where can I sign up for this mess?

      • HJ

        “let’s scrutize what he is really saying.”

        I find it interesting that you suggest scrutinizing ideas when you say, “But TIME was going to rename themselves Obamatimes!”

        I’ll scrutinize.
        1. Health care is a right. I can’t think of any reason why someone should be denied necessary health care. Perhaps you disagree with this and instead of calling me a communist, please explain.

        2. Pay as a group. We already do this, it’s just not very efficient. Go ahead and call me a Marxist, but paying through an insurance compay for every procedure, bandaid, e-mail…is wasteful and frustrating. You only have to read the desperation in the primary care comments to see this. Unless you are willing to pay for all your child’s cancer care out of your own pocket, you already agree to pool resources to pay for care.

        3. Put patient in charge. Is this a liberal slant? Perhaps you what your insurance company in charge.

        4. Computerize. Definitely liberal…

        5. Be efficient. Is this a bad idea?

        6. Invest in primary care. You disagree with this? Or is this way to much socialism for you.

        7. Give up more is better. Ok, this is definitely a call for rationing.

        • http://www.twitter.com/alicearobertson Alice

          From RealClearPolitics, and this is a real dose of reality:

          Wesley Smith, an invaluable investigative reporter on the dangers of government-controlled health care, describes the consequences if Obamacare is not repealed by the next Congress after the midterm elections:

          “Once the centralized planning of medical delivery is complete — with cost-containment boards controlling the standards of care and the extent of coverage for both the private and public sectors — insurance companies, HMOs and the government will be able to legally discriminate against the sickest, most disabled and most elderly in our country. In other words, those whose care is most expensive.”
          http://www.realclearpolitics.com/articles/2010/07/12/health_care_rationing_obama_believes_in_106268.html

        • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen

          HJ,

          “Health care is a right”. OK, you can stop right there. The whole purpose or rights is to protect the weakest minority (the individual) from being destroyed by other individuals, organizations, or the government itself. People should have a right to pursue their own happiness, and the freedom to do so. Rights are designed to be non-contradictory – as much as possible. So when you say that someone has a ‘right’ to health care – you are destroying the very concept of rights – since you automatically must say that others must provided that benefit and can have no right to refuse. Which means those other individuals have no right to their own property, or lives, or don’t have the freedom to refuse.

          To you it may sound cruel – but in fact, when it (protecting of rights) was practiced appropriately, it led to the greatest productive era the world has ever seen with benefits to everyone’s standard of living (including incredible medical advances) that hadn’t been dreamed of.

          • Mike

            You’re right. We should let all of those pathetic uninsured types die terrible deaths instead. That makes complete sense. Excuse me while I go pay my tax bill so that your child may receive a publicly-funded education. That is far more important than keeping human beings alive.

      • Alina

        Here we go again.

        Alice says: “…then add the French 21% mandatory for my healthcare on the single payer system” That’s simply not true. French pay 7.5% for CSG and 0.5% for CRDS.
        Not only that they have a 1 Euro copay for the GP and 10 Euros for a hospital stay, but they also don’t pay for anything when they have a chronic condition.
        The again, Dr Berwick was talking about the NHS (UK). If you would read a little bit more about the UK system, which you say you’re sooooo familiar with, you would know that in fact much of the data used by worldwide scientists and physicians comes from there. And btw, a cancer patient in the UK also receives free care, which is a lot more than we can say in the US.

        Let’s talk US for a minute. Let’s take your example for a minute: stay home mom with 6 children, one of them has cancer. Let’s say your husband is one of the millions of people who lost his job in the 2008 fiasco. With a family of 8 and one unemployment income of let’s say anywhere $10k – $25k per year you would most certainly qualify for Medicaid. Now, since you’re against any government plan, what would you do?

        Mind you at least you would still get something, but there are many others that would not even qualify for Medicaid.

        What makes one person better than another to the point that we would think it’s ok for some to receive care, while discard the others?

        • http://www.twitter.com/alicearobertson Alice

          Let’s talk US for a minute. Let’s take your example for a minute: stay home mom with 6
          children, one of them has cancer. Let’s say your husband is one of the millions of people
          who lost his job in the 2008 fiasco. With a family of 8 and one unemployment income of
          let’s say anywhere $10k – $25k per year you would most certainly qualify for Medicaid.
          Now, since you’re against any government plan, what would you do? [end quote]

          Wow, wee! I’m on welfare and food stamps too! I think I have seen the light! How about I go and get a job with insurance. Why did you think of the government first instead of employment for me? My youngest is at an age I could put her full time in the private school she is in and get a job. I told you I volunteer at a Judeo-Christian think tank and they offered me a job.

          When you get cancer do you want the government mandating your care or an insurance company? And why do you act like a crusader for the uninsured? I believe every person reading this wants to help, but some of us actually do help, and not sit online all day proclaiming our own humanitarian awards.

          • Alina

            “When you get cancer do you want the government mandating your care or an insurance company?”
            Which insurance company? The one that doesn’t cover treatment for its patients because it has to pay the CEO hundreds of millions of dollars per year so he can buy his yacht and that big beach house in the Hamptons? Do tell, who is that wonderful company you’re talking about.

            “Why did you think of the government first instead of employment for me?” You want to tell me that someone in your situation would rather go search for a job, which by the way is a full-time job in itself nowadays, instead of caring for the sick child? Let’s be realistic.

            “And why do you act like a crusader for the uninsured?” Because it sickens me when I hear people saying that’s ok for some to be covered, while others can’t. I cannot and I will not accept some non-sense free-market rhetoric to justify this kind of practice. It’s purely inhumane.

    • Alina

      BevMD,
      Thanks for the links.
      Dr Berwick is right on!

      • http://www.twitter.com/alicearobertson Alice

        “Why did you think of the government first instead of employment for me?” You want to tell me that someone in your situation would rather go search for a job, which by the way is a full-time job in itself nowadays, instead of caring for the sick child? Let’s be realistic. [end quote]

        Maybe you should ask more questions before making assumptions. If my child needed the care you imply do you really think I would be online? And if you really thought she needed that kind of care wouldn’t you back off and not worry about the uninsured mantra directed at me? My child is not bedridden, but I am handicapped mentally because I have what insurance can’t cover…..a crushed spirit and a broken heart. If you think for one minute I don’t recognize pain and suffering from a firsthand experience….please think again. And I have told you ad nauseam that my husband and I have firsthand experience with the UK system. It stinks….plain and simple. I don’t want it duplicated here. Just the wait time has our cousin on his deathbed experienced terrifies me, and I don’t want to spell out the needless suffering the poor man has went through (and he has private insurance, but it’s not like our private insurance, there are over-lapping features).

        Berwick is honest……..he’s a romantic…..he likes the Jane Austen plan…..you know the unrealistic one where we deny the suffering because we are so infatuated with the process.

  • DRJEBJ

    I participated in one of Dr Berwick’s collaboratives many years ago and was very impressed with his methods of evaluating what really works in practice. His Institute for Healthcare Improvement would invite participants to come together and brainstorm on a problem, in our case it was delays in the emergency room. The participants would then select the best of the ideas and go test them for about a year or so and then report back at another collaborative session to analyze the data. This was participant driven and facilitated those of us in the trenches to find real practical solutions to improve the quality and efficiency of our care. Dr. Berwick is not an ivory tower physician. He has a long history of being a good listener. Please give him a chance.
    PS Go Tea Party!

  • Michael Rack, MD

    “Pretty radical, indeed – returning power to the patient, from the practitioner.

    If Berwick’s opponents just took a minute to read what the guy really stands for, they’d discover he’s pretty much aligned with many ‘conservative’ principles – self responsibility, ownership, consumer-centered policies and practices.”

    There is nothing conservative about moving further away from medical paternalism and giving more power to patients. I don’t see anything about self-responsibility in the 8 points outlined. Other commenters have debated the merits of Dr. Berwick’s principles, my point is only that they are not conservative principles.

  • bev M.D.

    Alice;

    I am not pretending to defend Dr. Berwick, although I agree with
    DRJEBJ. I simply want people to read what he has said in context,directly from him.
    However, I think you missed #2 and 7 in the Time article, and the interview in which he cites at least 30% waste in the current healthcare system.I have heard him up that to 50% elsewhere (or maybe he said it there, I can’t remember).
    He is not responsible for Congress’ health care bill, but he does understand at least part of why medical costs are so high.

  • alice

    Droid problems…..sorry about that…..must need a government sponsored program for those who can afford a droid. Because I keep being accused of selfishness which is foolishness. In truth I think everyone cares, but one side brags and doesn’t listen in a romantic type of idealism while the other side is more realistic. If unemployment gets worse how in the world will you play hospital with the sick.

    How about you read the real NHS stats (the undoctored ones) and take your extra tax dollars you claim you are willing to pay and either help someone pay for better care, or get on a plane and go get some of that terrible British care, in one of their hospitals with high infection rates. You defend that which you know nothing about, and I seriously doubt you are volunteering and helping people get care as you proclaim others should be willing to do. Charity begins at home…..I am willing to pay more and give my time…..I just do not think the government is good at implementation, do not want to see rationalizing of care, and quite frankly I am tired of youe empty mantras and no action. Talk is cheap and doesn’t help anyone except it makes you look good.

  • http://www.twitter.com/alicearobertson Alice

    But in truth, we all want health care for the needy (I don’t know one person who wants someone else to suffer)……I just don’t think his model is a good one. Redistributing the wealth isn’t going to work, we have European countries now moving away from this because it’s crippling and they went into it with the same ideas as Berwick. It’s a lofty goal that hasn’t realistically been pulled off anywhere with the results that were promised.

    There is no health care utopia…..and I have experienced this model and it terrifies me…….I wish I could romantically think it would work.

    Bev you are reasonable and I appreciate your posts because you think and read……sigh…to a few others….but that said I fear the consequences of such lofty goals on a whole society. I read pure hypocrisy here at times. If we truly believe we don’t mind paying for others, then give…send a check somewhere, or go and pay someone’s hospital bill, or volunteer at a free clinic.

    You see if I have to start to pay let’s say $250 more a week I can’t help those I currently help. And I am helping people who don’t worry about healthcare, but death. Some are tortured for their faith, some are orphans from war. i will no longer be able to help them, and I want a choice in who I help. Government mandates do bring in socialism and we have seen that Germany is digging their way out of this exact same mess people here propose. Look to history and learn…………and quit proclaiming oneself so charitable, but not giving, just proclaiming others should.

    • HJ

      “I just don’t think his model is a good one. ”

      I haven’t seen any solutions from you, only accusations of redistribution of wealth and socialism comments.

      “Government mandates do bring in socialism…”

      Like the mandate that requires your insurance company to continue to pay for your child’s cancer treatment even though it would be better for the insurance market to cancel your policy.

      • HJ

        As long as we are talking about the evil of mandates, what about EMTALA, the mandate that allowed your son to get emergency care when he was unable to pay. This one certainly leads to socialism.

        • http://www.twitter.com/alicearobertson Alice

          As long as we are talking about the evil of mandates, what about EMTALA, the mandate that allowed your son to get emergency care when he was unable to pay. This one certainly leads to socialism. [end quote]

          Nope, once again you got your facts wrong. You think you found some whipping boy. A write-off is a write-off and it had no acronyms. Odd all these personal comments from an anonymous state worker.

      • http://www.twitter.com/alicearobertson Alice

        Like the mandate that requires your insurance company to continue to pay for your child’s cancer treatment even though it would be better for the insurance market to cancel your policy. [end quote]

        Well thanks for not once asking even once how my daughter is doing since her neck dissection. Once again you play games with facts. Not a mandate, it’s an insurance policy that is bought and paid for. Thank God we are not in the UK getting treatment. I believe she would be dead because of wait time. She had a fast growing cancer, but thanks so much for caring.

        • Alina

          Now, now Alice bringing out the whole guilt trip to silence people?

          “Not a mandate, it’s an insurance policy that is bought and paid for.”

          Right, the insurance company covers this out of the goodness of their heart! Please let us know what company is that so we can all change our coverage to these great humanitarians.

  • http://www.twitter.com/alicearobertson Alice

    I haven’t seen any solutions from you, only accusations of redistribution of wealth and
    socialism comments. [end quote]

    Alice: That’s because I am not hypocritical enough to think I have the answers to such a huge problem. I know what won’t work though, because we have European and Canadian examples. And I don’t sit here on a high throne following realists around bragging on my own lofty goals that aren’t lofty at all when they aren’t real and one has done nothing but cheap talk to help a real situation.

    • Alina

      “That’s because I am not hypocritical enough to think I have the answers to such a huge problem. I know what won’t work though, because we have European and Canadian examples.”

      Alice, do you read your posts? You just described yourself. You always seem to have the answer to just about anything but never experienced any of these systems, so how do you “know” that they don’t work? What makes you such the expert you claim you are? “We” who?
      Sources?

      “And I don’t sit here on a high throne following realists around bragging on my own lofty goals that aren’t lofty at all when they aren’t real and one has done nothing but cheap talk to help a real situation.”

      Can you actually provides some facts (real ones) for a change instead of attacking people merely because they point out the flaws and inacuracies in your comments?

      • http://www.twitter.com/alicearobertson Alice

        Alice, do you read your posts? You just described yourself. You always seem to have the answer to just about anything but never experienced any of these systems, so how do you “know” that they don’t work? What makes you such the expert you claim you are? “We” who?[end quote]

        Hmmmm……….I know I have experienced a whole lot of insincerity, lack of facts, from some anonymous posters who sit on a cyber-throne disguising themselves somewhere excoriating a real person, and their posts, and personal life, and try to keep me so personally on the defensive people can’t have a good debate. It’s a good tactic, but it’s completely uneducational, and a waste of the reader’s time.

  • http://www.twitter.com/alicearobertson Alice

    Alina I gave all the facts about the NHS and wait times (including NICE), but for whatever reason they didn’t get posted. I can’t be bothered hunting them down because I am unsure what happens to some of these posts, or why stuff that’s isn’t personal doesn’t get posted. It was really scary facts to. Facts that back up everything I have said….but, surely, you have seen them already if you have did your research?

    • Alina

      That’s just it. I have done a lot of research plus spoke with individuals who have the NHS insurance. The information I’ve seen and heard contradicts you comments. I’ve already told you this and you may remember you labeled these individuals “liberals in limousine” – another one of expert comments.
      Since this information comes from reliable sources (business associates without an agenda for one side or another) I trust it before I would trust anything that comes from someone that continuously labels everything socialist or communist without having the slightest idea of what that really means.

      • http://www.twitter.com/alicearobertson Alice

        This is the quotes from Hitchens on the “leftist limousine” set, but it’s about money Brits who get private insurance (even doctors). This has more facts directly from NHS reports and a firsthand observation that matches my horrible experiences, and my relatives experiences (some of my relatives are dead, and I believe would be alive or at least died with dignity if they were treated here. Yes, it’s wonderful to want to save humanity, but that’s what socialism does….it puts a price on our head).
        Read the comments section from travelers and others who experienced it firsthand. I don’t find this stuff scary, it’s bloody well terrifying to me. And considering the UK is only about as big as Pennsylvania and New York put together, the numbers would be on a much larger scale here and many more “unnecessary deaths”.

        http://www.humanevents.com/article.php?id=31173

        snippet:
        Then consider, my friends, Exhibit A. The foul sub-third-world conditions I’ve just described came not from my overactive imagination but from a newly-published official report into the parlous state of affairs at two state-run hospitals in the central English district of Mid Staffordshire.

        According to the report by the Healthcare Commission, standards of care were so “appalling” that between 2005 and 2008 as many as 1,200 patients may have died unnecessarily.

        You should see the photo shrine the victim’s families have erected on one of the walls inside the hospital — like a mini-9/11 memorial; it’s a heartbreaking sight. There are pictures of the loved ones while they were still smiling and healthy, their dates written underneath. And there are printed sheets detailing some of the myriad ways they suffered and died:

        “Medication not monitored for side effects.”

        “Staff shouting, squealing and laughing throughout the night disturbing patients”

        “Patients not helped to the toilet, told to use a bed pan — staff too busy.”

        “Patients not fed or given fluids — food trays just left on the table out of reach.”
        It has been described by the National Health Service’s medical director as a “gross and terrible breach of trust” of patients, though why he should be so shocked is anybody’s guess. It’s not as though this sort of thing hasn’t happened in Britain’s magnificent “free” healthcare system many, many times before

        This, remember, is the “service” so poor that 55 per cent of senior doctors take out private medical insurance so they don’t have to use it; the one where one in 300 hospital deaths is the result of a patient contracting an infection completely unrelated to the one they came in to have treated; where the cancer survival rates are the worst in the civilized world; where more patients die in hospital in a year — 40,000 — than were killed in the 2006 Iraqi civil war.

        • Alina

          Alice, you posted the same article as you did for another post. I already told you that this “journalist” is not a trusted source. After reading the first 2 paragraphs it was enough for me to know he’s full of it. Honestly I don’t know how people fall for this kind of stuff.
          You would not trust Time, CNN, Kaiser Family Foundation..because they are “liberal.” First of all there is no such thing as the media is owned by very wealthy people. Do you think that they would advocate socialism as you claim? Why would they? Regardless, just out of curiosity, what makes you chose one versus the other?

  • HJ

    To Alice

    The list from Time magazine didn’t mention government run health care or single payer system, why the quote?

    So you agree with all the points in the Time article or did you just disregard them because you think Time is liberal? Or is your bash on government run health care an indication that you disagree with the Time article? Please elaborate.

    Alice says, “Not a mandate, it’s an insurance policy that is bought and paid for.”

    Current Health Insurance Regulation
    Guaranteed renewability: Guaranteed renewability laws prohibit insurers from canceling coverage on the
    basis of medical claims or diagnosis of an illness. By the mid-1990’s 46 states had such requirements in
    the small group market.

    For individual policies, many states prohibit a practice called “reunderwriting” meaning that insurers may not
    target sick people for rate hikes at renewal, requiring premium increases to be spread among all insured people.

    So do you agree with the socialist intrusion into health care? Are you happy that your insurance company can’t cancel your policy or charge you more based on your child’s cancer?

    RE: EMTALA

    Enacted in 1986 to prevent hospitals from turning away those that need health care or “patient dumping.” Your son was treated even though he didn’t have the means to pay at the time of service. If he had gone to the hospital without this mandate, he could have been refused care. So I will ask this again, what about EMTALA? It is a regulation that your family has experienced.

    • http://www.twitter.com/alicearobertson Alice

      HJ the thing is you want, you want so badly to label, but you don’t have your facts right. You pigeon-hole in an effort to discredit. Again, you are wrong…and guess what….my daughter is 17 years old…they aren’t going to cancel her policy over cancer. Remember I had another child with a brain tumor (an astrocytoma…just so you won’t mess that fact up), and he had no problem getting insurance when he changed companies.

      This is what happens when people take an exception and try to make everyone else suffer, or make laws to help a few, and in many cases those few could find help elsewhere but don’t. You rant on like you care about the poor, the uninsured, yet do nothing about it on a personal level except try to make me look bad. My friend had no insurance and when her husband became ill, she found help. She was a fighter. He died from lung cancer with hospice care and didn’t suffer, and found says the care was exceptional and completely free. It pays to get up and fight and look for help, instead of sitting saying “Woe is me”.

      • Alina

        “Remember I had another child with a brain tumor (an astrocytoma…just so you won’t mess that fact up), and he had no problem getting insurance when he changed companies.”

        Alice, I asked you above what insurance company do you have. Honestly, I think a lot of people who do not have good insurance would like to take their business to a company that seems to be doing the right thing. Could you share this information?

        Your experience is quite an exception though. Nowadays even if you do have coverage through your employer if you have a pre-existing condition you are not covered for that particular illness for 1 full year. This trend will continue even with the new regulations as these employer-sponsored plans would be grand-fathered.
        If you have to get insurance on your own, there are several illnesses that would automatically make you uninsurable at least for 1 year.

        You wrote to HJ the following: “You rant on like you care about the poor, the uninsured, yet do nothing about it on a personal level except try to make me look bad.” Do you know HJ and others personally to make these kind of assumptions?

        “My friend had no insurance and when her husband became ill, she found help. She was a fighter. He died from lung cancer with hospice care and didn’t suffer, and found says the care was exceptional and completely free.” Where? How? You said you like to help people, so can you share so others would know how to go about? You’ve seen the study I posted from CNN where there are all these people that can’t even get medication for cancer, not to mention more.

        • http://www.twitter.com/alicearobertson Alice

          Call the hospital social worker and librarian. Their resources are phenomenal. My aunt called and was offered everything from free transportation, to nurse visits, an alert system, prescriptions. I know CNN can be a bit selective while building a picture, but some say the millions that will be helped with this health care bill could have found help already because of programs that aren’t utilized by those in care. And there are still charity hopitals. Yes, you may wait four hours to get through the process, but I know for a fact at Cleveland Clinic you can have a six figure income and they will help you financially.

          My friend was a fighter, she got a social worker, and it was literally phenomenal what she got. She was a well-pleased patient’s wife, and she lives way out in the country where there are few services. She ended up getting some funky bird virus and got all her care completely free. Her motto is to not give up until you have called, called, called, and sat for hours and persevered.

    • http://www.twitter.com/alicearobertson Alice

      Quick summation……you can quote government regulation, but some insurers honor policies without the regulation. It’s a back-up, it’s there if you need it. Also, you know my son had an unnecessary test. I told you that. Would you cough up thousands when they could have did your test in a urine analysis cup for maybe $100 (that was how they diagnosed a bladder infection)? I told you he wrote all of this out and it took hours. And he made a charitable donation to the hospital, and no tax dollars were lost…..why you insist on pulling this out all the time is beyond me (and it’s boring to the readers. I gave you my private e-mail address if you want to discuss this further it’s: arobert6@juno.com).

      My personal family history is silliness here (do you realize my son is 27 years old, and he never stepped foot in a public school, so I figure I saved the taxpayers well over $100,000…well that is if you’re counting and you seem to be).. I could be an axe murderer and it would still make the British healthcare system lousy, but ….then again….the victims would have a better chance of surviving right here in the good ole’ USA (even with all it’s flaws and problems it’s the exact place I would want treatment for my daughter’s cancer treatment. Actually, there is no other doctor in the world my daughter would want other than the one she currently has. We adore the man).

  • http://www.twitter.com/alicearobertson Alice

    Facts about how Berwick feels (we probably agree with his goal in many cases, but his method of getting there will destroy…..he is honest, he’s a romantic):

    “I am romantic about the National Health Service. I love it,” Berwick said during a 2008 speech to British physicians, going on to call it “generous, hopeful, confident, joyous, and just.” He compared the wonders of British health care to a U.S. system that he described as trapped in “the darkness of private enterprise.”
    Berwick was referring to a British health care system where 750,000 patients are awaiting admission to NHS hospitals. The government’s official target for diagnostic testing was a wait of no more than 18 weeks by 2008. The reality doesn’t come close. The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent.

    Overall, more than half of British patients wait more than 18 weeks for care. Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed.

    The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.

    At the forefront of this cost-based rationing is NICE. It acts as a comparative-effectiveness tool for NHS, comparing various treatments and determining whether the benefits the patient receives, such as prolonged life, are cost-efficient for the government.

    NICE, however, is not simply a government agency that helps bureaucrats decide if one treatment is better than another. With the creation of NICE,
    To Dr. Berwick , this is exactly how it should be. “NICE is not just a national treasure,” he says, “it is a global treasure.”
    *snip*
    And, Dr. Berwick wants to bring NICE-style rationing to this country. “It’s not a question of whether we will ration care,” he said in a magazine interview for Biotechnology Healthcare, “It is whether we will ration with our eyes open.”

    http://www.cato.org/pub_display.php?pub_id=11851

    • Alina

      This is simply not true and quite irresponsible to spread this type of misinformation. But then again it comes from CATO, so case closed!

      • http://www.twitter.com/alicearobertson Alice

        No it comes from the NHS, and remember how small Britain is compared to the US, so mulitiply those figures by many. And remember the NHS was caught doctoring stats last year. Denial is powerful, but it doesn’t help the sick.

        • http://www.twitter.com/alicearobertson Alice

          Some NHS reporting from the last few weeks to help with your research. I subscribe to The Scotsman, but the London papers would have much better reports. Just type in “NHS” on their page and the actual reports of wait times, and conditions will come up, cancer patients dying or fighting for care.

          Also, you said people don’t have to sell assets to get treatment, but that’s not accurate. One quick example of a desperate women who was refused her breast cancer medicine:
          snip

          One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

          By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

          “He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.
          “I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

          Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

          Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.
          “That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.
          snip
          “People swap from public to private sector all the time, and they’re topping up for virtually everything,” Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.

          “Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,” Dr. Charlson said.
          snip
          In any case, he said, the health service is riddled with inequities. Some drugs are available in some parts of the country but not in others. Waiting lists for treatment vary wildly from place to place. Some regions spend $280 per capita on cancer care, Professor Sikora said, while others spend just $90.
          snip
          Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. “It may be too bloody late,” she said.

          “I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government,” she added.
          snip

          snip
          Elderly ‘left to starve’ in NHS hospitals
          http://www.scotsman.com/news/Elderly-39left-to-starve39-in.6501528.jp

          Published Date: 30 August 2010
          By Tristan Stewart-Robertson
          ELDERLY patients are at risk of malnutrition in hospital because they are being left to go hungry on NHS wards,

          Young cancer victims missing out on help – Scotsman.comAug 16, 2010 … More than seven out of ten young people diagnosed with cancer in the UK … were not always considered and supported during their treatment. …
          http://www.scotsman.com/…/Young-cancer-victims-missing-out.6478105.jp

          Study shows cancer patients missing out on vital radiotherapy …Sep 6, 2010 … They said the treatment had “Cinderella status” on the NHS. Just 14 per cent of 2000 people polled were aware that half of all cancer …
          http://www.scotsman.com/…/Study-shows-cancer-patients-missing.6516230.jp

          Swinney warns of £3.7bn cuts in next four years – Scotsman.comSep 5, 2010 … He made the prediction ahead of a series of planned meetings with councils, NHS workers and business leaders over the next few days, …
          http://www.scotsman.com/scotland/Swinney-warns-of-37bn-cuts.6514165.jp

          Cut in doctors’ working time ‘will leave UK short of skilled …Aug 2, 2010 … ah n.h.s. cuts on the way.doctors making sure they get their point in ….. The NHS has to cut its budget. They will get rid of strategic …
          http://www.scotsman.com/news/Cut-in-doctors39-working-time.6451177.jp

  • HJ

    Alice says, “Again, you are wrong…and guess what….my daughter is 17 years old…they aren’t going to cancel her policy over cancer.”

    They aren’t going to cancel your policy because there is a regulation that prohibits your policy from being cancelled. Regulation is socialism. Your policy is not cancelled because of socialism. You don’t seem to understand that there are already regulations that benefit you. Do you think that the government should eliminate that socialist regulation so your insurance company can cancel your policy?

    • http://www.twitter.com/alicearobertson Alice

      HJ you argue from an all or nothing viewpoint. If you read what I said I am not against all government regulation. Good grief, I have shared the Teddy Roosevelt quote on the capitalists needing policing at times, and we need civil laws.

      • HJ

        Then what about your statement, “Government mandates do bring in socialism…”

        and the one, “If you read what I said I am not against all government regulation.”

        It seems to me that you support socialism.

        • http://www.twitter.com/alicearobertson Alice

          Hj the reason I say you argue from an all-or-nothing aspect is because liberals like to use Greenspanish types of examples, and his Ann Rand type of capitalism to limits that do hurt people. I have shared I am not an Ann Rand type of capitalist before with you, and shared that because we are humans we may need some regulation at times…..as little as possible, and shared I have libertarian leanings, but I am not a libertarian (smaller government, not no government, and the Constitution upheld). Ann Rand was against charity, exalted selfishness, but she would condemn altruism. Quite frankly, I find little use for her anti-God, to-hell-with-everyone brand of capitalism.

          Ann Rand was into a type of casino capitalism with no care for social responsibility. If capitalists would show this type of social responsibility we could let them on their merry way, but sometimes they don’t and that causes government regulation. I wish the capitalists would behave themselves, but often they don’t, so the governement comes in (hopefully not carrying a bat so heavy they kill the capitalists instead of constraining them a bit). What I am against is the government regulating us out of business (this just happened at my husband’s workplace, so it’s on my mind. Some companies up and move to other countries for freedom from fines from the government agencies are run into the millions).

          On the other extreme Marxism doesn’t work either. Nice romantic notion, but not realistic, we can look to Europe and see this.

          So arguing from the extremist capitalism point of view isn’t going to work and bogs down the conversation…which is the British model Berwick is highly recommending. I know I don’t want treated there, and I definitely don’t want any family members treated there. I believe I am emotionally vested because of some of the horrific deaths my relatives have experienced (two from MS while in their thirties, one from a hospital induced case of septis, another one from lung cancer died begging her family to kill her because they wouldn’t give her pain meds, our cousin is dying, my other cousin had mercury get into her after a routine operation and she died, two brother-in-laws dead while in their forties, one from a blood clot and one from diabetes….on and on….and sure mistakes happen here….but they are multiplied there)

          • HJ

            “So arguing from the extremist capitalism point…”

            I am just pointing out the flaws in your argument. You often use the word socialism when regulation is discussed. I would suggest you be careful chosing your words if you feel regulation is acceptable.

            I have not defended the British system, the French system, the Health Care Affordablility Act or any of the other things you rail against. You think regulation is bad until you’re helped by it. I have been called a Communist because I support Medicare paying our doctors a fair price. I am a Marxist because there is an “H” in my initials.

          • http://www.twitter.com/alicearobertson Alice

            HJ you aren’t reading, no one called you anything you have pigeon-holed yourself and others because you take an extremists position. You gave half an article about the Humanist Manifesto trying to make me wrong, but the very article made me right when I found the complete article. I told you it’s an extremely interesting document (s) and as a joke (because you remain anonymous) said I now know what the H means in your name because we debating “Humanisn”. That was not an absolute statement (it was a joke on an anonymous initial and it was very clearly facetious), but you zero in on a piece and refuse to see the whole picture. No one called you a commie, just sharing that the trumpet has been sounded that if we continue in this direction it will bring socialism. Can I ask what you think the socialism means?

            About regulation……there are loads of regulations that don’t help, loads I disagree with, loads that benefit those who implement it, and loads that should not be in place, and it’s a real mess. To say I want what is convenient to me isn’t fair. In truth, I had no trouble before all this regulation (my son’s brain tumor happened 25 years ago).

            As bad as Washington is and as much as everyone wants to replace them, if they gave those seats to you and I we would go there and not do any better. It’s a rigorous, rigged, route filled with powerful, greedy people, so I don’t proclaim to have the answers. But I can say I have been very honest, and forthright in sharing with you. I share everything……my life is an open book…….I don’t hide behind an anonymous name and badger people and get away from the actual point which is health care. I have a ton to learn, but again, I know what doesn’t work.

  • http://doctorrw.blogspot.com/ Robert W. Donnell

    This is one of the few articles to focus in on Berwick’s radical views on patient centered care. I have noted it in several of my own blog posts. But it is a mistake to imply that Berwick espouses conservative values. He has made it clear that he favors redistribution of wealth, the NHS model and rationing “with our eyes open” (whatever that means).

    So Berwick has made some contradictory statements. Most of these have been made separately, to different audiences. He has never bothered to explain his seemingly diametrically opposed positions. He seems bright and articulate enough to reconcile them, so why doesn’t he? Until he does, he comes across as flaky.

    BTW, can you imagine having families participate in all aspects of your rounds and having to negotiate each and every decision with them, while having to round on 20 patients, put out fires on the wards and take admissions from the ER?

  • bev M.D.

    OK you guys; I am submitting this comment in the vain hope that if I do not check the “notify me of followup comments” box, it will remove all these circular arguments from my inbox! I see no other way to do it! Good luck with the arguments!

    • http://www.twitter.com/alicearobertson Alice

      Bev you don’t have a link on your name, so I can’t write to you privately, but I agree….just go to the “Manage Your Subscriptions” and you can unclick this particularly thread. That said is there a way to add a thread without actually commenting?

  • Alina

    To David Allen

    “Ask yourself why the service is currently so bad in the hospital. Is it because of the free market – or something else?”

    Okay. Consider the example I offered above about the healthcare system that has the monopoly on the market. They have several hospitals, ER, you name it. In an emergency situation, due to the distance, it would make it impossible to chose any other facility. I don’t think that we can talk about free-market in this instance since we can only “opt” for that one company. No competition = no incentive to do the right thing since patients can’t go anywhere else. So, they don’t.

    “Could it have anything to do with the massive amount of regulation of the industry or the fact that the government spends 50% of all spent health care dollars? Could it be that the rules of Medicare billing are so complex that even the experts can’t agree on what is ‘correct’ billing.” Are there regulations? Sure, shouldn’t we have them? Sorry, but I don’t buy the whole regulations = high healthcare spending. We spend a good chunk of the $2.5 trillion on the middle-man, the insurance companies.

    I’ll give you that in general the regulations are complex and don’t agree with this. But, to be fair we should also mention that the industry has a hand in all this and participates in the process and create plenty of loop-wholes for themselves.

    “And, in addition, do-gooder government folks keep thinking that hospitals don’t know how to do things, so they develop ‘core measures’ and then hospitals are forced to try to document that they are meeting these core measures by filling out forms, and paperwork, and charts – while the poor patient is still waiting for their IV to be changed.”

    So you believe that we shouldn’t have core measures. I tend to see the glass half full and I don’t think it’s anything wrong with having a standard of care applied across if this has been proven to have positive outcomes. All of us have to multitask nowadays no matter where you work. The key is to prioritize your projects. I would think that feeding the patient or changing the IV would take priority.

    Besides this, in the example I offered above, not only that the nurse only came to my relative once, but I didn’t see any of them preoccupied with any other patients. I think that we have to admit that while there are wonderful, caring healthcare professionals, not everyone shares these traits. We have to also be able to admit that sometimes businesses don’t perform well because of lack of competence or organizational dysfunction. If we clean that out I’m sure that performance would increase dramatically. When hospitals charge this kind of fees good performance should not be a mere elective.

    On a related note regarding quality, currently we don’t have any data on this. I’m curious why some hospitals, many of them non-profit, refuse to report their data to the LeapFrog group. Do you know?

  • HJ

    Alice Says, “HJ you aren’t reading, no one called you anything you have pigeon-holed yourself and others because you take an extremists position.”

    What exactly is my extreme position? Raising Medicare rates? Read this carefully: I have not stated my position on this blog.

    Alice says, “yet it seems some liberals really do unwittingly promote communism with their, “I don’t mind if they raise my taxes to pay for this or that.”

    Some simple logic:
    Ok with taxes implies promoting communism (your premise)
    HJ is ok with taxes
    HJ promotes communism.

    Alice says, “In truth, I had no trouble before all this regulation.”

    It’s not all about you. Have you considered that others have had problems without all this regulation? What if I can’t get insurance because of a pre-existing condition and the new regulation make that possible? Do you agree with the regulation?

    Alice asks, “Can I ask what you think the socialism means?”

    I don’t make up meanings for words.

    The definition from dictionary.com is “a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole.”

    Notice that regulation isn’t included in the definition. Just because something is regulated doesn’t make it socialist. Many industries besides health care are regulated.

    Alice says, “About regulation……there are loads of regulations that don’t help, loads I disagree with, loads that benefit those who implement it, and loads that should not be in place, and it’s a real mess.”

    So you call all possible new regulations socialist?

  • gzuckier

    Evaluating the pros and cons of different propositions or appointments is missing the big picture; politics.
    Imagine the dream scenario: Congress crafts the perfect healthcare system and the administration appoints the team of Hippocrates, Albert Schweitzer, Florence Nightingale, Vesalius, and Galen to administer it. The system is an instant success, Americans immediately become the healthiest people in the world while paying mere pennies. Obama et al are universally acclaimed and the Democrats sweep the next elections.

    At this point, Republicans are interjecting, “Wait; what?”

    In the current political world, there is no upside at all for the opposition party in the possibility of the current administration doing anything to benefit the country. As a result, any possible progress must be sacrificed for the greater good of getting back into power. All the more so, when the basic platform of said opposition part is that government is inherently Evil.

    As a result, Republicans have inevitably become the party of “No”.
    And now we have the Tea Party, the party of “He11, No”.

  • http://www.twitter.com/alicearobertson Alice

    Hi! I took a break because it was becoming to hard to get a post approved. Sorry Alina I was not ignoring you, but if I can’t post, and there is no link on your name it becomes impossible to communicate. I just wanted you and HJ to read about what is happening in Cuba. Like the UK and Germany among others time has shown what Fidel Castro now admits….socialism doesn’t work. The government cannot sustain itself without a free market to generate more tax money. So next time there is scoffing when I bring up what has happened in Russia, and these other countries or show the idealism of Dr. Berwick….no matter how well intentioned I do not want to be viewed as a commodity that is draining the tax payers….we need to take heed to histioy. Marxism is a farce for the naive. Read up on Jeff Goldberg’s visit with Fidel and how idealism actually can hurt more people when we try to imprison a few capitalists. Marxist-Leninist givernments do not function well…..this is from Jaime Suschlicki from the UOM Research on Cuban Studies. Sometimes we need to watch what we dream for because our dream may be a real nightmare if played out.

  • Alice

    Mike who are you ranting about? I pay for private school, donate to help the less fortunate, and homeschool. Who in this thread wants to harm anyone but the capitalists. Actually, I pick up the bill for those who public educate while buying all my own curriculum…all our sports, splitting the price of very expensive coaches and facilities, and that is a choixe I am thrilled to have because, although costly, I have the constitutional right to do so. I am pleased we have a way to educate the masses…but to think about the vast amount of money the system iwasting means it is a mess. Davis Guggenheim’s, Waiting on Superman should be watched by every parent using the system.

    I just can’t figure out who are upset with because the analogy does not fit. For those who do want the truth Chuck Colson has a great five minute video on a discussion he had with a doctor about death panels. It is on his site at. Breakpoint.com. and you can use the search button and type in. “Death Panels” or look up something like, All the Right Questions where he questions a doctor (one with a logical brain) about taxation and ethics. What is odd is the media isn’t reporting accurately that we are signing more of our rights away because the last six months of a person’s life can be extremely expensive. Talk about a Pandora’s. Box.

  • Alice

    Well, Mike….or whoever you really are……….. are you saying that because you are a self-labeled, supposed, altruist then everyone who disagrees with you on Berwick just hasn’t studied? Hey, you can buy the false dream that Berwick is offering Nirvana for those whose minds are in a romantic box…but I KNOW different. I hope it is not you or one of your loved ones on a waiting list someday…ya’ know people are dying to get on one in other countries…sigh…yeah….Berwicks fictional romantic notions will kill people. Now who didn”t do their homework? We can only ;hope Berwick is temporary and maybe he can become a diplomat in the UK…then see where his own family will travel for healthcare.

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