MD Whistleblower

I feel bad for Jay Carney, the president’s spokesman.  Each day, he faces the Washington Press Corps -piranhas on the hunt – and he must dodge and obfuscate.  I am surprised that the velocity of his spinning hasn't resulted in him drilling himself a mile below the earth’s crust.  He is a human spinning tornado. Presumably, this role must be challenging for Carney, who formerly practiced as an actual journalist who was charged with ferreting out the truth.  Now, he is under orders to avoid the truth.  While I do not suggest that he openly prevaricates, withholding the truth qualifies as dishonesty, as I see it. Tornado or Jay Carney? Carney and all politicians leapfrog over the specific questions being asked.  Their non-responsive responses are exasperating to the questioner and to the public.  There are many rhetorical techniques that these professional double talkers use to change the subject.  Let me illustrate with a hypothetical interview. Interviewer:  “If the v

A few days ago, lawmakers sealed a deal to reopen the government and to relax the debt limit.  This was no O’Henry story with a surprise ending.  This was the outcome that all of us knew was forthcoming.  The GOP not only had no cards to play, but their empty hand was known to all.  It’s very hard to bluff when your cards are face up and you don’t even have a pair of deuces.   Obamacare was the GOP target that quickly became a phantom.  It disappeared.  Afterwards, there was nothing for them to shoot at except each other. GOP vs Dems A perusal of my posts nestled in the Health Care Reform Quality category will demonstrate my skepticism and hostility against Obamacare, which is an interim step toward something even worse.   But, the law was legally enacted, approved by voters in the last general election and was upheld by the U.S. Supreme Court.  That such a monumental program was passed in a unipartisan manner is wrong, but is not illegal.  The roll out of the exchanges ha

Even the most casual Whistleblower reader is aware of my hostility toward Obamacare, which appears destined for incremental implementation.  Ted Cruz’s paper mache weapons were no match for the Democrats' artillery brigade.   When the Chamber of Commerce, corporate America and organized labor are all on the same side of this issue, it suggests that healing this forerunner of socialized medicine will take more than a tweak or two to smooth it out.  Cruz Takes Aim There’s nothing unexpected or unfair here.  Romney campaigned hard against Obamacare.  The country had an opportunity to elect him, and declined to do so.   Did we expect that Obama would dismantle his signature legislative first term achievement in his second term?   When Romney lost, Obamacare won. The Affordable Care Act was legally enacted, albeit without a single Republican vote.  The Supreme Court determined that the law was constitutional.  Elections matter.  So, a flawed program, whose ultimate consequenc

During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform. No, Meat Loaf was not a medical policy wonk who offered health care solutions via allegory in his ballads. It’s the song title that caught me as I read yet another article on accountable care organizations (ACOs). Take a look at this banal 3 word description. Accountable Care Organization These new organizations have much more to do with accountability and organization than they do with care . In other words, Two Out of Three Ain’t Bad. ACOs are another coercive mechanism to track and compare physicians using quality metrics that are far removed from true medical quality measurements. As practicing physicians understand, and government re

President Obama enjoyed a towering victory days ago that I feel leaves the GOP reeling, although they are spinning the Supreme Court’s validation of Obamacare as a great gust of wind at their backs. While I would not have expected a different response from them, I fear that there is a developing wind that may blow them away in November. I offer this analysis as a tepid Romney supporter who will be voting more against Obama than I will be voting to support Romney. The phrase Obamacare is peppered throughout this blog. I was recently chastised by an unabashed whale-saving tree hugger that I should abandon this derisive term which detracts from my otherwise unvarnished objectivity. On the evening that the Supreme Court's decision was announced, I was watching CNN and its pontificating pundits. Various panelists were spewing forth verbal pabulum telling us benighted listeners what we were supposed to think. John King, the moderator, and many members of the spin squad all used the t

I write now from the nation’s capital, one of my favorite destinations. For one who dwells on history and politics, this is the place to be and to return to. During these few days, I took a kid to Ford’s Theater and then to Mount Vernon. Today, I hope to amble throughout the National Mall where I will stand in awe before the great monuments that remind us of what we all need to be reminded of. We will see the monument to Martin Luther King, Jr., which has been in the news because objections have been raised to the inscription carved into the monument. Words matter. The Korean War Veterans Memorial, one of the most moving memorials I've ever seen, is introduced by stark words of enormous power and meaning:  Freedom is Not Free. Many Washington, D.C. license tags are adorned with the the words, Taxation Without Representation, a demonstration of citizen protest that is unthinkable in so many other world nations. I recall years ago, when a protest developed when the Smithsonian

Leadership is convincing folks to follow a new and uncomfortable path. Folks have to believe that the new direction will ultimately serve their interests, even if it feels awkward and unsettling at first. This works when there exists a foundation of trust between leader and followers. Otherwise, there will be doubt as to the motives of the leader who will be suspected of serving his own parochial interests, and not the greater good.  Consider some examples. If your boss has always been stingy, it may be difficult for him to convince workers that the 'new and improved' health care plan is better for their families. If a presidential candidate receives $400 haircuts, can he convince the hoi polloi that he understands the common man and his travails? If a religious leader is discovered siphoning donations into his private accounts, will folks still call the ‘prayer line’ to offer a tithe? When trust in the leader is squandered, distrust lingers and will frustrate and impede f

Photo Credit Herman Cain gleefully shouts to adoring crowds that he now has a target on his back. Amazingly, this non-pol has vaulted to the front of the back, leapfrogging over career politicians who have been running for president and other political offices for years. Can Cain go the distance? Does he have the right stuff? With a 'wink' toward Genesis, is Cain ‘able’? He is derided over his 9-9-9 plan by folks who are scared that his bold and innovative reform proposal is attracting voters. They are more frightened that his plan may actually work. Critics point out or invent flaws in his proposal, trying to chip away at the edifice. Carping is a lot easier than constructing. I’m not an economist and I have no idea if the 9-9-9 plan should be championed or stuffed into a pizza box and recycled. Increasingly, the public believes that whatever flaws and inadequacies 9-9-9 may have are preferable to the deficiencies and abuses of the current tax system. Reform threatens

There was an extremely popular game show where several times each episode the emcee would shout out, "Survey Said!". Of course, this was just a game, not real life.  Now, several times each week I am asked to respond to surveys.  They pop up uninvited on the internet and are often veiled advertisements for products and services. They are on the back of receipts from coffee houses and doughnut shops.  Is it worth 10 minutes of my time clicking through the doughnut survey for either a free chocolate frosted doughnut or the chance to be entered into the grand prize drawing months later?  Hotels I stay at routinely follow-up with e-mail surveys for my feedback.  I suspect most folks delete these instantly, which skews the customer base to those who do respond. (Remember, disatisfied folks are often more motivated to give feedback than the rest of us are.) How often do we call a restaurant, a retail store, a bank or even a doctor's office to offer hosannas about great service?

Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity…The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities. The above quote wasn’t taken from an Obama administration policy proposal. These words are from a 1945 speech by President Harry Truman. It is astonishing that over 60 years later, the health care crisis is not only still with us, but is slowly smothering us. How many years of oxygen do we have left until health care in America is entirely asphyxiated? Each year, the challenges deepen and multiply, which pushes necessary solutions and reform further out of reach. The financial costs of simply maintaining the current system are sailing beyond t

In response to my prior post where I averred that cigarette companies were treated as scapegoats, I have had several cyber and actual conversations about personal responsibility. I believe that folks should realize the consequences and the benefits of freely made decisions. While we want American society to be compassionate, we do not want to punish success and reward failure. Our goal is to do all that we can to maximize everyone’s success. We should be ready to assist those who need and deserve our private and governmental assistance, but personal effort and responsibility are necessary elements of these interventions. When we see patients who are in financial difficulty, my physician partners and staff will do all that we can to help them. While it is not our policy to do colonoscopies for free, we will make whatever adjustments are necessary to make sure that the patient receives colon cancer screening. However, when patients who owe us money hang up on our calls, or express the

The intractable Israeli-Palestinian conflict has been raging and smoldering since I was born, over half a century ago. This suggests that it is an insoluble conundrum, yet all parties to the conflict and others admit that they know what the contours of the final peace would be. This reality heightens everyone’s frustration. The process is frozen within close view of the end zone. The Medicare crisis is analogous to Middle East peace process. The challenges are well known and the solutions are obvious. Yet, decades go by and politics have kept politicians, and those they serve, out of the end zone. They’ve been fumbling the ball for a generation. Now, it’s 4th down and they want to punt again. The problem is that the Medicare program is headed toward insolvency. The solution? Here’s three Mensa suggestions: Scale back benefits Spend more money Raise the age of eligibility Most folks support scaling back benefits, as long as it’s someone else’s benefits that will be adjusted. Si

My daughter, Elana, home from college on winter break, offered me a book to peruse from one of her classes. She correctly suspected that her father, the Whistleblower, would enjoy reading a book authored by a Whistleblower pro. The book, Overtreated, by Shannon Brownlee, should be required reading for first year medical students, who have not yet acquired views and habits that promulgate excessive medical care and treatment. For those of us already in practice, this book should be a required element of board recertification. The theme of the book appears as a subtitle on the cover. Why Too Much Medicine is Making us Sicker and Poorer Brownlee understands the medical system well and describes a culture of excess, conflicts of interests, absence of universal quality control mechanisms and fractured and disorganized care with no one in charge of a particular patient. She presents some chilling anecdotes of medical tragedies that have occurred at our most prestigious medical instituti

I’m blogging again while aboard an airplane. Continental demonstrated an effective strategy for bestowing a small measure of comfort onto its beleaguered passengers. The flight was on a one hour delay. Of course, time is an elastic concept to the airline industry. One hour can morph and expand into several hours. The most frustrating aspect for passengers is that we cannot rely upon the latest update to be a firm commitment. It is a modern day recreation of the Sisyphus myth, recalling the king who spends eternity pushing a boulder up a mountain, but never reaching the summit. Are the death panels back? You remember this distortion from the political right who claimed that coverage for discussions of end-of-life care would soon lead to pulling the plug on granny? This provision was excised from the president’s health care plan, but has been resurrected by executive regulation at the end of 2010. The president has demonstrated that if you can’t get it by legislation, then grab it by r

I begin this post a few thousand feet in the air, in the aisle seat in the rear of the aircraft. I suppose it is fitting that a gastroenterologist would be in the rear section. Fair is fair. Flying is a psychological test of one’s mettle. After enduring the security process, which is designed to find bad stuff instead of bad people, there are other layers of hassle to face. When I reached the cabin door, I was told that there was no available overhead space to store my bag. This development is often tolerable, as gate-checked bags are brought directly up to the arrival gate walkway after arrival, so you can avoid the hand-to-hand combat of the baggage claim arena. Not this time. For reasons, known but to the Almighty, my bag will be directed to the baggage claim, where I hope and pray that I will be properly reunited with it. Meanwhile, I will enjoy the luxury of an airline seat that would be quite comfortable for an average sized 4th grader. If the lady in front of me tilts her seat b

Thank you, Obamacare. The GOP, demoralized and frustrated, as they endured the Obama liberal juggernaut that trampled across the country these past 2 years, has been resuscitated. It’s more fun to be in the majority, as Nancy Pelosi can recall. Democratic hubris and rising public disapproval provided not just a strong wind, but a tornado, behind the GOP’s backs. Obviously, there’s nothing revolutionary here, as midterm elections tend to favor the minority, with rare exceptions. What is noteworthy here is the depth of disapproval with the current administration’s policies, affecting every demographic. The gains that the Republicans achieved, particularly in the House, have left Democrats numb and glum. Whistleblower readers will not be shocked to learn that I did not vote for Obama in 2008, but I was inspired by him. I wanted to believe that he would be the transformational figure that his campaign promised and that the country desperately needed. In particular, I was moved by his s

Do you see or do you observe? Most readers have likely given just a glancing glimpse of the photograph to the left, which I took during recent vacation in Costa Rica. Most, including me, would have recognized that the photograph is a tree, and then moved onto the riveting text. While this identification would be correct, it would not be the whole story. Look more carefully, and see if you overlooked a finding on the photo during your cursory review of it. The health care reform plan, now law, also has many camouflaged elements that were not visible, even to the informed public. In the coming years, as the layers are peeled back, there will be many surprises for the public and for the medical profession, which I hope and pray will remain a profession. The Patient Protection and Affordable Care Act was signed into law in March 2010. No, it won’t be repealed, despite some shrill populist campaigning to do so from the political right. I also doubt that the judiciary will turn it back,

Whistleblower readers know of my deep skepticism that the promises of Obamacare will be realized. As time goes on, my skepticism sinks deeper. The health care reform (HCR) legislation that was passed with reconciliation guarantees more taxes, more access to care for the uninsured and more government control of health care. But it fails in its promise to bend the cost curve, or does it? Perhaps, I’m being unfair and need to adopt a more literal approach to the president’s promise of cost control. President Obama’s program does bend the curve, but does so in the wrong direction. He wouldn’t be the first Democratic president in recent memory to engage in a public demonstration of linguistical gymnastics. If health care costs continue to rise, can we expect to hear the president lecture us in 2012 during his reelection compaign with his finger wagging “I kept my promise to bend the cost curve, and I did.” This past month, a national and respected health care organization reported that

The Patient Protection and Affordable Care Act was signed into law earlier this week by President Obama. The ceremony was notable for the president’s use of 20 pens to sign the bill, and for a vice-presidential expletive that has gone viral. Biden’s presumed private verbal ‘high five’ to the president was heard and widely circulated. Don’t these guys know that when they’re in public that they are never off mic? Our macho vice-president was emulating his vice-presidential predecessor who dropped a similar verbal bomb onto Senator Patrick Leahy in 2004. Cheney’s muscular rhetoric was no aerial drone attack; he delivered his message face to face to the Vermont senator. I wonder if Dick ever invited Pat on a hunting trip? Obamacare is now law. Will this lead us to Armageddon or to the Garden of Eden? I confess that I haven’t read the bill, but then neither did the legislators who voted for or against it. Sure, the specifics are important, but what we really crave to know is what the scor