Thursday, May 01, 2014

It's time to defy health-care mandates issued by bureaucrats not in the healing profession

There is a huge loss of medical manpower to time spent on compulsory paperwork and data entry


In my 23 years as a practicing physician, I've learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

As a group, the nearly 880,000 licensed physicians in the U.S. are, for the most part, well-intentioned. We strive to do our best even while we sometimes contend with unrealistic expectations. The demands are great, and many of our families pay a huge price for our not being around. We do the things we do because it is right and our patients expect us to.

So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?

The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are "meaningful use" criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements.

Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that "Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction."

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don't doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don't know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

At 58, I'll likely be retired in 10 years along with most physicians of my generation. Once we're gone, who will speak up for our profession and the individual physician in the trenches? The politicians? Our medical societies? Our hospital administrators? I think not. Now is the time for physicians to say enough is enough.



The instinct for free speech is fading worldwide

Mark Steyn

 In Australia, they're trying to get rid of Section 18c, which is (roughly) the equivalent of Canada's late and unlamented Section 13 thought-crime law, which was finally repealed last year. The Aussie campaign is not going well. "There is a danger that the Coalition resolve to repeal Section 18C will weaken further," warns The Independent Australian, saying there's an "urgent need to submit your views on 18C amendments by April 30th" - which is round about right now in Oz time.

What's going on? Well, in the western world today, there are far more lobby groups for censorship - under polite euphemisms such as "diversity", "human rights", "hate speech" - than there are for freedom of expression. If you attempt to roll back a law like Section 18c, you'll be opposed by the aboriginal lobby, the Muslim lobby, the Jewish lobby, the LGBT lobby, the higher-education lobby.... And you'll be supported by ...hardly anyone, save for me and Andrew Bolt and the usual suspects.

That's the hard political arithmetic of defending free speech in western chancelleries today: There aren't a lot of takers for it, and the opposition to it is very organized. A government minister with an eye to his press clippings has to believe in it an awful lot for it to be worth taking on.

What's happening in Britain is the next stage. On Saturday, Paul Weston of Liberty GB, a candidate in next month's European elections, was speaking on the steps of Winchester Guildhall and quoting Winston Churchill on the matter of Muslims (from The River War, young Winston's book on the Sudanese campaign). He was, in short order, arrested by half-a-dozen police officers, shoved in the back of a van and taken away to be charged under a "Section 27 Dispersal Notice". I had charitably assumed this was a more severe equivalent of the parade licensing that American municipalities use to discourage public participation by disfavored groups - ie, Mr Weston was arrested because he did not have his paperwork in order. I dislike such laws, but in America their use testifies at least to a certain squeamishness about directly punishing someone for the content of his speech.

Not so in Britain. The coppers dropped the Section 27 Dispersal business, and instead charged Mr Weston with a "Racially Aggravated Crime" - in other words, he's being charged explicitly for the content of that Churchill passage, and the penalty could be two years in jail. This is remarkable, and not just because Islam is not a race, as its ever more numerous pasty Anglo-Saxon "reverts" will gladly tell you. For one thing, the police have effectively just criminalized Liberty GB's political platform. There are words for regimes that use state power to criminalize their opponents and they're not "mother of parliaments" or "land of hope and glory".

More to the point, if Mr Weston is found guilty of a "racially aggravated crime" for reading Churchill's words, then why is the publisher of the book not also guilty and liable to two years in jail? Why is Churchill himself not guilty? Should he not be dug up from the churchyard in Bladon and re-interred in the cell next to Mr Weston?

Well, no. That's a bit dramatic. Civilized societies prefer to lose their liberties incrementally. It seems more likely that Sir Winston's River War will simply disappear from print, but so discreetly you won't even notice it's gone. Personally, while we're criminalizing Churchill, I'm in favor of banning that "Fight on the beaches" speech, on the grounds that all that "we will never surrender" stuff is very culturally insensitive, not to mention increasingly risible.

But, as in Australia, note how few takers there are - among everyone who matters in Britain, including those bozo cops - for the cause of free speech.

Next stop, America. The other day John Hinderaker wrote at Powerline:

"Mark Steyn believes (this is my characterization, not his) that he is engaged in an Armageddon of sorts; that free speech in America is under serious attack; and that the future of our mostly-free society hangs in the balance. Many consider such fears overblown."

Which I think is John's polite way of saying I'm a bit of a loon. But then he saw this Rasmussen poll:

"Fifty-five percent (55%) of Likely U.S. Voters believe the government should be allowed to review political ads and candidates' campaign comments for their accuracy and punish those that it decides are making false statements about other candidates. A new Rasmussen Reports national telephone survey finds that 31% oppose such government oversight. Fourteen percent (14%) are undecided."

Or to put it another way: fewer than a third of those polled give a hoot about the First Amendment.

John Hinderaker professes to be surprised by this result. But why? Two generations of Americans have been raised in an educational milieu that thinks, to pluck a current example at random, that using the phrase "Man up!" ought to be banned. If you've been marinated in this world from kindergarten, why would you emerge into the adult world with any attachment to the value of freedom of speech?

As I say, in Britain, Australia and America, free peoples are losing the habits of free speech, and thereby will lose their freedom.

Turning to my own current preoccupation, readers and commentators assume that I see the Mann vs Steyn trial as a free speech case simply because I think I have the right to say what I said about his "fraudulent" hockey stick. That's correct, but there's a bigger reason why I believe it's a free-speech battle: Climate science as a whole urgently needs to be wrested away from the thuggish control of Michael Mann and his climate mullahs and restored to vigorous, honest scientific inquiry. I have been, frankly, shocked by the stories I've been told of young scientists scared to speak out against Mann's "settled science" for fear that their careers will be ruined. This is the "consensus" of the longshoremen's union.



Men Who Work Full-Time Earn Less Than 40 Years Ago

An ever expanding bureaucracy eats up all efficiency gains

 The real median income of American men who work full-time, year-round peaked forty years ago in 1973, according to data published by the U.S. Census Bureau.

In 1973, median earnings for men who worked full-time, year-round were $51,670 in inflation-adjusted 2012 dollars. The median earnings of men who work full-time year-round have never been that high again.

In 2012, the latest year for which the Census Bureau has published an estimate, the real median earnings of men who worked full-time, year-round was $49,398. That was $2,272—or about 4.4 percent—below the peak median earnings of $51,670 in 1973.

In 1960, the earliest year for which the Census Bureau has published this data, the median earnings for men who worked full-time, year-round were $36,420 in 2012 dollars. Between 1960 and 1973 that increased $15,250—or about 41.9 percent.



Cruz: 'Words Matter'; Kerry Should Resign Over Israel/Apartheid Comment

Secretary of State John Kerry should resign over his reported comment that Israel risks becoming an “apartheid” state if it does not make peace soon, Sen. Ted Cruz (R-Texas) said on Monday.

“Secretary Kerry has long experience in foreign policy, and he understands that words matter,” Cruz said on the Senate floor. “ ‘Apartheid’ is inextricably associated with one of the worst examples of state-sponsored discrimination in history.”

“There is no place for this word in the context of the State of Israel.”

Kerry on Monday defended his support for Israel, saying he didn't mean it was an “apartheid” state, but admitting her shouldn't have used the word:

“I have been around long enough to also know the power of words to create a misimpression, even when unintentional,” he said in a statement. “And if I could rewind the tape, I would have chosen a different word to describe my firm belief that the only way in the long term to have a Jewish state and two nations and two peoples living side by side in peace and security is through a two-state solution.”



Elections: Actions Have Consequences

Democrats are putting on a brave face to hardcore supporters, imploring them to help the party retake the House and restore Nancy Pelosi as speaker, but, privately, Democrat strategists are far more worried about losing control of the Senate.

Fundraising for Republicans is strong to the point that Democrats warned in a recent fundraising email that “all hope is lost.” Conservative groups, led by Americans for Prosperity, are pouring millions into these races. But even contributions from the Democrats' favorite bogeymen, the Koch brothers, are less effective now, given that some big business competition is supplying millions to leftist advocacy groups. For example, Tom Steyer is a billionaire hedge fund manager who’s heavily invested in renewable energy projects, and he’s supplying millions to oppose the Keystone XL pipeline Barack Obama has dithered on for years.

Moreover, polls show support of ObamaCare is the new “third rail” of electoral politics, and Democrats' huge success in 2008 leaves them with many more incumbents to defend than Republicans, with several of them in swing states that backed Obama before his signature health care plan clumsily rolled out. Incumbent Democrats in Alaska, Arkansas, Colorado, Louisiana and North Carolina are all having difficulties in their races, and several open seats are already thought to be in the GOP column.

Unfortunately for Republicans, six months is a lifetime in politics and any number of gaffes, mistakes and misstatements seized upon by a partisan media are possible – just ask Todd Akin and Richard Mourdock. It’s also likely that the White House spin machine will do whatever it takes to either make ObamaCare look like a success or push the pain past the November elections, just as they originally decided to delay making most of it effective until the president’s second term.

Since the Democrats can’t win on the issues, their strategy going forward seems to be one of trying to turn out their base with incessant “war on women” and minimum wage pandering while goading the GOP to depress their own turnout with “bipartisan” deals on issues like immigration. Avoiding that siren song and giving the conservative base a reason to vote for Republicans by advocating for Liberty and limited government rather than just against Democrats is the key to victory, and the other side knows this, too.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC,  AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten.

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