The Health Care Fiscal Cliff is Next

No matter where your political views lie- most will agree that President Obama is a really good communicator. He’s easy to listen to, what he says seems to sound logical, and he just comes across as a “nice guy.” But, like everything else on the political scene anymore, I just don’t know if I trust him.


Obama gave another “photo op” speech yesterday to try to get the general public more engaged in the fiscal cliff debate in Congress. In front on an obviously staged audience, and standing in front of 14 “average Americans,” the President encouraged those watching to keep the pressure on Congress to get a deal done to avert the economic collision they created. Once again, his comments sounded logical, he was easy to listen to, and he seemed like a nice guy.

But he made a comment during his remarks that took me by surprise- and it was about Medicare.

Ever since March, 2010 I’ve been trying to get behind the health care model that was created by the Affordable Care Act. I don’t like the law, I don’t agree with many aspects of the law, but it is the law. Something has to be done to fix the crisis we’re going to experience with health care costs and the Affordable Care Act is what we have to work with. There are some provisions in the law that makes sense and a lot of things that don’t. But I thought it was all supposed to be based on changing the trajectory of health care costs (including Medicare) and contribute to a reduction in our deficit over time.

Yesterday, to highlight his willingness to compromise on a fiscal cliff deal, President Obama said, “For example, I’m willing to reduce our government’s Medicare bills by finding new ways to reduce the cost of health care in this country. . . We want to make sure that Medicare is there for future generations. But the current trajectory of health care costs has gone up so high, we’ve got to find ways to make sure that it’s sustainable.”

Silly me, I thought that was the whole idea behind the Affordable Care Act.

With the exception of enrolling more people into a high-cost, inefficient, health care system- I’m not sure what the Affordable Care Act is about any more. All I know is that it’s going to be expensive and it’s going to get even more complicated; not what I thought I was signing-up for.

Happy New Year

Asking the Wrong Questions

For the first time since 2000, Gallup has found a majority of Americans now feel it is not the federal government’s responsibility to make sure all Americans have healthcare coverage. According to a recent poll, 54% now feel it is not the government’s responsibility as opposed to 44% who say it is. 

Gallup also found most of those interviewed still think health care system has some major problems, don’t like the costs, but are generally satisfied with the care received when needed.

Whether or not it is the federal government’s responsibility to make sure American’s have health insurance isn’t the real question. If the question was changed to, “Is it the responsibility of the federal government to make sure American’s have access to affordable health care?” the answer results might be different. Considering the fact that health care costs are now impacting the entire economy, I know I’d say it is.

It’s pretty amazing that after all that has happened we’re still having separate discussions around these topics and haven’t put them together. Health insurance financing of health care and an affordable health care system are related.

The Health Care system is moving in the right direction but is resisting the change any way it can. It’s going slow. Until we bring the general public on-board, making the changes that are going to be required is going to be much more difficult. If we used Gallup’s numbers and assume over half the country may be resist the changes that are coming because they don’t understand them, the challenge may be overwhelming.

That is why educating the public about what is going on and getting them engaged critical. They are going to need to be more engaged than they are today to make the change happen.

Now Fix the Affordable Care Act

The election is over. It was close, but not as close as some thought it might be. At least we now have an idea of the direction we’re heading as we try to fix health care. The Affordable Care Act (ACA) is certainly not perfect and not too many folks actually like it (it’s expensive and very few understand how the pieces of the law are all supposed to fit together). But it’s what we have to work with.


The House of Representatives continues to be controlled by the Republicans and the Senate by the Democrats. And we have a Democratic President. No change from where we were before. The respective numbers changed slightly in both the House and Senate, but the overall picture looks the same. Hopefully, the two sides will start working better together more than they have been the last four years.

The pundits are analyzing the results. Some think President Obama has a “mandate” from the general population. I don’t think so. He was simply given more time to deliver results. This wasn’t a mandate, it was a message. Most of the general public is exhausted from the process and simply wants Washington to start fixing what needs to be fixed and quit the political warfare that has already cost us our debt rating has brought us close to the “fiscal cliff” that will occur on January 1 if some pretty bold actions aren’t taken, and the debt and costs continue to grow and the average citizen continues to feel the results. We won’t fix our problems if the two sides don’t start working better together. President Obama needs to lead by example.

Now would be a good time for both sides to sit down and re-evaluate the intent and status of the Affordable Care Act implementation. They should get rid of the costs and unnecessary bureaucracy that may not make sense considering our current economic picture. Some of the ideas that might have seemed logical in 2009-2010 may not be all that logical today.

The Affordable Care Act has some good ideas but in many ways misses the point on the fundamental problem we need to address. The ACA focusses on access (getting everyone into the health insurance pool; mandating health insurance) and doesn’t really deal with the costs until we’re further down the road. Cost is the issue. Including more people in a system that doesn’t immediately address the costs of health care is going to make the Affordable Care Act much more expensive than anticipated- ultimately losing any support from the general public it might have had.

Consumers/individuals will need to get on board at some point if the Affordable Care Act is going to work. Those in Washington can set the tone by doing what is right and doing what makes sense for us today.

Both sides need to have open minds. Instead of barreling “full steam ahead” regardless of the costs just to meet deadlines, DHHS (Department of Health and Human Services) should step back and (as a good Top Gun quote goes) “evaluate what has happened so you can apply what you’ve learned.”

Washington needs to work together to fix what needs fixing.

That’s what we elected them to do.

Election 2012- We've Only Just Begun

The election is Tuesday. Most are going to be glad when it’s finally over. But it’s really not going to be over- no matter who wins. It’s only the beginning.


We have some serious issues to address in this country. We can continue to kick the can down the road like we’ve been doing but we’re running out of road. And the stakes just keep getting bigger. We’re sitting here like the proverbial frog in the slowly boiling pot. We feel things getting hot, but we are not able to ask for a helping hand to get us out. Our politics won’t allow it.

It’s very likely that deciding the Presidential election on Tuesday may be a drawn-out affair. It is going to be close and could result in a president who has won the electoral college not the popular vote. That is not necessarily unusual. George W. Bush, Harry Truman, Woodrow Wilson (both times), Grover Cleveland (both times), Rutherford Hayes, Thomas Jefferson, and others have experienced the same thing. But this one may be different. Boatloads of lawyers are standing at the ready to challenge any and all aspects of the results. It could pull the country further apart rather than pulling us together.

At this point, it looks like the House will continue to be controlled by the Republicans and the Senate controlled by the Democrats. This hasn’t worked out all that well over the past four years. The emotions, the events, and the politics have created the most partisan Congress we’ve ever experienced in this country.

While the political process becomes more polarized we look ahead to “fiscal cliff” and the suffocating costs of health care we still have to address. Addressing them the right way will require real teamwork and collaboration between the parties and their constituents to reach some consensus on how to move forward. That’s the way a democracy is supposed to work. If we decide to keep growing further apart, every American is going to feel the consequences in some way or another.

So, no matter who ultimately “wins” the presidency on Tuesday (or whenever it is finally decided) this is only the beginning for the rest of us. Just because the election is settled doesn’t mean we can all shut-off our minds and move on to other things. There is too much at stake. We have a role we need to play to continue to hold those we have elected accountable and setting a direction that is good for the country and not based solely on a single political ideology. Believe it or not, both sides have some good ideas to share. Neither one has a lock on being right. While the elections may set a direction, we (the citizens) can do a lot to set the tone and demand the results.

We have a choice- not only about who is leading our country but about how it is going to be led. Now more than ever we need to stay involved and stay engaged and remain an integral part of the political process. If we continue to let individual party-ideology reign as the key determinant of how we're going to work in America- we're all going to lose. The choice is ours.

Romney Won The Debate- But Still Not Clear About Health Care

There’s no doubt about it- from a political scorecard point of view, Mitt Romney “won” the debate last night. He was clear in his remarks and came across as the executive you would expect him to be; a very solid performance. President Obama didn’t seem like he just wasn’t into it and would rather be somewhere else. He didn’t go on the attack like his more liberal followers expected. Chris Mathews and Ed Schultz (MSNBC) went into a tirade after the debate lamenting the fact that Obama missed an opportunity to put Romney away. Today, Rush Limbaugh and Shawn Hannity are declaring victory and triumph for the other side.

While the pundits may have expected more fireworks (particularly from Obama) I actually enjoyed the debate. I know I’m in the minority but I like it when a debate includes a factual discussion of the issues that are relevant to those watching it.

Jim Leher (the moderator) had his critics as well. Once again, I didn’t think he did that bad. I enjoyed the free flow of the discussion as opposed to the game-show atmosphere that was prevalent in some of the debates we watched during the Republican primary. Once again, in today’s world my view is certainly the minority. Our culture today seems to want the fireworks, the vitriol, and the entertainment as opposed to a no-nonsense factual debate of the issues to educate the general public.

While Romney performed well when addressing the topic areas (the debt, the economy, taxes) he still didn’t address the question of how he was proposing to fix health care. He talked about RomneyCare and premium support for Medicare but didn't address how it was all supposed to work. The facts he used to summarize his position were generally misleading, lacked context, and he didn’t provide the specifics needed for the average citizen to make an informed decision about the best approach to use to fix the crisis we’re in.

For me, it’s pretty simple: Addressing the unsustainable increasing costs of health care is one of the most critical issues facing our country today. If we fix health care, we can go a long way to addressing our debt. If we address our debt we can go further in growing the economy. If we grow the economy we can create jobs. And that’s the issue for many.

Obamacare (the Affordable Care Act) is too expensive and doesn’t go nearly as far as we need to go to change how health care delivery works in this country. Obamacare needs to be fixed but it’s a start. In my view, Mitt Romney and Paul Ryan still need to present a plan (not just talking points but an actual plan) that makes sense as an alternative to the Affordable Care Act- then, voters like me (who believe health care may very well create the next economic crisis in our country if something doesn’t change) can make a clear decision on which approach is best.

And that will determine the way we vote.

9-11; Eleven Years Later

Let us never forget

And always remember those who have sacrificed and continue to sacrifice to fight for our freedom.

New IOM Report- Will We Listen This Time?

The Institute of Medicine was created in 1970 as a subgroup of the National Academies and Sciences. The Institute is an “advisor to the nation” on the relevant policy and social issues of health and of the challenges facing our health care system and. It includes a lot of smart people from all areas of the health care system.


The Institute has already produced hundreds of studies and papers on a number of health care-related topics. Two of the most notable:

In 1999 the Institute produced “To Err is Human: Building a Safer Health System.” The research highlighted the number of deaths that are the result of medical errors in our health system.

In 2001 it released “Crossing the Quality Chasm; A New Health System for the 21st Century.” This paper emphasized the need for health care to become more “patient centered” and encouraged an entire restructuring of the delivery system. It stated, “What is perhaps most disturbing is the absence of real progress toward restructuring the health care system to address both quality and cost concerns. . .”

It just release another; “Best Care at Lower Cost; The Path to a Continuously Learning Health Care In America.” This study builds on the message it has tried to communicate to the general public for the past 13 years- the health care system is still in need of a fundamental restructuring in how it works and consumers need to be a fundamental part of the new system.

“Best Care at Lower Cost” estimates $750 billion was wasted in our health care system in 2009. Keep in mind Obama and Romney (regardless of what they say) are recommending to reduce Medicare payments (mainly through payment reductions to health plans, hospitals, home health) by $716 billion over ten years.

Eliminating the waste identified in the IOM report could reduce annual health expenditures by $750 billion in a single year or 30% of what we’re spending today. Not bad.

When “To Err is Human” was released in 1999, and “Crossing the Quality Chasm” was released in 2001 the media jumped on the conclusions for a short time, just like it did with the release of this report. Then health care went back to being health care. Our costs continued grow at unsustainable rates, our quality measures haven’t improved much, and somewhere between 75,000 and 100,000 people die unnecessarily each year due to medical errors.

One of these days we’re going to need to start listening to those prophesizing the reality of what we’re facing. The answers are out there and the general public needs to have a better understanding of the alternatives. Health care can be fixed- but is going to require a lot of changes. And we are all going to need to be part of the solution.