Doctors Lean Left

Since fewer doctors are owning their own practices, they are becoming more interested in patient care than low taxes and malpractice insurance. They are becoming less conservative as a group according to an NYT article.

doctors learning to cook

thank goodness

Kaiser Permanente, which is a provider and an insurer, is the largest nonprofit health care system in the country, with about 8 million members, 15,000 doctors and 170,000 employees, predominantly in western states. The sheer scale of Kaiser, which holds farmers’ markets at 30 sites, makes changing the way food is bought a challenge, but also an opportunity.

“We can leverage our size to create greater demand for healthy food,” Dr. Maring said. Kaiser Permanente Oakland, for example, serves 6,000 inpatient meals a day, 80 percent of which have no special restrictions.

“It’s difficult for farmers to crack the institutional supply chain,” he said. “We need a ‘universal adapter’ that can pair small producers with big customers.” Toward that end, he helped start a regional growers’ cooperative and joined the board of the nonprofit entity that administers it, the Community Alliance With Family Farmers.

Dr. Maring also envisions Kaiser’s role expanding into areas like environmental stewardship, and he has carved out a kind of subspecialty in institutional real estate, with the goal of eventually putting some of Kaiser’s undeveloped land into agriculture.

Health Care

Obama signed the health care overhaul! I'm excited, but it makes me uneasy how there are still so many people who oppose it. I should really figure out what the bill actually said. At any rate, MA already has mandatory health insurance, and the federal overhaul was modeled after MA's overhaul, so things aren't going to change that much in MA.

Here's President Obama's remarks in Iowa City.

He claims

But we have built into law all sorts of measures that in the years to come, health care inflation, which has been rising about three times as fast as people’s wages, is finally going to start slowing down. We’ll start reducing the waste in the system, from unnecessary tests to unwarranted insurance subsidies.

And once this reform is implemented, then health insurance exchanges are going to be created. This is the core -- the core aspect of this bill that is going to be so important to Americans who are looking for coverage. Basically, we set up a competitive marketplace where people without insurance, small businesses, people who were having to pay through the teeth because they’re just buying insurance on their own, maybe you’re self-employed -- you’re finally going to be able to purchase quality, affordable, health insurance because you’re going to be part of a big pool -- by the way, with members of Congress. So you will be able to get the same good deal that they’re getting, because if you’re paying their salary, you should have health insurance that’s at least as good as theirs.

Here's an article about More Doctors Taking Salaried Positions vs private practice. It could be generally good for patients as their records can pass through the system more easily, but could be letting Big Medicine more easily set high health care costs. However, "The process feeds on itself because doctors who remain in private practice worry that as their peers sell out, their own options become more limited and the prices for their own practices fall," implying that insurance companies are paying doctors less so I'm kind of confused about which is it.

“We wouldn’t go back,” he said, “now that we’ve seen the value of improved patient care and improved communication with primary care physicians.”

Michael Packnett, the president of Parkview and Dr. Mirro’s new boss, said that his organization was growing rapidly, while the number of independent hospital and doctor practices in northeast Indiana shrank. A key reason, Mr. Packnett said, is that many doctors have decided that the challenges of running their own businesses are simply too great.

“Now they get to refocus on practicing medicine,” Mr. Packnett said.

Bill Gates as a Public Figure

This past year was Gates' first year working full time on the Gates' Foundation. He put out an annual letter and has been going on the morning circuit with his views on various policy issues.

ABC News article and video with George Stephanopolous

article at PCWorld

Breakthough Institute blog

He has come out in support of bank fees and tax increases. At the same time, he seeks to moderate people's expectations in the government's ability to make a full recovery, saying that the government is limited in what it can really do. According to Gates, the best thing the government can do for the economy and for social equity is invest in education. The government needs to focus on long term goals. I think changing people's expectations would help a lot or else Scott Browns are going to get elected everywhere.

His main interest is in health services. He talked about the need for innovation in health and the need for more pills. What about preventative measures and things like diet, though? He also notes that we need a lot more investment in clean energy and he downplays the effectiveness of energy efficiency measures. He is right about the lack of funding of clean energy in the US, but I wonder what he would think about the concept of a steady state economy, less work hours, and less material throughput.

He even had a diplomatic analysis of the Google v. China free speech issue.

He has an interesting blog http://www.gatesnotes.com.

It's interesting how billionaires like Gates and Warren Buffet have much more credibility than any actual politicians. On the one hand, it makes sense because they are proven to be successful people. On the other hand, it's a little sad because I don't think there are any politicians that people really trust.

Senate Health Care Bill

I haven't had time lately to really research the health care bill, but I am going to make an effort to do that in the coming weeks.

NYTimes article "Obama Backs Senate on Health Bills' Disparities"
The current price tag of the health care of the Senate is $848 billion over 10 years. It's hard to understand what this means, though, because I'm not sure what our current trajectory costs. They say that the costs will not add to the deficit. But how much does it add to the deficit if we don't pass the health bill? I have a hard time believing it's zero.

Anyway, there are now four pillars of the health care bill

1. cadillac plans' excise tax
2. not adding to the deficit
3. Medicare commission
4. promote "delivery system reforms" for high quality care vs high quantity care

Labor unions are against the excise tax on expensive plans. Here is some more information on what it would do.

The Senate bill would impose an excise tax of 40 percent on the cost of employer-sponsored insurance policies above $8,500 for individuals and $23,000 for families. It provides for increasing those thresholds by $1,350 for individuals and $3,000 for families in cases where workers are in “a high-risk profession or employed to install electrical or telecommunications lines.” And there would be an additional increase in the thresholds, by the same amounts, in the 17 states where health insurance is most expensive.

More later on what these really all mean.