Wednesday, December 30, 2009

The Universe might end tonight....

There may be a Higgs Boson tonight. I am currently watching the third installment of the John Adams Miniseries....I am also drinking my third Sam Adams at this time. The potential subatomic effects of such a mixture makes me shudder. This could potentially create a rip in the space time continuum, and even produce the dreaded Higgs Boson. Possibly even to a greater effect then the Hadron collider was predicted to produce....

SO, in essence, if the entire fabric of the Universe should collapse upon itself, I want to apologize in advance now.


(YES, I am a geek)

Founding Fathers and Christianity...

I was in a conversation some time ago with a nurse who is a "devout" Christian....still not sure what that really means...but I digress. Her assertion was that Obama was muslim...which besides being quite erroneous...was a little comical. When I stated, that first of all, he's really not.....but, even if he was.....SO WHAT????? She got quite defensive, and said that this country has always been a christian nation, and should never be led by someone from another religion....I started to laugh. I asked her if she thought that Washington, Adams, Jefferson, et al were christian.....She argued that "OF course they were"......I stated that no, they really weren't....they believed in god, for sure...but they weren't Christian in the sense of how it is defined currently..... She argued that "her pastor said"......This is where things started to bother me. People are all too quick to simply take someone else's word as fact, without bothering to research things themselves. Please keep in mind that this is NOT meant as a slur against Christianity, and that this is NOT implied in my post, but that simply, the founding fathers were more Unitarian, than Christian in their beliefs. Here it is, in their words.

“The way to see by faith is to shut the eye of reason.” Benjamin Franklin Poor Richard's Almanack, 1758

"As to Jesus of Nazareth, my Opinion of whom you particularly desire, I think the System of Morals and his Religion, as he left them to us, the best the world ever saw or is likely to see; but I apprehend it has received various corrupt changes, and I have, with most of the present Dissenters in England, some Doubts as to his divinity; tho' it is a question I do not dogmatize upon, having never studied it, and I think it needless to busy myself with it now, when I expect soon an Opportunity of knowing the Truth with less Trouble...Benjamin Franklin.

“Lighthouses are more helpful than churches.”

“He (the Rev. Mr. Whitefield) used, indeed, sometimes to pray for my conversion, but never had the satisfaction of believing that his prayers were heard.”

“I have found Christian dogma unintelligible. Early in life, I absenteed myself from Christian assemblies.”

“Some volumes against Deism fell into my hands. They were said to be the substance of sermons preached at Boyle’s Lecture. It happened that they produced on me an effect precisely the reverse of what was intended by the writers; for the arguments of the Deists, which were cited in order to be refuted, appealed to me much more forcibly than the refutation itself. In a word, I soon became a thorough Deist.” Benjamin Franklin, from his autobiography

“Religious controversies are always productive of more acrimony and irreconcilable hatreds than those which spring from any other cause. I had hoped that liberal and enlightened thought would have reconciled the Christians so that their [not our?] religious fights would not endanger the peace of Society.” George Washington Letter to Sir Edward Newenham, June 22, 1792

The divinity of Jesus is made a convenient cover for absurdity.” John Adams

“The government of the United States is not, in any sense, founded on the Christian religion.” John Adams, Treaty of Tripoly, article 11

“But how has it happened that millions of fables, tales, legends, have been blended with both Jewish and Christian revelation that have made them the most bloody religion that ever existed.” John Adams, letters to family and other leaders 1735-1826

“Millions of innocent men, women, and children, since the introduction of Christianity, have been burned, tortured, fined, and imprisoned, yet we have not advanced one inch toward uniformity. What has been the effect of coercion? To make one half of the world fools and the other half hypocrites.” Thomas Jefferson, Notes on Virginia

“The day will come when the mystical generation of Jesus, by the Supreme Being as His father, in the womb of a virgin will be classed with the fable of the generation of Minerva in the brain of Jupiter.” Thomas Jefferson, Letter to John Adams, April 11, 1823

“In no instance have . . . the churches been guardians of the liberties of the people.”
“Religious bondage shackles and debilitates the mind and unfits it for every noble enterprise.” James Madison, April 1, 1774's quite clear that while they were religious, and believed in God, they were not enamored of christianity, and I think they would be quite alarmed at the status of our society today.....and also saddened.

The Cleveland Browns

have now won 3 in a row......

News at 11.

OH, and Mike Holmgren has now joined us, with all of the fanfare of the second coming.

Tuesday, December 22, 2009

Health Reform Cartoons....

Enjoy....these are quite good.

Monday, December 21, 2009

MLR, CBO and "the" Bill....

This has been a bit of a longer process than some, and so far, Obama has not had to use the nuclear option (aka Budget Reconciliation).

What was interesting was Lieberman's apparent about face last week. Especially on something that he had wholeheartedly supported 3 months earlier. Something didn't seem right. My friend over at Angry Bear nailed it.

Lieberman has received most of his money from the financial and insurance industry. One of the parts of this bill is a minimum MLR. The insurance CEO's are going completely ape about this. To be fair, the minimum MLR isn't new, it was in the House legislature initially as Sec:116, and due to pressure at that time, was removed. The insurance companies thought they had seen the last of it, they were wrong.

MLR stands for Medical Loss Ratio, and the insurance industry defines it as the number of cents per dollar coming in, that are paid out for medical services. During a hearing this summer, Senator Rockefeller was grilling the insurance companies about this ratio, and many LIED to congress. They stated that their MLR was already 90% or higher. But research then showed, that for employees at large business, the MLR averaged about 84%, for small business it was closer to 80%, and for individuals purchasing insurance, it was only 76%.

This means that for an individual buying health insurance, 25% of their payments goes to administration, marketing, and/or profit.

The initiative in the current Senate bill mandates a minimum of 90% for all insurance companies, while the House bill, only mandates 85 and 80% respectively.

Hence, Lieberman's temper tantrum. It had absolutely nothing to do with the Medicare buy in (which is a bad idea for several other reasons), but everything to do with protecting his money train.

Now, fast forward to this past weekend, and the CBO releases this memo..


The problem is, that this makes no sense. I am trying to understand how mandating a minimum MLR causes THEIR REVENUE and FINANCES to be considered in the federal budget. We regulate the financial industry, we regulate the energy industry to avoid price gouging, and neither are considered in the federal budget.....I don't quite get it, and neither do other economists. Although it now seems in a correction issued yesterday, that the CBO may be backing away from this a little. My initial impression is that this is similar to the HR 1252 bill that was titled "The Federal Price Gouging Protection Act". Not sure, if we mandate insurance, how regulating the insurers causes them to become financial liabilities against the federal budget.

This was on angry bear....

I just listened to the conference call with Gov. Dean and Wendall Potter.
Toward the very end of the call, the issue of medical loss ratio regulation came up. Seems like a reasonable thing to regulate especially if we are going to get Chicago School of Economics style health care reform implemented via the Shock Doctrine method. (Yes, I've finally started that book and I've got to say, what is happening here with health care reform reads all too familiar.)

Unfortunately, according to Gov. Dean, the CBO keeps scoring MLR regulation as a hit (as in mafia take down) to the budget. Seem from CBO's perspective, if you regulate that the MLR can be no less than somewhere around 90%, such a number placed on profit ability makes all of the nation's health care a government budget item. Thus, something like $2.5 trillion gets added to the budget numbers.

Funny thing this CBO view. Basically this means that I (We the People) can mandate that I buy insurance, that I can only buy it from the private market, that I can write the rules of the market that I buy into, but I can't tell a corporation that is granted a privilege by me to spend it's money on the product it has been granted a privilege to provide?

Maybe the CBO figures because I decided to help some people in buying the mandated insurance, that by regulating the MLR, I'm making that money a greater expense on the budget because now 90% is going to health care services and not 70%? I really can't figure this one. Is the CBO really saying that I (and you) the government, can not assure that I'm going to get my money's worth? How come this issue does not come up when the government negotiates drug prices for the VA?

I really think, after watching our congress deal with health care, finance reform, military, that we have a bigger problem in this nation regarding economics and who is the boss here than we are willing to admit. Hint: It's We the People who is the government. It just seems that we have definitely, completely entered the realm of reality where "the market" is the purpose and not the means. We have been turned to existing to serve "the market". We have put "the market" before all our needs and desires for us as people. This is primitive idolizing behavior. This is sick.

I have to go plow now.

This blog noted in PA Professional

Interesting, I didn't catch this at first, but someone else noted that this blog is noted as an example of social media in the December issue of PA Professional. Page 11.

Seems interesting to me, but this has really become more of a policy and research focused blog over time.

Tuesday, December 15, 2009

Wow, 1/3 of democrats might not vote next year..

News at 11...

WOW, WOW, WOW.....

Or as, Wow Wow Wubbzy says, WOW WOW everyone...

Recent Poll, found here:


This is striking: A new national poll finds that fully one third of Democratic voters say that they’re “less likely” to vote in 2010 if Congress doesn’t pass a public option, underscoring the possibility that dropping the provision seriously risks dampening the Dem base’s enthusiasm.

I was sent an advance look at these numbers by the Progressive Change Campaign Committee and Democracy for America, which commissioned the poll from the nonpartisan Research 2000 and will release the results later this morning. The poll asks:

If Congress does not pass a public option as part of health care reform, will that make you more likely or less likely to vote in the 2010 general election, or no effect?

Among Dems, 33% say it would make them less likely, while less than one fourth that amount, 7%, say it would make them more likely. Sixty percent say it would have no effect.

Among independent voters, 21% say it would make them less likely, and 13% say it would make them more likely, with 66% saying it would have no effect, suggesting that passing a public option would have a marginal impact among indys.

The poll also suggests that 81% of voters want to see Lieberman crucified....or at least punished.

Monday, December 14, 2009

Terminology and Doctoral Level Education

Using, and knowing your terminology....

I am an economics geek, I always have been. Can't help it, it's what moves me, draws me towards policy, and shapes how I see the world.

As many of you know, I am completing my doctoral degree now, and am in the midst of classes. One of which currently is, “Health Policy Development”...Yeah, I know, for me this is like...JACKPOT...I even have my professor asking ME for tips. Of course, other courses are not this far up “my alley”.

But I digress, I recently had a reply to a post of mine discussing free market economics and healthcare (for those of you who don’t know, I am only 3 classes short of my BS in economics, and it is one of my main interests as pertains to healthcare). My classmate, in essence wrote, “the elasticity price in health care cost has escalated. In fact, since year 2000, the premiums for family coverage have raised by 87%” although I am paraphrasing to a degree in order to preserve anonymity.

Some of my classmates have stated that perhaps I was a bit vigorous in my reply.
However, my thought is, at this level of education. If you are going to state something, you better know what you are saying, and you better know how it relates, and is used, and in what context. This isn’t undergrad, this isn’t even graduate level, this is terminal degree level. Using terminology incorrectly needs to be addressed.

My reply was:

Not to be nitpicky, but there is no “elasticity price in healthcare costs”

Price Elasticity refers really to the price elasticity of demand, and to a lesser degree supply, and is a tool measuring the responsiveness of a function or commodity to changes in parameters or, in this case, price. Simply put, the amount to which a supply or demand curve changes relative to changes in price determines the elasticity. Products or goods which are considered essential, like healthcare, or utilties (electric, gas, water) have scores of 0 or -1. This indicates inelasticity which means the goods are NOT SENSITIVE, or at least, not AS sensitive to price changes, because people will continue using them regardless of cost. This is part of what is driving the escalation in healthcare costs today. Additionally, this means that market forces, will be LESS likely to change behaviour.

Now, if we look at the electronic goods market, like TV’s and Computers, their elasticity scores are much higher. This denotes an elastic good, and this means, that if prices rise, demand will fall. This is why you can buy a 47” LCD HDTV for under 1000 dollars now.

If we really want to get fancy, we can look at the math:

PED = (∆Q/∆P) x P/Q. (∆Q/∆P)

But that is really inconsequential for our purposes.

I don’t know, but I don’t think I was harsh in the least.

Markets, Healthcare, and why things don't work...

This is something I've been meaning to post for awhile, but I log on, check out some of my colleagues blogs, and find that I've been beaten.....


Bob has it right. I've said this before as well. One way of keeping costs down, is working within an HMO or PPO network. Simply allowing insurers to cross state lines, won't fix this. In fact, out of state insurers, won't have established networks, won't be able to offer lower prices, or even really compete with in state companies, and won't alter the fact that insurance premiums continue to increase by 10% or more annually.

Now, sadly, most conservatives can't get past this...they can't reconcile the fact that "THE Market" can't fix everything.

Sometimes, competition doesn't help. But don't try and tell the Republican party that, they're rather myopic in this view.

Senatorial Ineptitude

Not suprisingly, and as I have predicted in the past, things have come to a screeching halt in the Senate. The House was predictable, and passed HR3962, which the CBO scored favorably, at least at first.

The problem was, that they also passed HR3961, which basically eliminates the SGR, and calls for a moratorium on Medicare cuts until 2019. The CBO, when evaluating the two bills together, found that it would INCREASE federal deficit spending by 84 billion over the next ten years. Which really isn't bad, but to paraphrase an old saying, "Don't lie to my face, when your screwing my ass!" In other words, be honest.

NOW, the gears have slowed, and the senate is crawling to a stop. Because of several individuals, (cough) BLUE DOGS (cough), as well as Senator Lieberman (cough) TURNCOAT (cough)....the idea of a robust, real public option is likely dead. So, there is now a proposal to extend Medicare coverage.

This is problematic on so many levels as to be comical. Medicare isn't even accepted by many physicians secondary to a dismal reimbursement structure. It is not financially solvent over the long term, and will likely be bankrupt before the next decade is over. This a dog...

Actually, it's worse, it's a dog with fleas.

Sunday, December 13, 2009

Physician Assistant Professional Paradigm Shift

Yep, that's what we need.

Over on Clinician One, there is a thread posting an homage to Mary Mundinger, and her incredible work on behalf of the NP profession.

Someone then mentions that we need a Mary Mundinger for our profession, then, someone mentions that they think that person is me. I am humbled by their thoughts, and I think that we do need an aggressive change in direction, but I think that comparing me (really, in the start or beginning of my political/advocacy career) to someone who has been at this for a long time is a bit premature.

I will however, state, that Ms, sorry, Dr Mundinger, understands the importance of language. I will also state that the entire APN profession has understood that quite well since their inception. Words matter, Titles matter, Descriptions matter. Dr Stead understood this with the initial impetus of calling our profession Physician Associates, however, we have since lived in essentially indentured servitude to our medical masters. I say NO MORE.

Here's a list of some that are used in the lexicon of the PA profession:

Physician Assistant
Supervisory Agreement
Delegatory practice
Dependent licensure

Despicable. EVERY single one of them. I understand their utilization when our profession was young, weak, and politically insignificant, but now I can think of much better substitions.

Physician Associate
Collaborative Arrangement
Specialty Dependent practice
Independence/Completely autonomous licensure

We need to adapt. All professions grow, they change, they are by their very nature dynamic. Like the economy, it is not a static unchanging thing. The PA profession HAS grown since it's inception, but it is now reaching the parabolical end of the rope.

It's time to change again.






I am so happy, I don't even know what to say. That was a great game to watch, and the Brownies almost have me thinking that we have a defense. But then I come back to reality, and realize just how far the Steelers have fallen....

Car Accidents Suck.....

SO, I am leaving work this past Thursday, on my way to pick up my 3 year old daughter, when I get into a car wreck....

Ugh. At least NO ONE got hurt. That's about the only good thing.

5400 dollars in damage to my truck.

I'm still quite a bit sore as well.

Saturday, December 5, 2009


For those of you that regularly follow this blog I wanted to apologize for the recent absence. I just finished arguably the toughest quarter of my doctoral degree, and during November had so many papers, projects, etc. due, that I needed to put this on the backburner for awhile.

But not to worry, I will be posting several posts a week again, starting tomorrow.

Best Regards,