Thoughts on Obama, last night, and the GOP

Okay, it was a fascinating evening. From a poly sci standpoint, this was a great election.

Several thoughts come to mind..

#1 The GOP is elated and confused at the same time. Why? Cause now they actually have to do something. Eric Cantor was interviewed by Wolf Blitzer last night who pressed him on WHAT exact cuts he was going to make to government. Cantor kept repeating 100 billion over ten years, but was unable, or unwilling to articulate exactly HOW they are getting to that figure.

John Boehner's tearful moment was the most disingenuous, comical thing of the evening. If you had ever met the man, you would realize within a second that that was staged. In his interviews he has stated many platitudes about the American people, and how they trust him, yada, yada, yada, but, like Cantor, when pressed on what cuts he needs to do, he is unable to answer at this time.

#2 Obama has failed in a more massive way than I thought possible. He was downright indignant in his interview today, and unwilling to concede that perhaps he might have been wrong. This better change, or he will most assuredly be a one term President.

His biggest failure is the one I never saw coming with him....COMMUNICATION. In uncertain financial times, tough times, with people losing their jobs, an economy struggling like a newborn horse to get on it's fight, people are scared. For right or for wrong, people are scared, frightened, and he did nothing to help assure people. In these difficult circumstances, people need comfort, they need re-assurance that things will be okay..

Where were Obama's fireside chats? Where were bi-weekly TV addresses to the nation taking tough questions, and trying to re-assure the populace? Had he done this, I think we might have seen a very different outcome last night, but we'll never know.

#3 The Tea Party has rolled in, they officially have candidates in office. From a poly sci standpoint, it will be interesting to see how they, and more specifically, the TP base reacts when they realize that they simply cannot achieve about 80% of their goals.....

What will they do? What will the elected TP officials do when they run into the machine that is DC? It changes everyone, and is akin to running full speed into a brick wall. It is immovable, and massive. What will happen to the TP candidates when lobbying money begins to come their way? How will the base react? Are they going to vote for the debt increase?

For example, healthcare will not be repealed. Not now, and not in 2012, even with a GOP administration. The bill is polling fairly well.

I DO see some tweaking of the bill, and some amendments to it. Likely interstate insurance sales, tort reform, and possibly an attempt to remove the mandate.

Of course, that will only hasten the collapse of the US healthcare system, so part of me hopes that they do it, but it will be interesting to see.

I'm getting a BIG bowl of popcorn, this is going to be a fascinating 2 years of political history to watch unfold before our eyes

Last Editorial....

Thought some might like to see my latest editorial which was published in JAAPA in September.


See HERE

I also have two clinical articles being published in JAAPA soon.

One on Etomidate and Sepsis and one on the use of Steroids in Spinal Cord Injuries.

Aging.....Not liking it

Okay,

So I am "officially" old now.

I was a friends wedding a couple weeks ago back home, and one day, when I was at my family's farm with my wife and daughter, everyone is hungry, and becoming crabby.

Well, the only real option near the farm is a McDonalds. I go there, and surprise, my 17 year old niece is working. She is very nice to me as I go through the drive thru...apparently, after I left. Her manager came over and asked, "Shaynna, why were you hitting on that old guy". Yeah, that was nice. Of course, my wife had to tell all my friends.

Then I return home, and go to see the eye doctor. I've been getting headaches for about 6 months, and found that I was holding papers farther and farther from my face. Yep...

I needed reading glasses. In fact, I've needed them for some time.

Nice.....I hate getting old.

Absence...I'm back

Okay,

I've been gone..lax...lazy....out of mind.

Actually, I've been in the grant writing process. Anyone who has done this in the past, will realize quite quickly how painful this is.

I'm also getting my "Assistant Professor of Medicine" rank.

I've been writing, publishing, speaking at various public venues..etc.

BUT, in the immortal words of the drunk pilot in "Independence Day", I'm BAAAACCCKKKKKKKKK!!!!!!

Health Insurance Premiums passed on to workers this year....

News at 11.

While this years premium increase was lower than in the past (average 10.4% increase per year from 1999-2009)...about 5% higher for single, and 3% higher for family premiums, workers contributions rose to 19% from 17% for single coverage, and 30% from 27% for family coverage.

Interestingly, since 2000, premiums have risen 114%, but the employee contribution has risen 147%.

This is problematic, and is not really addressed in the current legislation. At least not adequately, but only time will tell if the implementation of certain measures will lower preimum increases even further, or stagnate them eventually.

THIS

paper recently done at Kaiser is outstanding, and a must read for those trying to understand this a little better.

Patient perception in the ED.....

THIS

Article was written by a good friend, and it has certainly caused a stir. From the abstract...

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient
assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians,
we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a surveywas sent to a random
selection of ED residents and PAs. All respondents were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider
definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5%
of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than
nonphysicians.

This brings up the subject of educating the public about various providers, and the various discussions of the principles of ethical assent to treatment.

But there are also some flaws in this study. When we look at the methodology, this was done at only 3 academic medical center ED's. This creates an automatic selection bias. While I understand the intention of the authors to examine patient willingness to be seen by residents, as well as PA's and NP's, it could easily be argued that patient expectations in academic tertiary centers are quite different from those in small, community or rural hospitals. Also, the study was conducted only at hospitals in Pittsburgh, or Dallas. There may be a geographic variation in patient attitudes that remains untested.

While this is an important study, and discussion ABOUT this study is imperative, we must also resist the urge to draw extreme extrapolations from a limited study.

Perhaps a validation study, done in a series of smaller community ED's with no residency presence may yield different results, maybe not?

Also, perhaps repeating this, using the HRSA data to break up the country into geographic regions, and examining one academic, one community, and one rural ED in each area would provide a rich data yield, and would be an outstanding validation attempt.

Just a few thoughts....

Football season is coming soon....

It is almost upon us.....YAY...

OF course I am a Browns fan, so perhaps I should be in mourning.

Jake Delhommw...REALLY????

Mandates.....

So, the election in Missouri came and went....

WOW....Proposition C passed by 71%. Sounded like a major defeat to the health reform legislation, and analysts like myself were scratching our heads thinking, WHAT? Mainly because polling was showing increased support for the legislation with about 50% of Americans supporting the bill (AP polling).

SO, I dug a little deeper, AHA, there it is.....turnout was 65% republican.....which means that (assuming all R's voted against it), that approximately 6% of independents and democrats don't like the mandate.

From this link.

As written on the ballot, voters had to decide whether to “Deny government the authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful health care services” and “Modify laws regarding the liquidation of certain domestic insurance companies.”

Prop C did not ask Missourians if they’d like to repeal the entire federal health law (and, just an aside--how was a voter suppose to vote if, say, he or she supported the second statement but not the first?). That would require the ballot to also ask voters if they’re for or against parts of the law that the public approves, like prohibiting health insurers from excluding children with pre-existing conditions. Or banning the practice of insurance companies kicking people off their insurance plans when they get sick. But Missourians weren’t asked to judge these and other popular provisions of the health care act.

Absence

Sorry for all of those that read this, or should I say, USED to read this blog on a regular basis.

Summer came FAST and HARD. School was a bit overwhelming, trying to get two research projects off the ground, trying to get funding, and working. OH, and taking vacation. It left little time for anything else, and something had to give.

Anyway, I'm Baaaacccccckkkk.....

Robert Wood Johnson Fellowship

SO, when I was in DC, I was able to meet with, and talk with several of the Robert Wood Johnson Health Policy Fellows. It is a prestigious one year fellowship (residential) in DC for mid career providers to work ON the hill, and in the Senate and WH, writing the legislation, drafting proposals, leading meetings, and advising the POTUS and Congress.

It's an incredible position, and so far, NO PA has ever done it, it has always been MD's, and the occasional PhD, RN.

Well, to make a long story short, I also got to meet one of the directors who thinks I would be the "ideal" PA candidate with my interest in Health Policy, and my informal association with the Mayo Health Policy Center.

What an opportunity, but alas, I cannot. Family is more important. But I'd be lying if I said I haven't been thinking about it EVERY day since.