The swing to the right: the option and its effects on health reform

As Tom Friedman, who some of this year's unreasonable campaign mocked rhetoric in a recent column, I'd be in favor of the reality-based political campaigns... but that seemed, requires too much for this year.  Instead of truth, we now have truthiness.  The joke news shows (and your joke political rallies) seemed more popular than the evening news.  (I wish Jon Stewart and his 200,000 fans on the Washington Mall last weekend stayed home for your candidate for the election canvassing.)  Fact lady told us that many political ads of this year were "not true" or "Pants on fire" zones according to the Truth-O-meter.  But in the end, the tags seem their magic, worked out many "insiders" and "Outsiders" are.  The angry and impatient during the election campaign, in some cases adopted the line from the movie network: "I'm mad as hell and I won't do this anymore," perhaps forgotten network chefs for on air attack are arranged during this line collected character strong ratings, Howard Beale when his ratings fell.

The utopia melody at the top of this post "Swing to the right," comes to you from the Ronald Reagan era, and perhaps we see back swing of the pendulum to the new generation after rechts.Es the guilt seems to happen every 30 years or so... but not me-I'm from Massachusetts (home to a democratic sweep of this election night). 

The last two years have seen a tremendous amount of change in Washington.  The question of the moment, of course, is: How does the election results implementation of healthcare reform?

  The short answer is that even after the loss you have, the Democrats in Congress in the location, a presidential veto any GOP anti-health will be suffered reform maintain initiative.2012 Choosing can be the ultimate course health care reform bestimmen.Wenn wins the GOP more ground in two years, then implementation that can be much more difficult to achieve.

(By the way the mandate of health insurance challenges pending in courts around the country, of course, a potential threat to the health reform implementation.) Interestingly, GOP opposition against health insurance mandate coexists with support for the distribution of affordable health insurance for individuals, although combine the two positions no actuarial sense: without health insurance mandate-controlled purchases of young Invincibles, it can be no "affordable" health insurance for people in a community rated market.)

Stay tuned running political theater as the latest "doc fix" for the next bits from December 1, and the lame duck Congress decides what to do about the SGR and almost 25% Medicare Physician fee schedule cut, is some effect, unless it once again, there are last minute of Congress action.

To update 11/5/2010:Here is a better link with the 2007 MedPAC report, "assessment of the alternatives to the sustainable growth rate system" and a link to the Congressional testimony given on the MedPAC SGR report by Glenn Hackbarth.It is remarkable to check how many items of MedPAC's recommendations their way into the ACA, made while the SGR formula remained alone.When we forward in the realm of bundled payments and quality incentives (Massachusetts is getting it first), capping FFS inflation just isn't, where we should concentrate our energy.Here's hoping that if Don Berwick and Kathleen Sebelius in covered that you have to put a bug in the ears of the legislature documents get to testify to the lots of Congressional Committee hearings next year, so that a long-term solution can be SGR problem that implemented consonant with the way the rest will be the healthcare market is headed.

David, I have to take carefully your disagree of rally to mind.There was no Witz.Diese people are young, very political (usually on the centre-left) and the intention to methodology was ändern.Von what I see the rally only the Anfang.Die most of you are of age, if you think you can change the world for the better personally and the sky is the Grenze.Ich am not sure where it goes from here and I am naturally skeptical of anybody's ability to change such a massive and well firmly rooted system, but I have the effort to bewundern.Ich wish you all the best.

With regard to the health I hope certainly (against all hope) that the next two years are not static dog fight over the edges of the ACA, any page which attempts to tear-down/defend bits and pieces of the perimeter while the rest of the economy in flames is untergeht.vielleicht on sanity after all....

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Why Obama the right call on Berwick made

The recess appointment of Don Berwick CMS lead can bypass the Congressional approval process using a tactic seen worthy Machiavelli or Karl Rove as a cynical Act of political opportunism. Or it may be considered as a pragmatic decision by Obama to avoid debate a tedious and annoying re litigation of health care reform.

Death panels.Been there, done, die.So I choice # 2.

The right side of the blogosphere has broke out, paintings by Berwick as consumed academics who Welk would see the klieg lights and piercing questions from people like John Ensign and Jim Bunning.Diejenigen of us who know Don, who no doubt he would more than his own in the debate on the lessons learned from England's healthcare system and the need for objective rationing kept haben.Don is serious, hyper choices-articulate and intellectually nimble; in a real debate with members of the Senate of Finance Committee, would have all my money on him.

But the Berwick

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Perhaps being wrong is, better and more than right being human

If I was responsible for the medical residency programs in GrandRapids, Michigan, David Leach with me to master the advanced Dreyfus model as doctors from beginners can progress.  I impressed free doctors Wasalways as master approved, your Mistakesand used as a teaching tool.  As a young surgical Andcytopathologist saved my mind was more than once by University OfCalifornia San Francisco's Dr. Theodore R. Miller, a true master Ofcytology, is ready to share with me some of his.  I donot I honestly think I could have survived in diagnostic Pathologywithout his guidance and wisdom.  Years later, I remember still Dr.Miller showing me a breast fine needle aspiration biopsy slide the Fatnecrosis out that imitated ductal carcinoma and a case of wrong Diagnosedpancreatic cancer, inflammatory atypia proved.

Errors and error are on my mind because I just read some extraordinary works. 

Kathryn Schulz's being wrong: Adventures in the margin of the Error(New_York:_Ecco,_2010) has convinced me that we Ourusual pessimistic to replace model of error with an optimistic model of the error.All doctors make mistakes and are familiar with the former model and accompanying feelings of worthlessness, shame and Depression.Wiederentdeckend cases where I got the diagnosis wrong still make me Tothrow until years later to wollen.Schulz is right when she writes,

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Have a right to privacy?

As we to electronic health records (EHR) move, always be debates about security and privacy more frequently and more poignant. Of course we have HIPAA laws on the books and ONC has a tiger team privacy and security policies to recommend Secretary Sebelius. CIOs and the entire IT departments are all focused on the protection of privacy of the patient and their personal health information (PHI). Is this of course, as it should be, but how about the privacy of patient care? Have a right to privacy to doctors?

How EHRs are more widespread and connected is growing clinical and administrative data from the doctors Office sand in the beyond are flow.Most of this data is indeed patient information, but some of them could be combined, sliced and diced very extensive information about doctors ableiten.Zum example, and in no particular order:

Prescribing patterns

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