Guest Post by Dr. Chris Johnson

See his website (www.chrisjohnsonmd.com)

 Summary: Physicians under 40 are not the only ones adapting to EMRS. Veteran physicians also are making the transition. For many years, Chris Johnson was Director of the Pediatric Critical Care Service at the Mayo Clinic in Rochester, Minnesota, and Professor of Pediatrics at Mayo Medical School. He now practices in Santa Fe, New Mexico.  (Johnson is the author of three books, including Your Critically Ill Child:  Life and Death Choices Parents Must Face, 2007 and How Your Child Heals: An Inside Look at Common Childhood Ailments , 2001).

Johnson recognizes that we are “a long way from recognizing the brave promises of the EMR.”  Because there is no standard platform, he writes, “I’ve had to learn several, because different facilities choose different vendors. In our pluralistic medical system (if one can indeed call it a system), it’s a free-for-all. And each of them has its own maddening quirks.  . . . The computer whizzes who design the software don’t always seem to me to have quite the same goals as we doctors who use it.”

Nevertheless, he writes: “I find the EMR to be a powerful addition to my practice. In fact, I think I’m a better doctor for using it. I think a key reason for that is because of what I practice – critical care medicine

 At the same time, Johnson acknowledges friends in other specialties “who hate the EMR.”

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Summary: Rick Scott, the former hospital executive who is now a candidate to become Governor of Florida epitomizes the power that concentrated  wealth now has to influence American politics—and, perhaps, buy elections. As Jane Mayer explains in her superb New Yorker piece about the multi-billionaire Koch brothers: “they are trying to shape and control and channel the populist uprising into their own [libertarian] politics… They are out to destroy progressives.”

Of course there are real questions as to whether the “populist uprising” of tea-baggers is a genuine grass-roots movement– or a made-for-TV spectacle produced, directed and funded by conservative wealth. But what is certain is that Rick Scott, like the Koch brothers, is using it to present himself as a politician who represents the will of the people.

The Koch brothers operate in the shadows. Rick Scott has stepped into  the limelight. But their goals are the same. To  advance a conservative agenda  and “break Obama.”  That also means killing health care reform.

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The most recent Health Wonk Review, hosted by Joe Paduda at Managed Care Matters, raises provocative questions about making health care reform a reality. You’ll find Paduda’s round-up of some of the meatiest health care posts that have appeared on the blogosphere in recent weeks here:  http://www.joepaduda.com/archives/001888.html

Below, a summary of just a few posts, with my thoughts on the topics.  If I had more time, I would write about all of them. I urge you to check out the entire Review.

                                           Gawande: “All Health Care Is Local”

 Paduda begins by highlighting Boston Health News, where Tinker Ready quotes Dr. Atul Gawande saying that “all health care is local.” Ready reports that at a recent health care quality colloquium at Harvard, “Gawande made the case for locally driven reform . . .. Communities, he said, need to find ways to create working systems out of the complex, fragmented elements of medicine.” See Ready’s post here http://tinkerready.wordpress.com/2010/08/17/bhn-exclusive-gawande-on-reform-all-health-care-is-local/

I agree.  When it comes to health care reform, different strategies will work in different regions. In some places, Accountable Care Organizations will thrive; in other medical cultures, doctors will reject the idea of working on salary for a large organization, though they may be willing to take responsibility for outcomes by being paid a lump sum each year to keep a patient well (capitated care.)  In other cities, newly expanded community clinics will succeed in becoming “medical homes.”  In most states, experience suggests that Nurse Practitioners will be accepted (by both patients and doctors) as primary care providers. But in other places physicians and patients just won’t be comfortable with the idea.

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Summary: When I wrote Money-Driven Medicine, the Real Reason Health Care Costs So Much (Harper Collins, 2006),  Rick Scott stood out as one of the more memorable characters in a  rogues’ gallery of CEOs who helped create the stock market bubble of the 1990s.

This week, Rick Scott beat Florida Attorney General Bill McCollumn to win the Republican party’s nomination for governor, shattering campaign spending records by investing $50 million of his own money in the race.  Yesterday, in an interview with CNN, Scott said there is no limit on how much of his own money he would spend in the upcoming election.

The citizens of Florida might want to ask: Where did that money come from?

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Below, an excerpt from an imaginary dialogue between Rick Scott and Rick Scott’s “inner voice”  from Warren Langer’s blog “Still liberal at 83” http://stillliberalat83.net/2010/06/28/rick-scott-republican-candidate-for-florida-governor-talks-to-rick-scott/

It seems, to me, to capture Scott’s inner spirit in an important way.

Rick Scott, Republican Candidate for Florida Governor, talks to Rick Scott

Inner voice: What’s happening handsome?

Scott:         I’ve been thinking of taking over Florida. It’s broken and broke and I can pick it up cheap.

IV:              Peanuts cheap?

Scott:        A few TV spots, some snappy phrases and it’s mine. A state of my own.

IV:              Didn’t you have some problems with that chain of hospitals you ran?

Scott:         I already apologized; said I was the Chief Executive Officer and I was responsible.

IV:             Columbia HCA was fined $1.7 billion for Medicaid and Medicare fraud. Isn’t that a problem?

Scott:         I apologized.

IV:             And that’s it?

Scott:        Hey I not only apologized but said, “Let’s get to work.”

IV:             And that will do it?

Scott:        Look pal, Florida is a state with a collective IQ of 70. They don’t know from Medicare, Medicaid and Quantum Physics which may help in the bathroom. They want me, the next governor, the handsome bald guy, to fix potholes and have slot machines in every condo except for Lake City where they and I are against gambling of any kind except bingo.

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Over at Wachter’s World, Bob Wachter, M.D., Associate Chairman of the Department of Medicine at the University of California, San Francisco  relates what it’s like to be on a plane and hear the airplane’s PA system ask: “If there’s a doctor on board, please ring your call button!”

Wachter has been answering this request for some twenty years and offers a surprisingly candid, wonderfully funny, and ultimately reassuring description of how he has responded. Physicians are trained to be professionals, and most put patients’ interests first.

Over at the New Republic, Jon Cohn reports that the Affordable Care Act gives Kathleen Sebelius great latitude in regulating insurers. And Cohn thinks that she is likely to use it.

“It's not impossible,” to regulate private sector insurers, Cohn writes. “Countries like the Netherlands and Switzerland both have adopted this model with considerable success. But it's a difficult task, particularly in a country like ours without the same tradition of strong regulation and enlightened corporate management.

“The architects of the Affordable Care Act understood this and, to the extent they could, they packed the law with regulations designed to force insurers change their behavior. But, by design and necessity,” Cohn notes, “the law was relatively vague on a lot of matters, leaving final determination of the rules to the Secretary of Health and Human Services and her department.”

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Summary:  Some optimistic liberals have begun to suggest that if conservatives manage to block the Affordable Care Act (ACA) , this  could open the door to better reform legislation.

Why that won’t happen.

       ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~             

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA).  Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works. Most voters would be utterly disgusted if Congress returns to the health care debate this fall. It was ugly the first time around; virtually no one wants to watch re-runs on C-Span.  In the months ahead, Americans hope that their elected representatives will do just three things: create jobs, create jobs, and create jobs.

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Health Wonk Review offers a summary of some of the most provocative health care posts of the preceding two weeks. The newest edition went up today, and it’s hosted by the “Disease Management Care Blog’s” Jaan Sidorov here

Highlights:

Over at “Health Affairs,” Timothy Jost, a law professor at Washington and Lee University and co-author of Health Law, the nation's standard textbook for that subject, offers lucid in-depth analysis of yet another section of the Affordable Care Act (ACA): the temporary high risk health insurance pool.  Under the reform legislation insurers will not be able to deny coverage to customers suffering from pre-existing conditions—but that provision doesn’t kick in until 2014.  To bridge the distance between now and then ACA offers a temporary high risk pool known as the Pre-Existing Condition Insurance Plan, or PCI.P.  The program can be run either by the states or by the federal government through a nonprofit entity.  Twenty-nine states plus the District of Columbia chose to operate their own plans, while HHS will administer the program in 21 states. The federal PCIP  is in fact already taking applications, as are several state plans.

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