HEALTHY ONLINE

On March 20, 2015 the stars aligned to produce four simultaneous events that will never again coincide during the life of human civilization. The first three, the vernal equinox, a total solar eclipse and a new supermoon, were brought to us by the stars themselves, and the fourth one was thrown out there by the government. The regulations for Meaningful Use Stage 3 were finally published. Meaningful use of electronic health records (EHR) was presented to us back in 2009 as part of a stimulus bill to help the crashed economy and to improve the quality and affordability of health care services for all Americans. The program is administered by the Centers for Medicare and Medicaid Services (CMS) and implemented by the Office of the National Coordinator for Health Information Technology (ONC). In its first stage, the meaningful use program delivered billions of dollars to technology companies that specialize in manufacturing EHR software, and ensured that clinicians of all types are no lo...

One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra at their favorite charity gala. These wondrous creatures, having pored over a few disjointed numbers selectively allowed to escape from our struggle with health care, are informing us that there are good news worth celebrating at tonight’s black tie fundraiser event.  If you happen to be one of the uninvited or just invisible for all practical purposes except exploitation, you are welcome to go ahead and break out a can of Bud Light and a new bag of store brand Cheesy Poofs for the occasion. Obamacare is working better than anyone dared to hope. Following the astounding news that some 30 million people have Obamacare, we are now told that the way we buy Obamacare insurance on the public exchanges is good news for the ca...

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively promoting, paying you for value instead of work. Value is defined by a set of statistical metrics calculated across the spectrum of services you provide, and some that you don’t. So for example, if Starbucks were to be paid for value, they would get say, $2 for a venti latte, plus a fluctuating amount based on the average temperature of their lattes, the ratio of espresso to milk, the percent of air in the foam, the time from door to latte, etc., over a representative period of say 90 days in year one and maybe 12 months in subsequent years. To enable ...

America is spending $3 trillion on health care every year. Does that number include toothpaste? Surely toothpaste is very important to your health. How about baby powder, diapers, condoms, soap, lip balm, nail clippers, detergents, mops, vacuum cleaners, washing machines, smoke detectors, air filters and air bags? How about everything Nike sells, diet books, your gym membership, bicycles, skateboards, everything Sports Authority carries in its stores, and all Weight Watchers products? And then there is quinoa and edamame, spelt, flax, organic kale chips and those scrumptious gluten-free kelp smoothies. You can also count the entire budget of the EPA, the FAA, the CDC, the FDA and the USDA, and while at it let’s not forget the war on drugs, the war on poverty and the war on terror, and of course education and vacation, sunscreen, traffic lights, firefighters, police and those weirdly bluish ice-melting crystals for your driveway. It sure looks like we are spending all our money on carin...

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to those who pay for medical services and to physicians as well. As a result, primary care medicine was forced to price itself lower than specialized medicine, and now it is being forced to compete with a variety of other business models. Primary care seems to be experiencing an identity crisis, unable to decide if it is the cornerstone of medicine, or an antiquated service whose time has passed. What is primary care? The primary care name itself can be understood in two very different ways, depending on how you translate the word primar...

Did you know that the Ford Motor Company which created the first mass produced horseless carriage in 1908 is one of the largest manufacturers of automobiles a century later? Did you notice how cars today look almost the same as the Model T? They are all made of metal, have four wheels, a steering wheel, a dashboard, a windshield, two rows of seats and an engine. Closer inspection reveals that all newer car manufacturers make cars that look and feel just like the cars made by the Ford Motor Company. And they all drive on roads and use wheels, wheels, the hottest disruptive innovation of the Neolithic era. Truly disruptive innovation, unlike its short lived destructive cousins, stretches across millennia of useful applications. Strangely enough, beds and tables and chairs, and the houses they furnish, look basically the same as those used by Louis XIV. Bread loaves and wine look the same too, and so do fishes. Another thing that hasn’t changed much from the beginning of time is the ferti...

If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. Hayek was not an Ayn Rand sociopath, and he included in his vision reasonable government regulation of markets, strong safety nets, and something that looks awfully similar to the avant-garde “ guaranteed basic income ” discussed nowadays in some European countries. Unfortunately for us, and kudos to Prof. Hayek, seventy years after the publication of his book, we are well on our way to universal indentured servitude. Ordinary Citizens In September 2014, Martin Gilens and Benjamin Page, two Princeton researchers, published the results of a longitudinal study on policy decisions in the U.S. from 1981 to 2002. After crunching enormous am...