Dale Dauten in his Sunday column got me thinking with the closing statements: “If you have an idea you want to nurture, don’t plant it with the forest of the status quo; place it in a fresh field, away from the old growth. Give it a new group or try it in an experimental store, surrounded by people who want it there, who want it to thrive” and “Which brings us to an IBP (Important Business Principle) with a lovely Zen weightless heft: It’s easier to change people than to change people.”
Dale is right on both counts. My question is: “Can you and your company innovate?” Before you say yes - remember Casual Friday is not innovation! Does your organizational culture embrace the new - innovation, or is the status quo your lover? To quote Davis Balestracci (Quality Digest Magazine), “Quite simply, culture is created by what is tolerated.”
Here’s the test. You find someone intentionally destroying a computer in your office. It costs $600.00. What do you do? Ignore them? Fire them? Have them arrested? Send them to counseling? I’m guessing you don’t ignore them?
Here’s a second test. You introduce a great idea / innovation at your next management meeting and the first comment to follow is “Great idea but the devil’s in the detail.” More alarming is that all the heads are bobbing in agreement - “Yea - the devil’s in the detail.” Guess what - it’s time to change the sheets in the bed because you’ve been sleeping with the status quo (devil) too long. Michelangelo said, “God is in the detail.” The devil’s work will be done - innovation killed.
Time and space do not permit a thorough examination of all the reasons (a.k.a. excuses) you still believe you and your company are innovators. I’ll just offer the following two explanations of why this (“devil’s in the detail”) is the reaction. If you agree - do something about it, INNOVATE. If you disagree - quit reading you’re not going to change anyway! At least you’ll die in the arms of your lover.
Draw your organizational chart - now frame the perimeter. It’s a pyramid. You’re at the top and your managers / supervisors rest near the pinnacle. The worker bees and the trainees (worker bees in incubation) stand between you and the marketplace - your customers. If you innovate it will require flattening the organization - that’s not going to happen since your managers / supervisors have spent years clawing their way to the top and you want to do what - flatten the system? NO WAY!
Now superimpose a bell curve on the pyramid. At the front end are 20% of the folks willing to embrace the new. They are enthusiastic but will burn out quickly without change. On the back end are 20% who are retired in place. You send them a check each week in spite of the fact that they quit working for you years ago. The remaining 60% aren’t bad people - they are bad innovators. They kill ideas to protect you from yourself - you mean well but “the devil’s in the detail.” They’ve done it before - they’ll do it again. It’s what’s best. See IBP in paragraph # 1!
Copyright - Michael G. Manes (December 2009)
Tuesday, December 15, 2009
Sunday, November 29, 2009
The Status Quo Can Kill You
Years ago I read a mini-book called "The Portable Do It." It was a short version of the book, "Just get off your butt and do it." An underlying theme was that your “comfort zone” is the most dangerous place to be. In today’s world that is changing at warp speed, this premise has never been truer. Today with contribution of some smart folks - I’ll reinforce this theory.
Danny would always say, “If you’re on a plane headed in the wrong direction the best thing you can do is get off quickly.” Today - if you’re hunkered down in your status quo - you just as soon be going backwards.
Bob talked in 1975 of “paradigm thinking” and its potential to kill you. His parable was about a young lady speeding down the highway in her convertible. As she came out of the curve, she saw a state policeman going in the opposite direction and yelled - “Pig, Pig.” The cop was infuriated - he turned on his lights and siren and looked for a quick turn around. He ran into a pig on the highway and was killed.
Today I read an article from the New Yorker (12 / 06 / 04) titled "The Bell Curve." Don Berwick with the Institute for Health Care Improvement is quoted in the article. The excerpt follows.
“He began his speech with a gripping story about a 1949 Montana forest fire that engulfed a parachute brigade of firefighters. Panicking, they ran, trying to make it up a seventy-six-per-cent grade and over a crest to safety. But their commander, a man named Wag Dodge, saw that it wasn’t going to work. So he stopped, took out some matches, and set the tall dry grass ahead of him on fire. The new blaze caught and rapidly spread up the slope. He stepped into the middle of the burned-out area it left behind, lay down, and called out to his crew to join him. He had invented what came to be called an “escape fire,” and it later became a standard part of Forest Service fire training. His men, however, either thought he was crazy or never heard his calls, and they ran past him. All but two were caught by the inferno and perished. Inside his escape fire, Dodge survived virtually unharmed.
As Berwick explained, the organization had unraveled. The men had lost their ability to think coherently, to act together, to recognize that a lifesaving idea might be possible. This is what happens to all flawed organizations in a disaster, and, he argued, that’s what is happening in modern health care.”
Finally a true story to prove my theory and that of others - the status quo (your comfort zone) is dangerous and in times of turmoil, if you choose to "hunker down” in that dangerous place - you can be killed. Think about it.
Copyright - Michael G. Manes
All rights reserved
Danny would always say, “If you’re on a plane headed in the wrong direction the best thing you can do is get off quickly.” Today - if you’re hunkered down in your status quo - you just as soon be going backwards.
Bob talked in 1975 of “paradigm thinking” and its potential to kill you. His parable was about a young lady speeding down the highway in her convertible. As she came out of the curve, she saw a state policeman going in the opposite direction and yelled - “Pig, Pig.” The cop was infuriated - he turned on his lights and siren and looked for a quick turn around. He ran into a pig on the highway and was killed.
Today I read an article from the New Yorker (12 / 06 / 04) titled "The Bell Curve." Don Berwick with the Institute for Health Care Improvement is quoted in the article. The excerpt follows.
“He began his speech with a gripping story about a 1949 Montana forest fire that engulfed a parachute brigade of firefighters. Panicking, they ran, trying to make it up a seventy-six-per-cent grade and over a crest to safety. But their commander, a man named Wag Dodge, saw that it wasn’t going to work. So he stopped, took out some matches, and set the tall dry grass ahead of him on fire. The new blaze caught and rapidly spread up the slope. He stepped into the middle of the burned-out area it left behind, lay down, and called out to his crew to join him. He had invented what came to be called an “escape fire,” and it later became a standard part of Forest Service fire training. His men, however, either thought he was crazy or never heard his calls, and they ran past him. All but two were caught by the inferno and perished. Inside his escape fire, Dodge survived virtually unharmed.
As Berwick explained, the organization had unraveled. The men had lost their ability to think coherently, to act together, to recognize that a lifesaving idea might be possible. This is what happens to all flawed organizations in a disaster, and, he argued, that’s what is happening in modern health care.”
Finally a true story to prove my theory and that of others - the status quo (your comfort zone) is dangerous and in times of turmoil, if you choose to "hunker down” in that dangerous place - you can be killed. Think about it.
Copyright - Michael G. Manes
All rights reserved
Sunday, November 22, 2009
Harry and Ann, Rush and Nancy!
When the Health Care Reform debate began, no one - I repeat no one - would have believed this. Today at this historic signing of the Choice Health Care Plan - that passed unanimously - the vitriolic debate, the Tea Parties, the town hall meetings all seem surreal. Harry Reid and Ann Coulter are dancing in the Rose Garden - Nancy and Rush are holding hands as tears of joy are shed. What a country?
A simple suggestion from a Senate page started it. She said, “You have two groups that can never be reconciled - so why don’t you give each side what they want? Both groups will be happy and the vote will be unanimous.
Here’s the idea. Consider the real divide in America and then allow each of these market segments to enjoy the plan of their choice. The first group wants and will embrace a public plan. The remaining folks don’t want, won’t tolerate, and will not accept such a plan. Give the first group a “Medicare” type plan and give the second bunch a Federal Employee Health Benefit Plan like Congress enjoys. The first group wants to be taken care of and the other half seeks self-sufficiency without the burden of carrying the first group. There is already enough money to do this.”
The two market segments are based upon “Locus of Control.” One group believes that they are victims of their environment, that what happens is not their fault or their doing and not in their control. The second believes that with hard work, freedom and opportunity they can create the environment they want. They recognize “stuff happens” but as survivors - if they fall they will get back up.
The Victims are by nature dependent. They want a public plan. They want the government to take care of them and others. For efficiency it might be prudent to “roll” all the existing laws - Medicare, Medicaid, ER Access, SCHIP, mandates, illegal immigrants, etc. into one plan. This plan would only be required to pay for the care used by the Victims enrolled. Onerous regulations and the significant bureaucracy could continue - that’s the culture of Victims. Sameness is good.
Survivors by nature are independent. They tend to be generous but they have their limits. They see a past system that “robbed Peter to pay Paul” so of course this had the support of Paul. They believe they are the “Peters” and they have had enough. They want choice - to think and act and be free. They’ll live with the consequences.
A fire wall of choice would permanently separate these groups. As the silence became deafening - Harry and Nancy became overwhelmed. Then in a fit of enthusiasm, Nancy suggested that this model could work for all services not just Health Care. Mitch McConnell quickly offered to give broken California to the Victims as a pilot project. Other Survivors quickly agreed on the condition that the pilot be self-sustaining by the Victims and that these Victims would stay out of Survivor’s markets and wallets. Senator McConnell offered to take Iowa as a good pilot for the Survivors since culturally these folks seem self-sufficient. All agreed.
Copyright - Michael G. Manes (November 2009)
All rights reserved
A simple suggestion from a Senate page started it. She said, “You have two groups that can never be reconciled - so why don’t you give each side what they want? Both groups will be happy and the vote will be unanimous.
Here’s the idea. Consider the real divide in America and then allow each of these market segments to enjoy the plan of their choice. The first group wants and will embrace a public plan. The remaining folks don’t want, won’t tolerate, and will not accept such a plan. Give the first group a “Medicare” type plan and give the second bunch a Federal Employee Health Benefit Plan like Congress enjoys. The first group wants to be taken care of and the other half seeks self-sufficiency without the burden of carrying the first group. There is already enough money to do this.”
The two market segments are based upon “Locus of Control.” One group believes that they are victims of their environment, that what happens is not their fault or their doing and not in their control. The second believes that with hard work, freedom and opportunity they can create the environment they want. They recognize “stuff happens” but as survivors - if they fall they will get back up.
The Victims are by nature dependent. They want a public plan. They want the government to take care of them and others. For efficiency it might be prudent to “roll” all the existing laws - Medicare, Medicaid, ER Access, SCHIP, mandates, illegal immigrants, etc. into one plan. This plan would only be required to pay for the care used by the Victims enrolled. Onerous regulations and the significant bureaucracy could continue - that’s the culture of Victims. Sameness is good.
Survivors by nature are independent. They tend to be generous but they have their limits. They see a past system that “robbed Peter to pay Paul” so of course this had the support of Paul. They believe they are the “Peters” and they have had enough. They want choice - to think and act and be free. They’ll live with the consequences.
A fire wall of choice would permanently separate these groups. As the silence became deafening - Harry and Nancy became overwhelmed. Then in a fit of enthusiasm, Nancy suggested that this model could work for all services not just Health Care. Mitch McConnell quickly offered to give broken California to the Victims as a pilot project. Other Survivors quickly agreed on the condition that the pilot be self-sustaining by the Victims and that these Victims would stay out of Survivor’s markets and wallets. Senator McConnell offered to take Iowa as a good pilot for the Survivors since culturally these folks seem self-sufficient. All agreed.
Copyright - Michael G. Manes (November 2009)
All rights reserved
Friday, November 6, 2009
Would it be malpractice if?
Would it be malpractice if a doctor examined a patient, discovered cancer and a head cold and only treated the head cold? What if the doctor didn’t tell the patient about the cancer or told the patient that he’d take care of the cancer later? What if the doctor told the patient that curing the head cold would fix the cancer?
What if the doctor did this because treating a cold is easy and dealing with cancer is less pleasant? With cancer there is the cost, the time consuming nature of treatment, the emotion, and less chance for a permanent cure.
I’m guessing your answer to the question - “Would it be malpractice?” - would be yes and I’ll further speculate that you’d volunteer to be on the jury, just so you could be sure that justice is done? Am I right?
Here’s the reality of the Health Care and Health Care Financing Reform initiative being addressed in Washington. Our elected leaders - the President and Congress, the lobbyists that fund them, the special interests that elect them, and the Political Parties that exist to support them are - IN MY OPINION - guilty of malpractice.
They are telling us - the American people - that we’ve got a problem. They have correctly diagnosed the problem to be the cost, quality, and accessibility of Health Care. Unfortunately after that, their priorities, diagnosis, and prognosis are at best misunderstood, their efforts misdirected, and intentions self serving - they are being negligent or worse. At worst they are ignoring what they know needs to be done.
Here are the facts - our current health care system is great for some, limited in effectiveness for others, and not available too many. Its current cost is over $7,500 for every man, woman, and child and trending at a level that will double this cost in 6 - 8 years. Our current system is not sustainable. Our system is “infected” with two diseases of cost - one is the financing (insurance / Medicare /etc.) and the other is the delivery of care. Financing is our “cold” - the cost of delivery is the “cancer.”
Our elected officials are all focusing on the “financing” because (in their words) “insurance companies are evil (dishonest)” - the insurance industry is an easy “dog to kick.” The reality is that the cost of delivering care dictates the cost of insurance. For every premium dollar you spend 15 - 25% goes to the insurance company, while 75 - 85% goes to doctors, hospital companies, pharmaceuticals, etc.
If we cure the cold by eliminating insurance companies - we wouldn’t even save the quarter since some other payment mechanism would have to be developed. As a practical matter if we discontinued those evil insurance companies - our costs for Medicaid and Medicare would instantly go up because right now the federal government in the Medicare system and the state and federal government in the Medicaid program intentionally under fund the providers (doctors, hospitals, etc.) knowing that these costs will be paid by / shifted to the insurance companies.
What if we first chose to treat the cancer - the cost of care in our country? What if we not only acknowledged that the quality of our care could be better but that even the best care can’t make us well if WE CHOOSE TO BE SICK? What if we acted on what we know? Diet and exercise will fix obesity quicker, cheaper and longer than will gastric bypass surgery and pills that are temporary solutions at best.
What if we recognized that all of us are individuals made up of mind, body, and spirit and our ideal condition is “wellness” not sickness yet our Health Care System is built upon a “body” focus and a treatment of “sickness?” Add wellness and fitness diagnoses / protocols to the ICD 9 Codes. Pay doctors for these outcomes.
What if we acknowledged that the simple aspirin is the most effective medicine in Health Care today? What if we acknowledged that there are better answers than a prescription drug for every disease - every time - all the time?
What if we recognized that the most inefficient, costly, limited tool in our medical bag is the ink pen? Its usage has caused malpractice claims, creates massive problems with HIPAA, storage of documents, copies, etc. Left unchecked it encourages redundancy and waste. In the hands of the wrong player it can lead to fraud. What if we did in HC what every other segment of the economy has done - leverage technology to reduce paper, enhance efficiency, and improve effectiveness?
What if we chose to leverage technology not just for better care but for enhanced administration of care? What if we embraced a system that captures all information about our diagnoses, protocols established, and outcomes achieved? What if we used this to determine best practices and best of class procedures?
What if we used this technology to take us paperless, make regulation less onerous (eliminating over a hundred thousand pages of regulation that exist today)? What if we made lawyers the least utilized “specialist” in our system? What if we only allowed lawsuits for gross negligence or criminal acts and created a “no fault” (workers comp type) system to compensate patients for other bad results.
What if we acknowledged that there is and will be well into the future a significant shortage of physicians and other health care providers and leveraged technology (telemedicine) to create integrated care delivery teams that can deliver quality care that is readily available and affordable? What if we used licensing laws to assure all practitioners were qualified inside the context of their profession not to protect turf?
What if we redefined hospitals to the needs of their communities and recognized centers of excellence can do work better and less expensively and we used these centers for the most costly, high risk procedures? What if added incentives and disincentives to encourage individuals to eat better, exercise more, seek most appropriate care? What if we focused first on the cancer then on the cold?
What if Congress “treated” the cost of care first and financing second? What if?
Copyright - Michael G. Manes (November 6, 2009)
All rights reserved
What if the doctor did this because treating a cold is easy and dealing with cancer is less pleasant? With cancer there is the cost, the time consuming nature of treatment, the emotion, and less chance for a permanent cure.
I’m guessing your answer to the question - “Would it be malpractice?” - would be yes and I’ll further speculate that you’d volunteer to be on the jury, just so you could be sure that justice is done? Am I right?
Here’s the reality of the Health Care and Health Care Financing Reform initiative being addressed in Washington. Our elected leaders - the President and Congress, the lobbyists that fund them, the special interests that elect them, and the Political Parties that exist to support them are - IN MY OPINION - guilty of malpractice.
They are telling us - the American people - that we’ve got a problem. They have correctly diagnosed the problem to be the cost, quality, and accessibility of Health Care. Unfortunately after that, their priorities, diagnosis, and prognosis are at best misunderstood, their efforts misdirected, and intentions self serving - they are being negligent or worse. At worst they are ignoring what they know needs to be done.
Here are the facts - our current health care system is great for some, limited in effectiveness for others, and not available too many. Its current cost is over $7,500 for every man, woman, and child and trending at a level that will double this cost in 6 - 8 years. Our current system is not sustainable. Our system is “infected” with two diseases of cost - one is the financing (insurance / Medicare /etc.) and the other is the delivery of care. Financing is our “cold” - the cost of delivery is the “cancer.”
Our elected officials are all focusing on the “financing” because (in their words) “insurance companies are evil (dishonest)” - the insurance industry is an easy “dog to kick.” The reality is that the cost of delivering care dictates the cost of insurance. For every premium dollar you spend 15 - 25% goes to the insurance company, while 75 - 85% goes to doctors, hospital companies, pharmaceuticals, etc.
If we cure the cold by eliminating insurance companies - we wouldn’t even save the quarter since some other payment mechanism would have to be developed. As a practical matter if we discontinued those evil insurance companies - our costs for Medicaid and Medicare would instantly go up because right now the federal government in the Medicare system and the state and federal government in the Medicaid program intentionally under fund the providers (doctors, hospitals, etc.) knowing that these costs will be paid by / shifted to the insurance companies.
What if we first chose to treat the cancer - the cost of care in our country? What if we not only acknowledged that the quality of our care could be better but that even the best care can’t make us well if WE CHOOSE TO BE SICK? What if we acted on what we know? Diet and exercise will fix obesity quicker, cheaper and longer than will gastric bypass surgery and pills that are temporary solutions at best.
What if we recognized that all of us are individuals made up of mind, body, and spirit and our ideal condition is “wellness” not sickness yet our Health Care System is built upon a “body” focus and a treatment of “sickness?” Add wellness and fitness diagnoses / protocols to the ICD 9 Codes. Pay doctors for these outcomes.
What if we acknowledged that the simple aspirin is the most effective medicine in Health Care today? What if we acknowledged that there are better answers than a prescription drug for every disease - every time - all the time?
What if we recognized that the most inefficient, costly, limited tool in our medical bag is the ink pen? Its usage has caused malpractice claims, creates massive problems with HIPAA, storage of documents, copies, etc. Left unchecked it encourages redundancy and waste. In the hands of the wrong player it can lead to fraud. What if we did in HC what every other segment of the economy has done - leverage technology to reduce paper, enhance efficiency, and improve effectiveness?
What if we chose to leverage technology not just for better care but for enhanced administration of care? What if we embraced a system that captures all information about our diagnoses, protocols established, and outcomes achieved? What if we used this to determine best practices and best of class procedures?
What if we used this technology to take us paperless, make regulation less onerous (eliminating over a hundred thousand pages of regulation that exist today)? What if we made lawyers the least utilized “specialist” in our system? What if we only allowed lawsuits for gross negligence or criminal acts and created a “no fault” (workers comp type) system to compensate patients for other bad results.
What if we acknowledged that there is and will be well into the future a significant shortage of physicians and other health care providers and leveraged technology (telemedicine) to create integrated care delivery teams that can deliver quality care that is readily available and affordable? What if we used licensing laws to assure all practitioners were qualified inside the context of their profession not to protect turf?
What if we redefined hospitals to the needs of their communities and recognized centers of excellence can do work better and less expensively and we used these centers for the most costly, high risk procedures? What if added incentives and disincentives to encourage individuals to eat better, exercise more, seek most appropriate care? What if we focused first on the cancer then on the cold?
What if Congress “treated” the cost of care first and financing second? What if?
Copyright - Michael G. Manes (November 6, 2009)
All rights reserved
Friday, October 23, 2009
The Delcambre Canal - A Health Care Reform Model
What follows is a brief factual recap of a disaster and an “assumption” that might be the model needed for Health Care Reform. The Delcambre Canal is 1.2 miles south of Lake Peigneur. The Delcambre Canal forever had “flowed” water from the Lake to Vermillion Bay. The Delcambre Canal was an outlet for Lake Peigneur.
The facts are - (Wikipedia) November 20, 1980 a 14 inch drill bit from a Texaco oil rig penetrated the roof of the Diamond Crystal Salt Mine at Jefferson Island Louisiana. “This turned an almost 10-foot deep freshwater lake into a saltwater lake with a deep hole… So much water drained into those caverns that flow of the Delcambre Canal that usually empties the lake into Vermillion Bay was reversed, making the canal a temporary inlet.” These are facts… Now the assumption:
Somewhere along the Delcambre Canal there was a Cajun who has spent his entire life in a suspended animation - created by consumption of vast amounts of alcohol. On that November day when the Canal reversed itself, our Cajun friend had taken Old Crow from his pocket for his next drink. I’m assuming he looked down saw the change in water flow, poured out the remaining liquor, asked forgiveness from the good Lord, and changed is life forever - now he’s dry, prayerful, and better.
The Miracle of the Delcambre Canal was not that it reversed its flow - the Miracle is that our Cajun Friend changed his life - he became a new, better person - dry, thoughtful, prayerful, and productive. This is our hope for Health Care Reform.
Most agree that the “birth” of today’s health insurance system was in 1929 at Baylor University when teachers were guaranteed 21 days of hospital care for $6 a year. The insurance system created began the flow of dollars to providers as reimbursement for the care they provided and simultaneously began the intoxication of the patient / consumer to spend other peoples’ money (OPM). Now 80 years later - we none know or understand the cost of the care we demand, or utilize. We’ve gone from premiums of $6 a year per individual to over $3,000.
Like our Cajun Friend we, as the users of and payers for health care, need a life changing experience. We need to realize the problem is not just the dollars flowing into the system but the health of the population, the care provided, and waste, fraud, and inefficiency that overwhelm the system. All of us - consumers that use care, those that pay for it, those that provide it, and those that impact the system in any way - must become more responsible, thoughtful, accountable, and practical.
We must eat less and better, exercise more, seek care only when needed and demand quality for the care provided. Payment systems must “incent” better results for less cost. Regulation, paperwork, lawsuits, and defensive medicine must be reduced. Wellness, research, preventive care, etc. must be enhanced. We must spend less on facilities and more on results - less on advertising designer drugs and more to reduce use of prescriptions. We must all be responsible. We must all change…
Copyright - Michael G. Manes (October 2009)
All rights reserved
The facts are - (Wikipedia) November 20, 1980 a 14 inch drill bit from a Texaco oil rig penetrated the roof of the Diamond Crystal Salt Mine at Jefferson Island Louisiana. “This turned an almost 10-foot deep freshwater lake into a saltwater lake with a deep hole… So much water drained into those caverns that flow of the Delcambre Canal that usually empties the lake into Vermillion Bay was reversed, making the canal a temporary inlet.” These are facts… Now the assumption:
Somewhere along the Delcambre Canal there was a Cajun who has spent his entire life in a suspended animation - created by consumption of vast amounts of alcohol. On that November day when the Canal reversed itself, our Cajun friend had taken Old Crow from his pocket for his next drink. I’m assuming he looked down saw the change in water flow, poured out the remaining liquor, asked forgiveness from the good Lord, and changed is life forever - now he’s dry, prayerful, and better.
The Miracle of the Delcambre Canal was not that it reversed its flow - the Miracle is that our Cajun Friend changed his life - he became a new, better person - dry, thoughtful, prayerful, and productive. This is our hope for Health Care Reform.
Most agree that the “birth” of today’s health insurance system was in 1929 at Baylor University when teachers were guaranteed 21 days of hospital care for $6 a year. The insurance system created began the flow of dollars to providers as reimbursement for the care they provided and simultaneously began the intoxication of the patient / consumer to spend other peoples’ money (OPM). Now 80 years later - we none know or understand the cost of the care we demand, or utilize. We’ve gone from premiums of $6 a year per individual to over $3,000.
Like our Cajun Friend we, as the users of and payers for health care, need a life changing experience. We need to realize the problem is not just the dollars flowing into the system but the health of the population, the care provided, and waste, fraud, and inefficiency that overwhelm the system. All of us - consumers that use care, those that pay for it, those that provide it, and those that impact the system in any way - must become more responsible, thoughtful, accountable, and practical.
We must eat less and better, exercise more, seek care only when needed and demand quality for the care provided. Payment systems must “incent” better results for less cost. Regulation, paperwork, lawsuits, and defensive medicine must be reduced. Wellness, research, preventive care, etc. must be enhanced. We must spend less on facilities and more on results - less on advertising designer drugs and more to reduce use of prescriptions. We must all be responsible. We must all change…
Copyright - Michael G. Manes (October 2009)
All rights reserved
Sunday, October 18, 2009
Health Care Financing is like a pipeline
Health Care Financing is like a pipeline. On one side of the line - dollars flow in. On the other side of the line dollars flow out. Looking a little closer we learn that the dollars flowing in are premium dollars, tax dollars, and out of pocket expenses provided by individual consumers. On the opposite end of the line dollars flow out to pay the cost of health care, the administrative cost of delivering care, the cost of the legal / defensive medicine systems, and the cost of funding the care.
The ownership of this pipeline is shared. For profit insurance companies, not for profit companies, and the government are all invested in the line. For profits want extra dollars out to reward their stockholders, not-for-profit companies need extra dollars as reserves, and governments must have equal dollars in and out to avoid a deficit. If dollars in and dollars out don’t match up - the pipeline could collapse.
The problems we face today are not in the design, construction, or operation of the pipeline. The problem is simple - we the people want to use the legislative, regulatory, and consumer advocacy process to tighten the “valve” on the “dollars in” end of the line. We also want to use this same political, regulatory, and advocacy process to open the “valve” on the “dollars out” - payment end of the line.
All of us want to put in as few (premium, tax, and out of pocket) dollars as possible and simultaneously pay out maximum dollars for the “sick” folks. To make matters worse - the government (federal [Medicare] / state and federal [Medicaid]) chooses not to put in adequate dollars to cover the care they provide to their constituents so the private payers (insurance companies) must put in more than they really owe.
As an example - in 2007 in Louisiana insurance companies paid 133% more for the actual care utilized by their policyholders. This was necessary because the state’s Medicaid program was under funded by 12% and the Medicare program shorted the providers by 9%. (Adapted from the AHA and Avalere Health TrendWatch Chartbook 2007: Trends Affecting Hospitals and Health Systems)
Today - all agree that the pipeline is broken. The vast majority of our population that pays the premiums and taxes to fund this line has said, “ENOUGH!” Magnifying this problem is that most of the folks funding this adventure are not big users of the care they are funding. Most of the population is chronically well.
The average family that is insured is paying over $13,000.00 a year in premiums and other dollars in taxes and only recovering a small percentage of their contribution in claims. Now “reformers” are promising to add more users to the line.
The line is broken. To fix it we can’t focus only on the end of the line that flows dollars in - we must address the end that flows dollars out. We each must accept some responsibility for our individual health, exercise, diet, and utilization of care. We the people are part of the problem and must become part of the solution.
Copyright - Michael G. Manes (October 2009)
All rights reserved
The ownership of this pipeline is shared. For profit insurance companies, not for profit companies, and the government are all invested in the line. For profits want extra dollars out to reward their stockholders, not-for-profit companies need extra dollars as reserves, and governments must have equal dollars in and out to avoid a deficit. If dollars in and dollars out don’t match up - the pipeline could collapse.
The problems we face today are not in the design, construction, or operation of the pipeline. The problem is simple - we the people want to use the legislative, regulatory, and consumer advocacy process to tighten the “valve” on the “dollars in” end of the line. We also want to use this same political, regulatory, and advocacy process to open the “valve” on the “dollars out” - payment end of the line.
All of us want to put in as few (premium, tax, and out of pocket) dollars as possible and simultaneously pay out maximum dollars for the “sick” folks. To make matters worse - the government (federal [Medicare] / state and federal [Medicaid]) chooses not to put in adequate dollars to cover the care they provide to their constituents so the private payers (insurance companies) must put in more than they really owe.
As an example - in 2007 in Louisiana insurance companies paid 133% more for the actual care utilized by their policyholders. This was necessary because the state’s Medicaid program was under funded by 12% and the Medicare program shorted the providers by 9%. (Adapted from the AHA and Avalere Health TrendWatch Chartbook 2007: Trends Affecting Hospitals and Health Systems)
Today - all agree that the pipeline is broken. The vast majority of our population that pays the premiums and taxes to fund this line has said, “ENOUGH!” Magnifying this problem is that most of the folks funding this adventure are not big users of the care they are funding. Most of the population is chronically well.
The average family that is insured is paying over $13,000.00 a year in premiums and other dollars in taxes and only recovering a small percentage of their contribution in claims. Now “reformers” are promising to add more users to the line.
The line is broken. To fix it we can’t focus only on the end of the line that flows dollars in - we must address the end that flows dollars out. We each must accept some responsibility for our individual health, exercise, diet, and utilization of care. We the people are part of the problem and must become part of the solution.
Copyright - Michael G. Manes (October 2009)
All rights reserved
Sunday, October 4, 2009
Racism - Lemons and Lemonade
If the seven deadly sins (lust, gluttony, greed, sloth, wrath, envy, and pride) were being updated today, it is possible that Racism might be added or maybe hate would be added and racism would be included as an example in the definition. If a committee was formed to update this Top 7 List of Sins, I am certain there would be special interest groups to lobby for the inclusion of racism.
Racism is. It’s a bitter lemon in life - so is hate. Some might consider the 7 deadly sins life’s lemons as well. My observation is that the 7 sins as written are lemons we consume or that consume us. Racism and hate (most don’t see themselves as Racists or haters) are lemons that others consume and that we let make us sick. We can control 7 sins. We can’t control Racism (since we’re not racists / haters).
Jimmy Carter blamed significant numbers of Racists for the challenges that President Obama faces as he moves his agenda forward. Since Carter’s comments the media is consumed by discussions of the topic. Racism is the new Swine Flu.
In the name of full disclosure - I’m a “pink” American from the South. I’ve been a Democrat and Republican twice each. Nixon made me a Democrat and Carter made me a Republican. My history includes Native American blood, Cajuns exiled from Nova Scotia, mental illness, leprosy (Hansen’s Disease), and poverty. We all have problems and history. We never owned slaves. The “N” word was not allowed in our home. Two of the women that most influenced my childhood were black.
I believe some white people hate other folks because they are “colored” and I believe some black and brown people hate white folks because they aren’t. I believe there are “nuts” on the two ends of the Bell Curve we call America. In the middle you have the group that makes this country work. I believe most of us just want independence, jobs, opportunity, and progress - a better life for us and our kids.
If Ronald Reagan was black, would liberals and academics be demonstrating in Washington D.C.? If Thomas Sowell or Colin Powell was President today and was pursuing a right of center agenda, would there be as many people upset? Is today’s issue RACE or POLITICS? If Carter is right - Racists elected the President.
Henry Ford said, “If you think you can or you think you can’t, you are right.” I agree. I believe for some folks of color - Racism is motivation to work harder to succeed. For others it’s an excuse why they can’t. If liberals, democrats, and the Als and Jesses of the world dropped the “R” word for one year and focused all their efforts on teaching that personal growth can come through adversity - where would we be in 2011? What if every parent started showing their children how they can succeed versus saying why they can’t, what would happen? If the Great Society had “incented” personal responsibility versus “entitlement,” where would we be today?
Is it time to turn our lemons into lemonade? I think it is. Want some lemonade?
Copyright - Michael G. Manes
All rights reserved
Racism is. It’s a bitter lemon in life - so is hate. Some might consider the 7 deadly sins life’s lemons as well. My observation is that the 7 sins as written are lemons we consume or that consume us. Racism and hate (most don’t see themselves as Racists or haters) are lemons that others consume and that we let make us sick. We can control 7 sins. We can’t control Racism (since we’re not racists / haters).
Jimmy Carter blamed significant numbers of Racists for the challenges that President Obama faces as he moves his agenda forward. Since Carter’s comments the media is consumed by discussions of the topic. Racism is the new Swine Flu.
In the name of full disclosure - I’m a “pink” American from the South. I’ve been a Democrat and Republican twice each. Nixon made me a Democrat and Carter made me a Republican. My history includes Native American blood, Cajuns exiled from Nova Scotia, mental illness, leprosy (Hansen’s Disease), and poverty. We all have problems and history. We never owned slaves. The “N” word was not allowed in our home. Two of the women that most influenced my childhood were black.
I believe some white people hate other folks because they are “colored” and I believe some black and brown people hate white folks because they aren’t. I believe there are “nuts” on the two ends of the Bell Curve we call America. In the middle you have the group that makes this country work. I believe most of us just want independence, jobs, opportunity, and progress - a better life for us and our kids.
If Ronald Reagan was black, would liberals and academics be demonstrating in Washington D.C.? If Thomas Sowell or Colin Powell was President today and was pursuing a right of center agenda, would there be as many people upset? Is today’s issue RACE or POLITICS? If Carter is right - Racists elected the President.
Henry Ford said, “If you think you can or you think you can’t, you are right.” I agree. I believe for some folks of color - Racism is motivation to work harder to succeed. For others it’s an excuse why they can’t. If liberals, democrats, and the Als and Jesses of the world dropped the “R” word for one year and focused all their efforts on teaching that personal growth can come through adversity - where would we be in 2011? What if every parent started showing their children how they can succeed versus saying why they can’t, what would happen? If the Great Society had “incented” personal responsibility versus “entitlement,” where would we be today?
Is it time to turn our lemons into lemonade? I think it is. Want some lemonade?
Copyright - Michael G. Manes
All rights reserved
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