tag:blogger.com,1999:blog-6366429173923952672024-03-13T07:14:28.553-07:00healthcarethinktankTom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.comBlogger174125tag:blogger.com,1999:blog-636642917392395267.post-988024979096865322021-02-04T15:08:00.002-08:002021-02-04T15:08:45.620-08:00Vaccination Update<p> </p><p><span style="font-family: georgia; font-size: large;">The vaccination programs are picking up speed and are better organized than before January 20th.</span></p><p><span style="font-family: georgia; font-size: large;">We are not to a good place yet, but the programs are picking up speed.</span></p><p><span style="font-family: georgia; font-size: large;">Johnson and Johnson has asked for approval of its one dose vaccine, so may be 3 or 4 weeks.</span></p><p><span style="font-family: georgia; font-size: large;">Do not be passive, use the phone and Internet to find and register at vaccination sites. Some states are already moving into the 65 - 74 year old cohort.</span></p><p><span style="font-family: georgia; font-size: large;">There is light at the end of the tunnel, but it is a ways off.</span></p><p><span style="font-family: georgia; font-size: large;"><br /></span></p><p><br /></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-72379971989117764902021-01-22T08:52:00.003-08:002021-01-22T08:52:37.482-08:00Aggressive Action<p> </p><p><span style="font-family: georgia; font-size: large;">The Biden administration has come out of the gate with a number of agressive measures to combat the Covid-19 pandemic.</span></p><p><span style="font-family: georgia; font-size: large;">Will these meaures be effective? Are we too late?</span></p><p><span style="font-family: georgia; font-size: large;">Time will tell.</span></p><p><br /></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-77205722482969874832021-01-20T10:49:00.002-08:002021-01-20T10:49:28.225-08:00Deferred Care<p> </p><p><span style="font-family: georgia; font-size: medium;">The pandemic is causing a second crisis - deferred care.</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: medium;">Patients are hesitant to go to medical facilities and some facilities are limiting care, especially elective surgeries.</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: medium;">Not the providers' fault, not the patients' fault, but there will be a reckoning.</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: medium;">We need to begin addressing this soon.</span></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-47824076755681728512021-01-14T12:09:00.004-08:002021-01-14T14:07:31.834-08:00Vaccination Follies<p><span style="font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: large;">Getting enough doses to the states is going ok, but not great.</span></p><p><span style="font-size: large;"><span style="font-family: georgia;">Finding enough people and places to get people registered and have someone push the plunger</span> is moving very slowly.</span></p><p><span style="font-size: large;">This will get done, but not as fast as we would like.</span></p><p><span style="font-size: large;">For those of you coming nearer the top of the list, check every possible option within your range of easy travel.</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-27775052470377877492021-01-13T11:03:00.000-08:002021-01-13T11:03:30.462-08:00Long Form Writing<p><br /></p><p> <span style="font-family: georgia; font-size: medium;">As the blog is restarted I will also be writing long form pieces;</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: medium;">See https://tomealey.substack.com</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><span style="font-family: georgia; font-size: medium;">Many of the pieces will involve health care operations and policy.</span></p><p><span style="font-family: georgia; font-size: medium;"><br /></span></p><p><br /></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-22992866910321208102020-10-28T09:59:00.002-07:002020-10-28T10:01:28.582-07:00Deferred Health Care Pandemic Edition<p> </p><p><span style="font-family: "Georgia",serif; font-size: 13.5pt;">Due to the
pandemic many Americans, and especially many seniors, are delaying and
deferring diagnostic and preventative health care.</span><o:p></o:p></p>
<p><span style="font-family: "Georgia",serif; font-size: 13.5pt;">There is natural
concern about walking into a health care setting.</span><o:p></o:p></p>
<p><span style="font-family: "Georgia",serif; font-size: 13.5pt;">There is very
little indication that using routine health care services is a risk for
contracting Coronavirus.</span><o:p></o:p></p>
<p><span style="font-family: "Georgia",serif; font-size: 13.5pt;">Physicians should be proactive about follow up and informing patients of the safety versus risk of routine health
care services.</span><o:p></o:p></p><p><span style="font-family: "Georgia",serif; font-size: 13.5pt;"><br /></span></p><p><span style="font-family: "Georgia",serif; font-size: 13.5pt;"><br /></span></p><p><span style="font-family: "Georgia",serif; font-size: 13.5pt;">cross posted: protectingseniorcitizens@blogspot.com</span></p><p><span style="font-family: "Georgia",serif; font-size: 13.5pt;"><br /></span></p>
<p><o:p> </o:p></p>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com1tag:blogger.com,1999:blog-636642917392395267.post-50155079608082358952020-04-02T08:27:00.002-07:002020-04-02T08:27:43.071-07:00Zantac Recall<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The popular antacid Zantac (and generics) have been recalled because a chemical element can be a carcinogen.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Might cause cancer is of of course not the same as will call cancer.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Safe disposal: </span><a href="https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know">https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</a><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-42908498434499327232020-03-26T12:03:00.002-07:002020-03-26T12:03:54.373-07:00Lean Supply Chains<br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Modern supply chains have allowed providers and facilities to go to a near just-in-time inventory system, conserving cash and limiting storage space.</span><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Pick up the phone, log on to a website, and the next day a delivery truck rolls in with supplies.</span><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">No more.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The on-going pandemic has taught us a brutal lesson about failed supply chains, especially when the chain starts overseas, and really especially when the start of the supply chain is compromised by the same pandemic.</span><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">We have also learned lessons about depending on the federal government and strategic reserves.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Someday when we are out of the current crisis we must rethink out inventory and supply chain systems, and in particular critical items. Governments must also rethink their plans and capabilities. </span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-18020958836550615352020-03-24T13:53:00.000-07:002020-03-24T13:53:24.465-07:00Corona Scams<div class="a3s aXjCH msg-8340558000470751579" id=":oi">
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Of
course scammers are taking advantage of the current misery. Even the
Attorney General of Michigan was hacked (her staff was directed via
email to send her gift cards!).<br />
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The most dangerous scams are the health care scams, abetted by lots of misinformation.<br />
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So:<br />
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Drinking bleach or diluted bleach will not prevent or cure the virus.<br />
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Various "silver solutions" and miracle cures being pitched on tv and the
Internet will not prevent or cure the virus (convicted felon preacher
Jimmy Bakker is scamming once again).<br />
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There are no miracle cures and no effective prevention methods except avoidance.<br />
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Despite what you might hear from Washington, there are no medicines that have been tested to prevent or cure the virus.<br />
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And the usual financial scammers are busy, perhaps to take of people who
are off work or cloistered in their homes. Employment scams will soon
follow.<br />
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Common sense is the best defense. The best source of information so far has been from governors and state health departments.</span></div>
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Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-57039925936474867042019-10-31T07:23:00.002-07:002019-10-31T07:23:33.950-07:00Cheap Insurance is .... Cheap .....Insurance<br />
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<span style="font-size: large;">The Trump administration is working to empower short term easy-to-buy insurance plans.</span><br />
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<span style="font-size: large;">These are sometimes known as "association health plans."</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Problem is you get what you pay for.</span><br />
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<span style="font-size: large;">Lousy insurance is only marginally better than no insurance at all. Or maybe worse.</span><br />
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<span style="font-size: large;">The Affordable Care Act marketplace has better products and some at decent (but not cheap) prices.</span><br />
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<span style="font-size: large;">Buyer beware.</span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-67499628393519347342019-10-30T12:11:00.001-07:002019-10-30T12:11:59.767-07:00Ambush Billing<br />
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<span style="font-size: large;">Most people think of a hospital as a large building with lots of departments managed by a central group of executives.</span><br />
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<span style="font-size: large;">Maybe not.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Increasingly a hospital is a large building full of contractors and subcontractors hired by a central administration.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Problem is, not all of the contractors are necessarily contracted with major insurance companies. This is called OoN or Out of Network.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">This is especially prevalent with emergency department contractors.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Sometimes this failure to contract is very intentional... and the resulting billings can be massive as compared to in-network providers.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Both state and federal governments are talking about a fix, and the contractors are directing a fierce lobbying campaign toward protecting ambush billing.</span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-49225516621363807712019-05-19T09:18:00.000-07:002019-05-19T09:18:01.856-07:00Miracle Cures (?)<br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Advertisements abound for miracle cures for seniors.<br /><br /><strong>Stem cells:</strong><br /><br />Stem cell clinics are popping up everywhere promising cures and possibly a fountain of youth.<br /><br />There is scant valid evidence that stem cells cure much of anything in seniors, especially aging. They will make your wallet skinny.<br /><br /><strong>Cheap surgery:</strong><br /><br />Several Florida plastic surgery clinics are losing licenses due to killing and mutilating patients.<br /><br />The lure was cheap plastic surgery. Cheap and surgery are not really compatible.<br /><br />Some of the clinics were owned by felons with no medical background. Oops.<br /><br /><strong>Medical Tourism:</strong><br /><br />Travel to Mexico or India and get surgery for less money.<br /><br />Sometimes this works very well, sometimes it is a disaster.<br /><br />Buyer beware.<br /><br /><br /></span><br /><span style="font-family: Helvetica Neue, Helvetica, Arial, sans-serif; font-size: 16px;"> </span></div>
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Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-71753991248759108062019-04-04T14:22:00.001-07:002019-04-04T14:22:38.467-07:00TRUMP Health Care Plan1. Repeal the Affordable Care Act.<br />
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The End.Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-76044075921076336442018-08-04T12:55:00.000-07:002018-08-04T12:55:05.825-07:00How Did Larry Nassar and Richard Strauss Avoid Discovery? Three Cultural Factors <br />
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">How
did these physicians, who practiced very much in the open atmosphere of sports
medicine team doctors, avoid discovery?<o:p></o:p></span></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">There
are at least three cultural factors that enabled Nassar and Strauss to continue
their terror for about two decades each.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia",serif; font-size: 14.0pt;">Sports – winning is the
only thing!<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">Whether
pre-teen gymnasts or young adult college athletes, the pressure to win, perform
and conform were and are intense.<o:p></o:p></span></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">We
see now that sports and academic administrators will deny reality in order to
protect the program, to protect the brand.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia",serif; font-size: 14.0pt;">Patients<span style="mso-spacerun: yes;"> </span>- do not question your physician!<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">Physicians
are highly educated miracle workers who simply should never be questioned about
their examinations, diagnosis, prognosis or treatments.<o:p></o:p></span></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">Phooey.
Physicians must do everything they do within “informed consent” parameters, and
patients (and surrogates) have rights to be fully informed at a lay person
standard. Those who supervise physicians have a duty to enforce informed
consent practices and procedures.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Georgia",serif; font-size: 14.0pt;">Physicians Will Not Rat On
Physicians – the Lab Coat Line<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">Only
in extreme cases will physicians rat out other physicians for misconduct or
poor quality practice. Mediocrity is just ignored.<o:p></o:p></span></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">Medicine
is a statistical aberration, every physician is above average!<o:p></o:p></span></div>
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<span style="font-family: "Georgia",serif; font-size: 14.0pt;">But
physicians know better, nurses really know better, and executives and
administrators know better but will rarely admit as much.<o:p></o:p></span></div>
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<br />Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-17889844272469325742018-01-27T13:10:00.000-08:002018-01-27T13:10:00.106-08:00MSU and Nassar, FOIA responses<br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">FOIA responses and other related materials</span><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><a href="https://www.dropbox.com/sh/s6ml7cql6uj4aex/AACA7VN78cEV1MTqQo7coQv3a?dl=0" target="_blank">FOIA responses</a></span><br />
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<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">PDFs were retitled to provide easier access.</span><br />
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<br />Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-41333253276041569032017-11-06T08:31:00.002-08:002017-11-06T08:31:28.952-08:00Informed consent, scholastic athletes, minors and related topics<br />
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<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Informed
Consent<o:p></o:p></span></span></b></div>
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<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">A bedrock principle of medical practice is a patient should be
treated only after granting informed consent. There are only a few exceptions
(emergencies, mental health, drug overdose) when the patient is incapacitated
or incapable.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Informed consent is sometimes more complicated than it may
sound.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"> Diligent compliance especially
applies to minors and there is a significant body of law and best practices
around these issues (informed consent tends to be based in state law, providers
and school officials should be informed accordingly). In general, parents or
guardians (“surrogates”) make medical decisions for minors, although older
minors are sometimes subject to different state statutory rules.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Informed consent is not just about protecting the patient, it
is also about protecting the physician and the organization.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The focus here is scholastic athletes, both in K-12 and
college settings.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Implied
Consent / Overt Consent<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">When an adult goes to the doctor there is often implied
consent – the patient made an appointment, arrived at the appointed time,
presented an I.D., signed a HIPAA form, followed the nurses’ instructions, let
the physician do an examination and allowed testing. Clearly the adult was consenting to this
examination.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The consent, however, was not open ended. If the physician
recommends surgery or an invasive procedure additional consent would be needed,
preferably in writing.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">When young athletes join middle school, high school and
college sports teams there is at least an implied consent to athletic training
and health monitoring, and often some sort of “permission to play” and/or physical form involved which may
constitute overt consent. There may even be a full-fledged consent to treatment
form. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Permission to join the team by a parent or a college student
deciding to join a team would seem to provide consent for basic athletic
training, monitoring of health condition and emergent care. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The consent, however expressed, is not open ended. Especially
in the case of minor.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Legal risk attaches to the provider and school entity, outcome
risk attaches to the patient. All parties need to be aware of the risk and the
general legal rules.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Providers must stay within the “scope of practice” attached to
their license or certification by state law. School officials should be clear
on which clinician can and should provide which services.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">“Informed”<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The definition of informed is part art and part law. There is no absolute checklist.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The definition depends on context and the abilities of the
patient or surrogate.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">There is no requirement for “fully informed,” anyone who has
tried to read a pharmacy drug insert will understand that. The patient will not
be able to understand what is happening at the same level as the clinician. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Items the patient must
understand are the 1) current or
potential diagnosis, 2) the potential benefits of testing and/or treatment, 3) the
potential risks (especially with surgery) and 4) and any viable alternatives
(trying physical therapy before trying surgery).<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">In emergent situations there is no requirement for consent, but
notice to parents or surrogates should be as quick as possible, and at some
point the surrogate will be in a position to give or deny consent. Withholding
information from parents should get a coach or clinician fired (“we won’t tell
your parents, they might make you sit out!”)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The Team
Physician<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">High school and college teams will normally have a team
physician (or designated clinician) on the sidelines during the games. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">It would seem reasonable that joining a team provides implied
consent to be examined on the field by the team physician, as injuries would be
considered potentially emergent.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">When the team physician sees the athlete off the field in a
non-emergent situation, rules of informed consent would seem to kick in. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Clubs and
Camps and Community Sports<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Not all sports activity is provided for enrolled students of a
school or college.</span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span><span style="font-size: 12pt; line-height: 107%;">Sports such as gymnastics are often club based, or the athlete
may be trained and compete in club and school settings (and national gymnastics
is currently immersed in a scandal of immense proportions). Youth baseball,
flag football, swimming and other sport are offered through various community
organization.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Many middle school and high school athletes attend summer
camps, either sponsored by universities or by prominent coaching figures.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Again there are both implied consent and overt consent issues
and notice to parent issues, and failure by the sponsor or clinician might
trigger unwelcome liabilities.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">How to protect a child away from home? Investigate the camp
especially the regular chaperone system and the health care chaperone system.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><b><span style="font-size: 12pt; line-height: 107%;">Parents
and Legal Surrogates</span></b><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">What is a parent to do?<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Ask a lot of questions. And the higher the level, the rougher
the sport, the higher the likelihood of significant injury, the more questions
should be asked.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The horrific scandal in national gymnastics centered at Michigan
State University was based on lack of informed consent and lack of parental
information (and this is not to blame
the victims or parents).<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Ask a lot of questions. And do not proceed without
satisfactory answers.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Can an
Athlete, Parent or Surrogate Say No to a Clinician? <o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Informed consent requires <i>consent</i>,
and consent ultimately comes from the athlete, parent or the surrogate. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">If a clinician seems to be rushing an athlete back to the
field, or rushing the athlete into surgery, it is ok to say no. If a second
opinion is required, it is ok to say no.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">A parent or surrogate can also say no to a coach or athletic
trainer who wants to put a child back on the field, perhaps too quickly.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">It is ok to say NO! <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Many sports injuries involve orthopaedic surgery, something I
know a bit about. There are orthopaedists who fix knees, and orthos who specialize
in fixing knees. I would pick the latter, who will probably not be found in a
small town hospital, but in a major metro hospital. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Rub It in
the Dirt and Play Ball<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">There is an ethos in sport of playing through pain and injury.
<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">There is a difference in playing through dings and nicks
treated at bump clinics versus serious injuries
needing more sophisticated medical treatment, which often mean missing games or
meets.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">The NFL and its’ alumni are now reaping a bitter harvest of
this play-with-pain ethos.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Coaches should make the right decision, but parents should
never count on that happening, even at the college level. Coaches live with
pressures parents do not.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Responsible
Officials<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Like all executives and supervisors, school officials and
other sports program sponsors are responsible for the design and operation of
an appropriate risk management program. The program should be designed to
protect the athletes and to protect the entity, using practices that accomplish
both, but the athlete first.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">It seems the answer to almost every question these days is
“consult your lawyer.” A lawyer well versed in education law is a necessary
member of the management team.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Any Good
News?<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Every year millions of young people have safe, healthy
experiences with sports.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">And
remember….<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Adults are supposed to protect young people. We all have
responsibilities.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal">
<br /></div>
Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-862143241885713992017-08-18T13:57:00.003-07:002017-08-18T13:57:26.303-07:00Arbitraging Grandma - HCR in Trouble<br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">QCP, the REIT holding title to most of HCR Manorcare's real estate, served notice on the Securities and Exchange commission (8/18/17) of a pending receivership filing in a California state court.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">HCR has been in default on rent payments and has failed to cure the default.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">This is a huge story and developments will follow.</span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-8518511916558564442017-08-17T04:41:00.001-07:002017-08-17T04:51:47.080-07:00So Where Are We At?<br />
<br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">The GOP is in chaos.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Congress is stuck in the mud.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">The Democrats are impotent because they control nothing.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Obamacare is not imploding, but may suffer from benign neglect or intentional sabotage.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">MACRA/MIPS is a huge expensive headache.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Long term planning is not possible.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Meanwhile, health care goes on - to an uncertain fate.</span>Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-47042632215840316432017-08-16T06:53:00.001-07:002017-08-16T06:53:14.077-07:00Published on Linkedin - Arbitraging Grandma<br />
<br />
<br />
<br />
<span style="font-size: large;"><a href="https://www.linkedin.com/pulse/arbitraging-grandma-tom-ealey">Arbitraging Grandma</a></span><br />
<span style="font-size: large;"><br /></span>
<br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<br />
<br />Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-60995074923282426762017-07-09T12:20:00.000-07:002017-07-09T12:20:01.024-07:00Recent Media <br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Recent Media Dropbox link:</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><a href="https://www.dropbox.com/sh/dt30oy30qcrw9ky/AACotufFpL_w2m85QbT2xf5qa?dl=0">Dropbox link</a></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<br />
<br />Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-45269565739473440342017-04-12T11:44:00.000-07:002017-04-12T11:52:58.884-07:00Great Conference<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Attended and spoke at the annual convocation of the American College of Health Care Administrators. <i>www.achca.org</i></span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">For conference materials and updates please drop by Dropbox. </span><a href="https://www.dropbox.com/sh/guo7amx4y2tllgf/AACupSOZlULqmP702b4NnyfHa?dl=0" style="background-color: white; font-family: georgia, "times new roman", serif;"><b>Dropbox Share</b></a><br />
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<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
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Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-71517930088638009592017-03-01T07:39:00.000-08:002017-03-26T05:51:50.443-07:00"Chaperone" Policy Template<br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">There is a massive scandal raging at Michigan State University and widely across the national women's gymnastics program.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">One physician, left largely unsupervised for decades, is alleged to have committed perhaps hundreds (or more) sexual assaults on innocent athletes, some of them minors.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">We had policies for physician offices 25 years ago. Apparently not everyone was paying attention.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">A draft chaperone policy can be found at our Dropbox link.</span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Updates will follow. </span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">This is NOT legal advice.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span>
<br />
<div style="margin-bottom: 0in;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><a href="https://www.dropbox.com/sh/bxzad97qe0gbaac/AADk_RsW9NQM3JTLfq1MUp6pa?dl=0">MGMA
Dropbox Share Link</a></span><br />
<br /></div>
Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-48483156887766473962017-02-12T06:24:00.000-08:002017-02-12T06:24:07.608-08:00Ride the Tiger - Health Care Edition<br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">President Harry S. Truman and country
singer Buck Owens both used a familiar ancient idiom – when you grab
hold of a tiger letting go is dangerous.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Trump administration and the
Republicans in Congress have learned the same lesson the hard way,
they jumped on the health care tiger and now they do not know what to
do.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Where are We At?</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Republicans in Congress have
discovered some hard truths about health care.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">U.S. health care is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Affordable Care Act is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Health care economics is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Budget politics is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Writing new health care law is
complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Keeping promises is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Pleasing 325 million people, or even a
slice of that population, is complicated.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">So all of the chest thumping and
hollering about “repeal and replace” has so far turned into
hollow noise, because doing something of substance is a lot tougher
than shouting slogans.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">What They Don't Know</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In six years I
have not encountered a Republican, either face-to-face or through
their media presence, who sounded as if they actually knew what is in
Obamacare and why. I suppose such people exists.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is all about
the slogans.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“Death panels!”
“Illegal mandates!” “Crushing tax burdens!”</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The U.S. health
care system was complicated before the Affordable Care Act, and the
overwhelming complexity of ACA made it much worse. Add to this
thousands of pages of Obama-era regulations and there is a lot to
know about the current health care system.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">This cannot be
fixed with slogans.
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The GOP Menu (maybe)</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Conservative think
tanks and the GOP have been circulating the same ideas for decades.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Health Savings
Accounts – good for the affluent, not so good for anyone else</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Interstate sales
of health insurance – does absolutely nothing for consumers,
except expose them to lousy insurance plans - but good for lousy
insurance companies and salesmen</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“Market based”
consumer choices – as in buying oncology is like buying a
cheeseburger</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Dump ACA
subsidies, replace with tax credits (subsidies!)</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Special treatment
for Big Pharma – yes, Congressmen are for sale (both parties)</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Block grant
Medicaid – give Medicaid policy to Sam Brownback and Paul Lepage -
wow</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Send poor people
back to Emergency Departments (which hurts hospitals)</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">So What Am I Saying?</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The GOP does not
have a coherent plan to replace the Affordable Care Act and may never
have such a plan. There will likely be a repeal, total or partial,
but the replace will be difficult.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The GOP might
eventually have a plan to make Rush Limbaugh, the Koch brothers, the
Tea Party and Fox News happy, sort of. Even that may fail.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The GOP has been
blaming ACA for higher consumer costs (higher deductibles and
co-pays) , and may replace ACA with a plan with – you guessed it –
higher deductibles and co-pays,, including for seniors.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Repeal and Replace, or Partial
Repeal and Partial Replace, or Reform and Repair, or ?????</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">On Super Bowl
Sunday President Trump told Fox News that “repeal and replace”
could take up to a year. Huuuge!</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">A few days earlier
Rep. Jim Jordan, on the far right wing of Congress, said the total
and complete and quick repeal of ACA was the only viable strategy.
Soon.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In the last ten
days or so “repair” has become a popular word, often in a phrase
such as “reform and repair.” This implies that not all of ACA
would be repealed, some of it would be repealed and new features
would be added as a repair.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Ask ten
Republicans in Congress and get seven or eight different answers.
There is also squabbling about whether health care should be done
before tax reform. The House majority and the Senate majority have
different ideas, and the Senate majority is pretty thin.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">So, the GOP has
painted itself into a corner. The GOP could recover, stranger things
have happened in Washington, but as of early February consensus is
not looking either quick or easy, which makes near term legislation
unlikely.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Legislative strategy</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">IF, repeating IF
the GOP can agree on a plan, the various pieces and parts must
through the legislative process. Some parts could move through
reconciliation, others through the standard legislative process. This
could cause a problem in the Senate.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<b><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Longer Term</span></b></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">House Speak Paul
Ryan has promised to”fix” Medicare.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">There are ways to
fix Medicare, but Ryan apparently has no clue. There are serious
reform efforts already in motion to move Medicare from the original
fee-for-service model to a more sophisticated value-based model, the
legislation passed by bipartisan votes.
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">His approach is to
turn Medicare into a for-profit play pen for insurers and doing
tremendous damage to senior citizens. Wow.</span></div>
<br />
<div style="margin-bottom: 0in;">
<br />
</div>
Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-15202292847131767122017-01-16T11:49:00.002-08:002017-01-16T11:49:45.510-08:00Believe It Or Not?!<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, serif;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">President-elect Donald Trump has started inauguration week by promising to unveil a new replace plan for the GOP repeal-and-replace project.</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Trump is now promising, or at least dancing around promising:</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> universal insurance coverage</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> better quality</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> lower premiums</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> lower deductibles</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In other words, none of this is realistic in the slightest. Reality is no longer a concern.</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The only way "inexpensive insurance” works is if it really “cheap insurance.” Also known as <i><u>lousy insurance.
</u></i></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Reports have Congressional Republicans wondering where this came from and what it will look like. Not to mention, what it would cost? And how is it conservative?</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Trump has at least one good idea, the Medicare and Medicaid programs should be able to negotiate fixed prices with Big Pharma. Problem is, Congressional Republicans are committed to protecting Big Pharma even if the taxpayers continue to be cheated.</span></div>
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br />
</span></div>
<br />
<div align="LEFT" style="margin-bottom: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Stay tuned.</span></div>
Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0tag:blogger.com,1999:blog-636642917392395267.post-61005688483939744792016-12-26T10:23:00.002-08:002016-12-26T10:23:35.402-08:00Replace and Repeal<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
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<span style="font-family: Georgia, Times New Roman, serif;">Obamacare is dead! Long live Obamacare.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The Republican Party will control all branches of government
in January, and has a stated purpose to repeal and replace Obamacare (properly
the Affordable Care Act). <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Repealing Obamacare may not be as easy as it sounds, and replacing it has many risks
and uncertainties.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Both parties agree the system needs reform. That is about
all they agree on.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><b>Repeal:</b><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Obamacare care is much more than a piece of legislation, it
is now six years of regulation and innovation, and is intertwined through the
health care system. There is no unpeeling of an apple.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">There has been much to like about the intentions of
Obamacare, even if the design and
implementation were often
wretched. The latest regulations on Medicare physician payment run to 2171
pages of complex and convoluted
regulatory excess.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Obamacare gets a good grade on intentions, but not so good
on design or operations. Still, a full operational repeal is not possible, too
many changes are ingrained into the system for a full.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><b>Replace:</b><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Timing is everything. I just finished reading House Speaker
Paul Ryan's <i>A Better Way </i>plan
including the health care section. Whether or not Ryan is popular with his own
membership, his health plan lays out the key ingredients of any GOP or
conservative health reform plan. I am not impressed.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Leading the list are Health Savings Accounts (HSAs) and the
interstate sale of health insurance policies, neither of which are likely to
provide the salvation promised. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Health care markets do not work like the markets for buying a shirt, a car or a head of lettuce. The HSA idea may
be overrated as a tool of salvation, but good for the affluent.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The interstate sale of insurance policies saves money only
if the insurers under price their products, and that can only happen for a few
years before something bad happens. This is much like several of the ACA
exchanges. I fear interstate sales will empower 1-800-Lousy-Policy companies, a
consumer nightmare in the making. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The replace program promises cost savings through consumer
choice, a profound misreading of how consumer find and use health care.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Like most GOP initiatives, the plan works well for the
affluent and not so well for anyone
else. And when the GOP talks about “protecting Medicare,” I know we are in trouble. The pro-life GOP
will find a way to punish Medicaid recipients, count on it (and punish
hospitals in the process).</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Curiously, the GOP plan for patient protection includes many features – wait for it – of
Obamacare, just without the details. Lots of buzzwords though.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Perhaps I am a bit too cynical, but I think not. The Trump
administration will be a wild ride on many counts, and not the least of it will
be health care.<o:p></o:p></span></div>
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Tom Ealeyhttp://www.blogger.com/profile/10314700887828269919noreply@blogger.com0