Published CommPro.biz 2014.03.25

Congress Blocking Doctors

Last Friday (2014.03.21) was “Match Day.” On that day thousands of mostly young doctors opened an envelope that confirmed their acceptance into a residency program. In many cases it defines the path their medical career will take for the rest of their working life. In most cases they knew they were in and just awaited final confirmation. For some it was their first choice and this was the first year they had been down this path. For others, they settled for what they could get. Others were back for another try, having missed the cut in earlier years. Still others missed the cut this year and will have to wait for next year, or perhaps the next, or the next, often while staring at a massive student loan debt.

For a nation facing a massive physician shortage –100,000+/- by the end of this decade– this is insanity. The number of residency openings is controlled by the United States Congress. Why there should be a problem with supporting this vital aspect of our healthcare system escapes us. However, we are living under a nearly two decade old cap put in place by the Congress. Given those in that body who are focused on anything but serving the people of the United States, it’s not likely that we’ll see a change.

On the other hand there’s good news. The number of bright young people –split about evenly between men and women– who applied to medical schools and the number enrolled as first-year students hit record highs this year. Add to that a dramatic increase in young doctors choosing family medicine. Five years ago it was under 60% with more than four in ten opting for specialties. This year it’s over 66% with less than one in three aiming for the specialties. That indicates a growing awareness among young doctors that the team-based comprehensive care ACA encourages is where the future lies. Primary care doctors will head-off serious illness in the future, saving lives, improving the lives of their patients and reducing healthcare costs.

There’s a new day dawning; young people entering medicine see it. Beat illness to the draw, make prevention the goal. The old model, treat people after they get sick is on the way out. Paying doctors based on the number of patients they run through their practice is so over. Payment needs to be focused on outcomes, on the overall health of the patients under a doctor’s care. America spends more per patient than any country on this planet. Yet we rank among third world countries when it comes to outcomes. The ACA is a baby step in the right direction.

Our lawmakers need to do the job they were elected to do, to serve the interest of all the people of the United States. They can begin by opening up more residency slots for young doctors who have fought their way into medicine, and are ready to go to work.

Published CommPro.biz 2014.03.18

Wealthy Jerks

Put-upon billionaires have recently equated criticism of their wealth with actions of the Nazis leading up to World War Two. Reacting to suggestions that a tax loophole favoring the rich be closed, Stephen Schwarzman, Chairman of hedge fund Blackstone, is quoted, “It’s war. It’s like when Hitler invaded Poland in 1939.” Tom Perkins, another billionaire, went a step farther likening actions by the 99.9% to Kristallnacht, the 1938 Nazi riots targeting Jewish-owned businesses and synagogues. Both Schwarzman and Perkins later apologized, but there’s no question that some of the 0.1% feel attacked.

It’s part of the apparent fog that enters the minds of a few of those who do well; they begin to feel that they are rich because they deserve to be rich. After all, they worked hard, are smart, and that’s why they reached these lofty environs. It never occurs to them that where they were born may have helped, that being in the right place at the right time might have helped, that someone gave them a hand up, or that a host of other things –including luck– might have had a role in their success.

Paul Piff, a social psychologist at UC Berkeley, and his students look at us as a society and how various life circumstances change our views. They have discovered that some of us pick up very quickly on this viewpoint. In dozens of studies conducted around North America Piff and his associates have discovered that being rich turns some of us into jerks. In what we’ll call his street corner observations, Piff found that those driving luxury cars were more likely to run a red light or stop sign and paid little attention to those on the corner trying to cross. In another study they even found some of the rich would take candy from little children.

Most interesting were his rigged Monopoly games. Students rolled the dice before the game to see which one would be given huge advantages. No surprise, those with the advantage won. Big surprise, some thought they deserved to win, that it was their playing skill and not the advantage that made them winners.

Truth is there are lots of variables. Lots of hard workers with great ideas never make it and some clueless jerks do. Those who have to justify their wealth with some myth are to be pitied. Truth is those who win following the ethical business model –and it doesn’t insure success– are not jerks. They make up the majority of the rich, the know-how-they-got-there rich, the nice rich who look out for their customers, their team members, their vendors, their community, and the environment. And by the way –all things being equal– they make a lot more money than the jerks following the dog-eat-dog path. Jerks like Schwarzman and Perkins deserve to be unhappy and to feel threatened by those who point out the unfair advantages they enjoy. They deserve to live in the world they created.

 Published CommPro.biz 2014.03.13

Pain Killers Kill

Zohydro; even the name looks and sounds scary. And well it should; Zohydro is the latest opioid to get the greenlight from the FDA. An OK for a new souped-up hydrocodone formulation that is five to ten times more potent than any of the pain meds now available. There are a couple dozen opioids out there, all derived from heroin’s first cousin morphine or its artificial form. They are all candidates for abuse. They all have the potential to kill more than pain.

It’s hard to imagine how Zohydro gained FDA approval. More than forty doctors and drug abuse experts urged the FDA to nix Zohydro. They wrote, “In the midst of a severe drug addiction epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous high-dose opioid.” The Attorney Generals of 28 states and other elected officials have urged the FDA to back off, all to no avail.

Zohydro is a time release drug; each dose is designed to phase in over 12 hours so its full force is not at play at any one time. However, Zohydro lacks any measure to deter abuse. It is not clear why the manufacturer has not added a deterrent. There might be a clue in the background of the drug company CEO; he has a bachelor’s degree in accounting from a small Midwestern college. He may very well be focused on the well-being of mankind rather than the numbers he can ring up with Zohydro, but there’s nothing to indicate that in its present form.

Whatever their motivation adding a potent drug of this magnitude to the runaway levels of opioid prescriptions over the last few years makes no sense. The number of these prescriptions written in 2013 was down 5% from 2012. While any drop in this category is good, there were still 230 million opioid prescriptions written last year; that is up over 14% in just a half dozen years. Some experts say the potency of the pills in many prescriptions was up as much as 50%.

Everyone agrees that the abuse of prescription drugs is up. Kids are getting high from their parents’ pill bottles. Adults are liking how they feel on the drugs they get for pain and experimenting with more and more. Others are mixing opioids, booze and tranquilizers with dangerous and unforeseen results, too often death. It’s too easy for people with legitimate pain issues to find themselves in the “if this works, more must be better” spiral. If they can’t get what they want from their doctor or the hospital ER, they just find another doctor, or another ER.

It’s too easy for doctors to prescribe a pain killer when physical therapy would be a safer alternative. And it’s too easy for patients to pop a pill rather than make a trip to a physical therapist. Too easy to pop another pill when one doesn’t make the pain go away. Too easy to pop one too many and take everything away.

"Am I wrong?"--"Am I crazy?"

"What do you think?"--"Do you agree?"

 Published CommPro.biz 2014.03.04

Walmart And The Tax Creators
 

Are you sure you are getting a bargain when you shop at Walmart? Are you sure that your Big Mac doesn’t cost more than the price on the menu board? Are you sure that the upfront low prices you pay wherever minimum wage jobs are part of the picture are all you pay? Don’t be too sure.

If you pay taxes of any sort, you probably help pay for food stamps. You definitely help pay for Medicaid and subsidized housing; even welfare might soak up some of your tax dollars on their way to help the working poor. So when, the working poor are paid minimum wage, you help make up the rest of their income. They are on your payroll. So even if you don’t shop at Walmart or eat fast food, you are still not only picking up part of their workers’ paychecks, you are cutting their customers’ bill.

The largest recipient of welfare in America is Walmart. It’s their business model, along with reported bribery, to smooth out their growth. Walmart is America’s largest employer, so you are not just subsidizing some mom and pop outfit; you are subsidizing a huge enterprise controlled by the Walton family. They own a little over half the stock in Walmart, so whatever happens at Walmart is under the full control of these unbelievably rich folks. How rich are they? The Walton family riches equals the total riches of everybody in the bottom forty percent of Americans.

The first argument against raising the minimum wage is that it will cost jobs; that businesses paying minimum wages will lay people off. That assumes that these organizations have too many employees, or that they don’t want to give their customers quick efficient service. Or that they will have to raise their prices so much that they won’t have as many customers. Of course that falls apart if the competition has to raise their wages and prices too.

Then there’s the teen argument. That most of these jobs are filled by teens who are learning how to work and therefore should be paid a bit less. If that was ever true, it isn’t true today. Yes there are teens in minimum wage jobs, but the vast majority of those at this pay level are adults, most trying to support a family. So how about the teens? Perhaps a case could be made for a two tier minimum wage that would allow for a lower pay scale for teens during their first few months on the job until they become as productive as the adults.

In the end all the arguments against a decent wage level fall apart. And by the way, Walmart doesn’t skimp on payroll to offer lower prices; they do it to make the Waltons richer. In the end that’s what it’s all about, save on payroll, keep the extra bucks and let the taxpayers make up the difference with food stamps, Medicaid, and anything else it takes to help your workers scrape by.

"Am I wrong?"--"Am I crazy?"

"What do you think?"--"Do you agree?"