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Bohdan Oryshkevich
NY, NY
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Bohdan commented on the article |
It is a good cartoon. It is logical and makes sense. It builds on success.
It does not mention single payer once. It is not ideological. It is a strong argument for government participation in health care.
It is not an argument for single payer. It is an argument for government regulation as much as for government control.
It takes government skeptics to the next step. That is what government advocates must do. That is why the Kristof article makes sense.
That is something PNHP advocates do not understand.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |The reality is that no plan on the table that I have seen does anything to make an adequate commitment to primary care. To portray the primary care deficit as a conflict between doctors and nurses is unproductive.
Primary care is more complicated than people give it credit for. The preparation for it is totally inadequate in this country.
One could provide skilled primary care practitioners through the nursing track by lengthening their education and providing them with more responsibility through training. That in effect would be turning them into physicians. They would be just as much in debt and would be just as likely to go to into specialties.
The reality is that the current reforms that are proposed are only tinkering at the edges.
Reform is not going forward. It seems to be mired.
I hope that I am wrong.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |I am wondering whether the Obama plan for individual mandates and subsidies to insurance companies to take on the uninsured or the difficult to insure is just not another form of Medicare Advantage type subsidy?
What are the subsidies to the private insurance sector going to be with the various proposals on the table.
I do not know. I am just asking the question.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |
The level of understanding of single payer is weak in America both among supporters and among critics.
There is very little Canadian input. Canada does better than the USA without a doubt. But it lags behind the best performers in the world. 5 million people in Canada lack a primary care physician. Canada imports thousands of PCPs from South Africa and the UK, etc.
The Canadian solution is very conservative but it has been portrayed as very radical by both proponents and critics. PNHP never figured out a political strategy even for supporters let alone critics.
They have not even addressed primary care.
It is one thing to be next to Canada it is another to get there.
Let us hope dialogue, research, political activism slowly grow. And we move forward.
There are hundreds of American doctors who have moved to Canada. Why has no tapped them? I was in Canada essentially for seven years. I was in the UK.
PNHP was not interested in my thoughts because my approach was conservative and not romanticized.
Here is a Canadian presenter who lectures regularly in the USA but works primarily for Canada.
http://www.michaelrachlis.com/pubs/090616%20PDA%20M%20Rachlis.ppt
This is a debate at Rockefeller University before a VIP crowd and in which ABC reporters took part.
http://blog.michaelrachlis.com/post/7
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |
These hecklers add nothing. They are easily manipulated people by all sorts of front groups. It is very interesting but some of the main Republican operatives did a lot of this kind of work in Ukraine for the Party of Regions and Mr. Viktor Yanukovych. That kind of stuff is a much bigger part of their politics.
http://blog.kievukraine.info/2008/05/mccain-consultant-is-tied-to-work-for.html
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Bohdan commented on the article |
It is up to the leadership of Mr. Obama. He has a lot on his plate. But he has done much less than he should have done.
So far, the debate has been too superficial, too short with too little understanding and much too little commitment.
When I noted on this website that there must be pressure on the White House and President Obama rather than on the Republicans, I was told offline that I was out of line.
If you cannot expose hecklers for what they are, how will you ever have the firmness to run a reformed health care system?
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |I think that this country has come farther than most people think in the last few months. We still have a long way to go.
Unfortunately, the New York State Legislature is totally dysfunctional. I know, I testified before Mr. Dick Gottfried on universal health insurance with global budgeting over twenty years ago. New York State government is up there with Louisiana and Nevada. I hope that I am not offending anyone in those states.
Since I was not a lobbyist in the infinitely corrupt legislative chambers of Albany, I was dead last in line to testify.
I actually awoke Mr. Gottfried and Mr. Tallon.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |There is nothing wrong with the fee for service habit. Countries as diverse as Denmark, Japan, France, and Canada use it effectively to reimburse physicians. Fee for service for physicians is fully compatible with global budgeting.
Reimbursing physicians for outcomes will present similar problems. If each patient has a global budget, then doctors will avoid the sicker and more demanding patients.
The implication that fee for service is a habit like nicotine is a fundamentally false analogy.
The fundamental problem is that we do not have a physician workforce policy. We denigrate the cognitive skills of physicans through heavy student loans and perverse incentives that encourage procedures.
If we eliminated conflicts of interest from the practice of medicine such as physician owned technology and hospitals, fee for service for hospitals, we would achieve much more.
There is a fundamental difference between fee for service medicine and private practice and privately owned technology.
Demonizing doctors and how they are paid is not going to solve our health care problems. Only engaging doctors will. One has to read Ezra Klein to understand that.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |No, it was Dr. Satcher, then at Meharry who spoke in the early 1990s about medical student debt, health care reform, and minority medical education at a national forum on the topic. He was not able to do anything while Surgeon General.
That just shows you the influence of the Surgeon General. Dr. Koop used the bully pulpit on an issue of prejudice, HIV/AIDS. In general, Surgeon Generals do not get a lot done.
Bohdan A. Oryshkevich, MD, MPH
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Bohdan commented on the article |
Dr. Benjamin appears to be a true role model for the revival of primary care medicine.
But nothing will happen unless we fundamentally reform the financing of medical education. That is not happening.
So Dr. Benjamin is very sadly a token. Dr. Satcher, a former Surgeon General, was a passionate advocate of the reform of the financing of medical education eighteen years ago. Nothing happened. So, as Yogi Berra stated: This is deja vu all over again.
Democrats often get the symbolism right but not the policy.
Bohdan A. Oryshkevich, MD, MPH
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