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Bohdan Oryshkevich, MD, MPH
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Bohdan commented on the article |The first thing Dr. Farmer should do as a global health coordinator is promote primary care in this country so that we do not import primary care physicians from poor countries that can ill afford to lose them.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |We as Americans cannot think simply or comprehensively.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |Medical school tuition charges represent less than 0.2 percent of what we spend upon health care. If we made medical school free and required that fifty percent of medical students go into primary care, our cost savings would be much greater in the longer term than what this program proposes.
In short, there are many things that our country COULD do to rein in health care costs without relying on vague promises. But we are not willing to do them.
The promise is not for a 1.5 percent reduction in health care costs but a reduction of cost increases by 1.5 percent.
That is a very slight promise. I simply do not know how insurance companies can promise even that. What if there is a flu epidemic of some sort?
What is the track record of all these institutions?
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |I heard on NPR today (Friday) on the program On Point that President Obama hosted Mr. Dellums and Mr. Kucinich to the White House and told them that the single payer option is not going to be discussed. Does anyone know if this is true?
The program also made the very valid point that until there is public financing of elections there will be no single payer plan.
The other point that was made is that the majority of the population has health insurance and wants no change. That puts a limit on health care reform proposals.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |The Republicans raise legitimate concerns. One should not dissmiss them. One should address them.
I am all for any one of government run, administered, or funded universal health insurance programs.
But the first thing I learned at Harvard is that one has to not only do the right thing but one has to do it well.
Government can be heavy handed, etc.
So let us get it right.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |
I would agree with Carla that if the situation gets any worse, more civil disobedience may be in order. I am not against civil disobedience. But medicine requires careful planning and calm. We do need consensus. I cannot tell you how I feel about Senators being against universal health insurance or especially against SCHIP.
I would add that I am of the Columbia College class of '68 and I attribute the coming of Reagan to the demonstrations of the 60s.
I do not know and am totally perplexed why Americans do now worry about the 50 million people who have no health insurance. Solidarity has been beaten out of us. I have no health insurance at this moment. But I do not let outrage get the best of me.
I sent an op-ed to the Washington Post yesterday and spent much or all of today working on an innovative anti-obesity proposal for the poor. I cannot send the WP to you until it is rejected.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |
Protests will only work if there are enough people: something like a march on Washington. I do not see that happening.
People in America want order and they do not want to get their medical care from demonstrators. Demonstrators are easy to ridicule.
The reality is that very few experts in America are capable of dealing with the components necessary for universal health insurance with global budgeting. That includes PNHP. Verbal criticisms are likely to go further. Analysis could persuade others. There are few such people.
I think that having a humorist like Jon Stewart skewer the politicians is a good one. But is that going to happen?
Professor Uwe Reinhardt of Princeton is brilliant in his lampoons. But he only shows his pain and is at times not constructive.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |Embraced: German doctors are protesting.
In Canada, the article points out that something like ten to fifteen percent of doctors have EMR. The focus here is on the richest province: Alberta. When a minority of people take something on it hardly seems like an embrace.
EMR may be a good thing. But I doubt whether it can work here without prior health care reform.
If you have no primary care doctors and no insurance for the uninsured, EMRs will do nothing.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |
Please be informed.
The first seven pilot projects in a smart card system failed in Gernany, so the smart card system in Germany has been postponed.
http://www.ehealtheurope.net/news/4458/germany%E2%80%99s_e-health_smartcard_scaled_back
Canada is not much better on EMR than we are.
http://www.emrupdate.com/forums/p/18585/95035.aspx
http://www2.infoway-inforoute.ca/documents/The_Globe_and_Mail_-_March_6_2009_-_If_only_it_could_make.pdf
Please some basic research. Sloppiness in research will not solve our health care woes.
Bohdan A. Oryshkevich, MD, MPH -
Bohdan commented on the article |I think that in the first round we are in for a big disappointment.
In the absence of leadership from the President (reliance on Congress) nothing will happen. You cannot rely upon Congress to resist all the special interests. So far it does not appear that Mr. Obama is willing to risk his political capital on health care reform.
Second, without the public financing of medical education to create an appropriate workforce, no reform will be successful. Medical schools in this country are generally unwilling and unable to produce the primary care workforce that this country needs to implement a universal yet economical health care system. With Larry Summers on his team, Mr. Obama is not likely to confront HMS and other leading private and public medical schools on primary care.
Third, a watered down public insurance program will do little and will be privatized as soon as the Republicans get into power. Just as Sallie Mae, Fannie Mae etc were privatized at great profit to their executives.
Fourth, with the absence of a cohesive movement for comprehensive health care reform in the general public, nothing will happen, since there will be no accountability for politicians. PNHP has been marginal since its launch. As one who trained in internal medicine in Canada in order to learn within an ethical health care system, I have to sadly state that Americans do not have the social IQ to make universal health insurance happen.
Fifth, the five percent bonus for primary care is a very bad omen. If President Obama was working on health care reform behind the scenes, this five percent bonus would not have taken place. This 5 percent bonus reflects piece meal policies rather than reformative policies. After spending 19 billion dollars to stimulate EMR, it was becoming clear to me that the creation of a technological home for primary care does not include physicians in the picture. Read the recent Business Week for the influence of IT companies upon the Democrats.
My interpretation of events is that the administration is doing everything to reconcile insurance companies to some moderate reforms. That is: the agenda of the administration is to preserve the market for private insurance as much as to private better insurance for the average citizen. Somehow universality is disappearing from the debate. There will be a mandate for people to buy some form of health care insurance. That is why no opposition to health care reform has emerged. The pharmaceutical and insurance companies are still working on a deal.
I think that President Obama understands the issues from a consumer's point of view but he is too weak to forge a new policy on health care. I am yet to be persuaded that he understands the basic facts about health care reform. His heart may be in the right place. He regularly touted during his campaign and at the health care summit that we could save a trillion dollars over ten years if we solved the obesity problem. Sadly, he is off by an order of magnitude.
I do remember specifically from the campaign that he promised that all discussions with the pharmaceutical companies and insurance companies would be on C-Span and would be totally transparent. Where is the transparency?
Saying that one is for change and that the status quo is not acceptable is simple rhetoric. It is not specific enough. These are just sound bites. We have been into sound bites for so long that we have gotten to believe them. At this time the sound bites are a bit more progressive so they sound comforting.
I voted for him and I would vote again. But when I voted for him, I promised myself that I did not expect anything from him on health care. I do not know if there will be a second round.
I remember Nixon, Ford, Carter, Kennedy, and Clinton on health care reform. I see little progress and much decline since then.
Bohdan A. Oryshkevich, MD, MPH
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