Wednesday, February 21, 2007

John Edwards Health Care Plan "Pastiche"

A few weeks ago Presidential Candidate John Edwards put forth a health care plan ahead of the other leaders in the U.S. presidential race. At least he set a mark!

John Broder of The New York Times summarized it well

(The brave unelectable candidate Dennis Kucinich is co-sponsoring HR.676-Single payer- Medicare for all)

The trouble with the health care plan mark that Mr. Edwards has set is that it is a true "pastiche-collage-soggy mix and match"(you put in your own metaphor"________________ )multi-component,phased in plan, that still aligns we weary and broke U.S. health consumers with employer based-private insurance industry managed health care which Mr. Edwards himself admits has been a failure.

But to his credit Mr. Edwards says that his plan would create a federal health insurance agency that could someday (when?) become the basis for a single-payer system that would eventually (when?) do away with private health insurance.

Sorry Mr. Edwards, I understand that you can't "steer" a 2 trillion dollar "mega-ship" too quickly or too sharply lest it breaks apart thus producing what many are predicting would be serious dislocations to the US economy. But Mr. Edwards ,the mega-ship you are trying to steer, alas, is the Titanic and we have already hit the proverbial iceberg and sinking fast.

(I'll put aside for now the loss of campaign contributions from the industries that your plan might hurt).

My take is that in recent times we have little reason to trust the health care industries like Big PhRMA or Big BIO, the for profit and "not for profit" high tech Hospital Industry and certainly Big Insurance who feed together,like pigs at the trough, while the patients and even most providers get beaten up and beaten down.

Again in The New York Times Paul Krugman asks the question "is the health insurance business literally a racket?" citing racketeering lawsuits filed by two New York Hospitals against United Health Group.

Anyway we bloggers who attempt to cover this health care issue await the details of the leading other Dems for Prez like Hillary and Obama as well as the leading Pubs for Prez like Rudy Giuliani and Mr. McCain (I'm counting out Mitt Romney because I don't believe anyone who is named after a piece of athletic equipment or clothing can be president)

Anyway, thanks again Mr.Edwards for the kickstart which places increasing pressure on the other candidates to put forth details on their own health care reform plans.

A dear friend of mine believes in incrementalism as you seem to. He calls it "one slice of baloney at a time". Actually I wish he said salami because, so far, most of what I am tasting from the presidential candidates is "baloney" (not the food variety)

Stay tuned folks- When the war plans become clear, health care reform waits in the wings as the issue that will decide the Presidency in 2008

Dr. Rick Lippin

Saturday, February 17, 2007

The BIOtech Bubble is Bursting

Almost a decade ago I believed that the predictions that the humane genome project and more recently stem cell research would revolutionize medicine were overly optimistic both in their capacity to advance human health and to create a new economy in health care.

I know that many progressive, mostly democratic members of the US Congress, and high visibility governors such as Eliot Spitzer of New York and Arnold Schwarzenegger of California have placed their political and financial bets on these technologies and many average American citizens still hope that these technologies will yield cures to many of our most devastating diseases.

But alas- the politicians were duped by an overly optimistic report generated in 2004 by Stanford University health economist Lawrence Baker and Bruce Deal of The Analysis Group in preparation for the run up to a California Ballot initiative.(now known as the Baker-Deal Report)

And the American public has been duped, in my opinion, by probably well meaning mainstream media fed incorrect information by both the scientific community and very powerful for profit BIOtech companies into believing that these technologies were revolutionary. Instead the public should have been told the truth- that these technologies were in their infancy and that there were no guarantees that they would work at all?

For an excellent summary of this issue I commend to you a post by David Hamilton- a free lance writer from San Francisco on last week entitled The Biotech Bubble

Am I an anti-biomedical technology Luddite? By all means no- but I do believe, as many do, that we are currently on that part of the biomedical technology curve where real scientific and financial return is much more difficult to achieve for dollars and resources invsested. And since medical school, for me over 35 years ago, it became very apparent that technology in medicine would never solve all of its problems- not by any stretch of my imagination anyway.

Dr. Rick Lippin

Tuesday, February 13, 2007

Mayor of New York Comes Through For Prevention

In a landmark speech on health care reform yesterday the Honorable Michael R. Bloomberg, Mayor of the greatest city on the planet, New York, New York , jolted to the front of the pack among politicians by endorsing prevention by stating "we're paying for a disease care system- not a health care system." He also emphasized the role of "prevention-oriented electronic health records"(EHRs)

The good Mayor has a program of 10 preventive health care steps that every person can follow know as "Take Care New York"

Pinch me!

I've waited for a prominent politician to take this leap for at least a decade. Little did I know it would be a Mayor!

I would personally add that an important component of prevention are Institutions and yes, Government, stepping up to the plate as well as individuals regarding healthy environments in the broadest sense of the word. And healthy jobs for all!

Below is once more my own #8 point plan from 1995 (slightly revised after Katrina)


- Stop prolonging death. It’s both expensive and dehumanizing at best, greedy and cruel at worst.

-Empower US citizens to assume increased individual responsibility for health and convince medical consumers that it is in their best interests not to assume the role of helpless, dependent victims/patients.

-Yet also recognize that we have medicalized America’s social problems. So we must provide healthy and safe jobs for all able citizens thereby reducing poverty and all its subsequent health impacts (possibly 1/3rd of Health Care Costs)

-Provide healthy environments including healthy air, water, soil and food.

-Rebuild America’s public health infrastructure to ensure we provide appropriate macro and individual interventions to especially low income citizens such as childhood and adult immunizations and response to man-made and natural catastrophes.

-Face the reality that a very large percentage of illnesses, injuries and hospitalizations are entirely preventable. Subsequently, the elimination of tobacco, alcohol, drug, medication and dietary abuse alone could immediately reduce medical costs by a factor of at least fifty percent.

-Incent and train physicians to maintain the health of patients and populations. Radical changes in provider re-imbursement and medical education strategies are necessary

-Recognize that early childhood preventive medical education can profoundly affect lifelong health behaviors.

*proposed in June of 1995
Revised January 2006/2007

Mayor Bloomberg- I speak for many when I say we are in your debt for telling like it is-and it must be.

Prevention is our ONLY way out of our economically unsustainable disease care system. But please Mr. Mayor- Sick and injured people still need our help too- so please a transition to "Prevention with a heart" is the way to go.

Dr. Rick Lippin

Saturday, February 10, 2007


Today Barack Obama was electric again and spoke about prevention in health care during his Presidential announcement speech - my personal favorite solution to the "now everyone agrees" genuine crisis in US Health Care.

H.R. 676 (Conyers/Kucinich etc)- Single payer-"Medicare for All", for example, needs more prevention in it.

But Mr. Obama also has a bill in Congress called the Genomics and Personalized Medicine Act which is ill conceived and informed. The Human Genome so called health revolution is a myth

Below is what I wrote in January 1999-

Major advances in modern Neuroscience with all of its profound implications (like the physiology of human perception and the physiology of human intentionality or choice) will significantly dwarf, if not render childlike, all the projections that molecular biology and the human genome project will “revolutionize” Medicine in the 21st century.

(Feedback welcome on my 1999 comments)

But still Obama exudes passion and programs for the growing ranks of the disenfranchised and disillusioned Americans. He's a candidate to be taken seriously-no doubt about it!

Dr. Rick Lippin