A post by Andrew Barna

Well it has been a few months since I last posted on Hospital Impact, but with the new year, Gov. Schwarzenegger's plan to cover the 6.5 million uninsured in CA, the President's tax incentive plan is being dusted off again, and pretty much everyone is joining a coalition to tackle the problem of the uninsured, it seemed like time to rejoin the conversation.

I have perused the Schwarzenegger plan and frankly I am skeptical. Here are a few initial impressions.

First of all, the plan to tax hospitals and physicians in order to fund a MediCal increase just doesn't make sense. As the saying goes, why rob Paul to pay Peter? There just doesn't seem to be a point to tax providers. They are at the end of the food chain, so no new money is being added to the system that wasn't already there. There is no doubt that MediCal is severely underfunded - it pays between 9 and 13 cents on the dollar - but taxing providers is equivalent to cutting reimbursement.

One of the other big funding sources for this plan is a mysterious $5B coming from the federal government, but where is this money coming from (does the federal government match state medicaid dollars?). I know we have left SCHIP money on the table, but $5B is a lot of money.

The requirement for businesses with 10 or more employees to either provide insurance or pay into a state pool is not a bad idea on its face. It puts new money into the system and puts that money to good use. Unfortunately, CA is already a difficult state to do business in and this will be seen as putting an unfair burden on employers.

As for the President's perennial tax shifting scheme to help people pay for insurance coverage, I have said it before and I will say it again: unless the working poor see more money in their paychecks each week, they won't be able to buy insurance. The promise of less taxes/more refund on April 15th will not give the working poor the cash flow to pay monthly premiums.

The relatively good news is that more and more people are acknowledging the problems with our health system and jumping on the bandwagon to fix them. Perhaps a Democratically lead Congress can make healthcare a priority, but we still need to resolve some fundamental issues: mis-aligned incentives and who ultimately is going to pay for the healthcare we want.

by Nick Jacobs

Today, I opened the Sunday newspaper to see an article by David Wallechinsky that very carefully challenged us to look at ourselves as a nation. Under the realm of leadership the question has to be: When will our leaders begin to address these issues in a meaningful way? We have no national health care policy. We have no viable energy policy. We are still not open minded enough to even elect a female to the Presidency. Yet, according to Wallechinsky, we remain the strongest country economically in the world. Too bad economic strength isn't representative of moral, ethical and social strength and commitment.

As I sit with my children and grandchildren today, I can only hope that their generation will take hold of these issue. After such a strong start, we Boomers certainly seem to have missed our major opportunity to make a dent in these socially challenging situations.

From "Parade:Magazine" by David Wallechinsky

The U.S. spends the most on health care but lags in life expectancy.

43 Countries have more physicians per capita than we do.

33 Countries, including Cuba, have lower rates of infant deaths.

Residents of 27 countries live longer.

We lead all nations in the consumption of oil, using a quarter of the world's annual supply.

Highest per capita rate of people in prison, 737 per 100,000 people or 2.2 million.

We perform the fourth highest number of executions trailing only China, Iran and Saudi Arabia.

Only South Africa and Canada have higher rape rates.

We also have the 15th highest murder rate

71 countries do better at electing women to national legislatures.

Of eligible citizens who vote, U.S. ranks 139th of 172 nations.

WE consume more calories per capita than the citizens of any other nation, and lead the world in the prevalence of obesity.

By Nick Jacobs

The day starts with a trip to Starbucks where they hand me my decaf, nonfat, grande, latte. Reaching for my car keys the foamed skim milk drips onto my black top coat and as the sleeved cup is carefully placed in the holder between the seats, the car lunges forward. When I fumble to place my Bluetooth headset back into my right ear, the excess foam drips onto the screen of my Treo cell phone, and it’s only 6:30 AM.

The lighted icon of a yellow skidding vehicle appears on the top of my odometer as the company car flies toward the first meeting of the day with the medical staff. This group prefers the predawn hours of the day more than any other time. (As a former professional musician, the only time I enjoy seeing the sunrise is when I'm coming at it from the night before.)

After the medical staff meeting, the next three hours are filled with meetings with my direct reports. If charted, these meetings would look similar to my last EKG as the personality types move from conservative to liberal, from detailed to ethereal from muted to encouraging. It's a roller coaster ride of emotions, issues, problems and potential solutions as they bare their souls in this hourly cleansing session, receive absolution where appropriate and move on with their work lives with the same passion and commitment that Rudy displayed at Notre Dame, that Armstrong demonstrated on the moon, that Custer . . . well, you get the idea.

At noon, lunch is consumed as almost an afterthought. It's vegetable or meat loaf, tossed a salad and a whole wheat dinner roll with a side of bottled water. Chewing and swallowing continues as we contemplate the fates of the various physicians who have applied for privileges to work at our hospital. All are considered as the names are discussed by the various physician leaders. Their credentials, their recommendations, their history, their record with the Physician data bank and, when appropriate, the side of their head on which their hair is parted, are issues for discussion at this meeting.

After this working lunch, there is a one hour teleconference with six CEO's from other hospitals where we discuss governance issues for our regional organization.

All of the earlier meetings lead to the high light of my day, the marketing meeting. I'm sure that my peers from finance probably have a similar high from meeting with their number's jocks, but, for me, it's the right brain creative's, their interns, their assistants and subcontractors.

This group gathers in the conference room with a high level of positive energy, usually not exactly on time, usually not in an orderly fashion, sometimes with late lunch in hand. This group is filled with our dreamers, the positive, not usually too serious, creative types. They plan the press conferences, the television commercials, the employee parties and the strategic acceleration that will produce dynamic marketing surges for our various service lines. With this group it is about telling the positive stories, translating those complex medical issues into understandable human speak. Usually, these employees are fun . . . out of the box types who, without their input, would make my life a little more tense. In fact, I'm thinking that without this weekly meeting that grande, decaf, latte would include a couple of shots of something else!

Two more meetings with individual physicians and our Chief Operating Officer, a dinner board meeting of a local non profit, and then finally, at 9 PM the beginning of 90 minutes of e-mails that went unanswered during the day.

Bed finally arrives at 11:30 PM and the clock clangs again at 6 AM the next morning. Believe me when I tell you that, compared to many, this isn't a bad schedule.