Saturday, September 28, 2013

Primum Non Nocere……First Do No Harm

Fixing our healthcare system will require some combination of more money to provide the products and services some folks are not getting, reducing the cost of certain products and services and limiting the availability of certain products and services. I don’t think the Affordable Healthcare Act (aka Omabacare) gets us where we need to be. Furthermore, I’m not sure any politician has the guts to put forth a program that does. Providing healthcare for all, significantly reducing the cost of healthcare and determining what level of healthcare people are “entitled” to receive would seem to be way more than our government can handle. And then there is the question as to whether or not they should even be trying.

Certainly the government has a role to play in healthcare. We want and need certain controls, guidelines, certifications and oversight of healthcare related services. Rules and regulations are necessary up to a point. But we are headed in the wrong direction when the government mandates that everyone will have healthcare and then cobbles together a half-ass program and hopes that the people (especially the ones who vote) won’t get so pissed off that the political geniuses who came up the idea get run out of office.

The healthcare math is really simple. It still cost money to provide healthcare to people who do not have healthcare (or money). You can force young healthy uninsured people to pay for healthcare that they will not likely need at this point in their lives and cover some of the immediate costs. But it’s not going to come close to covering the overall cost of adding millions of uninsured, unhealthy people to the program. And the premiums you (and your employer) pay in when you are young will be needed to keep you upright and mobile when you get older. Trust me on this.

The cost of certain healthcare products and services can and should be reduced. The threat of litigation causes the industry to over test, over prescribe and over refer to specialists who over refer to other specialists. In many cases the process or sequence of tests and evaluations allowed by insurance providers ends up adding costs, not to mention delaying treatment. The “system” needs to be improved. The marketplace can do a pretty good job of driving down costs and improving service if it’s allowed to work. But, the healthcare, insurance and big pharmaceutical lobbyists have done a great job of stacking the deck in their favor. And, I predict that when it’s all said and done, they will do just fine under whatever sort of healthcare program we end up with. They will make sure that “the marketplace” works mostly to their benefit.

Which brings us to the third variable in the healthcare service and cost equation. What products and services will be available and who makes that determination? Interestingly, we are moving toward a hybrid healthcare system that is part public, non-profit, government entitlement program and part private sector, for-profit business. Perhaps the worst of all outcomes. The “for-profit” system which delivers the vast majority of healthcare related products and services cannot afford to lose money. Capital will evaporate and the businesses will go under. So this “for-profit” system will charge whatever they can and continue to lobby as hard they can. And, where they cannot figure out a way to make a profit, those products and services will become very difficult to access. Or they will only be available “outside” of the “affordable” system at prices few of us can afford.

There is no easy fix to our healthcare system. And it is indeed a shame that many people in this country do not have access to healthcare. We could improve that situation over time by upgrading our network of “public” healthcare services. But, there is no way to provide comprehensive healthcare for everyone without forcing some of us to pay for the healthcare of others while paying more for our own.

The real question is not are people entitled to healthcare. The real question is what sort of healthcare are people entitled to and what sort of healthcare should they pay for? And if they can’t pay for it, do they just live without it as best they can. For example, I had a total knee replacement back in December 2011. It has been a wonderful thing and I am thankful that I had insurance that covered most of the costs. But, should a person be “entitled” to a knee replacement? If you have no insurance and cannot afford a knee replacement, should the taxpayers pick up the tab? Tough question. No easy answers.

Saturday, September 14, 2013


There was a crooked man, and he walked a crooked mile.
He found a crooked sixpence against a crooked stile.
He bought a crooked cat, which caught a crooked mouse,
And they all lived together in a little crooked house.
- James Orchard Halliwell

By now you’ve probably heard about the Sports Illustrated report on the Oklahoma State football program. SI spoke with various sources including former players. Going back to the early 2000’s and as recently as 2011, OSU players were allegedly recruited and rewarded with cash, passing grades, drugs and sex. Perhaps not coincidentally, during this time OSU has had more talented players and their football program has risen from mediocre to exceptional.

I used to live in Oklahoma and would always root for OSU vs. OU. They were the underdog, not unlike my Texas Tech Red Raiders relative to the University of Texas. People in Oklahoma and Texas are passionate about sports, especially football. And when it comes to high school and college football, the passion can become an obsessive-compulsive disorder. The same can be said for other regions of the country. Having lived in the Southeast, I can confirm that they are the most passionate about college football. With all due respect to OU-Texas, Michigan-Ohio State and countless other intra or inter state rivalries; nothing comes close to Alabama-Auburn. Even Clemson-South Carolina, Georgia-Florida and any LSU game are crazier than anything you’ll see outside of the South.

But make no mistake, Oklahomans take their football seriously. Seriously enough to welcome Texas players by the dozens into their schools. Oklahoma high schools produce some great talent. Just not enough to fill OU and OSU rosters. Going back to the 1940’s OU made the commitment to build a national championship caliber football program. They were successful and ultimately were inspired to build a university that the football program could be proud of. And OU is now a great university. Likewise, OSU is a great university. But they have always been behind OU when it came to football. While their overall sports programs outshined OU, football is all that really matters in Oklahoma. OU was the bully and OSU the bullied.

Eventually, if they are determined to keep showing up, those who are bullied fight back. In the world of big-time college football how can a perennial underdog fight back? Hiring a good coach is a step in the right direction. Having a rich donor like Boone Pickens is even better. But coaches and facilities don’t win games. Players do. And if you are an OSU, or a Texas Tech, or a Baylor, or a Vanderbilt; how do you compete for talent up against traditional powerhouse programs? At some point, you start taking too many kids who can’t do even the most basic college course work. You take kids who want to be paid for their services. You take kids who like to party, a lot. All programs, including the so-called powerhouse programs have some of these kids. Unfortunately, for some programs, and OSU may be one of those, you can end up with too many of “those kids”.

Most individuals or groups that are in a competitive situation will tend to migrate toward actions and behaviors that get results even when those actions and behaviors are against the rules or are just plain unethical. Some years back we saw it in sports with steroids. Nobody really liked the idea of using steroids, but when you are competing against people who are using them and gaining advantage, you use them. Schools and coaches would prefer to have players who are capable of doing college level course work, but when the competition is taking the best athletes available including those who can’t read, you use them too. Great player who likes to party? We need more great players. So we’ll party? One does what one has to do.

And it goes on everywhere. From corporations competing for profits to local churches competing for members. From beauty pageants to how we drive on the highway. From resumes to “value proposition” sales spins. Most of us do what we have to do as long as it works and we don’t get caught. We tend to grade ourselves on the curve of “this is what we have to do in order to compete” and integrity as an absolute value is replaced by something we call winning.