Our Medical System should be run by doctors not corporations

Shortage of Doctors Proves Obstacle to Obama Goals

By ROBERT PEAR 27 April 2007 the New York Times

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

I wonder if Congress should instead focus on improving the income of doctors, reduce the fear of Mal-practive and insisting on deepening their education.  So that people will once again see it as a worthy profession and thus there will be enough doctors to serve our growing population, not simply here, but all over the world.

 As the Grandson, son and brother of doctors, I am driven to suggest to our Congress and the people that we must consider the investment someone must make to becoming a care practitioner and realize that we must encourage people to want to dedicate the time it takes to become proficient.  These dedicated individuals, unlike CEO’s and Wall Street millionaire, must excel in their studies and invest  four years at university, four years at  medical school and then finally before having the skills to serve us, invest an additional three to six years as a journey man (i.e. their their internship and residency).  Hundreds of thousand of dollars later and so much time and study does desire a fair reward. 

I also believe that we should begin to think about training our internist better, so they can be more effective and not simply pass the patient on to a specialist.  they as the gatekeep should have the education and practical training so unlike today thare are able to properly diagnosis the problem we the sick are facing. 

Simply look at the TV series House.  his dedication and effectiveness of his team is what we need.  People who truly think and only turn to specialists when they fibnally accept that the specialists skills are required.  Just to put a value to House.  my father a retired Park Avenue and renowned diagnostician finds this one medical program stimulates his thinking.

The other key issue that Obama and Congress must address is that medicine should be a cottage industry.  Instead corporations and insurance companies now run our health care system, Hillary Clinton’s efforts, although altruistic, probably drove corporations to seek profits at the expense of the real care-takers and unltimately you and I.  These new “medical?” tycoons are more worried about shareholder returns and annual bonuses than the health of the people who should be their focus and are in their care.

Is it a national health system that we need simply to “FIX” the problem.  Or is it a return to a system run by doctors who are properly trained and rewarded. We should think first of investing our taxes on helping the gatekeepers (family practitioners, gynecologist and internists) to be the front line, capable of dealing with most medical issues.  We should encourage their selfless commitment and  drive for education and practical training so they can effectively serve, thus drive down costs by being better at what they do.

Finally thought.  Risk is endemic in any system.  Lawyers drive risk out of the system by pursuing law suits because someone took at risk or was just like the rest of us a made an error.  The net result,t doctors have become overly cautious, dependent on too many tests and unwilling to say this is what I think is wrong and if we don’t do something (however risky) now MY patient will die.

Alternative Payment Methods

Ed Kountz of jupiter in his recent blog on Alternative online Payments offers an opinion that credit and debit cards where not designed for the Internet.  It is interesting to reflect back in history and remember when it was not the magnetic strip that was important to the execution of the transaction but the numbers printed on the front of the card a merchant could simply would say into a phone or type onto their telephone keypad to get an authorization. 

Move to the Internet and instead of asking the merchant to type in the account number and expiry date we ask the consumer to fill in an Internet form.  How can one argue that ISO7810-3 cards where not built for the Internet.

Back in the day, circa 1993, when we began to think about how we would secure payments over the Internet and address words like dis-intermediation.  It was clear that by any definition the ubiquitous credit card was already a vehicle for enabling eCommerce.  All the internet did was to take mail order and catalogue business and give it the power to become a global operation; no longer limited by the cost of a telephone call or postage.

Yes Mr Kountz is correct, there is a real issue with security and the Internet.  Yet the issue is no greater than what was faced when Card Not Present transactions started happening as telephone ordering became common place.  Did the payment associations attempt to keep up? MAYBE! 

First we saw the introduction of CVC2/CVV2 and address verification as tools to address the risks of someone who had captured the data on the face of the card from employing that card maliciously.  Not a bad solution, if the merchant was willing to make the changes to their web sites and call center procedures. 

Next came SET, now here was the perfect solution, yet at a cost that simply did not offer anyone a reason return on investment; even if Card Not Present Fraud was an issue.  Since then the payment associations tried to develop a simpler yet equally secure solution called 3D-Secure, Verified by Visa or SecureCode.  The idea is sound.   The issue of adoption came down to the simple issue of figuring out how to get the consumer to go through the additional step of activating their 3D-Secure password and better yet remember it.  Versus what became the reality, they simply said this is too difficult, I don’t need to buy that today, so they abandon the shopping cart.  Merchants saw 3D-Secure as a way to lose potential business and at a rate alarmingly larger than the cost of fraudulent transactions.

So what is the answer?  Create new means of payment that are designed for the specific trading environment (mobile, Internet, Mail Order, telephone Order, face to face …) or figure out how to get everyone to work together to come up with a workable solution that exploits the power of the Visa, Discover, MasterCard and American Express Brands.

In my opinion it is about communications and working together as a team.  Not once has the merchant been asked to participate in developing more secure solutions to payments.  They are simply told through compliance and rule changes this is what they shall do. 

Maybe the new Visa and MasterCard will find that merchants are now shareholders and bringing them to the table is in the interest of everyone especially the consumer.  Or is it time for a new payment Brand that is built to serve the merchant and operated by the Banks?

Interchange under judicial and legislative review

Today on Payments News – from Glenbrook Partners” they posted an article referencing the hearing taking place

Thursday 05/15/2008 – 11:00 AM
2141 Rayburn House Office Building
Judiciary Committee Antitrust Task Force
Hearing on H.R. 5546, the “Credit Card Fair Fee Act of 2008”

House Judiciary Committee Holds Hearing on US Interchange Fees

As we mentioned here on Payments News on Monday, the House Judiciary Committee is holding a hearing on Thursday, May 15th beginning at 11 AM Eastern time on H.R. 5546, the “Credit Card Fair Fee Act of 2008”. As of tonight, the committee’s website doesn’t list the witnesses who will be testifying – but it promises that a live webcast of the hearing will be available.

As an editorial comment, many of us in the payments industry find the “solution” proposed in this legislation to be overly complex. Read the actual text of the draft legislation – and you may reach the same conclusion! We wonder whether the merchant community in fact would be well served by the remedies proposed. A very basic question comes to mind: “Is this the best you can do?”

The legislation that is under review can be found at http://judiciary.house.gov/hearings.aspx?ID=204

My sense is that like Australia, Europe and other countries the USA Congress is ready to challenge the nature of how interchange is calculated and define methods of assuring merchants much reduced rates.  How the financial lobby will engage and how the associations will defend there position, should make for an interesting debate.

China, socialism and the world of electronic health records.

Today during a most enlightened networking meeting, beyond what someone in transition normally speaks of, we got into a most interesting and thought provoking conversation.

Electronic Health Care Records

Somehow we got into a discussion of the evolution and problems involved in developing the electronic patient record.  The gentleman, who will remain nameless, remembered a conversation he had with a man who was involved with the United Kingdom’s work on the exploration of space.  This knighted individual apparently suggested the key issue with developing the electronic health record was the issue of creating the patient’s electronic history from the previous pencil and pen records.

His approach to solving this problem was to use prisoners as the codifiers.  Of course such an idea immediately causes one to worry about privacy and the threat to the patient and doctors when these prisoners were freed.

As we talked an interesting thought occurred.  How often is a patient’s history relevant?  How often is the doctor quite happy to meet with a patient and simply focus on the symptoms described during that  persons visit?

As we reflected, we both realized that often the patient’s history will never be pertinent to a future diagnosis.  In those situations where the history is relevant, let’s say 10%, then there is value to the effort of codifying historic medical records, charts and the like.  The doctor and his office staff can find the time to organize the codification of the relevant data.  Clearly such an approach with the reduction is the cost of establishing the basic health record, is connected with the value a complete electronic health record will have in reducing the cost of long term care, something insurance companies and public health authorities can understand.

For that 90%, after the doctor has become automated and is part of a system designed to capture and retain the Patient Health Record, at the next appointment the doctor in conjunction with the patient can record important facts such as allergies, reactions to drugs, existing conditions and any pertinent operations or procedures the patient can remember.

Only when this basic profile indicates conditions that will have future implications, is there a need to go through the effort of backtracking through the records and recording any pertinent information.

China and Socialism

I asked my companion what he was up to.  He talked about the five companies he was working with in China and the various trips he had taken to remote parts of that great country.  He said three things that stuck in my mind.

  1. He remembered a bus trip where he asked about unemployment.  His Chinese companions asked him to look out the window and tell them what he saw.  His response “everyone is working”, “there are no beggars on the street”.  They smiled and he was reminded that in this socialist environment one of the fundamentals is that everyone has work however menial it may be.
  2. We then spoke of the economic divide that is emerging and like in all countries this is a reality that will always exist unless we can evolve to that social utopia described as the purest form of socialism.  A society where every man works to his ability and everyone shares equally. He then reflected on the reality that mobile phones, TVs and other luxuries were everywhere and the age old work ethic that is China, will drive these people to want more, therefore, work harder to get more.  It is this work ethic that is China’s strength and will be the issue we will have to address as the world moves forward in time.  If we in the west continue to expand our leisure time and the Chinese continue to follow their nature and continue to focus on work.  Who will win?  I think the answer is evident.  Those that work  will be the ones who win.
  3. He then spoke of issues within the industrial complex where mine accident occurred or dangerous products are released.  The interesting comment was that those in power, the top three managers, are shot when such things happen.  Of course this form of behaviour is abhorrent and clearly a violation of Christian thinking or western thoughts of punishment.

Yet what is interesting, assuming they learn to balance the punishment (100 dead in a mine cave do to poor conditions and insufficient safety standards) to the crime, is that those ultimately responsible are ones that are punished.

I then reflected on what happens in our society.  The executives always seem to go unscathed.  They successfully push the blame down to the supervisors and little people who work and manage the place where the disaster occurred.

If we were to dig deep enough I am sure we would find that they did all they could do with the tools and budget they were provided.  Budgets and tools authorized by executives sitting in big offices taking down big salaries and only getting worried when shareholders not employees come screaming for justice.

Assuming that China is going to continue to evolve.  That they are going to embrace compassionate forms of punishment.  While at the same time maintaining their work ethic and maintaining the premise that responsibility is top down not middle down.  They will become not only an economic power to deal with, but a country with a strong moral sense of responsibility and thus a threat to the soft life that has become the western dream.

A dream that balances not working more than 40 hours a week with demands for more and more vacation.  China will be a country where hard work is rewarded, pleasures are sought and people have a moral sense of responsibility to each other.

We in the west need to be mindful and learn from those countries that take the goodness of socialism, merge it with the power of capitalism and the forces of the global economy.