After listening to Obama for over a year now, I’m beginning to hear the same stuff with the same cadence and same vacuous content.  Like Cotton Candy, his speeches quickly dissolve into a sweet emptiness all the time enticing you to consume too much; in the end it just makes you queezy.

People, I’m convinced, are pretty much the same around this world, they respond to people they respect and it appears that though the world likes Obama, he’s not much respect.  They perceive, rightly so, that if they do something unseemly, the worse they can expect is a severe tongue lashing.  Most of the bad guys control their local media, hence the tongue lashing has no local effect.

Locally, Obama is loosing the healthcare debate because he doesn’t have the facts, and those he does have have been too often misrepresented.  Until this behavior stops and Obama begins leading, I fear we’re in for a bumpy and unpleasant ride.

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President Obama sells aesthetics, he sells the paint job not the car, the icing, not the cake; he’s been omnipresent and relentless on healthcare and it’s not working.

It seems to me that Obama wasn’t elected because he was smart, though I suspect he is, certainly not because he had an abundance of experience or that he had done anything; he was elected because we wanted to feel good.  The country wanted to feel good about having a charming, handsome and articulate young president.  We had no expectation that he would actually do anything, that’s wasn’t the point.  Electing Obama wasn’t about change, it was about aesthetics.  We just wanted to feel good about ourselves and for that, Obama was perfect.  You can see it in that Obama has been on the cover of Time magazine about 15 times over the past two years and the media loves him.  They love him because he sells, and this, in the end, is the point and product of Obama, nothing more is expected or wanted. He sells “feel good.”

The challenge is that no one told the Democratic Party in general and the congress in particular; they went for the head fake, and now they can’t get back into playing position.  Like that awkward moment that happens after you compliment someone and they think you want to take them out on a date.  The democrats have grossly over read the signs, and now we have to tell them that there will be no wedding.

Democrats are blind to these subtleties because aesthetics is all they do, they are all about what looks and feel good, hence they could not see it coming.  In the democratic world, there are no trade-offs, no balance sheets, no sense that activities have costs and that words have meaning.  They are all about the look and feel of what they want to do with no interest in the quality of actual outcomes, hence when the democrats started talking about fixing healthcare, people got scared and rightly so.

In the matter of one’s healthcare, outcomes really matter.  If your doctor tells you your cancer is cured, you want to know that those words have meaning and that they are true.  You can get away with misrepresenting paying for illegal aliens’ healthcare in a speech, but misrepresenting a diagnosis to another human being is unacceptable.  If you have to undergo a surgical procedure, you actually want to know that the person doing the surgery has experience and knows what they’re doing.  The looks of the physician and the quality of their speech is far less important than their knowledge and skill in doing the work.  In healthcare, we’re all conservative because we live with the results, no one else can do that for us.

Healthcare clarified the divide and the purpose of the Obama administration.  They are there to provide political counter point in deal making and sell copy (period).  As long as Obama stays in his lane, he’ll get along fine, he has already demonstrated the weakness of his experience and that he cannot be trusted to do anything more.

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Here’s the facts:

  1. Not all hospitals, clinics and physicians are equally talented and knowledgeable in the delivery of healthcare services; here are some which are simply better than others, and experience matters.
  2. It’s actually pretty difficult to kill someone.  The human body is amazing in its ability to adjust to changes, whether it is the loss of a limb due to trauma, or the loss of the function of a kidney or part of one’s heart due to a heart attack.  We adapt very well, but sometimes it’s not pretty.

For example, the difference in one’s quality of life when their heart is functioning at 50% capacity verses 20% capacity is astounding, as is the effect of the loss of function of both kidney’s rather than just one.  In both cases, the effect upon the individuals quality of life  is non-linear.

The challenge with healthcare is that neither the payer nor provider of services have to live with the results, that is solely left to the patient and their loved ones.

So then, what do we have with the current healthcare reform?  Well it pretty much looks like this:

  • It may provide coverage to more people (but we don’t know this for sure nor does it mean that you can go anywhere you want for care).
  • It won’t save money (virtually no one believes otherwise).
  • It doesn’t address the means by which we will have enough physicians and nurses to go around.
  • It will not improve effieincy in the delivery of care delivery.
  • It won’t address the cost of defensive medicine (which is huge).
  • It won’t make you better off.
  • It will lead to more taxes.

Is there anything I missed?

Thomas A. Coss, RN

Improving Labor Efficiency in Healthcare

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This site is focused upon efficiency as a contributing solution to the cost of providing healthcare services. Efficiency alone won’t carry all the water needed to address the cost of healthcare, but it will make a profound difference in the scope and amount of services provided per dollar spent.  Last year I began a study based up some data going back over two centuries.  In the early 19th century, over 80% of the US population was involved in agriculture…. they were farmers.  By the beginning of the 20th century, that percent fell to 40%, and by the beginning of this century it fell to below 2%.  This astounding increase in per worker productivity freed people to go into manufacturing at the beginning of the 20th century, leading to an amazingly robust century of innovation and improvements in the quality of life.

In 2008 I began looking into capital investment in heatlhcare as compared to other industries and found some interesting results.  As expensive as healthcare has become, investments into improving the efficiency of the labor that provides those services has been poor.  Per worker capital investment in healthcare is about 35% lower than it is in general manufacturing.  How can we hope to lower the cost and expand the availability of healthcare if we insist on providing those services the same way they’ve always been done? 

A more detailed explanation is available here until I hear: Improving Labor Efficiency in Healthcare.

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