TennCare and the Future of Single Payor

He was gone for a while, but now comes roaring back with another excellent post!   RangelMD.com first gives a good history lesson about TennCare, and its impending demise, then projects the lessons not learned there to the national stage:

So if ever they try and impose a nationalized health care system on the United States it is very likely to evolve in much the same way that Tenncare did. It is likely to look something like this;

1. In 2009 President Hillary Clinton will resurrect her long dead dream of nationalized government health insurance. Medicare and Medicaid will be combined and expanded into a massive program that will cover every American. It will be administered by the states and further subdivided into "managed care regions" which will act similar to the old HMOs.

It goes on, and makes me apprehensive about the future of medicine.

Setting the Record Straight: Kathleen Whitney and CNN

I am acquainted with an excellent ER nurse, who was recently made mildly famous in a CNN profile for being recalled to active duty.  However, while she knew she was being interviewed for an article about the difficulties of family separation, she expressed to me that the article was edited in a way that made her sound less than committed  (‘sandbagged by the editor’ is how it was put to me), and wants to set the record straight.

I asked her to write whatever she wished regarding the CNN piece, and here’s what she has to say:

My name is Kathleen Whitney and I am an emergency room nurse and a 1st Lieutenant in the Army reserve.  A few weeks ago I was featured in a story on CNN.com.  Let me start out by saying that the author of that article was my aunt, and I don’t believe she would ever intentionally misrepresent me.  However by the time the story got through the editors there was a definite liberal slant to it.

It is true that my plan when I became an officer was to remain in an army reserve unit until I became pregnant and then transfer to the IRR – (Inactive ready reserve) until my children were old enough to understand if I had to be deployed.  So when I got the letter calling me out of the IRR it was quite a shock and I was a little angry.  However what the article does not go on to say is that after much worrying and soul searching I came to this conclusion.  It’s a war.  It wasn’t meant to be easy on anyone.  Many, countless people have already sacrificed more than I have even begun to.  So right now my family and I just focus on ways to make things easier on my little boy, Matthew, if I do have to deploy somewhere.  I feel no animosity towards the military or President Bush for recalling me and others out of the IRR. The needs of the country have to come first.  And part of being a good parent, I think, means helping to make the world a better place for our children.  I remember Sept. 11.  I hope Matthew never lives to  see another day like that – where Americans are attacked on our own soil. 
 
One other thing that they neglected to mention in the article which I talked about in my interview was the guilt I already feel for not having been deployed.  When I was eight months pregnant my unit deployed to Baghdad, Iraq.  Of course there was no way I could have gone with them at eight months pregnant.  So I kept in touch with them as best I could via e-mail and care packages.  It never slipped my mind that while I was sitting in my air conditioned house rocking my new baby, my unit- the people I trained with, some of my best friends- were baking in the hot desert, enduring untold hardships.  It is hard to describe the feeling I had then, and still have now.  If I don’t deploy I am abandoning my country and my unit.  If I do deploy I am abandoning my family.  I am truly torn.  In the end if I am called to go, I will go and be happy to serve.  But I can not volunteer.  Because me volunteering would also mean volunteering my mother to take care of my child full time.  It would also mean volunteering my child to do without one of his parents for a year a more. 
   
I hope that this rebuttal or addendum to the CNN article will clear up any questions of my loyalty that may have been brought up.  Only time can tell what will happen from here.

emphasis mine

Good to hear from the source, we never questioned your patriotism.  And, thank you for your service to our country.

AAEM Proposes Merger with ACEP

…where their interests are similar:

At its board meeting on May 26, 2005, the AAEM board of directors passed the following resolution to promote unity in organized emergency medicine.  It is recognized that much common ground exists between the two major EM organizations regarding federal and state legislative issues such as the malpractice crisis and ED crowding.  It is also evident that each national organization has important activities that are best carried out by that organization alone.  It is the belief of the AAEM board of directors that the described steps will be good for the specialty of Emergency Medicine while preserving the integrity of the original AAEM mission.  We are interested in your feedback and will keep you informed as to progress related to this matter.  Thank you for your support.

Then to the actual proposal:

Proposal to Promote Unity in Organized EM Passed by the AAEM Board of Directors on May 26, 2005

Whereas, there now exists two competing general professional societies, the AAEM and the ACEP, in the specialty of Emergency Medicine; and

Whereas, at the federal and state level there exist certain issues where the specialty and the organizations would mutually benefit from a cooperative effort; and

Whereas, there exist other issues mostly internal to the specialty of EM that are best handled by one or the other organization; therefore be it

Resolved, that the AAEM board of directors approves of the below steps and will request of the ACEP that the two organizations take the following steps towards greater unity between these societies:

1.      The organizations will unify federal political efforts by contributing on a per full member basis equal funds to federal legislative action that will be pursued out of a unified Washington, D.C. office.
2.      The organizations will establish one government affairs committee with membership proportionate to the number of full members.
3.      The organizations will unify their political action committees with that board’s representation on a proportionate basis to the number of full members and each organization will recommend this as the preferred vehicle for PAC donations by their members.
4.      The organizations will institute by-laws changes to allow for the restructuring and renaming of the state chapters of ACEP and AAEM to allow for unified state ACEP/AAEM chapters that will require national membership in at least one of the organizations.

Machiavelli could learn at the feet of Robert McNamara, who basically invented AAEM, and who was their first president.   (Full disclosure: I’m a fellow of both AAEM and ACEP, but beyond general membership I’m just a grunt; I don’t go to special meetings or sit on committees, though I’m on email lists for two ACEP interest groups).  Also, I’ve had a nice dinner with Dr. McNamara and a bunch of colleagues when I was a resident, and he’s very passionate about EM docs not being taken advantage of (there’s a heck of a long story there).

As I see it, the spider has invited the fly to dinner; I expect the fly to demurrer.  AAEM, the underdog (and the one I like a little more,  as they have taken firm stands for EM docs against The Machine) has invited the very much bigger ACEP to join in Federal legislative initiatives.  Though I’m sure they have a lot of goals in common, there is so much acrimony between the two leaderships this has to be a political move to show, ‘hey, we’re trying to be colleagues’.

It’ll be interesting to see where this goes.  I’ll tell you when I know.

Update: fixed spelling.

Welcome D Magazine/Frontburner Readers

GruntDoc got a Link from the D Magazine online presence, which I frankly didn’t know existed:  DMagazine: Frontburner.

Look around, enjoy!  Here’s the post they linked to.

(Is it odd that I refer to my blog in the third person?)

Update: broken link now fixed.

DB?s Medical Rants: db gets published!!

Dr. Centor appears in USA Today: DB?s Medical Rants: db gets published!!.

I suspect that most bloggers would like to have an editorial published. Two weeks ago I received a phone call from USA today inviting me to write an opposing viewpoint. Since the topic was DTC drug advertising, I jumped at the chance. Today my thoughts appear in print!

I couldn’t give a hoot about appearing in a dead tree publication, but I salute Dr. Centor’s publication!

via Graham