Shockingly the one area of healthcare that hasn’t been addressed is cost. We simply spend too much. We have solid gold demands and a tin credit card. During this whole discussion no one will talk about the 1000 pound gorilla in the room.

Healthcare spending equals 16% of our GDP. Twenty years ago it was 6%. By 2020 it will be 25% on a projected basis. We have the best healthcare system in the world. BS. At 78.1 years, our life expectancy stands at 33^rd in the world. At 70.0 years, our healthy years are 33^rd. In infant mortality rate we rank 34^th. Next question?

I am not advocating socialized medicine but there is a strong case to be made. Since the advent of Medicare we have seen the medical/industrial complex evolve. We have simply made a business out of disease and medical treatment. As widely held stocks we have pushed these companies to show profit growth. Ergo, the sicker, the longer, the more complex, the better.

Today we bring out new drugs at higher prices. They in many cases are only marginally better than the old one. They advertise. The doctor is not going to argue with a patient that wants this or that. What does he care? Prescription drug benefits don’t quibble. Pay for all but God forbid there would be a bidding process to lower Medicare costs. How tacky.

Machines can look into anything. Studies have shown hospitals with the latest and greatest gizmo see a huge growth in usage. To make people better? No, to pay for the damn thing. There are sophisticated operating rooms. Gotta pay for them. Oncology, cardio, orthopedics, obstetrics… We have to have the best. But we have got to pay for them. Don’t forget the same is being done at two or three other hospitals across town.

One would think that competition would be could. No way. Rather than being a cost lowering piece we raise costs well above inflation. We have to make profits so we raise prices because nobody cares or checks. We can jam more procedures into a two day stay than you can shake a stick at.

Now enter the doctor. Now docs are wonderful people and many are friends at least until now. He is a traffic cop. He treats. He refers. He will prescribe tests, MRI’s and treatment. And don’t you dare question him. Sure you can seek a second opinion he says but you may die in the meantime. No one wants to be a GP because there is no money in it. Besides I want a specialty where I don’t have to work weekends or be on call.

Sounds cruel but you have to question someone who has a proprietary interest in an outpatient surgical suite, MRI machine or blood testing center. Ask the question next time. You will be shocked.

Enter the patient. If you have cancer it can be a daunting task just to get a straight answer about your odds. Docs and hospitals don’t like to talk about death. It is truly against their oath. The characterization of “death squads” really pissed me off. Sitting down with two or three specialists discussing your disease, your outcomes and treatments doesn’t sound scary to me.

I am not pulling plugs but I am trying to be rational. If it is profitable to keep me alive at all cost and no matter what my degeneration stage might be, then we have 65 million problems coming up real fast.

Today we don’t run hospitals for charity. If you are owned by a big corporation you have got to show profits. Fill those beds with paying customers. Show them the latest and greatest no matter what. But if you are an insurance company you cut this down to the bone. Fight them every inch of the way. But still you pay for all the overreach and if it is Medicare, bill them for anything. Oops, I put in the wrong code that changed that treatment from $500 to $10,000. Tylenol? Of course they are $14.73 per tablet.

We heal older people only to have them develop something else.

We don’t want to give up but it gets into the realm of the absurd. There was a 92 year old woman in final stages of cancer. She was being seen by 15 specialists, including a psychiatrist…..and she even has a Pabst Smear. I’d laugh if it wasn’t so sad.

It is said that 30% of our $2.5 trillion annual medical costs is wasted on unnecessary procedures. That is $750 BILLION. They say malpractice insurance and suits only account for 7% of medical costs. What was I thinking? That’s only $150 billion.

Once again I have nothing against medical professionals making money. But when the whole process is bloated by oversupply of facilities and machines there is something terribly wrong. We can see the heavy hand saying if you don’t do this you are going to die. I say if we keep doing this we are going to die any way.

As Always

Ted The Great

Factoid…sort of

Many of you know I work in hospice. I am there as people “pass on” as the new phraseology states. I asked one of the nurses if the person was not in hospice how long could they be kept alive on ventilators, feeding tubes etc? She said depending on the disease progression and treatment it could be anywhere from one month to over a year. I said “what about quality of life”?. There was no answer.

Medicare Fraud:

It is estimated that between $60-90 billion of Medicare costs are the result of fraud. Because of regulations to protect bona fide business owners many of those who defraud the government are back in business almost immediately or are not prosecuted because the staff members do not show up for hearings. I can’t make this stuff up.

Dateline: Denver …..Hick Governor Conquers all.

Here in Denver we have a governor by the unstately name of John Hickenlooper. Not to worry his appearance matches his name. In the eighties he was a geologist…got laid off. Became a developer. Then mayor of Denver. Now the top spot.

He is a strange one. He foregoes pomp for simplicity. Ties are worn only if they have to be. The governor’s mansion was vacated for his suburban home. He actually goes out without bodyguards. They are all attributes of living in a state of 5 million citizens and probably an equal number of livestock.

He went down in front of his capitol office last week to address the Wall Street protesters. They were on his front lawn so to speak. He didn’t yell or scream. He said they couldn’t stay there. Extolling the first amendment  he also simply stated that if the tent city burned down and killed people he was liable. Made perfect sense. They left.

But his down home diplomacy really hit home when Arrow Electronics, a Fortune 150 company decided to move from New York where they were founded to, you guessed it, Colorado. They are bringing 1500 employees.

The crazy part is how it came to be. Last May he assembled Arrow’s CEO, as well as  DaVita’s, Western Union’s and their wives at dinner…in his wonderful but simple house in Park Hill. There they sat in down home surroundings around the dinner table  and just talked about business as we all might on a Saturday night. No backdoor meetings. No falderall. Just talking.

We also got GE to build a $300 million solar panel facility in Aurora. My son in law who is in commercial real estate has a variety of deals either cooking or in the process of closing. I spoke with a wonderful young lady on Saturday who is in retail. Things are cooking. Twofold moral: Keep it simple east and left coast. The world is not coming to an end.

Are We Watching The Same Game?

The paper and pundits a week ago Friday described the market as a rally stalled. The market for the week was up about 700. On Friday it was down 30. Doesn‘t sound cataclysmic to me. Last week it kept climbing. We seem to be intent on giving nothing but bad news. As a readership we seem to gobble that up. Let the bad times roll.

Once again why do we get mired in sadness? Nothing like a four car fatal accident to spice up your evening. One mass murderer coming right up. Puppy mills. For desert let’s have Mitch, Harry and John and Barak come on stage as the Depression Ensemble doing Gloom and Doom in A minor. I am sticking with Hick.

Live and Let Die.

I speak of hospice. The other night I worked a shift at the Johnson Center in southeast Denver. We have 19 beds and a waiting list. Those amazing people were facing one of life’s progressions. For those that had family, they were at their sides. Some would probably go that night. Some would linger. They were all consenting adults.

I am not allowed to speak of specifics but suffice to say there were enough poignant moments to really get the tears going. Sometimes sad but always fulfilling. And in a crazy way a celebration of life.

The great part about the work is that you are really giving. It has nothing to do with you. You are a bit player and only if called upon. Our primary emphasis is on the patient. In every way he or she calls the shot. If they want you there that is cool. If not, you wait outside. You do not try to manage the situation. You are not a know it all. You are just there to serve.

The transient nature of hospice bespeaks life. I am always taken when I go back a week later to see rooms empty or with a new resident. The blackboard shifts like a lineup card in baseball. Life goes on. In a very surreal way it reminds me of a maternity ward. Women give birth. The family gathers around the bed to say hello. Here it is the end of the process we call life. We say good bye. We all love.

Travel

Kath and I are off for a bit but will I check in from time to time. I have stored up Ted’s Head. The great Megan Kane will transmit on Wednesdays and I hope it all works out okay. Thanks for listening. Thanks for reading. Most of all thanks for thinking. We need those creative juices going full bore.

As always

Ted The Great

Factoids:

Incredibly, hospice and other palliative care facilities were unheard of  anywhere in the world before the late 60’s. There are now over 10,000 programs.

Fully one third of people dying in the US last year took advantage of hospice. On that same note for some reason Canada makes hospice available to only 10% of their population. Not sure why but it is not taught in but a few nursing or medical schools there.

There is still a distinct disconnect when it comes to doctors discussing death with a patient. It could come from the Hippocratic Oath. It could come from the superman status attributed to doctors.They have egos and they have to while making instantaneous calls in many cases. It seems they have to grapple with the concept that they can do no more. It is counterintuitive.

Wow,  is there a lot of negativity in this man’s world. I have been reading a book by Tom Freidman “That Used To Be Us”. I know some of you will say “I know the gloom and doom he is writing” but wait. I love to read him because as TTG tries to do, he’s a pragmatic thinker. I don’t think he is being a downer but rather providing practical solutions to things. And he tells it like it is.

Several years ago Freidman really caught my eye on a special on PBS. He spent two weeks on either side of the wall in Israel. He listened and provoked discussion of everyday people from either flank. He found faults and strong points for both sides. He is a Jew. Ditto David Brooks. Their beliefs don’t prevent them from thinking clearly and without apparent bias. They say yes.

After detailing the world and peril we live in, Freidman says the way out is using the three C’s: Creativity/Critical Thinking, Communication and Collaboration. I really focused on the Creativity side.

Just for a moment think about our world and probably specifically you and I. We all have great ideas. We can look at the simplest of things and see possibly a way to do them better. You know “If only…” but it stops there. We are too busy or worse yet we are afraid to get dumped on.

Rejection and fear of failure sucks. Ridicule is worse. But how often in our day do we see that? Take politics. Well we can’t raise taxes. No. No. Don’t touch entitlements. No way. We can’t take out loopholes. I won’t get reelected.  And the beat goes on. Simpson Bowles was a great blueprint to solve the debt crisis but nobody even looked at it before it was shot down.

Think about our kids. We normally have two reactions. Do it my way and be careful you don’t go out on that ledge. Granted we want to protect them and yeah probably keep them in line but what are we really doing? Stifling original thoughts. You know when I was your age… We are  so afraid to let them fail. To be scarred.  But that is really the only way they can learn.

Schools today with their emphasis on testing never consider there could be another answer to the question. Just regurgitate back to me what I have told you. That is the right answer. Did I hear this week that Einstein’s Theory of Relativity might be in doubt? I am not a rocket scientist but that doesn’t keep me from trying another way.

I had a couple conversations this week. One with a mother and the other a manger of sorts. When I posed something new they were either doubtful or dismissive. I just imagined if I was one of their kids or employees. Ugh!

Going on with the book it became apparent that the “New Normal” was going to reward those who can think outside of the box. It was that creativity and critical thinking that couldn’t be done by a machine or the masses, which would engender value added and ergo higher return.

Here’s my try. We have 42,000 miles of interstate highways in the U.S.. We have enormous supplies of natural gas. What if we put a natural gas station every 50 or so miles on those biways? Even if we had to build them from scratch let’s say it would be $50 billion. One time cost. The nations trucking business consumes 54 billion gallons of fuel a year. Instead of oil from Arabia what if that was gas from the U.S.?

Now quickly test yourself. Did you say there is no way that will ever work or hey, maybe that’s a good idea. Let’s hear more. Did you take the idea and run with it a bit or just dismiss it? Don’t worry about me. I gave up being sensitive a long time ago.

What about all you geniuses out there? What about your kids? Please don’t tell me you are too busy. Just look around for simple things. Send them back and we will get you press time to the hardy souls that read this. Most importantly just get that great mind of your going. Creativity is looking at the ordinary and seeing the extraordinary.

One other chat I had this week was with a wonderful young man. He is smart and industrious. When I tried to engage him in my ruminations about the state of our country he begged off. As a matter of fact I think he was telling me in a polite way to bug off.

I got it but I wondered if his dislike of engagement was personal or endemic of a larger malaise. Get in your own foxhole. Forget about the rest of the world. Somehow I wanted to enable him. I wanted to tap into his ideas. I wanted to say yes. Maybe that is just me.

As always

Ted The Great

Factoids:

There are 15.5 million trucks in the U.S. Almost 4 million are tractor trailers.

UPS is the largest trucking company in the U.S. There are actually 500,000 companies overall. They all pay $21.5 billion in road taxes.

Google Creativity. There are 186,000.000 results.

PBS has a great show called “Everyday Edisons”. Have your kids watch it.

Da Vinci drew detailed sketches submarines, helicopters, parachutes, crossbows etc. In the 16^th century JUST SAY YES

Dear Barak, John, Mitch ,Harry etal.

My salutation speaks not to a lack of respect but to remind you from the start you are just one of us. I went to school in Washington and saw the pomp and circumstance in all its glory. It was not earned then. It is far from earned now.

The country is so tired and so frustrated. We need leaders. We need states people. The charade of speeches to empty houses, press conferences with all the resident thugs standing behind this one or that or the prospect of another presidential address just throw gasoline on the fires of our discontent.

With regard to the budget and deficit why is it so apparent to us and unfathomable by all of you ? We know taxes have to go up. On income. On gasoline. On a lot of things. The code has to be simplified and loopholes closed. Just deal with it. We already have.

As for Social Security there are two steps that can be taken immediately. First is to raise the age of retirement to 67 and 69 in 2040 and 2050 respectively. That’s 30 and 40 years from now. Actuarial charts alone show this to be long overdue. Secondly, raise the maximum salary for FICA to infinity. Forget AARP. This will clean up this mess in a hurry.

The major piece that is going to break us is healthcare. Medicare, Medicaid, prescription drug benefits, donut holes, fraud have not been addressed. Means testing is a reality not a third rail. Obamacare does nothing to address costs. These are pieces that are incredibly broken and you all stare at them like  red headed stepchildren.

The wars we have fought are ill gotten. They never should have happened but they did. And many of those votes took place on many of your watches. Let’s just get out and move on. The only people they served well were the tribal leaders and the military industrial complex. Incredibly we paid them all with our hard earned dollars and they funneled that money right back to so many of you with their lobbying and money.

Our alliance with Israel is an albatross around our necks. That is not anti semitic. It is a pragmatic observation. They should be protected but not spoiled. Both sides have been brats and fools. And it goes on.

We cried out for the Arab Spring and yet we want it only on our terms. We lambaste Iran and we should. But look the other way at Israel’s possession of atomic weaponry. Saudi Arabia? Syria? Where is our outrage? We have played chess in the Middle East for ten years with our wealth and our sons and daughters as the pawns. The rest of the world has made hay.

We should cut our defense budget. Yes, we should go with a lean, well trained force instead of brute force. Carrier groups and forward bases are a thing of the past. Get out of Germany, South Korea and Japan. 25,000 elite forces with drone support could do more damage to Al Quaeda than all of those poor devils we put up as IED fodder and propaganda.

It’s not the regulations that are holding back our economy. It’s lending and attitude. The banks aren’t out of money. The eight top banks control 80% of our dollar holdings. They borrow from the Fed at 0%. They refuse to lend. Why should they? Most of the top eight banks obtain  a bulk of their profits from trading.

I talk to regular Americans. Times are tough but they are making do. Sure they have cut back but they get it. Have you? They want to get better but the daily litany of petty fighting and childish back and forth has led them to believe you all have no intention of doing anything. You want to wait until the next election. That in case you haven’t realized is 16 months away from swearing in. Do you really think we have that long?

I could go on but what is the use? There are no miracle pills. There are no warm fuzzies. We are not going back whence we have come. It is sad but true. But all of you don’t get the new normal. You are cloaked in denial. The first thing an alcoholic has to do is admit he or she has got a problem. None of you have.

My daughter asked me today if any of you get it? I couldn’t name a one. I am apolitical and I mean it. I hope I speak for many Americans are not the lunatic fringes. We know the road ahead. Yours seem to be paved with outdated principles and warped realities. How incredibly sad.

Sincerely yours

Ted Kenny

Factoids:

2011 House schedule, 112^th Congress

Jan.29 – Feb. 6, constituent work week

Feb. 19 – 27, constituent work week

March 19 – 27, constituent work week

April 16 to May 1, spring recess

May 14 – 22, constituent work week

May 30, Memorial Day

June 4 – 12, constituent work week

June 25 – July 5, constituent work plus Independence Day

July 16 – 24, constituent work week

Aug. 6 – Sept. 5, August recess, with Labor Day

Sept. 24 – Oct. 2, constituent work week

Oct. 10, Columbus Day

Oct. 15 – Oct. 23 constituent work week

Nov. 5 – 13, constituent work week, including Veterans Day

Nov. 19 – 27, constituent work week

Nov. 24 – 27, Thanksgiving

Dec. 8, target for adjournment

With everything needing immediate attention the boys and girls you and I elected have 145 out of a possible 312 days off.

Harry Reid and John Boehner have found it impossible to allot any time to discuss and vote on the jobs bill.

There are approximately 1,515 bills introduced in the Senate and 2,830 in the House this session. See  http://www.opencongress.org/bill/all