ACA Can Be Very “Painful”

The issue of replacing health insurance coverage that many liked and used with an ACA “acceptable” plan continues to be painful for many. They often lose doctors they have used for years, and the new plan often becomes more costly. See this excellent article in the New York

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Statehouse Trumps City Hall

Governor Cuomo came out yesterday with a strong endorsement of New York City charter schools. He was responding to a 10,000 plus demonstration of charter school parents and students and against the much smaller union organized rally.

Perhaps fairness will reign in this ongoing battle that appears to be union organizers and supporters vs. concerned parents and corporate funding for better education.

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Filed under Children, Education, Governance of the Government, New York City

Two Enemies of Good Government

Ideologues and Political Rhetoric without Action

Good governing only comes with compromise, and ideologues seem to lack the common sense that they can’t prevail at all times.  Simply stated they are incapable of compromise.  Rhetoric without action can be worse since nothing is there to be discussed, modified and ultimately agreed.  Great pronouncement speeches are soon forgotten without the requisite follow through of action.

We have all witnessed these two shortcomings in our politicians, and unfortunately our well-intended new Mayor of New York seems to embrace both.  His Pre-K stance on tax the rich as the only path to offering universal Pre K even though the state has offered to fund it, is an excellent example of an ideologue that refuses to compromise, even when he is getting most of what he wants. He then goes on to embrace the second failing of rhetoric without action by announcing multiple projects and trashing existing ones without any specific plans to launch or improve them.  Take your pick, a rejuvenated Sandy, a “reset” of mid-town zoning, specifics on Pre-K, etc.

I for one am also tired of hearing the new mayor was elected with a 73% mandate.  Let’s take a quick look at those pesky facts:  There are 4.6 million registered voters in New York City.  Only 1.02 million actually voted which is only 22.2 % of eligible voters.  Of this 22.2 percent he did receive 73% of the vote.  This translates, mathematically and factually into 16.3 % of the vote of New York City voters…hardly a mandate.

However, it was clearly a mandate by the unions of New York City.  If 75% of the 300,000 union members of NYC voted for DeBlasio and their partner/spouse also voted for him, along with one parent or parent-in-law, that group alone would have accounted for almost the entire vote he received.  And, let’s not forget, union members are democrats, they vote regularly, and the new Mayor was promising retroactive pay increases.  They totally supported him and if the truth were known, single handedly, elected him. This calculation would leave 3.0 million registered voters who did not cast a vote (shame on them) and gave the Mayor his often-stated “mandate”.

The mayor must start delivering.  Compromise on the Pre-K, and you’ll be lauded and known as the Mayor who gave everyone Pre-K not the Mayor who compromised away his tax increase.  Release specifics on projects and “resets” that make sense and then follow through.

And, a few more thoughts Mr. Mayor.  Those nasty one-percenters are at their desk in the financial district long before your first meeting is scheduled and they show up on time, each and every day.  They are not 40 to 60 minutes late for their scheduled meeting and certainly not for their first of the day.  You’d be surprised to see how active the “street” is at 6AM or 7AM each morning.  Try getting up one morning and checking it out.  You’ll find the “other city” you often refer to up and working very hard long before you’ve had your first cup of coffee.

And above all, don’t become the Mayor Ed Koch spoke of in his memorable words:  “The people have spoken…and now they must be punished”

Good Luck Mr. Mayor.  Everyone really does want you to succeed, as that would be best for the city we all love.  But, you’ll have to get up early, show up on time and avoid the two enemies of good government.



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Filed under Governance of the Government, New York City, Politics

Charter Schools Under Attack…

What conceivable reasons are there for charter schools in NYC to be attacked other than to protect the teacher’s union?

Many of us have followed the plight of NYC Charter Schools.  They are under a vicious attack with the intention of eliminating them entirely.  How, buy kicking them out of school buildings they currently share, reversing Bloomberg era decisions to place new ones, taking away a quarter of a billion of capital funds dedicated to them and any other way Mayor DeBlasio and his band of merry men and women who have just taken office can conjure up.

These charter schools have improved children’s lives, provided an education most were not receiving in the NYC public school system, and encouraged them to become outstanding members of the community.

I defy anyone to provide a logical and realistic reason as to why the mayor and his friends are taking this position other than to please the teacher’s union.  Why?  There simply isn’t any other reason.



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Affordable Care Act… the Real Problem


We have estimated 40 to 60 million uninsured Americans for the last several decades.  The last available estimate in 2012 was 47.0 million.  It is commonly believed this group has not received routine health care, and has swarmed hospital emergency rooms and overwhelmed the system with acute health care needs.  This is all true… to a very small degree, and most importantly this main objective of the ACA remains unresolved.


The numbers coming in for the ACA enrollment clearly reflect a shift of previously insured parties to new insurance plans in the ACA.  This shift does nothing to resolve the uninsured problem; and won’t in the near or far term unless the plan is dramatically altered.


The almost accidental positives of ACA include no limit health care, removing pre-existing conditions, offering guaranteed issue to all, and extending coverage for aging dependent children.  The guaranteed issue comes with the cost of the myriad of extremely confusing state and federal plans.  There were far easier ways of accomplishing these offerings, none of which were used because of the administrations unilateral approach to the legislation.


The vast majority of participants in the new plans come from previous individual policy insured’s who were forced to change because their policy was canceled; or from Medicaid eligible individuals.  It is now clear the previous multi-millions of uninsured have not flocked to the new plans and probably will not do so.  Yes, the 47 million uninsured will be reduced, but probably only by a small percentage.  We will be left with some 30+ million uninsured and a revised health care financing system that will take years to sort out and modify in order to get it to run smoothly.


And, one of the dirty little truths is this large and hardly changed uninsured group will continue to visit ER’s but for an entirely different reason than once believed.


If you are sick and need to see a doctor and you don’t have a primary care physician, I would challenge you to A)  Fine one, and more importantly B) Find one that will see you right now to treat your acute medical issue, not in four or six weeks.  Studies are reflecting the fact that sick people seek medical care in the ER because they cannot see a doctor without waiting days or often times weeks…far too long for someone who is sick and hurting.

And, Medicaid is simply not the answer.  In fact, the Annals of Emergency Medicine published a survey that reflects this startling fact…61% of Medicaid patients visited the ER in the previous year.


Even those Medicaid patients who have primary care physicians — and that is less likely than for people with private insurance — report significant barriers to seeing their doctor.” senior study author Dr. Adit Ginde, of the University of Colorado School of Medicine, said in a journal news release.


“Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall,” Ginde added. “But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all.”


“The efforts by some states to keep Medicaid patients out of the ER do not take this lack of access to primary care into account,” Dr. David Seaberg, president of the American College of Emergency Physicians, said in the news release. “It puts both patients and providers into an impossible position that will only get worse as more people enroll in Medicaid.”


The real problem with healthcare in the U.S. is a drastic lack of primary care health providers and the ACA does absolutely nothing to help resolve this issue.  Further, it does almost nothing to reduce costs in this fee for service industry.


We can offer many suggestions on how the ACA should have been structured, but that won’t be constructive.  But, here are a few suggestions for reforming the ACA and making it more viable:


  • Immediately launch new educational programs outside the purview of the AMA for educating and training new primary care physicians.  Federally fund it by expanding the National Health Service Corps program to include urban areas.
  • Pass federal legislation empowering Physician Assistants and Nurse Practitioners to provide the basic functions of the primary care physician unfettered from the overly protective AMA guidelines and various state legislatures.  This will free up many primary care doctors to handle the more complex levels of treatment needed.
  • Federalize Medicaid and simply make it a part of Medicare…which would remove the hurdles to care and the stigma of being poor or unemployed.
  • Fund the Medicare system so healthcare providers at all levels will accept it and earn a well-deserved living for their many years of education and training they have invested;
  • Accomplish what has been threatened by every Congress since LBJ. REALLY get rid of fraud and waste without the accompanying silliness that drives providers crazy, wastes their time and doesn’t reduce costs or improve the system.
  • And yes, pass tort reform to protect both the patient and the system;


The problem of reform is extremely difficult if not impossible in the current political environment.  The unilateral approach to passing the initial legislation has led to the most cantankerous atmosphere not seen before in politics.  There is virtually no hope of cleaning up the ACA at the moment.  Perhaps our “best shot” is a one party takeover of the congress and their best effort to “save” health care by making some the much needed and obvious changes.   I honestly believe if either party had complete power, they would make the necessary changes, but the current split will simply not allow it.


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Filed under Healthcare, Politics

Musings of a Politically Independent Healthcare Consultant

Welcome to my Blog.

I created this blog to offer my opinion on a variety of subjects.  My areas of interest include politics, healthcare, New York City, fairness, diversity and a desire to help the needy and protect our children.  I do have opinions. I will express them, some will agree and others will not.  My purpose is two-fold:  express myself and instigate a dialogue.  I hope you enjoy my comments even though you may not agree.

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Filed under Children, Diversity, General, Healthcare, New York City, Politics