Physicians Are Eagles Who Believe They Are Chickens


There are 800,000 physicians in America and more than 65% believe the Maintenance of Certification process, known as MOC, has no clinical value for patients.  For the first time in the history of our profession, physicians have a fighting chance to topple a Goliath-esque organization, the American Board of Medical Specialties. 

In a 2018 survey conducted by Merritt-Hawkins, 78 percent of physicians said they experience some symptoms of professional burnout. Physician burnout is a public health crisis which threatens the health and well-being of all patients. 

A burned-out physician reminds me of the fable about an eagle who believed he was a chicken.  When the eagle was small, he fell from his nest.  A chicken farmer found the eagle, brought him to his farm, and raised him in the chicken coop with his chickens. The eagle grew up living like a chicken, doing what chickens do, and believing he was, indeed, a chicken. 

One day, a visitor came to the farm and was surprised to see an eagle –considered the king of the sky– strutting around the chicken coop, pecking at the ground, and acting like a chicken. The farmer explained that this bird was no longer an eagle, instead he was a chicken because he was trained to be a chicken. 

The man knew there was more to this great bird than “pretending” to be a chicken. He was born an eagle and had the heart of an eagle, and nothing could change that. The man lifted the eagle onto the fence surrounding the chicken coop and said, “Thou art an eagle. Stretch thy wings and fly.” The eagle looked at the man and glanced down at his home among the chickens in the chicken coop where he was comfortable.  He jumped down off the fence and did what chickens do.

The visitor asked the farmer to let him try one last time.

Medicare For All
is Completely Impossible, a Crazy Idea.
Unless You Do These Things …


Medicare For All — or any other way of covering everybody in the U.S. — is impossible. Unless we could do it for less, way less, than healthcare costs us today.

But that we can do. That’s the good news.

People assume that covering everyone will cost vastly more. Billionaire Michael Bloomberg said the other day that it would bankrupt America for a long time. Like Venezuela, he said. You want that?

No, they do more than assume it will cost vastly more. People insist. They get really mad about it. There are lots of ways to get called names online, this is one. One person actually told me recently that even talking about the possibility that we can do healthcare for much less is immoral; they call it lying, that it’s some part of a bait-and-switch chicanery to even talk about the possibility.

It’s apparently easy to go nuts on a subject like this.

The Red Pill moment

But imagine what if for a moment with me. Imagine covering everyone, taking care of everyone—and it costing less than what we pay today. Less for the government, less for employers, less for you. Way less. Half or less.

How could that be possible? This is really kind of a red pill moment. Because once I lay this out for you, you really can’t un-see it. You won’t be able to go back to the usual way we see this debate.

Some of this will be familiar to regular readers, but hold with me for a moment while I lay it out for the people in the back there, the ones who just came in.

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The AMA Is Using Its Government-Granted Healthcare Data Monopoly to Power a Sketchy New Commercial Venture



Like many academic institutions and non-profits these days, the American Medical Association (AMA) decided not long ago to get into the innovation business, launching Health 2047, a new for-profit Silicon Valley-style venture innovation incubator.

One of the AMA’s first new ventures is Akiri, a blockchain-enabled data transmitting and sharing network built to efficiently transmit the data the AMA owns among patients, physicians, and health systems. According to a news brief filed at the time, Akiri’s data transmission network includes health information exchanges, and will allow the personal health records of patients to be transmitted. [1]

What most people don’t know is that Congress effectively granted the AMA a monopoly on healthcare data back in the sixties.

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The Electronic Medical Mess


I posted a quick tweet about this a few months ago:

Over the years, I’ve worked with at least half a dozen projects where earnest, intelligent, diligent folks have tried to unlock the potential stored in mid to large scale batches of electronic medical records. In every case, without exception, we have wound up tearing our hair and rending our garments over the abysmal state of the data and the challenges in getting access to it at all. It is discordant, incomplete, and frequently just plain-old incorrect.

I claim that this is the result of structural incentives in the business of medicine.

What is a Medical Record?

Years ago the medical record was how physicians communicated amongst themselves. The “clinical narrative” was a series of notes written by a primary care physician, punctuated by requests for information and answers from specialists. Physicians operated with an assumption of privacy in these notes, since patients didn’t generally ask to see them. Of course they were still careful with what they wrote. If things went sideways, those notes might wind up being read aloud in front of a judge and jury.

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Q: How Do You Build a “Great Party of Healthcare?”
A: Build a Party of Doctors


The narrative goes like this:

The Democrats are the party of healthcare. The Republicans are the party that wants to take healthcare away from people. Dismantle the Affordable Care Act and we’ll have a disaster on our hands, millions will lose their healthcare coverage, middle class Americans will go bankrupt, the World will end

All this political propaganda ignores a fact that physicians have understood for some time now:   For doctors and millions of Americans, Obamacare already is a *total and unmitigated disaster*. From opening day when the administration’s web site symbolically blew up, it was clear that things weren’t going to be going according to plan.

Giving millions of people access to healthcare was a great thing and long overdue. But kowtowing to health insurers and pharmaceutical companies, obsessing about centralization, and endless digital paperwork all but guaranteed an epic fail.

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