Mortgage meltdown or medicine meltdown?

As we enter the final phases of the election cycle you can get a good idea of the spoils of big government just by looking at the rhetoric in the campaign.

Clearly, one issue is dominating the election this fall: the economy, and more specifically the lack of jobs.

So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don't necessarily have the answers, but I'm real good at asking questions.

Did government assisted mortgages help the economy? Certainly by artificially lowering mortgage rates and the creation of investor owned, government back sub-prime mortgage equities, the federal system of assistance in home buying has become the norm.

But given the meltdown in the mortgage industry, did we do a service to Americans by putting people in homes they couldn't afford? Flipping houses became the source for a evening cable television show and the folly of many particularly young home buyers.

As liquidity in the mortgage market disappeared so did the dreams and savings of many Americans -- including those that had invested in the "government" back equities of Fannie Mae and Freddie Mac.

Is government funded healthcare going to be beneficial for our country in the long term? Just like mortgages, are we going to put our country into a health system they can't afford?

Out current federal health legislation creates "coverage" for 85% of our citizens, but does nothing to promote access to care or an improvement in health care choices.

The latter is particularly concerning.

Regardless of the life style choices one makes, there is a guarantee of coverage. There certainly needed to be an improvement in health care services for the uninsured, and there needed to be some limitations on the growth in spending, but wouldn't it have been better to put incentives on the user?

The real question becomes: will we be facing a health care meltdown just like the mortgage industry? As the requirements for health care services rise, there being no limitations on cost, and no impediments to limiting health care decisions, can the system continue to function?

The biggest concern here is whether physicians and other health care industry providers (pharmaceutical companies, insurance companies, hospitals) can continue to function in an economic environment of continued declining reimbursement for services.

This is especially true given the proposed 23%+ cut in Medicare rates next month with more to follow in January.

Will there be a decline in health care liquidity?

Physicians and other health care providers may find themselves in a situation much like the mortgage industry: servicing consumers with health care services they and the government really can't afford.

I guess the real question is will there be a foreclosure on your new sub-prime health coverage?



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Obamacare - You want fries with that?

A recent article in the Wall Street Journal and the followup editorial concerning McDonald's decision to consider ending health care coverage for its work force has sparked controversy.

But it is a very compelling message.

Obamacare, or more correctly, the new federal health legislation passed in the spring by the Democratic Congress, promised to "keep your current health coverage intact."

But as the law goes into effect, it is confirming what we pundits have been screaming from the beginning: it will impact everyone in America.

Read: everyone. From the uninsured (which hopefully will see expanded coverage but still be challenged with with limited access) to tax payers to small business and yes, to physicians, everyone will see an impact.

And it will vary from the potential double digit increases on private indemnity insurance for those 25 year old new entrepreneurs to the seemingly bizarre requirement that small business owners will now have to issue thousands of additional 1099 forms to virtually every vendor they purchase products or services from.

So for McDonald's to be considering eliminating health care coverage may not come as a surprise. Now before my faithful readers start sending me emails about "how these were minimum benefit plans" and "these workers deserve better care," let me preempt you.

McDonald's offers ground level employment for thousands of young people -- and many part time workers. So for them to be offering any health care benefits to begin with was extraordinary.

And now to have them being forced to either enrich the plan with added benefits and cost, or abandon their current entry level health benefit structure is an example of how they too will be impacted by the legislation.

But for all the bad that has been said about the federal health regulations, the most chilling concern that I have is that at the end of the day despite the super-sized money and new statues that have been created -- we may not see an improvement in the access and quality of care.

There is no value meal here.

Texnology? -- Technology at Texas Dermatology

Technology invades our lives and our medical practice at Texas Dermatology is no exception. Over the last two years we have been on an aggressive campaign to upgrade our practice to include replacing virtually all of our hardware to create a paperless clinical environment.

We use a "cloud based" web software environment to handle all aspects of the clinical encounter from scheduling, checking on insurance eligibility, recording information in an electronic health record, and billing. It surprises many patients to learn that we use data centers all over the world to help us sort and keep track of clinical information. This allows us to rapidly, securely, and accurately file the thousands of pieces of data that are received by our practice every day.

One of the things I'm most proud of is our electronic prescribing rate. We only hand write a handful of prescriptions every month. Instead we send prescriptions to pharmacies directly which allows for patient convenience (its usually ready when they drive to pick it up!) and safety because we can cross check medications against both allergies and potential drug interactions. Refills are also automated and usually have a turn around time of less than an hour after the patient calls the pharmacy during business hours.

We hope that by the end of the year we will have a patient portal active which will allow patients access to some of their account and clinical information, scheduling, and even to submit and receive answers to their health questions.

So what would be the logical next step? A television studio of course.

Yes, its hard to believe but we have just completed construction of a state of the art broadcast studio in our Dallas office. Located in the "green room", we have lights, cameras, and action! We wouldn't have been able to do this project without the great folks at Dallas-based VideoTech and video genius Daryl Newman. He outfitted us with microphones, two broadcast quality cameras, and multiple cool LED lights -- as well as a some instruction!

But the heart of the system is a device from the San Antonio company NewTech. Its called a Tricaster and is sold as a "studio in a box" and that probably describes it well. We are able to mix multiple video inputs, internet feeds from remote broadcasts like Skype, and even local DVD video to make really cool live or recorded productions.

But probably the most exciting thing the device can do is to create "virtual sets". This is where we can use computer generated graphics to change the look and feel of the studio from a news room type environment to an auditorium for a PowerPoint presentation.

Why did we do this? We think it will add to the mission of our practice in communicating information to our patients and to that of our educational program and residency program.

Stay tuned to our website -- www.texasderm.com -- for more details as the project unfolds.


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Location:Kona, HI