THE BUMBLING COLOSSUS  By Henry F. Field                                              
The Regulatory State vs. the Citizen; How Good Intentions Fail and the Example of Health Care;
                                  A New Progressive's Guide    
  (available at amazon.com)
A Conversation on Rising Costs Leads to A Short Overview of Our Health Care Dilemma addressed in "The Bumbling Colossus"

“The Bumbling Colossus” in Brief: A Conversation with Doctors and a Health Care Leader on their Response to Rising Costs and What To Do

This interchange was sparked by January 2013 articles in the Wall Street Journal and N Y Times on sharp increases in health premiums in early 2013 in anticipation of the increased costs and uncertainties created by ObamaCare’s new mandates (a doubling in some cases).

Dr. Charles Hamlin, MD
Jan 9 (8 days ago)
to meDaveJamie
Hi Friends .  I was drawn to an article a couple of days ago in
the Times about private, for profit insurance companies rate
increases in California. And then again today, the lead article
in the business section, "Health Care And Profits. A Poor Mix."  I attach these.  To you wise men, what do you think?  

I looked again at Henry's book, and I think sadly, Henry has
come to 
some wrong conclusions on solving this mess.  
Though Americans don't 
particularly like government, they
DO want government to oversee, monitor 
and subsidize
health care.  And this  stands way ahead of military spending 
and protection.  We must run this "Bumbling C" and get it
under control.  The private, capitalist system seeks just the
opposite from what we need - profit as opposed to control of
costs.  Hell, in 24 months I might pay $2400. not what I paid 8
months ago, for a $75 dollar knee brace made in?  -  listed at
$1600, reduced to $750, my co-pay $135.  Americans are
unprepared and unqualified to be consumer savvy about
total knees and surgeons, or chemotherapy.  They can barely
make cogent decisions about an automobile.   Harrumph from the
slow-witted member of the clan. 

henry field 
Jan 11 (6 days ago)
to charles
charlie, w
e agree on costs, and soon everyone will too. The $64 Q is, what is the
best way to go from here?  The NY Times wants us to proceed down the same
failed regulatory road that has brought on the crisis and will lead us to reduced
services and concealed cost explosions in taxes. Doctor incomes will have to
shrink dramatically. Innovation in drugs and services will atrophy. The casualties
and harms to all of a centralized, bureaucratized system will mount.

All this is the experience around the world. It is not some secret. For decades we
have pooh-poohed costs in the name of expanding coverage to all, but the trade-
offs are unpleasant. As the Brit government recently said in recognizing the failure
of their famed national health service and seeking changes to open it up to market
and "patient power", "There is simply no more money." We don't want to go down
that path. A new way needs to be thought through and leadership provided. That is
what TBC is all about.

Instead of "Profits and Health Care Don't Mix", the N.Y. Times could have done a
different story labeled "Not-For-Profits and Health Care Don't Mix".  In TBC Ch 1, I
relate the 2010 events where we in Massachusetts enjoyed a huge jump in health
costs -- all from not-for-profit insurers!  And as TBC's Ch IX points out, we also
enjoy (with RomneyCare) the fastest acceleration in costs in the nation. 

Removing the profit motive in a competitive environment simply removes the
most powerful driver seeking to lower costs while also satisfying customers
(patients). Take Wal-Mart. Why not make it a non-profit -- a lot of poor folks use
it and buy a lot of things they hardly know anything about. Why can it have
"everyday low prices" ("low cost") while being also profit-seeking? Why not
make Merck and Pfizer into not-for-profits? (and watch research and innovation,
and new drugs, atrophy). People reading these stories react as Charlie did -- oh my
god, let's have government take it over. Single-payer is a short step away and few
recognize the harms looming (spelled out in TBC's Ch III). 

It is another example of wishful thinking leading to worse outcomes. I love Harold
Demsetz' stuff in TBC's Ch VIII describing "the Nirvana Approach", where failures
and shortcomings of an existing system are decried and an ideal state
(usually an omniscient government regulator) urged instead. This of course is
unreal and leads to folly and harms. Much of our "best health policy experts" and
journalists display this constantly in their writings and thought. I tried in TBC to
reveal this (TBC at 28-30 for example), explain its fallacy, and move on to a more
fruitful approach to achieve our common objectives.

Starting at TBC p 80 is my effort to address your Q re our incompetence on health
matters. I am also incompetent re computers, cars, internet, stocks and bonds
(although I run my own portfolio), engines (I am trying to buy a replacement diesel
for my boat), cooking, nutrition, tennis (although I play at it 2x per week),
social relations, marketing books, will and trusts (although I just redid mine), rental
and foreclosure (helping out a friend), and just about everything around here. Even
where we are trained professionals if you move us over an inch or two we quickly
get over our heads. In all of this we rely on trusted advice from others. Is health
care different? It never used to be. Should government regulate all these? Cuba
does. How are the people faring? (see TBC at pg. 103). Last I looked there aren't
any lines waiting to get into Cuba and a lot of folks trying to get out (like E. Europe
under the Soviets). 


On Jan 14, 2013, James McLane wrote:

I am traveling and talking to health insurance people & hospitals
the last few weeks. This article [on rapid cost escalation] captures
exactly what going on; plus insurers are pricing high now to build
capital for a quite uncertain future re risk and payouts. Plus, the
merging of hospitals has given them the negotiating leverage to
raise rates much higher.
 
Lastly, paying for each process rather than an overall procedure
like one price for a knee replacement and everything involved
including rehab just encourages more and more processes.

Jamie



From: Dr. Charles Hamlin, MD         January 14, 2013
 


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to James, me, David, re WSJ piece on sharp jump in health insurance premiums

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Quite scary if true.    If indeed the "inflation" rate has been about 9% per year, a good argument for the single payer theory.  Intermediate/long solution under one roof.  Broad market based systems have failed.  Good thoughts, Jamie on the complexity of the problem.


From: Henry Field

To: Dr Charles Hamlin, Dr Dave Simmons, Mr. James McLain, email 1/15/2013

Hi Charlie:

If brevity is the soul of wit, as the bard proclaimed, then your few-word summary is a riot (and what follows here is a lugubrious drudge). Nonetheless, it tickles a response. 

For starters, I am surprised by your assertion that broad market based systems have failed and that the solution to costs lies in single-payer. This has me wondering what you know I don't, or what I am missing.

Failed Market-Based Systems?  If by failed market based systems you are referring to our present employment-based group coverage and Medicare/Medicaid, as the book points out (TBC at 69-75) the driver of exploding costs is the distortions to the market caused by the WWII tax policy inadvertently encouraging employer-based group coverage, compounded by the (perhaps well-meaning) accumulation of state and recently federal mandates expanding required pools. The article I sent from the WSJ points out that it is insurers trying to cover their (increased) costs due to these mandates which we are now seeing. Instead, had the market been allowed to continue to prevail (in the absence of these regulatory distortions), people would buy their own coverage with higher net incomes (TBC at 70-71) and would be sensitive to costs -- how much they pay and what they get for it (TBC at 66, 80-82). Insurers would be free (which today they are not) to offer many types of coverage tailored to individual circumstances. Instead, today no one has this choice, so no one cares because they have been lulled into believing someone else is picking up the tab (the free lunch). The cruel joke is, it's themselves, in higher premiums and taxes. (TBC at 69-83).

The mandate biggies which ObamaCare brought in are community rating and guaranteed issue. TBC at 60-64 describes the known devastating adverse effects of these, yet Congress and the Administration plowed on. The ostensible reason for this was the % of uncovered, but as the book points out (TBC at 64-66), these folks are largely not poor. To make everyone's life harder and worse off on behalf of this group hardly makes sense. To raise the coverage universe from 83-85% to 93% (a 10% gain) -- leaving some 35 million still uncovered -- and creating a cost nightmare on everyone else just to achieve this half a loaf, should not appeal to anyone, particularly not a politician not hiding behind some truth-hiding electoral fog generator.

So our present system hardly fits your assertion of failed market based systems. Just the opposite. It is intrusive government regulation which has brought us to this point.

The book points out that the drafters of ObamaCare knew (or should have known) all this yet went ahead anyway, probably in the cynical belief that exactly the cost explosion we are seeing would occur, and because people are uninformed, they can easily be manipulated into concluding, as you did, that maybe the only escape is single-payer -- which is what many behind the Act wanted to begin with but couldn't politically pull off (TBC at 58-60). This conclusion is based upon 1) the inevitable economic consequences of the law and 2) their expressed preference for single-payer to start with (TBC at 60, fn 40). 

Is Single-Payer the Answer?  So this leaves us in quite a mess and leads to the Q, where do we go from here? The two alternative directions are 1) single-payer, and 2) change the law to allow reintroduction of market forces promoting individual choice and control. Single-payer would be great ("under one roof", as you put it) if it proves to have greater advantages than disadvantages. Those tantalized by single-payer should know that we have a lot of experience around the world with it, and careful observers conclude that the gain in equality (universal coverage) is far outweighed for all but the rich and powerful (who figure out how to get advantages anyway) by the costs -- to the public in increased taxation crowding out every other public priority, to the patient in "rationing by wait list" and decreased access to new technology, treatments and drugs (deteriorated service) , to doctors and other health professionals in lower incomes and less fun in practice (too much practice to the rules, high patient volumes, and degrading of the doctor-patient relationship). All this is spelled out at TBC, Ch III. The flight of doctors from Canada's health paradise for example is quite dramatic (TBC at 109). These effects are not mysteries or improbabilities; they are easily predictable based on simple economic theory.

Chapter III starting at p 89 sets out the evidence and arguments both for and against single-payer and analyses the core arguments single-payer advocates make. The case falls short. We don't want to go there. The book (TBC at 104-111) describes how the Brits are trying to reintroduce the market (individual choice) into the NHS because they ran out of money (taxpayers finally could take it no more) and conditions for doctors and patients degenerated to the point, felt by most every ordinary Brit, something had to be done. The Canadians, with a newer system, are reaching the same conclusion because they are experiencing the same kinds of degeneration too (TBC at 108-111), and are starting to try to reintroduce individual empowerment. But "all under one roof" systems, once in place, have a life of their own and create a "damn the people" attitude (TBC at 104-107), due largely to vested interests and perpetuation of myths about the virtues of equality and the false terrors of "cowboy capitalism" (TBC at 108-118).

The Failure of Intrusive Regulation   As noted, these conditions were eminently predictable. Look beyond health care itself to other industries or groups of industries where intrusive regulatory regimes were set up in the often well-intentioned belief they would eliminate perceived abuse and unfairness in markets. Careful observers over especially the last 60 years have found that the actual effects of the regimes, as opposed to their high-minded purposes, have been pretty uniformly to create worse outcomes for consumers and taxpayers than if nothing had been done at all (Ch VII at 191-210). This is true across the board where competition and markets have been reduced or limited. By contrast, where these intrusive regulations have been lifted, people prosper. 

The Success of Deregulation   For example, the book discusses the unambiguous successes of President Carter's deregulation of transportation (TBC at 83-85), including air, rail, bus, barge, truck. This was a landmark illuminator, or at least should have been. This success was followed by the elimination of the government-sponsored ATT telephone monopoly (TBC at 163-166), which somewhat strangely involved close friends of mine on both sides of the case, and which helped usher in the internet age. Deregulation of the most intrusive parts of our oil and gas industry has also been an unalloyed boon, the benefits of which we are now experiencing in the shale bonanza. 

It is no accident that perhaps our least regulated area, technology, is the greatest job creator and area of the greatest innovation. Meanwhile, banking and finance, under the dead hand (most recently) of the misguided Dodd-Frank, creaks along cutting services and jobs at a prodigious rate (TBC at 10-16, 201-208). There are no Facebooks or Googles there. The contrast is illuminating. For further on this area, see my new website (described later).

Charlie, I doubt your sweeping assertion of "failed market systems" was meant to include such examples of success.

In TBC Ch VII, the book narrates the history of numerous other failed intrusive regulatory regimes, many still with us because of the entrenched business and labor interests such regimes create and the persistence of political myths as to their net benefit. These include the SEC's review of new issues (TBC at198-199), the FDA (TBC at 200 and 236 at fn 223), and our one-after-the-other silly financial regulatory efforts including Dodd-Frank (TBC at 201-208), which misdiagnose the ills and therefore do nothing but heap harmful costs and limitations on our system. Then, of course, people complain banks are not lending enough and are languishing. Surprise!  

Good Regulation Distinguished    Not to say some appropriate type of regulation of each of these is not called for -- TBC Ch VII at 218-223 discusses what types of regulation to avoid and what to keep. No one complains about traffic laws, standard weights and measures, ingredient and product disclosure, many types of information-forcing laws, basic research. These and many similar regulations benefit consumers and don't restrict competition or transactions. They are not "intrusive". 

Intrusive regulation typically targets price control, as well as entry (qualifications, routes, etc) and seeks to limit key elements of business judgment. Setting market price for your product or service is a key element of business judgment, and sure enough, price control is at the heart of the ObamaCare regulatory set's dreams -- indeed the key to their efforts at cost control (TBC at 77-79, 90, 178-182). But price control does not eliminate the costs, merely shifting their locale and/or nature. If all of health care is "under one roof", it is easy to restrict prices, except for wide-scale cheating (black markets) which such restriction creates. But the larger cost in deteriorated service (examples Europe, Canada, Cuba, Soviets -- including health care) is inevitable and degrading. So the trouble with the intrusive regulatory mindset is that it invariably goes too far and imposes constraints which hurt the public more than they benefit. And cumulatively, the cost of regulation itself, although unnoticed because unbudgeted, is a tremendous drag on the economy and employment (TBC 182-186). 

Crony Capitalism Destroys Free Markets and Progress   Another distortion which intrusive regulatory regimes promote is the creation of "crony capitalism" (or crony socialism), whereby powerful vested interests and politicians responsible for supposed oversight of the regime lie in bed together to preserve their special privileges (TBC at 166-168, 212-219). We see this throughout American businesses wherever politicians create intrusive regulations. Goldman Sachs, Citigroup, ATT before the breakup, Countrywide, Detroit are examples of crony capitalists and/or crony labor. They are protected by regulatory regimes which deter competition. This phenomenon is called "regulatory capture" and is discussed at TBC 212-216. 

These phenomena are ubiquitous but often harder to see here, alhough quite obvious when one observes say, Latin American systems or Russia, much in the news, where oligopolists persevere by unholy combination with powerful pols. This is the capture of politics by business (or visa versa), and what many people decry as an evil of free market capitalism. In reality, it is the exact opposite -- it is the destruction of the competitive free market (and therefore the best interests of consumers and taxpayers)(explained at TBC at Ch VI) to the sole benefit of a privileged few. These conditions, unlike private monopolies, are long-lasting and extremely hard to dislodge (TBC at 166-168), because armies and police can be mustered to put down threats to continued "rents" (the economists' word for capturing unjustified benefits from regulation). 

It is in the self-interest of a competitor to capture, if it can, the levers of government. That is why one of the most important tasks of political life is to protect competition itself against the unholy combination of particular competitors, business or labor, with government agents and pols. These folks love regulation because regulations, and regulators, provide endless opportunities for the rich and powerful to shape rules to their benefit, entrench themselves, and restrict competition. This restricts the life blood of a successful growth economy (TBC at 150-153, 166-168).

Like marriage, intrusive regulation is not to be entered into lightly. Uniform experience teaches that we are better off without. So, don't we want to search for alternatives to this path?  

The concern for competition and freedom in markets is not just some ideological nicety or fixation. This is what spurs innovation and change, and thereby creates jobs. This is ultimately a moral or philosophical Q. The book takes the view that a person is better off with a good-paying job at a skill level he can perform than in having endless weeks of unemployment benefits or welfare. The Europeans have tilted too far in favor of welfare at the cost of lost job opportunities, and their sustained high unemployment is shocking, especially among the young and disfavored (TBC at 41-50). Yet they are a model some in power admire and seek us to become like. Save us from these beknighted.

Another trap people fall into is the myth that public employees are solely driven by pure intentions (TBC at 212-216). Public "servants" are just as self-interested as the rest of us -- always expanding their regimes and budgets regardless of the cost/benefit. The zealous pursuit of the public good, especially notable among the idealistic young, ends up in expanded bureaucracies, failed programs (think Head Start, education, Job Corps) with zero public benefit but life-long careers in government service (with powerful unions). Public service unions, promoting the interests of their members, and vested interests, make harder true progress towards the real public interest.

Why Read "The Bumbling Colossus"?  This kind of information is very important for how we think about our public choices at this point, and the unique thing about "The Bumbling Colossus" which you will find nowhere else is that this quite well established truth (known among many top economists) is unknown among so-called health policy experts, whose training is not in the economics of regulation and therefore are quite ignorant of the lessons we can learn from these experiences. Nor is it widely known among the mine-run of professors or practitioners, who spend their time learning about other things, or among media reporters or owners whose training is in journalism (sensationalism) and is therefore superficial when it comes to economic matters, leading the unwitting public down harmful paths. Nevertheless, these are the people with the most influence on the public debate and we all need to become aware of their limits. Of course the last place to look for well-informed views is the political set, whose training is in fog generation and personal advancement.

So where do we go from here? Confusion and misimpression about what "the market" is pervades. What are its benefits and what are its detriments? Why is profit a good thing and not-for profit a false hope? This is why the book includes in TBC Ch VI at 145-189 a (probably too lengthy) discussion of exactly that subject. Without understanding this, there is little hope for advancement, since the conventional wisdom, of which our politicians, media, and most professors are masters, teaches all the wrong lessons. 

How Good Economics and Morality Join Together   At TBC 148 the book sets out the best description that I know of how liberals and conservatives talk past one another without communicating. TBC at 75-77 and again in Ch VI discusses the presumed conflict between morality (everyone should have health care) and economics (how to maximize resource allocation), and shows why there is no such conflict, and how the economic approach sketched first at TBC 28-30 allows both to merge -- if good economics are followed. If not (as in ObamaCare, our present system, single-payer), the result is to create indiscriminate and inordinate harms, i.e. an immoral outcome. Therefore the type of analysis found in "The Bumbling Colossus" is the only sure way to proceed I know, good intentions notwithstanding, without causing more harm than good.

In Ch IV and V the book sketches how to achieve the equality goals which liberals and progressives want while avoiding the degeneration and harm which what the book calls "the old progressive agenda" inevitably ushers in. It shifts the focus of funding from control over all details by government agents and agencies, commissions, and bureaus to individuals and families. Why? This is because only centering the system on individuals and families guarantees that people pay attention to what they get for what they pay (TBC at 79-83). Without this, there is no effective cost control, for all efforts to control costs only squeeze everyone and degenerate service. This is the single-payer experience around the world, as Ch III shows, and certainly our own experience.

The book recommends that everyone have access to a health savings account which is tax-favored so it accumulates tax-free, and is capable of building. Those unable to afford to contribute to their accounts because of low income or other disabling circumstance should receive enough funds or funds-equivalent (such as health vouchers to limit spending on other matters). The law should be changed to stop inducing employment-based group coverage, which discriminates against the self- employed, ties people to unhappy employments, and disables them from being sensitive to their own cost/service balance. Interstate insurance should not be banned as at present, opening up competition. Mandates are counterproductive and unneeded with a voucher/support program. Other features of a system which unleashes competitive forces and builds up "patient power" are described in TBC Chs IV and V.

Milk Cows or Independent Spirits?    The point is to get us away from the mass enfeeblement and dependency which our present direction takes us in. We need to stop treating adults as children, which is self-defeating (TBC at 79-83), even apart from the cost explosion. We are not cows to be led back and forth for milking, but we can rapidly become so if the intrusive regulators prevail. Reread George Orwell's 1984. The real choice is between a world of dependency, thought to bring security, and one of individual strength and energy. And the dependency which government control of activity fosters is a false security because the free lunch it provides is only an illusion, in which (as experience from the British NHS to the Cuban paradise to the Soviet drabness to our own former transportation mess clearly reveals) living conditions -- standards of living -- weaken and crumble. So the road to security by intrusive regulation ends up in ever lower living conditions and insecurity.(TBC at 173-189).

Only when individuals and families are responsible for their own health choices (which necessarily means responsibility for paying), can the conditions for competition among providers, incentives for innovation in service and its components, and cost reduction occur. This is our experience across the board. This fits human nature. Suddenly people care about what they pay and what they get for it, and others respond to the opportunity. That this will occur is obvious from the way people have responded to the opportunities in internet software, where everyone's son and daughter is starting some internet-based company. This is what a regime based in economic freedom (competition and the absence of intrusive rules) brings.

But even beyond this, beyond the dry studies and dismal science, the essence of the matter is the question, what kind of people do we want our policies and laws to shape? Do we want a nation of dependency and "entitlement thinking" -- everyone demanding their "rights" before taking steps to improve themselves-- or a nation of independent spirits? Milk cows, or yeomen and entrepreneurs?

There is no question that our laws and institutions influence people, for good or ill. Take the Middle Ages, when everyone had a "place" in society and initiative and mobility were frowned upon. The church and the nobility combined to cull the excess returns for themselves. People were kept in place at pain of death. Government was in total control. Milk cows were the norm.

Things changed with the Reformation and Industrial Revolution. Individual initiative was no longer squashed. Business and the quest for profit was legitimated aided by the new concept of religion (TBC at 173-178). Standards of living started to explode. In our time, the examples of economic repressive regimes in Cuba, the Soviet Union and N Korea among others show the crushing debilitation to the spirit these regimes usher in. Take Germany. Although the Wall fell in 1989 and W. Germany did the unbelievably charitable thing in creating a one-for-one exchange of the Ost mark, today still the effects of 50 years of rigid intrusive economic regulation are revealed in the slowness of Ost recovery and the difficulties Ost people have in lost training, lost initiative, lost competence to survive in a competitive, merit-based economy. (TBC at 186).

Intrusive regulatory regimes create dependency, people "practice to the rule" instead of using independent best judgment, often missing the forest for the trees and creating harms. A study quoted in my website describes how regulation makes doctors practice to the rule, losing sight of the big picture. In medicine this can literally mean life or death.The book quotes Eric Schmidt, CEO of Google and a high-profile Democrat (TBC at 223) on this, and Pope John II (TBC at 221-222). 

"The Bumbling Colossus" takes the view that people are happier and more fulfilled when empowered by responsibility and enabled to exercise real choice. This promotes emotional, spiritual, and mental health. It is the opposite of greed. It allows charity. This is the essence of what we want to promote in our laws, including our health system, and goes way beyond simple accounting and number-crunching. The book explicates this, and its relation to free markets (TBC at 168-172, 186). Most people miss this, but it is central.

This means our system should aim for the greatest possible empowerment of the individual and family, financially where universality is desired as in health care. What about those unable to cope? That's where the federal government comes in, by direct support carefully dispensed. What about those few disabled by mental or emotional defect? A special program for them is needed. But the great mistake of single-payer and government control advocates is to change the whole system, hurting the vast majority, in the name of protecting a few. Overkill swamps the boat and drowns the passengers.

There may be other or better ways than TBC sets out at Chs IV and V of solving this dilemma of exploding costs causing reduced and degenerated service, but I am not creative enough to come up with them. Someone else may. What I do know is that our present direction will take us to a most unhappy end, one that is eminently foreseeable based on what we already have experienced and can observe around us. We are prisoners of the past and present constraints. We need to "think big", and get it right. We need to empower individuals, not government agents. That is what "The Bumbling Colossus" demonstrates. 

And lest you think this email exercise is not worth it, it benefits me in forcing me to condense down what is otherwise sort of a lengthy exposition in the book, and Charlie's comments provide a useful focal point. Thanks, Charlie. 

The great contribution of the The Bumbling Colossus is bringing together critical material which very few people realize, although many realize parts. It fits the pieces of the jigsaw puzzle together. I tried to make the book as readable as possible but I know many are unaccustomed to reading such subjects. I wish I were as good as one of The New Yorker's writers to really make it "sing" while still "getting it right" -- as too few of them do. 

This is still too long, but too bad; the subject is worth it. I can't match Dave & Charlie for brevity (and wit).

(BTW, check out the amazing stuff quoted in the website www.thebumblingcolossus.com   created to afford sort of a continuing graduate education on the subjects touched on in TBC. It quotes key passages from work published since the book by top people in their fields. Of course, given the comprehensive sweep of TBC, subjects beyond health care are discussed.)

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James McLane

4:26 PM

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to me, charles, David

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Henry, I don't know who you are, but I roomed with Dave and Charlie at Yale, had a career in finance, was Deputy Director of the Cost of Living Council 1972-74; ran Aetna Health Plans; served on several hospital boards and on boards of nursing home companies, medical device companies and physical therapy companies. Also I was a member of the Jackson Hole Group in 1992-95 to counter Hilary Care. We achieved our goals. Bottom line: I read your book and agree with it and your above comments.

But we now need to move from philosophy to action -- to focus on solutions to counter a government takeover of healthcare which will be an unmitigated disaster as you have so rightly shown. Government needs to be a partner in a joint solution.

 I am not smart enough to come up with solutions although I have some ideas. We need another Jackson Hole type group to propose practical alternatives and get them into the hands of people who can make the necessary corrections in the system happen. 

Good luck. You have my full support.

Jamie McLane

Dr. David Simmons, MD

Jan 17, 2013  2:09 PM

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to me, James, charles

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Henry,

Don’t let my silence make you think I don’t appreciate your recent “condensed” epistle. In fact, it awed me. Most of it flew over my head, but the problem is mine. I look forward to learning from informed folks like you and Jamie “noodling” together in an interactive dialogue box on your www.thebumblingcollossus.com web site.

 Best wishes,

Dave


"The Bumbling Colossus" is available at amazon.com







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