A Booster Shot for Common Sense

Chalk one up for sound science and common sense.

In state that too often makes policies, laws and regulations based on spasms of emotion, half-baked medical studies, distorted reality and political pressure, the approval of of Senate Bill 277, Sen. Richard Pan’s bill to require vaccines for schoolchildren, represents a major victory.

Major kudos to Governor Brown, who signed the bill into law yesterday, and to all those who voted for the measure in both houses.

For moderates, the significance of SB 277 is even bigger than the actual policy contained within the new law. It is a triumph over the hue and cry of a sincere, vocal minority of people holding passionate but extreme, irrational views. That includes moronic, mush-headed buffoons like Jim Carrey, who today called the Governor a “fascist.”

Right. We all want Jim Carrey dictating public health policy in California.

But let’s not kid ourselves. Whether it’s pesticides, ingredients used in consumer products or how water is best allocated, highly organized fringe groups will continue to push for policies based on the assumption of problems lacking credible science or data to support their positions. Just because these groups are loud, aggressive and committed does not make them right.

The nascent effort to eventually overturn SB 277 via a referendum will go down in flames, further making this point. So bring it on.

The success of  SB 277 suggests that maybe, just maybe, the lunatics really aren’t running the asylum after all. That common sense and science, not white-hot rhetoric, can in fact rule the day.

Here’s to hoping the Governor, California Legislature and the state’s quiet voters can keep it that way.

 

What’s Your S.O.S.?

Governor Schwarzenegger delivered his final State of the State (SOS) address this morning. It was a mixed bag. Sober reality check. Wistful glorification of California’s can-do spirit. A vague, punch-drunk plan of attack for rescuing California.Protecting education, cutting prisons, tax breaks. They all sound wonderful. How this stacks up with financial and political reality is highly suspect. But give the Governor credit for connecting the dots and trying to move ahead in the face of insurmountable odds.

Depending on your viewpoint and situation, S.O.S. can mean a lot of things.

* For castaways desperate for salvation, it’s the equivalent of a Hail Mary pass – “Save Our Souls.”

* For soldiers sick of canteen food, it’s “Sh*! on a Shingle.”

* For cynics in the capitol press corps and in The Building, it’s “Same of Sh@#.”

* For liberals, to paraphrase Democratic ex-Speaker Karen Bass, it’s “Save our Shreds” of what is now the social safety net.

* For Arnold, it boiled down to the “Same Optimistic Speech.”

The Blue Dog thinks it was very well-written and delivered pretty well. But the feel-good tone evaporated minutes after the speech . . . just inventory the pitiful track record of a Centrist Governor sandwiched between too-far right Republicans and the dominant left-wing Liberals. They are all talking about collaboration now. But as Sacramento political pundit Steve Swatt so nicely put it: “By summer the olive branches will be fire wood.”

Achieving some measure of budget reform should now be Governor Schwarzenegger’s drumbeat to a proud legacy, It’s a worthy goal and the Governor should be applauded for that. The Legislature should, but of course, won’t, do anything meaningful or visionary to help him.  After all, a broken system cannot fix itself.

Yes, Governor, California is a wonderful place indeed. But her glow has faded and she can’t rely on her looks any more. The fresh-faced beauty queen is now a haggard middle-aged woman with missing teeth and a crack pipe in her hand.  Optimism alone is not going to change that fact.

Docs’ Eye View of Healthcare Reform

Before mowing on a tasty Father’s Day dinner of BBQ spareribs, grilled corn and summer salad, the BlueDog posed the following question to his own father and brother-in-law, Mayo and Cleveland Clinic-trained Central Valley physicians with a combined 103-years of experience in American medicine:

If you could wave a wand and fix the healthcare system in the United States, what would you do?

Here is what they said. Bear in mind, these are fiercely opinionated and incredibly intelligent, ethical doctors who entered medicine as a calling and out of a love for medicine. They are on the far downside of their careers. They have no turf they need to protect.  They aren’t being paid to defend anyone’s position, including the AMA’s. [“Too many doctors nowadays think MD stands for much dough,” my brother-in-law even lamented.]. They just speak bluntly, as doctors often do, about how things should be. It’s about as pure a viewpoint you can get these days. You might be surprised at their views:

(1) The delivery system should be a single payer system -think Medicare for everyone – but run by a quasi-governmental organization such as the Federal Reserve, Tennessee Valley Authority or Base Closure Commission with strong input from respected professionals and medical economists and a minimum number of politicians.

(2) Cost containment is key and depends on properly placed provider incentives for efficiency – that is, (a) budgets negotiated with large physician run, cohesive, integrated multispecialty medical groups with strong leadership and experience in utilization review and quality assessment (there are many now in existence – Mayo’s, Cleveland Clinic, Sutter, Kaiser, etc., most participating in HMOS), (b) avoid physician-owned facilities and (c) negotiate a national drug formulary.

(3) Evidence-based medicine. Define quality using the most recent information from data-based medical studies. Require, as much as possible, that treatments and diagnostic procedures are in line with current standards as determined by professionals.

(4) Systems should be funded by a pay-as-you-go, transparent, fund from visible personal and business taxes, which over time would replace all or most of present private premiums. This should not be funded from general tax revenue. A reasonable administrative cost allowed, perhaps not over 5 percent. Commercial insurance would remain only is a supplemental form, covering deductibles and co-pays as is now allowed in Medicare.

(5) A federal cap on pain-and-suffering awards for malpractice. Experience in several states, including California suggests it lowers malpractice premiums.

When the BlueDog’s father speaks to community groups and seniors, he defines socialized medicine for them and asks if they are in favor of it. No hands are raised. But when he asks how many like Medicare, all hands go up. “This is socialized medicine,” he tells them. “And it basically works.”

So consider the source of these reforms. Two big-brained guys who have committed their lives to medicine and medical economics. No axes to grind. No skin in the game anymore. Just a passionate wish for medicine to be much more than it is today . . . in the richest nation on earth.