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What is a major problem with this country? The interns have broken out of the accounting department!!! (one bean for you, two beans for me - one bean for you, three beans for me -one bean for you, four beans for me, etc...)
Bob Lutz, President of Chrysler Corp. etc... is the author of ''Car Guys' vs. Bean Counters: The Battle for the Soul of American Business'. He was a car guy who saw the results when the bean counters hold sway:
"But then GM's leadership began to put their faith in analysis, determined to eliminate the "waste" and "personality worship" of the bygone creative leaders. Management got too smart for its own good. With the bean counters firmly in charge, carmakers (and much of American industry) lost their single-minded focus on product excellence. Decline followed."
"A common theme in the book - and as eluded to in the title - is the role of the over-analytical wave of thinking (primarily driven by MBA's) which was a contributing factor to the demise of GM. Bob also covers the other factors, that led to the eventual Chapter-11 filing, including rising fuel prices, staggering health insurance costs etc."
At least the auto industry had some choice. But my recollection was the cars seemed the same (while breaking down). Management would be on one board then on the board of a different auto company - until companies like Toyota came in and blew their doors off!
So what would one area of medicine look like if the "accounting interns" (aka MBAs) came in and gathered up all the dialysis clinics? Dialysis clinics by themselves are small monopolies, like utilities, and many times are the only option in a geographical area. Factor into that a kidney dialysis patient only really has two choices: get dialysis or die!!! Sounds like an monopolistic accounting intern's dream! Customer service, who needs that crap! Take all those little monopolies and make one big monopoly! I'll reiterate, what would this look like? Here is a picture. Someone needs to write a 'Medical Guys vs. Bean Counters' book (maybe someone has, but we will see).
Update: Someone did write a 'Medical Guys vs. Bean Counters' book! Thank you NYT's best-selling author Tom Mueller for 'How To Make a Killing'!
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Intro
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!!!P.S. The following History and recent Children's stats linked to, need to be emphasized!!! Update: And it gets worse: KIDS!!!!
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Jim Cramer, the stock guru, is famous for having had to sleep in his car at one point in his life. He knows a little of what it is like to come up the hard way. After having listened to his show for years (I do have one bad habit -stock investing - keeps me away from the racetrack) he is someone who has impressed me as a person who is sympathetic to the underdog. So I wrote the following redacted email to him! Why not! Sometimes long shots do come in:
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<redacted intro>
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(Questions for Warren Buffett and Becky Quick of CNBC can be sent to
This was emailed off to Becky Quick of CNBC who will be interviewing Warren Buffett and Charlie Munger at the Berkshire Hathaway meeting on May 6th, 2023:
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Quote:
Arundhati Roy
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By Kevin Sack
SEATTLE As Dr. Harry J. Shriver III examined 70-year-old Eleanor L. Riley one recent morning, he seemed in no hurry. He asked about her phlebitis and her gall bladder, and whether her gout was acting up. They discussed her blood pressure readings and whether she was getting any exercise.
“I surprise my patients by asking, ‘Is there anything else you want to talk about today?’ ” said Dr. Shriver, chief of a clinic near Seattle run by Group Health Cooperative of Puget Sound. “They’ve never heard a doctor say that.”
Dr. Shriver has the time because Group Health, one of the country’s few surviving health insurance cooperatives, has recently embraced electronic medical records and a collaborative model of primary care, allowing him to practice proactive medicine for the first time in years.
On Capitol Hill, those innovations have made Group Health a prototype for a political compromise that could unclog health care negotiations in the Senate and lead to a bipartisan deal. After a month of brainstorming, including briefings from Group Health executives, the Senate Finance Committee seems poised to propose private-sector insurance cooperatives instead of a new government health plan as its primary mechanism for stoking competition and slowing the growth of medical costs.
But state officials say Group Health’s impact on holding down costs has been mixed. And its successes may have less to do with its governance by a board that is elected by patients than with its ownership of a vast network of clinics and specialty care centers.
Above all, Group Health’s physicians are paid a salary and can earn bonuses of up to 20 percent for high-quality performance. Unlike most doctors, who are paid by the visit or procedure, they have little incentive to churn patients through and order unnecessary tests and operations.
At Group Health, doctors are rewarded for consulting by telephone and secure e-mail, which allows for longer appointments. Patients are assigned a team of primary care practitioners who are responsible for their well-being. Medical practices, and insurance coverage decisions, are driven by the company’s own research into which drugs and procedures are most effective.
As Congress and the White House debate a national health care overhaul, many in Washington agree that one reason health premiums have grown at four times the rate of inflation this decade is a dearth of competition. In 40 of 42 states studied by the American Medical Association last year, the two largest health insurers claimed at least half of all enrollment.
The question is how best to invigorate the system. Republicans and some moderate Democrats are concerned that competition from a government-run insurance plan would eventually drive private companies out of business and leave government as the sole insurer.
If the bill now being finalized by the Finance Committee includes cooperatives, it could set up a confrontation with the Health, Education, Labor and Pensions Committee, which has written legislation to create a government plan along the lines of Medicare.
House Democrats also prefer a public plan, as does President Obama. But Mr. Obama has signaled that he might settle for cooperatives if it would gain Republican support for the broader legislation.
There is much about the Group Health model that Congress and the White House would like to replicate. Whether that requires a cooperative structure is open to debate.
A number of company officials acknowledged that it is Group Health’s ability to directly manage its doctors that really drives innovation. The cooperative structure’s primary contribution, they said, is to create a consumerist ethos that keeps the company focused on patient care.
“There’s a kind of accountability to the patients in our system,” said Scott Armstrong, president of Group Health. “And when you bring the principles of a cooperative to bear, patients feel responsibility for holding the system together and for their own health.”
But Carolyn A. Watts, a health economist at the University of Washington, said the cooperative structure made little difference. “In the end, it’s not about who owns the place,” she said. “It’s about the incentives.”
Technically, Group Health Cooperative was misnamed when it was founded by trade unionists and Grange members in 1947. Structured as a not-for-profit corporation, its revenues ($2.6 billion last year) are reinvested rather than distributed among members. But it is governed like a cooperative and calls itself one because its board consists of and is elected by members.
With 550,000 enrollees in Washington, Group Health is the smallest of three major insurers in the state, with a 9 percent market share. It often does raise premiums by less than its competitors, but that does not mean the increases have been insignificant. Annual increases for individual policies have averaged 12.3 percent since 2000, peaking at 24.2 percent in 2003.
Mike Kreidler, formerly a Group Health optometrist and now Washington’s insurance commissioner, said governance by consumers had sometimes translated into generous benefits. “They haven’t had the dramatic impact on cost in this market that you might have anticipated,” he said.
Group Health is a rare survivor among the hundreds of rural health insurance cooperatives that formed in the 1930s and 1940s in the face of fierce resistance from organized medicine. But there is a feeling in Seattle that it has endured only by becoming more like its competitors.
In the 1980s, it ended the practice of charging all enrollees the same premiums, regardless of their health status, and it has since introduced deductibles, co-payments and out-of-network benefits. Only seven-tenths of 1 percent of enrollees voted in the last board election.
Senator Kent Conrad, a North Dakota Democrat who first proposed cooperatives as a compromise last month, said the Finance Committee was debating how a national network might be structured and how much seed money would be needed for state and regional branches. Mr. Conrad has said it would take up to $4 billion, while others have projected $10 billion.
Mr. Conrad estimates that cooperatives would need at least half a million members, about the size of Group Health in its 62nd year, to wield meaningful leverage. That scale will be possible, he said, if the Democrats succeed in bringing tens of millions of the uninsured into the market by mandating coverage and subsidizing premiums.
But supporters of a public plan argue that it will be a challenge to form pools that large any time soon. They predict that cooperatives will become dumping grounds for the sickest patients, and that they will have difficulty forming networks of physicians.
“The idea that these things will spontaneously erupt all over the country is just completely a dream,” said Timothy S. Jost, a law professor at Washington and Lee University.
https://www.nytimes.com/2009/07/07/health/policy/07coop.html
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In the last blog it was mentioned there were 1600 electric utility companies in the US vs. 2 dialysis companies (basically). The utilities have quite a hodgepodge of different business structures like Cleveland's community-owned Cleveland Public Power to large for-profit utilities. One business structure that stood out were cooperatives. There are more than 900 electric utility co-ops in the US! And what is the stated mission of these co-ops? "To power communities and empower members to improve the quality of their lives. And what is the mission of a for-profit company? "Increase your return on investments" "generate more sales and revenues or raise your prices". That last mission statement just doesn't have the same ring as the first does it?
Wouldn't it be nice if the medical field had their form of co-ops? Actually they do, they are called care cooperatives. And it has been said about them: "Local cooperative health organizations can and do provide top-quality integrated, coordinated care". An example is Seattle's Group Health. Here are blurbs from this article:
"“I surprise my patients by asking, ‘Is there anything else you want to talk about today?’ ” said Dr. Shriver, chief of a clinic near Seattle run by Group Health Cooperative of Puget Sound. “They’ve never heard a doctor say that.”
"Above all, Group Health’s physicians are paid a salary and can earn bonuses of up to 20 percent for high-quality performance. Unlike most doctors, who are paid by the visit or procedure, they have little incentive to churn patients through and order unnecessary tests and operations."
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And from a PBS article:
"One of the reasons Campbell (a patient) is a big fan of the Seattle-based HMO is because it's a cooperative. Its policies are determined by consumers like Campbell, who subscribe to a Group Health medical plan, either through their employer or on their own. Each policyholder can vote for the board of trustees at an annual meeting. And it is consumers who actually sit on the board."
"Although there is no specific plan of how such a national co-op would work, the idea is to create an organization where consumers review policies and can hire or fire the CEO. It's a concept that works well at Group Health, according to its CEO, Scott Armstrong."
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So what happened to medical care co-ops? Good question! That might take more digging.
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