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I'm a Family Doctor whose private practice was recently purchased by our local hospital system. It's not uncommon. We were purchased 3 years ago along with many other practices because the hospital system was responding to the ACA, also known as Obamacare.

But, why would that cause a hospital system to start buying private practices?

I've been at numerous lectures designed to indoctrinate myself and my colleagues to the concept of accountable medical care filled with charts and studies about how small areas with well coordinated doctors provided better care with less waste. Mostly this data was drawn from areas where one company insured a whole community, and all the doctors participated in the same insurance program that the company owned. They were all small contained experiments, but they were producing good outcomes.

This concept was the germination of the ACA, and it would require doctors to mimic these small groups and the groups would be called Accountable Care Organizations, or ACOs.

When I first heard about this concept of accountability, it reminded me of a summer job I had way before medical school. I was a dishwasher. A chef and sous chef came to the restaurant where I worked and approached the owner. They told him that they could run the kitchen with less waste than the previous season and they wanted to split the savings with him. He agreed and they turned around and offered to split their portion of the savings with the wait staff.

It changed the way the whole place operated. Waiters really pushed the dishes that were in over supply. They really did make sure the hash browns were substituted with french fries. Less food was tossed because of lackadaisical errors. Less food went unserved. The system was more efficient and money was saved. And, the customers were happy.

As I've come to learn about the concept of Accountable Care Organizations, I've also come to realize that it's not that different from the approach these shrewd chefs used to reduce waste and improve a system that was made up of individuals who were working towards a common goal without working together.

Follow the orange EKG strip for more. . .

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I was talking to the medical students who volunteer at a clinic that provides free medical care for uninsured people in Newark.

I asked, "Will Obamacare make this clinic unnecessary?"

It was a pregnant question. What do I hope is the answer?

Yes? It would be the goal of the ACA to make such a clinic for the uninsured unnecessary. I hope the ACA will make the concept of "Uninsured Patients" a thing of the past, and yet I doubted that the idea of a free clinic would ever go out of style.

If the ACA succeeds in providing insurance to the uninsured, will there be no uninsured people for medical students to volunteer to help?

The clinic will become unnecessary. Medical students will not volunteer.

Is that good?  

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I was hanging out with my buddy who is in a union. He said the ACA had caused his union health care contributions to triple.

So we discussed this. Everyone in the union contributes to the health care fund $7 per hour worked. Then they all get coverage till a catastrophic event occurs and then they cap out at $250,000.  He had stories of guys whose wives had breast cancer that went broke with the old system. But now that everyone with kids up to the age of 26 were covered, the union can't cover the costs without raising the contributions.

Basically, up till now that was his best option. The union insurance was lousy, but it was all he had, and they had fought for it.  The ACA made the crappy union insurance bear the same burden that the professional insurance companies had to, and he's feeling the hurt. Their risk pool was too small.

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Fri Dec 21, 2012 at 06:51 PM PST

Collecting Data about guns.

by New Jersey Boy

Pacifists will say, "get rid of all guns of all types."

Hunters, and hobbyists and regular folks who want to have a gun will say, "I want to have a gun." I'm not a "gun nut."

There is a second amendment and it's one of the checks and balances.

No quotes on that. That's true. Follow for more.

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Wed Oct 31, 2012 at 07:36 PM PDT

Halloween Postponed by Sandy

by New Jersey Boy

The Governor has declared no trick-or-treating till Monday, Nov. 5th.  

We made the classic ghost with a sheet with a pair of scissors for the 4 year old, and my 8 year old has forgotten about his "army man" costume upstairs with the black leather combat boots (size 3 - I couldn't believe it either!) And, although we have power, the doorbell has not rung.

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*My first diary, be kind.*

I have been watching this and I think Obama has played a cagey political game with the topic. When he began his career he came out very left leaning: probably atheist (from his book), pro-gay marriage, pro-single payor for health care, as a few examples.

As he became a "professional" politician, he honed his positions for the national audience. As an observer and supporter, I accepted that this was necessary - he might have concealed his true motives so that he could get elected and then try to carry them out.  Where I agreed with him, I accepted this with a wink and a nod.

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