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I'm surprised your prophet got out with her life.

In these parts, they're flayed by Cones and the remains put on display - to intimidate potential upstarts into silence.

This is one of the reasons Thom Tillis is toast this coming November.

Mary, my "prophet" was speaking to an audience that seemed to be fairly receptive to her point of view. Received some warm applause at the end of her talk.

Tommy, I have no idea what will happen in November. It rightfully should be an easy race for Hagan's opponent; but it might not turn out that way.

Accountable Care Organizations. That sounds like a conservative idea. Voluntarily grouping providers together to coordinate and deliver better care at lower cost. Free markets working together. Beats the current bill for service which is bankrupting this country.

I guess I could just pay you with eggs?

David, ACO's are not, by any stretch of the imagination, a "conservative idea". They are a creature originated by Obamacare. They are designed to be a proxy organization created by the force of government to enforce the withholding and rationing of care.

In addition, they are hardly "voluntary", because the objective is to assure that physicians feel forced to participate in order to remain economically viable.

We have been trying to get away from fee for service in health care for 30 years. Managing care provides better care for less.

Or I can pay you in eggs or collards?

Your choice.

Regarding Obamacare ACOs in Medicare:

"The Medicare program has substantial financing challenges in its near future, and the Obamacare ACO model will not result in the level of savings required to extend the solvency of the Medicare program. We’re still awaiting the 2014 Medicare Trustees report, but last year’s report projected the Part A trust fund to be exhausted by 2026 and under the most realistic scenario, the whole program has a long-term unfunded obligation of $36 trillion.

These financing challenges call for a much more significant structural reform to preserve the Medicare program for future generations. The best reform option, which would benefit both taxpayers and seniors, is premium support. As the CBO estimates, it could accomplish savings ranging from $15 billion to $45 billion in 2020 alone, with greater savings over the long-term."



Why ACOs Don't Work

"The ACOs are in effect latter-day health-maintenance organizations—doctors, hospitals and other health-care providers grouped together to provide coordinated care. The ACOs assume financial responsibility for the cost and quality of the care they deliver, making them accountable to patients. With President Obama's re-election making it certain that the Affordable Care Act will begin taking full effect next year, the number of ACOs will continue to increase.

We believe that many of them will not succeed. The ACO concept is based on assumptions about personal and economic behavior—by doctors, patients and others—that aren't realistic. Health-care providers are spending hundreds of millions of dollars to build the technology and infrastructure necessary to establish ACOs. But the country isn't likely to get the improvements in cost, quality and access that it so desperately needs."


Bob, there is certainly a feeling out there that the ACO's are not going to work as intended. Some in the North Carolina Senate share that perspective regarding ACO's and the effect they will have on Medicaid costs.

But let's remember that the design is to use the force of government to facilitate the rationing of care. The ACO is the proxy organization the government would use to make that happen. The very design is profoundly immoral. Government should not be in a position to force those kinds of decisions on the part of health care professionals who have an ethical obligation to provide medical care.

That does not mean, however, that government is obliged to offer a blank check. We can begin cutting back on what the government is guaranteeing to people.

David, ACO's are a socialist vehicle. In some respects, it would be preferable to be paid in collards and eggs than for all of us to be forced into the incremental socialism this represents.

There are better ways to reduce costs based on sound economic principles based on free markets and free enterprise.

More copy and paste from Bubba from dubious sources.

Show me one country where the free market works in providing affordable and efficient healthcare?

David, our nation used to have affordable, efficient healthcare before the full impact of excessive federal involvement was to be felt. I remember during my childhood years that our nation had affordable, efficient healthcare. That began to change probably during the mid-to-late 1970's.

But what the democratic socialists have wanted for many decades is a government-facilitated entitlement, a guarantee. That is much different than "affordable, efficient healthcare".

David, the more I read your posts - and Boyd's - the more I am amazed at how much you both HATE the physicians and nurses providing the care on the front lines. You simply HATE us.

You might as well be throwing eggs.

You demonize doctors to the nth degree, not understanding that the exponentially increased cost of healthcare since the early '90's is NOT because of doctors' salaries (just ask the New York Times).

Instead it is about the layer-upon-layer of expensive Federally-mandated bureaucracy and high-dollar "management" sucking its living off the backs of our labor - people who know nothing about the actual practice of medicine running medicine.

And then there's the legal vultures manipulating all of that . . .

In some respects, it actually IS doctors' fault. So many of us - me included - bought the notion that hospitals (particularly "non-profits") were always good, and that the business people running them would be accountable/always act in the community's - and patient's - best interests. Incrementally, we gave up nearly every bit of control and protection to the monster that has now engulfed us.

Someone else could manage the "business". We could just practice medicine. It was incredibly naive - just not so.

Indeed that's the REASON your good buddy, Edward- Cone-of-the-Moses-Cone-Hospital-Cones, worked overtime to BURY me/my story as a National Health Service Corps doctor hosed by greedy suits (cooperating with Cone Hospital) in my own hometown. Our dear Edward bought his seat on the Cone Hospital Board of directors with my blood, sweat and tears. He teamed up with an online predator with a history of violence to take me out.

It's not anything to be proud of, and I am now resolved to chase him to hell and back.

Economically, socially, medically, the progressive left has been WRONG about everything. It's playing out right in front of you, and still you refuse to admit that Obamacare was the wrong way to go about "reform".

We did actually need to know what was in the law BEFORE we passed it.

I've watched good people lose their jobs, their insurance, their security because of this damnable law - slash that - TAX. Our President and his minions LIED to us.

But you and yours defend him still. I was on the Cone Foundation's website last night and I had to shake my head. Such shills for a bad fix.

I don't have the slightest idea who you are, and therefore have no idea if you are a Parent or a Grandparent - but if you knew half of what has been going on in medicine in North Carolina - including the Piedmont - and particularly in hospital Pediatrics (and you don't because our noble newspapers NEVER report stuff like that) - you would not be able to sleep at night.

That is, assuming you have a soul and actually care about sick kids.

You CANNOT keep kicking the people who are providing the care/call services - demanding the best for nothing.

We are NOT "trolls". We are not the enemy. But our President/his party have treated us as one. And it WILL come back to bite.

Only Craft would call the Wall Street Journal a "dubious sourse." That's a typical response from someone who has no clue about what he's talking about.

Here's some news for you, Craft: You are the Poster child for dubious sources, particularly on this issue.

And as far as criticizing the fee for service model, I find that a howler, coming from someone whose business model depends on commisions and overrides for income.


"In the end, it's all about payment for outcomes and putting the consumer at the center. The ACO model fails to do this.

One of the most disappointing things about the recent commentary is that while some questions have been raised about sustainability and scalability, what's largely been absent from the debate are questions about ACOs' viability. ACOs will fail to improve healthcare costs and quality because they take a fundamentally broken system and create a complex bureaucratic overlay, making an already complicated system even more complex. And each layer of complexity will only add cost, decrease efficiency, and reduce transparency.

The answer isn't a new, complex organizational model, but rather greater transparency and greater accountability for costs and outcomes. Creating incentives that focus on achieving quality outcomes, providing choice and allowing real competition will get us there -- ACOs won't."


But of course to people like Craft, none of that matters. The only thing that matters is the enablement of wrong-headed policy that supports their warped agenda.

Don't believe it? Watch how he responds to this comment. It won't contain anything of substance to counter what's been presented by those whose analysis he doesn't like.

Sorry for not getting back to this sooner. Long Weekend.

So, where are we?

Joe pines back to a day that doesn't exist anymore. A time when health care was, well simple. Now we have CAT scans and drugs that cost thousands of dollars per month along with surgeries not imagined 50 years ago. Hard to manage health care like it was 50 years ago, when it is nothing like 50 years ago.

Bubba keeps copying and pasting.

When Mary Johnson shows up it turns into a pity party. Ugh.

The reason costs are as high as they are is because of the preponderance of third party insurance and near-first-dollar insurance. Fix that dynamic, get the government out of the picture as much as possible, and watch the costs return to a more realistic level.

All it would require is the will to do these things.

Craft, you and Cone and Brod and the rest of your little progressive band-of-internet-brothers are hopelessly PATHETIC . . . and you deserve the healthcare you shill for. But I don't. My patients don't.

WHY are things nothing like what they were 50 years ago? Could it be 50+ years of progressive/liberal thought . . . breeding generation-upon-generation of Americans who think everything about life is free - when it isn't? That they are somehow entitled to the hard labor/work/time of others when they aren't?

More locally and to the point of your comment (if you really wanna go, "Ugh!"), Edward Cone, sometimes-journalist-scion-of-the-Cone-family, claiming he wants to be a "friend", sells out a fellow blogger for a seat on the Cone Hospital Board (ultimately teaming up with a violent psychopath in the process) and it's a-okay with you and yours.

Free speech and hate speech are one-in-the-same as long as it's Mary Johnson you want to BURY.

It's abject (as I recall, one of Roch's favorite words) hypocrisy . . . flying in the face of everything that you noble lads otherwise wail and beat your chest about . . . you know, bullying/violence-against-women/tolerance-for-others'-opinions/respect-for-people-who-provide-the care/actually giving a damn about children.

But that ONLY applies if someone agrees with you, eh?

"Move on along - nothing more to see." In your book, anyone who disagrees with Obama/his pseudo-socialist polices is a "racist" or a "moron".

We on the more conservative side of the fence (who did tell you so - about just about everything) have put up with this sorry excuse for "debate"/reasoning for years. But the fact is that we can't have a decent conversation without being targeted for online (and professional) destruction. So a lot of us walked away.

GSO's Blogger-King pretty much ran anyone and everyone who had the guts to stand up to him out of the arena.

And you-all got what you wanted (which was, in fact, a wholesale sell-out of medicine to insurance companies and corporate monsters - with a government that cannot manage its way in out of a light rain "overseeing" the gigantic mess). It's all falling apart all around you, and STILL you won't budge from the sand sifting under your feet.

Even the hallowed Cone Foundation's website starts its sell with, " . . . while the ACA is not perfect . . .".

You betcha. It would be laughable if the state of things were not so desperately serious.

Maybe you ought to actually READ some of what Bubba cuts and pastes . . . just like your political goddess, Kay Hagen, ought to have read the law/tax she voted for BEFORE it was passed.

"Pity party?" How would you have liked your Mother - or your wife - or your daughter to have been subjected to even a small portion of what I have survived - courtesy of Cone Hospital?

And let's be clear that I've come to understand that it WAS Cone Hospital - affiliated with UNC (and now High Point). All the dots have connected. The boys at Randolph were sucking up for the right to claim a "cooperative relationship" - a seat at the kiddie table.

In your world, I should not be angry about any of it. In your world, I should have hung up on the terrified nurse, rolled back over, and gone back to sleep and let the Cone-owned doctor KILL the baby sixteen years ago. Because that's what would have happened if I'd not gone in an actively STOPPED him from what he was going to do.

In your world it's okay that my-life-as-I-knew-it . . . the world I had studied and worked years to build . . . was destroyed in a matter of days . . . because I did the right thing . . .

. . . and because I've fought back.

It's okay with you that sixteen years later, Pediatricians are walking away from hospital call in droves - in communities all over this state - because they simply cannot take the CRAP being dished out by overpaid executives and corporate lawyers whose mantra is that "Pediatrics doesn't make money", and who think that we are "a dime a dozen".

"Pity-parties" MATTER when a lot of people start showing up. I might have been first-in-the-door . . . but these days, I am NOT alone. And it WILL matter when you can't find anyone to take care of the sickest children in the nurseries and on the floors and in the ER's of our smaller community hospitals.

But hey, you're a big/bad/smart dude, and you live in Greensboro, and Cone has it all covered, so what do you care?

NONE of the self-described "smart" people in Blogsboro want to hear (much less LISTEN to) anything someone actually-practicing-medicine is telling you - about what is going on ON THE GROUND - outside of your little bubble-world.

But still we keep trying. We have to keep trying. And that deserves RESPECT.

You wanna, "Ugh"? I can give you "Ugh!". In spades. And I'll take your long weekend and raise it by two decades.

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