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AARP - Are They Supporting Their Members?
Healthcare has dominated the media outlets during the past month. Last year I finally registered as a AARP member. This organization speaking for approximately 40 million 50 plus Americans, has recently been in conflict with the interest of its membership over health care. The AARP position was underscored to me earlier this month in an e-mail from Barry Jackson of AARP, with the subject "MUST READ: Don't believe them."
I read the e-mail and looked up the internet site which Mr. Jackson claimed was in the AARP members best interest. I found the recommended webpage HealthActionNow.Org to be under the auspices of two former Clinton Administration operatives. The website campaigned for the single payer health care option. This option provides health care services from a single source created and controlled by the government.In other words, "socialized medicine." I sent a prompt response to Mr. Jackson with the following:
Barry - Your recommended website is essentially a campaign for socialized medicine. It would appear AARP has taken a position which is contrary to the interest of its membership. Barry you are lobbying, not communicating. Where are the surveys, the data to support your position? It's like an architect who designs by change order. Let's do the job the right the first time. Mimicking the Wizard of Oz, "Don't pay attention to (those who criticize you) the man behind the curtain is not winning you any points.
I received a form response inviting me to speak with them if I agreed with their campaign. More recently, I looked up the webpage; and it has changed. The AARP logo is provided several times on the front page along with a request to place your name and e-mail address on their petition. Unlike the earlier webpage, there is no information and only campaign slogans to support AARP's position on health care reform.


HEALTH CARE - AN INDUSTRY LIKE NO OTHER
By Dr. Theodore Topolewski
A number of people believe the current Administration's rhetoric that the healthcare industry can be remedied by government restructuring in the same manner as the financial and automotive industries. Thus far the formula for economic recovery of troubled and misaligned industries has been burdened with squandered funds and lack of oversight. The political and media spin is the nation will ultimately benefit. The next several years will reveal the "spinmeisters'" prophecy. The domestic automotive industry encompasses auto makers, parts suppliers and dealers. The automotive industry represents a sizable portion of the GDP. However, the industry boxed itself firmly into an economic corner in one Congressional room in Washington. Three CEOs appeared before Congressional committees which utilized a combination of brow beating and carrot dangling hyped by media spin.
While, the Banking/Finance industry is far larger than the automotive industry, the government has long regulated Banking/Finance industry under the jurisdictions of the Treasury Dept., Federal Reserve and SEC. Instead of three financially desperate automotive CEOs before Congress, at most ten to twelve Banking/Financial CEOs with hat in hand put on display will bring about the industry wide changes.
The Health Care Difference
Rolling the dice by throwing money at the problem will not achieve the desired result with health care. Health care creates giant logistical problems if the President and Congress pursue the automotive and Banking/Financial industry models. There is no congressional chamber big enough to accommodate the movers and shakers of the health care industry for a brow beating secession. Even a sports arena filled with health care industry CEOs would not adequately address the health care industry. Unlike the gentlemen CEO clubs of automotive and banking/finance, those gathered in the arena would not be an intimate group, as: (a) most would not know each other; (b) some would have no idea of the inner workings and problems of various industry sectors and; (c) a number would for competitive reasons dislike each other. Health care as a whole is profitable with some companies earning vast sums. Unlike automotive and banking/finance, no government hand out government is needed. As a result, many of the above would not feel the need to appear unless lawfully required.
The Fab Five
Health care is actually five large separate sector industries. Each industry contributes a critical function to the health care delivery system which represents over $2.5 trillion dollars or 16% GDP. This number is expected to grow to 20% of GDP within five to seven years. The five sectors are the hospital, private practitioner, third-party-insurer, long-term-care/rehab and pharma/biomed sectors. Two of these sectors, hospitals and long-term-care/rehab facilities (of which there are thousands) are essentially standalone. These CEOs could fill a rather large chamber by themselves.
Cross sector cooperation for the general good of American health care is noticeably lacking. How often does your family physician have a complimentary word about a third-party-insurers? Hospitals and private practice admitting physicians often disagree on medical protocols as to inpatient length of stay or medical supplies and ancillary tests used. Further, some physicians compete with hospitals by providing radiology and laboratory testing and independent surgery centers. Third-party-insurers often appear to be at war with the other sectors and the consumer in attempting to limit payments to providers (thus enhancing profits) claiming coverage exclusions.
Each sector believes it is in charge. Yet there is a symbiotic relationship between and among the five sectors in American health care. The lack of inter-sector cooperation creates an economic inefficiency adversely impacting patient care to health care providers over the last several decades. The various methods of reimbursement (payment plans) to health care provider over the last several decades are designed to provide economic benefit to the sectors on top. e.g.: managed care, capitation plans, out-of-pocket, out-of-network, in-network, PPO, pre-authorization as proof. It is a one competitive financial war for the fab five to divide up the $2.5 to $3 trillion spent annually on health care.
Tinker With Them All Or Not
At All Dividing up the health care spending pool has not been a zero sum game with the public paying more each year to feed the five sectors. That is the reason health care costs have been consistently higher than inflation. Political hype and loose mandates certainly will not stop this level of economic escalation. Further, tinkering with one or two sectors via regulation on finances or delivery systems will cause an unintended, adverse, domino affect on the other sectors.
What's a nation to do? As with anything large and complex, go slow, make sure you know how the parts interact with the whole. The issues (problems) must be thoroughly defined across all reporting lines. There is no quick fix, which few silver bullets and government mandates can remedy. It took decades to create the health care mess and it will take decades to fix. Thus, it is impossible to adequately address the health care sector in a single term of office.
Dr. Theodore Topolewski is a hospital administrator and consultant to the health care industry. He can be reached at ttopolewski@charter.net


Review of:
Dungeon, Fire and Sword: The Knights Templar in the Crusades
By John J. Robinson

Dungeon, Fire & Sword is one of the best Christmas gifts I have ever received. Reading it was pure joy. I became interested in the Knights Templar after one of my visits to the South of France and to the castle fortress of Carcasonne. John J. Robinson paints a spell-binding, comprehensive picture of the middle ages and its impact on today. Mr. Robinson takes us through the origin, the exploits and the ultimate demise of the Knights Templar - OR did the Knights Templar simply disperse and go underground? This is but one of the mysteries addressed in the book. Mr. Robinson ties in the "holy" alliance in the formation of the crusades with the medieval catholic church hierarchy and the politics and royalty of Europe. He draws in famous figures and their role during this time period including St. Francis of Assisi, Thomas Aquinas and Marco Polo. As if this were insufficient, Mr. Robinson provides a parallel history of the Middle East, Asia Minor and even Asia with Genghis Kahn. The result is a neatly wrapped history of the known world during the reign of the Knights Templar.

There are many side stories including the meaning of words. I found myself writing notes in the page margins. For example the word "slaves" was an outgrowth of the word "slavs" who upon defeat were cast into bondage. There are a number of church and state issues which I somehow missed while attending parochial school as a youth. Priests were married until a papal decree in the year 1000. King John of Magna Carta fame imposed a "sin" tax on priests who still maintained mistresses during the 1200s. The underlying strategy and politics occasionally delayed papal elections for years. This book is very even-handed in its approach to the events (and the corresponding personalities) which took place while the Knights Templar were in vogue. Mr. Robinson does not favor, detract from or otherwise reveal a bias that I could detect toward any one group, religion or political entity. Dungeon, Fire & Sword is simply a well written and interesting history of a lesser known time period. The battles for Europe, Byzantium, the Middle East and the merchant trade alliances are intertwined with the economies of war over the Holy Land. It is a book worth reading a second time and indispensable for any family library.
Lane J. Biviano
Rutherford, NJ

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