how will this impact Cleveland Clinic?

Anthem to stop paying for preventable errors - cleveland.com -- This is an interesting development: Anthem (Wellpoint) is stopping paying for erroneous procedures, poor care, and slipshod work. I would be curious to know how the larger institutions, like the Cleveland Clinic, will be financially affected by this withholding of payments. Will this eventually have a financial impact things like the plans for a medical mart?

Perhaps the effect will be so severe that they will begin to serve the Medicaid community once more, to make up for the loss of revenue. For those of you who aren't aware, the Cleveland Clinic opted out of serving the poor and less fortunate by opting out of the Medicaid HMOs last month, keeping the ER open to the poor as a token gesture of the Clinic's charitable intent, and thereby technically preserving their nonprofit status.

Another thing I'd really like to know is how much of the income of The Clinic is derived from being paid for poor work, things like operating on the wrong part of the wrong patient, leaving instruments inside people after operations, septic shock for staff and patients alike, urinary tract infections from forgotten catheters, pressure sores, and fractures compliments of the hospital stay?

We say around here we are in the health-care business. Actually, we are in the business of letting people get so sick and unhealthy that they require extraordinary methods to achieve normalcy once again. Is there more you can bill from treating the incredibly sick than you can for keeping people from getting sick? Is a hospital entitled to bill at all when they have in fact caused the problem for which they're billing?

WORTH Magazine: getting more useful each month

First Person Worth--WORTH Magazine grows more meaningful, for me, by the month; the editors are beginning to broaden the focus to include all of society and the impact proper deployment of wealth can have on the common good. Christy Mack's profile in an issue earlier this fall gives some insights into what giving really means, a lot along the lines of what we are hearing from Steven Post and Jack Ricchiuto. Her particular focus is integrative medicine. Read the whole thing, she has some good insights, one of which is--

For me, philanthropy is not about giving back. It is about sharing a part of who you are, whether it is your wealth or your wisdom, experience, knowledge, talent, skill or something as simple as a smile.

eaters speak: commodity farmers are welfare queens

Weed It and Reap - New York Times -- The politics of food are becoming more apparent, thank goodness, as we begin to question how subsidies affect the public health and ask why we pay so much to enable being porky and diabetic. This op-ed piece provides a very useful perspective on what we subsidize, and how it costs us in so many other ways as well. Our MTB talk with Phil Nabors of The Mustard Seed Market touched on this last fall, and we've talked with Maurice Small and Niki Gilotta since, about what it takes to be healthy and sensible about food.

The op-ed contributor, Michael Pollan, is a very good writer who skewers with wit and garnishes with wisdom. As the NYT briefly points out, Michael Pollan, a contributing writer at The Times Magazine and a professor of journalism at the University of California at Berkeley, is the author of “The Omnivore’s Dilemma” and the forthcoming “In Defense of Food: An Eater’s Manifesto.” Here are some samples, but read the whole piece:

Americans have begun to ask why the farm bill is subsidizing high-fructose corn syrup and hydrogenated oils at a time when rates of diabetes and obesity among children are soaring, or why the farm bill is underwriting factory farming (with subsidized grain) when feedlot wastes are polluting the countryside and, all too often, the meat supply. For the first time, the public health community has raised its voice in support of overturning farm policies that subsidize precisely the wrong kind of calories (added fat and added sugar), helping to make Twinkies cheaper than carrots and Coca-Cola competitive with water. Also for the first time, the international development community has weighed in on the debate, arguing that subsidized American exports are hobbling cotton farmers in Nigeria and corn farmers in Mexico. . . .

. . . . But as important as these programs are, they are just programs — mere fleas on the elephant in the room. The name of that elephant is the commodity title, the all-important subsidy section of the bill. It dictates the rules of the entire food system. As long as the commodity title remains untouched, the way we eat will remain unchanged.

The explanation for this is straightforward. We would not need all these nutrition programs if the commodity title didn’t do such a good job making junk food and fast food so ubiquitous and cheap. Food stamps are crucial, surely, but they will be spent on processed rather than real food as long as the commodity title makes calories of fat and sugar the best deal in the supermarket. We would not need all these conservation programs if the commodity title, by paying farmers by the bushel, didn’t encourage them to maximize production with agrochemicals and plant their farms with just one crop fence row to fence row.

And the government would not need to pay feedlots to clean up the water or upgrade their manure pits if subsidized grain didn’t make rearing animals on feedlots more economical than keeping them on farms. Why does the farm bill pay feedlots to install waste treatment systems rather than simply pay ranchers to keep their animals on grass, where the soil would be only too happy to treat their waste at no cost?

However many worthwhile programs get tacked onto the farm bill to buy off its critics, they won’t bring meaningful reform to the American food system until the subsidies are addressed — until the underlying rules of the food game are rewritten. This is a conversation that the Old Guard on the agriculture committees simply does not want to have, at least not with us.

five easy choices

Five Easy Ways to Go Organic - Well - Tara Parker-Pope - Health - New York Times Blog -- Here are five ways to quickly begin to experience the benefits of a cleaner diet. I really appreciate the one doctor's comments about our "buying into a whole chemical system of agriculture" if we're indiscriminate in our food-buying choices. I also remember how with the kids, ketchup was it's own food group, and the article acknowledges that, "For some families, ketchup accounts for a large part of the household vegetable intake." Absent from the discussion here is mention of fillers and stretchers, like high fructose corn syrup.

This is a good read; click through. They also link to another interesting organic-food-info source: "For a complete list of Dr. Greene’s strategic organic choices, visit Organic Rx on his website."

a new tax, because universal coverage isn't free

Insurers slice rates on health premiums - The Boston Globe--Interesting story in the Boston GLOBE about Deval Patrick tuning up Mitt Romney's mandatory health coverage. There is no magic here; there are no miracles. From the pricing I see in the article, this is pretty much a market rate, and it feels a bit on the high side. I see no subsidy or benefit of volume pricing. I wonder if this is more of a welfare plan designed to support the Massachusetts health industry than it is universal coverage to spread risk fairly and bring about an improvement in public health.

Also, I would like to know from the journalist (Jeffrey Krasner can be reached at krasner@globe.com) the cost of opting out, in dollars, for the same hypothetical people for whom they quote the premiums. That would be balanced reporting. These paid writers need to start earning their keep and not leaving it up to the public dialogues of the blogosphere to extract the facts and frame the issues as they should be framed.

We need to start talking about truly catastrophic insurance coverage to cover the big bills, cash-only fee-for-service care with uniform price schedules for most other procedures, and public-health-clinics for maintenance and wellness programs. If we want to have a health tax, then instead of putting it off soley on the people, we can also put it off on anybody who sells things that make us fat or sick or crippled--vendors of soft drinks, stores that sell cheap plastic shoes, smoking supplies (again), fast-food emporiums, publicly traded corporations who load foodstuffs up with preservatives to prolong shelf life or stretch things out with high fructose corn syrup to maximize profits, dealers who sell raggedy used cars--in short, anybody who now profits from selling a product whose health benefits to the buyers have been reduced to increase the bottom line.