Thursday, July 28, 2016

Trickle Down....

What’s trickled down is the hate and the solipsism of the conservative elite who have  pushed what they knew to be  the bogus trickle down economic theory.  It is a trickle down of morality not  of the economy.  They have connected with the baser elements of our morality, that, yes, exists in all levels of society.   Notwithstanding the virulence of these baser emotions extant in all sections of the non-elite, it has been the conservative elite that have prayed upon and stimulated these emotional and (im)moral proclivities.  No matter how disguised ( with  perhaps some self-delusion)  the fear and greed of our society is trickling down from , supported by,  the elite who will best be served by such divisive tactics. 

As for the economic trickle down malarkey, I am with David Cay Johnston who refutes that and more accurately calls it "Niagra Falls,  Up"

Wednesday, January 20, 2016

More PK and Single Payer

Paul K has another item on the unfeasibility of Single Payer.  This one utilizes the not uncommon mislabeling of  Vermont's attempts as "Single Payer."

A better account of Vermont's almost , but-not-really, single payer plan is at PNHP--.
Covers most of the same territory as the Kliff article-- but is more informed on single payer , e.g. --" It’s a misnomer to label Vermont’s Green Mountain Care plan 'single payer.' It was hemmed in by federal restrictions that precluded including 100 percent of Vermonters in one plan, and its designers further compromised on features needed to maximize administrative savings and bargaining clout with drug firms, and improve health planning."

I would add that Vermont's small population, and therefore, risk pool would hamper even a true single payer process. But, Single Payer would still be best. This was, indeed, a political/organizational failure, not an economic one.

Further-- it is also inaccurate to include doctors (and other practitioners) in the list of those who will be negatively financially impacted. Institutional costs-- pharma, hospitals and the like will be reduced. But practitioners will actually be more empowered, and less burdened, so as to be able to be appropriately compensated. Canadian institutional costs are far less than ours, Canadian practitioners-- particularly primary care physicians-- are compensated similarly to U.S.'s--- especially once you take the weight of insurance required work off of their backs. 

And BTW, Colorado Care's universal care initiative  to be voted on in November is not Single Payer either.  From funding tab of summary : ColoradoCare will serve as a supplemental plan to Medicare and will apply to become a Medicare Advantage Plan. For any other health insurance plans that are in effect, ColoradoCare will be a secondary payer, up to the payment level of ColoradoCare coverage.

Tuesday, January 19, 2016

An Appeal to Paul Krugman

Paul, Paul

You have recently expressed rejection of the idea that we can adopt single payer, expand coverage and services and still save lots o' money. 

Please, Please, if you haven't already, read Lewin report 2005 on California Single Payer and any of several of Gerald Friedman's  economic review of several SP plans, including for New York. (And just about every, if not every, SP study done.) They all consistently point out the savings and expansion in coverage and services that you decry as impossible.   Perhaps you have strong economic disagreement with them.  If so, I am sure we would be happy for your insight.

Saturday, January 9, 2016

Why Economists Took So Long to Focus on Inequality

Over at Bloomberg Views Justin Fox has an excellent article of the same name.  In fact it inspired my thoughts.  He does  a very good job of explaining the what--  needing data--  but not so much the why.   As always, "The Grail Question,"  -- Who does it Serve? helps us focus on understanding the underlying dynamics. 

The push for "data" to prove what we already know is a time honored delaying tactic.  It is endemic and, in  general, serves those who, we already know, will be disadvantaged once what we already know has been sufficiently "proven."

E.g. ,  We knew not only that there was growing inequality but that it is harmful to society ("children and other living things." ) Yet, for 30 years "no one had the data"  for what we all could see if we only looked. No one had the data for "welfare queens" either but that seemed more readily believed and influential in our economic and political discourse.  

End of the day--  there are plenty enough resources for education, mental health, health care, the 99%... It is just that it all resides in the pockets of those who are benefiting from a rigged system  (euphemism for--"they stole it !") and are "awaiting the date."

Wednesday, March 11, 2015

Fee for Service and the Consolidationistas

 This post  will be need more background to be completely comprehensible. But I will pay that background foward by excising some of the referenced material and posting it later... Meanwhile I do not want to lose the thrust energy of the below thoughts--


First of all -- I am talking  about how I see the proposed reimbursement structure for single payer.  Yes,  HR686 and other discussions allow for FFS.  But what I see is a continuing thrust not only to lower the already inadequate reimbursements but to marginalize, if not eventually eliminate, the utilization of that process. 

 Pay for Performance, Global Budgeting, Accountable Care Organizations, etc are already being pushed as the main administrative structures.  And MediCare, et al, are setting targets for enhancing this process.

As I see it these structures are being pushed as if they are already proven approaches.  This is far from true.  In vivo they are only retreads of Managed Care, Capitation , Case Rates, etc that proved such failures in the 90’s.   In research and logic they seem to primarily promote more administrative game playing in the service of  capturing income/profit at the expense of actual appropriate service delivery.

Further, it seems to me,  one of the largely unspoken drivers away from FFS is distrust of the professional—as if some big administrative agency can be held more accountable.  Do we need to appropriately monitor services for fraud and incompetency—of course we do.  But incentivizing ever larger corporate entities only makes it more difficult to hold them accountable.

All this would be moot, or, at least,  of less concern,  if  there were  actual co-committed efforts towards  sustainability and enhancement of FFS .  However, I certainly do not read the current environment (and tea leaves) that way. 

Two recent commentaries illuminate my concerns from opposing ends of the spectrum.   The first is Lessons from an Early Adopter  ACO  (free subscription may be required. ) This is from Open Minds—a Mental Health data advocate par extraordinaire,   that promotes- despite its own internal evidence to the contrary--  subservience to ACO’s as the only way to accrete the mountain of data that is seen as a good in its own right.   The second is from a  Don McCanne discussion of concerns about consolidators missing the point of interference with, not enhancement of, service delivery.

Anyway, I suspect much of this is falling on sympathetic ears.  But the main point I want to address is finding some way to enlarge this discussion.  I do not pretend to be in the know about all that is going on.  But, from twenty five years of public health, non-profit and political service and private practice it seems pretty clear to me that the corporatizing consolidationists continue to control the discussion and the actual people who deliver and receive the service are marginalized.   

Strong advocacy  for the efficacy and preference for FFS does not seem to be very visible.  I want to help change that. 

Wednesday, November 13, 2013


Probably not many have read the two previous blogs.  However, it occurs to me, belatedly?, that I should at least note that -----    I WON the election for membership to the Board of AAMFT-CA. ( 3 years beginning in January.)  As time permits, I will add to this post-- or add new ones for further thoughts/actions in re: ....

For now, suffice to express  my gratitude and  my excitement for the opportunity to  further  engage/educate/impact the process of a more people-sized mental health, medical and social reality.  NUF-SAID (stanlee)

Sunday, September 1, 2013


 I am on the ballot for the AAMFT-CA  Board of Directors-- with my main "platform plank" as  getting our organizations to be  proactive re: reimbursement and administrative issues with insurance companies, Affordable Care act, and more responsive to member concerns, etc

The ballot was e-blasted on 8/27.  And voting closes 9/20.  (If you have any difficulty with voting, please contact Gita Seshadri, Ph.D, Elections Council Chair, at

DID YOU KNOW  that  the general thrust of the corporatization of health care has, for example,  led the AAMFT to passively accept and advise those of us who are  insurance plan providers  to  “expect that the plans…will ask (us) to accept 2014 FEE RATES BELOW THOSE” we presently receive. (AAMFT Family Therap-eNews, 5/31/13)

I do NOT accept this.  It is one, very big, example of how we need to be more proactive in protecting our profession and expanding—not reducing-- its efficacy.  I believe I bring the experience in health care advocacy and organizing to help AAMFT-CA be an active, effective participant in this on-going process.
Further, as mundane as it may sound—the current AAMFT-CA  Board (it seems ) is all located in Southern California.  I am in the S. F./East Bay area--perhaps I can help bring some bioregional balance.   

Please VOTE FOR ME  and TELL YOUR AAMFT FRIENDS and COLLEAGUES  (Two vacancies but voting for only one increases chances of winning)

Happy to address any questions and to hear your comments and ideas.  Any help you can render-- of course-- greatly appreciated

THANK YOU VERY MUCH  (and my apologies if you have received multiple announcements)