Dr. Gabow Writes a Letter to Senator Alexander
Jun06

Dr. Gabow Writes a Letter to Senator Alexander

Dr. Patty Gabow shared a letter with me that she is sending to Senator Lamar Alexander, the chairman of the Senate’s Health, Education, Labor and Pensions Committee. I think several of her points deserve extra emphasis and I have bolded them. Dear Senator Alexander,   I am a physician who was the CEO of a large, integrated public safety net health care system for 20 years, so I am deeply committed to the care of all the...

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Mr. President, Please Read Chapter 6, “The Affordable Care Act in Hindsight”
May23

Mr. President, Please Read Chapter 6, “The Affordable Care Act in Hindsight”

In August 2015 I gave a talk on the history of the evolution of health insurance that was part of a seminar entitled “Practicing in the Era of Healthcare Reform.”  I concluded my talk with a slide labeled “Persistent Problems.” I recently reviewed the presentation and was surprised by how appropriate the list still is as we face the continuing dilemma of “repeal and replace.”   Persistent Problems: [As of August 2015] Healthcare...

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Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim
Apr25

Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim

After the failure of Paul Ryan’s American Health Care Act to get passed over the internal squabbling of House Republicans despite their forty four vote majority, David Brooks wrote an interesting tongue in cheek column entitled “The Coming Incompetence Crisis.” He articulated his concern:   …I worry that at the current pace the Trump administration is going to run out of failure. So far, we’ve lived in a golden age of...

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A Time to Renew and Expand Our Sense of Professionalism
Mar21

A Time to Renew and Expand Our Sense of Professionalism

Retirement is a time of reflection. Most of one’s agency lies in the past. I must organize opportunities to transfer bits of experience, insight and wisdom to those who still do the work if I am to have the joy of continuing to contribute to the dream of a future where we enjoy   …Care better than we’ve seen, health better than we’ve ever known, cost we can afford,…for every person, every time…in settings that support...

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“Repeal and Replace”: Finally, Something From the Republican Leadership
Feb28

“Repeal and Replace”: Finally, Something From the Republican Leadership

This last week Congress has been recessed for the Presidents’ Day holiday week. Paul Ryan accurately anticipated that many of Republican members of Congress would be having town meetings with their constituents and would face angry voters who wanted to talk down the plans to “repeal and replace” the ACA. Ryan met with his troops on the Thursday before they left Washington for their week of hometown meetings. Like a good general,...

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Applying Lean Thinking to the Future of the ACA
Feb21

Applying Lean Thinking to the Future of the ACA

Tom Price is now in place at his new office at HHS. One of Dr. Price’s first actions was to release a YouTube video that promises us a lot but does not say anything specific about what he plans to do. Seema Verma has been working her way toward Senate confirmation as the Administrator of CMS. Paul Ryan is throwing himself into the work of getting all his ducks in line for the repeal of the ACA. Across the country real people are...

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Good Strategy in a Fog of Uncertainty
Feb07

Good Strategy in a Fog of Uncertainty

There is no challenge like the challenge of creating a strategic plan in uncertain times. What do you do when you do not know what to do? That is a question that frequently challenges leaders. Over eight years ago, after Lehman Brothers had failed and the value of the stock market had fallen by almost fifty percent and we did not know if we were facing a deep recession or the second coming of the Great Depression, I was asking myself...

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Repeal and Replace and the Angst of “The Loyal Opposition”
Jan17

Repeal and Replace and the Angst of “The Loyal Opposition”

Readers of these postings are familiar with my use of the term VUCA, an acronym that is derived from the realization that we live in a world that is volatile, uncertain, complex and ambiguous. I have asserted before that our state of uncertainty about the future of healthcare in the era of repeal and replace complies with the spirit of VUCA. VUCA is a strategic concept. Since the term was introduced to strategic thinkers in the mid...

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