The biggest scariest thing about Obamacare, is that there is already a huge HUGE shortage of primary care providers across the country, and his bill isn't doing a single thing about it.

Can someone explain to me the logic in giving 47 million more people access to primary care and preventative medicine, when there is already a huge shortage of primary care providers.

Here in IL, the wait time to see a primarycare doctor is seven weeks minimum. In rurual ohio, where I'm originally from, it's almost three months just to get an appointment.

Mark my words, once Obamacare passes (and believe me it will, if you're counting on the blue dogs to stop it, you're kidding yourselves), the wait times to see a doctor will get worse and worse.

That's why I urge the people worried about this here, to please please go to this link and support this amendment to the bill...

Basically this amendment stops Obamacare from passing unless it addresses the huge shortage of primary care providers.

We need more primary care providers unless we're willing to wait months and months just to see a doctor once this bill passes. This amendment addresses that. So please go to that link. It just takes a minute of your time.

I scanned briefly through the on-line copy of the book "Innovator's Prescription". When I read "Harvard Business and Kennedy School for Government" I just about stopped but went on a bit. Not sure what to make of it. On the surface it would seem to be saying that the power of technology (EMR) can be used to disrupt current practices and revolutioinize the industry producing huge reductions in cost.

We shall see. My experiences with EMR just lead to new, unforseen problems that require yet another layer of expensive technicians that don't work nights or weekends. I will take this one small example. I (and I am sure many others) thought EMR would "save trees". After all we wouldn't need paper charts. When I started working as a physician on Active Duty in the '80s frequently I saw patients who had 20 years of care in a chart that was not even an eigth of an inch thick. Years of care were documented on one page. Entries were typically: 12May72 Cold Symptoms, Tylenol and Sudafed Maj. Smith.

Now after 20 years (15 with EMR) how thick do you think those charts are? The thickness is the fault of lawyers IMHO. Nervous administrators, worried about defending litigation or investigation advised that the above annotations were inappropriate and demanded "complete documentation" of all encounters. So now those charts are inches thick. I have seen a private rack up over 6 inches of chart in 6 months. EMR has made it possible to copy the entire thing with the click of a single button. How many trees have been saved? EMR has wiped out forests.

So one "goal" of EMR was it's promise of "paperlessness". We have already seen what an illusion that is. Outright hoax, actually. The change that the disruptor wants to begin (from the impression I got in a 5 min. scan) seems to be similar to something the Army tried when I was involved with them (which I no longer am). The Army tried to introduce a Field Manual known by the acronym ADMT (Algorithym Directed Medical Treatment). The manual itself said that the goal of the implementation would be to allow most soldiers to be evaluated by medics and treated quickly through use of symptom and sign directed algorithm use. The example given was that 90% of those showing up for care in the AM at sick call could be rapidly seen and returned to duty (or quarters) in one hour.

My medics brought me the Manual and said they had been trained in this and wanted to implement it. They felt they were being underutilized simply signing folks in and doing vital signs. I read it, and thought to myself "let's see, they want me to let them see and treat most of the 40 patients a day I am seeing?" (and I had 4 other providers that worked for me). We gave it a try. It was a disaster. Their few weeks of preparation in San Antonio hadn't really prepared them for what they claimed they could do. The algorithyms were OK but they didn't really have a good grasp of the definition of the words in them. They never got anywhere near 90% of soldiers at sick call not seeing the doctor. More like 90% of the algorithyms applied led to a box where "...or see doctor." and when they got to that box they were done. We hadn't used it for two months and when the chain of command heard we were using it they literally ordered us to stop. The entire program was suspended from what I understood. Apparently the upper levels of command weren't going to risk their carreers on privates and E-4s treating patients. Hmmm...

Retrospectively I was pretty naive at the time for letting them even try. The best trained and most experienced physician could potentially miss a 5 year old with Kawasaki Syndrome or some seriousl illness and the lawyers make a good living on that fact. What happens to outcomes when the training of the person providing the frontline care has a small fraction of the training of the physician?

If the author of that book thinks EMR and ADMT are going to "disruptively innovate" medical care like PCs did the computer industry I would expect some bad news for that author. I would expect that that author is probably one of the "highly paid consultants whose advice to businesses is so valuable because it allows them to leverage innovation into more succesful business models". This author is an idiot if that is the case. I can tell you that even with some 30 YEARS of EDUCATION and 25 years as a physician it can be very difficult to gain the trust of a sick person. "Doogie Howser" may have been a funny TV show (I wouldn't know, I don't watch TV Medicine) but folks arent' gonna be happy looking accros the room at a "provider" who is entering symptoms into a computer at an SEIU clinic and reading a print out of treatments and prescriptions back to them. I can predict how well that will work based on my experiences. It won't.

Whcih brings us to what really are the goals of the folks wanting to bring us all this "Hope and Change"? Well according to perfessers Cloward and Piven their goal is to destroy America. Hmmmm...

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I understand your suspicion about the Harvard connection, but Christensen's one of the good guys. He doesn't advocate EMRs per se, and he sees little positive in the generation of EMRs that Obama and his friends at GE and Allscripts are trying to foist onto physicians through ARRA.

But he does believe that information technology and the process changes that IT makes possible will inevitably produce disruptive change in the healthcare industry.

I think you'll enjoy this article describing the current situation as a "healthcare bubble". The author is actually describing a not-yet-available TED presentation by Dr. Alan Greene, who "said the attributes of a bubble are:

Trade in high volumes, at prices that are considerably at variance with intrinsic values
A situation where market prices are unsustainably high
Causes misallocation of resources into non-optimal uses
Comes to an end

"This is important. Healthcare as we know it today is dysfunctional – neither party (the patient nor the clinician) is getting from the relationship what they came for. This shall end. Alan laid out the economic forces that foretell the collapse, and participatory medicine (especially with do-it-yourself patient-generated solutions) is the force that will disrupt it."

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