The New President and Healthcare - Part II - Medical Services

Before wholesale changes are made to US healthcare system, Mr. Obama should fix the two health systems that federal government controls. The Military Health System and the Veterans Administration are two of the largest health systems in the United States and have serious problems.

The critical problems with these entities are led by incompetent, indifferent and anti-scientific management. Mr. Obama should immediately request the Bush Administration remove S. Ward Casscells, M.D. and Ellen Embrey. These two individuals are directly responsible for the lack of progress in the treatment of mental illness, mild-traumatic brain injury, traumatic brain injury, suicide and PTSD. They have led a campaign to continue the Bush Administration policy to underreport casualties in the Iraq and Afghanistan conflicts. Further, these individuals have aided and abetted the US Army’s program to deny benefits to wounded and disabled service members. Finally, they will babble endlessly about what we don’t understand about these injuries so it will require years of research. In fact, much more is known about these injuries then they would like Congress to believe. However, these scientific facts fly in the face of their political objectives so they have let contracts to friends of the US Army who will confuse the issue for years.

What to do following the dismissal of Dr. Casscells and Ellen Embrey.

First, quickly review all contracts let by these individuals for contract irregularities and pursue criminal prosecution. Next, remove the US Army from all leadership positions in programs related to mental health and brain injury. The US Army personnel should be replaced by officers from the Air Force and the Navy. The Air Force and Navy are more technologically enabled and lack a political agenda as both branches have honored their disability payments. It is not to say the US Army lacks officers with technical expertise in the areas of mental health or traumatic brain injury but they were excluded from the process because they could not get with the program. Instead, the US Army replaced them with people qualified as occupational therapists and physicians’ assistants. It is time to get organized and led by the right talent. Mental health and traumatic brain injury issues can be solved and could have been largely avoided if it had not become political. Finally, embrace the civilian medical sector. Much of the most advanced research in mental health and traumatic brain injury is at specialized centers such as the Kessler Institute in New Jersey. Civilian entities were willing an able to take a leading role in solving these problems but were denied participation by the hacks running MHS and the VA.

With regard to the VA, Mr. Obama should immediately remove the entire senior management. Dr. Jim Peake is the former US Army Surgeon General. When in uniform, he was part of the program that left the nation unprepared to deal with mental health and traumatic brain injury issues. He not only failed for active service members but also rewarded with even greater responsibility so he could fail them once of service members became veterans. Since the VA is evolved into a system to treat geriatric patients, the surge in younger service members should be guided to civilian medical resources at government expense. The major exception is in PTSD where the VA and CDC did some of the most distinguished work both scientifically and clinically. The VA needs to get some younger more aggressive leadership in this area and capitalize on the VAs expertise. It should also embrace private psychologists to screen and treat the less serious cases locally and triage the most complex cases to VA centers of excellence.

Again, the medical failure at MHS and the VA is not as much a monetary problem as it is a management problem. Last year $2,1B was distributed by Congress to the VA and MHS to treat wounded with TBI and mental health issues. Nonetheless, the leadership is unable to account for much of the spending and the results have been almost nonexistent. With little doubt, the bulk of our service members could have been identified and started treatment. It does and will require funds but funds well spent. Let’s fix the problem and stop the talk.

The New President and Healthcare - Part I - Research

Now that the United States has elected a new president, it is time for Mr. Obama that his talk of change is more than just talk. Mr. Obama has also implied that the US Federal Government can have a powerful and positive impact on healthcare.

The Federal Government is already a major force in healthcare ranging from basic research to direct provision of medical services to reimbursement of fee for service medical services. While enormous amounts of money are thrown into US healthcare, the results are have been less than stellar for the past 30 years. It is time to clean this mess up, and he should start will what the Federal government directly controls.

US Government research has been corrupted by politics for decades. The NIH, CDC and DoD value filling out forms more than the quality of the minds engaged in research. The peer review panels guide funding to politically connected individuals and entities or influenced by professional conflicts. The research is often conducted in the districts of well-connected congressman at third and fourth tier universities by third and fourth tier researchers. Much of the research is funded without results. Failure is fine and expected but what is unconscionable is that so many projects do not advance the field. Alzheimer’s disease, Traumatic Brain Injury and AIDs research are all examples heavily funded scientific political cesspools that have shown unremarkable progress in the past 20 years.

It is time to turn back the clock when NASA, NIH, DARPA, DoD, ONR and CDC when these organizations were led by people who were public intellectuals and visionaries. It was their mandate to identify the best talent and facilitate conquering an objective. Proficiency in filling out forms was low on the list of priorities. Speed and intellect were what counted. The average age of the team of scientists and engineers that put a man on the moon was 26. The average age of NIH grantee is approaching retirement age. Scientists and engineers make their great leaps forward in their 30’s and 40’s and generally extend the same line of work for the balance of the careers. Of course, there are exceptional minds that are super intellects (1% of 1%) and should be given unique permanent funding to indulge their interests. For the rest of the scientific, engineering and math communities, funding should be limited to 3 to 5 years renewable for 5 years. The funding should be based on clear objectives. Progress should be judged by peers in other fields as well as those in the art. Panels used by funding agencies tend to be filled with people who are third and fourth tier minds in the art who have nothing better to do than sit on a government panel. Identify people that don’t want to serve and who have something better to do and encourage them to identify and support the next generation of big brains.

People in the field, if infected with any degree of humility, can identify the most talented minds and people outside the field can generally identify those that are truly gifted from those that are merely hardworking. This will disturb many in Congress because the balance of funding will be concentrated on the coasts at the leading US research institutions like Columbia, Harvard, Yale, UCal, and Stanford and leave out East Podunk University. On the other hand, some of the most creative thinkers find their homes in the most unlikely places as their radical thoughts run contrary to orthodox views. It is incumbent on the federal government to find skilled administrators to find the talent and support it regardless of location or political influence. It is time to move the ball forward. It is also time to move it quickly and cost-effectively. More money without better methods will get us nowhere.

Part II – will deal with the US federal government’s provision of healthcare.

CDC Recommends People 60 and Older Receive the Shingles Vaccine

The Center’s for Disease Control has created guidelines that all citizens 60 years of age or older should receive the shingles vaccine ZOSTAVAX. Insurance companies should now reimburse the cost of the vaccinations.

One million cases of shingles are reported each year with half the cases occurring in people 60 years old or older. 50% of all people reaching the age of 85 will contract shingles. Shingles is caused by chickenpox virus, and its effects range from mild to debilitating.

ZOSTAVAX reduces the likelihood of getting shingles by 50%. The cost of the Merck vaccine is approximately $150.