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Tue Jul 28 12:51:33 BST 2009

Norm,
I too will place my last words on this subject in writing, 'cause I actually have to work to get paid.   Thanks to Ken for all of the behind the scenes work that he has and is doing to help with the reform, and thanks to both of you - and many others on the list - for keeping this discussion going in a professional and respectful manner.  There are some on the list that could learn from that.
Best wishes,
Ron

________________________________
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
Sent: Monday, July 27, 2009 10:45 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Centrist vs Local Social Systems

As a brief follow up. Katrina was a disaster by all participants... no one was prepared. When Gustov and Ike came along, both the private hospital system (HCA) and the public hospital system ( Charity Hospitals) did a great job. the federal government system (FEMA), failed again. That is what worries me

I have had my say on this subject.

Well yes.... one more word. Ken is very much on top of these problems. Ken, thank you for keeping us abreast of the current crisis.

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu<mailto:norman.mcswain at tulane.edu>

________________________________
From: trauma-list-bounces at trauma.org on behalf of KMATTOX at aol.com
Sent: Mon 7/27/2009 7:53 PM
To: trauma-list at trauma.org
Subject: Re: Centrist vs Local Social Systems

FIONA:

It seems that is you that in your post have shifted the goal posts from the
 government being the enemy or the one rushing to change the regulation TO
THE  INSURANCE COMPANY AS BEING THE BIG SATIN, and creating rules which are
unfair to  hospitals, doctors, and patients, and denying care, increasing
the hassle  factor, while taking 25% profit off the top.

Otherwise, it seems to me that you and Norm and supporting the same
concept.

Remember, it is possible to have a government as a protector, not a
provider, and in that protection, they can collect money, such as user fees,  etc.
and distribute those dollars to local areas for local solutions to local
problems.    That is done in so many areas of our  society.   Where the
Centrist Government in our country or any others  get into the personal aspects
of peoples lives (religion, banking, health care,  education, etc), it gets
all fuzzy and inefficient.    If you  liked what FEMA did for the country and
for individuals after Katrina, you are  going to love HEALTH CARE under our
centrist government in the United  States.

k

In a message dated 7/27/2009 7:42:47 P.M. Central Standard Time,
tielserrath at yahoo.co.uk writes:

If  you're going to make a case for this you need to stop shifting the
goalposts. First govt employees have no incentive to be productive,
now govt systems are simply 'unworkable'. Obama is going to make the
health system 'unworkable' like the others. What, exactly, do you  mean?

There seems to be a lot of complaining about possible changes,  but
very little factual evidence about why those changes will, or  will
not, work. Just the inevitable 'private good, government bad'  that
seems to pass for rational discussion in the States nowadays.  Everyone
seems to be ignoring the fact that the govt is currently  bailing out
the private sector with billions of dollars that could  have been
better used elsewhere.

As Pret has pointed out,  working only in high-level trauma care offers
a somewhat skewed view  of the health system. Only a tiny minority of
the population ever  requires these services. What is important is
excellent primary care  and appropriate and timely access to secondary
care on an inpatient  and outpatient basis. Plus being able to change
employment without  having to worry about losing health insurance. And
rationalisation  of preventive treatment - which inevitably means
making it free - to  reduce costs further downstream, without letting
moralising  interfere.

Fiona.

On 28/07/2009, at 8:45  AM, McSwain, Norman E Jr. wrote:

> I know that that are plenty of  workable systems elsewhere. I am
> lucky enough to see some of  them at work. The reality however is now
> we are faced at making  the US system work without bankrupting the
> entire country. Our  president has suggested a system that does not
> improve the  healthcare provided but only shifts the cost to the
> government  from the privates. Like it or not, we cannot suddenly
> make ours  like others. Unfortunately that is what he is trying to do
> but  without looking at the whole picture. We have several unworkable
> government systems Making the healthcare system unworkable like  the
> others will be very BAD for our patients. He is changing  the good
> without changing the bad and making a system that will  be much more
> expensive than our current one.
>  Norman
>
> Norman McSwain MD
> Trauma Director, Charity  Hospital
> Professor of Surgery, Tulane University
> New Orleans  LA
> 504 988 5111
> norman.mcswain at tulane.edu  <mailto:norman.mcswain at tulane.edu>
>
>  ________________________________
>
> From:  trauma-list-bounces at trauma.org on behalf of Fiona Wallace
> Sent: Mon  7/27/2009 5:25 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re:  Centrist vs Local Social Systems
>
>
>
> Capitalists  seem to struggle with the concept that there are many of
> us in the  health service for whom a fat paycheck is not the driving
> force. The  vast majority of people I have worked with both in medicine
> and  nursing consider it primarily vocational.
>
> There are doctors  and nurses in many first world countries who work
> for a salary that  most in the States would consider risible, yet do an
> excellent job  within a variety of systems. The nursing staff I
> currently work with  are all on permanent contracts as government
> employees, yet there is  no dead wood and everyone, without exception,
> works well and extremely  hard.
>
> Sorry, Norman - you need to step outside your own system  and see what
> is really possible elsewhere.
>
> [because  after all, Goldman-Sachs is such a shining example of how
> private  banking has done so much for the ordinary American.
http://www.smirkingchimp.com/author/matt_taibbi
>   ]
>
>  Fiona
>
>
>
>
>
>
> On 27/07/2009,  at 7:35 AM, McSwain, Norman E Jr. wrote:
>
>> Sorry to disagree  but I think it is the system that has failed or
>> has allowed the  entity to fail. There are many other well known
>> similar systems  that failed when they have become 'federalized' .
>> One of these is  well known medical system and the other one is a
>> travel agency.  Both of these systems started off with very good
>> intentions until  the members lost the incentive to be productive and
>> were just  looking for a place to remain protected and get their
>> paycheck.  More interested in the paycheck than the service that they
>> were  supposed to provide to the public. But of course that is a
>> person  opinion from one who is capitalist who believes in being
>> required  to be productive in order to get paid.
>>
>>  Norman
>>
>> Norman McSwain MD
>> Trauma Director,  Charity Hospital
>> Professor of Surgery, Tulane  University
>> New Orleans LA
>> 504 988 5111
>>  norman.mcswain at tulane.edu  <mailto:norman.mcswain at tulane.edu>
>>
>>  ________________________________
>>
>> From:  trauma-list-bounces at trauma.org on behalf of Doc Holiday
>> Sent: Sun  7/26/2009 2:24 PM
>> To: .Trauma List
>> Subject: RE:  Centrist vs Local Social  Systems
>>
>>
>>
>>
>> From:  nmcswai at tulane.edu
>>
>>
>>> left out the other  'wonderful' social system...US postal service...
>>
>>  ==> When it comes to nationally sponsored bodies he may have  also
>> left out the US Military and the judicial system, not only  the
>> USPS... There are success stories and failures, be they  among
>> capitalist entities or "socialised" ones or "federalised"  ones;
>> likely therefore that it is the entities which are at fault,  not the
>> sysem within which they live. The UK postal office is not  held up as
>> an example of success either.
>>  _________________________________________________________________
>>  Windows Live Messenger: Happy 10-Year Anniversary-get free winks  and
>> emoticons.
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