is up and ready for your perusal this Saturday morn’.  No better way to start off your day than a quick summary of the latest info and insight into health care!

MCM has been up and running for more than a dozen years, over 3,000 posts, and multiple iterations. We average about 1400 visitors each day we post.

It’s time to review what we do and see what needs to change.

Not to worry (or cheer, depending on your view) It’s not going away.  Nope, we’re going to continue doing what we do – reporting what we think is important; calling out the bad actors; applauding the good folks; digging into the details; and challenging you, dear reader, to think more deeply.

This is more important now than ever.

The American health care system  – patients, providers, payers, suppliers, intermediaries – accounts for one out of every six dollars in our economy.  17 percent plus of our GDP. Almost three trillion dollars. Likely 20 million + jobs, many of them well-paid.

As we’ve seen with ACA, changing this “system” is wrenching indeed. It’s incredibly politically charged, stupidly expensive, delivers poor results for what we pay, brutally hard to explain, and stuffed with great reasons to not change. Oh, and there are more lobbyists focused on pharma, medical devices, insurance, providers and health systems than for everything else combined (I kinda guessed at that last one, but it’s likely true).

After the most bizarre and unpredictable election in memory, it’s now the Republicans’ turn.  Reforming 1/6th of the nation’s economy is challenging indeed, and we all hope they get it right, as there is so much at stake.

For my work comp readers, we’re used to being the flea on the tail of the elephant. When you buy just 1.25% of all the health care services in the country, you get used to being whipped around and having almost no ability to choose where you go.

Make no mistake, the “reform of health reform” will dramatically affect workers comp.

Here’s what’s happening at MCM.

1. All comments will be moderated.  After a raft of nasty comments from a very few posters it’s no longer advisable to let comments go “live” without moderation.
2. We’re adding a new category – Health reform’s impact on worker’s comp. You can see those categories on the right side of the home page, where all posts are neatly categorized. Just click on the one you want and voila!
3. As always, courteous, intelligent, and fact-based disagreement is welcome. If you want to take issue with a post or specific content cite primary sources to back up your statements and claims. Unsupported rants will not be posted.
4. Anonymous comments may or may not be posted.  You know who I am, it’s only fair I – and other readers – know who you are.

In January, we’re launching a periodic podcast which will focus on key issues, update you on deals and transactions, provide context on health reform, and answer your questions.  Will keep you updated on that – it’s been a long time in coming!

There are thousands of veterans waiting for the Veterans’ Administration to streamline disability evaluations.  While they wait, the VA dithers.

This has dragged on for more than a year, a year in which the GAO pummelled the VA for failing to comply with its own contracting standards when awarding contracts to a huge defense contractor – Lockheed Martin – that has almost NO experience in disability evaluations.

According to a piece in Politico earlier this year;

the GAO “citing “prejudicial errors” has directed the Department of Veteran Affairs to go back to the drawing board…the office “recommended that the VA reopen negotiations with the offerers, solicit, obtain, and evaluate revised proposals; and make new source selection decisions” [emphasis added]

Oh, and the VA “misled two of the protestors during the conduct of discussions or negotiations.  These errors led the VA to make source selection decisions…that were unreasonable…” [emphasis added].

One of the protesting bidders – Veterans Evaluation Services – published an ad in yesterday’s WSJ calling on Trump to fix this.  Here’s hoping this gets results.  (disclosure – I’ve done work for VES in the past)

And fast, because our veterans have been waiting for far too long.

In an effort to get my head around Trump’s victory, I’ve spoken with several good friends with diametrically opposite political leanings, folks in the demographic that used to be called Northeast Republicans. The conversations have been long, heartfelt, passionate, and courteous. Here’s what I’ve learned.

The depth of disgust for the Obama years is deep.  One very knowledgeable colleague described economic growth under the President as “zero”.  While GDP growth has not been anywhere near as robust as one would like, it has averaged 2.1%. A detailed and dispassionate perspective is here. Job growth has been anemic indeed, labor force participation is low – but improving, while wages have improved markedly – if only recently. And, the last 8 years has also been a time of relatively low growth in world GDP, much lower than it was during the Reagan, GW Bush, and Clinton eras. Tough to grow a very mature economy when our buyers and sellers aren’t growing at all.

The discussions have been wide-ranging but all come back to this sense that the country is somehow on the “wrong track.”

Into this comes Donald Trump, a candidate with a chequered business career, well-documented behavioral issues that would disqualify him from being hired by most employers, is notoriously thin-skinned, and has policy positions that are, at the very least, confusing and ideologically inconsistent. And that’s leaving out the really ugly stuff.

Among his policy ideas/positions/stated plans:

• building the wall – consistent with GOP orthodoxy
• renegotiating NAFTA – not consistent
• declaring China a currency manipulator – not consistent
• raise the minimum wage – not consistent
• ramp up fossil fuels – consistent
• friendship with Putin – not consistent
• spending a trillion dollars on infrastructure- not consistent
• reduce taxes on the wealthy – consistent
• repeal “Obamacare” – consistent
• climate change is a hoax – consistent
• add $10 trillion to the debt to accomplish varied goals – not consistent.

Point here is not to get into policy details, but rather to note Trump doesn’t toe the ideological line, rather he jumps back and forth with amazing rapidity.

When I ask my friends why they voted for Trump, it clearly isn’t about policy. Trump’s “policies” are decidedly NOT conservative. They say things like:

• “I hope he surrounds himself with people smarter than him and listens to them”
• “he didn’t mean those things, he just says crazy stuff”
• “the legislature will do most of the policy setting work”
• “he will get the best SecDef (Secretary of Defense) and he (Trump) will lead from ahead”

I don’t see it.  Trump won by ignoring all experts, by going his own way, by following his own genius. And that has brought him to the most powerful position on the planet. Why would he listen to anyone else?

If anything, these conversations have gotten me even more bewildered. Middle-aged successful intelligent professionals decided to vote for – and support – a candidate with many views directly contrary to theirs, with serious behavioral issues, and with a temperament they acknowledge is highly concerning instead of a pretty ordinary but highly experienced center-left politician with a long reputation for working well with Republicans.

The risk:reward thing is what stumps me.  Trump will have the nuclear codes.  He will have the “trade-war codes”. He has control over foreign policy. All areas with huge risks – some of them existential. Yet none concerning enough that my colleagues didn’t vote for him.

I very much hope my colleagues’ optimism is well-placed.

And very much fear it isn’t.