PUBLIC (OPTION) ENEMIES: BLUE DOGS

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DEMOCRATS-IN-NAME-ONLY SCUTTLE AMERICANS' HEALTHCARE

REPUBLICANS IN & OUT OF DEMOCRATIC CLOTHING
WORK FOR BIG HEALTHCO AGAINST YOUR HEALTH

Could The Problems With Our Political System Be Any More Obvious?

OK, you can relax now. Put your pants back on. You're not getting healthcare for your tax dollars or your consumer dollars. Just another finger wave. All you'll get is exactly what you've always gotten: Whatever was left over after non-medical "insurance" middlemen and rich greedy Healthco's took as much profit as humanly possible, and then some. That's the purpose of the American healthcare "system": To make a few people rich while millions get sick and even die for lack of healthcare, including those who PAID for private health insurance. That's why we need a "public option." And that's why we're not getting one. Not a real one, anyway. Not ever, under the current political system. Because your "representatives" don't work for you. They work for the corporations; in this case, Big Healthco's.

Yeah, you thought with all this "CHANGE" you bought at the ballot box with your precious vote last November, you would AT LEAST get immediate single-payer universal national healthcare, right? Well, bullsh*t. That's all you're getting. B-U-L-L-S-H-*-T.

Who's to blame for this? Republicans. Conservatives. And their allies: "Moderates," "Centrist" DINO's and other right-wing -ssh-les and wh-res in the pay of Big Healthco's. Just read the lists below, and see if your "representatives" are on it.

Democratic President Obama and his Bush & Clinton staff and appointees just can't seem to put into action the will of 85% of the American people. Democratic Speaker of the House Nancy Pelosi just can't seem to wring a simple voting majority out of her overwhelming legislative majority of Democrats in the House of Representatives. Democratic Senate Majority leader Harry Reed is unable to get his 60-vote majority to back the Democratic Party's Number One Priority. The public option be damned. No matter what the public wants.

Are we not a democracy? No? Why not? Because Obama, Pelosi and Reed are part of and/ or beholden to a small group of obstructionist, traitorous right-wing so-called Democrats who deliberately take the side of multinational healthcare companies against the side of their own voters and other constituents. They do this because they are bought and paid for by those same healthco's, publicly and unashamedly. The healthco's "political contributions" to the Blue Dogs are all out in the open and on the record. The biggest wh-res get the most money. And it's all perfectly legal. Well, look who wrote the laws. The very same crooked sc-mbags who benefit by them financially.

So, it's time for Step Three of our "CHANGE." In Step One, we kicked many of the Nazi-wannabee Repukelickin's out of Congress. In Step Two we kicked even more of them out, and kept them from holding on to the White House. In Step Three, we clean out the closet-Republican Blue Dogs. In Step Four, we dump Obama, if he doesn't get his sh-t together. Four simple steps to a real democracy. Oh, and we MUST eliminate all corporate money from our political system. Money is NOT speech. And plutocracy is NOT freedom. Change it now.

Here's the public data on the Big Healthco Ho's In Congress. Gawd only knows what else they get under the table. Tip of the iceberg, much?

Anyone with career-damaging information on these Blue Dogs please post it. Everywhere. Pictures of them with live naked boys or dead naked girls a plus. Photoshopping is OK. Just Do It.


NY DAILY NEWS
"'Blue Dog' Democrats ignoring Americans' pain in resisting Obama health care plan"
Are ya SICK, yet?

' You know the Blue Dogs: They're the conservative Democrats who are dragging their paws on President Obama's wish to pass a law by September to give all Americans health insurance. The Blue Dogs used to be called Yellow Dogs, because they were so loyal to the Democratic Party that they'd "vote for a yellow dog if it was on the ticket." They changed to blue after feeling "choked blue" by the liberals. The 52 Blue Dogs are linked to the Republicans. They want to "reduce the subsidies lower-income Americans will get," The Wall Street Journal says. As it is, medical bills cause half the personal bankruptcies in the U.S., even for people with health insurance. We called Alpha Blue Doggie Rep. Mike Ross of Arkansas to ask if he wants poor Americans to get less health care than rich Americans. He didn't call back. The Blue Dogs also want to know how we're going to pay for insurance for the 46 million Americans, including 8 million children, who don't have any. Maybe their fear is fueled by the $508,000 their political action committee got from the health care sector - up 90% from two years before. Oh, well, since Congress is going to recess before doing anything... '

THE BALTIMORE SUN
"Blue Dogs: Fiscally responsible or corporate tools? "
Tools.

' Brad DeLong says: The Blue Dogs have been bought and paid for. They do not want a fiscally-responsible bill. They want to please their masters from the health insurance industry by trying their best to keep there from being a bill at all. '

THE NATION
"Ain't Nothing Centrist About Them"
Centrist? They're freakin' closet Nazi's!

' The Nation -- At this moment -- when 72 percent of the nation supports a public plan option and 14,000 people lose their healthcare every day -- the House Blue Dogs and conservative Democratic Senators are doing just about everything they can to cripple real health care reform. So why does the media keep ceding them the label of "centrist" or "moderate" as if they are the guardians of mainstream values? The danger is that promoting the view that these conservative Democrats are somehow at the center of our politics plays into the hands of those who would like to marginalize progressives as far outside of the mainstream. (And I have no doubt K Street is advising Republicans to constantly refer to their Democratic allies as "moderate" and "centrist".) It also misrepresents what most Americans want from the government in these times. As Drew Westen, professor of psychology at Emory University, founder of Westen Strategies, and author of the invaluable The Political Brain, told me: "The average American, according to all available data, has largely moved slightly left of where it was in the Reagan years, and with changing demographics, it will be far left of Reagan and Bush in twenty years. So to call Democrats who are substantially right of the center of the electorate (let alone of their party), like Heath Shuler, 'moderates,' is both to misrepresent the center of political gravity in the general electorate and in the Democratic Party." How we tell the story of this battle for health care reform matters and will impact whether the battle is won or lost. So-called "centrists" are far from the center of this debate. They are, in fact, out of touch and out of the mainstream -- like the rest of their conservative brethren. '

US HOUSE OF REPRESENTATIVES: BLUE DOG COALITION WEBSITE
"The Blue Dog Coalition: 15 Years of Leadership "
You tax dollars at work, f**king YOU. If your Congressperson is on this list, work to defeat him or her next time he or she runs for office.

' Blue Dog Leadership Team
Rep. Stephanie Herseth Sandlin (SD), Blue Dog Co-Chair for Administration
Rep. Baron Hill (IN-09), Blue Dog Co-Chair for Policy
Rep. Charlie Melancon (LA-03), Blue Dog Co-Chair for Communications
Rep. Heath Shuler (NC-11), Blue Dog Whip
Blue Dog Members
Altmire, Jason (PA-04)
Arcuri, Mike (NY-24)
Baca, Joe (CA-43)
Barrow, John (GA-12)
Berry, Marion (AR-01)
Bishop, Sanford (GA-02)
Boren, Dan (OK-02)
Boswell, Leonard (IA-03)
Boyd, Allen (FL-02)
Bright, Bobby (AL-02)
Cardoza, Dennis (CA-18)
Carney, Christopher (PA-10)
Chandler, Ben (KY-06)
Childers, Travis (MS-01)
Cooper, Jim (TN-05)
Costa, Jim (CA-20)
Cuellar, Henry (TX-28)
Dahlkemper, Kathy (PA-03)
Davis, Lincoln (TN-04)
Donnelly, Joe (IN-02)
Ellsworth, Brad (IN-08)
Giffords, Gabrielle (AZ-08)
Gordon, Bart (TN-06)
Griffith, Parker (AL-05)
Harman, Jane (CA-36)
Herseth Sandlin, Stephanie (SD)
Hill, Baron (IN-09)
Holden, Tim (PA-17)
Kratovil, Jr., Frank (MD-01)
McIntyre, Mike (NC-07)
Marshall, Jim (GA-03)
Matheson, Jim (UT-02)
Melancon, Charlie (LA-03)
Michaud, Mike (ME-02)
Minnick, Walt (ID-01)
Mitchell, Harry (AZ-05)
Moore, Dennis (KS-03)
Murphy, Patrick (PA-08)
Nye, Glenn (VA-02)
Peterson, Collin (MN-07)
Pomeroy, Earl (ND)
Ross, Mike (AR-04)
Salazar, John (CO-03)
Sanchez, Loretta (CA-47)
Schiff, Adam (CA-29)
Scott, David (GA-13)
Shuler, Heath (NC-11)
Space, Zack (OH-18)
Tanner, John (TN-08)
Taylor, Gene (MS-04)
Thompson, Mike (CA-01)
Wilson, Charles (OH-06) '

HUFFINGTON POST
"SENATE BLUE DOGS"
Makin' a list, checkin' it twice...

' The Leadership Team:
Senator EVAN BAYH Indiana
Senator BLANCHE LINCOLN Arkansas
Senator TOM CARPER Delaware
Members:
Senator MICHAEL BENNETT, Colorado
Senator MARK BEGICH, Alaska
Senator KENT CONRAD, North Dakota - Chairman, Senate Budget Committee
Senator KAY HAGAN, North Carolina
Senator HERB KOHL, Wisconsin
Senator MARY LANDRIEU, Louisiana
Senator JOE LIEBERMAN, Connecticut
Senator CLAIRE McCASKILL, Missiouri
Senator BEN NELSON, Nebraska
Senator BILL NELSON, Florida
Senator JEANNE SHAHEEN, New Hampshire
Senator MARK UDALL, Colorado
Senator MARK WARNER, Virginia '

CAMPAIGN DIARIES
"Of the power of conservative Senate Democrats"
Rats in the House, more rats in the Senate.

' Before becoming Majority Leader, Harry Reid was known as a moderate Senator, and it is possible that he would have been part of Bayh’s caucus had he not been part of the Democratic leadership. (The last time I wrote about Bayh’s group, I was only able to identify 12 other Senators: Landrieu, McCaskill, Lieberman, Lincoln, Pryor, Warner, Bill Nelson, Ben Nelson, Klobuchar, Shaheen, Casey and Begich. A recent NYT piece adds 5 names to the list: Tom Carper, Mark Udall, Michael Bennet, Kay Hagan and Herb Kohl. This is one of the first times Hagan has signaled she could cause trouble for progressive causes; Kohl’s presence helps explain why he is one of the Democratic hold-outs on EFCA.) '

538.com
"On Health Care, Who's Hooked on Special Interest Money?"
Who's feeding these rats?

' The AMA, however, is hardly the only player in the health player game. Based on data collected from OpenSecrets.org, I've tallied the amount of contributions that each of the 99 current senators have received from Political Action Committees -- PACs -- from the health care industry since 1989. This includes PACs associated with pharmaceutical companies, hospitals, HMOs, health services companies, medical supply companies and physicians', dentists' and nurses' groups. It does not include any money collected from individual contributors -- only money collected from PACs.

Share of Campaign Contributions from Health Industry PACs 1989-Present '

TALKING POINTS MEMO.COM
"Update: List of Dem Senators Who Don't Support the Public Option"
Is YOUR Senator opposed to the public option? Check the list below.

' Strongly Opposed (2)
Mary Landrieu (LA)-
Joe Lieberman (CT)- Both Lieberman and Landrieu have specifically opposed a public option.
Opposed (9)
Bill Nelson (FL)- Sits on the Finance committee, does not want to embrace the public option but has avoided openly opposing it.
Tom Carper (DE)- Co-sponsored the public plan-free Healthy Americans Act with Wyden. Wants co-ops.
Mark Warner (VA)- Deftly avoiding having to confront the public plan issue.
Mark Pryor (AR)- Blue dog senator who has kept quiet on the public option. I'll take that as secretive opposition. Again, if anyone else has better knowledge on a senator's position, let me know.
Ron Wyden (OR)- Frequent target of pro-reform ads, sponsor the Healthy Americans Act, which does not include a public option.
Mark Begich (AK)- Very little available about his opinion on the public option. He's from a weird state (sorry Alaskans). His next election isn't until 2014. I'm going to put his as a conditional tough sell until I learn more.
Jon Tester (MT)- I couldn't find much on his position, either. Maybe someone more familiar with his political tendencies can fill me in, but I'm going to fill him in as a tough sell.
Evan Bayh (IN)- Fiscally conservative Democrat. Wants to shift the focus away from public option, though he hasn't openly opposed it.
Diane Feinstein (CA)- Seems determined to avoid outright opposition to the public option, though it's clear she does not like it. Gets lots of $$ from insurance companies. Says criticism from left does not bother her. She has reason to worry, though, as her constituency is very liberal and probably very passionate about a public option.
Cajoleable (9)
Michael Bennet (CO)- Prefers the co-op idea, but said he could support a public option.
Max Baucus (MT)- He's been trying to compromise with Republicans by offering them compromises that don't include a public option, but he has said the public option is 'on the table', and he said he opposes the public option merely because it won't get enough votes, not on substance.
Maria Cantwell (WA)- Offered support for a public option, but was vague about what that means. She should be in a position to vote for the final bill.
Kent Conrad (ND)- Main reason for opposing the public option because it didn't have the votes, not because of its substance. If momentum picks up, I think he'll jump aboard.
Byron Dorgan (ND)- Said he would support public option if it doesn't put private insurers out of business.
Ben Nelson (NE)- Initially called the public option a 'deal breaker,' but recently claimed he would not support a filibuster.
Blanche Lincoln (AR)- Wrote a column today saying "Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan." The nonprofit concept almost certainly won't be included in the final bill.
Robert Byrd (WV)- Very old and very sick.
Kay Hagan (NC)- Recently caved to overwhelming criticism and said she would support some sort of public option, though she was vague on details.
Recent converts (2)
Harry Reid (NV)- Looks like Harry Reid has decided to take some leadership.
Mark Udall (CO)- Said he supports a public health care option. '

(Cross-posted at The Smirking Chimp by cosanostradamus.)


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WHORING HEALTH CARE

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CORPORATE PIMPS ABOUT TO SCORE BIG

YOUTUBE: HBO: REAL TIME
"New Rules with Bill Maher, Ronald Reagan and Greed are NOT Good 5/29/2009"
Cousin Bill gives 'em Hell.


WHY NOTHING GOOD WILL COME OF OBAMA'S HEALTH PLANS

The Whole Political System Is Rotten, And Must Be Reformed In Order To Get Anything Done

When I was involved in real estate in New Jersey back in the 1980's, I met quite a few doctors who were investors in property. They didn't spend much time with patients. They were hustlers, not healers. They built professional suites and office condo's, labs and hospitals, clinics and medical centers, and managed and staffed them with healers, many of them junior hustlers, all working to enrich themselves, not the lives of their patients. This was the new corporate America, soon to be ruled by the CEO's of giant multi-national conglomerates and their lawyers, accountants, MBA's and "creative" financiers. Everything became about money, nothing had any value except in terms of money, not even peoples' lives. If you couldn't put a price on something, then it had no value. These people would do anything for money, and everything was valued solely in terms of money. It was the beginning of the pimping of America. It just seemed the most shocking in medicine, which used to be a humanitarian calling, not a giant whorehouse.

Here we are almost thirty years later, and the prostitution of America is almost complete. The government is now entirely under the control of the corporate pimps. They are about to finish corporatizing medicine with the help of their whores in government. Our very lives will be in their hands on a daily basis, and huge amounts of our money will be directed to the profiteering corp's by Federal law. Quality, accessibility and cost will all get worse, and there will be no effective oversight. We will have no say in how our money is spent. The pimps will rule. Universal single-payer national health care is "off the table." Only private profiteering remains.

As long as private profit is the primary motivating factor in our health care system, there can be no reform. Until public health and making good quality care accessible to all are the dominant motivating factors, the system is never going to work, except as a cash machine for the rich and the corporations they hide behind. It's the basic outlook, the underlying philosophy, the political economics of the thing that are wrong, and nothing will change until those things change.

It has already been demonstrated on a daily basis over many decades that the so-called free market cannot or will not provide good quality healthcare for all. I'm sure that major healthco's all have a chart or a graph showing exactly where the lines are: Those above a certain income level, "A," can afford the best coverage and provide the most profit, if the smallest volume of business. Those below that down to the next lower level, "B," can afford some coverage, at less profit but higher volume. At the very bottom level, "C," the government picks up the tab, but only up to certain income or age levels; but it can be finagled and boondoogled and shortchanged as long as there are no major audits or crackdowns, so it can be very profitable.

All those who fall into the gray area, "D," between B and C simply are not a source of profit to the healthco's, and will not be served. That's where the breakdown really occurs: Those tens of millions of people get sick but don't get treatment. They slow down or drop out at work, and make other people sick around them. They go to emergency rooms at the few remaining public hospitals as a last resort and receive the least effective care at the highest price, which they frequently fail to pay. The taxpayer ends up paying for himself as well as for the poor, the elderly, and the uninsured. Since our tax system has become more regressive, those who earn the most and can afford the best healthcare are the only ones really benefiting from this system, along with the healthco's. In effect, we have a national healthcare plan now, funded by the taxpayers. It just doesn't work for anyone, except the rich and the healthco's.

So it's us, the underserved, over-taxed and overcharged majority, against them, the inefficient, overfed, undertaxed minority. Politically, it would seem to be a no-brainer, if this were actually a democracy. But, as the Courts have accurately noted, corporations are people, in fact a higher class of people, and money is speech, the corporations' speech. So the minority has outvoted the majority consistently for many years and we do not have a healthcare system that benefits everyone today, as a result. Nor are we ever likely to, until we get corporate money out of the system.

That isn't going to happen until we get the corporate whores out of our government and our political Parties. Anybody who thinks that our mean old corporate Daddies are going to let us have just this ONE big lollipop, real universal single-payer national healthcare, or anything like it, is crazy. The corp's have no reason to give in. They own the whole system. Until we change that, there will be no substantive positive change in any area.

What we are really just about to initiate here is the biggest government boondoggle since the permanent war began in 1941. The same kind of Treasury-milking blank check that "defense" has gotten for almost seventy years will now go to the big healthco's. The result will not be free or affordable quality healthcare for all, but some scheme that commits us all to everlastingly ensure the profits of the healthco's by requiring us all to become their customers and pay whatever they require, directly to them and/ or indirectly through the government. There will be no efficiencies enforced or economies of scale, any more than there have been in the defense industry. The "public-private" model will only mean public moneys going for private profits, with questionable benefit for the taxpaying healthcare consumer.

Without universal single-payer national health care, there will be the opposite of reform. But it doesn't matter right now if single-payer or any other idea is on the table or not: As long as mixed-market democratic socialism is off the political table in this country, and as long as corporate money is on that same table, there will never ever be any real reform.

We're going to lose this. And that's a good thing. It will serve as a rallying point to re-take and restructure our political Parties and our political system. It will clearly identify those who are with us, the progressive majority of the American people, and those who are corporate whores. If our political system cannot do the job for us, then it will have to be changed. That will take time, and it will require a lot of effort by a lot of people. But if all those who are now working so hard to patch and prop up an unworkable system turn their attentions to remaking the system itself, there is a vast number of Americans who will be right behind them. This is a fight we CAN win. It is a fight we MUST win.


THE SEMINAL: JASON ROSENBAUM
"The Public Option and Real Health Reform"
From your lips to Big Healthco's ears, Bubbie!

' If we don’t get health care costs down, health reform will not work. People will still go bankrupt, we will still ration care based on ability to pay, and we will still have a health care crisis. And when you get down to it, health care costs are about how much and what medicine your doctor orders for you. Conservatives will accuse those in favor of health reform of taking the easiest way out, in a sense. Health care costs are up? Ok, let’s ration care and drive those costs down. But that’s not what we’re proposing. And, as Gawande so eloquently points out, driving down health care costs and increasing the quality of that care actually can be one and the same. So that’s some pretty good news. One thing about this article leaves me puzzled, though. Gawande seems to set up a conflict between advocacy for a public health insurance option and what he apparently considers “real” health care reform, which is setting up incentives for doctors to provide better care, not just more care. Maybe he’s just reacting to the media coverage around health care reform, which has been largely centered around a public health insurance option. And maybe I’m biased, seeing as I’ve been working to shape that media battle. But I really don’t think it’s either/or. Actually, I think Gawande’s point makes the public health insurance option more critical. I agree with Gawande that we could end up with a public health insurance option that doesn’t foster the right incentives to control costs, and that wouldn’t be a big victory. But while Gawande is proposing some kind of outside board to control these incentives, I wonder if the public health insurance option isn’t the place where these reforms are put into action. '

THE NEW YORKER: ATUL GAWANDE
"The Cost Conundrum"
"Medicine has become a pig trough." And troughs attract pigs, not doctors; businessmen, not healers; profiteers, not care-givers.

' McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.” ... “Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures. The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” ... The first hospital I visited, McAllen Heart Hospital, is owned by Universal Health Services, a for-profit hospital chain with headquarters in King of Prussia, Pennsylvania, and revenues of five billion dollars last year. I went to see the hospital’s chief operating officer, Gilda Romero. ... She wasn’t the only person to mention Renaissance. It is the newest hospital in the area. It is physician-owned. And it has a reputation (which it disclaims) for aggressively recruiting high-volume physicians to become investors and send patients there. Physicians who do so receive not only their fee for whatever service they provide but also a percentage of the hospital’s profits from the tests, surgery, or other care patients are given. (In 2007, its profits totalled thirty-four million dollars.) Romero and others argued that this gives physicians an unholy temptation to overorder. ... But they really didn’t know the big picture of what was happening. And, I realized, few people in their position do. Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—surgery, imaging, home-nursing referrals—they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. A doctor sees a patient in clinic, and has her check into a McAllen hospital for a CT scan, an ultrasound, three rounds of blood tests, another ultrasound, and then surgery to have her gallbladder removed. How is Lawrence Gelman or Gilda Romero to know whether all that is essential, let alone the best possible treatment for the patient? It isn’t what they are responsible or accountable for. ... There was no sign, however, that McAllen’s doctors as a group were trained any differently from El Paso’s. One morning, I met with a hospital administrator who had extensive experience managing for-profit hospitals along the border. He offered a different possible explanation: the culture of money. “In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less. He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care. “There’s no lack of work ethic,” he said. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him. Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. “It’s a machine, my friend,” one surgeon explained. ... About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers. ... When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue. There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems. ... The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen. ... "Medicine has become a pig trough here,” he muttered. Dyke is among the few vocal critics of what’s happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said. '

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