Tuesday, July 14, 2015

Inside the Mind of Barack Hussein Obama

There has been much discussion, particularly in conservative circles these past few years about what motivates Barack Obama to do what he has done and continues to do. One camp believes that he is diabolically intentional about destroying the country.  Another postulates that he is simply dumb as a box of rocks.  I don't really think that either explanation is a true reflection of what is driving Obama to drive the country over a cliff.  Rather, I believe that he was raised and educated, perhaps indoctrinated in and by a steady stream of radical, liberal progressive ideology from a very early age and to the exclusion of any other philosophies.  This is the prism through which he views history and current events.  I don't believe that he can even fathom that there truly is any other valid point of view.  Facts and logic cannot overcome this lifelong immersion in liberal philosophy.  He is effectively hard-wired to view events, think and act according to this imprinting.  Nothing will sway him.  In his mind he probably cannot understand why everyone doesn't think the way he does.  He is undoubtedly honestly flummoxed at why so many vehemently oppose his efforts to make the world a much better place. I have no doubt that to the core of his being he truly believes that if he could just exert his will unfettered  he could bring about peace in the Middle East and throughout the world, economic prosperity for all, eliminate poverty, hunger and disease as well as make the Earth a beautiful garden of Eden.  Why wouldn't everyone want that? Now, one could classify that as a mental illness, megalomania or schizophrenic delusions of grandeur; and that might be accurate, but where does that leave us?  Impeachment, incarceration in an asylum, mandatory medication and counseling?  No, I think the lesson to be learned here is to not put people like this in positions of power (including the education system).  As to what can be done to undo the damage already wrecked upon the nation and that which is probably still to come, I will leave that to another time and perhaps other people.

Thursday, February 26, 2015

Democrat In Republican Clothing #DIRC

You've heard about RINO's, Republican In Name Only.  Well, now I think it's time to take it a step further with DIRC, Democrat In Republican Clothing.  I would nominate Governor Chris Christie and Jeb Bush to start with.  There are many more.  Join me on Twitter and nominate your favorite #DIRC!
Senator Lindsey Graham-SC
Senator Orrin Hatch-UT
Senator Jeff Flake-AZ

Tuesday, February 03, 2015

You Can Lead a Horse to Water...but That Doesn't Make it a Leader

Egads, companies all across America are obsessed with "Leadership Training."  Every employee from the bathroom janitor to the CEO are spending hours and days in classes hearing canned PowerPoint presentations from perky presenters touting the latest 12-step program that will transform anyone and everyone into the next Steve Jobs.  Over my nearly 60 decades I have read dozens of books on leadership and sat through lectures, presentations and training on finding and developing the leader within me.  Well, guess what?  There ain't one in there.  So let me give you my curbside consultation on what I have learned and believe about all of this.
I postulate that within the corporate hierarchy there are basically four categories.  You can call them by different names, but essentially most companies are comprised of one or two (if they are lucky enough to still have one) Leaders, a small batch of Managers, Supervisors and then Workers. It is my belief that people are born with, or without the tendency to fall into one of those categories.  It is pretty much genetically dictated.  My uncle was born with musical talent.  He took violin lessons when he was very young and quickly mastered that instrument.  One day he sat down and started playing the piano.  He didn't need sheet music, he would just hear something on the radio and start playing it and would transpose it into another key on the fly.  I wanted to play the piano but was not born with the innate talent.  I took lessons for years, fighting and struggling.  I can pick out the notes off of the page, but I don't make music.  My uncle made music.  He was a musician.  I, with all my years of lessons still could not claim to be a musician. While you can tweak and develop and improve the skills within your particular category I don't believe that there is much movement of an individual from one category to another.  Wanting to become a Leader and attending all of these myriad leadership classes does not make you a Leader any more than standing in a garage makes you a car.  If you're not born to be a Leader, you're probably not going to be one.  Or a Manager or Supervisor either for that matter.  And just because your company anoints you as a Leader or Manager or Supervisor and sends you to class doesn't make it so either.  They may just be setting you up to fail.  Leadership training companies rake in billions every year telling rooms full of chickens to 'fly, you're an eagle!'  Well, chickens are not eagles and they're not going to become eagles.  There are very few eagles.  And we needs chickens, there's nothing wrong with being a chicken.  But the allure to be a Leader is very intoxicating.  In my opinion, there are very few leaders in government or business, but a lot of wannabes.
Leaders cast the vision for the product, service and company.  They were probably the founder(s) of that particular enterprise.  The original Leader many not even be around any more.  Sadly, after the founding Leader is gone, many companies never really have another Leader and wallow around until they go bust.  They try to hire another Leader or promote a Manager into leadership, but usually with disastrous results.  Leaders are big idea people, not detail.  They think outside of the box, come up with new, novel ideas and sometimes come off as a bit quirky, eccentric and impractical.  The words 'no' and 'impossible' are not in their vocabulary.  The fact that something has never been done before excites them while it scares Managers.  The are oriented to the future.  Once they have put an idea for a product or service in motion and handed it off to the Managers, they are pretty much done with that one and off dreaming up the next big deal.
Managers may go by many names:  CEO, President, Vice-President, COO, CFO, Manager, General Manager, Superintendent.  These people are responsible for taking the Leader's visions, manifested as a product, service or company and make it happen. They break the vision down into its component projects and steps and then manage the necessary resources, budgets, personnel, policies, legal and regulatory demands and timetables and deadlines. They hire the Supervisors who will oversee the workers who will ultimately do the work of the vision.  Managers are more oriented to the details of the vision, relieving the Leader of that burden.
Supervisors oversee the Workers who are doing the day-to-day grunt work of bringing the Leader's vision to fruition.  They hire and fire them, make sure they have the necessary tools and training, make sure the work is done safely and strive to meet the deadlines and budgets given them by their Manager for their particular project. 
Workers have very specific skills for very specific jobs.  These are comprised of the industrial trades, skilled and unskilled workers.  They perform the daily heavy lifting (many times literally) of accomplishing the vision.  They perform repetitive tasks on a very specific part of a step or aspect of a project making up the vision. Without them, nothing much would happen.
It is my premise that Workers rarely if ever make good Supervisors, Supervisors rarely if ever make good Managers, and Managers rarely if ever make good Leaders.  Thus the problem with promoting up the chain from within an organization.  People really do tend to rise to their level of incompetency, unfortunately that is usually the point where they are promoted from one of these categories up to the next one.  They were doing a great job in the position for which they are best suited, and this is probably why there were singled out for promotion.  That, and the fact that someone has been around for a long time and now it's their turn.  Eeeek!  Formula for epic fail.  Rather than leaving that successful person in their best-suited job and trying to help them be the best they can be there, the company out of the goodness of their heart promotes them up to the next category where they flounder and founder for years, while attending multiple seminars on how to be a success in that job, but secretly knowing they never will.  Surprise, I am not a big proponent of promoting from within.  If a company needs a Leader (or Manager or Supervisor or Worker) they should look everywhere for the best person with those particular skills, inside and outside the company and hire the best person for job.  It is more important that the candidate have the requisite skill set for the particular category of job rather than know the product, service or company inside out.  Someone from outside with the right skills can learn the company, product and service quickly.  But remember, it's the skills you are really after, not company knowledge.  Someone with all of the company knowledge and experience in the world will still fail if promoted beyond their God-given skill set. 
I believe that companies should stop sending everyone to leadership training classes and spend their money and resources identifying employees' innate skills, matching that to the right job and then investing in helping them improve those preexisting skills to the highest level within the job and category that best suits them.  If a position needs to be filled, fill it with someone from inside or outside the company that already has the right skills for that category, then train them in that position. 

Sunday, March 30, 2014

God and Government

Let's clear up this church and state thing once and for all.  It's really quite simple, not complicated in the least.  The people who founded this nation were fleeing religious persecution under a state-mandated religion.  They set up a nation based upon the concept of religious freedom.  A nation where religion of all kinds, or none at all could flourish unimpeded by the heavy hand of the government.  People would be free to worship when and where and what they pleased, or not at all.  They did not distinguish between private and public religious practice.  They were not concerned about people expressing and practicing their religion in the public square and in the halls of government.  Just look at how many of our early politicians held strong religious beliefs, talked openly about them in the chambers of government and how many mentioned their faith in speeches on the floor of the House and Senate.  Look at how many Presidents prayed openly and encouraged prayer for our nation. The sessions of Congress are opened in prayer and Presidents are sworn in on Bibles (or other religious books) and swear their oath, so help them God.  Our founders did not intend for religion to be hidden away to only be practiced in the home or Sundays in church.  No, what they intended was a vibrant religious fervor throughout the land, in homes and churches and schools and businesses and the halls of government, unchecked by intrusion from the rulers.  The thing they did proscribed was any establishment of a state religion or policies setting one religion above another, or giving one special treatment over another, or prohibiting some altogether.  This is not to be construed to an interpretation which keeps religion out of the public and government realms, but rather keeps government out of the religious realms.  The separation of church and state is to keep the state out of the church, but not the church out of the state.  We have come a full 180 degrees since George Washington said in his farewell address of 1796, "Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports."  Atheists and agnostics are now everywhere lobbying for the removal of anything religious from our schools, public squares and halls of government.  What gives them the right to do so anymore than those of us with religious affiliation the right to remove them and their beliefs from these same places.  One could argue that atheism and agnosticism are simply religions of faith in things other than a supreme being.  In the world of the First Amendment they have no more right to demand religious cleansing than the religious to demand their cleansing.  No, we must all co-exist and blossom together in all aspects of life.  The First Amendment guarantees the right of freedom OF religion, not freedom FROM religion.  I would recommend that those who seek to remove anything religious from the public square grow thicker skin.  What religious people do doesn't harm them, and what they do doesn't harm the religious.  Live and let live.  The industry of being offended has become too much a growth industry.  A lot of what they do and what happens in our country and the world offends me, but I choose to let it roll off of me like water from a duck's back.  I do what I can to make a difference in the world from my perspective, they would be advised to do the same.  By the way, the Constitution and Bill of Rights nowhere guarantees a right to not be offended.  It's part of life.  Amen.

Wednesday, October 23, 2013

Article V--Let's Go!!


Now that we have read Mark Levin’s latest book, The Liberty Amendments and realize that this really IS the only path forward; we must confront the questions of how we move this idea forward to fruition and what can and must each of us do in that endeavor.  
It seems to me that before we can start the process we need to know exactly where we are now and we must be able to track our progress and make necessary adjustments along the way.  To that end here is my outline:

  • We need a central, searchable electronic database to collect and track data on all state legislators.  This should include the state, the individual’s name, party affiliation, mailing address, telephone numbers, fax numbers and social media contact information and when they will next face re-election.  We need to track changes with elections and vacancies.  Should this database be owned by Tea Party Patriot’s, some other group or should some new entity be formed for this specific task?
  • Each legislator needs to then be contacted to find out if they have read Mark’s book or if they are familiar with it and/or the proposal.  If not, the book and other supporting information needs to be made available to them and then follow up with them after having a chance to read it.  For those already familiar with the idea we should document if they favor or oppose the concept or if they are leaning in favor or opposition, or if they are completely undecided.  Depending upon their position they made to be provided with further information or have someone contact them directly to discuss the idea and answer questions and provide more information.  This, I think should ideally be done by constituents in their respective districts if possible.   We should continually follow up to find out if their position on the idea has changed, and hopefully moved in a positive direction.
  • We should identify sympathetic state legislators who would be willing to carry the proposal forward in their respective state legislatures and become champions and persuaders amongst their colleagues and points of contact for our movement.

Sunday, September 15, 2013

Patient's Statement of Rights

Please review and attach to my chart.

            In this era of health care reform and rapidly changing paradigms many patients feel as though they are on the losing end of a quickly shortening stick.  Every time you go to a physician’s office or hospital you are bombarded with all sorts of forms to sign with all sorts of rules and regulations.  Who on earth can know what it all means?  It seems that everyone is telling patients what they can and cannot do; their physician’s office, hospitals, pharmacies, insurance companies and then government is telling everyone what can and cannot be done.  Is anyone actually looking after the patient?  Sadly, it seems no.  In light of these realities, here are some patient responses to all of this.  These are the things that I the patient, will and will not do or permit:

  • When I call to make an appointment with my doctor, I want to see my doctor.  Not some other doctor or physician’s assistant or nurse practitioner; unless I specifically request or agree to that.
  •  I will not be financially responsible for any charges or fees not covered by my insurance for any tests, procedures, consultations or lab unless those charges are specifically discussed with me prior to any of them actually being incurred.  After the charges are discussed, I will then decide whether to proceed or not and will inquire as to alternatives or if they can be done cheaper elsewhere.  Of course, this applies to routine situations, not dire emergencies.  It would be wise and helpful for you to post your routine fees and charges on your website and on a large sign in your waiting room.
  •  I will not answer any questions about or provide any social or behavioral information, except things I may relate to my physician in private and confidence directly.  I do not give permission for any such information to be transmitted in any form to anyone or any private or governmental agency (local, state or federal) other than my physician.
  •  I do not give my permission for any information of any sort to be transmitted to any private or governmental agency (local, state or federal) other than my insurance company.
  •  I do not give my permission for any information to be stored off-site of my physician’s physical office.
  •  I do not use my social security number as a personal medical identification number.  Please use an alternative number such as my employee ID number from my employer who provides my health insurance.  I will not provide my social security to anyone and do not give my permission for you to obtain it by any means or from any source and do not give my permission for you to retain and/or store it.



Thank you!


__________________________________________                                    ___________________
Signed                                                                                                              Date (in effect until further                                                                                                                                         notice)

__________________________________________                                    ___________________
Printed Name                                                                                                  Date of Birth

Tuesday, July 16, 2013

The Smart Medical Shopper



The Smart Medical Shopper
Kyle C. Akers, M.D.
Tuesday, July 16, 2013


     We have the best medical care in the world, bar none.  Unfortunately, we have the most confusing, convoluted method of charging, pricing and paying for it that one can imagine.  Our medical care financing system is unlike any other sector of the economy or industry in the country.  This mixed up system leads to frustration, anger and sadly ultimately to ObamaCare.  The misnamed Affordable Care Act is not about medical care and certainly has nothing to with affordability.  We have the best doctors, hospitals, medicines and technology available.  ObamaCare is all about payment and it is the worst possible solution to come down the pike so far.  What we need is less government regulation, top down control over pricing and payment for medical care and more simplified, streamlined common sense interaction between doctors, patients and insurance companies.

      The current coding system for diagnoses and procedures which drives charges is a monopoly owned by the American Medical Association and is its largest source of revenue, given that only about 13% of physicians are members of this fading organization.  Medical charges are essentially driven across the industry by the Medicare tables of allowable payments.  This cobbled together system sets up a one-size-fits-all approach that tries to shoe-horn everyone into one payment system using the ubiquitous Medicare HCFA billing form, whether it works for individual doctors and patients or not.  Couple that with all of the different discount arrangements between insurance companies and doctors and you have a recipe for disaster and ever sky-rocketing costs.  No one knows what anything really costs.  In reality the same procedure can cost many different amounts for different insurance companies and patients.  Doctors have no idea what things cost and patients have no idea what charges they are incurring at the time of service, what insurance is going to pay or what discounts are being applied.  They only find out weeks or months later when they get an unexpected bill for their portion that insurance didn’t pay.  You would never buy a car that way.  You don’t buy anything else that way.  Would you let someone else pick things out for you, don’t tell you what they are costing you and after all is done send you a bill months later expecting you to pay for them?  Of course not.  Even attorneys meeting with a potential new client will explain what their hourly rate is, what the retainer will be up front and estimate what the whole cost will ultimately likely be.  All before the client pays a penny or commits to anything.  I once spoke with my doctor about my annual routine wellness laboratory work.  My insurance company pays 100% once a year for those tests.  He had no idea that if his office did not code the visit correctly, for a routine annual physical exam, then I would be liable for the full cost of the lab work.  Additionally, he was shocked that the cost of that lab work would be $600.00 out of my pocket (and actually it should be about $150.00 if you look at the actual real cost).

     Now, obviously in a medical emergency stopping to discuss fees and costs and options is not really feasible, but these situations account for a very small fraction of most people’s interactions in the medical system.  The vast majority of the time it would be possible for the physician to have a discussion with the patient about fees, costs and less costly options prior to committing to treatments and incurring expenses.  Unfortunately, right now doctors have no idea what those costs are.  They usually assume that insurance is going to pay everything, not realizing that their ordering decisions may incur hundreds or thousands of dollars in unexpected out-of-pocket expenses for their patient.  And the patient won’t even know that until weeks or months later. 

     Medical billing statements result from the coding employees at the doctor’s office reading through the doctor’s notes and trying to find the best fit diagnostic codes and procedure codes to reflect what was done.  This then drives the charges.  There is actually a lot of wiggle room in how these things get coded and what the ultimate charges wind up being.  Sometimes inadvertent mistakes are made, coders are only human.  Things get coded incorrectly or things get coded that never actually happened.  It’s not intentional fraud, just honest mistakes.  But these mistakes can cost you hundreds or thousands of dollars.  It’s funny, we will stop a clerk at the grocery store if the scanned price of an item does not reflect the $1.00 off sale price in order to correct it but we have no idea if the medical bills we get are accurate.  If you don’t get detailed, itemized statements and carefully review them, you just wind up paying these incorrect charges.  Many billing statements, particularly hospital bills only show the total owed, not the minute detail of the individual charges which comprise the total.  Always request and review detailed statements before making payments and ask questions if you’re not sure about specific charges.  Because of this slow, mixed up payment system doctors and hospitals routinely have patients sign forms (among the myriad forms one signs when checking in) agreeing to pay any charges not ultimately paid by the insurance company.  Wow!  How cool for them.  Why would anyone in their right mind sign such an agreement which could encumber you with hundreds or thousands of dollars in charges months down the road but you have no say or input at the time the charges are incurred?  You are generally not informed or asked to approve of the cost of things that are being ordered and done on your behalf at the time they are happening.  And let’s face it, most people are not medically savvy and are rather intimated by the people and process going on in a doctor’s office or hospital.  They might be sick or injured and not really thinking about cost at that moment.  Or it might be a routine visit, but people tend to trust the doctor and not question what is being done or inquire about the cost or less costly options.  It’s sort of like the restaurant menu that says “Market Price” next to the lobster.  Would you order the lobster without inquiring as to the “Market Price” today for the lobster?  No, of course not.  Doctors and hospitals should post their fees and prices on menus on their waiting room walls for all to see.

     Now let’s not leave insurance companies out of the discussion.  Has anyone read a medical insurance policy cover-to-cover lately?  I didn’t think so.  It’s sort of like a mortgage contract.  No one actually reads those things before signing them.  And if you did you wouldn’t understand it.  It’s the same with medical insurance policies.  Try wading through the individual deductibles, family deductibles, co-pays, co-insurance, in-network/out-of network, discounts, tiered prescription formularies, maximum annual out of pocket (and what ACTUALLY is applied to that and what is not, you will be surprised) and all of the exclusions and exceptions.  If that’s not bad enough, try figuring out in July where you are for the year in all of that.  Yikes!  It’s virtually impossible to know before a procedure or test just exactly how much the insurance plan is going to pay and how much you will be getting a bill for in several weeks.  Don’t think that your co-pay is going to always cover your financial responsibility for an office visit or procedure.  It depends on exactly what is done.  An in-office steroid injection might be covered or not, partly or in whole.  Doctors typically don’t discuss that with patients before doing the injection.  Their office might contact your insurance company for prior approval or not.   You will probably not know.  Even if they do, they may not tell you anything before the injection.

     So what is the average, medically uninitiated patient to do?  Well, until the medical industry realizes that it must start acting like every other business and post and discuss its prices before charging people for things, the patient must act proactively and aggressively to avoid incurring enormous surprise charges weeks or months down the road.  Here are some tips to help keep you in control of your medical costs: 


  •  Make sure you understand your insurance policy.  Ask your carrier for a clear summation page of your benefits, co-pays, co-insurance, maximum annual out-of-pocket cost, individual/family deductibles, in-network/out-of network details, in-patient vs. out-patient tests and procedure costs, annual wellness/screening 100% covered expenses, pharmacy details/co-pays, exclusions and exceptions. 

  • Ask your insurance carrier to provide a way (online dashboard) for you to quickly and accurately check where you are in your expenses in all of the various categories throughout the year. 

  •  Ask your insurance carrier for a quick, easy way for you (and doctors/hospitals) to check on covered charges and what your potential liability portion would be before authorizing any tests, treatments, medications or procedures.

  • Request that doctors/hospitals contact your insurance company and pre-authorize anything beyond your co-pay and discuss that with you before it is done.  If necessary, you contact the insurance carrier.

  • Discuss the cost of any and all procedures, tests, treatments or medications that your doctor wants to order for you prior to agreeing to them.  Discuss the possibility of cheaper alternatives or just waiting a while if possible.

  • Always ask your doctor to choose generic medications or cheaper alternative medications when possible.

  • When checking in at a doctor’s office or hospital, give them a note that you have signed and dated informing them that you will only be financially liable for charges (particularly beyond your co-pay) that have been discussed with you in detail prior to you authorizing those things that incur the charges.  Don’t sign blanket statements that you will be liable for any charges that your insurance company does not pay.  Have them (and/or you) contact the insurance company for clarification/pre-authorization if necessary.

  • Always ask for a detailed, line-item billing statement; not just a total bill due.  Review the bill for accuracy.  Get someone who is medically savvy to help you if necessary.  If you don’t understand something, ask the provider for clarification.  If you think there is an error, speak up!

  •  When communicating with doctor’s offices, billing offices, hospitals and insurance companies about charges, bills and disputes; always get everything in writing.

  • When communicating with billing offices about charges, bills and disputes always copy your insurance company and your employer HR/Benefits office (if you have employer provided medical insurance) on all correspondence to and from the billing office.

  • If you think a charge is way out of line, do some research.  See if you can find what the actual cost is and what other places are charging for similar services or products.  Ask for a price match; Wal-Mart will price match, why shouldn’t doctors and hospitals?  These medical people are in business after all.  Let them know there is some competition for you business out there and you’re willing to go where you can save money.

  • Ask doctor’s offices and hospitals not to share any information of yours (even non-identifiable generic information) with anyone other than your insurance company.  Not with any private company or any government agency; local, state or federal.

  • Unless required by a federal program such as Medicare or Medicaid, do not use your social security number for identification and do not give your number to doctor’s offices or hospitals.  If you ask them to use an alternative form of identification they must comply.  Similarly, let your medical insurance company and employer HR/Benefits department know that you will not use your social security number for medical care identification purposes and you do not permit them to use it.