If you have an Internet based system, all you would need is a simple computer that has a browser and internet connection. No servers, always up. Your system was part of a bad design, and bad implementation. And then, always have a backup creation system, that creates backup media, like microfilm, or printed charts that can always be read when things are down. Having the right people make these IT decisions is crucial. That's why we need a United States Chief Internet Architect. That's what I want to be.

I have worked at the top IT level for UPS, Delta Airlines, Turner Broadcasting, AT&T, Bank of America, and about 75 other companies through the years ranging from the very big to the very small. First of all, insurance companies, by far, are the worst run companies I have EVER seen, why? Because the slower the claim gets paid, the better for the insurance company, thus everything from the bottom to the top is the worst in organization. Does UPS run a tight ship? Yes they do. Because the package has to get their on time, or else they don't get paid. If you are in healthcare InfoTechnology, YOU DON'T DESERVE AS MUCH SALARY because the environment INSURANCE works in is run at such a poor quality level. Telling people they are senile in this environment is not appropriate. As I tell my older friends "If you are over 70 yrs old, it doesn't matter what day it is", but even if they don't know what day it is, I still value their opinion, wisdom and experience, and try to treat them with respect.
The point is, if you work in insurance and healthcare, you are obviously used to working at a very poor quality level, and I would be surprised if you, or your team, in insurance, were very productive. If I were to hire a software team, the least likely software developer that would be hired, would be an insurance IT guy. Insurance technology is never run well.

In response to orthodeb
- "So rather than screw it up and have everyone working separately with there own systems, why not bring in a true design genius to develop one that works for everyone? I do not think that it would be terribly difficult to develop."

BTW - I don't mean to be arrogant, I just want to share my skills -
I was a lead software architect:
- Desiging, Planning, developing Air Traffic Controller Information Systems for the largest and most sophisticated airlines in the US
- I was one of five lead architects who directed over 200 developers for the most widely used online banking system in the US.
- and I have completed many, many, high profile Info System Projects.

I AM NOT BRAGGING - Just trying to say, "here, this what I do, and what I am good at"
I am not a doctor, I can't do joint replacements.
But if you want a new healthcare information system and A NEW HEALTHCARE PARADIGM with out of the box thinking with correct balanced financial incentives in place, complete with data warehouseing, security, distribution, annual fees, insurance, etc., that I can do.
I have designed and led several teams in developing software for some of the largest medical and non-medical insurance companies in the US. From Oracle to Java to PHP to ColdFusion, Objective C, and about 30 other computer languages.

If you need a genius designer, Internet Architect, Ecomomist, etc. I am one of those people.
Have a degrees in Economis, and in Mathemacis and Computer Science, and its what I have been doing for the largest companies in America for many years.

As a matter of fact most Internet users use at least one of my patented software inventions every day, which is implemented by many large Internet companies.

So redesigning new govt, healthcare, legal, business and activity paradigms by leveraging computers and the Internet intelligently is what is what I have been doing for a living for a very, very long time.

Now that Obama is in, I think the best ideas may be heard on a national level.
Finally.
Thanks,
rmd

There are more people who need joint replacement than there are doctors who can provide them, so this is not a case where procedures are being done on people who simply don't need them.

I had a patient who had bone on bone end stage arthritis and could not work. He was a young man and would benefit significantly from having bilateral simultaneous total knee replacements. Yet the insurer insisted that he fail 12 weeks of therapy and bracing before they would approve the procedure. I personally wrote to the insurer and told them that these would be futile efforts and would cause the patient more pain and keep him out of work for longer, but they insisted. There is no research to support therapy or bracing for end-stage arthritis. Braces are expensive, and therapists get frustrated treating people they can't help. In this instance the insurer insisted on paying for more services, because of course the patient failed the treatment and needed the surgery, which by the way resulted in an exceptional outcome and got the patient back to work rapidly. You must also know that when a surgeon performs bilateral simultaneous procedures, the surgeon accepts being paid for only 50% for the second knee even though there is considerably more risk involved doing both knees at the same time. Not to mention there is a significant savings in the use of resources by doing both procedures at once. The physicians sees none of these savings. SO STOP BLAMING DOCTORS FOR THIS CRISIS BY CLAIMING OVERUSE OF RESOURCES!
Go to comment
------------------- RMD resposne Part 8
We all know that insurance sucks!!! Agreed!
So with OBAMA, and THIS plan, let's get rid of it.
Get rid of insurance paradigm, by ALLOWING A NEW PARADIGM TO EXIST, let people try it out and tell their friends... and we WIN!!!

ALL IS POSSIBLE WITH OBAMA!!!!
--------- end RMD response Part 8

Most insurers make you jump through all kind of hoops to get a procedure approved. Not to mention the reimbursement to the physician for these procedures is negligible or not that great such that it becomes "profitable" to do more procedures. In joint replacement you have to do more procedures from to keep from losing your shirt.
------ rmd response Part 7
We all know the insurance paradigm sucks.
So have the courage to get RID OF IT, at least enable a paradigm to exist that is supported and is not insurance based, and then let it grow. Eventually it will replace the insurance paradigm naturally, if it is supported and allowed to grow.
---------- end response Part 7

There are certainly physicians who commit fraud, but this is a small percentage. Physicians do unnecessary procedures to cover their butts and diffuse malpractice claims.
------- rmd Response Part 6
My plan would call an end to all this malpractice litigation waste.
Doctors would not be finanacially liable anymore because the incentives will have changed. Instead, if a Doctor performs badly one or more of the following occurs:
(i) Doctor must take remedial courses
(ii) Doctor must prove competence to a medical board
(iii) Doctor's activities must be managed and watched for a limited amount of time; Doctor may be required to perform with an assistant
(iv) Doctor may be suspended
(v) Doctor may be banned

Take the money out of it totally.
Doctors get to keep the money they earned while working.
Patients may get compensated something, but not huge rewards, and be compensated from govt or possibly insurance or something.
And Doctors get disciplined, suspended, or have licenses revoked, and that's it. My plan totally solves this litigation/ malpractice problem.
---------rmd end reponse Part 6

the American Academy of Orthopaedic Surgeon does all that it can to try and get Congress to listen to reason when they support these stupid policies that have been put forth by these insurers, but it falls on deaf ears. This is not a doctor problem, and I am sick of hearing misinformed comments on how this is somehow the fault of physicians.
----------- RMD response Part 5
I DO NOT THINK IT IS THE FAULT OF PHYSICIANS.
PHYSICIANS, LIKE ATTORNEYS, ARE OFTEN CAUGHT UP IN PARADIGMS THAT DON'T PROMOTE GOOD DECISIONS, ETHICS AND EFFICIENCY, ETC.
I AM TALKING ABOUT CHANGING THE PARADIGM!!!!
I am an Ecomomist. I know it's not the Doctor's fault.
It's the fault of the system.
------------end response Part 5

You must understand that unnecessary procedures are more done to prevent litigation rather than to make these huge profits you speak of. Most physicians are not making profits at all and many are leaving the field because they cannot afford to stay in business due to the severe decline in reimbursement. As a total hip and knee replacement specialist, I can deliver high quality care, at lower costs because of the protocols I use that have been proven to be successful in clinical research conducted by the institution where I did my training, yet the "recommended" treatment that the insurers want you to do in order to be reimbursed costs more and causes worse outcomes and more complications.
------------- RMD RESPONSE Part 4
In my plan, you, being a "procedure" type of doctor and not a "generalist", your job description would be EITHER one of the FOLLOWING, BUT NOT BOTH:
1) you order knee and hip replacements procedures when needed.
So in our example, the Internist would call you, and you would review the case, and you would be paid to review the case ONLY, and then you order the procedure. The Internist will be involved as well, if need be.
2) Then a DIFFERNET Knee and hip replacement doctor DOES the procedure. So then the guy GETTING PAID for the procedure DOES NOT MAKE THE DECISION to ORDER a proedure. Whether or not a knee and replacement Dr does ONLY reviews or ONLY procedures is left up for discussion as to how that would be handled. JUST DETAILS.... not a big deal...

-----------end RMD reponse Part 4

I agree that patients should negotiate directly with providers for services, and perhaps pay an annual fee for regular health maintenance, with insurance used only for catastrophic events, like life insurance. In other words, you pay a premium, and if something disastrous occurs, it is covered to prevent the patient from going bankrupt.
----------- RMD response part 3
we agree here... as I outlined above
YEAH WE AGREE ON A LOT !!!!!
-------- end rmd part 3 response

The system of paying per procedure was mainly developed by insurance companies, not physicians. Most physicians opposed this system. I agree that the changes we need will take courage, but your suggestion will not work for everything in medicine.

-------RMD Part 2 response
My suggestion was high level and 100% correct, you have not seen the whole plan... I have the solutions formulated.
----------- :) rmd end part 2