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-Competitive Medical Plans (known as Medicare HMOs or Medicare Risk Plans) as sponsored and defined by the Health Care Financing Administration are structurally flawed. The uneven risk selection and 30 day lock in provisions make these plans OK for seniors, great for HMO's and insurance companies, but a bad deal for the American Taxpayer and the objective of reducing the deficit.

-Capitation can't work unless the risk pools are large enough. The law of averages fails if adverse selection doesn't include both the healthy and the sick in the population included in the pool. The 80/20 rule is even more pronounced in health care policy than it is in life. The top 10 percentiles of health plan members are responsible for utilization of 75% of health care costs. It is a very steep Pareto curve that means the well subsidize the sick. Which is as it should be, and is what makes health insurance work.

-The theory that Primary Care Physician (PCP) control over referrals and a patients use of the health care system will reduce costs and result in better outcomes is flawed. PCPs work well for well patients, and everyone should have a PCP. But once you are sick, and/or have a chronic condition, the physicians who are best suited to caring for you are those who have advanced training in the specialty appropriate for your disease state. Think about it: When will a cardiologist, gastroenterologist, neurologist, or orthopod defer to the clinical judgement of a general practitioner or internist? Answer: Never...

-Full-Time Medical Directors of Health Plans who only push paper and who don't practice medicine by treating patients have much less credibility in the medical community than part-time Medical Directors who actually touch patuients.

-NCQA and the accreditation bandwagon are required in order to deal with the unfortunate propensity of health plans to focus too much on cost and not enough on quality. But the NCQA focus on process to the exclusion of results requires health plans to engage in the creation of expensive infrastructures to get the seal of approval, with little regard for whether those infrastructures actually improve patient care.

-Since Medical Mutual Of Ohio has demonstrated a year of success after losing its' affiliation as a Blue Cross and Blue Shield Plan, the Blue Cross and Blue Shield Association begins to cease to have a reason to exist...