An Ironic Take on Health Reform

Colin T. Son

Disclosures

August 11, 2009

It's not easy to refer to yourself in the third person. I should know; I've tried it in polite society. Dr. Richard Fogoros, "DrRich," knows it, too. In a unique style, Dr. Rich refers to himself in the third person when publishing pieces on The Covert Rationing Blog.

When one refers to oneself in the third person, one must expect to trigger occasional negative reactions among readers. And generally, Dr. Rich accepts such comments with magnanimity. After all, it is not his readers' fault that Dr. Rich has chosen to present himself as a pompous ass. In the blog's introduction, he writes:

In writing the Covert Rationing Blog, DrRich has affected a certain persona that (he humbly submits) is quite unlike his actual self. DrRich of the blogosphere is a bit haughty, perhaps with a bloated sense of self-worth, insisting, for instance, on referring to himself in the third person. He intentionally employs complex sentence structures and archaic verbiage, and in describing the American healthcare system he often resorts to exaggeration, satire, sarcasm, and, above all, irony.

The persona is amusing, sometimes even charming, but it shouldn't lead you astray. Dr. Rich knows his stuff.

Dr. Rich brings his charm and ego to Grand Rounds. The Covert Rationing Blog is hosting this week's edition of Grand Rounds on August 11, 2009.


A cardiologist by training, Dr. Rich left his long-standing clinical practice to enter the world of healthcare consulting and writing. In 2007, he wrote "Fixing American Healthcare: Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare."

In one of his latest blogs, "There's Not Enough Waste and Inefficiency in Healthcare," Dr. Rich argues that waste and inefficiency alone cannot account for the uncontrolled rise in healthcare spending, nor can its elimination be counted on to fund a new healthcare system.

Obviously, there's plenty of waste and inefficiency in our healthcare system, enough to suit almost any taste, and DrRich deplores every bit of it.

Indeed, DrRich strongly suspects that at least 20% to 30% of all healthcare spending is completely wasted, and has seen claims (masquerading as proof) that the actual value is as high as 50%. So again, despite the title of this post, no matter how you look at it there is plenty of waste and inefficiency to go around.

It's just that there’s not, well, enough.

He continues:

[W]e all know that any effective healthcare reform is going to have to find a way to control healthcare spending. And a central assumption of any reform plan yet proposed is that we can control spending by eliminating -- or at least substantially reducing -- the vast amount of waste and inefficiency in the healthcare system...

But this is unfortunately false. No matter how much waste and inefficiency you think might be plaguing our healthcare system today, there's not enough to explain the uncontrolled rise in healthcare spending we have been seeing for decades, and therefore, not enough to allow us to avoid rationing altogether.

Then he crunches the numbers to prove it.

The Covert Rationing Blog combines medicine, politics, and a writer who is full of himself. It makes for entertaining reading and generates passionate responses from his readers. A brief glance at readers' comments finds him being called "smug" and "childish." Or telling him, "I feel able to describe your prose as turgid, prolix, and with no redeeming merit. Stick to medicine."

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