Editor’s note: A friend in Chicago knows someone. That someone was so concerned about this strongly-worded inter-office email from the Obama transition team that they passed it along. It does not represent the thinking of ClinPage, L.L.C. or its staff.

Hey Dawg,

“Mr. President-Elect” still sounds ... offffficial? Is there a policy on when we gotta be more formal?

On the plane. National. Will be back in O’Hare by midnight. Lots on my mind. Flight attendant’s pissed.


#1. Bad news first.

That promise from the campaign—the one about immediately saving three grand per family with electronic health records (EHR)? By tomorrow?

Nope. Sorry. Doesn’t check out. Garbage. Republicans believed it, too. Does that help or make it worse? Debbie wanted to ask.

Turns out, EHRs will cost big bucks for centuries. Most doctors don’t know how to hook up their own computers. Or why. Or to what. It’s worse than we were told. Your new puppy will be more wired than these MDs. Secret Service got a transmitter for the dog.

At the doctor’s, they tell me, most docs don’t use email. Why? “No one will pay me,” is what I am told. MDs are way, way touchy about this. My advice: Don’t even bring UP the $$$-for-email issue if we ever do any photo ops or meet-n-greets at some nice hospital. Tender, tender, tender…

So these doctors make $200K a year & can’t afford EHRs. “That software doesn’t work and takes extra time,” Debbie says. True? Who cares? But THIS is why they claim you, me, i.e., Uncle Sam, needs to pay for it. Crazy if you think about it.

Anyway, suppose some MD does hire his teenager to hook up some sad, old monochrome computer from the Korean War. What then? Debbie’s researching this. Says the Korean War computer can’t talk to any other computer across town, even from the same system from the same EHR company. Hilarious.

Do any American doctors really USE computers? You asked. Debbie is on it. Short answer: MDs write stuff down on pieces of paper that are stapled inside brightly colored folders and put in the basement of the hospital. Then they’re lost. I am fairly sure she is serious but will 2X check when I get in.

It gets worse. Most of the people who are all excited about EHRs? They’re over in $#&@*% Europe. I am sooooo tired of hearing about Europe, I cannot tell you. All that fuss about government cost savings? From Europe! Diseases cured miraculously with EHRs? Europe. Europe. Europe. Trouble is, in Europe, Debbie says, every country has one health care computer system. One! One?!!? Jesus.

Topeka, Kansas, alone has like, dunno, 37 hospitals and 37,000 different hospital systems. None of them connected. We may want to just forget this EHR thing completely. Walk away… if Mass General can’t make it work, no one can.

Or double down. Different direction from W completely. (His EHR program never got funded by Congress, FYI.)  Thinking out loud here. Check this out.

A new Obama Administration program: No Doctor Left Behind. Like the kid-testing program. Sort of. Transition team say: “NDLB polls well.” We may have a winner. High tech, Gore-ish, Peace Corp-y, “space is the final frontier,” helping doctors who take care of poor folks. What’s not to like?

Here’s how No Doctor Left Behind would work. 30,000 ft view.

The Feds do buy lotsa EHRs. Spend billions. But. But: only for a few docs who deserve a little help. MDs on Indian reservations and in inner-city areas. I see you visiting ALL sorts of perfect little hospitals to check up on this. Plus, our No Doctor Left Behind doctors must be less than 40 years old—the older ones are hopeless. Plus, young Noah Wiley E.R. types tie it back into “No Child Left Behind,” right? Youth and vibrancy and hope, etc. etc.

BTW, re: your VA question. Debbie says: U.S. military docs DO have EHRs. But a lot of vets are still lugging around all their medical records in cardboard boxes, keep them in their cars. Not sure why. Makes you cry.

For my No Doctor Left Behind docs, we connect ‘em all up to Medicare/Medicaid. (Which is for poor people? I forget…) Later, administratively, we USE that sucker to reduce what we pay them. THAT’s how we get back the investment in the system. If anyone is paying attention. Which they aren’t.

Those other docs? In the suburbs? Doing cosmetic surgery and passing out heart pills like candy? They’re on their own. None of those doctors are going to vote for us anyway, once we “fix” the health care system.


Around the office, guy, you may hear people talking about $50 billion as the cost for NDLB. Maybe. Debbie says no, no, no—roughly a billion a year, $25,000 per doctor for 50,000 doctors. $1 billion may sound like nothing. It is half the FDA budget, give or take. But the number is forevah. Something about “perpetual licenses.” Seat licenses? Not sure. For now, think of $1 to $50 billion as an NDLB down payment. Do we really know what anything will cost these days? Just sayin’.


Sorry for such a long email. Flight attendant ballistic now.

This top job at FDA. It’s LESS desirable than we thought. Such a relief. Meaning: it will be WAY easier on our end to find some poor bastard to do it. Kennedy’s people all wrong on that.

There is one new name. More on him in a sec. No managers. Does that matter? Do we care?

Of course, none of the lady professors on the list from Mrs. Clinton have ever had more than 9 people working for them. An example: I met the last gal on Hillary’s list. Separate flight. Nice person. She’s got a secretary and a department of seven people. FDA has a couple thousand—Debbie is checking on the number. So anyway, our gal has a bow tie, tweed jacket, frizzy hair, Annie Hall got into med school. If it’s her, we will spend serious Palin-level wardrobe consulting dollars for the confirmation hearing. Debbie has ideas.

Anyway, I was ALSO in DC for about 18 hours. Phew.

Funny thing is, no one on Capitol Hill cares who you pick to run the FDA. Congress will disembowel whoever it is, given enough time. You could appoint Winston Churchill. Clint Eastwood. Mother Theresa. Doesn’t matter. It’s a no-win situation after your honeymoon is over next summer. Done.

Yeah, Congress wrote all the FDA rules. And their budget. But tearing down the place is so fun, so natural for those guys. Plus, guaranteed positive NATIONAL media coverage. Respect. Something they don’t get in farm districts.

Basically, bottom line? Congressional “thought leaders” on FDA don’t want to look too closely at their corn subsidies or some deluxe highway rest stop named in their honor. Debbie actually drove into one for our favorite Congressman (from Virginia) & said it’s lovely.

So bad-mouthing FDA is total, total gold from a “I stand up for the little guy,” how-many-business-bashing-press-releases-did-we-send-out-this-week perspective. I am starting to see why America hates these Congressmen, wrapped up in their stupid games for decades. Those flying, screeching monkeys on the Wizard of Oz would be easier to deal with. I say that as a lawyer-monkey myself. Still getting used to this “bipartisan” thing.

That’s it. A lot to digest on the Blackberry, I know. Yikes. The co-pilot is coming to talk to me. Do they know who I am? I miss the campaign plane.

One last thing? Based on the above, your FDA pick should probably be a person of color.  That will offer whoever it is some extra level of protection. For a few months. Debbie’s working on it. Colin Powell turned us down. We’re making progress on another name….Asian, corporate type, out of LA, a few minor divorce-related things we should discuss F2F re: the background check. Asians get divorced—who knew?

See you tomorrow ... Hope this helps.