The Tea Party and spontaneous order
In an episode on a libertarian plan, Bob Zadek described the Tea Party movement as something that did not originate with established political figures. He said it was not a top-down movement and named Bill Bennett, Dick Armey and Newt Gingrich as figures who did not get together to produce a master plan. Zadek said the movement instead arose with unusual spontaneity from many Americans, and he treated that spontaneity as evidence that the underlying sentiment was already present in the country A Libertarian Plan (2010).
Zadek’s guest, Matt Welch, described the movement as driving people batty because they could not find the snake’s head to cut off. Welch said America has identifiable quirks and traditions, that the point is to protect minorities against the tyranny of the majority, and that there is a bedrock understanding of capitalism in the country. He cited Thomas Jefferson’s observation that that government which governs least governs best, and said this tradition had been ignored and obscenely violated over the previous 10 years at both the federal and state levels. He said state governments on average doubled their budgets during the good period of 2002 to 2007 A Libertarian Plan (2010).
Welch contrasted the “Pledge to America,” which he called a piece of crap document the Republicans tried to pass, with a terse 10-point, 10-sentence contract from America that emerged from Tea Party organizations. Zadek said he hated the Pledge to America and had devoted a whole show to reviling it for 55 minutes about three weeks earlier. Welch said the little 10-point document was all about spending and restraining the size of government, and that what was getting people out in the streets in most cases was the idea that the country was spending too much money, putting itself at risk, and was the next Greece except with a worse financial house A Libertarian Plan (2010).
Zadek framed the question as which party would recognize the force behind the Tea Party. He said the Tea Party was not the force; the philosophy behind it was, and that it had been percolating in Americans and could not be restrained anymore. He said whichever party signed onto it first would be successful in upcoming elections, and that the Republicans had the edge. He described the parties as marketing cooperatives that exist only to get humans elected and do not exist to further any particular worldview A Libertarian Plan (2010).
The electronic health record mandate
In an episode on whether Americans would accept second class medicine, Dr. Jeffrey Singer told Bob Zadek that the shortage of primary care doctors is acute and serious. He said the government in the early part of the 2000s wanted to encourage doctors to go to electronic health records because it intuitively thought this would save money, even though there was no evidence-based data on the point. He said part of the stimulus bill passed in 2009 forced doctors and hospitals to become electronic by 2014 or face Medicare reimbursement penalties Will Americans Accept Second Class Medicine? (2013).
Zadek asked whether Singer was being told how to run his office. Singer said he was told he must go electronic, and that part of the stimulus money reimbursed him for the cost of the software and hardware. He said the reimbursement did not cover the two months in which he had to take people off productive work to enter paper charts into the computer, nor the following couple of months in which he could see only about 50% of the patients he usually could see because he was still learning to enter everything and felt more like a data entry technician Will Americans Accept Second Class Medicine? (2013).
Singer identified Newt Gingrich among the geniuses who thought electronic records would save money, saying Gingrich had talked this up big in the 1990s. Singer said that even though politicians want doctors to practice so-called evidence-based medicine, politicians do not practice evidence-based public policy, and that they passed the requirement based on an intuition that it would save money Will Americans Accept Second Class Medicine? (2013).
Singer described how the billing works. He said that to submit a bill to Medicare there are incredibly complicated codes, and that for an office consultation there are five different levels of codes, each depending on how many body systems the doctor inquired about or examined. He said competing software companies sell their product by telling doctors their payments will increase, and that the software prompts the doctor to enter things that enable a legitimate charge for a bigger code. He gave the example of a doctor who would ordinarily examine three body systems and charge for a level two consultation being prompted to add two more body systems to lift the visit to a level three. He said it is up to the honesty of the doctor whether to actually examine those systems or to cut and paste from a previous encounter Will Americans Accept Second Class Medicine? (2013).
Singer said there is already data, which he said Zadek might have read in the New York Times about six months earlier, showing that since hospitals went electronic, Medicare is actually spending more money in payouts to hospitals than before. He said the payers are getting higher bills, and that if they want to see electronically whether the data matches the level of the code, it is there. He said the records create long, voluminous notes that are difficult for a clinician to use, and described looking through pages and pages of a referred patient’s history — a family history of gout, an uncle on his mother’s side with colon cancer — while searching for the reason the patient was sent to see a surgeon. He said he ends up forgetting the notes, going into the exam room and asking the patient directly, and starting from scratch, because the notes are so long and voluminous that they become not clinically useful and because he does not trust half of what is in them Will Americans Accept Second Class Medicine? (2013).
Singer said the requirement to go electronic is so expensive for many practices that, combined with poor reimbursement in primary care, it has forced most primary care practices out of business. He said there is now an acute shortage of primary care doctors, and that in the Phoenix area he knows of only a handful still in private practice, with almost every one now working for a hospital. He described hospitals buying out practices so doctors can tap into the hospital’s electronic health records system, with staff working for the hospital, the office leased by the hospital, the doctor an employee, and the patient billed by the hospital’s billing system. He said this affects the doctor’s productivity and attitude because the patients are no longer his. He said more and more primary care doctors are going that way, and that more and more nurse practitioners and physician’s assistants are replacing primary care doctors, so that a person may wait and wait for a primary care appointment and then be seen by a paraprofessional rather than a doctor. He said that in many cases this is fine and that he did not want to denigrate the paraprofessional, but that in a market system a person should be able to decide whether to be evaluated by someone with the training of a paraprofessional or with the training of a physician Will Americans Accept Second Class Medicine? (2013).
Across episodes: no development
The excerpts touch on Newt Gingrich in two episodes, one on the Tea Party and spontaneous order and one on electronic health records and the primary care shortage, and they show no development between the earlier and later treatment: in the first he is named only as an establishment figure who did not author the Tea Party, and in the second only as an advocate of electronic health records.
What the sources do not cover
The excerpts do not contain any statement by Newt Gingrich himself, nor any account of his career, offices, campaigns or writings beyond the two passing references. They do not state what he proposed, when, or in what capacity, and they do not describe any bill, statute or agency action bearing his name. Nothing in the excerpts addresses his views on the Tea Party, on regulation generally, or on health policy beyond Dr. Singer’s remark that he talked up electronic health records in the 1990s.