MEDICAL TUESDAY . NET
Community For Better Health Care
Vol XII, No 10, Jan, 2014
In This Issue:
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The Annual World Health Care Congress
In April, the most forward-thinking health insurance, employer, hospital and health system executives and top health care thought leaders will come together to discuss transformative trends such as consolidation, transparency , quality metrics, engagement and procedural costs, payment model innovations.
Mention promo Code QPH357 and Save $300 off of the registration fee. Please take a moment to download the printable agenda (PDF).
As the national leadership forum to transform health care costs and quality, the 11th Annual World Health Care Congress www.worldhealthcarecongress.com drills down to find solutions to the challenges and issues facing health care executives in an unprecedented, peer-driven forum of open discussion and debate.
SEVEN dedicated, educational Summits provide focused presentations, along with interactive discussion on emerging trends and solutions. Join many organizations already sending their executive teams to cover all seven summits that include: www.worldhealthcarecongress.com
· Health Insurer and Payer Summit for VP, SVP, and C-Level Executives
· Health Reform & Policy Summit on Exchanges, Duals, Medicaid, & Medicare
· Network & Contract Management Summit for Providers & Insures
· Hospital, Health System & Physician Executive Summit for VP, SVP, C-Level Executives
· Health Information & Technology Summit for Insurers & Providers
· Business of Women’s Health Summit for Provider Marketing, Sales, & Strategy Executives
· Benefits, HR, & Wellness Executive Summit on Improving Employee Engagement, Health, & Wellness
These Summits take place April 7-9, 2014, at the 11th Annual World Health Care Congress (WHCC) in National Harbor, Maryland – the only health care meeting that simultaneously convenes all stakeholders to share global strategies and offers targeted summits focused on each health care sector. Please take a moment to download the printable agenda (PDF).
1. Featured Article: There Oughta Be a Law
by Adam Allouba
You may not hear that precise expression
every day, but you recognize the sentiment. It’s one that you probably feel
yourself now and then: The government should do something to fix some problem
or another. It may be something gravely serious or nothing more than a minor
nuisance; it may be something that oughta be mandatory or oughta be
illegal. But whatever it is, it needs to change and using the law is the way
to change it.
So what does it mean to assert
that government should do something? Let’s start at the beginning. The textbook definition
of the state is an entity with a monopoly on the legitimate use of force
(within its borders). It’s vital to understand that this is not some
eccentric libertarian viewpoint—any introductory political science textbook
will tell you the same thing. In practice, that means that if you violate the
state’s rules, you get punished through force. Drive too fast? Get fined.
Flunk a health inspection? Get shut down. Sell drugs? Get arrested.
To read the entire opinion, go to http://www.quebecoislibre.org/14/140115-10.html
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2. In the News: Misdiagnoses are harmful and costly.
by Laura Landro
A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child's fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis.
Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes—and more likely to harm patients—but they're also the leading cause of malpractice claims, accounting for 35% of nearly $39 billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to Johns Hopkins. Read more . . .
The good news is that diagnostic errors are more likely to be preventable than other medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis. . .
Part of the solution is automation—using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results. Another component is devices and tests that help doctors identify diseases and conditions more accurately, and online services that give doctors suggestions when they aren't sure what they're dealing with. . .
"Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar of the patient quality and safety movement," says Mark Graber, a longtime Veterans Administration physician. . .
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3. International Medicine: Canadian-Style Health Care System
May 23, 2013
I believe we are moving toward two different health systems. In one, patients will be able to see doctors promptly. They will talk to physicians by phone and email. They will have no difficulty scheduling needed surgery. If they have to go into a hospital, a “hospitalist” (who reports to them and not to the hospital administration) will be there to make sure their interests are looked after. They may even have an independent agency that reviews their medical records, goes with them when they meet with specialists, and gives them advice on every aspect of their care.
In the other system, waiting times will grow for almost everything ― to get appointments with physicians, to get tests, to obtain elective surgery, etc. Patients may find that they don’t have access to the best doctors or the best hospitals. They may find that the facility where they are treated does not have the latest technology. In terms of waiting times and bureaucratic hassles, health care for these patients may come to resemble the Canadian system. It may become even worse than the Canadian system. Read more . . .
The evolution toward a two-tiered system was already under way before Barack Obama became president. But ironically, the Affordable Care Act (ObamaCare) is accelerating the pace of change. It is doing so in four ways.
First, ObamaCare is supposed to insure 32 million additional people by this time next year. If the economic studies are correct, these newly insured will try to consume twice as much medical care as they have been. In addition, most of the rest of us will be forced to have more generous coverage than we previously had. There will be a long list of preventive services that all plans will be required to cover ― with no deductible and no copayment ― and commercial insurance will be required to cover a great many services previously avoided (including, everyone must know by now, contraception). These two changes alone will boost the demand for care considerably.
On the supply side, there is really no provision under ObamaCare to create more doctors. In fact, the supply of doctor services is likely to decrease because of two more features of health reform. Doctors, who are already weary from third-party interference in the practice of medicine, will step up their retirement dates as they contemplate the prospects of even more bureaucracy. Also, hospitals are acquiring doctors as employees at a rapid rate. Indeed, more than half of all doctors are now working for hospitals. When doctors quit their private practices and start working for hospitals, they reduce the number of hours they work. (Forty hour work weeks and golf on the weekends replaces 50 and 60 hour work weeks.) Since they have a guaranteed income, they also become less productive.
These four changes add up to one big problem: we are about to see a huge increase in the demand for care and a major decrease in the supply. In any other market, that would cause prices to soar. But government plans to control costs (even more so than in the past) by vigorously suppressing provider fees and the private insurers are likely to resist fee increases as well. That means we are going to have a rationing problem. Just as in Canada or Britain, we are going to experience rationing by waiting.
Consider how much waiting there already is in the U.S. health care system. On the average, patients must wait three weeks to see a new doctor. In Boston, where we are told they have universal coverage, the average wait time is two months to see a new family doctor. Amazingly, one in five patients who enters a hospital emergency room leaves without ever seeing a doctor ― presumably because they get tired of waiting.
All this is about to get worse. Waiting times are going to be especially lengthy for anyone in a health insurance plan that pays providers below-market fees. The elderly and the disabled on Medicare, low income families on Medicaid, and (if the Massachusetts precedent is followed) people who acquire health insurance in the new health insurance exchanges will find they are financially less desirable to providers than other patients. That means they will be pushed to the end of the waiting lines.
Those who can afford to will find a way to get to the head of the line. For a little less than $2,000 a year, for example, seniors on Medicare can contract with a concierge doctor. These doctors promise prompt access to care and usually talk with their patients by telephone and email. They serve as an advocate for their patients, in much the same way as an attorney is an advocate for his client.
But every time a doctor becomes a concierge doctor, he (or she) leaves an old practice serving about 2,500 patients and takes only about 500 patients into the concierge practice. (More attention means fewer patients.) That means about 2,000 patients now must find a new physician.
Because the two tiers of health care will compete with each other for resources, the growth of the first tier will make rationing by waiting even more pronounced in the second tier. As a result, waiting times in the second tier could easily exceed those in Canada.
I also believe all this is going to happen much more rapidly than anybody suspects.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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To confront America's health care crisis, we do not need more spending, more regulations or more bureaucracy. We do need to liberate every American, including every doctor and every patient, to use their intelligence, creativity and innovative abilities to make the changes needed to create access to low-cost, high-quality health care.
Here are 10 steps to achieve these goals.
1. Free the Doctor. Medicare pays for more than 7,000 specific tasks, and only for those tasks. Blue Cross, employer plans and most other insurers pay the same way. Notably absent from this list are such important items as talking to patients by telephone or e-mail, or teaching patients how to manage their own care or helping them become better consumers in the market for drugs. Further, as third-party payers suppress reimbursement fees, doctors find it increasingly difficult to spend any time on unbillable services. This is unfortunate, since it means that doctors cannot provide the type of low-cost, high-quality services that are normal in other professions. Read more. . .
To make matters worse, providers often face perverse incentives. When they lower costs and raise the quality of care, their income typically goes down, not up. For example, Geisinger Health System in central Pennsylvania gives heart patients a "warranty" on their surgeries. Patients who have to be readmitted because of complications pay nothing for the second admission. Whereas most hospitals make money on their mistakes, the warranty forces Geisinger's staff to provide higher quality care (to avoid readmissions) but lowers Geisinger's income from Medicare and other payers.
To change these perverse incentives, Medicare should be willing to pay for innovative improvements that save taxpayers money. And doctors and hospitals should be able to repackage and reprice their services (the way other professionals do), provided that the total cost to government does not increase and the quality of care does not decrease. This change in Medicare would almost certainly be followed by similar changes in the private sector.
2. Free the Patient. Many patients have difficulty seeing primary care physicians. All too often, they turn to hospital emergency rooms, where there are long waits and the cost of care is high. Part of the reason is that third-party payer (insurance) bureaucracies decide what services patients can obtain from doctors and what doctors will be paid. To correct this problem, patients should be able to purchase services not paid for by traditional health insurance, including telephone and e-mail consultations and patient education services. This can be done by allowing them to manage more of their own health care dollars in a completely flexible Health Savings Account.
3. Free the Employee. It is now illegal in almost every state for employers to purchase the type of insurance which employees most want and need: individually owned insurance that travels with the employee from job to job, as well as in and out of the labor market. We need to move in the opposite direction - making it as easy as possible for employees to obtain portable health insurance.
4. Free the Employer. Liberating employees would have the indirect effect of liberating employers as well. Employers have been put in the position of having to manage their employees' health care costs, even though many businesses lack the experience or expertise. Instead, employers could make a fixed-dollar contribution to each employee's health insurance each pay period. Like 401(k) accounts, the health plans would be owned by employees and travel with them as they move from job to job and in and out of the labor market.
5. Free the Workplace. If a new employee has coverage under her spouse's health plan, she doesn't need duplicate coverage. But the law does not allow her employer to pay higher wages instead. On the other hand, a part-time employee might be willing to accept lower wages in return for the opportunity to enroll in the employer's health plan. The law does not allow that either. The answer: Employers should be free to give employees the option to choose between benefits and wages, where appropriate.
6. Free the Uninsured. Most uninsured people do not have access to employer-provided health insurance, purchased with pretax dollars. If they obtain insurance at all, they must buy it with after-tax dollars, effectively doubling the after-tax price for middle-income families. The answer: People who must purchase their own insurance should receive the same tax relief as employees who obtain insurance through an employer.
7. Free the Kids. The recent expansion of the State Children's Health Insurance Plan (S-CHIP) to cover four million additional children will result in up to half losing private coverage, according to the Congressional Budget Office. However, under S-CHIP, children have access to fewer doctors and medical facilities than children in private plans.
These incentives should be reversed. S-CHIP money should be used to encourage parents to enroll their children in their employer's plan or another plan of the parents' choosing.
8. Free the Parents. Under the current system, a child could be enrolled in S-CHIP, a mother could be enrolled in Medicaid and a father could be enrolled in an employer's plan. However, medical outcomes are likely to be better with a single insurer. The answer: Medicaid and S-CHIP funds should be used to subsidize private health insurance, so that low-and moderate-income families are able to see the same doctors and enter the same facilities as other citizens.
9. Free the Chronically Ill. Under current regulations, insurers are not allowed to adjust premiums to reflect higher expected health care costs. This encourages insurers to seek the healthy and avoid the sick before enrollment. After enrollment, insurers have an incentive to over-provide care to the healthy and under-provide to the sick. These incentives need to be reversed. For example, in the Medicare Advantage program, the government pays higher premiums for seniors with more expensive health needs. This encourages insurance companies to create specialized plans - especially for chronic illnesses - that compete with each other.
Chronic patients also need to be able to manage more of their health care dollars directly. For example, "Cash and Counsel" programs in many states allow homebound, disabled Medicaid patients to hire and fire the vendors who provide them with services. Patient satisfaction in these programs is almost 100 percent.
10. Free the Early Retiree. Most baby boomers will retire early, before eligibility for Medicare. Two-thirds will not get health insurance from their former employer and even those who have been promised employer coverage may see those promises broken, since there is almost no prefunding of benefits. Under current law, an employer can include early retirees in its regular health plan, but cannot contribute to more economical, individually owned plans.
The answer: Employers should be able to contribute pretax dollars to the individually owned insurance of their retirees. Early retirees should be able to pay their share of premiums with pretax dollars. Both the employer and the employee should be able to save (pretax) in preparation for these events.
John C. Goodman is president and Kellye Wright Fellow at the National Center for Policy Analysis.
Read the entire report at http://www.ncpa.org/pub/ba669
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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There has been some confusion in this era with Personal Health Records with getting the patient more involved in his or her own care. Some patients have interpreted this as going to any doctor they feel they need at the moment. They do not see their personal physician as being their managing partner—but just a person they can see when all else fails and they don’t know which doctor they should see next. They don’t feel that cost should be a factor. They have no concept of the costs involve. They consider it as just another office call with a new or different doctor. One patient this week said it didn’t matter since she had Tri-Care, which allowed her to seen anyone she desires without authorization. Read more . . .
She had seen two new physicians since her previous evaluation. She had developed a cough with the phlegm clearing after a course of antibiotics. However, it did not clear her otherwise hacking cough. The allergist had done a pulmonary function test but she had no idea how well she did or what it showed. But she did begin allergy injections which over two months had no effect on her cough nor was it expected to do so in two months. The printout from our HMO suggests that each consultation, which usually requires additional lab tests, x-rays, or procedures, adds $1500 to $3500 to that patient’s medical costs.
She also had two urgent care visits since her last evaluation in our office. Urgent care center evaluation is by another new physician who makes a stab at the diagnosis in the minimal amount of time without benefit of the patient’s medical records. Hence, these evaluations have minimal value depending on how many tests previously done have been duplicated. This is also a costly and essentially unnecessary expense.
She also had a hospital emergency room visit and was given another antibiotic. In the absence of any phlegm, this also had no significant effect on her cough. She developed nausea and vomiting the second day and call the Emergency Department. She was told there were no other antibiotics and she should see her personal physician.
The hospital Emergency Department visits start at $600 in our community but frequently can be as high as $9000. The ER doctor does not have the benefit of the patient’s medical file which may have been developed over the course of years with numerous tests, x-rays and probable procedures which the patient may not recall during an emergency evaluation, and even if recalled, is not able to give a medically verifiable result.
As a Pulmonologist I felt somewhat frustrated to not have basic pulmonary data to confirm my diagnosis to chart her treatment. Should I repeat the PFT or treat her empirically? Her cough of several months duration, persisting through two doctors, two urgent care centers, and one emergency room, had not stopped the coughing.
The diagnosis should have been obvious. In a lady with allergic rhinitis (hay fever) who develops a cough, it more likely than not is allergic bronchitis sometimes called cough variant asthma. Examination did confirm asthma. She did not have her albuterol inhaler with her and didn’t have any idea that she should carry it with her at all times.
So we used a new inhaler in our office. She was advised to exhale fully, open her mouth wide, and take a deep breath as I gave her an albuterol spray which she inhaled. I quickly reminded her that she must hold her breath for 30 to 60 seconds. If she exhaled the albuterol, it obviously would not do her any good outside her lungs. She was able to hold it for 45 seconds. She was then given the second inhalation of albuterol and was able to hold it for 60 seconds.
She had not further coughing during the remainder of her evaluation.
She was advised in the future to see her personal pulmonologist before the $10,000 to $15,000 she cost her insurance company over the past two months which are the ones who pay their Blue Cross premiums for such gluttonous use of health insurance which then increases their premiums unnecessarily. She already had an albuterol inhaler and we advised her to use every time she coughed. Hence, our $150 office call which required no further prescriptions was more effective than the $15,000 she had incurred.
We reminded her that we are always able to see established patients with 48 hours of their call and none of her health care visits were emergencies. In fact, none of her health care visits were effective.
She had not told any of these doctors who her personal physician was. Hence, we had no reports from any of them and so they were irrelevant to her. She was told to have a report in our office before her next visit from all her doctors or we would withdraw from her care. We would not be party to such a flagrant abuse of health care resources.
Medical Gluttony thrives in Government and Health Insurance Programs as seen above.
It Disappears with Appropriate Deductibles and Co-payments on Every Service Provided.
In this case it would have saved more than $10,000.
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6. Medical Myths: Just give me some good cough syrup so I can sleep.
In section 2 above concerning the solution to medical errors, the article indicates the following:
Part of the solution [to medical errors] is automation—using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results. Another component is devices and tests that help doctors identify diseases and conditions more accurately, and online services that give doctors suggestions when they aren't sure what they're dealing with.
In another study it was determined that four out of five errors in making a diagnosis were the result of breakdown in the doctor-patient encounter. The leading causes were problems in history taking and lack of a complete physical examination.
It was the latter that was lacking in section 5 above. A focused medical history and a focused medical examination produced a more accurate diagnosis in one office call at a potential savings of $10,000 to $15,000. It appears the emphasis in physician training has been towards technology. If technology is not firmly based on a foundation of accurate medical history and physical findings, it may be pointed in the wrong direction and of little value despite the exorbitant cost.
Cough is one of the two most common causes for a doctor’s visit. However, in our experience it is generally treated with a cough syrup rather than towards the cause. Bronchospasm requires a bronchodilator, not a cough suppressant.
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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7. Overheard in the Medical Staff Lounge: Medicare Restrictions because of Obama Care
Dr. Rosen: The first year of the new health care reform has been concluded. Has it affected any of our practices?
Dr. Edwards: It has affected my practice in surprising ways. Not only with the Medicaid patients who have been incorporated into our HMOs, but also our Medicare patients who have experience untold denials of care.
Dr. Milton: We’ve experienced similar restrictions in our Medicare population. We thought it must be from the Medicare funding that Obama transferred (or stole) from the Medicare program to his own program.
Dr. Kaleb: We felt it must be the result of the same transfer of funds. The unfortunate result is that now both programs are so short of funds, that the strong arm of socialized medicine is affecting the quality of care in both programs.
Dr. Ruth: Since we don’t take Medicaid in our office, we weren’t sure why our Medicare patients are being so restricted. They complain that drugs they have gotten for years, are now severely restricted or unavailable to them. They are being asked to take different and unfamiliar prescriptions. That may be simple for young people, but Medicare patients are generally old and it is difficult for them to changes habits when they were doing so well before.
Dr. Rosen: It appears that Obama Care is causing a number of unintended consequences. The trajectory of each is still unclear and may remain unclear for years to come. The Medicare consequences are still evolving 50 years after inception. What a waste of physician talent.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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By Lawrence R. Huntoon, M.D., Ph.D. Editor, JAPS
Dr. Michael W. Fitzgibbons, an infectious diseases specialist and former chief of staff at Western Medical Center in Santa Ana, California, is not a man who simply walks away and gives up, even in the face of grave injustices inflicted upon him and his family. But more than demonstrating his integrity, his story shows how far some hospital administrators will take retaliation against a physician whistle blower. We all have a stake in the integrity of our judicial system. Many would choose another course, but though
paying a high professional and personal price, and uncertain of any level of victory, Dr. Fitzgibbons chose to stay on the battlefield.
The battle was which ended on Feb 8, 2013. The details of what was done to Dr. Fitzgibbons are frightening and shocking. His story was detailed in a series of articles published by the , weekly newspaper for Orange County, California, published in Costa Mesa, which covered the story intensely.
In 2004, the financially struggling Tenet Healthcare Corp sought to sell four hospitals in southern California—Western Medical Center of Anaheim, Chapman Hospital in Orange County, Coastal Community Hospital in Santa Ana, and Western Medical Center of Santa Ana, the hospital where Dr. Fitzgibbons practiced.
Some physicians expressed concerns about the proposed purchaser, Dr. Kali P. Chaudhuri and his company, Integrated Healthcare Holdings, Inc. (IHHI).
According to an article published in , “Four years ago, Chaudhuri’s KPC holding company closed 81 Southern California medical clinics it had purchased just a year before. The closures stranded 300,000 patients without care and, in many cases, without medical records. Insurers and doctors scrambled to pick up the pieces. Asked to account for the chain’s assets, a bankruptcy judge said the money trail was too complicated to follow. The resulting charges of mismanagement, fraud, and diversion of assets led to dozens of lawsuits and thousands of creditor claims against Chaudhuri and KPC, most of them unsatisfied to this day.”
According to another article, “So vehemently do they oppose Chaudhuri’s takeover of the four Tenet hospitals that in October Fitzgibbons and fellow physicians took to the streets with picket signs. More than 70 doctors from the targeted hospitals formed their own acquisition group and offered Tenet a competing bid.”
At the urging of Fitzgibbons and other physicians, state Senator Joe Dunn convened hearings in 2004 that resulted in an agreement to limit the involvement of Dr. Chaudhuri in the takeover of the four hospitals.
Michael W. Fitzgibbons, M.D., vs. Integrated Healthcare Holdings, Inc., et al., OCWeekly
While the last chapter in this saga has yet to be written, physicians can learn from it the tremendous power of hospital cartels, and the ruthlessness they may display in retaliating against a physician who opposes them or exposes their wrongdoing.
Lawrence R. Huntoon, M.D., Ph.D. is a practicing neurologist and editor-in-chief
of the Journal of American Physicians and Surgeons. Contact: email@example.com.
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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9. Book Review: Handbook on State Health Care Reform by John C. Goodman, PhD
Chapter 2: PRINCIPLES OF REFORM
What are the principles of health reform? One might suppose they are fairly easy to enumerate and command widespread support. As it turns out, that is not the case. Here are five recommended principles. If they are followed, the odds of successful health policy reform will be greatly enhanced.
Principle No. 1: No One Should Be Denied Basic Care because of a Lack of Ability to Pay.
A good society does not withhold basic health care from people because they lack the resources to pay for it at the time of delivery. This does not imply that people have a “right” to free care. If that were the case, everyone would have a perverse incentive to become “free riders,” wastefully over consuming care at everyone else’s expense. Instead, most people should be expected to pay their own way most of the time. But no one should have to forgo basic care because they can’t pay for it at the time of delivery. Read more . . .
Principle No. 2: Health Care Should Be Provided in a Competitive Marketplace.
The economic definition of efficiency is: Whatever is produced should be produced at minimum cost. Some studies lend credence to the idea that one out of every three dollars of health care spending is wasted. This implies that, in principle, the same health care could be provided for two-thirds the cost. Alternatively, there could be 50 percent more care for the same amount of money. In other markets, entrepreneurs spur efficient production by repackaging, repricing and taking advantage of new products
and innovations. Principle No. 2 is not being followed whenever entrepreneurs are arbitrarily prevented from serving this function.
Principle No. 3: The Appropriate Level of Insurance Depends on the Assets to Be Protected.
If Principle No. 1 is followed, people will not need insurance to receive care. Instead, they will need insurance in order to protect their earning power and other assets from unexpected health care costs. Other forms of insurance serve as a useful guide. The purpose of life insurance is primarily to protect earning capacity against the consequences of premature death.
Accordingly, the appropriate level of insurance depends on current assets and expected income. The purpose of casualty insurance is to protect the value of, say, a home or automobile. The appropriate level of insurance depends on the anticipated risk and the replacement value of the home or car. Similarly, the purpose of health insurance should be to protect assets against unexpected medical costs.
Principle No. 4: Health Insurance Should Be Personal, Portableand Renewable.
It is a mistake to have a system in which a change of health plans is virtually mandated whenever people change employers. Instead, health insurance should be portable (traveling with the employee from job to
job). Also, it defeats the whole purpose of insurance if premiums can rise in response to an adverse health event. Life insurers do not get to charge more to the insured who get AIDs or cancer. Insurance exists to transfer risk from the individual to an (insurance) pool. Th e price of that transfer is the periodic premium payment. Once the insurance contract is set, the practice of increasing premiums after an adverse event occurs would be like changing the odds on a horse race after the race is underway.2 Accordingly,
people should be able to buy health insurance that is renewable at rates that are independent of adverse health events. In most states, this is required under the laws governing individual insurance. However, such insurance is generally unavailable in the small group market.
Not withstanding all of the above, from time to time people may wish to change their insurance coverage. At that point they should be able to buy real insurance in a real market. It is to everyone’s advantage to be able to face real prices for risk when making changes in insurance coverage. Otherwise, people who are undercharged will over insure, and people who are overcharged will underinsure.
Principle No. 5: Private Insurance Should Be at Least as Attractive as Health Care Provided at Taxpayer Expense.
For many people, the implicit alternative to private insurance is to rely on charity care paid for by others. For those who qualify, Medicaid and S-CHIP programs are alternatives to private insurance. Perversely,
these alternatives encourage people to forgo private coverage paid from their own pockets in order to take advantage of care provided at taxpayer expense. Rational public policy would create the opposite incentives. At a minimum, government should be neutral — giving people just as much incentive to be in the private sector as in the public sector.
This book excerpt is found at http://www.ncpa.org/pdfs/statehcreform/Chapter_02_Pages%20from%20State_HC_Reform_6-8-07-2.pdf
The Book Review Section Is an Insider’s View of What Doctors are Reading about.
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10. Hippocrates & His Kin: Ants, Scars, and Corkscrews
Doctor: “You’ve simply got to have more diversion and relaxation in your life.”
Patient: “But, Doctor, I’m too busy.”
Doctor: “Nonsense! The ants are hard-working creatures, but they always take time to attend all the picnics.”
“Oh, doctor,” said the young lady, “will the scar show?”
“That, madam,” said the doctor, “is entirely up to you.”
The town doctor was in bed when his phone rang and an excited voice told him that the baby had swallowed a cork screw. The doctor was about to leave for the patient’s home when the phone rang again.
The same voice came on the line and said: “It’s all right now, doctor. We’ve found another corkscrew.”
Hippocrates and His Kin / Hippocrates Modern
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read the informative ?.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.
• To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. We must always be alert to RINOs such as Romney & Christie. They can do the real harm to health care, our patients, in addition to our formerly free society.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month read Choose recent issues. The last ten years of Imprimis are archived.
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of California. There is no additional cost or
fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
• PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
* * * * *
A lawyer’s briefs aren’t.
A government of law is a government of lawyers.
A lawsuit helps keep the lawyers in suits.
The more laws the more offenders that need lawyers.
Law is a bottomless pit.
God save us from a lawyer’s etceteras.
Nelson Mandela, the man who freed South Africa from apartheid, died on December 5th, aged 95
The Economist | Dec 14th 2013 | From the print edition
WHO was the greatest statesman of the 20th century? Discard the mass murderers such as Joseph Stalin and Mao Zedong; set aside the autocratic nationalists like Gamal Abdel Nasser and the more admirable, but probably less influential, anticommunists like Vaclav Havel; then winnow the list to half a dozen names. On it would perhaps be Mohandas Gandhi, Winston Churchill, Franklin Roosevelt, Charles de Gaulle, Jack Kennedy and Nelson Mandela. For many people, in many lands, the most inspirational of these would be the last. Read more . . .
Mr Mandela’s heroic status is a phenomenon. For years his fame was largely confined to his own country, South Africa. He did not become widely known abroad until his first trial, for high treason, ended in 1961. Though acquitted, he remained free for little more than a year before going to prison for 27 years and six months, convicted of sabotage and promoting revolution. During this long confinement, more than 17 years of which were spent on Robben Island, a wind-scorched Alcatraz off the Cape coast, little was heard of Mr Mandela and nothing was seen of him. When he emerged from captivity on February 11th 1990, no contemporary photograph of him had been published since 1964; the world had been able only to wonder what he looked like.
He was by then 71 years old, and barely ten years of semiactive politics remained to him. Nonetheless, more than any other single being, he helped during that decade to secure a conciliatory and mostly peaceful end to apartheid, one of the great abominations of the age, and an infinitely more hopeful start to a democratic South Africa than even the most quixotic could have imagined 20 years earlier.
On April 15:
Income tax filing deadline.
Lincoln died, 1865
S. S. Titanic sank in 1912 with loss of more than 1500 lives.
Leonardo da Vinci born in 1452
After Leonard and Thelma Spinrad
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Del Meyer, MD, Editor & Founder
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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.
We thank the readers who have inquired concerning the irregularity of MedicalTuesday as well as HPUSA. We have tried to convert our practice to the PracticeFusion EMR the past two years to prevent Medicare penalties. We will now abandon the extra two hours a day it took to convert our practice and forfeit any further incentives as not being cost effective. We will continue with the PracticeFusion EMR which is free and easy to learn. They make their revenue with medical ads similar to Google. I have not found it a problem to read a brief ad on the drugs I prescribe.
The ICD 10 implementation has been delayed to 2015, we will continue to practice until then. Having met many physicians who had a prison term with the last code changes, we would advised all physicians to seriously give up Medicare and Medicaid at that time.