MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing was introduced in this country with HMOs, under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:
1. Is There an Honest Man in the House?
2. EU Limits Junior Doctors’ Work Week to 58 Hour Weeks
3. UK Hospitals Face Penalties for Exceeding 90 Percent Bed Occupancy
4. UK Patients Face 18-month Wait in Hospital MRI Scanners Crisis
5. NHS Doctors Bribed to Hit Targets on Smoking
6. This Week’s Review of Socialized or Single-Payer Medicine
7. Medical Gluttony or Excessive HealthCare Costs
8. Medical Myths - Drinking Enough Water
9. Overheard in the Medical Staff Lounge
10. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

1. Is There an Honest Man in the House?
Reason Magazine, http://www.reason.org, celebrating 35 Years of Advancing Liberty,  thinks there is one. In their 35th anniversary issue, they list Congressman Ron Paul as one of their 35 heroes of freedom, the only member of the House of Representatives who always votes according to principles all should follow. First, Congressman Paul asks if the program is authorized by the Constitution. If it is, he then consults his campaign promises, which include pledges to never raise taxes or increase spending. We also join the Reason Foundation in saluting our colleague, Ron Paul, MD.

2. EU Limits Junior Doctors’ Work Week to 58 Hour Weeks
The EU issued a directive that beginning in August, junior doctors will not be allowed to work more than 58 hours a week. According to the BBC news on April 6, 2004, the UK government is pressing the European Commission to review the rules regarding how long junior doctors can work. Recent court rulings have also suggested that time "on call" must be counted as time worked. Health Secretary John Reid has written to the European Commission warning that such a policy could have "a severe impact" on the NHS. http://news.bbc.co.uk/1/hi/health/3605631.stm. The recent 80-hour restriction in the U.S. required hospitals to hire additional physicians to be able to reduce the average work week from 100 hours to 80 hours. This has cost some large hospitals up to several million dollars per year.

3. UK Hospitals Face Penalties for Exceeding 90 Percent Bed Occupancy
Government medicine with long waiting lists seems to be a catch 22 in the U.K. Jo Revill, health editor of The Observer, reported on Sunday, March 28, 2004: NHS trusts that have treated record numbers of patients are facing penalties of hundreds of thousands of pounds imposed by the private landlords of their hospitals. Secret clauses written into contracts between the NHS and the private consortia that build and run the hospitals stipulate that penalties must be paid if the number of patients treated exceeds a set figure, even if they are emergency cases. The money comes out of the hospitals' annual revenue budget, leaving less money in the pot for developments. The Worcestershire Royal Hospital, which has a deficit of around £15 million, was charged £200,000 this year under its penalty clause. Seven years ago, when NHS managers signed a deal with the private consortium Catalyst, it was agreed that bed occupancy would not rise above 90 percent. However, faced with a record number of emergency cases this year, it rose to 98 percent, so the 'fine' was imposed by Catalyst. http://www.guardian.co.uk/medicine/story/0,11381,1179704,00.html

4. UK Patients Face 18-month Wait in Hospital MRI Scanners Crisis
Gaby Hinsliff, chief political correspondent for The Observer, reports on Sunday, April 4, 2004, that patients are waiting up to 18 months for routine MRI scans from NHS to diagnose illness in a crisis that has triggered moves to buy thousands of scans from private firms. Patients at King's College Hospital in south London, which serves much of Surrey, Kent and the capital, are being told the waiting list for a non-urgent MRI scan is 72 weeks. In other parts of the country, waiting times have climbed. The wait at the North Cumbria Acute Hospitals Trust is eight months. It is eleven months in Glasgow. The Government aims to buy up to 80,000 extra MRI scans, about an extra 10 percent on top of what the NHS provides, that will be free to patients. Although the number of scans provided by NHS has more than doubled since 1997, a shortage of radiographers means they often cannot be read. The Tories say that the increased waiting times have been a convenient way of decreasing  the number of operations: until they have a scan, patients might not know whether they need surgery. http://www.guardian.co.uk/medicine/story/0,11381,1185466,00.html

Last week, I saw a patient with a severe unilateral headache that presented at my local suburban hospital. His waiting time for an MRI was about an hour. But waiting times similar to the NHS could occur in the United States if the Physicians for a National Health Program (PNHP), organized medicine, and other proponents of Universal Health Care and Single-Payer advocates could hoodwink enough votes to implement such a cruel and inhumane system.

5. NHS Doctors Bribed to Hit Targets on Smoking
We’ve previously reported in MedicalTuesday that one of the mechanisms the NHS was using to cut costs was to eliminate free care for the obese who don’t lose weight and smokers who don’t quit smoking. Certain targets were stated. It appears that the NHS missed these targets.

Francis Elliott and Michael Williams report that GPs were offered £100 to say patients have quit smoking. Health Service managers are offering family doctors cash bribes worth thousands of pounds to meet Whitehall targets, an investigation by The Independent on Sunday has revealed. Many expressed outrage at this “corrupt, demeaning scheme” of the NHS. http://news.independent.co.uk/uk/health/story.jsp?story=505827

This is yet another situation to illustrate that government mandates and regulations invite corruption. Unless the medical profession unites and ends government involvement in our internal affairs, which violates our patients’ confidential trust, we will go the way of the school teachers and others who have been de-professionalized. The public will always express outrage at physicians for obeying political directives, and physicians will be prosecuted for accepting government bribes labeled as incentives. When will the medical profession express outrage at the government for harming our patients?

6. This Week’s Review of Socialized or Single-Payer Medicine
Private Practice was a great journal in the 1970s and 1980s that discussed the practice issues of the day. As I recall, Francis Davis, MD, the owner and publisher, in his last editorial before it folded stated, “I regret that I have only one fortune to leave my country and my profession.” When I last saw him several years ago, he gave me permission to use any article I desired. I have recently come across a Freeman reprint of an article that a hospital administrator wrote outlining what government bureaucracy did to his hospital in Fort Wayne, Indiana. Joe Hochderffer, an administrator in one of three hospitals in Fort Wayne, was in the midst of an expansion program being resolved at the local level. A fourth hospital was being planned to add the number of beds the community needed.

At that time, federal health planning became the law of the land and interdicted Fort Wayne’s plans. Public Law 92-603, according to Hochderffer, was passed creating Health Planning Councils to correct the blunders of a previous Congress which, in 1965, created Medicare and Medicaid. The health planners descended on Fort Wayne creating a nine-county Health Planning Area. They determined that Fort Wayne needed 156 medical-surgical beds. They sent the proposals to the State Board of Health which dug out its guidelines and determined that Fort Wayne could only have three hospitals and thus the fourth hospital plans had to be canceled.

The three hospitals were asked if they could add the required beds more economically. Each hospital had expansion plans. But that was just the start of three years of bureaucratic delays. Mr Hochderffer was the part-time planner at his hospital, one of the most cost-effective hospitals in Indiana and in the United States. As the feds moved in, the number of planners grew to 25. What ensued was incessant bickering, two years of lawsuits and divided medical staffs.  With one percent inflation per month, the 36-month delay cost the community an extra $8 million. But that is probably less than the cost to taxpayers for 25 federal official planners, their offices and staff for three years and will continue into the next millenium. Although Mr Hochderffer was the administrator of the winning hospital, he said “there’s a dirty taste in my mouth.” Read the entire article at http://www.healthplanusa.net/JoeHochderffer.htm.

7. Medical Gluttony/Excessive Health Care Costs
Last week, I saw a 70-year-old male who wished to have a pulmonologist as his personal physician. He also wanted to continue with seven other specialists. He did have disease in seven organ systems and I felt three were complicated and warranted consultants. The other four were stable and did not require further investigation or a complicated treatment program. He stated that because Medicare pays for as many doctors as he feels are required, I should not be concerned with costs or overutilization. However, having a second physician on a case increases health care costs between 75 and 125 percent. Utilizing seven consultants twice a year will add at least 700 percent to this patient’s health care costs. This is why overutilization is measured in the 100s and 1000s of percent excess, never as the five or ten percent excess that Congress and administrators discuss. These costs cannot be contained by top down management or controls, only by patient responsibility through patient financial liability.

8. Medical Myths - Drinking Enough Water
Tufts University is a world premier Medical School and Medical Center concerning nutrition and health since the days when Dr Jean Mayer headed and developed that department. Their Health and Nutrition Letter continues that fine tradition by reporting the best in Nutrition and Health. The current issue lists four myths about drinking water: 1) Drink at least eight glasses of 8-ounces of water a day; 2) You should not wait until you’re thirsty to drink water; 3) Caffeinated beverages such as coffee, tea, and cola cause dehydration; and 4) Because thirst mechanism becomes blunted with age, older people, in particular, need to make a conscious effort to drink eight glasses of water daily. Tufts reminds us that all fluids count toward the eight glasses of fluids; that people are, in fact, consuming enough water each day from all sources without thinking a whit about how many glasses they’re drinking. With thirst as their guide, people are well hydrated.

During the past year, I had four patients who were driven into congestive heart failure as a result of following the four myths. This practice was encouraged and facilitated by well-meaning relatives, allied health workers, and health organization and health maintenance websites. My patients were literally drowning as a result of the excessive fluid intake. All the while, I was trying to reduce their fluid intake and even prescribing diuretics to eliminate excess fluid from their bodies and reverse their fluid overload which caused congestive heart failure. To review the current newsletter, see http://www.healthletter.tufts.edu/issues/2004-04/consumption_guidelines.html.

9. Overheard in the Medical Staff Lounge
Dr George mentioned that he has a number of patients who decline to pay for the annual flu vaccine since it is not covered by their health insurance. Other doctors have the same experience. Dr George felt this was an important public health problem and initially believed it probably should require a law mandating coverage for immunization. Later, however, he met one of these patients at the Veterinary when he took his Chow dog for rabies and Bordetella shots. The charges were $33 and $21. It dawned on Dr George that coverage for preventive care is not an insurance issue at all. Patients have gotten so used to thinking that if insurance doesn’t cover it, they don’t need or cannot afford it. We simply need to explain to them that paying $18 for a flu immunization shot may be lifesaving and just as important as paying $54 for their pet’s immunization shots.

10. MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, who, along with Devon Herrick, wrote Twenty Myths about Single-Payer Health Insurance which we have reviewed in this newsletter, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports. The new trustees' report on Medicare’s Financial Crises indicates the Medicare shortfall is seven years closer; it will run out of money at the time costs are set to explode as the nation's 77 million baby boomers join the plan, beginning in 2011. Read the report at http://www.ncpa.org/iss/hea/2004/pd032904c.html.

• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Susan Dudley, Director of Regulatory Studies Program, reports that the administrative costs of federal regulation are budgeted to reach an all-time high of $30.1 billion in 2003! Please log on to read the latest government accountability reports–their fifth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, and now director of the Mercatus Center’s Government Accountability Project which will be released tomorrow, April 14, 2004. To review this report, see http://www.mercatus.org/governmentaccountability/subcategory.php/131.html.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website at www.galen.org. The politics of Medicare reform becomes more complex by the day, but always are driven by deep and still-unresolved ideological fissures. The question that is always at the center of the debate over health care in this country is whether government or individuals should be in charge of managing resources and making decisions. This week, Grace-Marie and Conrad Meier discuss drug importation and risks to consumers. Find out where Canada imports their drugs from and ask yourself if you would use the local pharmaceuticals if you traveled in those countries. Read the current  newsletter at http://www.galen.org/fileuploads/Drug_Importation_Fact_Sheet.pdf.

• Greg Scandlen, Director of the “Center for Consumer-Driven Health Care” at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative and well-outlined newsletter that is distributed every Tuesday by logging onto www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/Search.asp?search=Consumer+Choice+Matters. This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen, an expert in Medical Savings Accounts (MSAs) which recently  became Health Savings Accounts (HSAs). Read the current issue about who’s pushing for universal mandates at http://www.galen.org/ccbdocs.asp?docID=598. With colleagues like this, it’s no wonder patients are confused. Many doctors are also confused and have difficulty recognizing the wolves in sheep’s clothing.

• The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor. We have referred to this Free-Market Think-Tank in previous newsletters via the Ethan-Allen website. After meeting Conrad Meier and realizing the importance of his quest for non-intrusive medical services to our sick and infirmed, we will highlight OpEd articles that reflect this need. For an overview of their free-market reform, including related efforts in education and telecommunications, go directly to http://www.heartland.org/Publications.cfm?pblId=2. To read this month’s health care feature by Dr Jane Orient, go to http://www.heartland.org/Article.cfm?artId=14643.

• The Foundation for Economic Education, www.fee.org, Richard M Ebeling, PhD, President, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, with 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. With each issue they have a treatise on the Free Market. This month read Dr Ebeling’s Globalization and Free Trade at  http://www.fee.org/vnews.php?nid=5867.

• The Council for Affordable Health Insurance,  http://cahionline.org, 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. They provide educational materials for consumers, legislators, employers and other interested parties. 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. To answer your question Can Government Force People to Buy Insurance? see http://cahionline.org/cahi_contents/resources/n123GovernmentMandate.pdf.

• The Health Policy Fact Checkers can be accessed from the preceding CAHI site or at http://www.factcheckers.org. This is a great resource to check the facts for accuracy in reporting. We thank them for giving us the information on the National Health Service this week.

• 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. Review her health care archives at http://www.i2i.org/author.aspx?AuthorID=7. Be sure to sign up for the monthly Health Care Policy Center Newsletter at http://www.i2i.org/HCPCBulletinJoin.aspx. To understand political control of education as well, read the current issue on efforts to prevent Colorado public schools from forcibly collecting political contributions in the form of Union Dues at http://i2i.org/article.aspx?ID=963.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois 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. Pierre Lemieux has an editorial, “The Running Dogs of State,” that contends that even if bureaucrats are often nice, girl-next-door types of people, they must realize that they are morally responsible for their collaboration in destroying our traditional liberties. If they don’t understand, we are completely justified to “denormalize” them. In fact, it is a social responsibility, if there is such a thing. See http://www.quebecoislibre.org/04/040320-3.htm.

• 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. Log on at http://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 at http://www.fraserinstitute.ca/health/index.asp?snav=he. The Institute’s latest editorial, “National Health Tax: Another Bad Idea,” discusses that the federal government has floated the idea of introducing a new dedicated health tax to finance even more spending on health care, rumored to be in the neighborhood of an additional $2.0 billion annually. See the Jason Clemens and Nadeem Esmail editorial at http://www.fraserinstitute.ca/shared/readmore1.asp?sNav=ed&id=264, which you can also email to a colleague or friend.

• The Heritage Foundation, founded in 1973, is a research and educational institute whose mission is 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. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site.  Keith Miller and Alison Fraser discuss “Cutting Spending and Living to Tell About It” at http://www.heritage.org/Research/Budget/bg1738.cfm.

• 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.  This week, read William H. Peterson on “The Power to Destroy” at http://www.mises.org/fullstory.asp?control=1477. You may also log onto Lew’s premier free-market site at  www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see http://www.lewrockwell.com/klassen/klassen46.html.

• 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. This week, CATO announces that Property Rights Champion Hernando de Soto wins the Friedman Prize for Liberty. de Soto has worked to bring property rights to the world's poor for over two decades, at times putting his own life in peril. "Everyone talks about helping the world's poor," says Cato Institute President Ed Crane. "This is a man who figured out how to do it. His work exemplifies the spirit and practice of liberty." To review de Soto’s biography, articles, books and his Lima-based Institute for Liberty and Democracy, or to register for the award dinner and celebrations in San Francisco on May 6, 2004, see http://www.cato.org/special/friedman/index.html.

• The Ethan Allen Institute 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. They will be meeting in Chicago on April 29. Please see http://www.ethanallen.org/index2.html and note that The Heartland Institute of Illinois has an extensive publications service incorporating products of all the SPN organizations and other groups. You may click on Heartland and go directly to their site or click on “links” to see the other 41 free-market organizations throughout the U.S. and Canada, which will then direct you to even more free-market sites.

• 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. You may log onto www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institute. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read an important essay, “The Threat from Lawyers is No Joke,” by Walter Olson, a senior fellow at the Manhattan Institute, and author of The Rule of Lawyers: How the New Litigation Elite Threatens America’s Rule of Law at http://www.hillsdale.edu/newimprimis/default.htm. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Del Meyer

Del Meyer, MD, CEO & Founder
DelMeyer@MedicalTuesday.net
www.medicaltuesday.net

If you think health care is expensive now, wait until you see what it costs when it's free.  - P.J. O'Rourke

No man’s life, liberty, or property are safe while the legislature is in session.  - Mark Twain, 1866.

On This Date in History - April 13
Today is the birthday of Thomas Jefferson, born in 1743, principal author of the Declaration of Independence and of the concepts embodied in the Constitution and the Bill of Rights. For the ability to express our opinions in this newsletter and for the freedom for uncensored speech wherever it is found, we owe a debt of gratitude to Thomas Jefferson.

Also on this date in history, my brother was born. Happy Birthday Eldor, and here’s wishing you many more good years.