Physicians, Business, Professional and Information Technology

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, August 26, 2003

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In This Issue:
1. HIPAA Is Already Reducing Quality of HealthCare and Increasing Costs
2. California’s Governor and Legislatures Have a Lower Approval Rating than Organized Medicine
3. Why Single-Payer Medicine Won’t Work in California
4. Our Monthly Review of Socialized Medicine
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring Patient Focused Private Practice

HIPAA
The Health Insurance Portability and Accountability Act, which may do none of those, is already reducing the quality and increasing the costs of health care. Prior to HIPAA’s initiation, the medical community has always been able to accommodate a large variety of unexpected patient requirements. For instance, if a new patient was being seen in my office, I could obtain recent lab tests by simply stating that the patient was currently being seen and the lab report was necessary for the proper diagnosis and medical course of action . Since the implementation of the federally mandated HIPAA rules and regulations, the laboratories are unwilling to release the necessary information except by restrictive mechanisms which cannot be accomplished easily or readily. This results in a decrease in the quality of health care. Physician offices are still willing to accommodate their patients and colleagues by quickly faxing patient-beneficial information to each other. This may change, however, when the first doctor is prosecuted for this act, which may not take long. When I mentioned this situation to a bureaucrat, he asked, “Which doctors are sending out information without written authorizations?” When I asked, “Why do you want to know the names?” he answered, “So I can report them and force compliance.” This provides further evidence that a bureaucrat’s interest is the wielding of power, not patient benefits. This wielding of government control is the very antithesis of the freedom that our founders designed for our country.

When discussing this with other physicians, one response was “Why fight it. Just get another lab chemistry panel. It’s the government that’s causing the increase in health care costs.” This is very true. But unfortunately it is the government, public radio and the anti personal health care press that blame the doctors for the excesses in health care costs. Hence, we are in a catch 22.

Politics
This month, California is marching into political frontiers that has all politicos scared to death. With a governor with less than a 20 percent approval rating, a legislature with even less approval in the opinion polls, and nine months after a RE-election, the pending recall elections may be a free-for-all. (Using the percent of doctors that pay full dues as the criteria, the governor's approval rating is even worse than the organized medicine entities that promote universal health care.) What if an outsider who is an astute business man of considerable means, pays $20 million a year in taxes, is a former Mr Universe and has never had any political experience, is elected to the helm of the world’s seventh largest economy? Wouldn’t that make the professional politicians look like they not only fail to understand politics, but people, society, and government as well? To be recognized as unknowledgeable about his or her profession, irresponsible with other people’s money (taxpayers) and totally unaccountable should be the death knell of professional politicians. But don’t hold your breath. They have no shame. And the greater tragedy is that there are still some that want these incompetents to determine your personal, private, confidential, mental, sexual and other medical matters through a Stalinist, universal, single-payer, socialized health care system.

Why Single-Payer Medicine Won’t Work in California
David J Gibson, MD, a national health care consultant, did some important research on why Single-Payer Medicine won’t work in California. He writes a regular column for Sacramento Medicine and he has kindly allowed the posting of many of his articles for the last two years. Be sure to check http://www.HealthPlanUSA.net/DavidGibson.htm and click on the Single Payer link to access the fine work he did. You may want to bookmark this page to facilitate easy return in order to read excellent research on such topics as: Corporate Practice, Health Care Inflation, (The worst thing we could do to Medicare is to add a pharmacy benefit.), Pharmacy Costs (We are spending too much on pharmaceutical products - in fact, we should be spending more.), Why Are The Uninsured, Uninsured? Why Does California Want a Third World Health Care System? and others. Watch this site for his next research on the Feminization of Medicine.

Socialized or Single-Payer Medicine–Our Monthly Overview
Jacob G Hornberger, a former trial attorney and adjunct professor of law and economics at the University of Dallas, and Richard M Ebeling, the Ludwig von Mises Professor of Economics at Hillsdale College, discuss the Free-Market approach to HealthCare in The Dangers of Socialized Medicine. In chapter 2, National Health Insurance and the Welfare State, Richard M Ebeling writes in Part I: After the experiences of the totalitarian states in the twentieth century, logic suggests that the world would have learned the lesson that every growth in state power - every extension of government control in social and economic affairs - threatens the liberty of the people. The alternative is always and ultimately a choice between the freedom of voluntary association among the citizens of a community and the coercing dictates of the political authority. Whether those coercing dictates originate in the commands of a tyrant who usurps power through military force or through the democratic procedures of election and debated legislation, the end result is  the same: the state takes upon itself the right to determine what social relationships will be permitted to exist among the members of the society.

[Totalitarianism in America]
Ebeling further states that the Clinton administration proposed to extend those political dictates in the form of national health insurance, which in earlier days was referred to more honestly as socialized medicine. In spite of the failure, disappointment and increasing costliness of every attempt by the state to politicize the services that normally are or should be provided on the basis of free, voluntary and private contract in the market, it appears likely that health insurance and medical care will soon be under the tutelage of the American government.

The drive for socialized medicine is not occurring in an ideological vacuum. It is another step in the trend of ideas that have dominated the world for more than a century. It is a trend founded in the belief that the individual is neither strong enough nor intelligent enough to plan his own affairs and to bear the primary responsibility for his own circumstances - and that the state has the wisdom and capability to manage the individual’s affairs better than the individual himself.

The Roots of Socialized Medicine
It is useful to understand the origin of ideas and policies to have a better perspective on what they mean and to where they may lead.

The modern welfare state and the implementation of socialized health care arose in nineteenth-century Germany, during the reign of Kaiser Wilhelm II and the administration of Chancellor Otto von Bismarck. In the 1870s, the Social Democratic Party had acquired increasing support among the German electorate and threatened to obtain a majority in the Reichstag, the German Parliament. The democratic triumph of Germany’s socialist party seemed likely in the near future. The German monarchy and the conservative parties realized that something had to be done to deflect support away from the socialists and back to the established order.

Thus, the Kaiser sponsored welfare - statist legislation that was enacted by the Reichstag. Bismarck had this tactical goal in mind: the masses would shift their support from the radical program of the socialist movement to a renewed allegiance for the monarchy and the political status quo.

But it would be a mistake to interpret the birth of welfare statism purely as a cynical political pragmatism. It was also argued for on the basis of “the social good” and a higher conception of human liberty than a mere protection of life, liberty and property by the state. The proponents of this view were known as the German Historical School, a leading member of which was Gustav van Schmoller of the University of Berlin.  They rejected radical or Marxian socialism and advocated what they called state socialism.

The German Historical School and the state socialists also rejected the “orthodox” laissez-faire economics of the classical economists and classical liberals. Rather they insisted, as William Dawson explained it, “No department of economic activity should on principle be closed to the State; whether it should or not participate, side by side with private enterprise, is a matter of expediency and public interest . . . ”

This was explained by Frederic C. Howe (an American intellectual who played a leading role in the Progressive movement and later served in Franklin Roosevelt’s New Deal) in his book Socialized Germany (1915):
 In the mind of the Germans the functions of the state are not susceptible of abstract, a priori deductions. Each proposal must be decided by the time and the conditions. If it seems advisable for the state to own an industry, it should proceed to own it; if it is wise to curb any class or interest it should be curbed. Expediency or opportunism is the rule of statesmanship,  not abstractions as to the philosophic nature of the state . . .  There is almost no dissent to the assumption of state supremacy, of subordination of the individual, of the necessity for personal  . . .  and class sacrifice to the Fatherland. . . . The individual exists for the state, not the state for the individual . . . This paternalism, does not necessarily mean less freedom to the individual than that which prevails in America or England. It is rather a different kind of freedom. . . . State socialism in Germany is of two kinds: first, productive socialism, and second, distributive socialism. One means the increase in the amount of wealth [through the use of government-sponsored cartels, state monopolies, protective tariffs and export subsidies] and the other its juster distribution .... Of the two the latter is more important. . . . First in the list of such [distributive] activities are the social insurance schemes which distribute to the community the burdens of sickness, old age, accident; and invalidity. These in themselves have freed millions of men and women from fear of the future, from loss of self-respect, and have kept them as producing members of the community. . . .

The German Welfare State
As a result, beginning in the 1880s, Imperial Germany implemented the main governmental programs that we today call the welfare state: unemployment insurance, old-age pensions, health insurance, workers’ compensation, workplace health and safety regulations, and many others. These, in fact, were the lasting contributions of Otto von Bismarck, the Iron Chancellor, who espoused “blood and iron,” In the words of Melchior Palyi in his volume Compulsory Medical Care and The Welfare State (1949):
 Bismarck’s role in modern history is rarely spoken of now-a-days. Undoubtedly, his political and administrative “genius” has shaped history down to our times. . . . When, on January 1, 1884, his compulsory sickness scheme went into operation it literally started a new era - a new age in the history of Welfarism.

And as German economist Walter Sulzbach expressed it in his monograph German Experience with Social Insurance (1947):
Bismarck’s fame is mainly based on his diplomatic and military successes and on the founding of the German Empire under Prussian leadership. Of all that nothing remains: The Kaiser is gone. . . . In domestic policy he failed to stop the Social Democrats . . .  [But] the idea of compulsory social insurance which neither he nor his contemporaries considered even remotely his principle achievement took roots and spread. It has been adopted by many countries, and its expansion continues.

Nineteenth-century Imperial Germany, therefore, was the starting point and the inspiration for the “social” liberalism - the state socialism - that triumphed over classical liberalism in the twentieth century. But besides being an intellectual inspiration for the global growth of the welfare state, it also provided an example of the consequences that would follow once the state undertook the task of provision and supervision of national health insurance. That experience is worth reviewing in detail, when we review Part II which we will do next month in this section.

Medical Gluttony or Excessive HealthCare Costs
This section of the newsletter, in which we review the excesses of medical care caused by Health Care being relatively free at the point where the service is provided, has produced the greatest feedback. Many have responded that it was this section that convinced them that Single Payer, or Universal Coverage, or Socialized Medicine could not work. Even though they previously were for universal coverage, some felt that those who proposed such an inhumane system must be thoroughly misguided. One quoted the Parable of the Good Shepherd where the master protects his property (sheep) from harm while the hired hand runs from the wolves. No one spends his money (property) as carefully as the person who owns it, and no one spends it more freely than when the government treasury hands it out in the form of Medicare, Medicaid, VA benefits or other entitlements. The government first had to steal it from the citizens under threat of incarceration. Most of the responders express amazement at the extent of Medical Gluttony, having previously thought it was relatively rare, rather than a common occurrence. For example:

When Viagra Is Free, Some Men Find It More Important for Urinating than for Sex. Last week a rather corpulent patient asked for a prescription for 26 Viagra tablets. He said his insurance plan allowed that amount each quarter (thirteen weeks). Looking at his massive front porch, I must have raised my eyebrow. He explained that the Viagra was not for having intercourse with his wife. He had difficulty looking around his stomach to find the “spigot” with which to empty his bladder. He took one-fourth pill before going to work every morning. He found that would keep his “spigot” large enough so that he could find it during the work day. . . . That sort of need would never be allowed by his health plan. There is no limit to the ingenuity of people. It far exceeds the mental capacities of congress and legislatures who think they can micro manage health care.

MedicalTuesday Supports These Efforts in Restoring Accountability in Medical Practice by Restoring the Doctor & Patient Relationship Unencumbered by Bureaucracy:

• PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of their cost. Dr. Berry also has an internal medicine practice.

• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting, the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available.

• Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or person may become a member of SimpleCare. Whether you are insured, underinsured, uninsured, or on Medicare, Welfare or other government programs, SimpleCare may reduce your out-of-pocket medical expenses. Use SimpleCare when insurance does not pay for the health services, providers or alternative care you choose. Remember, however, that SimpleCare IS NOT an insurance company nor does it provide any insurance services.

• Dr David MacDonald has partnered with Ron Kirkpatrick to start the Liberty Health Group (www.LibertyHealthGroup.com) to assist physicians by helping them to control their medical benefit costs for their staff and patients. You can obtain a quote from eHealthInsurance.com at this site. He is available to speak to your group on a consultative basis. Contact him at DrDave@LibertyHealthGroup.com.

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at http://www.newsmax.com/pundits/Medicine_Men.shtml. Every pundit in the land has his own diagnosis for the health care crisis. In the current issue, the Medicine Men discuss honesty and  the "prestigious" New England Journal of Medicine.
Read the whole issue at http://www.newsmax.com/archives/articles/2003/8/19/171827.shtml.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943,  representing physicians in their struggles against bureaucratic medicine and loss of medical privacy. The “AAPS News” is archived on this site providing valuable information on a monthly basis. They have renamed their official organ the Journal of American Physicians and Surgeons, and named Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. The 60th annual meeting is at the Grand Marriott Resort at Point Clear, Alabama on September 17-20, 2003. Topics include: War on Doctors, Criminalization of Medicine, Policy Parading as Medicine, Perversion of Science by Politics, and Stories from the front lines. Because HIPAA criminalizes so much of what we do, there has been renewed interest in the AAPS. You may register on the website above.

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