Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, December 7 , 2004
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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, a common component of government medicine
throughout the world, was introduced into the United States with Health
Maintenance Organizations (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.
We welcome you to the reestablishment of these MedicalTuesday interchanges, now occurring on the world wide web currently reaching into twenty-one countries and your own desktop. If this newsletter has been forwarded to you or you have not been on our email list, please go to www.MedicalTuesday.net and subscribe to continue to receive these free messages on alternate MedicalTuesdays. At this site you can also subscribe to the companion quarterly newsletter, HealthPlanUSA, designed to make HealthCare more affordable for all Americans. Please forward this message to your friends and your professional and business associates. If you do not wish to receive these messages, we have made it easier for you to unsubscribe simply by clicking the Remove Me link below.
In This Issue:
1. Medical Constituencies of Lay Health Organizations
2. Lottery Mentality in HealthCare - I Want Treatment Even if It Doesn't Help
3. This Week in Government Medicine - Medicare Insolvency
4. Medical News Tips: Take Your Brain for a Walk; Speedy PSA May Save Lives
5. Medical Gluttony - Medicine Working a Cross Purposes - HMO in the Past
6. Myths of American Medicine: Collectivizing Patients PROTECTS Independence and Confidentiality
7. Overheard in the Medical Staff Lounge - Dead Patients Can't Swallow
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare, Government & Society
Thanks, George, for making us aware that the ADA just
increased its own constituency by a potential 18 million members. This does not
only give it political clout, but also medical status in the eyes of the public
and medical power in the health care establishment. Have doctors been sidelined
in the health care field?
A study needs to be done on how these numbers would change in a patient-driven health care model. It really doesn't take much to make the patient call the shots. Frequently, only 10 percent financial responsibility will restore the rational decision-making process.
There was a case brought to trial in which an HMO
denied a bone marrow transplant in a breast cancer patient because the
likelihood of this $120,000 procedure improving her chances of survival was
about 1-2 percent. Although the patient won millions, which I understand was
never paid, a 10 percent personal financial responsibility before one could
force the other premium payers to foot the 90 percent of costs of unhelpful
treatment, could almost 100 percent guarantee that the decision would have been
made after the discussion of therapeutic possibilities by the oncologists. The
patient would have discussed it with her spouse, parents, siblings and children
and they would have agreed not invest $12,000 of their own money and $108,000 of
other people’s money in a procedure with little benefit. Acceptance of the
inevitable is much easier in patient-driven health care. The data would show
that health care costs drop precipitously in patient-driven health care. The
only problem is that the HMO divisions of insurance carriers, Medicare,
Medicaid, bureaucracies and, unfortunately, many doctors don't believe this. If
anyone has data on the issue, we would be interested in reviewing it.
Meanwhile, last week Sarah Lueck reported in the Wall Street Journal that Amid Deficit and Social Security Plans, the Fiscal Hawks are targeting Medicare and Medicaid. The federal budget deficit is almost $413 billion, and the president is weighing a potentially costly revamping of Social Security. To do all that, "I don't know how you can avoid cutting Medicare and Medicaid," says Cynthia Berry, a health-care lobbyist at Powell Goldstein LLP. The two programs are juicy targets for fiscal conservatives: At a combined cost of $473 billion a year to the federal government, they account for almost one-quarter of U.S. government spending, and their share is growing.
At $300 billion a year, Medicare makes up about 13% of
federal spending, and its share will grow as the drug benefit, the biggest
expansion in the program's history, takes effect in 2006. Hospitals are a prime
target. Under last year's bill, they are slated to get $25 billion in payment
increases over the next 10 years. If Congress trims the increases, it will be
following a seesaw pattern started years ago, in which it approves big rate
increases one year, only to backtrack later when budget pressures intensify. In
1997, Congress approved sharp cutbacks in provider payments, as part of the
Balanced Budget Act, and then restored some of the money in following years
under pressure from providers. Under existing law, physicians would undergo
eight years of payment cuts starting in 2006. Congress, however, may heed
doctors' arguments that the rate formula is flawed and needs to be fixed.
Physicians, for their part, may escape cuts and might even get increases.
For the entire report go to http://online.wsj.com/article_print/0,,SB110203615252789992,00.html.
This points out another factor in the evolution of preventive medicine. When PSAs were first introduced, the medical guidelines suggested obtaining a PSA if the digital prostatic exam was abnormal. PSA was suppose to remain normal until a tumor could be palpated on the prostate. Family doctors, however, obtain the test rather freely upon patients’ requests. This has made a marked decline in the history of prostate cancer.
A similar story involves the treatment of streptococcal infection with a late sequella of rheumatic heart disease and kidney disease. The medical guidelines extolled in my medical training were to obtain a throat culture and treat only the strep positive patients. However, the family physician out in the field found patients didn’t want to pay for a $50 throat culture to determine if a $5 shot of penicillin was needed. So penicillin shots were given with impunity. And decades later, rheumatic heart disease nearly disappeared from everyone’s medical practice.
So be cautious in your criticisms of doctors who
don’t follow the medical treatment guidelines. They may be practicing
cost-effective and health-effective medicine.
The family arrived at the hospital loading dock in a U-Haul truck and proceeded to load the entire bed, complete with traction devices, supporting wires and the patient, and drove off into the sunset. We never heard anything further about the patient’s progress or future relationship with his family. Perhaps, in this case, HMO stood for “Haul Me Off”!
°capitation payments to doctors per head of
°Diagnostic Related Group (DRGs) hospital admissions and releases
° Medicare Practice Guidelines requiring single standard medical conformity
°community rating for health insurance
° third-party determinations of medical necessity
These have potentially devastating results on patients' medical treatments and prognoses. Collectivizing patients directly affects their quality of life and sometimes influences whether they live or die.
Indirect effects of collectivizing patients are evident when their doctors are sued under criminal laws. Laws fingering doctors point also to their patients. White Coat Crime prosecutions of physicians under Medicare and Medicaid law could propel patients into jail cells with their doctors. Just as a doctor can be prosecuted, tried, and jailed for providing medically unnecessary medicine or surgery, so a patient may be similarly at risk for having received the care and collaborated in the "crime." Three clear and present dangers to patients are:
° loss of confidentiality of medical records
° loss of individuality and personal choice
° loss of personal liberty via imprisonment
This chapter calls patients to alarmed alert. No patients have as yet been convicted and sentenced to jail. But the stated law that now snares physicians also could claw their patients.
4: Collectivizing Patients DESTROYS Independence and Confidentiality
He wasn’t kidding. A VA doctor tells the true story. One day during rounds, the nursing assistant complained that a patient was not swallowing. The food just keeps running down his mouth onto his shirt. The doctor looked closely at the patient and noted that he was dead.
Now isn’t that something. Not only can you give your
life in the VA hospital, but after you’ve given your life, the staff doesn’t
even know that you’re dead.
As is well known, the government itself is a welfare system. It is the only employer that can employ the totally incompetent.
Or from another angle, while we’re debating
physician-assisted suicide, why don’t we just allow people to get admitted to
a VA hospital who want to die. Then nobody will know the difference.
• The Mercatus Center at George Mason University (http://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. To review Maurice McTigue’s reports on Rolling Back Government, Lessons from New Zealand, begin your search at http://www.mercatus.org/governmentaccountability/accountabilitynews/archives/014630.php.
• 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 onto their website at http://www.galen.org. This week, review her report to the CMA Leadership Conference last month at http://www.galen.org/ccbdocs.asp?docID=747. To read last week’s newsletters on Health Savings Accounts go to http://www.galen.org/ccbdocs.asp?docID=748.
• 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 newsletter that is distributed every Tuesday by logging onto http://www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/ccm_archives.asp. Read today’s newsletter, The End of PPOs by 2010, as well as the latest on Specialty Hospitals. 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 Health Savings Accounts (HSAs). Be sure to read Greg’s report to the CMA Leadership Conference last month also at http://www.galen.org/ccbdocs.asp?docID=747.
• The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor Emeritus. If you didn’t review their report last month on the number of “Tax & Spend” politicians voted out of office, be sure to check out the statistics at http://www.heartland.org/Article.cfm?artId=15971. If you missed Conrad Meier’s farewell editorial last month, be sure to read his evaluation of our current health care predicament at http://www.heartland.org/Article.cfm?artId=15691. Print it out and give it to people you care about.
• The Foundation for Economic Education, http://www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, has Richard M Ebeling, PhD, 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. This month, be sure to review Evenings at FEE with Harry Browne on The Greatest Mistake in American History: Letting Government Educate our Children, http://www.fee.org/vnews.php?sec=calendar#palmer.
• The Council for Affordable Health Insurance, http://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 Council for Affordable Health Insurance (CAHI) began a media ad campaign in three states promoting the Health Care Choice Act. The Health Care Choice Act would permit individuals to purchase coverage in another state with less expensive mandates, providing affordable option for many. See CAHI Director Dr. Merrill Matthews press release at http://www.cahi.org/article.asp?id=498.
• The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or at http://www.factcheckers.org/. Be sure to check the Daily Medical Follies on the latest woeful tale in government-run health care at http://www.factcheckers.org/showArticleSection.php?section=follies.
• The Independence Institute, http://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 at http://www.i2i.org/healthcarecenter.aspx. Read her latest newsletter with special attention to the section on Ideology Replaces Science at American Lung Association at http://www.i2i.org/HCPC_Nov_2004.aspx#1.
• The National Association of Health Underwriters, http://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 go to the "About NAHU" page and read the Code of Ethics which I believe the thousands of physicians, nurses, allied health specialists, medical writers, insurance executives, actuaries, accountants, administrators, business people, patients and attorneys that read MedicalTuesday can support. To read a press release on the latest issues of Health Savings Accounts , go to http://www.ustreas.gov/press/releases/js2112.htm.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at http://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. This month, read the a review by Gennady Stolyarov II of Hans-Hermann Hoppe's Democracy: the God That Failed. Hoppe eloquently dispels the deadly commonplace fallacy that liberty and democracy are mutually reinforcing, and demonstrates why, in fact, even the abuses of a monarchical tyranny pale in comparison to the modern welfare state, which exists because of, not despite the institution of majority rule at http://www.quebecoislibre.org/04/041115-5.htm. Now that’s something that can challenge your Betz cells.
• 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 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 where their recent publications and editorials are listed at http://www.fraserinstitute.ca/health/index.asp?snav=he. This week, be sure to read the press release earlier today: New Study Warns Against Expansive Welfare Policies in Ontario where the entire report can also be downloaded. http://www.fraserinstitute.ca/shared/readmore.asp?sNav=nr&id=636
• The Heritage Foundation, http://www.heritage.org/,
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 for
review at their site. This week, the Heritage weighs in on teenage sexual
activity. To gain perspective on the uninsured,
read Devon Herrick’s report that 75 percent of uninsured spells will be over
in one year or less and levels of insurance have actually increased by
about 15 percent over the past 10 years at http://www.heritage.org/press/dailybriefing/policyweblog.cfm?blogid=99664CA0-A0C9-D18A-0F4F2A80D17AB53D
• 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 http://www.mises.org to obtain the foundation’s daily reports. This week, read the report by Marcus Verhaegh: The Logic of Economic Law noting that we do not have to run millions of experiments to see that people value the good received in an exchange over the good given away. We do not have to run even one experiment to see this at http://www.mises.org/fullstory.aspx?Id=1681. Consumer-Driven Health promoters need to study this since they are criticized for lacking actuarial evidence that it is both better medicine and more cost-effective health care. 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 (http://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 at http://www.cato.org/people/cannon.html. This week, read Judge Andrew Napolitano’s report on how Governments Break the Law. “It should be against the law to break the law. Unfortunately, it is not. In early 21st-century America, a dirty little secret still exists among public officials, politicians, judges, prosecutors, and the police. The government—federal, state, and local—is not bound to obey its own laws. I know this sounds crazy, but too many cases prove it true. It should be a matter of grave concern for every American who prizes personal liberty.” Access this entire article, as well as Ed Crane’s article on The Ownership Society, at http://www.cato.org/pubs/policy_report/pr-index.html.
• The Ethan Allen Institute (http://www.ethanallen.org/index2.html) is one of some 41 similar but independent state organizations (click on "Links") associated with the State Policy Network (SPN) (http://www.spn.org/newsite/main/). 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. To review the presentations at their recent annual meeting, see http://www.spn.org/newsite/main/past_event_details.php?past_event_id=20.
• 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 http://www.hillsdale.edu
to register for the annual week-long von Mises Seminars, held every February, or
to register for their famous Shavano Institute. Congratulations to Hillsdale for
it's national rankings in the USNews College rankings. Please log on and
register to receive Imprimis, their
national speech digest that reaches more than one million readers each month.
This month, be sure to read the current issue of Imprimis
by Charles R Kesler, Editor of the
Claremont Review of Books, on his assessment of the last four years and
projections for the Next Four Years at http://www.hillsdale.edu/newimprimis/default.htm.
The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.
Meyer, MD, CEO & Founder
6620 Coyle Ave, Ste 122, Carmichael, CA 95608
Michael Goodman, MD:
Midlife Bible - A Woman’s Survival Guide: http://www.healthcarecom.net/bkrev_MidlifeBible.htm.
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