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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol VIII, No
16, Dec 22, 2009 |
In This Issue:
1.
Featured Article:
New
Predictors of Disease
2.
In
the News: Doctors'
boos show Obama's tough road
3.
International Medicine: The persecution of NHS
whistleblowers
4.
Medicare: Telling Doctors How to Practice Medicine
5.
Medical Gluttony:
Emergency Care is the most Gluttonous of all Health Care
6.
Medical Myths: The
uninsured cause overcrowding in emergency rooms, and increase costs
7.
Overheard in the Medical Staff Lounge: The National Health Care Debate
8.
Voices
of Medicine: Do we
still need the Ban on the Corporate Practice of Medicine?
9.
The Bookshelf: Health
Care in Crisis - Has it Changed?
10.
Hippocrates & His Kin: Government Health Care Costs More than Private Health
Care
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
Merry Christmas 2009
Thursday night, December 24, 1776, marks
the anniversary of George Washington leading his troops across the Delaware to
attack the British the next day in New Jersey. Thus began the greatest
experiment in human freedom the world has ever experienced. The history of
governments for millennia has been one of oppression and servitude. Freedom of
this magnitude was never previously sought nor enjoyed by a nation. This
freedom lasted for 150 years. It has been gradually restricting for the past 75
years. We must be forever on guard that our government does not repeat history.
Government has found a new access to our most personal and private lives - our
medical records. This last invasion now makes control over our very lives
absolute. Let's make our final stand against the Reid-Pelosi bill our battle of
Appomattox, which on April 9, 1865, preserved our nation in the Civil War. To
that end, MedicalTuesday is dedicated to restoring freedom in health care - the
only assurance of privacy in our personal health matters and in our lives.
After this battle is won in 2010, we will continue the battle for the Freedom
we won in 1776, lost in 1933, to eliminate the intrusion of government into our
personal and private lives.
* * * * *
1. Featured
Article: New Predictors of Disease
NOVEL CRYSTAL BALL: One day Y-shaped
molecules called autoantibodies in a patient's blood may tell doctors whether a
patient is "brewing" certain diseases and may even indicate roughly
how soon the individual will begin to feel symptoms.
By Abner Louis Notkins Scientific American
Overview/Predictive
Antibodies
■ In autoimmune diseases, such as type 1 diabetes, the immune
system mistakenly manufactures antibodies that target the body's tissues.
■ Certain of these "autoantibodies"
appear many years before overt symptoms of disease, suggesting that screening
for these molecules could be used to predict who is at risk of falling ill.
■ Autoantibodies might also serve as guides to
disease severity and progression and might even warn of risk for some nonimmune
disorders.
■ Screening for predictive autoantibodies could one day become
routine, although a dearth of preventive treatments currently stands in the way.
A middle-aged woman—call her Anne—was taken aback when one day her
right hand refused to hold a pen. A few weeks later her right foot began to
drag reluctantly behind her left. After her symptoms worsened over months, she
consulted a neurologist. Anne, it turned out, was suffering from multiple
sclerosis, a potentially disabling type of autoimmune disease. The immune
system normally jumps into action in response to bacteria and viruses,
deploying antibodies, other molecules and various white blood cells to recognize
and destroy trespassers. But in autoimmune disorders, components of the body's
immune system target one or more of the person's own tissues. In Anne's case,
her defensive system had begun to turn against her nerves, eroding her ability
to move.
Every story of autoimmune disease is
sad—but collectively the impact of these illnesses is staggering. More than 40
autoimmune conditions have been identified, including such common examples as
type 1 (insulin-dependent) diabetes, rheumatoid arthritis and celiac disease.
Together they constitute the third leading cause of sickness and death after heart
disease and cancer. And they afflict between 5 and 8 percent of the U.S.
population, racking up an annual medical bill in the tens of billions of
dollars.
Recent findings offer a way to brighten this gloomy picture. In the
past 10 years a growing number of studies have revealed that the body makes
certain antibodies directed against itself—otherwise known as
autoantibodies—years, and sometimes a decade, before autoimmunity causes
clinical disease, damaging tissues so much that people begin showing symptoms.
This profound insight is changing the way that doctors and researchers think
about autoimmune conditions and how long they take to arise. It suggests that
physicians might one day screen a healthy person's blood for certain
autoantibodies and foretell whether a specific disease is likely to develop
years down the line. Armed with such predictions, patients could start
fighting the ailment with drugs or other available interventions, thereby
preventing or delaying symptoms. . . .
Early
Insight from Diabetes
People familiar with
advances in genetics might wonder why researchers would want to develop tests
for predictive autoantibodies when doctors might soon be able to scan a
person's genes for those that put the individual at risk of various disorders.
The answer is that most chronic diseases arise from a complex interplay
between environmental influences and multiple genes (each of which makes but a
small contribution to a disease). So detection of susceptibility genes would
not necessarily reveal with any certainty whether or when an individual will
come down with a particular autoimmune condition. In contrast, detection of
specific autoantibodies would signal that a disease-causing process was already
under way. Eventually, genetic screening for those with an inherited predisposition to a disease may help reveal those who need
early autoantibody screening.
Studies of patients with type 1 diabetes provided the
first clues that autoantibodies could be valuable for predicting later
illness. In this condition, which typically arises in children or teenagers,
the immune system ambushes the beta cells in the pancreas. These cells are the
manufacturers of insulin, a hormone that enables cells to take up vital glucose
from the blood for energy. When the body lacks insulin, cells starve and blood
glucose levels soar, potentially leading to blindness, kidney failure, and a
host of other complications. . .
More important, these studies also raised the prospect that
doctors might forecast whether a child is at risk for type 1 diabetes by
testing blood for the presence of these autoantibodies. Clinical researchers
found that an individual with one autoantibody has a 10 percent risk of
showing symptoms within five years. With two autoantibodies, the chance of
disease jumps to 50 percent; with three autoantibodies, the threat rockets to
between 60 and 80 percent. . .
The discovery that autoantibodies frequently herald the
onset of type 1 diabetes prompted scientists to examine whether the same might
be true in other autoimmune diseases. One that has been the focus of
especially intense research is rheumatoid arthritis, a debilitating condition
that is highly prevalent, afflicting about 1 percent of the world's population.
In those affected, the immune system attacks and destroys the lining of the
joints, causing swelling, chronic pain and eventual loss of movement.
Predicting
Other Diseases
Immunologists have recently unearthed an autoantibody
that is present in 30 to 70 percent of patients diagnosed with rheumatoid
arthritis . . .
To
read the rest of this remarkable research. . .
* * * * *
2. In the News:
Analysis: Doctors' boos show Obama's tough road
Barack Obama isn't used to hearing boos.
[But with the lack of political sophistication of the AMA, it really
does not matter. Politicians cannot be too concerned about one-half of one
percent of America. Their votes are not even a blip on the vote tally.]
For all the young president's popularity,
the response he got Monday from doctors at an American Medical Association
meeting was a sign his road is only going to get rockier as he tries to sell
his plan to overhaul the nation's health care system.
The boos erupted when Obama told the
doctors in Chicago he wouldn't try to help them win their top legislative
priority — limits on jury damages in medical malpractice cases.
But what could they expect? If Obama
announced support for malpractice limits, that would set trial lawyers and
unions — major supporters of Democratic candidates — on the attack. Not to
mention consumer groups.
Every other group in the health care
debate has a wish list and a top priority. Insurers don't want competition from
the government. Employers don't want to be told they have to offer medical
coverage to their workers. Hospitals want to stave off Medicare cuts. Drug
companies want to charge what the market will bear.
Obama can't give all of them what they
want. . .
AMA insiders shouldn't have been surprised
by Obama's upfront refusal to consider malpractice caps.
The group couldn't get that idea passed by a Republican
Congress and president a few years ago. Some states have such curbs, but anyone
who can count votes knows the chances for national limits are slim to none with
Democrats in charge of Congress. . .
Read the entire analysis: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2009/06/15/national/w142459D89.DTL#ixzz0ZcS8z3Sf
EDITOR'S NOTE - Ricardo Alonso-Zaldivar reports on health care
policy for The Associated Press.
* * * * *
3.
International
Medicine: The persecution of NHS
whistleblowers
The
government says it supports whistleblowing, yet excuses are still being made
when they are sacked and humiliated by Beatrix
Campbell,
The www.guardian.co.uk.htm
"The government
supports whistleblowing," said culture secretary Ben Bradshaw in May.
"And the NHS is expected to support it too." Well, Dr Kim Holt
certainly didn't get any support from the NHS in London for warning in 2006 that child
protection had become unsafe in Haringey's St Ann's hospital – before the
brutal death of Peter Connelly (also known as Baby P) in August 2007. Nor was
she supported by her employer, the celebrated Great Ormond Street hospital
trust.
Her sin was to draw
attention to the effects of shortages compounded by cuts. This popular and
successful doctor says she felt doomed after she and the three other
consultants with questions about £400,000 cuts in an already shaky service
wrote a joint letter airing their concerns. . By February 2007 she was no
longer working at St Ann's. By the August when Connelly died there were no
experienced consultant paediatricians there.
Holt has been subjected
to the rage of a managerial machine that tolerates no dissent. Codes of conduct
sanctioned by the General Medical Council (GMC) oblige doctors to raise
concerns. But when they do doctors can rely neither on their managers, nor the
GMC, nor the government?
In 1998 Dr Rita Pal tried
to expose the frightening conditions at a Staffordshire
hospital. The GMC turned its gaze to her rather than the hospital management.
Uniquely, she sued the GMC. Judge Charles Harris concluded on 27 May 2004 that
there were "clearly triable" issues raised by Pal against the GMC and
that "cross-examination might be very revealing". The GMC settled.
But Pal was
no longer working in the health service by the time her critique was vindicated
earlier this year by the Healthcare Commission. The trust was imposing £10m million cuts and
between 400
and 1200 more patients were dying than would normally have been expected. .
.
Whistleblowers
do what they do because the system silences them. It humiliates them, scares
them and often sacks them. These whistleblowers have lost money, time, sleep
and self-esteem; they endured nightmares not only about their own future but
the safety of patients who needed on them. . . Read
the entire report . . .
The NHS does not give timely access to
healthcare; it only gives access to a waiting list.
Government medicine is the same the
world over.
Any Doctor that tries to improve it
gets Sacked and Humiliated.
Let's preserve what we have before it's
too late.
* * * * *
4. Medicare: Telling
Doctors How to Practice Medicine by John Goodman, PhD
In Redefining Health
Care, Michael Porter and Elizabeth Olmsted Teisberg explained that the key
to efficient health care is doctors' repackaging and repricing the services
they provide. In The Innovator's Prescription, Clay Christensen showed
that doctors need different payment structures, depending on the types of
activities they engage in. In Market-Driven Health Care and in other
books Regina Herzlinger argued for delivering health care in specialized,
focused factories. In reviewing these publications [here, here and here], I argued that the desired reforms would be natural
and normal in an unfettered medical marketplace.
Our system of third-party
payment, however, stands in the way of high-quality, low-cost care. To see how
health care could be different, we can look to those markets where the
third-party payers are absent. Concierge doctors, for example, consult with their patients
by phone and e-mail, keep medical records electronically, prescribe
electronically and provide other services that insurance normally doesn't pay
for. Walk-in clinics post their prices and strive to lower the
time cost as well as the money cost of care. In the medical tourism market, there is not only transparency, but
price and quality competition are the norm.
Yet, third-party payment
isn't going away. Given that, how can we get from where we are now to where we
need to be? The dominant view is that buyers of care should use the power of
the purse to force doctors to do what they probably would have done anyway if
the third-party payers had not been there in the first place. In a previous
Alert, I called this the "demand-side" approach to changing medical practice and
there isn't a chance in the world that it's going to succeed. . . Read the entire report. . .
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Just as in People Gluttony, Medical
Gluttony never sees itself as Gluttonous
Last month, a patient bemoaned the excesses of health
care in general and Medicare in particular. With 40 percent of health care
over-utilized or excessive, as my patient stated, he felt we should easily
afford giving everyone A-Number-1 health care by eliminating these excesses. He
felt that Obama care was good for the country and would make health care
available to all.
This week, he came in because his nose was congested
and he had been to the Emergency Department where he had a rather complete
evaluation, including CT scans of his nasal sinuses. He came in because his
$4,000 ER visit was not helpful. No treatment was provided. We provided him
complimentary nasal steroids and suggested some OTC antihistamines. He
responded and was well in two days.
Another patient came in last month having been to the
ER the night before with pain in his right leg. He had a venous Doppler of his
right leg, along with chest x-rays, ECGs and a variety of lab studies. He was
told he did not have thrombophlebitis or pulmonary embolization, but they were
not entirely sure. So he was told to have me order another venous Doppler of
his right leg since this one was normal, just in case. No treatment was provided.
His exam in the office revealed three plus ankle edema to his knees, orthopnea
to the extent he could not lie in bed and had to sleep in his Lazy Boy
Recliner, with neck veins distended to 45 degrees indicating rather significant
right heart failure. He responded nicely with intravenous furosemide with a
five-pound (five pints of fluid or ten glasses) diuresis overnight. He asked if
he should have the repeat studies that the ER had recommended. He was told the
ER evaluation was not directed to his primary rather acute problem, congestive
heart failure, and so they would not be necessary. He was better after a $125
office call than the ER call which was at least 20 times as expensive.
Another patient came in having been to the Emergency
Room with shortness of breath. A CXR, lung V/Q scan was unremarkable as was his
ECG, cardiac studies and a variety of other tests. The shortness of breath
occurred some months earlier and was associated with severe pleuritic chest
pain. He had been on a trip to Los Angeles, the classic finding for pulmonary
embolus. He was told he definitely did not have a pulmonary embolus, a blood
clot to his lung. However, being several months later, all the acute tests for
that diagnosis were no longer positive and would no longer be expected to be
diagnostic. This would be a clinical diagnosis, no longer accepted by medical
protocols, and he was given no explanation for his persistent three months of
shortness of breath. This shortness of breath did resolve after three months of
anticoagulation treatment for the clinical diagnosis.
What did all these three cases have in common?
Unnecessary emergency evaluation, with poorly directed diagnostic and costly
testing.
The billing costs of these three cases as compared
with similar known costs (since hospital charges are confidential) was
estimated at $20,000 to $30,000, even though only about three to five thousand
dollars would be collected by the hospital using comparative figures.
The office cost to correct these errors was about
$300, which could have been the entire cost if the ER visits had been avoided.
This information unfortunately will never be
highlighted nor understood in the current health care cost-cutting debate, even
though the magnitude of this Health Care Gluttony is major. These three
patients were initially seen in the same week, and this was an ordinary week.
Even considering $20,000 of excess charges, this would amount to $One million
in one year of excess Medical Gluttony seen in one practice during the course
of one year.
One of these three had stated that by eliminating this
over-utilization, we could provide free health care for all. When this was
presented to these patients, not one of them saw themselves as over-utilizing
or involved in excessive or unnecessary health care costs, much less as being
gluttonous.
Oh, that God the gift would give us, To see ourselves as
others see us -Robert Burns
[This should not be read as criticism for how emergency rooms work.
They have to attend to whatever patients bring to them and treat them in the ER
milieu, which is different than the office milieu. The answer as usual is more
citizen- or patient-responsible behavior. We should not expect our doctors to
be medical cops. To prevent this adversary arrangement, patients should have a
percentage co-payment on every test so they would be their own cops. They will
be more effective cost containers than any oversight or government agency.]
The Health Care Debate in our Nation this year has not even touched
this basic health care problem.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6. Medical Myths: The uninsured cause overcrowding in
emergency rooms
Myth 12. The uninsured cause overcrowding
in emergency rooms, and increase costs for the "rest of us" through
cost-shifting. AAPS July 29, 2009
The uninsured are frequently vilified as "free
riders" who receive care but shift the cost onto others—when they are not
being portrayed as victims who don't get as much medical care as some think
they should.
Thus they deserve punishment by higher taxes if they
don't accept their "individual responsibility" to buy costly
insurance—or else public subsidies to buy "coverage" (instead of
public payment for care actually received).
The problem is purportedly magnified by overuse of the
more costly emergency room by uninsured patients who delayed care they should
have gotten sooner from a lower-cost primary physician.
In fact, the Congressional Budget Office (CBO) finds
that "uncompensated
care is less significant than many people assume." Citing a study by
Jack Hadley and others in a Health Affairs web exclusive for Aug 25,
2008, the CBO noted that the $35 billion in uncompensated
care provided by hospitals in 2008 constituted less than 2% of total
expenditures, and the estimates are much smaller for other providers. The
amount potentially associated with cost-shifting from the uninsured is at most
1.7% of private health insurance costs, conclude Hadley et al.
The amount supposedly lost because of uncompensated
care is, moreover, likely calculated from grossly inflated
"chargemaster" prices.
The uninsured paid $30 billion out of pocket for
medical care in 2007. According to a California HealthCare Foundation study,
50% of uninsured residents with incomes at least twice the federal poverty
level obtained some medical care in the past year for which they were charged;
80% paid in full, and 10% were paying in installments. About 8% received pro
bono care (Wall St J 11/21/08).
A much more serious cause of cost-shifting is
underpayment by government programs, Medicare and Medicaid. The "leech
therapy" that these programs use to hold down their own costs by sucking
about $90 billion from the private sector adds some 11% (or $1,800 for the
average family) to the cost
of private plans, writes Shikha Dalmia (Forbes 6/17/09).
Additionally, two-thirds of all
medical bad debt is caused by insured patients, who decline to pay their
copayments and deductibles, leaving thousands of uncollected balances averaging
$500 to $1,000 (WSJ Market Watch 9/9/08).
As to the burden on emergency rooms, uninsured
patients are underrepresented there (JAMA
2008;300:1914-1924)—after all, they worry about the cost. In Massachusetts,
despite the decrease in the number of the uninsured, there has been little
change in ER use for routine problems (Kevin Sack, NY Times
5/28/09). One reason might be that expanded insurance coverage leads to
expanded demand, and nothing was done to increase available supply.
Hadley et al. estimated the increased demand that
would come from insuring all the uninsured: an increase of some $112 billion in
medical spending.
The experiment has already been done north of the
border. An ER physician in Thunder Bay, Ontario, estimated that nearly half of
the residents of his town could not find a family physician and thus flocked to
the ER for every medical need, reports Dave
Racer.
Additional information:
- "The
Gas-Siphoning Solution," AAPS News, October 2006.
- "Is Insurance
Evil?" AAPS News, July 2006.
- "Paying for
Medical Care," AAPS News, October 2005.
www.aapsonline.org/newsoftheday/00385
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
* * * * *
7. Overheard in the Medical Staff Lounge: The National
Health Care Debate
Dr. Rosen: The national health care
debate seems to be heating up.
Dr. Milton: There is a lot of heat,
but not much luminescence.
Dr. Edwards: Not even in the health care
dungeon?
Dr. Yancy: Don't you mean the hospital?
Dr. Milton: No I really mean Washington.
Dr. Ruth: But don't you think these
issues are now receiving media attention? Isn't that good?
Dr. Rosen: Yes, that would be good if
the national attention span were a bit longer than a 9-second blip.
Dr. Yancy: The national attention span gets shorter every year.
Some can't even say the name of the current health reform bill in 9 seconds.
Dr. Edwards: That does make the case that a national debate would
be non-productive.
Dr. Rosen: Greg Scandlen points out that all the arguments that
we're hearing are carryovers from the 1960s debates when a case could be made
for the poor and disabled, the seniors and the veterans. But these are all
covered now by entitlements.
Dr. Milton: Yes. But those for government medicine, who think
there never is enough of government involvement as long as independent citizens
are making their own choices, will never be satisfied until they think all
doctors are under their thumb.
Dr. Paul: Your paranoia is showing through, Milton.
Dr. Milton: You can't tell me that the members of Congress don't
really dislike us?
Dr. Paul: I've never heard one to make such an assertion.
Maybe it's your paranoia index on the rise?
Dr. Edwards: I think it's a valid suspicion. Sure, when they're
speaking with you one gets the impression that they're working in your court.
But it shouldn't take too many press conferences to realize that they are
avowed socialists and as such are anti-private practice, anti-capitalist, and
thus against professions that they think have public favor.
Dr. Rosen: Getting back to the issues in the health care debate,
the real issues are whom the uninsured are and what can be done to keep those
insured from over-utilizing expensive health care. It seems to me that the
uninsured today is a totally different population from the uninsured of the
1960s.
Dr. Milton: I agree with Scandlen that people are led to believe
the 1960s and that the poor, the seniors, the disabled, and the vets are now
covered. So the uninsured are those who are working and don't want to spend
their money on health insurance.
Dr. Edwards: In last week's Bee, there was an extensive article on
a physician's son who couldn't afford health insurance. How sad. Doesn't that
make you weep?
Dr. Milton: The uninsured are primarily those by choice who have
other priorities, and the bureaucrats utilize their status as part of the
argument. Except for the current recession with increased unemployment, the
uninsured are making $50,000 to $75,000 per year and choose other priorities. A
basic hospital and surgical plan for large liabilities can still be purchased
for $400 a month, which should be affordable by those making $4,000 to $6,000
per month.
Dr. Edwards: People should get use to paying for the usual basic
health care costs such as office calls, basic labs and x-rays. But most want
their health insurance to be pre-payment plans for everything rather than a
plan for costs that otherwise are difficult to afford.
Dr. Rosen: The Obama-Pelosi-Reid plan does not solve any health
care problems, is not really about health, and will make health care less
affordable than it is already.
Dr. Edwards: And will increase your taxes astronomically.
Dr. Milton: How can any reasonable doctor be for it?
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals and Articles
The San Mateo
County Medical Association July-August 2009 Bulletin discusses the efforts to
allow Hospitals to Practice Medicine.
There
are Multiple Legislative Efforts to Erode the Ban on the Corporate Practice of
Medicine
You may not be
following efforts in the current state legislative session to erode the corporate
bar that prevents hospitals from directly employing physicians, but you should
be aware of these efforts and contact our legislators to oppose these efforts.
Three bills related to this topic were introduced this legislative session, two
Assembly bills (AB 646 and 648) and one Senate bill (SB 726).
Modifying or
eliminating the corporate medicine bar allows certain hospitals to hire
physicians. Under current law, hospitals are barred from hiring doctors as
employees. This important law was created to prevent corporations or other
entities from unduly influencing the professional judgment and practice of
medicine by licensed physicians.
The California
Hospital Association (CHA) supports these legislative efforts and at least one
of the bills (AB 648) is backed by a powerful labor union—the American
Federation of State, County and Municipal Employees (AFSCME) — the largest
public employee and health care workers' union in the United States.
The proponents
argue that allowing certain hospitals and health care districts to hire doctors
will increase access in underserved areas. On the other hand, organized
medicine believes and has argued that there are more effective ways to increase
access in the underserved areas and that the interests of patient protection
served by the corporate bar are too important to be pushed aside. . .
You need to communicate
with our legislators that SB 726would eliminate important legal protections for
patients by allowing hospitals to directly employ physicians. It is important
for the integrity of patient care that physicians remain independent from the
corporate influence of the hospital administration, which must answer to
priorities other than patient care. An erosion would eliminate important legal
protections for patients, diminishing the equality of care that patients
receive in California hospitals. . .
The
corruption of personalized health care by corporations will pale in comparison
to how government medicine will essentially eliminate all individualized care.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
9. Book Review: Health Care in Crisis - Has it
Changed?
Code Blue: Health Care in Crisis
by Edward R. Annis. Regnery Gateway Press, Washington, D.C. 1993, 278 pages.
Reviewed by Del Meyer, MD
Doctor
Annis opens his introduction describing the two worlds that physicians live
in: The wonderland of modern medicine,
a gratifying and challenging world of achievement in research, education, and
clinical practice; and the faltering American health care world, which is on
the verge of collapse. Not unlike Charles Dickens in the opening to this Tale of Two Cities: "It was the best of times. It was the
worst of times."
Annis
gives us many anecdotal insights into the history of American medicine: Fleming's discovery of penicillin in England
in 1928, that sat on the shelf until American drug companies developed methods
of production in 1943, making it available to patients; sick England in the
postwar era to healthy America; the high death rate of Europe to increased life
expectancy to 68 years in America in 1949. The high cost of living is only
exceeded by the higher cost of dying. His chapter on health insurance
("Call the Plumber, We're Insured!") is a parody on why health
insurance is not insurance and, therefore, cannot work in its current format.
Edward
Annis, who never chaired a meeting or held an organized medicine office, was
elected president of the AMA at a young age in an attempt to counter a cunning
band of political sophists in Washington, D.C. He champions the fight to head
off government intrusion between doctor and patient and dispels the myth that a
"managed" health care system would solve America's problems. He feels
the problems in health care have a "Made in Washington" label. Health
care already is the most regulated industry in America, strangling doctors and
hospitals by senseless paper work, counterproductive bureaucracy, an abusive
civil court system, and price controls that are actually driving prices up. He
feels it should be labeled a crisis in government that can only be solved by
less government interference.
In
his final chapter, "What's the Solution?," Annis gives us his
analysis of why third-party systems aren't working. Clinton's health plan; and two well-thought-out plans which he
feels put the patient back in the driver's seat - in charge of his or her own
money. He favors "An Agenda for Solving America's Health Care
Crisis," by the National Center for Policy Analysis, which can be reached
at 214-386-6272. . .
Dr.
Annis quotes Tom Paine's 1976 Revolutionary Era treatise, Common Sense, decrying excessive government, Time makes more converts than reason.
This book review is found at
. . .
To read more book
reviews . . .
To read book reviews
topically . . .
* * * * *
10. Hippocrates & His Kin:
When is a tax not really a tax?
Telephone
Bill
I was looking over the charges on my telephone bill and noticed 8 lines of
taxes. There was another line that intrigued me: Monthly Regulatory Cost
Recover Charge $1.25 to help defray costs incurred in complying with State and
Federal telecom regulations; State and Federal Universal Service Charges, and surcharges
for customer-based and revenue-based state and local assessments on AT&T.
These are not taxes or government-required charges.
Is there
anyone out there that would like to tack on a Regulatory Cost Recovery Charge
for Physicians and see if we can get paid for what everyone else gets paid?
Car Service Bill
I was looking over my car statement for the last service job. There was an
environment charge for oil drain disposal.
Suppose we could add an environment charge
for needle and syringe disposal?
Sacramento thanks the taxpayers who had $25,000 taken from them
forcibly under threat of incarceration to pay our symphony for concerts in the
neighborhood.
The Philharmonic is able to once again bring the
classical music to neighborhoods because of $25,000 in federal stimulus package funds
approved by Congress earlier
this year. Seven musicians, a conductor, a singer and narrator will present
free performances of Igor
Stravinsky's "The Soldier's Tale" and other works, from Del Paso Heights to
Orangevale to Natomas. Sac Bee . . .
How Sad that Charity is no longer Voluntary.
Government
Health Care Simply Costs More than Private Health Care
Just looking at the gross numbers: the total cost of
the bill Sen. Reid presented to the Senate was estimated to be $848 billion. It
was said to extend insurance coverage to 31 million Americans (maybe, in a few
years). That would be about $27,000 per additional insured person.
Can't we
just give these people a $12,000 gold-plated Blue Cross policy and save
$15,000?
Democrats
began the year as masters of the political universe, winning the White House
and increasing their majorities in Congress. But the year is ending badly for
them. Their top initiative, health care, is deeply unpopular. Congress's
approval rating is 26%, Speaker Nancy Pelosi's is 28%, and Senate Majority
Leader Harry Reid's is an anemic 14%.
Would
Congress really try to redo one fifth of our ecomomy by a majority of one that
represents such a small fraction of who America really trusts?
If they do, it spells the
end of American Freedom - at least until the next election.
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
•
John and Alieta Eck, MDs, for their first-century solution to twenty-first
century needs. With 46 million people in this country uninsured, we need an
innovative solution apart from the place of employment and apart from the
government. To read the rest of the story, go to www.zhcenter.org and check
out their history, mission statement, newsletter, and a host of other
information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
•
Medi-Share Medi-Share is based on the biblical principles of
caring for and sharing in one another's burdens (as outlined in Galatians 6:2).
And as such, adhering to biblical principles of health and lifestyle are
important requirements for membership in Medi-Share.
This is not insurance. Read more . . .
•
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. I
also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT
THE TIME OF SERVICE. 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."
•
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 25–50 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to
$5000/year! To read the rest of the story, go to www.simplecare.com.
•
Dr David MacDonald started Liberty Health Group. To compare the
traditional health insurance model with the Liberty high-deductible model, go
to www.libertyhealthgroup.com/Liberty_Solutions.htm.
There is extensive data available for your study. Dr Dave is available to speak
to your group on a consultative basis.
•
Madeleine
Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in
health care, has died (1937-2006).
Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
She will be remembered for her
important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the
government's efforts in criminalizing medicine. For other OpEd articles that
are important to the practice of medicine and health care in general, click on
her name at www.healthcarecom.net/OpEd.htm.
•
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.
•
ReflectiveMedical Information Systems
(RMIS), delivering
information that empowers patients, is a new venture by Dr. David Gibson, one
of our regular contributors, and his research group which will go far in making
health care costs transparent. This site
provides access to information related to medical costs as an informational and
educational service to users of the website. This site contains general
information regarding the historical, estimates, actual and Medicare range of
amounts paid to providers and billed by providers to treat the procedures
listed. These amounts were calculated based on actual claims paid. These
amounts are not estimates of costs that may be incurred in the future. Although
national or regional representations and estimates may be displayed, data from
certain areas may not be included. You may want to
follow this development at www.ReflectiveMedical.com.
During your visit you may wish to enroll your own data to attract patients to
your practice. This is truly innovative and has been needed for a long time.
Congratulations to Dr. Gibson and staff for being at the cutting edge of
healthcare reform with transparency.
•
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, who 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.
•
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and
Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
•
Robert J
Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an
informative Medicine Men column at NewsMax, have now retired. Please log
on to review the archives.
He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
•
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:
AMA favors some of
worst features of Senate bill. Don't miss the "AAPS News,"
written by Jane Orient, MD, and archived on this site which provides valuable
information on a monthly basis. This month, be sure to read The Power Of The
Minority. 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.
* * * * *
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John
3:16 For God so loved the
world that he gave his only Son for our transgressions that whoever believes in
him, shall not perish but have eternal life.
"The essence of
optimism is that it takes no account of the present, but it is a source of
inspiration, of vitality and hope where others have resigned; it enables a man
to hold his head high, to claim the future for himself and not to abandon it to
his enemy." - Dietrich Bonhoeffer, a Lutheran pastor and man of
conscience, who was martyred for his opposition to Hitler in 1945.
Some Recent
Postings
The
Case Against the Electronic Medical Record by David Gibson, MD & Jennifer Shaw Gibson
Primary
Care - It is a Tough Business by
David Gibson, MD & Jennifer Shaw Gibson
Stay Current with the HealthPlan Debate . . . HealthPlanUSA.net/Newsletters
In Memoriam
Charis Wilson, model and writer,
died on November 20th, aged 95
From The Economist print
edition Dec 10th 2009
THE
first time she modelled for Edward Weston, in March 1934, Charis Wilson knew
she didn't look good. At 20 she was "a piece of jailbait", a mere
child, especially with the stumpy plaits into which she sometimes twisted her
hair. She was a drifter, moving in a miasma of angry despair in and out of
speakeasies and other people's beds because her father had refused to let her
go to college, even though she'd won a full scholarship to Sarah Lawrence, and
even though he would certainly have let her brother go. There was nothing to do
but work in her mother's dress shop, sleep around in San Francisco, get
pregnant, have an abortion. She had taken a solemn vow of chastity since then,
like one of her made-up childhood rituals of lying in freezing cold water, but
to someone with her natural generosity it was a heartless, bitter thing. She
looked pale, her chin jutting out in defiance and her whole face needing
something—like warts on her nose, her mother told her—to make it remotely interesting.
. . .
She
was not an exhibitionist, or not much of one, though she had scandalised her
Aunt Allie by sunbathing naked on the deck of the big family house at Carmel,
and it had been easy to take off her clothes for Edward. He didn't direct her,
or put her in a pose—she hated those anyway, couldn't hold them, preferred to
lie down comfortably with a book. He just let her move as she liked, in a sort
of slow motion until he stopped her; and she waited, almost floating, as when
she used to swim out from Carmel to the kelp beds and tie her bathing suit to a
stalk and lie there, her white arms—as Edward now saw them—as sinuous and
exquisite as the kelp itself.
The
lines of Nature
He
could be brutally direct about his nudes, who were also always his lovers,
talking about "doing" backs, buttocks, heads as though they were
lifeless bits of stone. It seemed that he could feel as much passion for a
pepper, in the dimpled line of its spine and its cushioned, fleshy base, as for
any young woman. Charis he found different, both more beautiful than the others
and perhaps "the great love of my life". His finest nudes, he
thought, were done with her. He had achieved "certain heights reached with
no other love".
He
had also met his match in her. Both of them wanted sex as much as photography,
and said so candidly. Everything they did in the 11 burning years they were
together was good collaborative work, at least as far as she was concerned. The
notion of a muse was nonsense to her, a passive thing. She knew exactly what
she was doing—how furniture framed her or shadows fell, how her knee or
shoulder would look turned just so, or what a good idea it would be to run and
roll naked down the giant sand dunes at Oceano, a small part of that infinite,
flowing unity of all forms that he was always looking for.
Soon
she knew his ideas well enough to write the text for his photographs, his
applications for grants and his articles for photographic magazines, for words
came easily to her as they never did to him. She took the notes, on her
clackety Royal typewriter, and also drove their puttering Ford on the giant
western trips they made in the late 1930s; the books that resulted, notably
"California and the West", were as much hers as his, but she was
seldom credited. In the end, this rankled. Though she felt she had pulled even
with him, he never saw her that way or gave her writing equal space with his
pictures. The grand romance cooled and in 1946 died, giving way to ordinary
life. . . .
Charis Wilson
On This Date in
History - December 22
Near this date in about 6 BC, God so loved
the world that he gave his only begotten Son to die for our transgressions,
that whosoever will believe in Him, will not perish, but have Eternal Life.
-John 3:16.
On this date in 1944, Germany demanded the
surrender of American troops at Bastogne, Belgium. Brigadier
General Anthony C. McAuliffe didn't negotiate. He didn't capitulate. His
memorable reply was "Nuts!" And he went on fighting the Battle of the
Bulge and won.
After Leonard and
Thelma Spinrad
The 7th Annual World
Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality.
The 7th
Annual World Health Care Congress will be held April 12-14, 2010
Washington, DC
www.worldhealthcarecongress.com
Toll Free: 800-767-9499
In partnership with MedicalTuesday.net, the 6th
Annual World Health Care Congress was the most prestigious meeting
of chief and senior executives from all sectors of health care. The 2010
conference will convene 2,000 CEOs, senior executives and government officials
from the nation's largest employers, hospitals, health systems, health plans,
pharmaceutical and biotech companies, and leading government agencies.