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Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, December 23, 2003
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In This Issue:
1. The Health Insurance Portability and Accountability Act (HIPAA) Destroys Medical Privacy
2. Extending Criminal Law to All Forms of Conduct and Now the Practice of Medicine
3. Is Preventive Medicine Cost Effective?
4. Our Monthly Review of Socialized or Single-Payer Medicine
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring Accountability in HealthCare & Government
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Theo Francis, a staff reporter to the Wall Street Journal, provides insight as to what is really happening. When a marketing company, on behalf of a surgery center, contacted Sally Scofield in 2002 to ask about her recent knee surgery, the Chicago legal secretary was taken aback: The company seemed to know all the details of the operation, as well as who she was and where she lived. She figured that her privacy rights had been violated under a law known as HIPAA passed by Congress in 1996 that was supposed to protect medical information. But as she pursued the matter, she was even more troubled to learn that, under new rules adopted by the Department of Health and Human Services this past April, patients actually have lost a surprising degree of control over their medical information. Anything she told a doctor or anything that appears in her medical records potentially could be disseminated without her knowledge or consent. "The things I've told my doctor, I'm just terrified," Ms. Scofield says. She also stopped going to the doctor. "I'd rather take the chance of getting ill."
In May, she joined several doctors, psychotherapists and others in a lawsuit filed against Health and Human Services. HHS maintains that the rules correctly balance HIPAA's demands for improving health-care efficiency while protecting privacy. However, it has never been shown that HHS or any other government program has ever increased health-care efficiency. HHS also states that the consent requirement was removed from the regulations for routine uses of medical information because keeping it "would have substantially delayed and interfered with the delivery of health-care services in a wide variety of circumstances -- in some cases to the detriment of patients' health and welfare." What seems to be missing is that it’s the doctor and consultants that should have free access to the patient’s records in the medical decision-making process, not a marketing company or a government bureaucracy. Read the entire article at http://online.wsj.com/article/0,,SB107101754026289100,00.html.
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2. Extending Criminal Law to All Forms of Conduct
and Now the Practice of Medicine
Erik Luna, in a recent policy report from CATO, discusses the troubling phenomenon of continually adding new crimes or more severe punishments to the penal code criminalizing and over criminalizing all forms of conduct, much of it innocuous, to the point of erasing the line between tolerable and unacceptable behavior. Where once the criminal law stood as a well-understood and indisputable statement of shared norms in American society, such as murder, rape, robbery, theft and arson, now there is a bloated compendium that looks more like the federal tax code. My CPA once pointed out the bloated Internal Revenue Tax Code Compendium on his desk and told me of the 50 volumes in his library that it took for experts to interpret this compendium. No one can know all the tax laws. The end result of arresting people that don’t know and would not be able to know the mass of federal, state and local laws can be downright ugly: a soccer mom in a small Texas town thrown in jail for failing to wear a seatbelt; a 12-year-old girl arrested and handcuffed for eating french fries in a Metro station in Washington, DC; defendants serving 25-years to life sentences in California for pilfering a slice of pizza; (to which I would add: a Sacramento physician serving 22 months in jail for using the wrong codes on his Medicaid patients; a San Diego surgeon serving 5 to13 years for using the wrong codes on his Medicare patients; and irrationally expanding mail and wire fraud so doctors that unknowingly use the wrong Medicare code when sending out mailed statements, are also guilty of mail fraud.) Luna reminds us that common law requires a convergence of harmful conduct (actus reus) and a culpable mental state (Mens rea). For example, larceny is not only taking someone’s private property, but knowing that the object belonged to another and intending to deprive him of that property–all of which is missing in the above examples. A common game in school was to see how long one could go before breaking a law. I would observe someone give a pack of cigarettes to another school mate and when he opened the pack without breaking the tax stamp, the former would look at his watch and tell him how many minutes it took him to break the law requiring the tax stamp be broken on opening a package or container. Now, with so many laws where no one can possibly know them all, Americans are essentially criminals on a regular basis. To read the whole article on America’s drive to criminalize and expand its appetite for a crime-of-the-month see http://www.cato.org/pubs/policy_report/v25n6/luna.pdf
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3. Is Preventive Medicine Cost Effective?
In view of continued patient demands for yearly exams, x-rays and other testing even when the results previously have been normal, a recent Galen HealthBenefitsReform Group sequence deserves emphasis. One member stated the premise that encouraging regular visits and preventive care would save money in the long run. It was pointed out that except for prenatal care, immunizations, and certain tests in subsets of high-risk population, complete physical exams do not save money but rather create tremendous expenditures. "Preventative care" has been used as a buzz word for years in order to help give legitimacy to ideas that cannot withstand scrutiny. And it was encouraged by our health insurance first-dollar coverage brought about by employment-based benefit programs. Prior to this time in our nation's history, health care consumed about 4.7 percent of GDP. It has now nearly quadrupled to about 16 percent and is still rising. One physician noted that, over a decade ago, there was a study in the Annals of Internal Medicine that obliterated the myth of the need for an annual physical exam. There were some elements of the exam determined to be useful depending on age - but for the most part there was very little that was shown to be useful. Annual physicals in asymptomatic people were shown to be a waste of time and money. Another recounted a study done of approximately 2,500 people who had annual physicals and 2,500 who didn't. There was no significant difference in outcome between the study and the control groups. He also recalled articles that fell back to the saying "An ounce of prevention is worth a pound of cure." Actually, if an effective cure is available, some experts say that prevention is worthless. Of course, it does behoove us as individuals to make the adjustments in our lives to eliminate the known risks––smoking, excessive drinking, over eating, substance abuse, risky life styles––that our doctor or our nurse or our hospital cannot do for us. Furthermore, the emphasis on yearly complete examinations will never change as long as such exams are free in most government and insurance programs. When the minimal yearly deductible equals the average cost of such examinations, which today is about $500, then patients will again make a market-based decision on what they deem as worthless health care by eliminating unnecessary costs. Those that feel it has value to them will then gladly pay for such value.
4. Our Monthly Review of Socialized or Single-Payer
Over the past year, we have reviewed Jacob G Hornberger and Richard M Ebeling’s treatise The Dangers of Socialized Medicine. Professor Ebeling, the Ludwig von Mises Professor of Economics at Hillsdale College, was recently named president of the Foundation for Economic Education that has published a Freedom’s Magazine for more than 50 years. Sheldon Richman, in his editorial message in the current issue called Ideas on Liberty, gives us his perspective on “Socialism in Theory.” Although Socialism has been discredited on economic grounds throughout the world, it has not been discredited on moral grounds in view of the common retort that while socialism doesn’t work in practice, it is good in theory. Richman terms this a strange notion that a theory that doesn’t work in the world can somehow be good. Where else can it be judged? One would think that a theory whose consistent realization requires gulags and secret police would be morally disqualified, even if it “worked.” Proponents really mean they regret that it doesn’t work. They feel socialistic people are not acquisitive and are more concerned about others. The regret turns out to be a regret about human nature. However, socialism promised a superabundance of goods and services so that no one would have to do without anything. Wasn’t that an appeal to acquisitiveness, even gluttony? But socialism has found limits, even in health care as every country with socialized medicine has discovered. The ugliness of socialist theory now comes into focus throughout the world. Under individualist and capitalist theory and practice, each person is free to determine his own needs and, through the division of labor and voluntary exchange, to produce what’s required to satisfy them. Under socialist theory, the individual’s needs are determined and satisfied collectively. It’s a mystery, Richman concludes, why anyone would find that theory beautiful or regret that it doesn’t work in practice.
Russell Roberts in his monthly column in the same issue comments on the argument that market forces don’t apply to health care because there isn’t anything close to a free market in health care. There are government programs and there’s insurance. He ascribes this distortion to college economic textbooks that teach that the perfect competition assumes there are huge numbers of small sellers. But in health care, we have more than 800,000 physician sellers in America (four to five million by some estimates in the world) which would be closer to the perfect free market than most goods and services. There is also the argument that there are usually only a few hospitals in a community and they can control the market. However, if hospitals were deregulated, that could not happen. I did my medical school preceptorship in a rural town in Kansas with a group of physicians who owned their own hospital as a service to the community. The room rate was $6, $8, and $10, depending on whether the patient wanted a four-bed, a two-bed or a private room. The public hospital in the next town charged twice as much. One would think that the doctors could easily have doubled the charges in their hospital, thus doubling their profit, without any loss of business. However, they told me they were making an adequate profit and as physicians provide service to humankind, we should not exploit those we serve. Hence, if there was only one hospital in a town, the free and open and unregulated Medical MarketPlace would be ruthless in providing the lowest possible cost for health care. If the patients and the community thought the hospital was charging too much, a new hospital would spring up very quickly. Even a competing doctor's hospital might drop charges precipitously, if unregulated, so the only hospital in town would drop their charges or go out of business.
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5. Medical Gluttony or Excessive HealthCare Costs
At a recent church function, I sat across from a retired military man with free health care and an 85-year-old gentleman with free health care. The military man stated that he had severe heart burn, and his wife, who had lost her first husband because of a coronary, suggested that he go to the emergency room. Since he has had acid indigestion frequently, I asked if he had taken his Prilosec (preventing acid secretion) and antacids (neutralizing any acid still in his stomach) to see if that would resolve symptoms. He had not. He extolled his military health benefits and began enumerating the tests he had that night. They ranged from a chest x-ray, an electrocardiogram, cardiac-related blood tests, stress cardiac imaging, and other testing that kept him busy for eight hours. When he was told that it wasn’t cardiac related, they gave him a Prilosec and antacids and he felt better within a few minutes. He was so elated over the night time emergency cardiac evaluation that it was difficult to make him realize that if he would have had to pay even a portion of that ER visit, he would have probably used his own Prilosec and antacids at home when his acid indigestion occurred. He did admit that he would have, but he confessed that “it made my wife feel better.” The 85-year-old Medicare recipient relayed a similar story. He also had extensive testing requiring six hours of his time. He was told that his heart was in as good a shape as a 40-year-old man. His discomfort also resolved promptly on Prilosec and antacids. Like the military man’s wife, his spouse was relieved by the news.
But how long can our nation afford this socialistic health care where nothing is too good, even if it’s not relevant to one’s health but for the sole purpose of making one’s spouse feel good? These two emergency room visits had to cost well over $2,000 each. In each case, a 75-cent Prilosec and 25 cents of antacids took care of the “non-emergency.” However a 2,000 fold excess cost because it is free does translate into a 200,000 percent gluttonous use of health care resources. And in case you missed it, the cost of Prilosec, which was originally $5 a capsule, dropped to 75 cents when competition set in. Yes, the open Medical MarketPlace even works for pharmaceuticals.
As Richman notes above, it is socialism that appeals to gluttony. It is capitalism or the open and free Medical MarketPlace that would allow the freedom for each individual to determine his own “needs” and not transfer his “wants” to the expense of others. Thus capitalism or the free market is what prompts responsible human behavior while socialism or single-payer health care or universal health care is what invites gluttonous and irresponsible behavior.
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6. 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. To see how Medicare treats doctors who don’t participate in the rules and regulations, click on “Medicare’s absurd impact on PATMOS” at the left margin. Congratulations to Dr Berry for a Wall Street Journal Front Page & Center article, Pay-as-You-Go MD: The Doctor Is In, But Insurance Is Out. To read, go to http://online.wsj.com/article/0,,SB10680718663821200-search,00.html.
• 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. Call 412-364-1994 or 724-929-5711 to join and be part of protecting and preserving what is right with American Healthcare–physicians, nurses, pharmacists, psychologists, all health professionals, and all concerned individuals are urged to join.
• Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. SimpleCare is a common-sense health care program designed by members of the American Association of Patients and Providers (AAPP). The non-profit AAPP was formed by practicing board-certified physicians in an effort to bring together the voices and strengths of patients, physicians and all health care providers as the "agents of change" across the nation. Any patient or person may become a member of SimpleCare. Remember, 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. Michael Arnold Glueck wrote a recent column: “The Medicare Mop Up” found at http://www.newsmax.com/archives/articles/2003/12/2/211320.shtml. It is paired with Robert Cihak’s “Silver Lining in the Medicare Cloud?” found at http://www.newsmax.com/archives/articles/2003/12/8/232925.shtml. This gives us two points of view on the recent medicare legislation.
• Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. Doctors are daily reviewed, suspended, lose their medical licenses, and go to jail on trumped up charges that most attorneys don’t understand. This week Dr Willner reports that during its December 11-12 board meeting, the Texas State Board of Medical Examiners took disciplinary action against 60 licensed physicians who received one or more of the following actions ranging from surrenders/revocations, suspensions, restrictions; public reprimands; and administrative penalties, totaling $156,000. The board had been criticized for not sanctioning enough doctors. In politics, the facts may not be important. It may be more important for board members to reduce the heat and sacrifice a few doctors. Dr Willner has opened a separate page for these issues. Stay posted at http://www.peerreview.org/texas.
• 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,” written by Jane Orient, MD, 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. AAPS also issues regular alerts and news releases about patients' rights, privacy and government action that could have a tremendous impact on you, your family, your practice and your patients. To receive notices of new postings, sign up for the email service. Also check the important resolution, how to Oppose Single-Payer Medical System, which can be sent to you directly from the website, which is a cyberspace library of books of interest, brochures, the journal, as well as congressional testimonies, fraud, economics, action alerts, and health care news.
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URL References for your perusal or study at leisure. You may want to Bookmark these or add to your Favorites.
Single-Payer Initiatives: http://www.healthcarecom.net/EditorialNov94.html
David Gibson, MD, National Health Care Consultant: http://www.healthplanusa.net/DavidGibson.htm
Single Payer: http://www.healthplanusa.net/DGSinglePayer.htm
Why are the uninsured, uninsured: http://www.healthplanusa.net/DGUninsured.htm
What’s behind health care costs: http://www.healthplanusa.net/DGRisingHealthCareCosts.htm
Pharmacy costs: http://www.healthplanusa.net/DGPharmacyCosts.htm
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If you would like to participate in the development of the affordable HealthPlan for All Americans and their employers, please send your resume to Personnel@HealthPlanUSA.net. We thank the international response we are receiving and look forward to meeting some of you at our next international meeting. Apparently professionals throughout the world look up to America to solve the health care problems without government enslavement. With your help we can do this. If you would like to be in investor, please send a personal email to DelMeyer@HealthPlanUSA.net.
Del Meyer, MD, CEO & Founder