1.
Featured Article:
Managing Diabetes,
Scientific American
Body
2.
In the News: Is
Science Faith Based, Like Religion?
3.
International Medicine: Universal
Health Care Equals Universal Neglect
4.
Medicare: What Are
the Real Medicare Costs Compared to Private Insurance
5.
Medical Gluttony: Regulations and
Mandates Produce Excessive Medical Costs
6.
Medical Myths:
Health Care Does Not Follow the Laws of Economics
7.
Overheard in the
Medical Staff Lounge: The Financial Drag on Doctors
8.
Voices of Medicine:
Post-Traumatic Pleasure Syndrome
9.
From the Physician
Patient Bookshelf: THE AMERICAN WAY OF
HEALTH
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MERRY CHRISTMAS & A HAPPY NEW YEAR
* * * * *
1.
Featured Article:
Special Report: Managing
Diabetes, Scientific
American Body-December 6, 2007
More than
171 million people have this increasingly common condition. But lizard spit,
new monitors and an array of other drugs and devices can help control diabetes
better than ever
Diabetes has reached virtually epidemic
levels in the modern world. In 2005 the U.S. Centers for Disease Control and Prevention estimated that about 7 percent of the
American population (20.9 million people) had diabetes - and 6.2 million of
them were unaware of it. More than 1.5 million people over the age of 20 will
be diagnosed with it in the U.S. this year. About 21 percent of those older
than 60 have the disease.
Small wonder, then, given the severe
complications associated with diabetes, that it continues to be the sixth
leading cause of death in the U.S. And although diabetes was often called a
"disease of affluence" in the past, it is now one of the
fastest-rising health concerns in developing nations as well: the World Health Organization pegs the global total at more than 171
million cases.
An unfortunate catch-22 of diabetes is
that although the right diet and exercise can help with its prevention and
management, diabetes itself can complicate both eating and physical activity.
Patients may need to pay extra attention to taking meals on a regular schedule
and to monitoring how exercise dehydrates them or lowers their blood glucose.
Some may fail to comply consistently with prescribed regimens that seem
inconvenient or unpleasant, thereby raising their risk of complications. But
thanks to leaps in science's understanding of the disease, doctors now wield a
diverse and growing arsenal of drugs and management technologies to fight the
progression - and even onset - of illness. People with diabetes have more and
better options than ever before for enjoying healthy, active, long lives. To read more, please go to www.medicaltuesday.net/index.asp.
Background
Diabetes is a disease in which too much of a sugar called glucose accumulates
in the blood because of a breakdown in how the body makes or reacts to the
hormone insulin. Insulin enables muscle, fat and other types of cells to take
up and process glucose. If cells can't burn or store glucose normally and the
blood levels rise chronically, damage accumulates throughout the body - in the
worst cases leading to blindness, amputation, kidney failure or death.
Most cases fall into one of two
categories:
Type 1 diabetes (formerly known as juvenile diabetes) occurs when the body
sabotages its own ability to produce insulin. A disorder of the patient's
immune system causes it to attack the insulin-making beta cells in the
pancreas. Consequently, patients with type 1 diabetes need an artificial source
of insulin. Although it is the most common form of diabetes in children, only 5
to 10 percent of all cases of diabetes in the U.S. are of this variety.
Type 2 diabetes, which has become increasingly prevalent during the past few
decades, arises from "insulin resistance," which causes cells, for
poorly understood reasons, to stop responding properly to the hormone. At
first, the pancreas can compensate by producing greater amounts of insulin. But
over time, the pancreas reduces its production, making matters worse. Initially
this type of diabetes may respond to diet, exercise and weight control, but
later medications, and perhaps insulin, may be necessary depending on the
severity of the case.
In addition, about 4 percent of all
pregnant women develop gestational
diabetes, a form that usually resolves itself
after delivery. Diabetes can also be a rare consequence of certain genetic
conditions or chemical exposures.
Symptoms, Risk Factors and Diagnosis
More than six million Americans have type 2 diabetes and don't know it because
its early symptoms can seem so harmless and vague:
·
Frequent urination
·
Extreme thirst and hunger
·
Irritability
·
Fatigue
·
Blurred vision
In contrast, type 1 diabetes comes on more
quickly and with more prominent symptoms, such as unexplained rapid weight loss,
dehydration or a severe illness called ketoacidosis. Medical science has still
not yet determined precisely why some people develop diabetes and others do not
- the genetic and environmental triggers for the disease are surprisingly
complex.
For example, type 1 diabetes is not simply
genetic in origin, because even the identical twin of someone with diabetes,
who shares the same genes, will develop the condition no more than 50 percent
of the time. Some as yet unidentified factor in the environment - perhaps a
virus - must therefore trigger the immune systems of genetically susceptible
people to attack the beta cells in their pancreas. Other environmental factors
also seem to be involved: research finds that type 1 diabetes is less common
among those who were breast-fed.
For type 2 diabetes, the genetic component
is greater: it tends to run more obviously in families, and the identical twin
of a person with diabetes will manifest the disease up to 75 percent of the
time. Yet it is also very strongly linked to weight gain and insufficient
exercise. As the American Diabetes Association (ADA) notes, "[A] family
history of type 2 diabetes is one of the strongest risk factors for getting the
disease, but it only seems to matter in people living a Western lifestyle."
In the U.S., type 2 diabetes is also more common among African-Americans,
Latinos, Asians and Native Americans.
Two ways to diagnose diabetes definitively
are testing a patient's blood with either a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT). The FPG measures the concentration of
glucose in the blood of a person who has been fasting for 12 hours; if it is
above 125 milligrams per deciliter, the patient is diabetic. The OGTT measures
the subject's blood glucose level both after a fast and two hours after
consuming a glucose-rich drink; diabetes is the diagnosis if the latter reading
is above 200 milligrams per deciliter. (The ADA favors the FPG because it is
less expensive, faster and easier for patients.)
Prevention and Prediabetes
People do not become diabetic overnight. Almost all of those who eventually
acquire type 2 diabetes move first through a "prediabetes" state in which their blood glucose levels
are elevated but not quite high enough to qualify as diabetes. (Prediabetes is
also called impaired glucose tolerance and impaired fasting glucose, depending
on the tests used to diagnose it.) Research suggests even those slightly less
than diabetic blood glucose levels may do long-term damage to the body, and
patients with prediabetes are at a 50 percent higher risk for heart disease and
stroke. In a major clinical trial from 2002 called the Diabetes Prevention Program (DPP), roughly 11 percent of those with prediabetes
became type 2 diabetics during the three years of the study.
The good news for the estimated 54 million
Americans who have prediabetes is that many can prevent their conditions from
progressing through moderate exercise and changes to diet. In fact, many of
them might even be able to return their blood glucose levels to normal. The DPP
found that patients who lowered their body weight by a mere 5 to 10 percent -
typically just 10 to 15 pounds - through diet and moderate exercise reduced
their risk of developing diabetes by 58 percent. These interventions were even
more effective among patients older than 60: their risk fell by 71 percent. And
it should go without saying that regular exercise and a healthy diet can help
keep people from acquiring prediabetes, too.
To read about management and treatment and
review the entire article, please go to www.sciam.com/article.cfm?id=managing-diabetes&print=true.
* * * * *
2.
In the News: Is Science Faith Based, Like Religion?
Accepting The Laws Of Science Takes A Leap Of Faith. By Paul Davies, Tempe, Ariz.
SCIENCE, we are repeatedly told, is the most reliable form
of knowledge about the world because it is based on testable hypotheses.
Religion, by contrast, is based on faith. The term "doubting Thomas"
well illustrates the difference. In science, a healthy skepticism is a
professional necessity, whereas in religion, having belief without evidence is
regarded as a virtue.
The problem with this neat separation into
"non-overlapping magisteria," as Stephen Jay Gould described science
and religion, is that science has its own faith-based belief system. All
science proceeds on the assumption that nature is ordered in a rational and
intelligible way. You couldn't be a scientist if you thought the universe was a
meaningless jumble of odds and ends haphazardly juxtaposed. When physicists
probe to a deeper level of subatomic structure, or astronomers extend the reach
of their instruments, they expect to encounter additional elegant mathematical
order. And so far this faith has been justified. To read
more, please go www.medicaltuesday.net/index.asp.
The most refined expression of the rational
intelligibility of the cosmos is found in the laws of physics, the fundamental
rules on which nature runs. The laws of gravitation and electromagnetism, the
laws that regulate the world within the atom, the laws of motion - all are
expressed as tidy mathematical relationships. But where do these laws come
from? And why do they have the form that they do?
When I was a student, the laws of physics were
regarded as completely off limits. The job of the scientist, we were told, is
to discover the laws and apply them, not inquire into their provenance. The
laws were treated as "given" - imprinted on the universe like a
maker's mark at the moment of cosmic birth - and fixed forevermore. Therefore,
to be a scientist, you had to have faith that the universe is governed by
dependable, immutable, absolute, universal, mathematical laws of an unspecified
origin. You've got to believe that these laws won't fail, that we won't wake up
tomorrow to find heat flowing from cold to hot, or the speed of light changing
by the hour. . .
To read the entire article, go to www.nytimes.com/2007/11/24/opinion/24davies.html?_r=1&oref=slogin.
Paul Davies is the director of Beyond, a research
center at Arizona State University, and the author of "Cosmic Jackpot: Why
Our Universe Is Just Right for Life."
* * * * *
3.
International
Medicine: Universal Health Care Equals Universal Neglect
Universal
Neglect
By
INVESTOR'S BUSINESS DAILY, November 06, 2007
Health Care: The
officials who run Great Britain's National Health Service apparently don't
believe patients need the benefits of medical innovations. Advanced medicine costs
too much, so they can just go without.
Medical treatment will always be rationed. Care may be
abundant in many parts of the world, but it's not unlimited. The question,
then, is who does the rationing? The patient? Or the government?
For years we've warned readers that the universal
health care model those on the left have been trying to force on the country
will establish a system in which the state takes over medical treatment and
makes decisions for the sick. To read more,
please go to www.medicaltuesday.net/intlnews.asp.
The ugly reality of this is evident in Britain, where
the NHS is denying cardiac patients access to a vital device.
"The Health Service's rationing watchdog says
drug-coated stents used to treat around 30,000 patients a year are not
cost-effective and should no longer be provided," Britain's Daily Mail
reported last week.
Surgeons say that holding back drug-coated stents will
actually increase NHS' costs because many patients who don't get the stents
will eventually need expensive heart bypass surgery. No matter. The bureaucracy
has spoken, and decisions have been made in the ivory towers that affect
others.
Briton Edward Crane didn't need a stent earlier this
year, but he did need hip surgery. So what does the NHS do? It cancels four
scheduled consultations with Crane. Fed up, the 75-year-old retiree, who had
paid into the NHS for decades, spent his life's savings to have a hip
replacement performed by a private practice.
Many Britons swear by their system, but they are not
the ones who have been denied care, put on long waiting lists or rudely
neglected, as Crane was, because bureaucrats are doling out the care.
No comment on universal care would be complete without
mentioning Canada, home of the Great White Waiting List. For an industrialized
nation, Canada's shortage of modern medical equipment is alarming. Among
Organization for Economic Cooperation and Development countries, the Fraser
Institute notes in a recent study, Canada ranks No. 13 out of 24 in access to
MRIs, No. 18 in CT scans and No. 7 out of 17 in access to mammograms.
Clearly, Britain and Canada are not the ideal places
to get sick.
www.ibdeditorials.com/IBDArticles.aspx?id=279244057766107
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canada's Supreme Court
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4. Medicare: What Are the Real Medicare Costs Compared to
Private Insurance?
Medicare Administrative Costs vs. Private Insurance
Administrative Costs
We hear estimates of Medicare administrative costs
ranging from 1.5% to 12%. We also hear bloviations of private insurance
companies' administration costs ranging from 10% to 50%. Definitions of what
constitutes administration, and what does not, vary widely. Some activities are
considered administration for private insurers but not for government programs.
So what exactly is administration? More importantly,
where can we find true numbers to make an intelligent comparison? With more and
more people screaming for Government medicine, wouldn't accuracy in comparing
systems lead to a much more sound decision?
At the end of the day, isn't the purest measure of
administrative costs the dollars allocated to the program less what is spent on
patient care, less any taxes? To read more,
please go to www.medicaltuesday.net/medicare.asp
The Medicare and Medicaid (CMS) website contains an
analysis of costs between private insurers, Medicare, and Medicaid. According
to their tables, private insurers have one line item entitled "Government
Administration and Net Cost of Private Health Insurance". This is the line
item so often quoted in isolation when proponents of government medicine are
trying to understate the costs of administration. For private insurers, this
one line item includes administrative costs, marketing, research, premium
taxes, facilities, equipment, insurance and reinsurance losses, as well as
profit. Perhaps the reason that these charges were all lumped into one line
item is because different private companies report differently or maybe private
carriers did not want their competitors to know who much they spend on any
particular line item?
The 2 main government programs; Medicare and Medicaid,
have additional line items which fall below the administration line. These are:
Government Public Health Activities, Research, and Structures and equipment.
Information on taxpayer funded public programs is more readily available,
non-patient care costs are easy to break down into 4 separate categories.
Medicare administration is also very different in that they actually don't pay
any claims themselves. These activities are delegated to private insurers.
Statistics, unfortunately are like a lamp post for a
drunk; they are used more for support than illumination. What is illuminating,
however is the actual per capita cost in absolute dollars of administering
government programs versus the per capita cost of administering private
programs. If we compare administrative cost of 4.02% for Medicare to 14,07% for
private insurance, we may mistakenly believe that Medicare has lower
administration costs. However, when we look at the percentage of costs for
activities not related to patient care (in other words the reciprocal of the
medical loss ratio ), we see that Private insurers non-patient care costs are
14.07% vs. 11.68% for Medicare and 31.12% for Medicaid. When we look at costs
in dollars per capita in Table 3 however, we come to a much different
conclusion ---the truth, which has been purposely hidden from us by the
proponents of government medicine. Even if we look at the one line item
entitled Government Administration and Net Cost of Private Health Insurance in isolation,
we quickly see that the NET costs of administering Medicare are 33% higher than
private insurers. When we include ALL non-patient care costs Medicare is 386%
the cost of private administration and Medicaid is 435% the cost. Combined
government administrative costs are more than 4 times the cost of private
insurers.
Anyone who has been inside the government will not be
surprised by this honest assessment of government efficiency. It is due to
these inefficiencies, that government projections are always low. They use the
percentages in Table 2 to project then they spend closer to the actual figures
n Table 3 and end up having to ration care to compensate.
Copyright © 2007 Ralph Weber CFP® REBC, All rights reserved. Used
with permission.
To review the tables, go to www.stopgovernmentmedicine.com/ and click on the title.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Regulations and Mandates Produce Excessive Medical Costs
A
Health-Insurance Solution By
MERRILL MATHEWS
December 12, 2007
Why
can't people living in New Jersey buy health insurance available to residents
of, say, Pennsylvania?
Rep. John Shadegg, an Arizona Republican, thinks they
should -- and today will reintroduce legislation to make that possible.
The Health Care Choice Act would allow residents in
one state to buy health insurance that is available in and regulated by another
state. If enacted, the law would create a competitive, 50-state market for
health insurance, likely making it cheaper. It would do this without imposing a
large cost on taxpayers and without creating a new government bureaucracy. To read more, please go to www.medicaltuesday.net/gluttony.asp.
This should be a no-brainer for Congress. But a few
years ago, Mr. Shadegg went looking for a Democratic cosponsor for his bill. He
found one who initially signed on, then withdrew under pressure from Democratic
House leaders who wanted to dismiss the Shadegg bill with the excuse that it
lacked bipartisan support.
The health-insurance market can be divided into three
segments. The first consists of mostly large employers, with self-funded plans,
and are regulated by the federal Employee Retirement Income Security Act
(ERISA) and thus not subject to state regulation. The two remaining segments of
the health-insurance market are heavily regulated by states: those that serve
small-group plans (typically covering two to 50 people), and individuals who
pay for their own insurance. Mr. Shadegg's bill only applies to the individual
market. . .
One of the most expensive state-level regulations is
"guaranteed issue," which requires insurers to sell insurance to
anyone willing to buy it, regardless of their health, or other factors that may
make it much more expensive to cover them. New Jersey, for example, enacted
guaranteed issue in 1994. At the time, a family policy could be purchased in
the state for as little as $463 a month or as much as $1,076, depending on
which of the 14 participating insurers a family chose. Now there are just 10
insurance companies offering plans in the state and the cost has soared to
$1,726 per month on the low end and $14,062 on the high end.
In New Jersey then, residents who buy their own
insurance have to pay at least $20,000 a year for the cheapest family policy.
Meanwhile, in neighboring Pennsylvania similar health-insurance policies cost a
third of what they cost in New Jersey. What Mr. Shadegg wants to do is to let
New Jersey residents buy what's now for sale in Pennsylvania.
Mandates are another reason the cost of health
insurance varies from state to state. States impose those mandates on what an
insurance plan must cover -- such as chiropractic care or mental-health
services. The Council for Affordable Health Insurance, which tracks mandates,
estimates that there are more than 1,900 state mandates nationwide. These
mandates can increase the cost of health insurance by as much as 50%, which can
then force residents in many states to decide between "Cadillac
coverage" -- insurance that covers nearly everything and costs a mini
fortune -- or no coverage at all.
Typically, state mandates are justified by the belief
that they make health insurance more comprehensive. But consider this: Idaho
has just 14 state mandates, the fewest in the nation, while Minnesota, with 63,
has the most. Yet, the people of Idaho aren't dying in the streets for lack of
mandates.
Critics of the Health Care Choice Act claim that it
would limit the ability of states to protect their residents. The assertion is
that cross-state health-insurance purchases are a risky experiment. In truth,
millions of people already have access to health insurance across state lines.
Employees of large companies with plans covered by ERISA are one example.
But there are others. Some small businesses cover
employees working across state lines. And, because people are mobile, some
people buy individual insurance in one state and then end up moving to another.
In many cases, they can take their health-insurance policies with them. A
person living in Pennsylvania with an individual policy now could retain that
policy even if he moved to New Jersey. Premiums would likely increase, but they
would be cheaper than if he had started out with a New Jersey policy.
If states are worried about losing regulatory control
over health insurance, they might try making their regulations competitive with
other states. Health insurers would likely respond by returning and offering a
wide range of affordable policies. As it stands, many states are
"protecting" their residents right into the uninsured camp.
The Health Care Choice Act won't solve every problem.
But it would increase competition and consumer choices currently denied to
residents in many states.
Mr. Matthews is executive director of the Council for
Affordable Health Insurance and a resident scholar with the Institute for
Policy Innovation.
http://online.wsj.com/article/SB119742880091722751.html?mod=todays_us_opinion
* * * * *
6.
Medical Myths:
Health Care Does Not Follow the Laws of Economics
Health Alert: Diabetics and Bagels by John Goodman, PhD
What do diabetics and bagels have in common? Almost nothing. However, the market for bagels might be useful for testing ideas about health care reform.I imagine that the market for diabetic care is about a thousand times more complicated than the market for bagels. So why not use the bagel market to experiment with hair-brained payment schemes think tanks propose to inflict on unsuspecting patients? Here's the argument: a) if a payment scheme doesn't work for bagels, it probably has no chance of working for diabetics either; b) the social cost from being wrong is far less if we are experimenting with bagels; and
c) just as the FDA requires drug companies to experiment first with rats, we should require policy wonks to try their ideas out on some relatively simple, inanimate product - and a bagel is just as good as any.To read more, please go towww.medicaltuesday.net/myths.asp.
All this is brought to mind by a recent missive from Karen Davis, president of the Commonwealth Fund. Karen says we pay doctors in the wrong way. That is true, but Karen is not suggesting that third parties butt out. She wants them to butt in - becoming even more meddlesome than they already are. Since she's not sure what the right answer is, she calls for third parties to experiment with many ideas. With hope that we do not cause unnecessary harm to either bagels or patients, I propose some mental experiments in form of the following challenges.The Bagel Challenge for the Commonwealth Fund: Take some part of the market, and have a third-party payer set delicatessen prices and pay at least 90 percent of the customer cost for fresh bagels (no more than 24 hours old). Show how the payment scheme would work, with no greater excess supply or excess demand from day to day and week to week than we have today. Feel free to make liberal use of pay for performance, best bagel practices, computerized bagel records, bagel utilization review, etc. Note: You don't have to actually implement the scheme. Just make a plausible case for how it would work. The Diabetes Challenge for Other Readers: Here is a far more productive challenge for everyone else. Start with a common insurance pool for diabetics in which all payments and all decisions are made by the insurer. Ignore catastrophic expenses and consider only routine care. Now begin to individualize the pool - giving patients more control over the dollars they are spending along with the power to individually negotiate prices and switch providers. Continue doing this as long as there are quality improvements and cost reductions. When no more improvements are possible, stop. Here's the question: At the stopping point, does the market for diabetic health care look like the market for bagels? Or, does the insurer retain control over some of the money and reserve the power to restrict some patient behavior? And if there is a residual role for the insurer, why is this good? (That is, why do all the original members of the pool benefit?)I don't expect to hear from Commonwealth any time soon. I hope I hear from others, however. If you want to submit a mathematical model, that's fine. In fact, it is preferable. If your response is verbal, keep it short and pithy.Cheers.John Goodman, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251
www.ncpa.org/
For Karen Davis' letter, go towww.commonwealthfund.org/aboutus/aboutus_show.htm?doc_id=559687.
For the NCPA's vision of how real markets would produce diabetic care, see the final chapter of Handbook on State Health Care Reform:www.ncpa.org/email/State_HC_Reform_Book_conclusion.pdf.
What do diabetics and bagels have in common? Almost
nothing. However, the market for bagels might be useful for testing ideas about
health care reform.
I imagine that the market for diabetic care is about
a thousand times more complicated than the market for bagels. So why not use
the bagel market to experiment with hair-brained payment schemes think tanks
propose to inflict on unsuspecting patients?
Here's the argument:
a) if a payment scheme doesn't work for bagels, it
probably has no chance of working for diabetics either;
b) the social cost from being wrong is far less if
we are experimenting with bagels; and
c) just as the FDA requires drug companies to
experiment first with rats, we should require policy wonks to try their ideas
out on some relatively simple, inanimate product - and a bagel is just as good
as any.
All this is brought to mind by a recent missive
from Karen Davis, president of the Commonwealth Fund. Karen says we pay doctors
in the wrong way. That is true, but Karen is not suggesting that third parties
butt out. She wants them to butt in - becoming even more meddlesome than they
already are. Since she's not sure what the right answer is, she calls for third
parties to experiment with many ideas.
With hope that we do not cause unnecessary harm to
either bagels or patients, I propose some mental experiments in form of the
following challenges.
The Bagel Challenge for the Commonwealth Fund: Take some part of the market, and have a
third-party payer set delicatessen prices and pay at least 90 percent of the
customer cost for fresh bagels (no more than 24 hours old). Show how the
payment scheme would work, with no greater excess supply or excess demand from
day to day and week to week than we have today. Feel free to make liberal use
of pay for performance, best bagel practices, computerized bagel records, bagel
utilization review, etc. Note: You
don't have to actually implement the scheme.
Just make a plausible case for how it would work.
The Diabetes Challenge for Other Readers: Here is a far more productive challenge for
everyone else. Start with a common
insurance pool for diabetics in which all payments and all decisions are made
by the insurer. Ignore catastrophic expenses and consider only routine care.
Now begin to individualize the pool - giving patients more control over the
dollars they are spending along with the power to individually negotiate prices
and switch providers. Continue doing this as long as there are quality
improvements and cost reductions. When no more improvements are possible, stop.
Here's the question: At the stopping point, does the market for diabetic health care
look like the market for bagels? Or,
does the insurer retain control over some of the money and reserve the power to
restrict some patient behavior? And if
there is a residual role for the insurer, why is this good? (That is, why do
all the original members of the pool benefit?)
I don't expect to hear from Commonwealth any time
soon. I hope I hear from others,
however. If you want to submit a mathematical model, that's fine. In fact, it is preferable. If your response
is verbal, keep it short and pithy.
Cheers.
John Goodman, President, National Center for Policy
Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251
For Karen Davis' letter, go to www.commonwealthfund.org/aboutus/aboutus_show.htm?doc_id=559687.
For the NCPA's vision of how real markets would
produce diabetic care, see the final chapter of Handbook on State Health Care
Reform: www.ncpa.org/email/State_HC_Reform_Book_conclusion.pdf.
* * * * *
7.
Overheard in the
Medical Staff Lounge: The Financial Drag on Doctors
Dr. Kaleb:
Remember the doctors who moved out of St. George, their complaint about a change
of address triggering six to nine months of harassment by Medicare is striking
home.
Dr. Rosen:
Sooner or later everyone will feel the strong arm of Government Medicine even
without Single Government Payer.
Dr. Sam: Why are
there any doctors for Single Payer Government Medicine? Are their heads in the
Sand?
Dr. Dave:
Doctors are so brow beaten, they don't know what to believe. So what's new with
you Kaleb? To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Kaleb: I've
been listening to your complaints since last spring and am now experiencing
what has been said. My wife has a general practice and moved last July. She has
just completed the Medicare application for the third time. They found a small
typo on the first two and she was not allowed to simply correct it, she had to
fill out a new 17-page and a 7-page additional application. It's been more than
six months since her last Medicare check. She's in solo practice and that
really is devastating except I'm getting paid. In fact, our group was going to
move, but because of all the discussion in the lounge over lunch, we decided to
stay put in our inadequate office and build up our hospital practice instead.
Dr. Rosen: We
delayed our initial application last May because they needed a voided check
with our new address. We had planned to use our old supply but Medicare
wouldn't accept that. They have the same bank routing number and the same
account number.
Dr. Yancy:
Simple harassment by Medicare.
Dr. Kaleb: When
I called Medicare to try to expedite my wife's application, I felt like I was
talking to a blank wall. The answers didn't speak to my question at all.
Dr. Michelle: OK
guys, I didn't move but I think you are grossly overplaying it. They are
treating me nice.
Dr. Sam: How
much of your fee are they paying you?
Dr. Michelle: About
half. Isn't that what you get?
Dr. Rosen: When
we got our first check last week after six months, we could plainly see that
the global return was now down to 40% of our billable charges and we haven't
raised our fees significantly in years.
Dr. Kaleb: Can
you imagine what medical practice would be like if Medicare was the only game in
town?
Dr. Michelle:
Don't you think if they were the only game in town, they would treat you
better?
Dr. Yancy: I
don't understand your logic at all, Michelle. Do leopards change their spots
when they eat their prey?
Dr. Sam: Maybe
the logic is that zebra's lose their stripes when they're eaten.
Dr. Milton: We
have to remember that doctors are a small minority of less than one-quarter of
one percent of the population. And the patients are totally defenseless in
protecting themselves from the government.
Dr. Rosen: This
means that unless we explain our position in a more unified voice to the
public-at-large, our minority will never become the majority.
Dr. Milton: But
we don't have a forum. Many of Oour Medical Societies
have gotten pro-government single-payer, and most doctors will not go against
the establishment and thus we remain fragmented.
Dr. Rosen: Maybe
we need to start our own forum outside of our societies. The MedicalTuesday
newsletter is now reaching more physicians than than many of the MedicalCalifornia
Societies' newsletters. Maybe we need get-togethers on MedicalTuesday evenings
on a monthly basis.
Dr. Edwards:
Didn't FirstTuesday reach a 100,000 business folks that way? I went to one in
Chicago and there was standing room only.
Dr. Rosen: Does
anyone have any remaining energy after working twice as hard for half the money
to spearhead that?
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
SONOMA MEDICINE, the Magazine of the Sonoma County Medical
Association
Medical
Arts: Post-Traumatic Pleasure Syndrome, By Sanjay Dhar, MD
I
remember the afternoon vividly. It was during the summer, when gentle coastal
fog brushes Sonoma County, giving us a brief reprieve from the insufferable heat.
I had paced the office hallways all morning, thinking about how to present the
details of the 24-hour ambulatory EKG monitor data to John. He was an
85-year-old veteran with recent episodes of extreme exhaustion, generalized
fatigue, dizziness, and exertional shortness of breath.
The
monitor data revealed that John had occasional very slow heartbeats, with heart
rates sometimes dipping into the mid-20s. His diagnosis was quite obvious, and
implanting a pacemaker would not have been difficult, except for his frail body
habitus. John walked with a limp, used a thick cane, and had only one arm. His
body was contorted because of severe kyphoscoliosis from previous trauma and
subsequent surgeries.
All
these features, along with extensive scar tissue on his lower neck and chest,
made implant surgery difficult.
Now
I stood in the exam room with John and his wife, detailing every possible
complication known for pacemaker implantation and subsequent management. John
listened to me quietly with a smile on his face. Halfway through my
presentation, he suddenly blurted out, "Have you ever killed anyone while
putting in a pacemaker?"
I
was a little stunned. After regaining my composure, I gravely said, "Sir,
we are discussing serious matters here."
John
stood up, limped toward me, and whispered in my ear, "Doc, you take your
job too seriously. Nothing can happen to me, especially with what I have gone
through in the past. I suffer from post-traumatic pleasure syndrome, not
post-traumatic stress disorder."
This
was a strange statement, especially in an era when many of us blame our current
inadequacies on some traumatic event we suffered in the past.
John
then gave me a detailed account of his own traumatic event. . .
To
read the whole tragic heartwarming story, go to www.scma.org/magazine/scp/Fall07/dhar.html.
Dr. Dhar is a cardiologist in private practice in
Santa Rosa.
To read other VOM, go to www.healthcarecom.net/vom2000.htm.
SONOMA MEDICINE, the Magazine of the Sonoma
County Medical Association
Medical Arts: Post-Traumatic
Pleasure Syndrome, By Sanjay
Dhar, MD
I remember the afternoon vividly. It was during the
summer, when gentle coastal fog brushes Sonoma County, giving us a brief
reprieve from the insufferable heat. I had paced the office hallways all
morning, thinking about how to present the details of the 24-hour ambulatory
EKG monitor data to John. He was an 85-year-old veteran with recent episodes of
extreme exhaustion, generalized fatigue, dizziness, and exertional shortness of
breath.
The monitor data revealed that John had occasional
very slow heartbeats, with heart rates sometimes dipping into the mid-20s. His
diagnosis was quite obvious, and implanting a pacemaker would not have been
difficult, except for his frail body habitus. John walked with a limp, used a
thick cane, and had only one arm. His body was contorted because of severe
kyphoscoliosis from previous trauma and subsequent surgeries.
All these features, along with extensive scar
tissue on his lower neck and chest, made implant surgery difficult.
To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
Now I stood in the exam room with John and his
wife, detailing every possible complication known for pacemaker implantation
and subsequent management. John listened to me quietly with a smile on his
face. Halfway through my presentation, he suddenly blurted out, "Have you
ever killed anyone while putting in a pacemaker?"
I was a little stunned. After regaining my
composure, I gravely said, "Sir, we are discussing serious matters
here."
John stood up, limped toward me, and whispered in
my ear, "Doc, you take your job too seriously. Nothing can happen to me,
especially with what I have gone through in the past. I suffer from
post-traumatic pleasure syndrome, not post-traumatic stress disorder."
This was a strange statement, especially in an era
when many of us blame our current inadequacies on some traumatic event we
suffered in the past.
John then gave me a detailed account of his own
traumatic event. . .
To read the whole tragic heartwarming story, go to www.scma.org/magazine/scp/Fall07/dhar.html.
Dr. Dhar is a cardiologist in
private practice in Santa Rosa.
To read other VOM, go to www.healthcarecom.net/vom2000.htm.
* * * * *
9.
Book Review From
our Archives: THE AMERICAN WAY OF HEALTH - How Medicine is Changing and What
it Means to You by Janice
Castro, Back Bay Books, (Little, Brown, & Company), Boston, 1994, x &
282 pages, including glossary, notes, & index, $9.95, Paperback.
Janice Castro, senior health-care correspondent at
TIME who interviews professionals, patients, and others, opens with "Ask most
people what they think about the state of American medicine, and they will tell
you about their own doctors, or about something that happened to them during an
illness. Chances are, if they see a need for health-care change, it will be
very specific, based on personal experience. On the other hand, listen to
American leaders discussing health-care reform. They speak of providers.
Access. Alliances. Competition. Mandates... The concepts seem impossibly
complicated and remote from the experience of one sick person needing
help." To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
She continues, "This book will help the
general reader understand how the American health system works, why it costs so
much... Medicine is too important, too personal, to be left to economists and
politicians... After all, the health-care debate is really about life and
death. It is about those times when people need help and about whether it will
be there, about one sick patient at a time and the doctor or nurse who provides
care... It is fundamentally a moral problem. Viewed in that light, the
challenge... begins to come more clearly into focus. It is not really that
complicated. We know what we need to do. We need to take care of old people...
Children should see doctors and dentists. A pregnant woman should be able to
check in with a doctor as the baby grows. People should not be dying in the
street... Families shouldn't lose their home over the cost of coping with
medical disasters. Breadwinners should not quit good jobs in order to qualify
for poor people's insurance... People should take responsibility for their own
health and for their family's. Children should not be having children..."
And, "If we are going to ensure that every
American has access to decent health care, while also controlling the
burgeoning costs, all of us must curb our medical greed. All of us must stop
pretending that someone else is paying the bills. 'What do you think most people
would say if one of their parents called up and said they needed a hundred and
twenty-five thousand dollars for an operation?' asks one economist. 'Do you
think that son or daughter would think twice and wonder whether that operation
was really necessary? Of course they would. But none of us think we pay for
medical care. And of course we all do.' All of us must pay our share..."
To read the entire review, please go to www.delmeyer.net/bkrev_AmericanWayOfHealth.htm.
To read other book reviews by topic, go to www.healthcarecom.net/bookrevs.htm.
To read other book reviews alphabetically, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
Janice Castro, senior health-care correspondent at
TIME who interviews professionals, patients, and others, opens with "Ask
most people what they think about the state of American medicine, and they will
tell you about their own doctors, or about something that happened to them
during an illness. Chances are, if they see a need for health-care change, it
will be very specific, based on personal experience. On the other hand, listen
to American leaders discussing health-care reform. They speak of providers.
Access. Alliances. Competition. Mandates... The concepts seem impossibly
complicated and remote from the experience of one sick person needing
help."
She continues, "This book will help the
general reader understand how the American health system works, why it costs so
much... Medicine is too important, too personal, to be left to economists and
politicians... After all, the health-care debate is really about life and
death. It is about those times when people need help and about whether it will
be there, about one sick patient at a time and the doctor or nurse who provides
care... It is fundamentally a moral problem. Viewed in that light, the
challenge... begins to come more clearly into focus. It is not really that
complicated. We know what we need to do. We need to take care of old people...
Children should see doctors and dentists. A pregnant woman should be able to
check in with a doctor as the baby grows. People should not be dying in the
street... Families shouldn't lose their home over the cost of coping with medical
disasters. Breadwinners should not quit good jobs in order to qualify for poor
people's insurance... People should take responsibility for their own health
and for their family's. Children should not be having children..."
And, "If we are going to ensure that every
American has access to decent health care, while also controlling the
burgeoning costs, all of us must curb our medical greed. All of us must stop
pretending that someone else is paying the bills. 'What do you think most
people would say if one of their parents called up and said they needed a
hundred and twenty-five thousand dollars for an operation?' asks one economist.
'Do you think that son or daughter would think twice and wonder whether that
operation was really necessary? Of course they would. But none of us think we
pay for medical care. And of course we all do.' All of us must pay our
share..." To read the entire review, please go to www.delmeyer.net/bkrev_AmericanWayOfHealth.htm.
To read other book reviews by topic, go to www.healthcarecom.net/bookrevs.htm.
To read other book reviews alphabetically, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
* * * * *
10. Hippocrates & His Kin: Bottled Water a Symbol
Similar to a Pack of Luckies?
Looking back, 2007 may well be remembered as the year green went mainstream:
Al Gore got an Oscar, Wal-Mart flogged organic jammies, and bottled water went
from being a symbol of purity to the beverage equivalent of a pack of Luckies.
www.fastcompany.com/magazine/120/at-frog-being-green-isnt-easy-its-essential.html
To read more
medical vignettes, go to www.medicaltuesday.net/hhk.asp.
What kind of an opinion do you need?
Three and a half years ago, the Lewin Group wrote a report for California state
Senator Sheila Kuehl which basically came to the conclusion that single-payer
government medicine with rationing was the best solution for California. On
December 12, 2007, the same Lewin Group, when hired to help the NFIB to prepare
healthcare reform policy came to the conclusion that "To the greatest
extent possible, Americans should receive their health insurance and health
care through the private sector." www.stopgovernmentmedicine.com/
It appears that you can buy any kind of data you wish.
But how can you tell if it's valid?
Why pregnant women don't tip over.
Researchers from Harvard University and the University
of Texas at Austin examined 19 pregnant women and discovered a number of
reinforcements in their backs that men lack, including a lumbar (lower back)
curve that spans three instead of two vertebrae and spinal joints that are 14
percent larger and positioned differently. These enhancements allow expectant
mothers to lean back by as much as 28 degrees more than normal to offset the
added heft of a baby bump - up to 30 pounds on average, or the weight of two
bowling balls - without destroying their backs, the investigators report in Nature.
www.sciam.com/article.cfm?id=news-bytes-why-pregnant-women-dont-tip
To read more HHK, go to www.healthcarecom.net/hhk1998.htm#September%201998.
To read more HMC, go to www.delmeyer.net/hmc2004.htm.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: