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 Networking to Restore Accountability in HealthCare & Medical Practice

  Tuesday, February 22, 2005

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MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counterproductive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:

  1. Government Intervention Creates Global Corruption
  2. How Government Destroys Medical Care
  3. It's Time for Fundamental Health Care Reform
  4. This Week's Review of Corporate Socialized Medicine - Drug Costs
  5. Medical Gluttony Will Precipitate The Realities of Medicare and Social Security
  6. Medical Myth Nine: Americans Are Incapable of Making Medical Choices and Need Government to Supply Medicine
  7. Medical Ethics: Hollywood Doesn't Get It Right with Million Dollar Baby
  8. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government

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  1. Government Intervention Creates Global Corruption

Richard Ebeling, President of the Foundation for Economic Education, reports in the last issue of The Freeman on how the Interventionist State causes global corruption.

In a recent survey of 50,000 people in 62 countries around the world, at least one out of every ten people admitted that he had bribed some corrupt political official or government administrator during the preceding 12 months. There seems to be very few places anywhere in the world where such political bribery does not occur. The omnipresence of such political corruption should not be surprising; it is inseparable from the modern interventionist state.

According to a report released in December by Transparency International (TI), a non-governmental organization headquartered in Berlin , one out of every two people in the West African nation of Cameroon had paid a bribe during the previous 12 months. In Albania , Bolivia , Kenya , Lithuania , Moldova , and Nigeria , one out of every three citizens said he had done so. In the Czech Republic , Ecuador , Ghana , Mexico , the Philippines , Pakistan , Romania , Russia , and Ukraine , one out of every four to five people acknowledged bribing someone connected with the government.

In 36 of the 62 countries surveyed, respondents said that political parties were the most corrupt, followed by parliaments and legislatures, the police, the legal system and judiciary, and the tax authorities. Seventy-seven percent of all respondents stated that petty political corruption (involving business licenses, traffic violations, and so on) was a big problem in their countries. Eighty-five percent said that "grand" political corruption at the highest levels of government involving the political elites and special-interest groups was a major problem. While few Americans or Canadians admitted they paid bribes ("petty" or "grand") to someone in government, in both countries the respondents said that on a scale of one to four (with one being "not at all" and four being "to a large extent"), the occurrence of political corruption ranked above a three. . . .

TI's more comprehensive 2004 Global Corruption Report, released last spring, revealed that the primary bases for political corruption around the world were government procurement contracts, electoral contributions by special-interest groups, and bribes for regulatory benefits or limits on both domestic and foreign competitors. The pervasiveness of political corruption, unfortunately, can be neither reduced nor eliminated through various forms of legislative and legal reform, as organizations such as TI often advocate. Corruption is an inevitable outgrowth of the interventionist state and can only be "cured" through the establishment of an unrestricted free-market economy. The essence of the market economy is that each of us can acquire what others have only through voluntary acts of exchange. We must each apply ourselves in ways we hope will attract potential customers, persuading them to purchase what we are selling instead of what our rivals are offering. On the free market, the only moral and legal "weapon" permitted to "capture" customers is to offer better, more useful, and less expensive goods to the buying public. Violence and fraud are outside of the market's "rules of the game." . . . .

The government taxes the public and has huge sums of money to disburse to various programs and projects. It imposes licensing and regulatory restrictions on free and open competition. It transfers great amounts of income and wealth to different groups through sundry "redistributive" schemes. It controls how and for what purpose people may use and dispose of their own property. It paternalistically imposes legal standards influencing the ways we may live, learn, associate, and interact with others around us. Those in the government who wield these powers hold the fate of virtually everyone in their decision making hands. It is inevitable that those drawn to employment in the political arena often will see the potential for personal gain in how and for whose benefit or harm they apply their vast life-determining decrees and decisions. Some will be attracted to such public service "because they are motivated by ideological visions they dream of imposing for the good of humanity."

Some will see that bribing those holding this political power is the only means to attain their ends. . . . The business of the interventionist state, therefore, is the buying and selling of favors and privileges. It must lead to corruption, because by necessity it uses political power to harm some for the benefit of others, and those expecting to be either harmed or benefited will inevitably try to influence what those holding power do with it.

In addition, it should not be forgotten that such corruption slowly eats away at the moral fiber of the society. Austrian economist Ludwig von Mises explained this over 70 years ago in his Critique of Interventionism

Public opinion is not mistaken if it scents corruption everywhere in the interventionist state. . . .

By constantly violating criminal laws and moral decrees they [the bribers and the bribed] finally lose the ability to distinguish between right and wrong, good and bad. If finally few economic goods can be produced or sold without violating some regulation, it becomes an unfortunate accompaniment of "life" to sin against law and morality. . . . The merchant who began by violating foreign exchange controls, import and export restrictions, price ceilings, et cetera, easily proceeds to defraud his partner. The decay of business morals . . . is the inevitable concomitant of the regulations that were placed on trade and production. . . .

The interventionist state is a political garden that inevitably sprouts the weeds of bribery and corruption. And over time it tends to envelop and replace all traditional and ethical norms of conduct and morality. Ending global political corruption in its various "petty" and "grand" forms, therefore, will only come with the removal of government from social and economic life. When government is limited to protecting our lives and property, there will be little left to buy and sell politically. Corruption then will be an infrequent annoyance and occasional scandal, rather than an inescapable aspect of today's social and economic life around the world. To read the entire article, click on the current issue at http://www.fee.org or go directly to http://www.fee.org/~web/0105iolpdf/fromprez.pdf.

When so many laws (mandates) are passed that no one can observe all of them, then you have a nation of lawbreakers. You can then get conviction after conviction for total servitude. - Ayn Rand

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  1. How Government Destroys Medical Care

Steven Greenhut, author of Abuse of Power: How the Government Misuses Eminent Domain, and senior editorial writer and columnist for the Orange County Register in Santa Ana , California , reports in the current issue of The Freeman on specific examples of how government destroys our health care system. Greenhut discusses the six emergency rooms that have closed in the Los Angeles area in the past 14 months. He also states that hospital and health care officials predict a further 10 percent to 15 percent reduction in the county's emergency room capacity, with three large ERs at private hospitals thought to be at risk of closure. Since 1988, the number of emergency rooms in LA County has dwindled from 97 to 79 and trauma centers have fallen from 16 to 13, while LA County population has grown by more than one million. The portion of uninsured residents has climbed from 20 percent to 27 percent during the same period.

The Los Angeles Times reporter uses terms such as "doomsday," "meltdown," and "health care Chernobyl" to describe the situation as emergency-room patients increasingly must wait 16 hours or more for treatment, or four days or more to get a bed in a hospital.

Greenhut opines that often California is on the cutting edge of most every troubling trend, and Los Angeles County , the nation's most populous county, often leads the state over the brink. Why can we who live here only shake our heads and wonder why local officials and residents don't understand the obvious root causes of the crises du jour, and why residents of other states don't catch on before the crises comes to them.

Greenhut first determined this on a visit to the emergency room for a gallbladder attack. He was about to show his insurance card and was told to "Put that away. We are not allowed to look at payment information before treating you." Federal law is quite simple: No one may be turned away from a hospital, unless the hospital does not offer the specific services needed. He concludes: All the recent crises have the same cause: Government meddling in the market. To read the entire article, see http://www.fee.org.

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  1. It's Time for Fundamental Health Care Reform

David Gibson, MD, has recently written on Fundamental Health Care Reform in several journals. He feels that in order to do something about the dysfunctional health care system, we have to take aim at hospitals, insurance companies, drug firms and labor costs. A version of this article can be found at http://www.SSVMS.org. Click on the current issue and then his article. (Our Voices of Medicine is in the same table of contents.)

California cannot begin to solve its structural budget deficit problem without first addressing the fundamental issues of health care's structure and cost. For years we have been avoiding the need for a substantive policy debate by concentrating our attention upon how we should pay for the current system. Further debates over single payer vs. private health plans will not lead to a resolution of California 's structural budget deficit problem. The longer we delay in joining this debate, the more likely it will be that California 's budgeting process will continue to spiral out of control and will ultimately lead to the State's insolvency.

In 2004, Medicaid cost the states and the federal government more than $300 billion. This year, the program is projected to cost the federal government alone over $190 billion with the combined state and federal projected expenditure to be roughly double this number.

According to the National Assn. of State Budget Officers, spending on Medicaid grows by around 8 percent a year on average, while total state spending annually grows an average of 4.5 percent. This growth is outpacing state revenues and is now a larger component of total state spending than elementary and secondary education combined. This program alone is driving most of the states toward insolvency.

The public is becoming aware that these trends are not sustainable. As a result, we are now hearing calls from across the political spectrum for "fundamental" change in health care; but, before we begin discussing fundamental changes within the health care system, it would serve us well to examine what this change will involve.

We should begin this discussion by understanding that health care's cost structure is based upon an artificially constructed market foundation. What we now have in America is a pricing structure for health care that is based upon the best funded payer's ability to pay (the employer and the government) rather than what patients and their families can ever afford. This has produced inflationary trends that are completely independent of the market forces that discipline the rest of America 's economy.

We also have an acuity-based health care system that spends most of its resources in the last two weeks of life. In essence, we try to use medicine to defeat death. Of course, this does not work.

Both of the above realities define our current health care system and represent an irrational foundation for America to have used in building its current health care system.

To review the changes that must be made, and understand the painful solutions, go to http://healthplanusa.net/DGFundamentalHealthCareReform.htm.

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  1. This Week's Review of Corporate Socialized Medicine - Drug Costs

Georges Halpern, MD, PhD, sends a missive on the cost of drugs. "In our independent investigation of how much profit drug companies really make, we obtained the actual price of active ingredients used in some of the most popular drugs sold in America . The chart below speaks for itself." The first item, a common nonsteroidal anti-inflammatory drug (NSAID) is illustrative of the entire list. Celebrex 100 mg. Consumer price (100 tablets): $130.27. Cost of general active ingredients: $0.60. Percent markup: 21,712 percent. At the end of the report, it was asked whether or not there were any pharmacies that did not adhere to this practice. They found that Costco consistently charged little over their cost for the generic drugs. They then went to the Costco site, and found their price. It says that the in-store prices are consistent with the online prices. They were only one-third of most other pharmacies. The author stated that he was appalled. Thus the high costs of drugs may not be the pharmaceutical companies, but the pharmacies, themselves.

When the government and every insurance carrier and HMO manipulates the market by contracting for a product, no one will ever realize the dramatic effect that market forces have in lowering health care costs. As far as pharmacy costs are concerned, it appears that if the market had to compete with Costco, prices would be reduced by two-thirds, thereby lowering the cost of health care. Thus, the Medicare Pharmacy Benefit program or any HMO pharmacy plan could never compete with drug costs on the open market. The market is ruthless in reducing health care costs. In this instance, two-thirds of the cost would disappear instantly.

Government is not the solution to our problems, government is the problem.

Ronald Reagan

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  1. Medical Gluttony Will Precipitate The Realities of Medicare and Social Security

An accountant in his prime is working on his laptop computer as his wife sits nearby reading Gone With The Wind. He has all his income projections, IRS files, bank statements, mortgage ledger, 40lK and investment accounts around him as he announces to his wife: "Since Social Security won't be around in thirty years and Medicare will go bankrupt in 20 years when we'll start getting sick, I project if we take a late retirement and an early death, we may just squeak by." (After Smaller)

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  1. Medical Myth Nine: Americans Are Incapable of Making Medical Choices and Need Government to Supply Medicine

Madeleine Pelner Cosman, PhD, JD, Esq, in her upcoming book, Who Owns Your Body, gives Nine Myths of American Medicine. Today we conclude with Myth 9. For the previous eight myths, see http://www.healthplanusa.net/MC-WhoOwnsYourBodyIntro.htm.

This chapter offers immediately applicable, common sense solutions for Americans who will not meekly accept loss of their body ownership rights. Rational, feasible, legal methods for reasserting individual body ownership are open to all Americans rich or poor, young or old:

· Medical Savings Accounts (MSAs)

· Tax credits for employees for medical insurance

· Health Reimbursement Arrangements (new in June, 2002)

· Defined contribution plans not defined benefit plans

· Prescription Drug Security cards and pharmaceutical plans

· Flexible Spending Accounts

· Independent Physicians and Hospitals

· Boutique Medicine and Simple Care

· Internet Information and Care Systems

· Christian Life-Style Medical Care

· Charitable Health Insurance Trusts (CHITS)

These are among dozens of consumer-driven methods consistent with body-ownership, self-responsibility, innovative achievement, and other values of a free society.

MSAs, created in 1996 via HIPAA, are especially important. Though imperfect, MSAs empower medical consumers with individual choice and control over money. MSAs celebrate intelligence, initiative, industry, and bodily integrity. This chapter compares the many exciting new consumer-driven products and answers such questions as:

· What is an MSA?

· How much does an MSA cost?

· How does an MSA work?

· How do I qualify for an MSA?

· How do I pay for an MSA?

· What are financial, personal, and legal benefits of an MSA?

· What happens to my MSA money at the end of the year?

· Where do I find MSAs?

MSAs, like many other consumer-driven medical methods, diminish, almost extinguish, the eight severest intrusions upon patient freedoms imposed by medical laws governing managed care, health maintenance organizations (HMOs), and Medicare. Consumer-driven medicine:

· avoids criminalizing physicians and surgeons

· avoids qui tam whistle blower actions for False Claims

· avoids collectivizing patients

· avoids capitation

· avoids community rating

· avoids violation of confidentiality

· avoids third party definitions of medically necessary treatment

· avoids medical rationing by third parties

MSAs and other consumer-driven medical modalities are rational, logical, responsible, judicious celebrations of the intelligence, individuality, and common sense of Americans. MSAs and other consumer-driven medical modalities are important for all who cherish medical freedom. MSAs encourage individual patients'' medical prudence. Almost everyone benefits. Patients freely select their doctors and make reasoned decisions about their own care. Employers pay considerably less for MSAs plus catastrophic health insurance than for other health plans. With consumer-driven health care everyone wins except social engineers who protect people against personal freedom, who control quality and quantity of medical care, and who redefine as medically necessary whatever their arrogance demands.

Who Owns Your Body? America's 9 Deadly Medical Myths refutes customary arguments against MSAs and free-market, consumer-driven medical care such as:

· only the healthy and wealthy benefit from consumer-driven medical care

· the retired cannot benefit from consumer-driven medical care

· consumer-driven medical care cannot help the millions of uninsured

MSAs and other free-market, consumer-driven medical programs will expand medical excellence, physical integrity, and responsible body ownership for all Americans.

Criminalizing physicians, collectivizing patients, and medicalizing select social dilemmas all result from the paradigm shift beginning in 1965, placing government and other third-parties at the center of medical responsibility. Perhaps well-intentioned and perhaps compassionate, the shift from individual to government control has had vicious consequences. Costs erupted, care decayed, choice evaporated, and physicians and surgeons have been exploited and brutalized.

Consumer-driven medicine will provide the necessary paradigm shift to place the individual American at the center of decision-making. Whoever pays, controls. Whoever pays, decides what shall be done or not done to the body luxuriating in vigorous health or debilitated by injury or disease. If that body is your body, do you prefer to assert the same ownership control for your anatomy as for your car and your house? Who decides what for whom?

Americans merit the best medicine of a free society. They have the courage, the intelligence, and the rights to buy it. Who Owns Your Body? America's 9 Deadly Medical Myths reveals deceptions and misconceptions in modern American medicine and charts the path to medical abundance, medical integrity, and medical excellence.

(TRUTH 9: Americans Will Thrive on Medical Savings Accounts and Free-Market, Patient-Driven Medicine.)

* * * * *

  1. Medical Ethics: Hollywood Doesn't Get It Right with Million Dollar Baby

James J Murtagh, M.D, Pulmonologist and writer, from Atlanta , Georgia , says "When they open the envelope for Best Picture at the Oscars next week, I'll be rooting hard for Million Dollar Baby - the dazzling new Clint Eastwood film about a woman left paralyzed after sustaining a neck injury during a boxing match. Because I like the movie so much, it's no fun to report that both the film and its critics have made a major mistake: they forgot that it's illegal for doctors to treat alert, rational patients against their will. Somehow, the film distorts the medical aspects of end-of-life decision-making almost beyond recognition."

Indeed, the movie's depiction of Hilary Swank's character (the Baby) as paralyzed on a ventilator and begging a friend to "pull the plug"- by sneaking into the hospital, turning off her respirator and giving her a shot of adrenaline - completely ignores the reality of routine medical ethics. Where was the patient's doctor? That doctor had a moral, legal and religious duty to honor the patient's wishes!

No one has to guess what Swank wants. She's not unconscious, she's not a vegetable, she's not depressed. She's depicted as completely rational. Which means that her wishes must be obeyed. As a matter of fact, failing to honor a patient's instructions for these end-of-life procedures is actually illegal - and theoretically could result in criminal prosecution of any doctor who insisted on keeping a patient alive artificially against the patient's will.

Unfortunately, the medical premise of Million Dollar Baby is dead wrong, because Baby could have refused the ventilator without a quibble, merely by asking. Since the famous Karen Quinlan case 30 years ago, U.S. doctors have been totally prohibited from insisting on unwanted therapy against a patient's wishes.

Pope Pius XII, himself, understood as much in 1952, when he condemned "extraordinary means" to maintain life against the will of patients. The major religions are in agreement. I have worked with chaplains and rabbis of all faiths to help patients make these decisions - and most of the priests I work with have written advanced directives to ensure they are never placed on a ventilator against their will.

Gray areas do arise when a patient is unconscious, however. Difficult ethical cases come up all the time. But a rational, talking patient could have refused the ventilator, the IV fluids, medicines, surgery - or a dozen other treatments needed to stay alive. Is the film really suggesting the doctors took the patient to surgery to remove a leg, in order to save her life without her consent? Had Baby refused the operation, she would have died from infection, and she would have spared the Eastwood character his torment, and her own attempt to end her life by biting her tongue.

Apparently unaware of this medical reality, the creators of Baby came up with a thoroughly Orwellian and barbaric plot twist in order to solve a non-existent problem - by having Eastwood sneak into Baby's hospital room to pull the plug.

But if the movie's depiction of a typical ventilator scenario was absurdly unrealistic, the talk-show and op-ed page debates that have followed it seem even more ludicrous. While conservatives Rush Limbaugh and Michael Medved huff and puff about "the sacred right to preserve life" and disability activists protest the depiction of Baby, nobody seems to have grasped a key fact: This is a total non-issue in American hospitals today!

To read Dr Murtagh's profile, go to http://www.healthcarecom.net/PhysicianProfiles.htm. From his page, you can read the entire movie review before the Oscars next week.

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  1. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HeathCare and Government

* * * * *

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same

The MedicalTuesday site has now been automated. Each individual on our mailing list and those that have been forwarded to us are now able to invite, register, or de-enroll as desired. You may want to copy this message to your Template file so that they are available to be forwarded or reformatted as new when the occasion arises. Then, save the message to a folder in your Inbox labeled MedicalTuesday. If you have difficulty de-enrolling, please send an email to Admin@MedicalTuesday.net with your "Remove" and "Email address" in the subject line.

Read the latest medical news of the day at http://www.healthplanusa.net/MedicalNews.htm which will also lead you to the headlines for the past month.

If you would like to participate in this informational campaign on behalf of your patients or the HeathCare community, please send your resume to Personnel@MedicalTuesday.net.

If you would like to participate in the development of the affordable HealthPlan for All Americans, please send your resume to Personnel@HealthPlanUSA.net.

Del Meyer

Del Meyer, MD, CEO & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6620 Coyle Avenue, Ste 122 , Carmichael , CA 95608

Words of Wisdom

Here's to Honest Abe and George. The last two presidents who could not tell a lie!

George Washington: Friendship is a plant of slow growth and must undergo and withstand the shocks of adversity before it is entitled to the appellation.

Abraham Lincoln: "As I would not be a slave, so I would not be a master. "

George Washington: Few people have the virtue to withstand the highest bidder.

Abraham Lincoln: "Those who deny freedom to others, deserve it not for themselves; and, under a just God, cannot long retain it."

George Washington: Government is not reason; it is not eloquent; it is force. Like fire, it is a dangerous servant and a fearful master.

Review some recent postings below.

Dr Muhammad Yunus, Global Health Care. A moving story of patient directed health care in Bangladesh . Please read Dr Yunus speech given at the World Health Care Congress last month at http://healthplanusa.net/GrameenBank.htm.

David Gibson, MD, Fundamental Health Care Reform. California cannot begin to solve its structural budget deficit problem without first addressing the fundamental issues of health care's structure and cost. Read the entire OpEd article at http://healthplanusa.net/DGFundamentalHealthCareReform.htm.

Voices of Medicine: To read a review of the first issue of Sacramento Medicine in 1950 go to http://www.ssvms.org/articles/0403vom.asp, remembering that the first 132 years are no longer available. To read last year's series of my column, the "Voices of Medicine," go to http://healthcarecom.net/vom2004.htm.

Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn't anything left for them, are we going to tell them we didn't fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it's all right because we got a piece of the pie? Read Dr Clark at http://www.healthcarecom.net/CBCPieceofPie.htm. Read his most recent posting, Feeding the Monster, at http://www.healthcarecom.net/CBCFeedingMonster.htm.

Ada P Kahn, PhD: Foreword to “Encyclopedia of Work-Related Injuries, Illnesses and Health Issues”. Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we've posted at http://www.delmeyer.net/MedInfo2004.htm. To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.

Henry Chang, MD: WEIGHT LOST FOREVER - The Five Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does, how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for "Best Health Book of the Year." Read our review at http://www.healthcarecom.net/bkrev_WeightLostForever.htm.

Tammy Bruce: The Death of Right and Wrong (Understanding the difference between the right and the left on our culture and values.) http://www.townhall.com/bookclub/bruce.html. Reviewed by Courtney Rosenbladt

An Alzheimer's Story: To read a touching story by a nurse about her Alzheimer's patient, go to http://www.delmeyer.net/MedInfo2003.htm.

An Entrepreneur's Story: AriadneCapital (http://www.AriadneCapital.com) provided the initial funding for MedicalTuesday and the Global Trademarking. Julie Meyer, the CEO, has a clear vision in her mind of the world that she wants to live in, and it's considerably different from how it looks now. If you're an entrepreneurial woman, or if you lost hope or are having difficulty envisioning success, (if you'll forgive a little nepotism), the following article may be of interest to you: http://observer.guardian.co.uk/business/story/0,6903,1237363,00.html.

On This Date in History - February 22

On this date in 1732, George Washington, the first president of the United States was born. He was really born on February 11, since he was born when the country was still on the old calendar. When we adopted the Gregorian calendar, which added 11 days, Washington eventually changed his birth date to February 22. In his day, one could not take a plane, or a truck, or a railroad train. But it seemed to be a time of much more hope for free men. Perhaps we should ask ourselves, why?

One this date in 1630, native American Indians introduced the Pilgrims to popcorn. This was part of a collection of folkways and family recipes that, put together, made up the American way of life. It seems that things have been popping every since.

 

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