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MEDICAL
TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol VI, No 22, Feb 26, 2007 |
In This Issue:
1.
Featured Article:
Not Tonight Dear, I Have to Reboot
2.
In the News: Blue
Cross Seeking Information that Could Lead to Policy Cancellations
3.
International Medicine: Hospital
Waiting Lists in Canada
4.
Medicare: Medicare
Cuts Are Still Increases in Spending
5.
Medical Gluttony:
Hospital Emergency Departments
6.
Medical Myths:
Socialized Medicine Improves Quality
7.
Overheard in the
Medical Staff Lounge: A Hypothetical Medical Ethics Issue
8.
Voices of Medicine: Third-Party Payment
Is the Main Problem Facing U.S. Health Care
9.
Physician Patient
Bookshelf: The Thing About Life Is That One Day You'll Be Dead
10.
Hippocrates &
His Kin: The World We Live In
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MOVIE EXPLAINING SOCIALIZED MEDICINE
TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements is the former publisher of
"American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.
* * * * *
1. Featured Article: Not Tonight, Dear, I Have to Reboot
Is love and marriage with robots an institute you can
disparage? Computing pioneer David Levy doesn't think so - he expects people
to wed droids by midcentury. Is that a good thing?
BY CHARLES Q. CHOI, © 2008 SCIENTIFIC AMERICAN, INC.
At the Museum of Sex in New York City,
artificial-intelligence researcher David Levy projected a mock image on a
screen of a smiling bride in a wedding dress holding hands with a short robot
groom. "Why not marry a robot? Look at this happy couple," he said to
a chuckling crowd.
When Levy was then asked whether anyone who would want
to marry a robot was deluded, his face grew serious. "If the alternative
is that you are lonely and sad and miserable, is it not better to find a robot
that claims to love you and acts like it loves you?" Levy responded.
"Does it really matter, if you're a happier person?" In his 2007
book, Love and Sex with Robots, Levy contends that sex, love and even
marriage between humans and robots are coming soon and, perhaps, are even
desirable. "I know some people think the idea is totally outlandish,"
he says. "But I am totally convinced it's inevitable." To read more, please go to www.medicaltuesday.net/index.asp.
The 62-year-old London native has not reached this
conclusion on a whim. Levy's academic love affair with computing began in his
last year of university, during the vacuum-tube era. That is when he broadened
his horizons beyond his passion for chess. "Back then people wrote chess
programs to simulate human thought processes," he recalls. He later became
engrossed in writing programs to carry on intelligent conversations with
people, and then he explored the way humans interact with computers, a topic
for which he earned his doctorate last year from the University of Maastricht
in the Netherlands. (Levy was sidetracked from a Ph.D. when he became an
international master at chess, which led him to play around the world and to
found several computer and chess organizations and businesses.)
Over the decades, Levy notes, interactions between
humans and robots have become increasingly personal. Whereas robots initially found
work, say, building cars in a factory, they have now moved into the home in the
form of Roomba the robotic vacuum cleaner and digital pets such as Tamagotchis
and the Sony Aibo.
And the machines can adopt a decidedly humanoid look:
the robot Repliee from Hiroshi Ishiguro, director of Osaka Universitys
Intelligent Robotics Laboratory, can fool people into believing that it is a
real person for about 10 seconds from a few feet away. And "it's just a
matter of time before someone takes parts from a vibrator, puts it into a doll,
and maybe adds some basic speech electronics, and then you'll have a fairly
primitive sex robot," Levy remarks.
Science-fiction fans have witnessed plenty of action
between humans and characters portraying artificial life-forms, such as with
Data from the Star Trek franchise or the Cylons from the reimagined Battlestar
Galactica. And Levy is betting that a lot of people will fall in love with
such devices. Programmers can tailor
the machines to match a person's interests or render them somewhat disagreeable
to create a desirable level of friction in a relationship. "It's not that
people will fall in love with an algorithm but that people will fall in love
with a convincing simulation of a human being, and convincing simulations can
have a remarkable effect on people," he says.
Indeed, a 2007 study from the University of
California, San Diego, found that toddlers grew to accept a two-foot-tall
humanoid robot named QRIO after it responded to the children who touched it. Eventually
the kids considered QRIO as a near equal, even covering it with a blanket and
telling it "night night" when its batteries ran out. "People who
grow up with all sorts of electronic gizmos will find android robots to be
fairly normal as friends, partners, lovers," Levy speculates. He also
cites 2005 research from Stanford University that showed people grew to like
and trust computer personalities that cared about their wins and losses in
blackjack and were generally supportive, much as they would respond to being
cared about by other people. . .
Based on what researchers know about how humans fall
in love, human-robot connections may not be all that surprising. Rutgers University biological anthropologist
Helen Fisher, renowned for her studies on romantic love, suggests that love
seems dependent on three key components: sex, romance and deep attachments.
These components, she remarks, "can be triggered by all kinds of things.
One can trigger the sex drive just by reading a book or seeing a movie - it
doesn't have to be triggered by a human being. You can feel a deep attachment
to your land, your house, an idea, a desk, alcohol or whatever, so it seems
logical that you can feel deeply attached to a robot. And when it comes to
romantic love, you can fall madly in love with someone who doesn't know you
exist. It shows how much we want to
love." . . .
Both Fisher and Turkle find the idea of legal
human-robot marriages ridiculous. . . it was only in the second half of the 20th
century that you had the U.S. federal government repealing laws in about 12
states that said marriage across racial boundaries was illegal. That's how much
the nature of marriage has changed."
As to what Levy's wife thinks, he laughs: "She
was totally skeptical of the idea that humans would fall in love with robots.
She's still fairly skeptical." A reasonable reaction - then again, a
Stepford wife with contrariness programmed into her would say that, too.
Charles Q.
Choi is a frequent contributor.
To read the article, got to
www.sciam.com/article.cfm?id=humans-marrying-robots.
To see the Navy shoot the
satellite slide show, go to www.scientificamerican.com/.
A Q&A version of his interview with Levy
is at www.SciAm.com/ontheweb.
* * * * *
2.
In the News: Physicians object to a letter from Blue Cross seeking
information that could lead to policy cancellations. By Lisa Girion, Los Angeles Times Staff Writer, February 12, 2008
The state's largest
for-profit health insurer is asking California physicians to look for
conditions it can use to cancel their new patients' medical coverage.
Blue Cross of California is sending physicians copies of health insurance
applications filled out by new patients, along with a letter advising them that
the company has a right to drop members who fail to disclose "material
medical history," including "pre-existing pregnancies."
Any condition not listed
on the application that is discovered to be pre-existing should be reported to
Blue Cross immediately," the letters say. The Times obtained a copy of a
letter that was aimed at physicians in large medical groups. . . To read
more, including the Blue Cross letter, go to www.medicaltuesday.net/news.asp..
The letter wasn't going down well with physicians.
"We're outraged that they are asking doctors to violate the sacred trust
of patients to rat them out for medical information that patients would expect
their doctors to handle with the utmost secrecy and confidentiality," said
Dr. Richard Frankenstein, president of the California Medical Assn.
Patients "will stop telling their doctors anything they think might be a
problem for their insurance and they don't think matters for their current
health situation," he said. "But they didn't go to medical school,
and there are all kinds of obscure things that could be very helpful to a
doctor."
WellPoint Inc., the Indianapolis-based company that operates Blue Cross of
California, said Monday that it was sending out the letters in an effort to
hold down costs. . . .
Blue Cross is one of
several California insurers that have come under fire for issuing policies
without checking applications and then canceling coverage after individuals
incur major medical costs. The practice of canceling coverage, known in the
industry as rescission, is under scrutiny by state regulators, lawmakers and
the courts. . . .
Physician groups and
doctors who received the letter told The Times they never had seen anything
like it. Also unfamiliar with such letters was Don Crane, executive director of
the California Assn. of Physician Groups, which represents many of the large
HMO-style medical groups.
"I have not heard any dialogue on this business of underwriting or
ferreting out existing" conditions, Crane said.
But WellPoint's Troughton said this was nothing new. "This is something
that has been in place for several years and to date we have not received any
calls or letters of concern for this service," she said.
It was important, Troughton added, "to note that participation in this
outreach effort is voluntary on the part of the physicians."
The California Medical Assn. sent a letter to state regulators Friday urging
them to order Blue Cross to stop asking doctors for the patient information,
saying it was "deeply disturbing, unlawful, and interferes with the
physician-patient relationship." . . .
Lynne Randolph, a spokeswoman
for the state Department of Managed Health Care, said the agency would review
the letter. Blue Cross is fighting a $1-million fine the department imposed in
March over alleged systemic problems the agency identified in the way the
company rescinds coverage.
A spokesman for state Insurance Commissioner Steve Poizner said the Insurance
Department had not received any complaints about Blue Cross' letter. But
because the medical association had sent a copy of its complaint to the
department, the letter is "on our radar now," spokesman Byron Tucker
said.
The letter is "extremely troubling on several fronts," Tucker said.
"It really obliterates the line between underwriting and medical care. It
is the insurer's job to underwrite their policies, not the doctors'. Doctors
deliver medical care. Their job is not to underwrite policies for
insurers."
Anthony Wright, executive director of HealthAccess California, a healthcare
advocacy organization, said the letter had put physicians in the
"disturbing" position of having to weigh their patients' interests
against a directive from the company that, in many cases, pays most of their
bills.
"They are playing a game of gotcha' where they are trying to use their
doctors against their patients' health interests," Wright said.
"That's about as ugly as it gets."
To read the
whole story, go to www.latimes.com/business/la-fi-bluecross12feb12,0,4319662.story.
To read a copy
of the letter, continue below:
BLUE
CROSS of CALIFORNIA
Attention:
Utilization Review Management
PMG/PCP #:
RE: Individual Policy Applications
Dear Provider:
Enclosed is a copy of an individual policy member's application
for your records. This member was recently assigned to your PMG/IPA. Please
retain this copy as part of his/her medical records.
The purpose of providing you with this copy is to help
you identify members who have failed to disclose medical conditions on their
application that may be considered pre-existing. Personal Blue Cross HMO
policies do not have waivers or waiting periods for maternity care. Any
condition not listed on the applications that is discovered to be pre-existing
should be reported to Blue Cross immediately.
We ask for your assistance to help identify medical
omissions because you, being the primary care provider, will have first-hand
knowledge of services provided and/or requested. Within the first 2 years of
membership, Blue Cross has the right to cancel the member's policy back to the
effective date for failure to disclose material medical history.
The attached Specialty Review Request Form should be
completed and either mailed or faxed to Blue Cross at the address/fax number provided
on the form.
Health history discrepancies are commonly identified
using the following sources:
1) Health
history questionnaire complete at the member's initial visit to the medical
group.
2) Pre-existing pregnancies. Identified
when the last menstrual period date is prior to the agreement's original
effective date.
3) Elective and emergency surgeries
perform within the first year of the original agreement effective date.
4) Member
requests for specialty referrals outside the medical group to providers
who previously provide care.
5) Member requests for specialty referrals
within the medical group for chronic conditions.
6) Claims from outside providers
requesting payment.
7) First year hospitalizations.
Blue Cross of California appreciates your support and
commitment to working with us as collaborative partners. If you have any
questions, please feel free to call our Customer Service Department at 1 (800)
333-0912.
Sincerely,
Individual Services
Department
Our copy of the letter was not
digitized. We apologize for any errors in transcription and logo.
* * * * *
3. International Medicine: WAITING YOUR
TURN, 2007, Seventeenth Edition of Critical Issues Bulletin, Hospital Waiting
Lists In Canada, by Nadeem Esmail and Michael Walker
Executive Summary
The Fraser
Institute's seventeenth annual waiting list survey found that Canada-wide
waiting times for surgical and other therapeutic treatments increased slightly
in 2007. Total waiting time between referral from a general practitioner and
treatment,
averaged across all 12 specialties and 10 provinces surveyed, increased from
17.8 weeks in 2006 to 18.3 weeks in 2007. This small nationwide deterioration
in access reflects waiting-time increases in 6 provinces, while concealing
decreases in waiting
time in British Columbia, Saskatchewan, New Brunswick and Prince Edward Island.
To
read more, please go to www.medicaltuesday.net/intlnews.asp.
Among the
provinces, Ontario achieved the shortest total
wait in 2007, 15.0 weeks, with British Columbia (19.0 weeks), and Quebec (19.4
weeks) next shortest. Saskatchewan exhibited the longest total wait, 27.2
weeks; the next longest waits were found in New Brunswick (25.2 Weeks) and Nova
Scotia (24.8 weeks).
www.fraserinstitute.org/commerce.web/publication_details.aspx?pubID=4962
To download the entire report, go to www.fraserinstitute.org/COMMERCE.WEB/product_files/wyt2007rev2.pdf.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court
Decision 2005 SCC 35, [2005] 1 S.C.R. 791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4.
Medicare:
Medicare Cuts Are Still Increases in Spending by Grace-Marie
Turner
All of the attention over President Bush's health care
proposals this week has focused on his proposed "cuts" in Medicare
spending. But what the media defines as cuts are in fact reductions in the increase
in spending. Medicare spending would still grow by 5%, which is faster than
inflation but slower than the projections that are rapidly propelling the
program toward insolvency.
"Americans must wake up to the fact that Medicare
outlays constitute an 'emergency' that must be acted upon," Health and
Human Services Secretary Michael Leavitt said in defending the administration's
proposal to lower Medicare spending by $183 billion over five years. To read more, please go to www.medicaltuesday.net/medicare.asp.
We have to start somewhere, and the consternation over
slowing spending increases shows how incredibly difficult that is.
What's not getting a lot of attention is the president's proposal for a dramatic
modernization of the tax treatment of health insurance, first introduced in
last year's budget. Mr. Bush again proposes exchanging the current tax
exclusion for employment-based health insurance for a direct deduction. While
it is failing to get any traction in Congress, the idea has been incorporated
into the health reform proposals of the major Republican presidential
candidates and will get a hearing in the public domain this year.
And the president also is proposing six changes to make Health Savings Accounts more flexible and
give individuals and employers more options in structuring coverage:
·
Health plans with 50%
coinsurance would qualify as a high-deductible health plan and would be
HSA-eligible.
·
People would have more time
to set up their HSAs since funds could be used to pay for medical expenses
incurred on or after the first day of HSA eligibility in a year, even if the
account hasn't actually been set up yet.
·
Employers would be able
to make larger HSA contributions for employees with chronic illnesses.
·
Deductibles would be
adjusted to make them more family-friendly.
·
If both spouses are
eligible as individuals for HSAs, they both could make catch-up contributions
to one of their HSAs.
·
Employees would be able
to contribute to an HSA, even if they are covered by a Health Reimbursement
Arrangement and Flexible Spending Account.
All of these proposals are responding to requests to
make HSAs more attractive to employers and individuals. The administration's Fiscal 2009 Budget outlines these proposals and rationale on pages
19-26.
Grace-Marie Turner is President of the Galen
Institute. To read more, go to
www.galen.org/component,8/action,show_content/id,14/category_id,0/blog_id,1018/type,33/.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Hospital Emergency Departments
A MedicalTuesday reader responded to a recent article in
this section and related she had pointed out to the ancillary staff at her ER
that she knew of many instances of chest pain, which in reality were heart
burns, but the admitting clerk signed them in as chest pain. As a ward
secretary, she stated that the hospital had informed her that this mechanism
has a higher reimbursement rate from Medicare, Medicaid, and most HMOs. She
stated she routinely sees the final bill for $9,000, when indeed it was only a
case of heart burns and the treatment in our last newsletter costs less than
one dollar. That was all that was required. This reader further mentions that
she's seen where a patient only needed to be catheterized to relieve a
distended bladder, but a CXR, ECG and a number of lab tests were routinely
done. Otherwise, the hospital would not have a sufficient revenue stream to
support their large expansions. To read more,
please go www.medicaltuesday.net/gluttony.asp.
Did she think the ER doctors were part of this scheme
to milk the system? She had overheard some of them speak from the dictation
area that they were over ordering tests but felt they had to do this or the
hospital would not renew their contract. But they felt they were ordering less
than the hospital desired.
One Independent Practice Association has suggested
that its doctors use terms such as "Chest Pain" if at all possible
for the reason that the IPA will be reimbursed by the HMO at a higher rate,
thus increasing the revenue.
Does a cost of $9,000 allow you to sleep at night when
one dollar would do?
The power establishments make it all the more
important that we maintain an independent physician profession. It is just as
important as an independent judicial system with long-term appointments for
high-ranking judges. When physicians are beholding to Government, HMOs and
Hospitals, objectivity and costs go out of the window. It is difficult to
determine if practicing medicine as taught in medical school and residency
programs could have professional adverse repercussions. Neither is in the best
interest of the patients. In this election year, we must be ever mindful of how
a single-payer system would enslave our profession and thereby enslave the
citizenry.
There are always clues to help us avoid voting for
such. Someone who has tried this on a national scale in the last decade, or her
opponent who has promised to do so if he is elected, should not be elected. Any
governor who has implemented such a program as in the state of Massachusetts, or
attempted to do so as in the state of California, can never and should never
again be trusted.
* * * * *
6.
Medical Myths:
Socialized Medicine Improves Quality
Health Alert: Does Non-price Rationing or Socialism Work? By John GoodmanI am probably one of the few people you interact with who has a real interest in understanding nonprice rationing of health care. In fact, I may be the only such person.By "real interest" I mean a desire to understand nonmarket processes the same way economists understand markets - which means, to be able to explain the past and predict the future. Most of what has been written about nonprice rationing of health care is descriptive, not analytical. In fact, I don't believe anyone has developed a real theory about it.What makes this so amazing is that almost nowhere in the developed world is health care really rationed by price.To read more, please go towww.medicaltuesday.net/myths.asp.
Here are five principles about nonmarket (socialist) systems that I offer without proof.Principle No. 1: Where excellence exists in socialist systems, it tends to be distributed randomly.When the NCPA studied public education in Texas, we found excellent teachers, excellent campuses and excellent school districts. But excellence was not correlated with spending, class size or any other objective variable. I found the same pattern in socialist health care systems. A hospital might have a modern laboratory side-by-side with an antiquated radiology department. A team of top cardiac surgeons might be practicing in the same hospital with mediocre physicians in other specialties. Since there is no financial reward for excellence and no financial penalty for mediocrity, excellence tends to be the result of the enthusiasm, energy and leadership of a few people scattered here and there.Principle No. 2: Access to excellence is not random.Even though socialist systems are supposed to treat everyone alike, they rarely do. Higher income people get more services and better services - usually in absolute terms, and certainly relative to their needs.Have you ever heard of children of high-income parents attending a really rotten public school? I haven't either. Yet the children of poor parents routinely end up in bad schools. The same pattern emerges in health care. Those senior citizens who cash the largest Social Security checks are the ones who spend the most Medicare dollars - even though health needs are inversely correlated with income. (More about this in a future Alert.)You can even make an argument that in Britain, New Zealand and Canada socialized medicine has led to more inequality in health care than would have existed otherwise.Principle No. 3: The skills that allow people to be successful in a market system are the same skills that make them successful in a non-market system. Granted, the skill sets do not perfectly overlap; but they are more similar than most people realize. Think of life as posing a series of puzzles. In a market economy, you have to figure out how to earn a high income in order to enjoy high consumption. In a socialist system, you have to figure out how to overcome bureaucratic obstacles to achieve the same outcome.Principle No. 4: Diverse people tend to make triage decisions in the same way.In a typical socialist health care system, rationing decisions are often made by doctors. Suppose you were one of them: If you had to choose between a young patient and a retiree, whose life would you save? If you had to choose between a highly productive patient and one who is unproductive, whose life would you save?If your choice is young over old and productive over nonproductive, you are like most other people.Here is the Goodman theory of triage: If you instructed doctors to make rationing decisions based only on the goal of maximizing GDP, their decisions would be very similar to the decisions they are making today.Principle No. 5: People at the bottom of the income ladder almost always do better in a market system.If a doctor charges $120 an hour in a market-based health care system, all you have to do is come up with $120 (less than what smokers spend on cigarettes every month) to buy an hour of her time. For $60, you can have half an hour. For $30, you can have 15 minutes.It doesn't matter who you know. Or what you know. Or whether you can even speak English. But in Canada, where these other things matter a great deal, it is against the law to pay a doctor for her time!Do the poor benefit from non-market redistribution? Maybe. But they would benefit tenfold more if they gained control of the dollars and could spend them in a real health care marketplace.Cheers
John Goodman, President
National Center for Policy Analysis, 12770 Coit Rd., Suite 800, Dallas, Texas 75251 www.ncpa.org
Government Medicine like Government Schools reduces quality and equality.
* * * * *
7.
Overheard in the Medical
Staff Lounge: A Hypothetical Medical Ethics Issue
Professor Gilbert Meilaender, who holds the Duesenberg
Chair in Christian Ethics at Valparaiso University, writes a column on Medical
Ethics in First Things. Here is an excerpt from his archives.
Is donating your own heart while you're healthy a
staff or ethics issue?
On some occasions organs are given by living
donors, but this can be permitted only within clear limits. Years ago Paul
Ramsey called attention to one of those limits, recounting the following
fictitious case study:
Many months ago the fifteen-year-old son of Mr. Roger
Johnson was admitted to a Houston, Texas hospital for tests to determine the
cause of his generally debilitated condition. Use of the latest available
diagnostic techniques and equipment eventually led to the conclusion that the
lad was suffering from a progressively deteriorating congenital condition of
the valves of the heart. The prognosis communicated to the distraught Mr.
Johnson was that his son could not live past the age of twenty, and that there
was no known treatment for the malady with which he was afflicted.
At first Mr. Johnson tried to resign himself to his
son's plight. Then he began to brood and think of the pleasures and joys of
adult life which he, at the age of forty-two, had already known, but which his
son would never know. The more he thought of this, the less willing he became
passively to accept the doctors' verdict. Finally he thought of a means by
which his son's life might be spared. To read
more, please go to www.medicaltuesday.net/lounge.asp..
His plan, which he communicated to a physician friend,
was an uncomplicated one. In light of the success of recent heart transplant
operations with unrelated donors and donees, he reasoned, there must be a high
probability that a transplant of the heart of a genetic relative would be
successful. Accordingly, he would simply donate his own heart to his son. He
had lived a full life, he said, and he could leave his son well provided for
financially. His wife had died several years earlier, so that complication was
not present. His own parents had no rightful claim to his continued life. He
asked his friend's aid in finding a physician who would perform the operation.
Not without considerable misgivings, his friend complied, eventually finding a
heart surgeon eager to attempt the transplant of a heart from a healthy and
related donor not in extremis at the time of the operation.
In the course of preparation for the transplant,
elaborate precaution was taken to ensure that the son would not know the real
nature of the proposed operation. He was told simply that a transplant
operation on his heart was to be attempted in the hope of prolonging his life,
and he agreed to try it with full knowledge that death could certainly result
if the try were unsuccessful. In reality, of course, it was contemplated that
Mr. Johnson's heart would be removed from his chest while he was under general
anaesthesia and that it would be transplanted in the chest cavity of his son.
When the date of the scheduled operation arrived, the
father went to the son's room, affectionately wished him good luck, and
returned to his own room to be prepared for his own operation. He was eventually
placed under general anaesthesia, and taken to a special operating room to
await the transfer of his heart to an oxygenating and circulating
"heart-lung" machine.
He is in the operating room now, and the surgeon is
scrubbing. You are chief of staff in the hospital in which the operation is to
take place. You had no prior knowledge of the operation, but this is frequently
so. A worried nurse has brought you word of the planned operation on this
occasion. You have power to stop the operation. Should you do it?
To read Dr. Meilaender's ethical response to these
issues as seen from a 1996 perspective, please go to www.firstthings.com/article.php3?id_article=3852&var_recherche=meilaender+%2B+body+parts.
To read other medical ethics articles, please go to www.firstthings.com/search.php?recherche=meilaender&search_type_ft=ft&search_type_blog=blog&x=9&y=3.
Next month, we'll bring you Dr. Meilaender's latest
installment.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals and the Press
Third-Party
Payment Is the Main Problem Facing U.S. Health Care by Robert S. Berry, M.D.
Published by: The Heartland Institute; Published in: Health Care News
In September, the ABC TV program 20/20 ran an
hour-long special on health care.
One of its producers contacted me last spring after
finding my congressional testimony on "consumer-directed doctoring"
to ask if I would participate by refuting Sicko, Michael Moore's movie
promoting a government takeover of health care.
Sharing 20/20 host John Stossel's passion for
individual freedom along with his deep-seated distrust of government power, I
agreed to the interview. I applaud Stossel for making a topic as complex as
health understandable and even entertaining.
If nothing else, he succeeded in demonstrating that a
government-run system would be worse than what we have now. With unforgettable
stories and images, he showed the delays in care and lack of choice in countries
with universal health insurance. To read more,
please go to www.medicaltuesday.net/voicesofmedicine.asp.
Insurance Portability
The program showed Hillary Rodham Clinton among a cheering
crowd campaigning for "universal health care for every single man, woman,
and child." The only thing universal about health care in countries such
as Britain and Canada is that it's in short supply and requires long waits.
Stossel didn't ignore the American health care
system's flaws--high costs, 45 million uninsured, people locked into jobs for
fear of losing their insurance. One North Carolina woman switched careers,
developed breast cancer that was treated into remission, and then lost her temporary
insurance. She tearfully wondered whether our system will abandon her now that
she has no health insurance.
Stossel could have boosted his argument for consumer
choice in health care if he had driven home the following point: Had the breast
cancer patient owned her insurance policy, she would not have lost it after
switching jobs.
Ideological Concerns
Stossel deserves credit for interviewing her. Moore
was not as fair or honest in Sicko. The truth, however, is that neither
has the answer for people confronting such tragedies. With a history of breast
cancer, the "free market" quoted the woman annual premiums of
$27,000, which she could not afford on an annual income of $60,000.
But in countries with universal health insurance, her
cancer most likely would have spread beyond cure while she waited for
treatment. She would have been unable to obtain the timely medical care she
needed at any price.
In the real world, real people fall through the cracks
of every health care system.
That's why I helped start PATMOS EmergiClinic in Greeneville, Tennessee seven years
ago. Without presuming upon other taxpayers through nonprofit incorporation or
direct government grants, the practice has grown to nearly 8,000 patients with
about 60 percent uninsured, despite the presence of three state-subsidized
clinics in Greene County.
Price Transparency
But how can consumers exchange their money for medical
services when they don't know the prices? Since day one, PATMOS has posted its prices--at the clinic, on our Web
site, and at one time, on billboards on a nearby highway. To my knowledge, no
other practice in this area publicizes its prices. Nor do our hospitals, even
though as nonprofits they are tax-exempt.
When prices are publicly available and people are free
to choose without government coercion or privilege, competition forces
producers to be accountable for the prices they charge and the quality they
provide. This--the free market--ensures value for consumers and fairness and
honesty in the exchange.
The reason PATMOS is able to offer services at relatively low prices is
that it does not accept insurance, and thus avoids the cost of settling
thousands of small medical claims each year. Most other health care providers
in this country don't make their prices available to the public because the
vast majority of Americans don't pay directly for medical care--even routine
care. Their insurance does.
Saving Money
Insurance not only obscures prices but also increases
costs. The annual overhead at PATMOS is about $200,000 less than that of the
average family physician who accepts insurance, according to data compiled by
the Medical Group Management Association. PATMOS has about 5,000 patient visits
per year, so the cost savings are about $40 per visit--which is nearly the
price of a PATMOS visit.
PATMOS has saved the uninsured and patients with high
deductibles more than $5 million since its inception nearly seven years ago
when compared with what they would have paid at local emergency rooms for
similar services. The free market saves consumers money.
If all 300,000 or so primary care physicians in this
country settled accounts directly with their patients, it would create annual
savings of about $60 billion. That's more than one-sixth of the approximately
$350 billion paid to physicians and their medical practices each year.
Other costs would be reduced as well, such as the
additional administrative costs incurred by insurers, employers, and
government. All of these deadweight costs are included in the price of every
good or service this country produces, which is partly why many American jobs
are being outsourced to other countries. Reintroducing the free market into
everyday health care would reduce labor costs and save American jobs.
Resource Allocation
PATMOS requires three fewer employees per physician
than the average medical office. This means about one million people nationwide
are doing little more than settling small claims for routine medical care.
This is not a trivial issue, considering the United
States will need 1.2 million new and replacement nurses by 2014. Eliminating
insurance payments for small medical claims would make more people available
for direct patient care. The free market ensures scarce financial and human
resources are deployed efficiently on the consumer's behalf.
Given PATMOS prices and the increasing cost of insurance, I believe
reasonable people should conclude Americans don't need and can't afford
insurance for everyday health care.
www.heartland.org/Article.cfm?artId=22532
Robert S. Berry, M.D. (rsberry@xtn.net) is a practicing physician with board certifications
in emergency medicine and internal medicine in Tennessee. He has testified
before Congress on "consumer-directed doctoring" and has appeared on
Fox News, ABC News, CNN, and in The Wall Street Journal.
The Heartland Institute, 19 South LaSalle Street #903,
Chicago, IL 60603
phone 312/377-4000 · fax 312/377-5000, www.heartland.org
* * * * *
9.
Book Review: THE
THING ABOUT LIFE IS THAT ONE DAY YOU'LL BE DEAD
By David Shields (Knopf, 225 pages,
$23.95)
The Long Road to the End A review by STEPHEN BATES,
WSJ February 15, 2008
"This is my research; this is what I now
know," David Shields writes in his prologue: "the brute facts of
existence, the fragility and ephemerality of life in its naked corporeality,
human beings as bare, forked animals, the beauty and pathos in my body... and
everyone else's body as well."
Points worth remembering, sure, but research? Fortunately,
Mr. Shields undersells himself. The author of previous works of fiction
and nonfiction, he has written a death book that resists pigeonholing.
(Only on the bookshelf does death achieve tidiness.) This isn't an account of
the author's dying or grieving, or a memoir of a professional to whom death is
routine, or a guidebook to the mythic "good death." Instead, Mr.
Shields offers a more panoramic version of Sherwin Nuland's "How We
Die," replete with tidbits that are provocative and, for the middle-aged,
often disheartening, covering the whole life cycle -- which is to say, the
death cycle. To read more, please go to www.medicaltuesday.net/bookreviews.asp.
Coordination and strength peak at 19, IQ at around 20,
bone mass at 30, Mr. Shields reports. On the down slope, the brain shrinks, the
eyes go cloudy, the metabolic rate falls. You slow down, you break down. If you
reach 100, odds are nine out of 10 that you're female -- testosterone makes life
and then takes it. More of longevity's secrets: "People with higher
education live six years longer than high school dropouts; Oscar winners
outlive unsuccessful nominees by four years; CEOs outlive corporate vice
presidents; religious people outlive atheists; tall people (men over 6'; women
over 5'7") outlive short people by three years;... American immigrants
live three years longer than natives." Laurie, Mr. Shields's wife, quotes
a friend -- "At 40, a woman must choose between her face and her ass: nice
ass, gaunt face; good face, fat ass." Laurie's choice.
In amiably meandering chapters, Mr. Shields
intersperses descriptions of the rise and fall of the typical human with
dispatches regarding the trajectory of a particular human: himself. "I
once felt animal joy in being alive and I felt this mainly when I was playing
basketball and I only occasionally feel that animal joy anymore and that's
life," he says. Like the onetime basketball hero of John Updike's Rabbit
novels, Mr. Shields now must seek pleasure elsewhere. "Today was
a disaster, I tell myself at least twice a week, stopping at a cafι that
makes the most perfect Rice Krispies Treats, but this tastes
delicious."
The sugar jolt passes, but not Mr. Shields's obsession
with his father. "I want to know: What is it like inside his skin?"
Milton Shields (formerly Shildcrout) looms large over book and son alike. He
was born in 1910 and, at least when the author finished writing, is still
alive. The father is an exercise junkie, a ham whose anecdotes aren't always
tethered to truth and, like Mr. Shields, a sports fanatic. But block that
stereotype: Shields the elder is also a manic-depressive who has undergone
electroshock therapy, has never held a job for long and, perhaps no
coincidence, has some less-than-suave moments. When a woman from the
senior-citizens center rebuffs his overtures and says she wants to remain
friends, the horny, hoary father bellows: "If I wanted a friend, I would
have bought a dog." Or so he claims.
Whereas the late-90s father is mostly untroubled by
thoughts of dying, they haunt the early-50s Mr. Shields. His shaved scalp
represents "an acknowledgment of death rather than a denial of death (as,
to take an extreme example, the comb-over is)." Plagued by a bad back, among
other reminders of mortality, he describes his accessorizing: "I go to
sleep with a night guard jammed between my teeth and a Breathe Right strip
stretched across my nose (to mitigate snoring), and a pillow between my legs. I
walk around with an ice pack stuck in one coat pocket and a baggie of ibuprofen
in the other. I'm not exactly the king of the jungle."
In addition to its other attractions, "The
Thing About Life Is That One Day You'll Be Dead" is a sort of
death-centric Bartlett's, although on this score the results are mixed. Some of
the quotations, such as James Thurber's deathbed "God bless. God
damn" are impeccably self-contained, but others cry out for commentary, or
at least some refereeing, as when Cicero, Victor Hugo, Joseph Conrad, Don Marquis
and Virginia Woolf all jostle for attention on one page. Although Mr. Shields
personalizes many a biological fact -- he suffered from such catastrophic acne
as an adolescent, he says, that his air-brushed senior yearbook photo prompted
people to ask who it was -- he slips offstage during many of the quotefests.
There's someone else offstage, too: Mr. Shields's
mother, who died of lung cancer at 51, long after the end of her rancorous
marriage to the author's father. Mr. Shields quotes an entry from her diary and
the instructions in her will for the disposal of her body, both of the passages
cool-headed and warm-hearted. "Although I do not want a religious memorial
service," she said in the will, "I hope it is helpful to family and
friends to have an informal gathering of people, so that each may draw strength
from one another." That's about it. Did Mr. Shields, who was in his early
20s when his mother died, decide to write the book as he neared her age at
death? Is the wound still too deep? Was she a peripheral figure in his life? He
doesn't say.
In a sense, these gaps pay tribute to the book. Mr.
Shields is a sharp-eyed, self-deprecating, at times hilarious writer.
Approaching the flatline of the last page, we want more.
Mr. Bates teaches in the Hank Greenspun School of
Journalism and Media Studies at the University of Nevada, Las Vegas.
http://online.wsj.com/article_print/SB120303667568470231.html
BOOK EXCERPT Read an excerpt from
David Shields' new book.
* * * * *
10. Hippocrates & His Kin: The World We Live In
A California Highway Patrol Officer was
conducting speed enforcement on I-15, North of MCAS Miramar, using a hand
held radar device to nab speeders cresting the hill.
The officer was dumbfounded when the radar gun
issued a 400 mph reading and went dead.
Just then, a deafening roar over the treetops revealed
that the radar had in fact locked onto a USMC F/A-18 Hornet engaged in a
low flying exercise. To read more, please go to www.medicaltuesday.net/hhk.asp.
Back at CHP Headquarters, the Patrol Captain fired
off a complaint to the USMC Base Commander. Back came a reply in true USMC
style:
Thank you for your message as it allows us to
complete the file on this incident. You may be interested to know that the
Hornet's tactical computer had instantaneously locked onto your hostile
radar equipment, sending a jamming signal back to it. Also,
the automatic air-to-ground missile systems aboard the
Hornet similarly locked onto your equipment, but fortunately the
Marine flying the Hornet recognized the situation for what it was and
quickly overrode the automated defense system before the target
was vaporized.
Thank you for your concerns.
We are grateful to the world's best fighting force,
The US Marine Corps, for protecting our freedom.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: