MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 22, Feb 26, 2007
In This Issue:
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
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
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.
* * * * *
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/.
* * * * *
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
Utilization Review Management
RE: Individual Policy Applications
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.
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
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
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.
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).
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,  1 S.C.R. 791
* * * * *
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
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
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.
* * * * *
Health Alert: Does Non-price Rationing or Socialism Work? By John Goodman
I 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 to www.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.
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.
* * * * *
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.
* * * * *
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 .
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.
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.
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.
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.
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.
Robert S. Berry, M.D. (email@example.com) 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
* * * * *
Book Review: THE
THING ABOUT LIFE IS THAT ONE DAY YOU'LL BE DEAD
By David Shields (Knopf, 225 pages, $23.95)
"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
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.
BOOK EXCERPT Read an excerpt from David Shields' new book.
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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.
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John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm. To read the story of how the uninsured pay four to ten times what it costs for their care to make up for the government's under payment for Medicare and Medicaid patients and HMOs who negotiated deeply discounted rates, go to www.zhcenter.org/newslettermore.asp?id=188800&page=1&newsid=2548.
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website. To read a recent OpEd piece, go to VOM above.
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
To read the rest of this section, please go to www.medicaltuesday.net/org.asp .
Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 2550 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
· Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm. Be sure to read our featured article by him in MedicalTuesday last month at www.medicaltuesday.net/archives/Jan2908.htm.
Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Will you be "harvested" before your time? "What? Me be harvested?" you might rightfully be wondering. Given recent reports and the incentives involved, it's likely that some doctors are indeed taking persons' organs from their bodies before death. To read the entire story, go to www.newsmax.com/medicine_men/donating_organs/2008/02/19/73765.html. To read a related column, go to HHK above in section 10.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day in Perspective: REAL ID, electronic tracking spark civil liberties concerns. Children are getting their fingerprints scanned every day at school - to make the lunch line move faster. It's more efficient than debit cards, ID cards or cash. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read STUPID IDEAS ON "HEALTH CARE REFORM. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York and Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the excellent articles on Restoring True Insurance or the extensive book review section.
* * * * *
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Del Meyer, MD, Editor & Founder
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Words of Wisdom and Aphorisms
Thomas Jefferson: If a nation expects to be Ignorant and Free, in a State of Civilization, it expects what never was and never will be.
James Bryce, March 23, 1914: [Medicine is] the only profession that labors incessantly to destroy the reason for its own existence.
Anonymous: Nobody cares about doctors till we need them.
Patient: Every morning when I get up I'm nauseous for an hour. What
should I do?
Doctor: I think you should get up an hour later.
BEYOND the town of Cordova, on Prince William Sound in south-eastern Alaska, the Copper River delta branches out in silt and swamp into the gulf. Marie Smith, growing up there, knew there was a particular word in Eyak, her language, for the silky, gummy mud that squished between her toes. It was c'a. The driftwood she found on the shore, u'l, acquired a different name if it had a proper shape and was not a broken, tangled mass. If she got lost among the flat, winding creeks her panicky thoughts were not of north, south, east or west, but of "upriver", "downstream", and the tribes, Eskimo and Tlingit, who lived on either side. And if they asked her name it was not Marie but Udachkuqax*a'a'ch, "a sound that calls people from afar". . .
This universe of words and observations was already fading when Marie was young. In 1933 there were 38 Eyak-speakers left, and white people with their grim faces and intrusive microphones, as they always appeared to her, were already coming to sweep up the remnants of the language. At home her mother donned a kushsl, or apron, to make cakes in an isxah, or round mixing bowl; but at school "barbarous" Eyak was forbidden. It went unheard, too, in the salmon factory where Marie worked after fourth grade, canning in industrial quantities the noble fish her people had hunted with respect, naming not only every part of it but the separate stems and shoots of the red salmonberries they ate with the dried roe.
As the spoken language died, so did the stories of tricky Creator-Raven and the magical loon, of giant animals and tiny homunculi with fish-spears no bigger than a matchstick. People forgot why "hat" was the same word as "hammer", or why the word for a leaf, kultahl, was also the word for a feather, as though deciduous trees and birds shared one organic life. They lost the sense that lumped apples, beads and pills together as round, foreign, possibly deceiving things. They neglected the taboo that kept fish and animals separate, and would not let fish-skin and animal hide be sewn in the same coat; and they could not remember exactly why they built little wooden huts over gravestones, as if to give more comfortable shelter to the dead.
Mrs Smith herself seemed cavalier about the language for a time. She married a white Oregonian, William Smith, and brought up nine children, telling them odd Eyak words but finding they were not interested. Eyak became a language for talking to herself, or to God. Only when her last surviving older sister died, in the 1990s, did she realise that she was the last of the line. From that moment she became an activist, a tiny figure with a determined jaw and a colourful beaded hat, campaigning to stop clear-cutting in the forest (where Eyak split-log lodges decayed among the blueberries) and to get Eyak bones decently buried. She was the chief of her nation, as well as its only full-blooded member. . .
As a child she had longed to be a pilot, flying boat-planes between the islands of the Sound. An impossible dream, she was told, because she was a girl. As an old woman, she said she believed that Eyak might be resurrected in future. Just as impossible, scoffed the experts: in an age where perhaps half the planet's languages will disappear over the next century, killed by urban migration or the internet or the triumphal march of English, Eyak has no chance. For Mrs Smith, however, the death of Eyak meant the not-to-be-imagined disappearance of the world.
Read the story at www.economist.com/obituary/displaystory.cfm?story_id=10640514.
On This Date in History - February 26
On this date in 1815, Napoleon Bonaparte, who had been exiled to the island of Elba after his reign as self-made Emperor of France, escaped to begin the war that climaxed at the Battle of Waterloo. In 100 days, countless lives were lost, and when it was over, Napoleon was back in exile, permanently, on another island, St. Helena.
On this date in 1846, Colonel William F. Cody was born. Also known as Buffalo Bill, he was a symbol of the old West, the wild west show, the thrills of the frontier. He was the original cowboys and Indians show making the American west glamorous and adventurous and postponed for three or four generations most public review of the ethics or the wisdom of our relationship with the Indians. His claim to have killed some 4,280 buffaloes would not endear him to us now.
After Leonard and Thelma Spinrad