1. Featured Article: Rising phases toward renewed
reliance on markets and limited government
Why is there renewed emphasis on socialized medicine
when it's failing in all industrialized countries throughout the world? Dr.
& Mrs. Friedman's explanation helps us understand this contradictory
phenomenon.
The Tide in the Affairs of Men, by Milton Friedman and Rose D. Friedman
The aim of this brief essay is to
present a hypothesis that a major change in social and economic policy is
preceded by a shift in the climate of intellectual opinion. The
intellectual tide is spread to the public by all manner of intellectual
retailers: teachers and preachers, journalists in print and on television,
pundits and politicians.
There are powerful tides in the
affairs of men, interpreted as the collective entity we call society, just as
in the affairs of individuals. The tides in the affairs of society are slow to
become apparent, as one tide begins to overrun its predecessor. Each tide lasts
a long time -- decades, not hours -- once it begins to flood and leaves its
mark on its successor even after it recedes. In almost every tide a crisis can
be identified as the catalyst for a major change in the direction of policy.
The Rise of Laissez Faire: The Adam
Smith Tide
The first tide we will examine begins
in 18th-century Scotland with a reaction against mercantilism expressed in the
writings of David Hume, Adam Smith's Theory of Moral Sentiments (1759),
and above all The Wealth of Nations (1776). On the other side of the
Atlantic 1776 also saw the proclamation of the Declaration of Independence, in
many ways the political twin of Smith's economics. Smith's work quickly became
common currency to the Founding Fathers. By the early 19th century the ideas of
laissez faire, of the operation of the invisible hand, of the undesirability of
government intervention into economic matters, had swept first the intellectual
world and then public policy. Reinforced by pressures arising out of the
Industrial Revolution, these ideas were beginning to affect public policy. To read more, please go to www.medicaltuesday.net/index.asp.
The repeal of the mercantilist Corn
Laws in Britain in 1846 is generally regarded as the final triumph of Adam
Smith after a 70-year delay. In fact some reductions in trade barriers had
started much earlier, and many nonagricultural items continued to be protected
by tariffs until 1874. So it took nearly a century for the completing of one
response to Adam Smith.
American Experience
The other countries of Europe and the
United States did not follow the British lead by establishing complete free
trade in goods. However during most of the 19th century, U.S. duties on imports
were primarily for revenue (not protection). Except for a few years after the
War of 1812, customs provided between 90 and 100% of total Federal revenues up
to the Civil War. And except for a few years during and after the Civil War,
customs provided half or more of Federal revenues until the Spanish- American
War at the end of the century. Nontariff barriers such as quotas were
nonexistent. Movement of people and capital was hardly impeded at all.
In the triumphant ideas of Adam Smith
offered both an explanation and an obvious alternative option; tariffs aside,
near complete laissez faire and nonintervention reigned into the next century.
Measuring the role of government in
the economy is not easy. One readily available, though admittedly imperfect,
measure is the ratio of government spending to national income. At the height
of laissez faire, peacetime government spending was less than 10% of national
income in both the United States and Great Britain. Federal spending was
generally less than 3% of national income, with half of that for the military.
On the broader scale the tide that
swept the 19th century brought greater political as well as economic freedom.
Despite occasional financial panics and crises, Britain and the United States
experienced remarkable economic growth. The United States in particular became
a Mecca for the poor of all lands. This was a result of the increasing adoption
of laissez faire as the guiding principle of government policy.
The Rise of the Welfare State
This remarkable progress did not
prevent the intellectual tide from turning away from individualism and toward
collectivism. How can we explain this shift in the intellectual tide when the
growing pains of laissez-faire policies had long been overcome and impressive
positive gains had been achieved?
Two effects of the success of laissez
faire fostered a reaction.
• First, success made residual evils
stand out all the more sharply, both encouraging reformers to press for governmental
solutions and making the public more sympathetic to their appeals.
• Second, it became more reasonable
to anticipate that government would be effective in attacking the residual
evils. A severely limited government has few favors to give. Hence there is
little incentive to corrupt government officials, and government service has
few attractions for people intent on personal enrichment.
Government was engaged primarily in
enforcing laws against murder, theft, and the like and in providing municipal
services such as local police and fire protection -- activities that engendered
almost unanimous citizen support. Britain, which went furthest toward complete
laissez faire, became legendary in the late 19th and early 20th centuries for
its incorruptible civil service and law-abiding citizenry -- precisely the
reverse of its reputation a century earlier.
But by 1900, the doctrine of laissez
faire had more or less lost its hold upon the English people. In the United
States the development was similar, though somewhat delayed. As late as 1929
Federal spending amounted to only 3.2% of the national income; one-half of this
was spent on the military plus interest on the public debt. Spending by
federal, state, and local governments on what today is described as income
support, Social Security, and welfare totaled less than 1% of national income.
The world of ideas, however, was
different. By 1929 socialism became the dominant ideology on the nation's
campuses. The New Republic and The Nation were the intellectuals'
favorite journals and [the socialist] Norman Thomas their political hero. The
critical catalyst for a major change was, of course, the Great Depression,
which shattered the public's confidence in private enterprise, leading it to
regard government involvement as the only effective recourse in time of trouble
and to treat government as a potential benefactor rather than simply a
policeman and umpire. The effect was dramatic. By the 1980s federal government
spending grew to 30%, and total government spending was over 40% of national
income. But spending alone cannot illustrate the role government came to play.
Many intrusions into people's lives involve little or no spending: tariffs and
quotas, price and wage controls, ceilings on interest rates, local ceilings on
rents, zoning regulations, building codes, and so on.
The Resurgence of Free Markets: The
Hayek Tide
Throughout the ascendancy of socialist
ideas there had, of course, been counter-currents -- kept alive by Friedrich
Hayek and some of his colleagues in Britain; by Ludwig von Mises and his
disciples in Austria; and by Albert Jay Nock, H. L. Mencken, and others in the
United States.
Hayek's Road to Serfdom in 1944 was
probably the first real inroad in the dominant intellectual view. Yet, at first, the impact of
the free market on the dominant tide of intellectual opinion was minute. Even
for those of us who were actively promoting free markets in the 1950s and 1960s
it is difficult to recall how strong and pervasive was the intellectual climate
of the times.
The tale of two books by the present
authors, both directed at the general public and both promoting the same
policies, provides striking evidence of the change in the climate of opinion.
The first, Capitalism and Freedom, published in 1962 and destined to
sell more than 400,000 copies in the next eighteen years, was not reviewed at
the time in a single popular American periodical. The second, Free to Choose,
published in 1980, was reviewed by every major publication and became the
year's best-selling nonfiction book in the United States with worldwide
attention.
Further evidence of the change in the
intellectual climate is the proliferation of think tanks promoting the ideas of
limited government and reliance on free markets.
Translating Ideas into Action
The same contrast is true of
publications. FEE's Freeman was the only one we can think of that was
promoting the ideas of freedom 30 to 40 years ago. Today numerous publications
promote these ideas, though with great differences in specific areas: The
Freeman, National Review, Human Events, The American Spectator, Policy Review, and
Reason. Even the New Republic and The Nation are no longer
the undeviating proponents of socialist orthodoxy that they were three decades
ago. . .
In Conclusion
Two new pairs of tides are now in
their rising phases: in public opinion, toward renewed reliance on markets and
more limited government. If the completed tides are any guide, the current wave
in opinion is approaching middle age and in public policy is still in its
infancy. Both are therefore still rising and the flood stage, certainly in
affairs, is yet to come.
For those who believe in a free
society and a narrowly limited role for government, that is reason for
optimism, but it is not a reason for complacency. Nothing is inevitable about
the course of history -- however it may appear in retrospect. Because we live
in a largely free society, we tend to forget how limited is the span of time
and the part of the globe for which there has ever been anything like political
freedom: the typical state of mankind is tyranny, servitude, and misery.
Once a tide in opinion or in affairs
is strongly set, it tends to overwhelm counter-currents and to keep going for a
long time in the same direction. The tides are capable of ignoring geography,
political labels, and other hindrances to their continuance.
Yet it is also worth recalling that their very success
tends to create conditions that may ultimately reverse them. The encouraging
tide in affairs that is in its infancy can be still overwhelmed by a renewed
tide of collectivism. The expanded role of government even in Western societies
that pride themselves in being part of the free world has created many vested
interests that will strongly resist the loss of privileges that they have come
to regard as their right.
Milton Friedman, one of the 20th century's
most eloquent spokesmen for liberty, died on November 16, 2006. His long and
successful life was a celebration of the American Dream. Born in 1912 to poor Jewish
immigrants in New York City, Friedman received the best education America could
offer: a B.A. from Rutgers University, an M.A. from the University of Chicago,
and a Ph.D. from Columbia University. In 1976 Milton Friedman won the Nobel
Prize in Economics.
As a young economist, fresh
from his Ph.D. studies at Columbia, Milton Friedman and George Stigler (a
future fellow Nobel laureate) co-wrote one of FEE's first monographs, Roofs or
Ceilings? Widely regarded as the leader of the Chicago school of monetary
economics, Friedman was senior research fellow at the Hoover Institution and
Paul Snowden Russell Distinguished Service Professor of Economics, Emeritus, at
the University of Chicago. He was awarded the Presidential Medal of Freedom in
1988 and received the National Medal of Science the same year. Milton Friedman
and Rose D. Friedman were co-authors of Capitalism and Freedom, Free to Choose,
and their memoirs, Two Lucky People.
Adapted from an article that appeared in the April 1989 issue
of The Freeman.
©2005 Foundation for Economic
Education. All Rights Reserved.
To read the entire article, go to www.fee.org/publications/notes/notes/theTide.asp.
* * * * *
2.
In the News: Do
We Need Another 50 Million Cops to Police Every Family?
A Cop in Every Living Room? By JOSEPH D. MCNAMARA, WSJ, January 27, 2007
PALO ALTO, Calif. -- California Assemblywoman Sally
Lieber is going to introduce a bill to make it a misdemeanor to spank children who
are four years of age or younger. Violators will be subject to a year in jail
and/or a $1,000 fine. . .
I recently had the chance to chat with Ms. Lieber on
NPR about her proposed legislation. She is intelligent, fluent and has
excellent sound bites. She defends her bill by saying that we need a law
against child beating. But California Penal Code section 11166 already
prohibits child abuse (beating etc.) and makes it a crime for doctors, teachers
and others in charge of children not to report suspected abuse to the
government child protection agencies. The police must also report and, like
CPAs, investigate the reports. Those convicted of child abuse are punished
quite severely.
Ms. Lieber justifies her proposal by saying at the
very least it will provoke a "dialogue." It has. The telegenic
assemblywoman has appeared on national TV and comes across as bright and
caring, which doesn't harm her political future. She deftly substitutes the
word "beating" for the vaguer term "spanking," putting her
opponents in the uncomfortable position of sounding indifferent to the terrible
cases of child abuse that we often see on TV.
However, even in a politically liberal state like
California, antispanking legislation has produced a backlash against government
interference with the traditional right and duty of parents to decide how best
to raise their children. To read more,
please go to www.medicaltuesday.net/news.asp.
Ms. Lieber also accurately remarks that decades ago,
the male-dominated police and judiciary ranks needed to be prodded by women's
advocates to arrest in domestic violence cases. However, assault and batteries
were already crimes. This new bill will create thousands of new crimes in
California whose criminal justice agencies are already in a state of crisis.
Police throughout the state are unable to fill their
ranks at a time when they are saddled with preventing terrorism, eliminating
gang violence, stopping an upswing in random shootings, an increase in
homicides, preventing drug use, putting an end to graffiti, controlling
traffic, devoting an increasing share of resources to investigating complaints
against officers and myriad other problems. The courts are swamped by the
volume of cases; the Supreme Court has declared California's sentencing to be
unconstitutional; the California prison system has been placed under
receivership by federal judges for overcrowding and prisoner abuse. Increases
in California's criminal justice costs have been out of control for decades.
The state's budget deficit, which threatens solvency, has to a large extent
been the result of runaway criminal justice costs. This could well worsen the
crime picture in the Golden State.
Spanking legislation will also have unforeseen
consequences. As Arnold Schwarzenegger remarked, "How do you enforce
that?" One can't expect children four and under to call 911 to turn in
their parents for spanking.
Just as important is the impact that such legislation
will have on families and the children it is intended to protect. Confused
parents may fail to provide necessary discipline for children to keep them from
running into traffic, playing with matches, falling into swimming pools or
engaging in other hazardous activities. Dragging parents into courts, putting
them in jail or fining them may do far more harm to the child than an
occasional swat on the rear end. . .
If someday Ms. Lieber and her husband David experience
the joy of bringing up children, they will also experience the constant concern
that parents have for their offspring's safety. It is a lot harder to believe
that parents are fools or brutal criminals who must be controlled by
unrealistic laws when you are a parent exercising your best judgment every day
on how to keep your children safe.
Mr. McNamara is a research fellow at the Hoover
Institution at Stanford.
To read the entire article, go to http://online.wsj.com/article_print/SB116986743854889878.html.
* * * * *
Drive to cut wait for
operations, By Nicholas Timmins, Public Policy Editor, FT,
Published: February 20 2007
Tony Blair yesterday
stepped up the drive to define his legacy by declaring that he wanted to see
"the framework" in place to ensure that by the end of 2008 no one
waits more than 18 weeks for an operation after seeing the GP. . .
It would mean that over the
course of a decade "what was the biggest problem in the National Health
Service - that people had to wait months and months, often in pain and
sometimes even dying for want of their operations" - would have been
"transformed", the prime minister said. . .
Some hospitals are
considering keeping operating theatres open in the evenings and at weekends.
But the NHS Confederation, which represents health authorities and trusts, said
many hospitals would have "to completely redesign how patients flow through
the system" to achieve the goal. To read more,
please go to www.medicaltuesday.net/intlnews.asp.
James Johnson, chairman
of council of the British Medical Association, said there were two
"stumbling blocks" to using operating theatres more intensively. One
was how to staff them.
But the other was that
"many parts of the NHS are broke. If primary care trusts have run out of
money, they clearly cannot buy a lot more operations. This and the lack of staff
have already prevented extended working from happening in many parts of the
NHS."
His comments came as the
health department is expected to announce today that, three-quarters of the way
through the financial year, the NHS finally looks on track to break even once a
big contingency reserve created earlier in the year by top-slicing primary care
trust allocations is taken into account.
That has been achieved,
however, by some primary care trusts delaying operations into the next
financial year, or putting a minimum wait on treatment, while, according to
suppliers, some parts of the NHS are paying bills late or cutting orders for
supplies until the financial year ends in March. . .
The figures emerged as a
doctors.net poll of more than 3,000 doctors for The Times showed that almost
three-quarters believe that the extra money for the NHS has not been spent
well. Some 28 per cent believe David Cameron would protect the NHS more
effectively than would Gordon Brown, who is favoured by just 15 per cent.
To read the entire
article, go to www.ft.com/cms/s/19ec376e-c089-11db-995a-000b5df10621.html.
Copyright The Financial Times Limited 2007
[Did you notice the overriding theme is
finances limiting the saving of lives? Isn't it great to live in a country
where if you need an operation done this afternoon, you call the hospital and schedule
it. The hospital provides all necessary services required in the physicians
professional judgement. To think that the hospital doesn't have the financial
resources to save lives is so foreign to us. Why would anyone want our Congress
to control this freedom and bring us down to the level of foreign countries?]
The NHS does not give timely
access to healthcare, it only gives access to a waiting list.
* * * * *
4.
Medicare:
California Style: Schwarzenegger's Folly, By John
Stossel
Gov. Arnold Schwarzenegger wants all Californians to
have medical insurance. So he's going to force them to have it.
Schwarzenegger abandoned his opposition to mandated
employer-based health insurance and embraced the idea as his own.
"Everyone in California must have insurance. If you can't afford it, the
state will help you buy it, but you must be insured," Schwarzenegger said last month.
Of course, his "solution" won't solve the
problem. By making medical care look cheap to people, expanded
insurance will push prices up even faster. Everyone will end up paying more.
But politicians benefit because the costs will be hidden.
The governor also wants to enlarge the state's
coverage for children by including people with incomes as high as $60,000 for a
family of four. Imagine that: You can make $60,000 a year and put your kids on
the dole. To read more, please go to www.medicaltuesday.net/medicare.asp.
This ought to dispel any notion that Schwarzenegger is
a believer in small government. Here he is following former Republican
Massachusetts Gov. Mitt Romney down the path of state socialized medicine.
Romney said compulsory insurance would cost a person $2,400 a year. But now we
know it's at least $4,560. . .
The root of the problem is that few people face the
true cost of medical care. Medicare and Medicaid beneficiaries don't because
taxpayers pay their bills. People with employer-based medical insurance don't
because insurance policies shield them from it. Since they pay only small
co-pays when they see a doctor, they don't ask, "Do I really need that
test?" but rather, "Does my insurance cover it?"
People who don't face the full cost of their choices
don't act like cost-conscious consumers. Higher prices result.
With a rational government policy, people would save
money for routine medical care and buy insurance for solvency-threatening
illness. After all, we don't buy auto insurance to pay for oil changes and
worn-out windshield-wiper blades. But today, people expect medical insurance to
cover routine physical exams because someone else seems to pay the premiums.
All this hurts people who buy their own insurance or
don't have it. It would be good if they could buy a basic high-deductible
catastrophic policy. For a healthy young person, such a policy would be
relatively cheap. But because of special-interest lobbying, most states mandate
that insurance cover things that most people would never buy if they were
paying the cost openly -- things like Viagra and substance-abuse counseling.
The Council for Affordable Health Insurance (CAHI) reports that states have
imposed 1,824 mandates on insurance companies. This makes even a high-deductible policy absurdly
expensive in many states. . .
The upshot is that, however well intentioned,
government regulation of medicine and insurance brings us mostly headaches, and
Gov. Schwarzenegger's plan will bring Californians even more. But that should be
between him and them. They should have the right to fail. . .
Let the states experiment! Universal coverage is a
feel-good idea that many people want Washington to impose. Better to have
models of failure in individual states so we all don't have to suffer! We need
living reminders of collectivism's faults. . . .
The feds should let us learn.
To read the entire article, please go to http://www.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2007/02/schwarzeneggers_folly.html.
Copyright 2007 Creators
Syndicate
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Hospital-Based Home Health Care
Severe infections are an increasing problem despite
the golden age of antibiotics. We've had two patients with presumed spider
bites that had serious cellulitis requiring intravenous antibiotics for an
extended period of time. Since no one can stay in the hospital at $2500 a day
just for antibiotics, this is frequently given at home by a hospital-based home
health-care service. Everyone simply assumed it was more cost-effective for a
nurse to spend an hour with a patient on a home visit administering an
antibiotic than to pay the high rent of a hospital.
I recall when I made home visits to a patient on life
support; my home visit charge of $125 was reduced to about $80 by Medicare. The
patient then showed me a Medicare receipt that revealed the hospital charged
$165 for the nurse visit and was paid the full amount by the government. I was
writing the nursing orders; however, the nurse carrying out my orders got paid
more than twice as much than I did while supervising the case. One of my
associates in a similar situation complained and Medicare stated that the
hospital not only had to provide the RN, but also the car and the mileage. When
my associate pointed out to Medicare that he also had to provide a car and pay
for the mileage, the letter went unanswered. To read more,
please go to www.medicaltuesday.net/gluttony.asp.
Why would any physician ever trust Medicare or the
government to be fair?
In the Medical Staff Lounge last week (see Overheard
in the Medical Staff Lounge below), one of my colleagues had a family member go
home from the hospital on IV antibiotics for four weeks, as recommended by the
Infectious Disease Consultant. The Hospital Home Health-Care Service would
provide the service and it would cost $2500 per injection for the four weeks or
about $70,000. The hospital would also provide the second antibiotic for $500 a
day or about $14,000 for the four weeks. My colleague was so incensed that he
called the drug company and found out that the drugs were now generic. He
called his pharmacist friend and found that it could be delivered the next day.
He found another company to provide service. The $2500 per injection per day
became $250 per week and the $500 per day became $50 per week. The weekly
charge on the open market was 1/10th the hospital daily charge
approved by the government in both cases. This calculates to a total cost for
the four weeks at 1/70th the government allowable.
Does anyone really believe that the hospital didn't
buy generic and charge proprietary prices? Does anyone really believe that
hospitals are not trying to control health care
costs?
We are running out of private businesses, including
hospitals, which believe in the free marketplace. Why should they when they can
gouge the public with the blessings of Medicare and the government and make 70
times as much by hiding costs? Is there anyone in Congress that understands
this travesty of justice (or just plain dishonesty)?
The open and free marketplace is the greatest reducer
of health care costs.
Hospital Cost Transparency would immediately allow
market forces to reduce costs.
* * * * *
6. Medical Myths: Government must join efforts to cut obesity, by Michael
Wilkes, MD, Sac Bee
Nearly every week, in the seminars that take place
before the start of clinic work, doctors in training complain about their
inability to treat obesity. When they meet with patients, they feel obligated
to inform patients that they are overweight. (As if this were news to them. How
many times a day must they look in the mirror wishing -- even praying -- they
were thinner?)
The doctors admonish these patients to lose weight. We
have taught doctors again and again all the medical dangers of obesity (high
blood pressure, heart disease, diabetes, etc.), but we have not taught them
effective ways to counsel around weight loss. Doctors, like many others, still
associate being overweight with a lack of willpower, and many doctors advise
patients simply to eat less and exercise. To read more, please go to www.medicaltuesday.net/myths.asp
Has anyone noticed this approach is not working?
Today, most doctors do not know much about nutrition or weight loss other than
that we should encourage it. The public is bombarded by companies selling
useless and expensive gimmicks that only shrink the pocketbook, not the
stomach. Advertising for foods and lifestyles that promote obesity is
everywhere. . .
Unfortunately, the U.S. government is not very good at
implementing aggressive, comprehensive interventions to address major social
problems. There is no question that preventing obesity is far more effective
than treating it. Pills and surgery are just not the answer for society. But
prevention requires diverse groups, who may not always have the same agenda, to
work together. It will require the government to admit it has a responsibility
to help and create programs that do not require great effort by the public,
with built-in incentives for businesses, schools and individuals to do the
right thing. It will require mandatory actions because voluntary actions are
not working.
To read Dr. Wilkes recommendations for treating
obesity, from warning labels, advertising bans, taxes on junk foods, requiring
health insurance companies to get more involved in practicing medicine,
policing vending machines, tax incentives for company fitness programs,
requiring bike lanes, etc, et al, please go to www.sacbee.com/296/v-print/story/124214.html.
[To pay for another half-dozen health care
bureaucracies to regiment and police a free society should easily get our
medical costs above 25 percent of our GDP. With the sum of our income,
property, sales, excise taxes and registration fees now approaching a 50
percent marginal rate, trying to live on the remaining 25 percent may force us
to buy junk foods to survive.]
For a professor and teacher of medical students to
castigate his profession for not knowing how to treat obesity may be more a
reflection on the teacher than on the profession. To further defer this
obligation to the incompetent government is indeed unfortunate.
Government involvement will always increase costs,
reduce benefits and create discord among us.
* * * * *
7.
Overheard in the
Medical Staff Lounge: How to Lose Your Staff Privileges
Dr. Dave: (who
had just grabbed his lunch and sat down at our table but was almost too emotional
to talk) My mother had a severe infection and was just discharged from the
hospital to receive home-based antibiotics for four weeks. (See Medical
Gluttony above for details.) I saved Medicare Part D a bunch of money by doing
the legwork to find generic antibiotics at 1/70th the cost.
Dr. Michelle: Why
would you do that?
Dr. Sam: Yes,
you just caused the hospital to lose nearly a $100,000. You better look behind
you wherever you go!
Dr. Dave: You've
got to be kidding. Won't I be Medicare's friend?
Dr. Rosen:
Medicare and the hospitals are both villains. The hospitals have enough
half-time salaried doctors in most departments now that they can do just about
anything they want. To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Dave: How
do you figure?
Dr. Rosen: These
half-time department chiefs who may make $90,000 a year from the hospital and
are also in practice in their private offices the other half-time can't offend
the hospital. Whose signature do you think is on those $90,000 worth of checks?
They don't want to risk losing that freebie.
Dr. Sam: Yes,
Dave, the administrator can just order the chief of your department to review
all your charts and send all question marks to the Peer Review Committee. He
doesn't have to say another word.
Dr. Dave: My
records are all up to par. They won't find anything wrong.
Dr. Sam: Don't
be so naïve, Dave. All of us make insignificant mistakes every day on every
patient we see that someone can take issue with. In fact, many may not be
mistakes at all but just normal professional variations. But what we do is seen
by the public as so important that doctors can't make errors and a therapeutic
variation will be seen by the public as a serious life-threatening mistake.
They will always side with the hospitals that they see as angels of Mercy.
Dr. Rosen:
Almost once a week, I have nurses bring some medication error to my attention
which may be a simple dosage variation of no consequence or if significant, can
be straightened out by varying or omitting the next dose. The question I'm
always asked is do I want an incident report filed? I always say no because
these are normal expected clinical human errors of no consequence. The last
thing I want to do is get the hospital attorneys, who review all such reports,
involved in laying down another layer of bureaucratic control that will then
produce far more errors and increase health-care costs unnecessarily.
Dr. Sam: Dave
you must have noticed that every year we have a doctor or two that leaves the
staff in disgrace having done nothing egregious except riled some competing
physician or cause the hospital to lose money. As one administrator told me, "Isn't
getting the money in the name of the game?"
Dr. Rosen: I
once had a competitor pull every procedure I did over a two-year period. When I
saw them in a Peer Review file, I went straight to the staff secretary and she
blanched. She said it was all a mistake. She immediately took them all out. She
avoided me for the next six months or so. But I monitored the file.
Dr. Sam: So
you see, Dave, someone went pfishing in Dr. Rosen's records to find errors and
got caught. Otherwise Dr. Rosen might be facing a hospital prosecutor and lose
his privileges, perhaps his license and be reported to the National Data
Center, the tomb for physicians who will never have another chance to practice
or support their families or send their children to college or ever retire except
to a prison cell.
Dr. Yancy: That's
why we need to eliminate hospitals from employing physicians who then turn on
us and become traitors.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
In San Francisco Medicine the Official Publication of
the San Francisco Medical Society, Stephen Askin, MD, discusses Health
Savings Accounts The Wave of the Future?
. . . A health savings account (HSA) is a relatively
new system for financing health care. It has two essential elements: a high
deductible health insurance policy and a savings account paid for by
tax-deferred dollars. The minimal
deductible is $1,000 for an individual and $2,000 for a family; the maximums
are $2,700 and $5,450, respectively.
This type of policy is significantly cheaper than a low-deductible
policy and is therefore an appealing option for some people. The trustee for
the account may be the insurance company, a bank, or a PPO, and the annual
contribution is usually close to the amount of the deductible. The money in the
account may be invested in an appropriate manner and is to be spent for health
care. If used for nonmedical purposes, tax must be paid, as well as a 10
percent penalty. When the insured turns sixty-five, the money can be withdrawn
tax-free. When the deductible has been met, the insurance is available for
serious and expensive illnesses, thus serving as catastrophic insurance. The
HSA embodies our "ownership society" in the health care sector, which
reflects a philosophical shift in emphasis from collective to individual
responsibility for the management and financing of care. To read more,
please go to www.medicaltuesday.net/voicesofmedicine.asp.
The concept of HSAs, or medical savings accounts
(MSAs), as they were initially called, was first discussed by the AMA and
others in the 1980s. Then in 1996, as part of HIPAA legislation, the law
enabled formation of MSAs on a trial basis. They were to be used only for
individuals or businesses with fifty or fewer employees, and a maximum of
750,000 plans were permitted nationwide. Congress originally allowed the plans
to operate on a four-year trial basis and then planned to reconsider them.
There was considerable political opposition to the MSAs from HMOs and others
who were not interested in competition, as well as those advocating a national
health plan. By 1999, only about 100,000 plans were operating, and in 2000 the
trials were extended for an additional two years.
In 2003, new legislation -- part of the Medicare
Improvement Act -- gave MSAs a new name, Health Saving Accounts (HSAs) and
removed many of their restrictions.
There was no sunset, the number of plans was unlimited, and the fine for
nonmedical use was reduced from $150 to $100.
The MSA permitted either the employer or the employee to contribute; the
HSAs permitted a sharing of the funding. HSAs seemed to gain popularity. . .
An HSA plan improves access to health care funding,
even for those in below average economic brackets. For starters, the insurance
is relatively cheap. Employers may help fund the savings account. If there is a
temporary stoppage of income, contributions can be deferred, making up the
funds at the time of a bonus or unexpected income. The HSA is portable, allowing patients to change jobs without
losing health coverage. According to
the General Accounting Office, 40 percent of people signing up in the MSA pilot
project were previously uninsured, showing its appeal to many in this group.
HSA plans expand consumer choice and control. There is
no limitation on specialists, labs, hospitals, drugs, etc., as long as the
consumer hasn't met the deductible. HSA
plans also increase savings. Most people will not spend all the funds in the
account but will let them accumulate tax free, with dividends and interest
leading to a nice nest egg available at age sixty-five, when the money can be
withdrawn without tax or penalty.
What does the future hold for HSAs? According to an estimate by Diamond Cluster
International, a management consulting firm, by 2010 more than 15 million
Americans, or about 10 percent of all insured, will have a health savings
account. And according to a New York Times article dated January 27,
2006, Wall Street groups -- including banks and money managers -- are
positioning themselves to become central players in the business of health care
by offering to manage HSAs. Maybe HSAs fill a need for a category of patients
that currently has no other appealing options?
Read the entire article from San Francisco
Medicine at www.sfms.org//AM/Template.cfm?Section=Home.
* * * * *
9. The Physician / Patient Book Shelf: Food Addiction
The other day at the nursing station, I observed the
ward clerk reading "Weight Watchers" as she devoured a "Babe
Ruth." I guess that keeps the scales balanced and the economy moving. It
also contributes to the epidemic in America – 50-60% of the population is
overweight with 25-33% affected with obesity. We consumed 15% more calories in
1994 than we did in 1970 and today we dine out twice as often. If obesity was
an infectious disease, we would call it a national crisis.
Of all the books that cross my desk, there is at least
one or two each month about dieting. The "diet industry" is
flourishing. But is there really any new information? At one bookstore, I
counted 107 different diet books. At another, there were over 200 titles. It is
interesting that as this deluge of new books was filling up the shelves, some
"dated" diet books that spoke of revolutionary new medical dietary
evidence were now on sale at 10% of their initial listing.
There are number of diet books written by celebrities.
These authors are obviously without credentials. However, some of these books
are quite basic and meet a need because of a co-author with credentials, e.g.,
RD, MS, PhD or MD, although the latter group may not always be as knowledgeable
as the public assumes.
A brief review of some of these books will describe
this self-perpetuating industry. The questions still remain. Are they of value
to the overweight Americans? Are they helpful to those with other dietary
problems such as hyperlipidemia, coronary artery disease, peripheral vascular
disease, hypertension or diabetes? Do they provide complete lifelong
nutritional programs? Do they incorporate exercise and stress management? There
are at least three that do. To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
The Pritikin Diet Programs of Nathan Pritikin have
been continued by his son Robert, director of the Pritikin Longevity Center.
The current volume, The New Pritikin Program by Robert Pritikin (Pocket
Books, $7) is friendlier and more in tune with a lifetime commitment. The
results of the first 893 people that participated in the 26-day Pritikin
Longevity Center program was published in 1974 and provided a wealth of data
that was evaluated by the Department of Biostatistics and Epidemiology at Loma
Linda University. The results indicated that 83% of hypertensive people lowered
their blood pressure to normal and left the program drug-free; 50% of
adult-onset diabetics on insulin left the program free of insulin; 90% of
diabetics on oral drugs left free of drugs; 62% of drug-taking angina patients
left the center drug free; cholesterol and triglycerides were each lowered an
average of 25%; overweight people lost an average of 13 pounds; of the 64
people who were recommended for bypass surgery, 80 % of them had not undergone
surgery even five years later. I remember that when Nathan Pritikin presented
his data to medical staffs in this community during the mid 1970s, he himself
had severe coronary artery disease and was recommended for bypass surgery. He
declined and developed this program instead, which reversed his own
atherosclerosis. There now have been over 50,000 people treated at the Pritikin
centers in the last 15 years. They feel that quick fixes simply don't work in
the long run and one may even worsen the problem. One must address all the
factors of health. There is nothing magical.
This is truly a proven formula for lifelong success and health.
A couple of years ago, my RN-NP introduced me to The
Zone Diet by Barry Sears, PhD. Since then, he has written additional
volumes, including Mastering the Zone, which I received in the current
package of audio tapes (Harper Audio, $25). Dr. Sears gives a very
comprehensive nutritional program that is easily put into action. After a
discussion of the ill effects of hyperinsulinism, he presents a system of
balanced eating so one always remains "in the zone." If you're
"in the zone" of normal insulin levels you should not have
postprandial lethargy. The current presentation seems more complete than what I
have encountered in the past. He also states that only in America can one go to
a gym and find valet parking. He advises that one should park at the most
remote regions of a parking lot and walk. He even suggests that we park our
cars about 15 minutes from work to provide at least 15 minutes of exercise
every morning and every evening. He sees no need to buy exercise equipment or
join a gym or pay to exercise. As physicians, we have people run in place for a
two minute exercise pulse in an eight foot exam room. Americans have a hard
time thinking that anything happens unless they spend money. Much of the world
feels we have too much of that. I found Sear's system very easy to follow and
quite effective. I lost my doctor-ordered 30 pounds in six months.
Eating Well for Optimum Health by Andrew Weil, MD, (Knopf, $25) is a very
comprehensive guide to food, diet, and nutrition. As a clinical professor of
medicine at the University of Arizona, and director of the Program in
Integrative Medicine, he speaks with authority and writes in textbook fashion.
However, it is very readable. He presents the basic facts about human nutrition
that allows us to make informed decisions about weight reduction. He gives us
the pros and cons about a number of diets. He's seen fad diets come and go and
then, sometimes, come again and go again. He gives pointers on how to read
labels on food products. He provides menu plans, recipes, and guidance for
eating at home or in restaurants. In accord with his previous volumes, he gives
dietary advice for a host of common ailments. . .
To read more, please go to www.healthcarecom.net/bkrev_Health.htm#Diets.
Reading these diet books reminds me of a recent
Classic Peanuts strip in which Charlie Brown tells Snoopy that he had just read
about a new diet. You can eat all you want, but you can't swallow. After Snoopy
throws the dog dish at Charlie Brown, he awakens from his concussion stating,
"It's no fun being a waiter if you can't joke with the customers!"
Obesity is not a laughing matter with obese patients. You better not try to
joke with them. On the other hand, it's hard sometimes to be serious with them
or even bring up the subject of their weight. But then, it is no wonder that
people get confused reading diet books. The messages indeed can be confusing. I
hope, however, this has been helpful. My thanks to all the publishers for
having sent them.
* * * * *
10. Hippocrates & His Kin: The typical state of
mankind is tyranny, servitude and misery.
For those who believe in a free
society and a narrowly limited role for government, that is reason for
optimism, but it is not a reason for complacency. Nothing is inevitable about the
course of history -- however it may appear in retrospect. Because we live in a
largely free society, we tend to forget how limited is the span of time and the
part of the globe for which there has ever been anything like political
freedom: the typical state of mankind is tyranny, servitude, and misery.
Friedman gives physicians a wake up call before we lose our
profession to servitude.
The answer to Health Care
Costs
Dilbert is working on a
unique totally affordable health plan: The Google Do-it-yourself Plan. Just
give Google your symptoms. They will lead you through a self-exam, feed in your
findings, and Google will make recommendations for the right confirmatory
tests. Then find a nurse practitioner who will sign the lab requisitions and
your prescriptions.
With 95% of health care
being non-surgical, your costs should be less than $100 a disease.
To read more,
please go to www.medicaltuesday.net/hhk.asp.
The Diet Dilemma
Sixty-nine-year-old-Ruby
came in for her annual pulmonary evaluation. Among other complaints, she was
putting on weight. Her exam confirmed a 20-pound weight gain since her last
evaluation. Ruby stated that the extra pounds were NOT from the food she was eating.
"In fact," she said, "I have to eat 5 or 6 times a day because
otherwise I wouldn't get enough."
The Answer to the Diet Problem
Crossing
Streets while Listening to an iPod May Be Illegal 2/8/2007
"You may be able to walk and chew gum at the same
time, but soon you may not be allowed to walk and listen to your iPod while
crossing a street in major New York cities. That's because Sen. Carl Kruger
(D-Brooklyn) plans to introduce legislation that would ban people from
listening to music players or using electronic devices that would hamper their
awareness of their surroundings while crossing the street, said Jason Joppel,
Kruger's chief of staff. The legislation would also apply to pedestrians using
iPods and other MP3 players, BlackBerries, cell phones or other devices."
It may be safer to quit working, go on welfare, be a
couch potato and watch the idiot box.
To read more on the moral consequences
of paternalism, please go to http://www.fee.org/publications/the-freeman/article.asp?aid=2552.
To read more medical vignettes, please
go www.healthcarecom.net/hhk1999.htm.
* * * * *
11.
Physicians
Restoring Accountability in Medical Practice, Government and Society:
·
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.
·
PATMOS EmergiClinic - www.emergiclinic.com
- 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.
·
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 25–50 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.
·
Dr. Elizabeth
Vaughan is another Greensboro physician who has developed some fame for not
accepting any insurance payments, including Medicare and Medicaid. She simply
charges by the hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com.
·
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.
·
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 his
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 by Michael "the Rotweiller" Glueck,
M.D is on The French Should Be
More Like Dogs Than Frogs and can be read
at www.newsmax.com/archives/articles/2007/2/20/124439.shtml.
·
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: Rationing of necessary services under
"universal" care or go directly to www.aapsonline.org/nod/newsofday395.php. 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 HILLARY CARE AGAIN? at www.aapsonline.org/newsletters/feb07.php.
Scroll further to the
official organ, the Journal of American Physicians and Surgeons, with
Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief - www.jpands.org/. There are a number of
important articles that can be accessed from the Table of Contents page of the
current issue: www.jpands.org/jpands1104.htm.
Don't miss the excellent articles on Fee Splitting by Ophthalmologists and Optometrist or the extensive book review section that
covers ten great books this month.