WELCOME TO THE MEDICAL TUESDAY NETWORK
Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, January 28, 2003
MedicalTuesday Is Gaining Momentum in Serving the
Profession to Help People
One of our members in Southern California emailed his
offer of assistance in promoting MedicalTuesday. He wanted his friends and
colleagues to receive the MedicalTuesday letter. At the age of 82, he is
learning to use a computer. He has learned how to send email. Twice a day
he accomplishes this at the library across the street from his home. However, he
was unable to figure out how to send his address book. Since he has no
difficulty sleeping on a bus, he departed from Los Angeles on a Friday evening
and I picked him up at the station in Sacramento on Saturday morning. As part of
the learning process, he watched as I entered his email addresses into the
computer. It was late when we finished putting the names of his friends and
colleagues into the MedicalTuesday address book, so he remained that evening as
a guest in our home. After church the following morning, he returned to Los
Angeles. We welcome all of his colleagues, both physicians and nurses, who
received our electronic column two weeks ago. Of the entire list, we received
only one “Please Remove” request from a faculty member who believes in and
lectures about private practice. Since he is dependent on government grants, he
does not want the newsletter in his university email box for fear it could be
read by others. If you have received this message as a forward, please click on DelMeyer@MedicalTuesday.net
and request your personal free subscription. Be sure to forward this message to
any person you feel is or might be interested in providing patients with
confidential, high quality, personalized health care without the intrusion of the
government. Government involvement will always compromise medical care,
confidentiality and privacy.
The Real Meaning of Success or What Should Doctors
Do with Their Life?
What Should I Do with My Life? The True Story of
People Who Answered the Ultimate Question is the latest book by P O
Bronson, author of three bestsellers. Answering That Question, he found,
is important to both the working class and serial entrepreneurs. The most
debilitating obstacle in taking on The Question is the fear that making
a choice is a one-way ride that closes all other doors forever. However, he
discovered “keeping the doors open” is a trap–an excuse to stay
uninvolved. He describes Phi Beta
Slackers as those who hopped between esteemed grad
schools, fat corporate
gigs and prestigious
fellowships, appearing as if they
had their act together yet ultimately feeling like
observers who left their intellect behind. He cites a young lady with
tremendous ability and infinite choices who finally figured out that it was the
need to look brilliant that kept her from answering The Question.
Fortunately, she was able to shift gears and make strides toward answering a
more important question, “To what can I devote my life?” This question resolves
the conflict between who we are and what we do. We are all writing the story of
our own life. It’s not a story of conquest. It’s a story of discovery.
Through trial and error, we learn what gifts we have to offer the world and are made
aware of what we really need. This Big Bold Leap
turns out to be only the first step.
Physicians Should Rededicate Their Life
to Helping
People–Their Own Patients
Bronson has a lesson for us as physicians. Many in our
profession have been caught up in the entrepreneurial trap.
They obtain MBAs,
become administrators,
politicians
or Phi Beta Slackers, or in some way sell their souls to corporate HMOs, managed care, Medicare
or government medicine. These physicians think they are actually providing a
great service; however, their
involvement places the
patient - the very reason
for our existence - at the bottom of the food chain. I remember the Reverend
Dennis Schlecht once sermonizing that the greatest harm to humankind is
sometimes done by people who feel they are doing the greatest good. When we went
to medical school and then postdoctoral general or specialized training, we
answered the question, What should I do with my life? We must now answer
the more important question, To what can I devote my life?
MedicalTuesday will continue to work endlessly to
help us devote our lives to those we serve, our
patients. We will not assist the insurance carrier or government
bureaucracy that neither helps us serve
our patients nor helps our patients obtain optimal
HealthCare. Instead, these third parties
only serve as an obstruction.
Medical Gluttony
Last week, a patient nearly 50 years old came in
for an annual exam. He requested an MRI for his aching shoulder, as well as a
colonoscopy since it was an insured benefit. Examination of the shoulder was
negative and the pain was not severe enough to take analgesics. Examination of
his prostate, which also includes a stool exam, was negative for blood. There was
no family history of cancer of the colon or any type of cancer. I explained that
there was no significant medical reason for adding approximately $3000 in
consultations and procedures. He stated his wife was a nurse and wanted him to
have the MRI and colonoscopy. To evaluate how this would play out in the private
market, I asked the patient if he would still want these additional $3000 of further consultations and
tests if
a co-payment of 10 percent or $300 were
required, expecting that I would get to 20 percent or 30 percent which is where my anecdotal information
suggests the market kicks in for outpatient medicine. However, in this case, the
patient was unwilling to pay even a 10 percent co-pay. The $3,000 worth of medical costs
would not be worth $300 to him. He wanted this unnecessary “benefit” only if
other people’s money (OPM) paid for it. We would add $90 billion annually to
our health care costs if 10 percent of the population (30 million people) expects
taxpayers or premium payers to pay 10 times the value that the recipient of care
feels it’s worth. This is why all single-payer or socialized systems
throughout the world have to severely ration health care. Patients would ration
their own unnecessary health care costs if health care were subject to market
forces. This is more patient sensitive than massive prolonged waiting lists as found in Canadian Medicare, British National Health Service and other
centralized plans throughout the world that jeopardize health care.
When HealthCare Is Part of Government, it Competes
with Every Government Program
Several decades ago, when I was a visiting consultant to
San Juan Hospital in Lima, Peru’s largest hospital, I was given a tour of the
facilities. The doctors showed me seven x-ray suites and were proud to announce
that two were functional, the most that ever worked on the same day. They showed
me their ICU with four monitored beds. I saw the new monitors but no tracings.
The doctors apologized that nonfunctional equipment had been purchased from
Eastern Europe but explained that they had no control over the purchasing
process. No medical input was required for the decision to purchase equipment that
monitors life in order to avoid death. They presented this as a business
transaction. However, in a business transaction both parties have to benefit.
This purchase was a bureaucratic decision in which Peru shipped anchovies to Eastern
Europe in exchange for the monitoring equipment. Whether or not the monitors
work is not always relevant in a socialistic system. At their grand rounds, the
physicians presented a smoker with a mass at the hilum that appeared on his chest x-ray
indicating lung cancer. This diagnosis needs to be
confirmed so that appropriate medical vs surgical
treatment can be rendered. After the clinical discussion, I asked for the
bronchoscopy findings. They apologized. They did not have a bronchoscope, but
quickly stated, “We have requested one each year for the last seven years.”
(The eight hospitals in Sacramento, with varying bed
capacities from 40 to 400, each had a bronchoscope while this 800-bed hospital
had none.) When I asked how tissue diagnosis would be made to determine medical
vs surgical treatment, the thoracic surgeon stated that he would do a
thoracotomy to make the determination. He had to cut into the chest to reach the
central portion of the lung to find out if surgery was needed, when a
bronchoscopic tube through the patient’s nose into his throat would very
likely have given the answer. What if it was a “small oat cell carcinoma”
where medical treatment is preferred since surgery may hasten death? Yes,
when health care is part of government, it will always suffer.
Redding Medical Center Was Big Business at
Taxpayer’s Expense
MedicalTuesday has been following the Redding, California,
Tenet Hospital “Scandal” in several of our issues. The Wall Street
Journal again gives the most comprehensive summary: At
first glance it looked like one more corporate scandal after government raids
and audits occurred. But looking more deeply, one finds a story of the perils of
running a public company in the regulatory maze known as Medicare. Health care
providers have been gaming Medicare since that bizarrely complex federal
insurance program evolved in the 1980s into a system of Soviet-style price
controls. Medicare pays a fixed amount for a treatment regardless of costs.
Companies, in turn, search for loopholes in the system’s 100,000 pages of
regulations to make up the difference. Sooner or later Medicare discovers the
“loophole,” closes it and the cycle starts all over. Medicare is a
government bureaucracy that fell years behind on its calculations of charges to
cost ratios. Tenet has a right to increase its charges and what they did may not
be illegal. Nor is Tenet an isolated case. Tenet did quit using this loophole
which reduced revenue by $2 million dollars a day or three-quarter billion per
year. If all of Tenet’s 140 hospitals have similar revenue, this
“loophole” could amount to $100 Billion in just one hospital system. WSJ
concludes that Tenet’s problems are an example of what happens when the
private market, which prices health care via actual demand and costs, runs
headlong into Medicare’s artificial world of regulations, price caps and
overage limits. Only when Medicare is reformed to respond to market incentives
rather than to bureaucratic command and control will “frauds” like Tenet
stop happening. The real shame is that so much American business ingenuity goes
into devising ways to navigate Medicare rules instead of finding better
health-care solutions. Tenet’s most pressing problem according to the WSJ
editorial isn’t surviving a Medicare audit, but regaining the trust of its
shareholders. There are no loopholes in that game.
Generic Drugs Are Moving Through an Artificial World
of Regulations
Milt Freudenheim writes in the New York Times
that the prices of generic drugs are rising almost twice as rapidly as prices of
brand-name drugs. This is happening for several reasons. First, a large number
of patents on popular brand-name drugs expired this year, allowing makers of
generic copies to enter the market. Makers of generic drugs typically charge
higher prices when the first generic versions of expensive medicines reach
pharmacy shelves. The price of one new generic drug, which replicates the ulcer
drug Prilosec, one of the best-selling drugs ever, is so close to the price of
the brand-name medicine that at least one large insurer is not even trying to
switch patients to the generic. David Olson, a spokesman for Health Net, a big
California-based health insurer, said that its members were typically charged
$30 or $40 for a month's supply of Prilosec, and for now the same co-payment
would apply to its generic omeprazole. In addition, the generic-drug industry is
consolidating, leaving fewer companies to compete on the prices of older generic
drugs. Last month, Watson Pharmaceuticals, a large manufacturer of generic
drugs, raised the price of the tranquilizer meprobamate, the generic version of
Miltown which lost patent protection more than 20 years ago, from 12 cents to 99 cents, a
725 percent increase. Other manufacturers have raised
the prices of some older generic drugs as much as 1,000 percent. And
wholesalers, drug-plan managers and pharmacies have all found they can make
higher profits on generic drugs and still offer
prices that are typically well below those of brand-name drugs. From
January to November
2002, consumers spent
$19.4 billion on generic drugs compared with $98.6 billion on brand-name drugs. The companies that distribute generic drugs
also find them to be more lucrative than brand-name drugs. Lawrence Marsh, a health
care securities analyst at Lehman Brothers, said the wholesalers often mark up
generic drugs 10 to 15 percent, compared with a typical 5 percent markup on
brand-name drugs. Pharmacists also say they rely on higher markups on generics
because they are allowed so little profit on brand-name drugs under managed
care. We must remember that the discrimination against pharmaceutical patents,
which were shortened many years ago to benefit patients, force the companies to
recover their billions of dollars of research costs in a relatively short period
of time. This drives
the price considerably higher than would otherwise occur if
they had the same number of recuperative years that other patents receive. So,
what was designed to help patients at the expense of the pharmaceutical industry may hurt patients in the long haul.
If the industry, while trying
to provide us with the latest lifesaving drugs, is unable to recap its research
cost, it will simply be forced out of business.
NCPA Names Capitol Hill Veteran, Michael F. Cannon,
Director of Government Affairs
The Dallas-based National Center for Policy Analysis
(NCPA) announced the addition of Michael F. Cannon,
as its Director of
Government Affairs. In this role, Cannon will represent the NCPA before the Bush
administration, on Capitol Hill, and will serve as a liaison to other think
tanks, trade groups and policy organizations. Cannon comes to the NCPA from the
U.S. Senate Republican Policy Committee where he served as a domestic policy
analyst, formulating policy and counseling Senators on health, education, labor,
welfare and Second Amendment legislation, among other duties.
"I am excited to have Michael on board," said NCPA President John C. Goodman. "He is highly regarded for his Washington savvy as well as his insights into a wide range of policy issues from health care to education to economic policy."
MedicalTuesday will also be looking forward to his reports. We will return to Dr Goodman’s Twenty Myths in the next issue. There has been a revision of his book on the website, which changed the numbering sequence, but we will review the next ten myths in their original sequence over the next ten months.
MedicalTuesday Recommends the Following in Restoring
Accountability:
• The National Center for Policy Analysis, John C
Goodman, PhD, President, issues a weekly Health Policy Digest which is a
health summary of the full NCPA daily report. You may log onto NCPA (www.ncpa.org)
and register to received one or more of these reports.
• The Mercatus Center at George Mason University
is a strong advocate for accountability in government. This week we heard from Maurice
McTigue, QSO, Distinguished Visiting Scholar, who was instrumental in
revolutionizing the way government did business in New Zealand from 1984 to
1994. By looking at how effective every single government program was in
achieving the required results, New Zealand went from having the most socialized
and highly-regulated economy of any western-style democracy, to having the
freest -- reducing the cost of government from nearly half to slightly
over a quarter of the GDP. He is optimistic about the progress the Mercatus
Center is making in the US. You may request a copy of the pamphlet, “A Day in
the Life of a Regulated American Family,” which explains just where the regulatory cost of $8,000
per family per year goes. Nobel Laureate
Vernon L Smith, PhD, has joined their Economics faculty. Please log on at www.mercatus.org
to read their government accountability reports and information on Dr
Smith’s economic experiments which help us understand health care issues. You
can also register to receive updates.
• Martin Masse, Director of the Montreal Economic
Institute, is the publisher of the webzine: Le Québécois Libre.
Please log on at www.quebecoislibre.org/apmasse.htm
to review his free market-based articles, some will allow you to brush up
on your French, or to register to receive copies of his webzine on a regular basis.
• We also recommend the Ludwig von Mises Institute,
Lew Rockwell, President, as a rich source of free market materials, probably
the best daily course in economics we’ve seen. If you read these essays on a
daily basis, it would probably be equivalent to taking Economics 11 and 51 in
college, with considerably less bias. Please log on at www.mises.org
to obtain the foundation’s daily reports. You may also log onto Lew’s
premier free market site at www.lewrockwell.com
to read some of his lectures to medical groups, such as how state medicine
subsidizes illness.
MedicalTuesday Supports These Efforts in Restoring
the Doctor & Patient Interface:
• PATMOS EmergiClinic at www.emergiclinic.com,
where Robert Berry, MD, an emergency physician and internist, provides
prompt care for many of the injuries and illnesses treated in Emergency Rooms at
a fraction of their cost, as well as an internal medicine practice.
• Dennis Gabos, MD, President of the Society for the
Education of Physicians and Patients (SEPP), www.sepp.net,
for making an effort in Protecting,
Preserving and Promoting, the Rights,
Freedoms and Responsibilities of Patients and Health Care Professionals, with a
special page for our colleagues in nursing.
• Drs David MacDonald and Vern Cherewatenko for
their success in restoring private-based medical practice which has grown
internationally through their SimpleCare model network, www.simplecare.com.
They will be presenting their plan at the AAPS meetings in San Antonio on
Saturday.
• The Association of American Physicians &
Surgeons, The Voice for Private Physicians Since 1943, for representing
physicians in their struggles against bureaucratic medicine and loss of medical
privacy. The AAPS midyear one-day conference, Thrive–Not Just Survive II,
is being held this Saturday, February 1, 2003, in San Antonio. This conference
sold out last year and the hotel is sold out this year. You may still register
Online and reserve rooms at nearby hotels at www.aapsonline.org.
This workshop is co-sponsored by the Baxter County Medical Society.
Topics this year include: Opting out of
Medicare; How to set up a Cash
Practice with SimpleCare; Billing, Coding, Compliance & Pitfalls;
Save on HIPAA compliance; Prepare for and Avoid Fraud Prosecutions and
Audits and how to make your Practice Judgment Proof; Surviving Sham
Peer Review and licensing hoops. You may also call 1-800-635-1196 to register.
Stay Tuned to the MedicalTuesday.Network
Each individual on our mailing list is personally known,
or requested to be placed on our mailing list, or was recommended as someone
interested in our cause of making Private HealthCare affordable and accountable.
If this is correct, you may consider opening a folder in your inbox labeled
MedicalTuesday or copying these messages to your template file so that they are
available to be forwarded or reformatted as new when the occasion arises. If
this is not correct or you are not interested in or sympathetic to a
Private Personal Confidential HealthCare system, email DelMeyer@MedicalTuesday.net
and your name will be sorrowfully removed.
Del Meyer
Del Meyer, MD, CEO & Founder
DelMeyer@MedicalTuesday.net
www.MedicalTuesday.net