MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 20, Jan 29, 2008
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.
* * * * *
Why Who Wins the 2008 Election Doesn't Matter
By David J. Gibson, MD, and Jennifer Shaw Gibson
Here is a radical if not subversive concept concerning elections in today's hyper-partisan environment: Elections are not about winning. They are about gaining the permission of the electorate to govern.
It should not be a surprise that voter turnout is lower in the U.S. than in other industrialized country - the most expensive campaigns are generally the most negative and depress voter interest. Wedge issues by definition cannot accommodate compromise and therefore have no place in public political dialogue. They serve only the interests of demagogues on both sides of these issues.
What substantive issues are being avoided by politicians in this election cycle? The following are but a few we should be discussing:
America has become a developed debtor country. As Niall Ferguson, the professor of history at Harvard University, noted recently in an op/ed column in the LA Times, the problem for America is that its electorate now thinks the world owes them a living.
As we are witnessing in this political season, politicians pander to this assumption by making a series of more or less incompatible promises: that expenditure on healthcare and education will always go up; that direct taxation will never go up; and that the assets against which voters borrow will never go down. The only way to fulfill these promises is to pump out ever more printed paper - bank notes, bills, bonds, stocks and the rest. The emerging exporter countries buy these. The net result for America is a creeping transfer of financial ownership to foreign investors. This process of acquiring liquidity through the sale of paper to foreign investors is about to enter a doomsday scenario. China has stockpiled £700billion worth of foreign currency, and has only to decide to slow its accumulation of dollars to weaken or destroy America's economy. We are now hearing clear warnings from China that it will be switching away from dollars into higher valued currencies such as the Euro in the future. Such a move will likely precipitate a liquidity crisis that will crush America's economy.
Benn Steil, an economist at the Council on Foreign Relations recently observed that the U.S. "could be seeing a secular shift in confidence in the dollar as a store of value as the impression grows that the United States, to some degree, is losing control of its destiny." It matters not how many troops, missiles, bombers or aircraft carriers America's military possesses. At the point of divestment by foreign exporting investors, our economy will implode without a shot being fired. This is the clear and present danger we now face and the reality our children are inheriting.
For the past generation, America's economy is consumer-based. Consumer spending, not saving and investing has sustained our economic prosperity. Unfortunately, this consumer-based economy is not sustainable.
Stephen Roach, the chairman of Morgan Stanley Asia estimates that the U.S. net national savings is now 1.4 percent of national income and household debt at 133 percent of personal disposable income. The median American family is going into what looks like a recession owing more than 100 percent of its income.
Despite the above, according to the 2007 Retirement Confidence Survey conducted by the Employee Benefit Research Institute (EBRI), about 60 percent of people age 45 and older have less than $100,000 in retirement savings (about 40 percent of the those 45 and older have managed to save less than $25,000). In fact, of all the workers surveyed, more than one-third has less than $10,000 in savings. Despite the apparent lack of adequate savings, roughly 70 percent of all EBRI survey respondents say they are somewhat or very confident of having a comfortable retirement.
One fundamental investment that individuals in middle years and older have traditionally held in their portfolio has been equity in their home. The graph below, taken from Investor's Business Daily, demonstrates that while homeownership rate climbed to a high of 69.2 percent in 2004, the equity homeowners hold in their houses slipped in recent decades, approaching the 50 percent barrier this year. For the past decade and a half, homeowners have been extracting equity from their homes in the form of second trust deed financing to support their consumerist life style.
Beneath the staggering U.S. corporate losses - over $100 billion since the credit crisis began - lie the individuals who assumed levels of debt they won't be able to pay. The only way prices for housing got so high was that people who could not afford to buy those homes were given mortgages they could not hope to repay unless home prices kept rising. A staggering number of these mortgages were either interest-only or so-called "negative amortization" contracts that left the principal owed either unreduced or mounting after monthly payments. All of this sets up the economy for the perfect storm that will occur during the next administration's time in office. The trust funds for both Social Security and Medicare have been eradicated with over $4 trillion in borrowing to pay for prolific spending by the federal government. Most individuals retiring over the next 20 years have little if any savings. No one in public life is warning the country of the crisis that is now unfolding.
The largest industry in America cannot be fundamentally restructured without the consent of the electorate and the taxpayers (the two are not synonymous). Thus far, the political debate has centered on the current system's shortcomings. As a result, health care reform is at the top of the 2008 election agenda. Near-universal coverage is being promised by most serious presidential contenders.
There are at least three problems with the current health care reform debate. The first involves the lack of candor concerning what reforming the system will require. National polling consistently demonstrates that reform proposals that threaten - or which can be made to appear to threaten - the plans that insured Americans (who are taxpayers and tend to vote more reliably than the preponderant non-tax paying uninsured) currently have will likely face a backlash similar to the Clinton debacle of 1993. This reality has doomed Schwarzenegger's "year of health care reform" in California.
Secondly, the debate has been superficial. Changing the structure of the underwriting system for health care is easy. Restructuring the cost per unit of service and the number of units of service delivered is the hard part of the reform process. In reality, how the underwriting system is structured is of little consequence - no underwriting system can support the current inflationary trend in health care.
Finally, the government cannot fund universal coverage. In fact, the cost of existing health care entitlements has bankrupted government at all levels, from the local school board to the federal. At the national level, the magnitude of the unfunded health care retirement liability for government employees is just coming into focus. Recent estimates by various benefits consulting firms of the total amount of public sector unfunded retiree health care obligations have exceeded $1 trillion. To put this in perspective, according to the Federal Reserve Board, the total amount of outstanding municipal securities in the United States as a whole at the end of the first quarter of 2007 was $2.5 trillion.
All of the above does not include the economic tsunami that both Medicare and Medicaid now represent. Medicare Part A expenditures alone are expected to grow 85 percent to $385 billion, and the projected annual shortfall between tax revenue and spending will grow to nearly $45 billion in 2016. The Medicare Trustees this year estimated that filling this shortfall in Medicare will require an income tax increase of 22.7 percent by 2030.
Since the passage of the 16th Amendment to the Constitution in 1913, the paradigm for the successful politician has been essentially unchanged. Once elected, politicians use taxpayer money to purchase goodwill of the electorate, to ensure longevity in office. Most of this spending has been financed through borrowing by government at all levels. With the ability to borrow now limited and the magnitude of the already-promised entitlement funding overwhelming, we face the reality of a perfect storm in public policy. Future politicians will of necessity be taking prized goodies away from their constituents. They will need to increase tax rates to near confiscatory levels, decrease spending by reneging on prior entitlement commitments, or a combination of both.
The new politician will look much like Tom McClintock here in California, a policy wonk who understands the precarious future facing public financing of government. America has no experience with this type of politician. How does a politician get elected by taking away programs and increasing tax rates simultaneously? Clearly, no current candidates from either party have any grasp of the imminent problems facing the country.
Unfortunately, the current outrageously expensive political season is not about governing, it is about winning. In place of substantive debates dealing with the above issues, we get sound bites accusing opponents of lacking fidelity to Ronald Regan or Martin Luther King. Promises are made to enact universal health care when knowledgeable insiders know that this is not feasible. The result: it does not matter who wins. Inconsequential social issues that should not be part of the public debate will be influenced but the winner will have neither the political capital nor the mandate from the electorate to govern in these perilous times.
David Gibson is a senior partner and Chief Medical Officer at Illumination Medical, Inc., a health care consulting and medical management company. Jennifer Gibson is an economist specializing in evolving health care markets as well as a futures commodity trader specializing in oil and gas.
To read the original, please go to www.ssvms.org/magazine.asp and click on the January 2008 issue.
* * * * *
2. In the News: Ranking the U.S. Health-Care System, By Jim Peron, The Freeman: Ideas on Liberty - November 2007
It is curious that the United States ranked below Europe in the World Health Organization's 2000 World Health Report, which rated 191 countries' medical systems. In his documentary Sicko, socialist Michael Moore makes hay out of the fact that the United States placed 37th, behind even Morocco, Cyprus, and Costa Rica. This ranking is used to "prove" that state-controlled health care is superior to the "free market."
This ranking is curious because the actual life expectancy of the average American differs very little from that of the average European. At birth, average life expectancy in the European Union is 78.7. For the average American it is 78. And this doesn't adjust for factors that can affect the averages which are unrelated to health care, such as lifestyle choices, accident rates, crime rates, and immigration. Health isn't entirely about longevity but it certainly is a major component.
What is not mentioned by Moore, or others citing the WHO report, are the measures being used to rate the various countries and who is doing the measuring. There are many ways to nudge ratings in one direction or another that are not directly related to the actual item being measured.
For instance, one might produce a study on transportation. The purpose of transportation is to get people from where they are to where they wish to be. You might rate how quickly people can move, how cheaply they can move relative to their income, how conveniently they can move, and how free they are to move.
You would think the United States would rate high in such a study. Americans tend to be wealthier than the rest of the world. There is widespread ownership of cars. Gasoline prices are lower than in most other countries. On average, the typical American can travel quicker, cheaper, and more conveniently than people in most parts of the world. But what if this index included other factors as well? For instance, if a major component was the percentage of commuters who use public transportation, that would push the United States far down in the ranking. A larger percentage of the people in other countries have no other option but public transportation.
In 2000, when the report was issued, WHO was run by Gro Harlem Brundtland, a former prime minister of Norway and a socialist. She doesn't think the results of a health system alone are important. Rather, she wants to know if the system is "fair." In introducing the WHO report she wrote that while the goal of a health system "is to improve and protect health," it also has "other intrinsic goals [that] are concerned with fairness in the way people pay for health care." She is clear about the ideological factors she thinks are important: "Where health and responsiveness are concerned, achieving a high average level is not good enough: the goals of a health system must also include reducing inequalities, in ways that improve the situation of the worst-off. In this report attainment in relation to these goals provides the basis for measuring the performance of health systems."
True to her ideological roots, Brundtland prefers socialized medicine over private care. Drawing her first conclusion about what makes a good medical system, she declares: "Ultimate responsibility for the performance of a country's health system lies with government. The careful and responsible management of the well-being of the population – stewardship - is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent."
One WHO discussion paper states, regarding "fairness" in financing, "we consider only the distribution, not the level, as there is no consensus on what the level of health spending should be." Equal results, not necessarily good results, are the focus.
When Moore or others refer to the WHO index as proof that private health care doesn't work, they aren't being totally honest because they fail to disclose that the index lowers the scores of systems that don't satisfy socialist presumptions.
A Second Rigged Study
The New York Times in August editorialized that American health care "lags well behind other advanced nations." The newspaper relied in part on the WHO rankings as proof. For the rest, it relied on a more recent study by the Commonwealth Fund. But that study, which compared the United States to five other wealthy countries, has weaknesses similar to the WHO study.
The Commonwealth Fund marked down the United States partly because "All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefits packages with no cost-sharing by the patients." Again the American system loses points because it doesn't provide socialized medicine. And the Times neglected to note that "no cost-sharing" means the people have paid through taxes whether they receive the care or not. . .
Finally, the United States is ranked last among the six nations surveyed in infant mortality. What is not discussed is that nations define infant mortality differently. Any infant, regardless of size or weight or premature status, who shows sign of life is counted as a live birth in the United States. Germany, which ranks number one in the Commonwealth Fund survey, doesn't count as a live birth any infant with a birth weight under 500 grams (one pound). How valuable is a comparison under those circumstances?
One could easily design a survey that would rank American health care high and other nations low. But this does not mean the American system is what it should be. Its successes and innovation can be attributed to the vestiges of freedom, but government has saddled the system with so much intervention that it is far from market oriented. Instead of worrying about irrelevant international rankings, we should be working toward freeing the medical market.
To read the entire article: www.fee.org/publications/the-freeman/article.asp?aid=8184&print_view=true
Jim Peron is a writer living in Berlin, Germany.
* * * * *
What Next? · Post-birth deaths 'probably linked', say experts
Around 140,000 patients were discharged after being inadequately fed on NHS wards last year, statistics obtained by the Conservatives reveal.
The number released from hospital suffering from malnutrition, nutritional anaemia, or other nutritional deficiencies has risen by 84 per cent in the decade since Labour came to power, from 74,431 in 1997 to 139,127.
The vast majority arrived in hospital suffering from these conditions. But the Department of Health figures also show the nutritional condition of at least 8,500 patients actually worsened while they were in hospital in the last year.
National Institute for Health and Clinical Excellence guidelines say all patients should be screened for signs of malnutrition on admission to hospital and treated accordingly.
Campaigners complain that elderly people in particular are not given enough help to eat in hospital.
There has also been a rise in the number of patients being admitted to hospital suffering from malnutrition to 130,594, up from 70,658 a decade ago.
The figure rose by 12 per cent in the last year alone.
The shadow health minister Stephen O'Brien, who obtained the statistics, described them as a "scandal".
He said: "Malnourished patients are more prone to infections, have more complications after surgery, and have higher mortality rates - yet the Government allows more than 130,000 patients to enter hospital in the state. . .
"It is a scandal that in 21st-century Britain, we allow vulnerable patients to be let out of hospital in a malnourished state, and it is even worse that we allow thousands of patients to get more poorly while they are in hospital."
The worst area in the country for malnutrition was the Pennine Acute Hospitals Trust in Greater Manchester, where 4,947 patients were discharged suffering malnourishment, followed by the University Hospitals of Leicester NHS Trust, with 2,771, and the Newcastle upon Tyne Hospitals NHS Foundation Trust. . .
Last year, the health minister Ivan Lewis admitted patients were being starved on wards, with some elderly people given little more than a scoop of mashed potato for lunch.
Others were "tortured" by having meal trays placed out of reach, which they were too weak to pull towards them. . .
"Nurses are so rushed off their feet that it is no surprise that patients end up malnourished.
"We have heard stories of elderly people who haven't had a meal all day because they have just been overlooked. The food is just taken away when the patient hasn't been able to eat any of it.
"It is a scandal in the 21st century - it ought never to happen."
The NHS does not give timely access to health care, it only gives access to a waiting list.
And if you make it past that, you're on a starvation list.
Oh, the tragedy of government medicine!
* * * * *
4. Medicare: The Rising Burden of Health Spending on Seniors, by Liqun Liu, Andrew J. Rettenmaier and Zijun Wang, NCPA Study No. 297
The United States spends about 17 percent of its national income on health care, the highest in the world. Some have wondered how high spending can go and what difference it will make. In thinking about that question, the experience of our senior citizens provides a vital clue.
Much of seniors' health spending is paid not by seniors themselves, but by public and private third parties like Medicare, Medicaid and previous employers. However, as spending on their health care rises, seniors will be asked to devote an increasing share of their own incomes to pay for it, crowding out other items like food, housing and travel.
Another way to look at health care spending by the elderly is to compare their total health consumption to their money incomes:
Since Social Security represents such a large portion of seniors' retirement income - particularly for older seniors - examining health spending as a percentage of Social Security benefits is also informative:
If health care spending rises as expected, seniors will likely be called upon to share the burden. That means current and future workers will need to extend their time in the labor market - or save and invest more money while working - to prepare for the higher expected health care costs waiting for them in retirement.
To read the entire extensive report, go to www.ncpa.org/pub/st/st297/.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
I recently saw a senior citizen for an initial evaluation because his physician had retired. After spending an hour interviewing him, examining him, and going over the need for tests I thought would be important, we arranged for some of these laboratory and x-ray appointments.
He came back a few weeks later and said he had all the tests done and many more. He had discussed his situation with the seniors at his residence who from experience told him that the fastest way to get a number of tests done without spending a week or two going from appointment to appointment was to go to the emergency room. He was also told that he should have an urgent reason for evaluation such as chest pain or a blackout spell so the ER doctor would do a thorough evaluation.
So he followed his friend's suggestions and had himself taken to the ER for chest discomfort and light-headedness. He returned to make sure he had obtained everything I had requested. He bragged about the tests he was able to achieve in the course of one afternoon.
With HIPAA, it is more difficult to acquire his hospital records but by faxing his written permission and requesting the records, my staff was able to obtain them within 30 minutes. HIPAA really interferes with the smooth practice of medicine, but we saw a couple of other patients while this administrative work was accomplished.
In the ER he not only had a chest x-ray, electrocardiogram, and blood tests, he also had an ECHOcardiogram, CT of his brain and Doppler of his carotid circulation in his neck. He then had a CT of his chest and abdomen to make sure nothing was missed by the ER doctors of what "else could have caused multi-organ system symptoms."
When I pointed out that he had far more extensive and expensive tests than I thought was necessary, he seemed astonished. "Don't you think it is marvelous that I was able to get everything you wanted in one evening and even far more?"
"But I had scheduled these tests in the private offices of the lab and radiologist which are far cheaper. You had them all in the hospital which charges at least two or three times as much as private doctor labs and x-rays. So these three to five hundred dollar tests are all being charged to Medicare for $1000 to $1500. Don't you think this is a lot of money?"
"But it's my health that's at stake. I think I deserve whatever Medicare thinks I deserve. And it only cost me one ER co-payment of $25 instead of three or four co-payments. A guy has to watch his costs, doesn't he?"
I ended the dialogue at this point realizing that his attitude was similar to a lot of Medicare patients. More and more is never enough. But what is the answer?
Health care reform is evolving. More physicians and health planners are recognizing the gluttonous habits of American patients. There has to be a percentage co-payment on every office visit, hospital stay, lab test and x-ray so that the patient begins policing his own gluttony. Even a 20 percent co-payment on this hospital ER outpatient evaluation would have made him begin to appreciate his gluttony after the first thousand or two dollars of testing before he ever reached the $10,000 this evaluation was charged. He would have stopped after the initial sequence of tests was normal. And before the month was over, he might have begun to realize that 20 percent co-payment of the private outpatient facilities would have been less than a third of the 20 percent of the hospital ER outpatient hospital facilities. He then would have gotten the reasonable tests we initially ordered. Health care costs would have policed themselves because patients will monitor every single cost and bring them down to the lowest level without any bureaucracy, HMO, insurance, government, Medicare, Medicaid, or VA intervention.
Health Care Reform is actually Very Simple.
A percentage co-payment will place the patient in charge instantly.
The patient will get costs to the rock bottom immediately without any other regulations.
Then Congress could go home and not interfere with the practice of medicine.
But could they? Would they? Will they?
* * * * *
Health Alert: Subj: Malpractice Solved
You are going to be a Good Samaritan. You are about to become a kidney donor so that someone else can live. The odds are in your favor. Only about 2 out of 10,000 fail to survive the operation.
Still, what if you were one of the two? What happens then?
Under the current system, there are only two options. Neither is very attractive.
On one hand, your spouse, children, heirs, et al., could hire a lawyer, subpoena documents and take depositions to see if malpractice has occurred and compensation is due them. Or they could accept the financial and emotional loss stoically - forever wondering if your death was preventable.
Fortunately, your friends at the National Center for Policy Analysis have discovered a new and better alternative. Prior to your surgery, you are asked to sign a contract with these terms:
1. You agree to waive your right to pursue any malpractice claim.
2. If you fail to survive the operation, your family gets a check for $1 million. No lawyers, no courtroom, no judges, no jurors - just a cool million, no questions asked.
3. For pennies on the dollar (out of your pocket), you can make the compensation even larger, say, $2, $3 or $4 million.
4. The hospital pledges to make all safety records public; and to facilitate comparisons, they are available at a special Web site.
Voila! Problem solved. Can it get any better than that? . . .Well. . . as it turns out. . . it can.
You go to the Web site and compare. There you discover that other hospitals offer larger amounts of compensation in case of an adverse event. In fact, Hospital B offers $2 million if you fail to survive.
Upon further investigation, you learn why.
Your chances of dying at Hospital A (your original choice) are twice as high as at B. So if Hospital B pays the same insurance premium as Hospital A, it can offer twice as much.
You have your procedure done at Hospital B. Fortunately, it's a success and another five months go by.
Then out of mere curiosity you return to the Web site and make an amazing discovery. All the hospitals are now offering the same compensation for kidney transplant fatalities. The reason: they now all have the same safety record.
Think about that. In less than six months, market incentives have accomplished what all the RWJ demo projects, Commonwealth studies, Health Systems Change conferences, HHS press releases, Newt-Hillary political alliances, and hectoring, harping, bullying, shaming, niggling, nagging speeches, editorials and op-ed pieces have not been able to accomplish since the dawn of time. (Okay, it only seems that long.)
Here's the basic idea: hospitals and doctors can get out of the malpractice system completely (other than for gross negligence) by agreeing to compensate patients for rare, unexpected adverse health events. The legislature decides (or sets up a procedure for deciding) in advance what the minimum compensation must be. To pay off the claims, providers purchase episode-specific insurance. The insurers (not bureaucrats, not lawyers, not even patients) then become the true monitors of safety - charging premiums that accurately reflect expected outcomes.
In no time at all, bad doctors and bad medical practices will vanish. They will be priced out of the market by insurance premiums they cannot afford to pay. Malpractice becomes very rare; high quality and safety become the norm; patients and their families get compensated, regardless of the cause of their injuries; and trial lawyers can go earn an honest living.
Space does not permit a full elaboration of details. You can find those at the NCPA Web site.
For the NCPA study on malpractice reform, go to: http://www.ncpa.org/pub/bg/bg163/bg163.pdf.
Have a good day,
National Center for Policy Analysis
12770 Coit Rd., Suite
Dallas, Texas 75251
Comment on this Health Alert at www.john-goodman-blog.com/.
* * * * *
Dr. Edwards: Well the elections are next week. Anyone willing to stick their necks out?
Dr. Dave: Mrs. Clinton has promised to destroy health care and complete what she didn't accomplish in 1992.
Dr. Edwards: Doctors will survive the enslavement or get out of practice. With all this hostility we have, I think the government would be happy about that.
Dr. Dave: But our patients would be thrown to the wolves. They wouldn't have any idea of what ate them?
Dr. Sam: I've quit worrying about this. I've got some good leads on non-government positions that I could immediately step into if my practice becomes too onerous.
Dr. Ruth: But wouldn't you miss your patients?
Dr. Sam: Certainly. But I can't be their savior from the ravenous wolves. They would just as soon eat me also.
Dr. Michelle: I'll just keep practicing no matter what happens. I'll do my 9 to 5 job and let the government worry about the rest of it.
Dr. Rosen: But will they let you?
Dr. Michelle: They will want me to see patients from 9-5. With all of you leaving, they will be even kinder to me for staying with it. They will begin paying me more to keep seeing patients.
Dr. Rosen: You have a point, Michelle. But I can't imagine the government ever liking me.
Dr. Edwards: But Mrs. Clinton isn't the only one that will destroy healthcare. Look at Mitt Romney. He introduced government medicine in Massachusetts. He's changed his mind but I would never trust a Chameleon.
Dr. Ruth: He also was for prenatal killing until he found out that his party didn't approve and he became a chameleon in that regards also.
Dr. Yancy: That malpractice lawyer who made his millions suing doctors has made it very clear that he would eliminate all choice in medicine. He would also force coverage of preventive care. That should double health care costs and be totally ineffective. People enjoy preventive care programs. It's like group therapy. People are social beings and just love to talk and discuss. But it doesn't change behavior.
Dr. Edwards: I've seen people choose smoking withdrawal programs that didn't make a big issue out of stopping smoking. One patient told me he joined Smoke Enders because you could keep on smoking. They just enjoyed the camaraderie of the group all supporting their inability to stop. Counter productive.
Dr. Rosen: I had a friend of Huckabee's in my office the other day. Boy did I get an earful. I think Huckabee is for big government European style. We would have pseudo-religious parties, like Christian Democrats for big government, and total control and more taxes. I think we need to be less like Europe than more.
Dr. Dave: I'm leaning to McCain more and more. As the WSJ stated, he, like Eisenhower, is the right man for the White House at this time in history.
Dr. Edwards: But he's for opening our borders.
Dr. Rosen: But he would never get that implemented. He has a better grasp of world affairs than any other candidate. Unless something else happens, I hope he's our candidate.
Dr. Michelle: I rather like Obama. He has fresh ideas for change.
Dr. Edwards: He's a bright lad. But he needs another eight years in the Senate to mature and get a grasp of world affairs and then he will be unbeatable.
* * * * *
Orange County Medical Association Bulletin: Guest Editorial - Variables in the Art of Medicine by Patrick Sheehy, MD, 9/1/07
As a handicapper, golfer and practicing physician, I take variables very seriously. They are the enticing emissions of possibility that spring from every difficult, soluble problem. Effective management of variables requires freedom, judgment, intuition and courage.
Here are seven ideas to restore the art of medicine.
In handicapping horse races, there are three major
variables and six minor ones to consider. Still, the best handicappers can only
consistently hit one out of three winners.
In swinging a golf club, there are also a limited number of major and minor variables to manage if the golf ball is to move from the tee into the cup.
In the practice of medicine, variables dominate, yet they are seldom mentioned in discussions about the field. Further, recognition of variables rarely emerges in analysis of quality by managed care organizations, government agencies, insurance companies or systems analysts.
As a handicapper, golfer and practicing physician, I take variables very seriously. They are the enticing emissions of possibility that spring from every difficult, soluble problem. Effective management of variables requires freedom, judgment, intuition and courage.
About the problem of spiraling healthcare costs--which exceed $2 trillion, or $7,000 per person, annually--governments, insurance companies, college professors and systems analysts seem to be either indifferent to or not cognizant of the variables controlling the interaction between disease and society.
In fact, managed care is antagonistic toward managing variables. The proof is that since managed care was introduced, the cost of healthcare has quadrupled, possibly because freedom, judgment and intuition have been hindered or denied. This miscalculation was like Pavlov being obsessed with the dog's wagging tail and not observing the excessive salivation. Managed care has corrupted physicians, sacrificed patients and assured financial success for insurance companies.
W. Edwards Deming and his followers advised that the complexity of disease could be simplified. Healthcare could be placed on a conveyer belt and delivered like an automobile being assembled. Doctors and nurses, seated around the conveyor belt, could manufacture increasingly better products, and the Japanese "automobile miracle" would be repeated in healthcare. The hypothesis promoted petrifying consistency to achieve quality, cost reduction and consumer satisfaction.
Forgotten in this model is that the art of medicine is a juggling affair managed by a practitioner's skill, judgment and daring. The systems people, never having practiced medicine, never understood all the variables.
The variables inherent in all patients, diseases and doctors confound the systems people. Further, the additional variables of oppressive government regulation, greedy insurance companies and megalithic hospitals have increased--not decreased--the complexity of the art of medicine. All of these interfere with the juggling affair that is medical practice. And nothing can heal the situation except physician moral courage and leadership, which are both in scarce supply.
When golfers and handicappers loose their finesse, they return to basic maneuvers to eliminate kinks. Below are my recommendations to restore the art of medicine:
-Physicians should contract with no one other than their patients, and physician fees should be the end result of open competition.
-Patients must be held responsible for managing costs by paying a portion of each bill, and healthcare costs must be made tax-deductible . . .
-All megalithic hospitals should be abandoned (or converted into hotels). Through entrepreneurship, leaner, meaner and disease-orientated centers should be established . . .
should die the death of communism--a dictatorial, expensive and corrupting
-Physicians must avoid all conflicts of interest when caring for patients.
There should be no investments in profit-making ventures where increased use would increase income. Prosperity should come from innovation and efficiency; pride should come from finessing the art of medicine.
To read the entire OpEd, go to www.socalphys.com/article/articles/545/1/Guest-Editorial---Variables-in-the-Art-of-Medicine/Page1.html/print/545.
Patrick Sheehy, MD, is a Newport Beach-based oncologist. He can be reached at email@example.com.
* * * * *
The University of Chicago was founded with John D. Rockefeller's money, and numerous public libraries were created through the philanthropy of Andrew Carnegie. People hear about philanthropic success stories and generally assume that charitable foundations are doing wonderful things with the fortunes of the nation's superrich. In fact, there is a common view that the charitable work done with the wealth amassed by business tycoons is a "giving back to society" that at least partially atones for their undoubted transgressions against law and/or morality.
But how often do people think about philanthropic blunders? Who reflects on the possibility that charitable foundations might actually do harmful things with the money at their disposal?
There is only one such person who comes to mind: Martin Morse Wooster, author of Great Philanthropic Mistakes. Wooster has made quite a study of philanthropy. His earlier book The Great Philanthropists and the Problem of Donor Intent examined the tendency for charitable foundations to be taken over by "experts" who overwhelmingly have a leftist outlook and steer the foundation's giving in ways that are often radically at odds with the philosophy of the donor. With his current book Wooster delves into the hubris of those "experts" who usually think there is no limit to the good they can do with vast sums of money. The trouble is that they often do no good at all - and sometimes considerable harm.
Wooster focuses on eight cases where huge foundations made mistakes: the Rockefeller Foundation's attempt to recast American medical education; the Lasker Foundation's war against cancer; the population-control campaign of the Ford and Rockefeller foundations; the Ford Foundation's "Gray Areas" program; the Carnegie Corporation's public-television campaigns; the Ford Foundation's school-decentralization initiative; the MacArthur Fellows program; and the Annenberg Foundation's public-school-reform crusade. After reading about each one, my mind was drawn to Milton Friedman's observation that no one spends other people's money as carefully as he spends his own.
Foundations don't act. The people who run them do. Wooster's eight cases center on foundation decision-makers who had grand visions for changing the world. Arguably, the one who best exemplifies the typical mindset was Ford Foundation president McGeorge Bundy. Bundy, who ran the giant in the 1960s and 1970s, once declared, "I may be wrong but I am never in doubt." It's that lack of doubt that is the root of the problem time after time. Ford's "Gray Areas" program is an excellent example. . .
Another illustrative failure Wooster highlights is the Annenberg Foundation's gigantic effort at public-school reform in the 1990s. Walter Annenberg made his money in magazines, especially TV Guide. His foundation announced in 1993 the "Annenberg Challenge" in which it put up half a billion dollars . . . All the funding, however, went into the educational status quo, which happily absorbed the money and went about business as usual. In 2002 the Annenberg Foundation published a report loaded with bromides such as, "[P]ublic education in America is better than its image," but conceding that public schools had not significantly improved despite all the money lavished on "reform."
To read the entire review, go to www.fee.org/publications/the-freeman/article.asp?aid=8153.
George Leef is book review editor of The Freeman.
* * * * *
It's been said that Ministers can forgive people's mistakes; they can do penance for their own mistakes; doctors can bury their mistakes; hospitals just make the medical records more voluminous so no one can find them; attorneys can lock up their mistakes; architects advise their clients to grow bushes and vines to camouflage their mistakes.
We try out best to avoid MISTAKES - but regulations in
medicine causes us to make even more.
Isn't the answer to decrease mistakes obvious?
Sign on the door of a law office: Hire an attorney. Get a second one free.
You suppose the third one is half price?
MENTAL HOSPITAL PHONE MENU
Hello and thank you for calling the State Mental Hospital. Please select from the following menu options:
If you are obsessive-compulsive, press 1 repeatedly.
If you are co-dependent, please ask someone to press 2 for you.
If you have multiple personalities, press 3, 4, 5 and 6.
If you are paranoid, we know who you are and what you want, stay on the line so we can trace your call.
If you are delusional, press 7 and your call will be forwarded to the Mother Ship.
If you are schizophrenic, listen carefully and a little voice will tell you which number to press.
If you are manic-depressive, it doesn't matter which number you press, nothing will make you happy anyway.
If you are dyslexic, press 9696969696969696.
If you are bipolar, please leave a message after the beep or before the beep or after the beep. Please wait for the beep.
If you have short-term memory loss, press 9. If you have short-term memory loss, press 9. If you have short-term memory loss, press 9.
If you have long-term memory loss, please hang up and try again to morrow. Maybe you'll remember then.
If you have low self-esteem, please hang up our operators are too busy to talk with you.
If you are menopausal, put the gun down, hang up, turn on the fan, lie down and cry. You won't be crazy forever.
During National Mental Health Care week, please do your part by remembering to contact at least one unstable person to show you care about them?
To read more vignettes, please go to www.healthcarecom.net/hhk1997.htm.
* * * * *
• 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 - 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."
• 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.
• 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 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 about Insurance Companies Robbing Patients.
• 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: New York: state-controlled hospitals, possible $50,000 malpractice surcharge on doctors. 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 Universal Coverage. 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. Be sure to read the important article on the AAPS win over the Texas Medical Board: Nation's Worst Medical Board Met Its Match at Extraordinary Hearing by Attorney Andrew Schlafly.
* * * * *
Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp, enter you email address and join the 20,000 members who receive this newsletter. If you are one of the 50,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above.
Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
To read the rest of MedicalTuesday, go to www.medicaltuesday.net/org.asp.
Words of Wisdom
Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.
Peter F. Drucker, the Man who invented Management: The ultimate test of management is performance. Management is a practice rather than a science or profession, although containing elements of both. No greater damage could be done to our economy or to our society than to attempt to professionalize management by licensing managers or by limiting access to management positions to people with a special academic degree.
Paranoia, hubris, and hatred - the unraveling of the greatest chess player ever, by Rene Chun
Bobby Fischer's Pathetic Endgame: He was, after all, Bobby Fischer - the greatest player in the history of the game.
Bobby Fischer was singing the blues. As he wailed along with a 1965 recording by Jackie ("Mr. Excitement") Wilson, his voice - a gravelly baritone ravaged by age but steeled by anger - rumbled through the microphone like a broken-down freight train on rusty wheels: "You go walking down Broadway, watchin' people catch the subway! Take it from me, don't ask for a helping hand, mmm, 'cause no one will understand!" With each note he became increasingly strident. "Bright lights will find you, and they will mess you around! Let me tell you, millions will watch you! Have mercy now, as you sink right down to the ground!" Even if you knew nothing about Bobby Fischer, listening to him sing this song would tell you all you needed to know. "There just ain't no pity. No, no, no, in the naked city, yeah - New York City."
This unlikely duet, featuring Jackie Wilson and the world's first and only chess grand master fugitive from justice, was broadcast live, on July 6, 2001, by DZSR Sports Radio, a Manila-based AM station that has embraced Fischer as a ratings booster. In exchange for these rare interviews (Fischer hasn't given a magazine or TV interview in thirty years), Sports Radio management has happily provided Fischer with hours of free airtime to spin his classic R&B records and to lash out at his enemies, both real and imagined. . .
This radio broadcast was Fischer's seventeenth in the Philippines. The bizarre karaoke interlude was a departure of sorts, but otherwise the broadcast was no different from the previous sixteen. Fischer's talking points never vary.
To read the entire obit, go to www.theatlantic.com/doc/200212/chun.
On This Date in History
Chinese New Year Began on January 29th in
the year 2006. Gung Hay Fat Choy! This is the Chinese greeting for the New
Year. America's 2006 is China's 4704
and according to Chinese
zodiac, it was also the year of the dog.
Anyone who was born in the Year of the Dog is now 12, 24, 36, 48, 60, 72, 84 or
96 years old.
In China, New Year is the most important holiday, and it is observed by Chinese all over the world. Since ancient times, Chinese people have been welcoming in the New Year and chasing away the evil spirits by setting off firecrackers. Large crowds gather in the narrow streets of Chinatown in New York, San Francisco and other cities. A cloth dragon dances in the streets. Following the dragon are people playing drums and gongs, and lion dancers with paper lion heads on sticks. As they pass, store and business owners give them money.
On this date in 1861, Kansas an area often referred to as the American "Heartland," was admitted as the 34th state into the union. It is named after the Kansas River that flows through it, which in turn was named after the Kansa tribe, who inhabited the area. The tribe's name (natively kką:ze) is often said to mean "people of the wind." Residents of Kansas are called "Kansans".
Historically, the area was home to large numbers of nomadic Native Americans that hunted bison. It was first settled by European Americans in the 1830s, but the pace of settlement accelerated in the 1850s, in the midst of political wars over the slavery issue. When officially opened to settlement by the U.S. government in 1854, abolitionist Free-Staters from New England and pro-slavery settlers from neighboring Missouri rushed to the territory to determine if Kansas would become a free state or a slave state. Thus, the area was a hotbed of violence and chaos in its early days as these forces collided, and was known as Bleeding Kansas. It was admitted as a free state in 1861.
After the Civil War, the population of Kansas exploded when waves of immigrants turned the prairie into productive farmland. Today, Kansas is one of the most productive agricultural states, producing many crops, and leading the nation in wheat and sunflower production most years.