Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, July 8, 2003

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In This Issue:
1. Happy 227th Birthday America
2. American Medical Writers in Service to the Medical Professional and Research Community
3. Our Monthly Review of the Myths of National Health Insurance and Medicare
4. Heritage Foundation Explains Where Our Tax Dollars Are Spent
5. Quality of HealthCare vs Medical Errors
6. The MedicalTuesday.Network for Restoring Accountability in HealthCare & Government

Happy Birthday America
We thank all the MedicalTuesday members from a number of countries who sent “Happy Birthday America” greetings. Although July 4, 1776 is considered our birthday with the Declaration of Independence signifying government intrusion of our private lives, it took thirteen years of trial and error before we had our first president, George Washington. Hence, the world should be patient if it takes that long or longer to help an enslaved country understand what freedom is all about. But it’s worth working for. It has brought our country the greatest prosperity and standard of living found anywhere on earth. And we export it without any strings of colonialism attached. May God continue to Bless America and our Prosperity and keep us humble in the process. Even some of our California newspapers, many of which are traditionally leftist and anti-American, had front page articles on new Americans celebrating their first 4th of July by observing fireworks, eating their first hot-dogs, thanking Americans for granting them asylum, and enjoying their first taste of freedom and opportunity. Some were given jobs by second generation Americans out of gratitude to the similar opportunity given their parents or grandparents. And may we continue to be blessed with a wide readership from more than twenty-five countries as we continue to verbalize the benefits of also keeping medicine free from government intrusion of harming our patients.

My wife Linda and I spent the evening at a movie then watched from the theater parking lot the California Exposition’s 12,000 fireworks light up the skies for a solid thirty minutes–which I believe means 400 displays or detonations per minute–culminating in a unique display of an undulating American flag.

American Medical Writers Association
This week, we continue to welcome our writing colleagues, especially members of the American Medical Writers Association (AMWA), hundreds of whom have been with us for more than a year. I joined AMWA more than ten years ago when I received my first of a number of appointments to medical practice journal editorships. AMWA is holding its annual meeting in Miami September 18-20, 2003. This year we will be treated with an address by Robert N. Butler, MD, Pulitzer Prize winner, and Jerome Groopman, MD, researcher, clinician and author whose articles have appeared in The New Yorker. You may make reservations, register and join at http://www.amwa.org. Although MedicalTuesday is not a biomedical journal, essentially every issue discussed impacts Medical Writers. AMWA is an International organization. Our Code of Ethics is at http://www.amwa.org/about/ethics.html

Preamble. The American Medical Writers Association (AMWA) is an educational organization that promotes advances and challenges in biomedical communication by recommending principles of conduct for its members. These principles take into account the important role of biomedical communicators in writing, editing, and developing materials in various media and the potential of the products of their efforts to inform, educate, and influence audiences. To uphold the dignity and honor of their profession and of AMWA, biomedical communicators should accept these ethical principles and engage only in activities that bring credit to their profession, to AMWA, and to themselves.

Medicare in America
John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), states that ordinary citizens lack an understanding of the defects of national health insurance and all too often have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information in the form of rebuttal to commonly held myths. We digress from his recent update of the “Twenty Myths about National Health Insurance” to bring you his latest Wall Street Journal editorial on the “Medicare Myth.” URL for the entire article: http://online.wsj.com/article/0,,SB105667221093149600,00.html.

The Medicare Myth:  Of all the myths that dominate the debate over Medicare reform, none is more insidious than the idea that we need billions of dollars of taxpayer money to furnish senior citizens with decent coverage
for prescription drugs. In fact, reform done the right way would require very few, if any, taxpayer funds; but it means allowing seniors access to the same kinds of health plans that the rest of the nation has access to. By contrast, reform done the wrong way could cost an almost unlimited amount of money. How can we get from here to there? By employing four ideas: integration, competition, choice and patient power. Here is how Goodman contends that it could work.

•• One Premium. One Plan. Medicare violates almost all of the principles of sound insurance. It pays too many small bills the elderly could easily afford themselves, while leaving them exposed to thousands of dollars of potential out-of-pocket expenses, including drug costs. Seniors are the only people in our society who routinely buy a second health plan to fill the gaps in the first. Paying a third premium to an additional plan for drug coverage, as they would under legislation before Congress, would be even more wasteful and inefficient.

 •• Market-Determined Benefits. If seniors could enroll in the same type of health plans the rest of America has access to, they would not need a special drug card. They would not have to buy drug coverage from drug-only insurance plans that the rest of the country has somehow managed to avoid. They would simply have health insurance. In order for seniors to have access to such plans, however, the market has to be free to provide them. Some members of Congress apparently believe government should design the benefit package and let the private sector compete on the price of supplying those benefits. They have it exactly backwards. Of all the things that can go wrong, the government is much worse on designing benefits than it is on skimping on reimbursement amounts. The last thing seniors need is for Congress to continue to design their health insurance.

•• Choice of Plans. Competition implies choice. But in their zeal to create choice, some in Congress are trying to give seniors many choices among inferior plans, but denying them the opportunity to join one really good plan. The immediate goal should be to allow seniors and insurers the freedom to combine Medicare and medigap money into comprehensive health plans.

•• Medical Savings Accounts. Outside of Medicare, unrestricted fee-for-service health insurance has largely vanished from the U.S. health-care system. It has been replaced by managed-care plans (where insurers or employers choose between health care and other uses of money) and Medical Savings Account plans (where patients make those choices). Seniors need these same options.

Reform of Medicare is not easy. But true reform is impossible without a clear goal. The goal should be to let seniors be part of the same health-care system the rest of the country is in. And that goal can be reached without creating huge burdens for future taxpayers.

How is Congress spending your Tax Dollars? Do You Want Your HealthCare Dollars Mixed In With This Soup?
The Heritage Foundation takes a look at how government wastes our tax dollars by pointing out a few expenditures: $849,000 for Swine Waste Management in North Carolina; $225,000 for Hoop Barns in Iowa; $200,000 for the National Peanut Festival Fairgrounds in Alabama.

The Heritage Foundation also asks us if we know these facts: the federal government can NOT ACCOUNT for OVER $17 Billion per year in overpayments; the US General Accounting Office (GAO) refuses to certify the federal government’s own accounting books because the bookkeeping is so poor; the Department of Agriculture was unable to account for $5 billion in receipts and expenditures; the Internal Revenue Service (IRS) does not even know how much it collects in payroll taxes?

With the federal government making a 400 percent error in projecting Medicare costs and now making errors in Medicare payments of more than $12 billion, can we really trust them to even consider single-payer or socialized medicine? Making such errors when health care is 15 percent of GDP, a 400 percent error when the government portion of health care costs triples under single-payer medicine would force the United States into bankruptcy.

Government bookkeeping errors, as well as the California Energy errors, certainly makes the Enron, World Com and PG&E off-book ledgers pale in comparison. Why do we apply such emotional and colorful terms as “scandal” to the latter and not to the former?

Quality of HealthCare vs Medical Errors
In our usual section on medical gluttony and excess health care costs, there is always a quality of care issue. Frequently that is not how it is perceived. When the Institute of Medicine issued a report on Medical Errors, the immediate fall out was that doctors and possibly nurses where, if not incompetent, certainly derelict in their health care duties. The Medical Grand Rounds at our local University of California at Davis Medical Center last week devoted a full hour to a discussion of these issues. One of the early Power Point slides pointed out that 83 percent of these errors were “system errors” and only 17 percent were “information errors.” It is easy to assign blame inasmuch as system errors are transmitted by doctors, nurses and other health care workers with the captain of the team, the physician, being given the harshest criticism. However, it is not just A doctor that is to blame. If not this doctor, the same error will be made by the next doctor who writes a similar order. Thus it is the system, not a lack of knowledge on the physician’s part, that caused these so called “errors.”

As with most things in society, there are always alternate interpretations of facts. There are those that believe in the concept that society will, in time, perfect itself by controlling the human element. It was epitomized in one slide quoting Mark Twain, “God made man the last day when He was tired.” Then there are those with the opposite point of view that believe the system will never be perfected and society will improve the most when we allow the human element, the doctor, nurse and health care worker, an unfettered milieu in which to operate.

In a centralized system, such as a health maintenance organization or a single-payer or socialized medicine delivery system, the system becomes all important. Any problem, however, requires a scapegoat with the doctor receiving the brunt of the blame as if he or she were the cause for errors. In fact, it’s five times more likely that it’s a system error (83 to 17) and any doctor in a similar situation would not have avoided it, even with all the necessary “information” in his head.

MedicalTuesday believes that it is the physician and nurse practicing in a free market environment that will allow the highest level of care with the fewest errors. And every time that physician or nurse attends a medical grand rounds, a scientific forum or a specialty society meeting, the advances in medical care are instantly transformed into a higher level of care with the very next patient. When my hospital was writing protocols for delivery of care, they spent years writing them. Many were essentially out of date before implemented. But systems, like old soldiers, just never die–they just slowly fade away. But not before they do considerable damage to sick and infirmed people. Centralized errors have a life of their own; whereas peripheral or information errors are discarded as soon as they are found and instantly replaced with the latest knowledge

• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Devon Herrick wrote Twenty Myths about Single-Payer Health Insurance which we review in this newsletter monthly, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports. If you were unable to read Goodmans recent editorial in the Wall Street Journal, you may want to try the Dallas Morning News:  http://www.dallasnews.com/opinion/viewpoints/stories/070303dnedigoodman.7f562.html

• The Mercatus Center at George Mason University is a strong advocate for accountability in government. Nobel Laureate Vernon L Smith, PhD, has joined its Economics faculty. Please log on at www.mercatus.org to read the government accountability reports–their fourth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former government minister in New Zealand, and now director of the Mercatus Center’s Government Accountability Project. Their quarterly, “Ideas into Action,” which has a goal of bringing about a freer more prosperous and peaceful society, can be found at http://www.mercatus.org/pdf/materials/211.pdf. Our American Medical Writers Assn members (AMWA) will want to keep up with this economic impact on medical affairs as well as related book reviews.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website at www.galen.org. The Galen Institute's survey on voter attitudes toward Medicare and a drug benefit received a great deal of attention during the recent debate in the House. The survey showed that the president had been right from the beginning in saying that a stand-alone drug benefit was a bad idea and resources should be put into improving the program overall. The poll, conducted last week by Zogby International, showed 82% of likely voters would like the option of a private health plan approved by Medicare, and 74% of seniors consider the Senate plan worse than their present coverage.

• Greg Scandlen, Director of the “Center for Consumer-Driven Health Care” at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative and well-outlined newsletter or read the current issue by logging onto www.galen.org and clicking Consumer Choice Matters. In last weeks issue 21, Scandlen sent us greetings from the Sausage Factory found at  http://www.galen.org/happenings/ccm062503.html  The old saw is if you like sausage or legislation, avoid watching either being made. In this week’s issue 22 found at http://www.galen.org/happenings/ccm070203.html, Scandlen continues with the intrepid heroes as they were figuring out what to do with income limits on "Health Savings Accounts," (HSAs) and other intricate finaglings. Now, in the wink of an eye, all of that has been resolved, the bill has passed the House, is now in Conference with the Senate, and may soon become the Law of the Land. But Scandlen says don't be surprised if more dangers lie ahead in our ongoing saga. (That is why MedicalTuesday recommends HealthPlanUSA that does not require any laws permitting health care to be passed. Otherwise, we may not accomplish our goals in a human life span.)

• 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. You may also register to receive copies of his webzine on a regular basis. He explains Ontario's Compulsory "Volunteer" Community Service at http://www.quebecoislibre.org. “Compulsory ‘volunteer’ community service is now an integral part of the Ontario high school curriculum, without which a student cannot receive a diploma. Previously, only those convicted of having committed a criminal offense were required to do compulsory community service as all or part of their sentences.”

• The Heritage Foundation contends that the current Medicare Prescription bill, if passed by both houses, is a Time Bomb to the 78 percent of retirees that already have prescription drug coverage. They contend that this Medicare Plan will hit many hard if companies drop retiree coverage in response to a worse government coverage. Read the entire article at http://www.heritage.org/Press/Commentary/ed063003a.cfm.

• The Ludwig von Mises Institute, Lew Rockwell, President, is 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. Please log on at www.mises.org to obtain the foundation’s daily reports. You will also see the report that this year marks the 70th Anniversary of the National Industrial Recovery Act, FDR's planning legislation that created the National Recovery Administration, the NRA. Hazlitt, who succeeded H.L. Mencken as editor of the American Mercury, argues that the NRA cannot assist recovery but rather will only cartelize industry. "You expect me to tell you anything about America?" said Montague Norman to a British audience in September. "It is two weeks at least since I have been there, and in those two weeks a new situation, almost a new country, has grown up. So continuous and so great are the changes that no one who is not on the spot is up-to-date." (Wisdom 70 years before Medical Protocols Lack of Wisdom.) You may also log onto Lew’s premier free market site at  www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness see http://www.lewrockwell.com/rockwell/sickness.html.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of “educating for liberty.” It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log onto www.hillsdale.edu to register for the annual week-long von Mises Seminars which are now held every February, or their famous Shavano Institutes. A United States flag that accompanied an Air Force pilot on his 30 missions over Iraq during Operations Southern Watch and Iraqi Freedom flew at the Hillsdale College War Memorial July 3-6, 2003. The pilot, Capt. Steven A. Givler, who is Chief of Intelligence at the 12th Air Command and Control Squadron at Robins Air Force Base in Georgia, gave the flag to the College as a gift of gratitude for its dedication to the principles of liberty upon which the country was founded. “Please accept this flag–already a symbol of so much–as a sign of my appreciation for what Hillsdale does,” Givler continued, “and my belief that the more people you reach, the safer my job becomes.” The Hillsdale College War Memorial was built in honor of the fact that more of its students fought for the Union in the Civil War than those from any other nonmilitary school. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. The last ten years of Imprimis are archived at http://www.hillsdale.edu/newimprimis/archives.htm.

Del Meyer

Del Meyer, MD, CEO & Founder
DelMeyer@MedicalTuesday.net
www.MedicalTuesday.net