For Better Health Care
Vol IV, No 7,
Review: From the PHYSICIAN PATIENT BOOKSHELF - An Old Message with Modern
- PATIENT POWER - The Free-Enterprise
Alternative . . .
* * * *
Smedinghoff, a health care Actuary, responded last week to a
HealthBenefitReform question regarding an important insurance principle.
“Rather than bother with the implications of the term ‘risk pool,’ I
will simply note that anyone who purchases any form of insurance is, by
definition, (assuming they aren’t fraudulently representing themselves to
the insurer) paying more than their expected loss. If a health insurer
calculates that the average person of your age, sex and health class will
spend $2,000 in health care this year, it will charge you perhaps $2,500 for
the insurance. The $500 excess
amount above your expected loss ($2,500 - $2,000 = $500) represents what
you’re willing to pay for the financial protection against a much larger
loss. That’s why it’s called an insurance premium.
The cost exceeds its nominal value.”
responding to the question, Gerry Smedinghoff reminds us that a portion of the
annual premium for the high deductible health plan is diverted (or pooled)
each year to pay claims of others who have incurred large health care
follows is the introduction to a work-in-progress paper I am writing to
explain the foibles and folly of Social Security, corporate pensions and other
unfunded liabilities such as Medicare. Note
that the premium in the example below is the fence (the extra cost to protect
one's property) or the wheat, (the extra cost for possible future crops), but
nevertheless it’s still a premium.
exponentially increasing wealth in Western society, created by
industrialization, coupled with the advances medical science, allowed the
working class - for the first time in human history - to outlive their useful
productive life span. This opportunity also presented a problem to working
classes for the first time in human history: the risk of outliving one’s
savings, and dying prematurely from poverty as the result of a lack of proper
planning and a market of robust financial products to protect their savings.
course, where there’s a risk, there’s a need for insurance. In modern
society, we face four basic risks of everyday life: property, income,
expenses and investments. And
we purchase insurance to protect ourselves against these risks.
Risks are your auto and home.
If your car gets stolen or your house is destroyed by fire, you can be
financially ruined. These
problems are easily solved in the short-term by property and casualty
insurance, which take into account the value of the property you own and the
probability it will be stolen or destroyed.
risks are dying too young and becoming disabled. If either of these tragedies strikes you, your family will suffer. If
you die too young during your working life, life insurance replaces your lost
income and takes care of your family. And if you become physically
incapacitated, disability insurance replaces your lost salary.
risk is living too long and running out of money before you die.
If you live longer than normal, a guaranteed pension or annuity is
designed to make sure that you don’t outlive your retirement savings.
risk is that your financial assets that represent your savings will drop in
value or become worthless.
people find the topic of insurance to be overly technical and far too complex
for their understanding. However,
the concept of insurance is very simple, and can even be illustrated
without using money. Ultimately,
insurance is an immediate small fixed reduction in wealth, in exchange for
protection against a future large uncontrollable loss.
see how simple the concept of insurance can work in practice, consider a
farmer who grows wheat on a plot of land next to railroad tracks.The greatest threat to his wheat crop is during the dry hot summer
months, from sparks that fly off the tracks when trains go by, which can
easily set his wheat field on fire, thus destroying his entire crop. To
insure his wheat crop against accidental destruction by fire, the farmer has
two options which involve taking an immediate small fixed reduction in his
Not planting any wheat within 50 feet of the railroad tracks,
so the sparks that fly off will land harmlessly on the dirt.
Here his immediate fixed loss amounts to the value of the extra crop he
could grow by planting wheat all the way up to the base of the tracks.
Building a fireproof fence along the tracks,
which would catch all the sparks flying off the tracks, thus allowing him to
plant his wheat on the 50 feet of dirt next to the tracks. Here his immediate
fixed loss amounts to the cost of building and maintaining the fireproof
farmer’s decision between the two insurance options will hinge on whether
the cost of building and maintaining a fence along the railroad tracks is
greater than the value of planting wheat on those 50 feet of dirt each year.
Note that in both cases, the farmer accepted a small fixed reduction in salary
(value of the wheat) or wealth (cost of the fence) immediately, in exchange
for protection against a large uncontrollable loss in the future (destruction
of his wheat crop by fire).
varieties of insurance you typically purchase operate on the same basic
principle of immediate wealth reduction. The only differences are:  instead
of independently self insuring the risk, other policyholders purchase similar
insurance to share or pool the risk, and  instead of dry dirt or a fence,
money is the medium of exchange for the transaction.
Thus, when 1,000 40 year old males each contribute $1,000 to an
insurance pool, the 999 who survive forfeit their premium, and the one who
dies gets the $1,000,000 benefit to make up for his lost income.
with pensions and Social Security, there are three other differences, which
are the primary cause of corporate and government unfunded liabilities - our
topic at hand.
short-term property and income risks slowly expire with the passage of time,
but your long-term pension risk of outliving your savings slowly accumulate
over time. If you want to protect
your life and property during the year 2004, you can buy insurance that starts
on January 1st and ends on December 31st.
Once the year has passed, so has the risk.
most people don’t die young and collect on their life insurance; but most
people do live long enough to retire and collect a pension.
About 90% of people in the
the risk of outliving your savings, in addition to involving the short-term
pooling of funds, involves the long-term investment risk of managing your
retirement savings. If you invest
foolishly or are defrauded by unscrupulous money managers, you lose out.
while the short-term property risks are relatively simple in practice, the
long-term pension risks are unnecessarily complicated and perverted by the
Internal Revenue Code (IRC), creating a moral hazard for everyone involved,
which entices them to gamble with your savings and adopt fraudulent accounting
standards and actuarial funding principles.”
thanks to Gerry Smedinghoff for making this preliminary draft available
to MedicalTuesday members.
* * * *
A. Silverglate, a lawyer working on a book concerning abusive federal
prosecutions, writes in the Wall Street Journal about "Dubious
Convictions for Dubious Crimes."
Justice Department . . . has built a record in business fraud cases that has
held up in court on Enron, WorldCom and Adelphia. In fact, the reasons the
feds have more success in court than Mr. Spitzer, [the Attorney General in
* * * *
Elliott, health reporter for BBC
News, reports that as the
of the Association of Forensic Radiographers say that Pathologists can
determine a lot about an explosion through the pattern of injuries. But, to
avoid any distressing errors, the work has to be painstaking and slow so
police have asked for families' patience while they analyze the evidence. Many
of the bodies are so badly injured they are impossible for relatives and
friends to identify.”
in some cases, experts only have body parts to work with. This is where
experts like forensic radiographer Mark Viner and his colleague Kim Hutchings
can be vital. They can use X-rays of the body to help create a positive
identification of the dead person."
Hutchings, based at
is possible to identify people by matching X-rays to the X-ray films they had
done in life. The team would identify any previous distinguishing marks,
pathology or injury, such as previous fractures, dental work or surgery, so
that the pathologist could identify them.’
might not be as obvious as a broken bone - for instance, old X-rays can show
up unusual patterns of growth. Medics can tell by looking at fractures whether
they are new or old by the amount of healing that has gone on.
the tiny amount of healing that has gone in a fracture that is one or two days
old can be enough for experts to distinguish between an old injury, or
one sustained at the point of death.
technique can even work to a degree for bodies that have no obvious
distinguishing marks from their previous medical history.
can inch towards a positive identification by measuring limbs to discover
their height, sex and sometimes even their age. The fact that the bones do not
fully fuse until the age of 25 can help pin down this last element....
Viner, based at Barts and the Royal London
Hospitals, helped in the identification of victims of the IRA bombings in
Victoria Station and
the case of the
work of identifying victims falls under the auspices of the Association of
spokesman said it was important to remember that, unlike the tsunami, the
read the entire article, go to http://news.bbc.co.uk/2/hi/health/4586281.stm.
* * * *
Griffith, Sacramento Bee Medical Writer, reported on
many baby boomers and their elders, the eye condition known as presbyopia can
make deciphering drug labels, threading needles and even writing notes
impossible without reading glasses.
as with every other symptom of growing older, presbyopia, the Greek term for
‘aging eye,’ is the target of new technologies to minimize the undesirable
effects of the march of time.
are a lot of people who are aging, and one of the (five senses) is sight,’
said Kathy Kelly, a spokeswoman for the company that makes crysta-lens, one of
two new types of lenses that replace cataracts but also correct presbyopia.
‘When you start losing your sight, you start feeling old.’
cataract surgery involves replacing the clouded human lens with an artificial
one that can be designed to improve long-distance vision. The new lenses go
further, fixing not just the cataract, but sharpening vision at all distances,
near and far.
are predicting the market for these new lenses will increase fivefold
following Medicare's decision in May to cover their cost, as long as patients
pay the difference in price - about $1,200 an eye - between the conventional
cataract lens and the presbyopia-correcting lens.
the federal Medicare program considers cataracts a debilitating condition and
covers their removal, it views presbyopia as an easily corrected vision
problem that does not merit a surgical fix. Similarly, the Food and Drug
Administration has approved the new lenses for cataract surgery, but not
solely as a means of correcting poor eyesight.
so, the new technologies are proving a big draw for baby boomers - many of
them too young to have cataracts but old enough to need glasses to make out a
listing in the phone book. About 80 percent of crystalens patients don't have
cataracts but are plunking down about $3,500 an eye to have their vision
corrected, said Dr. Stephen Wilmarth, a Sacramento eye surgeon using the new
trend raises concern among some eye surgeons, who like the products for
cataracts - a condition that ultimately blinds you - but say the invasive
operations pose unnecessary risks for people whose problem could be easily
fixed with a pair of dime store reading glasses.
uncomplicated cataract surgeries can, in rare instances, result in devastating
retinal problems, said Dr. Brent Reed, a
don't see intraocular surgery as a reasonable option at this point just to get
rid of reading glasses,’ he said. ‘If your patient ends up with retinal
detachment and you are trying to fix presbyopia, that
is a high price to pay.’
Halliday was willing to take the risk. At 46, she has worn contact lenses for
30 years to see better at a distance and more recently started using reading
glasses. ‘I am a nurse, so I have to have good eyesight,’ she said. ‘I
do a lot of reading, giving medication, drawing meds in syringes for
injections. I have to be accurate.’
she could live with the hassles of poor eyesight, she said, ‘I was
just not wanting to wear contacts and the glasses both for another 30,
40 or 50 years. Because surgery is available, I figured, why not?’ Not only
will the new lenses improve Halliday's near and far vision, but the artificial
lenses cannot form cataracts.
than 20 million Americans have cataracts, a condition that develops with age
as dead cells collect on the lens, clouding vision. Presbyopia is considered
the first sign of a cataract. With age, the lens stiffens, making it harder to
focus, especially up close. Presbyopia typically sets in around age 45, and
affects virtually everyone over age 51.
other intraocular lenses, crystalens, made of silicone, replaces
the body's natural lens. Unlike other cataract lenses, crysta-lens is designed
to work naturally with the eye muscles, changing shape as the patient focuses
near, far or anywhere in between.
Ed Latham of Antelope opted for crystalens for his cataract replacement
surgery. A retired minister of the
a cool morning in June, Latham was wheeled into an operating room where his
right eye was numbed, his vital signs monitored and an intravenous sedative
dripped into his veins to keep him calm. After cutting a slit in Latham's eye,
Wilmarth cleaved the lens away from the capsule surrounding the lens, then cut
it up and sucked out the yellow-tinged tissue that was the cataract. Into the
tiny opening he jiggled the crystalens, centered
it, flushed with solution and removed the air bubbles. The procedure was over
in about half an hour.
said the crystalens operation requires special
training, meticulous planning and surgical precision to achieve a good
outcome. Even so, up to 20 percent of patients will require surgical
adjustments to improve their distance vision. Halliday, for example, said her
eyesight with crystalens isn't perfect yet, and plans to have a tune-up with a
laser procedure soon.
are talking about the evolution of a technology,’ Wilmarth said. ‘We now
have something which was almost unthinkable five years ago. As time
progresses, we are going to improve in every aspect of our care.’
surgeons prefer Restor, made by Alcon Laboratories Inc. Restor is the newest
intraocular multifocal lens for cataracts. Like crystalens, the Restor lens
improves both distance and near vision, but it uses a different technology
that doesn't work in concert with the eye muscles.
said earlier efforts to make a multifocal lens resulted in patients seeing
halos, glare and rings of light, and made night vision particularly difficult.
These problems improved, but are not entirely resolved with Restor.
first patient in
of a sudden, I started having to have my prescription changed every three
months,’ he said. ‘It got worse and worse.’ Reed put Restor in
Thompson's left eye first. ‘Within three days of surgery I read the
newspaper without glasses,’ he said. ‘I looked at the computer without
with the remaining cataract in the right eye, Thompson said he couldn't sit
down and read a long Tom Clancy novel, as he yearns to do. Heading into
surgery for the other eye last week, Thompson said, ‘If this second eye
comes anywhere close to half the improvement that I got with the first eye, I
am going to be excited.’
surgery began smoothly. Reed made the incision, preparing to remove the cloudy
lens from Thompson's right eye. Reed inserted an instrument that uses
ultrasonic energy to break the cataract into small pieces and sends a watery
solution through the tip to turn the cataract to a slurry,
which is then sucked up through the instrument and out of the eye.
there were complications. Reed said the phacoemulsification machine burped
‘and for whatever reason the fluid flow pulsed and stopped just for a
second, but the suction continued.’
pulled the lens capsule forward, engaging the tip of the instrument. It
punctured the back of the capsule. Vitreous, the gelatinous material in the
back of the eye, leaked into the space where the new lens would have been
capsule rupture probably happens in one in every 200 eyes,’ Reed said later.
Thompson still got his Restor lens, but Reed was forced to put it in front of
the capsule rather than inside it, a functional though not optimal option.
rare, a punctured capsule can lead to serious problems down the road,
including retinal detachment. "We're going to
watch you like a hawk," Reed told Thompson after the surgery.
said lens implant surgeries are far riskier than Lasik, the popular laser
procedure that changes the shape of the cornea to correct nearsightedness,
because they can lead to serious infections or retinal problems.
he used Thompson's case to illustrate why patients without cataracts should
think twice about the invasive operation.
are upping the ante tenfold when you go inside the eye,’ Reed said. ‘The
real issue is nobody wants to get old or deal with the effects of aging. I
think that's fine as long as they don't put themselves at significant risk to
lose what they've still got.’
Bee's Dorsey Griffith can be reached at (916) 321-1089 or firstname.lastname@example.org.
To read the full report, go to
* * * *
pharmacy made a mistake on a prescription fill for one of my patients,
dispensing 20 mg tablets instead of 5 mg tablets. The patient came to the
office and we cross-checked the copy of the prescription in my file, which was
correctly written, but went ahead and wrote a new one. Both were completely
legible as evaluated by a medical assistant. The patient thanked me and said
she would toss the large dose into the toilet. When reminded that to do so was
tossing valuable medications down the sewer, she replied that it was only
worth $14. We informed her that the drug was really a $110 prescription with a
fixed copay of $14, and since the seal was not yet broken on the
bottle, it could still be used. She asked if I might have a poor patient who
could use the medication. Since it was a commonly prescribed drug in our
practice, I accepted it since I have a number of patients that would
appreciate a free month’s supply.
patients, as well as responders to last week's article concerning expiration
dates and when drugs do lose their potency, have told me that they had either
read, or a doctor had told them, to always throw extra pills into the toilet
and drain them down the sewer. How can this waste of valuable health care
costs be stopped?
type of behavior cannot be changed by altering the medical school curriculum
concerning one fact out of hundreds of thousands of medical facts; nor can it
be changed by a massive advertising campaign since no universal agreement
could ever be reached. It can only be altered by patient responsibility which
only becomes relevant when the patient pays a percentage of every medication
or medical service–not a fixed copay as in this
case. When patients share financial responsibility, they will find a way to
conserve their income.
will never conserve the expenses of the third party, whether insurance
carrier, Medicare, Medicaid, National Health Service, the VA, etc., that paid
the $96 that the insurance company paid for the prescription. But for example,
with a 30 percent copayment of the $110, it is significant enough that
patients will reduce their health care costs and save health resources.
* * * *
than one third of older Americans are able to pay for two or three years of
nursing home care, according to a recent study published by AARP. As baby
boomers who have failed to adequately prepare for old age retire, there will
be fewer seniors with the means to pay for such care, says legal researcher
the joint federal-state health care program for the poor, is the major funder
of long-term care in the United States. For example, when seniors in nursing homes
exhaust limited Medicare benefits, those who have not purchased long-term care
insurance must pay for their care themselves. If they consume their financial
assets and their incomes are low enough, they qualify for Medicaid coverage.
* Long-term care cost Medicaid $60 billion in 2002, according to
Centers for Medicare and Medicaid Services data.
* Federal and state laws allow Medicaid to seek reimbursement from
recipients’ estates, and under current laws the states now collect $350
million a year, according to the AARP.
most Medicaid recipients have no estate when they die, and an increasing
proportion of those who receive assistance are sheltering their financial
assets to meet the definition of poor under the Medicaid statutes. So while
their children receive the benefit of these assets, taxpayers pick up the tab
for their care,” says Pakula.
than 30 states have statutes that make adult children responsible for the care
of indigent elderly parents, but the laws are seldom enforced. Enforcement of
filial responsibility statutes could discourage much of this asset
shifting,” says Pakula.
Matthew Pakula, "The Legal Responsibility of Adult Children to Care for
more on Medicaid: Reform Proposals: http://www.ncpa.org/iss/hea/.
* * * *
Edwards was commenting on one of his patients who was heavily tattooed and
used a Harley as his mode of transportation. The patient had an altercation
and ended up with a knife wound and a bullet through his thigh. Since he was
on the wrong side of the law in previous experiences, and didn't want medical
documentation of his injury, he allegedly took a hot iron and seared the
wound. The patient said that he had heard this would kill all the germs. His
said it healed without medical attention and it didn't get infected. The
tattoos had nicely covered the burn scars.
* * * *
Toton, MD, a Healdsburg orthopaedic surgeon reports in Sonoma Medicine
about his experience when he worked at Kaiser Permanente.
an orthopaedic intern at
interview followed at Kaiser San Francisco, where there was an 'opening.'
It wasn’t exactly an interview; the physician-in-chief talked at me about
Kaiser’s history and practice opportunities for more than an hour. I left
with an application form and the experience of saying no more than 10 words. I
doubt he even knew who I was.
next contact, four months later, was a phone call letting me know I had a full
load of patients scheduled for next Monday! I didn’t even know I had been
hired; that was how Kaiser took you on board 30 years ago."
those days, Kaiser was a gold mine of opportunity, but not of the financial
kind. My general practitioner father was appalled at the starting salary for a
surgeon. Raises, and partnership, did come with time; but my income never kept
up with private practice in that “golden age” of medicine. . . .
practice of medicine at Kaiser has always been associative. Not too long ago,
before Kaiser grew, before budgets were strictly enforced, every doctor knew
every other doctor in his or her specialty in the other facilities and knew
many other members of the larger Permanente group as well. It is a shame that today,
very few doctors seem to have that regional perspective, except in their
specific referral areas.
a wide margin, Kaiser met most, if not all, of my professional and personal
goals. When you are off, at Kaiser, you are OFF. When you are at work, you are
‘fully busy at work,’ with no shortage of challenging and stimulating
patients to see. You may be tired, but you are never bored.
then, quite unexpectedly, probably because the stock market was hot and
medical dues were flat, Kaiser offered me an early-retirement package that was
too good to turn down. I suspect they wanted the top salaries to move on and
to hire younger and cheaper doctors. I was not insulted: although I always
felt I was a valued member of the group, I recognized early on that Kaiser is
a business and I was an employee.
was not compelled to take advantage of the retirement package, but I wanted to
see what was on the 'other side,' so I went into private practice. It has
been and continues to be a learning experience!”
savings and cash from unused sick leave and vacation pay, I opened a ‘second
opinion’ office in a
an old Kaiser associate, Tom Miles, invited me to join his private orthopaedic
practice in Healdsburg. He asked only one question: ‘Are you bored with
was leaving town (he’s since returned), so I could fill a need, with a
promise that I would jump into a world of good people, good loyal referral
doctors, a stable insurer (HPR), secure physician groups (SPA and HMG), and a
thriving hospital and medical community. In June 1999, it was all true, but
SPA, HMG, and HPR soon bit the dust.
is private practice different from Kaiser? First a disclaimer: my Kaiser
experience is now six years old and my private practice experience is six
years new. Before 1999, the Kaiser slogan was ‘good people, good
medicine,’ and our mindset was to offer ‘good medicine’ at an affordable
cost. Kaiser dues were usually near the bottom of medical insurance premiums.
We were part of a culture born in the pre- and post World War II unions; we
were the working man's health plan, fulfilling a 1960s dream of a ‘better
world.’ Our doctors were accused of being socialists, and acceptance in
medical societies was hard to obtain.”
Toton outlines these exciting years and how his life changed at Kaiser
Permanente. To read his comparison of private practice experience to his
Kaiser Permanente experience, go to www.scma.org/magazine/scp/sp05/toton.html.
* * * *
POWER - The Free-Enterprise
Alternative to Clinton’s Health Plan by
John C Goodman, PhD and Gerald L Musgrave, PhD. Cato Institute, Washington, DC
© 1994, ISBN: 1-882577-10-8, 134 pp, $1.00 (from Cato Institute).
the Preface, the authors state that a thorough economic analysis of the health
care system in the United States is complex, not because special theories are
needed, but because health care is the most regulated and most politicized
sector of our economy. It takes considerable understanding of economics,
medical care, politics, ethics and emotions before anyone can obtain a unified
view of health care. Patient Power is a synthesis of those aspects. The
abridged volume is a further condensation of that synthesis.
thesis of this book is simple: if we want to solve the nation's health care
crisis, we must apply the same common sense principles to medical care that we
apply to other goods and services. The irony is that health care costs are
rising because, for individual patients, medical care is cheap, not expensive.
to Patient Power, patients pay on the average only 5 cents out-of-pocket for
every dollar they spend in hospitals. The remainder is paid by private and
public health insurance. Patients pay less than 19 cents out-of-pocket for
every dollar they spend on physicians' services, and they pay less than 24
cents for every dollar they spend on health care of all types. Patients
therefore have an incentive to purchase hospital services until, at the
margin, they're worth only 5 cents on the dollar and to purchase physicians'
services until they are worth only 19 cents on the dollar. The wonder is that
we don't spend even more than what we do.
care, like other necessities such as food, clothing, housing and
transportation, is said to be a necessity. If we paid for any of those items
the way we pay for health care, we would face a similar crisis. If we paid
only 5 cents on the dollar for food, clothing or housing, for example, costs
would explode in each of those markets.
we are to control health care costs, we must be prepared to make tough
decisions about how much to spend on medical care versus other goods and
services. So far, we have avoided such choices, confident that health care
spending can be determined by "needs," rather than by choices among
competing alternatives. In that respect, the
the case of an 80-year-old man who suffered from the condition of
"slowing down." Despite the physician's counsel that the condition
was perfectly normal at age 80, the patient and his wife went on a literal
shopping spree in the medical marketplace. As the physician explained to the
New York Times:
few days ago the couple came in for a follow-up visit. They were upset. At
their daughter's insistence they had gone to an out-of-town neurologist. She
had wanted the "best" for her father and would spare no (Medicare)
expense to get it. The patient had undergone a CAT scan, a magnetic resonance
imaging, a spinal tap, a brain-stem evoke potential and a carotid duplex
remediable problems were discovered. The Medicare billing was more than $4,000
so far. . . . but they were emotionally exhausted
by the experience and anxious over what portion of the expenses might not be
covered by insurance.
have seen this Medicare madness happen too often. It is caused by many
factors, but contrary to public opinion, physician greed is not high on the
list. I tried to stop the crime, but found I was just a pawn in a ruthless
game, whose rules are excess and waste. Who will stop the madness?
potential demand for health care is virtually unlimited. Even if there were a
limit to what medical science can do (which, over time, there isn't), there is
an almost endless list of ailments that can motivate our desire to spend.
About 83 million people suffer from insomnia, 70 million have severe
headaches, 32 million have arthritis, 23 million have allergies and 16 million
have bad backs. Even when the illnesses are not real, our minds have
incredible power to convince us that they are.
the only way to control health care costs is to have someone choose between
health care and money (that is, other goods and services), who should that
someone be? There are only two fundamental alternatives: the choices must be
made either by the patients themselves or by a health care bureaucracy that is
ultimately answerable to government. This book makes the case for the
all arguments against empowering patients are variations on the notion that
individuals are not smart enough or knowledgeable enough to make wise
decisions. But if that argument is persuasive in health care, why isn't it
equally persuasive in every other area of life?
case for empowering patients rests on a different assumption. No one cares
more about us than we do. Thus, while prudent people seek and get advice from
specialists before making many decisions, it does not follow that we should
turn control of our lives over to the experts. In the long run, more good than
bad decisions are made when self-interested individuals are free to accept or
reject advice from many quarters.
corollary to the goal of empowering patients is the goal of creating
competitive markets in the health care sector, including physicians' services,
hospital services, other services and health insurance. Individuals pursuing
their own interests in a market are best served by suppliers who compete
vigorously to meet consumer needs with high-quality services produced at the
lowest possible cost.
the authors emphasize, this book represents a radical departure from the
conventional wisdom in the field of health policy. Whereas the vast majority
of health policy commentators take a bureaucratic approach to health care, the
authors' approach is individualistic, focusing on the decisions that
individuals make and the incentives they face when they make them. Whereas the
vast majority of health policy proposals call for more regulation and more
government spending, the authors find that government is the problem, not the
dominant view of what's needed in health policy, as regularly reported in the
national news media and parroted by syndicated columnists, editorial writers
and politicians, is not competition but monopoly. Instead of empowering
individuals, they assert, we should empower the bureaucracy. Rather than look
to the private sector for solutions, we should look to government. When
speaking to the general public, the socialism-works-in-health-care crowd
points to national health insurance in other countries, arguing that the
quality is high, the cost is low and the vast majority of people like it.
is no surprise that most people who live under national health insurance like
it. For minor aches and pains, they have no difficulty seeing general
practitioners and they perceive such services to be "free." But
that's not a useful test of a health care system. In any given year, only
about 4 percent of the population require access to
the remarkable advances made possible by modem medical science. The better
test is when people need such services; can they get them? And if they do get
them, how long do they have to wait? It is in answering those questions that
we uncover the worst tragedies of socialized medicine.
authors cite the case of Joel Bondy as illustrative of what we could be
facing. Joel was a two-year-old child with a serious congenital heart defect
that urgently needed surgery. It was a serious operation, but one that was
performed many times in hospitals across the
operation was repeatedly postponed as more critical cases preempted the
available facilities. Alarmed at their son's deteriorating
condition, Joel's parents arranged for him to be operated on in
authors state that such a tragedy could easily become commonplace in this
country if we make the wrong decisions on how to reform our health care
system. The examples given are somewhat dated, but they are as valid today as
when this book was written a decade ago. Even a decade ago, 793 hospital
communities in our country would be able to provide cardiac
surgery–frequently the same day as do now. However, in
* * * *
W. McCullough, reports in the Los Angeles Times: For
many doctors, beliefs influence their practices. More than three-fourths
believe in God and more than half believe in an afterlife, a survey finds.
Results surprise the study's author.
is the "unmovable foundation" on which Dr. James Keany bases his
practice of medicine. He sometimes stops and prays with a patient coping with
tragedy or life-changing illness, and he prays silently for many more.
are more than just an accumulation of lab tests and data. They are a living,
breathing, feeling, spiritual entity," the
an emergency medicine doctor at
new study has found that more than three-fourths of physicians believe in God
and more than half believe in an afterlife. The survey of 1,144 physicians,
published in the July issue of the Journal of General Internal Medicine, came
as a surprise to the study's main author.
are not as irreligious as we might have expected," said Dr. Farr Curlin,
an instructor in the department of medicine at the
physician's religion is utterly irrelevant to the patient," said Richard
P. Sloan, a professor of behavioral science at
noted that doctors hold considerable power in the clinical relationship.
Because physicians know patients' private matters, see them naked and examine
them in extremely personal ways, patients are in many ways vulnerable when
visiting a doctor. That vulnerability, Sloan cautioned,
means doctors should be extra vigilant about mixing religious beliefs with
their practice. "There is a tremendous potential for abuse," he
previous studies have shown the importance of patients' faith to their health,
well-being and medical decision-making. There has been comparatively little
research on doctors' religious beliefs, however.
slightly less religious than the general public, doctors still were similar in
their religious convictions, the survey found, with 76% of doctors saying they
believe in God versus 83% of the general public (a figure established in a
previous national survey). And 56% of doctors described themselves as
religious, compared with 62% of the general public.
were significantly more diverse in their religious backgrounds than the
from Christian backgrounds were more likely than any other religious group to
say that their religion influenced their practice of medicine, except for
Buddhists, who overwhelmingly said that it did.
is not clear from the study if doctors become more religious because of their
work, or if people with religious backgrounds are more likely to enter the
field of medicine, but Curlin said: "It's more likely that people go into
medicine because it is not only a scientific practice, it is also a moral
practice." He added that doctors would "cripple" their medical
practice if they only treated physical symptoms and refused to pay attention
to the spiritual needs of their patients.
agreed that doctors have a responsibility to respect and understand their
patients' spirituality, but disagreed that a doctor's faith is important to
the interaction. "You should treat your patients humanely and respect
their autonomy regardless if you are a fundamentalist Christian or a Jew or a
Muslim or an atheist," he said.
said he has come to believe that it would be "unconscionable" to
separate religion and the practice of medicine. "The technical aspect of
medicine is actually the easy part of medicine; the hard part is being
emotionally and in some cases spiritually available for the needs that a
patient has," he said.
he added that doctors must be sensitive to patients' beliefs. "If you
have an agenda," he says, "you will not be there for their
* * * *
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 reviewed in this newsletter
the first twenty months, issues a weekly Health Policy Digest, a
health summary of the full NCPA daily report. You may log on at www.ncpa.org
and register to receive one or more of these reports. This week, read more
about Medicare's new prescription drug benefit in the article
Galen Institute, Grace-Marie Turner President and Founder, has
a weekly Health Policy Newsletter sent every Friday to which you
may subscribe by logging on at www.galen.org.
A new study of purchasers of Health Savings Accounts shows that the new
health care financing arrangements are appealing to those who previously
were shut out of the insurance market, to families, to older Americans,
and to workers of all income levels. Read the current newsletter on Tax
Reform as the Road to Health Reform at http://www.galen.org/redtape.asp?docID=808.
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 newsletter that is distributed every Tuesday by logging
on at http://www.galen.org/www.galen.org
and clicking on Consumer Choice Matters. Archives are now located
This is the flagship publication of Galen's new Center for
Consumer-Driven Health Care and is written by its director, Greg Scandlen,
an expert in Health Savings Accounts (HSAs). Read a letter of resignation
from a National Health Service Surgeon, Mike Lavelle to chief executive
Peter Coles at http://www.galen.org/healthabroad.asp?docID=813.
What most physicians, who have a genuine concern and compassion for
their patients, don't understand is that most bureaucrats and attorneys
have none. Bureaucrats and attorneys actually welcome letters such as
these from what they feel are non-compliant public servants who use up
their budget resources. They may look in pity on a doctor who wishes to
help patients and are greatly relieved when they leave.
Heartland Institute, www.heartland.org,
publishes the Health Care News, Conrad Meier, Managing Editor Emeritus.
To understand how people who have an agenda set out to prove it
nonscientifically, such as is the problem in health care, read about why
the "Minnesota Team Abandons Effort to 'Prove' Global Warming"
Foundation for Economic Education,
has been publishing The Freeman - Ideas On
Liberty, Freedom’s Magazine, for over 50 years, with Richard M
Ebeling, PhD, President, and Sheldon Richman as editor. Having
bound copies of this running treatise on free-market economics for over 40
years, I still take pleasure in the relevant articles by Leonard Read and
others who have devoted their lives to the cause of liberty. I have a
patient who has read this journal since it was a mimeographed newsletter
fifty years ago. To read another timeless classic on "The Growth of
Government in the
Council for Affordable Health Insurance, www.cahi.org/index.asp,
founded by Greg Scandlen in 1991, where he served as CEO for five years,
is an association of insurance companies, actuarial firms, legislative
consultants, physicians and insurance agents. Their mission is to develop
and promote free-market solutions to
Health Policy Fact Checkers is a
great resource to check the facts for accuracy in reporting and can be
accessed from the preceding CAHI site or directly at www.factcheckers.org/.
This week, read the Claim: The cost of increased utilization of services
under the single-payer bill is offset by savings in administration at http://www.factcheckers.org/showArticle.php?id=530.
Then read The Grand Illusion: The Perennial
Quest for a Single-Payer Health Care System that Works at http://www.cahi.org/cahi_contents/resources/pdf/n127Singlepayer.pdf.
Independence Institute, www.i2i.org,
is a free-market think-tank in Golden,
National Association of Health Underwriters, www.NAHU.org.
NAHU's Vision Statement: Every American will have access to private sector
solutions for health, financial and retirement security and the services
of insurance professionals. There are numerous important issues listed on
the opening page. Join in the celebration of their accomplishments during
their first 75 years and their discussion as to "What's Next?" at
Masse launched the first
libertarian webzine in
Fraser Institute, an independent
public policy organization, focuses on the role competitive markets play
in providing for the economic and social well-being of all Canadians. Log
on at www.fraserinstitute.ca
for an overview of the extensive research articles that are available. You
may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he.
To read the current report on comparing provinces and the states with the
greatest economic freedom and those with the greatest wealth, go to http://www.fraserinstitute.ca/shared/readmore.asp?sNav=nr&id=673.
Heritage Foundation, www.heritage.org/,
founded in 1973, is a research and educational institute whose mission is
to formulate and promote public policies based on the principles of free
enterprise, limited government, individual freedom, traditional American
values and a strong national defense. The Center for Health Policy Studies
supports and does extensive research on health care policy that is
readily available at their site. This week, be sure to read what the
long-term consequences are of "Adolescent Virginity Pledges, Condom
Use, and Sexually Transmitted Diseases Among
Young Adults" at http://www.heritage.org/Research/Welfare/whitepaper06142005_1.cfm.
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. Be sure to read the reality of
economic theories of
John Maynard Keynes, late economic adviser to the British
Government "Stones into Bread: The Keynesian Miracle." You may
also log on to 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 www.lewrockwell.com/rockwell/sickness.html;
or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
The Cato Institute (www.cato.org)
was founded in 1977 by Edward H. Crane with Charles Koch of Koch
Industries. It is a nonprofit public policy research foundation
Ethan Allen Institute http://www.ethanallen.org/index2.html
is one of some 41 similar but independent state organizations associated
with the State Policy Network (SPN) http://www.spn.org/newsite/main/.
The mission is to put into practice the fundamentals of a free society:
individual liberty, private property, competitive free enterprise, limited
and frugal government, strong local communities, personal responsibility,
and expanded opportunity for human endeavor.
* * * *
Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
Meyer, MD, CEO & Founder
6620 Coyle Ave, Ste 122
J. O'Rourke: When buying and selling
are controlled by legislation, the first thing to be
bought and sold are legislatures.
Twain, (1866): There is no
distinctly native American criminal class save
This Date in History - July 12
this date in history, Julius Caesar was born in 102 BC. Caesar
this date in history, Henry Thoreau was born in 1817 AD.
Nearly two millennia later, Thoreau, who stood for all that was opposite to
the ideas of Caesar, was born in