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Physicians and the Business & Professional Community
Restoring Accountability in HealthCare & Medical Practice
Tuesday, July 16, 2002
Socialized Education. Lessons for
The recent US Supreme court decision concerning school vouchers in Cleveland as a rescue for public or socialized education in the United States has lessons for us in the medical practice arena. The public school system is run by and funded with government monies coercively procured from taxpayers by the local and state branches of government. In my own practice, essentially every public school teacher in the primary grades and high school areas considers the classroom a war zone with each day’s goal being getting through it without any catastrophes or casualties. Teaching children does not even enter the equation for many. The teachers are subjected to verbal, physical and mental abuse by their pupils. This creates a source of increasing anxiety, sometimes with panic attacks, with manifestations of peptic ulcers, gastroenteritis, colitis and other organ system diseases as well as psychiatric impairments.
The public school system has produced such dismal statistics as only one out of 10 Cleveland ninth graders is able to pass a basic proficiency exam and two-thirds of high school students are dropping out before graduation in a district that could not meet even one of the 18 state standards for minimal performance. Does this really suggest that there is very little difference between completing public education and no education?
Private Education is Cheaper than
I was chairman of the board of education of a private school in the 1980s; at that time we charged parents approximately $300 per month ($3,000 per year) for grades one through eight. Our students did better on achievement tests than the students at the public schools which cost taxpayers $6,000 per student per year. It should be apparent that if half of the parents chose private education, the reduction in taxes should equal twice the cost of private education. The challenge, of course, is that bureaucrats and politicians seldom ever return taxes to the taxpayers.
Are the Best Doctors no better than
the Worst Doctors?
The actuary I’m working with to design the ideal HealthPlan for the USA stated that HealthCare is the only other segment of our economy where the best and worst performers are paid the same amount. This drives the quality of health care to the lowest performer, just as it did in teaching. The current emphasis on improving the quality of health care is misplaced since doctors do this automatically. We take more continuing education than any other profession. We have produced the finest and most sophisticated HeathCare of anyplace in the world. However, quality will continue to spiral downward as costs spiral upwards if we continue to let government, health maintenance organizations, and other third party payers control our profession and manage the care we give our patients. Let’s take another look at Europe, specifically The Netherlands.
Medicine in The Netherlands - A
James T Hay, MD, President of the San Diego County Medical Society, suggested that the members of the society should talk to their patients about HealthCare. Evert P. van de Ven, former executive vice president of Novellus Systems, responded to the request to put his story in writing. The patient, a native of The Netherlands, offered to help us avoid “national health” in any way he could. Dr Hay was moved by this personal account of van de Ven and his wife’s family’s experience and reported it in the San Diego Physician.
Van de Ven states that the Dutch government started to promote socialized medicine about thirty years ago. Presently, everything related to HealthCare is government controlled, including compensation of physicians, the hospital budgets, prices for medication, even the hours HealthCare workers are allowed to work (36 hours per week). In addition they control the medical schools and limit admissions. Although 30 percent of the population has additional insurance from work, there is no benefit to the patient whether they have supplemental insurance or not, as the government goes to great lengths to make sure that everybody gets the same low level treatment. These are some of his examples:
1. A 78-year-old female with Transient Ischemic Attacks (TIAs or impending stroke) was seen by a neurologist who ordered an MRI of the brain. During the six-week wait, she completed her stroke and became paralyzed on the right side of her body. The family physician arrived within two hours but was unable to get her admitted to a hospital. It was Saturday and there were not enough beds and personnel available. Patients are not allowed to call an ambulance except for an accident. A physician has to check the patient and make a diagnosis and check for hospital and specialist availability before the ambulance can be called.
2. A 79-year-old female with congestive heart failure and insulin-dependent diabetes ran out of Zaroxolyn and gained weight. She had a myocardial infarction and was hospitalized. She received no treatment and was sent home to die. Today she is doing fairly well thanks to Zaroxolyn provided from the United States. Mr van de Ven’s discussion with pharmacists in the Netherlands highlighted a serious problem: Strict pricing limits the availability of medicine. The price restrictions were implemented after the government decided that the pharmaceutical companies were charging too much. The result has been a significant reduction of medicines available and reluctance of pharmaceutical companies to go through the approval process for costly new medications.
3. A 77-year-old female broke her hip as the result of an assault and had to wait until the next year for a hip replacement. The reason given for the delay was that the local hospitals had reached the allowance quota for hip transplants for the year and had to wait several months for the next allotment.
Mr van de Ven concludes: “It is amazing how a good, well-run medical system can be ruined in a few decades by ignorance and increased government control. The only thing done to limit the suffering of the elderly was to legalize euthanasia and allow physicians to prescribe a “suicide pill.”
Private Medical Care is Cheaper than
Public Medical Care
My actuarial consultant whom I mentioned above states that accountants, lawyers, and actuaries are making more money on HealthCare rather than doctors. He also stated that the former can make serious errors of analysis and cost projections, but get their full pay even though the information was of no value or even misleading. What isn’t recognized by many of these consultants that determine how we should practice, is that medical care is very elastic and variable. Even at international scientific sessions the experts in the field assembled for the final panel discussion often present views quite divergent from each other. If the experts can’t agree, we need to show the bureaucrats that there is no one way to treat a disease. However, that constant exchange of expert opinions produces the best care for the patient. But in a bureaucratic environment, that constant correcting factor is no longer operative. This is a critical and crucial topic which we will revisit on subsequent MedicalTuesday Ezines.
Government Medicine is for the
Government’s Welfare, not for the Patient’s Welfare
We cannot emphasize too often that the father of government social insurance, German Chancellor Otto von Bismarck, observed how Napoleon III used state pensions to buy support for his regime when he was Ambassador to Paris in 1861. “I have lived in France long enough to know that the faithfulness of most of the French to their government . . . is largely connected with the fact that most of the French receive a state pension.” According to Brink Lindsey writing in the journal Reason, for Bismarck the appeal of social insurance was that it bred dependence on, and consequently allegiance to, the state. Social insurance, whether social security, Medicare, or single payer medicine, was thus born of a contemptuous disregard for liberal principles: What mattered was not the well-being of the workers, but the well-being of the state. Returning accountability to the physician and patient is our mission. We must network our efforts before it’s too late.
The Medical MarketPlace
If you’re not interested in or sympathetic to a private personal HealthCare system, send an email to me at DelMeyer@HealthPlanUSA.net and we will sorrowfully removed your name. Feel free to email your comments and examples also.
Stay Tuned to the MedicalTuesday.Network twice a month and have your business and professional friends do likewise. This message, which was delayed one week because of vacation schedule, reaches the Physicians and the Business/Professional community in 12 states, 8 countries, on 4 continents. Feel free to forward this message to your doctor, business associates, friends and relatives whom you feel agree with our principles. The life you save may be your own, or a loved one – after you become ill.
Del Meyer, MD