For Better Health Care
Vol IV, No 8, July 26, 2005
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Featured Article: A
Victory for Freedom: the Canadian Supreme Court's Ruling Condemning the
Canadian Single-Payer Health Care System for Causing Situations in Which
Patients Suffered and Died on Waiting Lists, in Violation of the Rights to
Life, Liberty, and Security by Jacques Chaoulli, M.D. Heritage Lecture
#892, July 22, 2005.
BY ROBERT E. MOFFIT: Ladies and gentlemen, I am happy to join my
co-host, Grace-Marie Turner, President of the Galen Institute, in
welcoming you to The Heritage Foundation. We are honored to have with us Dr.
Jacques Chaoulli, whose recent case before the Canadian Supreme Court ended in
a major victory for health care freedom in Canada.
Canada, patients have long been legally prohibited from spending their own
money to purchase medical care privately if that care was also provided under
the Canadian government's health care program. Many Canadians who did not want
to endure the wait for treatment under the government program, or suffer the
pain or inconvenience of these restrictions, would often have to travel to the
United States to get the care that they wanted or needed. That is why Dr.
Chaoulli's victory in the Canadian Supreme Court, allowing patients to secure
private care in Canada, is historic.
Canadian case has relevance for Americans. While ordinary Americans would
consider government restrictions on their ability to spend their own money on
legal medical services to be a shocking violation of their personal freedom,
they should be reminded that the Clinton Administration and Congress enacted a
similar restriction in the Balanced Budget Act of 1997 for the Medicare
population. . . . Since the enactment of this bizarre law, subsequent
litigation and regulatory modifications have softened its impact, but it
nonetheless remains on Medicare's books.(1)
Canadian Supreme Court decision is a landmark case for one reason: It
reaffirms that personal freedom is the key value in health care policy. In the
continuing debates over health care access, cost, and quality, American
policymakers should not lose sight of why America exists.
Robert E. Moffit is Director of the Center for Health Policy Studies at The
BY GRACE-MARIE TURNER: Bob and I are honored to host Dr. Jacques
Chaoulli, the courageous physician who challenged restrictions in Canada's
government‑run health care system--and won. The Supreme
Court of Canada struck down on June 9, 2005, a Quebec law that had banned
private health insurance and private payment for services covered under
Medicare, Canada's socialized health care program.
Chaoulli was joined in the case by his patient, Montreal businessman George
Zeliotis, who was forced to wait a year for hip replacement surgery. Zeliotis,
73, tried to skip the public queue to pay privately for the surgery but
learned that was against the law. He argued that the wait was unreasonable,
endangered his life, and infringed on his constitutional rights. The two
fought their case all the way to the Canadian Supreme Court, which voted
4‑3 that they were correct.
to a waiting list is not access to health care," the court said in its
case involved the Quebec Hospital Insurance Act and technically applies only
to that province, but it is a wake up call to the other provinces, where
private insurance also is banned. "This is indeed a historic ruling that
could substantially change the very foundations of medicare as we know
it," Canadian Medical Association president Dr. Albert Schumacher said
after the ruling. The ruling means that Quebec residents can pay privately for
medical services, even if the services also are available in the provincial
health care system. . . .
United States has been a safety valve for Canadians unwilling or unable to
tolerate the long waits for medical care in their country. Now, the Canadian
government must face directly complaints about the long waiting lines, lack of
diagnostic equipment, and restrictions on access to the latest therapies,
including new medicines.
an almost laughable defense, lawyers for the government argued the Canadian
Supreme Court should not interfere with the government's health care system,
considered "one of Canada's finest achievements and a powerful symbol of
the national identity." Dr. Chaoulli had persevered in spite of two lower
court rulings against him. They had ruled the limitation on individual rights
was justifiable in order to prevent the emergence of a two‑tier health
Chaoulli was born in France and obtained his medical degree from the
University of Paris, before moving to Canada in 1978. He has practiced
medicine in Quebec since 1986. Welcome, Dr. Chaoulli.
- Grace-Marie Turner is President of the Galen Institute.
I did in Canada, anybody willing to do it could have done. My background is
was born in France. During the time I was studying medicine there, I never
heard about patients suffering or dying on a waiting list. After graduating in
1978 from the Paris University school of medicine, I moved to Canada. To my
great surprise, while practicing as a physician during the 1990s, I saw
patients suffering and dying on waiting lists under the Canadian
single‑payer health care system. Although I didn't have any knowledge of
law at the time, I already felt it was unacceptable. Actually, I was even more
surprised to see that nobody stood up against the government to claim that
those patients were victims of an infringement upon their human rights.
also felt the Canadian legal community was not up to speed. So, I studied the
law, I studied the health care systems from around the world, and I studied
more in the field of some medical and surgical specialties for which I noticed
important problems of access to timely and quality health care services in
launched the court case you know about, representing myself all along, and
invited a patient, Mr. Zeliotis, to join me in the legal proceedings as a
co-plaintiff, until my legal arguments eventually prevailed before the
Canadian Supreme Court.
to the end, most of the commentators thought I would fail. But on June 9,
2005, I won. Across Canada, the elite was astonished.
Dean of Canada's Osgoode Hall law school, Patrick Monahan, was quoted by
Canada's National Post three days ago as saying, "I didn't expect a
majority of the court to uphold Chaoulli's claim."
constitutional law professor from the same law school, Jamie Cameron, was
quoted as being "surprised at the judges' activism.... It's a huge step
for Section 7 [of the Canadian Charter of Rights and Freedoms}. I think that
the constraints that used to apply to Section 7 have pretty much blown out of
is significant that I won against a number of lawyers and top expert witnesses
representing the government side. For example, during the trial I
cross‑examined Professor Theodore Marmor from Yale University. Justice
Deschamps, concurring with the majority, rejected his testimony, on paragraphs
63, 64 and 67 of the judgment.
many years, in survey after survey, a majority of Canadians said that they
were in favor of private health care alongside the public system. After my
victory, ordinary people felt a sense of relief to hear that, for the first
time ever, the highest court in the land condemned the Canadian
single-payer health care system for causing situations in which patients
suffered and died on waiting lists, in violation of the rights to life,
liberty, and security protected by Section 7 of the Canadian Charter of Rights
a result of this historic judgment, Canadian legal scholars have now
classified Canada's legal history about rights and freedoms into two distinct
periods: before Chaoulli and after Chaoulli.
many years, I have been studying constitutional law, most of the time alone,
and during a short period of time, in year 2000, as a full‑time law
student in Canada. As a law student, I argued against most of my Canadian
professors of law, whose interpretation of the Canadian Charter of Rights and
Freedoms was opposed to my own interpretation. Ironically, five years later,
in 2005, the Canadian Supreme Court upheld my own interpretation of that
Canadian Charter of Rights and Freedoms.
my knowledge, it is the first time that a court has invalidated a government
health care action that had effectively resulted in the suffering or deaths of
Canadian Supreme Court ruled that a state may not force an individual to
endure poor quality health care services or unreasonable waiting times for
medically required services, and it cannot prevent average individuals from
getting access to private health insurance.
for Private Health Care
Canadian Supreme Court ruling was like the fall of a second Berlin Wall. It
opens up a unique opportunity, in the United States and in several OECD
countries, to counter what is called in the United States "liberal,"
and what I call "socialist," lobbies that are pushing their agenda
for socialized medicine.
commentators believe that this ruling would apply only to Quebec and not to
the rest of Canada. I respectfully disagree with their opinion. In my view, a
proper reading of the judgment leads to the conclusion that similar
legislation in other Canadian provinces may already be considered as violating
Section 7 of the Canadian Charter of Rights and Freedoms, which protects the
right to life, liberty, and security. For that reason, in my view, there is no
need to launch additional legal challenges in other Canadian provinces.
private hospitals, I was asking the court to declare my right to establish a
private hospital in Montreal. The majority of the Canadian Supreme Court gave
me the green light to go ahead in establishing a private hospital, when
Justice Deschamps, concurring with the majority, ruled at paragraph 51 of the
judgment that: "the Minister may not refuse to issue a permit solely
because he or she wishes to slow down the development of private institutions
that are not under agreement," and when at paragraph 54, she said:
"Not only are the restrictions real but Mr. Chaoulli's situation shows
clearly that they are."
speaking, that ruling opens the door for a parallel private health care system
in Canada running alongside the continuing socialized and compulsory Medicare
program run by the "States" or "Provinces," as in other
countries of Northern and Southern Europe, Australia, and New Zealand.
in terms of public health policy, such a result is not good enough. Those who
are unable to pay twice, through general taxation and the additional cost of
parallel private health care services, will continue to fall through the
cracks of a deficient Medicare program.
a long time, several experts have suggested that legislators should permit
individuals to opt out of a state's compulsory Medicare program. But as you
well know, legislators from around the world, including here in the United
States, have to deal with a potato which is not only hot, but also burning!
for the U.S.
victory is particularly important for American people, since they are facing
important health policy issues, both at the federal level, regarding the
Medicare program, and at the state level. The states of Vermont and California
have engaged, or are engaging themselves, in the process of establishing a
single-payer health care system which--there is no doubt in
my mind--shall lead, like in Canada, to a situation whereby some
patients will suffer and die on waiting lists.
believe that, were it not for particular interest groups pushing for their own
agenda, most people around the world would reject such a health care system
that inevitably leads to suffering and to death.
2002, particular interest groups thought they could introduce a
single-payer health care system in Oregon, through the initiative and
referendum called Measure 23. But three-quarters of the population of
Oregon rejected that model. Then, legislators in Vermont passed a bill
establishing a single-payer system.
few weeks ago, the Senate of California passed a bill that is even more
extremist, in the sense that, like in Quebec, it bans private health insurance
covering services already covered under a new California State Universal
Medicare program. That bill is likely to pass the Assembly as well. Maybe the
governor of California will use his veto power to block that bill, but such a
veto would last only as long as that same governor would remain in power. What
about the people of California if the bill is passed again and the next
governor fails to the veto that bill?
Canada, in the United States, and elsewhere, liberal groups should be
confronted with the failure of socialized medicine, which the four majority
justices exposed in the so‑called Chaoulli judgment. Moreover, and even
perhaps more importantly, they should be confronted with the terrifying
opinion of the three dissenting justices. Although the dissenting justices
acknowledged that some patients die as a result of the state monopoly, they
went on to say that the state monopoly is necessary in order to avoid what
they call an unfair situation, whereby those able to pay in a parallel private
health care system would save their own life, while those unable to pay would
have to wait in the public sector.
the first time in Canada, a Supreme Court Justice criticized publicly a
dissenting colleague sitting on the same bench. Justice Deschamps, about whom
I have spoken, wrote at paragraph 16 of the judgment: "The debate about
the effectiveness of public health care has become an emotional one.... The
tone adopted by my colleagues Binnie and Lebel JJ. is indicative of this type
of emotional reaction."
she clearly challenged the view of the three dissenting justices, when at
paragraph 85, she said: "It must be possible to base the criteria for
judicial intervention on legal principles and not on a socio-political
discourse that is disconnected from reality."
make no mistake about it. Although the Berlin Wall fell in 1989, many groups
driven by a socialist ideology are still very active in all the OECD
countries, including here in the United States, and they share the view of the
three dissenting justices I have mentioned.
might hear from the legislators of Vermont that the Chaoulli judgment is
irrelevant to them since the bill they passed doesn't ban private health
insurance. They would be right to say that their bill doesn't ban a parallel
private health care system. Still, down the road, like in Canada, in the UK,
and in several other OECD countries, I believe some patients from Vermont
shall inevitably suffer and die on waiting lists if the single‑payer
health care system is to be implemented in that state.
Deschamps had it right when she wrote, at paragraph 96: "Given the
tendency to focus the debate on a socio-political philosophy, it seems
that governments have lost sight of the urgency of taking concrete action. The
courts are therefore the last line of defence for citizens."
suggest her comment applies as well to the United States and to many countries
around the world. I suggest the time has come to take advantage of this
historic judgment in order to inform people in Canada, in the United States,
and elsewhere about the consequences in terms of human suffering from letting
legislators adopt, or maintain, single-payer health care systems.
feel close to the American people because of our common love for liberty and
long time ago, in 1776, the Virginia Declaration of Rights, drafted by George
Mason and Thomas Ludwell Lee, showed the world what liberty means. I am
afraid, within Western democracies, many people have forgotten the true
meaning of liberty.
have a dream. My dream is to show the world how to get rid of a new and subtle
form of tyranny hidden under the cover of a Welfare State's compulsory health
dream is remind the world of the original sense of liberty that the founding
fathers of the United States of America envisioned for generations to come,
not only for American people, but also for people around the world.
- Jacques Chaoulli, M.D., is a Senior Fellow at the Montreal Economic Institute.
read the full introductions and the entire Heritage lecture, go to .
an account of the Medicare private contracting legislation and subsequent
litigation, see Robert E. Moffit, Ph.D., "Congress Should End the
Confusion Over Medicare Private Contracting," Heritage Foundation
Backgrounder No. 1347, February 18, 2000, at .
* * * * *
In the News: Health Insurance for All Californians - Less Expensive
than You Think -
Gerald F. Kominski, in his Tuesday, July 19, 2005 article, states "the number of Californians without health insurance is growing rapidly. According to the California Health Interview Survey, in 2003, 6.6 million Californians (including 2.6 million undocumented immigrants) were uninsured at some time during the year, an increase from 6.3 million in 2001. Not only do these high numbers indicate a tremendous amount of needless suffering, but they also signal even greater fiscal pressure on federal, state and local governments.
"Still, conventional wisdom tells us that even once the state's budgetary
crisis turns around, there just won't be enough money to solve this problem.
Considering the billions being spent to provide health care to the uninsured,
however, it is clear that money isn't really the issue. . . .
"It will cost $9.8 billion in 2005 to provide health care to California's
uninsured, including $4.2 billion from out-of-pocket payments, $2.6 billion
from government sources and $3 billion from charitable organizations,
according to a report from the UCLA Center for Health Policy Research.
Federal, state and county governments will spend an additional $3.6 billion in
subsidies to safety-net providers to cover indirectly the costs of caring for
the uninsured, mostly in hospitals and community-health centers. Combining
these direct and indirect expenditures means that a combined total of $13.4
billion will be spent to care for uninsured Californians in 2005, including a
total of $6.2 billion in federal, state and county subsidies and $3 billion in
"According to our recent calculations at UCLA, the uninsured would use
approximately $14.3 billion in health-care services if fully insured, because
having insurance always increases spending. This is a staggering amount of
money -- equal to recent deficits in the state budget. But given that
Californians already spend $13.4 billion to care for the uninsured, our state
is looking at a gap of only about $900 million.
"This $900 million represents less than $150 additional dollars for each
uninsured individual in California. To place this number further in context,
$900 million represents an increase of about 6 percent in current total
spending for the uninsured and an increase of less than 1 percent of overall
health-care spending in the state. So, if health care for all Californians
really is so affordable, why can't we solve this persistent problem?
"One barrier is combining the diverse funding streams for the uninsured
into a single program. Facilities that currently receive subsidies are not
willing to give them up. However, if all uninsured Californians were provided
with health insurance, the indirect subsidies provided to safety-net
facilities to care for the uninsured could be reduced, because subsidies to
safety-net providers would be largely replaced by insurance payments. . . .
research indicates that current expenditures from all sources for the
uninsured in California, if combined into a single program and supplemented
with modest additional expenditures, could provide sufficient funding to
provide health insurance for all of California's uninsured. Isn't it time we
solved this problem once and for all?"
Gerald F. Kominski, Ph.D., is associate director of the UCLA Center for
Health Policy Research and professor of health services and associate dean of
the UCLA School of Public Health. Read the entire article at .
if California Single-Payer Actuaries are as smart as the Medicare Actuaries,
there should not be more than a 400% error in the above calculations.
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the World: Healthcare Systems in Europe
Hartung of Hannover in a study on the development of the German Healthcare
Systems, gives an overview of the German and Dutch system and compares them
with the EU. He states, "There are basically two types of healthcare
systems in Europe:
a "Beveridge-system", primarily financed by taxes, which you
will meet with in Northeuropean countries, in Ireland and the UK. Since the
eighties, the Southeuropean nations like Spain, Greece and Portugal have
a "Bismarck-system", primarily financed by social insurances
income related, which is introduced in Middleeuropean countries and since the
late nineties in Easteuropean countries as well.
of the EC, like Holland and Germany, however, meanwhile finance their
healthcare by a mix of taxes, social and private insurances. Altogether the
private contribution in all states of the EC is increasing, . . . Thus an
approach of both systems is expected within the next decade, a further reason
that our European Societies should be joined under a European roof. Though the
funding in our countries, Holland and Germany, is almost identical, still
little deviations can be detected. The figure reveals that Holland's
healthcare is less financed by taxes and more by social insurances and private
provisions. . . .
of competition as ruling control element
healthcare sector is increasingly understood as part of our competitive
society. Health performance is controlled by our pluralistic system by
application of competitive principles B a feature, which we have not been
witnessing to that extent. Competition has become the fundamental principle
for all, who render health services: i.e. health insurances and hospitals.
control is increasingly considered as a restraint counteracting against a free
development in healthcare.
of public structures
healthcare sector is still impaired by quite a number of antiquated
regulations. This becomes evident, when focusing on hospital corporations.
Particular public hospitals are still liable to public authorities. Since this
corporate form is by far less competitive on the market than the form of a
private company with limited liability the number of public hospitals is
reducing. Either they disappear or - what actually happens - they are changing
their corporation. . . ."
To read the entire report on Financing of Healthcare Systems in German, Holland and the EU by C Hartung, go to .
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4. Government Medicine: What You Can Expect in Medical Expenses After You Retire
his monthly newsletter, "From Inside Personal Finance," Ric
Edelman gives us a view of what health care will cost when we retire.
you estimate the expenses you are likely to incur after you retire, pay
attention to the costs of medical care, especially medical insurance. You are
likely to spend $3,500 to $11,000 annually on medical insurance - and that's
before you visit a doctor or hospital, before you even fill a prescription,
see a dentist, or visit an optician.
primary defense is Medicare. Sign up for it three months before your 65th
birthday. Medicare consists of Part A and Part B. Sign up for both; if you
delay signing up for Part B until after you lack coverage, the premium for
Part B increases 10% for every year you defer. Note: If you are still employed
and covered by health insurance at work, defer signing up for Part B until you
are no longer covered at work.
see what each part covers:
A is free - thank you, Uncle Sam - and it pays part of the expenses for
inpatient hospital charges. It also pays for skilled nursing facility care.
However, it pays nothing for the first 20 days, but for day 21 through 100, it
pays up to $114 per day. Part A also pays a very small amount of home health
Part A, you will pay the following for each benefit period. (Benefit periods
start the first day the Medicare client is provided inpatient hospital,
skilled nursing, or rehabilitation services and ends when the Medicare client
has not been an inpatient of a hospital or other facility for 60 consecutive
deductible of up to $912 for a hospital stay of 1-60 days. $228 per day
for days 61-90 of a hospital stay.
$456 per day for days 91-150 of a hospital stay. After 150 days,
you pay all costs.
I say Part A is free? Well, that's because you've been paying for it via
Social Security payroll taxes. Oh, you didn't have an earned income or
accumulate 40 quarters of Social Security coverage? Well, in that case, you
will have to pay the Part A premium, and it's expensive ($375 per month). So
it's worth staying - or getting - employed so you can rack up those 40
quarters (that's 10 years) under the Social Security "system.
B, by contrast, is not free. The monthly premium for one person is $78.20.
Thus, married couples will pay $1,876.80 this year. Part B pays for some
physician charges, outpatient hospital services, certain home health services,
and durable medical equipment. There's a $110 deductible this year, and you
pay 20% of the Medicare-approved amount for services after that.
even used together, Medicare Parts A and B don't cover everything.
Unfortunately, there are lots of gaps between what care costs and what
Medicare pays. For example, after 150 days in a hospital and 100 days in a
skilled nursing facility, Medicare pays little to nothing.
of these 'gaps,' the insurance industry offers a solution: So-called 'Medigap'
policies help cover what Medicare itself does not.
"There are 10 versions of Medigap insurance, labeled A to J. Look at all 10 and decide which you like best - A offers the least benefits and is the least expensive; J is the opposite - and then shop around for the best price. You'll pay $800 to $10,000 or more a year per person. To learn more about the policies and the costs, go to www.medicare.gov and click on 'Medicare Personal Plan Finder.'" www.ricedelman.com/planning/healthcare/medicalexpenses.asp
you think that health care is expensive now, wait until you see what it costs
when it's free.
* * * * *
Medical Gluttony: The Hospice Program Is a Revenue Gold Mine
Margie, one of our 94-year-old patients with Alzheimer's Dementia, had three very doting daughters who each swore that their mother would never go to a convalescent hospital. On several admissions over the past decade, the home health-care team tried to persuade the daughters to allow them to assume care of their mother. The daughters respectfully declined. Margie was never left alone without one of them always at her side.
this last admission, which I didn't attend since I've retired from the
hospital portion of my practice, the home health-care team finally prevailed
and began making home visits resulting in five pages of orders for me to sign.
The more I read the document, the more I realized that this was a significant
mechanism to milk the Medicare system.
page one, problem 001 was Pain, Acute/Chronic with expected outcomes. The
taxpayers were funding someone to assess the emotional factors; instruct in
the causes of pain; perform therapeutic touch; instruct in comfort measures
such as position changes, cool room, music, and touch; instruct on
premedication for activities (Note: the patient is senile, contracted, cannot
talk, or perform any activities), and notify appropriate supervisors if goals
were not attainable.
003 was Anticipatory Grief. Funding would apparently be provided for being
able to verbalize grief-related thoughts and emotions, to demonstrate
understanding of grief processes, to encourage the expression of feelings
about loss, to encourage life review, and instruct on stages of grief.
were two problems of those listed on the first of four pages. They all had
three digit numbers ranging from a selection of more than 500, suggesting
there were at least 500 ways to obtain Medicare money. All are worthwhile
ideals, but many were irrelevant to this patient.
reminded me of the monthly home visits I made for one of my
respiratory-failure patients who was on liquid oxygen. I received $72 of my
$120 home visit charge from Medicare. The patient showed me the Medicare
notice of payment. The hospital was paid $148 (as I recall) for the nurse
visit, which the patient stated was of shorter duration than mine. A
colleague, Dr Davis who was the editor of Private Practice, wrote
Medicare as to why they paid the hospital nurse twice as much as the doctor.
Medicare replied that the hospital had to provide the car and overhead
expenses for the nurse to make the visit. When he wrote back outlining the
overhead expense for his care, he was ignored.
just goes to show that given the opportunity to enhance any source of revenue,
a large hospital with unlimited resources will be able to obtain huge
reimbursements compared to solo or group practitioners. Government Medicare
and other bureaucratic forms of medicine will always allow this inequity,
which has no quality of health care or quality of life value. It just depletes
health care resources for honest hard-working Americans.
* * * * *
More Regulations and Laws Improved Health Care - Lessons from Colorado on How
to Feed the Lawyers: Make More Criminals
week at the Independence Institute, Mike Krause and Chelsea Johnson in
their Opinion Editorial report that New Crimes Mean More Criminals:
Colorado has plenty of both already.
July 1, several dozen of the more than 400 new laws passed by the 2005
Colorado Legislature went into effect. Some of these laws are changes and
updates, while others actually advance personal freedoms. But the Legislature
also managed to create more new crimes where no actual criminal behavior
Legislature's expansion of 'public welfare' lawmaking, which criminalizes
conduct not inherently wrong, but wrong due to a legislative declaration (malum
prohibitum) has increased dramatically over the last 50 years. The Legislature
should put the crime creation business on hold for at least a couple of
already has some 30,000 laws taking up a dozen volumes of statutes; more than
enough to ensure no one knows if one is in compliance or not. This in turn has
placed excessive burdens on the criminal justice system. Colorado's prison
population has more than doubled over the last decade, and local jails operate
beyond capacity throughout the state.
agencies from the Routt County Sheriff's Office to the Denver Police
Department, claim to be under‑staffed and overworked, while the court
system is overburdened and backlogged; in 2004, there were over 10,700 adult
criminal case filings in Colorado courts just for drug cases, still only one
quarter of criminal case filings.
are plenty of crimes and criminals in Colorado. So why does the Legislature
insist on creating yet more of both?
the basic violent crimes--murder, rape, assault and
robbery--have long been on the books, as have theft, trespassing,
and other property crimes, and while technology has created new ways to commit
fraud or embezzlement, the basic elements of these financial crimes have
remained unchanged from the days of common law.
real crimes against people and property have long been codified, legislators
now have to satisfy themselves with passing 'public welfare' laws in pursuit
of some perceived public benefit.
creation of yet more crimes, however, has failed to bring about an end to
these old, most important crimes. In fact, major crimes in Colorado increased
by almost 9 percent in 2004. Homicide alone increased by 18.5 percent.
crimes do however increase demands on police, the courts, and the public;
creating new criminals, while at the same time delivering often dubious
instance, Senate Bill 36 makes it a crime in Colorado for newly licensed
teenaged drivers to carry passengers under the age of 21 (except siblings) for
the first six months. They can carry just one teenaged passenger during the
next six months.
reality, criminalizing teenagers riding in cars will actually create new
scofflaws (those teens who will certainly ignore the new law), while at the
same time ensuring that there will be more inexperienced teenage drivers on
the road than ever before.
example, where a group of four 16-year-old friends might carpool
to high school, or several teens ride‑share to part time jobs at the
local mall, the law now demands they all drive separately, or find another
means of getting to class or work. If the Legislative logic behind the law
holds true, the new school year will actually mean less safe roads for the
rest of us. . . .
sheer number of such 'public welfare' laws on the books makes it impossible to
enforce these laws consistently. And since a sense of right and wrong is no
longer a guide to remaining a law-abiding citizen, the average
Coloradoan has no hope of complying with all of them. This breeds a lack of
respect for the rule of law itself.
time someone tells you, 'There ought to be a law,' remind them that there
probably already is one."
read the entire OpEd article, go to www.i2i.org/article.aspx?ID=1167.
* * * * *
Edwards was commenting on a patient that he had evaluated in consultation,
obtained an ECG, CXR, and PFT, spending over an hour with the patient. He
thought it had gone well, when a month or two later his CMA (Medical
Assistant) informed him that the patient had called with inflammatory insults.
She had received a statement for the charges that her insurance wouldn't pay.
She alleged it was not her problem. "That's the reason I have insurance
to pay all my medical expenses. Don't ever send me another statement."
Edwards had been surprised that day when he saw her in the office. He was very
cordial and took care of her medical needs. When she left, she looked him in
the eye, saying, "Doctor, I hope you get paid for this one."
* * * * *
of Medicine: New Physician ID Number - NPI (National
Provider Identification) to replace the Current Physician ID Number - UPIN
(Unique Provider Identification Number) — Another Bureaucrat with Too Much
Time on His Hands
their Bulletin, The Humboldt-Del Norte County Medical Society (HDNCMS) reminds
physicians to begin submitting applications for their unique National Provider
Number (NPI) because over the next two years, it will replace the existing
Unique Provider Identification Number (UPIN). Health plans are required to use
them by May 23, 2007. The NPI will be a ten-digit number unique to every
provider and is expected to stay with the physician regardless of practice
location. The Centers for Medicare and Medicaid Services (CMS) is tying this
closely to the HIPAA confidentiality requirements for electronic transfer of
health-care information. CMS is expecting to have a system in place that will
allow a physician to apply on-line.
The cost of
switching to the new system will not be cheap for CMS or for any of the health
plans. Small plans that can't make the two-year transition will be given an
extra year before they must begin using the new NPI number. See .
should make it easier for the government to police and control us ever more
tightly. The patients may not be sophisticated enough to know that the noose
is also around their necks.
* * * *
Review: MARKET DRIVEN HEALTH CARE - Who Wins, Who Loses in the
Transformation of America's Largest Service Industry by Regina
Herzlinger. Addison-Wesley Publishing Company, Inc. Reading, Mass, 1997,
xxviii & 379 pages, (includes index) $25. ISBN: 0-201-48994-5
Dr Herzlinger, Professor of Business
Administration, Harvard Business School, suggests by her title "how the
market--not managed care... will provide the solution to the deep problems
that plague the American health care system." Consumers in the United
States are ambivalent about medical care--bemoaning high costs and
inefficiency while applauding research advances and individual health care
providers such as doctors and pharmacists. The abundant information that is
available for other sectors--prices, cost, quality, availability--is
stunningly absent in health care... Even prices are generally quoted "a
la carte" not for the full episode of care. Herzlinger's book intends
to help remedy "the contradictions in the American health care system: to
keep what is so good about it and to purge what is so bad."
In Part One of this four-part book,
Herzlinger looks back twenty-five years to studies that found disparity in
patient care. Women in Maine underwent hysterectomy four times more often than
those in New Hampshire, implying that some back woods docs were a "greedy
lot." Nevertheless, providing equitable care to women seemed easy. Allow
a few smart doctors to routinize medicine and then tell the rest what to do
and how to do it. Quality would improve, and the cost of health care would
plunge--one of the cornerstones of today's powerful for-profit managed care
Herzlinger finds this strategy
puzzling when compared to recent changes in most sectors of the American
economy. She points to manufacturing's innovations in organizational
structure, technology, information, and employee empowerment. The author
describes "focused factories," where cleaving vertically
integrated firms and "outsourcing" goods and services have proved
beneficial, both in costs and customer service. These successful ideas have
eluded much of the health care system, which continues to replicate the
mistakes of long-gone manufacturing giants--believing that "big is
beautiful" and that direction should come from the top.
By 1986, fifteen years after
Herzlinger's initiation into the maddening contradictions of the American
health care system, she was convinced that the forces that had revitalized
manufacturing could reshape the health care system. A revolution was on its
way. However, unique barriers--complex technology, multiple professional
roles, and daunting legal requirements--had to be overcome. To prepare
potential medical care managers, Herzlinger developed an MBA course at the
Harvard Business School, "Creating New Health Care Ventures,"
proposing lower priced specialized medical care, "available before and
after working hours, in easy-to-reach locations like work sites, shopping
malls, homes, and schools," much as the eyewear sector and chain of
cancer centers are doing right now. There will be winners, healthier,
better-informed patients and health care providers no longer having to
answer to bottom-line-oriented managers, and losers, providers who do not
value customer convenience over their own and who also enjoy being in
In Part 2 , Dr Herzlinger, using
examples found in managed care and horizontal integration, analyzes why the
two popular remedies for the health care system--downsizing, or managed
care, and upsizing, or "big is beautiful," fail in most cases. She
gives examples that merged hospitals have increased their costs
In Part 3, the author applies two
industry proven ideas, the focused factory and the technology concept, to
the "resizing" of health care systems, a fundamental change in
structure--exchanging fat for muscle--which is the most difficult.
She points to Toronto's famed
Shouldice (Hernia) Hospital, a "focused factory" where 20 surgeons
only do herniorrhaphies, as a lesson in efficiency. This privately owned,
for-profit facility, charges $2,000 for a procedure that is otherwise
essentially free in Canada (after a long waiting period) and costs between
$2,400 and $15,000 in American hospitals. Birthing centers, already part of
the medical landscape, are another form of the focused factory. She reminds
us that clinical pathways are not equivalent to focused factories. She
presents data about the inefficiencies of diabetic, asthmatic, and
hypertensive care and why they are ripe for the cure: focused factories. The
Wilkerson Group, a consulting firm, speculates that HMOs will not invest in
a focused factory program because their large membership turnover of 20-25%
per year causes them to cast a dubious eye on programs that require
intensive efforts in the present to avoid massive costs in the future.
"The last thing they want to do is to attract more people with these
Industry uses technology to lower
costs; medicine does not. Further, the present proliferation of needless
technology raises costs, enabling health care institutions to raise prices.
Lastly in Part 4, Herzlinger
discusses reimbursement systems that encourage focused factories' growth and
how technological innovations, convenience, and information will improve our
health and reduce our health care costs.
Physicians concerned about the evolution of health care should consider taking this "MBA course" by reading Professor Herzlinger's text, which is succinctly written. Although the book reads well and presents a total picture, we must always speak with the physicians in the trenches. Herzlinger quotes the Shouldice hernia recurrence rate as less than 1%. Two surgeons have told me they have repaired several Shouldice recurrences. Statistics in clinical medicine may be less scientific fact than clinical impression. However, Herzlinger has presented this total picture for our continued dialogue of health care issues. Healthcare leaders will read and study these ideas which will guide them as they plan for health care's future. If physicians take that leadership role, it will empower our profession by making our patients health care more cost effective.
* * * *
& His Kin: Health Care Pork - Now That's Really Unhealthy Fat - Class
Action Pays Doctors $135 Million - or One Dollar per Patient Visit - Who's
Giving Us this Adverse Publicity - How Can We Get Our Professional
Organizations to Stop this Professional Homicide?
WellPoint, the nation's largest for-profit health insurer, said Monday that it will pay up to $198 million to settle class-action lawsuits brought by physician groups in California and more than a dozen other states accusing the company of underpaying doctors.
As part of the settlement, WellPoint
agreed to pay $135 million to physicians. The company also agreed to pay legal
fees up to $58 million. WellPoint has more than 28 million members nationwide.
On average that would be slightly less that five dollars per patient or about
one dollar per patient visit if the patient made five office visits during the
years in question. Can you believe spending $58 million on attorneys to get
five dollars back in reimbursement? I don't anticipate ever seeing my five
dollars. It would cost me ten times that amount in bookkeeping fees and paper
work to try to collect. No matter if you win or lose, your attorney always
of the $25 billion awarded each year goes to the lawyer.
Jess Brallier in Lawyers and Other Reptiles courtesy of my attorney.
Center Concept Is Mostly Medical Pork
Gershon replies to the editor of the Wall Street Journal, "If your
reporter offers only one side of the story with regard to the stroke center
juggernaut it isn't his fault ("Doctors Push Stroke Hospital
Network," June 17). Within the U.S. academic medical community there is
little voice in opposition to stroke centers. I believe this is mainly because
the most motivated authors and speakers are those with the most at stake
professionally and, unfortunately, financially in the development and funding
of stroke centers.
am one of the "interventional endovascular neuroradiologists"
referred to in your article, and I am speaking up to say that, in all honesty,
the stroke center concept is the fattest lump of pork ever hoisted on the
American taxpayer by the medical community.
a society with unlimited resources I think it would be a good idea to
financially support every medical endeavor with good intentions. But in the
U.S., where we are discussing how long Medicare can remain solvent, it is
revolting to see self-serving and frequently financially conflicted
academic stroke neurologists pushing the stroke center juggernaut."
S. Gershon, M.D., Assistant Clinical Professor, University of Connecticut
Medical School, Avon, Conn.
How about Doubling the Health Care Costs in the Name of Quality That Patients
Landro reports in the WSJ that "the largest federal program to improve the
nation's medical practices is coming under fire, as critics question whether it
is effective in fixing some of the most persistent and costly gaps in
multibillion-dollar program aims to address the enduring problem that many
patients don't get the most effective and up-to-date treatment. In fact,
research shows that patients in the U.S. receive only half the care recommended
by medical evidence."
an interesting technique to double the cost of health care from $17 trillion to
$34 trillion overnight in the name of quality by making a bureaucratic
correction that most patients wouldn't even recognize as an improvement in
health care but as something less than they would like? How do we improve the
quality of medical bureaucrats?
the whole story at http://online.wsj.com/article/0,,SB112060369315777806,00.html?mod=todays_us_personal_journal.
* * * *
Restoring Accountability in Medical Practice, HeathCare and Government
EmergiClinic - where Robert Berry, MD, an emergency physician and
internist states: "Our point-of-care payment clinic makes acute and
chronic primary medical care affordable to the uninsured of our community by
refusing to accept any insurance (along with the hassles and crushing
overhead that inevitably come with it). Read the rest of the story at www.emergiclinic.com/.
Read Dr Berry's response to Physician's Support of Single-Payer
Health Care or Socialism at www.delmeyer.net/hmc2004.htm.
Harris, MD - www.northernurology.com/-
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 pioneered the development of a contemporary and anatomically correct
method of radical perineal prostatectomy for prostate cancer while teaching
urology in San Antonio. In 1993, he entered the private practice of urology
and continues clinical research, which has been expanded to other common
urologic procedures. His publications reveal some of the most comprehensive
analyses of clinical outcomes in the management of prostate cancer. Dr
Harris is also 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" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
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/.
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.
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. You're invited to join them on September 16th, 2005 at
the Doubletree Hotel in Somerset, NJ for their 2nd annual Benefit Banquet.
Dr. Walt Larimore, MD, award-winning medical journalist, best selling author
and family physician educator will speak about providing health care to
those in financial need. For their article, "Are you really
insured?," go to www.healthplanusa.net/AE‑AreYouReallyInsured.htm.
Pelner Cosman, JD, PhD, Esq,
has made important efforts in restoring accountability in health care. She
has now published her important work, Who Owns Your Body. To read a
review, go to www.delmeyer.net/bkrev_WhoOwnsYourBody.htm.
Please go to www.healthplanusa.net/MPCosman.htmto
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.
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
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.
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/.
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/.
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. Be sure to consider attending their Health Care Summit:
"American Medicine in Crisis - A Time for Action" in Pittsburgh on
Saturday, October 22, 2005 with an impressive array of speakers. For more
information, go to www.sepp.net/.
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 on the United States Supreme Court decision in the
Kelo v. New London case which strikes at the heart of our freedoms B and, if
left unchallenged, imperils our right to life itself." and can be read
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. Read the News of the Day at www.aapsonline.org/nod/newsofday200.htm. The "AAPS
News," written by Jane Orient, MD, provides valuable information on
a monthly basis. Read last month's issue on Dependency and Death at www.aapsonline.org/newsletters/june05.htm. 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. Be sure to read the timely and insightful article by
Alphonse Crespo, M.D, "Outlawing Medicine" at http://www.jpands.org/vol10no2/crespo.pdf. There are an
excellent selection of book reviews at http://www.jpands.org/vol10no2/bookreviews.pdf.
Offer for Medical Tuesday readers: Receive a free gift subscription to the Newsletter
and Journal of the Association of American Physicians and Surgeons (AAPS).
"Each month we report on our actions promoting free market and ethical
medicine. In the past year AAPS has
helped defeat the California Medical Board, the FDA, the DOJ and currently has
briefs pending in multiple federal circuits. Learn
how to opt out of insurance and succeed with a cash practice.
Benefit from our network of thousands of like-minded physicians, and
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Tuned to the MedicalTuesday.Network to Maintain Your Perspective of HealthCare
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Meyer, MD, CEO & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608
D Eisenhower: There are a number of things wrong with Washington. One of
them is that everyone has been too long away from home. May 11, 1955.
(1764): The art of government consists of taking as much money as possible
from one party of citizens to give to the other.
Chaoulli, M.D.: My dream is to show the world how to get rid of a new and
subtle form of tyranny hidden under the cover of a Welfare State's compulsory
health care program.
This Date in History - July 26
this date in 1908, the Federal Bureau of Investigation was established by
Attorney General Charles Bonaparte.
this date in 1947, the United States Department of Defense was established
under the Armed Forces Unification Act. This signaled the recognition that, in
an era of the totality of war, there had to be one combined overall military