1.
Featured Article:
FIFTH ANNUAL WORLD HEALTH CARE CONGRESS-2008
As the above heading indicates, the most prestigious
health care meeting of the world has lived up to its reputation. The leaders in
industry, as well as health care executives and physicians, discussed all
issues of the current health care conundrum. A premier faculty of hundreds
spoke to an audience of more than 15,000 from all fields of health care. There
were 11 keynote addresses in open summits as well as ten simultaneous tracks of
topics that included International Health, Employer CEO/CFO, health care
insurance, evidence-based medicine, pricing and reimbursements etc., over three
days.
It was enlightening to hear from Steven Burd,
Chairman, President and CEO of Safeway Inc., who spoke knowledgeably about
health matters. He states the cost of the healthcare problem is the result of
market forces being absent. . . To
read more, please go to www.medicaltuesday.net/index.asp. Both the cost and the coverage problems can be
solved by introducing market factors. But one must be aware of the fluidity of
health care costs by understanding the following:
Seventy percent of healthcare costs are driven by
behavior.
Seventy-four percent of all costs are confined to four
chronic diseases. They are cardiovascular, cancer, diabetes and obesity.
Every private sector company can experience savings in
their health costs by behavior related incentives.
Eighty percent of diabetes is preventable.
Nearly all cases of obesity can be improved.
By introducing a 30 percent payment by the employees,
the costs were controlled and health improved. He felt that the primary source
of Safeway's cost reduction was Behavioral Incentives.
Health care costs are also related to specific
conditions: Smoking increases costs by $920 a year; obesity increases costs by
$705 a year. High cholesterol increases costs by $320 a year. He noted that by
emphasizing to the employees these health care costs, the Hershey chocolates disappeared
from all the secretaries' desks and eating habits improved.
Mr. Burd also pointed out that we need transparency in
health care costs. Their company had noted a disparity in costs of
colonoscopies from $630 to $6500; in arthroscopies from $2200 to $11,853; in
deliveries from $7,170 to $12,771. Most of these savings are when the
procedures are done in private centers rather than hospitals.
He considers Safeway as a cruise ship. If we spring a
leak, we will find it out before any agency will find it. We can then act on it
immediately.
www.worldcongress.com/events/HR08000/index.cfm?confCode=HR08000
|
|
Steven A. Burd |
Safeway Inc. is
one of the largest food and drug retailers in North America. Headquartered in
California, Safeway is a Fortune 50 company, operating 1,767 stores in the
United States and Canada. Regarded as one of the best managed food retail
companies, Safeway has been ranked by Fortune magazine as one of the
"most admired" companies in the food and drug sector.
Upon Mr. Burd's
arrival at Safeway in 1992, he spearheaded a significant turnaround that
produced industry-leading sales and cost reduction while developing an
excellent reputation for superior customer service. In 2003, Mr. Burd launched
a strategy to differentiate Safeway's offerings , by fundamentally reinventing
its business through its Lifestyle store format, product innovation,
operational efficiencies and new growth vehicles. The company has expanded its
reach into the prescription drug business with more than 1,300 in-store
pharmacies. In addition, it offers a wide range of proprietary products and
special features, including an extensive line of private label products, superb
perishables restaurant-quality prepared meals, fuel centers, online home
delivery and Starbucks coffee caf้s.
Mr. Burd is
considered a thought leader in advancing sound public policy on issues
impacting the retail industry. In 2007, he received the Food Marketing
Institute's Glenn P. Woodard Award for his leadership in public affairs.
Solving the health care crisis in America is a passion of Mr. Burd's. Under his
direction, Safeway has reversed the trend of rising health care costs by
implementing an innovative plan that pays 100% of preventive care, rewards good
behavior and allows employees to take more control of their health care
decisions. Participating employees have a better, more comprehensive health
plan while their out-of-pocket costs have decreased 22% to 32% over a two-year
period. More than 70% of eligible non-union employees participate in the plan.
. . To read the rest of his bio, go to www.worldcongress.com/speakerBio.cfm?speakerID=1869&confcode=HR08000.
Plan to participate: The 6th Annual World Health Care Congress
will be held April 14-16, 2009 in Washington, D.C. For more information, visit www.worldcongress.com. The future is occurring NOW.
* * * * *
2.
In the News:
Health Care Reform Now, George C. Halvorson, Chairman and CEO,
Kaiser Permanente, World Health Care Congress April 21, 2008
Mr. Halvorson gave a very concise delivery at the WHCC
of important issues in health care.
Health Ccare delivery in the
U.S. is uncoordinated, unfocused, inconsistent, unmeasured, extremely
inefficient, perversely incented, excessively expensive and sometimes
dangerous.
Health care delivery is, however, the fastest growing
and most profitable segment of the whole U.S. economy.
As an industry - as a business model - health care is
winning. It is taking everyone's money with an amazingly low level of
accountability for the product it sells.
We need to face the simple reality that -- --Health care
will never reform itself.
Smart people do not kill the geese that
lay lots of golden eggs. Health care is awash in both golden eggs and very
smart people.
In today's world, more efficient and
effective caregivers simply deprive themselves of income. . . To read more, please go
to www.medicaltuesday.net/news.asp..
Asthma: $200 to prevent; $10,000 to treat. Many
Treat; Few Prevent. So what should we do?
Reform care.
One Percent of Population
costs 35% of health Care Costs.
Cost Distribution of Care: $300 per month
is the average cost for the population as a whole.
The break- even cost of insuring that one
percent of the population:
$12,000 per month
Total Cost of
Care in America: Chronic Care 75% vs. Acute Care 25%
American health care could be transformed
fairly quickly if a number of high leverage buyers chose to strategically use
their market leverage.
Health care reform needs to be a "product"-- purchased and paid for
by high leverage buyers in a more sophisticated and targeted purchasing
strategy.
Health care purchasers have great leverage
relative to getting health plans to reform key elements of care.
We Need: 1)
Focus 2) Tools 3) Health
Be Well
|
|
George C. Halvorson |
George C.
Halvorson is chairman and CEO of Kaiser Foundation Health Plan, Inc. and Kaiser
Foundation Hospitals, headquartered in Oakland, California. Kaiser Permanente
is the nation's largest integrated health plan, serving more than 8.4 million
members in nine states and the District of Columbia. He has more than 30 years
of health care management experience. He was formerly President and CEO of
HealthPartners, headquartered in Minneapolis. He is the author of
"Epidemic of Care" published in April 2003, and "Strong
Medicine." He is currently writing two new books, one about racial
prejudice around the world, and another about systematic reform of health care
in America.
www.worldcongress.com/speakerBio.cfm?speakerID=318&confcode=HR08000
This prestigious meeting of chief and senior
executives from all sectors of health care will reconvene on April 14-16, 2009,
in Washington DC. For more information, visit www.worldcongress.com.
* * * * *
3.
International Medicine: Costs
of prescription drugs in Canada not to blame for unsustainable growth in health care spending - The Frasier Institute
TORONTO, ONTARIO - News Release - April
10, 2008. Government spending on prescription drugs is not responsible for the
health system's lack of financial sustainability, according to a new study from
independent research organization the Fraser Institute.
"Unsustainable growth in government
spending on health is a result of the flawed design of government health and
drug insurance programs, not the price of medical treatment or the introduction
of new medical technologies like patented drugs," said Brett Skinner, the
Institute's Director of Health, Pharmaceutical, and Insurance Policy Research
and author of The Misguided War Against Medicines.
"Prescription drugs in general and
patented drugs in particular account for a small percentage of government
health spending. The fact that government spending on all other areas of health
care is growing at unsustainable rates, while accounting for more than 90 per
cent of total government health spending, strongly suggests that targeting
prescription drugs is misguided."
Skinner's study sets out to examine the
often-cited claim that spending on prescription drugs is making the cost of
Canadian health care unsustainable. . . To
read more, please go to www.medicaltuesday.net/intlnews.asp.
. "Blaming patented medicines for rising
health care costs is a simplistic, knee-jerk reaction based more on
anti-business attitudes directed at the pharmaceutical industry than any
quantifiable research. It doesn't hold up under scrutiny," Skinner said.
The Misguided War Against Medicines shows that prescription drugs accounted
for only 9.3 per cent of total government spending on health in 2006, down from
9.6 per cent in 2005. Patented prescription drugs accounted for only 6.3 per
cent of total government health spending in 2006, down from 6.8 per cent in
2005.
After spending on drugs is subtracted, all
other areas of health care accounted for 91.4 per cent to 90.7 per cent of
total government health spending between 2002 and 2006.
The study also found that annual spending
on health professionals between 2002 and 2006 grew at a rate of 6.5 per cent on
average while annual spending on hospitals and institutions grew by 6.9 per
cent on average, and annual spending on government health, administration,
research, and other areas together grew by 7.2 per cent on average.
"These average annual growth rates
are between 1.2 and 1.4 times higher than the average annual growth in
consolidated provincial revenues over the same time period. It is also between
1.2 and 1.3 times higher than the average annual growth in national GDP and 2.9
to 3.2 times higher than the average annual growth in general inflation,"
Skinner said.
"This means that even if governments
spent nothing on drugs, government spending on all other medical goods and
services would still be rising at an unsustainable rate." . . .
Additionally, the study found that
Canadian government data showed average prices for existing patented
prescription drugs in Canada have grown at a slower annual pace than the
general rate of inflation for 17 of the last 19 years.
"Prices for existing patented drugs
are increasing at an even slower rate than they are allowed to grow under
federal price controls that permit annual price increases matching the general
rate of inflation. It also means that after adjusting for inflation, prices for
existing patented medicines have declined in real terms in 17 of the last 19
years," Skinner said.
Skinner concludes that the real cause of
unsustainable growth in government health spending is the flawed design of
government health and drug insurance programs.
"Government interference in health
care markets through public insurance programs actually distorts the efficient
allocation of medical resources, including prescription drugs. When government
health insurance attempts to provide equal access and 100 per cent insurance
coverage for any medical need on a universal basis, the system becomes
financially unsustainable," Skinner said. . .
To read the entire news
release, go to www.fraserinstitute.org/newsandevents/news/5429.aspx#.
The Fraser Institute is an independent research and
educational organization based in Canada. Its mission is to measure, study, and
communicate the impact of competitive markets and government intervention on
the welfare of individuals. To protect the Institute's independence, it does
not accept grants from governments or contracts for research.
Canadian Medicare does not give timely access to
healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R.
791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4.
Medicare: Ted
Kennedy vs. Universal Healthcare: A Double Irony by Richard
Parker M.D.
Senator Ted Kennedy recently underwent an operation to
remove a brain tumor at Duke University. Besides Hillary Clinton, no other
politician in America has devoted as much of his political career to the
enslavement of physicians. The name Ted Kennedy (and Clinton) is nearly
synonymous with the anti-concept "Universal Healthcare."
It was reported that Senator Kennedy chose his surgeon
for this difficult operation after very careful research and consultation with
his physicians in Boston. Using his free and independent judgment,
Kennedy chose Dr. Allan Friedman, a surgeon renowned for his experience
and expertise in the field of neuro-oncological surgery.
No government regulations restricted the Senator in
this extremely important personal choice. Facing a life threatening
illness, no bureaucrat forced the Senator to choose his surgeon nor hospital
from a government "approved" list--a list not generated by Kennedy's
independent and free judgment, but by "public servants" who's
expertise is not Kennedy's life, but the arbitrary and byzantine politics of
"pull", of favors owed and collected, of political pressure groups
and the bitter reality of healthcare rationing. No, Kennedy was not
forced to sacrifice his life, liberty nor property in the name of the so-called
"greater public good." To read more, please go to www.medicaltuesday.net/medicare.asp.
The surgeon he chose, Dr. Allan Friedman, has freely
devoted his life to treating patients with neurological tumors. Dr.
Friedman wasn't coerced into medicine; his patient load is not presently
rationed nor stipulated by bureaucrats. Dr. Friedman was still free to
accept Senator Kennedy as his patient and was free to choose the best surgical
approach for treating the Senator's tumor. No bureaucrat stipulated how
many patients per day, week, month or year Dr. Friedman may accept and treat
during the long decades he spent perfecting his life-saving skill. Dr.
Friedman is still relatively free to use his expert judgment in the face of the
awesome responsibility he assumes with each patient he treats.
Ironically, however, if Senator Kennedy succeeds in
his ambition of forcing a government financed (and therefore government
controlled) healthcare system onto the American people, all these life altering
and personal freedoms will vanish with the strokes of a few pens in
Washington. This is the reality of any government enforced healthcare
system - both patients and physicians will face a vast increase in taxation and
the loss of additional property (fines) and liberty (imprisonment) if they
violate the morass of arbitrary and contradictory regulations that will descend
on a healthcare industry that is already all but crippled with the slow but
steady creep of government controls over the past 50 years.
In her novel Atlas Shrugged, Ayn Rand
predicted one of the most pernicious aspects of so-called "Universal
Healthcare" - the refusal of talented minds to be forced at the point of a
gun. Dr. Hendricks, a neurosurgeon in Atlas Shrugged, describes
the indignation that led him to leave medicine:
"Do you know what it takes to perform a brain
operation? Do you know the kind of skill it demands, and the years of
passionate, merciless, excruciating devotion that go to acquire that skill? . .
. I observed that in all the discussions that preceded the enslavement of
medicine, men discussed everything -- except the desires of the doctors . . . .
I have often wondered at the smugness with which people assert their right to
enslave me, to control my work, to force my will, to violate my conscience, to
stifle my mind--yet what is it that they expect to depend on, when they lie on
an operating room table under my hands? Their moral code has taught them to believe
that it is safe to rely on the virtue of their victims. Well, that is the
virtue I have withdrawn."
Ted Kennedy will undoubtedly continue his push for the
enslavement of physicians with what remains of his political career. What he
will evade, of course, is that his surgeon chose to go to medical school and
spend decades training for and practicing neurosurgery in what is still the
freest healthcare system in the world. What Kennedy will refuse to
acknowledge is that under his vision of "Universal Healthcare" he
would never have had the absolute freedom to choose his surgeon, nor would his
surgeon have had the absolute freedom to treat him.
The fact that "Universal Healthcare" will destroy what freedoms in
American medicine still remain (and thus all the Dr. Friedman's under whose
virtue the fate of Kennedy's brain now lies), will be not only evaded but
explicitly denied - never mind that Kennedy chose not to go to one of
the many "industrialized countries that provide 'Universal
Healthcare'." Apparently, Kennedy ignored Michael Moore's claims of the
excellent healthcare provided in other "industrialized" communist and
socialist nations that provide "Universal Coverage", albeit this is
precisely what Kennedy seeks to bring to America at the point of a gun.
While the successful outcome of Senator Kennedy's operation depended on
freedom, Kennedy has devoted his political career to legislating freedom out of
existence. This is an irony that America's news media will evade, much less
report.
Article address: www.CapMag.com/article.asp?ID=5201
About the Author: Richard Parker is a
practicing physician in the Dallas-Fort Worth area. He holds an MD from Brown
and MD from Yale University. He has published in the scientific literature and
has written Op-Eds for the Ayn Rand Institute and Capitalism Magazine.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Is MediGap Insurance Good for Seniors?
We have always maintained in these newsletters that it
was the Medicare co-pays and deductibles in the original law that best
controlled Medicare spending. The responses show that our position has not been
fully accepted by the tens of thousands of MedicalTuesday supporters that we've
accumulated over the past seven years of our existence. Many Americans have
difficulty accepting responsibility for their health care as patients, feeling
that it deprives them of necessary and life-saving care. Hence, MediGap
insurance was born to make health care largely free of individual
responsibility. A recent example came to our office.
Ms. Gladys had just turned 65 and obtained both her
Medicare card and her MediGap insurance card, which paid for Medicare Co-pays
and Deductibles. She looked about ten years younger, had recently remarried and
commanded a very respectable mid-management job. Her husband was successful in
his business and they lived and traveled well. . . To read more, please go to www.medicaltuesday.net/gluttony.asp.
.
She came in to establish herself with a new physician
and, as she put it, "was going to be very proactive in her future health
care." This was ominous but we thought we would give her the appointment
hour to do a complete evaluation, write the appropriate requisitions and give
her a chance to make her case. She had a list. She was very articulate about
all her wants, desiring to avoid the pitfalls her friends had experienced, as
well as the ones she had read about. Her requests were extensive and most were
reasonable. We completed all the requests and because of their magnitude, we
suggested she make an appointment after she completed them to discuss the results.
We could then chart the future.
She did not keep her return appointment. We were
suspicious. Anyone who wanted thousands of dollars worth of tests surely would
be interested in the results. We called her a few weeks later and she politely
thanked us and stated she would be in when she needed our services again. After
a couple of months, we composed a letter and copied her chart in case we could
not continue with her demands.
She returned about six months later. Again she was
very articulate about her wants and as we started to discuss the medical
justification for additional tests, she failed to understand why she couldn't
have everything she thought was necessary. She had many highly placed friends
who were very knowledgeable about health care matters. As we tried to put the
breaks on unnecessary spending, she remarked that maybe she hadn't found the
right doctor after all.
We told her we agreed with that evaluation. I handed
her a copy of her entire chart with the cover letter requesting that she call
her insurance carrier in the morning and get reassigned to a new physician. She
was flabbergasted that we had both come to the same conclusion and that I had
already copied her records for her to give to her next physician. Two days
later, I sent her the fully typed copy of our last visit.
What were the issues playing here? We had a very
knowledgeable lady who we would normally enjoy having in our practice. However,
her insurance carrier rates us on our efficiency and cost per visit. We had
already exceeded the acceptable costs by perhaps three- or four-fold on the
initial visit. But we accepted that possible risk judging that we could control
the costs of future visits. But the second requests were even more costly and
not medically necessary. Thus, we decided that we could not meet her needs, or
rather demands, in the current health care environment.
This current environment was promoted by Congress to
reduce health care costs. Medicare pays HMOs a certain amount per month so that
Medicare doesn't have to manage the huge Medicare program. They have shown
their incompetence to do so. Congress does not believe Market Forces can
control costs. However, it is our position that if all Medicare Beneficiaries
had to sign a waiver to never obtain a MediGap policy, the cost to Medicare
would have been controlled without the necessity of paying thousands of nurses
and other health care workers to police utilization. This has led to the
barbaric approach of HMOs denying care, which lowers the quality of care and
puts patients at risk by penalizing the doctors who give high quality care at a
reasonable cost. Without MediGap, patients would be co-paying 20 percent of the
costs - a very effective utilization control. Medicare beneficiaries would
supervise their own costs and in the process eliminate all unnecessary Medicare
costs. Then the entire program would have continued to be under control.
We wish that Dr. Shultz had discussed this point in
his book distributed at the World Health Care Conference (see Item 9: Book Review
Section). Mr. Burd from Safeway, discussed in section one above, already
understands this concept.
MediGap insurance reduces patient's health care
responsibility, increases health care costs, and thus ultimately will not prove
beneficial to seniors, or to the rest of our citizens or country.
* * * * *
6. Medical Myths: Six Unhealthy Truths that aAre Changing the Shape
of Health Care
Kenneth Thorpe gave a
succinct presentation at the WHCC: "Six Unhealthy Truths that Tell the Story of the Rise of Chronic Disease
and Its Impact on Health and Health Care in the U.S."
Truth #1: Chronic diseases
are the #1 cause of death and disability in the U.S.
133 million Americans,
representing 45 percent%
of the total population, have at least one chronic disease.
Chronic diseases kill
more than 1.7 million Americans per year, and are responsible for 7 of 10
deaths in the U.S.
Truth #2: Patients with
chronic diseases account for 75 percent %
of the nation's health care spending.
During 2005, the U.S.
spent almost $2 trillion on health care.
Of every dollar spent .
. .
75 cents went towards treating patients with chronic disease. To read
more, please go to www.medicaltuesday.net/myths.asp.
In public programs, treatment of patients
with chronic diseases constitutes an even higher portion of spending: More than
96 cents in Medicare
and 83 cents
in Medicaid.
Truth #3: Two-thirds of the increase in health care spending is
due to increased prevalence of treated chronic disease.
Truth #4: The doubling of obesity between
1987 and today accounts for nearly 30% percent of the
rise in health care spending.
The percent of children and youth who are
overweight has tripled since 1980.
If the prevalence of
obesity was the same today as 1987, health care spending in the US would be 10
percent lower per person - about $200 billion.
Truth #5: The vast majority of cases of
chronic disease could be better prevented or managed.
The Centers for Disease Control and
Prevention (CDC) estimates
80% percent of heart disease and stroke; 80% percent of type 2 diabetes; 40 % percent of
cancer
could be prevented if only Americans were to do three things: Stop
smoking; Start eating healthy; Get in shape.
Management of chronic disease could also be
significantly improved: Chronically ill patients receive only 56% percent of
the clinically recommended preventive health care services.
Truth #6: Many Americans are unaware of
the extent to which chronic disease harms their health and their wallets.
Two in three (68% percent) Americans underestimate the magnitude of the problem: That in the U.S., chronic diseases represent
more than 70% percent of the deaths and 70% percent of health care costs.
Six Unhealthy Truths Tell the Story of the
Rise of Chronic Disease and Its Impact on Health and Health Care in the U.S.
|
|
Ken Thorpe, PhD |
Dr. Thorpe was the Vanselow Professor of Health Policy
and Director, Institute for Health
Services Research at Tulane University. He was previously Professor of Health
Policy and Administration at the University of North Carolina at Chapel Hill;
an Associate Professor and Director of the Program on Health Care Financing and
Insurance at the Harvard
University School of Public Health and Assistant Professor of Public Policy and
Public Health at Columbia University.
Dr. Thorpe was Deputy
Assistant Secretary for Health Policy in the U.S. Department of Health and
Human Services from 1993 to 1995.
Dr. Thorpe is a frequent
commenter on health care issues in the print media and television. He has
appeared on Nightline with Ted Koppel, NBC News with Tom Brokow, ABC World News
Tonight with Peter Jennings, CNN, CNBC and Newshour with Jim Lehrer.
www.worldcongress.com/speakerBio.cfm?speakerID=2613&confcode=HR08000
* * * * *
7.
Overheard in the
Medical Staff Lounge: Medicare Cuts, Reinstatement, Veto, Overridden
Dr. Milton: The
Medicare cuts were really worrisome.
Dr. Sam: But much of what the government does is
worrisome.
Dr. Milton: Aren't you glad the AMA went to bat to get
them reinstated?
Dr. Sam: Are you asking if winning a small skirmish
will win the War Against Doctors and Patients?
Dr. Dave: Don't you think if we win enough battles, we
can eventually win the war?
Dr. Sam: I
don't think so. The government will never be our friend. Is the UK government
the friend of British doctors? To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Edwards: I
don't think so. After 60 years, the battles are still the same. Only the issues
change from year to year depending on the whims of whoever is currently in
charge.
Dr. Rosen: I
agree with President Bush that there were enough downsides to the law that it
should not have been implemented. The other issues will haunt us in years to
come.
Dr. Dave: But
with the government, you'll never win. So, we have to get what we can get when
we can get it.
Dr. Edwards: There
are already cuts planned for 2009.
Dr. Sam: Let
the government cut Medicare every year. More and more doctors will opt out of
Medicare. When the Medicare folks can't find enough doctors, let them be the
bad guys complaining to Congress. As I see it, they have about 40 more free
hours a week than I have.
Dr. Milton: So you
don't agree with the AMA on their advocacy?
Dr. Sam:
Absolutely not. That's why the AMA and our own CMA are losing members because
most doctors don't agree with the issues they advocate.
Dr. Ruth: But
you can't please everyone.
Dr. Edwards: So
that is a good reason why professional organizations should stay away from
political issues. They will never be on the side of freedom. Our administrative
bureaucrats are just like politicians and have hidden alliances just like
members of Congress.
Dr. Ruth: They
seem to gearing up to the day when they will be our voice as we become
enslaved.
Dr. Rosen: Did
you see the article in the paper where the CMA Executive Director was featured
along with the various labor and union leaders as wielding influence? Our Execs
are no more professional than Union Bosses.
Dr. Yancy:
That's why I've never joined the CMA or the AMA or the local Sacramento Medical
Society. They don't represent me or my interests or what I think should be the
position of physicians and surgeons.
Dr. Edwards: Did
you note that the CMA gave $3 million to the election campaigns in addition to
the $4 million for lobbying? That's more than two hundred dollars per member or
about half our dues.
Dr. Sam: I'm
getting more interested in the doctors I read about that have forsaken all
insurance and practice for cash and credit cards only. Seems like they are less
busy than the rest of us,
working only a 50-hr week and enjoying life working only a 50-hour week -
like most normal Americans.
Dr. Michelle: And
I understand they are making a good living.
Dr. Yancy:
Better than I'm getting. I'm lucky if I get about one-fourth as much for each
operation as I did a decade ago.
Dr. Ruth: My
income slipped below a $100,000 last year for the first time. At a 3000-hour
work year, I make less per hour than a line worker. But he has a retirement
plan. I can't even retire.
Dr. Rosen: Join
the working crowd. Medicine will become a dead-end job like other laborers who
can't wait for the day when they don't have to work and can retire to the couch
and die in peace and comfort.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
The Bulletin of
the Humboldt-Del Norte Country Medical Society, April 2008
IN MY OPINION: Geese by GEORGE INGRAHAM, M.D.
If you have no iPod and are outside walking early
enough, you can hear the world wake up. In February, the geese return. When the
sky is clear they fly high and gabble quietly to one another. When the fog
is in they must wait at the refuge out near CR until
the fog is high enough to see the landmarks without running into them. Their
cackling takes a more nervous note when they aren't sure where the lead goose
is going.
Last week I saw two large flocks, one headed due north
and the other more easterly, cross paths at the same altitude as they emerged
from the mist. Near collisions made the conversation more animated: you could
almost understand it:
"Hey, chaps, careful there, eh?" (Canada
geese, you see*) . . . To read more, please go
to www.medicaltuesday.net/voicesofmedicine.asp.
"You're, um, going the wrong direction, you know:
that's the way to Honolulu!"
"Wrong way my (bleep) (Vernacular for the
sphincter at the end of the anal canal.): watch out, dummy!" (Canada goose
born in the US)
They dodged and swerved, and there were no collisions.
. . Some of the birds; lacking, perhaps, confidence in their leaders, changed
groups. The flocks diverged and flew off into the fog, the cackling fading into
the distance:
"Jeest! I almost hit that guy: scared the crap
outta me!"
"Tell me about it: I was right behind you."
This isn't the first year that campaign speeches have
touched upon universal medical care: I can remember Dwight Eisenhower
mentioning it, and I'm sure the subject came up before that. Early pols were up
against the AMA, who probably managed to scuttle the programs without raising a
sweat. "Socialized Medicine" was a wonderfully negative buzzword. The
drug companies were small potatoes in those days,
with campaign contributions to match; and there was hardly any medical
insurance industry at all. So, the pols felt safe in getting a little extra
applause with the medical care card. They promised nothing. And delivered. But
pressure slowly increased as technology improved, becoming more expensive, and
Medicare came along in the 1960's.
This political year, so splendid and exciting in so
many ways, may also well be the year that the US gets, or begins to get, a
universal health plan. Bet on it. Certainly if no program is at least begun
during the first term of the next president, he or she will enjoy no second.
But, like the geese in the fog, although we are quite clear where we wish to
go, we have differing ideas how to get there. The candidates are, however,
unworried about the details. They're confident that there will be people
willing to consult, and moreover even to construct and operate the new system.
They are right. Even now there are willing, even eager
volunteers for the task of overseeing, and eventually controlling, the advent
of our new tomorrow. Everybody wants to be the head goose, or at least the
navigator. Take, for example, the insurance industry, whose representations to
the newly elected Clintons in 1992 that the magical mystical HMO could
"save the country money by keeping people well" (Wm. J. Clinton, 1993) was entirely successful in
saving, if not much money, at least the pride of the then new Chief Executive
and the possible next new Chief Executive as well. And if (worst case scenario) it goes against them, they could be
entirely eliminated, a la Canada. And how nice it would be to save some of the
12-14% of the money now spent on running insurance companies!
And of course our friends in the drug industry (Ask
your doctor if Superpanacea is right for you!," the durable medical goods
industry ("ask your doctor if a nifty little electric scooter is right for
you!"), and the diagnostic machinery industry ("Come to the mall and
have a full body scan: a free Big Mac and fries with every study!") (OK I
made up about the Big Mac) can see this coming, and are preparing their
political connections to best advantage. . .
And it
is quite reasonable for all these folks to be doing this. The future course of
their careers, their incomes, and the care of their
our
patients will largely
be determined in the next few years. During that time we will be seeing
something not far removed from the Oklahoma land rush. For one brief shining
moment, everything will be on the table, and our elected officials will be
doing their sincere best to come with a system we can all work with and be
proud of. . . . So the message is (and always seems to be) it is a good time to
be telling our colleagues they should be joining organized medicine.
The only really enjoyable aspect of this is the quite
likely confusion in the ranks of the malpractice bar: for should a purely
federal system arise in these United States you
will search the blueprint in vain for the room, or even closet, labeled
"nuisance suits and obscenely generous judgements." Not to worry,
though. They'll take a hit, but they'll survive. . . To read the entire story, go to
www.humboldt1.com/~medsoc/images/bulletins/APRIL%202008%20BULLETIN_for%20web.pdf.
To read more VOM, please go to www.healthcarecom.net/voicemed.htm.
To read HMC, please go to www.delmeyer.net/HMC.htm.
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9. Book Review: Putting Our House in Order By George P. Shultz and John B. Shoven
Putting our House in Order A Guide to Social Security
& Health Care Reform, ฉ 2008, W. W. Norton & Co., New York, www.wwnorton.com/
George Shultz and John Shoven open their Guide Book
quoting Fed Chairman Ben Bernanke's Senate testimony concerning the right time
to address our entitlement programs, "I think the right time to start is
about ten years ago. The projected costs for these programs - Social Security,
Medicare, and Medicaid - loom with gathering intensity."
The unease is produced by a feeling that the costs of
entitlements are out of control and will overwhelm the budget. This will bring
a catastrophe for beneficiaries whose needs will not be served as well as for
the fiscal stability of the United States. . . To read more, please go to www.medicaltuesday.net/bookreviews.asp. But can the entitlement problems be
solved? Whether or not the political process can work out sensible changes is
certainly an open question but Shultz is confident that progress can be made by
reaffirming the wide consensus that the present programs are not sustainable
and by showing that there are workable alternatives.
The magnitude of these costs cannot be met by any
reasonable projection of future federal government revenues. Can the U.S. Body
politic somehow find a way to ensure that systems are in place to provide
reasonable income for the elderly that are consistent with fiscal sanity?
Dr. Shultz offers a different approach than the
impending catastrophe,
which is prevalent in much of the current writing on this subject. He cites
informed sources about careful projections of future costs made by the
Congressional Budget Office (CBO) which show that entitlement costs alone could
reach 28.5 percent of gross domestic product by 2050, clearly an unmanageable
level, especially considering that federal revenues have never exceeded 21
percent of GDP in the history of the Republic. And these projections reveal
only part of the problems before us. Commitments by state and city governments
and by private employers contribute substantially to the looming threat which
Shultz calls, "The Iceberg Ahead."
Shultz is optimistic of a positive approach. He relies
on America's solid record of economic achievements, which holds promise of continued success in
the future. He points out American success on many fronts. The U.S. economy
sets the world standard, and its growth is an essential ingredient in the
expanding global economy. The creativity and dynamism of the American economy
now yield strong gains in productivity (output per man-hour) that surpass the
rate of improvement in many prior decades. The U. S. economy produces one of
the highest per capita incomes in the world and no other major developed
country has been able to keep pace, let alone catch up. So it's clear: We have
success on our hands.
The economy is by no means the only area of success.
Not only do Americans live longer than ever before, but many are healthier and
capable of being productive far longer than at any time in the past. These
trends are likely to continue as a result of many breathtaking advances in
science and technology. He feels such momentous developments are opportunities
to nourish.
The contradiction between this clear evidence of
success and the current atmosphere of unease in the United States calls for a
change in mind-set. The projected gargantuan shortfalls in the U.S. budget stem
largely from the interaction of constantly expanding costs of health care and longer
life spans with relatively inflexible
entitlement programs. Increasing longevity and better health are developments
to celebrate. The challenge is to adapt income support and health care programs
to these changing demographics and health care options.
He feels the difficult problems in financing Social
Security and health care commitments must be approached from a realistic
perspective based on demography, medical developments, and fundamental
economics. In demographic terms, we are retiring earlier and living longer. The
result is a growing proportion of people outside the labor force compared with
those who are working. Medical treatment options too have expanded. As a
consequence, the federal government has increasingly become a mechanism for transferring
every-mounting sums of money from younger workers to older retired Americans.
The history of Social Security and health care
programs in the United States shows that their structural roots come from an
altogether different era, that of the Great Depression and World War II and its
aftermath. These programs must be adjusted to better accommodate increased
longevity as well as improved and promising medical treatments, which are often
costly.
Reform of these programs will not come easily. To
touch them, many politicians worry, is to touch a third rail. But
well-documented projections of the costs of current programs show that inaction
is simply not an option. Everything about the U.S. economy is dynamic except its
major entitlement programs.
.
Shultz
presents how these programs must be modernized so that they are suitable for
the twenty-first century, and meet the tests of fairness and fiscal
responsibility.
Shultz and Shoven present illustrations, health carse stories,
data, and a plausible solution to our retirement and health care conundrum that
is worth studying. We may not agree with all their solutions. However, it is a
well- researched
study with reasonable proposals that bear investigation by those who are
serious about the Health Care problems and solutions for the United States.
|
|
George P. Shultz |
George Shultz
has had a distinguished career in government, in academia, and in business. He
held four different cabinet posts, he taught at three of this country's
greatest universities, and he was president of a major engineering and construction
company.
Mr. Shultz graduated from Princeton University in 1942 with a B.A. in economics
and then began his service to the nation as a Marine. He resumed his studies at
MIT and earned a Ph.D. in industrial economics in 1949. Early in his career, he
served as a senior staff economist on President Eisenhower's Council of
Economic Advisors. He taught at MIT and The University of Chicago, where he
served as dean of the business school. He resumed public service under
President Nixon as Secretary of Labor, Director of the Office of Management and
Budget, and Secretary of the Treasury. Mr. Shultz left government service in
1974 to become president and director of the Bechtel Group, Inc.
Mr. Shultz held two key positions in President Reagan's administration:
Chairman of the President's Economic Policy Advisory Board (1981-1982), and
Secretary of State (1982-1989). His many awards include the Medal of Freedom,
the nation's highest civilian honor, and the Seoul Peace Prize. He has been a
Distinguished Fellow at the Hoover Institution, Stanford University, since
1989.
www.worldcongress.com/speakerBio.cfm?speakerID=39&confcode=HR08000
To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.
* * * * *
10. Hippocrates & His Kin: Thirty percent co-payment
controls health care costs.
Mr Burd of Safeway mentions that a 30 percent employee
co-payment reduced the cost of their health care program significantly. That
apparently put the health care decision-making process right in the lap of the
patients who then controlled their costs. How is that decision made?
Let's take an article from yesterday's paper. Some new
chemotherapy additions to cancer chemotherapy improve survival by one or two
months with a drug costing $50,000 to $60,000 for the full course of treatment.
This then would be the cost of the additional month of life gained.
If government or insurance pays the entire cost,
everyone would want the drug, demand it and write their congressman to make sure
it is available.
However, if the patients and their families would have
to fork over 30 percent of the $50,000 or so, the perspectives change. Most
patients, even those that could afford to write an extra $15,000 check, would
probably see their final days in a more healthy perspective, accept the
inevitable, spend time with spouse and family, and die in peace. They would
make the decision that an eleven-month life expectancy is not worth an extra
fifty thousand dollars. The family would appreciate a dignified final event
without drug side effects, tubes or life support. They would say their final
goodbye in their own homes with only loved ones around and maybe a nurse,
having thanked their physicians previously in a dignified manner.
Cost savings
produced by the 30 percent co-payment is very substantial and beneficial for
patients. Even the one-month shortened life may be thought of in a positive
perspective.
To read more, please go to www.medicaltuesday.net/hhk.asp.
Do Physicians still believe in individual freedom? To
practice as they really believe?
Physicians seem to be getting more liberal in the
sense of being for more government control over their freedom to practice what
is best for their patients. Have they just given up hope for a free and open
medical economy? They seem to be gravitating to the other political party that
promises everything and delivers little except more control over our private
lives. They have traditionally been the profession of the highest ethical
principles. Now they seem to go along with anything and everything.
Recently, a physician remarked that he no longer could
espouse his upbringing principles. It was useless and hopeless. He said: let
the liberals have their say and their way, let the men marry men, let the women
marry women, let everyone that wants an abortion have an abortion. He figured
that in about three generations, there wouldn't be liberals anymore. Wouldn't
that be a great legacy to leave his grandchildren?
Don't you just love it when a plan comes together so
well?
To read more HHK, go to www.healthcarecom.net/hhk2001.htm.
To read more HMC, go to www.delmeyer.net/hmc2005.htm.
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11.
Organizations
Restoring Accountability in HealthCare, Government and Society:
