MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IX, No 6, June 22, 2010
In This Issue:
1. Featured Article: The End of Medicine
2. In the News: ObamaCare Prevents Disincentives which Causes Overuse of HealthCare
4. Medicare: Another View of the Health Care Legislation
5. Medical Gluttony: Doctors Manipulating the Codes for Clinical Procedures
6. Medical Myths: Medicare is Efficient and Fair
7. Overheard in the Staff Lounge: Will your practice close with ObamaCare in 2013?
9. The Bookshelf: Socialized treatment isn't free, it's just depersonalized
10. Hippocrates & His Kin: Kaiser Permanente Ranked as Fifth Most Innovative Health Care Company
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.
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End of Medicine: Not With a Bang, But a Whimper by Theodore Levy
The Freeman, April 2010 • Volume: 60 • Issue: 3
Social change can be revolutionary, sudden, and swift, but more commonly it moves at a glacial pace. Yet glaciers work great change, and great damage, given enough time.
There has been much talk of people leaving the medical profession if government further bureaucratizes health care. But the odds are great that there won't be any dramatic job stoppage. No medical "Galt's Gulch" will form where masses of physicians on strike will live in peace and solitude, some building cars and others mining copper, all vowing never to return to medicine until their demands are met. Such is the stuff of fiction. But the reality is much worse.
What will happen is more insidious, though over time no less damaging. There will be an increase in early retirement, as more physicians tire of their jobs. More physicians will take time off and let their practices suffer at the margin. Patients will have slightly more difficulty making appointments . . . each year . . . year after year, though never so quickly as to lead to mass complaints or a recognition that things are obviously worse.
Coverage will be shunted to physicians' assistants, nurse practitioners, emergency department physicians, hospitalists, and partners. Fewer patients will feel they have their own doctors. This will not necessarily be worse—I don't feel I have my own McDonald's, yet the food remains as I expect—but it may be worse, to the extent quality of care depends on background knowledge of individuals.
The filter of who gets into medical school will change. Fewer will enter the field due to intellectual curiosity. More and more people who cannot tolerate bureaucracy will be weeded out. Questioning authority will become as dangerous in medicine as it is in policing or the military. The 40-hour physician work week, on the other hand, will become commonplace, and the type of person attracted to medicine will not be the type who is willing to work any longer, or any harder.
Health care will be less a service than a commodity. All your complaints will have answers, if not always the right answers. Workups will be standardized by "expert panels" allegedly educating physicians as to "best practices." And if the "best practice" is to not treat you because it is not cost-effective to society, the fact that you want and are willing to pay for the treatment will be seen as a problem rather than a solution. . . .
Does this sound unbelievable? It is happening already. In the 1990s the Office of Inspector General investigated major teaching hospitals in America. Taxpayers are billed by such institutions for training new generations of physicians. PATH (Physicians at Teaching Hospitals) audits found patients in these hospitals were commonly evaluated by medical students or interns only. Attending senior physicians were fraudulently simply "signing off," saying, "I agree," without ever seeing the patient. The University of Pennsylvania Hospital settled a PATH dispute for $30 million, and Thomas Jefferson University Hospital did so for $12 million. Anecdotes describing such problems abound, including hospital charts saying, "Physical exam shows both pupils equally reactive to light," when the patient had actually been blind in one eye for decades, a mistake much more easily attributable to the exam's never having been done than to error. . .
Pharmaceutical innovation, produced by those evil for-profit companies that even doctors love to denounce, will drop off. Not precipitously, but eventually. And people will die, as they have died since time immemorial, without anyone ever knowing what drugs might have improved or extended their lives, if only there had been greater incentives to produce them. . .
There is already a spectrum of quality available in medicine, and those with means can obtain better medical care than those without, just as O.J. Simpson was able to obtain better legal services than your average defendant—the first time. But that spectrum risks becoming more rigid, more settled. What has been, in America, health care for the poor will become health care for all but the very rich. But the cost curve will bend downward.
Or will it? Medical salaries will bend downward, certainly, but administrative costs associated with government programs are always huge, and always underestimated. Medicare spending now is an order of magnitude higher than the projections in 1965 of what it would be now. But we do know this: Bending the cost curve of medical care in either direction comes with costs. . .
We'll pride ourselves, as we do now, on "the best health care system in the world," even while we also brag that we have universal care, just like the great nations of Europe. And we'll suffer with double-digit unemployment, just like the great nations of Europe. And we'll have lower growth in productivity, just like the great nations of Europe. And we'll have smaller houses and cars, just like the great nations of Europe. But it will be all right, because we'll be able to wait . . . and wait . . . and wait . . . for our turn at the health care that is our right.
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The Unmet Promise of ObamaCare by Marc Siegel, Forbes 06.15.10
The number one question on my patients' minds as the new health reform bill passed was whether they would be able to keep their current health care plan, like the president promised. This past week, when the new 83-page draft of regulations was released jointly by the IRS, Health and Human Services, and the Department of Labor, an answer was offered. Unfortunately, it's a resounding no.
Whenever the federal government enacts a new law, agencies write regulations on how this law will be enforced. The newly released draft is about whether existing insurances can be "grandfathered in" and continue to be legal policies as the new health reform bill, known as the Patient Protection and Affordable Care Act, takes hold. In my field, whenever a new area of practice such as emergency medicine or geriatrics is established, "grandfathering in" simply means that if you were already established before the new board was created, you retain your credential.
But this usual and customary practice will not be the case with the health reform bill, as insurers will routinely lose their status by not jumping through the right hoops.
In fact, the regulations impose a major vise on private insurance, restricting a company's ability to increase cost sharing (such as coinsurance, deductibles and out-of pocket limits) as well as copayments ("more than the sum of medical inflation plus 15 percentage points or $5 increased by medical inflation"). So it is unlikely that many insurers will be able to remain viable without raising premiums (not restricted by the regulations) or slashing services.
Though the purpose of all the restrictions on insurance is to cut costs, as a practicing physician I worry that extending a one-size-fits-all insurance to more people will have the opposite effect because there will be no disincentive for patient overuse. In countries such as Belgium (where one-third of payments are out-of-pocket), it is precisely these patient responsibilities which help keep the cost of medical care down, as patients only come to doctors when absolutely necessary. I have noticed this effect in my own practice, where patients with high-deductible insurance (Health Savings Accounts can help deal with out of pocket office visits) only come to see me when they are sick. And there is no evidence that frequent office visits by healthy patients with easy to use insurance contributes significantly to preventive care.
At the same time, the draft regulations would imposed such an inflexible restriction on employers--for group insurance, if an employer decreases its contribution rate by more than 5% it will lose its grandfather status--that it is likely that many employers will drop their insurance plans altogether.
The draft's own midrange estimates reflect this bleak new world, predicting that 66% of the insurance plans offered by small employers and 45% offered by large employers will no longer be legal by 2013. And the numbers are no better for individual policies. The draft estimates that individual policies relinquishing their grandfathered status by failing to comply with the new regulations will be from 40% to 67%.
Patients who lose their existing insurance will flock to the new state insurance exchanges, sign up for Medicaid or pay the penalty for not having insurance. There will be a drastic shift in health care coverage, and the result will be lower quality care and more government oversight coming from HHS as well as newly formed committees and panels such as the Independent Medicare Advisory Panel. Young adults under the age of 26, who are eligible to join their parents' plans, will find that 20% of these parents will have plans that are not acceptable under the new law.
This new world of health care, filled with shifts and changes, is particularly unfortunate when you consider the draft's own research, which cites a survey in Health Affairs from 2000, showing that 83% of privately insured individuals stuck with their plans in the year prior to the survey. . .
Marc Siegel, M.D. is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Contributor.
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Prisoners in British prisons get better nutrition than patients in the country's hospitals, according to a study conducted by researchers from Bournemouth University.
"It's incredible that so many hospitals are failing to serve healthy meals," said Liberal Democrat health spokesman Norman Lamb. "If prisons can serve good food, then so can hospitals."
The study found that the primary problem in hospitals is that no one pays attention to make sure that patients eat the food prepared for them -- as many sick and elderly people either have suppressed appetites or have physical problems that interfere with their eating. Yet no one is designated in most hospitals to assist patients who have trouble eating. A total of 11 million meals are thrown out uneaten every year, the report found.
Food is often prepared hot and then left sitting out until an orderly gets around to taking it to patients, at which point it is often cold and unappetizing. Food may be placed out of some patients' reach, and other patients miss meals because they have tests or other procedures during a facility's only designated meal times.
"Ward staff also don't actually know how much patients are eating because it is domestics who clear the trays away," researcher Heather Hartwell said. "This is an example of fragmentation in hospitals that does not necessarily happen in prisons."
The report found that 242 patients died from malnutrition in British hospitals in 2007, higher than any year since 1997. More than 8,000 other patients were discharged under-nourished.
Hospitals also spend significantly less on each meal than prisons do, the report found. The food at prisons tends to be of higher quality -- high in carbohydrates and low in fat -- and prisoners are more likely to eat communally, which has been shown to increase food intake.
"If you are in prison then the diet you get is extremely good in terms of nutritional content," researcher John Edwards said. 'The food that is provided is actually better than most civilians have."
Sources for this story include: www.dailymail.co.uk. www.naturalnews.com/027999_hospital_food_prison.html
Government Health Care does not give timely access to healthcare; it only gives access to a hospital less nutritious than a prison.
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Richard A. Cloward and Frances Fox Piven were Columbia University sociologists who founded, in 1966, the National Welfare Reform Organization, a "parent organization" of the Association of Community Organizations for Reform Now (ACORN). They advocated what became known as the "Cloward-Piven strategy," which "seeks to hasten the fall of capitalism by overloading the government bureaucracy with a flood of impossible demands, thus pushing society into crisis and economic collapse." This is an instructive prism through which to view the recent health care legislation.
The legislation pushes millions into Medicaid, whose costs are already crushing state and local taxpayers into powder. Flooding it with new beneficiaries will hasten its bankruptcy. Likewise, Medicare is to be cut by $500 billion at a time when the baby boomers will be enrolling. The program is already running at a deficit, and will simply be unable to provide seniors the same level of service they currently enjoy. In other words, both systems will implode.
At the same time, incentives for employers to provide health care will be lessened, and many will drop coverage, sending millions to the government cooperatives for coverage. These policies will be heavily subsidized by the taxpayer, and will dramatically swell an already very bloated public sector. We are already mired in debt, and still bailing out Fannie and Fred with tens of billions of dollars each quarter, and with no end in sight. The health bill may be the coup de grace for our struggling economy . . .
. . . We are moving towards a dual system in medicine. There will be hospital-based physicians who will be mostly salaried, full-time or part-time employees. Their primary loyalty will be to their employer. They will follow protocols and guidelines, and work shifts. They will be assigned patients, rather than develop their own practices. They will eventually come under the heavy hand of the SEIU. As hospital revenues suffer under ObamaCare, they will find themselves increasingly burdened. Quality of care will deteriorate.
Outside the hospital setting will be a thriving, private, medical marketplace, anchored by a growing number of private physicians who are opting out of Medicare and other third party arrangements. These doctors will develop busy practices, and will be able to stay in business by setting their own rates, cutting overhead, and controlling their volume. They will be able to spend enough time with patients to ensure a high quality experience, and will work to keep patients healthy and out of the hospital. Unmoored from price controls, the cost of good care will plummet. Doctors, labs, and imaging facilities will compete on quality and price. There is no reason why an MRI shouldn't cost $100 in a competitive marketplace.
Patients must understand the reality of what is about to happen. As of this writing, Health Savings Accounts are still available. Get them while you can! Creating and funding an HSA is the best way to insure against the coming implosion of government-run health care. Even seniors on Medicare should set up these accounts. They should also consider opting out of Part B, which pays for doctors' services, since they will have difficulty finding private physicians who will accept Medicare. They will still have Part A in case they need hospitalization.
Like the doomed Korean ship the Cheonan, our health care system has been torpedoed. It hasn't sunk yet, but it will. Man the lifeboats!
Richard Amerling, MD, is a nephrologist practicing in New York City. He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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A few years ago, a Cardiologist and Cardiac Surgeon in Redding, California recognized that the Codes for Clinical Procedures and Terminology for several items in their specialty were very remunerative. They were so remunerative that they were used frequently when there was minimal medical or surgical indication for their use. As the Pot at the End of the Rainbow was filling up, they made larger pots and filled them with more Medicare Gold patients. As in the case of most Ponzi Schemes such as Medicare, the drain is finally so great that the criminals are found out and the Vein of Gold dries up.
Doctors are basically very honest. No one with an ulterior motive could get through four years of College, four years of Medical School, and four to eight years of specialty postdoctoral training unless they were very bright and honest. If you're dishonest, there are much easier ways to wealth. But temptations are a terrible thing. Many good people fail and fall. Ponzi schemes like Medicare or any stream of money harbors crime - even among those that would otherwise never consider the possibility.
I recall a politician who ran for office with the serious intent of cleaning up the House of Corruption, reducing entitlements and eliminating "pork barreling." He was an honest, upright God-fearing pillar of the community held in high esteem. Within one year, in a bid to purchase votes, he was adding entitlements to his own bills; eventually he became a master at it. He told the community that although he had previously agreed that such expenditure of funds for personal gain was essentially theft, in the House of Corruption it was considered good for one's constituency and essential to survival and re-election for the greater good in the community of which he also was a member.
On a recent urgent trip to Kansas for my older brother's "celebration of life," I sat next to the local retired Judge, a good Democrat who reads MedicalTuesday. He told me the tale about his mild breath restriction, which caused him to seek the services of a pulmonologist. After a brief interview and cursory exam, the physician asked if he sometimes fell asleep for no apparent reason. "Of course," he did, most nights after watching TV or working at his computer too long. The pulmonologist said, "You have Obstructive Sleep Apnea and need a Polysomnogram" (sleep study). The judge, being 80 years old, declined stating he didn't think he was any worse than his friends who were also in their 80's. The pulmonologist lost interest, got up and left the room. The Judge wondered if more doctors were losing interest in patient care and were simply milking the system. This pulmonologist didn't even give the Judge a screening breathing test, which is on the order of $80 (for which Medicare pays about $40) to determine the cause of his dyspnea while vying for the sleep study at $1800 (for which Medicare pays about $800). He was more interested in Medicare Gold than patient care.
This type of practice is causing us to lose respect and status as the public increasingly believes we're in it for money from procedures. But as Medicare pays less and less for diagnostic acumen and more for costly diagnostic procedures, it's hard to swim against the current. But we must stand firm like a rock or we will slowly destroy a great profession. Even though it may have been caused by Government Medicare, it is occurring on our watch. It is up to us to correct this corruption or at least not participate in this Ponzi scheme.
To follow the importance of this, why not subscribe to the HealthPlanUSA.net Quarterly. The last three issues are free. For complete access, a token fee is requested.
In matters of principle, stand like a rock; in matters of taste, swim with the current.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Medicare is immensely popular, has very low administrative costs, is already a working model, … it is said: Why not just have Medicare for all?
At one time, calling Medicare "socialized medicine for the elderly" caused stunned silence in the Congress. Now, if one opposes "socialized medicine," at least one listener is bound to dare you to say you're opposed to Medicare.
Government may bumble at almost everything, but in a handful of areas it does better than the private sector, writes Nicholas Kristof. He lists firefighting, police protection, and health care. Also postal service and education (NY Times 9/3/09).
And even if government is inefficient, he writes, at least it is fair. It doesn't cancel your coverage if you get sick.
Here's a reality check on Medicare:
· It is structured as a Ponzi scheme. Or should we call it a Madoff scheme? Its unfunded liabilities—an estimated $38 trillion—are unpayable. Promises made to Baby Boomers, who were forced to pay into the system throughout their working lives, simply cannot be kept. Their money is gone, just like that of Madoff's "investors."
· Its low administrative costs are a mirage. See Myth 2.
· It is sustained by the general fund and by cost-shifting. Medicare Part B premiums pay only about 25% of the cost; the rest must be made up from the general fund. In addition, Medicare underpays hospitals and physicians, and costs are shifted to private insurers. The hidden tax on private insurers to subsidize Medicare and Medicaid amounts to $89 billion/year, or $1,788 per average family in a PPO plan (Grace-Marie Turner and Joseph Antos, Wall St J 9/11/09).
· It is unfair to both patients and physicians. Payments to physicians are often so paltry that patients are having increasing difficulty in finding a physician who can afford to see them. Coverage of prolonged serious illness is poor; seniors who exceed the allowed number of hospital days are on their own. Neither is Medicare a model for comprehensive coverage of non-catastrophic costs. Seniors pay 50% of their medical bills out of pocket, and most buy supplemental coverage (ibid.).
· The system is rife with fraud. An anti-fraud campaign went into high gear with the passage of the Kassebaum-Kennedy, Health Insurance Portability and Accountability Act (HIPAA) of 1996. Hundreds of millions of dollars were made available to prosecutors, along with huge penalties and new tools: a fraud hotline, bounties of up to 30% of amounts collected, and money laundering charges, on which the accused can be convicted without being convicted of any underlying fraud. This amounted to a post-hoc criminalization of medicine. Still, despite allocating $1.13 billion for "program-integrity" and enforcement activities in 2008, government-wide "improper payments" allegedly amounted to $72 billion that year, writes John Iglehart (N Engl J Med 7/6/09). "[I]n our freewheeling society driven by capitalism, there is a strong distaste in many quarters for overzealous investigations," Iglehart opines. While physicians may be ruined or even imprisoned over alleged coding errors, the threshold for investigating a Medicare carrier is $200 million (Theresa Burr, J Am Phys Surg, winter 2003). The Government Accountability Office found that CMS enrollment and inspection procedures were so poor that it routinely granted billing privileges to fictitious companies with no clients and no inventory (GAO-09-838R Posthearing Questions; 2009).
· Government care costs much more. The passage of Medicare led to an immediate, enormous jump in spending. Between the introduction of Medicare in 1965, and 1970, real hospital expenditures jumped 23%, reports Linda Gorman (Library of Economics and Liberty 6/1/09). Since 1970, Medicare's per-patient costs have risen 35% more, and Medicaid's 34% more, than all other medical care in America. This analysis greatly underestimates the cost of government care by counting all Medicare prescription-drugs purchases as part of private care; not adjusting for billions of dollars in cost shifting from Medicaid to SCHIP; and counting care purchased privately by Medicare and Medicaid patients (including Medicare copayments and Medigap premiums) as private, without counting those patients as recipients of private care (Jeffrey H. Anderson, New York Post 7/18/09).
· Medicare taxes impose uncounted costs. Among the hidden costs of government programs is the deadweight cost of taxation. The taxes that finance Medicare impose costs on society in the range of 30% of Medicare spending (Michael Tanner, Cato Policy Analysis #642; Aug 6, 2009).
Medical Myths Originate When Someone Else Pays the Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
7. Overheard in the Medical Staff Lounge: Will your practice close with ObamaCare in 2013?
Dr. Rosen: What will our practices be like in 2013, only three years from now, when the full impact of ObamaCare will go into effect?
Dr. Sam: I plan to opt out of all government programs.
Dr. Dave: I'm hoping to do the same. Only I'm a little nervous about making any drastic moves.
Dr. Edwards: I'm with Dave. I want to drop out but fear retribution by the government.
Dr. Ruth: What kind of retribution?
Dr. Edwards: I'm not sure. I'm not sure Congress knows. But they will think of something if they think physicians are thwarting there plans for expanding healthcare.
Dr. Yancy: I'm essentially out of government controlling me and I will just proceed with seeing private patients.
Dr. Ruth: What if you won't have enough private patients?
Dr. Yancy: That's always the risk you have to take. Just like when we started decades ago. The government has always made it harder and harder but we've survived.
Dr. Ruth: You don't think you'll ever have to change course back again?
Dr. Yancy: Are you crazy? I'd never stoop to be a government whore again.
Dr. Paul: Those are pretty strong words, Yancy.
Dr. Yancy: You think we are still in the middle ages? Welcome to the real world.
Dr. Rosen: We thought the New World was the Real World in the 18th and 19th century. But in the last 75 years the New World has regressed to the old world or old Europe. Our generation has nearly forgotten the degree of freedom we accomplished in the first century and a half, a good share of which we've lost in the last three-quarter century.
Dr. Paul: I still feel I am free to practice medicine. In my pediatric practice, most of my patients could not afford me unless they have Medicaid. That's been a boon to care for our children.
Dr. Edwards: I don't think we can do justice to all the implications of that statement during a 20-minute lunch. The government programs may be just as much at fault in creating poverty as in managing poverty.
Dr. Milton: Is there going to be any momentum to those signs that started popping up in doctor's offices in Arizona?
Dr. Michelle: What signs?
Dr. Milton: The advance notice to patients that if ObamaCare is not repealed by Congress or ruled unconstitutional by the Supreme Court by 2013 when the full effects are felt, then "This office will close."
Dr. Paul: I don't think you can frighten the government like that. Do you think the government will care?
Dr. Milton: Of course not. Congress has nearly unlimited powers now to limit and restrict freedom including the freedom to practice one's own profession.
Dr. Rosen: They think they can tell doctors through the CMS how to treat patients appropriately and if they do so, and it produces a bad result, still hold the doctor guilty of malpractice.
Dr. Milton: Nice work if you can get it.
Dr. Rosen: A Catch 22.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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The Democrats and Obama passed the largest entitlement thus far. It too will fail. In the interim, Congress and Obama refuse to learn.
Social Security is now unfunded. This year Social Security will pay out more in benefits than it will receive in taxes. Social Security was supposed to reach that stage in 2016 according to the Congressional Budget Office. Stephen Goss, the chief actuary of the Social Security Administration, said the problem of joblessness and decreased payroll taxes are the issues. Social Security is a Ponzi scheme. It works just like Bernie Madoff's fraud.
When the tax money runs out, as it has, the US Treasury just prints more. It is good to be king.
The many reasons the latest entitlement of universal health care will fail are ignored by the Democrat Congress and the Democrat president.
Medical innovations originate in the USA more than any other place in the world. Nobel Prizes in Medicine and Physiology have gone to more Americans more than all other nations combined. Obama and the Democrats will kill that.
The British National Health Service is the third largest employer in the world with 1.4 million employees. The number of employed physicians is about 113,000. Most of the physicians are trained in Third World countries. One British trained physician shared a Nobel Prize in Medicine in 1988. He is the only one since 1946. Our so-called representatives are ignoring the reality and destroying the most productive medical care system in the world. They are rewarded with perks, high salaries and generous retirement.
References: Jason Cutts,
"This sums up Social Security"
Jim DiFillippo, "Will Social Security Be There for YOU?"
Saul William Seidman, MD, FACS, Trillion Dollar Scam, Exploding Health Care Fraud. available www.bn.com & www.amazon.com
Saul William Seidman, MD, FACS, Inevitable Incompetence, Soaring Medical Costs, Dangerous Medical Care, available www.amazon.com & www.bn.com
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
9. Book Review: Socialized treatment isn't free, it's just depersonalized
THE CANCER WARD by
Alexander Solzhenitsyn. (From our Archives)
Translated by Nicholas Bethel and David Burg, Noonday Press, New York, 1974. (Russian edition 1968)
This work of fiction is based on the author's own experiences as a patient in a cancer ward in the 1950's, but it speaks to us more clearly with each passing year as our country grapples with the problem of providing basic health care for all.
As the story opens, Nobel laureate Solzhenitsyn's Soviet world of 40 years ago seems like a strange and foreign place indeed, with its detached, impersonal, "universal free health care" system which serviced frightened powerless patients with competent but distant doctors whose passionless demeanor would have served them as well if they had been engineers or plumbers.
The chapter titled "The Old Doctor," is particularly prophetic. A 75-year-old physician, Dr. Oreshchenkov, mourns the extinction of the family doctor in modern Soviet medicine. He characterizes this practitioner of a bygone era as the "most comforting figure in our lives...a figure without whom the family cannot exist in a developing society. He knows the needs of each member of the family, just as the mother knows their tastes...the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful... But he has been cut down and foreshortened. [It is very difficult] to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you." A fellow physician and patient responds, "All right, but...they just can't be fitted into our system of universal, free, public health services." Dr Oreshchenkov retorts, "Universal and public--yes. Free, no." The colleague replies, "But the fact that it is free is our greatest achievement."
Dr Oreshchenkov then gives us the real message for our time: "What do you mean by 'free'? The doctors don't work without pay. It's just that the patient doesn't pay them, they're paid out of the public budget. The public budget comes from these same patients. Treatment isn't free, it's just depersonalized. If the cost of it were left with the patient, he'd turn the ten rubles over and over in his hands.
The Author then describes how he feels the health care system should be. He felt that primary treatment should be at the expense of the patient, but hospitalizations or costly procedures should be free. Then patients would be in control of when and how often and from whom they should seek medical treatment. "With the right kind of primary system, . . .there would be fewer cases altogether, and no neglected ones..." Each patient could be treated as a whole person instead of a collection of diseases, to be tossed from specialist to specialist like a basketball.
Solzhenitsyn's story is a classic - as relevant today in America as it was 30 years ago when it was first published in Russian. Its characterizations are vivid, its situations are hauntingly familiar, and its truths are timeless.
The Book Review Section Is an Insider's View of What Doctors Are Reading.
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10. Hippocrates & His Kin: Kaiser Permanente Ranked Fifth on Fast Company 2010 World's Most Innovative Health Care Company
Scherzer plans to stop practicing before 2014:
Dr. Joseph Scherzer, a Dermatologist in Scottsdale, Arizona, placed a sign in his office: "If you voted for ObamaCare, be aware these doors will close before it goes into effect, unless Congress or the Courts repeal the BILL." He said the stress is what would push him out the door. The maximum fine was previously $10,000; under the bill it will now be capped at $50,000. Scherzer said the fine system makes seeing Medicare patients a difficult and stressful exercise.
Now, that's pretty straight forward.
worth of Office Rent
Come to think about it, one fine equals four years worth of rent. That would close my doors whether I wanted to or not.
Will 2014 be the HealthCare Armageddon?
Congratulations to KP
Feb. 18, 2010 - Oakland, Calif. - Kaiser Permanente has been honored in Fast Company's annual Most Innovative Companies issue as the fifth Most Innovative Health Care Company in the World for its pioneering electronic health record that is the world's largest civilian electronic health record, and for its health care innovation center that develops the future of health care.
Kaiser Permanente was recognized for its pilot medical data exchange program with the U.S. Department of Veterans Affairs, which enables clinicians from VA and Kaiser Permanente to obtain a more comprehensive view of a patient's health using electronic health record information, including information about health issues, medications, and allergies.
The exchange program centers around Kaiser Permanente HealthConnect®, which gives the organization's 14,600 physicians immediate access to a patient's status and medical history, as well as decision support based on evidence-based practice guidelines and the latest medical research. Kaiser Permanente's members easily and conveniently can make and reschedule appointments, check lab results, and send e-mails to care providers via My Health Manager, the online personal health record that connects directly with KP HealthConnect.
also recognized Kaiser Permanente for its Sidney
R. Garfield Health Care Innovation Center, the only setting of its kind
that brings together technology, architecture, nurses, doctors and patients
with human-centered design thinking and low-fidelity prototyping and design to
brainstorm and test tools and programs for patient-centered care in a mock
hospital, clinic, office or home environment.
Kaiser Permanente used the Garfield Center to develop the Digital Operating Room of the Future and an award-winning medication error reduction program. It's also used to test disruptive technologies such as telemedicine, surface computing, robots, facial recognition, remote monitoring, video game consoles and a handheld computer tablet similar to the Apple iPad that Kaiser Permanente nurses and physicians have piloted in hospitals the last two years.
"This recognition is emblematic of a culture and spirit at Kaiser Permanente that enables the transformation of health care," said Kaiser Permanente Chief Information Officer Philip Fasano, who was recently recognized by Computerworld as one of the top 100 IT Leaders for 2010. "Our electronic health record and Garfield Health Care Innovation Center are exciting examples of the innovation fostered throughout our organization and are the starting point in our journey to deliver real-time, personalized health care."
TO PEE OR NOT TO PEE . . . that is the question
Like most folks in this country, I have a job. I work, they pay me. I pay my taxes & the government distributes my taxes as it sees fit.
In order to get that paycheck, in my case, I am required to pass a random urine test (with which I have no problem).
What I do have a problem with is the distribution of my taxes to people who don't have to pass a urine test.
So, here is my question: Shouldn't one have to pass a urine test to get a welfare check because I have to pass one to earn it for them?
Please understand that I have no problem with helping people get back on their feet. I do, on the other hand, have a problem with helping someone sitting on their butts, doing drugs while I work. Can you imagine how much money each state would save if people had to pass a urine test to get a public assistance check?
We could call this program "URINE OR YOU'RE OUT!"
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• John and 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. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, 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 is 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."
• Dr Vern 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.
• Dr David 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.
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to 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.
• David J 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 at www.ssvms.org. 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.
• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.
• Dr Richard 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.
• Semmelweis 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.
• Dennis 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. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
• The 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. How to opt out of Medicare. Be sure to read News of the Day in Perspective: While All Eyes Are On BP, Stopping the Medicare Fraud Gusher is Crucial Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read: The ability to proclaim, without fear, "Yes we can…say no we won't!" is one mark of a free country. Increasingly, physicians will be facing circumstances when "No we won't" is the only honorable, ethical response. Which will you choose? Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of California. There is no additional cost or
fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
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"The diseases of the mind are more and more destructive than those of the body." -Marcus Tullius Cicero: Was a 1st-century BC Roman philosopher.
"Motivation is what gets you started. Habit is what keeps you going." -Jim Ryun: Former track athlete and politician.
"People often say that motivation doesn't last. Well, neither does bathing - that's why we recommend it daily." -Zig Ziglar: Author and motivational speaker.
Achieving what you want is easy ... when you stop pushing and activate your automatic success mechanism! The human mind functions much like a goal-seeking device similar to those used to guide missiles on auto-pilot! -Dr. Maxwell Maltz found that you will NEVER be different from what your self-image says you are and that if you change your self-image to "think" of yourself as the person you want to be ... you will AUTOMATICALLY become that new person! -Psycho-Cybernetics by Maxwell Maltz, PhD.
Some Recent Postings
THE INNOVATOR'S DILEMMA,- The Revolutionary Book That Will Change the Way You Do Business, by Clayton M. Christensen, DBA
MARKET DRIVEN HEALTH CARE - Who Wins, Who Loses in the Transformation of America's Largest Service Industry by Regina Herzlinger
Lena Horne, entertainer, died on May 9th, age 92
From The Economist print edition | May 20th 2010
TO THOSE few Americans in the 1950s who did not care about race—who did not quibble about one-thirty-seconds or one-sixty-fourths, and who were happy to share washroom or soda fountain with people of another shade—Lena Horne was simply one of the most beautiful women in the world. There was something of Audrey Hepburn in her large brown eyes, and of Hedy Lamarr in her tall forehead; her nose was bobbed and cute. But to everyone else Ms Horne, before her beauty was even considered, was black.
There were ways of saying this gently, of course. She was not coal or piccaninny black; she was "dusky", "sepia", "milk-chocolate", café au lait. At Harlem's Cotton Club, where she started her career at 16 as a dancer, she was "tan and terrific", like the others. The MGM Studios in Hollywood, where she went at 24 in 1941, tried to pass her off as a Latina on her contract. A special make-up, called Light Egyptian, would be rubbed on her skin to make her look more coloured: a better match for the ink-black mammies and funny-men around her.
Her race-blind fans would have been prepared to see her star in any show, as elegant, satin-clad and triumphant as she eventually appeared in 1981 in "The Lady and her Music" in New York. But to casting directors during segregation she could only be a lady's maid or a jungle girl. At best she could star in all-black comedies, as a devil-sent temptress in "Cabin in the Sky" (1943), or as the lead in the Broadway musical "Jamaica" (1957). She belonged in the piny woods or under the palms.
Because she was lovely, and could sing bewitchingly, she was also allowed a few solo scenes in "white" films. There, like "a butterfly pinned to a column", she would deliver a number which could be seamlessly cut when the picture was shown in southern cinemas. Her greatest hope was to be allowed to play Julie, a mulatto, in "Show Boat". But Julie had to fall in love with a white man; so Ava Gardner played her, initially lip-synching to Miss Horne's recordings and even made browner with her Light Egyptian. Lena and Ava were friends. But it hurt to the end of her days.
It hurt all the more because the young Lena did not think of herself as black particularly. Her blood was mixed up on both sides with white European and native American, so that in her black school she was "yellow" to her playmates, and was whispered to have a white Daddy. Both blacks and whites felt she was not one of them. Her family's social models were the white bourgeoisie; her father, resplendent in a suit with a diamond stick-pin, had told Louis B. Mayer to his face that he didn't want his daughter playing maids in Hollywood, because she could have maids of her own. Not that it did any good. At one of her lowest points Miss Horne went to tea with Hattie McDaniel, who had played Mammy in "Gone with the Wind". They ate tiny sandwiches and cakes in her grand drawing room, while Hattie explained that a maid's role was her only realistic future on the screen. Pretty soon afterwards, she threw in the acting life.
Singing, though she made her career in it, proved no simpler. She toured with Charlie Barnet's all-white band in 1940, sleeping in the band bus when hotels would not take her in, but counted in her repertoire songs like "Sleepy Time Down South", which blacks were expected to sing. . .
Miss Horne's producers once complained that she opened her mouth too wide to sing. They meant it was a Negro thing. Certainly Miss Horne had a wide, extravagant smile, a real show-stopper. But it was on the face of a tiger. It hid a lifetime of ferocious resentment and regret.
On This Date in History - June 22
On this date in 1970, the voting age was lowered to eighteen by law. On June 30, 1971, the Twenty-sixth Amendment was ratified extending the suffrage at eighteen to state and local elections as well.
On this date in 1983, the space shuttle Challenger's crew deployed and retrieved a satellite, using the shuttle's mechanical arm.
After Leonard and Thelma Spinrad
The 7th Annual World Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality.
The 7th Annual World Health Care Congress was held April 12-14, 2010
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In partnership with MedicalTuesday.net, the 7th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies. Please watch this section for further reports in the future as well as www.HealthPlanUSA.net.