MEDICAL TUESDAY . NET
Community For Better Health Care
Vol V, No 24, Mar 27, 2007
In This Issue:
MOVIE AGAINST SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements' strategy is to release the
documentary this summer on the same day that Michael Moore's pro-socialized
medicine movie "Sicko" is released. This movie can only be made
in time if Clements finds 200 doctors willing to make a tax-deductible donation
of $5K each by the end of March. Clements is also seeking American doctors
willing to perform operations for Canadians on wait lists. Clements is the
former publisher of "American Venture" magazine who made news in 2005
for a property rights project against eminent domain called the "Lost
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.
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Technology Reveals Mummy's Past
ST. LOUIS (AP) -- The baby mummy had a European mom, and likely came from a wealthy family. But where he lived and why he died - and at such a young age - remain a mystery. The mummy, exhibited for the first time Thursday at the Saint Louis Science Center, has been the year-long focus of an international team of investigators. The museum said it may be the most extensive research project ever undertaken on a child mummy.
Acquired by a Hermann,
It sat in a museum warehouse until Al Wiman joined the Science Center as vice president two years ago and suggested that modern medical technology could unlock its secrets.
He spearheaded efforts
to get medical, science and art institutions in St. Louis, the U.S., and Egypt
to discover the mummy's past.
. . To read
more, please go to www.medicaltuesday.net/index.asp .
A team of radiologists and geneticists from Washington University studied the mummy. Salima Ikram, an Egyptologist and mummy specialist at The American University in Cairo; anthropologist Dean Falk at Florida State University; and conservator Emilia Cortes of The Metropolitan Museum of Art in New York also agreed to help.
A small snippet of the mummy's wrapping tested for carbon dating suggested the child had lived between 30 B.C. and 130 A.D., in Egypt's Roman period around the time of Mark Antony and Cleopatra.
Three-dimensional images from CT scans of the child's bones, skull, teeth and body cavity suggested the child lived to be seven or eight months. The CT scans revealed a long wooden rod against the child's back that supported the mummy wrapping. All of the scans were done without having to remove the wrap.
Scans detected a hole in the child's skull. The brain, like jelly, would have drained through the hole and out through a nostril as part of the mummification process, Washington University dentist and anthropologist Charles Hildebolt said. The scans also identified small incisions on the left side of the body through which the child's internal organs were removed and placed in jars.
One of the most interesting finds was a series of amulets or charms in the boy's body cavity and in the wrapping, suggesting his family was well-off. "The wrapping was a protective cocoon for the body," Hildebolt said. "Prayers and amulets were a protective cocoon for the metaphysical soul."
Corpses prepared for mummification were soaked in a salt and baking soda solution for 40 days, then kept in oils for 30 days.
Washington University geneticist Anne Bowcock said she feared the DNA would have undergone chemical changes or been "contaminated" by those who handled the corpse. But that wasn't a problem.
The challenge was boring into the mummy, which had petrified, to get three samples of degraded muscle, tissue and bone. She succeeded by inserting a thick needle into the chest and shoulder. After that, she extracted DNA using routine methods. Tests showed the boy's mother was European. She plans more tests to determine his father's ancestry. To read the entire story, please go to
On the Net: Saint Louis Science Center: www.slsc.org/
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2. In the News: The Massachusetts Mandate Update: The Slippery Slope
Slippery Slope to Expanded Private Health Insurance? by Ronald
Bailey | Reason |
Health care is the top domestic political issue for the upcoming 2008 presidential election. In a recent New York Times/CBS poll 64 percent of Americans said the government should guarantee health insurance for all. Not quite a majority (47 percent) favored a national health insurance program covering everyone, administered by the government and financed by taxpayers. Is there any way to stop the rapidly accelerating slide toward universal government-funded health care?
Today, employers purchase health insurance for 153 million workers and their families. Why is that? Because ridiculous federal tax laws allow employers, but not individuals, to purchase health insurance with pre-tax dollars. Rather than paying an employee $1,000 more in wages, of which $400 will be taxed away, companies purchase $1,000 in additional health insurance tax-free. In this way companies funnel more than $140 billion a year in federal tax breaks to their workers. One more obstacle prevents health insurance from being tied to individuals rather than to jobs-the feds require that employers purchase group insurance.
first glance, the mandate adopted by Massachusetts in April 2006 that every
state resident carry a health insurance policy looks like just one more
slippery step down the slope to nationalized health care. But is it? The
seductive idea behind this individual mandate is that responsible Massachusetts
policyholders and taxpayers should no longer have to pay $1 billion per year in
uncompensated care for free riding uninsured individuals. Under the mandate,
residents with incomes under the federal poverty level ($9,804 in annual income
for an individual and $20,004 for a family of four) are enrolled in
Massachusetts' version of Medicaid, called MassHealth. They
may choose among four private health management organizations (HMOs) that
already provide health care services financed by Medicaid. This is just more of
. To read more, please go to www.medicaltuesday.net/news.asp .
what does the
A state health insurance exchange like the Connector could address many of the distortions of our current system of third party payments for insurance. First, as they suggest, any resident could buy coverage through the exchange. Second, all of the plans sold through the exchange would effectively become individual policies. That means they are no longer linked to specific employers. Workers could take their health insurance with them as they pursue their careers with various employers. Third, employers could designate the exchange as an employer group plan. Why does this matter? Recall that in order to qualify for the health insurance tax break, employers must buy group health insurance. . .
The second core concept is the shift from subsidizing providers to subsidizing consumers. As previously described, the Mass Mandate transforms $1 billion paid out to providers for uncompensated care into subsidies for insurance premiums of lower income citizens who are not eligible for Medicaid or State Children's Health Insurance Program (SCHIP). Haislmaier and Owcharenko note that subsidies don't have to stop there. "Other states might consider a broader reform strategy that uses the exchange to cover some Medicaid or SCHIP enrollees," they suggest. . .
Massachusetts mandate has plenty of critics. Michael Tanner, director of health
and welfare studies at the libertarian Cato Institute, argues that the mandate is unlikely to actually achieve
universal coverage. He cites the fact that 47 states mandate car insurance, yet
more than 14 percent of drivers are uninsured. Massachusetts intends to enforce
the mandate by withholding state income tax refunds. Tanner is right that
attempts to enforce a mandate through monitoring, withholding or fines will be
However, enforcement will be much less difficult if lower income Americans are subsidized by means of vouchers with which they purchase their own health insurance. Vouchers will tend to be self-enforcing since they cannot be spent on other products or services. Tanner also argues that determining the proper subsidies for individuals will be complex and thus engender new intrusive bureaucracies. However, this difficulty might be avoided in part by establishing an annual open enrollment period in which Americans seeking vouchers would qualify based on their current incomes.
is also rightly concerned about "mandate creep." As 1800 current
state insurance mandates show, various disease and provider lobbies will
continue to seek to get politicians to mandate coverage of their specialties
and diseases. Tanner argues that as more "benefits" are added to the
mandated insurance package, costs will rise. In turn, politicians will be
pressured to increase subsidies to keep up with the rising costs. He believes
that this public choice dynamic would lead inevitably to price controls. Tanner
further suggests, "Since consumers would have little or no leverage over
insurers (they can no longer refuse to buy their products), they can eventually
be expected to turn to the only entity that can hold down their costs-the
government." In fact, the left-leaning Foundation for Taxpayer and
Consumer Rights is already calling for government cost controls on
Massachusetts health care plans.
While consumers must buy some coverage, they can refuse to buy any particular insurers' product. Under a universal mandate in which all insurance is purchased privately by individuals using their own money or dedicated vouchers, competition among insurers will tend to keep costs down. Unfortunately, Massachusetts has not chosen to use vouchers yet.
The Massachusetts mandate is far from perfect but it has set up the pre-conditions-a state health insurance exchange and consumer subsidies--for enabling the expansion of private health insurance. Given the growing clamor for national health care, individual mandates may be the only politically viable way to preserve private health care.
Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.
Disclosure: I am looking at individual mandates as a second-best alternative to what is likely to occur politically. The rationing and cost controls that come with nationalized health care would be the death of biomedical innovation. By the way, my friends over at Cato lump me in with the Republicans for Big Brother on this issue. Instead I would argue that I'm trying to figure out how to keep Big Brother from becoming Big Nurse. Oh yes, I don't own any stock in any health insurance companies.
To read the entire article, go to www.reason.com/news/printer/119147.html.
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3. International Medicine: I Wouldn't Trust This System to Select Someone to Water My Plants
Telegraph columnist Dr
Max Pemberton is one of the lucky junior doctors to have been granted an
interview under the Government's controversial Medical Training Application
Service. However, the experience has left him demoralized
So, I think to myself as I sit in the small, characterless room. This is it. Chairs are arranged around the edge, and everyone is sitting in silence, staring at the floor feeling uncomfortably close. A woman outside can be heard crying down the telephone.
And then some grey man in a grey suit walks in, stops and calls out my name. I stand up and he takes me away.
I am one of the lucky ones. I am here for one of the much coveted Medical Training Application Service (MTAS) interviews, the farcical scheme introduced by the Government to assess and recruit doctors for specialist training. As a result of its implementation, all the junior doctors in this country will, from August this year, have their contracts terminated and must re-apply for the jobs they have being doing perfectly competently up until now.
The new scheme, which
has cut drastically the total number of training posts (there were 30,000
applications for 22,000 positions) has failed in every way possible, and is
disrupting the lives of young doctors on an unprecedented scale. Many of those
who have spent nearly a decade in training are seeing their planned careers
. . To read more, please go to www.medicaltuesday.net/intlnews.asp .
In the waiting room, the fear is palpable. So much depends on the next few hours.
Any doctor awaiting an interview and hoping that the interview process will in some way be superior to the ludicrous, Kafkaesque application form should be warned: it isn't.
The grey man led me into a room filled with work stations manned by confused, bewildered looking interviewers. Some of them were doctors, some, I learned later, were not. None was properly introduced to me. It was clear they hadn't read my form and knew nothing about me. Each asked a series of formulaic questions to which I had a few minutes to provide equally formulaic answers.
There was no provision for me to discuss anything, to show my strengths and qualities, or to talk about the things that interest me. The bland questions were designed to elicit responses that could be ticked off on a form.
In all honesty, I wouldn't trust this system to select someone to water my plants, let alone look after me when I'm sick.
I left the interview feeling desperate: desperate for my colleagues who hadn't been selected for interview; desperate for those who had; desperate for the chance to continue in a career I have worked so hard to be a part of.
But I felt more desperate for the future state of health care in this country. What is happening now matters to every one of us.
Not only have our taxes paid for the training of every doctor who now faces unemployment, the system as it stands is failing to select the best doctors of the future.
This is a clear attempt to undermine the medical profession; to ensure that we become compliant, unquestioning automatons in a system that can be presided over by managers and politicians.
Doctors are notorious for being apathetic when it comes to fighting their corner. . . To read the entire article, go to www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/12/ndocs112.xml.
Information appearing on telegraph.co.uk is the copyright of Telegraph Media Group Limited.
The National Health Service does not give timely access to healthcare, it only gives access to a waiting list.
* * * * *
The Market for Medical Care: Why You Don't Know the Price; Why You Don't Know about Quality; And What Can Be Done about It. by Devon M. Herrick and John C. Goodman, NCPA.
In most markets, prices and quality indicators are transparent - clear and readily available to consumers. Health care is different: Prices are difficult to obtain and often meaningless when they are disclosed. Many patients never learn the cost of their care.
The primary reason why doctors and hospitals typically do not disclose prices prior to treatment is that they do not compete for patients based on price. Prices are usually paid not by patients themselves but by third parties - employers, insurance companies or government. As a result, patients have little reason to care about prices.
And it turns out, when providers do not compete on price, they do not compete on quality either. In fact, in a very real sense, doctors and hospitals are not competing for patients at all - at least not in the way normal businesses compete for customers in competitive markets.
This lack of competition for patients has a profound
effect on the quality and cost of health care. Long before a patient
enters a doctor's office, third-party bureaucracies have determined which
medical services they will pay for, which ones they will not and how much they
will pay. The result is a highly artificial market which departs in many
ways from how other markets function.
. . To read more, please go to www.medicaltuesday.net/medicare.asp .
In health care markets where third-party payers do not negotiate prices or pay the bills, the behavior of providers is radically different. In the market for cosmetic surgery, for example, patients are offered package prices covering all aspects of care - physician fees, ancillary services, facility costs and so forth. Not only is there price competition, but the real price of cosmetic surgery has actually declined over the past 15 years - despite a six-fold increase in demand and enormous technological change. Similarly, the price of conventional LASIK vision correction surgery (for which patients pay with their own money) has fallen dramatically, even as procedures become more technically advanced.
Increasingly, cash-paying "medical tourists" are traveling outside the United States for treatment or surgery. In contrast to the typical American hospital stay, a package price includes all the costs of treatment, and often air fare and post-operative hotel accommodations. Prices are one-third to one-fifth as much as treatment at a U.S. hospital and the quality is typically high.
Retail walk-in clinics in drugstores, shopping malls and big-box retailers are another example. Originally established to bypass traditional health insurance, they post prices for procedures and minimize waiting times. . .
Like walk-in clinics, a growing number of medical practices offer discounts for patients who pay bills directly and avoid third-party insurance. These entities almost always post their prices, and many store records electronically and offer e-mail and telephone consultations. Patients can also go outside their health insurance plan and arrange for telephone-based consultations with companies like TelaDoc Medical Services. A similar service, Doctor On Call, claims 70 percent of what physicians do can be done by phone! These services also store medical records electronically and "write" electronic prescriptions.
The marriage of the computer and telecommunications has also led to innovations that can increase economic efficiency and improve quality. Several new tools are now available to help physicians and patients find the most appropriate treatments using information on evidence-based protocols. Information on price and quality is available on the Internet to patients in some health plans. And objective, independent third parties often provide data for a fee.
The Internet is also transforming the market for prescription drugs. For example, when a patient logs on to Rxaminer.com and enters information about his or her prescription medications, the Web site produces a report including therapeutic and generic substitutes and over-the-counter alternatives for brand-name drugs. The drug-rating Web site AskAPatient.com lets patients compare experiences with drug therapies. Furthermore, ordering prescriptions online improves quality.
Patients paying with their own money can also use Internet services to order numerous lab tests on samples collected in convenient settings for fees that are nearly 50 percent less than tests ordered by physicians' offices.
We are likely to see more of these challenges to traditional health care in the future. The reason? Increasingly, patients are paying more costs out of pocket. Deductibles for the average plan, for example, have nearly doubled over the past decade. And due to recent changes in the tax law, employees are increasingly managing their own health care dollars through personal health accounts, usually coupled with high-deductible health plans. In 2006, of the approximately 12 million high-deductible health plans, about one-quarter were accompanied by Health Reimbursement Arrangements (HRAs) and about 3.2 million were coupled with Health Savings Accounts (HSAs). This consumer-driven health care revolution gives individuals the opportunity to benefit financially from consuming health care wisely.
Although the medical marketplace is changing, legal, regulatory and cultural barriers to competition, innovation and transparency remain. . . .
The biggest obstacle to transparency is a tax system that favors third-party insurance over individual self-insurance. For a middle-income employee, government is effectively paying almost half the cost of health insurance. This has encouraged consumers to use third-party bureaucracies to pay every medical bill.
Transparency is the natural product of a market in which patients control their own health care dollars and providers compete for those dollars. Thus, transparency will emerge as we fundamentally change the way we pay for health care. Some of these changes are already occurring, but government can speed the transition to greater transparency by removing obstacles to competition and innovation.
To read this rather extensive treatise, please proceed to www.ncpa.org/pub/st/st296/#a. It's well worth the study to becoming much better informed.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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I've been tracking the patients coming into my office for a variety of complaints. Many are for common problems that bring patients to any physician's office: cough, colds, shortness of breath, wheezing, head aches, back aches, foot aches, nausea, vomiting, diarrhea, the usual maladies that beset humans. What amazes me is the numbers that do not even think of self-care, which should be the biggest item in the health-care system. Before the advent of Medicare and the government intrusion into medicine, it was stated by my professors in Medical School that 95% of health care was self-care—patient directed treatment of the common ailments.
That made a notable change in 1966 with the advent of
government health care. Much of inexpensive self-care was converted into
Medicare. Well, that would be expected, wouldn't it? Why should one even bother
taking care of the simple things in life if the government is ready to pay?
To read more,
please go to www.medicaltuesday.net/gluttony.asp .
To evaluate a backache when the patient has not even tried routine aspirin, Tylenol, Motrin, Aleve, etc, does not allow effective treatment. If a patient has not obtained any relief from full doses of one or more of these anti-inflammatory drugs, the evaluation and treatment will be different from someone who has not even made any attempts and doesn't know if an aspirin alone might be effective. Since many patients are insulted if aspirin or Tylenol is suggested, I have a box of Tylenol packets in my exam rooms containing two ES Tylenols. I can give a patient two of these, busy myself with another patient and in 20 or 30 minutes re-evaluate the backache. I'm always amazed at the number of backaches cured in that half hour. Then treatment regimen becomes amazingly simple.
The ingenuity of Medicare recipients has no bounds. My chief of medicine in training told the story of a couple who had found love in their golden years after each had lost his spouse. They came in requesting that they use his examining table for making love. Since they had gotten rusty in the procedure, perhaps the professor could give them some pointers as he observed them in the act. The professor reneged and asked what was the real reason. Well, if they went to the lady's house, her children all had keys and would on occasion drop in. If they proceeded to his house, he would lose face with his neighbors who might think he was shacking up. If they went to a motel, it was rather costly on a social security budget. But they reasoned if they could do it in the doctor's office, he could charge Medicare an office visit for each of them and it would only cost them a co-pay, which was a fraction of a motel room charge.
Ingenious Americans will always find a way to utilize Congress' government programs in ways they never imagined. Congress should focus on the five departments necessary to run the country—State, Defense, Treasury, Justice and Public Health—and restore freedom to the rest of the country. Especially in health care so the cost could come down.
See Medicare, section 4 above.
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The United States spends more on health care than any
other country in the world, both in dollars per person and as a percent of
gross domestic product (GDP). Does this mean that the US, with a predominantly
private system, is less able to control health care spending than are developed
countries with national health insurance? John Goodman does not think so.
Health economist Joseph Newhouse found that 90 percent of the variation in
health care spending among developed countries is based on income alone. As
people have more income, they spend more on health care, whether their spending
takes place through the Medical MarketPlace, the political system or
quasi-public institutions. In countries with a national single-payer health
system, the government can, in principle, limit health care dollars and force
hospitals and doctors to ration services. But, that power is more apparent than
real as politicians who exercise it risk being replaced by their competitor. In
all political systems, just as in the U.S., there is unrelenting pressure to
spend more on health care.
To read more,
please go to www.medicaltuesday.net/myths.asp .
Most international statistics on health care spending are produced by the Organization for Economic Cooperation and Development (OECD). However, Goodman contends that these statistics are not always reliable because the various countries use widely different methods of reporting costs. For instance, Germany includes nursing home care as part of the total health expenditures and Britain does not. Some countries report hospital beds by counting bed frames, whether or not in use, while others count a bed only if it is staffed and operational. The U.S. has a lower inpatient rate (12) below the OECD average (16), because the U.S. figures do not count outpatient procedures, whereas OECD statistics include them. In the 1990s, health care spending in 12 of 15 OECD countries grew at the same rate or higher than the U.S. while expenditures on hospitalization and physician services actually decreased in the U.S. well below the OECD mean. Goodman contends that this is surprising since the U.S. has less rationing of care and greater access to medical technology with a wider range of health problems; AIDS is 10 times more prevalent in the U.S. than in Canada and obesity is a greater problem in the U.S. than in other developed countries. The U.S. has more health care costs related to war injuries, teenage pregnancies with a high premature baby rate, and twice as high a pregnancy rate.
Canada achieved the impressive feat of limiting the
real rate of health care growth to about half that of the U.S. by cutting
funding for services; however, it did so in ways that caused people to suffer.
There were draconian cuts in facilities and services. The Canadian federal
government reduced block grants to provinces for health care in 1986, 1989, and
froze expenditures in 1990 for five years. They then made further cuts through
the last half of the 1990s. The provincial governments reduced funds to
hospitals, severely limiting purchase of new technology and removed some
services from coverage. Many smaller hospitals were closed–50 in
Goodman concludes that unfortunately, these reductions in the availability of medical services had more to do with budgetary shortfalls than lack of medical need, meaning that patients often must do without needed care. Satisfaction with the Canadian health care system has fallen throughout the 1990s as the waiting lists have increased.
Oregon rejected the Canadian-style socialized medicine initiative by a 4 to 1 margin. They decided that there were already enough Guinea Pigs around the world who confirm that government medicine does not work, and only privatization is saving their system from disaster. Bill Virgin, a business columnist with the Seattle Post Intelligencer was impressed by the defeat of Single Payer in Oregon. He says "defeat" isn't the right word. The result, "requires more action oriented verbs such as shredded, pummeled, clobbered."
Single-payer systems control health-care costs, not by efficiency, but by eliminating services.
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Sacramento has a street called Sunrise Blvd. which connects I-80 (a route to North Lake Tahoe) and US 50 (a route to South Lake Tahoe). Halfway between is a cross street called Sunset. It was known as a very safe intersection with a long safety record. Then one day it happened. There was an auto accident at the corner of Sunrise and Sunset, which made the front-page headlines and all the news programs. Now electric wheelchairs are traversing the sidewalks and crossing intersections with the same right-of-way of any pedestrian. Instead of MVAs (motor vehicle accidents) we are seeing MWCA (motorized wheelchair accidents).
Dr. Sam: On going
home last night to
To read more, please go to www.medicaltuesday.net/lounge.asp .
Dr. Milton: Last week, coming off the freeway towards my office, I saw a MWC roll over—rather like a single-car accident. She also was able to right herself before I could offer assistance.
Dr. Edwards: I had a patient request a prescription for a MWC. As I was evaluating the medical need, the patient casually remarked that he would be able to do his shopping and go to the coffee shop, since all of these were within a block or two of his house. In fact, he had decided to sell his car when he obtained the MWC, which he thought was the only vehicle he needed.
Dr Yancy: My neighborhood is lousy with the electric wheelchairs. Some use the sidewalks, some the bike walks and some the street.
Dr. Sam: Looks like the DMV should get involved and begin licensing these disabled drivers.
Dr Rosen: These items that allow people to cash in on their cars and get vehicles from Medicare should have a significant co-pay since they replace items that are not part of healthcare.
Dr Edwards: The same logic applies to hospital beds. These replace other beds which no longer have to be purchased by the family, and thus should only be partially reimbursed by Medicare, or rather taxpayers.
Dr Rosen: I think what we're all saying is that most durable medical equipment, instead of being free Medicare benefits, basically replaces other durable goods, and thus should have a significant co-payment, something on the order of 40 to 50 percent. Why should patients or their families make a profit by selling their cars or their beds while insurance picks up the replacement?
Dr. Milton: And please, no DMV involvement. The most disabled need the MWC the worse.
* * * * *
G. Zacharia, M.D., discusses R - E - S - P - E - C - T: What Does It
mean To Thee? in the January 2007 issue of The Bulletin of the
As a profession, medicine earned respect by evolving from its religious origins to early medical science tempered with altruism. Along the way there were periods of light and dark. After the patent medicine era, around the turn of the 20th century, there was a significant ethical correction that freed the science from much of the historical dogma. What was primarily art tempered with a bit of science became a science tempered with reasonable comity and compassion. Respect must be earned, and it was a renaissance approach to science and philosophy that earned it.
What Are You Worth?
Contrary to persistent media and government-reinforced misconceptions, doctors do not earn like other highly trained professionals (bankers, lawyers, and other real businessmen). Few, if any, of the latter work as many hours per week for as many years to grind out a living through direct personal hourly labor. Fewer still serve the society as well.
There are two rewards for people who do
things, wage-salary and psycho-salary, and the balance is different for each of
us. Too much of one or the other is unsatisfying. Altruism begets love, but
rarely gets you paid. If you persist in it, your services will be taken for
granted. If your position is that your services are the public's right
to have, you will be treated like other entitlements, with more duty than
respect for your needs. A person whose services are another's right to
have is ultimately a slave. You may love your slave, but love does not pay the
read more, please go to www.medicaltuesday.net/voicesofmedicine.asp .
Except for priests, missionaries, and entitlements, profit drives a "free-market" democracy and motivates productivity. Physicians are increasingly taken for granted because we continue to tell the public that we want to be. It is a subtle economic truism, but an indentured servant (real or perceived) is never a legitimate player in the "free" market.
We are marketing ourselves into a miserable corner by supporting blind entitlement to our services believing that once the people are entitled to our services, they will be fair! It may seem like good public relations, but the more they think you love what you do and that your work is its own reward (with an oath, no less), eventually it will become public policy. Promising our services to the public gets politicians elected. Liberal support of short-sighted or naive legislation, such as the governor's recent proposal, seems philanthropic, but the message to the public and their representatives is that we will support whatever their politicians promise them, regardless of our own welfare. When those who should be grateful bite your helpful hand, you must defend yourself.
What's worse than taking your services for granted? Taxing you for the privilege of providing them. A wealthy gentler, kinder society can offer help to the less privileged, but when the amenity is the service of others, the burden must not be inequitably borne by the providers. I have no problem with voluntarily helping the poor as we always have, but MediCal rates are and will continue to be charity; and high-overhead specialty practices have to limit treatment of this population as an economic necessity.
The "Governator" has taken disregard of us to a new low by proposing a 2 percent indenture tax on physicians ostensibly to create more MediCal patients and increase what we are paid to treat the poor. He claims that the increased volume generated by providing universal health coverage will be a boon to physicians, but the fact that something is paid for in a fixed-market government plan does not mean that the payment is profitable or even covers the provider's costs. The cost of providing care to this population has always been underfunded. One cannot gain weight by eating one's own feet. This preposterous concept ignores our risks and overhead and may even be unconstitutional in California.
Government plans are not really "insurance." The amount paid for a service is set not by the market but by budget constraints and political wrangling in a one-sided contract. The governor has bought into the insurance lobby fallacy that we can lay off our charity losses on the insured population and has conveniently ignored the fact that in the era of Medicare/MediCal, PPOs, HMOs, regardless of our usual and customary charges, our choices are few: see only cash patients or be bound to accept what the payer reimburses after the fact. Health insurance is not health care–it is a profit-making enterprise with profits made by charging patients more (hindered by a free market) and paying us less (unimpeded by real antitrust exposure). Worse, the "unanticipated consequence" is that insurance companies will try to make the government charity rates a standard that will only reduce our average reimbursement.
Even were these kinds of initiatives to go forward, it would be foolhardy to believe that anything would stop future rate reductions or indenture tax increases. The basis of a market is supply, demand, negotiation, and contracting that represent a "meeting of the minds." When there is no contract, every other service provider "balance bills" the beneficiary or refuses to provide the service until a negotiated price is settled. The insurance lobby and the governor even begrudge us this. Even if the governor's proposal is a "straw man" raised to intimidate us into a less heinous compromise, his brazen attempts to abrogate our contract rights is indicative of the slave-owner mentality.
The Story of MICRA
When there was less hard science to know, we spent more time on developing an educated ethos and a place as leaders in our society. We had "the respect due the principled." But there is a more "practical" kind of respect, and the hard, cold fact is that it is spelled in two somewhat related ways, M-O-N-E-Y and F-E-A-R. We still get a fair amount of "principled" respect for what we do, but we are rapidly losing the "practical" kind, and it is getting harder to live in the narcissistic fantasy that what we do is so important that we can't hold out for financial respect like the other professions who are paid so well. For those of you younger than I, we were once pushed far enough to respond, and that response yielded a salubrious result for California and its physicians.
In the 1950s and 1960s patients were the beneficiaries of physician largesse when we could in fact do little. The subsequent era of defined and expected outcomes was heralded with the new concept of malpractice. Raised in the cordiality of honest scientific endeavor, we continued to naively voice the "patient welfare before doctor welfare" morality even when the patient side (government, the legal profession, and insurance companies) saw that there was money to be made.
But our adversaries miscalculated and ramped up the pressure on physicians so quickly in California that the ramifications of apathy became painfully clear. In May 1975 high-risk specialists responded with a minor rebellion—only urgent and emergent surgical care was rendered for a month. People were inconvenienced, but no one was hurt. The result was the first durable model of professional liability tort reform. Many physicians in other states provided little support for what was assumed to be a purely California phenomenon. Physicians in other states no longer laugh and now seek our support for their travails. . .
Before we assume that it is hopeless, we must remind ourselves of the vigor we displayed in 1975. There needs to be no less than a complete retraction of the very concepts of physician indenture taxation and exclusion from balance billing. To the extent we are successful, we will know how much the society really values our services in terms of measurable wage-respect. Perpetual, retroactive, and one-sided or implied contracts must be abolished and our contract rights reasserted. We need a level playing field with health insurance companies who enjoy enough antitrust immunity to collude against us to "low-pay, slow-pay, and no-pay." Insurers must be liable for at least "treble" damages when they repetitively "accidentally" defraud us so that we can get their attention.
And there are other ways to reach progressive goals. We can increase support for the county hospital system or allow physicians a reasonable tax deduction for services rendered below reasonable cost. Because we have become policy-irrelevant, these and other better ideas never seem to get to the table.
If they are smart, they will back off, but if we wish to reestablish respect, we will have to go through a work action anyway. Just as in 1975 we must remind those who would treat us badly that we still own the weapon. The only thing worse than involuntary indenture is to accept it as inevitable.
To read the entire article, go to www.smcma.org/Bulletin/BulletinIssues/Jan07issue/RESPECT.html.
Dr. Zacharia is an orthopaedic surgeon in Daly City.
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DENIAL OF THE SOUL - Spiritual and Medical Perspectives on Euthanasia and Mortality, M. Scott Peck, MD, Harmony Books, New York, 1997, 242 pp, $23, ISBN: 0- 517-70865-5.
Physician, psychiatrist, theologian, and author of the best-seller, The Road Less Traveled, F Scott Peck, MD, gives us an in-depth look at the current euthanasia movement and its origins in the inability of physicians to "pull the plug." Peck states that although Dr Kevorkian gives him the shivers, he must credit him more than any other individual for the genesis of this book. Almost single-handedly over the past five years, Kevorkian has turned the debate over euthanasia into a national issue within the United States.
But Kevorkian didn't inspire Dr Peck to write this
book–it was the public response to his behavior. Peck was surprised by the
number of people who admire Kevorkian. He was even further surprised by the
larger number who, though they feel no affections for Kevorkian, nevertheless
deeply approve of what he has been doing in assisting the suicides of those who
are ill. Most of all, Peck has been surprised by the huge number of Americans
who do not find Dr Kevorkian's work particularly objectionable.
To read more,
please go to www.medicaltuesday.net/bookreviews.asp .
The whole debate is strangely passionless and seemingly simplistic. But the subject of euthanasia is far from simplistic–it involves questions about who, if anyone, has a right to terminate a life; whether it's the same as or different from suicide or homicide; whether it differs from merely "pulling the plug;" and what role does pain, both physical and mental, play in euthanasia decisions. Among the stories he tells, is one about Tony, a patient of his when he was a psychiatric resident. He felt Tony's craziness was organic and referred him to neurology where he was found to have a large frontal brain tumor. The tumor was inoperable and failed to respond to radiation treatment.
Weeks later when Peck rotated on the neurology
service, Tony, now unresponsive and on a ventilator, reentered his life. He
wondered why anyone would decide to place Tony on life support. Was this
"heroic" medicine, or just a measure to prolong a life that had lost
its essence? Peck asked his chief of neurology at
Recalling the anguish of the family in waiting, Peck looked at Tony for the next 15 minutes, cut the levophed drip in half, went to the doctor's lounge, smoked a cigarette, returned 10 minutes later, found Tony dead, and informed the family. As they wept, speaking to each other in Italian, he could not tell whether they were weeping in grief or relief. He concluded, probably both. He, of course, had the presence of mind not to tell anyone about what he had done.
Peck wishes that he could have shared his solo decision 30 years ago. If he had, he would have opened himself to court-martial for unacceptable medical behavior. His actions would have been considered euthanasia or physician suicide. Today the decision to "pull the plug" is made in conjunction with the family and other physicians and occasionally the ethics committee.
Peck then takes us on a journey of inadequately treated pain, which is now a precursor to physician-assisted suicide. Nothing fuels the euthanasia debate so much as the fear of intractable pain. Peck states that if there were such a thing as intractable untreatable agonizing pain, one could make a case for physician-assisted suicide. In his entire professional life, Peck has never found one case in which pain could not be controlled with the appropriate type of morphine cocktail. Peck gives the fear of pain a lengthy treatment because he feels that many people look to euthanasia as a cure for physical pain they believe they will have to endure during the natural process of dying. But according to Peck, it is emotional–not physical pain that is the center of the euthanasia debate.
Once Peck establishes that it is emotional, not physical pain that is the center of the euthanasia debate, he then turns to mental illnesses, to suicide, natural death, and murder. Although he believes physician-assisted suicide should be illegal, he points out that not all people can obtain Hospice care to relieve pain and suffering and there are many unsympathetic physicians out there. He wishes there were a vigorous discussion in religious congregations, but feels they will do almost anything to avoid open debate. The author contends feels that all of these issues must be adequately explored before the underlying simplicity of the spiritual perspective will be accepted. We must become articulate in the Euthanasia–Physician Assisted Suicide debate before it's too late.
The review can be found at www.healthcarecom.net/Denial_of_the_Soul.htm.
To read other reviews on Medical Ethics, please go to www.healthcarecom.net/bkrev_MedEthics.htm.
To read reviews on Medical Practice, please go to www.healthcarecom.net/bkrev_MedicalPractice.htm.
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Two Senators on the Senate Health Care Committee went to the Senatorial Dining Hall for lunch. One noted that the saltshaker contained pepper. As he was surveying the problem and pondering the solutions, the other senator noted that the pepper shaker contained salt. This created a real problem, in their estimation, of great magnitude. What to do? One Senator suggested that they empty the pepper and salt into two saucers and then refill the shakers with the right ingredient. The other suggested that they need only to empty one shaker, transfer the contents into the other and then empty the bowl into the other.
The waitress, being sensitive to not interfere with matters of state that are of grave concern to Senators, allowed the discussion to proceed. When she noted the discussion slowing, she decided to proceed to the table to obtain the order. She asked the Honorable Senators if she could help them.
The Senators replied that they noted the saltshaker had pepper in it and the pepper shaker had salt.
The waitress replied, "I'm so sorry," as she proceeded to take the cap off of each and reverse them. As she smiled over the ease of the solution she again asked, "Have you decided what you'd like to have?"
The Senators replied that they had been so busy discussing matters of great importance to the country that they had not yet had a chance to review the menu.
Now we know that we best not look to Washington to solve any health-care issues. They might put internists in the operating room and surgeons in the TB Clinics.
To read more, please go to www.medicaltuesday.net/hhk.asp .
Doctor, I Haven't Found Myself?
Patients come in saying, they haven't found themselves. I don't believe the Cecil or Harrison (two basic textbooks of medicine) ever discussed this. How do you find yourself? Well, checking the news recently, we've found some suggestions.
Yoko Ono: She found herself in health. She proposes a global day to focus on health care for all people. It must be nice to solve the world's health care problems by meditating.
Al Gore: He found himself in Global Warming. He proposes that we all reduce our greenhouse gas emissions. He excludes himself, since he's emitting excessive greenhouse gases from his 20-room mansion and heated swimming pool. He assures us that he has networked with some people that are reducing their emission to balance for his excesses. It's like polluting industries buddying up with a clean air plant so that their combination meets OSHA requirements. Isn't it great to be committed?
Star: She found herself during the water crises some years ago when she
suggested that we all put a brick in our
toilet water closets to reduce each flush by the volume of one brick. When
someone went to check her home, they couldn't find any bricks in any of her ten
bathrooms. Wealthy movie stars shouldn't have to inconvenience themselves,
Congress, which is designing the health care system for the rest of us, have the world's most luxurious health plans for its own members.
Isn't It Great to Be Revolving in Isolation from Society While Solving Society's Problems?
So We Know in Advance That Anything They Design Won't Work.
The ten countries with the highest health spending in terms of the GDP: United States, Switzerland, Germany, Cambodia, Iceland, Norway, Lebanon, France, Canada and Greece.
I Would Certainly Hope We'd Be at the Top Of This Group.
To read more vignettes, please visit our archives at www.healthcarecom.net/hhk1998.htm.
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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.
• 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.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
NEUROLOGY is a Third-Party-Free
• 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."
To read the
rest of this section, please go to www.medicaltuesday.net/org.asp .
• 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.
· Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com, where you can see her march in a miniskirt (which doctors should not be wearing) for Breast Health without a Bra. Careful or you may change your habits if you read her entire page.
• 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.
• 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, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week, don't miss "The Real Scandals of Walter Reed."
• 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. Be sure to scroll down on the left to departments and click on News of the Day in Perspective: BC/BS outsourcing surgery to Thailand; medical tourism on the rise or go directly to it at http://www.aapsonline.org/nod/newsofday403.php. 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 HANDS OFF OUR KIDS. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the excellent articles on The Future of Medicine or the extensive book review section which covers five great books this month.
• Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Cherry Hill, NJ, on your planning calendar.
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Del Meyer, MD, Editor & Founder
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Words of Wisdom
The traditional axiom that an enterprise should aim for maximum integration is becoming obsolete in the new corporation. First, knowledge has become increasingly specialized. Knowledge is therefore increasingly expensive and difficult to maintain because knowledge rapidly deteriorates unless it is used constantly. Second, the new information technologies—Internet and e-mail—have practically eliminated the physical costs of communication. –Managing in the Next Society, by Peter F Drucker
Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.
Some Recent Postings
AMERICA ALONE, The End of the World as we Know It, by Mark Steyn www.delmeyer.net/bkrev_AmericaAlone.htm
WHO REALLY CARES - America's Charity Divide Who Gives, Who Doesn't, and Why It Matters by Arthur C. Brooks www.delmeyer.net/bkrev_WhoReallyCares.htm
Jean Baudrillard, philosopher of consumerism, died on March 6th, aged 77
AT SOME point in his career—neither date nor time being important—Jean Baudrillard took a large red cloth, draped it over a chair in his apartment, and sat on it. He may have smoked or thought for a while, or scratched his nose; a large, doughlike nose, supporting glasses. He then got up, leaving an impression of his body behind. The image pleased him: so much so, that he took a photograph. . .
Of all the people he offended, none took more umbrage than the Americans. This was interesting, for he was far more popular there than in France, lecturing on various campuses of the University of California and even appearing, at Whiskey Pete's outside Las Vegas, as some sort of lounge lizard in a gold lamé jacket. In 1986 he got in a car and drove across the country, both hating and adoring it. He had never been so fully in a land of hyperreality, cluttered with meaningless symbols or, as in Disneyland, with garish synthetic versions of ordinary life. He looked for America, he wrote, in "motels and mineral surfaces...in the speed of the screenplay, in the indifferent reflex of television, in the film of days and nights projected across an empty space." There he found himself, playing a French philosopher, roaring through "the desert of the real".
Americans did not like his book. They did not care to be called "the only remaining primitive society". . . To read the entire obit, go to www.economist.com/research/articlesBySubject/displayStory.cfm?subjectid=348996&story_id=8848290.
On This Date in History – March 27
On this date in 1899, Marconi sent radio signals across the English Channel. Although we live in the age of communication, this became possible when Guglielmo Marconi sent signals through the air on radio waves. This was a milestone in the march to the worldwide radio and television transmissions available today. Not to mention cell phones and GPS systems.
On this date in 1794, President George Washington, an old Army man, signed the Act of Congress to get a Navy built. Although the United States was born as a seafaring nation, and its naval victories began with the American Revolution, we had no Navy to speak of until after the war.
On this date in 1845, Wilhelm Roentgen, discoverer the Roentgen Ray, was born in Lennep, Germany. Although later called the X-ray, he opened a door through which modern physics has enlarged its view and understanding of the previously unknown.