Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, March 9, 2004
MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing was introduced in this country with HMOs, under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.
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In This Issue:
1. Are You Really Insured?
2. Charity, Altruism and Free-Market Medicine
3. The Martha Stewart Lesson for HealthCare
4. Overheard in the Medical Staff Lounge
5. This Week's Review of Socialized or Single-Payer Medicine
6. Medical Gluttony or Excessive HealthCare Costs
7. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government
1. Dr Eck Asks, Are You Really Insured?
If you get insurance through your employer, you are really not insured. For when you get too sick to work, you lose your job. You cannot afford COBRA.
If you are self-employed and buy your own insurance, you are really not insured. When
you get too sick to work, you cannot pay the premiums.
If you work for a big company and get your insurance through them, you are really not insured. The company can get downsized, lay you off or go bankrupt.
If you work for the government, you are only insured while you are employed. If you get
too sick to work, you lose your job and your insurance.
If you depend on the government programs such as Medicare or Medicaid, watch it--they will go bankrupt in 20 years. Young taxpayers will never be able to keep up with the cost of the programs. And the next generation will have little patience with us when we are old and infirm. We certainly will not be in a position to be demanding of health care. People enrolled in these programs are already finding that it is harder and harder to find physicians. The program bureaucrats are being paid before the caregivers.
The ONLY real insurance is the kindness of our families and our communities. This is
true charity-- fueled by love. We had better be setting up institutions that are very inexpensive to run. We had better be figuring out ways to lower costs and get the government mandates off our backs. We need to solve the medical malpractice problem and have patients be truly grateful for the help we give them.
There are only three levels of care: 1) Health Savings Accounts (HSA's) giving us the greatest degree of independence; 2) High deductible health insurance is good as long as we can afford it; 3) Charity for those who cannot pay their way and have no insurance. Alieta Eck, MD, www.zhcenter.org
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2. Dr Cosman On Charity, Altruism and Free-Market
Charity is not altruism that requires one to sacrifice self for others. Charity is free market compassion. It cannot be demanded. It cannot be extracted. It cannot be centrally controlled. Charity results from volitional self-interest. Whoever gives charity gets reward. The giver feels good, enjoys gratitude of the receiver, believes that doing the right thing is virtuous. Charity inspires pleasing confirmation from others that doing good is doing well. Religious people store up good works on earth now for Heavenly reward later. Some people give charity for an income tax deduction.
Remarkably, charity resembles Adam Smith's reminder that we do not get our dinner from the benevolence of the butcher, the baker, and the brewer but rather from their self-interest. Each exchanges value for value and in so doing expands the good. By working in one's self-interest one also serves the greater community by making more product, more choice, more items for more exchange. By exchanging each has vested interest in peace and basic fairness and ethics. Self-interest is the key to perpetuating charitable achievements, just as it is for capitalism.
Just as achievements and products of the free market are close to infinite, so is true charity. Markets work best when uncoerced, unregulated, and rewarded. Likewise, charity.
Charity may be the only 100% coverage. Free market medicine cannot be 100% coverage because a truly free system allows some to elect not to be treated, not to be helped, and recognizes that some are beyond help. Charity inherently has the same limitations: some potential receivers will refuse help and some help will not help. Charity stimulates ingenuity. Charity initiates innovation. Because charity is rewarded, unlike altruism which is coerced, charity expands and inspires.
Dr Madeleine P Cosman, Esq, President, Medical Equity, San Diego 92029
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3. The Martha Stewart Lesson for HealthCare
There are always two sides to every issue, including legal ones. Martha Stewart, who worked very hard and made millions, was charged with insider trading, a crime against fellow shareholders who deserve a level playing field in the world of investments. When she realized the magnitude of this error, she allegedly made some unfortunate moves toward concealment, a not uncommon semi-automatic response. But wait. The judge then threw out the charge for insider trading. But by then, these unfortunate moves she allegedly made were issues on their own. Ironically, this was based on the non approval for the cancer drug Erbitux, which has since been approved and released.
But the same type of issues occur daily in health care. I've always avoided investing in pharmaceuticals or medical devices. I never wanted to be tempted to compromise my medical decisions based on financial rewards. Many physicians do clinical studies for pharmaceutical and medical device companies and obtain all kinds of insider information. This is freely shared in the medical staff lounges, usually adjacent to cafeterias in most hospitals, where doctors gather for lunch. I am sure that this sharing of information may cause some professionals to change their investment strategy. It would appear that this could be a federal crime.
At every meeting of the Association of American Physicians and Surgeons, we hear reports from a number of physicians accused of some practice aberrancy. Many times during the course of investigation, these aberrancies are disproved, but the case goes to trial for some peripheral violation or corrective action found during the course of the investigation seen as evasive or a cover up, which in retrospect was not needed. This then becomes the FBI and the federal prosecutors raisin detre. Because of these illogical moves, many doctors have gone to jail. They lose their medical license (an investment of a quarter to half million dollars), their practice, their pension funds, and sometimes their spouse and home, while their title of Doctor is replaced by Felon.
Earl Nightingale said that if honesty had not been present, it would have to be invented before the world of business could proceed. He pointed out that on a verbal order, millions of dollars of investments are daily made on Wall Street and elsewhere. Verbal orders such as Martha Stewarts are difficult to prove in any court. I've heard attorneys advise their clients to freely state, I don't remember or recall, as being the best answer to most questions. Martha Stewarts statement of this sort would also have been difficult to disprove in any court. It is also common to see a trusted employee or friends take a dim view of what they see as lack of integrity and not be aware of their own lack of honesty in other matters.
A colleague tells the story of a senior citizen friend in Florida who bought a brand new sports car convertible. He had worked hard for his retirement and felt he could now enjoy the fruits of his labor. He took off down the road, pressing the accelerator to 80 mph and enjoying the wind blowing through what little hair he had left on his head. "This is great," he thought as he roared down I-75, pushing the pedal to 90 mph and then 100. He thought that never in his college or working life had he had such a thrill. Then he looked in his rear view mirror and saw a highway patrol trooper behind him, blue lights flashing and siren blaring. "I can get away from him with no problem," he thought as he put the pedal to the metal. He flew down the road at over 100 mph, 110, 120. Then he thought, "What am I doing? I'm too old for this kind of nonsense. This could ruin my retirement years. He pulled over to the side of the road and waited for the trooper to catch up with him. The trooper pulled in behind the sleek sports car and walked up to the man. "Sir," he said, looking at his watch, "at the speed I clocked you at, I could take you in, impound your car, and arrest you. But today is Friday and my shift ends in 30 minutes. If you can give me a reason why you were speeding that I've never heard before, I'll let you go."
The man looked at the trooper and said, "Years ago my wife ran off with a Florida state trooper. I was certain that you were bringing her back." The trooper replied, "Sir, lets both go home and you have a nice day - and do drive carefully."
What if Martha Stewart had come clean after initial charges were dismissed, would the FBI or prosecutor have told her to go home, have a nice day and be careful? Is there a federal prosecutor with human compassion? Their promotions are partially determined on the number of VIPs, CEOs and doctors they successfully prosecute. With 535 lawmakers in Washington and thousands more in the state capitals, passing laws daily and with attorneys admitting that even they cannot keep up with all the laws, how can the average American know even a small portion of the laws we are required to obey? On some level we are all law breakers and thus criminals.
When the practice of medicine is fully codified into law as some propose with Single-Payer Medicine, clinical judgment could become a crime. I remember one presentation in which the physician tried to explain clinically to an FBI officer why her treatment was appropriate and thought she was making progress in his clinical understanding. When she finished, the FBI investigator responded, You have now convinced me that you varied from standard treatment and are just trying to cover up your mistakes. Physicians will cease to be free to use their clinical judgment to treat our medical problems. Eventually, no physician will dare to vary from the treatment protocols that Single Payer requires, even if the prescribed protocol treatment would harm or even kill the patient. Allowing injury or death would be far safer than independent clinical judgment to save a patients life that has the potential of making your doctor a felon.
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4. Overheard in the Medical Staff Lounge
While having lunch in the medical staff lounge, I mentioned that my otologist had told me, as he pulled a huge wax plug out of my ear canal, that I should blow dry my ears every morning, thus avoiding the development of cerumen plugs. It worked. The Gynecologist at the table said she always advises her patients to blow dry under their breasts so as to prevent yeast infections. The Urologist said he always has his patients blow dry behind their prepuce to prevent balanitis. The Dermatologist said he advises his patients to blow dry between their toes to prevent tinea pedis or athletes feet. The Proctologist said he has his patients blow dry their painful hemorrhoids to decrease irritation. How did we ever get dressed in the morning before the blow dryer was invented.
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5. Dr Berry Responds to Physicians Support of
Single-Payer Health Care or Socialism
On February 12th, Modern Physician summarized an Archives of Internal Medicine survey of Massachusetts physicians that indicated "they overwhelmingly support a single-payer healthcare system." An article in the November 18th issue of the Annals of Internal Medicine entitled, "Support for National Health Insurance among U.S. Physicians: A National Survey" concluded that "a plurality of U.S. physicians supports government legislation to establish national health insurance."
Despite disdain from policy experts, I have found the uninsured neither destitute nor derelict. They are farmers, general contractors, local retailers, and beauticians who gladly pay our average $40 fee and partner with me in making intelligent, cost-effective decisions about their medical care. Some positively bristle at elitist paternalism. Most understand from experience the real costs of government mandates and are rightfully skeptical of political panaceas. All want a more level playing field similar to that which the new HSAs provide.
To our surprise, we have found that about one-third of our 4500 patients have some form of insurance. They have been willing to pay out of pocket for health care they have been unable to obtain with their health coverage.
Perhaps these insurance-free medical clinics (IFMCs) are what Harvard Business School professor Clay Christensen had in mind when he coined the phrase "disruptive innovation." They are indeed a cheaper, more efficient way of providing professional services initially directed at low-end users that will likely catch on soon in the mainstream and eventually come to dominate the primary medical care market. In Canada, however, they would be illegal.
With the growing number of IFMCs ready to accept the increasing number of patients with HSAs, one wonders why the major medical journals have been silent. Read Dr Robert Berry's entire response at http://www.delmeyer.net/hmc2004.htm#by Robert Berry
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6. Medical Gluttony or Excessive Health Care Costs
Last week, I saw a 34-year-old female who had inhaled one breath of diesel fumes during the course of her employment. She went to the emergency room but was essentially well by the time she arrived, only experiencing some residual nausea. She was referred by her employers workers compensation insurance carrier. My pulmonary medical evaluation was to determine the nature and extent of any pulmonary injury, whether there would be a continued or residual pulmonary problem and any need for future medical care. There were two volumes of medical records to be reviewed along with an investigative file. After spending a couple of hours reviewing all of her medical history, I found only three entries related to the problem of diesel inhalation and none with any positive clinical findings. After another hour of obtaining a complete medical history, doing a complete physical examination and discussing issues at length with her, I was unable to uncover any pulmonary symptoms, findings or problems. She had not even coughed or become short of breath during the course of the brief inhalation - a prima facie evidence of no significant pulmonary injury. She finally admitted that her only complaint was that she wanted credit for the two hours of work she missed while she went to the emergency room and to be reimbursed for the $35 copayment. I would be hard pressed to estimate the thousands of dollars it cost her employers workers compensation insurance for the medical evaluations and extensive investigative reports in order to determine that the issue was two hours of lost wages and a $35 copayment. Even a conservative estimate of $5000 of expense for a $100 claim, is a 5,000 percent excess of health care expense. No wonder workers compensation is in serious financial straits.
7. MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:
The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Devon Herrick wrote Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter monthly from April 2002 until December 2003, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports. There is a review of the reality of government medicine. Western Europe's welfare states have not been able to afford the vast amounts required to pay for unlimited health care benefits, according to overseas reports. So for nearly a decade in country after country, health care administrators are turning to market-oriented cost-control measures. http://www.ncpa.org/health/pdh49.html
The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government and the premier university source for market-based ideas. Susan Dudley of the Center reports that the administrative costs of federal regulation are budgeted to reach an all-time high of $30.1 billion in 2003! Please log on to http://www.mercatus.org/pdf/materials/591.pdf to read her entire congressional testimony. Also see the fourth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, and now director of the Mercatus Center's Government Accountability Project. http://www.mercatus.org/governmentaccountability/
The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website at www.galen.org. This week she reports: Now that Democrats have selected Sen. John Kerry as their presidential nominee, a quick review of his key health policy proposals seems in order. The most distinctive feature of the Kerry health initiative is his plan to have the federal government take over high health care costs for employers - and in a way that moves toward the cherished liberal goal of mandating that all employers provide health coverage to all workers. There is little talk in the Kerry plan about individuals having control over their own choices. The words consumer choice and Health Savings Accounts don't show up in any of his health proposals that I could find. Further, there is little acknowledgment that the world is changing and that insurance needs to be more portable, with costs and choices determined by consumers, not politicians. Bottom line cost of the Kerry plan: About $900 billion over 10 years to provide insurance coverage to 29 million more Americans. Read the current newsletter at http://www.galen.org/ownins.asp?docID=612.
Greg Scandlen, Director of the Center for Consumer-Driven Health Care at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative and well-outlined newsletter that is distributed every Tuesday by logging onto www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/Search.asp?search=Consumer+Choice+Matters. This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen, an expert in Medical Savings Accounts (MSAs) which recently became Health Savings Accounts (HSAs). Read the current issue on Health Savings Account at http://www.galen.org/ccbdocs.asp?docID=611.
The Council for Affordable Health Insurance, http://cahionline.org, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. They provide educational materials for consumers, legislators, employers and other interested parties. Their mission is to develop and promote free-market solutions to America's health care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care and may even make things worse. To answer your questions on HSAs, please see http://cahionline.org/cahi_index.shtml.
The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Review her health care archives at http://www.i2i.org/author.aspx?AuthorID=7. To sign up for the monthly Health Care Policy Center Newsletter, go to http://www.i2i.org/HCPCBulletinJoin.aspx. Be sure to read her current article on how evidence-based medicine does not trust your doctors clinical judgment and forces treatment by protocol committees, making human care less personalized than canine care. http://www.i2i.org/article.aspx?ID=982
Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This weeks editorial, Carl Menger and the German Historical School, is by Dr. Edward Younkins, the author of Capitalism and Commerce, and a Professor of Accountancy and Business Administration at Wheeling Jesuit University in West Virginia. According to Menger, statistics and numbers can give us the end results of economic activity but cannot provide us with the explicit reasons why the behavior occurred, the circumstances under which the same behavior will take place again, or how the results could be changed. The entire article, an excellent lesson in economics, is at http://www.quebecoislibre.org/04/040306-12.htm. Also read Martin Masses review at http://www.mises.org/fullstory.asp?control=1036.
The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well-being of all Canadians. Log on at http://www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at http://www.fraserinstitute.ca/health/index.asp?snav=he. Nadeem Esmail, Senior Health Policy Analyst & Manager, Health Data Systems, has a current editorial: A Healthy Alternative: Opting Out of Federal Health-care Funding Could Save Money and Lead to Better Access. http://www.fraserinstitute.ca/shared/readmore1.asp?sNav=ed&id=249
The Heritage Foundation, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. The current issue is on How to Get Federal Spending Under Control, http://www.heritage.org/Research/Budget/bg1733.cfm.
The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundations daily reports. This week, read William L. Anderson and Candice E. Jackson on Martha Stewart who they feel was not a "corrupt" executive and did not break the law when she sold her shares of the temporarily doomed ImClone stock. No, Stewart apparently committed the "crime" of being wealthy and well-connected. Moreover, the jurors apparently remained convinced that Stewart had engaged in the "crime" of "insider trading," or at least something similar, since they believed she was trying to cover up something illegal. Read the entire story at http://www.mises.org/fullstory.asp?control=1467. You may also log onto Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html.
CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. The chapter on Private Health Care in the Cato Handbook for Congress can be found at http://www.cato.org/pubs/handbook/hb108/hb108-27.pdf.
The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network. The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor. Please see http://www.ethanallen.org/index2.html. Click on links to see the other 41 free-market organizations throughout the U.S. and Canada, which will then direct you to even more free-market sites.
Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of educating for liberty. It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log onto www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institute. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read an important and timely essay by Walter Olson, a senior fellow at the Manhattan Institute: The Threat from Lawyers is No Joke. In almost every country but the U.S., legal systems incorporate a loser pays principle. If you sue someone and lose, you cant just walk away. You have to contribute something to making the victim of the lawsuit whole for what he has paid. We had that same principle in our legal system throughout much of American history, but it gradually died out. Until we reverse this process, it will remain the rule that if you want to hurt someone in America, you may not be able to do it with impunity using a scalpel or a car. But you can do it with a lawsuit and no one will lay a glove on you. http://www.hillsdale.edu/newimprimis/2004/march/march_printable.htm. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.
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