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. The Digital Age Is Here - Except Maybe in HealthCare
2. Health Care Is the Most Advanced and Yet the Most Backward Industry
3. Medicare - It Can Only Get Worse
4. Medicare Is Slouching Towards Bankruptcy and Part B Has Already Achieved It
5. This Week’s Review of Corporate Socialized Medicine
6. Medical Mistakes - Can We Avoid Them or Just Cover Them Up?
7. Medical Gluttony or Excessive HealthCare Costs
8. Medical Myths - The South Beach Diet
9. Overheard in the Medical Staff Lounge
10. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

1. Carly Fiorina Came to Sacramento & Told it Like it Is - Join the Digital Century
Carly Fiorina, CEO of Hewlett Packard and possibly the world’s most powerful business woman, came to speak at the Sacramento Chamber of Commerce last month. She was celebrating HP’s presence in Sacramento for the past 25 years. She said we are leaving the computer century and entering the digital century where time, space and geography have merged. Tech jobs are not only going overseas because of lower wage, they will go wherever there are skilled workers in a friendly business environment. It was the latter that caused HP to move 500 jobs from California to Texas, a more business-friendly state. China and India see the job issue strategically and are investing and building their capabilities, skills and talents by graduating millions of engineers a year.

The merging of time and space places London next door to Sacramento with business discussions occurring in real time as emails attach documents and contracts that are being sent and received wirelessly virtually anywhere in the world. Instantaneous information is seen as Google brings up 36 MedicalTuesday references in 0.3 second; 42 pages of HealthPlanUSA in 0.1 second; 226 pages of DelMeyer in 0.17 second; and 989 pages of our electronic journal, HealthCareCommunication, in 0.2 second. This merging is also occurring with digital phones where a whole country or an entire continent is a local call.

The Economist reports that phones are replacing cars as status symbols for the younger set. That mobile phones are taking on many of the social functions of cars is to be welcomed. While it is a laudable goal that everyone on earth should someday have a mobile phone, cars' ubiquity produces mixed feelings. They are a horribly inefficient mode of transport - why move a ton of metal around in order to transport a few bags of groceries?  A chirping handset is a much greener form of self-expression. It may irritate, but it is safe. In the hands of a drunk driver, a car becomes a deadly weapon. That is not true of a phone (though terrorists recently rigged mobile phones to trigger bombs in Madrid). Less pollution, less traffic, fewer alcohol-related deaths and injuries: the switch from cars to phones cannot happen soon enough, according to the Economist.

2. Health Care Is Simultaneously the Most Advanced and Most Backward Industry
Grace Marie Turner, reporting from Washington, DC, states that the health care industry is simultaneously the most advanced and the most backward technologically. The president said when announcing the initiative in Baltimore, most industries spend about $8,000 a year per worker on information technology, but the health care industry spends only $1,000 per worker on IT. Medical technologies for patient care - like computer-assisted surgery, molecular diagnostics and implantable cardiac defibrillators -  are dazzling. But anyone who has been to a doctor's office can see how backward the health care industry is in information technologies: [instead of being kept in computers] patient records are kept in walls of paper files, adding huge costs to the system in mistakes and duplicative procedures - and making the information in the files virtually useless for research [such as improving or making patient care more efficient].

3. Medicare - It Can Only Get Worse
According to the Wall Street Journal, the only surprise about the recent report (3-24-04) on the looming insolvency of Medicare is that anyone claims to be surprised. The combination of an open-ended health-care entitlement and a growing cohort of seniors who are living even longer was always unsustainable. Our politicians just didn't want to admit it to the voters.

The news in the annual report by the Medicare Trustees is that insolvency will come seven years sooner than they estimated a year ago. Medicare will begin tapping its trust fund assets this year to keep up with benefit demands, and it will go bust by 2019 without any policy changes. Members of Congress naturally fanned out to express their shock and awe -- which is impossible to take seriously.

One charm of this sort of report is that it presents the ridiculous in hilariously matter-of-fact terms: "In theory, the 2.9% payroll tax could be immediately increased to 6.02%, or expenditures could be reduced by a corresponding amount, although the latter change would require an immediate 48% reduction in benefits." How do you think that little detail would go over with seniors?

We should add that the Democrats who were blaming Republicans are entirely cynical. The Democratic Medicare drug proposals last year were even more expensive. Their solutions now, besides raising taxes, will be to impose price controls on drugs and slash payments to private Medicare insurers. Republicans may also be tempted to go this route because it is the path of least political resistance. But that would mean a quick death for the free-market reforms that are the one modest hope for reforming Medicare and restraining its costs in the future.

The political tragedy here is that Republicans have probably squandered their big chance to reform Medicare anytime soon. The prescription drug benefit was the only political carrot they could offer in return for genuine policy reforms. They settled instead for speculative policy changes on a long time fuse that may be swamped by the runaway costs of their new drug entitlement before the reforms ever have a chance work. The WSJ concludes: Was it Barry Goldwater, or perhaps Ronald Reagan, who first said that Republicans had become tax collectors for the welfare state?

4. Medicare Is Not Slouching Towards Bankruptcy - Part B Has Already Made It
Marvin S. Wool, M.D., Boston, reminds us that the reality is even more dismal, as Medicare is in essence already bankrupt. While its Part A Hospital Trust Fund shrinks toward insolvency in 2019, the Part B "Fund" for physician and outpatient services has no reserves whatsoever. In fact, each year 75 percent of its expenditures are met by nonrepayable transfers from general revenues (i.e. income taxes). For perspective, last year's transfusion of $82 billion equaled a third of the dwindling Part A Fund reserves.

5. This Week’s Review of Government Medicine - Hurting People Through Mandates
It’s not often that we see the effects of government-regulated medicine in action. This week, we have the opportunity to see just what cruelty can occur as the California legislature is poised to pounce on unsuspecting, hard-working citizens who jumped at the opportunity to buy inexpensive health coverage and removed themselves from the rolls of the uninsured.

Both Blue Cross of California and Health Net rolled out insurance plans last year with very low premiums. This was provided to those who did not need maternity benefits. This reduced the individual premium from $53 to $33 a month. One-third of the people that purchased this coverage were uninsured. It’s the type of coverage that could benefit tens of millions of Americans.

Planned Parenthood said this puts young women of child-bearing age in the impossible position of purchasing insurance that doesn’t cover pregnancy. Is this organization unable to help women plan pregnancies and obtain the type of insurance they need when they need it? What is to be gained by returning these women and others to the rolls of the uninsured by cruelly forcing coverage they don’t need and can’t afford?

California State Senator Jackie Speier has introduced a bill (SB 1555) to make this type of insurance illegal. To force people to pay $53 for coverage they do not need when $33 will do is more than a 50 percent increase in health insurance cost. It appears that difference increases the uninsured rolls, placing more people at risk and jeopardizing not only their health, but their very lives.

The pregnancy coverage mandate, like all other mandates, is motivated by political agendas, not a health care agenda designed to help people, reduce suffering, and save lives. As usual, political interference in health care increases costs and hurts the very people that the healing profession would like to help.

6. Medical MISTAKES - Can We Avoid Them or Just Cover Them Up?
It's been said that doctors can bury their MISTAKES; attorneys can lock up their MISTAKES; the clergy can hear confessions of MISTAKES and dispense divine forgiveness; but architects can only advise their clients to grow bushes and vines.

John Stossel, in an old 20/20 program, reports that the Congressional Record, an alleged verbatim report, is mostly Fake. In fact, it can be changed if the congressman doesn't like the first Fake record or find that it has MISTAKES in it to make it a more acceptable Fake. He concluded that Congress was wasting $469 per page and doesn't seem to be able to keep from “wasting money” with anything they “touch”. . . .  If we continue to let congress or the legislatures “touch” and “waste money” on government medicine, destroying our health care system, it would be the most critical of all MISTAKES, one that cannot be buried, locked up, disappear with forgiveness, or even covered with bushes and vines.

7. Medical Gluttony/Excessive Health Care Costs
In January, I mentioned a homeless patient that made good. He finessed renewal of all his entitlements before getting a great paying job as a truck driver, earning $33,000 a year. He thus got three checks - one from his job, one from social security and one from county welfare. I received an email from a social security worker asking if I had turned him in. Well, he came in last week and I asked him what he would do if I turned him in as a federal bureaucrat suggested. The patient stated that he would give up his job, give up his apartment, live in his car and collect his three checks again. What if he were prosecuted, I asked? He said he was not afraid of jail because he would get free room and board in a heated or air conditioned cell. He felt that certainly beats living in a car and taking a shower at the YMCA. But he hated to give up his cell phone.

8. Medical Myths - The South Beach Diet
Tufts University, a world premier Medical School and Medical Center concerning nutrition and health since the days when Dr Jean Mayer was Dean, has another excellent Newsletter this month. They opine: “It’s never a good sign when a weight-loss plan promises that you won’t ‘suffer any hunger pangs’ and that your cravings, especially for foods like sweets and baked goods, ‘will virtually disappear’ within the first week. But it sure does seem to help a diet book leapfrog to the top of the New York Times bestseller list. Enter The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss, by Arthur Agatston, MD. We combed the book cover to cover, allowing for the possibility that the hype used to attract buyers might belie a healthful, scientifically grounded weight-loss plan within. But that was not to be the case.” Read the entire medical report at www.healthletter.tufts.edu.

9. Overheard in the Medical Staff Lounge - Take My Lungs Out and Wash Them
A patient was brought in, by her husband, with recurrent green phlegm and exacerbation of her wheezing. This infection was happening frequently. He asked if we "could take her lungs out, clean them real good, and put them back in?" He appeared to be a reasonably industrious blue-collar worker, a sort of nuts and bolts type of man. The government may be right. Most individuals really would be unable to make their own health care decisions. But after reviewing the proposed new Medicare Programs, some of us are not convinced the civil servants have a superior ability over uninformed patients.

10. 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 the first twenty months, 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. This week, NCPA reports that the incidence of cardiovascular disease is rising in developing countries, particularly among working-age people. The report challenges the notion that cardiovascular disease is largely an illness of the affluent, industrialized world. It also supports mounting evidence that modern living standards in poorer countries come at a price. The report predicts that by 2030, heart attacks, strokes and diabetes will cumulatively account for as many as 41 percent of deaths among people between 35 and 64 in the developing world, compared with about 12 percent of U.S. deaths in the same age group. Read the entire Health Policy Digest at www.ncpa.org/iss/int/2004/pd042604a.html.

• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. 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, spoke at Hillsdale College’s five-day seminar on “The Conditions of Free-Market Capitalism.” The seminar is co-sponsored by the Center for Constructive Alternatives and the Ludwig von Mises Lecture Series. To review this report, see www.mercatus.org/blog/archives/011546.php.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging onto their website at www.galen.org. Political leaders, like House minority leader Nancy Pelosi, are doing seniors a great disservice by discouraging them from enrolling in the new Medicare drug discount card program. Low-income seniors could save up to 70percent on the cost of their medicines if they sign up for one of the new cards. Read the current newsletter at www.galen.org/pdrugs.asp?docID=639.

• 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 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). Greg cites the "The Wall Street Journal" which ran a big thoughtful piece by John Cogan, Glenn Hubbard and Daniel Kessler about real health care reform. The article demands to be read in its entirety. In a nutshell, it argues that costs are the essential problem in America's health care system, but "efforts by employers to stem the cost escalation have not only failed to succeed, they have also sharply diminished patient satisfaction and raised patient frustration." The authors call for a series of improvements, beginning with "reform the tax treatment of health-care expenses." They argue that providing a tax advantage exclusively to employer-sponsored health insurance was the "most far-reaching and misguided government policy" of the last 60 years. It has led to a system of third-party payment that is "so pervasive that we accept it as a natural part of the health-care system. Yet there's nothing natural about it." They say, "Leveling the playing field between employer-provided insurance and out-of-pocket payments is an essential step to fixing health care." They suggest "a simple change" in which "all individually purchased insurance and out-of-pocket expenses would become tax deductible for persons who have at least catastrophic insurance coverage." Read the entire newsletter at www.galen.org/ccbdocs.asp?docID=636.

• The Heartland Institute, www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor. We have on occasion referred to this Free-Market Think-Tank as an excellent source of non-intrusive medical services to our sick and infirmed. For an overview on such issues as Canadian Pharmacies Flunk Inspections, Canadian Health Care System Nears Collapse, The Commonwealth Fund Distorts Employer Attitudes, and others, go directly to www.heartland.org/Publications.cfm?pblId=2. To read this month’s Health Care News, go to www.heartland.org/Article.cfm?artId=14794.

• The Foundation for Economic Education, www.fee.org, Richard M Ebeling, PhD, President, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, with Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take  pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. This month, read Dr Ebeling’s “Free Markets, the Rule of Law, and Classical Liberalism,” at www.fee.org/vnews.php?nid=5926. If you haven’t read Dr George Yossif’s  classic “The Economics of Medical Care,” be sure to click on www.fee.org/vnews.php?nid=1528.

• The Council for Affordable Health Insurance, www.cahi.org/index.asp, 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 see their latest efforts in making sure that all Americans have affordable health care, see www.cahi.org/cahi_contents/newsroom/article.asp?id=218.

• The Health Policy Fact Checkers can be accessed from the preceding CAHI site or at www.factcheckers.org/. This is a great resource to check the facts for accuracy in reporting. This week, read the report on employer’s willingness to supply health insurance and Greg Scandlen’s analysis of this report at www.factcheckers.org/showArticle.php?id=470. Greg states that the two options given to employers concerning health care was like asking “Do you prefer to die by hanging or drowning?,” and then announce that 56 percent of people prefer death by drowning.

• 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 www.i2i.org/author.aspx?AuthorID=7. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx. Read her latest newsletter as well as policy updates at www.i2i.org/hcpcmay2004.aspx.

• 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. Pierre Lemieux has an editorial, “A Knock on the Door in the Night” wherein he points out that a peaceful and independent individual now has reasons to fear a knock on the door from cops as much as from bandits. For both groups are up against our liberties. See the Orwellian note at www.quebecoislibre.org/04/040415-14.htm. If you missed last month’s editorial, “The Running Dogs of State,” where in he contends it is our social and moral responsibility that nice, girl-next-door types of bureaucrats must be “denormalize,” see www.quebecoislibre.org/04/040320-3.htm.

• 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 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 www.fraserinstitute.ca/health/index.asp?snav=he. The Institute’s Nadeem Esmail’s latest editorial “Canada Spends Among the Highest on Health Care in Industrialized Countries but Ranks Low on Key Health Indicators” can be found at www.fraserinstitute.ca/shared/readmore.asp?sNav=nr&id=602.

• 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. Erin Hymel, Keith Miller and Alison Fraser discuss “The April Fools Diet: How Government Pork Fights American Obesity.” This legislation (proposed on April Fools’ Day, no less) is a pork-filled land grab just like its model, 1999’s Conservation and Reinvestment Act, and would significantly encroach upon many Americans’ private property rights and drive up federal spending. Read the report at www.heritage.org/Research/EnergyandEnvironment/wm500.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. Reading these essays on a daily basis would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation’s daily reports. This week, read Christopher Westley’s economic lesson, “Working Overtime to Ruin Lives” at www.mises.org/fullarticle.asp?control=1500&id=68. 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 www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.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 it 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. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Cannon has advanced free-market ideas in media nationwide including CNN, CNBC, C-SPAN, Fox News Channel and National Public Radio. He is a senior fellow with the National Center for Policy Analysis in Dallas, Texas, and a Lincoln Fellow with the Claremont Institute in Claremont, California. Please introduce yourself to Cannon, read his  bio, and some of his recent articles linked at www.cato.org/people/cannon.html.

• The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). 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. They will be meeting in Pavilion Office Building in Montpelier, Friday June 25. One keynote speaker will be Greg Scandlen of the Galen Institute. Please see www.ethanallen.org/index2.html and 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 Maurice McTigue’s address at the Seminar “Rolling Back Government: Lessons from New Zealand”(www.hillsdale.edu/newimprimis/2004/April/default.htmt). The last ten years of Imprimis are archived at www.hillsdale.edu/imprimis/archives.htm.

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Del Meyer

Del Meyer, MD, CEO & Founder
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www.MedicalTuesday.net

P.J. O'Rourke: If you think health care is expensive now, wait until you see what it costs when it's free.

Mark Twain, (1866): No man’s life, liberty, or property are safe while the legislature is in session.

On This Date in History - May 11 - two men were born in Europe who contributed greatly to the spirit of America.

Irving Berlin, b 1888 in Russia. Every time we sing “God Bless America” or hope for a “White Christmas” or sing “In Your Easter Bonnet,” we pay tribute to a great Jewish songwriter who wrote lyrics for Christian occasions, as an immigrant boy becomes poet laureate in the spirit of America.

Ottmar Mergenthaler, b 1854 in Germany. Coming to the United States when he was 18, he invented a machine that set printing type mechanically. His Linotype changed printing from a hand trade to a great mass production enterprise, making possible the large circulation of daily newspapers and mass produced books. The United States is a great inventive land because America is free, a place where inquisitive and inventive people are drawn.