TO THE MEDICAL TUESDAY NETWORK
Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical
May 25, 2004
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, a common component of government medicine
throughout the world, was introduced into the United States with Health
Maintenance Organizations (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.
We welcome you to the reestablishment of
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In This Issue:
Must HealthCare Be the Political Battlefield?
Learning Curve in HealthCare Is Flat
International Scene Is Even Worse
Should Not Be the Political Battlefield
Gluttony or Excessive HealthCare Costs
in the Medical Staff Lounge
Myths: Modern Drugs Conquer Diseases
MedicalTuesday Recommendations for Restoring Accountability in Medical Practice,
HealthCare and Government
* * * * *
Must HealthCare Be the Political Battlefield?
CalPERS, California’s Public Employee’s
Retirement System, with $171 billion in asset management, has eliminated Sutter
Hospitals, the largest hospital system in California, from PersCARE, their
health plan for state workers and retirees, in an effort to reduce health care
costs. Sutter Health has asked for documentation of CalPERS’s allegation that
they are 80 percent more expensive than other hospitals. PersCARE has declined
to submit the documentation. Since hospitals cannot practice medicine, they have
developed foundations that hire physicians who then have an obligation to use
the sponsoring hospital to admit their patients, thus interfering with the
freedom of choice in the practice of medicine. Eliminating a hospital interferes
with affiliated physicians being able to see patients that cannot be admitted to
the controlling hospital. The California newspapers are brimming with two sets
of stories: one questions whether CalPERS or Sutter is at fault or has a hidden
agenda and the other details stories from patients affected by this decision.
These patients are currently established with a personal physician who knows
their health problems and in whom they trust. They must now start over and
choose another physician that can admit patients to a competing hospital.
The process of physician selection by
patients is one that normally occurs during mid-life, as the need for health
care becomes manifest to an individual. At this time, a patient develops a
seasoned relationship with a physician with whom he or she can relate about all
personal and private medical needs. This relationship endures for the remainder
of the patient's life or until the doctor leaves practice. When this
doctor/patient relationship becomes the battleground between an insurance
carrier and hospitals, it interferes with the health care and the very lives of
good, but sick people. But then, aren’t all battlefields strewn with bloodied
and dead bodies? But why should they be strewn with the 53,000 sick civilians,
as in this case?
This week, Southwestern Bell Telephone
Company (SBC) is experiencing a four-day strike over health care benefits,
bringing new telephone and repair service to a screeching halt in all of the
Southwestern US. The issue? Health care copayments. Companies have increased the
copayment for obtaining health care as a means for reducing unnecessary health
care costs. This is critical for making health care affordable. As we have shown
on a regular basis in our “medical gluttony” section, health care costs,
when uninhibited, increase in geometric progression - not 10 or 20 percent
increases, but 100 or 1000 or 10,000 percent increases. This is not sustainable
even with a 100 percent tax structure. That the telephone employees union does
not accept this as reality thinking is only revealing their participation in
killing the goose that laid the golden egg. The egg was laid some sixty years
ago, during the second world war, when health care became part of a worker’s
pay because of other governmental restrictions and wage control. Thus, a
patient's health care also becomes the battlefield between employees and their
employers interfering with economic growth.
* * * * *
Learning Curve in HealthCare
We spend many years in the learning process,
from the time we start school until we give it up some twelve to twenty years
later when we join the work force to make a living for ourselves and our
families. The further we go, the more important the continuing learning process
becomes. This week, I’m attending the International Scientific Assembly of the
American Thoracic Society, where 16,000 of my pulmonary colleagues from 60
countries are congregated in Orlando, spending 35 or more hours in 50 concurrent
scientific lectures, seminars, and roundtable discussions of the latest
developments in Pulmonary Medicine, Thoracic Surgery, Pulmonary Pediatrics,
Pulmonary Pathology, Respiratory Nursing and Respiratory Therapy. (Our
specialty is known by five different names or synonyms: Chest, Lung, Thoracic,
Pulmonary, Respiratory, which is the outgrowth of our roots a hundred years ago
in tuberculosis, or Phthysiology.) The concurrent sessions vary from Power Point
presentations in lecture halls seating 1500 to conference rooms seating 50. If
one attended breakfast seminars at 7 AM, lunch seminars at noon, and evening
seminars from 7-9 PM, one could obtain nearly 12 hours of continuing medical
education (CME) credits each day for four days. Most of us take in a second
general medical meeting each year in addition to our specialty meeting. Since
many of us also attend weekly medical grand rounds in our hospitals or
university medical centers, we obtain at least 100 hours of CME yearly. Although
25 hours of CME are required yearly to maintain medical licensure and nursing
licensure, physicians and nurses have made this effort voluntarily, without any
government coercion. Individual quality-of-care enhancement has always exceeded
government-induced quality control. Although the Institute of Medicine alleges
that there are numerous medical errors causing injury or death, the numbers are
even higher in countries where health care is under government control. It is
also higher in government hospitals in this country. This is a tribute to the
high level of the learning curve in voluntary American Medicine.
When it comes to patients learning the
economics of health care utilization, the learning curve is markedly different.
Utilization is vastly different when patients pay for their own health care than
when someone else, whether employer (by diversion of personally earned income)
or government (by diversion of personal taxes) pays the bill. Utilization
sometimes doubles or triples when someone else pays. This shouldn't strike us as
unusual. If you loaned your credit card to a friend, wouldn’t you expect them
to be less frugal with your money than you would be? Of course. They are not
responsible for paying the monthly statement. You would also be less frugal
(responsible) with your own credit card if someone else, e.g. your employer or
government, paid the monthly bill. Single-payer or third-party health care is
using a health care credit card without limits or effective controls, with no
personal responsibility, which is why Medicare, Medicaid and VA programs are all
exceeding budgets with impending bankruptcy. That is why Medicare expenditures
are some 800 percent of projections over the four decades of its existence.
There is a lot of publicity recognizing that
if patients were educated concerning health care costs, they would be more
careful. It is now apparent that after two decades of instruction in the
economics of health care by health maintenance organizations (HMOs), the
patient’s learning curve is relatively flat. They still want whatever they can
talk their doctor into ordering and do not want to hear the medical indications
for a test or procedure. Patients think that since their friend obtained an
expensive CT or MRI, that they are also entitled to it. Whether they have the
right disease to justify it seems to be irrelevant. There is no way to fight
human nature, or human greed, not even with intensive education in the economics
of health care. We only learn when we are responsible for the bill.
With the current advance in Health Savings
Accounts, where a patient saves $5,000 on his health insurance premium in return
for paying for the first $3,000 of his yearly health care costs, there is an
immediate precipitous 30 percent drop in health care expenditures. By
transferring responsibility for health care spending from the employer or the
government to the patients, the health care costs of our nation would see an
immediate drop from about $1.5 trillion to about $1 trillion dollars. Health
expenditures would immediately have been brought under control without any
government intrusions, restrictions, mandates, employer health care
restrictions, or any controlling bureaucracy. And the doctor–patient
relationship would again become a confidential and personal matter. With
personal responsibility, the learning curve takes a sharp ascent after the first
medical bill arrives, even if insurance pays part of it, rather than remaining
flat for decades on end.
* * * * *
International Scene Is Even Worse
In Germany, the younger generation has been
complaining that their socialized medical schemes are going bankrupt because of
their elders excessive utilization. They are stating that their grandparents
should use a cane in their final years rather than get an expensive artificial
hip. But when it comes time for the government to introduce restrictions on
health care, none dare to implement a change for fear of not being reelected.
In France, the people are marching because
the government is attempting to impose 1 €, an insultingly small amount, for a
doctor’s visit. Despite the fact that the health care system has been in a
huge deficit for years, with spending in a near bankrupt mode, human greed is so
persuasive that it interferes with sound economic logic and decisions.
Thus once single-payer or socialized
medicine is fully implemented, patients will continue to be the human
battlefield for government programs. It is critically urgent to remove patients
from this battlefield of government medicine. But is it politically possible?
* * * * *
Should Not Be the Political Battlefield
Patients became the battleground quite
accidentally in Stalin’s Russia, in Otto von Bismarck’s and Hitler’s
Germany, in Mussolini’s Italy, and in Napoleon III’s France, when the
dictators found that social insurance was a convenient way to control and force
absolute support of their heinous regimes. In the postwar period, these
countries continued government medicine not realizing that elected officials
could be equally controlling. This did not gain root in the United States, and
by an accident of unfortunate government wage control, industry began to provide
social insurance and control. In the war between two economic systems, freedom
to personally determine our families needs vs socialized control, we should not
play it out with patients’ health care or their lives. But as paying for
health care became oppressive to business, moves were implemented to transfer
this obligation to government. This has now, unfortunately, been supported by
organized and unionized medicine. However, to remove our patients from the
bloody economic battlefield, medicine must now move forward to the free and
independent market place so that it will again be affordable to all. This will
allow the economic battle to be played on the battlefield of our economy–where
* * * * *
Gluttony Is Only Exceeded by Legal Lunacy
A thirty-year-old patient who also had
diabetes entered my practice in 1996. Her diabetes was difficult to manage only
because she was non-compliant in several spheres. She did not follow therapeutic
programs, she did not measure her glucose with Accu-checks, she did not keep
appointments that were made and she then expected prescription refills without
medical evaluations. She decided to go elsewhere where she could manipulate her
physician somewhat easier.
In about 1998, she showed up again as a
patient. At this time we noted that she was on Rezulin for her diabetes. Since
we were aware of some adverse reports on this drug, we changed her diabetic
medication. We didn’t hear from her again. . . until about six months ago when
we found that we were part of a class action lawsuit brought by a trial lawyer
group in Los Angeles against the manufacturers of Rezulin and every patient they
could find that took the drug, along with every physician who saw those
patients, whether they prescribed it or not. When our liability insurance
carrier came out to review the medical record, I asked, “Shouldn’t we have
gotten a letter of thanks from this patient that we took her off a medication
rather than run the risk of a 10% side effect?” And since she was suing her
several physicians (out of many thousands) that actually reduced her risk, why
don’t we countersue? (We were recently approached to purchase a reverse
liability insurance that would automatically countersue all such nuisance
But that’s not how attorneys make their
money off of health care. They make their money by allowing the full course of
action. Thousands of doctors and hospitals respond to their summons, which then
has to be distributed to the other thousands. Almost every day we get legal
documents, sometimes dozens running into the hundreds of pages, which we copy
and then forward to our Medical Liability Law Firm. This may take up to an hour
of my office time on some days. There must be thousands of defense firms across
the country each charging their Medical Liability Carriers the usual
several-hundred-dollars-per-hour fees for reading all these litigation documents
and filing various motions totaling billions of hidden health care dollars.
As was the case in the asbestos litigation,
my injured asbestos patients stated that they got only a few thousand dollars
for their lifetime injuries, while the attorneys all got wealthy. One alleged
that his lifetime injury award was $5,000 and that his attorney got twice that -
$5,000 in fees and $5,000 in legal expenses for the lawsuit.
It’s rather like John Grisham says in one
of his legal novels about a Class Action lawyer worth a half billion dollars who
sued the companies and doctors that prescribed a diet pill and then complained,
“If I didn’t have to share a third of my
winnings with the patients, I’d be a billionaire.”
* * * * *
in the Medical Staff Lounge
Speaking of quality of care in government
hospitals, Dr George mentioned that during his training, he spent a year at a
Veterans Administration Hospital. One day, as he was making rounds, a nurse’s
aid complained that her patient wasn't eating. When she fed him, the food just
ran out of his mouth. Dr George quickly checked the patient and found that he
had expired. Thank God for government medicine
which provides job security for the incompetent that don't know if a patient is
alive or dead.
* * * * *
Myths: Modern Drugs Conquer Diseases
The only drugs capable of curing anything
are antibiotics. No other drug cures. They simply suppress or control symptoms
such as headaches and heartburn, control abnormal laboratory abnormalities such
as elevated cholesterol and blood sugars in diabetes, or improve physical
findings such as hypertension, usually at the risk of causing a load of other
symptoms or signs. (After Gupta).
* * * * *
Supports These Efforts of the Medical and Professional Community in Restoring
Accountability in Medical Practice, HealthCare and Government
PATMOS EmergiClinic - where Robert Berry, MD, an emergency
physician and internist, provides prompt care for many of the injuries and
illnesses treated in Emergency Rooms at a fraction of the usual emergency room
fees. For a listing of his fees and payment policy, see www.emergiclinic.com.
To see Medicare's Absurd Impact on PATMOS, (as well as on any physician that
works on a cash basis) be sure to click on the title. Read Dr Berry’s response
to Physician’s Support of Single-Payer Health Care or Socialism at
Dr Vern Cherewatenko for success in restoring private-based medical
practice which has grown internationally through the SimpleCare model network, www.simplecare.com.
Any patient or provider may become a member of SimpleCare. There is a section on
Functional Medicine and one on Complementary and Alternative Medicine, a
practice that is becoming increasingly popular. To review the AP article on
April 27 concerning his practice, see: http://apnews.myway.com/article/20040404/D81O7R7O0.html
Be sure to click on the HSA Insider volume for a review of the Health Savings
Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com,
to assist physicians in controlling their own medical benefit costs for their
staff and patients. There is extensive data available for your study. He is
available to speak to your group on a consultative basis. Email DrDavid@LibertyHealthGroup.com
John and Alieta Eck, MDs, for their first-century approach to
twenty-first century problems. Please review their current newsletter at www.zhcenter.org/newsletter.asp?id=188800&page=1
and click on "Dr. Eck speaks before US Congressmen" wherein she
outlines the six laws in her state of New Jersey which leaves 2300 questions
unanswered and thus prevents the implementation of the Health Savings Account.
The entire address is worth printing out and studying and sharing with
colleagues and friends. For their article “Are you really insured?” go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
Madeleine Pelner Cosman, JD, PhD, Esq, for her important efforts in
restoring accountability in health care. Please visit www.healthplanusa.net/MPCosman.htm
to view some of her articles that highlight the government’s efforts in
criminalizing medicine, the introduction to her new book, Who
Owns Your Body, and other articles that are important to the practice of
medicine and health care in general.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc.
for his contributions to the free Medical MarketPlace. His series of articles in
Sacramento Medicine can be found at www.ssvms.org
and additional critically important articles such as Health Care Inflation at www.healthplanusa.net/DGHealthCareInflation.htm.
Dr Richard B Willner, President, Center Peer Review Justice Inc,
reports his latest success story and the secret of helping doctors keep their
medical license. On a daily basis, doctors are reviewed, are suspended, lose
their medical licenses and go to jail on trumped-up charges. These
"Extra"-legal services are an important service that lawyers do not
offer. Stay posted with a wealth of information at www.peerreview.org.
Semmelweis Society International, W. Hinnant MD, JD, President, 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 noted 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. He then went to St Rochus Hospital in the city of Pest and
reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was
still 10-15 percent. 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 www.semmelweissociety.org
with his own funds using Dr Semmelweis as a model: All we ask is that peer
review be done with “clean hands.” To read the article he wrote for
Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCMisc.htm#by%20Verner%20Waite%20and%20Robert%20Walker.
To see Attorney Sharon Kime’s response, see www.delmeyer.net/HMCMisc.htm.
For additional updates to the Peer Review section see www.delmeyer.net/HMCPeerRev.htm
and scroll downward for letters to the editor, the Medical Board response, a
member of the Medical Board's response to the executive director, Dr Deane
Hillsman's response and a former deputy attorney general for the Medical
Dennis Gabos, MD, President of the Society for the Education of Physicians
and Patients (SEPP), www.sepp.net, for
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and
Responsibilities of Patients and Health Care Professionals, with a special page
for our colleagues in nursing. Several free newsletters are available. The
current quarter newsletter is now available with numerous insightful articles to
scan and possibly read, including articles by Edward Annis on American Medicine.
Be part of protecting and preserving what is right with American
Healthcare–physicians, nurses, pharmacists, psychologists, all health
professionals and all concerned individuals are urged to join.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold
Glueck, M.D, write an informative Medicine
Men column that is now at NewsMax. Please log on to read or subscribe at www.newsmax.com/pundits/Medicine_Men.shtml.
This week’s column is on "Working on Limiting Lawsuits" and can be
found at www.newsmax.com/archives/articles/2004/5/20/93416.shtml.
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 to departments and The “AAPS
News,” written by Jane Orient, MD, and archived on this site, providing
valuable information on a monthly basis. Last month she had an important article
on Best Practices, How
Government Suppresses Data, and other important, sometimes controversial
items. In one such article, Thomas Sowell observes that in 1909, people spent
less than 18 percent of their income on housing. Since, the government started
providing housing in 1937 with a rash of “green tape,” 28 million Americans
spend more than 30 percent of their income on housing. She quotes Linda Gorman
who gave examples in natural gas, airlines and trucking, where deregulation
increased volume and innovation with costs falling 30 to 40 percent. “There
is every reason to expect the same benefits from deregulating medicine.”
The net burden of regulation probably exceeds
the annual cost of insuring 44 million people, according to Christopher Conover
of Duke University. Be sure to click on AAPS Doctors Tell Congress: “The
Doctor is In, Even If Insurance Is Out” at the Joint Economic Committee
Hearing on April 28, 2004. In addition to Dr Eck's testimony above, it also
gives Dr Robert Berry's testimony. Scroll further to their official organ, the Journal
of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a
neurologist in New York, and the Editor-in-Chief.
* * * * *
Stay Tuned to the
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Del Meyer, MD, CEO &
I don't make jokes. I just watch the government and report the facts.
Reagan (1986): The government's view of the economy could be summed up in
a few short phrases:
moves, tax it.
If it keeps
moving, regulate it.
And if it
stops moving, subsidize it.
recent postings below.
Review Story: Attorneys Sharon Barclay-Kime and former Deputy Attorney
General David M Gallie, former MBC Executive Dixon Arnett, MBC Member Lawrence
D. Door, MD, Deane Hillsman, MD and Verner Waite, MD, each give us their
perspective of physician inquisitions at www.delmeyer.net/HMCPeerRev.htm.
Clark, MD: A Piece of the Pie:
What are we going to tell those bright-eyed little boys and girls who are going
to be the doctors of tomorrow? When there isn’t anything left for them, are we
going to tell them we didn’t fight because the changes were inevitable anyway?
What are we going to say when they ask us why we laid down and died when things
got a little tough? Are we going to feel good about ourselves when we tell them
it’s all right because we got a piece of the pie? Read Dr Clark at www.healthcarecom.net/CBCPieceofPie.htm.
Ada P Kahn,
PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses
and Health Issues. Dr Kahn came to Sacramento in February and I joined her on a
Channel 31 interview about her book. I was privileged to write the foreword
which we’ve posted at www.delmeyer.net/MedInfo2004.htm.
To purchase the book, go to www.factsonfile.com
and type in KAHN under search.
Chang, MD: WEIGHT LOST
FOREVER - The
Five Second Guide to Permanent Weight Loss suggest daily weights to stem
the weight loss before it becomes a problem and, if it does, how to take
it off and keep it off. Congratulations to Dr
Chang for winning the Sacramento Publishers and Authors 2004 award for “Best
Health Book of the Year.” Read our review at www.healthcarecom.net/bkrev_WeightLostForever.htm.
Bruce: The Death of Right and Wrong (Understanding the difference between
the right and the left on our culture and values.) www.townhall.com/bookclub/bruce.html.
Reviewed by Courtney Rosenbladt.
On This Date in History
- May 25
The first session of the
US Constitutional Convention in Philadelphia, scheduled for May 14, 1787,
was delayed until May 25, 1787, when a quorum arrived. Because travel was
unpredictable, only Virginia and Pennsylvania were there on time. However, it
seems that state legislatures continue to have the same problem–only they no
longer can blame mode of travel. (After Spinrad)
1803 was Ralph Waldo Emerson’s birthday. He sparked New England’s
golden age of literature, and is famous for his comment: “Nothing
great was ever achieved without enthusiasm.” In fact, it is very hard
to make a speech without quoting something from Emerson. (After Spinrad)