MEDICAL TUESDAY . NET

    NEWSLETTER

Community For Better Health Care

Vol VIII, No 4, May 26, 2009

 

In This Issue:

1.                  Featured Article: Can the Government Create Jobs?

2.                  In the News: Who came to the Meeting President Obama had with Industry Leaders?

3.                  International Medicine: This health care 'reform' will kill thousands.

4.                  Medicare: Measuring Social Security's True Liability

5.                  Medical Gluttony: Entitlement Madness by John Goodman, PhD

6.                  Medical Myths: $64,000 Severance Pay! Why should I purchase my own health insurance?

7.                  Overheard in the Medical Staff Lounge: Where is the health care crisis?

8.                  Voices of Medicine: The True Costs of EMRs

9.                  The Bookshelf: Spiritual and Medical Perspectives on Euthanasia and Mortality

10.              Hippocrates & His Kin: Why Government Medicine Is Cheaper

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

* * * * *

MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. 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 Liberty Hotel."
For more information visit www.sickandsickermovie.com or email
logan@freestarmovie.com.

* * * * *

 

1.      Featured Article: Can the Government Create Jobs?

What is Seen and What is Unseen: Government "Job Creation"
By Larissa Price • FEE
, 11 February 2009 Larissa Price is a former FEE staff member.

Barack Obama says his roughly $800 billion American Recovery and Reinvestment Plan could save or create between three and four million American jobs by 2010. Many of these proposed jobs are New Deal-esque, involving the building or repairing of government infrastructure, such as roads, bridges, and buildings. There is a modern twist, of course, with the promise to develop "alternative energy sources" such as wind farms, solar panels, fuel-efficient cars, and the like. "The jobs we create will be in businesses large and small across a wide range of industries," Obama promised, "and they'll be the kind of jobs that don't just put people to work in the short term, but position our economy to lead the world in the long-term." (Emphasis added)

First, one may ask: how can Obama and his economic advisers know what kind of jobs will position our economy to "lead the world" in the long-term? Indeed, how can we expect anyone to know what kind of jobs will be able to offer such a guarantee of wealth and security, considering the enormous complexity of our world, which includes billions of individuals constantly making decisions based on their own expectations about the future, as well as potential ideological shifts and the inevitable changes in policy funding and support they bring. This is without considering technological advancements that can turn the best-laid central plans into white elephants. There is little an individual or group can possibly know or predict for the future, particularly on such a large scale as three to four million jobs.

However, assuming Obama and his advisers are right — that his plan will indeed save or create that many jobs — what proof do we have that it will leave us better off than if it's not implemented at all?

In his essay "What Is Seen and What Is Not Seen," the French classical-liberal economist Frédéric Bastiat explained that there is a tendency to only recognize the intended consequences of an action (what is seen). However, there are often other, subsequent effects that are not perceived as connected to the action (what is not seen). Furthermore, the short-run effects of an action can sometimes be quite different from the longer-run, unseen consequences.

In the case of public works, Bastiat explained that government produces nothing independent from the resources and labor it diverts from private uses. When government borrows money to create jobs, what is readily seen are people employed and the fruits of their labor. However, what is generally not considered are the many things that could have been produced if the capital had not been removed from the private sector to fund the government programs in the first place. Such policies necessarily benefit some (the favored workers) at the expense of others (those who would have had the jobs that were not created) and eventually the taxpayers who have to repay the debt.

New Deal

Bastiat's theory is evidenced in New Deal public-works projects, which not only failed to help lift the economy out of the Great Depression, but also served to make it "great."

First, many jobs created under FDR had little benefit to anyone other than those employed, such as studying the history of the safety pin, collecting campaign contributions for Democratic Party candidates, chasing tumbleweeds, and cataloguing 350 different ways to cook spinach, (See Lawrence Reed's
Great Myths of the Great Depression.)

In addition, much of the "job creation" was directed according to political preferences, rather than where jobs were arguably needed most. For instance, a disproportionate amount of public relief went to western "swing states" expected to help Roosevelt win votes in future elections, rather than to the poorest states, such as those in the South, which were already solidly Democratic during this period. Relief and public-works spending seemed eerily to increase during election years, and it has been shown that votes for FDR correlated closely with jobs and other special government benefits given. (See Burton Folsom's New Deal or Raw Deal? How FDR's Economic Legacy Has Damaged America.)

New Deal job-creation projects also impeded productivity by discouraging private firms from adopting new technologies. A prime example is a government farm in Arizona where a dairy crew discovered that it could turn a profit only by using milking machines, rather than milking by hand, and eliminating some the jobs. But that would have violated the terms of a government loan. So the machines were not brought in, and the staff members who made the suggestion were fired. (See Amity Shlaes's New Deal Jobs Myth.)

Roosevelt is still celebrated for his job-creating measures because the people who gained employment were easily seen. However, what wasn't (and isn't) so easily recognized is that to pay for his public-works experiments, the government sucked up much of the available capital by selling bonds and collecting taxes, including a 5 percent withholding tax on corporate dividends and ever-rising income taxes, with a top income tax rate that hit a staggering 90 percent. Thus the New Deal had the unintended consequence of prolonging the Great Depression by diverting resources that could have been used to create wealth.

Barack Obama and his advisers should take a lesson from history: the New Deal and its public-works projects were a disaster, and it would be remiss to think they should be given another try. As Bastiat explained, government doesn't create wealth; it only diverts it. When wealth is in the hands of the government it inevitably tends to serve political ends rather than consumers. FDR's New Deal policies are a testament to that, and if they are repeated in response to our current economic crisis, it will only hinder the recovery.

Read the entire article . . .

* * * * *

2.      In the News: Who came to the Meeting President Obama had with Industry Leaders?

Consumers Power Report (No 178, May 14, 2009) by Greg Scandlen

I'm not going to spend much time this week on the meeting President Obama had with some industry groups. There has been plenty of gushing about it already - far more than the event deserved. I thought it was interesting who was and wasn't in attendance. For instance, The SEIU was there but the AFL-CIO wasn't, AHIP was there but BCBS wasn't, the AHA was there but not FAHS. The AMA was there but no other physician group. There were no nurses, no nursing homes, no ambulatory surgery centers, no allied professions, no home health agencies, no insurance brokers. And certainly no patients, the only people that really count.

This was all about the Fat Cats divvying up the health care pie. And they are willing to roll over and get their bellies scratched if it means a big treat for them at the end of the day. It is Washington at its most sickening.

Meanwhile last Friday (May 8th) we had a great meeting in Milwaukee with over 80 people in attendance. Peter Fotos and I gave substantive presentations and State Rep Leah Vukmir gave the keynote address. About half the folks were from Americans for Prosperity, and I am looking forward to working with them in the future.

Read Greg Scandlen's Other Power Reports . . .

* * * * *

3.      International Medicine: Quality is an Unknown Political Issue

This health care 'reform' will kill thousands. --Karol Sikora, Tuesday, May. 12, 2009

One of the more unproductive elements of President Obama's stimulus bill is the $1.1 billion allotted for "comparative effectiveness research" to assess all new health treatments to determine whether they are cost-effective. It sounds great, but in Britain we have had a similar system since 1999, and it has cost lives and kept the country in a kind of medical time warp.  As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients—and higher overall health costs than if they had been treated properly: Sick people are expensive.  It is easy to see the superficial attraction for the United States. Health-care costs are rising as an aging population consumes ever-greater quantities of new medical technologies, particularly for long-term, chronic conditions, such as cancer.

As the government takes increasing control of the health sector with schemes such as Medicare and SCHIP (State Children's Health-care Insurance Program), it is under pressure to control expenditures. Some American health-policy experts have looked favorably at Britain, which uses its National Institute for Clinical Excellence (NICE) to appraise the cost-benefit of new treatments before they can be used in the public system.

If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through our public National Health Service, which provides care for the majority of Britons.  There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary. Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.

Partly as a result of these restrictions on new medicines, British patients die earlier. In Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer diagnosis. In Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. We are stuck with Soviet-quality care, in spite of the government massively increasing health spending since 2000 to bring the United Kingdom into line with other European countries.  Having a centralized "comparative effectiveness research" agency would also hand politicians inappropriate levels of control over clinical decisions, a fact which should alarm Americans as government takes ever more responsibility for delivering health care—already 45 cents in every health-care dollar. In Britain, NICE is nominally independent of government, but politicians frequently intervene when they are faced with negative headlines generated by dissenting terminal patients.

For years, NICE tried to block the approval of the breast cancer drug Herceptin. Outraged patient groups, including many terminally ill women, took to the streets to demonstrate. In 2006, the then-health minister suddenly announced the drug would be available to women with early stages of the disease, even though it had not fully gone through the NICE approval process.  A more recent example was the refusal to allow the use of Sutent for kidney cancer. In January, NICE made a U-turn because of pressure on politicians from patients and doctors. Twenty-six professors of cancer medicine signed a protest letter to a national newspaper—a unique event.  And yet this drug has been available in all Western European countries for nearly two years.  In Britain, the reality is that life-and-death decisions are driven by electoral politics rather than clinical need. Diseases with less vocal lobby groups, such as strokes and mental health, get neglected at the expense of those that can shout louder. This is a principle that could soon be exported to America.

Ironically, rationing medicines doesn't help the government's finances in the long run. We are entering a period of rapid scientific progress that will convert previous killers such as heart disease, stroke and cancer into chronic, controllable conditions. In cancer treatment, my specialty, the next generation of medicines could eliminate the need for time-consuming, expensive and unpleasant chemo and radiotherapy. These treatments mean less would have to be spent later on expensive hospitalization and surgery.

The risks of America's move toward British-style drug evaluation are clear: In Britain it has harmed patients. This is one British import Americans should refuse.

Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London, and former head of cancer control at the World Health Organization

Read the entire article and the Blog responses . . .

The NHS does not give timely access to modern healthcare, it only gives access to a waiting list.

 * * * * *

4.      Medicare: Measuring Social Security's True Liability by Laurence J. Kotlikoff, May 12, 2009

Every year the Social Security Trustees publish a report on the fiscal solvency of the program.  It details the program's unfunded liabilities, which is what the government will still owe after it uses current and future tax receipts to pay for current and future retiree benefits.

In 2005, the Social Security Trustees estimated that the program's unfunded liabilities were $8.5 trillion.  This means that even after accounting for payroll tax revenues the federal government would have to have this much money in the bank today, accruing interest, in order to pay promises to future retirees.

However, the Trustees appear to be underestimating the value of Social Security's unfunded liabilities because they are failing to take into account the riskiness of tax payments that have not yet been received and of benefits that have not yet been accrued and the certainty of those benefits that have been established.  In effect, the Trustees are understating the market value of Social Security's net liabilities - what the government would have to pay a private party or investor to take the obligation off its hands. . .

Underestimating Social Security Net Benefits to Current Workers by Not Adjusting for Real Wage Growth.  According to our study, the trustees have made two valuation mistakes in calculating Social Security's unfunded liabilities.  The first mistake involves failing to account for risk with respect to initial benefit awards as well as future tax payments.

The trustees' calculations assume that wage growth will be fairly constant from year to year.  Social Security benefits are based on a worker's covered earnings history with an adjustment for economy-wide average wage growth.  Payroll taxes are collected as a percentage of an individual's earnings (up to a limit on taxable wages).  Thus, the system's liabilities and tax receipts are largely dependent on wage growth.  The problem with the Trustees Report is that wage growth is assumed to be constant at 1.1 percent a year.   However, wage growth is highly variable, so there is no counting on it being 1.1 percent per year in the future.  Data from 1951 to 2005 shows that wages grew by as much as 6.4 percent in a single year and declined by as much as 4.6 percent in a single year.  In financial terms, when something is hard to predict it is considered a risk.  Thus, in addition to Social Security's assumed interest rate of 2.9 percent, a "risk premium" must be included that compensates for the uncertainty in tax revenues and benefit payments resulting from variable wage growth. 

Undervaluing Social Security Benefits Once They Begin.  The second mistake is the failure to account for the safety of the stream of Social Security benefits to a retiree once they commence.  Social Security benefits are paid out as inflation-indexed annuities.  Ignoring uncertainty in future mortality probabilities, as we do in our analysis, Social Security's benefit obligations to specific cohorts of workers - once they begin - are definite, real (inflation-adjusted) annual amounts.  Such streams need to be discounted using the rate of returns on comparable securities, which in this case are inflation-indexed bonds.  But the returns on Treasury Inflation Projected Securities for 2005 - the year we analyzed - were at least one-third less than the discount rate used by the Trustees.  In using too high a discount rate, Social Security understates the market value of these obligations; that is, Social Security is mispricing safe as well as risky streams of payments and receipts. . .

Conclusion.  No one would suggest that the prices of financial securities are independent of risk.  Such a proposition would deny fact, let alone theory.  The same financial laws that determine the prices of marketed securities govern the pricing of Social Security liabilities.  Unfortunately, the standard U.S. practice has been to ignore this relationship. . .  

Read the entire analysis . . .

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

 * * * * *

5.      Medical Gluttony: Entitlement Madness by John Goodman, PhD

As of last year's report, Social Security and Medicare had an unfunded liability in excess of $100 trillion (see Table I), about 6 ½ times the size of the entire economy. This is the excess of promises we have made over and above expected taxes and premiums. To avoid draconian benefit cuts or tax increase in future years we would need to have that $100 trillion in the bank, earning interest today. But of course we do not. (Although it is of small comfort, Jagadeesh Gokhale has shown that our European trading partners are in even worse shape.)

These obligations are especially important in light of the enormous increase in unfunded liability and cash flow deficits that are about to be added. Currently, about 100 million people depend on Medicare and Medicaid for their health care. Under President Obama's new health reform plan, an additional 100 million or so could be enrolled in public and quasi-public plans with the entitlement guarantee that their premiums will not exceed 10% of family income.

The $100 trillion figure is based on looking indefinitely into the future. (For reasons we have explained before a shorter time horizon gives misleading estimates.) Yet a different way of accounting is to use the method private companies and state and local governments now have to use. If we halted these programs tomorrow, collecting no more taxes and allowing no more benefit accruals, how much do we owe people for benefits they have already earned? Answer: $52 trillion. Read the entire blog . . .

MedicalTuesday has always recommended that the only way to save Medicare is to index it for longevity as Social Security started to do. Since longevity has increased from 62 years when social security started to 77 years today, this indexing must be gradual over a long time. Social Security has only reached an indexing level of 67 years. Adding an additional 100 million Americans to these benefits, that must be paid for by working Americans, is sheer lunacy. The Big Government advocates are criticizing our Health Care as costing too much at 17 percent of GDP. Why do we want to push it to 25 percent of GDP? Aren't we headed in the wrong direction for fiscal responsibility?

Medical Gluttony thrives in Government and Health Insurance Programs.

Gluttony is controlled with Appropriate Deductibles and Co-payments on Every Service.

* * * * *

6.      Medical Myths: $64,000 Severance Pay! Why should I purchase my own health insurance?

skip to main skip to sidebarFree American Health Care, Thursday, May 7, 2009

Wall Street Journal Joins the Media Chorus on "Universal" Health Care

When the Wall Street Journal starts fretting over the uninsured, we have a problem. This morning's paper featured two recently unemployed men: one in Illinois and one in the town of Hohenlockstedt in the German state of Schlewsig-Holstein.

Right off the bat, the reporter notes the key difference in outcomes for the two unemployed men: the American lost his health benefits and the German did not. I'm no fan of employer-based health "benefits", largely because they artificially inflate the number of uninsured. So, I have long advocated tax reform to give American families the same tax-break as American businesses for health insurance. It would make the price of health benefits transparent and give workers better opportunity to save money for a spell of unemployment, which they could use to pay premiums.

The featured American unemployed worker decided to give up snowmobiling and other recreation, because he had no health insurance. "It's scary being without insurance," he says, "but what do I give up? Food?"

Well, Illinois is not the easiest state for affordable health coverage, but it's not the worst: Various government interventions take it down to number 35 of 50 states in the U.S. Index of Health Ownership.

So, I had some sympathy for the fellow - until I got to the tail of the article, where the journalist decided to drop a pretty important fact: the worker received $64,000 of severance when he lost his job!

What did he do with the money? Paid off debts. So, now he cannot take responsibility for his own health insurance. And one man's inability to plan his personal finances becomes another excuse for government-run health care.

Http://Free-American-Healthcare.Blogspot.Com/2009/05/Wall-Street-Journal-Joins-Media-Chorus.Html

comments: Kevin said...

This points out what is the real cause of the inflation of health care costs. Patients see health care as a right and do not take personal responsibility for it. They want someone else to pay for it. This disengagement of demand from the burden of payment has obvious consequences. -Kevin Petersen, M.D.

John R. Graham

I'm the author of the U.S. Index of Health Ownership, the only project to rank all 50 states' health laws and regulations according to free-market principles; and the editor of a book addressing What States Can Do to Reform Health Care: A Free Market Primer. I'm also the primary author of the monthly Health Policy Prescriptions series, which addresses national health reform, and contribute to PRI's Capital Ideas series of short articles on public policy in California. I've written numerous articles covering diverse topics within health policy for periodicals including the Wall Street Journal and the Washington Post I speak frequently on health care reform on radio and television, and at conferences in the United States, Canada, and Europe. I've also worked as a management consultant and investment banker in Canada and Europe and previously served as an infantry officer in the Canadian Army in Canada, Germany, and Cyprus. I received my M.B.A. from the London Business School (England) and my B.A. (with Honors) in economics and commerce from the Royal Military College of Canada

Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

Medical Myths reappear when you have five years of premiums as severance pay but don't feel obligated to use it for health care because you think someone else should pay for it.

* * * * *

7.      Overheard in the Medical Staff Lounge: Where is the health care crisis?

Dr. Rosen: The political parties keep talking about a health care crisis? Exactly what is the crisis?

Dr. Ruth: The crisis is the paper work we have to do to get paid.

Dr. Paul: Every insurance plan has different criteria for care and billing. How can anyone keep up?

Dr. Nichols: People come into our ER for basic routine care. Only about 10 percent of visits are emergencies. So the non-emergencies have to wait an inordinate amount of time.

Dr. Rosen: Isn't that one fact enough of a deterrent for non-emergency patients to make an appointment with their personal physician?

Dr. Nichols: There are several factors operating here. Medical problems that occur during the day and can wait until the next day may create family work problems. If the patient works, it might save them money to go to the ER and wait six hours rather than miss a day of pay. Laborers do not always equate waiting time with lost work time.

Dr. Dave: And if the loss of work time eats up income and the ER time is free or relatively so, that tips the equation to extra evening or night medical care, which is cheaper than regular care during the day.

Dr. Patricia: I can see that. Balancing childcare with the options we've discussed so far may tip the equation to the right, favoring health care at night. Overtime in health care is not more expensive than daytime in health care.

Dr. Rosen: But we're not getting down to the real problem. The high-cost center of hospital care is relatively cheaper than outpatient office time.

Dr. Ruth: How would you change that?

Dr. Rosen: I think that we as physicians need to get involved in a more intense dialogue to change the equation so that co-payments and deductibles reflect the high-cost center. There needs to be a percentage co-payment on every charge so the patient will supervise every charge and not have the attitude, "Well, Doctor, I'm here. Let's do whatever can be done." That's why so many ER visits will add up to $9,000 rather than $600.

Dr. Dave: I agree. We have to become very vocal in rationalizing health care costs.

Dr. Rosen: Does that mean bringing back the County Hospitals?

Dr. Dave: That would certainly provide universal access like we had before Medicare.

The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

* * * * *

8.      Voices of Medicine: A Review of Local and Regional Medical Journals 

The True Costs of EMRs, By Kenneth Prosser III, MD Sonoma Medicine, Spring 2009

The practice of medicine has long enjoyed a successful relationship with advances in scientific technology. Since beginning my medical career in 1984, for example, I have seen the advent of MRIs, development of laparoscopic surgical procedures, two to three times as many new drugs and immunizations, and the initiation and completion of the human genome project. I have also witnessed the rise of the personal computer.

Though computers have been used in medicine for several decades, the use of the electronic health record (EHR) only began seriously in the United States about five years ago, when the Bush administration created the Office of the National Coordinator for Health Information Technology. Currently more than 300 EHR and electronic medical record (EMR) products are available, though only about two dozen are commonly used. (Just to clarify the nomenclature, EMR and EHR are currently used synonymously, but technically an EMR is a type of EHR. I will use EMR to discuss my own experiences with electronic records.) . . .

EMR usage in Sonoma County has expanded rapidly over the past few years. The larger hospitals as well as many private practices and clinics have undergone the transition to electronic records. My former group, Primary Care Associates, began phasing into an EMR system in early 2005 and went fully "live" by that September. Since our group consisted of both family medicine and pediatrics practices, we had to adopt a system that was not ideal for either but did attempt to meet everyone's needs.

The actual decision to go electronic was not met with equal enthusiasm by all in our group. The initial capital outlay and the ongoing costs in equipment support and licensing fees were enormous. Everyone understood, however, that the days of paper charts would end sooner than later, so we decided to move forward. . .

After the initial shock of transferring to EMRs and completing the initial training and practice, we had high hopes that our lives would eventually become much easier. Looking back to the list of benefits, we were successful with some but not others. For record accessibility, improved patient care, better communication, more efficient billing and reduced overhead, the EMR system definitely delivered on its promise. Many people in the office could look at the same record at different locations simultaneously (though only one person could enter information at a time).

Our patient care benefited from this increased access to information, which also produced more rapid lab results and better pharmacy interfacing. Patients with diabetes and other chronic diseases benefited through disease-management modules and tabular trends in labs and vitals. Patient referrals and insurance authorizations were processed much more efficiently, and copies of pertinent information required by schools, such as immunization records, could be faxed electronically. I particularly liked the positive impact on prescribing medications. One click and my prescription transmitted directly to the pharmacist's computer. . .

Despite the noted benefits to our patients, insurance companies and specialist referrals, the EMR significantly increased our workload, even with the advantages brought by improved intraoffice communication, lab and pharmacy interfaces, chart access, and legibility. Our physicians spent one or two hours more in charting throughout and at the end of the day. EMRs bring a large degree of efficiency, but one can only type and click so fast. Nurses and medical assistants also felt the increased workload in charting time. . .

An EMR, to be sure, is a big plus for medicine. Many people have benefited, but at whose cost? Speaking for myself, the cost in time, stress, reduced quality and satisfaction in my work has made me feel a bit worse. Unfortunately there is no going back. Computers are figuring more and more prominently in everyone's daily life.

A complete EMR is an impressive and beneficial tool. Furthermore, future reimbursement from Medicare and Medicaid will be tied to whether or not a provider is using an EMR. This is good news for those just now adopting, and there will apparently be some benefits for early adopters as well. Unfortunately, in our group's case, the initial capital outlay came straight out of our pockets, and we were unable to stay in business long enough to realize any payback from our investment.

www.scma.org/magazine/articles/?articleid=398

Dr. Prosser is a Santa Rosa pediatrician in private practice.

VOM Is Where Doctors' Thinking is Crystallized into Writing.

* * * * *

9.      Book Review: Spiritual and Medical Perspectives on Euthanasia and Mortality

DENIAL OF THE SOUL - Spiritual and Medical Perspectives on Euthanasia and Mortality, M. Scott Peck, MD, Harmony Books, New York, 1997, xi & 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.

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 Letterman General Hospital whether this effort to prevent inevitable death was the right thing to do? The Colonel commended him, obtained a portable EEG, and found an occasional distorted brain wave and pronounced that the patient was not yet certifiably brain-dead.

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. . .

Read the rest of this book review . . .

To read more book reviews . . . 

To read book reviews topically . . .

* * * * *

10.  Hippocrates & His Kin: Why Government Medicine Is Cheaper

Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.

Now we understand why Government Medicine is cheaper - less costly drugs and shorter life.


Prozac Nation

Employee to boss: "Did you really fire me, or were you just off your medications?"

Bosses never tell.

Read more . . .


Modern Bedtime Stories

Son: "Please daddy, one more strategy."

Father: "OK, son. One more investment strategy and then off to sleep."

Do we have a budding entrepreneur?


Modern Girl Stuff?

Husband: Why do you need such a big purse?

Wife: Oh, for "girl stuff." You know - cell phone, pager, PDA, laptop, fax/modem, printer . . .

Really a Laptop Briefcase.


Another East Coast Mystery

 "In New York today, two conglomerates gobbled each other up and disappeared without a trace."

It could only happen in New York - or maybe Detroit


In the City of Brotherly Love

In Philadelphia, in a complex court settlement, our parent company gets custody of us on weekends. Our new owners have us throughout the workweek, day and night. -After WSJ Business Cartoons.

To read more HHK . . .

To read more HMC . . . 

* * * * *

11.  Professionals Restoring Accountability in Medical Practice, Government and Society:

                      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.patmosemergiclinic.com/. To read more on Dr Berry, please click on the various topics at his website.

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. MORAL HEALTH CARE VS. "UNIVERSAL HEALTH CARE"  Lin Zinser and Paul Hsieh argue that the current crisis in American health care is the result of decades of government interference and violations of individual rights in health insurance and medicine. The only moral and practical solution to the problem is not more government controls but instead to gradually and systematically transition to a rights-respecting, fully free market in those industries. From the Winter 2007-2008 issue of The Objective Standard.

                      Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm. For The Recession and its Effect on Healthcare . . . For The Case Against the Electronic Medical Record . . . Review other OpEd articles at www.healthplanusa.net/david_gibson.asp or click on his name in any volume at www.ssvms.org/magazine.asp.

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives.

                      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 read News of the Day in Perspective:  HHS Secretary nominee pushes HIT's role in data mining even as new report of stolen electronic medical records surfaces. 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 SUDDEN DEATH FOR MEDICINE? Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents. 

Be sure to put September 30 - October 3, 2009 on your calendar for the AAPS 66th Annual Meeting in Nashville, TN. www.aapsonline.org/calendar.php 

* * * * *

Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp, enter you email address and join the 10,000 members who receive this newsletter. If you are one of the 80,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. 


Please note that sections 1-6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.


Be sure to go to HealthPlanUSA.net and click on Newsletter to sign up for our sister Newsletter which is now separate from MedicalTuesday and focuses more on health care issues and possible reform rather than practice issues.


ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.


Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication:  www.medicaltuesday.net/newsletter.asp


Del Meyer      

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

When the government controls your ability to get health care - they control you. Americans are such sheeple these days. -Jay Collins, Laconia

[Our Health Insurance] system is morally wrong because it runs on the same principle as organized crime. They charge you a monthly fee for protection against a possible and unknown threat, but then when the time comes they don't pay-up, or they underpay. And doctors won't even see people unless they can afford the enormous monthly fees! Health insurance is extortion. It's a scam, and its high-time we got rid of it! -Joe T, Derry, NH

The trouble with socialism is that it always runs out of other people's money. -Margaret Thatcher

 

Some Recent or Relevant Postings

A TIME FOR FREEDOM  by Lynne Cheney

WE THE PEOPLE - THE STORY OF OUR CONSTITUTION, by Lynne Cheney

HOW DOCTORS THINK by Jerome Groopman, MD

WHY GOVERNMENT DOESN'T WORK by Harry Browne

DIETS DON'T WORK  by Bob Schwartz, PhD

DOCTORING - The Nature of Primary Care Medicine by Eric J Cassell, MD

In Memoriam

Conservative hero: Jack Kemp A liberal Republican in the best sense

From The Economist print edition May 7th 2009 | WASHINGTON, DC

WINSTON CHURCHILL once said that he "preferred the past to the present and the present to the future". Jack Kemp had exactly the opposite point of view. For him the future always promised to be better than both the present and the past—provided that the government would just get out of the way.

Mr Kemp was one of the most prominent Republicans of his generation. He was secretary of housing and urban development under the first George Bush. He thought of running for the Republican nomination in 1996 and became Bob Dole's running-mate. But his real influence was ideological. He was a tireless advocate of supply-side economics: the man who persuaded Ronald Reagan to abandon deficit-hawk Republicanism in favour of aggressive tax cuts.

Mr Kemp started his career as a wiry, eager quarterback for the Buffalo Bills, before riding his popularity as a sports star to a seat in Congress. There he was consumed by a vision of how to make the world better. He lent his name to the Kemp-Roth tax cuts of 1981, one of the opening salvos of the Reagan revolution, and championed school vouchers, enterprise zones and housing vouchers.

The traditional wing of the party thought him a blow-dried wonder, but he could give as good as he got. In 1985 Bob Dole mocked him for wanting "a business deduction for hairspray". Mr Kemp shot back: "In a recent fire, Bob Dole's library burned down. Both books were lost. And he hadn't even finished colouring [sic] one of them."

Mr Kemp's world view was shaped by three things. Sympathy for the blacks he had got to know as a football player; contempt for urban liberalism, which he had seen at work in Buffalo, with its blighted housing estates and failed schools; and his commitment to supply-side economics. He never lost his enthusiasm for cutting taxes and expanding opportunities: virtues he had learnt as a not-so-dumb jock.

www.economist.com/world/unitedstates/PrinterFriendly.cfm?story_id=13611463


A Tribute to Jack Kemp by Jeffrey A. Tucker Mises Daily 5/6/2009

Despite having written some tough criticisms of Jack Kemp over the years, having even called him a socialist when he was running the Department of Housing and Urban Development (1989–1993) under the first Bush administration, I've always had a soft spot for him. His death is really a tragedy and all the more so that it was not even widely remarked upon in Republican ranks. He was a major intellectual force in his day, and his sympathies with genuine liberalism of the old school made him attractive, at some level, to libertarians, if only because we understood each others' language.

My impression is that the party machine decided to eat him after being a VP on a losing presidential ticket in 1996 and then coming out against the Iraq war in 2002. The way it works with these people is that you are deemed a rising star and courted insofar as you say the right things and can be useful in bringing power to the party, but once you lose an election or say something contrary to the party line, your ideas and your person are forgotten. It is a live-by-the-sword/die-by-the-sword situation, so in a political-party sense Jack Kemp was long gone. . .

Read more . . .

On This Date in History - May 26

On this date in 1886, Asa Yoelson was born in Srednike, Russia. The parents had hope for a Cantor when they came to America, but he became a jazz singer and changed his name to Al Jolson. He sang his way up from Rialto vaudeville theaters to Ziegfeld's Follies and finally to the motion picture screen becoming the first singer to be heard on film. His famous line was "You ain't heard nothing yet, folks."

On this date in 1979, Israel formally returned El Arish to Egypt under the terms of a peace pact. The capital of the Sinae peninsula had been occupied by Israel forces for over a decade. This deed showed both Egypt and the world that Israel meant to keep its promise to instigate a peaceful coexistence between the two nations. The next day, the border between Israel and Egypt was opened.

After Leonard and Thelma Spinrad