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Tuesday, May 27, 2003
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In This Issue:
1. Physicians Health Study Concludes After 20 Years
2. Continued Vilification of the Pharmaceutical
Industry
3. Medical Management–A Difficult Concept–But
That’s Where the Cost Saving’s At
4. Our Monthly Report on Socialized (Single-Payer)
Medicine
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring
Accountability in HealthCare & Government
7. The MedicalTuesday.Network for Restoring
Patient-Focused Private Practice
The Physicians Health Study Concludes After Twenty
Years
In 1980, the Harvard Medical School recruited 44,000
physicians for the famous aspirin study, and 44,000 cartons of twelve sheets of
white pills and red capsules were sent to these doctors yearly. In 1989, eight
years into the study, the code was broken and I found that I was one of 22,000
physicians that took an aspirin placebo. The advantage to me as well as all of
humankind is that those that took aspirin had fewer heart attacks and strokes.
When this news appeared in the New England Journal of Medicine and the
newspapers, it became the standard of care. Everyone over 35 should take one
baby aspirin daily, unless they have a contraindication to aspirin.
Concurrent with the white pill was a red capsule. This was the Beta Carotene study that was extended in 1991 to continue for another twelve years, making it a twenty-year study. The code was broken last week and there was no statistical difference in two endpoints–total cardiovascular disease and total cancer. This time I was in the group that received the ?-carotene drug.
Concurrent over the last twelve years was a Vitamin E, Vitamin C and Multivitamin study. We were asked to continue to take these three pills for at least another eight years. I feel great pride in having participated for 20 years without missing a day, as did most of the 44,000 physicians. We congratulate our colleagues who practiced what they preached and took these drugs or placebos so faithfully.
The Political Assault on the Pharmaceutical Industry
Doug Bandow, a senior fellow at the Cato Institute, states
that few sectors of the economy have provided more benefits to consumers than
the pharmaceutical industry. Patients and politicians, however, have vilified
drug makers because of what they see as unreasonably high drug costs. Yet
medicine is not the most important component of the recent rise in health care
expenses. Moreover, the primary reason for current increases in total drug costs
is that more and more people are using newer medicines–which means that
consumer benefits are rising even faster. Simplistic comparisons between drug
costs in the United States and those in other countries have little value.
Economic wealth, exchange rates, product liability rules, price controls and
other factors all contribute to the price of drugs. More importantly, prices for
U.S. pharmaceuticals are not excessive relative to the benefits they offer.
Drugs have contributed to the sharp reduction in mortality rates from many
diseases, including AIDS (Acquired Immune Deficiency Syndrome). Pharmaceuticals
also reduce the cost of alternative treatments. Thus, restricting access to the
newest and best drugs can be economically counterproductive. Unfortunately, the
only way to develop new drugs is to invest heavily in research and development
(R&D). The $30 billion spent annually by U.S. drug makers dwarfs the budget
of the National Institutes of Health and investments by foreign drug companies.
Profits of U.S. firms tend to be high, but not uniformly so, and they create a
"virtuous cycle" that encourages more R&D to create new medicine.
Yet industry critics propose everything from socialized medicine to price controls and limits on patents. Such measures would, however, reduce incentives to create new medicines. It is true that some people, especially poor people in less-developed countries, lack sufficient access to pharmaceuticals. Private charity at home and abroad should make pharmaceuticals more available to people who are most in need, and some feel that Medicare should include a drug benefit as part of overall Medicare reform. It would be a serious error for policymakers to avoid market forces and take steps that would, intentionally or not, wreck a world-leading industry and deny people access to life-saving medicines.
Our Monthly Overview of Socialized or Single-Payer
Medicine
Jacob G Hornberger, a former trial attorney and adjunct
professor who taught law and economics at the University of Dallas, discusses
the Real Free-Market Approach to Health Care in The Dangers of Socialized
Medicine which he edited with Richard M Ebeling. The debate over national
health care is a debate over the future of the United States. For most of this
century, the American people have moved away from the principles of private
property, free markets and limited government to which our Founders and their
nineteenth century successors subscribed. Unlike their ancestors, twentieth
century Americans have permitted the state to take control of their income,
their educational activities, their charitable acts and their economic
endeavors. And now comes the culmination of this devotion to omnipotent
government–the idea that the state should take control of people’s health
care. In the U.S., this idea is benignly called national health insurance or
single-payer health care, but it is actually nothing less than socialized
medicine.
Hornberger states that one can understand the attempt by public officials to extend their control over a wider gambit of people’s lives. For that is usually what governmental officials try to do–exercise more and more power over the lives and fortunes of more and more people. The disappointment lies instead with the American people. Despite the failure of governmental control and intervention all over the world–including the United States in such areas as welfare, public schooling and mail delivery–Americans continue to think that this time “they will get it right.” But they will never get it right. For central planning, coercive redistribution of wealth and governmental intervention in economic activity will always and inevitably produce the same failed results that they have always produced.
However, the debate over national health care is ultimately a moral one, not a practical one. Should the state have the power to take money from some and give it to others? Should the state have the power to force a person to live at the expense of someone else? Should the state have the power to force an individual to submit his will to that of the collective? Should the state have the power to interfere with mutually beneficial exchanges between consenting adults?
The immediate aim of this book is to expose the dangers of socialized medicine. But Hornberger and Ebeling’s purpose is much broader: first, to expose the immorality and failures of the entire welfare-state, managed-economy way of life and, second, to show the moral foundations and work-ability of the private-property, free-market alternative. They believe that a time has once again come–In the course of Human Events--for people to reexamine their relationship with their government and with themselves. . . To reject the ancient idea of omnipotent governmental control over their lives and fortunes. . . and to move toward the principles of freedom that have ignited the hearts and minds of men and women throughout history. They believe that a time has once again come for the American people to move toward a free, prosperous and healthy society.
Medical Management–A Clinical Challenge To Save
HealthCare Costs
When I was a medical student, my tour through the
emergency room was very illuminating regarding the foibles and variations in the
clinical management of people. I had evaluated a baby with fever of 101 degrees
Fahrenheit and found no cause, such as infected ears, throat, lungs or brain.
After reviewing the findings with my preceptor, we agreed this was an acute
viral syndrome that antibiotics would not help. He told the mother that we found
no source for the fever and it was important to keep the temperature in the
near-normal range. He prescribed two aspirins immediately after they returned
home and every two hours thereafter as long as the temperature was over 100
degrees. About three hours later, the baby had a full febrile convulsion and
returned with the same frantic mother. By then the temperature was 105 and the
baby was treated with aspirin and ice blankets. The body temperature was reduced
and the baby was hospitalized overnight for observation. No meningitis or other
serious diseases were found to explain the fever. It was undoubtedly due to a
virus and it continued for two days. The mother, when questioned, stated she had
been so relieved when she left the emergency room that she went shopping with
the baby, until the seizure occurred. She had not treated her baby with aspirin
as directed.
When I discussed this with friends that were politically inclined, the response was that there should be a law to prevent such incompetent behavior by a mother. Everyone had a different idea as to who that law should target: prosecute doctors and hospitals for not admitting the baby to prevent incompetent mothers from harming their children or prosecute the mother for not following directions. The first is irrational since there are neither enough beds nor money available to protect everyone against their own inadequacies. (A thousand dollars-a-day hospitalization in lieu of ten cents worth of aspirin is not cost effective–it is a 10,000 fold or one million percent increase in cost.) The second is also unworkable since there is not enough money and time available to prosecute everyone who does not reach the politicians expectations of medical behavior (when some feel it’s the intrusive politicians who cause much of our health care problems).
I simply handled this challenge by carrying a bottle of acetaminophen in my white coat pocket treating the pains and fevers of life without any further laws or intervention except my clinical judgement. When I found some patients sending a prescription for antibiotics to a mail order pharmacy and delaying treatment by a week or ten days, I try to give the first dose or two of most drugs that are sampled in my office. By no longer relying on the memory or understanding of patients in distress, I believe the level of health care has improved.
Medical Gluttony–Excessive HealthCare Costs
While attending a medical meeting, I experienced a sore
neck muscle with the inability to turn my head to the left. I took two
extra-strength aspirins and the pain nearly resolved. With some residual
discomfort a couple of hours later, I took another two extra-strength aspirins
and was free of pain and able to move my neck fully in all directions.
Last week I had three patients who made appointments for similar pains–one in a neck strap muscle, one in the pectoral muscle, and one in the trapezius muscle that operates the neck and shoulder. None had taken anything for relief and seemed somewhat indignant when I suggested they should have done this on their own. They felt that would be treatment without a diagnosis. However, taking a routine analgesic also gives the physician some bases for evaluating the pain–one so easily relieved would not require much concern or even a physician office visit. Recognizing that, I gave each of the patients two extra-strength acetaminophen after establishing that it was simply a minor inflammation of the muscles. I then excused myself and saw another patient. Within twenty minutes, the pain had disappeared. Instead of taking less than fifty cents worth of usual medications–ones that should be in any medicine cabinet–they chose to spend $50 of someone else’s money (either taxpayers or premium payers) since they were not responsible for any costs.
How would any system of health care solve such an excess? Those that believe in single-payer or socialized medicine are eternally optimistic that people can be taught the golden rule and not over-utilize health care which ultimately extracts money from other taxpayers or premium payers. However, the majority do not consider this inappropriate. Hence we have the insensitive world of single-payer or socialized medicine where everyone is trying to tell everyone else what needs to be done, but no one sees themselves involved.
Welcome to the kinder world found in private health care where every one learns from one indiscretion and never blames anyone else. The three patients that increased their health care costs from 50 cents to fifty dollars (a 10,000% increase) did not understand their excessive costs since there were no personal costs. They were refractory to my discussion. However, in free market-based medicine, they would have seen everything in perspective the very first time they paid the $50. The learning process would have been completed in one lesson and never forgotten. In the socialistic or single-payer system, such patients not only fail to understand excessive costs, but are angered when someone expresses concern for costs.
* * * * *
The MedicalTuesday Network Recommends the Following
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 review in this newsletter
monthly, 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.
• The Mercatus Center at George Mason University
is a strong advocate for accountability in government. Nobel Laureate Vernon L
Smith, PhD, has joined its Economics faculty. Please log on at www.mercatus.org
to read the government accountability reports–their fourth annual Performance
Report Scorecard. The analysis arrives at a crucial moment for the U.S.
Government, with revenues down and budgets crunched, recent war and
reconstruction on the horizon, and domestic programs squeezed by homeland and
national security efforts. The quality of information contained in agency
documents will be pivotal as Congress and the Administration make funding
decisions based on outcomes, says report author Maurice McTigue, QSO, a
Distinguished Visiting Scholar, a former government minister in New Zealand,
and now director of the Mercatus Center’s Government Accountability Project.
“The opportunity costs at a time like this are tremendous. If one government
agency can deliver results at lower unit cost than another program attempting
the same public benefit, policymakers should have that information.” He feels
he’s having success with our MBA President who understands efficiency issues.
Mercatus scholars identify which agencies are making progress and which have
reached plateau or regressed in these three key areas: transparency, documenting
tangible public benefits, and demonstrating forward-looking leadership.
• The Galen Institute, Grace-Marie Turner President
and Founder, has a weekly Health Policy Newsletter to which you may
subscribe by logging onto their website www.galen.org.
In her current issue of May 23, A United Front, she discusses upcoming
action on Medicare and prescription drugs with the Heritage Foundation and the
American Enterprise Institute.
* It's imperative that Congress uses any drug
benefit legislation to build a foundation for a market-based Medicare program in
which benefits are delivered by private, competing plans. * Premiums for the
plans should be set by negotiation, not a government fiat. * A new agency
outside the Centers for Medicare and Medicaid Services that understands
competitive bidding (like the Office of Personnel Management) should be charged
with running the new program. * Any new program should minimize crowding out the
drug coverage that three-quarters of the seniors already have. Read the entire
newsletter at http://www.galen.org/happenings/052303.html.
• 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 very informative
and well-outlined health care newsletter by logging onto www.galen.org
or reading his current newsletter by clicking on Consumer Choice Matters on this
website. The current issue 17 quotes "Managed Healthcare Executive"
which includes a very interesting interview with Mike Cascone, the CEO of Blue
Cross Blue Shield of Florida. The article quotes him as saying the most
important issue in health care is, "Keeping the government out of
benefits definition, and allowing people to shape the marketplace according to
the benefits they want." Read the entire newsletter at http://www.galen.org/happenings/ccm052103.html.
• Martin Masse, Director of 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 will allow you to brush up on
your French. You may also register to receive copies of his webzine on a regular
basis. This week he quotes David MacRae in the Contrarian- No 82 on FREE TRADE
101: The agitprops claim that free trade represents exploitation of the poor by
the multi-nationals and that the environment will be adversely affected. Both
claims are so wrong that if not outright lies, they are at least a willful
refusal to examine the facts. You may read the entire article at http://www.quebecoislibre.org/010428-13.htm.
• The Ludwig von Mises Institute, Lew Rockwell,
President, is a rich source of free market materials, probably the best
daily course in economics we’ve seen. If you read these essays on a daily
basis, it would probably be equivalent to taking Economics 11 and 51 in college
with considerably less bias. This weeks message, What is Wealth Inequality?,
points out that the much touted inequality in income of free enterprise may not
be unequal at all if we look at the four components of a human “good” in
economic terms. For the full economic lesson, see http://www.mises.org/fullstory.asp?control=1229.
Please log on at www.mises.org to
obtain the foundation’s daily reports. You may also log onto Lew’s premier
free market site at www.lewrockwell.com
to read some of his lectures to medical groups. To learn how state medicine
subsidizes illness see http://www.lewrockwell.com/rockwell/sickness.html.
• 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. Plan to attend one of the annual week-long
von Mises Seminars which are now held every February. You may log onto www.hillsdale.edu
to register for one of their famous Shavano Institutes. A Shavano Institute
seminar on “Educating for National Leadership” was held last month in
Dearborn, Michigan. Leading the list of nationally known speakers was Brit Hume,
the FOX News anchor, who delivered the keynote address on the topic “A Free
Press in a Time of War.” You may also log on to register to receive Imprimis,
their national speech digest that reaches more than one million readers each
month. The last ten years of Imprimis are archived at http://www.hillsdale.edu/newimprimis/archives.htm.
• Robert J Cihak, MD, & Michael Arnold Glueck,
M.D, write an informative Medicine Men Column that has recently moved to
NewsMax. Please log on at http://www.newsmax.com/pundits/Medicine_Men.shtml
or subscribe by sending Bob an email at rcihak@techline.com.
The current issue is on Cash Money Medical Care. Every pundit in the land has
his own diagnosis for the health care crisis du jour (pardon the French). Very
often the diagnosis is a lack of adequate health insurance and the solution is
more health insurance. Perhaps this health insurance fever is the wrong
diagnosis and what we really need is less insurance – not more! Read the
entire column at http://newsmax.com/archives/articles/2003/5/19/155540.shtml.
* * * * *
MedicalTuesday Supports These Efforts in Restoring
Accountability in Medical Practice by Restoring the Doctor & Patient
Relationship Unencumbered by Bureaucracy:
• PATMOS EmergiClinic - www.emergiclinic.com
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 their cost as well as an internal medicine practice.
Congratulation for his rebuttal of Jack Anderson who wrote, “The logical
answer to the nation’s medical woes is a national system that would be
publicly financed like Medicare,” pointing out that Mr. Anderson wrongly
concludes that health coverage equals health care when in fact, it makes health
care less available and less accessible. To read the entire article, go to http://www.johnsoncitypress.com/LettersToEditor.asp#2003.
• 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.
• Dr Vern Cherewatenko for success in restoring
private-based medical practice which has grown internationally through the
SimpleCare model network, www.simplecare.com.
He now reports that more than 1500 medical professionals and 15,000 patients are
engaging in PIFATOS (Payment In Full At Time Of Service). The time is now
to return medicine to patients and doctors by charging fair prices, getting paid
directly, and teaching patients to secure an affordable major medical policy to
cover catastrophic expenses.
• Dr David MacDonald has partnered with Ron
Kirkpatrick to start the Liberty Health Group (www.LibertyHealthGroup.com)
to assist physicians by helping them to control their medical benefit costs
for their staff and patients. He is available to speak to your group on a
consultative basis. You may contact him at DrDave@LibertyHealthGroup.com.
• Christopher Jones, MD, President of HealIndiana, a
supporter of market-based medicine. However, we are sorry to see this website www.HealIndiana.org,
whose mission is to educate people about health care and have open discussions
about any health care alternative, disappear.
• The Association of American Physicians &
Surgeons, (www.AAPSonline.org) The Voice
for Private Physicians Since 1943, representing physicians in their
struggles against bureaucratic medicine and loss of medical privacy. They have
renamed their official organ the Journal of Physicians and Surgeons, and named Larry
Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. The AAPS
is holding it’s quarterly meeting in Seattle on Saturday, May 31, 2003:
Thrive–Not JUST Survive III: "Shark Proof Your Practice." This
is a Practice Management & Asset Protection Workshop with eight CME credits.
You'll hear practicing physicians who have cut the cord to managed care and
Medicare - keeping their patients and creating a healthy bottom line. You'll get
the details on how to keep HIPAA claims problems from drying up your cash flow,
and how to respond to expected privacy complaints. Because of HIPAA
criminalizing so much of what we do, there has been renewed interest in these
meetings that resulted in all recent meetings being sold out. You may register
on the website above.
* * * * *
Stay Tuned to the MedicalTuesday.Network and Have
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Del Meyer, MD, CEO & Founder
DelMeyer@MedicalTuesday.net
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