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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
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
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
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.
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The MedicalTuesday Network Recommends the Following
for Their Efforts in Restoring Accountability in HealthCare, Government and
• 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 email@example.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.
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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.
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Del Meyer, MD, CEO & Founder