1.
Featured Article:
World Health Care Congress -– 2007
Keynote: The World's Top 10
Diseases: Tadataka Yamada, MD, MACP, President
of the Bill and Melinda Gates Foundation, addressed the issues facing global
health.
In Dr. Yamada's view, the biggest global health
problem is inequality, evidenced by 10 million children per year dying
in developing countries.
Many diseases in the developing world can be prevented
or easily treated through low-tech approaches.
Needed are more money ($25-$70 billion per
year), people (1 million health workers), and political will.
Also, governments in developing countries need to spend more on health care,
and individuals need to be more involved in their own health care in developing
countries (and the U.S.).
There is a big opportunity for the private sector in
developing marketing, in providing and financing health care, and in making
products for these markets.
The Gates Foundation is pursing public/private
partnerships that de-risk private sector undertakings. They try to catalyze
investments from others, especially governments.
Specific activities focus on infectious diseases,
maternal and reproductive issues, and
nutrition.
Consumer-Driven
Health Care (CDHC): How Is It Working? by John C. Goodman
Presentation
to World Health Care Congress: Do CDHC Patients Skimp on Care?
In Destiny Health: Immunizations are 12%
Higher and Well-Baby Visits 40% higher.
In UnitedHealth Group: Preventive care is up five
percent (in each of the three years) compared to non-CDHC members.
In Aetna: First-year HSA members had cervical cancer screenings at a
13.8 percent higher rate than PPO members. Use of asthma inhalers was six
percent higher than in PPO members.
Does CDHC Modify
Behavior?
UnitedHealth Group: Healthy CDHC members have 22 percent fewer hospital
admissions and 14 percent fewer emergency room visits; Chronically ill CDHC
members have eight percent fewer hospital admissions and 12 percent fewer
emergency room visits than non-CDHC members. CDHC members had the same level of
physician visits as PPO enrollees.
Keynote: Competition: Professor Michael Porter presented his thinking
on a new model for transforming health care. Aetna CEO Ronald Williams
and Kaiser CEO George Halverson then shared their reactions.
The current nature of competition in health care is
bad, zero-sum competition. The right type of competition will increase the
value of health care delivered. Fundamental change is needed in the delivery
of care. Needed is integrated, coordinated care for "conditions"
(such as diabetes) over the entire cycle of care. Measuring outcome
results will be the most important driver of systemic transformation.
"The type of competition that must take place is competition based on
value."
Mr. Williams and Mr. Halverson both agree with
Professor Porter's long-term, big-picture vision. Mr. Williams sees the
challenge as one of bringing about the change.
Mr. Halverson sees two models: 1) For acute care
(25% of costs) with a data-rich infrastructure so consumers can make more
informed decisions; and 2) For chronic care (75% of costs) requiring a
coordinated team approach.
IT will play a critical role in the transformation,
linking providers and aggregating data for decision-making.
There was agreement on the need to deal with the uninsured
population.
Health
Care Reform Needs to Focus on Health Care Reform,
By George C. Halvorson, Chairman and CEO, Kaiser Foundation Health
Plans and Hospitals
The current debate on
health care reform tends to ignore actual health care
reform.
The overwhelming focus
of the current debate is on health care financing - not health care reform.
Health Care costs are
simply off the American health policy radar screen - even though:
1)
That's where the expenses are!
2)
That's where the opportunities are!
Look at the numbers:
Who is spending health care dollars?
75% of
American health care costs involve people with chronic disease
Five chronic diseases drive over 2/3 of those
expenses. That's where we spend the money.
We do a really lousy job of taking care of people with
these five conditions:
Diabetes
Asthma
Congestive Heart Failure
Coronary Artery Disease
Depression
How well do we do in these diseases? We deliver right care barely half the time (Rand
Study)
Diabetes
32% of all money spent by Medicare
Number one cause of kidney failure, amputations, blindness and fatal co-morbidity with heart disease
Fastest growing disease in America
How often do we deliver
total right care for diabetics? 8% of the time (Minnesota Research)
8% is not good enough - 8% creates an incredible opportunity
We need to move the 8% to 80%.
Potential Opportunity:
50% drop in kidney failures
50% drop in complication rates
Much lower costs
Add in appropriate behavior changes:
50% drop in number of people becoming diabetic
We know what needs to be done - we need to do it.
We need more consistent and dependable care for people
with diabetes.
To read more,
please go to www.medicaltuesday.net/index.asp.
Similar opportunities
exist for:
Asthma, Congestive Heart Failure, Coronary Artery
Disease and Depression
Inconsistent Care
Unlinked care
Unmeasured care
Sometimes dangerous care
Date free care
We need a health care reform agenda with FOCUS on the
high opportunity diseases
Acute conditions are not
driving the big expense levels:
Cancer Care 5%
Maternity Care 4%
Chronic Care 75%
Health Care Reform Agenda:
I) Focus
II) Tools
So Let's Focus; Let's put the tools in place that are needed
to transform care.
What tools do we need?
We need data
We need to know which patients have asthma and whether they are receiving appropriate care
We need linkages between our caregivers
Care Linkage Deficiencies Abound Today (They should be unacceptable.)
So how can we get the needed tools in place?
Paper Medical Records Can Not Do The
Job
Paper Records are:
1) Incomplete
2) Unavailable
3) Illegible
4) Not interactive
5) Completely inadequate for the task at hand
Gold Standard for Electronic Information: Electronic
Medical Record (EMR)
Full Information to the caregiver at the point of care
-–
complete, interactive, real-time information and follow-up support for
patients and doctors.
Second Best Data Source
Personal Health Record
Claims payment based
Diagnosis, procedures, caregivers, prescriptions, lab test history, sequence of events
Electronically available ASAP
Health care reform should focus on reforming health
care
Three primary components of real Health Care Reform:
Focus
Tools
Health
We need a national
culture of health:
No trans-fats
Few saturated fats
Walk 5 days a week
(simple, high-leverage action steps)
We also need universal coverage –- both to save lives,
and create social equity
Most people equate universal coverage with
the Canadian single-payer system
But, most European countries with universal coverage
use a mixture of private plans and government programs.
So, what is the potential impact of a
single-payer system like Canada?
People usually cite the difference in administrative
expense between the U.S. & Canada as the most important number to
understand.
Is administrative
cost, the primary reason why Canadian health care costs are less than U.S.
health care costs?
Canadian care costs make the
difference between the U.S. and Canada.
The health care reform
efforts that have worked in the U.S. have focused on the costs of care.
We
need to refocus our overall efforts on reforming actual care.
Health Care Reform Should
Reform Health Care
www.kphealthysolutions.com/chronicConditions.do
Avivia Health from Kaiser Permanente
Healthy Solutions is your best health management solution. Our
evidence-based, scientifically rigorous program reduces health care costs, and
helps keep employees more productive, happier and healthier.
Studies show that about 20% of employees
are responsible for more than 70% of health care spending. Containing the high
cost of care is a national priority and a top priority of businesses
everywhere. Healthy Solutions helps control costs by educating members to get
maximum value from their physician visits, make informed decisions about
medical care, and avoid the need for intensive medical interventions by better
managing chronic health conditions.
www.kphealthysolutions.com/index.do
Healthy Heart
Robert Pearl, MD, Executive Director and CEO, The Permanente
Medical Group and Mary Ann Thode, President, Northern California Region, Kaiser
Foundation Health Plan and Hospitals are pleased to announce that for the first
time ever we are making our nationally recognized methods and tools for prevent
and managing heart disease available to all Californians.
The new program called Healthy Heart provides
tools and guidelines to help assess the risk of cardiovascular disease, mange
those risks, and ultimately reduce a patient's risks that can lead to death. Kaiser
Permanente's "open source" approach to the general public and
community caregivers will include:
1. Clinical
guidelines and education that we are making accessible to physicians and other
clinicians across the state.
2. Grants and consulting to community clinics and
public hospitals
3. A new Healthy Heart website for
the general public on how to prevent and manage the risks of heart disease.
Nationally, cardiovascular disease is the number one
killer in America. However, at Kaiser Permanente, our members have a 30 percent
lower risk of dying from heart disease than non-members in California. We are
very proud of this achievement, and by extending our expertise, tools and
approaches, we hope to save tens of thousands of lives over the next decade.
Our Healthy Heart initiative is consistent with our
mission to improve not only the health of our members, but to improve the
health of the communities around us.
Access only inside KP at this time: http://kpnet.kp.org/ncal/portal/.
* * * * *
2. In the News: UnitedHealth and the Ghost of Dr. McGuire
Bill McGuire was
a superstar who built a great company. Then came the options scandal. Now the
new CEO has to clean up the mess he left behind.
By Peter Elkind, Fortune editor-at-large, April 17 2007 http://money.cnn.com/magazines/fortune
[When physicians become primarily businessmen, they
act like any other businessman - —maybe worse.
Even if you're a non-Minnesota Lutheran, you wouldn't recognize Dr. Bill as a member
of your Family of Faith. With a $2 Billion scandal from sick people's money, he
still wants his $90 million retirement package? That seems to tell it all!]
(Fortune Magazine) -- No. 21) Inside the
ten-story headquarters of UnitedHealth Group, on an immaculate 25-acre campus
in a tranquil Minneapolis suburb, a new CEO, and his company, are trying to
sluice away the stink of scandal.
For 15 years UnitedHealth (Charts), now the nation's largest health insurer, was the
domain of Dr. William Wayne McGuire, a 6-foot-6, 260-pound titan of the
health-care industry. During his reign the company grew from a $600 million HMO
operator to a $70 billion colossus, generating an eye-popping average annual
return of nearly 30% for investors - better than General Electric under Jack
Welch. To read more, please go to www.medicaltuesday.net/news.asp.
But now McGuire is gone, bounced by a board that made
him a billionaire, after revelations that transformed the celebrated executive
into the public face of the stock options scandal. McGuire has been replaced by
his unassuming, handpicked deputy, Stephen Hemsley, a 54-year-old former CPA
and operations wizard who is busily trying to restore the company's battered
image and set a new tone of corporate responsibility and frugality. . .
. . . by the end of 2005, McGuire's total take for his
career as CEO had a staggering paper value of $2 billion. Hemsley's new
contract gives him zero options - and the board's grants, which made virtually
every director millions, have been cut in half.
More ugliness lies ahead: criminal and SEC
investigations, shareholder lawsuits, and the prospect of a nasty fight with
the departed CEO, in which the company may seek to recover hundreds of millions
while McGuire fights to secure a $90 million retirement package. Although
UnitedHealth remains extremely profitable, Hemsley also faces the challenge of
maintaining its stature as a highflying growth company, now that its visionary
leader has plummeted to earth. (McGuire and Hemsley declined to be interviewed
for this story.)
It's all part of the painful process of changing an
intensely personal corporate culture - one that fueled the company's ascent but
ended in flames. "A great CEO becomes dangerous over time," says
Goldman Sachs health-care analyst Matthew Borsch. "If you are incredibly
successful as CEO, you have tremendous power within the company, over the
board, and everybody's telling you that you're invincible. And then you become
the risk to the extent that your own arrogance becomes the problem."
‘'Rocket ship'
Among those who have followed the rise of
UnitedHealth, McGuire's stewardship is widely regarded as a work of genius.
"In my 30 years of being a health-care analyst, I've never seen one
executive add more value to one company than Bill McGuire," says Ken
Abramowitz, managing general partner of NGN Capital, a health-care venture
capital fund. "I covered 50 companies in the industry, and this was the
biggest rocket ship of them all."
McGuire took over as CEO of UnitedHealth in 1991, at
the age of 42, only six years after leaving private medical practice to jump
into the embryonic managed-care game. Trained as a pulmonologist, McGuire is a
cerebral, ambitious man, a collector of butterflies, wine, art, and antiques.
He rapidly proved himself that rarest of commodities: a physician with a gift
for business.
McGuire built UnitedHealth largely through a string of
acquisitions, first adding share in local markets, then doing bigger deals to
establish a national footprint. He adroitly moved the company in and out of
businesses, displaying a knack for jumping ahead of industry trends. As one
former McGuire deputy puts it, "He saw around the corner before you got to
the corner."
He had an eye for talent too, recruiting gifted
executives from outside the health-care business, including a former CEO of
Northwest Airlines. In 1997, when the company was starting to choke on its own
growth, McGuire hired Hemsley, a 23-year veteran of Arthur Andersen (he'd once
served as the firm's CFO), to make it all run smoothly. By 1999, Hemsley was
president and COO - Mr. Inside to McGuire's Mr. Outside. . .
Conscious of his industry's reputation for avarice,
McGuire wrapped UnitedHealth in the mission of transforming the American
health-care system. "He basically wanted us to change the way medicine was
practiced for the better, and do it with our power and influence," says
Dr. Lee Newcomer, the company's former chief medical officer. UnitedHealth won
praise for giving patients open access to medical specialists and focusing on
managing medical problems instead of denying coverage. "When we improve
health, we make money," McGuire declared. "When we improve health
more, we make more money."
* * * * *
3. International Medicine: Singapore - World-Class
HealthCare - Asia's Leading Medical Hub
[Singapore Medicine (www.singaporemedicine.com) had one of the larger booths at the 4th
Annual World Health Care Congress last month. Their health care system is
attracting traveling patients from all over the world, especially from the
United States, Canada and Europe. The first issue of the International Medical
Travel Journal had just been released. There are a number of world-class
medical centers developing in Bangkok (www.bangkokhospital.com/english/default.asp), Dubai (www.dhcc.ae), and in Antigua (www.zhcenter.org/custom.asp?id=188800&page=3 (www.zhcenter.org/custom.asp?id=188800&page=3)).
You may visit these premier international medical centers by attending the
World Health Care Congress as it meets in Singapore and Dubai during the course
of the next year.]
Singapore made world headlines when a team
of doctors and medical professionals successfully separated Nepalese twins,
Ganga and Jamuna, who were joined at the head, in an unprecedented operation
that lasted more than 90 hours in April 2001. This is one of many
breakthroughs in healthcare that have placed Singapore on the world
medical map.
As a leading healthcare services hub in the region, more than 400,000 (doubling
yearly) international patients come to Singapore each year for a whole range of
medical care. Some come for health screening, others for eye, heart and
brain surgeries. Yet others come for cancer treatment. Whether their
needs are basic or complex, patients find assurance in a world-class healthcare
system that emphasizes safety and pushes the boundaries of excellence. To read more, please go to www.medicaltuesday.net/intlnews.asp.
SINGAPORE is in a good position to lure
American medical travellers, the author of a new guide aimed at this market
said yesterday.
Mr Josef Woodman, author and publisher of Patients Beyond Borders, said
Singapore's strengths lie in its quality of health care and an "immediate
cultural familiarity" with the widespread use of English here.
Singapore has 11 hospitals that have been audited and certified by the Joint
Commission International (JCI), the overseas arm of the United States' largest
hospital accreditation agency.
That means it has the biggest number of JCI-accredited institutions worldwide
outside of the US. In contrast, India has five, while Thailand has two.
Mr Woodman said: "That is huge. Americans trust American
credentials." Yet Singapore is less known than India and Thailand in the
US as a destination for medical travel.
Dr Jason Yap, director of the Singapore Tourism Board's health-care services,
said: "A lot of the coverage in the American media has focused on India
and Thailand, so this book may help present Singapore as a third option that
compares very well to them."
To read more, go to www.singaporemedicine.com/.
* * * * *
4. Medicare:
Medicare Trustees Report To Force Reform Debate
Cash Flow Crunch to Compel Rethinking the Program,
Says NCPA
(WASHINGTON, D.C.) April 23, 2007 -– Deteriorating
Medicare finances will force the federal government to consider reforming the nation's
health care program for seniors, based on the just released annual report of
the Social Security and Medicare Trustees.
According to the report, Medicare is promising more in
benefits than the program has the ability to fund without an influx of outside
revenues. The estimated unfunded liability of Medicare is $34.2
trillion over the next 75 years, and $74.6 trillion looking
indefinitely into the future (see attached charts). The Medicare prescription drug program (Medicare
Part D) alone has an estimated unfunded liability of $8.4 trillion
over the next 75 years -–
nearly double that of Social Security. To read more,
please go to www.medicaltuesday.net/medicare.asp.
Today's
report triggers a provision of the 2003 Medicare Modernization Act that
requires the President to submit legislation that Congress must consider in an
expedited manner.
"Medicare and Social Security
need to be reformed," said Public Trustee Thomas R. Saving, director of
the Texas A&M University Private Enterprise Research Center and senior
fellow of the NCPA.
According to the report, the
deficits in Social Security and Medicare, will cause a steadily increasing
drain on other federal revenues. Until recently, the two programs took in
more revenue than they paid out in benefits. However:
·
By 2010, Social Security and Medicare will require almost
1 in 12 federal income tax dollars.
·
By 2020, spending
on these two programs will require more than 1
in 4.
·
By 2030, about
the midpoint of the baby boomer retirement years, Social Security and Medicare
spending will require almost 1 in every 2 income tax dollars.
·
By 2050, they
will require nearly 3
in every 4.
·
"Medicare and Social Security need to be
reformed," said Public Trustee Thomas R. Saving, director of the Texas
A&M University Private Enterprise Research Center and senior fellow of the
NCPA.
According to the report, the deficits in Social Security
and Medicare, will cause a steadily increasing drain on other federal
revenues. Until recently, the two programs took in more revenue than they
paid out in benefits. However:
By 2010, Social Security and
Medicare will require almost 1 in 12 federal income tax dollars.
•By 2020, spending on these
two programs will require more than 1 in 4.
•By 2030, about the midpoint
of the baby boomer retirement years, Social Security and Medicare spending will
require almost 1 in every 2 income tax dollars.
•By 2050, they will require
nearly 3 in every 4.
•Eventually, the deficits in
these two programs will absorb the entire federal budget.
Eventually, the deficits in these two programs will
absorb the entire federal budget.
"This means that if we are to keep our promises
to seniors, now and into the future, the federal government will have to stop
doing just about everything else," said Saving. "Alternatively,
we will have to either raise taxes or significantly cut benefits. Either option
will be very painful."
The NCPA is an
internationally known nonprofit, nonpartisan research institute with offices in
Dallas and Washington, D. C. that advocates private solutions to public policy
problems. We depend on the contributions of individuals, corporations and
foundations that share our mission. The NCPA accepts no government grants.
To read the
entire report, please go to www.ncpa.org/prs/rel/2007/20070423.html.
TRIGGERING A MEDICARE DEBATE By Matt Moore, THE WASHINGTON TIMES
Last week, the U.S. Treasury department published the
annual reports for Social Security and Medicare. The new volumes -- all 460
pages, five pounds worth -- met a so-what, ho-hum reception by both the
national media and congressional leaders.
Not
much changed since last year; what's the big deal, right?
Social
Security and Medicare are hurtling toward a cliff like lemmings... ho hum...
$70 trillion in unfunded promises... yadda yadda, whatever... disaster, death,
destruction. We've heard it all before.
But
this time, just maybe, it will turn out different. This time the president and
Congress have to do something about it. To read this entire report, please go
to http://www.washingtontimes.com/functions/print.php?StoryID=20070501-093736-3020r.
Matt
Moore is a senior policy analyst with the National Center for Policy Analysis.
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Patient Excessive Demands Must Be Handled with Sensitivity
Rosie was a smoker for more than 20 years and had a
pneumonia scar that was being followed with yearly chest x-rays. When it
appeared to be enlarging, a thoracic surgeon removed the lesion, which was
malignant. This carcinoma of her lung occurred at the relatively young age of
37. We obtained follow-up chest x-rays every three months for two years and
then suggested they be obtained every six months for another three years, until
we were assured of a five-year cure.
Rosie came unglued at waiting six months and presented
herself in three months; we obliged her with a CXR. We again re-iterated that
every six months would be more than adequate precaution but she returned every
three months fearing that the cancer may have recurred. To read more,
please go to www.medicaltuesday.net/gluttony.asp.
Her therapist could not allay her anxieties and so we
thought the most cost-effective process would be to continue to oblige her.
After the five-year cure, we suggested CXRs once every year. She said she would
go to pieces waiting that long but didn't show up until six months had passed.
She continued this pattern for several years.
When she was in last month, 15 years after the initial
cancer, it was noted that she actually missed her appointment last year. Now,
after 15 years, she's certain the cancer won't recur. Allaying her anxieties
with about twice as many chest x-rays as necessary was indeed
cost-effective. Had we not done this,
she would have sought out her primary physician or other practitioners who
would have ordered the x-rays. The cost of psychiatric care would also have
exceeded the cost she incurred. She was not educated or self-reflective. She
was not really a candidate for psychotherapy. The radiation was infinitesimal
since a chest x-ray only gives 0.6 Rroentgen
when our cancer patients may receive 6,000 rRoentgens.
Sometimes excessive costs
can be cost-effective.
* * * * *
6. Medical Myths: Most European Countries Have
Single-Payer Health Care
George C. Halvorson,
Chairman and CEO, Kaiser Foundation Health Plans and Hospitals
pointed out at the World Health Care Congress that
most people equate universal coverage with the Canadian single-payer system.
But, most European countries with universal coverage use a mixture of private
plans and government programs. To read more,
please go to www.medicaltuesday.net/myths.asp.
Medical Fact: Most
countries that have tried single-payer health care have or are evolving into a
mix that includes private health plans. It would be important for the United
States not to give up what Europeans and others are striving towards.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Is Dr Bill Going to Get His Comeuppance?
Dr. Yancy: I'm
sure glad that Dr. Bill McGuire from UnitedHealth is finally being prosecuted.
He made off with two billion dollars of our money.
Dr. Dave:
Wouldn't it be more accurate to say that he made off with $2 billion of our patient's
money and diverted it to his shareholders?
Dr. Yancy: Don't
forget that a large part of our professional fees were also diverted to himself
and his shareholders. To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Michelle: I've
always enjoyed the complementary copy of Clinical Evidence that Bill McGuire
sent out twice a year. That must have been a rather significant expense to send
a 550 page concise summary of clinical medicine to 500,000 physicians in the
USA, which was being expanded to the physicians on a more global basis.
Dr. Yancy: That
was just part of his own self-aggrandizement effort at patients' and doctors'
expense from the 40 percent reduction in our fees.
Dr. Michelle: Maybe
you're right. His name is on this book in which he wrote nothing, touting it as
the international source of the best available evidence for effective health
care.
Dr. Sam: I
hope they take him to the cleaners and make him pay every cent of that $2
billion back.
Dr. Yancy: I
hope he loses all of his assets and goes so far in the hole he will never be
able to make his mortgage payments, lose his house and have to move into a
rental.
Dr. Dave: Wouldn't
it really be justice if they made him so poor that he would have to apply for
Medicaid for his health insurance?
Dr. Yancy: Bill McGuire on welfare? Don't hold your breath.
Dr. Sam: But I
can still smile just thinking about the whole idea.
Dr. Dave: The government
has too much at stake to let the biggest proponent of managed care go down the
drain. They've been pushing for this for decades. No court could take this kind
of risk.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
From Sonoma Medicine: Medical Arts:
Capturing Beauty, By Sandra Rubin, MD
I recently met a lawyer at a figure-drawing
"marathon" who talked about balancing her analytical left-brain
activity with her drawing. The need for that kind of balance is an important
aspect of my art, too. I believe there are deep spiritual aspects to both
medicine and art that complement, enhance, and enrich each other.
As a doctor, I have witnessed and participated in
profound moments in people's lives. These experiences deepen my sense of
humanity and somehow pass through me into my art. And my art - the silent
moments of appreciating beauty in color and form and the challenge of
transforming paint, charcoal, or pastel to capture that beauty - somehow
enriches my relationships with patients. What could otherwise be routine or
mundane is never boring. To read more,
please go to www.medicaltuesday.net/voicesofmedicine.asp.
I have been drawing and painting for as long as I can
remember. During my first year of medical school, I simultaneously studied
anatomy with a cadaver and drew the nude figure. I had truly begun to
appreciate the human form.
As a child, I was told that art could be my hobby and that I should find some
other way to make my living. I do appreciate being able to support myself as a
doctor, and to afford the time and supplies needed to create art. Although I
have sold some paintings, I am glad I don't depend on that financially. The
practice of medicine has allowed me to pursue art as a passion, not as a
business.
I have studied art at community colleges and community
art centers. Here in Sonoma County I have had really wonderful teachers at
Santa Rosa Junior College, including Lisa Beernsten, Alan Azhderian, and Maury
Lapp. . .
For people who want to get started with painting or
drawing, I recommend taking a class as a way to commit to making the necessary
time. . .
I have begun to "put my work out there,"
another step in validating myself as an artist and looking for other people's
responses. I have shown at the Kaiser Diversity Art Show and at the Sebastopol
Center for the Arts. I have also donated paintings for fundraisers at Face to
Face, the Roseland Children's Health Center, and the Sonoma County Jewish
Community Agency. I have participated in Art at the Source for the past several
years, and I have a show planned at Plaza Arts in Healdsburg in March.
To view her paintings and drawings, go to www.scma.org/magazine/scp/wn07/rubin.html.
* * * * *
9.
Book Review: Redefining
Health Care -–
Creating Value-Based Competition on Results by Michael E. Porter & Elizabeth Olmsted Teisberg,
Harvard Business School Press, Boston,© 2006.
Dr. Porter presented one of the most thoughtful and
insightful Keynote Addresses at the World Health Care Congress last month.
Shortly after his presentation, the numerous available copies sold out.
Since 2001, Professor Porter has devoted considerable
attention to a fourth body of work on competition in the health care system, in
both the United States and other countries. His Harvard Business Review
article with Elizabeth Teisberg, ‘'Redefining Competition in Health Care'
(2004), stimulated a dialog in many countries. His joint book with Professor
Teisberg, Redefining Health Care: Creating Value-Based Competition on
Results (Harvard Business School Press), was published on May 25, 2006.
Professor Porter is currently playing an active role in catalyzing health care
reform in the United States and other countries, including Holland, German, and
the United Kingdom.
Porter alleges that health care in the United States
and other nations is on a collision course with patient needs and economic
reality. In today's dysfunctional competition, players strive not to create
value for patients but to capture more revenue, shift costs, and restrict
services. Competition takes place at the wrong levels and on the wrong
things-between broad line institutions, in the provision of discrete services,
and in local markets. Instead of rewarding good provider results with more
patients, administrators make costly and ineffective attempts to micromanage
care processes and second-guess provider decisions. To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
To reform health care, we must reform the nature of
competition itself. Redefining Health Care describes how all
participants-providers, health plans, employers, suppliers, consumers, and
governments can redefine their strategies, operating practices, and
organizational structures to unleash stunning improvements in the health value
delivered.
Porter and Teisberg shed new insights on:
Why decades of reform have only worsened the problem.
How physicians and provider organizations have misunderstood their true
business. Why current "solutions"- consumer-driven health care,
integrated health systems, pay-for-performance, electronic medical records,
single-payer systems - will not suffice. Why mandatory measurement and
reporting of patient results are the single most important steps in reforming
the system. Why higher-quality care should cost less. How mandatory health
insurance for all, with subsidies for low-income citizens, will actually make
the system more efficient.
Porter goes on to explain why rising costs, mounting
quality problems, and increasing numbers of citizens without health insurance are
unacceptable - —and
unsustainable.
We will plan to spend more time on this rather large
volume in the ensuing weeks and complete a more extensive review of this signal
work. To access Professor Porter's Institute for Strategy and Competitiveness site,
please go to www.isc.hbs.edu/. To
access another of his lectures, click on Singapore Competitiveness: A Nation
in Transition.
* * * * *
10. Hippocrates & His Kin: In God We Trust. All Others
Have to Bring Their Research Data.
To combat violent gangs, West Sacramento police fought back with a legal
injunction against gang members. It called for curfews and barred unnamed gang
members from gathering within a three-mile swath. The ACLU challenged and the California's
3rd District Court of Appeal struck down the injunction last week
saying it violated the due process rights of gang members. A three-judge panel
said that the police did not give members of the gang enough advance notice.
Marco Breton in Sacramento BEE replied: Yeah, sure. Gang members need plenty
of lead time. Just imagine their packed schedules: Monday - —carjacking.
Tuesday - —homicide.
Wednesday - —illegal
drug sales. They're busy people. www.sacbee.com/101/story/163061.html
Couldn't we send the gangs to some camp where they
would learn how to do suicide on Thursday?
To read more
vignettes, please go to www.medicaltuesday.net/hhk.asp.
Between the Office Visits: The office visit has been the best deal in
medicine--but that was when it lasted 15 minutes. Reduction to 10 minutes was a
bit tight. Now, Chicago University Professor Richard Epstein states he heard a
rumor that managed care office visits in California were down to 5
minutes--about 300 seconds. He suggested perhaps that was not enough time to
generate empathy and trust, but should be long enough to look into a pair of
ears or to check for a sore throat. Physicians are paid for the time they spend
with a patient; their technical training is the expensive input. Epstein holds
that their psychological insight can be duplicated by others whose hourly rate
is far less. To read more HHK, please go to www.healthcarecom.net/hhk1998.htm.
* * * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society:
•
The National Center for
Policy Analysis,
John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon
M. Herrick wrote Lives at Risk, issues
a weekly Health Policy Digest, a health summary of the full NCPA
daily report. You may log on at www.ncpa.org
and register to receive one or more of these reports. To view the current
"counting on a crises" be sure to go to www.ncpa.org/sub/dpd/index.php?Article_ID=14503.
•
Pacific Research Institute, (www.pacificresearch.org)
Sally C Pipes, President and CEO, John R Graham, Director of Health Care
Studies, publish
a monthly Health Policy Prescription newsletter, which is very timely to our
current health care situation. You may subscribe at www.pacificresearch.org/pub/hpp/index.html
or access their health page at www.pacificresearch.org/centers/hcs/index.html.
Just released: Questionable Cure for a Questionable Crises –
The Massachusetts Health Care.
•
The Mercatus Center
at George Mason University (www.mercatus.org)
is a strong advocate for accountability in government. Maurice McTigue, QSO,
a Distinguished Visiting Scholar, a former member of Parliament and cabinet
minister in New Zealand, is now director of the Mercatus Center's Government
Accountability Project. Join the Mercatus Center for Excellence in Government.
Be sure to read the 8th
Annual Performance Report Scorecard.
•
The National
Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will
have access to private sector solutions for health, financial and retirement security
and the services of insurance professionals. There are numerous important
issues listed on the opening page. Be sure to scan their professional journal,
Health Insurance Underwriters (HIU), for articles of importance in the Health
Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as
the executive editor, covers technology, legislation and product news -
everything that affects how health insurance professionals do business. Be sure
to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. To see my column, go to http://hiu.nahu.org/article.asp?article=1328&paper=0&cat=137.
•
The Galen Institute,
Grace-Marie Turner President and Founder, has
a weekly Health Policy Newsletter sent every Friday to which you may
subscribe by logging on at www.galen.org.
A new study of purchasers of Health Savings Accounts shows that the new health
care financing arrangements are appealing to those who previously were shut out
of the insurance market, to families, to older Americans, and to workers of all
income levels. Also, be sure to read that the Medicare debt is 5 times our
national debt?
•
The National Center for Policy Analysis, John C Goodman, PhD,
President, who along with Gerald L. Musgrave, and Devon
M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health
summary of the full NCPA daily
report. You may log on at www.ncpa.org and register to receive one or more of these
reports. To view the current "counting on a crises" be sure to go to www.ncpa.org/sub/dpd/index.php?Article_ID=14503.
Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham,
Director of Health Care Studies, publish a monthly Health Policy Prescription
newsletter, which is very timely to our current health care situation. You may
subscribe at www.pacificresearch.org/pub/hpp/index.html or access their health page at www.pacificresearch.org/centers/hcs/index.html. Just released: Questionable Cure for a
Questionable Crises – The Massachusetts Health Care.
The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in
government. Maurice McTigue, QSO, a
Distinguished Visiting Scholar, a former member of Parliament and cabinet
minister in New Zealand, is now director of the Mercatus Center's Government
Accountability Project. Join the Mercatus Center for Excellence in Government.
Be sure to read the 8th Annual
Performance Report Scorecard.
The National Association of
Health Underwriters, www.NAHU.org. The NAHU's Vision Statement:
Every American will have access to private sector solutions for health,
financial and retirement security and the services of insurance professionals.
There are numerous important issues listed on the opening page. Be sure to scan
their professional journal, Health Insurance Underwriters (HIU), for articles
of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler
as the executive editor, covers technology, legislation and product news -
everything that affects how health insurance professionals do business. Be sure
to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. To see my column, go to http://hiu.nahu.org/article.asp?article=1328&paper=0&cat=137.
•
To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
•
The Galen
Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every
Friday to which you may subscribe by logging on at www.galen.org. A new study of purchasers of Health Savings
Accounts shows that the new health care financing arrangements are appealing to
those who previously were shut out of the insurance market, to families, to
older Americans, and to workers of all income levels. Also, be sure to read that
the Medicare debt is 5 times our national debt?
•
Greg Scandlen, an expert in Health Savings Accounts (HSAs) has
embarked on a new mission: Consumers for Health Care Choices (CHCC). To read
the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change: Employers, insurers, providers, and the
government have all taken their turn at trying to fix American Health Care. Now
it's the Consumers turn at www.chcchoices.org/publications/cpr9.pdf.
•
The Heartland Institute,
www.heartland.org, publishes the Health Care News. Read the late Conrad
F Meier on What
is Free-Market Health Care?. You may sign up for their health care email
newsletter at www.heartland.org/Article.cfm?artId=10478.
•
The Foundation for
Economic Education, www.fee.org, has been publishing The Freeman - Ideas On
Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling,
PhD, President, and Sheldon Richman as editor. Having bound copies
of this running treatise on free-market economics for over 40 years, I still
take pleasure in the relevant articles by Leonard Read and others who have
devoted their lives to the cause of liberty. I have a patient who has read this
journal since it was a mimeographed newsletter fifty years ago. This month, be
sure to read The Myth of Health Insurance.
•
The Council for
Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as
CEO for five years, is an association of insurance companies, actuarial firms,
legislative consultants, physicians and insurance agents. Their mission is to
develop and promote free-market solutions to America's health-care challenges by
enabling a robust and competitive health insurance market that will achieve and
maintain access to affordable, high-quality health care for all Americans.
"The belief that more medical care means better medical care is deeply
entrenched . . . Our study suggests that perhaps a third of medical spending is
now devoted to services that don't appear to improve health or the quality of
care–and may even make things worse." The Council for Affordable Health
Insurance has released a new Issues & Answers explaining that universal health care proposals can
make it more difficult to access care.
•
The
Independence Institute, www.i2i.org, is a free-market think-tank in Golden,
Colorado, that has a Health Care Policy Center, with Linda Gorman as
Director. Be sure to sign up for the monthly Health Care Policy Center
Newsletter at www.i2i.org/healthcarecenter.aspx. Read her latest newsletter at www.i2i.org/main/page.php?page_id=9.
•
Martin Masse, Director of Publications at
the Montreal Economic Institute, is the publisher of the webzine: Le
Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of
which will allow you to brush up on your French. You may also register to
receive copies of their webzine on a regular basis. This month, read Jasmin
Guénette's editorial on SMOKING
IS HEALTHIER THAN FACISM.
•
The
Fraser Institute, an independent public policy organization,
focuses on the role competitive markets play in providing for the economic and
social well being of all Canadians. Canadians celebrated Tax Freedom Day on
June 28, the date they stopped paying taxes and started working for themselves.
Log on at www.fraserinstitute.ca for an overview of the extensive research
articles that are available. You may want to go directly to their health
research section at www.fraserinstitute.ca/health/index.asp?snav=he. This month, be sure to read The Misguided War Against Medicines.
•
The
Heritage Foundation, www.heritage.org/, founded in 1973, is a research and
educational institute whose mission is to formulate and promote public policies
based on the principles of free enterprise, limited government, individual
freedom, traditional American values and a strong national defense. The Center
for Health Policy Studies supports and does extensive research on health
care policy that is readily available at their site. This month, read an important
essay on World Wide Freedom.
•
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. Please log on
at www.mises.org to obtain the foundation's daily reports.
This month be sure to read Can the State Reduce Poverty at www.mises.org/story/2526. You may also log on to Lew's premier
free-market site at www.lewrockwell.com to read some of his lectures to medical
groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to
be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
•
CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane,
with Charles Koch of Koch Industries. It is a nonprofit public policy research
foundation headquartered in Washington, D.C. The Institute is named for Cato's
Letters, a series of pamphlets that helped lay the philosophical foundation for
the American Revolution. The Mission: The Cato Institute seeks to broaden the
parameters of public policy debate to allow consideration of the traditional
American principles of limited government, individual liberty, free markets and
peace. Ed Crane reminds us that the framers of the Constitution designed to
protect our liberty through a system of federalism and divided powers so that
most of the governance would be at the state level where abuse of power would
be limited by the citizens' ability to choose among 13 (and now 50) different systems
of state government. Thus, we could all seek our favorite moral turpitude and
live in our comfort zone recognizing our differences and still be proud of our
unity as Americans. Michael F. Cannon is the Cato Institute's Director of
Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. This month, be sure to read about "Why we're living longer, healthier, more comfortable
lives on a cleaner planet."
•
The Ethan
Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar
but independent state organizations associated with the State Policy Network
(SPN). The mission is to put into practice the fundamentals of a free society:
individual liberty, private property, competitive free enterprise, limited and
frugal government, strong local communities, personal responsibility, and
expanded opportunity for human endeavor.
•
The Free State Project, with a goal of Liberty in Our
Lifetime, http://freestateproject.org/, is an
agreement among 20,000
pro-liberty activists to move to New
Hampshire, where
they will exert the fullest practical effort toward the creation of a society in
which the maximum role of government is the protection of life, liberty, and
property. The success of the Project would likely entail reductions in taxation
and regulation, reforms at all levels of government to expand individual rights
and free markets, and a restoration of constitutional federalism, demonstrating
the benefits of liberty to the rest of the nation and the world. [It is indeed
a tragedy that the burden of government in the U.S., a freedom society for its
first 150 years, is so great that people want to escape to a state solely for
the purpose of reducing that oppression. We hope this gives each of us an
impetus to restore freedom from government intrusion in our own state.]
•
The St.
Croix Review, a bimonthly journal of ideas, recognizes
that the world is very dangerous. Conservatives are staunch defenders of the
homeland. But as Russell Kirk believed, war time allows the federal government
grow at a frightful pace. We expect government to win the wars we engage, and
we expect that our borders be guarded. But St Croix feels the impulses of the
Administration and Congress are often misguided. The politicians of both
parties in Washington overreach so that we see with disgust the explosion of
earmarks and perpetually increasing spending on programs that have nothing to
do with winning the war. There is too much power given to Washington. Even
in war time we have to push for limited government—while giving the government
the necessary tools to win the war. To read a variety of articles in this arena,
please go to www.stcroixreview.com.
•
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. While schools throughout the nation are
bowing to an unconstitutional federal mandate that schools must adopt a
Constitution Day curriculum each September 17th or lose federal
funds, Hillsdale students take a semester-long course on the Constitution
restoring civics education and developing a civics textbook, a Constitution Reader.
You may log on at www.hillsdale.edu to register for the annual weeklong von
Mises Seminars, held every February, or their famous Shavano Institute. You may
join them to explore the Roots of American Republicanism on a British Isles
cruise on July 10-21, 2006. Congratulations to Hillsdale for its national
rankings in the USNews College rankings. Changes in the Carnegie
classifications, along with Hillsdale's continuing rise to national prominence,
prompted the Foundation to move the College from the regional to the national
liberal arts college classification. Read President Arnn's comments at www.hillsdale.edu/arnn/usnews.asp. Also, read his comments on Ronald
Reagan, RIP, at www.hillsdale.edu/newimprimis/default.htm. Please log on and register to receive Imprimis,
their national speech digest that reaches more than one million readers each
month. This month, read Rev. Robert A. Sirico Socialism, Free Enterprise, and
the Common Good at www.hillsdale.edu/imprimis/2007/05/. The last ten years of Imprimis
are archived at www.hillsdale.edu/imprimis/archives.htm.
* * * * *
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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 your
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Please note
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Del Meyer
Del Meyer,
MD, Editor & Founder
DelMeyer@MedicalTuesday.net
6620 Coyle Ave, Ste 122, Carmichael, CA 95608
Words of Wisdom
Mark Twain: Suppose your were an idiot. And suppose
you were a member of Congress. But, I repeat myself.
Frederic Bastiat: Government is the great fiction, through
which everybody endeavors to live at the expense of everybody else.
Peter Drucker: Price of success in the Knowledge
Society. The upward mobility of the knowledge society comes at a high
price: the psychological pressures and emotional traumas of the rat race. There
can be winners only if there are losers. This was not true of earlier
societies. Japanese youngsters suffer sleep deprivation because they spend
their evenings at a crammer to help them pass their exams. Otherwise they will
not get into the prestige university of their choice, and thus into a good job.
Other countries, such as America, Britain, and France, are also allowing their
schools to become viciously competitive. That this happened over such a short
time - —no
more than thirty or forty years - —indicates how
much the fear of failure has already permeated the knowledge society. Given
this competitive struggle, a growing number of high successful knowledge
workers - —business
managers, university teachers, museum directors, doctors - —"plateau"
in their forties. If their work is all they have, they are in trouble.
Knowledge workers therefore need to
develop some serious satisfying outside interests.
Some Recent Postings
AMERICA ALONE, The End of the World as we Know It, by Mark Steyn www.delmeyer.net/bkrev_AmericaAlone.htm
WHO REALLY CARES - America's Charity Divide Who Gives, Who Doesn't,
and Why It Matters by Arthur C. Brooks
www.delmeyer.net/bkrev_WhoReallyCares.htm
AriadneCapital: The new rules of engagement are being written now by
strong feminine women who are doing amazing things. Some of us will write that
code. Others will merely read it. Still others will be trying to upgrade their
mental software frantically to interpret the writing on the screen. This is not
going to be easy. Women are demanding to make their unique contribution - each of
them - in the world. And they want men who are gentlemen in their lives - who
are strong enough to be happy that they have amazing women to treat well. If
you'll forgive a little nepotism, read what the CEO of Ariadne says at www.ariadnecapital.com/journal/v6e2/house_of_ariadne/article_smart_money_is_on_women.htm.
HPUSA April 2007 Newsletter: www.healthplanusa.net/April07.htm
HPUSA January 2007 Newsletter: www.healthplanusa.net/January07.htm
In Memoriam
Joseph Schumpeter: In praise of entrepreneurs, Apr 26th 2007, From The
Economist
The biography of
a man who believed that uproar was the music of capitalism.
MUCH honoured as an economic
prophet, Joseph Schumpeter has had to wait half a century after his death for
this splendid full-dress biography covering his ideas, life and times. In 1983 Forbes
pronounced him a better guide to the tumultuous world economy than John
Maynard Keynes. In 1986 J.K. Galbraith described him as "the most
sophisticated conservative of this century". In 2000 Business Week
ran an article about him to which it gave the title "America's hottest
economist died fifty years ago". There are Schumpeter lectures, Schumpeter
societies and Schumpeter prizes.
Now he has received yet another
accolade: a fat, learned biography by Thomas McCraw, one of America's most
respected business historians, the author of a Pulitzer prize-winning history
of the rise of regulation. He has found the perfect subject in Schumpeter. He
succeeds in getting inside the economist's head, explaining not just what he
thought but why he thought it. Beyond this, he also succeeds in painting a
portrait of his times. Fin de siècle Vienna, Weimar Germany, Harvard
University (where he is seen in our photograph) before and after the first
world war: all come to life on these pages. . . To read more, please scroll down at www.medicaltuesday.net/org.asp.
By his mid-50s he had lived in
nine cities and five countries. He was Austria's finance minister for a time,
and witnessed the collapse of the Habsburg Empire from close quarters. He
taught in Germany when it was succumbing to the Nazi temptation. He was one of
the first of the great European émigrés to the United States. Daniel Bell, a
liberal sociologist, described him as that rarest of creatures: an economist
with a tragic sense of life.
Schumpeter is best remembered
today for "Capitalism, Socialism and Democracy", published in 1942.
This was a firecracker of a book that challenged wartime conventional wisdom on
every front: praising giant companies as the engines of progress; giving
warning of the rise of a "new class" of anti-capitalist government
employees; worrying that risk-aversion might lead to the triumph of socialism.
To read the entire review, go to www.economist.com/books/displaystory.cfm?story_id=9070610.
On
This Date in History -– May 8
Today is World Red Cross Day, observed on the
anniversary of the birth of Jan Henri Dunant, founder of the Red Cross, in 1828
in Geneva, Switzerland. Dunant, the co-winner of the first Nobel Peace Prize,
helped make sure that mercy became an international language.
Today is VE Day. On this date in 1945, the World War
in Europe stopped. World War II began on that continent, almost six years
earlier; it still continued for a while in Asia; but the greatest bulk of the
conflict was over. Today, however, peace has become relative.
On this date in 1884, Harry S. Truman, President of
the United States, was born in Lamar, Missouri. He became President on April
12, 1945, when Franklin D. Roosevelt had died, and the War in Europe ended on
this, his 61st birthday. People
have disagreed about Truman's role in history, although generally he received
quite high marks. But there is no disagreement about the fact that Harry Truman
was the author and the exemplar of the tersest description ever given of the
Presidency of the United States: "The buck stops here."
After Leonard and Thelma
Spinrad
MOVIE EXPLAINING
SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements'
strategy is to release the documentary this summer on the same day that Michael
Moore's pro-socialized medicine movie "Sicko" is released. This
movie can only be made in time if Clements finds 200 doctors willing to make a
tax-deductible donation of $5K each by the end of March. Clements is also
seeking American doctors willing to perform operations for Canadians on wait
lists. 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.