MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IV, No 15,
3rd Annual World Health Care Congress, co-sponsored by The Wall
Street Journal, is the most prestigious meeting of chief and senior executives
from all sectors of health care. Renowned authorities and practitioners
assemble to present recent results and to develop innovative strategies that
foster the creation of a cost-effective and accountable
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1. Featured Article: Social Security and the Insurance Illusion by Will Wilkinson
In 1937, shortly after Franklin Roosevelt threatened to destroy the independence of the Supreme Court by “packing” it with ideological cronies, the Court came to heel and handed down verdicts in three cases affirming that the Social Security Act was, unlike several structurally similar pieces of pre-intimidation New Deal legislation, in accord with the U.S. Constitution.
Wilbur Cohen, a ubiquitous figure in the history of Social Security, provides a window into the administration’s state of mind on the Court’s momentous decision. At the time of the ruling Cohen was an assistant to Social Security board chairman Robert Altmeyer and recalls gliding down the Supreme Court steps that day “in a glow of ecstasy. . . . When I got back to the office I received Mr. Altmeyer’s approval to send out a memo to the staff stating that because of the decision, we could now call the old age benefits program ‘old age insurance.’
Why? Because insurance sounds a lot better to
voters than a tax and stream of welfare payments, which is what Social Security
is. Because, as Cohen explained it, “The American public was and still is
insurance-minded and opposed to welfare, the ‘dole’ and ‘handouts.’ ”The Brain
Trust knew about the importance of “framing” decades before
The irony, or hypocrisy, of Cohen’s ecstatic rush to reframe is that, executive intimidation aside, the government won the Social Security Act cases by arguing that Social Security is not insurance, but just a plain old tax on wages, falling under Congress’s taxing power, and an entirely separate and unconnected welfare program, falling under the “general welfare” provision. The Act was scrupulously drafted to ensure that the tax and the government transfers would not appear to have anything to do with each other. And the program is never described therein as “insurance.” The 1960 Flemming v. Nestor decision reaffirms that paying the tax creates no entitlement to benefits.
Nevertheless, FDR pushed hard for a dedicated payroll tax specifically so it would be connected in voters’ minds to their benefits in the way the premiums are connected to insurance payments—to create the illusion of property, contract, and legal, moral, and political entitlement. As FDR infamously declared, the dedicated payroll taxes “are political all the way through. We put those payroll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions . . .With those taxes in there, no damn politician can ever scrap my social security program.”
In anticipation of a constitutional challenge, Social Security officials went out of their way to purge their informational materials of insurance language. A 1937 pamphlet, written shortly before the Supreme Court decisions, described the program accurately and with a minimum of manipulative art: “The United States Government will send checks every month to retired workers . . . under the old-age benefits plan . . .The same law that provides these benefits for you and other workers sets up certain new taxes to be paid to the United States government.”
The 1938 pamphlet, published after the decisions, shows the insurance-framing project once again in full flower: “Your [Social Security] card shows that you have an insurance account with the U.S. Government—Federal old age and survivors insurance. This is a national insurance plan for all workers in commerce and industry . . . [T]axes are like the premium on any other kind of insurance.”
the program’s inception the lack of a legally binding entitlement to benefits
was deliberately obscured. By framing the program as insurance, it was possible
to make benefits seem earned rather than part of a socially stigmatized “dole.”
Accordingly, during “fireside chats” and public speeches,
Abe asks, “How many legs does a cow have?”
The bemused reply: “Four.”
“If we also call its tail a ‘leg’ how many legs does it have?”
“No, calling a tail a ‘leg’ doesn’t make it a leg!”
Nor does calling Social Security “insurance” make it insurance. Nevertheless, “To challenge the insurance analogy or resist using the terms,” writes Social Security scholar Martha Derthick, “was to show oneself an enemy of the program.” And this continues to be true today. Jonathan Chait of The New Republic writes, “Privatizers portray Social Security as a kind of low-performing 401(k) plan. But the program was never intended as a personal retirement plan. It’s a form of social insurance, designed to spread risks throughout the population.” But is it really? Is Social Security a leg because we call it a leg? Let us challenge the insurance analogy and risk showing ourselves as enemies of the program.
To read the entire article, including substantiating references, please go to www.fee.org/pdf/the-freeman/0905Wilkinson.pdf.
Government is the great fiction, through which everybody endeavors to live at the expense of everybody else.
-- Frederic Bastiat, French Economist (1801-1850)
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A Deadly Race With Bird Flu by Dr Charles Krauthammer, Columnist
WASHINGTON — While official Washington has been poring over Harriet Miers’ long-ago doings on the Dallas City Council and parsing the Byzantine comings and goings of the Fitzgerald grand jury, relatively unnoticed was perhaps the most momentous event of our lifetime — what is left of it, as I shall explain. It was announced last week that American scientists have just created a living, killing copy of the 1918 “Spanish” flu.
This is big. Very big.
First, it is a scientific achievement of staggering proportions. The Spanish flu has not been seen on this blue planet for 85 years. Its re-creation is a story of enterprise, ingenuity, serendipity, hard work and sheer brilliance. It involves finding deep in the bowels of a military hospital in Washington a couple of tissue samples from the lungs of soldiers who died in 1918 (in an autopsy collection first ordered into existence by Abraham Lincoln), and the disinterment of an Alaskan Eskimo who died of the flu and whose remains had been preserved by the permafrost.
Then, using slicing and dicing
techniques only Michael Crichton could imagine, they pulled off a
Which brings us to the second element
of this story: Beyond the brilliance lies the sheer terror. We have quite
literally brought back to life an agent of near-biblical destruction. It killed
more people in six months than were killed in the four years of the First World
War. It killed more humans than any other disease of similar duration in the
history of the world, says Alfred W. Crosby, who wrote a history of the 1918
pandemic. And, notes The New Scientist, when the re-created virus was given to
mice in heavily quarantined laboratories in
Now that I have your attention, consider, with appropriate trepidation, the third element of this story: What to do with this knowledge? Not only has the virus been physically re-created. But its entire genome has now been published for the whole world, good people and very bad, to see. The decision to publish was a very close and terrifying call.
On the one hand, we need the knowledge
disseminated. We’ve learned from this research that the 1918 flu was bird flu,
“the most bird-like of all mammalian flu viruses,” says Jeffery Taubenberger,
lead researcher in unraveling the genome. There is a bird flu epidemic right now
We are essentially in a life-and-death race with the bird flu. Can we figure out how to pre-empt it before it figures out how to evolve into a transmittable form with 1918 lethality that will decimate humanity? To run that race we need the genetic sequence universally known — not just to inform and guide but to galvanize new research.
On the other hand, resurrection of the virus and publication of its structure opens the gates of hell. Anybody, bad guys included, can now create it. . . .
One batch of 1918 flu has the capacity
for mass destruction that no Bond villain could ever dream of. Why try to steal
loose nukes in
We might have just given it to our enemies.
Have a nice day.
Charles Krauthammer’s column appears Monday on editorial pages of The Times. His e-mail address is email@example.com.
To read the entire column, please go to http://seattletimes.nwsource.com/html/opinion/2002565356_krauthammer17.html.
Use It to Fight the Flu. By David Dobbs, Medical
More than 10 million older Americans traveled last year, often in lousy weather, to stand in long lines and get poked in the arm with a flu shot. They made the trip in response to recommendations by the federal government that gave priority for flu vaccines to the elderly and the ailing. This, it turns out, is probably a bad idea. A Harvard study published last week adds to mounting evidence that the best way to ward off the flu’s ravages is to target transmission (meaning a disease’s main carriers, which in this case are kids) rather than risk (meaning the population at risk of death or serious illness, which with the flu is the old, the ailing, and infants). All signs are that giving children quick, painless nasal-spray vaccines while they’re already gathered at school could spare the elderly from standing in long lines for flu shots—and better protect them and everyone else.
The 60,000 deaths in the
Here’s why it makes sense to set up a better system based on vaccinating kids instead of the sick and the old. Because the human immune system weakens with age, only 28 percent of elderly people who get vaccinated develop immunity. The low rate of protection means that 84 percent of all elderly (the 72 percent whose vaccinations don’t take, along with those who don’t get vaccinated) remain prey to a flu virus that runs otherwise largely unchecked.
This vulnerability, combined with the aging of the population, has caused the nation’s overall flu death rate to rise 400 percent even as we vaccinate more of the elderly. (Click here for more numbers.) The Harvard study published last week, meanwhile, demonstrates why it makes more sense to vaccinate kids. The researchers confirmed that the flu spreads primarily via toddlers and school children, whose immature immune systems are easily infected and who have lousy hygiene. Kids often don’t wipe their noses, wash their hands, or cover their mouths when they sneeze or cough, and they touch everything. That’s why they catch the flu twice as often as and much earlier in the season than older people do. For an airborne virus, kids are the conduit of choice.
Fortunately, though, kids are also the
conduit most easily blocked. Their immune systems respond wonderfully to flu
vaccine. A whopping 90 percent are successfully immunized by a flu shot,
compared to the 28 percent figure for the elderly and 60 percent for
middle-aged adults. Kids’ 90 percent success rate has been used to set up viral
roadblocks high and wide enough to increase protection for whole populations.
In the late 1960s, for instance,
Establishing a national child-based
flu-vaccination system would also create an asset we lack—a simple, familiar,
and effective way to distribute and administer vaccines or antivirals if a flu
pandemic strikes. The recent analysis of the 1918 flu’s genetic code greatly
increases virologists’ chances of developing a vaccine or antiviral drug that
could check a pandemic arising from the avian flu now brewing in
In the mid-1970s, only 25 percent of
the country’s elderly were vaccinated; the current rate is 65 percent. Yet over
that same period, total
Vaccination Is The Medical Sacrament Corresponding To Baptism
--Samuel Butler (1835-1902) English author, Samuel Butler’s Notebooks (1951)
To see the global spread of bird flu, see these URLs:
How bird flu has spread: http://news.bbc.co.uk/1/shared/spl/hi/world/05/bird_flu_map/html/1.stm
Health risks from bird flu: http://news.bbc.co.uk/1/hi/health/4377648.stm
1918 killer flu ‘came from birds:’ http://news.bbc.co.uk/1/hi/health/4308872.stm
The bird flu that killed 40 million: http://news.bbc.co.uk/1/hi/health/4350050.stm
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Dr John Eck Chronicles the
Event That Will Result in Bringing a New Concept in Health Care to the
One afternoon ten years ago I was confronted with a medical dilemma. A sixty-year-old unemployed nuclear physicist presented in my office with sharp abdominal pain. I could see in his eyes that the pain was also associated with considerable fear and a sense of desperation. You see, he had entered into that most vulnerable world of the uninsured, unemployed, with home ownership. As an older male with assets, he could not qualify for welfare, nor would Medicare be of assistance. His company had left him exposed without medical benefits at the very time in his life when he needed them the most.
The fear etched on his face was well founded. While his diagnosis was fairly benign involving bilateral inguinal hernias and a peptic ulcer, the cost of such care became the real issue. I naively suggested that he call different hospitals to get a quote of what a hernia repair would cost. After much calling, being placed on hold, being told that the cost depended on which insurance he had, etc; He was finally given a figure of $14,000, not including surgeon’s fee or anesthesia.
his head bowed, and with resignation he assumed the worst. The total bill would
come to $20,000, requiring a lean on his house and a mortgage he could not
afford. Looking for a cure for this economic dilemma became more of a challenge
than the surgery! It occurred to me that I had just spent some time in a
mission hospital in
He returned . . . a month later, with a tan and very relaxed. The surgery had gone well. The ulcer had been treated, and he had spent 4 extra weeks in a resort recuperating and catching some sun. The total cost had been $2,400 including air fare. He was pleased and I was elated. I had found a possible solution to caring for the uninsured. However, before I could send my next patient down, I received a letter from the hospital surgeons requesting that I no longer plan such referrals. They had the impression that American doctors could still be sued in the states for work done overseas! While I thought that they were probably overreacting. I stopped. The idea stuck, however!
To read the entire address, as well as peruse a number of other heart warming health care studies, please go to www.zhcenter.org/newsletter.asp?id=188800&page=1.
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Medicare Reform: Pharmacy Benefit Program—What Must Be Done – A Clinician’s Point of View by
The varying estimates on the Medicare Pharmacy Benefit Program only reveal the hazards of projecting any entitlement program. Once implemented, all government programs increase and the costs are nearly impossible to control. The additional costs to the Medicare Program are not sustainable—even in the short term. Therefore, it is urgent that the program be modified before enrollment starts in a few months.
When Medicare was implemented in 1965, there was a nominal deductible on hospital and outpatient benefits, with an additional copayment of 20 percent for all physician and outpatient services. Had the deductibles and the copayment remained a responsibility of the patient, Medicare would not have experienced a spiral increase, as is the case today. For instance, if every $80 doctor’s office visit required a 20 percent or $16 copayment, only necessary office visits would be made. The copayment, a market restraint, would control utilization and thus costs. Oversight programs to watch and control every Medicare expense would not be necessary. External controls are never patient sensitive; while they reduce one patient’s excessive costs, they also eliminate another patient’s critical test for diagnosis or treatment.
Unfortunately, the insurance industry came to the “rescue” and provided coverage for the deductibles and copayment. This totally removed Medicare from the Medical MarketPlace environment. When patients pay for expensive health care with taxpayers’ dollars, there is no longer a disincentive to overuse. The lack of market-based discipline increases utilization dramatically and costs continue to spiral upwards.
The increase in cost includes the additional amount needed to pay the Medicare or Medicare-HMO nurse to review the records and report her findings to her supervisor. It also includes the supervisor’s salary, as well as the government bureaucrat’s who receive the data. If the doctor is paid $100 an hour for delivering the medical care, and the “policing” nurse is paid $30 an hour to evaluate and report that care (with every level of oversight at a probable higher cost), the increase is at least 30 percent if the RN and the team spend as much time reviewing the clinical record as the doctor spends in developing the clinical record. The market environment eliminates this increased cost.
But demands for expensive x-ray and laboratory testing, which were relatively free, exceeded a physician’s ability to modify patients’ avaricious appetite. Controls were placed on spending with some services being denied while others were curtailed. Patients threatened to report physicians to Medicare, and actually were encouraged to do so, if they felt they were not receiving the testing they desired. In Congress, a constituent’s desire is presumed to be a dire medical need. Thus, even the imposed controls were difficult to enforce.
If patients were required to pay the 20 percent copayment of all outpatient health care, the initial design of the Medicare law, they would evaluate every physician office visit, laboratory test, x-ray, CT, MRI, emergency room visit, urgent care visit and consultation on a cost-benefit basis. They would decide whether it was worth the 20 percent of an $80 office call to obtain their doctor’s opinion on a sneeze. They would also openly discuss with their physician whether it was worth 20 percent of a $170 chemistry panel, 20 percent of a $120 x-ray, 20 percent of a $300 CT scan, 20 percent of a $900 MRI, 20 percent of every $600 emergency room visit, or 20 percent of every $200 consultation for the additional information they could reasonably expect to obtain. (These estimates are based on data provided by patients or their HMOs.) This is the essence of consumer- or patient-driven health care in which the patient seeks the best cost-effective health care in consultation with his or her doctor.
So, how do we move forward to a point where we’ve previously been - at the inception of Medicare in 1965? By utilizing the Pharmacy Benefit fiasco as the carrot. All Medicare recipients that give up their MediGap insurance and thus pay for their own deductibles and copayments, would receive an unlimited pharmacy benefit at a 30 percent copayment. This would be self-policing by the Medical MarketPlace. Suppose a patient has a high cholesterol level. The physician then discusses the ways of reducing it. Many patients have not seriously considered low cholesterol and low fat diets or inexpensive Niacin, as long as the Statin drugs (Lipitor, Zocor, and others) are free. (Fixed copayments of $5 to $50 are irrelevant in restoring market restraint.) As pharmacy restrictions were imposed, patients demanded that their physicians write letters on their behalf illustrating how their circumstances were unique and that generic drugs never work for them. It takes additional physician and office personnel time to work out the variances in MediGap or Medicare-HMO coverage, as well as patient desires.
However, with a 30 percent insurance copayment plan, the cost savings would be large. It would streamline not only physician office time but also pharmacy time, and it would improve patient satisfaction. The physician would simply write the prescription. The patient would deal directly with the pharmacist concerning the desirability of the proprietary or the generic brand. The patient makes his decision immediately and does not have to wait or return to the pharmacy after the pharmacist and doctor discuss the various Medicare-HMO coverage options for that particular plan, which cannot be ascertained until the patient’s coverage card is entered into the HMO network. These market-based decisions also eliminate any Medicare oversight for pharmacy benefits.
So how does this market-based, cost-containment oversight occur? Why wouldn’t everyone obtain the expensive proprietary drugs? To read the entire OpEd piece, please to go to www.delmeyer.net/hmc2005.htm.
In Summary: Reinstate the annual deductibles and the 20 percent copayment for all outpatient Medicare benefits. Eliminate Medicare-HMO or MediGap insurance for those beneficiaries that desire a pharmaceutical benefit at 30 percent copayment. (Since many Medicare-HMOs are leaving certain geographic areas, this should be politically possible to implement.) Cancel the current Medicare Drug Benefit Program before it’s implemented in 2006 and over the next decade save the $720 billion (or $1.2 trillion by other projections). This will save Medicare for our grandchildren also.
To review some of the other Hippocrates Columns, please go to www.healthcarecom.net/hhkintro.htm.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Ms Maggie is a delightful elderly lady who is succumbing to her lifelong cigarette habit. Over the past decade, she became increasingly short of breath. She has been on continuous oxygen for about five years. When she comes in on oxygen, her arterial oxygen saturation is in the range of 80 percent. (The hemoglobin is normally about 97 percent saturated with oxygen as it leaves the lungs and returns back to the heart and lungs at 75 percent saturation.) When we take the oxygen off for 15 minutes, the hemoglobin oxygen saturation falls to 72 percent, appearing bluer than the venous blood in the normal individual.
One day, her family asked us to write a durable medical equipment prescription (DME) for an electric wheelchair. She normally came in with her usual wheelchair, pushed by her granddaughter. After discussing her ability to drive a motorized wheelchair, we decided that it would be hazardous for her in her weakened and frail condition to drive an approximate 300-400 pound powered vehicle.
So I was surprised when she came in last week in a brand new $5,000 electric wheelchair, about the size of a golf cart. She had great difficulty navigating it. The Para-Transit driver had to help her drive it into my office. It would barely fit through my doors and hallways. After the visit, Para-Transit could not come for an hour. So she had her family pick her up and asked Para-Transit to pick up her motorized wheelchair from our office after the weekend.
She was very evasive as to where she obtained the motorized vehicle and who authorized it. A former home health aid confidentially mentioned to me that many in the home health agency feel that doctors are too concerned about health care costs and just don’t understand the dire needs of their patients. So, it would seem that home care workers manipulate the system to sell DME items, and unless there is a detailed audit, no one will ever understand this diversion of taxpayer’s funds.
It is unfortunate that the physician, who holds the
key to reducing health care costs, has been maligned as the person responsible
for hugely expanding health care costs. Conservative estimates indicate that
the cost of controlling physicians who write health care orders exceeds 10
percent of all health care costs, or about $175 billion. If we eliminate this
bureaucracy, and place health care in a market environment, where the minimum
copayment on the expensive items is 10 percent with a progressively greater
copayment on outpatient health care, the
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The editor of Superfactory, www.superfactory.com/, who features Lean Manufacturing and favors us with
articles on Lean HealthCare, tells about his interface with health care in
To review his blog on Lean Healthcare & Clinical Excellence and my response, please go to http://superfactory.typepad.com/blog/2005/10/lean_healthcare.html.
Medical Reality: Health Care in the
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Dr Patricia: Smoking cessation was proposed as a
mandate for insurance coverage in
Dr Michelle: As the country is moving towards making
health insurance more like real insurance to cover costly and catastrophic
items that we would not be able to pay for should they occur to us, such as
hospitalizations, heart attacks, strokes, or major operations, the people that
should really know better are pushing for more and more mandates.
Dr Patricia: Cigarette withdrawal programs do not have a huge success rate. And without any personal financial commitment, the success rate would be even less. I remember when I had a smoking cessation clinic; one of my patients told me she wouldn’t come because I was too serious about patients stopping smoking. She was going to the Smoke Enders Clinic where you didn’t have to stop smoking.
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if tree bark were being studied for cures for cancer and paralysis, and it was
found that green tree bark had already yielded 100 cures and productive uses.
Blue tree bark yielded no cures or good uses, but instead led to dangerous
tumors in research mice. Where would you put your future research dollars?
What if the private research sector has already abandoned blue tree bark research, but there was a politician who endorsed a plan to issue bonds to borrow $300 million to continue to study blue tree bark, promising that the money will be paid off in the dollars earned from future cures. Would you vote for him? Is that a wise use of tax dollars?
While smart money is going for the green tree bark why would any public official push for money to research blue tree bark?
Now let’s get real. Non-embryonic or “adult” stem-cell research has already yielded 65 known uses and cures, while embryonic stem-cell research has yielded none, nada, zilch. In fact, when researchers have attempted to harness the growth of embryonic stem cells, they have failed, and 30 percent of the attempts in mice have led to dangerous tumors.
Yet Jon Corzine, candidate for governor, is pushing the plan to borrow $300 million to fund more embryonic stem-cell research. What is he thinking? This is money the taxpayers will have to pay back — and money that will not likely result in any return on investment.
Jon Corzine has put his weight behind embryonic stem cells. Has he personally researched this issue, or is he is responding to the hype of the media and the relentless push for the controversial and dangerous use of embryos? We need to ask him.
I recently returned from backpacking
solo down the
Perhaps I was a little defensive as I composed in my journal a list of 10 reasons why a rational man would persist in hiking alone on an unfamiliar trail. It was a good list. But on my third day, surrounded by beautiful undiscovered wilderness, I threw away my list and wrote, “All those reasons are just earnest blabber. You don’t really know why you do this until you do it. And then you REMEMBER.”
How do you describe the memory of a place you’ve never been before? Where in our neuronal circuitry does a new experience register itself as familiar? I don’t know. And if I did once know the molecular neurochemistry of memory, I’ve since forgotten it. I am among a generation of aging baby boomers about to enter its seventh decade. Enjoying unprecedented longevity, we are also hip to the prospect of living long enough to forget who we are. Is this what we asked for?
Alzheimer’s disease, the most common form of dementia, now affects over 4 million Americans, a number projected to double in the next 20 years. There is no cure. There is little effective treatment. We know the pathology, but we don’t know its cause. We don’t know if Alzheimer’s is preventable or if it’s an inexorable consequence of aging among those at genetic risk.
The mystery of memory goes far beyond the pathology of dementia. To paraphrase Buddha, “All that we are is the result of what we have thought.” For our conscious selves, his insight might be amended to, “All that we are is what we remember . . ."
When I was backpacking, I seemed to “remember” the surrounding wilderness, even though I had never seen it. I’ll stand by the validity of that memory but remain helpless to explain it. T.S. Eliot, in the last of his Four Quartets, offers a poetic glimpse far more eloquent than any explanation I can imagine:
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
To read the entire article, please go to www.scma.org/magazine/scp/Fall05/flinders.html.
Dr. Flinders, who serves on the SCMA editorial board, has taught full-time in Sutter’s Family Practice Residency Program for the past 20 years.
Nine tips guide you to appropriate, affordable personal insurance policies.
personal insurance needs are unique to your chosen profession—and they’re
probably changing right before your eyes. But you may not even be aware of it.
Here’s what you need to know today to make sure you’re adequately covered. —Russell
1 GET STATE-OF-THE-ART HEALTH INSURANCE.
2 SHOP AROUND FOR CAR WARRANTIES.
3 CHECK OUT MULTIPOLICY DISCOUNTS.
4 BE SURE TO TAP
5 DON’T CARRY EXCESS LIFE OR DISABILITY COVERAGE.
6 DON’T CARRY TOO LITTLE DISABILITY—IF YOU’RE YOUNGER.
7 INVEST IN LONG-TERM CARE COVERAGE.
8 PROTECT YOURSELF WITH AN UMBRELLA.
9 LET A PROFESSIONAL DO THE HEAVY LIFTING.
The same way you
send a patient to a specialist for specific medical needs, you should consult
with an insurance specialist to help with asset protection. “You really need
the advice of a professional,”
To read any of the nine topics, please go to www.socalphys.com/site/aug05/medical_world.pdf.
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9. Book Review: HEALTHY COMPETITION - What’s Holding Back Health Care and How to Free it by Michael F Cannon & Michael D Tanner, Cato Institute Washington, DC © 2005, ISBN 1-930865-81-3, 173 pp, $10.
Part I: The State of
critics of free markets conclude
many measures, the
should come as no surprise, then, that patients all over the world seeking
advanced medical care come to the
is important first to refine the critique by examining the first part of this
myth: that spending more than other nations is in itself undesirable. In fact,
high levels of medical spending are often a good thing. The second half of this
myth—that other nation’s health care systems outperform
Jones estimates that between one-half and three quarters of the growth in medical care expenditures from 1960 to 1997 was due to medical advances that enabled patients to get more per dollar spent. ‘‘Technology often leads to more spending,’’ Cutler and McClellan write, ‘‘but outcomes improve by even more.’’
While all countries can benefit from research and development expenditures made by a single country, only the health expenditures in the innovating country will include the costs of research and development. Health expenditures in non-innovating countries will exclude the research and development costs.’’
most important factor in evaluating how much a nation spends on medical care is
whether it gets its money’s worth. Critics of the
more useful comparison of different health care systems is how well they cope
with the same problem, such as infants of a given birth weight. Nicholas
Eberstadt of the American Enterprise Institute notes that controlling for birth
weight shows that the
there are variables other than health-care spending that determine infant
mortality rates and life expectancy, including genetic attributes, nutrition,
and how nations spend their health care dollars. A better measure of a
nation’s health care system is how it performs when confronted with particular
medical challenges. As noted earlier with regard to cancer patients and
low-birth-weight infants, evidence exists that the
Costs: Health insurance has become increasingly burdensome for employers and consumers alike.
Perhaps more troublesome is the obligation of government health programs. Medicare is the federal program that provides health care subsidies to the elderly and disabled. Medicaid is a joint federal state program of health care for the indigent. Each program places a large and growing burden on taxpayers. In 2004, the federal government spent a combined $473 billion on Medicare and Medicaid (not including the State Children’s Health Insurance Program, a Medicaid offshoot). That is more than Congress spent on national defense ($454 billion). When state Medicaid spending is included, these two programs cost taxpayers an estimated $606 billion in 2004, nearly one-quarter more than Social Security ($492 billion) (see Figure 2.1). According to the Congressional Budget Office, Medicare spending will double from the 2005 levels in eight years and federal Medicaid spending will nearly double in nine years. If current trends continue, Medicare and Medicaid alone will consume 11 percent of GDP by 2030.
The benefits promised to future Medicare beneficiaries under current law far exceed the capacity of existing revenue sources to meet those promises. If the federal government were to deposit funds in an interest-bearing account to cover all of Medicare’s future deficits, the amount it would have to deposit in 2005 would be $68.4 trillion. That amount is almost 70 percent larger than the combined GDPs of all the nations on earth, and more than five times the size of the U.S. GDP and the amount required to cover Social Security’s shortfalls.
It is true that errors and even preventable
deaths occur in
Medical errors will continue to occur as long as and
wherever humans practice medicine. When addressing the quality of medical care
Medical errors will continue to occur as long as and
wherever humans practice medicine. When addressing the quality of medical care
To read the rest of Part I – The State of
To read some of the other book reviews that are available, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
This will never be a civilized country until we expend more money for books than for chewing gum.
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Feisty 85-Year-Old Local Actress, Golden Henning, a Hit in Political Ad
TV-watchers have likely
caught the 30-second political ad on network and cable television depicting a
disgruntled senior citizen standing in front of her house, shaking her cane and
Can we get a shot of her and her cane walking past Congress and record what she might say in DC?
Doctor, I Can’t Lose Weight, I Need to Eat More.
Sixty-nine-year-old Ruby came in for her annual pulmonary evaluation. Among other complaints, she was putting on weight. Her exam confirmed a 20-pound weight gain since her last evaluation. Ruby stated that the extra pounds were NOT from the food she was eating. "In fact," she said, "I have to eat 5 or 6 times a day because otherwise I wouldn't get enough."
Aren’t You Supposed to Drink a
A 43-year-old Pickwickian male with hypersomnolence and alveolar hypoventilation secondary to the 325-pound weight was being evaluated. I began a serious discussion on reducing his caloric intake, even if only 500 calories a day, which would equal one pound per week. After a few minutes, I noticed that his hand opposite from me was wrapped around a 64-ounce plastic container that he continued to consume. I asked him how many of these 2,000-calorie fast food milk shakes he drank per day. He said, "About six. Aren't we supposed to drink a lot of fluids?" This man drank 12,000 calories a day on his way to the table before he even counted the calories in his food.
Our Patients Can Monitor Their Glucose Better at Home Than Socialized Hospitals Can
A member of our Editorial Committee has diabetes and
was hospitalized while visiting
As home health care devices become more sophisticated, socialized medicine in this country may be the quickest way to make hospitals irrelevant.
To read more vignettes, please go to www.healthcarecom.net/hhk1999.htm.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, 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. Be sure to read last week's report on VA medicine at www.ncpa.org/newdpd/dpdarticle.php?article_id=2434.
• Pacific Research Institute, (www.pacificresearch.org) Sally Pipes, President and CEO, John 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. This month, be sure to read False Promise of Single-Payer Health Care: A Close Look Inside the California Health Security Act, by logging on at www.pacificresearch.org/pub/sab/health/single_payer/sphealth.html.
The Mercatus Center at
• 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. Be sure to read her latest comments on Wal-Mart's announcement that it plans to offer Health Savings Accounts and other high-deductible health plans to its employees next year and calls it a win-win-win opportunity. www.galen.org/ccbdocs.asp?docID=840
• 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 http://www.chcchoices.org/publications.html. To join, go to http://www.chcchoices.org/join.html.
• The Heartland Institute, www.heartland.org, publishes the Health Care News founded and edited by Conrad F Meier in 2001. Conrad passed on unexpectedly earlier this year. Be sure to get his latest book at the CAHI site below. This month, read Why Employer-Based Health Insurance is Unraveling by Devon M. Herrick. www.heartland.org/Article.cfm?artId=17950
• 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,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 a modern classic on Global Capitalism: Curing Oppression and Poverty. www.fee.org/publications/the-freeman/article.asp?aid=5332
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
• The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or directly at www.factcheckers.org/. This month, read the Commonwealth claim that most workers want their employers to choose their health plan and Greg Scandlen’s reality check. www.factcheckers.org/showArticle.php?id=540
Independence Institute, www.i2i.org, is a free-market think-tank in Golden,
• 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 that gives you easy and direct access.
• Martin Masse, Director of Publications at 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 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, peruse the many excellent articles on several topics and savor two or three to improve your mind in the pursuit of freedom.
• 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. Be sure to read last week’s News Release that provincial health care spending is unsustainable. Based on the most recent five-year trends, Medicare is on pace to consume more than half of total revenues from all sources in 7 of 10 provinces by the year 2022. For details, go to www.fraserinstitute.ca/shared/readmore.asp?sNav=nr&id=693.
• 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. Be sure to read last week’s research on the effect of state regulations on health insurance premiums. www.heritage.org/Research/HealthCare/cda05-07.cfm
• 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. Be sure to read last week’s article, www.mises.org/story/1951, to understand why catastrophes in some countries are so much more devastating than in others. 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
• 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.
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P. J. O’Rourke: When buying and selling are controlled by legislation, the first things to be bought and sold are legislatures.
Mark Twain, (1866): It could probably be shown by facts and figures that there is no distinctly native American criminal class except Congress.