1. Featured Article: Ethical
and Moral Issues Are Inseparable from Health Care
Patients' Freedom of Conscience: The Case for
Values-Driven Health Plans by Robert E. Moffit, Ph.D., Jennifer A. Marshall, and
Grace V. Smith, Heritage Foundation, Executive Summary #1933
Ethical and moral issues are inseparable
from health care and are usually addressed by employers' health insurance
plans, government agencies, and national and state lawmakers. Through the
deliberations of their elected representatives, Americans will define and
refine the laws concerning abortion, medical care at the end of life, and such
other complex and difficult topics as the use of genetic information,
embryonic stem cell research, the use of fetal tissue, and the legitimacy of
physician-assisted suicide. Public debate on biomedical ethical issues is
necessary and should not be confined to experts. Every American has a stake in
these issues, which involve tax dollars as well as private dollars for health
insurance and medical care.
Primacy of Conscience. Regardless of how health policy issues are
resolved legally, Americans must retain their individual right not only to dissent
from existing public policies, but also to make personal health care decisions
- including how money is spent for health benefits, medical treatments, and
procedures - according to the dictates of their consciences. This is why,
regardless of their differing views on many controversial health issues, all
Americans should work together to protect patients' freedom of conscience in
health care. Recent debates on the rights of conscience have focused on
providers, not patients, but freedom of conscience for every person should be
the rule in health care, which is emerging as the central arena of new and
profoundly serious scientific and ethical issues. Americans should have the
option to control their health care dollars and to participate in plans that
respect their values and deliver medical benefits that are consistent with
those values.
But most Americans, as a practical matter,
do not have that kind of control. Third-party payers - administrators of
government and private health insurance plans - generally set the rules for
coverage: which plans are offered, what benefits are included, and how they
are funded. Many Americans are rightly concerned that they are progressively
losing control over the key decisions that affect their health care.
Biomedical Advances. The fruits of biomedical research will be
incorporated rapidly into advanced medical treatments and procedures. Once a
procedure is covered by a health insurance plan, its financing is spread among
all participants in the plan. In the case of publicly funded insurance, that
includes all taxpayers.
Because many emerging treatments and procedures
will have serious ethical ramifications, policymakers should enact major
reforms that would allow health care in America to function more as a genuine
consumer-driven and values-driven market functions. Freedom of conscience is
merely an abstraction unless individuals and families can act on it, especially
when spending their own money on insurance premiums, medical providers, and
medical procedures. In this way, individuals and families could "vote with
their feet," freely choosing which health benefit plans, packages, and
medical procedures they wish to support.
Emerging Ethical Challenges. Abortion and related issues are
flashpoints at the busy intersection of health care policy, medical ethics,
and personal morality. Meanwhile, embryonic stem cell research, therapeutic
cloning, pre-birth genetic screening to identify "unwanted" children,
therapies or treatments for genetic enhancement, and growing social acceptance
of physician-assisted suicide will create new ethical challenges. Individuals
and families cannot assume that employers, third-party administrators, or
government officials will resolve these sensitive issues in a manner consistent
with their personal beliefs.
Creating a New Environment for Personal
Freedom. Most individuals and families have little
control over the terms or conditions of their health insurance contracts or the
payment of premiums to doctors and other providers. Most Americans get what
they are given and pay what they are told to pay. Personal choice is limited,
and this limitation on personal freedom is a central defect of America's health
care system. Policymakers can correct this deficiency by returning control to
individuals and families in four major ways:
Allow all Americans to choose their own
health plans. In addition to conventional and
employer-sponsored health plans, Americans should be allowed to choose plans
sponsored by professional associations, employee organizations, unions, and
faith-based and religious groups. Individuals and families could then secure
coverage through health plans that are compatible with their ethical and moral
values.
Eliminate discrimination in the tax code. To make personal choice a reality, the
federal and state tax codes should treat all types of plans equally. The best
way to accomplish this is to give every person a refundable, individual health
care tax credit to purchase the plan of his or her choosing, regardless of
place of work. This change could foster the development of new kinds of plans,
including plans sponsored by religious organizations and church consortia.
Open up health insurance markets. Health insurance is governed by state law
and, to a lesser extent, federal law. State officials could open up current
markets by replacing the balkanized, highly regulated state health insurance
markets with a single statewide market, or insurance exchange. Through the
exchange, employers could contribute a defined amount to the health plans
designated by their employees, and plans would compete directly with each
other for consumers' dollars. Congress could allow Americans to purchase health
insurance across state lines, just as they buy many other goods and services,
including other types of insurance.
Allow values-driven health plans to
participate in public programs. Health plans sponsored by religious and other organizations
should be allowed to participate in Medicare, Medicaid, and the State
Children's Health Insurance Program, just as they already do in the Federal
Employees Health Benefits Program.
Conclusion. Individuals and families should be free
to control the flow of dollars in their health care plans and to make the
decisions that will affect their medical treatment and health care coverage,
including ethical decisions.
Robert E. Moffit, Ph.D., is Director of the Center for Health
Policy Studies, Jennifer A. Marshall is Director of Domestic Policy Studies,
and Grace V. Smith is a Research Assistant in Domestic Policy Studies at The
Heritage Foundation.
To read the entire paper, go to www.heritage.org/Research/HealthCare/bg1933.cfm.
Our thanks to Gretchen Longcore, AMWA,
Senior Medical Writer for MacroGenics, Inc, Rockville,
MD.
* * * *
2.
In the News:
Record Numbers Go Abroad for Health, The Sunday
Telegraph
Record numbers go abroad for health, By Laura Donnelly and Patrick Sawer, 29/10/2007
Record numbers of Britons are flying abroad for
medical treatment to escape NHS waiting lists and the rising threat of hospital
superbugs.
Thousands of "health tourists"
are going as far as India, Malaysia and South Africa for major operations –
such is their despair over the quality of health services.
The first survey of Britons opting for
treatment overseas shows that fears of hospital infections and frustration with
NHS waiting lists are fuelling the increasing trend.
More than 70,000 Britons will have
treatment abroad this year - a figure that is forecast to rise to almost 200,000
by the end of the decade. Patients needing major heart surgery, hip operations
and cataracts are using the internet to book operations to be carried out
thousands of miles away.
India is the most popular destination for
surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But
dozens more countries are attracting custom. Research by the Treatment Abroad
website shows that Britons have travelled to 112 foreign hospitals, based in 48
countries, to find safe, affordable treatment.
Almost all of those who had received
treatment abroad said they would do the same again, with patients pointing out
that some hospitals in India had screening policies for the superbug MRSA that
have yet to be introduced in this country.
Andrew Lansley, the shadow health
secretary, said the figures were a "terrible indictment" of
government policies that were undermining the efforts of NHS staff to provide
quality services.
The findings come amid further revelations
about the Government's mishandling of NHS policies, and ahead of official
statistics that will embarrass ministers:
• On Wednesday, figures are expected to
show rising numbers of hospital infections. Cases of the superbug Clostridium
difficile, which have risen five-fold in the past decade, are expected to
increase beyond the 55,000 cases reported last year.
• On the same day, statistics will show
that vast sums have been spent on pay, with GPs' earnings rising by more than
50 per cent in three years to an average of more than £110,000.
• New research shows that growing NHS
bureaucracy has left nurses with little time to see patients – most spending
long periods dealing with paperwork.
Katherine Murphy, of the Patients'
Association, said the health tourism figures reflected shrinking public faith in
the Government's handling of the NHS.
"The confidence that the public has
in NHS hospitals has been shattered by the growth of hospital infections and
this Government's failure to make a real commitment to tackling it," she
said. "People are simply frightened of going to NHS hospitals, so I am not
surprised the numbers going abroad are increasing so rapidly. My fear is that
most people can't afford to have private treatment - whether in this country or
abroad."
Some foreign hospitals touting for
business on the internet offer consultations in hotels in Britain. But other
patients are happy to rely on email to discuss their treatment with doctors
thousands of miles away. Low prices in India, where flights, hotels and a heart
bypass cost less than half the price charged by British private hospitals,
explain its top ranking in the survey by Treatment Abroad, a British website
providing information on hospitals overseas.
Hungary's popularity rests on a boom in
dentistry, thanks to a shortage of NHS dentists in Britain.
Mr Lansley said: "Healthcare is an
area where Britain could be a world beater because we have some of the best
research and best clinicians. If people don't trust the health service, then
that is a terrible indictment of this Government, which has turned the NHS into
a nationalised bureaucracy, instead of something able to focus on what patients
want."
The British Medical Association advised
people to be careful when considering treatment abroad, highlighting the
dangers of flying soon after surgery, which can cause complications.
A spokesman said: "Travelling can
place a great deal of stress on the body. Patients travelling abroad for
surgery should consider their fitness to fly and get an understanding of an
appropriate convalescence period before attempting to return home."
A Department of Health official said the
number of patients seeking treatment abroad was a tiny fraction of the 13
million treated on the NHS each year. Waiting times had fallen. Almost half of
patients were treated within 18 weeks of seeing a GP. Most people who had
hospital care did not contract infections.
www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/28/nhealth128.xml
Our thanks to Julie Meyer, CEO of AriadneCapital, our
correspondent in London.
* * * * *
Hundreds of GPs forced to take extra patients may
retire early, By Lorna Duckworth Health Correspondent, The Independent, 24
September 2002
Hundreds of over-stretched family doctors are considering
early retirement because of a massive increase in the number of patients being
imposed on their practices.
The problem stems from a shortage of newly qualified
GPs, which has left many practices, including those in affluent areas, unable
to fill staff vacancies.
Many doctors have closed their lists because of the
pressure of work. But health officials have to ensure that everyone has a GP so
they have forced some doctors to accept extra patients.
In the past year, the number of "compulsory allocations"
in some areas has trebled. In Liverpool, allocations rose from 1,563 in 2000 to
3,817 in 2001 and are likely to exceed 5,000 this year. . .
"Doctors feel their workload is so great that if
it increases any further, they won't be able to provide a safe service for
patients. Many GPs are already working 11, 12 or 13 hours a day.". . .
"For many GPs it will be more cost-effective to
resign from the partnership of a practice and go to work as a locum. The
patients are innocent victims. They have been told to expect a Rolls-Royce
service that we are having to deliver out of the back of a Mini."
http://news.independent.co.uk/health/article177949.ece
Dr Laurence Buckman: A Doctor writes: My profession is being vilified for
doing what was asked, The Independent Sunday, 01 November 2007
-- Family doctors are now being penalised for rising
to the challenge of performance-related-pay by delivering the quality care
-- The only pay rise that GPs got from the 2003 awards was for performance.
-- GP pay since then has been completely static but our expenses have risen, so
it is - in effect - a pay cut.
-- If you don't make the patient in front of you better, then you don't get the
extra pay.
http://comment.independent.co.uk/commentators/article3115517.ece
Doctor, doctor: How can
you justify a 10% pay increase? By
Jeremy Laurance, Health Editor, The Independent, Sunday, 01
November 2007
. . . Official figures published yesterday show GPs'
pay soared to an average of £110,000 a year in 2005-06, a rise of almost 10 per
cent on the previous year and 35 per cent in the two years since their new
contract was introduced in 2004.
British GPs are now among the highest earning family
doctors in the world. They have enjoyed a bonanza at a time when the NHS was
struggling to balance its books by closing wards and cutting services. A poll
last week found they were the happiest in Europe with their pay which has
increased from £100,170 in 2004-05 and £81,556 in 2003-04.
Part of that rise, it turns out, has come because they
have chosen to pay themselves more. GPs are self-employed and are paid a gross
sum (£245,020 in 2005-06) out of which they are expected to hire staff and buy
equipment to run their practices. What is left is their "profit" or
income for the year.
Not content with six-figure incomes, the report from
the NHS Information Centre published yesterday reveals that, during 2005-06,
they spent less on their practices and kept a larger profit for themselves -
for the second year running. Over the two years, the extra they have pocketed
amounts to £10,000 per doctor. . .
http://news.independent.co.uk/health/article3115515.ece
British health case studies
To read a series of health case reports, go to
www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/28/nhealth628.xml.
The NHS does not give timely access to healthcare, it
only gives access to a waiting list.
Our thanks to Bob Speth, MBA, MIS, for forwarding
these articles to MedicalTuesday.
* * * * *
4.
Medicare: Medicaid's Soaring Cost: Time to Step on the Brakes by Jagadeesh Gokhale
Jagadeesh Gokhale is a senior fellow at the Cato Institute and the
coauthor of Fiscal and Generational Imbalances: New Budget
Measures for New Budget Priorities.
Executive Summary
Current trends and policies imply unsustainable growth
in federal Medicaid outlays. In the year 2006, federal Medicaid spending was
11.9 percent of federal general revenues and 1.5 percent of GDP. Making
conservative assumptions about future growth in Medicaid enrollment and
spending per beneficiary, this paper estimates that the present value of
federal Medicaid outlays over the next 100 years will take up 24 percent of the
present value of federal general revenues and 3.7 percent of the present value
of GDP calculated over the same period.
By the end of the next 100 years, that is, in the year
2106, Medicaid's share of federal general revenues will be 48 percent - four
times larger than its 11.9 percent share in 2006. In the year 2106, federal
Medicaid spending as a share of GDP is estimated to be 7.4 percent - a fivefold
increase from its current share of 1.5 percent. If the federal government
continues to match state Medicaid outlays at the current rate, Medicaid's share
of GDP in the year 2106 will become 13 percent - or one-eighth of GDP in 2106.
If current policies and trends are maintained, federal
Medicaid outlays will take up 36 percent of lifetime federal general revenue
taxes for males born in 2025 and 69 percent for females born in that year. For
females born after 2050, almost all of their lifetime federal nonpayroll taxes
will be consumed by their lifetime Medicaid benefits.
Higher tax rates cannot plausibly cover this growing
spending commitment. On average, today's 35–year–old males are projected to
have 15 percent of their lifetime federal general revenues returned in the form
of Medicaid benefits. Maintaining that ratio for today's newborn males would
require a 78 percent increase in their lifetime nonpayroll taxes. Limiting
Medicaid spending growth is, thus, an essential component of putting the
federal budget on a sustainable course without imposing crushing tax burdens on
younger and future generations, thereby harming the prospects for future
economic growth.
Full Text of Policy Analysis no. 597
(PDF, 510 KB | HTML)
Government is
not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony:
Is Frequently Misinterpreted As Superb Health Care
Barber Don's wife turned 65, obtained Medicare and
enrolled in an HMO. She developed benign positional vertigo and her doctor
wanted an MRI. The HMO denied it and her doctor had a fit of rage that someone
would question his judgment. The MRI was accomplished. The test was negative.
(One of my patients last week had to pay $968 for a scan.) She was then given
an anti-vertigo drug and was discharged from the hospital.
The barber expounded on the great care his wife
obtained. However, vertigo is something that every practitioner sees
frequently, if not weekly. The usual treatment with anti-vertiginous drugs or
decongestants will, in most instances, alleviate the problem.
Some thoughts on this sequence of medical events: A
doctor that won't listen to alternative treatments should be treated with suspect.
There are usually several ways to treat many medical conditions. Second, there
is only one easy way to change this excessive utilization of health care costs.
Higher copay is not one of them. After paying a $50 or $100 copay, the sky is
still the limit. Only if the patient has to pay a percentage of every item of
health care will the patient be his or her own reviewer of medical necessity. A
copay of 10 or 20 percent would result in the patient querying the doctor about
the medical necessity. Many patients are getting very sophisticated medically
with the advent of Web Medicine and Patient Directed Health Care. They will
have a good idea of the seriousness or lack thereof for vertigo if they have a
stake in the costs.
Actuaries have estimated a 30 to 40 percent reduction
in health care costs with consumer or patient involvement. As evidence is
accumulating, it appears that health care costs in this country can almost be
cut in half with Patient Directed Health Care - any system in which the patient
is partially liable for every item of health care.
* * * * *
6.
Medical Myths:
Medical Care Should Be Evidence Based Objective Practice
In 2002, two women in their 80s had abnormal
mammograms. Both saw their doctors with their daughters. Both were alert and lucid
in their thinking. Both had the usual diseases that come in the ninth decade of
life - arthritis, atherosclerosis, mild non-limiting heart disease and mild
easily treated hypertension.
Mrs. Crystal had a small one-centimeter lesion in the
lower inner quadrant of her right breast. On speaking with the daughter in
front of the patient, they decided to go the entire route and an ultrasound was
obtained suggesting a solid non-cystic lesion, very like a carcinoma. The
family history was negative for cancer. The daughter stated that she wanted
everything done and wanted a surgeon for her mother. A biopsy was accomplished
and it was positive. She wanted to proceed to mastectomy and have her mother
cured. The patient was reticent but concurred. Her doctor pointed out that in
the ninth decade of life she could outlive her cancer even if nothing were
done. Nevertheless, a mastectomy was done on her right breast. The diagnosis
was reconfirmed and she received radiation therapy. She was also given
chemotherapy.
The patient had a fairly miserable year and then
seemed to do well. After two years, she developed metastases to her ribs and
was in severe pain for the next year. She then developed metastases to her
brain. Her daughter wanted to continue with all modes of diagnosis and
treatment. As she was being prepared for radiation therapy to the brain lesion
and as the black marks were placed on her shaved scalp by the radiation
oncologist, the patient reeled in horror at her reflection in the mirror. She
asked them to remove the ink markings so that she could be sociable with her
friends during the final months of her life. However, she had difficulty being
part of the "girls" and no longer could play bridge. She would
retreat to her room at the senior citizen's abode, sometimes in tears. She was
getting more depressed. She told her daughter that she did not want anything
else done. In fact, she wasn't sure that life was worth living anymore. She is
prepared to say goodbye to her daughter and her friends. The daughter is a
basket case. She tells her mother, "How can you do this to me after all I
did for you?"
Mrs. Berry had a small one-centimeter lesion in the
lower inner quadrant of her left breast. The daughter took her doctor aside and
asked about the prognosis. Could she live for several years in relative comfort
and not have surgery? The answer was a "probable yes." She said that
she had her mother's power-of-attorney and did not want anything done to cause
suffering or interfere with her mother's social contacts. She would prefer to
see her mother active, enjoying her friends, and live in comfort, even if for
only one or two years, rather than go for a radical cure. Her doctor said that
he would be happy to obtain a repeat mammogram in six months and every year
thereafter and follow the lesion expectantly. She stated that she would like
that. However, she wound up declining the follow-up mammograms since she had
already determined that removal of her mother's breast was not acceptable. Each
year she quietly asked the doctor to examine the breast manually to check for
any significant growth. After five years, it still was barely palpable. The
patient was enjoying life, playing bridge, and active in her senior citizen's
environment.
Two similar cases are never really alike. But these
two cases reveal a basic difference in how people react to the same medical
problems, which never really are the same. However, the first patient had
medical costs that exceeded $100,000 including the hospitalizations, surgery,
expensive radiation therapy, and expensive chemotherapy. Despite these major
costs to health care, she had a miserable first year, and a miserable 4th
and 5th year before dying. She had two years of relative wellness.
The second case had five years of relative wellness,
enjoyed life to the fullest and had essentially no significant health care
costs except the mammogram, five yearly office evaluations, at a total cost of
less than $1000, and is still alive and well.
What are the issues? If the patients had physicians that
followed evidence-based medicine, the costs would have been considerably more
for the second. The first with one hundred times the costs probably would not
have changed. If the government were directing the health care, the second
doctor might have been Peer Reviewed as giving inappropriate care and reported
to the State Medical Board, which may have resulted in his Medical License
being revoked. He then would have been reported to the National Data Bank as a
bad doctor and would never have been able to practice again. His bankruptcy
would result in the lost of home and family, since he no longer could support
them.
Costs would have increased astronomically with any
government infringement, despite the fact that government medicine always goes
bankrupt, and controls and delays are placed in the system. Thus, the public
does not perceive bankruptcy. We will see patient-sensitive doctors frightened
away from practicing clinical medicine, adding unnecessary costs to save their
license. Government medicine has numerous hidden and conflicting agendas and
will never deliver what patients need. They work under the pretext that they
have polled the patients and found what patients want but are unable, with
their lack of medical sophistication, to understand the problem or the issue at
hand. And costs will increase astronomically, ending up with bankruptcy.
However, the public will never perceive it as such because it is constantly
bailed out with increased taxation, as in the case of Medicare.
If you think health care is expensive now, wait until
you see what it costs when it's free.
- P. J. O'Rourke
* * * * *
7.
Overheard in the
Medical Staff Lounge: Medicare Subterfuge
Dr. Rosen: Well
what's the latest on the St George Remodeling Medicare fiasco?
Dr. Sam: I'm
without Medicare payment for going on six months now, and still no word from
Medicare.
Dr. Milton: Does
any one have any word on when this Medicare fiasco is going to be resolved?
Dr. Dave: I'm
redirecting my practice so I'm less dependent on government medicine.
Dr. Rosen: We
have one person from Stanford who reports that he waited nine months after his
change of address notice before he got paid. He got his congressman and Senator
involved hoping they could speed up the payment.
Dr. Milton:
Looks like that slowed the payment process even more.
Dr. Rosen:
Doesn't that mean that Medicare thinks they are above the law?
Dr. Edwards: Isn't
that an interesting and sad paradox. Congress is pushing for their control over
health care. But they will have to lateral it over to CMS [Center for
Medicare/Medicaid Services] who control Medicare and Medicaid for
implementation. CMS has such utter disregard for Congress they thumb their
noses at them when they call.
Dr. Rosen: So when
Congress through CMS tries to run a national health care plan, we will
immediately have warring factions. What a way to provide a sensitive
personalized service. And many in the public fail to understand that neither
faction cares a wit about them. They just want power and control. They could
care less about the public's health.
Dr. Yancy: I've
decided that I'm no longer accepting new Medicare patients. Then over time, I
will leave Medicare totally and have a completely private practice. Either
first class insurance payment or cash. No alternatives.
Dr. Michelle:
Aren't you going to see poor people, Yancy?
Dr. Yancy: I
operate every day on poor people for one-fourth the standard fee, which is what
Medicaid pays me. It doesn't cover my overhead. So, it's mostly charity. We
don't have an underclass in this country. All poor people have Medicaid
insurance, which beats the national health insurance found around the world.
Dr. Rosen: What
do you think is the reason for Medicare nonpayment?
Dr. Sam: The
government is in a financial bind and this is simply a way to delay payment for
six months or longer. Saves them a lot of money at no interest. The doctors and
the hospitals are losing money and paying interest on the money they are
borrowing to pay bills.
Dr. Edwards: I
think the government is angry at doctors and this is one way of retaliating.
Dr. Sam: I
have to agree with that also. The government, which includes Medicare,
Medicaid, Congress and Senate, want to control us.
Dr. Rosen: I've
done some work in Social Service for Disability evaluations. There was always
an undercurrent of hostility towards doctors. Many times one could walk into a
room and it would become immediately silent; you knew they were talking about
doctors. Many were openly hostile.
Dr. Edwards: This
hostility towards doctors is pervasive. I once walked into a room in this very
hospital where everyone was laughing and as I opened up the door, I heard one
person laughingly say, "And the doctors believed us!" as if we were
all ignoramuses.
Dr. Milton:
That's why hospitals walk all over doctors also. They blunt that perception by
hiring administrative doctors half time. As they get their half-time salaries
with the hospital's administrator's signature, they really fall in line.
Dr. Sam: Sort
of makes them hospital whores, doesn't it?
Dr. Ruth:
Wouldn't prostitutes be a better term? After all, aren't they getting paid?
Dr. Sam:
That's a good point, Ruth.
Dr. Dave: And
did you know that Medicare cuts fees in half when there is an associated psychiatric
diagnosis such as anxiety disorder?
Dr. Edwards: Can
you see anyone bailing a patient out of heart failure and that patient not be
anxious? And the doctor has to work twice as hard and long with a
life-threatening problem and sees his pay cut in half. Medicare has the cruelty
of reducing the well-earned fee in half?
Dr. Dave: And
the other paradox is that Medicare doesn't pay on many diagnoses but on
symptoms. Today my bookkeeper told me that if she doesn't change the diagnosis
of asthma to wheezing, we don't get paid for a pulmonary function test?
Dr. Rosen: If a
patient is actively wheezing, one shouldn't even get a PFT. One should wait
until the patient stabilizes and get a base line. That shows the medical
illiteracy of Medicare regulations.
Dr. Dave: Can't
you wait until all these Medical Illiterates run health care?
Dr. Rosen: So
we all agree that this Medicare Fiasco of not paying doctors for any picayunish
reason such as a simple change of address notice is abusive, hostile,
retributive, vindictive harassing subterfuge against a perceived privileged
group known as physicians?
Dr. Sam: Just
wait until these Medical Illiterates take over and the backlash against the
health care fiasco develops with a hundred million unhappy Americans ready to
March on Congress.
Dr. Ruth: I
think if I were in Washington then, I'd leave town.
Dr. Sam: But
Congress will blame the doctors and try to prosecute us.
Dr. Rosen:
Better start thinking about cross-training now.
Dr. Sam: A retired
physician told me the other day that if he had to do it all over again, he
would become a forensic pathologist, the one field that government doesn't yet
control.
Dr. Rosen: Who
is he kidding? Bureaucrats want control, they don't care about fiscal responsibility.
Or even who's on the autopsy table.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
SONOMA MEDICINE, the
Magazine of the Sonoma County Medical Association
Outside the Office: Please Google Me, By Sanjay Dhar, MD
I
recently came back home after a long weekend, only to find that names like
Paris Hilton and Lindsay Lohan have taken over the airwaves, electronic media,
and television stations. I can't find real news anymore, anywhere. I now depend
upon what is presented to me by people who decide what is important and what
they think I should know or care to know. Do I really care if Britney Spears
shaves her head?
I am not opposed to television or the Internet, but as
time goes on I am bombarded by more and more advertisements, each one more
colorful than the other, each one enticing me to buy or use their product. I
want to tell the advertisers, the television stations, the radio stations, the
people who send me tons of junk mail, and the spammers who blast me with
e-mails: "Please know more about me, please Google me."
I am secure in my current financial situation, and I
don't want to be told repeatedly that my mortgage needs to change hands because
someone has a better "no-interest" deal. I know that my relatives are
all doing well, and that I have no rich uncle in Nigeria who has just passed
away, leaving behind millions.
I am physically in good shape and don't need
medications to boost everything in my body. I don't want pop-up advertisements
on my computer screen every time I log on - so much so that I can't even see
the page I logged onto.
I am a married man with two children. I don't want to
see Victoria's Secret lingerie commercials while watching American Idol
with my daughter, and I don't want to watch commercials for Mortal Kombat while
watching Sponge Bob with my son.
Now that you have an idea about what I don't
want to know, maybe you should be aware of what I do want to know. . .
To read what Dr. Dhar wants to know, go to www.scma.org/magazine/scp/sm07/dhar.html.
Dr. Dhar is a Santa Rosa cardiologist.
* * * * *
9. Movie Review: Michael Clayton
Michael Clayton: Just Pretend This Isn't
Madness By James J. Murtagh, M.D.
I am Shiva, God of Death
Spoiler alert- Consider seeing the movie
before reading this Op Ed
Corporate crime films- from Silkwood,
to Serpico, the Insider, and SiCKO- focus on the victims,
and underdogs overcoming corruption. They are David versus Goliath films. But
whoever tells the inside story of the Goliaths?
Surely, Goliath didn't think of himself as
a monster. He saw himself as a tragic soldier, serving his own god, and his
family, unfairly defeated by a tiny man with a slingshot. What makes the giant
"scurvy spiders" of industry tick? How do good people go bad and sink
to corporate crime? In George Clooney's new film, Michael Clayton we see
a giant company's lawyers close up under siege.
In an inverse of Erin Brockovich, U/North,
the film's corporate Goliath, is caught red-handed in multi-billion dollar
environmental catastrophe, killing hundreds of persons. As events spin out of
control, lawyers and officers of U/North sweat bullets, and unblinkingly, this
film shows the people behind the disaster. They are just people, with mortgages
and families, and must overcome their circumstances to rise above the evil they
have slipped into.
"I am Shiva, God of Death,"
declares a key defense lawyer as he cracks under the stress and guilt, going
manic. So, U/North calls in groups of fixers; some semi-legitimate, such as
Michael Clayton; but other a strictly black ops paramilitary team. Every move,
every phone call, is being monitored by the black ops team that will do
whatever it takes. Clayton declares he is a janitor, and that "The truth
can be adjusted," updating Orwell's doublethink, the power of holding two
contradictory beliefs in one's mind simultaneously. Clayton apparently believed
at the film's beginning that "Ignorance is Bliss," and "Freedom
is Slavery."
"Will someone rid me of this
meddlesome priest?" Most wrenching and fascinating is the U/North top
legal ace cryptically ordering the death of the manic
lawyer-turned-whistleblower. But the silk-stocking legal ace can't bring
herself to say the actual words needed to order the killing. Through her
desperation, she manages to convey that she wants the killers to
"proceed."
The U/North counsel never has a moment of
peace after. Like a corporate Lady MacBeth, she is never able to wash off the
damned spot. The murder leads to more murder attempts, and events spiral out of
control until the end. Her moment of redemption is impossible, it appears,
until she is finally caught.
The suffering of tyrants has been the
subject of great tragedy from Sophocles to Shakespeare. How do corporate
tyrants live with their guilty consciences? In this film, guilt leads one
lawyer to a madness that was greater than the truth. Guilt leads other lawyers
to murder and cover-up. Guilt led Michael Clayton initially to complicity, to
gambling, to other vice, but finally led him to do the right thing and expose
the corporate culture of cover-up and murder.
"Corruption is why we win"
declared a character in George Clooney's related film, Syriana. Some
officers relish in wrongdoing. Others simply accept the banality of evil as a
fact of corporate life. Most characters just appear to slip into it. Few want
to accept any responsibility.
Corporate legal aces are the cream of our
society. Top lawyers have the finest educations, finest backgrounds, and finest
things that can be had in life. What leads to their downfall? What leads some
to become Tom Hagen and some to be Matlock? Why did Goliath become Goliath? We
need our best and brightest to work to end global warming instead of working
for Enron. We need our best reporters to live up to the ideals of Edward R.
Murrow, as portrayed in Clooney's Good Night, Good Luck. We must reject
double think.
Indeed, corporations, not government, may
be Big Brother. Beyond dispute, lawyers have been at the center of the great
scandals and cover-ups of our times. Understanding the descent of great legal
minds into morass is one of our society's great tasks.
Shiva, the ancient double-faced Hindu
deity, is both destroyer and life-giver, is a perfect symbol of the two sides
of corporate crime.
James J. Murtagh Jr., MD, Atlanta GA 30329 www.delmeyer.net/JM_MichaelClayton.htm
(James Murtagh
spent 20 years as an Intensive Care Unit physician. Dr. Murtagh is a member of
Semmelweis Society International, and has hosted several Congressional forums
on the Healthcare Integrity Project.)
To read other movie reviews,
please go to www.delmeyer.net/CinematicOpEdReviews.htm.
To read more book reviews,
please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
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10. Hippocrates & His Kin: Evading Do Not Call Lists,
P4P, Wealth Improves Health
Older Americans around the country are getting duped
by a seemingly innocuous tactic that can expose them to hard-sell pitches from
the insurance industry.
The technique is centered on a marketing tool called
the lead card, and it became popular after the federal government created its
Do Not Call Registry in 2003 to shield consumers from unwanted solicitors. Sent
through the mail, the lead card invites the recipient to mail off an enclosed
reply for free information about, say, estate planning.
But the cards fail to warn that by sending off
replies, recipients are giving up their right to avoid telephone solicitations
from the sender -- even if their phone numbers are on the Do Not Call list.
http://online.wsj.com/article/SB119335472901272206.html?mod=todays_us_page_one
Another unnecessary law with loopholes and consequences
that our not-so-bright Congress could not see. With modern technology and
caller ID, any person can monitor all incoming calls, which includes the phone
number and the person calling. Hence, any senior would be foolish to pick up
the receiver if it wasn't a friend or family. The whole Do Not Call list is an
unnecessary intrusion and expense that should never had been implemented. We
all could have done better and kept government out of the picture as it is now
mushrooming into an even larger taxpayer expense. Does anyone have any idea how
we can give Congress a ten year moratorium on passing new laws? That would
decrease the cost of government by at least, shall we estimate, 10 percent
annually? Newt, where are you when we need you?
Performance is all the
rampage now for doctors, nurses and hospitals. We should extend performance to
lawyers, senators and representatives. Any senator that doesn't perform
constitutionally will forfeit his/her pay and be sent to the National Data Bank
so that he or she can never run for office again in another state.
That should be an equalizer.
Doctors are being prosecuted
for sending patients to their own laboratories and imaging facilities even if
they provide superior services at less cost.
We propose that any lawmaker
that accepts any bribe (contribution from any citizen or group that benefits
from any previous or proposed legislation) should be prosecuted for bribery and
fraud and be immediately registered in the National Data Bank so that he or she
can never run for office again in any state.
That should be tit for tat.
Did you know that property
values are the best predictor of obesity? According to a new study in Tuft's
Health & Nutrition Letter, each $100,000 increase in value was associated with
a 2% decline in obesity prevalence.
Hasn't it always been known
that wealth improves health?
Meanwhile, the government
always emphasizes poverty. Ever since President Johnson tried to define
poverty, we have all kinds of benefits for every level of being poor: health
care, food stamps, Medicaid, subsidies, and now even some Medicare benefits are
contingent on being poor. We see patients maneuver daily on hiding assets or
transferring them to friends or children to become as poor as possible to obtain
the maximum amount of stolen goods from taxpayers.
At no time in history has
there been such a constant emphasis of becoming poor, which decreases health
and worsens disease.
To read more vignettes,
please go to www.healthcarecom.net/hhk1999.htm.
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11. Organizations Restoring Accountability in HealthCare,
Government and Society: