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Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, October 28, 2003
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In This Issue:
1. Canadian Health Care Waiting Lists
2. Why are Doctor Groups Anti Business and Anti Private Practice?
3. Does Government Solve Problems or Just Feather Nests?
4. Our Monthly Overview of Universal HealthCare, Single-Payer or Socialized Medicine
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring Patient-Focused Private Practice
Canadian Health Care Waiting Lists
Recently, one of our members was in Toronto for a conference and reports that there was a lot of talk about how doctors are fleeing Canada out of frustration over the lack of access (and support) to high tech medicine. He forwarded a survey by the Fraser Institute reported in the Toronto Star that 90 percent of average waiting times for health care is considered beyond clinically "reasonable," and there is growing desire to privatize Canadian health care.
"Canadians are waiting almost 18 weeks for essential medical care," said John Graham, the institute's Director of Health and Pharmaceutical Policy Research. The total waiting time — from the moment a patient gets a referral from a family doctor to the time he or she gets treatment — in a dozen specialties, such as cancer, heart, eye and orthopedic care, rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003. The survey suggests a 90 percent longer waiting time than in 1993. Graham states, “The survey shows that the federal and provincial governments are still failing to act in the face of international evidence that increasing patient options for private care reduces waiting times. The standard solution — throwing more money at the problem — is just not working."
However, any trend towards privatizing health care was blasted by Roy Romanow, Saskatchewan's former NDP premier, in his royal commission report on the future of health care in Canada.*
“The Fraser Institute isn't the first to put its finger on the unacceptably long waiting times for medical care,” said Michael Decter, a former Ontario deputy health minister who's now with the Canadian Institute for Health Information. "I'm not sure creating more private clinics would solve the problem at all, let me be clear on that," said Decter, who had no involvement in the Fraser survey.
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Why are Doctor Groups Anti Business and Anti
California just recalled its Governor for total incompetence after only 10 months into a newly elected term. Before he left office, he signed into law a bill mandating businesses to either provide health insurance to their employees or pay additional taxes. This has serious economic impact in California, the world’s sixth largest economy. The Sacramento Business Journal reports that an owner of four restaurants that grossed $11 million and made $400,000 in profit states the new law will cost him $1.5 million, which will put him over $1 million in the red. If the law isn’t reversed by the incoming Governor Arnold Schwarzenegger’s influence over a liberal democrat-controlled Senate and Assembly, he will be forced to close his restaurants. Governor Davis’ lame-duck action will force him to lay off 280 employees who will no longer have jobs or health care. The unfortunate corollary to this fiasco is that the two doctor organizations in California, the California Medical Association (CMA) and the Union of American Physicians and Dentist (UAPD), supported this anti-business, anti-private practice law. Their combined membership no longer represents the majority of physicians. If you decide to quit paying dues to these organizations, consider supporting the Association of American Physicians and Surgeons (AAPS), the only organization that has consistently supported private practice and less government intrusion into health care. Not only are their dues less than the CMA or the UAPD, but their membership seems to be increasing. You may join at www.AAPSonline.org
Does Government Solve Problems or Just Feather
Since all branches of government are discussing health care, it is important to understand how governments function. Do they methodically discuss, evaluate, and tackle a problem the way it is customarily done in the business world? Or are there other, more expensive agendas? Another example from our Governor Davis, who caused an energy crises in California that pales the Enron, WorldCom, and PG&E scandals, might be illustrative. The San Francisco Chronicle reports, “After losing his job in the October 7 recall election, Davis quietly appointed 94 people from the ranks of his top staff, as well as lobbyists and political supporters, to plum state jobs that pay as much as $117,396 per year–with some of the jobs requiring as little work as two meetings per month.” Overheard in the medical staff lounge, “I hope those two meetings were important enough to last all day.” The San Francisco Chronicle also reported that rewarding loyal supporters with plum assignments is a time-honored practice of outgoing governors. Last year, a bill to slash the salaries of people serving on boards and commissions from six-figures to $100 per diem plus travel expenses failed. But the $100,000 salary expense for $100 of work is about the same 1000 to 1 (100,000%) error in projections of most government programs. If the government took over health care, we would have the same mind set: It’s not how much medicine and solving patient-care problems you understand, but who you know that counts–or how to feather your own nest at the taxpayer’s expense.
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Single-Payer or Socialized Medicine--Our Monthly
Overview of Universal HealthCare
Jacob G Hornberger, a former trial attorney and adjunct professor of law and economics at the University of Dallas, and Richard M Ebeling, the Ludwig von Mises Professor of Economics at Hillsdale College, discuss the Free-Market approach to HealthCare in The Dangers of Socialized Medicine. Today we continue with Part III in chapter 2, “National Health Insurance and the Welfare State” by Richard M Ebeling.
Roots of Socialized Medicine and the German Welfare State. If you missed last month’s review of Part II, go to http://www.medicaltuesday.net/Sept2303.htm and scroll down to our monthly topic for a quick review. If you missed the previous month’s review of Part I, go to http://www.medicaltuesday.net/Aug2603.htm.
In his book, The Walls Came Tumbling Down: The Collapse of Communism in Eastern Europe (1993), historian Gale Stokes suggests, “Students who graduate from college after the turn of the millennium will almost certainly look back on the two great movements of the twentieth century, fascism and communism, with the same sort of incomprehension that students of earlier generations looked back on the religious wars of the sixteenth and seventeenth centuries. How was it possible that two movements whose claims seem so implausible, almost comical. . . should have not only attracted millions of enthusiastic followers, but, on the basis of what these adherents considered high principle, sent millions of people to anguishing deaths?”
A hundred years from now, as the twenty-first century approaches its end, equally incomprehensible will be the belief in the welfare state. Scholars as well as students will wonder how it was that so many people in practically every corner of the world shared the idea that some of the most personal and important matters of their private individual and family lives should be placed in the care of the state.
These scholars and students of the future will be equally puzzled by the fact that the dangers and problems of the welfare state had been clearly understood long before its formal institutionalization in the twentieth century–and that these warnings had gone unheeded. Perhaps they will come across the writings of the early nineteenth-century writer Dr. Thomas Chalmers, professor of moral philosophy at St. Andrews University in Scotland, who, in the 1820s and 1830s, pointed out many of the unintended consequences that always seem to follow in the wake of dependency upon the state.
Early Criticisms of the Welfare State
Criticizing the British poor-law system, under which the status of “pauperism” was legalized and on the basis of which individuals and families could draw their financial support from the state, Dr Chalmers, in Problems of Poverty, saw four serious consequences.
First, he said, it reduced the incentive for people to manifest the industriousness and frugality to care for themselves and their families, since now they knew that whether they worked and saved or not, the state could be relied upon to provide them with all the minimal necessities of life.
Second, he feared, it reduced, if not eliminated, the sense of family responsibility. Knowing that the state would care for the old and the infirm, Dr. Chalmers pointed out, “There is a cruel abandonment of charity,” as people develop the attitude that since they have paid their taxes, it is now the government’s duty to do what relatives traditionally did for each other.
Third, it threatened to harden the hearts of men towards their fellows and diminish the spirit of voluntary giving to others in the community. When assistance to others in society is voluntary, there usually is aroused in us “the compassion of our nature, and inclines us to the free and willing movement of generosity.” But when charity is made compulsory by the state, Dr. Chalmers argued, there is aroused in us “the jealously of our nature and puts us upon the attitude of surly and determined resistance.”
And, fourth, it weakened the spirit of community and assistance among those who were less well off. Dr. Chalmers noted that those who live in simple or poor conditions often show a support and sympathy for those around them who fall into even worse circumstances, and this creates a network of mutual help within those poorer portions of the wider community. But when each is made a ward of the state, the ties and connections between people in similar circumstances are weakened, with each now connected by one thread–their own individual dependency upon the state for all they need and desire.
And it should be added that Dr. Chalmers, in the early decades of the nineteenth century, had already been confronted with all arguments heard in the twentieth century as to why the welfare state could not be repealed. He was confronted, for example, with the counter-argument that without the mandatory provision of the state, the poor would fall into even worse conditions. And an even more forceful impediment to the denationalization of the welfare state, he said, came from the resistance of those who administered the system, that is, when the proponent of voluntarism “comes into collision with the prejudices or partialities of those who at present have the right or power of management” of the welfare programs. (*See Canada above for bureaucratic resistance to privatization.)
Tragically, those that don’t have an overview of history are destined to repeat the same mistakes. Unfortunately we will all go down together unless messages such as this take hold.
Medical Gluttony (Excessive Medical Cost)
Most advocates of Single-Payer Medicine or Universal HealthCare or Socialized Medicine think in terms of artificial alterations of the laws of economics. In the Canadian* example above, the discussions were about increasing the number of clinics, the number of doctors, but not the economic arrangement which would solve all the issues. One could double the number of doctors or clinics and the bureaucracy could still implement so many mandates and impediments to health care that the waiting lines could get even longer. By returning to the laws of economics, every patient’s need would be met by a willing doctor or hospital in record time because there would be an economic advantage to do so.
Last week, a patient called at 11 PM complaining of muscle aches and a 100 degree fever of ten days duration. Since there was no change in symptoms that evening, I suggested he be seen during regular office hours. He called the next day and made an appointment for the following morning. He went to an Urgent Care Center that night and they performed a number of tests with normal results that required no treatment. He was told to keep his appointment with me in the morning.
He was irate that I was not at his beck when he called two nights earlier. Insurance companies pay regular fees for night time work at no cost to him. I noticed that he had seen a podiatrist the previous month. He explained that since pedicurist in the State of California are no longer allowed to trim his heels, he had to have a podiatrist do this. (I use a twin track razor.) Do proponents of single-payer medicine or universal health care or socialized medicine understand the ingenuity of patients who transfer items of personal responsibility, such as trimming the edges of one heels, to insurance carriers or the state at taxpayers’ expense? If this caught on, at $50/visit for a hundred million Americans with Medicare or health insurance, our health care costs could include an additional $5 billion. But it would take the government or insurance carriers years to find this hole in the system. But the proponents of Single-Payer or Socialized Medicine that I’ve talk to don’t seem to care or don’t believe people actually do this. They are not interested in our health, only interested in controlling our private lives.
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MedicalTuesday Supports These Efforts in Restoring Accountability in Medical Practice by Restoring the Doctor & Patient Relationship Unencumbered by Bureaucracy:
• PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of their cost. Dr. Berry gave an address to the Association of American Physicians and Surgeons at their Annual Meeting last month. Please click on AAPS talk 09/2003 under Musings from Frontline Medicine at his website above to read and download this address, PATMOS EmergiClinic – A Return to Private Medicine.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting, the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available.
• Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or person may become a member of SimpleCare. Whether you are insured, underinsured, uninsured, or on Medicare, Welfare or other government programs, SimpleCare may reduce your out-of-pocket medical expenses. Remember, he cautions, that SimpleCare IS NOT an insurance company nor does it provide any insurance services.
• Dr David MacDonald has partnered with Ron Kirkpatrick to start the Liberty Health Group (www.LibertyHealthGroup.com) to assist physicians by helping them to control their medical benefit costs for their staff and patients. You can obtain a quote from eHealthInsurance.com at this site. He is available to speak to your group on a consultative basis. Contact him at DrDave@LibertyHealthGroup.com.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at http://www.newsmax.com/pundits/Medicine_Men.shtml. Every pundit in the land has his own diagnosis for the health care crisis. The current issue is titled "Fitness, Fatness, Freedom – Who Decides?" They point out that the recent British proposal to eliminate fat people from the National Health Service unless they diet and lose weight would have serious consequences if implemented in the U.S. With 20 percent of 300 million Americans obese, an additional 60 million would be uninsured. Read the whole issue at http://www.newsmax.com/archives/articles/2003/10/20/201329.shtml Thus, the consequence of universal health care, with the goal to provide coverage for 30 million Americans without health insurance, could actually triple the number of uninsured because no single-payer system in the world has ever worked.
• Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. Doctors are daily reviewed, suspended, stripped of their medical license and jailed on trumped up charges that most attorneys don’t understand. A Sacramento doctor who had a convalescent hospital practice was found guilty of using the wrong insurance code. When the new codes were implemented, which he did not understand, he depended on his staff to select the one closest to what they thought he did. Medicare informed him that it was the wrong code, and he apologized. Medicare then told him to sign a document admitting his mistake, which he did on the advice of his attorney in order to avoid jail time. He was then handcuffed and jailed for 22 months. He lost his medical license, his practice, his home, his income, his assets, and the family retirement. These so-called “errors” have nothing to do with the practice of medicine and only become legal traps. This week, Dr Willner reports another success against Sham Peer Review with suspension overturned, surgical privileges restored, and data banking deleted in a recent case. His secret? “WE CHOSE THE LAWYER!” The Center for Peer Review Justice acts as the Consultant to guide the non-legal aspect of a case. “We try to make sure that every act done is a positive one. No further review or assessment was necessary.” Read the pages of physicians targeted at http://www.peerreview.org/ and their stories. Thanks, Rich, for protecting us from professional homicide, and keep up the good work.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine and loss of medical privacy. The “AAPS News,” written by Jane Orient, MD, is archived on this site providing valuable information monthly. The official organ has been renamed the Journal of American Physicians and Surgeons, and Larry Huntoon, MD, PhD, a New York neurologist, is the Editor-in-Chief. The 60th annual meeting was at the Grand Marriott Resort at Point Clear, Alabama, on September 17-20, 2003. An important resolution passed by the Assembly to Oppose Single-Payer Medical System is copied below. You may have copies sent to you directly from the website.
WHEREAS: The Constitution of United States protects natural and unalienable rights to life, liberty, and property; and
WHEREAS: A right is something one possesses free and clear that can neither be created nor revoked by government, while, in contrast, a privilege is an entitlement granted by government, which therefore has the power to limit, restrict, or revoke that privilege at its whim; and
WHEREAS: If government grants a "right" -- which is actually a privilege-- to medical care, the government has the power to ration and regulate medical care; to force patients to pay for others' care; and to abrogate patients' protected rights to choose their physician[s] and contract for care they deem necessary in accordance with the highest standard of medical practice; and
WHEREAS: Government may not rightfully deprive people of rights in order to bestow privileges on others; and
WHEREAS: The physician, as any citizen, has the constitutional right of freedom to enter into -- or to decline to enter into-- agreements, contracts, and association with parties of his own choosing; and
WHEREAS: A government-bestowed privilege to medical care imposes an obligation on a physician to provide a service to anyone and everyone as demanded by government, therefore violating the physician's rights to liberty and property; and
WHEREAS: No individual is entitled to the services or fruits of another's labor without just compensation; yet a "right" to medical care compels physicians to become indentured servants, bound to the state, in violation of the Thirteenth Amendment; and
WHEREAS: The "Principles of Medical Ethics" of the Association of American Physicians and Surgeons states "The physician may choose whom he will treat..." and most physicians, because of compassion and generosity, do choose to provide medical care for the indigent; and
WHEREAS: The Oath of Hippocrates states: "I will prescribe regimen for the good of my patients according to my judgment..."; and
WHEREAS: The "Principles of Medical Ethics" of the Association of American Physicians and Surgeons states: "The physician's first professional obligation is to his patient" and "...the physician should not dispose of his services under terms to conditions which tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause a deterioration of the quality of medical care"; and
WHEREAS: A government-controlled or single payer system results in the loss of patients' control over their own medical care, and inevitably results in third-party rationing;
WHEREAS: A government-bestowed entitlement to medical care will result in worse care for patients, violation of patients' and physicians' natural rights, and to support such an entitlement is a breach of medical ethics;
THEREFORE: BE IT RESOLVED THAT: The Association of American Physicians and Surgeons declares that medical care is a not a right that can be bestowed by the state and that any laws, regulations, or policies that attempt to establish a government-mandated entitlement to medical care are not only unconstitutional and therefore illegal, but immoral and inimical to the physician's ethical principles;
AND BE IT FURTHER RESOLVED THAT: AAPS will actively oppose any and all state or federal initiatives to legislate such a "right" or entitlement via a government-controlled or single-payer plan under any name, and urges all physicians who take seriously their medical ethics to do the same in the best interests of their patients.
AND BE IT FURTHER RESOLVED THAT: AAPS urges all physicians to oppose a government-controlled or single-payer plan as harmful to patients, and therefore inconsistent with a high standard of medical ethics.
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URL References for your perusal or study at leisure. You may want to Bookmark these or add to your Favorites.
Single-Payer Initiatives: http://www.healthcarecom.net/EditorialNov94.html
David Gibson, MD, National Health Care Consultant:
Single Payer: http://www.healthplanusa.net/DGSinglePayer.htm
Why are the uninsured, uninsured?: http://www.healthplanusa.net/DGUninsured.htm
What’s behind health care costs?: http://www.healthplanusa.net/DGRisingHealthCareCosts.htm
Pharmacy costs: http://www.healthplanusa.net/DGPharmacyCosts.htm
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