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Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, September 24, 2002
Malpractice Premiums Force Big
Cutbacks in Medical Care
The New York Times featured article last week outlined a
dramatic scenario of 1300 hospitals affected by the rise in malpractice rates
and a number of closures predicting further cutbacks in services, including
maternity wards. An OBG colleague of mine mentioned his medical practice
liability premium as $9,000 per quarter, which exceeds my yearly premium as a
pulmonologist. He mentioned that some of his friends in Florida quit doing the
OB part of their practice. The Times article states that premiums in Miami are
$200,000 per year. Bush and the AMA are trying to implement California's MICRA
(Medical Injury Compensation and Reform Act) which limits pain and suffering to
$250,000 above an unlimited award for actual cost of error amortized over the
life of the patient. The lawyers are objecting that they cannot afford to sue on
behalf of a patient unless the pain and suffering is also unlimited. This
article states that in some cases outside of California the awards have gone as
high as $40 million. Now that's a lot of pain and suffering. I guess juries are
like patients, when it comes to suffering or health care--spare no money. The
attorneys would rather have their 30-50% or $12-20 million immediately rather
than have it dribble in at only a few hundred thousand dollars or a half million
a year for the life of the patient, which may go on for twenty or thirty years.
Reminds me of Attorney John Grisham’s latest novel, The Summons,
in which one attorney, enjoying huge class action awards, bemoans the fact that
he would be a billionaire if he didn't have to share half of the award with the
[injured] patients.
National HealthCare Systems in the
English-speaking World (Myth Number 3)
John C Goodman, PhD, president of the National Center for
Policy Analysis (NCPA), www.ncps.org in
his recent update of the “Twenty Myths about National Health Insurance,”
documents that Europeans, who are supposed to have universal access and care
that is mostly free at the point of service, are increasingly turning to foreign
travel as the only way to secure these services. The failures of national health
insurance are one of the great secrets of modern social science according to Dr
Goodman. Not only do ordinary citizens lack an understanding of the defects of
national health insurance, all too often they have an idealized view of
socialized medicine. For that reason, Goodman and his associates have chosen to
present their information in the form of rebuttal to commonly held myths.
(See Aug 27 & Sept 10 for Myth 1 & 2.)
Myth Three: Countries with Single-payer Health Insurance Make HealthCare Available on the Basis of Need Rather than Ability to Pay.
Most people in countries that ration health care believe that the wealthy, the powerful and the sophisticated move to the head of the line. Because government officials have little interest in verifying this fact, few formal studies exist. There is considerable evidence, however, that in the face of health care rationing those who can pay find other ways to obtain health care.
1. In Britain, more than seven million people, 13 percent of the population, have private health insurance and private sector spending makes up 15 percent of the country's total health care spending. Although 84 percent of a survey had no private insurance, 40 percent of Britons surveyed would consider going to a private facility to avoid waiting.
2 In Canada, the share of privately funded health care spending rose from 24 percent in 1983 to an estimated 30 percent in 1998.
3 In Australia, about one-third of the population has private health insurance, and private sector spending makes up around one-third of all health care spending.
4 In New Zealand, 35 percent of the population has private health insurance, and private sector spending is about 10 percent of the total health care spending.
Paying Privately for HealthCare in
Britain
From the time the National Health Service (NHS) was
formed, people who wanted to pay for private treatment could have access to it
as well as to the NHS. And despite the British claim that health care is a right
that is not conditioned on the ability to pay, last year an estimated 100,000
patients elected to pay for private surgery in the 300 private hospitals in
Britain, rather than wait for “free” care. Collectively, these hospitals
account for an increasingly larger share of total health care services in
Britain, including 20 percent of all non-emergency heart surgery, 30 percent of
all hip replacements and $25 billion worth of total health care annually,
primarily through employer provided insurance. The NHS earns $500 million per
year in fees from treating private patients. The existence of a large, viable
private health care industry suggests that many Britons do not believe they can
get adequate health care through “free” public channels.
Canadian Medicare
Since Canada does not allow private health insurance for
services covered by the country's Medicare system, Canadians who go to the
country's few private physicians or private hospital must pay most of the cost
out-of-pocket. Although the government may pay the surgeons fee, the patient is
still responsible for the $1000 to $1200 facilities fees. For many procedures a
growing number of Canadians go to the United States. The 1996 estimate was $1
billion. Due to long waits and the lack of equipment, seven of the 10 Canadian
provinces have begun sending some of their breast and prostate cancer patients
to the United States for radiation therapy.
Cost of Regulation
The Mercatus Center at George Mason University has a major
goal of bringing true accountability and results to the government. If
individuals spend their earnings on the basis of results, why shouldn’t the
government spend taxpayers’ funds based on results? The Office of Management
and Budget has introduced performance management standards to make continued
funding of government programs contingent upon their performance in previous
years. The average federal tax burden of the American family is now about
$20,000 per year. Our national HealthCare expenditures have now surpassed $1,000
billion per year. The cost of regulation is now $843 billion per year or $8,000
per year for every household. I understand that the cost and regulating of
social security, Medicare, Medicaid, and veteran’s medical programs is the
major portion. Unless we reverse this, we will be in the same state as the rest
of the world when tax funds of even greater magnitude are unable to pay the
exorbitant cost of government programs. Would it not make sense to reverse this
trend before the crises forces us to return to semi-private options after most
of them have disbanded? However, when government, even after total failure of
the socialized system, tries private options, many are programmed for failure
with the claim that personal accountability didn’t work, when in effect it was
not really tried. (www.mercatus.org)
Why Foreign Aid Doesn’t Help the
Poor or Sick
John Cassidy in his “Annals of Economics” which
appeared in The New Yorker earlier this year, considers “How Foreign Aid could
Benefit Everybody” after reviewing economist William Easterly’s book
entitled The Elusive Quest for Growth: Economists’ Adventures and
Misadventures in the Tropics. Easterly pointed out that between 1950 and 1995
the developed world dispensed the equivalent of more than a trillion dollars in
economic assistance, yet many of the aid recipients remain poverty-stricken. He
lists dozens of countries that wasted significant aid and some are now even
poorer. He told Cassidy that “Economic development is too important to be left
to politicians.” This is a contention which the Bush Administration has
endorsed and has begun cuts in economic support. Cassidy, however, is optimistic
that Bush will reverse these cuts since we will be more successful in achieving
results with the second trillion dollars. Optimism reigns supreme. I’m sure
when the second trillion dollars is squandered, optimism will nevertheless
continue to grow with the belief that the third trillion dollars will be
successful in helping the poor and the sick. In the real world, however, that
will never happen. If government handouts cannot help the poor and destitute, we
should make every effort to keep government bureaucracies from forcing a health
plan on the 85% of the citizens who can afford to do it more cheaply themselves.
Or as in Canada, where patients are prevented from obtaining individual
coverage. The United States is not a third world country. There is no economic
reason to bring third world health care to our country when it is clear that
government medicine has not worked, even in the developed world.
Debate with the Left on Private
Medical Care
This month Jim Peron opened his article, “The
Contradictions of Capitalism” in Ideas on Liberty with a
paragraph that's worth remembering: “We advocates of individual rights and
free markets can't win the intellectual debate with the ideological left. That's
because there is no intellectual debate with the left. There can't be a debate
since the opponents of capitalism are simply not open to a rational discussion.
They know that capitalism is inherently evil, and no argument, no evidence, no
facts will convince them otherwise.” Every other Tuesday we list arguments
made by renowned economists, actuaries, business and professional leaders in
this electronic newsletter which illuminate the failures of single payer
medicine or socialized medicine as promulgated by the liberal left. The fact
that every system of centralized medicine throughout the world has failed has no
effect on their thinking or on their continued effort to have a single payer
system in this country whereby they can control the personal lives of those who
can afford private care as well as the lives of the poor. Should we cease our
dissent since no argument will change the opinions of the left? Since the left
considers socialism, much as a religion, or akin to faith, the chances of
conversion to a system of personal responsibility is rather unlikely. The
administrator of one medical society points out that the periodic polls of its
membership have seen a slow but steady growth in members who are for single
payer or socialized medicine in California and in the USA. He feels in the next
few years they will become a majority. What the Judeo-Christian right must
recognize is that much of this is a sign of desperation and resignation
bordering on hopelessness.
But Against All These Odds, Is There
Still Hope?
Before the advent in the 1970s and 1980s of the For Profit
Health Maintenance Organizations (FP-HMOs as opposed to Non Profit
Kaiser-Permanente which is a well working staff model HMO–any generic
reference to HMOs in MedicalTuesday does not include Kaiser) the vast majority
of physicians still believed in a confidential Doctor/Patient interface and
accountability. Integrity was the doctor’s middle name and Trust
was the patient’s middle name. The written record of that interface was
inviolable. My medicine professor at KUMC contended that the medical record is
the doctor’s record, not the patient’s, and can be released only by mutual
agreement or court order. The reason is apparent. Otherwise, it would never
contain the important personal items concerning lifestyle, habits, (e.g., drug,
alcohol, diet or sexual abuse) or indiscretions, that colors so much of our
patients’ cause and response to illness. Then came the leftist social planners
who maintained that the patient’s record should be freely available upon
demand. In California, a law was passed that any patient could demand his
physician’s account of his illness upon walking in the office and paying the
cost of the copying fee. When patients realized the nature of the personal items
contained in their medical records, there was a huge outcry and legal activity.
Then it was decreed that a routine release could not include these personal
items. Therefore, they had to be cut or inked out. A special release, which
detailed the specific type of personal information to be given out, was
required. Doctors finally acquiesced by discontinuing to record such items which
was unfortunate since they were pertinent to fully understand and manage the
patient’s illness.
Then came the various codes that defined not only the Doctor/Patient interface, but listed the ICDA codes of the patient’s various diagnosis. This code became required for Medicare and Medicaid and third party payment making the patient’s health history essentially an open record. Since the patient’s record was so widely available, then came HIPAA, the Health Information Privacy and Accountability Act. This is a heinous assault against a non-violent profession, which re-instituted privacy, which only became a problem with governmental interference, with 300 pages of rules and regulations. Penalties for failure to adhere to these various codes reads more like the penalties for murder, burglary, robbery, or rape. For minor variations in coding, the penalty is up to $10,000 fine per line of code variation or interpretation and up to 10 years in prison, even if medical judgment and care was appropriate. This past week, at the AAPS meeting (Association of American Physicians and Surgeons) we heard from doctors who had been jailed for two to five years with fines exceeding their lifetime income. Considering that one might have 5-10 lines of diagnosis and/or procedure codes per patient encounter, the $50,000 to $100,000 fines per patient visit can add up to millions rather rapidly. And since any inconsistency is considered fraud, the physician always loses his/her medical license.
Yes, There is Hope
Also at the AAPS meetings, I met dozens of doctors who are
abandoning Medicare, Medicaid, or any government program. They are, as practice
consultant Barbara Lehman pointed out last week, developing Brand name
practices. She cited several examples of doctors who successfully tell their
patients to say no to HMOs and government health care and yes to
Personal HealthCare. Initially these physicians were not convinced that they
could survive without Medicare, Medicaid, and HMOs. But by reducing overhead and
eliminating the cost of billing, their incomes actually increased as patients
left their Medicare card at home and willingly paid cash. We will bring you
other examples in future issues.
The Goal of MedicalTuesday
One of the goals of MedicalTuesday is to continue to point
out the importance as well as the successes of non-governmental health care.
Although the number of physicians that believed in personal and patient
accountability may have dropped from 99% three decades ago to 70 percent (should
we believe the leftist numbers), MedicalTuesday realizes the futility of trying
to convert the left. As Peron (whom we mentioned previously) stated, there is no
rational debate. MedicalTuesday is sent primarily to those 70 percent who
believe in personal accountability in order to prevent further attrition to the
liberal left. The left will forever consign American HealthCare to a third world
status, which much of the developed world is now experiencing, and where less
than enthusiastic privatization efforts are being started.
MedicalTuesday Recommends
The Greg Scandlen Health Policy Comments as an important
source of market-based medicine. You may log onto NCPA (www.ncpa.org)
and register to received Greg’s weekly report or the full NCPA daily report.
We also recommend the market-based reports of Lew Rockwell, president of the
Ludwig von Mises institute. Please log on at www.mises.org
to obtain the foundation’s reports or log onto Lew’s premier free market
site at www.lewrockwell.com.
MedicalTuesday Recognizes
SimpleCare for their success in restoring private
practice, www.simplecare.com,
HealIndiana as a supporter of market-based medicine, www.HealIndiana.org.
The AAPS representing physicians in their struggles against bureaucratic
medicine www.AAPSOnline.org.
Republishing MedicalTuesday
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Tuesday e-letter. We grant permission to any non-profit organization to
republish this column with attribution to MedicalTuesday and its author as long
as a formatted copy of the portion that is republished is sent to Info@MedicalTuesday.net
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Stay Tuned to the
MedicalTuesday.Network
This week we welcome a number of new readers from the AAPS
and KUMC. We invite their response, the re-sending of this to their friends and
colleagues and other interested business and professional associates. It is our
understanding that each individual is personally known, requested to be placed
on our mailing list, or was recommended as someone interested in our cause of
making HealthCare affordable to all. If this is not correct or you are not
interested in or sympathetic to a Private Personal HealthCare system, email DelMeyer@MedicalTuesday.net
and your name will be sorrowfully removed.
Del Meyer, MD
DelMeyer@MedicalTuesday.net