MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 12, Sept 25, 2007

 

In This Issue:


1.                  Featured Article: The Ultimate Diagnostic Device

2.                  In the News: Hold onto your wallets! Legislators are at work.

3.                  International Medicine: Trust him, Gordon, he's a doctor.

4.                  Medicare: Medicare Meltdown By Thomas R. Saving

5.                  Medical Gluttony: Medicare is Now Paying Transportation Costs

6.                  Medical Myths: Doctor, I'd Feel Better If You Got An X-Ray On My Son

7.                  Overheard in the Medical Staff Lounge: Putting Individuals in Control of Health Care

8.                  Voices of Medicine: Solving the Health-Care Worker Shortage

9.                  From the Physician Patient Bookshelf: Health Wars: The Empire Strikes Back

10.              Hippocrates & His Kin: Plan Your Death Carefully

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

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SOCIALIZED MEDICINE AND MICHAEL MOORE'S SICKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. This movie can only be made if Clements finds 200 doctors or health care executives willing to make a tax-deductible donation of $5K. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit
www.sickandsickermovie.com or email logan@freestarmovie.com.

SiCKO and Its Malcontents: Health Care on Film http://liberty.pacificresearch.org/events/ID.37/detail.asp

More on Moore: John Goodman, PhD, President of the NCPA, announces that they have a new Michael Moore site: http://sicko.ncpa.org/. At his own site, Michael invites visitors to send him health horror stories—but only about the U.S. system! To add balance, our site has health horror stories about Canada, France and Britain. Read the reviews at http://sicko.ncpa.org/?c=reviews. Read the testimonials at http://sicko.ncpa.org/?c=Testimonials. Read the Rest of the Story by going directly to http://sicko.ncpa.org/?c=The-Rest-of-the-Story.

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1.      Featured Article: You've Got Drug-Resistant TB! The Ultimate Diagnostic Device

1.      By Thomas Goetz, WIRED Magazine, August 2007

Charles Daitch, CEO of Akonni Biosystems, has introduced the TruDiagnosis system to identify deadly pathogens quickly and cheaply.

In April 1989, the Centers for Disease Control and Prevention announced an audacious goal. In a report titled A Strategic Plan for the Elimination of Tuberculosis in the United States, the CDC declared that by the end of the 20th century, the number of TB cases in the US would drop to 10,000 a year — down from 22,000 in 1985. And by 2010, the scourge would be eradicated from our shores. "A great nation such as ours can carry out this plan," the authors wrote with an enthusiasm unusual for the buttoned-up agency. "It is time to commit to a tuberculosis-free society!"

It was stirring rhetoric — but that's about all. Instead of falling, cases of TB initially shot up, reaching almost 27,000 in 1992. In 2000, instead of 10,000 cases nationwide, there were still nearly 17,000. The surprising trend, revealed in a 1999 assessment of the plan's failure, could be attributed to several factors. For one thing, the arrival of HIV created an immunity-compromised population acutely susceptible to infection. For another, state and local agencies, misreading the statistics and assuming TB was under control, scaled back their surveillance, screening, and treatment programs. Meanwhile, the CDC hadn't recognized the emergence of new strains of TB that proved impervious to courses of typical antibiotics.

All of these problems could have been addressed by better detection and diagnosis. But the CDC was slow to spot new risks and slower yet to bolster its network for monitoring infectious disease. To read more, please go to www.medicaltuesday.net/index.asp. 

Almost 20 years after the CDC's plan, our inability to diagnose and track infectious disease quickly and accurately remains a serious problem. Take the case of Andrew Speaker, the Atlanta attorney with drug-resistant TB whose international odyssey was front-page news this past spring. Using conventional diagnostics, it took the CDC four months, by Speaker's account, to definitively identify his particular strain as extensively drug-resistant, or XDR, TB. That lag meant he was wandering about, potentially exposing thousands to a deadly strain of TB untreatable with most antibiotics. Better diagnostics would spot such a risk earlier. What's more, the fact that Speaker was able to evade quarantine and then slip back into the country demonstrates the inadequacy of our surveillance network. Better diagnostics could improve screening at airports and border crossings. And though Speaker's illness was a novelty in the US, XDR TB is despairingly prevalent worldwide, with half a million cases and climbing. Better diagnostics would give health authorities a weapon to stop that march.

The traditional way to do a quick diagnostic test for TB hasn't changed much since Robert Koch first identified the bacteria under his microscope in 1882. The technique, known as sputum microscopy, calls for sticking a piece of bloody phlegm under a microscope, adding a stain, and looking for the bacteria. That method takes only a few hours but misses about half of all cases. For a definitive diagnosis, labs still rely on the gold-standard technique: a culture. This was first developed by Julius Petri in 1877: Place the sputum in a dish, add nutrients, and let it sit for a few weeks. If there's TB, the sample will grow a colony of telltale bacteria. To use the terms of epidemiology, this method has 97†percent specificity (meaning it catches 97 percent of true negatives) and 80†percent sensitivity (meaning 20 percent of negative tests are actually true positives). Those figures are considered quite high, standing as benchmarks for any competing test.

The problem with cultures is that they take a long time — three weeks or more — to produce a definitive result. In those three weeks, antibiotics may be fortifying the bacteria's resistance rather than curing the patient. In those three weeks, a TB patient goes back into the population and spreads disease. In those three weeks, the bacteria have enough time to escape our grasp. What's needed, then, is a new way to diagnose the disease: one at least as fast as the sputum microscopy test, as accurate as the culture, and refined enough to differentiate between garden-variety bacteria and drug-resistant strains. What's needed is nothing less than a new gold standard.

Those tests might finally be at hand. There is a crop of diagnostic tools on the horizon, portable devices that can detect infectious disease with a degree of accuracy that measures up to that of lab-based cultures. Dozens of companies are investing hundreds of millions of dollars to develop these new tools. Some of the funding comes from venture capitalists ; some comes from the Defense Department (which sees infectious disease as an ideal vehicle for bioterrorism) and from the Bill & Melinda Gates Foundation (which has invested $155 million in diagnostics since 2000 as part of its fight against TB, malaria, and other infectious diseases). The new approach blends the values of the technology sector, in which products live or die based on how well they scale toward cheaper, simpler versions, with the priorities of global public health, which holds that if a solution isn't cheap and simple to use, it may as well not exist. The result is an emphasis on cost, speed, size, and simplicity. It's a formula that could change the way infectious disease is detected and treated.

How TruDiagnosis Works
1) A few microliters of DNA sample are dropped onto a cartridge the size of a business card.
2) The sample flows over an array of probes that test for six TB genes and 88 strain-specific mutations.
3) The card is inserted into a reader that uses a laser to detect which dots light up, indicating a genetic match.  . . .

TB has been a scourge of humanity for thousands of years, long enough to have earned a number of names (phthisis, the White Death, consumption) and to have taken an inconceivable number of lives. (Some estimates hold that TB has caused 3 billion deaths in human history, perhaps the greatest killer of all time.) Today, 2 million people worldwide die of TB annually, even though the pathogen would prefer not to kill us. It would rather we stay alive so it can continue to spread, something it does quite well. Fully one-third of humanity — some 2 billion people — carry TB. Most of those carriers have so-called latent infections and will never develop symptoms. But for 10 percent, the bacteria can lie dormant for as long as 20 years until something (we just don't know what) triggers the bacteria to attack the host, leading to an active case of TB. . .

The discovery of antibiotics in the 1940s provided the first opportunity to actually cure tuberculosis. But it also started a race with evolution that we're destined to lose, as the bacteria responds to the antibiotics by morphing into ever-more-hardy strains. Multidrug-resistant tuberculosis, or MDR TB, first took hold in the 1990s and is defined as resistance to isoniazid and rifampicin, the two most powerful anti-TB drugs. Its more lethal cousin XDR TB is resistant to not only these first-line drugs but also to fluoroquinolones, the last-resort antibiotics that can cause severe side effects, including depression and musculoskeletal problems. The cure rate for XDR TB is only about 50 percent in the general population; among people with lowered immunity, a stunning 85 percent will die. "It's the hot zone of the moment," says Tom Shinnick, lab director of the CDC's project on tuberculosis eradication. "Physicians are treating it with standard regimens, and the patients are failing the regimens. In the meantime, they're out there spreading the disease." A rapid test that would detect TB down to the particular strain, Shinnick says, "would make a tremendous difference." . . .

By current tools, of course, Espinal means those developed more than a century ago. At the time, Koch's microscope and Petri's dish represented a huge shift in health care: They shook medicine free from diagnosis based on symptoms and let scientists pursue causes instead. Molecular diagnostics pushes medicine back even further, to risks. That means treatment based on the likelihood of getting a disease. If a microarray test is precise enough, doctors could detect a pathogen even before it goes to work, allowing them to intervene far earlier than we do now. Indeed, before disease as we understand it has even started.

Deputy editor Thomas Goetz (thomas@wired.com) wrote about metabolic syndrome in issue 14.10.

To read the entire report, go to www.wired.com/medtech/health/magazine/15-08/mf_tuberculosis.

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2.      In the News: Hold onto your wallets! Legislators are at work. Sacramento Bee, Editorial, 9/12/07

Both chambers and both parties cook up a $1 billion gift for prison guards union.

Want to see what it looks like when your pocket gets picked? Look no further than the prison guards union's latest power play in the [California] Legislature.

A bit of recent history is in order. The union withdrew in late August from the mediation process set up to move contract talks along. On Sept. 1, an arbitrator ruled against the union's request that the state continue to pay increases until a new contract is negotiated, saying that for the state to give increases beyond the dates specified in the contract that expired July 2, 2006, "would result in automatic increases, without any collective bargaining, into the indefinite future."

But why bother with negotiating when you can get the Legislature to just open the public purse for you? So on Tuesday, the California Correctional Peace Officers Association pressed legislators to pass a last-minute, stealth amendment -- with no hearings and past the legislative deadline for amendments -- to add $1.2 billion in new pay increases based on the formula in the old 2001-2006 contract. To read more, please go to www.medicaltuesday.net/news.asp.

This cost is not in the Budget Act of 2007 that the Legislature passed and Gov. Arnold Schwarzenegger signed. The amendment would require the Legislature to get money "from any appropriate fund sources."

According to a fiscal analysis done by the Department of Personnel Administration, the cost of new increases based on the formula in the old contract would be $459 million in 2007-2008, $247 million in 2008-2009, plus retroactive costs of $177 million for 2006-2007. In addition, the amendment calls for further pay raises of 3.5 percent on April 1 and 6.1 percent on July 1, another $346 million.

. . . This is extortion, implying "no pay raises, no implementation of reforms."

This maneuver is a blatant attempt to get around not just the bargaining process but the legislative process as well.

How this happened is a study in legislative power politics. . . .

In short, legislators of both parties gave into thuggery by the union -- with no public notice, no hearings and no public debate. This travesty could cost taxpayers more than $1 billion. That's quite a successful exercise in picking the public's pockets, even by the standards of the guards union and their legislative lackeys.

To read the entire editorial, go to www.sacbee.com/110/v-print/story/373801.html.

[If this actually passes with 80 accomplices in the California Legislature, it would exceed all the accomplices of Kenneth Lay, Jeffrey Skilling, Andrew and Lea Fastow of Enron, Bernie Ebbers of WorldCom, John and Timothy Rigas of Adelphia Communications, Martha Stewart, Ivan Boesky, Michael Milliken, Leona Helmsley, and Bill McGuire, MD of UnitedHealth combined. Why aren't the Legislative Thugs prosecuted, tried and jailed like these other criminals? Even if this is reversed, it doesn't change the crime any more than the victim of an attempted murder surviving changes the crime.]

Never blame a legislative body for not doing something. When they do nothing, they don't hurt anybody. When they do something is when they become dangerous. --Will Rogers

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3.      International Medicine: Leading article: Trust him, Gordon, he's a doctor, The Independent on Sunday, Published: 29 July 2007

The present problem of the National Health Service is easily stated but fiendishly difficult to solve. For eight years, since the restraint on public spending was lifted by Gordon Brown and Tony Blair in 1999, vast amounts of extra money have been poured into the NHS. Yet the improvements purchased by this new spending have been patchy and disappointing. In some areas, it is possible that the care provided by the NHS is worse now than it was 10 years ago. To read more, please go to www.medicaltuesday.net/intlnews.asp.

It is difficult, for example, to be sure that Martin Bircher, one of the country's leading bone surgeons, is right. In an exclusive interview with The Independent on Sunday today, he says that trauma services worked better in the "good old days" before the internal market. "Somebody would ring me up about a patient. I'd say: 'Send them across', make one call to sister on the ward and it would happen," he says. Now, he complains, doctors are distracted by "sending each other little bills". . . 

It should not be the case – certainly not after spending on the health service has increased by more than half (taking inflation into account) – that people with broken bones should be waiting as long as three weeks before they are treated.

Thus far, everyone can agree. The difficult part is what to do about it. Mr Bircher's remedy sounds simple: "Involve the clinicians more in the decision-making. Like the Bank of England, let it go. Doctors, honestly, know best." It is a theme that has been picked up gratefully and with superficial acuity by David Cameron, the Conservative leader. In a policy document last month, he promised to "give NHS professionals the greatest opportunity to exercise their professional judgement and expertise" – as if simply repeating the word "professional" would make it happen.

The trouble is that "doctors know best" is not a policy. The complications become evident the moment Mr Bircher sets out his preferred structure. He wants trauma units to be directly funded by central government, thus bypassing local NHS trusts. This may be consistent with devolving power to frontline staff, but the possible contradiction is obvious.

This newspaper takes the view that much of the Blair reform programme, including the so-called internal market, was right in principle. But its implementation has suffered from poor management and erratic political leadership. In many ways, the NHS has been hampered not by too much bureaucracy but by too much poor-quality bureaucracy.

When the Prime Minister's Delivery Unit focused on the targets for waiting lists and Accident and Emergency waits, big changes could be forced through. But without intense pressure from the centre, institutional inertia wins out. Which is why the lengthy review of the reforms (it is scheduled to take a year), announced by Alan Johnson, the new Secretary of State for Health, is worrying. If this is an excuse for bureaucratic drift, Gordon Brown's claim that the NHS is his "immediate priority" on which he based his claim to be Prime Minister will ring hollow. If, on the other hand, it is a chance to pursue those reforms that are working with renewed vigour, then a difficult corner may be about to be turned.

Good management should be a matter of letting doctors get on with what they want to do, which is to treat patients, while trying to ensure that the priorities of the wider health service, which cannot be set by individual doctors, are the right ones. . .

To read the entire article, go to http://comment.independent.co.uk/leading_articles/article2814696.ece.

The NHS does not give timely access to health care, it only gives access to a waiting list.

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4.      Medicare: Medicare Meltdown By Thomas R. Saving

What's going to happen when the money runs out for Medicare? A recently released report by the program's trustees found that within seven years Medicare taxes will fall short of Medicare expenses by more than 45%. What's more, Medicare and Social Security combined are on track to eat up the entire federal budget.

While the bulk of Medicare dollars comes from payroll taxes and beneficiary premiums, a large and growing share of Medicare expenses is borne by general taxpayers. And although the same law that created the new Medicare drug benefit also requires the president to propose remedial legislation, Congress is not required to actually do anything. To read more, please go to www.medicaltuesday.net/medicare.asp.

The trustees' wake-up call comes none too soon. But what is needed are not minor adjustments. A major overhaul is in order.

The projected cash flow deficits in these two programs are staggering. For Social Security, the trustees estimate the 75-year burden on general revenues at $6.7 trillion. For Medicare the comparable burden on general revenues is $24.2 trillion, even after allowing the current transfers to grow with the economy. Thus the total burden these programs will impose on federal finances over the next 75 years is $31.9 trillion, more than six times the current outstanding federal debt. Looking beyond 75 years into the indefinite future, the combined long-run funding gap for Social Security and Medicare is $74.8 trillion in today's dollars.

Members of Congress will not have to wait long to experience the practical effects of all of this. Until a few years ago, Social Security and Medicare were taking in more than they spent, on the whole. Thus they provided revenue for other federal programs. That situation is now reversed, and last year the combined deficits in the two programs claimed 5.3% of federal income tax revenues. In 15 years these two programs will require more than a fourth of income tax revenues: In other words, in just 15 years the federal government will have to stop spending one out of every four non-entitlement dollars in order to balance the budget and keep its promises to the elderly.

As more and more baby boomers reach retirement, the financial picture will deteriorate rapidly. By 2030, about the midpoint of the baby boomer retirement years, these two programs will require almost one out of every two federal income tax dollars. By 2040, they will require nearly two out of every three federal income tax dollars. Eventually, the deficits in these two programs will absorb the entire federal budget.

Could we force the elderly to pay for future deficits with higher Medicare premiums? Monthly premiums in constant dollars would more than quadruple by 2020, and be almost 30 times their current level by 2080. At that point, the required monthly premiums would consume more than the entire Social Security benefit (from which they are automatically deducted) for average-wage earners.

Using taxation to fund the projected Medicare shortfalls is equally unpalatable. We would need a 10% increase in all nonpayroll taxes by 2020 and a 50% increase by 2080, the close of the trustees' 75-year projection period.

So what else can be done? In general, no reform should be taken very seriously unless it is specifically designed to slow the rate of growth of health-care spending. On the demand side, someone must choose between health care and other uses of money. That is, someone must decide that the next MRI scan or the next knee replacement, for example, is not worth the cost. Such decisions could be made by seniors themselves, by the government (as it is in other countries), or by private insurers operating under government rationing rules. On the supply side, the way health care is produced must fundamentally be changed, replacing cost-increasing innovations with cost-reducing ones.

To examine consequences of beneficiaries making their own rationing decisions, my colleague Andrew Rettenmaier and I estimated the effects of creating reformed Medicare based on a $5,000-deductible Health Savings Account (HSA), beginning with the baby boomer retirees. The size of the deductible and the HSA would grow through time (as health costs grow), and since deposits would be made with after-tax dollars, withdrawals for any purpose would be tax free. In this way, beneficiaries would be encouraged to make their own tradeoffs between health care and every other good or service. We estimate the effects would result in a reduction in Medicare's unfunded liability by between 25% and 40%. . .

Even with these reforms, however, we must still address the problem of pay-as-you-go financing. Today every dollar in Medicare payroll taxes is immediately spent. Nothing is saved. Nothing is invested. The payroll taxes contributed by today's workers pay the medical benefits of today's retirees. However, when today's workers retire, their benefits will be paid only if the next generation of workers agrees to pay even higher taxes. . .

If nothing is done, Social Security and Medicare deficits will engulf the entire federal budget. If our policy makers wait to address the growing deficits until they are out of control, the solutions will be drastic and painful. Let us hope that the current wake-up call is not ignored.

Mr. Saving is a public trustee of the Social Security and Medicare system, director of the Private Enterprise Research Center at Texas A&M University, and a senior fellow at the National Center for Policy Analysis.

To read the entire report, go to www.ncpa.org//edo/trs/20070509saving.htm.

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Transforming Self-Care into Group Health Care

Mrs. White had a sore shoulder from doing her house work. Examination revealed a mild degree of pectoral and deltoid muscle tenderness. She wasn't interested in taking analgesics or muscle relaxants or range- of- motion self physical therapy. She insisted on having Physical Therapy in the physical therapy department at the hospital. When I explained that it wasn't medically indicated and would cost hundreds of dollars of her health insurance money, she simply stated: "But it's more fun doing the exercises together with a bunch of ladies."

Remember the days when it was more fun to have all the kids tonsils removed on the same day?

To read more, please go to www.medicaltuesday.net/gluttony.asp.


Motorized Wheelc Chair Replacing a Second Automobile

Mr. Brown, an emphysema patient, requested a motorized wheelchair. He had found a model he would like for $3500. After his examination, his pulmonary function was reasonably good, his arterial oxygen was normal, and we explained to him that walking rather than riding in a wheel chair was good pulmonary rehabilitation. He then explained the real reason: His wife had just taken a part- time job, and they couldn't afford a second car, so they wanted a motorized wheel chair for him to visit his friends in the neighborhood and go shopping. Medicare will pay for it, won't it?

Isn't it amazing what you can stuff into your Medicare benefit bonanza? Maybe health foods next?


Doctor, Can't We Just Start Over?

Mrs. Green, came in with a number of complaints. They were all "non-serious" aches and pains; gas and bloating, weight gain, dry skin and flab. There were no life-shortening problems elicited such as heart disease, hypertension, diabetes, or cancer. She didn't want her prior record transferred, stating it was about six volumes and it was not helpful in finding what was wrong with her. It appeared that she had almost all tests done several times. She stated that no doctor had ever been able to help her. We reviewed the tests she already had, sometimes several times. Many were extremely expensive. It appeared that Medicare tax payers and Blue Cross premium payers had already invested in her health care somewhere between the price of a Lexus and a fine home in the country club district of Sacramento. She wanted this investment discarded. It became apparent after about 60 minutes that another similar investment would still not make her happy. Added to that, she was not self reflective enough that psychiatric consultation would have been accepted or helpful. It was finally decided that she would fare better with another physician in her endeavors to start over with other people's money.

What could stop this huge health care costs? Relatively free health care only increased her appetite. Only Consumer or Patient Directed Health Care (PDHC) would have helped this unhappy lady come to terms with her numerous complaints. By paying a certain percentage of every doctor's visit and every test she requested, she would begin to evaluate her entire medical history in a different, but more realistic, perspective.

The poorly understood paradox: PDHC puts more stringent controls on escalating health care costs than all the Medicare, Medicaid, VA, Managed Care, HMO and insurance restrictions combined. But the corollary that the establishment would support this is a greater paradox. Insurance carriers love a confusing picture that only they can understand. The Patient and Doctor Be Damned.

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6.      Medical Myths: Doctor, I'd Feel Better If You Got An X-Ray On My Son.

A mother brings her 15-year-old soccer-playing son to the doctor. "He twisted his ankle and needs an X-ray," she tells the physician.

The doctor conducts a careful physical exam and applies a set of clinical rules developed specifically to determine the likelihood that a bone is broken and whether an X-ray is needed. The exam on the soccer star suggests that the chance of a broken bone is remote; the doctor diagnoses a sprain and wraps the foot in a splint

"I'm glad you think it's a sprain; I'd feel better if we could get X-rays just to be sure," the mom replies. . To read more, please go to www.medicaltuesday.net/myths.asp.

Until these ankle guidelines were developed, billions of dollars a year were wasted on unnecessary ankle X-rays (the charge for a typical three-view ankle X-ray—including the reading—is $240). Doctors ordered the X-rays "just to be sure" because they didn't know enough about the accuracy of the physical exam.

So researchers set out to study the accuracy of each part of the ankle exam in determining a fracture. They then combined those parts of the exam that were best able to predict a fracture into a "rule." They tested these rules on thousands of people arriving at emergency rooms with ankle injuries, and found the rules had a very high ability to predict ankle fractures. . .

. . . the ankle rules have saved billions of dollars and missed few, if any, serious fractures. Now researchers have developed all sorts of clinical rules—for knee, back, neck and hip injuries, to name but a few. The rules are intended to improve care, decrease the use of unnecessary testing, and, of course, save money. (Sixteen percent of our gross domestic product is spent on health care—some estimate that 30 percent of this may be spent on unnecessary tests and treatments . . .

To read Prof Wilkes entire article, go to www.sacbee.com/health/v-print/story/329761.html.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.

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7.      Overheard in the Medical Staff Lounge: American Health Care in Critical Condition

The Staff Room was abuzz with John Stossels's 20/20 Special last week. We bring you a summation of the ABC Report that explains it better than capturing individual comments, which we may do at a later time.

The Case for Putting Individuals, Not Employers or Government, in Control of Health Care by John Stossel and Andrew Sullivan, Sept 14, 2007.

Most everyone agrees, America's health-care system is a mess.

Millions of Americans lack health insurance and still our annual health-care costs exceed $2 trillion  that's about the size of the entire economy of China. For the country with the world's "best" medical care, a lot of people seem unhappy.

Many hate the insurance industry.

Employers have seen insurance premiums rise 87 percent over the last seven years. General Motors now spends more on its employees' health insurance than on steel. Doctors are fed up, too; the average physician's office spends 14 percent of its income filling out paperwork.

No one seems angrier than the patients who have been denied care. . . To read more, please go to www.medicaltuesday.net/lounge.asp.

 

Insurance industry spokeswoman Karen Ignani is eager to report that . . . Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage. Only 3 percent of health insurance claims are denied, she says.

In his hit documentary "Sicko," Michael Moore focuses on tragic stories of people whose insurance claims have been denied. His prognosis? He calls for "the elimination of private profit-making health insurance companies" and suggests turning over all health-care spending to the government to provide "free" health care to everyone. He goes to countries like Canada and Britain and implies that their socialized systems are far better than that of the United States.

'What It Costs When It's Free'

There are many problems with health insurance, but that doesn't mean we should put the government in control. If it's decided that health care should be paid for with tax dollars, then it's up to the government to decide how that money should be spent. There's only so much money to go around, so the inevitable result is rationing.

It's just the law of supply and demand. Lowering prices increases demand. Lowering the price to nothing pushes demand through the roof. Author P.J. O'Rourke said it best: "If you think health care is expensive now, wait until you see what it costs when it's free."

When health care is free, governments deal with all that increased demand by limiting what's available.

The reality of "free" health care is that people wait. In the United Kingdom, one in eight patients waits more than a year for hospital treatment and the British government recently set its goal to keep wait times to less than 18 weeks: that's more than four months! In Canada, almost a million citizens are waiting for necessary surgery and more than a million Canadians can't find a regular doctor. In the small town of Norwood, Ontario, a weekly drawing is held in which a townsperson wins the right to access the town's one family doctor.

Governments ratchet down health-care costs in different ways. . .  In the United Kingdom, one hospital was inspired to save money by not changing sheets daily. British papers report that instead of washing the linens, nurses were told to just turn the bedsheets over.

Government is less the answer to our health-care crisis than the problem. It was our government that helped to create the absurd system in which two out of three Americans get health insurance through their employer. In a country where four in 10 Americans change their job every year, this system makes little sense; it leaves people . . . without coverage when they need it most.

The government also makes insurance expensive by mandating the medical services that policies must cover. Required services vary state by state and include massage therapy, pastoral counseling, acupuncture, hair prosthesis and dentures. Such mandates are a reason why an individual policy in New Jersey costs around $4,000 a year while a policy in Iowa costs only a third of that. Yet insurance regulations make it illegal for someone in New Jersey to buy a policy from out of state.

The Way We Pay

Another problem that raises costs, and keeps individuals from controlling their own health care, is the way we pay for medical care. Out of every dollar that the United States spends on health care, only 12 cents comes out of the pocket of patients, according to the Centers for Medicare and Medicaid Services. Most of us have our medical expenses covered by a third party, either an insurance company or the government.

When we pay for health care with someone else's money, it creates nasty incentives. It's good to be covered in case of a medical catastrophe, like a heart attack or cancer, but when patients pay for almost everything from physicals to acupuncture using third-party money, they have no reason to care about cost. Because the buyers don't care about cost, neither do the health-care providers.

"It's gotten to the point where doctors don't even know how much it costs them to provide this service or that service or how much an office visit should cost. Try asking a doctor how much an office visit costs and watch their face go blank," said Michael Cannon, director of health policy at the Cato Institute.

Our health-care system has become totally removed from the competitive market forces that have improved every other area of the economy. If patients cared about cost, health-care providers would compete to attract patients. They'd do innovative things to keep costs low while increasing quality.

Harvard Business School professor Regina Herzlinger, author of "Who Killed Health Care?", reminds people that "when Henry Ford came around, cars cost more than houses." By competing for profit, Ford revolutionized the auto industry. In eight years, he cut the price of cars in half while improving quality immensely. In nearly every sector of the economy, prices drop over time as technology improves. Not so in health care.

Customer Service, Competition, Control

Can you e-mail or call your doctor to ask quick questions? In the 21st century, when even small children regularly use computers, many doctors and hospitals don't.

"Why would they?" said Dr. David Gratzer, author of "The Cure." E-mail and telephone consultations aren't things most doctors can get paid for. Dr. John Goodman of the National Center for Policy Analysis, said, "The federal government has a list of 7,500 procedures it will pay for: the telephone's not on the list [and] neither is e-mail." . . .

'You and Me'

The more people control the money they spend on their own health care, the more people shop around and the more providers compete to attract patients by lowering prices while improving quality. It's putting individuals in control that could turn our health-care sector into the vibrant, competitive marketplace that we see in nearly every other area of our economy.

After all, it's our body and our health. Shouldn't we be in control of how our health-care dollars are spent?

Harvard's Herzlinger said, "Who should decide whether you live or die? Do you want the government to decide? Do you want a health insurer to decide? Who's gonna make that decision? Is it gonna be a government? Is it gonna be an insurer? Or is it gonna be you and me?"

Putting individuals in control of our health, rather than our employers or the government, is a better way to cure what ails America's health system.

Read more of the story at http://abcnews.go.com/2020/Stossel/story?id=3580676&page=1.

[The doctors seemed optimistic that the tide is changing. We must continue our efforts to enlighten the Doctor's Professional Organizations, the AMA, CMA and others; the Nurses, the ANA and CNA; HealthCare Administrators; Insurance carriers, and their brokers and agents; and the Public—a huge task—but a cause worth the effort to save the American Heritage and the American Dream that brought our grandparents to these shores to participate in the innovative but disruptive cause of individual Freedom.]

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8.      Voices of Medicine: From SONOMA MEDICINE, the Magazine of the Sonoma County Medical Association

Practical Concerns: Solving the Health-Care Worker Shortage By Ezbon Jen, DPH

Newspapers are filled with reports about the latest natural disaster or falling home prices, but some big stories never make the front page. Does a headline like "California has a serious nursing shortage" grab your attention? If it doesn't, it should. Sonoma County and many other counties across the United States face one of the most significant challenges ever: training the next generation of health-care workers.

By 2010, California will face a shortfall of more than 100,000 registered nurses. The Golden State ranks 49th in the nation in the number of RNs per capita; only Nevada has a lower ratio. Unlike previous cyclical nursing shortages, the current crisis is not expected to lessen anytime soon. To read more, please go to
www.medicaltuesday.net/voicesofmedicine.asp.

The nursing shortage is symptomatic of a critical shortage of health-care professionals throughout our state. For example, California ranks 48th in the nation in the number of pharmacists per capita, and there are currently about 6,000 unfilled full-time pharmacist positions in California. Sonographers are also in short supply, and the average age of practicing sonographers is 52. In Sonoma County, the average age of practicing registered nurses is 47. Nearly everywhere you look in the health-care industry, workers are getting scarce.

Meanwhile, demand for health-care services continues to increase. People are living longer, thanks to advances in science and the continuing discovery of new therapies for managing acute and chronic conditions. Octogenarians are the fastest-growing segment of our population, but the medical workers needed to care for them are retiring faster than they can be replaced. . .

As a physician or other health professional, you may wonder what you can do to help address the health-care workforce crisis. There are many ways to help, either directly or indirectly. Most of our students need financial aid because they have little time to work while enrolled in our intense training programs. Our financial aid and scholarship opportunities are limited, and students are faced with living on a tight budget as they pursue rigorous, full-time training. Contributing toward scholarship funds is a major way to assist our students.

Physicians can also serve on high school or college advisory committees, mentor students, volunteer to speak in classrooms, or become involved in our Summer Health Care Institute.

To read the entire article, go to www.scma.org/magazine/scp/sm07/jen.html.

Dr. Jen is Dean of Health and Life Sciences at Santa Rosa Junior College.

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9.      Book Review:  Health Care at Risk: A Critique of the Consumer-Driven Movement by Timothy Jost, Duke University Press, July 2007, $79.95 (used $74.25 at Amazon.com)

Health Wars:  The Empire Strikes Back by John Goodman, PhD, NCPA

Not everyone is enamored of Health Savings Accounts (HSAs) or patient power. There are even people who dislike HSAs almost as much as they dislike the syllogism. Alas, they are legion. We are surrounded by them. Were righteousness and virtue not on our side, we would have been vanquished long ago.  
Many of the complaints of HSA critics are forcefully argued in a new book entitled Health Care at Risk - which I take to be the Freudian counterpart to our own book titled, Lives at Risk. To read more, please go to www.medicaltuesday.net/bookreviews.asp. 
The author, Timothy Jost, is a law professor at Washington and Lee University.  
In a letter to me, he said his book is "fair and balanced."  Compared to the usual screeds, he has a point.  Jost actually reads what we write, instead of relying on the Newsweek summary.  Still, all the book jacket blurbs are from people on the other side.  Readers will have no difficulty understanding why.  
Jost offers a lot of interesting institutional background on the consumer directed health care movement and the people involved before getting down to two main points.  He says CDHC advocates, including yours truly, rely on the neoclassical economic model to understand the health care system (which is true), and he implies that there is some alternative model that could be used instead (which is not true).  
Jost devotes quite a few pages to explaining why the market for medical care is not like the market for breakfast cereal.  If you were otherwise inclined to think of those two markets as pretty much the same, his book is a good read.  That's as a prelude to his finding fault with virtually all of economic theory.  
Simple economic models, he says, ignore transactions costs, imperfect information, externalities, and anticompetitive behavior.     
Economists have learned to deal with these factors in more sophisticated versions of the model, he admits, but he doesn't say how.  The case for the prosecution is so lengthy and varied, there is literally no time for the defense.  
Jost doesn't even remind the reader that the model he is attacking is the very same model that is used to calculate the value of stock options and regulate the money supply; or that it is used by government agencies to forecast the effects of every bill before Congress, including all health legislation; or that it is used ubiquitously by the private sector to predict the effects of external shocks on markets, including all health markets. To read the entire review, go to www.healthcarecom.net/JG_HealthCareAtRisk.htm.    

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10.  Hippocrates & His Kin: Plan Your Death Carefully

Tom Sullivan writes a financial column outlining that many middle-class people forget that when they die, their life insurance and home may have increased in value above the two million dollar trigger for estate taxes and their children will be hit with 45 percent estate tax. It is going up to $3.5 million in 2009 and "sunsets" in 2011 when it falls to $1 million. He says the gallows humor among estate planners is to suggest to their clients that 2010 is a good year in which to die.

No humor exists. Just plan on moving to Oregon or The Netherlands in 2010 and have some doctor kill you (or shall we say, "put you to sleep") for the cost of a one-day stay in the hospital. Your children will love you for it.

Who would ever have thought that euthanasia could be so useful?

To read more vignettes, please go to www.medicaltuesday.net/hhk.asp.


Medicare Audits Are Very Profitable For Auditors

PRG-Schultz International, which is paid as much as 25 to 30 cents for each dollar of Medicare spending it identifies as wrongly paid, can keep its bounty as long as its findings are sustained through the first two levels of administrative review.

PRG-Schultz auditors have rejected almost all the claims for patients admitted after knee and hip replacement surgery, saying in essence the highly focused therapy they received was medically unnecessary and they should have been treated through outpatient services or sent to nursing homes.

As of last Sept. 30, according to a CMS report, $105 million in charges had been rejected by PRG-Schultz under the program. Its commission could be as high as $29 million. But since that report, the hospital association said thousands of additional claims have been rejected and that auditors are now starting to deny rehabilitation hospital services for stroke victims. www.sacbee.com/111/v-print/story/381576.html

Looks like Medicare is getting worse than HMOs in denying care under the subterfuge that it is only denying payment. Remember Linda Peeno? Stamped "Denied." Only the patient "Died."


Energy Problems Made by Lawmakers

Being from the Midwest, most farms had their own water wells and cisterns, windmills for pumping the water for the house and barn, and wind chargers to supply the energy for the house, barn, and farm. Then came cheap water and electricity and these energy savers went by the board.

Now we have expensive and diminishing water and electricity and it is nearly impossible to dig a well or put up an electricity-producing windmill. If they are actually illegal, they are so highly regulated as to make such an investment too costly.

California, as well as the Congress, should pass a law to remove the regulatory restrictions on energy, as well as on health care, which makes both very expensive. We should also have a law that whenever a new law is passed, the legislature must repeal 10 other useless and anti-energy, anti-health care laws.

With a thousand new laws per year, repealing 10,000 a year would be a good start to solve the energy and health care problems.

When Congress makes a joke it's a law, and when they make a law it's a joke. –Will Rogers

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11.  Physicians Restoring Accountability in Medical Practice, Government and Society:


 

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.


 

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

                      Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      To read the rest of this section, please go to www.medicaltuesday.net/org.asp.

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm.To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Hillary Clinton Still Pushing Healthcare Failures. 

                      The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians.  Be sure to scroll down on the left to departments and click on News of the Day in Perspective: Patients seeking an appointment with a dermatologist for Botox treatment of wrinkles can generally get in within a week or two. But if they are worried about a potentially life-threatening condition, such as a changing mole, they may have to wait months. Read the full story at www.aapsonline.org/nod/newsofday462.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read Freedom and the Right to Life at www.aapsonline.org/newsletters/sept07.php. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief, or go to the dedicated website: www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current: www.jpands.org/jpands1202.htm. Don't miss the excellent and extensive book review section which covers eight great books this month.
 
Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Philadelphia/Cherry Hill, NJ, on your planning calendar and get 17 CME units credit. Remember: the AAPS is one of two remaining organizations strictly dedicated to private practice issues. Most of our professional organizations are now dedicated to enslaving physicians in government medicine.


 

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Del Meyer             

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

Will Rogers: If you ever injected truth into politics you'd have no politics.

Mark Twain: Suppose you were an idiot. And suppose you were a member of Congress. But, I repeat myself.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Some Recent Postings

SiCKO and Its Malcontents: Health Care on Film (This event if free.) http://liberty.pacificresearch.org/events/ID.37/detail.asp

Health Care at Risk: A Critique of the Consumer-Driven Movement by Timothy Jost, Reviewed by Dr. Goodman, www.healthcarecom.net/bkrev_HealthCare.htm or directly at www.healthcarecom.net/JG_HealthCareAtRisk.htm

In Memoriam

Anita Roddick, pioneer of green capitalism, died on September 10th

THE only kind of entrepreneur who becomes famous in Britain, a nation sniffy about business people, is the flashy personality who embodies the brand. Think of the bearded Sir Richard Branson of Virgin Atlantic . . .  Or Dame Anita Roddick, a true child of the 1960s, whose Body Shop cosmetics chain blended sensuousness, environmentalism, feminism and glamour with a whiff of political correctness. To read more, please go to www.medicaltuesday.net/org.asp.

She was into green capitalism long before it became mainstream. Her cosmetics were not tested on animals and her materials were mostly natural, bought directly from producers in the developing world. Yet her products were cleverly packaged and promoted to capture a premium price, while making customers feel good about their supposed ethical purity—a formula the established cosmetics firms subsequently emulated.

To begin with, Dame Anita was not an activist or campaigner, simply a born trader who saw a business opportunity and opened her first shop in Brighton, on the English south coast, in 1976. Her bodycare products sent a refreshing message to women: nothing will make you stay young or grow more beautiful, but this stuff will make you feel better about yourself in the meantime. . .

She became Britain's fourth-richest woman, financing a range of pacifist, ecological and human-rights causes, and planned to give away her remaining fortune. But her real legacy was to pioneer greenery as a marketing tool, and bring the harnessing of environmental and ethical concerns into the business mainstream, for good or ill.

To read the rest of the story, go to www.economist.com/business/PrinterFriendly.cfm?story_id=9803795.

On This Date in History – September 25

On this date in 1690, the first American Newspaper appeared. It was called Public Occurrences Both Foreign and Domestic, and was published in Boston.

On this date in 1789, The Twelve proposed Amendments to the Constitution, which guarantees so many of our basic freedoms, was submitted to the states.  Ten of those amendments, constituting what has been known ever since as the Bill of Rights, were ratified. It is because of these we have the right to express reality as we see it in MedicalTuesday.

After Leonard and Thelma Spinrad