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
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 storiesbut 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.
* * * * *
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 97percent specificity (meaning it catches 97
percent of true negatives) and 80percent 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.
* * * * *
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
* * * * *
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.
* * * * *
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
* * * * *
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.
* * * * *
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-rayincluding the readingis $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 rulesfor 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 caresome 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.
* * * * *
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
Publica huge taskbut 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.]
* * * * *
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.
* * * * *
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 towww.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.
* * * * *
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
* * * * *
11. Physicians Restoring Accountability in Medical Practice,
Government and Society: