Physicians, Business, Professional and Information Technology
Networking to Restore Accountability in HealthCare & Government
MedicalTuesday, Vol IV, No 1, April 12, 2005
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MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive, and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced in the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.
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In This Issue:
1. Lifetime Health Insurance From Birth
Herb Rubin, a gastroenterologist, states, in a HealthBenefitsReform posting, that having a Health Savings Account with High Deductible Health Policy (HSA/HDHP) established at birth has so many good ideas within it, it's irresistible! It solves so many problems. Only the reactionary status quo-loving wonks will resist.
Below are just some of the many health insurance reasons to do it. There are so many good reasons for the HSA portion to be established at birth, they should be obvious to all by this time.
For one thing, no pre-existing health issues. No political fights about what's covered, or even lengthy applications. The health insurance would stay with the policyholder for a lifetime, more than likely never needed, like most insurance.
Need health care? For most issues just see any doctor you like, pay him at the time of service. No hassles.
The other obvious benefit is that it would be cheap, and stay cheap. No lengthy applications. Priced like a commodity. Generic. Purchased like an airline ticket in the open market.
Over time, it would completely supplant employer provided health insurance. "Who needs your crappy HMO; I've got my own. Give me higher wages" This assumes there are any employers left in the country who haven't outsourced everything to India or China, or gone belly up resisting the inevitable.
Insurance would be completely portable, owned by the kid/policyholder. Change jobs, no problem.
Over time, it would replace Medicaid and Medicare, which likely won't exist anyway for kids born today. Kids getting to retirement age won't even know what Medicare was, or have any reason to care, when they have their own private insurance.
The world, and the US economy, will be much healthier, not to mention the individuals with this plan, never dependent on what the boss or government decides to give them, completely free agents.
We will all benefit, even the wonks.
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2. Stolen Computers Had 185,000 Patient Records
Rachel Konrad reported that "A California medical practice is alerting 185,000 current and former patients that their personal data might have been compromised, the latest in a string of security breaches exposing hundreds of thousands of consumers to potential identity theft.
"San Jose Medical Group began sending letters to affected patients earlier this week after thieves stole two computers on March 28 from its administrative office in San Jose. The computers contained names, addresses and Social Security numbers, CEO Ernie Wallerstein wrote in the patients' letters, which California residents began receiving midweek. The computers contained billing codes that could be used to extrapolate medical histories and other sensitive data.
"The medical group's letters comply with a California law that took effect in 2003 and requires companies to notify residents whenever personal data has been compromised. California remains the only state with such a law, but U.S. Sen. Dianne Feinstein introduced federal legislation in February that would require companies to disclose breaches to consumers nationwide.
"After a series of corporate security problems in the last six months, attorneys general in dozens of states are demanding that companies send disclosure notices to residents outside California.
"More than 9.9 million Americans were victims of identity theft last year, costing the nation roughly $5 billion, not including lost productivity, according to the U.S. Postal Inspection Service. The Federal Trade Commission ranks identity theft as the No. 1 fraud-related complaint.
"On Feb. 15, data aggregation company ChoicePoint Inc. acknowledged it was notifying 35,000 Californians that con artists had accessed their data. After complaints from federal lawmakers and attorneys general in other states, the company began sending warnings to 110,000 consumers in other states.
"On March 11, a thief walked into an office on the University of California, Berkeley campus and swiped a laptop containing personal information for 98,369 alumni, graduate students and past applicants. UC Berkeley has set up a toll-free phone hot line and a Web site.
"In one of the state's largest security breeches, UC Berkeley warned 1.4 million Californians in October about a security breach that exposed the names, addresses, telephone numbers, Social Security numbers and birthdays of everyone who participated in a state in-home care program since 2001.
"Universities have accounted for 28 percent of the 50 security breaches of personal information recorded by California since 2003, said Joanne McNabb, the chief of the state's Office of Privacy Protection. That's more than any other group, including financial institutions, which have accounted for 26 percent of the breaches affecting Californians." To read the whole story, see
Did you happen to notice that the biggest privacy breech was the billing codes? Why do we need billing codes? When a patient goes to the doctor for any reason whatsoever, why does the insurance company need to know the diagnosis? In patient-directed personalized health care, the patient controls the cost and nothing private should be exposed. Another excellent reason to get rid of the clinical procedure terminology codes (CPT) and the diagnosis codes (ICD).
Unless someone thinks that legislators, congressmen and attorneys pass more and more laws to keep us all safe, we must remember not to be the one throwing the stone. My secretary's husband came across a discarded computer and took it home. When he fired it up, he found that it was a Windows 95 Pentium 2. Although somewhat dated, it worked rather well. As he was getting it programmed, he realized that it had come from an attorney's office inasmuch as he found a large number of confidential legal documents and contracts concerning many companies, businesses and individuals in the Sacramento area. But then attorneys pass laws for the rest of us to follow.
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3. The Double-Edge Sword of Medical Technology
"Physicians love fancy new medical devices, right? Not when they open the door to malpractice suits," according to Daniel Fisher in Forbes. "It ranks among the most traumatic experiences in a hospital: Paralyzed by powerful drugs yet aware of everything going on around him, the patient listens helplessly as a surgeon hacks away with scalpels and saws, chatting calmly about golf scores and the kids' soccer games while the patient suffers excruciating pain. Every year 40,000 people suffer the experience of waking up during surgery, unbeknownst to the physician. Anesthesia awareness, as it's called, happens 1 or 2 times per 1,000 operations. It has become a lucrative niche for malpractice lawyers, who argue their clients suffered permanent psychological damage from the pain and fear.
"So you might think that doctors would welcome a new brain wave monitor, made by Aspect Medical Systems, that indicates whether a patient is awake or asleep. Instead, the $5,000 device has caused a split among anesthesiologists. Many think it works just fine. But others fear the machine is yet another example of a technological advance that gives doctors useless or ambiguous information in the operating room but can provide a treasure trove of evidence in the courtroom. Once adopted as a standard, such devices become virtually mandatory because doctors can also be sued for not using them.
". . . Good recording devices can head off malpractice suits. Anesthesiologists opposed the pulse oximeter, for example, until it became clear the device cut down on malpractice litigation by providing a simple, unambiguous measure of a patient's blood oxygen.
"But doctors also remember the fetal heart monitor, introduced with great enthusiasm in the 1970s as a way to cut down on birth injuries by alerting doctors to fetal distress in time to remove the baby via Caesarean section. Subsequent research has shown the device doesn't reduce the incidence of cerebral palsy, which results in some of the most costly malpractice judgments against obstetricians. The paper record it produces, however, is a virtual script for trial lawyers seeking to convince jurors that somebody screwed up.
". . . Aspect, in Newton, Mass., says its brainwave sensor is more like the pulse oximeter than the fetal heart monitor. It reduces the chaotic patterns of brain waves to a simple 100-point scale to indicate level of awareness. Already installed in 15,000 operating rooms, the Food & Drug Administration-approved device is rapidly becoming a standard. The American Society of Anesthesiologists is expected to decide whether to endorse brainwave monitoring this fall.
". . . Richards believes that more-detailed medical records would help doctors--if courts adopted a simple change. Paid experts should see the record as the treating physician did, bit by bit in time order. "It's absolutely impossible to judge the physician's behavior fairly when you know the outcome," he says. Will it happen? No way: "The days of the surgeon being the captain of the ship are way past."" To read the entire article, go to http://www.forbes.com/forbes/2005/0425/048a_print.html.
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4. Government Medicine: Leon Lefson, a 90-year-old Political Activist, Still Marches On
Blair Anthony Robertson, Staff Writer for the Sacramento Bee, reported on Leon Lefson, a 90-year-old political activist. "He's been an activist a long time and, the way things are going - he can't stomach our president and he couldn't stand the guy who finished second - he doesn't have the luxury of slowing down even as his steps grow shorter and his aches and pains hurt a little longer.
". . . He's no mere liberal who wants to fine-tune an economic system that is working quite well for most. He is left of left - a Marxist, of all things - in the age of the Hummer, Sam's Club and HGTV. His revolution never happened. The masses are drinking gourmet coffee and talking on cell phones. And even a radical like Lefson lives in a gated community, which seems to embarrass him when it is mentioned.
He argued through the years like any good Marxist that the system creates and fortifies a small ruling class that wields disproportionate power over the rest of the population. "If you have to put your finger on one thing that is the cause of so much misery, it's the system itself, where the goals are not improving human welfare but the bottom line. The system is about profit and greed," says Lefson.
"What I find at this stage in my life is that despite the medical and technological progress that has made the lives of people better and longer, I find the rich are getting richer, the poor are getting poorer and roughly half of our wealth is devoted to finding bigger and better ways of killing people instead of helping them live more enriched, compassionate lives," he says.
". . . He and several friends have been meeting every Tuesday for years to discuss current events and politics. With his keen intellect and enthusiasm for ideas, Lefson is the force behind most discussions. But he has learned to tone down the rhetoric. . . . Even though Lefson would like to transform the American system, he has thrived under it." To read the entire article, go to http://www.sacbee.com/content/news/v_print/story/12697721p_13550294c.html.
Since Lefson meets with his group on Tuesdays, we thought about inviting him to our MedicalTuesday discussions. But someone who thinks that the wealthy, who are living under the rule of law, have less concern for people and have more power than Stalin, Hitler, Mussolini and Hussein dictators who ruthlessly kill their subjects, is hopelessly beyond repair.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony - Perceived As Excellent Care
Doctors have an infusion of new patients to their practice on a regular basis in order to build their practice and replace those patients that move out, or on, or die. These new patients bring a lot of medical practice history with them about how things were done. Many are used to a physician who farmed out every organ with a medical problem to a specialist. A patient with ulcer disease who initially saw his gastroenterologist, perhaps for an important reason such as a diagnostic ulcer problem needing a gastroscopy, continues to return to the GI consultant if for no other reason than to get his acid inhibitor filled every year. This is something the family doctor could do at a lower cost and as a part of the general prescription refills. But these expensive habits are hard to break. With Medicare, Medicaid or HMO, there is no patient financial incentive to reduce such expensive health care costs. No matter how vigorous the policing by Medicare, Medicaid and HMOs of every aspect of practice, the patient does not buy into the economic advantage since there is no economic advantage to the patient when a third party pays the bill. This, however, occurs automatically in consumer-driven or patient-directed personalized health care since the patient bears a portion of the cost. When the patient is at financial risk, even if only for 10 or 30 percent, these cost savings are automatic. There is no significant learning curve. There are no learning conferences that need to be attended, which are totally ineffective. Even the politicians who state that people have to be taught how to manage their own health care have no clue that this cannot be accomplished. Patients have no incentive to learn without a financial risk. In this age of digital medicine, people can no longer take the risk of sending large sums of their hard-earned money to congress which squanders a large portion of it and allocates it on a political basis unrelated to medical needs. The time for patient-directed personalized health care is upon us.
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6. Medical Myths - Emergency Medicine Perceived As Superior Care
When patients come into the doctors office stating that they had an emergency that drove them to the hospital emergency room, they usually seem very pleased even if they had to wait an extra four hours to be seen and may have spent eight or more hours in the emergency department. They are elated that they had chest x-rays, laboratory tests, electrocardiograms, and CT and MRI scans. They do not realize the cost may run into thousands of dollars.
Frequently, a physician has the opportunity to point out that most of these tests were performed in recent months with no change in the results. The doctor may have felt guilty obtaining all the initial tests. But the patient feels better having many of them done a second, unnecessary time. The same tests in the emergency room, a high-cost center, may have cost four or five times as much. But the patient does not understand, appreciate, or is even aware of the cost in a bureaucratic medicine situation such as Medicare, Medicaid, or HMO. A major goal for HMO patients then is to get as many tests as their plan allows or that they can talk their doctor into ordering.
What is perceived as superior high tech care can never be controlled in a bureaucracy without hurting other patients who may have different needs. To stop one patient's unnecessary test is impossible without stopping another patient's life-saving test. These can only be controlled in consumer-driven or Patient-Directed Personalized Health Care (PDPHC), where the cost is controlled instantly at its source. After a test or two in the emergency room, the patient realizes that these are some of the same tests he probably had the previous month or two in the doctor’s office that evaluated similar complaints to that being evaluated in the emergency room. He or she begins to put the breaks on the endless spending in the emergency room.
The cost savings of Patient-Directed Personalized Health Care is huge. The data is just only being accumulated.
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7. Patient Stories Overheard in the Medical Staff Lounge
Jacob, age 81, and Grace, age 80, are all excited about their decision to get married. They go for a stroll to discuss the wedding, and on the way they pass a drugstore. Jacob suggests they go in. He addresses the man behind the counter. "Are you the owner?" The pharmacist answers, "Yes."
Jacob: "We're about to get married. Do you sell heart medication?"
Pharmacist: "Of course we do."
Jacob: "How about medicine for hypertension and circulation?"
Pharmacist: "All kinds."
Jacob: "Medicine for arthritis, rheumatism, scoliosis?"
Jacob: "How about Levitra and Proscar?"
Pharmacist: "Of course."
Jacob: "Medicine for memory problem, Alzheimer’s, jaundice?"
Pharmacist: "Yes, a large variety - the works."
Grace: "What about lotions, creams, and beauty aids?"
Pharmacist: "All those and more to make you young again."
Grace: "Depends and Detrol?"
Pharmacists: "The most absorbent made anywhere and all kinds of bladder control medications."
Jacob: "What about vitamins, sleeping pills, Geritol, antidotes for poisons, Parkinson's disease?"
Jacob: "You sell wheelchairs and walkers?"
Pharmacist: "All speeds and sizes."
Jacob says to the pharmacist: "Excellent. May we use this store for our Bridal Registry?"
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8. MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:
Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Del Meyer, MD, CEO & Founder
6620 Coyle Avenue, Suite 122, Carmichael, CA 95608
Words of Wisdom
George Bernard Shaw: A government which robs Peter to pay Paul can always depend on the support of Paul.
P. J. O'Rourke: When buying and selling are controlled by legislation, the first thing to be bought and sold are legislatures.
Mark Twain, (1866): There is no distinctly native American criminal class save Congress.
Some Recent Postings
Dr Muhammad Yunus, Global Health Care A moving story of patient-directed health care in Bangladesh. Please read Dr Yunus speech given at the World Health Care Congress last January at http://healthplanusa.net/GrameenBank.htm.
David Gibson, MD, Fundamental Health Care Reform. A consensus is forming. California cannot begin to solve its structural budget deficit problem without first addressing the fundamental issues of health care’s structure and cost. Read the entire OpEd article at http://healthplanusa.net/DGFundamentalHealthCareReform.htm.
On This Date in History - April 12
Great Britain adopted the Union Jack on this date in 1606.
The American Civil War began on this date in 1861.
Franklin Delano Roosevelt died on this date in 1945.
The Salk Polio Vaccine was declared safe and
effective on this date in 1955.