Physicians and the Business & Professional Community

 Networking to Restore Accountability in HealthCare & Medical Practice

Tuesday, April 16, 2002

Why Medical Tuesday?

In Sacramento during the 1970s and 1980s, the Medical Society met the third Tuesday of the month. The Sacramento Society for Internal Medicine met the fourth Tuesday of the month. The family practice group also met the fourth Tuesday. The surgical group, as I recall, met on the second Tuesday.

It was a very rational decision since practice management data indicates that medical practices are busiest on Mondays and Fridays and no extra obligations should be planned on those days. Physicians work many evenings, nights, and weekends and are in the habit of taking a  compensatory afternoon break on either Wednesday or Thursday, making meetings on those two nights poorly attended. Hence, Tuesdays were the logical choice.

The founders of our Republic placed the election day also on a Tuesday. They were also wise enough to make sure it would never be on the first day of the month should it be a Tuesday, since the first day of any month is also a day that many meetings are missed. Witness hospital committee meetings on the first day of the month or the first day of the week are frequently missed. As the rush of a practice is tamed by midday, one realizes that the breakfast or lunch committee meeting was missed. Hence, the restoration of a medical meeting on Tuesdays is the most logical way to proceed. It was also the favorite day for the former Sacramento Tuesday literary club.

My research of meetings in other communities, states, and even several countries indicate the same course of events. The same holds for the business community. The most success business/venture capital network ever, occurred on Tuesdays with an electronic email network of over 85,000.

Then as administrators took over many aspects of our practice and professional organizations, they convinced us that we should devote our times to seeing patients and let them worry about the financial end of our lives. We shouldn't even have to be colleagueal on Tuesdays since it was superfluous. With administrators running the show, we just needed quarterly meetings to keep us informed. Then these quarterly meetings ceased to be business meetings because our elected board selected by our administrators and rubber stamped by the membership would take care of our financial future and we could start listening to attorneys and other administrators during these meetings and we shouldn't have to worry about much of anything.

What happened to our profession during the next decade or so is history.

At one of our recent Medical Society meetings, with 2800 doctors in our community, we had 28 attendees at the quarterly meeting. We need to reverse that and again take charge. Now with electronic networks, we can mobilize our profession and all interested business/professional groups, into a network which can bring about change.


This message is being sent to physicians in four countries and six states. We have a global problem. Please forward this message to all your professional colleagues.

If you don't believe in Market Based Medicine and would like to be removed, just send an email to me:  DelMeyer@HealthPlanUSA.net. 

Today, we feature Greg Scandlen, a Senior Fellow in Health Policy from the National Center for Policy Analysis. Before joining the NCPA, he was at the CATO Institute in Health Policy. He was the founder and CEO of the Council for Affordable Health Insurance. He was publisher of the Health Benefits Letter and worked in the Blue Cross--Blue Shield system for 12 years.

He reviewed Gratzer's Code Blue, the story of Canadian Health for Medical Sentinel, the Official Journal of the Association of American Physicians and Surgeons. His  recent revision follows. We think this message needs to be forwarded to every American.

Scandlen's Review of                                                                                       
Code Blue: Reviving Canada's Health Care System
by David Gratzer, MD
ECW Press, Toronto, Ontario
236 pages, $19.95

Long the shining beacon for the American Left, the grand example of successful socialism on North American soil, the Canadian health care system is falling apart, or so says David Gratzer in Code Blue: Revising Canada’s Health Care System. Gratzer was a medical student at the University of Manitoba when he wrote the book and now practices psychiatry in Toronto.

Canada’s system, known as “medicare,” is run by provincial governments and paid for by a combination of provincial and national funds. Copayments are not allowed, nor are people allowed to go outside the system and pay for services directly (unless one leaves the country). The system is plagued, Gratzer writes, by long waiting lists of sick patients, overcrowded hospitals, second-rate equipment, and a stream of doctors, nurses and patients fleeing to the United States. He documents these woes not only with a host of health care horror stories from Canadian newspapers, but with a long list of studies, both official and private.

Gratzer says, “Waiting lists are the biggest concern that Canadians have with their health care system. The lists are not a medical but an economic problem. Because patients have no incentive to think twice about using health care services, policy makers are forced to find ways to ration health care.”

Gratzer agrees that the Canadian system is less costly than the American one, but says the difference is overstated in a number of ways. Total American spending is inflated, and Canadian spending lowered, by the Canadians who cross the border to receive services in the States. He also points out that raw comparisons don't account for differences in spending on research, or differences in demographics or accounting procedures. He notes that, “Canada’s entire research budget is smaller than the R&D budget of the University of Texas’ M.D. Anderson Cancer Center.”

Even after adjusting for these differences, Canadian medicine may still be cheaper, but you fail to get what you fail to pay for – in this case, modern equipment, adequate facilities, and motivated physicians.

Gratzer’s most withering analysis is aimed at Canada’s “gutless” political establishment that relies on bromides and cliches in place of serious efforts to address the problems in Canadian medicine: “The badly needed national debate isn’t taking place. There is only the sound of silence as partisans of every political stripe advocate the intellectually vacant position of maintaining the status quo in an ideal system that doesn’t really exist.”

He maintains that the early success of medicare – back when the population was young and costs were low – became hard-wired in the Canadian psyche as a source of national pride. Now that the system is failing, no political leader wants to be the first to tell the truth. As with “The Emperor’s New Clothes,” denial reigns supreme.

Gratzer doesn’t stop at documenting the problems in Canadian medicine, nor at laying the responsibility at a political class that prefers to look the other way. He also examines  possible solutions and their consequences, including simply spending more money, applying user fees, or creating a parallel privatized system to supplement the public program. Any of these reforms would be an improvement, he says, but “the most important step toward renewing health care in [Canada] is to accept that medicare is fundamentally flawed.” He notes that medicare currently “consumes 21 cents of every dollar earned by working Canadians,” and the Office of the Superintendent of Financial Services projects a tax rate of 94.5 percent will be needed to support the program in 2040 without fundamental reform.

Instead, Dr. Gratzer would like to see patients making their own decisions about how to best spend their health care resources, whether those resources come through the government or directly out-of-pocket. And the best way to do this, he proposes, is through a national system of medical savings accounts (MSAs), combined with high-deductible indemnity insurance plans. He examines several alternative MSA designs, including the possibility of government-provided high deductible insurance and tax-payer funded “allowances” for MSA deposits. He prefers self-funded MSAs using tax-free deposits. He argues that the poor and persons with “special needs” could be granted extra assistance.

He concludes that “Medical savings accounts aren’t a miracle solution. But an MSA system has the potential to address many of the problems with the present health care system in Canada.” They could fix the problems of waiting lists, second-rate equipment and fleeing physicians, while maintaining accessibility and timeliness of care.

Stay tuned on Tuesdays--currently planned for twice a month. To have your friends be added to the mailing list, send their email address to me  DelMeyer@MedicalTuesday.net

Del Meyer, MD