A Forum for the Dialogue, Discussion, and Debate of the Medical MarketPlace
         The Restoration of the Confidential Doctor/Patient Relationship

Tuesday, April 30, 2002

The response to the recent review of David Gratzer, MD’s Code Blue: Reviving Canada’s Health Care System by Greg Scandlen, of the National Center for Political Analysis, (NCPA) has been very positive. We appreciate the e-mails, the phone calls, and your forwarding the review to your friends and the additional email addresses we’ve received. There is so much misinformation and disinformation concerning national health insurance, whether we call it single-payer, universal coverage or socialized medicine, that it will take considerable effort to correct.

The father of government social insurance, German Chancellor Otto von Bismarck, observed how Napoleon III used state pensions to buy support for his regime when he was Ambassador to Paris in 1861. “I have lived in France long enough to know that the faithfulness of most of the French to their government . . .  is largely connected with the fact that most of the French receive a state pension.” According to Brink Lindsey, writing in the journal Reason, the appeal of social insurance for Bismarck was that it bred dependence on, and consequently allegiance to, the state. Social insurance, whether social security, medicare, or single-payer medicine, was thus born of a contemptuous disregard for liberal principles:

What mattered was not the well-being of the workers, but the well-being of the state.

In all cases of single-payer medicine, the patients are the primary losers. When the bureaucracy becomes unbearable, the doctors simply leave their practice as soon as they find other sources of income or moonlight for additional income. We’ve all done that during our training periods and our military experiences. Unfortunately, with corporate socialized medicine (Medicare and For-Profit HMOs), doctors are doing that even from an HMO practice. We had a surgeon in our community who worked for the state eight hours a day and continued his surgical practice four hours a day plus evenings and weekends. Physicians will be resourceful. Unfortunately, our patients cannot be resourceful because of bureaucratic restrictions.

There is a major effort to implement a national health care plan within two years. Do we really want Medicaid for all? Nearly the entire world has bureaucratic medicine with reform on a continuous basis because of the high costs and lack of access. Universal access, the calling card for the social planners, frequently means no access until a year or two wait. Unfortunately, many of the doctors’ professional organizations don’t understand market medicine. We still have the opportunity to prevent our patients from being thrown to the bureaucratic wolves by pointing out how medicine working in the market is the most cost effective. That is the mission of our efforts.

UK & The National Health Service (NHS)
Although Dr Gratzer suggests government medicine is bad in Canada, it is deteriorating around the world. Let’s take a look this week at what’s happening in the UK which celebrated the 50th anniversary of the NHS this past year. Do we want this to happen in the United States? It certainly could if we don’t change course.

A goal of universal health care schemes is to eliminate economic variations in health status. However,  according to Reuters Health, that has proved difficult in practice with the health gap between rich and poor widening in the UK and throughout Europe. A monitoring agency reports in the British Medical Journal that in the United Kingdom the health gap between rich and poor in terms of life expectancy and infant mortality is widening, even between adjacent rich/poor Burroughs in London.

In a recent issue of The Economist, the NHS is still in a critical condition and, despite cheerleading from the ministers of health, is proving hard to cure. Despite a “spending spree” of expenditures from 6.8% to 7.5% of GDP, the ministers are cheering that the waiting time for an operation for over 10 thousand people has been decreased to 15 months and hopefully will decrease to 12 months during the next year. However, the King’s Fund, a health policy think tank, says there has been little increase in overall hospital activity in the past two years. “This means that meeting the target can only be met by distorting clinical priorities,” says Anthony Harrison, the Fund’s researcher. “Either fewer people get an initial appointment to approved treatment in the first place, or those who have not been waiting as long but need operations more urgently are pushed aside.” A similar slight of hand trick has been used in other countries to eliminate up to three years of a waiting list and start a new one with each reform.

It appears that Government medicine is not working well in the UK even after celebrating the 50th anniversary of the NHS with constant reforms only being window dressing, duplicitous in character, and unrelated to quality or sensitivity of care. One comment was that the NHS has been reformed to death and still doesn’t work. On my visit to London last year, the politicians were suggesting cost cutting programs such as “limiting antibiotics prescriptions to five per year.” One politician gloated that he would like to assure every Brit is entitle to three doctor visits per year and he should be able to bring up two medical problems during the allotted seven minutes. It would appear that the 15 to 40 million Americans (estimates seem to be based more on political leanings than facts) without health insurance probably get better care than 100% of the people in the United Kingdom. Stay tuned. The government medicine horror story is just beginning.

United States
There are a number of encouraging reports in our country. In the April 22 cover story issue of US News, innovative doctors are rethinking the office visit in order to put the care back in healthcare. With the push to “For Profit HMOs” (FP-HMO) a number of us have forgotten to do that. We have made patients commodities, (rather like good dry rice vs wet rice, which costs too much to dry before it can be marketed), doctors as implementers of administrator’s directives, with the latter reaping the profits and benefits as quality and sensitivity of care go down the toilet. A presentation of “Administrativectomy” at the annual meeting of the AAPS (Association of American Physicians and Surgeons) was well received.

Dr Gordon Moore in Rochester, NY, has eliminated most of his staff, answers his own phone in the office and his cell phone at the hospital and home, and makes his own appointments at a mutually agreeable time. Despite covering his practice day and night, he only gets calls after hours once or twice a month because patients in turn are kind and considerate of his time also and call only for a true emergency. Dr Danny Sands, an internist in Boston gives his patients a business card with the rules of doctor-patient email etiquette and feels he’s giving better care by using email extensively. Drs Steve Gordon and Chuck Kilo in Portland, Oregon, state that up to 75% of their patient contact is via E-mail. Dr Vern Cherewatenko of Renton, Washington, found that his HMO was paying $43 on his $79 office visit. When he determined that it cost him $20 to collect that, he decided to cut out his HMO and his income improved. He co-founded SimpleCare (www.simplecare.com) and sees patients for a “fair price.” SimpleCare was presented to the last national meeting of the AAPS (www.aapsonline.org) by Dr David MacDonald. Doctor & Patient (www.doctorandpatient.com) offers a new approach for private practitioners by eliminating a layer of bureaucratic profits from PPOs and adding the difference to the doctors income, from which is was taken in the first place.

Are any of these the answer for our nation at large? In our country there is room for all kinds of possibilities. Our first goal is to become acquainted with the options available. But in any case, what we have is far better than what any other country is experiencing. Be sure to send this note to your friends or add their email to our list. If you’re not interested in a market-based private healthcare system, send an email to me. DelMeyer@HealthPlanUSA.net

Stay Tuned to the MedicalTuesday.network.

Del Meyer, MD