Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, August 10, 2004

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

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 into 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.

We welcome you to the reestablishment of these MedicalTuesday interchanges, now occurring on the world wide web and your own desktop. If this newsletter has been forwarded to you or you have not been on our email list, please go to http://www.MedicalTuesday.net and subscribe to continue to receive these free messages on alternate MedicalTuesdays. At this site you can also subscribe to the companion quarterly newsletter, HealthPlanUSA, designed to make HealthCare more affordable for all Americans. Please forward this message to your friends and your professional and business associates. If you do not wish to receive these messages, we have made it easier for you to unsubscribe simply by clicking the Remove Me link below which will take you directly to the website where you can enter the email address you want to remove.

In This Issue:
1. French Health System Vs British National Health Service
2. Cancer in the UK: Patients Face Delays
3. Health Care in Germany: Projected to Take 34 Percent of Worker's Wages by 2030
4. American Health Coverage: Health Savings Accounts
5. Medical Gluttony - Unnecessary Durable Medical Equipment (DME)
6. Medical Myths - Chasing the Wrong Dream: Retirement?
7. Overheard in the Medical Staff Lounge - Pardon Me Doctor
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare, Government and Society

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1. French Health System Vs British National Health Service
Celia Hall, reporting in the Telegraph in London, states that for more than a decade the French health service has been regarded as the best in the world, occupying the high ground that was once the territory of the NHS. Not any more, says Dr Eric Chemla. "The French system is going down and the English system is going up. In fact they crossed three years ago, in my opinion. Standards are plummeting in France."

He did not always take this view but two years ago, at the age of 35, fed up with poor career prospects and awful pay in the French state system, he decided to move to England with his wife and young family. He insists that he is not going home.

Dr Chemla is a highly specialized micro-vascular and kidney transplant surgeon. He was snapped up by St George's Hospital, Tooting, where his surgical and research talents were quickly appreciated. Within a year he was appointed co-director of the hospital's kidney transplant unit, a regional service. He also advises the Department of Health on applications from doctors from abroad. He has invented a bypass system for doomed kidney patients who can no longer have dialysis after their veins become blocked. He believes the procedure will give them an extra five or six years of life, and perhaps, in that time, the chance of a transplant.

For years he believed that the French system was the best, he said. Then he became converted. "I realized I was arrogant," he said. "To realize this at 35 years old was terrible. They say the French system is the best in the world - the World Health Organization said so. But this is relying on statistics from 15 to 20 years ago.

"I saw quality plummeting and saw the service getting into greater and greater difficulty. But nobody will admit it. No one will say so. "People are now having to queue in France. Waiting lists? Yes, we have them. But it is too much of a shame for them to admit it. Waiting lists are an English thing, we don't even have a word for it."

But there is a foreign, less hierarchical culture in the NHS. "I have had to learn to be politically correct. Oh yes, it is quite OK to raise your voice in France. I have learned here, it is not good at all. And now I don't wave my finger. I have learned to sit like this," he said, smiling, with his arms crossed, hands pinned under his armpits.

To read the entire report go to http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2004/07/31/nmed31.xml.

What is not mentioned is that the NHS was plummeting until Prime Minister Tony Blair started a reversal several years ago. Certainly in all socialized countries there can be a national realization of poor quality health care that finally causes reform and improvement. But these improvements are evanescent and come in cycles. The British NHS was being considered as that of a third world country for many years until recent reforms. But after 55 years? Since most people don't need any significant health care until the last 55 years of their lives, that's a lifetime of inadequate care for some sick, suffering and infirmed citizens. Why should every other generation suffer until the politicians become motivated by media reports of poor care?

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2. Cancer in the UK: Patients Face Delays
Jenny Hope of the Daily Mail reports that cancer patients are being made to wait months for potentially life-saving radiotherapy. The delays are being caused by shortages of staff and equipment - and sometimes both. Some forms of cancer should be treated within four to six weeks to stop them spreading. But the Society of Radiographers study shows that a number of patients waited five months for follow-up treatment after having surgery. Only a third of women with breast cancer had radiotherapy within a month. Patients with other cancers had to wait several weeks after referral.

The survey - which covered half of Britain's radiography departments - was carried out for BBC Radio 4's Today program. It revealed delays of a year or more in getting X-rays and scans for a diagnosis. Dr Paul Dubbins, of the Royal College of Radiologists, said the number of patients waiting a "dangerously long time" for radiotherapy had doubled in two years. And two-thirds of the people were waiting longer than four weeks. Dr Dubbins said 150 radiography posts had been vacant for two years or more. "A number of hospitals have got new equipment but they have been unable to use it full time," he said. A damning Audit Commission report last August found a quarter of a million patients were waiting up to five months on average for scans to diagnose illnesses including cancer. Delays in radiology services were creating huge "bottlenecks" with some patients waiting almost nine months to determine how advanced their cancer was and whether treatment was possible.

Experts recommend women should get radiotherapy within a month of a breast tumor being removed to have the best chance of killing off any remaining diseased cells. Delyth Morgan, chief executive of the charity Breakthrough Breast Cancer, said: "It's extremely worrying that women are waiting longer than they should for treatment. We have known that waiting times at the beginning of the breast cancer journey are improving but the problems can emerge further down the line when waiting for radiotherapy. We must remember that so called bottlenecks are real people who deserve the best. We are making progress. There are more radiographers in the NHS than ever before. We have some of the most modern equipment of any health care system in Europe now being put in place."

Tory health spokesman Dr Liam Fox said: "These shocking findings make a further nonsense of the Government's claims only last week that real improvements in cancer services are now being achieved. Sadly this research confirms the experience of many people up and down the country. Delays for cancer treatment are deeply distressing in themselves. But we also know from bitter experience that they cost lives and that long delays result in curable conditions becoming incurable."

Hope concludes that John Hutton's response is yet further confirmation that the Government simply doesn't seem to understand that just setting targets doesn't make services better.

To read the entire report, go to http://www.mailonsunday.co.uk/pages/live/articles/health/thehealthnews.html?in_article_id=182340&in_page_id=1797.

And Dr Chemla says this is so much better than the French system? Wow!

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3. Health Care in Germany: Projected to Take 34 Percent of Worker's Wages by 2030
Last week's The Economist reports that "dropping" Otto von Bismarck's 19th-century health care system is a difficult but necessary step. Why the pressure for change? As in most western democracies, the cost of treatment is surging. What marks Germany out is the way that workers, and their employers, shoulder those costs, thanks to a system which acts as an increasingly prohibitive charge on labor. So how has the argument developed? In the past 25 years, health-care finance has been tinkered with as many times. Reforms have aimed to cut costs and to reduce coverage. In January, dental benefits were trimmed and patients made to pay a fee of €€10 ($12.40) per quarter for visits to the doctor. Such steps have kept spending by statutory health-insurance firms stable - although Germany spends a big share of its GDP on health. To this day, a uniform percentage is docked from pay, with employers matching the amount. People above a certain income level (now €€46,350 a year) can quit the public system and switch to a private health insurer, which links premiums to risk. These rules worked in days of full employment and closed economies; but they are not sustainable in a globalized era. Unemployment and early retirement have cut the base for contributions - driving up payments by employers and employees, from 8.2 percent of a worker's gross income in 1970 to 14.2 percent this year. If nothing is done, demography and rising costs will turn health contributions into an unbearable levy on labor: they could rise to 34 percent of a worker's wages by 2030.

Some reformers have suggested that Bismarck was a pragmatist, not a dogmatist; he wanted to pre-empt the socialists, not create a nanny state. If he were alive, he would cry "drop me" too.

To read the entire report, go to http://www.economist.com/printedition/displayStory.cfm?Story_ID=2945487.

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4. American Health Coverage: Health Savings Accounts
Meanwhile in the United States, private market-based Health Savings Accounts are taking off and reducing the ranks of the uninsured. Since becoming available to consumers on January 1, 2004, real data is emerging to replace speculation. In the first six months, tens of thousands of Americans have purchased HSAs, says Laura Trueman, executive director of the Coalition for Affordable Health Coverage (http://www.CAHC.net). Two companies have collected and shared demographics about who is purchasing HSAs: Assurant Health (formerly Fortis) and eHealthInsurance. The data provide a broad-based look at what is happening in the market, says Trueman.

HSAs have already reduced the number of uninsured Americans:
1) Some 43 percent of HSA applicants did not indicate any prior coverage, according to Assurant.
2) Nearly one-third (32.8 percent) of all HSA applicants to eHealthInsurance -- and about half of those with incomes under $35,000 -- had not had coverage for at least six months prior to enrollment.

HSA purchasers come from many income and vocational backgrounds:
1) Nearly half (46 percent) of HSA purchasers have family incomes of less than $50,000, according to eHealthInsurance.
2) Some 38 percent of its HSA purchasers have only high school or technical school training, says Assurant.
3) Many HSA purchasers live in modest homes -- 38 percent in homes with a market value of less than $125,000 -- and 27 percent of enrollees have a net worth of less than $25,000 (Assurant).

There is still much to be done to make health insurance more affordable to all Americans, but early experience with HSAs should make policymakers think seriously about how to harness the power of consumer choice and market incentives, says Trueman. To read Laura Trueman’s entire National Center for Policy Analysis (NCPA) report,  “Health Savings Accounts: Myth vs. Fact,”  go to http://www.ncpa.org/newdpd/dpdarticle.php?article_id=333&PHPSESSID=5a904c79cba5199ff329907aa13cda81.

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5. Medical Gluttony - Unnecessary Durable Medical Equipment (DME)
Excessive medical utilization is sometimes due to providers. In this column, providers include hospitals and emergency rooms, laboratory, x-ray and diagnostic centers, pharmacies, medical supply houses and treatment centers, as well as urgent care and surgicenters. Although physicians are frequently disparagingly referred to as providers, physicians are in reality the patient’s medical counselor and advocate who order and direct all of the patient's care, in conjunction with the patient's wishes, whether in the hospital, nursing facility, surgicenter, or the office. It's the abrogation of this responsibility that has done great harm to patients and caused the medical system to go out of control.

Today, I saw a patient that was admitted to a downtown Sacramento hospital because my hospital was full. She is a 92-year-old lady who has had bilateral strokes, is spastic in all extremities and unable to speak. Yet, she still demonstrated a probable recognition of me. I have cared for this patient for over two decades. She has four loving daughters that dote over her and take care of her. She had a lung infection and received excellent care at the Sacramento hospital. She was prescribed a nebulizer on discharge, which the daughters tried dutifully to clamp to her face in order to give her breathing treatments. However, this was totally ineffective, did not raise any secretions or phlegm and I saw no medical reason to utilize this mode of therapy.

There was a request from the hospital's home nursing service for me to authorize the purchase of the equipment that was ordered and delivered, which I declined to do. The family felt relieved. They observed a high-handed scheme of forced expensive equipment purchase from a hospital-related entity. Even though it was no cost to them, they felt nervous about interfering with the process until I reassured them that their instincts were probably correct. This expense of perhaps $800 could occur since there was no patient responsibility. I asked them if they would have gotten it if they had to make a 20 or 30 percent copayment. Their answer confirmed that a patient financial responsibility would have stopped this excessive medical cost in its tracks. They thanked me for stopping it a week later.

If this had occurred in my primary hospital, I'm sorry to admit, I would never have interfered with the excessive utilization. The powerful elements of the hospital in which I make a living, allied with commercial medical suppliers and affiliated home health agencies could cause loss of licensure through economic credentialing, otherwise known as Peer Review for economic reasons, all caused simply by my interfering with their unnecessary profit from the health care system.

This powerful alliance would not be appreciably different under single-payer or government-sponsored health care. This patient was already under a single-payer government system of Medicare and Medicaid that provided no disincentives. Having discussed this with colleagues in dozens of countries with socialized health care, the physicians comply with directives, even when they do not benefit the patient or are cost effective. Just like Dr Chemla, the surgeon from France now working in Britain, (see paragraph one above), who also said it was too risky to raise any objections to the National Health Service.

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6. Medical Myths - Chasing the Wrong Dream: Retirement?
While it's long been theorized that those who stay busy in their older years have better health, there has been little research to back it up. And it's never been clear whether older workers fared better because they were still working, or whether they were still working simply because they were healthier to start with.

But a long-term study of 1,000 men and women born in 1920 is shedding more light on just how much impact work and retirement can have on longevity. The participants all joined the study at the age of 70 and have been followed for the past 14 years by geriatrics researchers from the Hadassah Hospital Mt. Scopus in Jerusalem.

After crunching the data at the six-year and 12-year marks, and controlling for individuals' health at the beginning of the study, among other factors, the researchers found that it was work -- whether a person kept working or retired -- that emerged as a major determinant in whether a person was still alive. Among the 1,000 people studied, those who continued to work at the age of 70 and beyond were 2.5 times as likely to be alive at the age of 82 as those who had retired and weren't working at the beginning of the study.

It isn't clear from the data how long a person needs to continue working beyond the regular retirement age to reap the benefits to longevity, but it appears that the longer you continue working, the better. "We are more confident today that if you continue working and postpone your retirement as much as possible, you will be better off," says Yoram Maaravi, lead researcher and a senior physician at the Jerusalem hospital conducting the study. "But the majority of people around the world are waiting for retirement -- they are dreaming about retirement. It's only the minority who hope to keep on working."

Read the whole report by Tara Parker-Pope, Staff Reporter of The Wall Street Journal at

This should now give impetus to delay social security benefits. Franklin Delano Roosevelt set the Social Security retirement age at age 65 when life expectancy was 62 in the 1930s. We should immediately move the Social Security retirement age towards 75 where current life expectancy is. This would solve the Social Security fiscal problems, help our widows who frequently are neglected in family retirement planning, and improve longevity for the breadwinner. I recently became eligible for Social Security benefits and felt that I would not be able to utilize them for at least ten years since I would continue working in my profession. Unfortunately, this was all reversed by President Clinton who made everyone eligible for taxpayer's money at age 65, even if they continued working and making a good income. It could have been a stepping stone to indexing the retirement to age 75. I was prepared to forego these benefits for ten years. However, with the intertwining of Medicare and Social Security, it could be an economic nightmare. Hence, we all add to the problem. Socialism is as hard to reverse as any malignant metastatic cancer.

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7. Overheard in the Medical Staff Lounge - Pardon Me Doctor
In this era of government mandates and HMO administrative directives, e.g. to see six or eight patients per hour, priorities may get out of order and interfere with quality of health care.

Doctor to his HMO patient: “I'm going to put you on a beta blocker,” as he hurriedly starts writing the prescription.

Patient: “Pardon me, doctor. Don't you think I should first tell you my symptoms and what my problem is before you start treating me?”

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8. MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:

The National Center for Policy Analysis, John C Goodman, PhD, President, who, along with Devon Herrick, wrote Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter the first twenty months, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto http://www.ncpa.org and register to receive one or more of these reports. This week, NCPA reports on the breast cancer screening debate: MRI vs mammograms. Read the WSJ summary at  http://www.ncpa.org/newdpd/dpdarticle.php?article_id=402&PHPSESSID=4cbc7eb776e0281adef2691755ca9fc7.

The Mercatus Center at George Mason University (http://www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center’s Government Accountability Project. Congratulations are in order to Mercatus for making the front page of the WSJ “In Washington, a Tiny Think Tank Wields Big Stick on Regulation.http://www.mercatus.org/pdf/materials/806.pdf. To read the Government Accountability Project’s 5th Annual ranking of 24 federal agencies’ mandated Results Act (GPRA) disclosures, based on clarity and usefulness for policy makers and the public, go to http://www.mercatus.org/governmentaccountability/.

The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging onto their website at http://www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. Read a previous report on health systems abroad while Grace-Marie was attending the Institute for the Study of Civil Society. The 15 signatories to the UK Consensus Group statement calling for reform of the National Health Service have recommended a consumer-choice model. To read the report, go to http://www.galen.org/healthabroad.asp?docID=105.

Greg Scandlen, Director of the “Center for Consumer-Driven Health Care” at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative newsletter that is distributed every Tuesday by logging onto http://www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/ccm_archives.asp.  This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen, an expert in Medical Savings Accounts (MSAs) which have become Health Savings Accounts (HSAs). This week read about physicians responding to consumer driven health care and bypassing HMOs and government medicine, by either clicking on the transcript or the video moderated by Greg at  http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1174.

• The Heartland Institute, http://www.heartland.org, publishes the Health Care News with Conrad Meier as Managing Editor. The current issue highlights that consumer driven health care, a relatively new concept in the United States, has been flourishing in South Africa for more than a decade. “The parent company of Destiny, Discovery Health, started selling consumer-directed health plans in South Africa, the first in 1993. They've grown in 11 years to be the largest health insurance company in the country. More than 50 percent of the South African market has moved to consumer-driven health care." Read the whole report at http://www.heartland.org/Article.cfm?artId=15398.

The Foundation for Economic Education, Richard M Ebeling, PhD, President, http://www.fee.org, has been publishing The Freeman - Ideas On Liberty, Sheldon Richman, Editor. This has been Freedom’s Magazine, for over 50 years, and I have bound copies of this running treatise on free-market economics for over 40 years. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. The president’s column this month is on “The WHO Global Treaty on Tobacco - A Smokescreen for More Government Control.” Dr Ebeling gives us a greater insight on government control of our private habits and lives. This is an important read at http://www.fee.org/vnews.php?nid=6077.

• The Council for Affordable Health Insurance, http://www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. There is a specter haunting the U.S. health care system: it is the perennial hope that somewhere, somehow, someone has figured out how to make a single-payer health care system that actually works. This month read Merrill Matthews, Jr., Ph.D’s paper on “The Grand Illusion: The Perennial Quest for a Single-Payer Health System that Works” at http://www.cahi.org/cahi_contents/resources/pdf/n127Singlepayer.pdf. If you missed it, remember that during the “Cover the Uninsured Week,” they made an effort to get elected officials, the media and the public to focus on issues facing America’s uninsured with a series of five articles to highlight major problems. To read Solution #1: Fair Hospital Pricing, go to http://www.cahi.org/article.asp?id=222. To read Solution #2: Eliminate Guaranteed Issue, see http://www.cahi.org/article.asp?id=225. To read Solution #3: Tax Fairness, see http://www.cahi.org/article.asp?id=230. To read Solution # 4: Eliminate Mandates, see http://www.cahi.org/article.asp?id=232. To read Solution # 5: The CAHI Final Report, see http://www.cahi.org/article.asp?id=234.

• The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or at http://www.factcheckers.org/. This week read the first review of the dental workforce in the NHS since 1987, indicating that the Dentistry Crisis is Set to Worsen with staff shortages expected to more than double. Figures compiled and published by the Department of Health showed that in 2003 there was a shortage of 1,850 dentists in England. But projections for 2011 showed that shortages were expected to increase to at least 3,640 and perhaps as high as 5,100. The British Dental Association (BDA) said there was now no doubt that the supply of dentists had reached the crisis point. Read about this and other “Woeful Tales from the World of Nationalized Health Care” at http://news.scotsman.com/latest.cfm?id=3245926.

• The Independence Institute, http://www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at http://www.i2i.org/healthcarecenter.aspx.  Read her latest newsletter at http://www.i2i.org/hcpcjune2004.aspx which includes a section on PC Medicine and Euthanasia.  If you missed her excellent article on “Compulsory Evidence-Based Medicine: An Unproven Idea That Shouldn’t be Law,” go to http://www.i2i.org/articles/2004-F.pdf.

Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at http://www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. Those of us who complain about the increasing regulation of our lives in Canada or the USA should take the trouble to investigate the regulatory activities of the European Union which issues a seemingly never-ending stream of edicts that must be followed by the participating members of that union, by reading MUSINGS BY MADDOCKS: “EU's Enlargement, a Bureaucrat's Delight.” Go to http://www.quebecoislibre.org/04/040715-6.htm. If you missed Martin Masse's editorial last month, be sure to go to http://www.quebecoislibre.org/04/040615-2.htm.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well-being of all Canadians. Log on at http://www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at http://www.fraserinstitute.ca/health/index.asp?snav=he.  They have just released the Economic Freedom of the World, 2004 Annual Report. The executive summary states that the key ingredients of economic freedom are personal choice, voluntary exchange, freedom to compete, and protection of the person and property. Economic freedom liberates individuals and families from government dependence and gives them control of their own future. Empirical research shows this spurs economic growth by unleashing individual dynamism. It also leads to democracy and other freedoms as people are unfettered from government dependence. The Economic Freedom of the World is the most comprehensive index of economic freedom in the world and the only one that uses reproducible measures appropriate for peer-reviewed research. The 2004 annual report explores the evolution of economic freedom over the last quarter century and the impact of economic freedom on people's lives. The United States was tied for third and Canada dropped to seventh. You may download the entire 208 page volume, if you hurry, at http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=681. A most valuable study. Everyone should read it to understand how individual freedom will solve the health care problems of the world.

• The Heritage Foundation, http://www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. Be sure to read the editorial on Medicare Spending at http://www.heritage.org/Research/HealthCare/bp12.cfm. The unfunded Medicare promises add up to $42 trillion or $140,000 for every person in America. That means for a family of four, the debt is $560,000, the cost of a nice house (or two) in some parts of the country. To understand how government regulates us into higher prices see the current WebLog (BLOG) "Government Sues to Raise Drug Prices." Really? Just go to http://www.marginalrevolution.com/marginalrevolution/2004/08/government_sues.html and see how the US Attorney may think that "we're fighting to keep the costs of health care down for everyone," but in truth, by reducing competitive pressures to lower prices, they are helping the pharmaceutical firms to maintain a cartel. Or to put it this way, now that the government has successfully sued the pharmaceutical firms for reducing prices do you think a) the firms will now cut the price to Medicare to match the rebates or b) stop giving rebates?

The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we’ve seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at http://www.mises.org to obtain the foundation’s daily reports. To understand whether high taxes makes you work harder or makes you poorer, we have a real treat this week with Economist Stefan M. I. Karlsson writing and working from Sweden. See http://www.mises.org/fullstory.aspx?control=1569. You may also log onto Lew’s premier free-market site at  www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see Medical Writer Robert Klassen's article at http://www.lewrockwell.com/klassen/klassen46.html.

CATO. The Cato Institute (http://www.cato.org) was founded in 1977 by Edward H. Crane with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The CATO Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens’ ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at  http://www.cato.org/people/cannon.html. To read about Cato's health care studies go to http://www.cato.org/healthcare/.  To read about Social Security's Time Bomb with SS taxes going to $2,000 and then to $4,000 per worker, read a very disturbing report at http://www.cato.org/dailys/04-29-04.html, and that's before any more government health care.

• The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor. Please see http://www.ethanallen.org/index2.html and click on “links” to see the other 41 free-market organizations throughout the U.S. and Canada, which will then direct you to even more free-market sites. This week, let's click on Institute for Justice and read their mission statement and success stories at http://www.instituteforjustice.org/index.shtml.

Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of “educating for liberty.” It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log onto http://www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for it's national rankings in the US News College rankings. Read President Arnn's comments at  http://www.hillsdale.edu/arnn/usnews.asp. Also read his comments in the current Imprimis on Ronald Reagan, RIP, at http://www.hillsdale.edu/newimprimis/2004/july/july.htm. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

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Del Meyer

Del Meyer, MD, CEO & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

 Words of Wisdom

P. J. O'Rourke: When buying and selling are controlled by legislation, the first thing to be bought and sold are legislatures.

To Which We Would Add: When health care is controlled by legislation, the first thing to be bought and sold is the health of our citizens - unfortunately not the sick and dying, but those with the greatest ingenuity with strategic access to our congress and legislatures. What a travesty of American founding principles.

Mark Twain, (1866): There is no distinctly native American criminal class save Congress.

Congressional Intelligence - An Oxymoron. - From a column in The Wall Street Journal.

 Some Recent Postings

Voices of Medicine: To read a review of the first issue of Sacramento Medicine in 1950 go to http://www.ssvms.org/articles/0403vom.asp remembering that the first 132 years are no longer available. To read this years series of my column, the "Voices of Medicine," go to http://healthcarecom.net/vom2004.htm. To review the more than a hundred book reviews we've published in Sacramento Medicine, Medical Sentinel, Journal of Physicians and Surgeons, Sonoma Medicine, and the St Croix Review,  please see the Physician/Patient Bookshelf at http://www.delmeyer.net/PhysicianPatientBookshelf.htm.


Helped by an improving economy, Charitable Giving in the United States rose nearly 3% in 2003 to an estimated $240 billion, compared with about $234 billion in 2002, according to a study recently released. That's about $3200 per family of four in the USA. Religious gifts are by far the biggest recipients of charitable dollars making up about 36% of all charitable gifts, and last year grew more than 4% to an estimated $86 billion. Health and Human Services increased to $16.5 billion and education charities to $13 billion. http://online.wsj.com/article/0,,SB108777071859642355,00.html?mod=todays_us_marketplace

 On This Date in History - August 10

Chicago Incorporated as a Village in 1883. Every city wears different faces at different times. Nobody could have foreseen its hectic Prohibition days, its stockyards glory, its anguish at the Democratic convention of 1968, its colorful local politics, the number of inhabitants of its cemeteries that keep on voting year after year, or its contribution to American literature. A great city is different things, different problems, different solutions to different people at different times.

Smithsonian Established in 1846. The Smithsonian Institution was established by an Act of Congress, approved August 10, 1846, under the terms of the will of James Smithson of London, England, who bequeathed the money. Since then, units of the Smithsonian have been endowed by other private philanthropists - the Freer Gallery, the Mellon and Kress collections of paintings, the Hirshhorn and many others. It is not a single jewel, but rather a crown of jewels in the nation's capital. Supported by government funds in the main, it teaches a magnificent lesson in the value of the private sector which started it, public and private funds have continued to build it, public enthusiasm followed. In doing good, we should not wait for the government to take the initiative.

After Leonard and Thelma Spinrad

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