Physicians and the Business & Professional Community

 Restoring Accountability in HealthCare & Medical Practice

 Tuesday, August 27, 2002

National HealthCare Systems in the English-speaking World
John C Goodman, PhD, president of the National Center for Policy Analysis (NCPA), has recently updated his 1992 “Twenty Myths about National Health Insurance,” coauthored with Musgrave. In the current volume, he and coauthor Devon M Herrick focus primarily, although not exclusively, on the health care systems of the English-speaking countries, whose cultures are most similar to our own. These countries – Britain, Canada, New Zealand and Australia – are often cited by advocates of national health insurance as models for the US to emulate in reforming its health care system. He finds that these systems are no better suited to serve as models for reform today than they were ten years ago.

The Greatest Secret of Modern Social Science
The failures of national health insurance are one of the great secrets of modern social science according to Dr Goodman. Not only do ordinary citizens lack an understanding of the defects of national health insurance, all too often they have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information in the form of rebuttal to commonly held myths.

Myth:  In Countries with Single-payer HealthCare Systems People Have a “Right” to HealthCare.

Virtually every government with national health insurance has proclaimed health care to be a basic human “right.” But they are unable to guarantee that right and routinely “ration” care by delaying or denying needed care. In general, citizens of other countries have no enforceable right to any particular medical service. For example, they have no right to an MRI scan or heart surgery. They do not even have a right to a place on the waiting list. The 100th person waiting for heart surgery is not “entitled” to the 100th operation. Some patients succeed in jumping the queue, while others never receive the treatments they need.

Not only do people in these national health insurance schemes not have a right to health care, they may even have fewer rights to health care in their own country than foreigners have. While British patients were waiting for care, in 2001, about 10,000 patients received preferential private treatment in Britain’s top hospitals.

By US standards, rationing by waiting is one of the cruelest aspects of government run health care systems.  How much waiting is there? Beyond anecdotal reports in the press, Goodman finds that it is not an easy question to answer. Since waiting is viewed as an embarrassment to most governments, public officials are reluctant to collect and publish information about it. However, he has these facts available.

1. In England, with a population of 53 million, government statistics show that more than one million are waiting to be admitted to hospitals at any one time, with the total wait collectively more than one million years according the UK-based Adam Smith Institute. The British newspaper, The Observer, found the delays in treating colon cancer are so long in Britain that 20 percent of the cases considered curable at the time of diagnosis had become incurable by the time of treatment. Twenty-five percent of British cardiac patients die before receiving treatment.

2. In Canada, with a population of more than 31 million, private studies show that more than 878,000 are waiting for treatment of all types despite the fact that they spend more than $1 billion a year on US medical care.

3. In Norway, with a population of almost 4.5 million, 270,000 are waiting in health queues on any given day for various types of medical treatments, including hospital admissions.  Attempts to establish admission priorities failed to shorten the waiting lines. So, in 1999 the government intervened again with a patient’s bill of rights. Today, patients who have been waiting for extended periods are sent abroad by the Norwegian government for treatment in the private sector.

4. In New Zealand, with a population of about 3.6 million, the government reports that the number of people on waiting lists for surgery and other treatments is more than 90,000, of which 20,000 were waiting for a period of more than two years.

The statistics don’t include the waiting time in multiple queues. After the patient waits for a GP, who is the gatekeeper, there are waiting queues for the specialist, for the diagnostic tests, for the surgery or other recommended treatment. Formal patient protections still do not afford patients the security often taken for granted by Americans. Goodman and Musgrave argued a decade ago that the best way to provide health care is to apply the same commonsense principles to medicine that we apply to other goods and services. Other developed countries are now beginning to agree with us. They have learned through bitter experiences that the remedy for their HealthCare crises is not increasing government power, but increasing patient power. Unfortunately, there is continued pressure in the US to adopt the failed and discarded approaches of other countries under the euphemism of “single-payer health insurance.” Goodman and Herrick demonstrate that these single-payer initiatives will fail for the same reason: the Politics of Medicine. The problems of government-run HealthCare systems flow inexorably from the fact that they are government run.

Politics from Organized Medicine
We have received dozens of emails and postal mailings recently from “organized medicine,” including the local, state, and national organizations which listed a number of legislative and congressional bills that the membership should write, telephone, or email their representatives in order to register their opinion about proposed laws regulating the practice of medicine. The list was long and the time to respond as requested would have been about a day’s work and loss of income. Physicians must make decisions on whether to practice medicine or practice law with the implication that one cannot do the former without doing the latter. Unfortunately, many of the official positions were not, in my estimation, for the benefit of my patients.

Politics from Washington
A wire release last week reports that the minority leadership in the Congress recommended that the president veto a bill to be more assertive. These congressmen from the president’s political party were concerned about getting reelected if the president’s popularity dropped below 70 percent from the high of 90 percent. When asked what bill should he veto? The response was “Any bill.” Just do it. The sooner, the better. The real message, in case you missed it: Politicians do not care about people if doing so jeopardize building up their cash war chest or getting reelected.

The Reality of Political Medicine
And then recognition struck. One can spend $1350 a year for membership in the local, state, and national medical organizations, with the disclaimer that only a portion of it is now tax deductible dues to a professional society; One can spend additional time with loss of income writing or calling politicians expressing their opinions; One can spend money for local, state, and national political action committees; Then after years of practicing political medicine, if the politicians in Sacramento or Washington (or London, or Paris or Ottawa etc) have a different agenda on any one day, that varies from one day to the next, the multi-year effort, expense, and loss of income can be thwarted with the stroke of an ink pen.

Can We Afford Political Medicine?
Can we as physicians afford to divert this huge amount of time away from our mission in life of helping people in need of our services? Does our profession, which represents high academic, ethical and scholastic achievement, where honor, integrity and trust are our middle names, need this unusual preoccupation with regulation? Are attorneys judging us by their standards? Are the administrators in our “professional” organizations judging us by their standards? Our code of ethics is far superior to that of any of our critics. Unfortunately many doctors who join the administrative ranks adopt the ethics of administrators, which is simply “whatever the law allows is ethical.” Our standards have always been much higher.

Political Medicine Generally Backfires
The Health Insurance Portability and Accountability Act, HIPAA, (which may do none of those), an onerous piece of regulation, written by one political party and implemented by another, was forcing many physicians to consider closing their practices by October 16, 2002 when the regulations were effective. The Administrative Simplification Compliance Act, ASCA, was a rescue attempt this month to make it more palatable in order to keep doctors servicing Medicare recipients. Although extensions can be granted for one year, by April 14, 2003, encryption and privacy rules will be enforced. The reason for a privacy problem is frequently overlooked. It was the AMA E&M (Evaluation and Management) Guidelines that codify so much about our patients that encrypted software is required to keep this medical information from being viewed by other observers. The cost of computer hardware, billing software, and Medicare software for a small semi-retired consultative practice like mine will be a minimum of 10 percent of my practice income for the year. The question remains, will there be an acceptable cost benefit ratio after next April 14, 2003, for physicians to continue to work an average of 60 hours a week? Many physicians reported that they would drop Medicare and continue a limited practice. The bureaucrats notified doctors that the same requirements would be forced on them even if they saw no government patients. The noose tightens. You may want to attend the major national meeting next month on how to get out of the noose before the plank beneath you is removed and your cerebral circulation and alveolar ventilation becomes impaired. (see AAPS meeting program below)

Tuesdays were the evenings that doctors formerly met to eat together, get to know each other as colleagues, share ideas, listen to and discuss the latest medical information, as well as discuss practice related topics such as those above. (Mondays and Fridays are busy days in any practice. Wednesdays or Thursdays doctors took a half day off to compensate for the night and weekend work. Hence, Tuesdays were the logical days for medical meetings.) With the advent of “administrators” and others who became proactive in telling doctors how to practice medicine, these meetings were deemed to be counterproductive to the mission of managed care or single payer medicine. The meetings essentially disappeared. Sacramento had an attendance of less than 30 physicians at two of its quarterly meetings the past two years in a community of 3,000 physicians. Obviously the doctors voted with their feet overwhelmingly against the meeting agenda.

MedicalTuesday is now becoming our nationwide network using the advantages of the electronic age to restore our colleagueal relationships and reestablish the doctor patient relationship as our primary function and loyalty. We are now reaching physicians and professionals in 17 states. By reestablishing physician dialogue and discussion, we will ward off those who wish to reduce the quality of healthcare under the guise of single payer control in delivery and quality improvement, when our quality is already the highest in the world. The ideal and workable HealthPlan for the USA will evolve from these MedicalTuesday electronic gatherings. The problems and frustrations physicians encounter in delivering high quality healthcare are truly global in nature as we find from networking with colleagues in 11 countries on five continents. The MedicalTuesday website should open in a month or so. Send your ideas and anecdotes to Info@MedicalTuesday.net.

The Medical MarketPlace
MedicalTuesday recommends the Greg Scandlen Health Policy Comments as an important exposition of market-based medicine. You may log onto NCPA (www.ncpa.org) and register to received Greg’s weekly report or the full NCPA daily report. We also recommend the market-based reports of Lew Rockwell, president of the Ludwig von Mises institute. Please log on at www.mises.org to obtain the foundation’s reports or log onto Lew’s premier free market site at  www.lewrockwell.com.

MedicalTuesday recognizes HealIndiana as a supporter of market-based medicine. Visit their website at www.HealIndiana.org.  You will be able to informally meet Kim West, Executive Director, & Christopher Jones, MD, President, at the annual meeting of the Association of American Physicians and Surgeons in Tucson on September 18-21, 2002. You may register on the AAPS site at www.AAPSOnline.org. This meeting will also feature Ann Coulter, JD, who will sign her recent book, Slander, and give an address on “Big Brother and the Future of Medicine”; Wesley Smith, MD, who wrote Culture of Death and Forced Exit, will speak on “The New Bioethics”; Lawrence Stratton, JD, coauthor of The Tyranny of Good Intentions, will speak on “The New System of Justice and Its Impact on Medical Ethics.”

The Association of American Physicians and Surgeons (AAPS) is probably the only remaining medical practice organization that totally supports market based private practice. There still is time to register and network with physicians next month who will be discussing medical ethics; why peer review is flawed; why universal health care cannot work; how to opt out of Medicare before it destroys you or your practice; how Medicare stands between patients and cost-effective health care; and historical, political and economic perspectives of the current crises in medicine. Meet the physicians who have declared their independence from government intrusions into their lives and that of their patients.

Stay Tuned to the MedicalTuesday.Network twice a month and have your business and professional friends do likewise. Each individual was personally known, requested to be placed on our mailing list, or was recommended as someone interested in our cause of making HealthCare affordable to all. If this is not correct or you are not interested in or sympathetic to a Private Personal HealthCare system, send an email to me at DelMeyer@MedicalTuesday.net and your name will be sorrowfully removed.

Del Meyer, MD