Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in Government, HealthCare & Medical Practice

Tuesday, January 11, 2005

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

  Ronald Reagan


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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 counterproductive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced to 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.         The Health-Choice Headache

2.         Evidence-Based Medicine Examined

3.         Cost of Open-Ended Health Care

4.         Saving Social Security – It's Simple: Social Security Is Very Complex

5.         Medical Gluttony Can Only Occur in a Non-Market-Based Environment

6.         Medical Myths: Every American Has a Right to Medical Care

7.         Overheard in the Medical Staff Lounge - New Year's Eve Crises - argaiV

8.         The MedicalTuesday Recommendations for Restoring Accountability in HealthCare, Government and Society

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1.         The Health-Choice Headache

David Wessel, a reporter for the Wall Street Journal, (WSJ) writes in the December 9, 2004 , issue about the world of choices in health care. His report supports the premise of Barry Schwartz (author of The Paradox of Choice: Why More is Less) in Scientific American (that we discussed last week) that Americans today choose among more options in more parts of life than has ever been possible before but find that more is not always better than less.

Wessel sat down at the dining-room table with summaries of the three health-insurance options that the publisher of his newspaper offers its employees and the two options that his wife's employer offers. Wessel's goal was to pick the deal best for him, his wife and their two teenagers.

Wessel majored in economics in college, has always done his own tax returns and scrupulously checks those "explanation of benefit" forms to be sure they're correct. But after staring at the grids their employers provided, he surrendered: There was no way he could make a rational choice, and it's not just because it's impossible to predict if someone in the family will get sick next year.

Wessel's plan covers routine physicals only for kids up to age 13. His wife's covers physicals for the whole family. His plan charges $8 for a generic-drug prescription and $15 for a brand-name. Hers has six different charges from $5 to $100, depending on where the drug is purchased, whether it's generic and, if not, whether it's on the plan formulary.

Wessel's plan has a $400 per-person deductible for in-network care and $475 for out-of-network care. But they're combined: If he runs up a tab above $475, there's no deductible left. Hers has separate deductibles: If she uses $500 out-of-network, and then sees an in-network doctor, she's starts from scratch. His plan expects employees to know the difference between "co-payment" and "co-insurance."

When you shop for an auto loan or a mortgage, every lender has to calculate the "annual percentage rate" similarly so you can compare apples to apples. Health insurance doesn't work that way. Each big employer has its own way of presenting information and crafting benefits; so does each health insurer. And employers and insurers have sometimes conflicting goals: saving money, putting health benefits in the best light to boost worker morale, and devising co-pays and other incentives so workers use health care more wisely. But if health plans become so intricate that few workers understand them, then the incentives to be smart shoppers won't work.

Wessel concludes: "Choice and competition create complexity. It's almost always worth it. We don't want auto makers to restrict their offerings to three models of cars -- small, medium and large. But, gosh, help us make a smart choice. All we are saying is: Give us a chance to become smarter shoppers for health insurance, which is what you say you want us to be.” http://online.wsj.com/article/0,,SB110255187733595080,00.html

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2.         Evidence-Based Medicine Examined

Twila Brase, the President of the Citizens' Council on Health Care in Minnesota , has issued a powerful review of the Evidence-Based Medicine (EBM) movement. Her paper, "How Technocrats are Taking Over the Practice of Medicine - A Wake-up Call to the American People," is a landmark analysis of the attempt to bureaucratize medical practice, which has been happening largely under the radar screen of most Americans. In 25 pages, with 226 footnotes, she explains how the underlying assumptions and practical applications of EBM will turn physicians into pawns of the payers at the expense of their patients. EBM assumes, for instance, that variation in medical procedures is inherently bad and should be rooted out so that all physicians do the exact same thing. It ignores that variation in patients may require variation in practice. It assumes that there is one best way to do medicine - and that we know what that one best way is. It ignores that medical knowledge is exploding and what seemed to be right last week may be wrong next week.

One of the most powerful arguments in the paper discusses the validity of practice guidelines, and notes, "In 2000, a group of researchers determined that more than 75 percent of the guidelines developed between 1990 and 1996 needed updating." Ms. Brase says that "they discovered that half of the guidelines were outdated in 5.8 years." Yet the development of guidelines is slow, cumbersome and expensive, taking as long as two years and costing as much as $100,000 - unless the government does it, in which case it costs $800,000.

The guidelines themselves are based on "research" that may be biased, incomplete or self-interested. Certainly we have seen numerous examples of research not getting published because it contradicts the claims of the sponsors of the research. Even the decision of what research to fund is often made for political, not medical, reasons.

Research is often contradictory. Hormone Replacement Therapy was found to lower the risk of heart disease in the Nurses Health Study, while the Women's Health Initiative study found that it increased heart attacks by 40%. But neither study can tell a clinician how to treat one particular woman with one particular genetic profile and one particular set of risk factors and co-morbidities. Population-wide information may be interesting, but it is no substitute for individual diagnosis and treatment. Relying on averages never works when dealing with individuals.

In fact that may be the biggest problem with EBM - it is trying to standardize medicine at the very time when we should be customizing medicine so that each patient gets precisely the treatment that is best for his or her particular needs.

Still, research and guidelines for all their flaws can be very valuable in growing the knowledge base. The danger is not the research, but how the bureaucrats want to use the research. They want to control physicians who comply and punish those who do not through the use of financial incentives, malpractice exemptions, and even hospital privileges and licensure, all tied to compliance with EBM guidelines.

This is the polar opposite of consumer empowerment and choice. EBM advocates want only to empower themselves, and we all owe Twila Brase a hearty congratulations for bringing this to the attention of the American people.

SOURCE: http://www.cchconline.org/pdfreport.

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3.         Cost of Open-Ended Health Care

Shari Roan, health writer for the Los Angeles Times, recently discussed PET scans as an emerging vital tool to diagnose Alzheimer's. She quotes a number of directors of PET centers at Universities who feel that PET scans (Positron Emission Tomography), which have been used by pioneers in neurology for 10 years, are under utilized. They are 91 percent effective in diagnosing the disease about three years sooner than relying on medical examination, including psychological and cognitive testing. Some neurologists feel that starting therapy early helps to slow the process. Roan gives incidence of having Alzheimer's as 10 percent of people over age 65 and 50 percent of people over age 85. The current cost is $1500 per exam. Other statistics have estimated that there are 14 million Americans with Alzheimer's. If everyone had a PET exam, this would add $20 billion to our health care costs. This is down from the estimated $40 billion ten years ago, when the test cost was $2800.

If only those patients with Alzheimer's received the test, that would indicate that clinical judgement has a degree of accuracy approaching 100 percent. That would mean the test would only be an expensive confirmation of the diagnosis and would be unnecessary. To find everyone with a disease, one must screen far more than the anticipated number or many will be missed.

For instance, if a patient has a lung nodule, which has a 10 percent chance of being malignant, the pulmonologist of several decades ago would have to refer 20 percent of the most suspicious cases to the thoracic surgeon to be sure there weren't any missed. Hence, the surgical literature in the 1960s report a 50 percent malignant rate for lung nodules removed since it was 50 percent of those referred to the surgeon. However, the pulmonary literature which referred to all lung nodules seen in a pulmonary practice reported a 10 percent malignant rate since they included the 80 percent that were considered benign by standard criteria and were not referred to the thoracic surgeon. With modern bronchoscopy and imaging techniques, the pulmonologist of today evaluates essentially all lung nodules to a diagnosis, which means the surgeon only sees the ones that need resection (removal).

The corollary in evaluating demented people would be similar. When memory fades, every son or daughter is convinced that their parent has Alzheimer's. The physician receives an inordinate amount of pressure from families to make an accurate diagnosis, even if the treatment doesn't change. Using the aforementioned pulmonary nodule example, one could estimate that 28 million, rather than 14 million, people could justifiably be screened with PET scans if there weren't some restraints in place.

What restraints are effective and patient sensitive? In Medicare, Medicaid, HMOs and most insurance plans, one must traverse a formidable bureaucracy before the test will be approved. In HSAs, with a several thousand dollar deductible, the patient and family will evaluate the need for the test and proceed only if the physician can convince them that it is needed in order to proceed with effective and helpful treatment. In pay-as-you-go practices, the patient and his family constantly evaluate any medical recommendations on a cost-benefit analysis. Thus, only those tests are done that are really necessary. In the HealthPlanUSA working draft, based on anecdotal evidence, it has been determined that most outpatient medicine will return to the Medical MarketPlace with a 30 percent copayment. In this example, the patient and the family, in consultation with their physician, will balance the need for a PET scan with a 30 percent copayment or $450 copayment for the $1500 test, which prevents excessive utilization. HealthPlanUSA is only directed to that part of society without a government-sponsored health plan such as Medicaid and Medicare. But it also eliminates all bureaucratic overseeing, as well as all billing and bookkeeping costs. It is expected to reduce overhead in the same fashion as pay-as-you-go health care, which has reduced expenses in half and thus decreased professional fees by half. It has also reduced the malpractice problem because patients that pay only for necessary services don't pay if they are not satisfied and thus the medical liability problem is essentially resolved.

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4.         Saving Social Security – It's Simple: Social Security Is Very Complex

Bert McLachlan, author of Saving Social Security (from Congress), comments on Susan Lee's Wall Street Journal article, "All You Need to Know About Social Security" (http://online.wsj.com/article/0,,SB110117497648381576,00.html) that it is not nearly that simple. First you really need to know about the mythical "trust fund," and then about the way it invalidates "actuarial balance" calculations, which in turn invalidate the conclusions of the Presidential Commission's Model Two, along with all "costing" of congressional plans to "save Social Security" (politically, but not financially). Those who do not understand these "little details," which are perpetuated mainly by the Social Security Administration and its trustees, will unfortunately come up with bad proposed solutions because their understanding of the problems is based on misinformation. But that's where we are headed.

Herbert F. Reilly III also comments on Susan Lee's article. She did America a great service in her analysis of how to solve the Social Security dilemma. However, I think she underestimates the political shibboleth demagoguery that has been effectively used in budget discussions, namely that a reduction in rate of growth is considered a "cut." To counter that nonsense, Ms Lee should write another column entitled "Private Accounts -- Finally Giving Minorities Their Fair Share." The real crime of Social Security is that you pay into the system all your life, and reap benefits for only as long as you live thereafter. Life expectancies of the rich are much longer than those of the poor (better health care), and the well-off generally receive many more monthly Social Security annuity payments. Of course if you and your spouse die in an accident the day after you retire, your beneficiaries are shut out.

Shouldn't the poor be entitled to accounts of their own to use as they see fit, and pass on to family if they die early? Selling the concept of Social Security private accounts should be simple.

URL for this article: http://online.wsj.com/article/0,,SB110238266088492781,00.html.

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5.         Medical Gluttony Can Only Occur in a Non-market-Based Environment

Last week, we were deluged with a number of patients who could not see their usual doctor because the physician’s affiliated hospital had been blacklisted by a major insurance carrier. In evaluating these patients, it was helpful to review their previous records to see how their doctor had handled their medical problems. Many of these patients were surprised at some of the recorded diagnoses because they had never been discussed. These included major items such as hypertension, hyperlipidemia and diabetes. One record cited elevated lipids ranging from triglycerides of 400 to 800 (normal about 100) that had been dutifully measured and recorded every six months for a number of years, but never treated. Although transparency of laboratory charges are difficult at best, this is about a $75 to $100 test in some laboratories.

 Rather than embarrass a colleague, I asked other doctors in that hospital group how this could happen? The response was that the hospital physician group limited the time doctors could spend with patients, making it difficult to practice optimal medicine. The doctor just skimmed the surface of one or two major diseases, foregoing good care. Hence, some diseases just couldn't be treated in the allotted time frame.

 So, the HMO that came into existence to prevent excessive utilization caused gluttony of laboratory costs that played no role in the patient's health care. This supports our recurrent theme: Bureaucratic medicine reduces the quality of health care, whether HMO, NHS, Medicare, Canadian Medicare or Medicaid. In all these systems, the worst and the best hospitals and doctors get paid equally. Thus quality of care slips downward to that given by the worst. Quality is never an issue in private market-based health care. Patients left to their own choosing will always seek out the best doctor and the best hospital at the most competitive price.

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6.         Medical Myths: Every American Has a Right to Medical Care

Madeleine Pelner Cosman, PhD, JD, Esq, in her upcoming book, Who Owns Your Body, gives Nine Myths of American Medicine. Today we review Myth 6: Every American Has a Right to Medical Care. For the previous five, see http://www.healthplanusa.net/MC-WhoOwnsYourBodyIntro.htm.

This chapter presents the legal background of Americans’ medical rights of privacy and physical autonomy. It explores perceived rights to Medicare and to Medicaid. Congressmen, medical experts, and the media constantly refer to health care rights. They describe monies and surpluses in our Medicare Trust Funds. With Trust Fund money Congress offers to pay for generous prescription drug benefits for all American seniors. Despite impassioned political rhetoric asserting rights to medical care, four critical questions provide alarming answers.

a.         Is there a right to medical care?

b.         Is there a right to Medicare?

c.         Does any American have a Medicare Trust Fund?

d.         Is there a right to Medicaid?

If medical care, Medicare, and Medicaid are not rights, what are they? What is the difference between a liberty right and a welfare benefit? What distinguishes a substantive right from a mere procedural right?

There is no right to medical care in any of the seven articles of the U.S. Constitution, or in the first ten amendments called the Bill of Rights, or in the seventeen subsequent amendments. No state provides a right to medical care. Likewise, there is no Constitutional right to food, to clothes, or to housing. The Constitution guarantees such rights as to vote, to speak freely, and to be fairly compensated if the government takes our private property for public use. Our rights prevent government and other people from taking our freedom and our goods. No right provides free goods.

Welfare benefits are free goods. Our rich, compassionate nation provides welfare food benefits, housing, clothing, and medical benefits for those who cannot provide for themselves. Those benefits are not rights. If they were rights then you, I, and your wealthy aunt Jeannie could collect a monthly check for food. Or rent. Or clothes. We cannot. We should not. Why should we get free medical care? We cannot and we should not.

For every right, someone or some government entity has a legally enforceable responsibility to assure the right. If there were a right to food, every restaurant owner and every farmer would be obligated to provide food to anyone who demanded it. If medical care were a right, every physician and surgeon would be obligated to provide medical goods and services. Suppose a doctor was not willing or not able to treat a patient. Suppose the pay was too little to cover costs and expenses. Under a system with a right to health care the government could compel the physician to supply services under threat of prison.

Medicare Trust Funds violate the legal and linguistic meanings of "trust." Each payday working Americans pay into a Medicare Trust Fund money withheld from their paychecks. The implication is that each employee has a personal account invested for his benefit. Medicare Trust Funds are brutal deceptions. No Americans who paid into the Medicare program at any time from 1965 until today have paid into a Medicare Trust Fund for themselves or for others. No one owns a Medicare Trust Fund. None of the money they paid has been invested for their future or anyone else’s future medical care. They paid for anonymous retirees claiming Medicare benefits. Medicare always has been a pay as you go program. There is no money in the two Medicare Trust Funds now and there will be none later except for withholdings from future paychecks of future workers. While in 1965 the ratio of workers to retirees was 7 to 1, now it is fewer than 4 to 1, and soon will be 2 to 1. In fewer than a dozen years, the 41,000,000 people currently on Medicare and the 47,000,000 on Medicaid will suffer a tidal wave of new fervent competitors for "free" medical care. The first wave of 77,000,000 Baby Boomers hits shore in 2010. Who will be left working to pay for Medicare?

Now in 2003 Medicare is functionally bankrupt. It is running a deficit that according to the Congressional Budget Office (CBO) exceeds $1.1 trillion dollars. We neither see that number nor hear about it because CBO keeps the sinking Medicare ship afloat with general tax revenues. Accountancy tricks split the costs and revenues of the two sections of Medicare (Part A devoted to hospital costs is called Hospital Insurance and Part B dedicated to medical office expenses is called Supplemental Medical Insurance). The result is mythical trust accounts that have mythical revenues that generate mythical surpluses. Even the most fervent mythmakers will be shocked at the projections of the Medicare Trustees in their Annual Report of 2003. If current financial manipulations continue, our grandchildren will pay 71% of each paycheck to support Medicare’s aged and disabled. Medicare’s hazardous financial antics are far more pernicious than current, prosecuted corporate frauds and deceptions.

Americans who understand the perilous truth will act prudently, logically, and responsibly or suffer inevitable exploding costs, crushing taxation, and savage benefit cuts.

TRUTH 6: There is No Enumerated or Implied Constitutional Right to Medical Care

(To save Social Security and Medicare, we must make sure that those 77 million baby boomers don’t hit shore at age 65. Benefits which started at age 65 in the 1930s when life expectancy was less than 65, should have been indexed to the current increased life expectancy of age 75. We only have five years to complete this indexing or a Tsunami wave will hit our shores.)

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7.         Overheard in the Medical Staff Lounge - New Year's Eve Crises - argaiV

A patient called on New Year’s Eve day wanting an urgent refill for his "argaiV." (We must spell this medical word backwards otherwise this newsletter will be rejected by more than 500 Medical Tuesday members who receive this newsletter at their corporate address and email from our URL may be permanently banned. Increasingly, many spammators do the same). My staff tried to get him to come in. He said he couldn't make it and he would need the medication that evening. So, understanding the seriousness of the matter, we made an exception to our “no between-office-visits phone refills” and obliged.

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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, 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. MedicalTuesday members and readers are knowledgeable with Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter the first twenty months of its existence. Please read a review of their new book, Lives at Risk, http://www.healthcarecom.net/JGLivesAtRisk.htm, the definitive work on Single-Payer National Health Insurance Around the World. It shows that the United States has the best health care system in the world. The book can be ordered at http://www.ncpa.org/pub/lives_risk.htm. Be sure to read last week’s report by Bruce Bartlett, a senior fellow, stating that the Medicare system is on the verge of collapse.  The Financial Report of the United States Government for fiscal year 2004, released just before Christmas, says that the unfunded liability of the Social Security system is $12.5 trillion, an increase of $810 billion over the previous year. However, the Medicare deficit is twice as large: $24.6 trillion, an increase of $9.6 trillion from 2003. Instead of talking about reforming Medicare, we are getting ready to make them much worse: When the new Medicare drug benefit becomes fully effective next year, Medicare spending will sharply increase. Medicare’s trustees estimate the long-term cost of the drug benefit at $8.1 trillion, accounting for the bulk of the increase in its liabilities last year. To read Bartlett 's entire report go to http://www.ncpa.org/newdpd/dpdarticle.php?article_id=1075&PHPSESSID=7ee619328f4311d19647e9271c9d35b2.

$          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. Tyler Cowen is the Holbert C. Harris Professor of Economics at George Mason University and the Director of the Mercatus Center and the James Buchanan Center , both at George Mason University . He writes daily in his blog. He recently carried on an EconoBlog on Social Security at the WSJ that can be followed at http://online.wsj.com/public/resources/documents/econoblog11082004.htm.

$          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. This week, she discusses the December White House economic summit that set an agenda for the next year and beyond that will begin with a debate over Social Security and move into tax reform and tort reform. Will health care fall by the wayside? To read her most recent newsletters, "Off and Running" on prescription drugs, go to http://www.galen.org/pdrugs.asp?docID=759.

$          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 and well-outlined 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 recently  became Health Savings Accounts (HSAs). He reports that this has been An Interesting New Year - For Hospitals. To read the entire newsletter on "Ownership of Insurance," go to http://www.galen.org/ownins.asp?docID=757.

$          The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor Emeritus. Richard Rahn, reports last week on a speech given at the Finance Ministry in Vienna , Austria . The very highly regarded European economist and first woman president of the Mont Pelerin Society, Professor Victoria Curzon Price, called for eliminating the corporate income tax. There, in the center of socialist Europe, was not only the call to get rid of this destructive tax, but almost an entire audience of economists, various government finance officials, and public policy experts who appeared to agree with her. Read Rahn's entire heart-warming report at http://www.heartland.org/Article.cfm?artId=16224. Conrad Meier, editor emeritus, writes an excellent review of Lives at Risk, a Must Read to understand why a vocal and well-funded minority is still proposing a failed universal health care system for the United States at http://www.heartland.org/Article.cfm?artId=16224.

$          The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, has Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, read an article by Editor Richman, "The Shady Origins of Social Security" at http://www.fee.org/vnews.php?nid=6531.

$          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. “The belief that more medical care means better medical care is deeply entrenched . . .  Our study suggests that perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care–and may even make things worse.” Laws and regulations, such as state-imposed health insurance mandates, are enacted to protect consumers; however, they also make health insurance more expensive because mandates require insurers to pay for care consumers previously funded out of their own pockets. CAHI has identified 1,853 state-imposed health insurance mandates across America . To read about these mandates, go to http://www.cahi.org/cahi_contents/issues/article.asp?id=491.

To eliminate the uninsured problem, the politicians should pass just one law - eliminate all mandates and all community ratings - and then get out of the way of the problem so the solution can occur.

$          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/. Be sure to read the Daily Medical Follies: “Woeful Tales from the World of Nationalized Health Care” at http://www.factcheckers.org/showArticleSection.php?section=follies.

$          The Independence Institute, 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.

$          The National Association of Health Underwriters, http://www.NAHU.org, America ’s benefits specialist. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page.

$          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. This month, read Martin Masse's editorial http://www.quebecoislibre.org/04/040615-2.htm. The Department of Fisheries and Oceans recently advertised a 100,000-dollar-a-year position that was restricted to non-whites. "DFO believes it is important to ensure that our senior management team represents diversity," they wrote. "Competitions such as this one are aimed to help increase the involvement of Canadians within specific demographic groups…" To read this month’s OpEd article by Jayant Bhandari, “Racism, old and new,” or call it whatever you want: racism, reverse racism, or corrective racism, go to http://www.quebecoislibre.org/04/041215-15.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. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. 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. The Institute reports on the American Medical Savings Accounts and recommends them as Universal, Accessible, Portable and Comprehensive Health Care for Canadians. The literature in the United States indicates that MSAs or similar arrangements have the potential to reduce health expenditures up to 20 percent. One would predict an even larger decrease in health expenditures using Canadian data because Americans already face financial incentives with respect to their use of health care while Canadians do not for the most part. To read the report go to http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=222. To read the previous editorial, “Alberta Health Care is Mediocre at Best,” noting that Alberta ’s taxpayers are tossing dollars into the wind when it comes to health care, go to http://www.fraserinstitute.ca/health/index.asp?snav=he.

$          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 yesterday’s editorial “Bitter Pills #12: Can You See The Big Picture in Medicare Spending?” at http://www.heritage.org/Research/HealthCare/bp12.cfm. Every year, the Heritage Foundation and the Wall Street Journal publish the Index of Economic Freedom. The United States slipped from the top ten for the first time. To read Dr Feulner’s commentary, go to http://www.heritage.org/Press/Commentary/ed010605d.cfm.

$          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 read Thomas J. DiLorenzo’s article on the Tsunami disaster, “A Foreign Aid Disaster in the Making,” go to http://www.mises.org/fullstory.aspx?Id=1715. 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 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 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 his editorial on "Kerry Prescribes More Government-Run Health Care," see http://www.cato.org/dailys/03-30-04.html. To read about Medicare's grim outlook, see his article at http://www.cato.org/research/articles/cannon-040326.html. To read about the conflict federal workers have with the new Heath Savings Accounts, read Cannon's analysis at http://www.desertdispatch.com/cgi-bin/newspro/viewnews.cgi?newsid1080310702,29061. To review former Polish finance minister Leszek Balcerowicz’ important article on limited government and liberty, go to http://www.cato.org/pubs/journal/cj24n3/cj24n3-1.pdf.

$          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. The Pacific Legal Foundation in Sacramento applauded signs that a newly responsible approach to government pension programs may be developing at the state capital. To read Dawn Collier’s report, go to http://www.pacificlegal.org/view_PLFNews.asp?iID=265&sTitle=PLF+Applauds+New+Realism+in+Sacramento+on+Pension+Spending+and+Borrowing.

$          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 its national rankings in the USNews College rankings. Last year, changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Read President Arnn's comments at  http://www.hillsdale.edu/arnn/usnews.asp. Also read his comments on Ronald Reagan, RIP, at http://www.hillsdale.edu/newimprimis/default.htm. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read The Honorable Zell Miller’s comment on Vietnam , Iraq and the 2004 Election at http://www.hillsdale.edu/newimprimis/default.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 Ave, Ste 122 , Carmichael , CA 95608

Words of Wisdom

James Bryce, (1914): Medicine is the only profession that labors incessantly to destroy the reason for its own existence.

Franklin Pierce Adams : Nothing is more responsible for the good old days than a bad memory.

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.

Will Rogers : I don't make jokes. I just watch the government and report the facts.

Medical Aphorisms

In medicine, the more practice a doctor has, the less practice he needs.

Only a fool would make his doctor his heir.

Some Recent Postings

Lives at Risk: Single-Payer National Health Insurance Around the World shows that national single-payer health care systems in countries such as Great Britain , Canada , Australia and New Zealand have not delivered on the promise of a right to health care. See a brief review at http://www.healthcarecom.net/JGLivesAtRisk.htm.

Terrorism’s Next Target, by David Gibson, MD, http://www.healthplanusa.net/DGTerrorism'sNextTarget.htm.

Midlife Bible - A Woman’s Survival Guide by Michael Goodman, MD, http://www.healthcarecom.net/bkrev_MidlifeBible.htm.

On This Date in History - January 11

On this date in 49 B.C., Caesar crossed the Rubicon, committing himself irrevocably to war against Pompey and the Roman Senate. This phrase caught on and we may have a Personal Rubicon to cross, and countries have a National Rubicon to cross. Some think we are in it now.

On this date in 1935, Amelia Earhart Putnam became the first woman to fly solo across the Pacific from Honolulu arriving in Oakland , California on the following day, January 12.

On this date in 1755, Alexander Hamilton was born. Although he was important in American History, and his likeness is on a $10 bill, he lost his life in an "affair of honor," a victim of a duel with Aaron Burr.


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