1.
Featured Article: Why Who Wins the 2008 Election Doesn't
Matter
2.
In the News: Ranking the U.S. Health-Care System
3.
International
Medicine: Malnourishment in National Health Service Patients
4.
Medicare: The Rising Burden of Health Spending on Seniors
5.
Medical Gluttony: Gouging Medicare Takes a Sophisticated
Turn
6.
Medical Myths: The Malpractice Myth Exploded
7.
Overheard in the Staff Lounge: Will Next Tuesday's
Election Make Any Difference?
8.
Voices of Medicine:
Variables in the Art of Medicine
9.
From the Physician Patient Bookshelf: Great
Philanthropic Mistakes
10.
Hippocrates
& His Kin: Mental Hospital Phone Menu
11.
Related Organizations: Restoring Accountability in Medical
Practice and Society
MOVIE EXPLAINING SOCIALIZED
MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements is the former publisher of
"American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.
* * * * *
1.
Featured Article:
Why Who Wins the 2008 Election Doesn't Matter
By David J. Gibson, MD, and Jennifer Shaw Gibson
Here is a radical if not subversive concept concerning
elections in today's hyper-partisan environment: Elections are not about
winning. They are about gaining the permission of the electorate to govern.
It should not be a surprise that voter turnout is
lower in the U.S. than in other industrialized country - the most expensive
campaigns are generally the most negative and depress voter interest. Wedge
issues by definition cannot accommodate compromise and therefore have no place
in public political dialogue. They serve only the interests of demagogues on
both sides of these issues.
What substantive issues are being avoided by
politicians in this election cycle? The following are but a few we should be
discussing:
U.S. has lost control of its financial future
America has become a developed debtor country. As
Niall Ferguson, the professor of history at Harvard University, noted recently
in an op/ed column in the LA Times, the problem for America is that its electorate
now thinks the world owes them a living.
As we are witnessing in this political season,
politicians pander to this assumption by making a series of more or less
incompatible promises: that expenditure on healthcare and education will always
go up; that direct taxation will never go up; and that the assets against which
voters borrow will never go down. The only way to fulfill these promises is to
pump out ever more printed paper - bank notes, bills, bonds, stocks and the
rest. The emerging exporter countries buy these. The net result for America is
a creeping transfer of financial ownership to foreign investors. This process
of acquiring liquidity through the sale of paper to foreign investors is about
to enter a doomsday scenario. China has stockpiled £700billion worth of foreign
currency, and has only to decide to slow its accumulation of dollars to weaken
or destroy America's economy. We are now hearing clear warnings from China that
it will be switching away from dollars into higher valued currencies such as
the Euro in the future. Such a move will likely precipitate a liquidity crisis
that will crush America's economy.
Benn Steil, an economist at the Council on Foreign
Relations recently observed that the U.S. "could be seeing a secular shift
in confidence in the dollar as a store of value as the impression grows that
the United States, to some degree, is losing control of its destiny." It
matters not how many troops, missiles, bombers or aircraft carriers America's
military possesses. At the point of divestment by foreign exporting investors,
our economy will implode without a shot being fired. This is the clear and
present danger we now face and the reality our children are inheriting.
Our consumer-based economy is not sustainable
For the past generation, America's economy is
consumer-based. Consumer spending, not saving and investing has sustained our
economic prosperity. Unfortunately, this consumer-based economy is not
sustainable.
Stephen Roach, the chairman of Morgan Stanley Asia
estimates that the U.S. net national savings is now 1.4 percent of national
income and household debt at 133 percent of personal disposable income. The
median American family is going into what looks like a recession owing more
than 100 percent of its income.
Despite the above, according to the 2007 Retirement
Confidence Survey conducted by the Employee Benefit Research Institute (EBRI),
about 60 percent of people age 45 and older have less than $100,000 in
retirement savings (about 40 percent of the those 45 and older have managed to
save less than $25,000). In fact, of all the workers surveyed, more than
one-third has less than $10,000 in savings. Despite the apparent lack of
adequate savings, roughly 70 percent of all EBRI survey respondents say they
are somewhat or very confident of having a comfortable retirement.
One fundamental investment that individuals in middle
years and older have traditionally held in their portfolio has been equity in
their home. The graph below, taken from Investor's Business Daily, demonstrates
that while homeownership rate climbed to a high of 69.2 percent in 2004, the
equity homeowners hold in their houses slipped in recent decades, approaching
the 50 percent barrier this year. For the past decade and a half, homeowners
have been extracting equity from their homes in the form of second trust deed
financing to support their consumerist life style.
Beneath the staggering U.S. corporate losses - over
$100 billion since the credit crisis began - lie the individuals who assumed
levels of debt they won't be able to pay. The only way prices for housing got
so high was that people who could not afford to buy those homes were given
mortgages they could not hope to repay unless home prices kept rising. A
staggering number of these mortgages were either interest-only or so-called
"negative amortization" contracts that left the principal owed either
unreduced or mounting after monthly payments. All of this sets up the economy
for the perfect storm that will occur during the next administration's time in
office. The trust funds for both Social Security and Medicare have been
eradicated with over $4 trillion in borrowing to pay for prolific spending by
the federal government. Most individuals retiring over the next 20 years have
little if any savings. No one in public life is warning the country of the
crisis that is now unfolding.
Health care will not be reformed in the next
four years
The largest industry in America cannot be
fundamentally restructured without the consent of the electorate and the taxpayers
(the two are not synonymous). Thus far, the political debate has centered on
the current system's shortcomings. As a result, health care reform is at the
top of the 2008 election agenda. Near-universal coverage is being promised by
most serious presidential contenders.
There are at least three problems with the current
health care reform debate. The first involves the lack of candor concerning
what reforming the system will require. National polling consistently
demonstrates that reform proposals that threaten - or which can be made to
appear to threaten - the plans that insured Americans (who are taxpayers and
tend to vote more reliably than the preponderant non-tax paying uninsured)
currently have will likely face a backlash similar to the Clinton debacle of
1993. This reality has doomed Schwarzenegger's "year of health care
reform" in California.
Secondly, the debate has been superficial. Changing
the structure of the underwriting system for health care is easy. Restructuring
the cost per unit of service and the number of units of service delivered is
the hard part of the reform process. In reality, how the underwriting system is
structured is of little consequence - no underwriting system can support the
current inflationary trend in health care.
Finally, the government cannot fund universal
coverage. In fact, the cost of existing health care entitlements has bankrupted
government at all levels, from the local school board to the federal. At the
national level, the magnitude of the unfunded health care retirement liability
for government employees is just coming into focus. Recent estimates by various
benefits consulting firms of the total amount of public sector unfunded retiree
health care obligations have exceeded $1 trillion. To put this in perspective,
according to the Federal Reserve Board, the total amount of outstanding
municipal securities in the United States as a whole at the end of the first
quarter of 2007 was $2.5 trillion.
All of the above does not include the economic tsunami
that both Medicare and Medicaid now represent. Medicare Part A expenditures
alone are expected to grow 85 percent to $385 billion, and the projected annual
shortfall between tax revenue and spending will grow to nearly $45 billion in
2016. The Medicare Trustees this year estimated that filling this shortfall in
Medicare will require an income tax increase of 22.7 percent by 2030.
A failed political paradigm
Since the passage of the 16th Amendment to
the Constitution in 1913, the paradigm for the successful politician has been
essentially unchanged. Once elected, politicians use taxpayer money to purchase
goodwill of the electorate, to ensure longevity in office. Most of this spending has been financed
through borrowing by government at all levels. With the ability to borrow now
limited and the magnitude of the already-promised entitlement funding
overwhelming, we face the reality of a perfect storm in public policy. Future
politicians will of necessity be taking prized goodies away from their
constituents. They will need to increase tax rates to near confiscatory levels,
decrease spending by reneging on prior entitlement commitments, or a
combination of both.
The new politician will look much like Tom McClintock
here in California, a policy wonk who understands the precarious future facing
public financing of government. America has no experience with this type of
politician. How does a politician get elected by taking away programs and
increasing tax rates simultaneously? Clearly, no current candidates from either
party have any grasp of the imminent problems facing the country.
Unfortunately, the current outrageously expensive
political season is not about governing, it is about winning. In place of
substantive debates dealing with the above issues, we get sound bites accusing
opponents of lacking fidelity to Ronald Regan or Martin Luther King. Promises
are made to enact universal health care when knowledgeable insiders know that
this is not feasible. The result: it does not matter who wins. Inconsequential
social issues that should not be part of the public debate will be influenced
but the winner will have neither the political capital nor the mandate from the
electorate to govern in these perilous times.
DJGibson@winfirst.com
David Gibson is a senior partner and Chief Medical
Officer at Illumination Medical, Inc., a health care consulting and medical
management company. Jennifer Gibson is an economist specializing in evolving
health care markets as well as a futures commodity trader specializing in oil
and gas.
To read the original, please go to www.ssvms.org/magazine.asp and click on the January 2008 issue.
* * * * *
2.
In the News: Ranking the U.S. Health-Care System, By Jim Peron, The Freeman: Ideas on Liberty - November 2007
It is curious that the United States ranked below Europe
in the World Health Organization's 2000 World Health Report, which rated 191
countries' medical systems. In his documentary Sicko, socialist Michael Moore
makes hay out of the fact that the United States placed 37th, behind even
Morocco, Cyprus, and Costa Rica. This ranking is used to "prove" that
state-controlled health care is superior to the "free market."
This ranking is curious because the
actual life expectancy of the average American differs very little from that of
the average European. At birth, average life expectancy in the European Union
is 78.7. For the average American it is 78. And this doesn't adjust for factors
that can affect the averages which are unrelated to health care, such as
lifestyle choices, accident rates, crime rates, and immigration. Health isn't
entirely about longevity but it certainly is a major component.
What is not mentioned by Moore, or
others citing the WHO report, are the measures being used to rate the various
countries and who is doing the measuring. There are many ways to nudge ratings
in one direction or another that are not directly related to the actual item
being measured.
For instance, one might produce a
study on transportation. The purpose of transportation is to get people from
where they are to where they wish to be. You might rate how quickly people can
move, how cheaply they can move relative to their income, how conveniently they
can move, and how free they are to move.
You would think the United States
would rate high in such a study. Americans tend to be wealthier than the rest
of the world. There is widespread ownership of cars. Gasoline prices are lower
than in most other countries. On average, the typical American can travel
quicker, cheaper, and more conveniently than people in most parts of the world.
But what if this index included other factors as well? For instance, if a major
component was the percentage of commuters who use public transportation, that
would push the United States far down in the ranking. A larger percentage of
the people in other countries have no other option but public
transportation.
In 2000, when the report was issued,
WHO was run by Gro Harlem Brundtland, a former prime minister of Norway and a
socialist. She doesn't think the results of a health system alone are important.
Rather, she wants to know if the system is "fair." In introducing the
WHO report she wrote that while the goal of a health system "is to improve
and protect health," it also has "other intrinsic goals [that] are
concerned with fairness in the way people pay for health care." She
is clear about the ideological factors she thinks are important: "Where
health and responsiveness are concerned, achieving a high average level is not
good enough: the goals of a health system must also include reducing inequalities,
in ways that improve the situation of the worst-off. In this report attainment
in relation to these goals provides the basis for measuring the performance of
health systems."
True to her ideological roots,
Brundtland prefers socialized medicine over private care. Drawing her first
conclusion about what makes a good medical system, she declares: "Ultimate
responsibility for the performance of a country's health system lies with
government. The careful and responsible management of the well-being of the
population – stewardship - is the very essence of good government. The health
of people is always a national priority: government responsibility for it is
continuous and permanent."
One WHO discussion paper states,
regarding "fairness" in financing, "we consider only the
distribution, not the level, as there is no consensus on what the level of
health spending should be." Equal results, not necessarily good results,
are the focus.
When Moore or others refer to the WHO
index as proof that private health care doesn't work, they aren't being totally
honest because they fail to disclose that the index lowers the scores of
systems that don't satisfy socialist presumptions.
A Second Rigged Study
The New York Times in August
editorialized that American health care "lags well behind other advanced
nations." The newspaper relied in part on the WHO rankings as proof. For
the rest, it relied on a more recent study by the Commonwealth Fund. But that
study, which compared the United States to five other wealthy countries, has
weaknesses similar to the WHO study.
The Commonwealth Fund marked down the
United States partly because "All other major industrialized nations
provide universal health coverage, and most of them have comprehensive benefits
packages with no cost-sharing by the patients." Again the American system
loses points because it doesn't provide socialized medicine. And the Times neglected to note that
"no cost-sharing" means the people have paid through taxes whether
they receive the care or not. . .
Finally, the United States is ranked
last among the six nations surveyed in infant mortality. What is not
discussed is that nations define infant mortality differently. Any infant,
regardless of size or weight or premature status, who shows sign of life is counted
as a live birth in the United States. Germany, which ranks number one in the
Commonwealth Fund survey, doesn't count as a live birth any infant with a birth
weight under 500 grams (one pound). How valuable is a comparison under those
circumstances?
One could easily design a survey that
would rank American health care high and other nations low. But this does not
mean the American system is what it should be. Its successes and innovation can
be attributed to the vestiges of freedom, but government has saddled the system
with so much intervention that it is far from market oriented. Instead of
worrying about irrelevant international rankings, we should be working toward
freeing the medical market.
To read the entire article: www.fee.org/publications/the-freeman/article.asp?aid=8184&print_view=true
Jim Peron is a writer living in Berlin, Germany.
* * * * *
3.
International
Medicine: Malnourishment in National Health Service Patients
Patients left to
starve on NHS wards, By Rosa Prince, Political Correspondent 07/01/2008 (Jan 7)
The number of NHS patients suffering from malnourishment as they leave hospital has nearly doubled, new figures show.
What Next? · Post-birth deaths 'probably linked', say experts
· Mother's stroke 'misdiagnosed as grief'
Around 140,000 patients
were discharged after being inadequately fed on NHS wards last year, statistics
obtained by the Conservatives reveal.
The number released from
hospital suffering from malnutrition, nutritional anaemia, or other nutritional
deficiencies has risen by 84 per cent in the decade since Labour came to power,
from 74,431 in 1997 to 139,127.
The vast majority
arrived in hospital suffering from these conditions. But the Department of
Health figures also show the nutritional condition of at least 8,500 patients
actually worsened while they were in hospital in the last year.
National Institute for
Health and Clinical Excellence guidelines say all patients should be screened
for signs of malnutrition on admission to hospital and treated accordingly.
Campaigners complain
that elderly people in particular are not given enough help to eat in hospital.
There has also been a
rise in the number of patients being admitted to hospital suffering from
malnutrition to 130,594, up from 70,658 a decade ago.
The figure rose by 12
per cent in the last year alone.
The shadow health
minister Stephen O'Brien, who obtained the statistics, described them as a
"scandal".
He said:
"Malnourished patients are more prone to infections, have more
complications after surgery, and have higher mortality rates - yet the
Government allows more than 130,000 patients to enter hospital in the state. .
.
"It is a scandal
that in 21st-century Britain, we allow vulnerable patients to be let out of
hospital in a malnourished state, and it is even worse that we allow thousands
of patients to get more poorly while they are in hospital."
The worst area in the
country for malnutrition was the Pennine Acute Hospitals Trust in Greater
Manchester, where 4,947 patients were discharged suffering malnourishment,
followed by the University Hospitals of Leicester NHS Trust, with 2,771, and
the Newcastle upon Tyne Hospitals NHS Foundation Trust. . .
Last year, the health
minister Ivan Lewis admitted patients were being starved on wards, with some
elderly people given little more than a scoop of mashed potato for lunch.
Others were
"tortured" by having meal trays placed out of reach, which they were
too weak to pull towards them. . .
"Nurses are so
rushed off their feet that it is no surprise that patients end up malnourished.
"We have heard
stories of elderly people who haven't had a meal all day because they have just
been overlooked. The food is just taken away when the patient hasn't been able
to eat any of it.
"It is a scandal in the 21st century - it ought
never to happen."
Read the entire report at
www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/05/nnhs105.xml.
The NHS does not give timely
access to health care, it only gives access to a waiting list.
And if you make it past that,
you're on a starvation list.
Oh, the tragedy of
government medicine!
* * * * *
4.
Medicare: The
Rising Burden of Health Spending on Seniors, by Liqun Liu, Andrew J.
Rettenmaier and Zijun Wang, NCPA Study No. 297
Executive Summary
The United States spends about 17 percent of its
national income on health care, the highest in the world. Some have
wondered how high spending can go and what difference it will make. In
thinking about that question, the experience of our senior citizens provides a
vital clue.
- Today, more than two of every five dollars of
total potential consumption by the elderly (43 percent) is health care.
- In just 17 years (by 2024), health care will
equal 50 percent of seniors' total consumption.
- For the oldest seniors - age 75 and older -
health care already makes up more than half of all they consume.
Much of seniors' health spending is paid not by
seniors themselves, but by public and private third parties like Medicare,
Medicaid and previous employers. However, as spending on their health
care rises, seniors will be asked to devote an increasing share of their own
incomes to pay for it, crowding out other items like food, housing and travel.
- Today, seniors spend 17.2 percent of their cash
incomes on health care, on the average, including out-of-pocket
expenditures, as well as premiums for Medicare and individually purchased
Medigap insurance.
- That level will grow to almost one out of every
four dollars of income (23.5 percent) by 2030, and by midcentury seniors
will potentially spend almost one-third of their cash incomes (31.4
percent) on health care.
Another way to look at health care spending by the
elderly is to compare their total health consumption to their money incomes:
- Including all the spending by third parties, an
amount approaching two-thirds of seniors' cash incomes is currently spent
on health care.
- In another three decades (by 2039), an amount
equal to 100 percent of seniors' cash incomes will be spent on health
care.
Since Social Security represents such a large portion
of seniors' retirement income - particularly for older seniors - examining
health spending as a percentage of Social Security benefits is also
informative:
- Today's seniors spend from their own resources an
amount equal to 44.5 percent of their Social Security benefits on health
care.
- That amount will almost double (to 81.3 percent)
by midcentury.
If health care spending rises as expected, seniors
will likely be called upon to share the burden. That means current and
future workers will need to extend their time in the labor market - or save and
invest more money while working - to prepare for the higher expected health care
costs waiting for them in retirement.
To read the entire extensive report, go to www.ncpa.org/pub/st/st297/.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Gouging Medicare Takes a Sophisticated Turn
I recently saw a senior citizen for an initial
evaluation because his physician had retired. After spending an hour
interviewing him, examining him, and going over the need for tests I thought
would be important, we arranged for some of these laboratory and x-ray
appointments.
He came back a few weeks later and said he had all the
tests done and many more. He had discussed his situation with the seniors at
his residence who from experience told him that the fastest way to get a number
of tests done without spending a week or two going from appointment to
appointment was to go to the emergency room. He was also told that he should
have an urgent reason for evaluation such as chest pain or a blackout spell so
the ER doctor would do a thorough evaluation.
So he followed his friend's suggestions and had
himself taken to the ER for chest discomfort and light-headedness. He returned
to make sure he had obtained everything I had requested. He bragged about the
tests he was able to achieve in the course of one afternoon.
With HIPAA, it is more difficult to acquire his
hospital records but by faxing his written permission and requesting the
records, my staff was able to obtain them within 30 minutes. HIPAA really
interferes with the smooth practice of medicine, but we saw a couple of other
patients while this administrative work was accomplished.
In the ER he not only had a chest x-ray,
electrocardiogram, and blood tests, he also had an ECHOcardiogram, CT of his
brain and Doppler of his carotid circulation in his neck. He then had a CT of
his chest and abdomen to make sure nothing was missed by the ER doctors of what
"else could have caused multi-organ system symptoms."
When I pointed out that he had far more extensive and
expensive tests than I thought was necessary, he seemed astonished. "Don't
you think it is marvelous that I was able to get everything you wanted in one
evening and even far more?"
"But I had scheduled these tests in the private
offices of the lab and radiologist which are far cheaper. You had them all in
the hospital which charges at least two or three times as much as private
doctor labs and x-rays. So these three to five hundred dollar tests are all
being charged to Medicare for $1000 to $1500. Don't you think this is a lot of
money?"
"But it's my health that's at stake. I think I
deserve whatever Medicare thinks I deserve. And it only cost me one ER
co-payment of $25 instead of three or four co-payments. A guy has to watch his
costs, doesn't he?"
I ended the dialogue at this point realizing that his
attitude was similar to a lot of Medicare patients. More and more is never
enough. But what is the answer?
Health care reform is evolving. More physicians and
health planners are recognizing the gluttonous habits of American patients.
There has to be a percentage co-payment on every office visit, hospital stay,
lab test and x-ray so that the patient begins policing his own gluttony. Even a
20 percent co-payment on this hospital ER outpatient evaluation would have made
him begin to appreciate his gluttony after the first thousand or two dollars of
testing before he ever reached the $10,000 this evaluation was charged. He
would have stopped after the initial sequence of tests was normal. And before
the month was over, he might have begun to realize that 20 percent co-payment
of the private outpatient facilities would have been less than a third of the
20 percent of the hospital ER outpatient hospital facilities. He then would
have gotten the reasonable tests we initially ordered. Health care costs would
have policed themselves because patients will monitor every single cost and
bring them down to the lowest level without any bureaucracy, HMO, insurance,
government, Medicare, Medicaid, or VA intervention.
Health Care Reform is actually Very Simple.
A percentage co-payment will place the patient in charge instantly.
The patient will get costs to the rock bottom immediately without any other
regulations.
Then Congress could go home and not interfere with the practice of medicine.
But could they? Would they? Will they?
* * * * *
6.
Medical Myths:
The Malpractice Myth Exploded
Health Alert: Subj: Malpractice Solved
You are going to be a Good
Samaritan. You are about to become a
kidney donor so that someone else can live.
The odds are in your favor. Only
about 2 out of 10,000 fail to survive the operation.
Still, what if you were one
of the two? What happens then?
Under the current system,
there are only two options. Neither is very
attractive.
On one hand, your spouse,
children, heirs, et al., could hire a lawyer, subpoena documents and take
depositions to see if malpractice has occurred and compensation is due
them. Or they could accept the
financial and emotional loss stoically - forever wondering if your death was
preventable.
Fortunately, your friends at
the National Center for Policy Analysis have discovered a new and better
alternative. Prior to your surgery, you
are asked to sign a contract with these terms:
1. You agree to waive your right to pursue any malpractice claim.
2. If you fail to survive the operation, your family gets a check
for $1 million. No lawyers, no
courtroom, no judges, no jurors - just a cool million, no questions asked.
3. For pennies on the dollar (out of your pocket), you can make the
compensation even larger, say, $2, $3 or $4 million.
4. The hospital pledges to make all safety records public; and to
facilitate comparisons, they are available at a special Web site.
Voila! Problem solved. Can it get any better than that? . . .Well. . . as it turns out.
. . it can.
You go to the Web site and
compare. There you discover that other
hospitals offer larger amounts of compensation in case of an adverse
event. In fact, Hospital B offers $2 million
if you fail to survive.
Upon further investigation,
you learn why.
Your chances of dying at
Hospital A (your original choice) are twice as high as at B. So if Hospital B pays the same insurance
premium as Hospital A, it can offer twice as much.
You have your procedure done
at Hospital B. Fortunately, it's a
success and another five months go by.
Then out of mere curiosity
you return to the Web site and make an amazing discovery. All the hospitals are now offering the same
compensation for kidney transplant fatalities.
The reason: they now all have the same safety record.
Think about that. In less than six months, market incentives
have accomplished what all the RWJ demo projects, Commonwealth studies, Health
Systems Change conferences, HHS press releases, Newt-Hillary political
alliances, and hectoring, harping, bullying, shaming, niggling, nagging
speeches, editorials and op-ed pieces have not been able to accomplish since
the dawn of time. (Okay, it only seems
that long.)
Here's the basic idea:
hospitals and doctors can get out of the malpractice system completely (other
than for gross negligence) by agreeing to compensate patients for rare,
unexpected adverse health events. The
legislature decides (or sets up a procedure for deciding) in advance what the
minimum compensation must be. To pay
off the claims, providers purchase episode-specific insurance. The insurers (not bureaucrats, not lawyers,
not even patients) then become the true monitors of safety - charging premiums
that accurately reflect expected outcomes.
In no time at all, bad
doctors and bad medical practices will vanish.
They will be priced out of the market by insurance premiums they cannot
afford to pay. Malpractice becomes very
rare; high quality and safety become the norm; patients and their families get
compensated, regardless of the cause of their injuries; and trial lawyers can
go earn an honest living.
Space does not permit a full
elaboration of details. You can find
those at the NCPA Web site.
For the NCPA study on
malpractice reform, go to: http://www.ncpa.org/pub/bg/bg163/bg163.pdf.
Have a good day,
John Goodman
President
National Center for Policy
Analysis
12770 Coit Rd., Suite
800
Dallas, Texas 75251
Comment on this Health Alert at www.john-goodman-blog.com/.
* * * * *
7.
Overheard in the Medical
Staff Lounge: Will Next Tuesday's Election Make Any Difference?
Dr. Edwards: Well
the elections are next week. Anyone willing to stick their necks out?
Dr. Dave: Mrs.
Clinton has promised to destroy health care and complete what she didn't
accomplish in 1992.
Dr. Edwards:
Doctors will survive the enslavement or get out of practice. With all this
hostility we have, I think the government would be happy about that.
Dr. Dave: But
our patients would be thrown to the wolves. They wouldn't have any idea of what
ate them?
Dr. Sam: I've
quit worrying about this. I've got some good leads on non-government positions
that I could immediately step into if my practice becomes too onerous.
Dr. Ruth: But
wouldn't you miss your patients?
Dr. Sam: Certainly.
But I can't be their savior from the ravenous wolves. They would just as soon
eat me also.
Dr. Michelle: I'll
just keep practicing no matter what happens. I'll do my 9 to 5 job and let the
government worry about the rest of it.
Dr. Rosen: But
will they let you?
Dr. Michelle: They
will want me to see patients from 9-5. With all of you leaving, they will be
even kinder to me for staying with it. They will begin paying me more to keep
seeing patients.
Dr. Rosen: You
have a point, Michelle. But I can't imagine the government ever liking me.
Dr. Edwards: But
Mrs. Clinton isn't the only one that will destroy healthcare. Look at Mitt
Romney. He introduced government medicine in Massachusetts. He's changed his
mind but I would never trust a Chameleon.
Dr. Ruth: He
also was for prenatal killing until he found out that his party didn't approve
and he became a chameleon in that regards also.
Dr. Yancy: That
malpractice lawyer who made his millions suing doctors has made it very clear
that he would eliminate all choice in medicine. He would also force coverage of
preventive care. That should double health care costs and be totally
ineffective. People enjoy preventive care programs. It's like group
therapy. People are social beings and just
love to talk and discuss. But it doesn't change behavior.
Dr. Edwards: I've
seen people choose smoking withdrawal programs that didn't make a big issue out
of stopping smoking. One patient told me he joined Smoke Enders because you could
keep on smoking. They just enjoyed the camaraderie of the group all supporting
their inability to stop. Counter productive.
Dr. Rosen: I had
a friend of Huckabee's in my office the other day. Boy did I get an earful. I
think Huckabee is for big government European style. We would have
pseudo-religious parties, like Christian Democrats for big government, and
total control and more taxes. I think we need to be less like Europe than more.
Dr. Dave: I'm
leaning to McCain more and more. As the WSJ stated, he, like Eisenhower, is the
right man for the White House at this time in history.
Dr. Edwards: But
he's for opening our borders.
Dr. Rosen: But
he would never get that implemented. He has a better grasp of world affairs
than any other candidate. Unless something else happens, I hope he's our
candidate.
Dr. Michelle: I
rather like Obama. He has fresh ideas for change.
Dr. Edwards: He's
a bright lad. But he needs another eight years in the Senate to mature and get
a grasp of world affairs and then he will be unbeatable.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
Orange County Medical Association Bulletin: Guest
Editorial - Variables in the Art of Medicine by Patrick Sheehy, MD, 9/1/07
As a handicapper, golfer and practicing physician, I
take variables very seriously. They are the enticing emissions of possibility
that spring from every difficult, soluble problem. Effective management of
variables requires freedom, judgment, intuition and courage.
Here are seven ideas to restore the art of medicine.
In handicapping horse races, there are three major
variables and six minor ones to consider. Still, the best handicappers can only
consistently hit one out of three winners.
In swinging a golf club, there are also a limited number of major and minor
variables to manage if the golf ball is to move from the tee into the cup.
In the practice of medicine, variables dominate, yet they are seldom mentioned
in discussions about the field. Further, recognition of variables rarely
emerges in analysis of quality by managed care organizations, government
agencies, insurance companies or systems analysts.
As a handicapper, golfer and practicing physician, I take variables very
seriously. They are the enticing emissions of possibility that spring from
every difficult, soluble problem. Effective management of variables requires
freedom, judgment, intuition and courage.
About the problem of spiraling healthcare costs--which exceed $2 trillion, or
$7,000 per person, annually--governments, insurance companies, college
professors and systems analysts seem to be either indifferent to or not
cognizant of the variables controlling the interaction between disease and
society.
In fact, managed care is antagonistic toward managing variables. The proof is
that since managed care was introduced, the cost of healthcare has quadrupled,
possibly because freedom, judgment and intuition have been hindered or denied.
This miscalculation was like Pavlov being obsessed with the dog's wagging tail
and not observing the excessive salivation. Managed care has corrupted
physicians, sacrificed patients and assured financial success for insurance
companies.
W. Edwards Deming and his followers advised that the complexity of disease
could be simplified. Healthcare could be placed on a conveyer belt and
delivered like an automobile being assembled. Doctors and nurses, seated around
the conveyor belt, could manufacture increasingly better products, and the
Japanese "automobile miracle" would be repeated in healthcare. The
hypothesis promoted petrifying consistency to achieve quality, cost reduction
and consumer satisfaction.
Forgotten in this model is that the art of medicine is a juggling affair
managed by a practitioner's skill, judgment and daring. The systems people,
never having practiced medicine, never understood all the variables.
The variables inherent in all patients, diseases and doctors confound the
systems people. Further, the additional variables of oppressive government
regulation, greedy insurance companies and megalithic hospitals have
increased--not decreased--the complexity of the art of medicine. All of these
interfere with the juggling affair that is medical practice. And nothing can
heal the situation except physician moral courage and leadership, which are
both in scarce supply.
When golfers and handicappers loose their finesse, they return to basic
maneuvers to eliminate kinks. Below are my recommendations to restore the art
of medicine:
-Physicians should contract with no one other than their patients, and
physician fees should be the end result of open competition.
-Patients must be held responsible for managing costs by paying a portion of
each bill, and healthcare costs must be made tax-deductible . . .
-All megalithic hospitals should be abandoned (or converted into hotels).
Through entrepreneurship, leaner, meaner and disease-orientated centers should
be established . . .
-Managed care
should die the death of communism--a dictatorial, expensive and corrupting
management system.
-Physicians must avoid all conflicts of interest when caring for patients.
There should be no investments in profit-making ventures where increased use
would increase income. Prosperity should come from innovation and efficiency;
pride should come from finessing the art of medicine.
To read the entire OpEd, go to www.socalphys.com/article/articles/545/1/Guest-Editorial---Variables-in-the-Art-of-Medicine/Page1.html/print/545.
Patrick Sheehy, MD, is a Newport Beach-based oncologist. He can be reached
at psheehy@sbcglobal.net.
* * * * *
9.
Book Review: Great
Philanthropic Mistakes by Martin
Morse Wooster Hudson Institute • 2006 • 157
pages • $14.95 paperback.
Reviewed by George C. Leef
The University of Chicago was founded with John D.
Rockefeller's money, and numerous public libraries were created through the
philanthropy of Andrew Carnegie. People hear about philanthropic success
stories and generally assume that charitable foundations are doing wonderful
things with the fortunes of the nation's superrich. In fact, there is a common
view that the charitable work done with the wealth amassed by business tycoons
is a "giving back to society" that at least partially atones for
their undoubted transgressions against law and/or morality.
But how often do people think about philanthropic
blunders? Who reflects on the possibility that charitable foundations might
actually do harmful things with the money at their disposal?
There is only one such person who comes to mind:
Martin Morse Wooster, author of Great Philanthropic Mistakes. Wooster has made
quite a study of philanthropy. His earlier book The Great Philanthropists and
the Problem of Donor Intent examined the tendency for charitable foundations to
be taken over by "experts" who overwhelmingly have a leftist outlook
and steer the foundation's giving in ways that are often radically at odds with
the philosophy of the donor. With
his current book Wooster delves into the hubris of those "experts"
who usually think there is no limit to the good they can do with vast sums of
money. The trouble is that they
often do no good at all - and sometimes considerable harm.
Wooster focuses on eight cases where huge foundations
made mistakes: the Rockefeller Foundation's attempt to recast American medical
education; the Lasker Foundation's war against cancer; the population-control
campaign of the Ford and Rockefeller foundations; the Ford Foundation's
"Gray Areas" program; the Carnegie Corporation's public-television
campaigns; the Ford Foundation's school-decentralization initiative; the
MacArthur Fellows program; and the Annenberg Foundation's public-school-reform
crusade. After reading about each one, my mind was drawn to Milton Friedman's
observation that no one spends other people's money as carefully as he spends
his own.
Foundations don't act. The people who run them do.
Wooster's eight cases center on foundation decision-makers who had grand
visions for changing the world. Arguably, the one who best exemplifies the
typical mindset was Ford Foundation president McGeorge Bundy. Bundy, who ran
the giant in the 1960s and 1970s, once declared, "I may be wrong but I am
never in doubt." It's that lack of doubt that is the root of the problem
time after time. Ford's "Gray Areas" program is an excellent example.
. .
Another illustrative failure Wooster highlights is the
Annenberg Foundation's gigantic effort at public-school reform in the 1990s. Walter Annenberg made his money in
magazines, especially TV Guide. His foundation announced in 1993 the
"Annenberg Challenge" in which it put up half a billion dollars . . .
All the funding, however, went into the educational status quo, which happily
absorbed the money and went about business as usual. In 2002 the Annenberg
Foundation published a report loaded with bromides such as, "[P]ublic
education in America is better than its image," but conceding that public
schools had not significantly improved despite all the money lavished on
"reform."
To read the entire review, go to www.fee.org/publications/the-freeman/article.asp?aid=8153.
George Leef is book review editor of The Freeman.
* * * * *
10.
Hippocrates &
His Kin: Mistakes are Ubiquitous
It's been said that Ministers can forgive people's
mistakes; they can do penance for their own mistakes; doctors can bury their
mistakes; hospitals just make the medical records more voluminous so no one can
find them; attorneys can lock up their mistakes; architects advise their
clients to grow bushes and vines to camouflage their mistakes.
We try out best to avoid MISTAKES - but regulations in
medicine causes us to make even more.
Isn't the answer to decrease mistakes obvious?
Sign on the door of a law office: Hire an attorney.
Get a second one free.
You suppose the third one is half price?
MENTAL HOSPITAL PHONE MENU
Hello and thank you for calling the State Mental
Hospital. Please select from the following menu options:
If you are obsessive-compulsive, press 1 repeatedly.
If you are co-dependent, please ask someone to press 2
for you.
If you have multiple personalities, press 3, 4, 5 and
6.
If you are paranoid, we know who you are and what you
want, stay on the line so we can trace your call.
If you are delusional, press 7 and your call will be
forwarded to the Mother Ship.
If you are schizophrenic, listen carefully and a
little voice will tell you which number to press.
If you are manic-depressive, it doesn't matter which
number you press, nothing will make you happy anyway.
If you are dyslexic, press 9696969696969696.
If you are bipolar, please leave a message after the
beep or before the beep or after the beep. Please wait for the beep.
If you have short-term memory loss, press 9. If you have
short-term memory loss, press 9. If you have short-term memory loss, press 9.
If you have long-term memory loss, please hang up and
try again to morrow. Maybe you'll remember then.
If you have low self-esteem, please hang up our
operators are too busy to talk with you.
If you are menopausal, put the gun down, hang up, turn
on the fan, lie down and cry. You won't be crazy forever.
During National Mental Health Care week, please
do your part by remembering to contact at least one unstable person to show you
care about them?
To read more vignettes, please go to www.healthcarecom.net/hhk1997.htm.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: