Physicians, Business, Professional and Information Technology

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, June 10, 2003

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In This Issue:
1. HealthCare in Fifty Countries Not Reassuring
2. Private Research Funding Now Exceeds Taxpayer-Funded Research
3. Market Driven Health Care - Who Wins, Who Loses, A Book Review
4. Our Monthly Review of the Twenty Myths of National Health Insurance
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring Accountability in HealthCare & Government
7. The MedicalTuesday.Network for Restoring Patient-Focused Private Practice

Keeping Up with the Latest Developments in MedicalCare
The annual international meeting of my subspecialty in Internal Medicine, the American Thoracic Society (ATS), occurs every May. I look forward to sharing notes with as many colleagues from around the world as possible. This year in Seattle, Washington, approximately 15,000 converged to share the latest. All areas of subspecialty medicine share common interests. Hence we had pulmonary physicians, pediatricians, pathologists, thoracic surgeons, chest radiologists, respiratory nurse clinical specialists and respiratory therapists. With more than 40 concurrent sessions that ran from 7 a.m. until 9 p.m. for four days, it was a challenge selecting topics that would provide the most useful information to ones primary interest as possible. Tapes were available for nearly all sessions and many attendees purchased 30 to 40 tapes for sessions they were unable to attend. By listening to these lectures, one could gain the information from attending two of the 40 concurrent sessions. During the next year, the International Societies for Asthma, Emphysema, Pulmonary Fibrosis, Cystic Fibrosis, Tuberculosis, Critical Care Medicine, Thoracic Surgery, Bronchoscopy, and a host of related groups will be meeting to present the latest in their sub-subspecialty. These will be further distilled for the 100th  annual meeting of the ATS next May in Orlando, Florida. It truly represents a thirst for medical knowledge and allows the latest medical developments to be shared by the medical, nursing and respiratory therapy professions. Similar advances occur in the other dozen or so organ system subspecialties. In light of these massive efforts and evolving advances, with hundreds of thousands of research articles published each year, it is not only arrogant but unbelievably naive for politicians in our state assemblies or congress to suggest that they or their clerical and professional staffs can determine and make available the health care needs of the masses. Our founders stated, “We have given you a republic, if you can keep it.” This statement points out the forever demanding efforts we must use to keep patient-oriented rather than government-dominated MedicalCare alive and the wave of the future. Remember Richard A. Epstein wrote in Mortal Peril that unregulated health care will make more of this available to human kind than any socialized [or single-payer] governmental program. For a review of this book, see http://www.HealthCareCom.net/bkrev_MortalPeril.htm

HealthCare Practices in Fifty Countries–Not a Reassuring Message
I had the opportunity of meeting physicians from approximately twenty-five of the fifty countries at the ATS meeting. The recurring theme was the endless bureaucracy of HealthCare throughout the world. The sad fact was that although the majority of physicians saw the failing of their governmental health care, a large number were too young to have ever experienced private patient-centered medical care. They simply had difficulty envisioning unfettered health care without a bureaucrat making rules about how to provide care.

HealthCare Practices in the United States–a Reason for Concerted Efforts
During the four days of the meeting, my wife went on daily tours in Seattle and in the Pacific Northwest. She interfaced with spouses from many other states and many other countries. The foreign spouses are concerned with the hopelessness of HealthCare throughout the world of government medicine. The chief interest of the American spouses, many of which work in their husband’s offices, is centered around “if” and “when” the United States adopts a single-payer HealthCare like all the “enlightened” foreign countries. These messages are almost like a Tom Stoppard play, where two actors talk at cross-purposes, neither understanding the message of the other. Hopefully, we can become enlightened to the problems of single-payer or socialized medicine before the rest of the world privatizes, for if we become socialized, the rest of the world will give up. Private-based MedicalCare will cease to exist and government will control the lives of all people.

The Pharmaceutical Industry Research Exceeds That of the National Institutes of Health
The research supported voluntarily by the pharmaceutical industry now totals $30 billion dollars a year. This exceeds that of the National Institutes of Health which extracts funds from citizens through coercive taxation. The private research industry now pays for two-thirds of all research; taxpayer supported research has dropped from two-thirds to one-third. Thanks to the pharmaceutical industry for improving our lives with the latest treatment for illnesses. We hope the government does not destroy this noble endeavor in the United States, as has been done throughout much of Europe. If Europe does not change to a market-based pharmaceutical industry that allows noble human aspirations as well as profits, it will retreat to the eighteenth century.

Market Driven Health Care - Who Wins, Who Loses in the Transformation of America's Largest Service Industry by Regina Herzlinger. Dr Herzlinger, Professor of Business Administration, Harvard Business School, suggests by her title "how the market--not managed care... will provide the solution to the deep problems that plague the American health care system." Consumers in the United States are ambivalent about medical care--bemoaning high costs and inefficiency while applauding research advances and individual health care providers. The abundant information that is available for other sectors--prices, cost, quality, availability--is stunningly absent in health care. Read the review at http://www.healthcarecom.net/bkrev_MarketDrivenHealthCare.htm.

National HealthCare Systems in the English-Speaking World (No 15)
In his recent update of the “Twenty Myths about National Health Insurance,” John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), states that ordinary citizens lack an understanding of the defects of national health insurance and all too often 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. See previous issues or the archives at www.MedicalTuesday.net for the summary of the first fourteen myths or www.ncpa.org for the original 21 chapters of the book.

Myth Fifteen: Single-Payer Health Insurance Would Benefit America’s Elderly

If the experience of other countries is any guide, the elderly have the most to lose under a national health insurance system. In general, when life-saving care is rationed, the young get preferential treatment over the old.

Age Discrimination in Britain. For the most part, the elderly are able to schedule appointments with GPs and can usually gain access to medical facilities, albeit with difficulty. However, many find it difficult to receive the treatment and specialized care that many conditions associated with advanced age require. Access to surgery, both emergency and non-emergency, is limited, as younger, healthier patients are given priority and allowed to pass the seniors in queue. In Britain, what is termed “ageism” has been discussed extensively in medical circles and in the popular media.

•  Extrapolating from a Gallup survey, the U.K. charity Age Concern estimates that one in 10 people (nearly 2 million) notice a difference in their treatment from the NHS after their 50th birthday.
• One in 20 people over age 65 said they had been refused treatment; many said their doctors told them the money would be better spent on treating younger patients.
• According to an article published in the British Medical Journal, in many coronary care units, age rather than medical considerations often determines whether a patient will be treated.
• Although more than one-third of all diagnosed cancers occur in patients 75 years of age or older, most cancer-screening programs in the NHS do not include people over age 65.
• A report by the British Thoracic Society and the Society of Cardiothoracic Surgeons of Great Britain and Ireland said only one in 50 lung cancer patients over age 75 receives surgery.
• In one particularly disturbing case, BBC News alleged that 60 seniors died after being deprived of food and water by hospital staff in an effort to relieve the pressure on the hospital for beds.

Age discrimination is not just an action of individual doctors or hospital staff. In countries with single-payer health insurance systems, denial of care to the elderly also occurs as a result of institutional obstacles. For example, in Britain:

• Guidelines issued by the British Medical Association allow NHS doctors to withdraw food and water given by tube to elderly patients suffering from severe stroke and dementia even if they are not facing imminent death.
• In an effort to curb costs, the NHS has cut the number of geriatric beds in British hospitals by 50 percent over the past 20 years.

Some critics of the NHS claim that its policies toward the elderly are deliberately aimed at eliminating a burden on the system and amount to a strategy of conducting involuntary euthanasia with older patients.

Age Discrimination in New Zealand. The same sort of discrimination against the elderly exists in other countries with national health insurance. New Zealand’s guidelines for end-stage renal failure programs say that age should not be the sole factor in determining eligibility, but that “in usual circumstances people over 75 should not be accepted.” Since there is no private dialysis service in New Zealand, this amounts to a death sentence for the elderly with kidney failure.

International Comparisons. A recent Commonwealth Foundation survey asked seniors in the UK, Canada, and the US to rate the performance of their nation’s health care system. The survey found that the United States is the only country of the three in which the elderly are more satisfied with their health care system than the non-elderly.

As the proportion of the population that is elderly continues to grow in most developed countries, seniors’ access to health care in countries with single-payer health insurance systems is likely to deteriorate even further. These countries will increasingly be faced with the unpleasant choice of raising taxes or more rationing of care.

The World Sees America as Medical Gluttony–Excessive HealthCare Costs
One recurring theme from the physicians and health care workers from around the world at the International ATS meeting in Seattle noted above was that they have become so used to restricted care, that they think of HealthCare in America as Gluttonous Medicine. Whether from physicians in meetings or their spouses on tour, from Scandinavia to Asia to South America, they believe Americans are so used to excessive HealthCare that they would have a hard time getting use to socialized or single-payer medicine. We heard comments such as, “In Sweden, we understand that the government provides just the basics of health care. If we want more, then we have to pay for it privately.” In America, national single-payer or socialized medicine is promoted as providing even more care than HMOs provide, which does not bear up in these discussions.

The recurring theme from U.S. health care workers, including physician’s spouses working in medical offices, is that we should not put up with the restricted care that HMOs, Medicaid and Medicare demand, and we should have socialized or single-payer medicine so “everyone can have everything.” Americans cannot think of being denied drugs and procedures which are routinely denied in most countries of the world.

If office employed physician spouses who work through the current morass of restrictions think that socialized or single-payer HealthCare would be less restrictive, then the train may be out of the station and impossible to stop. Those parties that would like to enslave us into government medicine will have open season on rationally thinking responsible Americans, if health care workers are equally deluded.

However, we are optimistic that numerous efforts such as this will give responsible Americans pause to consider the constriction of Freedom such proposals will produce.

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The MedicalTuesday Network Recommends the Following for Their Efforts in Restoring Accountability in HealthCare, Government and Society:

The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Devon Herrick wrote Twenty Myths about Single-Payer Health Insurance which we review in this newsletter monthly, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports.

• The Mercatus Center at George Mason University is a strong advocate for accountability in government. Nobel Laureate Vernon L Smith, PhD, has joined its Economics faculty. Please log on at www.mercatus.org to read the government accountability reports–their fourth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former government minister in New Zealand, and now director of the Mercatus Center’s Government Accountability Project. This week we see another unintended consequence of mandates. Well-Intentioned Insurance Legislation May Increase Alcohol Abuse: In a new working paper, Mercatus scholars Jonathan Klick and Thomas Stratmann examine the effects of state laws requiring insurance policies to include treatment for alcohol and substance abuse. They statistically measure the effect on alcohol consumption today of laws that increase the level of insurance for addiction treatment in the future. They find that these insurance mandates lead to a statistically significant increase in alcohol consumption––on the order of an additional beer per week per person!

The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website www.galen.org. The health sector is poised to enter a dramatic new era of consumer-driven health care. People are demanding more control over decisions involving their health care and medical coverage. And the Internet allows consumers easy access to a wealth of medical information that was available only to professionals as recently as a few years ago. But public policy is lagging behind. It is suited to an Industrial Age, not our Information Age. Private and public sector bureaucracies, not consumers, are still in charge because they control the finances and therefore the decisions. We have expanded existing government health care programs, especially Medicaid, to cover more and more people and have even created new programs, like the State Children's Health Insurance Program. Yet the number of uninsured remains stubbornly high. It seems clear that we need to look for other solutions. And that means looking not at further expanding government programs but at harnessing the creativity and energy of the private sector. As amazing as it may seem in our capitalistic economy, this is the one thing we haven't tried! And the public policy change that will empower millions of consumers to lead this transformative change is giving them more financial control over their health care and coverage. Read the Galen philosophy at http://www.galen.org/news/transforming.html.

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 or read the current issue by logging onto www.galen.org and clicking Consumer Choice Matters. The current issue 18 cites a number of "Business Journals" which headlined "Big Businesses Call for Universal Health Care Coverage." Scandlen’s translation: "We've caved in to union demands for ever-richer [health care] benefits for decades, so now we want the government to mandate the same burden on our competitors." (Or in the vernacular, let’s make sure that everyone gets screwed equally.) SOURCE: washington.bizjournals.com/washington/stories/2003/05/26/newscolumn3.html.

Martin Masse, Director of the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free market-based articles, some will allow you to brush up on your French. You may also register to receive copies of his webzine on a regular basis. This week he discusses his interview with Father James Sadowsky who is not a well-known figure of the libertarian movement. But he is a pioneer and one of a small band of enlightened people who  met regularly in Murray Rothbard's apartment in Manhattan in the early sixties to discuss revolutionary ideas which today can be shared with hundreds of thousands of people through the Internet.  Martin Masse says, “I met Jim for the first time four years ago when he gave a lecture in Montreal . . .  on why the poor need capitalism. Since then, we've met regularly. . .  We've had dozens of wonderful conversations on economics, the Austrian school, history, religion, my Quebec French accent, cats, and many other things. I thought QL readers should have the chance to share one of these conversations with him.” Please give yourself a treat at http://www.quebecoislibre.org/030607-2.htm.

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 www.mises.org to obtain the foundation’s daily reports. The Current report: The journalist's skill as an observer can only take him so far, if he is observing with the wrong theory in mind. As Thomas Friedman's "Theory of Everything" shows, without the distinction between power and market . . . a theory of everything can easily turn into a theory of nothing.
 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.

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 www.hillsdale.edu to register for the annual week-long von Mises Seminars which are now held every February, or their famous Shavano Institutes. Call 800-797-9519 to join the Mediterranean Cruise October 1-13, 2003 to explore the Roots of Western Civilization. On-board speakers this year include Wall Street Journal Editor Emeritus Robert Bartley, Historian Paul Johnson, President Reagan’s UN Ambassador Jeane J Kirkpatrick, theologian Michael Novak and National Review contributor and FOX News analyst Victor Davis Hanson, who will also conduct a two-day pre-cruise excursion in Athens. There will be a gala in Rome with the US Ambassador to Italy. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. The last ten years of Imprimis are archived at http://www.hillsdale.edu/newimprimis/archives.htm.

Robert J Cihak, MD, & Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at http://www.newsmax.com/pundits/Medicine_Men.shtml. Every pundit in the land has his own diagnosis for the health care crisis. Dr Cihak feels that the frequently given diagnosis of lack of adequate health insurance is the wrong diagnosis and what we really need is less insurance – not more! After a recent experience with health insurance, he’s decided to pay cash and negotiate all HealthCare expenses including hospital care. So far it has been cost effective for him. This week read about "Rational Medical Ignorance" at http://www.newsmax.com/archives/articles/2003/6/2/203417.shtml. We appreciate his kind words about our efforts with MedicalTuesday.

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MedicalTuesday Supports These Efforts in Restoring Accountability in Medical Practice by Restoring the Doctor & Patient Relationship Unencumbered by Bureaucracy:

PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of their cost. Dr. Berry also has an internal medicine practice.  He has posted a letter sent to Senator Fred Thompson during the summer of 2000 after meeting with a representative from his office for about an hour. It was later forwarded to Senator Bill Frist, MD, and Representative Bill Jenkins. It received only perfunctory responses from the offices of each. “Seeing the futility of trying to effect change through the political process, I have not wasted anymore time trying to persuade the men who represent us at the level of the federal government.” Click on “Email to my Senators” on the website above. (Sounds like good advice for the Business/Professional community that is genuinely interested in helping patients.)

Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP) www.sepp.net, for making efforts in Protecting, Preserving, and Promoting, the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available.

Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. An 80-slide Power Point Lecture has been posted at http://www.simplecare.com/PowerPoint%20Files/SimpleCare%20Info%20Slide%20Show%205-17-03_files/frame.htm.

Dr David MacDonald has partnered with Ron Kirkpatrick to start the Liberty Health Group (www.LibertyHealthGroup.com) to assist physicians by helping them to control their medical benefit costs for their staff and patients. He is available to speak to your group on a consultative basis. Contact him at DrDave@LibertyHealthGroup.com.

Oregon Town Chooses SimpleCare: The McMinnville [Oregon] Physicians Organization (MPO) brought in David MacDonald, D.O., and Vern Cherewatenko, M.D., of Renton, WA, cofounders of SimpleCare, to speak to major employers in this town of 95,000. Of the 65 physicians in town, 62 joined SimpleCare. A $50/month major medical/hospital-only insurance policy has been made available. Dr. MacDonald told physicians that they could make more money and provide better service by charging patients directly, even at fees 20 to 50 percent less than the fee encumbered by insurance overhead. It is expected that physicians will back away from all of their insurance contracts.

The Association of American Physicians & Surgeons, (www.AAPSonline.org) The Voice for Private Physicians Since 1943,  representing physicians in their struggles against bureaucratic medicine and loss of medical privacy. They have renamed their official organ the Journal of American Physicians and Surgeons, and named Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. Dr Huntoon published a letter to the editor from Robert Cihak who feels that to call Medicare a Ponzi scheme is unfair to Mr Ponzi. Mr Ponzi’s scheme, although illegal, was voluntary. Medicare and Social Security are not–they are the “Law of the Land.” The AAPS had a successful quarterly  meeting in Seattle on Saturday, May 31, 2003. The annual meeting will be held at Point Clear, Alabama on September 17-20, 2003. You'll hear practicing physicians who have cut the cord to managed care and Medicare - keeping their patients and creating a healthy bottom line. You'll continue to get the details on how to keep HIPAA claims problems from drying up your cash flow, and how to respond to expected privacy complaints.  Because of HIPAA criminalizing so much of what we do, there has been renewed interest in the AAPS. You may register on the website above.

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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
Each individual on our mailing list is personally known, or requested to be placed on our mailing list, or was recommended as someone interested in our cause of making Private HealthCare accountable and affordable to all Americans and their employers. If this is correct, you may want to copy this message to your Template file so that they are available to be forwarded or reformatted as new when the occasion arises. Then save the message to a folder in your inbox labeled MedicalTuesday. MedicalTuesday does not purchase spam lists. Last month we added more than 700 individual email addresses for people concerned about health care and friends they felt should also be concerned. Their projections were quite accurate inasmuch as less than three percent asked to be removed, instead of the industry standard of 20 to 50 percent on such  recommended additions. However, if this is not correct or you are not interested in or sympathetic to a Private Personal Confidential Affordable HealthCare system, email Remove@MedicalTuesday.net and your name will sorrowfully be moved to the trash can.

Del Meyer

Del Meyer, MD, CEO & Founder