Of Physicians and the Business/Professional Community

 The Dialogue, Discussion, and Debate of Medical Practice Issues Worldwide

 Tuesday, June 11, 2002

The Ludwig von Mises Institute published an article today by Ted Roberts about why Governments Don’t Care, only Markets Do. Even businesses like Pepsi that sell sugared and flavored water listen to people’s comments about their products because they are in the marketplace. Mr Roberts, as he was making suggestions after being told that there was 55 mg of caffeine per can, was told that the Pepsi toll-free line has been humming with customer comments for 20 years, averaging a thousand calls a day. And they don’t contract out this service with the responder stating "We’re all Pepsi employees.” They either listen or don’t survive. An 800 line helps facilitate feedback from the people they serve.

The next morning, Roberts said he had some different takes on what the Secretary of State said and tried to call to make some suggestions. He found that no government agency, whether executive, congressional or judicial, except the IRS, has an 800 number or someone to take suggestions from the 50 million taxpayers that make his position possible.

Isn’t it strange that politicians are insensitive to the plight of individuals (taxpayers, patients),  while beverage and food conglomerates are sensitive to the individual consumers? Pepsi will never be able to disregard the consumer. Coke will see to that. The government monopoly can always disregard the consumer. There is no one to see that they don’t. Marches and demonstrations are never as effective as the simple competition of the market.

As physicians, we are sensitive to our patients’ wants and needs. Otherwise, we wouldn’t have a practice or income. When we work for the government, whether Medicare, Medicaid, a FP-HMO or any social program, we become insensitive to our patients. We have to respond to the call of the master in order to survive.

That’s what MedicalTuesday’s Mission is all about. Restoring the sensitive doctor–patient relationship in a private rather than a government/corporate practice. As we make our journey around the world on alternate Tuesdays, we see this dichotomy verified. As socialized medicine rules much of the world, patients and doctors are increasingly unhappy and bureaucrats increasingly confused and hapless. Restoring the medical marketplace will restore confidence in our profession; in the long run, our patients will be more satisfied with our services. The cost/benefit ratio will improve because prices will fall and benefits will be distributed based on individual needs. Thank you for your response and support and telling us where you’re located. This week we welcome new readers in New York, Florida, Arizona, and Kansas.

Last week, during Medical Grand Rounds at Mercy San Juan Medical Center in Sacramento, Dr Elliott Eisenbud, Endocrinologist, gave a truly academic Power Point presentation on the New Approach to the Management of  Diabetes and the concept of glucose toxicity. The medical staff room was abuzz for days about the practical information that was given concerning this management which ultimately improves patient welfare. To see so many physicians spending non-remunerative time, actually taking lecture notes, advancing their skills and improving patient care was truly remarkable.

A number of years ago, I was a visiting consultant to the Deutsches Kranken Haus in Munich, an 800-bed pulmonary center. My tentative diagnosis of the patient presented to me at Grand Rounds was recurrent pulmonary emboli and pulmonary hypertension. When I asked for the pulmonary artery pressure from their cardiac catheterization, they had an aside in German, not realizing I could understand them. They told me the catheterization was done in the late afternoon, 4:30 p.m., and the technicians terminated the invasive procedure before the necessary data was obtained because the limits of the federal budget would not authorized overtime. What a vacuous Grand Rounds performance and a reprehensible healthcare system. Such risk of human life without collecting the intended information would never be tolerated if the patient were an effective participant in the healthcare market.

Canada's National Health Care Leadership Conference issued their annual survey asking Canadians their opinion on Canada’s healthcare system. Scandlen of the NCPA considers the results fascinating. This "Health Care In Canada" survey reports that 58 percent of the public and nearly 70 percent of doctors and nurses say their confidence in the Canadian system is falling. It also states that 61 percent of the public feel that access to timely, quality care will worsen over the next five years, and 34 percent think it will improve. Only 53 percent say that Canadians are receiving quality healthcare right now, and 67 percent say the system needs either fundamental reform or complete rebuilding.

Anthony Browne, the health editor of the London Observer writes "Why the NHS is Bad for Us," a devastating summary of the problems with Britain's National Health Service. Mr. Brown says he used to support the NHS, until he began looking more closely. “I struggled with my beliefs ... until I came to the only conclusion that my heart, intellect and integrity would allow me: we must abolish the NHS as we know it, abandon our unique obsession that all health care should be free, and become as comfortable with mixed public and private medicine as they are elsewhere in the developed world. My beliefs make me a heretic among the Left.” He writes that thousands of people die every year in the UK because of “the blind faith the Government has in the ideology of the National Health and our unwillingness to accept, not just that it doesn't work, but that it can never work.” He says the health minister of France “condemned the NHS as 'medieval' and 'intolerable.” Now he says, “the NHS is the best intentioned organization in the world,” but it produces, “the worst health service in the developed world, in never-ending crisis, causing unnecessary misery and premature death.” He concludes, “the noble ideology behind the NHS should be ditched because it costs lives.”

The National Center for Policy Analysis (NCPA) continues an excellent series on reviewing the status of the various national health plans around the world. The picture isn’t very pretty. But we need to be informed before we have an ugly picture in the United States also.

The British Medical Journal reports that in response to public outcry over the deaths of some patients waiting for surgery, Spanish Prime Minister Jose Maria Aznar has announced a comprehensive drive to cut waiting lists for surgery in Spain's national health system. Extra evening surgery sessions will be added at a number of public hospitals, and in cases where waiting lists are especially long, patients will receive their operations in the private sector, paid for by the state.

    * According to recent data from the national health service, which covers about half the country's population, waiting lists for surgical procedures were reduced by an average of 20 percent (from 190,000 to 151,000 patients) between July 1996 and March 2000.

    * The number of patients waiting more than six months for an operation decreased by 96 percent during this period (from 53,822 to 1,908 patients).

    * And the average waiting time fell from 210 days to 61 days, with an overall reduction of 70 percent.

Just what is telemedicine? It is the use of voice, data and video connections to link patients with medical services they need, even if the providers of those services are hundreds or even thousands of miles away.

In follow up of our comments about e-medicine, one of our readers from Washington, DC responds about the current merger proposal between two communication satellite TV carriers, EchoStar and DIRECTV. This would allow physicians to observe patients on their own computer screen via a two-way broadband connection. This virtual equivalent of an office visit examination would allow the physician to talk with the patient at home while monitoring blood pressure, other vital signs and EKG . The cost savings to patients with chronic conditions - which account for 79 percent of healthcare spending today - would be significant. It would also allow high quality medicine to penetrate remote areas.

This is not Buck Rogers future gazing. Telemedicine applications are being performed right now, but they are rare because getting the broadband connections means expensive private line connections and costly equipment.

The necessary broadband connections that could provide these potential benefits of telemedicine and are on hold until the Federal Communications Commission and the U.S. Department of Justice give their respective blessings to the merger. Dr. David Charles, the Director of the Movement Disorders Clinic at Vanderbilt University Medical Center and Chairman of the National Alliance of Medical Researchers and Teaching Physicians, never thought he would see a prescription for high-quality, accessible healthcare written in the form of a merger.

The combined broadcast spectrum of these two companies would allow the merged company to deliver the high-speed data capacity known as broadband via satellite to every home, hospital and doctor's office in America. This widespread ability of broadband would finally make the promise of telemedicine available to millions of Americans – unless the government prevents it, or allows it and then controls it.


The Medical MarketPlace
If you’re not interested in, or sympathetic to, a private personal healthcare system, send an email to DelMeyer@HealthPlanUSA.net and we’ll sorrowfully remove your name.

Stay Tuned to the MedicalTuesday.Network twice a month and have your business and professional friends do likewise. Feel free to forward this message to your doctor, friends and relatives. The life you save may be your own – after you become ill.


Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by requiring social insurance. Thus socialized medicine, or any single-payer initiative, was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

Del Meyer, MD