Physicians, Business, Professional and Information Technology

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, June 24, 2003

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In This Issue:
1. How Many Genes Does it Take to Make a Human Being?
2. Medical Management–That’s Where the Cost Saving’s At–Not Federal Bureaucracies
3. Mandated Interpretation Closes a Physician’s Practice
4. HIPAA–Federal Intrusion into Patient Privacy
5. Our Monthly Report on Socialized (Single-Payer) Medicine
6. Medical Gluttony or Excessive HealthCare Costs
7. The MedicalTuesday.Network for Restoring Accountability in HealthCare & Government
8. The MedicalTuesday.Network for Restoring Patient-Focused Private Practice

How Many Genes Does it Take to Make a Human Being
All the information in this newsletter, including the graphics, is brought to you in binary code, a series of 0-1-0-1 that converts all information into a digital form. The human genome was supposed to reduce the complicated human being into more than 100,000 genes. However, scientists recently discovered that the 3.1 billion chemical units were encoded in only 31,000 genes, possibly further reduced to 25,000 genes. The final draft reveals only four nucleotides known as A, T, C and G, reducing the genetic deck to a quaternary code. This still provides for unlimited combinations. Ergo, we don’t have to worry about anyone being our double or taking our identity–unless we are foolish enough to allow human cloning.

Medical Management–A Clinical Challenge
During my medical school student externship, I learned that having a bottle of simple analgesics, such as aspirin or Tylenol, in my white coat pocket would not only relieve a lot of pain and suffering, but could save tens of thousands in health care costs. An example from my internship demonstrated that this same practice not only saved money but improved patient care and relieved pain more promptly, since many patients may not buy into a physician’s recommendations of simple therapy. My internship was at Wayne County General Hospital, Eloise, Michigan, one the world’s largest hospitals with 6700 patients distributed among 500 beds in the acute hospital, 800 beds in the infirmary, 1800 beds in the ambulatory division and 3500 beds in the psychiatric division. Almost any disease known could be found in Eloise, also known as the home of the “POGIES,” Poor Ole Guy In Eloise. In the Emergency Department, we had a huge flow of patients through the two trauma rooms that contained four surgical tables that were nearly always occupied, a dozen private rooms and two wards that managed the additional sick and infirmed. In triaging the mass of humanity in the female ward one night, I treated a diabetic with multiple severe problems, one of which was intractable pain. I reached into my pocket, gave her two aspirin tablets and moved on to find and treat pending emergencies in that mass of patients that could end in death if overlooked. About twenty patients later, the diabetic’s husband came in and asked what those two wonderful pills were that I had given his wife. He thought it was a miracle drug since he could not recall her ever being so free of pain. He refused to believe the relief had come from aspirin.

Politicians and other bureaucrats that speak so authoritatively on health care refuse to believe this story. With further questioning I realized that misconceptions vary. Some refused to believe that managing an emergency could be so simple. Others are surprised to learn that some patients don’t follow the prescribed therapy and that studies indicate that up to a half of the prescriptions written are never filled.  Recommendations are frequently not followed. Humans are variable. They do not follow prescribed patterns of behavior. This is where clinical judgment becomes important. The only two clinicians on the health care team that can assimilate all the patient variables are the Doctor and the Nurse. The other twenty-some allied health specialties deal only with a portion of the clinical picture. But the politicians and their advocates who see even less of this clinical picture were the same ones who felt we should have one national health plan to cover all conditions. No politician would be able to design a public program to accommodate all human variability. Neither could a physician who is still a clinician design such a plan. What is difficult to understand is that no program could be designed to give this woman two aspirin tablets. If it could, the politicians would measure it in terms of thousands and millions of dollars rather than the actual cost of 25 cents. It is best to let each patient interface with his/her physician. If it’s not a good relationship, there are nearly 800,000 physicians in this country and probably more than four or five million of us in the world to provide an alternate opinion that would never be available in an HMO or governmental panel. As Richard A Epstein, economist at Chicago University, says, unregulated health care will, in the long run, guarantee greater access to quality medical care for more people than any regulated or single-payer health care system.

Mandated Interpretation Closes a Physician’s Practice
It is now considered the law of the land for physicians to provide free certified medical interpreters for any non-English speaking patient. Brian A Shaw, MD, President of the Fresno-Madera Medical Society, reports that Dr Kwock, the son of an American-born Chinese immigrant, and his sister have served for 20 years as interpreters for family members requiring medical care, as well as others in their community. He was then told he had to provide this service, at his sole cost, for all of his patients. The Office of Civil Rights (OCR) states that this has been the law of the land since the Civil Rights Act of 1964, but they didn’t get around to this particular interpretation until 2000, when President Clinton issued an executive order regarding this new civil right. According to the AMA News, “Policy guidance from the U.S. Department of Health and Human Services clarified that physicians who accept federal funds, such as Medicare and Medicaid, must provide language assistance at no cost to any patient with limited English proficiency.” In a letter to Dr Kwock, the OCR stated that he “discriminated on the basis of race and national origin” when he failed to provide free interpreter services to a single patient, who then filed a complaint with the Fresno Health and Consumer Center. Dr Kwock readily admitted that he does not employ medical interpreters in his small private practice. The letter stated the chapter, section and verse of the law and 15 items Dr Kwock must take to respond to the complaint. Dr Kwock immediately complied with every instruction of the letter and posted signs that all patients have the right to free language assistance. He received a “Resolution Agreement” from the OCR mandating expensive and time-consuming upgrades of his small practice to accommodate every language spoken on the face of the globe. Dr Kwock then closed his practice.

The Health Insurance Portability and Accountability Act requires that patients be unaware of their doctor’s other patients because that would be considered an invasion of privacy. A local ophthalmologist and his colleagues are working on a special pair of glasses that patients wear to see only their records and no other faces. That way physicians can continue to practice medicine without the horrendous intrusion by the Feds. He once walked into the wrong examining room because he misidentified a chart that had been turned backwards or upside down to prevent others from seeing the name. If the Feds should ever visit a doctor’s office, they will demand that a twenty-chair waiting room be divided into twenty separate rooms to prevent patients from knowing each other. It is amazing that  federal bureaucrats feel they can manage health care, something they know nothing about, better than those who have devoted their lives to helping people. Confidentiality is the doctor’s middle name. It is driven into us from the beginning of medical school - never share patient information with anyone, not even your spouse. This confidentiality was breached by the politicians who passed laws to make this confidential record available to patients, their insurance carriers, and essentially anyone who felt the need to know. Now the Congress is learning what physicians have known since before seeing their first patient. When will physicians get the politicians out of the examining room?

Socialized or Single-Payer Medicine–Our Monthly Overview
Jacob G Hornberger, a former trial attorney and adjunct professor of law and economics at the University of Dallas, discusses the Real Free-Market Approach to Health Care in The Dangers of Socialized Medicine which he edited with Richard M Ebeling. The debate over national health care is a debate over the future of the United States. For most of this century, the American people have moved away from the principles of private property, free markets, and limited government, to which our Founders and their nineteenth-century successors subscribed. Unlike their ancestors, twentieth-century Americans have permitted the state to take control of their income, their educational activities, their charitable acts and their economic endeavors. And now comes the culmination of this devotion to omnipotent government–the idea that the state should take control of people’s health care. In the U.S., this idea is benignly called national health insurance or single-payer health care, but it is actually nothing less than socialized medicine that controls the masses at the expense of the individual.

End, Not Reform, Social Welfare
Hornberger maintains that the only solution to America’s health-care crisis is to end, not reform, governmental intervention into economic activity. What would this entail? A way of life in which people would be free:
• To do whatever they want, so long as their conduct is peaceful and does not intrude, in some direct way, on the rights of others to do the same;
• To engage in any economic activity without political permission or restriction;
• To enter into mutually beneficial exchanges with others;
• To accumulate unlimited amounts of wealth;
• To choose for themselves what to do with their own money–save, spend, donate, invest or whatever.

Hornberger maintains that generally, the solution to America’s social woes lies in ending, not reforming, its welfare-state, regulated-economy way of life. Specifically, the solution to America’s health-care crisis entails the elimination of income taxation, licensing laws, Medicare and Medicaid.

Income Taxation
What is the relationship of income taxation to the health-care crisis? A major part of the problem is that people cannot afford the costs of health care. But suppose income taxation had been abolished ten years ago. Assume that a person has paid an average of $15,000 a year in income taxes. If he had saved the money, this would mean, of course, that he would have $150,000 plus interest in his bank account-an amount that normally doubles every ten years and would be very helpful in paying medical bills and medical-insurance premiums today.

Now, granted, that’s water under the bridge. But his point is this -  the more money that government sucks out of the pockets of the people, the more difficult it is for people to afford health care and other things they wish to buy. Conversely, if people were free to keep everything they earn, they would be able to afford health-care costs, as well as a multitude of other things.

Helping the Poor
What about the poor-those who still would be unable to afford health care? Doesn’t government have a duty to help them?

Hornberger gives an emphatic No! First and foremost, it is important to remember the fundamental immorality of governmental assistance. Under Medicare, Medicaid or any other political subsidization, the money is taken by force from one person (primarily through income taxation) and given to another. When public officials engage in this conduct, they celebrate the “goodness” of their act. They say, “We are good because we are helping others.” But the truth is that their conduct is highly evil, for they are “being good” with the fruits of earnings that have been taken by force from others. In other words, while their conduct is legal, it ranks with that of private thieves in terms of morality.

What would happen to the poor if Medicare and Medicaid (and all coercive transfer programs) were eliminated (rather than reformed)? Would they starve in the streets or die for lack of medical care?

Governmental officials say, “Yes! The American people cannot be trusted to care for others on a voluntary basis. They must be forced to provide assistance to others through the Internal Revenue Service, Medicare, Medicaid and other welfare programs.”

It is a lie, according to Hornberger. And it is the most important lie underlying the entire welfare-state way of life. For if the American people ever conclude that they can be trusted to care for others on a purely voluntary basis, that will be the day that the welfare state will come to an end.

How do we know that the American people would help others if they were not forced to do so? Because the evidence is all around. The caring nature of others can be found everywhere.

Hornberger gives us a personal anecdote. “I grew up on a farm on the U.S.-Mexican border, near one of the poorest cities in the United States. One day, one of our farm hands–a Mexican illegal alien–discovered a lump on his neck. We took him to our physician, who diagnosed the lump as cancerous.”

What happened to him? Well, it’s a story that will warm your heart. We had a friend who had been poor for most of his life. His poverty had dramatically ended with the discovery of huge quantities of oil under lands on which he had a sizable interest. Our friend learned about the plight of our employee. The next day our friend picked up the employee, escorted him to the airport, put him on his Learjet, and had him flown to Houston for treatment at one of the world’s leading cancer clinics. The man was admitted into the clinic, even though he had no money (although we suspected that our friend may have covered the bill). The cancer was successfully treated-it never recurred.”

“And the same beneficent attitude characterized our family physician. Every time I visited him, his waiting room was filled with people who could not afford to pay for his services. I never saw him turn away-or heard of him turning away-any patient for lack of ability to pay. He just kept treating them even though the chances of his getting paid were minuscule.”

“Does this happen all over the country? You bet it does! But it takes a willingness to see it happen. The person who fails to see it is the person who does not want to see it!”

It is useless to try to convince governmental officials of the caring nature of the American people. For public officials have a vested interest in the continuation of the welfare state.

Our battle must be for the hearts and minds of those in the private sector. They must be persuaded not only to have faith in themselves, but, equally important, to have faith in others as well. People’s belief must go from, “I would help, but no one else would,” to “I would help, and I know that others would do the same.” Once this shift in mind-set takes place among the American people, the foundation of the welfare state will crumble.

Hornberger’s Conclusion
Several decades ago, the American people were seduced into abandoning the principles of our ancestors. The state took control over our education. It took control over our earnings. It took control over our economic activity. It took control over our social activity. It took control over our charitable activity.

And now the state wishes to take control over our health care. If we permit this to happen, we will reap the whirlwind, for the results will be as disastrous as they have been in every other field of governmental endeavor.

Social Security – a Ponzi Scheme
As David G. Surdam, an adjunct associate professor of economics at the Graduate School of Business, University of Chicago, noted in "Ideas on Liberty," March 2003, "The Social Security program has been dubbed a 'Ponzi scheme'.... The allegation is unfair to Mr. Ponzi. ..fraudulent as his scheme was, Ponzi had to persuade people to invest. The federal government doesn't use persuasion. As the commercial says, 'It's the law.' " Courtesy Robert J. Cihak, M.D., past President, Association of American Physicians and Surgeons.

Medical Gluttony or Excessive HealthCare Costs
A new patient I saw about six months ago had, among other things, a painful right femoral hernia. A surgical consultation was requested and a copy of our consult, chest x-ray, electrocardiogram and pulmonary function tests were faxed to the surgeon. Last week, the patient came in for preoperative clearance and had already obtain a repeat electrocardiogram and chest x-ray at a commercial laboratory. When asked why the duplication, she said the forms from the referring surgeon included orders to obtain these prior to the scheduled operation at the adjacent surgical center. When she noted my concerned, she simply shrugged saying that it didn’t cost her anything. When the surgeon was asked why he duplicated the preoperative tests, he said he had forgotten they had been done and he deferred the details to his staff.

This is precisely why socialized medicine, or single-payer medicine (or HMOs, Medicare, Medicaid) is so expensive.  Any system in which society rather than the patient is in charge really means that no one is in charge. The only way the patient is in charge is if he/she is financially responsible to a degree that he/she makes market-based decisions. It is our anecdotal experience that a 20 percent co-payment for surgicenter charges and 30 percent co-payment for outpatient medical charges makes the patient think in medically economic terms. The massive bureaucracies of HMOs, Medicare and Medicaid did not prevent this duplication. Politicians can only think in terms of enlarging the bureaucracy for even greater spending of more taxpayer funds to save this duplication, and it only gets worse. The simple concept of a 20 percent co-payment would have given this patient cause to question the duplication, even hold off on the elective surgery to reduce her co-payment, until the office staff of the surgeon sorted out the problem. Then everyone would have become aware of the problem. Without my raised eyebrow, no one would have known or even cared.

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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.

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.

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.

Robert J Cihak, MD, former president of the AAPS, & 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. This week read about “The Medicare Mess” and comments about historian Philip Gold in his forthcoming book, "Disaster by Design: The Death and Rebirth of American Medicine" at http://www.newsmax.com/archives/articles/2003/6/17/33040.shtml

• 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. The annual meeting is 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
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Del Meyer

Del Meyer, MD, CEO & Founder