Physicians, Business, Professional and Information Technology Communities

    Networking to Restore Accountability in HealthCare & Medical Practice

    Tuesday, May 25, 2004

MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:
1.    Why Must HealthCare Be the Political Battlefield?
2.    The Learning Curve in HealthCare Is Flat
3.    The International Scene Is Even Worse
4.    Patients Should Not Be the Political Battlefield
5.    Medical Gluttony or Excessive HealthCare Costs
6.    Overheard in the Medical Staff Lounge
7.    Medical Myths: Modern Drugs Conquer Diseases
8.    The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government

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1.    Why Must HealthCare Be the Political Battlefield?
CalPERS, California’s Public Employee’s Retirement System, with $171 billion in asset management, has eliminated Sutter Hospitals, the largest hospital system in California, from PersCARE, their health plan for state workers and retirees, in an effort to reduce health care costs. Sutter Health has asked for documentation of CalPERS’s allegation that they are 80 percent more expensive than other hospitals. PersCARE has declined to submit the documentation. Since hospitals cannot practice medicine, they have developed foundations that hire physicians who then have an obligation to use the sponsoring hospital to admit their patients, thus interfering with the freedom of choice in the practice of medicine. Eliminating a hospital interferes with affiliated physicians being able to see patients that cannot be admitted to the controlling hospital. The California newspapers are brimming with two sets of stories: one questions whether CalPERS or Sutter is at fault or has a hidden agenda and the other details stories from patients affected by this decision. These patients are currently established with a personal physician who knows their health problems and in whom they trust. They  must now start over and choose another physician that can admit patients to a competing hospital.

The process of physician selection by patients is one that normally occurs during mid-life, as the need for health care becomes manifest to an individual. At this time, a patient develops a seasoned relationship with a physician with whom he or she can relate about all personal and private medical needs. This relationship endures for the remainder of the patient's life or until the doctor leaves practice. When this doctor/patient relationship becomes the battleground between an insurance carrier and hospitals, it interferes with the health care and the very lives of good, but sick people. But then, aren’t all battlefields strewn with bloodied and dead bodies? But why should they be strewn with the 53,000 sick civilians, as in this case?

This week, Southwestern Bell Telephone Company (SBC) is experiencing a four-day strike over health care benefits, bringing new telephone and repair service to a screeching halt in all of the Southwestern US. The issue? Health care copayments. Companies have increased the copayment for obtaining health care as a means for reducing unnecessary health care costs. This is critical for making health care affordable. As we have shown on a regular basis in our “medical gluttony” section, health care costs, when uninhibited, increase in geometric progression - not 10 or 20 percent increases, but 100 or 1000 or 10,000 percent increases. This is not sustainable even with a 100 percent tax structure. That the telephone employees union does not accept this as reality thinking is only revealing their participation in killing the goose that laid the golden egg. The egg was laid some sixty years ago, during the second world war, when health care became part of a worker’s pay because of other governmental restrictions and wage control. Thus, a patient's health care also becomes the battlefield between employees and their employers interfering with economic growth.
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2.    The Learning Curve in HealthCare
We spend many years in the learning process, from the time we start school until we give it up some twelve to twenty years later when we join the work force to make a living for ourselves and our families. The further we go, the more important the continuing learning process becomes. This week, I’m attending the International Scientific Assembly of the American Thoracic Society, where 16,000 of my pulmonary colleagues from 60 countries are congregated in Orlando, spending 35 or more hours in 50 concurrent scientific lectures, seminars, and roundtable discussions of the latest developments in Pulmonary Medicine, Thoracic Surgery, Pulmonary Pediatrics, Pulmonary Pathology, Respiratory Nursing and Respiratory Therapy.  (Our specialty is known by five different names or synonyms: Chest, Lung, Thoracic, Pulmonary, Respiratory, which is the outgrowth of our roots a hundred years ago in tuberculosis, or Phthysiology.) The concurrent sessions vary from Power Point presentations in lecture halls seating 1500 to conference rooms seating 50. If one attended breakfast seminars at 7 AM, lunch seminars at noon, and evening seminars from 7-9 PM, one could obtain nearly 12 hours of continuing medical education (CME) credits each day for four days. Most of us take in a second general medical meeting each year in addition to our specialty meeting. Since many of us also attend weekly medical grand rounds in our hospitals or university medical centers, we obtain at least 100 hours of CME yearly. Although 25 hours of CME are required yearly to maintain medical licensure and nursing licensure, physicians and nurses have made this effort voluntarily, without any government coercion. Individual quality-of-care enhancement has always exceeded government-induced quality control. Although the Institute of Medicine alleges that there are numerous medical errors causing injury or death, the numbers are even higher in countries where health care is under government control. It is also higher in government hospitals in this country. This is a tribute to the high level of the learning curve in voluntary American Medicine.

When it comes to patients learning the economics of health care utilization, the learning curve is markedly different. Utilization is vastly different when patients pay for their own health care than when someone else, whether employer (by diversion of personally earned income) or government (by diversion of personal taxes) pays the bill. Utilization sometimes doubles or triples when someone else pays. This shouldn't strike us as unusual. If you loaned your credit card to a friend, wouldn’t you expect them to be less frugal with your money than you would be? Of course. They are not responsible for paying the monthly statement. You would also be less frugal (responsible) with your own credit card if someone else, e.g. your employer or government, paid the monthly bill. Single-payer or third-party health care is using a health care credit card without limits or effective controls, with no personal responsibility, which is why Medicare, Medicaid and VA programs are all exceeding budgets with impending bankruptcy. That is why Medicare expenditures are some 800 percent of projections over the four decades of its existence.

There is a lot of publicity recognizing that if patients were educated concerning health care costs, they would be more careful. It is now apparent that after two decades of instruction in the economics of health care by health maintenance organizations (HMOs), the patient’s learning curve is relatively flat. They still want whatever they can talk their doctor into ordering and do not want to hear the medical indications for a test or procedure. Patients think that since their friend obtained an expensive CT or MRI, that they are also entitled to it. Whether they have the right disease to justify it seems to be irrelevant. There is no way to fight human nature, or human greed, not even with intensive education in the economics of health care. We only learn when we are responsible for the bill.

With the current advance in Health Savings Accounts, where a patient saves $5,000 on his health insurance premium in return for paying for the first $3,000 of his yearly health care costs, there is an immediate precipitous 30 percent drop in health care expenditures. By transferring responsibility for health care spending from the employer or the government to the patients, the health care costs of our nation would see an immediate drop from about $1.5 trillion to about $1 trillion dollars. Health expenditures would immediately have been brought under control without any government intrusions, restrictions, mandates, employer health care restrictions, or any controlling bureaucracy. And the doctor–patient relationship would again become a confidential and personal matter. With personal responsibility, the learning curve takes a sharp ascent after the first medical bill arrives, even if insurance pays part of it, rather than remaining flat for decades on end.

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3.    The International Scene Is Even Worse
In Germany, the younger generation has been complaining that their socialized medical schemes are going bankrupt because of their elders excessive utilization. They are stating that their grandparents should use a cane in their final years rather than get an expensive artificial hip. But when it comes time for the government to introduce restrictions on health care, none dare to implement a change for fear of not being reelected.

In France, the people are marching because the government is attempting to impose 1 €, an insultingly small amount, for a doctor’s visit. Despite the fact that the health care system has been in a huge deficit for years, with spending in a near bankrupt mode, human greed is so persuasive that it interferes with sound economic logic and decisions.

Thus once single-payer or socialized medicine is fully implemented, patients will continue to be the human battlefield for government programs. It is critically urgent to remove patients from this battlefield of government medicine. But is it politically possible?

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4.    Patients Should Not Be the Political Battlefield
Patients became the battleground quite accidentally in Stalin’s Russia, in Otto von Bismarck’s and Hitler’s Germany, in Mussolini’s Italy, and in Napoleon III’s France, when the dictators found that social insurance was a convenient way to control and force absolute support of their heinous regimes. In the postwar period, these countries continued government medicine not realizing that elected officials could be equally controlling. This did not gain root in the United States, and by an accident of unfortunate government wage control, industry began to provide social insurance and control. In the war between two economic systems, freedom to personally determine our families needs vs socialized control, we should not play it out with patients’ health care or their lives. But as paying for health care became oppressive to business, moves were implemented to transfer this obligation to government. This has now, unfortunately, been supported by organized and unionized medicine. However, to remove our patients from the bloody economic battlefield, medicine must now move forward to the free and independent market place so that it will again be affordable to all. This will allow the economic battle to be played on the battlefield of our economy–where it belongs.

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5.    Medical Gluttony Is Only Exceeded by Legal Lunacy
A thirty-year-old patient who also had diabetes entered my practice in 1996. Her diabetes was difficult to manage only because she was non-compliant in several spheres. She did not follow therapeutic programs, she did not measure her glucose with Accu-checks, she did not keep appointments that were made and she then expected prescription refills without medical evaluations. She decided to go elsewhere where she could manipulate her physician somewhat easier.

In about 1998, she showed up again as a patient. At this time we noted that she was on Rezulin for her diabetes. Since we were aware of some adverse reports on this drug, we changed her diabetic medication. We didn’t hear from her again. . . until about six months ago when we found that we were part of a class action lawsuit brought by a trial lawyer group in Los Angeles against the manufacturers of Rezulin and every patient they could find that took the drug, along with every physician who saw those patients, whether they prescribed it or not. When our liability insurance carrier came out to review the medical record, I asked, “Shouldn’t we have gotten a letter of thanks from this patient that we took her off a medication rather than run the risk of a 10% side effect?” And since she was suing her several physicians (out of many thousands) that actually reduced her risk, why don’t we countersue? (We were recently approached to purchase a reverse liability insurance that would automatically countersue all such nuisance lawsuits.)

But that’s not how attorneys make their money off of health care. They make their money by allowing the full course of action. Thousands of doctors and hospitals respond to their summons, which then has to be distributed to the other thousands. Almost every day we get legal documents, sometimes dozens running into the hundreds of pages, which we copy and then forward to our Medical Liability Law Firm. This may take up to an hour of my office time on some days. There must be thousands of defense firms across the country each charging their Medical Liability Carriers the usual several-hundred-dollars-per-hour fees for reading all these litigation documents and filing various motions totaling billions of hidden health care dollars.

As was the case in the asbestos litigation, my injured asbestos patients stated that they got only a few thousand dollars for their lifetime injuries, while the attorneys all got wealthy. One alleged that his lifetime injury award was $5,000 and that his attorney got twice that - $5,000 in fees and $5,000 in legal expenses for the lawsuit.

It’s rather like John Grisham says in one of his legal novels about a Class Action lawyer worth a half billion dollars who sued the companies and doctors that prescribed a diet pill and then complained, “If I didn’t have to share a third of my winnings with the patients, I’d be a billionaire.”

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6.    Overheard in the Medical Staff Lounge
Speaking of quality of care in government hospitals, Dr George mentioned that during his training, he spent a year at a Veterans Administration Hospital. One day, as he was making rounds, a nurse’s aid complained that her patient wasn't eating. When she fed him, the food just ran out of his mouth. Dr George quickly checked the patient and found that he had expired. Thank God for government medicine which provides job security for the incompetent that don't know if a patient is alive or dead.

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7.    Medical Myths: Modern Drugs Conquer Diseases
The only drugs capable of curing anything are antibiotics. No other drug cures. They simply suppress or control symptoms such as headaches and heartburn, control abnormal laboratory abnormalities such as elevated cholesterol and blood sugars in diabetes, or improve physical findings such as hypertension, usually at the risk of causing a load of other symptoms or signs. (After Gupta).

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8.    MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HealthCare and Government

•    PATMOS EmergiClinic - 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 the usual emergency room fees. For a listing of his fees and payment policy, see www.emergiclinic.com. To see Medicare's Absurd Impact on PATMOS, (as well as on any physician that works on a cash basis) be sure to click on the title. Read Dr Berry’s response to Physician’s Support of Single-Payer Health Care or Socialism at www.delmeyer.net/hmc2004.htm#by%20Robert%20Berry.

•    Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com.  Any patient or provider may become a member of SimpleCare. There is a section on Functional Medicine and one on Complementary and Alternative Medicine, a practice that is becoming increasingly popular. To review the AP article on April 27 concerning his practice, see: http://apnews.myway.com/article/20040404/D81O7R7O0.html Be sure to click on the HSA Insider volume for a review of the Health Savings Accounts.

•    Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. There is extensive data available for your study. He is available to speak to your group on a consultative basis. Email DrDavid@LibertyHealthGroup.com

•    John and Alieta Eck, MDs, for their first-century approach to twenty-first century problems. Please review their current newsletter at www.zhcenter.org/newsletter.asp?id=188800&page=1 and click on "Dr. Eck speaks before US Congressmen" wherein she outlines the six laws in her state of New Jersey which leaves 2300 questions unanswered and thus prevents the implementation of the Health Savings Account. The entire address is worth printing out and studying and sharing with colleagues and friends. For their article “Are you really insured?” go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

•    Madeleine Pelner Cosman, JD, PhD, Esq, for her important efforts in restoring accountability in health care. Please visit www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine, the introduction to her new book, Who Owns Your Body, and other articles that are important to the practice of medicine and health care in general.

•    David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. for his contributions to the free Medical MarketPlace. His series of articles in Sacramento Medicine can be found at www.ssvms.org and additional critically important articles such as Health Care Inflation at www.healthplanusa.net/DGHealthCareInflation.htm.

•    Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges. These "Extra"-legal services are an important service that lawyers do not offer. Stay posted with a wealth of information at www.peerreview.org.

•    Semmelweis Society International, W. Hinnant MD, JD, President, is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noted that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. He then went to St Rochus Hospital in the city of Pest and reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was still 10-15 percent. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society  www.semmelweissociety.org with his own funds using Dr Semmelweis as a model: All we ask is that peer review be done with “clean hands.” To read the article he wrote for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCMisc.htm#by%20Verner%20Waite%20and%20Robert%20Walker. To see Attorney Sharon Kime’s response, see www.delmeyer.net/HMCMisc.htm. For additional updates to the Peer Review section see www.delmeyer.net/HMCPeerRev.htm and scroll downward for letters to the editor, the Medical Board response, a member of the Medical Board's response to the executive director, Dr Deane Hillsman's response and a former deputy attorney general for the Medical Board’s response.

•    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. The current quarter newsletter is now available with numerous insightful articles to scan and possibly read, including articles by Edward Annis on American Medicine. Be part of protecting and preserving what is right with American Healthcare–physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.

•    Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at www.newsmax.com/pundits/Medicine_Men.shtml. This week’s column is on "Working on Limiting Lawsuits" and can be found at www.newsmax.com/archives/articles/2004/5/20/93416.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, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down to departments and The “AAPS News,” written by Jane Orient, MD, and archived on this site, providing valuable information on a monthly basis. Last month she had an important article on Best Practices, How Government Suppresses Data, and other important, sometimes controversial items. In one such article, Thomas Sowell observes that in 1909, people spent less than 18 percent of their income on housing. Since, the government started providing housing in 1937 with a rash of “green tape,” 28 million Americans spend more than 30 percent of their income on housing. She quotes Linda Gorman who gave examples in natural gas, airlines and trucking, where deregulation increased volume and innovation with costs falling 30 to 40 percent. “There is every reason to expect the same benefits from deregulating medicine.” The net burden of regulation probably exceeds the annual cost of insuring 44 million people, according to Christopher Conover of Duke University. Be sure to click on AAPS Doctors Tell Congress: “The Doctor is In, Even If Insurance Is Out” at the Joint Economic Committee Hearing on April 28, 2004. In addition to Dr Eck's testimony above, it also gives Dr Robert Berry's testimony. Scroll further to their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, and the Editor-in-Chief.

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

Ronald Reagan (1986): The government's view of the economy could be summed up in a few short phrases:
If it moves, tax it.
If it keeps moving, regulate it.
And if it stops moving, subsidize it.

See some recent postings below.

The Peer Review Story: Attorneys Sharon Barclay-Kime and former Deputy Attorney General David M Gallie, former MBC Executive Dixon Arnett, MBC Member Lawrence D. Door, MD, Deane Hillsman, MD and Verner Waite, MD, each give us their perspective of physician inquisitions at www.delmeyer.net/HMCPeerRev.htm.

Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? Read Dr Clark at www.healthcarecom.net/CBCPieceofPie.htm.

Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we’ve posted at www.delmeyer.net/MedInfo2004.htm. To purchase the book, go to www.factsonfile.com and type in KAHN under search.

Henry Chang, MD: WEIGHT LOST FOREVER - The Five Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does,  how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for “Best Health Book of the Year.” Read our review at www.healthcarecom.net/bkrev_WeightLostForever.htm.

Tammy Bruce: The Death of Right and Wrong (Understanding the difference between the right and the left on our culture and values.) www.townhall.com/bookclub/bruce.html. Reviewed by Courtney Rosenbladt.

On This Date in History - May 25
The first session of the US Constitutional Convention in Philadelphia, scheduled for May 14, 1787, was delayed until May 25, 1787, when a quorum arrived. Because travel was unpredictable, only Virginia and Pennsylvania were there on time. However, it seems that state legislatures continue to have the same problem–only they no longer can blame mode of travel. (After Spinrad)

May 25, 1803 was Ralph Waldo Emerson’s birthday. He sparked New England’s golden age of literature, and is famous for his comment: “Nothing great was ever achieved without enthusiasm.” In fact, it is very hard to make a speech without quoting something from Emerson. (After Spinrad)