|
MEDICAL TUESDAY . NET |
NEWSLETTER |
|
Community For Better Health Care |
Vol VIII, No 4, May 26, 2009 |
In This Issue:
1.
Featured Article:
Can the Government Create Jobs?
2.
In
the News: Who came to
the Meeting President Obama had with Industry Leaders?
3.
International Medicine: This health care 'reform' will kill thousands.
4.
Medicare: Measuring
Social Security's True Liability
5.
Medical Gluttony:
Entitlement Madness by John Goodman, PhD
6.
Medical Myths:
$64,000 Severance Pay! Why should I purchase my own health insurance?
7.
Overheard in the Medical Staff Lounge: Where is the health care crisis?
8.
Voices
of Medicine: The True
Costs of EMRs
9.
The Bookshelf: Spiritual
and Medical Perspectives on Euthanasia and Mortality
10.
Hippocrates
& His Kin: Why
Government Medicine Is Cheaper
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
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:
Can the Government Create Jobs?
What is Seen
and What is Unseen: Government "Job Creation"
By Larissa Price FEE, 11
February 2009
Larissa
Price is a former FEE staff member.
Barack Obama says his roughly $800 billion American
Recovery and Reinvestment Plan could save or create between three and four
million American jobs by 2010. Many of these proposed jobs are New Deal-esque,
involving the building or repairing of government infrastructure, such as
roads, bridges, and buildings. There is a modern twist, of course, with the
promise to develop "alternative energy sources" such as wind farms,
solar panels, fuel-efficient cars, and the like. "The jobs we create will
be in businesses large and small across a wide range of industries," Obama
promised, "and they'll be the kind of jobs that don't just put people to
work in the short term, but position our economy to lead the world in the
long-term." (Emphasis added)
First, one may ask: how can Obama and his economic
advisers know what kind of jobs will position our economy to "lead the
world" in the long-term? Indeed, how can we expect anyone to know
what kind of jobs will be able to offer such a guarantee of wealth and
security, considering the enormous complexity of our world, which includes
billions of individuals constantly making decisions based on their own
expectations about the future, as well as potential ideological shifts and the
inevitable changes in policy funding and support they bring. This is without
considering technological advancements that can turn the best-laid central plans
into white elephants. There is little an individual or group can possibly know
or predict for the future, particularly on such a large scale as three to four
million jobs.
However, assuming Obama and his advisers are right
that his plan will indeed save or create that many jobs what proof do we have
that it will leave us better off than if it's not implemented at all?
In his essay "What
Is Seen and What Is Not Seen," the French classical-liberal economist
Frιdιric Bastiat explained that there is a tendency to only recognize the
intended consequences of an action (what is seen). However, there are often
other, subsequent effects that are not perceived as connected to the action
(what is not seen). Furthermore, the short-run effects of an action can
sometimes be quite different from the longer-run, unseen consequences.
In the case of public works, Bastiat explained that
government produces nothing independent from the resources and labor it diverts
from private uses. When government borrows money to create jobs, what is
readily seen are people employed and the fruits of their labor. However, what
is generally not considered are the many things that could have been produced
if the capital had not been removed from the private sector to fund the
government programs in the first place. Such policies necessarily benefit some
(the favored workers) at the expense of others (those who would have had the
jobs that were not created) and eventually the taxpayers who have to repay the
debt.
New Deal
Bastiat's theory is evidenced in New Deal public-works
projects, which not only failed to help lift the economy out of the Great
Depression, but also served to make it "great."
First, many jobs created under FDR had little benefit
to anyone other than those employed, such as studying the history of the safety
pin, collecting campaign contributions for Democratic Party candidates, chasing
tumbleweeds, and cataloguing 350 different ways to cook spinach, (See Lawrence
Reed's
Great
Myths of the Great Depression.)
In addition, much of the "job creation" was
directed according to political preferences, rather than where jobs were
arguably needed most. For instance, a disproportionate amount of public relief
went to western "swing states" expected to help Roosevelt win votes
in future elections, rather than to the poorest states, such as those in the
South, which were already solidly Democratic during this period. Relief and
public-works spending seemed eerily to increase during election years, and it
has been shown that votes for FDR correlated closely with jobs and other
special government benefits given. (See Burton Folsom's New
Deal or Raw Deal? How FDR's Economic Legacy Has Damaged America.)
New Deal job-creation projects also impeded
productivity by discouraging private firms from adopting new technologies. A
prime example is a government farm in Arizona where a dairy crew discovered
that it could turn a profit only by using milking machines, rather than milking
by hand, and eliminating some the jobs. But that would have violated the terms
of a government loan. So the machines were not brought in, and the staff
members who made the suggestion were fired. (See
Amity Shlaes's New
Deal Jobs Myth.)
Roosevelt is still celebrated for his job-creating
measures because the people who gained employment were easily seen. However,
what wasn't (and isn't) so easily recognized is that to pay for his
public-works experiments, the government sucked up much of the available capital by
selling bonds and collecting taxes, including a 5 percent withholding tax on corporate dividends and ever-rising
income taxes, with a top income tax rate that hit a staggering 90 percent. Thus the New Deal had
the unintended consequence of prolonging the Great Depression by diverting
resources that could have been used to create wealth.
Barack Obama and his advisers should take a lesson
from history: the New Deal and its public-works projects were a disaster, and
it would be remiss to think they should be given another try. As Bastiat
explained, government doesn't create wealth; it only diverts it. When wealth is
in the hands of the government it inevitably tends to serve political ends
rather than consumers. FDR's New Deal policies are a testament to that, and if
they are repeated in response to our current economic crisis, it will only
hinder the recovery.
* * * * *
2. In the News: Who came to the Meeting President Obama
had with Industry Leaders?
Consumers Power Report (No 178, May 14,
2009) by
Greg Scandlen
I'm not going to spend much time this week on the
meeting President Obama had with some industry groups. There has been plenty of
gushing about it already - far more than the event deserved. I thought it was
interesting who was and wasn't in attendance. For instance, The SEIU was there
but the AFL-CIO wasn't, AHIP was there but BCBS wasn't, the AHA was there but
not FAHS. The AMA was there but no other physician group. There were no nurses,
no nursing homes, no ambulatory surgery centers, no allied professions, no home
health agencies, no insurance brokers. And certainly no patients, the only
people that really count.
This was all about the Fat Cats divvying up the health
care pie. And they are willing to roll over and get their bellies scratched if
it means a big treat for them at the end of the day. It is Washington at its
most sickening.
Meanwhile last Friday (May 8th) we had a great meeting
in Milwaukee with over 80 people in attendance. Peter Fotos and I gave
substantive presentations and State Rep Leah Vukmir gave the keynote address.
About half the folks were from Americans for Prosperity, and I am looking forward
to working with them in the future.
Read
Greg Scandlen's Other Power Reports . . .
* * * * *
3. International Medicine: Quality is an Unknown Political Issue
This health care
'reform' will kill thousands. --Karol Sikora, Tuesday, May. 12, 2009
One of the more
unproductive elements of President Obama's stimulus bill is the $1.1 billion
allotted for "comparative effectiveness research" to assess all new
health treatments to determine whether they are cost-effective. It sounds
great, but in Britain we have had a similar system since 1999, and it has cost
lives and kept the country in a kind of medical time warp. As a practicing oncologist, I am forced to
give patients older, cheaper medicines. The real cost of this penny-pinching is
premature death for thousands of patientsand higher overall health costs than
if they had been treated properly: Sick people are expensive. It is easy to see the superficial attraction
for the United States. Health-care costs are rising as an aging population
consumes ever-greater quantities of new medical technologies, particularly for
long-term, chronic conditions, such as cancer.
As the government takes
increasing control of the health sector with schemes such as Medicare and SCHIP
(State Children's Health-care Insurance Program), it is under pressure to
control expenditures. Some American health-policy experts have looked favorably
at Britain, which uses its National Institute for Clinical Excellence (NICE) to
appraise the cost-benefit of new treatments before they can be used in the
public system.
If NICE concludes that a
new drug gives insufficient bang for the buck, it will not be available through
our public National Health Service, which provides care for the majority of
Britons. There is a good reason NICE
has attracted interest from U.S. policymakers: It has proved highly effective
at keeping expensive new medicines out of the state formulary. Recent research
by Sweden's Karolinska Institute shows that Britain uses far fewer innovative
cancer drugs than its European neighbors. Compared to France, Britain only uses
a tenth of the drugs marketed in the last two years.
Partly as a result of these
restrictions on new medicines, British patients die earlier. In Sweden, 60.3
percent of men and 61.7 percent of women survive a cancer diagnosis. In Britain
the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent
for women. We are stuck with Soviet-quality care, in spite of the government
massively increasing health spending since 2000 to bring the United Kingdom
into line with other European countries.
Having a centralized "comparative effectiveness research"
agency would also hand politicians inappropriate levels of control over
clinical decisions, a fact which should alarm Americans as government takes
ever more responsibility for delivering health carealready 45 cents in every
health-care dollar. In Britain, NICE is nominally independent of government,
but politicians frequently intervene when they are faced with negative
headlines generated by dissenting terminal patients.
For years, NICE tried to
block the approval of the breast cancer drug Herceptin. Outraged patient
groups, including many terminally ill women, took to the streets to
demonstrate. In 2006, the then-health minister suddenly announced the drug
would be available to women with early stages of the disease, even though it
had not fully gone through the NICE approval process. A more recent example was the refusal to allow the use of Sutent
for kidney cancer. In January, NICE made a U-turn because of pressure on
politicians from patients and doctors. Twenty-six professors of cancer medicine
signed a protest letter to a national newspapera unique event. And yet this drug has been available in all
Western European countries for nearly two years. In Britain, the reality is that life-and-death decisions are
driven by electoral politics rather than clinical need. Diseases with less
vocal lobby groups, such as strokes and mental health, get neglected at the
expense of those that can shout louder. This is a principle that could soon be
exported to America.
Ironically, rationing
medicines doesn't help the government's finances in the long run. We are
entering a period of rapid scientific progress that will convert previous
killers such as heart disease, stroke and cancer into chronic, controllable
conditions. In cancer treatment, my specialty, the next generation of medicines
could eliminate the need for time-consuming, expensive and unpleasant chemo and
radiotherapy. These treatments mean less would have to be spent later on
expensive hospitalization and surgery.
The risks of America's move
toward British-style drug evaluation are clear: In Britain it has harmed
patients. This is one British import Americans should refuse.
Karol Sikora,
a practicing oncologist, is professor of cancer medicine at Imperial College
School of Medicine,
London, and former head of cancer control at the World Health Organization
Read
the entire article and the Blog responses . . .
The NHS does
not give timely access to modern healthcare, it only gives access to a waiting
list.
* * * * *
4. Medicare: Measuring Social Security's
True Liability by Laurence J. Kotlikoff, May 12, 2009
Every year the Social Security Trustees publish a
report on the fiscal solvency of the program. It details the program's
unfunded liabilities, which is what the government will still owe after it uses
current and future tax receipts to pay for current and future retiree benefits.
In 2005, the Social Security Trustees estimated that
the program's unfunded liabilities were $8.5 trillion. This means that
even after accounting for payroll tax revenues the federal government would
have to have this much money in the bank today, accruing interest, in order to
pay promises to future retirees.
However, the Trustees appear to be underestimating the
value of Social Security's unfunded liabilities because they
are failing to take into account the riskiness of tax payments that have not
yet been received and of benefits that have not yet been accrued and
the certainty of those benefits that have been established. In effect,
the Trustees are understating the market value of Social
Security's net liabilities - what the government would have to pay a private
party or investor to take the obligation off its hands. .
.
Underestimating Social Security Net Benefits to
Current Workers by Not Adjusting for Real Wage Growth. According to our study, the trustees have made
two valuation mistakes in calculating Social Security's unfunded
liabilities. The first mistake involves failing to account for risk with
respect to initial benefit awards as well as future tax payments.
The trustees' calculations assume that wage growth
will be fairly constant from year to year. Social Security benefits are
based on a worker's covered earnings history with an adjustment for
economy-wide average wage growth. Payroll taxes are collected as a percentage
of an individual's earnings (up to a limit on taxable wages). Thus, the
system's liabilities and tax receipts are largely dependent on wage
growth. The problem with the Trustees Report is that wage growth is
assumed to be constant at 1.1 percent a year. However, wage growth
is highly variable, so there is no counting on it being 1.1 percent per year in
the future. Data from 1951 to 2005 shows that wages grew by as much as
6.4 percent in a single year and declined by as much as 4.6 percent in a single
year. In financial terms, when something is hard to predict it is
considered a risk. Thus, in addition to Social Security's assumed
interest rate of 2.9 percent, a "risk premium" must be included that
compensates for the uncertainty in tax revenues and benefit payments resulting
from variable wage growth.
Undervaluing Social Security Benefits Once They Begin. The second mistake is the failure to account
for the safety of the stream of Social Security benefits to a retiree once they
commence. Social Security benefits are paid out as inflation-indexed
annuities. Ignoring uncertainty in future mortality probabilities, as we
do in our analysis, Social Security's benefit obligations to specific cohorts
of workers - once they begin - are definite, real (inflation-adjusted) annual
amounts. Such streams need to be discounted using the rate of returns on
comparable securities, which in this case are inflation-indexed bonds.
But the returns on Treasury Inflation Projected Securities for 2005 - the year we
analyzed - were at least one-third less than the discount rate used by the
Trustees. In using too high a discount rate, Social Security understates
the market value of these obligations; that is, Social Security is mispricing
safe as well as risky streams of payments and receipts. . .
Conclusion. No one would suggest that the prices of financial securities are
independent of risk. Such a proposition would deny fact, let alone
theory. The same financial laws that determine the prices of marketed
securities govern the pricing of Social Security liabilities.
Unfortunately, the standard U.S. practice has been to ignore this
relationship. . .
Read the
entire analysis . . .
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Entitlement Madness by John Goodman,
PhD
As of last year's report, Social Security and Medicare
had an unfunded liability in excess of $100 trillion (see
Table I), about 6 ½ times the size of the entire economy. This is the
excess of promises we have made over and above expected taxes and premiums. To
avoid draconian benefit cuts or tax increase in future years we would need to
have that $100 trillion in the bank, earning interest today. But of course we
do not. (Although it is of small comfort, Jagadeesh Gokhale has shown that our
European trading partners are in even
worse shape.)
These obligations are especially important in light of
the enormous increase in unfunded liability and cash flow deficits that are
about to be added. Currently, about 100 million people depend on Medicare and
Medicaid for their health care. Under President Obama's new health reform plan,
an additional 100 million or so could be enrolled in public and quasi-public
plans with the entitlement guarantee that their premiums will not exceed 10% of
family income.
The $100 trillion figure is based on looking
indefinitely into the future. (For reasons we have explained before a shorter time
horizon gives misleading estimates.) Yet a different way of accounting is to
use the method private companies and state and local governments now have to
use. If we halted these programs tomorrow, collecting no more taxes and
allowing no more benefit accruals, how much do we owe people for benefits they
have already earned? Answer: $52 trillion. Read
the entire blog . . .
MedicalTuesday
has always recommended that the only way to save Medicare is to index it for
longevity as Social Security started to do. Since longevity has increased from
62 years when social security started to 77 years today, this indexing must be
gradual over a long time. Social Security has only reached an indexing level of
67 years. Adding an additional 100 million Americans to these benefits, that
must be paid for by working Americans, is sheer lunacy. The Big Government
advocates are criticizing our Health Care as costing too much at 17 percent of
GDP. Why do we want to push it to 25 percent of GDP? Aren't we headed in the
wrong direction for fiscal responsibility?
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony is controlled with Appropriate Deductibles and Co-payments
on Every Service.
* * * * *
6. Medical Myths: $64,000 Severance Pay! Why
should I purchase my own health insurance?
Free American Health Care, Thursday, May 7, 2009
Wall
Street Journal Joins the Media Chorus on "Universal" Health Care
When
the Wall Street Journal starts fretting over the uninsured, we have a
problem. This morning's paper featured two recently unemployed men: one
in Illinois and one in the town of Hohenlockstedt in the German state of
Schlewsig-Holstein.
Right
off the bat, the reporter notes the key difference in outcomes for the two
unemployed men: the American lost his health benefits and the German did not.
I'm no fan of employer-based health
"benefits", largely because they artificially inflate the number of
uninsured. So, I have long advocated tax reform to give American families the
same tax-break as American businesses for health insurance. It would make the
price of health benefits transparent and give workers better opportunity to
save money for a spell of unemployment, which they could use to pay premiums.
The
featured American unemployed worker decided to give up snowmobiling and other
recreation, because he had no health insurance. "It's scary being without
insurance," he says, "but what do I give up? Food?"
Well,
Illinois is not the easiest state for affordable health coverage, but it's not
the worst: Various government interventions take it down to number 35 of 50
states in the U.S. Index of Health Ownership.
So,
I had some sympathy for the fellow - until I got to the tail of the article,
where the journalist decided to drop a pretty important fact: the worker
received $64,000 of severance when he lost his job!
What
did he do with the money? Paid off debts. So, now he cannot take responsibility
for his own health insurance. And one man's inability to plan his personal
finances becomes another excuse for government-run health care.
Http://Free-American-Healthcare.Blogspot.Com/2009/05/Wall-Street-Journal-Joins-Media-Chorus.Html
comments: Kevin said...
This
points out what is the real cause of the inflation of health care costs.
Patients see health care as a right and do not take personal responsibility for
it. They want someone else to pay for it. This disengagement of demand from the
burden of payment has obvious consequences. -Kevin Petersen, M.D.
John R. Graham
I'm the
author of the U.S. Index of Health Ownership, the only project to rank all 50
states' health laws and regulations according to free-market principles; and
the editor of a book addressing What States Can Do to Reform Health Care: A
Free Market Primer. I'm also the primary author of the monthly Health Policy
Prescriptions series, which addresses national health reform, and contribute to
PRI's Capital Ideas series of short articles on public policy in California.
I've written numerous articles covering diverse topics within health policy for
periodicals including the Wall Street Journal and the Washington Post I speak
frequently on health care reform on radio and television, and at conferences in
the United States, Canada, and Europe. I've also worked as a management
consultant and investment banker in Canada and Europe and previously served as
an infantry officer in the Canadian Army in Canada, Germany, and Cyprus. I
received my M.B.A. from the London Business School (England) and my B.A. (with
Honors) in economics and commerce from the Royal Military College of Canada
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
Medical Myths reappear when you have five years of premiums as
severance pay but don't feel obligated to use it for health care because you
think someone else should pay for it.
* * * * *
7. Overheard in the Medical Staff Lounge: Where is the
health care crisis?
Dr. Rosen: The political parties keep talking about a health
care crisis? Exactly what is the crisis?
Dr. Ruth: The crisis is the paper work we have to do to get
paid.
Dr. Paul: Every insurance plan has different criteria for care
and billing. How can anyone keep up?
Dr. Nichols: People come into our ER for basic routine care. Only
about 10 percent of visits are emergencies. So the non-emergencies have to wait
an inordinate amount of time.
Dr. Rosen: Isn't that one fact enough of a deterrent for
non-emergency patients to make an appointment with their personal physician?
Dr. Nichols: There are several factors operating here. Medical
problems that occur during the day and can wait until the next day may create
family work problems. If the patient works, it might save them money to go to
the ER and wait six hours rather than miss a day of pay. Laborers do not always
equate waiting time with lost work time.
Dr. Dave: And if the loss of work time eats up income and the
ER time is free or relatively so, that tips the equation to extra evening or
night medical care, which is cheaper than regular care during the day.
Dr.
Patricia: I can see that. Balancing
childcare with the options we've discussed so far may tip the equation to the
right, favoring health care at night. Overtime in health care is not more
expensive than daytime in health care.
Dr. Rosen: But we're not getting down to the real problem. The
high-cost center of hospital care is relatively cheaper than outpatient office
time.
Dr. Ruth: How would you change that?
Dr. Rosen: I think that we as physicians need to get involved
in a more intense dialogue to change the equation so that co-payments and
deductibles reflect the high-cost center. There needs to be a percentage
co-payment on every charge so the patient will supervise every charge and not
have the attitude, "Well, Doctor, I'm here. Let's do whatever can be
done." That's why so many ER visits will add up to $9,000 rather than
$600.
Dr. Dave: I agree. We have to become very vocal in
rationalizing health care costs.
Dr. Rosen: Does that mean bringing back the County Hospitals?
Dr. Dave: That would certainly provide universal access like we
had before Medicare.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
The True Costs of EMRs, By Kenneth Prosser III, MD Sonoma Medicine, Spring 2009
The practice of
medicine has long enjoyed a successful relationship with advances in scientific
technology. Since beginning my medical career in 1984, for example, I have seen
the advent of MRIs, development of laparoscopic surgical procedures, two to
three times as many new drugs and immunizations, and the initiation and
completion of the human genome project. I have also witnessed the rise of the
personal computer.
Though computers have been used
in medicine for several decades, the use of the electronic health record (EHR)
only began seriously in the United States about five years ago, when the Bush
administration created the Office of the National Coordinator for Health
Information Technology. Currently more than 300 EHR and electronic medical
record (EMR) products are available, though only about two dozen are commonly
used. (Just to clarify the nomenclature, EMR and EHR are currently used
synonymously, but technically an EMR is a type of EHR. I will use EMR to
discuss my own experiences with electronic records.) . . .
EMR usage in Sonoma County has
expanded rapidly over the past few years. The larger hospitals as well as many
private practices and clinics have undergone the transition to electronic
records. My former group, Primary Care Associates, began phasing into an EMR
system in early 2005 and went fully "live" by that September. Since
our group consisted of both family medicine and pediatrics practices, we had to
adopt a system that was not ideal for either but did attempt to meet everyone's
needs.
The actual decision to go
electronic was not met with equal enthusiasm by all in our group. The initial
capital outlay and the ongoing costs in equipment support and licensing fees
were enormous. Everyone understood, however, that the days of paper charts
would end sooner than later, so we decided to move forward. . .
After the initial
shock of transferring to EMRs and completing the initial training and practice,
we had high hopes that our lives would eventually become much easier. Looking
back to the list of benefits, we were successful with some but not others. For
record accessibility, improved patient care, better communication, more
efficient billing and reduced overhead, the EMR system definitely delivered on
its promise. Many people in the office could look at the same record at
different locations simultaneously (though only one person could enter
information at a time).
Our patient care benefited from
this increased access to information, which also produced more rapid lab
results and better pharmacy interfacing. Patients with diabetes and other
chronic diseases benefited through disease-management modules and tabular
trends in labs and vitals. Patient referrals and insurance authorizations were
processed much more efficiently, and copies of pertinent information required
by schools, such as immunization records, could be faxed electronically. I
particularly liked the positive impact on prescribing medications. One click
and my prescription transmitted directly to the pharmacist's computer. . .
Despite the noted benefits to our patients, insurance
companies and specialist referrals, the EMR significantly increased our
workload, even with the advantages brought by improved intraoffice
communication, lab and pharmacy interfaces, chart access, and legibility. Our
physicians spent one or two hours more in charting throughout and at the end of
the day. EMRs bring a large degree of efficiency, but one can only type and
click so fast. Nurses and medical assistants also felt the increased workload
in charting time. . .
An EMR, to be sure, is a big
plus for medicine. Many people have benefited, but at whose cost? Speaking for
myself, the cost in time, stress, reduced quality and satisfaction in my work
has made me feel a bit worse. Unfortunately there is no going back. Computers
are figuring more and more prominently in everyone's daily life.
A complete EMR is an impressive
and beneficial tool. Furthermore, future reimbursement from Medicare and
Medicaid will be tied to whether or not a provider is using an EMR. This is
good news for those just now adopting, and there will apparently be some
benefits for early adopters as well. Unfortunately, in our group's case, the
initial capital outlay came straight out of our pockets, and we were unable to
stay in business long enough to realize any payback from our investment.
www.scma.org/magazine/articles/?articleid=398
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
9. Book Review: Spiritual and Medical Perspectives on
Euthanasia and Mortality
DENIAL OF THE SOUL - Spiritual and Medical
Perspectives on Euthanasia and Mortality, M. Scott Peck, MD, Harmony Books, New York, 1997, xi & 242 pp,
$23, ISBN: 0- 517-70865-5.
Physician, psychiatrist, theologian, and author of the
best-seller, The Road Less Traveled, F Scott Peck, MD, gives us an
in-depth look at the current euthanasia movement and its origins in the
inability of physicians to "pull the plug." Peck states that although
Dr Kevorkian gives him the shivers, he must credit him more than any other
individual for the genesis of this book. Almost single-handedly over the past
five years, Kevorkian has turned the debate over euthanasia into a national
issue within the United States.
But Kevorkian didn't inspire Dr Peck to write this
bookit was the public response to his behavior. Peck was surprised by the
number of people who admire Kevorkian..He was even further surprised by the
larger number who, though they feel no affections for Kevorkian, nevertheless
deeply approve of what he has been doing in assisting the suicides of those who
are ill. Most of all, Peck has been surprised by the huge number of Americans
who do not find Dr Kevorkian's work particularly objectionable.
The whole debate is strangely passionless and
seemingly simplistic. But the subject of euthanasia is far from simplisticit
involves questions about who, if anyone, has a right to terminate a life;
whether it's the same as or different from suicide or homicide; whether it differs
from merely "pulling the plug;" and what role does pain, both
physical and mental, play in euthanasia decisions. Among the stories he tells,
is one about Tony, a patient of his when he was a psychiatric resident. He felt
Tony's craziness was organic and referred him to neurology where he was found
to have a large frontal brain tumor. The tumor was inoperable and failed to
respond to radiation treatment.
Weeks later when Peck rotated on the neurology
service, Tony, now unresponsive and on a ventilator, reentered his life. He
wondered why anyone would decide to place Tony on life support. Was this
"heroic" medicine, or just a measure to prolong a life that had lost
its essence? Peck asked his chief of neurology at Letterman General Hospital whether
this effort to prevent inevitable death was the right thing to do? The Colonel
commended him, obtained a portable EEG, and found an occasional distorted brain
wave and pronounced that the patient was not yet certifiably brain-dead.
Recalling the anguish of the family in waiting, Peck
looked at Tony for the next 15 minutes, cut the levophed drip in half, went to
the doctor's lounge, smoked a cigarette, returned 10 minutes later, found Tony
dead, and informed the family. As they wept, speaking to each other in Italian,
he could not tell whether they were weeping in grief or relief. He concluded,
probably both. He, of course, had the presence of mind not to tell anyone about
what he had done. . .
Read the rest of this
book review . . .
To read more book
reviews . . .
To read book reviews topically
. . .
* * * * *
10. Hippocrates & His Kin: Why
Government Medicine Is Cheaper
Recent research by Sweden's Karolinska Institute shows
that Britain uses far fewer innovative cancer drugs than its European
neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in
the last two years.
Now we understand why Government Medicine is cheaper - less costly
drugs and shorter life.
Prozac Nation
Employee to boss: "Did
you really fire me, or were you just off your medications?"
Bosses never tell.
Modern Bedtime Stories
Son: "Please daddy, one
more strategy."
Father: "OK, son. One
more investment strategy and then off to sleep."
Do we have a budding entrepreneur?
Modern Girl
Stuff?
Husband: Why do you need such a big purse?
Wife: Oh, for "girl stuff." You know - cell
phone, pager, PDA, laptop, fax/modem, printer . . .
Really a Laptop Briefcase.
Another East
Coast Mystery
"In New
York today, two conglomerates gobbled each other up and disappeared without a
trace."
It could only happen in New York - or maybe Detroit
In the City
of Brotherly Love
In Philadelphia, in a complex court settlement, our
parent company gets custody of us on weekends. Our new owners have us
throughout the workweek, day and night. -After WSJ Business Cartoons.
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
John and Alieta Eck, MDs, for their first-century solution to twenty-first
century needs. With 46 million people in this country uninsured, we need an
innovative solution apart from the place of employment and apart from the
government. To read the rest of the story, go to www.zhcenter.org and check
out their history, mission statement, newsletter, and a host of other
information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
PATMOS EmergiClinic - where Robert Berry, MD, an emergency
physician and internist, practices. To read his story and the background for
naming his clinic PATMOS EmergiClinic - the island where John was exiled and an
acronym for "payment at time of service," go to www.patmosemergiclinic.com/. To
read more on Dr Berry, please click on the various topics at his website.
PRIVATE
NEUROLOGY is a Third-Party-Free
Practice in Derby, NY with
Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/)
Dr Huntoon does not allow any HMO or government interference in your medical
care. "Since I am not forced to use CPT codes and ICD-9 codes (coding
numbers required on claim forms) in our practice, I have been able to keep our
fee structure very simple." I have no interest in "playing
games" so as to "run up the bill." My goal is to provide
competent, compassionate, ethical care at a price that patients can afford. I
also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT
THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept
totally private and confidential - in accordance with the Oath of Hippocrates.
Since I am a non-covered entity under HIPAA, your medical records are safe from
the increased risk of disclosure under HIPAA law.
FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org,
researches and studies the work of scholars and policy experts in the areas
of health care, law, philosophy, and economics to inform and to foster public
debate on the causes and potential solutions of rising costs of health care and
health insurance. MORAL HEALTH CARE VS. "UNIVERSAL HEALTH CARE" Lin
Zinser and Paul Hsieh argue that the current crisis in American health care is
the result of decades of government interference and violations of individual rights
in health insurance and medicine. The only moral and practical solution to the
problem is not more government controls but instead to gradually and
systematically transition to a rights-respecting, fully free market in those
industries. From the Winter 2007-2008 issue of The Objective Standard.
Michael J. Harris, MD - www.northernurology.com - an active member in the
American Urological Association, Association of American Physicians and
Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry
practice in urology in Traverse City, Michigan. He has no contracts, no
Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally
recognized for his medical care system reform initiatives. To understand that
Medical Bureaucrats and Administrators are basically Medical Illiterates
telling the experts how to practice medicine, be sure to savor his article on
"Administrativectomy:
The Cure For Toxic Bureaucratosis."
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 2550 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to
$5000/year! To read the rest of the story, go to www.simplecare.com.
Dr David MacDonald started Liberty Health Group. To compare the
traditional health insurance model with the Liberty high-deductible model, go
to www.libertyhealthgroup.com/Liberty_Solutions.htm.
There is extensive data available for your study. Dr Dave is available to speak
to your group on a consultative basis.
Madeleine
Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in
health care, has died (1937-2006).
Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
She will be remembered for her
important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the
government's efforts in criminalizing medicine. For other OpEd articles that
are important to the practice of medicine and health care in general, click on
her name at www.healthcarecom.net/OpEd.htm.
David J Gibson, MD,
Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical
MarketPlace in speeches and writings. His series of articles in Sacramento
Medicine can be found at www.ssvms.org. To read his "Lessons from the
Past," go to www.ssvms.org/articles/0403gibson.asp. For
additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm;
for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
For The Recession and
its Effect on Healthcare . . . For The Case Against the
Electronic Medical Record . . . Review other OpEd articles at www.healthplanusa.net/david_gibson.asp
or click on his name in any volume at www.ssvms.org/magazine.asp.
Dr
Richard B Willner,
President, Center Peer Review Justice Inc, states: We are a group of
healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have
experienced and/or witnessed the tragedy of the perversion of medical peer
review by malice and bad faith. We have seen the statutory immunity, which is
provided to our "peers" for the purposes of quality assurance and
credentialing, used as cover to allow those "peers" to ruin careers
and reputations to further their own, usually monetary agenda of destroying the
competition. We are dedicated to the exposure, conviction, and sanction of any
and all doctors, and affiliated hospitals, HMOs, medical boards, and other such
institutions, who would use peer review as a weapon to unfairly destroy other
professionals. Read the rest of the story, as well as a wealth of information,
at www.peerreview.org.
Semmelweis
Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD,
FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD,
Secretary-Treasurer; 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 noticed 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. 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 with his own funds using Dr
Semmelweis as a model: To read the article he wrote at my request for
Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the
California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some
very interesting letters to the editor from the Medical Board of California,
from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and
how organized medicine still treats this problem, please go to www.semmelweissociety.net.
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
Robert J
Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an
informative Medicine Men column at NewsMax, have now retired. Please log
on to review the archives.
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 read News of the Day in
Perspective: HHS Secretary
nominee pushes HIT's role in data mining even as new report of stolen electronic medical records
surfaces. Don't miss the "AAPS News," written by Jane
Orient, MD, and archived on this site which provides valuable information on a
monthly basis. This month, be sure to read SUDDEN DEATH FOR
MEDICINE? Browse the archives of their official organ, the Journal of American Physicians and Surgeons,
with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief.
There are a number of important articles that can be accessed from the Table of Contents.
Be sure to put September 30 - October 3, 2009 on your
calendar for the AAPS 66th Annual Meeting in Nashville, TN. www.aapsonline.org/calendar.php
* * * * *
Thank you for joining the
MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this
as an invitation, please go to www.medicaltuesday.net/Newsletter.asp,
enter you email address and join the 10,000 members who receive this
newsletter. If you are one of the 80,000 guests that surf our web sites, we
thank you and invite you to join the email network on a regular basis by
subscribing at the website above.
Please note that sections 1-6, 8-9 are
entirely attributable quotes and editorial comments are in brackets. Permission
to reprint portions has been requested and may be pending with the
understanding that the reader is referred back to the author's original site.
Please also note: Articles that appear in MedicalTuesday may not reflect the
opinion of the editorial staff.
Be sure to go to HealthPlanUSA.net and click
on Newsletter to sign up for our sister Newsletter which is now separate from
MedicalTuesday and focuses more on health care issues and possible reform
rather than practice issues.
ALSO NOTE: MedicalTuesday receives no
government, foundation, or private funds. The entire cost of the website URLs,
website posting, distribution, managing editor, email editor, and the research
and writing is solely paid for and donated by the Founding Editor, while
continuing his Pulmonary Practice, as a service to his patients, his
profession, and in the public interest for his country.
Spammator Note:
MedicalTuesday uses many standard medical terms considered forbidden by many
spammators. We are not always able to avoid appropriate medical terminology in
the abbreviated edition sent by e-newsletter. (The Web Edition is always
complete.) As readers use new spammators with an increasing rejection rate, we
are not always able to navigate around these palace guards. If you miss some
editions of MedicalTuesday, you may want to check your spammator settings and
make appropriate adjustments. To assure uninterrupted delivery, subscribe
directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp
Del Meyer
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
When
the government controls your ability to get health care - they control you.
Americans are such sheeple these days. -Jay Collins, Laconia
[Our Health Insurance] system is morally wrong because it runs on
the same principle as organized crime. They charge you a monthly fee for
protection against a possible and unknown threat, but then when the time comes
they don't pay-up, or they underpay. And doctors won't even see people unless
they can afford the enormous monthly fees! Health insurance is extortion. It's
a scam, and its high-time we got rid of it! -Joe T, Derry, NH
The
trouble with socialism is that it always runs out of other people's money.
-Margaret Thatcher
Some Recent or
Relevant Postings
A TIME FOR
FREEDOM by Lynne Cheney
WE
THE PEOPLE - THE STORY OF OUR CONSTITUTION, by Lynne Cheney
HOW DOCTORS THINK by Jerome Groopman, MD
WHY GOVERNMENT
DOESN'T WORK by Harry Browne
DIETS
DON'T WORK by Bob Schwartz, PhD
DOCTORING - The
Nature of Primary Care Medicine
by Eric J Cassell, MD
In Memoriam
Conservative hero: Jack Kemp A liberal Republican in the best sense
From
The Economist print edition May 7th
2009 | WASHINGTON, DC
WINSTON CHURCHILL once said that he "preferred the past to
the present and the present to the future". Jack Kemp had exactly the
opposite point of view. For him the future always promised to be better than
both the present and the pastprovided that the government would just get out
of the way.
Mr Kemp was one of the most prominent Republicans of his
generation. He was secretary of housing and urban development under the first
George Bush. He thought of running for the Republican nomination in 1996 and
became Bob Dole's running-mate. But his real influence was ideological. He was
a tireless advocate of supply-side economics: the man who persuaded Ronald
Reagan to abandon deficit-hawk Republicanism in favour of aggressive tax cuts.
Mr Kemp started his career as a wiry, eager quarterback for the
Buffalo Bills, before riding his popularity as a sports star to a seat in
Congress. There he was consumed by a vision of how to make the world better. He
lent his name to the Kemp-Roth tax cuts of 1981, one of the opening salvos of
the Reagan revolution, and championed school vouchers, enterprise zones and
housing vouchers.
The traditional wing of the party thought him a blow-dried wonder,
but he could give as good as he got. In 1985 Bob Dole mocked him for wanting
"a business deduction for hairspray". Mr Kemp shot back: "In a
recent fire, Bob Dole's library burned down. Both books were lost. And he
hadn't even finished colouring [sic] one of them."
Mr Kemp's world view was shaped by three things. Sympathy for the
blacks he had got to know as a football player; contempt for urban liberalism,
which he had seen at work in Buffalo, with its blighted housing estates and
failed schools; and his commitment to supply-side economics. He never lost his
enthusiasm for cutting taxes and expanding opportunities: virtues he had learnt
as a not-so-dumb jock.
www.economist.com/world/unitedstates/PrinterFriendly.cfm?story_id=13611463
A Tribute to Jack Kemp by Jeffrey A. Tucker Mises
Daily 5/6/2009
Despite having written some tough criticisms of Jack
Kemp over the years, having even called him a socialist when he was running the
Department of Housing and Urban Development (19891993) under the first Bush administration,
I've always had a soft spot for him. His death is really a tragedy and all the
more so that it was not even widely remarked upon in Republican ranks. He was a
major intellectual force in his day, and his sympathies with genuine liberalism
of the old school made him attractive, at some level, to libertarians, if only
because we understood each others' language.
My impression is that the party machine decided to eat
him after being a VP on a losing presidential ticket in 1996 and then coming
out against the Iraq war in 2002. The way it works with these people is that
you are deemed a rising star and courted insofar as you say the right things
and can be useful in bringing power to the party, but once you lose an election
or say something contrary to the party line, your ideas and your person are
forgotten. It is a live-by-the-sword/die-by-the-sword situation, so in a
political-party sense Jack Kemp was long gone. . .
On This Date in
History - May 26
On this date in 1886, Asa Yoelson was born
in Srednike, Russia. The parents had hope for a Cantor when they came to
America, but he became a jazz singer and changed his name to Al Jolson. He sang
his way up from Rialto vaudeville theaters to Ziegfeld's Follies and finally to
the motion picture screen becoming the first singer to be heard on film. His
famous line was "You ain't heard nothing yet, folks."
On this date in 1979, Israel formally
returned El Arish to Egypt under the terms of a peace pact. The capital of
the Sinae peninsula had been occupied by Israel forces for over a decade. This
deed showed both Egypt and the world that Israel meant to keep its promise to
instigate a peaceful coexistence between the two nations. The next day, the
border between Israel and Egypt was opened.
After Leonard and
Thelma Spinrad