A Forum for the Dialogue, Discussion, and Debate of the Medical MarketPlace
 The Restoration of the Confidential Doctor/Patient Relationship
 California, the United States, and the World

 Tuesday, May 28, 2002

The response to the first two months of the MedicalTuesday.network has been gratifying. We appreciate the emails and the phone calls. Thanks for forwarding the messages to your friends and colleagues, and also for the email addresses you have asked us to add. If we continue to double the MedicalTuesday.network every month or two, we will truly be able to inform and save our profession from governmental intrusion into what should be a confidential doctor/patient relationship. There is so much misinformation and disinformation concerning national health insurance whether we call it single payer or socialized medicine. We still have the opportunity to prevent our patients from being thrown to the bureaucratic wolves. In the past two months we’ve discussed the unfortunate conditions in the US, Canada, France and the UK. However, things are deteriorating around the world. Let’s continue to observe what’s happening elsewhere.

Last month marked the passing of Barbara Castle at age 91. She was first elected to Parliament in 1945 with the promise to make Britain a socialist state. This second attempt (The first was in 1649. It fizzled out in 1660.) was an aggressive effort to take over the utilities: electricity, gas, railways and ports; then private industries including coal and steel. A welfare system was put in place promising to take care of everyone from womb to tomb. The National Health Service was begun in the final year of their six year reign. It took nearly 50 years to dismantle most of what they implemented before national bankruptcy could occur. No one wants to politically risk the dismantling of the last vestige of the experiment – the NHS. Failure becomes permanent.

For decades, advocates of socialized medicine in the United States and Canada have maintained that health care systems financed by taxes and under government control are more efficient than private sector models in their ability to control costs and maintain quality of health care. Central to this argument is the belief that user fees and the profit motive, both salient features of a private health system, favor the wealthy and are unfair to the poor. Advocates of national health care have frequently cited perceived successes in Western Europe’s social welfare states. But recently, policy-makers in Stockholm, the capital of Europe’s most heavily socialized Scandinavian state, began implementing market-style reforms that may deprive national health care proponents of their favorite example. According to the National Center for Policy Analysis (NCPA) in every category, the experiment has been a success.

Between 1992 and 1994, even as the advocates of “Hillarycare” in the United States were calling for wider government control of health care resources, the Health Services Council in Stockholm began contracting health services to private companies as part of an experiment to determine whether the private sector could perform better than the city’s public health institutions.

For decades, Stockholm relied on an under performing civic health service monopoly characterized by long waiting lists, chronic overspending and flagging quality. Since the experiment began, virtually every sector of Stockholm’s health system has undergone some form of privatization:
* Initially, the experiment included 150 private providers who were licensed to compete for health service contracts.
* In 1998 the Council began the gradual privatization of all primary care.
* In 1999 St. Göran’s, one of Sweden’s largest hospitals, was sold to a private company.

By the end of the experiment’s first five years, all but one of the original 150 private contractors had survived and were flourishing. Likewise, by the end of the first year of its privatization, St. Göran’s had shown significant improvements over its performance as a public facility.

A study conducted for the Stockholm government compared the costs of services in six medical specialties between physicians in 40 private practices and 20 public hospital outpatient clinics, and found the cost per consultation to be lower in private practice. For example:
* In ophthalmology, costs in the public sector were 28 percent higher.
* Among ENT specialists, costs were 17 percent higher.
* In general surgery, internal medicine and dermatology, costs averaged 13 percent higher.

In addition
* Private nursing home costs have fallen 30 percent.
* The costs of care among private specialists have been cut by 40 percent.
* For many types of treatment, doctors in the private sector have reduced expenses to levels 15 percent lower than the same procedures would cost in the public sector.

Savings have been even more dramatic in the hospital sector. At St. Göran’s:
* Costs for lab and X-ray services have fallen by 50 percent
* Overall costs are down 30 percent.

One result of decentralizing and divorcing health care providers from bureaucratic control in Stockholm has been that private sector companies have been able to introduce simple, professional management structures that enable doctors to spend less time on paperwork and more time with patients. This change has, in turn, increased productivity in several key areas. Most importantly, it has drastically reduced waiting times for treatment by increasing the number of patients being served. For example, at St. Göran’s:
* The average wait for heart surgery is two weeks, compared to 15 - 25 weeks in Sweden’s average public sector hospital.
* The average wait for hip replacement surgery is 10 weeks, compared to more than a year in the average public hospital.

No longer hampered by public system restraints, St. Göran’s is now treating an average of 100,000 more patients each year than it did as a public hospital - but using fewer resources. As a result of St. Göran’s success, the Council now has formal plans to sell all seven remaining public emergency hospitals in Stockholm to private investors.

The NCPA reached these conclusions:
While opponents of the privatization reforms had predicted that the private sector, by seeking to make a profit for shareholders, would drive costs up and efficiency standards down, the opposite has in fact been true.

Across the board, private contractors in Stockholm are operating with less staff on smaller budgets, while providing the same treatments to more patients than their public counterparts. As a pilot program for testing the potential effects of competitive market mechanisms on public health care systems, Stockholm’s internal market has proven the ability of the private sector to dramatically outperform state-administered facilities by reducing costs, improving care and saving lives.

This study by A. Wess Mitchell,  the Russell and Phoebe Perry Policy Intern with the National Center for Policy Analysis, is an eye opener for the United States; except for the elderly and the poor, the US is the last country without socialized or single payer medicine. Unless we take heed, our patients will get increasingly less optimal and lower quality care. Let’s not put our patients through 50-100 years of third world medicine as occurred in Europe and the NHS of the UK. They are slowly trying to salvage their healthcare by emulating private medicine which some groups in our country are trying to eliminate.

When colleagues and friends expound on people benefiting from socialized medicine or single payer medicine, remind them what it really means: In Europe, what mattered was not the well-being of the individual, but the well-being of the state. (Otto von Bismarck, the father of state medicine.)

Damaged Care, a Showtime movie, which chronicles Doctor Linda Peeno’s work with several HMOs was shown on May 26 and will be shown again on Wednesday, May 29, 2002 and early Thursday on Showtime. It details her moral struggles over denying care to patients which she never actually examined. She subsequently blew the whistle in a congressional hearing. Be sure to tune in Wednesday.

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

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

Del Meyer, MD