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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol X, No 20,
Jan 31, 2012 |
In This Issue:
1.
Featured Article:
Understanding
Lung Function
2.
In
the News: Have you thought about Outsourcing
your New Year’s Resolutions?
3.
International Medicine: Schumpeter:
Saving Britain's health service
4.
Medicare: Clowns to the left of me, jokers to the right
5.
Medical Gluttony:
A Letter from the
HMO concerning an 85-year-old patient with a stroke
6.
Medical Myths: The High Cost of
Technology
7.
Overheard in the Medical Staff Lounge: There will be no
effective opposition to Obama
8.
Voices
of Medicine: From the North Coast
Physician
9.
The Bookshelf: The Unbreakable Bond Between a Marine and His Military Working Dog
10.
Hippocrates
& His Kin: The Low Cost of
Technology
11.
Professionals
Restoring Accountability in Medical Practice, Government and Society:
Words of Wisdom,
Recent Postings, In Memoriam, Today in History . . .
* * * * *
Chancellor Otto von Bismarck, the father
of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by
making its citizens dependent on the state by social insurance. Thus socialized
medicine, any single payer initiative, Social Security was born for the benefit
of the state and of a contemptuous disregard for people’s welfare.
We must also remember that ObamaCare has
nothing to do with appropriate healthcare; it was similarly projected to gain
loyalty by making American citizens dependent on the government and eliminating
their choice and chance in improving their welfare or quality of healthcare.
Socialists know that once people are enslaved, freedom seems too risky to
pursue.
* * * * *
1.
Featured
Article: Understanding
Lung Function
Ahem! These Cells Help Clear Your Lungs by Ann Chin | Scientific
American | January 25,
2012
Courtesy of
Chris Kintner, Matthew Joens and James Fitzpatrick/Salk Institute for
Biological Studies
Scientists recently
identified the gene that instructs certain cells to develop hairlike structures
called multiple cilia, which move mucus out of the lungs to prevent infection. Christopher Kintner and his
team at the Salk Institute for Biological Studies made this discovery working
with Xenopus laevis (African clawed frog) embryos. The scanning
electric microscope image, below, magnified at 7,000 times actual size, shows
the gray surface of embryonic cells, which sprout hundreds of pink cilia that
beat in one direction to push fluids along. These multiciliated cells form on
the outside of the frog embryos, making the cells easy to study. Read more . . .
Kintner says this
research is a step toward a better understanding of how cilia form and
function. His finding, which appears in the January 8 online issue of Nature
Cell Biology, may be an important tool for creating multiciliate cells
from embryonic stem cells. "In the lung, multiciliate cells are [of] major
importance to cell population, and knowing how to generate these cells is the
basis for producing the methods and therapies for tissue regeneration,"
Kintner says. (Scientific American is part of Nature Publishing
Group.)
—Ann Chin
Read
the article at Scientific American – subscription required . . .
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* * * * *
2.
In the
News: Have you thought
about
Outsourcing your New Year’s Resolutions?
To Stick to New
Year's Resolutions, Try Outsourcing Them
Elizabeth Bernstein
If you'd like to make
your New Year's resolutions stick, try this: Have someone else—a significant
other, your best friend, maybe even your mom—make them for you. Read more . . .
Sure, resolutions are supposed to be personal. People can't change unless
they're ready to change. And having someone you love tell you how you could
become a better person could be terrifying.
But Mark Twain pretty much got it right when he said we make our annual
good resolutions on New Year's Day and "begin paving hell with them as
usual" the following week.
Most of us could use help achieving our goals. Who better to tell us how to
improve ourselves than someone who knows us well—perhaps better than we know
ourselves—and even may be all too happy to offer up some tough love? And if we
promise to check in regularly with this person to discuss our progress, we'll
probably do a much better job of keeping our resolutions.
"We all have blind spots, but the people we are intimate with can see
through them," says David Palmiter, a couples therapist and professor of
psychology at Marywood University, in Scranton, Pa. A loved one can encourage
us to meet our goals and hold us accountable when we slip, he says.
Elizabeth and Michael Singer made each other's New Year's resolutions last
December while driving home to New York after spending Christmas in Washington,
D.C. Ms. Singer, a 55-year-old psychoanalyst, broached the subject. Her
husband, 54, had retired from his antique jewelry business several years
earlier and was feeling restless. He was also spending a lot of time at home.
She suggested a goal for him for the coming year: "Start a new company.
Get out of my hair."
The couple, who have been married 19 years and live in Forest Hills, N.Y.,
brainstormed about what type of business Mr. Singer could create. Then, Ms.
Singer came up with two more resolutions for her husband: Choose movies that
the entire family would want to watch together. And eat more healthfully.
"Next year, the sandwich named for you at the corner deli will be tofu
and sprouts, not pastrami with roasted peppers and Russian dressing," she
told him.
Then she did something really brave. She asked her husband to come up with
resolutions for her. At first, he insisted that she was perfect. ("I
didn't want to hurt her feelings," he says.) Eventually he gave her three
goals: Be more adventurous and bold. Stop criticizing yourself so much. Cook
dinner twice a month.
The Singers took their resolutions seriously. In February, Mr. Singer
launched a tutoring company. He has started eating salads and sushi. Meanwhile,
Ms. Singer has taken a writing workshop and created a group therapy program for
actors. And she has been trying to silence her inner drillmaster . . .
Read
the entire report in the WSJ – Dec 27. 2011 – Subscription required . . .
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* * * * *
3.
International
Medicine: Schumpeter: Saving Britain's health service
The NHS needs to learn from
innovations in the rest of the world
The Economist | from the print edition | Jun 16th
NO SPECTACLE is “so
ridiculous as the British public in one of its periodical fits of morality”,
harrumphed Thomas Macaulay, a Victorian historian. Today there is no spectacle
so ridiculous as the British public in one of its periodic fits of panic about
the National Health Service (NHS). Every decade or so the government tries to
reform the NHS—and every decade or so the NHS masses its forces to work the
public into a frenzy. Read more . . .
Doctors threaten to
strike against “privatisation”. Bishops bleat that anxiety stalks the land. The
BBC waves blood-stained sheets. And the government eventually backs down. Thus
it was with Margaret Thatcher and (more mutedly) with Tony Blair. And thus it
is with David Cameron, who came to office promising to reinvent the welfare
state but now promises that the NHS of the future “will be much like what we
have today”.
This is a
mind-boggling statement. The internet and the mobile phone are revolutionising
social life. New drugs and surgical techniques are revolutionising treatment
and prolonging life. Entrepreneurs and innovators are demonstrating that you
can use new technology and clever business models to deliver better health care
for less money. As Britain ages and its medical bills soar, the NHS must
experiment or die.
The NHS was built on
the idea that patients are passive recipients of medical wisdom, most of it
delivered face-to-face. This is beginning to change: doctors now advise
patients to take exercise and eat their vegetables. But it has a long way to
go. The private sector has revolutionised productivity by getting customers to
do more things for themselves. Rather than waiting for a butcher or baker to
serve us, many people now choose their own groceries and scan them themselves
at the checkout. This model is now reaching health, too . . .
Much of the pressure
for a more collaborative approach to health care is coming from the bottom
up—from patients themselves and from what David Cameron calls the “big
society”. Voluntary organisations such as Alcoholics Anonymous have a better
record than the NHS at teaching people to look after themselves. People who
suffer from rare or debilitating diseases form online groups such as
PatientsLikeMe and WeAreUs to swap advice and support each other. There is a
growing community of “quantified selfers” who monitor their own bodily
functions and hold meetings to discuss their results. This combination of
monitoring and self-help holds the key to cost control as well as improved
health: about 75% of NHS spending is devoted to 17.5m people who suffer from
long-term problems.
The NHS was also
built on the assumption that general hospitals are the flagships of the system.
(Mr Cameron promises to defend them.) But across the developing world
entrepreneurs are demonstrating that “focused factories”, to use the jargon,
can use economies of scale and intense specialisation to improve productivity.
The Narayana Hrudayalaya Hospital in Bangalore has reduced the cost of heart
surgery to $2,000 (60% cheaper than most Indian hospitals). Its 42 surgeons
perform an impressive 3,000 operations a year. They become virtuosos in their
sub-specialisms. LifeSpring Hospitals, an Indian chain, has used standardised
procedures, borrowed from manufacturing, to reduce the cost of delivering a
baby to $40, a fifth of the cost at comparable local hospitals. Every year the
Aravind Eye Hospital performs 70% of the number of eye operations performed by
the entire NHS for just 1% of the cost. . .
Wanted: a medical Martin Luther
The struggle for NHS
reform has not been completely lost. On June 8th Reform, a think-tank, staged a
conference on “disruptive innovation” in health care. NHS veterans repeated the
old saw that the NHS is the closest thing Britain has to a national religion.
But they also listened excitedly as Indians and Mexicans told stories of
innovations back home. And they produced numerous examples of innovations of
their own. NHS Direct, a hotline, dishes out medical advice by phone and the
internet to 8m people. Boots and Specsavers, two high-street stores, apply
something like the franchise model to the distribution of spectacles. Pointing
out flaws in a nation’s religion will seldom win you friends. But sometimes it
takes a Reformation to save a church.
Economist.com/blogs/schumpeter
| from the
print edition | Business
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The NHS does
not give timely access to healthcare; it only gives access to a waiting list.
* * * * *
4.
Medicare: Clowns to the left of me, jokers to the
right
How
Doctors are Trapped By John Goodman
Health Alerts
| January 16, 2012
Every lawyer, every accountant, every
architect, every engineer — indeed, every professional in every other field —
is able to do something doctors cannot do. They can repackage and reprice their
services. If demand changes or if they discover a way of meeting their clients’
needs more efficiently, they are free to offer a different bundle of services
for a different price. Doctors, by contrast, are trapped. Read more . . .
To see how trapped, let’s look at
another profession: the practice of law. Suppose you are accused of a crime and
suppose your lawyer is paid the way doctors are paid. That is, suppose some
third-party payer bureaucracy pays your lawyer a different fee for each
separate task she performs in your defense. Just to make up some numbers that
reflect the full degree of arbitrariness we find in medicine, let’s suppose
your lawyer is paid $50 per hour for jury selection and $500 per hour for
making your final case to the jury.
What would happen? At the end of your
trial, your lawyer’s summation would be stirring, compelling, logical and
persuasive. In fact, it might well get you off scot free if only it were
delivered to the right jury. But you don’t have the right jury. Because of the
fee schedule, your lawyer skimped on jury selection way back at the beginning
of your trial.
This is why you don’t want to pay a
lawyer, or any other professional, by task. You want your lawyer to be able to
reallocate her time — in this case, from the summation speech to the voir dire proceeding. If each hour of
her time is compensated at the same rate, she will feel free to allocate the
last hour spent on your case to its highest valued use rather than to the
activity that is paid the highest fee.
Clowns to left of me, jokers to the right
Here I am, stuck in the middle with you
In a previous Health
Alert, I noted that Medicare has a list of some 7,500 separate tasks
it pays physicians to perform. For each task there is a price that varies
according to location and other factors. Of the 800,000 practicing physicians
in this country, not all are in Medicare and no doctor is going to perform
every task on Medicare’s list.
Yet Medicare is potentially setting
about 6 billion prices across the country at any one time.
Is there any chance that Medicare can
get all those prices right? Not likely.
What happens when Medicare gets them
wrong? One result: doctors will face perverse incentives to provide care that
is costlier and less appropriate than the care they should be providing.
Another result: the skill set of our nation’s doctors will become misallocated,
as medical students and practicing doctors respond to the fact that Medicare is
overpaying for some skills and underpaying for others.
The problem in medicine is not merely
that all the prices are wrong. A lot of very important things doctors can do
for patients are not even on the list of tasks that Medicare pays for. Some
readers will remember our Health
Alert on Dr. Jeffrey
Brennan in Camden, New Jersey. He is saving millions of dollars for Medicare
and Medicaid by essentially performing social work services to reduce spending
on the most costly patients. Because “social work” is not on Medicare’s list of
7,500 tasks, Brennan gets nothing in return for all the money he is saving the
taxpayers.
We have also seen that there are other
omissions — including telephone and e-mail consultations and teaching patients how to manage
their own care.
In addition, Medicare has strict rules
about how tasks can be combined. For example, “special needs” patients
typically have five or more comorbidities — a fancy way of saying that a lot of
things are going wrong at once. These patients are costing Medicare about
$60,000 a year and they consume a large share of Medicare’s entire budget.
Ideally, when one of these patients sees a doctor, the doctor will deal with
all five problems sequentially. That would economize on the patient’s time and
ensure that the treatment regime for each malady is integrated and consistent
with all the others.
Under Medicare’s payment system,
however, a specialist can only bill Medicare the full fee for treating one of
the five conditions during a single visit. If she treats the other four, she
can only bill half price for those services. It’s even worse for primary care
physicians. They cannot bill anything for treating the additional four
conditions.
Since doctors don’t like to work for
free or see their income cut in half, most have a
one-visit-one-morbidity-treatment policy. Patients with five morbidities are
asked to schedule additional visits for the remaining four problems with the
same doctor or with other doctors. The type of medicine that would be best for
the patient and that would probably save the taxpayers money in the long run is
the type of medicine that is penalized under Medicare’s payment system. . .
Take Dr. Richard Young, a Fort Worth
family . . . calls the payment rules “ridiculously complicated.”
That’s an understatement.
The
sick are fleeing trapped doctors by either purchasing high deductible health
insurance or by utilizing the International Medical Centers with charges of
one-third to one-tenth the cost of standard health insurance coverage in the
United States.
Read Dr. Goodman’s
entire OpEd at the NCPA . . .
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Government is not the solution to our
problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical
Gluttony: A Letter
from the HMO concerning an 85-year-old patient with a stroke.
[Dear Provider:]
As part of our effort to accurately
capture the health status of our Medicare Advantage members, CenseoHealth recently
performed an assessment on [your patient.]
This assessment relies on information from
our claim files, medical history provided by the patient, and a brief physical
examination performed at the time of the assessment. We are providing the
information gathered during the assessment to supplement the information
already contained in your chart. We realize that some of the information will be
duplicative. Read
more. . . We also realize the patients’ memories can be
incomplete, especially in the recall of counseling and immunization.
[Your patient] has been
asked to contact you to discuss whether these recommendations are appropriate
for her particular situation. Should you have any questions about the
information contained in this letter, please contact your Practice Support
advisor.
Sincerely,
//Signed//
Chief Medical Officer.
Page 2
The following patient
recommendations were triggered during the CenseoHealth assessment (these may
already be documented in patient’s chart):
- Discussion on aspirin
therapy
- Further
evaluation/treatment for hypertension
- Discussion on possible
risks of medications
- Colonoscopy
- Annual dental
evaluation
- Discussion on following
treatment plan
- Pneumococcal vaccine
- Annual influenza
vaccine
- Further
evaluation/treatment for osteoporosis
- Discussion of high risk
medications
- Discussion on your
chronic illness and side effects of treatment
We did a trial run on this patient. To cover the eleven points above,
took the equivalent of two office calls. The patient did not feel the 11 points
covered any new information that we had not covered before. She did not accept
any of the HMO recommendations. In fact, she had a good laugh over them. The
American College of Gastroenterology in the 2008 Colon Rectal Cancer Screening
Guidelines does not recommend colonoscopy in an 85-year-old patient with a
negative prior colonoscopy in her eighth decade of life. The GI colleagues on
our medical staff could not support a Colonoscopy in this patient. Clinically
in her medical state a colonoscopy could not be recommended and could be
hazardous if not life threatening.
This intrusion into our practice cannot be justified as cost effective,
or medically desirable. It should furthermore be noted that this major increase
in health care costs cannot be justified as improving Quality of Care. In fact,
it was the consensus of these GI specialists that we discussed this with, that
this would decrease the quality of care and could be hazardous to our patient’s
welfare, health and perhaps her life. It was furthermore the consensus that
this Health Maintenance Organization was not in any way “Maintaining Health”
and thus was an “Organization” misnomer.
It appears that our HMO
actually sent a physician to see this patient. In our experience it takes at
least five times as long to make a home visit as an office call provided the
patient does not live more than 15 minutes from our office. Plus two extra
office calls to evaluated this intrusion into our practice. Thus a discounted
office call of $100 grew to $500 for this intrusion. Their physician surely was
paid. My two extra office calls were not
paid just like all the extra work that the HMO piles onto a physician is not
paid. It doesn’t take long for the private physician in practice to understand
why our health care costs are so high. Wouldn’t it be great if Health
Maintenance Organizations understood costs? They don’t see the cost of all the
extra work they require from physicians. Since they don’t pay for this extra
work, they think it is free. Why do HMO physicians except this unnecessary
burden? No wonder HMOs will go out of existence in the next 10-20 years. Why
don’t physicians speed up this process?
It appears that this HMO is
vying to become an Obama ACO (An Obama Accountable Care Organization) which
will be rejected by the public in the same manner that HMOs are being rejected.
[HMOs dropped from 31 percent of the
healthcare market in 1996 to 17 percent in 2011]
Maybe they’re drinking too much of the Obama Kool-Aid.
"Drinking the Kool-Aid" is a
metaphor commonly used in the United States and Canada that refers to a
person or group's unquestioning belief in an ideology. . . en.wikipedia.org/wiki/Drinking_the_Kool-Aid
Feedback on this article will be appreciated. . .
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Medical Gluttony thrives in Government and Health Insurance Programs.
It has not been controlled by HMOs. It will not be controlled by the
Obama ACOs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6.
Medical
Myths: The High Cost of
Technology
In a presentation to investors Wednesday, Roche forecast that sales of
DNA-sequencing machines will nearly double to $2.1 billion by 2015, driven in
part by more routine use in everyday practice. . .
DNA-sequencing machines today are
largely used by researchers to scan large numbers of patients with a certain
disease to look for common genetic characteristics that may be causing the
disorder. The researchers can also run smaller sequencing jobs involving, for
example, tumor tissue to look for disease-causing mutations that are potential
drug targets. . . Read
more . . .
One stumbling block to widespread use of DNA sequencing is the reluctance
of some insurers to cover the cost, said David Goldstein, director of the
Center for Human Genome Variation at Duke University. But that will change, he
said, as the cost comes down and insurers realize genome sequencing can save
money. He cited the case of children with rare genetic diseases who sometimes
go for long periods without getting the right diagnosis. For such patients, he
said, DNA sequencing is increasingly common.
Just three years ago, it cost more than $200,000 to sequence an entire
human genome, according to the National Institutes of Health's National Human
Genome Research Institute, known as NHGRI, in the U.S. Now the cost is down to
about $3,000, with a recent claim by Life
Technologies Inc. that it will do the job for $1,000 by the end of the
year. *
That big cost reduction has prompted some predictions that millions of
patients will soon have their genomes sequenced so the data can be used to
guide disease prevention and treatment. But hardly anyone expects medicine to
be broadly affected overnight.
"We are convinced this is going to markedly change the way we are
looking after our patients," said Gianrico Farrugia, head of the recently
established Center for Individualized Medicine at the Mayo Clinic in Rochester,
Minn. "But it's not a question of getting the [sequencing] data. It's a
question of having mechanisms to interpret the data to make it most useful to
people."
Eric Green, head of the NHGRI, said that one of the biggest challenges with
genomics is how to analyze the data and put it to productive use. Both
sequencing costs and efforts to interpret the data are "all heading in the
right direction," he said. "But it will take years" for genomics
to become part of routine care. "It's not going to take five or 10. It
will take more than that.". . .
Technology always reduces costs.
Read
the entire article at the WSJ – subscription required . . .
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Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
This would be a very effective control on DNA-Sequencing requests increasing
in the near future.
* * * * *
7.
Overheard
in the Medical Staff Lounge: There will be no
effective opposition to Obama
Dr. Edwards: It looks like
the Musical Chairs Campaign is winding down to two candidates who not everybody
likes and are not presidential. Both the Daniel Henninger and the Karl Rove
columns in the WSJ this week talk about the sad predicament the Republicans are
in and what their awakening will be on Nov 6, 2012.
Dr. Sam. Too bad more of the A-Team didn’t stay
in the running.
Dr. Dave: Maybe
they were the smart ones. They knew it would be very unpopular to try to undo
Obama’s massive spending program. They didn’t want to be sacrificial lambs. Read more . . .
Dr. Edwards: Obama is one of
the most unpopular presidents at mid cycle that we’ve had. But we’ve had
unpopular candidates win elections. Look at Harry Truman. No one gave him a
chance. Even the New York Gray Lady put out her “Dewey Won” NY Times before the election was called.
Right now Bush is still so unpopular that many people would vote for a
candidate from the Chicago Mob rather than vote for what they perceive as Bush
Republicans.
Dr. Rosen: I’m not so
sure that Mitt Romney or Newt Gingrich could win the Doctor vote at this time.
This past week I was at a Medical Conference and was amazed at the number of
pediatricians' cars that had Obama 2008 stickers on them. That they are still
on their cars with his ratings plummeting in the polls suggests they are not
ashamed to be associated with what some of us feel is the greatest threat to
private practice.
Dr. Edwards: What’s even
worse, many don’t see Obama as a threat to our future welfare as a
freedom-loving country.
Dr. Rosen: I’m not
sure there is enough time between now and November to have an objective
discussion on any of the major issues of the day. There are so many people in a
fit of anger or despair that any candidate running against Obama will be a lamb
led to the slaughter. Looks like I might vote a full ballot but leave the
Presidential vote blank.
Dr. Edwards: Maybe that would be more effective than voting
for a losing candidate. The message may be clearer.
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8.
Voices of
Medicine: A Review of Regional Medical Journals: North Coast
Physician
North Coast Physician is
published monthly by the Humboldt-Del Norte County Medical Society
In My Opinion
Occupy Humana by Stephen Kamelgarn, MD, The GURU
2011 may be known as the year where the public finally stood up and
screamed, ala Network (1976): “I’m mad as Hell, and I’m not gonna take it
anymore!” Read
more . . .
First, we witnessed the awakenings of the
masses in Egypt, Tunisia, Libya, Syria and Yemen. This “Arab Spring” was then
followed by our own homegrown protests, of what is now known as “The Occupy”
movement. It started as Occupy Wall Street in Zuccoti Park, protesting Wall
Street’s destruction of the world’s economy and the criminal malfeasance of
“the 1%,” and has spread to virtually every major city in the US and many other
cities throughout the world. As the movement has moved and grown, it has
morphed into a variety of forms, and is taking on a local flavor in the
individual cities. Occupy Denver, for example, is also protesting treatment of
immigrants. Even up in our little corner of paradise we have Occupy Eureka and
Occupy Arcata. Not much I admit, but a presence in front of the courthouse or
Arcata city hall, nonetheless.
While the mainstream press has downplayed
or dismissed the protests as “a student lark,” or “they have no message,” the
protests are having an effect. In October alone, more than 600,000 Americans
moved their bank accounts into Credit Unions. This is more account transfers
than occurred in all of 2010! (US News & World Report Nov. 2, 2011 www.usnews.com/news/articles/2011/11/02/americans-closing-bank-accounts-moving-money-to-credit-unions.)
The nature of the national conversation has changed, and The Occupy’s motto of,
“We are the 99%,” is beginning to resonate all through society. Yes, the Occupy
Movement is definitely having an effect.
I think it’s time that we, as physicians,
jump on this bandwagon. It’s time for us to give a huge resounding NO to the
insurance industry. For years, I’ve been screaming about what the insurance
gorgon has done to ours and our patients’ lives. Obamacare has done nothing,
and I fully suspect that by the magic 2014 date, when most of the reforms are
supposed to kick in, what little remain of the minuscule reforms that were
actually enacted, way back in 2010, will have been gutted by the Supreme Court
and/or the pampered mandarins in Congress.
On Dec. 6, 2011, Michael Moore (of Sicko
and Fahrenheit 9/11 fame) posted an article on Truthout that had a recipe for
the Occupy movement to survive the coming winter. He listed five activities we
can do to keep the movement alive. Here’s Number 5:
5. Occupy the Insurance Man. It's time to
not only stand up for the 50 million without health insurance but to also issue
a single, simple demand: The elimination of for-profit, privately-controlled
health insurance companies. It is nothing short of barbaric to allow businesses
to make a profit off people when they get sick. We don't allow anyone to make a
profit when we need the fire department or the police. Until recently we would
never allow a company to make a profit by operating in a public school. The
same should be true for when you need to see a doctor or stay in the hospital.
So I say it's long overdue for us to go and Occupy Humana, United Health, Cigna
and even the supposed "nonprofit" Blue Crosses. An action on their
lawns, in their lobbies, or at the for-profit hospitals -- this is what is
needed. www.truth-out.org Dec. 6, 2011
Who, better than we physicians, knows how
malignant these bastards are. They siphon off 30% of their clients’ premiums
to pay for bloated executive salaries and perks, and to pay off investors and
stockholders. And how does this all get paid for: by exorbitant premiums, high
co-pays and deductibles on the income end, and restrictive formularies,
denials, discounted reimbursements, obfuscation, delays and exemptions on the
outlay side of the equation. These “responses to the market” netted them $12.2
billion in profits in 2009. . .
Back in 2009 (“Let’s kill all the Insurance
Execs,” The Bulletin April 2009), I wrote that I felt the insurance industry
was operating illegally by practicing medicine without a license, or was
committing malpractice by not performing good faith exams. I publicly called
for the California State Attorney General’s office to investigate and
criminally prosecute the most egregious offenders. Toward that end I sent both
the State Insurance Commissioner and the Attorney General dozens of charts and
letters of protest documenting insurance abuses.
Both offices refused to give me the time of day. I
spoke to the CMA who promised to follow-up, but I haven’t heard a thing. I’ve
thought of all kinds of things I’d like to do.
I’ve actually entertained the notion of hiring several
Eastern European Computer Geeks to hack the computer systems of the insurance
companies in such a manner that they approve 100% of the charges that come
through, no questions asked. And they won’t even know they’ve been hacked! Only
when they come up sinking below their bottom line, will the grossly overpaid
CEOs and CFOs realize they lost their gravy train. While this always remains an
attractive notion, something is sure to go wrong, and I have absolutely NO
desire to spend my retirement years in some Federal Prison. . .
What we can do is unify, and CANCEL all of our
insurance contracts. We then bill the insurance companies as “out of network
providers,” and let them know, in no uncertain terms, that we won’t accept
their measly discounted rates, restrictive formularies and onerous approval
rules.
We North Coast physicians may be in the best position
to do this: we’re a small, self-contained community, that is far from other
centers. There’s no way they can force their subscribers to brave the winter
passes to Redding for a well-child check, or maneuver through a rockslide
closed 101 to Santa Rosa for a pre-natal visit. In other words, we’re the only
game in town. If the insurance companies cannot put together a panel of
“network” physicians, they’re going to have to deal with us on our terms. If
we, as a community, hang together and negotiate as a unit to advocate for both
us and our patients, we just might get somewhere. We must demand that these
bloated parasites give back to the people who pay their salaries, and provide a
decent level of service and reimbursement. And if it gets us sued by the state
for anti-trust violations I say, in the words of our former Commander and
Thief: “Bring ‘em on.!”
Read the entire OpEd at the Humboldt-Del Norte County Medical Society
We at
MedicalTuesday publish this intemperate OpEd to reflect some of the anger
filtering through our society and why that will influence our elections in
November. This huge non-directed anger, whether the war, or Bush, or insurance,
or Wall Street, or just about anyone that gets in the way, including criminal
suggestions, will prevent any effective opposition to our sitting president.
Since the Republicans will not have a viable candidate, and any candidate that
will run will be “a sacrificial lamb led to the slaughter,” we would suggest
all conservatives, libertarians, constitutionalists and basic Americans to be
sure to vote, but leave the box for the president and vice president blank. It
the president got only 40 percent of the vote from the people that still give
him a positive rating, that will be more effective than any one from the “third
team of candidates” trying to get votes which no one will be able to interpret.
Feedback
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
* * * * *
9.
Book
Review: Meet the
Author Event at the Marines Memorial in SF
Sergeant Rex: The Unbreakable Bond Between
a Marine and His Military Working Dog
Sergeant Mike Dowling and his military working dog Rex
were part of the first Marine Corps military K9 teams sent to the front lines
of combat since Vietnam. It was Rex’s job to sniff out weapons caches, suicide
bombers, and IEDs, the devastating explosives that wreaked havoc on troops and
civilians alike. It was Mike’s job to lead Rex into the heart of danger time
and time again, always trusting Rex to bring them both back alive. Loyalty is
one of the hallmarks of any good Marine, and nowhere is that quality more
evident than in this astonishing account of Mike Dowling and Rex’s wartime
experiences. A moving story of how a man and a dog developed complete trust in
each other in the face of terrible adversity, Sergeant Rex is an
unforgettable tale of sacrifice, courage, and love. Read more . . .
Our special event will be a follow-on presentation by
"Canine Companions for Independence" and how dogs are trained to be
companions to our wounded Veterans. CCI is the largest and oldest service dog
organization in the world and has been assisting people with disabilities for
close to 38 years. In the past 4 years CCI created a special initiative
to assist veterans returning from the Middle East Conflicts. The trainers
will even bring a trained dog and show the many amazing commands they perform
to support the veteran with a disability. See their website at: http://www.cci.org/site/c.cdKGIRNqEmG/b.4011033/k.D44E/Veterans.htm.
The program will start at 6 pm on Monday, 6 February
at the Marines' Memorial Club in downtown San Francisco. Register now by
going to this website: www.MarineClub.com/events<http://www.MarineClub.com/events.
All active duty, retired, or previous members of the
military services are eligible to become members.
To
read a review, go to . . .
To read more book
reviews . . .
To read book reviews
topically . . .
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The
Book Review Section Is an Insider’s View of What Doctors are Reading about.
* * * * *
10. Hippocrates & His Kin: The Low Cost of
Technology
Will
Gene-Sequencing become part of a Doctor’s Office visit? WSJ
Just three years ago, it cost more than $200,000 to
sequence an entire human genome, according to the National Institutes of
Health’s National Human Genome Research Institute in the U.SA. Now the cost is
down to about $3,000 with a recent claim by Life Technologies Inc. that it will
do the job for $1,000 by the end of the year. Read more . . .
With technology reducing costs by 99% in just three years, how can we get
HMOs out of the way of progress?
It'd be nice if President Obama had a record
to defend. But he doesn't, and I've gotten over it.
—Karl Rove
Do Alcoholics really have it better than patients
in the UK?
Voluntary
organizations such as Alcoholics Anonymous have a better record than the NHS at
teaching people to look after themselves. [See the International section (3)
above]
Soros:
Romney Is Like Obama, Don't Worry
Billionaire financier George Soros likes Mitt Romney,
and is telling European liberals not to worry. He says of Obama and Romney
"there isn’t all that much difference" between them.
Like we’ve
been saying.
To read more HHK
. . .
To
read more HMC . . .
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
* * * * *
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. They have a new address and
their program is expanding.
•
Medi-Share Medi-Share is based on the biblical principles of
caring for and sharing in one another's burdens (as outlined in Galatians 6:2).
And as such, adhering to biblical principles of health and lifestyle are
important requirements for membership in Medi-Share.
This is not insurance. Read more . . .
•
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. To
review How
to Start a Third-Party Free Medical Practice . . .
•
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. Read Lin
Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes
in the field of medicine, the term “socialized medicine” is never used. Instead
we hear demands for “universal,” “mandatory,” “singlepayer,” and/or
“comprehensive” systems. These demands aim to force one healthcare plan
(sometimes with options) onto all Americans; it is a plan under which all
medical services are paid for, and thus controlled, by government agencies.
Sometimes, proponents call this “nationalized financing” or “nationalized
health insurance.” In a more honest day, it was called socialized medicine.
•
To read the rest
of this section, please go to www.medicaltuesday.net/org.asp.
•
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 25–50 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.
•
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.
•
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.
He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
•
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: Don't miss the "AAPS News,"
written by Jane Orient, MD, and archived on this site which provides valuable
information on a monthly basis. 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.
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of California. There is no additional cost or
fee to be a member of the AAPS California State Chapter.
Go to California
Chapter Web Page . . .
Bottom
line: "We are the best deal Physicians can get from a statewide physician
based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of
American Physicians and Surgeons (AAPS), a non-partisan professional
association of physicians in all types of practices and specialties across the
country. Since 1943, AAPS has been dedicated to the highest ethical standards
of the Oath of Hippocrates and to preserving the sanctity of the
patient-physician relationship and the practice of private medicine. We welcome
all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors
and other medical professionals are welcome to join as professional associate
members. Staff members and the public are welcome as associate members. Medical
students are welcome to join free of charge.
Our motto, "omnia pro aegroto"
means "all for the patient."
Words of Wisdom, Recent
Postings, In Memoriam, Today in History . . .
"Losers live in the past. Winners learn from the
past and enjoy working in the present toward the future." — Denis Waitley: is an American motivational speaker and writer.
"Inaction breeds doubt and fear. Action breeds
confidence and courage. If you want to conquer
fear, do not sit home and think about it. Go out and get busy." — Dale
Carnegie: was an American writer
and lecturer.
"Failures do what is tension relieving, while
winners do what is goal achieving" — Dennis Waitley: is an American motivational speaker and writer.
Some
Recent Postings
In The January 17th Issue: