Community For Better Health Care

Vol IV, No 15, Nov 8, 2005


In This Issue:

1.      Featured Article: Was There Really Government Subterfuge Implementing Social Security in the 1930s?

2.      In the News: The Impending Global Flu Pandemic – Will It Kill 50 Million This Time?

3.      International Medicine: Antigua and the American Health Care Refugee

4.      Medicare Reform: Pharmacy Benefit ProgramWhat Must Be DoneA Clinician’s Point of View

5.      Medical Gluttony: Ms Maggie and Her $5,000 Electric Wheelchair

6.      Medical Myths: Health Care in the United States is Market Based

7.      Overheard in the Medical Staff Lounge: Smoking Cessation Is Not an Insurable Coverage

8.      Voices of Medicine: Physician Opinions in Various Local and Regional Medical Journals and in the Press

9.      From the Physician Patient Bookshelf: HEALTHY COMPETITION - What’s Holding Back Health Care and How to Free itPart I: The State of America’s Health Care System

10.  Hippocrates & His Kin: I Wouldn’t Give You Two Cents for the Whole Bunch Of Them

11.  Related Organizations: Restoring Accountability in HealthCare, Government and Society

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The 3rd Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case study data. The 2006 conference will be held from April 17–19, 2006, in Washington, DC. For more information, visit

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1.      Featured Article: Social Security and the Insurance Illusion by Will Wilkinson

In 1937, shortly after Franklin Roosevelt threatened to destroy the independence of the Supreme Court by “packing” it with ideological cronies, the Court came to heel and handed down verdicts in three cases affirming that the Social Security Act was, unlike several structurally similar pieces of pre-intimidation New Deal legislation, in accord with the U.S. Constitution.

Wilbur Cohen, a ubiquitous figure in the history of Social Security, provides a window into the administration’s state of mind on the Court’s momentous decision. At the time of the ruling Cohen was an assistant to Social Security board chairman Robert Altmeyer and recalls gliding down the Supreme Court steps that day “in a glow of ecstasy. . . . When I got back to the office I received Mr. Altmeyer’s approval to send out a memo to the staff stating that because of the decision, we could now call the old age benefits program ‘old age insurance.’

Why? Because insurance sounds a lot better to voters than a tax and stream of welfare payments, which is what Social Security is. Because, as Cohen explained it, “The American public was and still is insurance-minded and opposed to welfare, the ‘dole’ and ‘handouts.’ ”The Brain Trust knew about the importance of “framing” decades before Berkeley linguist George Lakoff did.

The irony, or hypocrisy, of Cohen’s ecstatic rush to reframe is that, executive intimidation aside, the government won the Social Security Act cases by arguing that Social Security is not insurance, but just a plain old tax on wages, falling under Congress’s taxing power, and an entirely separate and unconnected welfare program, falling under the “general welfare” provision. The Act was scrupulously drafted to ensure that the tax and the government transfers would not appear to have anything to do with each other. And the program is never described therein as “insurance.” The 1960 Flemming v. Nestor decision reaffirms that paying the tax creates no entitlement to benefits.

Nevertheless, FDR pushed hard for a dedicated payroll tax specifically so it would be connected in voters’ minds to their benefits in the way the premiums are connected to insurance payments—to create the illusion of property, contract, and legal, moral, and political entitlement. As FDR infamously declared, the dedicated payroll taxes “are political all the way through. We put those payroll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions  . . .With those taxes in there, no damn politician can ever scrap my social security program.”

In anticipation of a constitutional challenge, Social Security officials went out of their way to purge their informational materials of insurance language. A 1937 pamphlet, written shortly before the Supreme Court decisions, described the program accurately and with a minimum of manipulative art: “The United States Government will send checks every month to retired workers . . . under the old-age benefits plan . . .The same law that provides these benefits for you and other workers sets up certain new taxes to be paid to the United States government.”

The 1938 pamphlet, published after the decisions, shows the insurance-framing project once again in full flower: “Your [Social Security] card shows that you have an insurance account with the U.S. Government—Federal old age and survivors insurance. This is a national insurance plan for all workers in commerce and industry . . .  [T]axes are like the premium on any other kind of insurance.”

From the program’s inception the lack of a legally binding entitlement to benefits was deliberately obscured. By framing the program as insurance, it was possible to make benefits seem earned rather than part of a socially stigmatized “dole.” Accordingly, during “fireside chats” and public speeches, Roosevelt told American workers that they have an “insurance policy” with the government, that “the insurance policy . . . is bought” with a payroll tax “premium” and is “far more favorable . . . than any policy that any private insurance company could afford to issue.” He told Congress that the “old-age insurance system” has created “individual accounts” for millions of workers who may be “likened to the policy holders of a private insurance company.”

Roosevelt’s framing strategy calls to mind an old story attributed to another formidable American president, Abraham Lincoln, that goes something like this:

Abe asks, “How many legs does a cow have?”

The bemused reply: “Four.”

“If we also call its tail a ‘leg’ how many legs does it have?”


“No, calling a tail a ‘leg’ doesn’t make it a leg!”

Nor does calling Social Security “insurance” make it insurance. Nevertheless, “To challenge the insurance analogy or resist using the terms,” writes Social Security scholar Martha Derthick, “was to show oneself an enemy of the program.” And this continues to be true today. Jonathan Chait of The New Republic writes, “Privatizers portray Social Security as a kind of low-performing 401(k) plan. But the program was never intended as a personal retirement plan. It’s a form of social insurance, designed to spread risks throughout the population.” But is it really? Is Social Security a leg because we call it a leg? Let us challenge the insurance analogy and risk showing ourselves as enemies of the program.

To read the entire article, including substantiating references, please go to

Government is the great fiction, through which everybody endeavors to live at the expense of everybody else.

-- Frederic Bastiat, French Economist (1801-1850)

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2.      In The News: The Impending Global Flu Pandemic – Will It Kill 50 Million This Time?

A Deadly Race With Bird Flu by Dr Charles Krauthammer, Columnist

WASHINGTON — While official Washington has been poring over Harriet Miers’ long-ago doings on the Dallas City Council and parsing the Byzantine comings and goings of the Fitzgerald grand jury, relatively unnoticed was perhaps the most momentous event of our lifetime — what is left of it, as I shall explain. It was announced last week that American scientists have just created a living, killing copy of the 1918 “Spanish” flu.

This is big. Very big.

First, it is a scientific achievement of staggering proportions. The Spanish flu has not been seen on this blue planet for 85 years. Its re-creation is a story of enterprise, ingenuity, serendipity, hard work and sheer brilliance. It involves finding deep in the bowels of a military hospital in Washington a couple of tissue samples from the lungs of soldiers who died in 1918 (in an autopsy collection first ordered into existence by Abraham Lincoln), and the disinterment of an Alaskan Eskimo who died of the flu and whose remains had been preserved by the permafrost.

Then, using slicing and dicing techniques only Michael Crichton could imagine, they pulled off a microbiological Jurassic Park: the first ever resurrection of an ancient pathogen. And not just any ancient pathogen, explained virologist Eddie Holmes, but “the agent of the most important disease pandemic in human history.”

Which brings us to the second element of this story: Beyond the brilliance lies the sheer terror. We have quite literally brought back to life an agent of near-biblical destruction. It killed more people in six months than were killed in the four years of the First World War. It killed more humans than any other disease of similar duration in the history of the world, says Alfred W. Crosby, who wrote a history of the 1918 pandemic. And, notes The New Scientist, when the re-created virus was given to mice in heavily quarantined laboratories in Atlanta, it killed the mice more quickly than any other flu virus ever tested.

Now that I have your attention, consider, with appropriate trepidation, the third element of this story: What to do with this knowledge? Not only has the virus been physically re-created. But its entire genome has now been published for the whole world, good people and very bad, to see. The decision to publish was a very close and terrifying call.

On the one hand, we need the knowledge disseminated. We’ve learned from this research that the 1918 flu was bird flu, “the most bird-like of all mammalian flu viruses,” says Jeffery Taubenberger, lead researcher in unraveling the genome. There is a bird flu epidemic right now in Asia that has infected 117 people and killed 60. It has already developed a few of the genomic changes that permit transmission to humans. Therefore, you want to put out the knowledge of the structure of the 1918 flu, which made the full jump from birds to humans, so that every researcher in the world can start looking for ways to anticipate, monitor, prevent and counteract similar changes in today’s bird flu.

We are essentially in a life-and-death race with the bird flu. Can we figure out how to pre-empt it before it figures out how to evolve into a transmittable form with 1918 lethality that will decimate humanity? To run that race we need the genetic sequence universally known — not just to inform and guide but to galvanize new research.

On the other hand, resurrection of the virus and publication of its structure opens the gates of hell. Anybody, bad guys included, can now create it. . . .

One batch of 1918 flu has the capacity for mass destruction that no Bond villain could ever dream of. Why try to steal loose nukes in Russia? A nuke can only destroy a city. The flu virus, properly evolved, is potentially a destroyer of civilizations.

We might have just given it to our enemies.

Have a nice day.

Charles Krauthammer’s column appears Monday on editorial pages of The Times. His e-mail address is

To read the entire column, please go to

Kid Power: Let’s Use It to Fight the Flu. By David Dobbs, Medical Examiner, Oct. 11, 2005

More than 10 million older Americans traveled last year, often in lousy weather, to stand in long lines and get poked in the arm with a flu shot. They made the trip in response to recommendations by the federal government that gave priority for flu vaccines to the elderly and the ailing. This, it turns out, is probably a bad idea. A Harvard study published last week adds to mounting evidence that the best way to ward off the flu’s ravages is to target transmission (meaning a disease’s main carriers, which in this case are kids) rather than risk (meaning the population at risk of death or serious illness, which with the flu is the old, the ailing, and infants). All signs are that giving children quick, painless nasal-spray vaccines while they’re already gathered at school could spare the elderly from standing in long lines for flu shots—and better protect them and everyone else.

The 60,000 deaths in the United States from ordinary flu each year are reason enough to consider changing the country’s approach to flu vaccination. Fighting the flu efficiently is all the more important in light of growing fears about an avian flu pandemic. Last week, researchers broke the genetic code of the killer 1918 Spanish flu epidemic and showed that it in some ways resembles the current bird-flu virus stalking Asia. If, as many experts fear, today’s avian flu makes a jump to human-to-human transmission like the Spanish flu did, quickly dosing key populations with vaccines or antivirals will be crucial to preventing or containing a pandemic. Yet as anyone who queued up last year for a flu shot knows—and as the draft of the Bush administration’s plan for controlling a flu pandemic that leaked last week makes doubly clear—the current system can’t handle the job.

Here’s why it makes sense to set up a better system based on vaccinating kids instead of the sick and the old. Because the human immune system weakens with age, only 28 percent of elderly people who get vaccinated develop immunity. The low rate of protection means that 84 percent of all elderly (the 72 percent whose vaccinations don’t take, along with those who don’t get vaccinated) remain prey to a flu virus that runs otherwise largely unchecked.

This vulnerability, combined with the aging of the population, has caused the nation’s overall flu death rate to rise 400 percent even as we vaccinate more of the elderly. (Click here for more numbers.) The Harvard study published last week, meanwhile, demonstrates why it makes more sense to vaccinate kids. The researchers confirmed that the flu spreads primarily via toddlers and school children, whose immature immune systems are easily infected and who have lousy hygiene. Kids often don’t wipe their noses, wash their hands, or cover their mouths when they sneeze or cough, and they touch everything. That’s why they catch the flu twice as often as and much earlier in the season than older people do. For an airborne virus, kids are the conduit of choice.

Fortunately, though, kids are also the conduit most easily blocked. Their immune systems respond wonderfully to flu vaccine. A whopping 90 percent are successfully immunized by a flu shot, compared to the 28 percent figure for the elderly and 60 percent for middle-aged adults. Kids’ 90 percent success rate has been used to set up viral roadblocks high and wide enough to increase protection for whole populations. In the late 1960s, for instance, University of Michigan researchers vaccinated 85 percent of the schoolchildren in Tecumseh, Mich. The program reduced flu cases by two-thirds. In the late 1990s, a Baylor College of Medicine study vaccinated just 25 percent of 18-month to 18-year-olds in Temple, Texas, every year for three years. Adult flu cases dropped 8 percent to 18 percent.

Then there’s Japan. Following a devastating 1957 epidemic, Japan in 1963 established mandatory childhood flu immunization. By 1970 the country was vaccinating 50 percent to 85 percent of schoolchildren annually. Between that year and 1987, flu-related deaths fell 40 percent, saving 40,000 lives a year. This drop occurred even though Japan’s elderly population almost doubled during that period. When the country phased out mandatory vaccinations for kids beginning in 1987, flu deaths in every age group started rising and have continued doing so ever since . . .

Establishing a national child-based flu-vaccination system would also create an asset we lack—a simple, familiar, and effective way to distribute and administer vaccines or antivirals if a flu pandemic strikes. The recent analysis of the 1918 flu’s genetic code greatly increases virologists’ chances of developing a vaccine or antiviral drug that could check a pandemic arising from the avian flu now brewing in Asia. But because bird flu spreads quickly, with people contagious before they’re symptomatic, a pandemic can be stopped only if public health officials can quickly get the drugs to key parts of the population. Our present ad hoc system can’t do this. A school-based system could.


In the mid-1970s, only 25 percent of the country’s elderly were vaccinated; the current rate is 65 percent. Yet over that same period, total U.S. flu deaths rose 400 percent. The main reason is that the elderly population as a whole—those 65 and over—grew 52 percent and the “elderly elderly”—people 85 and over—doubled. The very old are particularly unresponsive to vaccine and particularly likely to die from the flu: An 85-year-old, for example, is 16 times as likely to die as a 65-year-old.

David Dobbs, author of Reef Madness, writes on science, medicine, and culture.

To read the a
rticle, see the URL:

Vaccination Is The Medical Sacrament Corresponding To Baptism

--Samuel Butler (1835-1902) English author, Samuel Butler’s Notebooks (1951)

To see the global spread of bird flu, see these URLs:

How bird flu has spread:

Health risks from bird flu:

1918 killer flu ‘came from birds:’

The bird flu that killed 40 million:

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3.      International Medicine: Antigua and the American Health Care Refugee

Dr John Eck Chronicles the Event That Will Result in Bringing a New Concept in Health Care to the Caribbean Island of Antigua, Wednesday, September 21, 2005.

One afternoon ten years ago I was confronted with a medical dilemma. A sixty-year-old unemployed nuclear physicist presented in my office with sharp abdominal pain. I could see in his eyes that the pain was also associated with considerable fear and a sense of desperation. You see, he had entered into that most vulnerable world of the uninsured, unemployed, with home ownership. As an older male with assets, he could not qualify for welfare, nor would Medicare be of assistance. His company had left him exposed without medical benefits at the very time in his life when he needed them the most.

The fear etched on his face was well founded. While his diagnosis was fairly benign involving bilateral inguinal hernias and a peptic ulcer, the cost of such care became the real issue. I naively suggested that he call different hospitals to get a quote of what a hernia repair would cost. After much calling, being placed on hold, being told that the cost depended on which insurance he had, etc; He was finally given a figure of $14,000, not including surgeon’s fee or anesthesia.

With his head bowed, and with resignation he assumed the worst. The total bill would come to $20,000, requiring a lean on his house and a mortgage he could not afford. Looking for a cure for this economic dilemma became more of a challenge than the surgery! It occurred to me that I had just spent some time in a mission hospital in Ecuador working with US medical missionaries. Why couldn’t they do the same for my patient? After some phone calls, the arrangements were made, and my patient flew down to Quito where he had bilateral hernias repaired as well as having an upper endoscopic exam for the treatment of his peptic ulcer.

He returned . . . a month later, with a tan and very relaxed. The surgery had gone well. The ulcer had been treated, and he had spent 4 extra weeks in a resort recuperating and catching some sun. The total cost had been $2,400 including air fare. He was pleased and I was elated. I had found a possible solution to caring for the uninsured. However, before I could send my next patient down, I received a letter from the hospital surgeons requesting that I no longer plan such referrals. They had the impression that American doctors could still be sued in the states for work done overseas! While I thought that they were probably overreacting. I stopped. The idea stuck, however!

To read the entire address, as well as peruse a number of other heart warming health care studies, please go to

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4.      Medicare Reform: Pharmacy Benefit ProgramWhat Must Be DoneA Clinician’s Point of View by Del Meyer, MD

The varying estimates on the Medicare Pharmacy Benefit Program only reveal the hazards of projecting any entitlement program. Once implemented, all government programs increase and the costs are nearly impossible to control. The additional costs to the Medicare Program are not sustainable—even in the short term. Therefore, it is urgent that the program be modified before enrollment starts in a few months.

When Medicare was implemented in 1965, there was a nominal deductible on hospital and outpatient benefits, with an additional copayment of 20 percent for all physician and outpatient services. Had the deductibles and the copayment remained a responsibility of the patient, Medicare would not have experienced a spiral increase, as is the case today. For instance, if every $80 doctor’s office visit required a 20 percent or $16 copayment, only necessary office visits would be made. The copayment, a market restraint, would control utilization and thus costs. Oversight programs to watch and control every Medicare expense would not be necessary. External controls are never patient sensitive; while they reduce one patient’s excessive costs, they also eliminate another patient’s critical test for diagnosis or treatment.

Unfortunately, the insurance industry came to the “rescue” and provided coverage for the deductibles and copayment. This totally removed Medicare from the Medical MarketPlace environment. When patients pay for expensive health care with taxpayers’ dollars, there is no longer a disincentive to overuse. The lack of market-based discipline increases utilization dramatically and costs continue to spiral upwards.

The increase in cost includes the additional amount needed to pay the Medicare or Medicare-HMO nurse to review the records and report her findings to her supervisor. It also includes the supervisor’s salary, as well as the government bureaucrat’s who receive the data. If the doctor is paid $100 an hour for delivering the medical care, and the “policing” nurse is paid $30 an hour to evaluate and report that care (with every level of oversight at a probable higher cost), the increase is at least 30 percent if the RN and the team spend as much time reviewing the clinical record as the doctor spends in developing the clinical record. The market environment eliminates this increased cost.

But demands for expensive x-ray and laboratory testing, which were relatively free, exceeded a physician’s ability to modify patients’ avaricious appetite. Controls were placed on spending with some services being denied while others were curtailed. Patients threatened to report physicians to Medicare, and actually were encouraged to do so, if they felt they were not receiving the testing they desired. In Congress, a constituent’s desire is presumed to be a dire medical need. Thus, even the imposed controls were difficult to enforce.

If patients were required to pay the 20 percent copayment of all outpatient health care, the initial design of the Medicare law, they would evaluate every physician office visit, laboratory test, x-ray, CT, MRI, emergency room visit, urgent care visit and consultation on a cost-benefit basis. They would decide whether it was worth the 20 percent of an $80 office call to obtain their doctor’s opinion on a sneeze. They would also openly discuss with their physician whether it was worth 20 percent of a $170 chemistry panel, 20 percent of a $120 x-ray, 20 percent of a $300 CT scan, 20 percent of a $900 MRI, 20 percent of every $600 emergency room visit, or 20 percent of every $200 consultation for the additional information they could reasonably expect to obtain. (These estimates are based on data provided by patients or their HMOs.) This is the essence of consumer- or patient-driven health care in which the patient seeks the best cost-effective health care in consultation with his or her doctor.

So, how do we move forward to a point where we’ve previously been - at the inception of Medicare in 1965? By utilizing the Pharmacy Benefit fiasco as the carrot. All Medicare recipients that give up their MediGap insurance and thus pay for their own deductibles and copayments, would receive an unlimited pharmacy benefit at a 30 percent copayment. This would be self-policing by the Medical MarketPlace. Suppose a patient has a high cholesterol level. The physician then discusses the ways of reducing it. Many patients have not seriously considered low cholesterol and low fat diets or inexpensive Niacin, as long as the Statin drugs (Lipitor, Zocor, and others) are free. (Fixed copayments of $5 to $50 are irrelevant in restoring market restraint.) As pharmacy restrictions were imposed, patients demanded that their physicians write letters on their behalf illustrating how their circumstances were unique and that generic drugs never work for them. It takes additional physician and office personnel time to work out the variances in MediGap or Medicare-HMO coverage, as well as patient desires.

However, with a 30 percent insurance copayment plan, the cost savings would be large. It would streamline not only physician office time but also pharmacy time, and it would improve patient satisfaction. The physician would simply write the prescription. The patient would deal directly with the pharmacist concerning the desirability of the proprietary or the generic brand. The patient makes his decision immediately and does not have to wait or return to the pharmacy after the pharmacist and doctor discuss the various Medicare-HMO coverage options for that particular plan, which cannot be ascertained until the patient’s coverage card is entered into the HMO network. These market-based decisions also eliminate any Medicare oversight for pharmacy benefits.

So how does this market-based, cost-containment oversight occur? Why wouldn’t everyone obtain the expensive proprietary drugs? To read the entire OpEd piece, please to go to

In Summary: Reinstate the annual deductibles and the 20 percent copayment for all outpatient Medicare benefits. Eliminate Medicare-HMO or MediGap insurance for those beneficiaries that desire a pharmaceutical benefit at 30 percent copayment. (Since many Medicare-HMOs are leaving certain geographic areas, this should be politically possible to implement.) Cancel the current Medicare Drug Benefit Program before it’s implemented in 2006 and over the next decade save the $720 billion (or $1.2 trillion by other projections). This will save Medicare for our grandchildren also.

To review some of the other Hippocrates Columns, please go to

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Ms Maggie and Her $5,000 Electric Wheelchair

Ms Maggie is a delightful elderly lady who is succumbing to her lifelong cigarette habit. Over the past decade, she became increasingly short of breath. She has been on continuous oxygen for about five years. When she comes in on oxygen, her arterial oxygen saturation is in the range of 80 percent. (The hemoglobin is normally about 97 percent saturated with oxygen as it leaves the lungs and returns back to the heart and lungs at 75 percent saturation.) When we take the oxygen off for 15 minutes, the hemoglobin oxygen saturation falls to 72 percent, appearing bluer than the venous blood in the normal individual.

One day, her family asked us to write a durable medical equipment prescription (DME) for an electric wheelchair. She normally came in with her usual wheelchair, pushed by her granddaughter. After discussing her ability to drive a motorized wheelchair, we decided that it would be hazardous for her in her weakened and frail condition to drive an approximate 300-400 pound powered vehicle.

So I was surprised when she came in last week in a brand new $5,000 electric wheelchair, about the size of a golf cart. She had great difficulty navigating it. The Para-Transit driver had to help her drive it into my office. It would barely fit through my doors and hallways. After the visit, Para-Transit could not come for an hour. So she had her family pick her up and asked Para-Transit to pick up her motorized wheelchair from our office after the weekend.

She was very evasive as to where she obtained the motorized vehicle and who authorized it. A former home health aid confidentially mentioned to me that many in the home health agency feel that doctors are too concerned about health care costs and just don’t understand the dire needs of their patients. So, it would seem that home care workers manipulate the system to sell DME items, and unless there is a detailed audit, no one will ever understand this diversion of taxpayer’s funds.

It is unfortunate that the physician, who holds the key to reducing health care costs, has been maligned as the person responsible for hugely expanding health care costs. Conservative estimates indicate that the cost of controlling physicians who write health care orders exceeds 10 percent of all health care costs, or about $175 billion. If we eliminate this bureaucracy, and place health care in a market environment, where the minimum copayment on the expensive items is 10 percent with a progressively greater copayment on outpatient health care, the United States would easily save more than twice that amount, 20 percent or $350 billion in health care expenditures. Patients with a significant percentage copayment will monitor utilization more effectively and sensitively than any oversight program. We would all be enjoying working again as health care workers in an open market place without restrictive controls. Micromanagement of health care is never cost effective. It will always be cost excessive.

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6.      Medical Myths: Health Care in the United States is Market Based

The editor of Superfactory,, who features Lean Manufacturing and favors us with articles on Lean HealthCare, tells about his interface with health care in Michigan and warns us:  Don't Forget Who Your Customer Is.

To review his blog on Lean Healthcare & Clinical Excellence and my response, please go to

Medical Reality: Health Care in the United States is more regimented by government and HMO bureaucracy than in socialized countries – the very opposite of Market Based and Lean Health Care.

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7.      Overheard in the Medical Staff Lounge: Smoking Cessation is Not an Insurable Coverage

Dr Patricia: Smoking cessation was proposed as a mandate for insurance coverage in California. This shows how much legislators know about medicine, health care, motivation and even what is insurable.

Dr Michelle: As the country is moving towards making health insurance more like real insurance to cover costly and catastrophic items that we would not be able to pay for should they occur to us, such as hospitalizations, heart attacks, strokes, or major operations, the people that should really know better are pushing for more and more mandates.  California already has more insurance mandates than any other state at 48. The average mandate adds $35 to the health insurance premium. Mandates only make health insurance less affordable, increasing the number of uninsured.

Dr Patricia: Cigarette withdrawal programs do not have a huge success rate. And without any personal financial commitment, the success rate would be even less. I remember when I had a smoking cessation clinic; one of my patients told me she wouldn’t come because I was too serious about patients stopping smoking. She was going to the Smoke Enders Clinic where you didn’t have to stop smoking.

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8.      Voices of Medicine: Physician Opinions in Various Local and Regional Medical Journals and in the Press

Home News Tribune Online 10/20/05 by Alieta Eck, MD, Piscataway [NJ]

What if tree bark were being studied for cures for cancer and paralysis, and it was found that green tree bark had already yielded 100 cures and productive uses. Blue tree bark yielded no cures or good uses, but instead led to dangerous tumors in research mice. Where would you put your future research dollars?

What if the private research sector has already abandoned blue tree bark research, but there was a politician who endorsed a plan to issue bonds to borrow $300 million to continue to study blue tree bark, promising that the money will be paid off in the dollars earned from future cures. Would you vote for him? Is that a wise use of tax dollars?

While smart money is going for the green tree bark why would any public official push for money to research blue tree bark?

Now let’s get real. Non-embryonic or “adult” stem-cell research has already yielded 65 known uses and cures, while embryonic stem-cell research has yielded none, nada, zilch. In fact, when researchers have attempted to harness the growth of embryonic stem cells, they have failed, and 30 percent of the attempts in mice have led to dangerous tumors.

Yet Jon Corzine, candidate for governor, is pushing the plan to borrow $300 million to fund more embryonic stem-cell research. What is he thinking? This is money the taxpayers will have to pay back — and money that will not likely result in any return on investment.

Jon Corzine has put his weight behind embryonic stem cells. Has he personally researched this issue, or is he is responding to the hype of the media and the relentless push for the controversial and dangerous use of embryos? We need to ask him.

Read more:



From Sonoma Medicine, The Magazine of the Sonoma County Medical Association. Editorial: On Remembering by Rick Flinders, MD

I recently returned from backpacking solo down the Grand Canyon of the Tuolumne River. Going alone was not my first choice, but my usual trail companions were impeded by other commitments, and cancellation was not an option for me. My departure was accompanied by a chorus of grim adjectives, including dangerous, foolhardy, and stupid. To top things off, a dear friend of mine, with whom I share the same age and the same relative absence of coronary risk factors, had lately experienced an acute MI on a remote mountain in the Mexican wilderness.

Perhaps I was a little defensive as I composed in my journal a list of 10 reasons why a rational man would persist in hiking alone on an unfamiliar trail. It was a good list. But on my third day, surrounded by beautiful undiscovered wilderness, I threw away my list and wrote, “All those reasons are just earnest blabber. You don’t really know why you do this until you do it. And then you REMEMBER.”

How do you describe the memory of a place you’ve never been before? Where in our neuronal circuitry does a new experience register itself as familiar? I don’t know. And if I did once know the molecular neurochemistry of memory, I’ve since forgotten it. I am among a generation of aging baby boomers about to enter its seventh decade. Enjoying unprecedented longevity, we are also hip to the prospect of living long enough to forget who we are. Is this what we asked for?

Alzheimer’s disease, the most common form of dementia, now affects over 4 million Americans, a number projected to double in the next 20 years. There is no cure. There is little effective treatment. We know the pathology, but we don’t know its cause. We don’t know if Alzheimer’s is preventable or if it’s an inexorable consequence of aging among those at genetic risk.

The mystery of memory goes far beyond the pathology of dementia. To paraphrase Buddha, “All that we are is the result of what we have thought.” For our conscious selves, his insight might be amended to, “All that we are is what we remember . . ."

When I was backpacking, I seemed to “remember” the surrounding wilderness, even though I had never seen it. I’ll stand by the validity of that memory but remain helpless to explain it. T.S. Eliot, in the last of his Four Quartets, offers a poetic glimpse far more eloquent than any explanation I can imagine:

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.

To read the entire article, please go to

Dr. Flinders, who serves on the SCMA editorial board, has taught full-time in Sutter’s Family Practice Residency Program for the past 20 years.



From the Southern California Physician

Nine tips guide you to appropriate, affordable personal insurance policies.

Your personal insurance needs are unique to your chosen profession—and they’re probably changing right before your eyes. But you may not even be aware of it. Here’s what you need to know today to make sure you’re adequately covered. Russell A. Jackson












The same way you send a patient to a specialist for specific medical needs, you should consult with an insurance specialist to help with asset protection. “You really need the advice of a professional,” Norman says, “especially if you have other businesses or other assets to protect. An agent or broker can help pick appropriate deductibles and can help you devise a personal risk management approach to dealing with protecting your assets.”


To read any of the nine topics, please go to

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9.      Book Review: HEALTHY COMPETITION - What’s Holding Back Health Care and How to Free it by Michael F Cannon & Michael D Tanner, Cato Institute Washington, DC © 2005, ISBN 1-930865-81-3, 173 pp, $10. 

Part I: The State of America’s Health Care System

Many critics of free markets conclude America’s health care system demonstrates that free markets are an inferior way of providing medical care. Though inaccurate, this misperception is based on a partial truth. More than any other developed nation, America relies on private institutions and market mechanisms to deliver medical care. The harmful effects of government influence are significant, yet the successes of America’s relatively market-oriented approach to health care bear mentioning.


By many measures, the United States has the finest health care system in the world. Most of the world’s top doctors, hospitals, and research facilities are located in the United States. In the past 10 years, 14 of 25 recipients of the Nobel Prize for Medicine have been U.S. citizens. Four more practice in the United States. American research and development, particularly in the pharmaceutical field, has produced the majority of medical breakthroughs over the past 50 years. Of the 152 major medicines introduced worldwide over the past 20 years, U.S. companies developed nearly half. Eight of the ten top-selling drugs worldwide in 2002 were produced by U.S. firms; and Americans played a key role in eight of the ten most important medical advances in the past 30 years. Nearly every type of advanced medical technology or procedure is more abundant in the United States than anywhere else in the world. If you are diagnosed with a significant illness, the United States is the place you want to be. For example, cancer patients are less likely to die from the disease in the United States than in other countries. The United States also seems to fare well in comparison to other nations when it comes to treating heart attacks and lung cancer.

It should come as no surprise, then, that patients all over the world seeking advanced medical care come to the United States for treatment. One U.S. hospital alone, the Mayo Clinic, treats roughly 7,200 foreigners every year. Johns Hopkins University Medical Center treats more than 6,000. Nearly one-third of Canada’s doctors have sent a patient abroad for treatment, often to the United States, and Canadian governments and patients spend more than $1 billion every year on medical care in the United States.

Common Misperceptions

It is important first to refine the critique by examining the first part of this myth: that spending more than other nations is in itself undesirable. In fact, high levels of medical spending are often a good thing. The second half of this myth—that other nation’s health care systems outperform America’s—is also worth debunking.

Is Spending More Necessarily Bad?

The United States has, by far, the most expensive health care system in the world, whether measured as a percentage of gross domestic product (GDP) or as expenditure per capita. As a percentage of GDP, U.S. health care spending (15.5 percent) is nearly six percentage points higher than the average of other industrialized countries (Figure 1.3). Overall health care costs have outpaced GDP growth by more than four percentage points, on average, in the last five years and now total $1.8 trillion per year, more than was spent on housing, food, national defense, or automobiles. . . .

Mark McClellan and Harvard University economist David M. Cutler posit that the benefits of technological advances overwhelm the added costs. They estimate that advances in technology meant that every additional dollar spent on treating heart attacks in the 1980s yielded the equivalent of $7 worth of increased longevity and quality of life . . .

Jones estimates that between one-half and three quarters of the growth in medical care expenditures from 1960 to 1997 was due to medical advances that enabled patients to get more per dollar spent. ‘‘Technology often leads to more spending,’’ Cutler and McClellan write, ‘‘but outcomes improve by even more.’’

While all countries can benefit from research and development expenditures made by a single country, only the health expenditures in the innovating country will include the costs of research and development. Health expenditures in non-innovating countries will exclude the research and development costs.’’

Does the US Spend More but Get Less?

The most important factor in evaluating how much a nation spends on medical care is whether it gets its money’s worth. Critics of the U.S. health care system point out that despite large expenditures America does not compare well with other nations on such measures as life expectancy or infant mortality. For example, the Organization for Economic Cooperation and Development (OECD) reports that the United States ranks below most other industrialized nations in infant mortality.

A more useful comparison of different health care systems is how well they cope with the same problem, such as infants of a given birth weight. Nicholas Eberstadt of the American Enterprise Institute notes that controlling for birth weight shows that the United States does a better job than other nations. ‘‘By comparison with other Western societies enjoying especially low rates of infant mortality, U.S. babies at any given birth weight appear to have unusually good chances of surviving the perinatal period, regardless of race,’’ Eberstadt writes. ‘‘All other things being equal, this would seem to suggest that medical care for infants in the United States is actually rather better than in some other advanced industrial societies.’’

Clearly, there are variables other than health-care spending that determine infant mortality rates and life expectancy, including genetic attributes, nutrition, and how nations spend their health care dollars. A better measure of a nation’s health care system is how it performs when confronted with particular medical challenges. As noted earlier with regard to cancer patients and low-birth-weight infants, evidence exists that the United States outperforms other nations.

Real Problems

Costs: Health insurance has become increasingly burdensome for employers and consumers alike.

Perhaps more troublesome is the obligation of government health programs. Medicare is the federal program that provides health care subsidies to the elderly and disabled. Medicaid is a joint federal state program of health care for the indigent. Each program places a large and growing burden on taxpayers. In 2004, the federal government spent a combined $473 billion on Medicare and Medicaid (not including the State Children’s Health Insurance Program, a Medicaid offshoot). That is more than Congress spent on national defense ($454 billion). When state Medicaid spending is included, these two programs cost taxpayers an estimated $606 billion in 2004, nearly one-quarter more than Social Security ($492 billion) (see Figure 2.1). According to the Congressional Budget Office, Medicare spending will double from the 2005 levels in eight years and federal Medicaid spending will nearly double in nine years. If current trends continue, Medicare and Medicaid alone will consume 11 percent of GDP by 2030.

The benefits promised to future Medicare beneficiaries under current law far exceed the capacity of existing revenue sources to meet those promises. If the federal government were to deposit funds in an interest-bearing account to cover all of Medicare’s future deficits, the amount it would have to deposit in 2005 would be $68.4 trillion. That amount is almost 70 percent larger than the combined GDPs of all the nations on earth, and more than five times the size of the U.S. GDP and the amount required to cover Social Security’s shortfalls.

Quality: It is true that errors and even preventable deaths occur in U.S. hospitals. Recent studies suggest that many medical errors come from overworked interns and overwhelmed pharmacists.  Thousands of preventable injuries and deaths may be due to unnecessary procedures. America is not unique in this regard. A study of medical errors in Canada estimated that between 9,250 and 23,750 Canadian patients die every year following a medical error—the equivalent of 83,000 to 214,000 deaths in a country the size of the United States. Patient surveys suggest similar numbers of medical errors in both countries. Hospitals in a number of Canadian provinces have struggled with repeated incidences of deadly infections.

Medical errors will continue to occur as long as and wherever humans practice medicine. When addressing the quality of medical care in the United States, policymakers should begin with a clear understanding of the extent of the problem and the role that competition plays in promoting quality.

Bureaucracy: Medical errors will continue to occur as long as and wherever humans practice medicine. When addressing the quality of medical care in the United States, policymakers should begin with a clear understanding of the extent of the problem and the role that competition plays in promoting quality.

Next month, Part II: Misdiagnosis

To read the rest of Part I – The State of America’s Health Care, please go to the Cato Bookstore:

To read some of the other book reviews that are available, please go to

This will never be a civilized country until we expend more money for books than for chewing gum.       

–Elbert Hubbard

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10.  Hippocrates & His Kin: I Wouldn’t Give You Two Cents for the Whole Bunch Of Them

Feisty 85-Year-Old Local Actress, Golden Henning, a Hit in Political Ad

TV-watchers have likely caught the 30-second political ad on network and cable television depicting a disgruntled senior citizen standing in front of her house, shaking her cane and railing against California legislators. “I wouldn’t give you two cents for the whole bunch of ‘em!” she sneers.

Can we get a shot of her and her cane walking past Congress and record what she might say in DC?

Doctor, I Can’t Lose Weight, I Need to Eat More.

Sixty-nine-year-old Ruby came in for her annual pulmonary evaluation. Among other complaints, she was putting on weight. Her exam confirmed a 20-pound weight gain since her last evaluation. Ruby stated that the extra pounds were NOT from the food she was eating. "In fact," she said, "I have to eat 5 or 6 times a day because otherwise I wouldn't get enough."

Aren’t You Supposed to Drink a Lot Of Fluids?

A 43-year-old Pickwickian male with hypersomnolence and alveolar hypoventilation secondary to the 325-pound weight was being evaluated. I began a serious discussion on reducing his caloric intake, even if only 500 calories a day, which would equal one pound per week. After a few minutes, I noticed that his hand opposite from me was wrapped around a 64-ounce plastic container that he continued to consume. I asked him how many of these 2,000-calorie fast food milk shakes he drank per day. He said, "About six. Aren't we supposed to drink a lot of fluids?" This man drank 12,000 calories a day on his way to the table before he even counted the calories in his food.

Our Patients Can Monitor Their Glucose Better at Home Than Socialized Hospitals Can

A member of our Editorial Committee has diabetes and was hospitalized while visiting Florence. He states that he was better able to monitor his blood glucose with his American technology than the hospital could. So they let him measure his sugar with his portable American Glucometer.

As home health care devices become more sophisticated, socialized medicine in this country may be the quickest way to make hospitals irrelevant.

To read more vignettes, please go to  

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11.  Restoring Accountability in HealthCare, Government and Society:


                      The National Center for Policy Analysis, John C Goodman, PhD, President, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports. Be sure to read last week's report on VA medicine at

                      Pacific Research Institute, ( Sally Pipes, President and CEO, John Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at This month, be sure to read False Promise of Single-Payer Health Care: A Close Look Inside the California Health Security Act, by logging on at

                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center’s Government Accountability Project. This week, read and print out his Government Accountability Legislation Test that asks five questions - a simple and handy procedure for determining whether or not a proposed piece of legislation makes the grade for getting results.. These are worth scanning into your PDA:

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at Be sure to read her latest comments on Wal-Mart's announcement that it plans to offer Health Savings Accounts and other high-deductible health plans to its employees next year and calls it a win-win-win opportunity.

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to To join, go to 

                      The Heartland Institute,, publishes the Health Care News founded and edited by Conrad F Meier in 2001. Conrad passed on unexpectedly earlier this year. Be sure to get his latest book at the CAHI site below. This month, read Why Employer-Based Health Insurance is Unraveling by Devon M. Herrick.

                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman,Editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, be sure to read a modern classic on Global Capitalism: Curing Oppression and Poverty.

                      The Council for Affordable Health Insurance,, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America’s health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. “The belief that more medical care means better medical care is deeply entrenched. . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care–and may even make things worse.” This month, be sure to read How Guaranteed Issues and Community Ratings Destroyed the Individual Health Insurance Market in Eight States by Conrad F Meier. Bookflyer.pdf

                      The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or directly at This month, read the Commonwealth claim that most workers want their employers to choose their health plan and Greg Scandlen’s reality check.

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at  Read her latest news from the Health Policy Front at

                      The National Association of Health Underwriters, The NAHU’s Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page that gives you easy and direct access.

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, peruse the many excellent articles on several topics and savor two or three to improve your mind in the pursuit of freedom.

                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well-being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section at  Be sure to read last week’s News Release that provincial health care spending is unsustainable. Based on the most recent five-year trends, Medicare is on pace to consume more than half of total revenues from all sources in 7 of 10 provinces by the year 2022. For details, go to

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. Be sure to read last week’s research on the effect of state regulations on health insurance premiums.

                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we’ve seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at to obtain the foundation’s daily reports. Be sure to read last week’s article,, to understand why catastrophes in some countries are so much more devastating than in others. You may also log on to Lew’s premier free-market site at to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see; or to find out why anyone would want to be an MD today, see

                      CATO. The Cato Institute ( was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato’s Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens’ ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute’s Director of Health Policy Studies. Read his bio at Read a recent article on how supporters of government-run health care are trying to push all Americans into government health programs.

                      The Ethan Allen Institute,, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of “educating for liberty.” It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Dr Gilbert Meilaender’s article: C.S. Lewis on Moral Education. The last ten years of Imprimis are archived at

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Stay Tuned To The Medicaltuesday.Network And Have Your Friends Join In Also

Del Meyer

Del Meyer, MD, CEO & Founder

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

P. J. O’Rourke: When buying and selling are controlled by legislation, the first things to be bought and sold are legislatures.

Mark Twain, (1866): It could probably be shown by facts and figures that there is no distinctly native American criminal class except Congress.

Some Recent Postings

"Blackbox" by Gil Mileikowsky, MD:

Pharmacy Benefit Program by Del Meyer, MD:

Various Articles by James Murtagh, MD:


On This Infamous Date in History – November 8

Hitler’s beer hall putsch occurred on this date in 1923 when he and a group of semi-lunatics broke into a Munich beer hall in Germany and proclaimed a new government. Hitler had miscalculated the attitude of government and the people and a few days later Hitler fled, only to be arrested and sent to prison. Some people thought that was the end of Adolf Hitler. However, we cannot stop ideas—even the worst of them—by imprisonment. They can only be stopped by better ideas.

Franklin D Roosevelt was elected president on this date in 1932 and elected again and again and again. Whether liked or disliked, he was considered a politician par excellence. The progression of his programs, Social Security, Medicare, and now the Pharmacy Benefits Program continue to be the most hotly debated items on the national political scene as new ideas are being tested.