Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, November 11, 2003

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In This Issue:
1. Let’s Meet for Lunch, or How Does Government Really Work?
2. Canadian Drugs–Are They Safe?
3. Medicare Is Rationing Dialysis Treatments in the U.S.
4. Our Monthly Review of the Twenty Myths of National Health Insurance
5. Medical Gluttony or Excessive HealthCare Costs
6. The MedicalTuesday.Network for Restoring Accountability in HealthCare & Government

When Is a Meeting a Royal Hustle? Or How Does Government Really Work?
If the government took over health care, do we have examples of how government really works? Consider water, an even more basic need than medical care–without water, even health care becomes irrelevant. The Sacramento Bee had a recent editorial on "The Water Barons," a life inside California’s Hidden Government. It was approaching lunchtime in Gardena one fine day last March, and for a water district director there was money to be made and poker to be observed. He met up with a fellow water district director at the casino owned by porn mogul Jerry Flynt. The casino’s name–Hustler–was appropriate on more than one level. The director billed the lunch and tip to his West Basin Municipal Water District, the primary water provider to 185 square miles of the southern Los Angeles basin and its 17 cities.

The director also declared the lunch a “meeting.” That entitled him to a stipend of $176.08 for his troubles. Water districts pay their directors on a system that invites abuse. State law lets the districts pay their directors for up to 10 “meetings” a month. But what precisely is a meeting? The law doesn’t say. So a meeting can be just about anything a water district says it is.

After reviewing about 8,500 pages of director spending records from water districts outside the Sacramento area, the editor found that the practice is far from rare. The editorial mentions the following creative “meetings” in addition to lunching at Larry Flynt’s joint: attending a San Diego water art gala, chatting privately with the general manager, mingling with the Elks, attending Little League functions, picking up the phone at home and participating in a conference call on “water reuse,” networking inside the Democratic Party, doing Disneyland, doing the Las Vegas strip, and even talking with a fellow director.

In July 2002, a district director decided to go to the annual national conference of the Democratic Leadership Council. This took place in New York City and was a purely partisan affair. No one has been able to connect it to the water needs of ratepayers. The director charged the air fare, taxi fare and parking ($982), the hotel ($1,367) and meals ($758) to his district credit card. On the expense form line that says “per diem,” he declared that each day of his week in New York constituted a meeting, which amounted to seven meetings, at $171.52 each. Take-home pay from the Democratic conference: $1,200 cash plus $3,100 in perks.  This should be considered an abuse of California Water Code Section 20201, but it probably isn’t because of the loose definition of “meeting,”

For a meeting to be eligible for compensation, the editorial suggests one obvious yardstick: It is one that the public knows about and can attend. Lunch at Larry Flynt’s with a fellow hungry water director shouldn’t cut it.

Should doctors rethink their stand against single-payer or socialized medicine? Wouldn’t it be great to have a 40-hour work week instead of the 65 hours we average? Wouldn’t it solve the reimbursement problem by gouging the taxpayers an extra $4300 in benefits in one week for attending a convention that has nothing to do with helping patients? But there is one problem. All the doctors I bounced this off of said that they could neither neglect their patients nor their calling in life to such a degree.

Drug Re-Importation–Buyer Beware
Supporters of importation of pharmaceuticals from Canada claim that drugs that are good enough for Canadians are good enough for Americans. Many assume that Canadian Medicare makes cheaper drugs and so they should be able to obtain their prescriptions from Canada. But there are factors of which they may not be aware, says Merrill Matthews of the Institute for Policy Innovation:

    * Under Canadian law, a pharmaceutical wholesaler who isn't selling to Canadians isn't regulated by Health Canada, the agency that regulates prescription drugs.

    * They are, in essence, unregulated foreign mail drops that can sell to unsuspecting Americans drugs made anywhere in the world. The problem Americans face is how to tell the good pharmacies (and especially online pharmacies) from the bad ones–or more to the point, how to tell the good drugs from the bad ones.

The Food and Drug Administration has dramatically ramped up efforts to crack down on groups–which include organized crime and terrorists–involved in the production, sale and shipment of counterfeit drugs.

Medicare Is Rationing Dialysis Treatments
Medicare, the single-payer or socialized medicine plan for seniors in the U.S., is so expensive that it has begun rationing and developing waiting lists according to the NCPA Policy Digest.
o   Medicare pays for nearly all dialysis in the United States, regardless of the age of the patient, under a unique federal entitlement; the government spends more than $15 billion a year on dialysis and other treatment for kidney-failure patients.
o   Medicare does not pay for more than three treatments weekly, and because dialysis is covered by Medicare, most private insurers don't cover it.
o   The National Institutes of Health is planning a study on more intensive dialysis therapy, but the results won't be known until 2008.
o   Meanwhile, there are growing waiting lists at the few centers that offer the intensive dialysis treatment.
o   In 2001, the 292,000 people on dialysis, plus another 14,000 who had received a transplanted kidney, accounted for 6.4 percent of Medicare's $242 billion budget–although they represented about 1 percent of Medicare's enrollees. (640% excess cost)
Of 100 Americans on dialysis today, 23, on average, will be dead a year from now -- a worse mortality rate than breast or colon cancer.  About a third survive five or more years.

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National HealthCare Systems in the English-speaking World (No 19)
In his recent update of the “Twenty Myths about National Health Insurance,” John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), states that ordinary citizens lack an understanding of the defects of national health insurance and all too often have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information in the form of rebuttal to commonly held myths. See previous issues or the archives at www.medicaltuesday.net for the summary of the first eighteen myths or http://www.ncpa.org/studies/s166/s166.html for the complete 21 chapters of the book along with the well annotated references.

Myth Nineteen: Single-Payer Health Insurance Would Be Popular in the United States.
This notion is based largely on the assumption that it is popular in other countries. However, although there is hardly a clamoring in other countries to implement an American-style system, there appears to be a growing concern that the basic public health care model is failing. For example, between 1987 and 1997 the proportion of Canadians who were satisfied with their health care system dropped from 56 percent to 20 percent. In Britain, the sad state of the National Health Service has been a major campaign issue - with reports of long waits, low standards of care and even outright abuse appearing often in the British press.

However, even if socialized medicine were as popular elsewhere as its advocates assert, it would be unlikely to gain wide acceptance in the United States for one important reason: Americans are accustomed to a level of health care that socialized medical systems cannot provide.

Precisely because the U.S. medical market is largely private, Americans of every social rank are aware of the advanced state of medical technology that exists and have come to expect access to life-saving equipment and procedures. Having witnessed the efficacy of private medicine in improving lives, Americans are conditioned to expect immediate delivery of all that medical science has to offer if life or limb is threatened. When Americans were asked to agree or disagree with the statement “system needs completely rebuilt,” almost three of four insured individuals disagreed. More shocking is forty-one percent of uninsured individuals also disagreed with the statement.

Only a small percentage of Americans are dissatisfied with their family’s care. Moreover, satisfaction often has much to do with perceptions, even if erroneous. A recent survey was unique because it tracked those people who were unaware of their true insurance status. People who thought they were HMO members (even if they were not) were more likely to list themselves as dissatisfied than those who thought they were not in an HMO (even though they were).

“Don’t push me around” is a distinctively American phrase. In the United States we have widespread access to information about modern medical technology. In the age of the Internet, people are demanding far greater say in their treatment decisions. We also have a legal system that protects the rights of those without political power or money, and a strong devotion to basic rights of due process. Single-payer systems of national health insurance, as it operates in other countries, simply would not survive in the U.S. cultural and legal system.

Medical Gluttony
In this section, we cite examples of excessive health care costs and cases of Medical Gluttony. This section has had the largest reader response of any part of this newsletter. We thank all that have responded and appreciate additional anecdotes of Medical Gluttony. This week we cite the expense of overcoming an HMO’s resistance to needed care. We had a patient whose husband called stating that our patient was on the verge of committing suicide. What should he do? Because of government mandated programs, psychiatric wards have left general hospitals and become free-standing psychiatric “hospitals.” Patients can no longer be seen in the emergency rooms, stabilized, then transferred to the psychiatric ward of the hospital because they no longer exist. Being outside of the mainstream of health care, psychiatry has become less accessible. My staff called the patient’s insurance carrier to obtain authorization for psychiatric care which was summarily declined. We spent another 20 minutes on the telephone before emergency psychiatric help could be found. This maneuvering by insurance carriers to avoid payment for required medical services and secondary demands on office overhead expenses add up over time to a significant cost which cannot be recaptured. This has also led many practices to a cash-only basis, declining any dealings with insurance carriers. Several clinics that have said goodbye to insurance companies have estimated more than a 30 percent decrease in office costs, which they have then passed on to the patient by reducing charges by 30 percent. Paradoxically many of these practices have reported an increase in income. Many patients are recognizing that it’s cheaper to pay two-thirds of the usual office charges in cash and just have high deductible major medical insurance at less than a third the price of their present policies.

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MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:

The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Devon Herrick wrote Twenty Myths about Single-Payer Health Insurance which we review in this newsletter monthly, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports. This week be sure to read where the uninsured come from. The percentage of large companies that offer benefits has actually increased slightly, to more than 99 percent in recent years, according to U.S. Government survey data. However, between 1987 and 2001, the percentage of uninsured workers in large companies has increased to 11 percent from 7 percent. In order to control costs, fewer companies are offering benefits for part-time employees and more companies have raised eligibility standards. Read the report at http://www.ncpa.org/iss/hea/2003/pd102203d.html.

The Mercatus Center at George Mason University is a strong advocate for accountability in government. They are pleased to announce that Dr. Russell Roberts, one of our nation's leading communicators of economic ideas, has joined Mercatus and been appointed to the Department of Economics as Professor of Economics. Dr. Roberts has authored two popular books, The Invisible Heart: An Economic Romance and The Choice: A Fable of Free Trade and Protectionism.  Both books are novels that explain fundamental economic ideas and are widely used in the classroom.  The Choice was named one of the top ten books of 1994 by Business Week and one of the best books of 1994 by the Financial Times. Visit Dr Roberts personal website at http://invisibleheart.com/ to read chapters or reviews of his books, receive his newsletter, or read about economic aspects of the war in Iraq. Please log on at www.mercatus.org to read the government accountability reports–their fourth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, and now director of the Mercatus Center’s Government Accountability Project.

The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website at www.galen.org. The politics of Medicare reform become more complex by the day but always are driven by deep and still-unresolved ideological fissures. The question that is always at the center of the debate over health care in this country is whether government or individuals should be in charge of managing resources and making decisions. This week, Grace-Marie continues her discussion of prescription drugs for Medicare in The Final Stretch found at http://www.galen.org/pdrugs.asp?docID=560.

Greg Scandlen, Director of the “Center for Consumer-Driven Health Care” at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative and well-outlined newsletter that is distributed every Tuesday by logging onto www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/Search.asp?search=Consumer+Choice+Matters This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen. This week, be sure to read the report on a New Individual Plan from California Blue Cross called RightPlan. It has monthly premiums as low as $70, but requires a $40 physician copay and 40% coinsurance for hospital stays. Tom Morrison of the Segal Company says, "Consumers will learn they have to pay one way or another. They can pay on the front end to save money when they see a doctor, or they can delay expenses by paying low premiums and accepting that high co-payments and deductibles go with the territory." But Anthony Wright of Health Access says they "keep diluting the value of insurance. The point of insurance is to not worry about your bank account when you go to the doctor…." Read the news release at http://www.galen.org/ccbdocs.asp?docID=559. However, Mr “Wright” has it all “Wrong.” Not to worry about your bank account when you go to a doctor is like saying your car insurance should keep you from worrying about your bank account when you get it serviced. The car insurance is so you don’t have to worry if you have a collision or other catastrophe. Similarly your health insurance should keep you from worrying if you have a medical catastrophe such as a coronary, or stroke, or require surgery that demands hospital care, not office charges that are frequently less than a mechanic’s charges.

The Council for Affordable Health Insurance  http://cahionline.org 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. They provide educational materials for consumers, legislators, employers and other interested parties. 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. This week they report on the victory for regulators fighting drug imports with a federal court ordering Rx Depot Inc. to cease supplying medicines from Canada to U.S. consumers. The decision by a U.S. District Court judge in Tulsa, Oklahoma, came in response to a suit by Justice Department prosecutors acting on behalf of the Food and Drug Administration. The strongly worded ruling, which granted a temporary injunction sought by the government, will provide ammunition for state and federal regulators who contend that drug importation is almost always illegal and presents safety risks to consumers. Log on at http://cahionline.org/cgi-data/industry/files/135.shtml to read the report.

The Independence Institute, www.i2i.org, is a free-market think tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Ms Gorman is a Senior Fellow, a freelance writer and researcher who was a weekly columnist for the Colorado Daily in Boulder. Her articles have appeared in local newspapers, professional journals, and publications such as The Fortune Encyclopedia of Economics. She has worked as an economic researcher for a Denver mutual fund company, and was an adjunct professor and a principal investigator for several military manpower projects at the Naval Postgraduate School in Monterey, California. Her academic degrees are in economics. Review her health care archives at http://www.i2i.org/author.aspx?AuthorID=7. Be sure to sign up for the monthly Health Care Policy Center Newsletter at http://www.i2i.org/HCPCBulletinJoin.aspx. This week she has an excellent article on Health Scare: Six Myths about the U.S. Health Care System which can be found at http://www.i2i.org/article.aspx?ID=636 and is great to send to all your friends who are single and/or socialistic health-care advocates.

Martin Masse, Director of the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at www.quebecoislibre.org/apmasse.htm 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 his webzine on a regular basis. This week Chris Leithner discusses, WHAT ON EARTH HAS HAPPENED TO CANADA? Once called the "Switzerland of the North," as late as 1968 it was the world's second-richest country. Today, in terms of GDP per capita ($29,300), it ranks ahead of Australia ($27,500) and Britain ($26,400) but just below the G7 average ($30,100) and well behind the U.S. ($35,200). Canada's relative economic decline has been the rise of many and various interventionist schemes: high taxes, big deficits, growing debt, nationalisation of "key" industries, attempts to control consumer prices, regulation of investment, regional development and transfer payments from the wealthier provinces to the poorer ones (such as Manitoba). Alas, these policies have done nothing either to enrich the country as a whole or to narrow the gap between its wealthy and not-so-wealthy areas. (Mr Leithner, who grew up in Canada, lives in Australia, where he says, as in Canada: no social program ever fails – it is simply "underfunded.") Read the entire OpEd at http://www.quebecoislibre.org/031025-6.htm.

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. Log on at http://www.fraserinstitute.ca or go directly to their health research section at http://www.fraserinstitute.ca/health/index.asp?snav=he. This week there is a Policy Briefing concerning Canadian Prescriptions for American Patients: Consequences of the Illegal Cross-Border Pharmaceutical Trade. John R. Graham, Director of Health and Pharmaceutical Policy Research, The Fraser Institute, proclaims: Canada has a new industry: internet-based, mail-order pharmacies that ship lower-priced Canadian prescription drugs, “re-importing” them to American consumers who face higher prices south of the border. Sales are now estimated to be $650 million (US), a drop in the bucket of the US pharmaceutical market of $155 billion (US), but a significant share of Canada's $8 billion (US) market. So why should we care? Isn’t larger sales for Canadian firms a good thing? Unfortunately, the negative implications for Canadian patients, free trade, and the research and development of new medicines are enormous. Supply could be cut off to Canada, forcing us to have to break patents to manufacture pharmaceuticals. Or, the US could implement price controls on prescription drugs which would significantly impact their research & development budgets. Governments in Canada have not met this challenge, and one province even encourages its pharmacies to break US law. Mr. Graham explains the negative consequences of this illegal cross-border pharmaceutical trade and proposes policies to ensure that medicines shipped to Canada get to Canadian patients. Follow the details at http://www.fraserinstitute.ca/shared/readmore.asp?snav=ev&id=22.

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, http://www.heritage.org/Research/HealthCare/.  Read about the current Medicaid Difficulties at http://www.heritage.org/Research/HealthCare/wm355.cfm.Medicaid is the largest government health care program costing close to $259 billion, having increased dramatically over the past 10 years. In 1993, the program was estimated to have spent $132 billion, a doubling in a decade. In another year, the program is projected to reach $304 billion, suggesting that there will be a doubling every five years or possibly reach a trillion dollars in the next decade unless major reforms are implemented. Reforms mentioned include reducing provider payments, limiting prescription drugs, restricting eligibility and benefits–all the things that universal coverage or single-payer proponents think should be free for all Americans. If we can’t afford to care for the poorest one-eighth of society, how do they propose we can afford socialized medicine for 100 percent of society? You may email topics to your friends or receive regular updates.

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 www.mises.org to obtain the foundation’s daily reports.  This week read the Mises Economic Blog by Daniel Schuster on “Animals are Socialists?” It may come as a surprise, but apparently animals live in the wild in peaceful socialist communities and are not subject to the law of scarcity. Apparently bears have no trouble locating plentiful and unlimited food sources and voluntarily share their resources with not only all other bears but all other animals (except humans). Read about this indoctrination film, Brother Bear, which Schuster feels is possibly the most overtly manipulative children's film he has ever come across, at http://www.mises.org/blog.asp. The film’s explicit "animals good -- hunters bad" message is overshadowed only by its absurd treatment of basic economic concepts. You can review the film at http://disney.go.com/disneypictures/brotherbear/main.html. You may also log onto Lew’s premier free-market site at  www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html.

CATO. The Cato Institute was founded in 1977 by Edward H. Crane with Charles Koch of Koch Industries. It is a non-profit 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. Toward that goal, the Institute strives to achieve greater involvement of the intelligent, concerned lay public in questions of policy and the proper role of government. Ed Crane reminds us this month 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 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. Tom Miller, who spoke to the AAPS membership in September, is the Director of Health Care studies which can be accessed at http://www.cato.org/healthcare/index.html.

• The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network. 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. Please see http://www.ethanallen.org/index2.html. Click on “links” to see the other 41 free-market organizations throughout the U.S. and Canada which will then direct you to even more free market sites.

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 onto www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institutes. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Professor Victor Davis Hanson’s lecture delivered during the Hillsdale College cruise from Athens to Venice. He states there was a time, not so long ago, when we Americans understood that newcomers did not need to be taught in their own language in our schools. Even less did we believe that their children required special classes in ethnic pride or separate, race-based college graduation ceremonies. We believed in American civic education for immigrants, which, combined with intermarriage, integration and popular culture, led to rapid parity for those immigrants’ children in terms of education, income and influence. Read the adapted lecture at  http://www.hillsdale.edu/imprimis/default.htm. He also wrote An Autumn of War: What America Learned From September 11 and the War on Terrorism. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

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URL References for your perusal or study at leisure. You may want to Bookmark these or add to your Favorites.

HealthPlanUSA Quarterly Newsletters
Jan Newsletter: http://www.medicaltuesday.net/Dec3102.htm
April newsletter: http://www.medicaltuesday.net/Apr2903.html
July newsletter: http://www.medicaltuesday.net/July2903.html
October Newsletter: http://www.healthplanusa.net/October2003.htm

Single-Payer Initiatives: http://www.healthcarecom.net/EditorialNov94.html

David Gibson, MD, National Health Care Consultant: http://healthplanusa.net/DavidGibson.htm
Single Payer: http://www.healthplanusa.net/DGSinglePayer.htm
Why are the uninsured, uninsured: http://www.healthplanusa.net/DGUninsured.htm
What’s behind health care costs: http://www.healthplanusa.net/DGRisingHealthCareCosts.htm
Pharmacy costs: http://www.healthplanusa.net/DGPharmacyCosts.htm

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

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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Del Meyer

Del Meyer, MD, CEO & Founder

"If you think health care is expensive now, wait until you see what it costs when it's free."    -P.J. O'Rourke