Physicians, Business, Professional and Information Technology

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, October 1, 2002

Legal Gridlock - A Lesson for HealthCare
Leroy Greene, who served for 36 years in the California State Legislature and Senate, died at the age of 84. A Democrat who believed in a preponderance of laws, he wrote an OpEd piece for the suburban Carmichael Times shortly after he retired a few years ago. In it he stated that on a yearly basis he participated fully in the more than 1000 laws that were passed in California. He admitted that most years he was co-author on more than 100 bills of which about 10 were made into laws. However, after reflecting on his 36 years, he said that very few of these laws either help or protect people. In fact, he could only remember several that were beneficial. Most restrict. He highlighted the Helmet Law for motorcycle drivers as being restrictive but protective and appropriate since we use tax funds to build the highways and maintain the roads on which the cyclists have their near fatal accidents as well as their prolonged hospitalizations, many at taxpayer’s expense. He concluded that although we pass a thousand laws in California every year, we haven't learned to subtract. He maintained we are headed for legal gridlock. After looking at the number of medical and health care laws being proposed and passed, it appears that we’re headed for complete Medical-Legal Gridlock.

National HealthCare Systems in the English-speaking World (No 4)
John C Goodman, PhD, president of the National Center for Policy Analysis (NCPA), in his recent update of the “Twenty Myths about National Health Insurance” states that the failures of national health insurance are one of the great secrets of modern social science. Not only do ordinary citizens lack an understanding of the defects of national health insurance, all too often they 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.

Myth Four:  Although the United States Spends More on HealthCare per Capita than Countries with Single-payer Insurance, American Do Not Get Better HealthCare.

This myth is often supported by two references: 1) Life expectancy is not much different among the developed countries; 2) The US infant mortality rate is one of the highest among developed countries.

Life Expectancy and Health Care
General life expectancy rates tell us almost nothing about the efficacy of health care systems, because throughout the developed world, there is very little correlation between health care spending and general life expectancy – either among or within countries. The number of years a person will live is primarily a result of genetic and social factors, including lifestyle, environment and education. Japan has the longest life expectancy of any industrialized country. If the myth were true, then Japanese Americans would not live as long as their counterparts living in Japan. But they do.

Infant Mortality and Health Care
The US has a high infant mortality rate of 7.2 per 1,000 live births compared to a developed country average of 5.0. Again the US represents a composite of many ethnic groups with wide variation in geography, income, and education. The infant mortality rate for infants born to white mothers was 6.0. Geographic variations run from a low of 4.4 in New Hampshire to a high of 10.2 in Alabama. The income and education variability reflects that infants born to low income mothers who did not finish high school is 50 % higher than infants whose mothers finished college. This wide variation reflects that the US takes in five times more immigrants–both in total numbers and on a per capita basis than all the countries of Europe combined bringing with them the life expectancy of their native countries.  Goodman presents extensive data concerning the wide variations within Britain and Canada. He states that no one seriously claimed that the differences between these countries are the result of their health care systems. However, if a premature infant is born with spina bifida, or an adult has cancer, heart disease, renal failure or almost any serious illness, the chances of survival are best in the United States, where modern technology is most likely to be available and accessible.

Over Heard in the Pharmacy
Patient: I’d like this prescription filled. Pharmacist: That will be ninety eight dollars. Patient: How much is the placebo? I understand they are almost as good.

Exorbitant HealthCare Appetite
Last week a retired patient called after hours to inform us of his neck discomfort. His record did reflect discogenic disease of long standing. Since there was no current trauma, we suggested that he take an extra Vicodin for the pain. He said he needed to go to the Emergency Room for immediate attention and treatment. We suggested that he come in for an examination the next morning. He insisted on being evaluated in the ER immediately. We suggested that if he did go to the ER contrary to our medical recommendation, he should have his wife drive him over and save the cost of an ambulance. He said he would not do that since that would impose a six to ten-hour waiting in the queue. He furthermore stated, that if he called 911 and got there in an ambulance, he would be given first class service, seen immediately and out in just an hour or two. He actually did go to the Emergency Room for an evaluation, an x-ray was taken, which was no different from the last one, and he was sent home after three hours with a recommendation to take an extra Vicodin.

When he came to the office in three days for a followup exam, a standard requirement by all ERs and Urgent Care centers in order to transfer any liability back to the personal physician ASAP, he had findings of limitation of neck movement plus tenderness of his trapezius muscles which was essentially unchanged from prior examinations. He needed to continue applying heat, take his basic NSAID analgesics plus an occasional Vicodin for exacerbations of his chronic disease. He could not understand my concern about the increase in health care costs he had incurred, even though the ER recommendations were identical to the phone recommendations, because it had allayed so much of his wife’s anxiety.  Instead of a $75 office call, he had incurred a $750 ER visit and a $500 ambulance ride fully paid by his Medicare HMO insurance, plus the same $75 office call–a 1600% increase in costs with no improvement in his health or any change in the recommendations for his chronic medical problem. Or another way of looking at the increase in costs would be going from a $1 Vicodin narcotic pill to a $1250 charge plus the same Vicodin pill which is a 125,000 % increase in cost. Does anyone still wonder why all bureaucratic health care plans around the world are imploding? There is no system that can fund this common abuse which I see daily in my practice.

The above scenario occurred in a Medicare environment which could not interfere with what a patient considers an emergency. There is no way of controlling these types of cost from top down regulation. As many of my government patients have found out, be they Medicare or Medicaid, they can bypass the waiting time drag by forcing even additional unnecessary spending of taxpayer funds on a limousine (ambulance) ride to the hospital. A virtual writing of a check on the United States Treasury.

As Congress, the president, actuaries, and bureaucrats are trying to stem the cost of health care to 5 percent or 10 percent increase, and cutting re-imbursement by 5 percent or 10 percent, a common liberal leftist slight of hand, this patient still does not feel the 1600 percent increase in costs (or 125,000 percent increase) is unreasonable. He contended that he deserved the expense. Only after he calmed down from the effrontery of my concern, was I able to ask him: “If you had to pay 10 percent or $125 of the $1250 charges, would you have gone to the ER?” He could see no alternative primarily because his wife was extremely agitated about his pain.  When I asked him if he had to pay 20 percent or $250 of the $1250, would he have gone to the emergency room? He looked at me as though insulted, but did admit that if he had to pay $250, he would have taken that extra one dollar Vicodin that was recommended over the phone and would have seen me the next morning. My anecdotal experience illustrates how a 20 percent co-pay on ER or urgent care evaluations, and by extension to surgery center or hospital outpatient procedures, essentially returns market conditions due to its inherent self regulation. Patient understanding of the process is improved. There is no need for duplicate x-rays of the spine and other testing which a new physician (the emergency room doctor) who is unfamiliar with a new patient would have to do. There are no hostile responses to everyone else’s lack of understanding his emergency, and no need for bureaucratic oversight. Medical care again becomes individualized to each patient’s needs, desires and requirements.

MedicalTuesday Recommends
The Greg Scandlen Health Policy Comments as an important source of market-based medicine. You may log onto NCPA (www.ncpa.org) and register to received Greg’s weekly report, the weekly health policy digest or the full NCPA daily report. We also recommend the market-based reports of Lew Rockwell, president of the Ludwig von Mises institute. Please log on at www.mises.org to obtain the foundation’s reports or log onto Lew’s premier free market site at  www.lewrockwell.com.

MedicalTuesday Recognizes
SimpleCare for their success in restoring private practice,  www.simplecare.com, HealIndiana as a supporter of market-based medicine, www.HealIndiana.org. The AAPS representing physicians in their struggles against bureaucratic medicine www.AAPSOnline.org.

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Stay Tuned to the MedicalTuesday.Network
This week we welcome a number of new readers from the AAPS and KUMC. We invite their response, the re-sending of this to their friends and colleagues and other interested business and professional associates. It is our understanding that each individual is personally known, requested to be placed on our mailing list, or was recommended as someone interested in our cause of making HealthCare affordable and accountable. If this is correct, you may consider opening a folder in your inbox labeled MedicalTuesday so that they are available to be forwarded when the occasion arises. If this is not correct or you are not interested in or sympathetic to a Private Personal HealthCare system, email DelMeyer@MedicalTuesday.net and your name will be sorrowfully removed.

Del Meyer, MD