MEDICAL TUESDAY . NET                         NEWSLETTER


Community For Better Health Care                Vol IV, No 13, Oct 11, 2005

In This Issue:

1.         Featured Article: Healthy Competition - Foreword by George P Schultz

2.         In the News: The Longest War the United States Ever Fought  - The War on Poverty

3.         International Medicine: Medical Savings Accounts: The Singapore Experience

4.         Medicare: Watch Out for the Audit

5.         Medical Gluttony: The Differences in Medical Appetites - The Need to Know

6.         Medical Myths: San Francisco Fire Hydrant Problem Epitomizes Government’s Inability to Handle Simple Problems

7.         Overheard in the Medical Staff Lounge: We Are Approaching Medical Gridlock

8.         Voices of Medicine: My Left Breast - A One-Woman Autobiographical Monologue; Myths and Truths of Medical Spas

9.         From the Physician Patient Bookshelf: THE CANCER WARD by Solzhenitsyn

10.       Hippocrates & His Kin: Just a Notch Above Lawyers

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: Foreword by George P Schultz to Healthy Competition: What's Holding Back Health Care and How to Free It by Michael F Cannon & Michael D Tanner September 2005, ISBN: 1-930865-81-3.

We begin with a riddle. What country’s health care system offers the best health services in the world, is constantly criticized for not being accessible enough, and yet is so accessible that overutilization is leading to runaway costs? The first part reveals the answer could only be America. The remainder gives the contours of a paradox that vexes policymakers year in and year out. Welcome to health care, American-style. Untangling these apparent inconsistencies is an essential step in gearing our health system to the emerging modern world.

What are some of the characteristics of this modern world? For one thing, increased longevity, aging baby boomers, and new medical technologies presage greater use of medical care. Take demography. Our population’s age structure is changing. The baby boomers are about to start moving into the over-65 category, while longevity keeps increasing. We are getting older as well as healthier, or maybe, because we are healthier, we are getting older. Nevertheless, the older we are, the closer we are to death, and a disproportionate share of health care spending comes toward the end of a person’s life. Moreover, innovation enables modern medicine to satisfy needs that yesterday went unmet, which draws more resources into the health sector.

These trends are colliding with a health care system that already encourages overutilization. To a greater degree than even our neighbors to the north, Americans rely on someone else to pay for their health care—a tradition that had its inception in the World War II era. Employers needed workers, and the only enticement they could offer that was not subject to wartime wage and price controls was health benefits. Providing health insurance was a no-brainer for employers, but no one should be surprised that when the marginal cost of health care approaches zero, utilization skyrockets.

Entitlement programs add fuel to the fire. For example, Medicare is essentially ‘‘free’’ fee-for-service health care for the elderly. Seniors, even the well-to-do, pay few if any copayments. Dr. John E. Wennberg of Dartmouth has been studying regional variations in Medicare health care claims since 1967 and, more recently, their effects on health outcomes. Wennberg shows that about one-third of all health care purchased by Medicare is unnecessary—and some is possibly harmful. Life expectancy is no greater in regions that receive more intensive medical care, and Medicare surveys find that their quality of care is no better. A summary of Wennberg’s research concludes: ‘‘The difference in lifetime Medicare spending between a typical 65-year-old in Miami and one in Minneapolis is more than $50,000, equivalent to a new Lexus GS 400 with all the trimmings.’’ Such large inefficiencies suggest we could maintain—or even improve upon—current levels of productivity at a much lower cost. How?

America’s health care system needs to give consumers more responsibility and more control over their health care expenditures. Many authoritative studies show that consumer control can reduce costs drastically without any negative impact on health outcomes. The RAND Health Insurance Experiment demonstrated that as copayments increase, utilization goes down but health outcomes stay the same. (Read more about this experiment in Chapter 4 of this fascinating book.) The consumer-directed health care movement—with health savings accounts at the helm—is already hard at work ascertaining how to provide patients greater value for the dollar. The Cato Institute played a leading role in bringing health savings accounts to workers, and this new option is growing in popularity every day. In these pages, Michael Cannon and Michael Tanner build on that tradition and show that expanding health savings accounts can give consumers control over all of their health care dollars.

Consumer-directed health care has its detractors. Do consumers care enough to become informed? Do they have the capacity to understand health alternatives and to make intelligent choices? Overwhelmingly, the evidence answers in the affirmative. Ordinary Americans are increasingly on the ball when it comes to their health. In fact, markets are already recognizing and meeting consumers’ demand for accessible health care and more health information. For example, in some retail stores, nurse stations with basic equipment can provide you with quick diagnoses of ordinary problems for a small fee. WebMD, an online resource of medical information, receives an average of 889,000 visitors daily. Forrester Research reports that baby boomers are better educated and more affluent than previous generations, and are considerably more comfortable with technology. These rising seniors are using the Internet en masse for health and leisure  activities. European consumers too are increasingly likely to seek health information online.

Accustomed to serving themselves on retail and media sites, consumers hunger for useful online content and comparative evaluation tools from their health care providers. A growing wave of health care consumerism among young, health-conscious individuals is setting the stage for consumer-directed health plans (CDHP). Plans that are slow in developing a CDHP risk losing healthier, engaged consumers to rival plans. The more of a stake consumers have in their spending decisions, the better informed and the more demanding they will be.

Yet America needs more than just health savings accounts. To carry the health care debate on its next lap, America first needs a clear, well-informed, and well-reasoned analysis of the apparent paradox of its health care system. And it needs an agenda for reform that respects the wonders that modern medicine has developed and the creative market processes that deliver them. On the following pages, Cannon and Tanner offer proposals that would further tap the power of markets to make health care more valuable and more affordable. That makes Healthy Competition essential reading.

To purchase the book and read the rest of the story, please go to the Cato Bookstore:

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2.         In the News: The Longest War the United States Ever Fought  - The War on Poverty

Katrina crisis renews focus on U.S. poverty. The rate is virtually the same as in 1968 and is the developed world's worst. By David Westphal -- Bee Washington Bureau Chief Published 2:15 am PDT Sunday, September 18, 2005

Westphal reports: The searing images of thousands of New Orleans residents, stranded by floodwaters because they had no means to escape Hurricane Katrina, have exposed an abiding truth about poverty in America.

Despite more than 35 years of solid economic growth and income gains, the nation's poverty rate is virtually no better than it was in 1968, four years after President Johnson launched a war on poverty.

With poverty in hurricane-stricken areas approaching 30 percent - higher among African Americans - political leaders of many stripes have issued urgent calls for the nation to do something about the 37 million Americans who fall into the category of have-nots.

"We do, I think at some point, need to see that people couldn't evacuate who were poor," Secretary of State Condoleezza Rice said, "and understand better how to make sure that that doesn't happen again."

Former Democratic Sen. John Edwards of North Carolina called for a revival of Depression-era public works programs to prop up Gulf Coast residents now homeless and jobless.

Americans officially are considered in poverty if their household income is under about $19,000 for a family of four. The figure for a couple under 65 with no children is $12,649.

Making progress against American poverty constitutes a massive challenge. The nation's poverty rate is the worst, by many calculations, in the developed world. It's been growing for four straight years. Blacks and other minorities suffer at much higher rates.

Yet the United States' poverty picture is more complex than that. After worsening during the 1980s and early 1990s, poverty dramatically improved during the late 1990s - especially among minority groups and in some of the country's poorest neighborhoods.

Here are more questions and answers about poverty in the United States: . . .

But Douglas Besharov, a scholar at the American Enterprise Institute, says American poverty is not so much a matter of neglect as it is a purposeful decision to concentrate more on faster economic growth and lower rates of unemployment - at the expense of higher poverty. "I think what you're seeing now in Europe, with very slow economic growth, is an understanding that their big welfare systems extract too high a price."

To read the full article, please go to

The Bee's David Westphal can be reached at (202) 383-0002 or

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3.         International Medicine: Medical Savings Accounts: The Singapore Experience by Thomas A. Massaro, M.D., Ph.D. and Yu-Ning Wong, NCPA Policy Report No. 203 April 1996 ISBN #1-56808-071-9.

In 1984 Singapore adopted a system of Medisave accounts, individually owned accounts used to pay for many of the health care expenditures that in the United States would normally be covered by health insurance. The fact that people are spending their own money rather than that of a third-party insurer has helped to curtail Singapore's health care costs, which are about 3.1 percent of gross domestic product. Even with these low expenditures, the income of Singapore doctors is about the same in relation to average wages as physician income in the United States, and patients have easy access to such technology as CAT scans, organ transplants and bypass surgery.

Singapore also compares favorably to other "Asian tigers" in terms of spending and overall health indicators. For example, Singapore had an infant mortality rate of five per 1,000 live births in 1992, equal to that of Japan and lower than that of Hong Kong, which was six.

To achieve this record, the government has implemented three programs that help people pay for medical expenses: Medisave, Medishield and Medifund.

The Medisave Program.

Created in 1984, Medisave is a compulsory national health care savings program designed to help citizens meet their individual responsibilities and to supplement funds drawn from their own savings. Medisave contributions range between 6 and 8 percent according to the worker's age, and can be used to pay for a variety of specified inpatient and outpatient medical services, both before and after retirement.

The Medishield Program.

Since Medisave accounts alone may be insufficient to cover a serious or prolonged illness, Medishield was established in 1990 as a catastrophic insurance program to pay extraordinary hospital expenses for those under 70 years of age.

The Medifund Program.

Since the combination of out-of-pocket, Medisave and Medishield payments may not cover all low-income workers' medical expenses, Medifund was established in April 1993 to provide assistance.

Public institutions dominate Singapore's hospital sector: 13 of the 23 hospitals and 8,640 of the 10,469 beds are in facilities controlled by the Ministry of Health. A key component of the government's policy is a tiered structure of subsidies based on the setting in which care is delivered and the amenities provided with it. In the public hospitals, there are five classes of wards that receive varying degrees of subsidy, while private hospitals are unsubsidized.

In principle, individuals are free to choose among the five levels. Medical social workers provide financial counseling to everyone at the time of admission into the public hospitals. They advise patients that it is their responsibility to choose a ward class they can afford and to cover their expenses through a combination of subsidy, Medisave, Medishield and personal funds. If necessary, patients can draw on their spouse's, children's or parents' Medisave accounts.

Quality of service is an important issue for Singapore's hospitals. Hospital personnel are responsible for improving service, and senior management makes decisions based on the satisfaction of patients and other customers. For example, patients waiting less than 15 minutes at admission increased from 40 to 71 percent between 1991 and 1992.

Singapore has one of the most sophisticated health care delivery systems in Asia, serving citizens and foreign nationals alike in both private and public hospitals. . . .

To read the entire article, go to

About the Authors:

Dr. Thomas A. Massaro is the Harrison Foundation Professor of Medicine and Law. He is Professor of Pediatrics and Business Administration and a Senior Fellow of the Virginia Health Policy Center at the University of Virginia.

Yu-Ning Wong was an undergraduate at the University of Virginia at the time and then a medical student at the Robert Wood Johnson Medical School in New Jersey.

Closing comment at the time of this article:

"If MSAs Were Available in the United States,

Prudent Buying Would Begin to Chip Away at the High Cost of Care."

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4.         Medicare: Watch Out for the Audit

Some time ago, a family physician mentioned that he always had an internist or surgeon take care of his hospital patients. He was not able to provide daily hospital care. In fact, he normally saw his hospitalized patients only twice a week. Therefore, his office automatically entered a hospital charge on Tuesdays and Thursdays for his hospital patients since on those days his scheduled started an hour late to allow him time for hospital rounds. Once, because of family obligations, he saw the patients Monday, Wednesday and Friday. Unfortunately, he failed to tell his office who then failed to change the date of service.

On Medicare audit, he was charged with Medicare Fraud, and was about to be cited and fined because of Tuesday and Thursday charges for evaluations that did not occur. He pleaded that he had actually seen the patient three times rather than twice and that Medicare really owed him more money or in fact, as billed, saved money. Uncle Sam’s position was that not charging for Monday, Wednesday and Friday that week was his choice; but charging for Tuesday and Thursday and not seeing the patient was Medicare Fraud. It cost him about ten hours of legal fees for his attorney to straighten it out.

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

- Ronald Reagan

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5.         Medical Gluttony: The Differences in Medical Appetites - The Need to Know

A state senator commenting on the costs of health care stated, as I recall, that we needed to get the doctors and hospitals in line and under control to conserve expenditures. When told that patients have different and sometimes-huge appetites for health care, she replied, “I’m not aware of any patient using more care than absolutely necessary.”

This brings to mind two senior patients who were about the same age and had similar elevated blood pressures and dizziness when getting up or moving around quickly. There was about a 10 mm Hg drop in blood pressure in each on getting up from the sitting to the standing position. It would reverse in a matter of seconds. The neurological examination revealed that the cranial nerves, motor and sensory examination, reflexes and coordination were all intact. The doctor explained that it was most likely a postural effect, but could be due to small lacunar strokes in the central portion of his brain. Many times, these don’t even show on a CT scan of the brain.

The first patient accepted this explanation and revised his living habits by getting up more slowly and steadying himself on something solid when he made a change in position. He did quite well. Total cost: $100 (one office visit)

The second patient said, “I need to know exactly what caused it.” She didn’t care what it would cost to find out since she had Medicare. She insisted on a carotid Doppler to check her circulation. It was normal. She had a normal brain CT scan. She had a brain MRI scan that showed some small lacunar infarcts. She then insisted on seeing a brain specialist. A neurologist examined her very carefully and after a repeat detailed neurological examination, came to the same diagnosis as the personal physician: small lacunar strokes aggravated by postural blood pressure changes. Her baseline blood pressure was normal and he told her there was no treatment required for this problem and advised to keep her blood pressure normal. “You haven’t even done a brain wave on me,” was her response. So the neurologist ordered an EEG, which was normal. After talking with her friends and researching medical web sites, she returned to the neurologist and demanded a PET scan, the latest and most sophisticated brain test. So the neurologist ordered a $2300 PET scan, which was normal.

When she returned to her personal internist, he asked her if she was happy now that all the possibilities had been evaluated and we knew exactly what her problem was having done the most sophisticated tests - tests that would not be readily available in approximately 167 of the 192 countries of the world. She replied, “No. I’m more anxious than ever to think I may have had a stroke.” Do you want to discuss your anxieties with a psychiatrist? “Heavens no. I want someone to tell me I didn’t have a stroke.” Total estimated cost: $5600 (two office visits, carotid Doppler, CT brain, MRI brain, neurologic consultation, EEG, neurologic follow up to discuss all the findings, PET scan, final neurologic summation visit)

Did the second patient receive a higher quality of care than the first? No. The 55 fold (5,500% increase in cost) difference occurred in a government-controlled healthcare environment, such as the United States, where 90 percent of health care is government regulated - more socialized than in countries with socialized medicine. The only way to have reduced this cost would be in a market-based environment. If the patient had to pay a percentage of the cost, the expensive investigation would have stopped in its tracks after about the second unnecessary test.

Quality of care is not an issue in this case. In fact, if the QOC cops had evaluated this scenario, they would have faulted the first internist for not providing the best quality. QOC is only an issue in government-regulated healthcare. In a free market, quality continually improves automatically. In government medicine, quality of care always decreases to the level of the lowest incompetent physician or hospital.

Having recently visited the offices of lawmakers who do not understand human variations such as this, we must make every effort to neutralize their efforts in Healthcare.

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6.         Medical Myths: San Francisco's Fire Hydrant Problem Epitomizes Government’s Inability to Handle Simple Problems - Can You Imagine What Would Happened If They Had to Fight a Medical Problem?

The debate over San Francisco fire hydrants started more than a week ago, when The Chronicle reported that San Francisco was the only city in the state exempted from a law that required California's fire departments to standardize their hydrants and hoses after the 1991 Oakland Hills fire. Instead, San Francisco plans to hand out adapters -- which would narrow the 3-inch hose connections on its hydrants to fit the standard 2½-inch hose -- to outside fire departments in a mutual aid situation.

While disaster experts say the modification would greatly help fight multiple blazes after a major earthquake, Fire Chief Joanne Hayes-White says the cost would tax her department's budget. "Besides," she says, "the city's hydrants don't need changing."

Those who have made a study of the chaotic responses to such tragedies as the recent Hurricane Katrina, the Sept. 11, 2001, terrorist attacks and the Oakland firestorm said the city's plan is shortsighted and has the potential for major confusion.

For less than the price of a Noe Valley house -- about $800,000 -- San Francisco could retrofit its atypical hydrants so that departments from outside the city could better aid local firefighters in battling major infernos, according to a leading manufacturer.

"Standardization of equipment is vitally important," said Dale Chessey, a spokesman for the state Office of Emergency Services. "Sure, $800,000 is a lot of money to do all at once. But maybe they do it a little at a time."

[This should dispel any belief that even a local government can administer medical care effectively. Budgetary limits could allow an epidemic to spread unchecked while City Hall debates whether they can afford to spend the cost of a home to save lives.]

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7.         Overheard in the Medical Staff Lounge: We Are Approaching Medical Gridlock

Dr Edwards: Senator LeRoy Greene upon his retirement from the California legislature commented on the 1000 laws passed in California on a yearly basis, “We’re approaching legal gridlock.” That makes me think that with all the laws regulating medicine that make it increasingly difficult to practice medicine for the benefit of our patients, “We are approaching medical gridlock. Patients can no longer get the tests or treatment necessary for appropriate care. In legal gridlock, life goes on. In medical gridlock, life stops; you may die while the review committee debates whether you can be authorized the diagnostic test or the life-saving treatment.”

Dr Rosen: We must also remember that the members of the medical review committee are frequently further removed from the latest in standard of care and thus project an inferior standard on the doctors they review who are practicing on a higher standard.  Thus the review committee can further decrease the quality of care (QOC).

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8.         Voices of Medicine: A Review of Local and Regional Medical Journals and the Press

Medical Arts: A Different Kind of Healing reported by Stacey Kerr, MD, in Sonoma Medicine.

My Left Breast - A One-woman Autobiographical Monologue by Susan Miller, 15 years after she was diagnosed with breast cancer, as played by Stacey Kerr, MD.

“It was opening night, we had a sold-out house, and I was supposed to be doing my ‘warm-ups.’ I had to sharpen my senses, loosen up my body so it was available for the character, and fully explore my own emotional state. What was going on that might get in the way of the performance? I had to let it all go and then work to become as vulnerable as possible; turn my skin inside out and push past the edges of safety.

“Familiar with the warm-ups that were most effective, I worked to find within myself the truth of my mortality, the utter loneliness of being a single mother, the fear of dying alone and unfulfilled. I had a half hour to locate that dark place of bleak hopelessness and then to bring myself back up into sanity with bravery, lust, humor, and triumph. I worked for a foundation of life-threatening fear so I could rise above it. My stomach churned with dread, and I used every bit of that dread for the character I would become: Susan Miller, a one-breasted, menopausal, Jewish, bisexual, lesbian Mom.

“But this night I could only go so far into that vulnerability before my logical and scientific brain started asking the obvious: Why bother? What is it about human beings getting up on a stage and prancing around reciting words someone else has written? Isn’t this silly? I can’t take it seriously. Why not just get up there, remember the lines and the blocking, go through the motions, and get out of there alive? . . . .  To read more about Dr Kerr’s reaction to the play, see the link below. She concludes her story with the following comments:

“My Left Breast” was a successful play. In January, we sold out six performances in Sonoma and had demands for more. In March, we performed at the Luther Burbank Center; and with the generous underwriting of Frank Howard Allen Realtors, we were able to donate every cent of ticket sales to the Sutter Breast Care Center in Santa Rosa. In early June, we performed at the Ukiah Players Theater as a benefit for the Cancer Resource Center of Mendocino County. And the play goes on. While making money for good causes is wonderful, the real value of the play is in the faces and hearts of the audience members who respond to Susan Miller’s words with words of their own.

“I continue to treat strep throat and to recommend surgery when needed. I also continue to strive for truth and vulnerability when I work on stage, knowing that the work I do in theater can be as valid and powerful as the work I do in the examining room. It’s just a different kind of healing.

“Dr. Kerr, a Santa Rosa family physician, frequently performs in local theater productions.”  


Myths and Truths of Medical Spas

Janis Rizzuto gives us the first installation of a special report about the quick-moving medical spa marketing the Southern California Physician. “Physicians and others comment on the trend and clarify some incorrect assumptions.                                        

“In the past five years, the number of medical spas has increased 205 percent, according to the International Spa Association.

“Nonsurgical cosmetic procedures in 2004 increased 51 percent from 2003, according to the American Society for Aesthetic Plastic Surgery. The biggest increases were in dermal fillers (up 659 percent), laser skin resurfacing (up 363 percent) and cellulite treatments (up 193 percent).

“‘It’s a good thing that more physicians are getting involved,’ says Howard Murad, MD. ‘It’s a trend we can’t deny. Patients want more. They want to look healthier and feel better. They often feel they don’t have enough time for themselves, but in a spa environment, they have our full attention. They feel cared for much more than in a doctor’s office.’

“Dr. Murad should know. He is the renowned dermatologist who is widely considered the father of the medical spa industry, having launched the first medically supervised day spa in El Segundo back in 1988.

“But as medical spas caught on, so did permutations of the concept. ‘If you ask four doctors, you get five different opinions. Everyone has their own opinion of what a medical spa should be,’ Dr. Murad says. ‘Everybody uses the name and does something different.’

“Still, Dr. Murad, who is a member of the Los Angeles County Medical Association, takes a strict view that all medical procedures should be done by physicians, not just registered nurses or aestheticians under supervision. ‘We must concern ourselves that procedures are done correctly and done by who should be doing them,’ he says”.

To read this month’s entire article, go to

To read the continuation of this series, see the August issue at, September issue at and October issue at

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9.         Book Review: THE CANCER WARD  by Alexander Solzhenitsyn

Translated by Nicholas Bethel and David Burg, Noonday Press, New York, 1974. (Russian edition 1968)

This work of fiction is based on the author’s own experiences as a patient in a cancer ward in the 1950's, but it speaks to us more clearly with each passing year as our country grapples with the problem of providing basic health care for all.

As the story opens, Nobel laureate Solzhenitsyn’s Soviet world of 40 years ago seems like a strange and foreign place indeed, with its detached, impersonal, "universal free health care" system which serviced frightened powerless patients with competent but distant doctors whose passionless demeanor would have served them as well if they had been engineers or plumbers.

The chapter titled "The Old Doctor," is particularly prophetic. A 75 year old physician, Dr. Oreshchenkov, mourns the extinction of the family doctor in modern Soviet medicine. He characterizes this practitioner of a bygone era as the "most comforting figure in our lives...a figure without whom the family cannot exist in a developing society. He knows the needs of each member of the family, just as the mother knows their tastes...the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful... But he has been cut down and foreshortened. [It is very difficult] to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you." A fellow physician and patient responds, "All right, but...they just can’t be fitted into our system of universal, free, public health services." Dr Oreshchenkov retorts, "Universal and public--yes. Free, no." The colleague replies, "But the fact that it is free is our greatest achievement."

Dr Oreshchenkov then gives us the real message for our time: "What do you mean by 'free’? The doctors don’t work without pay. It’s just that the patient doesn’t pay them; they’re paid out of the public budget. The public budget comes from these same patients. Treatment isn’t free, it’s just depersonalized. If the cost of it were left with the patient, he’d turn the ten rubles over and over in his hands.

The Author then describes how he feels the health care system should be. He felt that primary treatment should be at the expense of the patient, but hospitalizations or costly procedures should be free. Then patients would be in control of when and how often and from whom they should seek medical treatment. "With the right kind of primary system,...there would be fewer cases altogether, and no neglected ones..." Each patient could be treated as a whole person instead of a collection of diseases, to be tossed from specialist to specialist like a basketball.

Solzhenitsyn’s story is a classic - as relevant today in America as it was 40 years ago when it was first published in Russian. Its characterizations are vivid, its situations are hauntingly familiar, and its truths are timeless.

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

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10.       Hippocrates & His Kin: Just a Notch above Lawyers

The Dutch government has expanded its euthanasia policy from the aged to newborns. With the coming flu pandemic expected to be as severe as the one in 1918 when 50 million people died, will we begin to euthanize people of any age with hopeless flu? M Stanton Evans, at the AAPS Meeting last month, stated during a euthanasia presentation: Old terms seems to have taken on new meaning. “You’re better off dead.” 



Leon Louw, the South African economist, says that in the past 30 years, the world has poured $450 billion of aid into Africa, but that average per capita income is lower than it was in the late 1960s. -Paul Gigot in WSJ, Sept 24/25-2005 [Let’s hope no one pours aid into the USA.]



Hostess pointing out guests to new arrivals at a cocktail party: "The Von Soostens under the chandelier represent old money; the Hendersons by the champagne punch represent new money; the Gibbons admiring the bookcase represent lottery money; the Krogers sitting on the velvet divan ladened with gold and diamonds around their wrists, waist, and necks represent managed care money; and Dr Livingstone, my HMO doctor, bending over the diving board with his wife tugging on his coat represents no money."



A patient brought in a hospital bill stating, "here’s one for your column." He had gone through a pulmonary rehabilitation program at one of the hospitals. The bill to Medicare was $4576 for 18 three-hour sessions. He said with a class of 12, it was $54,912 for the hospital or $3000 per session, which involved one respiratory therapist, or one employee making $1000 per hour for the hospital. He said he was unable to find any medical benefit. He called some of the twelve and they couldn’t either... Who needs beds anyway? Sounds like converting the patient rooms to a few exercise rooms should do it.



A prospective juror in an insurance case was asked if he had ever done business with the insurance company in question, and what he thought of insurance agents. He replied that he placed them "just a notch above lawyers." We may think of this as just another ploy to avoid serving on a lengthy jury trial, but the association is sobering--even if you don’t drink. Remember when "public confidence" polls placed doctors near the top along with priests, ministers, rabbis, and Supreme Court justices? At the other end of the spectrum were congressmen, legislators, lawyers, and used car salesmen. As we leave the high moral ground and become increasingly preoccupied with the bottom dwellers, who have the temerity to question our quality of care, might we not also fall to "just a notch above lawyers?"

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11.       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 reviewed in this newsletter the first twenty months, 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.

$          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. Join the Mercatus Center for Excellence in Government 2005-2006 by Susan E Dudley and Melinda Warren at 

$          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 A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

$          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 newsletter that is distributed every Tuesday by logging on at and clicking on Consumer Choice Matters. Archives are now located at  This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen, an expert in Health Savings Accounts (HSAs).

$          The Heartland Institute,, publishes the Health Care News, Conrad Meier, Managing Editor Emeritus. Be sure to read A Moment of Silence for John Walton … and Wal-Mart, at

$          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 as 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 is an opportunity to keep up with classics in economics. Be sure to read this month’s classic by political science expert Allan C. Brownfeld: Knowledge and Decisions at

$          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 the CAHI report on Association-Sponsored Health Plans at

$          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 week, read the Daily Medical Follies: “Woeful Tales from the World of Nationalized Health Care,” at

$          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 Be sure to read the report on government's wasteful spending of tax money on sex drugs for sex offenders and ceramic dildos for hookers 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, guides, and reports listed on the opening page that are very important in the world of health insurance. Be sure to bookmark for future reference their guides to all types of health insurance.

$          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, read an excellent report on “Should Canada Try Health Savings Accounts?” at

$          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 for an overview of the extensive research articles that are available. You may want to go directly to their health research section at

$          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 the timely research on “The Growing Disconnect: Federal Spending and Congressional Leadership” at

$          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 this week's Free Markets and Social Welfare by Gabriel Openshaw at 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. Read more on the continuing dialogue on how “An ownership society values responsibility, liberty, and property…” at, which will also direct you to a superb article at The Stanford Review.  Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at Stay tuned for more on his book

$          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. Vermont is celebrating their FreedomFest on October 15, 2005. Details can be accessed from the website.

$          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 George Will on The Doctrine of Preemption at  The last ten years of Imprimis are archived at

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


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 thing to be bought and sold is legislatures.

Mark Twain, (1866): There is no distinctly native American criminal class save Congress.

On This Date in History - October 11

General Pulaski Memorial Day: Casimir Pulaski, who came to the United States in 1777, was a hero of the fight for Polish independence. Two years after his arrival, he was leading a charge against the British lines in Savannah, Georgia, and was mortally wounded dying on This Day in 1779. Brigadier General Casimir Pulaski was the first of many Poles who found America worth fighting for.

Great Britain’s King Henry VIII denounced Dr Martin Luther’s Teachings on this date in 1521.