Physicians and the Business & Professional Community

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, September 10, 2002

Medicine Around the World: Japan's Lousy Health Care
Neil Weinberg’s article some time ago in Forbes was titled "Bad Medicine." Japan's Ministry of Health and Welfare oversees that country's system of socialized medicine, and observers say the results aren't pretty. For example, 26,200 patients in the U.S. received implantable defibrillators the previous year–compared to only 100 in Japan. Such tight controls have kept medical costs in Japan at 7 percent of gross domestic product, or half the U.S. level–but at a heavy cost in unmet patient needs.

Consultation fees to doctors are kept as low as $8 per office visit–compelling doctors to look for compensation elsewhere.  They find it by operating their own small hospitals and encouraging long patient stays. A procedure that might result in a one or two night stay in the United States can be prolonged to one or two weeks in Japan.  Japanese doctors also load their patients up with prescription drugs–marking up the price and pocketing the difference. As a result, Japan spends 28 percent of its health-care budget on prescription drugs–versus 9 percent in the U.S. Japanese Surgeons complain that the health ministry won't let them import many of the latest medical devices from abroad, in a misguided attempt to hold down the high costs of socialized medicine.

Putting Drag in the System Is Not a New Problem
One of my patients with a probable carcinoma of the lung required a bronchoscopy for diagnosis and staging of the disease. His medicare intermediary required prior authorization. I tried to explain the need over the phone to a representative of the carrier. She said that before she could act on the need, would I spell bronchoscopy?  As I was spelling bronchoscopy for this medical illiterate who would be involved in a decision on my patient, I recalled the words of Herodotus, “Of all men's miseries the bitterest is this: to know so much and to have control over nothing.” (484-424BC)

Just in: The Final Word on Worldwide Variations in Heart Disease
(We’re still checking out the scientific validity of this one.)
The Japanese eat very little fat, drink very little red wine and suffer fewer heart attacks than the British or Americans. The French eat a lot of fat, drink a lot of red wine and also suffer fewer heart attacks than the British or Americans. The Italians drink excessive amounts of red wine, eat a lot of cheese and also suffer fewer heart attacks than the British or Americans. Conclusion: Eat and drink what you like. Speaking English is what kills you.

National HealthCare Systems in the English-speaking World  (Chapter 2)
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,”  documents that Europeans who are supposed to have universal access and care that is mostly free at the point of service are increasingly turning to foreign travel as the only way to secure these services. The failures of national health insurance are one of the great secrets of modern social science according to Dr Goodman. 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 Two:  In Countries with Single-payer Health Insurance, All People Have an Equal Access to HealthCare.

Goodman points out that one of the most surprising features of European health care systems is the enormous amount of attention given to the notion of equality and the importance of achieving it. Aneurin Bevan, father of Britain’s National Health Service  (NHS), declared that “everyone should be treated alike in the matter of medical care.” The Beveridge Report, a blueprint for the NHS, promised “a health service providing full preventive and curative treatment of every kind for every citizen without exceptions.” The British Medical Journal predicted in 1942 that the NHS would be “a 100 percent service for 100 percent of the population.” The goal of NHS founders was to eliminate inequalities in health care based on age, sex, occupation, geographical locations and–most importantly–income and social class. As Bevan put it, “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not [an] advantage.” Similar statements have been made by politicians in virtually every country that has established a national health insurance program. Yet such rhetoric rarely corresponds with the facts.

Inequality in Britain
Britain’s ministers of health have long assured Britons that they were leaving no stone unturned in a relentless quest to root out and eliminate inequalities in health care. After 30 years, an official task force, the Black Report, concluded that there was little evidence of more equal access to health care in Britain than when the NHS was started. After 50 years, a second task force, the Acheson Report, found evidence that access had actually become more unequal in the years between the two studies. The problem of unequal access is so well known in Britain that the press has begun to refer to the NHS as a “postcode” lottery, your chances of timely treatment depend on the postcode in which you live. The Guardian, a staunch defender of socialized medicine, reported that the poorer you are, and the more socially deprived your area, the worse your care and access is likely to be.

Inequality in Canada
Canada is another country that puts a high premium on equality of access to medical care. The University of British Columbia routinely finds wide-spread inequality among British Columbia’s twenty or so health regions. Residents of Vancouver, a city with a population of almost two million receive three times more specialist services, five times more internist services, and thirty-one times more psychiatric services than residents of Peace River, a rural area of about 60,000. Spending on all services is three times as high in Vancouver than in Peace River. There is substantial evidence that when health care is rationed, the poor are pushed to the rear of the waiting line. In general, in almost every country, low-income people see physicians less often, spend less time with them, enter the hospital less often and spend less time there. More than 80% of physicians had been personally involved in managing a patient who had received preferential access on the basis of factors other than medical need. Of the patients who had received this preferential treatment, 93 percent had personal ties to the treating physician, 85 percent were high-profile public figures and 83% were politicians.  Studies have also shown that high-profile people received not only preferential treatment, but more frequent services, shorter waiting times and greater choice in specialists.

Access in the United States
Our poorest citizens–those enrolled in Medicaid, a government health program providing free care for more than 40 million people – probably have more access to better health care than the low-income citizens in any other country. Being on Medicaid usually means access to all the technology of the US health care system. Such technology is more available in the United States, and Medicaid will usually pay for it. Even though Medicaid rationing is prevalent, the United States has less rationing than most other countries. In addition to Medicaid, low-income families without health insurance have access to free care at city and country clinics and hospitals. A study by the Texas Comptroller of Public Accounts found that public and private organizations in Texas spend, on average, approximately $1,000 per year on care for each uninsured Texan. This $4,000 per year for a family of four would buy health insurance in many Texas cities.

The Safety Net
In every country, some people slip through the social safety net. But in considering the rationing of medical technology in countries with national health insurance, the United States may have gone further in removing barriers to medical care than any other country in the world. International polls that state that 20 percent of people in the United States have difficulty paying for health care compared to 6 percent in Canada where the politicians think they are providing 100 percent of citizens with free care, probably reflects differences in priorities. I have a number of patients I see on Medicaid who also have difficulty paying for their TVs and cars some of which are larger and more expensive than mine. A colleague met one of his Medicaid patients vacationing in Europe. When the patient happily greeted his doctor, who must have looked surprised, he quickly added that the extended international vacation was courtesy of a member of his family. It must be nice to have that kind of wealth in a welfare family. Obviously such international polls have an agenda that don’t compare identical circumstances.

HealthPlanUSA will Lower HealthCare Costs
An ideal health plan in our country should build on the exceptional safety net we already have for the poorest 15 percent of our population. Our most important mission is to network our efforts so that the other 85 percent are not subjugated to the bureaucratic control of socialized medicine seen throughout the world which has not brought equality to either medical care or access to medical care as Goodman’s study points out. It especially has not improved the quality of care or access to care for the poor. It has simply re-ordered access and privilege to the politicians and the politically connected, rather than to the judicious utilization of health care in a Medical MarketPlace which brings it to the lowest possible cost. This will never happen as long as politicians are in charge of the access and distribution because they will always look out for themselves rather than patients which the above data confirms. It also reconfirms Brink Lindsey, who in the journal Reason, pointed out that the appeal of social insurance for Bismarck, Napoleon, and others  was that it bred dependence on, and consequently allegiance to, the state. To which Lew Rockwell of the Mises Institute added Nicolas II, Lenin, Stalin, Hitler, Mussolini, Salazar, Franco, Hirohito, Peron, and FDR, stating  “What a list. As individuals, most  . . .  have been discredited and decried as dictators. But their medical care policies are still seen as the very soul of compassionate public policy, to be expanded and mandated, world without end.” Social insurance, whether social security, medicare, or single payer medicine, was thus born of a contemptuous disregard for freedom and liberal principles: What mattered was not the well-being of patients, but the well-being of the state.

The Medical MarketPlace
Next week I’m going to two medical conferences in two different cities which points out that the market brings about the lowest possible cost. Normally this three-point flight would be in the $800-$1000 price range. However, the airlines are having difficulty filling their seats. It would not be cost effective to have planes sit idle, or fly nearly empty, so they discount fares to fill the largest number of seats possible. It’s hard for me to believe that I will be flying 4,000 miles for $280. One can’t even ride a bus, train, or drive his own car for seven cents a mile. The same principle would apply to pharmaceuticals. Just like the airlines, if a pharmaceutical company is unable to sell a drug for the average of $120-$150 for a month’s supply in order to recapture the research and development costs before the patent runs out, the price will go down to $100, to $80, to $60, a month or whatever level is required to sell the product to recapture as much of the R & D costs as possible. The Medical MarketPlace will always produce the lowest possible cost. Currently each HMO has a contract with a different drug company for each class of drugs. This results in considerable cost to any practice since rewrites of a prescription for a similar “covered” product ties up staff time. We don’t have to worry about monopolies or price gauging in our country as long as the government stays out of the marketplace, because if the price is too high, someone will come out with a cheaper and better product which will drive the price down. Government involvement in The Netherlands has reduced prices, but many pharmaceutical firms have left the country since they cannot recap their R & D costs. Hence, patients are without many drugs readily available elsewhere.

Why MedicalTuesday?
Tuesdays were the evenings that doctors formerly met to dine together, get to know each other as colleagues, share ideas, listen to and discuss the latest medical information, as well as discuss practice related topics such as those above. (Mondays and Fridays are busy days in any practice. On Wednesdays or Thursdays, doctors took a half day off to compensate for the night and weekend work. Hence, Tuesdays were the logical days for medical meetings.) With the advent of “administrators” and others who became proactive in telling doctors how to practice medicine, these meetings were deemed to be counterproductive to the mission of managed care or single-payer medicine. The meetings essentially disappeared. One administrator actually said it was important to keep doctors out of the decision-making process. The meeting agendas were without substance. Sacramento, a community of 3,000 physicians, had an attendance of less than 30 physicians at two of its quarterly meetings the past two years. Obviously, the doctors voted with their feet overwhelmingly against the canned meeting agenda.

MedicalTuesday is now becoming our nationwide network using the advantages of the electronic age to restore our colleagueal relationships and reestablish the doctor-patient relationship as our primary function and loyalty. We are now reaching physicians and professionals in 18 states. By reestablishing physician dialogue and discussion, we will ward off those who wish to reduce the quality of healthcare under the guise of single-payer control in delivery and quality improvement, when our quality is already the highest in the world. Today we demonstrated that quality, as well as access, deteriorated in countries with national health plans. The ideal and workable HealthPlan for the USA will evolve from these MedicalTuesday electronic gatherings. The problems and frustrations physicians encounter in delivering high-quality healthcare are truly global in nature, as we find from networking with colleagues in 12 countries on five continents. Send your ideas and anecdotes to Info@MedicalTuesday.net

Republishing MedicalTuesday
We have received requests to reproduce the Medical Tuesday e-letter from a journal and a request to re-publish MedicalTuesday as a column from another journal. We hereby grant permission to any non-profit organization to republish this column with attribution as long as a formatted copy of the portion that is republished is sent to Info@MedicalTuesday.net along with the name of the publication and the date. Be sure that your readership is interested in the Medical MarketPlace rather than bureaucratic medicine. Subscription magazines should contact the author below concerning royalties.

MedicalTuesday Recommends
The Greg Scandlen Health Policy Comments as an important source of market-based medicine. You may log on to NCPA (www.ncpa.org) and register to received Greg’s weekly report 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.  You will be able to informally meet Kim West, Executive Director, & Christopher Jones, MD, President, at the annual meeting of the Association of American Physicians and Surgeons in Tucson next week on September 18-21, 2002. You may register on the AAPS site at www.AAPSOnline.org. This meeting will also feature Ann Coulter, JD, who will sign her recent book, Slander, and give an address on “Big Brother and the Future of Medicine”; Wesley Smith, who wrote Culture of Death and Forced Exit, will speak on “The New Bioethics”; Lawrence Stratton, JD, coauthor of The Tyranny of Good Intentions, will speak on “The New System of Justice and Its Impact on Medical Ethics.”

The Association of American Physicians and Surgeons (AAPS) is probably the only remaining medical practice organization that totally supports market based private practice. There still is time to register and network with physicians next week who will be discussing medical ethics; why peer review is flawed; why universal health care cannot work; how to opt out of Medicare before it destroys you or your practice; how Medicare stands between patients and cost-effective health care; and historical, political and economic perspectives of the current crises in medicine. Meet the physicians who have declared their independence from government intrusions into their lives and that of their patients.

Stay Tuned to the MedicalTuesday.Network
Twice a month and have your physician colleagues, business and professional friends do likewise. Each individual was personally known, requested to be placed on our mailing list, or was recommended as someone interested in our cause of making HealthCare affordable to all. 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