Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare, & Medical Practice

 Tuesday, September 14, 2004

MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:
1. Counterfeit Drugs - An Almost Perfect Crime
2. 'Same-day' Doctors Catching On
3. Are Americans "Too Greedy" to Be Trusted with Their Own Spending Decisions?
4. More Americans Have Health Insurance than Ever Before
5. Doctor Gluttony - Cardiologist in Dallas Exclude Their Competition
6. Medical Myths - Peer Review is to Protect Patients from Bad Doctors
7. Overheard in the Medical Staff Lounge - A $650 BandAid - But It's Liquid
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

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1. Counterfeit Drugs - Terrorism's Next Target - by David J Gibson, MD
Dr Gibson has favored us with an advanced copy of his latest article being published this week. For the entire article, go to  http://www.ssvms.org/articles/0409gibson.asp

Pharmaceutical Products not only cost a great deal. They also could be a source of danger. Because of concern over another terrorist attack, alert levels have been issued and defensive resources have been deployed. Amid all of this activity, it is worth reflecting upon the terrorists’ past behavior to predict their next initiative. They have consistently sought to strike us where we were not looking.

From the terrorists’ point of view, the ideal attack will be unexpected, meet minimal resistance and cripple an essential industry. This attack will not only injure Americans, it will also demonstrate that our government is incapable of protecting its citizens.

From the terrorists’ perspective, discrediting the government is much more important than causing physical damage. This ability to discredit is significantly enhanced if a known threat has been ignored. That happened on September 11. That is what is likely to happen again.

America’s Pharmaceutical Inventory
For some time it has been known that the Food and Drug Agency's (FDA) ability to protect the drug inventory in the United States has been compromised. As far back as 1996, the FDA warned that it had lost control over bulk drug shipments that enter the U.S. market. A recent FDA / U.S. Customs investigation revealed that 88 percent of the imported pharmaceuticals examined contain counterfeit drugs. Most counterfeit products are now produced in Pakistan, China, Columbia or India.

Since 1997, some 4,600 foreign drug makers have shipped medication into the U.S. without product inspection. In the past two years, the number of parcels containing prescription drugs entering the US from other countries has risen by 1,000 percent. Current screening by customs and postal authorities is inadequate to stop more than a token amount of prescription drugs being illegally shipped into the United States to individuals, distributors or various buyers’ clubs, wholesalers or storefront pharmacies.

Once in the United States, these prescription drugs journey through a convoluted distribution chain before reaching the consumer. Each link along the way is vulnerable to theft and tampering. Stolen products can readily be resold to wholesalers, where they seamlessly mesh back into the distribution chain.

Only Florida and Nevada have actively investigated the contamination of their drug inventories. A report by Florida's grand jury in 2003 found that counterfeiters "through greed and malice expose our most vulnerable citizens to death or grave injury every day." The report said “the wholesale pharmaceutical industry in Florida has been corrupted by the infiltration of a criminal element which is making a fortune while tainting our drug supply."

An Almost Perfect Crime
Drug counterfeiting is an almost perfect crime. The evidence is destroyed once the medicine is ingested and the packaging is thrown away. If the patient doesn't get any better, the physician and patient, neither being able to visually identify counterfeit product, believe the underlying disease process is causing the problem. The World Health Organization has warned that the trade in bogus drugs could be worth as much as $32 billion a year.

Counterfeiting of medicines is hugely lucrative, due to high demand and low production costs. Profits often rival those of narcotics trafficking –  but the potential misdemeanor penalties for counterfeiting are far lower.
There is mounting evidence that counterfeit drugs have permeated the U.S. drug inventory. FDA Commissioner Mark B. McClellan has warned that the FDA is “increasingly seeing large supplies of counterfeit versions of finished drugs being manufactured and distributed by well-funded and elaborately organized criminal networks."
Unfortunately, drug counterfeiting primarily occurs with the most expensive products. These are medications upon which individuals’ lives depend. Drugs used to treat AIDS, transplants, malignancies and chronic debilitating diseases are generally the target of counterfeiters.

To read the entire article, the extent of the problem, and Dr Gibson's proposed solution, go to http://www.healthplanusa.net/DGTerrorism'sNextTarget.htm.

Dr. Gibson, (DavidJGibson@msn.com) assistant editor of Sierra Sacramento Valley Medicine, the official magazine of the Sierra Sacramento Valley Medical Society, is the CEO of the new Fraud Prevention Institute, a California-based, not-for-profit Company dedicated to eliminating fraud in the health care system. More information is at www.fraudpreventioninstitute.org.

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2. 'Same-day' Doctors Catching On
CNN Health Column notes that if Steve Lunt, aka the "Handyman of Rochester," made his clients wait weeks for an appointment, he'd be out of business before long. But that's how Lunt's health care used to work, and it's the same for millions of other Americans.  "You're just a number," said the 47-year-old Lunt from Rochester, New York. "You go sit in the waiting room for an hour after waiting two weeks to get an appointment."

Life changed for Lunt and his wife when they called Dr. Gordon Moore, one of the growing number of doctors nationwide who have adopted same-day service. The idea, which experts say is gaining steam, is that scheduling patients immediately for even routine physicals will keep them healthier and happier, while saving money in the long run. If people know they'll get quick appointments, the reasoning goes, they're less likely to ignore their health problems, which will reduce costly emergency-room visits.

Moore, 43, who treats the Lunt family at his Ideal Medical Care clinic in the suburbs of Rochester, made the transition three years ago. Tired of working long hours with patients double- and triple-booked into time slots, Moore left the physicians' group he was with and started his own family practice. "People used to be shocked when they'd call up -- and half the time I answered the phone -- and we'd say, 'Come in at 3 p.m.’," said Moore.

"I don't have cranky patients. I don't get the no-show thing I used to have," he said. "My schedule is much more reliable. Doctors make a fine income, that's not the problem. The problem is imbalance and burnout. I have three small children. I want to be there for them."

The majority of patients, however, still wait for their care. A recent survey in 15 cities found that the average wait for a cardiology exam was 19 days. The average wait was 24 days for a dermatology appointment, and 23 days for an obstetrics-gynecology exam, according to the survey by Merritt, Hawkins & Associates, a national firm that recruits medical workers. Boston, despite a worldwide reputation for medical care, had the longest waits in three of the categories surveyed.

The movement is growing slowly but steadily, said Mosley, whose own doctor in Texas has adopted the practice. It came in handy last month when he noticed a bruise on his leg before leaving town on a business trip. He called his doctor, got a same-day appointment, and learned the bruise was from a spider bite. "He got me on antibiotics right away," Mosley said. "I would have been on the road and my leg would have ballooned like a sausage."

His wife, Mary Lou, 45, sees open access as a return to basics. She and her husband were so pleased about their care that they dropped their pediatrician and brought their two children to Moore. "I don't understand why more doctors aren't doing this," she said. "It's very empowering to the patients. It's changed our lives, really, at the risk of sounding dramatic."

To read the entire  article, go to http://www.cnn.com/2004/HEALTH/08/21/no.wait.doctors.ap/index.html.

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3. Are Americans "Too Greedy" to Be Trusted with Their Own Spending Decisions?
Holman W. Jenkins, Jr. of The Wall Street Journal puts Health Care Ownership in perspective. He notes that Mr. Bush has been selling HSAs on the stump for half a year, but nobody apparently listens to the president. HSAs went unmentioned at the Democratic convention, where acknowledging the dilemmas of unconstrained health-care inflation, let alone the potential solution, would violate the free-lunchism of the moment. Indeed, in a delicious episode in House Speaker Denny Hastert's new autobiography, he has Hillary Clinton opposing the Republican approach because Americans are "too greedy" to be trusted with their own spending decisions.

Right. Critics also said only the young, healthy and wealthy would opt for HSAs as just another way to shelter their incomes from taxation. Yet two early promoters of the accounts, eHealthInsurance and Assurant, found this year that more than one-third of their applicants were previously uninsured, two-thirds were over 40, and many were at the lower end of the income scale.

This is surprising only to those who never understood why the tax code was the problem in the first place. Notice that the typical family policy doled out by companies to their employees represents a total price-tag of about $9,086 a year. If you're in the top tax bracket, the effective after-tax cost to you is about $5,500. If you're in the working-poor bracket (i.e., pay no federal income tax), it's $9,086.

In fact, it's doubtful that such an insurance product would even exist in the marketplace in the absence of a massive tax subsidy, given the built-in incentives that naturally drive costs out of sight. Certainly you wouldn't buy gold-plated, first-dollar health insurance if you faced the full tab alone.

Yet even some who know better -- say, corporate America -- would rather lobby the government for more handouts than call for a restructuring of the tax incentive that causes all the trouble. The Big Three, for example, have had a fun time convincing a certain large, national newspaper that because their health spending amounts to $1,400 per car, they're at a disadvantage to Japanese automakers who don't pay for their employees' health care.

Oh yes they do. We all on average pay for what we consume with what we earn. That's true of health care, whether premiums are paid to a private insurer or taxes are paid to support a government-run system.

The Big Three have the same problem we all have: a tax code that waters and fertilizes a great deal of unnecessary, inefficient spending by beneficiaries that payers are at a loss to control. Fourteen hundred bucks per car -- that's roughly commensurate with health care's share of total GDP. No problem here. But consider that GM's health spending amounts to $14,000 per current employee and is growing at, say, 12 percent a year. That translates into $1,680 per year that workers are taking home in additional compensation but don't know it and don't feel it, because the extra money is being hoovered up to maintain existing benefit levels.

Putting a lid on health-care inflation, which means putting a lid on the tax distortion that feeds it, would assuage a lot of social dissatisfactions about stagnant pay and "jobless" prosperity. Benefits managers have cottoned on and talk, without irony, of a "revolution" in health-care finance. JP Morgan and Cigna just teamed up to start offering employers an HSA-style insurance policy coupled with a debit card workers can use for their out-of-pocket spending.

No serious person doubts that our over reliance on third-party payment is the problem that will be solved -- or will lead to a government-run, single-payer system that controls costs by denying care. In our information-rich economy, the medical industry doesn't even publish price lists. Is this not downright weird and a sign change is desperately needed? (The exception is cosmetic surgery, where, as health economist John Goodman points out, consumers pay out-of-pocket and competition has meant prices are flat or falling).

Hope for such boldness . . .  vanished the moment it became clear John Kerry was going backward in the polls. It may be just as well. The HSA revolution suggests that simply offering taxpayers a better choice may be the stealthy way to reform entitlements (and let's admit that the tax deductibility of employer health care is a giant middle-class entitlement) without frightening swing voters with any Big Bang-like proposals.

To read the article, go to http://online.wsj.com/article/0,,SB109399299814206295,00.html.

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4. Government Medicine: More Americans Have Health Insurance than Ever Before
The number of Americans who have health insurance is higher now than at any time in recent history, according to an analysis of the latest Census report by the National Center for Policy Analysis (NCPA). The NCPA also found that the greatest growing uninsured problem is among those who can apparently afford it, with incomes over $50,000 a year. According to Devon Herrick,  “Despite recent economic hard times, there has never been this many people with health insurance.”
    * The number of people with health insurance increased by 1 million people in 2003, to 243.3 million, or 84.4 percent of the population.
    * Meanwhile, the number of people without health insurance grew by 1.4 million, or 15.6 percent of the population.
    * The proportion of children who were uninsured did not change, remaining at 11.4 percent of all children, or 8.4 million in 2003.
    * Households that earn $50,000 per year or more account for about 90 percent of the increase in the number of uninsured over the past 10 years.  And almost two-thirds of that has occurred among households earning more than $75,000 per year.
    * Since 1993, the number of uninsured in households with annual incomes above $75,000 increased by almost 128 percent. By contrast, the number of uninsured with annual incomes below $25,000 fell by an estimated 15 percent.
Health Insurance in America is often a matter of choice,” said Herrick.  “Most uninsured people either can afford health insurance or qualify for government-sponsored health care programs; they just choose not to enroll.

The NCPA is an internationally known nonprofit, nonpartisan research institute with offices in Dallas and Washington, D. C. that advocates private solutions to public policy problems.  They depend on the contributions of individuals, corporations and foundations that share their mission.  The NCPA accepts no government grants.

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5. Doctor Gluttony - Cardiologists in Dallas Exclude their Competition
Peer Review, the battle between hospital doctors and their competition, has met its match. Terry Maxon, of The Dallas Morning News, reports that a Dallas federal district court jury awarded a Dallas cardiologist more than $366 million in damages against Presbyterian Hospital of Dallas and three doctors who helped suspend his right to perform heart catheterizations.

Dr. Lawrence Poliner had sued in 2000, two years after the chairman of Presbyterian's Department of Internal Medicine demanded that he voluntarily stop performing cardiac catheterizations or face termination.

The jury agreed that the hospital and the three doctors were liable on several grounds, including breach of contract, defamation, interference with contractual relations and intentional infliction of emotional distress, said Charla Aldous, one of Dr. Poliner's attorneys. "Dr. Poliner is relieved that the jury saw the truth and hopes that this verdict will be beneficial to promote the quality of patient care and the integrity of the peer review process," Ms. Aldous said.

In May 1998, Dr. James Knochel, internal medicine chairman, forced Dr. Poliner to quit doing catheterizations while the hospital reviewed his work. A month later, a peer review committee of doctors, most of whom competed for patients with Dr. Poliner, summarily suspended his "cath" and "echo" privileges at Presbyterian. In November 1998, the hospital's medical board voted to restore Dr. Poliner's privileges after a number of nationally recognized cardiologists in a hearing stoutly defended the quality of Dr. Poliner's work. However, the medical board also upheld Dr. Knochel's earlier decision to suspend Dr. Poliner's privileges. The suit alleges that doctors who were competing with Dr. Poliner for patients accused him of poor patient care, and that Dr. Knochel and Presbyterian relied on the competitors rather than independent reviews to conclude that Dr. Poliner's right to perform catheterizations and echocardiograms should be suspended.

Dr. Poliner alleged that the actions severely damaged his practice because doctors quit referring patients to him and another hospital declined to give him privileges. The jury awarded Dr. Poliner, 60, about $141 million to be paid by Dr. Knochel, $32 million each from Dr. Harper and Dr. Levin and $161 million from Presbyterian.

Dr. Poliner, who graduated from Cornell University Medical School in 1969, formerly taught at the University of Texas Southwestern Medical School and Baylor College of Medicine in Houston and had been director of internal medicine at Reese Air Force Base in Lubbock.

To read the entire report by Terry Maxon, please go to http://www.dallasnews.com/s/dws/news/localnews/stories/082904dnmetpresbyterian.a8bd3.html.

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6. Medical Myths - Peer Review is to Protect Patients from Bad Doctors

In section five above, the courts have ruled that "Bad" cardiologists weeded out a "good" cardiologist by using the hospital process called Peer Review which was designed to accomplish the reverse. John H. Fielder, PhD, has a chapter on Abusive Peer Review and Health Care Reform in the HEALTH CARE CRISES - The Search for Answers, Edited by Robert I Misbin, MD, Bruce Jennings, MA, David Orentlicher, MD, JD, and Marvin Dewar, MD, JD. (http://healthcarecom.net/bkrev496.htm)

In Section II, Dr. Fielder discusses three cases of Peer Review abuse: Dr Timothy Patrick formerly of Astoria, Oregon, Dr Deane Hillsman, of Sacramento, and Dr William Reid of Oak Ridge, Tennessee. He states that these three cases illustrate failures of the peer review system in medicine, a quality control procedure, and its misuse by removing competent physicians for primarily financial rather than medical reasons. Dr Fielder cites examples in which estimates of peer review initiated for economic reasons may be as high as 70%. What we are seeing, he states, is a disturbing pattern of reliance on peer review to remove unwanted doctors, frequently for underlying financial reasons.

Dr Fielder feels hospital bylaws are fatally deficient in due process and fail to protect competent doctors who are falsely accused. It provides a convenient means for unscrupulous hospitals and physicians to remove doctors who are a threat to their interest. He states that it is difficult for physicians who have received unfair peer reviews to succeed in a lawsuit against the hospital because of the extensive legal shielding of the peer review process by courts and legislatures. Dr Fielder predicts that with the growth of managed care, economic pressures on physicians will increase and we can expect to see a corresponding growth in abusive peer review.

In Sacramento, one of the three hotbeds of abusive Peer Review cited by Fielder, the physician involved was so arrogant that he said, "All doctors are objective even when they are judging competitive doctors." The other side of that coin is even worse. That physician did a liver biopsy on a patient who was on a ventilator. The liver rides with the diaphragm with each respiratory cycle and the patient is asked to exhale and hold his breath while the biopsy needle goes in and out of the liver. In a patient on a mechanical ventilator, the respiratory therapist stops the ventilator momentarily in full expiration, while the biopsy occurs. This physician who felt he was so objective in eliminating another pulmonologist for inferior work, despite all of his favorable outside reviews, failed to have his assistant hold the ventilator while he went into the liver for the biopsy. The process of having a needle in the liver, while the ventilator was pushing his liver up and down, caused a fatal tear in the liver. The medical records clerk was so nervous when this physician came in to change the record post mortem after confirmation of an iatrogenic death, that she notified the medical staff and the medical board so it wouldn't be on her conscience. Needless to say, neither the hospital nor the Medical Board of California took any action and this physician continued his progression to the administrative ranks of the medical staff.

Yes there is a myth floating around in the world that Peer Review is necessary to protect us from bad doctors. However, in practice, Peer Review, more often than not, protects bad doctors at the expense of good doctors who are generally non political and simply want to take care of their patients and are doing a good job of it. This is another case of where advocacy in organized medicine and unionized medicine, designed to protect doctors, is actually hurting, not only doctors, but also their patients.

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7. Overheard in the Medical Staff Lounge  - A $650 BandAid - But It's Liquid

Dr Thompson was referring to a column by Bob Shallit in the Sacramento Bee which is always available in our staff room. The son of a spokeswoman for CalPERS, an organization concerned with the rising health care costs, cut his finger. She took him to the local emergency room. The nurse took a look at the small cut and decided stitches were not need and applied a liquid Band-Aid to seal the cut and sent him home. A couple of weeks later, the bill came in. Seven hundred dollars for the Band-Aid. Her insurance paid $650 and wrote off $50. The CalPERS spokeswoman said she gained a new appreciation for the plight of those without insurance. She also advises "Don't go to the ER for a quarter-inch cut."

It is important to look at the basic economic issues before we are too critical and come to the conclusion that single-payer health care would solve the problem. This patient already had health care coverage and the insurance paid the exorbitant amount. The hospital by government mandate must provide an emergency room providing coverage 24 hours a day. Let us assume for sake of discussion that this emergency room has a basic overhead cost for the rent, supplies, high tech equipment, doctors, nurses, orderlies, attendants, x-ray technicians, lab technicians, CT technicians, MRI technicians, and a host of other support crew that totals $10,000 per day. If only ten patients come in per day, that means that every patient, including those requiring just a band-aid, would have to pay on the order of $1000 per visit. (Our review of our respiratory patients visiting the ER came to $930 per visit.) If five of the patients are Medicare, Medicaid, HMOs and others with a contract at $500 per visit, then the five patients without insurance have to be charged $1500 per visit. Since government mandates forbid discrimination, the non-discounted fee has to be $1500 per patient per day.

Let's now assume that we have market-based insurance with a deductible equal to the average maintenance cost of our bodies, which is not insurable, plus a copayment of say 20 percent for emergency room or urgent care coverage. In the free market, prices are always displayed. This lady, seeing the sign for $700 minimum charge for an ER visit, would have taken a look at her son's finger, which presumably she had already dressed with a band-aid, and made an immediate decision concerning costs vs benefits. She would have called her personal physician and if on a work day, traded the $700 ER visit for a $100 office visit or she would have utilized her mother instincts and made sure it was cleaned, added Peroxide or Betadiene, and after it dried, placed another band-aid on it.

Thus without any government mandates, or populist name calling, the health-care situation would resolve itself in a free economy without a call for single-payer medicine which would not have changed this lady's problem–only worsened it. Maybe going home at midnight still waiting to be seen.

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8. 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, 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. MedicalTuesday members and readers are knowledgeable with Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter the first twenty months of its existence. Next month, Lives at Risk, the definitive work on Single-Payer National Health Insurance around the World will be published. This advance copy received last week by John C Goodman, PhD, Gerald R Musgrave, PhD, and Devon M Herrick, PhD, shows that the United States has the best health care system in the world. Watch this space and MedicalTuesday as we bring you important details.

• The Mercatus Center at George Mason University (www.mercatus.org) 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. The Mercatus Center and Weidenbaum Center Release Annual Regulator's Budget Report by Susan Dudley and Melinda Warren. It is important to monitor the changes in federal regulatory employees and spending at http://www.mercatus.org/regulatorystudies/article.php/796.html.

• 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 onto their website at www.galen.org. A survey sponsored by America's Health Insurance Plans (AHIP) finds that 71 percent of Americans have a favorable opinion of HSAs, including 67 percent of Democrats and 62 percent of self-described liberals, while only 22 percent have an unfavorable opinion. This is despite the fact that 68 percent of the people who already have coverage on their jobs expressed satisfaction with their current coverage. To read her most recent newsletters go to http://www.galen.org/hpm_archives.asp

• 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/ccm_archives.asp. 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 Medical Savings Accounts (MSAs) which have became Health Savings Accounts (HSAs). Join in the excitement of the current issue by reading about the "Rapid Acceleration in HSA Activity" at http://www.galen.org/ccbdocs.asp?docID=676.

The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor.  The September issue of Health Care News features the seventh in the eight-state series of case studies, this one addressing New Hampshire--where elected officials have repealed community rating and guaranteed issue mandates adopted in 1994. Download the PDF version at http://www.heartland.org/Article.cfm?artId=15525.

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, has 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 month we feature columnist, Donald J. Boudreaux, whose current article Thoughts on Freedom - Playing by the Rules has some important corollaries on the mythical rules being tossed around in the health-care field which we discuss in every issue of MedicalTuesday.

• The Council for Affordable Health Insurance, http://www.cahi.org/index.asp, 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 read about how Health Insurance Mandates are raising the cost of health insurance and state legislators only have themselves to blame. While there were only a handful of mandates in the '60s, now there are 1,823 across America. Download the PDF version of the State-by-State Breakdown of Health Insurance Mandates at http://www.cahi.org/cahi_contents/resources/pdf/Mandatepub2004Electronic.pdf.
To eliminate the uninsured problem, the politicians should pass just one law - eliminate all mandates and all community ratings - and then get out of the way of the problem so the solution can occur. Nothing is more ruthless in reducing costs than the free market. Ever hear of WalMart?

• 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 at http://www.factcheckers.org/. This week read the Rhetoric vs. Reality: Employer Views on Consumer-Driven Health Care and then Greg Scandlen's response pointing out that using data from two years before HSAs were implemented doesn't even speak to employer's response to HSAs. Another Medical Folly: “Woeful Tales from the World of Nationalized Health Care.” Health Care so bad that a donated kidney is lost for lack of a transplant surgeon, http://www.factcheckers.org/showArticleSection.php?section=follies. Or read the original report in The Guardian at http://www.guardian.co.uk/medicine/story/0,11381,1236176,00.html.

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. Be sure to sign up for the monthly Health Care Policy Center Newsletter at http://www.i2i.org/healthcarecenter.aspx.  Read her latest newsletter at http://www.i2i.org/hcpcjune2004.aspx which includes a section on PC Medicine and Euthanasia.  If you missed her excellent article on “Compulsory Evidence-Based Medicine: An Unproven Idea That Shouldn’t be Law,” go to http://www.i2i.org/articles/2004-F.pdf.

• This week we would like to introduce MedicalTuesday members to The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to go to the "About NAHU" page and read the Code of Ethics which I believe that the thousands of physicians, nurses, allied health specialists, medical writers, insurance executives, actuaries, accountants, administrators, business people, patients, and attorneys that read MedicalTuesday can support.

• Martin Masse, Director of Publications at 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 their webzine on a regular basis. This month, read one of Martin Masse's past editorials on the Five Essential Libertarian Attitudes: 1. Take full responsibility for one’s actions; 2. Reject collective abstractions; 3. Tolerate other beliefs and ways of life; 4. See the human future with optimism; and 5. Aim at a constant improvement over the long term rather than immediate perfection. Even though we may not be Libertarians, Martin gives us a lot of food for tolerance.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well-being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at http://www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at http://www.fraserinstitute.ca/health/index.asp?snav=he. This week, read the Generic Drugopoly: "Why Non-patented Prescription Drugs Cost More in Canada than in the United States and Europe.”  Brett J. Skinner reports that "Studies comparing international prices of prescription pharmaceuticals have found that Canadian prices are close to the international median price for patented drugs but higher for non-patented single-source (usually brand-name) drugs, and also higher for non-patented multiple-source (mostly generic) drugs. Furthermore, in studies comparing Canadian to American drug prices, it has been found that Canadian prices are significantly lower overall for patented drugs, but are usually higher than American prices for generic drugs. Read entire article at http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=685.

• The Heritage Foundation, http://www.heritage.org/, 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. This week, if you’re open minded and welcome a total change of pace, read Richard Swenson, M.D, on "Why It's Time for Faith-Based Health Plans" at http://www.heritage.org/Research/HealthCare/hl850.cfm.

• 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.  Dale Steinreich wrote on the 100 year history of the Council on Medical Education of the American Medical Association in June titled: "100 Years of Medical Robbery." It can be read at http://www.mises.org/fullstory.aspx?control=1547&id=71.  Dr Steinreich received such an overwhelming response that he wrote "Real Medical Freedom" at  http://www.mises.org/fullstory.aspx?control=1588 last month. If you're interested in health care and the causes of many of our current problems, these articles are worth saving or book marking, and printing out for study. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see http://www.lewrockwell.com/klassen/klassen46.html.

CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens’ ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at  http://www.cato.org/people/cannon.html. The current "buzz" word seems to be ownership society in response to President's Bush statement that he wants America to be an “ownership society.” Cato has established a new website for this which David Boaz defines: An ownership society values responsibility, liberty, and property. Individuals are empowered by freeing them from dependence on government handouts and making them owners instead, in control of their own lives and destinies. In the ownership society, patients control their own health care, parents control their own children's education, and workers control their retirement savings. Read his article at  http://www.cato.org/special/ownership_society/boaz.html.

The Ethan Allen Institute (http://www.ethanallen.org/index2.html) is one of some 41 similar but independent state organizations (click on "Links") associated with the State Policy Network (SPN) (http://www.spn.org/newsite/main/). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of “educating for liberty.” It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log onto www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for it's national rankings in the USNews College rankings. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, be sure to read the current issue of Imprimis by Dr John R. Lott, Jr, on "Media Bias Against Guns" at http://www.hillsdale.edu/newimprimis/default.htm.  The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

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Del Meyer

Del Meyer, MD, CEO & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

 Medical Aphorisms

Why do the best doctors have the sickest patients?
Why are Good doctors usually bad patients?
Under Medicare, even the bills are doctored.

 Some Recent Postings

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 On This Date in History - September 14

On this date in 1814, Francis Scott Key wrote "The Star Spangled Banner" in Baltimore Harbor as he watched and waited to see whether the flag would still be there to signal that the United States had turned away the British invaders in the War of 1812. He ask the words, "Oh say can you see, by the dawn's early light," whether the star spangled banner still waved which has been uttered at more meetings in the United States than any other phrases known to man. The British had just burned our national capitol in Washington and if they had succeeded in taking Baltimore, that might have been the end of the United States of America.

On this date in 1849, in Ryazan, Russia, Ivan Pavlov was born. It was Pavlov who showed how animals could be trained to react in specific ways to specific signals. Since then, it has been shown that the whole course of life conditions us to certain reflex actions, even the closing of our minds to things we do not wish to hear.

On this date in 1883, Margaret Higgins Sanger, who was trained as a nurse, was born. She devoted her life to birth control, until her death in 1966. When she began her fight, birth control was a dirty word, contraceptive information was classified as obscene and barred from the mails and she was arrested on obscenity charge, though the case never went to trial. Thanks to her single-minded efforts, people are able to speak more freely and she helped to make freedom of speech a reality.

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