MEDICAL TUESDAY . NET                         NEWSLETTER


Community For Better Health Care               Vol IV, No 12, Sept 27, 2005

In This Issue:


1.         Featured Article: Survey of Higher Education - America's System of Higher Education Is the Best in the World. That Is Because There Is No System – The Economist

It is all too easy to mock American academia. Every week produces a mind-boggling example of intolerance or wackiness. Consider the twin stories of Lawrence Summers, one of the world's most distinguished economists, and Ward Churchill, an obscure professor of ethnic studies, which unfolded in parallel earlier this year. Mr Summers was almost forced to resign as president of Harvard University because he had dared to engage in intellectual speculation by arguing, in an informal seminar, that discrimination might not be the only reason why women are under-represented in the higher reaches of science and mathematics. Mr Churchill managed to keep his job at the University of Boulder, Colorado, despite a charge sheet including plagiarism, physical intimidation and lying about his ethnicity.

With such colourful [sic] headlines, it is easy to lose sight of the real story: that America has the best system of higher education in the world. The Institute of Higher Education at Shanghai's Jiao Tong University ranks the world's universities on a series of objective criteria such as the number of Nobel prizes and articles in prestigious journals. Seventeen of the top 20 universities in that list are American (see table displaystory.cfm?story_id=4339960); indeed, so are 35 of the top 50. American universities currently employ 70% of the world's Nobel prize-winners. They produce about 30% of the world's output of articles on science and engineering, according to a survey conducted in 2001, and 44% of the most frequently cited articles.

At the same time, a larger proportion of the population goes on to higher education in America than almost anywhere else, with about a third of college-aged people getting first degrees and about a third of those continuing to get advanced degrees. Non-traditional students also do better than in most other countries. The majority of undergraduates are female; a third come from racial minorities; and more than 40% are aged 25 or over. About 20% come from families with incomes at or below the poverty line. Half attend part-time, and 80% of students work to help support themselves.

Wealth clearly has something to do with it. America spends more than twice as much per student as the OECD average (about $22,000 versus $10,000 in 2001), and alumni and philanthropists routinely shower universities with gold. History also plays a part. Americans have always had a passion for higher education. The Puritans established Harvard College in 1636, just two decades after they first arrived in New England.

The main reason for America's success, however, lies in organisation [sic]. This is something other countries can copy. But they will not find it easy—particularly if they are developing countries that are bent on state-driven modernisation [sic].

The first principle is that the federal government plays a limited part. America does not have a central plan for its universities. It does not treat its academics as civil servants, as do France and Germany. Instead, universities have a wide range of patrons, from state governments to religious bodies, from fee-paying students to generous philanthropists. The academic landscape has been shaped by rich benefactors such as Ezra Cornell, Cornelius Vanderbilt, Johns Hopkins and John D. Rockefeller. And the tradition of philanthropy survives to this day: in fiscal 2004, private donors gave $24.4 billion to universities. . . .

The second principle is competition. Universities compete for everything, from students to professors to basketball stars. Professors compete for federal research grants. Students compete for college bursaries or research fellowships. This means that successful institutions cannot rest on their laurels.

The third principle is that it is all right to be useful. Bertrand Russell once expressed astonishment at the worldly concerns he encountered at the University of Wisconsin: “When any farmer's turnips go wrong, they send a professor to investigate the failure scientifically.” America has always regarded universities as more than ivory towers. Henry Steele Commager, a 20th-century American historian, noted of the average 19th-century American that “education was his religion”—provided that it “be practical and pay dividends”. . . .

. . . Most universities in other countries distribute power among the professors; American universities have established a counterbalance to the power of the faculty in the person of a president, which allows some of them to act more like entrepreneurial firms than lethargic academic bodies. . . .

To read more about academic meritocracy and education risks as government and society modify education which should be warning signals for single payer medicine, please review the original article at (print subscription required)

[Americans outside of Medicare, Medicaid, VA, and HMOs, may also have the best healthcare in the world for the same reason. That is because there is no system.]


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2.         In the News: How Japan’s Koizumi Is Privatizing Their Post Office, the Largest Bureaucracy in the World. 

The Man, Not the Plan by Michael R. Auslin, WSJ, September 13, 2005; Page A16

Junichiro Koizumi has pulled off the unthinkable: A smashing electoral victory that would be the equivalent of carrying 49 states and 525 electoral votes in an American presidential election, were his. The Japanese prime minister humiliated not only the main opposition, but also the "rebels" from his own Liberal Democratic Party, whose resistance to his sweeping postal reform bill provided the impetus for the election. He gave the LDP 296 of 480 seats in the lower house, a two-thirds majority when combined with coalition partners. He is claiming a mandate to reintroduce his bold plan to privatize the postal system, along with its approximately $3 trillion in assets. He has, it seems, firmly steered the Japanese ship of state into the strong current of administrative and economic reform he's been promising since taking the premiership in 2001.

Sober reflection on the election's outcome, however, raises questions about the true strength of the victory and the message voters were really sending. Far from a powerful affirmation of Mr. Koizumi's policies on the merits, the results reflect the lack of a viable opposition, as well as the citizenry's willingness to indulge bold schemes -- the details of which few really grasp, and which are so far in the future that they seem painless ways to endorse the idea of reform. Ironically, it is Japan's domestic stability that allows Mr. Koizumi to dramatize politics without appearing to be reckless.

Despite what many observers claim, the election was always more about personality than policy. Leading up to the votes on postal reform, Mr. Koizumi cunningly portrayed himself as David versus the Goliath of old machine-style LDP politics. His oft-repeated claim that he would "destroy" the party if it didn't pass his reform package grabbed the attention of an electorate starved for dramatic, meaningful politics.

And theatrical it was. The lower house, in a vote covered live on TV, passed the postal reform measure by a mere three votes, making the upper house vote crucial, since it was clear Mr. Koizumi did not have the votes in the lower house necessary to override the senior chamber. He lost the (again, televised) vote in that chamber decisively, thanks to the resistance of 20 LDP holdouts. He immediately dissolved the lower house, called a snap election and sacked a minister who refused to sign the dissolution decree.

Like many successful politicians, Mr. Koizumi is blessed with weak opponents. The LDP rebels symbolized the worst of the old system, coming off as backroom dealers beholden to special interests and championing the status quo. As for the opposition, Katsuya Okada, the head of the Democratic Party of Japan (DPJ), seemed unable to convince even himself that his party would triumph. He subsequently resigned to take responsibility for the debacle on Sunday. By contrast, Mr. Koizumi played the charismatic leader, a part he's perfected over the last four years. The battle was over before it was joined.

Mr. Koizumi's masterstroke was to make the election a referendum on the future of the LDP. This not only highlighted his progressive leadership against the forces of stagnation, it sucked the oxygen out of the DPJ's campaign. No one was listening to a party that seemed sidelined by the main event. Despite recent electoral successes, this election showed that the DPJ never established legitimacy as a true opposition party, especially since its founders had all come from the LDP. The DPJ dropped to 113 seats from 175, and was crushed by the LDP in the urban areas where it supposedly drew its strength: The LDP took 23 seats in Tokyo's wards, compared to just one for the DPJ. . . .

Likewise, the generally good economic indicators and the visual evidence provided by bustling city centers make the gamble of distant administrative reform seem palatable. Take away such conditions and it is questionable whether the traditionally conservative Japanese electorate would be willing to put up with Mr. Koizumi's quixotic trajectory. For his political opponents, then, there is always hope -- but their victory would come at a high price for Japan.

Mr. Auslin teaches Japanese history at Yale. To read the entire article, please go to (subscription required),,SB112657866783238964,00.html.

[This Gives Hope for the Healthcare Bureaucracy Throughout the World.]

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3.         International Medicine from the NHS: Healthcare May Be Free but Optional Extras (Like GP Appointments) Can Now Cost £250.

By Andrew Alderson and Tony Freinberg, (Filed: 11/09/2005) [Sept 11]

Patients are being made to pay more than £250 a year to guarantee an appointment with their family doctors. Surgeries across the country are encouraging National Health Service patients to switch to a private service if they want to ensure that they can see a doctor within 24 hours or have home visits.

Critics of the growing trend call it is "extremely alarming" and say it in effect guarantees a "two-track" health system. Many fear that it is only a matter of time before a significant number of general practitioners go the same way as dentists and offer only a private service.

Some have already quit the NHS, such as Dr Richard Willis, who set up his Salisbury Independent Medical Practice as a reaction to "intolerable political interference".

The revelation comes just days after official figures disclosed that millions of people are unable to get urgent appointments with their GPs. A survey from the Healthcare Commission, the Government watchdog, showed that almost five million patients have to wait longer than the 48-hour target set by ministers.

One practice in west London introduces its patients to an alternative "private" service on its website. The Bedford Park Surgery devotes a section on the site to the merits of private health care, describing it as "a comprehensive service with same-day appointment guarantee, 24-hour on call, reasonable charges".

The site lists its charges which include £255 a year for an adult, £395 for a couple and £575 for a family. There is an extra charge of £100 for a weekend or night home visit and £55 for a day home visit

At the Mayfair Medical Clinic, also in London, patients can either see the doctor on the NHS or pay £50 to go as a private patient. A private out-of-hours visit costs £100. When telephoned, the practice manager said: "Obviously, if you wanted to come as a private patient the only advantage is that we would give you an appointment. That's what you're paying for."

Other surgeries, from Yorkshire to Hampshire, offer similar private options where patients can get quicker and longer appointments with their GPs in exchange for paying an annual fee.

The findings were condemned last night by Michael Summers, the chairman of the Patients' Association pressure group. "The existence of a two-track health system is extremely alarming. Patients have already paid for their healthcare on the NHS and they continue to pay for it - and they shouldn't have to pay further fees in order to get an appointment," he said.

"It all seems a little strange - if you're a doctor, either you have availability or you don't. Frankly, allowing patients to pay for a private booking may be legal but it doesn't seem appropriate."

To read the entire article, that points out the doctors organization is in the government camp of socialized medicine and against private practice, please go to

When bureaucratic government healthcare becomes entrenched, competition becomes anathema.

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4.         Medicare: The NCPA Suggests Allowing Seniors to Choose Rather than Reform

As currently structured, Medicare pays the many small bills that the elderly could easily afford and does not pay the catastrophic expenses that could devastate them financially. Medicare is in need of serious reform.

The National Center for Policy Analysis proposes an alternative: allowing participants to choose among competing, private-sector insurance plans. For example, most Medicare participants could obtain catastrophic insurance to cover all expenses over a high deductible (say $3,000 or $4,000) and set up a Medical Savings Account to help pay expenses below the deductible. To finance the MSA and catastrophic insurance, Medicare would pay the private plan a portion of the funds (say, 90 percent) it otherwise would expect to pay.

To estimate the effects of the Medicare MSA proposal, this study made the following assumptions:

*Forty percent of Medicare spending is reserved for the 5.2 percent of high-risk enrollees; they would continue in the current program.

*Sixty percent of spending is redirected to a combination Medical Savings Account-catastrophic insurance program for the remaining 94.8 percent of enrollees.

*Private plans that accept Medicare enrollees would receive a risk-adjusted premium reflecting expected health care costs.

*The 33 million enrollees would effectively face a doubling of copayments — most of the increase paid out of MSAs funded by the difference between the costs of the catastrophic policy and the amount paid to beneficiaries.

*Because copayments would be effectively doubled, the National Center for Policy Analysis/FiscalAssociates Health Care Model finds that demand for health care would decrease. Because lower demand would ease pressure on medical prices, the rate of increase in health spending would slow.

* By the year 2005, Medicare spending would be 18 percent lower than currently projected spending, and total U.S. health care costs would be 8.7 percent lower.

* Hospital and home care costs — heavily subsidized by Medicare — would decrease by 16.3 percent.

* Spending on drugs and devices — not heavily subsidized by Medicare — would increase by 7.6 percent.

* An increase in the production of other goods and services would outweigh the resulting reduction in medical services.

* By the year 2005, annual GDP would be $55 billion (or 0.4 percent) higher than otherwise.

* Although spending on health care would decrease by $186 billion, the output of other goods and services would increase by $241 billion.

* There would be 367,000 more jobs than otherwise, and labor income would have increased by almost one-half trillion dollars between 1997 and 2005.

* Despite improved economic conditions, the stock of U.S. capital would be $179 billion lower due to the switch in demand from the relatively capital-intensive health care sector (e.g., hospitals) to other sectors of the economy.

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

Ronald Reagan

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5.         Legislative Gluttony: Have Funds Will Travel

France, Maui, Vegas - legislators hit the road using campaign cash, By Jim Sanders - Sac Bee Capitol Bureau

California State Sen. Kevin Murray has jetted to France, Cuba, Hawaii, Mexico, Boston, New York and Washington, D.C., during the past three years, paying the $36,000 tab with money solicited from political supporters.

Sen. Jim Battin has taken his family on two weeklong Hawaii vacations with campaign funds, staying at the posh Sheraton Maui hotel, where Battin spent mornings at a conference hosted by one of the state's most powerful labor unions.

Assemblyman Ron Calderon has spent nearly $30,000 on trips to the gambling mecca of Las Vegas - including 33 payments to the Mandalay Bay, Bellagio, Venetian or Las Vegas Hilton casino resorts - since he assumed office in 2002. . . .

Voters who contribute to their favorite politicians have no assurance the money will be used for get-out-

the-vote drives rather than round-trip airline tickets. Fifty-two of 95 incumbent legislators serving in 2003 and 2004 tapped into campaign funds for out-of-state travel during that period, according to records filed with the secretary of state.

The lawmakers collectively spent nearly $300,000 - perhaps much more because of limited reporting requirements - on trips that ranged from personal excursions to special-interest conferences to political-party events or state-sanctioned visitations.

Assemblyman Ed Chavez, D-La Puente, used campaign coffers to pick up the tab not only for himself but also for legislative employees during a Las Vegas trip in November 2003. He held a two-day staff retreat at the Bellagio Hotel, spending more than $4,000.

California law allows legislators to go anywhere in the world and spend unlimited campaign funds for job-related travel, taking their spouses and children with them if they desire.

By leaving the Capitol, lawmakers say, they can see firsthand how other states or nations have handled problems - such as electricity production - or they can push for increased trade or other benefits. But abuse or extravagance in travel can be hard to spot because of the state's limited disclosure requirements. Legislators must disclose the total of any payments made, but not with whom they met or what public purpose was served.

The result is that records will show $700 paid to United Airlines with no destination listed, for example, or $4,000 to a Las Vegas resort with no indication how the money was spent.

"Politicians depend on the inability of the public, including the press, to really get to the bottom of their politicking," said Doug Heller of the Foundation for Taxpayer and Consumer Rights, a nonprofit consumer advocacy group. "They depend on the lack of transparency to hide their self-indulgence."

When Sen. Edward Vincent visited his hometown of Steubenville, Ohio, last year, he spent $593 at the Holiday Inn and $469 for meals at Damon's Grill. Asked the purpose of his trip, however, the Inglewood Democrat said he could not remember.

Campaign funds are private donations, not public funds, but they were solicited to benefit public elections, and state law requires them to be spent for a political, legislative or governmental purpose.

Trips bankrolled by campaign dollars are given little scrutiny, however. Only one of every four legislative races is randomly audited - by the Franchise Tax Board - after statewide elections. Few abuses are found, records show.

Assemblyman Joe Canciamilla, D-Pittsburg, said he believes that most trips are legitimate.  “You're electing people to make decisions over your life," he said. "If you can't trust their judgment on buying a plane ticket to New York, then you shouldn't be voting for them. "I understand that there are abuses, and I understand that people take advantage of the situation. I don't think it's widespread."

Legislators largely decide for themselves what limits to set on job-related travel. Some decline to use campaign funds even for state or national conventions of their political party.  Assemblywoman Lois Wolk, D-Davis, said she would expect to pay her own tab. "It's hard for people to give me money in my district. It's not easy to raise it," Wolk said. "And I try to take good care of it and use it for what it was intended, which is to run my race."

Bob Stern, president of the Center for Governmental Studies in Los Angeles, said travel can be a good thing for the political process - exposing lawmakers to new possibilities. "I think that in almost all cases there's some legitimate reason for a trip - the question is, how legitimate?" he said. "That's pretty easy to determine if it was for a League of California Cities conference or a party convention. It's when they go to Paris, London, Hawaii and those kinds of places that it gets a little dicey."

Stern said traveling money typically is no object because few legislative races are hotly contested. "It shouldn't necessarily be called campaign money any more, because they don't always need it for campaigns," he said. . . .

"They say the best way to lobby legislators is to be on a private jet with them," Stern said. "Even if they want to leave, they can't. ... Like they say in the MasterCard ad: Priceless."

To read the entire article, please go to

MedicalTuesday has always supported transparency in hospital charges. We should also demand transparency in politicians’ income and expense accounts.

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6.         Medical Myths: Single-Payer Health Care Would Provide More Care to Everyone

The NCPA reports that Britain and Canada, for example, have fewer physicians per capita than the U.S. To adopt a single-payer system with resource allocation similar to Canada, the U.S. would have to fire around 171,000 physicians. Those doctors who remained would have to see, on average, 921 additional patients per year to match the average number of patients seen by Canadian physicians. As a result, the length of time patients spend with their physician during an office visit would likely be shorter.

Because of these factors, virtually all countries with a single-payer system of national health insurance experience chronic equipment shortages and long waiting lines for treatment (not to mention higher taxes). Waiting lists exist simply because there aren't enough specialists, treatment beds and operating facilities to accommodate patients needing care. Thus, care is given to those patients most likely to benefit - at the least cost. For instance, in England, the shortest waiting lists are often for non-critical procedures, while life-threatening ones require longer waiting times.

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7.         Overheard in the Medical Staff Lounge: How Do You Deal with Senility in the Senate?

Dr Edwards:  Judge Robert’s hearings made you realize that the time for term limits for Senators has arrived. Two members of the Senate Judiciary committee couldn’t remember their questions after they had completed them. Since Senators with Senile Dementia don’t have the courtesy to resign from the Cesspool, as one editorial put it, Senators should be limited to two or at most three six-year terms. And while we’re writing constitutional amendments, let’s limit Representatives to three four-year terms with half staggered each two years. And let’s get rid of this “One man-one vote” Supreme Court ruling. Since Senators represent a geographic area, or one state, with some states representing up to 30 times as many votes as others, each representative should represent a county or two counties at most with the larger counties having a second or third representative to eliminate gerrymandering where many votes don’t count at all.


Dr Michaels: Looks like WalMart was better mobilized and provided greater assistance to the New Orleans area either New Orleans or Louisiana. When the front line of disaster management was so incompetent that they didn’t even order the school bus drivers to drive their buses to higher ground  (we observed them immersed in water), it’s no wonder they tried to place the blame elsewhere. Maybe we should have Sam Wall run the city and the state. [For Wal-Mart Hurricane relief efforts for Katrina and Rita, see]

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

Disinformation Technology

Luther F Cobb, MD, president of the Humboldt-Del Norte County Medical Society, wonders whether IT has been mislabeled and really should be DT (Disinformation Technology). He observes that a keystroke menu can insert a large amount of data into the EMR [Electronic Medical Record] on the disease the patient has but otherwise has no relevance to the patient consultation. He notes:

"As we all know, there is great interest, both within and outside the medical profession, for converting to electronic medical records. Many are the benefits alleged to be derived from a massive conversion of medical information to an interchangeable, portable, and easily retrievable set of medical data. Many of us wonder why the medical profession has been slower to take advantage of the apparent advantages inherent in the easy exchange of information, which has been fundamental to other, seemingly similar, professional areas. Certainly, pundits outside the profession are asking this question of us. Recently, I saw an interview with Newt Gingrich on The Daily Show, which I regard as probably the best source of commentary and criticism of the political scene today. It turns out that Mr. Gingrich, one of  the principal authors of the Republican Revolution of the 1990’s, has now turned his considerable political talents to, believe it or not, health-care reform. In this effort, he has enlisted a most unlikely ally: Hillary Clinton. The erstwhile Speaker of the House of Representatives, now a fellow at the Hoover Institution at Stanford, believes that he can offer us backward physicians needed guidance. In his interview with Jon Stewart, he offered the opinion that electronic medical records, in and of themselves, could 'save 40,000 lives a year.'

"This is an interesting conflation of the Institute of Medicine’s famous (or infamous) publication, To Err is Human, which I discussed in a previous article. To put it briefly, based on two small studies, extrapolated nationwide, the Institute estimated that somewhere between 44,000 and 98,000 lives were lost annually in United States as the result of avoidable medical errors. If one takes the time to go back and read those studies, it becomes apparent that this is an estimate of cases where people died in hospitals and had errors made during the care of their final illness. It never purported to draw a causative link between those errors and the subsequent deaths, nor did it estimate how many of those people would have died shortly regardless of errors being made or not. Despite these limitations, because of the authority implied by its authorship, this study has entered the popular mind as a true and established fact.

"What is truly fascinating about this is that, now that this is accepted truth, it has been seized upon as a mandate for institution of electronic medical records, which purportedly would obviate all of these errors. That is a truly breathtaking leap of (il)logic. Yet, with the power of Newt and Hillary, and probably other heavyweight politicians behind it, perhaps this will become accepted wisdom as well. Can this be true?

"I write this having not converted to electronic medical records in my solo practice office. Although I find electronic information very useful, and in fact I am dictating this column using Dragon voice-recognition technology on the personal computer in my office, I have found, so far, that the electronic medical records I have seen in practice in other settings have been somewhat disappointing.

"Part of the problem is that there is no accepted standard or interchangeability among the various systems, but perhaps more importantly, much of the information contained in the office notes from the systems isn’t useful. A large measure of the blame for this rests on the Medicare E&M Coding regulations from 1997, which specify a specific amount of information that has to be contained in the documentation of an office visit in order to receive Medicare (and by extension, other third party payers) reimbursement. A lot of this information is simply not relevant to the particular of an office visit, yet it is included in order to justify a higher code for the specific patient encounter. For instance, I recently saw a patient in consultation for gallbladder disease, and was considering whether or not to perform laparoscopic cholecystectomy. In reviewing the information sent in the print-out from the patient’s referring clinic, there was an extensive section on risk factors for hepatitis C. Reading this, I was amazed that this patient had so many positive risk factors for hepatitis, and was somewhat concerned, especially since I was considering doing a cholecystectomy, and concomitant liver disease might be a very significant problem in the risk of that operation. However, when I got down to the end of this long list, it stated that the patient had refused to answer the questions regarding hepatitis C; in other words, all this information in that long printout was absolutely irrelevant to the consultation. Reading it had been a total waste of time.

"In the past, when it was only possible to include information if it was written down by hand, a physician tended to include only the information it was important and relevant to that specific office visit. Provided his or her handwriting was legible (which I admit is not an insignificant problem), one was able to figure out, fairly easily, what the referring or consulting physician had in mind as the important issues. Now, however, there is so much chaff in the information that the kernels of important information are hard to pick out. With some electronic systems, it’s very easy to include sentences and whole paragraphs with a single keystroke or entry from a menu, which satisfies the coding requirements but clutters up the record significantly.

"Of course, when such menu entries are inserted, it also calls into question the very cognitive input that such “bullet points” are supposed to document as having occurred. The professional technique of the clinical interview or taking the history, when done well, is a subtle and beautiful skill that I think is being eroded by this “disinformation technology.” . . .

To read the entire President's Message, go to 2005.pdf.

[It would be best if healthcare, including the EMS, evolved naturally rather than have another intrusion and course change just to benefit the IT establishment in their current silicon slump.]


From the UK:  Going Through Hoops Dreamt Up by the National Health Service

 'I was sick of going through hoops dreamt up in Whitehall' By Michael Day (Filed: 11/09/2005)

"Why should GPs have to do everything according to central dictates, when the chances are that we and our patients know what's really needed?" says Richard Willis, a Salisbury GP. "I was sick of jumping through hoops dreamt up by civil servants in Whitehall." Dr Willis set up the Salisbury Independent Medical Practice after quitting the NHS "due to intolerable political interference". For those patients who stayed with him, he charged an annual fee of £150, which included everything except prescriptions. That was in 1994. His standard fee has since risen to £300, but so has the number of patients on the practice's books, who, says Dr Willis, are from all walks of life.

Four other GPs have joined the practice, which is able to offer patients 15 to 30-minute consultations, with no patient waiting more than two days to see the GP of their choice. Patients can access hospital care within the NHS, under contractual arrangements already in place between the local primary care trust, South Wiltshire, and local hospitals.

He is a little coy about his list size, but says it is less than that of an average NHS GP (usually about 1,800). "If I had that many patients to look after I probably wouldn't be able to offer as much time in consultations," he says. "I probably earn a little less than the average GP. I would like to earn more, but as doctors are always saying, there are issues about job satisfaction."

As a member of the Independent Doctors Forum, Dr Willis is required to go through re-accreditation checks for fitness to practice. These, he says, are stricter than those required for NHS doctors. His patients say the practice's services are good value for money. . . . To read the whole report, please go to       



Sidestepping Risk - Extensions of Your Practice Come with Extended Risks

Russell A Jackson reporting in Southern California Physician on the nine malpractice risks notes:

"The liability landscape for physicians is changing rapidly, as new technology and new restrictions on medical expenditures drive doctors into often unexplored areas of practice. But knowing what’s looming can help you steer clear of risk management pitfalls. Here’s a look at nine particularly troubling areas of liability you face.

Medical Procedure Liability Still Dominates

If you’re a surgeon, your biggest trouble area is and always will be situations where a technical problem or surgical error occurred,” says Waldene Drake, RN, MBA, vice president for risk management and patient safety at Cooperative of American Physicians Inc., a malpractice carrier based in Los Angeles. “What often makes unexpected surgical outcomes worse is when patients had high expectations for those outcomes.”

In addition, the age-old problem of reimbursement restrictions takes on a new twist as it drives doctors to undertake less familiar procedures. “We see primary care doctors - the family practitioners and the internists - doing more and more of the care themselves, because in an HMO or when the patient has limited or no insurance, it’s harder to refer to a specialist.”

SPA Procedure Liability Looms

Be aware that extensions of your practice come with extended risks. “Many doctors looking for a way to make a little more money are moving into hair removal, dermabrasion, Botox and new products that make fuller lips and cheeks,” Drake says. “We see less-trained people doing that even though by law, only a nurse or physician’s assistant can do so under the direction of an MD.” The remaining risks are as follows:

Communication and documentation breakdowns persists

Business problems

Technology issues

Elective surgeries such as cosmetic or knee replacement in the elderly

The increasing risks of more prescriptions with three areas of liability

Patient non-compliance

And obesity patients represent a growing threat

To read the entire report and the discussion of the nine risks, go to

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9.         Book Review: From the Physician Patient Bookshelf: FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for Failure

FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for Failure by Daniel Callahan, Simon & Schuster, New York, 1998. 330 pp, $24, ISBN 0-684-81109-X

Daniel Callahan, cofounder of the Hastings Center and the Director of its International Programs, takes on the entire medical establishment--doctors, nurses, hospital administrators, medical researchers, and pharmaceutical and medical technology companies--all of whom he believes are united in a relentless pursuit of unlimited medical progress, stopping at nothing short of the conquest of all disease and the indefinite extension of life spans (see last month's review of Schwartz' Life Without Disease - The Pursuit of Medical Utopia).

The Hastings Center is an avant-garde institution where any idea can be explored (see "Duty to Die" in the HHK column in this issue of the Journal). Callahan, as the president of the Hastings Center from 1969 to 1996, must be taken seriously. In the preface, he presents his political leanings, aligning himself with the Clintons in their quest for healthcare reform. He bemoans the fact that no plan made it through Congress--not one bill, not a single reform. Callahan is even more appalled that at the next presidential election, both candidates all but ignored the issue.

Initially, the reason he takes this stance is not clear. However, he soon points out that the universal, if poorly financed and often corrupt, healthcare systems in China, Southeast Asia, and in much of Latin America, are turning to the marketplace and accepting privatization as their new gospel. He finds it most unsettling that the popular, well-managed, equitable health care systems of Western Europe have begun to unravel in the post WW II welfare state. These systems, beset with rising costs, are high on the budgetary hit lists of political leaders who are looking to the marketplace to reduce public benefits, thus securing their own future.

Callahan realizes that if everyone is having a problem, and all are looking for answers, there must be an underlying basic issue. Almost all healthcare reform efforts assume that the solution lies in better organization and financing. Callahan then observes that no matter how much money is spent and no matter what the health gains may be, they never seem to be enough. Conventional solutions do not address the real problem. No matter how much progress, they always seem insufficient to meet the "needs" of the day.

The most cherished and celebrated aims, commitments, and values of modern medicine are beginning to give us trouble. But challenging these ideas, Callahan reflects, is not new. Rene Dubois in his 1954 book Mirage of Health questioned the then imminently anticipated total conquest of disease and stated this would not happen, not soon, not ever. In the 1970s, theologian Ivan Illich, British physician John Powles, American physician Rick Carlson, and British professor of social medicine, Thomas McKeown, each showed in a systematic way that there is no clear correlation between population health and medical care. Carson boldly predicted the diminishing impact of physicians and hospitals on health by the year 2000.

Callahan emphasizes that "A serious transformation will require taking money away from the acute-care sector, including research into the cure of many lethal diseases, and using it instead on prevention research and massive educational efforts designed to change health-related behavior." Callahan asserts that sustainable medicine will do the following: give priority to preventing and treating diseases that afflict the many rather than finding cures for diseases that effect the few, improve the quality of life for the elderly rather than extend life indefinitely, and focus on primary care and public health measures that benefit society as a whole rather than satisfying the health needs of individuals.

Callahan as an ethicist explores topics and issues on which to base future dialogue as well as change the direction of the debate. But he doesn't give us the final answer. He does point out that many Americans are bypassing traditional physicians and hospitals and are going to alternative medicine practitioners whom they pay from their own pockets. According to some estimates, these visits exceed those to traditional practitioners. This demonstrates that patients will pay for what they perceive as valuable.

However, Callahan's prejudices outlined in the preface, may prevent an objective extension of the excellent groundwork he has developed. He might also have mentioned that the current debates in Britain and Europe include proposals for a significant transfer of costs from the national health systems to the individual through major co-payment plans, not only for office visits, but also for hospital stays in some instances. That may not be politically correct, but it would be a giant step toward what is economically correct for our patients.

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

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10.     Hippocrates & His Kin: Funniest Thing, Everyone Has Only One Bank Account - Even Uncle Sam and General Motors. The First Response to Medical Emergencies is Seldom the Doctor or Nurse. Why Shouldn’t Medicare Cover Everyone?

A Desperate Call in the Middle of the Night. Lisa Nichols, co-author of “Chicken Soup for the African American Soul,” had delivered a motivational speech to a group of 400 teenage girls. She received the call for help and heard the following. “I am class president, on the honor roll, a student peer counselor, and I have been accepted to six universities, but I don’t plan to attend any of them because I am looking at my suicide letter right now.” After Nichols talked her out of it and helped her obtain further counseling, she hired her as the first teen facilitator to work for her company, Motivating the Teen Spirit, an empowerment skills program designed to address the challenging issue of the teen experience.

Dr Michael, a local proponent of “Health Care for Everyone,” commented that Medicare should consider covering all providers such as Ms Nichols who certainly provided a valuable service before the class president interfaced with the medical establishment. When asked, “If Medicare should pay book authors for their services to people who become patients, why shouldn’t Medicare pay every person who provides CPR, or gives First Aid, or anyone who gives valuable medical advice (which may be better at times than that given by some physicians or nurses) and even the clerk in the drug or grocery store that helps shoppers obtain the correct over-the-counter medications?” Dr Michael commented, “Perhaps, it’s an idea whose time has come.”

Has Nirvana really arrived? Let’s see now: If everyone gets paid by the U.S. Treasury, and fewer and fewer pay into it, won’t it run out of money? Dr Michael said, “The U.S. Treasury could never run out of money. They would just tax the Medicare payments like they already tax Social Security to pay for benefits.” When asked, “Wouldn’t the taxes have to rise to 100 percent to keep the country afloat?” He said, “Not at all, the U.S. Treasury is a master at deficit spending. And there just isn’t any limit to that benefit. And besides, who knows how many hidden assets the government has off shore?”

The US Treasury must be an amazing bank account.

How many bank accounts does General Motors have? Recent news releases report that the health care costs allocated to each new automobile now exceeds the cost of the steel to manufacture it; that retirement benefits have to be cut or the company will cease to exist; that health and pension benefits for retires have to be cut or eliminated, and yet the unions are clambering for more wages and benefits. Businesses also have one bank account out of which it has to pay salaries and wages, taxes, health care, pension benefits, as well as all production and marketing overhead. If income remains stable, then any change in one item must produce a corresponding opposite change in the other items. They can’t all increase. Witness huge airlines that last week, after four years of deficit spending, had to declare bankruptcy. Remember Khadafy in Libya, when he ran out of money? He told the government that they had to increase the speed of printing money? But didn’t he have paresis of the insane?

A difficult concept for students with modern math: Outflow can’t exceed Inflow.

The Wall Street Journal asks about the great, unreported fiscal story of 2005: The shrinking federal deficit. It's down by at least $100 billion because federal tax receipts have skyrocketed this year by 14.6% (or $204 billion) through June.,,SB112113079506182976,00.html?mod=todays_us_opinion

Now we know why Congress doesn’t understand that by reducing the tax rate, the economy increases to such an extent that the lower tax RATE produces MORE tax revenue – It’s because of the increasing number of senators that are suffering from dementia. (See “Overheard . . . ”  section 7 above.

To review some of the other Hippocrates Columns, please go to

Couldn’t we at least pass out some Risperdal on the Senate floor to stabilize the decline?

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11.      Restoring Accountability in Medical Practice and Society


                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, “Are you really insured?,” go to Coming next month is their invitation from Antigua and Barbuda to develop an innovative and comprehensive health system for the country. You may want to start planning to take a month each year to practice in this resort environment. Their medical board is comprised of John and Alieta Eck, MDs.

                      PATMOS EmergiClinic - - where Robert Berry, MD, an emergency physician and internist, practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service. I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service." I have no third-party contracts...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts. My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. A year ago, over 95 percent of the patients I saw had no insurance. Today, that figure may be 75 percent. But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost. Everything is up front and honest. I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them. Because I need only one employee in my office, my costs are low. For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges. I am the best bargain in town. My income last year was about average of an ER doc -not great - but I'm free and having fun. If I can do it, caring for the uninsured in a small rural town, any doctor can.

As I see it, the real question is: Are we going to be Hippocratic doctors? What are we as physicians going to do about the uninsured? They are neither destitute nor derelict, and they pay their bills. They need our help, but they seem to be used only as pawns in a political attempt to garner public support for single payer healthcare. I hope Christian physicians will care for all people in need, to prevent the ever-increasing depersonalization of medicine. After all, we worship the ultimate Person and serve those in His image. I encourage you to entrust your professional future to a faithful Creator in doing what is right. Robert S. Berry, M.D.

                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at

                     Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the “Cash-Based Revolution.” The patient pays in full before leaving. Because doctor charges are anywhere from 25-50 percent inflated due to administrative costs caused by the health insurance industry, you’ll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to Please go to to view some of her articles that highlight the government’s efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc., has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at To read his "Lessons from the Past," go to For additional articles, such as the cost of  Single Payer, go to; for Health Care Inflation, go to

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states:  We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see - by Verner Waite and Robert Walker. To see Attorney Sharon Kime’s response, as wellas the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. Be sure to consider attending their Health Care Summit: "American Medicine in Crisis - A Time for Action" in Pittsburgh on Saturday, October 22, 2005 with an impressive array of speakers. For more information, go to

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks’ topics or click on archives to see the last two years’ topics at This week’s column is on “Would a Baby Boom Redeem Social Security?” and can be read at

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day. The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue.


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Del Meyer

Del Meyer, MD, CEO & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

Dwight D Eisenhower: There are a number of things wrong with Washington. One of them is that everyone has been too long away from home. May 11, 1955

George Washington couldn't tell a lie because it would have had a harmful effect on American mythology.

Winston Churchill: We contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

On This Date in History - September 27

On this date in 1722, Samuel Adams was born in Boston. He did so much to spark the American Revolution. He was the firebrand of his time, the leader of the resistance to the Stamp Act and one of the prime instigators of the Boston Tea Party. When Sam Adams spoke, things begin to happen. He was the second cousin of President John Adams.

On this date in 1840, Thomas Nast was born in Germany. Every time you see a donkey symbolizing the Democrats or an elephant symbolizing the Republicans, you are seeing the work of Thomas Nast, the great political cartoonist who flourished in the latter half of the nineteenth century. He created the Tammany tiger, and his cartoons of Boss Tweed did a great deal to harden public opinion against that political potentate. Thomas Nast showed the power of a picture.