An Electronic Forum
Designing the Patient-Centered Affordable HealthPlan for America
By Del Meyer, MD
Health Care throughout the world has become a political football for the past two centuries. But the doctors and their patients are no longer the quarterback or players. The players are the politicians and the doctors have become more like Pawns on a Chessboard that can move only one step in any direction. The governments are the Knights, Rooks and Queen and move freely about the boards. This could work if the government spoke with one voice. But there are two political parties, each with a different ideology. One believes in the integrity of mankind and that all men are created equally and endowed with inalienable rights. The other believes that mankind is basically evil and must be controlled and regimented. They believe that the people inside of government are more endowed with honor, integrity and intelligence than the private citizen. The history of government for millennia has been one of oppression and servitude. America was founded on the principle of Freedom of mankind. That worked for more than 150 years. During the past 75 years, government has followed the pattern of the Father of government social insurance, German Chancellor Otto von Bismarck, and has implemented many of his schemes without the benefit of a dictator.
As Britain privatized industry after industry under Margaret Thatcher, creating the most significant turnaround from State Enterprises to Free Enterprise ever, health care was totally omitted. Therefore, we have wide fluctuations in the types of plans. Coverage that's "in" this year may be "out" next year, depending on the Congress, the Minister of Health, Parliament, the Bundestag or the Dumas. In most countries, the possibility of private practice, outside of the seeing eyes of a government bureaucracy, extends to only 1/4 or fewer of the citizens. Only in the United States is the major portion of the most confidential matter relating to our bodies still out of the purview of the social planners and our elected leaders who have no interest in us personally as long as we vote for them. The excessive costs that we expend in a government-controlled environment may put the damper on expansion temporarily. Unfortunately, this has made a dramatic change with the recent Health Information Privacy and Accountability Act (HIPAA) which, under the illusion of increasing privacy, has opened our patients' medical files to the federal government, the state government, the county government, insurance carriers, managed care organizations, and the FBI. In doing so, it has made it more difficult for those caring for the patients - the doctors, nurses and hospitals - to share patient information.
The "micro-chip" or computer era has brought about the greatest increase in wealth and well being the world has ever seen. In America, seven percent of households have become millionaires. Why haven't we extended this cost-saving benefit to the health care field? Today, computers are inexpensive making them readily available to virtually everyone. This would bring the health information to the person most interested in his or her health and create personal involvement and efficiencies in delivery care.
I have a patient that formerly worked on one of the first IBM RAMDAC computers in the early 1960s. He tells me that in those days it was so large it required a room the size of a small gymnasium with major air conditioning to prevent overheating and a crew of about 20 technicians to keep it operating. Now in his retirement, he has a Pentium computer that cost less than $500 with more memory, more power and more disk storage space than the IBM of 40 years ago, which he thought cost the state about $5 million. It's unfortunate that health care technology was not allowed to follow the same pattern, making it more available to all of us.
My mother, who worked as a domestic before my father met her, always told us that we are fortunate that in this country we can count on wealthy people to employ the rest of us. Likewise, in America we can count on wealthy people and organizations to purchase $5 million dollar computers until technology brings the price within reach. The money from free enterprise enabled IBM and others to compete providing continued research and development for more efficient computers, which allowed the greater population to enjoy more benefits and capabilities for one-ten-thousandth of the price-$500 for a Pentium instead of $5,000,000 for the IBM mainframe RAMDAC.
Contrasting this with communist Russia, a state run economy, we find that their computers, when the "wall came tumbling down," had less memory than the 1986 Intel 08088, but cost many times more. Thus, even these antiquated machines remained out of the reach of the masses.
I am told by many of my friends in the technical areas of medicine that if free enterprise had been allowed to occur in medicine, a similar cost savings would have been realized. Instead of the cost of MRI machines going from $100,000s to $millions, it would have been reversed if large doctors' groups had been allowed to purchase MRIs for their group's own use rather than having to use the high costs of hospitals and diagnostic centers. Medicare prevented doctors from doing this since they saw it as self-serving rather than patient-serving. We still have not come to grips with this unusual hostility towards our profession.
Meanwhile, this technology is still more expensive in the rest of the world than in the United States. It is largely unavailable or severely restricted in government health plans. Where health plans such as the National Health Service of the UK or Medicare of Canada have this technology, it is still largely unavailable except through bureaucratic delays and hassles, with long waiting periods.
In the US, for instance, when my lung patients go to the emergency room of a hospital and mention in passing that they had a near syncopal episode, the ER physician obtains a CT of the brain to make sure that there is no stroke or brain tumor before they even call me about their lungs. An acquaintance in England, who had a massive stroke and was hospitalized in London, was not able to have his CT of the brain for a full three weeks, after which damage was so irreversible that nothing more could be done. Diagnostic technology is more available for secondary problems in the US than for the primary medical problems in other countries.
This electronic journal is an effort to discuss health care in the United States and the world so as to preserve the best of private health care in this country and allow it to become affordable through less cost controls. Government cost controls and insurance mandates ultimately increase costs, and decrease competition. Health care would become affordable if we got the governmental bureaucracy out of our intimate health care lives. One could make a case for the poor and needy, but charity may do a far better and human sensitive job than the government Medicaid programs are doing.
A quarterly newsletter, HealthPlanUSA.net, is published the first month of each quarter. This newsletter goes to physicians, nurses, health care workers and administrators on six continents and approximately 20 countries. We have our most active groups in Canada, the UK, India and Chile at this time.
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Physicians have traditionally met with their colleagues and the business and professional communities on Tuesday evenings. This came about because in any medical practice Monday and Friday are busy patient days. Doctors alternated taking Wednesday and Thursday afternoons off to compensate for the night and weekend work that goes with any medical practice. This left Tuesday as the night that all doctors are on duty for professional associations and networking. In Sacramento, the Medical Society met on the third Tuesday of each month filling the largest convention hall in the city. The internal medicine society met on the fourth Tuesday. The family doctors, pediatricians, surgeons as well as the other specialties also met on one of the Tuesday evenings. Our research indicates that more than 90 percent of medical societies in the United States traditionally met on Tuesdays. Hence, the name.
With the advent of government medicine, health maintenance organizations and other third party controls, which considered the Society Meetings as being unhelpful for the practice of medicine, the gatherings essentially disappeared. In fact, these organizations began having their own indoctrination meetings on a regular basis and made them mandatory. Attendance affected your quarterly bonus and so these took precedence over the professional society meetings. At a recent medical society meeting in a community of more than 2500 physicians, attendance was 25 members. That's only one percent of the physicians in the community. As they quit going to the society meetings, they began not paying their dues. Organized medicine is now estimated at representing only one-fourth of physicians.
We re-established MedicalTuesday networking in April 2002, by providing all interested individuals and organizations a free biweekly newsletter regarding the many issues of health care in the US and globally. MedicalTuesday has also become the networking arm of HealthPlanUSA.net, HealthPlanUK.net, HealthPlanIndia.net, HealthPlanCanada.net, HealthPlanChile.net and others. To sign up for the newsletter, please use the form on the right. Paid members have access to the complete newsletter archive.
We have kept a journal of most of our editorials, OpEd pieces, book reviews and columns since 1994. To review "editorials" written during my four-year editorship of Sacramento Medicine; articles written during my fifteen-year service on their editorial board including "Hippocrates & His Kin," "Voices of Medicine," and "Book Reviews" columns in Sacramento Medicine; articles written during my two-year service on the editorial board of California Physician; articles written for California Medicine; book reviews during my three-year term on the editorial board of Medical Sentinel and the Journal of American Physicians and Surgeons, where I serve on their editorial boards; and book reviews written for a number of journals including the St Croix Review, please go to www.HealthCareCom.net, an electronic HealthCare Communication Journal.
For my professional/practice web page, see www.DelMeyer.net, where you will find more recent columns including a general interest MedInfo Health Line, the Physician/Patient Bookshelf, and the professional Hippocrates Modern Colleagues series. Also included are details about my pulmonary practice and clinical research program. You can reach me at DelMeyer@DelMeyer.net. Please understand that the volume of email exceeds what I can respond to in a timely manner, but note that I will always utilize the information in these pages and journals, whose only purpose is to assist physicians in helping patients throughout the world obtain better and more cost-effective health care.
© Del Meyer, MD, 1/2009